proofreading team. outwitting our nerves a primer of psychotherapy by josephine a. jackson, m.d. helen m. salisbury [illustration] new york the century co. , by the century co. printed in u.s.a. to mary patterson manly a lover of truth foreword "your trouble is nervous. there is nothing we can cut out and there is nothing we can give medicine for." with these words a young college student was dismissed from one of our great diagnostic clinics. the physician was right. in a nervous disorder there is nothing to cut out and there is nothing to give medicine for. nevertheless there is something to be done,--something which is as definite and scientific as a prescription or a surgical operation. psychotherapy, which is treatment by the mental measures of psycho-analysis and re-education, is an established procedure in the scientific world to-day. nervous disorders are now curable, as has been proved by the clinical results in scores of cases from civil life, under treatment by freud, janet, prince, sidis, dubois, and others; and in thousands of cases of war neuroses as reported by smith and pear, eder, maccurdy, and other military observers. these army experts have shown that shell-shock in war is the same as nervousness in civil life and that both may be cured by psycho-analysis and re-education. for more than a decade, in handling nervous cases, i have made use of the findings of recognized authorities on psychopathology. truths have been applied in a special way, with the features of re-education so emphasized that my home has been called a psychological boarding-school. as the alumni have gone back to the game of life with no haunting memories of usual sanatorium methods, but with the equipment of a fuller self-knowledge and sense of power, they have sent back a call for some word that shall extend this helpful message to a larger circle. there has come, too, a demand for a book which shall give accurate and up-to-date information to those physicians who are eager for light on the subject of nervous disorders, and especially for knowledge of the significant contributions of sigmund freud, but who are too busy to devote time to highly technical volumes outside their own specialties. this need for a simple, comprehensive presentation of the freudian principles i have attempted to meet in this primer of psychotherapy, providing enough of biological and psychological background to make them intelligible, and enough application and illustration to make them useful to the general practitioner or the average layman. josephine a. jackson. pasadena, california, . contents part i: the strange ways of nerves chapter i page in which most of us plead guilty to the charge of "nerves." nervous folk chapter ii in which we learn what "nerves" are not and get a hint of what they are. the drama of nerves part ii: "how the wheels go round" chapter iii in which we find a goodly inheritance. the story of the instincts chapter iv in which we learn more about ourselves. the story of the instincts (continued) chapter v in which we look below the surface and discover a veritable wonderland. the subconscious mind chapter vi in which we learn why it pays to be cheerful. body and mind chapter vii in which we go to the root of the matter. the real trouble part iii: the mastery of "nerves" chapter viii in which we pick up the clue. the way out chapter ix in which we discover new stores of energy and relearn the truth about fatigue. that tired feeling chapter x in which the ban is lifted. dietary taboos chapter xi in which we learn an old trick. the bugaboo of constipation chapter xii in which handicaps are dropped. a woman's ills chapter xiii in which we lose our dread of night. that interesting insomnia chapter xiv in which we raise our thresholds. feeling our feelings chapter xv in which we learn discrimination. choosing our emotions chapter xvi in which we find new use for our steam. finding vent in sublimation glossary bibliography index outwitting our nerves chapter i _in which most of us plead guilty to the charge of "nerves."_ nervous folk who's who whenever the subject of "nerves" is mentioned most people begin trying to prove an alibi. the man who is nervous and knows that he is nervous, realizes that he needs help, but the man who has as yet felt no lack of stability in himself is quite likely to be impatient with that whole class of people who are liable to nervous breakdown. it is therefore well to remind ourselves at once that the line between the so-called "normal" and the nervous is an exceedingly fine one. "nervous invalids and well people are indistinguishable both in theory and in practice,"[ ] and "after all we are most of us more or less neurasthenic."[ ] the fact is that everybody is a possible neurotic. [footnote : putnam: _human motives_, p. .] [footnote : dubois: _physic treatment of nervous disorders_, p. .] so, as we think about nervous folk and begin to recognize our friends and relatives in this class, it may be that some of us will unexpectedly find ourselves looking in the mirror. some of our lifelong habits may turn out to be nervous tricks. at any rate, it behooves us to be careful about throwing stones, for most of us live in houses that are at least part glass. the earmarks =am i "like folks"?= before we begin to talk about the real sufferer from "nerves," the nervous invalid, let us look for some of the earmarks that are often found on the supposedly well person. all of these signs are deviations from the normal and are sure indications of nervousness. the test question for each individual is this: "am i 'like folks'?" to be normal and to be well is to be "like folks." can the average man stand this or that? if he can, then you are not normal if you cannot. do the people around you eat the thing that upsets you? if they do, ten chances to one your trouble is not a physical idiosyncrasy, but a nervous habit. in bodily matters, at least, it is a good thing to be one of the crowd. many people who would resent being called anything but normal--in general--are not at all loth to be thought "different," when it comes to particulars. are there not many of us who are at small pains to hide the fact that we "didn't sleep a wink last night," or that we "can't stand" a ticking clock or a crowing rooster? we sometimes consider it a mark of distinction to have a delicate appetite and to have to choose our food with care. if we are frank with ourselves, some of us will have to admit that our own ailments seem interesting, while the other person's ills are "merely nervous" or imaginary or abnormal. after all, a good many of us will have to plead guilty to the charge of nervousness. we have only to read the endless advertisements of cathartics and "internal baths," or to check up the quantity of laxatives sold at any drug store, to realize the wide-spread bondage to that great bugaboo constipation. he who is constipated can hardly prove an alibi to "nerves." then there are the school-teachers and others who are worn out at the end of each year's work, hardly able to hold on until vacation; and the people who can't manage their tempers; and those who are upset over trifles; and those who are dissatisfied with life. to a certain degree, at least, all of these are nervous persons. the list grows. =half-power engines.= these people are all supposed to be well. they keep going--by fits and starts--and as they are used to running on three cylinders, with frequent stops for repairs, they accept this rate of living as a matter of course, never realizing that they might be sixty horse-power engines, instead of their little thirty or forty. for this large and neglected class of people psychotherapy has a stimulating message, and for them many of the following pages have been written. =the real sufferers.= these so-called normal people are merely on the fringe of nervousness, on the border line between normality and disease. beyond them there exists a great company of those whose lives have been literally wrecked by "nerves." their work interrupted or given up for good, their minds harassed by doubts and fears, their bodies incapacitated, they crowd the sanatoria and the health resorts in a vain search for health. from new england to florida they seek, and on to colorado and california, and perhaps to hawaii and the orient, thinking by rest and change to pull themselves together and become whole again. there are thousands of these people--lawyers, preachers, teachers, mothers, social workers, business and professional folk of all sorts, the kind of persons the world needs most--laid off for months or years of treatment, on account of some kind of nervous disorder. =various types of nervousness.= the psychoneuroses are of many forms.[ ] to some people "nerves" means nervous prostration, breakdown, fatigue, weakness, insomnia, the blues, upset stomach, or unsteady heart,--all signs of so-called neurasthenia or nerve-weakness. to others the word "nerves" calls up memories of strange, emotional storms that seem to rise out of nowhere, to sweep the sky clear of everything else, and to pass as they came, leaving the victim and the family equally mystified as to their meaning. these strange alterations of personality are but one manifestation of hysteria, that myriad-faced disorder which is able to mimic so successfully the symptoms of almost every known disease, from tumors and fevers to paralysis and blindness. [footnote : the technical term for nervousness is _psycho-neurosis_--disease of the psyche. there are certain "real neuroses" such as paralysis and spinal-cord disease, which involve an organic impairment of nerve-tissue. however, as this book deals only with psychic disturbance, we shall, throughout, use the term _neuroses_ and _psycho-neuroses_ indiscriminately, to denote nervous or functional disorders.] to still other people nervous trouble means fear,--just terrible fear without object or meaning or reason (anxiety neuroses); or a definite fear of some harmless object (phobia); or a strange, persistent, recurrent idea, quite foreign to the personality and beyond the reach of reason (obsession); or an insistent desire to perform some absurd act (compulsion); or perhaps, a deadly and pall-like depression (the blues). as a matter of fact, the neuroses include all these varieties, and various shades and combinations of each. there are, however, certain mental characteristics which recur with surprising regularity in most of the various phases--dissatisfaction, lack of confidence, a sense of being alone and shut in to oneself, doubt, anxiety, fear, worry, self-depreciation, lack of interest in outside affairs, pessimism, fixed belief in one's powerlessness, along whatever line it may be. underneath all these differing forms of nervousness are the same mechanisms and the same kind of difficulty. to understand one is to understand all, and to understand normal people as well; for in the last analysis we are one and all built on the same lines and governed by the same laws. the only difference is, that, as jung says, "the nervous person falls ill of the conflicts with which the well person battles successfully." summary since at least seventy-five per cent. of all the people who apply to physicians for help are nervous patients; and since these thousands of patients are not among the mental incompetents, but are as a rule among the highly organized, conscientious folk who have most to contribute to the leadership of the world, it is obviously of vital importance to society that its citizens should be taught how to solve their inner conflicts and keep well. in this strategic period of reconstruction, the world that is being remodeled cannot afford to lose one leader because of an unnecessary breakdown. there is greater need than ever for people who can keep at their tasks without long enforced rests; people who can think deeply and continuously without brain-fag; people who can concentrate all their powers on the work in hand without wasting time or energy on unnecessary aches and pains; people whose bodies are kept up to the top notch of vitality by well-digested food, well-slept sleep, well-forgotten fatigue, and well-used reserve energy. that such a state of affairs is no utopian dream, but is merely a matter of knowing how, will appear more clearly in later chapters. chapter ii _in which we learn what "nerves" are not, and get a hint of what they are_ the drama of nerves an exploded theory ="nerves" not nerves.= pick up any newspaper, turn over a few pages, and you will be sure to come to an advertisement something like this: tired man, your nerves are sick! they need rest and a tonic to restore their worn-out depleted cells! no wonder people have believed this kind of thing. it has been dinned into their ears for many years. they have read it with their breakfast coffee and gazed at it in the street cars and even heard it from their family physicians, until it has become part and parcel of their thinking; yet all the time the fundamental idea has been false, and now, at last, the theory is exploded. so far as the modern laboratory can discover, the nerves of the most confirmed neurotic are perfectly healthy. they are not starved, nor depleted, nor exhausted; the fat-sheath is not wanting, there is no inflammation, there is nothing lacking in the cell itself, and there is no accumulation of fatigue products. paradoxical as it may sound, there is nothing the matter with a nervous person's nerves. the faithful messengers have borne the blame for so long that their name has gotten itself woven into the very language as symbolic of disease. when we speak of nervous prostration, neurasthenia, neuroses, nervousness, and "nerves" we mean that body and mind are behaving badly because of functional disorder. these terms are good enough as figures of speech, so long as we are not fooled by them; but accepting them in their literal sense has been a costly procedure. thanks to the investigations of physiologist and psychologist, usually combined in the person of a physician, "nervousness" has been found to be not an organic disease but a functional one. this is a very important distinction, for an organic disease implies impairment of the tissues of the organ, while a functional disorder means only a disturbance of its action. in a purely nervous disorder there seems to be no trouble with what the nerves and organs are, but only with what they do; it is behavior and not tissue that is at fault. of course, in real life, things are seldom as clear-cut as they are in books, and so it happens that often there is a combination of organic and functional disease that is puzzling even to a skilled diagnostician. the first essential is a diagnosis as to whether it be an organic disease, with accompanying nervous symptoms, or a functional disturbance complicated by some minor organic trouble. if the main cause is organic, only physical means can cure it, but if the trouble is functional, no amount of medicine or surgery, diet or rest, will touch it; yet the symptoms are so similar and the dividing line is so elusive, that great skill is sometimes required to determine whether a given symptom points to a disturbance of physical tissue or only to behavior. if the physician is sometimes fooled, how much more the sufferer himself! nausea from a healthy stomach is just as sickening as nausea from a diseased one. a fainting-spell is equally uncomfortable, whether it come from an impaired heart or simply from one that is behaving badly for the moment. it must be remembered that in functional nervousness the trouble is very real. the organs are really "acting up." sometimes it is the brain that misbehaves instead of the stomach or heart. in that case it often reports all kinds of pains that have no origin outside of the brain. pain, of course, is perceived only by the brain. cut the telegraph wire, the nerve, and no amount of injury to the finger can cause pain. it is equally true that a misbehaving brain can report sensations that have no external cause, that have not come in through the regular channel along the nerve. the pain feels just the same, is every bit as uncomfortable as though its cause were external. sometimes, instead of reporting false pains, the brain misbehaves in other ways. it seems to lose its power to decide, to concentrate, or to remember. then the patient is almost sure to fancy himself going insane. but insanity is a physical disease, implying changes or toxins in the brain cells. functional disorders tell another story. their cause is different, even though the picture they present is often a close copy of an organic disease. =distorted pictures.= it should not be thought, however, that the symptoms of functional and organic troubles are identical. hysteria and neurasthenia closely simulate every imaginable physical disease, but they do not exactly parallel any one of them. it may take a skilled eye to discover the differences, but differences there are. functional troubles usually show a near-picture of organic disease, with just enough contradictory or inconsistent features to furnish a clue as to their real nature. for this reason it is important that the treatment of the disease be solely the province of the physician; for only the carefully trained in all the requirements of diagnosis can differentiate the pseudo from the real, the innocuous from the disastrous. false or nervous neuritis may feel like real neuritis (the result of poisons in the blood), but it gives itself away when it localizes itself in parts of the body where there is no nerve trunk. the exhaustion of neurasthenia sometimes seems extreme enough to be the result of a dangerous physical condition; but when this exhaustion disappears as if by magic under the proper kind of treatment, we know that the trouble cannot be in the body. let it be said, then, with all the emphasis we can command, "nerves" are not physical. laboratory investigation, contradictory symptoms, and response to treatment all bear witness to this fact. whatever symptoms of disturbance there may be in pure nervousness, the nerves and organs can in no way be shown to be diseased. the positive side ="nerves" not imaginary.= "but," some one says, "how can healthy organs misbehave in this way? something must be wrong. there must be some cause. if 'nerves' are not physical, what are they? they surely can't be imaginary." most emphatically, they are real; nothing could be more maddening than to have some one suggest that our troubles are "mere imagination." no wonder such theories have been more popular with the patient's family than with the patient himself. many years ago a physician put the whole truth into a few words: "the patient says, 'i cannot'; his friends say, 'he will not'; the doctor says, 'he cannot will.'" he tries, but in the circumstances he really cannot. =the man behind the body.= the trouble is real; the organs do "act up"; the nerves do carry the wrong messages. but the nerves are merely telegraph wires. they are not responsible for the messages that are given them to carry. behind the wires is the operator, the man higher up, and upon him the responsibility falls. in functional troubles the body is working in a perfectly normal way, considering the perverted conditions. it is doing its work well, doing just what it is told, obeying its master. the troubles are not with the bodily machine but with the master. the man behind the body is in trouble and he really has no way of showing his pain except through his body. the trouble in nervous disorders is in the personality, the soul, the realm of ideas, and that is not your body, but _you_. loss of appetite may mean either that the powers of the physical organism are busily engaged in combating some poison circulating in the blood, or that the ego is "up against" conditions for which it has "no stomach." paralysis may be due to a hemorrhage into the brain tissues from a diseased blood vessel, or it may symbolize a sense of inadequacy and defeat. exaggerated exhaustion, halting feet, stammering tongue, may give evidence of a disturbed ego rather than of a diseased brain. =all body and no mind.= at last we have begun to realize what we ought to have known all along,--that the body is not the whole man. the medical world for a long time has been in danger of forgetting or ignoring psychic suffering, while it has devoted itself to the treatment of physical disease. by way of condoning this fault it must be recognized that the five years of medical school have been all too short to learn what is needed of physiology and anatomy, histology, bacteriology, and the various other physical sciences. but at last the medical schools are realizing that they have been sending their graduates out only half-prepared--conversant with only one half of a patient, leaving them to fend for themselves in discovering the ways of the other half. many an m.d. has gone a long way in this exploration. native common sense, intuition, and careful study have enabled him to go beyond what he had learned in his text-books. but in the best universities the present-day student of medicine is now being given an insight into the ways of man as a whole--mind as well as body. the movement can hardly proceed too rapidly, and when it has had time to reach its goal, the day of the long-term sentence to nervousness will be past. in the meanwhile most physicians, lacking such knowledge and with the eye fixed largely on the body, have been pumping out the stomach, prescribing lengthy rest-cures, trying massage, diet, electricity, and surgical operations, in a vain attempt to cure a disease of the personality. physical measures have been given a good trial, but few would contend that they have succeeded. sometimes the patient has recovered--in time--but often, apparently, despite the treatment rather than because of it. sometimes, in the hands of a man like dr. s. weir mitchell, results seem good, until we realize that the same measures are ineffective when tried by other men, and that, after all, what has counted most has been the personality of the physician rather than his physical treatment. no wonder that most doctors have disliked nervous cases. to a man trained in all the exactness of the physical sciences, the apparent lawlessness and irresponsibility of the psychic side of the personality is especially repugnant. he is impatient of what he fails to comprehend. =all mind and no body.= this unsympathetic attitude, often only half conscious on the part of the regular practitioners, has led many thousands of people to follow will-o'-the-wisp cults, which pay no attention to the findings of science, but which emphasize a realization of man's spiritual nature. many of these cults, founded largely on untruth or half-falsehood, have succeeded in cases where careful science has failed. despite fearful blunders and execrable lack of discrimination in attempting to cure all the ills that flesh is heir to by methods that apply only to functional troubles, ignorant enthusiasts and quacks have sometimes cured nervous troubles where the conscientious medical man has had to acknowledge defeat. =the whole man.= but thinking people are not willing to desert science for cults that ignore the existence of these physical bodies. if they have found it unsatisfactory to be treated as if they were all body, they have also been unwilling to be treated as if they were all mind. they have been in a dilemma between two half-truths, even if they have not realized the dilemma. it has remained for modern psychotherapy to strike the balance--to treat the whole man. solidly planted on the rock of the physical sciences, with its laboratories, physiological and psychological, and with a long record of investigation and treatment of pathological cases, it resembles the mind cure of earlier days or the assertions of christian science about as much as modern medicine resembles the old bloodletting, leeching practices of our forefathers. for the last quarter-century there have been scattered groups of physicians,--brilliant, patient pioneers,--who, recognizing man as spirit inhabiting body, have explored the realm of man's mind and charted its paths. these pioneers, beginning with charcot, have been men of acknowledged scientific training and spirit, whose word must be respected and whose success in treating functional troubles stands out in sharp contrast to the fumblings of the average practitioner in this field. the results of their work have been positive, not negative. they have not merely asserted that nervous disorders are not physical; they have discovered what the trouble is and have found it to be discoverable and removable in almost every case, provided only that the right method is used. =ourselves and our bodies.= if the statement that "nervous troubles are neither physical nor imaginary but a disease of the personality," sounds rather mystifying to the average person, it is only because the average person is not very conversant with his own inner life. we shall hope, later on, to find some definite guide-posts and landmarks which will help us feel more at home in this fascinating realm. at present, we are not attempting anything more than a suggestion of the itinerary which we shall follow. a book on physical hygiene can presuppose at least a rudimentary knowledge of heart and lungs and circulation, but a book on mental hygiene must begin at the beginning, and even before the beginning must clear away misconceptions and make clear certain fundamental principles. but the gist of the whole matter is this: in a neurosis, certain forces of the personality--instincts and their accompanying emotions--which ought to work harmoniously, having become tangled up with some erroneous ideas, have lost their power of coöperation and are working at cross purposes, leaving the individual mis-adapted to his environment, the prey of all sorts of mental and physical disturbances. the fact that the cause is mental while the result is often physical, should cause no surprise. in the physiological realm we are used to the idea that cause and effect are often widely separated. a headache may be caused by faulty eyes, or it may result from trouble in the intestines. in the same way, we should not be too much surprised if the cause of nervous troubles is found to be even more remote, provided there is some connecting link between cause and effect. the difficulty in this case is the apparent gulf between the realm of the spirit and the realm of the body. it is hard to see how an intangible thing like a thought can produce a pain in the arm or nausea in the stomach. philosophers are still arguing concerning the nature of the relation between mind and body, but no one denies that the closest relation does exist. every year science is learning that ideas count and that they count physically, as well as spiritually. =such stuff as "nerves" are made of.= dr. tom a. williams in the little composite volume "psychotherapeutics" says that the neuroses are based not on inherently weak nervous constitutions but on ignorance and on false ideas. what, then, are some of these erroneous ideas, these misconceptions, that cause so much trouble? we shall want to examine them more carefully in later chapters, but we might glance now at a few examples of these popular bugaboos that need to be slain by the sword of cold, hard fact. =popular misconceptions about the body.= "eight hours' sleep is essential to health. all insomnia is dangerous and is incompatible with health. nervous insomnia leads to shattered nerves and ultimately to insanity." "overwork leads to nervous breakdown. fatigue accumulates from day to day and necessitates a long rest for recuperation." "a carefully planned diet is essential to health, especially for the nervous person. a variety of food, eaten at the same time, is harmful. acid and milk--for example, oranges and milk--are difficult to digest. sour stomach is a sign of indigestion." "modern life is so strenuous that our nerves cannot stand the strain." "brain work is very fatiguing. it causes brain-fag and exhaustion." "constipation is at the root of most physical ailments and is caused by eating the wrong kind of food." some of these misconceptions are household words and are so all but universally believed that the thought that they can be challenged is enough to bewilder one. however, it is ideas like this that furnish the material out of which many a nervous trouble is made. based on a half-knowledge of the human body, on logical conclusions from faulty premises, on hastily swallowed notions passed on from one person to another, they tend by the very power of an idea to work themselves out to fulfilment. the power behind ideas =ideas count.= ideas are not the lifeless things they may appear. they are not merely intellectual property that can be locked up and ignored at will, nor are they playthings that can be taken up or discarded according to the caprice of the moment. ideas work themselves into the very fiber of our being. they are part of us and they _do_ things. if they are true, in line with things as they are, they do things that are for our good, but if they are false, we often discover that they have an altogether unsuspected power for harm and are capable of astonishing results, results which have no apparent relation to the ideas responsible for them and which are, therefore, laid to physical causes. thinking straight, then, becomes a hygienic as well as a moral duty. =ideas and emotions.= ideas do not depend upon themselves for their driving-power. life is not a cold intellectual process; it is a vivid experience, vibrant with feeling and emotion. it therefore happens that the experiences of life tend to bring ideas and emotions together and when an idea and an emotion get linked up together, they tend to stay together, especially if the emotion be intense or the experience is often repeated. the word emotion means outgoing motion, discharging force. this force is like live steam. an emotion is the driving part of an instinct. it is the dynamic force, the electric current which supplies the power for every thought and every action of a human life. man is not a passive creature. the words that describe him are not passive words. indeed, it is almost impossible to think about man at all except in terms of desire, impulse, purpose, action, energy. there are three things that may be done with energy: first, it may be frittered away, allowed to leak, to escape. secondly, it may be locked up; this results usually in an explosion, a finding of destructive outlets. finally, it may be harnessed, controlled, used in beneficent ways. health and happiness depend upon which one of the three courses is taken. character and health evidently, it is highly important to have a working knowledge of these emotions and instincts; important to know enough about them and their purpose to handle them rightly if they do not spontaneously work together for our best character and health. the problems of character and the problems of health so overlap that it is impossible to write a book about nervous disorders which does not at the same time deal with the principles of character-formation. the laws and mechanisms which govern the everyday life of the normal person are the same laws and mechanisms which make the nervous person ill. as boris sidis puts it, "the pathological is the normal out of place." the person who is master of himself, working together as a harmonious whole, is stronger in every way than the person whose forces are divided. given a little self-knowledge, the nervous invalid often becomes one of the most successful members of society,--to use the word successful in the best sense. =it pays to know.= to be educated is to have the right idea and the right emotion in the right place. to be sure, some people have so well learned the secret of poise that they do not have to study the why nor the how. intuition often far outruns knowledge. it would be foolish indeed to suggest that only the person versed in psychological lore is skilled in the art of living. psychology is not life; it can make no claim to furnish the motive nor the power for successful living, for it is not faith, nor hope, nor love; but it tries to point the way and to help us fulfil conditions. there is no more reason why the average man should be unaware of the instincts or the subconscious mind, than that he should be ignorant of germs or of the need of fresh air. if it be argued that character and health are both inherently by-products of self-forgetful service, rather than of painstaking thought, we answer that this is true, but that there can be no self-forgetting when things have gone too far wrong. at such times it pays to look in, if we can do it intelligently, in order that we may the sooner get our eyes off ourselves and look out. the pursuit of self-knowledge is not a pleasurable pastime but simply a valuable means to an end. knowing our machine =counting on ourselves.= knowing our machine makes us better able to handle it. for, after all, each of us is, in many ways, very like a piece of marvelous and complicated machinery. for one thing, our minds, as well as our bodies, are subject to uniform laws upon which we can depend. we are not creatures of chaos; under certain conditions we can count on ourselves. freedom does not mean freedom from the reign of law. it means that, to a certain extent, we can make use of the laws. psychic laws are as susceptible to investigation, verification, and use as are any laws in the physical world. each person is so much the center of his own life that it is very easy for him to fall into the way of thinking that he is different from all the rest of the world. it is a healthful experience for him to realize that every person he meets is made on the same principles, impelled by the same forces, and fighting much the same fight. since the laws of the mental world are uniform, we can count on them as aids toward understanding other people and understanding ourselves. ="intelligent scrutiny versus morbid introspection."= it helps wonderfully to be able to look at ourselves in an objective, impersonal way. we are likely to be overcome by emotion, or swept by vague longings which seem to have no meaning and which, just because they are bound up so closely with our own ego, are not looked at but are merely felt. unknown forces are within us, pulling us this way and that, until sometimes we who should be masters are helpless slaves. one great help toward mastery and one long step toward serenity is a working-knowledge of the causes and an impersonal interest in the phenomena going on within. introspection is a morbid, emotional fixation on self, until it takes on this quality of objectivity. what cabot calls the "sin of impersonality" is a grievous sin when directed toward another person, but most of us could stand a good deal of ingrowing impersonality without any harm. the fact that the human machine can run itself without a hitch in the majority of cases is witness to its inherent tendency toward health. people were living and living well through all the centuries before the science of psychology was formulated. but not with all people do things run so smoothly. there were demoniacs in bible times and neurotics in the middle ages, as there are nervous invalids and half-well people to-day. psychology has a real contribution to make, and in recent years its lessons have been put into language which the average man can understand. psychology is not merely interested in abstract terms with long names. it is no longer absorbed merely in states of consciousness taken separately and analyzed abstractly. the newer functional psychology is increasingly interested in the study of real persons, their purposes and interests, what they feel and value, and how they may learn to realize their highest aspirations. it is about ordinary people, as they think and act, in the kitchen, on the street cars, at the bargain-counter, people in crowds and alone, mothers and their babies, little children at play, young girls with their lovers, and all the rest of human life. it is the science of _you_, and as such it can hardly help being interesting. while psychology deals with such topics as the subconscious mind, the instincts, the laws of habit, and association of ideas and suggestion, it is after all not so much an academic as a practical question. these forces govern the thought you are thinking at this moment, the way you will feel a half-hour from now, the mood you will be in to-morrow, the friends you will make and the profession you will choose, besides having a large share in the health or ill-health of your body in the meantime. summary perhaps it would be well before going farther to summarize what we have been saying. here in a nutshell is the kernel of the subject: disease may be caused by physical or by psychic forces. a "nervous" disorder is not a physical but a psychic disease. it is caused not by lack of energy but by misdirected energy; not by overwork or nerve-depletion, but by misconception, emotional conflict, repressed instincts, and buried memories. seventy-five per cent. of all cases of ill-health are due to psychic causes, to disjointed thinking rather than to a disjointed spine. wherefore, let us learn to think right. in outline form, the trouble in a neurosis may be stated something like this: lack of adaptation to the social environment--caused by lack of harmony within the personality--caused by misdirected energy--caused by inappropriate emotions--caused by wrong ideas or ignorance. working backward, the cure naturally would be: right ideas--resulting in appropriate emotions--resulting in redirected energy--resulting in harmony--resulting in readjustment to the environment. if the reader is beginning to feel somewhat bewildered by these general statements, let him take heart. so far we have tried merely to suggest the outline of the whole problem, but we shall in the future be more specific. nervous troubles, which seem so simple, are really involved with the whole mechanism of mental life and can in no way be understood except as these mechanisms are understood. we have hinted at some of the causes of "nerves," but we cannot give a real explanation until we explain the forces behind them. these forces may at first seem a bit abstract, or a bit remote from the main theme, but each is essential to the story of nerves and to the understanding of the more practical chapters in part iii. as in a bernard shaw play, the preface may be the most important part of this "drama of nerves." nor is the figure too far-fetched, because, strange as it may seem, every neurosis is in essence a drama. it has its conflict, its villain, and its victim, its love-story, its practical joke, its climax, and its denouement. sometimes the play goes on forever with no solution, but sometimes psychotherapy steps in as the fairy god-mother, to release the victim, outwit the villain, and bring about the live-happily-ever-after ending. part ii: "how the wheels go round" chapter iii _in which we find a goodly inheritance_ the story of the instincts each in his own tongue a fire mist and a planet, a crystal and a cell, a jelly-fish and a saurian, and caves where cavemen dwell; then a sense of law and beauty, and a face turned from the clod; some call it evolution and others call it god.[ ] if we begin at the beginning, we have to go back a long way to get our start, for the roots of our family tree reach back over millions of years. "in the beginning--god." these first words of the book of genesis must be, in spirit at least, the first words of any discussion of life. we know now, however, that when god made man, he did not complete his masterpiece at one sitting, but instead devised a plan by which the onward urge within and the environment without should act and interact until from countless adaptations a human being was made. [footnote : william herbert carruth.] as the late dr. putnam of harvard university says, "we stand as the representative of a creative energy that expressed itself first in far simpler forms of life and finally in the form of human instincts."[ ] and again: "the choices and decisions of the organisms whose lives prepared the way through eons of time for ours, present themselves to us as instincts."[ ] [footnote : putnam: _human motives_, p. .] [footnote : putnam: _human motives_, p. .] introducing the instincts =back of our dispositions.= what is it that makes the baby jump at a noise? what energizes a man when you tell him he is a liar? what makes a young girl blush when you look at her, or a youth begin to take pains with his necktie? what makes men go to war or build tunnels or found hospitals or make love or save for a home? what makes a woman slave for her children, or give her life for them if need be? "instinct" you say, and rightly. back of every one of these well-known human tendencies is a specific instinct or group of instincts. the story of the life of man and the story of the mind of man must begin with the instincts. indeed, any intelligent approach to human life, whether it be that of the mother, the teacher, the preacher, the social worker or the neurologist, leads back inevitably to the instincts as the starting-point of understanding. but what is instinct? we are apt to be a bit hazy on that point, as we are on any fundamental thing with which we intimately live. we reckon on these instinctive tendencies every hour of the day, but as we are not used to labeling them, it may help in the very beginning of our discussion to have a list before our eyes. here, then, is a list of the fundamental tendencies of the human race and the emotions which drive them to fulfilment. the specific instincts and their emotions (after mcdougall) _instinct_ _emotion_ nutritive instinct hunger flight fear repulsion disgust curiosity wonder self-assertion positive self-feeling (elation) self-abasement negative self-feeling (subjection) gregariousness emotion unnamed acquisition love of possession construction emotion unnamed pugnacity anger reproductive instinct emotion unnamed parental instinct tender emotion these are the fundamental tendencies or dispositions with which every human being is endowed as he comes into the world. differing in degree in different individuals, they unite in varying proportions to form various kinds of dispositions, but are in greater or less degree the common property of us all. there flows through the life of every creature a steady stream of energy. scientists have not been able to decide on a descriptive term for this all-important life-force. it has been variously called "libido," "vital impulse" or "élan vital," "the spirit of life," "hormé," and "creative energy." the chief business of this life-force seems to be the preservation and development of the individual and the preservation and development of the race. in the service of these two needs have grown up these habit-reactions which we call instincts. the first ten of our list belong under the heading of self-preservation and the last two under that of race-preservation. as hunger is the most urgent representative of the self-preservative group, and as reproduction and parental care make up the race-preservative group, some scientists refer all impulses to the two great instincts of nutrition and sex, using these words in the widest sense. however, it will be useful for our purpose to follow mcdougall's classification and to examine individually the various tendencies of the two groups. =in debt to our ancestors.= an instinct is the result of the experience of the race, laid in brain and nerve-cells ready for use. it is a gift from our ancestors, an inheritance from the education of the age-long line of beings who have gone before. in the struggle for existence, it has been necessary for the members of the race to feed themselves, to run away from danger, to fight, to herd together, to reproduce themselves, to care for their young, and to do various other things which make for the well-being or preservation of the race. the individuals that did these things at the right time survived and passed on to their offspring an inherited tendency to this kind of reaction. mcdougall defines an instinct as "an inherited or innate psycho-physical disposition which determines its possessor to perceive or pay attention to objects of a certain class, to experience an emotional excitement of a particular quality upon perceiving such an object, and to act in regard to it in a particular manner, or at least to experience an impulse to such action." this is just what an instinct is,--an inherited disposition to notice, to feel, and to want to act in certain ways in certain situations. it is the something which makes us act when we cannot explain why, the something that goes deeper than reason, and that links us to all other human beings,--those who live to-day and those who have gone before. it is true that east is east and west is west, but the two do meet in the common foundation of our human nature. the likeness between men and between races is far greater and far more fundamental than the differences can ever be. =firing up the engine.= purpose is writ large across the face of an instinct, and that purpose is always toward action. whenever a situation arises which demands instantaneous action, the instinct is the means of securing it. planted within the creature is a tendency which makes it perceive and feel and act in the appropriate way. it will be noticed that there are three distinct parts to the process, corresponding to intellect, emotion, will. the initial intellectual part makes us sensitive to certain situations, makes us recognize an object as meaningful and significant, and waves the flag for the emotion; the emotion fires up the engine, pulls the levers all over the body that release its energy and get it ready for action, and pushes the button that calls into the mind an intense, almost irresistible desire or impulse to act. once aroused, the emotion and the impulse are not to be changed. in man or beast, in savage or savant, the intense feeling, the marked bodily changes, and the yearning for action are identical and unchangeable. the brakes can be put on and the action suppressed, but in that case the end of the whole process is defeated. could anything be plainer than that an instinct and its emotion were never intended to be aroused except in situations in which their characteristic action is to be desired? an emotion is the hot part of an instinct and exists solely for securing action. if all signs of the emotion are to be suppressed, all expression denied, why the emotion? but although the emotion and the impulse, once aroused, are beyond control, there is yet one part of the instinct that is meant to be controlled. the initial or receptive portion, that which notices a situation, recognizes it as significant, and sends in the signal for action, can be trained to discrimination. this is where reason comes in. if the situation calls for flight, fear is in order; if it calls for fight, anger is in order; if it calls for examination, wonder is in order; but if it calls for none of these things, reason should show some discrimination and refuse to call up the emotion. =the right of way.= there is a law that comes to the aid of reason in this dilemma and that is the "law of the common path."[ ] by this is meant that man is capable of but one intense emotion at a time. no one can imagine himself strenuously making love while he is shaken by an agony of fear, or ravenously eating while he is in a passion of rage. the stronger emotion gets the right of way, obtains control of mental and bodily machinery, and leaves no room for opposite states. if the two emotions are not antagonistic, they may blend together to form a compound emotion, but if in the nature of the case such a blending is impossible, the weaker is for the time being forgotten in the intensity of the stronger. "the expulsive power of a new affection" is not merely a happy phrase; it is a fact in every day life. the problem, then, resolves itself into ways of making the desirable emotion the stronger, of learning how to form the habit of giving it the head start and the right of way. in our chapter on "choosing the emotions," we shall find that much depends on building up the right kind of sentiments, or the permanent organization of instincts around ideas. however, we must first look more closely at the separate instincts to acquaint ourselves with the purpose and the ways of each, and to discover the nature of the forces with which we have to deal. [footnote : sherrington: _integrative action of the nervous system_.] i the self-preservative instincts =hunger.= hunger is the most pressing desire of the egoistic or self-preserving impulse. the yearning for food and the impulse to seek and eat it are aroused organically within the body and are behind much of the activity of every type of life. as the impulse is so familiar, and its promptings are so little subject to psychic control, it seems unnecessary to do more than mention its importance. =flight and fear.= all through the ages the race has been subject to injury. species has been pitted against species, individual against individual. he who could fight hardest or run fastest has survived and passed his abilities on to his offspring. not all could be strongest for fight, and many species have owed their existence to their ability to run and to know when to run. thus it is that one of the strongest and most universal tendencies is the instinct for flight, and its emotion, fear. "fear is the representation of injury and is born of the innumerable injuries which have been inflicted in the course of evolution."[ ] some babies are frightened if they are held too loosely, even though they have never known a fall. some persons have an instinctive fear of cats, a left-over from the time when the race needed to flee from the tiger and others of the cat family. almost every one, no matter in what state of culture, fears the unknown because the race before him has had to be afraid of that which was not familiar. [footnote : crile: _origin and nature of the emotions_.] the emotion of fear is well known, but its purpose is not so often recognized. an emotion brings about internal changes, visceral changes they are called, which enable the organism to act on the emotion,--to accomplish its object. there is only so much energy available at a given moment, stored up in the brain cells, ready for use. in such an emergency as flight every ounce of energy is needed. the large muscles used in running must have a great supply of extra energy. the heart and lungs must be speeded up in order to provide oxygen and take care of extra waste products. the special senses of sight and hearing must be sensitized. digestion and intestinal peristalsis must be stopped in order to save energy. no person could by conscious thought accomplish all these things. how, then, are they brought about? =internal laboratories.= in the wonderful internal laboratory of the body there are little glands whose business it is to secrete chemicals for just these emergencies. when an object is sighted which arouses fear, the brain cells flash instantaneous messages over the body, among others to the supra-renal glands or adrenals, just over the kidneys, and to the thyroid gland in the neck. instantly these glands pour forth adrenalin and thyroid secretion into the blood, and the body responds. blood pressure rises; brain cells speed up; the liver pours forth glycogen, its ready-to-burn fuel; sweat-glands send forth cold perspiration in order to regulate temperature; blood is pumped out from stomach and intestines to the external muscles. as we have seen, the body as a whole can respond to just one stimulus at a time. the response to this stimulus has the right of way. the whole body is integrated, set for this one thing. when fear holds the switchboard no other messages are allowed on the line, and the creature is ready for flight. but after flight comes concealment with the opposite bodily need, the need for absolute silence. this is why we sometimes get the opposite result. the heart seems to stop beating, the breath ceases, the limbs refuse to move, all because our ancestors needed to hide after they had run, and because we are in a very real way a part of them. =old-fashioned fear.= there is one passage from dr. crile's book which so admirably sums up these points that it seems worth while to insert it at length. we fear not in our hearts alone, not in our brains alone, not in our viscera alone--fear influences every organ and tissue. each organ or tissue is stimulated or inhibited according to its use or hindrance in the physical struggle for existence. by thus concentrating all or most of the nerve force on the nerve-muscular mechanism for defense, a greater physical power is developed. hence it is that under the stimulus of fear animals are able to perform preternatural feats of strength. for the same reason, the exhaustion following fear will be increased as the powerful stimulus of fear drains the cup of nervous energy even though no visible action may result.... perhaps the most striking difference between man and animals lies in the greater control which man has gained over his primitive instinctive reactions. as compared with the entire duration of organic evolution, man came down from his arboreal abode and assumed his new rôle of increased domination over the physical world but a moment ago. and now, though sitting at his desk in command of the complicated machinery of civilization, when he fears a business catastrophe his fear is manifested in the terms of his ancestral physical battle in the struggle for existence. he cannot fear intellectually, he cannot fear dispassionately, he fears with all his organs, and the same organs are stimulated and inhibited as if, instead of its being a battle of credit, or position, or of honor, it were a physical battle with teeth and claws.... nature has but one means of response to fear, and whatever its cause the phenomena are always the same--always physical.[ ] [footnote : crile: _origin and nature of the emotions_, p. ff.] * * * * * the moral is as plain as day: learn to call up fear only when speedy legs are needed, not a cool head or a comfortable digestion. fear is a costly proceeding, an emergency measure like a fire-alarm, to be used only when the occasion is urgent enough to demand it. how often it is misused and how large a part it plays in nervous symptoms, both mental and physical, will appear more clearly in later chapters. =repulsion and disgust.= akin to the instinct of flight is that of repulsion, which impels us, instead of fleeing, to thrust the object away. it leads us to reject from the mouth noxious and disgusting objects and to shrink from slimy, creepy creatures, and has of course been highly useful in protecting the race from poisons and snakes. it still operates in the tendency to put away from us those things, mental or physical, toward which we feel aversion or disgust. recent psychological discoveries have revealed how largely a neurosis consists in putting away from us--out of consciousness,--whatever we do not wish to recognize, and so it happens that disgust plays an unexpected part in nervous disorders. =curiosity and wonder.= fortunately for the race, it has not had to wait until different features of the environment prove to be helpful or harmful. there is an instinct which urges forward to exploration and discovery and which enables the creature not only to adapt itself to the environment but to learn how to adapt the environment to itself. this is the instinct of curiosity. it is the impulse back of all advance in science, religion, and intellectual achievement of every kind, and is sometimes called "intellectual feeling." =self-assertion.= it goes almost without saying that one of the strongest and most important impulses of mankind is the instinct of self-assertion; it often gets us into trouble, but it is also behind every effort toward developed character. at its lowest level self-assertion manifests itself in the strutting of the peacock, the prancing of the horse, and the "see how big i am," of the small boy. at its highest level, when combined with self-consciousness and the moral sentiments acquired from society and developed into the self-regarding sentiment, it is responsible for most of our ideas of right, our conception of what is and what is not compatible with our self-respect. =self-abasement.= self-assertion is aroused primarily by the presence of others and especially of those to whom we feel in any way superior, but when the presence of others makes us feel small, when we want to hide or keep in the background, we are being moved by the opposite instinct of self-abasement and negative self-feeling. it may be either the real or the fancied superiority of the spectators that arouses this feeling,--their wisdom or strength, beauty or good clothes. sometimes, as in stage-fright, it is their numerical superiority. bashfulness is the struggle between the two self-instincts, assertion and abasement. our impulse for self-display urges us on to make a good impression, while our feeling of inferiority impels us to get away unnoticed. hence the struggle and the painful emotion. =gregariousness.= man has been called a gregarious animal. that is, like the animals, he likes to run with his kind, and feels a pronounced aversion to prolonged isolation. it is this "herd-instinct," too, which makes man so extremely sensitive to the opinions of the society in which he lives. because of this impulse to go with the crowd, ideas received through education are accepted as imperative and are backed up by all the force of the instinct of self-regard. when the teachings of society happen to run counter to the laws of our being, the possibilities of conflict are indeed great.[ ] [footnote : for a thorough discussion of the importance of this instinct, see trotter's _instincts of the herd in peace and war_.] =acquisition.= another fundamental disposition in both animals and men is the instinct for possession, the instinct whose function it is to provide for future needs. squirrels and birds lay up nuts for the winter; the dog hides his bone where only he can find it. children love to have things for their "very own," and almost invariably go through the hoarding stage in which stamps or samples or bits of string are hoarded for the sake of possession, quite apart from their usefulness or value. much of the training of children consists in learning what is "mine" and what is "thine," and respect for the property of others can develop only out of a sense of one's own property rights. =construction.= there is an innate satisfaction in making something,--from a doll-dress to a poem,--and this satisfaction rests on the impulse to construct, to fashion something with our own hands or our own brain. the emotion accompanying this instinct is too indefinite to have a name but it is nevertheless a real one and plays a large part in the sense of power which results from the satisfaction of good work well done. later it will be seen how closely related is this impulse to the creative instinct of reproduction and how useful it can be in drawing off the surplus energy of that much denied instinct. =pugnacity and anger.= what is it that makes us angry? a little thought will convince us that the thing which arouses our fury is not the sight of any special object, but the blocking of any one of the other instincts. watch any animal at bay when its chance for flight has gone. the timidest one will turn and fight with every sign of fury. watch a mother when her young are threatened,--bear, or cat or lion or human. fear has no place then. it is entirely displaced by anger over the balking of the maternal instinct of protection. strictly speaking, pugnacity belongs among the instincts neither of self-preservation nor of race-preservation, but is a special device for reinforcing both groups. as fear supplies the energy for running, so anger fits us for fight,--and for nothing but fight. the mechanism is almost identical with that of fear. brain and liver, adrenals and thyroid are the means, but the emotion presses the button and releases the energy, stopping all digestion and energizing all combat-muscles. the blood is flooded with fuel and with substances which, if not used, are harmful to the body. we were never meant to be angry without fighting. the habit of self-control has its distinct advantages, but it is hard on the body, which was patterned before self-control came into fashion. the wise man, once he is aroused, lets off steam at the woodpile or on a long, vigorous walk. he probably does not say to himself that he is a motor animal integrated for fight and that he must get rid of glycogen and adrenalin and thyroid secretion. he only knows that he feels better "on the move." the wiser man does not let himself get angry in the first place unless the situation calls for fight. however, the fight need not be a hand-to-hand combat with one's fellow man. william james has pointed out that there is a "moral equivalent for war," and that the energy of this instinct may be used to reinforce other impulses and help overcome obstacles of all sorts. a good deal of the business man's zest, the engineer's determination, and the reformer's zeal spring from the fight-instinct used in the right way. as james, cannon, and others have pointed out, the way to end war may be to employ man's instinct of pugnacity in fighting the universal enemies of the race--fire, flood, famine, disease, and the various social evils--rather than let it spend its force in war between nations. even our sports may be offshoots of the fight-instinct, for mcdougall holds that the play-tendency has its root in the instinct of rivalry, a modified form of pugnacity. evidently fighting-blood is a useful inheritance, even to-day, and rightly directed is a necessary part of a complete and forceful personality. this, then, completes the list of self-preservative instincts, those which are commonly called egoistic and which have been given us for the maintenance of our own individual personal lives. but our endowment includes another set of impulses which are no less important and which must be reckoned with if human conduct is to be understood. chapter iv _in which we learn more about ourselves_ the story of the instincts (continued) ii. the race-preservative instincts =looking beyond ourselves.= we sometimes speak of self-preservation as though it were the only law of life, while as a matter of fact it is but half the story. nature has seen to it that there shall be planted in every living creature an innate urge toward the larger life of the race. although the creature may never give a conscious thought to the welfare of the race, he still bears within himself a set of instincts which have as their end and aim, not the individual at all, but society as a whole, and the life of generations that are to come. he is bigger than he knows. although he may have no notion why he feels and acts as he does, and although he may pervert the purpose for his own selfish end, he is continually being moved by the mighty impulse of the race-life, an impulse which often outrivals the desire i or his own personal existence. the craving to reproduce ourselves and the craving to cherish and protect our young are among the most dynamic forces in life. the two desires are so closely bound together that they are often spoken of as one under the name of the sex-instinct, or the family instincts. let us look first at that part of the yearning which urges toward perpetuating our own life in offspring. =watching nature work.= it is wonderful, indeed, to watch nature in the long process of evolution, as she adapts her methods to the growing complexity of the organism. with a variety and ingenuity of means, but always with the same steady purpose, she works from the lowest levels,--where there is no true reproduction, only multiplication by division,--on through the beginning of reproduction proper, where a single parent produces the offspring; then on to the level where it takes two parents of different structure to produce a new organism, and sex-life begins. at first nature does not even demand that father and mother shall come near each other. in the water, the female of this type lays an egg, and the male, guided by his instinct, swims to it and deposits his fertilizing fluid. in plant life, bird and bee, attracted by wonderfully planned perfumes and color and honey, are called in to carry the pollen from male to female cell. but it is when we come to the highest level that we find even more subtle ways planned to accomplish the desired end. here we enter the realm of individual initiative, for it is not now enough to leave to external forces the joining of the two life-elements. in order to make a new individual, father and mother must be drawn together, and so there enters into the situation a personal relationship with all that that implies. because nature has had to provide ways of drawing individuals to one another, she has put into the higher types of life the power of mutual attraction,--a power which in man, the highest of all types, is responsible for many outgrowths that seem far removed from the original purpose. =the love-motif.= on the one hand, there is the persistent desire to be attractive, which manifests itself in the subtlest ways. how many of the yearnings and activities of human life have their roots in this ancient and honorable desire! the love of pretty clothes,--however it may seem to be motivated and however it may be complicated by other motives,-draws its energy, fundamentally, from the same need that provides the gay plumage and limpid song of the bird or the painted wings of the butterfly. on the other hand, there is the capability of being attracted, with all the personal relationships which spring from the power of admiring and loving another person. the interest in others does not expend its whole force on its primary objects,--mate and children. it flows out into all human relationships, developing all the possibilities of loving which mean so much in human life; the love of man for man and woman for woman, as well as mutual love of man and woman. a force like this, once planted, especially in the higher types of life, does not spend all its energies in its main trunk. it sends out branches in many directions, bearing by-products which are rich in value for all of life. many of our richest relationships, our best impulses, and our most firmly fixed social habits spring from the family instincts of reproduction and parental care. the social life of our young people, so well calculated to bring young men and women together; all the beauty of family life and, as we shall later see, all the broader benevolent activities for society in general, are energized by the same love-instincts which form so large a part of human nature. learning to love =a four-grade school.= it is impossible to watch the growth of the love-life of a human being, to trace its development from babyhood up to its culmination in mating and parenthood, without a sense of wonder at the steady purpose behind it all. we used to believe that the love for the young girl that suddenly blooms forth in the callow youth was an entirely new affair, something suddenly planted in him as he developed into manhood; but now we know, thanks to the uncovering of human nature by the painstaking investigations of the psycho-analytic school of psychologists, that the seeds of the love-life are planted, not in puberty, but with the beginning of life itself. looked at in one way, all infancy and childhood are a preparation, a training of the love-instinct which is to be ready at the proper time to find its mate and play its part in the perpetuation of the race. nature begins early. as she plants in the tiny baby all the organs that shall be needed during its lifetime, so she plants the rudiments of all the impulses and tendencies that shall later be developed into the full-grown instincts. there have been found to be four periods in the love-life of the growing child, three of them preparatory steps leading up to maturity; periods in which the main current of love is directed respectively toward self, parents, comrades, and finally toward lover or mate. =like narcissus.= in the first stage, the baby's interest is in his own body. he is getting acquainted with himself, and he soon finds that his body contains possibilities of pleasurable sensations which may be repeated by the proper stimulation. besides the hunger-satisfaction that it brings, the act of sucking is pleasurable in itself, and so the baby begins to suck his thumb or his quilts or his rattle. later, this impulse to stimulate the nerves about the mouth finds its satisfaction in kissing, and still later it plays a definite part in the wooing process; but at first the child is self-sufficient and finds his pleasure entirely within himself. other regions of the body yield similar pleasure. we often find a tiny child rubbing his genital organs or his thighs or taking exaggerated pleasure in riding on someone's foot in order to stimulate these nerves, which he has discovered at first merely by chance. when he begins to run around, he loves to exhibit his own body, to go about naked. none of this is naughtiness or perversion; it is only nature's preparation of trends that she will later need to use. the child is normally and naturally in love with himself.[ ] but he must not linger too long in this stage. none of the channels which his life-force is cutting must be dug too deep, else in later life they will offer lines of least resistance which may, on occasion, invite illness or perversion. [footnote : this is the stage which is technically known as auto-eroticism or self-love.] =in love with his family.= presently nature pries the child loose from love of himself and directs part of his interests to people outside himself. before he is a year old, part of his love is turned to others. in this stage it is natural that at first his affection should center on those who make up his home circle,--his parents and other members of the household. even in this early choice we see a foreshadowing of his future need. the normal little boy is especially fond of his mother, and the normal little girl of her father. not all the love goes to the parent of the opposite sex, but if the child be normal, a noticeably larger part finds its way in that direction. observing parents can often see unmistakable signs of jealousy: toward the parent of the same sex, or the brother or sister of the same sex. the little boy who sleeps with his mother while his father is away, or who on these occasions gets all the attention and all the petting he craves, is naturally eager to perpetuate this state of affairs. many a small boy has been heard to say that he wished his father would go away and stay all the time,--to the horror of the parents who do not understand. all this is natural enough, but it is not to be encouraged. the pattern of the father or the mother must not be stamped too deep in the impressionable child-mind. too little love and sympathy are bad, leading to repression and a morbid turning in of the love-force; but too much petting, too many caresses are just as bad. sentimental self-indulgence on the part of the parents has been repeatedly proved to be the cause of many a later illness for the child. as the right kind of family love and comradeship, the kind that leads to freedom and self-dependence, is among the highest forces in life, so the wrong kind is among the worst. parents and their substitutes--nurses, sisters, and brothers--are but temporary stopping-places for the growing love, stepping-stones to later attachments which are biologically more necessary. the small boy who lets himself be coddled and petted too long by his adoring relatives, who does not shake off their caresses and run away to the other boys, is doomed to failure, and, as we shall later see, probably to illness.[ ] [footnote : one of the best discussions of this theme is found in the chapter "the only or favorite child," by a.a. brill, in _psychoanalysis_.] in the later infantile period, the child, besides wanting to exhibit his own body, shows marked interest in looking at the bodies of others, and marked curiosity on sex-questions in general. he particularly wants to know "where babies come from." if his questions are unfortunately met by embarrassment or laughing evasion, or by obvious lying about the stork or the doctor or the angels, his curiosity is only whetted, and he comes to the very natural conclusion that all matters of sex are sinful, disgusting, and indecent, and to be investigated only on the sly. this conception cannot be brought into harmony with the unconscious mental processes arising from his race-instincts nor with his instinctive sense that "whatever is is right." the resulting conflict in some four-year-old children is surprisingly intense. astonished indeed would many parents be if they knew what was going on inside the heads of their "innocent" little children; not "bad" things, but pathetic things which a little candor would have avoided. alongside the rudimentary impulses of showing and looking, there is developed another set of trends which nature needs to use later on, the so-called sadistic and masochistic impulses, the desire to dominate and master and even to inflict pain, and its opposite impulse which takes pleasure in yielding and submitting to mastery. these traits, harking back to the time when the male needed to capture by force, are of course much more evident in adolescence and especially in love-making, but have their beginning in childhood, as many a mother of cruel children knows to her sorrow. in adolescence, when sex-differentiation is much more marked, the dominating impulse is stronger in the boy and the yielding impulse in the girl; but in little children the differentiation has not yet begun. =gang and chum.= at about four or five years the child leaves the infantile stage of development, with its self-love and its intense devotion to parents and their substitutes. he begins to be especially interested in playmates of his own sex, to care more for the opinions of the gang--or if it be a little girl, of the chum--than for those of the parents. the life-force is leading him on to the next step in his education, freeing him little by little from a too-hampering attachment to his family. this does not mean that he does not love his father and mother. it means only that some of his love is being turned toward the rest of the world, that he may be an independent, socially useful man. this period between infancy and puberty is known as the latency period. all interest in sex disappears, repressed by the spontaneously developing sense of shame and modesty and by the impact of education and social disapproval. the child forgets that he was ever curious on sex-matters and lets his curiosity turn into other, more acceptable channels. =the mating-time.= we are familiar with the changes that take place at puberty. we laugh at the girl who, throwing off her tom-boy ways, suddenly wants her skirts let down and her hair done up. we laugh at the boy who suddenly leaves off being a rowdy, and turns into a would-be dandy. we scold because this same boy and girl who have always been so "sweet and tractable" become, almost overnight, surly and cantankerous, restive under authority and impatient of family restraint. we should neither laugh nor scold, if we understood. nature is succeeding in her purpose. she has led the young life on from self to parents, from parents to gang or chum, and now she is trying to lead it away from all its earlier attachments, to set it free for its final adventure in loving. the process is painful, so painful that it sometimes fails of accomplishment. in any case, the strain is tremendous, needing all the wisdom and understanding which the family has to offer. it is no easy task for any person to free himself from the sense of dependence and protection, and the shielding love that have always been his; to weigh anchors that are holding him to the past and to start out on the voyage alone. at this time of change, the chemistry of the body plays an important part in the development of the mental traits; all half-developed tendencies are given power through the maturing of the sex-glands, which bind them into an organization ready for their ultimate purpose. the current is now turned on, and the machinery, which has been furnished from the beginning, is ready for its task. after a few false starts in the shape of "puppy love," the mature instinct, if it be successful, seeks until from among the crowd it finds its mate. it has graduated from the training-school and is ready for life. civilization's problem =when nature's plans fall through.= we have been describing the normal course of affairs. we know that all too often the normal is not achieved. inner forces or outer circumstances too often conspire to keep the young man or the young woman from the culmination toward which everything has been moving. if the life-force cannot liberate itself from the old family grooves to forge ahead into new channels, or if economic demands or other conditions make postponement necessary, then marriage is not possible. all the glandular secretions and internal stimuli have been urging on to the final consummation, developing physical and emotional life for an end that does not come; or if it does come, is not sufficient to satisfy the demands of the age-old instinct which for millions of years knew no restraint. in any case, man finds himself, and woman herself, face to face with a pressing problem, none the less pressing because it is in most cases entirely unrecognized. =blundering instincts.= the older a person is, the more fixed are his habits. now, an instinct is a race-habit and represents the crystallized reactions of a past that is old. whatever has been done over and over again, millions of times, naturally becomes fixed, automatic, tending to conserve itself in its old ways, to resist any change and to act as it has always acted. this conserves energy and works well so long as conditions remain the same. but if for any reason there comes a change, things are likely to go wrong. by just so far as things are different, an automatic habit becomes a handicap instead of a help. this having to act under changed conditions is exactly the trouble with the reproductive instinct. under civilization, conditions have changed but the instinct has not. it is trying to act as it always has acted, but civilized man wills otherwise. the change that has come is not in the physical, external environment, but in man himself and in the social environment which he has created. there is in man an onward urge toward new and better things. side by side with the desire to live as he always has lived, there is a desire to make new adaptations which are for the advancement of the whole race-life. besides the natural wish to take his desires as he finds them, there is also the wish to modify them and use them for higher and more socially useful ends. as the race has found through long experience that monogamy is to be preferred to promiscuous mating; that the highest interests of life are fostered by loyalty to the institution of the family; that the careful rearing of several children rather than the mere production of many is in the long run to be desired; and that a single standard of morality is practicable; so society has established for its members a standard which is in direct opposition to the immeasurable urge of the past. to make matters worse, there have at the same time grown up in many communities a standard of living and an economic competition which still further limit the size of the family and the satisfaction of the reproductive impulse. =the perpetual feud.= there thus arises the strategic struggle between that which the race has found good in the past and that which the race finds good in the present. as the older race-experience is laid in they body and built into the very fiber of the individual, inherited as an innate impulse, it has become an integral part of himself, an individual need rather than a social one. on the other hand, man has, as another innate part of his being, the desire to go with the herd, to conform to the standards of his fellows, to be what he has learned society wants him to be. hence the struggle, insistent, ever more pressing, between two sets of desires within the man himself; the feud between the past and the present, between the natural and the social, between the selfish and the ideal. on one side, there is the demand for instinctive satisfaction; on the other, for moral control; on one side the demand for pleasure; on the other, the demands of reality.[ ] [footnote : "all the burdens of men or society are caused by the inadequacies in the association of primal animal emotions with those mental powers which have been so rapidly developed in man-kind."--shaler quoted by hinkle: introduction to jung's _psychology of the unconscious_.] two factors intensify the conflict. in the first place, the older habits have the head start. compared with the almost limitless extent of our past history, our desire for the control of the instincts is very new indeed. it requires the long look and the right perspective to understand how very lately we have entered into our new conditions and how old a habit we are trying to break. in the second place, the larger part of the stimulus comes from within the body itself. when studying the other instincts, we saw that the best way to control was to refuse to stimulate when the situation was not suitable for discharge. but with the organically aroused sex-instinct there is no such power of choice. we may fan the flame by the thoughts we think or the environment we seek, or we may smother the flame until it is out of sight, but we cannot extinguish it by any act of ours. the issue has always been too important to be left to the individual. the stimulation comes, primarily, not by way of the mind but by way of the body. with this instinct we cannot "stop before we begin," because nature has taken the matter out of our hands and begins for us. the bulwark we have built with the competing forces so strong and the issues so great, it is not to be wondered at that society has had to build up a massive bulwark of public opinion, to establish regulations and fix penalties that are more stringent than those imposed in any other direction. nor is it remarkable that in its effort to protect itself, society has sometimes made mistakes. these blunders seem to lie in two directions. assuming that it is nearly impossible for the male to control his instincts, and that, after all, it does not matter so much whether he does or not, society has blinked at license in men, and thus has fostered a demoralizing, anti-social double standard which has broken up countless homes, has been responsible for the spread of venereal diseases, and has been among the greatest curses of modern civilization. at the same time society, in its efforts to maintain its standards for woman, has taught its children, especially its girls, that anything savoring of the word "sexual" is sinful, disgusting, and impure. to be sure, very many women have modified their childish views, but an astonishingly large number conserve, even in maturity, their warped ideas about the whole subject of sex. many a mature woman secretly believes that she, at least, is not guilty of harboring anything so "vulgar" as a reproductive instinct, not realizing that if this were so, she would be, in very truth, a freak of nature. of course, woman is by nature as fully endowed with sex instincts as is man. kipling portrays the female of the species as "deadlier than the male" in that the very framework of her constitution outlines the one issue for which it was launched,--stanch against any attack which might endanger the carrying on of life. feeling the force of this instinctive urge, she braces herself against precipitancy in response by what seems almost a negation. just as we lean well in when riding around a corner, in order to keep ourselves from falling out, so by an "over-compensation" for what is unconsciously felt to be danger woman increases her feeling of safety by setting up a taboo on the whole subject of sex. it is time that we freed our minds from the artificial and perverted attitude toward this dominant impulse; time to rescue the word "sex" from its implications of grossness and sensuousness, and to recognize the instinct in its true light as one of the necessary and holy forces of life, a force capable of causing great damage, but also holding infinite possibilities for good if wisely directed. society only gets its members into trouble when, even by implication, it attempts to deny its natural make-up, and allows little children to grow up with the false idea that one of their strongest impulses is to be shunned by them as a thing of shame. we cannot dam back the flood by building a bulwark of untruth, and then expect the bulwark to hold. =adaptable energy.= we neither have to give in to our over-insistent desires nor to deny that they exist. man has a power of adaptation. just when we seem to run up against a dead wall, to face an irreconcilable conflict, we find a wonderful power of indirect expression that affords satisfaction to all the innate forces without doing violence to the ethical standards which have proved so necessary for the development of character. hunger, which, like the reproductive instinct, is stimulated by the changing chemistry of the body, can be satisfied only by achieving its primary purpose, the taking of material food; but the creative impulse to reproduce oneself possesses a unique ability to spiritualize itself and expend its energy in other lines of creative endeavor. there seems to be some sort of close connection between the especially intense energy of the reproductive instinct and the modes of expression of the instinct for construction; a connection which makes possible the utilization of threatening destructive energy by directing it toward socially valuable work. just as we harness the mountain stream and use its wild force to light our cities, or catch the lightning to run our trolley cars, so we find man and woman--under the right conditions--easily and naturally switching over the power of their surplus sex-energy to ends which seem at first only slightly related to its original aim, but which resemble it in that they too are self-expressive and creative. if a person is able to express himself in some real way, to give himself to socially needed work; if he can reproduce himself intellectually and spiritually in artistic production, in invention, in literature, in social betterment, he is drawing on an age-old reservoir of creative energy, and by so doing is relieving himself of inner tension which would otherwise seek less beneficent ways of expression. the world knew all this intuitively for a long time before it knew it theoretically. the novelists, who are unconsciously among the best psychologists, have thoroughly worked the vein. the average man knows it. "he was disappointed in love," we say, "and we thought he would go to pieces, but now he has found himself in his work"; or, "she will go mad if she doesn't find some one who needs her." it is only lately that science has caught up with intuition, but now the physicians and psychologists who have had the most intimate and first-hand acquaintance with the human heart are recognizing, to a man, this unique power of the love-instinct and its possibilities for creative work of every sort.[ ] [footnote : among those who have shown this connection between the love-force and creative work are freud, jung, jelliffe, white, brill, jones, wright, frink, and the late dr. putnam of harvard university, who writes: "freud has never asserted it as his opinion and it certainly is not mine, that this is the only root from which artistic expression springs. on the other hand, it is probable that all artistic productions are partly referable to this source. a close examination of many of them would enable any one to justify the opinion that it is a source largely drawn upon."--_human motives_. p. .] =higher levels.= freud has called this spiritualization of natural forces by a term borrowed from chemistry. as a solid is "sublimated" when transformed into a gas, so a primal impulse is said to be "sublimated" when it is diverted from its original object and made to serve other ends. by this power of sublimation the little exhibitionist, who loved to show himself, may become an actor; the "cruel" boy who loved to dissect animals may become a surgeon; the sexually curious child may turn his curiosity to other things and become a scholar; the "born mother," if denied children of her own or having finished with their upbringing, may take to herself the children of the city, working for better laws and better care for needy little ones; the man or woman whose sex-instinct is too strong to find expression in legitimate, direct ways, may find it a valuable resource, an increment of energy for creative work, along whatever line his talent may lie. there is no more marvelous provision in all life than this power of sublimation of one form of energy into another, a provision shadowing forth almost limitless possibilities for higher adaptations and for growth in character. as we think of the distance we have already traveled and the endless possibilities of ever higher excursions of the life-force, we feel like echoing paul's words: "he who began a good work in you will perfect it unto the end." the history of the past holds great promise for the future. =when sublimation fails.= but in the meantime we cannot congratulate ourselves too heartily. sublimation too often fails. there are too many nervous wrecks by the way, too many weak indulgers of original desires, too many repressed, starved lives with no outlet for their misunderstood yearnings; and, as we shall see, too many people who, in spite of a big lifework, fail to find satisfaction because of unnecessary handicaps carried over from their childhood days. "society's great task is, therefore, the understanding of the life-force, its manifold efforts at expression and the way of attaining this, and to provide as free and expansive ways as possible for the creative energy which is to work marvelous things for the future." if "the understanding of the life force" is to be available for use, it must be the property of the average man and woman, the fathers and mothers of our children, the teachers and physicians who act as their advisers and friends.[ ] this chapter is intended to do its bit toward such a general understanding. [footnote : "appropriate educational processes might perhaps guide this enormous impulsive energy toward the maintenance instead of the destruction of marriage and the family. but up to the present time, education with respect to this moral issue has commonly lacked any such constructive method. the social standard and the individual impulse have simply collided, and the individual has been left to resolve the conflict, for the most part by his own resources."--g.a. coe: _psychology of religion_, p. .] parental instinct and tender emotion =until they can fly.= only half of nature's need is met by the reproductive instinct. her carefulness in this direction would be largely wasted without that other impulse which she has planted, the impulse to protect the new lives until they are old enough to fend for themselves. the higher the type of life and the greater the future demands, the longer is the period of preparation and consequent period of parental care. this fact, coupled with man's power for lasting relationships through the organization of permanent sentiments, has made the, bond between parent and child an enduring one. needless to say, this relationship is among the most beautiful on earth, the source of an incalculable amount of joy and gain. however, as we have already suggested, there lurks here, as in every beneficent force, a danger. if parents forget what they are for, and try to foster a more than ordinary tie, they make themselves a menace to those whom they most love. any exaggeration is abnormal. if the childhood bond is over-strong, or the childhood dependence too long cultivated, then the relationship has overstepped its purpose, and, as we shall later see, has laid the foundation for a future neurosis. =mothering the world.= probably no instinct has so many ways of indirect expression as this mothering impulse of protection. aroused by the cry of a child in distress, or by the thought of the weakness, or need, or ill-treatment of any defenseless creature, this mother-father impulse is at the root of altruism, gratitude, love, pity, benevolence, and all unselfish actions. there is still a great difference of opinion as to how man's spiritual nature came into being; still discussion as to whether it developed out of crude beginnings as the rest of his physical and mental endowment has developed, or whether it was added from the outside as something entirely new. be that as it may, the fact remains that man has as an innate part of his being an altruistic tendency, an unselfish care for the welfare of others, a relationship to society as a whole,--a relationship which is the only foundation of health and happiness and which brings sure disaster if ignored. the egoistic tendencies are only a part of human nature. part of us is naturally socially minded, unselfish, spiritual, capable of responding to the call to lose our lives in order that others may find theirs. summary civilized man as he is to-day is a product of the past and can be understood only as that past is understood. the conflicts with which he is confronted are the direct outcome of the evolutional history of the race and of its attempt to adapt its primitive instincts to present-day ideals. character is what we do with our instincts. according to freud, all of a man's traits are the result of his unchanged original impulses, or of his reactions against those impulses, or of his sublimation of them. in other words, there are three things we may do with our instincts. we may follow our primal desires, we may deny their existence, or we may use them for ends which are in harmony with our lives as we want them to be. as the first course leads to degeneracy, the second to nervous illness, and the third to happy usefulness, it is obviously important to learn the way of sublimation. sometimes this is accomplished unconsciously by the life-force, but sometimes sublimation fails, and is reestablished only when the conscious mind gains an understanding of the great forces of life. this method of reeducation of the personality as a means of treatment in nervousness is called psycho-therapy. =religion's contribution.= if it be asked why, amid all this discussion of instincts and motives we have made no mention of that great energizer religion, we answer that we have by no means forgotten it, but that we have been dealing solely with those primary tendencies out of which all of the compound emotions are made. man has been described as instinctively and incurably religious, but there seems no doubt that religion is a compound reaction, made up of love,--sympathetic response to the parental love of god,--fear, negative self-feeling, and positive self-feeling in the shape of aspiration for the desired ideal of character; all woven into several compound emotions such as awe, gratitude, and reverence. it goes almost without saying that religion, if it be vital, is one of the greatest sources of moral energy and spiritual dynamic, and that it is and always has been one of the greatest aids to sublimation that man has found. a force like the christian religion, which sets the highest ideal of character and makes man want to live up to it, and which at the same time says, "you can. here is strength to help you"; which unifies life and fills it with purpose; which furnishes the highest love-object and turns the thought outward to the good of mankind--such a force could hardly fail to be a dynamic factor in the effort toward sublimation. this book, however, deals primarily with those cases for which religion has had, to call science to her aid in order to find the cause of failure, to flood the whole subject with light, and to help cut the cords which, binding us to the past, make it impossible to utilize the great resources that are at hand for all the children of men. =where we keep our instincts.= it must have been impossible to read through these two chapters on instinct without feeling that, after all, we are not very well acquainted with ourselves. the more we look into human nature, the more evident it becomes that there is much in each one of us of which we are only dimly aware. it is now time for us to look a little deeper,--to find where we keep these instinctive tendencies with which it is possible to live so intimately without even suspecting their existence. we shall find that they occupy a realm of their own, and that this realm, while quite out of sight, is yet open to exploration. chapter v _in which we look below the surface and discover a veritable wonderland_ the subconscious mind strangers to ourselves =hidden strings.= a collie dog lies on the hearthrug. a small boy with mischievous intent ties a fine thread to a bone, hides himself behind a chair, and pulls the bone slowly across the floor. the dog is thrown into a fit of terror because he does not know about the hidden string. a chinese in the early days of san francisco stands spell-bound at the sight of a cable car. "no pushee. no pullee. go allee samee like hellee!" he does not know about the hidden string. a woman of refinement and culture thinks a thought that horrifies her sensitive soul. it is entirely out of keeping with her character as she knows it. in her misunderstanding she considers it wicked and thrusts it from her, wondering how it ever could have been hers. she does not know about the hidden string. in the last two chapters we thought together about some of these strings, examining the fibers of which they are made and learning in what directions they pull. we found them to be more powerful than we should have supposed, more insistent and less visible. we found that instinctive desire is the string, the cable that energizes our every act, but that our desires are neither single nor simple, and are but rarely on the surface. many of us live with them a long time, feeling the tug, but not recognizing the string. =there's a reason.= we take our thoughts and feelings and actions for granted, without stopping very often to wonder where they come from. but there is always a reason. when the law of cause and effect reaches the doorsill of our minds, it does not stop short to give way to the law of chance. we wake up in the morning with a certain thought on top. we say it "just happens." but nothing ever just happens. no thought that ever comes into our heads has been without its history,--its ancestors and its determining causes. but what about dreams? they, at least, you say, have no connections, no past and no future, only a weird, fantastic present. strange to say, dreams have been found to be as closely related to our real selves, as interwoven with the warp and woof of our lives as are any of our waking thoughts. even dreams have a reason. we find ourselves holding certain beliefs and prejudices, interested in certain things and indifferent to others, liking some foods, some colors and disliking others. search our minds as we will, we find no clue to many of these inner trends. why? the answer is simple. the cause is hidden below the surface. if we try to explain ourselves on the basis of the open-to-inspection part of our minds, we must come to the conclusion that we are queer creatures indeed. only by assuming that there is more to us than we know, can we find any rational basis for the way we think and feel and act. =a real mind.= we learn of our internal machinery by what it does. we must infer a part of our minds which introspection does not reveal, a mind within the mind, able to work for us even while we are unaware of its existence. this inner mind is usually known as the subconscious, the mind under the level of consciousness.[ ] we forget a name, but we know that it will come to us if we think about something else. presently, out of somewhere, there flashes the word we want. where was it in the meanwhile, and what hunted it out from among all our other memories and sent it up into consciousness? the something which did that must be capable of conserving memories, of recognizing the right one and of communicating it,--surely a real mind. [footnote : writers of the psycho-analytic school use the word "unconscious" to denote the lower layers of this region, and "fore-conscious" to denote its upper layers. morton prince uses the terms "unconscious" and "conscious" to denote the different strata. as there is still a good deal of confusion in the use of terms, it has seemed to us simpler to use throughout only the general term "subconscious."] one evening my collaborator fumbled unsuccessfully for the name of a certain well-known journalist and educator. it was on the tip of her tongue, but it simply would not come, not even the initial letter. in a whimsical mood she said to herself just as she went to sleep, "little subconscious mind, you find that name to-night." in the middle of the night she awoke, saying, "williams--talcott williams." the subconscious, which has charge of her memories, had been at work while she slept. the history of literature abounds in stories of under-the-surface work. the man of genius usually waits until the mood is on, until the muse speaks; then all his lifeless material is lighted by new radiance. he feels that some one outside himself is dictating. often he merely holds the pen while the finished work pours itself out spontaneously as if from a higher source. but it is not only the man of genius who makes use of these unseen powers. he may have readier access to his subconscious than the rest of us, but he has no monopoly. the most matter-of-fact man often says that he will "sleep over" a knotty problem. he puts it into his mind and then goes about his business, or goes to sleep while this unseen judge weighs and balances, collects related facts, looks first at one side of the question and then at the other, and finally sends up into consciousness a decision full of conviction, a decision that has been formulated so far from the focus of attention that it seems to be something altogether new, a veritable inspiration. we must infer the subconscious from what it does. things happen,--there must be a cause. some of the things that happen presuppose imagination, reason, intelligence, will, emotion, desire, all the elements of mind. we cannot see this mind, but we can see its products. to deny the subconscious is to deny the artist while looking at his picture, to disbelieve in the poet while reading his poem, and to doubt the existence of the explosive while listening to the report. the subconscious is an artist, a poet, and an explosive by turns. if we deny its existence, a good portion of man's doings are unintelligible. if we admit it, many of his actions and his afflictions which have seemed absurd stand out in a new light as purposeful efforts with a real and adequate cause. =the submerged nine tenths.= the more deeply psychologists and physicians have studied into these things, the more certainly have they been forced to the conclusion that the conscious mind of man, the part that he can explore at will, is by far the smaller part of his personality. since this is to some people a rather startling proposition, we can do no better than quote the following statement from white on the relation of consciousness to the rest of the psychic life: consciousness includes only that of which we are _aware_, while outside of this somewhat restricted area there lies a much wider area in which lie the deeper motives for conduct, and which not only operates to control conduct, but also dictates what may and what may not become conscious. stanley hall has very forcibly put the matter by using the illustration of the iceberg. only one-tenth of the iceberg is visible above water; nine-tenths is beneath the surface. it may appear in a given instance that the iceberg is being carried along by the prevailing winds and surface currents, but if we keep our eyes open we shall sooner or later see a berg going in the face of the wind, and, so, apparently putting to naught all the laws of aerodynamics. we can understand this only when we come to realize that much the greater portion of the berg is beneath the surface and that it is moving in response to invisible forces addressed against this submerged portion. consciousness only arises late in the course of evolution and only in connection with adjustments that are relatively complex. when the same or similar conditions in the environment are repeatedly presented to the organism so that it is called upon to react in a similar and almost identical way each time, there tends to be organized a mechanism of reaction which becomes more and more automatic and is accompanied by a state of mind of less and less awareness.[ ] [footnote : white: _mechanisms of character formation_.] it is easy to see the economy of this arrangement which provides ready-made patterns of reaction for habitual situations and leaves consciousness free for new decisions. since an automatic action, traveling along well-worn brain paths, consumes little energy and causes the minimum of fatigue, the plan not only frees consciousness from a confusing number of details, but also works for the conservation of energy. while consciousness is busy lighting up the special problems of the moment, the vast mass of life's demands are taken care of by the subconscious, which constitutes the bulk of the mind. "properly speaking, the unconscious is the real psyche."[ ] [footnote : freud: _interpretation of dreams_, p. .] =the heart of psychology.= in the face of all this, it is not to be wondered at that the problem of the subconscious has been called not one problem of psychology but the problem. it cannot be denied that the discoveries which have already been made as to its activities have been of immense practical importance in the understanding of normal conduct and in the treatment of the psycho-neuroses. if some of the methods--such as hypnosis, automatic writing, and interpretation of dreams--which are used to investigate its activities seem to savor of the charlatan and the mountebank, it is because they have occasionally been appropriated by the ignorant and the unscrupulous. their real setting is the psychological laboratory and the physician's office. in the hands of men like sigmund freud, boris sidis, and morton prince, they are as scientific as the apparatus of any other laboratory and their findings are as susceptible of proof. we may, then, go forward with the conviction that we are walking on solid ground and that the main paths, at least, will turn into beaten highways. ancestral memories =race-memories.= an individual as he stands at any moment is the product of his past,--the past which he has inherited and the past which he has lived. in other words, he is a bundle of memories accumulated through the experience of the race, and through his own experience as a person. some of these memories are conscious, and these he calls his, while others fail to reach consciousness and are not recognized as part of his assets. the instincts form the starting-point of mind, conscious and subconscious, and are the foundation upon which the rest is built. they often show themselves as part of our conscious lives, but their roots are laid deep in the subconscious from which they can never be eradicated. this deepest-laid instinctive layer of the subconscious is little subject to change. it represents the earlier adjustments of the race, crystallized into habit. it takes no account of the differences between the present and the past. it knows no culture, no reason, no lately acquired prudence. it is all energy and can only wish, or urge toward action. but since only those race-memories became instincts which had proved needful to the race in the long run, they are on the whole beneficent forces, working for the good of the race and the good of the individual, if he learns how to handle them aright and to adapt them to present conditions. this instinctive urge toward action arouses in the individual an organic response that is felt as a tension or craving and is mainly dependent upon its own chemical constitution at the moment. hunger is the sensation caused by the little muscular contractions in the stomach when the body is low in its food supply. sudden fright is felt as an all-gone sensation "at the pit of the stomach." what really happens is a tightening up of the circular muscles of the blood-vessels lying in the network of the solar plexus, and a spasm of the muscles of the digestive tract. the hungry stomach impels to action until satisfied; the physical discomfort in fear impels toward measures of safety. the apparatus that is made use of by the subconscious in carrying out this instinctive urge is called the autonomic nervous system.[ ] it regulates all the functions of living, not only under the stress of emotion, but during every moment of waking or sleeping. [footnote : kempf: "the tonus of automatic segments as a cause of abnormal behavior," _journal of nervous and mental diseases_, january, .] =a capable manager.= the conscious mind could not possibly send messages to the numerous glands that fit the body for action, nor attend to all the delicate adjustments that enter into the process. the conscious mind in most of us does not even know of the existence of the organs and secretions involved, but something sends the messages and it is something that has a remarkable likeness to mind as we usually think of mind,--something which takes advantage of the past and gages means to an end with a nicety that excites our wonder. =take no anxious thought.= we take food into our stomachs and forget about it, if we are wise; and this subconscious overseer who through millions of years of experience has learned how to digest food does the rest. as with digestion, so with our heart-action; we lie down at night fairly sure that there will be no break in the regular rhythm of its beat. the subconscious overseer is "on the job" and he never rests. no matter how hard we sleep, he never lets us forget to take a breath; and if we trust him, he is very likely to wake us up at the appointed time in the morning. also, if we trust him, he carries us off to sleep as though we were babies. has he not had long practice in the days before insomnia was invented? =first aid to the injured.= in times of infection or injury, this subconscious manager is better than any doctor. the doctors say with truth that they only assist nature. if the infection is internal, antitoxins are produced within the body. if the injury is external, like a cut, the messages fly, and white blood-corpuscles are marshaled to take care of poisons and build up the tissue. if the injury is of the kind that needs rest, the subconscious doctor knows it. he therefore causes pain and rigidity, in order to induce us to hold the injured part still until it is restored. crile reminds us of a fact that is often noticed by surgeons. if patients under ether are handled roughly, especially in the intestinal region, respiration quickens and there are tremors and even convulsive efforts which interfere with the surgeon's work. the conscious mind cannot feel. it is asleep. but the subconscious mind, whose business it is to protect the body, is trying to get away from injury. the body uses up as much energy as though it had run for miles, and when the patient wakes up, we say that he is suffering from shock. the subconscious mind which is not affected by ether, has been exhausting itself in a vain attempt to get the body away from harm. =a tireless servant.= when the conscious mind undertakes a job, it is always more or less subject to fatigue. but the subconscious after its long practice seems never to tire. we say that its activities have become automatic. with all its inherited skill, the subconscious, if left to itself, can be depended upon to run the bodily machinery without effort and without hitch. the only things that can interfere with its work are the wrong kind of emotions and the wrong kind of suggestions from the conscious mind. barring these, it goes its way like a trusty servant, looking after details and leaving its master's mind free for other things. having been "in the family" for generations, it knows its business and resents any interference with its duties or any infringement of its rights. no man, then, comes into this world without inheritance: he receives from his ancestors two goodly sets of heirlooms, the instincts and the mechanism which carries on bodily functions. this is the capital with which man starts life; but immediately he begins increasing this capital, adding memories from his own experience to the accumulated race-records. personal memories no more startling secret has been unearthed by science than the discovery of the length and minuteness of our memories. no matter how much one may think he has forgotten, the tablets of his mind are closely written with records of infinitesimal experiences, shadowy sensations, old happenings which the conscious self has lost entirely and would scarcely recognize as its own. many of these brain records, or neurograms, as prince calls them, are never aroused from their dormant conditions. but others, aroused by emotion or association of ideas, may after years of inactivity, come forth again either as conscious memories or as subconscious forces, or even as physiological memories,--bodily repetitions of the pains, palpitations, and tremors of old emotional experiences. =irresistible childhood.= an experience that is forgotten is not necessarily lost. although the first few years of childhood are lost to conscious memory, these years outweigh all others in their influence on character. the jesuit priest was right when he said, "give me a child until he is six years old, and he will be a catholic all his life." as frink has so ably shown, the determining factors that enter into any adult choice, such as the choice of the catholic or the protestant faith, are in a large measure made up of subconscious memories from early childhood, forgotten memories of sunday-school and church, of lessons at home or passages in books,--experiences which no voluntary effort could recall, but which still live unrecognized in our mature judgments and beliefs. naturally we do not acknowledge these subconscious motives. we like to believe that all our decisions are based on reason, and so we invent plausible arguments for our attitudes and our actions, arguments which we ourselves implicitly believe. this process of substituting a plausible reason for a subconscious one is known as rationalization, a process which every one of us engages in many times a day. it is indeed true that the child is father to the man. those first impressionable years, when we believed implicitly whatever any one told us and when through ignorance we reacted emotionally to ordinary experiences, are molding us still, making us the men and women we are to-day, coloring with childish ideas many of the attitudes of our supposedly reasoning life. bergson says: the unconscious is our historical past. in reality the past is preserved automatically. in its entirety probably it follows us at every instant; all that we have felt, thought and willed from our earliest infancy is there, leaning over the present which is about to join it, pressing against the portals of consciousness that would fain leave it outside. =spontaneous outbursts.= "how do we know all this?" some one says. "what is the evidence for these sweeping statements? if we cannot remember, how can we discover these strange memories that are so powerful but so elusive? if they are below the level of consciousness, are they not, in the very nature of the case, forever hidden from view, in the sphere of the occult rather than that of science?" the answer to these questions is determined by one important fact; the line between the conscious and subconscious minds does not always remain in the same place; the "threshold of consciousness" is sometimes displaced, automatically allowing these buried memories to come to the surface. in sleep and delirium, in trance and hallucination, in hysteria and intoxication, the tables are turned; the restraining hand of the conscious mind is loosened and the submerged self comes forth with all its ancient memories. it is a common experience to have a patient in delirium repeat long-forgotten verses or descriptions of events that the "real man" has lost entirely. the renowned servant-girl, quoted by hudson, who in delirium recited passage after passage of hebrew, latin, and greek, which she had heard her one-time master repeat in his study, is typical of many such instances.[ ] [footnote : hudson: _the law of psychic phenomena_, p. . quoted from _coleridge's biographia literaria_, vol. i, p. (edit. ).] a young girl of nineteen, a patient of mine, lapsed for several weeks into a dissociated state in which she forgot all the memories and ideas of her adult life, and returned to the period of her childhood. she used to say that she saw things inside her head and would accurately describe events that took place before she was two years of age,--scenes which she had completely forgotten in her normal life. one day when i asked her to tell me what she was seeing, she began to talk about "little sister" (herself) and "little brother." "little sister and brother were the two little folks that lived with their mother and their daddy and they were playing on the sand-pile. you know there was only one sand-pile, not like all the ones they have down here (at the seaside), and they had a bucket that they would put sand in and they would dump it out again and they would make nice things, you know; they would play with their little dog ponto and he was white with black and brown spots on him. little brother had white hair and he was bigger than little sister and he had a little waist with ruffles down the front and around the collar and a black coat that came down to his knees and it had two little white bands around it. some of the waists he wore had blue specks and some had red and black specks in it. "little sister had yellow curls and she had a blue coat with jiggly streaks of white in it, and she had a little white bonnet that was crocheted, and she had little blue mittens on that were tied to a string that went around her neck and down the other arm. it got pretty cold where they lived. little sister and little brother would go out to the pile of leaves and jump on them and bounce and they would crackle. the leaves came down from the trees all of a sudden when they got tired, and they were different colors, brown and red. little sister could walk then but she could not walk one other time before then; she could stand up by holding to a chair, but she could not go herself. one morning big tom said 'run to daddy' and she went to her daddy, and after that she always walked; they were glad and she was glad. she walked all day long. big tom was a man who used to help daddy and little sister always liked him. he was a nice man." the mother verified this scene of the first walking, saying that it had occurred on her own wedding-anniversary when the child was twenty-three months old. one night i heard the same patient talk in her sleep in the slow and hesitating manner of a child reading phonetically from a printed page. i soon recognized the words as those of a poem of tagore's, called "my prayer," and remembered that a magazine containing the poem had been lying on the bed during the day. when she had finished i wakened her, saying, "now tell me what you have been dreaming." she answered in her childish way, "i think i do not dream." she went to sleep immediately and again repeated the poem, word for word, without a single mistake. again i awakened her with the words, "now tell me what you have been dreaming." and again she answered, "i think i do not dream." i said: "but yes; don't you remember you were just saying, 'when the time comes for me to go'?" (the last line of the poem). "oh, yes," she said, "i was seeing it, and i think i'll not go to sleep again. it tires me so to see it." while she was awake she had no recollection of having seen the poem and was indeed in her dissociated state quite incapable of understanding its meaning. asleep, she saw every word as plainly as if the page had been before her eyes. the distorted pictures of dreams are always made of the material which past experiences have furnished and which have in many cases been dropped out of consciousness for years only to rise out of their long oblivion when the conscious mind has been put to sleep. =unearthing old experiences.= however, psychology does not have to wait for buried memories to come forth of their own free will. it has a number of successful ways of summoning them from their hiding-place and helping them across the line into consciousness. in the hands of skilled investigators and therapeutists, hypnosis, hypnoidization, automatic writing, crystal-gazing, abstraction, free association, word-association, and interpretation of dreams have all been repeatedly successful in bringing to light memories which apparently have been for many years completely blotted out of mind. as we become better acquainted with these technical devices we shall find that there are four kinds of experiences whose records are carefully stored away in our minds. some were always so far from the center of our attention that we could swear they never had been ours; others, although once present in consciousness, were so trivial and unimportant that it seems ridiculous to suppose them conserved; others never came into our waking minds at all and entered our lives only in special states, such as sleep or delirium or dreams. all these we should expect to forget; the astonishing thing is that they ever were conserved. but there is a fourth class that is different. it is made up of experiences that were so vital, so emotional, so closely woven into the fiber of our being that it seems impossible that they ever could be forgotten. let us look at a few examples of records of all these four kinds of experiences, examples chosen from hundreds of their kind as illustrations of the all-embracing character of buried memories.[ ] [footnote : for further examples see prince, _the unconscious_; prince, _the dissociation of a personality_, and hudson, _the law of psychic phenomena_.] =out of the corners of our eyes.= in the first place, we are much more observing than we imagine. we may be so interested in our own thoughts that details of our environment are entirely lost on the conscious mind, but the subconscious has its eyes open, and its ears. people in hypnosis have been known to repeat verbatim whole passages from newspapers which they had never consciously read. while they were busy with one column, their wide-awake subconscious was devouring the next one, and remembering it. prince relates the story of a young woman who unconsciously "took in" the details of a friend's appearance: i asked b.c.a. (without warning and after having covered her eyes) to describe the dress of a friend who was present and with whom she had been conversing perhaps some twenty minutes. she was unable to do so beyond saying that he wore dark clothes. i then found that i myself was unable to give a more detailed description of his dress, although we had lunched and been together about two hours. b.c.a. was then asked to write a description automatically. her hand wrote as follows (she was unaware that her hand was writing): "he has on a dark greenish gray suit, a stripe in it--little rough stripe; black bow cravat; shirt with three little stripes in it; black laced shoes; false teeth; one finger gone; three buttons on his coat." the written description was absolutely correct. the stripes in the coat were almost invisible. i had not noticed his teeth or the loss of a finger and we had to count the buttons to make sure of their number owing to their partial concealment by the folds of the unbuttoned coat. the shoe-strings i am sure under the conditions would have escaped nearly every one's notice.[ ] [footnote : prince: _the unconscious_, p. .] automatic writing, the method used to uncover this subconscious perception, is a favorite method with some investigators and is often used by morton prince. the hand writes without the direction of the personal consciousness and usually without the person's being aware that it is writing. a dissociated person does this very easily; other people can cultivate the ability, and perhaps most of us approach it when we are at the telephone, busily writing or drawing remarkable pictures while the rest of us is engaged in conversation. the present epidemic of the ouija board shows how many persons there are who are able to switch off the conscious mind and let the subconscious control the muscles that are used in writing. the fact that the writer has no understanding of what he is doing and believes himself directed by some outside power, in no way interferes with the subconscious phenomenon. =everyday doings.= besides perceptions which were originally so far from the focus of attention that the conscious mind never caught them at all, there are the little experiences of everyday life, fleeting thoughts and impressions which occupy us for a minute and then disappear. every experience is a dynamic fact and no matter how trivial the experience may be or how completely forgotten, it still exists as a part of the personality. an amusing example of the everyday kind of forgotten experience occurred during the writing of this chapter. i wrote a sentence which pleased me very well. this is the sentence: "in the esthetic processes of evolution they [man's desires] have sunk below the surface as soon as formed, and have been covered over by an elastic and snug-fitting consciousness as the skin covers in the tissues and organs of the body." after showing this passage to my collaborator and remarking that this figure had never been used before, i was partly chagrined and partly amused to have her bring me the following sentence from white and jelliffe: "consciousness covered over and obscured the inner organs of the psyche just as the skin hides the inner organs of the body from vision." my originality had vanished and i was close to plagiarism. indeed, if a history of plagiarism could be written, it would probably abound in just such stories. i had read the article containing this sentence only once, about three years before, and had never quoted it or consciously thought of it. it had lain buried for three years, only to come forth as an original idea of my own. who knows how many times we all do just this thing without catching ourselves in the trick? =back-door memories.= there are other kinds of memories which hide in the subconscious, memories of experiences which have not come in by the front door, but have entered the mind during special states, such as sleep, delirium, intoxication, or hypnosis. what is known as post-hypnotic suggestion is the functioning of a suggestion received during hypnosis and emerging later as an impulse without being recognized as a memory. a man in a hypnotic state is told that at five o'clock he will take off his clothes and go to bed, without remembering that such a suggestion has been given him. he awakens with no recollection of the suggestion, but at five o'clock he suddenly feels impelled to go to bed, even though his unreasonable desire puts him into a highly embarrassing position. the suggestion, to be thus effective, must have been conserved somewhere in his mind outside of consciousness. suggestions that enter the mind during the normal sleep are also recorded,--a fact that carries a warning to people who are in the habit of talking of all sorts of matters while in the room with sleeping children. i have sometimes suggested to sleeping patients that on waking they will remember and tell me the cause of their symptoms. the following example shows not only the conservation of impressions gained in sleep, but also the sway of forgotten ideas of childhood, still strong in mature years. this young woman, a trained nurse, with many marked symptoms of hysteria, had been asked casually to bring a book from the public library. she cried out in consternation, "oh, no, i am afraid!" after a good deal of urging she finally brought the book, although at the cost of considerable effort. later, while she was taking a nap, i said to her, "you will not remember that i have talked to you. you will stay asleep while i am talking and while you are asleep there will come to your mind the reasons why you are afraid to go to the public library. when you waken, you will tell me all about it." upon awakening, she said: "oh, do you know, i can tell you why i have always been afraid to go to the public library. while i was in parochial school, father ---- used to come in and tell us children to use the books out of the school library and never to go to the public library." i questioned her concerning her idea of the reason for such an injunction and what she thought was in the books which she was told not to read. she hesitatingly stated that it was her idea, even in childhood, that the books dealt with topics concerning the tabooed subject of the birth of children and kindred matters. =smoldering volcanoes.= let us now consider those emotional experiences which seem far too compelling to be forgotten, but which may live within us for years without giving any evidence of their existence. memories like these are apt to be anything but a dead past. many of my own patients have uncovered emotional memories through simply talking out to me whatever came into their minds, laying aside their critical faculty and letting their minds wander on into whatever paths association led them. this is known as the free-association method, and simple as it seems, is one of the most effective in uncovering memories which have been forgotten for years. one of my patients, a refined, highly educated woman of middle age, had suffered for two years with almost constant nausea. one day, after a long talk, with no suggestion on my part, only an occasional, "what does that remind you of?" she told with great emotion an experience which she had had at eighteen years of age, in which she had for a moment been sexually attracted to a boy friend, but had recoiled as soon as she realized where her impulse was leading her. she had been so horrified at the idea of her degradation, so nauseated at what she considered her sin, that she had put it out of her mind, denied that such a thought had ever been hers, repressed the desire into the subconscious, where it had continued to function unsatisfied, unassimilated with her mature judgments. her nausea was the symbol of a moral disgust. physical nausea she was willing to acknowledge, but not this other thing. upon reciting this old experience, with every sign of the original shame, she cried: "oh, doctor! why did you bring this up? i had forgotten it. i haven't thought of it in thirty years." i reminded her that i couldn't bring it up,--i had never known anything about it. with the emotional incoming of this memory and the saner attitude toward it which the mature woman's mind was able to take, the nausea disappeared for good. this case is typical of the psycho-neuroses and we shall have occasion to refer to it again. the present emphasis is on the fact that an emotional memory may be buried for many years while it still retains the power of reappearing in more or less disguised manifestation. =repressed memories.= if we ask how so burning a memory could escape from the consciousness of a grown woman, we are driven to the conclusion that this forgetting can be the result of no mere quiet fading away, but that there must have been some active force at work which kept the memory from coming into awareness. it was not lost. it was not passive. out of sight was not out of mind. there must have been a reason for its expulsion from the personal consciousness. in fact, we find that there is a reason. we find that whenever a vital emotional experience disappears from view, it is because it is too painful to be endured in consciousness. nor is it ever the pain of an impersonal experience or even the thought of what some one else has done to us that drives a memory out of mind. as a matter of fact, we never expel a memory except when it bears directly on ourselves and on our own opinion of ourselves. we can stand almost anything else, but we cannot stand an idea that does not fit in with our ideal for ourselves. this is not the pious ideal that we should like to live up to and that we hope to attain some day, not the ideal that we think we ought to have--like never speaking ill of others or never being selfish--but the secret picture that each of us has, locked away within him, the specifications of ourselves reduced to their lowest terms, below which we cannot go. energized by the instinct of positive self-feeling, and organized with the moral sentiments which we have acquired from education and the ideals of society, especially those acquired in early childhood, this ideal of ourselves becomes incorporated into our conscience and is an absolute necessity for our happiness. we have found that when two emotions clash, one drives out the other. so in this case, the woman's positive self-feeling of self-respect, combined with disgust, drove from the field that other emotion of the reproductive instinct which was trying to get expression. speaking technically, one repressed the other. the woman said to herself, "no, i never could have had such a thought," and promptly forgot it. needless to say, this kind of handling did not kill the impulse. buried in the depths of her soul, it continued to live like a live coal, until in later years, fanned by the wind of some new experience, it burst into flame. in this case the wish had originally flashed into awareness for an instant, but very often the impulse never gets into consciousness at all. the upper layers of the subconscious, where the acquired ideals live, automatically work to keep down any desires which are thought to be out of keeping with the person as he knows himself. he then would emphatically deny that such desires had ever had any place in his life. freud has called this repressing force the psychic censor. to get into consciousness, any idea from the subconscious must be able to pass this censor. this force seems to be a combination of the self-regarding and herd-instincts, which dispute with the instinct for reproduction the right to "the common path" for expression. a considerable part of any person's subconscious is made up of memories, wishes, impulses, which are repressed in this way. of course any instinctive desire may be repressed, but it is easy to understand why the most frequently denied impulse, the instinct of reproduction, against whose urgency society has cultivated so strong a feeling, should be repressed more frequently than any other.[ ] [footnote : see foot-note, p. , chap. vii.] =past and present.= it matters not, then, in what state experiences come to us, whether in sleep or delirium, intoxication or hypnosis, or in the normal waking condition. they are conserved and may exert great influence on our normal lives. it matters not whether the experiences be full of meaning and emotion or whether they be so slight as to pass unnoticed, they are conserved. it matters not whether these experiences be mere sense-impressions, or inner thoughts, whether they be unacknowledged hopes or fears, undesirable moods and unworthy desires or fine aspirations and lofty ideals. they are conserved and they may at a later day rise up to bless or to curse us long after we had thought them buried in the past. the present is the product of the past. it is the past plus an element of choice which keeps us from settling down in the despair of fatalism and enables us to do something toward making the present that is, a help and not a stumbling-block to the present that is to be. some habits of the subconscious =the association of ideas.= it is only by something akin to poetic license that we can speak of lower and higher strata of mind. when we carry over the language of material things into the less easily pictured psychic realm, it is sometimes well to remind ourselves that figures of speech, if taken too literally, are more misleading than illuminating. when we speak of the deep-laid instinctive lower levels of mind and the higher acquired levels, we must not imagine that these strata are really laid in neat, mutually exclusive layers, one on top of the other in the chambers of the mind. nor must we imagine the mental elements of instinct, idea, and memory as jumbled together in chaotic confusion, or in scattered isolated units. as a matter of fact, the best word to picture the inside of our minds is the word "group." we do not know just how ideas and instincts can group themselves together, but we do know that by some arrangement of brain paths and nerve-connections, the laws of association of ideas and of habit take our mental experiences and organize them into more or less permanent systems. instinctive emotions tend to organize themselves around ideas to form sentiments; ideas or sentiments, which through repetition or emotion are associated together, tend to stay together in groups or complexes which act as a whole; complexes which pertain to the same interests tend to bind themselves into larger systems or constellations, forming moods, or sides to one's character. it is not highly important to differentiate in every case a sentiment from a complex, or a complex from a constellation, especially as many writers use "complex" as the generic term for all sorts of groups; but a general understanding of the much-used word "complex" is necessary for a comprehension of modern literature on psychology, psychotherapy or general education. "=what is a complex=?" reduced to its lowest terms, a complex is a group. it may be simply a group of associated movements, like lacing one's shoes or knitting; it may be a group of movements and ideas, like typewriting or piano-playing, which through repetition have become automatic or subconscious; it may be merely a group of ideas, such as the days of the week, the alphabet or the multiplication table. in all these types it is repetition working through the law of habit that ties the ideas and movements together into an organic whole. usually, however, the word complex is reserved for psychic elements that are bound together by emotion. in this sense, a complex is an emotional thought-habit. frink's definition, which is one of the simplest, recognizes only this emotional type: "a complex is a system of connected ideas, having a strong emotional tone, and displaying a tendency to produce or influence conscious thought and action in a definite and predetermined direction."[ ] [footnote : frink: "what is a complex?" _journal american medical assoc_., vol. lxii, no. , mar. , .] emotion and repetition are the great welders of complexes. emotion is the strongest cement in the world. a single emotional experience suffices to bind together ideas that were originally as far apart as the poles. sometimes a complex includes not only ideas, movements, and emotions, but physiological disturbances and sensations. some people cannot go aboard a stationary ship without vomiting, nor see a rose, even though it prove to be a wax one, without the sneezing and watery eyes of hay-fever. this is what is known as a "conditioned reflex." past associations plus fear have so welded together idea and bodily manifestation that one follows the other as a matter of course, long after the real cause is removed. in such ways innumerable nervous symptoms arise. the same laws which form healthy complexes, and, indeed, which make all education possible, may thus be responsible for the unhealthy mal-adaptive association-habits which lie back of a neurosis. fortunately, a knowledge of this fact furnishes the clue to the re-education that brings recovery. a complex may be either conscious or unconscious, but as it usually happens that either all or part of its elements are below the surface, the word is oftenest used to mean those buried systems of the subconscious mind that influence thought or behavior without themselves being open to scrutiny. it is these buried complexes, memory groups, gathered through the years of experience, that determine action in uniform and easily prophesied directions. every individual has a definite complex about religion, about politics, about patriotism, about business, and it is the sum of these buried complexes which makes up his total personality. =displacement.= association or grouping is, then, an intrinsic power of mind; but as all life seems to be built on opposites--light and darkness, heat and cold, love and hate--so mind, which is capable of association, is capable also of displacement or the splitting apart of elements which belong together. there is such a thing as the simple breaking up of complexes, when education or experience or neglect separate ideas and emotions which had been previously welded together; but displacement is another matter. here there is still a path between idea and emotion; they still belong to the same complex, but the connection is lost sight of. the impulse or emotion attaches itself to another substitute idea which is related to the first but which is more acceptable to the personality. sometimes the original idea is forgotten; repressed, or dissociated into the subconscious, as in anxiety neurosis; and sometimes it is merely shorn of its emotional interest and remembered as an unrelated or insignificant idea, as in compulsion neurosis. =transference.= another kind of displacement which seems hard to believe possible until it is repeatedly encountered in intelligent human beings is the process called transference, by which everybody at some time or other acts toward the people he meets, not according to rational standards but according to old unconscious attitudes toward other people. each of us carries, within, subconscious pictures of the people who surrounded us when we were children; and now when we meet a new person we are likely unconsciously to say to ourselves--not, "this person has eyebrows like my mother, or a voice like my nurse," or, "this person bosses me around as my father used to do," but, "this is my mother, this is my nurse, this is my father." whereupon we may proceed to act toward that person very much as we did toward the original person in childhood. transference is subconsciously identifying one person with another and behaving toward the one as if he were that other. analysis has discovered that many a man's hostile attitude toward the state or religion or authority in general, is nothing more than this kind of displacement of his childhood's attitude toward authority in the person of his perhaps too-domineering father. many a woman has married a husband, not for what he was in himself, but because she unconsciously identified him with her childish image of her father. students of human nature have always recognized the kind of displacement which transfers the sense of guilt from some major act or attitude to a minor one which is more easily faced, just as _lady macbeth_ felt that by washing her hands she might free herself from her deeper stain. this is a frequent mechanism in the psychoneuroses--not that neurotics are likely to have committed any great crime, but that they feel subconsciously that some of their wishes or thoughts are wicked. =the phenomena of dissociation.= when an idea or a complex, a perception or a memory is either temporarily or permanently shoved out of consciousness into the subconscious, it is said to be dissociated. when we are asleep, the part of us that is usually conscious is dissociated and the submerged part takes the stage. when we forget our surroundings in concentration or absent-mindedness, a part of us is dissociated and our friends say that we are "not all there," or as popular slang has it, "nobody home." when a mood or system of complexes drives out all other moods, one becomes "a different person." but if this normal dissociation is carried a step farther, we may lose the power to put ourselves together again, and then we may truly be said to be dissociated. almost any part of us is subject to this kind of apparent loss. in neurasthenia the happy, healthy complexes which have hitherto dominated our lives may be split off and left lying dormant in the subconscious; or the power of will or concentration may seem to be gone. in hysteria we may seem to lose the ability to see or feel or walk, or we may lose for the time all recollection of certain past events, or of whole periods of our lives, or of everything but one system of ideas which monopolizes the field of attention. sometimes great systems of memories, instincts, and complexes are alternately shifted in and out of gear, leaving first one kind of person on top and then another.[ ] stevenson's _dr. jekyll_ and _mr. hyde_ is not so fantastic a character as he seems. any one who doubts the ability of the mind to split itself up into two or more distinct personalities, entertaining totally different conceptions of life, disliking each other, playing tricks on each other, writing notes to each other, and carrying on a perpetual feud as each tries to get the upper hand, should read morton prince's "dissociation of a personality," a fascinating account of his famous case, miss beauchamp. [footnote : when a memory or system of memories is suddenly lost from consciousness the person is said to be suffering from amnesia or pathological loss of memory.] =internal warfare.= conflict, often accentuated by shock or fatigue, represses or drives down certain ideas, perceptions, wishes, memories, or complexes into the subconscious, where they remain, sometimes dormant and passive but often dynamic, emotional, carrying on an over-excited, automatic activity, freed from the control of reason and the modifying influence of other ideas, and able to cause almost any kind of disturbance. so long as there is team-work between the various parts of our personality we are able to act as a unit; but just as soon as we break up into factions with no communication between the warring camps, so soon do we become quite incapable of coördination or adjustment, like a nation torn by civil war. many of the seemingly fantastic and bizarre mental phenomena of which a human being is capable are the result of this kind of disintegration. however, nature has a remarkable power for righting herself, and it is only under an accumulation of unfortunate circumstances that there appears a neurosis, which is nothing more than a functioning of certain parts of the personality with all the rest dissociated. we shall later inquire more fully into the causes that lead up to such a result and shall find that the mechanisms involved are these processes of organization and disorganization by which mind is wont to group together or separate the various elements within its borders. summary gathering up our impressions, we find a number of outstanding qualities which we may summarize in the following way: the subconscious is: _ vast yet explorable_ the fraction that could accurately show the relation of the conscious to the unconscious part of ourselves would have such a small numerator and such a huge denominator that we might well wonder where consciousness came in at all.[ ] some one has likened the subconscious to the great far-reaching depths of the mammoth cave, and consciousness to the tiny, flickering lamp which we carry to light our way in the darkness. however, ever the subconscious mind is becoming explorable, and it may be that science is giving the tiny lamp the revealing power of a great searchlight. [footnote : "the entire active life of the individual may be represented by a fraction, the numerator of which is any particular moment, the denominator is the rich inheritance of the past."--jelliffe: "the technique of psychoanalysis," _psychoanalytic review,_ vol. iii, no. , p. .] _ ancient yet modern_ the lowest layers of the subconscious, represented by the instincts, are as old as life itself, with their lineage reaching back in direct and unbroken line to the first living things on the ooze of the ocean floor. the higher strata are more modern, full, and accurate records of our own lifetime, beginning with our first cry and ending with to-day's thoughts. _ primitive yet refined_ the lowest level, representing the past of the race, is primitive like a savage, and infantile, like a child; it is instinctive, unalterable, and universal; it knows no restraint, no culture, and no prudence. the higher level, the storehouse of individual experience, bears the marks of acquired ideals, of cultivated refinement, and represents among other things the precepts and prudence of civilized society. _ emotional yet intellectual_ our records of the past are not dead archives, but living forces--persistent, urging, dynamic and emotional. they give meaning to new experiences, color our judgments, shape our beliefs, determine our interests, and, if wrongly handled, make their way into consciousness as neurotic symptoms. however, the subconscious is not all emotion. it is a mind capable of elaborate thought, able to calculate, to scheme, to answer doubts, to solve problems, to fabricate the purposeful, fantastic allegories of dreams and to create from mere knowledge the inspired works of genius. but the subconscious has one great limitation, it cannot reason inductively. given a premise, this mind can reason as unerringly as the most skilful logician; that is, it can reason deductively, but it cannot arrive at a general conclusion from a number of particular facts. however, except for inductive reasoning and awareness, the subconscious seems to possess all the attributes of conscious mind and is in fact an intellectual force to be reckoned with. _ organized yet disorganizable_ the subconscious mind is a highly organized institution, but like all such institutions it is liable to disorganization when rent by internal dissension. ordinarily it keeps its ideas and emotions, its complexes and moods in fairly accurate order, but when upset by emotional warfare, it gets its records confused and falls into a chaotic state which makes regular business impossible. _ masterful yet obedient_ the subconscious, which is master of the body, is in normal life the servant of consciousness. one of its outstanding qualities is suggestibility. since it cannot reason from particulars to a general conclusion it takes any statement given it by consciousness, believes it implicitly and acts accordingly. the pilot wheel of the ship is, after all, the conscious mind, insignificant in size when compared with the great mass of the vessel, but all-powerful in its ability to direct the course of the voyage. nervous persons are people who are too much under the sway of the subconscious; so, too, are some geniuses, who narrowly escape a neurosis by finding a more useful outlet for their subconscious energies. while the poet, the inventor, and the neurotic are likely to be too largely controlled by the subconscious, the average man is to a greater extent ruled by the conscious mind; and the highest type of genius is the man whose conscious and subconscious minds work together in perfect harmony, each up to its full power. if, as many believe, the next great strides of science are to be in this direction, it may pay some of us to be pioneers in learning how to make use of these undeveloped riches of memory, organization, and surplus energy. the subconscious, which can on occasion behave like a very devil within us, is, when rightly used, our greatest asset, the source of powers whose appearance in the occasional individual has been considered almost superhuman, but which prove to be characteristically human, the common inheritance of the race of man. chapter vi _in which we learn why it pays to be cheerful_ body and mind the missing link =ancient knowledge.= people have always known that mind in some strange way carries its moods over into the body. the writer of the book of proverbs tells us, from that far-off day, that "a merry heart doeth good like a medicine, but a broken spirit drieth the bones." jesus in his healing ministry always emphasized the place of faith in the cure of the body. "thy faith hath made thee whole," is a frequent word on his lips, and ever since his day people have been rediscovering the truth that faith, even in the absence of a worthy object, does often make whole. faith in the doctor, the medicine, the charm, the mineral waters, the shrine, and in the good god, has brought health to many thousands of sufferers. people have always reckoned on this bodily result from a mental state. they have intuitively known better than to tell a sick person that he is looking worse, but they have not always known why. they have known that a fit of anger is apt to bring on a headache, but they have not stopped to look for the reason, or if they have, they have often gotten themselves into a tangle. this is because there has always been, until recently, a missing link. now the link has been found. after the last chapter, it will not be hard to understand that this connecting link, this go-between of body and mind, is nothing else than the subconscious mind. when we remember that it has the double power of knowing our thoughts and of controlling our bodies, it is not hard to see how an idea can translate itself into a pain, nor to realize with new vividness the truth of the statement that healthy mental states make for health, and unhealthy mental states for illness. =suggestion and emotion.= there are still many gaps in our knowledge of the ways of the subconscious, but investigation has thrown a good deal of light on the problem. two of the principles already discussed are sufficient to explain most of the phenomena. these are, first, that the subconscious is amenable to control by suggestion, and secondly, that it is greatly influenced by emotion. tracing back the principles behind any example of the power of mind over body, one finds at the root of the matter either a suggestion or an emotion, or both. if, then, the stimulating and depressing effects of mental states are to be understood, the first step must be a fuller understanding of the laws governing suggestion and emotion. the contagion of ideas one of the most important points about the subconscious mind is its openness to suggestion. it likes to believe what it is told and to act accordingly. the conscious mind, too,--proud seat of reason though it may be,--shares this habit of accepting ideas without demanding too much proof of their truth. even at his best, man is extremely susceptible to the contagion of ideas. most of us are even less immune to this mental contagion than we are to colds or influenza; for ideas are catching. they are such subtle, insinuating things that they creep into our minds without our knowing it at all; and once there, they are as powerful as most germs. let a person faint in a crowded room, and a good per cent. of the women present will begin to fan themselves. the room has suddenly become insufferably close. after we have read half a hundred times that ivory soap floats, a fair proportion of the population is likely to be seized with desire for a soap that floats,--not because they have any good reason for doing so, but simply because the suggestion has "taken." as for the harbingers of spring, they are neither the birds nor the wild flowers, but the blooming windows of the milliners, which successfully suggest in wintry february that summer is coming, and that felt and fur are out of season. it is evident that all advertising is suggestion. the training of children, also, if it is done in the right way, is largely a matter of suggestion. the little child who falls down and bumps his head is very likely to cry if met with a sympathetic show of concern, while the same child will often take his mishaps as a joke if his elders meet them with a laugh or a diverting remark. unlucky is the child whose mother does not know, either consciously or intuitively, that example and contagion are more powerful--and more pleasant--than command and prohibition. =everything suggestive.= human beings are constantly communicating, one to another. sometimes they "get over" an idea by means of words, but often they do it in more subtle ways,--by the elevation of an eyelid, the gesture of a hand, composure of manner in a crisis, or a laugh in a delicate situation. a suggestion is merely an idea passed from one person to another, an idea that is accepted with conviction and acted upon, even though there may be no logic, no reason, no proof of its truth. it is an influence that takes hold of the mind and works itself out to fulfilment, quite apart from its worth or reasonableness. of course, logical persuasion and argument have their place in the communication of ideas; an idea may be conveyed by other ways than suggestion. but while suggestion is not everything, it is equally true that there is suggestion in everything. the doctor may give a patient a very rational explanation of his case, but the doubtful shake of the head or the encouraging look of his eye is quite likely to color the patient's general impression. the eyes of our subconscious are always open, and they are constantly getting impressions, subtle suggestions that are implied rather than expressed. =abnormal suggestibility.= while everybody is suggestible, nervous people are abnormally so. it may be, as mcdougall suggests, that they have so large an amount of submission or negative self-feeling in their make-up that they believe anything, just because some one else says it is true. sometimes it is lack of knowledge that makes us gullible, and at other times the cause of our suggestibility is failure to use the knowledge that we have. sometimes our ideas are locked away in air-tight compartments with no interaction between them. the psychologists tell us that suggestion is greatly favored by a narrowing of the attention, a "contraction of the field of consciousness," a dissociation of other ideas through concentration. this all simply means that we forget to let our common sense bring to bear counter ideas that might challenge a false one; or that worry--a veritable "spasm of the attention"--has fixed upon an idea to the exclusion of all others; or that through fatigue or the dissociation of sleep or hypnosis or hysteria, our reasoning powers have been locked out and for the time being are unable to act. it was through experiments on hypnotized subjects that scientists first learned of the suggestibility of the subconscious mind. in hypnosis a person can be made to believe almost anything and to do almost anything compatible with the safety and the moral sense of the individual. the instinct of self-preservation will not allow the most deeply hypnotized person to do anything dangerous to himself; and the moral complexes, laid in the subconscious, never permit a person to perform in earnest an act of which the waking moral sense would disapprove. within these limits, a person in the dissociated hypnotic state can be made to accept almost any suggestion. we found in the last chapter how open to suggestion is a person in normal sleep. of the dissociation of hysteria we shall have occasion to speak in later chapters. although all these special states heighten suggestibility, we must not forget how susceptible each of us is in his normal waking state. =living its faith.= all this gathers meaning only when we realize that ideas are dynamic. they always tend to work themselves out to fulfilment. the subconscious no sooner gets a conviction than it tries to act it out. of course it can succeed only up to a certain limit. if it believes the stomach to have cancer, it cannot make cancer, but it can make the stomach misbehave. one of my patients, on hearing of a case of brain-tumor immediately imagined this to be her trouble, and developed a pain in her head. she could not manufacture a tumor, but she could manufacture what she believed to be the symptoms. there was another patient who was supposed to have brain-tumor. this young woman seemed to have lost almost entirely the power to keep her equilibrium in walking. her center of gravity was never over her feet, but away out in space, so that she was continually banging from one side of the room to the other, only saving herself from injury by catching at the wall or the furniture with her hands. several physicians who had been interested in the case had found the symptoms strongly suggestive of brain-tumor. there were, however, certain unmistakable earmarks of hysteria, such as childlike bland indifference to the awkwardness of the gait which was a grotesque caricature of several brain and spinal-cord diseases, with no accurate picture of any single one. this was evidently a case, not of actual loss of power but a dissociation of the memory-picture of walking. the patient was a trained nurse and knew in a general way the symptoms of brain-tumor. when the suggestion of brain-tumor had fixed itself in her mind she was able subconsciously to manufacture what she believed to be the symptoms of that disease. by injecting a keen sense of disapprobation and skepticism into the hitherto placidly accepted state of disability, by flashing a mirror on the physical and moral attitudes which she was assuming, i was able to rob the pathological complex of its (altogether unconscious) pleasurable feeling-tone, and to restore to its former strength and poise a personality of exceptional native worth and beauty. after a few weeks at my house she was able to walk like a normal person and went back to her work, for good. we have already learned enough about the inner self to see in a faint way how it works out its ideas. since the subconscious mind runs the bodily machinery, since it regulates digestion, the building up of tissue, circulation, respiration, glandular secretion, muscular tonus, and every other process pertaining to nutrition and growth, it is not difficult to see how an idea about any of these matters can work itself out into a fact. a thought can furnish the mental machinery needed to fulfil the thought. some one catches the suggestion: "concentration is hard on the brain. it soon brings on brain-fag and headache." not knowing facts to the contrary, the suggestible mind accepts the proposition. then one day, after a little concentration, the idea begins to work. whereupon the autonomic nervous system tightens up the blood-vessels that regulate the local blood supply, too much blood stays in the head, and lo, it aches! the next time, the suggestion comes with greater force, and soon the habit is formed,--all the result of an idea. it is a good thing to remember that constant thought about any part of the body never fails to send an over-supply of blood to that part; of course that means congestion and pain. =hands off!= by sending messages directly to an organ through the nerve-centers or by changing circulation, the subconscious director of our bodies can make any part of us misbehave in a number of ways. all it needs is a suggestion of an interfering thought about an organ. as we have insisted before, the subconscious cannot stand interference. sadler well says: "man can live at the equator or exist at the poles. he can eat almost anything and everything, but he cannot long stand self-contemplation. the human mind can accomplish wonders in the way of work, but it is soon wrecked when directed into the channels of worry."[ ] in other words, hands off!--or rather, minds off! don't get ideas that make you think about your body. the surest way to disarrange any function is to think about it. it is a stout heart that will not change its beat with a frequent finger on the pulse, and a hearty stomach that will not "act up" under attention. "judicious neglect" is a good motto for most occasions. take no anxious thought if you would be well. know enough about your body to counteract false suggestions; fulfil the common-sense laws of hygiene,--eight hours in bed, plenty of exercise and fresh air, and three square meals a day. then forget all about it. "a mental representation is already a sensation,"[ ] and we have enough legitimate sensations without manufacturing others. [footnote : sadler: _physiology of faith and fear_.] [footnote : dubois: _psychic treatment of nervous disorders_.] =from real life.= startling indeed are the tricks that we can play on ourselves by disregarding these laws. a patient who was unnecessarily concerned about his stomach once came to me in great alarm, exhibiting a distinct, well-defined swelling about the size of a match-box in the region of his stomach. i looked at it, laughed, and told him to forget it. whereupon it promptly disappeared. the first segment of the rectus muscle had tied itself up into a knot, under the stimulus of anxious attention. another patient appeared at my door one day saying, "look here!" examination showed that her abdomen was swollen to the size of more than a six-months pregnancy. as it happened, this woman had a friend who a short time before had developed a pseudo, or hysterical pregnancy which continued for several months. my patient, accepting the suggestion, was prepared to imitate her. i gave her a punch or two and told her to go and dress for luncheon. in the afternoon she had returned to her normal size. another woman, suffering from chronic constipation, was firmly convinced that her bowels could not move without a cathartic, which i refused to give. however, i did give her some strychnine pills, carefully explaining that they were not for her intestines and that they would have no effect there. she did not believe me, and promptly began to have an evacuation every day. it seems that sometimes two wrong ideas are equal to a right one. if doctors fully realized the power of suggestion, they would be more careful than they sometimes are about suggesting symptoms by the questions they ask their patients. a patient of mine with locomotor-ataxia suffered from the usual train of symptoms incident to that disease. it turned out, however, that many of the symptoms had been suggested by the questions of former physicians who had asked him whether he had certain symptoms and certain disabilities. the patient had answered in the negative and then promptly developed the suggested symptoms. when i told him what had happened, these false symptoms disappeared leaving only those which had a real physical foundation. another patient, a young girl, complained of a definite localized pain in her arm, and told me that she was suffering from angina pectoris. as we do not expect to find this disease in a young person, i asked her where she got such an idea. "dr. ---- told me so last may." "did you feel the pain in this same place before that time?" i asked. she thought a minute and then answered: "why no, i had a pain around my heart but i did not notice it in my arm until after that consultation." the wise physician lets his patients describe their own symptoms without suggesting others by the implication of his questions. =autosuggestion.= of course we must remember that an idea cannot always work itself out immediately. conditions are not always ripe. it often lies fallow a long time, buried in the subconscious, only to come up again as an autosuggestion, a suggestion from the self to the self. if some one tells us that nervous insomnia is disastrous, and we believe it, we shall probably store up the idea until the next time that chance conditions keep us awake. then the autosuggestion "bobs up," common sense is side-tracked, we toss and worry--and of course stay awake. an autosuggestion often repeated becomes the strongest of suggestions, successfully opposing most outside ideas that would counteract it,--reason enough for seeing to it that our autosuggestions are of the healthful variety. at the base of every psycho-neurosis is an unhealthful suggestion. this is never the ultimate cause. there are other forces at work. but the suggestion is the material out of which those other forces weave the neurosis. suggestibility is one of the earmarks of nervousness. a sensible and sturdy spirit, stable enough to maintain its equilibrium, is a fairly good antidote to attack. "as a man thinketh in his heart, so is he." why feelings count =the emotions again.= it seems impossible to discuss any psychological principle without finally coming back to the subject of emotions. it truly seems that all roads lead to the instincts and to the emotions which drive them. and so, as we follow the trail of suggestion, we suddenly turn a corner and find ourselves back at our starting-point--the emotional life. like all other ideas, suggestions get tied up with emotions to form complexes, of which the driving-power is the emotion. if we look into our emotional life, we find, besides the true emotions, with which we have become familiar in chapter iii, a great number of feelings or feeling-tones which color either pleasurably or painfully our emotions and our ideas. on the one hand there are pleasure, joy, exaltation, courage, cheer, confidence, satisfaction; and on the other, pain, sorrow, depression, apprehension, gloom, distrust, and dissatisfaction. every complex which is laid away in our subconscious is tinted, either slightly or intensely, with its specific feeling-tone. =emotions--tonic and poisonous.= all this is most important because of one vital fact; joyful emotions invigorate, and sorrowful emotions depress; pleasurable emotions stimulate, and painful emotions burden; satisfying emotions revitalize, and unsatisfying emotions sap the strength. in other words, our bodies are made for courage, confidence, and cheer. any other atmosphere puts them out of their element, handicapped by abnormal conditions for which they were never fashioned. we were written in a major key, and when we try to change over into minor tones we get sadly out of tune. there is another factor; painful emotions make us fall to pieces, while pleasant emotions bind us together. we can see why this is so when we remember that powerful emotions like fear and anger tend to dissociate all but themselves, to split up the mind into separate parts and to force out of consciousness everything but their own impulse. morton prince in his elaborate studies of the cases of multiple personality, miss beauchamp and b.c.a., found repeatedly that he had only to hypnotize the patient and replace painful, depressing complexes by healthy, happy ones to change her from a weak, worn-out person, complaining of fatigue, insomnia, and innumerable aches and pains, into a vigorous woman, for the time being completely well. on this point he says: exalting emotions have an intense synthesizing effect, while depressing emotions have a disintegrating effect. with the inrushing of depressive memories or ideas ... there is suddenly developed a condition of fatigue, ill-being and disintegration, followed after waking by a return or accentuation of all the neurasthenic symptoms. if on the other hand, exalting ideas and memories are introduced and brought into the limelight of attention, there is almost a magical reversal of processes. the patient feels strong and energetic, the neurasthenic symptoms disappear and he exhibits a capacity for sustained effort. he becomes re-vitalized, so to speak.[ ] [footnote : prince: _psycho-therapeutics_, chap. i.] in cases like this the needed strength and energy are not lost; they are merely side-tracked, but the person feels as weak as though he were physically ill. bodily response to emotional states =secretions.= let us look more carefully into some of the physiological processes involved in emotional changes. among the most apparent of bodily responses are the various external secretions. tears, the secretion of the lachrymal glands in response to an emotion, are too common a phenomenon to arouse comment. it is common knowledge that clammy hands and a dry mouth betray emotion. every nursing mother knows that she dares not become too disturbed lest her milk should dry up or change in character. most people have experienced an increase in urine in times of excitement; recently physiologists have discovered the presence of sugar in the urine of students at the time of athletic contests and difficult examinations.[ ] we have seen what an important role the various internal secretions, such as the adrenal and thyroid secretions play in fitting the body for flight and combat, and how large a part fear and anger have in their production. constant over-production of these secretions through chronic states of worry is responsible for many a distressing symptom. [footnote : cannon.] most graphic evidence of the disturbance of secretions by emotion is found in the response of the salivary and gastric glands to painful or pleasurable thinking. as these are the secretions which play the largest part in the digestive processes, they lead us naturally to our next heading. =digestion.= everybody knows that appetizing food makes the mouth water, but not everybody realizes that it makes the stomach water also. nor do we often realize the vital place that this watering has in taking care of our food. "well begun is half-done," is literally true of digestion. a good flow of saliva brings the food into contact with the taste-buds in the tongue. taste sends messages to the nerve-centers in the medulla oblongata; these centers in turn flash signals to the stomach glands, which immediately "get busy" preparing the all-important gastric juice. it takes about five minutes for this juice to be made ready, and so it happens that in five minutes after the first taste, or even in some cases after the first smell, the stomach is pouring forth its "appetite juice" which determines all the rest of the digestive process, in intestines as well as in stomach. experiments on dogs and cats by pawlow, cannon, and others have shown what fear and anger and even mildly unpleasant emotions do to the whole digestive process. cannon tells of a dog who produced . cubic centimeters of pure gastric juice in the twenty minutes following five minutes of sham feeding (feeding in which food is swallowed and then dropped out of an opening in the esophagus into a bucket instead of into the stomach). although there was no food in the stomach, the juice was produced by the enjoyment of the taste and the thought of it. on another day, after this dog had been infuriated by a cat, and then pacified, the sham feeding was given again. this time, although the dog ate eagerly, he produced only cubic centimeters of gastric juice, and this rich in mucus. evidently a good appetite and attractively served food are not more important than a cheerful mind. spicy table talk, well mixed with laughter, is better than all the digestive tablets in the world. what is true of stomach secretions is equally true of stomach contractions. "the pleasurable taking of food" is a necessity if the required contractions of stomach and intestines are to go forward on schedule time. a little extra dose of adrenalin from a mild case of depression or worry is enough to stop all movements for many minutes. what a revelation on many a case of nervous dyspepsia! the person who dubbed it "emotional dyspepsia" had facts on his side. =circulation.= it is not the heart only that pumps the blood through the body. the tiny muscles of the smallest blood-vessels, by their elasticity are of the greatest importance in maintaining an even flow, and this is especially influenced by fear and depression. blushing, pallor, cold hands and feet, are circulatory disturbances based largely on emotions. better than a hot-water bottle or electric pads are courage and optimism. a patient of mine laughingly tells of an incident which she says happened a number of years ago, but which i have forgotten. she says that she asked me one night as she carried her hot-water bottle to bed, "doctor, what makes cold feet?" and that i lightly answered "cowardice!" whereupon she threw away her beloved water-bag and has never needed it since. there is a disturbance of the circulation which results in very marked swelling and redness of the affected part. this is known as angio-neurotic edema, or nervous swelling. i do not have to go farther than my own person for an example of this phenomenon. when i was a young woman i taught school and went home every day for luncheon. one day at luncheon, some one of the family criticized me severely. i went back to school very angry. before i entered the school-room, the principal handed me some books which she had ordered for me. they were not at all the books i wanted, and that upset me still more. as i went into the schoolroom, i found that my face was swollen until my eyes were almost shut; it was a bright red and covered with purplish blotches. my fingers were swollen so that i could not bend the joints in the slightest degree. it was a day or two before the disturbance disappeared, and the whole of it was the result of anger. we hear much to-day about high blood pressure. they say that a man is as old as his arteries, and now it is known that the health of the arteries depends largely on blood pressure. since this is a matter that can be definitely measured at any minute, we have an easy way of noting the remarkable effect of shifting emotions. sadler tells of an ex-convict with a blood pressure of millimeters. it seems that he was worrying over possible rearrest. on being reassured on this point, his blood pressure began to drop within a few minutes, falling mm. in three hours, and mm. by the following day. =muscular tone.= a force that affects circulation, blood pressure, respiration, nutrition of cells, secretion, and digestion, can hardly fail to have a marked effect on the tone of the muscles, internal as well as external. when we remember that heart, stomach, and intestines are made of muscular tissue, to say nothing of the skeletal muscles, we begin to realize how important is muscular tone for bodily health. over and over again have i demonstrated that a courageous mind is the best tonic. perhaps an example from my "flat-footed" patients will be to the point. one woman, the young mother of a family, came to me for a nervous trouble. besides this, she had suffered for seven or eight years from severe pains in her feet and had been compelled to wear specially made shoes prescribed by a chicago orthopedist. the shoes, however, did not seem to lessen the pain. after an ordinary day's occupation, she could not even walk across the floor at dinner-time. a walk of two blocks would incapacitate her for many days. she was convinced that her feet could never be cured and came to me only on account of nervous trouble. on the day of her arrival she flung herself down on the couch, saying that she would like to go away from everybody, where the children would never bother her again. she was sure nobody loved her and she wanted to die. within three weeks, in ordinary shoes, this woman tramped nine miles up mount wilson and the next day tramped down again. her attitude had changed from that of irritable fretfulness to one of buoyant joy, and with the moral change had come new strength in the muscles. the death of her husband has since made it necessary for her to support the family, and she is now on her feet from eight to fourteen hours a day, a constant source of inspiration to all about her, and no more weary than the average person. flabbiness in the muscles often causes this trouble with the feet. "the arches of the foot are maintained by ligaments between the bones, supported by muscle tendons which prevent undue stretching of the ligaments and are a protection against flat-foot."[ ] muscle tissue has an abundant blood supply, while ligaments have very little and soon lose their resiliency if unsupported. any lack of tone in the calf-muscles throws the weight on the less resistant ligaments and on the cartilages placed as cushions between the bony structures of the arch. this is what causes the pain.[ ] [footnote : grey's anatomy--"the articulations."] [footnote : actual loss of the arch by downward displacement of the bones cannot be overcome by restoring muscle-tone. the majority of so-called cases of flatfoot are, however, in the stage amenable to psychic measures.] flat-footedness is only one result of weak muscles. eye-strain is another; ptosis, or falling of the organs, is another. in a majority of cases the best treatment for any of these troubles is an understanding attempt to go to the root of the matter by bracing up the whole mental tone. the most scientific oculists do not try to correct eye trouble due to muscular insufficiency by any special prisms or glasses. they know that the eyes will right themselves when the general health and the general spirits improve. i have found by repeated experience with nervous patients that it takes only a short time for people who have been unable to read for months or years to regain their old faculty. so remarkable is the power of mind. summary we have found that the gap between the body and the mind is not so wide as it seems, and that it is bridged by the subconscious mind, which is at once the master of the body and the servant of consciousness. in recording the physical effects of suggestion and emotion, we have not taken time to describe the galvanometers, the weighing-machines and all the other apparatus used in the various laboratory tests; but enough has been said to show that when doctors and psychologists speak of the effect of mind on body, they are dealing with definite facts and with laws capable of scientific proof. we have emphasized the fact that downcast and fearful moods have an immediate effect on the body; but after all, most people know this already. what they do not know is the real cause of the mood. when a nervous person finds out why he worries, he is well on the way toward recovery. an understanding of the cause is among the most vital discoveries of modern science. the discussion, so far, has merely prepared us to plunge into the heart of the question: what is it that in the last analysis makes a person nervous, and how may he find his way out? this question the next two chapters will try to answer. chapter vii _in which we go to the root of the matter_ the real trouble pioneers =following the gleam.= kipling's elephant-child with the "'satiable curiosity" finally asked a question which seemed simple enough but which sent him on a long journey into unknown parts. in the same way man's modest and simple question, "what makes people nervous?" has sent him far-adventuring to find the answer. for centuries he has followed false trails, ending in blind alleys, and only lately does he seem to have found the road that shall lead him to his journey's end. we may be thankful that we are following a band of pioneers whose fearless courage and passion for truth would not let them turn back even when the trail led through fields hitherto forbidden. the leader of this band of pioneers was a young doctor named freud. the search for truth =early beginnings.= in , when freud was the assistant to dr. breuer of vienna, there was brought to them for treatment a young woman afflicted with various hysterical pains and paralyses. this young woman's case marked an epoch in medical history; for out of the effort to cure her came some surprising discoveries of great significance to the open-minded young student. it was found that each of this girl's symptoms was related to some forgotten experience, and that in every case the forgetting seemed to be the result of the painfulness of the experience. in other words, the symptoms were not visitations from without, but expressions from within; they were a part of the mental life of the patient; they had a history and a meaning, and the meaning seemed in some way to be connected with the patient's previous attitude of mind which made the experience too painful to be tolerated in consciousness. these previous ideas were largely subconscious and had been acquired during early childhood. when by means of hypnosis a great mass of forgotten material was brought to the surface and later made plain to her consciousness, the symptoms disappeared as if by magic. =a startling discovery.= for a time breuer and freud worked together, finding that their investigations with other patients served to corroborate their former conclusions. when it became apparent that in every case the painful experience bore some relation to the love-life of the patient, both doctors were startled. along with most of the rest of the world, they had been taught to look askance at the reproductive instinct and to shrink from realizing the vital place which sex holds in human life. breuer dropped the work, and after an interval freud went on alone. he was resolved to know the truth, and to tell what he saw. when he reported to the world that out of all his hundreds of patients, he had been unable, after the most careful analysis, to find one whose illness did not grow from some lack of adjustment of the sex-life, he was met by a storm of protest from all quarters. no amount of evidence seemed to make any difference. people were determined that no such libel should be heaped on human nature. sex-urge was not respectable and nervous people were to be respected. despite public disapproval, the scorn of other scientists, and the resistance of his own inner prejudices, freud kept on. he was forced to acknowledge the validity of the facts which invariably presented themselves to view. like luther under equal duress, he cried: "here i stand. i can do no other." =freudian principles.= gradually, as he worked, he gathered together a number of outstanding facts about man's mental life and about the psycho-neuroses. these facts he formulated into certain principles, which may be summed up in the following way. there is no _chance_ in mental life; every mental phenomenon--hence every nervous phenomenon--has a cause and meaning. infantile mental life is of tremendous importance in the direction of adult processes. much of what is called forgetting is rather a repression into the subconscious, of impulses which were painful to the personality as a whole. mental processes are dynamic, insisting on discharge, either in reality or in phantasy. an emotion may become detached from the idea to which it belongs and be displaced on other ideas. sex-interests dominate much of the mental life where their influence is unrecognized. the disturbance in a psycho-neurosis is always in this domain of sex-life. "in a normal sexual life, no neurosis." if a shock is the precipitating cause of the trouble, it is only because the ground was already prepared by the sex-disturbance. freud was perhaps unfortunate in his choice of the word "sex," which has so many evil connotations; but as he found no other word to cover the field, he chose the old one and stretched its meaning to include all the psychic and physical phenomena which spring directly and indirectly from the great processes of reproduction and parental care, and which ultimately include all and more than our word "love."[ ] [footnote : freud and his followers have always said that they saw no theoretical reason why any other repressed instinct should not form the basis of a neurosis, but that, as a matter of fact, they never had found this to be the case, probably because no other instinct comes into such bitter and persistent conflict with the dictates of society. now, however, the great war seems to have changed conditions. under the strain and danger of life at the front there has developed a kind of nervous breakdown called shellshock or war-neurosis, which seems in some cases to be based not on the repression of the instinct of race-preservation but on the unusual necessity for repression of the instinct of self-preservation. army surgeons report that wounded men almost never suffer from shell-shock. the wound is enough to secure the unconsciously desired removal to the rear. but in the absence of wounds, a desire for safety may at the same time be so intense and so severely repressed that it seizes upon the neurosis as the only possible means of escape from the unbearable situation. in time of peace, however, the instinct of reproduction seems to be the only impulse which is severely enough repressed to be responsible for a nervous breakdown.] =later developments.= little by little, the scientific world came to see that this wild theorizer had facts on his side; that not only had he formulated a theory, but he had discovered a cure, and that he was able to free people from obsessions, fears, and physical symptoms before which other methods were powerless. one by one the open-minded men of science were converted by the overpowering logic of the evidence, until to-day we find not only a "freudian school," counting among its members many of the eminent scientists of the day, but we find in medical schools and universities courses based on freudian principles, with text-books by acknowledged authorities in medicine and psychology. we find magazines devoted entirely to psycho-analytic subjects,[ ] besides articles in medical journals and even numerous articles in popular magazines. not only is the treatment of nervous disorders revolutionized by these principles but floods of light are thrown on such widely different fields of study as ancient myths and folk lore, the theory of wit, methods of child training, and the little slips of the tongue and everyday "breaks" that have until recently been considered the meaningless results of chance. [footnote : _the psychoanalytic review_ and the _international journal of psychoanalysis._] =a searching question.= we find, then, that when we ask, "what makes people nervous?" we are really asking: "what is man like, inside and out, up and down? what makes him think, feel, and act as he does every hour of every day?" we are asking for the source of human motives, the science of human behavior, the charting of the human mind. it is hard to-day to understand how so much reproach and ridicule could have been aroused by the statement that the ultimate cause of nervousness is a disturbance of the sex-life. there has already been a change in the public attitude toward things sexual. training-courses for mothers and teachers, elementary teaching in the schools, lectures and magazine articles have done much to show the fallacy of our old hypersensitive attitude. since the war, some of us know, too, with what success the army has used the freudian principles in treating war-neurosis, which was mistakenly called shell-shock by the first observers. we know, too, more about the constitution of man's mind than the public knew ten years ago. when we remember the insistent character of the instincts and the repressive method used by society in restraining the most obstreperous impulse, when we remember the pain of such conflict and the depressing physical effects of painful emotions, we cannot wonder that this most sharply repressed instinct should cause mental and physical trouble. =what about sublimation?= on the other hand, it has been stated in chapter iv that although this universal urge cannot be repressed, it can be sublimated or diverted to useful ends which bring happiness, not disaster, to the individual. we have a right, then, to ask why this happy issue is not always attained, why sublimation ever fails. if a psycho-neurosis is caused by a failure of an insistent instinct to find adequate expression, by a blocking of the libido or the love-force, what are the conditions which bring about this blocking? the sex-instinct of every respectable person is subject to restraint. some people are able to adjust themselves; why not all? the question, "what makes people nervous?" then turns out to mean: what keeps people from a satisfactory outlet for their love-instincts? what is it that holds them back from satisfaction in direct expression, and prevents indirect outlet in sublimation? whatever does this must be the real cause of "nerves." the causes of "nerves" =plural, not singular.= the first thing to learn about the cause is that it is not a cause at all, but several causes. we are so well made that it takes a combination of circumstances to upset our equilibrium. in other words, a neurosis must be "over-determined." heredity, faulty education, emotional shock, physical fatigue, have each at various times been blamed for a breakdown. as a matter of fact, it seems to take a number of ingredients to make a neurosis,--a little unstable inheritance plus a considerable amount of faulty upbringing, plus a later series of emotional experiences bearing just the right relationship to the earlier factors. heredity, childhood reactions, and later experiences, are the three legs on which a neurosis usually stands. an occasional breakdown seems to stand on the single leg of childhood experiences but in the majority of cases each of the three factors contributes its quota to the final disaster. =born or made?= it used to be thought that neurotics, like poets, were born, not made. heredity was considered wholly responsible, and there seemed very little to do about it. but to-day the emphasis on heredity is steadily giving way to stress on early environment. there are, no doubt, such factors as a certain innate sensitiveness, a natural suggestibility, an intensity of emotion, a little tendency to nervous instability, which predispose a person to nerves, but unless the inborn tendency is reinforced by the reactions and training of early childhood, it is likely to die a natural death. childhood experiences =early reactions.= freud found that a neurotic is made before he is six years old. when by repeated explorations into the minds of his patients, he made this important discovery, he at first believed that the disturbing factor was always some single emotional experience or shock in childhood,--usually of a sexual nature. but freud and later investigators have since found that the trouble is not so often a single experience as a long series of exaggerated emotional reactions, a too intense emotional life, a precocity in feeling tending toward fixation of childhood habits, which are thus carried over into adult life. =fixation of habits.= fixation is the word that expresses all this,--fixation of childish habits. a neurotic is a person who made such strong habits in childhood that he cannot abandon them in maturity. he is too much ruled by the past. his unconscious emotional thought-habits are the complexes which were made in childhood and therefore lack the power of adaptation to mature life. we saw in chapter iv that nature takes great pains to develop in the child the psychic and physical trends which he will need later on in his mature love-life, and that this training is accomplished in a number of well-defined periods which lead from one to the other. if, however, the child reacts too intensely, lingers too long in any one of these phases, he lays for himself action lines of least resistance which he may never leave or to which he may return during the strain and stress of adult life. in either case, the neurotic is a grown-up child. he may be a very learned, very charming person, but he is nevertheless dragging behind him a part of his childhood which he should have outgrown long ago. part of him is suffering from an arrest of development,--not a leg or an arm but an impulse. =precocious emotions.= the habits which tend to become fixed too soon seem to be of four kinds; the habit of loving, the habit of rebelling, the habit of repressing normal instincts, and the habit of dreaming. in each case it is the excess of feeling which causes the trouble,--too much love, too much hate, too much disgust, or too much pleasure in imagination. exaggeration is always a danger-signal. an overdeveloped child is likely to be an underdeveloped man. especially in the emotions is precocity to be deplored. a premature alphabet or multiplication table is not nearly so serious as premature intensity of feeling, nor so likely to lead later to trouble. of course fixation in these emotional habits does not always lead to a serious breakdown. if the fixation is not too extreme, and if later events do not happen to accentuate the trouble, the arrest of development may merely show itself in certain weaknesses of character or in isolated symptoms without developing a real neurosis. let us examine each of these arrested habits and the excess emotion which sets the mold before it is ready for maturity. =too much self-love.= in the chapter on the reproductive instinct, we found that the natural way to learn to love is by successively loving oneself, one's parents and family, one's fellows, and one's mate. if the love-force gets too much pleasure in any one of these phases, it finds it hard to give up its old love and to pass on to the next phase. thus some children take too much pleasure in their own bodies or, a little later, in their own personalities. if they are too much interested in their own physical sensations and the pleasure they get by stimulating certain zones of the body, then in later life they cannot free themselves from the desire for this kind of satisfaction. try as they may, they cannot be satisfied with normal adult relations, but sink back into some form of so-called sex-perversion. perhaps it is another phase of self-love which holds the child too much. if, like narcissus, he becomes too fond of looking at himself, is too eager to show off, too desirous of winning praise, then forever after he is likely to be self-conscious, self-centered, thinking always of the impression he is making, unable ever to be at leisure from himself. he is fixed in the narcissistic stage of his life, and is unadapted to the world of social relations. =too much family-love.= we have already spoken of the danger of fixation in the second period, that of object-love--the period of family relationships. the danger is here again one of degree and may be avoided by a little knowledge and self-control on the part of the parents. the little girl who is permitted to lavish too much love on her father, who does not see anybody else, who cannot learn to like the boys is a misfit. the wise mother will see that her love for her boy does not express itself too much by means of hugs and kisses. the mother who shows very plainly that she loves her little boy better than she loves her husband and the mother who boasts that her adolescent boy tells her all his secrets and takes her out in preference to any girl--that deluded mother is trying to take something that is not hers, and is thereby courting trouble. when her son grows up, he may not know why, but no girl will suit him, and he will either remain a bachelor or marry some older woman who reminds him subconsciously of his mother. his love-requirements will be too strict; he will be forever trying either in phantasy or in real life to duplicate his earlier love-experiences. this, of course, cannot satisfy the demands of a mature man. he will be torn between conflicting desires, unhappy without knowing why, unable either to remain a child or to become a man, and impelled to gain self-expression in indirect and unsatisfactory ways. since it is not possible in this space to recite specific cases which show how often a nervous trouble points back to the father-mother complex,[ ] it may help to cite the opinions of a few of our best authorities. freud says of the family complex, "this is the root complex of the neurosis." jelliffe: "it is the foot-rule of measurement of success in life": by which he means that just so far as we are able at the right time to free ourselves from dependence on parents are we able to adjust ourselves to the world at large. pfister: "the attitude toward parents very often determines for a life-time the attitude toward people in general and toward life itself." hinkle: "the entire direction of lives is determined by parental relationships." [footnote : this is technically known as the oedipus complex.] =too much hate.= besides loving too hard, there is the danger of hating too hard. if it sounds strange to talk of the hatreds of childhood, we must remember that we are thinking of real life as it is when the conventions of adult life are removed and the subconscious gives up its secrets. several references have been made to the jealousy of the small child when he has to share his love with the parent of the same sex. for every little boy the father gets in the way. for every little girl the mother gets in the way. at one time or other there is likely to be a period when this is resented with all the violence of a child's emotions. it is likely to be very soon repressed and succeeded by a real affection which lasts through life. but underneath, unmodified by time, there may exist simultaneously the old childish image and the old unconscious reaction to it, unconscious but still active in indirect ways. jealousy is very often united with the natural rebellion of a child against authority. the rebellion may, of course, be directed against either parent who is final in authority in the home. in most cases this is the father. as the impulse of self-assertion is usually stronger in boys than in girls, and as the boy's impulse in this direction is reinforced by any existing jealousy toward his father, we find a strong spirit of rebellion more often playing a subconscious part in the life of men than of women. the novelist's favorite theme of the conflict between the young man and "the old man" represents the conscious, unrepressed complex. more often, however, there is true affection for the father, while the rebellion which really belongs to the childish father-image is displaced or transferred to other symbols of authority,--the state, the law, the king, the school, the teacher, the church, or perhaps to religion and authority in general. anarchists and atheists naturally rationalize their reasons for dissent, but, for all that, they are not so much intellectual pioneers as rebellious little boys who have forgotten to grow up. =liking to be "bossed."= there is a worse danger, however, than too much rebellion, and that is too little rebellion. sometimes this yielding spirit is the result of an overdose of negative self-feeling and an under-dose of positive self-feeling; but sometimes it is over-compensation for the repressed spirit of rebellion which the child considers wicked. consciously he becomes over-meek, because he has to summon all his powers to fight his subconscious insurrection. whether he be meek by nature or by training, he is likely to be a failure. everybody knows that the child who is too good never amounts to anything. he who has never disobeyed is a weakling. naturally resenting all authority, the normal individual, if he be well trained, soon learns that some authority is necessary. he rebels, but he learns to acquiesce, to a certain degree. if he acquiesces too easily, represses too severely his rebellious spirit, swings to the other extreme of wanting to be "bossed," he is very likely to end as a nervous invalid, unfitted for the battles of life. the neurotic in the majority of cases likes authority, clings to it too long, wants the teacher to tell him what to do, wants the doctor to order him around, is generally over-conscientious, and afraid he will offend the "boss" or some one else who reminds him of the father-image. all this carries a warning to parents who cannot manage their children without dominating their lives, even when the domination is a kindly one. perhaps the modern child is in more danger of being spoiled than bullied, but analysis of nervous patients shows that both kinds of danger still exist. =too much disgust.= the third form of excessive emotion is disgust. the love-force, besides being blocked by a fixation of childish love and of childish reactions toward authority, is very often kept from free mature self-expression by a perpetuation of a childish reaction against sex. we hardly need dwell longer on the folly of teaching children to be ashamed of so inevitable a part of their own nature. disgust is a very strong emotion, and when it is turned against a part of ourselves, united with that other strong impulse of self-regard and incorporated into the conscience, it makes a chinese wall of exclusion against the baffled, misunderstood reproductive instinct, which is thrust aside as alien. =restraint versus denial.= repression is not merely restraint. it is restraint plus denial. to the clamoring instinct we say not merely, "no, you _may_ not," but "no, you _are_ not. you do not exist. nothing like you could belong to me." the woman with nausea (chapter v) did not say to herself: "you are a normal, healthy woman, possessed of a normal woman's desires. but wait a while until the proper time comes." controlled by an immature feeling of disgust, she had said: "i never thought it. it cannot be." the difference is just this. when an ungratifiable desire is honestly faced and squarely answered, it is modified by other desires, chooses another way of discharge, and ceases to be desire. when a desire is repressed, it is still desire, unsatisfied, insistent, unmodifiable by mature points of view, untouched by time, automatic, and capable of almost any subterfuge in order to get satisfaction. a repressed desire is buried, shut away from the disintegrating effects of sunlight and air. while the rest of the personality is constantly changing under the influence of new ideas, the buried complex lives on in its immaturity, absolutely untouched by time. =childish birth-theories.= when a child's questions about where babies come from are met by evasions, he is forced to manufacture his own theories. his elders would laugh if they knew some of these theories, but they would not laugh if they knew how often the childish ideas, wide of the truth, furnish the material for future neuroses. frink tells the story of a young woman who had a compulsion for taking drugs. although not a drug-fiend in the usual sense, she was constantly impelled to take any kind of drug she could obtain. it was finally revealed that during her childhood she had tried hard to discover how babies were made, and had at last concluded that they grew in the mother as a result of some medicine furnished by the doctor. the idea had long been forgotten, only to reappear as a compulsion. the natural desire for a child was strong in her, but was repressed as unholy in an unmarried woman. the associated childish idea of drug-taking was not repellent to her moral sense and was used as a substitute for the real desire to bear a child. many of my patients have suffered from the effect of some such birth-theories. one young girl, twenty years old, was greatly afflicted with myso-phobia, or the fear of contamination. she spent most of her time in washing her hands and keeping her hands and clothing free from contamination by contact with innumerable harmless objects. when cleaning her shoes on the grass, she would kneel so that the hem of her skirt would touch the grass, lest some dust should fly up under her clothes. after eating luncheon in the park with a girl who had tuberculosis, she said that she was not afraid of tuberculosis in the lungs, but asked if something like tuberculosis might not get in and begin to grow somewhere else. her life was full to overflowing of such compulsive fears. as opportunity offered itself from day to day, i would catch her compulsive ideas in the very act of expressing themselves, and would pin her down as to the association and the source of her fear, always taking care not to make suggestions or ask leading questions. she was finally convinced out of her own mouth that her real fear was the idea of something getting into her body and growing there. then she told how she had questioned her mother about the reproductive life and had been put off with signs of embarrassment. for a long time she had been afraid to walk or talk with a boy, because, not knowing how conception might occur, she feared grave consequences. very soon after the beginning of her conversations with me, the girl realized that her fear was really a disguised desire that something might be planted within and grow. with her new understanding of herself, her compulsions promptly slipped away. she began to eat and sleep, and to live a happy, natural life. =chronic repression.= it takes first-hand acquaintance with nervous patients to realize how common are stories like these. unnecessary repressions based on false training are the cause of many a physical symptom and mental distress which a little parental frankness might have forestalled.[ ] [footnote : parents who are eager to handle this subject in the right way are often sincerely puzzled as to how to go about it. no matter how complete their education, it is very likely to fail them at this critical point. for the benefit of such parents, let it be said with all possible emphasis that the first and most important step must be a change in their own mental attitude. if there is left within them the shadow of embarrassment on the subject of sex, their children will not fail to sense the situation at once. a feeling of hesitation or a tendency to apologize for nature makes a far deeper impression on the child-mind than do the most beautiful of half-believed words on the subject. and this impression, subtle and elusive as it may seem, is a real and vital experience which is quite likely to color the whole of the child's life. if you would give your children a fair start, you must first get rid of your own inner resistances. after that, all will be clear sailing. in the second place, take the earliest opportunity to bring up the subject in a natural way. a young father told me recently that his little daughter had asked her mother why she didn't have any lap any more. "and of course your wife took that chance to tell her about the baby that is coming," i said. "oh, no," he answered, "she did nothing of the kind. mary is far too young to know about such things." there are always chances if we are on the look out for them--and the earlier the better. it has been noticed that children are never repelled by the idea of any natural process unless the new idea runs counter to some notion which has already been formed. the wise parent is the one who gets in the right impression before some other child has had a chance to plant the wrong one. then, too, we elders are judged quite as much by what we do not say as by what we do. happy is the child who is not left to draw his own conclusions from the silence and evasiveness of his parents. the sex-instruction which children are getting in the schools is often good, but it usually comes too late--the damage is always done before the sixth year. when it comes to the exact words in which to explain the phenomena of generation and birth each parent must naturally find his own way. the main point is that we must tell the truth and not try to improve on nature. if we say that the baby grows under the mother's heart and later the child learns that this is not true, he inevitably gets the idea that there is something not nice about the part of the body in which the baby does grow. what could be wrong with the simple truth that the father plants a tiny seed in the mother's body and that this seed joins with another little seed already there and grows until it is a real baby ready to come into the world? the question as to how the father plants the seed need cause no alarm. if brothers and sisters are brought up together with no artificial sense of false modesty, they very early learn the difference between the male and the female body. it is simple enough to tell the little child the function of the male structure. and it is easy to explain that the seeds do not grow until the little boy and girl have grown to be man and woman and that the way to be well and to have fine strong children is to leave the generative organs alone until that time. a sense of the dignity and high purpose of these organs is far more likely to prevent perversions--to say nothing of nervousness--than is an attitude of taboo and silence.] a certain amount of repression is inevitable and useful, but a neurotic is merely an exaggerated represser. he represses so much of himself that it will not stay down.[ ] he builds up a permanent resistance which automatically acts as a dam to his normal sex instinct and forces it into undesirable outlets. [footnote : "a neurosis is a partial failure of repression." frink: _morbid fears and compulsions_.] a resistance is a chronic repression, repression that has become fixed and subconscious, a habit that has lost its flexibility and outlives its usefulness. it is a fixation of repression, and is built out of an over-strong complex or emotional thought habit, acquired during childhood, incorporated into the conscience and carried over into maturity, where it warps judgment and interferes with normal development because it is fundamentally untrue and at variance with the laws of nature. =too much day-dreaming.= the fourth habit which holds back the adult from maturity and predisposes toward "nerves" is the habit of imagination. it need hardly be said that a certain kind of imagination is a good thing and one of man's greatest assets. but the essence of day-dreaming is the exact opposite; it is the desire to see things as they are not, but as we should like them to be,--not in order that we may bring them to pass, but for the mere pleasure of dreaming. instead of turning a microscope or a telescope on the world of reality, as positive imagination does, this negative variety refuses even to look with the naked eye. to dream is easier than to do; to build up phantasies is easier than to build up a reputation or a fortune; to think a forbidden pleasure is easier than to sublimate. "pleasure-thinking" is not only easier than "reality-thinking,"--it is the _older_ way. children gratify many of their desires simply by imagining them gratified. much of the difficulty of later life might be avoided if the little child could be taught to work for the accomplishment of his pleasures rather than to dream of them. the normal child gradually abandons this "pleasure-thinking" for the more purposeful thinking of the actual world, but the child who loiters too long in the realm of fancy may ever after find it hard to keep away from its borders. his natural interest in sex, if artificially repressed, is especially prone to satisfy itself by way of phantasy. =turning back to phantasy.= in later life, when the love-force for one reason or another becomes too strong to be handled either directly or indirectly in the real world, there comes the almost irresistible impulse to regress to the infantile way and to find expression by means of phantasy. after long experience freud concluded that phantasy lies at the root of every neurosis. jung says that a sex-phantasy is always at least one determiner of a nervous illness, and jelliffe writes that the essence of the neurosis is a special activity of the imagination. such a statement need not shock the most sensitive conscience. the very fact that a neurosis breaks out is proof that the phantasies are repellent to the owners of them and are thrust down into the subconscious as unworthy. in fact, every neurosis is witness to the strength of the human conscience. no phantasy could cause illness. it is the phantasy plus the repression of it that makes the trouble, or rather it is the conflict between the forces back of the phantasy and the repression. the neurosis, then, turns out to be a "flight from the real," the result of a desire to run away from a difficulty. when a problem presses or a disagreeable situation is to be faced, it is easier to give up and fall ill than to see the thing through to the end. here again, we find that nervousness is a regression to the irresponsible reactions of childhood. =maturity versus immaturity.= we have been thinking of the main causes of "nerves" and have found them to be infantile habits of loving, rebelling, repressing, and dreaming. we have tried to show that these habits are able to cause trouble because of their bearing on that inevitable conflict between the ancient urge of the reproductive instinct and the later ideals which society has acquired. if this conflict be met in the light of the present, free from the backward pull, of outgrown habits, an adjustment is possible which satisfies both the individual and society. we call this adjustment sublimation. this is rather a synthesis than a compromise, a union of the opposing forces, a happy utilization of energy by displacement on more useful ideas. but if the conflict has to be met with the mind hampered by immature thinking and immature feeling; if the demands of the here-and-now are met as if it were long ago; if unhealthy and untrue complexes, old loves and hates complicate the situation; if to the necessary conflict is added an unnecessary one; then something else happens. compromise of some kind must be made, but instead of a happy union of the two forces a poor compromise is effected, gaining a partial satisfaction for both sides, but a real one for neither. the neurosis is this compromise. later experiences =the last straw.= the precipitating cause may be one of a number of things. it may be entirely within, or it may be external. perhaps it is only a quickening of the maturing instincts at the time of adolescence, making the love-force too strong to be held by the old repressions. perhaps the husband, wife, or lover dies, or the life-work is taken away, depriving the vital energy of its usual outlets. perhaps the trigger is pulled by an emotional shock which bears a faint resemblance to old emotional experiences, and which stimulates both the repressing and repressed trends and makes the person at the same time say both "yes," and "no."[ ] perhaps physical fatigue lets down the mental and moral tension and makes the conflict too strong to be controlled. perhaps an external problem presses and arouses the old habit of fleeing from disagreeable reality. any or all these factors may cooperate, but not one of them is anything more than a last straw on an overburdened back. no calamity, deprivation, fatigue, or emotion has been able to bring about a neurosis unless the ground was prepared for it by the earlier reactions of childhood. [footnote : "the external world can only cause repression when there was already present beforehand a strong initial tension reaching back even to childhood."--pfister: _psychoanalytic method_, p. .] the breakdown itself ="two persons under one hat."= we can understand now why a neurotic can be described in so many ways. we often hear him called an especially moral, especially ethical person, with a very active conscience; an intensely social being, unable to be satisfied with anything but a social standard; a person with "finer intellectual insight and greater sensitiveness than the rest of mankind." at the same time we are told that a neurosis is a partial triumph of anti-social, non-moral factors, and that it is a cowardly flight from reality; we hear a nervous invalid called selfish, unsocial, shut in, primitive, childish, self-deceived. both these descriptions are true to life. a neurosis is an ethical struggle between these two sets of forces. if the lower set had triumphed, the man would have been merely weak; if the higher set had been victorious, he would have been strong. as it is, he is neither one nor the other,--only nervous. the neurosis is the only solution of the struggle which he is able to find, and serves the purpose of a sort of armed armistice between the two camps. serving a purpose if a neurosis is a compromise, if it is the easiest way out, if it serves a purpose, it must be that the individual himself has a hand in shaping that purpose. can it be that a breakdown which seems such an unmitigated disaster is really welcomed by a part of our own selves? nothing is more intensely resented by the nervous invalid than the accusation that he likes his symptoms,--and no wonder. the conscious part of him hates the pain, the inconvenience, and the disability with a real hatred. it is not pleasant to be ill. and yet, as it turns out, it is pleasanter to be ill than it is to bear the tension of unsatisfied desire or to be undeceived about oneself. every symptom is a means of expression for repressed and forgotten impulses and is a relief to the personality. it tends to the preservation of the individual, rather than to his destruction. the nervous invalid is not short-lived, but his family may be! it has been said that a neurosis is not so much a disease as a dilemma. rather might it be said that the neurosis is a way out of the dilemma. it is a harbor after a stormy sea, not always a quiet harbor, but at least a usable one. unpleasant as it is, every nervous symptom is a form of compensation which has been deliberately though unconsciously chosen by its owner. =rationalizing our distress.= among other things, a nervous symptom furnishes a seemingly reasonable excuse for the sense of distress which is behind every breakdown. something troubles us. we are not willing to acknowledge what it is. on the other hand, we must appear reasonable to ourselves, so we manufacture a reason. perhaps at the time when the person first feels distress, he is on a railroad train. so he says to himself, "it is the train. i must not go near the railway"; and he develops a phobia for cars. perhaps at the onset of the fear he happens to have a slight pain in the arm. he makes use of the pain to explain his distress. he thinks about it and holds on to it. it serves a purpose, and is on the whole less painful than the feeling of unexplained impending disaster which is attached to no particular idea. perhaps he happens to be tired when the conflict first gets beyond control. so he seizes the idea of fatigue to explain his illness. he develops chronic fatigue and talks proudly of overwork. in every case the symptom serves a real purpose, and is, despite its discomfort, a relief to the distressed personality. a neurosis is a subconscious effort at adjustment. like a physical symptom, it is nature's way of trying to cure herself. it is an attempt to get equilibrium, but it is an awkward attempt and hardly the kind that we would choose when we see what we are doing. =securing an audience.= besides furnishing relief from too intense strain, a nervous breakdown brings secondary advantages that are at most only dimly recognized by the individual. one of the most intense cravings of the primitive part of the subconscious is for an audience; a nervous symptom always secures that audience. the invalid is the object of the solicitous care of the family, friends, physician, and specialist. pomp and ceremony, so dear to the child-mind, make their appeal to the dissociated part of the personality. the repressed instincts, hungry for love and attention, delight in the petting and special care which an illness is sure to bring. secretly and unconsciously, the neurotic takes a certain pleasure in all the various changes that are made for his benefit,--the dismantling of striking clocks, the muffling of household noises, the banishing of crowing roosters, and the changes in menu which must be carefully planned for his stomach. this characteristic of finding pleasure in personal ministrations is plainly a regression to the infantile phase of life. the baby demands and obtains the center of the stage. later he has to learn to give it up, but the neurotic gets the center again and is often very loth to leave it for a more inconspicuous place. =capitalizing an illness.= then, too, a neurosis provides a way of escape from all sorts of disagreeable duties. it can be capitalized in innumerable ways,--ways that would horrify the invalid if he realized the truth. much of the resentment manifested against the suggestion that the neurosis is psychic in origin is simply a resistance against giving up the unconsciously enjoyed advantages of the illness. an honest desire to get well is a long step toward cure. the purposive character of a nervous illness is well illustrated by two cases reported by thaddeus hoyt ames.[ ] a young woman, the drudge of the family, suddenly became hysterically blind, that is, she became blind despite the fact that her eyes and optic nerves proved to be unimpaired. she remained blind until it was proved to her that a part of her welcomed the blindness and had really produced it for the purpose of getting away from the monotony of her unappreciated life at home. she naturally resented the charge but finally accepted it and "turned on" her eyesight in an instant. the other patient, a man, became blind in order to avoid seeing his wife who had turned out to be not at all what he had hoped. when he realized what he was doing, he decided that there might be better ways of adjusting himself to his wife. he then switched on his seeing power, which had never been really lost, but only disconnected and dissociated from the rest of his mind. [footnote : thaddeus hoyt ames: _archives of ophthalmology_, vol. xliii, no. , .] that the conscious mind has no part in the subterfuge is shown by the fact that both patients gave up their artificial haven as soon as they saw how they had been fooling themselves. the fact remains that every neurosis is the fulfilment of a wish,--a distorted, unrecognized, unsatisfactory fulfilment to be sure, but still an effort to satisfy desire. as frink remarks, "a neurosis is a kind of behaviour." we always choose the conduct we like. it is a matter of choice. does not this answer our question as to why some people always take unhealthy suggestions? if we take the bad one, it is because it serves the need of a part of our being. sign language =talking in symbols.= we have several times suggested that a nervous symptom is a disguised, indirect expression of subconscious impulses. it is the completeness of the disguise which makes it so hard for us to realize its true meaning. it takes a stretch of the imagination to believe that a pain in the body can mean a pain in the soul, or that a fear of contamination can signify a desire to bear a child. but in all this we must not forget the primitive, childlike nature of the instinctive life. the savage and the child do not think as civilized man thinks. savage or child thinks in pictures; he acts his feelings; he groups things according to superficial resemblances, he expresses an idea by its opposite; he talks in symbols. we still use these devices in poetic speech and in everyday thought. a wedding-ring stands for the marriage bond; the flag for a nation; a greyhound for fleetness; a wild beast for ferocity; sunrise for youth; and sunset for old age. "the essence of language consists in the statement of resemblance. the expression of human thought is an expression of association."[ ] [footnote : trigant burrow: _journal of american medical association_, vol. lxvi, no. ii, .] the association may be so accidental and superficial as to seem absurd to another person, or it may be so fundamental as to express the universal thought of man from the beginning of time. many of the signs and symbols which crop out in neurotic symptoms and in normal dreams are the same as those which appear in myths, fairy tales and folk-lore and in the art of the earlier races. =a secret code.= when the denied instincts of a man's repressed life insist on expression, and when the shocked proprieties of his repressing life demand conformity to social standards, the subconscious, held back from free speech, strikes a compromise by making use of figurative language. as trigant burrow says, if the moral repugnance is very strong, the disguise must be more elaborate, the symbols more far-fetched. the symbols of nervous symptoms and of dreams are a "secret code," understood by the sender but meaningless to the censoring conscience, which passes them as harmless. =the right kind of symbolism.= sublimation itself is merely a symbolic expression of basic impulses. it follows the line of our make-up, which naturally and fundamentally is wont to let one thing stand for another and to express itself in indirect ways. sublimation says: "if i cannot recreate myself in the person of a child, i will recreate myself in making a bridge, or a picture, or a social settlement,--or a pudding." it says: "if i cannot have my own child to love, i will adopt an orphan-asylum, or i will work for a child-labor law." it merely lets one thing stand for another and transfers all the passions that belong to the one on to the other, which is the same thing as saying that it gives vent to its original desire by means of symbolic expression. =the wrong kind of symbolism.= a nervous disorder is an unfortunate choice of symbols. instead of spiritualizing an innate impulse, it merely disguises it. the disguise takes a number of forms. one of the commonest ways is to act out in the body what is taking place in the soul. the woman with nausea converted her moral disgust into a physical nausea, which expressed her distress while it hid its meaning. the girl who was tired of seeing her work, and the man who wanted to avoid seeing his wife chose a way out which physically symbolized their real desire. a dentist once came to me with a paralyzed right arm. he had given up his office and believed that he would never work again. it turned out that his only son had just died and that he was dramatizing his soul-pain by means of his body. his subconscious mind was saying, "my good right arm is gone," and saying it in its own way. within a week the arm was playing tennis, and ever since it has been busy filling teeth. there were, of course, other factors leading up to the trouble, but the factor which determined its form was the sense of loss which acted itself out through the body. sometimes, as we have seen, the disguise takes another form. instead of conversion into a physical symptom, it lets one idea stand for another and displaces the impulse or the emotion to the substitute idea. the girl with the impulse to take drugs fooled her conscience by letting the drug-taking idea stand for the idea of conception. the girl with the fear of contamination carried the disguise still farther by changing the desire into fear,--a very common subterfuge. =the case of mrs. y.= there came to me a short time ago a little woman whose face showed intense fright. for several months she had spent much of the time walking the floor and wringing her hands in an agony of terror. in the night she would waken from her sleep, shaking with fear; soon she would be retching and vomiting, although she herself recognized the fact that there was nothing the matter with her stomach. part of the time her fear was a general terror of some unknown thing, and part of the time it was a specialized fear of great intensity. she was afraid she would choke her son, to whom she was passionately devoted. during the course of the treatment, which followed the lines of psycho-analysis to be described in the next chapter, i found that this fear had arisen one evening when she was lying reading by the side of her sleeping child. suddenly, without warning, she had a sort of mental picture of her own hands reaching out and choking the boy. naturally she was terrified. she jumped out of bed, decided that she was losing her mind and went into a hysterical state which her husband had great trouble in dispelling. after that she was afraid to be left alone with her children lest she should kill them. during the analysis it was discovered that what she had been reading on that first night was the thirteenth verse of the ninety-first psalm. "thou shalt tread upon the lion and the adder. the young lion and the dragon thou shalt trample under foot." to her the adder meant the snake, the tempter in the garden of eden, and hence sex. what she wanted to choke was her own insistent sex urge of which the child was the symbol and the result. on later occasions she had the same sort of hallucinations in connection with another child and on sight of a brutish kind of man who symbolized to the subconscious mind the sex-urge, of which she was afraid. not so much by what her mother had said as by what she had avoided saying, and by her expression whenever the subject was mentioned, had she given her little daughter a fundamentally wrong idea of the reproductive instinct. later when the girl was woman grown she still clung to the old conception, deploring the sex-part of the marriage relation and feeling herself too refined to be moved by any such sensual urge. but the strong sex-instinct within her would not be downed. it was so insistent as to be an object of terror to her repressing instinct, which could not bring itself to acknowledge its presence. the fear that came to the surface was merely a disguised and symbolic representation of this real fear which was turning her life into a nightmare. the nausea and vomiting in this woman seemed to be symbolic of the disgust which she felt subconsciously at the thought of her own sex-desires, but sometimes the physical disturbances which accompany such phobias are the natural physical reactions to the constant fear state. indigestion, palpitation, and tremors are not in themselves symbolic of the inner trouble but may be the result of an overdose of the adrenal and thyroid secretions and the other accompaniments of fear. in such cases the real symptom is the fear, and the physical disturbance an incidental by-product of the emotional state. in any case a nervous symptom is always the sign of something else--a hieroglyph which must be deciphered before its real meaning can be discovered. summary =three kinds of people.= absurd as it sounds, "nerves" turn out to be a question of morals; a neurosis, an affair of conscience; a nervous symptom an unsettled ethical struggle. the ethical struggle is not unusual; it is a normal part of man's life, the natural result of his desire to change into a more civilized being. the people in the world may be divided into three classes, according to the way they decide the conflict. =the primitive.= the first class merely capitulate to their primitive desires. they may not be nervous, but it is safe to say that they are rarely happy. the voice of conscience is hard to drown, even when it is not strong enough to control conduct. happily it often succeeds in making us miserable, when we desert the ways that have proved best for our kind. the "immoral" person has not yet "arrived"; he simply disregards the collective wisdom of society and gives the victory to the primitive forces which try to keep man back on his old level. we cannot break the ideals by which man lives, and still be happy. =the salt of the earth.= the second class of people decide the conflict in a way that satisfies both themselves and society. they give the victory to the higher trends and at the same time make a lasting peace by winning over the energy of the undesirable impulses. by sublimation they divert the threatening force to useful work and turn it out into real life, using its steam to make the world's wheels go round. their love-force, unhampered by childish habits, is free to give itself to adult relationships or to express itself symbolically in socially helpful ways. =nervous people.= to the third class belong the people who have not finished the fight. these are the folk with "nerves," the people in whom the conflict is fiercest because both sides are too strong. the victory goes to neither side; the tug of war ends in a tie. since the energy of the nervous person is divided between the effort to repress and the effort to gain expression, there is little left for the external world. there is plenty of energy wasted on emotion, physical symptoms, phantasy, or useless acts symbolizing the struggle. a neurotic is a normal person, "only more so." his impulses are the same impulses as those of every other person; his complexes are the same kind of complexes, only more intense. he is an exaggerated human being. he may be only slightly exaggerated, showing merely a little character-weakness or a slight physical symptom, or he may be so intensified as to make life miserable for himself and everybody near him. it is quantity, not quality, that ails him, for he differs from his steady-going neighbor not in kind but in degree. more of him is repressed and a larger part of him is fixed in a childish mold. =tricking ourselves.= a neurosis is a confidence game that we play on ourselves. it is an attempt to get stolen fruit and to look pious at the same time,--not in order to fool somebody else but to fool ourselves. no nervous symptom is what it seems to be. it is an arch pretender. it pretends to be afraid of something it does not fear at all, or to ignore something that interests it intensely. it pretends to be a physical disease, when primarily it has nothing to do with the body; and the person most deluded is the one who "owns" the symptom. its purpose is to avoid the pain of disillusionment and to furnish relief to a distracted soul which dares not face itself. although the true meaning of a symptom is hidden, there is fortunately a clue by which it can be traced. sometimes it takes the art of a psychic detective to follow the clues down, down through the different layers of the subconscious mind, until the troublesome impulses and complexes are found and dragged forth,--not to be punished for breaking the peace but to be led toward reconciliation. but "that is another story," and belongs to another chapter. we are approaching the way out. part iii--the mastery of "nerves" chapter viii _in which we pick up the clue_ the way out the science of re-education there is a story of an irishman at the world's fair in chicago. although his funds were getting low, he made up his mind that he would not go home without a ride on a camel. for several minutes he stood before a sign reading: "first ride ¢, second ride ¢, third ride ¢." then, scratching his head, he exclaimed, "faith, and i'll take the third ride!" should there by any chance be a reader who, eager to find the way out without paying the price of knowledge, is tempted to say to himself "faith, and i'll begin with part iii," we give him fair warning that if he does so, he will in all probability end by putting down the book in a confused and skeptical frame of mind. it is difficult to find our way out of a maze without some faint idea of the path by which we got in. he who brings to this chapter the popular notion that nervousness is the result of worn-out nerve-cells, can hardly be expected to understand how it can be cured by a process of mental adjustment. suggestion to that effect can scarcely fail to appear to him faddish and unpractical. but once a person has grasped the idea that "nerves" are merely a slip in the cog of hidden mental machinery, and has acquired at least a working-knowledge of "the way the wheels go round," he can scarcely fail to understand that the only logical cure must consist in some kind of readjustment of this underground machinery. if "nerves" were physical, then only physical measures could cure, but as they are psychic, the only effective measures must be psychic. =gross misconceptions.= nervousness is caused by a lack of adjustment to the world as it is; therefore the only possible cure must be some sort of readjustment between the person's inner forces and the demands of the social world. as this lack of adjustment is concerned chiefly with the repressed instinct of reproduction, it is only natural that there should be people who believe that "the way out" lies in some form of physical satisfaction of the sex-impulse--in marriage, in changing or ignoring the social code, in homo-sexual relations or in the practice of masturbation. but we have only to look about us to see that this prescription does not cure. freud naïvely asks whether he would be likely to take three years to uncover and loosen the psychic resistances of his patients, if the simple prescription of sex-license would give relief. since there are as many married neurotics as single, it is evident that even marriage is not a sure preventive of nervousness. license, on the other hand, can satisfy only a part of the individual's craving. freud insists that the sex-instinct has a psychic component as well as a physical one, and that it is this psychic part which is most often repressed. he maintains that for complete satisfaction there must be psychic union between mates, and that gratification of the physical component of sex when dissociated from psychic satisfaction, results in an accumulation of tension that reacts badly on the whole organism. the psychic tension accumulating in adult sex-relations has its inception in the mistaken attitude on the part of the wife, who remains true to her childhood training that any pleasure in sex is vulgar; or on the part of the man, who reacts to the mood of the wife, or is held by his own unbroken mother-son complex; or on the part of both the tension piles up because of society's taboo upon rearing large families. as the first two factors in this lack of adjustment grew largely out of some kind of faulty education or from faulty reaction to early experiences, the only effective way to secure a better adaptation must be through a re-education which reaches down to that part of the personality that bears the stamp of the unfortunate early factors. =remaking ourselves.= as a matter of fact, the science of psychotherapy or mental treatment is simply the science of re-education,--a process designed to break up old unhealthy complexes which disrupt the forces of the individual, and to build up healthy complexes which adjust him to the social world and enable him to use his energy in useful ways. fortunately, minds can be changed. it is easier to make over an unhealthy complex than to make over a weak heart, to straighten out a warped idea than to straighten a bent back. remarkable indeed have been some of the transformations in people who are supposed to have passed the plastic period in life. while it is true that some persons become "set" in middle life, and almost impervious to new ideas, it is also true that a person at fifty has more richness of experience upon which to draw, more appreciation of the value of the good, than has a person at twenty. if he really wants to change himself, he can do wonderful things by re-education. the first step in this re-education is a grasp of the facts. if you want to pull yourself out of a nervous disorder, first of all learn as much as you can about the causes of "nerves," about the general laws of mind and body, and about your own mental quirks. if this is not sufficient, go to a specialist trained in psychotherapy and let him help you uncover those trouble-making parts of your personality which you cannot find for yourself. it is the purpose of this book to summarize the facts which most need to be known. let us now consider those methods which the psychopathologist finds most useful in helping his patients to self-knowledge and readjustment. =various methods.= as there are a number of schools of medicine, so there are a number of distinct methods of psychotherapy, each with its own theories and methods of procedure, and each with its ardent supporters. these methods may be classified into two groups. the first group includes those methods, hypnosis and psycho-analysis, which make a thorough search through the subconscious mind for the buried complexes causing the trouble, and might, therefore, be called "re-education with subconscious exploration." the other group, includes so-called explanation and suggestion, or methods of "re-education without subconscious exploration," which content themselves with making a general survey and building up new complexes without going to the trouble of uncovering the buried past. although the theory and the technique vary greatly, the aim of all these methods is the same,--the readjustment of the individual to life. re-education with subconscious exploration =hypnosis.= the method by which most of the important early discoveries were made is hypnosis, or artificial sleep, a method by which the conscious mind is dissociated and the subconscious brought to the fore. it was through hypnosis that freud, janet, prince, and sidis made their first investigations into the nature of nervousness and worked their first cures. with the conscious mind asleep and its inhibitions out of the way, a hypnotized patient is often able to remember and to disclose to the physician hidden complexes of which he is unaware when awake. hypnosis may thus be a valuable aid to diagnosis, enabling the physician to determine the cause of troublesome symptoms. he may then begin to make suggestions calculated to break up the old complexes and to build new ones, made up of more healthful ideas, desirable emotions and happy feeling-tones. as we have seen, a hypnotized subject is highly suggestible. his counter-suggestions inactivated, he believes almost anything told him and is extremely susceptible to the doctor's influence. the dangers of hypnosis have been much exaggerated. indeed, as an instrument in the hands of a competent physician, it is not to be feared at all. it has, however, its limitations. many times the very memories which need to be unearthed refuse to come to the surface. stubborn resistances are more likely to be subconscious than conscious, and may prove too strong to be overcome in this way. moreover, the road to superficial success is very inviting. it is easy to cure the symptom, leaving the ultimate cause untouched and ready to break out in new manifestations. the drug and drink habits may be broken up without making any attempt to discover the unsatisfied longings which were responsible for the habit. a pain may be cured without finding the mental cause of the pain or initiating any measures to guard against its return, and without giving the patient any insight into the inner forces with which he still has to deal. since nervousness is a state of exaggerated suggestibility and abnormal dissociation, many psychologists believe that it is unwise to employ a method which heightens the state of suggestibility and encourages the habit of dissociation. they feel that it is wiser to use less artificial methods which rest on the rational control of the conscious mind and make the patient better acquainted with his own inner forces and more permanently able to cope with new manifestations of those forces. they believe that the character of the patient is strengthened and his morale raised by methods which increase the sovereignty of reason and decrease the role of unreasoning suggestibility. =psycho-analysis.= freud's contribution has been not only a discovery of the general causes of nervousness, but a special means of locating the cause in any particular case. abandoning hypnosis, he developed another method which he called psycho-analysis. what chemical analysis is to chemistry, psycho-analysis is to the science of the mind. it splits up the mental content into its component parts, the better to be examined and modified by the conscious mind. psycho-analysis is merely a technical process for discovering repressed complexes and bringing them into consciousness, where they may be recognized for what they are and altered to meet the demands of real life. it is a device for finding and removing the cause of nervousness,--for bringing to light hidden desires which may be honestly faced and efficiently directed instead of being left to seethe in dangerous insurrection. in order permanently to break up a real neurosis, a man must first know himself and then change himself. he must gain insight into his own mental processes and then systematically set to work to change those processes that unfit him for life. we shall later find that a detailed self-discovery through psycho-analysis is not always necessary, and that a more general understanding of oneself is sufficient for the milder kinds of nervousness. but because of the promise which psycho-analysis holds out to those stubborn cases before which other methods are powerless; because of the invaluable understanding of human nature which it places at the disposal of all nervous people, who may profit by its findings without undergoing an analysis; and because of the flood of light which it sheds on the motives, conduct, and character of every human being, no educated person can afford to be without a general knowledge of psycho-analysis.[ ] [footnote : it is unfortunate that the records of an analysis are too voluminous for use in so brief an account as this. since the report of one case would fill a book, and a condensed summary would require a chapter, we must refer to some of the volumes which deal exclusively with the psychoanalytic principles. for a list of these books, see bibliography.] =a chain of associations.= psycho-analysis is not, like hypnosis, based on dissociation; it is based on the association of ideas. its main feature is a process of uncritical thinking called "free association." to understand it, one must realize how intricately woven together are the thoughts of a human being and how trivial are the bonds of association between these ideas. one person reminds us of another because his hair is the same color or because he handles his fork in the same way. two words are associated because they sound alike. two ideas are connected because they once occurred to us at the same time. a subtle odor or a stray breeze serves to remind us of some old experience. connections that seem far-fetched to other people may be quite strong enough to bind together in our minds ideas and emotions which have once been associated, even unconsciously, in past experience. in this way, thoughts in consciousness and in the upper layers of the subconscious are connected by a series of associations, forming links in invisible chains that lead to the deepest, most repressed ideas. even a dissociated complex has some connection with the rest of the mind, if we only have the patience to discover it. therefore, by adopting a passive attitude, by simply letting his thoughts wander, by talking out to the physician everything that comes to his mind without criticizing or calling any thought irrelevant or far-fetched, and without rejecting any thought because of its painful character, the patient is helped to trace down and unearth the troublesome complex which may have been absolutely forgotten for many years. he is helped to relive the childhood experiences back of the over-strong habits which lasted into maturity. =resisting the probe.= naturally, it is not all fair sailing. the subconscious impulses which repressed the painful complex in the first place still shrink from uncovering it. in many cases the resistance is very strong. it, therefore, often happens that after a time the patient becomes restive; he begins to criticize the doctor and to ridicule the method. his mind goes blank and no thought will come; or he refuses to tell what does come. the nearer the probe comes to the sore spot, the greater the pain of the repressing impulses and the stronger the resistance. usually a strange thing happens; the patient, instead of consciously remembering the forgotten experiences, begins to relive them with his original emotions transferred on to the doctor. depending upon what person of his childhood he identifies with him, the patient develops either a strong affection or an intense antagonism to the physician, attitudes called in technical terms positive and negative transference. if the analyst is skilful, he is able to circumvent all the subterfuges of the resisting forces and to uncover and modify the troublesome complexes. sometimes this can be accomplished at one sitting, but more often it requires long hours of conversation. freud has spent three years on a single difficult case, and very frequently the analysis drags out through weeks or months. the amount of mental material is so great, especially in a person who is no longer young, that every analysis would probably be an interminable affair if it were not for three valuable ways of finding the clue and picking up the scent somewhere near the end of the trail. the first of these clues is nothing else than so despised a phenomenon as the patient's own night-dreams, which turn out to be not meaningless jargon, as we have supposed, but significant utterances of the inner man. =the message of the dream.= when freud rescued dreams from the mental scrap-basket and learned how to piece them together so that their message to man about himself became for the first time intelligible, he furnished the human race with what will probably be considered its most valuable key to the hidden mysteries of the mind. freeing the dream from the superstition of olden times and from the neglect of later days, freud was the first to discover that it is part and parcel of man's mental life, that it has a purpose and a meaning and that the meaning may be scientifically deciphered. it then invariably reveals itself to be not a prophecy for the future but an interpretation of the present and of the past, an invaluable synopsis of the drama which is being staged within the personality of the dreamer. as modern man has swung away from the idea of the dream as a warning or a prophecy, he has accepted the even more untrue conception of dreaming as the mere sport of sleep,--the "babble of the mind," the fantastic and insignificant freak-play of undirected mental processes, or the result of physical sensations without relation to the rest of mental life. no wonder, then, that freud's startling dictum, "a dream is a disguised fulfilment of a repressed wish," should be met with astonishment and incredulity. when a person is confronted for the first time with this statement, he invariably begins to cite dreams in which he is pursued by wild beasts, or in which his loved ones are seen lying dead. he then triumphantly asserts that no such dream could be the fulfilment of a wish. the trouble is that he has overlooked the word "disguised." like wit and some figures of speech, a dream says something different from what it means. it deals in symbols. its "manifest content" may be merely a fantastic and impossible scene without apparent rhyme or reason, but the "latent content," the hidden meaning, always expresses some urgent personal problem. although the dream may seem to be impersonal and unemotional, it nevertheless deals in every case with some matter of vital concern to the dreamer himself. it is a condensed and composite picture of some present problem and of some related childish repressed wish which the experiences of the preceding day have aroused. as frink says, a dream is like a cartoon with the labels omitted--absolutely unintelligible until its symbols are interpreted. although some dreams whose symbolism is that which man has always used, can be easily understood by a person who knows, many dreams are meaningless, even to an experienced analyst, until the patient himself furnishes the labels by telling what each bit of the picture brings to his mind. the dream, as a rule, merely furnishes the starting-point for free association. each symbol is an arrow pointing the way to forbidden impulses which are repressed in waking life but which find partial expression during sleep. the subconscious part of the conscience is still on the job, so the repressed desires can express themselves only in distorted ways which will not arouse the censor and disturb sleep. the purpose of the dream is thus two-fold,--to relieve the tensions of unsatisfied desire, and to do this in such a subtle way as to keep the dreamer asleep. sometimes it fails of its purpose, but when there is danger of our discovering too much about ourselves, we immediately wake up, saying that we have had a bad dream. it is at first difficult to believe that we are capable of this elaborate mental work while we are fast asleep. however, a little investigation shows us to be more clever than we realize. the subconscious mind, in its effort to satisfy both the repressing and the repressed impulses, carries on very complicated processes, disguises material by allowing one person to stand for another, two persons to stand for one, or one person to stand for two; it shifts emotion from important to trivial matters, dramatizes, condenses, and elaborates, with a skill that is amazing. we are all of us very clever playwrights and makers of allegories--in our sleep. also, we are all very clever at getting what we want, and the dream secures for us, in a way, something which we want very much indeed and which the world of social restraint or our own warped childish notion denies us. not every one can become an interpreter of dreams. it takes a skilled and patient specialist thoroughly to understand the process. but it is fortunate indeed that we possess such a valuable means of diagnosis when extraordinary conditions make it necessary to explore the subconscious in the search for trouble-making complexes.[ ] [footnote : for further study of the dream, see freud: _interpretation of dreams_; and _general introduction to psycho-analysis_.] =the word-test.= although dreams furnish the main clues to buried complexes, they are by no means the only instrument of the psycho-analyst. another device, called the association word-test, has been developed by dr. carl jung of switzerland. the analyst prepares a list of perhaps one hundred words, which he reads one by one to the patient, hoping in this way to strike some of the emotional reactions of which the patient himself is unaware. the latter responds with the first word that comes into his mind, no matter how absurd it may seem. the responses themselves are often significant, but the time that elapses is even more so. it usually happens that it takes very much longer for some responses than for others. if a patient's average time is one or two seconds, some responses may take five or ten or twenty seconds. sometimes no word comes at all and the patient says that his mind is a blank. he coughs or blushes, grows pale or trembles, showing all the signs of emotion even when he himself has no notion of the cause. the significant word has hit upon a subconscious association with some emotional complex. the blocking of the mind is an effort of the resistance to keep the painful ideas out of consciousness. the telltale word then furnishes a starting point for further associations. one of my patients blocked on the word "long." instead of saying "short" or "pencil" or "road" or "day" or any other word which might naturally be associated with "long," she laughed and said that no word would come. finally an emotional memory came to light. it seems that this woman had been courted by a man whom she unconsciously loved, but whom she had "turned down" because she was ambitious for a career. after the man had moved to another town, my patient heard that he was engaged to another girl. she then realized that she loved him and began to long for him with her whole heart. the meaningful word "long" thus led us to one of the emotional memories for which we were seeking. ="chance" signs.= there are other clues to hidden inner processes, other sign-posts pointing to the cause of a neurosis. not only through dreams and through emotional reactions to certain words does the subconscious reveal its desires, but also through the little slips of the tongue and of the pen, the "chance" acts and unconscious mannerisms which are usually ignored as entirely insignificant. when we "make a break" and say what we secretly mean but wish to hide from ourselves or others; when we forget an appointment which part of us really wishes to avoid, or forget a name with which we are perfectly familiar; when we lose the pen so that we cannot write or the desk key so that we cannot work; when we blunder and drop things and do what we did not mean to do; then we may know--the normal as well as the nervous person--that our subconscious minds with their repressed desires are trying to get the reins and are partially succeeding. an example from my own life may illustrate the point. in building a number of houses, i had occasion often to use the word studding, but on every occasion, i forgot the word and always had to end lamely by saying "those pieces of timber that go up and down." each time the builder supplied the word, but the next time it was no more accessible. finally, the reason came to me. one day when i was a little child i looked out of the window and cried, "oh, see that great big beautiful horse." my grandmother exclaimed, "sh! sh! that is a stud horse." over-reaction to that impression repressed the word stud so successfully that as a grown woman i could not recall another word which happened to contain the same syllable. during an analysis a patient of mine who had a mother-in-law situation on her hands told me a dream of the night before. "i dreamed that my mother-in-law, who has really been very ill, was taken with a sinking-spell. i rushed to the telephone to call the doctor, but found to my terror that i could not remember his number." "what is his number?" i asked, knowing that she ought to know it perfectly. "two-eight-nine-six," she answered at once. the number really was . asleep and awake, her repressed desire for release from the mother-in-law's querulous presence was attempting to have its way. in the dream, she avoided calling the doctor by forgetting his number entirely. awake, she evaded the issue by remembering a wrong number. in the dream she thinly disguised her desire by displacing the anxious emotion from the sense of her own guilty wishes to the idea of the mother-in-law's death. when confronted with this interpretation, the woman readily acknowledged its truth. even stammering, which has always been considered a physical disorder, has been proved, by psycho-analysis, to be the sign of an emotional disturbance. h. addington bruce reports the case of one of dr. brill's patients, a young man who had been stammering for several years. observation revealed the fact that his chief difficulty was with words beginning with k and although at first he firmly denied any significance to the letter, he later confessed that his sweetheart whose name began with k had eloped with his best friend and that he had vowed never to mention her name again. upon dr. brill's suggestion he tried to think of the unfaithful lover as miss w., but soon returned, saying that he was stammering worse than ever. investigation showed that the additional unpronounceable words contained the letter w. when he was induced to renounce his oath never to call the girl's name again, he found that he had no more difficulty with his speech.[ ] [footnote : h. addington bruce; "stammering and its cure," _mcclure's_, february, .] thus we see that even the halting tongue of a stammerer may point the way to the buried complex for which search is being made. since there is no accident in mental life, and since there is behind every action a force or group of forces, no smallest action is insignificant to the person trained to understand. if this at first seems disturbing, it is only because we do not realize that there is nothing within of which we need be ashamed. people are very much alike, especially in the deeper layers of their being. what belongs to the whole human race does not need to be hidden away in darkness. there is nothing to lose and everything to gain by an increasing understanding of the chance signals which reveal the forces at work within the depths of the mind. to the analyst every little unconscious act is a valuable clue pointing toward the end of his quest.[ ] [footnote : for further discussion of this subject, see freud's _psycho-pathology of everyday life_, translated by a.a. brill.] =the aim of psycho-analysis.= as we have seen, the object of all this technique is the discovery and the removal of the resistances which have been keeping the emotional conflicts in the dark. it is a long step just to learn that there are resistances; and by reliving, bit by bit, the earlier experiences responsible for unfortunate habits, we find that the habits themselves lose much of their old power. they can be seen for what they are, and changed to suit present conditions. a wish is incomparably stronger when unconscious than when conscious; and the old stereotyped, automatic reactions tend to cease when once they have been seen for what they are. they become assimilated with the rest of the personality and modified by the mature attitudes of the conscious mind. the person then re-educates himself by the very act of discovering himself. in other cases, the uncovering is merely the first step in the process of re-education. the analyst then assumes the rôle of educator, cutting away old shackles, breaking down false standards, building up new complexes, showing the patient the naturalness of his desires, inducing him to look at them as biologic facts, and showing him how to sublimate those which may not find direct expression; in fact, leading him out into the self-expression of a free, unhampered life.[ ] [footnote : "it will be readily understood that in the reconstruction of the shattered purposes, the frustrated hopes and the outraged instincts which are found to lie at the source of those human woes we call 'nervous disorders,' there takes place a gradual transposition of values, a total recasting of ideas, and that through the whole process, education in the deepest meaning of the word, enters at last into its full sovereign rights."--trigant burrow.] among my patients at one time was a woman subject to terrible fits of despondency. she was happily married and enjoyed the marriage relationship, but could not free herself from a terrible sense of guilt and degradation, a sense which was so acute that she wanted to end her life. although she was an active member of a church, she was starving for the real message of the church, continually bound by a feeling of aloofness which made her a stranger in the midst of friends. psycho-analysis revealed an experience of her childhood which she had kept a secret all these years. it seems that when she was seven years of age an old minister had driven her into town and had made some sort of sex-approach on the way. although ignorant of its significance, the child was badly frightened and overcome with a sense of guilt. she had already inferred that such subjects were not to be mentioned and she hesitated long before telling even her mother. smoldering within her through the years had been this emotional complex about the sex-life and about people connected with a church, so that even as a grown woman the relationships of her mature years were completely ruined by her old childish reaction. with insight as to the cause of her trouble, she was able to modify her attitudes and to live a free and happy life. several years ago there came to me a man of exceptional intellectual ability, who for years had been totally incapacitated because of blind resistances built up in childhood. although married to a woman whom he thoroughly liked and admired, he was absolutely miserable in his married life. he had, in fact, a deep-rooted complex against marriage, and had only allowed himself to be captured because the woman, with whom he had been good friends, had cried when he refused to marry her. during analysis it transpired that as a little boy of four he had often seen his silly young mother cry because she could not have a new dress. he had taken her side and bitterly felt that she was abused by his father. later, at six, he had heard some coarse stories about sex to which he had over-reacted. still later he had heard the workmen on the farm say that they could not go to the gold-fields because they had wives and were held back by marriage. "there are no idle words where children are," and this little boy had built up such a strong complex against marriage that he could not possibly be happy as a grown man. he was as much crippled by the old scar as is an arm which is bent and stunted from a deep scar in the flesh. after the analysis had broken up the adhesions, he found himself free, able to give mature expression to his repressed and dissatisfied love-instincts. psycho-analysis is not a process of addition, but one of subtraction. like a surgical operation, it undoes the results of old injuries, removes foreign material, and gives nature a chance to develop freely in her own satisfactory way. re-education without subconscious exploration =simple explanation.= so far, "the way out" sounds rather involved. it seems to require a special kind of doctor and a complicated, lengthy process before the exact trouble can be determined. but, fortunately for the average nervous patient, this lengthy process of analysis is by no means always necessary. people with troublesome nervous symptoms, and even those who have had a serious breakdown, are constantly being cured by a kind of re-education which breaks up subconscious complexes without trying to bring them to the surface. if the dead past can be let alone, so much the better. sometimes a bullet buried in the flesh sends up a constant stream of discomfort until it is dug out and removed; but if it has carried in no infection and the body can adjust itself, it is usually considered better to let it remain. the subconscious makes its own deductions. if resistances are not too strong it is often possible to introduce healthy ideas by way of the conscious reason, to break up old habits, and make over the mentality without going to the trouble of uncovering some of the reactions which are responsible for the difficulty. =moral hygiene.= because this is true, there has grown up a kind of psychotherapy which is known as simple explanation, or persuasion. as usually practised, this kind of re-education pays very little attention to the ultimate cause of "nerves." it has little to say about repressed instincts or the real reasons for fearful emotions and physical symptoms. instead, it attacks the symptom itself, contenting itself with teaching the patient that his trouble is psychic in origin; that it is based on exaggerated suggestibility and uncontrolled emotionalism; that it is made out of false ideas about the body, illogical conclusions, and unhealthy feeling-tones; and that it may be cured by a kind of moral hygiene, which breaks up these old habits and replaces them with new and better ones. it tries to inculcate the cheerful attitude of mind; to give the patient the conviction of power; to correct his false ideas about his stomach, his heart, or his head; to train him out of his emotionalism; to lead him into a state of mind more largely controlled by reason; and to make him find some useful and absorbing work. this kind of mental and moral treatment has been sufficient to cure many neuroses of long standing. in cases that are helped by this method, the patient's love-force, robbed of the material out of which it has woven its disguise, and trained out of its bad habits by re-education, automatically makes its own readjustments and forces new channels for itself out into more useful activities. very many nervous persons seem to need nothing more than this simple kind of help. =when simple explanation does not explain.= for very many cases, however, this procedure, good as it is, does not go deep enough. although it gives a sound objective education about the facts of one's body, it furnishes only the most superficial subjective knowledge of one's inner life. if the inner struggle be bitter, the competing forces will hold on to their poor refuge in the symptom, despite any number of explanations that the symptom can have no physical cause. sometimes it is enough for a person to be shown that he is too suggestible, but often it is far more helpful for him to get an inkling as to why he likes unhealthy suggestions, and to understand something of his starved instincts which he may learn to satisfy in better ways. psychological explanation between the two extremes of the cases which need a real analysis and those which are cured by simple explanation, i have found the great bulk of nervous cases. to simple explanation with its highly useful information, i therefore add what might be called psychological explanation, a re-education which makes use of all that illuminating material unearthed by the explorations of hypnosis and especially of psycho-analysis. along with correct ideas about such matters as digestion, sleep, and fatigue, i give, so far as the patient is able to understand, a comprehension of the rights of the denied instincts, the ways of the subconscious, the fettering hold of unfortunate childish habits, the various mental mechanisms by which we fool ourselves, and the ways by which we may make better adaptations. =according to the patient.= the treatment varies according to the nature of the trouble, and is somewhat dependent on the mentality of the patient. there are many people who would only be confused by being forced into a study of mental phenomena. not being students, they would be more bewildered than helped by the details of their inner mechanisms. others, of studious habits and inquiring minds, are encouraged to browse at will in a library of psychotherapy and to learn all that they can from the best authorities. in any case, i give the patients as much as they are able to take of my own understanding of the subject. there are no secrets in this method. the patient is treated as a rational human being who has nothing to lose and everything to gain by the fullest knowledge that he is able to acquire. without forcing him to plunge in over his depth, i encourage him to understand himself to the fullest possible extent. besides individual private conferences, we have twice a day an informal gathering of all the patients in my household--"the family" as we like to call ourselves--for a reading or talk on the various ways of the body and the mind, which need to be understood for normal living and for the cure of nerves. very often people of only average education, long without the opportunity of study, gain in a surprisingly short time enough insight to make new adaptations and cure themselves. for this, a college education is not nearly so important as an open mind. it is because of the success of this method that i have been encouraged to reach a larger number of people by means of a book, based on the same plan of re-education. =explanation vs. suggestion.= re-education through this kind of explanation is simply a matter of learning the truth and acting upon it. it is a process of real enlightenment, and is very different from suggestion which trades upon the patient's credulity, increasing his already exaggerated suggestibility. freud illustrates the difference between suggestion and psycho-analysis by saying that suggestion is like painting and psycho-analysis like sculpture. painting adds something from the outside, plastering over the canvas with extraneous matter, while sculpture cuts away the unnecessary material and reveals the angel in the marble. so suggestion covers over the real trouble by crying, "peace, peace, when there is no peace." without attempting to remove the cause, it says to the patient: "you have no pain. you are not tired. you will sleep to-night. you will be cheerful." sometimes the suggestion works and sometimes it does not, but at best the relief is likely to be a mere temporary makeshift. the symptom may be relieved, but the character is not changed and therefore no permanent relief is assured. it is far better for a nervous person to say to himself, "there is something wrong and i am going to find it," than to keep repeating over and over, "there is nothing wrong," and so on through a list of half-believed autosuggestions. on the other hand, psycho-analysis, and this kind of re-education based on psycho-analytic principles, do not pay a great deal of attention to the individual symptom. instead of adding from without they try to take away whatever has proved a hindrance to normal growth and development, and to remove unnecessary resistances which are responsible for the symptom, and which have been holding the patient back from the fullest self-expression. =incantation vs. knowledge.= there came to me one day a well-known public woman who had suffered from nervous indigestion for many years. as she was able to be with me for only one night, we had time for just one conversation, but in that time she discovered what she was doing and lost her indigestion. in the course of the conversation she turned to me, saying: "doctor, i know what a force suggestion is. i believe in its power. will you tell me why i have not been able to cure myself of this trouble? every night after i go to bed i repeat over and over these bible verses," naming a number of passages relating to god's goodness and care for his children. my answer was something like this: "you are too intelligent a woman to be cured by an incantation. when you feel surging up within you the sense of god's goodness, or when you actually want to realize his loving kindness, then by all means repeat the verses. but don't prostitute those wonderful words by making them into a charm and then expect them to cure your indigestion. it is a desecration of the words and a denial of your own intelligence. autosuggestion is a powerful force, but real psychotherapy is based not on the mechanical repetition of any set of words, but on a knowledge of the truth." =the "bullying method."= sometimes, to be sure, explanation is not enough. the brain paths between the associated ideas are so deeply worn that no amount of persuasion avails. it is easy for the doubter to say: "well, that sounds very well, but my case is different. i have tried over and over again and i know." with people of this sort, an ounce of demonstration is worth a pound of argument. by way of illustration we might mention the man who couldn't eat eggs. to be sure, he had tried many times but always had suffered the most intense cramps in his stomach, and no amount of talk could make him believe that an egg was not poison to him. i took the straight road of simply proving to him that he was mistaken, and had him eat an egg. after a time of apprehension and retching, he vomited the egg, thinking, of course, that he had proved his point. to his astonishment, i said, "now, let's go and eat another." with great consternation, he finally complied, evidently expecting to die on the spot; but as i immediately prescribed a game of tennis, he scarcely had time to think of the pain, which in fact failed to appear. however, as he thereafter insisted on eating four eggs a day,--with eggs at top-notch price i decided that the joke was on the doctor! =enjoying the right things.= in substituting healthful complexes for unhealthful ones, psychotherapy not only changes ideas and emotions, but alters the feelings of pleasure or pain that are bound up with the ideas. dr. tom a. williams writes: "the essence of psychotherapy and education is to associate useful activities with agreeable feeling-tones and to dissociate from injurious acts the agreeable feeling-tones that may have been acquired." right character consists not so much in enjoying things as in enjoying the right things. some people enjoy being martyrs. they love to tell about the terrible strain they have been under, the amount of work they have done, or the number of times they have collapsed. one of my patients gave every evidence of satisfaction as he told about his various breakdowns. "the last time i was ill," or "that time when i was in the sanatorium," were frequent phrases on his lips. finally, after i had asked him if he would boast about the number of times he had awkwardly fallen down in the street, and had shown him that a neurosis is not really a matter to be proud of, he saw the point and stopped taking pleasure in his mistakes. such signs of pleasure in the wrong things are evidence of suppressed wishes which we do not acknowledge but try to gratify in indirect ways.[ ] the pleasure which ought to be associated with the idea of good work well done has somehow been switched over to the idea of being an invalid. the satisfaction which ought to go with a sense of power and ability to do things has attached itself to the idea of weakness and inability. the pleasurable feeling-tone which normally belongs to ministering to others, regresses in the nervous invalid to the infantile satisfaction of being ministered unto. [footnote : for a further elaboration of this theme, see holt: _the freudian wish_.] but these things are only a habit. a good look in the mirror soon makes one right about face and start in the other direction. once started, a good habit is built up with surprising ease. it is really much more satisfying to cook a good dinner for the family's comfort than to think about one's ills; much pleasanter to enjoy a good meal than to insist on hot water and toast. once we have satisfied our suppressed longings in more desirable ways, or by a process of self-training have initiated a new set of habits, we feel again the old zest in normal affairs, the old interest and pleasure in activities which add to the joy of life. thus does re-education fit a man to take his place in the world's work as a socially useful being, no longer a burden, but a contributor to the sum total of human happiness. summary =knowing and doing.= having set out to learn how to outwit our nerves, we are now ready to sum up conclusions and in the following chapters to apply them to the more common nervous symptoms. it has been shown that a nervous person is in great need of change,--not, indeed, a change in climate or in scene, in work or in diet, but a change in the hidden recesses of his own being. outwitting nerves means first and foremost changing one's mind, an inner and spiritual process very different from the kind of change which used to be prescribed for the nervous invalid. as putnam says, the slogan of the suggestion-school of psychotherapy has always been, "you can do better if you try"; while that of the psycho-analytic school is, "you can do better when you know." refuting the old adage, "where ignorance is bliss 'tis folly to be wise," the best methods of psychotherapy insist that the first step in any thorough-going attempt to change oneself must be the great step of self-knowledge. as the conflicts which result in "nerves" are always far beyond those mental regions which are open to scrutiny, a real self-knowledge requires an examination of the half-conscious or wholly unconscious longings which are usually ignored. a real understanding of self comes only when one is willing, to analyze his motives until he sees the connection between them and his nervous symptoms, which are but the symbolic gratification of desires he dares not acknowledge. although these deeply buried complexes are the real force behind a nervous illness, the material out of which the symptoms are manufactured is taken largely from superficial misconceptions concerning the bodily functions. it is therefore a great help, also, to possess a fund of information,--not technical nor detailed but accurate as far as it goes,--about the more important workings of the bodily machinery. a little knowledge about the actual chemistry of fatigue and the way it is automatically cared for by the body is likely to do away with the idea of nervous exhaustion as resulting from accumulation of fatigue. a simple understanding of the biological and physiological facts concerning the assimilation of food and the elimination of waste material leaves the intelligent person less ready to convert his psychic discomfort into indigestion and constipation. chapters ix to xiii in this book, which at first glance may seem to belong to a work on physiology rather than on psychology are designed to give just such needed insight. but knowing the truth is only the first half of the way out. every neurosis is a deliberate choice by a part of the personality. self-discovery is helpful only when it leads to better ways of self-expression. the final aim of psychotherapy is the happy adjustment of the individual to the demands of society and the establishment of useful outlets for his energy. this phase of the subject will be discussed more fully in chapter xvi. =the future hope.= much has been said about the cure of a neurosis. there are enough people already in the maze of nervousness to warrant the setting up of numerous signs reading, "this way out." but after all, is not a blocking of the way in of vastly more importance? as it is always easier to prevent than to cure, so it is easier to train than to reform. if re-education is the cure, why is not education the ounce of prevention which shall settle the problem for all time? if the general public understood what "nerves" are, it is hardly conceivable that there could be so many breakdowns as there are at present. if a man's family and friends, to say nothing of himself, understood what he is doing when he suddenly collapses and has to quit work, it is not likely that he would choose that way out of his difficulties. most important of all, when parents know that the foundation of nervousness is laid in childhood, they will see to it that their children are started right on the road to health. when fathers and mothers realize that an over-strong bond between parents and children is responsible for a large proportion of nervous troubles, most of them will make sure that such exaggeration is not allowed to develop. and, finally, when parents are freed from their "conspiracy of silence" by a reverent attitude toward the whole of life, their very saneness will impart to their children a wholesome respect for the reproductive instinct. there will then be found in the next generation fewer half-starved men and women carrying the burden of unnecessary repressions and the pain of unsatisfied yearnings. not that such a day will usher in the millennium. we are not suggesting a panacea for all the social ills. there is an inevitable conflict between the instinctive urge of the life-force and the demands of society, a conflict which makes men and women either finer or baser, according to the way they handle it. what is claimed is that the right kind of education--using the word in its largest, deepest sense--will remove the most fruitful cause of nervousness by taking away the extra burden of misconception and making it easier for people to be "content with being moral."[ ] [footnote : frink: _morbid fears and compulsions._] chapter ix _in which we discover new stores of energy and learn the truth about fatigue_ that tired feeling unfailing resources "they that wait upon the lord shall renew their strength. they shall mount up with wings as eagles. they shall run and not be weary. they shall walk and not faint." it is safe to say that many a person loves this promise of the prophet isaiah without taking it in anything like a literal sense. the words are considered to be so figurative and so highly spiritualized that they seem scarcely to relate at all to this earthly life, much less to the possibilities of these physical bodies. besides the nervous folk who feel themselves so weary that they scarcely have strength to live, there are thousands upon thousands of men and women who are called normal but who have lost much of the joy of life because they feel their bodies inadequate to meet the demands of everyday living. to such men and women the biblical promise, "as thy day, so shall thy strength be," comes now as the message of modern science. nature is not stingy. she has not given the human race a meager inheritance. she did not blunder when she made the human body, nor did she allow the spirit of man to develop a civilization to whose demand his body is not equal. after its long process of development through the survival of the fittest, the human body, unless definitely diseased, is a perfectly adequate instrument, as abundantly able to cope with the complex demands of modern society as with the simpler but more strenuous life of the stone age. the body has stored within its cells enough energy in the shape of protein, carbohydrate and fat to meet and more than meet any drains that are likely to be made upon it, either through the monotony of the daily grind or the excitement of sudden emergency. nature never runs on a narrow margin. her motto seems everywhere to be, "provide for the emergency, enough and to spare, good measure, pressed down, running over." she does not start her engines out with insufficient steam to complete the journey. on the contrary, she has in most instances reserve boilers which are almost never touched. as a rule the trouble is not so much a lack of steam as the ignorance of the engineer who is unacquainted with his engine and afraid to "let her out." ="the energies of men."= perhaps nothing has done so much to reveal the hidden powers of mankind as that remarkable essay of professor william james, "the energies of men."[ ] listen to his introductory paragraph as he opens up to us new "levels of energy" which are usually "untapped": [footnote : james: _on vital reserves_.] every one knows what it is to start a piece of work, either intellectual or muscular, feeling stale--or _cold_, as an adirondack guide once put it to me. and everybody knows what it is to "warm up to his job." the process of warming up gets particularly striking in the phenomenon known as the "second wind." on usual occasions we make a practice of stopping an occupation as soon as we meet the first effective layer (so to call it) of fatigue. we have then walked, played or worked "enough," so we desist. that amount of fatigue is an efficacious obstruction on this side of which our usual life is cast. but if an unusual necessity forces us to press onward, a surprising thing occurs. the fatigue gets worse up to a certain critical point, when gradually or suddenly it passes away, and we are fresher than before. we have evidently tapped a level of new energy, masked until then by the fatigue-obstacle usually obeyed. there may be layer after layer of this experience. a third and fourth "wind" may supervene. mental activity shows the phenomenon as well as physical, and in exceptional cases we may find, beyond the very extremity of fatigue-distress, amounts of ease and power that we never dreamed ourselves to own, sources of strength habitually not taxed at all, because habitually we never push through the obstruction, never pass those early critical points. again professor james says: of course there are limits; the trees don't grow into the sky. but the plain fact remains that men the world over possess amounts of resource which only very exceptional individuals push to their extremes of use. but the very same individual, pushing his energies to their extreme, may in a vast number of cases keep the pace up day after day, and find no "reaction" of a bad sort, so long as decent hygienic conditions are preserved. his more active rate of energizing does not wreck him; for the organism adapts itself, and as the rate of waste augments, augments correspondingly the rate of repair.[ ] [footnote : ibid., pp. - .] another psychologist, boris sidis, writes: "but a very small fraction of the total amount of energy possessed by the organism is used in its relation with the ordinary stimuli of its environment."[ ] these men--professor james and dr. sidis--represent not young enthusiasts who ignorantly fancy that every one shares their own abundant strength, but careful men of science who have repeatedly been able to unearth unsuspected supplies of energy in "worn out" men and women, supposed to be at the end of their resources. every successful physician and every leader of men knows the truth of these statements. what would have happened in the great war if marshal foch had not known that his men possessed powers far beyond their ken, and had not had sublime faith in the "second wind"? [footnote : sidis: p. of the composite volume _pychotherapeutics_.] =what about being tired?= if all these things are true, why do people need to be told? if man's equipment is so adequate and his reserves are so ample, why after all these centuries of living does the human race need to learn from science the truth about its own powers? the average man is very likely to say that it is all very well for a scientist sitting in his laboratory to tell him about hidden resources, but that he knows what it is to be tired. is not the crux of the whole question summed up in that word "tired"? if we do not need to rest, why should fatigue exist? if the purpose of fatigue seems to be to slow down our efforts, why should we disregard it or seek to evade its warnings? the whole question resolves itself into this: what is fatigue? in view of the hampering effect of misconception on this point, it is evident that the question is not academic, but intensely practical. we shall find that fatigue is of two kinds,--true and false, or physical and moral, or physiological and nervous,--and that while the two kinds feel very much alike, their origin and behavior are quite different. physiological fatigue =fatigue, not exhaustion.= in the first place, then, fatigue very seldom means a lack of strength or an exhaustion of energy. the average man in the course of a lifetime probably never knows what it is to be truly exhausted. if he should become so tired that he could in no circumstances run for his life, no matter how many wild beasts were after him, then it might seem that he had drained himself of all his store of energy. but even in that case, a large part of his fatigue would be the result of another cause. =a matter of chemistry.= true fatigue is a chemical affair. it is the result of recent effort,--physical, mental, or emotional,--and is the sum of sensations arising from the presence of waste material in the muscles and the blood. the whole picture becomes clear if we think of the body as a factory whose fires continuously burn, yielding heat and energy, together with certain waste material,--carbon dioxide and ash. within man's body the fuel, instead of being the carbon of coal is the carbon of glycogen or animal starch, taken in as food and stored away within the cells of the muscles and the liver. the oxygen for combustion is continuously supplied by the lungs. so far the factory is well equipped to maintain its fires. nor does it fail when it comes to carrying away waste products. like all factories, the body has its endless chain arrangement, the blood stream, which automatically picks up the debris in its tiny buckets--the blood-cells and serum--and carries it away to the several dumping-grounds in lungs, kidneys, intestines, and skin. besides the products of combustion, there are always to be washed away some broken-down particles from the tissues themselves, which, like all machinery, are being continuously worn out and repaired. by chemical tests in the laboratory, the physiologist finds that a muscle which has recently been in violent exercise contains among other things carbon dioxid, urea, creatin, and sarco-lactic acid, none of which are found in a rested muscle. since all this debris is acid in reaction and since we are "marine animals," at home only in salt water or alkaline solution, the cells must be quickly washed of the fatigue products, which, if allowed to accumulate, would very soon poison the body and put out the fires. =no back debts.= the human machine is regulated to carry away its fatigue products as fast as they are made, with but slight lagging behind that is made good in the hours of sleep, when bodily activities are lessened and time is allowed for repair. unless the body is definitely diseased, it virtually never carries over its fatigue from one day to another. in the matter of fatigue, there are no old debts to pay. nature renews herself in cycles, and her cycle is twenty-four hours,--not nine or ten months as many school-teachers seem to imagine, or eleven months as some business men suppose. in order to make assurance doubly sure, many set apart every seventh day for a rest day, for change of occupation and thought, and for catching up any slight arrears which might exist. but the point is that a healthy body never gets far behind. if through some flaw in the machine, waste products do pile up, they destroy the machine. if the heart leaks or the blood-cells fail in their carrying-power, or if lungs, kidneys or skin are out of repair, there is sometimes an accumulation of fatigue products which poisons the whole system and ends in death. but the person with tuberculosis or heart trouble does not usually allow this to happen. the body incapacitated by disease limits its activities as closely as possible within the range of its power to take care of waste matter. even the sick body does not carry about its old toxins. the man who had not eliminated the poisons of a month-old effort would not be a tired man. he would be a dead man. =a sliding scale.= if all this be true, real fatigue can only be the result of recent effort. if one is still alive, the results of earlier effort must long since have disappeared. the tissue-cells retain not the slightest trace of its effects. fatigue cannot possibly last, because it either kills us or cures itself. up to a certain point, far beyond our usual high-water mark, the more a person does the more he can do. as professor james has pointed out, the rate of repair increases with the rate of combustion. under unusual stress, the rate of the whole machine is increased: the heart-pump speeds up, respirations deepen and quicken, the blood flows faster, the endless chain of filling and emptying buckets hurries the interchange of oxygen and carbon dioxid, until the extreme capacity is reached and the organism refuses to do more without a period of rest. the whole arrangement illustrates the wonderful provisions of nature. although each individual is continuously manufacturing enough carbonic-acid gas to kill himself in a very few minutes, he need not be alarmed for fear that he may forget to expel his own poisons. nobody can hold his breath for more than a few minutes. the naughty baby sometimes tries, but when he begins to get black in the face, he takes a breath in spite of himself. the presence of carbonic-acid gas in the circulation automatically regulates breathing, and the greater the amount of gas the deeper the breath. the faster we burn the faster we blow. as with breathing, so with all the rest of elimination and repair. the body dares not get behind. ="second wind."= a city man frequently sets out on a mountain tramp without any muscular preparation for the trip. he walks ten or fifteen miles when his average is not over one or two. sometimes after a few hours he feels himself exhausted, but a glorious view opens out before him and he goes on with new zest. he has merely increased his rate of repair and drawn on a new stock of energy. that night he is tired, and the next day he is likely to be stiff and sore. there is a little fatigue left in him, but it takes only a day or two for the body to be wholly refreshed, especially if he hastens the process by another good walk. up to a certain point, far beyond our usual limit, the more we do, the more we can do. one day after a long walk my little daughter said that she could go no farther and waited to be carried. but she soon spied a dog on ahead and ran off after him with new zest. she followed the dog back and forth, running more than a mile before she reached home, and then in the exuberance of her spirits, ran around the house three times. =the emotions again.= what is the key that unlocks new stores of energy and drives away fatigue? what is it in the amateur mountain-climbers that helps the body maintain its new standard? what keeps indefatigable workers on the job long after the ordinary man has tired? is it not always an invigorating emotion,--the zest of pursuit, the joy of battle, intense interest in work, or a new enthusiasm? all great military commanders know the importance of morale. they know that troops can stand more while they are going forward than while running away, that the more contented and hopeful they are, the better fighters they make; discouragement, lack of interest, the fighting of a losing game, dearth of appreciation, futility of effort, monotony of task, all conspire in soldier or civilian to use up and to lock up energy which might have been available for real work. approaching the matter from a new angle, we find once more that the difference between strength and weakness is in many cases merely a difference in the emotions and feeling-tones which habitually control. fatigue is a safety-device of nature to keep us within safe limits, but it is a device toward which we must not become too sensitive. as a rule it makes us stop long before the danger point is reached. if we fall into the habit of watching its first signals, they may easily become so insistent that they monopolize attention. attention increases any sensation, especially if colored by fear. fear adds to the waste matter of fatigue little driblets of adrenalin and other secretions which must somehow be eliminated before equilibrium is reestablished. this creates a vicious circle. we are tired, hence we are discouraged. we are discouraged, hence we are more tired. this kind of "tire" is a chemical condition, but it is produced not by work but by an emotion. he who learns to take his fatigue philosophically, as a natural and harmless phenomenon which will soon disappear if ignored, is likely to find himself possessed of exceptional strength. we can stand almost any amount of work, provided we do not multiply it by worry. we can even stand a good deal of real anxiety provided it is not turned in on ourselves and directed toward our own health. ="decent hygienic conditions."= if fatigue products cannot pile up, why is extra rest ever needed? because there is a limit to the supply of fuel. if the fat-supply stored away for such emergencies finally becomes low, we may need an extra dose of sleeping and eating in order to let the reservoirs fill again. but this never takes very long. the body soon fills in its reserves if it has anything like common-sense care. the doctrine of reserve energy does not warrant a careless burning of the candle at both ends. it presupposes "decent hygienic conditions,"--eight hours in bed, three square meals a day, and a fair amount of fresh air and exercise. ="over there."= on the other hand, the stories that floated back to us from the war zone illustrate in the most powerful way what the human body can do when necessity forbids the slightest attention to its needs. one of the best of these stories is dorothy canfield's account of dr. girard-mangin, "france's fighting woman doctor." better than any abstract discussion of human endurance is this vibrant narrative of that little woman, "not very strong, slightly built, with some serious constitutional weakness," who lived through hardships and accomplished feats of daring which would have been considered beyond the range of possibility--before the war. think of her out there in her leaky makeshift hospital with her twenty crude helpers and her hundreds of mortally sick typhoid patients; four hundred and seventy days of continuous service with no place to sleep--when there was a chance--except a freezing, wind-swept attic in a deserted village. think of her in the midst of that terrible battle of verdun, during four black nights without a light, among those delirious men, and then during the long, long ride with her dying patients over the shell-swept roads. listen to her as she speaks of herself at the end of that ride, without a place to lay her head: "oh, then i did feel tired! that morning for the first time i knew how tired i was, as i went dragging myself from door to door begging for a room and a bed. it was because i was no longer working, you see. as long as you have work to do you can go on." then listen to her as she receives her orders to rush to a new post, before she has had time to lay herself on the bed she has finally found. "then at once my tiredness went away. it only lasted while i thought of getting to bed. when i knew we were going into action once more, i was myself again." watch her as she rides on through the afternoon and the long dangerous night; as she swallows her coffee and plum-cake, and operates for five hours without stopping; as she sleeps in the only place there is--a "quite comfortable chair" in a corner; and as she keeps up this life for twenty days before she is sent--not on a vacation, mind you, but to another strenuous post.[ ] [footnote : dorothy canfield: _the day of glory._] this brave little woman is not an isolated example of extraordinary powers. the human race in the great war tapped new reservoirs of power and discovered itself to be greater than it knew. professor james's assertions are completely proved,--that "as a rule men habitually use only a small part of the powers which they actually possess," and that "most of us may learn to push the barrier (of fatigue) further off, and to live in perfect comfort on much higher levels of power." =how?= the practical question is: how may we--the men and women of ordinary powers, away from the extraordinary stimulus of a crisis like the great war--attain our maximum and drop off the dreary mantle of fatigue which so often holds us back from our best efforts? it may be that the first step is simply getting a true conception of physical fatigue as something which needs to be feared only in case of a diseased body, and which is quite likely to disappear under a little judicious neglect. in the second place, fatigue shows itself to be closely bound up with emotions and instincts. the great releasers of energy are the instincts. what but the mothering instinct and the love of country could uncover all those unsuspected reserves of dr. girard-mangin and others of her kind? what is it but the enthusiasm for work which explains the indefatigable energy of edison and roosevelt? if the wrong kind of emotion locks up energy, the right kind just as surely unlocks great stores which have hitherto lain dormant. if most people live below their possibilities, it is either because they have not learned how to utilize the energy of their instinctive emotions in the work they find to do, or because some of their strongest instincts which are meant to supply motive power to the rest of life are locked away by false ideas and unnecessary repressions, and so fail to feed in the energy which they control. in such a case, the "spring tonic" that is needed is a self-knowledge which shall release us from hampering inhibitions and set us free for enthusiastic self-expression. nervous fatigue _what of the nervous invalid?_ if the normal man lives constantly below his maximum, what shall we say of the nervous invalid? fatigability is the very earmark of his condition. in many instances he seems scarcely able to raise his hand to his head. sometimes he can scarcely speak for weariness. frequently to walk a block sends him to bed for a week. i once had a patient who felt that she had to raise her eyelids very slowly for fear of over-exertion. she could speak only about two or three words a day, the rest of the time talking in whispers. she could not raise a glass to her lips if it were full of water, but could manage it if only half full. a person nearly dead with some fatal disease does not appear more powerless than a typical neurasthenic. if it he true that accumulation of fatigue is promptly fatal, what shall we say of the woman who says that she is still exhausted from the labor of a year ago,--or of ten years ago? what of the business man who travels from sanatorium to sanatorium because five years ago he went through a strenuous year? what of the college student who is broken down because he studied too hard, or the teacher who is worn out because of ten hard years of teaching? there can be but one answer. no matter what their feelings, they can be suffering from no true physiological fatigue. something very real has happened to them, but only through ignorance and the power of suggestion can it be called fatigue and attributed to overwork. =stories of real people.= perhaps if we look over the stories of a few people who have been members of my household, we may work our way to an understanding of the truth. we give only the barest outline of the facts, thinking that the cumulative effect of a number of cases will outweigh a more detailed description of one or two. the most casual survey shows that whatever it was that burdened these fine men and women, it was not lack of energy. no matter how extreme had been their exhaustion, they were able at once, without rest or any other physical treatment, to summon strength for exertions quite up to those of a normal person. the second point that stands out clearly to any one acquainted with these inner histories is the conviction that in each case the trouble was related in some way to the unsatisfied love-life, to the insistent and thwarted instinct of reproduction. in some cases no search was made for the cause. the simple explanation that there was no lack of power was sufficient to release inhibited energy. but in every case where the cause was sought, it was found to be some outer lack of satisfaction, or some inner repression of the love-force. =from prostration to tennis.= one young woman, miss a., had suffered for ten years from the extremest kind of fatigue. she could not walk a block without support and without the feeling of great exhaustion. before her illness she had had a sweetheart. not understanding her normal physical sensations when he was near, she had felt them extremely wicked and had repressed them with all her strength. later, she broke off the engagement, and a little while after developed the neurosis. within a week after coming to my house, she was playing tennis, walking three miles to church, and generally living the life of a normal person. =making her own discoveries.= then there was miss b. who for four years had been "exhausted." she had such severe pains in her legs that she was almost helpless. if she sewed for half an hour on the sewing machine, she would be in bed for two weeks. although she was engaged to be married, she could not possibly shop for her trousseau. two years before, a very able surgeon had been of the opinion that the pain in the legs was caused by an ovarian tumor. he removed the tumor, assuring the patient that she would be cured. however, despite the operation and the force of the suggestion, the pains persisted. after she had been with me for a few days, she sewed for an hour on the machine. in a day or so she took a four-mile walk in a cañon near the house and, on returning in the afternoon, walked two and a half miles down town to do some shopping. i did not make an analysis in her case because she recovered so quickly,--going home well within two weeks. but she declared that she had found the cause while reading in one of the books on psychology. i had my suspicions that the long-drawn-out engagement had something to do with the trouble, but i did not confirm my opinion. a long engagement, by continually stimulating desire without satisfying it, only too often leads to nervous illness. =afraid of heat.= professor x., of a large eastern college, had been incapacitated for four years with a severe fatigue neurosis and an intense fear of heat. constantly watching the weather reports, he was in the habit of fleeing to the maine coast whenever the weather-prophet predicted warm weather. after a short reëducation, he discovered that his fatigue was symbolic of an inner feeling of inadequacy, and that it bore no relation to his body. discarding his weariness and throwing all his energies into the liberty loan campaign, he found himself speaking almost continuously throughout one of the hottest days in the history of california, with the thermometer standing at degrees. after that he had no doubt as to his cure. =in bed from fear.= miss c. was carried into my house rolled in a blanket. she had been confined to her bed except for fifteen minutes a day, during which time she was able to lie in a hammock! it seems that her illness was the result of fear, an over-reaction to early teaching about self-abuse. her mother had frightened her terribly by giving her the false idea that this practice often leads to insanity. having indulged in self-abuse, she believed herself going insane, and very naturally succumbed to the effects of such a fear. after a few days of re-education, she was as strong as any average person. having no clothing but for a sick-room, she borrowed hat, skirt, and shoes, and walked to church, a three-mile walk. =empty hands.= miss y., a fine woman of middle age, suffering from extreme fatigue could neither sleep nor eat. she could only weep. she had spent her life taking care of an invalid girl who had recently died. now her hands were empty. like many a mother whose family has grown up, she had no outlet for her mothering instinct, and her sense of impotency expressed itself in the only way it knew how,--through her body. as there is never any lack of unselfish work to be done, or of people who need mothering, she soon found herself and learned how to sublimate her energy in useful activities. =defying nature.= one young man from wyoming had felt himself obliged to give up his business because he could neither work nor eat. it soon cropped out that he and his wife had decided that they must not have any children. with a better understanding of the great forces which they were defying, his strength and his appetite came back and he went back to work, rejoicing. =left-over habits.= often a state of fatigue is the result of a carried-over habit. one of my patients, a young girl, had several years before been operated on for exophthalmic goiter. this is a disease of the thyroid gland, and is characterized by rapid heart, extreme fatigue, and numerous other symptoms. although this girl's goiter had been removed, the symptoms still persisted. she could not walk nor do even a little work, like wiping a few dishes. i took her down on the beach, let her feel her own pulse and mine and then ran with her on the sand. again i let her feel our pulses and discover for herself that hers had quickened no more than was normal and had slowed down as soon as mine. after a few such lessons, she was convinced that her symptoms were reverberations for which there was no longer any physical cause. another young girl, miss l., had had a similar operation for goiter six years before. since that time she had been virtually bedridden. during the first meal she had at my house her sister sat by her couch because she must not be left alone. by the second meal the sister had gone, and miss l. ate at the table with the other guests. that night she managed to crawl upstairs, with a good deal of assistance and with great terror at the probable results of such an effort. after that, she walked up-stairs alone whenever she had occasion to go to her room. her heart will always be a little rapid and her body will never be very strong, but she now lives a helpful happy life at home and among her friends. in cases like this the exaggeration proves the counterfeit. nobody could have been so down and out _physically_ without dying. the exaggeration secures attention and gives the little satisfaction to the natural desires which are denied expression, and which gain an outlet through habit along the lines previously worn by the real disease. many a person is still suffering from an old pain or an old disability whose cause has long since disappeared, but which is stamped on the mind and believed in as a present reality. since the sensation is as real as ever, it is sometimes very hard to believe that it is not legitimate, but if the person is intelligent, a little explanation and re-education usually suffices. =twenty years an invalid.= mr. s., from ohio, had spent much of his time for twenty years going from one sanatorium to another. there was scarcely a health resort in the country with which he was not familiar. the day he came to me he felt himself completely exhausted by the two-block walk from the car. he explained that he could scarcely listen to what i was saying because his brain was so fagged that concentration was impossible. when asked to read a book, he dramatically exclaimed, "books and i have parted company!" i set him to work reading "dear enemy" but it was not a week before he was devouring the deeper books on psychology, in complete forgetfulness of the pains in his head. playing golf and walking at least six miles every day, he rejoiced in a new sense of strength in his body, which for twenty years he had considered "used up." he is now doing a man-sized job in the business and philanthropic life of his home city. =brain-fag.= this feeling of brain-fag is one of the commonest nervous symptoms; and almost always it is supposed to be the result of intellectual overwork. some people who easily accept the idea that physical work cannot cause nervous breakdown can scarcely give up the deep-rooted notion that intense mental work is harmful. intellectual effort does give rise to fatigue in exactly the same way as does physical exertion, but the body takes care of the waste products of the one just as it does those of the other. du bois says that out of all his nervous cases he has not found one which can be traced to intellectual overwork. i can say the same thing, and i know no case in all the literature of the subject whose symptoms i can believe to be the result of mental labor. the college students who break down are not wrecked by intellectual work. in some cases, one strong factor in their undoing is the strain and readjustment necessary because of the discrepancies between some of their deepest religious beliefs and the truth as they learn it in the class-room. the other factors are merely those which play their part in any neurosis. =re-educating the teacher.= school-teachers are prone to believe themselves worn out from the mental work and the strain of the strenuous life of teaching. many a fine, conscientious teacher has come to me with this story of overwork. but the school-teacher is as easily re-educated as is any one else. i usually begin the process by stating that i taught school myself for ten years and can speak from experience. after i explain that there is no physical reason why the teachers of some cities are fagged out at the end of nine months while those in other cities whose session is longer can hold on for ten months, and stenographers who lead just as strenuous a life manage to exist with only a two-weeks' vacation, they begin to see that perhaps after all they have been fooling themselves by a suggestion, "setting" themselves for just so long and expecting to be done up at the end of the term. many of these same teachers have gone back to their work with a new sense of "enough and to spare" and some of them have written back that they have passed triumphantly through especially trying years with no sense of depletion. in any work, it is the feeling of strain which tells, the emotionalism and feeling sorry for oneself because one has a hard job. it is wonderful what a sense of power comes from the simple idea that we are equal to our tasks. =sudden relief.= the story of mr. v. illustrates professor james's statement that often the fatigue gets worse up to a certain critical point, and then suddenly passes away. mr. v. was another patient who was "physically exhausted." when the rest of "the family" went clamming on the beach, he felt himself too weak for such exertions, so i left him on the sand to hold the bag while the rest of us dug for clams. the minute i turned my back he disappeared. i found him lying flat on his back, resting, behind the bulk-head. i decided that he needed the two-mile walk home and we all set out to walk. "doctor, this is cruel. it is dangerous. my knees can never stand this. i shall be ill!" ran the constant refrain for the first mile. then things went a bit better. toward the last he found, to his absolute astonishment, that the fatigue had entirely rolled away. the last half-mile he accomplished with perfect ease. needless to say, he never again complained of physical exhaustion. =false neuritis.= miss t. was suffering from fatigue and very severe pains in her arms, pains which were supposed to be the result of real neuritis, but which did not correspond to the physiological picture of that disease. a consultation revealed the fact that her love-instinct had been repeatedly stimulated, and then at the last, when it had expected satisfaction, had been disappointed. a discussion of her life, its inner forces, and her future aims helped to pull her together again and give her instinct new outlets. the pains and the fatigue disappeared at once. =something wrong.= these cases are chosen at random and are typical of scores of others. in no single case was the trouble feigned or imaginary or unreal. but in every case it was a mistake. _the sense of loss of muscular power was really a sense of loss of power on the part of the soul._ some inner force was reaching out, reaching out after something which it could never quite attain. as it happened, in every case that i analyzed, the force which felt itself defeated and inadequate was the thwarted instinct of reproduction. like a man pinned to the ground by a stronger force, it felt itself most helpless while struggling the hardest. just as we feel a thrill of fright when we step up in the dark and find no step there, so this instinct had gotten itself ready for a step which was not there. inner repressions or outer circumstances had denied satisfaction and left only an undefined sense that something was wrong. the life-force, feeling itself helpless, limp, tired, had no way of expressing itself except in terms of the body. since expression is itself a relief and an outlet for feeling, the denied desire had seized on suggestions of overwork to explain its sense of weariness, and had symbolized its soul-pain by converting it into a physical pain. the feeling of inadequacy was very real, but it was simply displaced from one part of the personality to another,--from an unknown, inarticulate part to one which was more familiar and which had its own means of expression. =locked-up energy.= we do not know just how the soul can make its pain so intensely real to the body, but we do know that any conviction on the part of the subconscious mind is quickly expressed in the physical machine. a conviction of pain or of powerlessness is very soon converted into a feeling which can scarcely be denied. the mere suggestion that the body is overworked is enough to make it tired. we know, too, that the instincts are the great releasers of energy. so it happens that when our most dynamic instinct--that for the reproduction of the race--is repressed, we lack one of the greatest sources of usable energy. the energy is there, but it is not accessible. inhibited and locked away, it is not fed into the engine, and we feel exactly as though it were _nil_. despite its name, the disease neurasthenia does not signify a real asthenia or weakness. rather, it is a disorder in which there is plenty of energy that has somehow been temporarily misplaced. then, too, we must remember that under the depressing influence of chronic fear, not quite so much energy is stored away as would otherwise be. all the bodily functions are slowed down; food is not so completely assimilated, the heart-beat is weakened, the breathing is more shallow, and fatigue products are more slowly eliminated. as du bois says, "an emotion tires the organism more than the most intense physical or intellectual work." =avoid the rest-cure.= it is a healthful sign that the rest-cure is fast going out of style. wherever it has helped a nervous patient, the real curative agent has been the personality of the doctor and the patient's faith in him. the whole theory was based on ignorance of the cause of nerves. people suffering from "nervous exhaustion" are likely to be just as "tired" after a month in bed as they were before. why not? physical fatigue is quickly remedied, and what can rest do after that? what possible effect can rest have on the fatigue of a discouraged instinct? since the best releaser of energy is enthusiasm, don't try to get that by lying around in bed or playing checkers at a health resort. summary if you are chronically and perpetually fatigued, or if you tire more easily than the other people you know, consult a competent physician and let him look you over. if he tells you that you have neither tuberculosis, heart trouble, bright's disease, nor any other demonstrable disease, that you are physically fit and "merely nervous," give yourself a good shake and commit the following paragraphs to memory. a catechism for the weary one what? q. what is fatigue? a. it is a chemical condition resulting from effort that is very recent. q. what else creates fatigue? a. worry, fear, resentment, discontent, and other depressing emotions. q. what magnifies fatigue? a. attention to the feeling. q. what makes us weary long after the cause is removed? a. habit. why? q. why do many people believe themselves over-worked? a. because of the power of suggestion. q. why do they take the suggestion? a. because it serves their need and expresses their inner feelings. q. why are they willing to choose such an uncomfortable mode of expression? a. because they don't know what they are doing, and the subconscious is very insistent. who? q. who gets up tired every morning? a. the neurotic. q. who fancies his brain so exhausted that a little concentration is impossible? a. the neurotic. q. who still believes himself exhausted as the result of work that is now ancient history? a. the neurotic. q. who lays all his woes to overwork? a. the neurotic. q. who complains of fatigue before he has well begun? a. the neurotic. q. who may drop his fatigue as soon as he "gets the idea?" a. the neurotic. how? q. how can he get the idea? a. by understanding himself. q. how may he express his inner feelings? a. by choosing a better way. q. how can he forget his fatigue? a. by ignoring it. q. how can he ignore it? a. by finding a good stiff job. if he wants advice in a nutshell, here it is: get understanding! get courage! get busy! chapter x _in which the ban is lifted_ dietary taboos misunderstood stomachs =modern improvements.= most people have heard the story of the little girl who wanted to know what made her hair snap. after she had been informed that there was probably electricity in her hair, she sat quiet for a few minutes and then exclaimed: "our family has all the modern improvements! i have electricity in my hair and grandma has gas on her stomach!" judged by this standard many american families are well abreast of the times; and if we include among the modern improvements not only gas on the stomach but also nervous dyspepsia, acid stomach, indigestion, sick-headache, and biliousness, we must conclude that a good proportion of the population is both modern and improved. despite all this the stomach is one of the best-equipped mechanisms in the world. it, at least, is not modern. after their age-long development the organs of the body are remarkably standardized and adapted to the work required of them. it is safe to say that ninety per cent. of all so-called "stomach trouble" is due not to any inherent weakness of the organ itself but to a misunderstanding between the stomach and its owner. =organic trouble.= unfortunately, there are a few real organic causes for trouble. there are a few cancers of the stomach and a certain number of ulcers. but if the patients whom i have seen are in any way typical, the ulcers that really are cannot compare in number with the ulcers that are supposed to be. patients go to physicians with so many tales of digestive distress that even the best doctors are fooled unless they are especially alert to the ways of "nerves." they must find some explanation for all the various functional disturbances which the patients report, and as they are in the habit of taking only the body into account, they find the diagnosis of stomach ulcer as satisfactory as any. there is, of course, such a thing as an enlarged or sagging stomach. but it is only in the rarest of cases that such a condition leads to any functional disturbances unless complicated by suggestion. in most cases a person can go about his business as happily as ever unless he gets the idea that ptosis must inevitably lead to pain and discomfort. confusion sometimes arises when the stomach is blamed for disturbances which originate elsewhere. one day a very sick-looking girl came to me with eager expectation written all over her face. her stomach was misbehaving and she had heard that i could cure nervous indigestion. it needed little more than a glance to know that she was suffering from organic heart trouble. a boy of sixteen had been taking a stomach-tonic for three months, but the thin, wiry pulse pointed to a different ailment. his digestive disturbances were merely the echo of an organic disease of the kidneys. when the body is burdened by disease, it may have little energy left for digesting food, but in that case the trouble must be sought in other quarters than the stomach. aside from a few organic difficulties, there is almost no real disease of the stomach. its misdoings are not matters of food and chemistry, muscle-power and nerve supply, but are the end results of slips in the mental and emotional life of its owner. =fads dynamogenic.= what is it that gives the impetus to fads about eating, or about religious belief? are they advocated by the individual whose libido is finding abundant expression in the natural channels of business and family life, or by his less fortunate brother who can gain a sense of power only by means of some unaccustomed idea? william james says: this leads me to say a word about ideas considered as dynamogenic agents or stimuli for unlocking what would otherwise be unused reservoirs of individual power.... in general, whether a given idea shall be a live idea depends more on the person into whose mind it is injected than on the idea itself. which is the suggestive idea for this person and which for that one? mr. fletcher's disciples regenerate themselves by the idea (and the fact) that they are chewing and re-chewing and super-chewing their food. dr. dewey's pupils regenerate themselves by going without their breakfast--a fact, but also an ascetic idea. not every one can use these ideas with the same success. because it is so adaptable and sturdy, the stomach lends itself readily to these devices for gaining self-expression; but the danger lies in bringing the process of digestion into conscious attention which interferes with automatic functioning. still further, the disregard of physiological chemistry is likely to deprive the body of food-stuffs which it requires. the average person is too sensible to be carried off his feet by the enthusiasm of the health-crank, but as most of us are likely to pick up a few false notions, it may be well to be armed with the simple principles of food chemistry in order to combat the fads which so easily beset us and to know why we are right when we insist on eating three regular meals of the mixed and varied diet which has proved best for the race through so many years of trial and experience. what we need to eat =the essence of dietetics.= to the layman the average discussion of food principles is, to say the least, confusing. dealing largely, as it does, with unfamiliar terms like carbohydrate and hydrocarbon and calories, it is hard to translate into the terms of the potatoes left over from dinner and the vegetables we can afford to buy. but the practical deductions are not at all difficult to understand. boiled down to their simplest terms, the essential principles may be stated in a few sentences. the body must secure from the food that we eat, tissue for its cells, energy for immediate use or to be stored for emergency, mineral salts, vitamins, water and a certain bulk from fruits and vegetables,--this latter to aid in the elimination of waste matter. food for repairing bodily tissue is called protein and is secured from meat, eggs, milk, and certain vegetables, notably peas. fuel for heat and energy is in two forms--carbohydrate (starch and sugar) and fat. we get sugar from sugar-cane and beets, and from syrups, fruit, and honey. starch is furnished from flour products--mainly bread--from rice, potatoes, macaroni, tapioca, and many vegetables. fats come from milk and butter, from nuts, from meat-fat--bacon, lard and suet--and from vegetable oils. the mineral salts are obtained mainly from fruit and vegetables, which also provide certain mysterious vitamins necessary for health, but as yet not well understood. =what the market affords.= the moral from all this is plain. the human body needs all the foods which are ordinarily served on the table. whenever, through fad or through fear, we leave out of our diet any standard food, we are running a risk of cutting the body down on some element which it needs. they say that variety is the spice of life. in the matter of food it is more than that, it is the essence of life. eat everything that the market affords and you will be sure to be well nourished. if you leave out meat you will make your body work overtime to secure enough tissue material from other foods. if you leave out white bread, you will lose one of the greatest sources of energy. if you leave out tomatoes and cucumbers and strawberries, you deprive your body of the salts and vitamins which are essential. =a simple rule.= there is one point that is good to remember. the average person needs twice as much starch as he needs of protein and fat together. that is, if he needs four parts of protein and three of fat, he ought to eat about fourteen parts of starch. this does not mean that we need to bother ourselves with troublesome tables of what to eat, but only to keep in mind in a general way that we need more bread and potatoes than we do meat and eggs. the body does not have to rebuild itself every day. it is probable that a good many people eat too much protein food. if a man is doing hearty work he must have a good supply of meat, but the average person needs only a moderate amount. here again, the habits of the more intelligent families are likely to come pretty near the dictates of science. =for the children.= the mother of a family ought to know that the children need plenty of bread, butter, and milk. despite all the notions to the contrary, good well-baked white bread is neither indigestible nor constipating. it is indeed the staff of life. two large slices should form the background of every meal, unless there is an extraordinary amount of other starchy food or unless the person is too fat. milk-fat (from whole milk, cream, and butter) is by far the best fat for children. besides fat, it furnishes a certain growth-principle necessary for development. as the dairyman cannot raise good calves on skimmed milk, so we cannot raise robust children without plenty of butter and milk. the pity of it is that poor people are forced to try! milk is also the best protein for children, whose kidneys may be overstrained by trying to care for the waste matter from an excessive quantity of eggs and meat. bread and butter, milk, fruit, vegetables, and sugar in ample quantities and meat and eggs in moderate quantities are pretty sure to make the kind of children we want. above all things, let us train them not to be afraid of normal amounts of any regular food or of any combination of foods. =the fear of mixtures.= there are many people who can without flinching face almost any single food, but who quail before mixtures. perhaps there is no notion which is more firmly entrenched in the popular mind than this fear of certain food-combinations, acquired largely from the advertisements of certain so-called "food specialists." the most persistent idea is the fear of acid and milk. it is interesting to watch the new people when they first come to my table. confronted with grape-fruit and cream at the same meal, or oranges and milk, or cucumbers and milk, they eat under protest, in consternation over the disastrous results that are sure to follow. out of all these scores of people, many of whom are supposed to have weak stomachs, i have never had one case of indigestion from such a combination. when a person knows that the stomach juices themselves include hydrochloric acid which is far more acid than any orange or grapefruit, that the milk curdles as soon as it reaches the stomach, and that it must curdle if it is to be digested, he has to be very "set" indeed if he is to cling to any remnant of fear. of course to say that the stomach is well prepared chemically, muscularly, and by its nerve supply to handle any combination of ordinary food in ordinary amounts is not the same thing as saying that we may devour with impunity any amount of anything. it is a good thing for every one to know when he has reached his limit, and a person with organic heart disease should avoid eating large quantities at one time, or when he is extraordinarily fatigued or emotionally disturbed, lest at such a time he may put a fatal strain on the pneumogastric nerve that controls both stomach and heart. the fear of certain foods =physical idiosyncrasies.= most of our false fears on food subjects come from some tradition--either a social tradition or a little private, pet tradition of one's own. some one once was ill after eating strawberries and cream. what more natural than to look back to those little curdles in the dish and to start the tradition that such mixtures are dangerous? the worst of it is that the taboo habit is very likely to grow. one after another, innocent foods are thrown out until one wonders what is left. a patient of mine, mr. g., told me that he had a short time before gone to a physician with a tale of woe about his sour stomach. "what are you eating?" asked the doctor. "bran crackers and prunes." "then," said the learned doctor, "you will have to cut out the prunes!" needless to say, this man ate everything at my table, and flourished accordingly. there may be such a thing as physical idiosyncrasies for certain foods. i have often heard of them, but i have never seen one. i have often challenged my patients to show me some of the "spells" which they say invariably follow the eating of certain foods, but i have almost never been given an exhibition. the man who couldn't eat eggs did throw up once, but he couldn't do it a second time. many people have threatened to break out with hives after strawberries. one woman triumphantly brought me what looked like a nice eruption, but which proved to be the after-results of a hungry flea! after that she ate strawberries,--without the flea and without the hives. =not miracles but ideas.= conversions on food subjects are so common at my table that i should have difficulty in remembering the individual stories. scores of them run together in my mind and make a sort of composite narrative something like this: "oh, no, thank you, i don't eat this. you really must excuse me. i have tried many times and it is invariably disastrous." then a reluctant yielding and a day or two later some talk about miracles. "it really is wonderful. i don't understand," etc. experiences like these only go to show the power of the subconscious mind, both in building up wrong habit-reactions and in quickly substituting healthy ones, once the false idea is removed. among my stomach-patients there were two men, brothers-in-law, immigrants from the austrian tyrol, and now resident in one of the cow-boy states. leonardo spoke little english, and though giovanni understood a very little, he spoke only italian. several years before i knew them, giovanni had developed a severe case of stomach trouble and had finally gone to a medical center for operation. the disturbance, however, was not relieved by the operation and before long his brother-in-law fell into the same kind of trouble. for several years the two had spent much of their time dieting, vomiting, and worrying over their sour stomachs. giovanni finally became so ill that his sick-benefit society had actually assessed its members to pay for his funeral expenses. about this time a business man of their town, impressed by the cure of a former patient who had made a quick recovery after seven years of invalidism, persuaded the two men to take their little savings and come to california to be under my care. the evening meal and breakfast went smoothly enough, although the menu included articles which they had been taught to avoid. however, as i left the house on a necessary absence soon after breakfast, i saw leonardo weeping in the garden and giovanni spitting up his breakfast, out at the entrance gate. on my return, i found one of "the family" literally sitting on the coat-tails of leonardo, while giovanni hovered at a distance, safe from capture. leonardo upbraided me bitterly for having undone all the gain they had made in the long months of rigid dieting, for now the vomiting had returned, because they had eaten sugar on their oatmeal at breakfast! i made leonardo drink an egg-nog, took him into the consultation-room and held my hand on his knee to keep him in his chair, while explaining to him as best i could the physiologic action of the hydrochloric acid on the digestive juice, which he feared as a sour stomach, the sign of indigestion. during the conversation i said, "i suppose giovanni imitated you in this mistaken fear about your health." the reply was, "no, i got it off him!" nearly two hours later he exclaimed in astonishment: "why, that milk hasn't come up! maybe i am cured!" "of course you are cured," i answered; "there never was anything really the matter with your stomach, so you are cured as soon as you think you are." later giovanni was inveigled into the house by the promise that he would have to eat nothing more than milk soup. all was smooth sailing after this. for my own part i feared for the permanency of the cure, for they were returning to the old environment. but more than three years have passed, and grateful letters still come telling of their continued health. another patient, a teacher of domestic science in a big eastern university, had lived on skimmed milk and lime-water from easter to thanksgiving. several attempts to enlarge the dietary by adding cream or white of egg had only served to increase the sense of discomfort. finding nothing in the history of the case to warrant a diagnosis of organic disease of the stomach, i served her plate with the regular dinner, bidding her have no hesitancy even over the pork chops and potato chips. she gained nine pounds in weight the first week, and in two and a half months was forty pounds to the good. =when re-education failed.= but there is one patient who has had to have his lesson repeated at intervals. this man laughingly calls himself a disgrace to his doctor because he is a "repeater." his story illustrates the power of an autosuggestion and the disastrous effect of attention to a physiological function. when mr. t. came first to me he weighed only pounds, although he is over six feet tall and of large frame. from the age of sixteen he had followed fads in eating and thought he had a weak stomach. i treated his "weak stomach" to everything there was in the market, including mince-pies, cabbage, cheese, and all the other so-called indigestibles. he gained - / pounds the first week and pounds in five weeks. one would think that the idea about the weak stomach would have died a natural death, but it did not. again and again he came back to me like a living skeleton, the last time weighing only pounds, and again and again he has gone back to his home in the middle west plump and well. twice while he was at home he underwent unnecessary operations, once for an ulcer that was not there and once for supposed chronic spasm of the pylorus. needless to say, the operations did not help. you cannot cut out an idea with a knife. neither can you wash it out with a stomach-pump; else would mr. t. long ago have been cured! this particular idea of his seems to be proof against all my best efforts at re-education. psycho-analysis is impracticable, partly because of the duration of the habit of repression, but the history, and certain symbolic symptoms, indicate the freudian mechanisms at work. all i can do is to feed him up, bully him along, and keep him from starving to death. just now he is doing very well at home, although he has moved to california so as not to be too far away from "the miracle-worker." if mr. t.'s case had been typical, i should long ago have lost my faith in psychotherapy. keeping people from starving is worth while, but is less satisfactory than curing them of what ails them. the nervous patient who has a relapse is no credit to his doctor. it is only when the origin of his trouble is not removed that the bond of transference tends to become permanent. the neurotic who is well only while under the influence of his physician is still a neurotic. however, as most people's complexes are neither so deeply buried nor so obstinate as this, a simple explanation or a single demonstration is usually enough to loose the fettering hold of old misconceptions. common ailments ="gas on the stomach."= we all know people who suffer from "gas." indeed, very few of us escape an occasional desire to belch after a hearty meal. but the person with nervous indigestion rolls out the "gas" with such force that the noise can sometimes be heard all over the house. he may keep this up for hours at a time, under the conviction that he is freeing himself from the products of fermenting food. he may exhibit a well-bloated stomach as proof of the disastrous effect of certain articles of diet. the gas and the bloating are supposed to be the sign and the seal of indigestion, a positive evidence that undigested food is fermenting in the stomach. but what is fermentation? it is, necessarily, a question of the growth of bacteria and is a process which we may easily watch in our own kitchens. bread rises when the yeast-cells have multiplied and acted on the starch of the flour, producing enough gas to raise the whole mass. potatoes ferment because bacteria have multiplied within them. canned fruit blows up because enough bacteria have developed inside to produce sufficient gas to blow open the can. every housewife knows that it takes time for each of these processes. bread has to stand several hours before it will rise; potatoes do not ferment under twelve hours, and canned fruit is not considered safe from the fermenting process under three days. evidently there is some mistake when a person begins to belch forth "gas" within an hour or two after a meal. as a matter of fact, it is not gas at all but merely air that is swallowed with the food or that was present in the empty stomach. when the food enters the stomach it necessarily displaces air, which normally comes out automatically and noiselessly. but if, through fear or attention, a certain set of muscles contract, the pent-up air may come forth awkwardly and noisily or it may stay imprisoned until we take measures to let it out. a hearty laugh is as good as anything, but if that cannot be managed, we may have to resort to a cup of hot water which gives the stomach a slap and makes it let go. two belches are enough to relieve the pressure. after that we merely go on swallowing air and letting it out again, a habit both awkward and useless. if the emotion which ties the muscle-knot is very intense, and the stomach refuses to let go under ordinary measures, the pain may be severe. but a quantity of hot water or a dose of ipecac is sure to relieve the situation. if the person is able to give himself a good moral slap and relax his unruly muscles, he reaches the same end by a much pleasanter road. some people are fond of the popular remedy of hot water and soda. their faith in its efficacy is likely to be increased by the good display of gas which is sure to follow. as any cook knows, soda and acid always fizz. the soda is broken up by the hydrochloric acid of the stomach and forms salt and carbon dioxid, a gas. however, as the avowed aim of the remedy is the relief of gas rather than its manufacture, and as the soda uses up the hydrochloric acid needed in digestion, the practice cannot be recommended as reasonable. =gastritis.= i once knew a woman who went to a big city to consult a fashionable doctor. when she returned she told with great satisfaction that the doctor had pronounced her case gastritis. "it must be true," she added, "because i have so much gas on my stomach!" the diagnosis of gastritis used to be very common. the ending _itis_ means inflammation,--gastritis, enteritis, colitis, each meaning inflammation of the corresponding organ. an inflammation implies an irritant. there can be no kind of _itis_ without the presence of something which irritates the membrane of the affected part. if we get unusual and irritating bacteria in some spoiled food, we are likely to have an acute inflammation until the offending bacteria are expelled. but an inflammation of this kind never lasts. people who have had ptomaine poisoning sometimes assert that they are afterwards susceptible to poisoning by the kind of food which first made them ill. such a susceptibility is not so much a hold-over effect from the poison as a hold-over fear which tends to repeat the physical reaction whenever that food is eaten. i, myself, have had ptomaine poisoning from canned salmon, but i have never since had any trouble about eating salmon. =sour stomach.= sometimes when a person lies down an hour or so after a meal, some of the contents of his stomach comes up in his throat. then if he be ignorant of physiology, he may be very much alarmed because his stomach is "sour." not knowing that he would have far greater cause for alarm if his stomach were _not_ sour, he may, if the idea is interesting to him, begin to restrict his diet, to take digestive tablets, and to develop a regular case of nervous dyspepsia. sometimes when the specialists measure the amount of hydrochloric acid in the stomach, they do find too much or too little acid; but this merely means that an emotion has made the glands work overtime or has stopped their action for a little while. the functions of the body are so very, very old that there is little likelihood of permanent disturbance. =biliousness.= the stomach is not the only part of the body concerning which we lack proper confidence. next to it the liver is the most maligned organ in the whole body. although the liver is about as likely to be upset in its process of secreting bile as the ocean is likely to be lacking in salt, many an intelligent person labels every little disturbance "biliousness" and lays it at the door of his faithful, dependable liver. as a matter of fact, the liver is liable to injury from virtually but three sources--alcohol, bacterial infection, and cancer--and even a liver hardened by alcohol goes on secreting bile as usual. the patient dies of dropsy but not of "liver complaint." some people act as if they thought bile were a poison. on the contrary, it is a very useful digestant; it aids in keeping down the number of harmful bacteria and helps to carry the food from intestines to blood. every day the liver manufactures at least a pint of this important fluid. the body uses what it needs and stores the surplus for reserve in the gall-bladder. the flow is continuous and, despite all appearances to the contrary, there is no such thing as a torpid or an over-active liver. it is true that after a "bilious" person has vomited for a few minutes he is likely to throw up a certain amount of bile, which is supposed to have been lying in his stomach and causing the nausea. in fact, however, this bile is merely a part of the usual supply stored away in the gall-bladder. by the very act of retching, the bile is forced out of the bile channels into the stomach and thence up into the mouth. anybody can throw up bile at any time if he only tries hard enough. one of the favorite habits of certain people is the taking of calomel and salts. after such a dose they view with satisfaction the green character of the stools and conclude that they have rid themselves of a great amount of harmful matter. as a matter of fact, the greater part of the coloring in the stools is from the calomel itself, changed in the intestines from one salt of mercury to another. any excess bile is the result of the irritating action of the calomel on the intestinal wall, an irritation which makes the bowel hurry to cast out this foreign substance without waiting for the bile to be absorbed as usual. a patient once told me that he had bought medicine from a street fakir and by his direction had followed it with a dose of salts. he saved the bowel movement, washed it in a sieve, and discovered a great number of "gall-stones," which the medicine had so effectively washed from his system. he was much astonished when i told him that his gall-stones were merely pieces of soap. he did not know that everybody manufactures soap in his body every day, and that by taking an extra quantity of oil in the shape of the fakir's medicine and an extra quantity of potash in the salts, he had merely augmented a normal physiological process. the supposed action of calomel belongs to the same class of phenomena, and has no slightest effect on the liver or on real gall-stones, which are the precipitate of bile-salts in the gall-bladder, and which cannot be reached by any medicine. if the popular notions about biliousness are ill founded, what then causes the disturbances which undoubtedly do occur and which show themselves in attacks of nausea or sick headache? the answer can be given in a word of four letters; a coated tongue, a bilious attack and a sick headache are all the outcome of a mood. stocks have gone down or the wife is cranky or the neighbors are hateful. adrenalin and thyroid secretions are poured out as the result of emotion; digestion is stopped, circulation disturbed, and the whole apparatus thrown out of gear. =sick-headache.= sick-headache is primarily a circulatory disturbance; and although the disturbance may have been inaugurated by some chemical unbalance, the sum total of the force that makes a sick-headache is emotional. the emotion, of course, need not be conscious in order to be effective. if we picture the arteries all over the body as being supplied with, among other things, a wall of circular muscles, and then imagine messages of emotion being flashed to the nerves controlling this muscle wall, we may get an idea of what happens just before a sick-headache. some parts of the arteries contract too much and other parts relax. the arteries to the head tighten up at the extremities and become loose lower down. the force of the blood-stream against the constricted portion can hardly fail to cause pain. the sick part of the headache is merely a sympathetic strike of the nerves which control circulation and stomach. the moral of all this is plain. if a sick-headache is the result of an emotional spasm of the blood-vessels, the obvious cure is a change of the emotion. some people manage it by going to a party or a picnic, others by ignoring the symptoms and keeping on with their work. a woman physician whom i know was in the midst of a violent headache when called out on an obstetrical case. she felt sorry for herself, but went on the case. in the strenuous work which followed, she quite forgot the headache, which disappeared as if by magic. sometimes it happens that a headache recurs periodically or at regular intervals. it is easy to see that in such cases the exciting cause is fear and expectation. at some time in the past, headaches have occurred at an interval of, say, fourteen days; as the next fourteenth day approaches the sufferer says to himself: "it is about time for another headache. i am afraid it will come to-morrow," and of course it comes. one man told me that if he ate sunday-night supper he inevitably had a headache on monday morning. we were about to sit down to a simple sunday supper and he refused very positively to join us. i told him he could stay all night and that i would take care of him if the monday sickness appeared. he accepted my challenge but was unable to produce a headache. in fact, he felt so unusually flourishing the next morning that he insisted on frying the bacon for my entire family. that was the end of the monday headaches. =a few examples.= as sick-headache has always been considered a rather stubborn difficulty, not amenable to most forms of treatment, it may be well to cite a few cases which were helped by educational methods. a patient came home from a walk one day and announced that he was going to bed. when questioned, be said: "i am tired and i have a sick-headache. isn't it logical to go to bed?" to which i answered that it would be far more logical to put some food into his stomach and change the circulation than to lie in bed and think about his pain. this man was completely cured. i have had patients throw up one meal, and very rarely two, but i have never had to supply more than three meals at a time. the waste of food i consider amply justified by the benefit to the patient. there once came to me an elderly woman, the wife of a poor minister. she was suffering from attacks of nausea, which recurred every five to ten days with intense pain through the eyes, and with photo-phobia or fear of light. i found that she had by dint of heroic efforts raised a large and promising family on the salary of an itinerant minister--from four hundred to six hundred a year! all the time she had been feeling sorry for herself because her husband did not appreciate her. one day, after reading one of his letters which seemed to show an utter lack of appreciation of all that she was doing, she fell down in the field beside her plow, paralyzed. from that time on she had been more or less of an invalid, continually nursing her grudge and complaining that she ought not to have been made to bear so many children. after i had heard this plaint over and over for about a week, i said: "perhaps you ought not to have had that little daughter, the little ewe-lamb. maybe she was one too many." "oh, no," came the quick response. "i couldn't have spared _her_." then i went down the line of the fine stalwart sons. perhaps she could have spared john or tom or fred? finally she saw the whole matter in a different light,--saw herself as a queen among women, the mother of such a family. as to the husband, i tried to show her that she was not very clever to live with a man all those years without discovering that he was not likely to change. "you can't change him but you can change your reaction to him. if something keeps hurting your hand, you don't keep on being sore. you grow callous. isn't it about time you grew a moral callous, too?" i put her on the roof to sleep, on account of her fear of light. only once did she start a headache, which i quickly nipped in the bud by making her get up and dress. she had come to stay "three months or four,--if i get along well." at the end of four weeks she left, an apparently well woman. the last i heard of her she was stumping the state for temperance, the oldest of an automobile party of speakers, and the sturdiest physically. with the emotional grievance, disappeared also the physical effects in stomach and head. miss s., a very brilliant woman, ambitious to make the most of her life, had been shelved for twenty-five years because of violent sick-headaches which made it impossible for her to undertake any kind of work. she had not been able to read a half-hour a day without bringing on a terrible headache. i insisted on her reading, and very soon she was so deep in psychological literature that i had difficulty in making her go to bed at all. after learning the cause of her headaches and gaining greater emotional control, she succeeded so well in freeing herself from the old habit, that she now leads the busiest kind of useful life with only an occasional headache, perhaps once in six months. a certain minister suffered constantly from a dull pain in his head, besides having violent headaches every few days. he started in to have a bad spell the day after his arrival at my house. as i was going out of the door, he caught my sleeve. "doctor," he said, "would it be bad manners to run away?" "manners?" i answered. "they don't count, but morals, yes." he stayed--and that was his last bad headache. both chronic and periodic pains disappeared for good. one woman who had suffered from bad headaches for eighteen years lost them completely under a process of re-education. on the other hand, i have had patients who were not helped at all. the principles held good in their cases, but they were simply not able to lose the old habit of tightening up the body under emotion. =hysterical nausea.= sometimes nausea is merely the physical symbol of a subconscious moral disgust. we have already told the stories of "the woman with the nausea" (chapter v) and of mrs. y. (chapter vii). these cases are typical of many others. their bodies were perfectly normal, and when, through psycho-analysis and re-education, they were helped to make over their childish attitudes toward the sex-life, the nausea disappeared. =loss of appetite.= a nervous patient with a good appetite is "the exception that proves the rule." the neurotic is usually under weight and often complains that he feels satiated almost as soon as he begins to eat. loss of appetite may, of course, mean that the body is busy combating toxins in the blood, but in a nervous person it usually means a symbolic loss of appetite for something in life, a struggle of the personality against something for which he has "no stomach." psycho-analysis often reveals the source of the trouble, and a little bullying helps along the good work. by simply taking away a harmful means of expression, we may often force the subconscious mind to find a better language. summary since the stomach seems to be an organ which is much better fitted to care for food than to care for a depressing emotion or a false idea, it seems far more sensible to change our minds than to keep enlarging our list of eatables which are taboo. and since most indigestion is in very truth nothing more nor less than an emotional disturbance, worked up by fear, anger, discontent, worry, ignorance, suggestion, attention to bodily functions which are meant to be ignored, love of notice and the conversion of moral distress into physical distress, the best diet list which can be furnished to mr. everyman in search of health must read something like this: menu monday, tuesday, wednesday, thursday, friday, saturday, sunday a calm spirit plenty of good cheer a varied diet commonsense good cooking judicious neglect of symptoms forgetfulness of the digestive process a little accurate knowledge a determination to be like folks chapter xi _in which we relearn an old trick_ the bugaboo of constipation popular superstitions in line with the taboos connected with the taking of food are the ceremonials attendant upon its elimination. taking anxious thought about functions well established by nature is a feature of conversion-hysteria, the displacement of emotional desire from its psychic realm into symbolic physical expression. whatever other symptoms nervous people may manifest, they are almost sure to be troubled with chronic constipation. it is true that there are many constipated people who do not seem to be nervous and who resent being classed among the neurotics. everybody knows that the occasional individual who has difficulty in swallowing his food is nervous and that the, trouble lies not in the muscles of his throat but in the ideas of his mind. but very few people seem to realize that the more common individual who makes hard work of that other simple process--elimination of his intestinal waste matter--is suffering from the same kind of disturbance and giving way to a nervous trick. when all the facts are in, the constipated person will have hard work to clear himself of at least one count on the charge of nerves. =an oft-told tale.= sooner or later, then, the neurotic, whether he calls himself a neurotic or not, is very likely to begin worrying over his diet or his sedentary occupation. he imagines himself the victim of autointoxication, afflicted with paralysis of the colon or dearth of intestinal secretions. he leaves off eating white bread, berries, cheese, chocolate, and many another innocent food, and insists on a diet of bran-biscuit, flaxseed breakfast-foods, prunes, spinach, cream, and olive-oil with doses of mineral oil between meals. in all probability, he begins a course of massage or he starts to take extra long walks and to exercise night and morning, pulling his knees up to his chin and touching his fingers to his toes. when all these measures fail, he gives in to the morning enema or the nightly pill, in imminent danger of succumbing to a life-long habit. the truth about constipation =what the colon is for.= it is well, then to have a fair understanding of the structure and purpose of our intestinal machinery. contrary to general opinion, the intestines are not a dumping-ground but a digestive organ. after the food is partly digested in the stomach, it passes through a twenty-two foot tube (the small intestine) into a five-foot tube (the large intestine or colon) where digestion is completed, the nutriment is absorbed, and the waste matter is passed on and out through the rectum. as the food passes along the colon, pushed slowly ahead by the peristaltic wave, or rhythmic muscular contractions of the intestinal wall, it is seized upon by the four hundred varieties of friendly bacteria which inhabit the intestines of every healthy person, and is changed into a form which the body can assimilate. digestion in the stomach and small intestine is carried on by means of certain digestive juices, but in the large intestine it is the bacteria which do the work. without them we could not live. around the colon is a thick network of little blood vessels, all of which lead straight to the liver, the storehouse of the body. after the food is fully digested, it is passed through the thin intestinal wall into these tiny vessels and carried away to liver and muscles for storage or for immediate use. this process of absorption is carried on throughout the whole length of the colon. not until the very end of the intestine is reached is all the nutrition abstracted. the bowel-content can properly be called waste matter only after it has reached the rectum or pouch at the lower end of the colon. even then, this waste matter is not poison, but merely indigestible material which the body cannot handle. =food, not poison.= the colon is not a cesspool but a digestive and assimilating organ. its content is not poison but food. active elimination is important not so much because delay causes autointoxication or poisoning as because too large a mass is hard to manage and irritates the intestinal wall. the problem is not so much one of toxicology as of simple mechanics. if nature had put within the body five feet of tubing which could easily become a cesspool and a breeder of poison, it is not at all likely that she would have laid alongside an elaborate system of blood vessels leading not out to the kidneys but into the storehouse of the liver; and if civilized man's changed manner of living had so upset nature's plans as easily to transform his internal machinery into a chronic source of danger, we may be sure that he would long ago have gone the way of the unfit and succumbed to his own poisons. =possible invasions.= it is true that the intestinal tract, like the rest of the body, is open to attack by harmful bacteria. but in a great majority of cases, these enemy bacteria are either quickly destroyed by the beneficent microbes within or are immediately cast out as unfit. any germs irritating to the intestinal wall cause the mucous membrane to produce an unusual flow of mucus which washes away the offending bacteria in what we call a diarrhea.[ ] [footnote : if the invading army proves obstinate and the diarrhea continues a day or so, it is wise to assist nature by a dose of castor-oil, which gives an additional insult to the intestinal wall, spurs it on to a desperate effort, and hastens the cleansing process. in severe cases the more promptly the castor-oil is administered the better. such emergency measures are very different from the habitual use of insulting drugs.] sometimes the wrong kind of bacteria do persist, causing anemia, rheumatism, sciatica, or neuritis. when these disorders are not the result of infection from teeth, tonsils, or other sources of poison, but are really caused by intestinal bacteria, i have found that a diet of buttermilk (lactic acid bacteria), with turnip-tops or spinach to supply the necessary mineral salts, often succeeds in planting the right bacteria and driving out the disturbing ones. these disorders are invasions from without, like tuberculosis or malaria, and are as likely to attack the person with easy bowel movements as the one with the most chronic constipation. =autointoxication.= a good deal of the talk about autointoxication is just talk. it sounds well and affords an easy explanation for all sorts of ills, but in a large majority of cases the diagnosis can hardly be substantiated. uninformed writers of newspaper articles on the care of the body, or purveyors of purgatives or apparatus for internal baths are fond of dilating on the "foulness of the colon" as a leading cause of disease. as a rule, they advise either a strict diet, some kind of cathartic, or an elaborate process of washing out the colon to clear the body of its terrible accumulation of poisons. =cathartics and enemas.= he who makes a practice of flushing out his intestinal tract with high enemas and internal baths is like a person who eats a good dinner and then proceeds to wash out his stomach. in the mistaken idea that he is making himself clean, he is washing what was never intended to be washed and robbing the body of the nutrition which it needs. and the man who persists in the pill habit is making a worse mistake, adding insult to injury and forcing the mucous membrane to toughen itself against such malicious attacks. =cathartics and operations.= even in emergencies, the use of purgatives as a routine measure is happily decreasing year by year. for many years i have deplored the use of purgatives before and after operations. that other practitioners are coming to the same conclusion is witnessed by a number of papers recently read in medical societies condemning purgation at the time of operation. among the most favorably received papers of the california medical societies have been one by emmet l. rixford, surgeon of the stanford university medical college, read before the southern california medical society at los angeles december , , and one by w.d. alvarez at the california medical society, del monte, ,--both condemning the use of purgatives as a routine measure before operations. an article entitled the "use and abuse of cathartics" in the "journal of the american medical association" admirably summarizes the disadvantages of purgation at such a time.[ ] [footnote : " danger of dissemination of infection throughout the peritoneal cavity, in case localized infection exists. " increased absorption of toxins and greater bacterial activity by reason of the fact that undigested food has been carried down into the colon to serve as pabulum for bacteria, and that liquid feces form a better culture medium than solid feces. " increased distention of the intestine with gas and fluid, when it should be empty.... " psychic and physical weakness produced by dehydration of the body, disturbance in the salt balance of the system, and the loss of sleep occasioned by the frequent purging during the night preceding the operation. as oliver wendell holmes says: 'if it were known that a prize fighter were to have a drastic purgative administered two or three days before a contest, no one will question that it would affect the betting on his side unfavorably. if this be true for a powerful man in perfect health, how much more true must it be of the sick man battling for life.' " increase in postoperative distress and danger: thirst, gas pains, and even ileus...."--_journal of american medical association_, vol. , no. , p. , oct. . .] four years ago i was called to a near-by city to see a former patient who two days before had had a minor operation,--removal of a cyst of the breast. she was dazed, almost in a state of surgical shock and very near collapse. i found that she had been put through the usual course of purgation before operation and starvation afterward, and i diagnosed her condition as a state bordering on acidosis, or lowering of the alkaline salts of the body. i ordered food at once. she rallied and recovered. a few months later this same woman had to undergo a much more serious operation for multiple fibroids of the uterus and removal of the appendix. this time i advised the surgeon against the use of any purgative, and he took my remarks so seriously that he did not even allow an enema to be given. this time the patient showed no signs of exhaustion and had very few gas pains. i firmly believe that the day will soon come when a patient under operation, or a patient after childbirth, will no longer be depleted by a weakening and dehydrating cathartic and by a period of starvation, at a time when he needs all the energy he can summon. =cathartics and childbirth.= the article referred to in the "journal of the american medical association" cites the experiences of dr. r. mcpherson of the lying-in hospital of new york, "who showed that the routine purgation after confinement is not only useless but harmful. of women who were not purged, only three had fever (and one of them a mammary abscess); most of them had normal bowel movements and those who did not were given an enema every third day. of women who were delivered by the same technique and the same operators but were purged in the usual routine manner, twenty-eight had some fever." this experience of one physician is corroborated by that of others who find that the more we tamper with the natural functions in time of stress the harder do we make the recuperative process. there are certainly times when catharsis is necessary but "one thing is certain, the day for routine purgation is past."[ ] even in emergencies we need to know why we administer cathartics and in chronic cases we may be sure that they are always a mistake. [footnote : ibid, p. .] ="an old trick."= before we make a practice of interfering with nature's processes, it is well to remember how old and stable those processes are. as long as there has been the taking in of food, there has been also the casting out of waste matter. the sea-anemone closes in on the little mollusk that floats against its waving petals, assimilates what it can and rejects the rest. in the long line from sea-anemone to man, this automatic process of elimination has gone on without a hitch, adapting itself with perfect success to the changing habits of the varying types of life. so old a process is not easily upset. and, be it noted, in the human body this automatic, involuntary process still goes on with very little trouble until it reaches a point in the body where man, the thinking animal, tries to control it by conscious thought. =a question of evacuation.= much of the misconception about constipation arises from the mistaken idea that this is a disorder of the whole intestine or at least of the whole colon. as a matter of fact, the trouble is almost wholly in the rectum. there is no trouble with the general traffic movement, but only with the unloading at the terminus. in my experience, the patient reports that he feels the fecal mass in the lower part of the rectum, but that he is unable to expel it. examination by finger or by x-ray reveals a mass in the rectal pouch. if there is a piling up of freight further back on the line, it is only because the unloading process has been delayed at the terminus. so long as the bowel-content is in the region of automatic control, there is very little likelihood of trouble. an occasional case of organic trouble--appendicitis, lead-colic, mechanical obstruction, new growths or spinal-cord disease--may cause a real blockade, but in ninety-nine cases out of every hundred there is little trouble so long as the involuntary muscles, working automatically under the direction of the subconscious mind, are in control. by slow or rapid stages, on time or behind time, the bowel-content reaches the upper part of the rectum and passes through a little valve into the lower pouch. here is where the trouble begins. =meddlesome interference.= in the natural state the little human, like the other animals, empties his bowel whenever the fecal mass enters the lower portion of the rectum. the presence of the mass in the rectum constitutes a call to stool which is responded to as unthinkingly as is the desire for air in the taking of a breath. but the tiny child soon has to learn to control some of his natural functions. at the lower end of the rectum there is a purse-string muscle called the _sphincter-ani_, an involuntary muscle which may with training be brought partly under voluntary control. under the demands of civilization, the baby learns to tighten up this muscle until the proper time for evacuation. then, if he be normal, he lets go, the muscles higher up contract and the bowel empties itself automatically, as it always did before civilization began. there is, however, a possibility of trouble whenever the conscious mind tries to assume control of functions which are meant to be automatic. under certain conditions necessary control becomes meddlesome interference. if the child for one reason or another takes too much interest in the function of elimination; if he likes too much the sense-gratification from stimulation of the rectal nerves and learns to increase this gratification by holding back the fecal mass; if he gets the idea that the function is "not nice" and takes the interest that one naturally feels in subjects that are taboo; or if he catches from his elders the suggestion that the bowel movement is a highly important process and that something disastrous is likely to happen unless it is successfully performed every day; then his very interest in the matter tends to interfere with automatic regulation, and to cause trouble. just as people often find it hard to let go the bladder muscle and urinate when in a hurry or under observation, and just as an apprehensive woman in childbirth tightens up the purse-string muscle of the womb, so the little child, or the grown up who catches the suggestion of difficulty in the bowel movement, loses the trick of letting go. instead of merely exercising control by temporarily inhibiting the function, he tries to carry through the process itself by voluntary control--and fails. constipation is a perfect example of the power of suggestion, and of the troublesome effect of a fear-idea in the realm of automatic functions. food and constipation since the waste matter from all foods finally reaches the rectum, and since constipation is merely a difficulty in the forces of expulsion, it is hard to see how any normal food in the quantities usually eaten could have the slightest effect on the problem. when we remember that it takes food from twelve to twenty-four hours to reach the rectum, and that it has during all that time been subjected to the action of the powerful chemicals of the digestive tract, it is hard to imagine a piece of cheese, of whatever variety, strong enough to stop the contraction of the muscles of the upper rectum or to tie the sphincter-muscle into a knot. it would be difficult to find a food which could pass without effect through twenty-seven feet of intestinal tubing only to become suddenly effective on the wall of the rectum. if the wrong kind of food is the cause of constipation, why does the rectum prove to be the most refractory portion of the tube? on what principle could a piece of chocolate inhibit the call to stool or contract the sphincter muscle? on the other hand, even if it should be conceded that constipation were the result of lack of lubricating secretions in the colon, how could two tablespoonfuls of mineral oil be a sufficient lubricant after being mixed with liquid and solid food through many feet of the intestinal tract? =an adaptable apparatus.= the lining of the intestines has plenty of secretions to take care of its function. it is as well adapted to the vicissitudes of life as are the other parts of the body. the muscular coat is no more liable to paralysis or spasm than are the voluntary muscles. as the skin adapts itself to all waters and all weathers, and as the lungs adjust themselves to varying air-pressures, so the intestinal wall makes ready adaptation to any common-sense demands, adjusting itself with ease to an athletic or a sedentary life, and to the normal variations of diet. what man has eaten throughout the centuries man may eat to-day. if you will but believe it, your intestines will make no more objection to white bread, blackberries, and cheese, along with all other ordinary articles of food, than the skin makes to varying kinds of water. naturally, the suggested idea that a food will constipate tends to carry itself out to fulfilment and to prevent the call to stool from rising to the level of consciousness; but the real force lies not in the food but in the suggestion. =the bran fad.= it is when we try to improve on the normal human diet that we really insult the body. he who leaves off eating nourishing white bread and takes to bran muffins is simply cheating his body. bran has a small food value, but the human body is not made to extract it. not only does bran fail to give us any nourishment itself, but it lessens the power of the intestines to care for other food.[ ] the fad for bran is based on the well-known fact that we need a certain quantity of bulk in order to stimulate the intestinal wall to normal peristalsis. we do need bulk, but not more than we naturally get from a normal and varied diet including a reasonable amount of fruit and vegetables. [footnote : see an article entitled "bread and bran," _journal of american medical association_, july , , p. .] it is true that the suggestion of the efficacy of bran, dates, spinach, or any other food is frequently quite sufficient to give relief, temporarily, just as massage, manipulation of the vertebrae, the surgeon's knife, or mineral oil may be enough to carry the conviction of power to a suggestible individual. but who wants to take his suggestions in such inconvenient forms as these? =change of water.= another popular superstition centers around drinking-waters. there are people who cannot move from one town to another, much less take an extensive trip, without a fit of constipation--or a box of pills. if they only knew it, there is no water on earth which could make a person constipated. a new water, full of unusual minerals, might hasten the bowel movement, but on what possible principle could it retard it? constipation has nothing to do with food or with water, but solicitous care about either can hardly fail to create the trouble which it tries to avoid. the cure =taking off the brakes.= since constipation is wholly due to the acceptance of a false suggestion, the only logical cure must be release from the power of that suggestion. "he is able as soon as he thinks he is able"; not that thought gives the power, but that the right thought releases the inhibition of the mistaken thought. as soon as the brakes are taken off, the internal machinery is quite able to make the wheels go round. the bowel will empty itself if we let it. the function of elimination is not a new trick learned with difficulty by the aged, but a trick as old and as elemental as life itself. like balancing on a bicycle, it may not be done by any voluntary muscular effort, but it just does itself when one learns how. once the sense of power comes, once the mind forgets to be doubtful or afraid, then the old automatic habit invariably reasserts itself. meddlesome interference may throw the mechanism out of gear, but fortunately it cannot strip the gears. constipation is an inhibition or restraint of function, but is never a loss of function. no one is too old, no one is too fixed in the bad habit to relearn the old trick. i have had a good many patients with chronic constipation, but i have never had one who failed to learn. real conviction speedily brings success, and in many cases success seems to outrun conviction. so efficient is nature if she has only half a chance! =some people who learned.= unless you are over ninety-two, do not despair. one old lady of that age, a sort of patient by proxy, was able to cure herself without even one consultation. her daughter had been a patient of mine and had been cured of the constipation with which she had been busy for many years. the mother, who believed her own bowel paralyzed, had been in the habit of lying on the bed and taking a copious enema every second day of her life. when, however, she heard of her daughter's cure, the bright old woman gave up her enemas and let her bowels do their own functioning. she stayed cured until her death at ninety-five. =a fifty-year habit.= another old lady was not quite so easily convinced. she ridiculed the idea that her son of fifty, who had been "constipated in his cradle" could be cured of his lifelong habit, but he was cured. as long as there is life and the light of reason, so long may nature's functions be reëstablished. =the whole family.= nor is any one too young to learn. a tiny baby is easily taught. there came to me for two consultations a mother and her two babies, all three constipated. the four-year-old child, mentally deficient, had been fed on milk of magnesia from his infancy, and the four-months-old baby had been started on the same path. i explained to the mother the mechanism of elimination, told her to give up cathartics, and to set a regular time for herself and the baby, but was a little dubious about the mentally deficient four-year-old. however she soon reported that they had all three promptly acquired the new habit. four years later she told me that they had never had any more trouble. =a record history.= when miss h. first came to my house, she told a story that was almost incredible. she said that for many months she had been taking eight tablespoonfuls of mineral oil three times a day besides a cathartic at night, and an enema in the morning. no wonder she was a little dubious over such mild treatment as mine seemed to be! constipation was only one of this young woman's troubles. she could not sleep and was so fatigued that she believed herself at the end of her physical capital. when she first came to me she had tears in her eyes most of the time and used to confide to various people that she was sure she was a patient that i could not cure,--a very common belief among nervous invalids! she was sure that i did not understand her case, and that she could not get anything out of this kind of treatment. it was only a very short time, however, before her bowels were functioning like those of a normal person. she lost her insomnia and her fatigue and went away as well as ever. when she got back to her office, she found that her old position, which she had believed secure to her, had been given to another. she had to go out and hunt a new job and face conditions harder than she had had before, but she came through with flying colors. a short time ago miss h. came back to see me,--a happy, robust young woman, very different from the person i had first known. she assured me that she had never had any return of her old symptoms and that she was as well as a person could be. =living up to a suggestion.= mrs. t. had not had a natural movement of the bowels in twenty-five years. after the birth of a child, twenty-five years before, her physician had told her that her muscles had been so badly torn in labor that they could not carry through a natural movement. after that she had never gone a day without a pill or an enema. i explained to her that when any muscle of the rectum is injured in childbirth, it is the sphincter-ani, and that since this is the muscle whose contraction holds back the bowel content, its injury would tend to over-free evacuation rather than to constipation. she saw the point and within two or three days regained her old power of spontaneous evacuation. =practical steps.= the first step, then, in acquiring normal habits is the conviction of the integrity of our physical machines and a determination not to interfere by thought, or by physical meddling, with the elemental functions of our bodies. after this all-important step, there are a few practical suggestions which it is well to follow. most of them are nothing more than the common-sense habits of personal hygiene which are so obvious as to be almost axiomatic, but which are nevertheless often neglected: eat three square meals a day. drink when thirsty, having conveniently at hand the facilities for drinking. heed the call to stool as you heed the call of hunger. when the stool passes the little valve between the upper and lower portions of the rectum, it gives the signal that the time for evacuation has come. if this signal is always heeded, it will automatically start the machinery that leads to evacuation. if it is persistently ignored because one is too busy, or because the mind is filled with the idea of disability, the call very soon fails to rise to the level of consciousness. the feces remain in the rectum, and the bad habit is begun. choose a regular time and keep that appointment with yourself as regularly as possible. in all the activities of nature, there is a rhythm which it is well to observe. take time to acquire the habit. do not be in a hurry. do not strain. no amount of effort will start the movement. just let it come of itself. finally, should the unconscious suggestion of lack of power stubbornly remain in force, take a small enema on the third day. if the waste matter accumulates for three or more days, the bulk becomes so great that the circular muscles of the rectum are unable to handle it, just as the fingers cannot squeeze down to expel water from too large a mass of wet blankets. take only a small enema--never over a quart at a time--and expel the water immediately. one or two such measures will bring away the mass in the rectum. the material farther up still contains food elements and is not yet ready for expulsion. lessen the amount of water each time until no outside help is needed. once you get the right idea, all enemas will be superfluous. summary if you would have in a nutshell an epitome of the truth about constipation, indigestion, insomnia, and the other functional disturbances common to nervous folk, you can do, no better than to commit to memory and store away for future reference that choice limerick of the centipede, which so admirably sums up the whole matter of meddlesome interference: a centipede was happy quite until a frog in fun said, "pray, which leg comes after which?" this raised her mind to such a pitch, she lay distracted in the ditch, considering how to run. whoever tries to consider "which leg comes after which" in any line of physiological activity, is pretty sure to find himself in the ditch considering how to run. wherefore, remember the centipede! chapter xii _in which handicaps are dropped_ a woman's ills "the female of the species" if ever there was a man who wished himself a woman, he has hidden away the desire within the recesses of his own heart. but one does not have to wait long to hear a member of the female sex exclaim with evident emotion, "oh, dear, i wish i had been born a man!" it is probable that if these same women were given the chance to transform themselves overnight, they would hesitate long when it actually came to the point. the joys of being a woman are real joys. however, in too many cases these joys seem hardly to compensate for the discomforts of the feminine organism. it is the body that drags. painful menstrual periods, the dreaded "change of life," various "female troubles" with a number of pregnancies scattered along between, make some of the daughters of eve feel that they spend a good deal of their lives paying a penalty merely for being women. brought up to believe themselves heirs to a curse laid on the first woman, they accept their discomforts with resignation and try to make the best of a bad business. ="since the war."= nothing is quite the same since the war. among other things we have learned that many of our so-called handicaps were nothing but illusions,--base libels on the female body. under the stern necessity of war the women of the world discovered that they could stand up under jobs which have until now been considered quite beyond their powers. society girls, who were used to coddling themselves, found a new joy in hard and continuous work; middle-aged women, who were supposed to be at the time of life when little could be expected of them, quite forgot themselves in service. ambulance drivers, nurses, welfare workers, farmerettes, red-cross workers, street-car conductors and "bell-boys," revealed to themselves and to the world unsuspected powers of endurance in a woman's body. although some of the heavier occupations still seem to be "man's work," better fitted for a man's sturdier body, we know now that many of these disabilities were merely a matter of tradition and of faulty training. there still remains, however, a goodly number of women who are continuously or periodically below par because of some form of feminine disability. some of these women are suffering from real physical handicaps, but many of them need to be told that they are disabled not by reason of being women but by reason of being nervous women. ="nerves" again.= despite the organic disturbances which may beset the reproductive organs, and despite the havoc wrought by venereal diseases, it may be said with absolute assurance that the majority of feminine ills are the result neither of the natural frailty of the female body, nor even of man's infringement of the social law, but are the direct result of false suggestion and of false attitudes toward the facts of the reproductive life. the trouble is less a difficulty with the reproductive organs than a difficulty with the reproductive instinct. "something wrong" with the instinct is translated by the subconscious mind into "something wrong" with the related generative organs, and converted into a physical pain. that this relation has always been dimly felt is shown by the fact that the early greeks called nervous disorders _hysteria_, from the greek word for womb. it is only lately, however, that the blame has been put in the right place and the trouble traced to the _instinct_ rather than to the _organs_ of reproduction. =why women are nervous.= although women hold no monopoly, it must be conceded that they are particularly prone to "nerves." the reason is not hard to find. since the leading factor in a neurosis is a disturbance of the insistent instinct of reproduction, a disturbance usually based on repression, then any class of persons in whom the instinct is particularly repressed would, in the very nature of the case, be particularly liable to nervousness. no one who thoroughly knows human nature would attempt to deny that woman is as strongly endowed as man with the great urge toward the perpetuation of the race, or that she has had to repress the instinct more severely than has man. the man insists on knowing that the children he provides for are his own children. whatever the degree of his own fidelity, he must be sure that his wife is true to him. thus has grown up the insistence that, no matter what man does, woman, if she is to be counted respectable, shall control the urge of the instinct and live up to the requirements of continence set for her by society. unfortunately, however, there is more often blind repression than rational control. the measures taken to prevent a girl's becoming a tom-boy are measures of sex-repression quite as much as of sex-differentiation. over-reaction of sensitive little souls to lessons in modesty often causes distortion of normal sex-development. ignorance concerning the phenomena of life is commended as innocence, while it really implies a sex-curiosity which has been too severely repressed. the young woman blushes at thoughts of love, while the young man is filled with a sense of dignity. we smile at the picture of "miss philura's" confusion as she hesitatingly sends up to her creator a petition for the much-desired boon of a husband. but really, why shouldn't she want one? many a young woman, in order to deaden her senses to the unsuspected lure of the reproductive instinct by what is really an awkward attempt at _sublimation_, makes a fetish of dress and social position and considers only the marriage of convenience; or, on the other hand, she scorns men altogether and throws herself into a "career." young men are not so often taught to repress, but neither are they taught to swing their vital energies into altruistic channels through sublimation. since the woman of his class will not marry him until he has money, the young man too often satisfies his undirected instincts in a commercial way. the statistics of venereal diseases prove that here, as elsewhere, goods subject to barter are subject to contamination. in a late marriage, too often a contaminated body accompanies the material possessions which the standards of society have demanded of a husband. but the woman pays in still other coin for the repressions arising from faulty childhood training. unable to find expression for herself either in marriage or in devotion to work, because some old childish repression is still denying all outlet to her legitimate desire, she frequently falls into a neurosis; or if she escapes a real breakdown, she gives expression to unsatisfied longings in some isolated nervous symptoms which in many cases center about the organs of generation. there then results any one of the various functional disturbances which are only too often mistaken for organic disease. what is needed in cases like this is not a gynecologist nor a surgeon, but a psycho-pathologist--or perhaps only a grasp of the facts. let us look at the more common of these disturbances in order to gain an understanding of the situation. the menstrual period =potential motherhood.= among the normal phenomena of a woman's life is the recurring cycle of potential motherhood. every three or four weeks a new ovum or egg matures in the ovary and undergoes certain chemical changes, which send into the blood a substance called a hormone. this hormone is a messenger, stimulating the mucous membrane of the womb into making its velvet pile longer and softer, and its nutrient juices more abundant in readiness for the ovum. the same stimulus causes the whole organism to make ready for a new life. as in hunger, the chemistry of the body produces the muscle-tension that is felt as a craving for food, so this recurring chemical stimulus produces a definite craving in body and mind. this craving brings about an increased irritability or sensitiveness to stimuli which may result either in a joyous or a fretful mood. during sleep the social inhibitions are felt less distinctly and the sleeper dreams love-dreams woven from messages coming up from all the minute nerve-endings in the expectant reproductive organs. but if no germ-cell travels up the womb-canal and tube to meet and impregnate the ovum, the womb-lining rejects the egg as chemically unfit. all the furbishings are loosened from the walls and slowly cast out, constituting the menstrual flow. the phenomenon as a whole is a physiological function and should be accompanied by a sense of well-being and comfort as is the exercise of any other function, such as digestion or muscular activity. only too often, however, it is dreaded as an unmitigated disaster, a time for giving up work or fun and going to bed with a hot-water bottle until "the worst is over." let us see how this perversion comes about. =why menstruation is painful.= what sort of atmosphere is created for the young girl as she attains puberty? most girls get their first inkling of the menstrual period from the periodic "sick spells" of mother or sister. this knowledge comes without conscious thought and is a direct observation of the subconscious mind, which records impressions with the accuracy and completeness of a photographic plate. hearing the talk about a "sick-time" and observing the signs of "cramps" among older friends, the young girl's subconscious mind plays up to the suggestion and recoils with fear from the newly experienced sensations in the maturing organs of reproduction. this recoil of fear interferes with the circulation in the functioning organs, just as fear blanches the face or hinders digestion. there is several times as much blood in the stomach when it is full of food as there is between meals, but we do not for this reason fancy that we have a pain after each meal. there is more blood in the generative organs during their functioning, but this means pain only when fear ties up the circulation and causes undue congestion. fear acts further on the sturdy muscle of the womb, tying it up into just such knots as we feel in the esophagus when we say that we have a lump in the throat. it is safe to say that ninety-five cases of painful menstruation out of every hundred are caused by fear and by the expectation of pain. the cysts and tumors responsible for pain are so rare as to be fairly negligible, when compared with these other causes. dr. clelia duel mosher of stanford university has for many years carried on careful investigations among the students of the university. after describing in detail certain physical exercises which she has found of value, she continues: but more important even than this is an alteration of the morbid attitude of women themselves toward this function; and almost equally essential is a fundamental change in the habit of mind on our part as physicians; for do we not tend to translate too much, the whole of a woman's life into terms of menstruation? if every young girl were taught that menstruation is not normally a "bad time" and that pain or incapacity at that period is as discreditable and unnecessary as bad breath due to decaying teeth, we might almost look for a revolution in the physical life of women.... in my experience the traditional treatment of rest in bed, directing the attention solely to the sex-zone of the body, and the accepted theory that it is an inevitable illness while at the same time the mind is without occupation, produces a morbid attitude and favors the development and exaggeration of whatever symptoms there may be.[ ] [footnote : clelia duel mosher: _health and the woman movement_, pp. , , .] =pre-menstrual discomfort.= if it be objected that women often feel badly for a day or two before the period begins, before they know that it is due, and that this feeling of discomfort could not be caused by fear and expectation, it is easy to reply that the subconscious mind knows perfectly what is happening within the body. the emotion of fear, working within the subconscious, is able to translate all the varying bodily sensations into feelings of distress without any knowledge on the part of the conscious mind. sometimes before the period begins, a girl feels blue and upset for a day or two, a sign that the instinct is getting discouraged. the whole body is saying, "get ready, get ready," but it has gotten ready many times before, and to no purpose. unsatisfied striving brings discouragement. what reaches consciousness is a feeling of pessimism and a general dissatisfaction with life as a whole. if, instead of giving in to the blues or going to bed and predicting a pain, the girl finds other outlets for her energy, she finds that after all, her instinct may be satisfied in indirect ways and that she has strangely come into a new supply of _vim_. =the purpose of the pain.= although suggestion is behind all nervous symptoms, there is a deeper reason for the disturbance. when an unhealthy suggestion is seized and acted upon, it is because some unsatisfied part of the personality sees in it a chance for accomplishing its own ends. the pre-menstrual period is the blooming-time, the mating-time, the springtime of the organism. that means eminently a time for coming into notice, that one's charms may attract the desired complement. but if the rightfully insistent instinctive desires are held in check by unnatural repressions and misapplied social restrictions, the starved instinct can obtain expression only by a concealment of purpose. the disguise assumed is often one of indifference or positive distaste for the allurements of the other sex. but, as we know, an instinctive desire will not be denied. in this case, the misguided instinct which has been given the suggestion that menstruation means illness, fits this conception into the scheme of things and obtains notice in a roundabout way by the attention given to the invalid. =the treatment.= to find that the symptom has a purpose rather than a cause gives the indication for the treatment. judicious neglect causes the symptom to cease by defeating its very purpose,--that of drawing attention to itself. the person who never mentions her discomfort, thinks about it as little as possible, and goes about her business as usual, is likely to find her trouble gone before she realizes it.[ ] [footnote : violent exercise at this time is unwise, but continuing one's usual activity helps the circulation and keeps the mind from centering on the affected part. the physiological congestion is unduly intensified by standing; therefore all employments should afford facilities for the woman to sit at least part of the time while continuing work.] a little explanation gives the patient insight into the workings of her own mind, and usually causes the pain to disappear in short order. astonished, indeed, and filled with gratitude have been some of my young-women patients who had all their lives been unable to plan any work or social engagements for the time of this functioning. many of them were the worst kind of doubters when they were told that to go to bed and center their attention on the generative organs only made the muscles tighten up and the circulation congest. they could not conceive themselves up and around, pursuing their normal life during such a time. however, as they have found by experience that this point of view is not an optimistic dream, they have broken up the confidence-game which their subconscious had been playing on them, and have gone on their way rejoicing. there was one young girl, a doctor's daughter, who suffered continuously from pain in the abdomen, and from back-pain which increased so greatly at the time of the menses that she was in the habit of going to bed for several days, to be waited on with solicitous care by her family. in an attempt to cure the trouble she had undergone an operation to suspend the uterus, but the pain had continued as before. when she came to me, i explained to her that there was no physical difficulty and that her trouble was wholly nervous. i made her play tennis every day and she had just finished a game when her period came on. she stayed up for luncheon, went for a walk in the afternoon, ate her dinner with the family, and behaved like other people. her mother telephoned that evening and when i told her what her daughter had been doing, she gasped in astonishment. she had difficulty in believing that the new order was not miracle but simply the working out of natural law. since that time her daughter has had no more trouble. =the ounce of prevention.= if young girls had wiser counselors in their mothers and physicians, the misconception would never occur, and such an indirect outlet would not be needed; the organic sensations incident to puberty and the recurring menstrual period would have something of the significance of the annunciation to mary, bringing wonder and a sense of well-being. when your little daughter arrives at maturity, give her a joyous initiation into the noble order of women. she will welcome the new function as a badge of womanhood and as a harbinger of wonderful things to come. a girl of fifteen came under my care to be helped out of a mood of increasing depression and uneasiness. her glance was furtive, yet anxiously expectant. tears came unbidden as she sat alone or fingered the keys of the piano. tactful questioning elicited no response as to reasons for her unhappiness. opportunities for giving confidence were not accepted. at a chance moment our talk drifted to the subject of menstruation. "your periods are regular and easy; and do you know what they are for?" then i painted for her a picture of the preparations that are made throughout the whole organism, for the germ-cell that comes each month and has in it all the possibilities of a new little life. the result of this confidential talk may seem fanciful to any one but an eye-witness. we had only a week's association, but the depression ceased, the furtive look and deprecatory manner were replaced by a joyous buoyancy. in a few weeks the thin neck and awkward body rounded out into the symmetry which usually precedes the establishment of puberty, but which was delayed in this case until the unconscious conflict resolved itself. =in the large.= looked at from any angle, this subject is an important one. there are involved not only the physical comfort and convenience of the sufferers themselves, but also the economic prospects of women as a whole. if women are to demand equal opportunity and equal pay, they must be able to do equal work without periodic times of illness. when employers of women tell us that they regularly have to hire extra help because some of their workers lose time each month, we realize how great is the aggregate of economic waste, a waste which would assuredly be justified if the health of the country's womanhood were really involved, but which is inefficient and unnecessary when caused merely by ignorant tradition. "up to standard every day of every week," is a slogan quite within the range of possibility for all but the seriously ill. when reduced to their lowest terms, the inconveniences of this function are not great and are not too dear a price to pay for the possibilities of motherhood. the "change of life" =another phantom peril.= as the young girl is taught to fear the menstrual period, so the older woman is taught to dread the time when the periods shall cease. despite the general enlightenment of this day and age, the menopause or "change of life" is all too frequently feared as a "critical period" in a woman's life, a time of distressing physical sensations and even of danger to mental balance. as a matter of fact, the menopause is a physiological process which should be accomplished with as little mental and physical disturbance as accompanies the establishment of puberty. the same internal secretion is concerned in both. when the function of ovulation ceases the body has to find a new way to dispose of the internal secretion of the ovary. its presence in the blood is the cause of the sudden dilatation of the blood-vessels that is known as the "hot flash." the matter is altogether a problem of chemistry, with the necessity for a new adjustment among the glands of internal secretion. the body easily manages this if left to itself, but is greatly interfered with by the wrong suggestion and emotion. we have already seen how quickly emotion affects all secretions and how easily the adrenal and thyroid glands are influenced by fear. this is the root of the trouble in many cases of difficult "change." if an occasional body is not quite able to regulate the chemical readjustment, we may have to administer the glands of some other animal, but in the majority of cases, the body, unhampered by an extra burden of fear, is quite able to make its own adjustments. the hot flash passes in a moment, if not prolonged by emotion or if not converted into a habit by attention. one source of trouble in the menopause is that it comes at a time in a woman's life when she is likely to have too much leisure. in no way can a woman so easily handicap her body at this time as by stopping work and being afraid. those women who have to go on as usual find themselves past the change almost before they know it,--unless they consider themselves abused, and worry over the necessity for working through such a "critical time." =three rules.= here are a few pointers which have have been of help to a number of women: remember that this is a physiological process and therefore abundantly safeguarded by nature. if you don't expect trouble you will not be likely to find it. remember that the sweating and flushing are made worse by notice. do everything in your power to keep from the public the knowledge that you are no longer a potential mother. if you are past forty, do not mop your face or gasp for breath or carry a fan to the theater! shun attention and fear, and you will be surprised at the ease with which the "change" is effected. =nature's last chance.= while we are on the subject of the middle-aged woman, it may be well to mention a phenomenon sometimes noticed in the early forties. often an "old maid" who has considered herself settled for life in her bachelor estate, suddenly takes to herself a husband. (i use the verb advisedly!) mothers who have thought their child-bearing days long past sometimes find themselves pregnant. "the child of her old age" is not an uncommon occurrence. unmarried women who have "kept straight" all their lives sometimes go down before temptation at this late time. there is a reason. it is as though nature were making a last desperate attempt to produce another life before it is too late, speeding up all the internal secretions and flashing insistent messages throughout the whole organism. it may help some woman who feels herself inexplicably impelled toward the male sex to know that she is not being "tempted by the devil" but merely driven by the insistent chemicals within her body. she is likely to rationalize and tell herself that it is too bad for a worth-while person like herself to leave no progeny behind her; or she may say, as one of my patients did when contemplating running away with another woman's husband,--that she could make that man so much happier than his wife did, and that she really owed it to him as well as to herself. when a woman knows what is the matter with her, it makes it easier to bide her time and wait for the demands of nature to subside. chemicals may not be so romantic as love, but neither are they so melodramatic! other troubles ="speaking of operations."= physicians are often called upon to diagnose some such vague symptom as pain in the abdomen, back and head; ache in the legs; constipation, or loss of appetite. since the patient is very insistent that something shall be done, the physician may be driven to operate, even when he has an uneasy feeling that the trouble is "merely nervous." sixty per cent. of the operations on women are necessitated by the results of gonorrheal infection. next in frequency up to recent date, have been operations for nervous symptoms which could in no way be reached by the knife. only too often a nerve-specialist hears the tale of an operation which was supposed to cure a certain pain but which left it worse rather than better. it is a pleasure to see some of these pains disappear under a little re-education, but one cannot help wishing that the re-education had come before the knife instead of after it. a skilled surgeon can cut almost anything out of a person's body, but he cannot cut out an instinct. it sometimes takes great skill to determine whether the trouble is an organic affection or a functional disturbance caused by the misdirected instinct of reproduction. often, however, the clinical pictures are so different as to leave no room for doubt, provided the diagnostician has his eyes open and is not over-persuaded by the importunity of the poor neurotic, who insists that the surgeon shall remove her appendix, her gall-bladder, her genital organs, and her tonsils, and who finally comes back that he may have a whack at the operation scar. =the bearing of children.= a number of years ago i became acquainted with a charming young married woman who had all her life recoiled with fear from the phenomena of sex. she had been afraid of menstruation and of marriage, and had at this time almost a phobia for pregnancy and childbirth. before long she came to me in terror, telling me that she had become pregnant. i explained to her that pregnancy is the time when most women are at their best, that the nausea which is often troublesome in the beginning is caused merely by a mixing of messages from the autonomic nerves, which refer new sensations in the womb to the more usual center of activity in the stomach; and that after the body has become accustomed to these sensations, most women experience a greater sense of well-being and peace than at any other time in life. we had a conversation or two on the subject and everything seemed to go well for a while. as it happened, this young woman and her husband came to call on me one afternoon just before the baby was expected. during the visit she began to show signs of being in labor. again she was in terror. again i explained the phenomena of labor, telling her that the womb-contractions are caused by the presence in the blood of a chemical secretion (hormone) which continues its good work as long as there is a state of confidence, but which sometimes stops under fear or apprehension. i explained that these womb-efforts are a peristaltic movement, a contraction of the upper muscles and a letting go of the purse-string muscle at the mouth of the womb, and that fear only tends to tie up this purse-string muscle, making a difficult process out of one which was intended by nature to be much more simple. she seemed to understand and to lose a good deal of her fright. about six o'clock the couple went home on the street car from the upper end of pasadena to the far end of los angeles. the next morning i had a jubilant telephone message from the happy father, announcing that the boy-baby had arrived at midnight and that, wonderful to relate, he had come without the mother's experiencing any pain whatever. i give this account for what it is worth, without of course contending that labor could always be as easy as this. it happened that this girl was a normal, healthy woman and that there were no complications of any kind in the process of childbirth. a right attitude of mind could not have corrected any physical difficulty, but it did seem to help her let go of her fear, which would of itself have caused long and painful labor. a patient once told me that when her first baby came, she happened to be out in the country where she had to call in a doctor whom she did not know. he was an uncouth sort of fellow who inspired fear rather than confidence. she soon found that labor stopped whenever he came into the room, and started again when he went out. she had the good sense to send him out and complete her labor with only the help of her mother. unfortunate is the obstetrician who does not know how to inspire a feeling of confidence in his patients. even childbirth may be mightily helped or hindered by the mother's state of mind. summary a woman's body has more stability than she knows. it is sometimes out of order, but it is more often misunderstood; usually it is an unobtrusive and satisfactory instrument, quite fit for its daily tasks. the average woman is really well put together. we hear about the ones who have difficulty, but not about the great majority who do not. we notice the few who are upset during the menopause, and forget all the others. to be comfortable and efficient most of the time is, after all, merely to be "like folks." the special functions which nature has been perfecting in a woman's body are as a rule, easily carried through unless complicated by false ideas or by fear. if the woman who has no organic difficulty but who still finds herself handicapped by her body, will cease being either resigned to her languishing lot or envious of her stalwart brothers; if instead she will set out to learn how to be efficient as a woman, she will find that many of her ills are not the blunders of an inefficient creator, but are home-made products, which quickly vanish in the light of understanding. chapter xiii _in which we lose our dread of night._ that interesting insomnia the fear of staying awake to sleep or not to sleep! that is the question. in all the world there is nothing to equal it in importance,--to the man with insomnia. his days are mere interludes between troubled nights spent in restless tossing to and fro and feverish worry over the weary day to come. his mind filled with ideas about the disastrous effects of insomnia, he imagines himself fast sliding down hill toward the grave or the insane-asylum. it is true that his conversation very often politely begins something like this: "good morning. did you sleep well last night?" but if we fail to respond by an equally polite "and i hope you had a good night?" he seems restless until he has somehow disillusioned us by stating the exact number of hours and minutes during which he was able to lose himself in slumber. we must not ridicule the man who doesn't sleep. we are all very much alike. if any one of us happens to lie awake for a night or two, he is likely to get into a panic, and if the spell should last a week, he begins looking up steamship agents and talking of voyages to southern seas. the fact is that most people are dreadfully afraid of insomnia. knowing the effects of a few nights of enforced wakefulness, and having had a little experience with the fagged feeling after a restless night, they believe themselves only logical when they fall into a panic over the prospect of persistent insomnia. =two kinds of wakefulness.= as a matter of fact, insomnia is a phantom peril. there is not the slightest danger from lying awake nights, provided one is not kept awake by some irritating physical stimulus. all fear of insomnia is based on ignorance of the difference between enforced wakefulness and deliberate wakefulness, or insomnia. the man who has acquired the habit may stay awake almost indefinitely without appreciable harm, but the one who is kept awake for a week by a pain, by a chemical poison from infection, or by the necessity for staying up on his job, may easily be in a state of exhaustion. even in cases of prolonged pain or over-exertion, the body tends to maintain its equilibrium by hastening its rate of repair and by falling asleep before the danger point is reached. it is almost impossible to impair permanently the tissue of the brain except in the presence of a chemical irritant. in case of infection we often have to give medicine to neutralize the effect of the poison or to resort to narcotics which make the brain cells less susceptible to irritation. but nervous insomnia is another story. a harmless habit =long-lived insomniacs.= a man of my acquaintance once said in all seriousness and with evident alarm: "i am following in the footsteps of my mother. she lived to be seventy years old and she had insomnia all her life." if this man had been preaching a sermon on the harmlessness of chronic insomnia, he could not have chosen a better text, but he seemed just as much concerned about himself as if his mother had died from the effects of three months' wakefulness. people can live healthy lives during twenty or thirty years of insomnia because chronic insomnia is nothing more or less than a habit, and "habit spells ease." the brain cells are not irritated by either internal or external stimuli; there is no effort to keep awake; virtually no energy is expended,--except in restless tossing and worry. if the body is kept still and emotion eliminated, fatigue products are washed away and the reserves are filled in with perfect ease. =thinking in circles.= habit means automatic, subconscious activity, with the least expenditure of energy and the least amount of fatigue. we have already noted the ease with which heart and diaphragm muscles carry on their work from the beginning of life to its end. anything relegated to the subconscious mind can be kept up almost indefinitely without tire, and to this subconscious type of activity belong the thoughts of a chronic insomniac. despite all assertions to the contrary, his conscious mind is not really awake. if he is questioned about the happenings of the night, he is likely to have been unaware of the most audible noises. the thoughts that run through his brain are not new, constructive, energy-consuming thoughts, but the same old thoughts that have been going around in circles for days and weeks at a time. it is true that a person sometimes chooses to wake up and do his constructive planning in the night. this kind of thought does bring fatigue, up to a certain point. after that the body hastens its rate of repair or automatically goes to sleep. activity of this kind is always a matter of choice. he who really prefers sleep will shut the drawers containing the day's business and leave them shut until morning. =day-dreaming at night.= however, the man who makes a practice of staying awake rarely does much real thinking. he lets the thoughts run through his mind as they will, builds air-castles of things he would like to do and can't, or other kinds of air-castles about the disastrous effects of his insomnia on the day that is to come; he worries over his health, or his finances, and grieves over his sorrows. he is really indulging himself, thinking the thoughts he likes most to think, and these consume but little energy. like a horse that knows the rounds, they can go jogging on indefinitely without guidance from the driver. what causes the fatigue =tossing and fretting.= the thing that tires is not the insomnia but the emotion over the insomnia. if people who fail to sleep are perpetually fagged out, it is not from loss of sleep, but from worry and tossing. often they spend a good deal of the night feeling sorry for themselves. they turn and toss, exclaiming with each turn: "why don't i sleep? how badly i shall feel to-morrow! what a night! what a night!" such a spree of emotionalism can hardly fail to tire, but it is not fair to blame the insomnia. he who makes up his mind to it can rest almost as well without sleep as with it, provided he keeps his mind calm and his body relaxed. "decent hygienic conditions" demand not necessarily eight hours of sleep but eight hours of quiet rest in bed. tossing about drives away sleep and uses up energy. i make it a rule that my patients shall not turn over more than four times during the night. this is more important than that they should sleep. to be sure, i do not stay awake to enforce the rule, but most people catch the idea very quickly and before they know it they are sleeping. how to go to sleep =ceasing to care.= the best way to learn to sleep is not to care whether you do or not. nothing could be better than dubois's advice: "don't look for sleep; it flies away like a pigeon when one pursues it."[ ] attention to anything keeps the mind awake, and most of all, attention to sleep. more than one person has waked up to see whether or not he was going to sleep. we cannot, however, fool ourselves by merely pretending indifference. the only sensible way is to get the facts firmly fixed in our minds so that we actually realize that we do not need more sleep than our bodies take. as soon as it is realized that insomnia is really of no importance, it tends to disappear. [footnote : dubois: _psychic treatment of nervous disorders_, p. .] =catching the idea.= there came one day for consultation a very healthy-looking woman, a deaconess of the lutheran church. "doctor," she said, "i came to get relief from insomnia. for twenty years i have not slept more than one or two hours a night." "why do you want more?" i asked. "why, isn't it very unhealthy not to sleep?" she exclaimed in astonishment. "evidently not," i answered. this woman had tried every doctor she could think of, including the splendid s. weir mitchell. her insomnia had become a preoccupation with her, her chief thought in life. all i did was to explain to her that her body had been getting all the sleep it needed, and that neither body nor mind was in the least run down after twenty years of sleeplessness. "when you cease being interested in your insomnia, it will go away, although from a health standpoint it matters very little whether it does or not." we had two conversations on the subject, and a week later she came back to tell me that she was sleeping eight hours a night. one woman had had insomnia for thirty years. after i had explained to her that her body had adjusted itself to this way of living and that she need not try to get more sleep, she snored so loud all night and every night that the rest of the family began to complain! a certain banker proved very quick at catching the idea. he had been so troubled with insomnia and intense weakness that his doctors prescribed a six-months voyage in southern waters. knowing that my prescriptions involved a change in point of view rather than in scene, he came to me. although he had been getting only about half an hour's sleep a night, he went to sleep in his chair the first evening, and then went upstairs and slept all night. he resumed his duties at the bank, walking a mile and a half the first day and three miles the second. during the months following, he reported, "no more insomnia." =keeping account.= a bright young college graduate came to me for a number of ailments, chief among them being sleeplessness. she was also overcome by fatigue, having spent four months in bed. a four-mile walk in the cañon and a few other such outings soon dispelled the fatigue, but the insomnia proved more obstinate. after she had been with me for a week or two, i took her aside one day for a little talk. "well?" i said as we sat down. then she began: "sunday night i was awake from half-past one to four, monday from twelve to one, tuesday from one to three, wednesday from two to four, thursday--" by this time she became aware of the quizzical expression on my face and began to be embarrassed. then she stopped and laughed. "well," she said, "i did not know that i was paying so much attention to my sleep." she was bright enough to see the point at once, gave up her preoccupation in the all-absorbing topic and promptly forgot to have any trouble with so natural a function as sleep. =making new associations.= examples like this show how natural is childlike slumber when once we take away the inhibitions of a hampering idea. age-old habits like sleep are not lost, but they may easily be interfered with by a little too much attention. when a person who can scarcely keep his eyes open all the evening is instantly wide awake as soon as his head touches the pillow, we may be sure that a part of his trouble comes from the wrong associations which he has built up with the thought of night. when a dear little old lady told me of her constant state of apprehension about going to bed, i said to her: "when i go to my room, the darkness says sleep. when i take off my clothes, the very act says sleep. when i put my head on the pillow, the pillow says sleep." she liked that and found herself able to sleep all night. the next evening she wanted another "sleeping-potion" but as i did not want her to become dependent on anybody's suggestion, i put my mouth up close to her ear and whispered, "abra ca dabra, dum, dum, dum." she laughed, but saw the point. after that she slept very well. she merely broke the habit by making a new kind of association with the thought of bed. nature did the rest. it seems hardly necessary to remark that drug-taking is the most inefficient way of handling the situation. everybody knows that narcotics are harmful to the delicate cells of the brain and that the dose has to be continuously increased in cases of chronic insomnia. if a person realizes that the drug is far more harmful than the insomnia itself, he is weak indeed to yield to temptation for the sake of a few nights of sleep. as the cause of insomnia is psychic, so the only logical cure is a new idea and a new attitude of mind. the purpose of insomnia like all nervous symptoms, insomnia is not an affliction but an indulgence. somehow, and in ways unknown to the conscious mind, it brings a certain amount of satisfaction to a part of the personality. no matter how unpleasant it may be, no matter how much we consciously fear it, something inside chooses to stay awake. started, as a rule, through suggestion or imitation, insomnia is sometimes kept up as a means of making ourselves seem important,--to ourselves and to others. it at least provides an excuse for thinking and talking about ourselves, and furnishes a certain feeling of distinction. if something within us craves attention, even staying awake may not be too dear a price to pay for that attention. strange to say, there are other times when the insomnia is chosen by the primitive subconscious mind with the idea of doing penance for supposed sins whose evil effects might possibly be avoided by this kind of expiation. analysis shows that motives like this are not so uncommon as might be supposed. in other cases insomnia is chosen for the chance it gives for phantasy-building. a person denied the right kind of outlet for his instincts may so enjoy the day-dreaming habit that he prolongs it into the night, really preferring it to sleep. such a state of affairs is not at all incompatible with an intense conscious desire to sleep and a real fear of insomnia. so strange may be the motives hidden away within the depths of the most prosaic individual! summary nervous insomnia is something which a part of us makes use of and another part fears. it is a mistake on both sides. although not in the least dangerous, the habit can hardly be considered a satisfactory form of amusement. nature has provided a better way to spend the night, a way to which she speedily brings us when we choose to let her do it. we do not have to ask for sleep as for a special boon which may be denied. we simply have to lie down in trust, expecting to be carried away like a child. if our expectation is not at once realized we can still trust, as with relaxed mind and body we lie in calm content, knowing that nature is, minute by minute, restoring us for another day. chapter xiv _in which we raise our thresholds_ feeling our feelings finely strung violins the young girl had been telling me about her symptoms. "you know, doctor," she said. "i am a very sensitive person. in fact, i have always been told that i am like a finely strung violin." there was pride in every tone of her voice,--pride and satisfaction over possessing an organization so superior to the common clay of the average person. it was a typical remark, and showed clearly that this girl belonged among the nervous folk. for the nervous person is not only over-sensitive, but he accepts his condition with a secret and half-conscious pride as a token of superiority. it seems that there are a good many kinds of sensitiveness. whether it is a good or bad possession depends entirely on what kind of things a person is sensitive to. if he is quick to take in a situation, easily impressed with the needs of others, open-doored to beauty and to the appeal of the spiritual, keenly alive to the humorous, even when the joke is on himself and the situation uncomfortable, then surely he has a right to be glad of his sensitiveness. but too often the word means something else. it means feeling, intensely, physical sensations of which most people are unaware, or reacting emotionally to situations which call for no such response. it means, in short, feeling our feelings and liking to feel them. there seems to be nothing particularly praiseworthy or desirable about this kind of sensitiveness. if this is what it means to be a "finely-wrought violin," it might even be better to be a bass drum which can stand a few poundings without ruin to its constitution. "but," says the sensitive person, "are we not born either violins or drums? is not heredity rather than choice to blame? and what can a person do about it?" these questions are so closely bound up with the problems of nervous symptoms of indigestion, fatigue, a woman's ills, hysterical pains and sensations, and with all the problems of emotional control, that we shall do well to look more carefully into this question of sensibility, which is really the question of the relation of the individual to his environment. selecting our sensations =reaction and over-reaction.= every organism, if it is to live, must be normally sensitive to its environment. it must possess the power of response to stimuli. as the sea-anemone curls up at touch, and as the tiny baby blinks at the light, so must every living thing be able to sense and to react to the presence of a dangerous or a friendly force. only by a certain degree of irritability can it survive in the struggle for existence. the five senses are simply different phases of the apparatus for receiving communications from the outside world. other parts of the machinery catch the manifold messages continually pouring into the brain from within our bodies themselves. these communications cannot be stopped nor can we prevent their impress on the cells of the brain and spinal cord, but we do have a good deal to say as to which ones shall be brought into the focus of attention and receive enough notice to become real, conscious sensations. =paying attention.= if a human being had to give conscious attention to every stimulus from the outer world and from his own body, to every signal which flashes itself along his sensory nerves to his brain, he would need a different kind of mind from his present efficient but limited apparatus. as it is, there is an admirable provision for taking care of the messages without overburdening consciousness. the stream of messages never stops, not even in sleep. but the conscious mind has its private secretary, the subconscious, to receive the messages and to answer them. during any five minutes of a walk down a city street a man has hundreds of visual images flashed upon the retina of the eye. his eye sees every little line in the faces of the passers-by, every detail of their clothing, the decorations on the buildings, the street signs overhead, the articles in the shop-windows, the paving of the sidewalks, the curbings and tracks which he crosses, and scores of other objects to most of which the man himself is oblivious. his ear hears every sound within hearing distance,--the honk of every horn, the clang of every bell, the voices of the people and the shuffle of feet. some part of his mind feels the press of his foot on the pavement, the rubbing of his heel on his stocking, the touch of his clothing all over his body, and all those so-called kinesthetic sensations,--sensations of motion and balance which keep him in equilibrium and on the move, to say nothing of the never-ending stream of messages from every cell of every muscle and tissue of his body. out of this constant rush of stimuli our man gives attention to only the smallest fraction. whatever is interesting to him, that he sees and hears and feels. all other sensations he passes by as indifferent. unless they come with extraordinary intensity, they do not get over into his consciousness at all. ="listening-in" on the subconscious.= the subconscious mind knows and needs to know what is happening in the farthermost cell of the body. it needs to know at any moment where the knees are, and the feet; otherwise the individual would fall in a heap whenever he forgot to watch his step. it needs to know just how much light is entering the eye, and how much blood is in the stomach. to this end it has a system of communication from every point in the body and this system is in constant operation. its messages never cease. but these messages were never meant to be in the focus of attention. they are meant only for the subconscious mind and are generally so low-toned as to be easily ignored unless one falls into the habit of listening for them. unless they are invested with a significance which does not belong to them, they will not emerge into consciousness as real sensations. =psychic thresholds.= boris sidis has given us a word which has proved very useful in this connection. the limit of sensitivity of a cell--the degree of irritability--he calls the stimulus-threshold.[ ] as the wind must come in gusts to drive the rain in over a high doorsill, so must any stimulus--an idea or a sensation--come with sufficient force to get over the obstructions at the doorway of consciousness. these psychic thresholds do not maintain a constant level. they are raised or lowered at will by a hidden and automatic machinery, which is dependent entirely on the ideas already in consciousness, by the interest bestowed upon the newcomer. the intensity of the stimuli cannot be controlled, but the interest we feel in them and the welcome given them are very largely a matter of choice. [footnote : sidis: _foundations of normal and abnormal psychology_, chap. xxx.] each organism has a wide field of choice as to which ideas and which physical stimuli it shall welcome and which it shall shut out. we may raise our thresholds, build up a bulwark of indifference to a whole class of excitations, shut our mental doors, and pull down the shades; or we may lower the thresholds so that the slightest flicker of an idea or the smallest pin-prick of a sensation finds ready access to the center of attention. =thresholds and character.= there are certain thresholds made to shift frequently and easily. when one is hungry any food tastes good, for the threshold is low; but the food must be most tempting to be acceptable just after a hearty meal. on the other hand, a fairly constant threshold is maintained for many different kinds of stimuli. these stimuli are always bound together in groups, and make appeal depending upon the predominating interest. as anything pertaining to agriculture is noticed by a farmer, or any article of dress by a fashionable woman, so any stimulus coming from a "warm" group is welcomed, while any from a "cold" group is met by a high threshold. the kind of person one is depends on what kind of things are "warm" to him and what kind are "cold." the superman is one who has gained such conscious control of his psychic thresholds that he can raise and lower them at will in the interests of the social good. =thresholds and sensations.= the importance of these principles is obvious. the next chapter will show more of their influence on ideas and emotions; but for the present we will consider their lessons in the sphere of the physical. psychology speaks here in no uncertain terms to physiology. whoever becomes fascinated by the processes of his own body is bound to magnify the sensations from those processes, until the most insignificant message from the subconscious becomes a distressing and alarming symptom. the person whose mental ear is strained to catch every little creaking of his internal machinery can always hear some kind of rumble. if he deliberately lowers his thresholds to the whole class of stimuli pertaining to himself, there is small wonder that they sweep over the boundaries into consciousness with irresistible force. =the motives for sensitiveness.= sensitiveness is largely a matter of choice, but what determines choice? why is it that one person chooses altruism as the master threshold that determines the level of all the others, while another person who ought to be equally fine lowers his thresholds only to himself? what makes a person too interested in his own sensations and feelings? as usual there is a cause. the real cause back of most cases of chronic sensitiveness is an abnormal desire for attention. sometimes this love of attention arises from an under-developed instinct of self-assertion, or "inferiority complex." if there is a sense of inadequacy, a feeling of not being so important as other people, a person is quite likely to over-compensate by making himself seem important to himself and to others in the only way he knows. all unconsciously he develops an extreme sensitiveness which somehow heightens his self-regard by making him believe himself finely and delicately organized, and by securing the notice of his associates. or, again, the love of attention may be simply a sign of arrested development, a fixation of the narcissistic period of childhood which loves to look at itself and make the world look. or there may be lack of satisfaction of the normal adult love-life, a lack of the love and attention which the love-instinct naturally craves. if this instinct is not getting normal outlet, either directly through personal relationships or indirectly through a sublimated activity, what is more natural than that it should turn in on itself, dissociate its interest in other things and occupy itself with its own feelings, and at the same time secure the coveted attention through physical disability, with its necessity for special ministration? in any case there is likely to develop a general overreaction to all outside stimulation, a hypersensitiveness to some particular kind of stimulus, or a chronic hysterical pain which somehow serves the personality in ways unknown to itself. no one "feels his feelings" unless, despite all discomfort, he really enjoys them. a hard statement to accept perhaps, but one that is repeatedly proved by a specialist in "nerves"! determining causes =accidental association.= in many cases, the form which the sensitiveness takes is merely a matter of accident. often it is based on some small physical disability, as when a slight tendency to take cold is magnified into an intense fear of fresh air. sometimes a past fleeting pain which has become associated with the stream of thought of an emotional moment--what boris sidis calls the moment-consciousness--is perpetuated in consciousness in place of the repressed emotion. "in the determination of the pathology of hysteria, the accidental moment plays a much greater part than is generally recognized; if a painful affect--emotion--originates while eating but is repressed, it may produce nausea and vomiting and continue for months as an hysterical symptom."[ ] [footnote : freud: _selected papers_, p. .] one of freud's patients, miss rosalie h----, found while taking singing-lessons that she often choked over notes of the middle register, although she took with ease notes higher and lower in the scale. it was revealed that this girl, who had a most unhappy home life, had, during a former period, often experienced this choking sensation from a painful emotion just before she went for her music lesson. some of the left-over sensations had remained during the singing, and as the middle notes happen to involve the same muscles as does a lump in one's throat, she had often found herself choking over these notes. later on, while living in a different city and in a wholly different environment, the physical sensations from her throat muscles, as they took these middle notes, brought back the associated sensations of choking,--without, however, uncovering the buried emotion.[ ] many a painful hysterical affliction is based on just such mechanisms as these. as freud remarks, "the hysteric suffers mostly from reminiscences."[ ] [footnote : ibid, p. .] [footnote : ibid, p. .] =subconscious symbolism.= sometimes, as we have seen, the form which a hypersensitiveness assumes is not determined by any physical sensation, either past or symbolism which acts out in the body the drama of the soul. =facing the facts.= whatever the motives and whatever the determining causes, hypersensibility is in any case a feeling of feelings which is not warranted by the present situation. hypersensitiveness is never anything but a makeshift kind of satisfaction. despite certain subconscious reasoning, it does not make one more important nor more beloved. neither does it furnish a real expression for that great creative love-instinct whose outlet, if it is to bring satisfaction, must be a real outlet into the external world. an understanding of the motives is helpful only when it makes clear that they are short-sighted motives and that the real desires back of them may be satisfied in better ways. some lowered thresholds as the public appetite for specific cases appears to be insatiable, we will give from real life some examples of low thresholds which were raised through re-education. one hesitates to write down these examples because when they are on paper they sound like advertisements of patent medicines. however, there is no magic in any of these cures, but only the working out of definite laws which may be used by other sufferers, if they only know. re-education through a knowledge of oneself and the laws at work really does remarkable things when it has a chance. ="danger-signals" without the danger.= there was the man who had queer feelings all over his body, especially in his head and stomach, and who considered these sensations as danger-signals warning him to stop. this man had worked up from messenger boy to a position next to the president in one of the transcontinental railroad systems. on the appearance of these "danger-signals" he had tried to resign but had been given a year's leave of absence instead. half the year had gone in rest-cure, but he was still afraid to eat or work, and believed himself "done for." after three weeks of re-education he saw that instead of having overdrawn his capital, he had in another sense overdrawn his sensations. he went away as fit as ever, finished his leave of absence doing hard labor on his farm, and then went back to even harder tasks, working for the government in the administration of the railroads during the war. he is still at work. =enjoying poor health.= there was the woman who had been an invalid for twenty years, doing little else during all that time than to feel her own feelings. because of the distressing sensations in her stomach, she had for a year taken nothing but liquid nourishment. she had queer feelings in her solar-plexus and indeed a general luxury of over-feeling. she could not leave her room nor have any visitors. she was the star invalid of the family, waited on by her two hard-working sisters who earned the living for them all. her sisters had inveigled her to my house under false pretenses, calling it a boarding-house and omitting to mention that i was a doctor, because "she guessed she knew more about her case than any doctor." for the first week i got in only one sentence a day,--just before i slipped out of the door after taking in her "liquid nourishment." but at the end of the week i announced that thereafter her meals would be served in the dining-room. when she found that there was to be no more liquid nourishment, she had to appear at the family table. after that it was only a short time before she was at home, cooking for her sisters. when she saw the role she had been unconsciously playing, she could hardly wish to go on with it. =feeling his legs.= mr. r. suffered from such severe and distressing pains in his legs that he believed himself on the verge of paralysis. he was also bothered by a chronic emotional state which made him look like a "weepy" woman. his eyes were always full of tears and his chin a-quiver, and he had, as he said, a perpetual lump in his throat. under re-education both lump and paralysis disappeared completely and mr. r. took his wife across the continent, driving his machine with his own hands--and feet. =a subconscious association.= mr. d.'s case admirably illustrates the return of symptoms through an unconscious association. he was a lawyer, prominent in public affairs of the middle west, who had been my patient for several weeks and who had gone home cured of many striking disabilities. before he came to me, he had given up his public work and was believed by all his associates to be afflicted with softening of the brain, and "out of the game" for good. from being one of the ablest men of his state, he had fallen into such a condition that he could neither read a letter nor write one. he could not stand the least sunshine on his head, and to walk half a mile was an impossibility. he was completely "down and out" and expected to be an invalid for the rest of his life. but these symptoms had one by one disappeared during his five-weeks stay with me. he had done good stiff work in the garden, carried a heavy sack of grapefruit a mile in the hot sun, and was generally his old self again. now he was back in the harness, hard at work as of old. suddenly, as he sat reading in his home one evening, all his old symptoms swept over him,--the pains in his head and legs, the pounding of the heart, the "all-gone" sensations as though he were going to die on the spot. he became almost completely dissociated, but through it all he clung to the idea which he had learned,--namely that this experience was not really physical as it seemed but was the result of some idea, and would pass. he did not tell any one of the attack, ignored it as much as possible, and waited. in a few minutes he was himself again. then he looked for the cause and realized that the article he was reading was one he had read several months previous, when suffering most severely from the whole train of symptoms. when the familiar words had again gone into his mind, they had pressed the button for the whole physiological experience which had once before been associated with them. this is the same mechanism as that involved in prince's case, miss beauchamp, who became completely dissociated at one time when a breeze swept across her face. when dr. prince looked for the cause, he found that once before she had experienced certain distressing emotions while a breeze was fanning her cheek. the recurrence of the physical stimulation had been sufficient to bring back in its entirety the former emotional complex. =another kind of association.= one of my women patients illustrates another kind of association-mechanism, based not on proximity in time but proximity of position in the body. this woman had complained for years of "bladder trouble" although no physical examination had been able to reveal any organic difficulty. she referred to a constant distress in the region of the bladder and was never without a certain red blanket which she wrapped around her every time she sat down. during psycho-analysis she recounted an experience of years before which she had never mentioned to anybody. during a professional consultation her physician, a married man, had suddenly seized her and exclaimed, "i love you! i love you!" in spite of herself, the woman felt a certain appeal, followed by a great sense of guilt. in the conflict between the physiological reflex and her moral repugnance, she had shunted out of consciousness the real sex-sensation and had replaced it with a sensation which had become associated in her subconscious mind with the original temptation. since the nerves from the genital region and from the bladder connect with the same segment of the spinal cord, she had unconsciously chosen to mix her messages, and to cling to the substitute sensation without being in the least conscious of the cause. as soon as she had described the scene to me and had discerned its connection with her symptoms, the bladder trouble disappeared. =afraid of the cold.= patients who are sensitive to cold are very numerous. mr. g.--he of the prunes and bran biscuits--was so afraid of a draft that he could detect the air current if a window was opened a few inches anywhere in a two-story house. he always wore two suits of underwear, but despite his precautions he had a swollen red throat much of the time. his prescription was a cold bath every morning, a source of delight to the other men patients, who made him stay in the water while they counted five. he was required to dress and live like other folks and of course his sensitiveness and his sore throat disappeared. dr. b----, when he came to me, was the most wrapped-up man i had ever met. he had on two suits of underwear, a sweater, a vest and suit coat, an overcoat, a bear-skin coat and a jaeger scarf--all in pasadena in may! besides this fear of cold, he was suffering from a hypersensitiveness of several other varieties. so sensitive was his skin that he had his clothes all made several sizes too big for him so that they would not make pressure. he was so aware of the muscles of the neck that he believed himself unable to hold up his head, and either propped it with his hands or leaned it against the back of a chair. he had been working on the eighth edition of his book, a scientific treatise of nation-wide importance, but his eyes were so sensitive that he could not possibly use them and had to keep them shaded from the glare. he was so conscious of the messages of fatigue that he was unable to walk at all, and he suffered from the usual trouble with constipation. all these symptoms of course belonged together and were the direct result of a wrong state of mind. when he had changed his mind, he took off his extra clothes, walked a mile and a half at the first try, gave up his constipation, and went back to work. later on i had a letter from him saying that his favorite seat was an overturned nail-keg in the garden and that he was thinking of sawing the backs off his chairs. miss y---- had worn cotton in her ears for a year or two because she had once had an inflammation of the middle ear, and believed the membrane still sensitive to cold. there was miss e----, whose underwear always reached to her throat and wrists and who spent her time following the sun; and dr. i----, who never forgot her heavy sweater or her shawl over her knees, even in front of the fire. the procession of "cold ones" is almost endless, but always they find that their sensitiveness is of their own making and that it disappears when they choose to ignore it. =fear of light.= fear of cold is no more common than fear of light. nervous folk with half-shut eyes are very frequent indeed. from one woman i took at least seven pairs of dark glasses before she learned that her eye was made for light. a good example is furnished by a woman who was not a patient of mine at all, but merely the sister of a patient. after my patient had been cured of a number of distressing symptoms--pain in the spine, sore heels, a severe nervous cough, indigestion and other typical complaints,--she began to scheme to get her sister to come to me. this sister, the wife of a minister in the middle west, had a constant pain in her eyes, compelling her to hold them half-shut all the time. when she was approached about coming to me, she said indignantly, "if that doctor thinks that my trouble is nervous, she is much mistaken," and then proceeded to get well. once the subconscious mind gets the idea that its game is recognized, it is very apt to give it up, and it can do this without loss of time if it really wants to. =pain at the base of the brain.= of all nervous pains, that in the back of the neck is by all odds the most common. it is rare indeed to find a nervous patient without this complaint, and among supposedly well folk it is only too frequent. indeed, it almost seems that in some quarters such a pain stands as a badge of the fervor and zeal of one's work. but work is never responsible for this sense of discomfort. only an over-sensitiveness to feelings or a false emotionalism can produce a pain of this kind, unless it should happen to be caused by some poison circulating in the blood. the trouble is not with the nerves or with the spine, despite the fad about misplaced vertebræ. when a doctor examines a sensitive spine, marking the sore spots with a blue pencil, and a few minutes later repeats the process, he finds almost invariably that the spots have shifted. they are not true physical pains and they rarely remain long in the same place. pain in the spine and neck is an example of exaggerated sensibility or over-awareness. since all messages from every part of trunk and limb must go through the spinal cord, and since very many of them enter the cord in the region of the neck and shoulder blades, it is only natural that an over-feeling of these messages should be especially noticed in this zone. sometimes a false emotionalism adds to the discomfort by tensing the whole muscular system and making the messages more intense. when a social worker or a business man gets tense over his work or ties himself into knots over a committee meeting, he not only foolishly wastes his energy but makes his nerves carry messages that are more urgent than usual. then if he is on the look-out for sensations, he all the more easily becomes aware of the central station in the spine where the messages are received. by centering his attention on this station and tightening up his back-muscles, he increases this over-awareness and easily gets himself into the clutch of a vicious habit. sometimes a tenseness of the body is the result, not of a false attitude toward one's work, but of a lack of satisfaction in other directions. if the love-force is not getting what it wants, it may keep the body in a state of tension, with all the undesirable results of such tension. the person who keeps himself tense, whether because of his work or because of tension in other directions, has not really learned how to throw himself into his job and to forget himself, his emotions, and his body. =various pains.= tender spots may appear in almost any part of the body. there was the girl with the sore scalp, who was frequently so sensitive that she could not bear to have a single hair touched at its farthermost end, and who could not think of brushing her hair at such a time. there was the man whose wrists and ankles were so painful that the slightest touch was excruciating; the woman with the false sciatica; the man with the so-called appendicitis pains; and the man with the false neuritis, who always wore jersey coats several sizes too large. each one of these false pains was removed by the process of re-education. =low thresholds to fatigue.= mr. h. was habitually so overcome by fatigue that he could not make himself carry through the slightest piece of work, even when necessity demanded it. on sunday night, when there was no one else to milk the cow, he had had to stop in the middle of the process and go into the house to lie down. to carry the milk was impossible, so low were his thresholds to the slightest message of fatigue. it turned out that things were not going right in the reproductive life. his threshold was low in this direction, and it carried down with it all other thresholds. after a general revaluation of values, he found himself able to keep his thresholds at the normal level. a fine, efficient missionary from the orient had been so overcome with fatigue that he was forced to give up all work and return to this country. he had been with me for a while and was again ready to go to work. he came one day with a radiant face to bid me good-by. "why are you so joyous?" i asked. "because," he answered, "before i came home i was so fatigued that it used me up completely just to see the native servants pack our luggage. now we are taking back twice as much, and i not only packed it all myself but made the boxes with my own hands. no more fatigue for me!" a charming young girl who in many ways was an inspiration to all her associates fell into the habit of over-feeling her fatigue. "you know, doctor," she said, "that i give out too much of myself; everybody tells me so." that was just the trouble. everybody had told her so, and the suggestion had worked. it did not take her long to learn that in scattering abroad she was enriching herself, and that her "giving out" was not exhausting to her but rather the truest kind of self-expression. it is only when a "giving out" is accompanied by a "looking in" that it can ever deplete. the "see how much i am giving," and "how tired i shall be," attitude could hardly fail to exhaust, but a real self-expression and the fulfilment of a real desire to give are never anything else than exhilarating. there is something wrong with the minister who is used up after his sunday sermons. if his message and not himself is his real concern, he will have only a normal amount of fatigue, accompanied by a general sense of accomplishment and well-being, after he has fed his flock. to be sure, i have never been a minister, but i have had a goodly number among my patients and i speak from a fairly close acquaintance with their problems. =stopping our ears.= roosters seem to be a perpetual source of annoyance to the folk whose thresholds are not under proper control. but as roosters seem to be necessary to an egg-eating nation, it seems simpler to change the threshold than to abolish the roosters. there was one woman who complained especially about being disturbed by early-morning chanticleers. i explained that the crowing called for no action on her part, and that therefore she should not allow it to come into consciousness. "do you mean," she said, "that i could keep from hearing them?" as it happened, she was sitting under the clock, which had just struck seven. "did you hear the clock strike?" i asked. "no," she said; "did it strike?" this poor little woman, who suffered from a very painful back and other distressing symptoms, had been married at sixteen to a roué of forty; and, without experiencing any of the psychic feelings of sex, had been immediately plunged into the physical sex-relations. since sex is psycho-physical and since any attempt to separate the two elements is both desecrating and unsatisfactory; it is not surprising that misery, and finally divorce, had been her portion. another equally unpleasant experience had followed, and the poor woman in the strain and disappointment of her love-life, and in the lowering of the thresholds pertaining to this thwarted instinct, had unconsciously lowered the thresholds to all physical stimuli, until she was no longer master of herself in any line. when she saw the reason for her exaggerated reactions, she was able to gain control of herself, and to find outlet in other ways. too many persons fall into the way of being disturbed by noises which are no concern of theirs. as nurses learn to sleep through all sounds but the call of their own patients, so any one may learn to ignore all sounds but those which he needs to hear. connection with the outside world can be severed by a mental attitude in much the same way as this is accomplished by the physical effect of an anaesthetic. then the usual noises, those which the subconscious recognizes as without significance, will be without power to disturb. the well-known new york publisher who spent his last days on his private yacht, on which everything was rubber-heeled and velvet-cushioned, thought that he couldn't stand noises; but how much more fun he would have had, if some one had only told him about thresholds! summary there are two kinds of people in the world,--masters and puppets. there is the man in control of his thresholds, at leisure from himself and master of circumstance, free to use his energy in fruitful ways; and there is the over-sensitive soul, wondering where the barometer stands and whether people are going to be quiet, feeling his feelings and worrying because no one else feels them, forever wasting his energy in exaggerated reactions to normal situations. this "ticklish" person is not better equipped than his neighbor, but more poorly equipped. true adjustment to the environment requires the faculty of putting out from consciousness all stimuli that do not require conscious attention. the nervous person is lacking in this faculty, but he usually fails to realize that this lack places him in the class of defectives. a paralyzed man is a cripple because he cannot run with the crowd; a nervous individual is a cripple, but only because he thinks that to run with the crowd lacks distinction. something depends on the accident of birth, but far more depends on his own choice. understanding, judicious neglect of symptoms, whole-souled absorption in other interests, and a good look in the mirror, are sure to put him back in the running with a wholesome delight in being once more "like folks." chapter xv _in which we learn discrimination_ choosing our emotions liking the taste it was a summer evening by the seaside, and a group of us were sitting on the porch, having a sort of heart-to-heart talk about psychology,--which means, of course, that we were talking about ourselves. one by one the different members of the family spoke out the questions that had been troubling them, or brought up their various problems of character or of health. at length a splendid red cross nurse who had won medals for distinguished service in the early days of the war, broke out with the question: "doctor, how can i get rid of my terrible temper? sometimes it is very bad, and always it has been one of the trials of my life." she spoke earnestly and sincerely, but this was my answer: "you like your temper. something in you enjoys it, else you would give it up." her face was a study in astonishment. "i don't like it," she stammered; "always after i have had an outburst of anger i am in the depths of remorse. many a time i have cried my eyes out over this very thing." "and you like that, too," i answered. "you are having an emotional spree, indulging yourself first in one kind of emotion and then in another. if you really hated it as much as you say you do, you would never allow yourself the indulgence, much less speak of it afterward." her astonishment was still further increased when several of the group said they, too, had sensed her satisfaction with her moods. hard as it is to believe, we do choose our emotions. we like emotion as we do salt in our food, and too often we choose it because something in us likes the savor, and not because it leads to the character or the conduct that we know to be good. the power of choice whether we believe it or not, and whether we like it or not, the fact remains that we ourselves decide which of all the possible emotions we shall choose, or we decide not to press the button for any emotion at all. to a very large extent man, if he knows how and really wishes, may select the emotion which is suitable in that it leads to the right conduct, has a beneficial effect on the body, adapts him to his social environment, and makes him the kind of man he wants to be. =the test of feeling.= the psychologist to-day has a sure test of character. he says in substance: "tell me what you feel and i will tell you what you are. tell me what things you love, what things you fear, and what makes you angry and i will describe with a fair degree of accuracy your character, your conduct, and a good deal about the state of your physical health." since this test of emotion is fundamentally sound, it is not surprising that the nervous man is in a state of distress. indigestion, fatigue, over-sensibility, sound like problems in physiology, but we cannot go far in the discussion of any of them without coming face to face with the emotions as the real factors in the case. when we turn to the mental characteristics of nervous folk, we even more quickly find ourselves in the midst of an emotional disturbance. worried, fearful, anxious, self-pitying, excitable, or melancholy, the nervous person proves that whatever else a neurosis may be, it is, in essence, a riot of the emotions. there is small wonder that a riot at the heart of the empire should lead to insurrection in every province of the personality. it is only for the purpose of discussion that we can separate feeling from thinking and doing. every thought and every act has in it something of all three elements. an emotion is not an isolated phenomenon; it is bound up on the one hand with ideas and on the other with bodily states and conduct. whoever runs amuck in his emotions runs amuck in his whole being. the nervous invalid with his exhausted and sensitive body, his upset mind and irrational conduct is a living illustration of the central place of the emotions in the realm of the personality. but it is not the nervous person only who needs a better understanding of his emotional life. the well man also gets angry for childish reasons; he is prejudiced and envious, unhappy and suspicious for the very same reason as is the nervous man. since the working-capital of energy is limited to a definite amount, the control of the emotions becomes a central problem in any life,--a deciding factor in the output and the outcome, as well as in comfort and happiness by the way. nothing is harder for the average man to believe than this fact that he really has the power to choose his emotions. he has been dissatisfied with himself in his past reactions, and yet he has not known how to change them. his anger or his depression has appeared so undesirable to his best judgment and to his conscious reason that it has seemed to be not a part of himself at all but an invasion from without which has swept over him without his consent and quite beyond control. a house divided against itself most of the confusion comes from the fact that we know only a part of ourselves. what we do not consciously enjoy we believe we do not enjoy at all. what we do not consciously choose we believe to be beyond our power of choice,--the work of the evil one, or the natural depravity of human nature, perhaps; but certainly not anything of our choosing. the point is that a human being is so constituted that he can, without knowing it, entertain at the same time two diametrically opposite desires. the average person is not so unified as he believes, but is, in fact, "a house divided against itself." the words of the apostle paul express for most of us the truth about ourselves: "for what i would, that i do not; but what i hate that i do." what paul calls the law of his members warring against the law of his mind is simply what we call to-day the instinctive desires coming into conflict with our conscious ideal. =hidden desires.= although we choose our emotions, we choose in many cases in response to a buried part of ourselves of which we are wholly unaware, or only half-aware. when we do not like what we have chosen, it is because the conscious part of us is out of harmony with another part and that part is doing the choosing. if the emotions which we choose are not those that the whole of us--or at least the conscious--would desire, it is because we are choosing in response to hidden desires, and giving satisfaction to cravings which we have not recognized. repeated indulgence of such desires is responsible for the emotional habits which we are too likely to consider an inevitable part of our personality, inherited from ancestors who are not on hand to defend themselves. when we form the habit of being afraid of things that other people do not fear, or of being irritated or depressed, or of giving way to fits of temper, it is because these habit-reactions satisfy the inner cravings that in the circumstances can get satisfaction in no better way. these hidden desires are of several different kinds, when squarely looked at. some of the cravings are found to be childish, and so out of keeping with our real characters that we could not possibly hold on to them as conscious desires. others turn out to be so natural and so inevitable that we wonder how we could ever have imagined that they ought to be repressed. still others, legitimate in themselves, but denied because of outer circumstances, are found to be easily satisfied in indirect ways which bear no resemblance to their old unfortunate forms of outlet. when knowledge helps the way to get rid of an undesirable emotion is not by working at the emotion itself, but by realizing that this is merely an offshoot of a deeper root, hidden below the surface. the great point is to recognize this deeper root. =childish anger.= it helps to know that uncalled-for anger is a defense reaction--a sort of camouflage or smoke cloud which we throw out to hide from ourselves and others the fact that we are being worsted in an argument, or being shown up in an undesirable light. better than any amount of weeping over a hot temper is an understanding of the fact that when we fly into unseemly rage we are usually giving indulgence to a childhood desire to run away from unpleasant facts and to cover up our own faults. =enjoying the blues.= it helps to know that the easiest way to fight the blues is by realizing that they are a deliberate, if unconscious, attempt to gain the pity of ourselves and others. there seems to be in undeveloped human nature something that really enjoys being pitied, and if we cannot get the commiseration of other people, we can, without much trouble, work up a case of self-pity. most of us would have to acknowledge that we seldom find tears in our eyes except when our own woes are under consideration. "whatever else the blues accomplish, they certainly afford us a chance to submerge ourselves in a sea of self-engrossment."[ ] [footnote : putnam: _human motives_.] =the chip on the shoulder.= it helps to know that irritability and over-sensitiveness are usually the result of tension from unsatisfied desires which must find some kind of outlet. if a person is secretly restive under the fact that he cannot have the kind of clothes he wants, cannot shine in society, or secure a college education or a large fortune,--all of which minister to our insistent and rarely satisfied instinct of self-assertion,--or if he is secretly yearning for the satisfaction of the marriage relation, or for the sense of completion in parenthood; then the tension from these unsatisfied desires shows itself in a hundred little everyday instances of lack of self-control. these mystify him and his friends, but they are understandable when the whole truth is known. =anxiety and fear.= nowhere is understanding more valuable than when we approach the subject of anxiety and fear. whenever a person falls into a state of abnormal fear, his friends and his physician spend a good deal of time in attempting to prove to him that there is no cause for apprehension, and in exhorting him to use his reason and give up his fear. but how can a person help himself when he is fighting in the dark? how can he free himself when the thing he thinks he fears is merely a symbol of what he really fears? the woman who was afraid she would choke her child had been several months in the hands of christian scientists, and had earnestly tried to replace fear with courage. but in the circumstances, and without further knowledge, this was as impossible as it is for a man to lift himself by his own boot-straps. she had no point of contact with her real fear, as the man has no leverage contact with the earth from which he wishes to lift himself. to be sure there are many cases in which an assumed cheerfulness and courage do have a mighty effect on the inner man. the forces of the personality are not set, but plastic, and are constantly acting and interacting upon one another. surface habits do influence the forces below the surface. william james's advice, "square your shoulders, speak in a major key, smile, and turn a compliment," is good for most occasions, but sometimes even a little understanding of the cause is far more effective. it helps to know that persistent anxiety, lacking obvious cause, is found to be the anxiety of the thwarted instinct of reproduction. when the sex-instinct is repeatedly stimulated and then checked it sets in motion some of the same glands that are activated in fear. what comes up into consciousness is therefore very naturally a fear or dread of impending disaster, very like the poignant anxiety that one feels when stepping up in the dark to a step that is not there. simultaneous with the fear lest these repressed desires should not be satisfied, there is an intense fear lest they should. the more insistent the repressed desire, and the more it seems likely to break through into consciousness, the keener the anguish of the ethical impulses. abnormal fear, however it may seem to be externalized, always implies at the bottom a fear of something within. there is no truth which is harder to believe on first hearing but which grows more compelling with further knowledge, than this truth that an exaggerated fear always implies a desire which somehow offends the total personality. when we observe the various distressing phobias, such as the common fear of contamination, a woman's fear to undress at night, a fear that the gas was not turned off, or that one's clothing is out of order; fear lest the exact truth has not been told, or that the uttermost farthing of one's obligations has not been met,--then we may know that there is something in the fear situation which either directly or symbolically refers to some hidden desire; a desire which the individual would not for the world acknowledge to himself, but which is too keen to be altogether repressed. the close connection between fear and desire is often shown in the unfounded fear of having committed a crime. both doctors and lawyers in their professional work occasionally come upon individuals who believe that they have committed some heinous crime of which they are really innocent, and who insist upon their guilt despite all evidence to the contrary. a quiet, gentle youth who at the age of twenty was under my medical care, is still not sure in his own whether he, at twelve years of age, was the burglar who broke into the village store and killed the owner. it is difficult for the normally self-satisfied individual to understand the appeal of heroics to a person whose starved instinct of self-assertion makes him choose to be known as a villain rather than not to be known at all. =breaking the spell.= when once we bring up into consciousness these hidden desires that manifest themselves in such troublesome ways, we find that we have robbed them of much of their power over our lives. sometimes, it is true, a detailed and thorough exploration by psycho-analysis is necessary, but in many cases it is sufficient just to know that there are underlying causes. to know these things is far from excusing ourselves because of them. even though emotions are determined by forces that are deep in the subconscious, we may still choose in opposition to those forces, if we but know that we can do so. the fact that some of the roots of our bad habits reach down into the subconscious is no excuse for not digging them up. as dr. putnam says, "it is the whole of us that acts, and we are as responsible for the supervision of the unseen as for the obvious factors that are at work. the moon may be only half illumined and half visible, but the invisible half goes on, none the less, exerting its full share of influence on the motion of the tides and earth."[ ] [footnote : putnam: _freud's psychoanalytic method and its evolution_, p. .] the highest kind of choice there is no easier way to enliven any conversation than by dropping the remark that a human being always does what he wants to do. simple as the statement seems, it is quite enough to quicken the dullest table-talk and loosen the most reticent tongue. "i don't do what i want to do," says the college student. "i want to play tennis every afternoon; but what i do is to sit in a stuffy room and study." "i don't do what i want to do," says the mother of a family. "at night i want to sit down and read the latest magazine, but what i do is to darn stockings by the hour." nevertheless we shall see that, even in cases like these, each of us is acting in accordance with his strongest desire. there may be--there often is--a bitter conflict, but in the end the desire that is really stronger always conquers and works itself out into action. it is possible to imagine a situation in which a man would be physically unable to do what he wanted to do. bound by physical cords, held by prison walls, or weakened by illness, he might be actually unable to carry out his desires. but apart from physical restraint, it is hard to imagine a situation in real life in which a person does not actually do what he wants to do; that is, what _in the circumstances he wants to do_. this is simply saying in another way that we act in accordance with the emotion which is at the moment strongest. =will is choice.= just here we can imagine an earnest protest: "but why do you ignore the human will? why do you try to make man the creature of feeling? a high-grade man does--not what he wants to do but what he thinks he ought to do. in any person worthy of the adjective 'civilized' it is conscience, not desire, which is the motive power of his life." it is true: in the better kind of man the will is of central importance; but what is "will"? let us imagine a raw soldier in the trenches just before a charge into no-man's land. he is afraid, but the word of command comes, and instantly he is a new creature. his fear drops away and, energized by the lust of battle, he rushes forward, obviously driven by the stronger emotion. he goes ahead because he really wants to, and we say that he does not have to use his will. imagine another soldier in the same situation; with him fear seems uppermost. his knees shake and his legs want to carry him in the wrong direction, but he still goes forward. and he goes forward, not so much because there is no other possibility as because, in the circumstances, he really wants to. all his life, and especially during his military training, he has been filled with ideals of loyalty and courage. more than he fears the guns of the enemy or of his firing-squad does he fear the loss of his own self-respect and the respect of his comrades. greater than his "will to live" is his desire to play the man. there is conflict, and the desire which seems at the moment weaker is given the victory because it is reinforced by that other permanent desire to be a worthy man, brave, and dependable in a crisis. he goes forward, because in the circumstances, he really wants to, but in this case we say that he had to use his will. is it not apparent that will itself is choice,--the selection by the whole personality of the emotion and the action which best fit into its ideals? will is choice by the part of us which has ideals. mcdougall points out that will is the reinforcement of the weaker desire by the master desire to be a certain kind of a character.[ ] [footnote : "the essential mark of volition is that the personality as a whole, or the central feature or nucleus of the personality, the man himself, is thrown upon the side of the weaker motive."--mcdougall: _introduction to social psychology_, p. .] each human being as he goes through life acquires a number of moral ideals and sentiments which he adopts as his own. they become linked with the instinct of self-assertion, which henceforth acts as the motive power behind them, and attempts to drive from the field any emotion which happens to conflict. men, like the lower animals, are ruled by desire, but, as g.a. coe says, "men mold themselves. they form desires not merely to have this or that object, but to be this or that kind of a man."[ ] [footnote : coe: _psychology of religion_.] if a man be worthy of the name, he is not swayed by the emotion which happens for the moment to be strongest. he has the power to reinforce and make dominant those impulses which fit into the ideal he has built for himself. in other words, he has the power to choose between his desires, and this power depends largely upon the ideals which he has incorporated into his life by the complexes and sentiments which compose his personality. _ideas and ideals_. if emotion is the heart of humanity, ideas are its head. in our emphasis on emotion, we must not forget that as emotion controls action, so ideas control emotion. but ideas, of themselves, are not enough. everybody has seen weaklings who were full of pious platitudes. ideas do control life, but only when linked up with some strong emotion. no moral sentiment is strong enough to withstand an intense instinctive desire. if ideas are to be dynamic factors in a life, they must become ideals and be really desired. they must be backed up by the impulse of self-assertion, incorporated with the sentiment of self-regard, and so made a permanent part of the central personality. parents and teachers who try to "break a child's will" and to punish every evidence of independence and self-assertion little know that they are undermining the foundations of morality itself, and doing their utmost to leave the child at the mercy of his chance whims and emotions. there can be no strength of character without self-regard, and self-regard is built on the instinctive desire of self-assertion. =education and religion.= it is easy to see how important education is in this process of giving the right content to the self-regarding sentiment. the child trained to regard "temper" as a disgrace, self-pity as a vice, over-sensitiveness as a sign of selfishness, and all forms of exaggerated emotionalism as a token of weakness, has acquired a powerful weapon against temptation in later life. indulgence in any of these forms of gratification he will regard as unworthy and out of keeping with his personality. it is easy, too, to see how central a place a vital religious faith has in enriching and ennobling the ego-ideal, and in giving it driving-power. a force which makes a high ideal seem both imperative and possible of achievement could hardly fail to be a deciding factor. every student of human nature knows in how many countless lives the christian religion has made all the difference between mere good intentions and the power to realize those intentions; how many times it has furnished the motive power which nothing else seemed able to supply. moral sentiments which have been merely sentiments become, through the magic of a new faith, incorporated into conscience and endowed with new power. just here lies the value of any great love, or any intense devotion to a cause. as royce says: "to have a conscience, then, is to have a cause; to unify your life by means of an ideal determined by this cause, and to compare this ideal and the life."[ ] [footnote : royce: _philosophy of loyalty_, p. .] =avoiding the strain.= it seems that a human being is to a large extent controlled by will, and that will is in itself the highest kind of choice. but too often will is crippled because it does not speak for the whole personality. knowledge helps a person to relate conscience with hitherto hidden parts of himself, to assert his will, and to choose only those emotions and outlets which the connected-up, the unified personality wants. sometimes, indeed, a little knowledge makes the exercise of the will power unnecessary. using will power is, after all, likely to be a strenuous business. it implies the presence of conflict, and the strain of defeating the desire which has to be denied.[ ] why struggle to subdue emotional bad habits when a little insight dispels the desire back of them, and makes them melt away as if by magic? for example, why use our will to keep down fear or anger when a little understanding dissipates these emotions without effort? [footnote : freud: _introduction to psychoanalysis_, p. .] whatever we do with difficulty we are not doing well. when it requires effort to do our duty this means that a great part of us does not want to do it. when we get rid of our hidden resistances we work with ease. as a strong wind, applied in the right way, drives the ship without effort, just so the forces in our lives, if they are adjusted to one another, will without strain or stress easily and naturally work together to carry us in the direction we have chosen. when we get rid of blind conflicts, even the business of ruling our spirits becomes feasible. summary =various "sprees."= the human animal has a constitutional dislike for dullness and will seize upon almost any device which promises to lift him out of what he considers the monotony of daily grind. an elaborate essay might be written on the means which human beings have taken to create the sense of _aliveness_ which they so much crave. some of them--we call them savages--have found satisfactory certain wild orgies in primitive war-dances; others--we shall soon call them "out of date"--have found simpler a bottle of whisky or a glass of champagne; still others find a cold shower more invigorating, or a brisk walk or a good stiff job which sets them aglow with the sense of accomplishment. but there are always those who, for one reason or another, find most satisfactory of all a chronic emotional tippling, or a good old-fashioned emotional spree. persons who would be shocked at the idea of whisky or champagne allow themselves this other kind of indulgence without in the least knowing why. nor is the connection between alcoholism and emotionalism so far-fetched as it seems. psycho-analytic investigations have repeatedly revealed the fact that both are indulged in because they remove inhibitions, give vent to repressed desires, and bring a sense of life and power which has somehow been lost in the normal living. both kinds of spree are followed by the inevitable "morning after" with its proverbial headache, remorse, and vows of repentance but despite all this, both are clung to because the satisfaction they bring is too deep to be easily relinquished. whenever an emotion quite out of keeping with conscious desire is allowed to become habitual, we may know that it is being chosen by a part of the personality which needs to be uncovered and squarely faced. nervous symptoms and exaggerated emotionalism are alike evidence of the fact that the wrong part of us is doing the choosing and that the will needs to be enlightened on what is taking place in the outer edge of its domain. in the choice between emotionalism and equanimity, the selection of the former can only be in response to unrecognized desire. a nervous person is invariably an emotional person, and as a rule lays the blame for his condition upon past experiences. but experience is what happens to us _plus_ the way we take it. we cannot always ward off the blow, but we can decide upon our reaction. "even if the conduct of others has been the cause of our emotion, it is really we ourselves who have created it by the way in which we have reacted."[ ] [footnote : dubois: _psychic treatment of nervous disorders_, p. .] one ship drives east, another drives west, while the self-same breezes blow; 'tis the set of the sail, and not the gale that bids them where to go. like the winds of the sea are the ways of fate, as we journey along through life; 'tis the set of the soul that decides the goal, and not the calm or the strife. rebecca r. williams. chapter xvi _in which we find new use for our steam_ finding vent in sublimation the re-direction of energy a child pent up on a rainy day is a troublesome child. his energy keeps piling up, but there is no opportunity for him to expend it. the nervous person is just such a pent-up child. a portion of his personality is developing steam which goes astray in its search for vent; this portion is found to be the psychic side of his sex-life. something has blocked the satisfactory achievement of instinctive ends and turned his interest in on himself. perhaps he does not come into complete psychic satisfaction of his love-life because his wife is out of sympathy or is held back by her own childish repressions. perhaps his love-instinct is baffled by finding itself thwarted in its purpose of creating children, restrained by the social ban and the desire for a luxurious standard of living. perhaps he is jealous of his chief, or of an older relative whose business stride he cannot equal. jung has pointed out how frequently introversion or turning in of the life-force is brought about by the painfulness of present reality and by the lack of the power of adaptation to things as they are. but this lack always has its roots in childhood. the woman who is shocked at the thought of sex is the little girl who reacted too strongly to early impressions. the man of forty who is disgruntled because he is not made manager of a business created by others is the little boy who was jealous of his father and wanted to usurp his place of power. the man who suffers from a sense of inferiority because his friend has a handsomer or more intellectual wife is the same little boy who strove with his father for possession of the mother, the most desired object in his childish environment. the measure of escape from these childish attitudes means the measure of success in life. fortunately for society, the average person achieves this success. the normal person in his childhood learned how to switch the energy of his primitive desires into channels approved by society. stored away in his subconscious, this acquired faculty carries him without conscious effort through all the necessary adjustments in maturity. the nervous person, less well equipped in childhood, may fortunately acquire the faculty in all its completeness, although at the cost of genuine effort and patient self-study. =sublimation the key word.= in the prevention and in the cure of nervous disorders there is one factor of central importance, and that factor is sublimation--or the freeing of sex-energy for socially useful, non-sexual ends. to sublimate is to find vent for oneself and to serve society as well; for sublimation opens up new channels for pent-up energy, utilizing all the surplus of the sex-instinct in substitute activities. when the dynamic of this impulse is turned outward, not inward, it proves to be one of man's greatest possessions, a valuable contribution of energy to creative activities and personal relationships of every kind. =the failure to sublimate.= a neurosis is nonconstructive use of one's surplus steam. the trouble with a nervous person is that his love-force is turned in on himself instead of out into the world of reality. this is what his friends mean when they say that he is self-absorbed; and this is what the psychologists mean when they say that a neurotic is introverted. a person, in so far as he is nervous, does not see other people at all--that is, he does not see them as real persons, but only as auditors who may be made to listen to the tale of his woes. his own problems loom so large that he becomes especially afflicted with what cabot calls "the sin of impersonality"; or to use president king's words, he lacks that "reverence for personality" which enables one to see people vividly as real persons and not as street-car conductors or servants or merely as members of one's family. to be sure, many a so-called normal individual is afflicted with this same kind of blindness; here as elsewhere the neurotic simply exaggerates. engrossed in his own mental conflicts and physical symptoms, he is likely to find his interest withdrawing more and more from other people and centering upon himself. =sublimation and religion.= we do not need psychology to tell us that engrossment in self is a disastrous condition. when the psycho-analyst says that the life-force must be turned out, not in, he is approaching from a new angle the truth as it is found in the gospel,--"thou shalt love the lord thy god with all thy heart," and "thy neighbor as thyself." religion provides the love-object in the creator; altruism provides it in the "neighbor." christianity and psychology agree that as soon as love ceases to be an outgoing force, just so soon does the individual become an incomplete and disrupted personality.[ ] [footnote : for emphasis on religion as a means to sublimation, see freud, putnam, pfister, james, and dubois.] =carlyle's doctrine of work.= "produce! produce! produce!" life for a social being involves not only rich personal relationships, but absorbing, creative work. no nervous person is cured until he is willing to take and to keep a "man-size job." a good piece of work is not only the sign of a cure; it is the final step without which no cure is complete. =along nature's lines.= if the psychologist is asked what kind of task this is to be, he answers that each person must decide for himself his own life-work. an individual may not know why, but he does know that there are certain things which he most likes to do. sublimation is more readily accomplished if his energy is directed toward self-chosen interests. parents or teachers or physicians who try to force another person into any definite plan of action are making a grievous blunder. help may be given toward self-knowledge and the understanding of general principles, but advice should never be specific. taken in the large, it is found that men and women choose different ways of sublimation. man and woman differ in the psychic components of the sex-life even as they differ in the physical. sublimation to be successful must follow the lines laid down by nature. the urge of the average man is toward construction, domination, mastery. the urge of the average woman is toward mothering, protection, nurture. the masculine characteristics find ready sublimation in a career; the man builds bridges, digs canals, harnesses mountain streams, conquers pests, overcomes gravity, brings the ends of the earth together by "wireless" or by rail; he provides for the weak and the helpless--his own progeny--or, incarnated in the body of a hoover, he gives life to the children of the world. in woman, the dominant force is the nurturing instinct. child and man of her own come first, but when these are lacking, to paraphrase kipling, in default of closer ties, she is wedded to convictions; heaven help him who denies! only as a career opens up full vent for this nurturing instinct, will it provide satisfactory substitute in sublimation. its natural trend can be seen in the recent tidal wave of social legislation--for prohibition, child-labor laws, sanitation, recognition and control of venereal disease, acknowledgment of paternity to the illegitimate child. since the women of the day, in numbers up to the million, have been compelled to sacrifice both man and unformed babe to the grim juggernaut of war, this nurturing urge may press hard against many of the social and business barriers now impeding its flow. but if society understands and readjusts these barriers, making it possible for its citizens--women as well as men--to approximate the natural instinctive bent, it will not only save itself much unrest but will also go far toward preventing the spread of nervous invalidism. summary that which a nervous invalid most needs is a redirection of energy. since, in spite of appearances, there is never any real lack of energy, no time is needed for the making of strength, and a cure can take place just as soon as the inner forces allow the energy to flow out in the right direction. sometimes, indeed, an outer change may start the inner process. often the "work cure" does cure; occasionally the sudden necessity to earn one's living or to mother a little child frees the life-force from its old preoccupation and forces it into other channels. in most cases, however, the nervous invalid is suffering not from lack of opportunities for outside interest but from an inner inability to meet the opportunities which present themselves. the great change that has to be made is not in external conditions and habits but in the hidden corners of the mind; a change that can be accomplished only by self-knowledge and re-education. but if self-knowledge is the first step in any cure, so self-giving must be the final step. sooner or later in the life of every nervous invalid there comes a time when nothing will serve to unify his disorganized forces but steady and unswerving responsibility for a good stiff piece of work. happy for him that this is so and that he is living in a day when science no longer tells him to fold his hands and wait. glossary _autonomic nervous system:_ the vegetative nervous system which controls vital functions,--as digestion, respiration, circulation. _censor:_ a hypothetical faculty of the fore-conscious mind which resists the emergence into consciousness of questionable desires. _common path:_ in physiology, the final route over which response is made to physical stimulation; similarly in psychology, the one outlet for the finally dominant impulse. _compensation:_ exaggerated manifestation of one character-trend as a defense against its opposite which is painfully repressed; relief in substitute symptom formation. _complex:_ a group of ideas held together by emotion (usually referring to a group which is wholly or in part unconscious). _compulsion:_ a persistent compelling impulse to perform some seemingly unreasonable (but really substitute or symbolic) act, or to hold some irrational fear or idea; an emotional force which has been separated from the original idea. _conflict:_ (special) struggle between instincts (unconscious). _conversion:_ (special) the process by which a repressed mental complex expresses itself through a physical symptom. _displacement:_ . transposition of an emotion from its original idea to one more acceptable to the personality. . the shifting of emphasis, in dreams, from essential to less significant elements. _dissociation:_ . the state of being shut out from taking active part (applied to a group of ideas), as in normal forgetfulness. . (abnormal) an exaggerated degree of separation of groups of ideas, with loss to the personality of the forces or memories which these groups contain, as in double personality. _fixation:_ establishment in childhood of over-strong habit-reactions. _free association:_ a device for uncovering buried complexes by letting the mind wander without conscious direction. _homo-sexual:_ the quality of being more attracted by an individual of the same sex (abnormal) than by one of the opposite sex (hetero-sexual, normal). _hysteria:_ that form of functional nervous disorder which manifests itself in physical symptoms; an attempt to dramatize unconscious repressed desires. _inhibition:_ restraint (special) limitation of function, physical or ideational, due to unconscious emotional attitudes. _libido:_ life-force, élan vital, or (restricted) the energy of the sex-instinct. _neurosis:_ used loosely for psycho-neurosis or nervous disorder. _obsession:_ a compulsive idea inaccessible to reason. _oedipus complex:_ over-strong bond between mother and son, or (more loosely) between father and daughter. _over-determined:_ used of an impulse made over-strong by lack of discharge, with accumulation of emotional tension from added factors. _phobia:_ a persistent, unreasoning fear of some object or situation. _psycho-neurosis:_ "a perversion of normal (psychic) reactions," (prince); a general term for functional dissociation of the personality, resulting in: psychasthenia--disturbed ideation; neurasthenia--disturbed emotions; hysteria--disturbed motor or sensory activity. _psychotherapy:_ treatment by psychic or mental measures. _rationalization:_ the process of substituting a plausible, false explanation for a repressed, unconscious desire. _repression:_ expulsion from consciousness of a pain-provoking mental process. _resistance:_ the force which impedes the return of a repressed complex to consciousness. _subconscious:_ that part of the mind of which one is unaware; the storehouse of memories ancestral and personal. _sublimation:_ the act of freeing sex-energy from definitely sexual aims; utilization of sex-energy for nonsexual ends. _suggestion:_ the process by which any idea, true or false, takes hold of one; the idea may enter the mind consciously or unconsciously, through reason or through impulse. _symbol:_ an object or an attitude which stands for an ides or a quality; (special) that which stands for or represents some unconscious mental process. _threshold_ (door-sill): a figure which represents the level of the barrier erected by the mind against the perception of an idea or sensation. _transference:_ unconscious identification of a present personal relationship with an earlier one, with conveyance of the earlier emotional attitudes (hostile or affectionate) to the present relationship. bibliography books on the general laws of body and mind cannon, walter b: bodily changes in pain, hunger, fear and rage. crile, george w.: the origin and nature of the emotions. coe, george albert: the psychology of religion. hudson, thomas jay: the law of psychic phenomena. janet, pierre: the major symptoms of hysteria; the mental state of hystericals. james, william: psychology; talks to teachers on psychology; varieties of religious experience. jastrow, joseph: the subconscious. kempf, edward j.: the tonus of autonomic segments in psychopathology. long, constance: psychology of fantasy. mcdougall, william: social psychology. mosher, clelia duel: health and the woman movement. phillips, d. e.: elementary psychology. prince, morton: the unconscious; the dissociation of a personality; my life as a dissociated personality. sherrington, charles l.: the integrative action of the nervous system. sidis, boris: the foundations of normal and abnormal psychology; psychopathological researches. tansley, a. g.: the new psychology. thomson, william hanna: brain and personality. white, william a.: principles of mental hygiene; the mental hygiene of childhood. proceedings of the international conference of women physicians. (national board, y.w.c.a., lexington avenue, new york city.) books on mental hygiene brown, charles r.: faith and health. bruce, h. addington: scientific mental healing. cabot, richard: what men live by; social service and the art of healing. dubois, paul: the psychic treatment of nervous disorders. huckel, oliver: mental medicine. james, william: vital reserves. prince, morton, and others: psychotherapeutics. sadler, william s.: the physiology of faith and fear. worcester, elwood } mccomb, samuel } religion and medicine. coriat, isador h. } books on psycho-analysis brill, a. a.: fundamentals of psychoanalysis. emerson, l. e.: nervousness. freud, sigmund: the interpretation of dreams; the psychopathology of everyday life; wit and the unconscious; selected papers and sexual theory; a general introduction to psychoanalysis. frink, h. w.: morbid fears and compulsions. hitschmann, e.: freud's theories of the neuroses. holt, e. b.: the freudian wish. jung, carl g.: the psychology of the unconscious; analytical psychology. jones, ernest: psycho-analysis; treatment of the neuroses, including psychoneuroses--in modern treatment of nervous and mental diseases--white and jelliffe. pfister, oskar: the psychoanalytic method. putnam, james jackson: addresses on psychoanalysis--human motives. tridon, andré: psychoanalysis. white, william a.: the mechanisms of character formation. journals devoted to the subject of nervous disorders journal of abnormal psychology, published in boston. psychoanalytic review, published in washington, d.c. international journal of psychoanalysis, published in london. index a acid and milk, , acidosis, adjustment a neurosis an effort at, to new conditions causes consciousness, of the race, in subconscious, to the social whole, , , adolescence, adrenal secretion, , , , , alcoholism, relation to unconscious desires, alvarez, w.d., ames, thaddeus hoyt, amnesia, anaemia, buttermilk in, anger, ff. anxiety and fear, , , anxiety neurosis, , anxious thought in conversion hysteria, appetite, symbolic loss of, association accidental, a chain of, free, , making new, , of ideas, subconscious, word test, , audience, secured in a neurosis, auto-eroticism, auto-intoxication, , automatic writing, , autonomic nervous system, , , auto-suggestion, , b bacteria, in anaemia, sciatica, rheumatism, bashfulness, bergson, biliousness, birth-theories, , , blocking, in word association, bodily response to emotional states, brain, diseased in insanity, sound in neurosis, fag, , records, bran fad, breuer, joseph, brill, a.a., , , , bruce, h. addington, , burrow, trigant, , buttermilk in anaemia, c cabot, richard, , canfield, dorothy, cannon, walter b., , capitalizing an illness, catechism, cathartics, and acidosis, and bacterial infection, and child birth, , and operations, causes of nerves, , censor, psychic, , change of life, character and health, , , chemistry, , , , , , , , , , child, birth-theories of, father to the man, habit-fixation of, love-life, four periods , questions, too much bossing of, too much petting of, training, childhood, bonds too strong, determines future character, , experiences, reactions, choosing our emotions, a neurosis, , , our sensations, christian religion, , coe, george a., , colon, function of, , common path, compensation, , complex, against marriage, and conditioned reflex, and personality, breaking up of, , buried, , , , , , chance signs of, definition, dissociated, emotional, , father-mother, feeling-tone of, formation of, forming a resistance, making over, , mother-son, physiological, repressed, , , unconscious, compromise, , , compulsion neuroses, , , conditioned reflex, conduct, kind of, , , conflict, , , , , , , , , , , , conscience, , , , , consciousness, displaced threshold of, relation to the subconscious, rise of, constipation, ff. and food, , cure of, due to suggestion, purpose of, conversion-hysteria, , , , , , , crile, george w., , curiosity, child's concerning sex, displacement over to scientific investigation, d day-dreaming, , , defence-reaction, desire energy of, in dreams, in emotional habits, in nervous disorders, instinctive, instinctive and ideals, tensions of, diarrhoea, bacterial, dietetics, essence of, digestion, , , , disease, of the ego, physical, , , psychic, , , , disorders, functional and organic, displacement, , , , dissociation, abnormal, an example of, , in hypnosis, in hysteria, , in neurasthenia, increases suggestibility, normal, of a "personality," of memory picture of walking, of power of sight, dreams, ff. freud's dictum, latent content, manifest content, purpose of, work of, dubois, paul, , , , , e education, , in emotional control, emotion, , ff. and complexes, and fatigue, , and instincts, ff. and muscle tone, blood-pressure in, bodily response to, feeling tones in, precocious, repressed (see repression) secretions in, the strongest cement, tonic and poisonous, unrecognized desire in, energy, adaptable, creative, , , inhibited, libido, , misdirected, , new level of, physiological reserve, redirection of, releasers of, three uses of, utilization of, , "energies of men", environment, , , , evolution, exhaustion, nervous, , , , explanation vs suggestion, ff. f fads-dynamogenic, faith, family complex, fatigue, ff. a matter of chemistry, and insomnia, , and moral tension, and sex-repression, , true and false, fear, ff. exaggerated, externalized, of cold, of fatigue, , of food, , of heat, of noise, physical effects of, purpose of, symbolic of desire, feeling our feelings, ff. feeling-tones, , , , fermentation, finding new vents, fixation of habits, , , flat-foot, food, ff. and constipation, , for the children, idiosyncrasies, mixtures, variety essential, foreconscious, free association, , , freud, sigmund, , , , , , , , , , , , , , , , freudian principles, , , misconceptions concerning, , frink, h.w., , , , , , , g gall-stones, gas on the stomach, gastric juice, , gastritis, genius, girard-mangin, dr., goitre, h habit, defined, dissociation, dreaming, fixation of, , of insomnia, of loving, , of rebelling, , of repressing normal instincts, reactions, heredity, hidden desires, , hinkle, bertha m., holt, e.b., homosexuality, hoover, herbert a., hormone, , hudson, j.w., , hydrochloric acid, hygiene, laws of, moral, hygienic conditions, , hypersensitiveness, hypnosis, ff. aid to diagnosis, its drawbacks, suggestibility in, hysteria, , hysterical pains, hysterical pregnancy, (case), i ideas, and emotions, ascetic, contagion of, dynamogenic, not surgical, idiosyncrasies, physical, identification, imagination, incantation, indigestion; , inferiority complex, , inhibition, , , , , , insomnia, ff. instincts and their emotions, ff., ff. instincts, beneficent, energy releasers, race-inheritance, repressed, , , , , sex (see under sex) thwarted, , , , , , internal secretion, of ovary, , (see adrenal) (see thyroid) introspection, introversion, , j james, william, , , , , , , janet, pierre, jealousy, , jelliffe, smith ely, , , , jones, ernest, judicious neglect, jung, c.g., , , , , , k kempf, edward j., kinaesthetic sensations, l latency period, libido, , , liver trouble, m masturbation, mcdougall, wm., , , memories, ff. menopause, menstruation, mind (see consciousness and subconscious) misconceptions, about the body, , about theory of sex, mixtures, fear of, monogamy, moral hygiene, mosher, clelia duel, muscle-tone, , myth, n narcissus, , , nausea, , , of pregnancy, nerves, attitude toward, causes of, , drama of, , medical schools and, not physical, prevention of, neurasthenia, , neuritis, , neurosis, a compromise, a confidence game, a failure of sublimation, a flight from reality, an ethical struggle, an introversion, and shell-shock, and suggestion, anxiety, , awkwardness of, compulsion, caused by buried complexes, , definition origin in childhood, , , purpose of, root-complex of, o obsession, , oedipus complex, organic trouble, , , ouija board, over-awareness, over-compensation, over-determined, p pain, at base of the brain, chronic hysterical, menstrual, personality, alterations of, , , and emotions, , and will, choice by, complexes and, disrupted, multiple, , nervousness a disorder of, reverence for, unified, persuasion, pfister, oskar, , , phantasy, , phobia, , plagiarism, popular misconceptions, prince, morton, , , , , , , , , psycho-analysis, ff. psychological explanation, psychology, , , psycho-neurosis, , , , (see also neurosis) psycho-therapy, , , ptosis, , putnam, james j., , , , , , , r race-memories, rationalization, , , , reaction and over-reaction, , , , , reality, flight from, , re-education, ff. reflex, conditioned, physiological, regression to infantile state, , case of, religion, , , , reminiscences, hysteric suffers from, repression, , , , , , , resistance, , , , , rest-cure, rheumatism, buttermilk treatment of, rixford, emmet l., royce, josiah, s sadler, wm., , school, four grade, second wind, self-abuse, , self-pity, self-regard, , , , sensations, lowered threshold to, ff. sensitiveness, , sex, and artistic creation, and "nerves," ff. glands, secretion of, , , instinct organically aroused, instinct thwarted, , , instruction, license, life, , , perversion, phantasy, psychic component of, , , , repressed, sublimation of, , shell-shock, (see foreword) also , sherrington, chas., sick-headache, sidis, boris, , , , , , slips of tongue, etc., slogan, of psychoanalytic school, woman's, social code, soda, misuse of, "sour-stomach," , sprees, stammering, standard, double, single, stomach, and conversion hysteria, ff. fads, gas on, subconscious mind, ff. amenable to control by suggestion, emotion, functions of, , , habits of, , physical expression of, playing confidence game, store-house of memories, , tireless, sublimation, ff. a synthesis, and religion, , definition (freud), , failure of, , , in a career, in artistic creation, natural trends of, of energy, , , success, measure of, sugar in urine, suggestion, a method of psychotherapy, constipation the result of, , definition, false, in child training, in hypnosis, , in sleep, inconvenient forms of, power of, unhealthy, suggestibility, , , superman, symbolism, , , , symptoms, purpose of, t taboos, dietary, ff. interest in, tensions, psychic, , , , thresholds, psychic, ff. thyroid secretion, , , , transference, , , trotter, w., u unconscious, (see subconscious) v venereal disease, , vitamins, w white, wm. a., , , , will, williams, tom a., , wish fulfilment, , , , word-association test, work-cure, illustrations from cases a adolescence and depression, , anger and circulation, angina pectoris, false, anxiety-neurosis, b bearing children, brain fag, bran crackers and prunes, c cathartics, abuse of, childhood sex-reactions, constipation and lacerations in labor, constipation and mineral oil, constipation, recovery from, (some cases), contamination, fear of, conversion of moral distress to physical, d danger-signals and the railroad man, dissociated state, memories in, e emotion and sick-headache, "enjoying" poor health, , "exhaustion," eye-strain, twenty-five years, f fatigue, , , (two cases), fatigue and emotion, (three cases), fear, , of heat, fear of air, , fear of cold, (three cases), , fear of light, (two cases), fear complicating labor, "flat-foot," forgetting and repressed wish, free-love, chemical cause of, g gall-stones, i idiosyncrasy for eggs, insomnia and attention, insomnia and point of view, insomnia and wrong associations, insomnia, chronic, l library, child fear of, locomotor ataxia, exaggeration of symptoms, m menstrual pain, unnecessary, muscle-tumors, phantom, , n nausea, in sex-repression, , nervous indigestion, "neuritis," , false, noise, fear of, o obsession against marriage, p paralysis, fear of, , physical illness mistaken for functional, plagiarism, r recovering lost word, repression and disgust, s sick-headache, , skim-milk diet, "sour stomach" and two tyrolese, t temper, an indulgence, the "repeater" gains in weight, thyroid disturbance, fatigue in, , u unconscious association and symptoms, w walking, lost power of, word association test, transcriber's notes the following typographical errors were noted and corrected: on page of the book: heading changed from "a searching queston" to "a searching question". on page , "narcisstic" changed to "narcissistic". on page , "..the nausea disappearaed." changed to "disappeared". on page , "...nature's functions re reëstablished" changed to "be". on page , "...nor even of man's infringment..." changed to "infringement". on page , "i put my mouth up close to to her ear...", removed the duplicate "to". on page , for the paragraph starting "but these symptoms...", "disappeaared" changed to "disappeared". in the index, page , "thesholds" changed to "thresholds". note: project gutenberg also has an html version of this file which includes the original illustrations. see -h.htm or -h.zip: (http://www.gutenberg.net/dirs/ / / / / / -h/ -h.htm) or (http://www.gutenberg.net/dirs/ / / / / / -h.zip) disease and its causes by w. t. councilman, a.m., m.d., ll.d. professor of pathology, harvard university new york henry holt and company london williams and norgate the university press, cambridge, u.s.a. preface in this little volume the author has endeavored to portray disease as life under conditions which differ from the usual. life embraces much that is unknown and in so far as disease is a condition of living things it too presents many problems which are insoluble with our present knowledge. fifty years ago the extent of the unknown, and at that time insoluble questions of disease, was much greater than at present, and the problems now are in many ways different from those in the past. no attempt has been made to simplify the subject by the presentation of theories as facts. the limitation as to space has prevented as full a consideration of the subject as would be desirable for clearness, but a fair division into the general and concrete phases of disease has been attempted. necessarily most attention has been given to the infectious diseases and their causes. this not only because these diseases are the most important but they are also the best known and give the simplest illustrations. the space given to the infectious diseases has allowed a merely cursory description of the organic diseases and such subjects as insanity and heredity. of the organic diseases most space has been devoted to disease of the heart. there is slight consideration of the environment and social conditions as causes of disease. very few authors are mentioned in the text and no bibliography is given. there is lack of literature dealing with the general aspects of disease; the book moreover is not written for physicians, and the list of investigators from whose work the knowledge of disease has been derived would be too long to cite. it has been assumed that the reader has some familiarity with elementary anatomy and physiology, and these subjects have been considered only as much as is necessary to set the scene for the drama. i am indebted to my friend, mr. w. r. thayer, for patiently enduring the reading of the manuscript and for many suggestions as to phrasing. contents chapter page chapter i definition of disease.--characteristics of living matter.--cells as the living units.--amoeba as type of a unicellular animal.--the relation of living matter to environment.--capacity of adaptation to environment shown by living matter.--individuality of living matter.--the causes of disease extrinsic.--the relation of the human body to the environment.--the surfaces of the body.--the increase of surface by gland formation.--the real interior of the body represented by the various structures placed between the surfaces.--the fluids of the body.--the nervous system.--the heart and blood-vessels.--the cells of the blood.--the ductless glands chapter ii no sharp line of demarcation between health and disease.--the functional nutritive and formative activities of cells.--destruction and repair constant processes in living matter.--injuries to the body.--the effect of heat.--the action of poisons.--the lesions of disease.--repair.--the laws governing repair.--relation of repair to complexity of structure and age.--the reserve force of the body.--compensatory processes in the body.--old age.--the diminution of resistance to the effects of the environment a prominent factor in old age.--death.--how brought about.--changes in the body after death.--the recognition of death chapter iii the growth of the body.--growth more rapid in embryonic period.--the coÖrdination and regulation of growth.--tumors.--the growth of tumors compared with normal growth.--size. shape and structure of tumors.--the growth capacity of tumors as shown by the inoculation of tumors of mice.--benign and malignant tumors.--effect of inheritance.--are tumors becoming more frequent?--the effect produced by a tumor on the individual who bears it.--relation of tumors to age and sex.--theories as to the cause of tumors.--the parasitic theory.--the traumatic theory.--the embryonic theory.--the importance of the early recognition and removal of tumors chapter iv the reactions of the tissues of the body to injuries.--inflammation.-- the changes in the blood in this.--the lmigration of the corpuscles of the blood.--the evident changes in the injured part and the manner in which these are produced.--heat redness swelling and pain.--the production of blisters by sunburn.--the changes in the cells of an injured part.--the cells which migrate from the blood vessels act as phagocytes.--the macrophages.--the microphages.--chemotropism.--the healing of inflammation.--the removal of the cause.--cell repair and new formation.--new formation of blood vessels.--acute and chronic inflammation.--the apparently purposeful character of the changes in inflammation chapter v infectious diseases.--the historical importance of epidemics of disease.--the losses in battle contrasted with the losses in armies produced by infectious diseases.--the development of knowledge of epidemics.--the views of hippocrates and aristotle.--sporadic and epidemic diseases.--the theory of the epidemic constitution.--theory that the contagious material is living.--the discovery of bacteria by loewenhoeck in .--the relation of contagion to the theory of spontaneous generation.--needham and spallanzani.--the discovery of the compound microscope in .--the proof that a living organism is the cause of a disease.--anthrax.--the discovery of the anthrax bacillus in .--the cultivation of the bacillus by koch.--the mode of infection.--the work of pasteur on anthrax.--the importance of the disease chapter vi classification of the organisms which cause disease.--bacteria size shape structure capacity for growth multiplication and spore information.--the artificial cultivation of bacteria.--the importance of bacteria in nature.--variations in bacteria.--saprophytic and parasitic forms.--protozoa.--structure more complicated than that of bacteria.--distribution in nature.--growth and multiplication.--conjugation and sexual reproduction.--spore formation.--the necessity for a fluid environment.--the food of protozoa.--parasitism.--the ultra microscopic or filterable organisms.--the limitation of the microscopic.--porcelain filters to separate organisms from a fluid.--foot and mouth disease produced by an ultra microscopic organism.--other diseases so produced.--do new diseases appear? chapter vii the nature of infection.--the invasion of the body from its surfaces.--the protection of these surfaces.--can bacteria pass through an uninjured surface?.--infection from wounds.--the wounds in modern warfare less prone to infection.--the relation of tetanus to wounds caused by the toy pistol.--the primary focus or atrium of infection.--the dissemination of bacteria in the body.--the different degrees of resistance to bacteria shown by the various organs.--mode of action of bacteria.--toxin production.--the resistance of the body to bacteria.--conflict between parasite and host.--on both sides means of offense and defense.--phagocytosis.--the destruction of bacteria by the blood.--the toxic bacterial diseases.--toxin and antitoxin.--immunity.-- the theory of ehrlich chapter viii secondary terminal and mixed infections.--the extension of infection in the individual.--tuberculosis.--the tubercle bacillus.--frequency of the disease.--the primary foci.--the extension of bacilli.--the discharge of bacilli from the body.--influence of the seat of disease on the discharge of bacilli.--the intestinal diseases.--modes of infection.--infection by sputum spray.--infection of water supplies.--extension of infection by insects.--trypanasome diseases.--sleeping sickness.--malaria.--the part played by mosquitoes.--parasitism in the mosquito.--infection as influenced by habits and customs.--hookworm disease.--interrelation between human and animal diseases.--plague.--part played rats in transmission.--the present epidemic of plague chapter ix disease carriers.--the relation between sporadic cases of infectious disease and epidemics.--smallpox.--cerebrospinal meningitis.--polyomyelitis.--variation in the susceptibility of individuals.--conditions which may influence susceptibility.--racial susceptibility.--influence of age and sex.--occupation and environment.--the age period of infectious diseases chapter x inheritance as a factor in disease.--the process of cell multiplication.--the sexual cells differ from the other cells of the body.--infection of the ovum.--intrauterine infection.--the placenta as a barrier to infection.--variations and mutations.--the inheritance of susceptibility to disease.--the influence of alcoholism in the parents on the descendants.--the heredity of nervous diseases.--transmission of disease by the female only.--hemophilia.--the inheritance of malformations.--the causes of malformations.--maternal impressions have no influence.--eugenics chapter xi chronic diseases.--disease of the heart as an example.--the structure and function of the heart.--the action of the valves.--the production of heart disease by infection.--the conditions produced in the valves.--the manner in which disease of the valves interferes with their function,--the compensation of injury by increased action of heart.--the enlargement of the heart.--the result of imperfect work of the heart.--venous congestion.--dropsy.--chronic disease of the nervous system.--insanity.--relation between insanity and criminality.--alcoholism and syphilis frequent causes of insanity.--the direct and indirect causes of nervous diseases.--the relation between social life and nervous diseases.--functional and organic disease.--neurasthenia chapter xii the rapid development of medicine in the last fifty years.--the influence of darwin.--preventive medicine.--the dissemination of medical knowledge.--the development of conditions in recent years which act as factors of disease.--factory life.--urban life.--the increase of communication between peoples.--the introduction of plant parasites.--the increase in asylum life.--infant mortality.--wealth and poverty as factors in disease glossary index disease and its causes chapter i definition of disease.--characteristics of living matter.--cells as the living units.--amoeba as type of a unicellular animal.--the relation of living matter to the environment.--capacity of adaptation to the environment shown by living matter--individuality of living matter.--the causes of disease.--extrinsic.--the relation of the human body to the environment.--the surfaces of the body.--the increase of surface by gland formation.--the real interior of the body represented by the various structures placed between the surfaces.--the fluids of the body.--the nervous system.--the heart and blood-vessels.--the cells of the blood.--the ductless glands. there is great difficulty, in the case of a subject so large and complex as is disease, in giving a definition which will be accurate and comprehensive. disease may be defined as "a change produced in living things in consequence of which they are no longer in harmony with their environment." it is evident that this conception of disease is inseparable from the idea of life, since only a living thing can become diseased. in any dead body there has been a preëxisting disease or injury, and, in consequence of the change produced, that particular form of activity which constitutes life has ceased. changes such as putrefaction take place in the dead body, but they are changes which would take place in any mass similarly constituted, and are not influenced by the fact that the mass was once living. disease may also be thought of as the negation of the normal. there is, however, in living things no definite type for the normal. an ideal normal type may be constructed by taking the average of a large number of individuals; but any single individual of the group will, to a greater or less extent, depart from it. no two individuals have been found in whom all the bertillon measurements agree. disease has reference to the individual; conditions which in one individual would be regarded as disease need not be so regarded in another. comparisons between health and disease, the normal and the abnormal, must be made not between the ideal normal and abnormal, but between what constitutes the normal or usual and the abnormal in a particular individual. the conception of disease is so inseparably associated with that of life that a brief review of the structure and properties of living things is necessary for the comprehension of the definition which has been given. living matter is subject to the laws which govern matter, and like matter of any other sort it is composed of atoms and molecules. there is no force inherent in living matter, no vital force independent of and differing from the cosmic forces; the energy which living matter gives off is counterbalanced by the energy which it receives. it undergoes constant change, and there is constant interchange with the environment. the molecules which compose it are constantly undergoing change in their number, kind and arrangement. atom groups as decomposition products are constantly given off from it, and in return it receives from without other atom groups with which it regenerates its substance or increases in amount. all definitions of life convey this idea of activity. herbert spencer says, "life is the continuous adjustment of internal relations to external conditions." the molecules of the substances forming the living material are large, complex and unstable, and as such they constantly tend to pass from the complex to the simple, from unstable to stable equilibrium. the elementary substances which form living material are known, but it has hitherto not been found possible artificially so to combine these substances that the resulting mass will exhibit those activities which we call the phenomena of life. the distinction between living and nonliving matter is manifest only when the sum of the activities of the living matter is considered; any single phenomenon of the living may appear also in the non-living material. probably the most distinguishing criterion of living matter is found in its individuality, which undoubtedly depends upon differences in structure, whether physical or chemical, between the different units. certain conditions are essential for the continued existence of living matter. it must be surrounded by a fluid or semi-fluid medium in order that there may be easy interchange with the environment. it must constantly receive from the outside a supply of energy in the form of food, and substances formed as the result of the intracellular chemical activity must be removed. in the case of many animals it seems as though the necessity of a fluid environment for living matter did not apply, for the superficial cells of the skin have no fluid around them; these cells, however, are dead, and serve merely a mechanical or protective purpose. all the living cells of the skin and all the cells beneath this have fluid around them. living matter occurs always in the form of small masses called "cells," which are the living units. the cells vary in form, structure and size, some being so large that they can be seen with the naked eye, while others are so small that they cannot be distinctly seen with the highest power of the microscope. the living thing or organism may be composed of a single cell or, in the case of the higher animals and plants, may be formed of great numbers of cells, those of a similar character being combined in masses to form organs such as the liver and brain. in each cell there is a differentiated area constituting a special structure, the nucleus, which contains a peculiar material called "chromatin." the nucleus has chiefly to do with the multiplication of the cell and contains the factors which determine heredity. the mass outside of the nucleus is termed "cytoplasm," and this may be homogeneous in appearance or may contain granules. on the outside there is a more or less definite cell membrane. it is generally believed that the cell material has a semi-fluid or gelatinous consistency and is contained within an intracellular meshwork. it is an extraordinarily complex mass, whether regarded from a chemical or physical point of view. (fig. .) [illustration: fig. .--diagram of cell. . cell membrane. . cell substance or cytoplasm. . nucleus. . nuclear membrane. . nucleolus.] a simple conception of health and disease can be arrived at by the study of these conditions in a unicellular animal directly under a microscope, the animal being placed on a glass slide. for this purpose a small organism called "amoeba" (fig. ), which is commonly present in freshwater ponds, may be used. this appears as a small mass, seemingly of gelatinous consistency with a clear outline, the exterior part homogeneous, the interior granular. the nucleus, which is seen with difficulty, appears as a small vesicle in the interior. many amoebæ show also in the interior a small clear space, the contractile vesicle which alternately contracts and expands, through which action the movement of the intracellular fluid is facilitated and waste products removed. the interior granules often change their position, showing that there is motion within the mass. the amoeba slowly moves along the surface of the glass by the extension of blunt processes formed from the clear outer portion which adhere to the surface and into which the interior granular mass flows. this movement does not take place by chance, but in definite directions, and may be influenced. the amoeba will move towards certain substances which may be placed in the fluid around it and away from others. in the water in which the amoebæ live there are usually other organisms, particularly bacteria, on which they feed. when such a bacterium comes in contact with an amoeba, it is taken into its body by becoming enclosed in processes which the amoeba sends out. the enclosed organism then lies in a small clear space in the amoeba, surrounded by fluid which has been shown to differ in its chemical reaction from the general fluid of the interior. this clear space, which may form at any point in the body, corresponds to a stomach in a higher animal and the fluid within it to the digestive fluid or gastric juice. after a time the enclosed organism disappears, it has undergone solution and is assimilated; that is, the substances of which its body was composed have been broken up, the molecules rearranged, and a part has been converted into the substance of the amoeba. if minute insoluble substances, such as particles of carmine, are placed in the water, these may also be taken up by the amoeba; but they undergo no change, and after a time they are cast out. under the microscope only the gross vital phenomena, motion of the mass, motion within the mass, the reception and disintegration of food particles, and the discharge of inert substances can be observed. the varied and active chemical changes which are taking place cannot be observed. [illustration: fig. .--amoeba. . nucleus. . contractile vesicle. . nutritive vacuole containing a bacillus.] up to the present it has been assumed that the environment of the amoeba is that to which it has become adapted and which is favorable to its existence. under these conditions its structure conforms to the type of the species, as do also the phenomena which it exhibits, and it can assimilate food, grow and multiply. if, during the observation, a small crystal of salt be placed in the fluid, changes almost instantly take place. motion ceases, the amoebæ appear to shrink into smaller compass, and they become more granular and opaque. if they remain a sufficiently long time in this fluid, they do not regain their usual condition when placed again in fresh water. none of the phenomena which characterized the living amoebæ appear: we say they are dead. after a time they begin to disintegrate, and the bacteria contained in the water and on which the amoebæ fed now invade their tissue and assist in the disintegration. by varying the duration of the exposure to the salt water or the amount of salt added, a point can be reached where some, but not all, of the amoebæ are destroyed. whether few or many survive depends upon the degree of injury produced. much the same phenomena can be produced by gradually heating the water in which the amoebæ are contained. it is even possible gradually to accustom such small organisms to an environment which would destroy them if suddenly subjected to it, but in the process of adaptation many individuals will have perished. it is evident from such an experiment that when a living organism is subject to an environment to which it has not become adapted and which is unfavorable, such alterations in its structure may be produced that it is incapable of living even when it is again returned to the conditions natural to it. such alterations of structure or injuries are called the _lesions_ of disease. we have seen that in certain individuals the injury was sufficient to inhibit for a time only the usual manifestations of life; these returned when the organism was removed from the unfavorable conditions, and with this or preceding it the organisms, if visibly altered, regained the usual form and structure. we may regard this as disease and recovery. in the disease there is both the injury or lesion and the derangement of vital activity dependent upon this. the cause of the disease acted on the organism from without, it was external to it. whether the injurious external conditions act as in this case by a change in the surrounding osmotic pressure, or by the destruction of ferments within the cell, or by the introduction into the cell of substances which form stable chemical union with certain of its constituents, and thus prevent chemical processes taking place which are necessary for life, the result is the same. the experiments with the amoebæ show also two of the most striking characteristics of living matter. . it is _adaptable_. under the influence of unusual conditions, alterations in structure and possibly in substance, may take place, in consequence of which the organisms under such external conditions may still exhibit the usual phenomena. the organism cannot adapt itself to such changes without undergoing change in structure, although there may be no evidence of such changes visible. this alteration of structure does not constitute a disease, provided the harmonious relation of the organism with the environment be not impaired. an individual without a liver should not be regarded as diseased, provided there can be such an internal adjustment that all of the vital phenomena could go on in the usual manner without the aid of this useful and frequently maligned organ. . it is _individual_. in the varying degrees of exposure to unfavorable conditions of a more serious nature some, but not all, of the organisms are destroyed; in the slight exposure, few; in the longer, many. unfavorable conditions which will destroy all individuals of a species exposed to them must be extremely rare.[ ] there is no such individuality in non-living things. in a mass of sugar grains each grain shows just the same characteristics and reacts in exactly the same way as all the other grains of the mass. individuality, however expressed, is due to structural variation. it is almost impossible to conceive in the enormous complexity of living things that any two individuals, whether they be single cells or whether they be formed of cell masses, can be exactly the same. it is not necessary to assume in such individual differences that there be any variation in the amount and character of the component elements, but the individuality may be due to differences in the atomic or molecular arrangements. there are two forms of tartaric-acid crystals of precisely the same chemical formula, one of which reflects polarized light to the left, and the other to the right. all the left-sided crystals and all the right-sided are, however, precisely the same. the number of possible variations in the chemical structure of a substance so complex as is protoplasm is inconceivable. in no way is the individuality of living matter more strongly expressed than in the resistance to disease. the variation in the degree of resistance to an unfavorable environment is seen in every tale of shipwreck and exposure. in the most extensive epidemics certain individuals are spared; but here care must be exercised in interpreting the immunity, for there must be differences in the degree of exposure to the cause of the epidemic. it would not do to interpret the immunity to bullets in battle as due to any individual peculiarity, save possibly a tendency in certain individuals to remove the body from the vicinity of the bullets; in battle and in epidemics the factors of chance and of prudence enter. no other living organism is so resistant to changes in environment as is man, and to this resistance he owes his supremacy. by means of his intelligence he can change the environment. he is able to resist the action of cold by means of houses, fire and clothing; without such power of intelligent creation of the immediate environment the climatic area in which man could live would be very narrow. just as disease can be acquired by an unfavorable environment, man can so adjust his environment to an injury that harmony will result in spite of the injury. the environment which is necessary to compensate for an injury may become very narrow. for an individual with a badly working heart more and more restriction of the free life is necessary, until finally the only environment in which life is even tolerably harmonious is between blankets and within the walls of a room. the various conditions which may act on an organism producing the changes which are necessary for disease are manifold. lack of resistance to injury, incapacity for adaptation, whether it be due to a congenital defect or to an acquired condition, is not in itself a disease, but the disease is produced by the action on such an individual of external conditions which may be nothing more than those to which the individuals of the species are constantly subject and which produce no harm. [illustration: fig. .--a section of the skin. . a hair. notice there is a deep depression of the surface to form a small bulb from which the hair grows. . the superficial or horny layer of the skin; the cells here are joined to form a dense, smooth, compact layer impervious to moisture. . the lower layer of cells. in this layer new cells are continually being formed to supply those which as thin scales are cast off from the surface. . section of a small vein. . section of an artery. . section of a lymphatic. the magnification is too low to show the smaller blood vessels. . one of the glands alongside of the hair which furnishes an oily secretion. . a sweat gland. . the fat of the skin. notice that hair, hair glands and sweat glands are continuous with the surface and represent a downward extension of this. all the tissue below and is the corium from which leather is made.] [illustration: fig. .--diagrammatic section of a surface showing the relation of glands to the surface. (_a_) simple or tubular gland, (_b_) compound or racemose gland.] all of the causes of disease act on the body from without, and it is important to understand the relations which the body of a highly developed organism such as man has with the world external to him. this relation is effected by means of the various surfaces of the body. on the outside is the skin [fig. ], which surface is many times increased by the existence of glands and such appendages to the skin as the hair and nails. a gland, however complicated its structure, is nothing more than an extension of the surface into the tissue beneath [fig. ]. in the course of embryonic development all glands are formed by an ingrowth of the surface. the cells which line the gland surface undergo a differentiation in structure which enables them to perform certain definite functions, to take up substances from the same source of supply and transform them. the largest gland on the external surface of the body is the mammary gland [fig. ] in which milk is produced; there are two million small, tubular glands, the sweat glands, which produce a watery fluid which serves the purpose of cooling the body by evaporation; there are glands at the openings of the hairs which produce a fatty secretion which lubricates the hair and prevents drying, and many others. [illustration: fig. .--a section of the mammary gland. (_a_) the ducts of the gland, by which the milk secreted by the cells which line all the small openings, is conveyed to the nipple. all these openings are continuous with the surface of the skin. on each side of the large ducts is a vein filled with blood corpuscles.] [illustration: fig. .--photograph of a section of the lung of a mouse. _x x_ are the air tubes or bronchi which communicate with all of the small spaces. on the walls of the partitions there is a close network of blood vessels which are separated from the air in the spaces by a thin membrane.] the external surface passes into the interior of the body forming two surfaces, one of which, the intestinal canal, communicates in two places, at the mouth and anus, with the external surface; and the other, the genito-urinary surface, which communicates with the external surface at one place only. the surface of the intestinal canal is much greater in extent than the surface on the exterior, and finds enormous extensions in the lungs and in the great glands such as the liver and pancreas, which communicate with it by means of their ducts. the extent of surface within the lungs is estimated at ninety-eight square yards, which is due to the extensive infoldings of the surface [fig ], just as a large surface of thin cloth can, by folding, be compressed into a small space. the intestinal canal from the mouth to the anus is thirty feet long, the circumference varies greatly, but an average circumference of three inches may safely be assumed, which would give between seven and eight square feet of surface, this being many times multiplied by adding the surfaces of the glands which are connected with it. a diagram of the microscopic structure of the intestinal wall shows how little appreciation of the extent of surface the examination with the naked eye gives [fig. ]. by means of the intestinal canal food or substances necessary to provide the energy which the living tissue transforms are introduced. this food is liquefied and so altered by the action of the various fluids formed in the glands of the intestine and poured out on the surface, that it can pass into the interior of the body and become available for the living cells. various food residues representing either excess of material or material incapable of digestion remain in the intestine, and after undergoing various changes, putrefactive in character, pass from the anus as feces. [illustration: fig. .--a section of the small intestine to show the large extent of surface. (_a_) internal surface. the small finger-like projections are the villi, and between these are small depressions forming tubular glands.] by means of the lungs, which represent a part of the surface, the oxygen of the air, which is indispensable for the life of the cells, is taken into the body and carbonic acid removed. the interchange of gases is effected by the blood, which, enclosed in innumerable, small, thin-walled tubes, almost covers the surface, and comes in contact with the air within the lungs, taking from it oxygen and giving to it carbonic acid. the genito-urinary surface is the smallest of the surfaces. in the male (fig. ,-- , , ) this communicates with the general external surface by the small opening at the extremity of the penis, and in the female by the opening into the vagina. in its entirety it consists in a surface of wide extent, comprising in the male the urethra, a long canal which opens into the bladder, and is continuous with ducts that lead into the genital glands or testicles. the internal surface of the bladder is extended by means of two long tubes, the ureters, into the kidneys, and receives the fluid formed in these organs. in the female (fig ) there is a shallow external orifice which is continued into the bladder by a short canal, the urethra, the remaining urinary surface being the same as in the male; the external opening also is extended into the short, wide tube of the vagina, which is continuous with the canal of the uterus. this canal is continued on both sides into the fallopian tubes or oviducts. there is thus in the female a more complete separation of the urinary and the genital surfaces than in the male. practically all of the waste material of the body which results from cell activity and is passed from the cells into the fluid about them is brought by the blood to the kidneys, and removed by these from the blood, leaving the body as urine. [illustration: fig. .--a longitudinal section through the middle of the body showing the external and internal surfaces and the organs. . the skull. . the brain, showing the convolutions of the gray exterior in which the nerve cells are most numerous. . the white matter in the interior of the brain formed of nerve fibres which connect the various parts of this. . the small brain or cerebellum. . the interior of the nose. notice the nearness of the upper part of this cavity to the brain. . the hard or bony palate forming the roof of the mouth. . the soft palate which hangs as a curtain between the mouth and the pharynx. . the mouth cavity. . the tongue. . the beginning of the gullet or oesophagus. . the larynx. . the windpipe or trachea. . the oesophagus. . the thyroid gland. . the thymus gland or sweetbread. . the large vein, vena cava, which conveys the blood from the brain and upper body into the heart. - . lymph nodes; , of the neck; , of the abdomen. . cross section of the arch of the aorta or main artery of the body after it leaves the heart. . the sternum or breast bone. . the cavity of the heart. . the liver. . the descending aorta at the back of the abdominal cavity. . the pancreas. . the stomach. . cross section of the intestines. . the urinary bladder. . the entrance into this of the ureter or canal from the kidney. . cross sections of the pubic bone. . the canal of the urethra leading into the bladder. . the penis. . the spinal cord. . the bones composing the spinal column. . the sacrum. the space between this and no. is the pelvis. . the coccyx or extremity of the back bone. . the rectum. . the testicles.] between these various surfaces is the real interior of the body, in which there are many sorts of living tissues,[ ] each, of which, in addition to maintaining itself, has some function necessary for the maintenance of the body as a whole. many of these tissues have for their main purpose the adjustment and coördination of the activities of the different organs to the needs of the organism as a whole. the activity of certain of the organs is essential for the maintenance of life; without others life can exist for a time only; and others, such as the genital glands, while essential for the preservation of the life of the species, are not essential for the individual. there is a large amount of reciprocity among the tissues; in the case of paired organs the loss of one can be made good by increased activity of the remaining, and certain of the organs are so nearly alike in function that a loss can be compensated for by an increase or modification of the function of a nearly related organ. the various internal parts are connected by means of a close meshwork of interlacing fibrils, the connective tissue, support and strength being given by the various bones. everywhere enclosing all living cells and penetrating into the densest of the tissues there is fluid. we may even consider the body between the surfaces as a bag filled with fluid into which the various cells and structures are packed. [illustration: fig. .--a longitudinal section through the female pelvis. . the fallopian tube which forms the connection between the ovary and the uterus. . the ovary. . the body of the uterus. . the uterine canal. . the urinary bladder represented as empty. . the entrance of the ureter. . the pubic bone. . the urethra. . the vagina. . the common external opening or vulva. . the rectum and anus.] [illustration: fig. .--the lungs and windpipe. parts of the lungs have been removed to show the branching of the air tubes or bronchi which pass into them. all the tubes and the surfaces of the lungs communicate with the inner surface of the body through the larynx.] the nervous system (fig. ) represents one of the most important of the enclosed organs. it serves an important function, not only in regulating and coördinating all functions, but by means of the special senses which are a part of it, the relations of the organism as a whole with the environment are adjusted. it consists of a large central mass, the brain and spinal cord, which is formed in the embryo by an infolding of the external surface, much in the same way that a gland is formed; but the connection with the surface is lost in further development and it becomes completely enclosed. connected with the central nervous mass, forming really a part of it and developing from it, are the nerves, which appear as white fibrous cords and after dividing and subdividing, are as extremely fine microscopic filaments distributed to all parts of the body. by means of the nerves all impressions are conveyed to the brain and spinal cord; all impulses from this, whether conscious or unconscious, are conveyed to the muscles and other parts. the brain is the sole organ of psychical life; by means of its activity the impressions of the external world conveyed to it through the sense organs are converted into consciousness. whatever consciousness is, and on this much has been written, it proceeds from or is associated with the activity of the brain cells just as truly as the secretion of gastric juice is due to the activity of the cells of the stomach. the activity of the nervous system is essential for extra-uterine life; life ceases by the cessation of circulation and respiration when either the whole or certain small areas of its tissue are destroyed. in intra-uterine life, with the narrow and unchanging environment of the fluid within the uterine cavity which encloses the foetus, life is compatible with the absence or rudimentary development of the nervous system. the foetus in this condition may be otherwise well developed, and it would be not a misuse of words to say that it was healthy, since it is adjusted to and in harmony with its narrow environment, but it would not be normal. the intra-uterine life of the unborn child, it must be remembered, is carried out by the transmission of energy from the mother to the foetus by means of the close relation between the maternal and foetal circulation. it is only when the free existence demands activities not necessary in intra-uterine life that existence without a central nervous system becomes impossible. it is essential in so complicated a structure as the body that some apparatus should exist to provide for the interchange of material. the innumerable cell units of the body must have material to provide energy, and useless material which results from their activity must be removed. a household might be almost as much embarrassed by the accumulation of garbage and ashes as by the absence of food and coal. the food, which is taken into the alimentary canal and converted by the digestive fluids into material more directly adapted to the uses of cells, must be conveyed to them. a supply of oxygen is essential for the life of the cells, and the supply which is given by respiration must be carried from the lungs to every cell of the body. all this is effected by the circulation of the blood, which takes place in the system of branching closed tubes in which the blood remains (fig. ). certain of these tubes, the arteries, have strong and elastic walls and serve to convey and distribute the blood to the different organs and tissues. from the ultimate branches of the arteries the blood passes into a close network of tubes, the capillaries, which in enormous numbers are distributed in the tissues and have walls so thin that they allow fluid and gaseous interchange between their contents and the fluid around them to take place. the blood from the capillaries is then collected into a series of tubes, the veins, by which it is returned to the heart. this circulation is maintained by means of a pumping organ or heart, which receives the blood from the veins and by the contraction of its powerful walls forces this into the arteries, the direction of flow being determined as in a pump, by a system of valves. the waste products of cell life pass from the cells into the fluid about them, and are in part directly returned into the blood, but for the greater part pass into it indirectly through another set of vessels, the lymphatics. these are thin-walled tubes which originate in the tissues, and in which there is a constant flow towards the heart, maintained by the constant but varying pressure of the tissue around them, the direction of flow being maintained by numerous valves. the colorless fluid within these vessels is termed "lymph." at intervals along these tubes are small structures termed the lymph nodes, which essentially are filters, and strain out from the fluid substances which might work great injury if they passed into the blood. between the capillary vessels and the lymphatics is the tissue fluid, in which all the exchange takes place. it is constantly added to by the blood, and returns fluid to the blood and lymph; it gives material to the cells and receives material from them. [illustration: fig. .--a diagrammatic view of the blood vessels. an artery (_a_) opens into a system of capillaries, (_c_) and after passing through these collects into a vein (_b_). notice that the capillaries connect with other vascular territories at numerous points (_d_). if the artery (_a_) became closed the capillaries which it supplies could be filled by blood coming from other sources.] in addition to the strength and elasticity of the wall of the arteries, which enables them to resist the pressure of the blood, they have the power of varying their calibre by the contraction or expansion of their muscular walls. many of the organs of the body function discontinuously, periods of activity alternating with comparative repose; during the period of activity a greater blood supply is demanded, and is furnished by relaxation of the muscle fibres which allows the calibre to increase, and with this the blood flow becomes greater in amount. each part of the body regulates its supply of blood, the regulation being effected by means of nerves which control the tension of the muscle fibres. the circulation may be compared with an irrigation system in which the water supply of each particular field is regulated not by the engineer, but by an automatic device connected with the growing crop and responding to its demands. [illustration: fig. .--the various cells in the blood. (_a_) the red blood cells, single and forming a roll by adhering to one another; (_b_) different forms of the white blood cells; those marked " " are the most numerous and are phagocytic for bacteria.] the blood consists of a fluid, the blood plasma, in which numerous cells are contained. the most numerous of these are small cup-shaped cells which contain a substance called _hæmoglobin_, to which the red color of the blood is due. there are five million of these cells in a cubic millimeter (a millimeter is . of an inch), giving a total number for the average adult of twenty-five trillion. the surface area of all these, each being one thirty-three hundredth of an inch in diameter, is about thirty-three hundred square yards. the hæmoglobin which they contain combines in the lungs with the oxygen in the inspired air, and they give up this indispensable substance to the cells everywhere in the body. there are also eight thousand leucocytes or colorless cells in a cubic millimeter of blood, this giving a total number of four billion in the average adult, and these vary in character and in relative numbers (fig. ). the most numerous of these are round and slightly larger than the red cells; they have a nucleus of peculiar shape and contain granules of a definite character. these cells serve an important part in infectious diseases in devouring and destroying parasites. they have power of active independent motion and somewhat resemble certain of the free living unicellular organisms. the blood plasma, when taken from the vessels, clots or passes from a fluid into a gelatinous or semi-solid condition, which is due to the formation within it of a network of fine threads termed fibrin. it is by means of the clotting of the blood that the escape of blood from ruptured vessels is arrested. several of the organs of the body, in addition to the formation of secretions which are discharged on the surfaces by means of their ducts, produce also substances which pass directly into the blood or lymph, and have an influence in stimulating or otherwise regulating the activity of other organs. there are also certain organs of glandular structure which are called the _ductless glands_; these are not connected with the surface and all their secretion passes into the blood. it is a part of recent knowledge that the substances produced in these glands are of great importance for the body, some of them even essential for the maintenance of life. in front of the neck is such an organ, the thyroid gland (fig. , ). imperfect development or absence of this organ, or an inactive condition of it, produces in the child arrested growth and deficient mental development known as cretinism, and in the adult the same condition gives rise to mental deterioration, swelling of the skin, due to a greater content of water, and loss of hair. this deficiency in the production of thyroid secretion can be made good and the symptoms removed by feeding the patient with similar glands removed from animals. the very complex disease known as exophthalmic goitre, and shown by irregular and rapid action of the heart, protruding eyeballs and a variety of mental symptoms, is also associated with this gland, and occasioned not by a deficiency but by an excess or perversion of its secretion. adjoining the thyroid there are four small glands, the parathyroids, each about the size of a split pea. the removal of these glands in animals produces a condition resembling acute poisoning accompanied by spasmodic contraction of the muscles. a small glandular organ at the base of the brain, the pituitary body, produces a secretion, one of the most marked properties of which is a control of growth, particularly that of the bones. most cases of giantism, combined as they are with imperfect mentality, are due to disease of this gland. there are glands near the kidney which regulate the pressure of the blood in the arteries by causing contraction of their muscular walls. the sexual characteristics in the male and female are due to an internal secretion produced by the respective sexual glands which affects growth, body development and mentality. so is the body constituted. a series of surfaces, all connected, of enormous size, which enclose a large number of organs and tissues, the activities of which differ, but all are coördinated to serve the purposes of the organism as a whole. we should think of the body not as an assemblage of more or less independent entities, but as a single organism in which all parts are firmly knit together both in structure and in function, as are the components of a single cell. footnotes: [ ] they do, however, take place, since within comparatively few years whole species have completely disappeared; for example, the great auk and the passenger pigeon. in these cases it is not known what part disease played in the destruction. [ ] a tissue represents an aggregate of similar cells with the intercellular substances in relation with these as connective tissue, muscular tissue, etc. where such cell aggregates are localized and where the cells are arranged in structures having definite form and size and performing a definite function, it is customary to designate such structures as organs, as the brain, liver, etc. chapter ii no sharp line of demarkation between health and disease.--the functional nutritive and formative activities of cells.--destruction and repair constant processes in living matter.--injuries to the body.--the effect of heat.--the action of poisons.--the lesions of disease.--repair.--the laws governing repair.--relation of repair to complexity of structure and age.--the reserve force of the body.-- compensatory processes in the body.--old age.--the diminution of resistance to the effect of the environment a prominent factor in old age.--death.--how brought about.--changes in the body after death.-- the recognition of death. there is no sharp line separating health from disease; changes in the tissues of the same nature, or closely akin to those which are found in disease, are constantly occurring in a state of health. the importance of parasites in causing disease has led to the conception of disease as almost synonymous with parasitism; but it must be remembered that the presence of parasites living at the expense of the body is perfectly consistent with a state of health. degeneration, decay and parasitism only become disease factors when the conditions produced by them interfere with the life which is the normal or usual for the individual concerned. all the changes which take place in the cells are of great importance in conditions of both health and disease, for life consists in coördinated cell activity. the activities of the cells can be divided into those which are nutritive, those which are functional and those which are formative. in the functional activity the cell gives off energy, this loss being made good by the receipt of new energy in the form of nutritive material with which the cell renews itself. in certain cells an exact balance seems to be maintained, but in those cells whose activity is periodic function takes place at the expense of the cell substance, the loss being restored by nutrition during the period of repose. this is shown particularly well in the case of the nerve cells (fig. ). both the functional and nutritive activity can be greatly stimulated, but they must balance; otherwise the condition is that of disease. [illustration: fig .--nerve cells of an english sparrow (_a_) cells after a day's full activity, (_b_) cells after a night's repose. in (_a_) the cells and nuclei are shrunken and the smaller clear spaces in the cells are smaller and less evident than in (_b_). (hodge)] the formative activity of cells is also essential to the normal state. destruction of cells is constantly taking place in the body, and more rapidly in certain tissues than in others. dried and dead cells are constantly and in great numbers thrown off from the surface of the skin: such epidermic appendages as the hair and nails grow and are removed, millions of cells are represented in the beard which is daily removed. cells are constantly being destroyed on the intestinal surface and in the glands. there is an enormous destruction of the blood cells constantly taking place, certain essential pigments, as that of the bile, being formed from the hæmoglobin which the red blood corpuscles contain and which becomes available on their destruction. all such loss of cells must be made good by the formation of new ones and, as in the case of the nutritive and functional activity, the loss and renewal must balance. the formative activity of cells is of great importance, for it is by means of this that wounds heal and diseases are recovered from. this constant destruction and renewal of the body is well known, and it is no doubt this which has given rise to the belief, widely held, that the body renews itself in seven years and that the changes impressed upon it by vaccination endure for this period only. the truth is that the destruction and renewal of most tissues in the body takes place in a much shorter interval, and, as we shall see, this has nothing to do with the changes concerned in vaccination. all these activities of the cells vary in different individuals, in different parts and at different ages. the lesions or injuries of the body which form so prominent a part of disease vary in kind, degree and situation, depending upon the character of the injurious agent, the duration of its action and the character of the tissue affected. the most obvious injuries are those produced by violence. by a cut, blood vessels are severed, the relations of tissues disturbed, and at the gaping edges of the wound the tissue usually protected by the skin is exposed to the air, resulting in destruction of the cells contained in a thin layer of the surface. the discoloration and swelling of the skin following a blow is due to rupture of vessels and escape of blood and fluid, and further injury may result from the interruption of the circulation. by the application of heat the tissue may be charred and the albumen of the blood and tissue fluids coagulated. living cells are very susceptible to the action of heat, a temperature of degrees being the thermal death point, and even lower temperatures are fatal when their action is prolonged. the action of the heat may produce definite coagulation of the fluid within the cells in the same way that the white of an egg is coagulated. certain of the albumens of the body coagulate at a much lower temperature than the white of the egg (as the myosin, one of the albumens of the muscle which coagulates at ° f., egg white coagulating at ° f.), and in addition to such coagulation or without it the ferments within the cell and to the action of which cellular activity is due may be destroyed. in diseases due to parasites, the parasite produces a change in the tissue in its immediate vicinity often so great as to result in the death of the cells. the most general direct cause of lesions is toxic or poisonous substances, either introduced from without or formed in the body. in the case of the parasitic diseases the mere presence of the parasite in the body produces little or no harm, the injury being caused by poisons which it produces, and which act both locally in the vicinity of the parasite and at a distance, being absorbed and entering the blood stream. how certain of the poisonous substances act is easy to see. strong caustics act by coagulating the albumen, or by the withdrawal of water from the cell. other poisons act by forming stable chemical compounds with certain of the cell constituents and thereby preventing the usual chemical processes from taking place. death from the inhalation of illuminating gas is due to the carbon monoxide contained in this, forming a firm chemical union with the hæmoglobin of the red corpuscles so that the function of these as oxygen carriers is stopped. in order that most poisons may act, it is essential that they enter into the cell, and they cannot do this unless they are able to combine chemically with certain of the cell constituents. to this is due the selective action of many poisons. morphine, for example, acts chiefly on the cells of the brain; strychnine acts on the cells of the spinal cord which excite motion and thus causes the characteristic muscular spasm. the poisonous substances produced by bacteria, as in the case of diphtheria, act on certain of the organs only. different animal species owe their immunity to certain poisons to their cells being so constituted that a poison cannot gain entrance into them; pigeons, for example, cannot be poisoned by morphia. individual variations play an important part also; thus, shellfish are poisonous for certain individuals and not so for others. owing to the variability of living structures a substance may be poisonous at one time and not at another, as the following example shows. a man, very fond of crab meat, was once violently poisoned after eating crabs, being at that time seemingly in his usual state of health, and no illness resulted in others who had partaken of the same crabs. two months later a hearty meal of crabs produced no ill result. there are also individuals so constituted that so simple a food as the egg is for them an active poison. the lesions produced by the action of injurious conditions are usually so distinctive in situation and character that by the examination of the body after death the cause of death can be ascertained. the lesions of diseases may be very obvious to the naked eye, or in other cases only the most careful microscopic examination can detect even the presence of alterations. in the case of poisons the capacity of the cell for adaptation to unusual conditions is of great importance. it is probable that certain changes take place within the cells, owing to which the function can be continued in spite of the unusual conditions which the presence of the poison brings about. it is in this way that the habitual use of such poisons as morphine, alcohol and tobacco, to speak only of those best known, is tolerated. the cell life can become so accustomed to the presence of poisons that the cell activities may suffer in their absence. _repair_ of the injuries which the body receives is effected in a variety of ways. we do not know how intracellular repair takes place, but most probably the cells get rid of the injured areas either by ejecting them, or chemical changes are produced in the altered cell substance breaking up and recombining the molecules. when single cells are destroyed, the loss is made good by new formation of cells, the cell loss stimulating the formative activity of the cells in the vicinity. the body maintains a cell and tissue equilibrium, and a loss is in most cases repaired. the blood fluid lost in a hæmorrhage is quickly restored by a withdrawal of the fluid from the tissues into the blood, but the cells lost are restored by new formation of cells in the blood-forming organs. the blood cells are all formed in bone marrow and in the lymph nodes, and not from the cells which circulate in the blood, and the stimulus to new cell formation which the loss of blood brings about affects this remote tissue. in general, repair takes place most easily in tissues of a simple character, and where there is the least differentiation of cell structure for the purposes of function. a high degree of function in which the cell produces material of a complex character necessitates a complex chemical apparatus to carry this out, and a complicated mechanism is formed less easily than a simple one. in certain tissues the cells have become so highly differentiated that all formative activity is lost. such is the case in the nerve cells of the brain and spinal cord, a loss in which tissue is never repaired by the formation of new cells; and in the muscles the same is true. the least differentiation is seen in those cells which serve the purpose of mechanical protection only, as the cells of the skin, and in these the formative activity is very great. not only must the usual loss be supplied, but we are all conscious of slight injuries of the surface which are quickly repaired. repair, other things being equal, takes place more easily in the young than in the old. new formation of cells goes on with great rapidity in intra-uterine life, the child, beginning its existence as a single cell one two hundred and fiftieth of an inch in diameter, attains in nine months a weight of seven pounds. the only similar rapidity of cell formation is seen in certain tumors; although the body may add a greater amount of weight and in a shorter time, by deposit of fat, this in but slight measure represents a new formation of tissue, but is merely a storage of food material in cells. the remarkable repair and even the new formation of entire parts of the body in the tadpole will not take place in the completely developed frog. repair will also take place the more readily the less complicated is the architectural structure of the part affected. when a series of tissues variously and closely related to one another enter into the structure of an organ, there may be new formation of cells; but when the loss involves more than this, the complicated architectural structure will not be completely replaced. a brick which has been knocked out of a building can be easily replaced, but the renewal of an area of the wall is more difficult. in the kidney, for example, the destruction of single cells is quickly made good by new cell formation, but the loss of an area of tissue is never restored. in the liver, on the other hand, which is of much simpler construction, large areas of tissue can be newly formed. for the formation of new cells in a part there must be a sufficient amount of formative material; then the circulation of the blood becomes more active, more blood being brought to the part by dilatation of the vessels supplying it. repair after a loss can be perfect or imperfect. the tissue lost can be restored so perfectly that no trace of an injury remains; but when the loss has been extensive, and in a tissue of complex structure, complete restoration does not take place and a less perfect tissue is formed which is called a scar. examination of the skin in almost anyone will show some such scars which have resulted from wounds. they are also found in the internal organs of the body as the result of injuries which have healed. the scar represents a very imperfect repair. in the skin, for example, the scar tissue never contains such complicated apparatus as hair and sweat glands; the white area is composed of an imperfectly vascularized fibrous tissue which is covered with a modified epidermis. the scar is less resistant than the normal tissue, injury takes place more easily in it and heals with more difficulty. loss brought about by the injuries of disease can be compensated for, even when the healing is imperfect, by increased function of similar tissue in the body. there always seems to be in the body under the usual conditions a reserve force, no tissue being worked to its full capacity. meltzer has compared the reserve force of the body to the factor of safety in mechanical construction. a bridge is constructed to sustain the weight of the usual traffic, but is in addition given strength to meet unusual and unforeseen demands. the stomach provides secretion to meet the usual demands of digestion, but can take care of an unusual amount of food. the work of the heart may be doubled by severe exertions, and it meets this demand by increased force and rapidity of contraction; and the same is true of the muscles attached to the skeleton. the constant exercise of this reserve force breaks down the adjustment. if the weight of the traffic over the bridge be constantly all that it can carry, there quickly comes a time when some slight and unforeseen increase of weight brings disaster. the conditions in the body are rather better than in the case of the bridge, because with the increased demand for activity the heart, for example, becomes larger and stronger, and reserve force rises with the load to be carried, but the ratio of reserve force is diminished. this discussion of injury and repair leads to the question of old age. old age, as such, should not be discussed in a book on disease, for it is not a disease; it is just as natural to grow old and to die as it is to be born. disease, however, differs in many respects in the old as compared with the young and renders some discussion of the condition necessary. changes are constantly taking place in the body with the advance of years, and in the embryo with the advance of days. in every period of life in the child, in the adult, in the middle-aged and in the old we meet with conditions which were not present at earlier periods. there is no definite period at which the changes which we are accustomed to regard as those of old age begin. this is true of both the external appearances of age and the internal changes. one individual may be fully as old, as far as is indicated by the changes of age, at fifty as another at eighty. with advancing age certain organs of the body atrophy; they become diminished in size, and the microscopic examination shows absence or diminished numbers of the cells which are peculiar to them. the most striking example of this is seen in the sexual glands of females, and, to a less degree, in those of the male. there is a small mass or glandular tissue at the root of the neck, the thymus, which gradually grows from birth and reaches its greatest size at the age of fifteen, when it begins slowly to atrophy and almost disappears at the age of forty. this is the gland which in the calf is known as the sweetbread and is a delicious and valued article of food. the tonsils, which in the child may be so large as to interfere with breathing and swallowing, have almost disappeared in the adult; and there are other such examples. in age atrophy is a prominent change. it is seen in the loss of the teeth, in the whitening and loss of the hair, in the thinning of the skin so that it more easily wrinkles, in the thinning and weakening of the muscles so that there is not only diminished force of muscular contraction, but weakening of the muscles of support. the back curves from the action of gravity, the strength of the support of the muscles at the back not counteracting the pull of the weight of the abdominal viscera in front. the bones become more porous and more brittle. the effect of atrophy is also seen in the diminution of all functions, and in loss of weight in individual organs. that the brain shares in the general atrophy is evident both anatomically and in function. mental activity is more sluggish, impressions are received with more difficulty, their accuracy may be impaired by accompanying changes in the sense organs, and the concepts formed from the impressions may differ from the usual. the slowness of mental action and the diminution in the range of mental activity excited by impressions, and the slowness of expression, may give a false idea of the value of the judgment expressed. the expression changes, the face becomes more impassive because the facial muscles no longer reflect the constant and ever changing impressions which the youthful sense organs convey to a youthful and active brain. that the young should ape the old, should seek to acquire the gravity of demeanor, to restrain the quick impulse, is not of advantage. loss of weight of the body as a whole is not so apparent, there being a tendency to fat formation owing to the non-use of fat or fat-forming material which is taken into the body. one of the most evident alterations is a general diminution in the fluid of the tissues, to which is chiefly due the lack of plumpness, the wrinkles of age. the facial appearance of age is given to an infant when, in consequence of a long-continued diarrhoea, the tissues become drained of fluid. every market-man knows that an old animal is not so available for food, the tissues are tougher, more fibrous, not so easily disintegrated by chewing. this is due to a relative increase in the connective tissue which binds all parts together and is represented in the white fibres of meat. senile atrophy is complex in its causes and modes of production. the atrophy affects different organs in different degree and shows great variation in situation, in degree and in progress. atrophic changes of the blood vessels are of great importance, for this affects the circulation on which the nutrition of all tissues depends. while there is undoubted progressive wear of all tissues, this becomes most evident in the case of the blood vessels of the body. it is rare that arteries which can be regarded as in all respects normal are found in individuals over forty, and these changes progress rapidly with advancing age. so striking and constant are these vascular changes that they seem almost in themselves sufficient to explain the senile changes, and this has been frequently expressed in the remark that age is determined not by years, but by the condition of the arteries. comparative studies show the falsity of this view, for animals which are but little or not at all subject to arterial disease show senile changes of much the same character as those found in man. there is another condition which must be considered in a study of causes of age. in the ordinary course of life slight injuries are constantly being received and more or less perfectly repaired. an infection which may but slightly affect the ordinary well-being of the individual may produce a considerable damage. excess or deficiency or improper food, occasional or continued use of alcohol and other poisons may lead to very definite lesions. repair after injury is rarely perfect, the repaired tissue is more susceptible to injury, and with advancing age there is constant diminution in the ease and perfection of repair. the effect of the sum of all these changes becomes operative: a vicious circle is established in which injury becomes progressively easier to acquire and repair constantly less perfect. there is some adjustment, however, in that the range of activities is diminished, the environment becomes narrower and the organism adapts its life to that environment which makes the least demands upon it. whether there is, entirely apart from all conditions affecting nutrition and the effect of injuries which disturb the usual cell activities, an actual senescence of the cells of the body is uncertain. in the presence of the many factors which influence the obvious diminution of cell activity in the old, it is impossible to say whether the loss of cell activity is intrinsic or extrinsic. the life of the plant cell seems to be immortal; it does not grow old. trees die owing to accidents or because the tree acquires in the course of its growth a mass of tissue in which there is little or no life, and which becomes the prey of parasites. the growing tissue of a tree is comprised in a thin layer below the bark, and the life of this may seemingly be indefinitely prolonged by placing it in a situation in which it escapes the action of accidental injuries and decay, as by grafting on young trees. where the nature of the dead wood is such that it is immune from parasites and decay, as in the case of the sequoias, life seems to be indefinitely prolonged. the growing branches of one of these trees, whose age has been estimated with seeming accuracy at six thousand years, are just as fresh and the tree produces its flowers and fruit in the same degree as a youthful brother of one thousand years. nor does old age supervene in the unicellular organisms. an amoeba assimilates, grows and multiplies just as long as the environment is favorable. old age in itself is seldom a cause of death. in rare cases in the very old a condition is found in which no change is present to which death can be attributed, all organs seem to share alike in the senescence. death is usually due to some of the accidents of life, a slight infection to which the less resistant body succumbs, or to the rupture of a weakened blood vessel in the brain, or to more advanced decay in some organ whose function is indispensable. the causes and conditions of age have been a fertile source for speculation. many of the hypotheses have been interesting, that of metschnikoff, for example, who finds as a dominating influence in causing senescence the absorption of toxic substances formed in the large intestine by certain bacteria. he further finds that the cells of the body which have phagocytic powers turn their activity against cells and tissues which have become weakened. there may be absorption of injurious substances from the intestines which the body in a vigorous condition is able to destroy or to counteract their influence, and these may be more operative in the weaker condition of the body in the old. phagocytes will remove cells which are dead and often cells which are superfluous in a part, but there is no evidence that this is ever other than a conservative process. since it is impossible to single out any one condition to which old age is due, the hypothesis of metschnikoff should have no more regard given it than the many other hypotheses which have been presented. death of the body as a whole takes place from the cessation of the action of the central nervous system or of the respiratory system or of the circulation. there are other organs of the body, such as the intestine, kidney, liver, whose function is essential for life, but death does not take place immediately on the cessation of their function. the functions of the heart, the brain and the lungs are intimately associated. oxygen is indispensable for the life of the tissues, and its supply is dependent upon the integrity of the three organs mentioned, which have been called the tripos of life. respiration is brought about by the stimulation of certain nerve cells in the brain, the most effective stimulus to these cells being a diminution of oxygen in the blood supplying them. these cells send out impulses to the muscles concerned in inspiration, the chest expands, and air is taken into the lungs. respiration is then a more complicated process than is the action of the heart, for its contraction, which causes the blood to circulate, is not immediately dependent upon extrinsic influences. death is usually more immediately due to failure of respiration than to failure of circulation, for the heart often continues beating for a time after respiration has ceased. thus, in cases of drowning and suffocation, by means of artificial respiration in which air is passively taken into and expelled from the lungs, giving oxygen to the blood, the heart may continue to beat and the circulation continue for hours after all evident signs of life and all sensation has ceased. by this general death is meant the death of the organism as a whole, but all parts of the body do not die at the same time. the muscles and nerves may react, the heart may be kept beating, and organs of the body when removed and supplied with blood will continue to function. certain tissues die early, and the first to succumb to the lack of oxygenated blood are the nerve cells of the brain. if respiration and circulation have ceased for as short a time as twelve minutes, life ceases in certain of these cells and cannot be restored. this is again an example of the greater vulnerability of the more highly differentiated structure in which all other forms of cell activity are subordinated to function. there are, however, pretty well authenticated cases of resuscitation after immersion in water for a longer period than twelve minutes, but these cases have not been carefully timed, and time under such conditions may seem longer than it actually is; and there is, moreover, the possibility of a slight gaseous interchange between the blood and the water in the lungs, as in the case of the fish which uses the water for an oxygen supply as the mammal does the air. there are also examples of apparent death or trances which have lasted longer, and the cases of fakirs who have been buried for prolonged periods and again restored to life. in these conditions, however, all the activities of the body are reduced to the utmost, and respiration and circulation, so feeble as to be imperceptible to ordinary observation, suffice to keep the cells living. with the cessation of life the body is subject to the unmodified action of its physical environment. there is no further production of heat and the body takes the temperature of the surroundings. the only exceptions are rare cases in which such active chemical changes take place in the dead body that heat is generated by chemical action. at a varying interval after death, usually within twelve hours, there is a general contraction and hardening of the muscles due to chemical changes, probably of the nature of coagulation, in them. this begins in the muscles of the head, extends to the extremities, and usually disappears in twenty-four hours. it is always most intense and most rapid in its onset when death is preceded by active muscular exertion. there have been cases of instantaneous death in battle where the body has remained in the position it held at the moment of death, this being due to the instantaneous onset of muscular rigidity. the blood remains fluid for a time after death and settles in the more dependent parts of the body, producing bluish red mottled discolorations. later the blood coagulates in the vessels. the body loses moisture by evaporation. drying of the surface takes place where the epidermis is thin, as over the transparent part of the eye and over areas deprived of epidermis. decomposition and putrefaction of the body due to bacterial action takes place. the bacteria ever present in the alimentary canal make their way from this into the dead tissue. certain of these bacteria produce gas which accumulates in the tissues and the body often swells enormously. a greenish discoloration appears, which is due to the union of the products of decomposition with the iron in the blood; this is more prominent over the abdomen and appears in lines along the course of the veins. the rapidity with which decomposition takes place varies, and is dependent upon many factors, such as the surrounding temperature, the nutrition of the body at the time of death, the cause of death. it is usually not difficult to recognize that a body is dead. in certain cases, however, the heart's action may be so feeble that no pulse is felt at the wrist, and the current of the expired air may not move a feather held to the nostril or cloud the surface of a mirror by the precipitation of moisture upon it. this condition, combined with unconsciousness and paralysis of all the voluntary muscles, may very closely simulate death. the only absolute evidence of death is given by such changes as loss of body heat, rigor mortis or stiffening of the muscles, coagulation of the blood and decomposition. chapter iii the growth of the body.--growth more rapid in embryonic period.--the coÖrdination and regulation of growth.--tumors.--the growth of tumors compared with normal growth.--size, shape and structure of tumors.-- the growth capacity of tumors as shown by the inoculation of tumors of mice.--benign and malignant tumors.--effect of inheritance.--are tumors becoming more frequent?--the effect produced by a tumor on the individual who bears it.--relation of tumors to age and sex.--theories as to the cause of tumors.--the parasitic theory.--the traumatic theory.--the embryonic theory.--the importance of the early recognition and removal of tumors. the power of growth is possessed by every living thing, but growth is not limited to the living. crystals also will grow, and the rapidity and character of growth and the maximum size of the crystal depends upon the character of the substance which forms the crystal. from the single cell or ovum formed by the union of the male and female sexual cells, growth is continuous until a size corresponding to the type of the species is attained. from this time onward growth is limited to the degree necessary to supply the constant loss of material which the body undergoes. the rapidity of the growth of the body and of its component parts differs at different ages, and becomes progressively less active from its beginning in the ovum until the adult type of the species is attained. as determined by the volume, the embryo increases more than ten thousand times in size during the first month of intra-uterine life. at birth the average weight is six and a half pounds; at the end of the first year eighteen and a half pounds, a gain of twelve pounds; at the end of the second year twenty-three pounds, a gain of four and a half pounds. the growth is coördinated, the size of the single organs bearing a definite ratio, which varies within slight limits, to the size of the body, a large individual having organs of corresponding size. knowing that the capacity of growth is one of the inherent properties of living matter, it is much easier to understand the continuance of growth than its cessation. it is impossible to avoid the conclusion that there is some internal mechanism of the body which controls and regulates growth. in the first chapter reference was made to organs producing substances which pass directly into the circulation; these substances act by control of the activities of other parts, stimulating or depressing or altering their function. two of these glands, the thymus, lying in front, where the neck joins the body and which attains its greatest size at puberty, and the pituitary body, placed beneath the brain but forming no part of it, have been shown by recent investigations to have a very definite relation to growth, especially the growth of the skeleton. the growth energy chiefly resides in the skeleton, and if the growing animal has a diet sufficient only to maintain the body weight, the skeleton will continue to grow at the expense of the other tissues, literally living upon the rest of the body. disease of the glands mentioned leading to an increase or diminution or alteration of their function may not only inhibit or unduly increase the growth of the skeleton, but may also interfere with the sexual development which accompanies the skeleton growth. the difficulties which arise in an endeavor to comprehend normal growth are greater when the growth of tumors is considered. a tumor is a mass of newly formed tissue which in structure, in growth, and the relations which it forms with adjoining tissues departs to a greater or less degree from the type of the tissue to which it is related in structure or from which it originates. it is an independent structure which, like a parasite, grows at the expense of the body, contributing nothing to it, and its capacity for growth is unlimited. a tumor cannot be considered as an organ, its activities not being coordinated with those of the body. a part of the body it certainly is, but in the household economy it is to be considered as a wild and lawless guest, not influenced by or conforming with the regulations of the household. the rapidity of growth varies; certain tumors for years increase but little in size, while others may be seen to increase from day to day. the growth is often intermittent, periods of great activity of growth alternating with periods of quiescence. the nutrition and growth of a tumor is only slightly influenced by the condition of nutrition of the bearer. its cells have a greater avidity for food than have those of the body, and, like the growing bones of an insufficiently fed animal, growth in some cases seems to take place at the expense of the body, the normal cells not obtaining sufficient nutriment to repair their waste. a tumor may be of any size: so small as to be invisible to the naked eye, or its weight may exceed that of the individual who bears it. the limitations to its growth are extrinsic and not intrinsic. there is no distinct color. certain tumors have color which depends upon the presence of a dark brown or black pigment within the cells. hæmorrhages within them are not infrequent, and they may be colored by the blood or by pigments formed from it. usually they have a gray color modified by their varying vascularity, or the cut surface may be mottled due to areas of cell degeneration. the consistency varies; some tumors are so soft that they can be pressed through a sieve, others are of stony hardness. there is no distinct shape, this being influenced by the nature of the tumor, the manner of growth and situation. when the tumor grows on or near a surface, it may project from this and be attached by a narrow band only; in the interior of the body it may be irregular in outline, round or lobular, the shape being influenced by many factors. tumors like the tissues of the normal body are nourished by the blood and contain blood vessels often in great numbers. a tumor arises by the cells of a part of the body beginning to grow and taking on the characteristics of a tumor. its growth is independent, the cells of the adjoining tissue taking no part in it. the tissue in the vicinity of the tumor is partly pushed aside by the mass, or the tumor grows into it and the tissue disappears as the tumor advances. the destruction of the surrounding tissue is brought about partly by the pressure which the tumor exerts, partly by the compression of the blood vessels or the blood supply of the organs is diverted to the tumor. the characteristics of a tumor are due to the cells which it contains (fig ). these often become separated from the main mass and are carried by the blood into other parts of the body, where they grow and form tumors similar in character to the parent tumor. in the extraordinary capacity for growth possessed by tumor cells, they resemble vegetable rather than animal cells. there is no limit to the growth of a tumor save by the death of the individual who bears it, thus cutting off the supply of nutrition. the cells of tumors peculiar to man show a narrow range of adaptation. they will grow only in the body of the individual to whom the tumor belongs, and die when grafted on another individual. in the case of tumors which arise in animals, pieces of the tumor when grafted on another animal of the same species will grow, and in this way the growth capacity of the tumor cells has been estimated. thus, by transplanting a small section of a mouse tumor into other mice, the small transplanted fragments will in two weeks grow to the size of filberts, and each of these will furnish material to engraft upon ten mice. these new tumors are similar in character to the original tumor, and really represent parts of it in the same way that all the baldwin apples in the world are parts of the original tree which was found in baldwinville many years ago, and as all the concord grape vines are really parts of the original vine. it has been estimated that if all the growth capacity of this mouse tumor were availed of by the successive inoculation of other mice, a mass of tumor several times the diameter of the sun would grow in two years. the condition of the individual seems to exert no influence upon the growth of the tumor. growth may be as rapid when the bearer is in a condition of extreme emaciation as it is when the bearer is well nourished and robust. [illustration: fig .--photograph of a microscopic preparation from a cancer of the uterus. a large mass of cells is extending into the tissue of the uterus which is shown as the fibrous structure. such a cell mass penetrating into the tissue represents the real cancer, the tissue about the cell masses bear the blood vessels which nourish the tumor cells.] those tumors which grow rapidly and invade and destroy the surrounding tissue are called malignant tumors or cancers, but in a strict sense no tumor can be regarded as benign, for none can serve a useful purpose. a tumor after a period of slow growth can begin to grow rapidly. tumors may arise in any part of the body, but there are certain places of preference particularly for the more malignant tumors. these are places where the cells naturally have a marked power of growth, and especially where growth is intermittent as in the uterus and mammary gland. little is known in regard to the influence of inheritance on the formation of tumors. study of the tumors of mice show a slightly greater susceptibility to tumor formation in the progeny of mice who have developed tumors. studies of human families seem to show that heredity has a slight influence, but in the frequency of tumors such statistical evidence is of little value. the question of inheritance has much bearing on the origin of tumors. if the tumor is accidental and due entirely to extraneous causes, inheritance is not probable; but if there is some predisposition to tumor formation in certain individuals due to some peculiarity, then inheritance may exert an influence. the question as to whether tumors are an increasing cause of disease is equally difficult of solution. the mortality statistics, if taken at their face value, show an enormous increase in frequency; but there are many factors which must be considered and which render the decision difficult and doubtful. tumors are largely a prerogative of age, and the increased duration of life which preventive medicine has brought about brings more people into the age when tumors are more common. owing to the greater skill in the diagnosis of tumors, especially those of the internal organs, they are now recognized more frequently and more deaths are correctly ascribed to them. deaths from tumors were formerly often purposely concealed and attributed to some other cause. no age is immune to tumors. they may be present at birth or develop shortly afterwards. the age from five to twenty years is the most free from them, that from forty-five to sixty-five the most susceptible, particularly to the more malignant forms. a tumor is a local disease. the growing tissue of the tumor is the disease, and it is evident that if the entire tumor were removed the disease would be cured. this is the end sought by surgical interference, but notwithstanding seemingly thorough removal, the tumor often reappears after an interval of months or years. there are many conditions which may render the complete removal of a tumor difficult or impossible. it is often impossible to ascertain just how far the tumor cells have invaded the neighboring structures; the situation of the tumor may be such that an extended removal would injure organs which are essential for life, or at the time of removal the tumor cells may have been conveyed elsewhere by the blood or lymphatic vessels. successful removal depends mainly upon the length of time the tumor has been growing. at an early stage even the most malignant tumor may be successfully removed. it is evident from this how disastrous may be the neglect of proper surgical treatment of a tumor. the time may be very short between the first evidence of the presence of a tumor and the development of a condition which would render complete removal impossible. the effect of a tumor upon its bearer depends upon its character and situation. pain is very commonly present, and is due to the pressure which the growing tumor exerts upon the sensory nerves. pain may, however, not be present or appear only at the last. a condition of malnutrition and emaciation often results due to the passage into the blood of injurious substances formed in the tumor, or to the destruction of important organs by the growing tumor. the growth of a tumor in the intestine may obstruct or close the canal and thus interfere with nutrition. the cause or causes of tumors are unknown. we know that the tumor represents essentially an abnormal growth, and that this growth is due to new formation of cells. in certain cases the tumor repeats the structure of the organ or tissue in which it originates, in others it departs widely from this; always, however, its structure resembles structures found in the body at some period of life. the tumor cells, like all other cells of the body, grow by means of the nutriment which the body supplies; they have no intrinsic sources of energy. the great problem is what starts the cells to grow and why the growth differs from that of normal tissue, why it is not regulated and coördinated as are other forms of growth. when a small piece of the skin, for instance, is cut out growth as rapid as that in tumors takes place in the adjoining cells, _but it ceases when the loss is restored_. the same is true when a piece of the liver is removed. various hypotheses have been formed to explain the tumor, all of them of interest, and they have had great importance in that the attempt to prove or disprove the hypothesis by continued observation and experiment along definite lines has produced new knowledge. the various theories as to cause may be divided into three heads. the parasitic theory. this supposes that a living parasite invades the body, and by its presence excites the cells of certain tissues to grow in tumor form. it is known that active growth of the cells of the body can be excited in a number of ways, by chemical substances such as certain of the coal tar products, and that it often takes place under the influence of bacteria. it is further known that parasites can produce tumor-like growths in plants. the large, rough excrescences on the oaks are produced by a fly which lays its eggs in or beneath the bark, and the larva which develops from the egg secretes a substance which causes the cells about it to multiply, and a huge mass is formed which serves the developing insect for both food and protection. large tumor-like masses are formed on the roots and stalk of cabbages as the result of the invasion of the cells by a minute organism: the tumors of olive trees are due to a bacterium; the peculiar growths on cedar trees, the so-called "witches' brooms," are produced by a fungus, and there are many other such examples. these have many analogies with tumors in animals. under the stimulus of the parasite the cells seem to have unlimited growth capacity and a greater nutritive avidity than have the normal plant cells; the character of the mass produced differs as does the tumor, to a greater or less extent, from the normal growth; on the cedar, for instance, the "witches' broom" consists of a thick mass of foliage with small stems less green than the usual foliage, the leaves wider and not so closely applied to the stems. the entire plant suffers in its nutrition and a condition resembling tumor cachexia[ ] is produced, and there are no fundamental differences between the plant and animal tumors. support has also been given to the parasitic theory by the discovery within tumor cells of bodies which were supposed to be a peculiar sort of parasite. if the truth of the parasitic theory could be proved, there would be justifiable expectation that the tumor disease might be controlled as are many of the parasitic diseases, but the hypothesis awaits the demonstration of its correctness. despite the study of tumors which is being actively pursued in many places and by the most skilled investigators, no parasites have been found in animal tumors; the objects previously described as parasites have been found not to be such. it is difficult to bring in accord with the parasitic theory the great variation in tumor structure, the relation of certain tumors, as the malignant tumors of the breast and uterus, with the age of the bearer, the congenital tumors which develop in intra-uterine life, and there are many other conditions which oppose the theory. the traumatic[ ] theory. there is much in favor of this. in a certain number of cases tumors do develop at the site of injuries. the coincidence of injury and tumor is apt to be overestimated because of the strong tendency to connect succeeding events. tumors are not most common on those parts of the body which are most exposed to injury. they are rare, for instance, on the hands and feet, and very rarely do they appear at the site of wounds caused by surgical operations. for those tumors which develop in intra-uterine life it is difficult to assign injury as a cause. there does, however, seem to be a relation between tumors and injuries of a certain character. the natives of cashmere use in winter for purposes of heat a small charcoal stove which they bind on the front of the body; burns often result and tumors not infrequently develop at the site of such burns. injuries of tissue which are produced by the x-ray not infrequently result in tumor formation and years may elapse between the receipt of the injury and the development of the tumor. these x-ray injuries are of a peculiar character, their nature but imperfectly understood, and the injured tissues seem to have lost the capacity for perfect repair. in regard to the possible action of both injuries and parasites in causing tumors, the possibility that their effects on different individuals may not be the same must be considered. in addition to the trauma or the parasite which may be considered as extrinsic factors, there may be conditions of the body, intrinsic factors, which favor their action in tumor development. the peculiar tissue growth within the uterus called decidua, which occurs normally in pregnancy and serves to fasten the developing ovum to the inner lining of the uterus, may be produced experimentally. this growth depends upon two factors, an internal secretion derived from the ovary and the introduction into the uterus of a foreign body of some sort; in the case of pregnancy the developing embryo acts as the foreign body. it is not impossible that some variation in the complex relations which determine normal growth may be one factor, possibly the most important, in tumor formation. another theory is that the tumor is the result of imperfect embryonic development. the development of the child from the ovum is the result of a continued formation and differentiation of cells. a cell mass is first produced, and the cells in this differentiate into three layers called ectoderm, entoderm and mesoderm, from which the external and internal surfaces and the enclosed tissues respectively develop, and the different organs are produced by growth of the cells of certain areas of these layers. the embryonic theory assumes that in the course of embryonic development not all the cell material destined for the formation of individual organs is used up for this purpose, that certain of the embryonic cells become enclosed in the developing organs, they retain the embryonic capacity for growth and tumors arise from them. there is no doubt that something like this does take place. there is a relation between malformations due to imperfect development of the embryo and tumors, the two conditions occurring together too frequently to be regarded as mere coincidence. also tumors may occur in parts of the body in which there is no tissue capable of forming structures which may be present in the tumors. the theory, however, is not adequate, but it may be among the factors. the problems concerned in the nature and cause of tumors are the most important in medicine at the present time. no other form of disease causes a similar amount of suffering and anxiety, which often extends over years and makes a terrible drain on the sympathy and resources of the family. the only efficient treatment for tumors at the present time is removal by surgical operation, and the success of the operation is in direct ratio to the age of the tumor, the time which elapses from its beginning development. it is of the utmost importance that this should be generally recognized, and the facts relating to tumors become general knowledge. tumors form one of the most common causes of death (after the age of thirty-five one in every ten individuals dies of tumor); medical and surgical resources are, in many cases, powerless to afford relief and the tumor stands as a bar to the attainment of the utopia represented by a happy and comfortable old age, and a quiet passing. every possible resource should be placed at the disposal of the scientific investigation of the subject, for with knowledge will come power to relieve. footnotes: [ ] by cachexia is understood a condition of malnutrition and emaciation which is usually accompanied by a pale sallow color of the skin. [ ] by trauma is understood a wound or injury of any sort. chapter iv the reactions of the tissues of the body to injuries.--inflammation.-- the changes in the blood in this.--the emigration of the corpuscles of the blood.--the evident changes in the injured part and the manner in which these are produced.--heat, redness, swelling and pain.--the production of blisters by sunburn.--the changes in the cells of an injured part.--the cells which migrate from the blood-vessels act as phagocytes.--the macrophages.--the microphages.--chemotropism.--the healing of inflammation.--the removal of the cause.--cell repair and new formation.--new formation of blood-vessels.--acute and chronic inflammation.--the apparently purposeful character of the changes in inflammation. injury and repair have already been briefly considered in their relation to the normal body and to old age; there are, however, certain phenomena included under the term inflammation which follow the more extensive injuries and demand a closer consideration than was given in chapter ii. these phenomena differ in degree and character; they are affected by the nature of the injurious agent and the intensity of its action, by the character of the tissue which is affected and by variations in individual resistance to injury. a blow which would have no effect upon the general surface of the body may produce serious results if it fall upon the eye, and less serious results for a robust than for a weak individual. most of the changes which take place after an injury and their sequence can be followed under the microscope. if the thin membrane between the toes of a living frog be placed under the microscope the blood vessels and the circulating blood can be distinctly seen in the thin tissue between the transparent surfaces. the arteries, the capillaries and veins can be distinguished, the arteries by the changing rapidity of the blood stream within them, there being a quickening of the flow corresponding with each contraction of the heart; the veins appear as large vessels in which the blood flows regularly (fig. ). between the veins and arteries is a large number of capillaries with thin transparent walls and a diameter no greater than that of the single blood corpuscles; they receive the blood from the arteries and the flow in them is continuous. the white and red blood corpuscles can be distinguished, the red appearing as oval discs and the white as colorless spheres. in the arteries and veins the red corpuscles remain in the centre of the vessels appearing as a rapidly moving red core, and between this core and the wall of the vessels is a layer of clear fluid in which the white corpuscles move more slowly, often turning over and over as a ball rolls along the table. if, now, the web be injured by pricking it or placing some irritating substance upon it, a change takes place in the circulation. the arteries and the veins become dilated and the flow of blood more rapid, so rapid, indeed, that it is difficult to distinguish the single corpuscles. in a short while the rapidity of flow in the dilated vessels diminishes, becoming slower than the normal, and the separation between the red and white corpuscles is not so evident. in the slowly moving stream the white corpuscles move much more slowly than do the red, and hence accumulate in the vessels lining the inner surface and later become attached to this and cease to move forward. the attached corpuscles then begin to move as does an amoeba, sending out projections, some one of which penetrates the wall, and following this the corpuscles creep through. red corpuscles also pass out of the vessels, this taking place in the capillaries; the white corpuscles, on the other hand, pass through the small veins. not only do the white corpuscles pass through the vessels, but the blood fluid also passes out. the corpuscles which have passed into the tissue around the vessels are carried away by the outstreaming fluid, and the web becomes swollen from the increased amount of fluid which it contains. the injured area of the web is more sensitive than a corresponding uninjured area and the foot is more quickly moved if it be touched. if the injury has been very slight, observation of the area on the following day will show no change beyond a slight dilatation of the vessels and a great accumulation of cells in the tissue. everyone has experienced the effect of such changes as have been described in this simple experiment. an inflamed part on the surface of the body is redder than the normal, swollen, hot and painful. the usual red tinge of the skin is due to the red blood contained in the vessels, and the color is intensified when, owing to the dilatation, the vessels contain more blood. the inflamed area feels hot, and if the temperature be taken it may be two or three degrees warmer than a corresponding area. the increased heat is due to the richer circulation. heat is produced in the interior of the body chiefly in the muscles and great glands, and the increased afflux of blood brings more heat to the surface. a certain degree of swelling of the tissue is due to the dilatation of the vessels; but this is a negligible factor as compared with the effect of the presence of the fluid and cells of the exudate.[ ] the fluid distends the tissue spaces, and it may pass from the tissue and accumulate on surfaces or in the large cavities within the body. the greatly increased discharge from the nose in a "cold in the head" is due to the exudation formed in the acutely inflamed tissue, and which readily passes through the thin epithelial covering. various degrees of inflammation of the skin may be produced by the action of the sun, the injury being due not to the heat but to the actinic rays. in a mild degree of exposure only redness and a strong sense of heat are produced, but in prolonged exposure an exudate is formed which causes the skin to swell and blisters to form, these being due to the exudate which passes through the lower layers of the cells of the epidermis and collects beneath the impervious upper layer, detaching this from its connections. if a small wad of cotton, soaked in strong ammonia, be placed on the skin and covered with a thimble and removed after two minutes, minute blisters of exudate slowly form at the spot. the pain in an inflamed part is due to a number of factors, but chiefly to the increased pressure upon the sensory nerves caused by the exudate. the pain varies so greatly in degree and character that parts which ordinarily have little sensation may become exquisitely painful when inflamed. the pain is usually greater when the affected part is dense and unyielding, as the membranes around bones and teeth. the pain is often intermittent, there being acute paroxysms synchronous with the pulse, this being due to momentary increase of pressure when more blood is forced into the part at each contraction of the heart. the pain may also be due to the direct action of an injurious substance upon the sensory nerves, as in the case of the sting of an insect where the pain is immediate and most intense before the exudate has begun to appear. when an inflamed area is examined, after twenty-four hours, by hardening the tissue in some of the fluids used for this purpose and cutting it into very thin slices by means of an instrument called a microtome, the microscope shows a series of changes which were not apparent on naked eye examination. the texture is looser, due to the exudate which has dilated all the spaces in the tissue. red and white corpuscles in varying numbers and proportions infiltrate the tissue; all the cells which belong to the part, even those forming the walls of the vessels, are swollen, the nuclei contain more chromatin, and the changes in the nuclei which indicate that the cells are multiplying appear. the blood vessels are dilated, and the part in every way gives the indication of a more active life within it. there are also evidences of the tissue injury which has called forth all the changes which we have considered. (fig. .) [illustration: fig. --a section of an inflamed lung showing the exudate within the air spaces. compare this with fig . fig is from the human lung, in which the air spaces are much larger than in the mouse.] the microscopic examination of any normal tissue of the body shows within it a variable number of cells which have no intimate association with the structure of the part and do not seem to participate in its function. they are found in situations which indicate that these cells have power of active independent motion. in the inflamed tissue a greatly increased number of these cells is found, but they do not appear until the height of the process has passed, usually not before thirty-six or forty-eight hours after the injury has been received. the numbers present depend much upon the character of the agent which has produced the injury, and they may be more numerous than the ordinary leucocytes which migrate from the blood vessels. all these changes which an injured part undergoes are found when closely analyzed to be purposeful; that is, they are in accord with the conditions under which the living matter acts, and they seem to facilitate the operation of these conditions. it has been said that the life of the organism depends upon the coördinated activity of the living units or cells of which it is composed. the cells receive from the blood material for the purpose of function, for cell repair and renewal, and the products of waste must be removed. in the injury which has been produced in the tissue all the cells have suffered, some possibly displaced from their connections, others may have been completely destroyed, others have sustained varying degrees of injury. if the injury be of an infectious character, that is, produced by bacteria, these may be present in the part and continue to exert injury by the poisonous substances which they produce, or if the injury has been produced by the action of some other sort of poison, this may be present in concentrated form, or the injury may have been the result of the presence of a foreign body in the part. under these conditions, since the usual activities of the cells in the injured part will not suffice to restore the integrity of the tissue, repair and cell formation must be more active than usual, any injurious substances must be removed or such changes must take place in the tissue that the cell life adapts itself to new conditions. [illustration: fig. .--phagocytosis. _a_, _b_, _c_ are the microphages or the bacterial phagocytes. (_a_) contains a number of round bacteria, and (_b_) similar bacteria arranged in chains, and (_c_) a number of rod-shaped bacteria (_d_) is a cell phagocyte or macrophage which contains five red blood corpuscles.] all life in the tissues depends upon the circulation of the blood. there is definite relation between the activity of cells and the blood supply; a part, for instance, which is in active function receives a greater supply of blood by means of dilatation of the arteries which supply it. if the body be exactly balanced longitudinally on a platform, reading or any exercise of the brain causes the head end to sink owing to the relatively greater amount of blood which the brain receives when in active function. the regulation of the blood supply is effected by means of nerves which act upon the muscular walls of the arteries causing, by the contraction or the relaxation of the muscle, diminution or dilatation of the calibre of the vessel. after injury the dilatation of the vessels with the greater afflux of blood to the part is the effect of the greatly increased cell activity, and is a necessity for this. in many forms of disease it has been found that by increasing the blood flow to a part and producing an active circulation in it, that recovery more readily takes place and many of the procedures which have been found useful in inflammation, such as hot applications, act by increasing the blood flow. so intimate is the association between cell activity, as shown in repair and new formation of cells, and the blood flow, that new blood vessels frequently develop by means of which the capacity for nutrition is still more increased. the cornea or transparent part of the eye contains no blood vessels, the cells which it contains being nourished by the tissue fluid which comes from the outside and circulates in small communicating spaces. if the centre of the cornea be injured, the cells of the blood vessels in the tissue around the cornea multiply and form new vessels which grow into the cornea and appear as a pink fringe around the periphery; when repair has taken place the newly formed vessels disappear. the exudate from the blood vessels in various ways assists in repair. an injurious substance in the tissue may be so diluted by the fluid that its action is minimized. a small crystal of salt is irritating to the eye, but a much greater amount of the same substance in dilute solution causes no irritation. the poisonous substances produced by bacteria are diluted and washed away from the part by the exudate. not only is there a greater amount of tissue fluid in the inflamed part, but the circulation of this is also increased, as is shown by comparing the outflow in the lymphatic vessels with the normal. the fluid exudate which has come from the blood and differs but slightly from the blood fluid exerts not only the purely physical action of removing and diluting injurious substances, but in many cases has a remarkable power, exercised particularly on bacterial poisons, of neutralizing poisons or so changing their character that they cease to be injurious. we have learned, chiefly from the work of metschnikoff, that those white corpuscles or leucocytes which migrate from the vessels in the greatest numbers have marked phagocytic properties, that is, they can devour other living things and thus destroy them just as do the amoebæ. in inflammations produced by bacteria there is a very active migration of these cells from the vessels; they accumulate in the tissue and devour the bacteria. they may be present in such masses as to form a dense wall around the bacteria, thus acting as a physical bar to their further extension. the other form of amoeboid cell, which metschnikoff calls the macrophage, has more feeble phagocytic action towards bacteria, and these are rarely found enclosed within them. it is chiefly by means of their activity that other sorts of substances are removed. they often contain dead cells or cell fragments, and when hæmorrhage takes place in a tissue they enclose and remove the granules of blood pigment which result. they often join together, forming connected masses, and surround such a foreign body as a hair, or a thread which the surgeon places in a wound to close it. they may destroy living cells, and do this seemingly when certain cells are in too great numbers and superfluous in a part, their action tending to restore the cell equilibrium. the foreign cells do even more than this: they themselves may be devoured by the growing cells of the tissue, seemingly being actuated by the same supreme idea of sacrifice which led buddha to give himself to the tigress. the explanation of most of the changes which take place in inflammation is obvious. it is a definite property of all living things that repair takes place after injury, and certain of the changes are only an accentuation of those which take place in the usual life; but others, such as the formation of the exudate, are unusual; not only is the outpouring of fluid greatly increased, but its character is changed. in the normal transudation[ ] the substances on which the coagulation of the blood depends pass through the vessel wall to a very slight extent, but the exudate may contain the coagulable material in such amounts that it easily clots. the interchange between the fluid outside the vessels and the blood fluid takes place by means of filtration and osmosis. there is a greater pressure in the vessels than in the fluid outside of them, and the fluid filters through the wall as fluid filters through a thin membrane outside of the body. osmosis takes place when two fluids of different osmotic pressure are separated by animal membrane. difference in osmotic pressure is due to differences in molecular concentration, the greater the number of molecules the greater is the pressure, and the greater rapidity of flow is from the fluid of less pressure to the fluid of greater pressure. the molecular concentration of tissue and blood fluid is constantly being equalized by the process of osmosis. in the injured tissue the conditions are more favorable for the fluid of the blood to pass from the vessels: by filtration, because owing to the dilatation of the arteries there is increased amount of blood and greater pressure within the vessels, and the filtering membrane is also thinner because the same amount of membrane (here the wall of the vessel) must cover the larger surface produced by the dilatation. it is, moreover, very generally believed that there are minute openings in the walls of the capillaries, and these would become larger in the dilated vessel just as openings in a sheet of rubber become larger when this is stretched. osmosis towards the tissue is favored because, owing to destructive processes the molecular pressure in the injured area is increased; an injured tissue has been shown to take up fluid more readily outside of the body than a corresponding uninjured tissue. the slowing of the blood stream, in spite of the dilatation of the vessels, is due to the greater friction of the suspended corpuscles on the walls of the vessels. this is due to the loss from the blood of the outstreaming fluid and the relative increase in the number of corpuscles, added to by the unevenness of surface which the attached corpuscles produce. the wonderful migration of the leucocytes, which seems to show a conscious protective action on their part, takes place under the action of conditions which influence the movement of cells. when an actively moving amoeba is observed it is seen that the motion is not the result of chance, for it is influenced by conditions external to the organism; certain substances are found to attract the amoebae towards them and other substances to repel them. these influences or forces affecting the movements of organisms are known as _tropisms_, and play a large part in nature; the attraction of various organisms towards a source of light is known as _heliotropism_, and there are many other instances of such attraction. the leucocytes as free moving cells also come under the influence of such tropisms. when a small capillary tube having one end sealed is partially filled with the bacteria which produce abscess and placed beneath the skin it quickly becomes filled with leucocytes, these being attracted by the bacteria it contains. dead cells exert a similar attraction for the large phagocytes. such attraction is called _chemotropism_ and is supposed to be due in the cases mentioned, to the action of chemical substances such as are given off by the bacteria or the dead cells. the direction of motion is due to stimulation of that part of the body of the leucocyte which is towards the source of the stimulus. the presence in the injured part of bacteria or of injured and dead cells exerts an attraction for the leucocytes within the vessels causing their migration. when the centre of the cornea is injured, this tissue having no vessels, all the vascular phenomena take place in the white part of the eye immediately around the cornea, this becoming red and congested. the migration of leucocytes from the vessels takes place chiefly on the side towards the cornea, and the migrated cells make their way along the devious tracts of the communicating lymph spaces to the area of injury. the objection may be raised that it is difficult to think of a chemical substance produced in an injured area no larger than a millimeter, diffusing through the cornea and reaching the vessels outside this in such quantity and concentration as to affect their contents, nor has there been any evidence presented that definite chemical substances are produced in injured tissues; but there is no difficulty in view of the possibilities. it is not necessary to assume that an actual substance so diffuses itself, but the influence exerted may be thought of as a force, possibly some form of molecular motion, which is set in action at the area of injury and extends from this. no actual substance passes along a nerve when it conveys an impulse. we have left the injured area with an increased amount of fluid and cells within it, with the blood vessels dilated and with both cells and fluid streaming through their walls, and the cells belonging to the area actively repairing damages and multiplying. the process will continue as long as the cause which produces the injury continues to act, and will gradually cease with the discontinuance of this action, and this may be brought about in various ways. a foreign body may be mechanically removed, as when a thorn is plucked out; or bacteria may be destroyed by the leucocytes; or a poison, such as the sting of an insect, may be diluted by the exudate until it be no longer injurious, or it may be neutralized. even without the removal of the cause the power of adaptation will enable the life of the affected part to go on, less perfectly perhaps, in the new environment. the excess of fluid is removed by the outflow exceeding the inflow, or it may pass to some one of the surfaces of the body, or in other cases an incision favors its escape. the excess of cells is in part removed with the fluid, in part they disappear by undergoing solution and in part they are devoured by other cells. with the diminishing cell activity the blood vessels resume their usual calibre, and when the newly formed vessels become redundant they disappear by undergoing atrophy in the same way as other tissues which have become useless. when these changes take place rapidly the inflammation is said to be acute, and chronic when they take place slowly. chronic inflammation is more complex than is the acute, and there is more variation in the single conditions. the chronicity may be due to a number of conditions, as the persistence of a cause, or to incompleteness of repair which renders the part once affected more vulnerable, to such a degree even that the ordinary conditions to which it is subjected become injurious. a chronic inflammation may be little more than an almost continuous series of acute inflammations, with repair continuously less perfect. chronic imflammations are a prerogative of the old as compared with the young, of the weak rather than the strong. footnotes: [ ] the term exudation is used to designate the passing of cells and fluid from the vessels in inflammation; the material is the exudate. [ ] by transudation is meant the constant interchange between the blood and the tissue fluid. chapter v infectious diseases.--the historical importance of epidemics of disease.--the losses in battle contrasted with the losses in armies produced by--infectious diseases.--the development of knowledge of epidemics.--the views of hippocrates and aristotle.--sporadic and epidemic diseases.--the theory of the epidemic constitution.--theory that the contagious material is living.--the discovery of bacteria by loewenhoeck in .--the relation of contagion to the theory of spontaneous generation.--needham and spallanzani.--the discovery of the compound microscope in .--the proof that a living organism is the cause of a disease.--anthrax.--the discovery of the anthrax bacillus in .--the cultivation of the bacillus by koch.--the mode of infection.--the work of pasteur on anthrax.--the importance of the disease. these are diseases which are caused by living things which enter the tissues of the body and, living at the expense of the body, produce injury. such diseases play an important part in the life of man; the majority of deaths are caused directly or indirectly by infection. no other diseases have been so much studied, and in no other department of science has knowledge been capable of such direct application in promoting the health, the efficiency and the happiness of man. this knowledge has added years to the average length of life, it has rendered possible such great engineering works as the panama canal, and has contributed to the food supply by making habitation possible over large and productive regions of the earth, formerly uninhabitable owing to the prevalence of disease. it is not too much to say that our modern civilization is dependent upon this knowledge. the massing of the people in large cities, the factory life, the much greater social life, which are all prominent features of modern civilization, would be difficult or impossible without control of the infectious diseases. the rapidity of communication and the increased general movement of people, which have developed in equal ratio with the massing, would serve to extend widely every local outbreak of infection. the principles underlying fermentation and putrefaction which have been applied with great economic advantage to the preservation of food were many of them developed in the course of the study of the infectious diseases. whether the development of the present civilization is for the ultimate advantage of man may perhaps be disputed, but medicine has made it possible. the infectious diseases appearing in the form of great epidemics have been important factors in determining historical events, for they have led to the defeat of armies, the fall of cities and of nations. war is properly regarded as one of the greatest evils that can afflict a nation, since it destroys men in the bloom of youth, at the age of greatest service, and brings sorrow and care and poverty to many. but the most potent factor in the losses of war is not the deaths in battle but the deaths from disease. if we designate the lives lost in battle, the killed and the wounded who die, as , the loss of the german army from disease in - was . , that of the russians in - was . , that of the french in mexico was . , that of the french in the crimea . , that of the english in egypt . . the total loss of the german army in - from wounds and disease was , officers and men, and this seems a small number compared with the , deaths from smallpox in the same period in prussia alone. in the spanish american war there were , cases of typhoid fever with , deaths. in the south african war there were in the british troops , cases of typhoid with , deaths, and , deaths from other diseases while the loss in battle was , . the athenian plague which prevailed during the peloponnesian war, - b.c., not only caused the death of pericles, but according to thucydides a loss of , athenian soldiers, and brought about the downfall of the athenian hegemony in greece. in the crimean war between - , , english, , french and , russians died of typhus fever. the plague contributed as much as did the arms of the turks to the downfall of constantinople and the eastern empire in . it was the plague which in overthrew siena from her proud position as one of the first of the italian cities and the rival of florence, and broke the city forever, leaving it as a phantom of its former glory and prosperity. the work on the great cathedral which had progressed for ten years was suspended, and when it was resumed it was upon a scale adjusted to the diminished wealth of the city, and the plan restricted to the present dimensions. as a little relief to the darkness the same plague saw the birth of the novel in the tales of boccaccio, which were related to a delighted audience of the women who had fled from the plague in florence to a rural retreat. the knowledge which has come from the study of infectious disease has served also to broaden our conception of disease and has created preventive medicine; it has linked more closely to medicine such sciences as zoölogy and botany; it has given birth to the sciences of bacteriology and protozoölogy and in a way has brought all sciences more closely together. above all it has made medicine scientific, and never has knowledge obtained been more quickening and stimulating to its pursuit. although the dimensions of this book forbid much reference to the historical development of a subject, some mention must still be made of the development of knowledge of the infectious diseases. it was early recognized that there were diseases which differed in character from those generally prevalent; large numbers of people were affected in the same way; the disease beginning with a few cases gradually increased in intensity until an acme was reached which prevailed for a time and the disease gradually disappeared. such diseases were attributed to changes in the air, to the influence of planets or to the action of offended gods. the priests and charlatans who sought to excuse their inability to treat epidemics successfully were quick to affirm supernatural causes. hippocrates ( b.c.), with whom medicine may be said to begin, thought such diseases, even then called epidemics, were caused by the air; he says, "when many individuals are attacked by a disease at the same time, the cause must be sought in some agent which is common to all, something which everyone uses, and that is the air which must contain at this time something injurious." aristotle recognized that disease was often conveyed by contact, and varro ( - b.c.) advanced the idea that disease might be caused by minute organisms. he says, "certain minute organisms develop which the eye cannot see, and which being disseminated in the air enter into the body by means of the mouth and nostrils and give rise to serious ailments." in spite of this hypothesis, which has proved to be correct, the belief became general that epidemics were due to putrefaction of the air brought about by decaying animal bodies, (this explaining the frequent association of epidemics and wars,) by emanations from swamps, by periods of unusual heat, etc. with the continued study of epidemics the importance of contagion was recognized; it was found that epidemics differed in character and in the modes of extension. some seemed to extend by contact with the sick, and in others this seemed to play no part; it was further found impossible in many cases to show evidence of air contamination, and contamination of the air by putrefactive material did not always produce disease. most important was the recognition that single cases of diseases which often occurred in epidemic form might be present and no further extension follow; this led to the assumption in epidemics of the existence of some condition in addition to the cause, and which made the cause operative. in this way arose the theory of the epidemic constitution, a supposed peculiar condition of the body due to changes in the character of the air, or to the climate, or to changes in the interior of the earth as shown by earthquakes, or to the movements of planets; in consequence of this peculiar constitution there was a greater susceptibility to disease, but the direct cause might arise in the interior of the body or enter the body from without. the character of the disease which appeared in epidemic form, the "genius epidemicus," was determined not by differences in the intrinsic cause, but by the type of constitution which prevailed at that time. the first epidemic of cholera which visited europe in - was for the most part referred to the existence of a peculiar epidemic constitution for which various causes were assigned. it was only when the second epidemic of this disease appeared in that the existence of some special virus or poison which entered the body was assumed. meanwhile, by the study of the material of disease knowledge was being slowly acquired which had much bearing on the causes. the first observations which tended to show that the causes were living were made by a learned jesuit, athanasius, in . he found in milk, cheese, vinegar, decayed vegetables, and in the blood and secretions of cases of plague bodies, which he described as tiny worms and which he thought were due to putrefaction. he studied these objects with the simple lenses in use at that time, and there is little doubt that he did see certain of the larger organisms which are present in vinegar, cheese and decaying vegetables, and it is not impossible that he may have seen the animal and vegetable cells. the first description of bacteria with illustrations showing their forms was given by loewenhoeck, a linen dealer in amsterdam in . the fineness of the linen being determined by the number of threads in a given area, it is necessary to examine it with a magnifying lens, and he succeeded in perfecting a simple lens with which objects smaller than had been seen up to that time became visible. it must be added that he was probably endowed with very unusual acuteness of vision. he found in a drop of water, in the fluid in the intestines of frogs and birds, and in his evacuations, objects of great minuteness which differed from each other in form and size and in the peculiar motion which some of them possessed. in the year he presented to the royal society of london a paper describing a certain minute organism which he found in the tartar of his teeth. after these observations of loewenhoeck became known to the world they quickly found application in disease, although the author had expressed himself very cautiously in this regard. the strongest exponent of the view of a living contagion was plenciz, , a physician of vienna, basing his belief not only on the demonstration of minute organisms by loewenhoeck which he was able to verify, but on certain shrewdly conceived theoretical considerations. he was the first to recognize the specificity of the epidemic diseases, and argued from this that each disease must have a specific cause. "just as a certain plant comes from the seed of the same plant and not from any plant at will, so each contagious disease must be propagated from a similar disease and cannot be the result of any other disease." further he says, "it is necessary to assume that during the prevalence of an epidemic the contagious material undergoes an enormous increase, and this is compatible only with the assumption that it is a living substance." but as is so often the case, speculation ran far ahead of the observations on which it is based. there was a long gap between the observations of loewenhoeck and the theories of plenciz, justified as these have been by present knowledge. in the spirit of speculation which was dominant in europe and particularly in germany in the latter half of the eighteenth and the first half of the nineteenth centuries, hypotheses did not stimulate research, but led to further speculations. as late as ozanam expressed himself as follows: "many authors have written concerning the animal nature of the contagion of disease; many have assumed it to be developed from animal substance, and that it is itself animal and possesses the property of life. i shall not waste time in refuting these absurd hypotheses." the theory of a living contagion was too simple, and not sufficiently related to the problems of the universe to serve the medical philosophers. knowledge of the minute organisms was slowly accumulating. the first questions to be determined were as to their nature and origin. how were they produced? did they come from bodies of the same sort according to the general laws governing the production of living things, or did they arise spontaneously? a question which could not be solved by speculation but by experiment. the first experiments, by needham, , pointed to the spontaneous origin of the organisms. he enclosed various substances in carefully sealed watch crystals from which the air was excluded, and found that animalculi appeared in the substance, and argued from this that they developed spontaneously. in , spallanzani, a skilled experimental physiologist, in a brilliant series of experiments showed the imperfect character of needham's work and the fallacy of his conclusions. spallanzani placed fluids, which easily became putrid, in glass tubes, which he then hermetically sealed and boiled. he found that the fluid remained clear and unchanged; if, however, he broke the sealed point of such a tube and allowed the air to enter, putrefaction, or in some cases fermentation, of the contents took place. he concluded that boiling the substances destroyed the living germs which they contained, the sealed tubes prevented the air from entering, and when putrefaction or fermentation of the contents took place the organisms to which this was due, being contained in the air, entered from without. objection was made to the conclusions of spallanzani that heating the air in the closed tubes so changed its character as to prevent development of organisms in the contents. this objection was finally set aside by pasteur, who showed that it was not necessary to seal the end of the tube before boiling, but it could be closed by a plug of cotton wool, which mechanically removed the organisms from the air which entered the tube, or if the tube were bent in the shape of a _u_ and the end left open, organisms from the air could not pass into the tube against gravity when air movement within the tube was prevented by bending. the possibility of spontaneous generation cannot be denied, but that it takes place is against all human experience. it was not possible to attain any considerable knowledge of the bacteria discovered by loewenhoeck until more perfect instruments for studying them were devised. lenses for studying objects were used in remote antiquity, but the compound microscope in which the image made by the lens is further magnified was not discovered until , and when first made was so imperfect that the best simple lenses gave clearer definition. with the betterment of the microscope, increasing the magnifying power and the sharpness of the image of the object seen, it became possible to classify the minute organisms according to size and form and to study the separate species. the microscope has now reached such a degree of perfection that objects smaller than one one hundred thousandth of an inch in diameter can be clearly seen and photographed. great impetus was given to the biological investigation of disease by the discoveries which led to the formulation of the cell theory in and the brilliant work of pasteur on fermentation,[ ] but it was not until that it was definitely proved that a disease of cattle called anthrax was due to a species of bacteria. what should be regarded as such proof had been formulated by henle in . to prove that a certain sort of organism when found associated with a disease is the cause of the disease, three things are necessary: . the organism must always be found in the diseased animal and associated with the changes produced by the disease. . the organism so found must be grown outside of the body in what is termed pure cultures, that is, not associated with any other organisms, and for so long a time with constant transfers or new seedings that there can be no admixture of other products of the disease in the material in which it is grown. . the disease must be produced by inoculating a susceptible animal with a small portion of such a culture, and the organism shown in relation to the lesions so produced. it is worth while to devote some attention to the disease anthrax. this occupies a unique position, in that it was the first of the infectious diseases to be scientifically investigated. in this investigation one fact after another was discovered and confirmed; some of these facts seemed to give clearer conceptions of the disease, others served to make it more obscure; new questions arose with each extension of knowledge; in the course of the work new methods of investigation were discovered; the sides of the arch were slowly and painfully erected by the work of many men, and finally one man placed the keystone and anthrax was for a long time the best known of diseases. men whose reputation is now worldwide first became known by their work in this disease. it was a favorable disease for investigation, being a disease primarily of cattle, but occasionally appearing in man, and the susceptibility of laboratory animals made possible experimental study. anthrax is a disease of domestic cattle affecting particularly bovine cattle, horses and sheep, swine more rarely. the disease exists in practically all countries and has caused great economic losses. there are no characteristic symptoms of the disease; the affected cattle have high fever, refuse to eat, their pulse and respiration are rapid, they become progressively weaker, unable to walk and finally fall. the disease lasts a variable time; in the most acute cases animals may die in less than twenty-four hours, or the disease may last ten or fourteen days; recovery from the disease is rare and treatment has no effect. it does not appear in the form of epidemics, but single cases appear frequently or rarely, and there is seemingly no extension from case to case, animals in adjoining stalls to the sick are not more prone to infection than others of the herd. on examination after death the blood is dark and fluid, the spleen is greatly enlarged (one of the names of the disease "splenic fever" indicates the relation to the spleen) and there is often bloody fluid in the tissues. where the disease is prevalent there are numbers of human cases. only those become infected who come into close relations with cattle, the infection most commonly taking place from small wounds or scratches made in skinning dead cattle or in handling hides. the wool of sheep who die of the disease finds its way into commerce, and those employed in handling the wool have a form of anthrax known as wool-sorters' disease in which lesions are found in the lungs, the organisms being mingled with the wool dust and inspired. in boston occasional cases of anthrax appear in teamsters who are employed in handling and carrying hides. the disease in man is not so fatal as in cattle, for it remains local for a time at the site of infection, and this local disease can be successfully treated. the beginning of our knowledge of the cause dates from , when small rod-shaped bodies (fig. ) were found in the blood of the affected cattle, and by the work of a number of observers it was established that these bodies were constantly present. nothing was known of their nature; some held that they were living organisms, others that they were formed in the body as a result of the disease. next the causal relation of these bodies with the disease was shown and in several ways. the disease could be caused in other cattle by injecting blood containing the rods beneath the skin, certainly no proof, for the blood might have contained in addition to the rods something which was the real cause of the disease. next it was shown that the blood of the unborn calf of a cow who died of the disease did not contain the rods, and the disease could not be produced by inoculating with the calf's blood although the blood of the mother was infectious. this was a very strong indication that the rods were the cause; the maternal and foetal blood are separated by a membrane through which fluids and substances in solution pass; but insoluble substances, even when very minutely subdivided, do not pass the membrane. if the cause were a poison in solution, the foetal blood would have been as toxic as the maternal. the blood of infected cattle was filtered through filters made of unbaked porcelain and having very fine pores which allowed only the blood fluid to pass, holding back both the blood corpuscles and the rods, and such filtered blood was found to be innocuous. it was further shown that the rods increased enormously in number in the infected animal, for the blood contained them in great numbers when but a fraction of a drop was used for inoculation. attempts were also made with a greater or less degree of success to grow the rod shaped organisms or bacilli in various fluids, and the characteristic disease was produced by inoculating animals with these cultures; but it remained for koch, , who was at that time an obscure young country physician, to show the life history of the organism and to clear up the obscurity of the disease. up to that time, although it had been shown that the rods or bacilli contained in the blood were living organisms and the cause of the disease, this did not explain the mode of infection; how the organisms contained in the blood passed to another animal, why the disease occurred on certain farms and the adjoining farms, particularly if they lay higher, were free. koch showed that in the cultures the organisms grew out into long interlacing threads, and that in these threads spores which were very difficult to destroy developed at intervals; that the organisms grew easily in bouillon, in milk, in blood, and even in an infusion of hay made by soaking this in water. this explained, what had been an enigma before, how the fields became sources of infection. the infection did not spread from animal to animal by contact, but infection took place from eating grass or hay which contained either the bacilli or their spores. when a dead animal was skinned on the field, the bacilli contained in the blood escaped and became mingled with the various fluids which flowed from the body and in which they grew and developed spores. it was shown by pasteur that even when a carcass was buried the earthworms brought spores developed in the body to the surface and deposited them in their casts, and in this way also the fields became infected. from such a spot of infected earth the spores could be washed by the rains over greater areas and would find opportunity to develop further and form new spores in puddles of water left on the fields, which became a culture medium by the soaking of the dead grass. the contamination of the fields was also brought about by spreading over them the accumulations of stable manure which contained the discharges of the sick cattle. the tendency of the disease to extend to lower-lying adjacent fields was due to the spores being washed from the upper fields to the lower by the spring freshets. meanwhile pasteur had discovered that by growing the organisms at higher temperatures than the animal body, it was possible to attenuate the virulence of the bacilli so that inoculations with these produced a mild form of the disease which rendered the inoculated animals immune to the fatal disease. the description of pasteur's work on the disease as given in the account of his life by his son-in-law is fascinating. hides and wool taken from dead animals invariably contained the spores which could pass unharmed through some of the curing processes, and were responsible for some of the cases in man. owing to the introduction of regulations which were based on the knowledge of the cause of the disease and the life history of the organism, together with the prophylactic inoculation devised by pasteur, the incidence of the disease has been very greatly lessened. looking at the matter from the lowest point of view, the money which has been saved by the control of the disease, as shown in its decline, has been many times the cost of all the work of the investigations which made the control possible. it is a greater satisfaction to know that many human lives have been saved, and that small farmers and shepherds have been the chief sharers in the economic benefits. the indirect benefits, however, which have resulted from the application of the knowledge of this disease, and the methods of investigation developed here, to the study of the infections more peculiar to man, are very much greater. footnote: [ ] the interesting analogy between fermentation and infectious disease did not escape attention. a clear fluid containing in solution sugar and other constituents necessary for the life of the yeast cells will remain clear provided all living things within it have been destroyed and those in the air prevented from entering. if it be inoculated with a minute fragment of yeast culture containing a few yeast cells, for a time no change takes place; but gradually the fluid becomes cloudy, bubbles of gas appear in it and its taste changes. finally it again becomes clear, a sediment forms at the bottom, and on re-inoculating it with yeast culture no fermentation takes place. the analogy is obvious, the fluid in the first instance corresponds with an individual susceptible to the disease, the inoculated yeast to the contagion from a case of transmissible disease, the fermentation to the illness with fever, etc., which constitutes the disease, the returning clearness of the fluid to the recovery, and like the fermenting fluid the individual is not susceptible to a new attack of the disease. it will be observed that during the process both the yeast and the material which produced the disease have enormously increased. fermentation of immense quantities of fluid could be produced by the sediment of yeast cells at the bottom of the vessel and a single case of smallpox would be capable of infecting multitudes. chapter vi classification of the organisms which cause disease.--bacteria: size, shape, structure, capacity for growth, multiplication and spore formation.--the artificial cultivation of bacteria.--the importance of bacteria in nature.--variations in bacteria.--saprophytic and parasitic forms.--protozoa.--structure more complicated than that of bacteria.--distribution in nature.--growth and multiplication.-- conjugation and sexual reproduction.--spore formation.--the necessity for a fluid environment.--the food of protozoa.--parasitism.--the ultra-microscopic or filterable--organisms.--the limitation of the microscope.--porcelain filters to separate organisms from a fluid.-- foot and mouth disease produced by an ultra-microscopic organism.-- other diseases so produced.--do new diseases appear? the living organisms which cause the infectious diseases are classified under bacteria, protozoa, yeasts, moulds, and ultra-microscopic organisms. it is necessary to place in a separate class the organisms whose existence is known, but which are not visible under the highest powers of the microscope, and have not been classified. the yeasts and moulds play a minor part in the production of disease and cannot be considered in the necessary limitation of space. [illustration: fig. .--various forms of bacteria, _a_, _b_, _c_, _d_, round bacteria or cocci: (_a_) staphylococci, organisms which occur in groups and a common cause of boils; (_b_) streptococci, organisms which occur in chains and produce erysipelas and more severe forms of inflammation; (_c_) diplococci, or paired organisms with a capsule, which cause acute pneumonia; (_d_) gonococci, with the opposed surfaces flattened, which cause gonorrhoea. _e_, _f_, _g_, _h_, rod-shaped bacteria or bacilli: (_e_) diphtheria bacilli; (_f_) tubercle bacilli; (_g_) anthrax bacilli; (_h_) the same bacilli in cultures and producing spores; a small group of spores is shown. (_i_) cholera spirillæ. (_j_) typhoid bacilli. (_k_) tetanus bacillus; _i_, _j_, _k_ are actively motile, motion being effected by the small attached threads. (_l_) the screw-shaped spirochite which is the cause of syphilis.] the bacteria (fig. ) are unicellular organisms and vary greatly in size, shape and capacity of growth. the smallest of the pathogenic or disease-producing bacteria is the influenza bacillus, / of an inch in length and / of an inch in thickness; and among the largest is a bacillus causing an animal disease which is / of an inch in length and / of an inch in diameter. among the free-living non-pathogenic forms much larger examples are found. in shape bacteria are round, or rod-shaped, or spiral; the round forms are called micrococci, the rod-shaped bacilli and the spiral forms are called spirilli. a clearer idea of the size is possibly given by the calculation that a drop of water would contain one billion micrococci of the usual size. their structure in a general way conforms with that of other cells. on the outside is a cell membrane which encloses cytoplasm and nucleus; the latter, however, is not in a single mass, but the nuclear material is distributed through the cell. many of the bacteria have the power of motion, this being effected by small hair-like appendages or flagellæ which may be numerous, projecting from all parts of the organisms or from one or both ends, the movement being produced by rapid lashing of these hairs. a bacterium grows until it attains the size of the species, when it divides by simple cleavage at right angles to the long axis forming two individuals. in some of the spherical forms division takes place alternately in two planes, and not infrequently the single individuals adhere, forming figures of long threads or chains or double forms. the rate of growth varies with the species and with the environment, and under the best conditions may be very rapid. a generation, that is, the interval between divisions, has been seen to take place in twenty minutes. at this rate of growth from a single cholera bacillus sixteen quadrillion might arise in a single day. such a rate of growth is extremely improbable under either natural or artificial conditions, both from lack of food and from the accumulation in the fluid of waste products which check growth. many species of bacteria in addition to this simple mode of multiplication form spores which are in a way analogous to the seeds of higher plants and are much more resistant than the simple or vegetative forms; they endure boiling water and even higher degrees of dry heat for a considerable time before they are destroyed. when these spores are placed in conditions favorable for bacterial life, the bacterial cells grow out from them and the usual mode of multiplication continues. this capacity for spore formation is of great importance, and until it was discovered by cohn in , many of the conditions of disease and putrefaction could not be explained. spores, as the seeds of plants, often seem to be produced when the conditions are unfavorable; the bacterium then changes into this form, which under natural conditions is almost indestructible and awaits better days. the bacteria are divided into species, the classification being based on their forms, on the mode of growth, the various substances which they produce and their capacity for producing disease. the differentiation of species in bacteria is based chiefly upon their properties, there being too little difference in form and size to distinguish species. the introduction of methods of culture was followed by an immediate advance of our knowledge concerning them. this method consists in the use of fluid and solid substances which contain the necessary salts and other ingredients for their food, and in or on which they are planted. the use of a solid or gelatinous medium for growth has greatly facilitated the separation of single species from a mixture of bacteria; a culture fluid containing sufficient gelatine to render it solid when cooled is sown with the bacteria to be tested by placing in it while warm and fluid, a small portion of material containing the bacteria, and after being thoroughly mixed the fluid is poured on a glass plate and allowed to cool. the bacteria are in this way separated, and each by its growth forms a single colony which can be further tested. it is self-evident that all culture material must be sterilized by heat before using, and in the manipulations care must be exercised to avoid contamination from the air. the refraction index of the bacterial cell is so slight that the microscopic study is facilitated or made possible by staining them with various aniline dyes. owing to differences in the cell material the different species of bacteria show differences in the facility with which they take the color and the tenacity with which they retain it, and this also forms a means of species differentiation. the interrelation of science is well shown in this, for it was the discovery of the aniline dyes in the latter half of the nineteenth century which made the fruitful study of bacteria possible. from the simplicity of structure it is not improbable that the bacteria are among the oldest forms of life, and all life has become adapted to their presence. they are of universal distribution; they play such an important part in the inter-relations of living things that it is probable life could not continue without them, at least not in the present way. they form important food for other unicellular organisms which are important links in the chain; they are the agents of decomposition, by which the complex substances of living things are reduced to elementary substances and made available for use; without them plant life would be impossible, for it is by their instrumentality that material in the soil is so changed as to be available as plant food; by their action many of the important foods of man, often those especially delectable, are produced; they are constantly with us on all the surfaces of the body; masses live on the intestinal surfaces and the excrement is largely composed of bacteria. it has been said that life would be impossible without bacteria, for the accumulation of the carcasses of all animals which have died would so encumber the earth as to prevent its use; but the folly of such speculation is shown by the fact that animals would not have been there without bacteria. it has been shown, however, that the presence of bacteria in the intestine of the higher animals is not essential for life. the coldest parts of the ocean are free from those forms which live in the intestines, and fish and birds inhabiting these regions have been found free from bacteria; it has also been found possible to remove small animals from their mother by cæsarian section and to rear them for a few weeks on sterilized food, showing that digestion and nutrition may go on without bacteria. certain species of bacteria are aërobic, that is, they need free oxygen for their growth; others are anaërobic and will not grow in the presence of oxygen. most of the bacteria which produce disease are facultative, that is, they grow either with or without oxygen; but certain of them, as the bacillus of tetanus, are anaërobic. there is, of course, abundance of oxygen in the blood and tissues, but it is so combined as to be unavailable for the bacteria. bacteria may further be divided into those which are saprophytic or which find favorable conditions for life outside of the body, and the parasitic. many are exclusively parasitic or saprophytic, and many are facultative, both conditions of living being possible. it has been found possible by varying in many ways the character of the culture medium and temperature to grow under artificial conditions outside of the body most, if not all, of the bacteria which cause disease. thus, such bacteria as tubercle bacilli and the influenza bacillus can be cultivated, but they certainly would not find natural conditions which would make saprophytic growth possible. bacteria may be very sensitive to the presence of certain substances in the fluid in which they are growing. growth may be inhibited by the smallest trace of some of the metallic salts, as corrosive sublimate, although the bacteria themselves are not destroyed. if small pieces of gold foil be placed on the surface of prepared jelly on which bacteria have been planted, no growth will take place in the vicinity of the gold foil. variations can easily be produced in bacteria, but they do not tend to become established. in certain of the bacterial species there are strains which represent slight variations from the type but which are not sufficient to constitute new species. if the environment in which bacteria are living be unusual and to a greater or less degree unfavorable, those individuals in the mass with the least power of adaptibility will perish, those more resistant and with greater adaptability will survive and propagate; and the peculiarity being transmitted a new strain will arise characterized by this adaptability. bacteria with slight adaptability to the environment of the tissues and fluids of the animal body can, by repeated inoculations, become so adapted to the new environment as to be in a high degree pathogenic. in such a process the organisms with the least power of adaptation are destroyed and new generations are formed from those of greater power of adaptation. when bacteria are caused to grow in a new environment they may acquire new characteristics. the anthrax bacilli find the optimum conditions for growth at the temperature of the animal body, but they will grow at temperatures both above and below this. pasteur found that by gradually increasing the temperature they could be grown at one hundred and ten degrees. when grown at this temperature they were no longer so virulent and produced in animals a mild non-fatal form of anthrax which protected the animal when inoculated with the virulent strain. the well known variations in the character of disease, shown in differences in severity and ease of transmission, seen in different years and in different epidemics, may be due to many conditions, but probably variation in the infecting organisms is the most important. the protozoa, like the bacteria, are unicellular organisms and contain a nucleus as do all cells. they vary in size from forms seen with difficulty under the highest power of the microscope to forms readily seen with the unaided eye. their structure in general is more complex than is the structure of bacteria, and many show extreme differentiation of parts of the single cells, as a firm exterior surface or cuticle, an internal skeleton, organs of locomotion, mouth and digestive organs and organs of excretion. they are more widely distributed than are the bacteria, and found from pole to pole in all oceans and in all fresh water. there are many modes of multiplication, and these are often extremely complicated. the most general mode and one which is common to all is by simple division; a modification of this is by budding in which projections or buds form on the body and after separation become new organisms. in other cases spores form within the cell which become free and develop further into complete organisms. these simple modes of multiplication often alternate in the same organism with sexual differentiation and conjugation. there is never a permanent sexual differentiation, but the sexual forms develop from a simple and non-sexual organism. usually the sexual forms develop only in a special environment; thus the protozoon which in man is the cause of malaria, multiplies in the human blood by simple division, but in the body of the mosquito multiplication by sexual differentiation takes place. under no conditions is multiplication so rapid as with the bacteria, and in general the simpler the form of organism the more rapid is the multiplication. it is common to all of the protozoa to develop forms which have great powers of resistance, this being due in some cases to encystment, in which condition a resistant membrane is formed on the outside, in others to the production of spores. a fluid environment is essential to the life of the protozoa, but the resistant forms can endure long periods of dryness or other unfavorable environmental conditions. the universal distribution of the protozoa is due to this; the spores or cysts can be carried long distances by the wind and develop into active forms when they reach an environment which is favorable. their distribution in water depends upon the amount of organic material this contains. in pure drinking water there may be very few, but in stagnant water they are very numerous, living not on the organic material in solution in this, but on the bacteria which find in such fluid favorable conditions for existence. the food of protozoa consists chiefly of other organisms, particularly bacteria, and they are classed with the animals. the protozoa are the most widely distributed and the most universal of the parasites. the infectious diseases which they produce in man, although among the most serious are less in number than those produced by bacteria. so marked is the tendency to parasitism that they are often parasitic for each other, smaller forms entering into and living upon the larger. variation does not seem to be so marked in the protozoa as in the bacteria, though this is possibly due to our greater ignorance of them as a class. we are not able, except in rare instances, to grow them in pure culture, and study innumerable generations under changes in the environment, as the bacteria have been studied. if we regard the living things on earth from the narrow point of view as to whether they are necessary or useless or hostile to man, the protozoa must be regarded as about the least useful members of the biological society. it is very possible that such a conclusion is due to ignorance; so closely are all living things united, so dependent is one form of cell activity upon other forms that it is impossible to foretell the result of the removal of a link. the protozoa do not seem to be as necessary for the life of man as are the bacteria; they produce many of the diseases of man, many of the diseases of animals on which man depends for food; they cause great destruction in plant life, and in the soil they feed upon the useful bacteria. it is well to remember, however, that fifty years ago several of the organs of the body whose activity we now recognize as furnishing substances necessary for life were regarded as useless members and, since they became the seat of tumors, as dangerous members of the body. the only organ which now seems to come into such a class is the vermiform appendix, and its lowly position among organs is due merely to an unhappy accident of development. the class of organisms known as the filterable viruses or the ultra-microscopic or the invisible organisms have a special interest in many ways. the limitation in the power of the microscope for the study of minute objects is due not to a defect in the instrument but to the length of the wave of light. it is impossible to see clearly under the microscope using white light, objects which are smaller in diameter than the length of the wave which gives a limit of . µ. or / , of an inch. by using waves of shorter length, as the ultra-violet light, objects of . µ. or / of an inch can be seen; but as these methods depend upon photography for the demonstration of the object the study is difficult. the presence of objects still smaller than . m. can be detected in a fluid by the use of the dark field illumination and the ultra-microscope, the principle of which is the direction of a powerful oblique ray of light into the field of the microscope. the objects are not visible as such, but the dispersion of the light by their presence is seen. the demonstration that infectious diseases were produced by organisms so small as to be beyond demonstration with the best microscopes was made possible by showing, that some fluid from a diseased animal was infectious; and capable of producing the disease when inoculated into a susceptible animal. the fluid was then filtered through porcelain filters which were known to hold back all objects of the size of the smallest bacteria and the disease produced by inoculating with the clear filtrate. there are a number of such filters of different degrees of porosity manufactured, and they are often used to procure pure water for drinking, for which use they are more or less, generally however, less efficacious. the filter has the form of a hollow cylinder and the liquid to be filtered is forced through it under pressure. for domestic use the filter is attached by its open end to the water tap and the pressure from the mains forces the water through it. in laboratory uses, denser filters of smaller diameters are used, and the filter is surrounded by the fluid to be tested. the open end of the filter passes into a vessel from which the air is exhausted and filtration takes place from without inward. the test of the effectiveness of the filter is made by adding to the filtering fluid some very minute and easily recognizable bacteria and testing the filtrate for their presence. these filters have been studied microscopically by grinding very thin sections and measuring the diameter of the spaces in the material. these are very numerous, and from / to / of an inch in diameter, spaces which would allow bacteria to pass through, but they are held back by the very fine openings between the spaces and by the tortuosity of the intercommunications. when the coarser of such filters have been long in domestic service in filtering drinking water, bacteria may grow in and through them giving greater bacterial content to the supposed bacteria-free filtrate than in the filtering water. that an animal disease was due to such a minute and filterable organism was first shown by loeffler in for the foot and mouth disease of cattle. this is one of the most infectious and easily communicable diseases. the lesions of the disease take the form of blisters which form on the lips and feet and in the mouths of cattle, and inoculation with minute quantities of the fluid in the blisters produces the disease. loeffler filtered the fluid through porcelain filters, hoping to obtain a material which inoculated into other cattle would render them immune, and to his surprise found that the typical disease was produced by inoculating with the filtrate. naturally the first idea was that the disease was caused by some soluble poison and not by a living organism, but this was disproved in a number of ways. the most powerful poison known is obtained from cultures of the tetanus bacillus of which . , , of a gram (one gram is . grains) kills a mouse, or one gram kills ten million mice. loeffler found that / gram of the contents of the vesicles killed a calf of two hundred kilograms weight, and assuming that the essential poison was present in the fluid in one part to five hundred it would be several hundred times more powerful than the tetanus poison. further, the disease produced by inoculation of the filtrate was itself inoculable and could be transmitted from animal to animal. it was also found that when the virus was filtered several times it ceased to be inoculable, showing that each time the fluid was passed through the filter some of the minute organisms contained in it were held back. it is not known whether these organisms belong to the bacteria or protozoa, and naturally nothing is known as to their form, size and structure. up to the present about twenty diseases are known to be due to a filterable virus, and among these are some of the most important for animals and for man. among the human diseases, yellow fever, poliomyelitis, and dengue are so produced; of the animal diseases in addition to foot and mouth disease, pleuropneumonia, cattle plague, african horse sickness, several diseases of fowls and the mosaic disease of the tobacco plant have all been shown to be due to a filterable virus. of these organisms the largest is that which produces pleuropneumonia in cattle, and this alone has been cultivated. it gives a slight opacity to the culture fluids, and when magnified two thousand diameters appears as a minute spiral or round or stellate organism having a variety of forms. its size is such that it passes the coarse, but is held back by the finer, filters and it is possible that this does not belong to the same class with the others.[ ] the diseases produced by the filterable viruses taken as a class show much similarity. they run an acute course, are severe, and the immunity produced by the attack endures for a long time. considered in its biological relations, infection is the adaptation of an organism to the environment which the body of the host offers. it is rather singular that variations in organisms represented by such adaptation do not more frequently arise, in which case new diseases would frequently occur. it cannot be denied that new diseases appear, but there is no certain evidence that they do, and there is equally no evidence that diseases disappear. from the meagre descriptions of diseases, usually of the epidemic type, which have come down to us from the past, it is difficult to recognize many of the diseases described. the single diseases are recognized by comparing the causes, the lesions and the symptoms with those of other diseases, and new diseases are constantly being separated off from other diseases having more or less common features. many new diseases have been recognized and named, but it is always more than probable that previously they were confounded with other diseases. smallpox is such a characteristic disease that one would think it would have been recognized as an entity from the beginning, but although the description of some of the epidemics in remote times conform more or less to the disease as we know it, the first accurate description is in the eighth century by the arabian physician rhazes. cerebro-spinal meningitis was not recognized as a separate disease until , diphtheria not until , and the separation between typhoid and typhus fever was not made before . nor is it sure that any diseases have disappeared, although there seems to have been a change in the character of many. it is difficult to reconcile leprosy as it appears now with the universal horror felt towards it, due to the persistence of the old traditions. it is possible, however, that the disease has not changed its character, but that such diseases as smallpox, syphilis, and certain forms of tuberculosis were formerly confounded with leprosy, thus giving a false idea of its prevalence. in certain cases the adaptation of the organism is for a narrow environment; for example, the parasitism may extend to a simple species only, in others the adaptation may extend to a number of genera. in certain cases the adaptation is mutual, extending to both parasite and host and resulting in symbiosis, and this condition may be advantageous for both. certain of the protozoa harbor within them cells of algæ utilizing to their own advantage the green chlorophil of the algæ in obtaining energy from sunlight and in turn giving sustenance to the algæ. although the algæ are useful guests, when they become too numerous the protozoan devours them. it is evident that symbiosis is the most favorable condition for the existence of the parasite, and an injurious action exerted by the parasite on the host unfavorable. the death of the host is an unfortunate incident from the parasite's point of view in that it is deprived of habitation and food supply, being placed in the same unfortunate situation as may befall a social parasite by the death of his host. footnote: [ ] flexner has recently succeeded in isolating and cultivating the organism of poliomyelitis, but the organism is so small that its classification is not possible. chapter vii the nature of infection.--the invasion of the body from its surfaces.--the protection of these surfaces.--can bacteria pass through an uninjured surface.--infection from wounds.--the wounds in modern warfare less prone to infection.--the relation of tetanus to wounds caused by the toy pistol.--the primary focus or atrium of infection.--the dissemination of bacteria in the body.--the different degrees of resistance to bacteria shown by the various organs.--mode of action of bacteria.--toxin production.--the resistance of the body to bacteria.--conflict between parasite and host.--on both sides means of offense and defense.--phagocytosis.--the destruction of bacteria by the blood.--the toxic bacterial diseases.--toxin and antitoxin.--immunity.--the theory of ehrlich. as has been said, infection consists in the injury of the body by living organisms which enter it. the body is in relation to the external world by its surfaces only, and organisms must enter it by some one of these surfaces. it is true that the bacteria in the intestine--either those normally present or unusual varieties--may, under certain circumstances, produce substances which are injurious when absorbed; but this is not infection, and is analogous to any other sort of poisoning. each surface of the body has its own bacterial flora. organisms live on the surface either on matter which is secreted by the surface or they use up an inappreciable amount of body material. many of these bacteria are harmless, some are protective, producing by their growth such changes in the surface fluids that these become hostile to the existence of other and pathogenic forms. the surfaces also frequently harbor pathogenic organisms which await some condition to arise which will permit them to effect entrance into the tissues. the surfaces of the body protect from invasion to a greater or less degree. the skin protects by the impervious horny layer on the outside, the external cells of which are dead and constantly being thrown off. bacteria are always found on and in this layer, but the conditions for growth here are not very favorable and the surface is constantly cleansed by desquamation. the new cells to supply the loss are produced in the deepest layer of the epidermis, and the movement of cells and fluids takes place from within outwards. the protection is less perfect about the hairs and the sweat glands. infection by the route of the sweat glands is, however, uncommon, for the sweat is a fluid unfavorable for bacterial growth and the flow acts mechanically in washing away organisms which may have entered the ducts. infection by the route of the hair follicles is common. there is no mechanical cleansing as by the sweat, the space around the hair is large and the accumulated secretion of the hair glands and the desquamated cells furnish a material in which bacteria may grow. growing as a mass in this situation, they may produce sufficient toxic material to destroy adjacent living cells and thus effect entrance. infection from the eye is not common, the surface, though moist, is smooth; the eyelashes around the margin of the lids give some mechanical protection from the entrance of bacteria contained in dust, and the movements of the lids and the constant and easily accelerated secretion of tears act mechanically in removing foreign substances. it is possible that the mechanical cleansing of the skin by the daily bath may have some action in preventing infection. the internal surfaces are much more exposed to attack and the protection is not so efficient. the moisture of these surfaces is both a protection and a source of danger. it protects by favoring the lodgment near the orifices of organisms which are in the inspired air, for when bacteria touch a moist surface they cannot be raised from this and carried further by air currents. the moisture is a source of danger in that it favors the growth of bacteria which lodge on the surface. the respiratory surface which is most exposed to infection from the air is further protected by the cilia, which are fine hair-like processes covering the cells of the surface and which by their constant motion sweep out fine particles of all sorts which lodge upon them. the cavity of the mouth harbors large numbers of organisms, many of them pathogenic. it forms a depot from which bacteria may pass to communicating surfaces and infection from these may result. food particles collect in the mouth and provide culture material, and there are many crypts and irregularities of surface which oppose mechanical cleaning. infection of the middle ear, the most common cause of deafness, takes place by means of the eustachian tube which connects the cavity of the ear with the mouth. organisms from the mouth can extend into the various large salivary glands by means of the ducts and give rise to infections. the tonsils, particularly in children, provide a favorable surface for infection. the mucous surface extends into these forming deep pockets lined with very thin epithelium, and in these débris of all sorts accumulates and provides material favorable for bacterial growth. the lungs at first sight seem to offer the most favorable surface for infection. the surface, ninety-seven square yards, is enormous; it is moist, the epithelial covering is so thin as to give practically no mechanical protection, large amounts of air constantly pass in and out, and the surface is in contact with this. they are protected from infection in many ways. the tubes or bronchi by which the air passes into and from the lungs are covered with cilia; the surface area of these tubes constantly enlarges as they branch, the sum of the diameters of the small tubes being many times greater than that of the windpipe, and this enlargement by retarding the motion of the air favors the lodgment of particles on the surface whence they are removed by the action of the cilia. the entering air is also brought closely in contact with a moist surface at the narrow opening of the larynx. that bacteria and other foreign substances can enter the lungs in spite of these guards is shown not only by the infections which take place here, but also by the large amount of black carbon deposited in them from the soot contained in the air. infection rarely takes place from the surface of the gullet or oesophagus which leads from the mouth to the stomach. this is due to the smoothness of the surface and to the rapidity with which food passes over it. infection by the stomach also is rare, for this contains a strong acid secretion which destroys many of the bacteria which are taken in with the food. it is found impossible to infect animals with cholera unless the acidity of the stomach contents be neutralized by an alkali. many organisms, although their growth in the stomach is inhibited, are not destroyed there and pass into the intestines, where the conditions for infection are more favorable. this large and very irregular surface is bathed in fluid which is a good culture medium and but a single layer of cells covers it. the organisms which cause many of the infectious diseases in both man and animals find entrance by means of the alimentary canal, as cholera, dysentery, typhoid fever, chicken cholera, hog cholera. infection by the genito-urinary surface is comparatively rare. the surface openings are usually closed, and the discharge of urine has a mechanical cleansing effect. the wide tube of the vagina is further protected by a normal bacterial flora which produces conditions hostile to other and pathogenic bacteria. the most common infections are the sexual diseases, which are due to organisms which find favorable conditions for growth in and on the surface and which are conveyed from a similar surface by sexual contact. it remains a question whether bacteria can penetrate an intact surface producing no injury at the point of entrance and be carried by the lymph or blood into internal organs where they produce disease. internal infections are often found with seemingly intact body surfaces, but it is impossible to exclude the presence of minute or microscopic surface injuries by which the organisms may have entered. it is also possible that a slight injury at the point of entrance may heal so completely as to leave no trace. the chief danger from wounds is that their surfaces may become infected. death from wounds is due more frequently to infection than to the actual injury represented by the wounds. much depends upon the character of the wound. infection of clean wounds which are made by a sharp cutting instrument and from which there is abundant hæmorrhage with sealing of the edges of the wound by clotted blood, rarely happens. typical wounds of this sort are often made in shaving, and infection of such wounds is extraordinarily rare. if, with the wound, pathogenic organisms are placed in the tissue, or foreign substances such as bits of clothing are carried in with a bullet, for example, or if the instrument causing the wound be of such a character as to produce extensive lacerations of tissue, infection is more apt to occur. the less frequency of infection in modern wars is in part due to the simpler character of the wounds and in part to the fact that modern fixed ammunition is practically free from germs. the old spear-head, the arrow, the cross bow bolt, had little regard for the probabilities of infection. whether infection follows a wound depends both upon the entry of pathogenic organisms and upon these finding in the tissues suitable opportunities for growth. in wounds in which there is much laceration of tissue organisms find the most favorable conditions for development. the very slight wounds produced by the exploded cap in the toy pistol give suitable conditions for the development of the bacillus which produces tetanus or lockjaw. the deaths of children from lockjaw following a fourth of july celebration have often exceeded the total deaths in a central american revolution. the tetanus bacillus is a widely distributed organism, whose normal habitat is in the soil and which is usually present on the dirty hands of little boys. the toy-pistol wounds are made by small bits of paper or metal being driven into the skin by the explosion of the cap. the wound is of little moment, the surface becomes closed, and a bit of foreign substance, a few dead cells and the tetanus bacilli from the surface remain enclosed and in a few days the fatal disease develops. infection of the surfaces of old wounds such as the surface of an ulcer takes place with difficulty. large numbers of leucocytes which give protection by phagocytosis are constantly passing to the surface, and there is also a constant stream of fluid towards the surface. on such a surface there may be an abundant growth of pathogenic organisms, but no infection results. in most infections there is a focus where the infectious organisms are localized; this may correspond to the point of entrance on a surface or it may be in the interior of the body, the organisms being deposited there after entrance. at this primary localization, the _atrium_ of infection,[ ] the organisms multiply and from this point further invasion takes place. many secondary foci may be formed in the organs by distribution of the organisms, or there may be infection of the blood and fluids of the body. the injuries which are produced depend upon the nature of the infecting organisms. the most common lesion consists in the death of the tissue about the infecting organisms. in most cases the sum of the changes are so characteristic that from them the nature of the infection is easily determined, and these changes often give names to the disease; thus tuberculosis is a disease characterized by the formation of tubercles or little nodules in the body. the situation of the foci of disease is determined by many conditions, the most important being the varying resistance of the different organs of the body to the growth of bacteria. certain organs, such as the central nervous system, the muscles, the testicles and the ovaries, have a high resistance to the growth of bacteria. the disease may be localized in certain organs because only in these do the bacteria find favorable conditions for growth. in spite of a high general resistance to infection the lesions in chronic glanders are most marked in the muscles, those of poliomyelitis in the spinal cord. there are few bacterial diseases which are localized in the blood, but many of the diseases caused by protozoa have this localization. in every infection some organisms enter the blood, which acts as a carrier and deposits them in the organs. bacteria cause disease by producing substances called toxines which are poisonous to the cells, and of which two sorts are distinguished. one form of toxines is produced by the bacteria as a sort of secretion, and is formed both in the body and when the bacteria are growing in cultures. substances of this character, many of them highly poisonous, are produced both by animals and plants. they may serve the purpose both of offence and defence, as in the case of the snake venom, and in other cases they seem to benefit their producers in no way whatever, and may even be injurious to them. after the different cereals have been grown for succeeding years in the same place, growth finally diminishes not from the exhaustion of the soil, but from the accumulation in it of substances produced by the plants. beneath certain trees, as the norway maple, grass will not grow, and it has been shown that the tree produces substances which inhibit the growth of grass. when bacteria are grown in a culture flask, growth ceases long before the nutritive material has been consumed, from the accumulation of waste products in the fluid. the other class of toxic substances, called endotoxines, are not secretion products, but are contained in the bacterial substance and become active by the destruction and disintegration of the bacteria. they can be artificially produced by grinding up masses of bacteria, and in the body the destruction and solution of bacteria which is constantly taking place sets them free. the toxines and the endotoxines are of an albuminous nature, and act only when they come in contact with the living cells within the body. when taken into the alimentary canal they are either not absorbed or so changed by the digestive fluids as to be innocuous. many of the ordinary food substances, even a material apparently so simple as the white of an egg, are highly injurious if they reach the tissues in an unchanged form. by means of these substances the bacteria produce such changes in their environment within the body that this becomes adapted to their parasitic existence. in symbiosis the bacteria probably undergo changes by which they become adapted to the environment, and in parasitism the environment becomes adapted to them. in the same way man can change his immediate environment by means of clothing, artificial heating, etc., and adapt it to his needs; or by hardening his body he can adapt it to the environment. the pathogenic bacterium finds the living tissue hostile, its cells devour him, the tissue fluids destroy him, and by means of the toxines he changes the environment from that of living to dead tissue, or in other ways so alters it that it is no longer hostile. the parasite has also means of passive defence comparable to the armor of the warrior in the past. it may form a protective mantle called a capsule around itself, which serves to protect it from the action of the body fluids. such capsule formation is a very common thing in the pathogenic organisms, and they are found only when these are growing in the body and do not appear in cultures (fig. -c). it is evident that just as the parasite has his weapons of offence and defence so has the host, otherwise there would be no recovery from infectious diseases. although many of the infectious diseases have a high mortality, which in rare instances reaches one hundred per cent, the majority do recover. in certain cases the recovery is attended by immunity, the individual being protected to a greater or less degree from a recurrence of the same disease. the immunity is never absolute; it may last for a number of years only, and usually, if the disease be again acquired, the second attack is milder than the primary. probably the most enduring immunity is in smallpox, although cases are known of two and even three attacks; the immunity is high in scarlet fever, measles, mumps and typhoid fever. the immunity from diphtheria is short, and in pneumonia, although there must be a temporary immunity, future susceptibility to the disease is probably increased. in certain cases the immunity is only local; the focus of disease heals because the tissue there has evolved means of protection from the parasite, but if any other part of the body be infected, the disease pursues the usual course. a boil, for example, is frequently followed by the appearance of similar boils in the vicinity due to the infection of the skin by the micrococci from the first boil, which by dressings, etc., have become spread over the surface. the natural methods of defence of the host against the parasites have formed the main subject in the study of the infectious diseases for the last twenty years. speculation in this territory has been rife and most of it fruitless, but by patient study of disease in man and by animal experimentation there has been gradually evolved a sum of knowledge which has been applied in many cases to the treatment of infectious diseases with immense benefit. research was naturally turned to this subject, for it was evident that the processes by which the protection of the body was brought about must be known before there could be a really rational method of treatment directed towards the artificial induction of such processes, or hastening and strengthening those which were taking place. previous to knowledge of the bacteria, their mode of life, their methods of infection and knowledge of the defences of the body, most of the methods of prevention and treatment of the infectious diseases was based largely on conjecture, the one brilliant exception being the discovery of vaccination by jenner in . the host possesses the passive defences of the surfaces which have already been considered. the first theories advanced in explanation of immunity were influenced by what was known of fermentation. one, the exhaustion theory, assumed that in the course of disease substances contained in the body and necessary for the growth of the bacteria became exhausted and the bacteria died in consequence. another, the theory of addition, assumed that in the course of the disease substances inimical to the bacteria were formed. both these theories were inadequate and not in accord with what was known of the physiology of the body. the most general mode of defence is by phagocytosis, the property which many cells have of devouring and digesting solid substances (fig. -p). although this had been known to take place in the amoebæ and other unicellular organisms, the wide extent of the process and its importance in immunity was first recognized by metschnikoff in and the phagocytic theory of immunity advanced and defended by a brilliant series of experiments by metschnikoff and his pupils conducted in the pasteur institute. metschnikoff's first observations were made on the daphnea, a small animalcule just visible to the naked eye which lives in fresh water. the structure of the organism is simple, consisting of an external and internal surface between which there is a space, the body cavity; daphneæ are transparent and can be studied under the microscope while living. metschnikoff observed that certain of them in the aquarium gradually lost their transparency and died, and examining these he found they were attacked by a species of fungus having long, thin spores. these spores were taken into the intestine with other food; they penetrated the thin wall of the intestine, passed into the body cavity, multiplied there, and in consequence the animal died. in many cases, however, those penetrating became enclosed in cells which the body cavity contains and which correspond with the leucocytes of the blood; in these the spores were digested and destroyed. the daphneæ in which this took place recovered from the infection. here was a case in which all the stages of an infectious disease could be directly followed under the microscope, and the whole process was simple in comparison with infections in the higher animals. the pathogenic organism was known, the manner and site of invasion was clear, it was also evident that if the multiplication of the parasite was unchecked the animal died, but if the parasite was opposed by the body cells and destroyed the animal recovered. the studies were carried further into the diseases of the higher animals, and it was found the leucocytes in these played the same part as did the cells in the body cavity of the daphnea. the introduction of bacteria into certain animals was followed by their destruction within cells and no disease resulted; if this did not take place, the bacteria multiplied and produced disease. support also was given the theory by the demonstration at about the same time that in most of the infectious diseases the leucocytes of the blood became increased in number,--that in pneumonia, for instance, instead of the usual number of eight thousand in a cubic millimeter of blood, there were often thirty thousand or even fifty thousand. at about the same time also chemotaxis, or the action of chemical substances in attracting or repelling organisms, excited attention, and all these facts together became woven into the theory. it was soon seen, however, that this theory, based as it was on observation and supported by the facts observed, was not, at least in its first crude form, capable of general application. many animals have natural immunity to certain diseases; they do not have the disease under natural conditions, nor do they acquire the disease when the organisms causing it are artificially introduced into their tissues by inoculation. such natural immunity seemed to be unconnected with defence by phagocytosis, for the leucocytes of the animal might or might not have phagocytic reaction to the particular organisms to which the animal was immune. it was also seen that recovery from infection in certain diseases was unconnected with phagocytosis. it had also been demonstrated, by german observers chiefly, that the serum of the blood, the colorless fluid in which the corpuscles float, was itself destructive, and that in an animal rendered immune to a special bacterium the destructive action of the serum on that organism was greatly increased. in this hostile serum the bacteria often became clumped together in masses, the bodies became swollen, broken up, and finally disintegrated. this property of the serum was described as due to a substance in the serum called _alexine_, which in the immune animal became greatly increased in amount. it was even denied by some that phagocytosis of living bacteria took place, and that all those included in the cells were dead, having been destroyed in the first instance by the serum. the strife became a national one between the french and germans,--on the one side in france the phagocytic theory was defended, and in germany, on the other, the theory of serum immunity. the mass of experimental work which poured from the laboratories of the two countries in attack and defence became so great that it could not easily be followed. it had a good influence because, without the stimulation of this national rivalry, the knowledge which gradually arose from this work would not have been so quickly acquired. it is interesting that the mode of action of the serum in destroying bacteria was demonstrated not by a german but by bordet, a french observer and a pupil of metschnikoff. he showed that the serum contained two distinct substances, each necessary for the destructive action. the separate action of these substances can be studied since one is _thermolabile_, or destroyed by heating the serum to one hundred and thirty-three degrees; the other _thermostabile_, or capable of withstanding a greater degree of heat. these substances are known only by their effect, they have never been separated from the serum. the thermostabile substance, or _amboceptor_, as it is generally called, has in itself no destructive action on the bacteria; but in some way so alters them that they can be acted on by the thermolabile substance called _complement_ whose action is destructive. the amount of amboceptor may increase in the course of infection and its formation stimulated, the amount of complement remains unchanged. the action of the amboceptor is specific, that is, directed against a single species of bacterium only; the destructive power of the blood may be very great against a single bacterium species and have no effect on others. there seem naturally to be many different amboceptors in the blood, and the number may be very greatly increased. it has been shown as a result of the work of many investigators that the shield has two faces,--there is destruction both by cells and fluids and there is interaction by both. the amboceptors so necessary for the destructive action of the serum are produced by the body cells, particularly the leucocytes. the serum assists in pagocytosis by the action on bacteria of substances called _opsonins_ which are contained in it, and the formation of which can be very greatly stimulated. again, not all inclusion of bacteria within leucocytes is indicative of phagocytosis; in many cases the bacteria seem to find the best conditions for existence within the leucocytes, and these and not the bacteria are destroyed. so far it has been shown that the best defence of the body is, as is the best defence in war, by offensive measures, as illustrated by phagocytosis and destruction by the serum. both of these actions can be increased by their exercise just as the strength of muscular contraction can be increased by exercise, and the facility for doing everything increased by habit. certain of the infectious diseases are, as has been said, essentially toxic in their nature, and in cultures the organisms produce poisonous substances. by the injection into the tissues of such substances the same disturbances are produced as when the bacteria are injected. such a disease is diphtheria. in this there is only a superficial invasion of the tissues. the diphtheria bacilli are located on the surface of the tonsils or pharynx or windpipe, where, as a result of their action, the membrane so characteristic of the disease is produced. the membrane may be the cause of death when it is so extensively formed as to occlude the air passages, but the prominent symptoms of the disease, the fever, the weakness of the heart and the great prostration are due not to the presence of the membrane, but to the action of toxic substances which are formed by the bacteria growing in the superficial lesions and absorbed. tetanus, or lockjaw, is another example of these essentially toxic diseases. the body must find some means of counteracting or destroying these injurious toxic substances. it does this by forming antagonistic substances called antitoxines, which act not by destroying the toxines, but by uniting with them, the compound substance being harmless. it has been found that the production of antitoxine can be so stimulated by the injection of toxine that the blood of the animal used for the purpose contains large amounts of antitoxine. the horse is used in this way to manufacture antitoxine, and the serum injected into a patient with diphtheria has a curative action, a greater amount being thus introduced than the patient can manufacture. [illustration: fig. .--diagram to illustrate ehrlich's theory of antitoxine formation. the surface of the cell (_n_) is covered with receptors some of which (_b_) fit the toxine molecule, (_a_) allowing the toxine to act upon the cell. under the stimulus of this the cell produces these receptors in excess which enter into the blood and there combine with the toxine as in _a^ b^ _, thus anchoring it and preventing it from acting upon the cells. the receptors _c_ and _d_ do not fit the toxine molecule.] a very ingenious theory which well accords with the facts has been given by ehrlich in explanation of the production of antitoxine and of the reaction between toxine and antitoxine (fig. ). this is based on the hypothesis, which is in accord with all facts and generally accepted, that the molecules which enter into the structure of any chemical substance have in each particular substance a definite arrangement, and that in a compound substance each elementary substance entering into the compound molecule has chemical affinities, most of which may be satisfied by finding a suitable mate. ehrlich assumes that the very complex chemical substances which form the living cells have many unsatisfied chemical affinities, and that it is due to this that molecules of substances adapted for food can enter the cells and unite with them; but there must be some coincidence of molecular structure to enable the union to take place, the comparison being made of the fitting of a key into a lock. the toxines--that produced by the diphtheria bacillus being the best example--are substances whose molecular structure enables them to combine with the cells of the body, the combination being effected through certain chemical affinities belonging to the cells termed _receptors_. unless the living cells have receptors which will enable the combination with the toxine to take place, no effect can be produced by the toxine and the cells are not injured. this is the case in an animal naturally immune to the action of the diphtheria bacillus or its toxines. in the case of the susceptible animal the receptors of the cells of the different organs combine with the toxine to a greater or less extent, which explains the fact that different degrees of injury are produced in the different tissues; the toxine of tetanus, or lockjaw, for example, combines by preference with the nervous tissue, that of diphtheria with the lymphatic tissue. it is known that in accordance with the general law of injury and repair, a loss in any part of the body stimulates the tissue of the same kind to new growth and the loss is thus repaired; it is assumed that the cell receptors which combine with the toxine are lost for the cell which then produces them in excess. the receptors so produced pass into the blood, where they combine with the toxine which has been absorbed; the combination is a stable one, and the toxine is thus prevented from combining with the tissue cells. the antitoxine which is formed during the disease, and the production of which in the horse can be enormously stimulated by the injection of toxine, represents merely the excess of cell receptors, and when the serum of the horse containing them is injected in a case of diphtheria the same combination takes place as in the case of receptors provided by the patient. in the case of the destruction of bacteria in the blood by the action of amboceptor and complement, the amboceptor must be able to combine with both the bacterial cell and the complement which brings about its destruction, and just as antitoxine is formed so new amboceptors may be formed. few hypotheses have been advanced in science which are more ingenious, in better accord with the facts, have had greater importance in enabling the student to grasp the intricacies of an obscure problem, and which have had an equal influence in stimulating research. the immunity which results from disease in accordance with this theory, is due not to conditions preventing the entrance of organisms into the body, but to greater aptitude on the part of the cells to produce these protective substances having once learned to do so. an individual need not practise for many years, having once learned them, those combinations of muscular action used in swimming; but the habit at once returns when he falls into the water. infectious diseases and recovery are phases of the struggle for existence between parasite and host, and illustrate the power of adaptation to environment which is so striking a characteristic of living matter. footnotes: [ ] the comparison here is with the atrium of a pompeiian house. chapter viii secondary, terminal and mixed infections.--the extension of infection in the individual.--tuberculosis.--the tubercle bacillus.--frequency of the disease.--the primary foci.--the extension of bacilli.--the discharge of bacilli from the body.--influence of the seat of disease on the discharge of bacilli.--the intestinal diseases.--modes of infection.--infection by sputum spray.--infection of water supplies.--extension of infection by insects.--trypanosome diseases.--sleeping sickness.--malaria.--the part played by mosquitoes.--parasitism in the mosquito.--infection as influenced by habits and customs.--hookworm disease.--inter-relation between human and animal diseases.--plague.--part played by rats in transmission.--the present epidemic of plague. the infectious diseases are often complicated by secondary infections, some other organism finding opportunity for invasion in the presence of the injuries produced in the primary disease. in many diseases, such as diphtheria, scarlet fever and smallpox, death is frequently due to the secondary infection. the secondary invaders not only find local conditions favoring a successful attack, but the activity of the tissue cells on which the production of protective substances essentially depends has suffered by the primary infection, or the cells are occupied in meeting the exigencies of this. the body is in the position of a state invaded by a second power where all its forces and resources are engaged in repelling the first attack. what are known as terminal infections occur shortly before death. no matter what the disease which causes death, in the last hours of life the body usually becomes invaded by organisms which find their opportunity in the then defenceless tissues, and the end is often hastened by this invasion. there are also mixed infections in which two different organisms unite in attack, each in some way assisting in the action of the other. the best known example of this is in the highly infectious disease of swine known as hog cholera. it has been shown that in this disease two organisms are associated,--one an invisible and filterable organism, and the other a bacillus. it was first supposed that the bacillus was the specific organism; it was found in the lesions and certain, but not all, the features of the disease were produced by inoculating hogs with pure cultures. the disease so produced is not contagious, and the contagious element seems to be due to the filterable virus. the modes of transmission of infectious diseases are of great importance and are the foundation of measures of public health. in the preceding chapter we have seen that in the infected individual the disease extends from one part of the body to another. there is a primary focus of disease from which the extension takes place, and the study of the modes of extension in the individual throws some light on the much more difficult subject of the transmission of disease from one individual to another. there are four ways by which extension in the individual may take place. . by continuity of tissue, an adjoining tissue or organ becoming infected by the extension of a focus of infection. . by means of lymphatics. organisms easily enter these vessels which are in continuity with the tissue spaces and receive the exudate from the focus of infection. the organisms are carried to the lymph nodes, which, acting as filters, retain them and for a time prevent a further extension. the following illustrates the importance of the part the nodes may play in mechanically holding back a flood of infection. a physician examined after death the body of a person who died from infection with a very virulent micrococcus and in the course of the examination slightly scratched a finger. one of the organs of the body was removed, sent to a laboratory and received by a laboratory worker, a woman physician, who had slight abrasions and fissures in the skin of the hands from contact with irritating chemicals. in the course of a few hours the wound on the finger of the man became inflamed, intensely painful, and red lines extended up the arm in the course of the lymphatic vessels, showing that the organisms were in the lymphatics and causing inflammation in their course. the lymph nodes in the armpit into which these vessels empty became greatly inflamed, swollen, and an abscess formed in them which was opened. there was high fever, great prostration, a serious illness from which the man did not recover for several months. the woman only handled the organ which was sent to the laboratory in order to place it in a fluid for preservation. she also had a focus of infection of a finger with the same red lines on the arm, showing extension by the lymphatics; but there was no halt of the infection in the armpit, for all the lymph nodes there had been removed several years before in the course of an operation for a tumor of the breast. a general infection of the blood took place, there was very high fever, and death followed in a few days. the halt of the infection is important in allowing time for the body to make ready its means of defence. one cannot avoid comparing the lymph node with a strong fortress thrown in the path of a victorious invading army behind which the defenders may gather and which affords them time to renovate their strength. . by means of the blood. the blood vessels are universally distributed, the smaller vessels have thin walls easily ruptured and easily penetrated. it is probable that in every infection some organisms enter the blood which, under usual conditions, is peculiarly hostile to bacteria. these may, however, be carried by the blood to other organs and start foci of infection in these. . by means of continuous surfaces. the bacteria may either grow along such surfaces forming a continuous or more or less broken layer, or may be carried from place to place in the fluids which bathe them. all these modes of extension are well shown in tuberculosis. this disease is caused by a small bacillus which does not produce spores, has no power of saphrophytic growth under natural conditions, and is easily destroyed. moisture and darkness are favorable conditions for its existence, sunlight and dryness the reverse. there are three varieties or strains of the tubercle bacilli which infect respectively man, cattle and birds, and each class of animals shows considerable resistance to the varieties of the bacillus which are most infectious for the others. the primary seat of the infection in man is generally in the upper part of the lung. the organisms settle on the surface here and cause multiplication of the cells and an inflammatory exudate in a small area. with the continuous growth of the bacilli in the focus, adjoining areas of the lung become affected, and there is further extension in the immediate vicinity by means of the lymphatics. small nodules are formed and larger areas by their coalescence. infection with tuberculosis is so common that at least three-fourths of all individuals over forty show evidences of it. the examination of two hundred and twenty-five children of the average age of five years who had died of diphtheria showed tuberculous infection in one-fifth of the cases and the frequency of infection increases with age. the defence on the part of the body is chiefly by the formation of dense masses of cicatricial tissue which walls off the affected area and in which the bacilli do not find favorable conditions for growth. this mode of defence, which is probably combined with the production of substances antagonistic to the toxines produced by the bacilli, is so efficacious that in the great majority of cases no further extension of the process takes place. in certain cases, however, the growth of the bacilli in the focus is unchecked, the tissue about them is killed and becomes converted into a soft semi-fluid material; further extension then takes place. all parts of the enormous surface of the lungs are connected by means of the system of air tubes or bronchi, and the bacilli have favorable opportunity for distribution, which is facilitated by sudden movements of the air currents in the lung produced by coughing. the defence of the body can still keep pace with the attack, and even in an advanced stage the infection can be checked in some cases permanently; in others the check is but temporary, the process of softening continues, and large cavities are produced by the destruction of the tissue. on the inner surface of these cavities there may be a rapid growth of bacilli. from the lungs the bacilli are carried by the lymphatics to the lymph nodes at the root of the lungs, in which a similar process takes place; this, on the whole, is favorable, because further extension by this route is for a time blocked. the extension by means of surfaces continues, the abundant sputum which is formed in the lungs and which contains large numbers of bacilli, becomes the vehicle of transportation. the windpipe and larynx may become infected, the back parts of each are more closely in contact with the sputum and are the parts most generally infected. a large part of the sputum is swallowed and infection of the intestine takes place, the lesions taking the form of large ulcers. from the intestinal ulcers there is further extension by means of the lymphatics, to the large lymph nodes in the back of the abdominal cavity (fig. - ); the bacilli may also pass from the ulcers into the abdominal cavity and be distributed over the surface of the peritoneum resulting in tuberculous peritonitis. when the disease has reached an advanced stage, bacilli in small numbers continually pass into the blood and are distributed by this over the body, producing small nodules in many places. in rare cases distribution by the blood is the principal method of extension, and immense numbers of small foci of disease are produced, the form of disease being known as acute miliary tuberculosis. although the bacilli are distributed everywhere, certain organs, as the brain and muscles, are usually exempt, because in these the conditions are not favorable to further growth of the bacilli. tuberculosis, although frequently a very acute disease, is usually one of the best types of a chronic disease and may last for many years. the chronic form is characterized by periods of slow or rapid advance when conditions arise in the body favorable for the growth of the bacilli, and periods when the disease is checked and quiescent, the defensive forces of the body having gained the upper hand. often the intervention of some other disease so weakens the defences of the body that the bacilli again find their opportunity. thus typhoid fever, scarlet fever and other diseases may be followed by a rapidly fatal advance of the tuberculosis, starting from some old and quiescent focus of the disease. tuberculosis is also one of the best examples of what is known as latent infection. in this the infectious organisms enter the body and produce primary lesions in which the organisms persist but do not extend owing to their being enclosed in a dense and resistant tissue, or to the production of a local immunity to their action. dr. head has recently examined the children of households in which there was open tuberculosis in some member of the household. by open tuberculosis is understood a case from which bacilli are being discharged. he found with scarcely an exception that all the children in such families showed evidences of infection. the detection of slight degrees of tuberculous infection is now made easy by certain skin reactions on inoculation of the skin with a substance derived from the tubercle bacilli. such latent infections may never become active and in the majority of cases do not. when, however, in consequence of some intercurrent disease or conditions of malnutrition the general defences of the body become weakened extension follows. such latent infections explain the enormous frequency of tuberculosis in prisons. under the general prison conditions infection in the prisons probably does not take place to any extent, and the disease is as common when the prisoners are kept in individual cells as in common prisons. it is probable that in these cases the prisoners have latent tuberculosis when entering, and the disease becomes active under the moral and physical depression which prison life entails. for the extension of infection from one individual to another the infecting organisms must in some way be transferred. the most important of the conditions influencing this are the localization of the disease and the character of the infectious organisms, particularly with regard to their resistance to the conditions met with outside of the body. the seat of disease influences the discharge of organisms; thus, if the disease involve any of the surfaces the organisms become mingled with the secretions of the surface and are discharged with these. if the seat of disease be in the lungs, the throat or the mouth, the sputum forms the medium of extension, which can take place in many ways. the sputum may become dried, forms part of the dust and the organisms enter with the inspired air. the organisms which cause most of the diseases in which the sputum becomes infectious are quickly destroyed by conditions in the open, such as the sunlight and drying; street dust does not play so prominent a part in extension as is generally supposed. organisms find much more favorable conditions within houses. it is now generally recognized that infection with tuberculosis does not take place in the open, but in houses in which the bacilli on being discharged are not destroyed. the hands, the clothing and surroundings even with the exercise of the greatest care may become soiled with the saliva. it has been shown that in coughing and speaking very fine particles of spray are formed by the intermingling of air and saliva, which may be projected a considerable distance and remain floating in the air for some time. these particles are so fine as to be invisible; they may be inspired, and their presence in the air forms an area of indeterminate extent around the infected person within which such infection is possible. such spray formation is also an important means of the extension of infection in the sick individual, for it is continually formed and inspired. it is in this way that the extreme prevalence of broncho-pneumonia in infants and young children is to be explained. no matter what the essential disease, an almost constant finding in young children after death is small areas of inflammation in the lungs in and around the terminations of the air tubes. the situation renders it evident that the organisms which caused the lesions entered the lung by the air tubes. the mouth of the child is unclean and harbors numbers of the same sort of organisms as those causing the lung inflammation; but in the absence of such a mode of infection as is given by spray formation it is difficult to see how the extension from the mouth to the lungs could take place. the weakened condition of the body in these cases favors the secondary infection. if the disease be located in the intestines, as in typhoid fever and dysentery, the organisms are contained in the fecal discharges, and by means of these the infection is extended. in typhoid fever, dysentery and cholera massive infections of the populace may take place from the contamination of a water supply and the disease be extended over an entire city. one of the most striking instances of this mode of extension was in the epidemic of cholera in hamburg in . there were two sources of water supply, one of which was infected, and the cases were distributed in the city in the track of the infected supply. many such instances have been seen in typhoid fever. certain articles of food, particularly milk, serve as sources of infection. this is more apt to happen when the organism causing the infection grows easily outside of the body. a few such organisms entering into the milk can multiply enormously in a few hours and increase the amount of infectious material. in all these cases the sick individual remains a source of infection, for it is almost impossible to avoid some contamination of the body and the immediate surroundings with the organisms contained in the discharges. transmission by air plays but little part in the extension of infection. in such a disease as smallpox, where the localization is on the surface of the body, the organisms are contained in or on the thin epithelial scales which are constantly given off. these are light, and may remain floating in the air and carried by air currents just as is the pollen of plants. there seem to have been cases of smallpox where other modes of more direct transmission could be excluded and in which the organisms were carried in the air over a considerable space. all sorts of intermediate objects, both living and inanimate, such as persons, domestic animals, toys, books, money, etc., can serve as conveyors of infection. insects play a most important part in the transmission of disease, and in certain cases, as when a disease is localized in the blood, this is the only means of transmission. there are three ways in which the insect plays the rôle of conveyor. . the insect may play a purely passive part in that its exterior surface becomes contaminated with the discharges of the sick person, and in this way the organisms of disease may be conveyed to articles of food, etc. the ordinary house fly conveys in this way the organisms of typhoid and dysentery. flies seek the discharges not only for food, but for the purpose of depositing their eggs, and the hairy and irregular surface of their feet facilitates contamination and conveyance. when flies eat such discharges the organisms may pass through the alimentary canal unchanged and be deposited with their feces; they also often vomit or regurgitate food, and in this way also contaminate objects. flies very greedily devour the sputum of tuberculous patients, and the tubercle bacilli contained in this pass through them unchanged and are deposited in their feces. [illustration: fig. .--trypanosomes from birds. all the trypanosomes are very much alike. they contain a nucleus represented by the dark area in the centre and a fur-like membrane terminating in a long whip-like flagellum. they have the power of very active motion within the blood.] . diseases which are localized in the blood are transmitted by biting flies. the biting apparatus becomes contaminated with the organisms contained in the blood, and these are directly inoculated into the blood of the next victim. the trypanosome diseases form the best example of this mode of transmission. the trypanosomes are widely distributed, exclusively parasitic, flagellated protozoa which live in the blood of a large number of animals and birds (fig. ). they may give rise to fatal diseases, but in most cases there is mutual adaptation of host and parasite and they seem to do no harm. one of the most dangerous diseases in man, the african sleeping sickness, is caused by a trypanosome, and the disease of domestic cattle in africa, nagana, or tsetse fly disease, is also so produced. in certain regions of africa where a biting fly, the _glossina morsitans_, occurs in large numbers, it has long been known that cattle bitten by these flies sickened and died, and this prevented the settling and use of the land. in the blood of the sick cattle swarms of trypanosomes are found. the source from which the tsetse fly obtained the trypanosomes which it conveyed to the cattle was unknown until it was discovered that similar trypanosomes exist in the blood of the wild animals which inhabit the region, but these have acquired by long residence in the region immunity or adaptation to the parasite and no disease is produced. with the gradual extension of settlement of the country and the accompanying destruction of wild life the disease is diminishing. some of the inter-relations of infections are interesting. the destruction of wild animals in south africa which, by removing the sources of nagana, rendered the settlement of the country possible was due chiefly to the introduction of another infectious disease, rinderpest, which not only destroyed the wild animals but produced great destruction of the domestic cattle as well. the _sleeping sickness_ has many features of interest. in the old slavery days it was found that the negroes from the congo region in the course of the voyage or after they were landed sometimes were affected with a peculiar disease. they were lethargic, took little notice of their surroundings, slept easily and finally passed into a condition of somnolence in which they took no food and gradually died. there was no extension of the disease and it was attributed to extreme homesickness and depression. a similar disease has been known for more than one hundred years on the west coast of africa, and attracted a good deal of interest and curiosity on account of the peculiar lethargy which it produced and from which it has received the name of "sleeping sickness." although apparently infectious in its native haunts, it lost the power of spreading from man upon removal to regions where it did not prevail. at first confined to a very small region on the niger river, it gradually extended with the development of trade routes and the general increase of communications which trade brings, until it prevails in the entire congo basin, in the british and german possessions in east africa, and is extending north and south of these regions. the cause of the disease and its mode of conveyance was discovered in . the fly _glossina palpalis_ which conveys the disease is a biting fly about the size of the common house fly and lives chiefly in the vicinity of water. when such a fly bites an individual who has sleeping sickness its bite can convey the disease to monkeys, on whom the transmission experiments were made. after biting the fly is infectious for a period of two days. after this it is harmless, unless it again obtains a supply of living trypanosomes. there is quite a period in which there are no symptoms of the disease, although trypanosomes are found in the blood and in the lymph nodes, and the individual is a source of infection. the peculiar lethargy which has given the disease its name does not appear until the nervous system is invaded by the parasites. it is impossible to compute accurately the numbers of deaths from this disease--in the region of victoria nyanza alone the estimates extend to hundreds of thousands. . in the third mode of insect conveyance the insect does not play a merely passive rôle, but becomes a part of the disease, itself undergoing infection, and a period in the life cycle of the organism takes place within it. in all these cases quite a period of time must elapse before the insect is capable of transmitting the disease; in malaria, which is the best type of such a disease, this period is ten days. malaria is due to a small protozoan, the _plasmodium malariæ_, which was discovered by lavaran, a french investigator, in . the organism lives within or on the surface of the red blood corpuscles. it first appears as a very minute colorless body with active amoeboid movements, and increases in size, attacks a succession of corpuscles, and finally attains a size as large as or larger than a corpuscle. the corpuscles attacked become pale by the destruction of hæmoglobin, swell up and disintegrate, the hæmoglobin becoming converted into granules of black pigment inside the parasite. having attained a definite size the organism forms a rosette and divides into a number of forms similar to the smallest seen inside the corpuscles; these small forms enter other corpuscles and the cycle again begins. this cycle of development takes place in forty-eight hours, and segmentation is always accompanied by a paroxysm of the disease shown in a chill followed by fever and sweating which is due to the effect of substances liberated by the organism at the time of segmentation. a patient may have two crops of the parasite developing independently in the blood, and the two periods of segmentation give a paroxysm for each, so that the paroxysms may appear at intervals of twenty-four hours instead of forty-eight (fig. ). this cycle of development may continue for an indefinite time, and there may be such a rapid increase in the parasites as to bring about the death of the individual; but with him the parasite would also perish, for there would be no way of extending the infection and providing a new crop. the disease has been transmitted by injecting the infected blood into a normal individual. [illustration: fig. .--part of the cycle of development of the organism of malaria, _a-g_, cycle of forty-eight hour development, the period of chill coinciding with the appearance of _f_ and _g_ in the blood. the organisms _g_, which result from segmentation, attack other corpuscles and a new cycle begins. _h_, the male form or microgametocyte, with the protruding and actively moving spermatozoa, one of which is shown free. _i_ and _j_ are the macrogametes or female forms. _k_ shows one of these in the act of being fertilized by the entering spermatozoön. the differentiation into male and female forms takes place in the blood, the further development of the sexual cycle within the mosquito.] if a mosquito of the species _anopheles_ bites the affected person, it obtains a large amount of blood which contains many parasites. within the mosquito the parasite undergoes a further development into male and female sexual forms, which may also form in the blood, termed respectively _microgametocyte_ and _macrogamete_. from the microgametocyte small flagellate bodies, the male sexual elements _microgametes_ or _spermatozoa_, develop and fertilize the _macrogametes_; after fertilization this develops into a large body, the _oöcyst_ which is attached to the wall of the stomach of the mosquito. within the oöcyst, innumerable small bodies, the sporozoites, develop, make their way into the salivary glands and are injected into the individual who becomes the prey of the mosquito, and again the cycle of development begins. the presence of the parasite within the mosquito does not constitute a disease. so far as can be determined, life goes on in the usual way, and its duration in the insect is not shortened. the nature of the parasite which produces yellow fever is unknown, for it belongs to the filterable viruses; the infectious material, however, has been shown by inoculation to exist in the blood, and the disease is transmitted by a mosquito of another species, the _stegomyia_. the development cycle within this takes a period of twelve days, which time must elapse after the mosquito has bitten before it can transmit the disease. here again the mutual interdependence of knowledge is shown. nothing could have seemed less useful than the study of mosquitoes, the differentiation of the different species, their mode of life, etc., and yet without this knowledge discoveries so beneficial and of such far-reaching importance to the whole human race as that of the cause and mode of transmission of malaria and yellow fever would have been impossible; for it could easily have been shown that the ordinary _culex_ mosquito played no rôle. the rôle which insects may play in the transmission of disease was first shown by theobald smith in this country, in the transmission by a tick of the disease of cattle known as texas fever. the infecting organism _pyrosoma bigenimum_ is a tiny pear-shaped parasite of the red corpuscles. smith's investigations on the disease, published in , is one of the classics in medicine, and one of the few examples of an investigation which has not been changed or added to by further work. one of the most interesting methods of extension of infection, showing on what small circumstances infection may depend, is seen in the case of the hookworm disease, which causes such devastation in the southern states. the organism which produces the disease, the _uncinaria_, belongs to the more highly developed parasites, and is a small round worm one-third of an inch long. the worms which inhabit the intestines have a sharp biting mouth by which they fasten themselves to the mucous membrane and devour the blood. the most prominent symptom of the disease is anæmia, or loss of blood, due not only to the direct eating of the parasite, but to bleeding from the small wounds caused by its bite. large numbers of eggs are produced by the parasite which are passed out with the feces, which becomes the only infectious material. in a city provided with water-closets and a system of sewerage there would be no means of extension of infection. the eggs in the feces in conditions of warmth and moisture develop into small crawling larvæ which can penetrate the skin, producing inflammation of this, known in the region as the ground itch. the larvæ enter the circulation and are carried to the lungs, where they perforate the capillaries and reach the inner surface; from this they pass along the windpipe, and then by way of the gullet and stomach reach their habitat, the small intestine. unfortunately, the habits and poverty of the people in every way facilitate the extension of the infection. there is no proper disposal of the feces, few of the houses have even a privy attached to them, and the feces are distributed in the vicinity of the houses. this leads to contamination of the soil over wide areas. most of the inhabitants of the country go barefoot the greater part of the year, and this gives ready means of contact with the larvæ which crawl over the surface of the ground. the disease is necessarily associated with poverty and ignorance, the amount of blood is reduced to a low point, and industry, energy and ambition fall with the blood reduction; the schools are few and inefficient; the children are backward, for no child can learn whose brain cells receive but a small proportion of the necessary oxygen; and a general condition of apathy and hopelessness prevails in the effected communities. the control of the disease depends upon the disinfection of the feces, or at least their disposal in some hygienic method, the wearing of shoes, and the better education of the people, all of which conditions seem almost hopeless of attainment. the infection is also extended by means of the negroes who harbor the parasite, but who have acquired a high degree of immunity to its effects and whose hygienic habits are even worse than those of the whites. the organism was probably imported with the negroes from africa and is one of the legacies of slavery. the diseases of animals are in many ways closely linked with those of man. in the case of the larger parasites, such as the tapeworms and the trichina, there is a direct interchange of disease with animals, certain phases of the life cycle of the organisms are passed in man and others in various of the domestic animals. a small inconspicuous tapeworm inhabits the intestine of dogs and seems to produce no ill effects. the eggs are passed from the dog, taken into man, and result in the formation of large cystic tumors which not infrequently cause death. where the companionship between dog and man is very close, as in iceland, the cases are numerous. most of the diseases in animals caused by bacteria and protozoa are not transmitted to man, but there is a conspicuous exception. plague is now recognized as essentially an animal disease affecting rats and other small rodents, and from these the disease from time to time makes excursions to the human family with dire results. the greatest epidemics of which we have any knowledge are of plague. in the time of justinian, b.c., a great epidemic of plague extended over what was then regarded as the inhabited earth. this pandemic lasted for fifty years, the disease disappeared and appeared again in many places and caused frightful destruction of life. cities were depopulated, the land in many places reverted to a wilderness, and the works of man disappeared. the actual mortality cannot be known, but has been estimated at fifty millions. plague played a large part in the epidemics of the middle ages. an epidemic started in and had as great an extension as the justinian plague, destroying a fourth of the inhabitants of the places attacked; and during the fifteenth and sixteenth and seventeenth centuries the disease repeatedly raised its head, producing smaller and greater epidemics, the best known of which, from the wonderful description of de foe, is that of london in , and called the black death. little was heard of the disease in the nineteenth century, although its existence in asia was known. in it appeared in hong kong, extended to canton, thence to india, japan, san francisco, mexico, and, in fact, few parts of the tropics or temperate regions of the earth have been free from it. mortality has varied greatly, being greatest in china and in india; in the last the estimate since is seven million five hundred thousand deaths. the disease is caused by a small bacillus discovered in which forms no spores and is easily destroyed by sunlight, but in the dark is capable of living with undiminished virulence for an indefinite time. the disease in man appears in two forms, the most common known as bubonic plague, from the great enlargement of the lymph nodes, those of the groin being most frequently affected. the more fatal form is known as pneumonic plague, and in this the lungs are the seat of the disease. in the old descriptions of the disease it was frequently mentioned that large numbers of dead rats were found when it was prevalent, and the most striking fact of the recent investigations is the demonstration that the infection in man is due to transference of the bacillus from infected rats. there are endemic foci of the disease where it exists in animals, the present epidemic having started from such a focus in northern china, in which region the _tarabagan_, a small fur-bearing animal of the squirrel species, was infected. rats are easily infected, the close social habits of the animal, the vermin which they harbor, and the habits of devouring their dead fellows favor the extension of infection. the disease extends from the rat to man chiefly by means of the fleas which contain the bacilli, and in cases of pneumonic plague from man to man by means of sputum infection. the disease once established in animals tends to remain, the virus being kept alive by transmission from animal to animal, and the persistence of the infection is favored by mild and chronic cases. chapter ix disease carriers.--the relation between sporadic cases of infectious disease and epidemics.--smallpox.--cerebro-spinal meningitis.--poliomyelitis.--variation in the susceptibility of individuals.--conditions which may influence susceptibility.--racial susceptibility.--influence of age and sex.--occupation and environment.--the age period of infectious diseases. we have seen that insects serve as carriers of disease in two ways: in one, by becoming contaminated with organisms they serve as passive carriers, and in the other they undergo infection and form a link in the disease. the more recent investigations of modes of transmission of infectious diseases have shown that man, in addition to serving while sick as a source of infection, may serve as a passive carrier in two ways. for infection to take place not only must the pathogenic organism be present, but it must be able to overcome the passive and active defences of the body and produce injury. pathogenic organisms may find conditions favorable for growth on the surfaces of the body, and may live there, but be unable to produce infection, and the individual who simply harbors the organisms can transmit them to others. such an individual may be a greater source of infection than one with the disease, because there is no suspicion of danger. the organisms which thus grow on the surfaces have in some cases been shown to be of diminished virulence, but in others have full pathogenic power. such passive carriers of infection have been found for a number of diseases, as cerebro-spinal meningitis, diphtheria, poliomyelitis and cholera. in all these cases the organisms are most frequently found in those individuals who have been exposed to infection as members of a family in which there have been cases of disease. the other sort of carrier has had and overcome the disease, but mutual relations have been established with the organism which continues to live in the body cavity. diphtheria bacilli usually linger in the throat after convalescence is established, and until they have disappeared the individual is more dangerous than one actually sick with the disease. health officers have recognized this in continuing the quarantine against the disease until the organism disappears. in typhoid fever bacilli may remain in the body for a long time and be continually discharged, as in the well-known case of "typhoid mary."[ ] single cases of certain infectious diseases may appear in a community year after year, and at intervals the cases become so numerous that the disease is said to be epidemic. such a disease is smallpox. this is a highly infectious disease, towards which all mankind is susceptible. complete protection against the disease can be conferred by jenner's discovery of vaccination. the disease becomes modified when transferred to cattle, producing what is known as cowpox, in which vesicles similar to those of smallpox appear on the skin. the inoculation of man with the contents of such a vesicle produces a mild form of disease known as vaccinia, which protects the individual from smallpox. this protection is fully as adequate as that produced by an attack of smallpox, and we are warranted in saying that if thorough vaccination, or the inoculation with vaccinia, were carried out smallpox would disappear. there are great difficulties in the way of carrying out effective vaccination of the whole population, which are accentuated by the active opposition of people who are ignorant and wilfully remain so. there exists in every state a number of people unprotected by vaccination, and among these single cases of smallpox appear. the unprotected individuals gradually increase in number, forming an inflammable material awaiting the spark or infection which produces a conflagration in the one case and an epidemic in the other. cerebro-spinal meningitis is another example of a disease which exists in sporadic and epidemic form. this disease is caused by a small micrococcus, the organisms joined in pairs. the seat of the disease is in the meninges or membranes around the brain and spinal cord. the micrococci enter the body from the throat and nose, and either pass directly from here into the meninges, or they enter into the blood and are carried by this into the meninges. the organisms are easily destroyed and cannot long survive the conditions outside the body, so that for infection to take place the transmission must be very direct. carriers who have the organisms in the throat, but who do not have the disease, are the principal agents in dissemination. the mortality is high, and even in recovery permanent damage is often done to the brain or to the organs of special sense. sporadic cases constantly occur in small numbers, and it is difficult or impossible to trace any connection between these cases. at varying intervals, often twenty years intervening, an epidemic appears which sometimes remains local in a city or state, sometimes extends to adjoining cities or states, and may even extend over a very large area. in the epidemics the mortality is much higher than in the sporadic cases. the same explanation given for smallpox cannot apply here, for there is not a similar accumulation of susceptible material. we know there is a great deal of variation in the virulence of the different pathogenic organisms, and the virulence can be artificially increased and diminished. in epidemics of meningitis the virulence of the organisms is increased, as is shown by the greater mortality. it is highly probable that such epidemics are due to changes which arise in the organisms from causes we do not know and which increase their capacity for harm. it is possible that such a change would convert a carrier into a case of disease, the organism acquiring greater powers of invasion. such a strain of organisms arising in one place and producing an epidemic could be transported to another locality and exert the same action, or similar changes in the organisms could arise simultaneously in a number of places. analogies to such conditions are given in plants. in certain plants it has been shown that from unknown causes there appears a tendency to the production of variations. a very beautiful herbaceous peony known as "bridesmaid" after having grown for a number of years in single form, in one year wherever grown suddenly became double. the peculiar thing with the lower unicellular organisms is that the changes which so arise do not tend to become permanent, the organism reverts to its usual character, the disease to its sporadic type. a very fatal form of poliomyelitis has for a number of years prevailed in sweden. in the united states there have been continually a number of single cases of the disease, and it is not impossible that a more pathogenic strain of the organism has developed in sweden and has been imported into this country, giving rise to the much greater extension of the disease in a number of places. the most cursory study of the infectious diseases shows that there is great variation in the susceptibility of individuals. even in the most severe epidemics all are not equally affected, some escape the infection, others have the disease lightly, others severely, some die. chance enters into this, but plays a small part, for the same varying individual susceptibility is shown experimentally. if a given number of animals of the same species, age and weight, even those from the same litter, be inoculated with a given number of bacteria shown to be pathogenic for that species, the results differ. if the dose be necessarily fatal, death will take place at intervals; if a dose smaller than the fatal be used, some animals will die, others will recover. the defences of the organism being centred in the activity of the living tissue, any condition which depresses cell activity may have an effect in increasing susceptibility to infection. animals which ordinarily are not susceptible to infection with a certain organism may be made so by prolonged hunger, or fatigue, by the influence of narcotics, by reduction of the body temperature, by loss of blood. in man prolonged fatigue, cold, the use of alcohol to excess and even psychic depression increases susceptibility. it has been shown that such conditions are accompanied by a diminution in the power of the blood to destroy bacteria. there is variation in the susceptibility to infection in the different races of man. if a race be confined to one habitat with close intercourse between the people, such a race may acquire a high degree of immunity to local diseases by a gradual weeding out of the individuals who are most susceptible. a degree of comparative harmony may be gradually established between host and parasite, as is the case in wild animals. these have few diseases, the weak die, the resistant breed; they harbor, it is true, large numbers of parasites, but there is mutual adjustment between parasite and host. diseases in animals greatly increase under the artificial conditions of domestication. certain highly specialized breeds of cattle, as the alderneys, are much more susceptible to tuberculosis than the less specialized. the high development of the variation which consists in a marked ability to produce milk fat is probably combined with other qualities, shown in diminished resistance to disease, and under natural conditions the variation would not have persisted. the introduction of a new disease into an isolated people has often been attended with dire consequences. it is much the same thing with the introduction of disease of plants. in europe the brown-tail moth and the gypsy moth produce continuously a certain amount of damage to the trees, but their parasitic enemies have developed with them and check their increase. these pests were brought to this country in which there were no conditions retarding their increase and have produced great damage. it is very difficult to estimate the degree of racial susceptibility. the negro race seems to be more susceptible to certain diseases, such as tuberculosis and smallpox, less so to others, as yellow fever, malaria and uncinariasis. what are apparently differences in susceptibility may be explained by racial customs. a statistical inquiry into death in india from poisonous snakes might be interpreted as showing a marked resistance on the part of the white to the action of the venom, but it is merely a question of the boots of the whites and the naked feet and legs of the natives. the relatively greater frequency of smallpox in the blacks is due to the greater difficulties in carrying out vaccination measures among them and the greater opportunity for infection which results from their less hygienic life. it has always been noted that when plague prevails in oriental cities, the natives are more frequently attacked than are europeans. this does not depend upon differences in susceptibility, but on the better hygienic conditions of the whites which prevent the close relation to rats and vermin by which infection is extended. there would be but little extension of the hookworm disease in a community where shoes were worn and the habits were cleanly. it is by no means improbable that the formation of the habits of civilization was influenced by infection. most of these habits, such as personal cleanliness, the avoidance of close contact, the demand for individual utensils for eating and drinking, are all of distinct advantage in opposing infection. certain habits, on the other hand, such as kissing, which probably represents the extension of a habit of sexual origin, are disadvantageous and infection is often transmitted in this way. in syphilitic infection the mouth forms one of the most common localizations of the disease and may contain the causal organisms in great numbers. this, the _spirochæta pallida_, is an organism of great virulence, and man is the most susceptible animal. the disease, like gonorrhoea, is essentially a sexual disease, the primary location is in the sexual organs, and it is transmitted chiefly by sexual contact. of all the infectious diseases, it is the one most frequently transmitted to the unborn child; in certain cases the disease is transmitted, in others the developing foetus may be so injured by the toxic products of the disease that various imperfections of development result, as is shown in deformities, or in conditions which render the entire organism or individual organs, particularly the nervous system, more susceptible to injury. following the primary localization of the acquired form of the disease, there is usually secondary localization in the mucous membrane of the mouth, and the disease may be transmitted by kissing or by the use of contaminated utensils. the habit of indiscriminate kissing is one which might with great benefit be given up. there is definite relation between age and the infectious diseases. in general, susceptibility is increased in the young; young animals can be successfully inoculated with diseases to which the adults of the species are immune, and certain human diseases, such as scarlet fever, measles and whooping cough, seem to be the prerogatives of the child. it must be remembered, however, that one attack of these diseases confers a strong and lasting immunity and children represent a raw material unprotected by previous disease. where measles has been introduced into an island population for the first time, all ages seem equally susceptible. all ages are equally susceptible to smallpox, and yet in the general prevalence of the disease in the prevaccination period it was almost confined to children, the adults being protected by a previous attack. the habits and environment at different ages have an influence on the opportunities for infection. there is comparatively little opportunity for infection during the first year, in which period the infant is nursed and has a narrow environment within which infection is easily controlled. with increasing years the opportunities for infection increase. when the child begins to move and crawl on hands and knees the hands become contaminated, and the habit of putting objects handled into the mouth makes infection by this route possible. food also becomes more varied, milk forms an important part of the diet, and we are now appreciating the possibilities of raw milk in conveying infection. with the enlarging environment, with the school age bringing greater contact of the child with others, there come greater opportunities for infection which are partly offset by the increase in cleanliness. the dangers of infection in the school period are now greatly lessened by medical inspection and care of the school children. in the small epidemic of smallpox which prevailed in boston from to , there was a sharp decline in the incidence of the disease in children as soon as the school age was reached, this being due to the demand of vaccination as a condition for entrance into the schools. many of the infectious diseases are much milder in children than in adults. this is the case in typhoid fever, malaria and yellow fever. the comparative immunity of the natives to yellow fever in regions where this prevails seems to be due to their having acquired the disease in infancy in so mild a form that it was not recognized as such. the infectious diseases are preëminently the diseases of the first third of life. after the age of forty man represents a select material. he has acquired immunity to many infections by having experienced them. habits of life have become fixed and there is a general adjustment to environment. the only infectious disease which shows no abatement in its incidence is pneumonia, and the mortality in this increases with age. between thirty-five and fifty-five man stands on a tolerably firm foundation regarding health; after this the age atrophies begin, the effects of previous damage begin to be apparent, and the tumor incidence increases. footnote: [ ] this was the case of a woman, by occupation a cook, whose numerous exchanges of service were accompanied by the appearance of cases of typhoid fever in the families. this became so marked that an examination was made and she was found to be a typhoid carrier and as such constantly discharging typhoid bacilli. she is now isolated. chapter x inheritance as a factor in disease.--the process of cell multiplication.--the sexual cells differ from the other cells of the body.--infection of the ovum.--intra-uterine infection.--the placenta as a barrier to infection.--variations and mutations.--the inheritance of susceptibility to disease.--the influence of alcoholism in the parents on the descendants.--the heredity of nervous diseases.--transmission of disease by the female only.--hemophilia.-- the inheritance of malformations.--the causes of malformations.--maternal impressions have no influence.--eugenics. the question of inheritance of disease is closely associated with the study of infection, and the general subject of heredity in its bearing on disease can be considered here. by heredity is understood the transference of similar characteristics from one generation of organisms to another. the formation of the sexual cells is a much more complex process than that of the formation of single differentiated cells, for the properties of all the cells of the body are represented in the sexual cells, to the union of which the heredity transmission of the qualities of the parents is due. in the nucleus of all the cells in the body there is a material called _chromatin_, which in the process of cell division forms a convoluted thread; this afterwards divides into a number of loops called _chromosomes_, the number of which are constant for each animal species. in cell division these loops divide longitudinally, one-half of each going to the two new cells which result from the division; each new cell has one-half of all the chromatin contained in the old and also one-half of the cytoplasm or the cell material outside of the nucleus. the process of sexual fertilization consists in the union of the male and female sex cells and an equal blending of the chromatin contained in each (fig. ). in the process of formation of the sexual cells a diminution of the number of chromosomes contained in them takes place, but this is preceded by such an intimate intermingling of the chromatin that the sexual cells contain part of all the chromosomes of the undifferentiated cells from which they were formed. the new cell which is formed by the union of the male and female sexual cells and which constitutes a new organism, contains the number of chromosomes characteristic of the species and parts of all the chromatin of the undifferentiated cells of male and female ancestors. as a result of this the most complicated mechanism in nature, it is evident that in a strict sense there can be no heredity of a disease because heredity in the mammal is solely a matter of the chromosomes and these could not convey a parasite. the new organism can, however, quickly become diseased and, by the transference of disease to it and by either parent, there is the appearance of hereditary transmission of disease, though in reality it is not such. the ovum itself can become the site of infection; this, which was first discovered by pasteur in the eggs of silkworms, takes place not infrequently in the infection of insects with protozoa. in texas fever the ticks which transmit the disease, after filling with the infected blood, drop off and lay eggs which contain the parasites, and the disease is propagated by the young ticks in whom the parasites have multiplied. the same thing is true in regard to the african relapsing or tick fever, which is also transferred by a tick. in the white diarrhoea of chickens the eggs become infected before they are laid and the young chick is infected before it emerges from the shell. it is highly improbable, and there is no certain evidence for it, that the extremely small amount of material contributed by the male can become infected and bring infection to the new organism. in the cases in which disease of the male parent is transferred to the offspring, it is either by an infection of the female by the male, with transference of the infection from her to the developing organism, or with the male sexual cells there may be a transference to the female of the infectious material and the new organism may be directly infected. no other disease in man is so easily and directly transferred from either parent to offspring as is syphilis, and the disease is extremely malignant for the foetus, usually causing death before the normal period of intra-uterine development is reached. [illustration: fig. .--diagram showing the relation of the sexual cells to the somatic cells or those of the general body. the sexual cells are represented to the left of the line at the bottom of diagram and are black. from the fertilized ovum at the top there is a continuous cell development, with differentiation represented in the cell groups of the bottom row. it is seen that the sexual cells are formed directly from the germ cell and contain no admixture from the cells of the body.] the mother gives the protection of a narrow and unchanging environment and food to the new organism which develops within the uterus, and there is always a membranous separation between them. disease of the mother may affect the foetus in a number of ways. in most cases the membrane of separation is an efficient guard preventing pathogenic organisms reaching the foetus from the mother. in certain cases, however, the guard can be passed. in smallpox, not infrequently, the disease extends from the mother to the foetus, and the child may die of the infection or be born at term with the scars resulting from the disease upon it. syphilis in the mother in an active stage is practically always extended to the foetus. we have said that in an infectious disease substances of an injurious character are produced by bacteria, and such substances being in solution in the blood of the infected mother can pass through the membranous barrier and may destroy the foetus although the mother recovers from the infection. [illustration: fig. .--diagrammatic representation of the process of fertilization. (boveri.) in the first cell (_a_) the ovum is shown in process of fertilization by the entering spermatozoon or male sexual element. in the following cells there is shown the increase in amount of the male material and the final intimate commingling in _g_ which precedes the first segmentation. _g_ represents a new organism formed by the union of the male or female cell but differing from either of them.] living matter is always individual, and this individuality is expressed in slight structural variations from the type of the species as shown in an average of measurements, and also in slight variations in function or the reactions which living tissue shows towards the conditions acting upon it. the anatomical variations are more striking because they can be demonstrated by weight and measure, but the functional variations are equally numerous. thus, no two brains react in exactly the same way to the impressions received by the sense organs; there are differences in muscular action, differences in digestion; these variations in function are due to variations in the structure of living material which are too minute for our comparatively coarse methods of detection. in the enormous complexity of living matter it is impossible that there should not be minute differences in molecular arrangement and to this such functional variations may be due. chemistry gives us a number of examples of variations in the reaction of substances which with the same composition differ in the molecular arrangement. even in so simple a mechanism as a watch there are slight differences in structure which gives to each watch certain individual characteristics, but the type as an instrument constructed for recording time remains. in the fusion of the chromosomes of the male and female sexual cells, to which the hereditary transmission of the ancestral qualities to the new offspring is due, there are differences in the qualities of each, for the individuality of the parents is expressed in the germ cells, and the varying way in which these may fuse gives to the new cell qualities of its own in addition to qualities which come from each ancestor, and from remote ancestors through these. the qualities with which the new organism starts are those which it has received from its ancestors plus its individuality. the fact that the sexual cells are formed from the early formed cells of the new organism which represent all of the qualities of the fertilized ovum or primordial cell, renders it unlikely that the new offspring will contain qualities which the parents have acquired. the question of the inheritance of characteristics which the parents have acquired as the result of the action of environment upon them is one which is still actively investigated by the students of heredity, but the weight of evidence is opposed to this belief. in the new organism the type of the species is preserved and the variations from the mean to which individuality is due are slight. we are accustomed to regard as variations somewhat greater departures from the species type than is represented in individuality, but there is no sharp dividing line between them. very much wider departures from the species type are known as mutations. such variations and mutations, like individuality, may be expressed in qualities which can be weighed and measured, or in function, and all these can be inherited; certain of them known as dominant characteristics more readily than others, which are known as recessive. if these variations from the type are advantageous, they may be preserved and become the property of the species, and it is in this way that the characteristics of the different races have arisen. certain of the variations are unfavorable to the race. the varying predisposition to infection which undoubtedly exists and may be inherited represents such a variation. tuberculosis is an instance of this; for, while the cause of the disease is the tubercle bacillus, there is enormous difference in the resistance of the body to its action in different individuals. the disease is to a considerable extent one of families, but while this is true the degree of the influence exerted by heredity can be greatly overestimated. the disease is so common that in tracing the ancestry of tuberculous patients it is rare to find the disease not represented in the ancestors. a further difficulty is that the environment is also inherited. the child of a tuberculous parent has much better opportunity to acquire the infection than a child without such an environment [page ]. other diseases than the infectious seem to be inherited, of which gout is an example. in gout there is an unusual action of the cells of the body which leads to the formation and the retention in the body of substances which are injurious. here it is not the disease which is inherited, but the variation in structure to which the unusual and injurious action of the cells is due. while tuberculosis and gout represent instances in which, although the disease itself is not inherited yet the presence of the disease in the ascendants so affects the germinal material that the offspring is more susceptible to these particular diseases, much more common are the cases in which disease in the parents produces a defective offspring, the defect consisting in a general loss of resistance manifested in a variety of ways, but not necessarily repeating the diseased condition of the parent. in these cases the disease in the parents affects all the cells of the body including the germinal cells, and the defective qualities in the germ cells will affect the cells of the offspring which are derived from these. there is a tendency in these cases to the repetition in the offspring of the disease of the parents, because the particular form of the parental disease may have been due to or influenced by variation of structure. one of the best examples of affection of the offspring by diseased conditions of the parents produced by a toxic agent which directly or indirectly affects all the cells of the body is afforded by alcohol when used in excess. since drunkenness has become a medical rather than a moral question, a great deal of reliable data has accumulated in regard to it as a factor in the heredity of disease. grotjahn gives the following examples: six families were investigated in which there were thirty-one children. in all these families the father and grandfather on the father's side were chronic alcoholics, and in certain of the families drunkenness prevailed in the more remote ancestors. the following was the fate of the children: eight died shortly after birth of general weakness, seven died of convulsions in the first month, three were malformed, three were idiotic, three were feeble-minded, three were dwarfs, three were epileptics, two were normal. in a second group of three families there were twenty children. the fathers were drunkards, but their immediate ancestors were free: four children died of general weakness, three of convulsions in the first month, two were feeble-minded, one was a dwarf, one was an epileptic, seven were normal. in a family in which both father and mother and their ancestors were drunkards there were six children: three died of convulsions within six months, one was an idiot, one a dwarf, and one an epileptic. for comparison there were taken from the same station in life ten families in which there was no drunkenness: three children died from general weakness, three from intestinal troubles, two of nervous affection, two were feeble-minded, two were malformed, fifty were normal. legrain has studied on a larger scale the descendants of two hundred and fifteen families of drunkards in which there were eight hundred and nineteen children. one hundred and forty-five of these were insane, sixty-two were criminals, and one hundred and ninety-seven drunkards. of course all this cannot be attributed to alcohol alone. there is first to be considered a probable variation in the nervous system which is expressed in the alcoholic habit; second, the environment consisting in poverty, bad associates, etc., which the alcoholic habit brings; third, the alcohol alone. that defective inheritance so frequently takes the form of alcoholism is largely due to the environment. there has never been the opportunity to study on a large scale the effect of the complete deprivation of alcohol from a people living in the environment of modern civilization. there is a possibility, and even probability, that the defective nervous organization which predisposes to alcoholism would seek satisfaction in the use of some other sedative drug. so complex are all the interrelations of the social system that it would be possible to regard alcohol as an agent useful in removing the defective, were it not for its long-enduring action and its effects on the descendants, procreation not being affected by its use. diseases of the nervous system are particularly apt to affect the offspring, and often the inherited condition repeats that of the parents. this is due to the fact that most of the nervous diseases depend both upon intrinsic factors which consist in some defective condition of the nervous system representing a variation, and extrinsic factors due to environment or occupation which make the basal condition operative. the definite relation between alcoholism and insanity is due to alcohol acting not as an intrinsic but an extrinsic factor, bringing into effectiveness the hereditary weakness of the nervous system. the influence of heredity in producing insanity is variously estimated at from twenty-six per cent to sixty per cent of all cases. this great difference in the estimation of the hereditary influence is due to the personal equation of the statistician, and the care with which other factors are eliminated. in the more severe form of the hereditary degeneration the same pathological conditions are repeated in the descendants. in certain cases the severity of the condition increases from generation to generation. according to morel there may be merely what is recognized as a nervous temperament often associated with moral depravity and various excesses in the first generation; in the second, severe neuroses, a tendency to apoplexy and alcoholism; in the third, psychic disturbances, suicidal tendencies and intellectual incapacity; and in the fourth, congenital idiocy, malformations and arrests of development. there are some very definite data with regard to inheritance in the nervous disease known as epilepsy. the essential condition in this consists in attacks of unconsciousness, usually accompanied by a discharge of nerve force shown in convulsions, the attack being often preceded by peculiar sensations of some sort known as the aura. in the most marked forms of the affection heredity plays but little part, owing to the early supervention of imbecility and helplessness, and it is a greater factor in the better classes of society than in the proletariat. in the better classes, owing to the greater care of the cases and the avoidance of exciting causes of the attacks, the disease is better controlled and rarely advances to the extent that it does among the poor. the association of epilepsy and alcoholism is especially dangerous, for a slight amount of alcohol may greatly accentuate the disease. in five hundred and thirty-five children in whose parentage there were sixty-two male and seventy-four female epileptics, twenty-two were born dead, one hundred and ninety-five died from convulsions in infancy, twenty-seven died in infancy from other causes, seventy-eight were epileptics, eleven were insane, thirty-nine were paralyzed, forty-five were hysterical, six had st. vitus's dance, one hundred and five were ordinarily healthy. that variations in the nervous system which produce more or less unusual mental peculiarities and which do not take the form of nervous disease are inherited, the most superficial consideration shows. a child in its mental characteristics is said to take after one or the other of its parents, certain habits and mental traits are the same, often even the handwriting of a child resembles that of a parent. in certain cases the inheritance is transmitted by the female alone. this is the case in the hæmophilia, the unfortunate subjects of which are known as bleeders. there is in this a marked tendency to hæmorrhage which depends upon an alteration in the character of the blood which prevents clotting. this, the natural means of stopping bleeding from small wounds, being in abeyance, fatal hæmorrhage may result from pulling a tooth or from an insignificant wound. there is a seeming injustice in the inheritance, for the females do not suffer from the disease although they transmit it, while the males who have the disease cannot even create additional sympathy by transmitting it. the most obvious inheritance is seen in the case of malformations. these represent wide departures from the type of the species as represented in the form. there is no hard and fast line separating the slight departures from the normal type known as variations and mutations, from the malformations. certain of the malformations known as monstrosities hardly represent the human type. these are the cases in which the foetus is represented in a formless mass of tissue, or there is absence of development of important parts such as the nervous system or there is more or less extensive duplication of the body. there has always been a great deal of popular interest attached to the malformations owing to the part which maternal impressions are supposed to play in their production. in this, some striking impression made on the pregnant woman is supposed to affect in a definite way the structure of the child. the cases, for instance, in which a woman sees an accident involving a wound or a loss of an arm and the child at birth shows a malformation involving the same part. there is no association between maternal impressions and malformations, although there have been many striking coincidences. all malformations arise during the first six weeks of pregnancy known as the embryonic period, in which the development of the form of the child is taking place, and during which time there is little consciousness of pregnancy. maternal impressions are usually received at a later period, when the form of the child is complete and it is merely growing. it must be remembered also that there is neither nervous nor vascular connection between the child in the uterus and the mother, the child being from the period of conception an independent entity to which the mother gives nutriment merely. of course, as has been said, the mother may transmit to the child substances which are injurious, and in certain cases parasites may pass from the mother to the foetus. the same types of malformations which occur in man are also seen in birds, and it would require a more vigorous imagination than is usual to believe that a brooding hen could transmit an impression to an egg and that a headless chick could result from witnessing the sacrifice of an associate. the idea of the importance of maternal impressions in influencing the character of the offspring is a very old one, a well-known instance being the sharp practice of jacob's using peeled wands to influence the color of his cattle. in regard to coincidences the great number of cases in which strong impressions made on the mind of the pregnant mother without result on the offspring are forgotten. the belief has been productive of great anxiety and even unhappiness during a period which is necessarily a trying one, and should be dismissed as being both theoretically impossible and unsupported by fact. the malformations are divided anatomically into those characterized, first, by excess formation, second, by deficient formation, third, by abnormal displacement of parts. they are due to intrinsic causes which are in the germ, and which may be due to some unusual conditions in either the male or female germ cell or an imperfect commingling of the germinal material, and to extrinsic causes which physically, as in the nature of a shock or chemically as by the action of a poison, may affect the embryo through the mother. malformations are made more numerous in chickens by shaking the eggs before brooding. a number of malformations are produced by accidental conditions arising in the environment; for instance, the vascular cord connecting mother and child may become wound around parts constricting them or even cutting them off, and the membrane around the child may become adherent to certain parts and prevent the development of these. the extrinsic causes are more operative the more unfavorable is the environment of the mother. malformations are more common in illegitimate children than in legitimate and more common in alcoholic mothers; there is an unfavorable environment of poverty in both cases, added to in the latter and usually in the former by the injurious action of the alcohol. the more extensive malformations have no effect on heredity, because the subjects of them are incapable of procreation. the malformations which arise from the accidents of pregnancy and which are compatible with a perfectly normal germ are in the nature of acquired characteristics and are not inherited. those malformations, however, which are due to qualities in the germinal material itself are inherited, and certain of them with remarkable persistence. there are instances in which the slight malformation consisting in an excess of fingers or toes has persisted through many generations. it may occasionally lapse in a generation to reappear later. in certain cases, notably in the bleeders, the inheritance is transmitted by the female alone, in other cases by the sexes equally, but there are no cases of transmission by the male line only. it is evident that when the same malformation affects both the male and the female line the hereditary influence is much stronger. a case has been related to me in which most of the inhabitants in a remote mountain valley in virginia where there has been much intermarriage have one of the joints of the fingers missing. there is a very prevalent idea that in close intermarriage in families variations and malformations often unfortunate for the individual are more common. all experimental evidence obtained by interbreeding of animals shows that close interbreeding is not productive of variation, but that variations existing in the breed become accentuated. variations either advantageous or disadvantageous for the race or individual may either of them become more prevalent by close intermarriage. it seems, however, to have been shown by the customs of the human race that very close intermarriage is disadvantageous. eugenics, which signifies an attempt at the betterment of the race by the avoidance of bad heredity, has within recent years attracted much attention and is of importance. some of its advocates have become so enthusiastic as to believe that it will be possible to breed men as cattle and ultimately to produce a race ideally perfect. it is true that by careful selection and regulation of marriage certain variations, whether relating to coarse bodily form or to the less obvious changes denoted by function, can be perpetuated and strengthened. that the semitic race excels in commerce is probably due to the fact that the variation of the brain which affected favorably the mental action conducive to this form of activity, was favorable for the race in the hostile environment in which it was usually placed and transmitted and strengthened by close intermarriage. it is impossible, however, to form a conception of what may be regarded as an ideal type of the human species. the type which might be ideal in a certain environment might not be ideal in another, and environment is probably of equal importance with the material. the eugenics movement has enormously stimulated research into heredity by the methods both of animal experimentation and observation, and study of heredity in man. as in all of the beginning sciences there is not the close inter-relation of observed facts and theory, but there is excess of theory and dearth of facts. certain considerations, however, seem to be evident. it would seem to be evident that individuals should be healthy and enabled to maintain themselves in the environment in which they are placed, but the qualities which may enable an individual successfully to adapt himself to factory life, or life in the crowds and strong competition of the city, may not be, and probably are not, qualities which are good for the race in general or for his immediate descendants. at present our attempts to influence heredity should be limited to the heredity of disease only. we can certainly say that intermarriage between persons who have tuberculosis or in whose families the disease has prevailed is disadvantageous for the offspring; the same holds true for insanity and for nervous diseases of all sorts, for forms of criminality, for alcoholism, and for those diseases which are long enduring and transmitted by sexual contact such as syphilis and gonorrhoea. it is of importance that the facts bearing on the hereditary transmission of disease should become of general knowledge, in order that the dangers may be known and voluntarily avoided. no measures of preventive medicine are successful which are not supported by a public educated to appreciate their importance, and the same holds true of eugenics. how successful will be public measures leading to the prevention of offspring in the obviously unfit by sterilization of both males and females is uncertain. it is doubtful whether public sentiment at the present time will allow the measure to be thoroughly carried out. some results in preventing unfit heredity may be attained by the greater extension of asylum life, but the additional burden of this upon the labor of the people would be difficult to bear. at best such measures would only be carried out in the lower class of society. chapter xi chronic diseases.--disease of the heart as an example.--the structure and function of the heart.--the action of the valves.--the production of heart disease by infection.--the conditions produced in the valves.--the manner in which disease of the valves interferes with their function.--the compensation of injury by increased action of heart.--the enlargement of the heart.--the result of imperfect work of the heart.--venous congestion.--dropsy.--chronic disease of the nervous system.--insanity.--relation between insanity and criminality.--alcoholism and syphilis frequent causes of insanity.--the direct and indirect causes of nervous diseases.--the relation between social life and nervous diseases.--functional and organic disease.--neurasthenia. chronic diseases are diseases of long duration and which do not tend to result in complete recovery; in certain cases a cause of disease persists in the body producing constant damage, or in the course of disease some organ or organs of the body are damaged beyond the capacity of repair, and the imperfect action of such damaged organs interferes with the harmonious inter-relation of organs and the general well-being of the body. the effect of damage in producing chronic disease may not appear at once, for the great power of adaptation of organs and the exercise of reserve force may for a time render the damage imperceptible; when, however, age or the supervention of further injury diminishes the power of adaptation the condition of disease becomes evident. chronic disease may be caused by parasites when the relation between host and parasite is not in high degree inimical, as in tuberculosis, gonorrhoea, syphilis, most of the trypanosome diseases and the diseases produced by the higher parasites. in certain cases the chronic disease represents really a series of acute onsets; thus in the case of the parasites there may be periods of complete quiescence of infection but not recovery, the parasites remaining in the body and attacking when the defences of the body are in some way weakened. in such cases there may be temporary immunity produced by each excursion of the disease, but the immunity is not permanent nor is the parasite destroyed. there is a further connection between chronic disease and infection in that the damage to the organs, which is the great factor underlying chronic disease, is so often the result of an infection. the infectious diseases are those of early life; chronic disease, on the other hand, is most common in the latter third of life. this is due to the fact that in consequence of the general wear of the body this becomes less resistant, less capable of adaptation, and organic injury, which in the younger individual would be in some way compensated for, becomes operative. the territory of chronic disease is so vast that not even a superficial review of the diseases coming under this category can be attempted in the limits of this book, and it will be best to give single examples only, for the same general principles apply to all. one of the best examples is given in chronic disease of the heart. the heart is a hollow organ forming a part of the blood vascular system and serving to give motion to the blood within the vessels by the contraction of its strong muscular walls. it is essentially a pump, and, as in a pump, the direction which the fluid takes when forced out of its cavity by the contraction of the walls diminishing or closing the cavity space, is determined by valves. the contraction of the heart, which takes place seventy to eighty times in a minute, is automatic and is due to the essential quality of the muscle which composes it. the character, frequency and force of contraction, however, can be influenced by the nervous system and by the direct action of substances upon the heart muscle. the heart is divided by a longitudinal partition into a right and left cavity, and these cavities are divided by transverse septa, with openings in them controlled by valves, each into two chambers termed _auricle_ and _ventricle_. the auricle and ventricle on each side are completely separated. the circulation of the blood through the heart is as follows: the blood, which in the veins of the body is flowing towards the heart, passes by two channels, which respectively receive the blood from the upper and lower part of the body, into the right auricle. when this becomes distended it contracts, forcing the blood into the right ventricle; the ventricle then contracts and sends the blood into the arteries of the lungs, the passage of blood into the auricle being prevented by valves which close the opening between auricle and ventricle when the latter contracts upon its contents. when the ventricle empties by its contraction the wall relaxes and the back flow from the artery is prevented by crescentic-shaped valves placed where the artery joins the ventricle. a similar arrangement of valves is on the left side of the heart. the pressure given the blood by the contraction of the right ventricle sends it through the lungs; from these, after it has been oxygenated, it passes into the left auricle, then into the left ventricle and from this into the great artery of the body, the aorta, which gives off branches supplying the capillaries of all parts of the body. both of the auricles and both of the ventricles contract at the same, time, the ventricular contraction following closely upon the contraction of the auricles. contraction or systole is followed by a pause or diastole during which the blood flows from the veins into the auricles. the work which the right ventricle accomplishes is very much less than that of the left, and the right ventricle has a correspondingly thinner wall. the size of the heart is influenced by the size and the occupation of the individual being larger in the large individual than in the small, and larger in the active and vigorous than in the inactive. generally speaking, the heart is about as large as the closed fist of its possessor. imperfections of the heart which interfere with its action may be the result of failure of development or disease. an imperfect heart which can, however, fully meet the limited demands made upon it in intra-uterine life, may be incapable of the work placed upon it in extra-uterine life. children with imperfectly formed hearts may be otherwise perfect at birth, but they have a bluish color due to the imperfect supply of the blood with oxygen, and are known as blue babies. the condition becomes progressively worse due to the progressive demands made upon the heart, and death takes place after some days or months or years, the time depending upon the degree of the imperfection. much of the damage of the heart in later life is due to infection. the valves of the heart are a favorite place for attack by certain sorts of bacteria which get into the blood. this is due to the prominent position of the valves which brings them in contact with all the blood in the body, the large extent and unevenness of the surface and to the rubbing together and contact of their edges when closed. at the site of infection there is a slight destruction of tissue and on this the blood clots producing rough wart-like projections. the valves in some cases are to a greater or less extent destroyed, they may become greatly thickened and by the deposit of lime salts converted into hard, stony masses. essentially two conditions are produced. in one the thickened, unyielding valves project across the openings they should guard, and thus by constricting the opening interfere with the passage of blood either through the heart or from it. in the other the valves are so damaged that they cannot properly close the orifices they guard, and on or after the contraction of the cavities there is back flow or regurgitation of the blood. if, for instance, the orifice of the heart into the aorta is narrowed, then the left ventricle can only accomplish its work of projecting into the aorta a given amount of blood in a given time by contracting with greater force and giving a greater rapidity to the stream passing through the narrow orifice. this the heart can do because, like all other organs of the body, it has a large reserve force which enables it, even suddenly, to meet demands double the usual, and like all other muscles of the body it becomes larger and stronger by increased work. the condition here is much simpler than when the same valve is incapable of perfect closure, or when both obstruction and imperfect closure, are combined as they not infrequently are. in such cases the ventricle must do more than in the first case. it must force through the orifice, which may be narrowed, the amount of blood which is necessary to keep up the pressure within the aorta and give to the circulation the necessary rapidity of flow, and also the amount which flows back into the heart through the imperfectly acting valve. this it can do by contracting with greater force upon a larger amount of blood, the cavity becoming enlarged to receive this. not only may such damage to the valves be produced, but the muscular tissue of the heart may suffer from defective nutrition or from the effect of poisons, whether these are formed in the body as the effect of disease or introduced from without; or in consequence of disease in the lungs the flow of blood through them may be impeded, or disease elsewhere in the body, as in the kidneys may, by increasing the pressure of the blood within the arteries, throw more than the usual amount of work upon the heart. the power of the heart in meeting these conditions, however various they are and however variously they act, seems little short of marvellous, and it goes on throwing three and one-third ounces of blood seventy or eighty times a minute into a tube against nine feet of water pressure, working often perfectly under conditions which would be fatal to a machine. as long as this goes on the injury is said to be compensated for; the increased work which the heart is able to accomplish by the exercise of its reserve force and by becoming larger and stronger enables it to cope with the adverse conditions. with increased demand for work there is a gradual diminution of the reserve force. an individual may be able to carry easily forty pounds up a hill and by exerting all his force may carry eighty pounds, but if he habitually carries the eighty pounds, even though the muscles become stronger by exercise the load cannot be again doubled. the dilatation of the heart which is so important in compensation is fraught with danger, because any weakening of the muscle increases the dilatation, until a point is reached when, owing to the dilatation of the orifices between auricles and ventricles, the valves become incompetent to close them. when the heart is not able to accomplish its work, the effect of the condition becomes apparent by the accumulation of blood within the veins and a less active circulation. this affects the nutrition and the capacity for work of all the organs of the body, and the imperfect function of the organs may in a variety of ways make still greater demands upon an already overloaded heart. other conditions supervene. the increased pressure within the veins and capillaries due to the impossibility of the blood in the usual amount passing through or from the heart increases the amount of fluid in the tissues. there is always an interchange between the blood within the vessels and the fluid outside of them; the passage of fluid from the vessels is facilitated by the increased pressure within them, just as pressure upon a filtering fluid increases the rapidity of filtration, and the increase of pressure within veins and capillaries impedes passage of tissue fluid into them. the fluid accumulates within the tissues leading to dropsy, or the accumulation may take place in some of the cavities of the body. the diminished flow of blood through the lungs prevents its proper oxygenation; this may also be interfered with by the accumulation of fluid within the air spaces of the lungs. every additional burden thrown upon the heart increases the evil. in women the additional burden of pregnancy may suffice to overcome a compensation which has been perfect, and the same may result from an acute attack of disease. age, diminishing as it does the capacity for work in all organs, diminishes the compensation capacity of the heart, and a heart which at the age of forty acts perfectly may break down at the age of fifty. compensation may be gained in other ways, as by reducing the demand made upon the heart by changing the mode of life, by leading an inactive rather than an active life, by avoiding excitement or any condition which entails work of the heart. social conditions are of great importance; it makes a great difference whether the unfortunate possessor of such a heart be a stevedore whose capital lies in the strength of his muscles, or a more fortunately placed member of society for whom the stevedore works and whose occupation or lack of occupation does not interfere with the adjustment of his external relations to the condition of his heart. disease of the nervous system does not differ from disease elsewhere. the system is complex in structure and in function. it consists in nerves which are composed of very fine fibrils distributed in all parts of the body and serve the purpose of conduction, and a central body composed of the brain and spinal cord which is largely cellular in character; it receives impressions by means of the nerves and sends out impulses which produce or affect action in all parts. by means of the organs of special sense, the brain receives impressions from the outer world which it transforms into the concepts of consciousness. many of the impressions which the central nervous system receives from nerves other than those of special sense and even many of the impressions from these and the impulses which it sends out do not affect consciousness. the memory faculty is seated in the brain and all parts of the brain are closely connected by means of small nerve fibres. the nervous system plays an important part in the internal regulation and coordination of all parts of the body, and it is by means of this that the general adjustment of man with his environment is effected. malformations of the brain, except very gross conditions which are incompatible with extra-uterine existence, are not very common. at birth those parts of the brain which are the seat of memory and what are understood as the higher faculties are very imperfectly developed. variations in structure are extremely common, there are differences in different individuals in the nerves and in the number, size, form and arrangement of the nerve cells, and so complex is the structure that considerable variation can exist without detection. the tissue of the central nervous system has a considerable degree of resistance to the action of bacteria, but is, however, very susceptible to injury by means of poisons. serious injury or destruction of tissue of the brain and spinal cord is never regenerated or repaired, but adjustment to such conditions may be effected by reciprocity of function, other cells taking up the functions of those which were destroyed. certain parts of the brain are associated with definite functions; thus, there are areas which influence or control speech and motion of parts as the arm or leg, and there are large areas known as the silent areas whose function we do not know. all activity of the central nervous system, however expressed, is due to cell activity and is associated with consumption of cell material which is renewed in periods of repose and sleep. fig. shows a nerve cell of a sparrow at the end of a day's activity and the same after the repose of a night. diseases of the nervous system have a special interest in that they so often interfere with man in his relations with his fellows. in diseases of other organs the disturbances set up concern the individual only. thus, others need not be disturbed save by the demands made on their sympathies by an individual with a cold in the head or a cancer of the stomach. disease of the nervous system is another affair, instead of those reactions and expressions of activity to which we are accustomed and to which society is adjusted, the reactions and activities are unusual and the individual in consequence does not fit into the social state and is said to be anti-social. there are all possible grades of this, from mere unpleasantness in the social relations with such an individual, to states in which he is dangerous to society and must be isolated from it. insanity is an extreme case. there is no disease signified in the expression, but it is merely a legal term to designate those individuals whose actions are opposed to the social state and who are not responsible for them. in insanity there is falsity in impressions, in conceptions, in judgment, a defective power of will and an uncontrollable violence of emotion. the individual is prevented from thinking the thoughts or feeling the feelings and doing the duties of the social body in the community in which he lives. the insane are out of harmony with their social environment, but not necessarily in opposition to it. there is no very sharp line between insanity and criminality. the criminal is in direct antagonism to the laws of social life. an insane person may cause the same injury to society as a criminal, but his actions are not voluntary, whereas the criminal is one who can control his actions, but does not. mentally degenerated persons, however, can be both insane and criminal. whatever the state of society, this reprobates the actions of one opposed to it; in a society in which it were usual to appropriate the possessions of others or to devour unpleasant or useless relatives, virtue and lack of appetite would be reprobated as unsocial. the symptoms of insanity or the manner in which the defective action of the brain expresses itself and the various underlying pathological changes vary, and by combining these it has been possible to subdivide insanity into a number of distinct forms. there are both intrinsic and extrinsic causes of insanity. the intrinsic are the structural differences in the brain as compared with the normal or usual, whether these are due to imperfection in development or to defective heredity or to the injury of disease; the extrinsic causes are those which come from without and bring the intrinsic into activity. syphilis is a frequent cause of insanity, and probably the only cause of the condition known as general paralysis of the insane, acting by means of the injury which it produces in the cortex of the brain. the abuse of alcohol is another fertile cause, but the changes produced in this are not so obvious as in the case of syphilis. tumors of the brain are not infrequently a cause, and the same is true of infections, even those not located in the brain. how susceptible the brain is to the effects of the toxines of the infectious diseases is shown in the frequency of delirium in these diseases. there is an interesting relation between this and alcoholism. alcohol abuse may produce injury, but not sufficient to manifest itself under ordinary conditions; when, however, the action of toxic substance is superadded to the effect of the alcohol the delirium of fever is more marked. probably of greater importance than the acquired pathological conditions of the brain in producing insanity is a congenital condition in which the nervous system is defective. the most fertile cause of insanity lies in the inheritance; by this it must not be understood that insane parents produce insane offsprings, but that conditions inherited from immediate or remote ancestors appear in a diminished resistance of the nervous system which is sooner or later expressed as insanity. given such a defective nervous system, extrinsic conditions which would have no effect on another individual or would be felt in different ways may produce insanity. in these cases occupation plays a great role. the excitement and privations of war especially in the tropics and the ennui of camps leads to insanity in soldiers; occupations such as that of the baker in which there is loss of sleep and the mental strain of students can all act in the same way. a woman who gives no sign of nervous defect may become insane under the strain of pregnancy. although insanity is determined by the social relations of man, that part of the social organization which is termed _society_, and which has been developed by the idle as a diverting game, is a fertile source of nervous disease and even of insanity, affecting particularly females. the strenuosity of the life, the nervous excitement alternating with ennui, the lack and improper times of sleep, the lack of rest and particularly of restful occupation, the not infrequent use of alcohol in injurious amounts, are all factors calculated to make a defect operative. the so-called "coming out" of young girls is an important element in the game, and their headlong plunge into such a life at a period under any conditions full of danger to the nervous system is especially to be reprobated. if we consider the influence of the game in other respects as conducing to lack of moral sense, to alcoholic abuse (for without the seeming stimulation, but which is really the blunting of impressions which alcohol brings, the game would not be possible), to discontent, to mental enfeeblement, it is all bad. curiously enough the game is one which in all periods has been played by the idle, but its evil influence is greater now than before when it was the game of royalty chiefly, because there are now more people living from the work of others. the unusual mental action of the insane not infrequently expresses itself by suicide. the analysis of three hundred deaths from suicide showed pathological changes in the brain in forty-three per cent, and when we think that mental disturbances are very often without recognizable anatomical changes after death, the percentage is very large. in another analysis of one hundred and twenty-four suicides forty-four of these were mentally affected to various degrees. five of the men and seven women were epileptics, in ten of the families there was hysteria, twenty-four of the men and four of the women were chronic alcoholics. it is extremely difficult at the present time to say whether insanity is increasing. statistics in all lands giving the numbers committed to insane hospitals show on their face a great increase, but so many factors enter into these statistics that their value is uncertain. there is now an ever-increasing provision for the care of the insane. owing to the recognition of insanity as a part of nervous disease and its separation from criminality there is no longer the same attempt to conceal it as was formerly the case, and hospitals for the insane are no longer associated with ideas of bedlam. it is generally believed that modern conditions in the hurry and excitement of life, and the extreme social differences, the greater urban life, the greater extension of factory life, all tend to an increase in insanity, but there is no absolute proof that this is true. we know very little about insanity in the middle ages, but the conditions then were not conducive to a quiet life. there prevailed then as now excess and want, luxury and poverty, enjoyment and deprivations, balls and dinner parties and other features of the social game. there were factions in the cities, public executions, not infrequent sieges, scenes of horror, epidemics, famines, and all these combined with religious superstition and the often unjust and cruel laws should have been factors for insanity. there were actual epidemics of insanity affecting masses of the population, as shown in the children's crusade, the jewish massacres and the dancing mania in the rhine provinces. where civilization seems to be the highest, statistics show the most insane, but this most probably depends upon better recognition of the condition and better provision for asylum care. the so-called functional diseases have a close relation with diseases of the nervous system, for they chiefly concern the reactions of nerve tissue. disease expressing itself in disturbance of function only, does not seem to fit in with the conceptions of disease which have been expressed, nor can we imagine a disturbance of function which does not depend upon a change of material. living matter does not differ intrinsically from any other sort of matter; like other matter its reactions depend upon its composition structure[ ] and the character of the action exerted upon it. by functional disease there is expressed merely that no anatomical or chemical change is discoverable in the material which gives the unusual reaction. the further our researches into the nature of disease extend, particularly the researches into the physiology and chemistry of disease, the smaller is the area of functional disease. in functional disease there may be either vague discomfort or actual pain under conditions when usually such would not be experienced, and on examination no condition is found which in the vast majority of cases would alone give rise to that impression on the nervous system which is interpreted as pain. in the production of the sensations of disease there can be change at any place along the line, in the sense organs, in the conducting paths or in the central organ. thus there may be false visual impressions which may be due to changes in the retina or in the optic nerve or in the brain matter to which the nerve is distributed. it is perfectly possible that substances of an unusual character or an excess or deficiency of usual substances in the fluids around brain cells may so change them that such unusual reactions appear. there may be, of course, very marked individual susceptibility, which may be congenital or acquired. the perception of every stimulus involves activity of the nerve cells, and it is possible that the constant repetition of stimuli of an ordinary character may produce sufficient change to give rise to unusual reactions, and this particularly when there is lack of the restoration which repose and sleep bring. we know into what a condition one's nervous system may be thrown by the incessant noise attending the erection of a building in the vicinity of one's house or the pounding of a plumber working within the house, this being accentuated in the latter case by the thought of impending financial disaster. even the confused and disagreeable sound due to the clatter of high-pitched women's voices at teas and receptions may, when frequently repeated, be productive of changes in the nerve cells sufficiently marked to give rise to the unusual reactions which are evidence of disease. in the condition known as neurasthenia, which is often taken as a type of a functional disease, the basal and intrinsic cause is activity of the nervous system with the using up of material which is not compensated for by the renewal which comes in repose and sleep. neurasthenia is one of the common conditions of our civilization, found among children and adults, the poor and rich, the idle and the factory worker; it is rife in the scholastic professions and among those who earn their living by brain work. it seems to be more common in the upper classes and particularly in the women, but this is because these are more subject to medical care and the condition is more in evidence. there are all sorts of symptoms attached to the condition, for the unusual mental action can be variously expressed. the cerebral form has been thus described by a well-known medical writer: "one of the most characteristic features of cerebral neurasthenia is a weary brain. the sensation is familiar enough to any fagged man, especially if he fall short of sleep. impressions seem to go half into one's head and there sink into a woolly bed and die. voices sound far off, the lines of a book run into one another and the meaning of them passes unperceived. doors bang and windows rattle as they never did before; if a shoestring breaks, an imprecation is upon the lips. business matters are in a conspiracy to go wrong. letters are left unopened partly from want of will, partly from a senseless dread lest they contain bad news. at night the patient tosses on his bed possessed by all the cares which blacken with darkness. headache is common, loss of memory is distressing, and in severe cases it is wider and deeper than mere inattention can explain. there is often the torture of acute hearing, or an inability to suppress attention; the hater of clocks and crowing cocks is a neurasthenic." the disease is especially common in the women players of the social game, and its unhappy victims too often seek relief from the nervous irritability which is a common early symptom in still greater nervous excitement. it is a sad commentary on our civilization that one of the means of treatment for these persons which has been found efficacious is to supply them with some restful household occupation such as knitting or plain sewing, and there are institutions which combine refuge from social activities, often called duties, with simple occupation. footnote: [ ] by structure as used in this wide sense, there must be understood not merely the anatomical structure, which is revealed by the dissecting knife and microscope, but molecular structure, or the manner in which elements are arranged to form the molecule, as well. chapter xii the rapid development of medicine in the last fifty years.--the influence of darwin.--preventive medicine.--the dissemination of medical knowledge.--the development of conditions in recent years which act as factors of disease.--factory life.--urban life.--the increase of communication between peoples.--the introduction of plant parasites.--the increase in asylum life.--infant mortality.--wealth and poverty as factors in disease. certain conditions have arisen in the past fifty years which have profoundly affected the thoughts, the beliefs and the activities of man. within this period what is generally known as darwinism, including under this evolution, has developed. unlike theories which came from philosophical speculation only, the theory of evolution was one which could be subjected to observation and experiment. it freed man's mind from dogmas, it stimulated the imagination, it enlarged the territory in which it seemed possible to extend knowledge by the methods of science, and has resulted in an enormous increase of knowledge. this has been more striking in medical science than elsewhere, and in this of more far-reaching influence. evolution coincided with another important development. history shows that all great periods of civilization have at their back sources of energy. in the civilizations of the past such sources of energy have come from the enslavement of conquered peoples or from commerce, or more direct forms of robbery, which have enabled a favored class to appropriate for its purposes the results of the work of others. while these sources have not been absent in the development of our civilization, the great source of energy has come from the rapid, and usually wasteful and reckless, utilization of the stored energy of the earth. the almost incredible advance in medical and other forms of scientific knowledge and the utilization of this knowledge is largely due to the greater forces which we have become possessed of. disease plays such a large part in the life of man and is so closely related to all of his activities that the changes in this period must have exerted an influence on disease. we have already seen that within the period we have obtained knowledge of the causes of disease and the conditions under which these causes became operative. the mystery which formerly enveloped disease is gone; disease is recognized as due to conditions which for the most part are within the control of man, and like gravity and chemical attraction it follows the operation of definite laws. there has been developed within the period what is known as preventive medicine, which aims rather at prevention than cure, and the resources of prevention are capable of much greater extension. have there been new conditions developed within the period, or an increase of existing conditions which can be regarded as disease factors and which counterbalance the results which have come from the knowledge of prevention and cure? there has been an increase of certain factors of immense importance in the extension of disease. these are: . the increase in industrialism, involving as this does an increase in factory life. in many ways this is a factor in disease. (_a_) by favoring the extension of infection, particularly in such diseases as tuberculosis. (_b_) the life indoors, and frequently with the combination of insufficient air and space, produces a condition of malnutrition and deficient general resistance. (_c_) the family life is interfered with by the mothers, whose primary duty is the care of home and children, working in factories, and the too frequent conversion of the house into a factory. (_d_) the influence of factory life is towards a loss of moral stamina rendering more easy of operation the conditions of alcoholism and general immorality. how great has been this increase in industrialism, fostered as it has been by conditions both natural and artificially created by unwise legislation, is shown in the figures from the last census. the number of factory operatives increased forty per cent between and and the total population of the country in the period between and increased twenty per cent. it is probable that the future will see an extension rather than a diminution of mass labor. . the increase in urban life is as conspicuous as the increase in industrialism. in , twenty-nine and five-tenths per cent of the population was urban and seventy and five-tenths per cent was rural; in , forty-six and three-tenths per cent was urban and fifty-three and seven-tenths was rural, the increase being most marked in cities of over five hundred thousand inhabitants. of the total increase in population between and , seven-tenths per cent was in the cities and three-tenths per cent in the country. city life in itself is not necessarily unhealthy and there are many advantages associated with it. the conditions which have chiefly fostered it are the immigration of people who are accustomed to community life, the increase in factory life and the increased number of people of wealth who seek the advantages which the city gives them. the city has always been the favored playground for the social game. the unhealthy conditions of city life are due to the crowding, the more uncertain means of livelihood, the greater influence of vice and alcoholism. prostitution and the sexual diseases are almost the prerogatives of the cities. . all means of transportation have increased and communication between peoples has become more extended and more rapid. in the past isolation was one of the safeguards of the people against disease. with the increase and greater rapidity of communication there is a tendency not only to loss of individuality in nations as expressed in dress, customs, traditions and beliefs, but many diseases are no longer so strictly local as formerly--pellagra, for example. only those diseases which are transmitted by insects which have a strictly local habitat remain endemic, although the region of endemic prevalence may become greatly extended, as is seen in the distribution of sleeping sickness. diseases of plants and of animals have become disseminated. any plants desirable for economic use or for beauty of foliage and flower become generally distributed, their parasites are removed from the regions where harmonious parasitic inter-relations have been established, and in new regions the parasites may not find the former restrictions to their growth. there have been many examples of this, such as the ravages of the brown-tail and gypsy moths which were introduced into new england and of the san jose scale which was introduced into california. there have been many other examples of the almost incredible power of multiplication of an animal or plant when taken into a new environment, removed from conditions which held it in check, as the introduction of the mongoose into jamaica, the rabbit into australia, the thistle into new south wales and the water-plant chara into england. it is very difficult to say, but it seems as though there is an increasing unevenness in the distribution of wealth, an increase in the number of persons who live at the expense of the laboring class. mass labor, effective though it be, makes it easier to divert the proceeds of labor from the laborers. the evidence of this is seen in the increase in number and the prosperity of those pursuits which purvey to luxury, as the automobile industry and the florists' trade and the greatly increased scope and activity of the social game. on the other hand, there is an increase in the number of people who are to a greater or less extent dependent upon extraneous aid, evinced among other ways by the increase in the asylum populations. both these conditions, wealth and poverty, are important disease factors. tuberculosis is now a disease of the proletariat chiefly. the measures both of prevention and cure can be and are carried out by the well-to-do, but the disease must remain where there are the conditions of the slums. of all the conditions favoring infant mortality poverty comes first. in erfurt, a small city of germany, of one thousand infants born in each of the different classes, there died of the illegitimate children three hundren and fifty-two; of those of the laboring class, three hundred and five; of those in the medium station (official class largely), one hundred and seventy-three; of those in higher station, eighty-nine. the same relation of infant mortality to poverty becomes apparent when estimated in other ways. in berlin, with an average infant mortality of one hundred and ninety-six per thousand, the deaths in the best districts of the city were fifty-two and in the poorer quarters four hundred and twenty. the effect of poverty is seen particularly in the bottle-fed infants; with natural nursing the child of poverty has almost as good a chance as the child of wealth. from reasons which are almost self-evident, the mortality in illegitimate infants is almost double that of the legitimate. the greater infant mortality in poverty is due to the more numerous children preventing individual care, the separation of the mother from the nursing child in consequence of the demand made upon her earning capacity, and the decline in breast nursing. wealth is on the whole more advantageous from the narrow point of view of disease than is poverty, but if we regard its influence on the race its advantages are not so evident. nothing can be worse for a race than that it should die out, and wealthy families have never reproduced themselves. conditions always tending to destruction are a necessary part of the environment of poverty; wealth voluntarily creates these conditions, and chiefly by the pernicious influence of its amusements on the young. a new and in many respects a nobler conception of medicine has been developed. formerly medical practice was almost exclusively a personal service to the sick individual, and measures looking toward the general relief of disease and its prevention received scanty consideration. the idea of a wider service to the city, to the state, to the nation, to humanity rather than the personal service to the individual, is becoming dominant in medicine. this is seen in the establishment of laboratories by boards of health in cities and states in which knowledge obtained by exact investigations can be made of direct service to the people; in the medical inspection of schools and factories; in promulgating laws directed against conditions which affect health, in the extension of hospitals, and in divers other ways. the idea of public service and of returning to the people in an effective way some of the results of their labor also underlies the large donations which have been given for the creation of special laboratories and institutes in which, through research, greater knowledge of disease may be obtained and made available. the researches which have been made on the nutrition of man and the nutritive value of different foods are of great importance, and this knowledge has not yet begun to be applied as it should be. there seems to be a balance maintained between the restriction of disease by prevention and the increased influence of social conditions which are in themselves factors of disease. preventive medicine seems to have made possible, by restricting their harmful influence, the increase in industrialism, in urban life, and in the intercommunications of peoples. the most important aid in the future to the influence of preventive medicine must be the education of the people so that the conditions of disease, the intrinsic and the extrinsic causes and the manner in which these act, shall all become a part of general knowledge, and the sympathy of the people with health legislation and their active assistance in carrying out measures of prevention may be obtained. the effect of social conditions on disease must become more generally recognized. glossary atrophy--a condition of imperfect nutrition producing diminution in size and loss of function of parts. bertillon--a french anthropologist who devised a system of measurements of the human body for purposes of identification. blood-plasma--the fluid of the blood. cell--the unit of living matter. living things may be unicellular or composed of a multitude of cells which are interdependent. the general mass of material forming the cell is termed cytoplasm. in this there is a differentiated area termed nucleus which governs the multiplication of cells. in the nucleus is a material termed chromatin which bears the factors of heredity. chemotropism--the influence of chemical substances in directing the movement of organisms. exudate--the material which passes from the blood into an injured part and causes the swelling. fibrin--the gelatinous material formed in the blood when it clots. hÆmoglobin--a substance which gives the red color to the blood; by means of its ready combination with the oxygen of the air in the lungs this necessary element is carried to all parts of the body. inflammation--literally a "burning"; the changes which take place in a part after injury. lymph--the fluid which is contained in the lymphatic vessels--nodes. circumscribed masses of cells connected with the lymphatic vessels. osmosis--the process of diffusion between fluids of different molecular pressures. spore formation--a mode of reproduction in lower forms of life by which resistant bodies, _spores_, are formed. these have many analogies with the seed of higher plants. symbiosis--a mutual adaptation between parasite and host. transudation--the normal interchange of fluid between the blood and the tissue fluids. the material interchanged is the transudate. tropism--the influence of forces which direct the movement of cells. ultra-microscope--a form of microscope which by means of oblique illumination renders visible objects so small as to be invisible with the ordinary microscope. virus--a substance either living or formed by living things which may cause disease. index amoeba, anthrax, antitoxin, bacteria, adaptation in, ærobic, anærobic, artificial cultivation of, distribution in nature, growth and reproduction, mode of action in disease, size, spore formation, substances affecting growth of, toxin production by, variations in, blood, circulation of, , vessels, body, defenses of, organs of, reserve force of, surfaces of, brain, cerebro-spinal meningitis, chemotropism, cretinism, darwinism, death, decomposition after, rigor after, signs of, disease, action of poisons, acute and chronic, industrialism as factor in, lesions of, superstitions concerning, urban life as factor in, wealth and poverty as factors in, ductless glands, embryo, epilepsy, eugenics, foetus, infection of, foot and mouth disease, glands, growth, heart, , disease of, heliotropism, heredity, influence of alcohol, of insanity, variations and imitations, hookworm disease, immunity, theories of, natural, infection, from external surface, from genito-urinary surface, from lungs, from mouth, from stomach and intestines, from wounds, in children, in wild animals, latent, mixed, racial susceptibility to, resistance to, by air, by insects, infectious diseases, carriers of, comparison with fermentation, epidemics of, endemic, epidemic and sporadic forms, modes of transmission, inflammation, acute and chronic, injury, - insanity, causes of, question of increase, lesion, leucocytes, migration of, living matter, malaria, rôle of mosquito in transmitting, malformations, heredity of, maternal impressions, nervous system, disease of, effect of social life on, neurasthenia, old age, atrophy in, blood vessels in, causes of death in, in animals and plants, mental activity in, osmosis, opsonius, ovum, fertilization of, infection of, phagocytosis, plague, transmission by animals, plasmodium malariae, preventive medicine, protozoa, distribution in nature, mode of growth, sexual differentiation, spore formation, polyomyelitis, repair, conditions influencing, scar, skin, sleeping sickness, smallpox, spontaneous generation, sunburn, syphilis, tetanus, thymus, thyroid, tonsils, toxins, tropisms, trypanosomes, tuberculosis, infection by sputum, modes of extension, tumors, benign and malignant, cells of, color, size and shape, growth of, importance of, origin of, question of increase, theories of cause, treatment of, typhoid fever, ultra-microscopic organisms, virus, yellow fever, proofreading team. epilepsy, hysteria, and neurasthenia their causes, symptoms, & treatment by isaac g. briggs a.r.s.i. methuen & co. ltd. essex street w.c. london _first published in _ * * * * * to albert e. woodruff of stoke prior nr. bromsgrove my old schoolmaster * * * * * contents chapter page preface ix i. major and minor epilepsy ii. rarer types of epilepsy iii. general remarks iv. causes of epilepsy v. prevention of attacks vi. first-aid to victims vii. neurasthenia viii. hysteria ix. advice to neuropaths x. first steps toward health xi. digestion xii. indigestion xiii. dieting xiv. constipation xv. general hygiene xvi. sleeplessness xvii. the effects of imagination xviii. suggestion treatment xix. medicines xx. patent medicines xxi. training the nervous child xxii. dangers at and after puberty xxiii. work and play xxiv. heredity xxv. character xxvi. marriage xxvii. summary bibliography index * * * * * preface i hope this book will meet a real need, for when one considers how prevalent epilepsy, hysteria and neurasthenia are, among all ranks and ages of both sexes, it seems remarkable some such popular book was not written long ago. i add nothing to our knowledge of these ills, my object being to put what we know into simple words, and to insist on the necessity for personal discipline being allied to expert aid. the book aims at helping, not ousting, the doctor, who may find it of use in getting his patient to see--and to act on--the obvious. "nervous disease", as here used, includes only the three diseases treated of; "neuropath"--victims of them. "advice" to a neuropath is usually a very depressing decalogue of "thou shalt nots!" if it be made clear _why_ he must _not_ do so-and-so, the patient endeavours to obey; peremptorily ordered to obey, he rebels. much sound advice is wasted for lack of an interesting, convincing, "reason why!" which would ensure the hearty and very helpful co-operation of a patient who had been taught that writing prescriptions is not the limit of a doctor's activities. many folk, with touching belief in his own claims, regard the quack as a hoary-headed sage, who from disinterested motives devotes his life to curing ailments, by methods of which he alone has the secret, at low fees. to fight this dangerous idea i have tried to show in an interesting way how science deals with nerve ills, and to prove that qualified aid is needed. suggestions and criticisms will be welcomed. i. g. briggs the university, birmingham, _june_, * * * * * "lette than clerkes enditen in latin, for they have the propertie of science, and the knowing in that facultie: and lette frenchmen in their frenche also enditen their queinte termes, for it is kyndely to their mouthes; and let us showe our fantasies in soche wordes as we lerneden of our dames tongue." --chaucer. * * * * * epilepsy, hysteria, and neurasthenia * * * * * chapter i major and minor epilepsy (_grand and petit mal_) "my son is sore vexed, for ofttimes he falleth into the fire, and ofttimes into the water."--matthew xvii, . "oft, too, some wretch before our startled sight, struck as with lightning with some keen disease, drops sudden: by the dread attack o'erpowered he foams, he groans, he trembles, and he faints; now rigid, now convuls'd, his labouring lungs heave quick, and quivers each exhausted limb. * * * * * "he raves, since soul and spirit are alike disturbed throughout, and severed each from each as urged above, distracted by the bane; but when at length the morbid cause declines, and the fermenting humours from the heart flow back--with staggering foot first treads led gradual on to intellect and strength."--lucretius. epilepsy, or "falling sickness", is a chronic abnormality of the nervous system, evinced by attacks of _alteration of consciousness_, usually accompanied by convulsions. it attacks men of every race, as well as domesticated animals, and has been known since the earliest times, the ancients imputing it to demons, the anger of the gods, or a blow from a star. it often attacks men in crowds, when excited by oratory or sport, hence the roman name: _morbus comitialis_ (crowd sickness). in mediæval times, sufferers were regarded with awe, as being possessed by a spirit. witch doctors among savages, and founders and expounders of differing creeds among more civilized peoples, have taken advantage of this infirmity to claim divine inspiration, and the power of "seeing visions" and prophesying. epilepsy has always interested medical men because of its frequency, the difficulty of tracing its cause, and its obstinacy to treatment, while it has appealed to popular imagination by the appalling picture of bodily overthrow it presents, so that many gross superstitions have grown up around it. the description in mark ix. - , is interesting: "master, i have brought thee my son, which hath a dumb spirit. and wheresoever he taketh him, he teareth him: and he foameth, and gnasheth with his teeth, and pineth away: ... straightway the spirit tare him; and he fell on the ground, and wallowed foaming. "and he asked his father, how long is it ago since this came unto him? and he said, of a child. and ofttimes it hath cast him into the fire, and into the waters, to destroy him. "and he said unto them, this kind can come forth by nothing, but by prayer and fasting." up to the present, epilepsy can be ascribed to no specific disease of the brain, the symptoms being due to some morbid disturbance in its action. epilepsy is a "functional" disease. grand mal ("_great evil_") an unusual feeling called an _aura_ (latin--vapour), sometimes warns a patient of an impending fit, commonly lasting long enough to permit him to sit or lie down. this is followed by giddiness, a roaring in the ears, or some unusual sensation, and merciful unconsciousness. in many cases this stage is instantaneous; in others it lasts some seconds--but an eternity to the sufferer. this stage is all that victims can recall (and this only after painful effort) of an attack. as unconsciousness supervenes, the patient becomes pale, and gives a cry, which varies from a low moan to a loud, inhuman shriek. the head and eyes turn to one side, or up or down, the pupils of the eyes enlarge and become fixed in a set stare, and the patient drops as if shot, making no effort to guard his fall, being often slightly and sometimes severely injured. the whole body then becomes stiff. the hands are clenched, with thumbs inside the palms, the legs are extended, the arms stiffly bent, and the head thrown back, or twisted to one side. the muscles of the chest and heart are impeded in their action, breathing ceases, the heart is slowed, and the face becomes pale, and then a livid, dusky blue. the skin is cold and clammy, the eyebrows knit; the tongue may be protruded, and bitten between the teeth. the eyeballs seem starting from their sockets, the eyes are fixed or turned up, so that only the sclerotic ("whites") can be seen, and they may be touched or pressed without causing blinking. the stomach, bladder, and bowels may involuntarily be emptied. this _tonic_ stage only lasts a few seconds, and is followed by convulsions. the head turns from side to side, the jaws snap, the eyes roll, saliva and blood mingle as foam on the lips, the face is contorted in frightful grimaces, the arms and legs are twisted and jerked about, the breathing is deep and irregular, the whole body writhes violently, and is bathed in sweat. the spasms become gradually less severe, and finally cease. deep breathing continues for some seconds; then the victim becomes semi-conscious, looks around bewildered, and sinks into coma or deep sleep. "...as one that falls, he knows not how, by force demoniac dragg'd to earth, and through obstruction fettering up in chains invisible the powers of man; who, risen from his trance, gazeth around bewilder'd with the monstrous agony he hath indured, and, wildly staring, sighs: ..." in a few hours he wakes, with headache and mental confusion, not knowing he has been ill until told, and having no recollection of events just preceding the seizure, until reminded of them when they are slowly, and with painful effort, brought to mind. he is exhausted, and often vomits. in severe cases he may be deaf, dumb, blind, or paralysed for some hours, while purple spots (the result of internal hemorrhage) may appear on the head and neck. victims often pass large quantities of colourless urine after an attack, and, as a rule, are quite well again within twenty-four hours. this is the usual type, but seizures vary in different patients, and in the same sufferer at different times. the cry and the biting of the tongue may be absent, the first spasm brief, and the convulsions mild. epilepsy of all kinds is characterized by an _alteration_ (not necessarily a _loss_) of consciousness, followed by loss of memory for events that occurred during the time that alteration of consciousness lasted. attacks may occur by day only, by day and by night, or by night only, though in so-called nocturnal epilepsy, it is _sleep_ and not night that induces the fit, for night-workers have fits when they go to sleep during the day. victims of nocturnal epilepsy may not be awakened by the seizure, but pass into deeper sleep. intermittent wetting of the bed, occasional temporary mental stupor in the morning, irritability, temporary but well-marked lapses of memory, sleep-walking, and causeless outbursts of ungovernable temper all suggest nocturnal epilepsy. such a victim awakes confused, but imputes his mental sluggishness to a hearty supper or "a bad night". a swollen tongue, blood-stained pillow, and urinated bed arouse suspicion as to the real cause, suspicion which is confirmed by a seizure during the day. he is more fortunate (if such a term can rightly be used of any sufferer from this malady) than his fellow victim whose attacks occur during the day, often under circumstances which, to a sensitive nature, are very mortifying. epileptic attacks are of every degree of violence, varying from a moment's unconsciousness, from which the patient recovers so quickly that he cannot be convinced he has been ill, to that awful state which terrifies every beholder, and seems to menace the hapless victim with instant death. every degree of frequency, too, is known, from one attack in a lifetime, down through one in a year, a month, a week, or a day; several in the same periods, to _hundreds_ in four-and-twenty hours. petit mal ("_little evil_") this is incomplete _grand mal_, the starting stages only of a fit, recovery occurring before convulsions. _petit mal_ often occurs in people who do not suffer from _grand mal_, the symptoms consisting of a loss of consciousness for _a few seconds_, the seizure being so brief that the victim never realizes he has been unconscious. he suddenly stops what he is doing, turns pale, and his eyes become fixed in a glassy stare. he may give a slight jerk, sway, and make some slight sound, smack his lips, try to speak, or moan. he recovers with a start, and is confused, the attack usually being over ere he has had time to fall. if talking when attacked, he hesitates, stares in an absent-minded manner, and then completes his interrupted sentence, unaware that he has acted strangely. whatever act he is engaged in is interrupted for a second or two, and then resumed. a mild type of _petit mal_ consists of a temporary _blurring_ of consciousness, with muscular weakness. the victim drops what he is holding, and is conscious of a strange, extremely unpleasant sensation, a sensation which he is usually quite unable to describe to anyone else. the view in front is clear, he understands what it is--a house here, a tree there, and so on--yet he does not _grasp_ the vista as usual. other victims have short spells of giddiness, while some are unable to realize "where they are" for a few moments. frequent _petit mal_ impairs the intellect more than _grand mal_, for convulsions calm the patient as a good cry calms hysterical people. after a number of attacks of _petit mal, grand mal_ usually supervenes, and most epileptics suffer from attacks of both types. some precocious, perverse children are victims of unrecognized _petit mal_, and when pushed at school run grave risks of developing symptoms of true epilepsy. the "little evil" is a serious complaint. * * * * * chapter ii rarer types of epilepsy if it be true that: "one half the world does not know how the other half lives", how true also is it that one half the world does not know, and does not care, what the other half suffers. epilepsy shows every gradation, from symptoms which cannot be described in language, to severe _grand mal_. gowers says: "the elements of an epileptic attack may be extended, and thereby be made less intense, though not less distressing. if we conceive a minor attack that is extended, and its elements protracted, with no loss of consciousness, it would be so different that its epileptic nature would not be suspected. swiftness is an essential element of ordinary epilepsy, but this does not prevent the possibility of deliberation." in serial epilepsy, a number of attacks of _grand mal_ follow one another, with but very brief intervals between. serial epilepsy often ends in _status epilepticus_, in which a series of _grand mal_ attacks follow one another with no conscious interval. the temperature rises slowly, the pulse becomes rapid and feeble, the breathing rapid, shallow and irregular, and death usually occurs from exhaustion or heart-failure. though not invariably fatal, the condition is so very grave that a doctor must instantly be summoned. nearly all victims of severe, confirmed epilepsy ( per cent of all epileptics) die in _status epilepticus_. jacksonian epilepsy, named after hughlings jackson, who in traced its symptoms to their cause, is not a true epilepsy, being due to a local irritation of the cortex (the outermost layer) of the brain. there is usually an _aura_ before the attack, often a tingling or stabbing pain. the chief symptoms are convulsions of certain limbs or areas of the body, which, save in very severe cases, are confined to one side, and are not attended by loss of consciousness. the irritation spreads to adjacent areas, as wavelets spread from a stone thrown into a pond, with the result that convulsions of other limbs follow in sequence, all confined to one side. as every part of the brain is connected to every other part by "association fibres", in very violent attacks of jacksonian epilepsy the irritation spreads to the other side of the brain also, consciousness is lost, the convulsions become general and bilateral, and the patient presents exactly the same picture as if the attack were due to _grand mal_. all degrees of violence are seen. the convulsions may consist only of a rapid trembling, or the limb or limbs may be flung about like a flail. jackson said: "the convulsion is a brutal development of a man's own movements, a sudden and excessive contention of many of the patient's familiar motions, like winking, speaking, singing, moving, etc." these acts are learned after many attempts, and leave a memory in certain groups of brain cells; irritate those cells, and the memorized acts are performed with convulsive violence. the convulsions are followed by temporary paralysis of the involved muscles, but power finally returns. as we should expect, this paralysis lasts longest in the muscles first involved, and is slightest in the muscles whose brain-centres were irritated by the nearly exhausted waves. if the disease be untreated, the muscles in time may become totally paralysed, wasted, and useless. friends should very carefully note exactly where and how the attack begins, the exact part first involved, and the precise order in which the spasms appear, as this is the only way the doctor can localize the brain injury. the importance of this cannot be overrated. the consulting surgeon will say if operation is, or is not, advisable, but _operation is the sole remedy for jacksonian epilepsy_, for the causes that underly its symptoms cannot be reached by medicines. patients must consult a good surgeon; other courses are _useless_. psychic or mental epilepsy is a trance-state often occurring after attacks of _grand_ or _petit mal_, in which the patient performs unusual acts. the epileptic feature is the patient's inability to recall these actions. the complaint is fortunately rare. the face is usually pale, the eyes staring, and there may be a "dream state". without warning, the victim performs certain actions. these may be automatic, and not seriously embarrassing--he may tug his beard, scratch his head, hide things, enter into engagements, find the presence of others annoying and hide himself, or take a long journey. such a journey is often reported in the papers as a "mysterious disappearance". yet, had he committed a crime during this time, he would probably have been held "fully responsible" and sentenced. the actions may be more embarrassing: breaking something, causing pain, exhibiting the sexual organs; the patient may be transported by violent rage, and abuse relatives, friends or even perfect strangers; he may spit carelessly, or undress himself--possibly with a vague idea that he is unwell, and would be better in bed. finally the acts may be criminal: sexual or other assault, murder, arson, theft, or suicide. in this state, the patient is dazed, and though he appreciates to some extent his surroundings, and may be able to answer questions more or less rationally, he is really in a profound reverie. the attack soon ends with exhaustion; the victim falls asleep, and a few moments later wakes, ignorant of having done or said anything peculiar. we usually think of our _mind_ as the aggregate of the various emotions of which we are actually _conscious_, when, in reality, consciousness forms but a small portion of our mentality, the _subconscious_--which is composed of all our past experiences filed away below consciousness--directing every thought and act. inconceivably delicate and intricate mind-machinery directs us, and our idlest fancy arises, _not by chance_ as most people surmise, but through endless associations of subconscious mental processes, which can often be laid bare by skilful psycho-analysis. our subconscious mind does not let the past jar with the present, for life would be made bitter by the eternal vivid recollection of incidents best forgotten. every set of ideas, as it is done with, is locked up separately in the dungeons of subconsciousness, and these imprisoned ideas form the basis of memory. _nothing is ever forgotten_, though we may never again "remember" it this side the grave. in a few cases we can unlock the cell-door and release the prisoner--we "remember"; in some, we mislay the key for awhile; in many, the wards of the lock have rusted, and we cannot open the door although we have the key--we "forget"; finally, our prisoner may pick the lock, and make us attend to him whether we wish to or not--something "strikes us". normally, only one set of ideas (a complex) can hold the stage of consciousness at any one time. when two sets get on the boards together, double-consciousness occurs, but even then they cannot try to shout each other down; one set plays "leading lady", the other set the "chorus belle" and so life is rendered bearable. this "dissociation of consciousness" occurs in all of us. a skilled pianist plays a piece "automatically" while talking to a friend; we often read a book and think of other things at the same time: our full attention is devoted to neither action; neither is done perfectly, yet both are done sufficiently well to escape comment. day-dreaming is dissociation carried further. "leading lady" and "chorus belle" change places for a while--imaginary success keeps us from worrying about real failure. dissociation, day-dreaming, and mental epilepsy are but few of the many milestones on a road, the end of which is insanity, or complete and permanent dissociation, instead of the partial and fleeting dissociation from which we all suffer. the lunatic never "comes to", but in a world of dreams dissociates himself forever from realities he is not mentally strong enough to face. the writing of "spirits" through a "medium" is an example of dissociation, and though shown at its best in neuropaths, is common enough in normal men, as can be proved by anyone with a planchette and some patience. if the experimenter puts his hands on the toy, and a friend talks to him, while another whispers questions, he may write more or less coherent answers, though all the time he goes on talking, and does not know what his hand is writing. his mind is split into two smaller minds, each ignorant of the other, each busily liberating memory-prisoners from its own block of cells in the gaol of the subconscious. the writing often refers to long-forgotten incidents, the experiment sometimes being of real use in cases of lost memory. dreams are dissociations in sleep, while the scenes conjured up by crystal-gazing are only waking dreams, in which the dissociation is caused by gazing at a bright surface and so tiring the brain centres, whereupon impressions of past life emerge from the subconscious, to surprise, not only the onlookers to whom they are related, but also the gazer herself, who has long "forgotten them". it is childish to attach supernatural significance to either dreams or crystal-gazing, both of which mirror, not the future, but only the past, the subject's own past. it is noteworthy that women dream more frequently and vividly than men. when a dreamer has few worries, he usually dreams but forgets his dream on waking; when greatly worried, he often carries his problems to bed with him, and recent "representative dreams" are merely unprofitable overtime work done by the brain. occasionally, dreams have a purely physical basis as when palpitation becomes transformed in a dream into a scene wherein a horse is struggling violently, or where an uncovered foot originates a dream of polar-exploration; in this latter type the dream is protective, in that it is an effort to side-track some irritation without breaking sleep. since freud has traced a sex-basis in all our dreams, many worthy people have been much worried about the things they see or do in dreams. let them remember that virtue is not an inability to conceive of misconduct, so much as the determination to refrain from it, and it may well be that the centres which so determinedly inhibit sexual or unsocial thoughts in the day, are tired by the very vigour of their resistance, and so in sleep allow the thoughts they have so stoutly opposed when waking to slip by. the man who is long-suffering and slow to wrath when awake, may surely be excused if he murders a few of his tormentors during sleep. epileptiform seizures are convulsions due to causes other than epilepsy, and only a doctor can tell if an attack be epileptic or not and prescribe appropriate treatment. to give "patent" medicines for "fits", to a man who may be suffering from lead poisoning or heart disease, is criminal. convulsions in children often occur before or after some other ailment. such children need careful training, but less than per cent of children who have convulsions become epileptic. epilepsy should only be suspected if the first attack occurs in a previously healthy child of over two years of age. there are many possible causes for infantile convulsions, and but one treatment; call in a doctor _at once_, and, while waiting for him, put the child in a warm bath (not over ° f.) in a quiet, darkened room, and hold a sponge wrung out of hot water to the throat at intervals of five minutes. never give "soothing syrups" or "teething powders". the "soothing" portion of such preparations is some essential oil, like aniseed, caraway or dill, and there are often present strong drugs unsuitable for children. according to the analyses made by the british medical association, the following are the _essential_ ingredients of some well-known preparations for children: mrs. winslow's soothing potassium bromide, syrup. aniseed, and syrup (sugar and water). woodward's gripe sodium bicarbonate, water. caraway, and syrup. atkinson and barker's pot. and magnesium royal infant bicarbonate, several preservative. oils, and syrup. mrs. johnson's american spirits of salt, common soothing syrup. salt, and honey. convulsions during pregnancy. send for a doctor instantly. feigned epilepsy is an all-too-common "ailment". the false fit, as a rule, is very much overdone. the face is red from exertion instead of livid from heart and lung embarrassment, the spasms are too vigorous but not jerky enough, the skin is hot and dry instead of hot and clammy, the hands may be clenched, but the thumb will be _outside_ instead of _inside_ the palm, foam comes in volumes but is unmixed with blood, and the whole thing is kept up far too long. almost before a crowd can gather an epileptic seizure is over, whereas the sham sufferer does not begin seriously to exhibit his questionable talents until a crowd has appeared. pressure on the eye, which will blink while the "sufferer" will swear; bending back the thumb and pressing in the end of the nail, when the hand will be withdrawn in feigned but not in true epilepsy; blowing snuff up the nose, which induces sneezing in the sham fit alone, or using a cold douche will all expose the miserable trick. it is, unfortunately, far easier to suggest than to apply these tests, for anyone foolish enough to try experiments within reach of the wildly-waving arms will probably get such a buffet as will damp his ardour for amateur diagnosis for some time. * * * * * chapter iii general remarks "do not muse at me, my most worthy friends; i have a strange infirmity, which is nothing to those that know me." "macbeth," act iii. starr's table shows that combinations of all types of epilepsy are possible, and that mental epilepsy is rare: grand mal grand and petit mal petit mal jacksonian mental grand mal and jacksonian grand mal, petit mal and jacksonian grand mal and mental grand mal, petit mal and mental petit mal and mental fits by day only fits day and night fits by night only the majority of victims have attacks both by day and by night. of , seizures tabulated by clark, , occurred during the day ( a.m. to p.m.) and , by night. the _usual course_ of a case of epilepsy is somewhat as follows: the disease begins in childhood, the first convulsion, about the age of three, being followed some twelve months later by a second, and this again by a third within a few months. then attacks occur more frequently until a regular periodicity--from one a day to one a year--is reached after about five years, and this frequently persists throughout life. the effect of epilepsy on the general health is not serious, but it has a more serious effect on the mind, for epileptic children cannot go to school (though special schools are now doing something towards removing this serious disability), and grow up with an imperfect mental training. they become moody, fretful, ill-tempered, unmanageable, and at puberty fall victims to self-abuse, which helps to lead to neurasthenia. then they may drift slowly into a state of mental weakness, and often require as much care as imbeciles. if the fits are severe from an early age, arrest of mental development and imbecility follow. if the disease be very mild in character, and especially if it be _petit mal_, the victim may be very precocious, get "pushed" at school, and later become eccentric or insane. adult victims necessarily lead a semi-invalid life, often cut off from wholesome work and from the pleasures of life, and become hypersensitive, timid, impulsive, forgetful, irritable, incapable of concentration, suspicious, show evidences of a weakened mind, have few interests, and are difficult to manage. about per cent--the very severe cases--go on to insanity; either temporary attacks of mania, calling for restraint, or permanent epileptic dementia with progressive loss of mind. some victims are accidentally killed in, or die as a result of a fit; about per cent--severe cases again--die in _status epilepticus_, but the majority after being sufferers throughout life are finally carried off by some other disease. there are many exceptions to this general course. some patients have attacks very infrequently, and are possessed of brilliant talent, though apt to be eccentric. others may have a number of seizures in youth, and then "outgrow" the complaint. a few victims are attacked only after excessive alcoholic or sexual indulgence, some women only during their menses, while other women are free from attacks during pregnancy, which state, however (contrary to popular belief), commonly aggravates the trouble. victims may be free from attacks during the duration of, and for some time after, an infectious disease; while spratling says that a consumptive epileptic may have no fits for months, or even years. some epileptics are normal in appearance, but many show signs of degeneration. this is common in the insane, but less frequent and pronounced in neurasthenics. an abnormal shape of the head or curvature of the skull, a high, arched palate, peculiarly-shaped ears, unusually large hands and feet, irregular teeth from narrow jaws, a small mouth, unequal length and size of the limbs, a projecting occiput, and poor physical development may be noted. these are most pronounced in intractable cases, in whom mental peculiarities are most frequently seen--either dullness, stupidity and ungovernable temper, or very marked talent in one direction with as marked an incapacity in others. in all epileptics, the pupils of the eye are larger than normal, and, after contracting to bright light soon enlarge again. the facial expression of most epileptics indicates abnormal mentality. when the seizures have been so frequent and severe as to cause mental decay, the actions are awkward, and the gait slouching and irregular. progressive poor memory is one of the first signs of intellectual damage consequent upon severe epilepsy. though the disease may occur at any age, most cases occur before the age of twenty, there being good reason to look for other causes (often syphilis) in cases which occur after that age. of , of gowers' cases, per cent commenced before the age of ten; per cent before twenty. in starr's , cases, per cent commenced before the patient was twenty-one. according to turner, the first epoch is from birth to the age of six, during which per cent of all cases commence, usually associated with mental backwardness, and some due to organic brain trouble. the second epoch is ten to twenty-two, the time of puberty and adolescence, during which time no less than per cent of all cases commence. this is, _par excellence_, the age of onset of genuine epilepsy, the mean age of maximum onset being fourteen in men and sixteen in women. the remaining per cent of cases occur after the age of twenty-two. in cases of epilepsy in children, osler found that were attacked before they reached the age of five, between five and ten, and between ten and fifteen. epilepsy, then, is a disease of early youth, coming on when the development and growth of the nervous and reproductive systems is taking place. during this period, causes, insignificant for stable people, may light up the disease in those of unstable, nervous constitution, a fact which explains the importance of training the child. both sexes are attacked. if we consider only cases of true idiopathic epilepsy female patients are probably in excess, but in epilepsy in adults, from all causes, males predominate. in females, the menopause may arrest the disease. in days gone by, epilepsy more rarely commenced after the age of twenty, but in these days of nerve stress it commences more frequently than formerly in people of mature age. a victim who has a fit for the first time after the age of twenty, however, should consult a nerve specialist immediately. in its early stages there are no changes of the brain due to, or the cause of, epilepsy, but in long-standing, severe cases, well-marked, morbid changes may be found. these are the effects, not the cause, of the disease, and they vary in intensity according to the manner of death and the length and severity of the malady. they probably cause the mental decay and slouching gait mentioned before. fits may suddenly cease for a long time, but they usually recur, and most patients have them more or less regularly through life. the fact that recovery is rare should not be hidden from patients and friends. perhaps per cent of all classes recover--and "recovery" may only be a long interval--but per cent of these are jacksonian, syphilitic or accident cases. only one victim in every thirty recovers from true epilepsy; and these are very mild cases, in which the fits are infrequent, there is no mental impairment, and bromides are well borne. the earlier the onset, the more severe and frequent the attacks, the deeper the coma, and the worse the mental decay, the poorer the outlook. _cure is exceptional_, but by vigorous treatment the severity of the malady may be much abated. _petit mal_ is no more hopeful than _grand mal_; less so in cases with severe giddiness; in all cases, the better the physical condition and digestive powers of the patient, the brighter the outlook. to sum up, epilepsy is a chronic abnormality of the higher nervous system, characterized by periodic attacks of alteration of consciousness, often accompanied by spasms of varying violence, affecting primarily the brain and secondarily the body, based on an abnormal readiness for action of the motor cells, occurring in persons with congenital nerve weakness, and leading to mental decay of various types and degrees of severity. * * * * * chapter iv causes of epilepsy "find out the cause of this effect, or rather say, the cause of this defect, for this effect defective comes by cause." "hamlet," act ii. the mechanism of the fit the brain consists of cells of _grey matter_, grouped together to form centres for thought, action or sensation, and _white matter_, consisting of nerve strands, which act as lines of communication between different parts of brain and body. the wrinkled surface (_cortex_) of the brain, is covered with grey matter, which dips into the fissures. there are also islands of grey matter embedded in the white. the front part of the brain is supposed, with some probability, to be the seat of intelligence, while a ribbon three inches wide stretched over the head from ear to ear would roughly cover the rolandic area, in which are contained the _motor cells_ through which impulse is translated to action. these motor cells are controlled by _inhibitory cells_, which act as brakes and release nerve energy in a gentle stream; otherwise our movements would be convulsive in their violence, and life would be impossible through inability usefully to direct our energy. that is how inhibition acts physically; mentally it is the power to restrain impulses until reason has suggested the wisest course. irritation of the cortex, especially the motor area, causes convulsions, and experiment has shown that epilepsy may be due to a disease or instability of certain inhibitory cells of the cortex. the motor cells of epileptics are restrained, with some difficulty, by these cells in normal times. when irritation from any cause throws additional strain on the motor cells, the defective brakes fail, and the uncontrolled energy, instead of flowing in a gentle stream through the usual channels, bursts forth in a tidal wave through other areas of the brain, causes unconsciousness, and exhausts itself in those violent convulsions of the limbs which we term a fit. the primary cause of epilepsy is an inherent instability of the nervous system. secondary causes are factors which cause the first fit in a person with predisposing nervous instability; later, the brain gets the _fit habit_, and attacks recur independently of the secondary cause. in most cases no secondary causes can be discovered, and the disease is then termed _idiopathic_, for want of an explanation. injuries to the brain may cause epilepsy, and many cases date from birth, a difficult labour having caused a minute injury to the brain. some accident is often wrongly alleged as the cause of fits, for most victims come of a bad stock, and when the first fit occurs, their relatives recollect an injury or a fright in the past, which is said to be the cause. great fright may cause epilepsy, as in the case of a nervous girl whose brother entered her room, covered with a sheet, as a "ghost", a "joke" that was followed by a fit within an hour. sunstroke may cause fits, and a few cases follow infectious diseases. alcoholism is a strong secondary factor, fits often occurring during a drinking-bout and in topers, but in many cases, drunkenness, instead of being the cause, is only the result of a lack of self-control following epilepsy. pregnancy may be a secondary cause of the malady: it may lead to more frequent and severe seizures in women who are already victims; bring on a recurrence of the malady after it has apparently been cured; or, very rarely, induce a temporary or permanent cure. epilepsy may be due to abortives. these drugs wreck the constitution of the undesired children, who contract epilepsy from causes which would not so have affected them had they started fairly. in many families, the first child, who was wanted, is normal; some or all the others, who were not desired and on whom attempts were probably made to prevent birth, are neuropaths, as are many illegitimate children. it cannot too emphatically be stated that there is no drug known which will procure abortion without putting the woman's life in so grave a danger as to prevent medical men using it; legal abortion is always procured surgically. dealing in abortifacients would be a capital offence under the laws of a rational community. self-abuse may perhaps play some part in epilepsy commencing or recurring after the age of ten. the onset of menstruation often coincides with the onset of epilepsy, and in some cases irregularity of the menses seems to be a secondary or exciting cause. exciting causes aggravate the trouble when present, causing more frequent and severe seizures. the chief are irritation of stomach and bowels (from decaying teeth, unchewed, unsuitable, or indigestible food, constipation, or diarrhoea), exhaustion, work immediately after a meal, passion or excitement, fright, worry, mental work, alcoholism, sexual excess, nasal growths, eye-strain; in short, anything that irritates brain or body. theories as to cause. epilepsy is usually classed as a _functional disorder_; that is, the brain cells are physically normal, but, for some unknown reason, they act abnormally at certain times. this term is a very loose one, and there is reason to believe that the basis of epilepsy is some obscure disease of the brain which has not been detected by present methods. the new school of psychologists regard the malady as a mental _complex_--a system of ideas strongly influenced by the emotions--the convulsions being but minor symptoms. fits are most frequent between - p.m. the hours of deepest repose. one school says this is due to anæmia of the brain during sleep. clark traces the cause to lessened inhibitory powers owing to the higher brain centres being at rest, while haig claims to have explained the high incidence at this hour by the fact that uric acid is present in the system in the greatest amount at this time. some doctors have thought, on the contrary, that _excess_ of blood in the head was the cause, but results of treatment so directed did not bear out the sanguine hopes built on the theory. the fact that convulsions occur in diabetes and alcoholism, suggested that epilepsy was due to poisons circulating in the blood, and thus irritating the brain. every act uses up cell material and leaves waste products, exactly as the production of steam uses up coal and leaves ashes. various waste products have been found in more than normal quantities in the blood of epileptics, but it is uncertain whether accumulation of waste products causes the seizure. a convincing theory must satisfactorily account for all the widely diverse phenomena seen in epilepsy, and the problem must remain largely a matter of speculation, until research work has given us a far deeper insight into the biochemistry of both the brain cells, and the germ-plasm than we have at present. * * * * * chapter v prevention of attacks in health matters, prevention is nine points of the law. some patients are obsessed by a peculiar sensation (the "aura") just before a fit. this warning takes many forms, the two most common being a "sinking" or feeling of distress in the stomach, and giddiness. the character of the aura is very variable--terror, excitement, numbness, tingling, irritability, twitching, a feeling of something passing up from the toes to the head, delusions of sight, smell, taste, or hearing (ringing, or buzzing, etc.), palpitation, throbbing in the head, an impulse to run or spin around--any of these may warn a victim that a fit is at hand. some patients "lose themselves" and make curious mistakes in talking. the warning is nearly always the same each time with the same patient, and is more common in mild than in severe cases. rarely, the attack does not go beyond this stage. when the patient becomes conscious of the aura he should sit in a large chair, or lie down on the floor, well away from fire, and from anything that can be capsized. he must never try to go upstairs to bed. some one should draw the blind, as light is irritating. if the warning lasts some minutes, the patient should carry with him, a bottle of uncoated one-hundredth-grain tabloids of nitroglycerin, replacing the screw cap with a cork, so that they can quickly be extracted. when the warning occurs, one--or two--should be taken, and the head bent forward. the arteries are dilated, the blood-pressure thus lowered, and the attack _may_ be averted. the use of nitroglycerin is based on the theory that seizures are caused by anæmia due to vasomotor constriction. success is only occasional, but this is so welcome as to justify the habitual use of the method. if the aura be brief, buy a few "pearls" of amyl nitrite, crush one in your handkerchief, and sniff the vapour. this has the same affect as nitroglycerin, but the action occurs in seconds and only persists minutes. a headache occasionally follows the use of these drugs, and they should not be employed without professional advice. when the warning is felt in the hand or foot, a strap should be worn round the ankle or wrist, and pulled tight when the aura commences. this sometimes aborts a fit, as biting a finger in which the aura commences may also do. if a victim feels unwell after a meal, he must never eat the next meal at the usual time, simply because it _is_ the usual time. should a patient feel unwell between, say, dinner and tea, instead of eating his tea he must empty his bowels by an enema, or croton oil (see chemist), and his stomach by drinking a pint of warm water in which has been stirred a tablespoonful of mustard powder and a teaspoonful of salt. after vomiting, drink warm water. _never attempt to empty the stomach at the onset of a definite aura_, for if the seizure occurs, the vomit will probably obstruct the trachea, and suffocate the victim. after the stomach has been empty ten minutes, the patient should take a double dose of bromides (chapter xix) and go to bed. next morning he will be well, whereas if he eats but a single piece of bread-and-butter he will probably have a fit within five minutes. unfortunately, in per cent of cases, there is no warning at all, while in those cases which do exhibit an aura, the measures mentioned above more often fail than succeed. * * * * * chapter vi first-aid to victims "first-aid is the assistance which can be given in case of emergency by those who, with certain easily acquired knowledge are in a position, not only to relieve the sufferer, but also to prevent further mischief being done pending the arrival of a doctor."--dickey. _never try to cut short a fit_. placing smelling-salts beneath the nose, together with all other remedies for people who have "fainted", are useless in epilepsy. lay the patient on his back, with head slightly raised; admit air freely; remove scarf or collar and tie, unfasten waistcoat, shirt, stays or other tight garments, and if it be known or observed that the victim wears artificial teeth, remove them. if five people are at hand, let two persons grasp each a leg of the victim, holding it above the ankle and above the knee; two others should each hold a hand and the shoulder; the fifth supports the head. do not kneel opposite the feet or you may receive a severe kick. prevent the limbs from striking the floor, but _allow them full play_. if the victim rolls on his face gently turn him on his back. roll a large handkerchief up _from the side_ (not diagonally) and holding one end firmly, tie a knot in the other end, and place it between the teeth to protect the tongue; or slide the handle of a spoon or a piece of smooth wood between the teeth, and thus hold the tongue down. soft articles like cork and indiarubber should not be used, for if they are bitten through, the rear portion will fall down the throat and choke the victim. after the fit, lower the head to one side to clear any vomitus which, if left, might be drawn into the windpipe, lift the patient on to a couch, cover him warmly, and let him sleep. an epileptic's bed should be placed on the ground floor; if his bed be upstairs, it is difficult to get him there after an attack, while he may at any time fall downstairs and be killed. any effort to rouse him will only make the post-epileptic stupor more severe, but whether he sleeps or not, he must carefully be watched, for patients in this state are apt to slip away, often half-clothed, and travel towards nowhere in particular at a wonderfully rapid rate. if several fits follow one another, or if one is very long or severe, send for a doctor. when a seizure occurs in public, a constable should be summoned, who, being a "st. john" man, will be of far more use than bystanders brimming over with sympathy--_and ignorance_. if some kindly householder near by will allow the victim to sleep for an hour or two--a boon usually denied more from fear of recurrence than lack of sympathy, it is better than taking him home. if not, let someone call a cab, and deliver the victim safely to his friends. every epileptic should carry always with him a card stating his full name and address, with a request that some one present at any seizure will escort him home. if the victim wakes with a headache, give him a -grain aspirin powder, or a -grain phenalgin tablet; _never patent "cures"_. if possible, the patient should lie abed the day after a fit, undisturbed, taking only soda-and-milk and eggs beaten up in _hot_ milk. * * * * * chapter vii neurasthenia "some of your hurts you have cured, and the worst you still have survived; but what torments of mind you endured from evils which never arrived." --lowell. to-day, the need to eat forces even sensible men to live--and die--at a feverish rate. in bygone days the world was a peaceful place, in which our forefathers were denied the chance of combining exercise with amusement dodging murderous taxis; knew not the blessings of "bile beans", nor the biliousness they blessed either; they did not fall victims to "advert-diseases"; and they left the waters beneath to the fishes, and the skies above to the birds. withal they were sound trenchermen, who called their few ailments "humours" or "vapours" and knew what peace of mind meant. sixty years ago there was one lunatic in every six hundred people; to-day there is one in every two hundred. at the same time, the "neurasthenic temperament" is not altogether a modern product, for plato described it with great precision, and declared such people to be "undesirable citizens" for his ideal republic. neurasthenia is due to exhaustion and poisoning of the nervous system, the chief symptoms of which is persistent _neuro-muscular fatigue with general irritability_. its minor symptoms are almost as numerous as the various activities possible in mind and body. the predisposing cause of neurasthenia is inherited nervous instability, but among nervous diseases, neurasthenia seems the least dependent on heredity, this factor playing a less important part than exciting causes which are the sparks that fire explosive trains laid by the living, and often by the dead. worry in any form (especially when accompanied by excess of brain-work), accident-shock, sexual abuse, abuse of drink, drugs or tobacco, lack of exercise, exhausting diseases, menopause, and diseases of the womb, "society life", retirement, are the commonest exciting causes of neurasthenia; hard brain-work, unless accompanied by worry, not being injurious. the disease is more common in men than women (because of the more active part played by them in the struggle for existence), in cities than in the country, in mental than in manual workers, in the "idle rich", and in races which live feverishly, like the americans. it is rare in old age. ambition, the race for "success", the struggle to carry out projects beyond the reasonable capacity of one man, and the ceaseless work and worry with little sleep and no real rest which mark life to-day are responsible for this disease. competition has increased in all conditions of life; free course is given to ambition, individuals impose on their brains a work beyond their strength; and then comes care and perhaps reverse of fortune; and the nervous system, under the wear and tear of incessant excitation, at last becomes exhausted, the basic symptom is an inability to stand a normal amount of mental or physical strain, and shows itself in seven marked ways: . muscular fatigue, which is often most marked in the morning. the patient rises reluctantly, feeling as if he had not slept, is listless and "lazy", and can neither work nor play much without getting unduly tired. this weariness may pass off as the day wears on. . backache is often constant and annoying. it may be a pain, or a general discomfort, and may be felt anywhere in the back, the nape of the neck and down the spine being common places. the legs often "give way", and, in severe cases, patients believe they cannot stand, and become bed-ridden. under sudden excitement they may walk again, becoming "miracles of healing". these _spinal symptoms_ are common in neurasthenia following accident. . headache is more often an abnormal sensation than an intense pain. pulsations, feelings of distress, of lightness, fullness, heaviness and pressure are common, or a band may seem to be drawn tightly round the head across the forehead. the sensations are usually located in the back of the head, and may be accompanied by dizziness, noises in the ears, or dimness of sight. there may be a feeling of unsteadiness when walking, or a sense of being in motion when at rest. the headache varies in intensity; it is worst in the morning, is increased by thinking, diminished after eating, often improves at night, and never keeps the patient awake. . stomach and bowel disorders. the victim is indifferent to food, though dainties often tempt him, when he cannot face a square meal. he has a feeling of general well-being after a meal, but within an hour signs of imperfect digestion arise; he feels oppressed, and has flatulence. later, there are flushes of heat, palpitation, drowsiness, and a craving for food. constipation is usually obstinate, while diarrhoea may cause great weakness. . sleeplessness. some patients go to sleep readily, but after some instants wake suddenly, in a state of excitement that persists despite their efforts to calm themselves, and only at an early hour in the morning do they sleep again. other patients go to bed with the conviction they will not sleep, and are kept awake by incessant cogitation, their minds being harassed by a rapid flow of images, ideas and memories. in some cases the person is calm, his mind is at rest, yet he cannot sleep. . circulatory disturbances. more blood flows to an organ at work than to one at rest. in health we do not notice these changes, but in neurasthenia these internal tides are exaggerated as rushes of blood to the head, flushings of various parts, and coldness of hands and feet. heart palpitation is alarming but not dangerous, and the distended blood-vessels of the ears may set up vibrations in the drum, so that at night when the head is on the pillow, every beat of the heart is heard as a thump, which banishes sleep, and works the victim into a state of high tension. a pain in the chest, arms and elbows is often felt, limbs may swell (shown by the tightness of rings, collars, etc.) while the hands and feet are usually moist and clammy. the patient may have to empty the bladder every half-hour. disorders of menstruation are common. . mental fatigue. hundreds of pages would be needed to describe all the symptoms due to mental fatigue, the morbid belief that the victim has a fatal disease being very common, though his "disease" rarely makes him lie up; in the day he works, at night describes his symptoms to the home circle. the inability of most men to apply themselves steadfastly to any one set of ideas is seen in the immense popularity of music halls, cinemas, and short-story magazines, which offer a change of interest every few minutes. in normal people there is a slight consciousness of mental processes, but the mind rarely watches itself work; the neurasthenic is unable to concentrate, and gets charged with inconstancy and shiftlessness. his ideas are restive, continuous thought is impossible, and when talking he has to be "brought back to the point" many times. memory and attention flag, and he listens to a long conversation, or reads pages of a book without grasping its import, and consequently he readily "forgets" what in reality he never laboured to learn. trembling of limbs is common. he lacks initiative, and whatever course he is forced to take--after much indecision--he is convinced, a moment later, it would have been wiser to have taken the opposite one. all his acts are done inattentively. he goes to his room for something, but has forgotten what when he gets there; later, he wonders if he locked the drawer, and goes back to see. at night he gets up to make sure he bolted the door, put out the gas, and damped the fire. regret for the past, dissatisfaction with the present, and anxiety for the future are plagues common to most people, but they become acute in a neurasthenic, who reproaches himself with past shortcomings of no moment, infuriates himself over to-day's trivialities, and frets himself over evils yet unborn. such a patient is often greatly upset by a trifle, yet little affected by a real shock, which by its very severity arouses his reactive faculties which lay dormant and left him at the mercy of the minor event. he will fret over a farthing increase in the price of a loaf, but if his bank fails he sets manfully to. duty that should be done to-day he leaves to be shirked to-morrow; he is easily discouraged, timid, and vacillating. extremely self-conscious, he thinks himself the observed of all observers. if others are indifferent toward him, he is depressed; if interested, they have some deep motive; if grave, he has annoyed them; if gay, they are laughing at him; the truth, that they are minding their own business, never occurs to him, and if it did, the thought that other people were _not_ interested in him, would only vex him. he is extremely irritable (slight noises make him start violently), childishly unreasonable, wants to be left alone, rejects efforts to rouse him, but is disappointed if such efforts be not made, broods, and fears insanity. the true melancholic is convinced he himself is to blame for his misery; it is a just punishment for some unpardonable sin, and there is no hope for him in this world or the next. the neurasthenic, on the contrary, ascribes his distress to every conceivable cause save his own personal hygienic errors. a neurasthenic, if epileptic, fears a fit will occur at an untoward moment. he dreads confined or, maybe, open spaces, or being in a crowd. when he reaches an open space (after walking miles through tortuous byways in an endeavour to avoid it) he becomes paralysed by an undefinable fear, and stops, or gets near to the wall. he fears trains, theatres, churches, social gatherings, or the office. other victims fear knives, canals, firearms, gas, high places, and railway tracks, when the basic fear is of suicide. many patients have sudden impulses--on which the attention is focussed with abnormal intensity--to perform useless, eccentric, or even criminal actions; to count objects, to touch lamp-posts, to continually reiterate certain words, and so on. the victim is fully aware that there are no grounds for his panic or impulse, but though his reason ridicules, it cannot disperse, his fear, and the wretched man finds relief in sleep alone, which adds to his woes by being a coy lover. an almost invariable stage is that wherein the patient studies a patent-medicine advertisement and finds that a disease, or collection of diseases, is the root of his troubles. this alarms but interests him; he studies other advertisements, sends for pamphlets, and so becomes familiar with a few medical terms. he then takes a "treatment", and talks of his "complaint" and how he "diagnosed" it. he has become hypochondriac. he borrows a book on anatomy from the public library to discover in what part of the body his ailment is located. he draws up (or copies) a special diet-sheet, and talks of "proteids", notices a slight cloudiness in his urine, and underlines "the uric-acid diathesis" in one of his pamphlets. then his heart bumps, he diagnoses anew, and so goes on, usually ending by taking phosphorus for his "brain fag". then he finds he has a disease unknown to the faculty, which discovery interests him as intensely as it irritates his unfortunate friends. this prince of pessimists has a conviction that, compared with him, job was a happy man, and that he will go insane. he does not know that it is only when there are flaws in the brain from inheritance or organic disease that mental worry leads to lunacy; a sound brain never becomes unhinged from intellectual stress alone. books and friends are daily questioned about his "diseases", and in spite of reassuring replies, he continues to doubt, re-question and cross-examine endlessly, feeding his hopes on the same assurances, consoling himself with the same sympathies, and worrying himself with the same fears. other folk may be "nervy", he is seriously ill; he _knows_ it because he _feels_ it. he expects the greatest consideration himself, denies it to others, and then complains he is "misunderstood". "every symptom becomes magnified; the trifling ache or pain, the trivial flatulence, the disinclination or mere hesitation of the bowels to adhere to a strict schedule, all minor events such as occur to the majority of healthy men from time to time unheeded, come to be of vast importance to the psychasthenic individual." he keeps a record of hourly changes in his condition, and pesters his family doctor to death. he goes from physician to physician, from hospital to hospital. having been induced by his friends to see a specialist, he bores that good man--who knows him all too well--with a minute description of his symptoms, presenting for inspection carefully preserved prescriptions, urinary examination records, differential blood counts, and the like. coming away with precious advice, he feels he omitted to describe all his symptoms, begins to doubt if the specialist really understands _his_ case, and so the pitiful farce goes on--for years. the extraordinary fact is that while he is suffering (_sic_) from cancer, or heart disease, or bright's disease, and spasmodically from minor affections like tuberculosis, arterio-sclerosis, and liver-fluke, he is probably running a successful business. while making money he forgets his ills; the moment his attention is diverted from the "root of evil" he proceeds to further "diagnosis". in the end, he makes a pleasant hobby of his imaginary maladies, trying each patent nostrum, and giving herbalists, electric-belt men, christian scientists, and dozens of other weird "specialists" a chance to cure him. sexual neurasthenia occurs chiefly in young men given to self-abuse or sexual excesses. erections and emissions are frequent, first at night with amorous dreams, then in the day as a result of sexual thoughts; weakness and pain in the back follow, and the sexual act may become impossible. the patient usually studies a quack advertisement, and passes into the hands of men who make a living by bleeding such wretches dry. cold baths and the treatment outlined in chapter ix will cure him. course and outlook. neurasthenia is very curable. if the cause be removed, and vigorous treatment instituted, the victim may be well in a couple of months, but in most cases there are obstacles to radical treatment, and the disease drags on indefinitely. egoism, moral cowardice, and sexual excess play a part in much neurasthenia, but relatives must not forget, in their indignation at these laxities, that the patient really _is_ ill; it is unkind, unjust and useless to tell an ailing man the unpalatable truth that it is his own fault. * * * * * chapter viii hysteria "diseased nature oftentimes breaks forth in strange eruptions; ..." "king henry iv." hysteria, recorded in legend and law, in manuscript and marble, in folk-lore and chronicle, right from history's dawn, is still a puzzle of personality, and only equalled by syphilis in the protean nature of its manifestations. the sacred books of the east said delayed menstruation due to a devil was its cause; the thrashing-out of the devil its cure. chinese legends describe it, and its symptoms were ascribed by the inquisition to witchcraft and sorcery. old egyptian papyri tell how to dislodge the devil from the stomach, and there were hysteria specialists in b.c. all old theories fix on the womb as the seat of the disease. the name hysteria is the greek word for womb, and per cent of patients are women. a few of the very numerous modern theories may be noticed. the unconscious (or the subconscious) and the conscious are only parts of one whole. our "conscious" activities are those which have developed late in the history of the race, and which develop comparatively late in the history of the individual. the "conscious" is the product of the racial education of the "unconscious"; the first is the man, the modern, the civilized; the last is the child, the primitive, the savage. between the two there is no gulf fixed, and the oxford metaphysician need not go to timbuctoo to seek a superstitious savage; he may find one within himself. in hysteria, janet says, the field of consciousness is narrowed, and the patient lives through subconscious experiences, which she forgets when she again "comes to". she journeys back into the past, back a few years individually, back centuries or æons racially, and becomes a savage child again. normally, when anything goes wrong, or we suffer from excessive emotion, we give vent to our feelings by tears, abuse, anger, or impulsive action; in some way we "hit back", and relieve ourselves of the feeling of oppression. then we forget, which heals the sore, and closes the experience. if, at the moment, we bottle up our emotions, they obtrude later at inconvenient times until we "get them off our mind" by confiding in some one, when we get peace of mind. open confession _is_ good for the soul, and it is better to "cry your eyes out" than to "eat your heart out". there are some experiences, however, to which we cannot react by anger or confidence, and so we imprison our emotions, and try to obtain peace of mind by forgetting the irritation. freud thinks perverted sex ideas are thus repressed, and cause hysteria by coming into conflict with the normal sex life. if these old sores can be laid bare by psycho-analysis, and the mental abscess drained by confession and contrition, cure follows. the biologists consider hysteria as an adult childishness, a primitive mode of dodging difficulties. victims cannot live up to the complicated emotional standard of modern life, and so act on a standard which to us seems natural only in children and uncivilized races. savill gives the following differences between neurasthenia and hysteria: neurasthenia hysteria sex both sexes equally. per cent females. age any age. first attack before page of . mental intellectual weakness; deficient will power, peculiarities bad memory want of control and attention. over emotions. causes overwork; dyspepsia; emotional upset or accident; shock. nervous shock. course fairly even. paroxysms. vary from hour to hour. mental mental exhaustion; emotional; wayward; symptoms unable to study; no self-analysis, restless; sad; living by irritable; not rule or reading equal to medical books; amusement. may fond of gaiety; be suicidal. sad and joyous by turns. never suicidal. general occasional giddiness; flushing; convulsions symptoms fainting rare; and fainting convulsions; common; no headache; backache; symptoms between sleeplessness; no attacks; local loss of feeling. anæsthesia or hyperæsthesia. termination lasts weeks or lasts lifetime in months. spasms. curable. temporarily curable. hysteria is a disease of youth, usually ceasing at the climacteric. social, financial and domestic worries are exciting causes, a happy marriage often curing, and an unhappy one greatly aggravating the complaint. it is most common among the races we usually deem "excitable", the slavs, latin races and jews, and is often associated with anæmia and pelvic disorders. symptoms. changeability of mood is striking. "all is caprice. they love without measure those they will soon hate without reason." sensationalism is manna to them. they _must_ occupy the limelight. pains are magnified or manufactured to attract sympathy; they pose as martyrs--refusing food at table, and eating sweets in their room, or stealing down to the larder at night--to the same end. if mild measures fail, then self-mutilation, half-hearted attempts at suicide, and baseless accusations against others are brought into play to focus attention on them. minor attacks usually commence with palpitation and a "rising" in the stomach or a lump in the throat, the _globus hystericus_, which the patient tries to dislodge by repeated swallowing. this is followed by a feeling of suffocation, the patient drags at her neck-band, throws herself into a chair, pants for breath, calls for help, and is generally in a state of great agitation. she may tear her hair, wring her hands, laugh or weep immoderately, and finally swoon. the recovery is gradual, is accompanied by eructations of gas, and a large quantity of pale, limpid, urine may be passed later. major attacks have attracted attention through all ages, ancient statues showing the same poses as modern photographs. the beginning stage--which may last a few moments or a few days--is one of mental unrest, the victim being irritable and depressed. in some cases a warning aura then occurs; clutchings at the throat, or the _globus hystericus_, palpitation, dizziness, sounds in the ears, spots dancing before the eyes, or feelings of intense "_tightness_" as if the skin is about to tear or the stomach to burst. the victim throws herself on a chair or couch, from which she slides to the floor, apparently senseless, the head being thrown back, the arms extended, the legs held straight and stiff. the face is that of a dreamer, and the crucifix position is not uncommon. this stage is a gigantic sexual stretch. next comes the convulsive stage, but the convulsions are not the true jerky movements of epilepsy, but are bilateral tossing, kicking, and rolling movements, interspersed with various irregular passionate attitudes. there is great alteration but _not loss_ of consciousness. the patient struggles with those about her, bites them, but never her own tongue, shrieks and fights, but never passes urine, throws things about, and arches the back until the body rests on head and feet (_opisthotonos_). the stretching and convulsive stages alternate, and the attack lasts a long time, being stopped by pain or by the departure of onlookers. during this stage the face may reflect the various emotions passing through the mind--with a fidelity that would rouse the envy of an irving. the patient gradually calms down, and a fit of tears or a scream ends the attack, after which the worn-out victim is depressed but not confused, though memory for the events of the attack may only be partial. the patient sometimes passes into the "dream state", described in chapter ii, for some hours or occasionally for far longer; these are the women described with much gusto in the local press as being in a trance--"the living dead". the victim of these attacks _is_ suffering from a disease, for she shows many temporary mental symptoms which could not possibly be feigned, while there is often a genuine partial forgetfulness of the incidents of an attack. she says she cannot help it; candid friends say she will not. the truth is that she cannot _will_ not to help it; for though intelligence and memory are often good and sometimes abnormal, the judgment and will are always weak--indecision, obstinacy, and doubt being common. treatment. a thorough examination by a doctor is _absolutely essential_, to prove that the patient is merely hysterical, and not the victim of unrecognized organic disease. in a few cases, skilled attention to some minor ailment will result in an apparently miraculous cure. many who habitually "go into hysterics", are merely grown-up "spoiled children", and in all cases, the basic factor is a lack of control and self-discipline. unfortunately, these tainted individuals who are so exquisitely sensitive that any reproof brings floods of tears, turn with mercurial rapidity from passionate fury to passionate self-reproach, and assuage by impassioned protestations of affection the distress they have carelessly inflicted, and, as a consequence of their momentary but undoubtedly sincere contrition, escape blame and punishment. harmful sympathy is thus substituted for helpful discipline, and the more stable members of the family are often made slaves to the whims and caprices of the hysterical member. the usual home treatment of the victim passes through various stages, and lacks persistence. violent methods are succeeded by studied indifference; and that again by reproaches and recriminations. greene's remarks are very pertinent: "the condition must be regarded as an acquired psycho-neurosis to be ameliorated, and perhaps removed, by suggestion and a complete control, which, though kind, is firm, persistent, insistent, and _lacking in every element that enters into the upbuilding of the hysterical temperament_." for anæmic patients, the following is a useful prescription: r. quininæ valerianatis gr. xx ferri valerianatis gr. xx ammon. valerianatis gr. xx misce et fiant pilulæ no. xx sig.: one or two three times a day, after meals. as far as the minor symptoms are concerned, the disease is usually chronic, for as soon as one symptom has been overcome another takes its place, and there is little hope of cure save when the case is taken vigorously in hand in childhood, treatment being best given in a home or hospital. home treatment consists in an attempt to inculcate the lost or never-acquired habit of self-control, and in the hygienic measures laid down for neuropaths in general in the rest of this book. in a major attack, _show no sympathy_. let every one leave the room, save one attendant, whom the victim knows to be of firm character, and calm but determined disposition. this attendant should get a jug of water, and threaten to douche the victim unless she makes vigorous efforts to control herself. if she cannot, or will not, _douche her_, then hold a towel over her nose and mouth, and she will perforce cease her gymnastics to breathe, though the attendant must be prepared for an outburst of abuse when she has recovered her breath. between attacks, all who are brought into contact with the victim, must adopt a tolerant but unsympathetic attitude, while efforts are made to inculcate habits of control. * * * * * chapter ix advice to neuropaths "great temperance, open air, easy labour, little care." the above quotation epitomizes the cure for neurasthenia, for as huxley said: "our life, fortune, and happiness depend on our knowing something of the rules of a game far more complicated than chess, which has been played since creation; every man, woman and child of us being one of the players in a game of our own. the board is the world, the pieces the phenomena of the universe, while the rules of the game are the laws of nature. though our opponent is hidden, we know his play is fair, just and patient, but we also know to our sorrow that he never overlooks a mistake or makes the slightest allowance for ignorance. to the man who plays well, the highest stakes are paid with that overflowing generosity with which the strong show their delight in strength. the one who plays badly is checkmated; without haste, but without remorse. ignorance is visited as sharply a as wilful disobedience; incapacity meets with the same punishment as crime." in many cases some real trouble is the best medicine for a neurasthenic, for though disaster may crush him, it is more likely to act as a spur, by diverting his thoughts from his woes, and making him fight instead of fret. since such blessings in disguise cannot be booked to order, first see a doctor. though little be physically wrong, the sense of comfort and relief from fear, which a clear idea of what _is_ wrong brings, goes a long way towards cure by giving the patient hope and confidence. having seen the doctor, assist him by carrying out the following advice as far as real limitations--not lazy inclinations--permit. do not say after reading this chapter, "i know all that"; you have to _do_ "all that", for medicine alone, whether patent or prescribed, is useless. * * * * * go for a long sea voyage, if possible. if not, get a long holiday in a quiet farmhouse, or, better still, get to the country for good, be it in never so humble a capacity, for a healthy cowman is happier than a neurasthenic clerk. the rural worker has no theatres, but he can walk miles without meeting another; he has woods to roam in, hills to climb, trees to muse under: he has ample light and air, and his is a far happier lot than that of a vainglorious but miserable, sedentary machine in a great city. the rural districts round braemar, the channel islands, cromer, deal, droitwich, scarborough, and weston-super-mare are, in general, suitable holiday resorts for neuropaths. avoid alcohol, tea, coffee, much meat, all excitement, anger and _worry_. take tickets only for comedy at the theatre, and leave lectures, social gatherings and dances alone. nerve-starvation needs generous feeding with easily digested food. drink milk in gradually increasing amounts up to half a gallon per day. if more food is needed, add eggs, custard, fruit, spinach, chicken, or fish, but do not forgo any milk. avoid starchy foods and sweets. eat only what you can digest, and digest all you eat. chew every mouthful a hundred times. this is one of the few sensible food fads. drink water copiously between meals, and take no liquid (save the milk) with them. keep the bowels open. if you _must_ "occupy your mind", take up some very simple, quiet hobby. gardening, fretwork, photography and gymnastics are not necessarily quiet hobbies. chess, billiards, and contortions with gymnastic apparatus are not to be recommended. if you _must_ read, peruse only humorous novels. never study, and leave exciting fiction and medical work alone. symptoms are the most misleading things in a most misleading world. after your evening meal, take a quiet walk, go to bed _and sleep_. you should occasionally spend from saturday midday to monday morning in bed, with blinds drawn, living on milk, seeing nobody and doing _nothing_. the deepest degradation of the sabbath is to fill it with odd jobs which have accumulated through the week. do not get out of bed too early in the morning, but rise in time to eat your breakfast slowly, attend to the toilet, and catch the car without haste. if your occupation be an indoor one, rise an hour earlier, and walk or cycle quietly to work. take a warm bath followed by a cold douche on rising. if no warm after-glow follows, use tepid water. keep your body warm; your head cool. be continent. nerve-tone and sexual delights are not compatible. matrimony, while a convenient cloak, is no excuse for lust. try suggestion for fears and impulses (see chapter xviii), for it is useless to try to "reason them out", though it is useful for a brief period each day to try deliberately to turn the mind away from the obsession, by singing or whistling, gradually prolonging the attempts. rest, to prevent the manufacture of more waste products, the elimination of those present, and the generation of nerve-strength from nourishing food are the things that cure. chapters xix and xx deal with the drug treatment. do not worry. whatever your trouble is, it is useless to "look before and after, and sigh for what is not" for the future cannot be rushed nor the past remedied. all patients reply promptly that they "can't help" worrying, when in truth they do not try. work never hurt anyone, but harassing preoccupation with problems which no amount of thought will solve drives many thousands to early graves. anger exhausts itself in a few minutes, fatigue in a few hours, and real overwork with a week's rest, but worry grows ever worse. ponder meredith's lines: "i _will_ endure; i will not strive to peep behind the barrier of the days to come." "look on the bright side!" said an optimist to a melancholy friend. "but there is no bright side." "then polish up the dull one!" was the sound advice tendered. _learn to forget_! one cannot open a periodical without being exhorted to train one's memory for a variety of reasons. the neuropath needs a system of forgetfulness. lethe is often a greater friend than mnemosyne. to brood on disappointments, failures and griefs only wastes energy, sours temper, and upsets the general health. resolve _beforehand_ that when unhappy ideas arise you will _not_ dwell on them, but turn your thoughts to pleasant trifles; take up a humorous book, or take a turn in the fresh air, and you will soon acquire the habit of laughing instead of whining at fate. to sum up: go slow! your neurons have been exhausted in your foolish attempt to "live this day as if thy last" in a wrong sense; feverish activity and unnecessary work must be abandoned to enable the nerves to recuperate. when the doctor says "rest", he means "_rest_", not change your bustle from work to what you are pleased to regard as play. so much is _absolute rest_ recognized as the foundation of treatment, that severe cases undergo the "weir-mitchell treatment". the patient is _utterly secluded_; letters, reading, talking, smoking and visits from friends are forbidden. he is put to bed, not allowed even to sit up, sees no one save nurse and doctor, is massaged, treated electrically, grossly overfed, fattened up, and freed from every care. in leaving his habitual circle, the patient escapes the too-attentive care of his relatives, and the incessant questions about his complaint with which they overwhelm him. the results of this régime with semi-insane wrecks are marvellous. it is a very drastic but very successful "rest-cure", and while it cannot be undergone at home, neurasthenics will benefit by following its principles as far as they can in their own homes. high-frequency or static electricity sometimes works wonders in the hands of a specialist, but the electric batteries, medical coils, finger-rings and body-belts so persistently advertised are _useless_. when the patient has in some measure recuperated, he may try the following exercises in mental concentration. vittoz claims good results from them, but they must be done quite seriously. . walk a few steps with the definite idea that you are putting forward right and left feet alternately. go on by easy stages until you concentrate on the movement of the whole body. . take any object in your hand, and note its exact form, weight, colour, etc. . look in a shop-window while you count ten, and as you walk on, try to recall all the objects therein exhibited. . accustom yourself to defining the sounds you hear, and concentrating on a special one, as that of a passing tram, or a ticking watch. . make a rapid examination several times daily of your feelings and thoughts, and try to express them definitely. . concentrate on the mental reproduction of a regular curve: a figure placed on its side. . listen to a metronome, and, a friend having stopped it, mentally repeat the ticking to time. . whenever you handle anything, try to retain the impression of that object and its properties for several minutes, to the exclusion of other ideas. . concentrate on ideas of calm, and of energy controlled. . place three objects on a sheet of white paper. remove them one by one, at the same time effacing the impression of each one as it is removed, until the mind, like the paper, is blank. . efface two of the objects, and retain the impression of one only. . replace the impressions in your mind, but not the objects on the paper, one by one. the object of these exercises is to get your wandering mind daily a little more under control; do not exhaust yourself. after some months of treatment, ask yourself-- am i able to walk ten miles with ease? when introduced to a stranger of either sex or any age, to converse agreeably, profitably and without embarrassment? to entertain visitors so that all enjoy themselves? to read essays or poetry with as much pleasure as a novel? to listen to a lecture, and be able afterwards to rehearse the main points? to be good company for myself on a rainy day? to submit to insult, injustice or petulance with dignity and patience, and to answer them wisely and calmly? when you are able to answer, "yes!" to these queries, your nerves are sound. * * * * * chapter x first steps towards health "all sick people want to get well, but rarely in the best way. a 'jolly good fellow' said: 'strike at the root of the disease, doctor!' and smash went the whisky bottle under the faithful physician's cane." in neuropaths, all irritation to the nervous system is dangerous, and must be eliminated, and to this end, eyes, ears, nose and teeth, all in close touch with nerves and brain, must be put and kept in perfect order. the eye. only per cent, of people have _perfect_ sight. errors in refraction--common in neuropaths--mean that the unstable brain-cells are constantly irritated. dodd corrected eye-errors in epileptics, of whom showed improvement. you take your watch to a watchmaker, not a chemist; take your eyes to an oculist, and if you cannot afford to see one privately, get an eye-hospital note. (to allow a chemist or "optician" to try lenses until he finds a pair through which you "see better" is very dangerous.) then you go to a qualified optician, who makes a proper frame, and inserts the lenses prescribed. patients should inquire if the glasses are to be worn continually, or only when doing close work or reading. the ears. giddiness and other unpleasant symptoms may be due to ear trouble. if there is any discharge, buzzing or ringing, see a doctor, for if ear disease gains a firm hold it is usually incurable. the nose. neuropaths often suffer from moist nasal catarrh, or from a dry type in which crusts of offensive mucus form, the disagreeable odour of which is not apparent to the patient himself. he must pay careful attention to the general health, take nourishing food, and wash out the nose three times a day with: oz. bicarbonate of soda, oz. common salt, oz. borax, dissolved in pint hot water. for obstinate nasal trouble, consult an aural surgeon. the teeth. "most men dig their graves with their teeth."--chinese proverb. serious ills are caused by defective teeth, for microbes decompose the food left in the crevices to acid substances which dissolve the lime salts from the teeth, and this process continues until the tooth is lost. faulty teeth are common in neuropaths, and at the risk of being wearisome--and good advice is wearisome to people--patients must get proper aid, privately or at a dental hospital, from a _registered dentist_, who, like a doctor, does not advertise. teeth gone beyond recall will be painlessly extracted, those going, "stopped", and tartar or scale scraped off. if necessary, have artificial teeth, but remember that the comfort of a plate depends upon skilled workmanship, not on gold or platinum. everyone should visit the dentist as a matter of routine once a year. buy ozs. precipitated chalk, oz. chlorate of potash, and brush the teeth with this mixture ere going to bed; use tepid water after meals. do not brush across, but, holding the brush horizontally, brush with a circular motion, cleaning top and bottom teeth at once. use a moderately hard brush with a curved surface which fits the teeth. after each meal, it is essential to cleanse the interstices between the teeth with a quill toothpick or dental floss, never with a pin, for it is the decomposition of tiny particles that starts decay; _a tooth never decays from within_. ½ fl. oz. glycerine, fl. oz. carbolic acid, ½ fl. oz. methylated chloroform. with ten drops of this mixture in a wineglassful of tepid water, wash out your mouth and gargle your throat after every meal, sending vigorous waves between the teeth, and so removing any particles left by toothpick and brush. children should be taught these habits as soon as they can eat, for the custom of a lifetime is easy. * * * * * chapter xi digestion "we may live without poetry, music and art; we may live without conscience, and live without heart; we may live without friends, we may live without books, but civilized man cannot live without cooks." the human digestive system consists of a long tube, in which food is received, nutriment taken from it as it passes slowly downwards, and from which waste is discharged, in from sixteen to thirty hours afterwards. six glands pour saliva into the mouth, where it should be--but how rarely is--mixed with the food, causing chemical changes, and moistening the bolus to pass easily down. the acid gastric juice, of which a quart is secreted daily, stops the action of the saliva, and commences to digest the proteins, which pass through several stages, each a little more assimilable than the last. the lower end of the stomach contracts regularly and violently, churning the food with the juice, and gradually squirting it, when liquified to chyme, into the small intestine. if food is not chewed until almost liquified, the gastric juice cannot act normally, but has to attack as much of the surface of the food-lump as possible, leaving the interior to decompose, causing dyspepsia and flatulence. most people suppose the stomach finishes digestion, but it only initiates the digestion of those foodstuffs which contain nitrogen, leaving fats, starches and sugars untouched. by an obscure process, the acid chyme stimulates the walls of the bowel to send a chemical messenger, a hormone through the blood to the liver and pancreas, warning them their help is needed, whereupon they actively secrete their ferments. the secretion of the pancreas is very complex. it carries on the work of the saliva, and also splits insoluble fats into a soluble milky emulsion. fats are unaffected in the mouth and stomach, which explains why hot, buttered toast, and other hot, greasy dishes are so indigestible. the butter on plain bread is quickly cleared off, and the bread attacked by the gastric juice, but in toast or fatty dishes, the fat is intimately mixed with other ingredients, none of which can properly be dealt with. always butter toast when cold. to continue: the secretion of the pancreas also contains a very active ferment, which, on entering the bowel, meets and mixes with another ferment four times as powerful as gastric juice, which completes the digestion of the proteids. meantime, the secretions of lieberkühn's glands (of which there are immense numbers in the small intestine) are further aiding the digestion of the chyme, while the liver (the largest and most important gland in the body) sends its ferments, and the gall-bladder its bile, which further emulsifies the fatty acids and glycerin until they are ready to be absorbed. the chemically-changed chyme is now termed chyle, and is ready to be absorbed by the minute, projecting villi. the fatty portion of the chyle is absorbed by minute capillaries and ultimately mingles with the blood, which may look quite milky after a fatty meal. the remaining food is absorbed by the blood capillaries in the villi, and passes to the liver for filtration and storage. the large bowel has lieberkühn's glands, but not villi, and is relatively unimportant, though most of the water the body needs is absorbed from here. how food becomes energy and tissue we do not know. the tissues are continually being built up from assimilated food, and as constantly being burnt away, oxygen for this purpose being extracted from the air we inhale, and carried via the blood to every corner of the body. the ashes of this burning are expelled into the blood and lymph, and carried out of the body by the kidneys, lungs, skin and bowels. the product of the burning is the marvel--life; the extinction of the fire is the terror--death. energy is obtained almost solely from the combustion of fats and sugars, proteids being reconverted into albumin, and then broken down to obtain their carbon for combustion, the nitrogen being expelled, but proteids are essential for the building of the tissues themselves, the stones of the furnaces which burn up carbohydrates and fats. the time taken in the digestion of foods was first studied through a wound in the stomach of st. martin, a canadian. experiments were made with various well-masticated foods, and with similar foods placed unchewed, into the stomach through the wound, the latter experiment being carried out by millions of people at every meal, by a slightly different route. boiled food is more easily digested than fried or roasted (the frying pan should be anathema to a neuropath); lean meat than fat; fresh than salt; hot meat than cold; full-grown than young animals, though the latter are more tender; white flesh than red; while lean meat is made less, and fat meat more digestible, by salting or broiling. oily dishes, hashes, stews, pastries and sweetmeats are hard to digest. bread should be stale, and toasted crisply _right through_. the time, compared with the thoroughness of digestion, is of little importance, as it varies widely within physiologic bounds. most people fancy that the more they eat the stronger they become, whereas the digestion of all food beyond that actually needed to repair the waste due to physical and mental effort consumes priceless nerve energy, and weakens one. the greater part of excessive food has literally to be _burnt away_ by the body, which causes great strain, mainly on the muscles. the question is not: "how much can i eat?" but: "how much do i need?" * * * * * chapter xii indigestion "we know how dismal the world looks during a fit of indigestion, and what a host of evils disappear as the abused stomach regains its tone. indigestion has lead to the loss of battles; it has caused many crimes, and inspired much sulphurous theology, gloomy poetry and bitter satire."--hollander. the nervous dyspeptic suffers no marked pain, but often feels a "sinking", has no appetite, and cannot enjoy life because his stomach, though sound, does not get enough nerve-force to run it properly. a great deal of nerve-force is required for digestion, and if a man comes to the table exhausted, bolts his food, uses nerve-force scheming while he is bolting, and, immediately he has bolted a given amount, rushes off to work, digestion is imperfectly performed, nutriment is not assimilated, the nerve-force supply becomes deficient. he continues to overdraw his account in spite of the doctor's warning, and stomachic bankruptcy occurs, followed by a host of ills. nervous dyspepsia is a very obstinate complaint, but if tackled resolutely, it can to a great extent be mitigated; but let it be emphasized at once, that medicines, patent or otherwise, are useless. if dyspepsia be aggravated by other complaints, these should receive appropriate treatment, but the assertions so unblushingly made in patent-pill advertisements are unfounded. the very variety of the advertised remedies is proof of the uselessness of all. set aside certain periods three times a day for meals. fifteen minutes before meal times, sit in a comfortable chair, relax all your muscles, close the eyes, and try to make the mind a blank. _rest_! then eat the meal slowly and thoroughly. conversation may lighten and lengthen a meal, but avoid politics, "shop" and topics of that type. what is wanted at table is wit, not wisdom. water may be drunk with meals, provided it is drunk between eating, and not while masticating, for it has decidedly beneficial effects upon the digestive functions. water is usually forbidden with meals because if patients drink while eating, the water usurps the functions of saliva, and moistens the bolus, which is then swallowed with little or no mastication. if you cannot drink between mouthfuls, then drink only between meals. _never drink while food is in the mouth!_ after the meal, lie down on the right side for half an hour, _resting_, and so directing all available nerve-energy to getting digestion well under way. indifferent appetites must be tempted by wholesome dishes made up in a variety of enticing ways. fats are good, but must be taken in a tasty form. eat fruit deluged with cream. the crux of digestion is to "_chew_! chew!! and keep on chewing!!!" for until food is thoroughly masticated there will be no relief. the only part of the whole digestive process placed under the control of consciousness is mastication, and, paradoxically, it is the only part that consciousness usually ignores. a healthy man never knows he has a stomach; a dyspeptic never knows he has anything else, because he will not _eat_ his food, but throws it into his stomach as the average bachelor throws his belongings into a trunk. a varied, tasty diet, thoroughly chewed and salivated, with rest before and after meals, is the only means of curing dyspepsia, for no medicine can supply and properly distribute nerve-energy. digestive pills are all purgatives, with a bitter to increase appetite, and occasionally a stomachic, bound together with syrup or soap. practically all contain aloes, and very rarely a minute quantity of a digestive ferment like pepsin. taken occasionally as purges, most digestive pills would be useful, but none are suited to continuous use, and the price is, as a rule, out of all proportion to the primary cost, while one or two are, frankly, barefaced swindles. the analyses of the british medical association give the following as the probable formulæ for some well-known preparations: beecham's pills.............................aloes; ginger. holloway's pills............................aloes; ginger. page woodcock's ............................aloes; ginger; capsicum; cinnamon and oil of peppermint. carter's little liver.......................aloes; podophyllin; pills liquorice. burgess' lion pills.........................aloes; ipecacuanha; rhubarb; jalap; peppermint. cockle's pills..............................aloes; colocynth; jalap. barclay's pills.............................aloes; colocynth; jalap. whelpton's pills............................ginger; colocynth; gentian. bile beans..................................cascara; rhubarb; liquorice; peppermint. cicfa.......................................cascara; capsicum; pepsin; diastase; maltose. * * * * * chapter xiii dieting "simple diet is best; many dishes bring many diseases," --pliny. "alas! what things i dearly love-- puddings and preserves-- are sure to rouse the vengeance of all pneumogastric nerves!" --field. the man who pores over a book to discover the exact number of calories (heat units) of carbohydrates, proteins and fats his body needs, means well, but is wasting time. in theory it is excellent, for it should ensure maximum work-energy with minimum use of digestive-energy, but in practice it breaks down badly, a weakness to which theories are prone. one man divided four raw eggs, an ounce of olive oil, and a pound of rice into three meals a day. theoretically, such a diet is ideal, and for a short time the experimenter gained weight, but malnutrition and dyspepsia set in, and he had to give up. the best diet-calculator is a normal appetite, and fancy aids digestion more than a pair of scales. in spite of rabid veget- and other "arians", most foods are good (making allowances for personal idiosyncrasy) if thoroughly masticated. the oft-quoted analogy of the cow is incorrect, for herbivora are able to digest cellulose; but even cows masticate most laboriously. meat juices are the most digestion-compelling substances in existence, and a little meat soup, "oxo" or "bovril" is an excellent first course. no one needs more than three meals per day, while millions thrive on one or two only, which should be ready at fixed hours; for the stomach when habituated becomes congested and secretes gastric juice at those hours without the impulse of the will, is ready to digest food, and gets that rest between-times which is essential to sound digestion. the man who has snacks between meals, and chocolates and biscuits between snacks can never hope to get well. to eat the largest meal at midday, as is the custom of working-men, is best, provided one can take half an hour's rest afterwards. drink a pint of tepid water half an hour before every meal. if the stomach be very foul, add a teaspoonful of bicarbonate of soda to the water. the question of alcohol is a vexed one, but paul's "take a little wine for thy stomach's sake," is undoubtedly sound advice, though had paul been trained at a london hospital, he would have added "after meals". unfortunately, moderation is usually beyond the ability of the neuropath, and consequently he should be forbidden to take alcohol at all. spirits must be avoided. moderately strong, freshly made tea or coffee may be consumed in reasonable quantity. vegetable salads are excellent if compounded with liquids other than vinegar or salad oil, and of ingredients other than cucumbers, radishes, and the like. take little starchy food and sweetmeats. it may surprise those with "a sweet tooth" to learn that, to the end of the middle ages, sugar was used only as a medicine. meat must be eaten--if at all--in the very strictest moderation, and never more than once a day. eggs, fish and poultry--in moderation too--take its place. healthy children need very little meat, while it is a moot point if children of unstable, nervous build need any at all. the diet at homes for epileptics is usually vegetarian, and gives excellent results. never swallow skin, core, seeds or kernels of fruits, many of which, excellent otherwise, are forbidden because of the irritation caused to stomach and bowels by their seeds or skins. bromides are said to give better results if salt is not taken. a little may be used in cooking, if, as is usually the case, the patient has to eat at the common table, but condiments are unnecessary and often irritating to delicate stomachs. the diet of nervous dyspeptics must be very simple, and though it is trying and monotonous to forgo harmful dainties in favour of wholesome dishes, it is but one of the many limitations nature inflicts on neuropaths. many an epileptic, after believing himself cured, has brought on a severe attack by an imprudent meal. la rochefoucauld says: "preserving the health by too strict a regimen is a wearisome malady", but it is open to all men to choose whether they will endure the remedy or the disease. most men eat six times the minimum and twice the optimum quantity of food per day. for every one who starves, hundreds gorge themselves to death. "food kills more than famine", and the poor, who eat sparsely from necessity, suffer far less from gout, cancer, rheumatism and other food-aggravated diseases than the rich. most books give detailed lists of foods to be eaten and to be avoided, but this we believe is productive of little good. let the patient eat a mixed diet, well and suitably cooked, taking what he fancies in reason, masticating everything thoroughly, and gradually eliminating foods which experience teaches him are difficult for him to digest. * * * * * chapter xiv constipation "causing a symptom to disappear is seldom the cure of any ill; the true course is to _prevent_ the symptom." rings of muscle cause wormlike movements of the bowels, and so propel forward food and waste. weakening of these muscles or their nerve controls from any cause, results in a "condition of the bowels in which motions occur only when provoked by medicines or injections". in some cases though motions occur freely, food ingested is retained too long in the digestive tract. the blood extracts what water it needs from the fluid waste in the large bowel, but when the weak muscles allow this to remain too long, an excess of moisture is removed, leaving hard, dry masses, painful to pass. when the fæces reach the anus, they cause an uneasy feeling, which directs us to seek relief, but if we neglect this impulse the bowel may become so insensitive that it ceases to warn its owner of the need to evacuate. meantime, the muscles which expel the fæces get weak, so that every motion needs a strong effort of will, and much harmful straining. much misery is caused by false modesty in the presence of others. it can never be immodest to attend to the calls of nature, and such hypersensitiveness is dangerous, for rupture, piles, fissure, prolapse, fistula, are often due to straining. lack of exercise weakens the intestinal and abdominal muscles. unsuitable or imprudent foods or drinks, indigestion, excessive worry, and anything that lowers the general health tend to produce constipation. bacteria flourish freely in fæces, and though it is doubtful whether the "auto-intoxication" so freely ascribed to them, is supported by facts, it cannot be doubted that, whatever the precise mechanism by which the effects are produced, constipation does result in a lowering of the resistance to disease. more frequent fits, colic, foul breath, headache right across the forehead, lost appetite, drowsiness, skin eruptions, irritability, insomnia, melancholia and anæmia (especially the "green sickness" of women, usually connected with menstrual irregularities) are but a few of many ills partly or wholly due to or consequent upon constipation. the symptoms of constipation of the small bowel are dry stools, usually light in colour. to cure this type, more water should be drunk, so that the waste may pass to the large bowel in a fluid state. drink freely between meals, especially in summer, when profuse perspiration often causes obstinate constipation. the symptoms of constipation of the large bowel are furred tongue, foetid breath, sallow or jaundiced complexion, and mottled stools of round, hard balls, the first portion being very firm, and the remainder nearly liquid. there are occasional attacks of colic. the first step towards cure is to form regular habits. at a suitable time, say shortly after breakfast, or after supper if you suffer from hæmorrhoids, go to the lavatory, whether you feel uncomfortable or not. wait patiently, do not try to hasten matters by violent straining, and if for some weeks there is little improvement, do not despair, for the habits of a lifetime are not overcome in five minutes, just because you have decided to amend your careless ways. a short, brisk walk beforehand often helps. if necessary, use a chamber and "squat" as savages do. in this position, the thighs support the abdomen, and force is exerted without straining. massaging the abdomen by firmly rubbing it round and round, clockwise, with the hand, often does good, as does pressure with a finger on the flesh between the end of the backbone and the anus. try every method before taking purgatives, for with patience and determination these are rarely necessary. carefully cooked and "concentrated", easily digested and "pre-digested" foods contain little residue; every meal should contain some indigestible matter to stimulate the intestines. brown bread, porridge, lettuce, cress, apples and coarse vegetables are all good for this purpose, but if taken too freely may cause heartburn and flatulence. meat, milk, fish, eggs and most patent foods have not enough waste. boiled milk is very constipating. purgatives, injections and medicines, alone, are useless, for the bowel becomes still more insensitive to natural calls under the artificial stimulation of drugs, on which it becomes so entirely dependent that without their aid it will not act. it may be necessary to clean out the bowel by an enema. make a lather with clean warm water and plain soap, and fill the enema syringe (a half-pint size is useful). smear the nozzle with vaseline, lean forward and insert into the anus, pointing a little to the left. press the bulb, withdraw the nozzle, retain the liquid a few moments and a desire to go to stool will be felt. a simpler plan is to buy glycerin suppositories. one is inserted into the anus and acts like an injection. it must be clearly understood that these are emergency measures. if internal piles come down at stool, do not allow them to remain and get engorged with blood. see that your hands are scrupulously clean, and your nails closely cut and free from dirt; then moisten the middle finger with a little vaseline taken to the lavatory for the purpose, and gently return the hæmorrhoids, sitting down for a few minutes to retain them. a mild purge may be taken once a week with advantage. glauber's salts (sodium sulphate), cascara sagrada, and liquid paraffin are all good, while castor oil globules are suited for children. for flatulence, take a -minim capsule of terebine after meals, or charcoal, either as french rusks ("biscols fraudin") or a teaspoonful of powdered charcoal between meals. one drop of creosote on a lump of sugar, peppermint water, and sal volatile may also be used. sufferers should toast bread, and use sugar sparingly. patent medicines almost invariably contain a brisk aperient. * * * * * chapter xv general hygiene "better to hunt in fields for health unbought, than fee the doctor for a nauseous draught." --dryden. if men but realized what complicated machines they were, they would use themselves better. in the body are bones and hundreds of muscles. the heart, no bigger than the clenched fist, beats , times a day; the aerating surface of the lungs is equal in area to the floors of a six-roomed house, and by means of its minute blood-vessels which would stretch across the atlantic, gallons of blood are brought into contact with over , gallons of air every day. seven million sweat-glands, miles long, get rid of a pint of liquid and an ounce of solid waste each day while it takes a tube feet long, with millions of glands, to deal with a sip of milk. man's finest steam engine turns one-eighth of the energy supplied into work; nature's engine, muscle, turns one-third into work. the body contains gallons of water, enough carbon to make , lead pencils, phosphorus for , boxes of matches, iron for tacks, and salt enough to fill half a dozen salt-cellars. over food-ferments have been found in the liver; there are , , red and , white blood corpuscles in a space as big as a pin's head, each one of which travels a mile a day and lives but a fortnight, millions of new ones being built up in the bone-marrow every second; a flash of light lasting only one eight-millionth of a second, will stimulate the eye, which can discriminate half a million tints. the ear can distinguish , tones, and is so sensitive that we hear waves of air less than one sixty-thousandth of an inch long; a mass of almost liquid jelly--for per cent of the brain is water, and aristotle thought it was a wet sponge to cool the hot heart--sends out impulses ordering our every thought and act, and stores up memory, we know not how or where. there are , , , of cells in the brain cortex alone, and , fibres pass from the brain down the spinal cord. a clear, watery cell, no larger than the dot on an "i" encloses factors causing genius or stupidity, honesty or roguery, pride or humility, patience or impulsiveness, coldness or ardour, tallness or shortness, form of head or hands, colour of eyes and hair, male or female sex, and the thousand details that make a man. yet man uses this marvellous mechanism but carelessly, and the widespread poverty, the worry and discord in the lives of the happiest, our ignorance, the evil habits we contract, and the vice, miseries, diseases and labours to which most expectant mothers are too often exposed, explain why one baby in every eight never walks; why but four of them live to manhood; why less than years is now man's average span; and why this brief space is filled with suffering and misery, from which many escape by self-destruction. sound children do not come from unclean air, surroundings, habits, pursuits, passions and parents. children conceived in unsuitable surroundings by unsuitable parents, die; must die; ought to die. they are not built for the stern battle of life. * * * * * "where the sun does not enter, the doctor does!" --italian proverb. plenty of fresh, clean air is essential to health. in all rooms a block of wood nine inches high should be inserted beneath the whole length of the bottom sash of the window. this leaves a space between the top and bottom sashes through which fresh air passes freely, without draught, both night and day, for it should never be closed. a handy man will fit a simple device to prevent the windows being forced at night, but better let in a burglar than keep out air. if it be cold or draughty in the bedroom, hang a sheet a foot from the window, put more blankets or an overcoat on the bed, or put layers of brown paper above the sheets, _but never close the window_. you can take too much of many good things, but never too much pure air. cleanliness. keep the body clean by taking at least one hot bath per week; per day if possible. much filth is excreted by your sweat-pores; why let it cake on skin and underlinen, and silently silt up your thirty miles of skin canals, thus overworking the other excretory organs, and gradually poisoning yourself? neuropaths always suffer from sluggish circulation of the extremities, and to improve this, hot and cold baths, spinal douches and massage are excellent. a hot bath ( - ° f.) ensures a thorough cleansing, but it brings the blood to the surface, where its heat is quickly lost, enervating one, and causing a bout of shivering which increases the production of heat by stimulating the heat-regulating centre in the brain. baths above ° f. induce faintness. to prevent shivering, take a cold douche after the hot bath, and have a brisk rub down with a coarse towel, when a delightful, warm glow will result. do not freeze yourself, or the reaction will not occur; what is wanted is a short, sharp shock, which sends the blood racing from the skin, to which it returns in tingling pulsations, which brace up the whole system. the douche is over in a few seconds, and may be enjoyed the year round, commencing in late spring. the cold bath must not be made a fetish. if the glow is not felt, give it up, and bathe in tepid ( - ° f.) or warm ( - ° f.) water. when started in the vigour of youth, the cold bath may often be continued through life, but it is unwise to commence in middle life. parents should never force their children to take cold baths, to "harden them". other hygienic points. tobacco is undesirable for neuropaths, save in moderation. clothes should be light, loose, and warm. epileptics should wear low, stiff collars, half a size too large, with clip ties. such a combination does not form a tight band round the neck, and can quickly be removed if necessary. wear thick, woollen socks, and square-toed, low-heeled, double-soled boots. hats should be large, light, and of soft material. woollen underwear is best. change as often as possible, and aim at health, not appearance. let all rooms be well lighted, well ventilated, moderately heated, and sparsely furnished with necessities. shun draperies, have no window boxes, cut climbing plants ruthlessly away from the windows, and never obstruct chimneys. buy muller's "my system", which gives a course of physical exercises without apparatus, which only take fifteen minutes a day. the patient must conscientiously perform the exercises each morning, not for a week, nor for a month, but for an indefinite period, or throughout life. finally, remember that so few die a natural death from senile decay because so few live a natural life. * * * * * chapter xvi sleeplessness "o magic sleep! o comfortable bird that broodest o'er the troubled sea of the mind till it is hushed and smooth." --keats. some men need only a few hours' sleep, but no one ever overslept himself in natural slumber. there are anecdotes of great men taking little sleep, but their power usually consisted in going without sleep for some days when necessary, and making up for it in one long, deep sleep. neuropaths require from - hours to prepare the brain for the stress of the next day, but quality is more important than quantity. patients go to bed tired, but cannot sleep; fall asleep, and wake every other hour the night through; sleep till the small hours, and then wake, to get no more rest that night; only fall asleep when they should be rising; or have their slumber disturbed by nightmare, terrifying dreams, heart palpitation, and so on. noise often prevents sleep. a clock that chimes the quarters, or a watch that in the silence ticks with sledge-hammer beats, has invoked many a malediction. traffic and other intermittent noises are very trying, as the victim waits for them to recur. townsmen who seek rural quiet have got so used to town clatter, that barking dogs, rippling streams, lowing cows, rustling leaves, singing birds or chirruping insects keep them awake. too much light, eating a heavy supper, all tend to banish repose, as do also violent emotions which produce toxins, torturing the brain and causing gruesome nightmares. grief and worry--especially business and domestic cares--constipation, indigestion, bad ventilation, stimulants, excitement and a hearty supper are a few of the many causes of insomnia. in children sleeplessness is often due to the bad habit of picking a child up whenever it cries, usually from the pain of indigestion due to having been given unsuitable food. feed children properly, and train them to regular retiring hours. school home-work may cause insomnia; if so, forbid it. man spends a third of his life in the bedroom, which should be furnished and used for no other purpose. pictures, drapery above or below the bed, and wallpaper with weird designs in glaring colours are undesirable. the wall should be distempered a quiet green or blue tint, and the ceiling cream. a bedroom should never be made a storeroom for odds and ends, nor is the space beneath the bed suitable for trunks; least of all for a soiled-linen basket. some time before retiring, excitement and mental work should be avoided. the patient should take a quiet walk after supper, drink no fluid, empty bladder and bowels, and take a hot foot-bath. retire and rise punctually, for the brain, like most other organs, may be trained to definite habits with patience. if sleeplessness be ascribed, rightly or wrongly, to an empty stomach, a glass of hot milk and two plain biscuits should be taken in bed; dyspeptics should take no food for three hours before retiring. if the patient wakes in the early morning he may find a glass of milk (warmed on a spirit-stove by the bedside) and a few plain biscuits of value. a victim of insomnia should lie on his side on a firm bed with warm, light coverings, open the window, close the door, and endeavour to fix his attention on some monotonous idea; such as watching a flock of white sheep jump a hedge. think of trifles to avoid thinking of troubles. how often do we hear people complain that they suffer from insomnia, when in fact they get a reasonable amount of sleep, and indeed often keep others awake by their snoring. when you wake, _get up_, for a second sleep does no good. when some one, on seeing the narrow camp-bed in which wellington slept, said: "there is no room to turn about in it," the iron duke replied: "when a man begins to turn about in his bed it is time he turned out of it." the only safe narcotic is a day's hard work. for severe insomnia consult a doctor; do not take drugs--that way lies ruin. by taking narcotics, or patent remedies containing powerful drugs, you will easily get sleep--for a time only--and then fall a slave to the drug. such victims may be seen in dozens in any large asylum. * * * * * chapter xvii the effects of imagination "the surest way to health, say what they will is never to suppose we shall be ill; most of the ailments we poor mortals know from doctors and imagination flow." --churchill. "men may die of imagination, so depe may impression be take." --chaucer. "suggestion is the introduction into the mind of a practical belief that works out its own fulfilment."--guyau. man suffers from no purely imaginary ills, for mental ills are as real as physical ills, and though an individual be ailing simply because he persuades himself he is ailing, his mind so affects his body that he is actually unwell physically, though the cause of his trouble is purely mental. the suffering of this world is out of all proportion to its actual disease, many people being tortured by fancied ills. some dread a certain complaint because a relative has died of it. others are unwell, but while taking proper treatment they brood gloomily, and get worse instead of better as they should and _could do_. cheap medical and pseudo-medical works are not an unmixed blessing, for many a person who knows, and needs to know, nothing about disease, gets hold of one, and soon has most of the ills known to the faculty and some which are not. if a patient be an optimist and persuades himself he is improving, he _does_ improve. this is the explanation of "faith moving mountains", for the curative power of prayer, christian science, laying-on of hands, suggestion treatment and patent medicine, depends on man's own faith, not on the supernatural. a doctor in whom a patient has perfect confidence, will do him far more good with the same medicines, or even with no medicines at all, than one of riper experience in whose skill he has no faith. eloquent, though often inaccurate accounts of the benefits derived from patent medicines are persistently advertised until the mind is so influenced by the constant reiteration of miraculous cures, that, either because the healing forces of the body are thereby stimulated, or because the disease is curable by suggestion, the patient is benefited by such medicines. thinking of pain makes it worse and vice versa. the curative effects of auto-suggestion were demonstrated at the siege of breda in . the garrison was on the point of surrender when a learned doctor eluded the besiegers, and got in with some minute phials of an extraordinary eastern elixir, one drop of which taken after each meal cured all the ills flesh was heir to; two drops were fatal. the "learned doctor" was a quick-witted soldier, and the elixir was _coloured water_ sold by order of the commander. its potency was due to the faith of all, who persuaded each other they were getting better, and an epidemic of infectious wellness followed ills due to depressed spirits. one man after reading a list of symptoms said in great alarm: "good heavens. i have got that disease!" and, on turning the page, found it was... _pregnancy_. as the great scotch physiologist, reid, said seventy years ago: "hope and joy promote the surface circulation of the body, and the elimination of waste matter and thus make the body capable of withstanding the causes which lead to disease, and of resisting it when formed. grief, anguish and despair enfeeble the circulation, diminish or vitiate the secretions, favour the causes which induce disease, and impede the action of the mechanism by which the body may get rid of its maladies. an army when flushed with victory and elated with hope maintains a comparative immunity from disease under physical privations and sufferings which, under the opposite circumstances of defeat and despair, produce the most frightful ravages." the classic description of the woeful effects of imagination is in jerome's "three men in a boat". harris, having a little time on his hands, strolls into a public library, picks up a medical work, and discovers he has every affliction therein mentioned, save housemaid's knee. he consults a doctor friend and is given a prescription. after an argument with an irate chemist, he finds he has been ordered to take beefsteak and porter, and not meddle with matters he does not understand. a sounder prescription never was penned. * * * * * chapter xviii suggestion treatment "to purge the veins of melancholy, and clear the heart of those black fumes that make it smart; and clear the brain of misty fogs which dull our senses, our souls clog." --burton. hypnosis and suggestion have suffered from those people who put back every reform many years--quacks and cranks--for while science, with open mind, was testing this new treatment, the quacks exploited it up hill and down dale. yet there is nothing supernatural in suggestion, for we employ it on ourselves and others every hour we live. conscience consists only of the countless stored-up suggestions of our education, which by opposing any contrary suggestions, cause uneasiness. many of us conform through life to the suggestions of others, affection, awe, hero-worship and fear taking the place of reason. the most resolute of men are influenced by tactful suggestions, which quietly "tip-toe" on to the margin of consciousness, awaken ideas which link up more and more associations, until an avalanche is started which forces itself on to the field of consciousness, the subject thinking the idea is his own. author and actor try by suggestion to make us think, laugh, or weep at their will, books are sold by suggestive titles, and many clothes are worn only to suggest wealth or respectability. the best salesman is he who by artful suggestion sells us what we do not want; the best buyer he who by equally astute suggestion makes the seller part at a price which makes him regret the bargain the moment it is closed. suggestion treatment is of great use in curing nervous states and bad habits, and all neuropaths should practice self- or auto-suggestion. in severe cases a specialist must give the treatment. the patient is taken by the neurologist to a cosy, restfully-furnished, half-lighted room, and placed in a huge easy chair facing a cheery fire. he sinks into the depths of the chair, relaxes every muscle, allows his thoughts to wander pleasantly, and soon his brain is at rest, and his mind, undisturbed by the fears which usually harass it, is ready to receive suggestions. the doctor talks quietly, soothingly, but with the conviction born of knowledge to the patient about his trouble, assuring him that he _can_ control his cravings; that he _can_ put away the doubts or fears that have grown upon him. the true reason of his illness is pointed out, any little organic factors given due weight, and the idea that it is hereditary or due to fate dispelled. faults of character, reasoning and living are unsparingly exposed and appropriate remedies suggested, and he is shown how unmanly his self-torturing reproaches are, and how futile is remorse unless transmuted into reform. the doctor's earnestness inspires confidence, and the patient unburdens his secret troubles, discusses means of remedying them, and turns from pain to promise, from remorse to resolve, from introspection to action, from dreading to doing. struck by the way the psycho-analyst reads his soul and lays bare petty meannesses, impressed by the patient thoroughness with which the doctor attends to each little symptom, confident that organic troubles--if there be any--will receive appropriate treatment, ready to carry out instructions, and disposed to believe the new treatment is of real value: under all these circumstances, the physician's suggestions carry very great weight with the patient. the resolutions passed by the victim in this calm state sink deep into subconsciousness, and when next temptation, impulse or fear assails him, his own resolutions and the doctor's suggestions are so vividly recalled that he tries to control his thoughts, and, in due time he "wins out". anyone may induce the calm state, and repeat suitable suggestions. the patient should go to a quiet room, and, reclining on a comfortable couch before a cheery fire, close the eyes, relax the muscles, breathe deeply, and avoid all sense of strain. the next step is to fix the imagination on some scene which suggests tranquility--smooth seas, autumnal landscapes, snow-clad heights, old-world gardens, deep, shady silent pools, childhood's lullabies, secluded backwaters, dim aisles of ancient churches. after a few evenings' practice, you will be able gradually to exclude all other ideas, and focus on one, inducing a state which, somewhat similar outwardly, is free from the excitement of religious exaltation, and from the delusions of a medium's trance. in this state, an appropriate suggestion must be made, sincerely, and with _absolute faith_ in its power. christ's miracles were the result of suggestive therapeutics, and he took care to inspire relatives with faith, to exclude scoffers, to surround himself by his believing apostles, and, after treatment, said: "see thou tell no man!" well knowing that suggestion cannot withstand derision. in this way, a patient of limited means can do for himself exactly what more fortunate ones pay large fees to specialists to do for them. the treatment is uncommon, but sound, for the medical profession is perhaps the most conservative on earth, and when specialists of repute use a method, you may be confident it is of value. to cure sleeplessness, see that stomach and brain are at rest, bed comfortable, and feet warm; calm yourself, and focus on the idea of sleep, saying: "i shall go to sleep in a few minutes, and wake at eight o'clock in the morning." repeat this a few times, persist for a few nights and you will quickly get drowsy, and fall asleep. phrases for other requirements will readily occur, as: "i shall feel confident in open spaces!" "i shall find no more pleasure in alcohol!" and so on. suggestion will not cure epilepsy, hysteria or neurasthenia, but it overcomes many of the symptoms which make the patient so wretched. "crutches are hung on the walls of miraculous grottos, but _never a wooden leg_." suggestion may move a paralysed arm, but the muscles only become healthy again in many days by slow repair; suggestion releases the catch, but the spring must be wound up by energy suitably applied. * * * * * chapter xix medicines "of simples in these groves that grow he'll learn the perfect skill; the nature of each herb, to know which cures and which can kill." --dryden. so distressing a malady as epilepsy early attracted attention, and every treatment superstition could devise, or science could suggest, has been tried. culpepper in his "herbal" ( years old), recommends bryony; lunar caustic (nitrate of silver) was extensively used, because silver was the colour of the moon, which caused madness. the royal touch for scrofula (king's evil) was also extended to epilepsy, the king blessing a ring, which was worn by the sufferer. another old remedy was to cut off a lock of the victim's hair while in a seizure and put it in his hand, which stopped (?) the attack. in berkshire a piece of silver collected at the communion service and made into a ring was specific, but in devon a ring made of three nails from an old coffin was preferred. lupton says: "a piece of child's navel-string borne in a ring is good against falling sickness." nearly every drug in the pharmacopoeia has been tried, the drugs now generally used being sodium, potassium and ammonium bromide. before bromides were introduced by locock in , very strict hygienic, dietic and personal disciplinary treatment combined with the use of drugs often effected improvement. since the use of bromides, these personal habits have, unfortunately, been neglected, far too much reliance being placed on the "three times a day after meals" formula. all bromides are quickly absorbed from the stomach and bowels, and enter the blood as sodium bromide, which lowers the activity of both motor and sensory centres, and renders the brain less sensitive to disturbing influences. unfortunately, the influence of bromides is variable, uncertain, and markedly good in only a small proportion of cases. in about per cent of cases, in which mild seizures occur at long periods, without mental impairment, the bromides arrest the seizures, either temporarily or permanently, after a short course. in another per cent the bromides lessen the frequency and severity of the fits, this being the common _temporary_ result of their use in _all cases_ in the first stages. in quite per cent of cases, the effect of bromides diminishes as they are continued, and they finally exert no influence at all. many cases are temporarily "cured", the drug is stopped, and the seizures recur. bromides are valuable in recent and mild cases, but no medicine exerts much effect on severe cases of long standing, which usually end in an institution. when these drugs are taken continuously, nausea, vomiting, sleepiness, confusion of thought and speech, lapses of memory, palpitation, furred tongue, unsteady walk, acne and other symptoms of "bromism" may arise, whereupon the patient must stop taking bromides and see a doctor, who will substitute other drugs for a time. if heart palpitation be troublesome while using bromides, take a teaspoonful of sal volatile in water. see a doctor if you can; _until_ you see him, get from a chemist: potassii bromidi grains. sodii bromidi grains. boracis purificati grains. aquæ fluid ounce. two tablespoonfuls in water three times a day after meals. this prescription is for an adult. if the patient be under twenty-one, tell the chemist his age, and he will make it up proportionately. victims who have seizures with some regularity at a certain time, should take the three doses in one, two hours before the attack is expected. if there are long intervals between attacks, cease taking bromides after one fit and recommence three weeks before the next seizure is apprehended. when there is an interval of six months or more between attacks, take no drugs. bromides in solution are unpalatable, patients grow careless of regularity and dosage. you must learn from your doctor and your own experience the prescription, time and dose best suited to your case, and then _never miss a dose until you have been free from fits for two years_, for the beneficial action of bromide depends on the tissues becoming and remaining "saturated" with the drug. never give up bromides suddenly after long use, but gradually reduce the dose. it is just when the disease has been brought under control, that patients consider further doctor's bills an unnecessary expense, with the result that a little later the fits recur, and a tedious treatment has to be commenced over again. no value can be placed on any specific for epilepsy until it has been thoroughly tested for some years, and so proved that its effects are permanent, for almost any treatment is of value for a time, possibly through the agency of suggestion. * * * * * chapter xx patent medicines "men who prescribe purifications and spells and other illiberal practices of like kind."--hippocrates. "...corrupted by spell and medicines bought of mountebanks." "othello." act i. carlyle said the world consisted of "so many million people, _mostly fools_"; and he was right, for to public credulity alone is due the immense growth of the patent-medicine trade. it was formerly thought that for each disease, a specific drug could be found, but this idea is exploded. the doctor determines the exact condition of his patient, considers how he best may assist nature or prevent death, and selects suitable drugs. he carefully notes their action and modifies his treatment as required. the use of set prescriptions for set diseases is obsolete; the doctor of to-day treats the patient, not the disease. a few patent medicines are of limited value; many are made up from prescriptions culled from medical works, and the rest are frauds, like potato starch. the evil lies in charging from three to four hundred times a just price, in ascribing to a medicine which may be good for a certain disorder, a "cure-all" virtue it does not possess, and in inducing ignorant people to take powerful drugs, reckless of results. ephemeral patent-medicine businesses, run by charlatans, whose aim is frankly to make money before they are exposed, spring up like mushrooms; and their cunningly worded advertisements meet the eye in the columns of every paper one opens for a few months; then they drop out, to reappear under another name, at another address. these rogues buy a few gross pills from a wholesale druggist, insert a small advertisement, and so lay the foundations of a profitable business. the lure of the unknown is turned to account. "the discoverer went back to the heart of nature--and found many rare herbs used by native tribes." "the "heart of nature" was probably a single-room office tucked away down a fleet street alley, and analysis proves these medicines contain only common drugs, one "_herbal remedy_" being _metallic_ phosphates. a common procedure is to send a question form, and, after answering the query, "what are you suffering from?" with "neurasthenia", the company "carefully study" this, and then inform you with a gravity that would grace the pages of "punch", "you are the victim of a very intractable type of neurasthenia", so intractable in fact that it will need "additional treatment"--at an "additional" fee. the quack's advertisements are models of the skilful use of suggestion, and turn to rare account the half-knowledge of physiology most men pick up from periodicals. he frightens you with alarming and untrue statements, gains your confidence by a display of semi-true facts reinforced where weak by false assertions, and, having benefited himself far more than you, leaves you to do what you should have done at first, go to a doctor or a hospital. were it made compulsory for the recipe to be printed on all patent medicines, people would lose their childlike faith in coloured water and purges, and cease the foolish and dangerous practice of treating diseases of which they know little with drugs of which they know less. the british medical association of , strand, london, w.c., issue two _s_. books--"secret remedies: what they cost and what they contain", "more secret remedies"--giving the ingredients and cost price of most patent medicines. you are strongly urged to send for these books, which should be in every home. _the basis of every cure for epilepsy_ (not obviously fraudulent) _is bromides_. the usual method is to condemn vigorously the use of potassium bromide, and substitute ammonium or sodium bromide for it. some advertisers condemn all the bromides, and prescribe a mixture of them; others condemn potassium bromide, and shamelessly forward a pure solution of this same salt in water as a "positive cure!" in all cases the sale price is out of reasonable proportion to the cost, victims paying outrageous sums for very cheap drugs. most epileptics are poor, because their infirmity debars them from continuous or well-paid work, leaving them dependent on relatives, often in poor circumstances also. the picture of patients, already lacking many real necessities, still further denying themselves for weeks or months to purchase a worthless powder, is truly a pitiful one. bromides are unsatisfactory drugs in the treatment of epilepsy, but they are the best we have at present. get them made up to the prescription of a doctor, and see him every month to report progress and be examined. in the end, this plan will be very much cheaper, and incomparably better, than buying crude bromides from quacks. * * * * * there is no drug treatment for either hysteria or neurasthenia, and when the doctor gives medicines for these complaints, it is to remedy organic troubles, or, more often because necessity forces him to pander to the irrational and pernicious habit into which the public have fallen of expecting a bottle of medicine whenever they visit a doctor. osier, the famous professor of medicine at oxford, truly observed that he was the best doctor who knew the uselessness of medicines. but when public opinion demands a bottle, and is unwilling either to accept or pay for advice alone, the doctor may be forced to give medicines which he feels are of little value, hoping that their suggestive power will be greater than is their therapeutic value. neuropaths invariably contract the habit of physicking themselves, and taking patent foods and drugs which are valueless. so universal is this pernicious habit that we deem it desirable to criticize it here at some length. one highly popular type consists of port wine, reinforced (?) by malt and meat extracts, and sold under a fanciful name. it has about the same value as a bottle of port, which costs considerably less. it is well to remember that many a confirmed drunkard has commenced with these "restoratives". malt extracts are also popular. they contain diastase, and therefore aid the digestion of starch, but the diastatic power of most commercial extracts is negligible. meat extracts of various makes contain no nourishment, but are valuable appetisers. meat gravy is as effective and far cheaper. foods containing digestive ferments, which are widely advertised under various proprietary names are practically valueless, as are the ferments themselves sold commercially. digestive disorders are very rarely due to deficiency of ferments, while pepsin is the only one among all the ferments that could act (and that only for a little while) in the digestive system. some of the disadvantages of predigested foods have been noted, and their prices are usually so exorbitant that eggs at _s._ _d._ each would be cheaper. the remarks of sollmann the great pharmacologist are pertinent: _limitations_. the administration of food in the guise of medicine is sometimes advantageous; but medicinal foods are subject to the ordinary law of dietetics, and therefore cannot accomplish the wonders which are often claimed for them. the proprietary foods have been enormously overestimated, and have probably done more harm than good. the ultimate value of any food depends mainly on the amount of calories which it can yield, and on its supplying at least a minimum of proteins. in these respects, the medical foods are all inferior, for they cannot be administered practically in sufficient quantity to supply the needs of the body. they have a place as adjuvants to other foods, permitting the introduction of more food than the patient could otherwise be induced to take. aside from the special diabetes foods and cod-liver oil, their value is largely psychic. _predigested foods_. the value of these is doubtful, for digestive disturbances involve the motor functions and absorption more commonly than the chemical functions. their continued use often produces irritation. _liquid predigested foods_. as sold, these are flavoured solutions containing small amounts (½- per cent) of predigested proteins, ½- per cent of sugars and other carbohydrates, with - per cent of alcohol, and often with large quantities (up to per cent) of glycerin. their protein content averages less than that of milk, and in energy value they are vastly inferior. their daily dose yields but - calories including their alcohol; this is only one-thirtieth to one-fifth the minimum requirements of resting patients. to increase their dose to that required to maintain nutrition would mean the ingestion of an amount of alcohol equivalent to a pint of whisky per day. of recent years very expensive preparations of real or alleged organic iron compounds have had a large sale. iron is a component of hæmoglobin, a solid constituent ( per cent by weight) of the blood, which combines with the oxygen in the lungs, and is carried (as oxyhæmoglobin) all over the body, giving the oxygen up to the tissues. hæmoglobin is an exceedingly complex substance, but it contains only one-third per cent by weight of iron in organic form. the liver is the storehouse of iron, its reserve being depleted when there is an extraordinary demand for iron. the minute amounts of iron in ordinary food are amply sufficient for all our needs; any excess is simply stored, and, later excreted, and has no effect whatever on the circulating hæmoglobin. iron is only of value in certain forms of anæmia, and the many patent medicines purporting to contain hæmoglobin or organic iron are therefore useless to neuropaths. the roman plan of drinking water in which swords had been rusted, is quite as valuable as drinking expensive proprietary compounds. when iron is indicated blaud's pills are perhaps the best preparation. huge quantities of patent medicines containing phosphates in the form of hypo-or glycerophosphates, and (or) lecithin are sold annually. all phosphorus compounds are reduced to inorganic phosphates in the digestive tract, absorbed and eliminated, so that, as with iron, if phosphates are needed, the form in which they are taken is of no moment. why, then, pay huge sums for organic-phosphorus compounds (synthesized from inorganic phosphates) when they are immediately reduced to the same constituents from which they were constructed, the only value in the reduction process being seen in the immense fortunes which patent-medicine proprietors accumulate? lecithin is isolated from animal brain, or egg-yolk, and commercial lecithin is impure. not only does the ordinary daily diet contain ample lecithin ( grammes), but two eggs will double this, while liver or sweetbread, both rich in phosphorous, may be eaten. the much-vaunted glycerophosphates are decomposed to and excreted as phosphates. sollmann's remarks apply to all similar proprietary articles: "a proprietary compound of glycerophosphates and casein has been widely and extravagantly advertised as 'sanatogen'. it is a very costly food, and in no sense superior to ordinary casein, such as cottage cheese." hypophosphites have been boomed by various people, chiefly for financial reasons. five or six of them are usually prescribed, with the addition of cod liver oil, and perhaps quinine, and (or) iron and strychnine, the complexity of the prescription being expected, apparently, to compensate for the uselessness of its various ingredients. to deduce rational remedies, it is first necessary to elucidate the causes of inefficiency; and to expect a brain which is out of order to function in an orderly manner simply because it is supplied with one of the substances necessary to its normal functioning (regardless of whether a deficiency of that substance is the cause of the disorder), is as rational as it would be to expect to restart an automobile engine, the magneto of which was broken, by filling up the half-empty petrol tank. * * * * * chapter xxi training the nervous child "when shall i begin to train my child?" said a young mother to an old doctor. "how old is the child, madam?" "two years, sir!" "then, madam, you have lost just two years," answered the old physician, gravely. neuropathic children are super-emotional, and from them come prodigies, geniuses, perverts and madmen. they are usually spare of build, with pale, sallow complexions, and dark rings under the eyes. they can never sit still, but wriggle restlessly about on their seats, pick their nostrils, and bite their nails. they are always wanting to be doing something, but soon tire of it, and start something else, which is as quickly cast aside; their energy is feverish but fitful. they jump to conclusions, quickly grasp ideas; as quickly forget them. having no capacity for calm, reasoned judgment, they are creatures of impulse, imperative but timid, suffer from strange ideas, and worry over trifles. the affections are strong and vehement, likes and dislikes are taken without reason, while intense personal attachments--often unrequited--occur, but not seldom swing round to indifference, or even bitter enmity. the passions and emotions are all abnormal, for owing to deficiency in the higher inhibitory centres, the victim is blown about by every idle emotional wind that blows. the slightest irritation may provoke an outburst of maniacal rage, or a fit. consequently, they require the most careful, but firm training, right from birth, to bring them up with a minimum of nerve-strain. twitchings, night or day terrors, sleep walking, and incontinence of urine often trouble them. they should be examined by a doctor once a year. these children have no _balance_, and are usually selfish, always garrulous, with a love of romancing, while a ready wit combined with fertile imagination often gains them a bubble reputation for learning they do not possess. invention, poetry, music, artistic taste and originality are occasionally of a high order, and the memory is sometimes phenomenal; but desultory, half-finished work, and shiftlessness are the rule. their appetite is fitful and fanciful, they like unsuitable foods, and their digestive system is easily upset. at puberty, sexual perversity is common, and the animal appetite, is as a rule, very strong, though rarely, it may be absent. during adolescence, there is excessive shyness or bravado, always introspection, and exaggerated self-consciousness. as they grow older, they readily contract hypochondria, neurasthenia, hysteria, alcoholism, insomnia and drug habits, and react unduly to the most trifling external causes, even to the weather, by which they are exhilarated or depressed. education. send them to school only when the law compels you, and observe them closely while there, for health is far more important to them than education. "infant prodigies" lack the mental staying power and physical robustness which real success demands, though they may do well for a time. go to your old school: the successes of to-day were dunces twenty years ago; about those whose names are proudly emblazoned in fading gold on rolls of honour, a discreet silence is maintained. keep a keen lookout for symptoms of over-effort. sleepiness, languor, a vacant expression, forehead wrinkled, eyebrows knit, eyes dull, sunken and surrounded by dark rings, twitchings, restlessness, or loss of appetite are all warnings that the pace is too strong for the child. "these are the cases in which the school board--who ordain that if children are well enough to play or run errands, they are well enough to attend school--should be defied." this defiance must of course be reinforced by a doctor's certificate. to the healthy, the strain of preparing for and enduring an examination is tremendous; to highly strung children it is dangerous. home-work should be forbidden in spite of the authorities. let the child join in the sports of the school as much as possible. school misdemeanours form a thorny problem, for discipline must be maintained, and a stern but just discipline is very wholesome for this type, who are too apt to assume that because they are abnormal, they can be idle and refractory. on the other hand, parents should promptly and vigorously object to their children being punished for errors in lessons, or struck on the head. diet. food, while being nourishing, and easily digested, must not be stimulating or "pappy". meat, condiments, tea, coffee and alcohol are highly undesirable, a child's beverage being milk and water. meals should be ready at regular hours, and capricious appetites should freely be humoured among suitable foods, served in appetizing form to tempt the palate. let them chatter, but see they do not get the time to talk by bolting their food. most children can chew properly soon after they are two, but they are never taught. their food is "mushy", or is carefully cut, and gives them no incentive to masticate. so long as food is digestible, the harder it is the better, and plain biscuits, raw fruits, and foods like "grape nuts", are splendid. mastication helps digestion; it also prevents nasal troubles. the desire for food at odd moments causes trouble, which is aggravated if the meals are not ready at stated hours. gently but firmly refuse the piece of bread-and-butter they crave, explain why you do so, and though they weep, or fly into a passion, do not lose your own temper, or beat, or give way to them. when accustomed to regular hours and firm refusals they will not crave for titbits between meals. it is very hard for them to see other members of the family freely partaking of condiments, drinks and unsuitable foods, and be told they are the only ones who must refrain. a little personal self-sacrifice helps immensely, and if your child _must_ refrain so _might_ you. all foods must be pure. avoid tinned goods, and cheap jams, which contain mangels and glucose. judged by the nutriment they contain--most cheap foods are very expensive. lightly boil, poach, or scramble eggs; steam fish and vegetables; cook rice and sago in the oven for three hours. see that milk puddings are chewed, for usually they are bolted more quickly than anything else. the stomach is expected to deal with unchewed rice pudding, because it is "nourishing". so are walnuts, but you do not swallow them whole. fruit must be fresh, ripe and raw, with skin and core removed. brown bread, crisply toasted and buttered when cold, is best. porridge is admirable, but many children dislike it. try to induce a taste by giving plenty of milk, and sugar or syrup with it. the starch-digesting ferments in the saliva and pancreas are not active until the age of months, before which infants must not be given starchy foods like potatoes, cereals, puddings and bread. all greenstuffs must be thoroughly washed, or worms may pass into the system. foul breath, picking the nose, restlessness, fever and startings are often attributed to worms, when the real "worms" are mince pies, raisins, sour apples, and even beer. never force fat on children in a form they do not like, for there are plenty of palatable fats, as butter, dripping, lard and milk. cream is as cheap, as good, and far nicer than cod-liver oil. decide on your children's diet, but do not discuss it with or before them. if a child _does_ dislike a dish, never force it on him, but try to induce a liking by serving it in a more appetizing way. never mix medicines with food. worms. various symptoms are due to intestinal worms, and a sharp lookout should be kept for the appearance of any in the stools, and suitable treatment given when necessary. treatment for thread and round worms: r. santonini........................gr. ij. hydrarg. chloridi mitis..........gr. ij. pulv. aromatici..................gr. iv. mix and divide into four. take one at bedtime every other night, followed by castor oil in the morning. tapeworms. these are rarer, being much more frequently talked or read about than seen. a doctor should be consulted. moral training. the road to hell is broad and easy; so is that to heaven, for if bad habits are easily acquired, so are good ones. example is the best moral precept, and if the conduct of parents is good, little moral exhortation is needed. "what is the moral ideal set before children in most families? not to be noisy, not to put the fingers in the nose or mouth, not to help themselves with their hands at table, not to walk in puddles when it rains, etc. to be 'good'!" to hedge in the child's little world, the most wonderful it will ever know, by hidebound rules enforced by severe punishments, is to repress a child, not to train it. while the commonest error is to spoil a child, it is just as harmful to crush it. be firm, be kindly, and, above all, _be fair_. issue no command hastily, but only if necessary, and shun prohibitions based on petulance or pique. give the child what it wants if easily obtainable and not harmful. if the desire is harmful, explain why, but if a child asks for a toy, do not pettishly reply: "it's nearly bedtime!" when it is not, or even if it is. discipline is essential, but discipline does not consist in inconsistent nagging; harshly insisting on unquestioning obedience to some unreasonable command one moment, and weakly giving way--to avoid a scene--on some matter vitally affecting the child's welfare the next. there must be no coddling, and no inducement to self-pity. such children must be taught that they are capable of real success and real failure, and that upon personal obedience to the laws of health of body and of mind, this success or failure largely depends. a child should be early accustomed to have confidence in himself. for this purpose all about him must encourage him and receive with kindliness whatever he does or says out of goodwill, only giving him gently to understand, if necessary, that he might have done better and been more successful if he had followed this or that other course. nothing is more apt to deprive a child of confidence in himself than to tell him brutally that he does not understand, does not know how, cannot do this or that, or to laugh at his attempts. his educators must persuade him that he _can_ understand, and that he _can_ do this thing or that, and must be pleased with his slightest effort. it seems a trifle to let a child have the run of cake plate or sweet-tray, or to stay up "just another five minutes, mummy!" to avoid a howl, but these are the trifles that sow acts to reap habits, habits to reap character, and character to fulfil destiny. it is selfish of parents to avoid trouble by not teaching their children habits of obedience, self-restraint, order and unselfishness. between five and ten is the age of greatest imitation, when habits are most readily contracted. come to no decision until hearing the child's wishes or statements, and thinking the matter out; having come to it, _be inexorable_ despite the wiles, whines and wails of a subtle child. reduce both promises and threats to a minimum, but _rigidly_ fulfil them, for a threat which can be ignored, and a promise unfulfilled, are awful errors in training a child. persuade, rather than prohibit or prevent, a child from doing harmful actions. if it wants to touch a hot iron, say clearly it is hot, and will burn, but _do not move it_. then, if the child persists, it will touch the iron tentatively, and the small discomfort will teach it that obedience would have been better. let it learn as far as possible by the hard, but wholesome, road of experience. makeshift answers must never be given to a child. awkward questions require truthful answers, even though these only suggest more "whys?" sentimentality must be nipped promptly in the bud, and an imaginative and humorous view of things encouraged. the child must be taught to keep the passions under control, and to face pain (that great educator which neurotic natures feel with exaggerated keenness) with fortitude. fear must be excluded from a child's experience. "bogies!" "ghosts!" "robbers!" and "black-men!" if unintroduced, will not naturally be feared. the mental harm a highly strung child does by rearing most fearsome imaginings on small foundations is incalculable, and has led more than one to an asylum. try to train the child to go to sleep in the dark, but if it is frightened give it a nightlight. as guthrie says, the comfort derived from the assurance that unseen powers are watching over it, is small compared to that given by a nightlight. he mentions a child who, when told she need not fear the dark because god would be with her, said: "i wish you'd take god away and leave the candle." if the child wakes terrified, it is stupid and wicked to call upstairs: "go to sleep!" a child cannot go to sleep in that state, and a wise mother will go up and softly soothe the frightened eyes to sleep. neuropathic children often have night terrors within an hour or two of going to bed. piercing screams cause a hasty rush upstairs, where the child is found sitting up in bed, crouching in a corner, or trying to get out of door or window. his face is distorted with fear and he stares wildly at the part of the room in which he sees the terrifying apparition. he clings to his mother but does not know her. after some time he recovers, but is in a pitiful state and has to have his hand held while he dozes fitfully off. he often wets the bed or passes a large amount of colourless urine. medical treatment is imperative. corporal punishment is unsuitable for neuropathic children, for the mere suggestion of its application usually causes such excessive dread, mental upset and terror as make it really dangerous. such children are often said to be "naughty" when in reality they are unable to exercise self-control, owing to defective inhibitory power. try patiently to inculcate obedience from the desire to do right, and make chastisement efficacious from its very exceptional character. "the young child is too unconscious to have a deliberately perverse intention; to ascribe to him the fixed determination to do evil, is to judge him unjustly and often to develop in him an evil instinct. it is better in such a case to tell him he has made a mistake, that he did not foresee the consequences to which his action might lead, etc." many parents fall into a habit of shaking, ear-boxing, and such-like harmful minor punishments for equally minor offences, which should be overlooked. in all little troubles, keep _quite calm_. the child's nerve and association centres have not yet got "hooked up", and you cannot expect it to act reasonably instead of impulsively. this excuse does not apply to you. one excitable person is more than enough, for if both get angry, sensible measures will certainly not result. the necessity for calmness cannot too strongly be urged. the treatment for a fit of temper, is to give the unfortunate child a warm bath, and put it to bed, with a few toys, when it will soon fall asleep, and awake refreshed and calm. proceed gently but with absolute firmness, _start early_, and remember that example is better than precept. religion. offering advice on this subject is skating on very thin ice, and we do so but to give grave warning against neuropathic youth being allowed to contract religious "mania", "ecstasy", or "exaltation". neuropaths are given naturally to "see visions and dream dreams", and if this tendency be exaggerated an unbalanced moral type results. jones says: "the epileptic is apt to be greatly influenced by the mystical or awe-inspiring, and is disposed to morbid piety. he has an outer religiousness without corresponding strictness of morals; indeed the sentiment of religious exaltation may be in great contrast to his habitual conduct, which is a mixture of irritability, vice and perverted instincts." lay stress on the simple moral teaching of the new testament, and avoid cranky creeds, cross references, or higher criticism. teach them to practise the moral precepts, not to quote them by the page. without this practical bent, a "revival" meeting is apt to result in a transient but harmful "conversion"; a form of religious sentiment which finds outlet, not so much in works as in morbid excitement. in these people, as in the insane, there is often a weird mixing-up of religious and sexual emotion. teach these children that the greatest good is not to sob over their fancied sins at "salvation" meetings, but to love the just and good, to hate the unjust and evil, and to do unto others as they would others should do unto them. it is better for them to join one of the great churches, than become members of those small sects which maintain peculiar tenets. a word of special warning must be given against spiritualism. there may or may not be a foundation for this belief, but it is highly abnormal, and has led thousands into asylums. the medium and the majority of her audience are highly neurotic, and a more unwholesome environment for an actual or potential neuropath could not be imagined. the educated neuropath often peruses certain agnostic works, the result usually being deplorable, for this class are dependent on some stable base outside themselves, such as is found in a calm religion manifested in a steadfast attempt to overcome the weakness of the flesh, by ordering life in accordance with the teachings of the new testament. so long as abnormalities of character do not become too pronounced, friends must be content. such children must be trained to express themselves in a practical manner, not in weaving gorgeous phantasies in which they march to imaginary victory. day dreams form one of those unlatched doors of the madhouse that swing open at a touch, the phantasy of to-day being written "emotional dementia" on a lunacy certificate to-morrow. finally, remember that above them hangs the curse: "unstable as water, _thou shall not excel_." "go thou softly with them, all their days!" and whether your tears fall on the ashes of a loved and loving, but weak and wilful one, or whether their tears bedew the grave of the only friend they ever knew, you will not have lacked a rich reward. * * * * * chapter xxii dangers at and after puberty "th' expense of spirit in a waste of shame is lust in action; and till action, lust is perjured, murderous, bloody, full of blame, savage, extreme, rude, cruel, not to trust; enjoyed no sooner but despised straight; past reason hunted; and, no sooner had, past reason hated, as a swallow'd bait on purpose laid to make the taker mad; mad in pursuit, and in possession so; had, having had, and in quest to have, extreme; a bliss in proof, and proved, a very woe; before, a joy proposed; behind, a dream; all this the world well knows; yet none knows well, to shun the heaven that leads men to this hell!" --shakespeare. sonnet . at puberty (from the age of - ) a boy becomes capable of paternity, a girl of maternity; during adolescence (from puberty to ) the body in general, and the reproductive organs in particular, grow and mature. in the boy, semen is secreted, the voice breaks, the genitals enlarge, hair grows on the pubes, face and armpits, and there is a rapid increase in height owing to growth of bone. in the girl menstruation commences, the pelvis is enlarged, bust and breasts develop, the complexion brightens, the hair becomes glossy, and the eyes bright and attractive. in both, the sexual instinct awakens, and the mental, like the physical, changes are profound. there is great general instability, the child, at one time shy and reticent, is at another, boisterous and self-assertive. parents rarely realize the importance and trying nature of this period when "there awakes an appetite which in all ages has debased the weak, wrestled fiercely with the strong and overwhelmed too often even the noble". adolescents suffer more from the lack of understanding, sympathy, appreciation and wise guidance shown by their blind parents, than they do from their own ignorance and perfervid imagination. the transitions from radiant joy and confident expectation, reared on a flimsy basis of supposition, to dire despair consequent on a wrong reading of physical and mental changes, are rapid. friends, lovers and heroes quickly succeed one another, play their parts, and give place to others. the awakening of the sexual appetite is usually ignored, and children are left to gain knowledge of man's noblest power from companions, casual references in the bible and other books, and unguarded references in conversation. under such conditions not one in a thousand--and _your_ child is _not_ that one--escapes impurity and degraded sex ideas. wherever youth congregate, this subject crops up, and those who talk most freely to the others are just those with the most distorted and vicious ideas, whose discourse abounds in obscene detail and ribald jest. your child must learn either from ignorant, unclean minds, or be taught in a clean, sacred way, which will rob sex of secrecy and obscenity; _learn he will_; if you will not teach your child, his pet rabbit will. when children ask awkward questions, say quietly that such matters are not discussed with children, but promise to tell them all about it when they are ten years old; delay no longer, for most children learn self-abuse between ten and twelve. self-abuse is a bad habit, and no more a "sin" than is biting the nails. unfortunately, people with no other qualification than a desire to do good, wrongly harp on the "sin" of it and draw lurid pictures of physical and mental wreck as the end of such "sinners", ignorant that if all masturbators went mad the world would be one huge asylum. exaggeration never pays in teaching youth. tell the truth, which is bad enough without adding "white lies" with an eye to effect. coitus causes slight prostration, nature's device to remind man to keep sexual intercourse within bounds, for while in moderation it is harmless, in excess it causes great prostration. _exactly the same applies to self-abuse_, for, paradoxical as it seems, the real harm is done by the _fear_ of the supposed harm. the masturbator first suffers from the knowledge he is indulging in a pleasure he knows would be forbidden, and from fear of being found out; later he learns from friends, quack advertisements, or well-meaning books that self-abuse is a most deadly practice, and thereupon a tremendous struggle occurs between desire and fear, each act ending in an agony of remorse and dread of future consequences, which struggle does a thousand-fold more harm than the loss of a little semen. the ill-effects of these mental struggles disappear after marriage, which means greater indulgence, but indulgence free from mental stress. in neuropaths, these mental struggles are the worst things that could occur, for they tend to make permanent the states we are trying to cure. the most serious results of masturbation are moral not physical. loss of will-power, self-reliance, presence of mind, reasoning power, memory, courage, idealism, and self-control; mental and physical debility, laziness, a diseased fondness for the opposite sex, and in later years, some degree of impotence or sterility, are its commoner results. teach _your_ child, therefore, not from fear of physical harm, but because you wish him to be one of those fortunate few who live and die "gentlemen unafraid", because they had wise parents. let the mother instruct a girl, the father a boy, and not leave so vital a matter to an unsuitable pamphlet. buy one of the many "knowledge for boys or girls" books and read it carefully. having made sure you can convey a simple account of the wonders of reproduction, and that you have rooted out the idea that sex is something to be apologized for, see the child and tell him it is time he learned of his private parts, as manhood draws near. then, speaking in a quiet, unembarrassed way, deliver your little homily, all the time insisting on the marvel, the romance, the poetry and the beauty of the sex. let chivalry be your text, not fear, and repeat the squire's sound parting advice to tom brown: "never listen to or say things you would not have your mother or sister hear." give a clear and complete description in simple words of the mechanism and marvel of reproduction, for half-knowledge generates a prurient curiosity about the other sex, thus defeating the very end you have so earnestly striven for. purity not impurity should be your text, and you should only refer to masturbation as a harmful habit, which should not be contracted. warn them to "keep the heart with all diligence, for out of it are the issues of life!" by turning their thoughts instantly and determinedly away from sex ideas when they arise, as they _will_ arise, time and again. it is useless to try _not_ to think of them, the child must instantly turn its thoughts to to _something else_, for one who cannot stamp out a spark will not subdue a fiercely-raging conflagration. babies should not be carelessly caressed, and a fretful infant must never be soothed by playing with the genitals, as is done innocently by some mothers and nurses, and by others from motives more questionable. freud showed that there are subconscious sexual desires in infants, which die out until reanimated at puberty in nature's own way. if exaggerated by exuberant fondling, they gather force in the dark corners of the mind, and are later manifested in morbid sexual or mental perversity. if you have good grounds for believing the habit has already been contracted, enlist medical advice. a great factor in the successful treatment of self-abuse is early recognition, and, after the unhygienic nature of the habit has carefully been pointed out, the child's sense of honour should be invoked. without further reference to the matter, try to become your child's confidant, for he will have to fight fires within and foes without. see that his time is filled with healthy sport and play, and ennoble his ideas with talk, books and plays which lay stress on chivalry and manliness. give him plain food, tepid douches, and a firm bed with light, fairly warm clothing. get him up reasonably early in the morning, and let him play until he is "dog-tired" at night. let children rub shoulders with others, keep them from highly exciting tales, let them read but little, and train them to be observant of external objects all the time. neuropaths develop very early sexually, and contract bad habits in the endeavour to still their unruly passions; with them, the future is darker than with the normal child, and the parent who neglects his duty may justly be held accountable for what happens to his child or his child's children. puberty is always a critical period in epilepsy, many cases commencing at this time, while in a number, fits commence in infancy, cease during childhood, and recommence at puberty, the baneful stimulus of masturbation being undoubtedly a factor in many of these cases. * * * * * chapter xxiii work and play although most people would assume that epileptics are unable to follow a trade, there is hardly an occupation from medicine to mining, from agriculture to acting, that does not include epileptics among its votaries. outdoor occupations involving but little mental work or responsibility are best, but unfortunately just those which promise excitement and change are those which appeal to the neuropath. a light, clean, manual trade should be chosen, and those that mean work in stuffy factories, amid whirring wheels and harmful fumes, using dangerous tools, or climbing ladders, must be avoided. for the fairly robust, gardening or farming are good occupations, such workers getting pure air, continuous exercise, and little brain-work. wood-working trades are good, if dangerous tools like circular saws are left to others. for the frail neuropath with a fair education, drawing, modelling, book-keeping, and similar semi-sedentary work may do. other patients might be suited as shoemakers, stonemasons, painters, plumbers or domestic servants, so long as they always work on the ground. some work is essential; better an unsuitable occupation than none at all, for the downward tendency of the complaint is sufficiently marked without the victim becoming an idler. work gives stability. epilepsy limits patients to a humble sphere, and though this is hard to a man of talent, it is but one of many hard lessons, the hardest being to realize clearly his own limitations. if seizures be frequent, the ignorant often refuse to work with a victim, who can only procure odd jobs, in which case he should strive to find home-work, at which he can work slowly and go to bed when he feels ill. a card in the window, a few handbills distributed in the district, judicious canvassing, and perhaps the patronage of the local doctor and clergy may procure enough work to pay expenses and leave a little over, for the essential thing is to occupy the mind and exercise the body, not to make money. very few trades can be plied at home and many swindlers obtain money under the pretence of finding such employment, charging an excessive price for an "outfit", and then refusing to buy the output, usually on the pretext that it is inferior. envelope-addressing, postcard-painting and machine-knitting have all been abused to this end. an auto-knitter seems to offer possibilities, but victims must investigate offers carefully. photography is easy. a cheap outfit will make excellent postcards, modern methods having got rid of the dark room and much of the mess, and postcard-size prints can be pasted on various attractive mounts. if the work is done slowly, and in a good light, and the patient has an aptitude for it, ticket-writing is pleasant. among small shopkeepers there is a constant demand for good, plainly printed tickets at a reasonable price. on an allotment near home vegetables and poultry might be raised, an important contribution to the household, and one which removes the stigma of being a non-earner. the mental discipline furnished by this home-work is invaluable, neuropaths, especially if untrained, are unable to concentrate their attention on any matter for long, and do their work hastily to get it finished. when they find that to sell the work it must be done slowly and perfectly they have made a great advance towards training their minds to concentrate. their weak inhibitory power is thus strengthened with happy results all round. when the work and the weather permit, work should be done outdoors, and when done indoors windows should be opened, and, if possible, an empty or sparsely-furnished bedroom chosen for the work. recreations. these offer a freer choice, but those causing fatigue or excitement must be avoided, for patients who have no energy to waste need only fresh air and quiet exercise. manual are better than mental relaxations. dancing is unsuitable, swimming dangerous, athletics too tiring and exciting. bowls, croquet, golf, walking, quoits, billiards, parlour games and quiet gymnastics without apparatus are good, if played in moderation and much more gently than normal people play them. play is recreation only so long as a pastime is not turned into a business. when a player is annoyed at losing, though he loses naught save his own temper, any game has ceased to be recreative. * * * * * chapter xxiv heredity "man is composed of characters derived from pre-existing germ-cells, over which he has no control. be they good, bad, or indifferent, these factors are his from his ancestry; the possession of them is to him a matter of neither blame nor praise, but of necessity. they are inevitable."--leighton. the body is composed of myriads of cells of _protoplasm_, in each of which, is a _nucleus_ which contains the factors of the hereditary nature of the cell. in growth, the nucleus splits in half, a wall grows between and each new cell has half the original factors, female _ovum_ and male _sperm_ (the cells concerned with reproduction) divide, thus losing half their factors, and when brought together by sexual intercourse form a _germ-cell_ having an equal number of factors from mother and father. how these factors are mingled--whether shuffled like two packs of cards, or mixed like two paints--we do not know. if two opposite factors are brought together, one must lie dormant. the offspring may be male or female, tall or short; it cannot be both, nor will there be a mixture. _this rule only applies to clearly defined factors._ we are _made by_ the _germ-plasm_ handed down to us by our ancestors; in turn we pass it on to our children, _unaltered_, but mixed with our partner's plasm. "the dead dominate the living" for our physical and mental inheritance is a mosaic made by our ancestors. variations which may or may not be inheritable do arise spontaneously, we know not how, and by variations all living things evolve. a child resembles his parents more than strangers, not because they made cells "after their own image" but because both he and they got their factors from the same source. man's physical and mental, and the _basis_ of his moral, qualities depend entirely on the types of ancestral plasm combined in marriage. man may control his environment; his heritage is immutable. to suppress an undesirable trait the germ-cell must unite with one that has never shown it--one from a sound stock. an unsuitable mating in a later generation, however, may bring it out again (for factors are indestructible), and the individual showing it will have "reverted to ancestral type". to give an instance: does the son of a drunkard inherit a tendency to drink? no! the father is alcoholic because he lacks control, consequent upon the factors which make for control having been absent from his germ-plasm. he passes on this lack; if the mother does the same, the defect occurs--in a worse form--in the son. if the mother gives a control factor, the son may be unstable or _apparently_ stable, this depending entirely on chance, but if the mother's plasm contains a _strong_ control-factor, the defect will lie dormant in her son, who will have self-control, though if he marries the wrong woman he will have weak-willed children. if the son becomes a toper, therefore, it is because he, like his father before him, was born with a defect--weak control--which might have made of him a drug-fiend, a tobacco-slave, a rake, or a criminal; in his home drink would naturally be the temptation nearest to hand, and he would show his lack of control in drunkenness. the way a lily-seed is treated makes a vast difference to the plant which arises. if sown in poor soil, and neglected, a dwarf, sickly plant will result; if sown in rich soil, and given every care that enthusiasm, money and skill can suggest or procure, the result will be magnificent. so with man. a well-nourished mother, free from care and disease, may have a finer child than a half-starved woman, crushed by worry and work, but neither starvation nor nourishment alter the inborn character of the child. the _body-cells_ are greatly changed by disease, poison, injury, and overwork, but these changes are not passed on, and despite the influence of disease from time immemorial, the _germ-cell_ produces the same man as in ancient days. without this fixity of character, this "continuity of the germ-plasm", "man" would cease to be, for the descendants of changeable cells would be of infinite variety, having fixity of neither form nor character. epilepsy, hysteria and neurasthenia are all outward signs of defect in the germ-plasm, and so they (or a predisposition to them) can be passed on, and inherited. if a man shows a certain character, his plasm, had, and has, the causative factor. he may have received it from _both_ his parents, when it will be _strong_, or from one only, when it will be _normal_. if he have it not, it is absent. the same applies to the plasm of the woman he mates, so there are six possible combinations, with results according to "mendel's law." _all_ the children will not inherit a taint unless _both_ parents possess it, but, however strong one parent be, if the other is tainted, _none_ of the children can be absolutely clean, but will show the taint, weak, strong, or dormant. this means that neuropathy will recur--and that it has previously occurred--in the same family, unless there be continual mating into sound stocks. if there is continual mating into bad stocks, it will recur frequently and in severe forms. all intermediate stages may occur, depending entirely on the qualities of the combining stocks. from this we shall expect, in the same stock, signs of neuropathic taint other than the three diseases dealt with here, and these we get; for alcoholism, criminality, chorea, deformities, insanity and other brain diseases, are not infrequent among the relatives of a neuropath, showing that the family germ-plasm is unsound. epilepsy, one symptom of taint, is more or less interchangeable with other defects; the taint, as a whole, is an inheritable unit whose inheritance will appear as any one of many defects. this is shown by the fact that very few epileptics have an epileptic parent. starr's analysis of cases of epilepsy emphasizes this point. epilepsy in a parent epilepsy in a near relative alcoholism in a parent nervous diseases in family rheumatism and tuberculosis combinations of above diseases as medicine and surgery cannot add or delete plasmic factors, the only way to stamp out neuropathy in severe forms would be to sterilize victims by x-rays. this would be painless, would protect the race and not interfere with personal or even with sexual liberty. in fifty years such diseases would be almost extinct, and those arising from accident or the chance union of dormant factors in apparently normal people could easily be dealt with. there are , epileptics in great britain, and as _all_ their children carry a taint which tends to reappear as epilepsy in a later generation _the number of epileptics doubles every forty years_. we protect these unfortunates against others; why not posterity against them? neuropaths must pass on _some_ defect; therefore, though victims may marry, _no neuropath has a right to have children_. * * * * * chapter xxv character "all men are not equal, either at birth or by training. nature gives each of us the neural clay, with its properties of pliability and of receiving impressions; nurture moulds and fashions it, until a _character_ is formed, a mingling of innate disposition and acquired powers. but clay will be clay to the end; you cannot expect it to be marble."--thomson & geddes. "heaven lay not my transgression to my charge."--king john. it is essential that attendants, relatives, and friends carefully study the character of neuropaths, and recognize clearly how abnormal it is, for untold misery is caused by judging neuropaths by normal standards. patients are often harshly treated because others regard the victim of defective inhibition as having gone deliberately to work, through wicked perversity and pure wilfulness, to make himself a nuisance, to persist in being a nuisance, and to refuse to be other than a nuisance, rather than exercise what more fortunate men are pleased to term self-control. character is usually appraised as "good" or "evil" by the nature of a man's actions, the assumption being made that he can control his impulses if he be so minded. this is not so. "good" and "evil" are only relative terms. what one man thinks "evil", a second holds "good", while a third is not influenced. now the performance of the act judged is directed by the performer's brain, the constitution of which was pre-determined by the germ-plasm from which he arose, so that _the basis of character is inherited_. the moral sense is the last evolved and least stable attribute of the last evolved and least stable of our organs, the brain; and brains are born, not made to order. to blame a man for having weak control--a sick will--is as unreasonable as to blame him for a cleft palate or a squint. the "good" people who jog so quietly through life little reck how much they owe their ancestors, from whom they received stability. these tendencies represent the total material for building character. training and environment can only nourish good tendencies and give bad ones no encouragement to grow gigantic. if training and environment alone formed character, then children reared together would be of similar disposition; by no means the case. similarly, if external influences altered inborn tendencies, then, not only would the evil man be totally reformed by strong inducements to virtue, but strong inducements to vice would lead totally astray the good man, for "good" is no _stronger_ than "evil", both being attributes of mind. in mind as in body, from the moment he is conceived to the moment his dust rests in the tomb, man is directed by immutable laws, though he is not simply a machine directed by impulses over which he has no control. there is real meaning in "strong will" and "weak will" will being a tendency to deliberate before and be steadfast in action, a tendency which varies immensely in different people. the fallacy of "free will" lies in assuming that every one has this tendency equally developed, making character a mere matter of saying "yes!" and "no!" without reference to the individual's mental make-up. deliberate, persistent wickedness implies a strong will, just what neuropaths lack. a man of weak will can never be a very good nor yet a very bad man. he will be very good at times, very bad at times, and neutral at times, but neither for long; before sudden impulses, whether good or bad, neuropaths are largely powerless. the many perversities of a neuropath are not deliberately put forth of his "free will" to annoy both himself and others, for the neuropath inherits his weak-control no less than his large hands. friends _must_ remember they are dealing with a person whose _nature_ it is to "go off half-cock", and who cannot be normal "if he likes". the neuropath, young or old, says what he "thinks" _without thinking_, that is he says what he _feels_, and acts hastily without weighing consequences. _cassius_: have you not love enough to bear with me, when that rash humour which my mother gave me makes me forgetful? _brutus_: yes, cassius; and, from henceforth when you are over-earnest with your brutus, he'll think your mother chides, and leave you so. * * * * * one cannot detail the effects of neuropathy on character, when its victims include madmen, sexual perverts, idiots, criminals, imbeciles, prostitutes, humble but honest citizens, common nuisances, invalids of many kinds, misanthropists, designers, enthusiasts, composers, communists, reformers, authors, artists, agitators, statesmen, poets, prophets, priests and kings. very mild epilepsy--from one fit a year to one in several years--instead of hindering, seems rather to help mentality, and many geniuses have been epileptic. these talented victims, are less rare than the public suppose, owing to the jealous care with which symptoms of this disease are guarded. socrates, julius cæsar, mahomet, joan of arc, peter the great, napoleon, byron, swinburne, and dostoieffsky are but a few among many great names in the world of art, religion and statecraft. epileptic princes, kings and kinglets who have achieved unenviable notoriety might be named by scores, wilhelm ii being the most notable of modern times. this brilliant mentality is always accompanied by instability, and usually by marked disability in other ways. the success of these men often depends on an ability to view things from a new, quaint or queer standpoint, which appeals to their more normal fellows. in matters that require great fertility, a quick grasp, ready wit, and brilliant but not sustained mental effort, numerous neuropaths excel. in things calling for calm, well-balanced judgment, or stern effort to conquer unforseen difficulties, they fail utterly. subtle in debate, they are but stumbling-blocks in council; brilliant in conception, they fail in execution; fanciful designers, they are not "builders of bridges". they are boastful, sparkling, inventive, witty, garrulous, vain and supersensitive, outraging their friends by the extravagance of their schemes; embarrassing their enemies by the subtlety of their intrigues. they wing on exuberant imagination from height to height, but the small boulders of difficulty trip them up, for they are hopelessly unpractical; they have neither strength of purpose nor fortitude, and their best-laid schemes are always frustrated at the critical moment, by either the incurable blight of vacillation, or by the determination to amplify their scheme ere it has proved successful, sacrificing probable results for visionary improvements. great and cunning strategists while fortune smiles, they are impotent to direct a retreat, but flee before the fury they ought to face. they rarely have personal courage, but are timid, conciliatory and vacillating just when bravery, sternness, and determination are needed; furious, obstinate and reckless, when gentleness, diplomacy and wisdom would carry their point. they are ready to forgive when there is magnanimity, vainglory and probably folly in forgiveness, but will not overlook the most trivial affront when there is every reason for so doing. they have brain, but not ballast, and their whole life is usually a lopsided effort to "play to the gallery". in poetry and literature, fancy has free play, and they often succeed, sometimes rising to sublime heights; usually in the depiction of the whimsical, the wonderful, the sardonic, the bizarre, the monstrous, or the frankly impossible. they are not architects as much as jugglers of words, and descriptive writing from an acute angle of vision is their forte. they sometimes succeed as artists or composers, for in these spheres they need not elaborate their ideas in such clean-cut detail, but many who might succeed in these branches have not sufficient strength of purpose to do the preliminary "spadework". they have too many talents, too many differing inclinations, too much impetuosity, too much vanity, too little concentration and will-power, and they fail in ordinary walks of life from the lack of resolution to lay the foundations necessary to successful mediocrity. no greater obstacle to progress exists than the reputation for talent which this class acquire on a flimsy basis of superficial brilliance in conversation or a penchant for witty repartee. they are self-opinionated and egoistical, with a conceit and assurance out of all proportion to their abilities. their mental perspective is distorted and they are conspicuous for their obstinacy. in conversation they are prolix and pretentious, and they often contract religious mania, in which their actions by no means accord with their protestations, for they have very elementary notions of right and wrong, or no notions at all. often they are precocious, but untruthful, cruel, and vicious; the despair of relatives, friends, and teachers. they combine unusual frankness with an audacity and impulsiveness that is very misleading, for below this show of fire and power there is no stability. their character is a tangle of mercurial moods, the neuropath being passionate but loving, sullen one moment, overflowing with sentimental affection the next, vicious a little while later, quick to unreasoning anger, and as quick to repent or forgive, obstinate but easily led, versatile but inconstant, noble and mean by turns, full of contradictions and contrasts, at best a brilliant failure, vain, deaf to advice or reproof, having in his ailing frame the virtues and vices of a dozen normal men. mercier aptly describes him: "there is a large class of persons who are often of acute and nimble intelligence, in general ability equal to or above the average, of an active, bustling disposition, but who are utterly devoid of industry. for by industry we mean steady persistence in a continuous employment in spite of monotony and distastefulness; an employment that is followed at the cost of present gratification for the sake of future benefit. of such self-sacrifice these persons are incapable. they are always busy, but their activity is recreative, in the sense that it is congenial to them, and from it they derive immediate gratification. as soon as they tire of what they are doing, as soon as their occupation ceases to be in itself attractive it is relinquished for something else, which in its turn is abandoned as soon as it becomes tedious. "such people form a well-characterized class: they are clever; they readily acquire accomplishments which do not need great application; and agreeably to the recreative character of their occupations, their natures are well developed on the artistic side. they draw, paint, sing, play, write verses and make various pretty things with easy dexterity. their lack of industry prevents them ever mastering the technique of any art; they have artistic tastes, but are always amateurs. "with the vice of busy idleness they display other vices. the same inability to forgo immediate enjoyment, at whatever cost, shows itself in other acts. they are nearly always spendthrifts, usually drunkards, often sexually dissolute. next to their lack of industry, their most conspicuous quality is their incurable mendacity. their readiness, their resources, their promptitude, the elaborate circumstantiality of their lies are astonishing. the copiousness and efficiency of their excuses for failing to do what they have undertaken would convince anyone who had no experience of their capabilities in this way. "withal, they are excellent company, pleasant companions, good-natured, easy-going, and urbane. their self-conceit is inordinate, and remains undiminished in spite of repeated failures in the most important affairs of life. they see themselves fall immeasurably behind those who are admittedly their inferiors in cleverness, yet they are not only cheery and content, but their confidence in their own powers and general superiority to other people remains undiminished. "_the lack of self-restraint is plainly an inborn character_, for it may show itself in but one member of the family brought up in exactly the same circumstances as other members who do not show any such peculiarity. the victim is born with one important mental faculty defective, precisely as another may be born with hare-lip." in neuropaths the mental mechanism of _projection_, which we all show, is often marked. any personal shortcoming, being repugnant to us causes self-reproach, which we avoid by "projecting" the fault (unconsciously) on some one else. readers should get "the idiot" by fedor dostoieffsky, an epileptic genius who saw that for those like him, happiness could be got through peace of mind alone, and not in the cut-throat struggle for worldly success. he projected his stabler self into prince muishkin, the idiot, and every one of the six hundred odd pages of this amazing description of a neuropathic nation is stamped with the hall-mark of genius. * * * * * chapter xxvi marriage "between two beings so complex and so diverse as man and woman, the whole of life is not too long for them to know one another well, and to learn to love one another worthily."--comte. no neuropath should have children, but marriage is good in mild cases, for neuropaths are benefited by sympathetic companionship, and their sexual passions are so strong that they must be gratified, by marriage, prostitution, or unnaturally. bernard shaw's sneer-- "marriage is popular because it combines the maximum of temptation with the maximum of opportunity"-- is justifiable, though the "maximum of opportunity" is better than a maximum of unnatural devices to satisfy and intensify normal and abnormal cravings. there is a popular belief that an epileptic girl is cured by pregnancy, a state that ought never to occur. the lack of sex-education causes millions of miserable marriages. sexual desire is cultivated out of all proportion to other desires, the will cannot control the desire to relieve an intolerable sense of discomfort, and men eagerly seize the first chance of being able to satisfy these fierce cravings at pleasure. if sex were treated sensibly it would develop into a powerful instead of an overpowering appetite, and reason would have some say in the choice of a life-partner. a neuropath needs a calm, even-tempered, "motherly" wife. for him, gentleness, self-control, sound common sense and domestic virtues are superior to wit or beauty. unfortunately, contrary to public belief, people are attracted by their like, not by their opposites. the sensitive, refined neuropath finds the normal person insipid and dull; the normal person is rendered uncomfortable by the morbid caprices of the neuropath. there must be no disparity of age, for at the menopause the woman no longer seeks the sexual embrace, and if her husband be young unfaithfulness ensues. not only that, but she, knowing, probably to her sorrow, how rarely the hopes of youth mature, cannot take a keen interest in his ambitions like a younger woman, or fire his dying enthusiasm at difficult parts of the way. if he be his wife's senior he will be as little able to appreciate her ideas and habits. an excitable, volatile, garrulous, "neighbourly" woman, or one who can do little save strum on the piano or make embroidery as intricate as it is useless, means divorce or murder. for him, sweetness, gentleness, self-control, sound common sense, shrewdness, and domestic virtues are incomparably superior to any mental brilliance or physical comeliness. he needs a "homely" woman, and should remember that no banking account can match a sweet, womanly personality, and no charms compare to a sunny heart, and an ability steadfastly to "see the silver lining". he must on no account marry a woman in indifferent health, for under the strain of her husband's infirmity the woman, who if she were well would be a help, is a source of expense, worry and friction. on the other hand the woman who receives a proposal from a neuropath, be he ever so gifted, has grave grounds for pausing, though it is hard to counter the specious arguments of one who may be "a man o' pairts", a witty companion and an ardent lover. it is doubtful if a neuropath is ever permeated by a steadfast emotion, for all his emotions are fierce but unstable, the love of an inconsistent man being ten times more ardent than that of a faithful one, _while it lasts_. "you can't marry a man without taking his faults with his virtues," and love must be strong enough to stand, not storms alone, but the minor miseries of life, the incessant pinpricks, the dreary days when the smile abroad has become the scowl at home. at best, her husband will be capricious, hard to please, and though rabidly jealous without cause, at the same time very partial to the attractions of other women. he usually needs the attention of the whole household, which his varying health and moods keep in a mingled state of anxious solicitude and smouldering resentment. his infirmity may mean a very secluded and humdrum life. she will have to make home an ever-cheery place, an ideal that means hard work and self-sacrifice through lonesome years in which her nobility will be unrecognized and unrewarded. a woman fond of amusements and sport, and having many acquaintances would find this unbearable. any happiness in marriage to a neuropath is largely dependent on the self-sacrifice of the wife. should marriage occur, the wife must judiciously curb her husband's passions without driving him to other women by coldness, a problem which is often solved by separation. the suggestion should never come from her, and the more she can curb his ardour by tactful suggestion, the healthier will he and the happier will she be, for nothing causes such an irritable, nervous state as excessive coitus. she will often have to give way in this matter, but must be firm on the necessity for preventing conception, for she can only bear a tainted child; her responsibility is great, and she must _insist_ that her husband use those simple methods which prevent conception, thereby ending in himself one branch of a worthless tree. this must be done at any cost, for her happiness is nought compared to the welfare of future generations. bitter though it be that no fruit of her womb may call her blessèd, it is less bitter than hearing her children call themselves accursèd. "so many severall wayes are we plagued and punished for our father's defaultes, that it is the greatest part of our felicity to be well born, and it were happy for humankind if only such parentes as are sounde of body and mind should be suffered to marry. an husbandman will sow none but the choicest seed upon his lande; he will not reare a bull nor an horse, except he be right shapen in all his parts, or permit him to cover a mare, except he be well assured of his breed; we make choice of the neatest kine, and keep the best dogs, and how careful then should we be in begetting our children? in former tyme, some countreys have been so chary in this behalf, so stern, that if a child were crooked or deformed in body or mind, they made it away; so did the indians of old, and many other well gouverned commonwealths, according to the discipline of those times. heretofore in scotland, if any were visited with the falling sickness, madness, goute, leprosie, or any such dangerous disease, which was like to be propagated from the father to the son, he was instantly gelded; a woman kept from all company of men; and if by chance, having some such disease, she was found to be with child she with her brood were buried alive; and this was done for the common good, lest the whole nation should be injured or corrupted. a severe doom, you will say, and not to be used among christians. yet to be more looked into than it is. for now, by our too much facility in this kind, in giving way to all to marry that will, too much liberty and indulgence in tolerating all sorts, there is a vast confusion of hereditary diseases; no family secure, no man almost free from some grievous infirmity or other. our generation is corrupt, we have so many weak persons, both in body and mind, many feral diseases raging among us, crazed families: our fathers bad, and we like to be worse." her husband will want much petting and caressing, and she must foster his love by lavishing on him much fondness, and ignoring amours as but the mischievous results of his restless, intriguing mind. she must let him see in an affectionate way that she can let others enjoy his company betimes, secure in the knowledge that she is supreme in his affections--cajolery that flatters his overweening vanity, and rarely fails. in anger, as in every other emotion, the neuropath is as transient as he is truculent. a trivial "tiff" will make him blaze up in ungovernable rage and say most abominable and untruthful things; even utter violent threats. he will not admit he is wrong, but like a spoilt child must be kissed and coaxed into a good temper, first with himself and with others next. at one moment he is in a perfect paroxysm of fury; five minutes later he is passionately embracing the luckless object of it and vowing eternal devotion. in a further five he has forgotten all his remarks and would hotly deny he used the vexing statements imputed to him. epileptics are morbidly sensitive, and reference to their malady must be avoided. victims are intensely suspicious, and a pitying look will reveal to them the fact that some outsider knows all about the jealously-guarded skeleton. resentment, distrust and misery follow such an exposure, for every innocent look is then translated into a contemptuous glance, and the victim detects slights undreamt of in any brain save his own. unless seizures are severe, no one should be called in; if they cause alarm, ask a discreet male neighbour to assist when necessary, leaving when the convulsions abate so that the victim is not aware of his presence. avoid the word "fit" and "epilepsy", and if reference to the attack be necessary, refer to it as a "faint" or "turn". living with a man liable to have a fit at inopportune times is a tremendous strain, and the soundest advice one can offer a woman thinking of marrying such a one is punch's--"don't!" we have painted the black side, but, tactfully managed, a neuropath will merge in the kindest of husbands, the most constant of lovers. the wife need not be unhappy. tactless, masterful women will fail, but no one is more easily led, particularly in the way he should not go, than a neuropath. a man with definite views of his own value will not be successful foil for "mother-in-lawing", nor remain quiet under the interference of relatives, who should remember that well-meaning intentions do not justify meddling actions. many a neuropath led a useful life and gained success in a profession, solely because his wife tactfully kept him in the path, watched his health, prevented him frittering away his gifts in many pursuits or useless repining, and made home a real haven. when the yolk seems unbearably heavy, the wife should remember her husband has to bear the primary, she only the reflected misery, for the limitations neuropathy puts on every activity and ambition, social and professional, are frightfully depressing. in spite of his peevishness her husband may be trying hard to minimize his defects and be a reasonable, helpful companion. "judge not the working of his brain, and of his heart thou can'st not see; what looks to thy dim eyes a stain in god's pure light may only be a scar brought from some well-fought field, where thou would'st only faint and yield." magnify his virtues and be tenderly charitable to his many frailties, for he is "not as other men" and too well he knows it. love at its best is so complex that it easily goes awry, but death will one day dissolve all its complexity, and when, maybe after "many a weary mile" "the voice of him i loved is still, the restless brain is quiet, the troubled heart has ceased to beat and the tainted blood to riot"-- it will comfort you to reflect that you did your duty and, to best the of your ability, fulfilled your solemn pledge to love and honour him. to quote george eliot: "what greater reward can thou desire than the proud consciousness that you have strengthened him in all labour, comforted him in all sorrow, ministered to him in all pain, and been with him in silent but unspeakably holy memories at the moment of eternal parting?" surely, none! we have considered the mournful case of a wife with a neuropathic husband, and must now say a few words about the truly distressing fate of a husband afflicted with a neuropathic wife, for neuropathy in its unpleasant consequences to others is far worse in woman than in man. a man is at work all day, and his mind is perforce distracted from his woes, and, though he retails them at night to the home circle, they get so used to them as to disregard them, proffering a few words of agreement, sympathy or scorn quite automatically. with women the distraction of work is not so complete, for housework can be neglected, there are always neighbours and friends to listen to tales of woe and thus generate a very harmful self-pity, and women are not content to enumerate their woes, but demand the attention and sympathy of all listeners. many of the facts in the foregoing parts of this chapter apply with equal force to both sexes, but women being usually more patient, tactful, resigned and self-sacrificing than men, can--and often do--alleviate the lot of the male neuropath; whereas the absence of these qualities in the average man means that he aggravates, instead of alleviating, the lot of any female neuropath to whom he may be wedded. having taken her "for better, for worse" he will find her irritating, unreasonable, and unfitted to shoulder domestic responsibilities. her likes and dislikes, fickle fancies, unreasonable prejudices, selfish ways will cause trouble; he must be prepared for misunderstandings and feuds with relatives and friends, and on reaching home tired and worried, he is like to find his house in disorder, be assailed by a tale of woe, and perhaps find that his wife's vagaries have involved him in a tiff with neighbours. she will be fretful, exacting, impatient, and given to ready tears. sensitive to the last degree, she will see slights where none are intended, and a chiding word, a reproachful look, or a weary sigh will mean a fit of temper or depression. not only are men less gifted for "managing" women than vice versa, but women are far less susceptible to tactful management than men; a man, like a dog, can be led almost anywhere with a little dragging at the chain and growling now and then; a woman, like a cat, is more likely to spit, swear, and scratch than come along. consequently, it is almost impossible to suggest means of obtaining relief to one who has been luckless enough to marry, or be married by, a neuropathic woman. if the husband sympathize, the condition will but be aggravated; medicinal measures will only increase, instead of diminishing, the number of symptoms; indifference will procure such an exhibition as will both prove its uselessness and ensure the attention craved. * * * * * chapter xxvii summary to sum up: we have learnt that epilepsy is a very ancient disease due to some instability of the brain, in which convulsions are a common but not invariable symptom. its actual cause is unknown. heredity plays a big part, but there are secondary causes beside factors which excite attacks. various methods and drugs to prevent seizures have a limited use. first-aid treatment consists solely in preventing the victim sustaining any injury. neurasthenia is a disease due to nerve-exhaustion and poisoning from overwork and worry. its symptoms are many, but fatigue and irritability are the chief. hysteria is an obstinate, functional, nervous disease in which the patient acts in an abnormal manner, which is highly provoking to other individuals. the cure for hysteria and neurasthenia is solely hygienic, and depends mainly on the patient. the first step towards health consists in getting any slight organic defects remedied. digestion is often poorly performed. this must be remedied by thorough mastication and rational dieting. constipation is very inimical to neuropaths, and must be remedied. patients must pay careful attention to general hygiene. insomnia is exhausting and must be conquered. the effects of imagination are profound. suggestion treatment overcomes imaginary ills. drug treatment is either of very limited utility, or frankly useless. patent medicines are never of the slightest use. the rational training of neuropathic children is a very difficult but essential task. puberty and adolescence are very critical times. occupations and recreations must be wisely chosen. heredity is the primary cause of these diseases. as it cannot be treated, sufferers must not have children. character is abnormal in nervous disease. marriage is very undesirable. as a parting injunction, whether you are an epileptic or a neurasthenic, or a friend, relative, or attendant of such a one: "go thou softly all thy days!" * * * * * bibliography "oh! for a booke and a shadie nooke, eyther indoore or oute; where i maie reade, all atte my ease both of the newe and olde: for a jollie goode booke, whereonne to looke is better to me than golde!" the following books are suitable for laymen, and are most of them very readable. epilepsy we know of no book suitable for laymen, neurasthenia and hysteria "nervous disorders of men" (kegan paul) hollander. "nervous disorders of women" (kegan paul) hollander. "national degeneration" (cornish, birmingham) d.f. harris. "hysteria and neurasthenia" j.m. clarke. "the management of a nerve patient" schofield. "confessions of a neurasthenic" (f.a. davis co., philadelphia) marrs. "conquest of nerves" (macmillan) courtney. general: indigestion "indigestion" herschell. dieting "dietetics" (jack's people's books) a. bryce. "diet in dyspepsia" tibbles. "cookery for common ailments" brown. constipation "constipation" bigg. hygiene "laws of life and health" a. bryce. "health" m.m. burgess. insomnia "sleep and sleeplessness" h.a. bruce. "the meaning of dreams" i.h. coriat. imagination "psychology in daily life" seashore. "hygiene of the mind" t.s. clouston. suggestion "hypnotism and suggestion" hollander. "how to treat by suggestion" ash. "hypnotism and self-education" (jack's people's books) hutchinson. patent medicines "patent foods and patent medicines" (bale & davidson) hutchinson. see chapter xx for b.m.a. books. the child "our baby" r.d. clark. "abnormal children" (kegan paul) hollander. "the baby" (jack's people's books) anonymous. "training the child" (jack's people's books) spiller. puberty "youth and sex" (jack's people's books) scharlieb and sibley. "woman in childhood, wifehood, and motherhood" m.s. cohen. "the adolescent period" starr. "physiology" (home univ. library) mckendrick. "human physiology" leonard hill. heredity and character "evolution" (home univ. library) thomson and geddes. "heredity in the light of recent research" (cam. univ. press) doncaster. "the psychology of insanity" (cam. univ. press) bernard hart. marriage "on conjugal happiness" r.g.s. krohn "race culture and race suicide" r.r. rentoul. * * * * * index abortives, use of, as cause of epilepsy, age-incidence in epilepsy, , air, fresh, importance of, alcohol, the question of, alcoholic excess in relation to epilepsy, , - ---- ---- neurasthenia, amyl nitrite, to check the aura in epilepsy, analyses of proprietary preparations for children, ---- ---- purgative medicines, ---- of secret remedies, british medical association, , , arson as manifestation of mental epilepsy, aspirin for post-epileptic headache, aura, the, , , ----, ----, in jacksonian epilepsy, ----, treatment of the, , auto-intoxication, auto-suggestion, value of, , backache in neurasthenia, baths, advice as to, for neuropaths, , , blaud's pills, brain, morbid changes in, associated with epilepsy, , ----, structure of the, bromides, action of, hindered by salt, ---- in the prevention of epilepsy, ---- ---- treatment of epilepsy, - , ---- the basis of every epilepsy cure, bromism, brooding, harmful to neuropaths, , calm necessary in dealing with nervous children, carlyle, character, - ----, the basis of, chyle, the, chyme, the, circulation, the, in neuropaths, circulatory disturbances in neurasthenia, clark on frequency of fits during repose, clark's statistics of epilepsy, cleanliness, climacteric, in relation to hysteria, clothing for neuropaths, coddling, danger of, for nervous children, "complex", the, in consciousness, , concentration, lack of, in neurasthenia, ----, mental, exercises in, confession, the value of, conscious mind, the, , consciousness, alteration of, in epileptic attack, , , ----, dissociation of, constipation, - ----, causes of, , ----, symptoms of, ----, treatment of, - convulsions, epileptic. _see_ "fit" ---- in alcoholism, ---- in children, ---- in diabetes, ---- in pregnancy, cooking in relation to digestibility, country resorts suitable for neuropaths, criminal acts in psychic or mental epilepsy, , culpepper's herbal, dark, nervous children's fear of the, day-dreaming, , death, degeneration, signs of, in epileptics, dementia, epileptic, demonic influence in relation to epilepsy, , dieting, - digestion of foods, , ---- ----, time occupied by the, ----, the process of, - digestive troubles in relation to epilepsy, , ---- ----, neurasthenia, , discipline of the nervous child, - dissociation of consciousness, dostoieffsky's "the idiot", a study of epilepsy, douche, the cold, for neuropaths, dreams, ----, sex-basis in, drug habit, the, in neuropaths, duties and trials of a neuropath's wife, - ears, care of the, egoism in relation to neurasthenia, electrical treatment for neuropaths, emotional repression as a factor in hysteria, enema, the use of the, energy from food, epilepsy a functional disease, ----, ancient remedies for, ---- as a mental complex, ---- ascribed to demonic influence, , ----, biblical reference to, ----, causes of, - ----, clinical course of, - ----, cure in, ----, definition of, , ----, effect of, on general health, ----, feigned, ----, ----, diagnosis of, ----, historical account of, , ---- in mediæval times, ---- in neurasthenics, ---- in relation to genius, - ---- ---- marriage, ----, jacksonian, - ----, ----, its relative frequency, ----, major and minor, - ----, medicines for, - ----, mental, , ----, ----, rarity of, ----, nocturnal, , ----, ----, its relative frequency, ----, preventive treatment of, - ----, prognosis in, ----, psychic, , ----, rarer types of, - ----, serial, ----, superstitions attached to, , epileptic children, care of, ---- dementia, ---- fit _see_ "fit" ---- fits, times of occurrence of, , epileptiform seizures, exercise for neuropaths, , , eyes, care of the, facial expression in epilepsy, fats, digestion of, fears, baseless, in neurasthenia, , feeding, generous, needed for neuropaths, fit, epileptic, description of an, , ----, ----, mechanism of an, , ----, ----, first-aid to victims of, , flatulence, treatment of, foods, proprietary, , "free will", the fallacy of, , freud on perverted sex-ideas as a cause of hysteria, ---- ---- subconscious sexual desires in infants, ---- ---- the sex-basis in dreams, fright as cause of epilepsy, gastric juice, the, genius, epilepsy in relation to, - "germ-plasm", the, ---- in relation to neuropathic tendencies, , , _globus hystericus_, glycerin suppositories, glycerophosphates, "good" and "evil", , gowers on epilepsy, gowers' statistics as to age-incidence of epilepsy, _grand mal_, - ---- ----, its relative frequency, greene on hysteria, habit, importance of, in relation to constipation, haig on relation of uric acid to epilepsy, headache in neurasthenia, heredity, - hobbies for neuropaths, hormone, the function of a, hughlings jackson, dr, on the epileptic convulsion, husband of a neuropath, advice to the, , huxley on the rules of the game of life, hygiene, general, - hypochondriasis in neurasthenics, hypophosphites, hysteria, - ----, age incidence of, ----, ancient views as to, ---- and neurasthenia contrasted, ---- causes of, , ----, modern theories as to, ----, race incidence of, ----, sex-incidence of, , ----, symptoms of, - ----, treatment of, hysterical attack, the, , imagination, effects of, - indigestion, - infantile convulsions, ---- ----, relation of to epilepsy, ---- ----, treatment of, inhibitory cells of brain, , injuries to brain as cause of epilepsy, insanity in relation to dissociation of consciousness, ---- ---- epilepsy, insomnia _see_ "sleeplessness" intestinal worms, iron preparations, jacksonian epilepsy, , , janet on consciousness in hysteria, jones on the religious sentiment in neuropaths, , king's evil, the, la rochefoucauld on health and regimen, lecithin, lieberkuhn's glands, , life, in relation to tissue change, locock's introduction of bromides for epilepsy, machine, the human, , malt extracts, marriage, - ---- and neuropathy, , , ---- of neuropaths should be childless, , mastication, importance of thorough, masturbation, - ----, effects of, , ---- in relation to epilepsy, , , ---- ---- neurasthenia, meals, number and time of, meat extracts, ---- juices, value of, ----, moderation in its use necessary, memory in epilepsy, ----, its subconscious basis, mendel's law of inheritance, , menopause in relation to neurasthenia, menstruation, disordered, in neurasthenia, ---- in relation to epilepsy, , mental attitude of neurasthenics, - ---- fatigue in neurasthenia, , mercier on the characteristics of the neuropath, - mind in relation to consciousness, moral cowardice in relation to neurasthenia, _morbus comitialis_, motor cells of brain, , murder as manifestation of mental epilepsy, narcotics, use and abuse of, nervous child, training of the, - ---- dyspepsia, ---- ----, diet in, neurasthenia, - ---- and hysteria contrasted, ----, causes of, , , ----, course and outlook in, , ---- in relation to epilepsy, ---- ---- self abuse, , ----, sexual, ----, symptoms of, - , neuropath, the, his need of a wife, neuropathic children, characteristics of, , ---- ----, diet of, - ---- ----, education of , ---- ----, moral training of, - neuropaths, advice to, - ----, mental characteristics of, - neuropathy in relation to marriage, , - ----, the only way to eradicate, night terrors, nitroglycerine to check the epileptic aura, , nose, care of the, opisthotonos, optimism, value of, osler on age-incidence of epilepsy, ---- ---- the use of medicines, palpitation during use of bromides, ---- in neurasthenia, parentage in relation to inherited qualities, , patent medicines, - ---- ---- and the dyspeptic, , ---- ---- ---- ---- neurasthenic, ---- ----, explanation of their benefit, pepsin, _petit mal_, , ---- ---- in childhood, ---- ----, its relative frequency phenalgin for post-epileptic headache, phosphorus preparations, piles, port wine in proprietary preparations, predigested foods, , pregnancy, convulsions during, ---- in relation to epilepsy, , psycho-analysis in the treatment of hysteria, puberty, bodily changes at, ----, dangers at and after, - ---- in relation to epilepsy, , , punishment, corporal, unsuited for nervous children, , pupils in epilepsy, the, purgatives, the abuse of, ----, suitable, quack advertisements, , reading for neuropaths, recovery in epilepsy, recreations for neuropaths, reid on the effect of emotions on bodily functions, religion, question of, in nervous children, - rest for neuropaths, , responsibility in relation to mental epilepsy, , sanatogen, savill on differences between neurasthenia and hysteria, self-abuse _see_ "masturbation" self control, how far possible to neuropaths, - self-restraint, the neuropath's lack of, , sentimentality to be discouraged in nervous children, sex education, the need for, sex-incidence in epilepsy, sex instruction for children, , sexual development early in neuropaths, , ---- excesses in relation to epilepsy, , ---- ---- in relation to neurasthenia, , ---- instinct, awakening of, , ---- neurasthenia, ---- offences as manifestations of mental epilepsy, , ---- rules for neuropaths, shaw, bernard, his sneer at marriage, sleep, relation of, to epileptic fit, sleeplessness, - ----, causes of, , ----, treatment of, , , ---- in neurasthenia, sollmann on proprietary foods, , soothing syrups, "sound nerves", spirit writing, , spiritualism, danger of, for neuropaths, spratling on epilepsy in consumptives, starr's statistics as to age-incidence in epilepsy, ---- ---- heredity in epileptics, ---- ---- types of epilepsy, _status epilepticus_, ---- ----, as final termination of epilepsy, subconscious mind, the, suggestion treatment, - suicide in neurasthenics and hysterical subjects, , , sunstroke as cause of fits, sweetmeats, the use of, sympathy, harm done by, in hysteria, , tape worms, tea and coffee, teeth, care of the, , tobacco undesirable for neuropaths, trades for epileptics, ---- ---- neuropaths, - turner on age-incidence of epilepsy, unconscious activities, , unconsciousness in epilepsy, - urine, incontinence of, in epilepsy, - vegetable foods, villi, the intestinal, vittoz's exercises in mental concentration, vomiting, risk of, in epilepsy, water, when to drink, , , weir mitchell treatment, wife for the neuropath, the, - ---- of a neuropath, advice to the, - will, neuropath's lacking in, work and play, - worms, intestinal, worry as cause of neurasthenia, ---- to be avoided by neuropaths, , _printed in great britain by jarrold & sons, ltd., norwich_ this book is one of the pioneering works in laryngology. the original text is from the library of indiana university department of otolaryngology-head and neck surgery, bruce matt, md. it was scanned, converted to text, and proofed by alex tawadros. bronchoscopy and esophagoscopy a manual of peroral endoscopy and laryngeal surgery by chevalier jackson, m.d., f.a.c.s. professor of laryngology, jefferson medical college, philadelphia; professor of bronchoscopy and esophagoscopy, graduate school of medicine, university of pennsylvania; member of the american laryngological association; member of the laryngological, rhinological, and otological society; member of the american academy of ophthalmology and oto-laryngology; member of the american bronchoscopic society; member of the american philosophical society; etc., etc. with illustrations and four color plates philadelphia and london w. b. saunders company copyrights , by w. b. saunders company made in u.s.a. to my mother to whose interest in medical science the author owes his incentive, and to my father whose constant advice to "educate the eye and the fingers" spurred the author to continual effort, this book is affectionately dedicated. preface this book is based on an abstract of the author's larger work, peroral endoscopy and laryngeal surgery. the abstract was prepared under the author's direction by a reader, in order to get a reader's point of view on the presentation of the subject in the earlier book. with this abstract as a starting point, the author has endeavored, so far as lay within his limited abilities, to accomplish the difficult task of presenting by written word the various purely manual endoscopic procedures. the large number of corrections and revisions found necessary has confirmed the wisdom of the plan of getting the reader's point of view; and these revisions, together with numerous additions, have brought the treatment of the subject up to date so far as is possible within the limits of a working manual. acknowledgment is due the personnel of the w. b. saunders company for kindly help. chevalier jackson. october, . ii contents page chapter i instrumentarium chapter ii anatomy of larynx, trachea, bronchi and esophagus, endoscopically considered chapter iii preparation of the patient for peroral endoscopy chapter iv anesthesia for peroral endoscopy chapter v bronchoscopic oxygen insufflation chapter vi position of the patient for peroral endoscopy chapter vii direct laryngoscopy chapter viii direct laryngoscopy (continued) chapter ix introduction of the bronchoscope chapter x introduction of the esophagoscope chapter xi acquiring skill chapter xii foreign bodies in the air and food passages chapter xiii foreign bodies in the larynx and tracheobronchial tree chapter xiv removal of foreign bodies from the larynx chapter xv mechanical problems of bronchoscopic foreign body extraction chapter xvi foreign bodies in the bronchi for prolonged periods chapter xvii unsuccessful bronchoscopy for foreign bodies chapter xviii foreign bodies in the esophagus chapter xix esophagoscopy for foreign body chapter xx pleuroscopy chapter xxi benign growths in the larynx chapter xxii benign growths in the larynx (continued) chapter xxiii benign growths primary in the tracheobronchial tree chapter xxiv benign neoplasms of the esophagus chapter xxv endoscopy in malignant disease of the larynx chapter xxvi bronchoscopy in malignant growths of the trachea chapter xxvii malignant disease of the esophagus chapter xxviii direct laryngoscopy in diseases of the larynx chapter xxix bronchoscopy in diseases of the trachea and bronchi chapter xxx diseases of the esophagus chapter xxxi diseases of the esophagus (continued) chapter xxxii diseases of the esophagus (continued) chapter xxxiii diseases of the esophagus (continued) chapter xxxiv diseases of the esophagus (continued) chapter xxxv gastroscopy chapter xxxvi acute stenosis of the larynx chapter xxxvii tracheotomy chapter xxxviii chronic stenosis of the larynx and trachea chapter xxxix decannulation after cure of laryngeal stenosis bibliography index [ ] chapter i--instrumentarium direct laryngoscopy, bronchoscopy, esophagoscopy and gastroscopy are procedures in which the lower air and food passages are inspected and treated by the aid of electrically lighted tubes which serve as specula to manipulate obstructing tissues out of the way and to bring others into the line of direct vision. illumination is supplied by a small tungsten-filamented, electric, "cold" lamp situated at the distal extremity of the instrument in a special groove which protects it from any possible injury during the introduction of instruments through the tube. the bronchi and the esophagus will not allow dilatation beyond their normal caliber; therefore, it is necessary to have tubes of the sizes to fit these passages at various developmental ages. rupture or even over-distention of a bronchus or of the thoracic esophagus is almost invariably fatal. the armamentarium of the endoscopist must be complete, for it is rarely possible to substitute, or to improvise makeshifts, while the bronchoscope is in situ. furthermore, the instruments must be of the proper model and well made; otherwise difficulties and dangers will attend attempts to see them. _laryngoscopes_.--the regular type of laryngoscope shown in fig. i (a, b, c) is made in adult's, child's, and infant's sizes. the instruments have a removable slide on the top of the tubular portion of the speculum to allow the removal of the laryngoscope after the insertion of the bronchoscope through it. the infant size is made in two forms, one with, the other without a removable slide; with either form the larynx of an infant can be exposed in but a few seconds and a definite diagnosis made, without anesthesia, general or local; a thing possible by no other method. for operative work on the larynx of adults, such as the removal of benign growths, particularly when these are situated in the anterior portion of the larynx, a special tubular laryngoscope having a heart-shaped lumen and a beveled tip is used. with this instrument the anterior commissure is readily exposed, and because of this it is named the anterior commissure laryngoscope (fig. , d). the tip of the anterior commissure laryngoscope can be used to expose either ventricle of the larynx by lifting the ventricular band, or it may be passed through the adult glottis for work in the subglottic region. this instrument may also be used as an esophageal speculum and as a pleuroscope. a side-slide laryngoscope, used with or without the slide, is occasionally useful. _bronchoscopes_.--the regular bronchoscope is a hollow brass tube slanted at its distal end, and having a handle at its proximal or ocular extremity. an auxiliary canal on its under surface contains the light carrier, the electric bulb of which is situated in a recess in the beveled distal end of the tube. numerous perforations in the distal part of the tube allow air to enter from other bronchi when the tube-mouth is inserted into one whose aerating function may be impaired. the accessory tube on the upper surface of the bronchoscope ends within the lumen of the bronchoscope, and is used for the insufflation of oxygen or anesthetics, (fig. , a, b, c, d). for certain work such as drainage of pulmonary abscesses, the lavage treatment of bronchiectasis and for foreign-body or other cases with abundant secretions, a drainage-bronchoscope is useful the drainage canal may be on top, or on the under surface next to the light-carrier canal. for ordinary work, however, secretion in the bronchus is best removed by sponge-pumping (q.v.) which at the same time cleans the lamp. the drainage bronchoscope may be used in any case in which the very slightly-greater area of cross section is no disadvantage; but in children the added bulk is usually objectionable, and in cases of recent foreign-body, secretions are not troublesome. as before mentioned, the lower air passages will not tolerate dilatation; therefore, it is necessary never to use tubes larger than the size of the passages to be examined. four sizes are sufficient for any possible case, from a newborn infant to the largest adult. for infants under one year, the proper tube is the mm. by cm.; the child's size, mm. by cm., is used for children aged from one to five years. for children six years or over, the mm. by cm. bronchoscope (the adolescent size) can be used unless the smaller bronchi are to be explored. the adult bronchoscope measures mm. by cm. the author occasionally uses special sizes, mm. x cm., mm. x cm., mm. x cm. _esophagoscopes_.-the esophagoscope, like the bronchoscope, is a hollow brass tube with beveled distal end containing a small electric light. it differs from the bronchoscope in that it has no perforations, and has a drainage canal on its upper surface, or next to the light-carrier canal which opens within the distal end of the tube. the exact size, position, and shape of the drainage outlets is important on bronchoscopes, and to an even greater degree on esophagoscopes. if the proximal edge of the drainage outlet is too near the distal end of the endoscopic tube, the mucosa will be drawn into the outlet, not only obstructing it, but, most important, traumatizing the mucosa. if, for instance, the esophagoscope were to be pushed upon with a fold thus anchored in the distal end, the esophageal wall could easily be torn. to admit the largest sizes of esophagoscopic bougies (fig. ), special esophagoscopes (fig. ) are made with both light canal and drainage canal outside the lumen of the tube, leaving the full area of luminal cross-section unencroached upon. they can, of course, be used for all purposes, but the slightly greater circumference is at times a disadvantage. the esophageal and stomach secretions are much thinner than bronchial secretions, and, if free from food, are readily aspirated through a comparatively small canal. if the canal becomes obstructed during esophagoscopy, the positive pressure tube of the aspirator is used to blow out the obstruction. two sizes of esophagoscopes are all that are required-- mm. x cm. for children, and mm. x cm. for adults (fig. , a and b); but various other sizes and lengths are used by the author for special purposes.* large esophagoscopes cause dangerous dyspnea in children. if, it is desired to balloon the esophagus with air, the window plug shown in fig. , is inserted into the proximal end of the esophagoscope, and air insufflated by means of the hand aspirator or with a hand bulb. the window can be replaced by a rubber diaphragm with a perforation for forceps if desired. it will be noted that none of the endoscopic tubes are fitted with mandrins. they are to be introduced under the direct guidance of the eye only. mandrins are obtainable, but their use is objectionable for a number of reasons, chief of which is the danger of overriding a foreign body or a lesion, or of perforating a lesion, or even the normal esophageal wall. the slanted end on the esophagoscope obviates the necessity of a mandrin for introduction. the longer the slant, with consequent acuting of the angle, the more the introduction is facilitated; but too acute an angle increases the risk of perforating the esophageal wall, and necessitates the utmost caution. in some foreign-body cases an acute angle giving a long slant is useful, in others a short slant is better, and in a few cases the squarely cut-off distal end is best. to have all of these different slants on hand would require too many tubes. therefore the author has settled upon a moderate angle for the end of both esophagoscopes and bronchoscopes that is easy to insert, and serves all purposes in the version and other manipulations required by the various mechanical problems of foreign-body extraction. he has, however, retained all the experimental models, for occasional use in such cases as he falls heir to because of a problem of extraordinary difficulty. * a mm. x cm. esophagoscope will reach the stomach of almost all adults and is somewhat easier to introduce than the mm. x cm., which may be omitted from the set if economy must be practiced. [fig. i.--author's laryngoscopes. these are the standard sizes and fulfill all requirements. many other forms have been devised by the author, but have been omitted from the list as unnecessary. the infant diagnostic laryngoscope (c) is not for introducing bronchoscopes, and is not absolutely necessary, as the larynx of any infant can be inspected with the child's size laryngoscope (b). a adult's size; b, child's size; c, infant's diagnostic size; d, anterior commissure laryngoscope; e, with drainage canal; , intubating laryngoscope, large lumen. all the laryngoscopes are preferred without drainage canals.] [fig. .--the author's bronchoscopes of the sizes regularly used. various other lengths and diameters are on hand for occasional use for special purposes. with the exception of a mm. x cm. size for older children, these special bronchoscopes are very rarely used and none of them can be regarded as necessary. for special purposes, however, special shapes of tube-mouth are useful, as, for instance, the oval end to facilitate the getting of both points of a staple into the tube-mouth the illustrated instruments are as follows: a, infant's size, mm. x cm.; b, child's size, mm. x cm.; c, adolescent's size, mm. x cm.; d, adult's size, mm. x cm.; e, aspirating bronchoscope made in all the foregoing sizes, and in a special size, mm. x cm.] [fig. .--the author's esophagoscopes of the sizes he has standardized for all ordinary requirements. he uses various other lengths and sizes for special purposes, but none of them are really necessary. a gastroscope, mm. x cm., is useful for adults, especially in cases of gastroptosis. drainage canals are placed at the top or at the side of the tube, next to the light-carrier canal. a, adult's size, mm. x cm.; b, child's size, mm. x cm.; c and d, full lumen, with both light canal and drainage canal outside the wall of the tube, to be used for passing very large bougies. this instrument is made in adult, child, and adolescent ( mm. by cm.) sizes. gastroscopes and esophagoscopes of the sizes given above (a) and (b), can be used also as gastroscopes. a small form of c, mm. x cm. is used in infants, and also as a retrograde esophagoscope in patients of any age. e, window plug for ballooning gastroscope, f.] [fig. .--author's short esophagoscopes and esophageal specula a, esophageal speculum and hypopharyngoscope, adult's size; b, esophageal speculum and hypopharyngoscope, child's size; c, heavy handled short esophagoscope; d, heavy handled short esophagoscope with drainage.] [fig. .--cross section of full-lumen esophagoscope for the use of largest bourgies. the canals for the light carrier and for drainage are so constructed that they do not encroach upon the lumen of the tube.] [ ] the special sized esophagoscopes most often useful are the mm. x cm., the mm. x cm., and the mm. x cm. these are made with the drainage canal in various positions. for operations on the upper end of the esophagus, and particularly for foreign body work, the esophageal speculum shown at a and b, in fig. , is of the greatest service. with it, the anterior wall of the post-cricoidal pharynx is lifted forward, and the upper esophageal orifice exposed. it can then be inserted deeper, and the upper third of the esophagus can be explored. two sizes are made, the adult's and the child's size. these instruments serve, very efficiently as pleuroscopes. they are made with and without drainage canals, the latter being the more useful form. [fig. .--window-plug with glass cap interchangeable with a cap having a rubber diaphragm with a perforation so that forceps may be used without allowing air to escape. valves on the canals (e, f, fig. ) are preferable.] _gastroscopes_.--the gastroscope is of the same construction as the esophagoscope, with the exception that it is made longer, in order to reach all parts of the stomach. in ordinary cases, the regular esophagoscopes for adults and children respectively will afford a good view of the stomach, but there are cases which require longer tubes, and for these a gastroscope mm. x cm. is made, and also one mm. x cm., though the latter has never been needed but once. [ ] _pleuroscopes_.--as mentioned above the anterior commissure laryngoscope and the esophageal specula make very efficient pleuroscopes; but three different forms of pleuroscopes have been devised by the author for pleuroscopy. the retrograde esophagoscope serves very well for work through small fistulae. _measuring rule_ (fig. ).--it is customary to locate esophageal lesions by denoting their distance from the incisor teeth. this is readily done by measuring the distance from the proximal end of the esophagoscope to the upper incisor teeth, or in their absence, to the upper alveolar process, and subtracting this measurement from the known length of the tube. thus, if an esophagoscope cm. long be introduced and we find that the distance from the incisor teeth to the ocular end of the esophagoscope as measured by the rule is cm., we subtract this cm. from the total length of the esophagoscope ( cm.) and then know that the distal end of the tube is cm. from the incisor teeth. graduation marks on the tube have been used, but are objectionable. [fig. .--measuring rule for gauging in centimeters the depth of any location by subtraction of the length of the uninserted portion of the esophagoscope or bronchoscope. this is preferable to graduations marked on the tubes, though the tubes can be marked with a scale if desired.] _batteries_.--the simplest, best, and safest source of current is a double dry battery arranged in three groups of two cells each, connected in series (fig. ). each set should have two binding posts and a rheostat. the binding posts should have double holes for two additional cords, to be kept in reserve for use in case a cord becomes defective.* the commercial current reduced through a rheostat should never be used, because there is always the possibility of "grounding" the circuit through the patient; a highly dangerous accident when we consider that the tube makes a long moist contact in tissues close to the course of both the vagi and the heart. the endoscopist should never depend upon a pocket battery as a source of illumination, for it is almost certain to fail during the endoscopy. the wires connecting the battery and endoscopic instrument are covered with rubber, so that they may be cleansed and superficially sterilized with alcohol. they may be totally immersed in alcohol for any length of time without injury. * when this is done care is necessary to avoid attempting to use simultaneously the two cords from one pair of posts. [fig .--the author's endoscopic battery, heavily built for reliability. it contains dry cells, series-connected in groups of cells each. each group has its own rheostat and pair of binding posts.] _aspirating tubes_.--independent aspirating tubes involve delay in their use as compared to aspirating canals in the wall of the endoscopic tube; but there are special cases in which an independent tube is invaluable. three forms are used by the author. the "velvet eye" cannot traumatize the mucosa (fig. ). to hold a foreign body by suction, a squarely cut off end is necessary. for use through the tracheotomic wound without a bronchoscope a malleable tube (fig. ) is better. [fig. .--the author's protected-aperture endoscopic aspirating tube for aspiration of pharyngeal secretions during direct laryngoscopy and endotracheobronchial secretions at bronchoscopy, also for draining retropharyngeal abscesses. the laryngoscopes are obtainable with drainage canals, but for most purposes the independent aspirating tube shown above is more satisfactory. the tubes are made in , , and cm. lengths. an aperture on both sides prevents drawing in the mucosa. it can be used for insufflation of ether if desired. an aspirating tube of the same design, but having a squarely cut off end, is sometimes useful for removing secretions lying close to a foreign body; for removing papillomata; and even for withdrawing foreign bodies of a soft surface consistency. it is not often that the foreign bodies can be thus withdrawn through the glottis, but closely fitting foreign bodies can at least be withdrawn to a higher level at which ample forceps spaces will permit application of forceps. such aspirating tubes, however, are not so safe to use as the protected, double aperture tubes.] [fig. .--the author's malleable tracheotomic aspirating tube for removal of secretions, exudates, crusts, etc., from the tracheobronchial tree through the tracheotomic wound without a bronchoscope. the tube is made of copper so that it can be bent to any curve, and the copper wire stylet prevents kinking. the stylet is removed before using the tube for aspiration.] [ ] _aspirators_.--the various electric aspirators so universally used in throat operations should be utilized to withdraw secretions in the tubes fitted with drainage canals. they, however, have the disadvantages of not being easily transported, and of occasionally being out of order. the hand aspirator shown in fig. is, therefore, a necessary part of the instrumental equipment. it never fails to work, is portable, and affords both positive and negative pressures. the positive pressure is sometimes useful in clearing the drainage canal of any particles of food, tissue, clots, or secretion which may obstruct it; and it also serves to fill the stomach or esophagus with air when the ballooning procedure is used. the mechanical aspirator (fig. ) is highly efficient and is the one used in the bronchoscopic clinic. the positive pressure will quickly clear obstructed drainage canals, and may be used while the esophagoscope is in situ, by simply detaching the minus pressure tube and attaching the plus pressure. in the lungs, however, high plus pressures are so dangerous that the pressure valve must be lowered. [fig. --portable aspirator for endoscopy with additional tube connected with the plus pressure side for use in case of occlusion of the drainage canal. this aspirator has the advantage of great power with portability. where portability is not required the electrically operated aspirator is better.] [fig. .--robinson mechanical aspirator adapted for bronchoscopic and esophagoscopic aspiration by the author. the positive pressure is used for clearing obstructed drainage canals and tubes.] [fig. .--apparatus for insufflation of ether or chloroform during bronchoscopy, for those who may desire to use general anesthesia. the mechanical methods of intratracheal insufflation anesthesia subsequently developed by meltzer and auer, elsberg, geo. p. muller and others have rightly superseded this apparatus for all general surgical purposes.] _sponge-pumping_.--while the usually thin, watery esophageal and gastric secretions, if free from food, are readily aspirated through a drainage canal, the secretions of the bronchi are often thick and mucilaginous and aspirated with difficulty. further-more, bronchial secretions as a rule are not collected in pools, but are distributed over the walls of the larger bronchi and continuously well up from smaller bronchi during cough. the aspirating bronchoscopes should be used whenever their very slight additional area of cross-section is unobjectionable. in most cases, however, the most advantageous way to remove bronchial secretion has been found to be by introducing a gauze swab on a long sponge carrier (fig. ), so that the sponge extends beyond the distal end of the bronchoscope, causing cough. then withdrawal of the sponge carrier will remove all of the secretion in the tube just as the plunger in a pump will lift all of the water above it. by this maneuver the walls of the bronchus are wiped free from secretions, and the lamp itself is cleansed. [fig. .--sponge carrier with long collar for carrying the small sponges shown in fig. . the collar screws down as in the coolidge cotton carrier. about a dozen of these are needed and they should all be small enough to go through the mm. (diameter) bronchoscope and long enough to reach through the cm. (length) esophagoscope, so that one set will do for all tubes. the schema shows method of sponging. the carrier c, armed with the sponge, s, when rotated as shown by the dart, d, wipes the field, p, at the same time wiping the lamp, l. the lamp does not need ever to be withdrawn for cleaning during bronchoscopy. it is protected in a recess so that it does not catch in the sponges.] [fig .--exact size to which the bandage-gauze is cut to make endoscopic sponges. each rectangle is the size for the tubal diameter given. the dimensions of the respective rectangles are not given because it is easier for the nurse or any one to cut a cardboard pattern of each size directly from this drawing. the gauze rectangles are folded up endwise as shown at a, then once in the middle as at b, then strung one dozen on a safety pin. in america gauze bandages run about threads to the centimeter. different material might require a slightly different size and the pattern could be made to suit.] [ ] the gauze sponges are made by the instrument nurse as directed in fig. , and are strung on safety pins, wrapped in paper, the size indicated by a figure on the wrapper, and then sterilized in an autoclave. the sterile packages are opened only as needed. these "bronchoscopic sponges" are also made by johnston and johnston, of new brunswick, n. j. and are sold in the shops. _mouth-gag_.--wide gagging prevents proper exposure of the larynx by forcing the mandible down on the hyoid bone. the mouth should be gently opened and a bite block (fig. ) inserted between the teeth on the left side of the patient's mouth, to prevent closing of the jaws on the delicate bronchoscope or esophagoscope. [fig. .--bite block to be inserted between the teeth to prevent closure of the jaws on the endoscopic tube. this is the mckee-mccready modification of the boyce thimble with the omission of the etherizing tube, which is no longer needed. the block has been improved by dr. w. f. moore of the bronchoscopic clinic.] _forceps_.--delicacy of touch and manipulation are an absolute necessity if the endoscopist is to avoid mortality; therefore, heavily built and spring-opposed forceps are dangerous as well as useless. for foreign-body work in the larynx, and for the removal of benign laryngeal growths, the alligator forceps with roughened jaws shown in fig. serve every purpose. [fig. .--laryngeal grasping forceps designed by mosher. for my own use i have taken off the ratchet-locking device for all general work, to be reapplied on the rare occasions when it is required.] _bronchoscopic and esophagoscopic grasping forceps_ are of the tubular type, that is, a stylet carrying the jaws works in a slender tube so that traction on the stylet draws the v of the open jaws into the lumen of the tube, thus causing the blades to approximate. they are very delicate and light, yet have great grasping power and will sustain any degree of traction that it is safe to exert. they permit of the delicacy of touch of a violin bow. the two types of jaws most frequently used, are those with the forward-grasping blades shown in fig. , and those having side-grasping blades shown in fig. . the side-curved forceps are perhaps the most generally useful of all the endoscopic forceps; the side projection of the jaws makes them readily visible during their closure on an object; their broader grasp is also an advantage., the projection of the blades in the side-curved grasping forceps should always be directed toward the left. if it is desired that they open in another direction this should be accomplished by turning the handle and not by adjusting the blade itself. if this rule be followed it will always be possible to tell by the position of the handle exactly where the blades are situated; whereas, if the jaws themselves are turned, confusion is sure to result. the forward-grasping forceps are always so adjusted that the jaws open in an up-and-down direction. on rare occasions it may be deemed desirable to turn the stylet of either forceps in some other direction relative to the handle. [fig. .--the author's forward grasping tube forceps. the handle mechanism is so simple and delicate that the most exquisite delicacy of touch is possible. two locknuts and a thumbscrew take up all lost motion yet afford perfect adjustability and easy separation for cleansing. at a is shown a small clip for keeping the jaws together to prevent injurious bending in the sterilizer, or carrying case. at the left is shown a handle-clamp for locking the forceps on a foreign body in the solution of certain rarely encountered mechanical problems. the jaws are serrated and cupped.] [fig. .--jaws of the author's side-curved endoscopic forceps. these work as shown in the preceding illustration, each forceps having its own handle and tube. originally the end of the cannula and stylet were squared to prevent rotation of the jaws in the cannula. this was found to be unnecessary with properly shaped jaws, which wedge tightly.] _rotation forceps_.--it is sometimes desired to make traction on an irregularly shaped foreign body, and yet to allow the object to turn into the line of least resistance while traction is being made. this can be accomplished by the use of the rotation forceps (fig. ), which have for blades two pointed hooks that meet at their points and do not overlap. rotation forceps made on the model of the laryngeal grasping forceps, but having opposing points at the end of the blades, are sometimes very useful for the removal of irregular foreign bodies in the larynx, or when used through the esophageal speculum they are of great service in the extraction of such objects as bones, pin-buttons, and tooth-plates, from the upper esophagus. these forceps are termed laryngeal rotation forceps (fig. ). all the various forms of forceps are made in a very delicate size often called the "mosquito" or "extra light" forceps, cm. in length, for use in the mm. and the mm. bronchoscopes. for the mm. bronchoscopes heavier forceps of the cm. length are made. for the larger tubes the forceps are made in cm., cm., and cm. lengths. a square-cannula forceps to prevent turning of the jaws was at one time used by the author but it has since been found that round cannula pattern serves all purposes. [fig. .--the author's rotation forceps. useful to allow turning of an irregular foreign body to a safer relation for withdrawal and for the esophagoscopic removal of safety pins by the method of pushing them into the stomach, turning and withdrawal, spring up.] _upper-lobe-bronchus forceps_.--foreign bodies rarely lodge in an upper-lobe bronchus, yet with such a problem it is necessary to have forceps that will reach around a corner. the upper-lobe-bronchus forceps shown in fig. have curved jaws so made as to straighten out while passing through the bronchoscope and to spring back into their original shape on up from the lower jaw emerging from the distal end of the bronchoscopic tube, the radius of curvature being regulated by the extent of emergence permitted. they are made in extra-light pattern, cm. long, and the regular model cm. long. the full-curved model, giving degrees and reaching up into the ascending branches, is made in both light and heavy patterns. forceps with less curve, and without the spiral, are used when it is desired to reach only a short distance "around the corner" anywhere in the bronchi. these are also useful, as suggested by willis f. manges, in dealing with safety pins in the esophagus or tracheobronchial tree. [fig. .--tucker jaws for the author's forceps. the tiny lip projecting down from the upper, and up from the lower jaw prevents sidewise escape of the shaft of a pin, tack, nail or needle. the shaft is automatically thrown parallel to the bronchoscopic axis. drawing about four times actual size.] [ ] _tucker forceps_--gabriel tucker modified the regular side-curved forceps by adding a lip (fig. ) to the left hand side of both upper and lower jaws. this prevents the shaft of a tack, nail, or pin, from springing out of the grasp of the jaws, and is so efficient that it has brought certainty of grasp never before obtainable. with it the solution of the safety-pin problem devised by the author many years ago has a facility and certainty of execution that makes it the method of choice in safety-pin extraction. [fig. .--the author's down-jaw esophageal forceps. the dropping jaw is useful for reaching backward below the cricopharyngeal fold when using the esophageal speculum in the removal of foreign bodies. posterior forceps-spaces are often scanty in cases of foreign bodies lodged just below the cricopharyngeus.] [fig. .--expansile forceps for the endoscopic removal of hollow foreign bodies such as intubation tubes, tracheal cannulae, caps, and cartridge shells.] _screw forceps_.--for the secure grasp of screws the jaws devised by dr. tucker for tacks and pins are excellent (fig. ). _expanding forceps_.--hollow objects may require expanding forceps as shown in fig. . in using them it is necessary to be certain that the jaws are inside the hollow body before expanding them and making traction. otherwise severe, even fatal, trauma may be inflicted. [fig. .--the author's fenestrated peanut forceps. the delicate construction with long, springy and fenestrated jaws give in gentle hands a maximum security with a minimum of crushing tendency.] [fig. --the author's bronchial dilators, useful for dilating strictures above foreign bodies. the smaller size, shown at the right is also useful as an expanding forceps for removing intubation tubes, and other hollow objects. the larger size will go over the shaft of a tack.] [fig. .--the author's self-expanding bronchial dilator. the extent of expansion can be limited by the sense of touch or by an adjustable checking mechanism on the handle. the author frequently used smooth forceps for this purpose, and found them so efficient that this dilator was devised. the edges of forceps jaws are likely to scratch the epithelium. occasionally the instrument is useful in the esophagus; but it is not very safe, unless used with the utmost caution.] _tissue forceps_.--with the forceps illustrated in fig. specimens of tissue may be removed for biopsy from the lower air and food passages with ease and certainty. they have a cross in the outer blade which holds the specimen removed. the action is very delicate, there being no springs, and the sense of touch imparted is often of great aid in the diagnosis. [fig. .--the author's upper-lobe bronchus forceps. at a is shown the full-curved form, for reaching into the ascending branches of the upper-lobe bronchus a number of different forms of jaws are made in this kind of forceps. only are shown.] [fig --the author's endoscopic tissue forceps. the laryngeal length is cm. for esophageal use they are made and cm. long. these are the best forceps for cutting out small specimens of tissue for biopsy.] the large basket punch forceps shown in fig. are useful in removing larger growths or specimens of tissue from the pharynx or larynx. a portion or the whole of the epiglottis may be easily and quickly removed with these forceps, the laryngoscope introduced along the dorsum of the tongue into the glossoepiglottic recess, bringing the whole epiglottis into view. the forceps may be introduced through the laryngoscope or alongside the tube. in the latter method a greater lateral action of the forceps is obtainable, the tube being used for vision only. these forceps are cm. long and are made in two sizes; one with the punch of the largest size that can be passed through the adult laryngoscope, and a smaller one for use through the anterior-commissure laryngoscope and the child's size laryngoscope. [fig. .--the author's papilloma forceps. the broad blunt nose will scalp off the growths without any injury to the normal basal tissues. voice-destroying and stenosing trauma are thus easily avoided.] [fig. .--the author's short mechanical spoon ( cm. long).] _papilloma forceps_.--papillomata do not infiltrate; but superficial repullulations in many cases require repeated removals. if the basal tissues are traumatized, an impaired or ruined voice will result. the author designed these forceps (fig. ) to scalp off the growths without injury to the normal tissues. [fig. .--the author's laryngeal rotation forceps.] [fig. .--enlarged view of the jaws of the author's vocal-nodule forceps. larger cups are made for other purposes but these tiny cups permit of that extreme delicacy required in the excision of the nodules from the vocal cords of singers and other voice users.] [fig .-extra large laryngeal tissue forceps. cm. long, for removing entire growths or large specimens of tissue. a smaller size is made.] _bronchial dilators_.--it is not uncommon to find a stricture of the bronchus superjacent to a foreign body that has been in situ for a period of months. in order to remove the foreign body, this stricture must be dilated, and for this the bronchial dilator shown in fig. was devised. the channel in each blade allows the closed dilator to be pushed down over the presenting point of such bodies as tacks, after which the blades are opened and the stricture stretched. a small and a large size are made. for enlarging the bronchial narrowing associated with pulmonary abscess and sometimes found above a bronchiectatic or foreign body cavity, the expanding dilator shown in fig. is perhaps less apt to cause injury than ordinary forceps used in the same way. the stretching is here produced by the spring of the blades of the forceps and not by manual force. the closed blades are to be inserted through the strictured area, opened, and then slowly withdrawn. for cicatricial stenoses of the trachea the metallic bougies, fig. , are useful. for the larynx, those shown in fig. are needed. [fig. .--a, mosher's laryngeal curette; b, author's flat blade cautery electrode; c, pointed cautery electrode; d, laryngeal knife. the electrodes are insulated with hard-rubber vulcanized onto the conducting wires.] [fig. .--retrograde esophageal bougies in graduated sizes devised by dr. gabriel tucker and the author for dilatation of cicatricial esophageal stenosis. they are drawn upward by an endless swallowed string, and are therefore only to be used in gastrostomized cases.] [fig. .--author's bronchoscopic and esophagoscopic mechanical spoon, made in , and cm. lengths.] [fig. .--schema illustrating the author's method of endoscopic closure of open safety pins lodged point upward the closer is passed down under ocular control until the ring, r, is below the pin. the ring is then erected to the position shown dotted at m, by moving the handle, h, downward to l and locking it there with the latch, z. the fork, a, is then inserted and, engaging the pin at the spring loop, k, the pin is pushed into the ring, thus closing the pin. slight rotation of the pin with the forceps may be necessary to get the point into the keeper. the upper instrument is sometimes useful as a mechanical spoon for removing large, smooth foreign bodies from the esophagus.] _esophageal dilators_.--the dilatation of cicatricial stenosis of the esophagus can be done safely only by endoscopic methods. blind esophageal bouginage is highly dangerous, for the lumen of the stricture is usually eccentric and the bougie is therefore apt to perforate the wall rather than find the small opening. often there is present a pouching of the esophagus above a stricture, in which the bougie may lodge and perforate. bougies should be introduced under visual guidance through the esophagoscope, which is so placed that the lumen of the stricture is in the center of the endoscopic field. the author's endoscopic bougies (fig. ) are made with a flexible silk-woven tip securely fastened to a steel shaft. this shaft lends rigidity to the instrument sufficient to permit its accurate placement, and its small size permits the eye to keep the silk-woven tip in view. these endoscopic bougies are made in sizes from to , french scale. the larger sizes are used especially for the dilatation of laryngeal and tracheal stenoses. for the latter work it is essential that the bougies be inspected carefully before they are used, for should a defective tip come off while in the lower air passages a difficult foreign body problem would be created. soft-rubber retrograde dilators to be drawn upward from the stomach by a swallowed string are useful in gastrostomized cases (fig. ). [fig .--half curved hook, cm. and cm. full curved patterns are made but caution is necessary to avoid them becoming anchored in the bronchi. spiral forms avoid this. the author makes for himself steel probe-pointed rods out of which he bends hooks of any desired shape. the rod is held in a pin-vise to facilitate bending of the point, after heating in an alcohol or bunsen flame.] _hooks_.--no hook greater than a right angle should be used through endoscopic tubes; for should it become caught in some of the smaller bronchi its extraction might result in serious trauma. the half curved hook shown in fig. is the safest type; better still, a spiral twist to the hook will add to its uses, and by reversing the turning motion it may be "unscrewed" out if it becomes caught. hooks may easily be made from rods of malleable steel by heating the end in a spirit lamp and shaping the curve as desired by means of a pin-vise and pliers. about cm. of the proximal end of the rod should be bent in exactly the opposite direction from that of the hook so as to form a handle which will tell the position of the hook by touch as well as by sight. coil-spring hooks for the upper-lobe-bronchus (fig. ) will reach around the corner into the ascending bronchus of the upper-lobe-bronchus, but the utmost skill and care are required to make their use justifiable. [fig. .--author's coil-spring hook for the upper-lobe, bronchus] _safety-pin closer_.--there are a number of methods for the endoscopic removal of open safety-pins when the point is up, one of which is by closing the pin with the instrument shown in fig. in the following manner. the oval ring is passed through the endoscope until it is beyond the spring of the safety-pin, the ring is then turned upward by depressing the handle, and by the aid of the prong the pin is pushed into the ring, which action approximates the point of the pin and the keeper and closes the pin. removal is then less difficult and without danger. this instrument may also be used as a mechanical spoon, in which case it may be passed to the side of a difficultly grasped foreign body, such as a pebble, the ring elevated and the object withdrawn. elsewhere will be found a description of the various safety-pin closers devised by various endoscopists. the author has used arrowsmith's closer with much satisfaction. _mechanical spoon_.--when soft, friable substances, such as a bolus of meat, become impacted in the upper esophagus, the short mechanical spoon (fig. ) used through the esophageal speculum is of great aid in their removal. the blade in this instrument, as the name suggests, is a spoon and is not fenestrated as is the safety-pin closer, which if used for friable substances would allow them to slip through the fenestration. a longer form for use through bronchoscopes and esophagoscopes is shown in fig. . a laryngeal curette, cautery electrodes, cautery handle, and laryngeal knife are illustrated in fig. . the cautery is to be used with a transformer, or a storage battery. _spectacles_.--if the operator has no refractive error he will need two pairs of plane protective spectacles with very large "eyes." if ametropic, corrective lenses are necessary, and duplicate spectacles must be in charge of a nurse. for presbyopia two pairs of spectacles for cm. distance and cm. distance must be at hand. hook temple frames should be used so that they can be easily changed and adjusted by the nurse when the lenses become spattered. the spectacle nurse has ready at all times the extra spectacles, cleaned and warmed in a pan of heated water so that they will not be fogged by the patient's breath, and she changes them without delay as often as they become soiled. the operator should work with both eyes open and with his right eye at the tube mouth. the operating room should be somewhat darkened so as to facilitate the ignoring of the image in the left eye; any lighting should be at the operator's back, and should be insufficient to cause reflections from the inner surface of his glasses. [fig. .--the author's endoscopic bougies. the end consists of a flexible silk woven tip attached securely to a steel shank. sizes to french catheter scale. a metallic form of this bougie is useful in the trachea; but is not so safe for esophageal use.] [fig. .--the author's laryngeal bougie for the dilatation of cicatricial laryngeal stenosis. made in sizes. the shaded triangle shows the cross-section at the widest part.] [fig. .--the author's bronchoscopic and esophagoscopic table.] [ ] _endoscopic table_.--any operating table may be used, but the work is facilitated if a special table can be had which allows the placing of the patient in all required positions. the table illustrated in fig. is so arranged that when the false top is drawn forward on the railroad, the head piece drops and the patient is placed in the correct (boyce) position for esophagoscopy or bronchoscopy, i.e., with the head and shoulders extending over the end of the table. by means of the wheel the plane of the table may be altered to any desired angle of inclination or height of head. _operating room_.--all endoscopic procedures should be performed in a somewhat darkened operating room where all the desired materials are at hand. an endoscopic team consists of three persons: the operator, the assistant who holds the head, and the instrument assistant. another person is required to hold the patient's arms and still another for the changing of the operator's glasses when they become spattered. the endoscopic team of three maintain surgical asepsis in the matter of hands and gowns, etc. the battery, on a small table of its own, is placed at the left hand of the operator. beyond it is the table for the mechanical aspirator, if one is used. all extra instruments are placed on a sterile table, within reach, but not in the way, while those instruments for use in the particular operation are placed on a small instrument table back of the endoscopist. only those instruments likely to be wanted should be placed on the working table, so that there shall be no confusion in their selection by the instrument nurse when called for. each moment of time should be utilized when the endoscopic procedure has been started, no time should be lost in the hunting or separating of instruments. to have the respective tables always in the same position relative to the operator prevents confusion and avoids delay. [fig .--the author's retrograde esophagoscope.] _oxygen tank and tracheotomy instruments_.--respiratory arrest may occur from shifting of a foreign body, pressure of the esophagoscope, tumor, or diverticulum full of food. rare as these contingencies are, it is essential that means for resuscitation be at hand. no endoscopic procedure should be undertaken without a set of tracheotomy instruments on the sterile table within instant reach. in respiratory arrest from the above mentioned causes, respiratory efforts are not apt to return unless oxygen and amyl nitrite are blown into the trachea either through a tracheotomy opening or better still by means of a bronchoscope introduced through the larynx. the limpness of the patient renders bronchoscopy so easy that the well-drilled bronchoscopist should have no difficulty in inserting a bronchoscope in or seconds, if proper preparedness has been observed. it is perhaps relatively rarely that such accidents occur, yet if preparations are made for such a contingency, a life may be saved which would otherwise be inevitably lost. the oxygen tank covered with a sterile muslin cover should stand to the left of the operating table. _asepsis_.--strict aseptic technic must be observed in all endoscopic procedures. the operator, first assistant, and instrument nurse must use the same precautions as to hand sterilization and sterile gowns as would be exercised in any surgical operation. the operator and first assistant should wear masks and sterile gloves. the patient is instructed to cleanse the mouth thoroughly with the tooth brush and a per cent alcohol mouth wash. any dental defects should, if time permit, as in a course of repeated treatments, be remedied by the dental surgeon. when placed on the table with neck bare and the shoulders unhampered by clothing, the patient is covered with a sterile sheet and the head is enfolded in a sterile towel. the face is wiped with per cent alcohol. it is to be remembered that while the patient is relatively immune to the bacteria he himself harbors, the implantation of different strains of perhaps the same type of organisms may prove virulent to him. furthermore the transference of lues, tuberculosis, diphtheria, pneumonia, erysipelas and other infective diseases would be inevitable if sterile precautions were not taken. all of the tubes and forceps are sterilized by boiling. the light-carriers and lamps may be sterilized by immersion in per cent alcohol or by prolonged exposure to formaldehyde gas. continuous sterilization by keeping them put away in a metal box with formalin pastilles or other source of formaldehyde gas is an ideal method. knives and scissors are immersed in per cent alcohol, and the rubber covered conducting cords are wiped with the same solution. _list of instruments_.--the following list has been compiled as a convenient basis for equipment, to which such special instruments as may be needed for special cases can be added from time to time. the instruments listed are of the author's design. adult's laryngoscope. child's laryngoscope. infant's diagnostic laryngoscope. anterior commissure laryngoscope. bronchoscope, mm. x cm. bronchoscope, mm. x cm. bronchoscope, mm. x cm. bronchoscope, mm. x cm. esophagoscope, mm. x cm. esophagoscope, mm. x cm. esophagoscope, full lumen, mm. x cm. esophagoscope, full lumen, mm. x cm. esophageal speculum, adult. esophageal speculum, child. forward-grasping forceps, delicate, cm. forward-grasping forceps, regular, cm. forward-grasping forceps, regular, cm. side-grasping forceps, delicate, cm. side-grasping forceps, regular, cm. side-grasping forceps, regular, cm. rotation forceps, delicate, cm. rotation forceps, regular, cm. rotation forceps, regular, cm. laryngeal alligator forceps. laryngeal papilloma forceps. esophageal bougies, nos. to french (larger sizes to no. may be added). special measuring rule. light sponge carriers. aspirator with double tube for minus and plus pressure. endoscopic aspirating tubes and cm. half curved hook, cm. triple circuit bronchoscopy battery. rubber covered conducting cords for battery. box bronchoscopic sponges, size . box bronchoscopic sponges, size . box bronchoscopic sponges, size . box bronchoscopic sponges, size . bite block, adult. bite block, child. dozen extra lamps for lighted instruments. extra light carrier for each instrument.* yards of pipe-cleaning, worsted-covered wire. [* messrs. george p. pilling and sons who are now making these instruments supply an extra light carrier and extra lamps with each instrument.] _care of instruments_.--the endoscopist must either personally care for his instruments, or have an instrument nurse in his own employ, for if they are intrusted to the general operating room routine he will find that small parts will be lost; blades of forceps bent, broken, or rusted; tubes dinged; drainage canals choked with blood or secretions which have been coagulated by boiling, and electric attachments rendered unstable or unservicable, by boiling, etc. the tubes should be cleansed by forcing cold water through the drainage canals with the aspirating syringe, then dried by forcing pipe-cleaning worsted-covered wire through the light and drainage canals. gauze on a sponge carrier is used to clean the main canal. forceps stylets should be removed from their cannulae, and the cannulae cleansed with cold water, then dried and oiled with the pipe-cleaning material. the stylet should have any rough places smoothed with fine emery cloth and its blades carefully inspected; the parts are then oiled and reassembled. nickle plating on the tubes is apt to peel and these scales have sharp, cutting edges which may injure the mucosa. all tubes, therefore, should be unplated. rough places on the tubes should be smoothed with the finest emery cloth, or, better, on a buffing wheel. the dry cells in the battery should be renewed about every months whether used or not. lamps, light carriers, and cords, after cleansing, are wiped with per cent alcohol, and the light-carriers with the lamps in place are kept in a continuous sterilization box containing formaldehyde pastilles. it is of the utmost importance that instruments be always put away in perfect order. not only are cleaning and oiling imperative, but any needed repairs should be attended to at once. otherwise it will be inevitable that when gotten out in an emergency they will fail. in general surgery, a spoon will serve for a retractor and good work can be done with makeshifts; but in endoscopy, especially in the small, delicate, natural passages of children, the handicap of a defective or insufficient armamentarium may make all the difference between a success and a fatal failure. a bronchoscopic clinic should at all times be in the same state of preparedness for emergency as is everywhere required of a fire-engine house. [plate i--a working set of the author's endoscopic tubes for laryngoscopy, bronchoscopy, esophagoscopy, and gastroscopy: a, adult's laryngoscope; b, child's laryngoscope; c, anterior commissure laryngoscope; d, esophageal speculum, child's size; e, esophageal speculum, adult's size; f, bronchoscope, infant's size, mm. x cm.; g, bronchoscope, child's size, mm. x cm.; h, aspirating bronchoscope for adults, mm. x cm.; i, bronchoscope, adolescent's size, mm. x cm., used also for the deeper bronchi of adults; j, bronchoscope, adult size, g mm. x cm.; k, child's size esophagoscope, mm. x cm.; l, adult's size esophagoscope, full lumen construction, mm. x cm.; m, adult's size gastroscope. c, i, and e are also hypopharyngoscopes. c is an excellent esophageal speculum for children, and a longer model is made for adults. if the utmost economy must be practised d, e, and m may be omitted. the balance of the instruments are indispensable if adults and children are to be dealt with. the instruments are made by charles j. pilling & sons, philadelphia.] [ ] chapter ii--anatomy of larynx, trachea, bronchi and esophagus, endoscopically considered the _larynx_ is a cartilaginous box, triangular in cross-section, with the apex of the triangle directed anteriorly. it is readily felt in the neck and is a landmark for the operation of tracheotomy. we are concerned endoscopically with four of its cartilaginous structures: the epiglottis, the two arytenoid cartilages, and the cricoid cartilage. the _epiglottis_, the first landmark in direct laryngoscopy, is a leaf-like projection springing from the anterointernal surface of the larynx and having for its function the directing of the bolus of food into the pyriform sinuses. it does not close the larynx in the trap-door manner formerly taught; a fact easily demonstrated by the simple insertion of the direct laryngoscope and further demonstrated by the absence of dysphagia when the epiglottis is surgically removed, or is destroyed by ulceration. closure of the larynx is accomplished by the approximation of the ventricular bands, arytenoids and aryepiglottic folds, the latter having a sphincter-like action, and by the raising and tilting of the larynx. the _arytenoids_ form the upper posterior boundary of the larynx and our particular interest in them is directed toward their motility, for the rotation of the arytenoids at the cricoarytenoid articulations determines the movements of the cords and the production of voice. approximation of the arytenoids is a part of the mechanism of closure of the larynx. the _cricoid cartilage_ was regarded by esophagoscopists as the chief obstruction encountered on the introduction of the esophagoscope. as shown by the author, it is the cricopharyngeal fold, and the inconceivably powerful pull of the cricopharyngeal muscle on the cricoid cartilage, that causes the difficulty. the cricoid is pulled so powerfully back against the cervical spine, that it is hard to believe that this muscles is inserted into the median raphe and not into the spine itself (fig. ). the _ventricular bands_ or false vocal cords vicariously phonate in the absence of the true cords, and assist in the protective function of the larynx. they form the floor of the _ventricles_ of the larynx, which are recesses on either side, between the false and true cords, and contain numerous mucous glands the secretion from which lubricates the cords. the ventricles are not visible by mirror laryngoscopy, but are readily exposed in their depths by lifting the respective ventricular bands with the tip of the laryngoscope. the _vocal cords_, which appear white, flat, and ribbon-like in the mirror, when viewed directly assume a reddish color, and reveal their true shelf-like formation. in the subglottic area the tissues are vascular, and, in children especially, they are prone to swell when traumatized, a fact which should be always in mind to emphasize the importance of gentleness in bronchoscopy, and furthermore, the necessity of avoiding this region in tracheotomy because of the danger of producing chronic laryngeal stenosis by the reaction of these tissues to the presence of the tracheotomic cannula. the _trachea_ just below its entrance into the thorax deviates slightly to the right, to allow room for the aorta. at the level of the second costal cartilage, the third in children, it bifurcates into the right and left main bronchi. posteriorly the bifurcation corresponds to about the fourth or fifth thoracic vertebra, the trachea being elastic, and displaced by various movements. the endoscopic appearance of the trachea is that of a tube flattened on its posterior wall. in two locations it normally often assumes a more or less oval outline; in the cervical region, due to pressure of the thyroid gland; and in the intrathoracic portion just above the bifurcation where it is crossed by the aorta. this latter flattening is rhythmically increased with each pulsation. under pathological conditions, the tracheal outline may be variously altered, even to obliteration of the lumen. the mucosa of the trachea and bronchi is moist and glistening, whitish in circular ridges corresponding to the cartilaginous rings, and reddish in the intervening grooves. the right bronchus is shorter, wider, and more nearly vertical than its fellow of the opposite side, and is practically the continuation of the trachea, while the left bronchus might be considered as a branch. the deviation of the right main bronchus is about degrees, and its length unbranched in the adult is about . cm. the deviation of the left main bronchus is about degrees and its adult length is about cm. the right bronchus considered as a stem, may be said to give off three branches, the epiarterial, upper- or superior-lobe bronchus; the middle-lobe bronchus; and the continuation downward, called the lower- or inferior-lobe bronchus, which gives off dorsal, ventral and lateral branches. the left main bronchus gives off first the upper-or superior-lobe bronchus, the continuation being the lower-or inferior-lobe bronchus, consisting of a stem with dorsal, ventral and lateral branches. [fig. .--tracheo-bronchial tree. lm, left main bronchus; sl, superior lobe bronchus; ml, middle lobe bronchus; il, inferior lobe bronchus.] the septum between the right and left main bronchi, termed the carina, is situated to the left of the midtracheal line. it is recognized endoscopically as a short, shining ridge running sagitally, or, as the patient lies in the recumbent position, we speak of it as being vertical. on either side are seen the openings of the right and left main bronchi. in fig. , it will be seen that the lower border of the carina is on a level with the upper portion of the orifice of the right superior-lobe bronchus; with the carina as a landmark and by displacing with the bronchoscope the lateral wall of the right main bronchus, a second, smaller, vertical spur appears, and a view of the orifice of the right upper-lobe bronchus is obtained, though a lumen image cannot be presented. on passing down the right stem bronchus (patient recumbent) a horizontal partition or spur is found with the lumen of the middle-lobe bronchus extending toward the ventral surface of the body. all below this opening of the right middle-lobe bronchus constitutes the lower-lobe bronchus and its branches. [fig. .--bronchoscopic views. s; superior lobe bronchus; sl, superior lobe bronchus; i, inferior lobe bronchus; m, middle lobe bronchus.] [ ] coming back to the carina and passing down the left bronchus, the relatively great distance from the carina to the upper-lobe bronchus is noted. the spur dividing the orifices of the left upper- and lower-lobe bronchi is oblique in direction, and it is possible to see more of the lumen of the left upper-lobe bronchus than of its homologue on the right. below this are seen the lower-lobe bronchus and its divisions (fig. ). _dimensions of the trachea and bronchi_.--it will be noted that the bronchi divide monopodially, not dichotomously. while the lumina of the individual bronchi diminish as the bronchi divide, the sum of the areas shows a progressive increase in total tubular area of cross-section. thus, the sum of the areas of cross-section of the two main bronchi, right and left, is greater than the area of cross section of the trachea. this follows the well known dynamic law. the relative increase in surface as the tubes branch and diminish in size increases the friction of the passing air, so that an actual increase in area of cross section is necessary, to avoid increasing resistance to the passage of air. the cadaveric dimensions of the tracheobronchial tree may be epitomized approximately as follows: adult male female child infant diameter trachea, x x x x length trachea, cm. . . . . length right bronchus . . . . length left bronchus . . . . length upper teeth to trachea . . . . length total to secondary bronchus . . . . in considering the foregoing table it is to be remembered that in life muscle tonus varies the lumen and on the whole renders it smaller. in the selection of tubes it must be remembered that the full diameter of the trachea is not available on account of the glottic aperture which in the adult is a triangle measuring approximately x x mm. and permitting the passage of a tube not over mm. in diameter without risk of injury. furthermore a tube which filled the trachea would be too large to enter either main bronchus. the normal movements of the trachea and bronchi are respiratory, pulsatory, bechic, and deglutitory. the two former are rhythmic while the two latter are intermittently noted during bronchoscopy. it is readily observed that the bronchi elongate and expand during inspiration while during expiration they shorten and contract. the bronchoscopist must learn to work in spite of the fact that the bronchi dilate, contract, elongate, shorten, kink, and are dinged and pushed this way and that. it is this resiliency and movability that make bronchoscopy possible. the inspiratory enlargement of lumen opens up the forceps spaces, and the facile bronchoscopist avails himself of the opportunity to seize the foreign body. the esophagus a few of the anatomical details must be kept especially in mind when it is desired to introduce straight and rigid instruments down the lumen of the gullet. first and most important is the fact that the esophageal walls are exceedingly thin and delicate and require the most careful manipulation. because of this delicacy of the walls and because the esophagus, being a constant passageway for bacteria from the mouth to the stomach, is never sterile, surgical procedures are associated with infective risks. for some other and not fully understood reason, the esophagus is, surgically speaking, one of the most intolerant of all human viscera. the anterior wall of the esophagus is in a part of its course, in close relation to the posterior wall of the trachea, and this portion is called the party wall. it is this party wall that contains the lymph drainage system of the posterior portion of the larynx, and it is largely by this route that posteriorly located malignant laryngeal neoplasms early metastasize to the mediastinum. [ ] [fig .--esophagoscopic and gastroscopic chart birth yr. yrs. yrs. yrs. yrs.adults cm. greater curvature cm. cardia cm. hiatus cm. left bronchus cm. aorta cm. cricopharyingeus cm. incisors fig. .--the author's esophagoscopic chart of approximate distances of the esophageal narrowings from the upper incisor teeth, arranged for convenient reference during esophagoscopy in the dorsally recumbent patient.] the lengths of the esophagus at different ages are shown diagrammatically in fig. . the diameter of the esophageal lumen varies greatly with the elasticity of the esophageal walls; its diameter at the four points of anatomical constriction is shown in the following table: constriction diameter vertebra cricopharyngeal transverse mm. ( in.) sixth cervical antero-posterior mm. ( / in.) aortic transverse mm. ( in.) fourth thoracic antero-posterior mm. ( / in.) left-bronchial transverse mm. ( in.) fifth thoracic antero-posterior mm. ( / in.) diaphragmatic transverse mm. ( in+) tenth thoracic antero-posterior mm. (in.--) for practical endoscopic purposes it is only necessary to remember that in a normal esophagus, straight and rigid tubes of mm. diameter should pass freely in infants, and in adults, tubes of mm. the demonstrable constrictions from above downward are at . the crico-pharyngeal fold. . the crossing of the aorta. . the crossing of the left bronchus. . the hiatus esophageus. there is a definite fifth narrowing of the esophageal lumen not easily demonstrated esophagoscopically and not seen during dissection, but readily shown functionally by the fact that almost all foreign bodies lodge at this point. this narrowing occurs at the superior aperture of the thorax and is probably produced by the crowding of the numerous organs which enter or leave the thorax through this orifice. _the crico-pharyngeal constriction_, as already mentioned, is produced by the tonic contraction of a specialized band of the orbicular fibers of the lowermost portion of the inferior pharyngeal constrictor muscle, called the cricopharyngeal muscle. as shown by the author it is this muscle and not the cricoid cartilage alone that causes the difficulty in the insertion of an esophagoscope. this muscle is attached laterally to the edges of the signet of the cricoid which it pulls with an incomprehensible power against the posterior wall of the hypopharynx, thus closing the mouth of the esophagus. its other attachment is in the median posterior raphe. between these circular fibers (the cricopharyngeal muscle) and the oblique fibers of the inferior constrictor muscle there is a weakly supported point through which the esophageal wall may herniate to form the so-called pulsion diverticulum. it is at this weak point that fatal esophagoscopic perforation by inexperienced operators is most likely to occur. _the aortic narrowing_ of the esophagus may not be noticed at all if the patient is placed in the proper sequential "high-low" position. it is only when the tube-mouth is directed against the left anterior wall that the actively pulsating aorta is felt. the bronchial narrowing of the esophagus is due to backward displacement caused by the passage of the left bronchus over the anterior wall of the esophagus at about cm. from the upper teeth in the adult. the ridge is quite prominent in some patients, especially those with dilatation from stenoses lower down. the hiatal narrowing is both anatomic and spasmodic. the peculiar arrangement of the tendinous and muscular structure of the diaphragm acts on this hiatal opening in a sphincter-like fashion. there are also special bundles of muscle fibers extending from the crura of the diaphragm and surrounding the esophagus, which contribute to tonic closure in the same way that a pinch-cock closes a rubber tube. the author has called the hiatal closure the "diaphragmatic pinchcock." _direction of the esophagus_.--the esophagus enters the chest in a decidedly backward as well as downward direction, parallel to that of the trachea, following the curves of the cervical and upper dorsal spine. below the left bronchus the esophagus turns forward, passing through the hiatus in the diaphragm anterior to and to the left of the aorta. the lower third of the esophagus in addition to its anterior curvature turns strongly to the left, so that an esophagoscope inserted from the right angle of the mouth, when introduced into the stomach, points in the direction of the anterior superior spine of the left ileum. it is necessary to keep this general course constantly in mind in all cases of esophagoscopy, but particularly in those cases in which there is marked dilatation of the esophagus following spasm at the diaphragm level. in such cases the aid of this knowledge of direction will greatly simplify the finding of the hiatus esophageus in the floor of the dilatation. the extrinsic or transmitted movements of the esophagus are respiratory and pulsatory, and to a slight extent, bechic. the respiratory movements consist in a dilatation or opening up of the thoracic esophageal lumen during inspiration, due to the negative intrathoracic pressure. the normal pulsatory movements are due to the pulsatile pressure of the aorta, found at the th thoracic vertebra ( cm. from the upper teeth in the adult), and of the heart itself, most markedly felt at the level of the th and th thoracic vertebrae (about cm. from the upper teeth in adults). as the distances of all the narrowings vary with age, it is useful to frame and hang up for reference a copy of the chart (fig. ). the intrinsic movements of the esophagus are involuntary muscular contractions, as in deglutition and regurgitation; spasmodic, the latter usually having some pathologic cause; and tonic, as the normal hiatal closure, in the author's opinion may be considered. swallowing may be involuntary or voluntary. the constrictors are anatomically not considered part of esophagus proper. when the constrictors voluntarily deliver the bolus past the cricopharyngeal fold, the involuntary or peristaltic contractions of the esophageal mural musculature carry the bolus on downward. there is no sphincter at the cardiac end of the esophagus. the site of spasmodic stenosis in the lower third, the so-called cardiospasm, was first demonstrated by the author to be located at the hiatus esophageus and the spasmodic contractions are of the specialized muscle fibers there encircling the esophagus, and might be termed "phrenospasm," or "hiatal esophagismus." regurgitation of food from the stomach is normally prevented by the hiatal muscular diaphragmatic closure (called by the author the "diaphragmatic pinchcock") plus the kinking of the abdominal esophagus. in the author's opinion there is no spasm in the disease called "cardiospasm." it is simply the failure of the diaphragmatic pinchcock to open normally in the deglutitory cycle. a better name is functional hiatal stenosis. at retrograde esophagoscopy the cardia and abdominal esophagus do not seem to exist. the top of the stomach seems to be closed by the diaphragmatic pinchcock in the same way that the top of a bag is closed by a puckering string. [ ] chapter iii--preparation of the patient for peroral endoscopy the suggestions of the author in the earlier volumes in regard to preparation of the patient, as for any operation, by a bath, laxative, etc., and especially by special cleansing of the mouth with per cent alcohol, have received general endorsement. care should be taken not to set up undue reaction by vigorous scrubbing of gums unaccustomed to it. artificial dentures should be removed. even if no anesthetic is to be used, the patient should be fasted for five hours if possible, even for direct laryngoscopy in order to forestall vomiting. except in emergency cases every patient should be gone over by an internist for organic disease in any form. if an endolaryngeal operation is needed by a nephritic, preparatory treatment may prevent laryngeal edema or other complications. hemophilia should be thought of. it is quite common for the first symptom of an aortic aneurysm to be an impaired power to swallow, or the lodgment of a bolus of meat or other foreign body. if aneurysm is present and esophagoscopy is necessary, as it always is in foreign body cases, "to be fore-warned is to be forearmed." pulmonary tuberculosis is often unsuspected in very young children. there is great danger from tracheal pressure by an esophageal diverticulum or dilatation distended with food; or the food maybe regurgitated and aspirated into the larynx and trachea. therefore, in all esophageal cases the esophagus should be emptied by regurgitation induced by titillating the fauces with the finger after swallowing a tumblerful of water, pressure on the neck, etc. aspiration will succeed in some cases. in others it is absolutely necessary to remove food with the esophagoscope. if the aspirating tube becomes clogged by solid food, the method of swab aspiration mentioned under bronchoscopy will succeed. of course there is usually no cough to aid, but the involuntary abdominal and thoracic compression helps. should a patient arrive in a serious state of water-hunger, as part of the preparation the patient must be given water by hypodermoclysis and enteroclysis, and if necessary the endoscopy, except in dyspneic cases, must be delayed until the danger of water-starvation is past. as pointed out by ellen j. patterson the size of the thymus gland should be studied before an esophagoscopy is done on a child. every patient should be examined by indirect, mirror laryngoscopy as a preliminary to peroral endoscopy for any purpose whatsoever. this becomes doubly necessary in cases that are to be anesthetized. [ ] chapter iv--anesthesia for peroral endoscopy a dyspneic patient should never be given a general anesthetic. cocaine should not be used on children under ten years of age because of its extreme toxicity. to these two postulates always in mind, a third one, applicable to both general and local anesthesia, is to be added--total abolition of the cough-reflex should be for short periods only. general anesthesia is never used in the bronchoscopic clinic for endoscopic procedures. the choice for each operator must, however, be a matter for individual decision, and will depend upon the personal equation, and degree of skill of the operator, and his ability to quiet the apprehensions of the patient. in other words, the operator must decide what is best for his particular patient under the conditions then existing. _children_ in the bronchoscopic clinic receive neither local nor general anesthesia, nor sedative, for laryngoscopic operations or esophagoscopy. bronchoscopy in the older children when no dyspnea is present has in recent years, at the suggestion of prof. hare, been preceded by a full dose of morphin sulphate (i.e., / grain for a child of six years) or a full physiologic dose of sodium bromide. the apprehension is thus somewhat allayed and the excessive cough-reflex quieted. the morphine should be given not less than an hour and a half before bronchoscopy to allow time for the onset of the soporific and antispasmodic effects which are the desiderata, not the analgesic effects. dosage is more dependent on temperament than on age or body weight. atropine is advantageously added to morphine in bronchoscopy for foreign bodies, not only for the usual reasons but for its effect as an antispasmodic, and especially for its diminution of endobronchial secretions. true, it does not diminish pus, but by diminishing the outpouring of normal secretions that dilute the pus the total quantity of fluid encountered is less than it otherwise would be. in cases of large quantities of pus, as in pulmonary abscess and bronchiectasis, however, no diminution is noticeable. no food or water is allowed for hours prior to any endoscopic procedure, whether sedatives or anesthetics are to be given or not. if the stomach is not empty vomiting from contact of the tube in the pharynx will interfere with work. with _adults_ no anesthesia, general or local, is given for esophagoscopy. for laryngeal operation and bronchoscopy the following technic is used: one hour before operation the patient is given hypodermatically a full physiologic dose of morphin sulphate (from / , to / gr.) guarded with atropin sulphate (gr. / ). care must be taken that the injection be not given into a vein. on the operating table the epiglottis and pharynx are painted with per cent solution of cocain. two applications are usually sufficient completely to anesthetize the exterior and interior of the larynx by blocking of the superior laryngeal nerve without any endolaryngeal applications. the laryngoscope is now introduced and if found necessary a per cent cocain solution is applied to the interior of the larynx and subglottic region, by means of gauze swabs fastened to the sponge carriers. here also two applications are quite sufficient to produce complete anesthesia in the larynx. if bronchoscopy is to be done the gauze swab is carried down through the exposed glottis to the carina, thus anesthetizing the tracheal mucosa. if further anesthetization of the bronchial mucosa is required, cocain may be applied in the same manner through the bronchoscope. in all these local applications prolonged contact of the swab is much more efficient than simply painting the surface. [ ] in cases in which cocain is deemed contraindicated morphin alone is used. if given in sufficient dosage cocain can be altogether dispensed with in any case. it is perhaps _safer for the beginner_ in his early cases of esophagoscopy to have the patient relaxed by an ether anesthesia, provided the patient is not dyspneic to begin with, or made so by faulty position or by pressure of the esophagoscopic tube mouth on the tracheoesophageal "party wall." as proficiency develops, however, he will find anesthesia unnecessary. local anesthesia is needless for esophagoscopy, and if used at all should be limited to the laryngopharynx and never applied to the esophagus, for the esophagus is without sensation, as anyone may observe in drinking hot liquids. _direct laryngoscopy in children_ requires neither local nor general anesthesia, either for diagnosis or for removal of foreign bodies or growths from the larynx. general anesthesia is contraindicated because of the dyspnea apt to be present, and because the struggles of the patient might cause a dislodgment of the laryngeal intruder and aspiration to a lower level. the latter accident is also prone to follow attempts to cocainize the larynx. _technic for general anesthesia_.--for esophagoscopy and gastroscopy, if general anesthesia is desired, ether may be started by the usual method and continued by dropping upon folded gauze laid over the mouth after the tube is introduced. endo-tracheal administration of ether is, however, far safer than peroral administration, for it overcomes the danger of respiratory arrest from pressure of the esophagoscope, foreign body, or both, on the trachea. chloroform should not be used for esophagoscopy or gastroscopy because of its depressant action on the respiratory center. for bronchoscopy, ether or chloroform may be started in the usual way and continued by insufflating through the branch tube of the bronchoscope by means of the apparatus shown in fig. . in case of paralysis of the larynx, even if only monolateral, a general anesthetic if needed should be given by intratracheal insufflation. if the apparatus for this is not available the patient should be tracheotomized. hence, every adult patient should be examined with a throat mirror before general anesthesia for any purpose, and the necessity becomes doubly imperative before goiter operations. a number of fatalities have occurred from neglect of this precaution. _anesthetizing a tracheotomized patient_ is free from danger so long as the cannula is kept free from secretion. ether is dropped on gauze laid over the tracheotomic cannula and the anesthesia watched in the usual manner. if the laryngeal stenosis is not complete, ether-saturated gauze is to be placed over the mouth as well as over the tracheotomy tube. _endo-tracheal anesthesia_ is by far the safest way for the administration of ether for any purpose. by means of the silk-woven catheter introduced into the trachea, ether-laden air from an insufflation apparatus is piped down to the lungs continuously, and the strong return-flow prevents blood and secretions from entering the lower air-passages. the catheter should be of a size, relative to that of the glottic chink, to permit a free return-flow. a number french is readily accommodated by the adult larynx and lies well out of the way along the posterior wall of the larynx. because of the little room occupied by the insufflation catheter this method affords ideal anesthesia for external laryngeal operations. operations on the nose, accessory sinuses and the pharynx, apt to be attended by considerable bleeding, are rendered free from the danger of aspiration pneumonia by endotracheal anesthesia. it is the safest anesthesia for goiter operations. endo-tracheal anesthesia has rendered needless the intricate negative pressure chamber formerly required for thoracic surgery, for by proper regulation of the pressure under which the ether ladened air is delivered, a lung may be held in any desired degree of expansion when the pleural cavity is opened. it is indicated in operations of the head, neck, or thorax, in which there is danger of respiratory arrest by centric inhibition or peripheral pressure; in operations in which there is a possibility of excessive bleeding and aspiration of blood or secretions; and in operations where it is desired to keep the anesthetist away from the operating field. various forms of apparatus for the delivery of the ether-laden vapor are supplied by instrument makers with explicit directions as to their mechanical management. we are concerned here mainly with the technic of the insertion of the intratracheal tube. the larynx should be examined with the mirror, preferably before the day of operation, for evidence of disease, and incidentally to determine the size of the catheter to be introduced, though the latter can be determined after the larynx is laryngoscopically exposed. the following list of rules for the introduction of the catheter will be of service (see fig. ). rules for insertion of the catheter for insufflation anesthesia . the patient should be fully under the anesthetic by the open method so as to get full relaxation of the muscles of the neck. . the patient's head must be in full extension with the vertex firmly pushed down toward the feet of the patient, so as to throw the neck upward and bring the occiput down as close as possible beneath the cervical vertebrae. . no gag should be used, because the patient should be sufficiently anesthetized not to need a gag, and because wide gagging defeats the exposure of the larynx by jamming down the mandible. . the epiglottis must be identified before it is passed. . the speculum must pass sufficiently far below the tip of the epiglottis so that the latter will not slip. . too deep insertion must be avoided, as in this case the speculum goes posterior to the cricoid, and the cricoid is lifted, exposing the mouth of the esophagus, which is bewildering until sufficient education of the eye enables the operator to recognize the landmarks. . the patient's head is lifted off the table by the spatular tip of the laryngoscope. actual lifting of the head will not be necessary if the patient is fully relaxed; but the idea of lifting conveys the proper conception of laryngeal exposure (fig. ). [ ] chapter v--bronchoscopic oxygen insufflation bronchoscopic oxygen insufflation is a life-saving measure equalled by no other method known to the science of medicine, in all cases of asphyxia, or apnea, present or impending. its especial sphere of usefulness is in severe cases of electric shock, hanging, smoke asphyxia, strangulation, suffocation, thoracic or abdominal pressure, apnea, acute traumatic pneumothorax, respiratory arrest from absence of sufficient oxygen, or apnea from the presence of quantities of irrespirable or irritant gases. combined with bronchoscopic aspiration of secretions it is the best method of treatment for poisoning by chlorine gas, asphyxiating, and other war gases. bronchoscopic oxygen insufflation should be taught to every interne in every hospital. the emergency or accident ward of every hospital should have the necessary equipment and an interne familiar with its use. the method is simple, once the knack is acquired. the patient being limp and recumbent on a table, the larynx is exposed with the laryngoscope, and the bronchoscope is inserted as hereinafter described. the oxygen is turned on at the tank and the flow regulated before the rubber tube from the wash-bottle of tank is attached to the side-outlet of the bronchoscope. it is necessary to be certain that the flow is gentle, so that, with a free return flow the introduced pressure does not exceed the capillary pressure; otherwise the blood will be forced out of the capillaries and the ischemia of the lungs will be fatal. another danger is that overdistension causes inhibition of inspiration resulting in apnea continuing as long as the distension is maintained, if not longer. the return flow from the bronchoscope should be interrupted for or seconds several times a minute to inflate the lungs, but the flow must not be occluded longer than seconds, because the intrapulmonary pressure would rise. a pearl of amyl nitrite may be broken in the wash bottle. slow rhythmic artificial respiratory movements are a useful adjunct, and unless the operator is very skillful in gauging the alternate pressures and releases with the thumb according to the oxygen pressure, it is vitally necessary to fill and deflate the lungs rhythmically by one of the well known methods of artificial respiration. anyone skilled in the introduction of the bronchoscope can do bronchoscopy in a few seconds, and it is especially easy in cases of respiratory arrest, because of the limp condition of the patient. the foregoing applies to cases in which a pulmotor would be used, such as apnea from electric shocks, etc. for obstructive dyspnea and asphyxia, tracheotomy is the procedure of choice, and the skillful tracheotomist would be justified in preferring tracheotomy for the other class of cases, insufflating the oxygen and amyl nitrite through the tracheotomic wound. the pulmotor and similar mechanisms are, perhaps, the best things the use of which can be taught to laymen; but as compared to bronchoscopic oxygen insufflation they are woefully inefficient, because the intraoral pressure forces the tongue back over the laryngeal orifice, obstructing the airway in this "death zone." by the introduction of the bronchoscope this death zone is entirely eliminated, and a free airway established for piping the oxygen directly into the lungs. [ ] chapter vi--position of the patient for peroral endoscopy it is the author's invariable practice to place the patient in the dorsally recumbent position. the sitting position is less favorable. while lying on a well-padded, flat table the patient is readily controlled, the head is freely movable, secretions can be easily removed, the view obtained by the endoscopist is truly direct (without reversal of sides), and, most important, the employment of one position only favors smoother and more efficient team work, and a better endoscopic technic. _general principles of position_.--as will be seen in fig. the trachea and esophagus are not horizontal in the thorax, but their long axes follow the curves of the cervical and dorsal spine. therefore, if we are to bring the buccal cavity and pharynx in a straight line with the trachea and esophagus it will be found necessary to elevate the whole head above the plane of the table, and at the same time make extension at the occipito-atloid joint. by this maneuver the cervical spine is brought in line with the upper portion of the dorsal spine as shown in fig. . it was formerly taught, and often in spite of my better knowledge i am still unconsciously prone to allow the head and cervical spine to assume a lower position than the plane of the table, the so-called rose position. with the head so placed, it is impossible to enter the lower air or food passages with a rigid tube, as will be shown by a study of the radiograph shown in fig. . extension of the head on the occipito-atloid joint is for the purpose of freeing the tube from the teeth, and the amount required will vary with the degree to which the mouth can be opened. whether the head be extended, flexed, or kept mid-way, the fundamental principle in the introduction of all endoscopic tubes is the anterior placing of the cervical spine and the high elevation of the head. the esophagus, just behind the heart, turns ventrally and to the left. in order to pass a rigid tube through this ventral curve the dorsal spine is now extended by lowering the head and shoulders below the plane of the table. this will be further explained in the chapter on esophagoscopy. in all of these procedures, the nose of the patient should be directed toward the zenith, and the assistant should _prevent rotation of the head_ as well as _prevent lowering of the head_. the patient should be urged as follows: "don't hold yourself so rigid." "let your head and neck go loose." "let your head rest in my hand." "don't try to hold it." "let me hold it." "relax." "don't raise your chest." [fig. .--schematic illustration of normal position of the intra-thoracic trachea and esophagus and also of the entire trachea when the patient is in the correct position for peroral bronchoscopy. when the head is thrown backward (as in the rose position) the anterior convexity of the cervical spine is transmitted to the trachea and esophagus and their axes deviated. the anterior deviation of the lower third of the esophagus shows the anatomical basis for the "high low" position for esophagoscopy] [fig. .--correct position of the cervical spine for esophagoscopy and bronchoscopy. (_illustration reproduced from author's article jour. am. med. assoc., sept. , _)] [fig. .--curved position of the cervical spine, with anterior convexity, in the rose position, rendering esophagoscopy and bronchoscopy difficult or impossible. the devious course of the pharynx, larynx and trachea are plainly visible. the extension is incorrectly imparted to the whole cervical spine instead of only to the occipito-atloid joint. this is the usual and very faulty conception of the extended position. (_illustration reproduced from author's article, jour. am. med. assoc., sept. , ._)] [ ] for _direct laryngoscopy_ the patient's head is raised above the plane of the table by the first assistant, who stands to the right of the patient, holding the bite block on his right thumb inserted in the left corner of the patient's mouth, while his extended right hand lies along the left side of the patient's cheek and head, and prevents rotation. his left hand, placed under the patient's occiput, elevates the head and maintains the desired degree of extension at the occipito-atloid joint (fig. ). [fig .--direct laryngoscopy, recumbent patient. the second assistant is sitting holding the head in the boyce position, his left forearm on his left thigh his left foot on a stool whose top is cm. lower than the table-top. his left hand is on the patient's sterile-covered scalp, the thumb on the forehead, the fingers under the occiput, making forced extension. the right forearm passes under the neck of the patient, so that the index finger of the right hand holds the bite-block in the left corner of the patient's mouth. the fingers of the operator's right hand pulls the upper lip out of all danger of getting pinched between the teeth and the laryngoscope. this is a precaution of the utmost importance and the trained habit of doing it must be developed by the peroral endoscopist.] _position for bronchoscopy and esophagoscopy_.--the dorsally recumbent patient is so placed that the head and shoulders extend beyond the table, the edge of which supports the thorax at about the level of the scapulae. during introduction, the head must be maintained in the same relative position to the table as that described for direct laryngoscopy, that is, elevated and extended. the first assistant, in this case, sits on a stool to the right of the patient's head, his left foot resting on a box about inches in height, the left knee supporting the assistant's left hand, which being placed under the occiput of the patient maintains elevation and extension. the right arm of the assistant passes under the neck of the patient, the bite block being carried on the middle finger of the right hand and inserted into the left side of the patient's mouth. the right hand also prevents rotation of the head (fig. ). as the bronchoscope or esophagoscope is further inserted, the head must be placed so that the tube corresponds to the axis of the lumen of the passage to be examined. if the left bronchus is being explored, the head must be brought strongly to the right. if the right middle lobe bronchus is being searched, the head would require some left lateral deflection and a considerable degree of lowering, for this bronchus, as before mentioned, extends anteriorly. during esophagoscopy when the level of the heart is reached, the head and upper thorax must be strongly depressed below the plane of the table in order to follow the axis of the lumen of the ventrally turning esophagus; at the same time the head must be brought somewhat to the right, since the esophagus in this region deviates strongly to the left. [fig. .--position of patient and assistant for introduction of the bronchoscope and esophagoscope. the middle of the scapulae rest on the edge of the table; the head and shoulders, free to move, are supported by the assistant, whose right arm passes under the neck; the right middle finger inserts the bite block into the left side of the mouth. the left hand, resting on the left knee maintains the desired degree of elevation, extension and lateral deflection required by the operator. the patient's vertex should be cm. higher than the level of the top of the table. this is the boyce position, which has never been improved upon for bronchoscopy and esophagoscopy.] [fig. .--schema of position for endoscopy. a. normal recumbency on the table with pillow supporting the head. the larynx can be directly examined in this position, but a better position is obtainable. b. head is raised to proper position with head flexed. muscles of front of neck are relaxed and exposure of larynx thus rendered easier; but, for most endoscopic work, a certain amount of extension is desired. the elevation is the important thing. c. the neck being maintained in position b, the desired amount of extension of the head is obtained by a movement limited to the occipito-atloid articulation by the assistant's hand placed as shown by the dart (b). d. faulty position. unless prevented, almost all patients will heave up the chest and arch the lumbar spine so as to defeat the object and to render endoscopy difficult by bringing the chest up to the high-held head, thus assuming the same relation of the head to the chest as exists in the rose position (a faulty one for endoscopy) as will be understood by assuming that the dotted line, e, represents the table. if the pelvis be not held down to the table the patient may even assume the opisthotonous position by supporting his weight on his heels on the table and his head on the assistant's hand.] in obtaining the position of high head with occipito-atloid extension, the easiest and most certain method, as pointed out to me by my assistant, gabriel tucker, is first to raise the head, strongly flexed, as shown in fig. ; then while maintaining it there, make the occipito-atloid extension. this has proven better than to elevate and extend in a combined simultaneous movement. if the patient would relax to limpness exposure of the larynx would be easily obtained, simply by lifting the head with the lip of the laryngoscope passed below the tip of the epiglottis (as in fig. ) and no holding of the head would be necessary. but only rarely is a patient found who can do this. this degree of relaxation is of course, present in profound general ether anesthesia, which is not to be thought of for direct laryngoscopy, except when it is used for the purpose of insertion of intratracheal insufflation anesthetic tubes. for this, of course, the patient is already to be deeply anesthetized. the muscular tension exerted by some patients in assuming and holding a faulty position is almost as much of a hindrance to peroral endoscopy as is the position itself. the tendency of the patient to heave up his chest and assume a false position simulating the opisthotonous position (fig. ) must be overcome by persuasion. this position has all the disadvantages of the rose position for endoscopy. [fig. .--the author's position for the removal of foreign bodies from the larynx or from any of the upper air or food passages. if dislodged, the intruder will not be aided by gravity to reach a deeper lodgement.] the one exception to these general positions is found in procedures for the removal of foreign bodies from the larynx. in such cases, while the same relative position of the head to the plane of the table is maintained, the whole table top is so inclined as to elevate the feet and lower the head, known as jackson's position. this semi-inversion of the patient allows the foreign body to drop into the pharynx if it should be dislodged, or slip from the forceps (fig. ). [ ] chapter vii--direct laryngoscopy _importance of mirror examination of the larynx_.--the presence of the direct laryngoscope incites spasmodic laryngeal reflexes, and the traction exerted somewhat distorts the tissues, so that accurate observations of variations in laryngeal mobility are difficult to obtain. the function of the laryngeal muscles and structures, therefore, can best be studied with the laryngeal mirror, except in infants and small children who will not tolerate the procedure of indirect laryngoscopy. a true idea of the depth of the larynx is not obtained with the mirror, and a view of the ventricles is rarely had. with the introduction of the direct laryngoscope it is found that the larynx is funnel shaped, and that the adult cords are situated about cm. below the aryepiglottic folds; the cords also assume their true shelf-like character and take on a pinkish or yellowish tinge, rather than the pearly white seen in the mirror. they are not to any extent differentiated by color from the neighboring structures. their recognition depends almost wholly on form, position and movement. accurate observation is stimulated in all pathologic cases by making colored crayon sketches, however crude, of the mirror image of the larynx. the location of a growth may be thus graphically recorded, so that at the time of operation a glance will serve to refresh the memory as to its site. it is to be constantly kept in mind, however, that in the mirror image the sides are reversed because of the facing positions of the examiner and patient. direct laryngoscopy is the only method by which the larynx of children can be seen. the procedure need require less than a minute of time, and an accurate diagnosis of the condition present, whether papilloma, foreign body, diphtheria, paralysis, etc., may be thus obtained. the posterior pharyngeal wall should be examined in all dyspneic children for the possible existence of retropharyngeal abscess. [plate ii--direct and indirect laryngeal views from author's oil-color drawings from life: , epiglottis of child as seen by direct laryngoscopy in the recumbent position. , normal larynx spasmodically closed, as is usual on first exposure without anesthesia. , same on inspiration. , supraglottic papillomata as seen on direct laryngoscopy in a child of two years. , cyst of the larynx in a child of four years, seen on direct laryngoscopy without anesthesia. , indirect view of larynx eight weeks after thyrotomy for cancer of the right cord in a man of fifty years. , same after two years. an adventitious band indistinguishable from the original one has replaced the lost cord. , condition of the larynx three years after hemilaryngectomy for epithelioma in a patient fifty-one years of age. thyrotomy revealed such extensive involvement, with an open ulceration which had reached the perichondrium, that the entire left wing of the thyroid cartilage was removed with the left arytenoid. a sufficiently wide removal was accomplished without removing any part of the esophageal wall below the level of the crico-arytenoid joint. there is no attempt on the part of nature to form an adventitious cord on the left side. the normal arytenoid drew the normal cord over, approximately to the edge of the cicatricial tissue of the operated side. the voice, at first a very hoarse whisper, eventually was fairly loud, though slightly husky and inflexible. , the pharynx seen one year after laryngectomy for endothelioma in a man aged sixty-eight years. the purple papilla; anteriorly are at the base of the tongue, and from this the mucosa slopes downward and backward smoothly into the esophagus. there are some slight folds toward the left and some of these are quite cicatricial. the epiglottis was removed at operation. the trachea was sutured to the skin and did not communicate with the pharynx. (direct view.)] _contraindications to direct laryngoscopy_.--there are no absolute contraindications to direct laryngoscopy in any case where direct laryngoscopy is really needed for diagnosis or treatment. in extremely dyspneic patients, if the operator is not confident in his ability for a prompt and sure introduction of a bronchoscope, it may be wise to do a tracheotomy first. _instructions to the patient_.--before beginning endoscopy the patient should be told that he will feel a very disagreeable pressure on his neck and that he may feel as though he were about to choke. he must be gently but positively made to understand ( ) that while the procedure is alarming, it is absolutely free from danger; ( ) that you know just how it feels; ( ) that you will not allow his breath to be shut off completely; ( ) that he can help you and himself very much by paying close attention to breathing deeply and regularly; ( ) and that he must not draw himself up rigidly as though "walking on ice," but must be easy and relaxed. _direct laryngoscopy. adult patient_.--before starting, every detail in regard to instrumental equipment and operating room assistants, (including an assistant to hold the arms and legs of the patient) must be complete. preparation of the patient and the technic of local anesthesia have been discussed in their respective chapters. the dorsally recumbent patient is draped with (not pinned in) a sterile sheet. the head, covered by sterile towels, is elevated, and slight extension is made at the occipitoatloid joint by the left hand of the first assistant. the bite block placed on the assistant's right thumb is inserted into the left angle of the patient's open mouth (see fig. ). the laryngoscope must always and invariably be held in the left hand, and in such a manner that the greatest amount of traction is made at the swell of the horizontal bar of the handle, rather than on the vertical bar. the right hand is then free for the manipulation of forceps, and the insertion of the bronchoscope or other instrument. during introduction, the fingers of the right hand retract the upper lip so as to prevent its being pinched between the laryngoscope and the teeth. the introduction of the direct laryngoscope and exposure of the larynx is best described in two stages. . exposure and identification of the epiglottis. . elevation of the epiglottis and all the tissues attached to the hyoid bone, so as to expose the larynx to direct view. _first stage_.--the spatular end of the laryngoscope is introduced in the right side of the patient's mouth, along the right side of the anterior two-thirds of the tongue. it was the german method to introduce the laryngoscope over the dorsum of the tongue but in order to elevate this sometimes powerful muscular organ considerable force may be required, which exercise of force may be entirely avoided by crowding the tongue over to the left. when the posterior third stage of the tongue is reached, the tip of the laryngoscope is directed toward the midline and the dorsum of the tongue is elevated by a lifting motion imparted to the laryngoscope. the epiglottis will then be seen to project into the endoscopic field, as seen in fig. . [fig. .--end of the first of direct laryngoscopy, recumbent adult patient. the epiglottis is exposed by a lifting motion of the spatular tip on the tongue anterior to the epiglottis.] _second stage_.--the spatular end of the laryngoscope should now be tipped back toward the posterior wall of the pharynx, passed posterior to the epiglottis, and advanced about cm. the larynx is now exposed by a motion that is best described as a suspension of the head and all the structures attached to the hyoid bone on the tip of the spatular end of the laryngoscope (fig. ). particular care must be taken at this stage not to pry on the upper teeth; but rather to impart a lifting motion with the tip of the speculum without depressing the proximal tubular orifice. it is to be emphasized that while some pressure is necessary in the lifting motion, great force should never be used; the art is a gentle one. the first view is apt to find the larynx in state of spasm, and affords an excellent demonstration of the fact that the larynx can he completely closed without the aid of the epiglottis. usually little more is seen than the two rounded arytenoid masses, and, anterior to them, the ventricular bands in more or less close apposition hiding the cords (fig. ). with deep general anesthesia or thorough local anesthesia the spasm may not be present. by asking the patient to take a deep breath and maintain steady breathing, or perhaps by requesting a phonatory effort, the larynx will open widely and the cords be revealed. if the anterior commissure of the larynx is not readily seen, the lifting motion and elevation of the head should be increased, and if there is still difficulty in exposing the anterior commissure the assistant holding the head should with the index finger externally on the neck depress the thyroid cartilage. if by this technic the larynx fails to be revealed the endoscopist should ask himself which of the following rules he has violated. [fig. .--schema illustrating the technic of direct laryngoscopy on the recumbent patient. the motion is imparted to the tip of the laryngoscope as if to lift the patient by his hyoid hone. the portion of the table indicated by the dotted line may be dropped or not, but the back of the head must never go lower than here shown, for direct laryngoscopy; and it is better to have it at least cm. above the level of the table. the table may be used as a rest for the operator's left elbow to take the weight of the head. (note that in bronchoscopy and esophagoscopy the head section of the table must be dropped, so as to leave the head and neck of the patient out in the air, supported by the second assistant.)] [fig. .--endoscopic view at the end of the second stage of direct laryngoscopy. recumbent patient. larynx exposed waiting for larynx to relax its spasmodic contraction.] rules for direct laryngoscopy . the laryngoscope must always be held in the left hand, never in the right. . the operator's right index finger (never the left) should be used to retract the patient's upper lip so that there is no danger of pinching the lip between the instrument and the teeth. . the patient's head must always be exactly in the middle line, not rotated to the right or left, nor bent over sidewise; and the entire head must be forward with extension at the occipitoatloid joint only. . the laryngoscope is inserted to the right side of the anterior two-thirds of the tongue, the tip of the spatula being directed toward the midline when the posterior third of the tongue is reached. . the epiglottis must always be identified before any attempt is made to expose the larynx. . when first inserting the laryngoscope to find the epiglottis, great care should be taken not to insert too deeply lest the epiglottis be overridden and thus hidden. . after identification of the epiglottis, too deep insertion of the laryngoscope must be carefully avoided lest the spatula be inserted back of the arytenoids into the hypo-pharynx. . exposure of the larynx is accomplished by pulling forward the epiglottis and the tissues attached to the hyoid bone, and not by prying these tissues forward with the upper teeth as a fulcrum. . care must be taken to avoid mistaking the ary-epiglottic fold for the epiglottis itself. (most likely to occur as the result of rotation of the patient's head.) . the tube should not be retained too long in place, but should be removed and the patient permitted to swallow the accumulated saliva, which, if the laryngoscope is too long in place, will trickle down the trachea and cause cough. (swallowing is almost impossible while the laryngoscope is in position.) the secretions may be removed with the aspirator. . the patient must be instructed to breathe deeply and quietly without making a sound. [ ] _difficulties of direct laryngoscopy_.--the larynx can be directly exposed in any patient whose mouth can be opened, although the ease varies greatly with the type of patient. failure to expose the epiglottis is usually due to too great haste to enter the speculum all the way down. the spatula should glide slowly along the posterior third of the tongue until it reaches the glossoepiglottic fossa, while at the same time the tongue is lifted; when this is done the epiglottis will stand out in strong relief. the beginner is apt to insert the speculum too far and expose the hypopharynx rather than the larynx. the elusiveness of the epiglottis and its tendency to retreat downward are very much accentuated in patients who have worn a tracheotomic cannula; and if still wearing it, the patient can wait indefinitely before opening his glottis. over extension of the patient's head is a frequent cause of difficulty. if the head is held high enough extension is not necessary, and the less the extension the less muscular tension there is in the anterior cervical muscles. only one arytenoid eminence may be seen. the right and the left look different. practice will facilitate identification, so that the endoscopist will at once know which way to look for the glottis. of the difficulties that pertain to the operator himself the greatest is lack of practice. he must learn to recognize the landmarks even though a high degree of spasm be present. the epiglottis and the two rounded eminences corresponding to the arytenoids must be in the mind's eye, for it is only on deep, relaxed inspiration that anything like a typical picture of the larynx will be seen. he must know also the right from the left arytenoid when only one is seen in order to know whether to move the lip of the laryngoscope to the right or the left for exposure of the interior of the larynx. _instruments for direct laryngoscopy_.--in undertaking direct laryngoscopy one must always be prepared for bronchoscopy, esophagoscopy, and tracheotomy, as well. preparations for bronchoscopy are necessary because the pathological condition may not be found in the larynx, and further search of the trachea or bronchi may be required. a foreign body in the larynx may be aspirated to a deeper location and could only be followed with the bronchoscope. sudden respiratory arrest might occur, from pathology or foreign body, necessitating the inserting of the bronchoscope for breathing purposes, and the insufflation of oxygen and amyl nitrite. trachectomy might be required for dyspnea or other reasons. it might be necessary to explore the esophagus for conditions associated with laryngeal lesions, as for instance a foreign body in the esophagus causing dyspnea by pressure. in short, when planning for direct laryngoscopy, bronchoscopy, or esophagoscopy, prepare for all three, and for tracheotomy. a properly done direct laryngoscopy would never precipitate a tracheotomy in an unanesthetized patient; but direct laryngoscopy has to deal so frequently with laryngeal stenosis, that routine preparation for tracheotomy a hundred unnecessary times is fully compensated for by the certainty of preparedness when the rare but urgent occasion arises. _direct laryngoscopy in children_.--the epiglottis in children is usually strongly curled, often omega shaped, and is very elusive and slippery. the larynx of a child is very freely movable in the neck during respiration and deglutition, and has a strong tendency to retreat downward during examination, and thus withdraw the epiglottis after the arytenoids have been exposed. in following down with the laryngoscope the speculum is prone to enter the hypopharynx. lifting in this location will expose the mouth of the esophagus and shut off the larynx, and may cause respiratory arrest. practice, however, will soon develop a technic and ability to recognize the landmarks in state of spasm, so that on exposing the approximated arytenoid eminences the endoscopist will maintain his position and wait for the larynx to open. the procedure should be done without any form of anesthesia for the following reasons: . anesthesia is unnecessary. . it is extremely dangerous in a dyspneic patient. . it is inadmissable in a patient with diphtheria. . if anesthesia is to be used, direct laryngoscopy will never reach its full degree of usefulness, because anesthesia makes a major procedure out of a minor one. . cocain in children is dangerous, and its application more annoying than the examination. _inducing a child to open its mouth (author's method)_.--the wounding of the child's mouth, gums, and lips, in the often inefficacious methods with gags, hemostats, raspatories, etcetera, are entirely unnecessary. the mouth of any child not unconscious can be opened quickly and without the slightest harm by passing a curved probe between the clenched jaws back of the molars and down back of the tongue toward the laryngopharynx. this will cause the child to gag, when its mouth invariably opens. [ ] chapter viii--direct laryngoscopy (_continued_) _technic of laryngeal operations_.--preparation of the patient and anesthesia have been mentioned under their respective chapters. the prime essential of successful laryngeal operations is perfect mastery of continuous left-handed laryngeal exposure. the right hand must be equally trained in the manipulation of forceps, and the right eye to gauge depth. blood and secretions are best removed by a suction tube (fig. ) inserted through the laryngoscope, or directly into the pharynx outside the laryngoscope. _for the removal of benign growths_ the author's papilloma forceps, fig. , or the laryngeal grasping forceps shown in fig. will prove more satisfactory than any form of cutting forceps. these growths should be removed superficially flush with the normal structure. the crushing of the base incident to the plucking off of the growth causes its recession. by this conservative method damage to the cords and impairment of the voice are avoided. for growths in the anterior portion of the larynx, and in fact for the removal of most small benign growths, the anterior commissure laryngoscope is especially adapted. its shape allows its introduction into the vestibule of the larynx, and if desired it may be introduced through the glottic chink for the treatment of subglottic conditions. it will not infrequently be observed that a pedunculated subglottic growth which is found with difficulty will be pulled upward into view by the gauze swab introduced to remove secretions. the growth is then often held tightly between the approximated cords for a few seconds--perhaps long enough to grasp it with forceps. [ ] _removal of growth from the laryngeal ventricle_.--after exposing the larynx in the usual manner, if the head is turned strongly to the right, the tip of the laryngoscope, directed from the right side of the mouth, may be used to lift the left ventricular hand and thus expose the ventricle, from which a growth may be removed in the usual manner (fig. ). the right ventricle is exposed by working from the left side of the mouth. [fig. .-schema illustrating the lateral method of exposing a growth in the ventricle of morgagni, by bending the patient's head to the opposite side, while the second assistant externally fixes the larynx with his hand. m, patient's mouth; t, thyroid cartilage; r, right side; l, left. v, b, ventricular band. c, c, vocal cord. the circular drawing indicates the endoscopic view obtainable by this method. the tube, e, is dropped to the corner of the mouth, b, and the tube is inserted down to r. the lip of the spatula can then be used to lift the ventricular band so as to expose more of the ventricle. the drawing shows an unusually shallow ventricle.] _taking a laryngeal specimen for diagnosis_.--the diagnosis of carcinoma, sarcoma, and some other conditions can be made certain only by microscopic study of tissue removed from the growth. the specimen should be ample but will necessarily be small. if the suspected growth be small it should be removed entire, together with some of the basal tissues. if it is a large growth, and there are objections to its entire removal, the edge of the growth, including apparently normal as well as neoplastic tissue, is necessary. if it is a diffuse infiltrative process, a specimen should be taken from at least two locations. tissue for biopsy is to be taken with the punch forceps shown in fig. or that in fig. . the forceps may be inserted through the tube or from the angle of the mouth; the "extubal" method (see fig. ). [fig. .--schema illustrating removal of a tumor from the upper part of the larynx by the author's "extubal" method for large tumors. the large alligator basket punch forceps, f, is inserted from the right corner of the mouth and the jaws are placed over the tumor, t, under guidance of the eye looking through the laryngoscope, l. this method is not used for small tumors. it is excellent for amputation of the epiglottis with these same punch forceps or with the heavy snare.] _removal of large benign tumors above the cords_ may be done with the snare or with the large laryngeal punch forceps. both are used in the extubal method. _amputation of the epiglottis_ for palliation of odynophagia or dysphagia in tuberculous or malignant disease, is of benefit when the ulceration is confined to this region; though as to tuberculosis the author feels rather conservatingly inclined. early malignancy of the extreme tip can be cured by such means. the function of the epiglottis seems to be to split the food bolus and direct its portions laterally into the pyriform sinuses, rather than to take any important part in the closure of the larynx. following the removal of the epiglottis there is rarely complaint of food entering the larynx. the projecting portion of the epiglottis may be amputated with a heavy snare, or by means of the large laryngeal punch forceps (fig. ). _endoscopic operations for laryngeal stenosis_.--web formations may be excised with sliding punch forceps, or if the web is due to contraction only, incision of the true band may allow its retraction. in some instances liberation of adhesions will favor the formation of adventitious vocal cords. a sharp anterior commissure is a large factor in good phonation. _endoscopic evisceration of the larynx_ will cure a few cases of laryngeal cicatricial stenosis, and should be tried before resorting to laryngostomy. a sliding punch forceps is used to remove all the tissue in the larynx out to the perichondrium, but care should be taken in cicatricial cases to avoid removing any part of either arytenoid cartilage. in cases of posticus paralysis the excision may include portions of the vocal processes of the arytenoids. ventriculocordectomy is preferable to evisceration. the ventricular floor is removed with punch forceps (fig. ) first on one side, then after two months, on the other. _vocal results_.--a whispering voice can always be had as long as air can pass through the larynx, and this may be developed to a very loud penetrating stage whisper. if the arytenoid motility has been uninjured the repeated pulls on the scar tissue may draw out adventitious bands and develop a loud, useful, though perhaps rough and inflexible voice. _galvano-cauterization_ is the best method of treatment for chronic subglottic edema or hyperplasia such as is seen in children following diphtheria, when the stenosis produced prevents extubation or decannulation. the utmost caution should be used to avoid deep cauterizations; they are almost certain to set up perichondritis which will increase the stenosis. some of the most difficult cases that have come to the author have been previously cauterized too deeply. _galvano-cautery puncture_ of tuberculous infiltrations of the larynx at times yields excellent results in cases with mild pulmonary lesions, and has quite replaced the use of the curette, lactic acid, and other caustics. the direct method of exposing the larynx renders the application of the cautery point easy and accurate. in severely stenosed tuberculous larynges a tracheotomy should first be done, for though the reaction is slight it might be sufficient to close a narrowed glottis. the technic is the usual one for laryngeal operations. local anesthesia suffices. the larynx is exposed. the rheostat having been previously adjusted to heat the electrode to nearly white heat, the circuit is broken and the electrode introduced cold. when the point is in contact with the desired location the current is turned on and the point thrust in as deeply as desired. usually it should penetrate until a firm resistance is felt; but care must be used not to damage the cricoarytenoid joint. the circuit is broken at the instant of withdrawal. punctures should be made as nearly as possible perpendicular to the surface, so as to minimize the destruction of epithelium and thus lessen the reaction. a minute gray fibrous slough detaches itself in a few days. cautery puncture should be repeated every two or three weeks, selecting a new location each time, until the desired result is obtained. great caution, as mentioned above, must be used to avoid setting up perichondritis. many cases of laryngeal tuberculosis will recover as quickly by silence and a general antituberculous regime. _radium_, in form of capsules or of needles inserted in the tissues may be applied with great accuracy; but the author is strongly impressed with pyriform sinus applications by the freer method. _after-care of endolaryngeal operations_ includes careful cleansing of the teeth and mouth; and if the extrinsic area of the larynx is involved in the wound, sterile liquid food and water should be given for four days. the patient should be watched for complications by a special nurse who is familiar with the signs of laryngeal dyspnea (q.v.). _complications during endolaryngeal operations_ are rare. dyspnea may require tracheotomy. idiosyncrasy to cocain, or the sight or taste of blood may nauseate the patient and cause syncope. serious hemorrhage could occur only in a hemophile. the careless handling of a bite block might damage a frail tool or dental fixture. _complications after endolaryngeal operations_ are unusual. carelessness in asepsis has been known to cause cervical cellulitis. emphysema of the neck has occurred. edema of the larynx occasionally occurs, and might necessitate tracheotomy. serious bleeding after operation is very rare except in bleeders. hemorrhage within the larynx can be stopped by the introduction of a roll of gauze from above, tracheotomy having been previously performed. morphin subcutaneously administered, has a constricting action on the vessels which renders it of value in controlling hemorrhage. [ ] chapter ix--introduction of the bronchoscope no one should do bronchoscopy until he is able to expose the glottis by left-handed direct laryngoscopy in less than one minute. when he has mastered this, one minute more should be sufficient to introduce the bronchoscope into the trachea. technic of bronchoscopy local anesthesia is usually employed in the adult. the patient is placed in the boyce position shown in fig. , with head and shoulders projecting over the edge of the table and supported by an assistant. the glottis is exposed by left-handed laryngoscopy. the instrument-assistant now inserts the distal end of the bronchoscope into the lumen of the laryngoscope, the handle being directed to the right in a horizontal position. the operator now grasps the bronchoscope, his eye is transferred from the laryngoscope to the bronchoscope, and the bronchoscope is advanced and so directed that a good view of the glottis is obtained. the slanted end of the bronchoscope should then be directed to the left, so as clearly to expose the left cord. in this position it will be found that the tip of the slanted end is in the center of the glottic chink and will slip readily into the trachea. no great force should be used, because if the bronchoscope does not go through readily, either the tube is too large a size or it is not correctly placed (fig. ). normally, however, there is some slight resistance, which in cases of subglottic laryngitis may be considerable. the trained laryngologist will readily determine by sense of touch the degree of pressure necessary to overcome it. when the bronchoscope has been inserted to about the second or third tracheal ring, the heavy laryngoscope is removed by rotating the handle to the left, removing the slide, and withdrawing the instrument. care must be taken that the bronchoscope is not withdrawn or coughed out during the removal of the laryngoscope; this can be avoided by allowing the ocular end to rest against the gown-covered chest of the operator. if preferred the operator may train his instrumental assistant to take off the laryngoscope, while the operator devotes his attention to preventing the withdrawal of the bronchoscope by holding the handle with his right hand. at the moment of insertion of the bronchoscope through the glottis, an especially strong upward lift on the beak of the spatula will facilitate the passage. it is necessary to be certain that the axis of the bronchoscope corresponds to the axis of the trachea, in order to avoid injury to the subglottic tissue which might be followed by subglottic edema (fig. ). if the subglottic region is already edematous and causes resistance, slight rotation to the laryngoscope, and bronchoscope will cause the bronchoscope to enter more easily. [fig. .--insufflation anesthesia with elsberg apparatus. anesthetist has exposed the larynx and is about to introduce the silk-woven catheter. note the full extension of the head on the table.] [fig. .--schema illustrating the introduction of the bronchoscope through the glottis, recumbent patient. the handle, h, is always horizontally to the right. when the glottis is first seen through the tube it should be centrally located as at k. at the next inspiration the end b, is moved horizontally to the left as shown by the dart, m, until the glottis shows at the right edge of the field, c. this means that the point of the lip, b, is at the median line, and it is then quickly (not violently) pushed through into the trachea. at this same moment or the instant before, the hyoid bone is given a quick additional lift with the tip of the laryngoscope.] [fig. .--schema illustrating oral bronchoscopy. the portion of the table here shown under the head is, in actual work, dropped all the way down perpendicularly. it appears in these drawings as a dotted line to emphasize the fact that the head must be above the level of the table during introduction of the bronchoscope into the trachea. a, exposure of larynx; b, bronchoscope introduced; c, slide removed; d, laryngoscope removed leaving bronchoscope alone in position.] _difficulties in the introduction of the bronchoscope_.--the beginner may enter the esophagus instead of the trachea: this might be a dangerous accident in a dyspneic case, for the tube could, by pressure on the trachea, cause respiratory arrest. a bronchoscope thus misplaced should be resterilized before introducing it into the air passages, for while the lower air passages are usually free from bacteria, the esophagus is a septic canal. if the given technic is carefully carried out the bronchoscope will not be contaminated with mouth secretions. the trachea is recognized as an open tube, with whitish rings, and the expiratory blast can be felt and tubular breathing heard; while if by mistake the bronchoscope has entered the gullet it will be observed that the cervical esophagus has collapsed walls. a puff of air may be felt and a fluttering sound heard when the tube is in the esophagus, but these lack the intensity of the tracheal blast. usually a free flow of secretion is met with in the esophagus. in diseased states the tracheal rings may not be visible because of swollen mucosa, or the trachea itself may be in partial collapse from external pressure. the true expiratory blast will, however, always be recognized when the tube is in the trachea. wide gagging of the mouth renders exposure of the larynx difficult. [fig. .--insertion of the bronchoscope. note direction of the trachea as indicated by the bronchoscope. note that the patient's head is held above the level of the table. the assistant's left hand should be at the patient's mouth holding the bite-block. this is removed and the assistant is on the wrong side of the table in the illustration in order not to hide the position of the operator's hands. note the handle of the bronchoscope is to the right.] [fig. .--the heavy laryngoscope has been removed leaving the light bronchoscope in position. the operator is inserting forceps. note how the left hand of the operator holds the tube lightly between the thumb and first two fingers of the left hand, while the last two fingers are hooked over the upper teeth of the patient "anchoring" the tube to prevent it moving in or out or otherwise changing the relation of the distal tube-mouth to a foreign body or a growth while forceps are being used. thus, also, any desired location of the tube can be maintained in systematic exploration. the assistant's left hand is dropped out of the way to show the operator's method. the assistant during bronchoscopy holds the bite-block like a thimble on the index finger of the left hand, and the assistant should be on the right side of the patient. he is here put wrongly on the left side so as not to hide the instruments and the manner of holding them.] _examination of the trachea and bronchi_.--all bronchial orifices must be identified _seriatim_; because this is the only way by which the bronchoscopist can know what part of the tree he is examining. appearances alone are not enough. it is the order in which they are exposed that enables the inexperienced operator to know the orifices. after the removal of the laryngoscope, the bronchoscope is to be held by the left hand like a billiard cue, the terminal phalanges of the left middle and ring fingers hooking over the upper teeth, while the thumb and index finger hold the bronchoscope, clamping it to the teeth tightly or loosely as required (fig. ). thus the tube may be anchored in any position, or at any depth, and the right hand which was directing the tube may be used for the manipulation of instruments. the grasp of the bronchoscope in the right hand should be similar to that of holding a pen, that is, the thumb, first, and second fingers, encircle the shaft of the tube. the bronchoscope should never be held by the handle (fig. ) for this grasp does not allow of tactile sense transmission, is rigid, awkward, and renders rotation of the tube a wrist motion instead of but a gentle finger action. any secretion in the trachea is to be removed by sponge pumping before the bronchoscope is advanced. the inspection of the walls of the trachea is accomplished by weaving from side to side and, if necessary, up and down; the head being deflected as required during the search of the passages, so that the larynx be not made the fulcrum in the lever-like action. [fig. .--at a is shown an incorrect manner of holding the bronchoscope. the grasp is too rigid and the position of the hand is awkward. b, correct manner, the collar being held lightly between the finger and the thumb the thumb must not occlude the tube mouth.] _the fulcrum of the bronchoscopic lever is at the upper thoracic aperture; never at the larynx_.--disregard of this rule will cause subglottic edema and will limit the lateral motion of the tip of the bronchoscope. it is the function of the assistant to make the head and neck follow the direction of the proximal end of the bronchoscope and thus avoid any pressure on the larynx (see peroral endoscopy, fig. , p. ). in passing down the trachea the following two rules must be kept in mind: . before attempting to enter either main bronchus the carina must be identified. . before entering either main bronchus the orifices of both should be identified and inspected. _the carina_ is identified as a sharp vertical spur (recumbent patient) at the distal end of the trachea, on either side of which are the openings of the main bronchi. as the carina is situated to the left of the midline of the trachea, the lip of the bronchoscope should be turned toward the left, and slight lateral pressure should be made on the left tracheal wall while the head of the patient is held slightly to the right. this will expose the left bronchial orifice and carina. _entering the bronchi_.--the lip of the bronchoscope should be turned in the direction of the bronchus to be explored, and the axis of the bronchoscope should be made to correspond as nearly as possible to the axis of this bronchus. the position of the lip is designated by the direction taken by the handle. upon entering the right bronchus, the handle of the bronchoscope is turned horizontally to the right, and at the same time the assistant deflects the head to the left. _the right upper-lobe bronchus_ is recognized by its vertical spur; the orifice is exposed by displacing the right lateral wall of the right main bronchus at the level of the carina. usually this orifice will be thus brought into view. if not the bronchoscope may be advanced downward or cm., carefully to avoid overriding. this branch is sometimes found coming off the trachea itself, and even if it does not, the overriding of the orifice is certain if the right bronchus is entered before search is made for the upper-lobe-bronchial orifice. the head must be moved strongly to the left in order to view the orifice. a lumen image of the right upper-lobe bronchus is not obtainable because of the sharp angles at which it is given off. _the left upper-lobe bronchus_ is entered by keeping the handle of the bronchoscope (and consequently the lip) to the left, and, by keeping the head of the patient strongly to the right as the bronchoscopist goes down the left main bronchus. this causes the lip of the bronchoscope to bear strongly on the left wall of the left main bronchus, consequently the left upper-lobe-bronchial orifice will not be overridden. the spur separating the upper-lobe-bronchial orifice from the stem bronchus is at an angle approximately from two to eight o'clock, as usually seen in the recumbent patient. a lumen image of a descending branch of the upper-lobe bronchus is often obtained, if the patient's head be borne strongly enough to the right. [fig. .--schema illustrating the entering of the anteriorly branching middle lobe bronchus. t, trachea; b, orifice of left main bronchus at bifurcation of trachea. the bronchoscope, s, is in the right main bronchus, pointing in the direction of the right inferior lobe bronchus, i. in order to cause the lip to enter the middle lobe bronchus, m, it is necessary to drop the head so that the bronchoscope in the trachea tt, will point properly to enable the lip of the tube mouth to enter the middle lobe bronchus, as it is seen to have done at ml.] branches of the stem bronchus in either lung are exposed, or their respective lumina presented, by manipulation of the lip of the bronchoscope, with movement of the head in the required direction. posterior branches require the head quite high. a large one in the left stem just below the left upper-lobe bronchus is often invaded by foreign bodies. anterior branches require lowering the head. the _middle-lobe bronchus_ is the largest of all anterior branches. its almost horizontal spur is brought into view by directing the lip of the bronchoscope upward, and dropping the head of the patient until the lip bears strongly on the anterior wall of the right bronchus (see fig. ). [ ] chapter x--introduction of the esophagoscope the esophagoscope is to be passed only with ocular guidance, never blindly with a mandrin or obturator, as was done before the bevel-ended esophagoscope was developed. blind introduction of the esophagoscope is equally as dangerous as blind bouginage. it is almost certain to cause over-riding of foreign bodies and disease. in either condition perforation of the esophagus is possible by pushing a sharp foreign body through the normal wall or by penetrating a wall weakened by disease. landmarks must be identified as reached, in order to know the locality reached. the secretions present form sufficient lubrication for the instrument. a clear conception of the endoscopic anatomy, the narrowings, direction, and changes of direction of the axis of the esophagus, are necessary. the services of a trained assistant to place the head in the proper sequential "high-low" positions are indispensible (figs. and ). introduction may be divided into four stages. . entering the right pyriform sinus. . passing the cricopharyngeus. . passing through the thoracic esophagus. . passing through the hiatus. the patient is placed in the boyce position as described in chapter vi. as previously stated, the esophagus in its upper portion follows the curves of the cervical and dorsal spine. it is necessary, therefore, to bring the cervical spine into a straight line with the upper portion of the dorsal spine and this is accomplished by elevation of the head--the "high" position (figs. - ). [plate iii--esophagoscopic views from oil-color drawings from life, by the author: , direct view of the larynx and laryngopharynx in the dorsally recumbent patient, the epiglottis and hyoid bone being lifted with the direct laryngoscope or the esophageal speculum. the spasmodically adducted vocal cords are partially hidden by the over-hang of the spasmodically prominent ventricular hands. posterior to this the aryepiglottic folds ending posteriorly in the arytenoid eminences are seen in apposition. the esophagoscope should be passed to the right of the median line into the right pyriform sinus, represented here by the right arm of the dark crescent. , the right pyriform sinus in the dorsally recumbent patient, the eminence at the upper left border, corresponds to the edge of the cricoid cartilage. , the cricopharyngeal constriction of the esophagus in the dorsally recumbent patient, the cricoid cartilage being lifted forward with the esophageal speculum. the lower (posterior) half of the lumen is closed by the fold corresponding to the orbicular fibers of the cricopharyngeus which advances spasmodically from the posterior wall. (compare fig. .) this view is not obtained with an esophagoscope. , passing through the right pyriform sinus with the esophagoscope; dorsally recumbent patient. the walls seem in tight apposition, and, at the edges of the slit-like lumen, bulge toward the observer. the direction of the axis of the slit varies, and in some instances it is like a rosette, depending on the degree of spasm. , cervical esophagus. the lumen is not so patulent during inspiration as lower down; and it closes completely during expiration. , thoracic esophagus; dorsally recumbent patient. the ridge crossing above the lumen corresponds to the left bronchus. it is seldom so prominent as in this patient, but can always be found if searched for. , the normal esophagus at the hiatus. this is often mistaken for the cardia by esophagoscopists. it is more truly a sphincter than the cardia itself. in the author's opinion there is no truly sphincteric action at the cardia. it is the failure of this hiatal sphincter to open as in the normal deglutitory cycle that produces the syndrome called "cardiospasm." , view in the stomach with the open-tube gastroscope. the form of the folds varies continually. , sarcoma of the posterior wall of the upper third of the esophagus in a woman of thirty-one years. seen through the esophageal speculum, patient sitting. the lumen of the mouth of the esophagus, much encroached upon by the sarcomatous infiltration, is seen at the lower part of the circle. , coin (half-dollar) wedged in the upper third of the esophagus of a boy aged fourteen years. seen through the esophageal speculum, recumbent patient. forceps are retracting the posterior lip of the esophageal "mouth" preparatory to removal. , fungating squamous-celled epithelioma in a man of seventy-four years. fungations are not always present, and are often pale and edematous. , cicatricial stenosis of the esophagus due to the swallowing of lye in a boy of four years. below tile upper stricture is seen a second stricture. an ulcer surrounded by an inflammatory areola and the granulation tissue together illustrates the etiology of cicatricial tissue. the fan-shaped scar is really almost linear, but it is viewed in perspective. patient was cured by esophagoscopic dilatation. , angioma of the esophagus in a man of forty years. the patient had hemorrhoids and varicose veins of the legs. , luetic ulcer of the esophagus cm. from the upper teeth in a woman of thirty-eight years. two scars from healed ulcerations are seen in perspective on the anterior wall. branching vessels are seen in the livid areola of the ulcers. , tuberculosis of the esophagus in a man of thirty-four years. , leukoplakia of the esophagus near the hiatus in a man aged fifty-six years.] the hypopharynx tapers down to the gullet like a funnel, and the larynx is suspended in its lumen from the anterior wall. the larynx is attached only to the anterior wall, but is held closely against the posterior pharyngeal wall by the action of the inferior constrictor of the pharynx, and particularly by its specialized portion--the cricopharyngeus muscle. a bolus of food is split by the epiglottis and the two portions drifted laterally into the pyriform sinuses, the recesses seen on either side of the larynx. but little of the food bolus passes posterior to the larynx during the act of swallowing. it is through the pyriform sinus that the esophagoscope is to be inserted, thereby following the natural food passage. to insert the esophagoscope in the midline, posterior to the arytenoids, requires a degree of force dangerous to exert and almost certain to produce damage to the cricoarytenoid joint or to the pharyngeal wall, or to both. the esophagoscope is steadied by the left hand like a billiard cue, the terminal phalanges of the left middle and ring fingers hooked over the upper teeth, while the left index finger and thumb encircle the tube and retract the upper lip to prevent its being pinched between the tube and upper teeth. the right hand holds the tube in pen fashion at the collar of the handle, not by the handle. during introduction the handle is to be pointed upward toward the zenith. _stage i. entering the right pyriform sinus_.--the operator standing (as in fig. ), inserts the esophagoscope along the right side of the tongue as far as and down the posterior pharyngeal wall. a lifting motion imparted to the tip of the esophagoscope by the left thumb will bring the rounded right arytenoid eminence into view (a, fig. ). this is the landmark of the pyriform sinus, and care must be taken to avoid injury by hooking the tube mouth over it or its fellow. the tip of the tube should now be directed somewhat toward the midline, remembering the funnel shape of the hypopharynx. it will then be found to glide readily through the right pyriform sinus for or cm., when it comes to a full stop, and the lumen disappears. this is the spasmodically closed cricopharyngeal constriction. [fig. .--esophagoscopy by the author's "high-low" method. first stage. "high" position. finding the right pyriform sinus. in this and the second stage the patient's vertex is about cm. above the level of the table.] _stage . passing the cricopharyngeus_ is the most difficult part of esophagoscopy, especially if the patient is unanesthetized. local anesthesia helps little, if at all. the handle of the esophagoscope is still pointing upward and consequently we are sure that the lip of the esophagoscope is directed anteriorly. force must not be used, but steady firm pressure against the tonically contracted cricopharyngeus is made, while at the same time the distal end of the esophagoscope is lifted by the left thumb. at the first inspiration a lumen will usually appear in the upper portion of the endoscopic field. the tip of the esophagoscope enters this lumen and the slanted end slides over the fold of the cricopharyngeus into the cervical esophagus. there is usually from to cm. of this constricted lumen at the level of the cricopharyngeus and the subjacent orbicular esophageal fibers. [ ] [fig. .--schematic illustration of the author's "high-low" method of esophagoscopy. in the first and second stages the patient's head fully extended is held high so as to bring it in line with the thoracic esophagus, as shown above. the rose position is shown by way of accentuation.] [fig. .--schematic illustration of the anatomic basis for difficulty in introduction of the esophagoscope. the cricoid cartilage is pulled backward against the cervical spine, by the cricopharyngeus, so strongly that it is difficult to realize that the cricopharyngeus is not inserted into the vertebral periosteum instead of into the median raphe.] [fig. .--the upper illustration shows movements necessary for passing the cricopharyngeus. the lower illustration shows schematically the method of finding the pyriform sinus in the author's method of esophagoscopy. the large circle represents the cricoid cartilage. g, glottic chink, spasmodically closed; vb, ventricular band; a, right arytenoid eminence; p, right pyriform sinus, through which the tube is passed in the recumbent posture. the pyriform sinuses are the normal food passages.] _stage . passing through the thoracic esophagus_.--the thoracic esophagus will be seen to expand during inspiration and contract during expiration, due to the change in thoracic pressure. the esophagoscope usually glides easily through the thoracic esophagus if the patient's position is correct. after the levels of the aorta and left bronchus are passed the lumen of the esophagus seems to have a tendency to disappear anteriorly. the lumen must be kept in axial view and the head lowered as required for this purpose. _stage . passing through the hiatus esophageus_.--when the head is dropped, it must at the same time be moved horizontally to the right in order that the axis of the tube shall correspond to the axis of the lower third of the esophagus, which deviates to the left and turns anteriorly. the head and shoulders at this time will be found to be considerably below the plane of the table top (fig. ). the hiatal constriction may assume the form of a slit or rosette. if the rosette or slit cannot be promptly found, as may be the case in various degrees of diffuse dilatation, the tube mouth must be shifted farther to the left and anteriorly. when the tube mouth is centered over the hiatal constriction moderately firm pressure continued for a short time will cause it to yield. then the tube, maintaining this same direction will, without further trouble glide into and through the abdominal esophagus. the cardia will not be noticed as a constriction, but its appearance will be announced by the rolling in of reddish gastric mucosal folds, and by a gush of fluid from the stomach. [fig. .--schematic illustration of the author's "high-low" method of esophagoscopy, fourth stage. passing the hiatus. the head is dropped from the position of the st and nd stages, cl, to the position t, and at the same time the head and shoulders are moved to the right (without rotation) which gives the necessary direction for passing the hiatus.] [fig. .--esophagoscopy by the author's "high-low" method. stage . passing the hiatus the patient's vertex is about cm. below the top of the table.] _normal esophageal mucosa_ under proper illumination is glistening and of a yellowish or bluish pink. the folds are soft and velvety, rendering infiltration quickly noticeable. the cricoid cartilage shows white through the mucosa. the gastric mucosa is a darker pink than that of the esophagus and when actively secreting, its color in some cases tends toward crimson. _secretions_ in the esophagus are readily aspirated through the drainage canal by a negative pressure pump. food particles are best removed by "sponge pumping," or with forceps. should the drainage canal become obstructed positive pressure from the pump will clear the canal. _difficulties of esophagoscopy_.--the beginner may find the esophagoscope seemingly rigidly fixed, so that it can be neither introduced nor withdrawn. this usually results from a wedging of the tube in the dental angle, and is overcome by a wider opening of the jaws, or perhaps by easing up of the bite block, but most often by correcting the position of the patient's head. if the beginner cannot start the tube into the pyriform sinus in an adult, it is a good plan to expose the arytenoid eminence with the laryngoscope and then to insert the mm. esophagoscope into the right pyriform sinus by direct vision. passing the cricopharyngeal and hiatal spasmodically contracted narrowings will prove the most trying part of esophagoscopy; but with the head properly held, and the tube properly placed and directed, patient waiting for relaxation of the spasm with gentle continuous pressure will usually expose the lumen ahead. in his first few esophagoscopies the novice had best use general anesthesia to avoid these difficulties and to accustom himself to the esophageal image. in the first favorable subject--an emaciated individual with no teeth--esophagoscopy without anesthesia should be tried. in cases of kyphosis it is a mistake to try to straighten the spine. the head should be held correspondingly higher at the beginning, and should be very slowly and cautiously lowered. once inserted, the esophagoscope should not be removed until the completion of the procedure, unless respiratory arrest demands it. occasionally in stenotic conditions the light may become covered by the upwelling of a flood of fluid, and it will be thought the light has gone out. as soon as the fluid has been aspirated the light will be found burning as brightly as before. if a lamp should fail it is unnecessary to remove the tube, as the light carrier and light can be withdrawn and quickly adjusted. a complete instrument equipment with proper selection of instruments for the particular case are necessary for smooth working. _ballooning esophagoscopy_.--by inserting the window plug shown in fig. the esophagus may be inflated and studied in the distended state. the folds are thus smoothed out and constrictions rendered more marked. ether anesthesia is advocated by mosher. the danger of respiratory arrest from pressure, should the patient be dyspneic, is always present unless the anesthetic be given by the intratracheal method. if necessary to use forceps the window cap is removed. if the perforated rubber diaphragm cap be substituted the esophagus can be reballooned, but work is no longer ocularly guided. the fluoroscope may be used but is so misleading as to render perforation and false passage likely. _specular esophagoscopy_.--inspection of the hypopharynx and upper esophagus is readily made with the esophageal speculum shown in fig. . high lesions and foreign bodies lodged behind the larynx are thus discovered with ease, and such a condition as a retropharyngeal abscess which has burrowed downward is much less apt to be overlooked than with the esophagoscope. high strictures of the esophagus may be exposed and treated by direct visual bouginage until the lumen is sufficiently dilated to allow the passage of the esophagoscope for bouginage of the deeper strictures. _technic of specular esophagoscopy_.--recumbent patient. boyce position. the larynx is to be exposed as in direct laryngoscopy, the right pyriform sinus identified, the tip of the speculum inserted therein, and gently insinuated to the cricopharyngeal constriction. too great extension of the head is to be avoided--even slight flexion at the occipito-atloid joint may be found useful at times. moderate anterior or upward traction pulls the cricoid away from the posterior pharyngeal wall and the lumen of the esophagus opens above a crescentic fold (the cricopharyngeus). the speculum readily slides over this fold and enters the cervical esophagus. in searching for foreign bodies in the esophagus the speculum has the disadvantage of limited length, so that should the foreign body move downward it could not be followed. _complications following esophagoscopy_.--these are to be avoided in large measure by the exercise of gentleness, care, and skill that are acquired by practice. if the instructions herein given are followed, esophagoscopy is absolutely without mortality apart from the conditions for which it is done. injury to the crico-arytenoid joint may simulate recurrent paralysis. posticus paralysis may occur from recurrent or vagal pressure by a misdirected esophagoscope. these conditions usually recover but may persist. perforation of the esophageal wall may cause death from septic mediastinitis. the pleura may be entered,--pyopneumothorax will result and demand immediate thoracotomy and gastrostomy. aneurysm of the aorta may be ruptured. patients with tuberculosis, decompensating cardiovascular lesions, or other advanced organic disease, may have serious complications precipitated by esophagoscopy. _retrograde esophagoscopy_.--the first step is to get rid of the gastric secretions. there is always fluid in the stomach, and this keeps pouring out of the tube in a steady stream. fold after fold is emptied of fluid. once the stomach is empty, the search begins for the cardial opening. the best landmark is a mark with a dermal pencil on the skin at a point corresponding to the level of the hiatus esophageus. when it is desired to do a retrograde esophagoscopy and the gastrostomy is done for this special purpose, it is wise to have it very high. once the cardia is located and the esophagus entered, the remainder of the work is very easy. bouginage can be carried out from below the same as from above and may be of advantage in some cases. strictural lumina are much more apt to be concentric as approached from below because there has been no distortion by pressure dilatation due to stagnation of the food operating through a long period of time. at retrograde esophagoscopy there seems to be no abdominal esophagus and no cardia. the esophagoscope encounters only the diaphragmatic pinchcock which seems to be at the top of the stomach like the puckering string at the top of a bag. retrograde esophagoscopy is sometimes useful for "stringing" the esophagus in cases in which the patient is unable to swallow a string because he is too young or because of an epithelial scaling over of the upper entrance of the stricture. in such cases the smallest size of the author's filiform bougies (fig. ) is inserted through the retrograde esophagoscope (fig. ) and insinuated upward through the stricture. when the tip reaches the pharynx coughing, choking and gagging are noticed. the filiform end is brought out the mouth sufficiently far to attach a silk braided cord which is then pulled down and out of the gastrostomic opening. the braided silk "string" must be long enough so that the oral and the abdominal ends can be tied together to make it "endless;" but before doing so the oral end should be drawn through nose where it will be less annoying than in the mouth. the purpose of the "string" is to pull up the retrograde bougies (fig. ) [ ] chapter xi--acquiring skill endoscopic ability cannot be bought with the instruments. as with all mechanical procedures, facility can be obtained only by educating the eye and the fingers in repeated exercise of a particular series of maneuvers. as with learning to play a musical instrument, a fundamental knowledge of technic, positions, and landmarks is necessary, after which only continued manual practice makes for proficiency. for instance, efficient use of forceps requires that they be so familiar to the grasp that their use is automatic. endoscopy is a purely manual procedure, hence to know how is not enough: manual practice is necessary. even in the handling of the electrical equipment, practice in quickly locating trouble is as essential as theoretic knowledge. there is no mystery about electric lighting. no source of illumination other than electricity is possible for endoscopy. therefore a small amount of electrical knowledge, rendered practical by practice, is essential to maintain the simple lighting system in working order. it is an insult to the intelligence of the physician to say that he cannot master a simple problem of electric testing involving the locating of one or more of five possibilities. it is simply a matter of memorizing five tests. it is repeated for emphasis that a commercial current reduced by means of a rheostat should never be used as a source of current for endoscopy with any kind of instrument, because of the danger to the patient of a possible "grounding" of the circuit during the extensive moist contact of a metallic endoscopic tube in the mediastinum. the battery shown in fig. should be used. the most frequent cause of trouble is the mistake of over-illuminating the lamps. _the lamp should not be over-illuminated to the dazzling whiteness usually used in flash lights_. excessive illumination alters the proper perception of the coloring of the mucosa, besides shortening the life of the lamps. the proper degree of brightness is obtained when, as the current is increased, the first change from yellow to white light is obtained. never turn up the rheostat without watching the lamp. _testing for electric defects_.--these tests should be made beforehand; not when about to commence introduction. if the first lamp lights up properly, use it with its light-carrier to test out the other cords. if the lamp lights up, but flickers, locate the trouble before attempting to do an endoscopy. if shaking the carrier cord-terminal produces flickering there may be a film of corrosion on the central contact of the light carrier that goes into the carrier cord-terminal. if the lamp fails to show a light, the trouble may be in one of five places which should be tested for in the following order and manner. . the lamp may not be firmly screwed into the light-carrier. withdraw the light-carrier and try screwing it in, though not too strongly, lest the central wire terminal in the lamp be bent over. . the light-carrier may be defective. . the cord may be defective or its terminals not tight in the binding posts. if screwing down the thumb nuts does not produce a light, test the light-carrier with lamp on the other cords. reserve cords in each pair of binding posts are for use instead of the defective cords. the two sets of cords from one pair of binding posts should not be used simultaneously. . the lamp may be defective. try another lamp. . the battery may be defective. take a cord and light-carrier with lamp that lights up, detaching the cord-terminals at the binding posts, and attach the terminals to the binding posts of the battery to be tested. _efficient use of forceps_ requires previous practice in handling of the forceps until it has become as natural and free from thought as the use of knife and fork. indeed the coordinate use of the bronchoscopic tube-mouth and the forceps very much resembles the use of knife and fork. yet only too often a practitioner will telegraph for a bronchoscope and forceps, and without any practice start in to remove an entangled or impacted foreign body from the tiny bronchi of a child. failure and mortality are almost inevitable. a few hundred hours spent in working out, on a bit of rubber tubing, the various mechanical problems given in the section on that subject will save lives and render easily successful many removals that would otherwise be impossible. it is often difficult for the beginner to judge the distance the forceps have been inserted into the tube. this difficulty is readily solved if upon inserting the forceps slowly into the tube, he observes that as the blades pass the light they become brightly illuminated. by this _light reflex_ it is known, therefore, that the forceps blades are at the tube-mouth, and distance from this point can be readily gauged. excellent practice may be had by picking up through the bronchoscope or esophagoscope black threads from a white background, then white threads from a black background, and finally white threads on a white background and black threads on a black background. this should be done first with the mm. bronchoscope. it is to be remembered that the majority of foreign body accidents occur in children, with whom small tubes must be used; therefore, practice work, after say the first hours, should be done with the mm. bronchoscope and corresponding forceps rather than adult size tubes, so that the operator will be accustomed to work through a small calibre tube when the actual case presents itself. [ ] _cadaver practice_.--the fundamental principles of peroral endoscopy are best taught on the cadaver. it is necessary that a specially prepared subject be had, in order to obtain the required degree of flexibility. injecting fluid of the following formula worked out by prof. j. parsons schaeffer for the bronchoscopic clinic courses, has proved very satisfactory: sodium carbonate-- / lbs. white arsenic-- / lbs. potassium nitrate-- lbs. water-- gal. boil until arsenic is dissolved. when cold add: carbolic acid c.c. glycerin c.c. alcohol ( %) c.c. for each body use about gal. of fluid. the method of introduction of the endoscopic tube, and its various positions can be demonstrated and repeatedly practiced on the cadaver until a perfected technic is developed in both the operator and assistant who holds the head, and the one who passes the instruments to the operator. in no other manner can the landmarks and endoscopic anatomy be studied so thoroughly and practically, and in no other way can the pupil be taught to avoid killing his patient. the danger-points in esophagoscopy are not demonstrable on the living without actually incurring mortality. laryngeal growths may be simulated, foreign body problems created and their mechanical difficulties solved and practice work with the forceps and tube perfected. _practice on the rubber-tube manikin_.--this must be carried out in two ways. . general practice with all sorts of objects for the education of the eye and the fingers. . before undertaking a foreign body case, practice should be had with a duplicate of the foreign body. it is not possible to have a cadaver for daily practice, but fortunately the eye and fingers may be trained quite as effectually by simulating foreign body conditions in a small red rubber tube and solving these mechanical problems with the bronchoscope and forceps. the tubing may be placed on the desk and held by a small vise (fig. ) so that at odd moments during the day or evening the fascinating work may be picked up and put aside without loss of time. complicated rubber manikins are of no value in the practice of introduction, and foreign body problems can be equally well studied in a piece of rubber tubing about inches long. no endoscopist has enough practice on the living subject, because the cases are too infrequent and furthermore the tube is inserted for too short a space of time. practice on the rubber tube trains the eye to recognize objects and to gauge distance; it develops the tactile sense so that a knowledge of the character of the object grasped or the nature of the tissues palpated may be acquired. before attempting the removal of a particular foreign body from a living patient, the anticipated problem should be simulated with a duplicate of the foreign body in a rubber tube. in this way the endoscopist may precede each case with a practical experience equivalent to any number of cases of precisely the same kind of foreign body. if the object cannot be removed from the rubber tube without violence, it is obvious that no attempt should be made on the patient until further practice has shown a definite method of harmless removal. during practice work the value of the beveled lip of the bronchoscope and esophagoscope in solving mechanical problems will be evidenced. with it alone, a foreign body may be turned into favorable positions for extraction, and folds can always be held out of the way. sufficient combined practice with the bronchoscope and the forceps enable the endoscopist easily to do things that at first seem impossible. it is to be remembered that lateral motion of the long slender tube-forceps cannot be controlled accurately by the handle, this is obtained by a change in position of the endoscopic tube, the object being so centered that it is grasped without side motion of the forceps. when necessary, the distal end of the forceps may be pushed laterally by the manipulation of the bronchoscope. [fig. .--a simple manikin. the weight of the small vise serves to steady the rubber tubing. by the use of tubing of the size of the invaded bronchus and a duplicate of the foreign body, any mechanical problem can he simulated for solution or for practice, study of all possible presentations, etc.] _practice on the dog_.--having mastered the technic of introduction on the cadaver and trained the eye and fingers by practice work on the rubber tube, experience should be had in the living lower air and food passages with their pulsatory, respiratory, bechic and deglutitory movements, and ever-present secretions. it is not only inhuman but impossible to obtain this experience on children. fortunately the dog offers a most ready subject and need in no way be harmed nor pained by this invaluable and life-saving practice. a small dog the size of a terrier (say to pounds in weight) should be chosen and anesthetized by the hypodermic injection of morphin sulphate in dosage of approximately one-sixth of a grain per pound of body weight, given about minutes before the time of practice. dogs stand large doses of morphin without apparent ill effect, so that repeated injection may be given in smaller dosage until the desired degree of relaxation results. the first effect is vomiting which gives an empty stomach for esophagoscopy and gastroscopy. vomiting is soon followed by relaxation and stupor. the dog is normal and hungry in a few hours. dosage must be governed in the clog as in the human being by the susceptibility to the drug and by the temperament of the animal. other forms of anesthesia have been tried in my teaching, and none has proven so safe and satisfactory. phonation may be prevented during esophagoscopy by preventing approximation of the cords, through inserting a silk-woven cathether in the trachea. the larynx and trachea may be painted with cocain solution if it is found necessary for bronchoscopy. a very comfortable and safe mouth gag is shown in fig. . great gentleness should be exercised, and no force should be used, for none is required in endoscopic work; and the endoscopist will lose much of the value of his dog practice if he fails to regard the dog as a child. he should remember he is not learning how to do endoscopy on the dog; but learning on the dog how safely to do bronchoscopy on a human being. the degree of resistance during introduction can be gauged and the color of the mucosa studied, while that interesting phenomenon, the dilatation and lengthening of the bronchi during inspiration and their contraction and shortening during expiration, is readily observed and always forms subject for thought in its possible connection with pathological conditions. foreign body problems are now to be solved under these living conditions, and it is my feeling that no one should attempt the removal of a foreign body from the bronchus of a child until he has removed at least foreign bodies from the dog without harming the animal. dogs have the faculty of easily ridding their air-passages of foreign objects, so that one need not be alarmed if a foreign body is lost during practice removal. it is to be remembered that dogs swallow very large objects with apparent ease. the dog's esophagus is relatively much larger than that of human beings. therefore a small dog (of six to eight pounds' weight) must be used for esophagoscopic practice, if practice is to be had with objects of the size usually encountered in human beings. the bronchi of a dog of this weight will be about the size of those of a child. [fig. .--author's mouth gag for use on the dog. the thumb-nut serves to prevent an uncomfortable degree of expansion of the gag. a bandage may be wound around the dog's jaws to prevent undue spread of the jaws.] _endoscopy on the human being_.--dog work offers but little practice in laryngoscopy. because of the slight angle at which the dog's head joins his spine, the larynx is in a direct line with the open mouth; hence little displacement of the anterior cervical tissues is necessary. moreover the interior of the larynx of the dog is quite different from that of the human larynx. the technic of laryngoscopy in the human subject is best perfected by a routine direct examination of the larynx of anesthetized patients after such an operation as, for instance, tonsillectomy, to see that the larynx and laryngopharynx are free of clots. to perform a bronchoscopy or esophagoscopy under these conditions would be reprehensible; but direct laryngoscopy for the seeking and removal of clots serves a useful purpose as a preventative of pulmonary abscess and similar complications.* diagnosis of laryngeal conditions in young children is possible only by direct laryngoscopy and is neglected in almost all of the cases. no anesthesia, general or local, is required. much clinical material is neglected. all cases of dyspnea or dysphagia should be studied endoscopically if the cause of the condition cannot be definitely found and treated by other means. invaluable practice in esophagoscopy is found in the treatment of strictures of the esophagus by weekly or biweekly esophagoscopic bouginage. * dr. william frederick moore, of the bronchoscopic clinic, has recently collected statistics of cases of post-tonsillectomic pulmonary abscess that point strongly to aspiration of infected clots and other infective materials as the most frequent etiologic mechanism (moore, w. f., pulmonary abscess. journ. am. med. assn., april , , vol. , pp. - ). in acquiring skill as an endoscopist the following paraphrased aphorisms afford food for thought. aphorisms educate your eye and your fingers. be sure you are right, but not too sure. follow your judgment, never your impulse. cry over spilled milk enough to memorize how you spilled it. let your mistakes worry you enough to prevent repetition. let your left hand know what your right hand does and how to do it. nature helps, but she is no more interested in the survival of your patient than in the survival of the attacking pathogenic bacteria. [ ] chapter xii--foreign bodies in the air and food passages the air and food passages may be invaded by any foreign substance of solid, liquid or gaseous nature, from the animal, vegetable, or mineral kingdoms. its origin may be from within the body (blood, pus, secretion, broncholiths, sequestra, worms); introduced from without by way of the natural passages (aspirated or swallowed objects); or it may enter by penetration (bullet, dart, drainage tube from the neck). _prophylaxis_.--if one put into his mouth nothing but food, foreign body accidents would be rare. the habit of holding tacks, pins and whatnot in the mouth is quite universal and deplorable. children are prone to follow the bad example of their elders. no small objects such as safety pins, buttons, and coins should be left within a baby's reach; children should be watched and taught not to place things in their mouths. mothers should be specially cautioned not to give nuts or nut candy of any kind to a child whose powers of mastication are imperfect, because the molar teeth are not erupted. it might be made a dictum that: "no child under years of age should be allowed to eat nuts, unless ground finely as in peanut butter." digital efforts at removal of foreign bodies frequently force the object downward, or may hook it forward into the larynx, whereas if not meddled with digitally the intruder might be spat out. before general anesthesia the mouth should be searched for loose teeth, removable dentures, etc., and all unconscious individuals should be likewise examined. when working in the mouth precautions should be taken against the possible inhalation or swallowing of loose objects or instruments. [ ] objects that have lodged in the esophagus, larynx, trachea, or bronchi should be endoscopically removed. _foreign bodies in the insane_.--foreign bodies may be introduced voluntarily and in great numbers by the insane. hysterical individuals may assert the presence of a foreign body, or may even volitionally swallow or aspirate objects. it is a mistake to do a bronchoscopy in order to cure by suggestion the delusion of foreign body presence. such "cures" are ephemeral. _foreign bodies in the stomach_.--gastroscopy is indicated in cases of a foreign body that refuses to pass after a month or two. foreign bodies in very large numbers in the stomach, as in the insane, may be removed by gastrostomy. _the symptomatology of foreign bodies_ may be epitomized as given below; but it must be kept in mind, that certain symptoms may not be manifest immediately after intrusion, and others may persist for a time after the passage, removal, or expulsion of a foreign body. esophageal foreign body symptoms . there are no absolutely diagnostic symptoms. . dysphagia, however, is the most constant complaint, varying with the size of the foreign body, and the degree of inflammatory or spasmodic reaction produced. . pain may be caused by penetration of a sharp foreign body, by inflammation secondary thereto, by impaction of a large object, or by spasmodic closure of the hiatus esophageus. . the subjective sensation of foreign body is usually present, but cannot be relied upon as assuring the presence of a foreign body for this sensation often remains for a time after the passage onward of the intruder. . all of these symptoms may exist, often in the most intense degree, as the result of previous violent attempts at removal; and the foreign body may or may not be present. symptoms of laryngeal foreign body . initial laryngeal spasm followed by wheezing respiration, croupy cough, and varying degrees of impairment of phonation. . pain may be a symptom. if so, it is usually located in the laryngeal region, though in some cases it is referred to the ears. . the larynx may tolerate a thin, flat, foreign body for a relatively long period of time, a month or more; but the development of increasing dyspnea renders early removal imperative in the majority of cases. symptoms of tracheal and bronchial foreign body . tracheal foreign bodies are usually movable and their movements can usually be felt by the patient. . cough is usually present at once, may disappear for a time and recur, or may be continuous, and may be so violent as to induce vomiting. in recent cases fixed foreign bodies cause little cough; shifting foreign bodies cause violent coughing. . sudden shutting off of the expiratory blast and the phonation during paroxysmal cough is almost pathognomonic of a movable tracheal foreign body. . dyspnea is usually present in tracheal foreign bodies, and is due to the bulk of the foreign body plus the subglottic swelling caused by the traumatism of the shiftings of the intruder. . dyspnea is usually absent in bronchial foreign bodies. . the respiratory rate is increased only if a considerable portion of lung is out of function, by the obstruction of a main bronchus, or if inflammatory sequelae are extensive. . the asthmatoid wheeze is usually present in tracheal foreign bodies, and is often louder and of lower pitch than the asthmatoid wheeze of bronchial foreign bodies. it is heard at the open mouth, not at the chest wall; and prolonged expiration as though to rid the lungs of all residual air, may be necessary to elicit it. . pain is not a common symptom, but may occur and be accurately localized by the patient, in case of either tracheal or bronchial foreign body. early symptoms of irritating foreign body such as a peanut kernel in the bronchus . initial laryngeal spasm is almost invariably present with foreign bodies of organic nature, such as nut kernels, peas, beans, maize, etc. . a diffuse purulent laryngo-tracheo-bronchitis develops within hours in children under years. . fever, toxemia, cyanosis, dyspnea and paroxysmal cough are promptly shown. . the child is unable to cough up the thick mucilaginous pus through the swollen larynx and may "drown in its own secretions" unless the offender be removed. . "drowned lung," that is to say natural passages idled with pus and secretions, rapidly forms. . pulmonary abscess develops sooner than in case of mineral foreign bodies. . the older the child the less severe the reaction. symptoms of prolonged foreign body sojourn in the bronchus . the time of inhalation of a foreign body may be unknown or forgotten. . cough and purulent expectoration ultimately result, although there may be a delusive protracted symptomless interval. [ ] . periodic attacks of fever, with chills and sweats, and followed by increased coughing and the expulsion of a large amount of purulent, usually more or less foul material, are so nearly diagnostic of foreign body as to call for exclusion of this probability with the utmost care. . emaciation, clubbing of the fingers and toes, night sweats, hemoptysis, in fact all of the symptoms of tuberculosis are in most cases simulated with exactitude, even to the gain in weight by an out-door regime. . tubercle bacilli have never been found, in the cases at the bronchoscopic clinic, associated with foreign body in the bronchus.* in cases of prolonged sojourn this has been the only element lacking in a complete clinical picture of advanced tuberculosis. one point of difference was the almost invariably rapid recovery after removal of the foreign body. the statement in all of the text-books, that foreign body is followed by phthisis pulmonalis is a relic of the days when the bacillary origin of true tuberculosis was unknown, hence the foreign-body phthisis pulmonalis, or pseudo tuberculosis, was confused with the true pulmonary tuberculosis of bacillary origin. . the subjective sensation of pain may allow the patient accurately to localize a foreign body. . foreign bodies of metallic or organic nature may cause their peculiar taste in the sputum. . offensive odored sputum should always suggest bronchial foreign body; but absence of sputum, odorous or not, should not exclude foreign body. . sudden complete obstruction of one main bronchus does not cause noticeable dyspnea provided its fellow is functionating. [ ] . complete obstruction of a bronchus is followed by rapid onset of symptoms. . the physical signs usually show limitation of expansion on the affected side, impairment of percussion, and lessened trans-mission or absence of breath-sounds distal to the foreign body. * the exceptional case has at last been encountered. a boy with a tack in the bronchus was found to have pulmonary tuberculosis. symptoms of gastric foreign body foreign body in the stomach ordinarily produces no symptoms. the roentgenogram and the fluoroscopic study with an opaque mixture are the chief means of diagnosis. diagnosis of foreign body in the air or food passages the questions arising are: i. is a foreign body present? . where is it located? . is a peroral endoscopic procedure indicated? . are there any contraindications to endoscopy? in order to answer these questions the definite routine given below is followed unvaryingly in the bronchoscopic clinic. . history. . complete physical examination, including mirror laryngoscopy. . roentgenologic study. . endoscopy. the history should note the date of, and should delve into the details of the accident; special note being made of the occurrence of laryngeal spasm, wheezing respiration heard by the patient or others (asthmatoid wheeze), fever, cough, pain, dyspnea, dysphagia, odynphagia, regurgitation, etc. the amount, character and odor of sputum are important. increasing amounts of purulent, foul-odored, sometimes blood-tinged sputum strongly suggest prolonged bronchial foreign body sojourn. the mode of onset of the persisting symptoms, whether immediately following the supposed accident or delayed in their occurrence, is to be noted. do attacks of sudden dyspnea and cyanosis occur? what has been the previous treatment and what attempts at removal have been made? the nature of the foreign body is to be determined, and if possible a duplicate thereof obtained. _general physical examination_ should be complete including inspection of the eyes, ears, nose, pharynx, and mirror inspection of the naso-pharynx and larynx. special attention is paid to the chest for the localization of the object. in order to discover conditions rendering endoscopy unusually hazardous, all parts of the body are to be examined. aneurysm of the aorta, excessive blood pressure, serious cardiac and renal conditions, the presence of a hernia and the existence of central nervous disease, as tabes dorsalis, should be at least known before attempting any endoscopic procedure. dysphagia might result from the pressure of an unknown aneurysm, the symptoms being attributed to a foreign body, and aortic aneurysm is a definite contraindication to esophagoscopy unless there be foreign body present also. there is no absolute contraindication to the endoscopic removal of a foreign body, though many conditions may render it wise to post-pone endoscopy. laryngeal crises of tabes might, because of their sudden onset, be thought due to foreign body. physical signs in esophageal foreign body there are no constant physical signs associated with uncomplicated impaction of a foreign body in the esophagus. should perforation of the cervical esophagus occur, subcutaneous emphysema, and perhaps cellulitis, may be found; while a perforation of the thoracic region causing mediastinitis is manifested by toxemia, fever, and rapid sinking. perforation of the pleura, with the development of pyopneumothorax, is manifested by the usual signs. it is to be emphasized that blind bouginage has no place in the diagnosis of any esophageal condition. the roentgenologist will give the information we desire without danger to the patient, and with far greater accuracy. foreign bodies in the larynx laryngeally lodged foreign bodies produce a wheezing respiration, the quality of which is peculiar to the larynx and is readily localized to this organ. if swelling or the size of the foreign body be sufficient to produce dyspnea, inspiratory indrawing of the suprasternal notch, supraclavicular fossae, costal interspaces and lower sternum will be present. cyanosis is only an accompaniment of suddenly produced dyspnea; the facies will therefore usually be anxious and pale, unless the patient is seen immediately after the aspiration of the foreign body. if labored breathing has been prolonged, and exhaustion threatened, the heart's action will be irregular and weak. the foreign body can be seen with the mirror, but a roentgenograph must nevertheless be made, for the object may be of another nature than was first thought. the roentgenograph will show its position, and from this knowledge the plan of removal can be formulated. for example, a straight pin may be so placed in the larynx that only a portion of its shaft will be visible, the roentgenogram will tell where the head and point are located, and which of these will be the more readily disengaged. (see chapter on mechanical problems.) physical signs of tracheal foreign body if fixed in the trachea the only objective sign of foreign body may be a wheezing respiration, the site of which may be localized with the stethoscope, by the intensity of the sound. movable foreign bodies may produce a palpatory thrill, and the rumble and sudden stop can be heard with the stethoscope and often with the naked ear. the lungs will show equal aeration, but there may be marked dyspnea without the indrawing of the fossae, if the object be of large size and located below the manubrium. to the peculiar sound of the sudden subglottic, expiratory or bechic arrest of the foreign body the author has given the name "audible slap;" when felt by the thumb on the trachea he calls it the "palpatory thud." these signs can be produced by no condition other than the arrest of some substance by the subglottic taper. once heard and felt they are unmistakable. physical signs of bronchial foreign body in most cases there will be limitation of expansion on the invaded side, even though the foreign body is of such a shape as to cause no bronchial obstruction. it has been noted frequently in conjunction with the presence of such objects as a common straight pin in a small branch bronchus. this peculiar phenomenon was first noted by thomas mccrae in one of the author's cases and has since been abundantly corroborated by mccrae and others as one of the most constant physical signs. to understand the peculiar physical findings in these cases it is necessary to remember that the bronchi are not tubes of constant caliber; there occurs a dilatation during inspiration, and a contraction of the lumen during expiration; furthermore, the lumen may be narrowed by swollen mucosa if the foreign body be of an irritant nature. the signs vary with the degree of obstruction of the bronchus, and with the consequent degree of interference with aeration and drainage of the subjacent portion of the lung. we have three definite types which show practically constant signs in the earlier stages of foreign body invasion. . complete bronchial occlusion. . obstruction complete during expiration, but allowing the passage of air during the bronchial dilatation incident to inspiration, constituting an expiratory valve-like obstruction. . partial bronchial obstruction, allowing to-and-fro passage of air. . _complete bronchial obstruction_ is manifested by limitation of expansion, markedly impaired percussion note, particularly at the base, absence of breath-sounds, and rales on the invaded side. an atelectasis here exists; the air imprisoned in the lung is soon absorbed, and secretions rapidly accumulate. on the free side a compensatory emphysema is present. . _expiratory valve-like obstruction_.--the obstructed side shows marked limitation of expansion. percussion is of a tympanitic character. the duration of the vibrations may be shortened giving a muffled tympany. various grades and degrees of tympany may be noted. breath sounds are markedly diminished or absent. no rales are heard on the invaded side, although rales of all types may be present on the free side. in some cases it is possible to hear a short inspiratory sound. vocal resonance and fremitus are but little altered. the heart will be found displaced somewhat to the opposite side. these signs are explained by the passage of some air past the foreign body during inspiration with its trapping during expiration, so that there is air under pressure constantly maintained in the obstructed area. this type of obstruction is most frequently observed when the foreign body is of an organic nature such as nut kernels, beans, corn, seed, etc. the localized swelling about the irritating foreign body completes the expiratory obstruction. it may also be present with any foreign body whose size and shape are such as to occlude the lumen of the bronchus during its contracted expiratory phase. it was present in cases of pebbles, cylindrical metallic objects, thick tough balls of secretion etcetera. the valvular action is here produced most often by a change in the size of the valve seat and not by a movement of the foreign body plug. in other cases i have found at bronchoscopy, a regular ball-valve mechanism. pneumothorax is the only pathologic condition associated with signs similar to those of expiratory, valve-like bronchial obstruction by a foreign body. . _partial bronchial obstruction_ by an object such as a nail allows air to pass to and fro with some degree of retardation, and impairs the drainage of the subjacent lung. limitation of expansion will be found on the invaded side. the area below the foreign body will give an impaired percussion note. breath-sounds are diminished in the area of dullness, and vocal resonance and fremitus are impaired. rales are of great diagnostic import; the passage of air past the foreign body is accompanied by blowing, harsh breathing, and snoring; snapping rales are heard usually with greatest intensity posteriorly over the site of the foreign body (usually about the scapular angle). a knowledge of the topographical lung anatomy, the bronchial tree, and of endoscopic pathology* should enable the examiner of the chest to locate very accurately a bronchial foreign body by physical signs alone, for all the significant signs occur distal to the foreign body lodgment. * jackson, chevalier. pathology of foreign bodies in the air and food passages. mutter lecture, . surgery, gynecology and obstetrics, march, . also, by the same author, mechanism of the physical signs of foreign bodies in the lungs. proceedings of the college of physicians, philadelphia, . _the asthmatoid wheeze_ has been found by the author a valuable confirmatory sign of bronchial foreign body. it is a wheezing heard by placing the observer's ear at the open mouth of the patient (not at the chest wall) during a prolonged forced expiration. thomas mccrae elicits this sign by placing the stethoscope bell at the patient's open mouth. the quality of the sound is dryer than that heard in asthma and the wheeze is clearest after all secretion has been removed by coughing. the mechanism of production is, probably, the passage of air by a foreign body which narrows the lumen of a large bronchus. as the foreign body works downward the wheeze lessens. the wheeze is often so loud as to be heard at some distance from the patient. it is of greatest value in the diagnosis of non-roentgenopaque foreign body but its absence in no way negates foreign body. its presence or absence should be recorded in every case. _prolonged bronchial obstruction_ by foreign body is followed by bronchiectasis and lung abscess usually in a lower lobe. the symptoms may with exactitude simulate tuberculosis, but this disease should be readily excluded by the basal, unilateral site of the lesion, absence of tubercle bacilli in the sputum, and roentgenographic study. chest examination in the foreign body cases reveals limitation of expansion, often some retraction, flat percussion note, and greatly diminished or absent breath-sounds over the site of the pulmonary lesion. rales vary with the amount of secretion present. these physical signs suggest empyema; and rib resection had been done before admission in a number of cases only to find the pleura normal. roentgenray study in foreign body cases _roentgenography_.--all cases of chest disease should have the benefit of a roentgenologic study to exclude bronchial foreign body as an etiological factor. negative opinions should never be based upon any plates except the best that the wonderful modern development of the art and science of roentgenology can produce. in doubtful cases, the negative opinion should not be conclusive until a roentgenologist of long experience in chest work, and especially in foreign body cases, has been called in consultation. even then there will be an occasional case calling for diagnostic bronchoscopy. antero-posterior and lateral roentgenograms should always be made. in an antero-posterior film a flat foreign body lying in the lateral body plane might be invisible in the shadow of the spine, heart, and great vessels; but would be revealed in the lateral view because of the greater edgewise density of the intruder and the absence of other confusing shadows. fluoroscopic examination will often discover the best angle from which to make a plate; but foreign bodies casting a very faint shadow on a plate may be totally invisible on the fluoroscopic screen. the value of a roentgenogram after the removal of a foreign body cannot be too strongly emphasized. it is evidence of removal and will exclude the presence of a second intruder which might have been overlooked in the first study. fluoroscopic study of the swallowing function with barium mixture, or a barium-filled capsule, will give the location of a nonroentgenopaque object (such as bone, meat, etc.) in the esophagus. if a flat or disc-shaped object located in the cervical region is seen to be lying in the lateral body plane, it will be found to be in the esophagus, for it assumed that position by passing down flatwise behind the larynx. if, however, the object is seen to be in the sagittal plane it must lie in the trachea. this position was necessary for it to pass through the glottic chink, and can be maintained because of the yielding of the posterior membranous wall of the trachea. the roentgenographic signs of expiratory-valve-like bronchial obstruction the roentgenray signs in expiratory valve-like obstruction of a bronchus are those of _an acute obstructive emphysema_ (fig. ), namely, . greater transparency on the obstructed side (iglauer). . displacement of the heart to the free side (iglauer). . depression and flattening of the dome of the diaphragm on the invaded side (iglauer). . limitation of the diaphragmatic excursion on the obstructed side (manges). it is very important to note that, as discovered by manges, the differential emphysema occurs at the end of expiration and the plate must be exposed at that time, before inspiration starts. he also noted that at fluoroscopy the heart moved laterally toward the uninvaded side during expiration.* * dr. manges has developed such a high degree of skill in the fluoroscopic diagnosis of non-opaque foreign bodies by the obstructive emphysema they produce that he has located peanut kernels and other vegetable substances with absolute accuracy and unfailing certainty in dozens of cases at the bronchoscopic clinic. [fig. --expiratory valve-like bronchial obstruction by non-radiopaque foreign body, producing an acute obstructive emphysema. peanut kernel in right main bronchus. note (a) depression of right diaphragm; (b) displacement of heart and mediastinum to left; (c) greater transparency of the invaded side. ray-plate made by willis f. manges.] _complete bronchial obstruction_ shows a density over the whole area the aeration and drainage of which has been cut off (fig. ). pulmonary abscess formation and "drowned lung" (accumulated secretion in the bronchi and bronchioli) are shown by the definite shadows produced (fig. ). [ ] dense and metallic objects will usually be readily seen in the roentgenograms and fluoroscope, but many foreign bodies are of a nature which will produce no shadow; the roentgenologist should, therefore, be prepared to interpret the pulmonary pathology, and should not dismiss the case as negative for foreign body because one is not seen. even metallic objects are in rare cases exceedingly difficult to demonstrate. [fig. .--radiograph showing pathology resulting from complete obstruction of a bronchus with atelectasis and drowned lung resulting. foot of an alarm clock in left bronchus of year old child. present days. plate made by johnston and grier.] _positive films of the tracheo-bronchial tree as an aid to localization_.--in order to localize the bronchus invaded by a small foreign body the positive film is laid over the negative of the patient showing the foreign body. the shadow of the foreign body will then show through the overlying positive film. these positive films are made in twelve sizes, and the size selected should be that corresponding to the size of the patient as shown by the roentgenograph. the dome of the diaphragm and the dome of the pleura are taken as visceral landmarks for placing the positive films which have lines indicating these levels. if the shadow of the foreign body be faint it may be strengthened by an ink mark on the uncoated side of the plate. [fig. .--partial bronchial obstruction for long period of time pathology, bronchiectasis and pulmonary abscess, produced by the presence for years of a nail in the left lung of a boy of years] _bronchial mapping_ is readily accomplished by the author's method of endobronchial insufflation of a roentgenopaque inert powder such as bismuth subnitrate or subcarbonate (fig. ). the roentgenopaque substance may be injected in a fluid mixture if preferred, but the walls are better outlined with the powder (fig. ). [fig. .--roentgenogram showing the author's method of bronchial mapping or lung-mapping by the bronchoscopic introduction of opaque substances (in this instance powdered bismuth subnitrate) into the lung of the patient. plate made by david r. bowen. (illustration, strengthened for reproduction, is from author's article in american journal of roentgenology, oct., .)] errors to avoid in suspected foreign body cases . do not reach for the foreign body with the fingers, lest the foreign body be thereby pushed into the larynx, or the larynx be thus traumatized. . do not hold up the patient by the heels, lest a tracheally lodged foreign body be dislodged and asphyxiate the patient by becoming jammed in the glottis. [ ] . do not fail to have a roentgenogram made, if possible, whether the foreign body in question is of a kind dense to the ray or not. . do not fail to search endoscopically for a foreign body in all cases of doubt. . do not pass blindly an esophageal bougie, probang, or other instrument. . do not tell the patient he has no foreign body until after roentgenray examination, physical examination, indirect examination, and endoscopy have all proven negative. summary symptomatology and diagnosis of foreign bodies in the air and food passages _initial symptoms_ are choking, gagging, coughing, and wheezing, often followed by a symptomless interval. the foreign body may be in the larynx, trachea, bronchi, nasal chambers, nasopharynx, fauces, tonsil, pharynx, hypopharynx, esophagus, stomach, intestinal canal, or may have been passed by bowel, coughed out or spat out, with or without the knowledge of the patient. initial choking, etcetera may have escaped notice, or may have been forgotten. _laryngeal foreign body_.--one or more of the following laryngeal symptoms may be present: hoarseness, croupy cough, aphonia, odynphagia, hemoptysis, wheezing, dyspnea, cyanosis, apnea, subjective sensation of foreign body. croupiness in foreign body cases, as in diphtheria, usually means subglottic swelling. obstructive foreign body may be quickly fatal by laryngeal impaction on aspiration, or on abortive bechic expulsion. lodgement of a non-obstructive foreign body may be followed by a symptomless interval. direct laryngoscopy for diagnosis is indicated in every child having laryngeal diphtheria without faucial membrane. (no anesthetic, general or local is needed.) in the presence of laryngeal symptoms, think of the following: . a foreign body in the larynx. . a foreign body loose or fixed in the trachea. . digital efforts at removal. . instrumentation. . overflow of food into the larynx from esophageal obstruction due to the foreign body. . esophagotracheal fistula from ulceration set up by a foreign body in the esophagus, followed by the leakage of food into the air-passages. . laryngeal symptoms may persist from the trauma of a foreign body that has passed on into the deeper air or food passages or that has been coughed or spat out. . laryngeal symptoms (hoarseness, croupiness, etcetera) may be due to digital or instrumental efforts at the removal of a foreign body that never was present. . laryngeal symptoms may be due to acute or chronic laryngitis, diphtheria, pertussis, infective laryngotracheitis, and many other diseases. . deductive decisions are dangerous. . if the roentgenray is negative, laryngoscopy (direct in children, indirect in adults) without anesthesia, general or local, is the only way to make a laryngeal diagnosis. . before doing a diagnostic laryngoscopy, preparation should be made for taking a swab-specimen and for bronchoscopy and esophagoscopy. _tracheal foreign body_.--( ) "audible slap," ( ) "palpatory thud," and ( ) "asthmatoid wheeze" are pathognomonic. the "tracheal flutter" has been observed by mccrae in a case of watermelon seed. cough, hoarseness, dyspnea, and cyanosis are often present. diagnosis is by roentgenray, auscultation, palpation, and bronchoscopy. listen long for "audible slap," best heard at open mouth during cough. the "asthmatoid wheeze" is heard with the ear or stethoscope bell (mccrae) at the patient's open mouth. history of initial choking, gagging, and wheezing is important if elicited, but is valueless negatively. _bronchial foreign body_.--initial symptoms are coughing, choking, asthmatoid wheeze, etc. noted above. there may be a history of these or of tooth extraction. at once, or after a symptomless interval, cough, blood-streaked sputum, metallic taste, or special odor of foreign body may be noted. non-obstructive metallic foreign bodies afford few symptoms and few signs for weeks or months. obstructive foreign bodies cause atelectasis, drowned lung, and eventually pulmonary abscess. lobar pneumonia is an exceedingly rare sequel. vegetable organic foreign bodies as peanut-kernels, beans, watermelon seeds, etcetera, cause at once violent laryngotracheobronchitis, with toxemia, cough and irregular fever, the gravity and severity being inversely to the age of the child. bones, animal shells and inorganic bodies after months or years produce changes which cause chills, fever, sweats, emaciation, clubbed fingers, incurved nails, cough, foul expectoration, hemoptysis, in fact, all the symptoms of chronic pulmonary sepsis, abscess, and bronchiectasis. these symptoms and some of the physical signs may suggest pulmonary tuberculosis, but the apices are normal and bacilli are absent from the sputum. every acute or chronic chest case calls for the exclusion of foreign body. _the physical signs_ vary with conditions present in different cases and at different times in the same case. secretions, normal and pathologic, may shift from one location to another; the foreign body may change its position admitting more, less, or no air, or it may shift to a new location in the same lung or even in the other lung. a recently aspirated pin may produce no signs at all. the signs of diagnostic importance are chiefly those of partial or complete bronchial obstruction, though a non-obstructive foreign body, a pin for instance, may cause limited expansion (mccrae) or, rarely, a peculiar rale or a peculiar auscultatory sound. the most nearly characteristic physical signs are: ( ) limited expansion; ( ) decreased vocal fremitus; ( ) impaired percussion note; ( ) diminished intensity of the breath-sounds distal to the foreign body. complete obstruction of a bronchus followed by drowned lung adds absence of vocal resonance and vocal fremitus, thus often leading to an erroneous diagnosis of empyema. varying grades of tympany are obtained over areas of obstructive or compensatory emphysema. with complete obstruction there may be tympany from the collapsed lung for a time. rales in case of complete obstruction are usually most intense on the uninvaded side. in partial obstruction they are most often found on the invaded side distal to the foreign body, especially posteriorly, and are most intense at the site corresponding to that of the foreign body. a foreign body at the bifurcation of the trachea may give signs in both lungs. early in a foreign body case, diminished expansion of one side, with dulness, may suggest pneumonia in the affected side; but absence of, or decreased, vocal resonance, and absence of typical tubular breathing should soon exclude this diagnosis. bronchial obstruction in pneumonia is exceedingly rare. memorize these signs suggestive of foreign body: . expansion--diminished. . percussion note--impaired (except in obstructive emphysema). . vocal fremitus--diminished. . breath sounds--diminished. the foregoing is only for memorizing, and must be considered in the light of the following fundamental note by prof. mccrae "there is no one description of physical signs which covers all cases. if the student will remember that complete obstruction of a bronchus leads to a shutting off of this area, there should be little difficulty in understanding the signs present. the diagnosis of empyema may be made, but the outline of the area of dulness, the fact that there is no shifting dulness, and the greater resistance which is present in empyema nearly always clear up any difficulty promptly. the absence of the frequent change in the voice sounds, so significant in an early small empyema, is of value. a large empyema should give no difficulty. if difficulty remains the use of the needle should be sufficient. in thickened pleura vocal fremitus is not entirely absent, and the breath-sounds can usually be heard, even if diminished. in case of partial obstruction of a bronchus, it is evident that air will still be present, hence the dulness may be only slight. the presence of air and secretion will probably result in the breath-sounds being somewhat harsh, and will cause a great variety of rales, principally coarse, and many of them bubbling. difficulty may be caused by signs in the other lung or in a lobe other than the one affected by the foreign body. if it is remembered that these signs are likely to be only on auscultation, and to consist largely in the presence of rales, while the signs in the area supplied by the affected bronchus will include those on inspection, palpation, and percussion, there should be little difficulty." _the roentgenray_ is the most valuable diagnostic means; but careful notation of physical signs by an expert should be made in all cases preferably without knowledge of ray findings. expert ray work will show all metallic foreign bodies and many of less density, such as teeth, bones, shells, buttons, etcetera. if the ray is negative, a diagnostic bronchoscopy should be done in all cases of unexplained bronchial obstruction. peanut kernels and watermelon seeds and, rarely, other foreign bodies in the bronchi produce obstructive emphysema of the invaded side. fluoroscopy shows the diaphragm flattened, depressed and of less excursion on the invaded side; at the end of expiration, the heart and the mediastinal wall move over toward the uninvaded side and the invaded lung becomes less dense than the uninvaded lung, from the trapping of the air by the expiratory, valve-like effect of obliteration of the "forceps spaces" that during inspiration afford air ingress between the foreign body and the swollen bronchial wall. this partial obstruction causes obstructive emphysema, which must be distinguished from compensatory emphysema, in which the ballooning is in the unobstructed lung, because its fellow is wholly out of function through complete "corking" of the main bronchus of the invaded side. _esophageal foreign body_.--after initial choking and gagging, or without these, there may be a subjective sense of a foreign body, constant or, more often, on swallowing. odynphagia and dysphagia or aphagia may or may not be present. pain, sub-sternal or extending to the back is sometimes present. hematemesis and fever may occur from the foreign body or from rough instrumentation. symptoms referable to the air-passages may be present due to: ( ) overflow of the secretions on attempts to swallow through the obstructed esophagus; ( ) erosion of the foreign body through from the esophagus into the trachea; or ( ) trauma inflicted on the larynx during attempts at removal, digital or instrumental, the foreign body still being present or not. diagnosis is by the roentgenray, first without, then, if necessary, with a capsule filled with an opaque mixture. flat objects, like coins, always lie with their greatest diameter in the coronal plane of the body, when in the esophagus; in the sagittal plane, when in the trachea or larynx. lateral, anteroposterior, and sometimes also quartering roentgenograms are necessary. one taken laterally, low down on the neck but clear of the shoulder, will often show a bone or other semiopaque object invisible in the anteroposterior exposure. [ ] chapter xiii--foreign bodies in the larynx and tracheobronchial tree the protective reflexes preventing the entrance of foreign bodies into the lower air passages are: ( ) the laryngeal closing reflex and ( ) the bechic reflex. laryngeal closing for normal swallowing consists chiefly in the tilting and the closure of the upper laryngeal orifice. the ventricular bands help but slightly; and the epiglottis and the vocal cords little, if at all. the gauntlet to be run by foreign bodies entering the tracheobronchial tree is composed of: . epiglottis. . upper laryngeal orifice. . ventricular bands. . vocal cords. . bechic blast. the epiglottis acts somewhat as a fender. the superior laryngeal aperture, composed of a pair of movable ridges of tissue, has almost a sphincteric action, in addition to a tilting movement. the ventricular bands can approximate under powerful stimuli. the vocal cords act similarly. the one defect in the efficiency of this barrier, is the tendency to take a deep inspiration preparatory to the cough excited by the contact of a foreign body. _site of lodgment_.--the majority of foreign bodies in the air passages occur in children. the right bronchus is more frequently invaded than the left because of the following factors: i. its greater diameter. . its lesser angle of deviation from the tracheal axis. . the situation of the carina to the left of the mid-line of the trachea. . the action of the trachealis muscle. . the greater volume of air going into the right bronchus on inspiration. the middle lobe bronchus is rarely invaded by foreign body, and, fortunately, in less than one per cent of the cases is the object in an upper lobe bronchus. _spontaneous expulsion of foreign bodies from the air passages_. a large, light, foreign body in the larynx or trachea may occasionally be coughed out, but the frequent newspaper accounts of the sudden death of children known to have aspirated objects should teach us never to wait for this occurrence. the cause of death in these cases is usually the impaction of a large foreign body in the glottis producing sudden asphyxiation, and in a certain proportion of these cases the impaction has occurred on the reverse journey, when cough forced the intruder upward from below. the danger of subglottic impaction renders it imperative that attempts to aid spontaneous expulsion by inverting the patient should be discouraged. sharp objects, such as pins, are rarely coughed out. the tendency of all foreign bodies is to migrate down and out to the periphery as their size and shape will allow. most of the reported cases of bechic expulsion of bronchially lodged foreign bodies have occurred after a prolonged sojourn of the object, associated which much lung pathology; and in some cases the object has been carried out along with an accumulation of pus suddenly liberated from an abscess cavity, and expelled by cough. this is a rare sequence compared to the usual formation of fibrous stricture above the foreign body that prevents the possibility of bechic expulsion. to delay bronchoscopy with the hope of such a solution of the problem is comparable to the former dependence on nature for the cure of appendiceal abscess. we do our full duty when we tell the patient or parents that while the foreign body may be coughed up, it is very dangerous to wait; and, further, that the difficulty of removal usually increases with the time the foreign body is allowed to remain in the air passages. _mortality and morbidity of bronchoscopy_ vary directly with the degree of skill and experience of the operator, and the conditions for which the endoscopies are performed. the simple insertion of the bronchoscope is devoid of harm if carefully done. the danger lies in misdirected efforts at removal of the intruder and in repeating bronchoscopies in children at too frequent intervals, or in prolonging the procedure unduly. in children under one year endoscopy should be limited to twenty minutes, and should not be repeated sooner than one week after, unless urgently indicated. a child of years will bear to minutes work, while the adult offers no unvarying time limit. more can be ultimately accomplished, and less reaction will follow short endoscopies repeated at proper intervals than in one long procedure. _indications for bronchoscopy for suspected foreign body_ may be thus summarized: . the appearance of a suspicious shadow in the radiograph, in the line of a bronchus. . in any case in which lung symptoms followed a clear history of the patient having choked on a foreign body. . in any case showing signs of obstruction in the trachea or of a bronchus. . in suspected bronchiectasis. . symptoms of pulmonary tuberculosis with sputum constantly negative for tubercle bacilli. if the physical signs are at the base, particularly the right base, the indication becomes very strong even in the absence of any foreign body circumstance in the history. . in all cases of doubt, bronchoscopy should be done anyway. there is no absolute _contraindication to bronchoscopy for foreign bodies_. extreme exhaustion or reaction from previous efforts at removal may call for delay for recuperation, but pulmonary abscess and even the rarer complications, bronchopneumonia and gangrene of the lung, are improved by the early removal of the foreign body. _choice of time to do bronchoscopy for foreign body_.--the difficulties of removal usually increase from the time of aspiration of the object. it tends to work downward and outward, while the mucosa becomes edematous, partly closing over the foreign body, and even completely obliterating the lumen of smaller bronchi. later, granulation tissue and the formation of stricture further hide the object. the patient's health deteriorates with the onset of pulmonary pathology, and renders him a less favorable subject for bronchoscopy. organic foreign bodies, which produce early and intense inflammatory reaction and are liable to swell, call for prompt bronchoscopy. when a bronchus is completely obstructed by the bulk of the foreign body itself immediate removal is urgently demanded to prevent serious lung changes, resulting from atelectasis and want of drainage. in short, removal of the foreign body should be accomplished as soon as possible after its entrance. this, however, does not justify hasty, ill-planned, and poorly equipped bronchoscopy, which in most cases is doomed to failure in removal of the object. the bronchoscopist should not permit himself to be stampeded into a bronchoscopy late at night, when he is fatigued after a hard day's work. _bronchoscopic finding of a foreign body_ is not especially difficult if the aspiration has been recent. if secondary processes have developed, or the object be small and in a bronchus too small to admit the tube-mouth, considerable experience may be necessary to discover it. there is usually inflammatory reaction around the orifice of the invaded bronchus, which in a measure serves to localize the intruder. we must not forget, however, that objects may have moved to another location, and also that the irritation may have been the result of previous efforts at removal. care must be exercised not to mistake the sharp, shining, interbronchial spurs for bright thin objects like new pins just aspirated; after a few days pins become blackened. if these spurs be torn pneumothorax may ensue. if a number of small bronchi are to be searched, the bronchoscope must be brought into the line of the axis of the bronchus to be examined, and any intervening tissue gently pushed aside with the lip of the bronchoscope. blind probing for exploration is very dangerous unless carefully done. the straight forceps, introduced closed, form the best probe and are ready for grasping if the object is felt. once the bronchoscope has been introduced, it should not be withdrawn until the procedure is completed. the light carrier alone may be removed from its canal if the illumination be faulty. complications and after-effects of bronchoscopy all foreign body cases should be watched day and night by special nurses until all danger of complications is passed. complications are rare after careful work, but if they do occur, they may require immediate attention. this applies especially to the subglottic edema associated with arachidic bronchitis in children under years of age. _general reaction_.--there is usually no elevation in temperature following a short bronchoscopy for the removal of a recently lodged metallic foreign body. if, however, an inflammatory condition of the bronchi existed previous to the bronchoscopy, as for instance the intense diffuse, purulent laryngotracheobronchitis associated with the aspiration of nut kernels, or in the presence of pulmonary abscess from long retained foreign bodies, a moderate temporary rise of temperature may be expected. these cases almost always have had irregular fever before bronchoscopy. disturbance of the epithelium in the presence of pus without abscess usually permits enough absorption to elevate the temperature slightly for a few days. _surgical shock_ in its true form has never followed a carefully performed and time-limited bronchoscopy. severe fatigue resulting in deep sleep may be seen in children after prolonged work. _local reaction_ is ordinarily noted by slight laryngeal congestion causing some hoarseness and disappearing in a few days. if dyspnea occur it is usually due to ( ) drowning of the patient in his own secretions. ( ) subglottic edema. ( ) laryngeal edema. _drowning of the patient in his own secretions_.--the accumulation of secretions in the bronchi due to faulty bechic powers and seen most frequently in children, is quickly relievable by bronchoscopic sponge-pumping or aspiration through the tracheotomic wound, in cases in which the tracheotomy may be deemed necessary. in other cases, the aspirating bronchoscope with side drainage canal (fig. , e) may be used through the larynx. frequent peroral passage of the bronchoscope for this purpose is contraindicated only in case of children under years of age, because of the likelihood of provoking subglottic edema. in such cases instead of inserting a bronchoscope the aspirating tube (fig. ) should be inserted through the direct laryngoscope, or a low tracheotomy should be done. _supraglottic edema_ is rarely responsible for dyspnea except when associated with advanced nephritis. _subglottic edema_ is a complication rarely seen except in children under years of age. they have a peculiar histologic structure in this region, as is shown by logan turner. even at the predisposing age subglottic edema is a very unusual sequence to bronchoscopy if this region was previously normal. the passage of a bronchoscope through an already inflamed subglottic area is liable to be followed by a temporary increase in the swelling. if the foreign body be associated with but slight amount of secretion, the child can usually obtain sufficient air through the temporarily narrowed lumen. if, however, as in cases of arachidic bronchitis, large amounts of purulent secretion must be expelled, it will be found in certain cases that the decreased glottic lumen and impaired laryngeal motility will render tracheotomy necessary to drain the lungs and prevent drowning in the retained secretions. subglottic edema occurring in a previously normal larynx may result from: . the use of over-sized tubes. . prolonged bronchoscopy. . faulty position of the patient, the axis of the tube not being in that of the trachea. . trauma from undue force or improper direction in the insertion of the bronchoscope. . the manipulation of instruments. . trauma inflicted in the extraction of the foreign body. _diagnosis_ must be made without waiting for cyanosis which may never appear. pallor, restlessness, startled awakening after a few minutes sleep, occurring in a child with croupy cough, indrawing around the clavicles, in the intercostal spaces, at the suprasternal notch and at the epigastrium, call for tracheotomy which should always be low. such a case should not be left unwatched. the child will become exhausted in its fight for air and will give up and die. the respiratory rate naturally increases because of air hunger, accumulating secretions that cannot be expelled because of impaired glottic motility give signs wrongly interpreted as pneumonia. many children whose lives could have been saved by tracheotomy have died under this erroneous diagnosis. _treatment_.--intubation is not so safe because the secretions cannot easily be expelled through the tube and postintubational stenosis may be produced. low tracheotomy, the tracheal incision always below the second ring, is the safest and best method of treatment. [ ] chapter xiv--removal of foreign bodies from the larynx _symptoms and diagnosis_.--the history of a sudden choking attack followed by impairment of voice, wheezing, and more or less dyspnea can be usually elicited. laryngeal diphtheria is the condition most frequently thought of when these symptoms are present, and antitoxin is rightly given while waiting for a positive diagnosis. extreme dyspnea may render tracheotomy urgently demanded before any attempts at diagnosis are made. further consideration of the symptomatology and diagnosis of laryngeal foreign body will be found on pages , and . _preliminary examination_.--in the adult, mirror examination of the larynx should be done, the patient being placed in the recumbent position. whenever time permits roentgenograms, lateral and anteroposterior, should be made, the lateral one as low in the neck as possible. one might think this an unnecessary procedure because of the visibility of the larynx in the mirror; but a child's larynx cannot usually be indirectly examined, and even in the adult a pin may be so situated that neither head nor point is visible, only a portion of the shaft being seen. the roentgenogram will give accurate information as to the position, and will thus allow a planning of the best method for removal of the foreign body. a bone in the larynx usually is visible in a good roentgenogram. accurate diagnosis in children is made by direct laryngoscopy without anesthesia, but direct laryngoscopy should not be done until one is prepared to remove a foreign body if found, to follow it into the bronchus and remove it if it should be dislodged and aspirated, and to do tracheotomy if sudden respiratory arrest occur. [ ] _technic of removal of foreign bodies from the larynx_.--the patient is to be placed in the author's position, shown in fig. . no general anesthesia should be given, and the application of local anesthesia is usually unnecessary and further, is liable to dislodge and push down the foreign body.* because of the risk of loss downward it is best to seize the foreign body as soon as seen; then to determine how best to disimpact it. the fundamental principles are that a pointed object must either have its point protected by the forceps grasp or be brought out point trailing, and that a flat object must be so rotated that its plane corresponds to the sagittal plane of the glottic chink. the laryngeal grasping forceps (fig. ) will be found the most useful, although the alligator rotation forceps (fig. ) may occasionally be required. * in adolescents or adults a few drops of a per cent solution of cocain applied to the laryngopharynx with an atomizer or a dropper will afford the minimum risk of dislodgement; but the author's personal preference is for no anesthesia, general or local. [ ] chapter xv--mechanical problems of bronchoscopic foreign body extraction* * for more extensive consideration of mechanical problems than is here possible the reader is referred to the bibliography, page , especially reference numbers , , and . the endoscopic extraction of a foreign body is a mechanical problem pure and simple, and must be studied from this viewpoint. hasty, ill-equipped, ill-planned, or violent endoscopy on the erroneous principle that if not immediately removed the foreign body will be fatal, is never justifiable. while the lodgement of an organic foreign body (such as a nut kernel) in the bronchus calls for prompt removal and might be included under the list of emergency operations, time is always available for complete preparation, for thorough study of the patient, and localization of the intruder. the patient is better off with the foreign body in the lung than if in its removal a mediastinitis, rupture into the pleura, or tearing of a thoracic blood vessel has resulted. the motto of the endoscopist should be "i will do no harm." if no harm be inflicted, any number of bronchoscopies can be done at suitable intervals, and eventually success will be achieved, whereas if mortality results, all opportunity ceases. the first step in the solution of the mechanical problem is the study of the roentgenograms made in at least three planes; ( ) anteroposterior, ( ) lateral, and ( ) the plane corresponding to the greatest plane of the foreign body. the next step is to put a duplicate of the foreign body into the rubber-tube manikin previously referred to, and try to simulate the probable position shown by the ray, so as to get an idea of the bronchoscopic appearance of the probable presentation. then the duplicate foreign body is turned into as many different positions as possible, so as to educate the eye to assist in the comprehension of the largest possible number of presentations that may be encountered at the bronchoscopy on the patient. for each of these presentations a method of disimpaction, disengagement, disentanglement or version and seizure is worked out, according to the kind of foreign body. prepared by this practice and the radiographic study, the bronchoscope is introduced into the patient. the location of the foreign body is approached slowly and carefully to avoid overriding or displacement. a _study of the presentation_ is as necessary for the bronchoscopist as for the obstetrician. it should be made with a view to determining the following points: . the relation of the presenting part to the surrounding tissues. . the probable position of the unseen portion, as determined by the appearance of the presenting part taken in connection with the knowledge obtained by the previous ray study, and by inspection of the ray plate upside down on view in front of the bronchoscopist. . the version or other manipulation necessary to convert an unfavorable into a favorable presentation for grasping and disengagement. . the best instruments to use, and which to use first, as, hook, pincloser, forceps, etc. . the presence and position of the "forceps spaces" of which there must be two for all ordinary forceps, one for each jaw, or the "insertion space" for any other instrument. until all of these points are determined it is a grave error to insert any kind of instrument. if possible even swabbing of the foreign body should be avoided by swabbing out the bronchus, when necessary, before the region of the intruder is reached. when the operator has determined the instrument to be used, and the method of using it, the instrument is cautiously inserted, under guidance of the eye. [ ] _the lip of the bronchoscope_ is one of the most valuable aids in the solution of foreign-body problems. with it partial or complete version of an object can be accomplished so as to convert an unfavorable presentation into one favorable for grasping with the forceps; edematous mucosa may be displaced, angles straightened and space made at the side of the foreign body for the forceps' jaw. it forms a shield or protector that can be slipped under the point of a sharp foreign body and can make counterpressure on the tissues while the forceps are disembedding the point of the foreign body. with the bronchoscopic lip and the forceps or other instrument inserted through the tube, the bronchoscopist has bimanual, eye-guided control, which if it has been sufficiently practiced to afford the facility in coordinate use common to everyone with knife and fork, will accomplish maneuvers that seem marvelous to anyone who has not developed facility in this coordinate use of the bronchoscopic instruments. _the relation of the tube mouth and foreign body_ is of vital importance. generally considered, the tube mouth should be as near the foreign body as possible, and the object must be placed in the center of the bronchoscopic field, so that the ends of the open jaws of the forceps will pass sufficiently far over the object. but little lateral control is had of the long instruments inserted through the tube; sidewise motion is obtained by a shifting of the end of the bronchoscope. when the foreign body has been centered in the bronchoscopic field and placed in a position favorable for grasping, it is important that this position be maintained by anchoring the tube to the upper teeth with the left, third, and fourth fingers hooked over the patient's upper alveolus (fig. ) _the light reflex on the forceps_.--it is often difficult for the beginner to judge to what depth an instrument has been inserted through the tube. on slowly inserting a forceps through the tube, as the blades come opposite the distal light they will appear brightly illuminated; or should the blades lie close to the light bulb, a shadow will be seen in the previously brilliantly lighted opposite wall. it is then known that the forceps are at the tube mouth, and the endoscopist has but to gauge the distance from this to the foreign body. this assistance in gauging depth is one of the great advances in foreign body bronchoscopy obtained by the development of distal illumination. _hooks_ are useful in the solution of various mechanical problems, and may be turned by the operator himself into various shapes by heating small probe-pointed steel rods in a spirit lamp, the proximal end being turned over at a right angle for a controlling handle. hooks with a greater curve than a right angle are prone to engage in small orifices from which they are with difficulty removed. a right angle curve of the distal end is usually sufficient, and a corkscrew spiral is often advantageous, rendering removal easy by a reversal of the twisting motion (bib. , p. ). _the use of forceps in endoscopic foreign body extraction_.--two different strengths of forceps are supplied, as will be seen in the list in chapter . the regular forceps have a powerful grasp and are used on dense foreign bodies which require considerable pressure on the object to prevent the forceps from slipping off. for more delicate manipulation, and particularly for friable foreign bodies, the lighter forceps are used. spring-opposed forceps render any delicacy of touch impossible. forceps are to be held in the right hand, the thumb in one ring, and the third, or ring finger, in the other ring. these fingers are used to open and close the forceps, while all traction is to be made by the right index finger, which has its position on the forceps handle near the stylet, as shown in fig. . it is absolutely essential for accurate work, that the forceps jaws be seen to close upon the foreign body. the impulse to seize the object as soon as it is discovered must be strongly resisted. a careful study of its size, shape, and position and relation to surrounding structures must be made before any attempt at extraction. the most favorable point and position for grasping having been obtained, the closed forceps are inserted through the bronchoscope, the light reflex obtained, the forceps blades now opened are turned in such a position that, on advancing, the foreign body will enter the open v, a sufficient distance to afford a good grasp. the blades are then closed and the foreign body is drawn against the tube mouth. few foreign bodies are sufficiently small to allow withdrawal through the tube, so that tube, forceps and foreign body are usually withdrawn together. [fig. .--proper hold of forceps. the right thumb and third fingers are inserted into the rings while the right index finger has its place high on the handle. all traction is made with the index finger, the ring fingers being used only to open and close the forceps. if any pushing is deemed safe it may be done by placing the index finger back of the thumb-nut on the stylet.] _anchoring the foreign body against the tube mouth_.--if withdrawal be made a bimanual procedure it is almost certain that the foreign body will trail a centimeter or more beyond the tube mouth, and that the closure of the glottic chink as soon as the distal end of the bronchoscope emerges will strip the foreign body from the forceps grasp, when the foreign body reaches the cords. this is avoided by anchoring the foreign body against the tube mouth as soon as the foreign body is grasped, as shown in fig. . the left index finger and thumb grasp the shaft of the forceps close to the ocular end of the tube, while the other fingers encircle the tube; closure of the forceps is maintained by the fingers of the right hand, while all traction for withdrawal is made with the left hand, which firmly clamps forceps and bronchoscope as one piece. thus the three units are brought out as one; the bronchoscope keeping the cords apart until the foreign body has entered the glottis. [fig. --method of anchoring the foreign body against the tube mouth after the object has been drawn firmly against the lip of the endoscopic tube the left finger and thumb grasp the forceps cannula and lock it against the ocular end of the tube, the other fingers of the left hand encircle the tube. withdrawal is then done with the left hand; the fingers of the right hand maintaining closure of the forceps.] [ ] _bringing the foreign body through the glottis_.--stripping of the foreign body from the forceps at the glottis may be due to: . not keeping the object against the tube mouth as just mentioned. . not bringing the greatest diameter of the foreign body into the sagittal plane of the glottic chink. . faulty application of the forceps on the foreign body. . mechanically imperfect forceps. should the foreign body be lost at the glottis it may, if large become impacted and threaten asphyxia. prompt insertion of the laryngoscope will usually allow removal of the object by means of the laryngeal grasping forceps. the object may be dropped or expelled into the pharynx and be swallowed. it may even be coughed into the naso-pharynx or it may be re-aspirated. in the latter event the bronchoscope is to be re-inserted and the trachea carefully searched. care must be used not to override the object. if much inflammatory reaction has occurred in the first invaded bronchus, temporarily suspending the aerating function of the corresponding lung, reaspiration of a dislodged foreign body is liable to carry it into the opposite main bronchus, by reason of the greater inspiratory volume of air entering that side. this may produce sudden death by blocking the only aerating organ. _extraction of pins, needles and similar long pointed objects_.--when searching for such objects especial care must be taken not to override them. pins are almost always found point upward, and the dictum can therefore be made, "search not for the pin, but for the point of the pin." if the point be found free, it should be worked into the lumen of the bronchoscope by manipulation with the lip of the tube. it may then be seized with the forceps and withdrawn. should the pin be grasped by the shaft, it is almost certain to turn crosswise of the tube mouth, where one pull may cause the point to perforate, enormously increasing the difficulties by transfixation, and perhaps resulting fatally (fig. ). [fig. .--schematic illustration of a serious phase of the error of hastily seizing a transfixed pin near its middle, when first seen as at m. traction with the forceps in the direction of the dart in schema b will rip open the esophagus or bronchus inflicting fatal trauma, and probably the pin will be stripped off at the glottic or the cricopharyngeal level, respectively. the point of the pin must be disembedded and gotten into the tube mouth as at a, to make forceps traction safe.] [fig. .--schema illustrating the mechanical problem of extracting a pin, a large part of whose shaft is buried in the bronchial wall, b. the pin must be pushed downward and if the orifice of the branches, c, d, are too small to admit the head of the pin some other orifice (as at a) must be found by palpation (not by violent pushing) to admit the head, so that the pin can be pushed downward permitting the point to emerge (e). the point is then manipulated into the bronchoscopic tube-mouth by means of co-ordinated movements of the bronchoscopic lip and the side-curved forceps, as shown at f.] _inward rotation method_.--when the point is found to be buried in the mucosa, the best and usually successful method is to grasp the pin as near the point as possible with the side-grasping forceps, then with a spiral motion to push the pin downward while rotating the forceps about ninety degrees. the point is thus disengaged, and the shaft of the pin is brought parallel with that of the forceps, after which the point may be drawn into the tube mouth. the lips added to the side-curved forceps by my assistant dr. gabriel tucker i now use exclusively for this inward rotation method. they are invaluable in preventing the escape of the pin during the manipulation. a hook is sometimes useful in disengaging a buried point. the method of its use is illustrated in fig. . [fig. .--mechanical problem of pin, needle, tack or nail with embedded point. if the forceps are pulled upon the pin point will be buried still deeper. the side curved forceps grasp the pin as near the point as possible then with a corkscrew motion the pin is pushed downward and rotated to the right when the pin will be found to be parallel with the shaft of the forceps and can be drawn into the tube. if the pin is prevented by its head from being pushed downward the point may be extracted by the hook as shown above the side curved forceps may be used instead of the hook for freeing the point, the author's "inward rotation" method. the very best instrument for the purpose is the forceps devised by my assistant, dr. gabriel tucker (fig. ). the lips prevent all risk of losing the pin from the grasp, and at the same time bring the long axis of the pin parallel to that of the bronchoscope.] pins are very prone to drop into the smaller bronchi and disappear completely from the ordinary field of endoscopic exploration. at other times, pins not dropping so deeply may show the point only during expiration or cough, at which times the bronchi are shortened. in such instances the invaded bronchial orifice should be clearly exposed as near the axis of its lumen as possible; the forceps are now inserted, opened, and the next emergence watched for, the point being grasped as soon as seen. _extraction of tacks, nails and large headed foreign bodies from the tracheobronchial tree_.--in cases of this sort the point presents the same difficulty and requires solution in the same manner as mentioned in the preceding paragraphs on the extraction of pins. the author's inward-rotation method when executed with the tucker forceps is ideal. the large head, however, presents a special problem because of its tendency to act as a mushroom anchor when buried in swollen mucosa or in a fibrous stenosis (fig. ). the extraction problems of tacks are illustrated in figs. , , and . nails, stick pins, and various tacks are dealt with in the same manner by the author's "inward rotation" method. _hollow metallic bodies_ presenting an opening toward the observer may be removed with a grooved expansile forceps as shown in figs and , or its edge may be grasped by the regular side-grasping forceps. the latter hold is apt to be very dangerous because of the trauma inflicted by the catching of the free edge opposite the forceps; but with care it is the best method. should the closed end be uppermost, however, it may be necessary to insert a hook beyond the object, and to coax it upward to a point where it may be turned for grasping and removal with forceps. [fig. .--"mushroom anchor" problem of the upholstery tack. if the tack has not been _in situ_ more than a few weeks the stenosis at the level of the darts is simply edematous mucosa and the tack can be pulled through with no more than slight mucosal trauma, _provided_ axis-traction only be used. if the tack has been in situ a year or more the fibrous stricture may need dilatation with the divulsor. otherwise traction may rupture the bronchial wall. the stenotic tissue in cases of a few months' sojourn maybe composed of granulations, in which case axis-traction will safely withdraw it. the point of a tack rarely projects freely into the lumen as here shown. more often it is buried in the wall.] [ ] [fig. .-schema illustrating the "mushroom anchor" problem of the brass headed upholstery tack. at a the tack is shown with the head bedded in swollen mucosa. the bronchoscopist, looking through the bronchoscope, e, considering himself lucky to have found the point of the tack, seizes it and starts to withdraw it, making traction as shown by the dart in drawing b. the head of the tack catches below a chondrial ring and rips in, tearing its way through the bronchial wall (d) causing death by mediastinal emphysema. this accident is still more likely to occur if, as often happens, the tack-head is lodged in the orifice of the upper lobe bronchus, f. but if the bronchoscopist swings the patient's head far to the opposite side and makes axis-traction, as shown at c, the head of the tack can be drawn through the swollen mucosa without anchoring itself in a cartilage. if necessary, in addition, the lip of the bronchoscope can be used to repress the angle, h, and the swollen mucosa, h. if the swollen mucosa, h, has been replaced by fibrous tissue from many months' sojourn of the tack, the stenosis may require dilatation with the divulsor.] [fig. .--problem of the upholstery tack with buried point. if pulled upon, the imminent perforation of the mediastinum, as shown at a will be completed, the bronchus will be torn and death will follow even if the tack be removed, which is of doubtful possibility. the proper method is gently to close the side curved forceps on the shank of the tack near the head, push downward as shown by the dart, in b, until the point emerges. then the forceps are rotated to bring the point of the tack away from the bronchial wall.] [ ] _removal of open safety pins from the trachea and bronchi_.-- removal of a closed safety pin presents no difficulty if it is grasped at one or the other end. a grasp in the middle produces a "toggle and ring" action which would prevent extraction. when the safety pin is _open with the point downward_ care must be exercised not to override it with the bronchoscope or to push the point through the wall. the spring or near end is to be grasped with the side-curved or the rotation forceps (figs. , and ) and pulled into the bronchoscope, thus closing the pin. an open safety pin lodged point up presents an entirely different and a very difficult problem. if traction is made without closing the pin or protecting the point severe and probably fatal trauma will be produced. the pin may be closed with the pin-closer as illustrated in fig. , and then removed with forceps. arrowsmith's pin-closer is excellent. another method (fig. ) consists in bringing the point of the safety pin into the bronchoscope, after disengaging the point with the side curved forceps, by the author's "inward rotation" method. the forceps-jaws (fig. ) devised recently by my assistant, dr. gabriel tucker, are ideal for this maneuver. as the point is now protected, the spring, seen just off the tube mouth, is best grasped with the rotation forceps, which afford the securest hold. the keeper and its shaft are outside the bronchoscope, but its rounded portion is uppermost and will glide over the tissues without trauma upon careful withdrawal of the tube and safety pin. care must be taken to rotate the pin so that it lies in the sagittal plane of the glottis with the keeper placed posteriorly, for the reason that the base of the glottic triangle is posterior, and that the posterior wall of the larynx is membranous above the cricoid cartilage, and will yield. a small safety-pin may be removed by version, the point being turned into a branch bronchial orifice. no one should think of attempting the extraction of a safety pin lodged point upward without having practiced for at least a hundred hours on the rubber tube manikin. this practice should be carried out by anyone expecting to do endoscopy, because it affords excellent education of the eye and the fingers in the endoscopic manipulation of any kind of foreign body. then, when a safety pin case is encountered, the bronchoscopist will be prepared to cope with its difficulties, and he will be able to determine which of the methods will be best suited to his personal equation in the particular case. [fig. .--schema illustrating the "upper-lobe-bronchus problem," combined with the "mushroom-anchor" problem and the author's method for their solution. the patient being recumbent, the bronchoscopist looking down the right main bronchus, m, sees the point of the tack projecting from the right upper-lobe-bronchus, a. he seizes the point with the side-curved forceps; then slides down the bronchoscope to the position shown dotted at b. next he pushes the bronchoscopic tube-mouth downward and medianward, simultaneously moving the patient's head to the right, thus swinging the bronchoscopic level on its fulcrum, and dragging the tack downward and inward out of its bed, to the position, ). traction, as shown at c, will then safely and easily withdraw the tack. a very small bronchoscope is essential. the lip of the bronchoscopic tube-mouth must be used to pry the forceps down and over, and the lip must be brought close to the tack just before the prying-pushing movement. s, right stem-bronchus.] [fig. .--one method of dealing with an open safety pin without closing it.] _removal of double pointed tacks_.--if the tack or staple be small, and lodged in a relatively large trachea a version may be done. that is, the staple may be turned over with the hook or rotation forceps and brought out with the points trailing. with a long staple in a child's trachea the best method is to "coax" the intruder along gently under ocular guidance, never making traction enough to bury the point deeply, and lifting the point with the hook whenever it shows any inclination to enter the wall. great care and dexterity are required to get the intruder through the glottis. in certain locations, one or both points may be turned into branch bronchi as illustrated in fig. , or over the carina into the opposite main bronchus. another method is to get both points into the tube-mouth. this may be favored, as demonstrated by my assistant, dr. gabriel tucker, by tilting the staple so as to get both points into the longest diameter of the tube-mouth. in some cases i have squeezed the bronchoscope in a vise to create an oval tube-mouth. in other cases i have used expanding forceps with grooved blades. [fig. .-schema illustrating podalic version of bronchially-lodged staples or double-pointed tacks. h, bronchoscope. a, swollen mucosa covering points of staple. at e the staple has been manipulated upward with bronchoscopic lip and hooks until the points are opposite the branch bronchial orifices, b, c. traction being made in the direction of the dart (f), by means of the rotation forceps, and counterpressure being made with the bronchoscopic lip on the points of the staple, the points enter the branch bronchi and permit the staple to be turned over and removed with points trailing harmlessly behind (k).] _the extraction of tightly fitting foreign bodies from the bronchi. annular edema_.--such objects as marbles, pebbles, corks, etc., are drawn deeply and with force by the inspiratory blast into the smallest bronchus they can enter. the air distal to the impacted foreign body is soon absorbed, and the negative pressure thus produced increases the impaction. a ring of edematous mucosa quickly forms and covers the presenting part of the object, leaving visible only a small surface in the center of an acute edematous stenosis. a forceps with narrow, stiff, expansive-spring jaws may press back a portion of the edema and may allow a grasp on the sides of the foreign body; but usually the attempt to apply forceps when there are no spaces between the presenting part of the foreign body and the bronchial wall, will result only in pushing the foreign body deeper.* a better method is to use the lip of the bronchoscope to press back the swollen mucosa at one point, so that a hook may be introduced below the foreign body, which then can be worked up to a wider place where forceps may be applied (fig. ). sometimes the object may even be held firmly against the tube mouth with the hook and thus extracted. for this the unslanted tube-mouth is used. * the author's new ball forceps are very successful with ball-bearing balls and marbles. [fig. .--schema illustrating the use of the lip of the bronchoscope in disimpaction of foreign bodies. a and b show an annular edema above the foreign body, f. at c the edematous mucosa is being repressed by the lip of the tube mouth, permitting insinuation of the hook, h, past one side of the foreign body, which is then withdrawn to a convenient place for application of the forceps. this repression by the lip is often used for purposes other than the insertion of hooks. the lip of the esophagoscope can be used in the same way.] _extraction of soft friable foreign bodies from the tracheobronchial tree_.--the difficulties here consist in the liability of crushing or fragmenting the object, and scattering portions into minute bronchi, as well as the problem of disimpaction from a ring of annular edema, with little or no forceps space. there is usually in these cases an abundance of purulent secretion which further hinders the work. the great danger of pushing the foreign body downward so that the swollen mucosa hides it completely from view, must always be kept in mind. extremely delicate forceps with rather broad blades are required for this work. the fenestrated "peanut" forceps are best for large pieces in the large bronchi. the operator should develop his tactile sense with forceps by repeated practice in order to acquire the skill to grasp peanut kernels sufficiently firmly to hold them during withdrawal, yet not so firmly as to crush them. nipping off an edge by not inserting the forceps far enough is also to be avoided. small fragments under mm. in diameter may be expelled with the secretions and fragments may be found on the sponges and in the secretions aspirated or removed by sponge pumping. it is, however, never justifiable deliberately to break a friable foreign body with the hope that the fragments will be expelled, for these may be aspirated into small bronchi, and cause multiple abscesses. a hook may be found useful in dealing with round, friable, foreign bodies; and in some cases the mechanical spoon or safety-pin closer may be used to advantage. the foreign body is then brought close to, but not crushed against the tube mouth. [ ] _removal of animal objects from the tracheobronchial tree_ is readily accomplished with the side-curved forceps. leeches are not uncommon intruders in european countries. small insects are usually coughed out. worms and larvae may be found. cocaine or salt solution will cause a leech to loosen its hold. _foreign bodies in the upper-lobe bronchi_ are fortunately not common. if the object is not too far out to the periphery it may be grasped by the upper-lobe-bronchus forceps (fig. ), guided by the collaboration of the fluoroscopist. these forceps are made so as to reach high into the ascending branches of the upper-lobe bronchus. full-curved coil-spring hooks will reach high, but must be used with the utmost caution, and the method of their disengagement must be practiced beforehand. _penetrating projectiles_.--foreign bodies that have penetrated the chest wall and lodged in the lung may be removed by oral bronchoscopy if the intruder is not larger than the lumen of the corresponding main bronchus (see bibliography, ) [fig. .--schematic illustration of the author's upper-lobe-bronchus forceps in position grasping a pin in an anteriorly ascending branch of the upper-lobe bronchus. t, trachea; ul, upper-lobe bronchus; lb, left bronchus; sb, stem bronchus. these forceps are made to extend around degrees.] rules for endoscopic foreign body extraction . never endoscope a foreign body case unprepared, with the idea of taking a preliminary look. . approach carefully the suspected location of a foreign body, so as not to override any portion of it. [ ] . avoid grasping a foreign body hastily as soon as seen. . the shape, size and position of a foreign body, and its relations to surrounding structures, should be studied before attempting to apply the forceps. (exception cited in rule .) . preliminary study of a foreign body should be from a distance. . as the first grasp of the forceps is the best, it should be well planned beforehand so as to seize the proper part of the intruder. . with all long foreign bodies the motto should be "search, not for the foreign body, but for its nearer end." with pins, needles, and the like, with point upward, _search always for the point_. try to see it first. . remember that a long foreign body grasped near the middle becomes, mechanically speaking, a "toggle and ring." . remember that the mortality to follow failure to remove a foreign body does not justify probably fatal violence during its removal. . _laryngeally lodged_ foreign bodies, because of the likelihood of dislodgment and loss, may be seized by any part first presented, and plan of withdrawal can be determined afterward. . for similar reasons, laryngeal cases should be dealt with only in the author's position (fig. ). . an esophagoscopy may be needed in a bronchoscopic case, or a bronchoscopy in an esophageal case. in every case both kinds of tubes should be sterile and ready before starting. it is the unexpected that happens in foreign body endoscopy. . do not pull on a foreign body unless it is properly grasped to come away readily without trauma. then do not pull hard. . do no harm, if you cannot remove the foreign body. . full-curved hooks are to be used in the bronchi with greatest caution, if used at all, lest they catch inextricably in branch bronchi. [ ] . don't force a foreign body downward. coax it back. the deeper it gets the greater your difficulties. . the watchword of the bronchoscopist should be, "if i can do no good, i will at least do no harm." _fluoroscopic bronchoscopy_ is so deceptively easy from a superficial, theoretical, point of view that it has been used unsuccessfully in cases easily handled in the regular endoscopic way with the eye at the proximal tube-mouth. in a collected series of cases by various operators the object was removed in . per cent with a mortality of . per cent. in the problem of a pin located out of the field of bronchoscopic vision, the fluoroscopist will yield invaluable aid. an extremely delicate forceps is to be inserted closed into the invaded bronchus, the grasp on the object being confirmed by the fluoroscopist. it is to be kept in mind that while the object itself may be in the grasp of the forceps, the fluoroscope will not show whether there may not be included in the forceps' grasp a bronchial spur or other tissue, the tearing of which may be fatal. therefore traction must not be sufficient to lacerate tissue. if the foreign body does not come readily it must be released, and a new grasp may then be taken. all of the cautions in faulty seizure already mentioned, apply with particular force to fluoroscopic bronchoscopy. the fluoroscope is of aid in finding foreign bodies held in abscess cavities. the fluoroscope should show both the lateral and anteroposterior planes. to accomplish this quickly, two coolidge tubes and two screens are necessary. fluoroscopic bronchoscopy, because of its high mortality and low percentage of successes, should be tried only after regular, ocularly guided, peroral bronchoscopy has failed, and only by those who have had experience in ocularly guided bronchoscopy. [ ] chapter xvi--foreign bodies in the bronchi for prolonged periods the sojourn of an inorganic foreign body in the bronchus for a year or more is followed by the development of bronchiectasis, pulmonary abscess, and fibrous changes. the symptoms of tuberculosis may all be presented, but tubercle bacilli have never been found associated with any of the many cases that have come to the bronchoscopic clinic.* the history of repeated attacks of malaise, fever, chills, and sweats lasting for a few days and terminated by the expulsion of an amount of foul pus, suggests the intermittent drainage of an abscess cavity, and special study should be made to eliminate foreign body as the cause of the condition, in all such cases, whether there is any history of a foreign body accident or not. bronchoscopy for diagnosis is to be done unless the etiology can be definitely proven by other means. in all cases of chronic chest disease foreign body should be eliminated as a matter of routine. * one exception has recently come to the clinic. _the time of aspiration of a foreign body_ may be unknown, having possibly occurred in infancy, during narcosis, or the object may even enter the lower air passages without the patient being aware of the accident, as happened with a particularly intelligent business man who unknowingly aspirated the tip of an atomizer while spraying his throat. in many other cases the accident had been forgotten. in still others, in spite of the patient's statement of a conviction that the trouble was due to a foreign body he had aspirated, the physician did not consider it worthy of sufficient consideration to warrant a roentgenray examination. it is curious to note the various opinions held in regard to the gravity of the presence of a bronchial foreign body. one patient was told by his physician that the presence of a staple in his bronchus was an impossibility, for he would not have lived five minutes after the accident. others consider the presence of a foreign body in the bronchus as comparatively harmless, in spite of the repeated reports of invalidism and fatality in the medical literature of centuries. the older authorities state that all cases of prolonged bronchial foreign body sojourn died from phthisis pulmonalis, and it is still the opinion of some practitioners that the presence of a foreign body in the lung predisposes to the development of true tuberculosis. with the dissemination of knowledge regarding the possibility of bronchial foreign body, and the marvellous success in their removal by bronchoscopy, the cases of prolonged foreign body sojourn should decrease in number. it should be the recognized rule, and not the exception, that all chest conditions, acute or chronic, should have the benefit of roentgenographic study, even apart from the possibility of foreign body. often even with the clear history of foreign-body aspiration, both patient and physician are deluded by a relatively long period of quiescence in which no symptoms are apparent. this symptomless interval is followed sooner or later by ever increasing cough and expectoration of sputum, finally by bronchiectasis and pulmonary abscess, chronic sepsis, and invalidism. _pathology_.--if the foreign body completely obstructs a main bronchus, preventing both aeration and drainage, such rapid destruction of lung tissue follows that extensive pathologic changes may result in a few months, or even in a few weeks, in the case of irritating foreign bodies such as peanut kernels and soft rubber. very minute, inorganic foreign bodies may become encysted as in anthracosis. large objects, however, do not become encysted. the object is drawn down by gravity and aspirated into the smallest bronchus it can enter. later the negative pressure below from absorption of air impacts it still further. swelling of the bronchial mucosa from irritation plus infection completes the occlusion of the bronchus. retention of secretions and bacterial decomposition thereof produces first a "drowned lung" (natural passages full of pus); then sloughing or ulceration in the tissues plus the pressure of the pus, causes bronchiectasis; further destruction of the cartilaginous rings results in true abscess formation below the foreign body. the productive inflammation at the site of lodgement of the foreign body results in cicatricial contraction and the formation of a stricture at the top of the cavity, in which the foreign body is usually held. the abscess may extend to the periphery and rupture into the pleural cavity. it may drain intermittently into a bronchus. certain irritating foreign bodies, such as soft rubber, may produce gangrenous bronchitis and multiple abscesses. for observations on pathology (see bibliography, ). _prognosis_.--if the foreign body be not removed, the resulting chronic sepsis or pulmonary hemorrhage will prove fatal. removal of the foreign body usually results in complete recovery without further local treatment. occasionally, secondary dilatation of a bronchial stricture may be required. all cases will need, besides removal of the foreign body, an antituberculous regimen, and offer a good prognosis if this be followed. _treatment_.--bronchoscopy should be done in all cases of chronic pulmonary abscess and bronchiectasis even though radiographic study reveals no shadow of foreign body. the patient by assuming a posture with the head lowered is urged to expel spontaneously all the pus possible, before the bronchoscopy. the aspirating bronchoscope (fig. , e) is often useful in cases where large amounts of secretion may be anticipated. granulations may require removal with forceps and sponging. disturbed granulations result in bleeding which further hampers the operation; therefore, they should not be touched until ready to apply the forceps, unless it is impossible to study the presentation without disturbing them. for this reason secretions hiding a foreign body should be removed with the aspirating tube (fig. ) rather than by swabbing or sponge-pumping, when the bronchoscopic tube-mouth is close to the foreign body. it is inadvisable, however, to insert a forceps into a mass of granulations to grope blindly for a foreign body, with no knowledge of the presentation, the forceps spaces, or the location of branch-bronchial orifices into which one blade of the forceps may go. dilatation of a stricture may be necessary, and may be accomplished by the forms of bronchial dilators shown in fig. . the hollow type of dilator is to be used in cases in which the foreign body is held in the stricture (fig. ). this dilator may be pushed down over the stem of such an object as a tack, and the stricture dilated without the risk of pushing the object downward. it is only rarely, however, that the point of a tack is free. dense cicatricial tissue may require incision or excision. _internal bronchotomy_ is doubtless, a very dangerous procedure, though no fatalities have occurred in any of the three cases in the bronchoscopic clinic. it is advisable only as a last resort. [ ] chapter xvii--unsuccessful bronchoscopy for foreign bodies the limitations of bronchoscopic removal of foreign bodies are usually manifested in the failure to find a small foreign body which has entered a minute bronchus far down and out toward the periphery. when localization by means of transparent films, fluoroscopy, and endobronchial bismuth insufflation has failed, the question arises as to the advisability of endoscopic excision of the tissue intervening between the foreign body and bronchoscope with the aid of two fluoroscopes, one for the lateral and the other the vertical plane. with foreign bodies in the larger bronchi near the root of the lung such a procedure is unnecessary, and injury to a large vessel would be almost certain. at the extreme periphery of the lung the danger is less, for the vessels are smaller and serious hemorrhage less probable, through the retention and decomposition of blood in small bronchi with later abscess formation is a contingency. the nature of the bridge of tissue is to be considered; should it be cicatricial, the result of prolonged inflammatory processes, it may be carefully excised without very great risk of serious complications. the blood vessels are diminished in size and number by the chronic productive inflammation, which more than offsets their lessened contractility. the possibility of the foreign body being coughed out after suppurative processes have loosened its impaction is too remote; and the lesions established may result fatally even after the expulsion of the object. pulmonary abscess formation and rupture into the pleura should not be awaited, for the foreign body does not often follow the pus into the pleural cavity. it remains in the lung, held in a bed of granulation tissue. furthermore, to await the development is to subject the patient to a prolonged and perhaps fatal sepsis, or a fatal pulmonary hemorrhage from the erosion of a vessel by the suppurative process. the recent developments in thoracic surgery have greatly decreased the operative mortality of thoracotomy, so that this operation is to be considered when bronchoscopy has failed. bronchoscopy can be considered as having failed, for the time being, when two or more expert bronchoscopists on repeated search have been unable to find the foreign body or to disentangle it; but the art of bronchoscopy is developing so rapidly that the failures of a few years ago would be easy successes today. before considering thoracotomy months of study of the mechanical problem are advisable. it is probable that any foreign body of appreciable size that has gone down the natural passages can be brought back the same way. in the event of a foreign body reaching the pleura, either with or without pus, it should be removed immediately by pleuroscopy or by thoracotomy, without waiting for adhesive pleuritis. the problem may be summarized thus: . large foreign bodies in the trachea or large bronchi can always be removed by bronchoscopy. . the development of bronchoscopy having subsequently solved the problems presented by previous failures, it seems probable that by patient developmental endeavor, any foreign body of appreciable size that has gone down through the natural passages, can be bronchoscopically removed the same way, provided fatal trauma is avoided. at the author's bronchoscopic clinics . per cent of foreign bodies have been removed. chapter xviii--foreign bodies in the esophagus _etiology_.--the lodgement of foreign bodies in the esophagus is influenced by: . the shape of the foreign body (disc-shaped, pointed, irregular). . resiliency of the object (safety pins). . the size of the foreign body. . narrowing of the esophagus, spasmodic or organic, normal, or pathologic. . paralysis of the normal esophageal propulsory mechanism. the lodgement of a bolus of ordinary food in the esophagus is strongly suggestive of a preexisting narrowing of the lumen of either a spasmodic or organic nature; a large bolus of food, poorly masticated and hurriedly swallowed, may, however, become impacted in a perfectly normal esophagus. carelessness is the cause of over per cent of the foreign bodies in the esophagus (see bibliography, ). _site of lodgement_.--almost all foreign bodies are arrested in the cervical esophagus at the level of the superior aperture of the thorax. a physiologic narrowing is present at this level, produced in part by muscular contraction, and mainly by the crowding of the adjacent viscera into the fixed and narrow upper thoracic aperture. if dislodged from this position the foreign body usually passes downward to be arrested at the next narrowing or to pass into the stomach. the esophagoscopist who encounters the difficulty of introduction at the cricopharyngeal fold expects to find the foreign body above the fold. such, however, is almost never the case. the cricopharyngeus muscle functionates in starting the foreign body downward as if it were food; but the narrowing at the upper thoracic aperture arrests it because the esophageal peristaltic musculature is feeble as compared to the powerful inferior constrictor. _symptoms_.--_dysphagia_ is the most frequent complaint in cases of esophageally lodged foreign bodies. a very small object may excite sufficient spasm to cause aphagia, while a relatively large foreign body may be tolerated, after a time, so that the swallowing function may seem normal. intermittent dysphagia suggests the tilting or shifting of a foreign body in a valve-like fashion; but may be due to occlusion of the by-passages by food arrested by the foreign body. _dyspnea_ may be present if the foreign body is large enough to compress the trachea. _cough_ may be excited by reflex irritation, overflow of secretions into the larynx, or by perforation of the posterior tracheal wall, traumatic or ulcerative, allowing leakage of food or secretion into the trachea. (see chapter xii for discussion of symptomatology and diagnosis.) _prognosis_.--a foreign body lodged in the esophagus may prove quickly fatal from _hemorrhage_ due to perforation of a large vessel; from _asphyxia_ by pressure on the trachea; or from _perforation_ and _septic mediastinitis_. slower fatalities may result from suppuration extending to the trachea or bronchi with consequent edema and asphyxia. sooner or later, if not removed, the foreign body causes death. it may be tolerated for a long period of time, causing abscess, cervical cellulitis, fistulous tracts, and ultimately extreme stenosis from cicatricial contraction. perichondritis of the laryngeal or tracheal cartilages may follow, and result in laryngeal stenosis requiring tracheotomy. the damage produced by the foreign body is often much less than that caused by blind and ill-advised attempts at removal. if the foreign body becomes dislodged and moves downward, the danger of intestinal perforation is encountered. the _prognosis_, therefore, must be guarded so long as the intruder remains in the body. _treatment_.--it is a mistake to try to force a foreign body into the stomach with the stomach tube or bougie. sounding the esophagus with bougies to determine the level of the obstruction, or to palpate the nature of the foreign body, is unnecessary and dangerous. esophagoscopy should not be done without a previous roentgenographic and fluoroscopic examination of the chest and esophagus, except for urgent reasons. the level of the stenosis, and usually the nature of the foreign body, can thus be decided. blind instrumentation is dangerous, and in view of the safety and success of esophagoscopy, reprehensible. if for any reason removal should be delayed, bismuth sub-nitrate, gramme . , should be given dry on the tongue every four hours. it will adhere to the denuded surfaces. the addition of calomel, gramme . , for a few doses will increase the antiseptic action. should swallowing be painful, gramme . of orthoform or anesthesin will be helpful. emetics are inefficient and dangerous. holding the patient up by the heels is rarely, if ever, successful if the foreign body is in the esophagus. in the reported cases the intruder was probably in the pharynx. _external esophagotomy_ for the removal of foreign bodies is unjustifiable until esophagoscopy has failed in the hands of at least two skillful esophagoscopists. it has been the observation in the bronchoscopic clinic that every foreign body that has gone down through the mouth into the esophagus can be brought back the same way, unless it has already perforated the esophageal wall, in which event it is no longer a case of foreign body in the esophagus. the mortality of external esophagotomy for foreign bodies is from twenty to forty-two per cent, while that of esophagoscopy is less than two per cent, if the foreign body has not already set up a serious complication before the esophagoscopy. furthermore, external esophagotomy can be successful only with objects lodged in the cervical esophagus and, moreover, it has happened that after the esophagus has been opened, the foreign body could not be found because of dislodgement and passage downward during the relaxation of the general anesthesia. should this occur during esophagoscopy, the foreign body can be followed with the esophagoscope, and even if it is not overtaken and removed, no risk has been incurred. esophagoscopy is the one method of removal worthy of serious consideration. should it repeatedly fail in the hands of two skillful endoscopists, which will be very rarely, if ever, then external operation is to be considered in cervically lodged foreign bodies. [ ] chapter xix--esophagoscopy for foreign body _indications_.--esophagoscopy is demanded in every case in which a foreign body is known to be, or suspected of being, in the esophagus. _contraindications_.--there is no absolute contraindication to careful esophagoscopy for the removal of foreign bodies, even in the presence of aneurism, serious cardiovascular disease, hypertension or the like, although these conditions would render the procedure inadvisable. should the patient be in bad condition from previous ill-advised or blind attempts at extraction, endoscopy should be delayed until the traumatic esophagitis has subsided and the general state improved. it is rarely the foreign body itself which is producing these symptoms, and the removal of the object will not cause their immediate subsidence; while the passage of the tube through the lacerated, infected, and inflamed esophagus might further harm the patient. moreover, the foreign body will be difficult to find and to remove from the edematous and bleeding folds, and the risk of following a false passage into the mediastinum or overriding the foreign body is great. water starvation should be relieved by means of proctoclysis and hypodermoclysis before endoscopy is done. the esophagitis is best treated by placing dry on the tongue at four-hour intervals the following powder: rx. anesthesin...gramme . bismuth subnitrate...gramme . calomel, gramme . to . may be added to each powder for a few doses to increase the antiseptic effect. if the patient can swallow liquids it is best to wait one week from the time of the last attempt at removal before any endoscopy for extraction be done. this will give time for nature to repair the damage and render the removal of the object more certain and less hazardous. perforation of the esophagus by the foreign body, or by blind instrumentation, is a contraindication to esophagoscopy. it is manifested by such signs as subcutaneous emphysema, swelling of the neck, fever, irritability, increase in pulsatory and respiratory rates, and pain in the neck or chest. gaseous emphysema is present in some cases, and denotes a dangerous infection. esophagoscopy should be postponed and the treatment mentioned at the end of this chapter instituted. after the subsidence of all symptoms other than esophageal, esophagoscopy may be done safely. pleural perforation is manifested by the usual signs of pneumothorax, and will be demonstrated in the roentgenogram. esophagoscopic extraction of foreign bodies it is unwise to do an endoscopy in a foreign-body case for the sole purpose of taking a preliminary look. everything likely to be needed for extraction of the intruder should be sterile and ready at hand. furthermore, all required instruments for laryngoscopy, bronchoscopy or tracheotomy should be prepared as a matter of routine, however rarely they may be needed. sponging should be done cautiously lest the foreign body be hidden in secretions or food accumulation, and dislodged. small food masses often lodge above the foreign body and are best removed with forceps. the folds of the esophagus are to be carefully searched with the aid of the lip of the esophagoscope. if the mucosa of the esophagus is lacerated with the forceps all further work is greatly hampered by the oozing; if the laceration involve the esophageal wall the accident may be fatal: and at best the tendency of the tube-mouth to enter the laceration and create a false passage is very great. _"overriding" or failure to find a foreign body known to be present_ is explained by the collapsed walls and folds covering the object, since the esophagoscope cannot be of sufficient size to smooth out these folds, and still be of small enough diameter to pass the constricted points of the esophagus noted in the chapter on anatomy. objects are often hidden just distal to the cricopharyngeal fold, which furthermore makes a veritable chute in throwing the end of the tube forward to override the foreign body and to interpose a layer of tissue between the tube and the object, so that the contact at the side of the tube is not felt as the tube passes over the foreign body (fig. ). the chief factors in overriding an esophageal foreign body are: . the chute-like effect of the plica cricopharyngeus. . the chute-like effect of other folds. . the lurking of the foreign body in the unexplored pyriform sinus. . the use of an esophagoscope of small diameter. . the obscuration of the intruder by secretion or food debris. . the obscuration of the intruder by its penetration of the esophageal wall. . the obscuration of the intruder by inflammatory sequelae. [fig. .--illustrating the hiding of a coin by the folding downward of the plica cricopharyngeus. the muscular contraction throws the beak of the esophagoscope upward while the interposed tissue prevents the tactile appreciation of contact of the foreign body with the side of the tube after the tip has passed over the foreign body. other folds may in rare instances act similarly in hiding a foreign body from view. this overriding of a foreign body is apt to cause dangerous dyspnea by compression of the party wall.] _the esophageal speculum for the removal of foreign bodies_ is useful when the object is not more than cm. below the cricoid in a child, and cm. in the adult. the fold of the cricopharyngeus can be repressed posteriorward by the forceps which are then in position to grasp the object when it is found. the author's down-jaw forceps (fig. ) are very useful to reach down back of the cricopharyngeal fold, because of the often small posterior forceps space. the speculum has the disadvantage of not allowing deeper search should the foreign body move downward. in infants, the child's size laryngoscope may be used as an esophageal speculum. general anesthesia is not only unnecessary but dangerous, because of the dyspnea created by the endoscopic tube. local anesthesia is unnecessary as well as dangerous in children; and its application is likely to dislodge the foreign body unless used as a troche. forbes esophageal speculum is excellent. mechanical problems of esophagoscopic removal of foreign bodies the bronchoscopic problems considered in the previous chapter should be studied. _the extraction of transfixed foreign bodies_ presents much the same problem as those in the bronchi, though there is no limit here to the distance an object may be pushed down to free the point. thin, sharp foreign bodies such as bones, dentures, pins, safety-pins, etcetera, are often found to lie crosswise in the esophagus, and it is imperative that one end be disengaged and the long axis of the object be made to correspond to that of the esophagus before traction for removal is made (fig. ). should the intruder be grasped in the center and traction exerted, serious and perhaps fatal trauma might ensue. [ ] [fig. .--the problem of the horizontally transfixed foreign body in the esophagus. the point, d, had caught as the bone, a, was being swallowed. the end, e, was forced down to c, by food or by blind attempts at pushing the bone downward. the wall, f, should be laterally displaced to j, with the esophagoscope, permitting the forceps to grasp the end, m, of the bone. traction in the direction of the dart will disimpact the bone and permit it to rotate. the rotation forceps are used as at k.] [fig. .--solution of the mechanical problem of the broad foreign body having a sharp point by version. if withdrawn with plain forceps as applied at a, the point b, will rip open the esophageal wall. if grasped at c, the point, d, will rotate in the direction of f and will trail harmlessly. to permit this version the rotation forceps are used as at h. on this principle flat foreign bodies with jagged or rough parts are so turned that the potentially traumatizing parts trail during withdrawal.] the extraction of broad, flat foreign bodies having a sharp point or a rough place on part of their periphery is best accomplished by the method of rotation as shown in fig. . _extraction of open safety-pins from the esophagus_.--an open safety pin with the point down offers no particular mechanical difficulty in removal. great care must be exercised, however, that it be not overridden or pushed upon, as either accident might result in perforation of the esophagus by the pin point. the coiled spring is to be sought, and when found, seized with the rotation forceps and the pin thus drawn into the esophagoscope to effect closure. an open safety-pin lodged point upward in the esophagus is one of the most difficult and dangerous problems. a roentgenogram should always be made in the plane showing the widest spread of the pin. it is to be remembered that the endoscopist can see but one portion of the pin at a time (except in cases of very small safety-pins) and that if he grasps the part first showing, which is almost invariably the keeper, fatal trauma will surely be inflicted when traction is made. it may be best to close the safety pin with the safety-pin closer, as illustrated in fig. . for this purpose arrowsmith's closer is excellent. in other cases it may prove best to disengage the point of the pin and to bring the pointed shaft into the esophagoscope with the tucker forceps and withdraw the pin, forceps, and esophagoscope, with the keeper and its shaft sliding alongside the tube. the rounded end of the keeper lying outside the tube allows it to slip along the esophageal walls during withdrawal without inflicting trauma; however, should resistance be felt, withdrawal must immediately cease and the pin must be rotated into a different plane to release the keeper from the fold in which it has probably caught. the sense of touch will aid the sense of sight in the execution of this maneuver (fig. ). when the pin reaches the cricopharyngeal level the esophagoscope, forceps, and pin should be turned so that the keeper will be to the right, not so much because of the cricopharyngeal muscle as to escape the posteriorly protuberant cricoid cartilage. in certain cases in which it is found that the pointed shaft of a small safety pin has penetrated the esophageal wall, the pin has been successfully removed by working the keeper into the tube mouth, grasping the keeper with the rotation forceps or side-curved forceps, and pulling the whole pin into the tube by straightening it. this, however, is a dangerous method and applicable in but few cases. it is better to disengage the point by downward and inward rotation with the tucker forceps. _version of a safety pin_.--a safety pin of very small size may be turned over in a direction that will cause the point to trail. an advancing point will puncture. this is a dangerous procedure with a large safety pin. _endogastric version_.--a very useful and comparatively safe method is illustrated in figs. and . in the execution of this maneuver the pin is seized by the spring with a rotation forceps, and thus passed along with the esophagoscope into the stomach where it is rotated so that the spring is uppermost. it can then be drawn into the tube mouth so as to protect the tissues during withdrawal of the pin, forceps, and esophagoscope as one piece. only very small safety-pins can be withdrawn through the esophagoscope. _spatula-protected method_.--safety-pins in children, point upward, when lodged high in the cervical esophagus may be readily removed with the aid of the laryngoscope, or esophageal speculum. the keeper end is grasped with the alligator forceps, while the spatular tip of the laryngoscope is worked under the point. instruments and foreign body are then removed together. often the pin point will catch in the light-chamber where it is very safely lodged. if the pin be then pulled upon it will straighten out and may be withdrawn through the tube. [fig. .--endogastric version. one of the author's methods of removal of upward pointed esophageally lodged open safety-pins by passing them into stomach, where they are turned and removed. the first illustration (a) shows the rotation forceps before seizing pin by the ring of the spring end. (forceps jaws are shown opening in the wrong diameter.) at b is shown the pin seized in the ring by the points of the forceps. at c is shown the pin carried into the stomach and about to be rotated by withdrawal. d, the withdrawal of the pin into the esophagoscope which will thereby close it. if withdrawn by flat-jawed forceps as at f, the esophageal wall would be fatally lacerated.] _double pointed tacks and staples_, when lodged point upward, must be turned so that the points trail on removal. this may be done by carrying them into the stomach and turning them, as described under safety-pins. _the extraction of foreign bodies of very large size_ from the esophagus is greatly facilitated by the use of general anesthesia, which relaxes the spasmodic contractions of the esophagus often occurring when attempt is made to withdraw the foreign body. general anesthesia, though entirely unnecessary for introduction of the esophagoscope, in any case may be used if the body is large, sharp, and rough, in order to prevent laceration through the muscular contractions otherwise incident to withdrawal.* in exceptional cases it may be necessary to comminute a large foreign body such as a tooth plate. a large smooth foreign body may be difficult to seize with forceps. in this case the mechanical spoon or the author's safety-pin closer may be used. * it must always be remembered that large foreign bodies are very prone to cause dyspnea that renders general anesthesia exceedingly dangerous especially in children. [fig. .--lateral roentgenogram of a safety-pin in a child aged months, demonstrating the esophageal location of the pin in this case and the great value of the lateral roentgenogram in the localization of foreign bodies. the pin was removed by the author's method of endogastric version. (plate made by george c. johnston )] _the extraction of meat and other foods from the esophagus_ at the level of the upper thoracic aperture is usually readily accomplished with the esophageal speculum and forceps. in certain cases the mechanical spoon will be found useful. should the bolus of food be lodged at the lower level the esophagoscope will be required. _extraction of foreign bodies from the strictured esophagus_.--foreign bodies of relatively small size will lodge in a strictured esophagus. removal may be rendered difficult when the patient has an upper stricture relatively larger than the lower one, and the foreign body passing the first one lodges at the second. still more difficult is the case when the second stricture is considerably below the first, and not concentric. under these circumstances it is best to divulse the upper stricture mechanically, when a small tube can be inserted past the first stricture to the site of lodgement of the foreign body. _prolonged sojourn of foreign bodies in the esophagus_, while not so common as in the bronchi is by no means of rare occurrence. following their removal, stricture of greater or less extent is almost certain to follow from contraction of the fibrous-tissue produced by the foreign body. _fluoroscopic esophagoscopy_ is a questionable procedure, for the esophagus can be explored throughout by sight. in cases in which it is suspected that a foreign body, such as pin, has partially escaped from the esophagus, the fluoroscope may aid in a detailed search to determine its location, but under no circumstances should it be the guide for the application of forceps, because the transparent but vital tissues are almost certain to be included in the grasp. [ ] complications and dangers of esophagoscopy for foreign bodies. asphyxia from the pressure of the foreign body, or the foreign body plus the esophagoscope, is a possibility (fig. ). faulty position of the patient, especially a low position of the head, with faulty direction of the esophagoscope may cause the tube mouth to press the membranous tracheo-esophageal wall into the trachea, so as temporarily to occlude the tracheal lumen, creating a very dangerous situation in a patient under general anesthesia. prompt introduction of a bronchoscope, with oxygen and amyl nitrite insufflation and artificial respiration, may be necessary to save life. the danger is greater, of course, with chloroform than with ether anesthesia. cocain poisoning may occur in those having an idiosyncrasy to the drug. cocain should never be used with children, and is of little use in esophagoscopy in adults. its application is more annoying and requires more time than the esophagoscopic removal of the foreign bodies without local anesthesia. traumatic esophagitis, septic mediastinitis, cervical cellulitis, and, most dangerous, gangrenous esophagitis may be present, caused by the foreign body itself or ill-advised efforts at removal. perforation of the esophagus with the esophagoscope is rare, in skillful hands, if the esophageal wall is sound. the esophageal wall, however, may be weakened by ulceration, malignant disease, or trauma, so that the possibility of making a false passage should always deter the endoscopist from advancing the tube beyond a visible point of weakening. to avoid entering a false passage previously created, is often exceedingly difficult, and usually it is better to wait for obliterative adhesive inflammation to seal the tissue layers together. _treatment_.--acute esophagitis calls for rest in bed, sterile liquid food, and the administration of bismuth powder mentioned in the paragraph on contraindications. an ice bag applied to the neck may afford some relief. the mouth should be hourly cleansed with the following solution: dakin's solution part cinnamon water parts. emphysema unaccompanied by pyogenic processes usually requires no treatment, though an occasional case may require punctures of the skin to liberate the air. gaseous emphysema and pus formation urgently demand early external drainage, preferably behind the sternomastoid. should the pleura be perforated by sudden puncture pyo-pneumothorax is inevitable. prompt thoracotomy for drainage may save the patient's life if the mediastinum has not also been infected. foreign bodies ulcerating through may reach the lung without pleural leakage because of the sealing together of the visceral and parietal pleurae. in the serious degrees of esophageal trauma, particularly if the pleura be perforated, gastrostomy is indicated to afford rest of the esophagus, and for alimentation. a duodenal feeding tube may be placed through an esophagoscope passed into the stomach in the usual way through the mouth, avoiding by ocular guidance the perforation into which a blindly passed stomach tube would be very likely to enter, with probably dangerous results. [ ] chapter xx--pleuroscopy _foreign bodies in the pleural cavity_ should be immediately removed. the esophageal speculum inserted through a small intercostal incision makes an excellent pleuroscope, its spatular tip being of particular value in moving the lung out of the way. this otherwise dark cavity is thus brilliantly illuminated without the necessity of making a large flap resection, an important factor in those cases in which there is no infection present. the pleura and wound may be immediately closed without drainage, if the pleura is not infected. excessive plus pressure or pus may require reopening. in one case in which the author removed a foreign body by pleuroscopy, healing was by first intention and the lung filled in a few days. drainage tubes that have slipped up into the empyemic cavity are foreign bodies. they are readily removed with the retrograde esophagoscope even through the smallest fistula. the aspirating canal keeps a clear field while searching for the drain. _pleuroscopy for disease_.--most pleural diseases require a large external opening for drainage, and even here the pleuroscope may be of some use in exploring the cavities. usually there are many adhesions and careful ray study may reveal one or more the breaking up of which will improve drainage to such an extent as to cure an empyema of long standing. repeated severing of adhesions, aspiration and sometimes incision of the thickened visceral pleura may be necessary. the author is so strongly imbued with the idea that local examination under full illumination has so revolutionized the surgery of every region of the body to which it has been applied, that every accessible region should be thus studied. the pleural cavity is quite accessible with or without rib-resection, and there is practically no risk in careful pleuroscopy. [ ] chapter xxi--benign growths in the larynx benign growths in the larynx are easily and accurately removable by direct laryngoscopy; but perhaps no method has been more often misused and followed by most unfortunate results. it should always be remembered that benign growths are benign, and that hence they do not justify the radical work demanded in dealing with malignancy. the larynx should be worked upon with the same delicacy and respect for the normal tissues that are customary in dealing with the eye. _granulomata in the larynx_, while not true neoplasms, require extirpation in some instances. _vocal nodules_, when other methods of cure such as vocal rest, various vocal exercises, etcetera have failed may require surgical excision. this may be done with the laryngeal tissue forceps or with the author's vocal nodule forceps. sessile vocal nodules may be cured by touching them with a fine galvanocautery point, but all work on the vocal cords must be done with extreme caution and nicety. it is exceedingly easy to ruin a fine voice. _fibromata_, often of inflammatory genesis, are best removed with the laryngeal grasping forceps, though the small laryngeal punch or tissue forceps may be used. if very large, they may be amputated with the snare, the base being treated with galvanocautery though this is seldom advisable. strong traction should be avoided as likely to do irreparable injury to the laryngeal motility. _cystomata_ may get well after simple excision or galvanopuncture of a part of the wall of the sac, but complete extirpation of the sac is often required for cure. the same is true of _adenomata._ [ ] angiomata, if extensive and deeply seated, may require deep excision, but usually cure results from superficial removal. usually no cauterization of the vessels at the base is necessary, either to arrest hemorrhage or to lessen the tendency to recurrence. a diffuse telangiectasis, should it require treatment, may be gently touched with a needle-pointed galvanocaustic electrode at a number of sittings. the galvanonocautery is a dangerous method to use in the larynx. radium offers the best results in this latter form of angioma, applied either internally or to the neck. _lymphoma, enchondroma and osteoma_, if not too extensively involving the laryngeal walls, may be excised with basket punch forceps, but lymphoma is probably better treated by radium.* _true myxomata and lipomata_ are very rare. _amyloid tumors_ are occasionally met with, and are very resistant to treatment. _aberrant thyroid tumors_ do not require very radical excision of normal base, but should be removed as completely as possible. in a general way, it may be stated that with benign growths in the larynx the best functional results are obtained by superficial rather than radical, deep extirpation, remembering that it is easier to remove tissue than to replace it, and that cicatrices impair or ruin the voice and may cause stenosis. * in a case reported by delavan a complete cure with perfect restoration of voice resulted from radium after i had failed to cure by operative methods. (proceedings american laryngological association, .) [ ] chapter xxii--benign growths in the larynx (continued) papillomata of the larynx in children of all benign growths in the larynx papilloma is the most frequent. it may occur at any age of childhood and may even be congenital. the outstanding fact which necessarily influences our treatment is the tendency to recurrences, followed eventually in practically all cases by a tendency to disappearance. in the author's opinion multiple papillomata constitute a benign, self-limited disease. there are two classes of cases. . those in which the growth gets well spontaneously, or with slight treatment, surgically or otherwise; and, , those not readily amenable to any form of treatment, recurrences appearing persistently at the old sites, and in entirely new locations. in the author's opinion these two classes of case represent not two different kinds of growths, but stages in the disease. those that get well after a single removal are near the end of the disease. papillomata are of inflammatory origin and are not true neoplasms in the strictest sense. _methods of treatment_.--irritating applications probably provoke recurrences, because the growths are of inflammatory origin. formerly laryngostomy was recommended as a last resort when all other means had failed. the excellent results from the method described in the foregoing paragraph has relegated laryngostomy to those cases that come in with a severe cicatricial stenosis from an injudicious laryngofissure; and even in these cases cure of the stenosis as well as the papillomata can usually be obtained by endoscopic methods alone, using superficial scalping off of the papillomata with subsequent laryngoscopic bouginage for the stenosis. thyrotomy for papillomata is mentioned only to be condemned. fulguration has been satisfactory in the hands of some, disappointing to others. it is easily and accurately applied through the direct laryngoscope, but damage to normal tissues must be avoided. radium, mesothorium, and the roentgenray are reported to have had in certain isolated cases a seemingly beneficial action. in my experience, however, i have never seen a cure of papillomata which could be attributed to the radiation. i have seen cases in which no effect on the growths or recurrence was apparent, and in some cases the growths seemed to have been stimulated to more rapid repullulations. in other most unfortunate cases i have seen perichondritis of the laryngeal cartilages with subsequent stenosis occurring after the roentgenotherapy. possibly the disastrous results were due to overdosage; but i feel it a duty to state the unfavorable experience, and to call attention to the difference between cancer and papillomata. multiple papillomata involve no danger to life other than that of easily obviated asphyxia, and it is moreover a benign self-limited disease that repullulates on the surface. in cancer we have an infiltrating process that has no limits short of life itself. _endolaryngeal extirpation_ of papillomata in children requires no anesthetic, general or local; the growths are devoid of sensibility. if, for any reason, a general anesthetic is used it should be only in tracheotomized cases, because the growths obstruct the airway. obstructed respiration introduces into general anesthesia an enormous element of danger. concerning the treatment of multiple papillomata it has been my experience in hundreds of cases that have come to the bronchoscopic clinic, that repeated superficial removals with blunt non-cutting forceps (see chapter i) will so modify the soil as to make it unfavorable for repullulation. the removals are superficial and do not include the subjacent normal tissue. radical removal of a papilloma situated, for instance, on the left ventricular band or cord, can in no way prevent the subsequent occurrence of a similar growth at a different site, as upon the epiglottis, or even in the fauces. furthermore, radical removal of the basal tissues is certain to impair the phonatory function. excellent results as to voice and freedom from recurrence have always followed repeated superficial removal. the time required has been months or a year or two. only rarely has a cure followed a single extirpation. if the child is but slightly dyspneic, the obstructing part of the growth is first removed without anesthesia, general or local; the remaining fungations are extirpated subsequently at a number of brief seances. the child is thus not terrified, soon loses dread of the removals, and appreciates the relief. should the child be very dyspneic when first seen, a low tracheotomy is immediately done, and after an interim of ten days, laryngoscopic removal of the growth is begun. tracheotomy probably has a beneficial effect on the disease. tracheal growths require the insertion of the bronchoscope for their removal. _papillomata in the larynx of adults_ are, on the whole, much more amenable to treatment than similar growths in children. tracheotomy is very rarely required, and the tendency to recurrence is less marked. many are cured by a single extirpation. the best results are obtained by removal of the growths with the laryngeal grasping-forceps, taking the utmost care to avoid including in the bite of the forceps any of the subjacent normal tissue. radical resection or cauterization of the base is unwise because of the probable impairment of the voice, or cicatricial stenosis, without in anyway insuring against repullulation. the papillomata are so soft that they give no sensation of traction to the forceps. they can readily be "scalped" off without any impairment of the sound tissues, by the use of the author's papilloma forceps (fig. ). cutting forceps of all kinds are objectionable because they may wound the normal tissues before the sense of touch can give warning. a gentle hand might be trusted with the cup forceps (fig. , large size.) sir felix semon proved conclusively by his collective investigations that cancer cannot be caused by the repeated removals of benign growths. therefore, no fear of causing cancer need give rise to hesitation in repeatedly removing the repullulations of papillomata or other benign growths. indeed there is much clinical evidence elsewhere in the body, and more than a little such evidence as to the larynx, to warrant the removal of benign growths, repeated if necessary, as a prophylactic of cancer (bibliography, ). [ ] chapter xxiii--benign growths primary in the tracheobronchial tree extension of papillomata from the larynx into the cervical trachea, especially about the tracheotomy wound, is of relatively common occurrence. true primary growths of the tracheobronchial tree, though not frequent, are by no means rare. these primary growths include primary papillomata and fibromata as the most frequent, aberrant thyroid, lipomata, adenomata, granulomata and amyloid tumors. chondromata and osteochondromata may be benign but are prone to develop malignancy, and by sarcomatous or other changes, even metaplasia. edematous polypi and other more or less tumor-like inflammatory sequelae are occasionally encountered. _symptoms of benign tumors of the tracheobronchial tree_.--cough, wheezing respiration, and dyspnea, varying in degree with the size of the tumor, indicate obstruction of the airway. associated with defective aeration will be the signs of deficient drainage of secretions. roentgenray examination may show the shadow of enchondromata or osteomata, and will also show variations in aeration should the tumor be in a bronchus. _bronchoscopic removal of benign growths_ is readily accomplished with the endoscopic punch forceps shown in figs. and . quick action may be necessary should a large tumor producing great dyspnea be encountered, for the dyspnea is apt to be increased by the congestion, cough, and increased respiration and spasm incidental to the presence of the bronchoscope in the trachea. general anesthesia, as in all cases showing dyspnea, is contraindicated. the risks of hemorrhage following removal are very slight, provided fungations on an aneurismal erosion be not mistaken for a tumor. multiple papillomata when very numerous are best removed by the author's "coring" method. this consists in the insertion of an aspirating bronchoscope with the mechanical aspirator working at full negative pressure. the papillomata are removed like coring an apple; though the rounded edge of the bronchoscope does not even scratch the tracheal mucosa. many of the papillomata are taken off by the holes in the bronchoscope. aspiration of the detached papillomata into the lungs is prevented by the corking of the tube-mouth with the mass of papillomata held by the negative pressure at the canal inlet orifice. chapter xxiv--benign neoplasms of the esophagus as a result of prolonged inflammation edematous polypi and granulomata are not infrequently seen, but true benign tumors of the esophagus are rare affections. keloidal changes in scar tissue may occur. cases of retention, epithelial and dermoid cysts have been observed; and there are isolated reports of the finding of papillomata, fibromata, lipomata, myomata and adenomata. the removal of these is readily accomplished with the tissue forceps (fig. ), if the growths are small and projecting into the esophageal lumen. the determination of the advisability of the removal of keloidal scars would require careful consideration of the particular case, and the same may be said of very large growths of any kind. the extreme thinness of the esophageal walls must be always in the mind of the esophagoscopist if he would avoid disaster. [ ] chapter xxv--endoscopy in malignant disease of the larynx the general surgical rule applying to individuals past middle life, that benign growths exposed to irritation should be removed, probably applies to the larynx as well as to any other epithelialized structure. the facility, accuracy and thoroughness afforded by skilled, direct, laryngeal operation offers a means of lessening the incidence of cancer. to a much greater extent the facility, accuracy, and thoroughness contribute to the cure of cancer by establishing the necessary early diagnosis. well-planned, careful, external operation (laryngofissure) followed by painstaking after-care is the only absolute cure so far known for malignant neoplasms of the larynx; and it is a cure only in those intrinsic cases in which the growth is small, and is located in the anterior two-thirds of the intrinsic area. by limiting operations strictly to this class of case, eighty-five per cent of cures may be obtained.* in determining the nature of the growth and its operability the limits of the usefulness of direct endoscopy are reached. it is very unwise to attempt the extirpation of intrinsic laryngeal malignancy by the endoscopic method, for the reason that the full extent of the growth cannot be appreciated when viewed only from above, and the necessary radical removal cannot be accurately or completely accomplished. * the author's results in laryngofissure have recently fallen to per cent of relative cures by thyrochondrotomy. _malignant disease of the epiglottis_, in those rare cases where the lesion is strictly limited to the tip is, however, an exception. if amputation of the epiglottis will give a sufficiently wide removal, this may be done en masse with a heavy snare, and has resulted in complete cure. very small growths may be removed sufficiently widely with the punch forceps (fig. ); but piece meal removal of malignancy is to be avoided. _differential diagnosis of laryngeal growths in the larynx of adults_.--determination of the nature of the lesion in these cases usually consists in the diagnosis by exclusion of the possibilities, namely, . lues. . tuberculosis, including lupus. . scleroma. . malignant neoplasm. in the bronchoscopic clinic the following is the routine procedure: . a wassermann test is made. if negative, and there remains a suspicion of lues, a therapeutic test with mercury protoiodid is carried out by keeping the patient just under the salivation point for eight weeks; during which time no potassium iodid is given, lest its reaction upon the larynx cause an edema necessitating tracheotomy. if no improvement is noticed lues is excluded. if the wassermann is positive, malignancy and the other possibilities are not considered as excluded until the patient has been completely cured by mercury, because, for instance, a leutic or tuberculous patient may have cancer; a tuberculous patient may have lues; or a leutic patient, tuberculosis. . pulmonary tuberculosis is excluded by the usual means. if present the laryngeal lesion may or may not be tuberculous; if the laryngoscopic appearances are doubtful a specimen is taken. lupoid laryngeal tuberculosis so much resembles lues that both the therapeutic test and biopsy may be required for certainty. . in all cases in which the diagnosis is not clear a specimen is taken. this is readily accomplished by direct laryngoscopy under local anesthesia, using the regular laryngoscope or the anterior commissure laryngoscope. the best forceps in case of large growths are the alligator punch forceps (fig. ). smaller growths require tissue forceps (fig. ). in case of small growths, it is best to remove the entire growth; but without any attempt at radical extirpation of the base; because, if the growth prove benign it is unnecessary; if malignant, it is insufficient. _inspection of the party wall in cases of suspected laryngeal malignancy_.--when taking a specimen the party wall should be inspected by passing a laryngoscope or, if necessary, an esophageal speculum down through the laryngopharynx and beyond the cricopharyngeus. if this region shows infiltration, all hope of cure by operation, however radical, should be abandoned. _radium and the therapeutic roentgenray_ have given good results, but not such as would warrant their exclusive use in any case of malignancy in the larynx operable by laryngofissure. with inoperable cases, excellent palliative results are obtained. in some cases an almost complete disappearance of the growth has occurred, but ultimately there has been recurrence. the method of application of the radium, dosage, and its screening, are best determined by the radiologist in consultation with the laryngologist. radium may be applied externally to the neck, or suspended in the larynx; radium-containing needles may be buried in the growth, or the emanations, imprisoned in glass pearls or capillary tubes, may be inserted deeply into the growth by means of a small trocar and cannula. for all of these procedures direct laryngoscopy affords a ready means of accurate application. tracheotomy is necessary however, because of the reactionary swelling, which may be so great as to close completely the narrowed glottic chink. where this is the case, the endolaryngeal application of the radium may be made by inserting the container through the tracheotomic wound, and anchoring it to the cannula. the author is much impressed with freer's method of radiation from the pyriform sinus in such cases as those in which external radiation alone is deemed insufficient. the work of drs. d. bryson delavan and douglass m. quick forms one of the most important contributions to the subject of the treatment of radium by cancer. (see proceedings of the american laryngological association, ; also proceedings of the tenth international otological congress, paris, .) [ ] chapter xxvi--bronchoscopy in malignant growths of the trachea the trachea is often secondarily invaded by malignancy of the esophagus, thyroid gland, peritracheal or peribronchial glands. primary malignant neoplasms of the trachea or bronchus have not infrequently been diagnosticated by bronchoscopy. peritracheal or peribronchial malignancy may produce a compressive stenosis covered with normal mucosa. endoscopically, the wall is seen to bulge in from one side causing a crescentic picture, or compression of opposite walls may cause a "scabbard" or pear shaped lumen. endotracheal and endobronchial malignancy ulcerate early, and are characterized by the bronchoscopic view of a bleeding mass of fungating tissue bathed in pus and secretion, usually foul. the diagnosis in these cases rests upon the exclusion of lues, and is rendered certain by the removal of a specimen for biopsy. sarcoma and carcinoma of the thyroid when perforating the trachea may become pedunculated. in such cases aberrant non-pathologic thyroid must be excluded by biopsy. endothelioma of the trachea or bronchus may also assume a pedunculated form, but is more often sessile. _treatment_.--pedunculated malignant growths are readily removed with snare or punch forceps. cure has resulted in one case of the author following bronchoscopic removal of an endothelioma from the bronchus; and a limited carcinoma of the bronchus has been reported cured by bronchoscopic removal, with cauterization of the base. most of the cases, however, will be subjects for palliative tracheotomy and radium therapy. it will be found necessary in many of the cases to employ the author's long, cane-shaped tracheal cannula (fig. , a), in order to pipe the air down to one or both bronchi past the projecting neoplasm. it has recently been demonstrated that following the intravenous injection of a suspension of the insoluble salt, radium sulphate, that the suspended particles are held in the capillaries of the lung for a period of one year. intravenous injections of a watery suspension, and endobronchial injections of a suspension of radium sulphate in oil, have had definite beneficial action. while as yet, no relatively permanent cures of pulmonary malignancy have been obtained, the amelioration and steady improvement noted in the technic of radium therapy are so encouraging that every inoperable case should be thus treated, if the disease is not in a hopelessly advanced stage. in a case under the care of dr. robert m. lukens at the bronchoscopic clinic, a primary epithelioma of the trachea was retarded for years by the use of radium applied by dr. william s. newcomet, radium-therapist, and miss katherine e. schaeffer, technician. [ ] chapter xxvii--malignant disease of the esophagus cancer of the esophagus is a more prevalent disease than is commonly thought. in the male it usually develops during the fourth and fifth decades of life. there is in some cases the history of years of more or less habitual consumption of strong alcoholic liquors. in the female the condition often occurs at an earlier age than in the male, and tends to run a more protracted course, preceeded in some cases by years of precancerous dysphagia. squamous-celled epithelioma is the most frequent type of neoplasm. in the lower third of the esophagus, cylindric cell carcinoma may be found associated with a like lesion in the stomach. sarcoma of the esophagus is relatively rare (bibliography , p. ). the sites of the lesion are those of physiologic narrowing of the esophagus. the middle third is most frequently involved; and the lower third, near the cardia, comes next in frequency. cancer of the lower third of the esophagus preponderates in men, while cancer of the upper orifice is, curiously, more prevalent in women. the lesion is usually single, but multiple lesions, resulting from implantation metastases have been observed (bibliography , p. ). bronchoesophageal fistula from extension is not uncommon. _symptoms_.--malignant disease of the esophagus is rarely seen early, because of the absence, or mildness, of the symptoms. dysphagia, the one common symptom of all esophageal disease, is often ignored by the patient until it becomes so marked as to prevent the taking of solid food; therefore, the onset may have the similitude of abruptness. any well masticated solid food can be swallowed through a lumen millimeters in diameter. the inability to maintain the nutrition is evidenced by loss of weight and the rapid development of cachexia. when the stenosis becomes so severe that the fluid intake is limited, rapid decline occurs from water starvation. pain is usually a late symptom of the disease. it may be of an aching character and referred to the vertebral region or to the neck; or it may only accompany the act of swallowing. blood-streaked, regurgitated material, and the presence of odor, are late manifestations of ulceration and secondary infection. in some cases, constant oozing of blood from the ulcerated area adds greatly to the cachexia. if the recurrent laryngeal nerves are involved, unilateral or bilateral paralysis of the larynx may complicate the symptoms by cough, dyspnea, aphonia, and possibly septic pneumonia. _diagnosis_.--it has been estimated that per cent of stenoses of the esophagus in adults are malignant in nature. this should stimulate the early and careful investigation of every case of dysphagia. when all cases of persistent dysphagia, however slight, are endoscopically studied, precancerous lesions may be discovered and treated, and the limited malignancy of the early stages may be afforded surgical treatment while yet there is hope of complete removal. luetic and tuberculous ulceration of the esophagus are to be eliminated by suitable tests, supplemented in rare instances by biopsy. aneurysm of the aorta must in all cases of dysphagia be excluded, for the dilated aorta may be the sole cause of the condition, and its presence contraindicates esophagoscopy because of the liability of rupture. foreign body is to be excluded by history and roentgenographic study. spasmodic stenosis of the esophagus may or may not have a malignant origin. esophagoscopy and removal of a specimen for biopsy renders the diagnosis certain. it is to be especially remembered, however, that it is very unwise to bite through normal mucosa for the purpose of taking a specimen from a periesophageal growth. fungations and polypoid protuberances afford safe opportunities for the removal of specimens of tissue. _the esophagoscopic appearances of malignant disease_, varying with the stage and site of origin of the growth, may present as follows:-- . submucosal infiltration covered by perfectly normal membrane, usually associated with more or less bulging of the esophageal wall, and very often with hardness and infiltration. . leucoplakia. . ulceration projecting but little above the surface at the edges. . rounded nodular masses grouped in mulberry-like form, either dark or light red in color. . polypoid masses. . cauliflower fungations. in considering the esophagoscopic appearances of cancer, it is necessary to remember that after ulceration has set in, the cancerous process may have engrafted upon it, and upon its neighborhood, the results of inflammation due to the mixed infections. cancer invading the wall from without may for a long time be covered with perfectly normal mucous membrane. the significant signs at this early stage are: . absence of one or more of the normal radial creases between the folds. . asymmetry of the inspiratory enlargement of lumen. . sensation of hardness of the wall on palpation with the tube. . the involved wall will not readily be made to wrinkle when pushed upon with the tube mouth. in all the later forms of lesions the two characteristics are (a) the readiness with which oozing of blood occurs; and (b) the sense of rigidity, or fixation, of the involved area as palpated with the esophagoscope, in contrast to the normally supple esophageal wall. esophageal dilatation above a malignant lesion is rarely great, because the stenosis is seldom severely obstructive until late in the course of the disease. _treatment_.--the present per cent mortality in cancer of the esophagus will be lowered and a certain percentage of surgical cures will be obtained when patients with esophageal symptoms are given the benefit of early esophagoscopic study. the relief or circumvention of the dysphagia requires early measures to prevent food and water starvation. _bouginage_ of a malignant esophagus to increase temporarily the size of the stenosed lumen is of questionable advisability, and is attended with the great risk of perforating the weakened esophageal wall. _esophageal intubation_ may serve for a time to delay gastrostomy but it cannot supplant it, nor obviate the necessity for its ultimate performance. the charters-symonds or guisez esophageal intubation tube is readily inserted after drawing the larynx forward with the laryngoscope. the tube must be changed every week or two for cleaning, and duplicate tubes must be ready for immediate reinsertion. eventually, a smaller, and then a still smaller tube are needed, until finally none can be introduced; though in some cases the tube can be kept in the soft mass of fungations until the patient has died of hemorrhage, exhaustion, complications or intercurrent disease. _gastrostomy_ is always indicated as the disease progresses, and it should be done before nutrition is greatly impaired. surgeons often hesitate thus to "operate on an inoperable case;" but it must be remembered that no one should be allowed to die of hunger and thirst. the operation should be done before inanition has made serious inroads. as in the case of tracheotomy, we always preach doing it early, and always do it late. if postponed too long, water starvation may proceed so far that the patient will not recover, because the water-starved tissues will not take up water put in the stomach. _radiotherapy_.--radium and the therapeutic roentgenray are today our only effective means of retarding the progress of esophageal malignant neoplasms. no permanent cures have been reported, but marked temporary improvement in the swallowing function and prolongation of life have been repeatedly observed. the combination of radium treatment applied within the esophageal lumen and the therapeutic roentgenray through the chest wall, has retarded the progress of some cases. the dosage of radium or the therapeutic ray must be determined by the radiologist for the particular individual case; its method of application should be decided by consultation of the radiologist and the endoscopist. two fundamental points are to be considered, however. the radium capsule, if applied within the esophagus, should be so screened that the soft, irritating, beta rays, and the secondary rays, are both filtered out to prevent sloughing of the esophageal mucosa. the dose should be large enough to have a lethal effect upon the cancer cells at the periphery of the growth as well as in the center. if the dose be insufficient, development of the cells at the outside of the growth is stimulated rather than inhibited. it is essential that the radium capsule be accurately placed in the center of the malignant strictured area and this can be done only by visual control through the esophagoscope (fig. ) drs. henry k. pancoast, george e. pfahler and william s. newcomet have obtained very satisfactory palliative effects from the use of radium in esophageal cancer. [ ] chapter xxviii--direct laryngoscopy in diseases of the larynx the diagnosis of laryngeal disease in young children, impossible with the mirror, has been made easy and precise by the development of direct laryngoscopy. no anesthetic, local or general, should be used, for the practised endoscopist can complete the examination within a minute of time and without pain to the patient. the technic for doing this should be acquired by every laryngologist. anesthesia is absolutely contraindicated because of the possibility of the presence of diphtheria, and especially because of the dyspnea so frequently present in laryngeal disease. to attempt general anesthesia in a dyspneic case is to invite disaster (see tracheotomy). it is to be remembered that coughing and straining produce an engorgement of the laryngeal mucosa, so that the first glance should include an estimation of the color of the mucosa, which, as a result of the engorgement, deepens with the prolongation of the direct laryngoscopy. _chronic subglottic edema_, often the result of perichondritis, may require linear cauterization at various times, to reduce its bulk, after the underlying cause has been removed. _perichondritis and abscess_, and their sequelae are to be treated on the accepted surgical precepts. they may be due to trauma, lues, tuberculosis, enteric fever, pneumonia, influenza, etc. _tuberculosis of the larynx_ calls for conservatism in the application of surgery. ulceration limited to the epiglottis may justify amputation of the projecting portion or excision of only the ulcerated area. in either case, rapid healing may be expected, and relief from the odynphagia is sometimes prompt. amputation of the epiglottis is, however, not to be done if ulceration in other portions of the larynx coexist. the removal of tuberculomata is sometimes indicated, and the excision of limited ulcerative lesions situated elsewhere than on the epiglottis may be curative. these measures as well as the galvanocautery are easily executed by the facile operator; but their advisability should always be considered from a conservative viewpoint. they are rarely justifiable until after months of absolute silence and a general antituberculous regime have failed of benefit. _galvanopuncture_ for laryngeal tuberculosis has yielded excellent results in reducing the large pyriform edematous swellings of the aryepiglottic folds when ulceration has not yet developed. deep punctures at nearly a white heat, made perpendicular to the surface, are best. care must be exercised not to injure the cricoarytenoid joint. fungating ulcerations may in some cases be made to cicatrize by superficial cauterization. excessive reactions sometimes follow, so that a light application should be made at the first treatment. _congenital laryngeal stridor_ is produced by an exaggeration of the infantile type of larynx. the epiglottis will be found long and tapering, its lateral margins rolled backward so as to meet and form a cylinder above. the upper edges of the aryepiglottic folds are approximated, leaving a narrow chink. the lack of firmness in these folds and the loose tissue in the posterior portion of the larynx, favors the drawing inward of the laryngeal aperture by the inspiratory blast. the vibration of the margins of this aperture produces the inspiratory stridor. diagnosis is quickly made by the inspection of the larynx with the infant diagnostic laryngoscope. no anesthetic, general or local, is needed. stridorous respiration may also be due to the presence of laryngeal papillomata, laryngeal spasm, thymic compression, congenital web, or an abnormal inspiratory bulging into the trachea of the posterior membranous tracheo-esophageal wall. the term "congenital laryngeal stridor" should be limited to the first described condition of exaggerated infantile larynx. _treatment of congenital laryngeal stridor_ should be directed to the relief of dyspnea, and to increasing the nutrition and development of the infant. the insertion of a bronchoscope will temporarily relieve an urgent dyspneic attack precipitated by examination; but this rarely happens if the examination is not unduly prolonged. tracheotomy may be needed to prevent asphyxia or exhaustion from loss of sleep; but very few cases require anything but attention to nutrition and hygiene. recovery can be expected with development of the laryngeal structures. _congenital webs of the larynx_ require incision or excision, or perhaps simply bouginage. congenital goiter and congenital laryngeal paralysis, both of which may cause stertorous breathing, are considered in connection with other forms of stenosis of the air passages. _aphonia_ due to cicatricial webs of the larynx may be cured by plastic operations that reform the cords, with a clean, sharp anterior commissure, which is a necessity for clear phonation. the laryngeal scissors and the long slender punch are often more useful for these operations than the knife. [ ] chapter xxix--bronchoscopy in diseases of the trachea and bronchi _the indications for bronchoscopy in disease_ are becoming increasingly numerous. among the more important may be mentioned: . bronchiectasis. . chronic pulmonary abscess. . unexplained dyspnea. . dyspnea unrelieved by tracheotomy calls for bronchoscopic search for deeper obstruction. . paralysis of the recurrent laryngeal nerve, the cause of which is not positively known. . obscure thoracic disease. . unexplained hemoptysis. . unexplained cough. . unexplained expectoration. _contraindications to bronchoscopy in disease_ do not exist if the bronchoscopy is really needed. serious organic disease such as aneurysm, hypertension, advanced cardiac disease, might render bronchoscopy inadvisable except for the removal of foreign bodies. _bronchoscopic appearances in disease_.--the first look should note the color of the bronchial mucosa, due allowance being made for the pressure of tubal contact, secretions, and the engorgement incident to continued cough. the carina trachealis normally moves slowly forward as well as downward during deep inspiration, returning quickly during expiration. impaired movement of the carina indicates peritracheal and peribronchial pathology, the fixation being greatest in advanced cancer. in children and in the smaller tubes of the adult, the lengthening and dilatation of the bronchi during inspiration, and their shortening and contraction during expiration are readily seen. _anomalies of the tracheobronchial tree_.--tracheobronchial anomalies are relatively rare. congenital esophagotracheal and esophagobronchial fistulae are occasionally seen, and cases of cervicotracheal fistulae have been reported. congenital webs and diverticula of the trachea are cited infrequently. laryngoptosis and deviation of the trachea may be congenital. substernal goitre, aneurysm, malignant growths, and various mediastinal adenopathies may displace the trachea from its normal course. the emphysematous chest fixed in the deep voluntary inspiratory position produces in some cases an elevation of the superior thoracic aperture simulating laryngoptosis (bibliography r, pp. , ). _compression stenosis of the trachea and bronchi_.--compression of the trachea is most commonly caused by goiter, substernal or cervical, aneurysm, malignancy, or, in children, by enlarged thymus. less frequently, enlarged mediastinal tuberculous, leukemic, leutic or hodgkin's glands compress the airway. the left bronchus may be stenosed by pressure from a hypertrophied cardiac auricle. compression stenosis of the trachea associated with pulmonary emphysema accounts for the dyspnea during attacks of coughing. the endoscopic picture of compression stenosis is that of an elliptical or scabbard-shaped lumen when the bronchus is at rest or during inspiration. concentric funnel-like compression stenosis, while rare, may be produced by annular growths. _treatment of compression stenoses of the trachea_.--if the thymus be at fault, rapid amelioration of symptoms follows roentgenray or radium therapy. tracheotomy and the insertion of the long cane-shaped cannula (fig. ) past the compressed area is required in the cases caused by conditions less amenable to treatment than thymic enlargement. permanent cure depends upon the removability of the compressive mass. should the bronchi be so compressed by a benign condition as to prevent escape of secretions from the subjacent air passages, bronchial intubation tubes may be inserted, and, if necessary, worn constantly. they should be removed weekly for cleansing and oftener if obstructed. _influenzal laryngotracheobronchitis_.--influenzal infection, not always by the same organism, sweeps over the population, attacking the air passages in a violent and quite characteristic way. bronchoscopy shows the influenzal infection to be characterized by intense reddening and swelling of the mucosa. in some cases the swelling is so great as to necessitate tracheotomy, or intubation of the larynx; and if the edema involve the bronchi, occlusion may be fatal. hemorrhagic spots and superficial erosions are commonly seen, and a thick, tenacious exudate, difficult of expectoration, lies in patches in the trachea. infants may asphyxiate from accumulation of this secretion which they are unable to expel. the differential diagnosis from diphtheria is sometimes difficult. the absence of true membrane and the failure to find diphtheria bacilli in smears taken from the trachea are of aid but are not infallible. in doubtful cases, the administration of diphtheria antitoxin is a wise precaution pending the establishment of a definite diagnosis. the pseudomembrane sometimes present in influenzal tracheobronchitis is thinner and less pulpy than that of the earlier stages of diphtheria. the casts of the later stages do not occur in influenzal tracheobronchitis (bibliography i, p. ). _edematous tracheobronchitis_.--this is chiefly observed in children. the most frequently encountered form is the epidemic disease to which the name "influenza" has been given (q.v. supra). the only noticeable difference between the epidemic and the sporadic cases is in the more general susceptibility to the infective agent, which gives the influenzal form an appearance of being more virulently infective. possibly the sporadic form is simply the attack of children not immunized by a previous attack during an epidemic. there is another form of edematous tracheobronchitis often of great severity and grave prognosis, that results from the aspiration of irritating liquids or vapors, or of certain organic substances such as peanut kernels, watermelon seeds, etcetera. tracheotomy should be done if marked dyspnea be present. secretions can then be easily removed and medication in the form of oily solutions be instilled at will into the trachea. in the bronchoscopic clinic many children have been kept alive for days, and their lives finally saved by aspiration of thick, tough, sometimes clotted and crusted secretions, with the aspirating tube (fig. ). it is better in these cases not to pass the bronchoscope repeatedly. if, however, evidences of obstruction remain, after aspiration, it is necessary to see the nature of the obstruction and relieve it by removal, dilatation, or bronchial intubation as the case may require. it is all a matter of "plumbing" i.e., clearing out the "pipes," and maintaining a patulous airway. _tracheobronchial diphtheria_.--urgent dyspnea in diphtheria when no membrane and but slight lessening of the laryngeal airway is seen, calls for bronchoscopy. many lives have been saved by the bronchoscopic removal of membrane obstructing the trachea or bronchi. in the early stages, pulpy masses looking like "mother" of vinegar are very obstructive. later casts of membrane may simulate foreign bodies. the local application of diphtheria antitoxin to the trachea and bronchi has also been recommended. a preparation free from a chemical irritant should be selected. _abscess of the lung_.--if of foreign-body origin, pulmonary abscess almost invariably heals after the removal of the object and a regime of fresh air and rest, without local measures of any kind. acute pulmonary abscess from other causes may require bronchoscopic drainage and gentle dilatation of the swollen and narrowed bronchi leading to it. some of these bronchi are practically fistulae. obstructive granulations should be removed with crushing, not biting forceps. the regular foreign-body forceps are best for this purpose. caution should be used as to removal of the granulations with which the abscess "cavity" is filled in chronic cases. the term "abscess" is usually loosely applied to the condition of drowned lung in which the pus has accumulated in natural passages, and in which there is neither a new wall nor a breaking down of normal walls. chronic lung-abscess is often successfully treated by weekly bronchoscopic lavage with cc. or more of a warm, normal salt solution, a : watery potassium permanganate solution, or a weak iodine solution as in the following formula: rx. monochlorphenol (merck) . lugol's solution . normal salt solution . perhaps the best procedure is to precede medicinal applications by the clearing out of the purulent secretions by aspiration with the aspirating bronchoscope and the independent aspirating tube, the latter being inserted into passages too small to enter with the bronchoscope, and the endobronchial instillation of from to cc. of the medicament. the following have been used: argyrol, per cent watery solution; silvol, per cent watery solution; iodoform, oil emulsion per cent; guaiacol, per cent solution in paraffine oil; gomenol, per cent solution in oil; or a bismuth subnitrate suspension in oil. robert m. lukens and william f. moore of the bronchoscopic clinic report excellent results in post-tonsillectomy abscesses from one tenth of one per cent phenol in normal salt solution with the addition of per cent lugol's solution. chlorinated solutions are irritating, and if used, require copious dilution. liquid petrolatum with a little oil of eucalyptus has been most often the medium. _gangrene of the lung_.--pulmonary gangrene has been followed by recovery after the endobronchial injection of oily solutions of gomenol and guaiacol (guisez). the injections are readily made through the laryngoscope without the insertion of a bronchoscope. a silk woven catheter may be used with an ordinary glass syringe or a long-nozzled laryngeal syringe, or a bronchoscopic syringe may be used. _lung-mapping_ by a roentgenogram taken promptly after the bronchoscopic insufflation of bismuth subnitrate powder or the injection of a suspension of bismuth in liquid petrolatum is advisable in most cases of pulmonary abscess before beginning any kind of treatment. _bronchial stenosis_.--stenosis of one or more bronchi results at times from cicatricial contraction following secondary infection of leutic, tuberculous or traumatic lesions. the narrowing resulting from foreign body traumatism rarely requires secondary dilatation after the foreign body has been removed. tuberculous bronchial stenoses rarely require local treatment, but are easily dilated when necessary. luetic cicatricial stenosis may require repeated dilatation, or even bronchial intubation. endobronchial neoplasms may cause a subjacent bronchiectasis, and superjacent stenosis; the latter may require dilatation. cicatricial stenoses of the bronchi are readily recognizable by the scarred wall and the absence of rings at or near the narrowing. _bronchiectasis_.--in most cases of bronchiectasis there are strong indications for a bronchoscopic diagnosis, to eliminate such conditions as foreign body, cicatricial bronchial stenosis, or endobronchial neoplasm as etiologic factors. in the idiopathic types considerable benefit has resulted from the endobronchial lavage and endobronchial oily injections mentioned under lung abscess. it is probable that if bronchoscopic study were carried out in every case, definite causes for many so-called "idiopathic" cases would be discovered. lung-mapping as elsewhere herein explained is invaluable in the study of bronchiectasis. _bronchial asthma_ affords a large field for bronchoscopic study. as yet, sufficient data to afford any definite conclusions even as to the endoscopic picture of this disease have not been accumulated. of the cases seen in the bronchoscopic clinic some showed no abnormality of the bronchi in the intervals between attacks, others a chronic bronchitis. in cases studied bronchoscopically during an attack, the bronchi were found filled with bubbling secretions and the mucosa was somewhat cyanotic in color. the bronchial lumen was narrowed only as much as it would be, with the same degree of cough, in any patient not subject to asthma. the secretions were removed and the attack quickly subsided; but no influence on the recurrence of attacks was observed. it is essential that the bronchoscopic studies be made, as were these, without anesthesia, local or general, for it is known that the application of cocain or adrenalin to the larynx, or even in the nose, will, with some patients, stop the attack. when done without local anesthesia, allowance must be made for the reaction to the presence of the tube. in those cases in which other means have failed to give relief, the endobronchial application of novocain and adrenalin, orthoform, propaesin or anesthesin emulsion may be tried. cures have been reported by this treatment. argentic nitrate applied at weekly intervals has proven very efficient in some cases. associated infective disease of the bronchial mucosa brings with it the questions of immunity, allergy, anaphylaxis, and vaccine therapy; and the often present defective metabolism has to be considered. _autodrownage_.--autodrownage is the name given by the author to the drowning of the patient in his own secretions. tracheobronchial secretions in excess of the amount required to moisten the inspired air, become, in certain cases, a mechanical menace to life, unless removed. the cough reflex, forced expiration, and ciliary action, normally remove the excess. when these mechanisms are impaired, as in profound asthenia, laryngeal paralysis, laryngeal or tracheal stenosis, etc.; and especially when in addition to a mild degree of glottic stenosis or impaired laryngeal mobility, the secretions become excessive, the accumulation may literally drown the patient in his own secretions. this is illustrated frequently in influenza and arachidic bronchitis. infants cannot expectorate, and their cough reflex is exceedingly ineffective in raising secretion to the pharynx; furthermore they are easily exhausted by bechic efforts; so that age may be cited as one of the most frequent etiologic factors in the condition of autodrownage. bronchoscopic sponge-pumping (_q.v._) and bronchoscopic aspiration are quite efficient and can save any patient not afflicted with conditions that are fatal by other pathologic processes. _lues of the tracheobronchial tree_.--compared to laryngeal involvement, syphilis of the tracheobronchial tree is relatively rare. the lesions may be gummatous, ulcerative, or inflammatory, or there may be compressive granulomatous masses. hemoptysis may have its origin from a luetic ulceration. excision of fungations or of a portion of the margin of the ulceration for biopsy is advisable. the wassermann and therapeutic tests, and the elimination of tuberculosis will be required for confirmation. luetic stenoses are referred to above. _tuberculosis of the tracheobronchial tree_.--the bronchoscopic study of tuberculosis is very interesting, but only a few cases justify bronchoscopy. the subglottic infiltrations from extensions of laryngeal disease are usually of edematous appearance, though they are much more firm than in ordinary inflammatory edema. ulcerations in this region are rare, except as direct extensions of ulceration above the cord. the trachea is relatively rarely involved in tuberculosis, but we may have in the trachea the pale swelling of the early stage of a perichondritis, or the later ulceration and all the phenomena following the mixed pyogenic infections. these same conditions may exist in the bronchi. in a number of instances, the entire lumen of the bronchus was occluded by cheesy pus and debris of a peribronchial gland which had eroded through. as a rule, the mucosa of tuberculosis is pale, and the pallor is accentuated by the rather bluish streak of vessels, where these are visible. erosion through of peri-bronchial or peri-tracheal lymph masses may be associated with granulation tissue, usually of pale color, but occasionally reddish; and sometimes oozing of blood is noticed. a most common picture in tuberculosis is a broadening of the carina, which may be so marked as to obliterate the carina and to bulge inward, producing deformed lumina in both bronchi. sometimes the lumina are crescentic, the concavity of the crescent being internal, that is, toward the median line. absence of the normal anterior and downward movement of the carina on deep inspiration is almost pathognomonic of a mass at the bifurcation, and such a mass is usually tuberculous, though it may be malignant, and, very rarely, luetic. the only lesion visible in a tuberculous case may be cicatrices from healed processes. in a number of cases there has been a discharge of pus coming from the upper-lobe bronchus. [fig. .--the author's tampons for pulmonary hemostasis by bronchoscopic tamponade. the folded gauze is cm. long; the braided silk cord cm. long.] _hemoptysis_.--in cases not demonstrably tuberculous, hemoptysis may require bronchoscopic examination to determine the origin. varices or unsuspected luetic, malignant, or tuberculous lesions may be found to be the cause. it is mechanically easy to pack off one bronchus with the author's packs (fig. ) introduced through the bronchoscope, but the advisability of doing so requires further clinical tests. _angioneurotic edema_.--angioneurotic edema manifests itself by a pale or red swollen mucosa producing stenosis of the lumen. the temporary character of the lesion and its appearance in other regions confirm the diagnosis. _scleroma of the trachea_ is characterized by infiltration of the tracheal mucosa, which greatly narrows the lumen. the infiltration may be limited in area and produce a single stricture, or it may involve the entire trachea and even close a bronchial orifice. drying and crusting of secretions renders the stenosis still more distressing. this disease is but rarely encountered in america but is not infrequent in some parts of europe. treatment consists in the prevention of crusts and their removal. limited stenotic areas may yield to bronchoscopic bouginage. urgent dyspnea calls for tracheotomy. radium and roentgenray therapy have been advised, and cure has been reported by intravenous salvarsan treatment (see article by s. shelton watkins, on scleroma in surg. gynecol. and obst., july, , p. ). _atrophic tracheitis_, with symptoms quite similar to atrophic rhinitis is a not unusual accompaniment of the nasal condition. it may also exist without nasal involvement. on tracheoscopy the mucosa is thinned, pale and dry, and is covered with patches of thick mucilaginous secretion and crusts. decomposition of secretion produces tracheal "ozena," while the accumulated crusts give rise to the sensation of a foreign body and may seriously interfere with respiration, making bronchoscopic removal imperative. the associated development of tracheal nodular enchondromata has been described. the internal administration of iodine and the intratracheal injection of bland oily solutions of menthol, guaiacol, or gomenol are helpful. [ ] chapter xxx--diseases of the esophagus the more frequent causes of the one common symptom of esophageal disease, dysphagia, are included in the list given below. to avoid elaboration and to obtain maximum usefulness as a reminder, overlapping has not been eliminated. . anomalies. . esophagitis, acute. . esophagitis, chronic. . erosion. . ulceration. . trauma. . stricture, congenital. . stricture, spasmodic, including cramp of the diaphragmatic pinchcock. . stricture, inflammatory. . stricture, cicatricial. . dilatation, local. . dilatation, diffuse. . diverticulum. . compression stenosis. . mediastinal tumor. . mediastinal abscess. . mediastinal glandular mass. . aneurysm. . malignant neoplasm. . benign neoplasm. . tuberculosis. . lues. . actinomycosis. . varix. . angioneurotic edema. . hysteria. . functional antiperistalsis. . paralysis. . foreign body in (a) pharynx, (b) larynx, (c) trachea, (d) esophagus. [ ] _diagnosis_.--the swallowing function can be studied only with the fluoroscope; esophagoscopy for diagnosis, should therefore always be preceded by a fluoroscopic study of deglutition with a barium or other opaque mixture and examination of the thoracic organs to eliminate external pressure on the esophagus as the cause of stenosis. complete physical examination and wassermann reaction are further routine preliminaries to any esophagoscopy. special laboratory tests are done as may be indicated. the physical examination is meant to include a careful examination of the lips, tongue, palate, pharynx, and a mirror examination of the larynx when age permits. _indications for esophagoscopy in disease_.--any persistent abnormal sensation or disturbance of function of the esophagus calls for esophagoscopy. vague stomach symptoms may prove to be esophageal in origin, for vomiting is often a complaint when the patient really regurgitates. _contraindications to esophagoscopy_.--in the presence of aneurysm, advanced organic disease, extensive esophageal varicosities, acute necrotic or corrosive esophagitis, esophagoscopy should not be done except for urgent reasons, such as the lodgment of a foreign body; and in this case the esophagoscopy may be postponed, if necessary, unless the patient is unable to swallow fluids. esophagoscopy should be deferred, in cases of acute esophagitis from swallowing of caustics, until sloughing has ceased and healing has strengthened the weak places. the extremes of age are not contraindications to esophagoscopy. a number of newborn infants have been esophagoscoped by the author; and he has removed foreign bodies from patients over years of age. _water starvation_ makes the patient a very bad surgical subject, and is a distinct contraindication to esophagoscopy. water must be supplied by means of proctoclysis and hypodermoclysis before any endoscopic or surgical procedure is attempted. if the esophageal stenosis is not readily and quickly remediable, gastrostomy should be done immediately. _rectal feeding_ will supply water for a limited time, but for nutrient purposes rectal alimentation is dangerously inefficient. _preliminary examination of the pharynx and larynx with tongue depressor_ should always precede esophagoscopy, for any purpose, because the symptoms may be due to laryngeal or pharyngeal disease that might be overlooked in passing the esophagoscope. a high degree of esophageal stenosis results in retention in the suprajacent esophagus of the fluids which normally are continually flowing downward. the pyriform sinuses in these cases are seen with the laryngeal mirror to be filled with frothy secretion (jackson's sign of esophageal stenosis) and this secretion may sometimes be seen trickling into the larynx. this overflow into the larynx and lower air passages is often the cause of pulmonary symptoms, which are thus strictly secondary to the esophageal disease. anomalies of the esophagus _congenital esophagotracheal fistulae_ are the most frequent of the embryonic developmental errors of this organ. septic pneumonia from the entrance of fluids into the lungs usually causes death within a few weeks. _imperforate esophagus_ usually shows an upper esophageal segment ending in a blind pouch. a lower segment is usually present and may be connected with the upper segment by a fistula. _congenital stricture_ of the esophagus may be single or multiple, and may be thin and weblike, or it may extend over a third or more of the length of the esophagus. it may not become manifest until solids are added to the child's diet; often not for many months. the lodgment of an unusually large bolus of unmasticated food may set up an esophagitis the swelling of which may completely close the lumen of the congenitally narrow esophagus. it is not uncommon to meet with cases of adults who have "never swallowed as well as other people," and in whom cicatricial and spasmodic stenosis can be excluded by esophagoscopy, which demonstrates an obvious narrowing of the esophageal lumen. these cases are doubtless congenital. _webs in the upper third of the esophagus_ are best determined by the passage of a large esophagoscope which puts the esophagus on the stretch. the webs may be broken by the insertion of a closed alligator forceps, which is then withdrawn with opened blades. better still is the dilator shown in fig. . this retrograde dilatation is relatively safe. a silk-woven esophagoscopic bougie or the metallic tracheal bougie may be used, with proper caution. subsequent dilatation for a few times will be required to prevent a reproduction of the stenosis. _treatment of esophageal anomalies_.--gastrostomy is required in the imperforate cases. esophagoscopic bouginage is very successful in the cure of all cases of congenital stenosis. any sort of lumen can be enlarged so any well masticated food can be swallowed. careful esophagoscopic work with the bougies (fig. ) will ultimately cure with little or no risk of mortality. any form of rapid dilatation is dangerous. congenital stenosis, if not an absolute atresia, yields more readily to esophagoscopic bouginage than cicatricial stenosis. rupture and trauma of the esophagus these may be spontaneous or may ensue from the passage of an instrument, or foreign body, or of both combined, as exemplified in the blind attempts to remove a foreign body or to push it downwards. digestion of the esophagus and perforation may result from the stagnation of regurgitated gastric juice therein. this condition sometimes occurs in profound toxic and debilitated states. rupture of the thoracic esophagus produces profound shock, fever, mediastinal emphysema, and rapid sinking. pneumothorax and empyema follow perforation into the pleural cavity. rupture of the cervical esophagus is usually followed by cervical emphysema and cervical abscess, both of which often burrow into the mediastinum along the fascial layers of the neck. lesser degrees of trauma produce esophagitis usually accompanied by fever and painful and difficult swallowing. the treatment of traumatic esophagitis consists in rest in bed, sterile liquid food, and the administration of bismuth subnitrate (about one gramme in an adult), dry on the tongue every hours. rupture of the esophagus requires immediate gastrostomy to put the esophagus at rest and supply necessary alimentation. thoracotomy for drainage is required when the pleural cavity has been involved, not only for pleural secretions, but for the constant and copious esophageal leakage. it is not ordinarily realized how much normal salivary drainage passes down the esophagus. the customary treatment of shock is to be applied. no attempt should be made to remove a foreign body until the traumatic lesions have healed. this may require a number of weeks. decision as to when to remove the intruder is determined by esophagoscopic inspection. subcutaneous emphysema does not require puncture unless gaseous, or unless pus forms. in the latter event free external drainage becomes imperative. acute esophagitis this is usually of traumatic or cauterant origin. if severe or extensive, all the symptoms described under "rupture of the esophagus" may be present. the endoscopic appearances are unmistakable to anyone familiar with the appearance of mucosal inflammations. the pale, bluish pink color of the normal mucosa is replaced by a deep-red velvety swollen appearance in which individual vessels are invisible. after exudation of serum into the tissues, the color may be paler and in some instances a typical edema may be seen. this may diminish the lumen temporarily. folds of swollen mucosa crowd into the lumen if the inflammation is intense. these folds are sometimes demonstrable in the roentgenogram by the bismuth or barium in the creases between which the prominence of the folds show as islands as beautifully demonstrated by david r. bowen in one of the author's cases. if the inflammation is due to corrosives, a grayish exudate may be visible early, sloughs later. ulceration of the esophagus superficial erosions of the esophagus are by no means an uncommon accompaniment of the stagnation of food and secretions. from the irritation they produce, spastic stenosis may occur, thus constituting a vicious circle; the spasm of the esophagus increases the stagnation which in turn results in further inflammation and ultimate ulceration. healing of such ulcers may result in cicatricial contraction and organic stenosis. ulceration may follow trauma by instrument, foreign body, or corrosive. differential diagnosis of ulcer of the esophagus _simple ulcer_ requires the exclusion of lues, tuberculosis, epithelioma, endothelioma, sarcoma, and actinomycosis. simple ulcer of the esophagus is usually associated with stenosis, spastic or organic. _luetic ulcers_ commonly show a surrounding inflammatory areola, and they usually have thickened elevated edges, generally free from granulation tissue, with a pasty center not bleeding readily when sponged. the wassermann reaction may contribute to the diagnosis; but if negative, a thorough and prolonged test with mercury is imperative. it must be remembered that a person with lues may have a simple, mixed, or malignant ulceration of the esophagus, or the three lesions may even be combined. it may be in some cases possible to demonstrate the treponema pallidum in scrapings taken from the ulcer. the single _tuberculous ulcer_ is usually pale, superficial, and granular in base. if it is a continuation from more extensive extra-esophageal tuberculous ulceration, pale cauliflower granulations may be present. slight cicatrices may be seen. tuberculosis in other organs can almost always be demonstrated by roentgenographic, physical, or laboratory studies. tuberculin tests and animal injection with an emulsion of a specimen of tissue may be required. the specimen must be taken very superficially to avoid risk of perforation. _sarcomatous ulcers_ do not differ materially in appearance from those of carcinoma, but they are much more rare. _carcinomatous ulcer_ is usually characterized by the very vascular bright red zone, raised edges, fungations, granulation tissue that bleeds freely on the lightest touch, and above all, it is almost invariably situated on an infiltrated base which communicates a feeling of hardness to the pressure of sponges or the esophagoscope itself. a scar may be from the healing of an ulcer from stasis, or one of specific or precancerous character. it may be a cancerous process developing on the site of a scar, so that the presence of scar tissue does not absolutely negative malignancy. as a rule, however, scars are absent in cancer of the esophagus. the firm and sometimes prominent ridge of the crossing of the left bronchus must not be mistaken for infiltration, and the esophagoscopist must be familiar with the normal rigidity of the cricopharyngeus. [ ] mixed infection gives to all esophageal ulceration a certain uniformity of appearance, so that laboratory studies of smears or histologic and bacteriologic study of tissue specimens taken from fungations or thickened edges are often required to confirm the endoscopic diagnosis. if the edges are thin and flat, the taking of a specimen involves some risk; fungations can be removed without risk; so can nodules, but care must be taken that projecting folds are not mistaken for nodules. it is always wise to push the therapeutic test with potassium iodid and especially mercury in any case of esophageal ulceration unassociated with stasis. _treatment of acute and subacute inflammation and ulceration of the esophagus_.--bismuth subnitrate in doses of about one gramme, given dry on the tongue and swallowed without water, has a local antiseptic and protective action. its antiseptic power may be enhanced by the addition of calomel to the powder, in such amount as may be tolerated by the bowels. if pain be present the combination of a grain or two of anesthesin or orthoform with the bismuth will be grateful. the local application of argyrol in per cent watery solution is also of great value. the mouth and teeth are to be kept clean with a mouth wash of dakin's solution, part, to peppermint water, parts. the esophagus must be placed at rest as far as possible by liquid diet or, if need be, by gastrostomy. chronic esophagitis this is usually a result of stagnation of food or secretion, and will be considered under spasmodic stenosis and diffuse dilatation of the esophagus. a very marked case with local distress and pain extending through to the back was seen by the author in consultation with dr. john b. wright who had made the diagnosis. the patient was a sufferer from ankylostomiasis. [ ] compression stenosis of the esophagus the esophagus may be narrowed by the pressure of any periesophageal disease or anomaly. the lesions most frequently found are: . goiter, cervical or thoracic. . malignancy of any of the intrathoracic viscera. . aneurysm. . cardiac and aortic enlargement. . lymphadenopathies. hodgkins' disease. leukemia. lues. tuberculosis. simple infective adenitis. . lordosis. . enlargement of the left hepatic lobe. endoscopically, compression stenosis of the esophagus is manifested by a slit-like crevice which occupies the place of the lumen and which does not open up readily before the advancing tube. the long axis of the slit is almost always at right angles to the compressive mass, if the esophageal wall be uninvolved. the covering mucosa may be normal or it may show signs of chronic inflammation. malignant compressions are characterized by their hardness when palpated with the tube. associated pressure on the recurrent laryngeal nerve often makes laryngeal paralysis coexistent. the nature of the compressive mass will require for its determination the aid of the roentgenologist, internist, and clinical laboratory. compression by the enlarged left auricle has been observed a number of times. the presence of aneurysm is a distinct contraindication to esophagoscopy for diagnosis except in case of suspected foreign body. _treatment of compressive stenosis of the esophagus_ depends upon the nature of the compressive lesion and is without the realm of endoscopy. in uncertain cases potassium iodid, and especially mercury, should always be given a thorough and prolonged trial; an occasional cure will result. esophageal intubation is indicated in all conditions except aneurysm. gastrostomy should be done early when necessary. diffuse dilatation of the esophagus this is practically always due to stagnation ectasia, which is invariably associated with either organic or "spasmodic" stricture, existing at the time of observation or at some time prior thereto. the dilating effect of the repeatedly accumulated food results in a permanent enlargement, so that the esophagus acts as the reservoir of a large funnel with a very small opening. when food is swallowed the esophagus fills, and the contents trickle slowly through the opening. gases due to fermentation increase the distension and cause substernal pressure, discomfort, and belching. a very large dilatation of the thoracic esophagus indicates spastic stenosis. cicatricial stenoses do not result in such large dilatations and the dilatation above a malignant stenosis is usually slight, probably because of its relatively shorter duration. the _treatment of diffuse esophageal dilatation_ consists in dilating the "diaphragmatic pinchcock" that is, the hiatal esophagus. chronic esophagitis is to be controlled by esophageal lavage, the regulation of the diet to liquefiable foods and the administration of bismuth subnitrate. the patient can be taught to do the lavage. the local esophagoscopic application of a small quantity of a per cent watery solution of argyrol may be required for the static esophagitis. the redundancy probably never disappears; but functional and subjective cures are usually obtainable. [ ] chapter xxxi--diseases of the esophagus (_continued_) spasmodic stenosis of the esophagus _etiology_.--the functional activity of the esophagus is dependent upon reflex action. the food is propulsed in a peristaltic wave by the same mechanism as, and through an innervation (auerbach and meissner plexus) similar to that which controls intestinal movements. the vagus also is directly concerned with the deglutitory act, for swallowing is impossible if both vagi are cut. anything which unduly disturbs this reflex arc may serve as an exciting cause of spasmodic stenosis. bolting of food, superficial erosions, local esophageal disease, or a small foreign body, may produce spasmodic stenosis. spasm secondary to disease of the stomach, liver, gall bladder, appendix, or other abdominal organ is clinically well recognized. a perpetuating cause in established cases is undoubtedly "nerve cell habit," and in many cases there is an underlying neurotic factor. shock as an exciting cause has been well exemplified by the number of cases of phrenospasm developing in soldiers during the world war. _cricopharyngeal spasmodic stenosis_ usually presents the subjective symptom of difficulty in starting the bolus of food downward. once started, the food passes into the stomach unimpeded. regurgitation, if it occurs, is immediate. the condition consists in a tonic contraction, ahead of the bolus, of the circular fibers of the inferior constrictor known as the cricopharyngeus muscle, or in a failure of this muscle to relax so as to allow the bolus to pass. in either case the disorder may be secondary to an organic lesion. local malignant disease or foreign bodies may be the cause. globus hystericus, "lump in the throat," and the sense of constriction and choking during emotion are due to the same spasmodic condition. _diagnosis_.--at esophagoscopy there will be found marked exaggeration of the usual spasm which occurs at the cricopharyngeus during the introduction of the tube. the lumen may assume various shapes, or be so tightly closed that the folds form a mammilliform projection in the center. if the spasm gradually yields, and a full-sized esophagoscope passes without further resistance, it may be stated that the esophagus is of normal calibre, and a diagnosis of spasmodic stenosis can be made. considerable experience is required to distinguish between normal and pathologic spasm in an unanesthetized individual. to the less experienced esophagoscopist, examination under ether anesthesia is recommended. deep anesthesia will relax the normal cricopharyngeal reflex closure as well as any abnormal spasm, thus assisting in the differentiation between an organic stricture and one of functional character. under deep general anesthesia, however, it is impossible to differentiate between the normal reflex and a spasmodic condition, since both are abolished. many cases of intermittent esophageal stenosis supposed to be spasmodic are due to organic narrowness of lumen plus lodgement of food, obstructive in itself and in the esophagitis resulting from its presence. the organic narrowing, congenital or pathologic, is readily recognizable esophagoscopically. _treatment_.--the fundamental cause of the disturbance of the reflex should be searched for, and treated according to its nature. purely functional cases are often cured by the passage of a large esophagoscope. recurrences may require similar treatment. [ ] functional hiatal stenosis. hiatal esophagismus. phrenospasm, diaphragmatic pinchcock stenosis. (so-called cardiospasm) there is no sphincteric muscular arrangement at the cardiac orifice of the esophagus, so that spasmodic stenosis at this level is not possible and the term cardiospasm is, therefore, a misnomer. it was first demonstrated by the author that in so-called cardiospasm the functional closure of the esophagus occurred at the diaphragmatic level, and that it was due to the "diaphragmatic pinchcock." anatomical studies have corroborated this finding by demonstrating a definite sphincteric mechanism consisting of muscle bands springing from the crura of the diaphragm and surrounding the esophagus at the under surface of the hiatus. an inspection of the cadaveric diaphragm from below will demonstrate an arrangement like double shears admirably adapted to this "pinchcock" action. further confirmation is the fact that all dilatation of the esophagus incident to spasm at its lower extremity is situated above the diaphragm. in passing it may be stated that the pinchcock action, plus the kinking of the esophagus normally prevents regurgitation when a man with a full stomach "stands on his head" or inverts his body. for the upward escape of food from the stomach an involuntary co-ordinated antiperistaltic cycle is necessary. the dilatation resulting from phrenospasm may reach great size (fig. a), and the capacity of the sac may be as much as two liters. while the esophagus is usually dilated, the stomach on the other hand is often contracted, largely from lack of distention by food, but possibly also because of a spastic state due to the same causes as the phrenospasm. recently mosher has demonstrated that hepatic abnormality may furnish an organic cause in many cases formerly considered spasmodic. the _symptoms of hiatal esophagismus_ are variable in degree. substernal distress, with a feeling of fullness and pressure followed by eructations of gas and regurgitation of food within a period of a quarter of an hour to several hours after eating, are present. if the esophageal dilatation be great, regurgitation may occur only after an accumulation of several days, when large quantities of stale food will be expelled. the general nutrition is impaired, and there is usually the history of weight loss to a certain level at which it is maintained with but slight variation. this is explained by the trickling of liquified food from the esophageal reservoir into the stomach as the spasm intermittently relaxes, this occurring usually before a serious state of inanition supervenes. at times the hiatal spasms are extremely violent and painful, the pain being referred from the xiphoid region to the back, or upward into the neck. patients are often conscious of the times of patulency of the esophagus; they will know the esophagus to be open and will eat without hesitation, or will refuse food with the certain knowledge that it will not pass into the stomach. periods of remission of symptoms for months and years are noted. the neurotic character of the lesion in some cases is evidenced by the occasionally sudden and startling cures following a single dilatation, as well as by the tendency to relapse when the individual is subject to what is for him undue nervous tension. in a very few cases, with patients of rather a stolid type, all neurotic tendencies seem to be absent. the _diagnosis of hiatal esophagismus_ requires the exclusion of local organic esophageal lesions. in the typical case with marked dilatation, the esophagoscopic findings are diagnostic. a white, pasty, macerated mucosa, and normally contracted hiatus esophageus which when found permits the large esophagoscope to pass into the stomach, will be recognized as characteristic by anyone who has seen the condition. in the cases with but little esophageal distension the diagnosis is confirmed by the constancy of the obstruction to a barium mixture at the phrenic level, while at esophagoscopy the usual resistance at the hiatus esophageus is found not to be increased, and no other local lesion is found as the esophagoscope enters the stomach. it is the failure of the diaphragmatic pinchcock to open, as in the normal deglutitory cycle, rather than a spasmodic tightness, that obstructs the food. the presence of organic stenosis at the hiatus may remove the case altogether from the spasmodic class, or a cicatricial or infiltrated narrowing may be the result of static esophagitis. a compressive stenosis due to hepatic abnormality may simulate spasmodic stenosis as shown by mosher, who believes that per cent of so-called cardiospasms are organic. _treatment of hiatal esophagismus (so-called cardiospasm)_ consists in the over-dilatation of the "diaphragmatic pinchcock" or hiatus esophageus, and in proper remedial measures for the removal of the underlying neurosis. the simple passage of the esophagoscope suffices to cure some cases. further dilatation by endoscopic guidance may be obtained by the introduction of mosher's divulsor through the esophagoscope, by which accurate placement is obtained. the distension should not usually exceed mm. numerous water and air bags have been devised for stretching the hiatus, and excellent results have been obtained by their use. possibly some of the cures have been due to the dilatation of organic lesions, or to the crowding back of an enlarged malposed, or otherwise abnormal left lobe of the liver, which mosher has shown to be an etiologic factor. certain cases prove very obstinate of cure, and require esophageal lavage for the esophagitis, and feedings through the stomach tube to increase nutrition and to dilate the contracted stomach. gastrostomy for feeding rarely becomes necessary, for a stomach tube can always be placed with the esophagoscope if it will not pass otherwise. retrograde dilatation with the fingers through a gastrostomy opening has been done, but seems hardly warranted in view of the excellent results obtainable from above. instructions should be given concerning the proper mastication of food, and during treatment the frequent partaking of small quantities of liquid foods is recommended. liquids and foods should be neither hot nor cold. the neurologist should be consulted in cases deemed neurotic. [ a.-functional hiatal stenosis. cramp of the diaphragmatic pinchcock (so-called cardiospasm).] endocrine imbalance should be investigated and treated, as urged by macnab. _esophageal antiperistalsis_ is the name given by the author to a heretofore undescribed disease associated with regurgitation of food from the esophagus, the food not having reached the stomach. it may be continuous or paroxysmal and may be of so serious a degree as to threaten starvation. the best treatment in severe cases is gastrostomy to put the esophagus at rest. milder cases get well under liquid diet, rest in bed, endocrine therapy, cure of associated abdominal disease, etcetera. [ ] chapter xxxii--diseases of the esophagus (_continued_) cicatricial stenosis of the esophagus _etiology_.--the accidental swallowing of caustic alkali in solutions of lye or proprietary washing and cleansing powders, is the most frequent cause of cicatricial stenosis. commercial lye preparations are about per cent sodium hydroxide. the cleansing and washing powders contain from eight to fifty per cent of caustic alkali, usually soda ash, and are sold by grocers everywhere. the labels on their containers not only give no warning of the dangerous nature of the contents nor antidotal advice, but have such directly misleading statements as : "will not injure the most delicate fabric," "will not injure the hands," etc. utensils used to measure or dissolve the powders are afterward used for drinking, without rinsing, and thus the residue of the powder remaining is swallowed in strong solution. at other times solutions of lye are drunk in mistake for water, coffee, or wine. these entirely preventable accidents would be rare if they were as conspicuously labelled "poison" as is required by law in the case of these and any other poisons, when sold by druggists. the necessity for such labelling is even greater with the lye preparations because they go into the kitchen, whereas the drugs go to the medicine shelf, out of the reach of children. "household ammonia," "salts of tartar" (potassium carbonate), "washing soda" (sodium carbonate), mercuric chloride, and strong acids are also, though less frequently, the cause of cicatricial esophageal stricture. tuberculosis, lues, scarlet fever, diphtheria, enteric fever and pyogenic conditions may produce ulceration followed by cicatrices of the esophagus. spasmodic stenosis with its consequent esophagitis and erosions, and, later, secondary pyogenic infection, may result in serious cicatrices. peptic ulcer of the lower esophagus may be a cause. the prolonged sojourn of a foreign body is likely to result in cicatricial narrowing. [fig. .--schematic illustration of a series of eccentric strictures with interstrictural sacculations, in the esophagus of a boy aged four years. the strictures were divulsed seriatim from above downward with the divulsor, the esophageal wall, d, being moved sidewise to the position of the dotted line by means of a small esophagoscope inserted through the upper stricture, a, after divulsion of the latter.] _location of cicatricial esophageal strictures_.--the strictures are often multiple and their lumina are rarely either central or concentric (fig. ). in order of frequency the sites of cicatricial stenosis are: . at the crossing of the left bronchus; . in the region of the cricopharyngeus; . at the hiatal level. stricture at the cardia has rarely been encountered in the bronchoscopic clinic. stenosis of the pylorus has been noted, but is rare. _prognosis_.--spontaneous recovery from cicatricial stenosis probably never occurs, and the mortality of untreated small lumen strictures is very high. blind methods of dilatation are almost certain to result in death from perforation of the esophageal wall, because some pressure is necessary to dilate a stricture, and the point of the bougie, not being under guidance of the eye, is certain at sometime or other to be engaged in a pocket instead of in the stricture. pressure then results in perforation of the bottom of the pocket (fig. ). this accident is contributed to by dilatation with the wrinkled, scarred floor which usually develops above the stricture. rapid divulsion and internal esophagotomy are mechanically very easily and accurately done through the esophagoscope, and would yield a few prompt cures; but the mortality would be very high. under certain circumstances, to be explained below, gentle divulsion of the proximal one of a series of strictures has to be done. with proper precautions and a gentle hand, the risk is slight. under esophagoscopic bouginage the prognosis is favorable as to ultimate cure, the duration of the treatment varying with the number of strictures, the tightness, and the extent of the fibrous tissue-changes in the esophageal wall. mortality from the endoscopic procedure is almost nil, and if gastrostomy is done early in the tightly stenosed cases, ultimate cure may be confidently expected with careful though prolonged treatment. [fig. .--schema illustrating the mechanism of perforation by blind bouginage. on encountering resilient resistance the operator, having a false conception, pushes on the bougie. perforation results because in reality the bougie is in a pocket of the suprastrictural eccentric dilatation.] _symptoms_.--dysphagia, regurgitation, distress after eating, and loss of weight, vary with the degree of the stenosis. the intermittency of the symptoms is sometimes confusing, for the lodgment of relatively large particles of food often simulates a spasmodic stenosis, and in fact there is often an element of spasm which holds the foreign body in the strictured area until it relaxes. static esophagitis results in a swelling of the esophageal walls and a narrowing of the lumen, so that swallowing is more or less troublesome until the esophagitis subsides. _esophagoscopic appearances of cicatricial stenosis_.--the color of the cicatricial area is usually paler than the normal mucosa. the scars may be very white and elevated, or they may be flush with the normal mucosa, or even depressed. occasionally the cicatrix is annular, but more often it is eccentric and involves only a part of the circumference of the wall. if the amount of scar tissue is small, the lumen maintains its mobility; opens and closes during respiration, cough, and vomiturition. between two strictures there is often a pouch containing food remnants. it is rarely possible to see the lumen of the second stricture, because it is usually eccentric to the first. stagnation of food results in superjacent dilatation and esophagitis. erosions and ulcerations which follow the stagnation esophagitis increase the cicatricial stenosis in their healing. _differential diagnosis_.--when the underlying condition is masked by inflammation and ulceration, these lesions must be removed by frequent lavage, the administration of bismuth subnitrate with the occasional addition of calomel powder, and the limitation of the diet to strained liquids. the cicatricial nature of the stenosis can then be studied to better advantage. in most cases the cicatrices are unmistakably conspicuous. spasmodic stenoses are differentiated by the absence of cicatrices and the yielding of the stenosis to gentle but continuous pressure of the esophagoscope. while it is possible that spasmodic stenosis may supplement cicatricial stenosis, it is certainly exceedingly rare. nearly all of the occasions in which a temporary increase of the stenosis in a cicatricial case is attributed to an element of spasm, the real cause of the intermittency is not spasm but obstruction caused by food. this occurs in three ways: . actual "corking" of the strictured lumen by a fragment of food, in which case intermittency may be due to partial regurgitation of the "corking" mass with subsequent sinking tightly into the stricture. . the "cork" may dissolve and pass on through to be later replaced by another. . reactionary swelling of the esophageal mucosa due to stagnation. here again the obstruction may be prolonged, or it may be quite intermittent, due to a valve-like action of the swollen mucosal surfaces or folds intermittently coming in contact. cancerous stenosis is accompanied by infiltration of the periesophageal tissue, and usually by projecting bleeding fungations. cancer may, however, develop on a cicatrix, favored no doubt by chronic inflammation in tissue of low resistance. compression stenosis of the esophagus is characterized by the sudden transition of the lumen to a linear or crescentic outline, while the covering mucosa is normal unless esophagitis be present. the compressive mass can be detected by the sensation transmitted to the touch by the esophagoscope. _treatment_.--blind bouginage should be discarded as an obsolete and very dangerous procedure. if the stenosis be so great as to interfere with the ingestion of the required amount of liquids, gastrostomy should be done at once and esophagoscopic treatment postponed until water hunger has been relieved. gastrostomy aids in the treatment by putting the esophagus at rest, and by affording the means of maintaining a high degree of nutrition unhampered by the variability or efficiency of the swallowing function. careful diet and gentle treatment will, however, usually avoid gastrostomy. the diet in the gastrostomy-fed patients should be as varied as in oral alimentation; even solids of the consistency of mashed potatoes, if previously forced through a wire gauze strainer, may be forced through the tube with a glass injector. liquids and readily liquefiable foods are to be given the non-gastrostomized patient, solids being added when demonstrated that no stagnation above the stricture occurs. thorough mastication and the slow partaking of small quantities at a time are imperative. should food accumulation occur, the esophagus should be emptied by regurgitation, following which a glassful of warm sodium bicarbonate solution is to be taken, and this also regurgitated if it does not go through promptly. the esophagus is thus lavaged and emptied. in all these cases, whether being fed through the mouth or the gastrostomic tube, it is very important to remember that milk and eggs are not a complete dietary. a pediatrist should be consulted. prof. graham has saved the lives of many children by solving the nutritive problems in the cases at the bronchoscopic clinic. fruit and vegetable juices are necessary. vegetable soups and mashed fruits should be strained through a wire gauze coffee strainer. if the saliva is spat out by the child because it will not go through the stricture the child should be taught to spit the saliva into the funnel of the abdominal tube. this method of improving nutrition was discovered by miss groves at the bronchoscopic clinic. _esophagoscopic bouginage_ with the author's silk-woven steel-shank endoscopic bougies (fig. ) has proven the safest and most successful method of treatment. the strictured lumen is to be centered in the esophagoscopic field, and three successively increasing sizes of bougies are used under direct vision. larger and larger bougies are used at the successive treatments which are given at intervals of from four to seven days. no anesthesia, general or local, is used for esophagoscopic bouginage. the tightness of the grasping of the bougie by the stricture on withdrawal, determines the limitation of sizes to be used. when the upper stricture is dilated, lower ones in the series are taken seriatim. if concentric, two or more closely situated strictures may be simultaneously dilated. for the use of bougies of the larger sizes, the special esophagoscopes with both the light-carrier canal and the drainage canal outside the lumen of the tube are needed. functional cure is obtained with a relatively small lumen at the point of stenosis. a lumen of mm. will allow the passage of any well masticated food. it is unwise and unsafe to attempt to restore the lumen to its normal anatomic size. in cicatricial stricture cases it is advisable to examine the esophagus at monthly periods for a time after a functional cure has been obtained, in order that tendency to recurrence may be early detected. _divulsion_ of an upper stricture may be deemed advisable in order to reach others lower down, especially in cases of multiple eccentric strictures (fig. ). this procedure is best done with the author's esophagoscopic divulser, accurately placed by means of the esophagoscope; but divulsion requires the utmost care, and a gentle hand. even then it is not so safe as esophagoscopic bouginage. _internal esophagotomy_ by the string-cutting instruments and esophagotome are relatively dangerous methods, and perhaps yield in the end no quicker results than the slower and safe bouginage per tubam. _electrolysis_ has been used with varying results in the treatment of cicatricial stenosis. _thermic bouginage_ with electrically heated bougies has been found useful in some cases by dean and imperatori. [ ] _string-swallowing_, with the passage of olives threaded over the string has yielded good results in the hands of some operators. the string may be used to pull up dilators in increasing sizes, introduced through a gastrostomic fistula. the string stretched across the stomach from the cardia to the pylorus, is fished out with the author's pillar retractor, or is found with the retrograde esophagoscope (fig. ). the string is attached to a dilator (fig. ), and a fresh string is pulled in to replace the one pulled out. this is the safest of the blind methods. it is rarely possible to get a child under two years of age to swallow and tolerate a string. it is better after each treatment to draw the upper end of the string through the nose, as it is not so likely to be chewed off and is less annoying. with the esophagoscope, the string is not necessary, because the lumen of the stricture can be exposed to view by the esophagoscope. _retrograde esophagoscopy_ through a gastrostomy wound offers some advantages over peroral treatment; but unless the gastrostomy is high, the procedure is undoubtedly more difficult. the approach to the lowest stricture from below is usually funnel shaped and free from dilatation and redundancy. it must be remembered the stricture seen from below may not be the same one seen from above. roentgenray examination with barium mixture or esophagoscopes simultaneously in situ above and below are useful in the study of such cases. _impermeable strictures_ of the cervical esophagus are amenable to external esophagotomy, with plastic reformation of the esophagus. those in the middle third have not been successfully treated by surgical methods, though various ingenious operations for the formation of an extrathoracic esophagus have been suggested as means of securing relief. impermeable strictures of the lower third can with reasonable safety be treated by the brenneman method, which consists in passing the esophagoscope down to the stricture while the surgeon, inserting his finger up into the esophagus from the stomach, can feel the end of the esophagoscope. an incision through the tissue barrier is then made from below, passing the knife along the finger as a guide. a soft rubber stomach-tube is pulled up from below and left in situ, being replaced at intervals by a fresh one, pulled up from the stomach, until epithelialization of the new lumen is complete. catheters are used in children. in replacing the catheter or stomach tube the fresh one is attached to the old one by stitching in a loop of braided silk. frequent esophagoscopic bouginage will be required to maintain the more or less fistulous lumen until it is epithelialized, and in occasional cases, for a long time thereafter. in cases of absolute atresia the saliva does not reach the stomach. no one realizes the quantity of normal salivary drainage, nor its importance in nutritive processes. oral insalivation is of little consequence compared to esophagogastric drainage. gastrostomized children with absolute atresia of the esophagus do not thrive unless they regurgitate the salivary accumulations into the funnel of the gastrostomic feeding tube. this has been abundantly proven by observations at the bronchoscopic clinic. my attention was first called to this clinical fact by miss frances groves who has charge of these cases. _intubation of the esophagus_ with soft rubber tubes has occasionally proven useful. [ ] chapter xxxiii--diseases of the esophagus (_continued_) diverticulum of the esophagus diverticula may, and usually do, consist in a pouching by herniation, of the whole thickness of the esophageal wall; or they may be herniations of the mucosa between the muscular layers. they are classified according to their etiology, as traction and pulsion diverticula. [fig. .--traction diverticulum of the esophagus rendered visible in the roentgenogram by a swallowed opaque mixture. case of h. w. dachtler, am. journ. roentgenology.] _traction diverticulum of the esophagus_ (fig. ) is a rare condition, usually occurring in the thorax, and as a rule constituting a one-sided enlargement of the gullet rather than a true pouch formation. it is supposed to be formed by the pulling during cough, respiration, and swallowing, on localized adhesions of the esophagus to periesophageal structures, such as inflammatory peribronchial glands. _diagnosis_ is often incidental to examination of the gastrointestinal tract for other conditions, because traction diverticula usually cause no symptoms. unless a very large esophagoscope be used, a traction diverticulum may easily be overlooked in the mucosal folds. careful lateral search, however, will reveal the dilatation, and the localized periesophageal fixation may be demonstrated. the subdiverticular esophagus is readily followed, its lumen opening during inspiration unless very close to the diaphragm, which is very rare. perhaps most cases will be discovered by the roentgenologist. it has been said that traction diverticula are more readily demonstrated in the roentgenologic examination, if the patient be placed with pelvis elevated. _pulsion diverticulum of the esophagus_ is an acquired hernia of the mucosa between the circular and oblique fibers of the inferior constrictor muscle of the pharynx. a congenital anatomic basic factor in etiology probably exists. the pouching develops in the middle part of the posterior wall, between the orbicular and oblique fibers of the cricopharyngeus muscle, at which point there is a gap, leaving the mucosa supported only by a not very resistant fascia (fig. ). when small, the sac is in the midline, but with increase in size, it presents either to the right or the left side, commonly the latter. the sac may be very small, or it may be sufficiently large to hold a pint or more, and to cause the neck to bulge when filled. when large, the pouch extends into the mediastinum. it will be seen that anatomically the pulsion diverticulum has its origin in the pharynx; the symptoms, however, are referable to the esophagus and the subdiverticular esophagus is stenosed by compression of the pouch; therefore, it is properly classified as an esophageal disease. [fig. .--schema illustrative of the etiology of pressure diverticula. o, oblique fibers of the cricopharyngeus attached to the thyroid cartilage, t. the fundiform fibers, f, encircle the mouth of the esophagus. between the two sets of fibers is a gap in the support of the esophageal wall, through which the wall herniates owing to the pressure of food propelled by the oblique fibers, o, advance of the bolus being resisted by spasmodic contraction of the orbicular fibers, f.] _etiology_.--pressure diverticula occur after middle life, and more often in men than in women. the hasty swallowing of unmasticated food, too large a bolus, defective or artificial teeth, flaccidity of tissues, and spasm of the cricopharyngeus muscle, are etiologic factors. cicatricial stenosis below the level of the inferior constrictor is a contributory cause in some cases. _prognosis_.--after the pouch is formed, it steadily increases in size, since the swallowed food first fills and distends the sac before the overflow passes down the esophagus. when a pendulous sac becomes filled with food, it presses on the subdiverticular esophagus, and produces compression stenosis; so that there exists a "vicious circle." the enlargement of the sac produces increasing stenosis with consequent further distension of the pouch. this explains the clinically observed fact, that unless treated, pulsion diverticula increase progressively in size, and consequently in distressing symptoms. the sac becomes so large in some cases as to contribute to the occurrence of cerebral apoplexy by interference with venous return. practically all cases can be cured by radical operation. the operative mortality varies with the age, state of nutrition, and general health of the patient. in general it may be said to have a mortality of at least per cent, largely due to the fact that most cases are poor surgical subjects. recurrences after radical operation are due to a persistence of the original causes, i.e., bolting of food; stenosis, spasmodic or organic, of the esophageal lumen; and weakness in the support of the esophageal wall, which, unsupported, has little strength of its own. _symptoms_.--dysphagia, regurgitation, a gurgling sound and subjective bubbling sensation on swallowing, sour odor to the breath, and cough, are the chief symptoms. with larger pouches, emaciation, pressure sensation in the neck and upper mediastinum, and the presence of a mass in the neck when the sac is filled, are present. tracheal compression by the filled pouch may produce dyspnea. the sac may be emptied by pressure on the neck, this means of relief being often discovered by the patient. the sac sometimes spontaneously empties itself by contraction of its enveloping muscular layer, and one of the most annoying symptoms is the paroxysm of coughing, waking the patient, when during the relaxation of sleep the sac empties itself into the pharynx and some of its contents are aspirated into the larynx. there are no pathognomonic symptoms. those recited are common to other forms of esophageal stenosis, and are urgent indications for diagnostic esophagoscopy. _diagnosis_.--roentgenray study with barium mixtures, is the first step in the diagnosis (fig. ). this is to be followed by diagnostic esophagoscopy. malignant, spasmodic, cicatricial, and compression stenosis are to be excluded by esophagoscopic appearances. aneurysm is to be eliminated by the usual means. the boyce sign is almost invariably present, and is diagnostic. it is elicited by telling the patient to swallow, which action imprisons air in the sac. the imprisoned air is forced out by finger-pressure on the neck, over the sac. the exit of the air bubble produces a gurgling sound audible at the open mouth of the patient. _esophagoscopic appearances in pulsion diverticulum_.--the esophagoscope will without difficulty enter the mouth of the sac which is really the whole bottom of the pharynx, and will be arrested by the blind end of the pouch, the depth of which may be from to cm. in some cases the bottom of the pouch is in the mediastinum. the walls are often pasty, and may be eroded, or ulcerated, and they may show vessels or cicatrices. on withdrawing the tube and searching the anterior wall, the subdiverticular slit-like opening of the esophagus will be found, though perhaps not always easily. the esophageal speculum will be found particularly useful in exposing the subdiverticular orifice, and through this a small esophagoscope may be passed into the esophagus, thus completing the diagnosis. care must be exercised not to perforate the bottom of the diverticular pouch by pressure with the esophagoscope or esophageal speculum. the walls of the sac are surprisingly thin. [fig. .--pulsion diverticulum filled with bismuth mixture in a man of fifty years.] _treatment of pulsion diverticulum_.--if the pouch is small, the subdiverticular esophageal orifice may be dilated with esophagoscopic bougies, thus overcoming the etiologic factor of spastic or organic stenosis. the redundancy remains, however, though the symptoms may be relieved. cutting the common wall between the esophagus and the sac by means of scissors passed through the endoscopic tube, has been successfully done by mosher. various methods of external operation have been devised, among which are: ( ) freeing the sac through an external cervical incision and suturing its fundus upward against the pharynx, which has proved successful in some cases. ( ) inversion of the sac into the pharynx and suture of the mouth of the pouch. in a case so treated the pouch was blown out again during a fit of sneezing eight months after operation. ( ) plication of the walls of the sac by catgut sutures, as in the matas obliterative operation for aneurysm. ( ) freeing and removing the sac, with suture of the esophageal wound. ( ) removal of the sac by a two-stage operation, in which method the initial step is the deliverance of the sac into the cervical wound, where it remains surrounded by gauze packing until adhesions have walled off the mediastinum. the work is completed by cutting off the sac and either suturing the esophageal wound or touching it with the cautery, and allowing it to heal by granulation. external exposure and amputation of the sac has been more frequently done than any other operation. unless the pouch is large, it is extremely difficult to find after the surgeon has exposed the esophagus, for the reasons that at operation it is empty and that when the adhesions about it are removed the walls of the sac contract. after removal, the sac is disappointingly small as compared with its previous size in the roentgenogram, which shows it distended with opaque material. it has been the chagrin of skilled surgeons to find the diverticulum present functionally and roentgenographically precisely the same as before the performance of the very trying and difficult operation. the time of operation may be shortened at least by one-half by the aid of the esophagoscopist in the gaub-jackson operation. intratracheally insufflated ether is the anesthesia of choice. after the surgeon has exposed the esophagus by dissection, the endoscopist introduces the esophagoscope into the sac, and delivers it into the wound, while the surgeon frees it from adhesions. the esophagoscope is now withdrawn from the pouch and entered into the esophagus proper, below the diverticulum, while the surgeon cuts off the hernial sac and sutures the esophagopharyngeal wound over the esophagoscope. the presence of the esophagoscope prevents too tight suture and possible narrowing of the lumen (fig. ). [fig. .--schematic representation of esophagoscopic aid in the excision of a diverticulum in the gaub-jackson operation. at a the esophagoscope is represented in the bottom of the pouch after the surgeon has cut down to where he can feel the esophagoscope. then the esophagoscopist causes the pouch to protrude as shown by the dotted line at b. after the surgeon has dissected the sac entirely loose from its surroundings, traction is made upon the sac as shown at h and the esophagoscope is inserted down the lumen of the esophagus as shown at c. the esophagoscope now occupies the lumen which the patient will need for swallowing. it only remains for the surgeon to remove the redundancy, without risk of removing any of the normal wall. the esophagoscope here shown is of the form squarely cut off at the end. the standard form of instrument with slanted end will serve as well.] _after-care_.--feeding may be carried on by the placing of a small nasal feeding tube into the stomach at the time of operation. gastrostomy for feeding as a preliminary to the esophageal operation has been suggested, and is certainly ideal from the viewpoint of nutrition and esophageal rest. the decision of its performance may perhaps be best made by the patient himself. should leakage through the neck occur, the fistula should be flushed by the intake of sterile water by mouth. oral sepsis should, of course, be treated before operation and combated after operation by frequent brushing of the teeth and rinsing of the mouth with dakin's solution, one part, to ten parts of peppermint water. a postoperative barium roentgenogram should be made in every case as a matter of record and to make certain the proper functioning of the esophagus. [ ] chapter xxxiv--diseases of the esophagus (_continued_) paralysis of the esophagus the passage of liquids and solids through the esophagus is a purely muscular act, controlled, after the propulsive usually voluntary start given to the bolus by the inferior constrictor, by a reflex arc having connection with the central nervous system through the vagus nerve. gravity plays little or no part in the act of deglutition, and alone will not carry food or drink to the stomach. paralysis of the esophagus may be said to be motor or sensory. it is rarely if ever unassociated with like lesions of contiguous organs. _motor paralysis of the esophagus_ is first manifested by inability to swallow. this is associated with the accumulation of secretion in the pyriform sinuses (the author's sign of esophageal stenosis) which overflows into the larynx and incites violent coughing. motor paralysis may affect the constrictors or the esophageal muscular fibers or both. _sensory paralysis of the esophagus_ by breaking the continuity of the reflex arc, may so impair the peristaltic movements as to produce aphagia. the same filling of the pyriform sinuses will be noted, but as the larynx is usually anesthetic also, it may be that no cough is produced when secretions overflow into it. _etiology_.-- . toxic paralysis as in diphtheria. . functional paralysis as in hysteria. . peripheral paralysis from neuritis. . central paralysis, usually of bulbar origin. embolism or thrombosis of the posterior cerebral artery is a reported cause in two cases. lues is always to be excluded as the fundamental factor in the groups and . esophageal paralysis is not uncommon in myasthenia gravis. _esophagoscopic findings_ are those of absence of the normal resistance at the cricopharyngeus, flaccidity and lack of sensation of the esophageal walls, and perhaps adherence of particles of food to the folds. the hiatal contraction is usually that normally encountered, for this is accomplished by the diaphragmatic musculature. in paralysis of sensation, the reflexes of coughing, vomiturition and vomiting are obtunded. _diagnosis_.--hysteria must not be decided upon as the cause of dysphagia, until after esophagoscopy has eliminated paralysis. dysphagia after recent diphtheria should suggest paralysis of the esophagus. the larynx, lips, tongue, and pharynx also, are usually paralyzed in esophageal paralysis of bulbar origin. the absence of the cricopharyngeal resistance to the esophagoscope passed without anesthesia, general or local, is diagnostic. _treatment_.--the internist and neurologist should govern the basic treatment. nutrition can be maintained by feeding with the stomach-tube, which meets no resistance to its passage. should this be contraindicated by ulceration of the esophagus, gastrostomy should be done. lues of the esophagus _esophageal syphilis_ is a rather rare affection, and may show itself as a mucous plaque, a gumma, an ulceration, or a cicatrix. cicatricial stenosis developing late in life without history of the swallowing of escharotics or ulcerative lesions is strongly suggestive of syphilis, though the late manifestation of a congenital stenosis is a possibility. _esophagoscopic appearances_ of lues are not always characteristic. as in any ulcerative lesion, the inflammatory changes of mixed infections mask the basic nature. the mucous plaque has the same appearance as one situated on the velum, and gummata resemble those seen in the mucosa elsewhere. there is nothing characteristic in luetic cicatrices. _the diagnosis_ of luetic lesions of the esophagus, therefore, depends upon the history, presence of luetic lesions elsewhere, the serologic reaction, therapeutic test, examination of tissue, and the demonstration of the treponema pallidum. the therapeutic test by prolonged saturation of the system with mercury is imperative in all suspected cases and no other negative result should be deemed sufficient. _the treatment_ of luetic esophagitis is systemic, not local. luetic cicatrices contract strongly, and are very resistant to treatment, so that esophagoscopic bouginage should be begun as early as possible after the healing of a luetic ulceration, in order to prevent stenosis. a silk-woven endoscopic bougie placed in position by ocular guidance, and left _in situ_ for from half to one hour daily, may prevent severe contraction, if used early in the stage of cicatrization. prolonged treatment is required for the cure of established luetic cicatricial stenosis. if gastrostomy has been done retrograde bouginage (fig. ) may be used. tuberculosis of the esophagus _esophageal tuberculosis_ is not commonly met, but is probably not infrequently associated with the dysphagia of tuberculous laryngitis. it may rarely occur as a primary infection, but usually the esophagus is involved in an extension from a tuberculous process in the larynx, mediastinal lymphatics, pleura, bronchi, or lungs. primary lesions appear as superficial erosions or ulcerations, with a surrounding yellowish granular zone, or the granules may alone be present. the mucosa in tuberculous lesions is usually pallid, the absence of vascularity being marked. invasion from the periesophageal organs produces more or less localized compression and fixation of the esophagus. the character of open ulceration is modified by the mixed infections. healed tuberculous lesions, sometimes resulting from the evacuation of tuberculous mediastinal lymph nodes into the esophagus may be encountered. the local fixation and cicatricial contraction may be the site of a traction diverticulum. tuberculous esophago-bronchial fistulae are occasionally seen. _diagnosis_, to be certain, requires the demonstration of the tubercule bacilli and the characteristic cell accumulation of the tubercle in a specimen of tissue removed from the lesion. actinomycosis must be excluded, and the possibility of mixed luetic and tuberculous lesions is to be kept in mind. post-tuberculous cicatrices have no recognizable characteristics. _treatment_.--the maintenance of nutrition to the highest degree, and the institution of a strict antituberculous regime are demanded. local applications are of no avail. gastrostomy for feeding should be done if dysphagia be severe, and has the advantage of putting the esophagus at rest. the passage of a stomach-tube for feeding purposes may be done, but it is often painful, and is dangerous in the presence of ulceration. pain is not marked if the lesion be limited to the esophagus, though if it is present orthoform, anesthesin, or apothesin, in powder form, swallowed dry, may prove helpful. varix and angioma of the esophagus these lesions are sometimes the cause of esophageal hemorrhage, the regurgitated blood being bright red, and alkaline in reaction, in contradistinction to the acid "coffee ground" blood of gastric origin. esophageal varices may coexist with the common dilatation of the venous system in which the veins of the rectum, scrotum, and legs are most conspicuously affected. cirrhosis and cancer of the liver may, by interference with the portal circulation, produce dilatation of the veins in the lower third of the esophagus. angioma of the esophagus is amenable to radium treatment. actinomycosis of the esophagus _esophageal actinomycosis_ has been autoptically discovered. its diagnosis, and differentiation from tuberculosis, would probably rest upon the microscopic study of tissue removed esophagoscopically, though as yet no such case has been reported. angioneurotic edema _angioneurotic edema_ involving the esophagus, may produce intermittent and transient dysphagia. the lesions are rarely limited to the esophagus alone; they may occur in any portion of the gastrointestinal, genitourinary, or respiratory tracts, and concomitant cutaneous manifestations usually render the diagnosis clear. the treatment is general. deviation of the esophagus _deviation of the esophagus_ may be marked in the presence of a deformed vertebral column, though dysphagia is a very uncommon symptom. the lack of esophageal symptoms in deviation of spinal production is probably explained by the longitudinal shortening of the spine which accompanies the deflection. compression stenosis of the esophagus is commonly associated with deviations produced by a thoracic mass. [plate iv a, gastroscopic view of a gastrojejunostomy opening drawn patulous by the tube mouth. (gastrojejunostomy done by dr. george l. hays.) b, carcinoma of the lesser curvature. (patient afterward surgically explored and diagnosis verified by dr. john j. buchanan.) c, healed perforated ulcer. (patient referred by dr. john w. boyce.) drawn from a case of postdiphtheric subglottic stenosis cured by the author's method of direct galvanocauterization of the hypertrophies. a, immediately after removal of the intubation tube; hypertrophies like turbinals are seen projecting into the subglottic lumen. b, five minutes later; the masses have now closed the lumen almost completely. the patient became so cyanotic that a bronchoscope was at once introduced to prevent asphyxia. c, the left mass has been cauterized by a vertical application of the incandescent knife. d, completely and permanently cured after repeated cauterizations. direct view; recumbent patient. photoprocess reproductions of the author's oil-color drawings from life] [ ] chapter xxxv--gastroscopy the stomach of any individual having a normal esophagus and normal spine can be explored with an open-tube gastroscope. the adult size esophagoscope being cm. long will reach the stomach of the average individual. longer gastroscopes are used, when necessary, to explore a ptosed stomach. various lens-system gastroscopes have been devised, which afford an excellent view of the walls of the air-inflated stomach. the optical system, however, interferes with the insertion of instruments, so that the open-tube gastroscope is required for the removal of gastric foreign bodies, the palpation of, or sponging secretions from, gastric lesions. the open-tube gastroscope may be closed with a window plug (fig. ) having a rubber diaphragm with a central perforation for forceps, when it is desired to inflate the stomach. _technic_.--relaxation by general anesthesia permits lateral displacement of the dome of the diaphragm along with the esophagus, and thus makes possible a wider range of motion of the distal end of the gastroscope. all of the recent gastroscopies in the bronchoscopic clinic, however, have been performed without anesthesia. the method of introduction of the gastroscope through the esophagus is precisely the same as the introduction of the esophagoscope (q.v.). it should be emphasized that with the lens-system gastroscopes, the tube should be introduced into the stomach under direct ocular guidance, without a mandrin, and the optical apparatus should be inserted through the tube only after the stomach has been entered. blind insertion of a rigid metallic tube into the esophagus is an extremely dangerous procedure. the descriptions and illustrations of the stomach in anatomical works must be disregarded as cadaveric. in the living body, the empty stomach is usually found, on endoscopic inspection, to be a collapsed tube of such shape as to fit whatever space is available at the particular moment, with folds and rugae running in all directions, the impression given as to form being strikingly like searching among a mass of earth worms or boiled spaghetti. the color is pink, under proper illumination, if no food is present. poor illumination may make the color appear deep crimson. if food is present, or has just been regurgitated, the color is bright red. to appreciate the appearance of gastritis, the eye must have been educated to the endoscopic appearances under a degree of illumination always the same. the left two-thirds of the stomach is most easily examined. the stomach wall can be pushed by the tube into almost any position, and with the aid of gentle external abdominal manipulation to draw over the pylorus it is possible to examine directly almost all of the gastric walls except the pyloric antrum, which is reachable in relatively few cases. a lateral motion of from to cm. can be imparted to the gastroscope, provided the diaphragmatic musculature is relaxed by deep anesthesia. the stomach is explored by progressive traverse. that is, after exploring down to the greater curvature, the tube-mouth is moved laterally about centimeters, and the withdrawing travel explores a new field. then a lateral movement affords a fresh field during the next insertion. this is repeated until the entire explorable area has been covered. ballooning the stomach with air or oxygen is sometimes helpful, but the distension fixes the stomach, lessens the mobility of the arch of the diaphragm, and thus lessens the lateral range of gastroscopic vision. furthermore, ballooning pushes the gastric walls far away from the reach of the tube-mouth. a window plug (fig. ) is inserted into the ocular end of the gastroscope for the ballooning procedure. [ ] like many other valuable diagnostic means, gastroscopy is very valuable in its positive findings. negative results are entitled to little weight except as to the explorable area. the gastroscopist working in conjunction with the abdominal surgeon should be able to render him invaluable assistance in his work on the stomach. the surgeon with his gloved hand in the abdomen, by manipulating suspected areas of the stomach in front of the tube-mouth can receive immediately a report of its interior appearance, whether cancerous, ulcerated, hemorrhagic, etc. _lens-system ballooning gastroscopy_ may possibly afford additional information after all possible data from open-tube gastroscopy has been obtained. care must be exercised not to exert an injurious degree of air-pressure. the distended portion of the stomach assumes a funnel-like form ending at the apex in a depression with radiating folds, that leads the observer to think he is looking at the pylorus. the foreshortening produced by the lens system also contributes to this illusion. the best lens-system gastroscope is that of henry janeway, which combines the open-tube and the lens system. _gastroscopy for foreign bodies_.--the great majority of foreign bodies that reach the stomach unassisted are passed per rectum, provided the natural protective means are not impaired by the administration of cathartics, changes in diet, etcetera. this, however, does not mean that esophageal foreign bodies should be pushed into the stomach by blind methods, or by esophagoscopy, because a swallowed object lodged in the esophagus can always be returned through the mouth. foreign bodies in the stomach and intestines should be fluoroscopically watched each second day. if an object is seen to lodge five days in one location in the intestines, it should be removed by laparotomy, since it will almost certainly perforate. certain objects reaching the stomach may be judged too large to pass the pylorus and intestinal angles. these should be removed by gastroscopy when such decision is made. it is to be remembered that gastric foreign bodies may be regurgitated and may lodge in the esophagus, whence they are easily removed by esophagoscopy. the double-planed fluoroscope of manges is helpful in the removal of gastric foreign bodies, but there is great danger of injury to the stomach walls, and even the peritoneum, unless forceps are used with the utmost caution. [ ] chapter xxxvi--acute stenosis of the larynx _etiology_.--causes of a relatively sudden narrowing of the lumen of the larynx and subjacent trachea are included in the following list. two or more may be combined. . foreign body. . accumulation of secretions or exudate in the lumen. . distension of the tissues by air, inflammatory products, serum, pus, etc. . displacement of relatively normal tissues, as in abductor paralysis, congenital laryngeal stridor, etcetera. . neoplasms. . granulomata. _edema of the larynx_ may be at the glottic level, or in the supraglottic or subglottic regions. the loose cellular tissue is most frequently concerned in the process rather than the mucosal layer alone. in children the subglottic area is very vascular, and swelling quickly results from trauma or inflammation, so that acute stenosis of the larynx in children commonly has its point of narrowing below the cords. dyspnea, and croupy, barking, cough with no change in the tone or pitch of the speaking voice are characteristic signs of subglottic stenosis. edema may accompany inflammation of either the superficial or deep structures of the larynx. the laryngeal lesion may be primary, or may complicate general diseases; among the latter, typhoid fever deserves especial mention. _acute laryngeal stenosis_ complicating typhoid fever is frequently overlooked and often fatal, for the asthenic patient makes no fight for air, and hoarseness, if present, is very slight. the laryngeal lesion may be due to cordal immobility from either paralysis or inflammatory arytenoid fixation, in the absence of edema. perichondritis and chondritis of the laryngeal cartilages often follow typhoid ulceration of the larynx, chronic stenosis resulting. _laryngeal stenosis in the newborn_ may be due to various anomalies of the larynx or trachea, or to traumatism of these structures during delivery. the normal glottis in the newborn is relatively narrow, so that even slight encroachment on its lumen produces a serious degree of dyspnea. the characteristic signs are inspiratory indrawing of the supraclavicular fossae, the suprasternal notch, the epigastrium, and the lower sternum and ribs. cyanosis is seen at first, later giving place to pallid asphyxia when cardiac failure occurs. little air is heard to enter the lungs, during respiratory efforts and the infant, becoming exhausted by the great muscular exertion, soon ceases to breathe. paralytic stenosis of the larynx sometimes follows difficult forceps deliveries during which stretching or compression of the recurrent nerves occur. _acute laryngeal stenosis in infants, from laryngeal perichondritis_, may be a delayed result of traumatism to the laryngeal cartilages during delivery. the symptoms usually develop within four weeks after birth. lues and tuberculosis are possible factors to be eliminated by the usual methods. _surgical treatment of acute laryngeal stenosis_.--multiple puncture of acute inflammatory edema, while readily performed with the laryngeal knife used through the direct laryngoscope, is an uncertain measure of relief. tracheotomy, if done low in the neck, will completely relieve the dyspnea. by its therapeutic effect of rest, it favors the rapid subsidence of the inflammation in the larynx and is the treatment to be preferred. intubation is treacherous and unreliable except in diphtheritic cases; but in the diphtheritic cases it is ideal, if constant skilled watching can be had. [ ] chapter xxxvii--tracheotomy _indications_.--tracheotomy is indicated in dyspnea of laryngotracheal origin. the cardinal signs of this form of dyspnea are: . indrawing at the suprasternal notch. . indrawing around the clavicles. . indrawing of the intercostal spaces. . restlessness. . choking and waking as soon as the aid of the voluntary respiratory muscles ceases in falling to sleep. . cyanosis is a dangerously late symptom. as a therapeutic measure in diseases of the larynx its place has been thoroughly established. marked improvement of the laryngeal lesions has been observed to follow tracheotomy in advanced laryngeal tuberculosis, and in cancer of the larynx. it has proven, in some cases, a useful adjunct in the treatment of luetic laryngitis, though it cannot be regarded as indicated, in the absence of dyspnea. perichondritis and other inflammations are benefited by tracheotomy. a marked therapeutic effect on multiple laryngotracheal papillomata in children has been noted by the author in hundreds of cases. _tracheotomy for foreign body_ is no longer indicated either for the removal of the intruder, or for the insertion of the bronchoscope. tracheotomy may be urgently indicated for foreign body dyspnea, but not for foreign body removal. _subcutaneous rupture of the trachea_ from external trauma may produce dyspnea and generalized emphysema, both of which will be relieved by tracheotomy. [ ] _acromegalic stenosis of the larynx_ is a rare but urgent indication for tracheotomy. _contraindications_.--there are no contraindications to tracheotomy for dyspnea. _the instruments_ required for an orderly tracheotomy are: headlight scalpels retractors trousseau dilator hemostats scissors (dissecting) tracheal cannulae (six sizes) curved needles needle holder hypodermic syringe for local anesthesia no. plain catgut ligatures linen tape gauze sponges these are sterilized and kept in a sterile copper box ready for instant use. beside the patient's bed following the tracheotomy the following sterile materials are placed: sterile gloves hemostat sterile new gauze trousseau dilator scissors duplicate tracheotomy tube silver probe basin of bichloride of mercury solution, : , tracheotomy is one of the oldest operations known to surgery, yet strange to say, it is probably more often improperly performed today, and more often followed by needless mortality, than any other operation. the two chief preventable sequelae are death from improper routine surgical care and wrongly fitted tube, and stenosis from too high an operation. the classical descriptions of crico-thyroidotomy and high and low tracheotomy have been handed down to generations of medical students without revision. every medical graduate has been taught that there are two kinds of tracheotomy, high and low, the low operation being very difficult, the high operation very easy. when he is suddenly called upon to do an emergency tracheotomy, this erroneous teaching is about all that remains in the dim recesses of his memory; consequently he makes sure of doing the operation high enough, and goes in through the larynx, usually dividing the cricoid cartilage, the only complete ring in the trachea. as originally made the distinction between high and low as applied to tracheotomy referred to operations above and below the isthmus of the thyroid gland, in a day when primitive surgery attached too much importance to operations upon the thyroid gland. the isthmus is entitled to absolutely no consideration whatever in deciding the location at which to incise so vital a structure as the trachea. students are taught different short skin incisions for these two operations, and it is no wonder that they, as did their predecessors, find tracheotomy a difficult, bloody, and often futile operation. the trachea is searched for at the bottom of a short, deep wound filled with blood, the source of which is difficult to find and impossible to control. _tracheotomic cannulae_ should be made of sterling silver. german silver plated with pure silver is good enough for temporary use, but the plating soon wears off under the galvanic action set up between the two metals. aluminum becomes roughened by boiling and contact with secretions, and causes the formation of granulations which in time lead to stenosis. hard rubber tubes cannot be boiled, the walls are so thick as to leave too little lumen, and the rubber is irritating to the tissues. all tracheotomy tubes should be fitted with pilots. many of the tubes furnished to patients have no pilots to facilitate the introduction, and the tubes are inserted with somewhat the effect of a cheese tester, and with great pain and suffering on the part of the patient. most of the the tubes in the shops are too short to allow for the swelling of the tissues of the neck following the operation. they may reach the trachea at the time of the operation, but as soon as the reactionary swelling occurs, the end of the tube is pulled out (fig. ) of the tracheal incision; the air hissing along the tube is considered by the attendant to indicate that the tube is still in place, and the increasing dyspnea and accelerated respiratory rate are attributed to supposed pneumonia or edema of the lungs, under which erroneous diagnosis the patient is buried. in all cases in which it is reported that in spite of tracheotomy the dyspnea was only temporarily relieved, the fault is the lack of a "plumber." that is, an attendant who will make sure that there is at all times a clear airway all the way down to the lungs. with a bronchoscope and aspirator he will see that the airway is clear. to begin with, a proper sized cannula must be selected. the series of different sized, full curved tubes, one of which is illustrated in fig. , will under all conditions reach the trachea. if the tube seems to be too long in any given case, it will usually be found that the tracheotomy has been done too high, and a lower one should be done at once. if the operation has not been done too high, and the cannula is too long, a pad of gauze under the shield will take up the surplus length. in cases of tracheal compression from new growth, thymus or other such cases, in which the ordinary tube will not pass the obstruction, the author's long cane-shaped cannula (see fig. ) can be inserted past the obstruction, and if necessary into either bronchus. the fenestrum placed in the cannula in many of the older tubes, with the supposed function of allowing partial breathing through the larynx, is a most pernicious thing. a properly fitted tube should not take up more than half of the cross section of the trachea, and should allow the passage of sufficient air for free laryngeal breathing when it is completely corked. the fenestrum is, moreover, rarely so situated that air can pass through it; the fenestral edges act as a constant irritant to the wound, producing bleeding and granulation tissue. [fig. .--schema showing thick pad of gauze dressing, filling the space, a, and used to hold out the author's full-curved cannula when too long, prior to reactionary swelling, and after subsidence of the latter. at the right is shown the manner in which the ordinary cannula of the shops permits a patient to asphyxiate, though some air is heard passing through the tracheal opening, h, after the cannula has been partially withdrawn by swelling of the tissues, t.] [fig. .--the author's tracheotomic cannulae. a, shows cane-shaped cannula for use in intrathoracic compressive or other stenoses. b, shows full curved cannula for regular use. pilots are made to fit the outer cannula; the inner cannula not being inserted until after withdrawal of the pilot.] _anesthesia_.--no dyspneic patient should be given a general anesthetic; because any patient dyspneic enough to need a tracheotomy for dyspnea is depending largely upon the action of the accessory respiratory muscles. when this action is stopped by beginning unconsciousness, respiration ceases. if the trachea is not immediately opened, artificial respiration instituted, and oxygen insufflated, the patient dies on the table. skin infiltration along the line of incision with a very weak cocaine solution ( / of per cent), apothesine ( per cent), novocaine, schleich's fluid or other local anesthetic, suffices to render the operation painless. the deeper structures have little sensation and do not require infiltration. it has been advocated that an interannular injection of cocaine solution with a hypodermic syringe be done just prior to incision of the trachea for the purpose of preventing cough after the incision of the trachea and the insertion of the cannula. it would seem, however, that this introduces the risk of aspiration pneumonia and pulmonary abscess, by permitting the aspiration and clotting of blood in small bronchi, followed by subsequent breaking down of the clots. as the author has so often said, "the cough reflex is the watch dog of the lungs," and if not drugged asleep by local or general anesthesia can safely be relied upon to prevent all possibility of the blood or the pus which nearly always is present in acute or chronic conditions calling for tracheotomy, being aspirated into the deeper air-passages. cocaine in any form, by any method, and in any dosage, is dangerous in very young children. _technic_.--the patient should be placed in the recumbent position, with the extended head held in the midline by an assistant. the shoulders, not the neck, should be slightly raised with a sand bag. the head should be somewhat lower than the feet, to lessen the danger of aspiration of blood. a midline incision dividing the skin and fascia is made from the thyroid notch to just above the suprasternal notch. the cricoid is now located, and the deeper dissection is continued from below this point. the ribbon muscles are separated with dissecting scissors or knife, and held apart with retractors. if the isthmus of the thyroid gland is in the way, it may be retracted upward; if large, however, it should be divided and ligated, for it is apt to slip over the tracheal incision afterward, and render difficult the quick finding of the incision during after-care. this covering of the tracheal incision by the slipping back of the drawn-aside thyroidal isthmus is one of the most frequent avoidable causes of mortality, because it deflects the cannula off into the tissues when it is replaced after cleaning during the early postoperative period. the corrugated surface of the trachea can be felt, and its exact location can be determined by the index finger. if the tracheotomy is proceeding in an orderly manner, all bleeding points should be caught and tied with plain catgut (no. ) before the trachea is opened. because of distension of vessels during cough, all but the tiniest vessels should be ligated. side-cut veins are particularly treacherous. they should be freed of tissue, cut across and the divided ends ligated. the _incision in the trachea_ should be as low as possible, and should never be made through the first ring. the incision should be through the third, fourth and fifth rings. only in cases of laryngoptosis will it be necessary to incise the trachea higher than this. the incision must be made in the midline, and in the long axis of the trachea, and care must be exercised that the point of the knife does not perforate the posterior tracheal wall. stab incisions are always to be avoided. if the incision in the trachea is found to be of insufficient length, the original incision must be found and elongated. a second incision must not be made, for the portion of cartilage between the two incisions will die and will almost certainly make a site of future tracheal stenosis. the cricoid should never be cut, for stenosis is almost sure to follow the wearing of a cannula in this position. a trousseau dilator should now be inserted in the tracheal incision, its blades gently separated. with the tracheal lumen thus opened, a cannula of proper size is introduced with absolute certainty of its having entered the trachea. a quadruple-folded square of gauze in the form of a pad about four inches square is moistened with mercuric chloride solution ( : , ) and is slit from the lower border to its midpoint. this pad is slipped from above downward under the tape holder of the cannula, the slit permitting the tubal part of the cannula to reach the central part of the pad (fig. ), and completely covers the wound. no attempt should be made to suture the skin wound, for this tends to form a pocket in which lodge the bronchial secretions that escape alongside the tube, resulting in infection of the wound. furthermore it renders the daily changing of the tube much more difficult. in fact it prevents the attendant from being certain that the tube is actually placed in the trachea. suturing of the skin to the trachea should never be done, for the sutures soon tear out and often set up a perichondritis of the tracheal cartilages, with resulting difficult decannulation. [fig. .--schema of practical gross anatomy to be memorized for emergency tracheotomy. the middle line is the safety line, the higher the wider. below, the safety line narrows to the vanishing point vp. the upper limit of the safety line is the thyroid notch until the trachea is bared, when the limit falls below the first tracheal ring. in practice the two-dark danger lines are pushed back with the left thumb and middle finger as shown in fig. , thus throwing the safety line into prominence. this is generally known as jackson's tracheotomic triangle.] [fig. .--schema showing the author's method of rapid tracheotomy. first stage. the hands are drawn ungloved for the sake of clearness. the upper hand is the left, of which the middle finger (m) and the thumb are used to repress the sterno-cleido-mastoid muscles, the finger and thumb being close to the trachea in order to press backward out of the way the carotid arteries and the jugular vein. this throws the trachea forward into prominence, and one deep slashing cut will incise all of the soft tissues down to the trachea.] _emergency tracheotomy_.--stabbing of the cricothyroid membrane, or an attempted stabbing of the trachea, so long taught as an emergency tracheotomy, is a mistake. the author's "two stage, finger guided" method is safer, quicker, more efficient, and not likely to be followed by stenosis. to execute this promptly, the operator is required to forget his textbook anatomy and memorize the schema (fig. ). the larynx and trachea are steadied by the thumb and middle finger of the left hand, which at the same time push back the important nerves and vessels which parallel the trachea, and render the central safety line more prominent (fig. ). a long incision is now made from the thyroid notch almost to the suprasternal notch, and deep enough to reach the trachea. this completes the first stage. [fig. .--illustrating the author's method of quick tracheotomy. second stage. the fingers are drawn ungloved for the sake of clearness. in operating the whole wound is full of blood, and the rings of the trachea are felt with the left index which is then moved slightly to the patient's left, while the knife is slid down along the left index to exactly the middle line when the trachea is incised.] second stage. the entire wound is full of blood and the trachea cannot be seen, but its corrugations can be very readily felt by the tip of the free left index finger. the left index finger is now moved a little to the patient's left in order that the knife shall come precisely in the midline of the trachea, and three rings of the trachea are divided from above downward (fig. ). the trousseau dilator should now be inserted, the head of the table should be lowered, and the patient should be turned on the side to allow the blood to run away from the wound. if respiration has ceased, a cannula is slipped in, and artificial respiration is begun. oxygen insufflation will aid in the restoration of respiration, and a pearl of amyl nitrite should be crushed in gauze and blown in with the oxygen. in all such cases, excessive pressure of oxygen should be avoided because of the danger of producing ischemia of the lungs. hope of restoring respiration should not be abandoned for half an hour at least. one of the author's assistants, dr. phillip stout, saved a patient's life by keeping up artificial respiration for twenty minutes before the patient could do his own breathing. the _after-care_ of the tracheotomic wound is of the utmost importance. a special day and night nurse are required. the inner tube of the cannula must be removed and cleaned as soon as it contains secretion. secretion coughed out must be wiped away quickly, but gently, before it is again aspirated. the gauze dressing covering the wound must be changed as soon as soiled with secretions from the wound and the air-passages. each fresh pad should be moistened with very weak bichloride of mercury solution ( : , ). the outer tube must be changed every twenty-four hours, and oftener if the bronchial secretion is abundant. student-physicians who have been taught my methods and who have seen the cases in care of our nurses have often expressed amazement at the neglect unknowingly inflicted on such cases elsewhere, in the course of ordinary routine surgery. it is not unusual for a patient to be sent to the bronchoscopic clinic who has worn his cannula without a single changing for one or two years. in some cases the tube had broken and a portion had been aspirated into the trachea. [fig. .--method of dressing a tracheotomic wound. a broad quadruple, in-folded pad of gauze is cut to its centre so that it can be slipped astride of the tube of the cannula back of the shield. no strings, ravellings or strips of gauze are permissible because of the risk of their getting down into the trachea.] if the respiratory rate increases, instead of attributing it to pulmonary complications, the entire cannula should be removed, the wound dilated with the trousseau forceps, the interior of the trachea inspected, and all secretions cleaned away. then the tracheal mucosa below the wound should be gently touched with a sterile bent probe, to induce cough to rid the lower air passages of accumulated secretions. in many cases it is a life-saving procedure to insert a sterile long malleable aspirating tube to remove secretions from the lower air-passages. when all is clear, a fresh sterile cannula which has been carefully inspected to see that its lumen has been thoroughly cleaned, is inserted, and its tapes tied. good "plumbing," that is, the maintenance at all times of a clear, clean passage in all the "pipes," natural and artificial, is the reason why the mortality in the bronchoscopic clinic has been less than half of one per cent, while in ordinary routine surgical care in all hospitals collectively it ranges from to per cent. _bronchial aspiration_.--as mentioned above, bronchial aspiration is often necessary. when the patient is unable to get up secretions, he will, as demonstrated by the author many years ago, "drown in his own secretions." in some cases bronchoscopic aspiration is required (peroral endoscopy, p. ). occasionally, very thick secretions will require removal with forceps. pus may become very thick and gummy from the administration of morphin. opiates do not lessen pus formation, but they do lessen the normal secretions that ordinarily increase the quantity and fluidity of the pus. when to this is added the dessicating effect of the air inhaled through the cannula, unmoistened by the upper air-passages, the secretions may be so thick as to form crusts and plugs that are equivalent to foreign bodies and require removal with forceps. diphtheritic membrane in the trachea may require removal with bronchoscope and forceps. thinner secretions may be removed by sponge-pumping. in most cases, however, secretions can be brought up through an aspirating tube, connected to a bronchoscopic aspirating syringe (fig. ), an ordinary aspirating bottle, or preferably, a mechanical aspirator such as that shown in fig. . in this, combined with bronchoscopic oxygen insuflation (q.v.), we have a life-saving measure of the highest efficiency in cases of poisoning by chlorine and other irritant and asphyxiating gases. an aspirating tube for insertion into the deeper air passages should be of copper, so that it can be bent to the proper curve to reach into the various parts of the tracheobronchial tree, and it should have a removable copper-wire core to prevent kinking, and collapse of the lumen. the distal end should be thickened, and also perforated at the sides, to prevent drawing-in of the mucosa and trauma thereto. a rubber tube may be used, but is not so satisfactory. the one shown in fig. i had made by mr. pilling, and it has proved very satisfactory. _decannulation_.--when the tracheal incision is placed below the first ring, no difficulty in decannulation should result from the operation per se. when by temporarily occluding the cannula with the finger it is evident that the laryngeal aperture has regained sufficient size to allow free breathing, a smaller-sized tracheotomic tube should be substituted to allow free passage of air around the cannula in the trachea. in doing this, the amount of secretion and the handicap of impaired glottic mobility in the expulsion of thick secretions must be borne in mind. babies labor under a special handicap in their inefficient bechic expulsion and especially in their small cannulae which are so readily occluded. if breathing is not free and quiet with the smaller tube; the larger one must be replaced. if, however, there is no trouble with secretions, and the breathing is free and quiet, the inner cannula should be removed, and the external orifice of the outer cannula firmly closed with a rubber cork. if the laryngeal condition has been acute, decannulation can usually be safely done after the patient has been able to sleep quietly for three nights with a corked cannula. if free breathing cannot be obtained when the cannula is corked, the larynx is stenosed, and special work will be required to remove the tube. children sometimes become panic stricken when the cannula is completely corked at once and they are forced to breathe through the larynx instead of the easier shortcut through the neck. in such a case, the first step is partially to cork the cannula with a half or two-thirds plug made from a pure rubber cord fashioned in the desired shape by grinding with an emery wheel (fig. ). thus the patient is gradually taught to use the natural air-way, still feeling that he has an "anchor to windward" in the opening in the cannula. when some swelling of the laryngeal structures still exists, this gradual corking has a therapeutic effect in lessening the stenosis by exercising the muscles of abduction of the cords and mobilizing the cricoarytenoid articulation during the inspiratory effort. the forced respiration keeps the larynx freed from secretions, which are more or less purulent and hence irritating. after removing the cannula, in order that healing may proceed from the bottom upward, the wound should be dressed in the following manner: a single thickness of gauze should be placed over the wound and the front of the neck, and a gauze wedge firmly inserted over this to the depths of the tracheotomic wound, all of this dressing being held in place by a bandage. if the skin-wound heals before the fibrous union of the tracheal cartilages is complete, exuberant granulations are apt to form and occlude the trachea, perhaps necessitating a new tracheotomy for dyspnea. it is so important to fix indelibly in the mind the cardinal points concerning tracheotomy that i have appended to this chapter the teaching notes that i have been for years giving my classes of students and practitioners, hundreds of whom have thanked me for giving them the clear-cut conception of tracheotomy that enabled them, when their turn came to do an emergency tracheotomy, to save human life. resume of tracheotomy _instruments_. headlight sandbag scalpel hemostats small retractors tenaculum tracheotomic cannulae (proper kind) long. half area cross-section trachea. proper curve: radius too short will press ant. tracheal wall; too long, post. wall. sterling silver tracheobronchial aspirator. probe. tapes for cannulae trousseau dilator sponges infiltration syringe and solution oxygen tank. _indications_: laryngeal dyspnea. (indrawing guttural and clavicular fossae and at epigastrium. pallor. restlessness. drowning in his own secretions.) do it early. don't wait for cyanosis. [ ] never use general anesthesia on dyspneic patient. forget about "high" and "low" distinctions until trachea is exposed. memorize jackson's tracheotomic triangle. patient recumbent, sand bag under shoulders or neck. nose to zenith. infiltration, _intra_dermatic. incise from adam's apple to guttural fossa. hemostasis. keep in middle line. feel for trachea. expose isthmus of thyroid gland. draw it upward or downward or cut it. ligature, torsion, etc. before incising trachea. hold trachea with tenaculum. incise trachea below first ring. avoid cutting cricoid or first ring. cut rings vertically. don't hack. don't cut posterior wall which almost touches the anterior wall during cough. spread carefully, with trousseau dilator. insert cannula; _see_ it enter tracheal lumen; remove pilot; tie tapes. don't suture wound. dress with large squares. don't give morphine. decannulation by corking partially, after changing to smaller cannula. do not remove cannula permanently until patient sleeps without indrawing with corked cannula. resume of emergency tracheotomy the following notes should be memorized. . essentials: knife and pair of hands (but full equipment better). [ ] . don't do a laryngotomy, or stabbing. . "two stage, finger guided" operation better. . sand bag or substitute. . press back danger lines with left thumb and middle finger, making safety line and trachea prominent. . memorize jackson's tracheotomic triangle. . incise exactly in middle line from adam's apple to sternum. . feel for tracheal corrugations with left index in pool of blood, following trachea with finger downward from superficial adam's apple. . pass knife along index and incise trachea (not too deeply, may cut posterior wall). . don't mind bleeding; but keep middle line and keep head straight; keep head low; don't bother about thyroid gland. . don't expect hiss when trachea is cut if patient has stopped breathing. . start artificial respiration. . amyl nitrite. oxygen. . practice palpation of the neck until the tracheal landmarks are familiar. . practice above technic, up to point of incision, at every opportunity. . _jackson's tracheotomic triangle_: a triangulation of the front of the neck intended to facilitate a proper emergency tracheotomy. apex at suprasternal notch. sides anterior edge sternomastoids. base horizontal line lower edge cricoid. resume of after-care of a tracheotomic case . always bear in mind that tracheotomy is not an ultimate object. the ultimate object is to pipe air down into the lungs. tracheotomy is only a means to that end. . sterile tray beside bed should contain duplicate (exact) tracheotomy tube, trousseau dilator, hemostat, thumb forceps, silver probe, scissors, scalpel, probe-pointed curved bistoury. sterile gloves ready. . special nursing necessary for safety. . laxative. . sponge away secretions before they are drawn in. . cover wound with wide large gauze square slit so it fits around cannula under the tape holder. pull off ravelings. keep wet with : , bichloride solution. . change dressing every hour or oftener. . abundance of fresh air, temperature preferably about degrees. . _nurse should remove inner cannula as often as needed and clean it with pipe cleaner before boiling._ . outer cannula should be changed every day by the surgeon or long-experienced tracheotomy nurse. a pilot should be used and care should be taken not to injure the cut ends of the tracheal cartilage. . a sterile, bent probe may be inserted downward in the trachea with both cannulae out to excite cough if necessary to expel secretions. an aspirating tube should be used, when necessary. . a patient with a properly fitted cannula free of secretions breathes noiselessly. any sound demands immediate attention. . if the respiratory rate increase it is much more likely to be due to obstruction in, malposition of, or shortness of the cannula than to lung complications. . be sure that: (a) the cannula is clear and clean. (b) the cannula is long enough to reach well down into the trachea. a cannula that was long enough when the operation was done may be too short after the cervical tissues swell. (c) the distal end of the cannula actually is deeply in the trachea. the only way to be sure is, when inserting the cannula, to spread the wound and the tracheal incision with a trousseau dilator, then _see_ the interior of the tracheal lumen and _see_ the cannula enter therein. . if after attending to the above mentioned details there are still signs of obstructive dyspnea, a bronchoscopy should be done for finding and removal of the obstruction in the trachea or main bronchi. . if all the "pipes," natural and instrumental, are clear there can be no such thing as obstructive dyspnea. . pneumonia and pulmonary edema may exist before tracheotomy, but they are rare sequelae. . decannulation, in cases of tracheotomy done for temporary conditions should not be attempted until the patient has slept at least nights with his cannula tightly corked. a properly fitted cannula (i.e. one not larger than half the area of cross section of the trachea) permits the by-passage of plenty of air. a partial cork should be worn for a few days first for testing and "weaning" a child away from the easier breathing through the neck. in cases of chronic laryngeal stenosis a prolonged test is necessary before attempting decannulation. . a tracheotomic case may be aphonic, hence unable to call for help. . the foregoing rules apply to the post-operative periods. after the wound has healed and a fistula is established, the patient, if not a child, may learn to care for his own cannula. [ ] . do not give cough-sedatives or narcotics. the cough reflex is the watch dog of the lungs. notes on nursing tracheotomized patients bedside tray should contain: duplicate cannula scalpel trousseau dilator hemostat dressing forceps sterile vaseline scissors tape probe gauze sponges gauze squares probe-pointed curved bistoury. . room should be abundantly ventilated, as free from dust and lint as possible, and the air should be moistened by steam in winter. . keep mouth clean. tooth brush. rinse alcohol : . . sponge away secretion after the cough before drawn in. . remove inner cannula (not outer) as often as needed. not less often than every hour. replace immediately. never boil a cannula until you have thoroughly cleaned it. . obstruction of cannula calling for cleaning indicated by: blue or ashy color. indrawing at clavicles, sternal notch, epigastrium. noisy breathing. (learn sound.) . surgeon (in our cases) will change outer cannula once daily or oftener. . duplicate cannulae. . be careful in cleaning cannulae not to damage. . watch for loose parts on cannula. . change dressing (in our cases) as often as soiled. not less often than every hour. large squares. never narrow strips. . watch color of lips and ears and face. [ ] . report at once if food or water leaks through wound. (coughing and choking). . never leave a tracheotomized patient unwatched during the first days or weeks, according to case. . remember trousseau dilator or hemostat will spread the tracheal wound or fistula when cannula is out. . remember life depends on a clear cannula if the patient gets no air through the mouth. . remember it takes very little to clog the small cannula of a child. . remember a tracheotomized patient cannot call for help. . decannulation. testing by corking partially. watch corks not too small, or broken. attach them by braided silk thread. pure rubber cord ground down makes best cork. [ ] chapter xxxviii--chronic stenosis of the larynx and trachea the various forms of laryngeal stenosis for which tracheotomy or intubation has been performed, and the difficulties encountered in restoring the natural breathing, may be classified into the following types: . panic . spasmodic . paralytic . ankylotic (arytenoid) . neoplastic . hyperplastic . cicatricial (a) loss of cartilage (b) loss of muscular tissue (c) fibrous _panic_.--nothing so terrifies a child as severe dyspnea; and the memory of previous struggles for air, together with the greater ease of breathing through the tracheotomic cannula than through even a normal larynx, incites in some cases so great a degree of fear that it may properly be called panic, when attempts at decannulation are made. crying and possibly glottic spasm increase the difficulties. _spasmodic stenosis_ may be associated with panic, or may be excited by subglottic inflammation. prolonged wearing of an intubation tube, by disturbing the normal reciprocal equilibrium of the abductors and adductors, is one of the chief causes. the treatment for spasmodic stenosis and panic is similar. the use of a special intubation tube having a long antero-posterior lumen and a narrow neck, which form allows greater action of the musculature, has been successful in some cases. repeated removal and replacement of the intubation tube when dyspnea requires it may prove sufficient in the milder cases. very rarely a tracheotomy may be required; if so, it should be done low. the wearing of a tracheotomic cannula permits a restoration of the muscle balance and a subsidence of the subglottic inflammation. corking the cannula with a slotted cork (fig. ) will now restore laryngeal breathing, after which the tracheotomic cannula may be removed. [plate v--photoprocess reproductions of the author's oil-color drawings from life--laryngeal and tracheal stenoses: , indirect view, sitting position; postdiphtheric cicatricial stenosis permanently cured by endoscopic evisceration. (see fig. .) , indirect view, sitting position; posttyphoid cicatricial stenosis. mucosa was very cyanotic because cannula was re-moved for laryngoscopy and bronchoscopy. cured by laryngostomy. (see fig. .) , indirect view, sitting position; posttyphoid infiltrative stenosis, left arytenoid destroyed by necrosis. cured by laryngostomy; failure to form adventitious band (fig. ) because of lack of arytenoid activity. , indirect view, recumbent position; posttyphoid cicatricial stenosis. cured of stenosis by endoscopic evisceration with sliding punch forceps. anterior commissure twice afterward cleared of cicatricial tissue as in the other case shown in fig. . ultimate result shown in fig. . , same patient as fig. ; sketch made two years after decannulation and plastic. , same patient as fig. ; sketch made four years after decannulation and plastic. , same patient as fig. ; sketch made three years after decannulation and plastic. , same patient as fig. ; sketch made one year after decannulation, fourteen months after clearing of the anterior commissure to form adventitious cords. , direct view, recumbent patient; web postdiphtheric (?) or congenital (?). "rough voice" since birth, but larynx never examined until stenosed after diphtheria. web removed and larynx eviscerated with punch forceps; recurrence of stenosis (not of web). cure by laryngostomy. this view also illustrates the true depth of the larynx which is often overlooked because of the misleading flatness of laryngeal illustrations. , direct laryngoscopic view; postdiphtheric hypertrophic subglottic stenosis. cured by galvanocauterization. , direct laryngoscopic view; postdiphtheric hypertrophic supraglottic stenosis. forceps excision; extubation one month later; still well after four years. , bronchoscopic view of posttracheotomic stenosis following a "plastic flap" tracheotomy done for acute edema. , direct laryngoscopic view; anterolateral thymic compression stenosis in a child of eighteen months. cured by thymopexy. , indirect laryngoscopic (mirror) view; laryngostomy rubber tube in position in treatment of post-typhoid stenosis. , direct view; posttyphoid stenosis after cure by laryngostomy. dotted line shows place of excision for clearing out the anterior commissure to restore the voice. , endoscopic view of posttracheotomic tracheal stenosis from badly placed incision and chondrial necrosis. tracheotomy originally done for influenzal tracheitis. cured by tracheostomy.] _paralysis_.--bilateral abductor laryngeal paralysis causes severe stenosis, and usually tracheotomy is urgently required. in cadaveric paralysis both cords are in a position midway between abduction and adduction, and their margins are crescentic, so that sufficient airway remains. efforts to produce the cadaveric position of the cords by division or excision of a portion of the recurrent laryngeal nerves, have been failures. the operation of _ventriculocordectomy_ consists in removing a vocal cord and the portion or all of the ventricular floor by means of a punch forceps introduced through the direct laryngoscope. usually it is better to remove only the portion of the floor anterior to the vocal process of the arytenoid. in some cases monolateral ventriculocordectomy is sufficient; in most cases, however, operation on both sides is needed. an interval of two months between operations is advisable to avoid adhesions. in almost all cases, ventriculocordectomy will result in a sufficient increase in the glottic chink for normal respiration. the ultimate vocal results are good. evisceration of the larynx, either by the endoscopic or thyrotomic method, usually yields excellent results when no lesion other than paralysis exists. only too often, however, the condition is complicated by the results of a faultily high tracheotomy. a rough, inflexible voice is ultimately obtained after this operation, especially if the arytenoid cartilage is unharmed. in recent bilateral recurrent paralysis, it may be worthy of trial to suture the recurrent to the pneumogastric. operations on the larynx for paralytic stenosis should not be undertaken earlier than twelve months from the inception of the condition, this time being allowed for possible nerve regeneration, the patient being made safe and comfortable, meanwhile, by a low tracheotomy. _ankylosis_.--fixation of the crico-arytenoid joints with an approximation of the cords may require evisceration of the larynx. this, however, should not be attempted until after a year's lapse, and should be preceded by attempts to improve the condition by endoscopic bouginage, and by partial corking of the tracheotomic cannula. _neoplasms_.--decannulation in neoplastic cases depends upon the nature of the growth, and its curability. cicatricial contraction following operative removal of malignant growths is best treated by intubational dilatation, provided recurrence has been ruled out. the stenosis produced by benign tumors is usually relieved by their removal. _papillomata_.--decannulation after tracheotomy done for papillomata should be deferred at least months after the discontinuance of recurrence. not uncommonly the operative treatment of the growths has been so mistakenly radical as to result in cicatricial or ankylotic stenoses which require their appropriate treatments. it is the author's opinion that recurrent papillomata constitute a benign self-limited disease and are best treated by repeated superficial removals, leaving the underlying normal structures uninjured. this method will yield ultimately a perfect voice and will avoid the unfortunate complications of cicatricial hypertrophic and ankylotic stenosis. _compression stenosis of the trachea_.--decannulation in these cases can only follow the removal of the compressive mass, which may be thymic, neoplastic, hypertrophic or inflammatory. glandular disease may be of the hodgkins' type. thymic compression yields readily to radium and the roentgenray, and the tuberculous and leukemic adenitides are sometimes favorably influenced by the same agents. surgery will relieve the compression of struma and benign neoplasms, and may be indicated in certain neoplasms of malignant origin. the possible coexistence of laryngeal paralysis with tracheal compression is frequently overlooked by the surgeon. monolateral or bilateral paralysis of the larynx is by no means an uncommon postoperative sequel to thyroidectomy, even though the recurrent nerves have been in no way injured at operation. probably a localized neuritis, a cicatricial traction, or inclusion of a nerve trunk accounts for most of these cases. _hyperplastic and cicatricial chronic stenoses_ preventing decannulation may be classified etiologically as follows: . tuberculosis . lues . scleroma . acute infectious diseases (a) diphtheria (b) typhoid fever (c) scarlet fever (d) measles (e) pertussis . decubitus (a) cannular (b) tubal . trauma (a) tracheotomic (b) intubational (c) operative (d) suicidal and homicidal (e) accidental (by foreign bodies, external violence, bullets, etc.) most of the organic stenoses, other than the paralytic and neoplastic forms, are the result of inflammation, often with ulceration and secondary changes in the cartilages or the soft tissues. [ ] _tuberculosis_.--in the non-cicatricial forms, galvanocaustic puncture applied through the direct laryngoscope will usually reduce the infiltrations sufficiently to provide a free airway. should the pulmonary and laryngeal tuberculosis be fortunately cured, leaving, however, a cicatricial stenosis of the larynx, decannulation may be accomplished by laryngostomy. _lues_.--active and persistent antiluetic medication must precede and accompany any local treatment of luetic laryngeal stenosis. prolonged stretching with oversized intubation tubes following excision or cauterization may sometimes be successful, but laryngostomy is usually required to combat the vicious contraction of luetic cicatrices. _scleroma_ is rarely encountered in america. radiotherapy has been advocated and good results have been reported from the intravenous injection of salvarsan. radium may be tried, and its application is readily made through the direct laryngoscope. _diphtheria_.--chronic postdiphtheritic stenosis may be of the panic, spasmodic or, rarely, the paralytic types; but more often it is of either the hypertrophic or cicatricial forms. only too frequently the stenosis should be called posttracheotomic rather than postdiphtheritic, since decannulation after the subsidence of the acute stenosis would have been easy had it not been for the sequelae of the faulty tracheotomy. prolonged intubation may induce either a supraglottic or subglottic tissue hyperplasia. _the supraglottic type_ consists in an edematous thickening around the base of the epiglottis, sometimes involving also the glossoepiglottic folds and the ventricular bands. an improperly shaped or fitted tube is the usual cause of this condition, and a change to a correct form of intubation tube may be all that is required. excessive polypoid tissue hypertrophy should be excised. the less redundant cases subside under galvanocaustic treatment, which may be preceded by tracheotomy and extubation, or the intubation tube may be replaced after the application of the cautery. the former method is preferable since the patient is far safer with a tracheotomic cannula and, further, the constant irritation of the intubation tube is avoided. _subglottic hypertrophic stenosis_ consists in symmetrical turbinal-like swellings encroaching on the lumen from either side. cautious galvanocauterant treatment accurately applied by the direct method will practically always cure this condition. preliminary tracheotomy is required in those cases in which it has not already been done, and in the cases in which a high tracheotomy has been done, a low tracheotomy must be the first step in the cure. cicatricial types of postdiphtheritic stenosis may be seen as webs, annular cicatrices of funnel shape, or masses of fibrous tissue causing fixation of the arytenoids as well as encroachment on the glottic lumen. (see color plates.) as a rule, when a convalescent diphtheritic patient cannot be extubated two weeks after three negative cultures have been obtained the advisability of a low tracheotomy should be considered. if a convalescent intubated patient cough up a tube and become dyspneic a low tracheotomy is usually preferable to forcing in an oversized intubation tube. _typhoid fever_.--ulcerative lesions in the larynx during typhoid fever are almost always the result of mixed infection, though thrombosis of a small vessel, with subsequent necrosis is also seen. if the ulceration reaches the cartilage, cicatricial stenosis is almost certain to follow. _trauma_.--the chief traumatic factors in chronic laryngeal stenosis are: (a) prolonged presence of a foreign body in the larynx (b) unskilled attempts at intubation and the wearing of poorly fitting intubation tubes; (c) a faulty tracheotomy; (d) a badly fitting cannula; (e) war injuries; (f) attempted suicide; (g) attempted homicide; (h) neglect of cleanliness and care of either intubation tubes or tracheotomic cannulae allowing incrustation and roughening which traumatize the tissues at each movement of the ever-moving larynx and trachea. _treatment of cicatricial stenosis_.--a careful direct endoscopic examination is essential before deciding on the method of treatment for each particular case. granulations should be removed. intubated cases are usually best treated by tracheotomy and extubation before further endoscopic treatment is undertaken. a certain diagnosis as to the cause of the condition must be made by laboratory and therapeutic tests, supplemented by biopsy if necessary. vigorous antiluetic treatment, especially with protiodide of mercury, must precede operation in all luetic cases. necrotic cartilage is best treated by laryngostomy. intubational dilatation will succeed in some cases. [fig. .--schema showing the author's method of laryngostomy. the hollow upward metallic branch (n) of the cannula (c) holds the rubber tube (r) back firmly against the spur usually found on the back wall of the trachea. moreover, the air passing up through the rubber tube (r) permits the patient to talk in a loud whisper, the external orifice of the cannula being occluded most of the time with the cork (k). the rubber tubing, when large sizes are reached may extend down to the lower end of the cannula, the part c coming out through a large hole cut in the tubing at the proper distance from the lower end.] _laryngoscopic bouginage_ once weekly with the laryngeal bougies (fig. ) will cure most cases of laryngeal stenosis. for the trachea, round, silk-woven, or metallic bougies (fig. ) are better. [ ] _laryngostomy_ consists in a midline division of the laryngeal and tracheal cartilages as low as the tracheotomic fistula, excision of thick cicatricial tissue, very cautious incision of the scar tissue on the posterior wall, if necessary, and the placing of the author's laryngostomy tube for dilatation (fig. ). over the upward branch of the laryngostomy tube is slipped a piece of rubber tubing which is in turn anchored to the tape carrier by braided silk thread. progressively larger sizes of rubber tubing are used as the laryngeal lumen increases in size under the absorptive influence of the continuous elastic pressure of the rubber. several months of wearing the tube are required until dilatation and epithelialization of the open trough thus formed are completed. painstaking after-care is essential to success. when dilatation and healing have taken place, the laryngostomy wound in the neck is closed by a plastic operation to convert the trough into a trachea by supplying an anterior wall. _intubational treatment of chronic laryngeal stenosis_ may be tried in certain forms of stenosis in which the cicatrices do not seem very thick. the tube is a silver-plated brass one of large size (fig. ). a post which screws into the anterior surface of the tube prevents its expulsion. over the post is slipped a block which serves to keep open the tracheal fistula. detailed discussion of these operative treatments is outside the scope of this work, but mention is made for the sake of completeness. before undertaking any of the foregoing procedures, a careful study of the complete descriptions in peroral endoscopy is necessary, and a practical course of training is advisable. [fig. .--the author's retaining intubation tube for treatment of chronic laryngeal stenosis. the tube (a) is introduced through the mouth, then the post (b) is screwed in through the tracheal wound. then the block (c) is slid into the wound, the square hole in the block guarding the post against all possibility of unscrewing. if the threads of the post are properly fitted and tightly screwed up with a hemostat, however, there is no chance of unscrewing and gauze packing is used instead of the block to maintain a large fistula. the shape of the intubation tube has been arrived at after long clinical study and trials, and cannot be altered without risk of falling into errors that have been made and eliminated in the development of this shape.] [ ] chapter xxxix--decannulation after cure of laryngeal stenosis in order to train the patient to breathe again through the larynx it is necessary to occlude the cannula. this is best done by inserting a rubber cork in the inner cannula. at first it may be necessary to make a slot in the cork so as to permit some air to enter through the tube to supplement the insufficient supply obtainable through the insufficiently patulous glottis, new corks with smaller grooves being substituted as laryngeal breathing becomes easier. corking the cannula is an excellent orthopedic treatment in certain cases where muscle atrophy and partial inflammatory fixation of the cricoarytenoid joints are etiological factors in the stenosis. the added pull of the posterior cricoarytenoid muscles during the slight effort at inspiration restores their tone and increases the mobility of all the attached structures. by no other method can panic and spasmodic stenosis be so efficiently cured. [fig. .--illustration of corks used to occlude the cannula in training patients to breathe through the mouth again, before decannulation. the corks allow air leakage, the amount of which is regulated by the use of different shapes. a smaller and still smaller air leak is permitted until finally an ungrooved cork is tolerated. a central hole is sometimes used instead of a slot. a, one-third cork; b, half cork; c, three-quarter cork; d, whole cork.] following the subsidence of an acute laryngeal stenosis, it is my rule to decannulate after the patient has been able to breathe through the larynx with the cannula tightly corked for days and nights. this rule does not apply to chronic laryngeal stenosis, for while the lumen under ordinary conditions might be ample, a slight degree of inflammation might render it dangerously small. in these cases, many weeks are sometimes required to determine when decannulation is safe. a test period of a few months is advisable in most cases of chronic laryngeal stenosis. recurrent contractions after closure of the wound are best treated by endoscopic bouginage. the corks are best made of pure rubber cord, cut and ground to shape, and grooved, if desired, on a small emery wheel (fig. ). the ordinary rubber corks and those made of cork-bark should not be used because of their friability, and the possible aspiration of a fragment into the bronchus, where rubber particles form very irritant foreign bodies. [fig. .--this illustration shows the method of making safe corks for tracheotomic cannulae by grinding pure rubber cord to shape on an emery wheel. after grinding the taper, if a partial cork is desired, a groove is ground on the angle of the wheel. if a half-cork is desired half of the cork is ground away on the side of the wheel. reliable corks made in this way are now obtainable from messers charles j. pilling and son.] bibliography the following list of publications of the author may be useful for reference: . peroral endoscopy and laryngeal surgery, textbook, . (contains full bibliography to date of publication.) . acromegaly of the larynx. journ. amer. med. asso., nov. , , vol. lxxi, pp. - . . a fence staple in the lung. a new method of bronchoscopic removal. journ. amer. med. asso., vol. lxiv, june , , pp. - . . amalgam tooth-filling aspirated into lung during extraction. dental cosmos, vol. lix, may, , pp. - . . amalgam filling removed from lung after a seven months' sojourn: case report. dental cosmos, april, . . a mechanical spoon for esophagoscopic use. the laryngoscope, january, , pp. - . . an anterior commissure laryngoscope. the laryngoscope, vol. xxv, aug., , p. . . ancient foreign body cases. editorial. the laryngoscope, vol. xxvii, july, , pp. - . . an esophagoscopic forceps. the laryngoscope, jan., , p. . . a new diagnostic sign of foreign body in trachea or bronchi, the "asthmatoid wheeze." amer. journ. med. sciences, vol. clvi, no. , nov., , p. . . a new method of working out difficult mechanical problems of bronchoscopic foreign-body extraction. the laryngoscope, vol. xxvii, oct., , p. . . arachidic bronchitis. journ. amer. med. asso., aug. , , vol. lxxiii, pp. - . . band of a gold crown in the bronchus: report of a case. dental cosmos. vol. lx, oct., , p. . . bronchiectasis and bronchiectatic symptoms due to foreign bodies. penn. med. journ., vol. xix, aug., , pp. - . . bronchoscopic and esophagoscopic postulates. annals of otology, rhinology and laryngology, june, , pp. - . . bronchoscopic removal of a collar button after twenty-six years sojourn in the lung. annals of otology, rhinology and laryngology, june, . . bronchoscopy. keen's surgery, , vol. viii. . caisson bronchoscopy in lung-abscess due to foreign body. surg., gyn. and obstet., oct., , pp. - . . cancer of the larynx. is it preceded by a recognizable precancerous condition? proceedings amer. laryngol. soc., . . din. editorial. the laryngoscope, vol. xxvi, dec., , pp. - . . endoscopie perorale et chirurgie laryngienne. arch. de laryngol., t. xxxvii, no. , , pp. - . . endoscopy and the war. editorial. the laryngoscope, vol. xxvi, june, , p. . . endothelioma of the right bronchus removed by peroral bronchoscopy. amer. journ. of med. sci., no. , vol. clii, march, , p. . . esophageal stenosis following the swallowing of caustic alkalies, journ. amer. med. asso., july , , vol. lxxvii, pp. - . . esophagoscopic radium screens. the laryngoscope, feb., . . foreign bodies in the insane. editorial. the laryngoscope, vol. xxvii, june, , pp. - . . foreign bodies in the larynx, trachea, bronchi and esophagus etiologically considered. trans. sec. laryn., otol. and rhin., amer. med. asso., , pp. - . . gold three-tooth molar bridge removal from the right bronchus: case report. dental cosmos, oct., . . high tracheotomy and other errors the chief causes of chronic laryngeal stenosis. surg., gyn. and obstet., may, , pp. - . . inducing a child to open its mouth. editorial. the laryngoscope, vol. xxvi, nov., , p. . . intestinal foreign bodies. editorial. the laryngoscope, vol. xxvi, may, , p. . . laryngoscopic, esophagoscopic and bronchoscopic clinic. international clinics, vol. iv, . j. b. lippincott co. . local application of radium supplemented by roentgen therapy (discussion). amer. journ. of roentgenology. . localization of the lobes of the lungs by means of transparent outline films. amer. journ. roent., vol. v, oct., , p. . also proc. amer. laryn., rhin. and otol. soc., . . mechanical problems of bronchoscopic and esophagoscopic foreign body extraction, journ. am. med. assn., jan. , . . observation on the pathology of foreign bodies in the air and food passages based on the analysis of cases. mutter lecture, , surg. gyn. and obstet., mar., , pp. - . . orthopedic treatment by corking. journ. of laryn. and otol., london, vol. xxxii, feb., . . peroral endoscopy. journ. of laryn. and otol., edinburgh, nov., . . peroral endoscopy and laryngeal surgery. the laryngoscope, feb., . . postulates on the cough reflex in some of its medical and surgical phases. therapeutic gazette, sept. , . . prognosis of foreign body in the lung. journ., amer. med. asso., oct. , , vol. lxxvii, pp. - . . pulsion diverticulum of the esophagus. surg., gyn. and obstet., vol. xxi, july, , pp. - . . radium. editorial. the laryngoscope, vol. xxvi, aug., , pp. - . . reaction after bronchoscopy. penn. med. journ., april, . vol. xxii p. . . root-canal broach removed from the lung by bronchoscopy. the dental cosmos, vol. lvii, march, , p. . . safety pins in stomach, peroral gastroscopic removal without anesthesia. journ. amer. med. asso., feb. , , vol. lxxvi, pp. - . . symptomatology and diagnosis of foreign bodies in the air and food passages. am. journ. med. sci., may, , vol. clxi, no. , p. . . the bronchial tree, its study by insufllation of opaque substances in the living. amer. journ. roentgenology, vol. , oct., , p. . also proc. amer. laryn., rhinol. and otol. soc., . . thymic death. editorial. the laryngoscope, vol. xxvi, may, , p. . . tracheobronchitis due to nitric acid fumes. new york med. journ., nov. , , pp. - . . treatment of laryngeal stenosis by corking the tracheotomic cannula, the laryngoscope, jan., . . ventriculocordectomy. proceedings amer. laryngol. soc., . . new mechanical problems in the bronchoscopic extraction of foreign bodies from the lungs and esophagus. annals of surgery, jan., . . the diaphragmatic pinchcock in so-called cardiospasm. laryngoscope, jan., . how to eat a cure for "nerves" ----------------------------------------------------------------------- "whosoever wishes to eat much must eat little." cornaro, in saying this, meant that if a man wished to eat for a great many days--that is, desired a long life--he must eat only a little each day. ----------------------------------------------------------------------- how to eat a cure for "nerves" by thomas clark hinkle, m.d. rand mcnally & company chicago--new york ----------------------------------------------------------------------- copyright, , by rand mcnally & company ----------------------------------------------------------------------- the contents page i. where the trouble lies ii. how to overcome the trouble iii. right and wrong diet for nervous people iv. value of outdoor life and exercise v. effect of right living on worry and unhappiness ----------------------------------------------------------------------- "nature, desirous to preserve man in good health as long as possible, informs him herself how he is to act in time of illness; for she immediately deprives him, when sick, of his appetite in order that he may eat but little." --cornaro ----------------------------------------------------------------------- the introduction this author-physician's cure for "nerves" vividly recalls the simplicity of method employed in the complete restoration to health of one of olden time whose story has come ringing down the ages in the book of books. naaman, captain of the host of the king of syria, a mighty man of valor and honorable in the sight of all men, turned away in a rage when elisha, the prophet of the most high, prescribed for his dread malady a remedy so simple that it was despised in his eyes. but "his servants came near and said ... 'if the prophet had bid thee do some great thing, wouldest thou not have done it?'" in "how to eat" the author offers the sufferer from "nerves" a remedy as simple as that elisha offered naaman. he gives him an opportunity to profit by his well-tested knowledge that overeating and _rapidity_ in eating are ruinous to health and shorten life. it is seldom that there emanates from the pen of a doctor a book which, concerning any physical disorder, minimizes the efforts of the medical practitioner. while this author-physician gives full credit to the conscientious physician for the great service he is able to render in all other spheres of his profession, he wholly denies the necessity for medical care in cases of nervous breakdown, and discounts liberally the benefits to be derived from professional advice except in so far as the doctor is the patient's counselor and dictator as to what and how and how much he shall eat and drink, and the way he shall employ his time. any discourse is valuable which incites a man having a marked tendency to depressing, morbid ideas, to rid himself of them. dr. hinkle helps the sufferer to gain that confidence and cheer which result from knowledge of certain immunity from dreaded ills and positive assurance of recovery by mere regulation of food or employment along the lines of simple, everyday living. but that alone is not sufficient. it is made quite clear that no one thing by itself will insure a cure of "nerves." the cure must come through common sense exerted along several related avenues of endeavor. no matter how steadfastly one may adhere to directions as to abstaining from harmful food and injurious methods of partaking of those foods which are beneficial, if he spends the larger portion of his time idly rocking in a convenient arm chair, exerting neither body nor mind nor will, that which might be gained by proper nutrition is largely nullified by lack of physical exercise and mental activity. that this little book may serve as a spur to the bodily self-denial and self-repression and the intellectual and spiritual uplift which make for character-building, is the very evident goal of its writer. from self-analysis and self-cure he has worked out a philosophy--a system or _art_--by which those afflicted with nervous breakdown may be healed. and by putting into print the result of his practical experiments in diet and exercise he has broadened immeasurably the scope of his helpfulness to all nervebound sufferers by placing within their reach the simplest of measures by which release is secured from a condition which wholly incapacitates for active service or even for quiet, everyday usefulness. it is because the things dr. hinkle advises are so commonplace, and because the doing of them day after day, year in and year out, is so monotonous, that people will be tempted to disregard or make light of their helpfulness. but the commonplace things which make up life are all important, as susan coolidge has so aptly expressed in these lines which fittingly illustrate the author's thought: "the commonplace sun in the commonplace sky makes up the commonplace day. the moon and the stars are commonplace things, and the flower that blooms and the bird that sings; but dark were the world, and sad our lot if the flowers failed, and the sun shone not; and god, who studies each separate soul, out of commonplace lives makes his beautiful whole." it therefore behooves the sufferer from "nerves" and that great host of others who are in danger of a nervous breakdown if they do not speedily mend their ways of eating and living, to heed the kindly admonitions and follow the precepts of this author who practices what he preaches. by persistently doing commonplace things in the most commonplace way, keeping ever in mind the great objects to be attained thereby--good health, good cheer, and increased usefulness throughout a long life--the reader of this little treatise will find it worth many, many times its size, weight, and bulk. and heeding the author's admonition, "go thou and do likewise," he will not shorten his life or lose it altogether in fruitless quests for the strength and nerve vigor which constantly elude him because of lack of self-control and failure to persist in the simple but efficacious measures of relief here outlined. m. f. s. ----------------------------------------------------------------------- how to eat a cure for nerves i. where the trouble lies "what we leave after making a hearty meal does us more good than what we have eaten." --cornaro it is now over twenty years since i had my first nervous breakdown. about ten years later i had another, far worse than the first one. the first lasted six months; the second a little more than two and one half years. doubtless if i had not in the strangest way in the world found out how to cure myself it would have lasted until now, unless death in the meantime had come to my relief. but right here i want to say that if you are looking for some new or miraculous treatment for such unfortunate people you might as well close the book now, for you will be disappointed. there is a cure for "nerves" but the cure is as old as the world. the trouble with poor deluded mortals--doctors included--is, we are constantly looking for a miracle to cure us, but if we look back on all the real cures that we have ever heard about, we shall find they were as simple as the sun or the rain. and in the name of common sense let me ask: what is the difference _how_ we are cured if we _are_ cured and are _happy_ as a result of it? isn't that enough? most certainly it is. and now, as we journey along through the pages of this book, i want you to know that these words have been written by one who has nothing to offer you except human experience. as we proceed you will notice that every statement is tremendously positive. when a man has been through this literal hell of "nerves" he knows all about it and what can be done for it. and so when i tell you the things you must do to get well and _stay well_, i want you to understand that i know. there is absolutely no theory to be found in these pages. if you put your finger in the fire you burn it. you don't have to take your finger out of the fire, call in a lot of learned gentlemen and say to them: "now tell me your candid opinion about my finger. is it burned or is it not?" and i am just as positive about my cure of "nerves" as you could be that fire burned your finger. that brings me to what i want to say about the so-called "rest cures" at the sanitariums. it is a well-known fact that if a case of "nerves" is pronounced cured at a sanitarium the cure is only temporary. sooner or later every one of these patients goes down hill again. and remember i am talking about people who have nervous breakdowns through no fault of their own. i have no time to spare for the person who has brought on his own trouble. i am chiefly concerned with that host of children in america--and there is a host, i am sorry to say--born of what i choose to call "pre-nervous" parents. the girls of such parents frequently break down in high school. and many of the finest boys that i know have this dreadful "thing" fastened firmly upon them just at the very beginning of their lifework. you may think i am a little vehement, but to me one of the most damnable and disgusting things in the world is that the medical profession remains so ignorant concerning the _real cure_ for such cases. i believe the late sir william osler was the greatest physician of his generation. he was not only a man of talent, he was a genius, and his knowledge of medicine almost passes understanding. yet osler himself was as much in the dark concerning the _real_ cure for so-called _neurasthenia_ as the physicians who read his works on practice. if one wants to find out how ignorant the whole profession is on the subject of a permanent cure, let the thing get hold of him, and then let him make the rounds of the physicians, follow out their advice, and see where he comes out! i have said that even the sanitariums of this country--and for that matter i might have said of any other country--do not _permanently cure_ these people. i have ample proof of this statement. i have met these people everywhere and no doubt you have, too. quite recently the subject was brought up anew to me. i had written an article on the subject for one of the magazines, a magazine having a large circulation. in a very short time my mail was literally flooded with letters. every incoming mail brought great numbers of them. they came from physicians of the regular school, and from physicians of many other schools, too. i won't mention any of them, for this is a treatise on a dreadful affliction and how one may get rid of it; it is not intended as a criticism of anyone. i have no desire to criticize and i haven't time. i am stating facts interwoven with my own life. if the cure is real, the people will find it out after they have tried it; if it is not, they will also find that out. in fact, it's exactly as gamaliel, the teacher of paul, said to the men of israel when they would have slain the apostles for teaching christ's sayings, "refrain from these men and let them alone: for if this counsel or this work be of men, it will come to naught: but if it be of god, ye cannot overthrow it." and it's exactly the same way with this healing art. the very fact that physicians of all schools of medicine--physicians who were sufferers from "nerves"--wrote me, shows plainly that they could not heal themselves. i have many letters from people who have been in sanitariums for years and who still have "nerves." the sanitariums do some people a lot of good, but they cannot remove the _cause_ of nervousness. i am certain that the very best rest cure for women is the one dr. weir mitchell first used. but such women are sure to go down again and again and still again if that is _all_ that is done for them. now frankly, if christian science could cure such cases and make them _stay_ cured i should want a practitioner of this cult to treat them. but christian science simply cannot cure them because the underlying cause of this trouble is _physical_, not _mental_. in other words, the mind becomes ill because the body is made ill by certain poisons, and the nature of the disease is so peculiar that most of these miserable sufferers will not even try a thing unless some one brings them overwhelming evidence of its having wrought a cure. or, if they do try it, they usually quit the treatment before nature has had time to do her work and set their bodies right. i have the most profound sympathy for such people. i want to speak directly to them. that is the task that i have set myself in this work. i want to talk directly to those of you who are sufferers from "nerves." i see you in every state, in every city, in every village, and throughout the farming districts of this country. i have received letters from many farmers who are suffering with this "thing." to them let me say, i know just how you feel, and from the very bottom of my heart i pity you. i know the horrible suffering of each one of you. i don't care what your ambition has been or is. i don't care what your situation in life may be. i don't care how rich or how poor you are. i don't care how much trouble you have had, or the nature of it. i want you to know these words are being written by one who knows more about your sufferings than you can imagine. i want you to believe this, because it is true. if you have longed and prayed for death, remember that the one who is writing these words also has longed and prayed for death. but one thing you must be sure to remember: while you are waiting and trying to get well you must have _patience_. i recollect one beautiful day in early spring when traveling in nebraska i passed a little cemetery. how sweet and restful the place seemed, and as i looked out over those little white stones i prayed silently that the great god who made me would not hold me much longer on earth, that he would soon grant me the rest and peace which i believed was to be found only in death and the grave. but _remember this_: in those dark days never for a moment did i think of taking my own life! these words may reach some one who has had such a thought. if so, i say to you that to take one's life is the most cowardly thing a human being can do. this is the only place where i feel like being severe with you people. shame on the man or woman who will not go on to the end fighting honorably! and now if you have ever given thought to such a thing, blot it from your mind forever. i can see how these miserable people might long for death, as i did. but no matter how we may long for release through death, the god of nature must be the judge of our time of going. now this brings me to what i want to say about such sufferers going insane. believe me, they never do! remember this always. you won't become insane. you couldn't if you tried! in letter after letter among the flood of them i have had from all over this country and canada, i read how the poor sufferer feared he or she might be going insane. i know, poor souls, just how you feel. that feeling is, i think, the most dreadful of all things connected with "nerves." i suffered from it for years. it is a dreadful feeling, but there is not the least bit of danger of such a thing happening to you. you will _not_ go insane. such persons can't. do you really get me? such persons cannot go insane. this disease is nothing but what we call a functional nervous trouble. and so forget about the danger of insanity for all time. you can be cured, but you will make your return to health just that much slower by harboring this fear. and it would be simply foolish for you to go on thinking it possible after i--let me say it again--after i have told you that it cannot happen. for the value of this treatise lies in the "i." its value is just like that of the treatise by cornaro. he lived it. and so likewise have i lived it. i have been laid low with this malady. i have staggered in black despair with staring eyes and bleeding feet and crying soul along this road strewn with thorns and stones. i know what it is to lie awake all night and cry like a baby, with none to know and none to tell me what to do. i know what it is to be tremendously ambitious. ambition! ambition! ah, god of heaven! how a poor soul suffers who beyond everything else, craves to be able to do something big in this world because he knows he should, yet is held down by this dreadful thing, "nerves!" and how little, how unspeakably little, do physicians, even the greatest of them, know, actually know, how we suffer, unless indeed there be one in whose own body the fiend has sunk deep its talons. after i had my first breakdown i made up my mind to study medicine because something told me that i was one of those "peculiar" people who just _think_ there is something the matter with them. is it not strange that with all the advance that has been made in general medicine, little or nothing has been done for the relief of the people born with this curse hanging over them? i wish this book could be put into the hands of every nervous parent for, think as you may, all nervous parents beget nervous children. but does it follow that such children should have a nervous breakdown almost before they are out of their teens? no, decidedly not; and what is more, they never should and never would break down, if they had proper food. i look back with horror on the many nights of my childhood when i suffered with "night terrors." and right here let me say: no child will _ever have night terrors_ if he is given just what he should eat, and is kept from overeating. and now a few words about the _first_ great point concerning the prevention as well as the cure of "nerves." nervous people, and many others as well, eat too much. that, you say, is nothing new. but that is just where the dreadful wrong begins; and why there has been tragedy after tragedy, and why even while this is being written there will be many more tragedies. you will hear lecturers say--i myself have said it, and to large audiences: "you people eat too much." but if that's all that is said, people straightway go away and say: "oh, yes, he's right, of course. we all eat too much." and there it ends. until recently people did not know--most of them don't know yet--that each day they are actually bringing the grave nearer by overeating. not long ago the great life insurance companies of this country held a notable convention in the city of new york. now after everything had been said and done, after every phase of life insurance had been discussed, what do you suppose was the great outstanding statement from that remarkable body of men who know more about why people die than any other body of people on earth? it was this: "the average american _man or woman_ dies at the age of because he eats what he wants to eat rather than what he should eat." that means, of course, that practically all americans overeat. they are all like the child who says, "i'm not hungry for bread and butter. i'm hungry for cake." and i find that most of these poor deluded nervous sufferers eat what they want under the supposition that it is good for them because they crave it. i myself used to do so. i would eat candy by the pound. and it is odd but quite true that nervous people crave the very things that hurt them most. but there is no more sense in eating what you crave because you crave it than there is in the man who is addicted to alcohol, drinking alcohol because he craves it. i once used tobacco; i craved it, but i did not need it just because i craved it. it is true the body naturally needs some fats, some carbohydrates; in fact, a balanced ration, as we shall see later. but i want to make it mighty plain here that never was there a greater error than that of supposing you need chocolates or sweets just because you crave them. and you don't need to overeat, and keep on doing it, just because you must eat. ii. how to overcome the trouble "he who pursues a regular course of life need not be apprehensive of illness, as he who has guarded against the cause need not be afraid of the effect." --cornaro we have now come to the second step in the cure of "nerves"--eating the right food in the right way. you must chew all food until it is of the consistency of cream, and you must also sip all liquids slowly. and now, as you read these things that i have set down, i want you to remember this: doing any one thing--and doing that alone--will not cure this malady. no, it is doing a number of things at the right time. i know this is true because i have tried it. for a time i chewed my food to a cream, but that was the only thing i did in an endeavor to get well. i was doing none of the other things that are absolutely necessary for a cure. this is one great trouble with all such people. they will fletcherize for a time and then say there is nothing to that because it does not cure them. well, as i've said, that alone will not, and i want to dwell at length on this because nobody knows as well as i do, what harm such a belief does the nervous sufferer. trying out fletcherizing alone, which i say must be done together with other things if you want to get well and stay well, is like taking the handle of an axe and going out into the woods to cut down a tree. now with fletcherizing you have a perfectly good handle, but you know very well that you can't cut a tree down with only an axe handle. but that is not the fault of the handle. the fault is obviously your own. now suppose you get the axe and fit the handle to it. you can then cut the tree down if you work hard enough at the task. again, suppose you cut the tree half way through and quit. will the axe keep on until the work is done? you know it will not, and you very well know if you wish to be cured you must keep on doing your part of the work or dieting will be of no value whatever to you. now suppose a man comes along and tells you that the axe you have is no good and therefore it is no use for you to keep on trying to use it. that is exactly what some physicians still say about fletcherizing. but you say, "i must cut this tree down. nobody will do it for me; how shall i get it down? can you give me an axe that will cut it down?" "oh, no," he replies, "but anyway there's no use fooling with that one." then, if you are determined to do the work, you say, "i have to cut the tree down. you have no other axe to offer me, so i'm going to try the one i have." and you go ahead and cut down the tree. then just as you have finished, the man comes your way again, and in great delight you call out to him: "come and see! i cut this tree down with the axe you said was no good!" the man comes over to you and says, "where's the tree? i don't see it!" you are astonished and you tell him, "there it lies on the ground right before your eyes! can't you see it?" but he turns and walks away saying: "there is no tree there; it is all in your mind." this is exactly what people with "nerves" have been told again and again by physicians, by relatives, and by most other people who have never had "nerves." i tell you these things so that when you begin to eat sparingly and chew your food to a cream you may fortify yourself against well-meaning but mistaken friends and relatives. and, oddly enough, it does seem that the individual with "nerves" has more friends and relatives than any other person in the world. remember you must not only chew your food to the consistency of cream for one or two months, you must make this practice a lifelong habit. if you cannot take time to eat a meal in this way, you had much better go hungry. to people who travel and must frequently take their meals in railroad eating houses, i would say, get some bread and butter sandwiches and eat them slowly while on the train. there is always a chance to secure all you need to eat, too. you may not always be able to sit an hour at the table--the time we should give to a meal if we eat as we should. i know many object to this rule on the ground that if we followed it we should get nothing else done. but that is nonsense. did not the master of us all say, "are there not twelve hours in the day?" then can we not devote three of the twelve to our food? if we have nine hours in which we are at our highest efficiency, is it not good sense, if we eat three meals a day, to give three hours to these meals? there is only one sane answer to the question; we should take an hour for a meal. every now and then some magazine writer will state that the chewing of food to a cream does not help anybody. he will tell you that you can swallow your food any old way and it will not hurt you in the least. in fact, i actually saw an article in one of our leading periodicals containing just such statements. we should, i suppose, have only pity for an editor who would give space to such stuff, and should also pity the poor wretch who by writing it is striving to attain notoriety. at any rate there is one excellent thing about such lies, they do harm for only a little while. when people find out that a thing is harmful to them, they usually quit it, no matter how many notoriety seekers are urging and encouraging them to keep on. usually the sufferer with "nerves" is the only one in the household who will eat sparingly and chew his food slowly. but now and then i find an intelligent, sympathetic man who will do so because it is helpful to his wife. he sympathizes with her infirmity, and with fine self-denial eats as she does. and note this: he usually derives benefit from so doing. time after time when i have put a nervous woman under this regimen, and then her husband elected to go along with her, i have had the man come to me and say: "well, doctor, i declare i'm feeling a whole lot better myself! i don't get sleepy any more during the daytime, and that pain i used to have in the region of my liver is gone!" and so on and on. the fact is just this: anybody who follows the rules that i learned to apply in my own case cannot fail to be benefited. and although those not inclined to "nerves" can eat a greater variety of food, it's greatly to be desired when there is a nervous person in a household of grownups that all other members of the family enter together into this thing. it could not fail to help every one of them. to be truthful, in the beginning you will all find it mighty hard to persist in chewing all your food to a cream. mouthful after mouthful of food will get away from you when you are not thinking. this just goes to show how we are in the habit of bolting our food. at first people who fletcherize or chew their food perfectly, usually lose weight. i most certainly did. i lost about twenty pounds because of it, but i was so well and felt so good i could almost have jumped over the north star. i know that, unfortunately, a lot of people with "nerves" have started to chew their food carefully and to eat sparingly, but the minute they found themselves losing weight they were frightened and quit. they went on carrying that ten or twenty or thirty pounds of flesh and all the time suffering the tortures of the damned just in order that they might keep it. but of what benefit are a certain number of extra pounds of flesh and how can a man explain such a senseless action? the astonishing thing is that many physicians are willing to condemn a cure just as soon as they find the patient has lost a pound of beef. but as i said before, the primary mission of man in this world is not to raise beef. i do not find fault with the raising of beef in the feeding yards, but if beef must be raised let us confine the industry to the cattle pens and stock yards. let us not worship it to the degree that we would rather live in hell than part with a few extra pounds that overload our own bodies. now just here i want it distinctly understood, as i have said before, that this text is primarily for _functional nervous cases_. tubercular people belong to an entirely different class. they should live out of doors day and night and should, if possible, be treated at outdoor institutions established for such cases. but the individual with "nerves" will find what he needs and will find it abundantly if he has enough determination to take hold of it and keep at it. on the part of many it will take all the determination they have to chew their food to a cream and always eat sparingly. in regard to the amount of food taken, judgment must of course be used. we all know that it is possible to eat too little. but you should always quit eating while you still feel you would like a little more. i know of no better guide than this to offer you. but i have observed that the person who eats slowly and chews his food to a cream never eats as much food as he would if he bolted it. it is just like letting a thirsty horse drink water. i remember, as a boy on the farm, when i led a very thirsty horse from the field to the water tank how rapidly he would swallow. if my father were with me, after the horse had drunk a while he would say, "make him hold his head up." frequently when i did so the horse would draw a long breath and drink no more. had he gone right on drinking, as a thirsty horse will if you permit him to do so, he might have drunk twice as much as was good for him. and that's the way people eat. as a result the horse that drinks and drinks and drinks when he is very thirsty sometimes dies in a few hours. i have seen a horse die from drinking too much water and i have also seen people die in a few hours after a terrible gorge that they could not get rid of. do you know that most nervous people have a way of sitting down to the table and eating until they are literally full? if you could take out the stomach of such a person and look at it, the sight would frighten you. and with good reason. for as a result of this habit many nervous people have dilated stomachs. but if they would correct their manner of eating there is usually enough tone in the muscular walls of the stomach to get it back to normal. i marvel again and again over how miraculously nature restores herself even after she has been terribly abused, if only she is given a chance. i am certain that all human beings would be more efficient if they chewed all solid food to a cream and sipped all liquids slowly. the late professor william james, the great harvard psychologist, testified to the value of such a habit, as did a number of other distinguished harvard professors. i regret that some physicians still hold out in their belief that it does no good although the evidence stands out as clearly before them as a tree along the roadside. but they are like the physician who some years ago declared that bathing was bad for people. i recall how hard we all bore down upon him, as he richly deserved, and how the journal of the american medical association printed a short poem ridiculing him. i am quite certain that the members of the regular school of medicine have progressed infinitely farther toward the cure of diseases than members of all the other schools combined. i do not say this simply because i happen to be a physician of the regular school; i say it because a candid survey of what has been accomplished, and by whom, proves it. but as to diet, we have done little compared with what we should do. we have made no greater progress along this line because so many of us have been blinded by prejudice--the curse of the human race. with regard to chewing all food to a cream, most modern writers on dietetics, while acknowledging that this super-mastication is useful, maintain that it does not increase the value of the food. but they err greatly in this, as we can prove in a very few words: if a certain amount of proteins, fats, and carbohydrates is bolted by a nervous man suffering from a breakdown, it will cause intestinal toxemia as a result of the bolted food, but if he chews the food to a cream it will be digested in a normal manner and will not cause gas in the stomach or intestines. the proper amount of food is absorbed and nourishes the man as it should. now did not the thorough mastication of that food increase the value of the proteins, fats, and carbohydrates? the thing is a self-evident fact. in the first case a man takes food which quickly turns to a loathsome poison. in the second instance the same kind of food is so thoroughly mixed with the ptyalin in the saliva that whatever is eaten becomes of value as protein or fat or some other food element. after many years of sad experience with this malady we call "nerves" i am convinced that the reason why people have this disease is because they are literally "food drunk." i have treated men who had been on an alcohol debauch and i know how terribly depressed they are after such a spree is over. it is exactly the same way with the pre-nervous people that break down. they sit down to a big meal and overeat. there is a temporary stimulus, just as in the case of the person who takes intoxicants, followed by that terrible mental depression that all who have suffered from "nerves" know. and because the individual with the "nerves" is overeating two or three times each day, he stays drunk with the poisons that form in his stomach and intestines. such people over-assimilate the poisonous products of proteins, especially of sugars. of course this may seem oddly stated because we would not want any absorption of the poisons in the intestines, but it is probable that nature can and does take care of a little of it there in the healthy individual. it is perfectly absurd to say, as some physicians still continue to say, that no poisonous matter is ever absorbed in the intestinal tract. give a child something that causes intestinal indigestion and see how quickly he has a rise in temperature. this fever is the direct result of poisons absorbed in the intestines. in the case of the nervous adult, however, this poison does not as often result in fever as it does in a horrible mental depression and a complete inability to perform any sort of work. and so there seems no question but that this terrible malady we call "nerves," or a nervous breakdown in any of its many forms, is in a majority of cases the result of the wrong eating habits of the individual. the chewing of all food to a cream will go far toward curing the trouble, but in most cases this alone will not effect a cure. it would not have done so in my own case, although i did see much improvement as a result of that practice alone. and here i want to say this: there are many who say they cannot eat acid fruits because of the distress they cause. now if such people would always chew an apple, a pear, or other fruit to a cream, no distress would result from eating fresh fruit. but such people must follow in detail the diet i shall give farther on. now, facts cannot be stated too strongly. it is certain acid fruits will cause distress if you do not chew them to a cream. i would swell up like a toad if i ate only one apple hurriedly. i don't dare think what might happen to me if i ate three or four in that way. i might possibly find myself transformed into a human balloon and float away into space. but i don't eat apples that way--not now. some who read these pages may think it very strange, yet it is quite true that there really are persons suffering with "nerves" who have not gumption enough to follow this simple rule of chewing all food to a cream. i despair of ever helping those people. they still continue to dispose of a big meal in fifteen minutes, and then insist they have chewed all their food carefully. i have had that thing happen right before my own eyes. then think of their complaining that they cannot eat apples because they cause so much gas in the stomach! one reason why a large number of such people are troubled with gas, even though they do chew their food to a cream, is because they immediately follow a meal with one or two cups of tea or coffee. now please remember this: an individual afflicted with "nerves" has no business drinking either tea or coffee. he should let them both alone. plain hot water is the very best drink in the world for a nervous person. if you want a drink after your meal drink a cup of plain hot water. and you should also drink a cup of hot water half an hour before breakfast. if you do not care for breakfast, and feel you do not need this meal, drink the hot water anyway. the victim of "nerves" should never drink during the meal but after it, if he must drink anything at all. he should also drink a pint or more of cold water between meals every day. now, another thing with regard to chewing all solid food to a cream. it has been proved over and over again in my own case and in that of many others, that in doing this the brain and muscles are both made stronger and keener for work, that those who chew their food in this way have much greater endurance, both mental and physical, than those who do not. today if i should relax my vigilance in respect to chewing my food i should soon go down again. but with this aid, which i now so easily employ, combined with exactly the right things to eat, i find i need have no fear. it has been ten years since my last breakdown and in that interval i have done the very best work and by far the hardest brain work of a lifetime. i do not believe people break down from overwork. you may think that a perfectly absurd statement. but i have good grounds upon which to base my belief. if nervous people would eat sparingly and chew their food to a cream, eating the foods i shall mention later on, i am confident they would rarely, if ever, break down. it is certain that in the last ten years, with the greatest mental strain on me, i should have gone down again, and perhaps more than once, if i had not found what caused "nerves" and how to prevent it. in the meantime i have written ten or more books, and every writer, at least, knows what a nerve-racking profession writing is. in addition to all this mental labor i have gone right ahead with my medical practice. surely there is balm in this particular gilead. but if you will not chew your food to a cream you need not expect to win the entire reward. and you must do this not only one day or one week or one month or one year, but all the days, weeks, months, and years that you may live. and, alas! i know only too well all the trouble well-meaning but deluded people who sit at the table with a nervous individual will make him when they discover how much time he is taking to chew his food. at first, because of the length of time i spent at a meal, such people thought i must be eating as much as a horse. but, here and there, for i was in many places, when people found out what i was doing, they would only courteously deride me for being so gullible about what they termed fads. we are all well aware that the vast majority of americans do not chew their food to a cream or anything like it. and there are those, therefore, who advance as an argument that because the majority do not there must be something wrong with the minority who do. well, let us follow this out a little: not so many hundred years ago everybody believed the world was _flat_. but their theory did not make it flat. and so, even though thousands of people who crowd our eating houses do bolt their food, that does not prove there is no danger in the practice. and they who do it are digging their graves with their teeth. _chew your food!_ iii. right and wrong diet for nervous people "he who leads a sober and regular life, and commits no excess in his diet, can suffer but little from disorders of any kind." --cornaro people who are the offspring of nervous parents and who have had a nervous breakdown should not eat commercial sugar, eggs, or animal food of any kind whatever. these statements may seem wholly unimportant to some people, but i realize what a tremendous bomb i throw into the camps of others when they read them. you see, for centuries people have believed meat and eggs to be the best of all foods; so when i make a statement like the foregoing, the effect is not unlike that which followed columbus' statement that no matter what people believed, the fact was that the earth was round, not flat. from the very beginning it has not made a single bit of difference as to what physicians or anybody else thought; facts count. and no matter what we may think or how long we have thought it, facts go right on being facts just the same. sometimes, even after twenty years' experience, about once in two or three months--because there is nothing else at hand--i find myself eating a small bit of meat. this usually happens when i am on a lecture tour. but if i eat only a small slice of bacon at the evening meal i dream bad dreams and the next morning feel drowsy, heavy, and sluggish. animal foods as well as eggs and commercial sugar poison all those born of nervous parents. i have proved the truth of this by my own case and by several years' observation of other cases. do your children have "night terrors"? you answer, yes. well, let me tell you how to stop these horrors in the little ones. if you give them meat--and remember you should never give them pork--let them have a very small piece at noon, never at night. and they should never be permitted to have it for breakfast. give the child his one small bit of meat at noon. for the evening meal give him some cereal with milk or cream, but no sugar. give him all he wants of this special dish, but nothing else at that meal, and you will find his "night terrors" and moaning will cease. i look back on most of the nights of my childhood with horror, for until i became a man i talked in my sleep and had the most horrible dreams. i used also to get up in my sleep and walk about the room. my parents were well aware of the fact that all of their eight children were poor sleepers, and of them all i was by far the worst. and, although it was innocently done, the food they were giving us was poisoning us. you don't need to think that in order to take poison you must have strychnine or arsenic. no, indeed you don't. we were fed exactly as hundreds and thousands of poor little ones are being fed now as this is being written. we were fed on meat, eggs, and fats, and when we became ill, friends round about us thought they were doing something real kind when they sent in a nice piece of fried rabbit or some celebrated golden brown fried chicken. but we vomited at the sight of the food--which was really our salvation. i have two boys of my own. the elder, a sturdy chap not yet ten years of age, has to have clothes for a fourteen-year-old boy, and he is much stronger than any boy of his age he has ever met. the younger boy is now seven and his physical development is wonderful for a child of that age. now these boys hardly know what an egg is. they never eat one. as to meat, i am certain that since they were born they have not eaten it on an average of once a week. they have eaten a little, but you will admit that eating meat not more than once a week, and often going weeks without a bit of it, certainly is eating very little. there have been times when they have not seen meat for three months. now, i don't eat as i do and have my children eat as they do just for a fad. i think nothing is more stupid and silly than for people to do certain things just because somebody else does them. we should all have good sound reasons for our actions in this world. we should all try our very best to use sound common sense. that's why i say that people who are the offspring of nervous parents should not eat animal food of any kind after they are twenty-one, and they should never at any time eat eggs. it would be far better for them if they did not eat commercial sugar. but i do admit that when some of these people get well by dieting, they are able to eat sparingly of all these things and still keep well. but some people can never eat them and i am one of the number. i remember one summer about two years ago i was on a lecture tour for a chautauqua bureau, and it seemed that surely i got into the very worst eating places that summer that i ever had in my life. for three or four days i ate only eggs, as they seemed to be about the only food i could get besides bread and butter. at the end of the third day--i remember the time very well--when night came i could not sleep, and just as when i had one of my nervous breakdowns, that old feeling of inexpressible gloom began to settle over me. i knew instantly the cause of it, because twice before when i had purposely experimented with eating eggs i had had similar experiences. i immediately took a heavy cathartic and after having thoroughly rid myself of the poison i again slept well. but i am not alone in this fight against the use of eggs for nervous people. john burroughs said that eggs poisoned him, and i have talked with men of great wealth and great business ability who have reached the top by their own efforts, who have told me that eggs poisoned them. now i have found that for these nervous people animal food is a slow poison. sooner or later it will do its work. and just here i wish to say that there are some people who seemingly can eat almost anything and not suffer from so doing. last summer i talked with count ilya tolstoy, son of leo tolstoy, the celebrated russian writer. the count, who is also a lecturer, told me that he was obliged to have eggs and that he had eaten them all his life. he said his appetite was never satisfied unless he ate eggs. he is now past sixty, and apparently is strong and rugged. now eggs no doubt are good for him. but right here is where infinite harm can be done to nervous people like myself. people who can eat everything--and among physicians seemingly there are many who can do so--will say to these poor sufferers: "why, it's all nonsense about things hurting you! eat anything you want and all you want and then forget about it." physicians have said that to me and during the past twenty years i have heard them say it thousands of times to others. personally i do not believe in christian science--physicians of the regular school do not believe in it; but do you know that when a physician says to a sufferer from "nerves," "it's all nonsense about what you eat hurting you; eat anything you want and then forget about it," that physician is fully endorsing christian science. he is telling the person to whom he is talking that there is no such thing as physical suffering. of course, such a physician is nothing but a fool. yet that's why so many of these people turn to christian science. yes, that is exactly why they try it. it bolsters up a sufferer for a time just as contact with a magnetic and hopeful personality may for a time bolster one up. but such persons almost always go back to the sanitariums. "nerves" is not a mental disease; that is, the seat of the trouble is not mental but physical, and the mental phase of "nerves" is only a symptom, or rather one of the symptoms of the disease. we people who have gone down into the dark valley have experienced a million, more or less, different kinds of feelings. i fully believe one half of the american people are the offspring of nervous parents. this means that there are fifty-five million of this nervous type of americans. this type includes people all the way from the man in an office who gets angry quickly, to the individual who is in a state of complete collapse. and the man who is afflicted with nothing more than a quick temper, or is living under high nervous tension, is liable to beget children who will suffer from the malady in a far worse degree than ever he will, unless, indeed, he eats only the things he should eat and observes a number of other rules besides the two i have already laid down. now, the ideal diet for nervous people is a slightly modified vegetarian diet. to be specific, it is a lacto-vegetarian diet minus eggs. there are, however, two things included in this diet that i would warn one in the beginning to eat of sparingly. these are bananas and cooked cabbage. if they agree with you, well and good; but if they do not, let them strictly alone. eat all kinds of vegetables, both fresh and cooked. eat all kinds of fruits, especially fresh fruits. there is an old saying and a good one, "an apple a day keeps the doctor away." there are a thousand ways to prepare vegetables and fruits for the table, and there are a number of books that give good recipes. if a nervous individual has never yet had a breakdown i believe he can safely eat most of the vegetarian dishes that have eggs in them, but it would be a serious mistake to select the special dishes that contain eggs and live on those just because they contain eggs. i believe, too, that after a nervous person is restored to health, if he strictly observes the rules of eating sparingly and of chewing all food to a cream, he may safely try out such courses as are found in _bardsley's recipes for food reformers_ or _broadbent's forty vegetarian dinners_. it may seem odd, but there are people who for some reason or other lack the instinct, or whatever is needed, to know that a certain thing they eat hurts them. i have had men and women sit in my office and say with the utmost sincerity that they were certain that it wasn't anything they ate that hurt them because they never had any pain in the abdomen. sometimes these people were in a dreadful state of nervous breakdown. so you see the danger that lies here. if you know, you can always tell what special thing disagrees with you. for example, i know eggs disagree with me, and like john burroughs and many others, i know when they harm me. therefore, after you have recovered you might try being your own physician. but if you are not sure as to what disagrees with you, you would much better stick to a vegetarian diet and go without eggs the remainder of your days. commercial sugar also is the cause of many breakdowns among the people of this country. and is it not strange how these poor suffering people crave sweets--the very thing they should not have. they will argue with themselves--and some physicians will agree with them--that they should go right on eating candy because they want it. but, as i have already said, there is just as much sense in saying a man should have whiskey because he craves it or that a young man should have tobacco because he craves it, as to say that any one should have candy because he craves it. there is absolutely no sense in such an argument. if you are suffering from a nervous breakdown, for sixty days quit eating candy and everything sweet except honey, and follow the other rules i have already laid down. it may be that you will have to stick to this diet for three months. but try it. that is exactly what cured all my bodily ills and brought my soul out of the dark and gloomy night after everything else had failed. i do not mean to say that this diet alone cured me, but i do say it was the biggest factor in the cure. there are, however, some other things that it would be worse than folly to ignore. this i shall come to later. but just here i want to have it understood that this thing of eating--how you eat, and how much you eat, and what you eat--is of transcendent importance in the cure. of course, under some circumstances connected with cases of breakdown, nothing but the good judgment of friends will avail. for example, the question of how much one shall eat is something that not all the books in the world nor all the physicians in the world can determine. i say, always quit while you want a little more. i cannot say more or less than that. so many have written me recently asking just what i eat, that it may be a help to some of them if i set down here just what i ate today. i ate no breakfast at all. sometimes i go for weeks without eating breakfast. this is especially apt to be the case if i am engaged in writing a magazine article or a book. i find my brain is much clearer and that i can work much better when i eat no breakfast. but i do drink one or two cups of very weak tea. i use just enough tea to color the water. now i do not advise everybody to go without breakfast. some people tell me that they have a headache unless they eat something. and some writers say that if they do not eat a little breakfast they cannot write so well. thus you see where the question of common sense and using your own judgment comes in. there are always a few things you will have to decide for yourselves. at noon i ate about two handfuls of corn flakes with milk and cream but no sugar, finishing with about four ounces of bread pudding that had a little brown sugar in it. now, in mid-afternoon, as i write this, i am not hungry. tonight i shall eat another dish of corn flakes and some buttered toast and three or perhaps four good-sized apples, i usually eat three or four apples a day. if i want a piece of pie for lunch, i eat it, but i eat nothing else. i live on the plainest of plain foods. apples used to create a lot of gas in my stomach, but now they do not because i chew them to a cream. milk used to make me constipated, but it does not when i chew the cereal with it carefully and eat a number of apples. most nervous people are constipated. but apples are really the salvation of nervous people. if you are constipated, drink, or rather, sip, a glass of hot water half an hour before breakfast, then eat nothing for breakfast but apples; eat two big ones and chew them slowly to a cream. go to stool regularly every morning. this habit is half the cure of constipation. apples, of all things i know, are the finest things for the liver. if you take a patient ill from chronic indigestion, whose stools are clay colored, and put him on a diet of apples, if he chews properly, in less than twenty-four hours the stools will be of the regulation dark brown color, as they should be when the liver is working in a normal, healthful manner. and eating apples will work in exactly the same way with children as with adults. apples, apples, apples! eat them no matter what the price. you remember how good adam found the apple--or at least we presume it was an apple that he found so good--and i can think of no other single thing that would tempt a man to make all the trouble he did. if he had to sin, then i'm for adam every time, for i think had i been in his place and eve had offered me a big juicy red apple, i should have taken it and eaten it. i don't know but that i might even have eaten it without the invitation. i think that adam's great mistake was not so much in eating the apple as in trying to lay the blame on the woman. nobody should ever apologize for having eaten an apple. now, generally speaking, there is one thing a nervous parent--or any other kind of parent for that matter--should never say to a child. never tell him he is nervous. if we realize that our children are the offspring of nervous parents, it is, as i have already suggested, much better for all concerned, for we cannot avoid a danger unless we know what or where the danger is. when we know the child is nervous we should plan carefully, leaving out of his diet all pastries and rich greasy foods, and keep him largely on a vegetarian diet. but, as i have already suggested, we do not need to diet a nervous child as strictly as we do a nervous adult where infinite harm has already been done. give the nervous child meat only a part of the time, and if he goes without eggs it will be all the better for him. i wish from the bottom of my heart that i had never tasted an egg! what a fine thing it would be if we so trained our children that they would never suffer from "nerves"! and usually it could be done. the belief that because nervous parents have broken down their children sooner or later must break down, is our greatest curse. but such a belief is absurd, for if dieting, outdoor exercise, and a few other simple rules are observed, there is no danger that it will happen. to be sure, these rules must be definitely understood and strictly adhered to. if we treat this misfortune in the manner i shall mention later, we can make our lives more successful and infinitely happier than the lives of those who have never learned self-control. for instance, i am far healthier than men all around me who seem to be able to eat three christmas dinners each day. they sit at the table and boast about being "good feeders," then later they come to me for pills, saying, "there is nothing the matter with me, doctor, but i thought i had better take a little medicine so i won't get ill." but they don't fool me. i know exactly what is the matter with them. they are so full of pork they can't think. to tell the truth, we people who have suffered from a nervous breakdown or some illness akin to it, and have learned that we must eat right or die, are of all people the most fortunate. every now and then i hear some good old sister, with a face like a full moon and jowls like a bloodhound, say, as she finishes her third piece of mince pie,--her waist line having extended accordingly,--"isn't it too bad about poor brother jones! he looks so terribly thin! they say he has fallen away from one hundred and sixty pounds to only a hundred and fifty. and they do say he can't eat meat and eggs at all! the poor man!" but the real facts of the case are that brother jones is able to walk ten miles any day, and the possibility is that in the not distant future he will read in his morning paper that sister sue portly has been operated on for gall stones and the number reported is almost unbelievable, about three hundred, in fact. and so, all the time sister portly was feeling sorry for lithe, energetic brother jones, she was a walking stone quarry, as it were, and yet didn't know it. so don't worry because you have to diet or because after reading these lines you determine that you must begin to diet. for, whoever you are, and wherever you may be, you belong to a most fortunate class of people. and now i wish to say some things about what nervous people should do besides dieting, and especially do i wish to say these things to those now suffering from a nervous breakdown. much of it at least will apply to children of nervous parentage. you will observe as you go along that i keep mentioning "these children." i do so always with the thought in mind that there is absolutely no need for them ever to break down if these common sense rules are followed. i take it that not any one of us or a number of us, but that all of us love our children more than we love ourselves. admitting the truth of this, then we should all be interested in this system for them as well as for ourselves, for as their nerves are so shall their success be. iv. value of outdoor life and exercise "better to hunt in fields for health unbought. the wise for cure on exercise depend; god never made his work for man to mend." --dryden people in this country are now beginning to get away from the idea that a man or woman who is past sixty is getting "old." when the rev. john wesley, the itinerant preacher and author, was eighty-eight years old--please note the eighty-eight--he walked six miles to keep a preaching appointment. when asked if the walk tired him, he laughed and said: "why, no! not at all! the only difference i can see in my endurance now and when i was twenty is that i cannot run quite so fast." i know there are calamity-howlers who say: "oh, well, some people are born to success and long life and some are not!" the individual who permits himself to get into that frame of mind is doomed and no one can help him. such reasoning is of course all nonsense. john wesley was always a spare eater. yet he lived an active outdoor life, often traveling forty and even sixty miles a day on horseback. he never failed to keep an appointment on account of the weather. and he was a tireless worker, often preaching four and five times a day. at the same time he read and wrote every spare moment, turning out a large amount of literary work. dr. eliot, ex-president of harvard college, a constant writer and speaker, and among the greatest of american educators--now nearer than years of age--is also a moderate eater. he says, "i have always eaten moderately of simple food in great variety. this practice is probably the result, first, of a natural tendency, and then of confirmed habit and much experience under varying conditions of work and play. from much observation of eating habits of other people, both the young and the mature, i am convinced that moderation, simplicity, and variety in eating are more important than any other bodily habit towards maintaining good health, power of work, and, barring accidents, attaining to enjoyable old age." it is interesting to note what that eminent lawyer, legislator, and orator, chauncey m. depew, had to say on the occasion of his eighty-seventh birthday about a simple diet and reaching the century mark. "the true philosophy of life is this: the more you like a thing the more reason there is for giving it up if you find it is not good for you. if you treat nature properly, nature will adjust herself to you. "my diet is very simple. i have the same breakfast every day in the year, and it consists of an orange, one four-minute egg, one half of a corn muffin, and a cup of coffee which is mainly hot milk. i have this at half past eight. my hour of rising is seven every morning. "for luncheon i partake principally of vegetables, with no meat, and a glass of water. this is at one o'clock. at dinner i skip most of the courses and enjoy small portions of vegetables, fish, and fowl. i never eat between meals and consume now less than half i did at fifty." the vigor and long life of bishop fallows of chicago are mainly due to his living and mental habits and to his simple diet. he is well over years of age, but few men of three-score years can do as much work, the year round. there are two or three sermons and several public addresses each week, and the work of a large parish--from marriages and christenings to funerals and parish visitings--which is never slighted. an active grand army man and civil war veteran, he is asked to address countless military and patriotic gatherings, and his energy seems as tireless as his spirit is willing. his ability to meet these demands can be traced back to simple living and simple eating. the bishop is temperate in all things, and refuses to worry. he neither drinks nor smokes. in regard to his diet he says, "i eat very little meat, but take plenty of fruit, cereals and vegetables. i take regularly before breakfast a cup of hot grape juice. i use it frequently at other times. i take buttermilk daily." night and morning he takes simple physical exercises, and always walks at least a couple of miles each day. the bishop's ancestors were long-lived. his great grandfather lived to be ; his grandfather, ; his eldest brother, . his father's death from a fall occurred at the age of . he has a brother who is . this in itself is evidence that he comes of a family in which right living--which means simple living--has prevailed until its effects have shown in each succeeding generation. the world-renowned american inventor, thomas a. edison, now in his th year, has today a mind as brilliant and ingenious, and a skill as remarkable for inventing things that are of practical use, as when at he invented his automatic repeater which did so much for telegraphy. and edison is another spare eater. what he ate at the three meals of the day on which he wrote the following letter, is characteristic of the small amount he eats every day in the year. and you will learn that this is true of every man or woman who has lived long and is still doing active brain work. and so, once for all, let us think right about this matter. we get out of ourselves just about what we put into ourselves or do for ourselves in the way of food and exercise. [transcriber's note: the following is the text of a letter from mr. edison that was included as an illustration in the book.] from the laboratory of thomas a. edison, orange, n.j. march , . dr. thomas clark hinkle cawker city, kansas. dear sir: your letter of february th was received. my food for the one day on which your letter was received, was as follows: breakfast cup coffee / milk, / coffee. two pieces toast, - / " Ã� ", / " thick. another piece toast with two small sardines on it. midday meal glass milk. two pieces of dry toast. evening meal two glasses milk. three pieces very thin dry toast. small piece steak, - / " wide, / " thick, " long. small baked potato. one piece nut chocolate. yours very truly, thos a edison [transcriber's note: this additional note was handwritten on the typewritten letter being reproduced in this section.] weight lbs can diminish this diet without loss of weight e [transcriber's note: end of letter.] most people do not take enough systematic outdoor exercise. and exercise, i would have you understand, is another essential in the cure of one who has "nerves." but i am quite sure that a lot of bad advice has been given women sufferers along this line. i find that as a rule, women make better progress, at least at first, with complete rest or as much rest as they can possibly get. i have seen great harm come from telling a woman afflicted with "the mysterious disease"--as it is often called--to take long walks. i am always extremely careful about telling such a woman to indulge in vigorous exercise. some women, of course, are much stronger than others. my advice to a woman is to walk in the open air unless she is so ill she cannot walk at all without becoming very weak. and here again each person must use common sense and decide the matter herself. but no person with a nervous breakdown should ever work at any task or take any kind of exercise to the point of exhaustion. i well remember a man who came to me some years ago suffering from this malady. he had been trying to get well by doing heavy stunts in a gymnasium. he was very muscular, in fact he was an athlete, and was still under twenty-five years of age. his cheeks were ruddy, and to the ordinary observer he appeared to be in the pink of condition. but he had that peculiar expression of the eyes that flashed his story to me as plainly as if blazoned forth by the letters of an electric sign. i told him at once that he could never hope to cure his nerves by such violent exercises. and right here let me advise men in this condition not to run. i receive many letters of inquiry from young men with broken-down nerves who tell me they are taking long walks and finishing with a run. to all such i say: do not run. i know all about it for i have tried it. i was on my university football team. and all my life i have been fond of athletics. i am still fond of this kind of life and always expect to be, but exercise is frequently overdone by nervous people. usually, the physically strong man who breaks down with "nerves" thinks at once of physical training. but strange as it may seem, you can make such a man's muscles as hard as iron but that alone will not cure him. and it is true that many people in this condition do not seem nervous for they are not at all shaky, as some think an individual should be if he is the victim of a nervous breakdown. i well remember that one day when at my worst i could not work nor concentrate my mind on anything. i chanced to be in topeka, kansas, and passed a shooting gallery. i was a good rifle shot and i had been taking long walks and shooting kansas jack rabbits. i went in, picked up one of the rifles, and started firing at the biggest target. i rang the bell twice on that target in succession, and then aimed at the finest target there and rang the bell twice in succession on that. the proprietor was very much surprised, saying it was remarkably good shooting; and yet i was down and out with "nerves." i have seen many athletes who, to the untrained observer, looked well, but who in reality were nervous wrecks. outdoor exercise alone will not cure such people, or if seemingly it does--and this is important--sooner or later the individual is sure to go down again. you have first to remove the cause, and that is largely wrong diet. now of course it is only reasonable to say that if such an individual does not get out of doors at all he cannot get well. that is one trouble with many of our women today. they will go on a diet and stick to it, but they will not get out of doors. if they do go out, they ride a little distance in a street car or in an automobile to do some shopping. or they go to a store and spend a good deal of time there--indoors, mind you--and then are whirled home again. some of them seem to think that is taking outdoor exercise, but of course it is not. so many times they have said to me, "why, i do get out!" yes, they do get out, but they immediately go indoors again. the nervous individual, unless the collapse is so severe that the first few weeks must be spent in bed, should get out of doors at least three or four hours a day, every day in the week. this is a general rule that should be observed by everyone. it takes genuine courage, i know, for a man or woman to spend this much time out of doors. and i know that those who are compelled to work for a living cannot take three hours all at one time. but labor conditions in this country are such that i am sure the vast majority of our people could spend this much time outdoors in wholesome recreation if they would make up their mind to do so. and remember this: after the nervous person is cured he should never let anything prevent him from continuing such outdoor exercise. i am constantly trying to make this point--when you get well you should stay well. one breakdown is bad enough; don't have another. and you will not have another if you will change the habits of a lifetime as you are advised to do. among farmers there are many, the offspring of nervous parents with bad eating habits, who suffer from nervous breakdowns. so you see exercise out of doors alone will not cure such cases. sometimes a farmer will tell me he fears to give up eating meat because he will grow weak as a result. but just here i wish to call your attention to the fact that there are nations that have for ages lived on this lacto-vegetarian diet. i myself have not eaten meat or eggs for ten years. at least i have not eaten them except the few times mentioned. and every time i did break the rule i was harmed far more than i was benefited. i am very sure the farmer who chooses this lacto-vegetarian diet will thrive on it. members of our profession discovered not very long ago that at an advanced age the peasants of bulgaria are a wonderfully preserved people both mentally and physically. foolishly a great number of the profession immediately jumped to the conclusion that buttermilk alone did the miracle for these people. the drinking of buttermilk became such a fad that some of the largest of our physicians' supply houses began and are still making "buttermilk tablets." and physicians, many of them, are credulous enough to prescribe them. they might just as well prescribe chalk. while buttermilk tablets are harmless, they are of no benefit whatever. how easily fooled people--physicians included--may be! bulgarian peasants are strong and rugged and live to a great age not because they drink buttermilk, but because they live on milk and fruits and vegetables and stay out of doors. buttermilk is a good healthful drink, but it is only a minor reason for the health and strength of the bulgarian peasant. now, really, could you think of anything more absurd than to prescribe buttermilk or buttermilk tablets as the fountain of youth when the patient is breaking all the laws of health, as most buttermilk laymen and physicians are doing? it seems almost impossible that people--physicians in particular--should for a moment believe such things. but they do. barnum said there was a "sucker" born every minute, and this certainly seems to be true. no, there is no royal road to health. the buttermilk-tablet route will not take you there. if you will live out of doors as bulgarian peasants do, and if you will eat as they do,--as man is expected to eat,--you will live just as long as they do, and you will get a great deal more out of life and be much more helpful to others. when the "time" comes round for your next buttermilk tablet, do not take it. instead, do as those peasants do--leave off eating meat and take a two-hour walk in the sunshine. then when nine o'clock comes, like the bulgarian, go to bed and stay there until morning. if the person afflicted with "nerves" expects to get well and stay well, he must go to bed at an early hour and get eight or nine hours of sleep not only some nights but every night in the week. when one begins dieting and taking outdoor exercise he should go to bed regularly at an early hour even though he has not been sleeping well. no matter how many sleepless nights he has experienced before beginning this regime, he should retire early just the same, because, sooner or later, sleep will come and the relaxed body is resting even if the individual does not sleep. now i have been through all this lying awake at night, so i know from experience that it is best to go to bed early and at a regular hour. if you can, you should sleep nine hours. nervous people need more sleep than others. sleep is a better restorer of nerves than anything else we can try. i do not believe that ten or even eleven hours' sleep would be harmful to a nervous adult, because very often i have seen such a person benefited by it. children should have all the sleep they want up to ten or twelve hours. but after a child has wakened in the morning he should be permitted to get up. it is not good for him to lie in bed after he wishes to rise, for nature is calling him to get up and exercise. the nervous individual not only should exercise systematically out of doors but he should play some game. you remember when we were children how much we loved to play? well, to give up play when we grow up is all nonsense. and just because people quit playing is the reason they have wrinkles and frowns. did you ever notice how often people laugh when at play? there is something about play that compels one to laugh. and what all people need, nervous people and others as well, is to get into the habit of laughing more. and it is not hard to find something to play. i like to play at basket ball with a child, and i can enjoy tossing a ball for an hour if the child will stick to the game that long. playing basket ball in the open air on a sunshiny day is one of the very finest exercises in the world. if you are suffering from "nerves" and are able to be out of doors at all,--i mean if you are well enough to be out, and at least nine out of ten sufferers are,--get a basket ball and get some one to play with you. if at first you are poor at catching the ball you will with practice improve. gradually toss the ball a little higher and a little higher until you have difficulty in catching it. any woman or girl can stand this sort of open air exercise. if the weather is cold, no matter; wrap up and play anyway. but enter into the game with spirit. playing the regular game of basket ball is too violent exercise for the nervous person. the victim of "nerves" should always keep in mind that it is mild outdoor exercise that will do him good. tennis is too violent an exercise for people who have had nervous trouble. anyway, there is no use in one's doing anything that will make his heart beat like a trip-hammer. a women can toss a basket ball and laugh and get rosy cheeks and grow younger and prettier as easily as when playing tennis. golf is also good exercise, but a large number of people who work for a living and suffer from "nerves" would have little chance for exercise if golf were all that could be offered them. furthermore golf is practically only a summer game, and an individual belonging to the pre-nervous class needs outdoor exercise every day in the year. but golf is excellent exercise, and there is nothing better if one has the time to give to it and has access to links. bicycling is splendid exercise for nervous people, but automobiles are so numerous that it is now considered almost dangerous to ride a wheel on any of our main traveled roads. mountain climbing, i believe, is not to be recommended for most people suffering from "nerves." i have known such people to go to colorado and spend some time climbing mountains, and then come back much worse than when they went away. my advice to the nervous person who goes to the mountains is to be out of doors all the time he can, but to take things easy. it would be better for such a person to walk about slowly on the level ground through some of the towns or along the foothills. let leisure be your watchword in a hill country. i know i injured my nerves out in colorado one summer because i was ill advised. mountain air is good for you, but the mountains will do you more good if you simply look at them. if you think you must go to the top, take a burro. you will find that the burro will give you a lesson in how to do things in a leisurely way. do not get out of patience with him and whip him. remember that the burro is smarter than you are in regard to the business of mountain climbing. he has never had a nervous breakdown, and if you will let him have his own way he never will have. it will do you good to let him have his way; he affords a tremendous lesson in patience. patience, that's just what we need, and we need it badly. walking slowly in the open air for two or three hours is the best exercise for man. fortunately, like the water we drink, it is free to the poor as well as the rich. for the nervous man who is able to do it, i know of nothing better to build up muscles and keep the liver and other internal organs in good shape than sawing wood. don't scorn this sort of exercise because you have been told that the ex-kaiser is taking it. that is not to be laid up against the wood or the exercise, for, quite fortunately, the wood does not care who saws it. get some wood, then, and a buck saw, and saw wood for your own benefit. you can do this morning and evening. wood sawing brings into play every muscle in the body, and the exercise is just enough to make a man comfortably tired without doing him harm. many people who go to sanitariums for a cure pay from fifty to seventy-five dollars per week for the privilege of sawing wood, and you can take this exercise just as well and at considerably less expense at home, sawing your own wood instead of that of the sanitarium. another splendid diversion for a man with "nerves," if he can have it, is a small workshop where he can make just any old thing out of boards and nails. if one is apt in this line, he can make things that will interest children. this sort of work requires a certain kind of concentration that is most excellent for the nervous sufferer. this suggestion would of course apply to a woman, too, if she cared to try such an experiment. sewing, and especially fine needlework, is very trying to a woman's nerves, and if she has broken down under that kind of work she should quit it and do something else. if she has to make her living in that way, she of all people should observe the outdoor rules as well as rules for dieting. i am sure nervous people profit by frequenting all possible outdoor games. if a number of people afflicted with "nerves" could get together and take daily walks and at the same time determine that their conversation should always have a humorous slant, it would help all of them wonderfully. riding in an automobile is beneficial if the machine is driven slowly and the patient is kept out of doors from three to four hours. but the fast driving that is generally done is bad for these people. they come back from a ride worse than when they started. it may be set down as a general rule that any form of outdoor exercise or play is good for the nervous person if it is not violent. nervous people should, if possible, take a vacation once a year and get into new surroundings. i am certain, however, that it does not make any difference where one lives. a man is just as likely to have a breakdown in one part of the world as another. while on these vacations he should stick to his rules just as rigidly as when he is at home. i have had letters from people in canada and from others in florida who have suffered nervous breakdowns. in california some go to pieces. i have had many letters from people living there who have broken down. people also break down in colorado and in new york; in fact, in every state in the union. climate does not seem to make any difference so far as this trouble is concerned, with the exception that in high altitudes i have observed nervous people are inclined to be more restless than elsewhere. some years ago i went up pike's peak, to the summit house. i went to bed and spent the night there, but i do not say i slept, for in reality i slept only about half an hour. i was not at all sick at the stomach, as so many are who climb up there; i had prevented this by eating a very light breakfast and chewing my food to a cream. but i was extremely nervous. i have found a great many other nervous people who do not feel quite right when in a high altitude. as a general rule, sea level is as good a place as a nervous individual can find to live. but people break down there, too. the diet, you see, is the big thing. and when i say "diet" i mean the way food is eaten and the amount eaten quite as much as i do the kind of food eaten. and once more let me say, systematic outdoor exercise also counts, and you can't keep fit if you exercise only one, two, or three days a week. some people who take long walks in the country on sunday think that will suffice. but it will not. you must have exercise every day and must have some play along with it. gymnasium work is of very little value as compared to outdoor exercise. in the summertime, gardening is a splendid form of exercise. and so is the care of a small flock of chickens, which is possible for those living in the smaller towns. it is always better, when taking outdoor exercise, to have something definite to do. when walking it is a good plan, if you can, to have some definite place to go. and if you have an agreeable companion to keep up a rapid-fire talk, that will help also. all these things are mentally stimulating. then, if possible, sleep the year round on a sleeping porch. if you don't possess a porch, then, have all the windows in your sleeping room wide open day and night. if for a time you have to take physic, it is best to take some hot mineral water half an hour before breakfast. but adhering to dieting and exercise, and eating enough apples, usually overcomes constipation. now, there are some things about which a person must use his own good judgment. for instance, if you have any bad teeth you should at once go to a good dentist and have them attended to. nobody with bad teeth can have good health. again, if your tonsils have become mere pus sacs you will have to go to a good nose and throat specialist and have them removed before you can expect to have good health. this, however, applies to all people, whether nervous or not. the same thing is true with regard to your eyes. if you are suffering from eye strain because you need glasses, you cannot hope to get well of "nerves" until your eyes are properly fitted to glasses by some reliable eye specialist. these are things that each individual must discover and do for himself. he should consult a dentist, an oculist, an aurist, or other specialist according to his particular need. v. effect of right living on worry and unhappiness "neither melancholy nor any other affection of the mind can hurt bodies governed with temperance and regularity." --cornaro a very sad thing about some nervous people is the fact that in their lives there are domestic or other troubles which no physician can overcome. some of them live in depressing surroundings, but for all these there is hope. there is no doubt that if we can restore the brain to a perfectly normal, healthful state the human being can bear more suffering than when the brain is affected. perhaps when speaking of the spirit we had better call it that, rather than the brain, for that mysterious something we call spirit does make its home in the brain of man. this has been proven scientifically. so then, in this life the temple of the spirit, or soul, does affect the mind. and when i say this life, i take the opportunity to say here that i not only believe in the immortality of the soul, but now, at , i am as certain of it as i am of my own existence. but for some reason--although as yet no one understands why it should do so--when this temple in which the spirit dwells is out of condition, it affects the soul or spirit. so, you see, if we can make the physical man or woman well, we most certainly can help the spirit that dwells within the body. and so i recommend dieting, temperance in eating, and the careful chewing of food to all those sufferers who unfortunately live in depressing surroundings and cannot get away from them. when referring to the many pitiful letters i have received from poor human beings thus situated, i realize that i am treading on sacred ground. such things are written, of course, to a physician in confidence and the confidence must therefore be forever sacred. i have not only had letters from these unfortunate people, but have repeatedly come in contact with many of them in their every day life. i know well what added suffering such conditions bring to them. i know of nothing in this world more pitiful than a noble, high-spirited, ambitious woman, pure and clean of heart, who marries a man and becomes the mother of his children and is then condemned to live the life of a mere animal. and all too frequently the opposite also obtains. sometimes a man of high, pure purpose finds that he has chosen as the mother of his children a coarse, sensual woman. now why in the world were these two people attracted to each other? this is one of life's biggest puzzles to those who have thought much along this line. in many instances extreme youth is the reason given. while youth is mating time, it also is the time of bad judgment. thousands of young people have made this dreadful mistake simply because they married too young. on the other hand, youth is not altogether to blame. when people, young or old, are courting, each individual endeavors to appear at his or her best before the other. without being actually aware of it, under such circumstances both man and woman are doing all that lies in their power to deceive one another. if people would do their courting in everyday clothes, and if the girl would go about her housework while the man looked on, or better still, if he helped her with it for one or two years, they would undoubtedly become better acquainted. but, after all, except, perhaps, in unusual cases, there is absolutely nothing by which people know that they are going to be properly mated. if a man with a tendency to neurasthenia breaks down and is tied to a nagging wife, that is usually the last straw in the way of his recovery. this is just as true of the woman who breaks down and has a nagging husband. there are, i regret to say, thousands of such cases all over the country. on the other hand i have had a man come to me and say that he was willing to do anything on earth to aid his wife, but he could not get her to diet or even to make a serious attempt to get well. i am always tremendously sorry for such a man because he has a mighty heavy burden to bear. such a wife should try to get well as much for the man's sake as for her own. she should understand that she is needlessly torturing the one best friend she has on earth. a woman of this kind should remember that, no matter how much she may suffer, she is hopelessly selfish if she will not do all in her power to diet and to obey other necessary rules that will enable her to get rid of the malady. sometimes when a physician puts this before her kindly but firmly it results in her making a beginning and by and by getting well. i have seen this happen many times. and i wish to say right here that while i believe i was born with some natural tact, yet if i had not gone through all this horrible suffering myself i should not, i know, be able to say the things that would induce these people to do that which it is their duty to do. and here is one big difficulty i have always had to contend with. some of these people have tried so many so-called nonsense cures--eating buttermilk tablets, for instance--and have had no benefit from them, that they are unwilling to try the one and only thing that will cure them--the thing that will cure them as sure as the sun shines. i wonder why it is that since the time of christ people are always looking for a sensational or miraculous cure. our life and everything pertaining to it is miracle enough, if we only had the sense to see it. the woman or the man with "nerves" is not going to get well eating buttermilk tablets or taking patent dope while lying on a couch and shut in a house. you must bestir yourself. you must get out of doors, and above all, you must eat right. today thousands of these people are languishing in hospitals and sanitariums, and most of them will come out only to go back again and again. the institutional treatment is good for the beginning of the cure, but if an individual with "nerves" is going to get well and stay well he must change his lifelong habits. and i want to say again, that any person, man or woman, in the midst of depressing conditions can triumph over them if he will eat as he should and live as he should. there is something about the human soul, if it is pure and fine, and if proper attention is given to right living, that will enable a person to meet great sorrow and triumph over it. in fact, no amount of sorrow can defeat a person who keeps his heart and body right. and i would have you all realize that there is something far more to us than mere bones and veins and nerves. i know the terrible tendency of the one with "nerves" to get angry. but lay fast hold of yourself. fight anger as you would poison, because in reality it is poison to your nerves. anger will hurt you; it will hurt anybody. but no matter how hard you find it at first, get control of your temper. if you succeed in doing this in a year you will have won one of the greatest victories man can win in this world. i would rather meet a so-called plain man who has perfect control over his physical and mental faculties, and sit and talk quietly with him, than to meet the prime minister of england or the president of the united states if either lacked this control. for i say to you that no matter what others may say, the true measure of success does not rest in the position you occupy but in your having complete control of yourself. if you are to gain this control it means that each day you are confronted by a mighty big task, but if finally successful, you will have accomplished the greatest thing a man can do in this life. now, here is something for you to take hold of, you who all these years have believed that your life ambition has been thwarted. but your ambition, let me tell you, has not been thwarted. perhaps you have not done just what you wanted to do. but it's quite possible that you had no business trying to do that special thing anyway. most of us, i find, can be greatly mistaken about what we think we want to do. at any rate, we can never be happy unless we gain entire control of ourselves. this is something the person afflicted with "nerves" most certainly can do, and he can use this terrible "thing" as i myself and thousands of others have used it as a ladder to climb to the sunlit peaks where worry and clouds and storms cannot trouble. and, after all, no matter who we are, no matter how poor or how rich we are, and no matter where we live, life holds about the same general possibilities for all of us. i mean by this that life affords to all the same opportunities for real happiness. i know very well that there are those who will be quite unwilling to grant this, but it is as true as the life we live. many people in this old world still hold the notion that those who roll in wealth are the happy ones. but i say to you this notion is all wrong, and from knowledge gained through experience i know that in their hearts many of these wealthy people are dissatisfied and not one whit happier than you are. the most restless people, the most unhappy people, and the most thoroughly dissatisfied people that i have ever met have been people who had everything that riches could give them. andrew carnegie said he had noticed that after a man had accumulated a million dollars smiles were seldom seen on his face. i cannot understand why people insist on going through life making themselves and all those they really love miserable just because they do not happen to have riches. and a great many high-strung sensitive men are utterly cast down because they have failed to acquire wealth by the time they are forty-five or fifty years of age. i wish i could make all such poor, afflicted people see what goes to make up happiness and learn the only way to be happy. in order to get well the thing we have to do is to follow nature's simple rules--rules our creator gave to us. we must get control not only of our appetites but of all such passions as anger, hate, and envy, which poison our bodies. and let us also cast suspicion out of our minds. this is a good rule to observe: never suspect folks. it is useless, anyway, for by and by what they are or what they do is always bound to come to the surface. by gaining perfect control over yourself--and most certainly to do so is worth every effort you may make--you will also gain patience, and that is, i think, one of the crowning virtues. sometimes i think it the greatest of all virtues. certainly it stands very high in the perfecting of character. to the sufferer with "nerves" i would say: have the courage to believe that you are going to get well. then you can do it. no matter how depressing or discouraging your surroundings, do the very best you can every day. then, no matter what your ideas of success may have been, you are really succeeding wonderfully! see that you keep right on doing it! if you are a mother and have children, live for them. or if you are a father and have children, and have met with disappointments, live for those children! do everything in your power to make them happy, high of heart, and gallant of soul. do not live for yourself, live for your children. if you have no children of your own, look about and get interested in some other person's children. you will find a lot of children all around you--blessed little beings--that you can help to make happy. get your mind off yourself and your troubles and on the children of this world, and keep it there. when you were a child no doubt you had many happy days. some of us had a very happy childhood, while others may have been denied what their hearts desired. but if we did not have a happy childhood that is all the more reason why we should be glad to help some other little ones have a happy one. more and more each year i live i come to believe that it depends entirely upon grown people whether in this world children are happy or not happy. if you had a happy childhood--and most people had--do you not recall the glorious times you had? i know you do, for we all do. and i know, too, how much people affected with nerves dwell on those memories, and how much they wish they might go back to those blessed days when the sun was always shining and the birds were always singing and the streams always beckoning them to play along their sands. do you realize that you can live in those days again? i do, and i go back and dwell in them more and more the older i get. i do not mean that i am not looking forward, for i am, tremendously. how stupid we poor miserable creatures of this world become after we leave our childhood days behind us! we really should never lose sight of them. i have said that the person afflicted with "nerves" should not run. i did not quite mean all that implies. after such a man has recovered, if he has a good heart, he should run a little. i run; i can't help it. i feel so good i have to run a little now and then to work off steam. but you know very well when most people see a man running they at once think a house is afire somewhere. it is almost unbelievable that we should actually surround ourselves with so many utterly senseless customs that tend to nothing but misery and unhappiness. we should dress for comfort, and we should have the courage to live in a youthful world where all may be happy. "if the blind lead the blind," so the bible tells us, "both shall fall into the ditch." we need so to live and act that we shall not fail to be happy. happiness really is what everybody is chasing, but how very far away from it most people are getting! go back to the memories of your childhood. be with children and play with them all you possibly can. if you are a mother, begin this very day to exercise more patience with your children, recalling over and over again that when you were a child you were just as they are. and remember, for it is only too true, that the day is fast coming when your little boy will no longer be a little boy, he will be a man, and will have gone away from you. then many times you will wish him back, and you will look back on those days when you thought your nerves were being ruined, and feel a great swelling in your breast, and breathing a sigh, whisper to yourself, "dear god, i hope i did all i ought to have done for him while he was little." i know that any one can live with children and find happiness in being one with them, and i know of no better thing to do. after we have hold of ourselves with a firm grip we should endeavor to do this. i have had people suffering with "nerves" tell me they had lost a little boy or a little girl, and that it seems impossible to get over this loss. i cannot tell you how much i long to help such people. but i always urge them to go right on playing with other children and to remember, for to me it is certain truth, that they will meet that little child again. there should be nothing to grieve about in such a loss. to find compensation, the one who has had such a grief has only to keep on playing the part of a true man or true woman. childhood with all its pains and pleasures is everywhere about us. and childhood is only the beginning of immortality. late one night, a number of years ago, i was sitting in a little restaurant in a western town, and was feeling very lonely and miserable. sorrow weighed heavily upon me that night and the world never seemed blacker, yet i think my belief in the immortality of the soul had never been more certain. i looked up and high on the smoke-stained wall hung a painted picture of an old-time ship with many sails set. this painting pictured the ship sailing through the darkness of night. but through the dark, seemingly restless clouds the moon gleamed brightly on the white canvas of the sails. i had never before been so powerfully impressed by any picture. it seemed fairly to speak to me. i took an envelope from my pocket and set down the verses given here. these verses were afterwards published in one or two metropolitan papers. mr. james bryce, then english ambassador at washington, saw them and wrote me a beautiful letter about them, in which he said, "your little poem 'the last journey' attracts me very much." you see he was beginning to grow old, and i knew that was the reason these lines of mine had made an appeal to him. not very long after this i also had a letter about the verses from dr. osler, then regius professor of medicine at oxford. in it he said, "i have read your little poem 'the last journey' with unusual interest." and again i knew why. you see, it does not matter very much what our rank or our station here, no matter whether a human being is a king or what his station in life may be, he still is a human being. we are all reaching out after the same great thing. the fine thing about the sentiment of these little verses is that although you wish to and may not believe it, it is coming true anyway. ----------------------------------------------------------------------- the last journey one night when in a youthful dream, i saw a moonlit sea, and sailing o'er its dark expanse, a ship of mystery. the lonely traveler seemed to be on some great mission bound, as o'er the darkened waters it sailed without a sound. long years have passed; old age has come: the fire of life is low. again i think of that strange dream of youth so long ago. and in the ship that swiftly sailed that silent moonlit sea, i seem to see a storm-tossed soul bound for eternity. now to my mind this sweet dream comes, a peaceful memory, for soon i'll be a youth again, with immortality! this treatise on the diseases of women is dedicated to the women of the world. yours for health lydia e. pinkham this entire book copyrighted in and by the lydia e. pinkham medicine co., of lynn, mass., u. s. a. all rights reserved and will be protected by law. list of lydia e. pinkham's remedies. +illustration of products+ lydia e. pinkham's vegetable compound. put up in three forms: liquid, lozenge, and pills price, $ . lydia e. pinkham's liver pills, per box " . lydia e. pinkham's blood purifier " . lydia e. pinkham's sanative wash, per packet " . all the above, excepting the liquids, can be sent by mail on receipt of price. all druggists sell mrs. pinkham's remedies. chapter i. a woman best understands a woman. =experience a perfect teacher.=--do you know what it is to suffer pain? have you had your body racked and torn with intense suffering? have you ever experienced that indescribable agony which comes from overworked nerves? have you ever felt the sharp, stinging pain, the dull, heavy pain, the throbbing, jumping pain, the cramping, tearing pain, the sickening, nauseating pain? then you know all about them. nobody can tell you anything more. experience is a perfect teacher. =book-learning alone not sufficient.=--suppose you had never experienced pain, but had just read about it in a book, do you think you would have any kind of an idea of what genuine suffering was? most certainly not. book knowledge is valuable. it teaches the location of countries, the use of figures, and the history of nations; but there are some things books cannot do, and the greatest of these is, they cannot describe physical and mental suffering. these are things that must be experienced. =personal experience necessary.=--after you have once suffered, how ready you are to sympathize with those who are going through the same severe trials. if a member of your own home or a friend is passing through the trying ordeal of motherhood, and you have suffered the same, how you can advise, suggest, comfort, guide! if you have had a personal experience of intense agony once every month, do you not think you are in a far better position to talk with one who is suffering in the same way than you would be if you had never gone through all this? =you best understand yourself.=--but let us go a little farther in this study. when you listen to an eminent orator, you have but little idea whether he is nervous or not, but little idea whether he is undergoing a severe strain or not; for you have never been in his place, cannot understand just that condition. men become greatly interested in political matters; perhaps it often seems to you that they become too much disturbed; and yet how can you judge, for you have never been in their place? and so we might go on, giving illustration after illustration as additional proof to this one great fact. it takes a woman to understand a woman. =man cannot know woman's suffering.=--what does a man know about the thousand and one aches and pains peculiar to a woman? he may have seen manifestations of suffering, he may have read something about these things in books, but that is all. even though he might be exceedingly learned in the medical profession, yet what more can he know aside from that which the books teach? did a man ever have a backache like the dragging, pulling, tearing ache of a woman? no. it is impossible. =even medical men cannot understand these things.=--to a man, all pain must be of his kind; it must be a man-pain, not a woman-pain. take, for instance, the long list of diseases and discomforts which come directly from some derangement of the female generative organs; as, for instance, the bearing-down pains, excessive flowing, uterine cramps, and leucorrhoea. do you think it possible for a man to understand these things? granting that he may be the most learned man in the medical profession, how can he know anything about them only in a general way? you know, we know, everybody knows that he cannot. a woman can best prescribe for a woman. =relief first offered in .=--away back in ' these thoughts came to lydia e. pinkham. she saw the most intense suffering about her on every hand, and yet no one seemed able to give relief. her thorough education enabled her to understand that nearly all the suffering of womankind was due to diseases and affections peculiar to her sex. the whole question resolved itself into just this: if a remedy could be made that would relieve all inflammations and congestions of the ovaries, fallopian tubes, uterus, and other female organs, the days of suffering for women would be largely over. =first made on a kitchen stove.=--could this be done? mrs. pinkham believed with all her heart that it was possible. so on a kitchen stove she began the great work which has made her name a household word wherever civilization exists. without money, but with a hopeful heart, she made up little batches of this remedy to give to neighbors and friends whom she felt could be relieved by it. the story soon spread from house to house, from village to village, from city to city. now it looked as if a business might be established upon a permanent basis, a basis resting upon the wonderful curative properties of the medicine itself. ="we can trust her."=--by judicious advertising the merits of this remarkable remedy were set forth; and before she was hardly aware of it, she found herself at the head of one of the largest enterprises ever established in this country. that face so full of character and sympathy, soon after it was first published, years ago, began to attract marked attention wherever it was seen. women said, "here is one to whom we can tell our misery, one who will listen to our story of pain, one whom we can fully trust." and so the letters began to arrive from every quarter. now hundreds of these letters are received every day. more than a hundred thousand were written in a single year. everyone is opened by a woman, read by a woman, sacredly regarded as written strictly in confidence by one woman to another. men do not see these letters. =men never see your letters.=--do you want a strange man to hear all about your particular disease? would you feel like sitting down by the side of a stranger and telling him all those sacred things which should be known only by women? it isn't natural for a woman to do this; it isn't like her, isn't in keeping with her finer sense of refinement. =no boys around.=--and then, how would it be when some boy opens the letters, steals time to read a few before they are handed to some other boy clerk to distribute (and probably read) around the office to the various departments? it makes one almost indignant to think how light and trivial these serious matters are so often regarded. =you write to a woman.=--but when you know your letter is going to be seen only by a woman, one who sympathizes with you, feels sorry for you, knows all about you, how different all this seems. =confidence never violated.=--although there are preserved in the secret files of lydia e. pinkham's laboratory many hundreds of thousands of letters from women from all parts of the world, yet in not a single instance has the writer accused mrs. pinkham of violating her confidence. =the largest experience in the world.=--the one thing that qualifies a person to give advice on any subject is experience--experience creates knowledge. no person can speak from a greater experience with female ills nor a greater record of success than mrs. pinkham. thousands of cases come each month, some personally, others by mail; and this has been going on thirty years, day after day, and day after day, thirty years of constant success--think of the knowledge thus gained. surely women are wise in seeking advice from a woman with such an experience--especially when it is free. if you are ill get a bottle of lydia e. pinkham's vegetable compound at once--then write mrs. pinkham, lynn, mass. what medical man has ever lived who has prescribed for so many women? what whole corps of physicians in any hospital or medical college has answered so many letters, or treated in any way so many patients? =she helps everyone.=--no woman ever writes to her for advice without getting help. no matter how rare you think your case may be, she is almost certain to find letters on file asking advice for other cases of the same kind. by special permission of the writers i print a few of the letters showing what cures have been effected. but if the reader could go through these secret files which are never shown, she might hour after hour, day after day, week after week, spend her whole time reading letters, each one telling some special story of rescue from serious illness, intense suffering, or impending death. =the largest record of cures.=--the writers of these letters are found in every clime and there is hardly a country in the world without its multitude of grateful women cured by lydia e. pinkham's medicines. they have the largest record of absolute cures from female ills known to have been effected by any physician or his medicines. chapter ii. what shall the future generation be? =important to the nation.=--it is impossible to fully comprehend how important to us as a nation is the health of the young women of to-day. we fail to realize that these women are to be the mothers of the next generation, and that in their hands will lie, in large measure, the power to form the characters and direct the destinies of the boys and girls of the future. =woman must be strong.=--we may educate our young men all we wish, yet we cannot have national power through their strength alone. the women of the country must have this physical education if we are to have a people that is strong and hearty. upon the sound health and vigor of the young women of to-day will depend, to a large extent, the health and capacity of the future generations. =what are girls worth?=--it is estimated that there are about twelve million young women in the united states between fourteen and twenty-eight years of age. what are these young women worth to the home, to the state, to the nation, to the human race? this is largely a question of physical health. it is the stern duty of the mother to make this clear to her daughter, and it is the solemn duty of every young woman to thoroughly study the subject herself. =not prepared for motherhood.=--but largely through ignorance, often through indifference, these young girls become mothers when little prepared to do so, and they find not only their own health shattered thereby, but also that they are the mothers of weak, delicate, and perhaps deformed children. =women desire children.=--we read a great deal in the newspapers about how american women are doing everything they possibly can to prevent having children. this is not in accord with our experience. it is a slander on american womanhood,--it is an outrageous falsehood. in not one letter in a thousand which we receive do wives ask how childbearing may be prevented, while every day brings us many, many letters asking if something cannot be done in order that there may be a baby in the house. =a healthy mother and child.=--if you desire a child, you wish a healthy child; and you certainly desire to be a strong mother, one capable of caring for her infant in every way, and able to direct it all through its young life. then let us give you some advice. =why some women do not have children.=--the reason why some wives do not have children may be entirely the fault of the husband; but if this is not the case, then in all probability there is some inflammation of the generative organs. this may be of recent or of old standing. it must be thoroughly removed before the impregnated egg from the ovary can become attached. =the cure for this condition.=--that these changes can be brought about in a vast number of cases i have the most positive testimony. i have advised such wives to continually use lydia e. pinkham's vegetable compound; and, with this treatment alone, such a healthy condition of the generative organs has been brought about that pregnancy has very soon followed. this is precisely according to nature's laws, as i have indicated before. therefore, i say to every wife who desires a child, "give lydia e. pinkham's vegetable compound a thorough trial. if the fault is yours, the compound will surely remove it, and the longing of your heart will be satisfied." chapter iii. reproduction. =the reproductive instinct strong.=--the reproductive instinct is very strong in the human race, as is indicated by the large amount of energy the woman expends in the bearing of children, and by both sexes in the care and education of their young. as we know, it is only by the production of new individuals that the continuance of the race is assured. =problems of reproduction.=--the problems of reproduction are extremely broad, involving not only the immediate questions of individual reproduction, but also those broader and deeper ones which relate to heredity. =a new life, by chance.=--it is a most astonishing fact that nearly all persons born into the world are given life as the result of chance rather than by careful design. "if my parents had only known!" is the frightful wail of many a wretched life. =to create is divine.=--at no time does man come so near being omnipotent as when, by the tremendous powers given him, a new life is called into existence. and yet, whether strong or weak, refreshed or exhausted, healthy or diseased, sober or intoxicated, sweet or ill-tempered, yielding or resisting, a new life is begun which may be either of two extremes. how great are such questions! the human mind seems appalled when asked to consider them. =education on these subjects necessary.=--it is not the purpose of this book to moralize upon these themes, or to say what should and should not be done; but knowing something of the wretchedness of womankind, and the fearful slavery she often has to endure, i can only hope, with all my heart, that the coming generation may be better educated on these most important topics. it is with a thought or two of this kind in mind that i append the following brief outline of this subject:-- =two sexes necessary.=--in the higher animals two sexes are necessary for the reproduction of the race, the male and the female. each contributes some particular element toward the beginning of a new life; this is known as the germ-cell. =the germ-cells.=--the germ-cells of the male are called spermatozoa, and those of the female, ova. the reproductive process is simply a fusion, or union of these male and female germ-cells. =the male elements.=--the spermatozoa are exceedingly delicate and minute; they constitute the greatest part of the semen, or sperm. they are peculiar shaped bodies, having a head, body, and tail, as illustrated in the accompanying figure, and they can only be seen by powerful magnifying glasses. (fig. .) ~fig. . at the left are six spermatozoa, or male-elements, male germ-cells. at the right is an ovum, egg, female germ-cell. all highly magnified.~ they have the remarkable property of moving about with considerable activity, and their number is almost beyond computation. =only one male element necessary.=--although this number is so vast, yet only a single one is required to endow the female cell, or egg, with life. it is another illustration of how nature does everything possible to increase the chances of perpetuating the race, for without such immense numbers, the chances of the female egg being fertilized would be much less. =may live for days.=--although these male elements can live but a few hours outside of the body, even when especial precautions are taken to make every thing favorable to their existence, yet they have been known to maintain their full life in the vaginal canal for more than eight days after their discharge; another remarkable provision of nature, for the prolonged existence of these cells increases the probability of the fertilization of an egg, and thus increases the chances of producing a new life. =the female element.=--as i have already said, the female germ-cell is also known as the ovum, or egg. a single ovum is shown in fig. . if not fertilized by the male elements, the egg passes off into the outside world; if fertilized, it stops in the cavity of the uterus, where it forms an attachment. here it remains until perfectly developed, when, at the end of nine months, it is brought forth to the outside world as a perfect infant. =one female element; many male elements.=--the human ovum is often said to be a miniature of the egg of the common fowl, although there are some quite marked differences between the two. it is a very interesting fact to note that there is only one egg given off at a time; while there are many thousands of the male elements. this is in harmony with the larger size of the egg, and the fact that while this egg awaits fertilization it is most carefully protected within the body of the mother. =where is life first made?=--where the wonderful union of the male and female elements takes place is not definitely known, although it is generally believed that it is upon the surface of the ovary, itself. if this be true, then it is necessary for the male element to traverse the whole length of the uterine cavity, out along the course of the fallopian tube, and there be deposited on the surface of the ovary. =the fertilized egg.=--when a fertilized or impregnated egg is set free from the surface of the ovary, it follows the same course that the unimpregnated egg does until it reaches the uterus. here some most remarkable changes immediately take place whereby the egg is held firmly to the inner wall of the uterine cavity; while the unimpregnated egg, as i have said, passes down the uterine cavity into the vagina, and thus out of the body. in other words, the fertilized egg is retained within the body, while the unfertilized one is cast off. =one egg discharged each month.=--an ovum, or egg, is discharged during each menstrual period. it cannot be seen because of its minute size, a magnifying glass being necessary to detect it, even under favorable conditions. at just what time during this period the ovum is cast from the body is not definitely known, but it is generally thought to be toward the latter part. =time when fertilization is most probable.=--from this it is seen that but one egg fully develops and ripens ready to be fertilized each month. as it is the ripened egg which is thrown off at each menstrual period, therefore it follows that the fertilization of this egg would be most probable at about the time of menstruation. =times when ova do not ripen.=--as a rule, these ova do not ripen, or develop, either during pregnancy, or during the nursing of the child, although there are certain exceptions to this rule; for menstruation occasionally takes place during lactation and pregnancy, and pregnancy itself may occur while the mother is nursing her child. chapter iv. the remedy that cures. =a vegetable compound.=--i hardly think it necessary to mention in detail the separate ingredients of lydia e. pinkham's vegetable compound. we wish to call your attention, however, to that word "vegetable." i do not believe in mercury, arsenic, and the host of mineral poisons which are found in so many remedies. when taken into the system they disturb every function, interfere with the most vital processes, and produce the most disastrous consequences. =the purest and best.=--knowing these things, mrs. pinkham was exceedingly careful to put only the purest and choicest of products of the vegetable kingdom into her compound. each of the roots and herbs is selected with the most extreme care, and all are prepared under the personal supervision of the most thoroughly trained specialists. =one secret.=--one great secret of the success of lydia e. pinkham's vegetable compound is that each vegetable is so treated that all useful elements are retained, and all useless discarded. =highly concentrated.=--for instance, it is possible for the expert workmen in our laboratory to condense all the medicinal power that exists in a pound of the coarse root into a mass no larger than could be held on the point of a knife. in this way it is possible for a teaspoonful of the vegetable compound to represent all the curative properties usually found in eight or ten times that quantity; in other words, it is highly concentrated. =acts upon female organs.=--mrs. pinkham knew from the very first that she was on the right track. she knew that her vegetable compound contained medicines which act directly and naturally upon the female organs. she knew that one ingredient produced certain effects on the uterus, while other ingredients tended to relieve pain in the ovaries. she knew that one remedy would heal an inflamed uterine cavity, while another ingredient would cause better circulation in the blood-vessels of this part of the body. having the theory all worked out most carefully, she awaited the practical test, feeling confident as to the result. =success was immediate.=--but she did not have to wait long. immediately the cures began, and her neighbors and friends told each other what had been done for them. soon letters came by the hundreds from all parts of the world. thousands upon thousands have written to mrs. pinkham telling her their story, and giving to her, also, full permission to use their testimonials. =it bridges the gulf.=--i am sure you would be delighted, as well as surprised, if you could see the immense difference between the first and last letters received from women. the first is the story of suffering, of extreme agony with prolonged misery and abandoned hope. the last is a song of gratitude, of great love, of joy and peace. the first tells of disease, the last of health. but what an immense gulf between these two!--a gulf, however, i am glad to say, that can be bridged with lydia e. pinkham's vegetable compound. =you cannot possibly doubt.=--i do not believe you can possibly doubt for one moment the power of this marvelous remedy to cure the diseases of women. how can you doubt it? for a quarter of a century it has gone into every city, village, and hamlet in our land, and into almost every country home. across the water it is finding its way among the rich and the poor. no remedy was ever known that was so generally used. wherever there are women, there are suffering women; and wherever there are suffering women you are sure to find lydia e. pinkham's vegetable compound. =the testimonials are true.=--do you think there are hundreds of thousands of your own sex who would wilfully falsify? do you think that any could be found who would deliberately do this, and without hope of gain or reward? yet i could point you to hundreds of thousands of letters received from women who write from the fulness of the heart to thank us for what we have done for them. =we speak strongly.=--then am i not justified in speaking strongly to you? don't you think we feel sure of our position? i certainly know what we have done for others, and that makes us feel sure we can do the same for you. =we can cure you.=--i believe our vegetable compound will cure you. i believe it will cure every case where a cure is among the possibilities. you need not be particular whether the soreness in the lower part of your body is in the right side or the left side; whether the pain is sharp, or dull and heavy; whether you suffer terrible agony each month with local pain, or whether it is mental depression; whether the flow is too scant or too profuse. =it corrects the wrong.=--you need not be particular about these things, for they all show that something is wrong, and lydia e. pinkham's vegetable compound corrects this wrong. that is what it was made for; that is precisely the work it does. =have faith in us.=--don't purchase a bottle thinking you will "see what it will do," having made up your mind that you will "try the experiment." don't come in this spirit, for there is no need of it. come with the feeling that has inspired so many thousands of your sisters,--come believing that you have at last found a remedy that will relieve you from this terrible slavery to suffering. i am anxious to have you enjoy all the robust health that is your right. i am anxious to make you happy, hopeful, healthy. put your confidence in lydia e. pinkham's vegetable compound. you will never be disappointed. chapter v. the female pelvis and its contents. =the pelvis.=--the pelvis is the bony framework which forms the lower part of the body. on each side it forms a union with the hip bone to make the hip joint. the female pelvis contains the reproductive organs (uterus, vagina, and ovaries), and also the bladder and lower bowel. fig. gives a very good idea of the shape and general structure of this bony framework; while a careful study of fig. will enable one to form a very correct idea of the relative size and position of the various parts contained in this framework. ~fig. . the female pelvis. the flanging sides form the hips. the union of the bones in front forms the pubic arch which is felt at the front of the lower part of the body. the lower end of the spinal column, or backbone, is seen at the back of the figure.~ =the vagina.=--the vagina is a membranous canal extending from the surface of the body to the uterus, or womb. its posterior wall is about - / inches long, and its anterior about inches. a careful study should be made of our illustration, in order that the relation of the vagina and uterus to the rectum behind and the bladder in front may be thoroughly understood; also the angle which is formed by the vagina and the uterus. notice should be taken, also, of the opening of the uterus into the upper part of the vagina; as inflammation of the uterus often causes a discharge which passes into the upper part of the vagina and finally out of the body. this gives rise to the belief that the only trouble is in the vagina itself, whereas the real seat of the disease may be high up in the uterus. ~fig. . a lateral view of the contents of the female pelvis. . the vagina; . uterus; . bladder; . lower bowel; . bone forming the pubic arch; . the spinal cord, with bone in front and back of it.~ =the uterus.=--the uterus, or womb, is a hollow organ formed of muscular tissue, and lined with a delicate mucous membrane. the bladder is in front, the rectum behind, and the vagina below. =three parts.=--physicians divide this important organ into three parts,--the fundus, body, and neck. the fundus is all the upper rounded portion; the body all that portion between the fundus and the neck; and the neck all the rounded lower part. =the cavity of the uterus.=--this is divided into the cavity of the body and the cavity of the neck. by consulting our illustration it is seen that these cavities differ greatly in shape; that of the body being triangular, while that of the neck is barrel-shaped. by referring again to fig. it will be seen that the cavity of the body has three openings, one on either side at the top going to the fallopian tubes, and an opening at the bottom passing into the cavity of the neck. a constriction exists between these two cavities; but after childbirth this is largely done away with, and there is not that marked difference which existed formerly. =glands in uterus.=--in the mucous membrane lining the uterus are vast numbers of minute glands which secrete mucus. it has been asserted that in the cavity of the neck alone there are from ten to twelve thousand of these glands. it is in this mucous membrane that such remarkable changes occur each month during menstruation, and still more wonderful changes during pregnancy. =the ligaments of the uterus.=--by referring to fig. it will be seen that there are on each side of the uterus flat bands of tissue known as "broad ligaments." these ligaments are attached to the sides of the pelvic cavity, and aid greatly in holding the uterus firmly in place. there are also other ligaments concerned in this same work, although the broad ligaments are most important. the illustration also shows the walls of the vagina cut open, in order that the position of the mouth of the uterus may be easily seen. ~fig. . this illustration shows the cavities in a uterus which has been pregnant. , the vagina; , cavity of the neck of the uterus; , cavity of the body, above which is the fundus of the uterus; , fallopian tubes, extending to the ovaries.~ ~fig. . the female generative organs. , the vagina; , uterus; , broad ligament of left side; , a smaller ligament; , fallopian tube; , ovary; , fringed end of fallopian tube.~ =blood-vessels surrounding uterus.=--the uterus is well supplied with blood-vessels, as fig. shows. indeed, there is all over the walls of the uterus and through its tissue a vast network of these vessels. whenever, for any reason, the circulation of the blood through the pelvis is disturbed, these blood-vessels are likely to become engorged, over-filled, producing congestion and inflammation. ~fig. . the blood-vessels of the right side of the uterus. , blood vessels; , end of the fallopian tube; , ovary; , right edge of uterus.~ =all parts closely related.=--the close relation of these blood-vessels to the blood-supply of the bowels, liver, etc., makes it possible for most serious disturbances to take place even from slight causes. =study the illustrations.=--by studying these illustrations it can be readily seen how an over-distended rectum may produce such an impediment to the circulation that there will be congestion of all the neighboring parts. or, the intestines themselves may become over-distended with fæcal matter, or gas, from dyspepsia, and the pressure induced thereby may be sufficient to interfere with the free circulation of these parts, and thus uterine congestion produced. it is also seen how improper dress may compress the organs about these parts, and thus interfere with the circulation. again, it is easily understood, simply from studying the illustrations alone, how any of these causes might produce dislocation of the uterus itself. =object of uterus.=--the uterus is the source of the menstrual discharge, a place for the foetus during its development, and the source of the nutritive supply of this foetus. it is the uterus which contracts at full term and expels the child. =uterus not rigidly fixed.=--in a perfectly normal condition there is considerable mobility to the uterus; in other words, it is not fixed firmly by the ligaments already mentioned. it is rather simply suspended, or hung in the pelvic cavity, by these broad flat bands of tissue. a full bladder will push it backward, while a distended rectum will move it forward; as the body changes its posture, so will the uterus change its position by force of gravity. =cannot be bent upon itself.=--the uterus cannot be bent upon itself without producing injury; neither can it be pushed too far forward or backward, nor crowded down too far without causing great distress and actual disease. =fallopian tube.=--figs. and show that there is given off from each side of the upper part of the uterus a tube. this is called the fallopian tube. each tube is about four inches long. near the uterus its cavity will just admit an ordinary bristle; but near its free end, at the ovary, it is as large as a goose-quill. it is a peculiar tube in that it terminates in a number of fringe-like processes, one of which is always attached to the ovary itself. ~fig. . part of an ovary, showing a ripe ovum, or egg, about to be cast off, as occurs at each menstrual period. it is here this egg may be fertilized or impregnated by the male elements.~ =object of this tube.=--the fallopian tube conveys the sperm of the male from the uterus to the ovary, and also takes the germ-cell (or ovule, or egg) from the ovary to the uterus. when a ripe egg is about to be discharged from the ovary, one of these fringe-like processes of the fallopian tube grasps it and receives it into the mouth of the tube, whence it is conveyed directly into the uterine canal. =ovary.=--on each side of the uterus and in each side of the pelvic cavity is an ovary. it is about one and a half inches in length, three-fourths of an inch in width, and one-third of an inch in thickness. it weighs from one to two drachms, and is an elongated, oval-shaped body. ~fig. . this figure illustrates the course followed by an ovum. the ripened egg leaves the ovary ( ), passes down the fallopian tube ( ), and thence into the uterine cavity ( ).~ ~fig. . an exceedingly minute piece of an ovary, highly magnified. it shows eight ova or eggs.~ =object of ovaries.=--the ovaries are the essential organs of generation in the female. in each ovary are large numbers of cells, ovules, or eggs, one of which, at least, is supposed to pass into the uterine cavity with each menstruation. anatomists tell us that each human ovary contains as many as , of these ovules, or eggs. local treatment.--fast passing away. =it makes one indignant.=--when i recall the terrible and almost horrible treatment which women have had to undergo in the past, i cannot help but become deeply indignant. it seems as if all medical study had gone for naught, as if the teachings of nature had been forgotten, and most of all, as if no such thing as delicacy and modesty existed. =this makes confirmed invalids.=--it is only necessary for a woman to complain of discomfort in the back, a bearing-down pain, or some unnatural discharge, when some physician says that local treatment, and local treatment only, must be taken. women so thoroughly understand what their physician is going to say that they do not consult him, but go on suffering more and more until they become almost confirmed invalids. others, after they are told what must be done, return home and become gloomy and melancholy over the outlook. =specialists are crazy for work.=--the specialists are so crazy for this kind of work that it seems as though they would gladly scrape and burn the inside of the stomach for dyspepsia, if they could do so! or, they would take a long probe and go down into the interior of the lungs and apply strong caustics, if such a thing were possible! =the patient is deceived.=--if the ache, or the pain, or the discharge was on the back of the hand where it could be seen, and where these "treatments" could be watched, the specialists would have a hard showing indeed, for the patient herself would then see that little good came from these local applications. but being situated within the body, so that only the physician himself can examine the parts, the patient has to rest content, not knowing whether a little pure water is applied (and the fee collected), or whether the strongest acids which burn deep into the tissues are used (and the fee collected). =local treatment unnecessary.=--now all of this is almost invariably unnecessary. it is not showing ordinary common-sense, not in accord with nature, and not in keeping with the best medical science of to-day. yet thousands upon thousands of women are undergoing the worst kind of mental and physical torture in taking these local treatments, while all the savings of the household have to go toward paying the enormous bills of the specialist. =the true doctor not blamed.=--_do not misunderstand me, please. i am not talking against doctors, not against the real, true, genuine, noble physicians and surgeons._ there is no nobler profession than that of the physician, none practiced more faithfully than the good old family physician of this country practice theirs. the best of them are glad to help their patients in any way they can, and in spite of professional prejudice, many have tried lydia e. pinkham's vegetable compound upon their patients and have been delighted at the wonderful success of the trial. =nature the best teacher.=--the trouble with so many of these physicians who call themselves "specialists on diseases of women" is that they get it into their head that they know more than nature. they map out a course of their own, and pay no attention whatever to the laws of health. just as if a dog barking at the moon would make it shine less brightly! now any one who has given any thought to the preservation of the health can readily understand how impossible it would be to cure an inflammation of the uterus or ovaries, or check an unnatural discharge from the vagina, by applying strong acids, nitrate of silver, pure carbolic acid, strong tincture of iodine, or other destroying, caustic, irritating, and dangerous drugs. all of these must be injurious, must postpone recovery, and if their use be continued for any great length of time must make a cure quite impossible. =a good medicine needed.=--of course what is needed in these cases is something that will restore the natural circulation of the blood through the tissues of the uterus, something that will relieve congestion and cure inflammation. when the swelling and irritation have subsided, then the nerves are no longer irritated, and all pain disappears. =what this will do.=--then all these parts become better nourished, the weakened and diseased tissues take on new strength, and all unnatural discharges cease. when the relaxed ligaments are properly fed and toned up, then they hold the uterus in its natural position, and all bearing-down pains and other symptoms of displacement quickly disappear. of course this constitutional treatment with lydia e. pinkham's vegetable compound is hastened by keeping the parts perfectly clean, which can be easily done with lydia e. pinkham's sanative wash. =a hearty welcome to the perfect cure.=--a hearty welcome to the most scientific treatment; a hearty welcome to the most natural, the most easy, and the most perfect method of cure; a hearty welcome to lydia e. pinkham's vegetable compound; a hearty welcome to the remedy that never fails to restore the uterus to perfect health and natural position. chapter vi. menstruation. =occurs monthly.=--once every twenty-eight days very remarkable changes occur in the uterus, giving rise to that peculiar monthly periodicity called menstruation, monthly sickness, monthlies, or being unwell. although this usually occurs once in about four weeks, yet it may be a week less or a week longer; or, indeed, the variation may be even greater than this. =symptoms of its approach.=--as a perfectly natural menstrual period approaches, there is a certain degree of discomfort and lassitude, a sense of weight in the lower part of the body, and more or less disinclination to enter society. these symptoms may be slightly pronounced or very prominent, for it is quite unusual to find a person who does not have at least some general discomfort at this time. =its appearance.=--first there is a slight discharge of mucus which soon becomes of a rusty brown or yellow color from the mixture of a small quantity of blood. by the second or third day the discharge has the appearance of pure blood. the unpleasant sensations which were so marked at first now gradually subside, and the discharge, after continuing for a certain number of days, grows more and more scanty. the color changes from a pure red to a rusty tinge, and finally disappears altogether. then the ordinary duties are resumed. =the age of puberty.=--menstruation begins at about fourteen or fifteen years of age, this period being known as "the age of puberty." it is preceded and attended by peculiar signs. the whole figure becomes more plump and round, the hips increase in breadth, and the breasts rapidly develop. the more striking changes, however, occur in the inclinations and emotional susceptibilities. =age modified.=--a great many circumstances modify the age at which the first menstruation takes place. in hot climates this takes place earlier, the difference between hot and cold countries being as great as three years; yet heredity has more to do with this than anything else. "as was the mother so is the child" is a common saying among women. =continues about thirty years.=--the menstrual function continues active from this age until about the forty-fifth year, although this may be extended even ten years later. during all these years the woman is capable of bearing children, because at each month there has been a fully developed ovum, or egg, ready to be fertilized. =the change of life.=--when the menstrual function ceases, then the period of childbearing is over. the time of its disappearance is known as "the change of life, or menopause." =amount of monthly loss.=--the amount of blood lost during menstruation varies greatly with different individuals, and it would be quite impossible to give anything like an accurate rule. it varies, normally, from one to eight ounces, the average being probably about five ounces. =duration of period.=--the duration of the period is from one to eight days, the average being five days. hence it will be seen that the average loss of fluid per day would be about one ounce. =loss should be small.=--it should be stated here that, as a rule, those enjoy the best health who lose but a small quantity of blood at this time. some persons seem to think that a very free discharge is necessary, and that they feel better at such times; but there is no possible reason why this should be the case. =the first menstruation.=--the appearance of the first menstruation is a most critical time in the life of every young girl, and the mother should be prepared to give her daughter the best of advice. some slight inattention, some undue exposure, some thoughtlessness due entirely to ignorance on these great subjects, may change the whole future from a life of comfort and good health to prolonged days of misery and intense suffering. =menstruation and childbearing.=--it is the belief at the present time, among all who have studied this subject, that menstruation is closely connected with the function of childbearing. the changes which take place each month within the uterine cavity are of precisely the proper character to prepare this tissue for the reception of the fertilized egg. =rules to be observed.=--a few rules should be carefully followed during each menstruation, in order that future trouble may be prevented. first of all, it is necessary to avoid taking cold; yet a person should not stay in the house by the side of a fire, or in a warm room all the time, for this would increase the susceptibility to cold. care should be taken to avoid undue exposure, for nothing will disturb the menstrual process quicker than the sudden chilling of the body, especially when moist with perspiration. intense mental excitement should be avoided, also. if the young girl is at school, she should be told to study more lightly at this time; while any great excitement of any kind, as giving way to anger, or extreme merriment, should be avoided. the feeling of debility and depression which usually accompanies this time is a gentle warning by nature that the body should remain quiet and at rest. it is natural for many persons to be especially depressed at this time; an effort should be made by those who understand the situation to make everything as agreeable and pleasant as possible to the sufferer. =danger to school girls.=--without the slightest doubt, many women are suffering intensely to-day who might be enjoying the best of health had they not been obliged to study so intensely while in school. a moderate amount of study does no harm at this time, but the dread of examinations, with our modern system of cramming at certain times of the school year, has, without doubt, so worked upon the nervous system that many a life has been made miserable as a result. =danger to office girls.=--it is astonishing, when one fully understands the processes of menstruation, how so many girls and young women can remain all day behind the counter in the store, or at the work-table, during these few trying days, and even escape without serious illness. employers never think of the subject, and there is a natural delicacy on the part of those most concerned to mention the subject. there should be in all such establishments some woman to whom these girls could confide their condition. this woman, or overseer, could easily be made responsible for the apparent neglect of duties by these girls at such times. =criminal carelessness.=--how often is it true that young ladies attend balls, skate, and otherwise recklessly expose themselves at this most critical time. one is almost inclined to call such exposures really criminal, because of the terrible consequences so sure to follow. a simple wetting of the feet, or resting quietly in a draught after exercise, during menstruation may impose upon the person a life-long injury. how carefully, then, should mothers watch their daughters at these periods, and how strongly should they impress upon them the necessity of special care. =condition of bowels important.=--the condition of the bowels should also be carefully looked after at these times. indeed, this is so important that it should never be neglected. there should be at least one good movement of the bowels each day. nothing can more certainly derange the menstrual function than persistent constipation. =regularity important.=--every mother should make careful inquiry into the exact frequency of the menstrual period with her young daughter, at least during the first two years of the menstrual function. if there is pain at this time, then something is certainly wrong, and treatment should be taken at once. if there is irregularity, this also requires most prompt attention, as it will surely develop into something serious sooner or later. if the flow is too free, or not free enough, or if there is any deviation from the standard of health, the mother should be acquainted with it, and should proceed at once to correct the difficulty. =first two years very important.=--if a girl can get through the first two years of her menstrual life without serious disease, she stands a very good chance of enjoying good health during the rest of her life; while a slight mistake at this time may produce the most serious disease in later life. if you do not understand your ailments write to mrs. pinkham, lynn, mass. her advice is free and always helpful. chapter vii. disorders of menstruation. =amenorrhoea.=--this is a condition in which the monthly flow is suspended. it can hardly be called a disease, as it is rather a symptom of some disorder of the uterus, or of some constitutional defect. this may occur at the time when menstruation should normally appear, namely, from fourteen to fifteen years of age. =danger of a decline.=--if the young girl does not menstruate at sixteen, seventeen, or eighteen, something is certainly wrong, and treatment should be taken at once in order to correct the difficulty before the girl goes into a decline. it is not wise to trust too much to nature in these cases. such girls are generally thin and pale, with a peculiar sallow, or yellowish-green color to the skin which has given rise to the term "green-sickness," or "chlorosis." they fall easy victims to scrofula, consumption, nervous prostration, insomnia, and other diseases. =treatment.=--when the time for menstruation arrives, and the flow does not appear, the mother should give her daughter regular doses of lydia e. pinkham's vegetable compound. this remedy acts strictly according to the laws of nature, and simply brings about natural conditions. for some reason nature may not succeed in beginning this important change in the girl's life, but with the help that comes from the vegetable compound, this is sure to come to pass. =how lydia e. pinkham's vegetable compound acts.=--a better circulation is established, the condition of the blood is improved, the nervous system is greatly invigorated, and, as a result, the menstrual flow is established. this should set at rest a great deal of worry on the part of the mother, and it means a great deal to the daughter, as well. now, the mother can be assured that one great danger is passed, and, with proper care and attention, there need be no more trouble. lydia e. pinkham's vegetable compound, however, should be taken for some weeks or months until the habit is well established and menstruation appears regularly every twenty-eight days. =delicate girls.=--if the young girl menstruates, and yet is not in good health, then she should certainly take the vegetable compound for a week before the time when menstruation is expected; the great object being to establish regularity in the menstrual function. =keep the bowels regular.=--in all these cases attention should be given to the condition of the bowels, which are usually constipated. to correct this, the girl should take laxative doses of lydia e. pinkham's liver pills, just enough each night so that there may be one good, natural movement the day following. =look well to the diet.=--a great deal can be done, also, in the way of diet. girls, especially at this time, have a most perverted appetite, preferring pickles, olives, rich pies and cakes, and other indigestible foods. these are all bad, of course, as they disturb the digestion and keep the blood thin. let the diet consist principally of rich milk, eggs, lamb chops, beefsteak, chicken, and good bread and butter. if the milk rests heavy on the stomach, then add a tablespoonful of lime water to each glass of milk. daily exercise in the open air is also of value, and the sleeping-room should be well ventilated, especially at night. =menstruation suspended during pregnancy.=--during pregnancy menstruation is usually suspended, although the regular monthly flow may continue for two or three months. of course, suspension at this time is natural, and nothing should be done to bring on the flow. if menstruation appears when there is a strong probability that pregnancy exists, then the person should remain quietly in bed and eat only light food, and every precaution should be taken lest a miscarriage be brought on. =should a mother nurse her child while menstruating?=--menstruation is also usually suspended during nursing, although not infrequently this function is resumed again three or four months after childbirth. the question here arises whether the mother should continue to nurse her child while menstruating. if the child remains healthy, keeps steadily gaining in weight, and seems to be well nourished, and if the mother is not losing ground in any way, then there is no reason why the mother should not keep on nursing her child. if, however, the mother's health fails, or if there is evidence that the child is not prospering, then weaning should take place. as a rule, a menstruating mother does not have good milk for her child; it is usually thin and watery; although, as i have said, under certain conditions nursing may continue. =sudden suppression.=--sudden suppression of menstruation is most generally due to a cold, mental shock, or undue exposure of some kind. it is always accompanied with pain in the back, headache, more or less fever, and other unpleasant symptoms. it should generally be considered as a dangerous condition, and every effort should be made to restore the menstrual function. sometimes when menstruation is suddenly suppressed in this way, a so-called "vicarious" menstruation occurs, and there is hemorrhage from the lungs, the nose, the gums, the bowels, or from some other source. =treatment of suppression.=--the treatment of sudden suppression consists of a hot foot-bath, or sitting in a tub of hot water. at the same time the person should drink a bowl of hot ginger tea, or hot lemonade, be covered well with blankets, and every effort be made to bring about a profuse sweating. then have the person go to bed, and apply hot cloths across the lower part of the bowels. place at the feet bottles of hot water, or hot bricks, and keep up the perspiration in this way for an hour or two. this is all that need be done in the great majority of cases. =only one medicine to be taken.=--as the shock to the system tends to disturb the menstrual function for some time to come, the person should begin at once with lydia e. pinkham's vegetable compound, and should continue it through the coming month, in order to insure that the next menstruation may be normal in every way. =scanty menstruation.=--often menstruation appears with perfect regularity and yet is greatly deficient in amount. as we have stated elsewhere, there is no rule about this, and yet when the menstrual function is scanty, it is almost invariably a symptom of anæmia, or poverty of the blood. =anæmic girls.=--such girls are listless, easily tired, nervous, with little appetite, poor digestion, and with no resistive power. by taking lydia e. pinkham's blood purifier regularly a most remarkable change is brought about; and by the use of an easily digested and very nourishing diet, as just given in this chapter, together with plenty of outdoor exercise, this condition can be corrected before serious trouble ensues. =dysmenorrhoea.=--this is better known as "painful menstruation." it is due to a large number of causes, and yet can almost invariably be relieved by proper treatment. =two great causes.=--in the great majority of cases the cause is two-fold: weakness of the nerves and congestion of the uterus. these are so closely allied that it is often quite impossible to tell which is the ruling factor; indeed, one seems to be largely dependent upon the other. it is certainly true that congestion of the uterus almost invariably produces neuralgia of different parts of the body; while nervous exhaustion, nervous prostration, neuralgia, and general nervousness often show themselves by this increased pain at the menstrual period. =symptoms of dysmenorrhoea.=--usually the most marked pain is before the flow is well established. the person has a heavy pain in the lower part of the bowels, with sharp, darting pains extending down the back of the limbs. then the pain becomes more concentrated in the uterus itself, or sometimes in an ovary at the side. the pain may begin as a dull, heavy ache, which gradually changes into a sharp, darting pain, and which culminates at last in distinct and positive attacks of uterine colic, or cramps. the person suffers such intense pain that a chill may be produced which is followed by a high fever. often the pains are of a bearing-down character, and are not unlike those in the last stages of ordinary labor. =often make a complete wreck.=--these attacks of uterine cramps tell severely on the general health of the person, and if they are allowed to continue without treatment, they almost invariably make a complete wreck of the constitution. =can be cured.=--this most distressing and most agonizing complaint may be quickly and entirely cured by a thorough course of treatment with lydia e. pinkham's vegetable compound. this remedy should be taken continuously; not a day should pass without the regular dose. =old cases cured.=--if the disease has existed for some time, it must not be expected that it can be cured in a month, but by perseverance the cure will certainly come and will be perfectly satisfactory. =a valuable aid.=--in the meantime, the person who suffers from painful menstruation, a day or two before menstruation is expected, should take lydia e. pinkham's vegetable compound, being careful to keep the bowels in good condition. =additional treatment.=--if possible, the person had better remain in bed, or recline upon a sofa, for at least a day before the expected menstruation, certainly as soon as the first uncomfortable symptoms appear. then have her take a hot foot-bath, get into bed and cover with warm blankets, with bags or bottles of hot water, or hot bricks at the feet and back, and with warm cloths over the lower part of the abdomen. =temporary relief.=--if the pain is exceedingly severe, and is not relieved by these simple measures, then wring out flannel cloths from as hot water as can be borne and place these over the lower part of the bowels, directly over the uterus, covering them with dry flannels. as soon as these become cool, change for hot cloths again, using care, of course, that the cloths be not hot enough to burn. it is often surprising what instant relief from pain this simple procedure will produce. =do not take opium.=--no one should think for a moment of taking opium in any form at these times, as the opium habit is very easily contracted and is almost impossible to break up. this is also true of other anodyne remedies. by carrying out the suggestions given above, it will be found that their use will not be necessary. =thousands of grateful letters.=--if the readers of this book could only see the thousands of letters from grateful women the world over telling how this vegetable compound relieved them from the fearful torture which they had been enduring for years once a month, they would use every endeavor possible to spread the good news to every suffering friend that at last there is a perfect and absolute cure for this most distressing and most frightful complaint. =reasons for these startling cures.=--the reason why lydia e. pinkham's vegetable compound works so admirably in these cases is easily understood when we call to mind the fact that some of its ingredients are the strongest of nerve tonics, building up, strengthening, and giving tone to the whole nervous system; while other ingredients have the remarkable property of relieving congestion of all the female generative organs. =to illustrate "congestion."=--if a string be tied around the base of the finger snugly, but not too tightly, the finger soon becomes darkened from the obstructed circulation. we say the finger is "congested." all that has to be done, in this case, is to cut the string and the congestion is promptly relieved. =cures congestion.=--in cases of congestion of the uterus, lydia e. pinkham's vegetable compound removes obstruction to the circulation as effectually as cutting the string relieves the congestion of the finger. when the circulation is perfectly natural through these parts, then the congestion and inflammation must disappear and the uterus itself must again resume its natural position. =menorrhagia.=--this is better known as "profuse menstruation." just what constitutes an unnatural loss of blood cannot be stated, as each woman is a rule to herself. from experience she knows just about what is the normal amount she should lose each month and retain her health and strength. when this amount is more than natural, especially when sufficient to produce weakness and prostration, then it becomes "profuse." =occurs in the full-blooded.=--profuse menstruation may occur in those who are very full-blooded, or in those who are extremely weak and pale. when occurring in the former, the person usually complains of a dull, heavy, throbbing headache, pain in the back, and other symptoms of fever. such persons recover from an excessive flow of blood quite promptly, and do not suffer severely from it. =occurs in the pale.=--on the other hand, when this condition occurs in those who are very weak, pale, and thin, there is usually great prostration, which may even become most alarming. =treatment for the former.=--when profuse menstruation occurs in those who are full-blooded, the diet should be quite simple and plain. indeed, it would be better if the person should take but two meals a day and should eat but little or no meat. immediately upon the appearance of menstruation she should go to bed and remain there as quiet as possible, for in this way the pain and fever will be less and the amount of the flow greatly diminished. =treatment when pale and debilitated.=--it is a much more serious matter when this excessive loss occurs in those who are pale and debilitated. often the most energetic measures are necessary even to preserve life itself. the following rule should be observed when possible:--just as soon as menstruation appears, the person should go to bed and remain there quietly until the flow is nearly over. of course it is an easy matter to give these directions, and exceedingly hard, often quite impossible, for them to be carried out. many women have work that must be done, or children who must be cared for during these days just as well as any other time, and it is almost out of the question for them to remain quiet. yet the question seems to be whether they will remain in bed two or three days at this time, and then have far better health for the rest of the month, or whether they will drag along through all the month. we would certainly urge that this suggestion be carried out as often as possible, and that for one or two days the person keep as quietly in bed as possible. =when very excessive.=--if the flow is very free, then the foot of the bed may be raised three or four inches by placing blocks of wood under each lower corner. this will tend to check the flow. =wonderful cures possible.=--lydia e. pinkham's vegetable compound has made some most startling and almost miraculous cures in just these conditions. an immense number of letters are on file from women who have despaired of relief, given up all hope, and who were confirmed invalids until after taking this famous remedy. its continued use heals the inflammation in the cavity of the uterus, causes a better circulation through that organ, makes the blood richer, strengthens the digestion, and thus greatly improves the general health. =relief is prompt.=--the very next month after beginning its use the flow is diminished, the next month it is still less, and so on, until soon there is only a regular, natural menstruation. =a happy change.=--and what a change this means to suffering women! it means new life, new hope, new ambition, new courage. it means work better done, children better cared for, and all social and domestic duties better performed. i am indeed most happy in being able to tell suffering women what prompt relief lydia e. pinkham's vegetable compound is sure to bring them. in these cases i always recommend the use of the vegetable compound in the form of lozenges, or pills. =metrorrhagia.=--when there is great loss of blood at other times than during the menstrual period, it is given the technical name of metrorrhagia. it means "uterine hemorrhage." keep the person quietly in bed, and have the foot of the bed raised as suggested above. if the hemorrhage is at all severe, a physician should be summoned in order that a careful examination may be made and the cause of this unusual occurrence thoroughly understood. =if you do not understand your ailments write to mrs. pinkham, lynn, mass. her advice is free and always helpful.= all such letters are strictly confidential; only women assist her in answering them. chapter viii. diseases of the uterus and ovaries. =inflammation of the uterus.=--inflammation of the uterus may be either acute or chronic. when acute, as following an abortion, taking cold during menstruation, etc., there is considerable fever, pain in the lower part of the bowels, nausea, and sometimes vomiting, tenderness on pressure over the uterus, pain when passing the urine and general discomfort. =treatment of the acute form.=--the treatment consists in having the person remain quietly in bed, applying bottles of hot water to the feet, if they are cold, and keeping cool cloths over the head if hot from the fever. in this way the circulation may be better balanced, and the tendency to congestion relieved. then take a flannel cloth about six inches square, dip it in hot water, and wring as dry as possible with the hands; now sprinkle ordinary spirits of turpentine freely over one side, and place this side directly over the centre of the lower part of the bowels, that is, just over the uterus. cover this flannel with another warm, dry flannel, and allow it to remain on until the smarting is quite pronounced, or the skin red. then remove this, and apply hot cloths wrung from hot water. use the turpentine cloth again in four or six hours, if the tenderness and pain still persist. =only one medicine needed.=--begin at once with lydia e. pinkham's vegetable compound, in order that the attack may be cut short. this the compound will certainly do if taken faithfully according to directions. after the acute attack is over, if there is any constipation, this should be relieved by lydia e. pinkham's liver pills; and if there is any discharge from the uterus, lydia e. pinkham's sanative wash should be used once or twice each day, in order to hasten recovery all that is possible. =chronic inflammation.=--it is not exaggerating in the least to say that probably out of every women in the world have more or less chronic inflammation of the uterus. =causes.=--the causes of this are many, as improper dress, which constricts the waist, and presses down upon the delicate organs in the pelvis; improper attention to the health at each menstruation; over-work; anxiety; miscarriages; unskillful treatment at childbirth, etc. =lives of suffering and sorrow.=--what miserable lives women have to endure who go about from day to day with a chronic inflammation of the uterus. each hour there is that dragging, pulling, bearing-down pain; that heavy weight; that terrible depression; and that feeling of abandoned hope. yet hundreds of thousands, i might say millions of women have had all this suffering and sadness turned to joy and comfort, simply by taking lydia e. pinkham's vegetable compound. =stories almost beyond belief.=--the stories received from our friends seem almost beyond belief. the most striking of them cannot be printed because i fear my readers would think such cures were quite impossible. the letters tell as terrible stories, as frightful conditions as could possibly exist, and yet all this has quickly and promptly changed to robust health by the use of lydia e. pinkham's vegetable compound. so often has this been reported that there is not the least room for doubt. =i speak positively.=--i am not guessing in this matter; it is altogether too serious; there is too much at stake. so i urge upon you to give lydia e. pinkham's vegetable compound a thorough trial, feeling positive, without the slightest question of a doubt, that you will be quickly and permanently cured. =leucorrhoea.=--this is also known as "the whites, or the female weakness." it is a symptom of inflammation of the uterus; and that this disease is so prevalent is again proved by this almost universal ailment among women. it is characterized by a white discharge from the vagina which often becomes very irritating, and is especially bad just before or after menstruation. it is a symptom that should not be allowed to go untreated, for it shows that there is serious trouble which may bring about an incurable condition. yet when properly treated, it may be quickly remedied, and all danger removed. =treatment.=--first of all, it is necessary to remove the inflammation that exists in the uterus itself. this is done by the persistent use of lydia e. pinkham's vegetable compound. as i have described elsewhere, this will remove all congestion, heal the inflammation, and bring about a healthy circulation. for this i strongly recommend that lydia e. pinkham's sanative wash be also used with a syringe for local treatment.[ ] this should be used each night as a vaginal injection, according to directions, thus thoroughly cleansing the parts, and entirely relieving all irritation which these acrid secretions are sure to set up. if this discharge has been irritating enough to cause any chafing, eruption, itching, or uncomfortable sensation of any kind about the external parts, then the sanative wash should be used for bathing the parts; the relief will be immediate, and the cure very prompt. =may be quickly cured.=--i speak with great positiveness here, because of vast experience and because of the universal success of this treatment. i do not believe there is a case of leucorrhoea which cannot be relieved and soon permanently cured by this treatment. there is no delay; relief comes at once. a great improvement in all the symptoms is very marked, even after the second or third day of treatment. =neglect causes ulceration.=--i would add a word of caution here to women who are afflicted in this way, as the retention of these discharges is likely to produce an irritation about the mouth of the uterus which will result in serious ulceration, and even be the means of producing the most serious and most incurable diseases. =ulcers on the uterus.=--because of the low condition of the system, thin blood, and the local inflammation in the uterus itself, ulcers may form about the mouth of the uterus. these are accompanied by more or less pain, a sense of heaviness and weight in the lower part of the bowels, and a whitish discharge similar to that of leucorrhoea only frequently streaked, or tinted, with blood. the discharge continues about the same all through the month between the days of menstruation. this condition should have the same treatment as that mentioned above for leucorrhoea, and the recovery will be equally prompt. =early treatment necessary.=--if women only understood better how easy a matter it is for these ulcerations to widen and deepen until some incurable and terrible disease results, they would be more prompt in taking treatment, especially when this is sure to be followed by a perfect cure. when the blood is thin and poor, and when the weight is reduced, lydia e. pinkham's blood purifier should be used regularly. the blood purifier, the vegetable compound, and the sanative wash, have done as great work in preventing serious disease as in curing it. =displacement of the uterus forward.=--the uterus may be displaced either forward, backward, or downward. by referring to the illustration in the first part of this book, it will be noticed that the uterus naturally tips slightly forward, so that when it is displaced forward, the condition is simply an exaggeration of its natural state. =causes bladder trouble.=--by referring to this illustration again, it is at once apparent that this tipping forward must bring about some difficulty with the bladder, and such is the case. the most marked symptom is painful and frequent passing of the urine, with a dull and heavy pain across the lower part of the bowels. often this weight is so increased by walking that the person can be upon the feet only a short time without causing discomfort and pain. this condition may be brought about by some unusual effort at lifting, jumping, or straining, or especially by wearing too tight clothing about the waist, tight lacing being probably the most frequent cause of all. =the cure.=--the general treatment here consists in taking a thorough course of treatment with lydia e. pinkham's vegetable compound, in order to strengthen the ligaments of the uterus which hold this organ in place. when the condition of the system is improved, the nerves strengthened, and the blood made more rich by the use of this compound, then these ligaments partake of this general improvement, and by becoming more tense, bring the uterus back into position. =displacement backwards.=--the uterus may be tipped backward, in which case it will rest against the lower bowel. the principal symptom here is pain in the lower part of the back, as if a movement of the bowels were necessary. there is great discomfort in walking, because of this sense of pressure. the pain is always increased when the bowels move, and is associated with a sense of obstruction, and painful menstruation is very common. =the treatment.=--here the same treatment should be followed as mentioned for the opposite condition above. in the first place, the bowels should be kept in good condition by the use of lydia e. pinkham's liver pills, taking these in just sufficient amount to cause a free movement of the bowels daily. then thorough and prolonged treatment with mrs. pinkham's vegetable compound will give such strength and tone to the ligaments about the uterus that they will again bring back this organ to its proper position. =falling of the womb.=--the most distressing of all these displacements is that known as "prolapsus, or falling of the womb." the most frequent cause of this condition is complete relaxation of the ligaments which naturally support this organ. when the ligaments become weak, they easily stretch, and thus allow the uterus to fall down into the vaginal canal, even nearly to the surface of the body. =symptoms.=--this displacement causes irritation of the bladder and lower bowel, discomfort in walking, painful menstruation, leucorrhoea, a dragging pain in the back, and most marked bearing-down pain in the lower part of the body. =the cure is certain.=--the treatment of this most distressing affection is usually followed by prompt and permanent results. lydia e. pinkham's vegetable compound should always be taken, because of its great power to relieve all inflammation and give strength and tone to the ligaments which hold up the uterus. lydia e. pinkham's sanative wash should be used, also, for its cleansing and strengthening properties, on the local parts. if a sitz bath-tub is in the house it may be used to great advantage in these cases. a single pail of water will be sufficient, and should be as hot as can be comfortably borne. if a tub of this kind is not at hand, then an ordinary bath-tub may be used, having in it sufficient water to come well over the hips when the person sits in it. =the one permanent cure.=--by taking lydia e. pinkham's vegetable compound, these relaxed ligaments are given strength and tone so that they assume their former power. as they gain strength they contract, pulling the uterus up into its natural position, and holding it there permanently. i can most positively assure every woman who is suffering from all the discomfort and terrible distress which always accompany falling of the womb, that she may be promptly and most perfectly cured if she will only follow my advice. =an abundance of proof.=--so many letters have come from women who have suffered and have been cured that it is not possible for a reasonable person to doubt what they say. i can only urge all affected with these complaints to give lydia f. pinkham's vegetable compound a good trial, feeling perfectly assured that they will be abundantly satisfied in every way. if you do not understand your ailments write to mrs. pinkham, lynn, mass. her advice is free and always helpful. such letters are strictly confidential communications from one woman to another who will never betray the confidence. footnote: [ ] every woman suffering from uterine or vaginal troubles should own and use a syringe. i would recommend the use of ruth paxton's improved fountain syringe. i believe it is the only one that will convey the solution to every part of the vaginal cavity. the ordinary syringe is inadequate. it can be obtained by sending to the r. paxton company, columbus ave., boston, mass. price $ . , postpaid--registered letter or postal note. it will repay you a thousand times to take the trouble to send for it, as the recoveries from disease are quicker when it is used. anyway, send two-cent stamp for her little book of information. you will see by the letters it contains how the syringe is regarded by those who are using it. chapter ix. diseases of uterus and ovaries (continued). =ovaries, congestion of.=--this disease usually comes from taking cold during menstruation, from some injury, extra strain during lifting, or from some slow inflammatory process. the symptoms are pain and tenderness in one or both sides of the lower part of the body. there is more or less continuous pain, which is always worse in standing or walking. the tenderness in the sides is increased during menstruation, especially if pressure be made over the part. sometimes the pain is quite severe when the bowels move. there is always a feeling of distress, frequently associated with nausea, and often more or less fever. =treatment.=--for treatment the person should have as good surroundings as possible, and should take complete rest during menstruation. in order to relieve the congestion in these parts and thoroughly control the pain, lydia e. pinkham's vegetable compound should be taken at once. =removal of ovaries.=--this condition of the ovaries gave rise to the practice of removing these organs. just as soon as a woman consulted a physician and complained of tenderness over the ovaries, he was sure to advise her to have these organs removed. =less operating than formerly.=--but this practice is rapidly passing away, and the very surgeons who were so anxious to operate a few years ago are now found advising against it. this is because of the serious results which follow this operation. while the pain and tenderness in these parts would be relieved, yet the profound and overwhelming impression made upon the nervous system, by producing such a remarkable change in the life of the woman, was even worse than the disease itself. =results of removal of ovaries.=--women who have had their ovaries removed are frequently the victims of hysteria, melancholia, extreme nervous prostration, insomnia, and other distressing and dangerous complaints. =surgical operations unnecessary.=--then, again, it is becoming well known over the whole country that lydia e. pinkham's vegetable compound can relieve congestion and pain so thoroughly that the surgeon's knife is unnecessary. i am so confident in this belief that it hardly seems possible that any woman would continue to suffer in this way, when it is so useless. i know we can make every woman perfectly comfortable and at rest, no matter how long she may have suffered, if she will only follow our simple directions. =the one certain cure.=--all she has to do is to keep her bowels in good condition by taking lydia e. pinkham's liver pills, and at the same time take a thorough course of treatment with the vegetable compound. if you have any friends or neighbors who are suffering from this disease, and who fear that it will lead to ovarian tumors, which must ultimately necessitate a dangerous surgical operation, i urge upon you to tell them the story of this vegetable compound. =always brings good cheer.=--it has brought happiness to so many homes, has relieved so much suffering, and has cheered and comforted so many thousands of women, that i am sure you will be doing a great deed of charity if you will only aid in spreading this glad news. =tumors of the uterus.=--the uterus is subject to tumors, or growths, the symptoms of which are much like those of chronic inflammation. as a rule, the person suffering from these tumors knows nothing whatever of their existence until some competent physician has told her such is the case. =fibroid tumors.=--the most common tumors are known as fibroids. they are often small, and yet sometimes attain a considerable size. until within a few years surgeons were always anxious to operate upon these tumors; but this is now largely done away with, for they are not fatal in themselves, and only become serious when they attain an exceedingly large size, or, what is more frequently the case, cause excessive flowing during or between the menstrual periods. =tumors cured without the knife.=--in these cases lydia e. pinkham's vegetable compound shows its remarkable power to great advantage. by establishing a better circulation through the uterus, and relieving the congestion in the surrounding parts, and by giving strength and tone to the smaller blood-vessels, the hemorrhage is controlled and the inflammation is reduced. the tumors cease to grow, diminish in size, and disappear altogether under its influence. =vagina, inflammation of.=--occasionally there is an acute and most intense inflammation of the vagina caused by exposure to cold, irritating discharges from the womb, the use of pessaries, supporters, or some contagious disease. many women suffer from this complaint towards the close of menstruation, when the discharges are acrid and most irritating. =promptly cured.=--this inflammation can be promptly cured by the frequent use of lydia e. pinkham's sanative wash. prepare this strictly according to the directions on each package, and use it as a vaginal injection two or three times a day. the cure will be hastened by employing a sitz-bath (sitting in a tub of hot water, or in a bath-tub). =to prevent extension of disease.=--in order to prevent the inflammation from extending into the uterus, it is always wise to take lydia e. pinkham's vegetable compound for a few days after an attack of this kind. =pruritus, itching.=--pruritus, or itching of the external parts, is a most annoying affection, which often renders life itself almost unendurable. its most frequent cause is due to irritating discharges from the uterus or vagina. quite a large per cent of the women who are passing through the "change of life" are troubled in this way. it is also a marked symptom of diabetes, or "sugar in the urine;" and if the itching is associated with an unusually large flow of urine, together with dryness of the mouth and extreme thirst, there is a probability that the person is suffering from diabetes. in such a case a specimen of the urine should be taken to a competent physician, and he should be asked to make a thorough examination of it in order to definitely determine this point. =treatment.=--the treatment of pruritus consists in keeping the parts thoroughly cleansed by frequent vaginal injections of lydia e. pinkham's sanative wash, even three or four injections daily; and also bathing the external parts with the same solution. =can be promptly controlled.=--although medical writers so generally claim that this disease is almost impossible to relieve, and although they recommend the application of severe caustics, yet i have never found any difficulty in promptly controlling and curing this affection by the faithful and persistent use of lydia e. pinkham's sanative wash as a local application and the vegetable compound for its constitutional effects. =constitutional treatment necessary.=--although this disease shows itself in only one place, yet the difficulty is in the whole system, and can only be thoroughly removed by the internal use of lydia e. pinkham's vegetable compound. thousands of letters from women tell that their life of agony, distress, and sleeplessness was changed to one of perfect comfort almost immediately upon the use of these remedies. =bladder, inflammation of.=--sometimes the inflammation of the vagina and uterus is so severe that it involves the bladder; or an irritable condition of the bladder may be produced by a pregnant uterus pressing forward against it; or the uterus may be tipped forward a trifle more than natural, and thus press against the bladder sufficient to cause irritation. =symptoms.=--the principal symptom of congestion or inflammation of the bladder is a frequent desire to pass the urine. this act is almost always painful, and is sometimes accompanied with spasmodic contractions of the walls of the bladder, causing severe straining. =may become chronic.=--if treatment be neglected, this condition easily becomes chronic, when it is very difficult to cure. prompt treatment in these cases is strongly urged because it can be cured in every instance, and thus an immense amount of suffering avoided. =treatment.=--if possible, the person should remain in bed or recline on a couch. the diet should consist largely of liquids, nothing being better than good milk. meats, rich soups, and all pastries should be avoided. mrs. pinkham's vegetable compound should be taken at once, because of its most happy effect in relieving congestion and inflammation of all the pelvic organs. indeed, here is one instance where the vegetable compound is alike useful to both sexes. the most flattering testimonials have come from men who have tried this remedy "because it was in the house," and who were most happily surprised to find that the relief was prompt and the cure speedy. for all irritable conditions of the bladder, whether of recent or old standing, i do not believe there is a remedy in the world that holds out such great promises of complete relief equal to lydia e. pinkham's vegetable compound. =the menopause, or "change of life."=--this is a cessation of menstruation. it usually occurs between the ages of forty and fifty years, although frequently before and even after this time. =symptoms.=--the person first notices that although menstruation had previously been regular, yet now it has become irregular, not appearing more frequently than once every six weeks or two months; or possibly passing over a month, and then appearing regularly again for the following two or three months; or the flow may be less and less month after month, until gradually it disappears altogether; or, not infrequently, menstruation ceases abruptly, without any warning whatever. =a natural condition.=--the change of life should be a perfectly natural condition, not associated with any unpleasant symptom whatever. yet this is rarely the case, while often the suffering at this time is most intense in every way. =affects nervous system.=--the most severe effects are frequently produced on the nervous system. these are known as "heat flashes." it is a marked symptom with a great many women, and is described as a sensation of waves of heat passing over the body. sometimes these are very severe, causing the face to become very red, producing dizziness and intense headache. often there is melancholia, great depression, and not infrequently complete prostration of the nervous system. the digestion may be disturbed, producing constipation, diarrhoea, dyspepsia, loss of appetite, offensive breath, biliousness, etc. most marked changes are certainly taking place in the whole system, and it is but natural that every part of the body should be profoundly impressed. =not expensive treatment.=--i cannot urge too strongly upon my readers the necessity of their taking lydia e. pinkham's vegetable compound all through these remarkable changes. it is not a great expense to take this vegetable compound in moderate doses four times a day for weeks, or even months, during these changes. =a critical time.=--if this period of life be passed over in safety, then there may be years and years of robust health remaining; while if it be not attended to properly, the remainder of the life may be one prolonged day of agony. even when persons have suffered during all their menstrual life, they can now have perhaps a score or more of years of complete relief if they properly care for themselves during this change. =keep under its influence.=--lydia e. pinkham's vegetable compound is a great tonic in itself, bracing up the whole nervous system, aiding digestion, and causing all the forces of the body to act more in accord with nature. then it has a special influence over the uterus and ovaries; indeed, so marked is its power to correct disease that all the trying days of the "change of life" may be passed over in perfect safety, if only the system be continuously kept under its influence. =may be made easy and natural.=--women who have been dreading this change, and who have been made to look upon it as something horrible to pass through, may now lay all such anxiety aside, for mrs. pinkham long ago solved the problem of making this time of life as healthy and natural as any other. it is not claiming too much to say that if women everywhere will only take lydia e. pinkham's vegetable compound through this trying time, they will come out of it feeling better in every way than they have felt for many years. =if you do not understand your ailments, write to mrs. pinkham, lynn, mass. her advice is free and always helpful. such letters are strictly confidential and answered with the help of women only.= chapter x. pregnancy, its symptoms, diseases, etc. =sometimes difficult to tell.=--even the most skilled physicians sometimes make mistakes in stating that pregnancy exists when it does not. =the first sign.=--the most valuable and striking sign of pregnancy is the cessation of the monthly periods; yet even this is not always reliable. sometimes menstruation continues for three or four months, especially during the first pregnancy, although this is exceedingly rare. as a rule, to which there is hardly an exception, if menstruation ceases in a married woman who has previously been regular, she is, in all probability, pregnant. =other signs.=--another important sign is the enlargement of the abdomen, although this cannot be detected much before the fourth month. a valuable sign, also, is the enlargement of the breasts, with a widening and browning of the pink ring around the nipples. enlargement of the breasts often begins as early as the second month, and is quite marked by the fourth or fifth month. =morning sickness.=--morning sickness is a symptom present in the majority of cases. it usually consists of a marked nausea upon rising, and perhaps vomiting. this may last only a few hours in the early morning, or continue through the greater part of the day. it generally appears in the second month and lasts only through the third month, although, in bad cases, it may continue through the whole period, and very seriously affect the health. =treatment.=--there are any number of remedies recommended for the treatment of this morning sickness. what will cure one case seems to be perfectly useless in another. it has been my experience that the best way to manage these cases is as follows: have the person take a slice of toasted bread, or a toasted cracker, with a little coffee if desired, while in bed, remaining there at least half an hour after eating. or, the person may take a glass of milk to which two tablespoonfuls of lime water have been added. then, by rising slowly and moving about carefully, it is often possible to go through the day without any sickness whatever. i have known many cases to be entirely relieved by eating a little ordinary pop-corn. =the morning meal.=--the morning meal may consist of milk to which a little lime water has been added; or a poached or soft-boiled egg. sometimes scarped beef, lean and rare, salted and spread on very thin bread, quiets the stomach at once, while it is highly nourishing. =only one medicine needed.=--it is surprising what happy changes lydia e. pinkham's vegetable compound brings about in this condition. the irritability subsides, the digestion is greatly improved, the nervous system is strengthened, and all these uncomfortable and disagreeable symptoms pass away. the compound should be taken in small doses three times a day, after meals. =a bandage may relieve nausea.=--an abdominal bandage will sometimes relieve the morning sickness, if placed snugly, but not too tightly, about the body. it need be worn only a week or two, for a trial, and should always be taken off at night. if the nausea persists during the day, then let the food be light and taken in small amounts, at frequent intervals. ="quickening."=--this is another sign of pregnancy. the word refers to the detection by the mother of the movements of the child. although, without doubt, the child moves within the mother at a much earlier period, yet these movements are too feeble to be noticed until pregnancy has advanced four or four and a half months. =other symptoms of pregnancy.=--other symptoms are morbid longings for unusual articles of food, as sour apples, vinegar, charcoal, clay, slate pencils, etc. these longings, however, should not be satisfied, as they do not represent the demand of nature for these substances. they belong to the same class of changes which are shown by a marked difference in the disposition of a person whereby the lively and cheerful woman becomes melancholy, gloomy, and irritable. =diet during pregnancy.=--the diet during the whole of pregnancy should be generous, yet easily digestible. a great many women do not change their diet at all, and if the person is in good health and does not suffer in any way, there is no reason whatever why the diet should be changed, unless the evening meal be made somewhat lighter. =eat sparingly of meat.=--it is always wise not to eat meat more than once a day. this is because a meat diet throws more work upon the kidneys, and any failure of the kidneys increases the probability of serious trouble at childbirth. so far as is known, there is no foundation for the belief that any special article of diet has any particular effect upon the development of the child. =care of the breasts.=--the care of the breasts during pregnancy must be commenced early. all pressure of the clothing should be removed, in order to give them full opportunity to develop. they should be kept warm, however, and well supported, if the size renders them uncomfortable. =mothers should nurse their children.=--statistics show that the summer diarrhoeas and dysenteries, which carry off such immense numbers of children each year, are almost unknown among babies that nurse. it is the artificially fed child which suffers from wasting diseases and disturbances of the digestion which are so fatal to life. therefore, every prospective mother should do everything in her power to prepare for the proper nursing of her child. =care of the nipples.=--if the nipples are flat, they can be pulled out gently each day with the fingers, and thus the difficulty entirely remedied. at the beginning of the last month of pregnancy, the nipples should be hardened in order that nursing may be painless, and that all fissures, or cracks, may be avoided. every morning and night apply the following solution to the nipples with a piece of absorbent cotton:-- glycerite of tannin, fluid ounce. water, fluid ounce. allow this to remain on the nipple. this cannot be used after confinement, for the bitter taste would be objectionable to the child. =can sex be foretold?=--mothers often wish to know if it is possible to determine the sex of the child before it is born. although a great deal has been written on this subject, and a number of so-called rules have been made, yet it is absolutely impossible to tell whether the child will be a boy or a girl; and it is also equally impossible to do anything that could in any way exert an influence in producing a child of the desired sex. =to tell time of confinement.=--for two hundred and eighty days, or forty weeks, the prospective mother has been conducting herself in the best way she thought possible, that all good might be exerted upon the new life. the question now comes, when may the day of confinement be expected? i give here a table for calculating this day, which i am sure will be found very convenient. obstetrical table. --------+---------------------------------------------- january | oct'r | --------+---------------------------------------------- feb'y | nov'r | --------+---------------------------------------------- march | dec'r | --------+---------------------------------------------- april | jan'y | --------+---------------------------------------------- may | feb'y | --------+---------------------------------------------- june | march | --------+---------------------------------------------- july | april | --------+---------------------------------------------- august | may | --------+---------------------------------------------- sept'r | june | --------+---------------------------------------------- october | july | --------+---------------------------------------------- nov'r | aug | --------+---------------------------------------------- dec'r | sept'r | --------+---------------------------------------------- ---------------------------------------------+------ | |nov. ---------------------------------------------+------ | |dec. ---------------------------------------------+------ | |jan. ---------------------------------------------+------ | |feb. ---------------------------------------------+------ | |mar. ---------------------------------------------+------ | |april. ---------------------------------------------+------ | |may. ---------------------------------------------+------ | |june. ---------------------------------------------+------ | |july. ---------------------------------------------+------ | |aug. ---------------------------------------------+------ | |sept. ---------------------------------------------+------ | |oct. ---------------------------------------------+------ as labor occurs in the larger proportion of cases between and days from the first day of the last menstruation, days is the average. the table presents at a glance the beginning and end of days for every day in the year. find the date of menstruation in the upper line of the horizontal column, and the figure below, with the corresponding month, will indicate days. =to avoid miscarriage.=--the pregnant woman must be very careful as the usual time for menstruation approaches. it is then that any undue effort, unusual lifting, excessive grief, or shock to the system, may bring on a miscarriage. this is especially true if such a misfortune has previously occurred. =a great preventive.=--the most abundant testimony shows that lydia e. pinkham's vegetable compound is an almost certain preventive to miscarriage or abortion. it gives strength to the uterine walls, quiets the first approach of pain, controls any spasmodic contractions, and brings about such a healthy condition that all danger is averted. i cannot speak too strongly of this vegetable compound for these cases. so many mothers have written us that they are now happy in the possession of a child, when, for time and time again, they would have a miscarriage at the third or fourth month. =keep it in the house.=--every pregnant woman should always keep in the house a bottle of lydia e. pinkham's vegetable compound. she does not know the day when she will need it, and when that day comes she will require it promptly. at any time when there is soreness, tenderness, unusual pain, any unnatural discharge, or any symptom whatever that shows pregnancy is not pursuing a perfectly natural course, she should begin to use the vegetable compound at once. it should be taken in small doses two or three times a day, just enough to produce its strengthening, quieting, and healing effects. if she finds she has been overdoing, has strained herself in any way, or fears that some unfortunate result will follow an extra hard day's labor, let her take a few doses of lydia e. pinkham's vegetable compound as a certain preventive to future trouble. =the one universal cure.=--in other words, i repeat what i have already said so many times, that whenever there is trouble of any kind with any part of the female generative organs, whenever these do not act in a perfectly natural manner, then the lydia e. pinkham vegetable compound is indicated; for it is the one great, universal and never-failing cure for all the affections which fall to the lot of womankind. =makes mother and child strong.=--many thousands of wives owe the fact that they are mothers to-day to this grand remedy, and thousands upon thousands of children are happy, strong and robust because their mothers were wise enough to use it. keep it in the house. do not be a day without it. have it where you can reach it at any time. put your confidence in it. 'twill prove a never-failing friend to you in time of need. =mothers' marks.=--there is a wide belief among women that any strong impression made at a certain time during pregnancy will exert a powerful influence in producing some defect or deformity in the child. the opposite is also held, to the effect that beautiful objects, delightful music, and everything elevating and ennobling will have a favorable effect upon the body or mind of the child. an immense amount of testimony can be produced on both sides of this question. the weight of evidence, however, is rather in favor of these so-called "maternal impressions." in other words, it seems possible that under very unusual conditions the mother may affect her unborn child because of some powerful impression made upon the system. yet hundreds of thousands of mothers become frightened and undergo the most terrible experiences without having the slightest unfavorable effect upon the child; while other mothers give birth to deformed children when they have been surrounded with every comfort and have not been disturbed in any way. no one understands this subject, and but little can truly be said about it. =hereditary influences are strong.=--on the other hand, we all know how strong is heredity. therefore it is only acting the part of ordinary wisdom for every pregnant woman to avoid all disagreeable things possible and cultivate everything that is good and true. =early training necessary.=--when we come to study the theory of heredity, we see that it is impossible for any mother to completely change her course of life simply during pregnancy and have a corresponding effect upon her child. to produce the best results on the offspring it is necessary that the mother should have cultivated her own mind and body through many years of training. =were cured early in life.=--lydia e. pinkham's vegetable compound has done untold good to the present generation. there are hundreds of thousands of children living to-day who are healthy and happy because years before they were born their mothers, when young girls, took this grand household medicine. they were restored to health, a great load was lifted, and things again looked cheerful and bright, and in this condition a happy baby was born into the world. =if you do not understand your ailments write to mrs. pinkham, lynn, mass. her advice is free and always helpful. such letters are strictly confidential and answered with the help of women only.= chapter xi. problems in nursing. =diet during nursing.=--many mothers believe that it is necessary to eat only certain articles of diet while nursing their baby, for fear the child may be given the colic. while this may be true in certain cases, yet it is the exception. as a rule, mothers may eat nearly everything digestible without fear of affecting the baby. =exceptions.=--sometimes raw fruits or acid substances may change the milk in some way so that it will disagree with the baby, but as i have said, this is not the rule. occasionally, however, when such articles of diet as onions, cauliflower, and cabbage have been eaten, these will impart such an odor and taste to the milk that the child will refuse to nurse. =must be guided by experience.=--the only precaution the mother need take is that if she finds some article of diet disagrees with her, or if she knows a certain article always causes pain or discomfort in the child, then these should be avoided. it is true that certain medicines, especially purgatives, may be taken by the mother which will affect the child very quickly. here the same rule should be the guide as should always govern one, namely, no article of diet should be used which is known to disturb the digestion. =insufficient supply of milk.=--when a mother knows that the chances of her child's life are greatly increased if it has its natural food, she will certainly make unusual efforts to supply all the food necessary. mothers are too likely to think that an increase in the quantity of the milk answers every purpose; but this is of no use unless the quality is increased as well. the free use of soups and some malt extracts may increase the quantity, but this does the child no good. it too much resembles the example of the milk-man who uses the well-pump to increase his supply of milk. =how increased.=--however, the supply of milk can easily be increased in quantity and correspondingly improved in quality if the mother will drink freely of cow's milk, and use other substantial foods at the same time. if the milk is constipating, or rests heavy on the stomach, then a little lime water may be added to it in the proportion of one or two tablespoonfuls to a glass of milk. regular exercise in the open air is also necessary in order that the general health may be kept in the best possible condition. =anger may poison milk.=--it is a fact that if the child nurses after the mother has had a severe fright, or has become violently angry, the milk will sometimes act as an intense poison. in such cases the mother had better empty the breasts with a breast-pump, and not nurse the child for ten or twelve hours afterward, substituting some artificially prepared food. =extra supply of milk.=--sometimes the secretion of milk is so great that even a strong child cannot take it all. this produces a distention of the breasts, causing what is known as "caked breasts," or "milk cake." this should be promptly attended to, as there is great danger of an abscess forming. =to prevent caked breasts.=--the way to relieve this condition is to gently but firmly rub the breasts with warm sweet-oil, continuing this for fifteen or twenty minutes at a time. an occasional use of the breast-pump is necessary also. =how to diminish supply.=--when weaning-time comes, the question arises how the secretion of milk may be diminished. this is best done by having the mother take as little liquid as possible, whether of water, tea, milk, soup, or anything of this kind. she should also take a gentle laxative each day, as a little hunyadi water, or laxative mineral water of any kind. then support the breasts by passing a broad band beneath them, and carrying it over the shoulders, compressing the breasts slightly, but not too greatly. the breast-pump should be used as soon as any distention becomes painful, and the breasts should be diligently rubbed with warm sweet-oil. =if you do not understand your ailments write to mrs. pinkham, lynn, mass. her advice is free and always helpful. such letters are strictly confidential and answered with the help of women only.= chapter xii. to prevent convulsions at childbirth. =work of the kidneys most important.=--the kidneys are constantly engaged in removing from the body certain poisonous substances which are held in solution in the urine. if they should fail to do this work, or if no urine should be secreted for even a few hours, most serious consequences would follow. =cause of convulsions.=--when these poisons are retained in the system to a sufficient degree they cause convulsions and unconsciousness, and are frequently fatal. the convulsions which some women have at childbirth are caused by this imperfect action of the kidneys. =to tell if danger is present.=--an examination of the urine at any time will tell whether the kidneys are acting well or not, and thus it is possible to determine whether there is danger of having these convulsions during confinement. therefore i urge upon all pregnant women the necessity of having their urine examined once or twice during the course of pregnancy, and certainly during the eighth or ninth month. =albumen in the urine.=--imperfect action of the kidneys is shown by the appearance of albumen in the urine. any competent physician can easily determine whether this albumen is in the urine or not, and if present he can take such prompt measures as to remedy the evil before any serious danger occurs. of course i know that hundreds of thousands of women pass safely through childbirth and have no unfavorable symptom at all; yet i also know that now and then a most valuable life is lost when it might just as well have been spared as not, if these simple suggestions had been carried out. it is the teaching of all the best medical authorities in the world that this precaution should be taken by every expectant mother. =symptoms of kidney trouble.=--when the kidneys are not performing their work properly, the mother may know it, herself. if she finds her feet and ankles swelling at night, if she has a puffy look under the eyes, and especially if the amount of urine passed in twenty-four hours is not so great as formerly, then there is probably albumen in the urine. in this case she should stop eating meat of all kinds, and live largely upon milk, keeping the bowels in laxative condition by using lydia e. pinkham's liver pills, and bathing the skin well once or twice a day. she should also begin at once the use of lydia e. pinkham's vegetable compound, resting assured that this will remove the congestion in the kidneys, and will cause a more free secretion of the urine. =self-abuse (masturbation).=--this is a cause of many of the diseases of women, also men. small girls learn the practice from larger ones, and through ignorance continue it often to maturity without knowing that it is bringing upon them a physical and moral injury. _if mothers instructed their daughters on this subject there would be fewer broken lives._ symptoms.--the main symptoms are wakefulness, restless nights, headache, indolence, melancholy, indisposition to study, forgetfulness, despondency, weakness in the back and private organs, no confidence in one's own abilities, a desire for seclusion from society; whites, hysterics, and inability to look any one in the face. sometimes the muscles are relaxed, limbs tremble, the skin is sallow and dry, with pain in the womb. =remarks. write to mrs. pinkham in perfect confidence, and she will tell you exactly what to do. delay is dangerous in this matter.= chapter xiii. dyspepsia, constipation, general debility, sleeplessness. =dyspepsia, acute.=--acute dyspepsia is usually caused by some improper diet, as the eating of an unusual article of food or of a larger amount than necessary. such articles of diet as cucumbers, unripe or overripe fruit, an excessive amount of sweets, rich salads, heavy puddings, etc., may so irritate the stomach that an acute attack of dyspepsia follows. =nature often cures.=--nature often makes a prompt cure in these cases by causing a sharp attack of vomiting or diarrhoea. if a cure is not made in this way, then we can imitate nature by giving an emetic, or by taking a laxative, in order to rid the body of the indigestible material as soon as possible. =treatment.=--if there is much pain in the stomach, a mustard plaster should be placed directly over the pit of the stomach, or cloths wrung out in hot water. for the next day following the attack the diet should be restricted to milk, or poached eggs on toast, or something of this kind. =chronic dyspepsia.=--it is chronic dyspepsia, however, which is so annoying because of its persistence. it has been called "the american disease" because so many people are troubled with it. =symptoms.=--persons suffering from chronic dyspepsia complain of a bad taste in the mouth, dry throat, nausea, and a feeling of great weight in the stomach for an hour or two after each meal. frequently there is no appetite whatever, or it may be even more ravenous than natural because of the irritation and inflammation in the stomach. when the latter is the case, food does not satisfy, and it becomes necessary to eat every two or three hours in order to quiet the gnawing and empty feeling in the stomach. the chronic dyspeptic suffers greatly from nervousness and depression of spirits; indeed, it seems almost impossible to maintain the usual cheerfulness. =thought to be the heart.=--many persons go to their family physician thinking they have a serious form of heart disease, when the whole trouble is with the stomach, the violent beating of the heart being simply a nervous manifestation caused by the irritable condition of the stomach. =two diseases closely associated.=--chronic dyspepsia is almost invariably associated with the diseases of women. indeed, the two seem almost inseparable, for whenever you find a woman complaining of soreness across the lower part of the bowels, irregular menstruation, ovarian irritation, inflammation of the bladder, leucorrhoea, etc., you will find a confirmed dyspeptic. the blood is thin and watery, the bowels are constipated, and the whole nervous system seems to be upset. =which disease is the cause?=--the question comes whether the disease in the pelvis causes the difficulty with the stomach, or whether the stomach produces the inflammation in the uterus and surrounding parts. probably one is true at one time and another at another time. the fact is that both conditions need correcting, and there is one remedy which answers perfectly in each case. =both must be cured.=--the digestion certainly cannot be perfect while there is this inflammation in the pelvic organs; while the latter can hardly maintain a healthy condition if the stomach fails to do its work. =both may be cured.=--by paying attention to a few rules of diet, and by taking lydia e. pinkham's vegetable compound for a short time, i believe every case will promptly yield to treatment. =cures dyspepsia of men.=--indeed, strange as it may seem, a great many men who have taken lydia e. pinkham's compound because they have seen its good action on the stomach in cases of other members of the family have written reporting good results. it certainly has a most soothing and strengthening power on this organ, while its gently stimulating effect on the whole alimentary canal brings about the most desirable changes. =regular action of the bowels.=--i would recommend that lydia e. pinkham's liver pills be taken each night in just sufficient doses to cause a regular action of the bowels each day. then if lydia e. pinkham's vegetable compound be taken, it will not only allay all inflammation in the stomach and impart great strength, but it will at the same time remove the soreness and pain in the pelvic organs. =a simple but valuable aid.=--all such persons will obtain relief by drinking a cupful of hot water at least half an hour before breakfast each morning; and if the case is very bad, then the hot water may be repeated before each meal. the water should be as hot as can be comfortably taken. =useful hints.=--i would strongly urge the necessity of thoroughly chewing the food and eating slowly. if this rule alone were observed there would be far less dyspeptics in the country. drink should be used sparingly at meal-time, also, for while the body requires a great deal of liquid during the day, yet this should be taken between meals rather than during meals. the stomach should certainly have time to rest from its work of digesting the food, hence nothing should be eaten between meals. the habit so many girls have of eating before retiring is very injurious to the health, and should be corrected at once. meals should be taken at regular intervals and not at any time when most convenient. =diet for dyspeptics.=--the chronic dyspeptic should use soups sparingly, for, as a rule, they are quite difficult of digestion, while they do not contain much nourishment. plain mutton and beef soup without much fat are the least harmful. such fish as pickerel, trout, shad, and white fish may be used moderately; while oysters, especially when raw, are easily digested. the best kinds of meat are roasted or broiled beef, lamb chops, and some fowl, as chicken. eggs are easily digested, and are exceedingly valuable as an article of diet for the dyspeptic. they may be cooked in almost any form except hard-boiled. they are highly nourishing, can be prepared in many delicate ways, and are, as i have said, as valuable an article of diet as the dyspeptic can have. persons with chronic dyspepsia do not digest vegetables well, as a rule, although such green vegetables as lettuce, green peas, asparagus, celery, and spinach may be used. potatoes often ferment in the stomach, producing gases, and should be used sparingly. toast is always well borne, but should never be buttered while hot. bread should not be used until it is at least a day old. rolled oats, cracked wheat, etc., may be taken, although with many they cause fermentation. nearly all cooked fruits are well borne by the stomach, and so are nearly all ripe fruits. puddings made from rice and custard are easily digested. milk is valuable at all times, and if the chronic dyspeptic bears it well, this diet alone will frequently make a marked cure. if it rests heavy on the stomach, a little lime water may be added to it in the proportion of a tablespoonful of lime water to a cupful of milk. =forbidden diet.=--there are certain articles of diet which the dyspeptic should not use under any circumstances. among such are fried foods of all kinds, pork, liver, veal, rich soups, turkey, goose, duck, mackerel, lobster, cucumbers, cabbage, turnips, parsnips, string beans, pies and cakes, cheese and nuts. =constipation.=--as we have already stated, constipation is productive of the most serious evils. when the lower bowel is distended, pressure is made upon the surrounding blood-vessels, and thus the circulation seriously interfered with. =causes inflammation of uterus.=--as a result, there is congestion in the blood-vessels of the ovaries and uterus, and inflammation of these organs is likely to follow with its long train of ailments. constipation also seriously interferes with the general health, producing nausea, indigestion, headache, backache, nervousness, general debility, etc. =daily movements necessary.=--nature intended that the alimentary canal should be relieved of its contents at least once every twenty-four hours, and if this is not done, then certain poisons are absorbed into the blood which produce the most undesirable effects. =to cure constipation.=--for constipation i strongly recommend lydia e. pinkham's liver pills. i know they give the most prompt and satisfactory relief. i have received letters from hundreds of women who have been cured of the most distressing ailments of the uterus and bladder simply by using these liver pills, and all because constipation was cured and in this way the cause of the suffering removed. =diarrhoea.=--diarrhoea, as a rule, is an effort of nature to get rid of some offensive material. while this may be the first reason for its existence, yet if it is allowed to go on, it produces such an irritation in the bowels that serious results may easily follow. =treatment.=--if the person is conscious of having eaten something indigestible, as unripe or overripe fruit, then it is best to aid nature by taking some gentle laxative, as a laxative dose of lydia e. pinkham's liver pills, thus hastening the removal of the indigestible substance. if, however, there have been a number of movements of the bowels, until the offending material is probably all removed, then the following plan is all that will be necessary to make a cure: let the person rest at full length upon a couch or bed, remaining as quiet as possible. for the diet nothing should be taken but hot milk. a glass of hot milk can be slowly sipped once every three hours, and nothing else whatever should be taken into the stomach for a day, at least, or until the diarrhoea is checked. if the pain is quite severe in the stomach or bowels, then a mustard plaster may be placed over the most painful part, or cloths wrung from hot water; or a poultice of linseed meal or slippery elm may be applied. i have seen the good results of this treatment of "rest and hot milk" in so many cases, and it is so exceedingly simple, that i earnestly recommend its trial. =general debility, exhaustion, anæmia.=--many women go about suffering from great debility, being hardly able to drag themselves through the day. when night comes they are too tired to sleep, and when morning comes it seems they are more tired than they were at night. all parts of the body partake of this general weakness. there are great discomfort and suffering through the lower part of the body, difficulty in passing the urine, constipation of the bowels, leucorrhoea, and all other affections which naturally come from an impoverished condition of the blood. =may be promptly cured.=--to all women who are suffering from this general debility, exhaustion, and nervous prostration i earnestly recommend lydia e. pinkham's blood purifier. if the inflammation in the uterus and surrounding organs is quite marked at the same time, then the blood purifier may be taken before meals and the vegetable compound after. if the female generative organs are not much involved, then the blood purifier may be used alone. =a grand medicine.=--this grand medicine has done great good, and i am confident it will build up the system, purify the blood, and greatly improve the general health. persons suffering from general debility of this kind do not prosper well on a milk diet alone. they need more hearty food, such as rare beefsteak, rare roast beef, lamb chops, and eggs. =sleeplessness.=--sleeplessness is frequently the result of a too liberal use of tea or coffee. many persons cannot take a cup of coffee at any time during the evening without lying awake many hours to pay for it. it is a strong stimulant to those who have a sensitive nervous system, and should be used only sparingly at all times and never after the midday meal. strong tea acts in this way upon a great many, and if any of my readers are troubled with sleeplessness, and yet at the same time use tea and coffee freely, i would suggest that they try, first of all, to do without these drinks and note the effect. =treatment.=--a warm (not hot) foot-bath taken just before retiring will often cause a good night's rest, as it draws the blood from the head, makes the circulation more evenly distributed, and in this way induces sleep. frequently a baby or young child may be made to sleep all through the night if a warm bath be given just before retiring. when the sleeplessness is due to nerve exhaustion, as is frequently the case, the very best results will follow the use of lydia e. pinkham's vegetable compound, because of its great nerve tonic properties. =a hard cold.=--whenever any one has taken a hard cold, it can often be speedily and completely broken up in the following manner: take a hot foot-bath for at least half an hour. while the feet are still in the hot water throw a blanket completely about the limbs and body, in order to retain all the heat possible. at the same time drink one or two cupfuls of hot lemonade, or hot ginger tea. then retire to bed, having the bed previously well warmed, if during the wintertime. put on plenty of covering, keeping a hot flat-iron or a hot water-bottle at the feet, and in every way try to induce free perspiration. after an hour or two, gradually remove the extra clothing. be careful about going out the next morning, for the body will be especially susceptible to the cold. in this way it is possible to break up a hard cold at once. if there is any tendency to cough, or any tightness or soreness in the chest, place a mustard plaster directly over the chest, and allow it to remain on until the skin is quite red. =sore throat.=--an old-fashioned remedy for sore throat, and a very good one, too, is to bind on each side of the throat a piece of salt pork. the surface of the pork may be slightly covered with black pepper, in order to increase its drawing power. this is allowed to remain on all night, but should be taken off in the morning. during the day a flannel is worn about the neck. a gargle for sore throat may be made by dissolving half a teaspoonful of chlorate of potash in a cupful of warm water. gargle the throat with this every hour or two during the day, but do not swallow the mixture. after this has been used for a day or two, then a solution may be made by adding a teaspoonful of pulverized alum to a cupful of warm water; this is applied to the inflamed sides of the throat by means of a swab. gargling the throat with a solution of ordinary extract of witch hazel, one part, and water two parts, also very useful. =croup.=--as a rule, croup may be quickly cured by the use of either hot or cold water. immediately the child begins to breathe hard and cough with a dry, hollow, barking cough, wring out a towel from cold water and apply around the throat, covering this with a dry towel. the wet towel should be changed in a few minutes, just as soon as it becomes a little warm. often before the second cloth is removed the spasm will be broken, and the danger passed. _cool_ water will not answer; it must be _cold_. if the spasm does not break, and the breathing does not become easy within fifteen or twenty minutes, then change to hot water. wring out the cloth from water as hot as can be borne and apply about the neck, changing in a few moments, and so on. =how to lose flesh.=--i have often been asked whether it were possible to have the flesh reduced without in any way affecting the general health. if the person be only slightly heavier than usual, and is in the best of health, it certainly seems wrong to experiment in any way to reduce the weight, especially when this is done only to better follow the dictates of fashion. if, however, the excess of flesh is becoming so great as to be uncomfortable, to interfere with the regular work, or to cause weak action of the heart, etc., then something should be done. there are a few rules which a person may follow to advantage in such cases, although the change should be made gradually. so long as a person continues to gain in flesh, it is positive evidence that more food is being taken than necessary. therefore the first rule is that the quantity of food should be gradually diminished. the second rule is that exercise should be taken regularly. this will keep up the general health, while it will cause the fat to be more evenly distributed over the body. another rule is to keep the bowels well open, so that there may be at least two movements daily. for this special purpose the mineral laxative waters are best. =diet for reducing the flesh.=--fatty foods should be avoided, and so should all drinks in excess. foods containing sugar or starch should be taken sparingly, as oatmeal, potatoes, rice, cakes, sweetened tea and coffee. milk is very fattening to many, hence should not be used. the eminent dr. mitchell, of philadelphia, instituted a course of treatment for reducing the weight, which is quite rigid, but nevertheless effective. the regular diet should be changed gradually until it meets dr. mitchell's demands. he prescribes outdoor exercise, and a diet of one cupful of milk and one egg every three hours when awake. no other food or drink is allowed for twenty days, when the list of foods is gradually extended. there are a number of anti-fat remedies upon the market, but many of them depend for a cure upon their power to disturb digestion, and thus interfere with the general health. =how to gain flesh.=--when it is natural for persons to be thin, it is quite impossible for them to gain in weight under any kind of diet or treatment. many persons, however, are thin simply because some of the digestive organs do not perform their work properly; or because the diet is not the right kind. thin persons need good meats and some vegetables. if the digestion is all right, then such meats as mutton, chicken, broiled bacon, broiled ham, etc., may be used; also rare broiled steak, rare roast beef, etc. eggs may be used in any way except hard-boiled. good bread, oatmeal, cracked wheat, hominy, etc., are good. such indigestible foods as pork and veal, thin soups, cabbage, turnips, pickles, pies, and pastries of all kinds should not be used. often a good preparation of cod-liver oil will increase the weight; and this is also true of many of the extracts of malt. it is useless, however, to try to increase the weight by using a generous diet, unless the digestion is in good order. when the digestion is weak, the person should take lydia e. pinkham's vegetable compound because of its power to strengthen the digestion and enable the system to obtain all the good possible from the food. =pimples, rashes, eruptions.=--many persons, especially young girls, are afflicted with pimples on the face, rashes, blackheads, etc. to cure this condition it is necessary that the bowels be made to act regularly each day, which is easily done by the use of lydia e. pinkham's liver pills. then a good course of treatment should be taken with lydia e. pinkham's blood purifier in order to make the blood perfectly pure in every way. attention should also be paid to the diet, and such indigestible articles as pork, pickles, rich pies and cakes, and rich sauces, sweetmeats and nuts should be avoided. for local treatment, the face should be washed each day in warm, soapy water, using the best castile soap. then with a sponge or wash cloth wash off this water with as hot water as can be borne. it is best to keep up this sponging with the hot water for at least five minutes in order that the face may become thoroughly steamed. the face should then be wiped dry and rubbed briskly for a few minutes. =burns.=--burns are likely to occur at any time in the household, and one should always know what to do promptly. the best treatment is to add a teaspoonful of ordinary baking-soda to a cupful of water. saturate some cloths in this solution and lay them over or loosely bind them about the burned part. this will take out the pain and sting at once. as the cloths become dry, more of the solution should be poured over them, and they should not be removed from the burned parts. after a few hours, these wet cloths may be replaced by cloths well covered with vaseline. =if you do not understand your ailments write to mrs pinkham. her advice is free and always helpful. such letters are strictly confidential; they are never shown without the writer's express permission; women only assist in answering them.= free medical advice to women all correspondence strictly confidential +lady with raised hand+ in addressing mrs. pinkham you are confiding your private ills to a woman--a woman who speaks from a greater experience in treating women's diseases than can any living physician--male or female. you can talk freely to a woman when it is revolting to relate your private troubles to a man--besides, a man does not understand--simply because he is a man. many women suffer in silence and drift along from bad to worse, knowing full well that they ought to have immediate assistance, but a natural modesty impels them to shrink from exposing themselves to the questions and probably examinations of even their family physician. it is unnecessary. without money or price you can consult a woman, who can speak from a greater actual experience than can any local physician in the world. every one will agree that there are the strongest of all reasons why, if we are ill, we should appeal to the person who knows the most about the kind of illness with which we are afflicted--one who has had the greatest experience in treating just such cases and meeting just the symptoms that are manifest in our particular case. what confidence does one gain by consulting one who has occasionally met a case just like ours, but has had no great experience? none whatever. all treatment under such a person must of necessity be experimental. but in writing mrs. pinkham you consult one who has, actually filed in her office for ready reference, an immense correspondence with patients suffering from female ills which has been constantly going on for more than twenty-five years; and it is safe to say there is not a case or complication of female derangements with which she is not familiar. it is a positive fact, easily verified, that within the last few months she, with her corps of trained women assistants, has advised in over one hundred thousand cases, and that a vast number of the women of this country owe the restoration of their health to her advice and lydia e. pinkham's vegetable compound. now, if a woman is ill and miserable, it seems to us only simple justice to herself that she should avail herself of the help of a woman of such enormous experience. mrs. pinkham's standing invitation. women suffering from any form of female weakness are invited to promptly communicate with mrs. pinkham, at lynn, mass. she asks nothing in return, except their good will, and her advice has relieved thousands. surely any woman, rich or poor, is very foolish if she does not take advantage of this generous offer of assistance. =address simply mrs. pinkham, lynn, mass., u. s. a.= el compuesto vegetal de lydia e. pinkham es un remedio seguro para todas las enfermedades de las mujeres, incluyendo la caída del útero, leucorrea, menstruaciones irregulares y dolorosas, inflamaciones y ulceraciones de la matriz y del ovario, para toda clase de afecciones de los órganos de la generación, así como también para las enfermedades de los riñones de ambos sexos. este remedio está compuesto de las raíces y yerbas mas puras y escogidas, que se encuentran en la naturaleza para las enfermedades de las mujeres. =menstruación.=--las menstruaciones tempranas no son deseables, aunque muchas menstruaciones aparecen de los trece á los quince años; sin embargo mucho depende de la constitución de la muchacha. si habiendo llegado á esta edad no ha menstruado todavía, la madre deberá prestar singular cuidado á la hija; esta probablemente crecerá delgada y pálida con una complexión lívida, que hará de ella una víctima fácil y segura de la tisis y de la nevrastenia. nada hay comparable para estos casos al compuesto vegetal de lydia e. pinkham. ayuda y promueve los cambios importantes que han de verificarse en la vida de la muchacha en esa edad previniendo largos años de padecimientos los cuales son resaltados seguros de la negligencia. el compuesto deberá tomarse siguiendo estrictamente las direcciones hasta que la menstruación ocurra regularmente cada veinte y ocho días. si hay propensión á estreñimiento, las píldoras de hígado de lydia e. pinkham deberán tomarse juntamente con el compuesto vegetal. estas píldoras han sido hechas especialmente para mujeres y obran in perfecta harmonía con el compuesto vegetal. =supresión de las reglas= es la suspensión de la menstruación. si la supresión de las reglas ocurriese, excepto en los casos de preñez ó de amamantamiento, el compuesto vegetal de lydia e. pinkham deberá tomarse hasta que la menstruación vuelva á producirse regularmente. curará todas las irregularidades. =menstruaciones dolorosas.=--muchas mujeres sufren dolores terribles durante la menstruación. el compuesto vegetal de lydia e. pinkham curará esos martirizantes dolores. nada importa que el caso sea reciente ó que haya existido durante muchos meses, si el compuesto vegetal se toma regularmente y siguiendo las instrucciones, la cura será un hecho cierto. =menstruaciones abundantes= ocurren á menudo en las personas sanguíneas y en las pálidas y linfáticas. el compuesto vegetal de lydia pinkham ha hecho algunas de las curas más asombrosas precisamente en esas condiciones. para las menstruaciones abundantes avisamos que se tome el compuesto vegetal de lydia e. pinkham en forma seca, es decir en píldoras ó pastillas. =la inflamación y la ulceración del útero= es la causa de casi todas las enfermedades de las mujeres. el compuesto vegetal de lydia e. pinkham ha curado más de un millón de casos de enfermedades uterinas. el número de relaciones recibidos de mujeres que han estado enfermas á punto de morir y han sido curadas por este remedio es casi increíble. una mujer puede conocer perfectamente si padece de alguna enfermedad del útero, porque estas enfermedades vienen acompañadas de terribles dolores en el abdomen, espalda etc., desmayos, pesadez en las extremidades, y de toda clase de otros dolores. una cura segura se encuentra en el compuesto vegetal de lydia e. pinkham. =leucorrea (ó flores blancos).=--uno de los primeros síntomas de la inflamacíon del útero es la leucorrea, familiarmente conocida bajo el nombre de flores blancos, la cual consiste en una secreción blancusca de la vagina la cual debilita muchísimo el sistema y produce una irritación de la membrana mucosa que reviste el canal vaginal. el uso regular del compuesto vegetal, por sus efectos en la constitución, y la loción sanativa de lydia e. pinkham usada en inyecciones curará positivamente los casos más graves de leucorrea. la negligencia de esta dolorosa enfermedad originará úlceras, flujos excesivos, estableciendo los cimientos para la más terrible de todas las enfermedades--el cancer. =caída del utero.=--existen muchos desplazamientos del útero, pero el más principal es él conocido generalmente con el nombre de la caída del utero. esto es debido muchas veces á la flojedad de los ligamentos que soportan este órgano. el compuesto vegetal de lydia e. pinkham fortalece lás ligamentos, alivia todas las inflamaciones y gradualmente restaura los órganos á su propia condición. el compuesto vegetal de lydia e. pinkham removerá los tumores del útero en su temprano desenvolvimiento tan seguro como el sol brilla. =la inflamación de los ovarios= es una de las enfermedades más desesperantes que atacan á las mujeres de á años. esta enfermedad va siempre acompañada de algunos dolores de la región de los ovarios y de una sensación de pesadez especialmente durante la menstruación. a menudo el dolor extiéndese por el costado y la espalda, especialmente en el lado izquierdo produciendo continuos deseos de orinar. a menos que esta enfermedad se ataque prontamente nada curará á la paciente que no sea la cuchilla del cirujano. el compuesto vegetal de lydia e. pinkham a curado miles de mujeres que sufrían enfermedades del ovario, salvándolas de los riesgos de una seria operación. =la esterilidad= es á menudo debida á la extrema debilidad e inflamación crónica del útero; frecuentemente el uso regular del compuesto vegetal de lydia e. pinkham ha restaurado los órganos reproductivos de la mujer á sus condiciones normales quitándolas la idea de que su esterilidad era imposible de curarse. =cambio de vida= es el período peligroso por el cual pasan todas las mujeres que han cumplido años; durante este período las mujeres sufren toda clase de dolores y enfermedades, pero si el compuesto vegetal de lydia e. pinkham se toma regularmente este cambio importante puede ser pasado sin peligro de enfermedades ó muerte. =las enfermedades de los riñones y de la vejiga= son comunes en ambos sexos, generalmente de difícil curación, pero pueden curarse si se atienden á tiempo; nada sin embargo es tan fatal como el no atenderlos debidamente á su tiempo, siendo la muerte el resultado inevitable. el compuesto vegetal de lydia e. pinkham no reconoce rival entre los remedios que para estas enfermedades han sido descubiertos. es digno de absoluta confianza tanto por hombre como por mujer. =los dolores de la espalda= no son una enfermedad pero son uno de los principales síntomas; cuando existe una enfermedad de los órganos de la generación, ésta es telegrafiada, como si dijeramos, al gran nervio simpático que tiene uno de sus principales centros en la parte mas baja de la espalda. el compuesto vegetal de lydia e. pinkham curando las enfermedades del útero y de los riñones hará desaparecer los dolores de la espalda. =dispepsia é indigestión.=--nada en el mundo será descubierto que pueda compararse al compuesto vegetal de lydia e. pinkham, para las enfermadedes del estómago. =preñez.=--muchos dolores y sufrimientos que ocurren al dar á luz á un niño podrían evitarse enteramente, si la madre fortificase su sistema durante dos meses antes del nacimiento con el compuesto vegetal de lydia e. pinkham. direcciones generales. una cucharada del compuesto vegetal de lydia e. pinkham deberá tomarse cada horas al día para cualquiera de las enfermedades arriba mencionadas. * * * * * empápese un cuarto del paquete le la loción sanativa de lydia e. pinkham en cantidad suficiente de agua para hacer una pinta después de haberse filtrado; cuando los flujos son profusos, úsese la mitad de esta cantidad, añadiendo una pinta de agua caliente. * * * * * para estreñimiento, dolores de cabeza, biliosidades tómense tres píldoras de hígado de lydia e. pinkham la primera noche, dos la segunda y una la tercera, y á menos que se obtenga una saludable flojedad de los intestinos deberá seguirse tomando una cada noche, hasta concluir la caja. * * * * * cuando la sangre es pobre y el paciente se sienta débil y cansado, y desganado, nada en el mundo es tan bueno como el "purificador de la sangre" de lydia e. pinkham. una cucharada tres veces al día curará el reumatismo, scrófula, erupciones de la piel, etc. etc. * * * * * de venta por todos los farmaceúticos y droguistas. preparado por the lydia e. pinkham medicine company, lynn, mass., e. u. de a. lydia e. pinkham's Ã�rt-medicin ar ett säkert botemedel för alla qvinnosjukdomar, sÃ¥som lifmoderns nedfallande, hvitsot, oregelbunden och smärtsam rening, inflammation och sÃ¥rnad pÃ¥ lifmodern och äggstockarne, samt alla andra svagheter uti de qvinliga skaporganen, äfvensom njurlidande hos bÃ¥da könen. det är sammansatt af utvalda och renaste slag af rötter och örter, sÃ¥som naturen sjelf frÃ¥mställt dem för botandet af qvinnans lidanden. =rening.=--för tidig rening är icke önskvärd, ehuru densamma vanligen börjar vid omkring tretton intill femton Ã¥rs Ã¥lder; emellertid beror dervid mycket pÃ¥ flickans kroppsbyggnad. om hon nÃ¥tt denna Ã¥lder och ännu icke haft rening, bör modren fästa särskild uppmärksamhet dervid; hennes dotter blir antagligen mager och blek, med en egendomlig gulblek hy och hon blir ett säkert och lätt offer för lungsot och nervös nedslagenhet. ingenting i verlden när upp till lydia e. pinkhams vegetable compound i dylika fall. det bidragar att Ã¥stadkomma den vigtiga förändring uti en flickas lif, som bör ega rum vid omkring denna Ã¥lder och förebygger sÃ¥lunda Ã¥ratal af elände, som är en säker följd af uraktlÃ¥tenhet. medicinen mÃ¥ste tagas bestämdt enligt föreskrift, intill reningen inträffar regelbundet hvarje tjuguÃ¥ttonde dag. om inelfvorna äro benägna att hoptränga sig, borde lefver-piller (lydia e. pinkhams liver-pills) begagnas, hvilka blifvit särskildt sammansatta för qvinnans bruk och verka i fullkomlig harmoni med vegetable compound. =förhindrande af flytningen= är ett uppharonde sedan reningen vederbörligen börjat. om ett upphörande eger rum, sÃ¥ framt det icke är en följd af hafvandeskap eller gifvande af di, är det ett allvarligt fall och lydia e. pinkhams vegetable compound bör tagas tills reningen Ã¥ter blir regelbunden. den förbättrar säkert alla oregelbundenheter. =smärtsam rening.=--mÃ¥nga qvinnor lida marterande smärta under reningen. lydia e. pinkhams vegetable compound botar säkert denna smärtande känsla. det inverkar ej om detta förhÃ¥llande nyligen inträdt eller om det egt rum under mÃ¥nga mÃ¥nader; om lydia e. pinkhams vegetable compound tages regelbundet och enligt föreskrift är ett botande säkert. =för ymnig rening= förekommer ofta hos dem, som äro blodfulla, liksom hos dem som äro bleka och svaga. lydia e. pinkhams vegetable compound har Ã¥tstadkommit Ã¥tskilliga af de mest förvÃ¥nansvärda botaden i just dylika fall. för för ymnig rening eller flytning rekommendera vi alltid lydia e. pinkhams vegetable compound i torr form, antingen som piller eller kakor. =inflammation och sÃ¥rnad pÃ¥ lifmodern= är orsaken till nästan alla qvinnosjukdomar. lydia e. pinkhams vegetable compound har botat mera än en million fall af lifmoderfel. de skildringer, som erhÃ¥llits frÃ¥n qvinnor, hvilka varit dödsjuka och som botats genom lydia e. pinkhams vegetable compound äro nästan otroliga. en qvinna vet säkerligen om hon har nÃ¥got slags lifmoderfel, enär dylikt nästan alltid Ã¥tföljes af en nedtyngande känsla uti underlifvet, ryggvärk, svimmingsanfall, styfhet i lederna och all annan tänkbar värk och smärta. ett aldrig svikande botemedel är lydia e. pinkhams vegetable compound. =leucorrhea eller hvitflytning.=--en af de första symptomerna af lifmoderns inflammation är leucorrhea, vanligen kallad "hvitt," hvilken bestÃ¥r af en hvit flytning frÃ¥n moderslidan och som är mycket kraftnedsättande för systemet och retande för moderslidans känsliga slemhinna. ett regelbundet begagnande af lydia e. pinkhams vegetable compound pÃ¥ grund af dess inverkanpÃ¥ kroppsbeskaffenheten och lydia e. pinkhams läkande medel för insprutning uti moderslidan, botar säkert de allvarligaste fall af hvitflytning. försummande af denna ledsamma sjukdom förorsakar sÃ¥rnader, öfverdrifven flytning och lägger grunde för den forskräckligaste af alla sjukdomar nemligen kräfta. =lifmoderns nedfallande.=--det finnes mÃ¥nga olika rubbningar hos lifmodern, den vanligaste känd under namn af lifmoderns nedfallande. detta beror hufvudsakligast pÃ¥ förslappning af de band som uppbara detta organ eller hÃ¥lla det pÃ¥ sin plats. lydia e. pinkhams vegetable compound starker dessa band, lindrar inflammation och Ã¥terställer sÃ¥ smÃ¥ningen delarne uti deras behöriga läge. lydia e. pinkhams vegetable compound borttager svullnad uti lifmodern i dess tidigare stadium lika säkert som solen skiner. =inflammation uti Ã�ggstockarne= är en särdeles allvarlig sjukdom, som angriper qvinnan mellan och Ã¥rs Ã¥lder. den Ã¥tföljes alltid af ömhet och hÃ¥rda smärtor i trakten af äggstockarne och en känsla af uppfyllnad isynnerhet under reningen. ofta utstracka sig smartorna till sidan och ryggen, isynnerhet till venstra sidan, med ett ständigt begÃ¥r att urinera. sä framt icke denna sjukdom genast häfvas, kan ingenting rädda patienter frÃ¥n operationsknifven. lydia e. pinkhams vegetable compound har emellertid botat tusentals qvinnor för sjukdomar uti äggstockarne och räddat mÃ¥ngfaldiga frÃ¥n hospitalet och en allvarlig operation. =ofruktbarhet= har often sin orsak uti ytterlig svaghet och kroniskt inflammeradt tillstÃ¥nd af lifmodern. regelbundet begagnande af lydia e. pinkhams medicin har ofta Ã¥terställt lifmoderns fruktbara organer till deras normala tillstÃ¥nd och lindrat frÃ¥n den bekymrande tanken att ofruktbarheten var obotlig. =förändring i lifvet= ar en farlig period för alla qvinnor, som hunnit till Ã¥rs Ã¥lder. under denna tid har qvinnan all slags sjukdom och smärta, men om lydia e. pinkhams vegetable compound tages regelbundet, kan denna vigtiga förändring i en qvinnas lif passeras utan fara för sjugdom eller död. =njurlidande och blÃ¥skatarr= hos bÃ¥da könen aro vanliga och svÃ¥ra sjukdomar, men de kunna botas om de tagas itu med i rätt tid. ingenting ar emellertid sÃ¥ olycksbringande som symptomerna till dessa sjukdomar om de ej gifvas akt pÃ¥ i tid och döden är oundviklig. lydia e. pinkhams vegetable compound öfverträffas ej af nÃ¥got annat botemedel, som nÃ¥gonsin uppstÃ¥ckts för botande af alla sjugdomar i njurarne och blÃ¥san. det är fullt tillförlitligt bÃ¥de för män och qvinnor. =ryggvark= är icke en sjukdom utan en tydlig symptom da sjukdom förefinnes uti skaporganen och ger sig tillkänna som om det vore uti den stora sympatiska nerv, som har ett af sina förnämsta lägen i lägre delen af ryggen. lydia e. pinkhams vegetable compound, som häfver lifmoders-, äggstocks-, och njurlidanden, botar tryckande ryggvärk. =magsyra och dÃ¥lig matsmÃ¥ltning.=--ingenting verlden har nÃ¥gonsin uppstäckts, som uppnÃ¥r lydia e. pinkhams vegetable compound for magsjukdomar. =hafvande tillstand.=--vid barnsbörd intraffer mycken smärta och lidande, som kunde helt och hÃ¥llet undvikas om den blifvande modern stärkte sitt system genom regelbunden behandling med lydia e. pinkhams vegetable compound under en period af tvÃ¥ mÃ¥nader före barnsbörden. allmÃ�n ordination. en matsked af lydia e. pinkhams vegetable compound hvarje fjerde timma under dagens lopp för hvilken som helst af förutnmände sjukdomar. lägg ett fjerdedels paket af lydia e. pinkhams läkande medel i tillräckligt med vatten för att utgöra en pint sedan det silats. dÃ¥ flytningen är för riklig, tag hälften deraf och tillsätt en pint varmt vatten. begagna dagligen för insprutning i moderslidan. för föstoppning, hufvudvärk och gallsjukdom tages tre lydia e. pinkhams lefverpiller första natten, tvÃ¥ den andra och en den tredje och sÃ¥vida ej en regelbunden och helsosÃ¥m förändring inträdt uti underlifvet, fortsätt att taga ett hvarje afton sÃ¥ länge de räcka. när blodet är fattigt och patienten är svag samt alltid känner sig trött, är mager och ej har appetit, sÃ¥ är intet i verlden sÃ¥ välgörande som lydia e. pinkhams blodrenare. en matsked tre gÃ¥nger dagligen botar rheumatism, skrofler, hudsjukdomar m. m. säljes hos apotekare, prepareradt af lydia e. pinkham medicine company, lynn, mass., förenta staterna. le remÃ�de vÃ�gÃ�tal de lydia e. pinkham. =le remède végétal de lydia e. pinkham= est un remède absolument sûr pour toutes les maladies de femme telles que le prolapsus de la matrice, la leucorrhée, les menstrues irregulières et douloureuses, l'inflammation et l'ulcération de la matrice et des ovaires, ainsi que pour toutes les autres affections des organes génitaux de la femme, et les maladies des reins et du foie des deux sexes. il se compose des herbes et racines les plus pures, telles que les pourvoit la nature elle même. =menstrues.=--il n'est pas à désirer que les règles aient lieu a un âge trop jeune, quoiqu'en général les menstrues commencent entre la e et la e année, la constitution de la jeune fille y jouant un certain rôle. si la fille a atteint cet âge et qu'elle n'ait pas encore ses règles, la mère ne saurait être trop soigneuse; il est probable que la fille est pâle et maigre, et que son teint montre cette couleur livide qui nous fait craindre qu'elle ne devienne sous peu la victime de la phthisie et qu'elle ne devienne fortement neurasthénique. pour empêcher un tel malheur rien n'égale "lydia e. pinkham's vegetable compound." il produit d'une manière salutaire et prompte le changement qui devrait alors avoir lieu, en prévenant ainsi de longues années de souffrances, résultat inévitable de tout manque de précaution. lydia e. pinkham's vegetable compound doit être pris strictement selon les instructions, jusqu'à ce que les règles aient lieu tous les jours. si, de plus, il y a de la constipation, on se servira des pilules de foie de lydia e. pinkham, faites exprès pour l'usage des femmes et opérant entièrement d'accord avec le remède. =l'absence des règles= après qu'elles ont commencé une fois, à moins qu'elle ne soit due à la grossesse ou à l'allaitement, est une affaire de la plus grande importance et personne ne devrait manquer de se servir de lydia e. pinkham's vegetable compound jusqu'à ce que de nouveau les menstrues se montrent regulièrement. =règles douloureuses.=--il y a bien des femmes qui, pendant le temps de leurs règles, souffrent des douleurs tout à fait terribles. notre remède guérira d'une maniere sûre cette affection n'importe si c'est un cas récent ou vieux de plusieurs mois. on peut s'attendre à une guérison sûre et efficace pourvu que le remède soit pris regulièrement et suivant les instructions. =les règles excessives= se montrent d'abord chez des personnes sanguines et chez les personnes affaiblies et pales. notre remède, lydia e. pinkham's vegetable compound, a obtenu des résultats tout à fait merveilleux dans ces cas. pour guérir l'excès ou l'hémorrhagie des règles nous conseillons l'emploi du remède dans sa forme sèche, c'est à dire en pilules ou en pastilles. =l'inflammation ainsi que l'ulcération de la matrice= peuvent être regardées comme cause de presque toutes les maladies de la femme. cependant lydia e. pinkham's vegetable compound a guéri plus d'un million de maladies de la matrice. les rapports que nous recevons des femmes qui ont failli en mourir et qui ensuite ont été gueries, sont presque incroyables. la femme peut s'assurer assez facilement, si elle est atteinte ou non d'une affection de la matrice, vu le fait qu'ordinairement elle est sujette à des tiraillements d'estomac, à des peines dans les reins, à des évanouissements, à l'engourdissement des membres et à une foule d'autres douleurs. le seul remède infaillible pour guérir toutes ces affections est lydia e. pinkham's vegetable compound. =la leucorrhée= que nous connaissons plus familièrement sous le nom de "fleurs blanches," représente un des premiers symptômes de l'inflammation de la matrice. le mal se montre sous la forme d'une secrétion blanchâtre du vagin, enfaiblissant le système et exerçant un irritation très sérieuse sur la muqueuse du vagin. l'emploi régulier de lydia e. pinkham's vegetable compound, grâce à son effet sur le système, ainsi que de la lotion sanitaire de lydia e. pinkham (lydia e. pinkham's sanative wash) appliquée sous forme d'injections dans le vagin, ne tardera guère de guérir les cas les plus obstinés de leucorrhée. en négligeant cette maladie désastreuse on est sûr de donner lieu à des secrétions excessives, à des ulcères ainsi qu'a la plus dangereuse de toutes les maladies--le cancer. =prolapsus de la matrice.=--il y a un grand nombre de déplacements dont le plus important est appelé "le prolapsus de la matrice." celui-ci est produit d'abord par une relaxation des ligaments qui, dans leur état normal, maintiennent cet organe à sa place. lydia e. pinkham's vegetable compound fortifiera ces ligaments, l'inflammation disparaîtra et peu à peu l'organe sera remis dans sa condition normale. notre remède aura de plus un succès indiscutable pour guérir toutes les tumeurs de la matrice pourvu qu'on commence à s'en servir dès leurs première phases. =l'inflammation des ovaires= est une des maladies les plus désastreuses atteignant les femmes entre la vingtième et la quarantième année. les personnes qui en souffrent s'aperçevront vite d'une sensibilité extraordinaire dans la région des ovaires, de plus des sensations d'enflements désagréables, surtout dans la période des règles. souvent la douleur s'étend aux flancs et au dos, surtout au flanc gauche, et il se fait sentir un désir incessant d'uriner. a moins que cette affection ne soit arrêtée promptement rien ne pourra sauver la malade d'une opération. lydia e. pinkham's vegetable compound, cependant, a guéri les maladies d'ovaires de milliers de femmes et bien de femmes ont été assez heureuses, par conséquent, pour échapper à un long traitement à l'hôpital ainsi qu'à une opération des plus sérieuses. =la stérilité= est très souvent une conséquence directe d'une inflammation chronique de la matrice et d'une faiblesse extrême. l'emploi régulier de lydia e. pinkham's vegetable compound a souvent rétabli les fonctions normales de l'organe générateur, et a ainsi détruit cette idée fatale que la stérilité etait incurable. =la période climatérique ou changement de vie= est une période très importante et assez dangereuse pour toute femme qui a passé l'âge de ans. pendant cette période les femmes sont atteintes de toute espèce de maladies et de peines; l'emploi régulier de lydia e. pinkham's vegetable compound cependant va leur garantir une immunité parfaite contre tout accident dangereux qui pourrait leur survenir dans cette période. =les maladies des reins et de la vessie=, chez les deux sexes, sont très frequentes et très obstinées. aussi peuvent-elles devenir très dangereuses et même fatales, si l'on manque de s'en occuper dès l'apparence des premiers symptômes. lydia e. pinkham's vegetable compound, que nous conseillons d'employer le plus tôt possible, est la =médicine par excellence= qui dans tous les cas de maladies du foie et de la vessie produira un résultat simplement merveilleux chez l'homme et chez la femme, et qui ne manquera guère de sauver une vie trop souvent menacée fatalement. =le mal de dos=, quelque fréquent qu'il soit, n'est guère une maladie proprement dite, mais plutôt un symptôme de la plus haute importance, comme il indique par le centre dorsal du grand nerf sympathique, qu'il y a une affection des organes générateurs qu'on fera bien de ne point négliger. aussitôt que ces affections ou utérines, ou ovariennes ou rénales sont guéries par l'emploi de lydia pinkham's vegetable compound, ce mal de dos tourmentant va cesser tout seul. =dyspepsie et indigestion.=--rien au monde n'égale la force guérissante de notre remède pour toutes les maladies de l'estomac. =grossesse.=--une grande partie des douleurs et des souffrances qu'en général les femmes doivent endurer en accouchant pourraient être evitées, si elles se préparaient convenablement en fortifiant leur système par l'emploi de lydia e. pinkham's vegetable compound, à peu près deux mois avant l'accouchement. mode d'emploi. prenez une cuillerée de lydia e. pinkham's vegetable compound toutes les heures pendant la journée pour guérir chacune des maladies décrites ci-dessus. trempez le quart d'un paquet de lydia e. pinkham's sanative wash (lotion sanitaire) dans assez d'eau pour obtenir une pinte après la filtration; la secrétion étant très forte on doit employer la moitié de cette quantité à laquelle on ajoutera une pinte d'eau chaude. employez la lotion chaque jour en l'injectant dans le vagin. pour guérir la constipation, la migraine, les attaques bilieuses, prenez trois pilules la première nuit, deux la suivante et une la troisième et continuez jusqu'à ce que la boîte soit vide, à moins qu'il n'y ait pas une évacuation regulière plus tôt. quand le sang est appauvri et que le malade est toujours fatigué, bien amaigri et sans appétit, rien au monde ne lui fera autant de bien que le remède purificateur lydia e. pinkham's blood purifier. une cuillerée trois fois par jour guérira les rhumatismes, la scrofule et toutes sortes d'éruptions de la peau. vendu chez tous les pharmaciens. préparé par lydia e. pinkham medicine company, lynn, mass., e. u. lydia e. pinkham's kräutermittel, unter dem namen "vegetable compound" auf den markt gebracht, ist ein absolut zuverlässiges heilmittel für sämmtliche frauenkrankheiten, einschlieÃ�lich vorfall der gebärmutter, leukorrhoe, unregelmäÃ�ige und schmerzhafte menstruation, entzündung und geschwürbildung in der gebärmutter und den eierstöcken, ferner für alle sonstigen schwächezustände in den weiblichen geschlechtsorganen und für nierenkrankheiten bei beiden geschlechtern. das mittel ist aus den reinsten und erlesensten wurzeln und kräutern, wie sie mutter natur zur heilung aller frauenleiden selbst geschaffen hat, zusammengestellt. =menstruation.= eine übermäÃ�ig frühe menstruation ist keineswegs wünschenswerth; obwohl die monatsregel oder menstruation im allgemeinen in der zeit vom dreizehnten bis zum fünfzehnten jahre aufzutreten pflegt, wobei jedoch viel von der constitution des betreffenden mädchens abhängt. hat sie jedoch dieses alter erreicht, und sollte sich die menstruation noch nicht eingestellt haben, so muÃ� die mutter sich um die sache bekümmern. wahrscheinlich ist das junge mädchen mager und blaÃ�, wobei der teint ein besonders, gelbliches aussehen hat, so daÃ� es nur zu leicht ein opfer der auszehrung und allgemeiner nervenschwäche wird. für solche fälle ist lydia e. pinkham's vegetable compound geradezu unvergleichlich. es trägt vor allem dazu bei, daÃ� der wechsel im mädchenleben, der um diese zeit eintreten sollte, auch richtig stattfindet, und es verhindert somit jahrelanges leiden, das in der regel eine sichere folge einer vernachlässigung in diesem sinne bildet. lydia e. pinkham's vegetable compound sollte genau nach vorschrift eingenommen werden, bis die regeln regelmäÃ�ig sich alle tage einstellen. zeigt sich anlage zu verstopfung, so muÃ� man auch lydia e. pinkham's leberpillen brauchen, die speciell für den gebrauch von frauen zusammengestellt worden sind und in jeder beziehung harmonisch mit dem "compound" zusammenwirken. =ausbleiben der regeln.= mit diesem ausdruck bezeichnet man das nichterscheinen der menstruation, nachdem dieselbe einmal zu erscheinen angefangen hat. ein derartiges ausbleiben, sofern es nicht der schwangerschaft oder dem stillen zuzuschreiben ist, ist eine ernsthafte angelegenheit, und lydia e. pinkham's vegetable compound muÃ� eingenommen werden, bis die menstruation wieder regelmäÃ�ig eintritt. durch den gebrauch dieses mittels kann man zuverlässig alle unregelmäÃ�igkeiten beseitigen. =schmerzhafter monatsfluÃ�.= bei vielen frauen verursacht der monatsfluÃ� überaus groÃ�e schmerzen, und alle, die daran leiden, sollten ja nicht verfehlen, sich durch den gebrauch von lydia e. pinkham's vegetable compound von dieser wahrhaften geiÃ�el zu retten. dabei ist es gleichgültig, ob der fall ein akuter ist oder ob er schon viele monate gedauert hat. vorausgesetzt, daÃ� das vegetable compound regelmäÃ�ig und genau nach vorschrift genommen wird, darf man zuverlässig eine heilung erwarten. =zu starker monatsfluÃ�.= sowohl vollblütige als auch besonders bleichsüchtige und schwächliche personen leiden häufig unter zu starker menstruation. gerade mit bezug auf derartige zustände vermag lydia e. pinkham's vegetable compound auÃ�erordentlich günstige resultate aufzuweisen. doch empfehlen wir bei zu reichlich auftretender blutung lydia e. pinkham's vegetable compound in seiner trockenen form, d. h. in der form von pillen oder pastillen einzunehmen. beinahe alle frauenkrankheiten haben ihren ursprung in =entzündung und geschwürbildung in der gebärmutter=, und es ist daher nicht genug hervorzuheben, daÃ� lydia e. pinkham's vegetable compound schon mehr als eine million fälle von gebärmutteraffektionen glücklich geheilt hat. fast unglaublich klingen die berichte vieler frauen, die todtkrank waren, und die dem vegetable compound ihre rettung verdanken. es ist nicht schwer für eine frau zu erkennen, ob sie an einer affektion der gebärmutter leidet, da eine derartige erkrankung fast stets von ziehenden, äuÃ�erst empfindlichen schmerzen im unterleib, rückenschmerzen, ohnmachtsanfällen, erstarrung »einschlafen« der gliedmaÃ�en, sowie von einer reihe anderer schmerzen begleitet ist. lydia e. pinkham's vegetable compound ist ein unfehlbares mittel gegen alle derartigen erkrankungen. =die leukorrhoe oder der weiÃ�e fluÃ�.= eines der allerersten symptome, die eine entzündung der gebärmutter anzeigen, ist die leukorrhoe, oder wie man sich gewöhnlich ausdrückt: der weiÃ�e fluÃ�. derselbe zeigt sich als eine weiÃ�liche absonderung aus der vagina oder mutterscheide, die den körper auffallend angreift und schwächt und besonders die empfindliche schleimhaut des scheidekanals irritiert. aber selbst die hartnäckigsten fälle von weiÃ�em fluÃ� lassen sich positiv kurieren durch den gebrauch von lydia e. pinkham's vegetable compound in verbindung mit lydia e. pinkham's "sanative wash" oder »hygienischem waschwasser.« das erstere stärkt das system und das zweite heilt die lokalen erscheinungen, da es direct in die scheide eingespritzt wird. man hüte sich ja, diese art von krankheit zu vernachlässigen, da sich sonst leicht geschwüre und übermäÃ�ige absonderung einstellen können, die oftmals den ersten grund zu der schrecklichsten aller krankheiten -- dem krebs legen. =gebärmuttervorfall.= es giebt eine reihe von fällen, wo die gebärmutter eine veränderung ihrer normalen lage erleidet; von diesen ist der wichtigste der sogenannte gebärmuttervorfall. derselbe kommt hauptsächlich von einer erschlaffung der bänder her, die dieses organ stützen und in seiner richtigen lage erhalten sollen. lydia e. pinkham's vegetable compound stärkt diese bänder, vermindert die entzündung und verleiht nach und nach den erkrankten theilen ihren früheren, normalen zustand wieder. die =entzündung der eierstöcke= ist eine äuÃ�erst schwere erkrankung, die frauen im alter von bis jahren befällt. sie ist stets von groÃ�er empfindlichkeit und scharfen schmerzen in der gegend der eierstöcke begleitet, wozu sich ein gefühl der völle, besonders zur zeit der menstruation, gesellt. die schmerzen erstrecken sich auch häufig auf die seite und den rücken, mit vorliebe aber auf die linke seite, in verbindung mit fortwährendem verlangen das wasser abzuschlagen. wird nicht prompt gegen diese erkrankung eingeschritten, so vermag nichts den kranken vom messer des chirurgen zu retten. lydia e. pinkham's vegetable compound hat aber tausende von fällen von eierstockerkrankungen geheilt und hat viele frauen der nothwendigkeit enthoben, sich im hospital einer gefährlichen operation auszusetzen. =unfruchtbarkeit= ist oft weiter nichts als der folgezustand ausnehmender schwäche, sowie einer chronischen entzündung der gebärmutter. der regelmäÃ�ige gebrauch von lydia e. pinkham's vegetable compound hat schon in vielen fällen die weiblichen zeugungsorgane wiederum ihrer normalen thätigkeit zurückgegeben und eine anscheinend gänzliche unfruchtbarkeit glücklich gehoben. die sogenannten =wechseljahre= oder die =menopause= sind eine zeit wirklicher gefahr für alle diejenigen frauen, die das . jahr überschritten haben. während dieser zeit sind die frauen allen möglichen beschwerden und erkrankungen ausgesetzt, die sich aber alle vermeiden lassen, ohne ernstliche krankheit oder sogar den tod fürchten zu müssen, wenn man während dieser sehr wichtigen periode des frauenlebens regelmäÃ�ig lydia e. pinkham's vegetable compound einnimmt. =nieren- und blasenbeschwerden= sind häufige und hartnäckige leiden beider geschlechter. sie sind alle heilbar, vorausgesetzt, daÃ� man sich bei zeiten um sie kümmert; werden sie aber vernachlässigt, so können sie leicht verhängnisvoll werden und sogar den tod nach sich ziehen. sicher ist aber, daÃ� lydia e. pinkham's vegetable compound als ausgezeichnetes mittel zur heilung aller nieren- und blasenkrankheiten von keinem anderen bisher erfundenen mittel übertroffen wird. männer und frauen können volles vertrauen in dasselbe setzen. =rückenschmerzen= sind nicht eine krankheit, sondern sind vielmehr nur ein, gewisse krankheiten anzeigendes, symptom. bei krankheiten der geschlechtsorgane wird der groÃ�e sympathische nerv, dessen hauptcentrum im unteren theil des rückens liegt, in mitleidenschaft gezogen und verkündet sozusagen das vorhandensein einer derartigen krankheit. dadurch, daÃ� lydia e. pinkham's vegetable compound alle affektionen der gebärmutter, der eierstöcke und der nieren heilt, heilt es auch das so sehr peinigende rückenweh. =verdauungsbeschwerden.= es giebt in der ganzen welt kein besseres mittel gegen alle störungen der magenthätigkeit als gerade lydia e. pinkham's vegetable compound. =schwangerschaft.= oftmals ist die geburt eines kindes mit vielen schmerzen und beschwerden für die mutter verbunden, und doch könnten alle diese zum groÃ�en theil vermieden werden, wollte nur die mutter ungefähr zwei monate vor der entbindung anfangen, ihren körper durch den regelmäÃ�igen gebrauch von lydia e. pinkham's vegetable compound zu kräftigen. gebrauchsanweisung. für sämmtliche oben erwähnte beschwerden nehme man alle vier stunden während des tages je einen eÃ�löffel voll von lydia e. pinkham's vegetable compound ein. * * * * * man weiche ein viertel packet von lydia e. pinkham's sanative wash in genügend wasser, um nach dem durchseihen ein pint zu haben. ist die absonderung sehr bedeutend, so brauche man die hälfte der so erhaltenen flüssigkeit, füge noch ein pint warmen wassers dazu und benütze diese flüssigkeit, um täglich einspritzungen in die scheide zu machen. * * * * * gegen verstopfung, migräne, sowie gallendrang nehme man drei von lydia e. pinkham's leberpillen die erste nacht, zwei die zweite nacht und eine die dritte nacht; tritt auch dann noch kein regelmäÃ�iger stuhlgang ein, so nehme man eine pille jede nacht soweit der vorrath reicht. * * * * * befindet sich das blut in schlechtem zustande und ist der patient immer müde, abgemagert und angegriffen, und leidet er dazu noch an appetitmangel, so benütze er lydia e. pinkham's blood purifier (blut-reiniger), das beste mittel auf der welt für diesen zweck. dreimal im tage ein eÃ�löffel voll heilt zuverlässig alle fälle von rheumatismus, skropheln, hautausschläge, &c. &c. in allen apotheken zu haben. hergestellt von der lydia e. pinkham medicine company, =lynn, mass., v. s. von a.= read the following testimonials. dear mrs. pinkham: i wish all women suffering from female troubles might know what you have done for me. a year ago last june i was very sick, and on examination my physician said i had polypus of the womb and that i would not stop flowing until i had an operation. i always had a horror of operations and could not bear the thoughts of having one, as i am a nervous person. i wrote to you and followed all your directions faithfully, and all the while i prayed that i might not have to have one. at that time i could hardly walk across the floor and i was pale and thin. now i weigh one hundred and thirty-five pounds, do all my work, and my husband and children say that i am growing young. i am still taking your medicine and will do so until after the turn of life. mrs. nelson bavier, west hartford, conn. dear mrs. pinkham: i suffered for over three years with female weakness brought on by falling on an icy pavement. i had frequent backache and fearful headaches, blinding me with pain. i also had intense pains at the menstrual period. my family physician prescribed several remedies, but although he was considered an excellent physician, he was unable to relieve me. a cousin who visited me had a bottle of lydia e. pinkham's vegetable compound with her and spoke so highly of its efficacy that i took a few doses of it. i was pleased and surprised to find that it seemed to relieve my pains in twenty-four hours. i took it regularly, and within twenty-four hours more i felt like a different woman, and two weeks continued use of it restored me to health and strength such as i had not known in years. i consider lydia e. pinkham's vegetable compound the only medicine on the market which is reliable for the ills of the sex. miss maud bell, lanwee west, lansing, mich. grand recorder, daughters of american independence. september , . i would like to have your advice as i am a married woman and would be pleased to have children. i cannot tell what is the trouble, but i lose them and i am as careful as i can be. it happens just when i am on the fourth month. i have just had my third miscarriage and been flowing over two weeks and have much pain in back and womb. my menstruation is very painful and some months i have it twice. my stomach bothers me. i suffer with indigestion and dyspepsia. mrs. frank wilcox. august , . i will let you know that i have a son, and if it had not been for lydia e. pinkham's vegetable compound i would not have my baby. your medicine kept me well until the last minute. i did not know what an ache was. i used fourteen bottles of the compound and three boxes of your liver pills. i cannot thank your medicine too much as it has done me more good than the doctors. mrs. frank wilcox. orange st., bloomfield, n. j. june , . i have been a sufferer for seven years with womb trouble, ever since my child was born. my doctor says my ovaries are affected also and will have to be taken out. i suffer with pains in my back and left side and at times cannot rest day or night. i have leucorrhoea and menstruation is very irregular and very free with a good deal of pain. i was told to write you for advice. mrs. j. d. curtis. september , . i am still taking lydia e. pinkham's vegetable compound and have improved wonderfully, have gained ten pounds and feel like a new woman. i will recommend your medicine to all women suffering from female trouble for it has done me more good than the doctors have for three years. you are perfectly welcome to use my name and statement for the good of others for everyone ought to know of your wonderful medicine. mrs. j. d. curtis, box , monaca, pa. january , . i was reading to-day in a paper of the recovery of a lady after writing to you and as her case seemed to be very much the same as mine, i was impressed with the desire to write to you to see if i could not get relief. i am the mother of two children and have never had any weakness of any kind until the past year. i am pregnant at present, my back pains me nearly all the time and left side of abdomen. my back pains so sometimes i cannot stand on my feet or straighten up. my appetite is poor and my friends tell me i look badly. i hope that you will be able to give me some advice. mrs. d. d. eddy. june , . about one year and a half ago, i wrote you in regard to my taking your medicine. i was pregnant at the time and in perfect misery. i suffered everything. you very kindly wrote to me advising your lydia e. pinkham's vegetable compound which i began to take at once and when my baby was born, i was sick only half an hour and the sixth day i was upon my feet and felt as well and strong as i ever felt in my life. my baby is a strong healthy boy. i wish to thank you from the bottom of my heart for your kind letter to me. lydia e. pinkham's vegetable compound is the grandest medicine in the world for women. i shall recommend it as long as i live. mrs. d. d. eddy, east ave., saratoga springs, n.y. dear mrs. pinkham: i am very grateful for the good lydia pinkham's vegetable compound did for me. i began using it when i thought there was no help for me and that i would be an invalid for life. the doctor said that i would not get well unless i underwent an operation for ovarian and female difficulties. i was afraid that my health would not stand the strain and so when a friend who was similarly afflicted told me of the good lydia pinkham's vegetable compound did her, i immediately began to use it and i am glad that i did so, for in less than four months i could report as she did a perfect cure. words fail to express my thankfulness. very truly yours, margrite ryan, hotel english, indianapolis, ind. treasurer st. andrews society. dear mrs. pinkham: last spring my health seemed gradually to decline, until i finally felt so weak i thought i would have to give up entirely. i lost my appetite, had headaches, and bearing down pains with cramps so that i was in perfect misery. i became wakeful and extremely nervous. reading of the value of lydia e. pinkham's vegetable compound in our paper here, i decided to try it, and am pleased to state that i derived immediate benefit, and soon enjoyed permanent relief. within eight weeks i was restored to normal health, and felt refreshed and strengthened as though i had enjoyed a lengthy vacation. since that time i have recommended your compound to a number of my lady friends suffering with female irregularities, and those who have used it report great benefit from its use. mrs. e. e. van dinter, college ave., appleton, wis. vice-president social economic club. +lady on sofa with head obscured by pillows; child sitting on floor crying+ ~don't~ don't wait until your suffering have driven you to despair, with your nerves all shattered and your courage gone. help and happiness surely await you if you accept mrs. pinkham's advice. disease makes women nervous, irritable, and easily annoyed by children and household duties; such women need the counsel and help of a woman who understands the peculiar troubles of her sex; that woman is mrs. pinkham, who with that famous medicine, =lydia e. pinkham's vegetable compound=, has restored thousands upon thousands of sick and discouraged women to health and happiness. her address is lynn, mass., and her advice is free. write to-day, do not wait. =will not the volumes of letters from women who have been made strong by lydia e. pinkham's vegetable compound convince others of the virtues of this great medicine?= =when a medicine has been successful in more than a million cases, is it justice to yourself to say, without trying it, "i do not believe it would help me?"= =surely you cannot wish to remain weak and sick and discouraged, exhausted with each day's work. if you have some derangement of the feminine organism try lydia e. pinkham's vegetable compound. it will surely help you.= i am firmly persuaded after eight years experience with lydia e. pinkham's vegetable compound that it is the safest and best medicine for any suffering woman to use. immediately after my marriage i found that my health began to fail me. i became weak and pale with severe bearing down pains, fearful headaches and frequent dizzy spells. the doctors prescribed for me and yet i did not improve. i would at times bloat after eating and have frequent vomiting. i had acrid discharge and pains down through my limbs so i could hardly walk. it was as bad a case of female trouble as i have ever known. lydia e. pinkham's vegetable compound cured me within four months and since that time i have had occasion to recommend it to a number of patients suffering with all forms of female difficulties and i found that while it is considered unprofessional to recommend patent medicines, i could honestly recommend your vegetable compound for i have found it cures where other medicines fail. my mother and two sisters have used it also and their health has been restored and their strength renewed. it is a grand medicine for sick women. mrs. martha pohlman, chester ave., newark, n. j. graduate nurse from blockley training school at philadelphia and for - / years the chief clinic nurse at the philadelphia hospital. march , . lydia e. pinkham's vegetable compound has done me a great deal of good. when i first had my monthly period i suffered very much. i would have such headaches, also pain in abdomen and side. was not able to go to school. after taking several bottles of your medicine i was relieved of my trouble and i am now well and enjoying good health. miss mary e. rogers, kipton, ohio. october , . it gives me great pleasure to tell what your vegetable compound has done for me for the benefit of other suffering women. i would have been a total wreck and probably not living to-day had i not taken your medicine. my legs were so stiff and my back so sore that i could not be on my feet and at times i would have the sick headache so bad that i did not know what i was doing. i also had leucorrhoea all the time which caused me to feel very weak. i lost in flesh until i weighed only ninety-eight pounds. i was unable to carry babe to maturity. my first child being born in seven months. since taking your medicine i have had two little girls which are pictures of health and which i owe to lydia e. pinkham's vegetable compound. i have taken twelve bottles of the vegetable compound, used one box of liver pills which i found excellent to regulate the bowels. i am now in good health and weigh one hundred and twenty-five pounds. i cannot praise your medicine enough for the benefit i have derived from its use. what a blessing it is that women can consult with a lady and if every woman feels as i do, they would all consult you far and near. mrs. nelson f. spangler, center oak, pa. april , i will now write you a letter of gratitude for what your medicine has done for me. i suffered with very painful menstruation and could not become pregnant which was my great desire. i began the use of your medicine and after taking sixteen bottles i found myself pregnant. i continued the use of your vegetable compound and felt well all the time. last october my baby was born, it was a girl and weighed eleven and one-half pounds. it is my belief that i would never have had my baby if i had not used your medicine. i recommend lydia e. pinkham's vegetable compound to all, believing there is no better medicine for women. mrs. chas. rohde, vine street, peoria, ill. i have intended for some time to write to you and tell you what lydia e. pinkham's vegetable compound has done for me. i had been feeling weak and nervous, very easily tired and had much backache. i took two bottles of your compound and felt so much better that i enjoyed, instead of dreading my household duties. i can and do gladly recommend your medicines to anyone suffering from female troubles. mrs. m. e. shepler, amesbury place, cleveland, ohio. household cares +top right: lady sitting in chair with large broom in the backgroud; bottom left: lady standing with forefinger on cheek+ a sick woman's devotion to duty is a heroism which a well person cannot understand. how distressing to see a woman struggling with her daily round of household duties, when her back and head are aching, and every movement brings out a new pain. one day the poor woman is wretched and utterly miserable; in a day or two she is better, and laughs at her fears, thinking there is nothing much the matter after all; but before night the deadly backache reappears, the limbs tremble, the lips twitch--it seems as though all the imps of satan were clutching her vitals; she "goes to pieces" and is flat on her back. no woman ought to arrive at this terrible state of misery, because these symptoms are a sure forerunner of womb troubles. she must remember that =lydia e. pinkham's vegetable compound= is almost an infallible cure for all female ills, such as irregularity of periods, which cause weak stomach, sick headache, etc., displacements and inflammation of the womb, or any of the multitude of illnesses which beset the female organism. read how mrs. frake wrote to mrs. pinkham when she was in great trouble. her letter tells the result, and how a cure was effected by the use of lydia e. pinkham's vegetable compound. _read these letters from mrs. frake._ "dear mrs. pinkham:--i have read of your medicine making so many cures, and have been advised to write to you, but i feel that it is of no use. the doctor says that i have womb trouble, but he does not seem to help me a great deal. i have such a weakness across me most of the time--have backache, am very nervous, and am troubled with leucorrhoea. i am very weak, cannot walk any distance or stand long unless i ache all over. i would like to know it you think your medicine would do me any good."--mrs. samuel frake, prospect plains, n.j. "dear mrs. pinkham:--i cannot thank you enough for what =lydia e. pinkham's vegetable compound= has done for me. when i first wrote to you i had suffered for years. the doctor said i had congestion of the womb, was troubled with my kidneys and bladder, my back ached dreadfully all the time, and i suffered with bearing-down feeling, could scarcely walk about to do my own housework. i stopped doctoring with the physician and took your medicine, and am now able to do my own work, have no more backache or weakness across me, and can do all my own work. i cannot praise your medicine enough, and would advise all suffering women to try it."--mrs. samuel frake, prospect plains, n.j. the medicine that has restored a million women to health is lydia e. pinkham's vegetable compound. june , . my daughter sixteen years old, has been in very poor health ever since the change to womanhood a year ago. she had the best of doctors but they did her little good. she complained of feeling tired all the time, did not care for anything, pain in her back, very nervous, poor in flesh and so pale. it made her tired to ride or walk any distance, could not go to school. some thought she could not live long. through the use of lydia e. pinkham's vegetable compound she is now in the best of health. i feel that your medicine saved her life. mrs. anna hughes, altmar, n. y. december , . about a month ago i took a very bad cold and it was at time of menstruation and it stopped my menses. i began to have pains in my ovaries and at last i had inflammation of the ovaries and pain in my kidneys and bladder. i got over that but did not flow hardly any. the last time i came around i began to have that pain in my right ovary and it lasted a week and i have been flowing for a week. i would like some advice as i do not know what to think of my case. miss ruby mushrush. july , . about three months ago the doctor turned the x-ray on me to see what was the matter and found that i had an abscess near my ovary and in a place that if it had broken would have killed me right away. the doctor's medicine did me no good, so mama went to the store and got me a bottle of lydia e. pinkham's vegetable compound. i am now so well that i can work, thanks to your medicine. it has saved me from an operation. miss ruby mushrush, east chicago, ind. february , . as i have heard and read so much about your medicine, i have decided to write you and tell you my trouble and ask your advice. i am completely run down, am a widow, twenty-five years old, and have one boy five years old. i have never been strong since the birth of my child. menstruation is irregular and scanty and am always in such distress, pain in lower abdomen and limbs, pain and dizziness in head, cold hands and feet, poor appetite, sick headache, nervous, have leucorrhoea badly, bearing down pains in small of back, pain in both sides, also have catarrh of head and throat. i have had different doctors but they do not help me and i am discouraged. i will be glad to hear from you. would like to feel well once more. mrs. annie m. wahl. june , . i think it is my duty to let everyone know what lydia e. pinkham's vegetable compound has done for me. it has made me well and happy. five months ago i could hardly walk across the room, i was so full of pain. i could scarcely step. i now feel like a new woman. i sleep well and have a good appetite. i used to get such awful sick headache spells, but now i have them no more. also would be troubled with awful bearing down pain at time of menstruation but have also been relieved of this. i cannot praise your medicine enough. i think it is the best thing made for women. i advise, everyone who suffers with female trouble to try lydia e. pinkham's vegetable compound. mrs. annie m. wahl, bellwood, blair co., pa. october , . i think it is my duty to let you know the good that lydia e. pinkham's vegetable compound has done for me. i think it is the best medicine in the world. i was well until i weaned my baby and then i began to bloat and had bearing down pains. i took to filling up with water in my abdomen. i had the doctor and he said it was abdominal dropsy and that not having menstruation was the cause of it. he said i would have to be tapped. he tapped me once and took eleven quarts of water from me and in a week i began to fill up again and he was waiting to tap me again. i wrote to mrs. pinkham and began to take the vegetable compound and the water began to leave me. when i had taken two bottles it had all left me and menses appeared. i now feel as well as i ever did and am able to do all my work. i feel very thankful to you. mrs. hattie riley, waterford, ohio. backache ~miss pearl ackers.~ the ordinary every-day life of most of our women is a ceaseless treadmill of work. how much harder the daily tasks become when some derangement of the female organs makes every movement painful and keeps the nervous system all unstrung. one day she is wretched and utterly miserable; in a day or two she is better and laughs at her fears, thinking there is nothing much the matter after all; but before night the deadly backache reappears, the limbs tremble, the lips twitch--it seems as though all the imps of satan were clutching her vitals, she "goes to pieces" and is flat on her back. no woman ought to arrive at this terrible state of misery, because these symptoms are a sure indication of womb diseases, and backache is merely a symptom of more serious trouble. women should remember that an almost infallible cure for all female ills, such as irregularity of periods, which cause weak stomach, sick headache, etc., displacements and inflammation of the womb, or any of the multitudes of illnesses which beset the female organism may be found in lydia e. pinkham's vegetable compound =when a medicine has been successful in more than a million cases, why should you say, "i do not believe it will help me?" if you have some derangement of the feminine organism try lydia e. pinkham's vegetable compound. it will surely help you. if there is anything in your case about which you would like special advice, write freely to mrs. pinkham, lynn, mass.; her advice is given free and will greatly help you.= "dear mrs. pinkham:--about two years ago i consulted a physician about my health, which had become so wretched that i was no longer able to be about. i had severe backache, bearing-down pains, pains across the abdomen, was very nervous and irritable, and this trouble grew worse each month. "the physician prescribed for me, but i soon discovered he was unable to help me, and i then decided to try =lydia e. pinkham's vegetable compound=, and soon found that it was doing me good. my appetite was returning, the pains disappearing, and the general benefits were well marked. "you cannot realize how pleased i was, and after taking the medicine for only three months, i found i was completely cured of my trouble, and have been well and hearty ever since and no more fear of the monthly period, as it now passes without pain to me. yours very truly, miss pearl ackers, north summer st., nashville, tenn." march , . i now write to tell you what your medicine has done for me. after my first child was born, my womb came down so far that the doctor had to replace it and it was always weak and would never stay in place. a friend told me about lydia e. pinkham's vegetable compound. i got one bottle of it without any faith at all for i was so bad, i did not think it would do as much good as she said. well, i took seven bottles and now i am entirely well. i have used the vegetable compound right along when pregnant and found it a great help, child-birth being almost painless. i have had four children and have always been able to do my work even the washing until the child was born. it certainly is a wonderful medicine for pregnant women and i would not be without it at that time. mrs. george goodchild, port kennedy, pa. june , . i had falling of the womb and such an aching across my pelvis bone could hardly walk as the least jar hurt so. i was better before i had finished the second bottle and after taking six bottles was entirely cured. i can recommend lydia e. pinkham's vegetable compound to any one. mrs. rosa g. burton, brandywine st., phila., pa. august , . i take great pleasure in writing to thank you for what lydia e. pinkham's vegetable compound has done for me. i suffered for years with painful menstruation, pains in the back, leucorrhoea, dizziness and nervous prostration. since taking your medicine, i feel like a new woman. i never will be without your vegetable compound and will recommend it as long as i live. hoping my testimonial may be of benefit to others, i remain, yours truly, mrs. mary brady, dumaine st., nr. prieur, new orleans, la. july , i have been taking lydia e. pinkham's vegetable compound for the past eight months and it has done me a great deal of good. before taking it, i suffered with my head and pains in my back and when i had my changes i suffered agony, could hardly stand on my feet. i have taken twelve bottles of the compound and to-day i am a well woman. i weighed one hundred and twenty pounds before taking it and now i weigh one hundred and forty-five. i keep a laundry and recommend your medicine to my customers. augusta bliss, e. th st., new york, n. y. april , . i write this letter so that all suffering women may know what your wonderful medicine has done for me. before i began taking your medicine i was very weak and not able to do anything. i had had a miscarriage and a bad flooding spell and my husband had given up all hopes of my ever getting strong again. some of my friends told me to try lydia e. pinkham's vegetable compound. i was in bed at the time. after taking a few doses i began to feel better. i have taken now three bottles and am telling my friends what it has done for me. my husband would not have me do without the medicine. mrs. george perry, box , fort gibson, ind. ter. june , . when i wrote to you for advice a year and a half ago, i was confined to my bed and had just about given up hopes of ever being well again. i had heard so much about lydia e. pinkham's vegetable compound i told my husband i would like to try it. he got me a bottle and after taking two bottles i was able to get up and walk a little. my trouble was enlargement of the womb, also had ovarian trouble. i had spells of flooding nearly losing my life at monthly periods. altogether i was sick and discouraged. the pains and aches i suffered i cannot explain. i took seventeen bottles of your vegetable compound and was cured. in due time i gave birth to a nice baby girl. my baby is now six months old and so fat and healthy and i am so well, no more female trouble or pain in back. mrs. may m. morgareidge, mayoworth, wyo. fibroid tumors cured. a distressing case of fibroid tumor, which baffled the skill of boston doctors. mrs. hayes, of boston, mass., in the following letter tells how she was cured, after everything else failed, by =lydia e. pinkham's vegetable compound=. =mrs. hayes' first letter appealing to mrs. pinkham for help:= "dear mrs. pinkham--i have been under boston doctors' treatment for a long time without any relief. they tell me i have a fibroid tumor. i cannot sit down without great pain, and the soreness extends up my spine. i have bearing-down pains both back and front. my abdomen is swollen, and i have had flowing spells for three years. my appetite is not good. i cannot walk or be on my feet for any length of time. "the symptoms of fibroid tumor given in your little book accurately describe my case, so i write to you for advice."--(signed) mrs. e. f. hayes, ruggles st., (roxbury) boston, mass. =note the result of mrs. pinkham's advice--although she advised mrs. hayes, of boston, to take her medicine--which she knew would help her--her letter contained a mass of additional instructions as to treatment, all of which helped to bring about the happy result.= "dear mrs. pinkham--sometime ago i wrote to you describing my symptoms and asked your advice. you replied, and i followed all your directions carefully, and to-day i am a well woman. "the use of =lydia e. pinkham's vegetable compound= entirely expelled the tumor and strengthened my whole system. i can walk miles now. "=lydia e. pinkham's vegetable compound= is worth five dollars a drop. i advise all women who are afflicted with tumors or female trouble of any kind to give it a faithful trial."--(signed) mrs. e. f. hayes, ziegler st., (roxbury) boston, mass. =mountains of gold could not purchase such testimony--or take the place of the health and happiness which lydia e. pinkham's vegetable compound brought to mrs. hayes.= woman's kidney troubles. lydia e. pinkham's vegetable compound is especially successful in curing this fatal woman's disease. of all the diseases known with which the female organism is afflicted, kidney disease is the most fatal. in fact, unless early and correct treatment is applied, the weary patient seldom survives. being fully aware of this, mrs. pinkham, early in her career, gave exhaustive study to the subject, and in producing her great remedy for woman's ills--lydia e. pinkham's vegetable compound--was careful to see that it contained the correct combination of herbs which was sure to control that fatal disease, woman's kidney troubles. the vegetable compound acts in harmony with the laws that govern the entire female system, and while there are many so-called remedies for kidney troubles, lydia e. pinkham's vegetable compound is the only one especially prepared for women. the following letters will show how marvellously successful it is. oct. , . i have noticed your advertisement in the papers of your wonderful medicine, and i wish to consult you in regard to my sickness. i have been a sufferer of female weakness for the past six months; have doctored a great deal, but it has done me no good. i have _kidney_ and _bladder_ trouble, backache, constipation, headache, terrible pains in my left side, have leucorrhoea, painful menstruation, which compels me to take my bed for two and three days; also have falling of the womb. blood is very thin. i hope to hear from you soon. mrs. w. n. matthews, w. jefferson st., springfield, ill. april , . i am almost ashamed to acknowledge the receipt of your letter received last fall. after i had doctored for a year without receiving any relief, i then wrote you for advice in regard to my sickness and began the use of your medicine. i am happy to say that i never felt better in my life than i do now. i can eat hearty, sleep well, and feel like a new woman. many thanks for your kind and highly appreciated letter. i wish every suffering woman would try lydia e. pinkham's vegetable compound. mrs. w. n. matthews, w. jefferson st., springfield, ill. june , . it affords me great pleasure to give you my testimony in regard to the value of lydia e. pinkham's valuable remedies. i suffered for some time with internal trouble, being at times unable to walk across the floor. i had weakness of the bladder and was very nervous. after taking one bottle vegetable compound i felt better. i continued its use, and after taking five bottles could walk two miles without difficulty. my health is now good and i am sixty years old. i think your vegetable compound the best medicine i have ever taken. mrs. henry gittelman, n. th st., reading, pa. june , . i will write and let you know how much good lydia e. pinkham's vegetable compound has done me. i cannot express the terrible suffering i have had to endure. i was taken last may with nervous prostration; also had female trouble, liver, stomach, _kidney_ and _bladder_ trouble. i was in a terrible condition. the doctor attended me for a year, but i kept getting worse. i got so i was not able to do any work. was confined to my bed most of the time, and thought i would never be able to do anything. people thought i would not live. i decided to try your medicine. i have taken twelve bottles vegetable compound and cannot praise it too highly, for i know it will do all and even more than it is recommended to do. i tell every suffering woman about your medicine and urge them to try it. mrs. emma sawyer, conyers, ga. ~change of life~ a danger period through which every woman must pass. owing to modern methods of living, not one woman in a thousand approaches this perfectly natural change without experiencing a train of very annoying and sometimes painful symptoms. at this period a woman indicates a tendency towards obesity or tumorous growths. those dreadful hot flashes, sending the blood surging to the heart until it seems ready to burst, and the faint feeling that follows, sometimes with chills, as if the heart were going to stop forever, are only a few of the symptoms of a dangerous nervous trouble. the nerves are crying out for assistance. the cry should be heeded in time. =lydia e. pinkham's vegetable compound= was prepared to meet the needs of woman's system at this trying period of her life, and all women who use it pass through this trying period with comfort and safety. august , . my trouble was change of life and cramping. no human tongue can describe what i suffered with the cramp. i dreaded from one time to another so much that i almost wanted to die. our family physician did everything he could for me, but i got no relief. he said if i lived to get through with the other trouble it would wear away after a time, but i had it six years, and could not walk or exercise in any way without bringing on an attack of the cramp, and i would suffer untold misery until i would be perfectly exhausted and helpless. i read in one of your little books about lydia e. pinkham's vegetable compound being good for female trouble and change of life, and thought there was no harm in trying it. so i did, and it helped me, and i was able to take walks and work some. i am very thankful for the relief your medicine has been to me. mrs. v. m. blake, deep water, w. va. dear mrs. pinkham: i began to dread the approach of change of life some years ago, as so many of my friends had been miserable for five or six years during that period and as i was not very strong and being subject to headaches and weakness, i felt that i did not have the strength to carry me through this dangerous period and had it not been for lydia e. pinkham's vegetable compound, i feel that i would not have been alive to-day. i began to take it about three years ago when i felt the change coming on and continued taking it for three months, then i did not take any for a couple of months, and began to feel so badly that i started to use it again, and then continued to take it for about six months out of every year for three years and am pleased to state that it has kept me free from sickness. very truly yours, mrs. george shepherd, berlin, wis. vice-president mothers' club. june , . i thought i would write and state my condition to you and ask if you think you can do me any good. i am fifty-five years old, never had any children. i came here from brooklyn for my husband's health, he having consumption. i have always had good health, never any trouble with my menses, always regular until two or three months before my husband died, which was march , . as soon as he died, i commenced and flowed constantly ever since. i know it must be the change of life. i did not worry about it for four or five months, then i had a doctor but he did me no good. i had another with the same result. last may i had to go to new york and traveling i think was too much for me as i have been worse. i saw a doctor there and he wanted me to go to the hospital and have my womb curetted, but i did not feel like having that done. i never have any pain only once in a while a little backache. please let me know if you think you can do me any good. mrs. j. j. reardon. january , . i feel that i must write and thank you for the good you have done me. i wrote to you my case last summer. i flowed constantly for sixteen months so badly that i dared not go any where and the doctors all said an operation. nothing did me any good. as a last resort i appealed to you. i had no faith in your medicine, but thought i would try it and if it did me no good i would go to the hospital. i took two boxes of the lydia e. pinkham's compound pills and started on the third and now i am all right. i was run down, nervous, could not sleep, no appetite, but lydia e. pinkham's compound has cured me entirely. i am very grateful to you and wish that everyone afflicted as i was would try it. mrs. j. j. reardon, milford, pa. november , . lydia e. pinkham's vegetable compound did wonders for me during the _change of life_. i was troubled with backache and headache, hot flashes and cold chills, pains in my hips, and at times would have such pains under my shoulder blades that i could hardly move for a while. i hope that other suffering women will take your medicine. many thanks for what you have done for me. mrs. sarah derfer, dundee, ohio. +ladies in profile+ tired mothers =a nervous, irritable mother, often on the verge of hysterics, is unfit to care for children; it ruins a child's disposition and reacts upon herself. the trouble between children and= their mothers too often is due to the fact that the mother has some female weakness, and she is entirely unfit to bear the strain upon her nerves that governing a child involves; it is impossible for her to do anything calmly. she cannot help it, as her condition is due to suffering and shattered nerves caused by some derangement of the uterine system with backache, headache, and all kinds of pain, and she is on the verge of nervous prostration. when a mother finds that she cannot be calm and quiet with her children, she may be sure that her condition needs attention, and she cannot do better than to take lydia e. pinkham's vegetable compound it builds up her system, strengthens her nerves, and enables her to calmly handle a disobedient child without a scene. the children will soon realize the difference, and seeing their mother quiet, will themselves become quiet. _=read what the vice-pres. of the mothers' club, at hot springs, ark., says:=_ "dear mrs. pinkham--=lydia e. pinkham's vegetable compound= will make every mother well, strong, healthy and happy. i dragged through nine years of miserable existence, worn out with pain and weariness. i then noticed a statement of a woman troubled as i was, and the wonderful results she had obtained from your compound, and decided to try what it would do for me, and used it for three months. at the end of that time i was a different woman, and the neighbors remarked it, and my husband fell in love with me all over again. it seemed like a new existence. i had been suffering with inflammation and falling of the womb, but your medicine cured that, and built up my entire system, till i was indeed like a new woman."--sincerely yours, mrs. chas. f. brown, vice-pres. mothers' club, hot springs, ark. free medical advice to women. =from a vast experience in treating female ills, extending over years, mrs. pinkham has gained a knowledge which is of untold value.= =if there is anything in your case about which you would like special advice, write freely to mrs. pinkham. address is lynn, mass. her advice is free, always confidential and helpful.= lydia e. pinkham's vegetable compound +lady gazing upwards+ =has cured more women than any other medicine in the world.= its annual sales are greater than those of any other medicine exclusively for women. it holds the record for the greatest number of actual cures of woman's ills. this fact is attested by hundreds of thousands of letters from grateful women which are on file in the pinkham laboratory, and which are constantly being published. merit alone can produce such results. good advertising serves to call attention for a time, but merit alone can stand the test of time. the ablest specialists now agree that lydia e. pinkham's vegetable compound is the most universally successful remedy for woman's ills known to medicine. all sick women should note these facts, and placing all possible prejudices aside, should realize the truthfulness of these statements, and that a cure for their troubles actually exists. wise is the woman who has faith in lydia e. pinkham's vegetable compound, for health and happiness is sure to follow its use. =you can get helpful advice free.--if there is anything about your illness you do not understand, mrs. pinkham, at lynn, mass., will be glad to receive a letter from you telling her all the details. she will send you promptly a reply which may save you years of suffering and pain. she has helped thousands of women. for all this she will not charge you a cent; besides, she will keep your letter strictly confidential. write her to-day.= october , . i suffer something terrible with flooding every month and pass large clots of blood. the pains are excruciating. i can hardly stand them. the doctor says my ovaries are decayed and my womb needs to be scraped. i do not wish to go under the operation if i can possibly avoid it. i hope you can relieve me. mrs. mary dimmick. september , . after giving lydia e. pinkham's wonderful remedies a thorough trial, i am very anxious to send in my testimonial that others may learn of their great value. i have been a great sufferer for the last eight years, the trouble first originating from painful menstruation, and i also had inflammation and ulceration of the womb. the doctor told me i must have an operation or i could not live. i then wrote you telling all my ailments. i followed your advice very carefully and am now entirely well. i can walk miles without an ache or pain and can safely say i owe my life and health to lydia e. pinkham's vegetable compound. i cannot speak too highly of its merits. my friends all look at me in astonishment, for my case was very serious and it seems almost a miracle that i am cured. i wish suffering women could read this testimonial and realize the value of your remedy. i shall take much pleasure in recommending it to all. mrs. mary dimmick, th and e. capitol st., benning p. o., washington, d. c. july , . words cannot express the gratitude i feel towards you for what lydia e. pinkham's vegetable compound has done for me. my trouble was misplacement of the womb, also womb was lacerated, and had inflammation of the ovaries. i went away for treatment to a specialist on female diseases and passed through twelve operations. was gone from home eight weeks and gradually grew worse and returned home to die, having given up all hope of ever getting well. my heart would stop beating at times and i became very weak, could not sit up in bed. a friend of mine brought me a bottle of the vegetable compound and i began its use and by the time i had taken half a bottle i could see that i had improved. i used in all twelve bottles of the compound and am now able to do all my house work and enjoy better health than i have in six years. i owe my life to you, for i believe i would have been in my grave to-day had it not been for the vegetable compound. your medicine is a god-send to suffering women. mrs. j. a. jordan, canoe station, ga. march , . dear mrs. pinkham: i would like some advice from you as i have such very bad pains in ovaries, falling of the womb, and every time i have my monthlys i have the cramps very bad, and seem to be getting worse. i always have it a week and i am so very nervous. i don't want an operation. every time i become pregnant i carry the child only seven months, and then it is born and lives only a week or two. i have lost four children this way and hope you will tell me what to take as i know you have helped others. mrs. fred seydel. august , . dear mrs. pinkham: over a year ago i wrote you a letter asking for advice how to carry my babes to full time as i had lost four children between five and seven months. i took lydia e. pinkham's vegetable compound and did as you instructed me, and now i have a beautiful baby girl about six months old and we are both healthy. i advise all suffering women to call on you for help and i tell every one of the good you have done me. mrs. fred seydel, n. th st., west phila., pa. june , . last summer i had terrible pains in my back and head. i went to the doctor and he told me i had a touch of bright's disease and gave me some medicine but it did me no good. my mother advised me to take some of your medicine, and after taking eight bottles of lydia e. pinkham's vegetable compound i can say that i am feeling well. mrs. annie damback. grand street, rahway, n. j. +ladies with children+ dyspepsia of women =requires treatment which acts in harmony with the female system.= a great many women suffer with a form of indigestion or dyspepsia which does not seem to yield to ordinary medical treatment. while the symptoms seem to be similar to those of ordinary indigestion, yet the medicines universally prescribed do not seem to restore the patient's normal condition. =mrs. pinkham= claims that there is a kind of dyspepsia that is caused by derangement of the female organism, and which while it causes disturbance similar to ordinary indigestion cannot be relieved without a medicine which not only acts as a stomach tonic, but has peculiar utero-tonic effects as well; in other words, a derangement of the female organs may have such a disturbing effect upon a woman's whole system as to cause serious indigestion and dyspepsia, and it cannot be relieved without curing the original cause of the trouble, which seems to find its source in the pelvic organs. as proof of this theory, we call attention to the letter from mrs. maggie wright, who was completely cured by the use of lydia e. pinkham's vegetable compound. "my dear mrs. pinkham--for two years i suffered more or less with dyspepsia, which so degenerated my entire system that i was unfit to properly attend to my daily duties. i felt weak and nervous, and nothing i ate tasted good or felt comfortable in my stomach. i tried several dyspeptic cures, but nothing seemed to help me permanently. i decided to give =lydia e. pinkham's vegetable compound= a trial, and was happily surprised to find that it acted like a fine tonic, and in a few days i began to enjoy and properly digest my food. my recovery was rapid, and in five weeks i was a different woman. seven bottles completely cured me, and a dozen or more of my friends have used it since."--mrs. maggie wright, van voorhis st., brooklyn, new york. =many women were utterly discouraged, and life lacked all joy to them when they wrote mrs. pinkham, lynn, mass. they received advice which made them strong women again.= +lady sitting in chair with elbow on table and hand propped on chin+ the blues =don't wait until your sufferings have driven you to despair, with your nerves all shattered and your courage gone.= when a cheerful, brave, light-hearted woman is suddenly plunged into that perfection of misery, the blues, it is a sad picture. it is usually this way: she has been feeling "out of sorts" for some time; head has ached, and back also; has slept poorly, been quite nervous, and nearly fainted once or twice; head dizzy, and heart beats very fast; then that bearing-down feeling. her doctor says: "cheer up; you have dyspepsia; you will be all right soon." but she does not get "all right." she grows worse day by day, till all at once she realizes that a distressing female complaint is established. her doctor has made a mistake. she has lost faith in him; hope vanishes; then comes the brooding, morbid, melancholy, everlasting blues. =lydia e. pinkham's vegetable compound= instantly asserts its curative powers in all those peculiar ailments of women, and the story recited above is the true experience of hundreds of american women, whose letters of gratitude we constantly publish. =surely you cannot wish to remain weak, and sick and discouraged, exhausted with each day's work. if you have some derangement of the female organism try the remedy that has restored a million women to health=, lydia e. pinkham's vegetable compound. "dear mrs. pinkham--i cheerfully recommended =lydia e. pinkham's vegetable compound= to my suffering sisters as a perfect medicine for all female derangements. i was troubled with displacement of the womb and other female weakness. had headache, backache, and such bearing-down pains i could hardly walk across the floor, and was very nervous. a friend advised me to try your medicine, which i did, and after using the first bottle i began to improve. i took in all twelve bottles of vegetable compound, one box of liver pills, also used the sanative wash and was cured, and have no return of my troubles. i am as well now as i ever was. i am more thankful every day for my cure. i know that your medicine will do everything that it is recommended to do for suffering women."--mrs. dora anderson, north muskegon, mich. "dear mrs. pinkham--i want to tell you what your remedies have done for me. before taking them i used to have a continuous headache, would be very dizzy, would have spells when everything seemed strange, and i would not know where i was. i went to our local doctor. he gave me some medicine, but it did not seem to do me any good, but after taking =lydia e. pinkham's vegetable compound=, i began to improve at once. i can honestly recommend your remedies to all suffering women and advise all to give it a trial."--mrs. henry sell, van wyck, wash. free medical advice to women. =if there is anything in your case about which you would like special advice, write freely to mrs pinkham. she will hold your letter in strict confidence.= in the treatment of female troubles such as leucorrhoea, and all inflammation of the vaginal passage by local application, experience has proven that nothing excels lydia e. pinkham's sanative wash for vaginal injections. every woman will find this a most valuable assistant whenever a =vaginal injection= is desirable. it is soothing, cleansing and healing. in connection with the vegetable compound it hastens the cure. we are permitted to publish on this page several testimonials which demonstrate the virtue of the sanative wash, and should convince every woman that she should place complete reliance on any statement made by mrs. pinkham in regard to the virtue and reliability of any of these medicines. directions for using the sanative wash. steep one-fourth of the package in sufficent water to make one pint after it is strained. when the discharge is very profuse, use one-half of this, adding to it one pint of warm water, daily, as a vaginal injection. = cents per package. sold by druggists everywhere.= sanative wash. i feel that i neglect a duty in not writing you that others may know what your vegetable compound has done for me. before taking it i was almost an invalid, could not walk any distance and suffered pain all the time. after taking nine bottles i was very much better, and can now do my house work and ride a wheel. it would take too much space to tell you all of its merits but i must not forget to speak of the sanative wash for it simply acts like magic. trusting that this may help some other sufferer, i remain. yours truly, mrs. a. c. saxton, port jefferson, n. y. sanative wash. it affords me great pleasure to tell you of the benefit i have derived from taking your vegetable compound and sanative wash. i can hardly find words to express my gratitude to you for the boon which you have offered suffering women in your excellent remedies. before taking your compound i was thin, sallow and nervous. i was troubled with leucorrhoea, and my menstrual periods were very irregular. i tried three physicians and gradually grew worse. about a year ago i was advised by a friend to try your sanative wash and vegetable compound, which i did. after using your vegetable compound and sanative wash i am now enjoying better health than i ever did, and attribute the same to your wonderful remedies. i cannot find words to express what a godsend your remedies have been to me. whenever i begin to feel nervous and ill, i know i have a never failing physician at hand. it would afford me pleasure to know that my words have directed my suffering sisters to the road to health and strength through your most excellent remedies. i thank you again for what your remedies have done for me. miss mary sachner, e. town st., columbus, ohio. sanative wash. i am glad to state that through the use of your vegetable compound and sanative wash, etc., i am cured from the worst form of female weakness. i was troubled very much with leucorrhoea, bearingdown pains and backache. it seemed that i had no strength at all. i was in pain all over. i began to feel better after taking the first dose of vegetable compound, and am now like a new woman. i know if other suffering women would only try it, it would help them. mrs. george. w. shepard, box , boonville, n. y. lydia e. pinkham's blood purifier is far superior to any other known remedy for the cure of all diseases arising from impurities of the blood, such as scrofula, cancerous humor, erysipelas, rheumatism, canker, salt rheum and skin diseases. impure blood can be made rich and pure. there is no condition of the human system so uncertain or so deceptive as the condition of the blood. other disease makes itself known by aches or appearance, but the blood courses on with no sign of vitiation, carrying its poison to every nerve and fibre of the body. suddenly comes the awakening; pains that were never thought of before, ulcers or eruptions where never a pimple existed, make you ask in wonder, if not in agony, the cause. this effect may come in various ways, but the cause is always impure blood. this impurity or blood poisoning produces _rheumatism_, _debility_, _neuralgia_, _scrofula_, _mercurial or syphilitic ulcers_, _fistula_, _eruptions_, _consumption_, _scurvy_, _&c._ indigestion and biliousness. these two complaints are closely akin and generally exist together. _dyspepsia, or chronic indigestion_, is more prevalent in this country than anywhere else on the face of the earth, the chief reason being that we eat with intemperate haste, and consequently do not, as a rule, properly masticate our food. the work that should be done by the dental mill we remit to the stomach; and, as it cannot accomplish the task, the _food-grist_ is not properly ground up and applied, and the whole body--aye, every fibre and tissue of it--suffers. we need not here describe the pains and penalties of _dyspepsia_. they are within the personal experience of two-thirds of the adult population of the united states. _biliousness_ is a somewhat indefinite term, but it means, in its common acceptation, an _unnatural determination of bile to the channels of circulation_. the yellow tinge of the skin and of the white of the eyes in bilious cases is caused by the undue presence of bile in the superficial blood-vessels. a proper course of lydia e. pinkham's blood purifier, together with her celebrated liver pills, will purify the blood and drive off the bile, making you happy and pleasant, instead of grouty and disagreeable. lydia e. pinkham's blood purifier is as great a success as her celebrated vegetable compound, and may be used with great benefit in all diseases caused by impurities of the blood. do not class it with bitters of any kind. it is not a drink or an appetizer, but a _strictly medicinal preparation_. it is a powerful alterative, but a purely vegetable preparation, and may be taken without fear by any invalid. the dose is small and with good nutritious diet of any kind, avoiding highly seasoned or greasy food, you will be free from the tortures of rheumatism, clear of scrofulous sores or ulcers, and eradicate every taint, whether inherited or contracted. you will have a beautiful complexion and a soft, smooth skin, and rejoice in a healthy body and pure blood. =for sale by your druggist, $ . per bottle.= sept. , . i feel it my duty to send you a testimonial and tell you how much good lydia e. pinkham's vegetable compound and blood purifier has done my daughter. she feels like a different person. her menstruation was irregular; did not come around for two months. she took some medicine from the doctor which did not help her, and he thought she would have to take treatments. she took some of your vegetable compound and now her menses are regular again and she rests well nights, which she had not been able to do for about a year. her friends all wonder at her improved looks as well as health. i never fail to recommend your medicine when i know of any woman who has female troubles. mrs. magdalena schick, washington, ill. jan. , . i will tell you what your remedy has done for me. i was in a very bad condition with scrofula swellings around my neck. it started with a bunch on the side of my neck, and it kept growing until the whole side of my face was swollen. i had tried everything in the shape of patent medicines for five years. i had gone under an operation in one of the hospitals in boston and had them cut out. i had thirty little tubular glands taken from back of my ear down my shoulder. they looked like a bunch of grapes, and about the same size. after the cuts healed over they started to come again worse than before. after suffering so much i thought i would try lydia e. pinkham's blood purifier, and before i had taken two bottles there was a great change in the swellings. i continued its use and to-day i am a well woman. every word of this is true. i cannot speak too highly in praise of your blood purifier. mrs. w. h. haynes, adams ave., everett, mass. lydia e. pinkham's liver pills are especially adapted to the needs of the stomach and liver, the derangement of which they prevent and cure. they are purely vegetable and perfectly harmless. they do not purge, gripe or weaken, but are a gentle effective laxative which stimulates the natural action of the bowels. they are excellent in conjunction with the vegetable compound; especially in those cases when the complaints that are peculiar to women are attended with constipation and sluggishness of the liver. in such cases these pills enable the vegetable compound to do its work more speedily and effectively. the enormous sale of lydia e. pinkham's liver pills has been attained purely on their merit. during the last years, we have found nothing to excel them. one box contains more than three times the number of pills ordinarily sold for cents and we therefor justly claim superiority both in quantity and quality. january , . i write you these few lines to see if you can suggest some means to cure me. a little more than a year ago, i was sick with menstruation for the first time and since then i am sick all the time in some way or other. i have painful and irregular menstruation. i went to summer resorts for my health and was doctored all summer, but to no effect. i have not flowed for two months and thought i would see if you could do me any good. marion barber. may , . about two years ago i wrote to you for advice, being troubled with irregular menstruation and womb disease. i began taking lydia e. pinkham's vegetable compound and liver pills and using the sanative wash and i am glad to say i am completely cured and have not had any sickness since. i wish to thank you for your kind advice and shall recommend your medicine to my lady friends. marion barber, bracewell ave., north adams, mass. i am passing through the change of life, am suffering from extreme nervousness and depression of spirits, am very constipated and blood impoverished. i have heard so much about lydia e. pinkham's medicine i wish to give it a trial. please advise me. mrs. alice pickering, george street, providence, r. i. june , . six months ago i wrote to you stating my case. you advised me to take lydia e. pinkham's vegetable compound, blood purifier and liver pills. i followed your instructions. i never used anything in my life that benefited me so much. they are wonderful medicines. i cannot say enough in their praise. i know i should have been insane if i had not taken them. mrs. alice pickering, george street, providence, r. i. important when writing to mrs. pinkham for advice and counsel, it is highly important that you should answer the following questions: =is your menstruation regular?= =is your menstruation profuse?= =is your menstruation scanty?= =is your menstruation painful?= =are you married or single?= =if married, have you borne children?= =have you any discharge from the vagina other than the courses?= =have you a free movement of the bowels daily?= =are you constipated?= =is your blood in good condition?= write out plainly all symptoms you do not understand. be sure of the strictest confidence. mrs. pinkham never betrays a trust. you can rely on her help implicitly. address your letters to "mrs. pinkham, lynn, mass." a word of warning. no other medicine in the world has received such widespread and unqualified endorsement as has lydia e. pinkham's vegetable compound. no other medicine has such a record of cures of female troubles or such hosts of grateful friends. do not be persuaded that any other medicine is just as good. any dealer who asks you to buy something else when you go into his store purposely to buy lydia e. pinkham's vegetable compound, has no interest in your case. he is merely trying to sell you something on which he can make a larger profit. he does not care whether you get well or not, so long as he can make a little more money out of your sickness. if he wished you well he would, without hesitation, hand you the medicine you ask for, and which he knows is the best woman's medicine in the world. follow the record of this medicine, and remember that these thousands of cures of women whose letters are constantly printed in this paper were not brought about by "something else," but by =lydia e. pinkham's vegetable compound, the great woman's remedy for woman's ills=. those women who refuse to accept anything else are rewarded a hundred thousand times, for they get what they want--a cure. moral--stick to the medicine that you =know= is best. =when a medicine has been successful in restoring to health more than a million women, you cannot well say without trying it, "i do not believe it will help me." if you are ill, do not hesitate to get a bottle of lydia e. pinkham's vegetable compound at once, and write mrs. pinkham, lynn, mass, u. s. a., for special advice. it is free and helpful, and will cost you nothing.= this entire book copyrighted in and by the lydia e. pinkham medicine co., of lynn, mass., u. s. a. all rights reserved and will be protected by law. ~the home of lydia e. pinkham's remedies lynn, mass., u. s. a.~ transcriber's notes: passages in italics are indicated by _underscore_. passages in bold are indicated by =bold=. illustration captions are indicated by ~caption~. illustration descriptions added by the transcriber are indicated by +description+. the obstetrical table on page was split in half for this text file. misprints corrected: "grea" corrected to "great" (page ) "ryggväkr" corrected to "ryggvärk" (page ) missing "to" added (page ) (this file was produced from images produced by core historical literature in agriculture (chla), cornell university) transcriber's note: the spelling in this text has been preserved as in the original. obvious printer's errors have been corrected. a list of the corrections can be found at the end of this e-text. * * * * * cattle and their diseases embracing their history and breeds, crossing and breeding, and feeding and management; with the diseases to which they are subject, and the remedies best adapted to their cure. to which is added a list of the medicines used in treating cattle. by robert jennings, v. s., professor of pathology and operative surgery in the veterinary college of philadelphia; late professor of veterinary medicine in the agricultural college of ohio; secretary of the american veterinary association of philadelphia; author of "the horse and his diseases," etc., etc. [illustration: with numerous illustrations.] philadelphia: john e. potter and company, sansom street. entered according to act of congress, in the year , by john e. potter, in the clerk's office of the district court of the united states, in and for the eastern district of pennsylvania. preface. a marked interest has of late years been manifested in our country relative to the subject of breeding and rearing domestic cattle. this has not been confined to the dairyman alone. the greater portion of intelligent agriculturists have perceived the necessity of paying more attention than was formerly devoted to the improvement and perfection of breeds for the uses of the table as well. in this respect, european cattle-raisers have long taken the precedence of our own. the gratifying favor with which the author's former publication, "the horse and his diseases," has been received by the public, has induced him to believe that a work, similar in spirit and general treatment, upon cattle, would not be without interest for the agricultural community. in this belief, the present treatise has been prepared. the author has availed himself of the labors of others in this connection; never, however, adopting results and conclusions, no matter how strongly endorsed, which have been contradicted by his own observation and experience. in a field like the one in question, assuredly, if anywhere, some degree of independent judgment will not be censured by those who are familiar with the sad consequences resulting from the attempted application of theories now universally exploded, but which in the day and generation of their originators were sanctioned and advocated by those who claimed to be magnates in this department. to the following works, especially, the author acknowledges himself indebted: american farmer's encyclopædia; stephens's book of the farm; flint's milch-cows and dairy farming; laurence on cattle; allen's domestic animals; youatt and martin on cattle; thomson's food of animals; allen's rural architecture; colman's practical agriculture and rural economy; goodale's breeding of domestic animals; and prof. gamgee's valuable contributions to veterinary science. particular attention is requested to the division of "diseases." under this head, as in his former work, the author has endeavored to detail the symptoms of the most common ailments of cattle in such a manner that every farmer and cattle-owner can at once understand them, and also to suggest such procurable remedies as a wide experience has proved to be most efficacious. a generous space has been devoted to the consideration of that fatal epidemic, now generally known as "pleuro-pneumonia," as it has manifested itself in europe and this country, in the belief that a matter of such vital importance to the stock-raiser ought to receive a complete exposition in a work like the present. as the author's personal experience in connection with the treatment of this peculiar disease has been, perhaps, as large and varied as that of any american practitioner, he is not without the hope that his views upon the matter may prove productive of some benefit to others. should the present volume prove as acceptable to those interested as did his former work, the author will be abundantly satisfied that he has not mistaken in this instance the wants of the public. contents. history and breeds of cattle, the british ox, american cattle, the ayrshire, the jersey, the short-horns, the dutch, the hereford, the north-devon, native cattle, natural history of cattle, gestation, formation of teeth, points of a good cow, the milk-mirror, crossing and breeding, pregnancy, treatment before calving, feeding and management, soiling, culture of grasses for fodder, the barn, milking, raising of calves, points of fat cattle, driving and slaughtering, diseases and their remedies, abortion, apoplexy, black-water, bronchitis, consumption, coryza, cow-pox, diarrhoea, dysentery, enteritis, epizoötics, epizoötic catarrh, fardel, foul in the foot, garget, gastro-enteritis, hoose, hoove, hydatids, inflammation of the bladder, inflammation of the haw, inflammation of the kidneys, inflammation of the liver, laryngitis, lice, mange, murrain, navel-ill, obstructions in the oesophagus, open joints, parturition, free martins, cleansing, inversion of the uterus, phrenitis, pleurisy, pleuro-pneumonia, pneumonia, protrusion of the bladder, puerperal fever, quarter evil, rabies, red water, rheumatism, strangulation of the intestines, thrush in the mouth, tumors, ulcers about the joints, warbles, worms, worms in the bronchial tubes, surgical operations, castration, tracheotomy, spaying, list of medicines used in treating cattle, doses of various medicines, illustrations. page a prize bull, the well-fed beasts, an ayrshire bull, a short-horn bull, a north devon steer, draft oxen, skeleton of the ox, teeth at birth, teeth at second week, teeth at three weeks, teeth at a month, teeth at five to eight months, ten months teeth, twelve months teeth, fifteen months teeth, eighteen months teeth, teeth at two years past, teeth at three years past, teeth at four years past, teeth at five years past, teeth at ten years past, a good milch cow, milk-mirror (a), milk-mirror (b), milk-mirror (c), milk-mirror (d), milk-mirror (e), milk-mirror (f), milk-mirror (g), milk-mirror (h), milk-mirror (k), milk-mirror (l), cow and calf, ready for action, a sprightly youth, feeding, the family pets, buying cattle, calling in the cattle, "on the rampage", patiently waiting, a chance for a selection, a west highland ox, barn for thirty-four cows and three yoke of oxen, transverse section, room over the cow-room, the preferable method, maternal affection, frolicksome, points of cattle, a frontispiece, scotch mode of cutting up beef, english mode of cutting up beef, diseases and their remedies, a chat on the road, the mad bull, an aberdeenshire polled bull, taking an observation, the twins, a rural scene, taking it easily, home again, [illustration] history and breeds it is quite certain that the ox has been domesticated and in the service of man from a very remote period. we are informed in the fourth chapter of genesis, that cattle were kept by the early descendants of adam; jubal, the son of lamech--who was probably born during the lifetime of adam--being styled the father of such as have cattle. the ox having been preserved by noah from the flood of waters, the original breed of our present cattle must have been in the neighborhood of mount ararat. from thence, dispersing over the face of the globe--altering by climate, by food, and by cultivation--originated the various breeds of modern ages. that the value of the ox tribe has been in all ages and climates highly appreciated, we have ample evidence. the natives of egypt, india, and hindostan, seem alike to have placed the cow amongst their deities; and, judging by her usefulness to all classes, no animal could perhaps have been selected whose value to mankind is greater. the traditions, indeed, of every celtic nation enroll the cow among the earliest productions, and represent it as a kind of divinity. in nearly all parts of the earth cattle are employed for their labor, for their milk, and for food. in southern africa they are as much the associates of the caffre as the horse is of the arab. they share his toils, and assist him in tending his herds. they are even trained to battle, in which they become fierce and courageous. in central africa the proudest ebony beauties are to be seen upon the backs of cattle. in all ages they have drawn the plough. in spain they still trample out the corn; in india they raise the water from the deepest wells to irrigate the thirsty soil of bengal. when cæsar invaded britain they constituted the chief riches of its inhabitants; and they still form no inconsiderable item in the estimate of that country's riches. the parent race of the ox is said to have been much larger than any of the present varieties. the urus, in his wild state at least, was an enormous and fierce animal, and ancient legends have thrown around him an air of mystery. in almost every part of the continent of europe and in every district of england, skulls, evidently belonging to cattle, have been found, far exceeding in bulk any now known. as the various breeds of cattle among us were introduced into this country from great britain, we propose, before going into the details of the leading american breeds, to glance somewhat briefly at the history of the british ox. in the earliest and most reliable accounts which we possess of the british isles--the commentaries of cæsar--we learn that the ancient britons possessed great numbers of cattle. no satisfactory description of these cattle occurs in any ancient author; but, with occasional exceptions, we know that they possessed no great bulk or beauty. cæsar tells us that the britons neglected tillage and lived on milk and flesh; and this account of the early inhabitants of the british isle is corroborated by other authors. it was such an occupation and mode of life as suited their state of society. the island was divided into many little sovereignties; no fixed property was secure; and that alone was valuable which could be hurried away at the threatened approach of the invader. many centuries after this, when--although one sovereign seemed to reign paramount over the whole of the kingdom--there continued to be endless contests among the feudal barons, and therefore that property alone continued to be valuable which could be secured within the walls of the castle, or driven beyond the assailant's reach--an immense stock of provisions was always stored up in the various fortresses, both for the vassals and the cattle; or it was contrived that the latter should be driven to the domains of some friendly baron, or concealed in some inland recess. when the government became more powerful and settled, and property of every kind was assured a proportionate degree of protection, as well as more equally divided, the plough came into use; agricultural productions were oftener cultivated, the reaping of which was sure after the labor of sowing. cattle were then comparatively neglected and for some centuries injuriously so. their numbers diminished, and their size also seems to have diminished; and it is only within the last century and a half that any serious and successful efforts have been made materially to improve them. in the comparatively roving and uncertain life which the earlier inhabitants led, their cattle would sometimes stray and be lost. the country was at that time overgrown with forests, and the beasts betook themselves to the recesses of these woods, and became wild and sometimes ferocious. they, by degrees, grew so numerous as to be dangerous to the inhabitants of the neighboring districts. one of the chronicles asserts that many of them harbored in the forests in the neighborhood of london. strange stories are told of some of them, and, doubtless, when irritated, they were fierce and dangerous enough. as, however, civilization advanced, and the forests became thinned and contracted, these animals were seen more rarely, and at length almost disappeared. a few of them, however, are still to be found in the parks of some of the leading english noblemen, who keep them for ornament and as curiosities. the color of this wild breed is invariably white, the muzzle being black; the whole of the inside of the ear, and about one-third of the outside, from the tips downward, red; horns white, with black tips, very fine, and bent upward; some of the bulls have a thin, upright mane, about an inch and a half or two inches long. the beef is finely marbled and of excellent flavor. at the first appearance of any person they set off in full gallop, and at the distance of about two hundred yards, make a wheel around and come boldly up again in a menacing manner; on a sudden they make a full stop at the distance of forty or fifty yards, looking wildly at the object of their surprise; but upon the least motion they all again turn round and fly off with equal speed, but not to the same distance, forming a shorter circle; and, again returning with a more threatening aspect than before, they approach probably within thirty yards, when they again make another stand, and then fly off; this they do several times, shortening their distance and advancing nearer and nearer, till they come within such short distance that most persons think it prudent to leave them. when the cows calve, they hide their calves for a week or ten days in some retired situation, and go and suckle them two or three times a day. if any persons come near the calves they clap their heads close to the ground to hide themselves--a proof of their native wildness. the dams allow no one to touch their young without attacking with impetuous ferocity. when one of the herd happens to be wounded, or has grown weak and feeble through age or sickness, the rest set on it and gore it to death. the breeds of cattle which are now found in great britain, are almost as various as the soil of the different districts or the fancies of the breeders. they have, however, been very conveniently classed according to the comparative size of the horns; the _long-horns_, originally from lancashire, and established through most of the midland counties; the _short-horns_, generally cultivated in the northern counties and in lincolnshire, and many of them found in every part of the kingdom where the farmer pays much attention to his dairy, or where a large supply of milk is desired; and the _middle-horns_, a distinct and valuable breed, inhabiting, principally, the north of devon, the east of sussex, herefordshire, and gloucestershire; and of diminished bulk and with somewhat different character, the cattle of the scottish and welsh mountains. the alderney, with its _crumpled horn_, is found on the southern coast; while the polled, or _hornless_, cattle prevail in suffolk, norfolk, and galloway, whence they were first derived. these leading breeds, however, have been intermingled in every possible way. they are found pure only in their native districts, or on the estate of some wealthy and spirited individuals. each county has its own mongrel breed, often difficult to be described, and not always to be traced--neglected enough, yet suited to the soil and the climate; and among small farmers, maintaining their station, in spite of attempts at improvements by the intermixture or the substitution of foreign varieties. much dispute has arisen as to the original breed of british cattle. the battle has been sharply fought between the advocates of the middle and of the long-horns. the short-horns and the polls are out of the lists; the latter, although it has existed in certain districts from time immemorial, being probably an accidental variety. the weight of argument appears at present to rest with the middle horns; the long-horns being evidently of irish extraction. [illustration: the well-fed beasts.] great britain has shared the fate of other nations, and oftener than they been overrun and subjugated by invaders. as the natives retreated they carried with them some portion of their property, consisting, in the remote and early times, principally of cattle. they drove along with them as many as they could, when they retired to the fortresses of north devon and cornwall, or the mountainous region of wales, or when they took refuge in the retirement of east sussex; and there, retaining all their prejudices, manners, and customs, were jealous of the preservation of that which reminded them of their native country before it yielded to a foreign yoke. in this way was preserved the ancient breed of british cattle. difference of climate produced some change, particularly in their bulk. the rich pasturage of sussex fattened the ox into its superior size and weight. the plentiful, but not so luxuriant, herbage of the north of devon produced a smaller and more active animal; while the privations of wales lessened the bulk and thickened the hide of the welsh stock. as for scotland, it set its invaders at defiance; or its inhabitants retreated for a while, and soon turned again on their pursuers. they were proud of their country, and of their cattle, their choicest possession; and there, also, the cattle were preserved, unmixed and undegenerated. thence it has resulted, that in devon, in sussex, in wales, and in scotland, the cattle have been the same from time immemorial; while in all the eastern coasts and through every district of england, the breed of cattle degenerated, or lost its original character; it consisted of animals brought from all the neighboring, and some remote districts, mingled in every possible variety, yet conforming to the soil and the climate. careful observations will establish the fact, that the cattle in devonshire, sussex, wales, and scotland are essentially the same. they are middle horned; not extraordinary milkers, and remarkable for the quality rather than the quantity of their milk; active at work, and with an unequalled aptitude to fatten. they have all the characters of the same breed, changed by soil, climate, and time, yet little changed by man. the color, even, may be almost traced, namely: the red of the devon, the sussex, and the hereford; and where only the black are now found, the recollection of the red prevails. as this volume is intended especially for the farmers of our own country, it is deemed unnecessary in this connection to present any thing additional under the present head, except the names of the prominent species of british cattle. these are, commencing with the middle horns, the north devon, the hereford, the sussex, the welsh (with the varieties of the pembrokeshire, the glamorganshire, the radnor black, the anglesea and some others); and the scotch with its chief varieties, the west highlanders, the north highlanders, the north eastern, the fife, the ayrshire, and the galloways. as to the long horns, which came originally from craven in yorkshire, it may be remarked that this breed has been rapidly disappearing of late, and has everywhere given place to better kinds. of this species there are--or perhaps were--two leading classes, the lancashire and the leicestershire improved. of the short horns, the leading breeds are the dutch, the holderness, the teeswater, the yorkshire, the durham, the northumberland, and some others. american cattle. the breeds of cattle which stock the farms of the united states are all derived from europe, and, with few exceptions, from great britain. the highest breeds at the present time are of comparatively recent origin, since the great improvements in breeding were only commenced at about the period of the american revolution. the old importations made by the early settlers, must consequently have been from comparatively inferior grades. in some sections of the union, and more particularly in new england, the primitive stock is thought to have undergone considerable improvement; whilst in many parts of the middle, and especially of the southern states, a greater or less depreciation has ensued. the prevailing stock in the eastern states is believed to be derived from the north devons, most of the excellent marks and qualities of which they possess. for this reason they are very highly esteemed, and have been frequently called the american devon. the most valuable working oxen are chiefly of this breed, which also contributes so largely to the best displays of beef found in the markets of boston, new york, and philadelphia. by means of this domestic stock, and the importations still extensively made of selections from the short horns, and others of the finest european breeds, the cattle, not only of new england, but of other sections, are rapidly improving, especially in the middle and western states. a brief sketch of the principal breeds of american cattle, as well as of the grades or common stock of the country, will be of service to the farmer in making an intelligent selection with reference to the special object of pursuit--whether it be the dairy, the production of beef, or the raising of cattle for work. in selecting any breed, regard should be had to the circumstances of the individual farmer and the object to be pursued. the cow most profitable for the milk dairy, may be very unprofitable in the butter and cheese dairy, as well as for the production of beef; while, for either of the latter objects, the cow which gave the largest quantity of milk might be very undesirable. a union and harmony of all good qualities must be secured, so far as possible. the farmer wants a cow that will milk well for some years; and then, when dry, fatten readily and sell to the butcher for the highest price. these qualities, often supposed to be utterly incompatible, will be found united in some breeds to a greater extent than in others; while some peculiarities of form have been found, by observation, to be better adapted to the production of milk and beef than others. it is proposed, therefore, to sketch the pure breeds now found in america. the ayrshire. [illustration: an ayrshire bull.] this breed is justly celebrated throughout great britain and this country for its excellent dairy qualities. though the most recent in their origin, they are pretty distinct from the scotch and english races. in color, the pure ayrshires are generally red and white, spotted or mottled, not roan like many of the short horns, but often presenting a bright contrast of colors. they are sometimes, though rarely, nearly or quite all red, and sometimes black and white; but the favorite color is red and white brightly contrasted; and, by some, strawberry-color is preferred. the head is small, fine and clean; the face long and narrow at the muzzle, with a sprightly, yet generally mild expression; eye small, smart and lively; the horns short, fine, and slightly twisted upward, set wide apart at the roots; the neck thin; body enlarging from fore to hind quarters; the back straight and narrow, but broad across the loin; joints rather loose and open; ribs rather flat; hind quarters rather thin; bone fine; tail long, fine, and bushy at the end; hair generally thin and soft; udder light color and capacious, extending well forward under the belly; teats of the cow of medium size, generally set regularly and wide apart; milk-veins prominent and well developed. the carcass of the pure bred ayrshire is light, particularly the fore quarters, which is considered by good judges as an index of great milking qualities; but the pelvis is capacious and wide over the hips. on the whole, the ayrshire is good looking, but wants some of the symmetry and aptitude to fatten which characterize the short horn, which is supposed to have contributed to build up this valuable breed on the basis of the original stock of the county of ayr, which extends along the eastern shore of the firth of clyde, in the southwestern part of scotland. the original stock of this country are described as of a diminutive size, ill fed, ill shaped, and yielding but a scanty return in milk. they were mostly of a black color, with large stripes of white along the chine and ridge of their backs, about the flanks, and on their faces. their horns were high and crooked, having deep ringlets at the root--the surest proof that they were but scantily fed; the chine of their backs stood up high and narrow; their sides were lank, short, and thin; their hides thick and adhering to the bones; their pile was coarse and open; and few of them gave more than six or eight quarts of milk a day when in their best condition, or weighed, when fat, more than from a hundred to a hundred and sixty pounds avoirdupois, rejecting offal. a wonderful change has since been made in the condition, aspect, and qualities of the ayrshire dairy stock. they are now almost double the size, and yield about four times the quantity of milk that the ayrshire cows formerly yielded. a large part of this improvement is due to better feeding and care, but much, no doubt, to judicious crossing. strange as it may seem, considering the modern origin of this breed, all that is certainly known touching it is, that about a century and a half ago there was no such breed as ayrshire in scotland. the question has therefore arisen, whether these cattle came entirely from a careful selection of the best native breed. if they did, it is a circumstance without a parallel in the history of agriculture. the native breed may indeed be ameliorated by careful selection; its value may be incalculably increased; some good qualities, some of its best qualities, may be developed for the first time; but yet there will be some resemblance to the original stock, and the more the animal is examined, the more clearly can be traced the characteristic points of the ancestor, although every one of them is improved. youatt estimates the daily yield of an ayrshire cow, for the first two or three months after calving, at five gallons a day, on an average; for the next three months, at three gallons; and for the next four months, at one gallon and a half. this would give eight hundred and fifty gallons as the annual average; but, allowing for some unproductive cows, he estimates the average of a dairy at six hundred gallons a year for each cow. three gallons and a half of the ayrshire cow's milk will yield one and a half pounds of butter. some have estimated the yield still higher. one of the four cows originally imported into this country by john p. cushing, esq., of massachusetts, gave in one year three thousand eight hundred and sixty-four quarts, beer measure, or about nine hundred and sixty-six gallons, at ten pounds the gallon; being an average of over ten and a half beer quarts a day for the entire year. the first cow of this breed, imported by the massachusetts society, for the promotion of agriculture, in , yielded sixteen pounds of butter a week for several successive weeks, on grass feed only. it should be borne in mind, in this connection that the climate of new england is less favorable to the production of milk than that of england and scotland, and that no cow imported after arriving at maturity can be expected to yield as much, under the same circumstances, as one bred on the spot where the trial is made, and perfectly acclimated. on excellent authority, the most approved shape and marks of a good dairy cow are as follows: head small, long, and narrow toward the muzzle; horns small, clear, bent, and placed at considerable distance from each other; eyes not large, but brisk and lively; neck slender and long, tapering toward the head, with a little loose skin below; shoulders and fore quarters light and thin; hind quarters large and broad; back straight, and joints slack and open; carcass deep in the rib; tail small and long, reaching to the heels; legs small and short, with firm joints; udder square, but a little oblong, stretching forward, thin skinned and capacious, but not low hung; teats or paps small, pointing outward, and at a considerable distance from each other; milk-veins capacious and prominent; skin loose, thin, and soft like a glove; hair short, soft, and woolly; general figure, when in flesh, handsome and well proportioned. if this description of the ayrshire cow be correct, it will be seen that her head and neck are remarkably clean and fine, the latter swelling gradually toward the shoulders, both parts being unencumbered with superfluous flesh. the same general form extends backward, the fore quarters being, light the shoulders thin, and the carcass swelling out toward the hind quarters, so that when standing in front of her it has the form of a blunted wedge. such a structure indicates very fully developed digestive organs, which exert a powerful influence on all the functions of the body, and especially on the secretion of the milky glands, accompanied with milk-veins and udder partaking of the same character as the stomach and viscera, being large and capacious, while the external skin and interior walls of the milk-glands are thin and elastic, and all parts arranged in a manner especially adapted for the production of milk. a cow with these marks will generally be of a quiet and docile temper, which greatly increases her value. a cow that is of a quiet and contented disposition feeds at ease, is milked with ease, and yields more than one of an opposite temperament; while, after she is past her usefulness as a milker, she will easily take on fat, and make fine beef and a good quantity of tallow, because she feeds freely, and when dry the food which went to make milk is converted into fat and flesh. but there is no breed of cows with which gentle gentleness of treatment is so indispensable as with the ayrshire, on account of her naturally nervous temperament. if she receives other than kind and gentle treatment, she will often resent it with angry looks and gestures, and withhold her milk; and if such treatment is long continued, will dry up; but she willingly and easily yields it to the hand that fondles her, and all her looks and movements toward her friends are quiet and mild. the ayrshires in their native country are generally bred for the dairy, and for no other object; and the cows have justly obtained a world-wide reputation for this quality. the oxen are, however, very fair as working cattle, though they cannot be said to excel other breeds in this respect. the ayrshire steer maybe fed and turned at three years old; but for feeding purposes the ayrshires are greatly improved by a cross with the short horns, provided regard is had to the size of the animal. it is the opinion of good breeders that a high-bred short horn bull and a large-sized ayrshire cow will produce a calf which will come to maturity earlier, and attain greater weight, and sell for more money than a pure-bred ayrshire. this cross, with feeding from the start, may be sold fat at two or three years old, the improvement being most noticeable in the earlier maturity and size. in the cross with the short horn, the form ordinarily becomes more symmetrical, while there is, perhaps, little risk of lessening the milking qualities of the offspring, if sufficient regard is paid to the selection of the individual animals to breed from. it is thought by some that in the breeding of animals it is the male which gives the external form, or the bony and muscular system of the young, while the female imparts the respiratory organs, the circulation of the blood, the organs of secretion, and the like. if this principle be true, it follows that the milking qualities come chiefly from the mother, and that the bull cannot materially alter the conditions which determine the transmission of these qualities, especially when they are as strongly marked as they are in this breed. until, however, certain mooted questions connected with breeding are definitively settled, it is the safest plan, in breeding for the dairy, to adhere to the rule of selecting only animals whose progenitors on both sides have been distinguished for their milking qualities. it may be stated, in conclusion, that for purely dairy purposes the ayrshire cow deserves the first place. in consequence of her small, symmetrical, and compact body, combined with a well-formed chest and a capacious stomach, there is little waste, comparatively speaking, through the respiratory system; while at the same time there is very complete assimilation of the food, and thus she converts a very large proportion of her food into milk. so remarkable is this fact, that all dairy farmers who have any experience on the point, agree in stating that _an ayrshire cow generally gives a larger return of milk for the food consumed than a cow of any other breed_. the absolute quality may not be so great, but it is obtained at a less cost; and this is the point upon which the question of profit depends. the best milkers which have been known in this country were grade ayrshires, larger in size than the pure bloods, but still sufficiently high grades to give certain signs of their origin. this grade would seem to possess the advantage of combining, to some extent, the two qualities of milking and adaptation to beef; and this is no small recommendation of the stock to farmers situated as american farmers are, who wish for milk for some years and then to turn over to the butcher. the jersey. these cattle are now widely known in this country. many of them have been imported from an island of the same name in the british channel, near the coast of france, and they may now be considered, for all practical purposes, as fully acclimated. they were first introduced, upward of thirty years ago, from the channel islands, alderney, guernsey, and jersey. this race is supposed to have been originally derived from normandy, in the northern part of france. the cows have been long celebrated for the production of very rich milk and cream, but till within the last twenty-five or thirty years they were comparatively coarse, ugly, and ill-shaped. improvements have been very marked, but the form of the animal is still far from satisfying the eye. the head of the pure jersey is fine and tapering, the cheek small, the throat clean, the muzzle fine and encircled with a light stripe, the nostril high and open; the horns smooth, crumpled, but not very thick at the base, tapering and tipped with black; ears small and thin, deep orange color inside; eyes full and placid; neck straight and fine; chest broad and deep; barrel hoofed, broad and deep, well ribbed up; back straight from the withers to the hip, and from the top of the hip to the setting of the tail; tail fine, at right angles with the back, and hanging down to the hocks; skin thin, light color, and mellow, covered with fine soft hair; fore legs short, straight and fine below the knee, arm swelling and full above; hind quarters long and well filled; hind legs short and straight below the hocks, with bones rather fine, squarely placed, and not too close together; hoofs small; udder full in size, in line with the belly, extending well up behind; teats of medium size, squarely placed and wide apart, and milk-veins very prominent. the color is generally cream, dun, or yellow, with more or less of white, and the fine head and neck give the cows and heifers a fawn-like appearance, and make them objects of attraction in the park; but the hind quarters are often too narrow to work well, particularly to those who judge animals by the amount of fat which they carry. it should be borne in mind, however, that a good race of animals is not always the most beautiful, as that term is generally understood. beauty in stock has no invariable standard. in the estimation of some, it results mainly from fine forms, small bones, and close, compact frames; while others consider that structure the most perfect, and therefore the most beautiful, which is best adapted to the use for which it is destined. with such, beauty is relative. it is not the same in an animal designed for beef and in one designed for the dairy or for work. the beauty of a milch cow is the result of her good qualities. large milkers are very rarely cows that please the eye of any but a skillful judge. they are generally poor, since their food goes mainly to the production of milk, and because they are selected with less regard to form than to good milking qualities. the prevailing opinion as to the beauty of the jersey, is based on the general appearance of the cow when in milk--no experiments in feeding exclusively for beef having been made public, and no opportunity to form a correct judgment from actual observation having been furnished; and it must be confessed that the general appearance of the breed would amply justify the hasty conclusion. the bulls are usually very different in character and disposition from the cows, and are much inclined to become restive and cross at the age of two or three years, unless their treatment is uniformly gentle and firm. the jersey is to be regarded as a dairy breed, and that almost exclusively. it would not be sought for large dairies kept for the supply of milk to cities; for, though the quality would gratify the customer, the quantity would not satisfy the owner. the place of the jersey cow is rather in private establishments, where the supply of cream and butter is a sufficient object; or, in limited numbers, to add richness to the milk of large butter dairies. even one or two good jersey cows with a herd of fifteen or twenty, will make a great difference in the quality of the milk and butter of the whole establishment; and they would probably be profitable for this, if for no other object. the short horns. no breed of cattle has commanded more universal admiration during the last half century than the improved short horns, whose origin can be traced back for nearly a hundred years. according to the best authorities, the stock which formed the basis of improvement existed equally in yorkshire, lincolnshire, northumberland, and the adjoining counties; and the pre-eminence was accorded to durham, which gave its name to the race, from the more correct principles of breeding which seem to have obtained there. there is a dispute among the most eminent breeders as to how far it owes its origin to early importations from holland, whence many superior animals were brought for the purpose of improving the old long horned breed. a large race of cattle had existed for many years on the western shores of the continent of europe. as early as , they were imported from denmark into new england in considerable numbers, and thus laid the foundation of a valuable stock in farming at a very early date in holland, and experience led to the greatest care in the choice and breeding of dairy stock. from these cattle many selections were made to cross over to the counties of york and durham. the prevailing color of the large dutch cattle was black and white, beautifully contrasted. [illustration: a short horn bull.] the cattle produced by these crosses a century ago were known by the name of "dutch." the cows selected for crossing with the early imported dutch bulls were generally long horned, large boned, coarse animals, a fair type of which was found in the old "holderness" breed of yorkshire--slow feeders, strong in the shoulder, defective in the fore quarter, and not very profitable to the butcher, their meat being coarse and uninviting. their milking qualities were good, surpassing those, probably, of the improved short horns. whatever may be the truth with regard to these crosses, and however far they proved effective in creating or laying the foundation of the modern improved short horns, the results of the efforts made in yorkshire and some of the adjoining counties were never so satisfactory to the best judges as those of the breeders along the tees, who selected animals with greater reference to fineness of bone and symmetry of form, and the animals they bred soon took the lead and excited great emulation in improvement. importations of short horns have been frequent and extensive into the united states within the last few years, and this famous breed is now pretty generally diffused over the country. the high-bred short horn is easily prepared for a show, and, as fat will cover faults, the temptation is often too great to be resisted; and hence it is not uncommon to see the finest animals rendered unfit for breeding purposes by over-feeding. the race is susceptible of breeding for the production of milk, as several families show, and great milkers have often been known among pure-bred animals; but it is more common to find it bred mainly for the butcher, and kept accordingly. it is, however, a well-known fact, that the dairies of london are stocked chiefly with short horns and yorkshires, or high grades between them, which, after being milked as long as profitable, feed equal, or nearly so, to pure-bred short horns. it has been said, by very good authority, that the short horns improve every breed with which they cross. the desirable characteristics of the short horn bull may be summed up, according to the judgment of the best breeders, as follows: he should have a short but fine head, very broad across the eyes, tapering to the nose, with a nostril full and prominent; the nose itself should be of a rich flesh color; eyes bright and mild; ears somewhat large and thin; horns slightly covered and rather flat, well set on; a long, broad, muscular neck; chest wide, deep, and projecting; shoulders fine, oblique, well formed into the chine; fore legs short, with upper arm large and powerful; barrel round, deep, well-ribbed horns; hips wide and level; back straight from the withers to the setting on of the tail, but short from hips to chine; skin soft and velvety to the touch; moderately thick hair, plentiful, soft, and mossy. the cow has the same points in the main, but her head is finer, longer, and more tapering; neck thinner and lighter, and shoulders more narrow across the chine. the astonishing precocity of the short horns, their remarkable aptitude to fatten, the perfection of their forms, and the fineness of their bony structure, give them an advantage over most other races when the object of breeding is for the shambles. no animal of any other breed can so rapidly transform the stock of any section around him as the improved short horn bull. it does not, however, follow that the high-bred short horns are unexceptionable, even for beef. the very exaggeration, so to speak, of the qualities which make them so valuable for the improvement of other and less perfect races, may become a fault when wanted for the table. the very rapidity with which they increase in size is thought by some to prevent their meat from ripening up sufficiently before being hurried off to the butcher. the disproportion of the fatty to the muscular flesh, found in this to a greater extent than in races coming more slowly to maturity, makes the meat of the thorough-bred short horn, in the estimation of some, less agreeable to the taste, and less profitable to the consumer; since the nitrogenous compounds, true sources of nutriment, are found in less quantity than in the meat of animals not so highly bred. in sections where the climate is moist, and the food abundant and rich, some families of the short horns may be valuable for the dairy; but they are most frequently bred exclusively for beef in this country, and in sections where they have attained the highest perfection of form and beauty, so little is thought of their milking qualities that they are often not milked at all, the calf being allowed to run with the dam. the dutch. this short horned race, in the opinion of many--as has been previously remarked--contributed largely, about a century ago, to build up the durham or teeswater stock. it has been bred with special reference to dairy qualities, and is eminently adapted to supply the wants of the dairy farmer. the cows of north holland not only give a large quantity, but also a very good quality, so that a yield of sixteen to twenty-five quarts, wine measure, at every milking, is not rare. the principles upon which the inhabitants of holland practise, in selecting a cow from which to breed, are as follows: she should have, they say, considerable size--not less than four and a half or five feet girth, with a length of body corresponding; legs proportionally short; a finely formed head, with a forehead or face somewhat concave; clear, large, mild and sparkling eyes, yet with no expression of wildness; tolerably large and stout ears, standing out from the head; fine, well curved horns; a rather short, than long, thick, broad neck, well set against the chest and withers; the front part of the breast and shoulders must be broad and fleshy; the low-hanging dewlap must be soft to the touch; the back and loins must be properly projected, somewhat broad, the bones not too sharp, but well covered with flesh; the animal should have long curved ribs, which form a broad breast bone; the body must be round and deep, but not sunken into a hanging belly; the rump must not be uneven, the hip-bones should not stand out too broad and spreading, but all the parts should be level and well filled up; a fine tail, set moderately high up and tolerably long, but slender, with a thick, bushy tuft of hair at the end, hanging down below the hocks; the legs must be short and low, but strong in the bony structure; the knees broad, with flexible joints; the muscles and sinews must be firm and sound, the hoofs broad and flat, and the position of the legs natural, not too close and crowded; the hide, covered with fine glossy hair, must be soft and mellow to the touch, and set loose upon the body. a large, rather long, white and loose udder, extending well back, with four long teats, serves also as a characteristic mark of a good milch cow. large and prominent milk-veins must extend from the navel back to the udder; the belly of a good milch cow should not be too deep and hanging. the color of the north dutch cattle is mostly variegated. cows with only one color are no favorites. red or black variegated, gray and blue variegated, roan, spotted and white variegated cows, are especially liked. the hereford. these cattle derive their name from a county in the western part of england. their general characteristics are a white face, sometimes mottled; white throat, the white generally extending back on the neck, and sometimes, though rarely, still further along on the back. the color of the rest of the body is red, generally dark, but sometimes light. eighty years ago the best hereford cattle were mottled or roan all over; and some of the best herds, down to a comparatively recent period, were either all mottled, or had the mottled or speckled face. the expression of the face is mild and lively; the forehead open, broad, and large; the eyes bright and full of vivacity; the horns glossy, slender and spreading; the head small, though larger than, and not quite so clear as, that of the devons; the lower jaw fine; neck long and slender; chest deep; breast-bone large, prominent, and very muscular; the shoulder-blade light; shoulder full and soft; brisket and loins large; hips well developed, and on a level with the chine; hind quarters long and well filled in; buttocks on a level with the back, neither falling off nor raised above the hind quarters; tail slender, well set on; hair fine and soft; body round and full; carcass deep and well formed, or cylindrical; bone small; thigh short and well made; legs short and straight, and slender below the knee; as handlers very excellent, especially mellow to the touch on the back, the shoulder, and along the sides, the skin being soft, flexible, of medium thickness, rolling on the neck and the hips; hair bright; face almost bare, which is characteristic of pure herefords. they belong to the middle horned division of the cattle of great britain, to which they are indigenous, and have been improved within the last century by careful selections. hereford oxen are excellent animals, less active but stronger than the devons, and very free and docile. the demand for herefords for beef prevents their being much used for work in their native county, and the farmers there generally use horses instead of oxen. it is generally conceded that the qualities in which herefords stand pre-eminent among the middle-sized breeds are in the production of oxen and their superiority of flesh. on these points there is little chance of their being excelled. it should, however, be borne in mind that the best oxen are not produced from the largest cows; nor is a superior quality of flesh, such as is considered very soft to the touch, with thin skin. it is the union of these two qualities which often characterizes the short horns; but hereford breeders--as a recent writer remarks--should endeavor to maintain a higher standard of excellence--that for which the best of the breed have always been esteemed--a moderately thick, mellow hide, with a well apportioned combination of softness with elasticity. a sufficiency of hair is also desirable, and if accompanied with a disposition to curl moderately, it is more in esteem; but that which has a harsh and wiry feel is objectionable. in point of symmetry and beauty of form, the well bred herefords may be classed with the improved short horns, though they arrive somewhat more slowly at maturity, and never attain such weight. like the improved short horns, they are chiefly bred for beef, and their beef is of the best quality in the english markets, commanding the highest price of any, except perhaps, the west highlanders. the short horn produces more beef at the same age than the hereford, but consumes more food in proportion. the herefords are far less generally spread over england than the improved short horns. they have seldom been bred for milk, as some families of the latter have; and it is not very unusual to find pure-bred cows incapable of supplying milk sufficient to nourish their calves. they have been imported to this country to some extent, and several fine herds exist in different sections; the earliest importations being those of henry clay, of kentucky, in . the want of care and attention to the udder, soon after calving, especially if the cow be on luxuriant grass, often injures her milking properties exceedingly. the practice in the county of hereford has generally been to let the calves suckle from four to six months, and bull calves often run eight months with the cow. but their dairy qualities are perhaps as good as those of any cattle whose fattening properties have been so carefully developed; and, though it is probable that they could be bred for milk with proper care and attention, yet, as this change would be at the expense of other qualities equally valuable, it would evidently be wiser to resort to other stock for the dairy. the north devons. [illustration: a north devon steer.] this beautiful race of middle horned cattle dates further back than any well established breed among us. it goes generally under the simple name of devon; but the cattle of the southern part of the country, from which the race derives its name, differ somewhat from those of the northern, having a larger and coarser frame, and far less tendency to fatten though their dairy qualities are superior. the north devons are remarkable for hardihood, symmetry and beauty, and are generally bred for work and for beef, rather than for the dairy. the head is fine and well set on; the horns of medium length, generally curved; color usually bright blood-red, but sometimes inclining to yellow; skin thin and orange-yellow; hair of medium length, soft and silky, making the animals remarkable as handlers; muzzle of the nose white; eyes full and mild; ears yellowish, or orange-color inside, of moderate size; neck rather long, with little dewlap; shoulders oblique; legs small and straight, with feet in proportion; chest of good width; ribs round and expanded; loins of first-rate quality, long, wide, and fleshy; hips round, of medium width; rump level; tail full near the setting on, tapering to the tip; thighs of the bull and ox muscular and full, and high in the flank, though in the cow sometimes thought to be light; the size medium, generally called small. the proportion of meat on the valuable parts is greater, and the offal less, than on most other breeds, while it is well settled that they consume less food in its production. the devons are popular with the smithfield butchers, and their beef is well marbled or grained. as working oxen, the devons perhaps excel all other races in quickness, docility, beauty, and the ease with which they are matched. with a reasonable load, they are said to be equal to horses as walkers on the road, and when they are no longer wanted for work they fatten easily and turn well. as milkers, they do not excel--perhaps they may be said not to equal--the other breeds, and they have a reputation of being decidedly below the average. in their native country the general average of the dairy is one pound of butter a day during the summer. they are bred for beef and for work, and not for the dairy; and their yield of milk is small, though of a rich quality. several animals, however, of the celebrated patterson herd would have been remarkable as milkers even among good milking stock. still, the faults of the north devon cow, considered as a dairy animal, are too marked to be overlooked. the rotundity of form and compactness of frame, though they contribute to her remarkable beauty constitute an objection to her for this purpose: since it is generally admitted that the peculiarity of form which disposes an animal to take on fat is somewhat incompatible with good milking qualities. on this account, youatt--who is standard authority in such matters--says that for the dairy the north devon must be acknowledged to be inferior to several other breeds. the milk is good, and yields more than the average proportion of cream and butter; but it is deficient in quantity. he also maintains that its property as a milker could not be improved without producing a certain detriment to its grazing qualities. distinguished devon breeders themselves have come to the same conclusion upon this point. the improved north devon cow may be classed, in this respect, with the hereford, neither of which has well developed milk-vessels--a point of the utmost consequence to the practical dairyman. native cattle. the foregoing comprise the pure-bred races in america; for, though other and well-established breeds--like the galloways, the long horns, the spanish, and others--have, at times, been imported, and have had some influence on our american stock, yet they have not been kept distinct to such an extent as to become the prevailing stock of any particular section. a large proportion, however--by far the largest proportion, indeed--of the cattle known among us cannot be included under any of the races to which allusion has been made; and to the consideration of this class the present article is devoted. the term "breed"--as was set forth in the author's treatise, "the horse and his diseases"--when properly understood, applies only to animals of the same species, possessing, besides the general characteristics of that species, other characteristics peculiar to themselves, which they owe to the influence of soil, climate, nourishment, and the habits of life to which they are subjected, and which they transmit with certainty to their progeny. the characteristics of certain breeds or families are so well marked, that, if an individual supposed to belong to any one of them were to produce an offspring not possessing them, or possessing them only in part, with others not belonging to the breed, it would be just ground for suspecting a want of purity of bloods. in this view, no grade animals, and no animals destitute of fixed peculiarities or characteristics which they, share in common with all other animals of the class of which they are a type, and which they are capable of transmitting with certainty to their descendants, can be recognized by breeders as belonging to any one distinct race, breed, or family. the term "native" is applied to a vast majority of our american cattle, which, though born on the soil, and thus in one sense natives, do not constitute a breed, race, or family, as correctly understood by breeders. they do not possess characteristics peculiar to them all, which they transmit with any certainty to their offspring, either of form, size, color, milking or working properties. but, though an animal may be made up of a mixture of blood almost to impurity, it does not follow that, for specific purposes, it may not, as an individual animal, be one of the best of the species. indeed, for particular purposes, animals might be selected from among those commonly called "natives" in new england, and "scrubs" at the west and south, equal, and perhaps superior, to any among the races produced by the most skillful breeding. there can be no objection, therefore, to the use of the term "native," when it is understood as descriptive of no known breed, but only as applied to the common stock of a country, which does not constitute a breed. but perhaps the entire class of animals commonly called "natives" would be more accurately described as grades; since they are well known to have sprung from a great variety of cattle procured at different times and in different places on the continent of europe, in england, and in the spanish west indies, brought together without any regard to fixed principles of breeding, but only from individual convenience, and by accident. the first importations to this country were doubtless those taken to virginia previous to , though the exact date of their arrival is not known. several cows were carried there from the west indies in , and in the next year no less than one hundred arrived there from abroad. [illustration: draft oxen.] the earliest cattle imported into new england arrived in . at the division of cattle which took place three years after, one or two are distinctly described as black, or black and white, others as brindle, showing that there was no uniformity of color. soon after this, a large number of cattle were brought over from england for the settlers at salem. these importations formed the original stock of massachusetts. in , the first importation was made into new york from holland by the dutch west india company, and the foundation was then laid for an exceedingly valuable race of animals, which, subsequent importations from the same country, as well as from england, have greatly improved. the points and value of this race in its purity have been already adverted to under the head of the dutch cattle. in , cattle were brought from sweden to the settlements on the delaware, by the swedish west india company. in , , and , several importations were made into new hampshire by captain john mason who, with gorges, had procured the patent of large tracts of land in the vicinity of the piscataqua river, and who immediately formed settlements there. the object of mason was to carry on the manufacture of potash. for this purpose he employed the danes; and it was in his voyage to and from denmark that he procured many danish cattle and horses, which were subsequently scattered over that entire region, large numbers being driven to the vicinity of boston and sold. these danish cattle are described as large and coarse, of a yellow color; and it is supposed that they were procured by mason as being best capable of enduring the severity of the climate and the hardships to which they would be subjected. however this may have been, they very soon spread among the colonists of the massachusetts bay, and have undoubtedly left their marks on the stock of the new england and the middle states, which exist to some extent even to the present day, mixed in with an infinite multitude of crosses with the devons, the dutch cattle already alluded to, the black cattle of spain and wales, and the long horn and the short horn--most of which crosses were accidental, or due to local circumstances or individual convenience. many of these cattle, the descendants of such crosses, are of a very high order of merit; but to which particular cross this is due, it is impossible to say. they generally make hardy, strong, and docile oxen, easily broken to the yoke and quick to work, with a fair tendency to fatten when well fed; while the cows, though often ill-shaped, are sometimes remarkably good milkers, especially as regards the quantity which they give. indeed, it has been remarked by excellent judges of stock, that if they desired to select a dairy of cows for milk for sale, they would make their selection from cows commonly called native, in preference to pure-bred animals of any of the established breeds, and that they believed they should find such a dairy the most profitable. in color, the natives, made up as already indicated, are exceedingly various. the old denmarks, which to a considerable extent laid the foundation of the stock of maine and new hampshire, were light yellow. the dutch of new york and the middle states, were black and white; the spanish and welsh were generally black; the devons, which are supposed to have laid the foundation of the stock of some of the states, were red. crosses of the denmark with the spanish and welsh naturally made a dark brindle; crosses of the devon often made a lighter or yellowish brindle while the more recent importations of jerseys and short horns have generally produced a beautiful spotted progeny. the deep red has long been a favorite color in new england; but the prejudice in its favor is fast giving way to more variegated colors. among the earlier importations into this country were also several varieties of hornless cattle, which have been kept measurably distinct in some sections; or where they have been crossed with the common stock there has been a tendency to produce hornless grades. these are not unfrequently known as "buffalo cattle." they were, in many cases, supposed to belong to the galloway breed; or, which is more likely, to the suffolk dun, a variety of the galloway, and a far better milking stock than the galloways, from which, it sprung. these polled, or hornless cattle vary in color and qualities, but they are usually very good milkers when well kept, and many of them fatten well, and attain good weight. the hungarian cattle have also been imported, to some extent, into different parts of the country, and have been crossed upon the natives with some success. many other strains of blood from different breeds have also contributed to build up the common stock of the country of the present day; and there can be no question that its appearance and value have been largely improved during the last quarter of a century, nor that improvements are still in progress which will lead to satisfactory results in the future. but, though we already have an exceedingly valuable foundation for improvement, no one will pretend to deny that our cattle, as a whole, are susceptible of it in many respects. they possess neither the size, the symmetry, nor the early maturity of the short horns; they do not, as a general thing, possess the fineness of bone, the beauty of form and color, nor the activity of the devons or the herefords; they do not possess that uniform richness of milk, united with generous quality, of the ayrshires, nor the surpassing richness of milk of the jerseys: but, above all, they do not possess the power of transmitting the many good qualities which they often have to their offspring--which is the characteristic of all well established breeds. it is equally certain, in the opinion of many good judges, that the dairy stock of the country has not been materially improved in its intrinsic good qualities during the last thirty or forty years. this may not be true of certain sections, where the dairy has been made a special object of pursuit, and where the custom of raising the best male calves of the neighborhood, or those that came from the best dairy cows, and then of using only the best formed bulls, has long prevailed. although in this way some progress has, doubtless, been made, there are still room and need for more. more attention must be paid to correct principles of breeding before the satisfactory results which every farmer should strive to reach can be attained. having glanced generally at the leading breeds of cattle in great britain, and examined, more in detail, the various breeds in the united states, the next subject demanding attention is, the natural history of cattle. [illustration: skeleton of the ox as covered by the muscles. . the upper jaw-bone. . the nasal bone, or bone of the nose. . the lachrymal bone. . the malar, or cheek bone. . the frontal bone, or bone of the forehead. . the horns, being processes or continuations of the frontal. . the temporal bone. . the parietal bone, low in the temporal fossa. . the occipital bone, deeply depressed below the crest or ridge of the head. . the lower jaw. . the grinders. . the nippers, found on the lower jaw alone. . the ligament of the neck, and its attachments. . the atlas. . the dentata. . the orbits of the eye. . the vertebræ, or bones of the neck. . the bones of the back. . the bones of the loins. . the sacrum. . the bones of the tail. . the haunch and pelvis. . the eight true ribs. . the false ribs, with their cartilages. . the sternum. . the scapula, or shoulder-blade. . the humerus, or lower bone of the shoulder. . the radius, or principal bone of the arm. . the ulna, its upper part forming the elbow. . the small bones of the knee. . the large metacarpal or shank bone. . the smaller or splint bone. . the sessamoid bones. . the bifurcation at the pasterns, and the two larger pasterns to each foot. . the two smaller pasterns to each foot. . the two coffin bones to each foot. . the navicular bones. . the thigh bone. . the patella, or bone of the knee. . the tibia, or proper leg bone. . the point of the hock. . the small bones of the hock. . the metatarsals, or larger bones of the hind leg. . the pasterns and feet.] division. _vertebrata_--possessing a back-bone. class. _mammalia_--such as give suck. order. _ruminantia_--chewing the cud. family. with horns. genus. _bovidæ_--the ox tribe. of this tribe there are eight species: _bos urus_, the ancient bison. _bos bison_, the american buffalo. _bos moschatus_, the musk ox. _bos frontalis_, the gayal. _bos grunniens_, the grunting ox. _bos caffer_, the south african buffalo. _bos bubalus_, the common buffalo. _bos taurus_, the common domestic ox. gestation. the usual period of pregnancy in a cow is nine calendar months, and something over: at times as much as three weeks. with one thousand and thirty one cows, whose gestations were carefully observed in france, the average period was about two hundred and eighty-five days. formation of teeth. it is of the utmost importance to be able to judge of the age of a cow. few farmers wish to purchase a cow for the dairy after she has passed her prime, which will ordinarily be at the age of nine or ten years, varying, of course, according to care, feeding, &c., in the earlier part of her life. the common method of forming an estimate of the age of cattle is by an examination of the horn. at three years old, as a general rule, the horns are perfectly smooth; after this, a ring appears near the nob, and annually afterward a new one is formed, so that, by adding two years to the first ring, the age is calculated. this is a very uncertain mode of judging. the rings are distinct only in the cow; and it is well known that if a heifer goes to bull when she is two years old, or a little before or after that time, a change takes place in the horn and the first ring appears; so that a real three-year-old would carry the mark of a four-year-old. [illustration: teeth at birth.] the rings on the horns of a bull are either not seen until five, or they cannot be traced at all; while in the ox they do not appear till he is five years old, and then are often very indistinct. in addition to this, it is by no means an uncommon practice to file the horns, so as to make them smooth, and to give the animal the appearance of being much younger than it really is. this is, therefore, an exceedingly fallacious guide, and cannot be relied upon by any one with the degree of confidence desired. [illustration: second week.] the surest indication of the age in cattle, as in the horse, is given by the teeth. the calf, at birth, will usually have two incisor or front teeth--in some cases just appearing through the gums; in others, fully set, varying as the cow falls short of, or exceeds, her regular time of calving. if she overruns several days, the teeth will have set and attained considerable size, as appears in the cut representing teeth at birth. during the second week, a tooth will usually be added on each side, and the mouth will generally appear as in the next cut; and before the end of the third week, the animal will generally have six incisor teeth, as denoted in the cut representing teeth at the third week; and in a week from that time the full number of incisors will have appeared, as seen in the next cut. [illustration: three weeks.] [illustration: month.] [illustration: five to eight months.] [illustration: ten months.] [illustration: twelve months.] [illustration: fifteen months.] these teeth are temporary, and are often called milk-teeth. their edge is very sharp; and as the animal begins to live upon more solid food, this edge becomes worn, showing the bony part of the tooth beneath, and indicates with considerable precision the length of time they have been used. the centre, or oldest teeth show the marks of age first, and often become somewhat worn before the corner teeth appear. at eight weeks, the four inner teeth are nearly as sharp as before. they appear worn not so much on the outer edge or line of the tooth, as inside this line; but, after this, the edge begins gradually to lose its sharpness, and to present a more flattened surface; while the next outer teeth wear down like the four central ones; and at three months this wearing off is very apparent, till at four months all the incisor teeth appear worn, but the inner ones the most. now the teeth begin slowly to diminish in size by a kind of contraction, as well as wearing down, and the distance apart becomes more and more apparent. [illustration: eighteen months.] from the fifth to the eighth month, the inner teeth will usually appear as in the cut of the teeth at that time; and at ten months, this change shows more clearly, as represented in the next cut; and the spaces between them begin to show very plainly, till at a year old they ordinarily present the appearance of the following cut; and at the age of fifteen months, that shown in the next, where the corner teeth are not more than half the original size, and the centre ones still smaller. [illustration: two years past.] the permanent teeth are now rapidly growing, and preparing to take the place of the milk-teeth, which are gradually absorbed till they disappear, or are pushed out to give place to the two permanent central incisors, which at a year and a half will generally present the appearance indicated in the cut, which shows the internal structure of the lower jaw at this time, with the cells of the teeth, the two central ones protruding into the mouth, the next two pushing up, but not quite grown to the surface, with the third pair just perceptible. these changes require time; and at two years past the jaw will usually appear as in the cut, where four of the permanent central incisors are seen. after this, the other milk-teeth decrease rapidly, but are slow to disappear; and at three years old, the third pair of permanent teeth are but formed, as represented in the cut; and at four years the last pair of incisors will be up, as in the cut of that age; but the outside ones are not yet fully grown, and the beast can hardly be said to be full-mouthed till the age of five years. but before this age, or at the age of four years, the two inner pairs of permanent teeth are beginning to wear at the edges, as shown in the cut; while at five years old the whole set becomes somewhat worn down at the top, and on the two centre ones a darker line appears in the middle, along a line of harder bone, as appears in the appropriate cut. [illustration: three years past.] [illustration: four years past.] [illustration: five years past.] [illustration: ten years past.] now will come a year or two, and sometimes three, when the teeth do not so clearly indicate the exact age, and the judgment must be guided by the extent to which the dark middle lines are worn. this will depend somewhat upon the exposure and feeding of the animal; but at seven years these lines extend over all the teeth. at eight years, another change begins, which cannot be mistaken. a kind of absorption begins with the two central incisors--slow at first, but perceptible--and these two teeth become smaller than the rest, while the dark lines are worn into one in all but the corner teeth, till, at ten years, four of the central incisors have become smaller in size, with a smaller and fainter mark, as indicated in the proper cut. at eleven, the six inner teeth are smaller than the corner ones; and at twelve, all become smaller than they were, while the dark lines are nearly gone, except in the corner teeth, and the inner edge is worn to the gum. points of a good cow. after satisfaction is afforded touching the age of a cow, she should be examined with reference to her soundness of constitution. a good constitution is indicated by large lungs, which are found in a deep, broad, and prominent chest, broad and well-spread ribs, a respiration somewhat slow and regular, a good appetite, and if in milk a strong inclination to drink, which a large secretion of milk almost invariably stimulates. in such a cow the digestive organs are active and energetic, and they make an abundance of good blood, which in turn stimulates the activity of the nervous system, and furnishes the milky glands with the means of abundant secretion. such a cow, when dry, readily takes on fat. when activity of the milk-glands is found united with close ribs, small and feeble lungs, and a slow appetite, often attended by great thirst, the cow will generally possess only a weak and feeble constitution; and if the milk is plentiful, it will generally be of bad quality, while the animal, if she does not die of diseased lungs, will not readily take on fat, when dry and fed. [illustration: a good milch cow.] in order to have no superfluous flesh, the cow should have a small, clean, and rather long head, tapering toward the muzzle. a cow with a large, coarse head will seldom fatten readily, or give a large quantity of milk. a coarse head increases the proportion of weight of the least valuable parts, while it is a sure indication that the whole bony structure is too heavy. the mouth should be large and broad; the eye bright and sparkling, but of a peculiar placidness of expression, with no indication of wildness, but rather a mild and feminine look. these points will indicate gentleness of disposition. such cows seem to like to be milked, are fond of being caressed, and often return caresses. the horns should be small, short, tapering, yellowish, and glistening. the neck should be small, thin, and tapering toward the head, but thickening when it approaches the shoulder; the dewlaps small. the fore quarters should be rather small when compared with the hind quarters. the form of the barrel will be large, and each rib should project further than the preceding one, up to the loins. she should be well formed across the hips and in the rump. the spine or back-bone should be straight and long, rather loosely hung, or open along the middle part, the result of the distance between the dorsal vertebræ, which sometimes causes a slight depression, or sway back. by some good judges, this mark is regarded as of great importance, especially when the bones of the hind quarters are also rather loosely put together, leaving the rump of great width and the pelvis large, and the organs and milk-vessels lodged in the cavities largely developed. the skin over the rump should be loose and flexible. this point is of great importance; and as, when the cow is in low condition or very poor, it will appear somewhat harder and closer than it otherwise would, some practice and close observation are required to judge well of this mark. the skin, indeed, all over the body, should be soft and mellow to the touch, with soft and glossy hair. the tail, if thick at the setting on, should taper and be fine below. but the udder is of special importance. it should be large in proportion to the size of the animal, and the skin thin, with soft, loose folds extending well back, capable of great distension when filled, but shrinking to a small compass when entirely empty. it must be free from lumps in every part, and provided with four teats set well apart, and of medium size. nor is it less important to observe the milk-veins carefully. the principal ones under the belly should be large and prominent, and extend forward to the navel, losing themselves, apparently, in the very best milkers, in a large cavity in the flesh, into which the end of the finger can be inserted; but when the cow is not in full milk, the milk-vein, at other times very prominent, is not so distinctly traced; and hence, to judge of its size when the cow is dry, or nearly so, this vein may be pressed near its end, or at its entrance into the body, when it will immediately fill up to its full size. this vein does not convey the milk to the udder, as some suppose, but is the channel by which the blood returns; and its contents consist of the refuse of the secretion, or of what has not been taken up in forming milk. there are also veins in the udder, and the perineum, or the space above the udder, and between that and the buttocks, which it is of special importance to observe. these veins should be largely developed, and irregular or knotted, especially those of the udder. they are largest in great milkers. the knotted veins of the perineum, extending from above downwards in a winding line, are not readily seen in young heifers, and are very difficult to find in poor cows, or those of only a medium quality. they are easily found in very good milkers, and if not at first apparent, they are made so by pressing upon them at the base of the perineum, when they swell up and send the blood back toward the vulva. they form a kind of thick network under the skin of the perineum, raising it up somewhat, in some cases near the vulva, in others nearer down and closer to the udder. it is important to look for these veins, as they often form a very important guide, and by some they would be considered as furnishing the surest indications of the milking qualities of the cow. full development almost always shows an abundant secretion of milk; but they are far better developed after the cow has had two or three calves, when two or three years' milking has given full activity to the milky glands, and attracted a large flow of blood. the larger and more prominent these veins the better. it is needless to say that in observing them some regard should be had to the condition of the cow, the thickness of skin and fat by which they may be surrounded, and the general activity and food of the animal. food calculated to stimulate the greatest flow of milk will naturally increase these veins, and give them more than usual prominence. the milk-mirror. the discovery of m. guénon, of bordeaux, in france--a man of remarkable practical sagacity, and a close observer of stock--consisted in the connection between the milking qualities of the cow and certain external marks on the udder, and on the space above it, called the perineum, extending to the buttocks. to these marks he gave the name of milk-mirror, or escutcheon, which consists in certain perceptible spots rising up from the udder in different directions, forms and sizes, on which the hair grows upward, whilst the hair on other parts of the body grows downward. the reduction of these marks into a system, explaining the value of particular forms and sizes of the milk-mirror, belongs exclusively to guénon. [illustration: milk-mirror [a.]] he divided the milk-mirror into eight classes, and each class into eight orders, making in all no less than sixty-four divisions, which he afterward increased by subdivisions, thus rendering the whole system complicated in the extreme, especially as he professed to be able to judge with accuracy, by means of the milk-mirror, not only of the exact quantity a cow would give, but also of the quality of the milk, and of the length of time it would continue. he endeavored to prove too much, and was, as a matter of consequence, frequently at fault himself. despite the strictures which have been passed upon guénon's method of judging of cows, the best breeders and judges of stock concur in the opinion, as the result of their observations, that cows with the most perfectly developed milk-mirrors are, with rare exception, the best milkers of their breed; and that cows with small and slightly developed milk-mirrors are, in the majority of cases, bad milkers. there are, undoubtedly, cows with very small mirrors, which are, nevertheless, very fair in the yield of milk; and among those with middling quality of mirrors, instances of rather more than ordinary milkers often occur, while at the same time it is true that cases now and then are found where the very best marked and developed mirrors are found on very poor milkers. these apparent exceptions, however, are to be explained, in the large majority of cases, by causes outside of those which affect the appearance of the milk-mirror. it is, of course, impossible to estimate with mathematical accuracy either the quantity, quality, or duration of the milk, since it is affected by so many chance circumstances, which cannot always be known or estimated by even the most skillful judges; such, for example, as the food, the treatment, the temperament, accidental diseases, inflammation of the udder, premature calving, the climate and season, the manner in which she has been milked, and a thousand other things which interrupt or influence the flow of milk, without materially changing the size or shape of the milk-mirror. it has, indeed, been very justly observed that we often see cows equally well formed, with precisely the same milk-mirror, and kept in the same circumstances, yet giving neither equal quantities nor similar qualities of milk. nor could it be otherwise; since the action of the organs depends, not merely on their size and form, but, to a great extent, on the general condition of each individual. [illustration: milk-mirror [b.]] [illustration: milk-mirror [c.]] the different forms of milk-mirrors are represented by the shaded parts of cuts, lettered a, b, c, d; but it is necessary to premise that upon the cows themselves they are always partly concealed by the thighs, the udder, and the folds of the skin, which are not shown, and therefore they are not always so uniform in nature as they appear in the cuts. [illustration: milk-mirror [d.]] their size varies as the skin is more or less folded or stretched; while the cuts represent the skin as uniform or free from folds, but not stretched out. it is usually very easy to distinguish the milk-mirrors by the upward direction of the hair which forms them. they are sometimes marked by a line of bristly hair growing in the opposite direction, which surrounds them, forming a sort of outline by the upward and downward growing hair. yet, when the hair is very fine and short, mixed with longer hairs, and the skin much folded, and the udder voluminous and pressed by the thighs, it is necessary, in order to distinguish the part enclosed between the udder and the legs, and examine the full size of the mirrors, to observe them attentively, and to place the legs wide apart, and to smooth out the skin, in order to avoid the folds. the mirrors may also be observed by holding the back of the hand against the perineum, and drawing it from above downward, when the nails rubbing against the up-growing hair, make the parts covered by it very perceptible. as the hair of the milk-mirror has not the same direction as the hair which surrounds it, it may often be distinguished by a difference in the shade reflected by it. it is then sufficient to place it properly to the light in order to see the difference in shade, and to make out the part covered by the upward-growing hair. most frequently, however, the hair of the milk-mirror is thin and fine, and the color of the skin can easily be seen. if the eye alone is trusted, we shall often be deceived. [illustration: milk-mirror [e.]] in some countries cattle-dealers shave the back part of the cow. just after this operation the mirrors can neither be seen nor felt; but this inconvenience ceases in a few days. it may be added that the shaving--designed, as the dealers say, to beautify the cow--is generally intended simply to destroy the milk-mirror, and to deprive buyers of one means of judging of the milking qualities of the cows. it is unnecessary to add that the cows most carefully shaven are those which are badly marked, and that it is prudent to take it for granted that cows so shorn are bad milkers. milk-mirrors vary in position, extent, and the figure which they represent. they may be divided according to their position, into mirrors or escutcheons, properly so called, or into lower and upper tufts, or escutcheons. the latter are very small in comparison with the former, and are situated in close proximity to the vulva, as seen at , in cut e. they are very common on cows of bad milking races, but are very rarely seen on the best milch cows. they consist of one or two ovals, or small bands of up-growing hair, and serve to indicate the continuance of the flow of milk. the period is short, in proportion as the tufts are large. they must not be confounded with the escutcheon proper, which is often extended up to the vulva. they are separated from it by bands of hair, more or less large, as in cut marked f. [illustration: milk-mirror [f.]] milk-mirrors are sometimes symmetrical, and sometimes without symmetry. when there is a great difference in the extent of the two halves, it almost always happens that the teats on the side where the mirror is best developed give more milk than those of the opposite side. the left half of the mirror, it may be remarked, is almost always the largest; and so, when the perinean part is folded into a square, it is on this side of the body that it unfolds. of three thousand cows in denmark, but a single one was found, whose escutcheon varied even a little from this rule. the mirrors having a value in proportion to the space which they occupy, it is of great importance to attend to all the rows of down-growing hairs, which diminish the extent of surface, whether these tufts are in the midst of the mirror, or form indentations on its edges. these indentations, concealed in part by the folds of the skin, are sometimes seen with difficulty; but it is important to take them into account, since in a great many cows they materially lessen the size of the mirror. cows are often found, whose milk-mirrors at first sight appear very large, but which are only medium milkers; and it will usually be found that lateral indentations greatly diminish the surface of up-growing hair. many errors are committed in estimating the value of such cows, from a want of attention to the real extent of the mirror. all the interruptions in the surface of the mirror indicate a diminution in the quantity of the milk, with the exception, however, of small oval or elliptical plates which are found in the mirror, on the back part of the udders of the best cows, as represented in the cut already given, marked a. these ovals have a peculiar tint, which is occasioned by the downward direction of the hair which forms them. in the best cows these ovals exist with the lower mirrors very well developed, as represented in the cut just named. in short, it should be stated that, in order to determine the extent and significance of a mirror, it is necessary to consider the state of the perineum as to fat, and that of the fullness of the udder. in a fat cow, with an inflated udder, the mirror would appear larger than it really is; whilst in a lean cow, with a loose and wrinkled udder, it appears smaller. fat will cover faults--a fact to be borne in mind when selecting a cow. in bulls, the mirrors present the same peculiarities as in cows; but they are less varied in their form, and especially much less in size. in calves, the mirrors show the shapes which they are afterwards to have, only they are more contracted, because the parts which they cover are but slightly developed. they are easily seen after birth; but the hair which then covers them is long, coarse, and stiff; and when this hair falls off, the calf's mirror will resemble that of the cow, but will be of less size. with calves, however, it should be stated, in addition, that the milk-mirrors are more distinctly recognized on those from cows that are well kept, and that they will generally be fully developed at two years old. some changes take place in the course of years, but the outlines of the mirror appear prominent at the time of advanced pregnancy, or, in the case of cows giving milk, at the times when the udder is more distended with milk than at others. m. mayne, who has explained and simplified the method of m. guénon, divides cows, according to the quantity which they give, into four classes: first, the very good; second, the good; third, the medium; and fourth, the bad. in the first class he places cows, both parts of whose milk mirror, the mammary--the tuft situated on the udder, the legs and the thighs--and the perinean--that on the perineum, extending sometimes more or less out upon the thighs--are large, continuous, and uniform, covering at least a great part of the perineum, the udder, the inner surface of the thighs, and extending more or less out upon the legs, as in cut a, with no interruptions, or, if any, small ones, oval in form, and situated on the posterior face of the udder. [illustration: milk-mirror [g.]] such mirrors are found on most very good cows, but may also be found on cows which can scarcely be called good, and which should be ranked in the next class. but cows, whether having very well developed mirrors or not, may be reckoned as very good, and as giving as much milk as is to be expected from their size, food, and the hygienic circumstances in which they are kept, if they present the following characteristics: veins of the perineum large, as if swollen, and visible on the exterior--as in cut a--or which can easily be made to appear by pressing upon the base of the perineum; veins of the udder large and knotted; milk-veins large, often double, equal on both sides, and forming zig-zags, under the belly. to the signs furnished by the veins and by the mirror, may be added also the following marks: a uniform, very large, and yielding udder, shrinking much in milking, and covered with soft skin and fine hair; good constitution, full chest, regular appetite, and great propensity to drink. such cows rather incline to be poor than to be fat. the skin is soft and yielding; short, fine hair; small head; fine horns; bright, sparkling eye; mild expression; feminine look; with a fine neck. cows of this first class are very rare. they give, even when small in size, from ten to fourteen quarts of milk a day; and the largest sized from eighteen to twenty-six quarts a day, and even more. just after calving, if arrived at maturity and fed with good, wholesome, moist food in sufficient quantity and quality, adapted to promote the secretion of milk, they can give about a pint of milk for every ten ounces of hay, or its equivalent, which they eat. they continue in milk for a long period. the best never go dry, and may be milked even up to the time of calving, giving from eight to ten quarts of milk a day. but even the best cows often fall short of the quantity of milk which they are able to give, from being fed on food which is too dry, or not sufficiently varied, or not rich enough in nutritive qualities, or deficient in quantity. [illustration: milk-mirror [h.]] the second class is that of _good cows_; and to this belong the best commonly found in the market and among the cow-feeders of cities. they have the mammary part of the milk-mirror well developed, but the perinean part contracted, or wholly wanting, as in cut g; or both parts of the mirror are moderately developed, or slightly indented, as in cut h. cut e belongs also to this class, in the lower part; but it indicates a cow, which--as the upper mirror, , indicates--dries up sooner when again in calf. these marks, though often seen in many good cows, should be considered as certain only when the veins of the perineum form, under the skin, a kind of network, which, without being very apparent, may be felt by a pressure on them; when the milk-veins on the belly are well-developed, though less knotty and less prominent than in cows of the first class; in short, when the udder is well developed, and presents veins which are sufficiently numerous, though not very large. it is necessary here, as in the preceding class, to distrust cows in which the mirror is not accompanied by large veins. this remark applies especially to cows which have had several calves, and are in full milk. they are medium or bad, let the milk-mirror be what it may, if the veins of the belly are not large, and those of the udder apparent. the general characteristics which depend on form and constitution combine, less than in cows of the preceding class, the marks of good health and excellent constitution with those of a gentle and feminine look. small cows of this class give from seven to ten or eleven quarts of milk a day, and the largest from thirteen to seventeen quarts. they can be made to give three-fourths of a pint of milk, just after calving, for every ten ounces of hay consumed, if well cared for, and fed in a manner favorable to the secretion of milk. they hold out long in milk, when they have no upper mirrors or tufts. at seven or eight months in calf, they may give from five to eight quarts of milk a day. the third class consists of _middling cows_. when the milk-mirror really presents only the mammary or lower part slightly indicated or developed, and the perinean part contracted, narrow, and irregular--as in cut k--the cows are middling. the udder is slightly developed or hard, and shrinks very little after milking. the veins of the perineum are not apparent, and those which run along the lower side of the abdomen are small, straight, and sometimes unequal. in this case the mirror is not symmetrical, and the cow gives more milk on the side where the vein is the largest. [illustration: milk-mirror [k.]] these cows have large heads, and a thick, hard skin. being ordinarily in good condition, they are beautiful to look at, and seem to be well formed. many of them are nervous and restive, and not easily approached. cows of this class give, according to size, from three or four to ten quarts of milk. they very rarely give, even in the most favorable circumstances, half a pint of milk for every ten ounces of hay which they consume. the milk diminishes rapidly, and dries up wholly the fourth or fifth month in calf. the fourth class is composed of _bad cows_. as they are commonly in good condition, these cows are often the most beautiful of the herd and in the markets. they have fleshy thighs, thick and hard skin, a large and coarse neck and head, and horns large at the base. the udder is hard, small and fleshy, with a skin covered with long, rough hair. no veins are to be seen either on the perineum or the udder, while those of the belly are slightly developed, and the mirrors are ordinarily small, as in cut l. with these characteristics, cows give only a few quarts of milk a day, and dry up in a short time after calving. some of them can scarcely nourish their calves, even when they are properly cared for and well fed. sickly habits, chronic affections of the digestive organs, the chest, the womb, and the lacteal system, sometimes greatly affect the milk secretion, and cause cows troubled with them to fall from the first or second to the third, and sometimes to the fourth class. without pushing this method of judging of the good milking qualities of cows into the objectionable extreme to which it was carried by its originator, it may be safely asserted that the milk-mirror forms an important additional mark or point for distinguishing good milkers; and it may be laid down as a rule that, in the selection of milch cows, as well as in the choice of young animals for breeders, the milk-mirror should, by all means, be examined and considered; but that we should not limit or confine ourselves exclusively to it, and that other and long-known marks should be equally regarded. there are cases, however, where a knowledge and careful examination of the form and size of the mirror become of the highest importance. it is well known that certain signs or marks of great milkers are developed, only as the capacities of the animal herself are fully and completely developed by age. the milk-veins, for instance, are never so large and prominent in heifers and young cows as in old ones, and the same may be said of the udder, and of the veins of the udder and perineum; all of which it is of great importance to observe in the selection of milch cows. those signs, then, which in cows arrived at maturity are almost sufficient in themselves to warrant a conclusion as to their merits as milkers, are, to a great extent, wanting in younger animals, and altogether in calves, as to which there is often doubt whether they shall be raised; and here a knowledge of the form of the mirror is of immense advantage, since it gives, at the outset and before any expense is incurred, a somewhat reliable means of judging of the future milking capacities of the animal; or, if a male, of the probability of his transmitting milking qualities to his offspring. [illustration: milk-mirror [l.]] it will be seen, from an examination of the points of a good milch cow that, though the same marks which indicate the greatest milking qualities may not always indicate the greatest aptitude to fatten, yet that the signs which denote good fattening qualities are included among the signs favorable to the production of milk; such as soundness of constitution, marked by good organs of digestion and respiration fineness and mellowness of the skin and hair, quietness of disposition--which inclines the animal to rest and lie down while chewing the cud--and other marks which are relied on by graziers in selecting animals to fatten. in buying dairy stock the farmer generally finds it for his interest to select young heifers, as they give the promise of longer usefulness. but it is often the case that older cows are selected with the design of using them for the dairy for a limited period, and then feeding them for the butcher. in either case, it is advisable, as a rule, to choose animals in low or medium condition. the farmer cannot commonly afford to buy fat; it is more properly his business to make it, and to have it to sell. good and well-marked cows in poor condition will rapidly gain in flesh and products when removed to better pastures and higher keeping, and they cost less in the original purchase. it is, perhaps, superfluous to add that regard should be had to the quality of the pasturage and keeping which a cow has previously had, as compared with that to which she is to be subjected. the size of the animal should also be considered with reference to the fertility of the pastures into which she is to be put. small or medium-sized animals accommodate themselves to ordinary pastures far better than large ones. where a very large cow will do well, two small ones will usually do better; while the large animal might fail entirely where two small ones would do well. it is better to have the whole herd, so far as may be, uniform in size; for, if they vary greatly, some may get more than they need, and others will not have enough. this, however, cannot always be brought about. [illustration] crossing and breeding the raising of cattle has now become a source of profit in many sections,--to a greater extent, at least, than formerly--and it becomes a matter of great practical importance to our farmers to take the proper steps to improve them. indeed, the questions--what are the best breeds, and what are the best crosses, and how shall i improve my stock--are now asked almost daily; and their practical solution would add many thousand dollars to the aggregate wealth of the farmers of the country, if they would all study their own interests. the time is gradually passing away when the intelligent practical farmer will be willing to put his cows to any bull, simply because his services may be had for twenty-five cents; for, even if the progeny is to go to the butcher, the calf sired by a pure-bred bull--particularly of a race distinguished for fineness of bone, symmetry of form, and early maturity--will bring a much higher price at the same age than a calf sired by a scrub. blood has a money value, which will, sooner or later, be generally appreciated. the first and most important object of the farmer is to get the greatest return in money for his labor and his produce; and it is for his interest to obtain an animal--a calf, for example--that will yield the largest profit on the outlay. if a calf, for which the original outlay was five dollars, will bring at the same age and on the same keep more real net profit than another, the original outlay for which was not twenty-five cents, it is certainly for the farmer's interest to make the heavier original outlay and thus secure the superior animal. setting all fancy aside, it is merely a question of dollars and cents; but one thing is certain--and that is, that no farmer can afford to keep poor stock. it eats as much, and requires nearly the same amount of care and attention, as stock of the best quality; while it is equally certain that stock of ever so good a quality, whether grade, native, or thorough-bred, will be sure to deteriorate and sink to the level of poor stock by neglect and want of proper attention. how, then, is our stock to be improved? not, certainly, by that indiscriminate crossing, with a total disregard of all well-established principles, which has thus far marked our efforts with foreign stock, and which is one prominent reason why so little improvement has been made in our dairies; nor by leaving all the results to chance, when, by a careful and judicious selection, they may be within our own control. we want cattle for distinct purposes, as for milk, beef, or labor. in a large majority of cases--especially in the dairy districts, at least, comprising the eastern and middle states--the farmer cares more for the milking qualities of his cows, especially for the quantity they give, than for their fitness for grazing, or aptness to fatten. these latter points become more important in the western and some of the southern states, where much greater attention is paid to breeding and to feeding, and where comparatively slight attention is given to the productions of the dairy. a stock of cattle which would suit one farmer might be wholly unsuited to another, and in such particular case the breeder should have some special object in view, and select his animals with reference to it. there are, however, some well-defined general principles that apply to breeding everywhere, and which, in many cases, are not thoroughly understood. to these attention will now be directed. the first and most important of the laws to be considered in this connection is that of _similarity_. it is by virtue of this law that the peculiar characters, properties, and qualities of the parents--whether external or internal, good or bad, healthy or diseased--are transmitted to their offspring. this is one of the plainest and most certain of the laws of nature. the lesson which it teaches may be stated in five words:--breed only from the best. judicious selection is indispensable to success in breeding, and this should have regard to every particular--general appearance, length of limb, shape of carcass, development of chest; in cattle, to the size, shape, and position of the udder, thickness of skin, touch, length and texture of hair, docility, and all those points which go to make up the desirable animal. not only should care be exercised to avoid _structural defects_, but especially to secure freedom from _hereditary diseases_; as both defects and diseases appear to be more easily transmissible than desirable qualities. there is, oftentimes, no obvious peculiarity of structure or appearance which suggests the possession of diseases or defects which are transmissible; and for this reason, special care and continued acquaintance are requisite in order to be assured of their absence in breeding animals; but such a tendency, although invisible or inappreciable to careless observers, must still, judging from its effects, have as real and certain an existence as any peculiarity of form or color. in neat cattle, hereditary diseases do not usually show themselves at birth; and sometimes the tendency remains latent for many years, perhaps through one or two generations, and afterward breaks out with all its former severity. the diseases which are found hereditary in cattle are scrofula, consumption, dysentery, diarrhoea, rheumatism, and malignant tumors. as these animals are less exposed to the exciting causes of disease, and less liable to be overtasked or subjected to violent changes of temperature, or otherwise put in jeopardy, their diseases are not so numerous as those of the horse, and what they have are less violent, and generally of a chronic character. with regard to hereditary diseases, it is eminently true that "an ounce of prevention is worth a pound of cure." as a general and almost invariable rule, animals possessing either defects or a tendency to disease, should not be employed for breeding. if, however, for special reasons it seems desirable to breed from one which has some slight defect of symmetry, or a faint tendency to disease--although for the latter it is doubtful whether the possession of any good qualities can fully compensate--it should be mated with one which excels in every respect in which it is itself deficient, and on no account with one which is near of kin to it. there is another law, by which that of similarity is greatly modified--the law of _variation_ or divergence. all animals possess a certain flexibility or pliancy of organization, which renders them capable of change to a greater or less extent. when in a state of nature, variations are comparatively slow and infrequent; but when in a state of domestication they occur much oftener and to a much greater extent. the greater variability in the latter case is doubtless owing, in some measure, to our domestic productions' being reared under conditions of life not so uniform as, and different from, those to which the parent species was exposed in a state of nature. among what are usually reckoned the more active causes of variation may be named _climate_, _food_, and _habit_. animals in a cold climate are provided with a thicker covering of hair than in warmer ones. indeed, it is said that in some of the tropical provinces of south america, there are cattle which have an extremely rare and fine fur, in place of the ordinary pile of hair. the supply of food, whether abundant or scanty, is one of the most efficient causes of variation known to be within the control of man. a due consideration of the natural effects of climate and food is a point worthy the careful attention of the stock-husbandman. if the breeds employed be well adapted to the situation, and the capacity of the soil be such as to feed them fully, profit may be safely anticipated. animals are to be regarded as machines for converting herbage into money. the bestowal of food sufficient, both in amount and quality, to enable animals to develop all the excellencies inherent in them, and yield all the profit of which they are capable, is something quite distinct from undue forcing of pampering. the latter process may produce wonderful animals to look at, but neither useful nor profitable ones, and there is danger of thus producing a most undesirable variation, since in animals the process may be carried far enough to produce barrenness. instances are not wanting, particularly among the more recent improved short-horns, of impotency among the males and of barrenness among the females; and in some cases where the latter have borne calves, they have failed to secrete sufficient milk for their nourishment. impotency in bulls of various breeds has, in many instances, occurred from too high feeding, especially when connected with a lack of sufficient exercise. a working bull, though perhaps not so pleasing to the eye as a fat one, is a surer stock-getter; and his progeny is more likely to inherit full health and vigor. _habit_ has a decided influence toward producing variations. we find in domestic animals that use--or the demand created by habit--is met by a development or change in the organization adapted to the requirement. for instance, with cows in a state of nature, or where required only to suckle their young, the supply of milk is barely fitted to the requirement. if more is desired, and the milk is drawn completely and regularly, the yield is increased and continued longer. by keeping up the demand there is induced, in the next generation, a greater development of the secreting organs, and more milk is given. by continuing the practice, by furnishing the needful conditions of suitable food and the like, and by selecting in each generation those animals showing the greatest tendency toward milk, a breed specially adapted for the dairy may be established. it is just by this mode that the ayrshires have, within the past century, been brought to be what they are--a breed giving more good milk upon a certain amount of food than any other. [illustration: ready for action.] it is a fact too well established to be controverted, that the first male produces impressions upon subsequent progeny by other males. to what extent this principle holds, it is impossible to say. although the instances in which it is known to be of a very marked and obvious character may be comparatively few, yet there is ample reason to believe that, although in a majority of cases the effect may be less noticeable, it is not less real; and it therefore demands the special attention of breeders. the knowledge of this law furnishes a clue to the cause of many of the disappointments of which practical breeders often complain, and of many variations otherwise unaccountable, and it suggests particular caution as to the first male employed in the coupling of animals--a matter which has often been deemed of little consequence in regard to cattle, inasmuch as fewer heifers' first calves are reared, than those are which are borne subsequently. the phenomenon--or law, as it is sometimes called--of atavism, or _ancestral influence_, is one of considerable practical importance, and well deserves the careful attention of the breeder of farm stock. every one is aware that it is by no means unusual for a child to resemble its grandfather, or grandmother, or even some ancestor still more remote, more than it does either its own father or mother. the same occurrence is found among our domestic animals, and oftener in proportion as the breeds are crossed or mixed up. among our common stock of neat cattle, or natives--originating, as they did, from animals brought from england, scotland, denmark, france, and spain, each possessing different characteristics of form, color, and use, and bred, as our common stock has usually been, indiscriminately together, with no special object in view, with no attempt to obtain any particular type or form, or to secure adaptation for any particular purpose--frequent opportunities are afforded of witnessing the results of this law of hereditary transmission. so common, indeed, is its occurrence, that the remark is often made, that, however good a cow may be, there is no telling beforehand what sort of a calf she may have. the fact is sufficiently obvious, that certain peculiarities often lie dormant for a generation or two and then reappear in subsequent progeny. stockmen often speak of it as "breeding back," or "crying back." the lesson taught by this law is very plain. it shows the importance of seeking thorough-bred or well-bred animals; and by these terms are simply meant such as are descended from a line of ancestors in which for many generations the desirable forms, qualities, and characteristics have been _uniformly shown_. in such a case, even if ancestral influence does come in play, no material difference appears in the offspring, the ancestors being all essentially alike. from this standpoint we best perceive in what consists the money value of a good "pedigree." this is valuable, in proportion as it shows an animal to be descended, not only from such as are purely of its own race or breed, but also from such individuals of that breed as were specially noted for the excellencies for which that particular breed is esteemed. probably the most distinctly marked evidence of ancestral influence among us, is to be found in the ill-begotten, round-headed calves, not infrequently dropped by cows of the common mixed kind, which, if killed early, make very blue veal, and if allowed to grow up, become exceedingly profitless and unsatisfactory beasts; the heifers being often barren, the cows poor milkers, the oxen dull, mulish beasts, yielding flesh of very dark color, of ill flavor and destitute of fat. _the relative influence_ of the male and female parents upon the characteristics of progeny has long been a fruitful subject of discussion among breeders. it is found in experience that progeny sometimes resembles one parent more than the other--sometimes there is an apparent blending of the characteristics of both--sometimes a noticeable dissimilarity to either, though always more or less resemblance somewhere--and sometimes the impress of one may be seen upon a portion of the organization of the offspring, and that of the other parent upon another portion; yet we are not authorized from such discrepancies to conclude that it is a matter of chance; for all of nature's operations are conducted in accordance with fixed laws, whether we be able fully to discover them or not. the same causes always produce the same results. in this case, not less than in others, there are, beyond all doubt, certain fixed laws; and the varying results which we see are easily and sufficiently accounted for by the existence of conditions or modifying influences not fully open to our observation. it may be stated, on the whole--as a result of the varied investigations to which this question has given rise--that the evidence, both from observation and the testimony of the best practical breeders, goes to show that each parent usually contributes certain portions of the organization to the offspring, and that each has a modifying influence upon the other. facts also show that the same parent does not always contribute the same portions, but that the order is at times, and not rarely, reversed. where animals are of distinct species or breeds, transmission is usually found to be in harmony with the principle, that the male gives mostly the outward form and locomotive system, and the female chiefly the interior system, constitution and the like. where the parents are of the same breed, it appears that the proportions contributed by each are governed, in a large measure, by the condition of each in regard to age and vigor, or by virtue of individual potency or superiority of physical endowment. this potency or power of transmission, seems to be legitimately connected with high breeding, or the concentration of fixed qualities, obtained by continued descent for many generations from such only as possess in the highest degree the qualities desired. practically, the knowledge obtained dictates in a most emphatic manner that every stock-grower use his utmost endeavor to obtain the services of the best sires; that is, the best for the ends and purposes in view--that he depend chiefly on the sire for outward form and symmetry--and that he select dams best calculated to develop the good qualities of the male, depending chiefly upon these for freedom, from internal disease, for hardihood and constitution, and, generally, for all qualities dependent upon the vital or nutritive system. the neglect of the qualities of the dam, which is far too common--miserably old and inferior animals being often employed--cannot be too strongly censured. with regard to the laws which regulate the sex of the progeny very little is known. many and extensive observations have been made, without reaching any definite conclusion. nature seems to have provided that the number of each sex; produced, shall be nearly equal; but by what means this result is attained, has not as yet been discovered. it has long been a disputed point, whether the system of _breeding in-and-in_, or the opposite one of frequent crossing, has the greater tendency to improve the character of stock this term, in-and-in, is often very loosely used and as variously understood. some confine the phrase to the coupling of those of exactly the same blood, as brothers and sisters, while others include in it breeding from parents and offsprings; and others still employ it to embrace those of a more distant relationship. for the last, the term breeding-in, or close breeding, is generally deemed more suitable. the current opinion is decidedly against the practice of breeding from any near relatives; it being usually found that degeneracy follows, and often to a serious degree; but it is not proved that this degeneracy, although very common and even usual, is yet a necessary consequence. that ill effects follow, in a majority of cases, is not to be doubted; but this is easily and sufficiently accounted for upon quite other grounds. perhaps, however, the following propositions may be safely stated: that in general practice, with the grades and mixed animals common in the country, _close-breeding should be scrupulously avoided_ as highly detrimental. it is better _always_ to avoid breeding from near relatives whenever stock-getters of the same breed and of equal merit can be obtained which are not related. yet, where this is not possible, or where there is some desirable and clearly defined purpose in view--as the fixing and perpetuating of some valuable quality in a particular animal not common to the breed--and the breeder possesses the knowledge and skill needful to accomplish his purpose, and the animals are perfect in health and development, close breeding may be practised with advantage. the practice of _crossing_, like that of close breeding, has its strong and its weak side. judiciously practised, it offers a means of providing animals _for the butcher_, often superior to, and more profitable than, those of any pure breed. it is also admissible as the foundation of a systematic and well-considered attempt to establish a new breed. but when crossing is practised injudiciously and indiscriminately, and especially when so done for the purpose of procuring _breeding animals_, it is scarcely less objectionable than careless in-and-in breeding. [illustration: a sprightly youth.] the profitable style of breeding for the great majority of farmers to adopt, is neither to cross nor to breed from close affinities--except in rare instances, and for some specific and clearly understood purpose--but to _breed in the line_; that is, to select the breed or race best adapted to fulfil the requirement demanded, whether it be for the dairy, for labor, or for such combination of these as can be had without too great a sacrifice of the principal requisite, and then to procure a _pure-bred_ male of the kind determined upon, and breed him to the females of the herd; and if these be not such as are calculated to develop his qualities, endeavor by purchase or exchange to procure such as will. let the progeny of these be bred to another _pure-bred_ male of the same breed, but as distantly related to the first as may be. let this plan be faithfully pursued, and, although we cannot, without the intervention of well-bred females, procure stock purely of the kind desired, yet in several generations--if proper care be given to the selection of males, that each one be such as to retain and improve upon the points gained by his predecessor--the stock, for most practical purposes, will be as good as if thorough-bred. if this plan were generally adopted, and a system of letting or exchanging males established, the cost might be brought within the means of most persons, and the advantages which would accrue would be almost beyond belief. a brief summing-up of the foregoing principles may not be inappropriate here. the law of similarity teaches us to select animals for breeding which possess the desired forms and qualities in the greatest perfection and best combination. regard should be had, not only to the more obvious characteristics, but also to such hereditary traits and tendencies as may be hidden from cursory observation and demand careful and thorough investigation. from the hereditary nature of all characteristics, whether good or bad, we learn the importance of having all desirable qualities _thoroughly inbred_; or, in other words, so firmly in each generation that the next is warrantably certain to present nothing worse--that no ill results follow from breeding back to some inferior ancestor--that all undesirable traits or points be, so far as possible, _bred-out_. so important is this consideration, that, in practice, it is decidedly preferable to employ a male of ordinary external appearance--provided his ancestry be all which is desired--rather than a grade, or cross-bred animal, although the latter be greatly his superior in personal beauty. a knowledge of the law of variation teaches us to avoid, for breeding purposes, such animals as exhibit variations unfavorable to the purpose in view; to endeavor to perpetuate every real improvement gained; as well as to secure, as far as practicable, the conditions necessary to induce or continue any improvement, such as general treatment, food, climate, habits, and the like. where the parents do not possess the perfections desired, selections for coupling should be made with critical reference to correcting the faults or deficiencies of one by corresponding excellencies in the other. to correct defects, too much must not be attempted at once. pairing those very unlike oftener results in loss than gain. avoid all extremes, and endeavor by moderate degrees to attain the end desired. crossing, between different breeds, for the purpose of obtaining animals for the shambles, may be advantageously practised to a considerable extent, but not for the production of breeding animals. as a general rule, cross-bred males should not be employed for propagation, and cross-bred females should be served by thorough-bred males. in ordinary practice, breeding from near relatives is to be scrupulously avoided. for certain purposes, under certain conditions and circumstances, and in the hands of a skillful breeder, it may be practised with advantage--but not otherwise. in a large majority of cases--other things being equal--we may expect in progeny the outward form and general structure of the sire, together with the internal qualities, constitution, and nutritive system of the dam; each, however, modified by the other. particular care should always be taken that the male by which the dam first becomes pregnant is the best which can be obtained; also, that at the time of sexual congress both are in vigorous health. breeding animals should not be allowed to become fat, but always kept in thrifty condition; and such as are intended for the butcher should never be fat but once. in deciding with what breeds to stock a farm, endeavor to select those best adapted to its surface, climate, and degree of fertility; also, with reference to probable demand and proximity to markets. no expense incurred in procuring choice animals for propagation, no amount of skill in breeding, can supersede, or compensate for, a lack of liberal feeding and good treatment. the better the stock, the better care they deserve. pregnancy the symptoms of pregnancy in its early stage were formerly deemed exceedingly unsatisfactory. the period of being in season--which commonly lasts three or four days, and then ceases for a while, and returns in about three weeks--might entirely pass over; and, although it was then probable that conception had taken place, yet in a great many instances the hopes of the breeder were disappointed. it was not until between the third and fourth month, when the belly began to enlarge--or, in many cases, considerably later--and when the motions of the foetus might be seen, or, at all events, felt by pressing on the right flank, that the farmer could be assured that his cow was in calf. that greatest of improvements in veterinary practice, the application of the ear to the chest and belly of various animals, in order to detect by the different sounds--which after a short time, will be easily recognized--the state of the circulation through most of the organs, and consequently, the precise seat and degree of inflammation and danger, has now enabled the breeder to ascertain the existence of pregnancy at as early a stage as six or eight weeks. the beating of the heart of the calf may then be distinctly heard, twice, or more than twice, as frequent as that of the mother; and each pulsation will betray the singular double beating of the foetal heart. this will also be accompanied by the audible rushing of the blood through the vessels of the placenta. the ear should be applied to the right flank, beginning on the higher part of it, and gradually shifting downward and backward. these sounds will thus soon be heard, and cannot be mistaken. treatment before calving. little alteration needs to be made in the management of the cow for the first seven months of pregnancy; except that, as she has not only to yield milk for the profit of the farmer, but to nourish the growing foetus within, she should be well, yet not too luxuriantly, fed. the half-starved cow will not adequately discharge this double duty, nor provide sufficient nutriment for the calf when it has dropped; while the cow in high condition will be dangerously disposed to inflammation and fever, when, at the time of parturition, she is otherwise so susceptible of the power of every stimulus. if the season and the convenience of the farmer will allow, she will be better at pasture, at least for some hours each day than when confined altogether to the cow-house. at a somewhat uncertain period before she calves, there will be a new secretion of milk for the expected little one; and under the notion of somewhat recruiting her strength, in order better to enable her to discharge her new duty--but more from the uniform testimony of experience that there is danger of local inflammation, general fever, garget in the udder, and puerperal fever, if the new milk descends while the old milk continues to flow--it has been usual to let the cow _go dry_ for some period before parturition. farmers and breeders have been strangely divided as to the length of this period. it must be decided by circumstances. a cow in good condition may be milked for a much longer period than a poor one. her abundance of food renders a period of respite almost unnecessary; and all that needs to be taken care of, is that the old milk should be fairly gone before the new milk springs. in such a cow, while there is danger of inflammation from the sudden rush of new milk into a bag already occupied, there is almost always considerable danger of indurations and tumors in the teats from the habit of secretion being too long suspended. the emaciated and over-milked beast, however, must rest a while before she can again advantageously discharge the duties of a mother. if the period of pregnancy were of equal length at all times and in all cows, the one that has been well fed might be milked until within a fortnight or three weeks of parturition, while a holiday of two months should be granted to the poorer beast; but as there is much irregularity about the time of gestation, it may be prudent to take a month or five weeks, as the average period. the process of parturition is necessarily one that is accompanied with a great deal of febrile excitement; and, therefore, when it nearly approaches, not only should a little care be taken to lessen the quantity of food, and to remove that which is of a stimulating action, but a mild dose of physic, and a bleeding regulated by the condition of the animal, will be very proper precautionary measures. a moderately open state of the bowels is necessary at the period of parturition in the cow. during the whole time of pregnancy her enormous stomach sufficiently presses upon and confines the womb; and that pressure may be productive of injurious and fatal consequences, if at this period the rumen is suffered to be distended by innutritious food, or the manyplus takes on that hardened state to which it is occasionally subject. breeders have been sadly negligent in this respect. the springing of the udder, or the rapid enlargement of it from the renewed secretion of milk--the enlargement of the external parts of the bearing (the former, as has been said by some, in old cows, and the latter in young ones)--the appearance of a glaring discharge from the bearing--the evident dropping of the belly, with the appearance of leanness and narrowness between the shape and the udder--a degree of uneasiness and fidgetiness--moaning occasionally--accelerated respiration--all these symptoms will announce that the time of calving is not far off. the cow should be brought near home, and put in some quiet, sheltered place. in cold or stormy weather she should be housed. her uneasiness will rapidly increase--she will be continually getting up and lying down--her tail will begin to be elevated and the commencement of the labor-pains will soon be evident. in most cases the parturition will be natural and easy, and the less the cow is disturbed or meddled with, the better. she will do better without help than with it; but she should be watched, in order to see that no difficulty occurs which may require aid and attention. in cases of difficult parturition the aid of a skillful veterinary surgeon may be required. [illustration] feeding and management no branch of dairy farming can compare in importance with the management of cows. the highest success will depend upon it, whatever breed be selected, and whatever amount of care and attention be given to the points of the animals; for experience will show that very little milk comes out of the bag, that is not first put into the throat. it is poor economy, therefore, to attempt to keep too many cows for the amount of feed one has; for it will generally be found that one good cow well-bred and well fed will yield as much as two ordinary cows kept in the ordinary way; while a saving is effected both in labor and room required, and in the risks on the capital invested. if an argument for the larger number on poorer feed is urged on the ground of the additional manure--which is the only basis upon which it can be put--it is enough to say that it is a very expensive way of making manure. it is not too strong an assertion, that a proper regard to profit and economy would require many an american farmer to sell off nearly half of his cows, and to feed the whole of his hay and roots hitherto used into the remainder. an animal, to be fully fed and satisfied, requires a quantity of food in proportion to its live weight. no feed is complete that does not contain a sufficient amount of nutritive elements; hay, for example, being more nutritive than straw, and grains than roots. the food, too, must possess a bulk sufficient to fill up to a certain degree the organs of digestion of the stomach; and, to receive the full benefit of its food, the animal must be wholly satisfied--since, if the stomach is not sufficiently distended, the food cannot be properly digested, and of course many of the nutritive principles which it contains cannot be perfectly assimilated. an animal regularly fed eats till it is satisfied, and no more than is requisite. a part of the nutritive elements in hay and other forage plants is needed to keep an animal on its feet--that is, to keep up its condition--and if the nutrition of its food is insufficient for this, the weight decreases, and if it is more than sufficient the weight increases, or else this excess is consumed in the production of milk or in labor. about one sixtieth of their live weight in hay, or its equivalent, will keep horned cattle on their feet; but, in order to be completely nourished, they require about one thirtieth in dry substances, and four thirtieths in water, or other liquid contained in their food. the excess of nutritive food over and above what is necessary to sustain life will go, in milch cows, generally to the production of milk, or to the growth of the foetus, but not in all cows to an equal extent; the tendency to the secretion of milk being much more developed in some than in others. with regard, however, to the consumption of food in proportion to the live weight of the animal, it must be taken, in common with all general principles, with some qualifications. the proportion is probably not uniform as applied to all breeds indiscriminately, though it may be more so as applied to animals of the same breed. the idea of some celebrated stock-raisers has been that the quantity of food required depends much upon the shape of the barrel; and it is well known that an animal of a close, compact, well-rounded barrel, will consume less than one of an opposite make. the variations in the yield of milch cows are caused more by the variations in the nutritive elements of their food than by a change of the form in which it is given. a cow, kept through the winter on mere straw, will cease to give milk; and, when fed in spring on green forage, will give a fair quantity of milk. but she owes the cessation and restoration of the secretion, respectively, to the diminution and increase of her nourishment, and not at all to the change of form, or of outward substance in which the nutriment is administered. let cows receive through winter nearly as large a proportion of nutritive matter as is contained in the clover, lucerne, and fresh grass which they eat in summer, and, no matter in what precise substance or mixture that matter be contained, they will yield a winter's produce of milk quite as rich in caseine and butyraceous ingredients as the summer's produce, and far more ample in quantity than almost any dairyman with old-fashioned notions would imagine to be possible. the great practical error on this subject consists, not in giving wrong kinds of food, but in not so proportioning and preparing it as to render an average ration of it equally rich in the elements of nutrition, and especially in nitrogenous elements, as an average ration of the green and succulent food of summer. we keep too much stock for the quantity of good and nutritious food which we have for it; and the consequence is, that cows are, in nine cases out of ten, poorly wintered, and come out in the spring weakened, if not, indeed, positively diseased, and a long time is required to bring them into a condition to yield a generous quantity of milk. it is a hard struggle for a cow reduced in flesh and in blood to fill up the wasted system with the food which would otherwise have gone to the secretion of milk; but, if she is well fed, well housed, well littered, and well supplied with pure, fresh water, and with roots, or other _moist_ food, and properly treated to the luxury of a frequent carding, and constant kindness, she comes out ready to commence the manufacture of milk under favorable circumstances. _keep the cows constantly in good condition_, ought, therefore, to be the motto of every dairy farmer, posted up over the barn, and on and over the stalls, and over the milk-room, and repeated to the boys whenever there is danger of forgetting it. it is the great secret of success; and the difference between success and failure turns upon it. cows in milk require more food in proportion to their size and weight than either oxen or young cattle. in order to keep cows in milk well and economically, regularity is next in importance to a full supply of wholesome and nutritious food. the animal stomach is a very nice chronometer, and it is of the utmost importance to observe regular hours in feeding, cleaning, and milking. this is a point, also, in which very many farmers are at fault--feeding whenever it happens to be convenient. the cattle are thus kept in a restless condition, constantly expecting food when the keeper enters the barn; while, if regular hours are strictly adhered to, they know exactly when they are to be fed, and they rest quietly till the time arrives. if one goes into any well-regulated dairy establishment an hour before feeding, scarcely an animal will rise to its feet; while; if it happens to be the hour of feeding, the whole herd will be likely to rise and seize their food with an avidity and relish not to be mistaken. with respect to the exact nurture to be pursued, no rule could be prescribed which would apply to all cases; and each individual must be governed much by circumstances, both regarding the particular kinds of feed at different seasons of the year, and the system of feeding. it has been found--it may be stated--in the practice of the most successful dairymen, that, in order to encourage the largest secretion of milk in stalled cows, one of the best courses is, to feed in the morning, either at the time of milking--which is preferred by many--or immediately after, with cut feed, consisting of hay, oats, millet, or cornstalks, mixed with shorts, and indian linseed, or cotton-seed meal, thoroughly moistened with water. if in winter, hot or warm water is far better than cold. if given at milking-time, the cows will generally give down their milk more readily. the stalls and mangers should first be thoroughly cleansed. [illustration: the family pets.] roots and long hay may be given during the day; and at the evening milking, or directly after, another generous meal of cut feed, well moistened and mixed, as in the morning. no very concentrated food, like grains alone, or oil-cakes, should be fed early in the morning on an empty stomach, although it is sanctioned by the practice in the london milk-dairies. the processes of digestion go on best when the stomach is sufficiently distended; and for this purpose the bulk of food is almost as important as the nutritive qualities. the flavor of some roots, as cabbages and turnips, is more apt to be imparted to the flesh and milk when fed on an empty stomach than otherwise. after the cows have been milked and have finished their cut feed, they are carded and curried down, in well-managed dairies, and then either watered in the stall--which, in very cold or stormy weather, is far preferable--or turned out to water in the yard. while they are out, if they are let out at all, the stables are put in order; and, after tying them up, they are fed with long hay, and left to themselves till the next feeding time. this may consist of roots--such as cabbages, beets, carrots, or turnips sliced--or of potatoes, a peck, or--if the cows are very large--a half-bushel each, and cut feed again at the evening milking, as in the morning; after which, water in the stall, if possible. the less cows are exposed to the cold of winter, the better. they eat less, thrive better, and give more milk, when kept housed all the time, than when exposed to the cold. a case is on record, where a herd of cows, which had usually been supplied from troughs and pipes in the stalls, were, on account of an obstruction in the pipes, obliged to be turned out thrice a day to be watered in the yard. the quantity of milk instantly decreased, and in three days the diminution became very considerable. after the pipes were mended, and the cows again watered, as before, in their stalls, the flow of milk returned. this, however, must be governed much by the weather; for in very mild and warm days it may be judicious not only to let them out, but to allow them to remain out for a short time, for the purpose of exercise. any one can arrange the hour for the several processes named above, to suit himself; but, when once fixed, it should be rigidly and regularly followed. if the regular and full feeding be neglected for even a day, the yield of milk will immediately decline, and it will be very difficult to restore it. it may be safely asserted, as the result of many trials and long practice, that a larger flow of milk follows a complete system of regularity in this respect than from a higher feeding where this system is not adhered to. one prime object which the dairyman should keep constantly in view is, to maintain the animal in a sound and healthy condition. without this, no profit can be expected from a milch cow for any considerable length of time; and with a view to this, there should be an occasional change of food. but, in making changes, great care is requisite in order to supply the needful amount of nourishment, or the cow will fall off in flesh, and eventually in milk. it should, therefore, be remembered that the food consumed goes not alone to the secretion of milk, but also to the growth and maintenance of the bony structure, the flesh, the blood, the fat, the skin, and the hair, and in exhalations from the body. these parts of the body consist of different organic constituents. some are rich in nitrogen, as the fibrin of the blood and albumen; others destitute of it, as fat; some abound in inorganic salts, phosphate of lime, and salts of potash. to explain how the constant waste of these substances may be supplied, a celebrated chemist observes that the albumen, gluten, caseine, and other nitrogenized principles of food, supply the animal with the materials requisite for the formation of muscle and cartilage; they are, therefore, called flesh-forming principles. fats, or oily matters of the food, are used to lay on fat, or for the purpose of sustaining respiration. starch, sugar, gum, and a few other non-nitrogenized substances, consisting of carbon, oxygen, and hydrogen, supply the carbon given off in respiration, or they are used for the production of fat. phosphate of lime and magnesia in food principally furnish the animal with the materials of which the bony skeleton of its body consists. saline substances--chlorides of sodium and potassium, sulphate and phosphate of potash and soda, and some other mineral matters occurring in food--supply the blood, juice of flesh, and various animal juices, with the necessary mineral constituents. the healthy state of an animal can thus only be preserved by a mixed food; that is, food which contains all the proximate principles just noticed. starch or sugar alone cannot sustain the animal body, since neither of them furnishes the materials to build up the fleshy parts of the animal. when fed on substances in which an insufficient quantity of phosphates occurs, the animal will become weak, because it does not find any bone-producing principle in its food. due attention should, therefore, be paid by the feeder to the selection of food which contains all the kinds of matter required, nitrogenized as well as non-nitrogenized, and mineral substances; and these should be mixed together in the proportion which experience points out as best for the different kinds of animals, or the particular purpose for which they are kept. relative to the nutrition of cows for dairy purposes, milk may be regarded as a material for the manufacture of butter and cheese; and, according to the purpose for which the milk is intended to be employed, whether for the manufacture of butter or the production of cheese, the cow should be differently fed. butter contains carbon, oxygen, and hydrogen, and no nitrogen. cheese, on the contrary, is rich in nitrogen. food which contains much fatty matter, or substances which in the animal system are readily converted into fat, will tend to increase the proportion of cream in milk. on the other hand, the proportion of caseine or cheesy matter in milk is increased by the use of highly nitrogenized food. those, then, who desire much cream, or who produce cream for the manufacture of butter, select food likely to increase the proportion of butter in the milk. on the contrary, where the principal object is the production of milk rich in curd--that is, where cheese is the object of the farmer--clover, peas, bran-meal, and other plants which abound in legumine--a nitrogenized organic compound, almost identical in properties and composition with caseine, or the substance which forms the curd of milk--will be selected. and so the quality, as well as the quantity, of butter in the milk, depends on the kind of food consumed and on the general health of the animal. cows fed on turnips in the stall always produce butter inferior to that of cows living upon the fresh and aromatic grasses of the pastures. succulent food in which water abounds--the green grass of irrigated meadows, green clover, brewers' and distillers' refuse, and the like--increases the quantity, rather than the quality, of the milk; and by feeding these substances the milk-dairyman studies his own interest, and makes thin milk without diluting it with water--though, in the opinion of some, this may be no more legitimate than watering the milk. but, though the yield of milk may be increased by succulent or watery food, it should be given so as not to interfere with the health of the cow. food rich in starch, gum, or sugar, which are the respiratory elements, an excess of which goes to the production of fatty matters, increases the butter in milk. quietness promotes the secretion of fat in animals and increases the butter. cheese will be increased by food rich in albumen, such as the leguminous plants. [illustration: buying cattle.] the most natural, and of course the healthiest, food for milch cows in summer, is the green grass of the pastures; and when these fail from drought or over-stocking, the complement of nourishment may be made up with green clover, green oats, barley, millet, or corn-fodder and cabbage-leaves, or other succulent vegetables; and if these are wanting, the deficiency may be partly supplied with shorts, indian-meal, linseed or cotton-seed meal. green grass is more nutritious than hay, which always loses somewhat of its nutritive properties in curing; the amount of the loss depending chiefly on the mode of curing, and the length of exposure to sun and rain. but, apart from this, grass is more easily and completely digested than hay, though the digestion of the latter may be greatly aided by cutting and moistening, or steaming; and by this means it is rendered more readily available, and hence far better adapted to promote a large secretion of milk--a fact too often overlooked even by many intelligent farmers. in autumn, the best feed will be the grasses of the pastures, so far as they are available, green-corn fodder, cabbage, carrot, and turnip leaves, and an addition of meal or shorts. toward the middle of autumn, the cows fed in the pastures will require to be housed regularly at night, especially in the more northern latitudes, and put, in part at least, upon hay. but every farmer knows that it is not judicious to feed out the best part of his hay when his cattle are first put into the barn, and that he should not feed so well in the early part of winter that he cannot feed better as the winter advances. at the same time, it should always be borne in mind that the change from grass to a poor quality of hay or straw, for cows in milk, should not be too sudden. a poor quality of dry hay is far less palatable in the early part of winter, after the cows are taken from grass, than at a later period; and, if it is resorted to with milch cows, will invariably lead to a falling off in the milk, which no good feed can afterward wholly restore. it is desirable, therefore, for the farmer to know what can be used instead of his best english or upland meadow hay, and yet not suffer any greater loss in the flow of milk, or in condition, than is absolutely necessary. in some sections of the eastern states, the best quality of swale hay will be used; and the composition of that is as variable as possible, depending on the varieties of the grasses of which it was made, and the manner of curing. but, in other sections, many will find it necessary to use straw and other substitutes. taking good english or meadow hay as the standard of comparison, and calling that one, . times the weight of rye-straw, or . times the weight of oat-straw, contains the same amount of nutritive matter; that is, it would take . times as good rye-straw to produce the same result as good meadow hay. in winter, the best food for cows in milk will be good sweet meadow hay, a part of which should be cut and moistened with water--as all inferior hay or straw should be--with an addition of root-crops, such as turnips, carrots, parsnips, potatoes, mangold-wurtzel, with shorts, oil-cake, indian meal, or bean meal. it is the opinion of most successful dairymen that the feeding of moist food cannot be too highly recommended for cows in milk, especially to those who desire to obtain the largest quantity. hay cut and thoroughly moistened becomes more succulent and nutritive, and partakes more of the nature of green grass. as a substitute for the oil-cake, hitherto known as an exceedingly valuable article for feeding stock, there is probably nothing better than cotton-seed meal. this is an article whose economic value has been but recently made known, but which, from practical trials already made, has proved eminently successful as food for milch cows. chemists have decided that its composition is not inferior to that of the best flaxseed cake, and that in some respects its agricultural value surpasses that of any other kind of oil-cake. it has been remarked by chemists, in this connection, that the great value of linseed-cake, as an adjunct to hay, for fat cattle and milch cows, has been long recognized; and that it is undeniably traceable, in the main, to three ingredients of the seeds of the oil-yielding plants. the value of food depends upon the quantities of matters it contains which may be appropriated by the animal which consumes the food now, it is proved that the fat of animals is derived from the starch, gum, and sugar, and more directly and easily from the oil of the food. these four substances, then, are fat-formers. the muscles, nerves, and tendons of animals, the brine of their blood and the curd of their milk, are almost identical in composition with, and strongly similar in many of their properties to, matters found in all vegetables, but chiefly in such as form the most concentrated food. these blood (and muscle) formers are characterized by containing about fifteen and a half per cent. of nitrogen; and hence are called nitrogenous substances. they are, also, often designated as the albuminous bodies. the bony framework of the animal owes its solidity to phosphate of lime, and this substance must be furnished by the food. a perfect food must supply the animal with these three classes of bodies, and in proper proportions. the addition of a small quantity of a food, rich in oil and albuminous substances, to the ordinary kinds of feed, which contain a large quantity of vegetable fibre or woody matter, more or less indigestible, but, nevertheless, indispensable to the herbivorous animals, their digestive organs being adapted to a bulky food, has been found highly advantageous in practice. neither hay alone nor concentrated food alone gives the best results. a certain combination of the two presents the most advantages. some who have used cotton-seed cake have found difficulty in inducing cattle to eat it. by giving it at first in small doses, mixed with other palatable food, they soon learn to eat it with relish. cotton-seed cake is much richer in oils and albuminous matters than the linseed cake. a correspondingly less quantity will therefore be required. three pounds of this cotton-seed cake are equivalent to four of linseed cake of average quality. during the winter season, as has been already remarked, a frequent change of food is especially necessary, both as contributions to the general health of animals, and as a means of stimulating the digestive organs, and thus increasing the secretion of milk. a mixture used as cut feed and well moistened is now especially beneficial, since concentrated food, which would otherwise be given in small quantities, may be united with larger quantities of coarser and less nutritive food, and the complete assimilation of the whole be better secured. on this subject it has been sensibly observed that the most nutritious kinds of food produce little or no effect when they are not digested by the stomach, or if the digested food is not absorbed by the lymphatic vessels, and not assimilated by the various parts of the body. now, the normal functions of the digestive organs not only depend upon the composition of the food, but also on its volume. the volume or bulk of the food contributes to the healthy action of the digestive organs, by exercising a stimulating effect upon the nerves which govern them. thus the whole organization of ruminating animals necessitates the supply of bulky food, to keep the animal in good condition. feed sweet and nutritious food, therefore, frequently, regularly, and in small quantities, and change it often, and the best results may be confidently anticipated. if the cows are not in milk, but are to come in in the spring, the difference in feeding should be rather in the quantity than the quality, if the highest yield is to be expected from them during the coming season. the most common feeding is hay alone, and oftentimes very poor hay at that. the main point is to keep the animal in a healthy and thriving condition, and not to suffer her to fail in flesh; and with this object, some change and variety of food are highly important. [illustration: calling in the cattle.] toward the close of winter, a herd of cows will begin to come in, or approach their time of calving. care should then be taken not to feed too rich or stimulating food for the last week or two before this event, as it is often attended with ill consequences. a plenty of hay, a few potatoes or shorts, and pure water will suffice. in spring, the best feeding for dairy cows will be much the same as that for winter; the roots in store over winter, such as carrots, mangold wurtzel, turnips, and parsnips, furnishing very valuable aid in increasing the quantity and improving the quality of milk. toward the close of this season, and before the grass of pastures is sufficiently grown to make it judicious to turn out the cows, the best dairymen provide a supply of green fodder in the shape of winter rye, which, if cut while it is tender and succulent, and before it is half grown, will be greatly relished. unless cut young, however, its stalk soon becomes hard and unpalatable. all practical dairymen agree in saying that a warm and well-ventilated barn is indispensable to the promotion of the highest yield of milk in winter; and most agree that cows in milk should not be turned out, even to drink, in cold weather; all exposure to cold tending to lessen the yield of milk. in the london dairies, in which, of course, the cows are fed so as to produce the largest flow of milk, the treatment is as follows: the cows are kept at night in stalls. about three a. m. each has a half-bushel of grains. when milking is finished, each receives a bushel of turnips (or mangolds), and shortly afterward, one tenth of a truss of hay of the best quality. this feeding occurs before eight a. m., when the animals are turned into the yard. four hours after, they are again tied up in their stalls, and have another feed of grains. when the afternoon milking is over (about three p. m.), they are fed with a bushel of turnips, and after the lapse of an hour, hay is given them as before. this mode of feeding usually continues throughout the cool season, or from november to march. during the remaining months they are fed with grains, tares, and cabbages, and a proportion of rowen, or second-cut hay. they are supplied regularly until they are turned out to grass, when they pass the whole of the night in the field. the yield is about six hundred and fifty gallons a year for each cow. mr. harley--whose admirable dairy establishment was erected for the purpose of supplying the city of glasgow with a good quality of milk, and which has contributed more than any thing else to improve the quality of the milk furnished to all the principal cities of great britain--adopted the following system of feeding with the greatest profit: in the early part of the summer, young grass and green barley, the first cutting especially, mixed with a large proportion of old hay or straw, and a good quantity of salt to prevent swelling, were used. as summer advanced, less hay and straw were given, and as the grass approached ripeness, they were discontinued altogether; but young and wet clover was never given without an admixture of dry provender. when grass became scarce, young turnips and turnip leaves were steamed with hay, and formed a good substitute. as grass decreased, the turnips were increased, and at length became a complete substitute. as the season advanced, a large proportion of distillers' grains and wash was given with other food, but these were found to have a tendency to make the cattle grain-sick; and if this feeding were long-continued, the health of the cows became affected. boiled linseed and short-cut wheat straw mixed with the grains, were found to prevent the cows from turning sick. as spring approached, swedish turnips, when cheap, were substituted for yellow turnips. these two roots, steamed with hay and other mixtures, afforded safe food till grass was again in season. when any of the cows were surfeited, the food was withheld till the appetite returned, when a small quantity was given, and increased gradually to the full allowance. but the most elaborate and valuable experiments in the feeding and management of milch cows, are those made, not long since, by mr. t. horsfall, of england, and published in the journal of the royal agricultural society. his practice, though adapted more especially, perhaps, to his own section, is nevertheless of such general application and importance as to be worthy of attention. by his course of treatment he found that he could produce as much and as rich butter in winter as in summer. his first object was to afford a full supply of the elements of food adapted to the maintenance, and also to the produce of the animal; and this could not be effected by the ordinary food and methods of feeding, since it is impossible to induce a cow to consume a quantity of hay requisite to supply the waste of the system, and keep up, at the same time, a full yield of the best quality of milk. he used, to some extent, cabbages, kohl rabi, mangolds, shorts, and other substances, rich in the constituents of cheese and butter. "my food for milch cows," says he, "after having undergone various modifications, has for two seasons consisted of rape cake five pounds, and bran two pounds, for each cow, mixed with a sufficient quantity of bean-straw, oat-straw, and shells of oats, in equal proportions, to supply them three times a day with as much as they will eat. the whole of the materials are moistened and blended together, and, after being well steamed, are given to the animal in a warm state. the attendant is allowed one pound to one pound and a half per cow, according to circumstances, of bean-meal, which he is charged to give to each cow in proportion to the yield of milk; those in full milk getting each two pounds per day, others but little. it is dry, and mixed with the steamed food on its being dealt out separately. when this is eaten up, green food is given, consisting of cabbages, from october to december, kohl rabi till february, and mangold till grass time, with a view to nicety of flavor. i limit the quantity of green food to thirty or thirty-five pounds per day for each. after each feed, four pounds of meadow hay, or twelve pounds per day, is given to each cow. they are allowed water twice a day, to the extent which they will drink." bean-straw uncooked having been found to be hard and unpalatable, it was steamed to make it soft and pulpy, when it possessed an agreeable odor, and imparted its flavor to the whole mass. it was cut for this purpose just before ripening, but after the bean was fully grown, and in this state was found to possess nearly double the amount of albuminous matter, so valuable to milch cows, of good meadow or upland hay. bran or shorts is also vastly improved by steaming or soaking with hot water, when its nutriment is more readily assimilated. it contains about fourteen per cent. of albumen, and is rich in phosphoric acid. rape-cake was found to be exceedingly valuable. linseed and cotton-seed cake may probably be substituted for it in this country. mr. horsfall turned his cows in may into a rich pasture, housing them at night, and giving them a mess of the steamed mixture and some hay morning and night; and from june to october they had cut grass in the stall, besides what they got in the pasture, and two feeds of the steamed mixture a day. after the beginning of october the cows were kept housed. with such management his cows generally yielded from twelve to sixteen quarts of milk (wine measure) a day, for about eight months after calving, when they fell off in milk, but gained in flesh, up to calving-time. in this course of treatment the manure was far better than the average, and his pastures constantly improved. the average amount of butter from every sixteen quarts of milk was twenty-five ounces--a proportion far larger than the average. [illustration: "on the rampage."] how widely does this course of treatment differ from that of most farmers! the object with many seems to be, to see with how little food they can keep the cow alive. from a correct point of view, the milch cow should be regarded as an instrument of transformation. the question should be--with so much hay, so much grain, so many roots, how can the most milk, or butter, or cheese, be made? the conduct of a manufacturer who owned good machinery, and an abundance of raw material, and had the labor at hand, would be considered very senseless, if he hesitated to supply the material, and keep the machinery at work, at least so long as he could run it with profit. stimulate the appetite, then, and induce the cow to eat, by a frequent change of diet, not merely enough to supply the constant waste of her system, but enough and to spare, of a food adapted to the production of milk of the quality desired. soiling. of the advantages of soiling milch cows--that is, feeding exclusively in the barn--there are yet many conflicting opinions. as to its economy of land and feed there can be no question, it being generally admitted that a given number of animals may be abundantly fed on a less space; nor is there much question as to the increased quantity of milk yielded in stall feeding. its economy, in this country, turns rather upon the cost of labor and time; and the question raised by the dairyman is, whether it will pay--whether its advantages are sufficient to balance the extra expense of cutting and feeding, over and above cropping on the pasture. the importance of this subject has been strongly impressed upon the attention of farmers in many sections of the country, by a growing conviction that something must be done to improve the pastures, or that they must be abandoned altogether. thousands of acres of neglected pasture-land in the older states are so poor and worn out that from four to eight acres furnish but a miserable subsistence for a good-sized cow. no animal can flourish under such circumstances. the labor and exertion of feeding are too great, to say nothing of the vastly inferior quality of the grasses in such pastures, compared with those on more recently seeded lands. true economy would dictate that such pastures should either be allowed to run to wood, or be devoted to sheep-walks, or ploughed and improved. cows, to be able to yield well, must have plenty of food of a sweet and nutritious quality; and, unless they find it, they wander over a large space, if at liberty, and thus deprive themselves of rest. if a farmer or dairyman unfortunately owns such pastures, there can be no question that, as a matter of real economy, he had better resort to the soiling system for his milch cows; by which means he will largely increase his annual supply of good manure, and thus have the means of improving, and bringing his land to a higher state of cultivation. a very successful instance of this management occurs in the report of the visiting committee of an agricultural society in massachusetts, in which they say: "we have now in mind a farmer in this county who keeps seven or eight cows in the stable through the summer, and feeds them on green fodder, chiefly indian corn. we asked him his reasons for it. his answer was: . that he gets more milk than he can by any other method. . that he gets more manure, especially liquid manure. . that he saves it all, by keeping a supply of mud or mould under the stable, to be taken out and renewed as often as necessary. . that it is less troublesome than to drive his cows to pasture; that they are less vexed by flies, and have equally good health. . that his mowing land is every year growing more productive, without the expense of artificial manure.--he estimates that on an acre of good land twenty tons of green fodder may be raised. that which is dried is cut fine, and mixed with meal or shorts, and fed with profit. he believes that a reduced and worn-out farm--supposing the land to be naturally good--could be brought into prime order in five years, without any extra outlay of money for manure, by the use of green fodder in connection with the raising and keeping of pigs; not fattening them, but selling at the age of four or five months." he keeps most of his land in grass, improving its quality and productiveness by means of top-dressing, and putting money in his pocket--which is, after all, the true test both for theory and practice. another practical case on this point is that of a gentleman in the same state who had four cows, but not a rod of land on which to pasture them. they were, therefore, never out of the barn--or, at least, not out of the yard--and were fed with grass, regularly mown for them; with green indian corn and fodder, which had been sown broadcast for the purpose; and with about three pints of meal a day. their produce in butter was kept for thirteen weeks. two of them were but two years old, having calved the same spring. all the milk of one of them was taken by her calf for six weeks out of the thirteen, and some of the milk of the other was taken for family use, the quantity of which was not measured. these heifers could not, therefore, be estimated as equal to more than one cow in full milk. and yet from these cows no less than three hundred and eighty-nine pounds of butter were made in the thirteen weeks. another pound would have made an average of thirty pounds a week for the whole time. it appears from these and other similar instances of soiling, or stall-feeding in summer on green crops cut for the purpose, that the largely increased quantity of the yield fully compensates for the slightly deteriorated quality. and not only is the quantity yielded by each cow increased, but the same extent of land, under the same culture, will carry double or treble the number of ordinary pastures, and keep them in better condition. there is also a saving of manure. but with us the economy of soiling is the exception, and not the rule. in adopting this system of feeding, regularity is required as much as in any other, and a proper variety of food. a succession of green crops should be provided, as near as convenient to the stable. the first will naturally be winter rye, in the northern states, as that shoots up with great luxuriance. winter rape would probably be an exceedingly valuable addition to the plants usually cultivated for soiling in this country, in sections where it would withstand the severity of the winter. cabbages, kept in the cellar or pit, and transplanted early, will also come in here to advantage, and clover will very soon follow them; oats, millet, and green indian-corn, as the season advances; and, a little later still, perhaps, the chinese sugar-cane, which should not be cut till headed out. these plants, in addition to other cultivated grasses, will furnish an unfailing succession of succulent and tender fodder; while the addition of a little indian, linseed, or cotton-seed meal will be found economical. in the vicinity of large towns and cities, where the object is too often to feed for the largest quantity, without reference to quality, an article known as distillers' swill, or still-slop, is extensively used. this, if properly fed in limited quantities, in combination with other and more bulky food, may be a valuable article for the dairyman; but, if given--as it too often is--without the addition of other kinds of food, it soon affects the health and constitution of the animals fed on it. this swill contains a considerable quantity of water, some nitrogenous compounds, and some inorganic matter in the shape of phosphates and alkaline salts found in the different kinds of grain of which it is made up, as indian corn, wheat, barley, rye, and the like. where this forms the principal food of milch cows, the milk is of a very poor quality--blue in color, and requiring the addition of coloring substances to make it saleable. it contains, often, less than one per cent. of butter, and seldom over one and three-tenths or one and a half per cent.--while good, saleable milk should contain from three to five per cent. it will not coagulate, it is said, in less than five or six hours; while good milk will invariably coagulate in an hour or less, under the same conditions. its effect on the system of young children is, therefore, very destructive, causing diseases of various kinds, and, if continued, death. so pernicious have been the consequences resulting from the use of this "swill-milk," as it is called, in the largest city of this country, that the legislature of the state of new york, at a recent session ( - ), interfered in behalf of the community by making the sale of the article a penal offence. culture of grasses for fodder. as has been already stated, the grasses in summer, and hay in winter, form the most natural and important food for milch cows; and, whatever other crops come in as additional, these will form the basis of all systems of feeding. the nutritive qualities of the grasses differ widely; and their value as feed for cows will depend, to a considerable extent, on the management of pastures and mowing-lands. some considerations bearing upon the subject of the proper cultivation of these leading articles of food are, therefore, proposed in this article. [illustration: patiently waiting.] if the turf of an old pasture is carefully examined, it will be found to contain a large variety of plants and grasses adapted for forage; some of them valuable for one purpose, and some for another. some of them, though possessing a lower percentage of nutritive constituents than others, are particularly esteemed for an early and luxuriant growth, furnishing sweet feed in early spring, before other grasses appear; some of them, for starting more rapidly than others, after having been eaten off by cattle, and, consequently, of great value as pasture grasses. most grasses will be found to be of a social character, and do best in a large mixture with other varieties. in forming a mixture for pasture grasses, the peculiar qualities of each species should, therefore, be regarded: as the time of flowering, the habits of growth, the soil and location on which it grows best, and other characteristics. among the grasses found on cultivated lands in this country, the following are considered as among the most valuable for ordinary farm cultivation; some of them being adapted to pastures, and others almost exclusively to mowing and the hay-crop: timothy, meadow foxtail, june or kentucky blue grass, fowl meadow, rough-stalked meadow, orchard grass, perennial rye grass, italian rye grass, redtop, english bent, meadow fescue, tall oat grass, sweet-scented vernal, hungarian grass, red clover, white or dutch clover, and some others. of these, the most valuable, all things considered, is timothy. it forms a large proportion of what is commonly called english, or in some sections meadow, hay, though it originated and was first cultivated in this country. it contains a large percentage of nutritive matter, in comparison with other agricultural grasses. it thrives best on moist, peaty, or loamy soils, of medium tenacity, and is not well suited to very light, sandy lands. on very moist soils, its root is almost always fibrous; while on dry and loamy ones it is bulbous. on soils of the former description, which it especially affects, its growth is rapid, and its yield of hay large, sometimes amounting to three or four tons the acre, depending much, of course, upon cultivation. but, though very valuable for hay, it is not adapted for pasture, as it will neither endure severe grazing, nor is its aftermath to be compared with that of meadow foxtail, and some of the other grasses. june grass, better known in some sections as kentucky blue grass, is very common in most sections of the country, especially on limestone lands, forming a large part of the turf, wherever it flourishes, and being held in universal esteem as a pasture grass. it starts early, but varies much in size and appearance, according to the soil; growing in some places with the utmost luxuriance, and forming the predominant grass; in others, yielding to the other species. if cut at the time of flowering, or a few days after, it makes a good and nutritious hay, though it is surpassed in nutritive qualities by several of the other grasses. it starts slowly after having been cut, especially if not cut very early. but its herbage is fine and uniform, and admirably adapted to lawns, growing well in almost all soils, though it does not endure very severe droughts. it withstands, however, the frosts of winter better than most other grasses. in kentucky--a section where it attains its highest perfection and luxuriance, ripening its seeds about the tenth of june--and in latitudes south of that, it sometimes continues green through the mild winters. it requires three or four years to become well set, after sowing, and it does not attain its highest yield as a pasture grass till the sod is even older than that. it is not, therefore, suited to alternate husbandry, where land usually remains in grass but two or three years before being ploughed up. in kentucky, it is sown any time in winter when the sun is on the ground, three or four quarts of seed being used to the acre. in spring the seeds germinate, when the sprouts are exceedingly fine and delicate. stock is not allowed on it the first year. the meadow foxtail is also an excellent pasture grass it somewhat resembles timothy, but is earlier, has a softer spike, and thrives on all soils except the dryest. its growth is rapid, and it is greatly relished by stock of all kinds. its stalks and leaves are too few and light for a field crop, and it shrinks too much in curing to be valuable for hay. it flourishes best in a rich, moist, and rather strong soil, sending up a luxuriant aftermath when cut or grazed off, which is much more valuable, both in quality and nutritive value, than the first crop. in all lands designed for permanent pasture, therefore, it should form a considerable part of a mixture. it will endure almost any amount of forcing, by liquid manures or irrigation. it requires three or four years, after soiling, to gain a firm footing in the soil. the seed is covered with the soft and woolly husks of the flower, and is consequently light; weighing but five pounds to the bushel, and containing seventy-six thousand seeds to the ounce. the orchard grass, or rough cocksfoot, for pastures, stands pre-eminent. this is a native of this country, and was introduced into england, from virginia, in , since which time its cultivation has extended into every country of europe, where it is universally held in very high estimation. the fact of its being very palatable to stock of all kinds, its rapid growth, and the luxuriance of its aftermath, with its power of enduring the cropping of cattle, have given it a very high reputation, especially as a pasture grass. it blossoms earlier than timothy; when green, is equally relished by milch cows; requires to be fed closer, to prevent its forming tufts and growing up to seed, when it becomes hard and wiry, and loses much of its nutritive quality. as it blossoms about the same time, it forms an admirable mixture with red clover, either for permanent pasture or mowing. it resists drought, and is less exhausting to the soil than either rye grass or timothy. the seed weighs twelve pounds to the bushel, and when sown alone requires about two bushels to the acre. the rough-stalked meadow grass is somewhat less common than the june grass, but is considered equally valuable. it grows best on moist, sheltered meadows, where it flowers in june and july. it is readily distinguished from june grass by its having a rough sheath, while the latter has a smooth one, and by having a fibrous root, while the root of the other is creeping. it possesses very considerable nutritive qualities, and comes to perfection at a desirable time, and is exceedingly relished by cattle, horses and sheep. for suitable soils it should form a portion of a mixture of seeds, producing, in mixture with other grasses which serve to shelter it, a large yield of hay, far above the average of grass usually sown on a similar soil. it should be cut when the seed is formed. seven pounds of seed to the acre will make a good sward. the grass loses about seventy per cent. of its weight in drying. the nutritive qualities of its aftermath exceed very considerably those of the crop cut in the flower or in the seed. fowl meadow grass is another indigenous species, of great value for low and marshy grounds, where it flourishes best; and, if cut and properly cured, makes a sweet and nutritious hay, which, from its fineness, is eaten by cows without waste. according to sinclair--who experimented, with the aid of sir humphrey davy, to ascertain its comparative nutritive properties--it is superior in this respect to either meadow foxtail, orchard grass, or tall meadow oat grass; but it is probable that he somewhat overrates it. if allowed to stand till nearly ripe, it falls down, but sends up innumerable flowering stems from the joints, so that it continues green and luxuriant till late in the season. it thrives best in mixture with other grasses, and deserves a prominent place in all mixtures for rich, moist pastures, and low mowing-lands. rye grass has a far higher reputation abroad than in this country, and probably with reason; for it is better adapted to a wet and uncertain climate than to a dry and hot one. it varies exceedingly, depending much on soil and culture; but, when cut in the blossom to make into hay, it possesses very considerable nutritive power. if allowed to get too ripe, it is hard and wiry, and not relished by cows. the change from a juicy and nutritious plant to a woody fibre, containing but little soluble matter, is very rapid. properly managed, however, it is a tolerably good grass, though not to be compared to timothy, or orchard grass. redtop is a grass familiar to every farmer in the country. it is the herd's grass of pennsylvania, while in new york and new england it is known by a great variety of names and assumes a great variety of forms, according to the soil in which it grows. it is well adapted to almost every soil, though it seems to prefer a moist loam. it makes a profitable crop for spending, in the form of hay, though its yield is less than that of timothy. it is well suited to our permanent pastures, where it should be fed close, otherwise it becomes wiry and innutritious, and cattle refuse it. it stands the climate of the country as well as any other grass, and so forms a valuable part of any mixture for pastures and permanent mowing-lands; but it is, probably, rather over rated by us. english bent, known also by a number of other names, is largely cultivated in some sections. it closely resembles redtop, but may be distinguished from it by the roughness of the sheaths when the hand is drawn from above downward. it possesses about the same qualities as redtop. meadow fescue is one of the most common of the fescue grasses, and is said to be the randall grass of virginia. it is an excellent pasture grass, forming a very considerable portion of the turf of old pasture lands and fields; and is more extensively propagated and diffused from the fact that it ripens its seeds before most other grasses are cut, and sheds them to spring up and cover the ground. its long and tender leaves are much relished by cattle. it is rarely sown in this country, notwithstanding its great and acknowledged value as a pasture grass. if sown at all, it should be in mixture with other grasses, as orchard grass, and rye grass, or june grass. it is of much greater value at the time of flowering than when the seed is ripe. [illustration: a chance for a selection.] the tall oat grass is the ray grass of france. it furnishes a luxuriant supply of foliage, is valuable either for hay or for pasture, and has been especially recommended for soiling purposes, on account of its early and luxuriant growth. it is often found on the borders of fields and hedges, woods and pastures, and is sometimes very plenty in mowing-lands. after having been mown it shoots up a very thick aftermath, and, on this account, partly, is regarded of nearly equal excellence with the common foxtail. it grows spontaneously on deep, sandy soils, when once naturalized. it has been cultivated to a considerable extent in this country, and is esteemed by those who know it mainly for its early, rapid, and late growth, making it very well calculated as a permanent pasture grass. it will succeed on tenacious clover soil. the sweet-scented vernal grass is one of the earliest in spring and one of the latest in autumn; and this habit of growth is one of its chief excellencies, as it is neither a nutritious grass, nor very palatable to stock of any kind, nor does it yield a very good crop. it is very common in new england and all over the middle states, coming into old worn-out fields and moist pastures spontaneously, and along every roadside. it derives its name from its sweetness of odor when partially wilted or crushed in the hand, and it is this chiefly which gives the delicious fragrance to all new-mown bay. it is almost the only grass that possesses a strongly-marked aromatic odor, which is imparted to other grasses with which it is cured. its seed weighs eight pounds to the bushel. in mixtures for permanent pastures it may be of some value. hungarian grass, or millet, is an annual forage plant, introduced into france in , and more recently into this country. it germinates readily, and withstands the drought remarkably, remaining green when other grasses are parched and dried up. it has numerous succulent leaves which furnish an abundance of sweet fodder, greatly relished by stock of all kinds. it attains its greatest luxuriance on soils of medium consistency and richness, but does very well on light and dry plains. red clover is an artificial grass of the leguminous family, and one of the most valuable cultivated plants for feeding to dairy cows. it flourishes best on tenacious soils and stiff loams. its growth is rapid, and a few months after sowing are sufficient to supply an abundant sweet and nutritious food. in the climate of new england, clover should be sown in the spring of the year, while most of the natural grasses do far better when sown in the fall. it is often sown with perfect success on the late snows of march or april, and soon finds its way down into the soil and takes a vigorous hold with its root. it is valuable not only as a forage plant, but as shading the ground, and thereby increasing its fertility. the introduction of clover among the cultivated plants of the farm has done more, perhaps, for modern agriculture than that of any other single plant. it is now considered indispensable in all good dairy districts. white clover, often called honeysuckle, is also widely diffused over this country, to which it is undoubtedly indigenous. as a mixture in all pasture grasses it holds a very high rank, as it is exceedingly sweet and nutritious, and relished by all kinds of stock. it grows most luxuriantly in moist grounds and moist seasons, but easily accommodates itself to a great variety of circumstances. with respect to the mixtures of grass-seeds most profitable for the dairy farmer, no universal rule can be given, as they depend very much upon the nature of the soil and the locality. the most important point to be observed, and the one as to which, probably, the greatest deficiency exists, is to use a large number of species, with smaller quantities of each than those most commonly used. this is nature's rule; for, in examining the turf of a rich old pasture, a large number of different species will be found growing together, while, if the turf of a field sown without two or three species is examined, a far less number of plants is found to the square foot, even after the sod is fairly set. in the opinion of the most competent judges, no improvement in grass culture is more important than this. as an instance of what he would consider an improvement on the ordinary mixtures for _permanent pastures_, mr. flint, in his "milch cows and dairy farming," suggests the following as likely to give satisfactory results, dependent, of course, to a considerable extent, on the nature and preparation of the soil: meadow foxtail, flowering in may and june, pounds orchard grass, " " " " " sweet-scented vernal, " " april and may, " meadow fescue, " " may and june, " redtop, " " june and july, " june grass, " " may and june, " italian rye grass, " " june, " perennial do., " " " " " timothy, " " june and july, " rough-stalked meadow grass, " " " perennial clover, flowering in june, " white clover, " " may to september - " for mowing-lands the mixture would, of course, be somewhat changed. the meadow foxtail and sweet-scented vernal would be left out entirely, and some six or eight pounds added to the timothy and red clover. the proper time to lay down lands to grass in the latitude of new england is august or september, and no grain crop should be sown with the seed. stiff or clayey pastures should never be overstocked, but when fed pretty close the grasses are far sweeter and more nutritious than when they are allowed to grow up rank and coarse; and if, by a want of sufficient feeding, they get the start of the stock, and grow into rank tufts, they should be cut and removed, when a fresh grass will start up, similar to the aftermath of mowing-lands, which will be eaten with avidity. grasses for curing into hay should be cut either at the time of flowering, or just before, especially if designed for milch cows. they are then more succulent and juicy, and, if properly cured, form the sweetest food. grass cut in the blossom will make more milk than if allowed to stand later. cut a little before the blossoming; it will make more than when in blossom, and the cows prefer it, which is by no means an unimportant consideration, since their tastes should always be consulted. grass cut somewhat green, and properly cured, is next to fresh, green grass in palatable, nutritive qualities. every farmer knows the milk-producing properties of rowen, or second crop, which is generally cut before it ripens. no operation on the farm is of greater importance to the dairyman than the cutting of his grass and the manner of curing hay; and in this respect the practice over the country generally is susceptible of very marked improvement. the chief object is to preserve the sweetness and succulence of the grass in its natural state, so far as possible; and this object cannot be attained by exposing it too long to the scorching suns and drenching rains to which our climate is liable. as a general thing, farmers try to make their hay too much. as to the best modes of curing clover, the following, among others, is adopted by many successful farmers: what is mown in the morning is left in the swath, to be turned over early in the afternoon. at about four o'clock, or while it is still warm, it is put into small cocks with a fork, and, if the weather is favorable, it may be housed on the fourth or fifth day, the cocks being turned over on the morning of the day in which it is to be carted. by this method all the heads and leaves are saved, and these are more valuable than the stems. for new milch cows in winter scarcely any food is better. it will cause them to give as great a flow of milk as any hay, unless it be good rowen. indian corn makes an exceedingly valuable fodder, both as a means of carrying a herd of milch cows through our severe droughts of summer, and as an article for soiling cows kept in the stall. no dairy farmer will neglect to sow an extent in proportion to the number of cows which he keeps. the most common practice is, to sow in drills from two and a half to three feet apart, on land well tilled and thoroughly manured, making the drills from six to ten inches wide with the plough, manuring in the furrow, dropping the kernels about two inches apart, and covering with the hoe. in this mode of culture, the cultivator may be used between the rows when the corn is from six to twelve inches high, and, unless the ground is very weedy, no other after culture is needed. the first sowing usually takes place about the middle of may, and this is succeeded by other sowings, at intervals of a week or ten days, till july, in order to have a succession of green fodder; but, if it is designed to cut it up to cure for winter use, an early sowing is generally preferred, in order to be able to cure it in warm weather, in august or early in september. sown in this way, about three or four bushels of corn are required for an acre; since, if sown thickly, the fodder is better, the stalks smaller, and the waste less. the chief difficulty in curing corn cultivated for this purpose, and after the methods just spoken of, arises from the fact that it comes at a season when the weather is often colder, the days shorter, and the dews heavier, than when the curing of hay takes place. nor is the curing of corn cut up green so easy and simple as that of the drying of stalks of indian corn cut above the ear, as in the common practice of topping. the plant is then riper, less juicy, and cures more readily. the method sometimes adopted is to cut and tie into small bundles, after it is somewhat wilted, and then to stook upon the ground, where it is allowed to stand, subject to all the changes of weather, with only the protection of the stook itself. the stooks consist of bunches of stalks first bound into small bundles, and are made sufficiently large to prevent the wind from blowing them over. the arms are thrown around the tops to bring them as closely together as possible, when the tops are broken over or twisted together, or otherwise fastened, in order to make the stook "shed the rain" as well as possible. in this condition they remain out until they are sufficiently dried to be put in the barn. corn fodder is very excellent for young dairy stock. common millet is another very valuable crop for fodder in soiling, or to cure for winter use, but especially to feed out during the usual season of drought. many varieties of millet are cultivated in this country, the ground being prepared and treated as for oats. if designed to cut for green fodder, half a bushel of seed to the acre should be used; if to ripen seed, twelve quarts, sown broadcast, about the last of may or early in june. a moist loam or muck is the best soil adapted to millet; but very great crops have been grown on dry upland. it is very palatable and nutritious for milch cows, both green and when properly cured. the curing should be very much like that of clover, care being taken not to over-dry it. for fodder, either green or cured, it is cut before ripening. in this state all cattle eat it as readily as green corn, and a less extent will feed them. millet is worthy of a widely-extended cultivation, particularly on dairy farms. indian millet is another cultivated variety. rye, as a fodder plant, is chiefly valuable for its early growth in spring. it is usually sown in september or october--from the middle to the end of september being, perhaps, the most desirable time--on land previously cultivated and in good condition. if designed to ripen only, a bushel of seed is required to the acre, evenly sown; but, if intended for early fodder in spring, two or two and a half bushels of seed per acre should be used. on warm land the rye can be cut green the last of april or the first of may. care should be taken to cut early; since, if it is allowed to advance too far towards maturity, the stalk becomes hard and unpalatable to cows. oats are also sometimes used for soiling, or for feeding green, to eke out a scanty supply of pasture feed; and for this purpose they are valuable. they should be sown on well-tilled and well-manured land, about four bushels to the acre, towards the last of april or the first of may. if the whole crop is to be used as green fodder, five bushels of seed will not be too much for good, strong soil. they will be sufficiently grown to cut by the first of july, or in some sections earlier, depending upon the location. the chinese sugar-cane also may deserve attention as a fodder plant. experiments thus far made would seem to show that when properly cultivated, and cut at the right time, it is a palatable and nutritious plant, while many of the failures have been the result of too early cutting. for a fodder crop the drill culture is preferable, both on account of the larger yield obtained and because it is thus prevented from becoming too hard and stalky. of the root crops the potato is the first to be mentioned. this produces a large quantity of milk, though the quality is inferior. the market value of this root is, at times, too great to allow of feeding extensively with it, even in milk dairies, where it is most valuable as a food for cows; still, there are locations where it may be judicious to cultivate this root for dairy feed, and in all circumstances there is a certain portion of the crop of unmarketable size, which will be of value fed to milch cows or swine. it should be planted in april or may, but in many sections in june, on good mellow soil, first thoroughly plowed and harrowed, then furrowed three feet apart, and manured in the furrows with a mixture of ashes, plaster of paris, and salt. the seed may be dropped in the furrows, one foot apart, after the drill system--or in hills, two and a half or three feet apart--to be covered with the plough by simply turning the furrows back, after which the whole should be rolled with the field-roller, when it can be done. if the land is not already in good heart from continued cultivation, a few loads of barnyard manure may be spread, and plowed under, by the first plowing. used in this way it is far less liable to cause the rot, than when it is put in the hill. if a sufficient quantity of wood-ashes is not at hand, sifted coal-ashes will answer the purpose, and these are said to be valuable as a preventive of rot. in this way, one man, two boys, and a horse can plant from three to four acres a day on mellow land. by another method two acres a day on the sod have been planted. the manure is first spread upon the grass, and then a furrow made by a yoke of oxen and one man, another following after and dropping, a foot apart, along the outer edge of the furrow on the grass. by quick work, one hand can nearly keep up with the plow in dropping. when arrived at the end of the piece, a back furrow is turned up to the potatoes, and a good plowman will cover nearly all without difficulty. on the return furrow, the man or boy who dropped follows after, covering up any that may be left or displaced, and smoothing off the top of the back-furrows when necessary. potatoes thus planted have come out finely. the cost of cultivation in this mode, it must be evident, is but trifling, compared with the slower method of hand-planting. it requires a skillful ploughman, a quick, active lad, and a good yoke of oxen, and the extent of the work will depend somewhat upon the state of the turf. the nutritive equivalent for potatoes in a hundred pounds of good hay is pounds; that is, it will take . pounds of potatoes to afford the same amount of nourishment as one pound of hay. the great value of roots is as a change or condiment calculated to keep the animal in a healthy condition. [illustration: a west highland ox.] the carrot is somewhat extensively fed, and is a valuable root for milch cows. this, like the potato, has been cultivated and improved from a wild plant. carrots require a deep, warm, mellow soil, thoroughly cultivated, but clean, and free from weed-seed. the difference between a very good profit and a loss on the crop depends much upon the use of land and manures perfectly free from foul seeds of any kind. ashes, guano, seaweed, ground bones, and other similar substances, or thoroughly-rotted and fermented compost, will answer the purpose. after plowing deep, and harrowing carefully, the seed should be planted with a seed-sower, in drills about eighteen inches apart, at the rate of four pounds to the acre, about the middle of may. the difference between sowing on the fifteenth of may and on the tenth of june in new england is said to be nearly one-third in the crop on an average of years. in weeding, a little wheel hoe is invaluable, as with it a large part of the labor of cultivation is saved. a skillful hand can run this hoe within a half an inch of the young plants without injury, and go over a large space in the course of a day, if the land was properly prepared in the first place. the american farmer should always plan to economize labor, which is the great item of expense upon a farm. by this is not meant that he should strive to shirk or avoid work, but that he should make the least amount of work accomplish the greatest and most profitable results. labor-saving machinery on the farm is applied, not to reduce the number of hours of labor, or to make the owner a man of leisure--who is, generally, the unhappiest man in the world--but to enable him to accomplish the greatest results in the same time that he would be compelled to obtain smaller ones. carrots will continue to grow and increase in size late into the fall. when ready to dig, plow around as near to the outside rows as possible, turning away the furrow from the row. then take out the carrots, pulling off the tops, and throw the carrots and tops into separate heaps on the plowed furrows. in this way a man and two boys can harvest and put into the cellar upwards of a hundred bushels a day. the turnip, and the swedish turnip, or ruta baga, are also largely cultivated as a field crop to feed to stock; and for this purpose almost numberless varieties are used, furnishing a great amount of succulent and nutritious food, late into winter, and, if well-kept, late into spring. the chief objection to the turnip is, that it taints the milk. this may be remedied--to a considerable extent, if not wholly--by the use of salt, or salt hay, and by feeding at the time of milking, or immediately after, or by steaming before feeding, or putting a small quantity of the solution of nitre into the pail, and milking upon it. turnips may be sown any time in june, in rich land, well mellowed by cultivation. very large crops are obtained, sown as late as the middle of july, or the first of august, on an inverted sod. the michigan, or double-mould-board plow leaves the land light, and in admirable condition to harrow, and drill in turnips. in one instance, a successful root-grower cut two tons of hay to the acre, on the twenty-third of june, and after it was removed from the land spread eight cords of rotten kelp to the acre, and plowed in; after which about three cords of fine old compost manure were used to the acre, which was sown with ruta baga seed, in drills, three feet apart, plants thinned to eight or ten inches in the drill. no after cultivation was required. on the fifteenth of november he harvested three hundred and seventy bushels of splendid roots to the acre, carefully measured off. the nutritive equivalent of swedish turnips as compared with good meadow hay is , taking hay as a standard at ; that is, it would require . pounds of turnips to furnish the same nutriment as one pound of good hay; but fed in connection with other food--as hay, for example--perhaps five pounds of turnips would be about equal to one pound of hay. the english or round turnip is usually sown broadcast after some other crop, and large and valuable returns are often obtained. the swede is sown in drills. both of these varieties are used for the production of milk. the chief objection to the turnip crop is that it leaves many kinds of soil unfit for a succession of some other crops, like indian corn, for instance. in some sections, no amount of manuring appears to make corn do well after turnips or ruta bagas. the mangold wurtzel, a variety of the common beet, is often cultivated in this country with great success, and fed to cows with advantage, furnishing a succulent and nutritive food in winter and spring. the crop is somewhat uncertain. when it does well, an enormous yield is often obtained; but, not rarely, it proves a failure, and is not, on the whole, quite as reliable as the ruta baga, though a more valuable crop when the yield is good. it is cultivated like the common beet in moist, rich soils; three pounds of seed to the acre the leaves may be stripped off, towards fall, and fed out, without injury to the growth of the root. both mangolds and turnips should be cut with a root-cutter, before being fed out. the parsnip is a very sweet and nutritious article of fodder, and adds richness and flavor to the milk. it is worthy of extended culture in all parts of the country where dairy husbandry is pursued. it is a biennial, easily raised on deep, rich, well-cultivated and well-manured soils, often yielding enormous crops, and possessing the decided advantage of withstanding the severest winters. as an article of spring feeding, therefore, it is exceedingly valuable. sown in april or may, it attains a large growth before winter. then, if desirable, a part of the crop may be harvested for winter use, and the remainder left in the ground till the frost is out, in march or april, when they can be dug as wanted, and are exceedingly relished by milch cows and stock of all kinds. they make an admirable feed at the time of milking, and produce the richest cream, and the yellowest and finest-flavored butter, of any roots used among us. the best dairy farmers on the island of jersey often feed to their cows from thirty to thirty-five pounds of parsnips a day, in addition to hay or grass. both practical experiment and scientific analysis prove this root to be eminently adapted to dairy stock, where the richness of milk or fine-flavored butter is any object. for mere milk-dairies, it is not quite so valuable, probably, as the swedish turnip. the culture is similar to that of carrots, a rich, mellow, and deep loam being best; while it has a great advantage over the carrot in being more hardy, and rather less liable to injury from insects, and more nutritive. for feeding and fattening stock it is eminently adapted. to be sure of a crop, fresh seed must be had, as it cannot be depended on for more than one year. for this reason the largest and straightest roots should be allowed to stand for seed, which, as soon as nearly ripe, should be taken out and spread out to dry, and carefully kept for use. for field culture, the hollow-crowned parsnip is the best and most profitable; but on thin, shallow soils the turnip-rooted variety should be used. parsnips may be harvested like carrots, by plowing along the rows. let butter or cheese dairymen give this crop a fair and full trial, and watch its effect in the quality of the milk and butter. the kohl rabi is also cultivated to a considerable extent in this country for the purpose of feeding stock. it is supposed to be a hybrid between the cabbage and the turnip and is often called the cabbage-turnip, having the root of the former, with a turnip-like or bulbous stem. the special reason for its more extensive cultivation among us is its wonderful indifference to droughts, in which it seems to flourish best, and to bring forth the most luxuriant crops. it also withstands the frosts remarkably, being a hardy plant. it yields a somewhat richer quality of milk than the ordinary turnip, and the crop is generally admitted to be as abundant and profitable. very large crops of it have been produced by the ordinary turnip or cabbage cultivation. as in cabbage-culture, it is best to sow the seed in march or april, in a warm and well-enriched seed-bed; from which it is transplanted in may, and set out after the manner of cabbages in garden culture. it bears transplanting better than most other roots. insects injure it less than the turnip, dry weather favors it, and it keeps well through winter. for these reasons, it must be regarded as a valuable addition to our list of forage plants adapted to dairy farming. it grows well on stronger soils than the turnip requires. linseed meal is the ground cake of flaxseed after the oil is pressed out. it is very rich in fat-forming principles, and given to milch cows increases the quality of butter, and keeps them in condition. four or five pounds a day are sufficient for cows in milk, and this amount will effect a great saving in the cost of other food, and at the same time make a very rich milk. it is extensively manufactured in this country, and largely exported, but it is worthy of more general use here. it must not be fed in too large quantities to milch cows, for it would be liable to give too great a tendency to fat, and thus affect the quantity of the milk. cotton-seed meal is an article of comparatively recent introduction. it is obtained by pressing the seed of the cotton-plant, which extracts the oil, when the cake is crushed or ground into meal, which has been found to be a very valuable article for feeding stock. from analysis it is shown to be equal or superior to linseed meal. practical experiments only are needed to establish it. it can be procured in market at a reasonable price. the manures used in this country for the culture of the above named plants are mostly such as are made on the farm, consisting chiefly of barnyard composts of various kinds, with often a large admixture of peat-mud. there are few farms that do not contain substances, which, if properly husbanded, would add very greatly to the amount of manure ordinarily made. the best of the concentrated manures, which it is sometimes necessary to use, for want of time and labor to prepare enough upon the farm, is, unquestionably, peruvian guano. the results of this, when properly applied, are well known and reliable, which can hardly be said of any other artificial manure offered for the farmer's notice. the chief objection to depending upon manures made off the farm is, in the first place, their great expense; and in the second--which is equally important--the fact, that, though they may be made valuable, and produce at one time the best results, a want of care in the manufacture, or designed fraud, may make them almost worthless, with the impossibility of detecting the imposition, without a chemical analysis, till it becomes too late, and the crop is lost. it is, therefore, safest to rely mainly upon the home manufacture of manure. the extra expense of soiling cattle, saving and applying the liquid manure, and thus bringing the land to a higher state of cultivation, when it will be capable of keeping more stock and furnishing more manure, would offer a surer road to success than a constant outlay for concentrated fertilizers. the barn. the farm barn, next to the farm house, is the most important structure of the farm itself, in the northern and middle states; and even at the south and southwest, where barns are less used, they are of more importance in the economy of farm management than is generally understood. indeed, to the eyes of a person of taste, a farm or plantation appears incomplete, without good barn accommodations, as much as without good household appointments--and without them, no agricultural establishment can be complete in all its proper economy. the most _thorough_ barn structures, perhaps, to be seen in the united states, are those of the state of pennsylvania, built by the german farmers of the lower and central counties. they are large, and expensive in their construction; and, in a strictly economical point of view, are, perhaps, more costly than is required. yet, there is a substantial durability about them, that is exceedingly satisfactory, and, where the pecuniary ability of the farmer will admit, they may well furnish models for imitation. in the structure of the barn, and in its interior accommodation, much will depend upon the branches of agriculture to which the farm is devoted. a farm cultivated in grain chiefly requires but little room for stabling purposes. storage for grain in the sheaf, and granaries, will require its room; while a stock farm requires a barn with extensive hay storage, and stables for its cattle, horses, and sheep, in all climates which do not admit of such stocks living through the winter in the field, as is the case in the great grazing districts west of the alleghanies. again, there are wide districts of country where a mixed husbandry of grain and stock is pursued, which require barns and outbuildings accommodating both. it may be well here to remark that many designers of barns, sheds, and other outbuildings for the accommodation of farm stock, have indulged in fanciful arrangements for the comfort and convenience of animals, which are so complicated that when constructed, as they sometimes are, the practical, common-sense farmer will not use them; and by reason of the learning which is required for their use, they are altogether unsuitable for the treatment and use which they generally receive from those who have the daily care of the stock for which they are intended, and for the rough usage which they experience from the animals themselves. a very pretty and plausible arrangement of stabling, feeding, and all the other requirements of a barn establishment may be thus got up by an ingenious theorist at the fireside, which will work charmingly as he dilates upon its good qualities, untried; but, which, when subjected to experiment, will be utterly worthless for practical use. there can be no doubt that the simplest plan of construction, consistent with an economical expenditure of the material of food for the consumption of stock, is by far the most preferable. another item to be considered in this connection, is the comparative value of the stock, the forage fed to them, and the labor expended in feeding and taking care of them. to illustrate: suppose a farm to lie in the vicinity of a large town or city. its value is, perhaps, a hundred dollars an acre. the hay cut upon it is worth fifteen dollars a ton, at the barn, and straw and coarse grains in proportion, and hired labor ten or twelve dollars a month. consequently, the manager of this farm should use all the economy in his power, by the aid of cutting-boxes and other machinery, to make the least amount of forage supply the wants of his stock; and the internal economy of his barn should be arranged accordingly, since labor is his cheapest item, and food his dearest. therefore, any contrivance by which to work up his forage the closest--by way of machinery, or manual labor--so that it shall serve the purposes of keeping his stock, is true economy; and the making and saving of manures are items of the first importance. his buildings and their arrangements throughout should, for these reasons, be constructed in accordance with his practice. if, on the other hand, lands are cheap and productive, and labor comparatively dear, a different practice will prevail. the farmer will feed his hay from the mow without cutting. the straw will be stacked out, and the cattle turned to it, to pick what they like of it, and make their beds of the remainder; or, if it is housed, he will throw it into racks, and the stock may eat what they choose. to do this requires but one-third, or one-half of the labor which is required by the other mode, and the saving in this makes up, and perhaps more than makes up, for the increased quantity of forage consumed. again, climate may equally affect the mode of winter-feeding the stock. the winters may be mild. the hay may be stacked in the fields when gathered, or put into small barns built for hay storage alone; and the manure, scattered over the fields by the cattle, as they are fed from either of them, may be knocked to pieces with the dung-beetle, in the spring, or harrowed and bushed over the ground; and with the very small quantity of labor required in all this, such practice will be more economical than any other which can be adopted. in latitudes, however, in which it becomes necessary to stall-feed during several months of the year, barns are indispensable. these should be warm, and at the same time well ventilated. the barn should be arranged in a manner suitable to keeping hay and other fodder dry and sweet, and with reference to the comfort and health of the animals, and the economy of labor and manure. the size and finish will, of course, depend on the wants and means of the farmer or dairyman; but many little conveniences, it should not be forgotten, can be added at comparatively trifling cost. the accompanying cut of a barn is given merely as an illustration of a convenient arrangement for a medium-sized dairy, and not as being adapted to all circumstances or situations. this barn is supposed to stand upon a side-hill or an inclined surface, where it is easy to have a cellar, if desired; and the cattle-room, as shown in the cut, is in the second story, or directly over the cellar, the bottom of which should be somewhat dished, or lower in the middle than around the outer sides, and carefully paved, or laid in cement. [illustration: barn for thirty-four cows and three yoke of oxen.] on the outside is represented an open shed, _m_, for carts and wagons to remain under cover, thirty feet by fifteen, while _l l l l l l_ are bins for vegetables, to be filled through scuttles from the floor of the story above, and surrounded by solid walls. the area of this whole floor equals one hundred feet by fifty-seven. _k_, is an open space, nearly on a level with the cow-chamber, through the door _p_. _s_, stairs to the third story and to the cellar, _d d d_, passage next to the walls, five feet wide, and nine inches above the dung-pit. _e e e_, dung-pit, two feet wide, and seven inches below the floor where the cattle stand. the manure drops from this pit into the cellar below, five feet from the walls, and quite around the cellar. _c c c_, plank floor for cows, four feet six inches long. _b b b_, stalls for three yoke of oxen, on a platform five feet six inches long, _n n_, calf-pens, which may also be used for cows in calving. _r r_, feeding-troughs for calves. the feeding-boxes are made in the form of trays, with partitions between them. water comes in by a pipe, to cistern _a_. this cistern is regulated by a cock and ball, and the water flows by dotted lines, _o o o_, to the boxes; each box being connected by lead pipes well secured from frost, so that, if desired, each animal can be watered without leaving the stall, or water can be kept constantly before it. a scuttle, through which sweepings and refuse may be put into the cellar, is seen at _f_. _g_ is a bin receiving cut hay from the third story, or hay-room, _h h h h h h_, bins for grain-feed. _i_ is a tunnel to conduct manure or muck from the hay-floor to the cellar. _j j_, sliding-doors on wheels. the cows all face toward the open area in the centre. this cow-room may be furnished with a thermometer, clock, etc., and should always be well ventilated by sliding windows, which at the same time admit the light. the next cut is a transverse section of the same cow-room; _a_ being a walk behind the cows, five feet wide; _b_, dung-pit; _c_, cattle-stand; _d_, feeding-trough, with a bottom on a level with the platform where the cattle stand; _k_, open area, forty-three feet, by fifty-six. [illustration: transverse section.] the story above the cow-room--as represented in the next cut--is one hundred feet by forty-two; the bays for hay, ten on each side, being ten feet front and fifteen feet deep; and the open space, _p_, for the entrance of wagons, carts, etc., twelve feet wide. _b_, hay-scales. _c_, scale beam. _m m m m m m_, ladders reaching almost to the roof. _l l l_, etc., scuttle-holes for sending vegetables directly to the bins, _l l l_, etc., below. _a a b b_, rooms on the corners for storage. _d_, scuttles; four of which are used for straw, one for cut hay, and one for muck for the cellar. _n_ and the other small squares are eighteen-feet posts. _f_, passage to the tool-house, a room one hundred feet long by eighteen wide. _o_, stairs leading to the scaffold in the roof of the tool-house. _i i_, benches. _g_, floor. _h_, boxes for hoes, shovels, spades, picks, iron bars, old iron, etc. _j j j_, bins for fruit. _k_, scuttles to put apples into wagons, etc., in the shed below. one side of this tool-house may be used for plows and large implements, hay-rigging, harness, etc. proper ventilation of the cellar and the cow-room avoids the objection that the hay is liable to injury from noxious gases. [illustration: room over the cow-room.] the excellent manure-cellar beneath this barn extends only under the cow-room. it has a drive-way through doors on each side. no barn-cellar should be kept shut up tight, even in cold weather. the gases are constantly escaping from the manure, unless held by absorbents, which are liable not only to affect the health of the stock, but also to injure the quality of the hay. to prevent this, while securing the important advantages of a manure-cellar, the barn may be furnished with good-sized ventilators on the top, for every twenty-five feet of its length, and with wooden tubes leading from the cellar to the top. there should also be windows on different sides of the cellar to admit the free circulation of air. with these precautions, together with the use of absorbents in the shape of loam and muck, there will be no danger of rotting the timbers of the barn, or of risking the health of the cattle or the quality of the hay. the temperature at which the cow-room should be kept is somewhere from fifty to sixty degrees, fahrenheit. the practice and the opinions of successful dairymen differ somewhat on this point. too great heat would affect the health and appetite of the herd; while too low a temperature is equally objectionable, for various reasons. the most economical plan for room in tying cattle in their stalls, is to fasten the rope or chain, whichever is used--the wooden stanchion, or stanchel, as it is called, to open and shut, enclosing the animal by the neck, being objectionable--into a ring, which is secured by a strong staple into a post. this prevents the cattle from interfering with each other, while a partition effectually prevents any contact from the animals on each side of it, in the separate stalls. there is no greater benefit for cattle, after coming into winter-quarters, than a systematic regularity in every thing pertaining to them. every animal should have its own particular stall in the stable, where it should always be kept. the cattle should be fed and watered at certain fixed hours of the day, as near as may be. if let out of the stables for water, unless the weather is very pleasant--when they may be permitted to lie out for a short time--they should be immediately put back, and not allowed to range about with the outside cattle. they are more quiet and contented in their stables than elsewhere, and waste less food than if permitted to run out; besides being in every way more comfortable, if properly bedded and attended to, as every one will find upon trial. the habit which many farmers have, of turning their cattle out of the stables in the morning, in all weathers--letting them range about in a cold yard, hooking and annoying each other--is of no possible benefit, unless it be to rid them of the trouble of cleaning the stables, which pays more than twice its cost in the saving of manure. the outside cattle, which occupy the yard--if there are any--are all the better that the stabled ones do not interfere with them. they become habituated to their own quarters, as do the others, and all are better for being, respectively, in their proper places. milking. the manner of milking exerts a more powerful and lasting influence on the productiveness of the cow than most farmers are aware. that a slow and careless milker soon dries up the best of cows, every practical farmer and dairyman knows; but a careful examination of the beautiful structure of the udder will serve further to explain the proper mode of milking, in order to obtain and keep up the largest yield. the udder of a cow consists of four glands, disconnected from each other, but all contained within one bag or cellular membrane; and these glands are uniform in structure. each gland consists of three parts: the _glandular_, or secreting part, _tubular_ or conducting part, and the _teats_, or receptacle, or receiving part. the glandular forms by far the largest portion of the udder. it appears to the naked eye composed of a mass of yellowish grains; but under the microscope these grains are found to consist entirely of minute blood-vessels forming a compact plexus, or fold. these vessels secrete the milk from the blood. the milk is abstracted from the blood in the glandular part; the tubes receive and deposit it in the reservoir, or receptacle; and the sphincter at the end of the teat retains it there until it is wanted for use. this must not be understood, however, as asserting that all the milk drawn from the udder at one milking is contained in the receptacle. the milk, as it is secreted, is conveyed to the receptacle, and when that is full, the larger tubes begin to be filled, and next the smaller ones, until the whole become gorged. when this takes place, the secretion of the milk ceases, and absorption of the thinner or more watery part commences. now, as this absorption takes place more readily in the smaller or more distant tubes, it is invariably found that the milk from these, which comes last into the receptacle, is much thicker and richer than what was first drawn off. this milk has been significantly styled afterings, or strippings; and should this gorged state of the tubes be permitted to continue beyond a certain time, serious mischief will sometimes occur; the milk becomes too thick to flow through the tubes, and soon produces, first irritation, then inflammation, and lastly suppuration, and the function of the gland is materially impaired or altogether destroyed. hence the great importance of emptying these smaller tubes regularly and thoroughly, not merely to prevent the occurrence of disease, but actually to increase the quantity of milk; for, so long as the smaller tubes are kept free, milk is constantly forming; but whenever, as has already been mentioned, they become gorged, the secretion of milk ceases until they are emptied. the cow herself has no power over the sphincter at the end of her teat, so as to open it, and relieve the overcharged udder; neither has she any power of retaining the milk collected in the reservoirs when the spasm of the sphincter is overcome. thus is seen the necessity of drawing away the last drop of milk at every milking; and the better milker the cow, the more necessary this is. what has been said demonstrates, also, the impropriety of holding the milk in cows until the udder is distended much beyond its ordinary size, for the sake of showing its capacity for holding milk--a device to which many dealers in cows resort. thus much of the internal structure of the udder. its external form requires attention, because it indicates different properties. its form should be spheroidal, large, giving an idea of capaciousness; the bag should have a soft, fine skin, and the hind part upward toward the tail be loose and elastic. there should be fine, long hairs scattered plentifully over the surface, to keep it warm. the teats should not seem to be contracted, or funnel-shaped, at the inset with the bag. in the former state, teats are very apt to become corded, or spindled; and in the latter, too much milk will constantly be pressing on the lower tubes, or receptacle. they should drop naturally from the lower parts of the bag, being neither too short, small, or dumpy, or long, flabby, and thick, but, perhaps, about three inches in length, and so thick as just to fill the hand. they should hang as if all the quarters of the udder were equal in size, the front quarters projecting a little forward, and the hind ones a little more dependent. each quarter should contain about equal quantities of milk; though, in the belief of some, the hind quarters contain rather the most. largely developed milk-veins--as the subcutaneous veins along the under part of the abdomen are commonly called--are regarded as a source of milk. this is a popular error, for the milk-vein has no connection with the udder; yet, although the office of these is to convey the blood from the fore part of the chest and sides to the inguinal vein, yet a large milk-vein certainly indicates a strongly developed vascular system--one favorable to secretions generally, and to that of the milk among the rest. milking is performed in two ways, stripping and handling. _stripping_ consists in seizing the teat firmly near the root between the face of the thumb and the side of the fore-finger, the length of the teat passing through the other fingers, and in milking the hand passes down the entire length of the teat, causing the milk to flow out of its point in a forcible stream. the action is renewed by again quickly elevating the hand to the root of the teat. both hands are employed at the operation, each having hold of a different teat, and being moved alternately. the two nearest teats are commonly first milked, and then the two farthest. _handling_ is done by grasping the teat at its root with the fore-finger like a hoop, assisted by the thumb, which lies horizontally over the fore-finger, the rest being also seized by the other fingers. milk is drawn by pressing upon the entire length of the teat in alternate jerks with the entire palm of the hand. both hands being thus employed, are made to press alternately, but so quickly following each other that the alternate streams of milk sound to the ear like one forcible, continued stream. this continued stream is also produced by stripping. stripping, then, is performed by pressing and passing certain fingers along the teat; handling, by the whole hand doubled, or fist, pressing the teat steadily at one place. hence the origin of both names. [illustration: the preferable method.] of these two modes, handling is the preferable, since it is the more natural method--imitating, as it does, the suckling of the calf. when a calf takes a teat into its mouth, it makes the tongue and palate by which it seizes it, play upon the teat by alternate pressures or pulsations, while retaining the teat in the same position. it is thus obvious that handling is somewhat like sucking, whereas stripping is not at all like it. it is said that stripping is good for agitating the udder, the agitation of which is conducive to the withdrawal of a large quantity of milk; but there is nothing to prevent the agitation of the udder as much as the dairymaid pleases, while holding in the other mode. indeed, a more constant vibration could be kept up in that way by the vibrations of the arms than by stripping. stripping, by using an unconstrained pressure on two sides of the teat, is much more apt to press it unequally, than by grasping the whole teat in the palm of the hand; while the friction occasioned by passing the finger and thumb firmly over the outside of the teat, is more likely to cause heat and irritation in it than a steady and full grasp of the entire hand. to show that this friction causes an unpleasant feeling even to the dairymaid, she is obliged to lubricate the teat frequently with milk, and to wet it at first with water; whereas the other mode requires no such expedients. and as a further proof that stripping is a mode of milking which may give pain to the cow, it cannot be employed, when the teats are chapped, with so much ease to the cow as handling. the first requisite in the person that milks is, of course, the utmost _cleanliness_. without this, the milk is unendurable. the udder should, therefore, be carefully cleaned before the milking commences. milking should be done _fast_, to draw away the milk as quickly as possible, and it should be continued as long as there is a drop of milk to bring away. this is an issue which cannot be attended to in too particular a manner. if any milk is left, it is re-absorbed into the system, or else becomes caked, and diminishes the tendency to secrete a full quantity afterward. milking as dry as possible is especially necessary with young cows with their first calf; as the mode of milking and the length of time to which they can be made to hold out, will have very much to do with their milking qualities as long as they live. old milk left in the receptacle of the teat soon changes into a curdy state, and the caseous matter not being at once removed by the next milking, is apt to irritate the lining membrane of the teat during the operation, especially when the teat is forcibly rubbed down between the finger and thumb in stripping. the consequence of this repeated irritation is the thickening of the lining membrane, which at length becomes so hardened as to close up the orifice at the end of the teat. the hardened membrane may be easily felt from the outside of the teat, when the teat is said to be _corded_. after this the teat becomes _deaf_, as it is called, and no more milk can afterward be drawn from the quarter of the udder to which the corded teat is attached. the milking-pail is of various forms and of various materials. the dutch use brass ones, which are brilliantly scoured every time they are in use. tin pitchers are used in some places, while pails of wood in cooper-work are employed in others. a pail of oak, having thin staves bound together by bright iron hoops, with a handle formed by a stave projecting upward, is convenient for the purpose, and may be kept clean and sweet. one nine inches in diameter at the bottom, eleven inches at the top, and ten inches deep, with an upright handle or leg of five inches, has a capacious enough mouth to receive the milk as it descends; and a sufficient height, when standing on the edge of its bottom on the ground, to allow the dairymaid to grasp it firmly with her knees while sitting on a small three-legged stool. of course, such a pail cannot be milked full; but it should be large enough to contain all the milk which a single cow can give at a milking; because it is undesirable to rise from a cow before the milking is finished, or to exchange one dish for another while the milking is in progress. the cow being a sensitive and capricious creature, is, oftentimes so easily offended that if the maid rise from her before the milk is all withdrawn, the chances are that she will not again stand quietly at that milking; or, if the vessel used in milking is taken away and another substituted in its place, before the milking is finished, the probability is that she will _hold_ her milk--that is, not allow it to flow. this is a curious property which cows possess, of holding up or keeping back their milk. how it is effected has never been satisfactorily ascertained; but there is no doubt of the fact that when a cow becomes irritated, or frightened from any cause, she can withhold her milk. of course, all cows are not affected in the same degree; but, as a proof how sensitive cows generally are, it may be mentioned that very few will be milked so freely by a stranger the first time, as by one to whom they have been accustomed. there is one side of a cow which is usually called the _milking side_--that is the cow's left side--because, somehow custom has established the practice of milking her from that side. it may have been adopted for two reasons: one, because we are accustomed to approach all the larger domesticated animals by what we call the _near side_--that is, the animal's left side--as being the most convenient one for ourselves; and the other reason may have been, that, as most people are right-handed, and the common use of the right hand has made it the stronger, it is most conveniently employed in milking the hinder teats of the cow, which are often most difficult to reach on account of the position of the hind legs and the length of the hinder teats, or of the breadth of the hinder part of the udder. the near side is most commonly used in this country and in scotland; but in many parts of england the other side is preferred. whichever side is selected, that should uniformly be used, as cows are very sensitive to changes. in scotland it is a rare thing to see a cow milked by any other person than a woman, though men are very commonly employed at it in this country and in england. one never sees a man milking a cow without being impressed with the idea that he is usurping an office which does not become him; and the same thought seems to be conveyed in the terms usually applied to the person connected with cows--a dairy-_maid_ implying one who milks cows, as well as performs the other duties connected with the dairy--a dairy-_man_ meaning one who owns a dairy. there can be but little question that the charge of this branch of the dairy should generally be entrusted to women. they are more gentle and winning than men. the same person should milk the same cow regularly, and not change from one to another, unless there are special reasons for it. cows are easily rendered troublesome on being milked; and the kicks and knocks which they usually receive for their restlessness, only render them more fretful. if they cannot be overcome by kindness, thumps will never make them better. the truth is, restless habits are continued in them by the treatment which they receive at first, when, most probably, they have been dragooned into submission. their teats are tender at first; but an unfeeling, horny hand tugs at them at stripping, as if the animal had been accustomed to the operation for years. can the creature be otherwise than uneasy? and how can she escape the wincing but by flinging out her heels?--then hopples are placed on the hind fetlocks, to keep her heels down. the tail must then be held by some one, while the milking is going on; or the hair of its tuft be converted into a double cord, to tie the tail to the animal's leg. add to this the many threats and scoldings uttered by the milker, and one gets a not very exaggerated impression of the "breaking-in." some cows, no doubt, are very unaccomodating and provoking; but, nevertheless, nothing but a rational course toward them, administered with gentleness, will ever render them less so. there are cows which are troublesome to milk for a few times after calving, that become quite quiet for the remainder of the season; others will kick pertinaciously at the first milking. in this last case the safest plan--instead of hoppling, which only irritates--is for the dairymaid to thrust her head against the flank of the cow, and while standing on her feet, stretch her hands forward, get hold of the teats the best way she can, and send the milk on the ground; and in this position it is out of the power of the cow to hurt her. these ebullitions of feeling at the first milking after calving, arise either from feeling pain in a tender state of the teat, most probably from inflammation in the lining membrane of the receptacle; or they may arise from titillation of the skin of the udder and teat, which becomes the more sensible to the affection from a heat which is wearing off. at the age of two or three years the milking glands have not become fully developed, and their largest development will depend very greatly upon the management after the first calf. cows should have, therefore, the most milk-producing food; be treated with constant gentleness; never struck, or spoken harshly to, but coaxed and caressed; and in ninety-nine cases out of a hundred, they will grow up gentle and quiet. the hundredth had better be fatted and sent to the butcher. harshness is worse than useless. be the cause of irritation what it may, one thing is certain, that gentle discipline will overcome the most turbulent temper. nothing does so much to dry a cow up, especially a young cow, as the senseless treatment to which she is too often subjected. the longer the young cow, with her first and second calf, is made to hold out, the more surely will this habit be fixed upon her. stop milking her four months before the next calf, and it will be difficult to make her hold out to within four or six weeks of the time of calving afterward. induce her, if possible, by moist and succulent food, and by careful milking, to hold out even up to the time of calving, if you desire to milk her so long, and this habit will be likely to be fixed upon her for life. but do not expect to obtain the full yield of a cow the first year after calving. some of the very best cows are slow to develop their best qualities; and no cow reaches her prime till the age of five or six years. the extreme importance of care and attention to these points cannot be overestimated. the wild cows grazing on the plains of south america, are said to give not more than three or four quarts a day at the height of the flow; and many an owner of large herds in texas, it is said, has too little milk for family use, and sometimes receives his supply of butter from the new york market. there is, therefore, a constant tendency in milch cows to dry up; and it must be guarded against with special care, till the habit of yielding a large quantity, and yielding it long, becomes fixed in the young animal, when, with proper care, it may easily be kept up. cows, independently of their power to retain their milk in the udder, afford different degrees of pleasure in milking them, even in the quietest mood. some yield their milk in a copious flow, with the gentlest handling that can be given them; others require great exertion to draw the milk from them even in streams no larger than a thread. the udder of the former will be found to have a soft skin and short teats; that of the latter will have a thick skin, with long rough teats. the one feels like velvet; the other is no more pleasant to the touch than untanned leather. to induce quiet and persuade the animal to give down her milk freely, it is better that she should be fed at milking-time with cut feed, or roots, placed within her easy reach. if gentle and mild treatment is observed and persevered in, the operation of milking, as a general thing, appears to be a pleasure to the animal, as it undoubtedly is; but, if an opposite course is pursued--if at every restless movement, caused, perhaps, by pressing a sore teat, the animal is harshly spoken to--she will be likely to learn to kick as a habit, and it will be difficult to overcome it ever afterward. whatever may be the practice on other occasions, there can be no doubt that, for some weeks after calving, and in the height of the flow, cows ought, if possible, to be milked regularly three times a day--at early morning, noon, and night. every practical dairyman knows that cows thus milked give a larger quantity of milk than if milked only twice, though it may not be quite so rich; and in young cows, no doubt, it has a tendency to promote the development of the udder and milk-veins. a frequent milking stimulates an increased secretion, therefore, and ought never to be neglected in the milk-dairy, either in the case of young cows, or very large milkers, at the height of the flow, which will commonly be for two or three months after calving. there being a great difference in the quality as well as in the quantity of the milk of different cows, no dairyman should neglect to test the milk of each new addition to his dairy stock, whether it be an animal of his own raising or one brought from abroad. a lactometer--or instrument for testing the comparative richness of different species of milk--is very convenient for this purpose; but any one can set the milk of each cow separately at first, and give it a thorough trial, when the difference will be found to be great. economy will dictate that the cows least to the purpose should be disposed of, and their places supplied with better ones. the raising of calves. it has been found in practice that calves properly bred and raised on the farm have a far greater intrinsic value for that farm, other things being equal, than any that can be procured elsewhere; while on the manner in which they are raised will depend much of their future usefulness and profit. these considerations should have their proper weight in deciding whether a promising calf from a good cow and bull shall be kept, or sold to the butcher. but, rather than raise a calf at hap-hazard, and simply because its dam was celebrated as a milker, the judicious farmer will prefer to judge of the peculiar characteristics of the animal itself. this will often save the great and useless outlay which has sometimes been incurred in raising calves for dairy purposes, which a more careful examination would have rejected as unpromising. [illustration: maternal affection.] the method of judging stock which has been recommended in the previous pages is of practical utility here, and it is safer to rely upon it to some extent, particularly when other appearances concur, than to go on blindly. the milk-mirror on the calf is, indeed, small, but no smaller in proportion to its size than that of the cow; while its shape and form can generally be distinctly seen, particularly at the end of ten or twelve weeks. the development of the udder, and other peculiarities, will give some indication of the future capacities of the animal, and these should be carefully studied. if we except the manure of young stock, the calf is the first product of the cow, and as such demands our attention, whether it is to be raised or hurried off to the shambles. the practice adopted in raising calves differs widely in different sections of the country, being governed very much by local circumstances, as the vicinity of a milk-market, the value of milk for the dairy, the object of breeding, whether mainly for beef, for work, or for the dairy, etc.; but, in general, it may be said, that, within the range of thirty or forty miles of good veal-markets, which large towns furnish, comparatively few are raised at all. most of them are fattened and sold at ages varying from three to eight or ten weeks; and in milk-dairies still nearer large towns and cities they are often hurried off at one or two days, or, at most, a week old. in both of these cases, as long as the calf is kept it is generally allowed to suck the cow, and, as the treatment is very simple, there is nothing which particularly calls for remark, unless it be to condemn the practice entirely, upon the ground that there is a more profitable way of fattening calves for the butcher, and to say that allowing the calf to suck the cow at all is objectionable on the score of economy, except in cases where it is rendered necessary by the hard and swollen condition of the udder. if the calf is so soon to be taken away, it is better that the cow should not be suffered to become attached to it at all: since she is inclined to withhold her milk when it is removed, and thus a loss is sustained. the farmer will be governed by the question of profit, whatever course it is decided to adopt. in raising blood-stock, however, or in raising beef cattle, without any regard to economy of milk, the system of suckling the calves, or letting them run with the cow, may and will be adopted, since it is usually attended with somewhat less labor. the other course, which is regarded as the best where the calf is to be raised for the dairy, is to bring it up by hand. this is almost universally done in all countries where the raising of dairy cows is best understood--in switzerland, holland, some parts of germany, and england. it requires rather more care, on the whole; but it is decidedly preferable, since the calves cost less, as the food can be easily modified, and the growth is not checked, as is usually the case when the calf is taken off from the cow. allusion is here made, of course, to sections where the milk of the cow is of some account for the dairy, and where it is too valuable to be devoted entirely to nourishing the calf. in this case, as soon as the calf is dropped the cow is allowed to lick off the slimy moisture till it is dry, which she will generally do from instinct, or, if not, a slight sprinkling of salt over the body of the calf will immediately tempt her. the calf is left to suck once or twice, which it will do as soon as it is able to stand. it should, in all cases, be permitted to have the first milk which comes from the cow, which is of a turbid, yellowish color, unfit for any of the purposes of the dairy, but somewhat purgative and medicinal, and admirably and wisely designed by nature to free the bowels and intestines of the new-born animal from the mucous, excrementitious matter always existing in it after birth. too much of this new milk may, however, be hurtful even to the new-born calf, while it should never be given at all to older calves. the best course would seem to be--and such is in accordance with the experience of the most successful stock-raisers--to milk the cow dry immediately after the calf has sucked once, especially if the udder is painfully distended, which is often the case, and to leave the calf with the cow during one day, and after that to feed it by putting the fingers into its mouth, and gently bringing its muzzle down to the milk in a pail or trough when it will imbibe in sucking the fingers. no great difficulty will be experienced in teaching the calf to drink when taken so young, though some take to it much more readily than others. what the calf does not need should be given to the cow. some, however, prefer to milk immediately after calving; and, if the udder is overloaded, this may be the best course, though the better practice appears to be, to leave the cow as quietly to herself as possible for a few hours. the less she is disturbed, as a general thing, the better. the after-birth should be taken from her immediately after it is dropped. it is customary to give the cow, as soon as convenient after calving, some warm and stimulating drink--a little meal stirred into warm water, with a part of the first milk which comes from her, seasoned with a little salt. in many cases the calf is taken from the cow immediately; and before she has seen it, to a warm, dry pen out of her sight, and there rubbed till it is thoroughly dry; and then, when able to stand, fed with the new milk from the cow, which it should have three or four times a day, regularly, for the first fortnight, whatever course it is proposed to adopt afterwards. it is of the greatest importance to give the young calf a thrifty start. the milk, unless coming directly from the cow, should be warmed. some object to removing the calf from the cow in this way, on the ground of its apparent cruelty. but the objection to letting the calf suck the cow for several days, as they do, or indeed of leaving it with the cow for any length of time, is, that she invariably becomes attached to it, and frets and withholds her milk when it is at last taken from her. she probably suffers much more, after this attachment is once formed, at the removal of the object of it, than she does at its being taken at first out of her sight. the cow's memory is far more retentive than many suppose; and the loss and injury sustained by removing the calf after it has been allowed to suck her for a longer or shorter period are never known exactly, because it is not usually known how much milk the calf takes; but it is, without doubt, very considerable. if the udder is all right, there seems to be no good reason for leaving the calf with the cow for two or three days, if it is then to be taken away. the practice in holland is to remove the calf from its mother even before it has been licked, and to take it into a corner of the barn, or into another building, out of the cow's sight and hearing, put it on soft, dry straw, and rub it dry with some hay or straw, when its tongue and gums are slightly rubbed with salt, and the mucus and saliva removed from the nostrils and lips. after this has been done, the calf is made to drink the milk first taken as it comes from the mother. it is slightly diluted with water, if taken last from the udder; but, if the first of the milking, it is given just as it is. the calf is taught to drink in the same manner as in this country, by putting the fingers in its mouth, and bringing it down to the milk, and it soon gets so as to drink unaided. it is fed, at first, from four to six times a day, or even oftener; but soon only three times, at regular intervals. its food for two or three weeks is clear milk, as it comes warm and fresh from the cow. this is never omitted, as the milk during most of that time possesses certain qualities which are necessary to the calf, and which cannot be effectually supplied by any other food. in the third or fourth week the milk is skimmed, but warmed to the degree of fresh milk; though, as the calf grows a little older, the milk is given cold, while less care is taken to give it the milk of its own mother, that of other cows now answering equally well. in some places, calves are fed on buttermilk at the age of two weeks and after; but the change from new milk, fresh from the cow, is made gradually, some sweet skimmed milk and warm water being first added to it. at three weeks old, or thereabouts, the calf will begin to eat a little sweet, fine hay, and potatoes cut fine, and it very soon becomes accustomed to this food. many now begin to give linseed-meal mixed into hot water, to which is added some skim-milk or buttermilk; and others use a little bran cooked in hay-tea, made by chopping the hay fine and pouring on boiling-hot water, which is allowed to stand awhile on it. an egg is frequently broken into such a mixture. others still take pains at this age to have fresh linseed-cake, broken into pieces of the size of a pigeon's egg; putting one of these into the mouth after the meal of milk has been finished, and when it is eager to suck at any thing in its way. it will very soon learn to eat linseed-meal. a little sweet clover is put in its way at the age of about three weeks, and it will soon begin to eat that also. in this manner the feeding is continued from the fourth to the seventh week, the quantity of solid food being gradually increased. in the sixth or seventh week the milk is by degrees withheld, and water or buttermilk used instead; and soon after this, green food may be safely given, increasing it gradually with the hay to the age of ten or twelve weeks, when it will do to put them upon grass alone, if the season is favorable. a lot as near the house as possible, where they can be easily looked after and frequently visited, is the best. calves should be gradually accustomed to all changes; and even after having been turned out to pasture, they ought to be put under shelter if the weather is not dry and warm. the want of care and attention relative to these little details will be apparent sooner or later; while, if the farmer gives his personal attention to these matters, he will be fully paid in the rapid growth of his calves. it is especially necessary to see that the troughs from which they are fed, if troughs are used, are kept clean and sweet. but there are some--even among intelligent farmers--who make a practice of turning their calves out to pasture at the tender age of two or three weeks--and that, too, when they have sucked the cow up to that time--and allow them nothing in the shape of milk and tender care. this, certainly, is the poorest possible economy, to say nothing of the manifest cruelty of such treatment. the growth of the calf is checked, and the system receives a shock from so sudden a change, from which it cannot soon recover. the careful dutch breeders bring the calves either skimmed milk or buttermilk to drink several times a day after they are turned to grass, which is not till the age of ten or twelve weeks; and, if the weather is chilly, the milk is warmed for them. they put a trough generally under a covering, to which the calves may come and drink at regular times. thus, they are kept tame and docile. in the raising of calves, through all stages of their growth, great care should be taken neither to starve nor to over-feed. a calf should never be surfeited, and never be fed so highly that it cannot be fed more highly as it advances. the most important part is to keep it growing thriftily without getting too fat, if it is to be raised for the dairy. the calves in the dairy districts of scotland are fed on the milk, with seldom any admixture; and they are not permitted to suck their dams, but are taught to drink milk by the hand from a dish. they are generally fed on milk only for the first four, five, or six weeks, and are then allowed from two to two and a half quarts of new milk each meal, twice in the twenty-four hours. some never give them any other food when young except milk, lessening the quantity when the calf begins to eat grass or other food, which it generally does when about five weeks old, if grass can be had; and withdrawing it entirely about the seventh or eighth week of the calf's age. but, if the calf is reared in winter, or early in spring, before the grass rises, it must be supplied with at least some milk until it is eight or nine weeks old, as a calf will not so soon learn to eat hay or straw, nor fare so well on them alone as it will on pasture. some feed their calves reared for stock partly with meal mixed in the milk after the third or fourth week. others introduce gradually some new whey into the milk, first mixed with meal; and, when the calf gets older, they withdraw the milk, and feed it on whey and porridge. hay-tea, juices of peas and beans, or pea or bean-straw, linseed beaten into powder, treacle, etc., have all been sometimes used to advantage in feeding calves; but milk, when it can be spared, is, in the judgment of the scotch breeders, by far their most natural food. in galloway, and other pastoral districts, where the calves are allowed to suck, the people are so much wedded to their own customs as to argue that suckling is much more nutritious to the calves than any other mode of feeding. that it induces a greater secretion of saliva, which, by promoting digestion, accelerates the growth and fattening of the young animal, cannot be doubted; but the secretion of that fluid may likewise be promoted by placing an artificial teat in the mouth of the calf, and giving it the milk slowly, and at the natural temperature. in the dairy districts of scotland, the dairymaid puts one of her fingers into the mouth of the calf when it is fed, which serves the purpose of a teat, and will have nearly the same effect as the natural teat in inducing the secretion of saliva. if that, or an artificial teat of leather, be used, and the milk be given slowly before it is cold, the secretion of saliva may be promoted to all the extent that can be necessary; besides, secretion is not confined to the mere period of eating, but, as in the human body, the saliva is formed and part of it swallowed at all times. as part of the saliva is sometimes seen dropping from the mouths of the calves, it might be advisable not only to give them an artificial teat when fed, but to place, as is frequently done, a lump of chalk before them to lick, thus leading them to swallow the saliva. the chalk would so far supply the want of salt, of which cattle are often so improperly deprived, and it would also promote the formation of saliva. indeed, calves are very much disposed to lick and suck every thing which comes within their reach, which seems to be the way in which nature teaches them to supply their stomachs with saliva. [illustration: frolicksome.] but though sucking their dams may be most advantageous in that respect, yet it has also some disadvantages. the cow is always more injured than the calf is benefited by that mode of feeding. she becomes so fond of the calf that she does not, for a long time after, yield her milk freely to the dairyman. the calf does not when young draw off the milk completely, and when it is taken off by the hand, the cow withholds a part of her milk, and, whenever a cow's udder is not completely emptied every time she is milked, the lactic secretion--as before stated--is thereby diminished. feeding of calves by hand is also, in various respects, advantageous. instead of depending on the uncertain, or perhaps precarious supply of the dam, which may be more at first than the young animal can consume or digest, and at other times too little for its supply, its food can, by hand-feeding, be regulated to suit the age, appetite, and the purposes for which the calf is intended; other admixtures or substitutes can be introduced into the milk, and the quantity gradually increased or withdrawn at pleasure. this is highly necessary when the calves are reared for stock. the milk is in that case diminished, and other food introduced so gradually that the stomach of the young animal is not injured as it is when the food is too suddenly changed. and, in the case of feeding calves for the butcher, the quantity of milk is not limited to that of the dam--for no cow will allow a stranger-calf to suck her--but it can be increased, or the richest or poorest parts of the milk given at pleasure. such are, substantially, the views upon this subject which are entertained by the most judicious farmers in the first dairy districts of scotland. in those districts--where, probably, the feeding and management of calves are as well and as judiciously conducted as in any other part of great britain--the farmers' wives and daughters, or the female domestics, have the principal charge of young calves; and they are, doubtless, much better calculated for this duty than men, since they are more inclined to be gentle and patient. the utmost gentleness--as has been already remarked, in another connection--should always be observed in the treatment of all stock; but especially of milch cows, and calves designed for the dairy. persevering kindness and patience, will, almost invariably, overcome the most obstinate natures; while rough and ungentle handling will be repaid in a quiet kind of way, perhaps, by withholding the milk, which will always have a tendency to dry up the cow; or, what is nearly as bad, by kicking and other modes of revenge, which often contribute to the personal discomfort of the milker. the disposition of the cow is greatly modified, if not, indeed, wholly formed, by her treatment while young; and therefore it is best to handle calves as much as possible, and make pets of them, lead them with a halter, and caress them in various ways. calves managed in this way will always be docile, and suffer themselves to be approached and handled, both in the pasture and in the barn. with respect to the use of hay-tea--often used in this country, but more common abroad, where greater care and attention are usually bestowed upon the details of breeding--youatt says: "at the end of three or four days, or perhaps a week, or near a fortnight, after a calf has been dropped, and the first passages have been cleansed by allowing it to drink as much of the cow's milk as it feels inclined for, let the quantity usually allotted for a meal be mixed, consisting, for the first week, of three parts of milk and one part of hay-tea. _the only nourishing infusion of hay is that which is made from the best and sweetest hay, cut by a chaff-cutter into pieces about two inches long_, and put into an earthen vessel; over this, boiling water should be poured, and the whole allowed to stand for two hours, during which time it ought to be kept carefully closed. after the first week, the proportions of milk and hay-tea may be equal; then composed of two-thirds of hay-tea and one of milk; and at length, one-fourth part of milk will be sufficient. this food should be given to the calf in a lukewarm state _at least three, if not four times a day, in quantities averaging three quarts at a meal_, but gradually increasing to four quarts as the calf grows older. toward the end of the second month, beside the usual quantity given at each meal--composed of three parts of the infusion and one of milk--a small wisp or bundle of hay is to be laid before the calf, which will gradually come to eat it; but, if the weather is favorable, as in the month of may, the beast may be turned out to graze in a fine, sweet pasture, well sheltered from the wind and sun. this diet may be continued until toward the latter end of the third month, when, if the calf grazes heartily, each meal may be reduced to less than a quart of milk, with hay-water; or skimmed milk, or fresh buttermilk, may be substituted for new milk. at the expiration of the third month, the animal will hardly require to be fed by hand; though, if this should still be necessary, one quart of the infusion given daily--which, during the summer, need not be warmed--will suffice." the hay-tea should be made fresh every two days, as it soon loses its nutritious quality. this and other preparations are given, not because they are better than milk,--than which nothing is better adapted to fatten a calf, or promote its growth,--but simply to economize by providing the simplest and cheapest substitutes. experience shows that the first two or three calves are smaller than those which follow; and hence, unless they are pure-bred, and to be kept for the blood, they are not generally thought to be so desirable to raise for the dairy as the third or fourth, and those that come after, up to the age of nine or ten years. opinions upon this point, however, differ. according to the comparative experiments of a german agriculturist, cows which as calves had been allowed to suck their dams from two to four weeks, brought calves which weighed only from thirty-five to forty-eight pounds; while others, which as calves had been allowed to suck from five to eight weeks, brought calves which weighed from sixty to eighty pounds. it is difficult to see how there can be so great a difference, if, indeed, there be any; but it may be worthy of careful observation and experiment, and as such it is stated here. the increased size of the calf would be due to the increased size to which the cow would attain; and if as a calf she were allowed to run in the pasture with her dam for four or five months, taking all the milk she wanted, she would doubtless be kept growing on in a thriving condition. but taking a calf from the cow at four or even eight weeks must check its growth to some extent; and this may be avoided by feeding liberally, and bringing up by hand. after the calf is fully weaned, there is nothing very peculiar in the general management. a young animal will require for the first few months--say up to the age of six months--an average of five or six pounds daily of good hay, or its equivalent. at the age of six months, it will require from four and a half to five pounds; and at the end of the year, from three and a half or four pounds of good hay, or its equivalent, for every one hundred pounds of its live weight; or, in other words, about three and a half or four per cent. of its live weight. at two years old, it will require three and a half, and some months later, three per cent. of its live weight daily in good hay, or its equivalent. indian-corn fodder, either green or cured, forms an excellent and wholesome food at this age. the heifer should not be pampered, nor yet poorly fed or half starved, so as to receive a check in her growth. an abundant supply of good healthy dairy food and milk will do all that is necessary up to the time of her having her first calf--which should not ordinarily be till the age of three years, though some choose to allow them to come in at two, or a little over, on the ground that it early stimulates the secretion of milk, and that this will increase the milking propensity through life. this is undoubtedly the case, as a general rule; but greater injury is at the same time done by checking the growth, unless the heifer has been fed up to large size and full development from the start--in which case she may perhaps take the bull at fifteen or eighteen months without injury. even if a heifer comes in at two years, it is generally deemed desirable to let her run barren for the following year, which will promote her growth and more perfect development. the feeding which young stock often get is not such as is calculated to make good-sized or valuable cattle of them. they are often fed on the poorest of hay or straw through the winter, not infrequently left exposed to cold, unprotected and unhoused, and thus stinted in their growth. this is, surely, the very worst economy, or rather it is no economy at all. properly viewed, it is an extravagant wastefulness which no farmer can afford. no animal develops its good points under such treatment; and if the starving system is to be followed at all, it had better be after the age of two or three years, when the animal's constitution has attained the strength and vigor which may, possibly, enable it to resist ill treatment. to raise up first-rate milkers, it is absolutely necessary to feed on dairy food even when they are young. no matter how fine the breed is, if the calf is raised on poor, short feed, it will never be so good a milker as if raised on better keeping; and hence, in dairy districts, where calves are raised at all, they ought to be allowed the best pasture during the summer, and good, sweet and wholesome food during the winter. points of fat cattle. whatever theoretical objections may be raised against over-fed cattle, and great as may be the attempts to disparage the mountains of fat,--as highly-fed cattle are sometimes designated,--there is no doubt of the practical fact, that the best butcher cannot sell any thing but the best fatted beef; and of whatever age, size, or shape a half-fatted ox may be, he is never selected by judges as fit for human food. hence, a well-fatted animal always commands a better price per pound than one imperfectly fed, and the parts selected as the primest beef are precisely the parts which contain the largest deposits of fat. the rump, the crop, and the sirloin, the very favorite cuts,--which always command from twenty to twenty-five per cent. more than any other part of the ox,--are just those parts on which the largest quantities of fat are found; so that, instead of the taste and fashion of the age being against the excessive fattening of animals, the fact is, practically, exactly the reverse. where there is the most fat, there is the best lean; where there is the greatest amount of muscle, without its share of fat, that part is accounted inferior, and is used for a different purpose; in fact, so far from fat's being a disease, it is a condition of muscle, necessary to its utility as food,--a source of luxury to the rich, and of comfort to the poor, furnishing a nourishing and healthy diet for their families. fattening is a secretive power which grazing animals possess, enabling them to lay by a store of the superfluous food which they take for seasons of cold or scarcity. it collects round the angular bones of the animal, and gives the appearance of rotundity; hence the tendency to deposit fat is indicated, as has been stated, by a _roundness_ of form, as opposed to the _fatness_ of a milk-secreting animal. but its greatest use is, that it is a store of heat-producing aliment, laid up for seasons of scarcity and want. the food of animals, for the most part, may be said to consist of a saccharine, an oleaginous, and an albuminous principle. to the first belong all the starchy, saccharine, and gummy parts of the plants, which undergo changes in the digestive organs similar to fermentation before they can be assimilated in the system; by them also animal heat is sustained. in indolent animals, the oily parts of plants are deposited and laid up as fat; and, when vigor and strength fail, this is taken up and also used in breathing to supply the place of the consumed saccharine matter. the albuminous, or gelatinous principle of plants is mainly useful in forming muscle; while the ashes of plants, the unconsumable parts, are for the supply, mainly, of bone, hair, and horn, but also of muscle and of blood, and to supply the waste which continually goes on. now, there are several qualities which are essentially characteristic of a disposition to fatten. there have not, as yet, been any book-rules laid down, as in the case of m. guénon's indications of milking-cows; but there are, nevertheless, marks so definite and well understood, that they are comprehended and acted upon by every grazier, although they are by no means easy to describe. it is by skillful acumen that the grazier acquires his knowledge, and not by theoretical rules; observation, judgment, and experience, powerful perceptive faculties, and a keen and minute comparison and discrimination, are essential to his success. [illustration: points of cattle.] the first indication upon which he relies, is the _touch_. it is the absolute criterion of _quality_, which is supposed to be the keystone of perfection in all animals, whether for the pail or the butcher. the skin is so intimately connected with the internal organs, in all animals, that it is questionable whether even our schools of medicine might not make more use of it in a diagnosis of disease. of physiological tendencies in cattle, however, it is of the last and most vital importance. it must neither be thick, nor hard, nor adhere firmly to the muscles. if it is so, the animal is a hard grazer, a difficult and obstinate feeder--no skillful man will purchase it--such a creature must go to a novice, and even to him at a price so low as to tempt him to become a purchaser. on the other hand, the skin must not be thin, like paper, nor flaccid, nor loose in the hand, nor flabby. this is the opposite extreme, and is indicative of delicateness, bad, flabby flesh, and, possibly, of inaptitude to retain the fat. it must be _elastic_ and velvety, soft and pliable, presenting to the touch a gentle resistance, but so delicate as to give pleasure to the sensitive hand--a skin, in short, which seems at first to give an indentation from the pressure of the fingers, but which again rises to its place by a gentle elasticity. the _hair_ is of nearly as much importance as the skin. a hard skin will have straight and stiff hair; it will not have a curl, but be thinly and lankly distributed equally over the surface. a proper grazing animal will have a _mossy_ coat, not absolutely curled, but having a disposition to a graceful curl, a semifold, which presents a waving inequality; but as different from a close and straightly-laid coat, as it is from one standing off the animal at right angles, a strong symptom of disease. it will also, in a thriving animal, be licked here and there with its tongue, a proof that the skin is duly performing its functions. there must be, also, the full and goggle _eye_, bright and pressed outward by the fatty bed below; because, as this is a part where nature always provides fat, an animal capable of developing it to any considerable extent, will have its indications here, at least, when it exists in excess. so much for feeding qualities in the animal, and their conformations indicative of this kindly disposition. next come such formations of the animal itself as are favorable to the growth of fat, other things being equal. there must be _size_ where large weights are expected. christmas beef, for instance, is expected to be large as well as fat. the symbol of festivity should be capacious, as well as prime in quality. but it is so much a matter of choice and circumstance with the grazier, that profit alone will be his guide. the axiom will be, however, as a general rule, that the better the grazing soil the larger the animal may be; the poorer the soil, the smaller the animal. small animals are, unquestionably, much more easily fed, and they are well known by experienced men to be best adapted to second-rate feeding pastures. but, beyond this, there must be _breadth_ of carcass. this is indicative of fattening, perhaps, beyond all other qualifications. if rumps are favorite joints and produce the best price, it is best to have the animal which will grow the longest, the broadest, and the best rump; the same of crop, and the same of sirloin; and not only so, but breadth is essential to the consumption of that quantity of food which is necessary to the development of a large amount of fat in the animal. thus, a deep, wide chest, favorable for the respiratory and circulating functions, enables it to consume a large amount of food, to take up the sugary matter, and to deposit the fatty matter,--as then useless for respiration, but afterwards to be prized. a full level crop will be of the same physiological utility; while a broad and open framework at the hips will afford scope for the action of the liver and kidneys. there are other points, also, of much importance; the head must be small and fine; its special use is indicative of the quick fattening of the animal so constructed, and it is also indicative of the bones being small and the legs short. for constitutional powers, the beast should have his ribs extended well towards the thigh-bones or hips, so as to leave as little unprotected space as possible. there must be no angular, or abrupt points; all must be round, and broad, and parallel. any depression in the lean animal will give a deficient deposit of flesh and fat at that point, when sold to the butcher, and thus deteriorate its value; and hence the animal must be round and full. but either fancy, or accident, or skill--it is unnecessary to decide which--has associated _symmetry_ with quality and conformation, as a point of great importance in animals calculated for fattening; and there is no doubt that, to a certain extent, this is so. the beast must be a system of mathematical lines. to the advocate of symmetry, the setting-on of a tail will be a condemning fault; indeed the ridge of the back, like a straight line, with the outline of the belly exactly parallel, viewed from the side, and a depth and squareness when viewed from behind,--which remind us of a geometrical cube, rather than a vital economy,--may be said to be the indications of excellence in a fat ox. the points of excellence in such an animal are outlined under the subsequent head, as developed in the cutting up after slaughter. now, these qualities are inherent in some breeds; there may be cases and instances in all the superior breeds, and in most there may be failures. driving and slaughtering. it is necessary that cattle which have been disposed of to the dealer or butcher, or which are intended to be driven to market, should undergo a preparation for the journey. if they were immediately put to the road to travel, from feeding on grass or turnips, when their bowels are full of undigested vegetable matter, a scouring might ensue which would render them unfit to pursue their journey; and this complaint is the more likely to be brought on from the strong propensity which cattle have to take violent exercise upon feeling themselves at liberty after a long confinement. they in fact, become light-headed whenever they leave the barn or enclosure, so much so that they actually "frisk and race and leap," and their antics would be highly amusing, were it not for the apprehension that they may hurt themselves against some opposing object, as they seem to regard nothing before them. on being let out for the first time, cattle should be put for awhile into a larger court, or on a road well fenced with enclosures, and guarded by men, to romp about. two or three such allowances of liberty will render them quiet; and, in the mean time, to lighten their weight of carcass, they should have hay for a large proportion of their food. these precautions are absolutely necessary for cattle which have been confined in barns; otherwise, accidents may befall them on the road, where they will at once break loose. even at home serious accidents sometimes overtake them, such as the breaking down of a horn, casting off a hoof, spraining a tendon, bruising ribs, and heating the whole body violently; and, of course, when any such ill luck befalls, the animal affected must be left behind, and become a drawback upon the value of the rest, unless kept for some time longer. having the cattle prepared for travel, the drover takes the road very slowly for the first two days, not exceeding seven or eight miles a day. at night, in winter, they should be put into an open court, and supplied with hay, water, and a very few turnips; for, if roots are suddenly withdrawn from them,--since it is taken for granted that these have formed a staple portion of their food,--their bellies will become shrunken up into smaller dimensions--a state very much against favorable appearance in market. after the first two days they may proceed faster, say twelve or thirteen miles a day, if very fat; and fifteen, if moderately so. when the journey is long and the beasts get faint from travel, they should have corn to support them. in frosty weather, when the roads become very hard, they are apt to become shoulder-shaken, an effect of founder; and if sleet falls during the day, and becomes frozen upon them at night, they may become so chilled as to refuse food, and shrink rapidly away. cattle should, if possible, arrive the day before in the neighborhood of a distant market, and be supplied with a good feed of roots and hay, or grass, to make them look fresh and fill them up again; but if the market is at but short distance, they can travel to it early in the morning. [illustration: a frontispiece.] in driving cattle the drover should have no dog, which will only annoy them. he should walk either before or behind, as he sees them disposed to proceed too fast or to loiter upon the road; and in passing carriages, the leading ox, after a little experience, will make way for the rest to follow. on putting oxen on a ferry-boat the shipping of the first one only is attended with much trouble. a man on each side should take hold of a horn, or of a halter made of any piece of rope, should the beast be hornless, and two other men, one on each side, should push him up behind with a piece of rope held between them as a breeching, and conduct him along the plank into the boat; if it have low gunwales, a man will be required to remain beside him until one or two more of the cattle follow their companion, which they will most readily do. from neglecting this precaution in small ferry-boats, the first beast sometimes leaps into the water, when it becomes a difficult task to prevent some of the rest doing the same thing. whatever time a lot of cattle may take to go to a market, they should never be _overdriven_. there is great difference of management in this respect among drovers. some like to proceed upon the road quietly, slowly, but surely, and to reach the market in a placid, cool state. others, again, drive smartly along for some distance, and then rest to cool awhile, when the beasts will probably get chilled and have a staring coat when they reach their destination; while others like to enter the market with their beasts in an excited state, imagining that they then look gay; but distended nostrils, loose bowels, and reeking bodies are no recommendations to a purchaser. good judges are shy of purchasing cattle in a heated state, because they do not know how long they may have been in it; and to cover any risk, will give at least five dollars a head below what they would have offered for them in a cool state. some drovers have a habit of thumping at the hindmost beast of the lot with a stick while on the road. this is a censurable practice, as the flesh, where it is thumped, will bear a red mark after the animal has been slaughtered,--the mark receiving the appropriate name of _blood-burn_--and the flesh thus affected will not take on salt, and is apt to putrefy. a touch up on the shank, or any tendonous part, when correction is necessary, is all that is required; but the voice, in most cases, will answer as well. the flesh of overdriven cattle, when slaughtered, never becomes properly firm, and their tallow has a soft, melted appearance. a few large oxen in one lot look best in a market on a position rather above the eye of a spectator. when a large lot is nearly alike in size and appearance, they look best and most level on a flat piece of ground. very large fat oxen never look better than on ground on the same level with the spectator. an ox, to look well, should hold his head on a line with the body, with lively ears, clear eye, dewy nose, a well-licked hide, and should stand firmly on the ground on all his feet. these are all symptoms of high health and good condition. whenever an ox shifts his standing from one foot to another, he is _foot-sore_, and has been driven far. whenever his head hangs down and his eyes water, he feels ill at ease inwardly. when his coat stares, he has been overheated some time, and has got a subsequent _chill_. all these latter symptoms will be much aggravated in cattle that have been fed in a barn. cattle are made to fast before being slaughtered. the time they should stand depends upon their state on their arrival at the shambles. if they have been driven a considerable distance in a proper manner, the bowels will be in a tolerably empty state, so that twelve hours may suffice; but if they are full and just off their food, twenty-four hours will be required. beasts that have been overdriven, or much struck with sticks, or in any degree infuriated, should not be immediately slaughtered, but allowed to stand on dry food, such as hay, until the symptoms disappear. these precautions are absolutely necessary that the meat may be preserved in the best state. the mode of slaughtering cattle varies in different countries. in the great slaughter-houses at montmartre, in paris, they are slaughtered by bisecting the spinal cord of the cervical vertebræ; and this is accomplished by the driving of a sharp-pointed chisel between the second and third vertebræ, with a smart stroke of a mallet, while the animal is standing, when it drops, and death or insensibility instantly ensues, and the blood is let out immediately by opening the blood-vessels of the neck. the plan adopted in england is, first to bring the ox down on his knees, and place his under-jaw upon the ground by means of ropes fastened to his head and passed through an iron ring in the floor of the slaughterhouse. he is then stunned with a few blows from an iron axe made for the purpose, on the forehead, the bone of which is usually driven into the brain. the animal then falls upon his side, and the blood is let out by the neck. of the two modes, the french is apparently the less cruel, for some oxen require many blows to make them fall. some butchers, however, allege that the separation of the spinal cord, by producing a general nervous convulsion throughout the body, prevents the blood from flowing as rapidly and entirely out of it as when the ox is stunned in the forehead. the skin is then taken off to the knees, when the legs are disjointed, and also off the head. the carcass is then hung up by the tendons of the hough on a stretcher, by a block and tackle, worked by a small winch, which retains in place what rope it winds up by means of a wheel and ratchet. after the carcass has hung for twenty-four hours, it should be cut down by the back-bone, or chine, into two _sides_. this is done either with the saw, or chopper; the saw making the neatest job in the hands of an inexperienced butcher, though it is the most laborious; and with the chopper is the quickest, but by no means the neatest plan, especially in the hands of a careless workman. in london, the chine is equally divided between both sides; while in scotland, one side of a carcass of beef has a great deal more bone than the other, all the spinous processes of the vertebræ being left upon it. the bony is called the _lying_ side of the meat. in london, the divided processes in the fore-quarters are broken in the middle when warm, and chopped back with the flat side of the chopper, which has the effect of thickening the fore and middle ribs considerably when cut up. the london butcher also cuts the joints above the hind knee, and, by making some incisions with a sharp knife, cuts the tendons there, and drops the flesh of the hind-quarter on the flank and loins, which causes it to cut up thicker than in the scotch mode. in opening the hind-quarter he also cuts the aitch bone, or pelvis through the centre, which makes the rump look better. some butchers in the north of england score the fat of the _closing_ of the hind-quarter, which has the effect of making that part of both heifer and ox look like the udder of an old cow. there is far too much of this scoring practised in scotland, which prevents the pieces from retaining--which they should, as nearly as possible--their natural appearance. in cutting up a carcass of beef the london butcher displays great expertness; he not only discriminates between the qualities of its different parts, but can cut out any piece to gratify the taste of his customers. in this way he makes the best use of the carcass and realizes the largest value for it, while he gratifies the taste of every grade of customers. a figure of the scotch and english modes of cutting up a carcass of beef will at once show the difference; and upon being informed where the valuable pieces lie, an opinion can be formed as to whether the oxen the farmer is breeding or feeding possess the properties which will enable him to demand the highest price for them. [illustration: scotch mode of cutting up beef.] the sirloin is the principal roasting-piece, making a very handsome dish, and is a universal favorite. it consists of two portions, the scotch and english sides; the former is above the lumbar bones, and is somewhat hard in ill-fed cattle; the latter consists of the muscles under these bones, which are generally covered with fine fat, and are exceedingly tender. the better the beast is fed, the larger is the under muscle, better covered with fat, and more tender to eat. the hook-bone and the buttock are cut up for steaks, beefsteak pie, or minced collops, and both these, together with the sirloin, bring the highest price. the large round and the small round are both well known as excellent pieces for salting and boiling, and are eaten cold with great relish. the hough is peculiarly suited for boiling down for soup, having a large proportion of gelatinous matter. brown soup is the principal dish made of the hough, but its decoction forms an excellent _stock_ for various dishes, and will keep in a state of jelly for a considerable time. the thick and the thin flank are both admirable pieces for salting and boiling. the tail, insignificant as it may seem, makes a soup of a very fine flavor. hotel-keepers have a trick of seasoning brown soup or rather beef-tea, with a few joints of tail, and passing it off for genuine ox-tail soup. these are all the pieces which constitute the hind-quarter; and it will be seen that they are valuable both for roasting and boiling, not containing a single coarse piece. in the fore-quarter, is the spare rib, the six ribs of the back end of which make an excellent roast, and when taken from the side opposite to the _lying_ one, being free of the bones of the spine, it makes a large one; and it also makes excellent beefsteaks and beefsteak pie. the two runners and the nineholes make salting and boiling pieces; but, of these, the nineholes is much the best, as it consists of layers of fat and lean without any bone; whereas the fore parts of the runners have a piece of shoulder-blade in them, and every piece connected with that bone is more or less coarse-grained. the brisket eats very well boiled fresh in broth, and may be cooked and eaten with boiled greens or carrots. the shoulder-lyar is a coarse piece, and fit only for boiling fresh to make into broth or beef-tea. the nap, or shin, is analogous to the hough of the hind-leg, but not so rich and fine, there being much less gelatinous matter in it. the neck makes good broth; and the sticking-piece is a great favorite with some epicures, on account of the pieces of rich fat in it. it makes an excellent stew, as also sweet barley-broth, and the meat eats well when boiled in it. these are all the pieces of the fore-quarter; and it will be seen that they consist chiefly of boiling-pieces, and some of them none of the finest--the roasting-piece being confined to the six ribs of the spare rib, and the finest boiling-piece, corned, only to be found in the nineholes. [illustration: english mode of cutting up beef.] the loin is the principal roasting-piece; the rump is the favorite steak-piece; the aitch-bone, the favorite stew; the buttock, the thick flank, and the thin flank are all excellent boiling-pieces when corned; the hock and the shin make soup and afford stock for the various requirements of the culinary art; and the tail furnishes ox-tail soup--a favorite english luncheon. these are all the pieces of the hind-quarter, and they are valuable of their respective kinds. in the fore-quarter, the fore-rib, middle-rib, and chuckle-rib are all roasting-pieces, not alike good; but in removing the part of the shoulder-blade in the middle-rib, the spare-ribs below make a good broil or roast; the neck makes soup, being used fresh, boiled; the back end of the brisket is boiled, corned, or stewed; the leg-of-mutton piece is coarse, but is as frequently stewed as boiled; the shin is put to the same use as the shin and hock of the hind-quarter. on comparing the two modes of cutting-up, it will be observed that in the english there are more roasting-pieces than in the scotch, a large proportion of the fore-quarter being used in that way. the plan, too, of cutting the loin between the rump and aitch-bone in the hind-quarter, lays open the steak-pieces to better advantage than in the scotch bullock. extending the comparison from one part of the carcass to the other, in both methods, it will be seen that the most valuable pieces--the roasting--occupy its upper, and the less valuable--the boiling--its lower part. every beast, therefore, that lays on beef more upon the upper part of its body is more valuable than one that lays the same quantity of flesh on its lower parts. it is deemed unnecessary to enter into details as to the modes of cutting-up most in vogue in this country, as there is a needlessly great want of uniformity. of the qualities of beef obtained from the different breeds of cattle in england, there is no better meat than from the west highlanders for fineness of grain and cutting up into convenient pieces for family use. the galloways and angus, when fattened in english pastures, are great favorites in the london market. the short horns afford excellent steaks, being thick of flesh, and the slice deep, large and juicy, and their covered flanks and nineholes are always thick, juicy, and well-mixed. the herefords are somewhat similar to the short horns, and the devons, may, perhaps, be classed among the galloways and angus, while the welsh cannot be compared to the west highlanders. taking, then, the breeds of scotland as suppliers of good beef, they seem to be more valuable for the table than those of england. there are, perhaps, not sufficient data in existence to determine the true proportion of offal of all kinds to the beef of any given fat ox; but approximations have been made, which may serve the purpose until the matter is investigated by direct experiment, under various circumstances. the dead weight bears to the live weight a ratio varying between . and . to ; and on applying one or the other multiplier to the cases of the live weight, a pretty correct approximation is reached. the tallow is supposed to be eight one-hundredths of the live weight; so that the multiplier is the decimal . . the hide is supposed to be five one-hundredths of the live weight; so to obtain its weight, a multiplier, . , is used. the other offals are supposed to be in a proportion of about one-fourth of the live weight; so that the multiplier, . , is as near as can be proposed under existing experience. beef is the staple animal food of this country, and it is used in various states--fresh, salted, smoked, roasted, and boiled. when intended to be eaten fresh, the _ribs_ will keep the best, and with care will keep five or six days in summer, and in winter ten days. the middle of the _loin_ is the next best, and the _rump_ the next. the _round_ will not keep long, unless it is salted. the _brisket_ is the worst, and will not keep more than three days in summer, and in winter a week. in regard to the power of the stomach to digest beef, that which is eaten boiled with salt only, is digested in two hours and forty-five minutes. beef, fresh, lean, and rarely-roasted, and a beefsteak broiled, takes three hours to digest; that fresh, and dry-roasted, and boiled, eaten with mustard, is digested in three and a half hours. lean fresh beef fried, requires four hours, and old hard salted beef boiled, does not digest in less than four and a quarter hours. fresh beef-suet boiled takes five and a half hours. the usual mode of preserving beef is by salting; and, when intended to keep for a long time, such as for the use of shipping, it is always salted with brine; but for family use it should be salted only with good salt; for brine dispels the juice of meat, and saltpetre only serves to make the meat dry, and give it a disagreeable and unnatural red color. various experiments have been made in curing beef with salt otherwise than by hand-rubbing, and in a short space of time, and also to preserve it from putrefaction by other means than salt. some packers put meat in a copper which is rendered air-tight, and an air-pump then creates a vacuum within it, thereby extracting all the air out of the meat; then brine is pumped in by pressure, which, entering into every pore of the meat formerly occupied by the air, is said to place it in a state of preservation in a few minutes. the carcass of an ox was preserved, in france, for two years from putrefaction by injecting four pounds of saline mixture into the carotid artery. whether any such contrivance can be made available for family purposes, seems doubtful. cattle, when slaughtered, are useful to man in various other ways than by affording food from their flesh,--their offal of tallow, hides, and horns, forming extensive articles of commerce. of the _hide_, the characteristics of a good one for strong purposes are strength in its middle, or _butt_, as it called, and lightness in the edges, or _offal_. a bad hide is the opposite of this--thick in the edges and thin in the middle. a good hide has a firm texture; a bad one, loose and soft. a hide improves as the summer advances, and it continues to improve after the new coat of hair in autumn until november or december, when the coat gets rough from the coldness of the season, and the hide is then in its best state. it is surprising how a hide improves in thickness after the cold weather has set in. the sort of food does not seem to affect the quality of the hide; but the better it is, and the better cattle have been fed, and the longer they have been well fed, even from a calf, the better the hide. from what has been said of the effect of weather upon the hide, it seems a natural conclusion that a hide is better from an ox that has been fed in the open air, than from one that has been kept in the barn. dirt adhering to a hide injures it, particularly in stall-fed animals; and any thing that punctures a hide, such as warbles arising from certain insects, is also injurious. the best hides are obtained from the west highlanders. the short horns produce the thinnest hides, the aberdeenshire the next, and then the angus. of the same breed, the ox affords the strongest hide; but, as hides are applied to various uses, the cow's, provided it be large, may be as valuable as that of the ox. the bull's hide is the least valuable. hides are imported from russia and south america. hides, when deprived of their hair, are converted into _leather_ by an infusion of the astringent property of bark. the old plan of tanning used to occupy a long time; but, such was the value of the process, that the old tanners used to pride themselves upon producing a substantial article--which is more than can be said in many instances under modern improved modes, which hasten the process, much to the injury of the article produced. strong infusions of bark make leather brittle; one hundred pounds of skin, quickly tanned in a strong infusion, produce one hundred and thirty-seven pounds of leather; while a weak infusion produces only one hundred and seventeen and a half,--the additional nineteen and a half pounds serving only to deteriorate the leather, and causing it to contain much less textile animal solid. leather thus highly charged with tanning is so spongy as to allow moisture to pass readily through its pores, to the great discomfort and injury of those who wear shoes made of it. the proper mode of tanning lasts a year, or a year and a half, according to the quality of the leather wanted and the nature of the hides. a perfect leather can be recognized by its section, which should have a glistening marbled appearance, without any white streaks in the middle. the hair which is taken off hides in tanning, is employed to mix with plaster, and is often surreptitiously put into hair-mattresses. the principal substances of which _glue_ is made are the parings of ox and other thick hides, which form the strongest article and the refuse of the leather-dresser. both afford from forty-five to fifty-five per cent. of glue. the tendons, and many other offals of slaughter-houses, also afford materials, though of an inferior quality, for this purpose. the refuse of tanneries--such as the ears of oxen and calves--are better articles. animal skins also, in any form, uncombined with tannin, may be worked into glue. _ox-tallow_ is of great importance in the arts. candles and soap are made of it, and it enters largely into the dressing of leather and the use of machinery. large quantities are annually exported from russia. ox-tallow consists of seventy-six parts of stearine and twenty-four of oleine, out of one hundred parts. the _horns_ of oxen are used for many purposes. the horn consists of two parts: an outward horny case, and an inward conical-shaped substance, somewhat intermediate between indurated hair and bone, called the _fluid_ of the horn. these two parts are separated by means of a blow upon a block of wood. the horny exterior is then cut into three portions by means of a frame saw. the lowest of these, next the root of the horn, after undergoing several processes by which it is rendered flat, is made into combs. the middle of the horn, after having been flattened by heat, and its transparency improved by oil, is split into thin layers, and forms a substitute for glass in lanterns of the commonest kind. the tip of the horns is used by makers of knife-handles and of the tops of whips, and for other similar purposes. the interior, or core of the horn, is boiled down in water. a large quantity of fat rises to the surface; this is put aside, and sold to the makers of yellow soap. the itself is used as a kind of glue, and is purchased by the cloth-draper for stiffening. the bony substance remaining behind is then sent to the mill, and, after having been ground down, is sold to farmers for manure. besides these various purposes to which the different parts of the horn are applied, the clippings which arise in comb-making are sold to the farmer for manure, as well as the shavings which form the refuse of the lantern-makers. horn, as is well known, is easily rendered soft and pliant in warm water; and by this peculiarity and its property of adhering like glue, large plates of horn can be made by cementing together the edges of small pieces rendered flat by a peculiar process, as a substitute for glass. imitation of tortoise-shell can be given to horn by means of various metallic solutions. horn, also, when softened, can be imprinted with any pattern, by means of dies. [illustration] diseases and their remedies under this head it is proposed to notice such diseases as are most common among cattle, together with their symptoms, and to suggest such treatment of the same as has been found in the practice of the author, in the main, effective. he is aware that much more space might have been appropriated to this head, as has been the case in other treatises of this class; but he doubts the propriety of multiplying words about diseases which are of very rare occurrence, deeming it more fitting to leave such instances exclusively to the intelligent consideration of the reliable veterinary practitioner. for convenience of reference, the diseases here noticed have been arranged in alphabetical order; the whole concluding with information as to two or three operations which cannot be uninteresting to, or unprofitable for, the reader. abortion. the cow is, more than any other animal, subject to abortion, or slinking, which takes place at different periods of pregnancy, from half of the usual time to the seventh, or almost to the eighth month. the symptoms of the approach of abortion, unless the breeder is very much among his stock, are not often perceived; or, if perceived, they are concealed by the person in charge, lest he should be accused of neglect or improper treatment. the cow is somewhat off her feed--rumination ceases--she is listless and dull--the milk diminishes or dries up--the motions of the foetus become more feeble, and at length cease altogether--there is a slight degree of enlargement of the belly--there is a little staggering in her walk--when she is down she lies longer than usual, and when she gets up she stands for a longer time motionless. as the abortion approaches, a yellow or red glairy fluid runs from the vagina (this is a symptom, which rarely, or never, deceives) her breathing becomes laborious and slightly convulsive. the belly has for several days lost its natural rotundity, and has been evidently falling,--she begins to moan,--the pulse becomes small, wiry, and intermittent. at length labor comes on, and is often attended with much difficulty and danger. if the abortion has been caused by blows or violence, whether from brutality, or the animal's having been teased by other cows in season, or by oxen, the symptoms are more intense. the animal suddenly ceases to eat and to ruminate--is uneasy, paws the ground, rests her head on the manger while she is standing, and on her flank when she is lying down--hemorrhage frequently comes on from the uterus, or when this is not the case the mouth of that organ is spasmodically contracted. the throes come on, are distressingly violent, and continue until the womb is ruptured. if all these circumstances be not observed, still the labor is protracted and dangerous. abortion is sometimes singularly frequent in particular districts, or on particular farms, appearing to assume an epizoötic or epidemic form. this has been accounted for in various ways. some have imagined it to be contagious. it is, indeed, destructively propagated among the cows, but this is probably to be explained on a different principle from that of contagion. the cow is a considerably imaginative animal, and highly irritable during the period of pregnancy. in abortion, the foetus is often putrid before it is discharged; and the placenta, or after-birth, rarely or never follows it, but becomes decomposed, and, as it drops away in fragments, emits a peculiar and most noisome smell. this smell seems to be peculiarly annoying to the other cows: they sniff at it and then run bellowing about. some sympathetic influence is exercised on their uterine organs, and in a few days a greater or less number of those that had pastured together likewise abort. hence arises the rapidity with which the foetus is usually taken away and buried deeply, and far from the cows; and hence the more effectual preventive of smearing the parts of the cow with tar or stinking oils, in order to conceal or subdue the smell; and hence, too, the inefficacy, as a preventive, of removing her to a far-distant pasture. the pastures on which the blood or inflammatory fever is most prevalent are those on which the cows oftenest slink their calves. whatever can become a source of general excitation and fever is likely, during pregnancy, to produce inflammation of the womb; or whatever would, under other circumstances, excite inflammation of almost any organ, has at that time its injurious effect determined to this particular one. every farmer is aware of the injurious effect of the coarse, rank herbage of low, marshy, and woody countries, and he regards these districts as the chosen residence of red water; it may be added, that they are also the chosen residence of abortion. hard and mineral waters are justly considered as laying the foundation of many diseases among cattle, and of abortion among the rest. some careful observers have occasionally attributed abortion to disproportion in size between the male and the female. farmers were formerly too fond of selecting a great overgrown bull to serve their dairy or breeding cows, and many a heifer, or little cow, was seriously injured; and she either cast her calf, or was lost in parturition. the breeders of cattle in later years are beginning to act more wisely in this matter. cows that are degenerating into consumption are exceedingly subject to abortion. they are continually in heat; they rarely become pregnant, or if they do, a great proportion of them cast their calves. abortion, also, often follows a sudden change from poor to luxuriant food. cows that have been out, half-starved in the winter, when incautiously turned on rich pasture in the spring, are too apt to cast their calves from the undue general or local excitation that is set up. hence it is, that when this disposition to abort first appears in a herd, it is naturally in a cow that has been lately purchased. fright, from whatever cause, may produce this trouble. there are singular cases on record of whole herds of cows slinking their calves after having been terrified by an unusually violent thunder-storm. commerce with the bull soon after conception is also a frequent cause, as well as putrid smells--other than those already noticed--and the use of a diseased bull. besides these tangible causes of abortion, there is the mysterious agency of the atmosphere. there are certain seasons when abortion is strangely frequent, and fatal; while at other times it disappears in a manner for several successive years. the consequences of premature calving are frequently of a very serious nature; and even when the case is more favorable, the results are, nevertheless, very annoying. the animal very soon goes again to heat, but in a great many cases she fails to become pregnant; she almost invariably does so, if she is put to the bull during the first heat after abortion. if she should come in calf again during that season, it is very probable that at about the same period of gestation, or a little later, she will again abort: or that when she becomes in calf the following year, the same fatality will attend her. some say that this disposition to cast her young gradually ceases; that if she does miscarry, it is at a later and still later period of pregnancy; and that, in about three or four years, she may be depended upon as a tolerably safe breeder. he, however, would be sadly inattentive to his own interests who keeps a profitless beast so long. the calf very rarely lives, and in the majority of cases it is born dead or putrid. if there should appear to be any chance of saving it, it should be washed with warm water, carefully dried, and fed frequently with small quantities of new milk, mixed, according to the apparent weakness of the animal, either with raw eggs or good gruel; while the bowels should, if occasion requires, be opened by means of small doses of castor-oil. if any considerable period is to elapse before the natural time of pregnancy would have expired, it will usually be necessary to bring up the little animal entirely by hand. the treatment of abortion differs but little from that of parturition. if the farmer has once been tormented by this pest in his dairy, he should carefully watch the approaching symptoms of casting the calf, and as soon as he perceives them, should remove the animal from the pasture to a comfortable cow-house or shed. if the discharge be glairy, but not offensive, he may hope that the calf is not dead; he will be assured of this by the motion of the foetus, and then it is possible that the abortion may still be avoided. he should hasten to bleed her, and that copiously, in proportion to her age, size, condition, and the state of excitation in which he may find her; and he should give a dose of physic immediately after the bleeding. when the physic begins to operate, he should administer half a drachm of opium and half an ounce of sweet spirits of nitre. unless she is in a state of great debility, he should allow nothing but gruel, and she should be kept as quiet as possible. by these means he may occasionally allay the general or local irritation that precedes or causes the abortion, and the cow may yet go to her full time. should, however, the discharge be fetid, the conclusion will be that the foetus is dead, and must be got rid of, and that as speedily as possible. bleeding may even then be requisite if much fever exists; or, perhaps, if there is debility, some stimulating drink may not be out of place. in other respects the animal must be treated as if her usual time of pregnancy had been accomplished. much may be done in the way of preventing this habit of abortion among cows. _the foetus must be got rid of immediately._ it should be buried deep, and far from the cow-pasture. proper means should be taken to hasten the expulsion of the placenta. a dose of physic should be given; ergot of rye administered; the hand should be introduced, and an effort made, cautiously and gently, to detach the placenta; all violence, however, should be carefully avoided; for considerable and fatal hemorrhage may be speedily produced. the parts of the cow should be well washed with a solution of the chloride of lime, which should be injected up the vagina, and also given internally. in the mean time, and especially after the expulsion of the placenta, the cow-house should be well washed with the same solution. the cow, when beginning to recover, should be fattened and sold. this is the first and the grand step toward the prevention of abortion, and he is unwise who does not immediately adopt it. all other means are comparatively inefficient and worthless. should the owner be reluctant to part with her, two months, at least, should pass before she is permitted to return to her companions. prudence would probably dictate that she should never return to them, but be kept, if possible, on some distant part of the farm. abortion having once occurred among the herd, the breeding cows should be carefully watched. although they should be well fed, they should not be suffered to get into too high condition. unless they are decidedly poor and weak, they should be bled between the third and fourth months of pregnancy, and a mild dose of physic administered to each. if the pest continues to reappear, the owner should most carefully examine how far any of the causes of abortion that have been detected, may exist on his farm, and exert himself to thoroughly remove them. an interesting paper upon this subject may be found in the veterinary review, vol. ., p. , communicated by prof. henry tanner, of queen's college, birmingham, england. as it suggests a theory as to the origin of this disease which is, to say the least, quite plausible, we transfer the article:-- "i shall not go into any notice of the general subject of abortion, but rather restrict my remarks to a cause which is very much overlooked, and yet which is probably more influential than all other causes combined. i refer to the growth of ergotized grass-seeds in our pastures. "the action of ergot of rye (_secale cornutum_) upon the womb is well known as an excitant to powerful action, which usually terminates in the expulsion of the foetus. we have a similar disease appearing on the seeds of our grasses, but especially on the rye grass, and thus we have an ergot of the seeds of rye grass produced, possessing similar exciting powers upon the womb to those produced by the ergot of rye. "two conditions are necessary for the production of this ergot upon the seed of rye grass. the first is, the grass must be allowed to run to seed; and the second is, that the climate must be favorable for encouraging the development of the ergot. "in practice, we find that on land which has been fed on during the summer, unless it has been grazed with unusual care, much of the grass throws up seed-stalks and produces seed. in districts where the climate is humid and rain abundant, as well as in very wet seasons, these seeds become liable to the growth of this ergot. cattle appear to eat it with a relish, and the result is that abortion spreads rapidly through the herd. heifers and cows, which, up to the appearance of the ergot, have held in calf, are excited to cast their calves by consuming it in their food. the abortion having once commenced, we know that the peculiarly sensitive condition of the breeding animal will cause its extension, even where the original cause may not be in operation; but their combined action renders the loss far more serious. if we add to this the tendency which an animal receives from her first abortion, to repeat it when next in calf, we see how seriously the mischief becomes multiplied. "a somewhat extended observation, added to my own experience, has led me to the conviction that very much of the loss arising from abortion in our cows may be traced to the cause i have named. i feel assured the influence is even more extended than i have stated; for not only would the foetus be thrown off in its advanced stage, but also in its earlier growth, thus causing great trouble to breeders of high-bred stock, the repeated turning of cows to the bull, and at most irregular intervals. "the remedy differs in no respect from the ordinary mode of treatment, except that it compels a removal of the stock from the influence of the cause. much, however, may be done by way of prevention; and this i shall briefly notice. "it simply consists in keeping breeding cows and heifers upon land free from these seeds. grass which has been grazed during the summer, will very generally, in a humid climate, have some of this ergotized seed; but i have not observed it produced before the end of july, or early in august; and i doubt its existence, to any injurious degree, up to this time. we may, therefore, consider such ground safe up to this period. if the breeding stock are then removed to grass land which, having been mown for this operation is a guaranty against any seeds remaining, it will seldom, if ever, happen that any injury will result from the production of ergotized grass later in the season. "i will not venture to say that such will not appear in some cases where the grass has been cut early and has been followed by a rapid growth; but, at any rate, we have grazing land free from this excitant from july until september; and in the grass which has been mown late, i do not consider that there is the least fear of ergot's being again formed in that season. in this manner a farmer may keep grass land for his breeding stock entirely free from ergotized grass; and, consequently, so far as this cause is concerned, they will be free from abortion. how far young heifers may be prejudicially influenced, before they are used for breeding, by an excitement of the womb, appears to me to be a subject worthy of some attention on the part of the veterinary profession." apoplexy. this is a determination of blood to the head, causing pressure upon the brain. animals attacked with this disease are generally in a plethoric condition. the usual symptoms are _coma_ (a sleepy state), eyes protruding, respiration accelerated; finally, the animal falls, struggles, and dies. in such cases, bleeding should be resorted to at an early period; give in drink one pound of epsom-salts. black water. this is simply an exaggerated stage of the disease known as red water,--to which the reader is referred in its appropriate place,--the urine being darker in color in consequence of the admixture of venous blood. the symptoms are similar, though more acute. there is constipation at first, which is followed by diarrhoea, large quantities of blood passing away with the evacuations from the bowels; symptoms of abdominal pain are present; the loins become extremely tender; and the animal dies in a greatly prostrated condition. the treatment does not differ from that prescribed in case of red water. bronchitis. the trachea and bronchial tubes are frequently the seat of inflammation, especially in the spring of the year,--the symptoms of which are often confounded with those of other pulmonary diseases. this inflammation is frequently preceded by catarrhal affections; cough is often present for a long time before the more acute symptoms are observed. bronchitis occasionally makes its appearance in an epizoötic form. _symptoms._--a peculiarly anxious expression of the countenance will be observed; respiration laborious; a husky, wheezing, painful cough; on placing the ear to the windpipe a sonorous _râle_ is heard; symptomatic fever also prevails to a greater or less extent. _treatment._--counter-irritation should be early resorted to; strong mustard, mixed with equal parts of spirits of hartshorn and water, and made into a thin paste, should be applied all along the neck, over the windpipe, and to the sides, and should be well rubbed in; or, the tincture of cantharides, with ten drops of castor-oil to each ounce, applied in the same manner as the former, will be found equally effective. give internally ten drops of fleming's tincture of aconite every four hours, until five or six doses have been given; after which give one of the following powders twice a day: nitrate of potash, one ounce; barbadoes aloes, one ounce; jamaica ginger, half an ounce; pulverized-gentian root, one ounce; mix and divide into eight powders. if necessary a pound of salts may be given. consumption this affection--technically known as _phthisis pulmonalis_--is the termination of chronic disease of the lungs. these organs become filled with many little cysts, or sacks, containing a yellowish or yellowish-white fluid, which in time is hardened, producing a condition of the lungs known as tuberculous. these tubercles in turn undergo another change, becoming soft in the centre and gradually involving the whole of the hardened parts, which, uniting with adjoining ones, soon forms cysts of considerable size. these cysts are known as abscesses. no treatment will be of much service here. it is, therefore, better, if the animal is not too poor in flesh, to have it slaughtered. coryza in the spring, and late in the fall, catarrhal affections are quite common, occurring frequently in a epizoötic form. coryza, or nasal catarrh,--commonly called a cold in the head,--is not very common among cows. as its name implies, it is a local disease, confined to the lining membrane of the nose; and, consequently, the general system is not usually disturbed. _symptoms._--the animal will be observed to sneeze; the schneiderian membrane (membrane of the nose) is heightened in color; cough sometimes accompanies; there is also a muco-purulent discharge from the nose. neglect to attend to these early symptoms frequently occasions disease of a more serious nature; in fact, coryza may be regarded as the forerunner of all epizoötic pulmonary disorders. [illustration: a chat on the road.] _treatment._--the animal should be kept on a low diet for a few days; the nostrils occasionally steamed, and one of the following powders given night and morning, which, in most cases, will be all the medicine required: nitrate of potassa, one ounce; digitalis leaves pulverized and tartrate of antimony, of each one drachm; sulphate of copper, two drachms; mix, and divide into eight powders. should the disease prove obstinate, give for two or three days two ounces of epsom-salts at a dose, dissolved in water, three times a day. cow-pox. two varieties of sore teats occur in the cow, in the form of pustular eruptions. they first appear as small vesicles containing a purulent matter, and subsequently assume a scabby appearance, or small ulcers remain, which often prove troublesome to heal. this latter is the cow-pox, from which jenner derived the vaccine matter. _treatment._--foment the teats well with warm water and castile-soap; after which, wipe the bag dry, and dress with citrine ointment. the preparations of iodine have also been recommended, and they are very serviceable. diarrhoea. cattle are frequently subject to this disease, particularly in the spring of the year when the grass is young and soft. occasionally it assumes a very obstinate form in consequence of the imperfect secretion of gastric juice; the _fæces_ are thin, watery, and fetid, followed by very great prostration of the animal. the symptoms of diarrhoea are too well known to require any detailed description. _treatment._--if in a mild form, the diet should be low; give two ounces of epsom-salts, twice a day. in a more obstinate form, give two drachms of carbonate of soda in the food. oak-bark tea will be found very useful in these cases; or one of the following powders, twice a day, will be found very advantageous: pulverized opium and catechu, each one and a half ounces; prepared chalk, one drachm; to be given in the feed. calves are particularly subject to this disease, and it often proves fatal to them. it sometimes assumes an epizoötic form, when it is generally of a mild character. so long as the calf is lively and feeds well, the farmer should entertain no fear for him; but if he mopes about, refuses his food, ceases to ruminate, wastes in flesh, passes mucus and blood with the _fæces_, and exhibits symptoms of pain, the case is a dangerous one. in such an emergency, lose no time, but give two or three ounces of castor-oil with flour-gruel, or two ounces of salts at a dose, followed with small draughts of oak-bark tea; or give, twice a day, one of the following powders: pulverized catechu, opium, and jamaca ginger, of each half an ounce; prepared chalk, one ounce; mix, and divide into twelve powders. bran washes, green food, and flour-gruel should be given, with plenty of salt. dysentery this disease is very frequently confounded with the foregoing. a distinction, however, exists,--since inflammation appears in this disease, while it is absent in the former. in this affection, inflammation of the large intestines takes place, which is attended with diarrhoea. the _fæces_ are covered with blood; the animal rapidly becomes prostrated, and death frequently comes to his relief. youatt says: "it is, however, with dysentery that the practitioner is most loth to cope,--a disease that betrays thousands of cattle. this, also, may be either acute or chronic. its causes are too often buried in obscurity, and its premonitory symptoms are disregarded or unknown. there appears to be a strong predisposition in cattle to take on this disease. it seems to be the winding-up of many serious complaints, and the foundation of it is sometimes laid by those that appear to be of the most trifling nature. it is that in cattle which glanders and farcy are in the horse,--the breaking up of the constitution. "dysentery may be a symptom and concomitant of other diseases. it is one of the most fearful characteristics of murrain; it is the destructive accompaniment, or consequence, of phthisis. it is produced by the sudden disappearance of a cutaneous eruption; it follows the cessation of chronic hoose; it is the consequence of the natural or artificial suspension of every secretion. were any secretion to be particularly selected, the repression of which would produce dysentery, it would be that of the milk. how often does the farmer observe that no sooner does a milch cow cease her usual supply of milk than she begins to purge! there may not appear to be any thing else the matter with her; but she purges, and, in the majority of cases, that purging is fatal. "it may, sometimes, however, be traced to sufficient causes, exclusive of previous disease. unwholesome food--exposure to cold--neglect at the time of calving--low and marshy situations--the feeding in meadows that have been flooded, where it is peculiarly fatal--the grazing (according to mr. leigh, and our experience confirms his statement) upon the clays lying over the blue lias rock--the neighborhood of woods and of half-stagnant rivers--the continuation of unusually sultry weather--overwork, and all the causes of acute dysentery, may produce that of a chronic nature; an acute dysentery--neglected, or badly, or even most skillfully treated--may degenerate into an incurable chronic affection. half starve a cow, or over-feed her, milk her to exhaustion, or dry her milk too rapidly--and dysentery may follow. "the following will, probably, be the order of the symptoms, if they are carefully observed: there will be a little dullness or anxiety of countenance, the muzzle becoming short or contracted; a slight shrinking when the loins are pressed upon; the skin a little harsh and dry; the hair a little rough; there will be a slight degree of uneasiness and shivering that scarcely attracts attention; then--except it be the degeneracy of acute into chronic dysentery--constipation may be perceived. it will be to a certain extent, obstinate; the excrement will voided with pain; it will be dry, hard, and expelled in small quantities. in other cases, perhaps, purging will be present from the beginning; the animal will be tormented with _tenesmus_, or frequent desire to void its excrement, and that act attended by straining and pain, by soreness about the _anus_, and protrusion of the _rectum_, and sometimes by severe colicky spasms. in many cases, however, and in those of a chronic form, few of these distressing symptoms are observed, even at the commencement of the disease; but the animal voids her _fæces_ oftener than it is natural that she should, and they are more fluid than in a state of health; while at the same time she loses her appetite and spirits and condition, and is evidently wasting away." _treatment._--give one drachm of the extract of belladonna, three times a day, dissolved in water; or calomel and powdered opium, of each one drachm three times daily. as soon as the inflammatory stage passes by, give one of the following three times daily, in their gruel: nitrate of potash pulverized, gentian-root pulverized, of each one ounce; pulverized jamaica ginger, one half an ounce; pulverized caraway, or anise-seed, six drachms. a bottle of porter given once or twice a day, will be found of very great advantage. enteritis. this is an inflammation of the external or internal coat of the intestines, sometimes attended with violent purging, especially when it is confined to the internal coats. oxen in good condition are more subject to this disease than are cows. it most frequently occurs in dry, hot weather. it is sudden in its attacks, and often fatal in its termination. _symptoms._--the animal is dull, and not disposed to move about; the muzzle is dry, and the coat staring; the animal yields, on pressure of the _loins_; a weak, staggering gait, when forced to move; respiration hurried; pulse accelerated but small; eyes red, full and fiery; head protruding; mouth, ears, and horns hot; appetite bad; rumination ceases; the bowels become constipated; the animal moans continually, and froths at the mouth. these symptoms violently increase as the disease advances. the animal becomes more depressed and feeble, grinds his teeth, and appears half unconscious, and dies in convulsions. of the causes of this disease, youatt, who is almost the only authority we have upon this subject, says: "it seems occasionally to be epidemic; for several instances of it occur, of the same character, and in the same district. m. cruzel gives an illustration of this in his description of the disease that destroyed so many cattle, in the years to , in the department _de la nievre_. out of two hundred and eighteen cattle belonging to three farmers, one hundred and thirteen were attacked by this disease, and eighty-three of them died. one farmer in a neighboring district had nineteen head of cattle, all of which sickened, but only three were lost. these were unusually hot summers. the upland pasture was burnt up, or what remained of it was rendered unusually stimulating; and the acrid plants of the marshes and low grounds acquired additional deleterious agency. "when isolated cases occur, they may generally be attributed to mismanagement. exposure to cold, or the drinking of cold water when overheated with work; too hard work in sultry weather; the use of water stagnant, impure, or containing any considerable quantity of metallic salts; the sudden revulsion of some cutaneous eruption; the crowding of animals into a confined place; too luxuriant and stimulating food generally; and the mildewed and unwholesome food on which cattle are too often kept, are fruitful sources of this complaint." _treatment._--in the early stage of the disease, give an active purge, and follow it with ten drops of fleming's tincture of aconite, four times daily, for two days; then give drachm doses of the extract of belladonna; give no food for twenty-four or forty-eight hours, according to circumstances. bleeding, if done early, is often beneficial. counter-irritants to the belly are also recommended; the best are mustard, hartshorn, and water, mixed together--or tincture of cantharides, with one drachm of croton-oil added to every ounce. epizoÖtics. diseases of this class have the same relation to the inferior animals that epidemic diseases have to man. of course, they assume a very pestilential character. scarcely a year passes away without diseases of this nature making their appearance in some parts of the world. they occur at all seasons of the year, but more generally prevail in the spring and fall. the period of their duration varies from months to years. they are, at times, mild in their attacks, and yield readily to proper treatment; at other times, they become painful pestilences, destroying every thing in their course. the causes are generally sought for in some peculiar condition of the atmosphere. the use of the milk and flesh of diseased cattle has frequently been productive of malignant diseases in the human family. silius italicus describes a fearful epizoötic, which first attacked the dog, then the feathered biped, then horses, and cattle, and, last of all, the human being. "on mules and dogs the infection first began, and, last, the vengeful arrows fixed in man." epizoötics, occurring in rats, cats, dogs, horses, and cattle, which were followed in the succeeding years by more fearful ones which attacked the human family, are numerously recorded. these scourges have appeared in all ages of the world; but, as time and space will not allow our entering upon an extended consideration of them,--however interesting they might be to the general reader,--we shall content ourselves by quoting, somewhat in brief, from the lectures of the late william youatt on these fatal maladies:-- "in the year , and at the commencement of the reign of charlemagne, an epidemic disease devastated a great portion of his dominions. this was attributed to the villainy of the duke of benevento, who was said to have employed a great many persons in scattering an enchanted powder over the fields, which destroyed both the cattle and the food of the cattle. m. paulet seems inclined to give full credence to this, and says that history offers many proofs of this destructive and diabolical practice. he affirms that many persons were punished in germany, france, and, particularly, at toulouse, for the commission of this crime. several of the suspected agents of these atrocities were put to the torture and made full confession of their crime. "of the occurrence of these diseases from the year to ,--an interval of mental darkness, and of horrors and calamities of every kind,--history records twenty cases, more or less destructive, and extending, with greater or less devastation, over france and germany, italy and england. of these twenty, four date their origin from an excessive moisture in the air, accompanied by almost continual rains, and flooding the country to a considerable extent. one was supposed to be the consequence of long-continued drought and excessive heat; one was traced to the influence of an eclipse of the sun; another, to a comet; and a fourth, to a most unusually stormy winter. the reader will have the kindness to remember that we are here expressing the opinions of the writers of the day, and by no means, our own belief of the matter. "of the four which trace their origin to extreme wet and its consequences, the first occurred in france, in , after a long continuance of rain; and it was equally fatal to men and cattle. the second, which was equally fatal to both, appeared in lorraine, in . the third broke out among the cavalry of the army of arnoul, in its passage over the alps, on its return to italy. the fourth pervaded the whole of england in , and was equally fatal to the biped and the quadruped. "that which followed excessive heat and drought, was generally prevalent throughout europe, but especially so in germany. it attacked oxen, sheep, and pigs. it appeared in , and lasted six months. "the one which was attributed to the comet, and which principally attacked cattle, appeared in france in almost every animal perished. "another, that was supposed to be connected with an eclipse of the sun, was prevalent throughout the greater part of germany, among men and animals, in . "the disease, which was the consequence of a cold and boisterous winter, was principally prevalent in france, in , and committed sad ravages among the herds of cattle and sheep. "of the twelve others, of which, authors do not indicate the cause, the first was in france, in , and principally among cattle. the second was also in france, in , and almost depopulated the country of cattle. the third, in , was common to all animals in france. the fourth, in , was in the same country, and caused severe loss among cattle. the fifth prevailed on the rhine and in germany, and destroyed an almost incalculable number of cattle. the sixth attacked the horses of the army of arnoul in lorraine, in . the seventh, in , destroyed a vast number of cattle in france, italy, and germany. the eighth and ninth were in france, in and , and almost all the cattle in the country perished. the tenth pestilence broke out in england, in the year , and frightful was its devastation among all animals, and, particularly, horned cattle. the eleventh also devastated our country, in , and the ravages were dreadful. the twelfth was chiefly fatal in germany, and particularly in gueldres, in . "these twenty pestilences occurred in the space of years. five or six of them were most prevalent among cattle; two were almost confined to horses; twelve included, to a greater or less degree, almost every species of quadrupeds; and four extended to the human being. among these the ravages of eight were most destructive in france; as many in germany; and four in italy and england. "as far as we have hitherto proceeded, it will also appear that cattle are more subject to these diseases than any other species of domesticated animals, and that the pestilence is always most fearful among them. it is also evident that the maladies which proceed from cold or humidity are more frequent in the temperate and southern parts of europe than those which depend upon drought, or almost any other cause. "the malady lingers in different countries, in proportion to its want of power to accomplish at once all its devastation. "after this time, there are few satisfactory accounts of these diseases for more than five centuries. we only know that, occasionally suspending their ravages,--or, rather, visiting new districts when they had ceased to desolate others--they have continued to be objects of terror and instruments of devastation, even unto the present day; and it is only within a few years that they have been really understood, and have become, to a certain degree, manageable." in the united states, epizoötic diseases have been of frequent occurrence; but, owing to the want of properly qualified veterinary surgeons, they have not, until within a very recent period, been properly described or understood. the day however, is fast approaching when this void will be filled, and when epizoötic and other diseases will be correctly noted and recorded. the necessity for this must have been forcibly impressed upon the minds of the inhabitants of our country from the experience of the last ten or twelve years. respecting the late epizoötic among cattle in portage county, ohio, william pierce, v.s., of ravenna, thus describes the symptoms as they appeared, in a letter to the author: "a highly-colored appearance of the sclerotic coat of the eye, also of the _conjunctiva_ (a lining membrane of the eyelid) and the schneiderian membrane of the nose; a high animal heat about the head and horns; a highly inflammatory condition of the blood; contraction of all the abdominal viscera; hurried respiration; great prostration and nervous debility; lameness; followed by gangrene of the extremity of the tail, and the hind-feet; terminating in mortification and death." mr. pierce is convinced that these symptoms are produced by the continued use of the ergot, or spur of the june grass,--the effects being similar to those produced upon the human family by long-continued use of ergot of rye. this disease assumes both an acute and chronic form. the same gentleman also says: "ordinary observers, as well as those who claim to be scientific, have entertained very conflicting opinions as to its general character; some regarding it as epizoötic, others as contagious; some attributing it to atmospheric influence, others to foulings in the stable or yard. others, again, attribute it to freezing of the feet in winter. cattle-doctors in a majority of cases, fail to cure it. i have, however, by a simple course of treatment, effected many signal cures. some parties are so confident of the contagious character of the disease that they refuse to drive cattle along a road where it is known to exist. they even, oftentimes, wash their boots previous to entering their barnyards, after walking over the ground where such diseased cattle have been running. "caution is both proper and commendable. i do not, however, regard it as a contagious disease, nor can it be transmitted by inoculation. the calf is carried during the progress of the disease, and delivered in apparently good health. the milk of the cow appears to be unaffected and harmless. i call this disease _sphacial fever_, or _gangrenous fever_. [illustration: the mad bull.] "the ergot, or spur of the hay, is confined to the june grass, as far as my observation extends; owing, probably, to its early maturity. most other kinds of grass are cut before the seeds have matured sufficiently to produce the spur. i was suspicious of the foulness of the feed before i examined any hay, and have found the spur in the hay wherever the disease is found. "mr. sanford, of edinburgh, ohio, purchased one half of a mow of hay from mr. bassett, of randolph, which was removed to his farm in randolph, eight miles distant. of this hay, mr. sanford fed eleven cows some six or eight weeks. mr. bassett had been feeding the same to four cows. at about the same time, both heads began to show lameness. i visited mr. s. after he had lost six cows, and examined the remaining five, four of which were lame and the other showed symptoms of the disease. he had two other cows, one of which was loaned to a neighbor, and the other was fed upon different hay, for convenience. the loaned cow was returned about the first of march,--the two then running with the ailing ones until the th of april, when i saw them sound and in good health. "i then visited mr. bassett's stock, which i found infected with the same disease,--he having lost one, and the remaining three being lame, and much debilitated. the hoofs were sloughing off. some of the same hay remained in the snow, which, upon examination, exhibited an abundance of the spur. upon inquiry, i found that no such disease existed between the two farms, or in the neighborhood of either mr. s. or mr. b. the peculiarity of this circumstance at once swept away the last vestige of doubt from my mind. mr. e. chapman, of rootstown, accompanied me, and can vouch for the correctness of these statements. "he hooted at my opinions, asserting that he understood the disease, and that it was caused by the freezing of the feet. he has since, however, abandoned that idea, and honestly 'acknowledged the corn.' this ergot is regarded by some as a parasitic fungus, formed in other grains, an abundant vegeto-animal substance, and much disposed to putrefaction. we appear to be in the dark regarding its real composition. the little which has been written upon the subject, appears to be founded upon hypothesis, and that the most obscure. the articles to which i refer may differ in quality or property to a considerable extent, and we may forever remain in the dark, unless chemical investigation be instituted. "in this particular disease, there appears to be singularity in the symptoms through all its various stages, which is likely to originate in the peculiarity of the cause which produces them. the effects and symptoms arising from the continued use of the ergot of rye, as manifested in the human system, have been but briefly hinted at by authors, and, probably, some of them are only reasonable conjectures. all they say is, that it produces violent headache, spaculation in the extremities, and death. hitherto, its effects upon the inferior animal have been subjected to no investigation, and its peculiarity in the symptoms, differing from like phenomena by other causes, may yet be demonstrated. i am not alone in my opinion of this disease. i have taken counsel of those whose judgment cannot be questioned. whatever difference of opinion exists is attributable to a want of investigation, and it will continue to exist until this singular phenomenon is clearly accounted for. every opinion should be thoroughly criticized till facts are obtained. every man's opinion is sacred to himself, but we should yield to conviction. "two classes of this disease are exhibited: one, of irritation, and the other, of debility; one, an acute, the other, a chronic form. the point at which it assumes the chronic form is between congestion and gangrene. by close observation we can discover these to be different and higher degrees of the same disease. all subsequent degrees are dependent upon the first. "the first symptom, or degree, is, probably, an attack upon the systematic circulation, produced by a certain medicinal and deleterious property existing in the ergot, and communicated to the blood through the absorption of the tongue. this is more evident from the fact that the digestive organs retain their normal condition till the last stages of the chronic form. the blood in the first two stages is healthy, and the peculiar influence is only apparent in the subsequent stages; as evidenced by the fact that the muscles and general good appearance, as well as life itself, last longer than could be possible, if this deleterious influence were exhausted upon the digestive organs and the blood, in its first stages. and, as we suppose that fever and congestion constitute an attack upon the red blood, which is exhibited by hurried pulsation, we might rationally infer that the next degree would be gangrene of the globule, causing sloughing, the same as if it were carried to the muscles, or surface. this sloughing of the globule would be the same as if exhibited on any other part of the organization, for the fibrin is identical with muscle, as albumen is identical with the white of an egg; and since congestion is the forerunner of gangrene at the extremities, or on the surface, so fever and quick pulsation are the forerunners of congestion of the blood. gangrene cannot ensue without obstruction in the blood-vessels; and congestion cannot take place without obstruction in that which sustains the globule. as gangrene, then, is the first stage of decomposition of animal matter, so is congestion the first stage of decomposition of the globule; and as mortification is death in the organized body, so is congestion death in the organized globule. "it appears evident that this disease, in all its forms and degrees of intensity, seeks vent or release; in other words, nature conflicting with it, throws it off its track, or balance, and offers means of escape, or shows it a door by which it may make its exit. in the first stage of the disease, the dermoid (skin) tissues make the effort. in the inflammatory, the serous, and the congestive, the mucous gangrene seeks vent; if obtained, mortification is prevented; if not, mortification directly supervenes, and death terminates the case. "in the case to which i refer, observation confirms my opinion that absolute mortification without vent determines the gangrene of the blood, and is hardly curable; but that gangrene's finding vent determines it to be curable, and the recovery highly probable." epizoÖtic catarrh. catarrh frequently assumes an epizoötic form of a very virulent character, originating spontaneously and extending over a large section of country at or about the same time. a cold spring succeeding a mild winter, is peculiarly productive of malignant catarrh. this is one of the most distressing and fatal diseases to which cattle are subject. _symptoms._--the animal appears dull, and unwilling to move about, staggering when forced to do so; obstinate costiveness is usually one of the earliest symptoms, succeeded by diarrhoea, which is equally difficult of management; sometimes, however, diarrhoea is present from the first; the animal loses flesh rapidly; the coat is staring; appetite is lost; tumors form about the head, neck, back, and joints, which appear to be filled with air, and upon pressure cause a crepitating sound; saliva flows from the mouth, becoming very fetid as the disease progresses. the animal always dies of putrefaction. _treatment._--this disease should be treated early, or not at all. good nursing is very essential. when costiveness is present, give barbadoes aloes, one ounce; croton-oil, ten drops; mix together; or give one pint of linseed-oil, to which add from ten to twenty drops of castor-oil. if the bowels are not open in twenty-four hours, give four ounces of sulphate of magnesia every six hours until they are opened. follow this with tincture of aconite, ten drops in water, every four hours, until the fever has abated. bleeding has been recommended by some writers; but the author has failed to experience any benefit from resorting to it, but, on the contrary, has seen much injury result from the use--or, rather, the abuse--of the lancet. he is, indeed, inclined to attribute much of the fatality attending this disease to indiscriminate blood-letting. when much debility exists, the animal should be sustained by tonics and stimulants. one ounce of nitric ether and half an ounce of tincture of opium, given in a little water, will be found beneficial. it should be given twice a day. pulverized gentian-root, one ounce; jamaica ginger, half an ounce; pulverized cloves, half an ounce; mixed, and divided into four powders, one to be given at night and at morning; will be found useful, in place of the opium and ether. fardel. this disease is properly known by the name of clue-bound. the manyplus, or omasum (third stomach), frequently becomes so choked up with food that it is hard and dry, and the operation of the digestive organs is very seriously impaired. the animal eats voraciously, for a time, but stops suddenly and trembles; the countenance assumes a peculiarly haggard appearance; there is a wild expression of the eye; a foaming at the mouth; a tendency to pitch forward, and at times a falling head-foremost to the ground. occasionally, the symptoms are very active, speedily terminating in death. there are few diseases of a constitutional character in which the stomach is not, more or less, sympathetically involved. "toward the end of september, , a great number of cows died at osterwich, in the principality of halberstadt. lieberkuhn, a celebrated physician,--there were no veterinary surgeons at that time,--was sent to examine into the nature of the disease, which was supposed to be one of the species of murrain that was then committing such ravages among the cattle in various parts of the continent. there were none of the tumors, or pestilential buboes, that, in an earlier or later period of the malady, usually accompanied and characterized murrain; but upon inspection of the dead bodies, considerable peritoneal inflammation was found; the first and second stomachs were filled with food, but the third stomach was the palpable seat of the disease; its leaves were black and gangrened. the mass contained between the leaves was black, dry, and so hard that it could scarcely be cut with a scalpel. it intercepted the passage of the food from the first two stomachs to the fourth; and this latter stomach was empty and much inflamed. neither the heart, nor the lungs, nor the intestines exhibited any trace of disease. twelve cows were opened, and the appearances were nearly the same in all of them." _treatment._--give one and a half pounds of epsom-salts, dissolved in three pints of water; or one quart of potash, three times daily, dissolved in water, will be found useful in this disease. foul in the foot. this is caused by hard or irritating substances making their way in between the claws of the foot, causing inflammation, and sometimes ulceration, in the parts. the pasterns swell, and the animal becomes lame. the foot should be thoroughly washed, and all foreign substances removed. a pledget of tow, saturated with tar and sprinkled with powdered sulphate of copper, should be inserted between the claws. this usually requires but one or two applications. garget. this is a hard, knotty condition of the udder, which sometimes follows calving, in consequence of the sudden distention of the bag with milk; and the inflammation which supervenes causes a congealed or coagulated condition of the milk to take place, of which, if neglected, suppuration and abscesses are the result. _treatment._--let the calf suck the dam as speedily as possible, and, if the hardness is not then removed, foment the udder with warm water; after which, wipe it dry, and apply to the entire surface melted lard as hot as the animal will bear. this is, generally, all that is required, the most obstinate cases yielding to it. if abscesses form, they should be lanced. gastro-enteritis. this disease--otherwise known as wood-evil, or moor-ill--arises from eating the buds of oak, young ash, and other trees, which are of a very highly stimulating or irritating character. as the intestinal canal is liable to inflammatory action from irritant substances admitted into it, animals are found to become diseased from eating too freely of these vegetable substances. _symptoms._--loss of appetite and suspended rumination; mouth hot; skin dry; pulse from sixty to seventy; swelling and pain of the belly; obstinate constipation; fæces hard and covered with blood; urine of a strong odor, highly colored, and voided with difficulty. _treatment._--the animal should be bled, and a strong purgative administered, followed by aconite and belladonna, as in enteritis. injections of castile-soap and water should be freely used; the application of the mustard, hartshorn, and water to the belly will also be found very beneficial. hoose. this disease--known also as catarrh--is occasionally the sequence of coryza, but more frequently it arises from an impure atmosphere; consequently, in cow-houses where animals are crowded together in numbers, it is most frequently found. scanty provender, and of an inferior quality, is among the exciting causes of hoose, producing, as it does, a debilitated state of the system, which, upon exposure of the animal to cold, or wet, hastens the disorder. some breeds of cattle are peculiarly liable to this disease, which, if not arrested in its early stage, runs on, involving the lungs, and frequently terminating in consumption. of all our domestic animals, neat cattle are most subject to pulmonary diseases. this is attributable to the neglect and exposure which are far too often their lot. butchers will testify that a large portion of all cattle slaughtered have abscesses and other diseases of the lungs. _symptoms._--loss of appetite; muzzle dry; coat rough, or staring; respiration quickened; horns hot; ears, nose, and legs cold; husky cough; pulse from sixty to seventy, small and thready; bowels frequently constipated. _treatment._--give one ounce of the following powders every six hours, until the bowels are opened: barbadoes aloes, one and half ounces; nitrate of potassa, half an ounce; ginger, six drachms; mix and divide into six powders. setons in the dewlap are often of great benefit. hoove. hoove, or blown, so common, and often so speedily fatal in cattle, is the result of fermentation in the _rumen_, or paunch, in consequence of the animal's having eaten large quantities of wet grass, luxuriant clover, turnips, etc. an accumulation of gas is the result of this fermentation, which greatly disturbs the haunch and left side of the belly, causing much pain to the animal, and frequently threatening suffocation. _treatment._--drench the animal with one ounce of spirits of hartshorn in one quart of water, the object being to neutralize the gas which is present in the rumen; or, two ounces of table salt dissolved in one quart of water will be found very effectual. if these do not speedily give relief, an active purge should be given. injections of soap and water should be freely used. if the case still proves obstinate, and the life of the animal is threatened, the paunch should be punctured. for this purpose, the trochar--an instrument specially adapted--should be used; but, in the absence of an instrument, an ordinary pocket-knife may be employed, taking care not to make a large opening. the proper point to operate is midway between the last rib and the prominent point of the hip-bone, about twelve inches from the centre of the back or loins. few cases have a fatal termination where this operation has been properly performed. hydatids. worms in the brain occasionally occur, causing great uneasiness to the animal and generally proving fatal. the symptoms are, loss of appetite; suspended rumination; a fevered condition of the system; horns and ears hot; respiration disturbed; coat staring, etc. no course of treatment will prove efficacious in this disease. pressure on the brain may occur from an accumulation of water, tumors, bruises, etc., in the cranial case. in either case, the same effects are produced as are observed in apoplexy. inflammation of the bladder. inflammation of the bladder generally accompanies inflammation of the kidneys, though it is sometimes found disconnected and alone. it is occasionally caused by calculous concretions in the bladder,--which should be removed,--causing very acute abdominal pain to the animal. she makes frequent efforts to stale, passing but a few drops of urine at a time. the pulse is full and rapid; mouth clammy; nose dry; eyes bloodshot; appetite lost; moaning, and walking with a staggering gait. _treatment._--inject into the bladder one quart of tepid water, and from one to two ounces of tincture of opium mixed together. give internally one of the following powders every hour until relieved; nitrate of potassa, one ounce; tartrate of antimony, and pulverized digitalis leaves, each one drachm; mix, and divide into six powders. mucilaginous draughts should be freely given. rupture of the bladder sometimes occurs, but there are no symptoms by which it may be known; and, if there were, no service could be rendered in the way of repairing the injury; the animal must die. inflammation of the haw. the ox, like the horse, has a membrane of semilunar form in the inner corner of the eye, which is capable of being thrown over the entire eyeball, for the purpose of cleansing the eye from any foreign substance which may get into it. this membrane is commonly called the haw, and is susceptible of attacks of inflammation, which cause it to swell, frequently even closing up the eye. _treatment._--give a dose of physic, and, if the animal is plethoric, extract a little blood from the vein on the same side as the affected eye. apply to the eye either of the following washes: tincture of opium, one ounce; rain-water, one pint; or, tincture of aconite, one drachm, to one pint of water. bathe two or three times a day. inflammation of the kidneys. this disease--sometimes called nephritis--occurs occasionally in cattle in consequence of their eating bad or unwholesome food, or of the abuse of diuretics, etc. the symptoms are very insidious in their approach. the loins are very tender upon pressure; the urine is voided in small quantities. as the disease advances, the symptoms become more marked and acute. the animal is dull, and feeds daintily; the evacuation of urine is attended with increased pain, and the urine is highly colored and bloody; the nose is dry; the horns, ears, and extremities are cold; respiration hurried; the pulse full, hard, and throbbing. _treatment._--give one pint of linseed-oil and ten drops of castor-oil, mixed together; follow this with small doses of salts once a day, for three or four days; give injections of water, one half a gallon to two ounces of tincture of arnica. mustard applications to the loins are also very useful. inflammation of the liver. diseases of the liver are of very common occurrence,--a fact with which all beef-butchers are familiar. perhaps no organ in the animal economy is so liable to disease. the obscurity of the symptoms and the good condition of the animal prevent its discovery, as a general thing, during its lifetime. when, however, the disease assumes an active form,--known as the yellows, jaundice, or inflammation of the liver,--the symptoms are more readily detected. _symptoms._--a yellowish color of the eye will be observed; skin, urine, etc., highly colored; soreness, on pressure, on the right side; loss of appetite; dullness; constipation of the bowels, etc. _treatment._--calomel is the most reliable medicine known to practitioners for diseases of the liver. its abuse, however, has brought it into disrepute. yet, as with ordinary care it may be advantageously used, we will prescribe it as that upon which the most dependence is to be placed, and in doing so, will endeavor to have it used safely. bleeding has been recommended: but the author has never found any benefit resulting. give epsom-salts, in doses of four ounces each, every night, with one scruple of calomel, until the animal is relieved. mustard and water should be frequently applied to the right side, and well rubbed in. laryngitis. this disease is of rare occurrence in cattle. in it, the mucous membrane lining the larynx is in a very irritable condition; the least pressure upon the parts affected causes intensely excruciating pain; the respiration becomes quick, painful, and laborious; the animal often appears to be hungry, yet does not eat much, in consequence of the pain occasioned by the act of swallowing. _treatment._--apply to the throat externally strong mustard, mixed, with equal parts of aqua ammonia and water, to a thin paste, every hour, until it produces an effect upon the skin; sponging the parts each time with warm water before applying the mustard. the animal should not be bled. give upon the tongue, or in drink, half-drachm doses of nitrate of potassa, every three or four hours, until relief is obtained. if suffocation threatens, the operation of tracheotomy is the only resort. [illustration: an aberdeenshire polled bull.] cloths saturated with cold water, wrapped around the neck so as to cover the larynx, frequently afford relief. a purgative will also be found useful. lice. cattle are very subject to lice, particularly when they are neglected, half-starved, and in poor condition. good care and good feeding--in connection with the treatment recommended in mange, to which the reader is referred--will comprise all that is requisite. mange. mange, or leprosy, is one of the most unpleasant and difficult diseases to manage of all the ailments to which cattle are subject requiring the nicest care and attention to render it easy of cure. an animal badly nursed will not, under the most skillful treatment, quickly recover. its causes are in the main, due to poor food, which produces a debilitated condition of the system, and in connection with a want of cleanliness, causes a development of the _acari_, or minute insects, exciting very great irritation upon the skin and causing the cow to rub herself against every object with which she comes in contact. the hair falls off; a scurfy appearance of the skin is perceptible; and the animal is poor in condition and in milk. the great trouble in treating this disease springs from its contagious character; for, no sooner is the animal, oftentimes, once free from the _acari_ than it comes in contact with some object against which it has previously been rubbing, when the _acari_ which were left upon that object are again brought in contact with the animal, and the disease is reproduced. if, immediately after the proper applications are made, the animal is removed to other quarters, and not allowed to return to the former ones for six or eight weeks, there is, generally speaking, but little trouble in treating the disease. take the animal upon a warm, sunny day, and with a scrubbing-brush cleanse the skin thoroughly with castile-soap and water; when dry, apply in the same manner the following mixture; white hellebore, one ounce; sulphur flower, three ounces; gas-water, one quart; mix all well together. one or two applications are, generally, all that will be required. give internally one of the following powders in the feed, night and morning: flowers of sulphur, two ounces; black antimony, one ounce; nitrate of potassa, one ounce; mix, and divide into eight powders. murrain. this is one of the most malignant diseases to which cattle are liable. fortunately, however, true murrain is comparatively rare in this great stock-raising country. the entire system seems to partake of the disease. the first indication of its approach is a feverish condition of the system, attended with a frequent and painful cough; the pulse is small, hard, and rapid. as the disease advances, the respiration becomes disturbed; the flanks heave; vesicular eruption is observed upon the teats, mouth, and feet; the horns are cold; the animal is sometimes lame; constipation and, sometimes, diarrhoea are accompanying symptoms; _fæces_ black and fetid; the eyes weep and become much swollen; great tenderness along the spine; a brown or bloody discharge from the nose and mouth; the animal moans incessantly, grinds his teeth, rarely lies down, but to get up again quickly; finally, the breath becomes very offensive; tumors make their appearance in various parts of the body, which, in favorable cases, suppurate, and discharge a fetid matter. _treatment._--give one fourth of a pound of epsom-salts, with one drachm of jamaica ginger, twice a day, for two or three days. a bottle of porter, twice a day, will be found serviceable. very little medicine is required internally in this disease, but much depends upon good nursing. external applications are chiefly to be depended upon. a solution of chloride of lime should be applied to the eruptions, or a solution of the chloride of zinc, twenty grains to an ounce of water; or, of sulphate of zinc, two drachms to a pint of water; or pulverized charcoal applied to the parts will be found useful. navel-ill. inflammation of the navel in calves occasionally occurs, causing redness, pain, and sudden swelling in the part affected. this disease, if not promptly attended to, speedily carries off the creature. _treatment._--foment the part well with warm hop-tea; after which, the application of a cloth, well saturated with lead-water and secured by bandages, should be applied. internally, doses of epsom-salts, of two ounces each, dissolved in half a pint of water, should be given until the bowels are acted upon. after the inflammation has subsided, to counteract the weakness which may follow, give a bottle of porter two or three times a day. obstructions in the oesophagus. choking in cattle is of common occurrence, in consequence of turnips, potatoes, carrots, or other hard substances, becoming lodged in the oesophagus, or gullet. these obstructions can sometimes be removed by careful manipulations with the hand; but, where this can not be accomplished, the flexible probang should be employed. this is a long india-rubber tube, with a whalebone stillet running through it, so as to stiffen it when in use. this instrument is passed down the animal's throat, and the offending substance is thus pushed down into the stomach. open joints. opening of the joint generally results from accidents, from puncturing with sharp substances, from kicks, blows, etc. these injuries cause considerable nervous irritation in the system, and sometimes cause lock-jaw and death. _treatment._--close up the wound as speedily as possible. the firing-iron will sometimes answer the purpose very well. the author depends more upon the application of collodion--as recommended in his work upon "the horse and his diseases" for the same trouble--than upon any other remedy. it requires care in its application, in order to make it adhere firmly. shoemakers'-wax, melted and applied, answers a very good purpose. parturition. in natural labor--as has been suggested in a former part of this work--the aid of man is rarely required in bringing away the calf. but it not infrequently happens that, from malformation or wrong presentation, our assistance is required in order to deliver the animal. the brute force, which has been far too often heretofore resorted to, should no longer be tolerated, since the lives of many valuable animals have been sacrificed by such treatment. very often, by gentle manipulation with the greased hand, the womb can be so dilated as to afford a comparatively easy exit for the _foetus_. if, however, the calf is presented wrong, it must be pushed back and placed in its proper position, if possible. in natural labor, the fore-legs, with the head lying between them, are presented; in which position--unless deformity, either in the _pelvis_ of the cow, or in the _foetus_, exists--the calf is passed with little difficulty, and without assistance. it sometimes happens that the head of the foetus is turned backward. when this happens, the attendant should at once strip himself to the waist, bathe his arms, and hands with a little sweet-oil, or lard, and introduce them into the _vagina_, placing a cord around both fore-feet, and then, pushing them back, search for the head, which is to be brought forward to its proper position. the feet are next to be brought up with it. no force should be used, except when the cow herself makes the effort to expel the calf; otherwise, more harm than good may be done. a case of this kind recently occurred in the author's practice, being the third within a year. the subject was a cow belonging to william hance, esq., of bordentown, new jersey. after she had been in labor for some twenty hours, he was called upon to see her. upon inquiry, he found that several persons had been trying, without success, to relieve her. she was very much prostrated, and would, doubtless, have died within two or three hours, had no relief been afforded. the legs of the _foetus_ protruded as far as the knees; the head was turned backward, and with the body, pressed firmly into the _vagina_, so that it was impossible to return it, or to bring the head forward. the operation of embryotomy was, therefore, at once performed, by cutting away the right shoulder, which enabled the operator, with the aid of his appropriate hooks, to bring the head forward, when the calf came away without further trouble,--the whole operation not requiring fifteen minutes. the _uterus_ was then washed out, and the animal placed in as comfortable a position as possible, and a stimulating draught given, composed of two ounces of nitric ether, one ounce of tincture of opium, and a half pint of water. this was followed with a few doses of fleming's tincture of aconite, ten drops in a little water, every few hours. in a few days the animal had entirely recovered. occasionally, the head comes first, or the head and one leg. in such cases, a cord should be slipped around the jaw and leg, and these then pushed back, so as to allow the other leg to be brought up. when this cannot be done, the _foetus_ can, in most cases, be removed in the original position. breech, side, back, and other presentations sometimes occur; in all of which instances, the _foetus_ must be turned in such a position that it can be brought away with as little trouble as possible. when this cannot be accomplished, the only resort is embryotomy, or cutting up of the _foetus_, which operation can only be safely performed by the qualified veterinary surgeon. since writing the above, another case has occurred in the author's practice. the cow--belonging to samuel barton, esq., near bordentown, new jersey--had been in labor some eighteen hours; upon an examination of the animal, the calf was found to be very much deformed, presenting backwards,--one of the hind-legs having been pulled off by the person or persons assisting her previous to the author's arrival. finding it impossible to deliver her in the usual way, embryotomy was in this instance employed. by this means, after taking out the intestines, lungs, etc., of the _foetus_, and cutting away its hind-quarters, the fore-parts were brought away. the head presented a singular appearance; the under jaw was so twisted as to bring the front teeth on the side of the face; the spinal column or back-bone, was turned twice around, resembling a spiral string; the front legs were over the back; the ribs were much contorted; the hind-parts were as much deformed; and, taken altogether, the deformity was the most singular which has been brought under the author's observation. free martins.--it has long been supposed by stockbreeders, that if a cow produce twins, one of which is a male and the other a female, the female is incapable of producing young, but that the male may be a useful animal for breeding purposes. many instances have occurred when the twin sister of a bull has never shown the least desire for the male. this indifference to sexual commerce arises, doubtless, from the animal's being but imperfectly developed in the organs of generation. this fact has been established by the investigations of mr. john hunter, who had three of these animals slaughtered for anatomical examination. the result is thus reported: "the external parts were rather smaller than is customary in the cow. the _vagina_ passed on, as in the cow, to the opening of the _urethra_, and then it began to contract into a small canal, which passed on into the division of the _uterus_ into the two horns; each horn passed along the edge of the broad ligament laterally toward the _ovaria_. "at the termination of these horns were placed both the ovaries and the testicles. both were nearly of the same size, which was about as large as a small nutmeg. to the _ovaria_, i could not find any fallopian tube. "to the testicles were _vasa deferentia_, but they were imperfect. the left one did not come near the testicle; the right one only came close to it, but did not terminate in the body called the _epididymis_. they were both pervious and opened into the _vagina_, near the opening of the _urethra_. "on the posterior surface of the bladder, or between the _uterus_ and the bladder, were the two bags, called _vesiculæ seminales_ in the male, but much smaller than they are in the bull. the ducts opened along with the _vasa deferentia_. this animal, then, had a mixture of all the parts, but all of them were imperfect." well-authenticated cases have, however, occurred where the female has bred, and the offspring proved to be good milkers. there are several instances on record of cows' giving birth to three, four, and even five calves at a time. there were on exhibition, in , at bordentown, new jersey, three free martins, two sisters and a brother, which were beautiful animals. these were from a cow belonging to mr. joab mershon, residing on biles island, situated in the delaware river, a short distance above bordentown. they were calved november st, , and were therefore nearly four years of age. they had never shown the least desire for copulation. their aggregate weight was pounds. we extract the following from the london veterinarian, for :--"a cow, belonging to mr. john marshall, of repton, on wednesday last, gave birth to _five, live healthy calves_, all of which are, at the time i write, alive and vigorous, and have every appearance of continuing so. they are all nearly of a size, and are larger and stronger than could be supposed. four of them are bull-calves. "the dam is by no means a large one, is eleven years old, of a mongrel breed, and has never produced more than one offspring at any previous gestation. i saw her two days after she had calved, at which time she was ruminating, and did not manifest any unusual symptoms of exhaustion. i may mention that the first four calves presented naturally; the fifth was a breech-presentation." cleansing.--the _placenta_, or after-birth, by which the _foetus_ is nourished while in embryo, should be removed soon after calving. generally, it will come away without any assistance. this is what is called "cleansing after calving." when, however, it remains for some time, its function having been performed, it becomes a foreign body, exciting uterine contractions, and therefore injurious. the sooner, then, it is removed, the better for the animal as well as the owner. to accomplish this, the hand should be introduced, and, by pulling gently in various directions, it will soon yield and come away. should it be allowed to remain, it rapidly decomposes, producing a low, feverish condition of the system, which greatly interferes with the general health of the animal. inversion of the uterus.--the _uterus_ is sometimes turned inside out after calving. this is, generally, the result of debility, or severe labor. the _uterus_ should be replaced as carefully as possible with the hands, care being taken that no dirt, straw, or other foreign substance adheres to it. should it again be expelled, it would be advisable to quiet the system by the use of an anæsthetic, as chloroform, or--which is much safer--chloric ether. as soon as the animal is under the influence of this, the _uterus_ may be again replaced. the hind-quarters should be raised as high as possible, in order to favor its retention. the animal should have a little gruel and a bottle of porter given to her every five or six hours, and the _vulva_ should be bathed frequently with cold water. phrenitis. inflammation of the brain is one of those dreadful diseases to which all animals are liable. it is known to the farmer as frenzy, mad staggers, etc. the active symptoms are preceded by stupor; the animal stubbornly stands in one position; the eyes are full, red, and fiery; respiration rapid; delirium soon succeeds; the animal, bellowing, dashes wildly about, and seems bent on mischief, rushing madly at every object which comes in its way. the causes of this disease are overwork in warm weather, a plethoric condition of the system, and too stimulating food. prof. gamgee, of the edinburgh veterinary college, relates a case resulting from the presence within the external _meatus_ of a mass of concrete cerumen, or wax, which induced inflammation of the ear, extending to the brain. _treatment._--as this is attended with considerable risk, unless it is taken prior to the frenzied stage, bleeding almost to fainting should be resorted to, and followed by a brisk purge. take one ounce of barbadoes aloes, and ten to fifteen drops of croton-oil; mix the aloes with one pint of water and the oil, using the mixture as a drench. one pound of epsom-salts will answer the purpose very well, in cases where the aloes and oil cannot be readily obtained. application of bags of broken ice to the head, is very beneficial. spirits of turpentine, or mustard, together with spirits of hartshorn and water should be well rubbed in along the spine, from the neck to the tail. pleurisy. this is an inflammation of the _pleura_, or the serous membrane which lines the cavity of the chest, and which is deflected over the lungs. inflammation of this membrane rarely occurs in a pure form, but is more generally associated with inflammation of the tissue of the lungs. if this disease is not attended to at an early period, its usual termination is in hydrothorax, or dropsy of the chest. the same causes which produce inflammation of the lungs, of the bronchia, and of the other respiratory organs, produce also pleurisy. _symptoms._--the respiration is quick, short, and painful; pressure between the ribs produces much pain; a low, short, painful cough is present; the respiratory murmur is much diminished,--in fact, it is scarcely audible. this condition is rapidly followed by effusion, which may be detected from the dullness of the sounds, on applying the ear to the lower part of the lungs. the febrile symptoms disappear; the animal for a few days appears to improve, but soon becomes weak, languid, and often exhausted from the slightest exertion. _treatment._--the same treatment in the early stage is enjoined as in inflammatory pneumonia, which the reader will consult--counter-irritation and purgatives. bleeding never should be resorted to. when effusion takes place, it is necessary to puncture the sides with a trochar, and draw away the fluid, giving internally one of the following purges three times a day: rosin, eight ounces; saltpetre, two ounces, mix, and divide into eight powders. half-drachm doses of the iodide of potash, dissolved in water, to be given three times daily, will be found useful in this disease. pleuro-pneumonia. this disease, as its name implies, is an inflammatory condition of the lungs and the _pleura_, or the enveloping membrane of the lungs and the lining membrane of the chest. it is sometimes called contagious, infectious, and epizoötic pleuro-pneumonia,--contagious or infectious, from its supposed property of transmission from the diseased to the healthy animal. [illustration: taking an observation.] a contagious character the author is not ready to assign to it,--contagious, as he understands it, being strictly applicable to those diseases which depend upon actual contact with the poison that it may be communicated from one animal to another. this does not necessarily imply the actual touching of the animals themselves; for it may be communicated from the poison left in the trough, or other places where the diseased animal has been brought in contact with some object, as is often the case in glanders in the horse; the matter discharged from the nose, and left upon the manger, readily communicating that disease to healthy animals coming in contact with it. contagious diseases, therefore, travel very slowly, starting, as they do, at one point, and gradually spreading over a large district, or section of country. this disease is, however, regarded by the author as infectious; by which term is meant that it is capable of being communicated from the diseased to the healthy animal through the medium of the air, which has become contaminated by the exhalations of poisonous matter. the ability to inoculate other animals in this way is necessarily confined to a limited space, sometimes not extending more than a few yards. infectious diseases, accordingly, spread with more rapidity than contagious ones, and are, consequently, more to be dreaded; since we can avoid the one with comparatively little trouble, while the other often steals upon us when we regard ourselves as beyond its influence, carrying death and destruction in its course. the term by which this disease is known, is a misnomer. pleuro-pneumonia proper is neither a contagious, nor an infectious disease; hence, the denial of medical men that this so-called pleuro-pneumonia is a contagious, or infectious disease, has been the means of unnecessarily exposing many animals to its poisonous influence. in the _recuéil de médécine vétérinaire_, for , will be found a very interesting description of this fatal malady. the author, m. lecoy, assistant professor at the veterinary school of lyons, france, says: "there are few districts in the _arrondissement_ of avesnes where more cattle are fattened than in that of soire-le-chateau. the farmers being unable to obtain a sufficient supply of cattle in the district, are obliged to purchase the greater part of them from other provinces; and they procure a great number for grazing from franche comté. the cattle of this country are very handsome; their forms are compact; they fatten rapidly; and they are a kind of cattle from which the grazer would derive most advantage, were it not that certain diseases absorb, by the loss of some of the animals, the profits of the rest of the herd. amongst the diseases which most frequently attack the cattle which are brought from the north, there is one very prevalent in some years, and which is the more to be dreaded as it is generally incurable; and the slaughter of the animal, before he is perceptibly wasted, is the only means by which the farmer can avoid losing the whole value of the beast. "this disease is chronic pleuro-pneumonia. the symptoms are scarcely recognizable at first, and often the beast is ill for a long time without its being perceived. he fattens well, and when he is slaughtered the owner is astonished to find scarcely half of the lungs capable of discharging the function of respiration. when, however, the ox has not sufficient strength of constitution to resist the ravages of disease, the first symptom which is observed is diminution, or irregularity of appetite. soon afterwards, a frequent, dry cough is heard, which becomes feeble and painful as the disease proceeds. the dorso-lumbar portion of the spine (loins) grows tender; the animal flinches when the part is pressed upon, and utters a peculiar groan, or grunt, which the graziers regard as decisive of the malady. "quickly after this, the movements of the flanks become irregular and accelerated, and the act of respiration is accompanied by a kind of balancing motion of the whole body. the sides of the chest become as tender as the loins, or more so; for the animal immediately throws himself down, if pressed upon with any force. the elbows become, in many subjects, more and more separated from the sides of the chest. the pulse is smaller than natural, and not considerably increased. the muzzle is hot and dry, alternately. the animal lies down as in a healthy state, but rumination is partially or entirely suspended. the _fæces_ are harder than they should be; the urine is of its natural color and quantity; the mouth is often dry; and the horns and ears retain their natural temperature. "this first stage of the disease sometimes continues during a month, or more, and then, if the animal is to recover, or at least, apparently so, the symptoms gradually disappear. first of all, the appetite returns, and the beast begins to acquire a little flesh. the proprietor should then make haste and get rid of him; for it is very rare that the malady, however it may be palliated for a while, does not reappear with greater intensity than before. "in most cases, the disease continues to pursue its course toward its termination without any remission,--every symptom gradually increasing in intensity. the respiration becomes more painful; the head is more extended; the eyes are brilliant; every expiration is accompanied with a grunt, and by a kind of puckering of the angles of the lips; the cough becomes smaller, more suppressed, and more painful; the tongue protrudes from the mouth, and a frothy mucus is abundantly discharged; the breath becomes offensive; a purulent fluid of a bloody color escapes from the nostrils; diarrhoea, profuse and fetid, succeeds to the constipation; the animal becomes rapidly weaker; he is a complete skeleton, and at length he dies. "examination after death discloses slight traces of inflammation in the intestines, discoloration of the liver, and a hard, dry substance contained in the manyplus. the lungs adhere to the sides and to the diaphragm by numerous bands, evidently old and very firm. the substance of the lungs often presents a reddish-gray hepatization throughout almost its whole extent. at other times, there are tubercles in almost every state of hardness, and in that of suppuration. the portion of the lungs that is not hepatized is red, and gorged with blood. besides the old adhesions, there are numerous ones of recent date. the pleura is not much reddened, but by its thickness in some points, its adhesion in others, and the effusion of a serous fluid, it proves how much and how long it has participated in the inflammatory action. the trachea and the bronchia are slightly red, and the right side of the head is gorged with blood. "in a subject in which, during life, i could scarcely feel the beating of the heart, i found the whole of the left lobe of the lungs adhering to the sides, and completely hepatized. in another, that had presented no sign of disease of the chest, and that for some days before his death vomited the little fodder which he could take, the whole of that portion of the oesophagus that passed through the chest was surrounded with dense false membranes, of a yellowish hue, ranging from light to dark, and being in some parts more than an inch in thickness, and adhering closely to the muscular membrane of the tube, without allowing any trace to be perceived of that portion of the mediastinal pleura on which this unnatural covering was fixed and developed. "the cattle purchased in franche comté are brought to avesnes at two periods of the year--in autumn and in the spring. those which are brought in autumn are much more subject to the disease than those which have arrived in the spring; and it almost always happens that the years in which it shows itself most generally are those in which the weather was most unfavorable while the cattle were on the road. the journey is performed by two different routes,--through lorraine and through champagne,--and the disease frequently appears in cattle that have arrived by one of these routes. the manner in which the beasts are treated, on their arrival, may contribute not a little to the development of the malady. these animals, which have been driven long distances in bad weather, and frequently half starved, arrived famished, and therefore the more fatigued, and some of them lame. calculating on their ravenous appetite, the graziers, instead of giving them wholesome food, make them consume the worst that the farm contains,--musty and mouldy fodder; and it is usually by the cough, which the eating of such food necessarily produces, that the disease is discovered and first developed. "is chronic pleuro-pneumonia contagious? the farmers believe that it is, and i am partly of their opinion. when an animal falls sick in the pasture, the others, after his removal, go and smell at the grass where he has lain, and which he has covered with his saliva, and, after that, new cases succeed to the first. it is true that this fact is not conclusive, since the disease also appears in a great number of animals that have been widely separated from each other. but i have myself seen three cases in which the cattle of the country, perfectly well before, have fallen ill, and died with the same symptoms, excepting that they have been more acute, after they have been kept with cattle affected with this disease. this circumstance inclines me to think that the disease is contagious; or, at least, that, in the progress of it, the breath infects the cow-house in which there are other animals already predisposed to the same disease. i am induced to believe that most of the serious internal diseases are communicated in this manner, and particularly those which affect the organs of respiration, when the animals are shut up in close, low, and badly-ventilated cow-houses." [_rec. de méd. vét. mai, ._] no malady can be more terrible and ruinous than this among dairy-stock; and its spread all over the country, together with its continuance with scarcely any abatement, must be attributed to the combination of various causes. the chief are: _first_, the very contagious or infectious nature of the disorder; _second_, inattention on the part of government to the importation and subsequent sale of diseased animals; and, _third_, the recklessness of purchasers of dairy or feeding cattle. this disease may be defined as an acute inflammation of the organs of the chest, with the development of a peculiar and characteristic poison, which is the active element of infection or contagion. it is a disease peculiar to the cattle tribe, notwithstanding occasional assertions regarding observations of the disease among horses, sheep, and other animals,--which pretended observations have not been well attested. the infectious, or contagious nature of this virulent malady is incontestibly substantiated by an overwhelming amount of evidence, which cannot be adduced at full length here, but which may be classified under the following heads: _first_, the constant spreading of the disease from countries in which it rages to others which, previously to the importation of diseased animals, had been perfectly free from it. this may be proved in the case of england, into which country it was carried in , by affected animals from holland. twelve months after, it spread from england to scotland, by means of some cattle sold at all-hallow fair, and it was only twelve months afterward that cattle imported as far north as inverness took the disease there. lately, a cow taken from england to australia was observed to be diseased upon landing, and the evil results were limited to her owner's stock, who gave the alarm, and ensured an effectual remedy against a wider spread. besides, the recent importation of pleuro-pneumonia into the united states from holland appears to have awakened our agricultural press generally, and to have convinced them of the stubborn fact that our cattle have been decimated by a fearfully infectious, through probably preventable, plague. a letter from this country to an english author says: "its (pleuro-pneumonia's) contagious character seems to be settled beyond a doubt, though some of the v.s. practitioners deny it, which is almost as reasonable as it would be to deny any other well-authenticated historic fact. every case of the disease is traceable to one of two sources; either to mr. chenery's stock in belmont (near boston, massachusetts), into which the disease was introduced by his importation of four dutch cows from holland, which arrived here the d of last may; or else to one of the three calves which he sold to a farmer in north brookfield, massachusetts, last june." _ dly._ apart from the importation into countries, we have this certain proof--to which special attention was drawn several years ago--that cattle-dealers' farms, and public markets, constitute the busy centres of infection. most anxious and careful inquiries have established the proposition that in breeding-districts, where the proprietors of extensive dairies--as in dumfries, scotland, and other places--abstain from buying, except from their neighbors, who have never had diseases of the lungs amongst their stock, pleuro-pneumonia has not been seen. there is a wide district in the vicinity of abington, england, and in the parish of crawford, which has not been visited _by_ this plague, with the exception of two farms, into which market-cattle had been imported and thus brought the disease. _ dly._ in appeared a report of the researches on pleuro-pneumonia, by a scientific commission, instituted by the minister of agriculture in france. this very able pamphlet was edited by prof. bouley, of alfort, france. the members of the commission belonged to the most eminent veterinarians and agriculturists in france. magendie was president; regnal, secretary; besides rayer, the renowned comparative pathologist; yvart, the inspector-general of the imperial veterinary schools; renault, inspector of the imperial veterinary schools; delafond, director of alfort college; bouley, lassaigne, baudemont, doyére, manny de morny, and a few others representing the public. if such a commission were occasionally appointed in this country for similar purposes, how much light would be thrown on subjects of paramount importance to the agricultural community! conclusions arrived at by the commission are too important to be overlooked in this connection. the reader must peruse the report itself, if he needs to satisfy himself as to the care taken in conducting the investigations: but the foregoing names sufficiently attest the indisputable nature of the facts alluded to. in instituting its experiments, the commission had in view the solving of the following questions:-- _ stly._ is the epizoötic pleuro-pneumonia of cattle susceptible of being transmitted from diseased to healthy animals by cohabitation? _ dly._ in the event of such contagion's existing, would all the animals become affected, or what proportion would resist the disease? _ dly._ amongst the animals attacked by the disease, how many recover, and under what circumstances? how many succumb? _ thly._ are there any animals of the ox species decidedly free from any susceptibility of being affected from the contagion of pleuro-pneumonia? _ thly._ do the animals, which have been once affected by a mild form of the disease, enjoy immunity from subsequent attacks? _ thly._ do the animals, which have once been affected by the disease in its active form, enjoy such immunity? to determine these questions, the commission submitted at different times to the influence of cohabitation with diseased animals forty-six perfectly healthy ones, chosen from districts in which they had never been exposed to a similar influence. of these forty-six animals, twenty were experimented on at pomeraye, two at charentonneau, thirteen at alfort, and eleven, in the fourth experiment, at charentonneau. of this number, twenty-one animals resisted the disease when first submitted to the influence of cohabitation, ten suffered slightly, and fifteen took the disease. of the fifteen affected, four died, and eleven recovered. consequently, the animals which apparently escaped the disease at the first trial amounted to . per cent., and those affected to . per cent. of these, . per cent. recovered, and . per cent. died. but the external appearances in some instances proved deceptive, and six of the eleven animals of the last experiment, which were regarded as having escaped free, were found, on being destroyed, to bear distinct evidence of having been affected. this, therefore, modifies the foregoing calculations, and the numbers should stand thus:-- enjoy immunity, or . per cent. indisposed, " . " animals cured, " . " dead, " . " of the forty-two animals which were exposed in the first experiments at pomeraye and charentonneau, and which escaped either without becoming affected, or recovering, eighteen were submitted to a second trial; and of these eighteen animals, five had, in the first experiment, suffered from the disease and had recovered; five had now become affected; and four had been indisposed. the four animals submitted to the influence of contagion a third time, had been affected on the occasion of the first trial. none of the eighteen animals contracted the disease during these renewed exposures to the influence of contagion. from the results of these experiments, the commission drew the following conclusions:-- _ stly._ the epizoötic pleuro-pneumonia is susceptible of being transmitted from diseased to healthy animals by cohabitation. _ dly._ all the animals exposed do not take the disease; some suffer slightly, and others not at all. _ dly._ of the affected animals, some recover and others die. _ thly._ the animals, whether slightly or severely affected, possess an immunity against subsequent attacks. these are the general conclusions which the commission deemed themselves authorized to draw from their experiments. the absolute proportion of animals which become affected, or which escape the disease, or of those which die and which recover, as a general rule, cannot be deduced from the foregoing experiments, which, for such a purpose, are too limited. the commission simply state the numbers resulting from their experiments. from these it transpires that forty five of the animals became severely affected with pleuro-pneumonia, and twenty-one per cent. took the disease slightly, making the whole sixty-six per cent. which were more or less severely attacked. thirty-four per cent. remained free from any malady. the proportion of animals which re-acquired their wonted appearance of health amounted to eighty-three per cent., whereas seventeen per cent. died. many minor points might be insisted on, but it is sufficient here to say, that the most careful analysis of all facts has proved to practical veterinarians, as well as to experienced agriculturists, and must prove to all who will calmly and dispassionately consider the point, that pleuro-pneumonia is pre-eminently an infectious, or contagious disease. [illustration: the twins.] _symptoms._--from the time that an animal is exposed to the contagion to the first manifestation of symptoms, a certain period elapses. this is the period of incubation. it varies from a fortnight to forty days, or even several months. the first signs, proving that the animal has been seized, can scarcely be detected by any but a professional man; though, if a proprietor of cattle were extremely careful, and had pains-taking individuals about his stock, he would invariably notice a slight shiver as ushering in the disorder, which for several days, even after the shivering fit, would limit itself to slight interference in breathing, readily detected on auscultation. perhaps a cough might be noticed, and that the appetite and milk-secretion diminished. the animal becomes costive, and the shivering fits recur. the cough becomes more constant and oppressive; the pulse full and frequent, usually numbering about eighty per minute at first, and rising to upwards of one hundred. the temperature of the body rises, and all the symptoms of acute fever set in. a moan, or grunt, in the early part of the disease indicates a dangerous attack, and the _alae nasi_ (cartilages of the nose) rise spasmodically at each inspiration; the air rushes through the inflamed windpipe and bronchial tubes, so as to produce a loud, coarse respiratory murmur; and the spasmodic action of the abdominal muscles indicates the difficulty the animal also experiences in the act of expiration. pressure over the intercostal (between the ribs) spaces, and pressing on the spine, induce the pain so characteristic of pleurisy, and a deep moan not infrequently follows such an experiment. the eyes are bloodshot, mouth clammy, skin dry and tightly bound to the subcutaneous textures, and the urine is scanty and high-colored. upon auscultation, the characteristic dry, sonorous _râle_ of ordinary bronchitis may be detected along the windpipe, and in the bronchial tubes. a loud sound of this description is, not infrequently, detected at the anterior part of either side of the chest; whilst the respiratory murmur is entirely lost, posteriorly, from consolidation of the lungs. a decided leathery, frictional sound is detected over a considerable portion of the thoracic surface. as the disease advances, and gangrene, with the production of cavities in the lungs, ensues, loud, cavernous _râles_ are heard, which are more or less circumscribed, occasionally attended by a decided metallic noise. when one lobe of the lungs is alone affected, the morbid sounds are confined to one side, and on the healthy side the respiratory murmur is uniformly louder all over. by carefully auscultating diseased cows from day to day, interesting changes can be discovered during the animal's lifetime. frequently, the abnormal sounds indicate progressive destruction; but, at other times, portions of the lungs that have been totally impervious to air, become the seat of sibilant _râles_, and gradually, a healthy respiratory murmur proves that, by absorption of the materials which have been plugging the tissues of the lungs, resolution is fast advancing. some very remarkable cases of this description have been encountered in practice. unfortunately, we often find a rapid destruction of the tissues of the lungs, and speedy dissolution. in other instances, the general symptoms of hectic, or consumption, attend lingering cases, in which the temperature of the body becomes low, and the animal has a dainty appetite, or refuses all nourishment. it has a discharge from the eyes, and a fetid, sanious discharge from the nose. not infrequently, it coughs up disorganized lung-tissue and putrid pus. great prostration, and, indeed, typhus symptoms, set in. there is a fetid diarrhoea, and the animal sinks in the most emaciated state, often dying from suffocation, in consequence of the complete destruction of the respiratory structures. _post mortem_ appearances.--in acute cases, the cadaverous lesions chiefly consist in abundant false membranes in the trachea, or windpipe, and closure of the bronchial tubes by plastic lymph. the air-vesicles are completely plugged by this material, and very interesting specimens may be obtained by careful dissection, in the shape of casts of the bronchial tubes and air-vesicles, clustered together like bunches of grapes. on slicing the lungs in these cases, hepatization is observed, presenting a very peculiar appearance, which is, in a great measure, due to the arrangement of the lung-tissue in cattle. the pulmonary lobules are of a deep-red or brown color, perfectly consolidated, and intersected or separated, one from the other, by lighter streaks of yellowish-red lymph, occupying the interlobular, areolar tissue. in the more chronic cases, the diseased lobes and lobules are found partly separated from the more healthy structures. this occurs from gangrene, and putrefactive changes, or in some instances, from the ulcerative process, so constantly observed in the segregation of dead from living tissues. abscesses are not infrequently found in different parts of the lungs. sometimes circumscribed, at others connected with bronchial tubes, and not infrequently communicating with the pleural cavity. true empyema is not often seen; but, at all times, the adhesions between the costal and visceral pleura are extensive, and there is much effusion in the chest. in dressed carcasses of cows that have been slaughtered from pleuro-pneumonia, even though the disease has not been far advanced, it will be found that the butcher has carefully scraped the serous membrane off the inner surface of the ribs, as it would otherwise be impossible for him to give the pleura its healthy, smooth aspect, from the firm manner in which the abundant false membranes adhere to it. the diseased lungs sometimes attain inordinate weight. they have been known to weigh as much as sixty pounds. _treatment._--the veterinary profession is regarded by many who have sustained heavy losses from pleuro-pneumonia, as deeply ignorant, because its members cannot often cure the disease. persons forget that there are several epidemics which prove equally difficult to manage on the part of the physician, such as cholera, yellow fever, etc. the poison in these contagious, epizoötic diseases is so virulent that the animals may be regarded as dead from the moment they are attacked. its elimination from the system is impossible, and medicine cannot support an animal through its tardy, exhausting, and destructive process of clearing the system of so potent a virus. all antiphlogistic means have failed, such as blood-letting and the free use of evacuants. derivatives, in the form of mustard-poultices, or more active blisters, are attended with good results. stimulants have proved of the greatest service; and the late prof. tessona, of turin, strongly recommended, from the very onset of the disease, the administration of strong doses of quinine. maffei, of ferrara, states that he has obtained great benefit from the employment of ferruginous tonics and manganese in the very acute stage of the malady, supported by alcoholic stimulants. recently, the advantages resulting from the use of sulphate of iron, both as a preventive and curative, have been exhibited in france. it would appear that the most valuable depurative method of treatment yet resorted to is by the careful use of the roman bath. acting, like all other sudorifics in cases of fever and blood diseases, it carries off by the skin much of the poison, without unduly lowering the vital powers. _prevention._--the rules laid down in denmark, and indeed in many other places, appear the most natural for the prevention of the disease. if they could be carried out, the disease must necessarily be stopped; but there are practical and insuperable difficulties in the way of enforcing them. thus, a dr. warneke says, prevention consists in "the avoidance of contagion; the slaughter of infected beasts; the prohibition of keeping cattle by those whose cattle have been slaughtered, for a space of ten weeks after the last case occurring; the disinfection of stalls vacated by slaughtering; the closing of infected places to all passing of cattle; especial attention to the removal of the dung, and of the remains of the carcasses of slaughtered beasts; and, finally, undeviating severity of the law against violators." dr. williams, of hasselt, suggested and carried out, in , the inoculation of the virus of pleuro-pneumonia, in order to induce a mild form of the disease in healthy animals, and prevent their decimation by the severe attacks due to contagion. he met with much encouragement, and perhaps more opposition. didot, corvini, ercolani, and many more accepted dr. williams's facts as incontestable, and wrote, advocating his method of checking the spread of so destructive a plague. the first able memoir which contested all that has been said in favor of inoculation, appeared in turin, and was written by dr. riviglio, a piedmontese veterinary surgeon. this was supported by the views of many others. prof. simonds wrote against the plan, and, in , the french commission, whose report has been before mentioned, confirmed, in part, riviglio's views, though, from the incompleteness of the experiments, further trials were recommended. inoculation is performed as follows: a portion of diseased lung is chosen, and a bistoury or needle made to pierce it so as to become charged with the material consolidating the lung, and this is afterward plunged into any part, but, more particularly, toward the point of the tail. if operated severely, and higher up, great exudation occurs, which spreads upward, invades the areolar tissue round the rectum and other pelvic organs, and death soon puts an end to the animal's excruciating suffering. if the operation is properly performed with lymph that is not putrid, and the incisions are not made too deep, the results are limited to local exudation and swelling, general symptoms of fever, and gradual recovery. the most common occurrence is sloughing of the tail; and in london, at the present time, dairies are to be seen in which all the cows have short-tail stumps. dr. williams and others have gone too far in attempting to describe a particular corpuscle as existing in the lymph of pleuro-pneumonia. all animal poisons can be alone discovered from their effects. in structure and chemical constitution, there is no difference, and often the most potent poisons are simple fluids. the belgian commission, appointed to investigate the nature and influence of inoculation for pleuro-pneumonia, very justly expressed an opinion that dr. williams had not proved that a specific product, distinguished by anatomical characters, and appreciable by the microscope, existed in this disease. the all-important question, "is inoculation of service?" has to the satisfaction of most been solved. the belgian and french commissions, the observations of riviglio, simond, herring, and many others, prove that a certain degree of preservative influence is derived by the process of inoculation. it does not, however, arrest the progress of the disease. it certainly diminishes to some extent--though often very slightly so--the number of cases, and, particularly, of severe ones. this effect has been ascribed to a derivative action, independent of any specific influence, and, indeed, similar to that of introducing setons in the dewlap. in london, some dairymen have considerable faith in inoculation, though its effect is uncertain, and the manner of its working a mystery. the best counsel, in the premises, which can be given to the keeper of dairy stock is, to select his own animals from healthy herds, and strictly to avoid public markets. in many instances, a faithful observance of these injunctions has been sufficient to prevent the invasion of this terrible disease. [gamgee.] the existence of this disease in the united states was not generally known until the year , when mr. chenery, of belmont, near boston, massachusetts, imported several cows from holland, which arrived in the early part of the spring of that year. some of the animals were sick when they arrived, but the true nature of the disease was not at that time suspected. several of them were so bad that they were carried in trucks to mr. chenery's barn. some two months passed away before the character of the disease was discovered. upon the facts becoming known, the citizens of massachusetts became panic-stricken, as the disease was rapidly spreading over that state. an extra session of the legislature was speedily convened, when a joint special committee was appointed, to adopt and carry out such measures as in their judgment seemed necessary for the extirpation of this monster, pleuro-pneumonia. the committee met in the hall of the house of representatives, thursday, may, , , to receive evidence as to the contagious or infectious character of the disease, in order to determine concerning the necessity of legislative action. mr. walker, one of the commissioners appointed by the governor, made the following statement: "the disease was introduced into north brookfield from belmont. mr. curtis stoddard, a young man of north brookfield, went down, the very last of june, last year, and purchased three calves of mr. chenery, of belmont. he brought these calves up in the cars to brookfield. on their way from the depôt to his house, about five miles, one of the calves was observed to falter, and when he got to his house, it seemed to be sick, and in two or three days exhibited very great illness; so much so, that his father came along, and, thinking he could take better care of it, took the calf home. he took it to his own barn, in which there were about forty head of cattle; but it grew no better, and his son went up and brought it back again to his own house. in about ten days after that, it died. his father, who had had the calf nearly four days, in about a fortnight afterward observed that one of his oxen was sick, and it grew worse very fast and died. two weeks after, a second also sickened, and died. then a third was attacked and died, the interval growing wider from the attack of one animal to that of another, until he had lost eight oxen and cows. young stoddard lost no animal by the infection,--that is, no one died on his hands. prior to the appointment of this commission, about the first of november,--for reasons independent of this disease, which i don't suppose he then knew the nature of,--he sold off his stock. he sold off eleven heifers, or young animals, and retained nine of the most valuable himself; which shows that he did not then know any thing was the matter with them. "these nine were four oxen, and five young cattle. the four he took to his father's, three of the others to his uncle's, and the remaining two to his father-in-law's; distributing them all among his friends,--which furnishes another proof that he did not suppose he was doing any mischief. he disposed of his herd in that way. from this auction, these eleven animals went in different directions, and wherever they went, they scattered the infection. without a single failure the disease has followed those cattle; in one case, more than two hundred cattle having been infected by one which was sold at curtis stoddard's auction, when he was entirely ignorant of the disease. "when the commission was appointed, they went and examined his cattle, and were satisfied that they were diseased,--at least, some of them. they examined his father's herd, and found that they were very much diseased; and when we came to kill curtis stoddard's cattle, seven of the nine head were diseased. two were not condemned, because the law says, 'cattle not appearing to be diseased, shall be appraised.' nevertheless, it proved that these animals were diseased; so that his whole herd was affected. "in regard to leonard stoddard's cattle, he lost fourteen of his animals before the commissioners went to his place. they took eighteen more, all of which were diseased,--most of them very bad cases,--indeed, extreme cases. that left eight heads, which were not condemned, because not appearing to be diseased. here i remark, that when this disease is under the shoulder-blade, it cannot be detected by percussion. the physicians did not say that the animal was not diseased, but that they did not see sufficient evidence upon which to condemn. such animals were to be paid for, upon the ground of their not appearing to be diseased. nevertheless, it is proper to state that the remaining eight which were not condemned, were suspected to be diseased, and we told mr. stoddard that we had the impression that they were diseased, notwithstanding appearances. he said, 'there is a three-year-old animal that has never faltered at all. she has never manifested the slightest disease. if you will kill her, and she is diseased, i shall make up my mind that i have not a well animal in my stalls.' we killed the animal, and found her to be badly diseased. "thus, the first two herds were all infected by the disease; and in the last of curtis stoddard's oxen which we killed, we found a cyst in the lungs of each. one of these lungs is now in this building, never having been cut open, and medical men can see the cyst which it contains. i have said in what manner mr. curtis stoddard's cattle spread the infection. "in regard to mr. leonard stoddard's: in the first place, he kept six or eight oxen which he employed in teaming. he was drawing some lumber, and stopped over night, with his oxen, at mr. needham's. needham lost his whole herd. he lost eight or ten of them, and the rest were in a terrible condition. seven or eight more were condemned, and his whole herd was destroyed, in consequence of mr. stoddard's stopping with him over night. mr. stoddard sold an animal to mr. woodis of new braintree. he had twenty-three fine cows. it ruined his herd utterly. seven or eight animals died before the commissioners got there. mr. l. stoddard also sold a yoke of cattle to mr. olmstead, one of his neighbors, who had a very good herd. they stayed only five days in his hands, when they passed over to mr. doane. in these five days they had so infected his herd that it was one of the most severe instances of disease that we have had. one third were condemned, and another third were passed over as sound, whether they were so, or not. they did not appear to be diseased. the cattle that were passed from mr. stoddard through mr. olmstead to mr. doane, were loaned by mr. d. to go to a moving of a building from oakham to new braintree. they were put in with twenty-two yoke of cattle, and employed a day and a half. it has since been proved that the whole of these cattle took the contagion. they belonged to eleven different herds, and of course, each of these herds formed a focus from which the disease spread. now, in these two ways the disease has spread in different directions. "but, when the commissioners first commenced, they had no idea that the disease extended further than those herds in which there were animals sick. hence, their ideas and the ideas of those who petitioned for the law, did not extend at all to so large a number of herds as have since been proved to be diseased, because they only judged of those who manifested disease. as soon as we began in that circle, we found a second circle of infection, and another outside of that; and by that time it had branched off in various directions to various towns. it assumed such proportions that it was very evident that the commissioners had not the funds to perform the operations required by the law. the law confines the commissioners to one operation,--killing and burying. no discretionary power is given at all. the commissioners became entirely dissatisfied with that condition of things, because other measures besides merely killing and burying, are quite as necessary and important. when they arrived at that point and discovered to what extent the infection had spread, they stopped killing the herds, and i believe there has not been a herd killed for twenty days. "the policy was then changed to circumscribing the disease, by isolating the herds just as fast as possible and as surely as possible. a man's herd has been exposed. there is no other way than to go and examine it, and take the diseased animals away. then he knows the animals are diseased, and his neighbors know it. that has been the business of the commissioners for the last twenty days; and the facts that they have no discretionary power whatever, and that they were entirely circumscribed in their means, and that it was hard for the farmers to lose their stock and not be paid for it,--induced them to petition the governor, in connection with the board of agriculture, for the calling of a session of the legislature, to take measures for the extinction of the disease." in response to a question, "whether any animals that had once been affected, had afterward recovered?"--the same gentleman stated that instances had occurred where cattle had been sick twice, and had, apparently, fully recovered; they ruminated readily, and were gaining flesh. upon examination, however, they were pronounced diseased, and, when killed, both lungs were found in a hopeless case, very badly diseased. dr. george b. loring, another of the commissioners, stated that eight hundred and forty-two head of cattle had, at that time, been killed, and that, from a careful estimate, there still remained one thousand head, which should either be killed, or isolated for such a length of time as should establish the fact that they had no disease about them. twenty thousand dollars and upwards had already been appraised as the value of the cattle then killed. as to disinfecting measures, the farmers who had lost cattle were requested to whitewash their barns thoroughly, and some tons of a disinfecting powder were purchased for the advantage of the persons who wished to use it. an early application was advised, that the barns might be in readiness for hay the then coming season. the practice adopted by the commissioners was, to appraise the cattle whenever a herd was found which had been exposed, and a surgeon was appointed to pass judgment upon the number of diseased animals. after that judgment, the remaining animals that were pronounced sound were killed and passed to the credit of the owner, after an appraisement made by these persons. the fair market-prices were paid, averaging about thirty-three dollars a head. at the time of the meeting of the committee, some seventy cattle had died of the disease. an examination was made of some of the animals killed, and the following facts obtained:-- case .--this cow had been sick for nineteen days; was feeble, without much appetite, with diarrhoea, cough, shortness of breathing, hair staring, etc. percussion dull over the whole of the left side of the chest; respiration weak. killed by authority. several gallons of serum were found in the left side of the chest; a thick, furzy deposit of lymph over all the _pleura-costalis_. this lymph was an inch in thickness, resembling the velvety part of tripe, and quite firm. there was a firm deposit of lymph in the whole left lung, but more especially at its base, with strong adhesions to the diaphragm and _pleura-costalis_ near the spine. the lung was hard and brittle, like liver, near its base. no pus. right lung and right side of chest healthy. case .--this cow was taken very sick, january th. in fourteen days, she began to get better. april th, she is gaining flesh, breathes well, hair healthy, gives ten quarts of milk a day, and in all other respects bids fair for a healthy animal hereafter, except a slight cough. percussion dull over base of the left lung, near the spine, and respiration feeble in the same regions. autopsy.--left lung strongly adherent to diaphragm and costal pleura; the long adhesions well smoothed off; _pleura-costalis_ shining and healthy. also, the surface of the lung, when there were no adhesions, sound and right; all the lung white, and free for the entrance of air, except the base, in which was a cyst containing a pint or two of pus. loose in this pus was a hard mass, as large as a two-quart measure, looking like marble; when cut through its centre, it appeared like the brittle, hardened lining in case . it appeared as though a piece of lung had been detached by suppuration and enclosed in an air-tight cyst, by which decomposition was prevented. the other lung and the chest were sound. it is to be inferred, as there were adhesions, that there had been pleurisy and deposit of lymph and serum, as in case , and that nature had commenced the cure by absorbing the serum from the chest, and the lymph from the free pleural surface, and smoothed off every thing to a good working condition. the lump in the cyst was brittle and irregular on its surface, as though it was dissolving in the pus. no good reason can be given why nature should not consummate the work which she had so wisely begun. case .--this cow had been sick fourteen days; was coughing and breathing badly; percussion dull over both chests and respiration feeble. killed. autopsy.--both chests filled with water; deposits of lymph over all the _pleura-costalis_, presenting the same velvety, furzy appearance as in case . both lungs were hardened at the base, and the left throughout its whole extent, and firmly adherent to diaphragm and costal pleura, near the spine. the right lung had nearly one-third of its substance in a condition for the entrance of air; but this portion, even, was so compressed with the water, that a few hours longer would have terminated the case fatally without state aid. this case had not proceeded far enough for the formation of the cyst or pus. in mr. needham's herd, about twenty-eight days intervened between the first and second case of disease, instead of about fourteen, as in mr. olmstead's. case .--a nice heifer, in fair condition, eating well, only having a slight cough. percussion dull over base of the left lung. autopsy.--base of left lung adherent to diaphragm and costal pleura; lung hardened. on cutting into base, found ulceration and a head of timothy grass, four or five inches long. animal in every other way well. case .--this cow was taken, january st, with a cough, difficulty of breathing, and the other symptoms of the disease, and continued sick till march st. on taking her out, april th, to be slaughtered, she capered, stuck up her tail, snuffed, and snorted, showing all the signs of feeling well and vigorous. autopsy.--right lung firmly adherent to diaphragm and costal pleura, near the spine. base of lung hardened, containing a cyst with a large lump, of the size of a two-quart measure, floating in pus; outside of the lump was of a dirty yellow-white, irregular, brittle, and cheesy; the inside mottled, or divided into irregular squares; red like muscle, and breaking under the finger, like liver. costal pleura smooth, shining; adhesions where there was motion; card-like and polished; no serum; lung apparently performing its functions well, except for a short distance above the air-tight cyst, where it was still hardened. it would seem as though nature was intending to dissolve this lump, and carry it off by absorption. she knows how, and would have done it, in the opinion of the writer, had she been allowed sufficient time. case .--was taken december th, and was very sick; in three weeks she was well, except a cough, quite severe, and so continued till about the first of march, when she coughed harder and grew worse till seven days before she was killed, april th, when she brought forth a calf, and then commenced improving again. autopsy.--right lung adherent to diaphragm and costal pleura. at its base, was a flabby, fluctuating cyst. in cutting into it, the lump was found to be breaking up by decomposition, and scenting badly. every thing else normal. was not the cyst broken through by some accident, thus letting in the air, when she grew worse? would she not, probably, have overcome this disagreeable accident, and recovered, in spite of it? this cow's hair did not look well, as did that of those in which the cyst was air-tight; but still she was beginning to eat well again, and appeared in a tolerable way for recovery. case .--this heifer had coughed slightly for six weeks, but the owner said he thought no one going into his herd would notice that any thing was the matter with her. [illustration: a rural scene.] autopsy.--slight adhesions of lung to diaphragm. near these adhesions are small cysts, of the size of a walnut, containing pus and cheesy matter; about the cysts a little way the lung was hardened, say for half an inch. there were several cysts, and they appeared as though the inflammation attacked only the different lobes of the lungs, leaving others healthy between,--nature throwing out coagulable lymph around the diseased lobe, and forming thereby an air-tight cyst, cutting around the diseased lobe by suppuration, so that it could be carried off by absorption. in the herd to which this animal belonged, nine days after the first cow died, the second case occurred. first cow was sick five weeks. the time of incubation could not have been over six weeks,--probably not over three weeks. of these cows, one improved in eight weeks, the other in three weeks. case .--this cow had been sick three weeks. killed. autopsy.--large quantities of serum in left chest; lung adherent, and hardened at base. on cutting into the hardened lung, one side of the lump was found separated from the lung, with pus between the lines of separation, and the forming coat of the cyst outside of the pus; the other side of the lump was part and parcel of the hardened lung which had not yet had time to commence separation. the costal pleura was covered with organized lymph to the thickness of an inch, with the usual characteristics. the right chest contained a small quantity of serum, and had several small, hardened red spots in that lung, with some tender, weak adhesions; but most of the right lung was healthy. case .--sick four weeks. killed. autopsy.--right lung hardened at base; adherent to diaphragm and costal pleura; lump separated on one side only. cyst beginning to form, outside of separation; pus between cyst and lump, but in a very small quantity. these two cases settle the character of the lump, and the manner of the formation of the cyst; the lump being lung and lymph, cut out by suppuration,--the cyst being organized, smoothed off by suppuration, friction, etc. case .--killed. hair looked badly; but the cow, it was said, ate, and appeared well. this case, however, occurred in a herd, of which no reliable information, in detail, could be procured. autopsy.--base of lung hardened, adherent to diaphragm; containing a cyst, in which was a lump, of the size of a quart measure, but little pus. this lump had air-tubes running through it, which were not yet cut off by suppuration; and in one place, the cyst was perforated by a bronchial tube, letting in the external air to the lump, which was undergoing disorganization, and swelling badly. when cut into, it did not present the red, mottled, organized appearance of those cases with air-tight cysts. quite a number of other cases were examined, but these ten present all the different phases. one or two cases are needed of an early stage of the disease, to settle the point, whether, in all cases, the primary disease is lung fever, and the pleurisy a continuation, merely, of the primary disease; together with some six or eight cases, during five, six, seven, eight months from attack, and so on till entire, final recovery. some cases were sick almost a year since, and are now apparently quite well; perhaps all the lump and pus are not yet gone. many practitioners think that no severe case will ever recover, and some think that none ever get entirely well. others, however, can see no reason why, as a general rule, all single cases should not recover, and all double cases die. the disease was the most fatal in mr. chenery's (the original) herd, although it was the best-fed and the warmest-stabled. he attributed the fatality, in part, to a want of sufficient ventilation. the other herds, in which all the fatal cases occurred in two hours, consisted, originally, one of forty-eight head, of which thirteen died, or were killed, to prevent certain death; of twenty-three head, of which seven died; of twenty-two head, of which eight died; of twenty-two head, of which eight also died; and of twenty-one head, of which four died. a little less than thirty per cent., therefore, of these herds died. this estimate excludes the calves. most of the cows which had not calved before being attacked, lost their calves prematurely. the probable time of incubation, as deduced from those massachusetts cases, is from two to three weeks; of propagation, about the same time; the acute stage of the disease lasting about three weeks. the author's attention was first directed to this disease, upon its appearance in camden and gloucester counties, new jersey, in the year , at about the same time it made its advent in massachusetts. the singularity of this coincidence inclined him for the time to regard the disease as an epizoötic--having its origin in some peculiar condition of the atmosphere--rather than as a contagious, or infectious disease, which position was at that time assumed by him. this opinion was strengthened by the fact, that no case occurring in new jersey could be traced to a massachusetts origin, in which state it was claimed that the disease never had existed in this country previous to its introduction there. it was, therefore, denied by the veterinary surgeons in the eastern states, that the disease in new jersey was the true european pleuro-pneumonia, but it was called by them the swill-milk disease of new york city, and it was assigned an origin in the distillery cow-houses in brooklyn and williamsburg. in it found its way across the delaware river into philadelphia, spreading very rapidly in all directions, particularly in the southern section of the county, known as the neck,--many of the dairymen losing from one third to one half of their herds by its devastating influence. in order to save themselves--in part, at least--from this heavy loss, many of them, upon the first indications of the malady, sent their animals to the butcher, to be slaughtered for beef. in the disease found its way into delaware, where its ravages were severely felt. so soon, however, as it became known that the disease was infectious or contagious, an effort was made to trace it to its starting-point; but, in consequence of the unwillingness of dairymen to communicate the fact that their herds were affected with pleuro-pneumonia, all efforts proved fruitless. in the disease found its way up the delaware to riverton, a short distance above the city of philadelphia. a cattle-dealer, named ward, turned some cattle into a lot, adjoining which several others were grazing. the residents of this place are chiefly the families of gentlemen doing business in the city, many of whom lost their favorite animals from this destructive malady. the first case occurring at this place, to which the author's attention was called, was a cow belonging to mr. d. parrish, which had been exposed by coming in contact with ward's cattle, had sickened, and died. an anxiety having been manifested to ascertain the cause of the death, the author made an examination of the animal, which, upon dissection, proved the disease to be a genuine case of the so-called pleuro-pneumonia. this examination was made august th, , at the time of the massachusetts excitement. two cows, belonging to mr. rose, of the same place, had been exposed, and both had taken the disease. his attention having been called to them, he placed them under the author's treatment, and by the use of diffusible stimulants and tonics, one of these animals recovered, while the other was slaughtered for an examination, which revealed all the morbid conditions so characteristic of this disease. the next case was a cow belonging to mr. g. h. roach, of the same place, which had been grazing in a lot adjoining that of mr. parrish. this cow was killed in the presence of charles wood, v.s., of boston, mass., and arthur s. copeman, of utica, n. y., who was one of a committee appointed by the new york state agricultural society for the purpose of investigating the disease. both of these gentlemen having witnessed the disease in-all its forms, as it appeared in massachusetts, were the first to identify this case with those in that state. upon opening the cow, the left lung was found to be completely consolidated, and adhered to the left side, presenting the appearance usual in such cases. as she was with calf, the lungs of the foetus were examined, disclosing a beautiful state of red hepatization. the author's attention was next called to the herd of mr. lippincott, a farmer in the neighborhood, who had lost several cattle by the disease; but as he had been persuaded that treatment was useless, he abandoned the idea of attempting to save his stock in that way. from riverton it soon spread to burlington, some ten miles farther up the river, where it carried off large numbers of valuable cattle, and it continued in existence in that neighborhood for some time. the disease was not then confined to these localities alone, but has spread over a large extent of country,--and that, too, prior to its appearance in massachusetts, as will be shown by extracts from the following letters, published in the _country gentleman_:-- "we have a disease among the cattle here, i will class it under these names,--congestion of the lungs, terminating with consumption, or dropsy of the chest. now, i have treated two cases; one five years since, as congestion,--and the first is still able to eat her allowance, and give a couple of pails of milk a day,--and the other, quite recently. the great terror of this disease is, that it is not taken in its first stages, which are the same in the cow as in the man--a difficulty in breathing, which, if not speedily relieved, terminates in consumption or dropsy. i have no doubt that consumption is contagious; but is that a reason why every one taken with congestion should be killed to check the spread of consumption? so i should reason, if i had pleuro-pneumonia in my drove of cattle. j. baldwin. "newark, n. j., june , ." "i notice that a good deal of alarm is felt in different parts of the country about what is called the cattle-disease. "from the diagnosis given in the papers, i have no doubt this is pleuro-pneumonia, with which i had some acquaintance a few years ago. if it is the same, my observation and experience may be of some service to those suffering now. "it was introduced into my stock, in the fall of , by one of my own cows, which, in the spring of that year, i had sent down to my brother in brooklyn, to be used during the summer for milk. she was kept entirely isolated through out the summer, and in november was sent up by the boat. there were no other cattle on the boat at the time, nor could i learn that she had come in contact with any in passing through the streets on her way to the boat; and she certainly did not, after leaving it, until she mingled with her old companions, all of whom were then, and long afterward, perfectly well. after she had been home about two weeks, we noticed that her appetite failed, and her milk fell off: she seemed dull and stupid, stood with her head down, and manifested a considerable degree of languor. "soon her breathing became somewhat hurried, and with a decided catch in it; she ground her teeth; continued standing, or, if she lay down, it was only to jump up again instantly. her cough increased, and so, too, a purulent and, bloody discharge from her nostrils and mouth. the excrement was fetid, black, and hard. "in this case, we twice administered half a pound of epsom-salts, and afterward, a bottle of castor-oil. very little, but a temporary effect was produced by these doses. "the symptoms all increased in intensity; strength diminished; limbs drawn together; belly tucked up, etc.; until the eight day, when she partly lay, and partly fell down, and never rose again. "in a _post-mortem_ examination, the lungs were gorged with black, fetid blood; the substance of them thickened and pulpy. the pleura and diaphragm also showed a good deal of disease and some adhesion. this cow, on her arrival here, was put in her usual place in the stable, between others. she remained there for two or three days after she was taken sick, before we removed her to the hospital. "in about three weeks from the time she died, one and then the other of those standing on either side of her were attacked in the same way, and with but two days between. this, certainly, looks very much like contagion; but my attention had not before been called to this particular disease, and to suppose inflammation or congestion of the lungs contagious was so opposed to my preconceived notions, that i did not even then admit it; and these animals were suffered to remain with the others until their own comfort seemed to require the greater liberty of open pens. "one of them was early and copiously bled twice, while epsom-salts were administered, both by the stomach and with the injective-pump. the other we endeavored to keep nauseated with ipecacuanha, and the same time to keep her bowels open by cathartic medicine. all proved to be of no avail. they both died,--the one in ten, the other in thirteen days. before these died, however, others were taken sick. and thus, later, i had eight sick at one time. "the leading symptoms in all were the same, with minor differences; and so, too, was the appearance after death, on examination. "of all that were taken sick (sixteen) but two recovered; and they were among those we did the least for, after we had become discouraged about trying to cure them. in all the last cases we made no effort at all, but to keep them as comfortable as we could. in one case, the acute character of the disease changed to chronic, and the animal lived six or eight weeks, until the whole texture of the lungs had become destroyed. she had become much emaciated, and finally died with the ordinary consumption. "at the time the first case appeared, i had a herd of thirty-one animals, all valuable ayrshires, in fine condition and healthy. in all the first cases, i had a veterinary surgeon of considerable celebrity and experience, and every ordinary approved method of treatment was resorted to and persevered in. the last cases--as before intimated--we only strove to make comfortable. "after i had paid the third or fourth forfeit, i began to awake up to the idea that the disease was, in a high degree, contagious, whether i would have it so or not; and that my future security was in prevention, and not in remedy. i therefore separated all the remaining animals; in no instance having more than two together, and generally but one in a place. "all were removed from the infected stalls, and put into quarantine. isolated cases continued to occur after this for some weeks, but the spread of the disease was stayed; nor did a single case occur after this, which we did not think we traced directly to previous contact. "it is impossible to account for the first case of which i have spoken. but, as the cow in that case was put into a sale-stable in new york while waiting for the boat,--though there were no cattle then present,--yet i have supposed it not unlikely that diseased animals had been there, and had left the seeds of the disease. "but, account for this case as we may,--and i have no doubt it is sometimes spontaneous,--i feel convinced it is very highly contagious; and that the only safety to a herd into which it has been introduced, is in complete isolation,--and in this i feel as convinced that there is safety. my cattle were not suffered to return to the barnyard or to any part of the cattle-barns, except as invalids were sent to 'the hospital' to die, until late the next fall, _i.e._, the fall of . in the mean time, the hay and straw had all been removed; the stables, stalls, cribs and all thoroughly scrubbed with ashes and water, fumigated, and white washed with quicklime. i have had no case since, and am persuaded i should have avoided most of those i had before, if i had reasonably admitted the evidence of my senses in the second and third cases. e. p. prentice. mount hope, june th, ." the author's experience with the disease, during the last year in new jersey, proves the efficacy of remedial agents when applied in the early stages of the disease. late in the spring of , mr. j. e. hancock, of burlington county (residing near columbus, n. j.), purchased some cattle in the philadelphia market, which, after they were driven home, he turned in with his other stock. soon after this purchase, one of the animals sickened and died. this was in august; after which time mr. h. lost eight cows,--having, at the time of the death of the last animal, some five others sick with the same disorder. the author was called in, december th, , and the five animals then placed under his treatment. on the th of december, in the same year, one of these cows, at his suggestion, was killed, which, upon the _post-mortem_ examination, beautifully illustrated the character of the disease. the right lung was comparatively healthy; the left one completely hepatized, or consolidated, and so enlarged as to fill up the left cavity of the chest to it's utmost capacity. this lung weighed thirty pounds. there was no effusion in the chest, but there was considerable adhesion of the _pleura-costalis_ and _pleura-pulmonalis_. all the other tissues appeared to be healthy. to the remaining animals, was administered the following: aqua ammonia, three drachms; nitric ether, one ounce; pulverized gentian-root, half an ounce; mixed with one quart of water, and drenched three times a day. the last thing at night was given a teaspoonful of phosphate of lime, mixed in a little feed, or in gruel. setons, or rowels, in the dewlap are also very beneficial. under this treatment they all did well. soon after the introduction of the disease into this herd, it found its way to the herd of william hancock, a brother of the former gentleman, who had an adjoining farm. in this herd one cow died, and the disease was found by the author developed in four more cows and two oxen, all of which--with a single exception--did well under the above treatment. the disease afterward showed itself in the herd of john pope, half a mile distant, who lost nine animals by it. thursday, december th, was selected for the purpose of making an examination of the hancock herds; but, after some ten or twelve animals had been examined and all pronounced tainted with the disease, the owners concluded to stop the investigation, expressing themselves dissatisfied with the result, as not one of the animals examined had shown any symptoms of disease. in order to convince them of the correctness of the diagnosis, a cow was selected and destroyed, which the hancocks believed to be in perfect health. upon opening the animal, several small patches of hepatized lung were brought into view. upon making a longitudinal section of the lump, as both were involved, they presented a red, speckled appearance. all the other tissues were healthy. the symptoms in these cases were quite different from any which had been previously seen in an experience of three years with the disease in and about philadelphia, inasmuch as they were not preceded by cough; in fact, cough did not appear in many of the animals at any time during the progress of the disease. the animals looked, ate, and milked well, previously to the development of the disease, so that the owners were thrown completely off their guard by these deceptive symptoms of health. knowing the uncertain character of this disease, and wishing to stay its ravages, a suggestion was made by the author as to the propriety of having the entire herd killed for beef. this was done the more readily, as the sale of the meat is legalized in europe, it being regarded as uninjured, and therefore wholesome meat. this suggestion was acted upon, and thus these two farms were rid of this dreadful scourge at one blow. mr. a. gaskill, of mount holly, n. j., purchased a cow from one of the hancocks, for his own family use, which was sent to mr. frank lippincott's to pasture and turned in with mr. l.'s own herd. soon after, this cow sickened and died. this was soon followed by the loss of six of mr. l.'s own cattle,--three oxen, two cows, and one steer. from this herd, it was communicated to the widow lippincott's, who occupied a neighboring farm; as also to mr. cleavenger's, who lost four animals; and to mr. smith's, who had, at one time, seven animals sick; and from cleavenger's to noaknuts, who lost two cows. some two or three cows, belonging to mr. logan, in the same neighborhood, got upon the road and broke into mr. lippincott's pasture, mixing with his herd. as soon as mr. logan was informed of the fact, he isolated these cows by enclosing them in a pen at some distance from his other cattle; but they managed to break out, and mingled with his other stock. it could scarcely be expected that his herd could escape the disease, considering the exposure to which they had been subjected. the disease manifested itself in the herds of several other farmers in the country, but space will not allow a more extended notice of the subject. the treatment which has been found most successful in this country is as follows, all of which has been tested by the author upon various occasions: in the acute, inflammatory stage of the disease, give ten drops of flemming's tincture of aconite in water, every four hours, until a change takes place; follow this with aqua ammonia, three drachms; nitric ether, one ounce; pulverized gentian-root, one half an ounce; water, one quart. drench three times a day, and give, late in the evening, a tablespoonful of phosphate of lime, in a little feed, or drench with gruel. put setons, or rowels in the dewlap, so as to have a dependent opening. this course has been found very advantageous. or, the following will be found quite satisfactory; nitrate of potash, two drachms; camphor, half a drachm; tartrate of antimony, half a drachm; mix, and give in a little gruel, night and morning. or, the following: glauber-salts, four ounces; water, one pint; give twice a day. a gill of cold-drawn castor-oil, added to the above, would be beneficial. continue until the bowels are freely opened. the following has also been found efficacious: sulphate of magnesia, eight ounces; nitrate of potash and pulverized jamaica ginger-root, of each one ounce. repeat as often as may be required. apply externally the following ointment to the sides; biniodide of mercury, four drachms; castor-oil, half an ounce; lard, four ounces; mix for use. preventive measures.-- st. the complete isolation of all herds in which the disease has made its appearance. d. such animals as show symptoms of the disease should be placed under proper treatment. d. in england, it is recommended that animals recovering from the disease should be fattened and slaughtered for beef, as they are not safe even after their apparent recovery. th. all animals beyond medical treatment should be killed and buried; recompense in part, at least, being made to the owners. th. no animal, healthy or diseased, should be allowed to run at large upon the public highway so long as the disease may exist in its neighborhood. [illustration: taking it easily.] the united action of all those interested would soon rid the country of a disease which has smitten all europe. the author takes this occasion to acknowledge the receipt of two very ably written articles upon this subject, which, in consequence of their length and the comparatively limited space allotted, he is reluctantly compelled to omit. one is from the pen of r. mcclure, v.s., and the other from isaiah michener, v.s. for the benefit his readers, however, he desires to make a single extract from the last-named communication, without being considered as endorsing the opinion advanced therein:-- "i am inclined to favor the hypothesis that pleuro-pneumonia is produced by animalculæ, and that these enter the lungs by myriads, and thereby set up irritation and inflammation, which lead to all the phenomena and pathological conditions which are to be found upon dissection. this is my opinion of the cause of the malignant pleuro-pneumonia which has existed in the united states for the last seven years." after writing the foregoing, the author was informed that this disease had made its appearance in mr. logan's herd, already mentioned as exposed. he was called to visit the herd of mr. g. satterthwaite, who likewise lost two cows, and had two cows and a calf sick at the time of sending for him. pneumonia. there are two conditions of the lungs known as pneumonia,--one, the inflammatory, and the other, the congestive stage. the former may follow an attack of bronchitis, or it may have a spontaneous origin. the congestive is generally the result of cold suddenly applied to an overheated animal, causing a determination of blood to the lungs, which sometimes causes death by suffocation. _symptoms._--the disease is preceded by a shivering fit; dry skin; staring coat; clammy mouth; short cough; schneiderian membrane (of the nose) very much reddened; respiration hurried or laborious. in the congestive stage, upon applying the ear to the sides, no sound will be detected; while in the inflammatory stage, a crackling or crepitating sound will be distinctively heard. _treatment._--in the congestive stage, plenty of pure air will be necessary. bleed freely; and give in drench one pound of glauber-salts, with two drachms of jamaica ginger. nothing more will be required by way of treatment. in the inflammatory stage, bleeding should seldom be resorted to, except where the animal is in full condition. apply the following blister to the sides, well rubbed in: oil of turpentine, one ounce; croton-oil, twelve drops; aqua ammonia, half an ounce; linseed-oil, four ounces; mix all together. give internally one pound of salts in drench, and follow with one of the following powders every four hours: nitrate of potash, one ounce; tartrate of antimony and pulverized digitalis leaves, of each, one drachm; mix all together, and divide into eight powders. or the following may be given with equal advantage: nitrate of potash, one and a half ounces; nitrate of soda, six ounces; mix, and divide into six powders; one to be given in wash or gruel every six hours. protrusion of the bladder. this sometimes occurs during the throes in difficult cases of parturition in cows, and the aid of a skillful veterinary surgeon is requisite to replace the inverted bladder. puerperal fever. this disease--milk fever, or dropping after calving--rarely occurs until the animal has attained mature age. the first symptoms make their appearance in from one to five or six days after parturition. it appears to be a total suspension of nervous function, independent of inflammatory action, which is suddenly developed, and, in favorable cases, as suddenly disappears. it is called dropping after calving, from its following the parturient state. _symptoms._--tremor of hind legs; a staggering gait, which soon terminates in loss of power in the hind limbs; pulse rises to sixty or eighty per minute; milk diminishing in quantity as the disease progresses; the animal soon goes down, and is unable to rise, moans piteously; eyes set in the head; general stupor; and slow respiration. _treatment._--this disease, though generally regarded as a febrile disorder, will not yield to the general practice of taking blood, as a large majority of the cases so treated die. the bowels must be opened, but the veins never. give epsom-salts, one pound; jamaica ginger, two ounces; dissolve in warm water, one quart, and drench. the author usually gives with good effect, some five or six hours after the salts, two ounces of nitric ether and one ounce of tincture of opium, in half a pint of water. rub well in, along the back and loins, the following: strong mustard, three ounces; aqua ammonia and water, each one and a half ounces. some modifications in the treatment of this disease, as well as of most others, will be necessary under certain circumstances, which can only be determined by the veterinary practitioner. quarter evil. in some sections of the country, this disease--known by the other names of black quarter, and joint murrain--is quite common among young cattle, and is generally fatal in its termination. there is little or no warning of its approach. the first animals in a herd to be attacked are generally those in a full, plethoric condition. _symptoms._--the joints suddenly become swollen, and so painful as to produce severe lameness, particularly in the hind parts. general irritative fever exists in the system, attended with great tenderness of the loins; the head is poked out; eyes red and bulging; the roots of the horns, as well as the breath, are hot; the muzzle dry, and nostrils expanded; pulse rises to seventy or eighty, full and hard; respiration is hurried; the animal is constantly moaning, and appears to be unconscious of surrounding objects; the swelling of the limbs extends to the shoulder and haunch; the animal totters, falls and dies in from twelve to twenty-four hours. _treatment._--early bleeding is requisite here, to be followed by active purgatives; after which, give one of the following powders every half hour: nitrate of potassa, two ounces; tartrate of antimony and pulverized digitalis, of each one and a half drachms; mix, and divide into eight powders. these should not be renewed. cold linseed tea should be freely given. rabies. hydrophobia in cattle is the result of the bite of a rabid dog, from which bite no animal escapes. the effects produced by the wound made by the teeth of such an animal, after the virus is once absorbed into the circulation of the blood, are so poisonous that all treatment is useless. the proper remedies must be instantly applied to prevent this absorption, or the case is utterly hopeless. among men, nine out of every ten bitten by rabid dogs escape the terrible effects resulting from this dreadful disorder, without resorting to any applications to prevent it. it is a well-established fact, that men, when bitten by dogs, are generally wounded in some part protected by their clothing, which guards them from the deleterious effects of the saliva which covers the teeth, and which, at such times, is deadly poison. the teeth, in passing through the clothing, are wiped clean, so that the virus is not introduced into the blood; hence the comparatively few cases of rabies occurring in man. when, however, the wound is made upon an exposed surface, as the flesh of the hand, or of the face, this fatal disease is developed in spite of every precaution, unless such precautions are immediately taken. for this reason, cattle when bitten, do not escape the disease. _symptoms._--the animal separates itself from the rest of the herd, standing in a kind of stupor, with the eyes half-closed; respiration natural; pulse quickened; temperature of body and limbs natural; the slightest noise agitates, causing the eyes to glare and exciting bellowing; the bark of a dog produces the most violent effects; the animal foams at the mouth and staggers as it walks; if water is offered, the muzzle is plunged into it, but the victim cannot drink; in making the effort, the most fearful consequences are produced. the animal now seeks to do mischief,--and the quicker it is then destroyed, the better. _treatment._--this must be applied quickly, or not at all. the moment an animal is bitten, that moment the wound should be searched for, and when found, should be freely opened with a knife, and lunar caustic, caustic potash, or the permanganate of potash at once applied to all parts of the wound, care being taken not to suffer a single scratch to escape. this, if attended to in time, will save the animal. red water. this disease derives its name from the color of the urine voided in it. it is one of the most common complaints of horned cattle, and one of the most troublesome to manage. _symptoms._--respiration hurried; rumination ceases; a high degree of fever presented; the animal moans, arches the back, and strains in passing the urine, which is tinged with blood, or presents the appearance of pure blood. prof. gamgee, of the edinburgh veterinary college, says: "the cause is almost invariably feeding on turnips that have grown on damp, ill-drained land; and very often a change of diet stops the spread of this disease in the byre. other succulent food, grown under similar circumstances, may produce the same symptoms, tending to disturb the digestive organs and the blood-forming process. "in the course of my investigations as to the cause of various cattle-diseases, and of red water in particular. i have found that it is unknown on well-drained farms and in dairies where turnips are used only in a moderate degree. the lands of poor people furnish the roots most likely to induce this disorder; and i can confirm the statement of the late mr. cumming, of elton, who, in his very interesting essay upon this subject, says, particularly in reference to aberdeenshire, that it is 'a disease essentially attacking the poor man's cow; and to be seen and studied, requires a practice extending into the less favorably situated parts of the country. on large farms, where good stock is well kept, and in town dairies, where artificial food is used to supplement the supply of turnips, it is seldom now seen.' "_symptoms._--general derangement attracts the dairyman's attention, and, upon observing the urine which the animal has voided, it is seen to be of a red, or of a reddish brown, or claret color; sometimes transparent, at others clear. the color increases in depth; other secretions are checked; the animal becomes hide-bound, and the milk goes off. appetite and rumination are suspended; the pulse becomes extremely feeble and frequent, though--as in all debilitating, or anæmic, disorders--the heart's action is loud and strong, with a decided venous pulse, or apparent regurgitation, in the large veins of the neck. "in some cases, if even a small quantity of blood be withdrawn, the animal drops in a fainting state. in red water, the visible mucous membranes are blanched, and the extremities cold, indicating the languid state of the blood's circulation and the poverty of the blood itself. constipation is one of the most obstinate complications; and many veterinary surgeons--aware that, if the bowels can be acted on, the animal is cured--have employed purgatives in quantities far too large, inducing at times even death. occasionally, diarrhoea is one of the first, and not of the unfavorable, symptoms." _treatment._--give one pint of linseed-oil; clysters of soap and water should be freely used; and give plenty of linseed-tea to drink. when the urine is abundant, give one ounce of tincture of opium, with one drachm of powdered aloes, three times, at intervals of six or eight hours. rheumatism. this is a constitutional inflammatory affection of the joints, affecting the fibrous tissue and serous, or synovial membrane. it is caused by exposure to cold and wet; being quite common in low, marshy sections. _symptoms._--loss of appetite; upon forcing the animal to move, every joint seems stiffened; nose dry; coat staring; constipation is also an attendant symptom; the joints, one or more, become swollen and painful. this may be regarded as a metastic, or shifting disease; first one part, and then another, seems to be affected. _treatment._--mild purgatives should be used; one-half-ounce doses of colchicum-root pulverized will be found useful; one-ounce balls of pine-tar may also be given with advantage. as a local application, the author has found nothing to equal kerosene oil, one pint, to two ounces of aqua ammonia, well rubbed in, two or three times a day. strangulation of the intestines. this disease in cattle,--popularly styled knot, or gut-tie,--in consequence of the peculiar arrangement of the abdominal viscera, is of very rare occurrence. when, however, it does occur, the symptoms accompanying are those of inflammation of the intestines. no kind of treatment will be successful, and the poor brute must suffer until death comes to its relief. thrush in the mouth. aptha, or thrush in the mouth, is a vesicular disease of the mouth, sometimes occurring as an epizoötic. it is often mistaken for blain,--inflammation of the tongue, or black tongue,--and usually occurs in the winter, or early in the spring. it appears in the form of vesicles, or pustules all over the mouth, occasionally extending to the outside of the lips. these pustules break, discharging a thin, sanious fluid, leaving minute ulcers in their places. this disease yields readily to treatment, when it is properly applied. three ounces of epsom-salts, once a day for three or four days, should be given in drench; wash the mouth well with a solution of alum, tincture of myrrh, or vinegar and honey, and it will disappear in a few days. tumors. these enlargements so common in cattle, have been so admirably described, in the veterinarian for , by john ralph, v.s.,--who has been so successful in the treatment of these morbid growths, that the benefit of his experience is here given. he says: "of all the accidental productions met with among cattle, with the exception of wens, a certain kind of indurated tumor, chiefly situated about the head and throat, has abounded most in my practice. "the affection often commences in one of the thyroid glands, which slowly but gradually increases in size, feels firm when grasped, and evinces very little tenderness. generally the attendant is alarmed by a snoring or wheezing noise emitted by the animal in respiration, before he is aware of the existence of any tumefaction. this continues to increase, embracing in its progress the adjacent cellular and muscular tissues, and frequently the submaxillary and parotid glands. it becomes firmly attached to the skin through which an opening is ultimately effected by the pressure of pus from the centre of the tumor. "the swelling often presents an irregular surface, and various centres of maturation exist; but the evacuations only effect a partial and temporary reduction of its bulk, in consequence of the continued extension of the morbid growth and ulcerative process which often proceed towards the pharynx, rendering respiration and deglutition still more difficult, until at length the animal sinks from atrophy or _phthisis pulmonalis_. "in the early part of my practice, having been frustrated in my attempts to establish healthy action in these ulcers, and referring to the works that i had on surgery for information, i concluded that they bore some resemblance to cancer in the human being, and determined to attempt extirpation. subsequently, numerous cases have occurred in which i have successfully carried that determination into effect. i have had some instances of failure, which failure always arose from some portion of the morbid growth having been left. "in the first stage, i have reason to believe that the tumor may be dispersed by the general and topical use of the iodurets. after the suppuration, i have tried them in vain. "as soon as the nature of the tumor is clearly developed, i generally attempt its removal, and, when most prominent by the side of the larynx, i proceed in the following manner:--having cast the beast, turned the occiput toward the ground, and bolstered it up with bundles of straw, i proceed to make an incision through it, if the skin is free, parallel with, and over, and between the trachea and _sterno-maxillaris_, extending it sufficiently forward into the inter-maxillary spaces. if i find it firmly attached to the apex of the tumor, i then enclose it in a curvilinear incision and proceed to detach the healthy skin to beyond the verge of the tumor. "its edges being held by an assistant, the knife is directed downwards through the subcutaneous parts, and all those that exhibit the slightest change from healthy structure are removed. "by tying any considerable blood-vessel before dividing it, and by using the handle of the scalpel and the fingers in detaching the portion of the parotid gland towards the ear the hemorrhage was always inconsiderable. "the wound is then treated in the ordinary way; except that detergents and even antiseptics are often needed to arouse healthy action, and the addition of some preparation of iodine is often made to the digestive. in directing the constitutional treatment, our chief aim must be to support the animal system with plenty of gruel until rumination is restored. "i need not note that the operation should be performed after the animal has fasted some hours. "as the success of the operation depends on an entire removal of the diseased parts, and as the submaxillary and parotid glands, with important branches of nerves and blood-vessels, are often enveloped therein, we must not hesitate to remove the former, nor to divide the latter. it has occasionally happened that a rupture has been made in the oesophagus, or pharynx, during the operation. in that case, a portion of the gruel with which the animal is drenched escapes for a few days; but i always found that the wound healed by granulation, without any particular attention. "the weight of these tumors varies from a few ounces to some pounds. one that i removed from a two-year-old galloway bullock, weighed six pounds and a quarter. a considerable portion of the skin that covered it was excised and included in the above weight. it comprehended one of the parotid glands, and i had to divide the trunk of the carotid artery and jugular vein. "this affection may be distinguished from parotiditis and other _phlegmasiæ_ by the action of constitutional disturbance, and heat, and tenderness, and by the lingering progress it makes. i was once called to a bull laboring under alarming dyspnoea that had gradually increased. no external enlargement was perceptible; but on introducing my hand into the mouth, a large polypus was found hanging from the _velum palati_ into the pharynx, greatly obstructing the elevation of the epiglottis and the passage of food. after performing tracheotomy, to prevent suffocation, i passed a ligature around its pedicle in the way suggested by the old anatomist, cheselden. "a section of one of these tumors mostly displays several abscesses, with matter varying in consistency and often very fetid, enclosed in what seems to me to be fibro-cartilaginous cysts, the exterior of which sometimes gradually disappears in the surrounding more vascular abnormal growth. osseous matter (i judge from the grating of the scalpel upon it) occasionally enters into the composition of the cysts. "i have treated this affection in cattle of the long-horned, short-horned, galloway, and highland breeds; and from the number of bulls in this class of patients, have reason to conclude that they are more liable to it than the female. "about twelve months ago, i examined the head of a cow, on the right facial region of which there existed an enormous tumor, extending from the eye to the lips, and which i mistook during life for a periosteal enlargement. on cutting into it, my mistake was evident. there was scarcely a trace of the original bones beneath the mass; even those forming the nasal sinuses on that side were replaced by a formation much resembling the cysts before alluded to, and full of abscesses. the progress of the disease was decisively marked in the inferior rim of the orbital cavity, where the osseous matter was being removed, and the morbid structure deposited." ulcers about the joints. occasionally, the joints assume a tumefied appearance, generally ulcerating, and causing painful wounds. _treatment._--the application of one part of alum to two parts of prepared chalk, powdered and sprinkled upon the parts, is usually all that is required. warbles. it has been a prevalent opinion among farmers, that warbles are so many evidences of the good condition of their cattle. it must, however, be borne in mind that the warbles are the _larvæ_ of the _oestrus bovis_, which is said to be the most beautiful variety of gad-fly. this fly, judging from the objects of its attack, must be particularly choice in its selection of animals upon which to deposit its eggs, as it rarely chooses those poor in flesh, or in an unhealthy condition. from this circumstance, probably, has arisen the opinion above-mentioned. [illustration: home again.] these warbles--or _larvæ_ of the _oestrus bovis_--so nearly resemble bots in the horse--or _larvæ oestrus equi_--that, were it not for their increased size, they might readily be mistaken the one for the other. there is, however, one other difference, and that is in the rings which encircle the body; those of the former being perfectly smooth, while those of the latter are prickly, and from one third to one half smaller. the author was called, in the year , to see the prize cow, pet, belonging to james kelly, of cleveland, ohio, whose extraordinary yield of butter and milk had been reported in the _ohio farmer_, a short time previous to his visit. this animal was found by him in rather poor condition; the causes of which he could only trace to the existence of these worms, comfortably located, as they were, beneath the animal's hide, and forming small tumors all along the spinal column, each being surrounded by a considerable quantity of pus. a number of these were removed by means of a curved bistoury and a pair of forceps, since which time--as he has been informed--the animal has rapidly improved, regaining her former good condition. some may urge that this is an isolated case; but an examination of cattle for themselves, will convince them to the contrary. it may be added, that two other cows, belonging to the same gentleman, were also examined at the same time,--one of them being in good condition, and the other, out of condition. from the back of the latter several of these insects were removed, since which time she also has much improved. the former was entirely free from them. these cows were all kept in the same pasture, received the same care, and were fed on the same food, and at the same time; and as the removal of these larvæ has been productive of such beneficial results, have we not a right to infer that these insects are injurious? if we go further and examine, in the spring of the year, all cattle which are subject to them, instead of finding them in the fine condition which one would naturally expect,--considering the abundance of fresh young grass whose vigorous life they may incorporate into their own,--they are out of condition, and out of spirits, with a laggard eye, a rough coat, and, in some cases, a staggering gait, as though their strength had failed in consequence. how shall such attacks be prevented? during the months of august and september this gad-fly is busily engaged in depositing its eggs. some are of the opinion that they are placed on the hairs of the animal; others, that the skin is perforated, and the egg deposited in the opening, which would account for the apparent pain manifested by cattle at and after the time of such deposit. be this as it may, it is certain that the maggot works its way into the muscular fibre of the back, and depends upon the animal's blood for the nourishment which it receives. the author has been informed, by persons in whom he ought to have confidence, that the _free use of the card_, during the above-named months, is a specific protection against the attacks of the _oestrus bovis_. he repeats this information here, not without diffidence; since so large a majority of stock-owners evince, by their lack of familiarity with the practical use of this convenient and portable instrument, an utter disbelief in its reliability and value. worms. cattle are not so subject to worms proper as are the other domestic animals; nor, when these parasites do exist, is any injurious effect apparent, except it be in the case of young calves of a weakly constitution. worms are most commonly located in the small intestines, and cause there considerable irritation, and consequently, general emaciation, or at least a tendency to it. the cause, however, is easily removed by administering doses of sulphate of iron, one-half drachm each, in molasses once or twice a day. worms in the bronchial tubes. inflammation of the bronchial tubes is often caused by worms of the _strongylus_ species. upon examination after death, the bronchial passages are completely blocked-up by these hangers-on. _symptoms._--a rough, staring coat; hide-bound; painful cough; respiration hurried, etc. _treatment._--but little can be done by way of treatment in this disease. the administration of small doses of spirits of turpentine has, in some instances, proved successful. surgical operations. castration. the period most commonly selected for this operation is between the first and third months. the nearer it is to the expiration of the first month, the less danger attends the operation. some persons prepare the animal by the administration of a dose of physic; but others proceed at once to the operation when it best suits their convenience, or that of the farmer. care, however, should be taken that the young animal is in perfect health. the mode formerly practised was simple enough:--a piece of whip-cord was tied as tightly as possible around the scrotum. the supply of blood being thus completely cut off, the bag and its contents soon became livid and dead, and were suffered to hang, by some careless operators, until they dropped off, or they were cut off on the second or third day. it is now, however, the general practice to grasp the scrotum in the hand, between the testicles and the belly, and to make an incision in one side of it, near the bottom, of sufficient depth to penetrate through the inner covering of the testicle, and of sufficient length to admit of its escape. the testicle immediately bursts from its bag, and is seen hanging by its cord. the careless or brutal operator now firmly ties a piece of small string around the cord, and having thus stopped the circulation, cuts through the cord, half an inch below the ligature, and removes the testicle. he, however, who has any feeling for the poor animal on which he is operating, considers that the only use of the ligature is to compress the blood-vessels and prevent after-hemorrhage, and, therefore, saves a great deal of unnecessary torture by including them alone in the ligature, and afterwards dividing the rest of the cord. the other testicle is proceeded with in the same way and the operation is complete. the length of the cord should be so contrived that it will immediately retract, or be drawn back, into the scrotum, but not higher, while the ends of the string hang out through the wound. in the course of about a week, the strings will usually drop off, and the wounds will speedily heal. there will rarely be any occasion to make any application to the scrotum, except fomentation of it, if much swelling should ensue. a few, whose practice cannot be justified, seize the testicle as soon as it escapes from the bag, and, pulling violently, break the cord and tear it out. it is certain that when a blood-vessel is thus ruptured, it forcibly contracts, and very little bleeding follows; but if the cord breaks high up, and retracts into the belly, considerable inflammation has occasionally ensued, and the beast has been lost. the application of _torsion_--or the twisting of the arteries by a pair of forceps which will firmly grasp them--has, in a great degree, superseded every other mode of castration, both in the larger and the smaller domesticated animals. the spermatic artery is exposed, and seized with the forceps, which are then closed by a very simple mechanical contrivance; the vessel is drawn a little out from its surrounding tissue, the forceps are turned around seven or eight times, and the vessel liberated. it will be found to be perfectly closed; a small knot will have formed on its extremity; it will retract into the surrounding surface, and not a drop more of blood will flow from it; the cord may then be divided, and the bleeding from any little vessel arrested in the same way. neither the application of the hot iron, nor of the wooden clamps, whether with or without caustic, can be necessary in the castration of the calf. a new instrument was introduced in france, some few years since, for this purpose, called the _acraseur_,--so constructed as to throw a chain over the cord, which is wound up by means of a screw working upon the chain, and at the same time the cord is twisted off. no bleeding follows this method of operating. this instrument is constructed upon the same principle as the _acraseur_ for use in the human family, for the removal of hemorrhoids, etc., the dimensions of the two only varying. the advantages resulting from the use of this instrument over all other methods are, that the parts generally heal within a week,--the operation is not so painful to the animal,--it is less troublesome to the operator,--also to the owner of the animal,--and lastly, it is a safer and more scientific operation. its success in france soon gave it a reputation in england, and recently it has been introduced by the author into this country, and with the best results. contractors, hearing of the success attending this new mode of operating, have visited him from all parts of the country to witness its performance, and not one has returned without leaving an order for this instrument,--so well convinced have they been of its decided superiority over all other methods. tracheotomy. in consequence of the formation of tumors about the throat in cattle, from inflammation of the parotid gland, blain, etc., so characteristic of this species of animals, it sometimes becomes necessary to perform this operation in order to save their lives. it never fails to give instant relief. after the animal has been properly secured,--which is done by an assistant's holding the nose with one hand, and one of the horns with the other,--the operator draws the skin tight over the windpipe with the thumb and fingers of his left hand; then, with the scalpel in his right, cuts through the skin, making an incision about three inches long, dissecting up the skin on each side, which brings the _trachea_, or windpipe, in full view. he then cuts out a piece of the cartilaginous rings, about two inches long and about half an inch wide. this simple operation has saved the lives of very many valuable animals. the wound readily heals, and seldom leaves any perceptible blemish, if the work is properly performed. spaying. to secure a more uniform flow and a richer quality of milk, cows are sometimes spayed, or castrated. the milk of spayed cows is pretty uniform in quality; and this quality will be, on an average, a little more than before the operation was performed. in instances where the results of this operation have been carefully noted,--and the operation is rarely resorted to in this country, in comparison with the custom in france and other continental countries,--the quality of the milk has been greatly improved, the yield becoming regular for some years, and varying only in accordance with the difference in the succulence of the food. the proper time for spaying is about five or six weeks after calving, or at the time when the largest quantity of milk is given. there seems to be some advantages in spaying for milk and butter dairies, where attention is not paid to the raising of stock. the cows are more quiet, never being liable to returns of seasons of heat, which always more or less affect the milk, both in quantity and quality. they give milk nearly uniform in these respects, for several years, provided the food is uniformly succulent and nutritious. their milk is influenced like that of other cows, though to a less extent, by the quality and quantity of food; so that in winter, unless the animal is properly attended to, the yield will decrease somewhat, but will rise again as good feed returns. this uniformity for the milk-dairy is of immense advantage. besides, the cow, when old and inclined to dry up, takes on fat with greater rapidity, and produces a juicy and tender beef, superior, at the same age, to that of the ox. the following method of performing this operation is sanctioned by the practice of eminent veterinary surgeons in france:-- having covered the eyes of the cow to be operated upon, she is placed against a wall, provided with five rings firmly fastened and placed as follows: the first corresponds to the top of the withers; the second, to the lower anterior part of the breast; the third is placed a little distance from the angle of the shoulder; the fourth is opposite to the anterior and superior part of the lower region; and the fifth, which is behind, answers to the under-part of the buttocks. a strong assistant is placed between the wall and the head of the animal, who firmly holds the left horn in his left hand, and with his right, the muzzle, which he elevates a little. this done, the end of a long and strong-plaited cord is passed, through the ring which corresponds to the lower part of the breast, and fastened; the free end of the cord is brought along the left flank, and through the ring which is below and in front of the withers. this is brought down along the breast behind the shoulder and the angle of the fore-leg in order to pass it through the third ring; then it must be passed around against the outer angle of the left hip, and fastened after having been drawn tightly to the posterior ring, by a simple bow-knot. the cow being thus firmly fixed to the wall, a cord is fastened by a slip-noose around her hocks, to keep them together in such a manner that she cannot kick the operator, the free end of the cord and the tail being held by an assistant. the cow thus secured cannot, during the operation, move forward, nor lie down, and the operator has all the ease desirable, and is protected from accident. the operator next--placed opposite to the animal's left flank, with his back turned a little toward the head of the animal--cuts off the hair which covers the hide in the middle of the flanks, at an equal distance between the back and hip, for the space of thirteen or fourteen centimetres in circumference (the french _centimetre_ is rather more than thirty-nine one hundredths of an inch); a convex bistoury is placed, opened, between his teeth, the edge out, the joints to the left; then, with both hands, he seizes the hide in the middle of the flank, and forms of it a wrinkle of the requisite elevation, running lengthwise of the body. the assistant seizes with his right hand the right side of this wrinkle; the operator takes the bistoury and cuts the wrinkle, at one stroke, through the middle; the wrinkle having been suffered to go down, a separation of the hide is presented, of sufficient length to admit the introduction of the hand; the edges of the hide are separated with the thumb and fore-finger of the left hand, and in like manner the abdominal muscles are cut through, for the distance of a centimetre from the lower extremity of the incision made in the hide,--the _iliac_ slightly obliquely, and the _lumbar_ across; a puncture of the peritoneum, at the upper extremity of the wound, is then made with the straight bistoury; the buttoned bistoury is then introduced, and moved obliquely from above to the lower part, up to the termination of the incision made in the abdominal muscles. the flank being opened, the right hand is introduced into the abdomen, and directed along the right side of the cavity of the pelvis, behind the paunch, and underneath the rectum, to the matrix; after the position of these viscera is ascertained, the organs of reproduction, or ovaries, are searched for, which are at the extremity of the matrix; when found, they are seized between the thumb and fore-finger, detached completely from the ligaments which keeps them in their place, and by a light pull, the cord and the vessels, the uterine or fallopian tube, are separated at their place of union with the ovarium, by means of the nails of the thumb and fore-finger, which present themselves at the point of touch, thus breaking the cord and bringing away the ovary. the hand is again introduced into the abdominal cavity, and the remaining ovaries brought away in like manner. a suture is then placed of three or four double threads, waxed at an equal distance, and at two centimetres, or a little less, from the lips of the wound, passing it through the divided tissues; a movement is made from the left hand with the piece of thread; having reached that point, a fastening is made with a double knot, the seam placed in the intervals of the thread from the right, and as the lips of the wound are approached, a fastening is effected by a simple knot, with a bow, care being taken not to close too tightly the lower part of the seam, in order to allow the suppuration, which may be established in the wound, to escape. the wound is then covered up with a pledget of lint, kept in its place by three or four threads passed through the stitches, and the operation is complete. it happens, sometimes, that in cutting the muscles before mentioned, one or two of the arteries are severed. should much blood escape, a ligature must be applied before opening the peritoneal sac; since, if this precaution is omitted, blood will escape into the abdomen, which may occasion the most serious consequences. for the first eight days succeeding, the animal should have a light diet, and a soothing, lukewarm draught; if the weather should be cold, cover with a woollen covering. she must be prevented from licking the wound, and from rubbing it against other bodies. the third day after the operation, bathe morning and evening about the wound with water of mallows lukewarm, or anoint it with a salve of hog's lard, and administer an emollient glyster during three or four days. eight days after the operation, take away the bandage, the lint, the fastenings, and the thread. the wound is at that time, as a general thing, completely cicatrized. should, however, some slight suppuration exist, a slight pressure must be used above the part where it is located, so as to cause the pus to leave, and if it continues more than five or six days, emollients must be supplied by alcolized water, or chloridized, especially in summer. the animal is then to be brought back gradually to her ordinary nourishment. in some cows, a swelling of the body is observable a short time after having been spayed, attributable to the introduction of cold air into the abdomen during the operation; but this derangement generally ceases within twenty-four hours. should the contrary occur, administer one or two sudorific draughts, such as wine, warm cider, or a half-glass of brandy, in a quart of warm water,--treatment which suffices in a short time to restore a healthy state of the belly,--the animal at the same time being protected by two coverings of wool. the only precaution, in the way of management, to be observed as a preparative for the operation is, that on the preceding evening not so copious a meal should be given. the operation should also be performed in the morning before the animal has fed, so that the operator may not find any obstacle from the primary digestive organs, especially the paunch, which, during its state of ordinary fullness, might prevent operating with facility. the advantages of spaying milch-cows are thus summed up by able french writers: first, rendering permanent the secretion of milk, and having a much greater quantity within the given time of every year; second, the quality of milk being improved; third, the uncertainty of, and the dangers incident to, breeding being, to a great extent, avoided; fourth, the increased disposition to fatten even when giving milk freely, or when, from excess of age or from accidental circumstances, the secretion of milk is otherwise checked; fifth, the very short time required to produce a marketable condition; and sixth, the meat of spayed cattle being of a quality superior to that of ordinary cattle. this operation would seem to have originated in this country. the london veterinary journal of contains the following, taken from the united states southern agriculturist:--"some years since, i passed a summer at natchez, and put up at a hotel there, kept by mr. thomas winn. during the time that i was there i noticed two remarkably fine cows, which were kept constantly in the stable, the servant who had charge of the horses, feeding them regularly three times a day with green guinea grass, cut with a sickle. these cows had so often attracted my attention, on account of the great beauty of their form, and deep red color, the large size of their bags, and the high condition in which they were kept, that i was at length induced to ask mr. winn to what breed of cattle they belonged, and his reasons for keeping them constantly in the stable in preference to allowing them to run in the pasture, where they could enjoy the benefit of air and exercise, and at the same time crop their own food, and thereby save the labor and trouble of feeding them? mr. winn, in reply to these inquiries, stated that the two cows which i so much admired were of the common stock of the country, and he believed, of spanish origin; but they were both spayed cows, and that they had given milk either two or three years. considering this a phenomenon (if not in nature at least in art), i made further inquiries of mr. winn, who politely entered into a very interesting detail, communicating facts which were as extraordinary as they were novel. mr. winn, by way of preface, observed that he, in former years, had been in the habit of reading english magazines, which contained accounts of the plowing-matches which were annually held in some of the southern counties of england, performed by cattle, and that he had noticed that the prizes were generally adjudged to the plowman who worked with spayed heifers; and although there was no connection between that subject and the facts which he should state, it was, nevertheless, the cause that first directed his mind into the train of thought and reasoning which finally induced him to make the experiments, which resulted in the discovery of the facts which he detailed, and which i will narrate as accurately as my memory will enable me to do it, after the lapse of more than twenty years. mr. winn's frequent reflections had (he said) led him to the belief "that if cows were spayed soon after calving, and while in a full flow of milk, they would continue to give milk for many years without intermission, or any diminution of quantity, except what would be caused by a change from green to dry, or less succulent food." to test this hypothesis, mr. winn caused a very good cow, then in full milk, to be spayed. the operation was performed about one month after the cow had produced her third calf; it was not attended with any severe pain, or much or long continued fever. the cow was apparently well in a few days, and very soon yielded her usual quantity of milk, and continued to give freely for several years without any intermission or diminution in quantity, except when the food was scarce and dry; but a full flow of milk always came back upon the return of a full supply of green food. this cow ran in the mississippi low grounds or swamp near natchez, got cast in deep mire, and was found dead. upon her death, mr. winn caused a second cow to be spayed. the operation was entirely successful. the cow gave milk constantly for several years, but in jumping a fence stuck a stake in her bag, that inflicted a severe wound, which obliged mr. winn to kill her. upon this second loss, mr. winn had two other cows spayed, and, to prevent the recurrence of injuries from similar causes with those which had occasioned him the loss of the first two spayed cows, he resolved to keep them always in the stable, or some safe enclosure, and to supply them regularly with green food, which that climate throughout the greater part of, if not all, the year enabled him to procure. the result, in regard to the last two spayed cows, was, as in the case of the first two, entirely satisfactory, and fully established, as mr. winn believed, the fact, that the spaying of cows, while in full milk, will cause them to continue to give milk during the residue of their lives, or until prevented by old age. when i saw the last two spayed cows it was, i believe, during the third year that they had constantly given milk after they were spayed. the character of mr. winn (now deceased) was highly respectable, and the most entire confidence could be reposed in the fidelity of his statements; and as regarded the facts which he communicated in relation to the several cows which he had spayed, numerous persons with whom i became acquainted, fully confirmed his statements." in november , the author was called to perform this operation upon the short-horn galloway cow, josephine the second, belonging to henry ingersoll, esq., of this city. this cow was born may th, . the morning was cold and cloudy. about ten o'clock the cow was cast, with the assistance of r. mcclure, v.s., after which she was placed under the influence of chloric ether. he then made an incision, about five inches in length, through the skin and walls of the abdomen, midway between the pelvis bone and the last rib on the left side, passing in his right hand, cutting away the ovaries from the fallopian tubes with the thumbnail. the opening on the side was then closed by means of the interrupted suture. the animal recovered from the influence of the anæsthetic in about fifteen minutes, when she was allowed to rise, and walk back to her stall. upon the morning of the second day succeeding the operation, the animal was visited and found to be in good spirits, apparently suffering very little pain or inconvenience from the operation, and the wound healing nicely. since that time, he has operated upon some twenty cows, all of which, with a single exception, have thus far proved satisfactory. several of these cows are under the direction of a committee from the philadelphia society for promoting agriculture, whose duty it is to have a daily record kept of each cow's yield of butter and milk, for one year from the time of spaying. their report will be perused by the agricultural community with much interest. the author's own experience will not justify him in speaking either in favor of, or against, this operation; as sufficient time has not as yet elapsed to satisfy him as to its relative advantages and disadvantages. he, however, regards the operation as comparatively safe. the french estimate the loss at about fifteen per cent., and the gain at thirty per cent. of those upon which he has operated, not a single animal died. a list of medicines used in treating cattle. the medicines used in the treatment of the diseases of cattle, are essentially the same as those in vogue for the diseases of the human being and the horse,--the only difference being in their combination and the quantities administered. absorbents.--medicines which destroy acidities in the stomach and bowels; such as chalk, magnesia, etc. alteratives.--medicines which restore the healthy functions of secretion, by gradually changing the morbid action in an impaired constitution. those in most common use are Æthiops mineral, antimony, rosin, sulphur, etc., which form the principal ingredients in all condition-powders, and are chiefly useful in diseases of the skin, such as hide-bound, mange, surfeit, etc. alterative powder.--sulphur pulverized, one pound; black antimony, one half a pound; nitrate of potassa, four ounces; sulphate of iron, one half a pound; linseed meal, one pound; mix well; dose, one half an ounce, night and morning. antacids.--agents which neutralize, by their chemical action, acids in the stomach; as ammonia, carbonate of potassa, chalk, lime-water, magnesia, and soda. anthelmintics.--remedies used for the expulsion of worms from the stomach and intestines. these may act chemically or by their cathartic operation. the most reliable are Æthiops mineral, nux vomica, preparations of mercury, wormwood, etc. anthelmintic powders.--nux vomica, in one half-drachm doses, two or three times daily, to an ox or cow; for calves, the dose must be diminished, according to age. antidotes.--medicines which neutralize the effects of poisons by a chemical union, forming an insoluble compound, or a mild, harmless one. alkaline solutions are antidotes for the mineral acids; as soap in solution, a simple remedy, and always at hand. lard, magnesia, and oil are antidotes for poisoning by arsenic; albumen,--in the form of the white of an egg,--milk, etc., for corrosive sublimate, and other mercurial preparations. antiseptics.--medicines which prevent putridity in animal substances, and arrest putrefaction, when already existing. these are used both externally and internally. the chief specifics of this class are the acids, alcohol, ammonia, asafoetida, camphor, charcoal, chloride of lime, cinchona, ether, and opium. antispasmodics.--medicines which exert their power in allaying inordinate motions or spasms in the system, arising from various causes, such as debility, worms, etc. those most generally in use are ammonia, asafoetida, camphor, cinchona, ether, lactacarium, mercury, and opium. antispasmodic draught.--tincture of opium, one ounce; nitric ether, two ounces; water, one-half pint. mix for drench; if repeated, it should be followed by a purgative, as soon as the spasms have subsided. or, use the following: sulphuric ether, one to two ounces; water, one-half pint mix for drench; repeat every hour, if necessary. aromatics.--medicines possessing a grateful, spicy scent, and an agreeable, pungent taste; as anise-seed, cardamoms, cinnamon, cloves, ginger, etc. they are principally used in combination with purgatives, stomachics, and tonics. astringents.--medicines which serve to diminish excessive discharges, as in diabetes, diarrhoea, etc. the principal agents of this class are the acids, alum, chalk, lime-water, opium, and the sulphate of copper, lead, iron, or zinc. astringent powder.--opium, one drachm; prepared chalk, half an ounce; jamaica ginger, six drachms. mix, and divide into four powders; one to be given every hour, in a little flour gruel. or, the following: opium, one drachm; catechu, two drachms; prepared chalk, one ounce. mix, and divide into four powders; to be given as before. cardiacs.--cordials--so termed, from their possessing warm and stimulating properties--given to invigorate the system. cathartics.--medicines--also known as purgatives--which cause free evacuations of the bowels. the only purgatives used by the author in his cattle practice, as a general rule, are aloes, cream of tartar, epsom-salts, lard and linseed-oil. these answer all the indications, where purgatives are useful; indeed, no better purgative for cattle can be found than epsom-salts, combined with a carminative or aromatic drug, such as ginger. caustics.--substances which burn or destroy parts, by combining with them and causing their disorganization; used to destroy unhealthy action, or morbid growths, such as foul ulcers, foul in the foot, warts, etc. the most powerful remedial of this class is actual cauterization with a red-hot iron; caustic potash, lunar caustic, nitrous and sulphuric acids, permanganate of potash, etc., are also used. cordials.--best brandy, three ounces; orange peel, one drachm; tepid water, one pint. mix all together, for one dose. or, this for a single dose: ale, one pint; jamaica ginger, two drachms. or, the following, also a single dose: allspice, three drachms; ginger, one drachm; caraway seeds, two drachms. demulcents.--mucilaginous medicaments, which have the power of diminishing the effects of stimulating substances upon the animal system. of this class, garden rue, or marsh-mallow, gum-arabic, and gum-tragacanth are the most useful. detergents.--agents which remove foulness from ulcers. detergent powder.--prepared chalk, two ounces; alum, one ounce. mix; to be sprinkled on the part, after washing with castile-soap and water. this powder is also an admirable application for foot-rot in sheep. diaphoretics.--agents which increase the natural discharge through the pores of the skin, and in some animals induce perspiration. digestives.--medicines which promote suppuration. digestive ointment.--mix together equal portions of spirits of turpentine and lard. or, mix together with a gentle heat the following: venetian turpentine, one ounce; lard, one ounce; pulverized sulphate of copper, two drachms. or this, mixed: rosin, two ounces; spirits of turpentine, one ounce; red precipitate, one-half an ounce; lard, two ounces. diuretics.--medicines that stimulate the action of the kidneys, and augment the secretion of urine. these are very useful in swellings of the legs, or body. take of nitrate of potash and rosin, each six drachms; mix, and divide in three powders; one to be given daily. or, the following: spirits of turpentine, half an ounce; castile-soap, one ounce; jamaica ginger, one drachm; opium, one drachm. mix: and divide in two balls; one to be given each day. emollients.--medicines which relax the lining tissues, allay irritation, and soften the parts involved,--generally of a mucilaginous, or oily character. lard, linseed meal, and marsh-mallows are chiefly used. lithontriptics.--medicines possessing the power of dissolving _calculi_, or stones in the urinary passages; composed principally, according to the researches of modern chemists, of lithic or uric acid. the preparation most successfully employed by the author in such cases is muriatic acid, in doses of from one to two drachms, in a pail of water, once or twice a day. narcotics.--medicines that stupefy, and produce sleep. belladonna, camphor, hyoscyamus and opium, are among the narcotics in common use. nauseants.--agents which cause loss of appetite, and produce the sensation of vomiting, without affecting it. for this purpose, aloes, tartrate of antimony, white hellebore, etc., are used. parturients.--agents which act upon the uterus. in cases of difficult parturition, or calving, resort is occasionally had to them. ergot of rye is the most powerful. refrigerants.--cooling applications, which reduce the temperature of the blood and body; as cold water, ether, lead-water, etc. rubefacients.--medicines which gently irritate the skin, producing redness on white surfaces. of this class, are aqua ammonia, creosote, mustard, turpentine, etc. sedatives.--agents which depress the vital energies, without destroying life; as aconite, digitalis, hellebore, hydrochloric acid, hyoscyamus, opium, and tartrate of antimony. tonics.--medicines which increase the action of the muscular system, giving strength and vigor to the animal. these are among the most useful remedies known to man, and are beneficial in all cases of debility, toning up the stomach, and improving the appetite and condition of the animal. tonic powder.--pulverized gentian-root, one ounce; jamaica ginger, one half an ounce; anise-seed, six drachms. mix, and divide in eight powders; one to be given night and morning. traumatics.--medicines which excite the healing process of wounds; as aloes, friar's balsam, myrrh, rosin, sulphate of copper or zinc, tar, etc. traumatic lotion.--mix tincture of aloes, one ounce; tincture of myrrh, two ounces. or, melt together, tar, one ounce; rosin, two ounces; lard, four ounces. or, mix sulphate of zinc, one drachm; rain-water, one half pint. or, use the following, the celebrated friar's balsam; benzoin, in powder, four ounces; balsam of peru, two ounces; socotrine aloes, one half ounce; rectified spirits, one quart. digest for ten or twelve days; then filter for use. doses of various remedies used in cattle practice. aconite.--[_monk's hood_; _wolf's bane_.] an active poison. used as a sedative in tincture; ten to twenty drops in water. Æthiops mineral.--[_hydrargyri sulphuretum._] one to two drachms. alcohol.--a stimulant; three to six ounces. allspice.--[_pimento berries._] aromatic; two to four drachms. aloes.--cathartic and tonic; tonic dose, one half to one drachm--cathartic, one to two ounces. alum.--[_alumen._] irritant, astringent, and sedative; two to four drachms. ammonia.--[_aqua ammonia_; _liquor ammonia_; _hartshorn_.] principally used in combination with mustard, as an external irritant, and internally, as a diffusible stimulant; two to six drachms. of carbonate of ammonia, three to six drachms. anise-seed.--[fruit of the _pimpinella anisum_.] one to two drachms. antimony.--[_sulphate of antimony._] used in condition-powders; one to three drachms. muriate of antimony. [_oil, or butter, of antimony._] caustic; very good in foul in the foot. tartarized antimony. [_tartar emetic._] one to four drachms. the author, in the last instance, varies from the dose prescribed by veterinary authors, never giving it in more than one-half-drachm doses, believing its action thus more certain and satisfactory. asafoetida.--stimulant; two to four drachms. axunge.--[_hog's lard._] ointment, principally; may be used as purgative in doses of from one to one and a half pounds. balsam of peru.--stimulant, and tonic; two to four drachms. belladonna.--[_deadly nightshade._] narcotic, anti-spasmodic, and irritant poison; one to two drachms. benzoin.--[_gum benjamin._] ointment; see traumatics. calomel.--[_hydrargyri chloridum._] one half to one drachm. camomile.--[_anthemis._] stomachic, carminative, and tonic; one to two ounces. camphor.--[_camphora officinarum._] narcotic and irritant; in small doses, sedative and stimulant; one to four drachms. cantharides.--[_spanish flies._] internally, stimulant and diuretic; twenty to thirty grains. externally, vesicant; used in form of ointment, or tincture. caraway.--[fruit of the _carum carisi_.] used chiefly for flavoring purposes. cardamoms.--[fruit of the _elettaria cardamomum_.] used to communicate an agreeable flavor to other medicines. catechu.--[_acacia catechu._] astringent, and antiseptic; three to six drachms. chalk.--[_carbonate of lime_; _calcis carbonas_.] two to three ounces. charcoal.--[_carbo ligni._] antiseptic; one half to one ounce. cinchona.--[_peruvian bark._] astringent and tonic; one to two ounces. copper, sulphate of.--[_blue vitriol._] tonic and astringent; two to four drachms. creosote.--[_creosotum._] a sedative, anodyne, astringent, narcotic, and irritant poison; fifteen to twenty drops. croton oil.--[_crotonis oleum._] internally, as a cathartic, six to ten drops in linseed-oil; externally, as a counter-irritant. digitalis.--[_fox glove._] sedative and diuretic; one to two scruples. epsom-salts.--[_sulphate of magnesia._] cathartic; one pound, combined with ginger. ergot.--[_spurred rye._] parturient; two to six drachms. ether.--stimulant, narcotic, and anæsthetic; one to two ounces. gentian.--[root of _gentiana lutea_.] stomachic and tonic; one to two ounces. ginger.--[_zengiber officinale._] stomachic, carminative, and slightly tonic; one to two ounces. gum-arabic.--[_gummi acaciæ._] demulcent and emollient; one to two ounces. gum-tragacanth. same action and same doses as the former. hellebore.--[_helleborus._] irritant poison, and sedative; twenty to thirty grains. hyoscyamus.--[_henbane._] narcotic, anodyne, and anti-spasmodic; ten to twenty grains. iodine.--[_iodineum._] internally, as a tonic; two to three scruples; also as a tincture, and in ointments for reducing enlargements of the soft tissues. iron, sulphate of.--[_ferri sulphas_; _green vitriol_, _coppera_.] irritant, astringent, and tonic; two to four drachms. koosso. anthelmintic; two to four drachms. lime, chloride of.--antiseptic; dose internally, one to two drachms. linseed oil.--cathartic; one pint. lunar caustic.--[_nitrate of silver._] used as a caustic. magnesia.--[see epsom-salts.] marsh-mallow.--[_altheæ radix._] demulcent and emollient; principally used for poultices and fomentations. muriatic acid.--[_hydrochloric acid_; _spirit of salt_.] tonic, irritant, and caustic; dose internally, one to two drachms. mustard.--[_sinapis._] counter-irritant; used principally as an external application. myrrh.--stimulating tonic to unhealthy sores; seldom used internally. nitric acid.--[_aqua fortis._] astringent and tonic; one to two drachms in water. used also as a caustic. nux vomica.--[seeds of _strychnos_.] in large doses, a deadly poison; in medicinal doses, a powerful tonic and anthelmintic; one half to one drachm. opium.--[_papaver somniferum._] narcotic, sedative, anodyne, stimulant, and anti-spasmodic; two to four drachms. potash, carbonate of.--[_potassæ carbonas._] antacid and diuretic; three to six drachms. potash, caustic.--[_potassa fusa._] used only as a caustic. potassa, permanganate of.--used externally as a caustic. rosin.--diuretic; two to three ounces. salt, common.--[_chloride of sodium._] irritant, cathartic, stimulant, and antiseptic; one to one and a half pounds. salts, glauber.--[_sulphate of soda._] cathartic and diuretic; one to one and a half pounds. saltpetre.--[_nitrate of potassa._] diuretic, febrifuge, and refrigerant; one half to one ounce. sublimate, corrosive.--[_protochloride of mercury._] seldom used internally; externally, caustic and stimulant. sulphur.--[_brimstone._] stimulant and laxative; three to four ounces. sulphuric acid.--irritant, caustic, and astringent; two to three drachms. tartar, cream of.--[_potassæ tartras._] cathartic; three to four ounces. turpentine.--stimulant, anthelmintic, diuretic, and laxative; one to two ounces. zinc, sulphate of.--[_white vitriol._] astringent and tonic; one to two drachms. new and late books furnished by the publishers of this volume. mailing notice.--_any 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or, sketches of border life. feats of hero hunters and thrilling exploits among the indians; furnishing the names of hunters well known in western history, and showing the most exciting drama of border warfare, and, as a whole, the most intensely interesting and instructive work upon indian life now offered the public. by henry c. watson. with engravings. cloth. $ . thrilling adventures among the early settlers. a series of desperate encounters with indians, daring exploits of texan rangers, incidents of guerilla warfare, fearful deeds of desperadoes and regulators of the west, and graphic delineations of hunting and trapping well worthy universal preservation. by warren wildwood, esq. more than engravings. cloth. $ . thrilling incidents in american history. events which are among the most striking and important in our national annals, covering the revolution, the french war, the tripolitan war, the indian wars, the war of , and the mexican war--all of which are of great usefulness to the student and general reader. by the author of "the army and navy of the united states." with three hundred illustrations. cloth. $ . scouting expeditions of the texan rangers. operations which occurred during some of the prominent events of the mexican war, together with sketches of the celebrated partisan chiefs, hays, mcculloch, and walker, whose courage, sagacity, and remarkable exploits should be familiar to all americans. by samuel c. reid, jr., late of the texan rangers, and member of the louisiana bar. with illustrations. cloth. $ . the battle-fields of the revolution. the most brilliant points in the history of the revolutionary war, recounting the principal battles, sieges, and other important events--the whole interspersed with numerous characteristic anecdotes. by thomas y. rhoads. with many illustrations. cloth. $ . thrilling adventures among the indians. in which are enumerated the most remarkable incidents of the early indian wars, which abound in dangers, vindictiveness, endurance, heroism, gratitude, treachery, stoicism, and revenge, and in which there is much to fascinate the reader, and store the inquiring mind. by john frost, ll. d. with more than illustrations. cloth. $ . the hero girl, and how she became a captain in the army. the highly dramatic story of molly pitcher who, having lost her husband at the battle of monmouth, gallantly stepped forward, took his place at the cannon, and continued serving it until the battle ended--after which the rank of captain was conferred on her by gen. washington. by thrace talmon. with illustrations. cloth. $ . mrs. partington's knitting work, and what was done by her plaguy boy ike. in which all will see the acid and sugar, and spirit and water--forming an intellectual punch, of which all can partake without headache or heartache. wrought by the old lady herself. with characteristic illustrations, including a portrait of the old lady in specs, surrounded by the partington family. cloth. $ . way down east; or, portraitures of yankee life. embodying some of the raciest stories of the "down easter" ever published by this humorous author--containing much of genuine wit and attractive thought. by seba smith, the original major jack downing. with several rich and original illustrations. cloth. $ . * * * * * transcriber's note: summarized here are the corrections applied to the text. list of illustrations: "frolicksome" was spelled "frolicsome" as opposed to the illustration in color, the pure ayrshires are generally red "ayrshires" was printed as "aryshires" some packers put meat in a copper which is rendered air-tight "meat" was printed as "meal" the principal substances of which _glue_ is made "substances" was printed as "subtances" degeneracy of acute into chronic dysentery "disentery" was printed as "dystentery" it most frequently occurs in dry, hot weather. "frequently" was printed as "freqently" acquired additional deleterious agency "acquired" was printed as "accquired" and have found the spur in the hay wherever the disease is found. "disease" was printed as "diesase" differing from like phenomena by other causes "phenomena" was printed as "phenonema" until this singular phenomenon is clearly accounted for "phenomenon" was printed as "phenonemon" embryotomy was in this instance employed "embryotomy" was printed as "emrbyotomy" the diseased lungs sometimes attain inordinate weight. "diseased" was printed as "direased" supported by alcoholic stimulants. "alcoholic" was printed as "alcholic" when cut into, it did not present the red, mottled, organized appearance of those cases with air-tight cysts. "present" was printed as "prevent" it comprehended one of the parotid glands "comprehended" was printed as "comprehened" drawn tightly to the posterior ring, by a simple bow-knot. "knot" was printed as "not" must be supplied by alcolized water "alcolized" was printed as "alcotized" the arabian art of taming and training wild & vicious horses. by t. gilbert, bro. ramsey & co. printed and sold for the publisher by henry watkins printer, & west fifth street, cincinnati, ohio . introduction. the first domestication of the horse, one of the greatest achievements of man in the animal kingdom, was not the work of a day; but like all other great accomplishments, was brought about by a gradual process of discoveries and experiments. he first subdued the more subordinate animals, on account of their being easily caught and tamed, and used for many years the mere drudges, the ox, the ass, and the camel, instead of the fleet and elegant horse. this noble animal was the last brought into subjection, owing, perhaps, to man's limited and inaccurate knowledge of his nature, and his consequent inability to control him. this fact alone is sufficient evidence of his superiority over all other animals. man, in all his inventions and discoveries, has almost invariably commenced with some simple principle, and gradually developed it from one degree of perfection to another. the first hint that we have of the use of electricity was franklin's drawing it from the clouds with his kite. now it is the instrument of conveying thought from mind to mind, with a rapidity that surpasses time. the great propelling power that drives the wheel of the engine over our land, and ploughs the ocean with our steamers, was first discovered escaping from a tea-kettle. and so the powers of the horse, second only to the powers of steam, became known to man only as experiments, and investigation revealed them. the horse, according to the best accounts we can gather, has been the constant servant of man for nearly four thousand years, ever rewarding him with his labor and adding to his comfort in proportion to his skill and manner of using him; but being to those who govern him by brute force, and know nothing of the beauty and delight to be gained from the cultivation of his finer nature, a fretful, vicious, and often dangerous servant; whilst to the arabs, whose horse is the pride of his life, and who governs him by the law of kindness, we find him to be quite a different animal. the manner in which he is treated from a foal gives him an affection and attachment for his master not known in any other country. the arab and his children, the mare and her foal, inhabit the tent together; and although the foal and the mare's neck are often pillows for the children to roll upon, no accident ever occurs, the mare being as careful of the children as of the colt. such is the mutual attachment between the horse and his master, that he will leave his companions at his master's call, ever glad to obey his voice. and when the arab falls from his horse, and is unable to rise again, he will stand by him and neigh for assistance; and if he lays down to sleep, as fatigue sometimes compels him to do in the midst of the desert, his faithful steed will watch over him, and neigh to arouse him if man or beast approaches. the arabs frequently teach their horses secret signs or signals, which they make use of on urgent occasions to call forth their utmost exertions. these are more efficient than the barbarous mode of urging them on with the spur and whip, a forcible illustration of which will be found in the following anecdote. a bedouin, named jabal, possessed a mare of great celebrity. hassad pacha, then governor of damascus, wished to buy the animal, and repeatedly made the owner the most liberal offers, which jabal steadily refused. the pacha then had recourse to threats, but with no better success. at length, one gafar, a bedouin of another tribe, presented himself to the pacha, and asked what he would give the man who should make him master of jabal's mare? "i will fill his horse's nose-bag with gold," replied hassad. the result of this interview having gone abroad; jabal became more watchful than ever, and always secured his mare at night with an iron chain, one end of which was fastened to her hind fetlock, whilst the other, after passing through the tent cloth, was attached to a picket driven in the ground under the felt that served himself and wife for a bed. but one midnight, gafar crept silently into the tent, and succeeded in loosening the chain. just before starting off with his prize, he caught up jabal's lance, and poking him with the butt end, cried out: "i am gafar! i have stolen your noble mare, and will give you notice in time." this warning was in accordance with the customs of the desert; for to rob a hostile tribe is considered an honorable exploit, and the man who accomplishes it is desirous of all the glory that may flow from the deed. poor jabal, when he heard the words, rushed out of the tent and gave the alarm, then mounting his brother's mare, accompanied by some of his tribe, he pursued the robber for four hours. the brother's mare was of the same stock as jabal's but was not equal to her; nevertheless, he outstripped those of all the other pursuers, and was even on the point of overtaking the robber, when jabal shouted to him: "pinch her right ear and give her a touch of the heel." gafar did so, and away went the mare like lightning, speedily rendering further pursuit hopeless. the _pinch in the ear_ and the _touch with the heel_ were the secret signs by which jabal had been used to urge his mare to her utmost speed. jabal's companions were amazed and indignant at his strange conduct. "o thou father of a jackass!" they cried, "thou hast helped the thief to rob thee of thy jewel." but he silenced their upbraidings by saying: "i would rather lose her than sully her reputation. would you have me suffer it to be said among the tribes that another mare had proved fleeter than mine? i have at least this comfort left me, that i can say she never met with her match." different countries have their different modes of horsemanship, but amongst all of them its first practice was carried on in but a rude and indifferent way, being hardly a stepping stone to the comfort and delight gained from the use of the horse at the present day. the polished greeks as well as the ruder nations of northern africa, for a long while rode without either saddle or bridle, guiding their horses, with the voice or the hand, or with a light switch with which they touched the animal on the side of the face to make him turn in the opposite direction. they urged him forward by a touch of the heel, and stopped him by catching him by the muzzle. bridles and bits were at length introduced, but many centuries elapsed before anything that could be called a saddle was used. instead of these, cloths, single or padded, and skins of wild beasts, often richly adorned, were placed beneath the rider, but always without stirrups; and it is given as an extraordinary fact, that the romans even in the times when luxury was carried to excess amongst them, never desired so simple an expedient for assisting the horseman to mount, to lessen his fatigue and aid him in sitting more securely in his saddle. ancient sculptors prove that the horsemen of almost every country were accustomed to mount their horses from the right side of the animal, that they might the better grasp the mane, which hangs on that side, a practice universally changed in modern times. the ancients generally leaped on their horse's backs, though they sometimes carried a spear, with a loop or projection about two feet from the bottom which served them as a step. in greece and rome, the local magistracy were bound to see that blocks for mounting (what the scotch call _loupin_-on-stanes) were placed along the road at convenient distances. the great, however, thought it more dignified to mount their horses by stepping on the bent backs of their servants or slaves, and many who could not command such costly help used to carry a light ladder about with them. the first distinct notice that we have of the use of the saddle occurs in the edict of the emperor theodosias, (a.d. ) from which we also learn that it was usual for those who hired post-horses, to provide their own saddle, and that the saddle should not weigh more than sixty pounds, a cumbrous contrivance, more like the howdahs placed on the backs of elephants than the light and elegant saddle of modern times. side-saddles for ladies are an invention of comparatively recent date. the first seen in england was made for anne of bohemia, wife of richard the second, and was probably more like a pillion than the side-saddle of the present day. a pillion is a sort of a very low-backed arm-chair, and was fastened on the horse's croup, behind the saddle, on which a man rode who had all the care of managing the horse, while the lady sat at her ease, supporting herself by grasping a belt which he wore, or passing her arm around his body, if the _gentleman was not too ticklish_. but the mexicans manage these things with more gallantry than the ancients did. the "pisanna," or country lady, we are told is often seen mounted before her "cavalera," who take the more natural position of being seated behind his fair one, supporting her by throwing his arm around her waist, (a very appropriate support if the bent position of the arm does not cause an occasional contraction of the muscles.) these two positions may justly be considered as the first steps taken by the ladies towards their improved and elegant mode of riding at the present day. at an early period when the diversion of hawking was prevalent, they dressed themselves in the costume of the knight, and rode astride. horses were in general use for many centuries before anything like a protection for the hoof was thought of, and it was introduced, at first, as a matter of course, on a very simple scale. the first foot defense, it is said, which was given to the horse, was on the same principle as that worn by man, which was a sort of sandal, made of leather and tied to the horse's foot, by means of straps or strings. and finally plates of metal were fastened to the horse's feet by the same simple means. here again, as in the case of the sturrupless saddle, when we reflect that men should, for nearly a thousand years, have gone on fastening plates of metal under horses' hoofs by the clumsy means of straps and strings, without its ever occurring to them to try so simple an improvement as nails, we have another remarkable demonstration of the slow steps by which horsemanship has reached its present state. in the forgoing remarks i have taken the liberty of extracting several facts from a valuable little work by rolla springfield. with this short comment on the rise and progress of horsemanship, from its commencement up to the present time, i will proceed to give you the principles of a new theory of taming wild horses, which is the result of many experiments and a thorough investigation and trial of the different methods of horsemanship now in use. the three fundamental principles of my theory founded on the leading characteristics of the horse. first.--that he is so constituted by nature that he will not offer resistance to any demand made of him which he fully comprehends, if made in a way consistent with the laws of his nature. second.--that he has no consciousness of his strength beyond his experience, and can be handled according to our will, without force. third.--that we can, in compliance with the laws of his nature by which he examines all things new to him, take any object, however frightful, around, over or on him, that does not inflict pain, without causing him to fear. to take these assertions in order, i will first give you some of the reasons why i think he is naturally obedient, and will not offer resistance to anything fully comprehended. the horse, though possessed of some faculties superior to man's being deficient in reasoning powers, has no knowledge of right or wrong, of free will and independent government, and knows not of any imposition practiced upon him, however unreasonable these impositions may be. consequently, he cannot come to any decision what he should or should not do, because he has not the reasoning faculties of man to argue the justice of the thing demanded of him. if he had, taking into consideration his superior strength, he would be useless to man as a servant. give him _mind_ in proportion to his strength, and he will demand of us the green fields for an inheritance, where he will roam at leisure, denying the right of servitude at all. god has wisely formed his nature so that it can be operated upon by the knowledge of man according to the dictates of his will, and he might well be termed an unconscious, submissive servant. this truth we can see verified in every day's experience by the abuses practiced upon him. any one who chooses to be so cruel, can mount the noble steed and run him 'till he drops with fatigue, or, as is often the case with more spirited, fall dead with the rider. if he had the power to reason, would he not vault and pitch his rider, rather than suffer him to run him to death? or would he condescend to carry at all the vain imposter, who, with but equal intellect, was trying to impose on his equal rights and equally independent spirit? but happily for us, he has no consciousness of imposition, no thought of disobedience except by impulse caused by the violation of the law of nature. consequently when disobedient it is the fault of man. then, we can but come to the conclusion, that if a horse is not taken in a way at variance with the law of his nature, he will do anything that he fully comprehends without making any offer of resistance. _second._ the fact of the horse being unconscious of the amount of his strength, can be proven to the satisfaction of any one. for instance, such remarks as these are common, and perhaps familiar to your recollection. one person says to another, "if that wild horse there was conscious of the amount of his strength, his owner could have no business with him in that vehicle; such light reins and harness, too; if he knew he could snap them asunder in a minute and be as free as the air we breathe;" and, "that horse yonder that is pawing and fretting to follow the company that is fast leaving him, if he knew his strength he would not remain long fastened to that hitching post so much against his will, by a strap that would no more resist his powerful weight and strength, than a cotton thread would bind a strong man." yet these facts made common by every day occurrence, are not thought of as anything wonderful. like the ignorant man who looks at the different phases of the moon, you look at these things as he looks at her different changes, without troubling your mind with the question, "why are these things so?" what would be the condition of the world if all our minds lay dormant? if men did not think, reason and act, our undisturbed, slumbering intellects would not excel the imbecility of the brute; we would live in chaos, hardly aware of our existence. and yet with all our activity of mind, we daily pass by unobserved that which would be wonderful if philosophised and reasoned upon, and with the same inconsistency wonder at that which a little consideration, reason and philosophy would be but a simple affair. _thirdly._ he will allow any object, however frightful in appearance, to come around, over or on him, that does not inflict pain. we know from a natural course of reasoning, that there has never been an effected without a cause, and we infer from this, that there can be no action, either in animate or inanimate matter, without there first being some cause to produce it. and from this self-evident fact we know that there is some cause for every impulse or movement of either mind or matter, and that this law governs every action or movement of the animal kingdom. then, according to this theory, there must be some cause before fear can exist; and, if fear exists from the effect of imagination, and not from the infliction of real pain, it can be removed by complying with those laws of nature by which the horse examines an object, and determines upon its innocence or harm. a log or stump by the road-side may be, in the imagination of the horse, some great beast about to pounce upon him; but after you take him up to it and let him stand by it a little while, and touch it with his nose, and go through his process of examination, he will not care any thing more about it. and the same principle and process will have the same effect with any other object, however frightful in appearance, in which there is no harm. take a boy that has been frightened by a false-face or any other object that he could not comprehend at once; but let him take that face or object in his hands and examine it, and he will not care anything more about it. this is a demonstration of the same principle. with this introduction to the principles of my theory, i shall next attempt to teach you how to put it into practice, and whatever instructions may follow, you can rely on as having been proven practical by my own experiments. and knowing from experience just what obstacles i have met with in handling bad horses, i shall try to anticipate them for you, and assist you in surmounting them, by commencing with the first steps taken with the colt, and accompanying you through the whole task of breaking. how to succeed in getting the colt from pasture. go to the pasture and walk around the whole herd quietly, and at such a distance as not to cause them to scare and run. then approach them very slowly, and if they stick up their heads and seem to be frightened, hold on until they become quiet, so as not to make them run before you are close enough to drive them in the direction you want to go. and when you begin to drive, do not flourish your arms or hollow, but gently follow them off leaving the direction free for them that you wish them to take. thus taking advantage of their ignorance, you will be able to get them in the pound as easily as the hunter drives the quails into his net. for, if they have always run into the pasture uncared for, (as many horses do in prairie countries and on large plantations,) there is no reason why they should not be as wild as the sportsman's birds and require the same gentle treatment, if you want to get them without trouble; for the horse in his natural state is as wild as any of the undomesticated animals, though more easily tamed than most of them. how to stable a colt without trouble. the next step will be, to get the horse into a stable or shed. this should be done as quietly as possible, so as not to excite any suspicion in the horse of any danger befalling him. the best way to do this, is to lead a gentle horse into the stable first and hitch him, then quietly walk around the colt and let him go in of his own accord. it is almost impossible to get men, who have never practiced on this principle, to go slow and considerate enough about it. they do not know that in handling a wild horse, above all other things, is that good old adage true, that "haste makes waste;" that is, waste of time, for the gain of trouble and perplexity. one wrong move may frighten your horse, and make him think it is necessary to escape at all hazards for the safety of his life, and thus make two hours work of a ten minutes job; and this would be all your own fault, and entirely unnecessary; for he will not run unless you run after him, and that would not be good policy, unless you knew that you could outrun him; or you will have to let him stop of his own accord after all. but he will not try to break away, unless you attempt to force him into measures. if he does not see the way at once, and is a little fretful about going in, do not undertake to drive him, but give him a little less room outside, by gently closing in around him. do not raise your arms, but let them hang at your side; for you might as well raise a club. the horse has never studied anatomy, and does not know but they will unhinge themselves and fly at him. it he attempts to turn back, walk before him, but do not run; and if he gets past you, encircle him again in the same quiet manner, and he will soon find that you are not going to hurt him; and you can soon walk so close around him that he will go into the stable for more room, and to get farther from you. as soon as he is in, remove the quiet horse and shut the door. this will be his first notion of confinement--not knowing how to get in such a place, nor how to get out of it. that he may take it as quietly as possible, see that the shed is entirely free from dogs, chickens, or anything that would annoy him; then give him a few ears of corn, and let him remain alone fifteen or twenty minutes, until he has examined his apartment, and has become reconciled to his confinement. time to reflect. and now, while your horse is eating those few ears of corn, is the proper time to see that your halter is ready and all right, and to reflect on the best mode of operations; for, in the horsebreaking, it is highly important that you should be governed by some system. and you should know before you attempt to do anything, just what you are going to do, and how you are going to do it. and, if you are experienced in the art of taming wild horses, you ought to be able to tell within a few minutes the length of time it would take you to halter the colt, and learn him to lead. the kind of halter. always use a leather halter, and be sure to have it made so that it will not draw tight around his nose if he pulls on it. it should be of the right size to fit his head easily and nicely; so that the nose band will not be too tight or too low. never put a rope halter on an unbroken colt under any circumstances whatever. they have caused more horses to hurt or kill themselves, than would pay for twice the cost of all the leather halters that have ever been needed for the purpose of haltering colts. it is almost impossible to break a colt that is very wild with a rope halter, without having him pull, rear and throw himself, and thus endanger his life; and i will tell you why. it is just as natural for a horse to try to get his head out of anything that hurts it, or feels unpleasant, as it would be for you to try to get your hand out of a fire. the cords of the rope are hard and cutting; this makes him raise his head and draw on it, and as soon as he pulls, the slip noose (the way rope halters are always made) tightens, and pinches his nose, and then he will struggle for life, until, perchance, he throws himself; and who would have his horse throw himself, and run the risk of breaking his neck, rather than pay the price of a leather halter. but this is not the worst. a horse that has once pulled on his halter, can never be as well broke as one that has never pulled at all. remarks on the horse. but before we attempt to do anything more with the colt, i will give you some of the characteristics of his nature, that you may better understand his motions. every one that has ever paid any attention to the horse, has noticed his natural inclination to smell of everything which to him looks new and frightful. this is their strange mode of examining everything. and, when they are frightened at anything, though they look at it sharply, they seem to have no confidence in this optical examination alone, but must touch it with the nose before they are entirely satisfied; and, as soon as this is done, all is right. experiments with the robe. if you want to satisfy yourself of this characteristic of the horse, and learn something of importance concerning the peculiarities of his nature, etc., turn him into the barn-yard, or a large stable will do, and then gather up something that you know will frighten him; a red blanket, buffalo robe, or something of that kind. hold it up so that he can see it; he will stick up his head and snort. then throw it down somewhere in the center of the lot or barn, and walk off to one side. watch his motions, and study his nature. if he is frightened at the object, he will not rest until he has touched it with his nose. you will see him begin to walk around the robe and snort, all the time getting a little closer, as if drawn up by some magic spell, until he finally gets within reach of it. he will then very cautiously stretch out his neck as far as he can reach, merely touching it with his nose, as though he thought it was ready to fly at him. but after he has repeated these touches a few times, for the first (though he has been looking at it all the time) he seems to have an idea what it is. but now he has found, by the sense of feeling, that it is nothing that will do him any harm, and he is ready to play with it. and if you watch him closely, you will see him take hold of it with his teeth, and raise it up and pull at it. and in a few minutes you can see that he has not that same wild look about his eye, but stands like a horse biting at some familiar stump. yet the horse is never well satisfied when he is about anything that has frightened him, as when he is standing with his nose to it. and, in nine cases out of ten, you will see some of that same wild look about him again, as he turns to walk from it. and you will, probably, see him looking back very suspiciously as he walks away, as though he thought it might come after him yet. and, in all probability, he will have to go back and make another examination before he is satisfied. but he will familiarize himself with it, and, if he should run in that lot a few days, the robe that frightened him so much at first, will be no more to him than a familiar stump. suppositions on the sense of smelling. we might very naturally suppose, from the fact of the horse's applying his nose to every thing new to him, that he always does so for the purpose of smelling these objects. but i believe that it is as much or more for the purpose of feeling; and that he makes use of his nose or muzzle, (as it is sometimes called.) as we would of our hands; because it is the only organ by which he can touch or feel anything with much susceptibility. i believe that he invariably makes use of the four senses, seeing, hearing, smelling and feeling, in all of his examinations, of which the sense of feeling is, perhaps, the most important. and i think that in the experiment with the robe, his gradual approach and final touch with his nose was as much for the purpose of feeling, as anything else, his sense of smell being so keen, that it would not be necessary for him to touch his nose against anything in order to get the proper scent; for it is said that a horse can smell a man the distance of a mile. and, if the scent of the robe was all that was necessary, he could get that several rods off. but, we know from experience, that if a horse sees and smells a robe a short distance from him, he is very much frightened, (unless he is used to it,) until he touches or feels it with his nose; which is a positive proof that feeling is the controlling sense in this case. prevailing opinion of horsemen. it is a prevailing opinion among horsemen generally, that the sense of smell is the governing sense of the horse. and faucher, as well as others, have, with that view, got up receipts of strong smelling oils, etc., to tame the horse, sometimes using the chesnut of his leg, which they dry, grind into powder and blow into his nostrils. sometimes using the oil of rhodium, organnnum, etc.; that are noted for their strong smell. and sometimes they scent the hands with the sweat from under the arm, or blow their breath into his nostrils, etc., etc. all of which, as far as the scent goes have no effect whatever in gentling the horse, or conveying any idea to his mind; though the works that accompany these efforts--handling him, touching him about the nose and head, and patting him, as they direct you should, after administering the articles, may have a very great effect, which they mistake to be the effect of the ingredients used. and faucher, in his work entitled, "the arabian art of taming horses," page , tells us how to accustom a horse to a robe, by administering certain articles to his nose; and goes on to say, that these articles must first be applied to the horse's nose before you attempt to break him, in order to operate successfully. now, reader, can you, or any one else, give one single reason how scent can convey any idea to the horse's mind of what we want him to do? if not, then of course strong scents of any kind are of no account in taming the unbroken horse. for every thing that we get him to do of his own accord, without force, must be accomplished by some means of conveying our ideas to his mind. i say to my horse "go 'long" and he goes; "ho!" and he stops: because these two words, of which he has learned the meaning by the tap of the whip, and the pull of the rein that first accompanied them, convey the two ideas to his mind of go and stop. faucher, or no one else, can ever learn the horse a single thing by the means of a scent alone. how long do you suppose a horse would have to stand and smell of a bottle of oil before he would learn to bend his knee and make a bow at your bidding, "go yonder and bring your hat," or "come here and lay down?" thus you see the absurdity of trying to break or tame the horse by the means of receipts for articles to smell of, or medicine to give him, of any kind whatever. the only science that has ever existed in the world, relative to the breaking of horses, that has been of any account, is that true method which takes them in their native state, and improves their intelligence. powel's system of approaching the colt. but, before we go further, i will give you willis j. powel's system of approaching a wild colt, as given by him in a work published in europe, about the year , on the "art of taming wild horses." he says, "a horse is gentled by my secret, in from two to sixteen hours." the time i have most commonly employed has been from four to six hours. he goes on to say: "cause your horse to be put in a small yard, stable, or room. if in a stable or room, it ought to be large in order to give him some exercise with the halter before you lead him out. if the horse belong to that class which appears only to fear man, you must introduce yourself gently into the stable, room, or yard, where the horse is. he will naturally run from you, and frequently turn his head from you; but you must walk about extremely slow and softly, so that he can see you whenever he turns his head towards you, which he never fails to do in a short time, say in a quarter of an hour. i never knew one to be much longer without turning towards me. "at the very moment he turns his head, hold out your left hand towards him, and stand perfectly still, keeping your eyes upon the horse, watching his motions if he makes any. if the horse does not stir for ten or fifteen minutes, advance as slowly as possible, and without making the least noise, always holding out your left hand, without any other ingredient in it than that what nature put in it." he says, "i have made use of certain, ingredients before people, such as the sweat under my arm, etc., to disguise the real secret, and many believed that the docility to which the horse arrived in so short a time, was owing to these ingredients; but you see from this explanation that they were of no use whatever. the implicit faith placed in these ingredients, though innocent of themselves, becomes 'faith without works.' and thus men remained always in doubt concerning this secret. if the horse makes the least motion when you advance toward him, stop, and remain perfectly still until he is quiet. remain a few moments in this condition, and then advance again in the same slow and imperceptible manner. take notice: if the horse stirs, stop without changing your position. it is very uncommon for the horse to stir more than once after you begin to advance, yet there are exceptions. he generally keeps his eyes steadfast on you, until you get near enough to touch him on the forehead. when you are thus near to him, raise slowly, and by degrees, your hand, and let it come in contact with that part just above the nostrils as lightly as possible. if the horse flinches, (as many will,) repeat with great rapidity these light strokes upon the forehead, going a little further up towards his ears by degrees, and descending with the same rapidity until he will let you handle his forehead all over. now let the strokes be repeated with more force over all his forehead, descending by lighter strokes to each side of his head, until you can handle that part with equal facility. then touch in the same light manner, making your hands and fingers play around the lower part of the horse's ears, coming down now and then to his forehead, which may be looked upon as the helm that governs all the rest. "having succeeded in handling his ears, advance towards the neck, with the same precautions, and in the same manner; observing always to augment the force of the strokes whenever the horse will permit it. perform the same on both sides of the neck, until he lets you take it in your arms without flinching. "proceed in the same progressive manner to the sides, and then to the back of the horse. every time the horse shows any nervousness return immediately to the forehead as the true standard, patting him with your hands, and from thence rapidly to where you had already arrived, always gaining ground a considerable distance farther on every time this happens. the head, ears, neck and body being thus gentled, proceed from the back to the root of the tail. "this must be managed with dexterity, as a horse is never to be depended on that is skittish about the tail. let your hand fall lightly and rapidly on that part next to the body a minute or two, and then you will begin to give it a slight pull upwards every quarter of a minute. at the same time you continue this handling of him, augment the force of the strokes, as well as the raising of the tail, until you can raise it and handle it with the greatest ease, which commonly happens in a quarter of an hour in most horses; in others almost immediately, and in some much longer. it now remains to handle all his legs. from the tail come back again to the head, handle it well, as likewise the ears, breast, neck, etc., speaking now and then to the horse. begin by degrees to descend to the legs, always ascending and descending, gaining ground every time you descend until you get to his feet. "talk to the horse in latin, greek, french, english, or spanish, or in any other language you please; but let him hear the sound of your voice, which at the beginning of the operation is not quite so necessary, but which i have always done in making him lift up his feet. hold up your foot--'live la pied'--'alza el pie'--'aron ton poda,' etc., at the same time lift his foot with your hand. he soon becomes familiar with the sounds, and will hold his foot up at command. then proceed to the hind feet and go on in the same manner, and in a short time the horse will let you lift them and even take them up in your arms. "all this operation is no magnetism, no galvanism; it is merely taking away the fear a horse generally has of a man, and familiarizing the animal with his master; as the horse doubtless experiences a certain pleasure from this handling, he will soon become gentle under it, and show a very marked attachment to his keeper." remarks on powel's treatment how to govern horses of any kind. these instructions are very good, but not quite sufficient for horses of all kinds, and for haltering and leading the colt; but i have inserted it here, because it gives some of the true philosophy of approaching the horse, and of establishing confidence between man and horse. he speaks only of the kind that fear man. to those who understand the philosophy of horsemanship, these are the easiest trained; for when we have a horse that is wild and lively, we can train him to our will in a very short time; for they are generally quick to learn, and always ready to obey. but there is another kind that are of a stubborn or vicious disposition, and, although they are not wild, and do not require taming, in the sense it is generally understood, they are just as ignorant as a wild horse, if not more so, and need to be learned just as much; and in order to have them obey quickly, it is very necessary that they should be made to fear their masters; for, in order to obtain perfect obedience from any horse, we must first have him fear us, for our motto is _fear, love, and obey_; and we must have the fulfilment of the first two before we can expect the latter, and it is by our philosophy of creating fear, love and confidence, that we govern to our will every kind of a horse whatever. then, in order to take horses as we find them, or all kinds, and to train them to our likings, we will always take with us, when we go into a stable to train a colt, a long switch whip, (whale-bone buggy whips is the best,) with a good silk cracker, so as to cut keen and make a sharp report, which, if handled with dexterity, and rightly applied, accompanied with a sharp, fierce word, will be sufficient to enliven the spirits of any horse. with this whip in your right hand, with the lash pointing backward, enter the stable alone. it is a great disadvantage in training a horse, to have any one in the stable with you; you should be entirely alone, so as not to have nothing but yourself to attract his attention. if he is wild you will soon see him in the opposite side of the stable from you; and now is the time to use a little judgement. i would not want for myself, more than half or three-quarters of an hour to handle any kind of a colt, and have him running about in the stable after me; though i would advise a new beginner to take more time, and not to be in too much of a hurry. if you have but one colt to gentle, and are not particular about the length of time you spend, and have not had any experience in handling colts, i would advise you to take mr. powel's method at first, till you gentle him, which he says takes from two to six hours. but, as i want to accomplish the same, and what is much more, learn the horse to lead in less than one hour, i shall give you a much quicker process of accomplishing the same end. accordingly, when you have entered the stable, stand still and let your horse look at you a minute or two, and as soon as he is settled in one place, approach him slowly, with both arms stationary, your right hanging by your side, holding the whip as directed, and the left bent at the elbow, with your hand projecting. as you approach him, go not too much towards his head or croop, so as not to make him move either forward or backward, thus keeping your horse stationary, if he does move a little forward or backward, step a little to the right or left very cautiously; this will keep him in one place, as you get very near him, draw a little to his shoulder, and stop a few seconds. if you are in his reach he will turn his head and smell at your hand, not that he has any preference for your hand, but because that it is projecting, and is the nearest portion of your body to the horse. this all colts will do, and they will smell of your naked hand just as quick as they will of any thing that you can put in it, and with just as good an effect, however much some men have preached the doctrine of taming horses by giving them the scent articles from the hand. i have already proved that to be a mistake. as soon as he touches his nose to your hand, caress him as before directed, always using a very light, soft hand, merely touching the horse, all ways rubbing the way the hair lays, so that your hand will pass along as smoothly as possible. as you stand by his side you may find it more convenient to rub his neck or the side of his head, which will answer the same purpose, as rubbing his forehead. favor every inclination of the horse to smell or touch you with his nose. always follow each touch or communication of this kind with the most tender and affectionate caresses, accompanied with a kind look, and pleasant word of some sort, such as: ho! my little boy, ho! my little boy, pretty boy, nice lady! or something of that kind, constantly repeating the same words, with the same kind, steady tone of voice; for the horse soon learns to read the expression of the face and voice, and will know as well when fear, love or anger, prevails as you know your own feelings; two of which, _fear and anger_, a good horseman _should never feel_. how to proceed if your horse is of a stubborn disposition. if your horse, instead of being wild, seems to be of a stubborn or _mulish_ disposition; if he lays back his ears as you approach him, or turns his heels to kick you, he has not that regard or fear of man that he should have, to enable you to handle him quickly and easily; and it might be well to give him a few sharp cuts with the whip, about the legs, pretty close to the body. it will crack keen as it plies around his legs, and the crack of the whip will affect him as much as the stroke; besides one sharp cut about his legs will affect him more than two or three over his back, the skin on the inner part of his legs or about his flank being thinner, more tender than on his back. but do not whip him much, just enough to scare him, it is not because we want to hurt the horse that we whip him, we only do it to scare that bad disposition out of him. but whatever you do, do quickly, sharply and with a good deal of fire, but always without anger. if you are going to scare him at all you must do it at once. never go into a pitch battle with your horse, and whip him until he is mad and will fight you; you had better not touch him at all, for you will establish, instead of fear and regard, feelings of resentment, hatred and ill-will. it will do him no good but an injury, to strike a blow, unless you can scare him; but if you succeed in scaring him, you can whip him without making him mad; for fear and anger never exist together in the horse, and as soon as one is visible, you will find that the other has disappeared. as soon as you have frightened him so that he will stand up straight and pay some attention to you, approach him again and caress him a good deal more than you whipped him, then you will excite the two controlling passions of his nature, love and fear, and then he will fear and love you too, and as soon as he learns what to do will quickly obey. how to halter and lead the colt. as soon as you have gentled the colt a little, take the halter in your left hand and approach him as before, and on the same side that you have gentled him. if he is very timid about your approaching closely to him, you can get up to him quicker by making the whip a part of your arm, and reaching out very gently with the but end of it, rubbing him lightly on the neck, all the time getting a little closer, shortening the whip by taking it up in your hand, until you finally get close enough to put your hands on him. if he is inclined to hold his head from you, put the end of the halter strap around his neck, drop your whip, and draw very gently; he will let his neck give, and you can pull his head to you. then take hold of that part of the halter, which buckles over the top of his head, and pass the long side, or that part which goes into the buckle, under his neck, grasping it on the opposite side with your right hand, letting the first strap loose--the latter will be sufficient to hold his head to you. lower the halter a little, just enough to get his nose into that part which goes around it, then raise it somewhat, and fasten the top buckle, and you will have it all right. the first time you halter a colt you should stand on the left side, pretty well back to his shoulder only taking hold of that part of the halter that goes around his neck, then with your hands about his neck you can hold his head to you, and raise the halter on it without making him dodge by putting your hands about his nose. you should have a long rope or strap ready, and as soon as you have the halter on, attach this to it, so that you can let him walk the length of the stable without letting go of the strap, or without making him pull on the halter, for if you only let him feel the weight of your hand on the halter, and give him rope when he runs from you, he will never rear, pull, or throw himself, yet you will be holding him all the time, and doing more towards gentling him, than if you had the power to snub him right up, and hold him to one spot; because, he does not know any thing about his strength, and if you don't do any thing to make him pull, he will never know that he can. in a few minutes you can begin to control him with the halter, then shorten the distance between yourself and the horse, by taking up the strap in your hand. as soon as he will allow you to hold him by a tolerably short strap, and step up to him without flying back, you can begin to give him some idea about leading. but to do this, do not go before and attempt to pull him after you, but commence by pulling him very quietly to one side. he has nothing to brace either side of his neck, and will soon yield to a steady, gradual pull of the halter; and as soon as you have pulled him a step or two to one side, step up to him and caress him, and then pull him again, repeating this operation until you can pull him around in every direction, and walk about the stable with him, which you can do in a few minutes, for he will soon think when you have made him step to the right or left a few times, that he is compelled to follow the pull of the halter, not knowing that he has the power to resist your pulling; besides, you have handled him so gently, that he is not afraid of you, and you always caress him when he comes up to you, and he likes that, and would just as leave follow you as not. and after he has had a few lessons of that kind, if you turn him out in a lot he will come up to you every opportunity he gets. you should lead him about in the stable some time before you take him out, opening the door, so that he can see out, leading him up to it and back again, and past it. see that there is nothing on the outside to make him jump, when you take him out, and as you go out with him, try to make him go very slowly, catching hold of the halter close to the jaw, with your left hand, while the right is resting on the top of the neck, holding to his mane. after you are out with him a little while, you can lead him about as you please. don't let any second person come up to you when you first take him out; a stranger taking hold of the halter would frighten him, and make him run. there should not even be any one standing near him to attract his attention, or scare him. if you are alone, and manage him right, it will not require any more force to lead or hold him than it would to manage a broke horse. how to lead a colt by the side of a broken horse. if you should want to lead your colt by the side of another horse, as is often the case, i would advise you to take your horse into the stable, attach a second strap to the colt's halter, and lead your horse up alongside of him. then get on the broke horse and take one strap around his breast, under his martingale, (if he has any on,) holding it in your left hand. this will prevent the colt from getting back too far; besides, you will have more power to hold him, with the strap pulling against the horse's breast. the other strap take up in your right hand to prevent him from running ahead; then turn him about a few times in the stable, and if the door is wide enough, ride out with him in that position; if not, take the broke horse out first, and stand his breast up against the door, then lead the colt to the same spot, and take the straps as before directed, one on each side of his neck, then let some one start the colt out, and as he comes out, turn your horse to the left, and you will have them all right. this is the best way to lead a colt; you can manage any kind of a colt in this way, without any trouble; for, if he tries to run ahead, or pull back, the two straps will bring the horses facing each other, so that you can easily follow up his movements without doing much holding, and as soon as he stops running backward you are right with him, and all ready to go ahead. and if he gets stubborn and does not want to go, you can remove all his stubbornness by riding your horse against his neck, thus compelling him to turn to the right, and as soon as you have turned him about a few times, he will be willing to go along. the next thing, after you are through leading him, will be to take him into a stable, and hitch him in such a way as not to have him pull on the halter, and as they are often troublesome to get into a stable the first few times, i will give you some instructions about getting him in. how to lead a colt into the stable and hitch him without having him pull on the halter. you should lead the broke horse into the stable first, and get the colt, if you can, to follow in after him. if he refuses to go, step up to him, taking a little stick or switch in your right hand; then take hold of the halter close to his head with your left hand, at the same time reaching over his back with your right arm so that you can tap him on the opposite side with your switch; bring him up facing the door, tap him lightly with your switch, reaching as far back with it as you can. this tapping, by being pretty well back, and on the opposite side, will drive him ahead, and keep him close to you, then by giving him the right direction with your left hand you can walk into the stable with him. i have walked colts into the stable this way, in less than a minute, after men had worked at them half an hour, trying to pull them in. if you cannot walk him it at once this way, turn him about and walk him round in every direction, until you can get him up to the door without pulling at him. then let him stand a few minutes, keeping his head in the right direction with the halter, and he will walk in, in less than ten minutes. never attempt to pull the colt into the stable; that would make him think at once that it was a dangerous place, and if he was not afraid of it before, he would be then. besides we don't want him to know anything about pulling on the halter. colts are often hurt, and sometimes killed, by trying to force them into the stable; and those who attempt to do it in that way, go into an up-hill business, when a plain smooth road is before them. if you want to hitch your colt, put him in a tolerably wide stall which should not be too long, and should be connected by a bar or something of that kind to the partition behind it; so that, after the colt is in he cannot get far enough back to take a straight, backward pull on the halter; then by hitching him in the center of the stall, it would be impossible for him to pull on the halter, the partition behind preventing him from going back, and the halter in the center checking him every time he turns to the left or right. in a state of this kind you can break every horse to stand hitched by a light strap, any where, without his ever knowing any thing about pulling. but if you have broke your horse to lead, and have learned him the use of the halter (which you should always do before you hitch him to any thing), you can hitch him in any kind of a stall, and give him something to eat to keep him up to his place for a few minutes at first and there is not one colt in fifty that will pull on his halter. the kind of bit and how to accustom a horse to it. you should use a large, smooth, snaffle bit, so as not to hurt his mouth, with a bar to each side, to prevent the bit from pulling through either way. this you should attach to the head-stall of your bridle and put it on your colt without any reins to it, and let him run loose in a large stable or shed, some time, until he becomes a little used to the bit, and will bear it without trying to get it out of his mouth. it would be well, if convenient, to repeat this several times before you do anything more with the colt; as soon as he will bear the bit, attach a single rein to it, without any martingale. you should also have a halter on your colt, or a bridle made after the fashion of a halter, with a strap to it, so that you can hold or lead him about without pulling on the bit much. he is now ready for the saddle. how to saddle a colt. any one man, who has this theory, can put a saddle on the wildest colt that ever grew, without any help, and without scaring him. the first thing will be to tie each stirrup strap into a loose knot to make them short, and prevent the stirrups from flying about and hitting him. then double up the skirts and take the saddle under your right arm, so as not to frighten him with it as you approach. when you get to him, rub him gently a few times with your hand, and then raise the saddle very slowly until he can see it, and smell, and feel it with his nose. then let the skirts loose, and rub it very gently against his neck the way the hair lays, letting him hear the rattle of the skirts as he feels them against him; each time getting a little farther backward, and finally slip it over his shoulders on his back. shake it a little with your hand, and in less than five minutes you can rattle it about over his back as much as you please, and pull it off and throw it on again, without his paying much attention to it. as soon as you have accustomed him to the saddle, fasten the girth. be careful how you do this. it often frightens a colt when he feels the girth binding him, and making the saddle fit tight on his back. you should bring up the girth very gently, and not draw it too tight at first, just enough to hold the saddle on. move him a little, and then girth it as tight as you choose, and he will not mind it. you should see that the pad of your saddle is all right before you put it on, and that there is nothing to make it hurt him, or feel unpleasant to his back. it should not have any loose straps on the back part of it to flap about and scare him. after you have saddled him in this way, take a switch in your right hand to tap him up with, and walk about in the stable a few times with your right arm over the saddle, taking hold of the reins on each side of his neck, with your right and left hands. thus marching him about in the stable until you learn him the use of the bridle, and can turn him about in any direction, and stop him by a gentle pull of the rein. always caress him, and loose the reins a little every time you stop him. you should always be alone, and have your colt in some tight stable or shed, the first time you ride him; the loft should be high so that you can sit on his back without endangering your head. you can learn him more in two hours time in a stable of this kind, than you could in two weeks in the common way of breaking colts, out in an open place. it you follow my course of treatment, you need not run any risk, or have any trouble in riding the worst kind of a horse. you take him a step at a time, until you get up a mutual confidence and trust between yourself and horse. first learn him to lead and stand hitched, next acquaint him with the saddle, and the use of the bit; and then all that remains, is to get on him without scaring him, and you can ride him as well as any horse. how to mount the colt. first gentle him well on both sides, about the saddle, and all over, until he will stand still without holding, and is not afraid to see you any where about him. as soon as you have him thus gentled, get a small block, about one foot or eighteen inches in height, and set it down by the side of him, about where you want to stand to mount him; step up on this, raising yourself very gently; horses notice every change of position very closely, and if you were to step up suddenly on the block, it would be very apt to scare him; but by raising yourself gradually on it, he will see you, without being frightened, in a position very near the same as when you are on his back. as soon as he will bear this without alarm, untie the stirrup strap next to you, and put your left foot into the stirrup, and stand square over it, holding your knee against the horse, and your toe out, so as to touch him under the shoulder with the toe of your boot. place your right hand on the front of the saddle and on the opposite side of you. taking hold of a portion of the mane and the reins as they hang loosely over his neck with your left hand; then gradually bear your weight on the stirrup, and on your right hand, until the horse feels your whole weight on the saddle; repeat this several times, each time raising yourself a little higher from the block, until he will allow you to raise your leg over his croop, and place yourself in the saddle. there are three great advantages in having a block to mount from. first, a sudden change of position is very apt to frighten a young horse that has never been handled; he will allow you to walk up to him, and stand by his side without scaring at you, because you have gentled him to that position, but if you get down on your hands and knees and crawl towards him, he will be very much frightened, and upon the same principle, he would frighten at your new position if you had the power to hold yourself over his back without touching him. then the first great advantage of the block is to gradually gentle him to that new position in which he will see you when you ride him. secondly, by the process of leaning your weight in the stirrups, and on your hand, you can gradually accustom him to your weight, so as not to frighten him by having him feel it all at once. and in the third place the block elevates you so that you will not have to make a spring in order to get on to the horse's back, but from it you can gradually raise yourself into the saddle. when you take these precautions, there is no horse so wild, but what you can mount him without making him jump. i have tried it on the worst horses that could be found, and have never failed in any case. when mounting, your horse should always stand without being held. a horse is never well broke when he has to be held with a tight rein while mounting; and a colt is never so safe to mount, as when you see that assurance of confidence, and absence of fear, which causes him to stand without holding. how to ride the colt. when you want him to start do not touch him on the side with your heel or do anything to frighten him and make him jump. but speak to him kindly, and if he does not start pull him a little to the left until he starts, and then let him walk off slowly with the reins loose. walk him around in the stable a few times until he gets used to the bit, and you can turn him about in every direction and stop him as you please. it would be well to get on and off a good many times until he gets perfectly used to it before you take him out of the stable. after you have trained him in this way, which should not take you more than one or two hours, you can ride him any where you choose without ever having him jump or make any effort to throw you. when you first take him out of the stable be very gentle with him, as he will feel a little more at liberty to jump or run, and be a little easier frightened than he was while in the stable. but after handling him so much in the stable he will be pretty well broke, and you will be able to manage him without trouble or danger. when you first mount him take a little the shortest hold on the left rein, so that if any thing frightens him you can prevent him jumping by pulling his head around to you. this operation of pulling a horse's head around against his side will prevent any horse from jumping ahead, rearing up, or running away. if he is stubborn and will not go you can make him move by pulling his head around to one side, when whipping would have no effect. and turning him around a few times will make him dizzy, and then by letting him have his head straight, and giving him a little touch with the whip, he will go along without any trouble. never use martingales on a colt when you first ride him; every movement of the hand should go right to the bit in the direction in which it is applied to the reins, without a martingale to change the direct of the force applied. you can guide the colt much better without them, and learn him the use of the bit in much less time. besides, martingales would prevent you from pulling his head around if he should try to jump. after your colt has been rode until he is gentle and well accustomed to the bit, you may find it an advantage if he carries his head too high, or his nose too far out, to put martingales on him. you should be careful not to ride your colt so far at first as to heat, worry or tire him. get off as soon as you see he is a little fatigued; gentle him and let him rest, this will make him kind to you and prevent him from getting stubborn or mad. the proper way to bit a colt. farmers often put bitting harness on a colt the first thing they do to him, buckling up the bitting as tight as they can draw it to make him carry his head high, and then turn him out in a lot to run a half day at a time. this is one of the worst punishments that they could inflict on the colt, and very injurious to a young horse that has been used to running in pasture with his head down. i have seen colts so injured in this way that they never got over it. a horse should be well accustomed to the bit before you put on the bitting harness, and when you first bit him you should only rein his head up to that point where he naturally holds it, let that be high or low; he will soon learn that he cannot lower his head, and that raising it a little will loosen the bit in his mouth. this will give him the idea of raising his head to loosen the bit, and then you can draw the bitting a little tighter every time you put it on, and he will still raise his head to loosen it; by this means you will gradually get his head and neck in the position you want him to carry it, and give him a nice and graceful carriage without hurting him, making him mad, or causing his mouth to get sore. if you put the bitting on very tight the first time, he cannot raise his head enough to loosen it, but will bear on it all the time, and paw, sweat and throw himself. many horses have been killed by falling backward with the bitting on, their heads being drawn up, strike the ground with the whole weight of the body. horses that have their heads drawn up tightly should not have the bitting on more than fifteen or twenty minutes at a time. how to drive a horse that is very wild, and has any vicious habit take up one fore foot and bend his knee till his hoof is bottom upwards, and merely touching his body, then slip a loop over his knee, and up until it comes above the pasture joint to keep it up, being careful to draw the loop together between the hoof and pasture joint with a second strap of some kind, to prevent the loop from slipping down and coming off. this will leave the horse standing on three legs; you can now handle him as you wish, for it is utterly impossible for him to kick in this position. there is something in this operation of taking up one foot that conquers a horse quicker and better than any thing else you can do to him. there is no process in the world equal to it to break a kicking horse, for several reasons. first, there is a principle of this kind in the nature of the horse; that by conquering one member you conquer to a great extent the whole horse. you have perhaps seen men operate upon this principle by sewing a horse's ears together to prevent him from kicking. i once saw a plan given in a newspaper to make a bad horse stand to be shod, which was to fasten down one ear. there were no reasons given why you should do so; but i tried it several times, and thought it had a good effect--though i would not recommend its use, especially stitching his ears together. the only benefit arising from this process is, that by disarranging his ears we draw his attention to them, and he is not so apt to resist the shoeing. by tying up one foot we operate on the same principle to a much better effect. when you first fasten up a horse's foot he will sometimes get very mad, and strike with his knee, and try every possible way to get it down; but he cannot do that, and will soon give it up. this will conquer him better than anything you could do, and without any possible danger of hurting himself or you either, for you can tie up his foot and sit down and look at him until he gives up. when you find that he is conquered, go to him, let down his foot, rub his leg with your hand, caress him and let him rest a little, then put it up again. repeat this a few times, always putting up the same foot, and he will soon learn to travel on three legs so that you can drive him some distance. as soon as he gets a little used to this way of traveling, put on your harness and hitch him to a sulky. if he is the worst kicking horse that ever raised a foot you need not be fearful of his doing any damage while he has one foot up, for he cannot kick, neither can he run fast enough to do any harm. and if he is the wildest horse that ever had harness on, and has run away every time he has been hitched, you can now hitch him in a sulky and drive him as you please. and if he wants to run you can let him have the lines, and the whip too, with perfect safety, for he cannot go but a slow gait on three legs, and will soon be tired and willing to stop; only hold him enough to guide him in the right direction, and he will soon be tired and willing to stop at the word. thus you will effectually cure him at once of any further notion of running off. kicking horses have always been the dread of every body; you always hear men say, when they speak about a bad horse, "i don't care what he does, so he don't kick." this new method is an effectual cure for this worst of all habits. there are plenty of ways by which you can hitch a kicking horse and force him to go, though he kicks all the time; but this don't have any good effect towards breaking him, for we know that horses kick because they are afraid of what is behind them, and when they kick against it and it hurts them they will only kick the harder, and this will hurt them still more and make them remember the scrape much longer, and make it still more difficult to persuade them to have any confidence in any thing dragging behind them ever after. but by this new method you can hitch them to a rattling sulky, plow, wagon, or anything else in its worst shape. they may be frightened at first, but cannot kick or do any thing to hurt themselves, and will soon find that you do not intend to hurt them, and then they will not care any thing more about it. you can then let down the leg and drive along gently without any farther trouble. by this new process a bad kicking horse can be learned to go gentle in harness in a few hours' time. on balking. horses know nothing about balking, only as they are brought into it by improper management, and when a horse balks in harness it is generally from some mismanagement, excitement, confusion, or from not knowing how to pull, but seldom from any unwillingness to perform all that he understands. high spirited, free going horses are the most subject to balking, and only so because drivers do not properly understand how to manage this kind. a free horse in a team may be so anxious to go that when he hears the word he will start with a jump, which will not move the load, but give him such a severe jerk on the shoulders that he will fly back and stop the other horse; the teamster will continue his driving without any cessation, and by the time he has the slow horse started again he will find that the free horse has made another jump, and again flew back, and now he has them both badly balked, and so confused that neither of them knows what is the matter, or how to start the load. next will come the slashing and cracking of the whip, and hallooing of the driver, till something is broken or he is through with his course of treatment. but what a mistake the driver commits by whipping his horse for this act. reason and common sense should teach him that the horse was willing and anxious to go, but did not know how to start the load. and should he whip him for that? if so, he should whip him again for not knowing how to talk. a man that wants to act with any rationality or reason should not fly into a passion, but should always think before he strikes. it takes a steady pressure against the collar to move a load, and you cannot expect him to act with a steady, determined purpose while you are whipping him. there is hardly one balking horse in five hundred that will pull true from whipping; it is only adding fuel to fire, and will make them more liable to balk another time. you always see horses that have been balked a few times, turn their heads and look back, as soon as they are a little frustrated. this is because they have been whipped and are afraid of what is behind them. this is an invariable rule with balked horses, just as much as it is for them to look around at their sides when they have the bots; in either case they are deserving of the same sympathy and the same kind, rational treatment. when your horse balks, or is a little excited, if he wants to start quickly, or looks around and don't want to go, there is something wrong, and needs kind he treatment immediately. caress him kindly, and if he don't understand at once what you want him to do he will not be so much excited as to jump and break things, and do everything wrong through fear. as long as you are calm and can keep down the excitement of the horse, there are ten chances to have him understand you, where there would not be one under harsh treatment, and then the little _flare up_ would not carry with it any unfavorable recollections, and he would soon forget all about it, and learn to pull true. almost every wrong act the horse commits is from mismanagement, fear or excitement; one harsh word will so excite a nervous horse as to increase his pulse ten beats in a minute. when we remember that we are dealing with dumb brutes, and reflect how difficult it must be for them to understand our motions, signs and language, we should never get out of patience with them because they don't understand us, or wonder at their doing things wrong. with all our intellect, if we were placed in the horse's situation, it would be difficult for us to understand the driving of some foreigner, of foreign ways and foreign language. we should always recollect that our ways and language are just as foreign and unknown to the horse as any language in the world is to us, and should try to practice what we could understand, were we the horse, endeavoring by some simple means to work on his understanding rather than on the different parts of his body. all balked horses can be started true and steady in a few minutes time; they are all willing to pull as soon as they know how, and i never yet found a balked horse that i could not teach him to start his load in fifteen, and often less than three minutes time. almost any team, when first balked, will start kindly, if you let them stand five or ten minutes, as though there was nothing wrong, and then speak to them with a steady voice, and turn them a little to the right or left, so as to get them both in motion before they feel the pinch of the load. but if you want to start a team that you are not driving yourself, that has been balked, fooled and whipped for some time, go to them and hang the lines on their hames, or fasten them to the wagon, so that they will be perfectly loose; make the driver and spectators (if there is any) stand off some distance to one side, so as not to attract the attention of the horses; unloose their checkreins, so that they can get their heads down, if they choose; let them stand a few minutes in this condition, until you can see that they are a little composed. while they are standing you should be about their heads, gentling them; it will make them a little more kind, and the spectators will think that you are doing something that they do not understand, and will not learn the secret. when you have them ready to start, stand before them, and as you seldom have but one balky horse in a team, get as near in front of him as you can, and if he is too fast for the other horse, let his nose come against your breast; this will keep him steady, for he will go slow rather than run on you; turn them gently to the right, without letting them pull on the traces, as far as the tongue will let them go; stop them with a kind word, gentle them a little, and then turn them back to the left, by the same process. you will have them under your control by this time, and as you turn them again to the right, steady them in the collar, and you can take them where you please. there is a quicker process that will generally start a balky horse, but not so sure. stand him a little ahead, so that his shoulders will be against the collar, and then take up one of his fore feet in your hand, and let the driver start them, and when the weight comes against his shoulders, he will try to step; then let him have his foot, and he will go right along. if you want to break a horse from balking that has long been in that habit, you ought to set apart a half day for that purpose. put him by the side of some steady horse; have check lines on them; tie up all the traces and straps, so that there will be nothing to excite them; do not rein them up, but let them have their heads loose. walk them about together for some time as slowly and lazily as possible; stop often, and go up to your balky horse and gentle him. do not take any whip about him, or do any thing to excite him, but keep him just as quiet as you can. he will soon learn to start off at the word, and stop whenever you tell him. as soon as he performs right, hitch him in an empty wagon; have it stand in a favorable position for starting. it would be well to shorten the stay chain behind the steady horse, so that if it is necessary he can take the weight of the wagon the first time you start them. do not drive but a few rods at first; watch your balky horse closely, and if you see that he is getting balky, stop him before he stops of his own accord, caress him a little, and start again. as soon as they go well, drive them over a small hill a few times, and then over a large one, occasionally adding a little load. this process will make any horse true to pull. to break a horse to harness. take him in a tight stable, as you did to ride him; take the harness and go through the same process that you did with the saddle, until you get him familiar with them, so that you can put them on him and rattle them about without his caring for them. as soon as he will bear this, put on the lines, caress him as you draw them over him, and drive him about in the stable till he will bear them over his hips. the _lines_ are a great aggravation to some colts, and often frighten them as much as if you were to raise a whip over them. as soon as he is familiar with the harness and line, take him out and put him by the side of a gentle horse, and go through the same process that you did with the balking horse. always use a bridle without blinds when you are breaking a horse to harness. how to hitch a horse in a sulky. lead him to and around it; let him look at it, touch it with his nose, and stand by it till he does not care for it; then pull the shafts a little to the left, and stand by your horse in front of the off wheel. let some one stand on the right side of the horse, and hold him by the bit, while you stand on the left side, facing the sulky. this will keep him straight. run your left hand back and let it rest on his hip, and lay hold of the shafts with your right, bringing them up very gently to the left hand, which still remains stationary. do not let anything but your arm touch his back, and as soon as you have the shafts square over him, let the person on the opposite side take hold of one of them and lower them very gently on the shaft bearers. be very slow and deliberate about hitching; the longer time you take, the better, as a general thing. when you have the shafts placed, shake them slightly, so that he will feel them against each side. as soon as he will bear them without scaring, fasten your braces, etc., and start him along very slowly. let one man lead the horse to keep him gentle, while the other gradually works back with the lines till he can get behind and drive him. after you have driven him in this way a short distance, you can get into the sulky, and all will go right. it is very important to have your horse go gently, when you first hitch him. after you have walked him awhile, there is not half so much danger of his scaring. men do very wrong to jump up behind a horse to drive him as soon as they have him hitched. there are too many things for him to comprehend all at once. the shafts, the lines, the harness, and the rattling of the sulky, all tend to scare him, and he must be made familiar with them by degrees. if your horse is very wild, i would advise you to put up one foot the first time you drive him. how to make a horse lie down. every thing that we want to learn the horse must be commenced in some way to give him an idea of what you want him to do, and then be repeated till he learns it perfectly. to make a horse lie down, bend his left fore leg, and slip a loop over it, so that he cannot get it down. then put a circingle around his body, and fasten one end of a long strap around the other fore leg, just above the hoof. place the other end under the circingle, so as to keep the strap in the right hand; stand on the left side of the horse, grasp the bit in your left hand, pull steadily on the strap with your right; bear against his shoulder till you cause him to move. as soon as he lifts his weight, your pulling will raise the other foot, and he will have to come on his knees. keep the strap tight in your hand, so that he cannot straighten his leg if he raises up. hold him in his position, and turn his head toward you; bear against his side with your shoulder, not hard, but with a steady equal pressure, and in about ten minutes he will lie down. as soon as he lies down he will be completely conquered, and you can handle him as you please. take off the straps, and straighten out his legs; rub him lightly about the face and neck with your hand the way the hair lays; handle all his legs, and after he has lain ten or twenty minutes, let him get up again. after resting him a short time, make him lie down as before. repeat the operation three or four times, which will be sufficient for one lesson. give him two lessons a day, and when you have given him four lessons, he will lie down by taking hold of one foot. as soon as he is well broken to lie down in this way, tap him on the opposite leg with a stick when you take hold of his foot, and in a few days he will lie down from the mere motion of the stick. how to make a horse follow you. turn him into a large stable or shed, where there is no chance to get out, with a halter or bridle on. go to him and gentle him a little, take hold of his halter and turn him towards you, at the same time touching him lightly over the hips with a long whip. lead him the length of the stable, rubbing him on the neck, saying in a steady tone of voice as you lead him, come along boy! or use his name instead of boy, if you choose. every time you turn, touch him slightly with the whip, to make him step up close to you, and then caress him with your hand. he will soon learn to hurry up to escape the whip and be caressed, and you can make him follow you around without taking hold of the halter. if he should stop and turn from you, give him a few cuts about the hind legs, and he will soon turn his head toward you, when you must always caress him. a few lessons of this kind will make him run after you, when he sees the motion of the whip--in twenty or thirty minutes he will follow you about the stable. after you have given him two or three lessons in the stable, take him out into a small lot and train him; and from thence you can take him into the road and make him follow you anywhere, and run after you. how to make a horse stand without holding. after you have him well broken to follow you, stand him in the center of the stable--begin at his head to caress him, gradually working backward. if he move, give him a cut with the whip and put him back in the same spot from which he started. if he stands, caress him as before, and continue gentling him in this way until you can get round him without making him move. keep walking around him, increasing your pace, and only touch him occasionally. enlarge your circle as you walk around and if he then moves, give him another cut with the whip and put him back to his place. if he stands, go to him frequently and caress him, and then walk around him again. do not keep him in one position too long at a time, but make him come to you occasionally and follow you round in the stable. then stand him in another place, and proceed as before. you should not train your horse more than half an hour at a time. the horseman's guide and farrier. by john j. stutzman, west rushville, fairfield county, ohio. i will here insert some of the most efficient cures of diseases to which the horse is subject. i have practised them for many years with unparalleled success. i have cured horses with the following remedies, which, (in many cases,) have been given up in despair, and i never had a case in which i did not effect a cure. cure for colic. take gill of turpentine, gill of opium dissolved in whisky; quart of water, milk warm. drench the horse and move him about slowly. if there is no relief in fifteen minutes, take a piece of chalk, about the size of an egg, powder it, and put it into a pint of cider vinegar, which should be blood warm, give that, and then move him as before. another.--take ounce laudanum, ounce of ether, ounce of tincture of assafoetida, ounces tincture of peppermint, half pint of whisky; put all in a quart bottle, shake it well and drench the horse. cure for the bots. take - / pint of fresh milk, (just from the cow,) pint of molasses. drench the horse and bleed him in the mouth; then give him pint of linseed oil to remove them. for distemper. take mustard seed ground fine, tar and rye chop, make pills about the size of a hen's egg. give him six pills every six hours, until they physic him; then give him one table spoonful of the horse powder mentioned before, once a day, until cured. keep him from cold water for six hours after using the powder. long fever. in the first place bleed the horse severely. give him spirits of nitre, in water which should not be too cold, for it would chill him. keep him well covered with blankets, and rub his legs and body well; blister him around the chest with mustard seed, and be sure to give him no cold water, unless there is spirits of nitre in it. rheumatic liniment. take croton oil, aqua ammonia, f.f.f; oil of cajuput, oil of origanum, in equal parts. rub well. it is good for spinal diseases and weak back. cuts and wounds of all kinds. one pint of alcohol, half ounce of gum of myrrh, half ounce aloes, wash once a day. sprains and swellings. take - / ounces of harts-horn, ounce camphor, ounces spirits of turpentine, ounces sweet oil, ounces alcohol. anoint twice a day. for glanders. take of burnt buck's horn a table spoonful, every three days for nine days. if there is no relief in that time, continue the powder until there is relief. saddle or collar liniment. one ounce of spirits of turpentine, half ounce of oil of spike, half ounce essence of wormwood, half ounce castile soap, half ounce gum camphor, half ounce sulphuric ether, half pint alcohol, and wash freely. liniment to set the stifle joint on a horse. one ounce oil of spike, half ounce origanum, half ounce oil amber. shake it well and rub the joints twice a day until cured, which will be in two or three days. eye water. i have tried the following and found it an efficient remedy. i have tried it on my own eyes and those of others. take bolus muna ounce, white vitrol ounce, alum half ounce, with one pint clear rain water: shake it well before using. if too strong, weaken it with rain water. liniment for windgalls, strains and growth of lumps on man or horse. one ounce oil of spike, half ounce origanum, half ounce amber, aqua fortis and sal amoniac drachm, spirits of salts drachm oil of sassafras half ounce, harts-horn half ounce. bathe once or twice a day. horse powder. this powder will cure more diseases than any other medicine known; such as distemper, fersey, hidebound, colds, and all lingering diseases which may arise from impurity of the blood or lungs.--take lb. comfrey root, half lb. antimony, half lb. sulphur, oz. of saltpetre, half lb. laurel berries, half lb. juniper berries, half lb. angetice seed, half lb. rosin, oz. alum, half lb. copperas, half lb. master wort, half lb. gun powder. mix all to a powder and give in the most cases, one table spoonful in mash feed once a day till cured. keep the horse dry, and keep him from the cold water six hours after using it. for cuts or wounds on horse or man. take fishworms mashed up with old bacon oil, and tie on the wound, which is the surest and safest cure. oil for collars. this oil will also cure bruises, sores, swellings, strains or galls. take fishworms and put them in a crock or other vessel hours, till they become clean; then put them in a bottle and throw plenty of salt upon them, place them near a stove and they will turn to oil; rub the parts affected freely. i have cured knee-sprung horses with this oil frequently. sore and scummed eyes on horses. take fresh butter or rabbit's fat, honey, and the white of three eggs, well stirred up with salt, and black pepper ground to a fine powder; mix it well and apply to the eye with a feather. also rub above the eye (in the hollow,) with the salve. wash freely with cold spring water. for a bruised eye. take rabbit's fat, and use as above directed. bathe freely with fresh spring water. i have cured many bloodshot eyes with this simple remedy. poll-evil or fistula. take of spanish flies oz., gum euphorbium drachms, tartar emetic oz., rosin oz.; mix and pulverize, and then mix them with a half lb. of lard. anoint every three days for three weeks; grease the parts affected with lard every four days. wash with soap and water before using the salve. in poll-evil, if open, pulverize black bottle glass, put as much in each ear as will lay on a dime. the above is recommended in outside callous, such as spavin, ringbone, curbs, windgalls, etc. etc. for the fersey. take quart of sassafras root bark, quart burdock root, spice wood broke fine, pint rattle weed root. boil in - / gallons of water; scald bran; when cool give it to the horse once a day for or days. then bleed him in the neck and give him the horse powder as directed. in extreme cases, i also rowel in the breast and hind legs, to extract the corruption and remove the swelling. this is also an efficient remedy for blood diseases, etc., etc. to make the hair grow on man or beast. take milk of sulphur / drachm, sugar of lead / drachm, rose water / gill, mix and bathe well twice a day for ten days. cholera or diarrhea tincture. oz. of laudanum, oz. of spirits of camphor, oz. spirits of nitre, / oz. essence of peppermint, drops of chloroform; put all in a bottle, shake well, and take / teaspoonful in cold water once every six, twelve and twenty-four hours, according to the nature of the case. cure for the heaves. give grains of tartar emetic every week until cured. process of causing a horse to lay down. approach him gently upon the left side, fasten a strap around the ancle of his fore-foot; then raise the foot gently, so as to bring the knee against the breast and the foot against the belly. the leg being in this position, fasten the strap around his arm, which will effectually prevent him from putting that foot to the ground again. then fasten a strap around the opposite leg, and bring it over his shoulder, on the left side, so that you can catch hold of it; then push these gently, and when he goes to fall, pull the strap, which will bring him on his knees. now commence patting him under the belly; by continuing your gentle strokes upon the belly, you will, in a few minutes, bring him to his knees behind. continue the process, and he will lie entirely down, and submit himself wholly to your treatment. by thus proceeding gently, you may handle his feet and legs in any way you choose. however wild and fractious a horse may be naturally, after practicing this process a few times, you will find him perfectly gentle and submissive, and even disposed to follow you anywhere, and unwilling to leave you on any occasion. unless the horse be wild, the first treatment will be all sufficient; but should he be too fractious to be approached in a manner necessary to perform the first named operation, this you will find effectual, and you may then train your horse to harness or anything else with the utmost ease. in breaking horses for harness, after giving the powders, put the harness on gently, without startling him, and pat him gently, then fasten _the chain_ to a log, which he will draw for an indefinite length of time. when you find him sufficiently gentle, place him to a wagon or other vehicle. note.--be _extremely_ careful in catching a horse, not to affright him. after he is caught, and the powders given, rub him gently on the head, neck, back and legs, and on each side of the eyes, the way the hair lies, but be very careful not to whip, for a young horse is equally passionate with yourself, and this pernicious practice has ruined many fine and valuable horses. when you are riding a colt (or even an old horse), do not whip him if he scares, but draw the bridle, so that his eye may rest upon the object which has affrighted him, and pat him upon the neck as you approach it; by this means you will pacify him, and render him less liable to start in future. means of learning a horse to pace. buckle a four pound weight around the ancles of his hind legs, (lead is preferable) ride your horse briskly with those weights upon his ancles, at the same time, twitching each rein of the bridle alternately, by this means you will immediately throw him into a pace. after you have trained him in this way to some extent, change your leaded weights for something lighter; leather padding, or something equal to it, will answer the purpose; let him wear these light weights until he is perfectly trained. this process will make a smooth and easy pacer of any horse. horsemanship. the rider should, in the first place, let the horse know that he is not afraid of him. before mounting a horse, take the rein into the left hand, draw it tightly, put the left foot in the stirrup, and raise quickly. when you are seated press your knees to the saddle, let your leg, from the knee, stand out; turn your toe in and heel out; sit upright in your saddle, throw your weight forward--one third of it in the stirrups--and hold your rein tight. should your horse scare, you are braced in your saddle and he cannot throw you. indication of a horse's disposition. a long, thin neck indicates a good disposition, contrariwise, if it be short and thick. a broad forehead, high between the ears, indicates a very vicious disposition. cures, &c. _cure for the founder._--let - / gallons of blood from the neck vein, make frequent applications of hot water to his forelegs; after which, bathe them in wet cloths, then give one quart linseed oil. the horse will be ready for service the next day. _botts._--mix one pint honey with one quart sweet milk, give as a drench, one hour after, dissolve oz. pulverized coperas in a pint of water, use likewise, then give one quart of linseed oil. cure effectual. _colic._--after bleeding copiously in the mouth, take a half pound of raw cotton, wrap it around a coal of fire in such a way as to exclude the air; when it begins to smoke, hold it under the horse's nose until he becomes easy. cure certain in ten minutes. _distemper._--take - / gallons blood from the neck vein, then give a dose of sassafras oil, - / ounces is sufficient. cure speedy and certain. _fistula._--when it makes its appearance, rowel both sides of the shoulder; if it should break, take one ounce of verdigris, ounce oil rosin, ounce copperas, pulverize and mix together. use it as a salve. receipt for bone spavin or ring-bone. take a table-spoonful of corrosive sublimate; quicksilver about the size of a bean; or drops of muriatic acid; iodine about the size of a pea, and lard enough to form a paste; grind the iodine and sublimate fine as flour, and put altogether in a cup, mix well, then shear the hair all off the size you want; wash clean with soap-suds, rub dry, then apply the medicine. let it stay on five days; if it does not take effect, take it off, mix it over with a little more lard, and add some fresh medicine. when the lump comes out, wash it clean in soap-suds, then apply a poultice of cow dung, leave it on twelve hours, then apply healing medicine. temperance beverage. one quart of water, three pounds of sugar, one teaspoonful of lemon oil, one table-spoonful of flour, with the white of four eggs, well beat up. mix the above well together, then divide the syrup, and add four ounces of carbonic soda in one-half, and three ounces of tartaric acid in the other half; then bottle for use. sarsaparilla syrup. one ounce sarsaparilla, two pounds brown sugar, ten drops wintergreen, and half pint of water. "the most wonderful book ever written." esoteric anthropology interior science of man. a comprehensive and confidential treaties on the structure and functions, passional attractions and perversions; true and false physical and social conditions, and the most intimate relations of men and women. by t.l. nichols, m.d. pages, engravings, cloth. this book is all that its title indicates.--it treats of the generation, formation, birth, infancy youth, manhood, old age, and death of man; of health and disease, marriage and celibacy, virtue and vice, happiness and misery; of education, development and the laws of a true life. it is intended to answer all questions, and to give the fullest and most reliable information on every subject of a physiological or medical nature--to be a faithful friend in health and disease, and in all the conditions of life, especially to the young of both sexes, and those who are about to enter upon new relations. it contains the highest and deepest truths in human physiology, with their individual and social application; the true nature and hidden causes of disease; the condition of health, physical and passional; all that information which every human being needs, which few dare to ask for, or know how to obtain, but which, amid the discordances of civilization, is of priceless value. the portion of the work on the generative system, is written with entire frankness and fully illustrated, and is unquestionably the most remarkable exposition of the physical, spiritual, and passional nature of man ever written--so remarkable indeed, that it has seemed to many persons to be the result of direct inspiration. the whole subject of the relations of the sexes, or love, marriage, and paternity, is laid open, as it never has been by any other author. a miscellaneous chapter, forming an appendix to this portion of the work, is also of a very remarkable character. it has been truly said, "there can scarcely be any important question, which any man or woman can ever need to ask a physician, to which this book does not contain an answer." the diseases of the generative system, physical and passional, are treated of with great fitness. hundreds of voluntary testimonials to the extraordinary character and merits of this book have been received from persons eminently qualified to judge, among which are clergymen, physicians, lawyers, college professors, etc. we select the following: "i look upon it," says dr. stephens, of forest city, n.y., "as the most wonderful book ever written. it marks a new era in literature and life." "what a pity," says dr. schell, of ind., "that a copy cannot be found in every family in the whole world!" "this book," says dr. dodge, of owego, n.y., "contains more that is weighty in fact, and sound in philosophy; more that is useful in medical science and effective in medical art; more that is purificative and elevative of man than any one work, in volumes few or many that has ever grace the librarie medicale of civilization." "it contains," says dr. baker, of racine, wis. "just such knowledge as a suffering world needs, to enlighten, develop, and ennoble the minds of the people." dr. farrar, of portland, me., says, "esoteric anthropology is vital in every part, refreshing every man's and woman's soul that reads it with a most grateful sense of its truth and importance. i know of no work in the world like it, or comparable with it." "i have read 'esoteric anthropology' with all the deep earnestness and absorbing interest with which i have ever perused the most brilliant romance. it has inspired nobler emotions, and deeper pleasure. 'truth' is more attractive than 'fiction.' the work, i believe to be eminently true to nature--to her unerring laws; i hesitate not, therefore, to pronounce it a noble work. it will be a great blessing to humanity."--prof. allen, of antioch college. the enthusiastic letters respecting it, received, would fill a volume, larger than book itself. sacrificing every personal consideration, and changing his first intention, which was to keep it as strictly private and professional work, a physiological mystery, as its title indicates--the author offers esoteric anthropology to the whole public of readers; satisfied that no permanent evil can result to any human being, from the knowledge of the deepest truths, and most sacred mysteries of the science of life. mark this.--nearly every other work on this subject directs the reader to apply to its author for a prescription in case of sickness, accompanied by a fee; while this, although its author is a practising physician, contains not a line of this kind; its whole tendency being to place every reader, whether male or female, entirely above the need of a physician. * * * * * sent free by mail for one dollar. * * * * * watkin & nicholson, publishers no. fifth street, cincinnati, o. _the attention of lecturers and book agents is especially called to this work as being likely to give more satisfaction to the thoughtful and inquiring reader than almost and other they could introduce._ a complete edition of the works of nancy luce, of west tisbury, dukes county, mass., containing god's words--sickness--poor little hearts--milk--no comfort--prayers--our saviour's golden rule--hen's names, etc. new bedford: mercury job press. . complete works of nancy luce. god's words. the lord has put down in the bible; he says: the sin in the world,-- it grieves him to his heart. the lord he forbiddeth all cruelty to dumb creatures, and helpless human too. he will cut the sinners asunder hereafter. god says: "ye shall not afflict any helpless or fatherless child. if thou afflict them in any wise, and they cry at all unto me, i will surely hear their cry." human, they cannot get into heaven, without they do god's commandments, in deeds, words, and thoughts, to human, and dumb creatures too. consider how you would feel yourselves to be crueled. the greatest sin is to cruel the poor harmless dumb creatures, they cannot speak, nor help themselves, the next sin is to cruel sick human, the next sin is to cruel any who cannot help themselves. the lord give human his word, to do justice to the afflicted and needy, to all poor sufferers, human and dumb creatures too, to be tender and kind to all. o may our sympathizing hearts, in generous pleasures know, kindly to share in others' joy, and weep for others' woe. o charity, thou heavenly grace, all tender, soft and kind; a friend to all the living race, to all that's good inclined. the lord takes pleasure in them, which will not hurt dumb creatures, nor human, in not any way whatever, have holy hearts, tender and kind. the wicked shall their triumph see, and gnash their teeth in agony, they and their envy, pride, and spite, sink down to everlasting punishment. the full rank of evil one wants all to be cruel, to the poor harmless dumb creatures, and cruel to sick human too, and take the advantage and cruel all. the full rank of evil one wants all to be murders, and lie, rob, cheat, and steal, and deceit, and contraryness, and so on, and plague every body they can. the good god of heaven, will cast off such sinners, to their double rank, punishment hereafter. poor thoughtless sinners, going on in sin, minding the evil one, their punishment they will have hereafter. god has given human his word, to have no evil conduct, and no evil speaking, and no evil thoughts. god wants all to be tender and kind, soft be our hearts, their misery to feel, and swift our hands to aid. this world a place of misery, some of the worst of sinners have destroyed my head, i cannot bear it up, o my misery, their heart is made of stone, to do such a thing. o lord, my god of heaven, i pray for thy holy spirit to go in all the needy hearts in the whole wide world around. o that they may be tender and kind to all the poor harmless dumb creatures, and sick human too, and others too. the sinners will have their punishment according to their sins, if they will not have the holy spirit. o lord, my god of heaven, i pray thee, enable me what to do, and what to say, and what to think, day after day. o lord, my god, be with me. love god with all your soul and strength, with all your heart and mind, be faithful, just, and kind, have tender feelings in your heart. deal with another as you'd have another deal with you, what you're unwilling to receive be sure you never do. the wicked shall see it, and grieve away, and gnash with their teeth, and melt away, the desire of the wicked shall perish away, and away they will go, to punishment great. they slay the helpless, they murder the fatherless, god will hold up the fatherless child, if it is his own. o god, the father of the fatherless, have mercy on me, deliver me from the wicked. god says, depart from evil, and good they must do. prepare ye the way of the lord, and make your paths straight. be ye therefore merciful, as your father in heaven also is merciful. thus saith the lord of hosts: turn ye now from your evil ways, and from your evil doings. thus saith the lord of hosts; consider your ways. i am cast down to the dust of the earth, with trouble, trials, and sickness, i am grieved to my heart for sin in the world, for the poor harmless dumb creatures, and for the best human too. * * * * * lines composed by nancy luce about poor little tweedle tedel beebee pinky, when she was a little chicken. and you will find more reading in the book about her. when poor little heart pinky, was about six weeks old, she was taken with the chicken distemper, chickens died off all over this island. she was catching grasshoppers, and crickets, in the forenoon smart, at twelve o'clock she was taken sick, and grew worse. at one o'clock she was past opening her eyes, and could not stand, her body felt cold and stiff to my hand. i give her a portion of epsom salts, with a little black pepper in it, i wept over her that afternoon, i prayed to the lord to save me her life. i sat up that night, with her in my lap, till eleven o'clock that night, then she seemed to be better. then i put her in a thing, a good soft bed, and lay down and spoke to her often, say how do you do, little dear, she answered me quick, then i knew she was better. the next day i gave her warm water to drink, the third day she was herself, got well and smart. she remained well four years, and laid me pretty eggs, then the lord thought best to take her from the evil to come, without being sick but a very little while. when i was raising poor little dear in my lap, and it rained on the window, she would look at the rain, and put her head under my cape. and take it out every once in a while, and look at the rain, and put it under my cape again, up most to my shoulder. poor cunning little dear, my heart is broken for her, she and i loved each other so well, and she had more than common wit. that dear little heart, remembered four years, ever since she was a little chicken, i know it by many things. her dear friend is left in trouble, and undergo sickness too. them that knew me once, know--me--no--more, her death renewed me to seek for god, to land in heaven hereafter. nancy luce west tisbury, dukes county, mass., . prayer. hear my prayer, o lord, my god of heaven, grant me i beseech thee, o lord, send thy holy spirit into all the needy hearts, in the whole wide world around, convince them of sin, give them the holy spirit, o that they may be kind and tender to the poor harmless dumb creatures, they cannot speak, nor help themselves, o lord, prepare the inhabitants of the earth to live in this world and in the world to come. o lord, i beseech thee, protect me from committing sin, o lord, help me to watch and pray, o lord, i give thee thanks for what blessings i have, o lord, can thou deliver me from sickness, trouble and trials? o lord, stand my friend in this world and in the world to come. o lord, that the professing inhabitants may not fall back and go to sinning again. o that they may be true christians, the holy spirit, love and tender kindness for dumb creatures and human too, love god and land in heaven, o lord, enable me to have the holy spirit all the days of my life, o lord, grant me i beseech thee, i pray for thy kingdom to come, to destroy all sin, for the poor harmless dumb creatures, and for sick human too. and for all the troubled in the wide world round, human and dumb creatures too, for thine is the kingdom and the glory forever. amen. sickness. sickness distressing, by trouble and trials, walk, stir, or do a little in the house, it hurts me very bad, and i cannot ride to have comfort. my head a misery place all of my time, and part of my time in great misery, and noise sets my head in a dreadful condition. most nothing hurts me, and most nothing beats me out, i am dreadful worn down with long sickness, and trials, and sometimes trouble too. sick i do feel all my whole time, and misery feelings from head to feet. a number of years, i have undergone great sickness. some of my diseases are cured a few years ago, and some of them helped some, and some of them patched along, and some of them not any better at all, but i am dreadful wore down with long sickness. a common thing in my sickness, milk my cow, take care of my hens, in such misery, i felt as if i must fall at every step, but i must do it, i must do it. oh, thou who dry'st the mourner's tear, how dark this world would be. if when deceived and wounded here, we could not fly to thee. when sore afflictions press me down, i need thy quickning powers, thy word that i have rested on, shall help my heaviest hours. poor little hearts. a sketch of two poor little banties, they died with old age, over twelve years ago, poor little ada queetie died over thirteen years ago, in . poor little beauty linna died over twelve years ago, in . o my poor deceased little ada queetie, she knew such a sight, and her love and mine, so deep in our hearts for each other, the parting of her and her undergoing sickness and death, o heart rending! she and i could never part, do consider the night i was left, what i underwent, no tongue could express, weeping the whole night through. poor little ada queetie's sickness and death, destroyed my health at an unknown rate, with my heart breaking and weeping, i kept fire going night after night, to keep poor little dear warm, i kept getting up nights to see how she was, and see what i could do for her. three her last days and nights, she breathed the breath of life here on earth, she was taken down very sick, then i was up all night long, the second night i was up till i was going to fall, then i fixed her in her box warm, close by the fire, put warm clothes under, over and around, and left fire burning and lay down, with all my clothes on, a very little while, and got up and up all the time. the third night i touched no bed at all, poor little heart, she was struck with death at half past eleven o'clock. she died in my arms at twelve o'clock at night, o heart rending! i could been heard to the road, from that time till daylight, no tongue could express my misery of mind. she had more than common wit, and more than common love, her heart was full of love for me, o do consider my poor little heart. she was my dear and nearest friend, to love and pity me, and to believe that i was sick, she spoke to me, and looked at me most all the time, and could not go from me. poor little heart, she used to jump down to the door to go out, she would look around, and call to me to go with her, she found i could not go, she would come in again, she loved her dear friendy so well she could not go out and leave me. o my dear beloved little heart, she was my own heart within me, when she was well and i was sick, and made out to sit in my chair, she knew i was sick, because i didn't say but a very little to her. she would stand close to me all the time, and speak to me, i could not take her eyes off my face, and look as grieved as it her heart must break, she was so worried for me, and if i was forced to lay down, then she was more worried than ever. when poor little heart happened to be out the room, and i was forced to lay down, she would come and peek at me, and take on, as if her heart must break, and come straight to me and lament my cause, and would not go from me, her feelings was so deeply rooted in her heart for me. they was brought from chilmark to new town, and remained there one year for me to get able to take care of them. and then they was brought to me. poor little ada queetie, she used to do everything i told her, let it be what it would, and knew every word i said to her. if she was as far off as across the room, and i made signs to her with my fingers, she knew what it was, and would spring quick and do it. if she was far off and i only spoke her name, she would be sure to run to me quick, without wanting anything to eat. she would do wonderful cunning things, poor sissy would do , they would do part of them without telling, and do all the rest of them with telling. i use to dream distressing dreams, about what was coming to pass, and awoke making a dreadful noise, and poor little ada queetie was making a mournful noise, she was so worried for me, then i would speak to her and say: little dear, nothing ails you friendy. then she would stop and speak a few pretty words to me. she use to shake my cape, with all her strength and might, every time i told her, they would both put one foot into my hand, every time i told them, they would both scratch my hand, and peck on my cap, every time i told them. when some one used to happen to shut them out the room, they would take on at a dreadful rate, i let them straight in, and as soon as the person was gone, poor little ada queetie would not keep out of my lap, squeezing me close up, talking to me, and poor little beauty linna would not keep off my shoulders, with her face squeezed close to my face, talking to me, they was so glad they got back in this room with me, and i wasn't hurt and carried away. consider those dear hearts, that loved me so well, and depended all on me to be their true friend. poor little beauty linna, departed this life, my hands around her by the fire, my heart aching, i wept steady from that time, till next day, i took the best of care of her, days and nights, i did everything could be done, i did the best i could do, i sat up nights with her, till it made me very lame, then i fixed her in her bed, warm, close by the fire, put warm clothes under, over and around, and left fire burning and lay down with all my clothes on, and got up very often with her, and sat up as long as i could. i never took off none of my clothes for days and nights. poor little heart, never can call me back no more, when i go out the room, she did it as long as she was able, for eight months after poor sissy's decease, she would not let me go out the room, called me straight back, as soon as i went out. i fed her with a teaspoon in her sickness, good milk and nutmeg, and good porridge, and so i did poor sissy. i made fire days and nights, to keep poor beauty linna warm, the day before poor little dear was taken away, she opened her eyes and looked me up into my face, for the last time, o heart melting, poor little beauty linna, she could not have the wind to blow on her, all her last summer through, she would keep out the wind. a mournful scene it was to me, to see their breath depart, consider soon my time will come, and i must follow on. anxiety of mind will keep any one up and doing, if they have a friend sick, if their own health is very miserable. no one here on earth can know, but only them that knows, how hard it is to undergo trouble and sickness. when i am taken away, i must be buried to the east side, of my poor little dears' graves. poor little beauty linna, she remembered poor sissy, for eight months after poor sissy's decease, i know it by many things. they would always have the best of good cake, and best of good wheat, brought from the west. when they was both alive, and i had fire in the north room, and it came up too cold for them, they would go in the east room, and call me to come to them, they would stand side and side, and look at the fire place, and look at me, deaning me to make fire there for them, then i would make fire there, and they and i sat down together, now they are gone and i am left broken hearted. when poor little ada queetie departed this life, that was the first cause of my seeking for god. the path of sorrow, and that path alone, leads to the land where sorrows are unknown. the sick, the troubled, god hears when they complain, and all the sons of grief, with tender heart, delights to bless, and love to give relief. it is not every one that says, lord, lord, that can enter the kingdom of heaven, it is them that doeth god's commandments, in deeds, words, and thoughts, to human and dumb creatures too, and love god and hate the evil one. milk. you needn't talk against milk, if you make your victuals of water, what you put with water won't go half so far, and awful eating and distress ailing folks, and no nourishment to it. make your victuals of milk, and what you put with milk will go twice as far, and good eating and nourishment to it. milk is cooling to health, and strengthening, other victuals distress my stomach, because i am out of health; milk agrees with me, other victuals distress me. i cannot eat bread, &c., i must have milk to live on or go without eating till i die. no comfort. you don't know how hard it is to me, because i cannot ride somewhere, i cannot ride nor walk out, impossible yet, i used to ride once in a while, on a canter, galop, and run, o what comfort that was. i have had horses to run with me, so that the ground looked all in black and white streaks. there never was a horse that ever started me from their back, now i am deprived from all comforts of life. poor, sick i, days are very dark, to undergo sickness, and no comforts of life, i hope to have comfort in heaven. o how much better to go to house of mourning, than to go to house of plays and frolicking, sorrow is better than laughter, by sadness of the countenance the heart is made better. o how i love the holy law, 'tis daily my delight, and thence my meditations draw, divine advice by night. touched with sympathy within, christ knows our feeble frame, he knows what sore temptations mean, for he has felt the same. restraining prayer we cease to fight, prayer makes the christian's armor bright, and satan trembles when he sees, the weakest saint upon his knees. afflictions, though they seem severe, in mercy oft are sent, they stopped the prodigal's career, and forced him to repent. prayer makes the darkened cloud withdraw, prayer climbs the ladder jacob saw, gives exercise to faith and love, brings every blessing from above. the lord will sustain our weakest powers, with his almighty arm, and watch our most unguarded hours, against surprising harm. poor, weak, and worthless though i am, i have a rich, almighty friend, jesus, the saviour, is his name, he freely loves and without end. human, god is love and truth, god requires human to consider dumb creatures, what a site of wit they have got, and what a site of love they have got for one another, and love for human too, if they are kind to them, if human are cruel to dumb creatures in any way, or let them suffer in any way, god will cast off such sinners, to everlasting punishment. god requires human to take it to their own case, if they was dumb creatures, could not speak, nor help themselves, and human crueled them in any way, or let them suffer in any way. consider what you would undergo to be crueled, if you could not help yourselves. god requires human to leave off all their sins, and pray to the lord with truth, to take away their heart of stone, and give them a good heart, the holy spirit, prepare them to both live, and die, without true repentance, they will go to punishment, according to their sins, the thoughts are the ground work of all sin, and ground work of all goodness too, if any one is cruel to dumb creatures, they cannot get into heaven, they have not love of god in their hearts, they will go to punishment hereafter. prayers. our father in heaven, o lord, grant me i beseech thee, send thy holy spirit to all the wicked inhabitants in this world, that they may see the evil of their ways, and have the holy spirit, true christians, love and tenderness for the poor harmless dumb creatures, and human too, love and serve the lord all their days, and land in heaven hereafter. o that the professing inhabitants may not fall back, and go to sinning again, o that they may be true christians, the holy spirit, love and tenderness for the poor harmless dumb creatures, and human too, love and serve the lord all their days, and then land in heaven, o grant me i beseech thee, enable me to have the holy spirit all my days, and not fall back, and love and serve the lord all the days of my life, then land in heaven. o lord protect me from committing sin, o lord, help me to watch, and pray, o lord, enable me to put my whole trust in thee, that i may be protected from all harm in this world, and in the world to come, o lord, i beseech thee, help me through this world of misery, and land me in heaven, where no sickness, no trouble, no trials, distress me no more, come quickly, lord jesus, come, and put a stop to all sin, thy kingdom come, thy will be done on earth as it is done in heaven, for thine is the kingdom, the power and the glory forever. amen. this world a place of misery, i am grieved to my heart, for sin in the world. blessed are the merciful: for they shall obtain mercy. blessed are they which are persecuted for righteousness sake: for theirs is the kingdom of heaven. the lord give human his word to do justice to the afflicted and needy, to all the poor sufferers, human, and dumb creatures too, to be kind, and tender to all. god forbiddeth all profaning of any thing, thereby god maketh himself known. god says, all the horns of the wicked will be cut off, but the horns of the righteous will be exalted. hear my prayer, o lord, my god of heaven, and let my cry come unto thee, grant me i beseech thee, o lord, send thy holy loving kindness into the whole wide world around, and protect all the poor harmless dumb creatures from all cruelty till the world ends, o that i may praise thee for thy holy loving kindness, as long as i have breath to breathe. o lord, i beseech thee, send thy holy loving kindness and protect me from all cruelty, from the wicked, as long as i live. o there i may praise thee as long as i live. o lord, grant me, i beseech thee, send thy holy loving kindness and protect all the good folks from cruelty from the wicked, till the world ends. o that i may praise thee as long as i live. o lord, land me in the best place in heaven. o deliver me from sickness, trouble, trials. the lord is nigh unto them that call upon him in truth. o god, my heart is fixed, i will praise thee. the lord will maintain the cause of the afflicted. the lord is righteous, he will cut asunder the cords of the wicked. amen. poor little heart. poor tweedle, tedel, bebbee, pinky. she is gone. she died june th, , at quarter past o'clock in the evening, with my hands around her, aged years. i never can see poor little dear again. poor pinky, that dear little heart, she is gone, sore broke in her, died in distress, poor little heart, o it was heart rending. o sick i do feel ever since, i am left broken hearted, she was my own heart within me, she had more than common wit. poor pinky's wit, and she loved me so well, them was the reasons, i set so much by her, and i raised her in my lap too. she is taken from the evil to come, if i had died and left her, she would mourn for me, and suffer, and die for me. i wept all that night, and by spells ever since, to god i cried, he supported me, god has held me up, through all my trials, and all i have to lean upon, in every cause. if i had died and left her, to mourn, and suffer, and could have known i should die and leave her, i should have felt a great deal worse to leave her, than i do now, that she is gone before me. i must be as reconciled as i can, to part with poor little dear, all i have to comfort me is, she is taken from the evil to come. i hope i never shall have a hen, to set so much by again, from over sea, she was brought to me, one week old, i raised her in my lap, she loved me dreadful dearly. she would jam close to me, every chance she could get, and talk to me, and want to get in my lap, and set down close. and when she was out from me, if i only spoke her name, she would be sure to run to me quick, without wanting anything to eat. she placed her whole affections on me; when she was alive, and saw me to the east window, she would put her head through the pickets, and look at me, as long as she could see my face. she had more wit than any hen i ever knew, poor, sweet little dear, down in her silent grave, turning to dust, o heart rending, i never can see her again. god is supporting me under my trouble, he took away my dear friend, he has done it for the best, it is all right and just. but o it was heart rending, for that poor little heart, to undergo death, and for me to part with her. when overwhelmed with grief, my heart within me dies, helpless, and far from all relief, to heaven i lift my eyes. this world a place of misery, o lord land me in heaven, that holy, happy place, when i bid adieu to this vain world. blessed are they, which have feelings to melt, for the poor harmless dumb creatures, and for sick human too. and for all the troubled, in the wide world around, human and dumb creatures too, great sympathy and love, they will have from the lord. i must be as reconciled as i can, to part with poor little dear, it is all for the best, from the evil to come. she was sick and died very sudden, only two hours and a quarter, about fifteen minutes dying. bloody water pouring out her mouth, and her breath agoing, poor little heart. o dreadful melancholy i do feel for my dear, she laid eggs till three days before her death, she laid the most eggs, this four years around, than any hen i have on earth. soon my turn will come, and i must follow on, i hope to land on that blest shore, where no sickness, no trouble, no trials, distress me no more. my heart is fix'd on thee, my god, i rest my hope on thee alone, christ wept so much himself, he counts, and treasures up my tears. prayer an answer will obtain, through the lord a little delay; none shall seek his name in vain, none be empty sent away. the lord takes pleasure in the just, whom sinners treat with scorn, the meek, that lie despised in dust, salvation shall adorn. blest are the meek who stand afar, from rage and passion, noise and war, god will secure their happy state, and plead their cause against the great. to god i cried when troubles rose, he heard me and subdued my foes, he did my rising fears control, and strength diffused through all my soul. consider how distressing sickness is to undergo, and how distressing in many ways, my parents' sickness, a number of years, caused them to sell cows, oxen, horses, and sheep, english meadow, clear land, and wood land, consider how distressing sickness is in many ways. our saviour's golden rule. be you to others kind and true, as you'd have others be to you, and never do nor say to them, whate'er you would not take again. hen's names. teedie lete, phebea peadeo, letoogie tickling, jaatie jafy, reanty fyfante, speackekey lepurlyo, pondy lily, kalallyphe roseiekey, tealsay mebloomie, levendy ludandy, appe kaleanyo, meleany teatolly, aterryryree roseendy, vailatee pinkoatie. * * * * * hear my prayer, o lord, my god of heaven, grant me i beseech thee o lord, i pray for thy kingdom to come, to ease this misery world, it is now a place of misery, for some human, and some poor harmless dumb creatures, thy kingdom come, be no more dying, no sickness, no crying, no misery of no kind, the sinners have their punishment for their sins. thy kingdom come. amen. nancy luce. _west tisbury, dukes co., mass.,_ . hens--their diseases and cure. human, do understand how to raise up sick hens to health. some folks do not know how to doctor hens, they doctor them wrong, it hurts them, and it is dreadful cruel to let them die. it is as distressing to dumb creatures to undergo sickness, and death, as it is for human, and as distressing to be crueled, and as distressing to suffer. god requires human to take good care of dumb creatures, and be kind to them, or not keep any. now do understand, and i will tell you exact. stoppage in stomach.--if a hen has stoppage in her stomach, her corn stops in her crop, hard and swell large, and she sick, first work with your fingers carefully, get it soft, then take a small teaspoon and measure it full of epsom salts, and dissolve it in water, and give it to her with a teaspoon; you must keep to work with your fingers often, to keep it from hardening again, and the next day, if her breath smells bad, there is a rottenness in her stomach, then give her most as much of epsom salts again. put a little flour porridge in her mouth with a teaspoon, three times a day, and a little soaked cracker, soaked in water; put a little in her mouth if she can swallow it, in five days she eat with the hens and be well. this is the way i cure them. folks bring hens to me in this disease, to the point of death, been sick a long time, i cure them in five days; they must not have any milk in this disease, it will kill them, do as i tell you and you can cure them. once in a great while one of my hens have stoppage in their stomach; i cure them with only my fingers, because i take her as soon as the corn stops. milk does not agree with hens in sickness nor health, it keeps up in their stomach, and they vomit it up. i think strange it does not agree with hens, because milk is so good for human. you must not give your hens any castor oil, nor rhubarb, in not any disease whatever; it is poison for them, my reason tells me so, and i hear of folks killing their hens by giving them such stuff. my hens all keep healthy, because i keep them clean, and keep victuals and clean water standing by them, and take good care of them. i can cure a good many diseases for hens, but i cannot cure every disease. every once in a while a sick hen is brought to me, to the point of death, been sick a great while, most dead, some ail one disease, some ail a number of diseases; i receive them into my care, i doctor them, and take care of them, i raise them up to health, i am unable to do anything, but i must take pity. froth in throat.--if a hen has froth in her throat and crop, measure a small teaspoonful of epsom salts, dissolve it, put in a little black pepper, and give it to her with a teaspoon, it will cure this disease; but if she make a screaming noise with it, and distressed with it, then a sore growing in her, then no cure. gapes.--if a hen or chicken gapes a great deal, and sick, and complains of her throat, make pills of black pepper, cream, white flour, and put a pill in her mouth and make her swallow it till she takes down enough; the black pepper kills the worms. i cure them so. bag stone.--this is a seldom case, i have known this case once in a while. if a hen has a bag of stones grow in her, hang down under her, you must give her the best of good cake to eat, the stones will consume in a few weeks, then she will eat corn and oats with the hens, and lay you eggs; but if you do not give her the best of cake she will certainly die, she cannot eat anything else then, in this disease, but best of cake. i cured them so. skin in hen.--if a hen goes on her nest, and try to lay an egg, and cannot, and there most all day, then a skin of an egg is in her, she will certainly die if the skin of egg is not took out of her; some one has a small finger, and common sense, take the skin of egg out of her, then she is all right. i cure them so. bones.--if a hen is wounded in her hips, or any of her bones, bathe freely with mcquesten's extractor a number of times every day, put on a good deal, till she gets well; i have cured a number of hens with this extractor, they could not stand nor walk, their bones was so spraint, and so wrenched, &c. if their bones stiff too, then put on dr. job sweet's sprain liniment, if any sore, then put on castile soap. i cure them so. wild.--i bought a young hen last year, she was dreadful wild, and when one week was at an end she came to me, and let me take her up, she keep still, and eat out of my hand, she remains gentle ever since, and a good hen to lay eggs. green.--if a hen has bright green come from her, look same as bright green paint, with yellow in it, give her rice water with nutmeg grated in it, and jamaica ginger, a number of times a day, till it cures this disease. i cure them in a few days. feeling.--it is your duty to take good care, and not let anything hurt your hens, consider dear little hens. birds.--when i step down to the door, the little harmless birds come fly down on the ground, only one yard off my feet, and some of them half a yard off my feet. i give them oats and dough to eat; they eat it. will they come to any one else? so few folks have feeling. diarrhoea.---if a hen has diarrhoea, and pain with it, you must be as careful about what she eats, as her medicines; she must not have not any corn, and not any corn meal dough, not till she is well. give her a little warm flour porridge, five times a day, with a teaspoon; her medicine, jamaica ginger, put in warm rice water, and grate in good deal nutmeg, give it to her three times a day, take good care of her, and she get well. i cure them so. lice.--human, some of them, have lice on their hens, it is cruel, the reason is, the hen-house above the ground, and keep dirty, that breeds lice on hens, and breeds diseases too; have a cellar for your hens, and take up the dressing every morning, be no lice, lice will not breed in a cellar, i never have any lice on my hens, and they keep healthy. folks bring sick hens to me, i cure them, and lice on them too, i put black pepper in their feathers, it kills the lice. god meant for human to take good care of dumb creatures, and be kind to them, or not keep any. do by dumb creatures as you would wish to be done by if you was dumb creatures, consider how you would feel. cows.--meal is good for cows, but it will not do for her to have it dry, it gets in her nose and lungs, and hurt her, wet it; the best way is to scald it, and cool it, does more good. cracked corn is better; boil it, put on cover, it steams it soft very soon, one quart makes two and a half. cows must not have dusty hay, it hurts their lungs, &c. cows ought not to have timothy herds grass hay, it is physic. hay ought to be wet. warped neck.--if a hen has warped neck, rub on castor oil, faithful, a number of times, and give her a little huile d'olive to take inside, a good chance, her neck come in place again. swelled head.--if a hen has swelled head and face, and blue black, put on huile d'olive, i had one so, i cured her. fever.--if a hen has a fever, and her crop swelled soft, take a small teaspoon full of epsom salts and dissolve it in warm water, and put in a little black pepper in it, and give it to her with a teaspoon, and give her as much warm water as she wants to drink in her sickness, i cure hens and chickens so in three days, and give her a little porridge with a teaspoon, five times a day, till she is able to eat. i cure them so. feeling.--if any one is cruel to dumb creatures, they will go to everlasting punishment, and have the greatest punishment. sick, i am, and very unable to do anything, but i must take pity,--dear little hens. * * * * * god is good, love and truth, merciful in all his ways. if the will of god could be done in full, it would be a great happiness among dumb creatures and human too. cruelty is of the evil one. the good god is looking down upon such folks; he will cast them off to everlasting punishment. human must do god's commandments in deeds, words and thoughts. be kind to poor hens in every way, and not let them suffer with hunger nor cold; cruelty not in any way; must not affrighten them; doctor them when they have diseases. be good and kind to them. think how good god is. act up to his will in all your ways and all your thoughts too. you must keep your hens from suffering with cold, and give them enough to eat, and keep them clean, and not affrighten them, &c., &c., or they cannot lay you eggs. if your hens or chickens have their crops swelled soft, and a fever, give them a portion of epsom salts, with a little black pepper in it, and give them as much warm water as they can drink; in their sickness take good care of them, they get well. if they have stoppage in their stomach, their crop swelled hard, take your fingers and jam carefully till their crop is soft, then give them a portion of epsom salts. i have cured them with only my fingers, they get well. if they have itching feet and scurfy, if mutton tallow will not cure it, then put their feet in a thing of warm water and wash them every morning till they get well. when they shed their feathers, their stomach is weak then, they must have soft victuals then, hard corn will distress their stomach then. if hen's body comes out, put it back in her and see to her, she be well by the next day. if it comes more than half way out, it can be put back if any one has common sense. if a string of hen's insides comes out, with a egg fast to it, break the egg, and take it off from her insides and put her insides back in her and see to her, she be well by the next day. if hen's legs chilled with cold for want of sun, and they cannot walk, take them by the fire and rub their legs and feet, faithful, half a day, then rub on black pepper mixed with warm water, they get well. if a hen is starved she must not have hard corn at first, give her flour bread soaked soft in milk, till she is able to eat corn. hens must not go in snow, it hurts them. they must not have fat meat. they must not be crowded, their room must be large enough. their roosts must not be too high, for them to fly down on hard floor, it hurts their feet and hips. i know it. hens want sun in winter and shade in summer. if hens' feet crack, bleed, and sore places, melt mutton tallow and white sugar together, rub it on faithful, they get well. if they bleed great deal, put on warm alum water first, they get well. if hens' feet swell, put on sweet apple balsam every day, they get well. if hens' head turns over, give her epsom salts and black pepper, she get over it for a while. if hens have diarrhoea, give them boiled rice, black pepper, nutmeg, mixed, they get well if you take good care of them. hens must not have fish, it physics them. hens must not have anything relaxing. if hens have rattling in their throat give them epsom salts and black pepper, they get well. if hen has her head quiver, and stagger, give her epsom salts, and keep her quiet, and her food soak cracker in milk, she get well. if hens taken lame in the afternoon without being hurt, rub on mutton tallow and black pepper, they get well. if hen's bones spraint or bruised, bathe freely with mequesten's extracter, take good care of her, she get well in time, must have little time for it. this medicine will cure burns, scalds, on human, no doubt on hens too. it will cure sores, put it on when they first begin to come. if anything ails hens' eyes, rain-water is good, new milk put on, mutton tallow put around her eyes, salve made of rose water and cream, put around her eyes. hens must not be confined in wind, it hurts them, they cannot lay you eggs. god placed us in this world to be kind to dumb creatures, or not keep any, and kind to human too. consider what a wickedness it is to go contrary from it. i keep cow and hens, i do my duty for them. if hens have watery stomachs give them black pepper, put it in their dough, if they are able to eat it, if not able, then mix the pepper with water, and give it to her with a teaspoon, be careful and not have it too strong, to take her breath. if hens have pip, give them the same medicine, it will cure pip and watery stomach. help them in season. if hen has swelled throat, put on sweet oil and black pepper, she get well. you must not give your hens salt, it will kill them. you must not give them rye, it will hurt them. if hen lays soft shell eggs, let her set two or three weeks, she lay hard shell eggs again. you must take good care of your poor hens or they cannot lay you eggs. hens must be kept clean and must not have any bad smell with them, it will poison them. you must not give them cayenne pepper, it will poison them, it drives a redness into their heads, then they fail till they die. black pepper is good for them when they need it. hens must have clean victuals and clean water to drink. take the chill off the water in winter. keep good yellow southern corn standing by them, they take a little when they want it, it does them more good, and it takes less to keep them. give them boiled oats, it is good for them to lay eggs. i give my hens boiled oats all the time, and corn standing by them. i give them some other victuals too, sometimes, and sometimes i give them some boiled potatoes. i mash it with cream for them. my hens lay me more eggs than anybody's hens anywhere, by what i hear. good flour bread is splendid to make them lay eggs, but i am not able to cook it for them. the bread must not be sour. keep fine clam shells by them, and gravel sand. they must be kept warm in winter and cool in summer. they must have clean, warm cellar room, you will have double the eggs. take up the dressing every morning certain, and oftener, if they stay down there days. when cold, keep them in the cellar, when the weather is suitable, let them out days. if cold morning, keep them in till the sun gets up warm. be clever to them. they must not be affrighted. they can never get over it. i hear what folks do all my days, and their poor hens cannot lay much and they die off. it is wicked for folks to be so cruel. be good and kind to all that breathes, act up our good saviour's laws, have tender feelings in your hearts, for all the poor, harmless dumb creatures. my hens are all in better order since i had a cellar for them, than they were before, and lay me double the eggs. hens must not suffer with the cold, nor no other sufferings, you cannot have eggs. raise your chickens on good flour bread, it will make them healthy, grow fast and smart; they must be fed often; i do not think meal is very good for hens or chickens; meal is splendid for cows. if you are forced to give your hens or chickens meal, you must sift it fine and scald it and cool it. i used to raise my chickens on flour middlings dough, it is splendid for them. flour bread is better. i do not set any hens now. you must not let young chickens go in cold nor wet ground, nor rain, &c., &c. you must boil some corn in winter, and give it to your hens warm, besides other victuals. human, those that are cruel to dumb creatures and to human too, and murder, rob, steal, cheat, contrary, spite, deceit, and take the advantage of any one, to damage them in any way, &c., &c., those will go to everlasting punishment hereafter, and have the greatest punishment. be tender hearted, be kind one to another, do your duty to those who still live. god requires human to do as they wish to be done by, in deeds, words and thoughts, to human and dumb creatures too. the greatest sin is, in the sight of god, is to cruel the poor harmless dumb creatures, they cannot speak nor help themselves. the next sin is to cruel sick human, the next sin is to cruel any who cannot help themselves, and especially the cruel to the poor, harmless dumb creatures. the lord will cut asunder the cords of such sinners. this world a place of misery, i pray for thy kingdom to come, to destroy all sin, o lord, land me in heaven, that holy, happy place, when i bid adieu to this vain world, my good god in heaven, my only true friend, has held me up with his arm, and all i have to lean upon. christ, a man of grief, he wept so much himself, on him i lean, who not in vain, he counts and treasures up my tears. nancy luce. west tisbury, dukes county, mass., . * * * * * this reading below is on my gravestones: poor little heart, ada queetie, o my heart is consumed in the coffin under ground, o how i feel for her, she and i could never part, she was my own heart within me, she had more than common love, and more than common wit. poor little heart, beauty linna, she has consumed, in the coffin under ground, o how i feel for her, she was a cunning little heart. poor tweedle, tedel, beebe, pinky, poor dear little heart, sore broke in her, i am left broken-hearted, she was my own heart within me, she had more than common wit, she is taken from the evil to come. them that knew me once, know--me--no--more, till all things have their end, and they, and i, do meet in heaven. prayers. o i pray for my lord jesus christ, to destroy all sin, and all misery, for the afflicted, for the poor harmless dumb creatures, and for all the troubled, in the wide world around, for all that breathes the breath of life, dumb creatures, and human too. o that i may leave this world of misery, o that i may see my lord jesus christ, and live with him in heaven. o that i may meet my deceased friends in heaven; o that i may rise above those earthly afflictions, sickness, trials, and trouble. amen. o lord, my god of heaven, grant me, i beseech thee, o lord, i pray for thy kingdom to come, to destroy all sin, be done on earth as it is done in heaven, for the poor harmless dumb creatures, and for all the troubled in the wide world around. o i pray for all the inhabitants of the earth to be prepared to live in this world, and in the world to come. o that they may be true children of god, tender feelings, and kind to dear little hens, and other dumb creatures. o lord, my god of heaven, i know thee will cut asunder the sinners hereafter and cast them to everlasting wo, if any one is cruel to dear little hens, and other dumb creatures. o lord, i hope there is not any one so cruel, so sinful. thy kingdom come. amen. o lord protect me from committing sin. nancy luce. competition by james causey _they would learn what caused the murderous disease--if it was the last thing they did!_ greta _january , earth time_ i wish max would treat me like a _woman_. an hour ago, at dinner, john armitage proposed a toast, especially for my benefit. he loves to play the gallant. big man, silver mane, very blue eyes, a porcelain smile. the head of wsc, the perfect example of the politician-scientist. "to the colony," he announced, raising his glass. "may epsilon love them and keep them. may it only be transmittal trouble." "amen," max said. we drank. taylor bishop put down his glass precisely. bishop is a gray little man with a diffident voice that belies his reputation as the best biochemist in the system. "has farragut hinted otherwise?" he asked mildly. armitage frowned. "it would be scarcely prudent for senator farragut to alarm the populace with disaster rumors." bishop looked at him out of his pale eyes. "besides, it's an election year." the silence was suddenly ugly. then armitage chuckled. "all right," he said. "so the senator wants to be a national hero. the fact still remains that epsilon had better be habitable or pan-asia will scream we're hogging it. they want war anyway. within a month--boom." * * * * * for a moment, i was afraid he was going to make a speech about earth's suffocating billions, the screaming tension of the cold war, and the sacred necessity of our mission. if he had, i'd have gotten the weeping shrieks. some responsibilities are too great to think about. but instead he winked at me. for the first time, i began to realize why armitage was the director of the scientists' world council. "hypothesis, greta," he said. "epsilon is probably a paradise. why should the test colony let the rest of the world in on it? they're being selfish." i giggled. we relaxed. after supper, armitage played chess with bishop while i followed max into the control room. "soon?" i said. "planetfall in eighteen hours, doctor." he said it stiffly, busying himself at the controls. max is a small dark man with angry eyes and the saddest mouth i've ever seen. he is also a fine pilot and magnificent bacteriologist. i wanted to slap him. i hate these professional british types that think a female biochemist is some sort of freak. "honestly," i said. "what do you think?" "disease," he said bitterly. "for the first six months they reported on schedule, remember? a fine clean planet, no dominant life-forms, perfect for immigration; unique, one world in a billion. abruptly they stopped sending. you figure it." i thought about it. "i read your thematic on venusian viruses," he said abruptly. "good show. you should be an asset to us, doctor." "thanks!" i snapped. i was so furious that i inadvertently looked into the cabin viewplate. bishop had warned me. it takes years of deep-space time to enable a person to stare at the naked universe without screaming. it got me. the crystal thunder of the stars, that horrible hungry blackness. i remember i was sort of crying and fighting, then max had me by the shoulders, holding me gently. he was murmuring and stroking my hair. after a time, i stopped whimpering. [illustration: illustrated by stone] "thanks," i whispered. "you'd better get some sleep, greta," he said. i turned in. i think i'm falling in love. * * * * * _january _ today we made planetfall. it took max a few hours to home in on the test colony ship. he finally found it, on the shore of an inland sea that gleamed like wrinkled blue satin. for a time we cruised in widening spirals, trying to detect some signs of life. there was nothing. we finally landed. max and armitage donned spacesuits and went toward the colony ship. they came back in a few hours, very pale. "they're dead." armitage's voice cracked as he came out of the airlock. "all of them." "skeletons," max said. "how?" bishop said. armitage's hands were shaking as he poured a drink. "looks like civil war." "but there were a hundred of them," i whispered. "they were _dedicated_--" "i wonder," bishop said thoughtfully. "white and brown and yellow. russian and british and french and german and chinese and spanish. they were chosen for technical background rather than emotional stability." "rot!" armitage said like drums beating. "it's some alien bug, some toxin. we've got to isolate it, find an antibody." he went to work. * * * * * _january _ i'm scared. it's taken three days to finalize the atmospheric tests. oxygen, nitrogen, helium, with trace gases. those trace gases are stinkers. bishop discovered a new inert gas, heavier than xenon. he's excited. i'm currently checking stuff that looks like residual organic, and am not too happy about it. still, this atmosphere seems pure. armitage is chafing. "it's in the flora," he insisted today. "something, perhaps, that they ate." he stood with a strained tautness, staring feverishly at the chronometer. "senator farragut's due to make contact soon. what'll i tell him?" "that we're working on it," bishop said dryly. "that the four best scientists in the galaxy are working toward the solution." "that's good," armitage said seriously. "but they'll worry. you _are_ making progress?" i wanted to wrap a pestle around his neck. we were all in the control room an hour later. armitage practically stood at attention while farragut's voice boomed from the transmitter. it was very emetic. the senator said the entire hemisphere was waiting for us to announce the planet was safe for immigration. he said the stars were a challenge to man. he spoke fearfully of the coming world crisis. epsilon was man's last chance for survival. armitage assured him our progress was satisfactory, that within a few days we would have something tangible to report. the senator said we were heroes. finally it was over. max yawned. "wonder how many voters start field work at once." armitage frowned. "it's not funny, cizon. not funny at all. inasmuch as we've checked out the atmosphere, i suggest we start field work at once." taylor blinked. "we're still testing a few residual--" "i happen to be nominal leader of this party." armitage stood very tall, very determined. "obviously the atmosphere is pure. let's make some progress!" * * * * * _february _ this is progress? for the past ten days, we've worked the clock around. quantitative analysis, soil, water, flora, fauna, cellular, microscopic. nothing. max has discovered a few lethal alkaloids in some greenish tree fungus, but i doubt if the colony were indiscriminate fungus eaters. bishop has found a few new unicellular types, but nothing dangerous. there's one tentacled thing that reminds me of a frightened rotifer. max named it _armitagium_. armitage is pleased. perhaps the fate of the hundred colonists will remain one of those forever unsolved mysteries, like the fate of the _mary celeste_ or the starship _prometheus_. this planet's _clean_. * * * * * _february _ today max and i went specimen-hunting. it must be autumn on epsilon. everywhere the trees are a riot of scarlet and ocher, the scrubby bushes are shedding their leaves. once we came upon a field of thistlelike plants with spiny seed-pods that opened as we watched, the purple spores drifting afield in an eddy of tinted mist. max said it reminded him of scotland. he kissed me. on the way back to the ship we saw two skeletons. each had its fingers tightly locked about the other's throat. * * * * * _february _ we have, to date, analyzed nine hundred types of plant life for toxin content. bishop has tested innumerable spores and bacteria. our slide file is immense and still growing. max has captured several insects. there is one tiny yellow bush-spider with a killing bite, but the species seem to be rare. bishop has isolated a mold bacterium that could cause a high fever, but its propagation rate is far too low to enable it to last long in the bloodstream. the most dangerous animal seems to be a two-foot-tall arthropod. they're rare and peaceable. bishop vivisected one yesterday and found nothing alarming. last night i dreamed about the first expedition. i dreamed they all committed suicide because epsilon was too good for them. this is ridiculous! we're working in a sort of quiet madness getting no closer to the solution. armitage talked to senator farragut yesterday and hinted darkly that the first ship's hydroponics system went haywire and that an improper carbohydrate imbalance killed the colony. pretty thin. farragut's getting impatient. bishop looks haggard. max looks grim. * * * * * _february _ our quantitative tests are slowing down. we play a rubber of bridge each night before retiring. last night i trumped max's ace and he snarled at me. we had a fight. this morning i found a bouquet of purple spore-thistles at my cabin door. max is sweet. this afternoon, by mutual consent, we all knocked off work and played bridge. bishop noticed the thistle bouquet in a vase over the chronometer. he objected. "they're harmless," max said. "besides, they smell nice." i can hardly wait for tomorrow's rubber. our work is important, but one does need relaxation. * * * * * _february _ armitage is cheating. yesterday he failed to score one of my overtricks. we argued bitterly about it. taylor, of course, sided with him. three hands later, armitage got the bid in hearts. "one hundred and fifty honors," he announced. "that's a lie," i said. "it was only a hundred," he grinned. "but thank you, greta. now i shan't try the queen finesse." no wonder they've won the last three evenings! max is furious with them both. * * * * * _february _ we played all day. max and i kept losing. i always knew armitage was a pompous toad, but i never realized he was _slimy_. this afternoon it was game all, and armitage overcalled my diamond opener with three spades. bishop took him to four and i doubled, counting on my ace-king of hearts and diamonds. i led out my diamond ace and armitage trumped from his hand. bishop laid down his dummy. he had clubs and spades solid, with doubleton heart and diamonds. "none?" max asked armitage dangerously. armitage tittered. i wanted to scratch his eyes out. he drew trump immediately and set up clubs on board, dumping the heart losers from his hand, and finally sluffing--_two diamonds_. "made seven," he said complacently, "less two for the diamond renege makes five, one overtrick doubled. we were vulnerable, so it's game and rubber." i gasped. "you reneged deliberately!" "certainly. doubleton in hearts and diamonds in my hand. if you get in, i'm down one. as it was, i made an overtrick. the only penalty for a renege is two tricks. the rule book does not differentiate between deliberate and accidental reneges. sorry." i stared at his florid throat, at his jugular. i could feel my mouth twitching. on the next hand i was dummy. i excused myself and went into the lab. i found a scalpel. i came up quietly behind armitage and bishop saw what i was going to do and shouted and i was not nearly fast enough. armitage ducked and bishop tackled me. "thanks, dear," max said thoughtfully, looking at the cards scattered on the floor. "we would have been set one trick. club finesse fails." "she's crazy!" armitage's mouth worked. "the strain's too much for her!" i cried. i apologized hysterically. after a while, i convinced them i was all right. max gave me a sedative. we did not play any more bridge. over supper i kept staring at armitage's throat. after eating, i went for a long walk. when i got back to the ship, everyone was sleeping. * * * * * _march _ bishop found armitage this morning, in his cabin. he came out, very pale, staring at me. "you bitch," he said. "ear to ear. now what'll i do for a partner?" "you can't prove it," i said. "we'll have to confine her to quarters," max said wearily. "i'll tell farragut." "and let him know the expedition is failing?" max sighed. "you're right. we'll tell them armitage had an accident." i said seriously, "it was obviously suicide. his mind snapped." "oh, god," max said. they buried armitage this afternoon. from my cabin, i watched them dig the grave. cheaters never prosper. * * * * * _march _ max talked with senator farragut this morning. he said armitage had died a hero's death. farragut sounds worried. the pan-asians have withdrawn their embassy from imperial africa. tension is mounting on the home front. immigration _must_ start this week. max was very reassuring. "just a few final tests, senator. we want to make sure." we puttered in our laboratories all afternoon. bishop seemed bored. after dinner he suggested three-handed bridge and max said he knew a better game, a friendly game his grandmother had taught him--hearts. * * * * * _march _ it's a plot! all day long bishop and max have managed to give me the queen of spades. it's deliberate, of course. three times i've tried for the moon and bishop has held out one damned little heart at the end. once max was slightly ahead on points and bishop demanded to see the score. i thought for a moment they would come to blows, but bishop apologized. "it's just that i hate to lose," he said. "quite," max said. when we finally turned in, bishop was ahead on points. too far ahead. * * * * * _march _ i suppose it's bishop's laugh. it has a peculiar horselike stridency that makes me want to tear out his throat. twice today i've broken down and cried when he made a jackpot. i'm not going to cry any more. supper was the usual, beef-yeast and vita-ale. i remember setting bishop's plate in front of him, and the way his pale eyes gleamed between mouthfuls. "three thousand points ahead," he gloated. "you'll never catch me now. never, never!" that was when he gripped his throat and began writhing on the floor. max felt his pulse. he stared at me. "very nice," he said. "quick. did you use a derivative of that green fungus?" i said nothing. max's nostrils were white and pinched. "must i make an autopsy?" "why bother?" i said. "it's obviously heart failure." "yes, why bother?" he said. he looked tired. "stay in your cabin, greta. i'll bring your meals." "i don't trust you." his laughter had a touch of madness. * * * * * _march _ max unlocked my cabin door this morning. he looked drawn. "listen," he said. "i've checked my respiration, pulse, saliva, temperature. all normal." "so?" "come here," he said. i followed him into the lab. he indicated a microscope. his eyes were bright. "well?" "a drop of my blood," he said. "look." i squinted into the microscope. i saw purple discs. oddly, they did not attack the red blood cells. there was no fission, no mitosis. the leucocytes, strangely enough, let them alone. my hands were shaking as i took a sterile slide and pricked my finger. i put the slide under the microscope. i adjusted the lens and stared. purple discs, swimming in my bloodstream. thriving. minding their own business. "me, too," i said. "they're inert," max said hoarsely. "they don't affect metabolism, cause fever, or interfere with the body chemistry in any way. do they remind you of anything?" i thought about it. then i went to the slide file that was marked _flora--negative_. "right," max said. "the purple thistle. spores! the atmosphere is clogged with them. greta, my sweet, we're infected." "i feel fine," i said. all day long we ran tests. negative tests. we seem to be disgustingly healthy. "symbiosis," max said finally. "live and let live. apparently we're hosts." only one thing disturbs me. most symbiotes _do_ something for their host. something to enhance the host's survival potential. we played chess this evening. i won. max is furious. he's such a poor sport. * * * * * _march _ max talked with senator farragut this morning. he gave epsilon a clean bill of health and the senator thanked god. "the first starship will leave tonight," the senator said. "right on schedule, with ten thousand colonists aboard. you're world heroes!" max and i played chess the rest of the day. max won consistently. he utilizes a fianchetto that is utterly impregnable. if he wins tomorrow, i shall have to kill him. * * * * * max _march _ it was, of course, necessary for me to destroy armitage and bishop. they won far too often. but i am sorry about greta. yet i had to strangle her. if she hadn't started that infernal queen's pawn opening it would have been different. she beat me six times running, and on the last game i pulled a superb orang-outang, but it was too late. she saw mate in four and gave me that serpent smirk i know so well. how could i have ever been in love with her? * * * * * _march _ frightfully boring to be alone. i have a thought. chess. right hand against left. white and black. jolly good. * * * * * _march _ i haven't much time. left was black this morning and i beat him, four out of five. we're in the lab now. he's watching me scribble this. his thumb and forefinger are twitching in fury. he looks like some great white spider about to spring. he sees the scalpel, by the microscope. now his fingers are inching toward it. treacherous beast. i'm stronger. if he tries to amputate ... --james causey transcriber's note: this etext was produced from _galaxy science fiction_ may . extensive research did not uncover any evidence that the u.s. copyright on this publication was renewed. minor spelling and typographical errors have been corrected without note. note: project gutenberg also has an html version of this file which includes the original illustrations. see -h.htm or -h.zip: (http://www.gutenberg.net/dirs/ / / / / / -h/ -h.htm) or (http://www.gutenberg.net/dirs/ / / / / / -h.zip) transcriber's note: this book contains many characters not displayed by ascii or iso- - (latin ) character sets. in the text file these characters have been denoted by enclosing explanatory text within square brackets. two of the more commonly occurring such characters are the oe-ligature (denoted by [oe] or [oe]) and a-macron (denoted by [=a]. some, but not all, of the other such characters display properly in the html version. text enclosed between pound signs was in bold face in the original (#bold face#). a detailed transcriber's note is at the end of the e-text. essentials of diseases of the skin including the syphilodermata arranged in the form of questions and answers prepared especially for students of medicine by henry w. stelwagon, m.d., ph.d. * * * * * get the best the new standard dorland's american illustrated medical dictionary for students and practitioners a new and complete dictionary of the terms used in medicine, surgery, dentistry, pharmacy, chemistry, and kindred branches; together with new and elaborate tables of arteries, muscles, nerves, veins, etc.; of bacilli, bacteria, micrococci, etc.; eponymic tables of diseases, operations, signs and symptoms, stains, tests, methods of treatment, etc. by w.a.n. dorland, m.d., editor of the american pocket medical dictionary. large octavo, nearly pages, bound in full flexible leather. price, $ . net; with thumb index, $ . net. just issued--new ( ) revised edition-- new words _it contains a maximum amount of matter in a minimum space and at the lowest possible cost._ this book contains #double the material in the ordinary students' dictionary#, and yet, by the use of a clear, condensed type and thin paper of the finest quality, is only - / inches in thickness. it is bound in full flexible leather, and is just the kind of a book that a man will want to keep on his desk for constant reference. the book makes a special feature of #the newer words#, and defines hundreds of important terms not to be found in any other dictionary. it is especially #full in the matter of tables#, containing more than a hundred of great practical value, including new tables of tests, stains and staining methods. a new feature is the inclusion of numerous handsome illustrations, many of them in colors, drawn and engraved specially for this book. "i must acknowledge my astonishment at seeing how much he has condensed within relatively small space. i find nothing to criticise, very much to commend, and was interested in finding some of the new words which are not in other recent dictionaries."--roswell park, _professor of principles and practice of surgery and clinical surgery, university of buffalo_. "dr. dorland's dictionary is admirable. it is so well gotten up and of such convenient size. no errors have been found in my use of it."--howard a. kelly, _professor of gynecology, johns hopkins university, baltimore_. w. b. saunders company, walnut st., phila. london: , henrietta street, covent garden fifth edition, just ready with complete vocabulary the american pocket medical dictionary edited by w.a. newman dorland, a.m., m.d., assistant demonstrator of obstetrics, university of pennsylvania. hundreds of new terms bound in full leather, limp, with gold edges. price, $ . net; with patent thumb index, $ . net. the book is an #absolutely new one#. it is not a revision of any old work, but it has been written entirely anew and is constructed on lines that experience has shown to be the most practical for a work of this kind. it aims to be #complete#, and to that end contains practically all the terms of modern medicine. this makes an unusually large vocabulary. besides the ordinary dictionary terms the book contains a wealth of #anatomical and other tables#. this matter is of particular value to students for memorizing in preparation for examination. "i am struck at once with admiration at the compact size and attractive exterior. i can recommend it to our students without reserve."--james w. holland, m.d., _of jefferson medical college_. "this is a handy pocket dictionary, which is so full and complete that it puts to shame some of the more pretentious volumes."--_journal of the american medical association._ "we have consulted it for the meaning of many new and rare terms, and have not met with a disappointment. the definitions are exquisitely clear and concise. we have never found so much information in so small a space."--_dublin journal of medical science._ "this is a handy little volume that, upon examination, seems fairly to fulfil the promise of its title, and to contain a vast amount of information in a very small space.... it is somewhat surprising that it contains so many of the rarer terms used in medicine."--_bulletin johns hopkins hospital_, baltimore. w. b. saunders company, walnut st., phila. london: , henrietta street, covent garden * * * * * essentials of diseases of the skin. since the issue of the first volume of the #saunders question-compends#, over , copies of these unrivalled publications have been sold. this enormous sale is indisputable evidence of the value of these self-helps to students and physicians. saunders' question-compends. no. . essentials of diseases of the skin including the syphilodermata arranged in the form of questions and answers prepared especially for students of medicine by henry w. stelwagon, m.d., ph.d. professor of dermatology in the jefferson medical college, philadelphia; dermatologist to the howard and philadelphia hospitals, etc. seventh edition, thoroughly revised illustrated philadelphia and london w. b. saunders company set up, electrotyped, printed, . reprinted july, . revised, reprinted, june, . reprinted march, . revised, reprinted, august, . reprinted september, , may, , september, . revised, reprinted january, . reprinted march, . revised, reprinted march, . printed in america press of w. b. saunders company philadelphia preface to seventh edition. in the present--seventh--edition the subject matter, especially as regards the practical part, has been gone over carefully and the necessary corrections and additions made. nineteen new illustrations have been added, a few of the old ones being eliminated. it is hoped that the continued demand for this compend means a widening interest in the study of diseases of the skin, sufficiently keen as to lead to the desire for a still greater knowledge. h.w.s. preface to first edition. much of the present volume is, in a measure, the outcome of a thorough revision, remodelling and simplification of the various articles contributed by the author to pepper's system of medicine, buck's reference handbook of the medical sciences, and keating's cyclopædia of the diseases of children. moreover, in the endeavor to present the subject as tersely and briefly as compatible with clear understanding, the several standard treatises on diseases of the skin by tilbury fox, duhring, hyde, robinson, anderson, and crocker, have been freely consulted, that of the last-named author suggesting the pictorial presentation of the "anatomy of the skin." the space allotted to each disease has been based upon relative importance. as to treatment, the best and approved methods only--those which are founded upon the aggregate experience of dermatologists--are referred to. for general information a statistical table from the transactions of the american dermatological association is appended. h.w.s. contents. page anatomy of the skin the epidermis the blood-vessels the nervous and vascular papillæ the hair and hair-follicle symptomatology primary lesions secondary lesions distribution and configuration relative frequency contagiousness rapidity of cure ointment bases class i.--disorders of the glands hyperidrosis sudamen hydrocystoma anidrosis bromidrosis chromidrosis uridrosis phosphoridrosis seborrh[oe]a (eczema seborrhoicum) comedo milium steatoma class ii.--inflammations erythema simplex erythema intertrigo erythema multiforme erythema nodosum erythema induratum urticaria urticaria pigmentosa dermatitis dermatitis medicamentosa x-ray dermatitis dermatitis factitia dermatitis gangrænosa erysipelas phlegmona diffusa furunculus carbunculus pustula maligna post-mortem pustule framb[oe]sia verruga peruana equinia miliaria pompholyx herpes simplex hydroa vacciniforme epidermolysis bullosa dermatitis repens herpes zoster dermatitis herpetiformis psoriasis pityriasis rosea dermatitis exfoliativa lichen planus pityriasis rubra pilaris lichen scrofulosus eczema prurigo acne acne rosacea sycosis dermatitis papillaris capillitii impetigo contagiosa impetigo herpetiformis ecthyma pemphigus class iii.--hemorrhages purpura scorbutus class iv.--hypertrophies lentigo chloasma keratosis pilaris keratosis follicularis molluscum epitheliale callositas clavus cornu cutaneum verruca nævus pigmentosus ichthyosis onychauxis hypertrichosis [oe]dema neonatorum sclerema neonatorum scleroderma elephantiasis dermatolysis class v.--atrophies albinismus vitiligo canities alopecia alopecia areata atrophia pilorum propria atrophia unguis atrophia cutis class vi.--new growths keloid fibroma neuroma xanthoma myoma angioma telangiectasis lymphangioma rhinoscleroma lupus erythematosus lupus vulgaris tuberculosis cutis ainhum mycetoma perforating ulcer of the foot syphilis cutanea lepra pellagra epithelioma paget's disease of the nipple sarcoma granuloma fungoides class vii.--neuroses hyperæsthesia dermatalgia anæsthesia pruritus class viii.--parasitic affections tinea favosa tinea trichophytina tinea imbricata tinea versicolor erythrasma actinomycosis blastomycetic dermatitis scabies pediculosis pediculosis capitis pediculosis corporis pediculosis pubis cysticercus cellulosæ filaria medinensis ixodes leptus [oe]strus pulex penetrans cimex lectularius culex pulex irritans table showing relative frequency of the various diseases of the skin diseases of the skin. #anatomy of the skin.# [illustration: fig. i. vertical section of the skin--diagrammatic. (_after heitsmann._)] #the epidermis.# [illustration: fig. . _c_, corneous (horny) layer; _g_, granular layer; _m_, mucous layer (rete malpighii). the stratum lucidum is the layer just above the granular layer. nerve terminations--_n_, afferent nerve; _b_, terminal nerve bulbs; _l_, cell of langerhans. (_after ranvier._)] #the blood-vessels.# [illustration: fig. . _c_, epidermis; _d_, corium; _p_, papillæ; _s_, sweat-gland duct. _v_, arterial and venous capillaries (superficial, or papillary plexus) of the papillæ. deep plexus is partly shown at lower margin of the diagram; _vs_--an intermediate plexus, an outgrowth from the deep plexus, supplying sweat-glands, and giving a loop to hair papilla. (_after ranvier._)] #the nervous and vascular papillæ.# [illustration: fig. . _a_, a vascular papilla; _b_, a nervous papilla; _c_, a blood-vessel; _d_, a nerve fibre; _e_, a tactile corpuscle. (_after biesiadecki._)] #the hair and hair-follicle.# [illustration: fig. . _a_, shaft of the hair; _b_, root of the hair; _c_, cuticle of the hair; _d_, medullary substance of the hair. _e_, external layer of the hair-follicle; _f_, middle layer of the hair-follicle; _g_, internal layer of the hair-follicle; _h_, papilla of the hair; _i_, external root-sheath; _j_, outer layer of the internal root-sheath; _k_, internal layer of the internal root-sheath. (_after duhring._)] #symptomatology.# the symptoms of cutaneous disease may be objective, subjective or both; and in some diseases, also, there may be systemic disturbance. #what do you mean by objective symptoms?# those symptoms visible to the eye or touch. #what do you understand by subjective symptoms?# those which relate to sensation, such as itching, tingling, burning, pain, tenderness, heat, anæsthesia, and hyperæsthesia. #what do you mean by systemic symptoms?# those general symptoms, slight or profound, which are sometimes associated, primarily or secondarily, with the cutaneous disease, as, for example, the systemic disturbance in leprosy, pemphigus, and purpura hemorrhagica. #into what two classes of lesions are the objective symptoms commonly divided?# primary (or elementary), and secondary (or consecutive). #primary lesions.# #what are primary lesions?# those objective lesions with which cutaneous diseases begin. they may continue as such or may undergo modification, passing into the secondary or consecutive lesions. #enumerate the primary lesions.# macules, papules, tubercles, wheals, tumors, vesicles, blebs and pustules. #what are macules (maculæ)?# variously-sized, shaped and tinted spots and discolorations, without elevation or depression; as, for example, freckles, spots of purpura, macules of cutaneous syphilis. #what are papules (papulæ)?# small, circumscribed, solid elevations, rarely exceeding the size of a split-pea, and usually superficially seated; as, for example, the papules of eczema, of acne, and of cutaneous syphilis. #what are tubercles (tubercula)?# circumscribed, solid elevations, commonly pea-sized and usually deep-seated; as, for example, the tubercles of syphilis, of leprosy, and of lupus. #what are wheals (pomphi)?# variously-sized and shaped, whitish, pinkish or reddish elevations, of an evanescent character; as, for example, the lesions of urticaria, the lesions produced by the bite of a mosquito or by the sting of a nettle. #what are tumors (tumores)?# soft or firm elevations, usually large and prominent, and having their seat in the corium and subcutaneous tissue; as, for example, sebaceous tumors, gummata, and the lesions of fibroma. #what are vesicles (vesiculæ)?# pin-head to pea-sized, circumscribed epidermal elevations, containing serous fluid; as, for example, the so-called fever-blisters, the lesions of herpes zoster, and of vesicular eczema. #what are blebs (bullæ)?# rounded or irregularly-shaped, pea to egg-sized epidermic elevations, with fluid contents; in short, they are essentially the same as vesicles and pustules except as to size; as, for example, the blebs of pemphigus, rhus poisoning, and syphilis. #what are pustules (pustulæ)?# circumscribed epidermic elevations containing pus; as, for example, the pustules of acne, of impetigo, and of sycosis. #secondary lesions.# #what are secondary lesions?# those lesions resulting from accidental or natural change, modification or termination of the primary lesions. #enumerate the secondary lesions.# scales, crusts, excoriations, fissures, ulcers, scars and stains. #what are scales (squamæ)?# dry, laminated, epidermal exfoliations; as, for example, the scales of psoriasis, ichthyosis, and eczema. #what are crusts (crustæ)?# dried effete masses of exudation; as, for example, the crusts of impetigo, of eczema, and of the pustular and ulcerating syphilodermata. #what are excoriations (excoriationes)?# superficial, usually epidermal, linear or punctate loss of tissue; as, for example, ordinary scratch-marks. #what are fissures (rhagades)?# linear cracks or wounds, involving the epidermis, or epidermis and corium; as, for example, the cracks which often occur in eczema when seated about the joints, the cracks of chapped lips and hands. #what are ulcers (ulcera)?# rounded or irregularly-shaped and sized loss of skin and subcutaneous tissue resulting from disease; as, for example, the ulcers of syphilis and of cancer. #what are scars (cicatrices)?# connective-tissue new formations replacing loss of substance. #what are stains?# discolorations left by cutaneous disease, which stains may be transitory or permanent. #distribution and configuration.# #what do you mean by a patch of eruption?# a single group or aggregation of lesions or an area of disease. #when is an eruption said to be limited or localized?# when it is confined to one part or region. #when is an eruption said to be general or generalized?# when it is scattered, uniformly or irregularly, over the entire surface. #when is an eruption universal?# when the whole integument is involved, without any intervening healthy skin. #when is an eruption said to be discrete?# when the lesions constituting the eruption are isolated, having more or less intervening normal skin. #when is an eruption confluent?# when the lesions constituting the eruption are so closely crowded that a solid sheet results. #when is an eruption uniform?# when the lesions constituting the eruption are all of one type or character. #when is an eruption multiform?# when the lesions constituting the eruption are of two or more types or characters. #when are lesions said to be aggregated?# when they tend to form groups or closely-crowded patches. #when are lesions disseminated?# when they are irregularly scattered, with no tendency to form groups or patches. #when is a patch of eruption said to be circinate?# when it presents a rounded form, and usually tending to clear in the centre; as, for example, a patch of ringworm. #when is a patch of eruption said to be annular?# when it is ring-shaped, the central portion being clear; as, for example, in erythema annulare. #what meaning is conveyed by the term "iris"?# the patch of eruption is made up of several concentric rings. difference of duration of the individual rings, usually slight, tends to give the patch variegated coloration; as, for example, in erythema iris and herpes iris. #what meaning is conveyed by the term "marginate"?# the sheet of eruption is sharply defined against the healthy skin; as, for example, in erythema marginatum, eczema marginatum. #what meaning is conveyed by the qualifying term "circumscribed"?# the term is applied to small, usually more or less rounded, patches, when sharply defined; as, for example, the typical patches of psoriasis. #when is the qualifying term "gyrate" employed?# when the patches arrange themselves in an irregular winding or festoon-like manner; as, for instance, in some cases of psoriasis. it results, usually, from the coalescence of several rings, the eruption disappearing at the points of contact. #when is an eruption said to be serpiginous?# when the eruption spreads at the border, clearing up at the older part; as, for instance, in the serpiginous syphiloderm. #relative frequency.# #name the more common cutaneous diseases and state approximately their frequency.# eczema, . %; syphilis cutanea, . %; acne, . %; pediculosis, %; psoriasis, . %; ringworm, . %; dermatitis, . %; scabies, . %; urticaria, . %; pruritus, . %; seborrh[oe]a, . %; herpes simplex, . %; favus, . %; impetigo, . %; herpes zoster, . %; verruca, . %; tinea versicolor, %. total: eighteen diseases, representing per cent. of all cases met with. (these percentages are based upon statistics, public and private, of the american dermatological association, covering a period of ten years. in private practice the proportion of cases of pediculosis, scabies, favus, and impetigo is much smaller, while acne, acne rosacea, seborrh[oe]a, epithelioma, and lupus are relatively more frequent.) #contagiousness.# #name the more actively contagious skin diseases.# impetigo contagiosa, ringworm, favus, scabies and pediculosis; excluding the exanthemata, erysipelas, syphilis and certain rare and doubtful diseases. [at the present time when most diseases are presumed to be due to bacteria or parasites the belief in contagiousness, under certain conditions, has considerably broadened.] #rapidity of cure.# #is the rapid cure of a skin disease fraught with any danger to the patient?# no. it was formerly so considered, especially by the public and general profession, and the impression still holds to some extent, but it is not in accord with dermatological experience. #ointment bases.# #name the several fats in common use for ointment bases.# lard, petrolatum (or cosmoline or vaseline), cold cream and lanolin. #state the relative advantages of these several bases.# _lard_ is the best all-around base, possessing penetrating properties scarcely exceeded by any other fat. _petrolatum_ is also valuable, having little, if any, tendency to change; it is useful as a protective, but is lacking in its power of penetration. _cold cream_ (ungt. aquæ rosæ) is soothing and cooling, and may often be used when other fatty applications disagree. _lanolin_ is said to surpass in its power of penetration all other bases, but this is not borne out by experience. it is an unsatisfactory base when used alone. it should be mixed with another base in about the proportion of % to %. these several bases may, and often with advantage, be variously combined. #what is to be added to these several bases if a stiffer ointment is required?# simple cerate, wax, spermaceti, or suet; or in some instances, a pulverulent substance, such as starch, boric acid, and zinc oxide. #class i.--disorders of the glands.# #hyperidrosis.# [illustration: fig. . a normal sweat-gland, highly magnified. (_after neumann._) _a_, sweat-coil: _b_, sweat-duct; _c_, lumen of duct; _d_, connective-tissue capsule; _e_ and _f_, arterial trunk and capillaries.] #what is hyperidrosis?# hyperidrosis is a functional disturbance of the sweat-glands, characterized by an increased production of sweat. this increase may be slight or excessive, local or general. #as a local affection, what parts are most commonly involved?# the hands, feet, especially the palmar and plantar surfaces, the axillæ and the genitalia. #describe the symptoms of the local forms of hyperidrosis.# the essential, and frequently the sole symptom, is more or less profuse sweating. if the hands are the parts involved, they are noted to be wet, clammy and sometimes cold. if involving the soles, the skin often becomes more or less macerated and sodden in appearance, and as a result of this maceration and continued irritation they may become inflamed, especially about the borders of the affected parts, and present a pinkish or pinkish-red color, having a violaceous tinge. the sweat undergoes change and becomes offensive. #is hyperidrosis acute or chronic?# usually chronic, although it may also occur as an acute affection. #what is the etiology of hyperidrosis?# debility is commonly the cause in general hyperidrosis; the local forms are probably neurotic in origin. #what is the prognosis?# the disease is usually persistent and often rebellious to treatment; in many instances a permanent cure is possible, in others palliation. relapses are not uncommon. #what systemic remedies are employed in hyperidrosis?# ergot, belladonna, gallic acid, mineral acids, and tonics. constitutional treatment is rarely of benefit in the local forms of hyperidrosis, and external applications are seldom of service in general hyperidrosis. precipitated sulphur, a teaspoonful twice daily, is also well spoken of, combined, if necessary, with an astringent. #what external remedies are employed in the local forms?# astringent lotions of zinc sulphate, tannin and alum, applied several times daily, with or without the supplementary use of dusting-powders. weak solutions of formaldehyde, one to one hundred, are sometimes of value. dusting-powders of boric acid and zinc oxide, to which may be added from ten to thirty grains of salicylic acid to the ounce, to be used freely and often:-- [rx] pulv. ac. salicylici ................. gr. x-xxx. pulv. ac. borici ..................... [dram]v. pulv. zinci oxidi .................... [dram]iij m. diachylon ointment, and an ointment containing a drachm of tannin to the ounce; more especially applicable in hyperidrosis of the feet. the parts are first thoroughly washed, rubbed dry with towels and dusting-powder, and the ointment applied on strips of muslin or lint and bound on; the dressing is renewed twice daily, the parts each time being rubbed dry with soft towels and dusting-powder, and the treatment continued for ten days to two weeks, after which the dusting-powder is to be used alone for several weeks. no water is to be used after the first washing until the ointment is discontinued. one such course will occasionally suffice, but not infrequently a repetition is necessary. faradization and galvanization are sometimes serviceable. repeated mild exposures to the röntgen rays have a favorable influence in some instances. #sudamen.# (_synonym:_ miliaria crystallina.) #what is sudamen?# sudamen is a non-inflammatory disorder of the sweat-glands, characterized by pin-point to pin-head-sized, discrete but thickly-set, superficial, translucent whitish vesicles. #describe the clinical characters.# the lesions develop rapidly and in great numbers, either irregularly or in crops, and are usually to be seen as discrete, closely-crowded, whitish, or pearl-colored minute elevations, occurring most abundantly upon the trunk. in appearance they resemble minute dew-drops. they are non-inflammatory, without areola, never become purulent, and evince no tendency to rupture, the fluid disappearing by absorption, and the epidermal covering by desquamation. #give the course and duration of sudamen.# new crops may appear as the older lesions are disappearing, and the affection persist for some time, or, on the other hand, the whole process may come to an end in several days or a week. in short, the course and duration depend upon the subsidence or persistence of the cause. #what is the anatomical seat of sudamen?# the lesions are formed between the lamellæ of the corneous layer, usually the upper part; and are thought to be due to some change in the character of the epithelial cells of this layer, probably from high temperature, giving rise to a blocking up of the surface outlet. #what is the cause of sudamen?# debility, especially when associated with high fever. the eruption is often seen in the course of typhus, typhoid and rheumatic fevers. #how would you treat sudamen?# by constitutional remedies directed against the predisposing factor or factors, and the application of cooling lotions of vinegar or alcohol and water, or dusting-powders of starch and lycopodium. #hydrocystoma.# #describe hydrocystoma.# hydrocystoma is a cystic affection of the sweat-gland ducts, seated upon the face. the lesions may be present in scant numbers or in more or less profusion. they have the appearance of boiled sago grains imbedded in the skin; the larger lesions may have a bluish color, especially about the periphery. it is not common, and is usually seen in washerwomen and laundresses, or those exposed to moist heat. in some cases it tends to disappear during the winter months. there are no subjective symptoms. treatment consists of puncturing the lesions and application of dusting-powder. avoidance of the exciting cause (moist heat) is important. #anidrosis.# #describe anidrosis.# it is the opposite condition of hyperidrosis, and is characterized by diminution or suppression of the sweat secretion. it occurs to some extent in certain systemic diseases and also in some affections of the skin, such as ichthyosis; nerve-injuries may give rise to localized sweat-suppression. treatment is based upon general principles; friction, warm and hot-vapor baths, electricity and similar measures are of service. #bromidrosis.# (_synonym:_ osmidrosis.) #describe bromidrosis.# bromidrosis is a functional disturbance of the sweat-glands characterized by a sweat secretion of an offensive odor. the sweat production may be normal in quantity or more or less excessive, usually the latter. the condition may be local or general, commonly the former. it is closely allied to hyperidrosis, and may often be considered identical, the odor resulting from rapid decomposition of the sweat secretion. the decomposition and resulting odor have been thought due to the presence of bacteria. #what parts are most commonly affected in bromidrosis?# the feet and the axillæ. #what is the treatment of bromidrosis?# it is essentially the same as that of hyperidrosis (_q. v._), consisting of applications of astringent lotions, dusting-powders, especially those containing boric acid and salicylic acid, and the continuous application of diachylon ointment. in obstinate cases weak formaldehyde solutions, röntgen rays, and high-frequency currents can be tried. #chromidrosis.# #describe chromidrosis.# this is a functional disorder of the sweat-glands characterized by a secretion variously colored, and usually increased in quantity. it is, as a rule, limited to a circumscribed area. the most common color is red. the condition is probably of neurotic origin and tends to recur. (true chromidrosis is extremely rare; most of the cases formerly thought to be such are now known to be examples of pseudochromidrosis.) treatment should be invigorating and tonic, with special reference toward the nervous system. the various methods of local electrization should also be resorted to. mild antiseptic and astringent lotions or dusting powders should also be advised. _red chromidrosis_ or _pseudochromidrosis_ is a condition in which the coloring of the sweat occurs after its excretion and is due to the presence of chromatogenous bacteria which are found attached to the hairs of the part in agglutinated masses. the axilla is the favorite site. treatment consists of frequent soap-and-water washings, and the application of boric acid, resorcin, and corrosive sublimate lotions. #uridrosis.# #describe uridrosis.# uridrosis is a rare condition in which the sweat secretion contains the elements of the urine, especially urea. in marked cases the salt may be noticeable upon the skin as a colorless or whitish crystalline deposit. in most instances it has been preceded or accompanied by partial or complete suppression of the renal functions. #phosphoridrosis.# #describe phosphoridrosis.# phosphoridrosis is a rare condition, in which the sweat is phosphorescent. it has been observed in the later stages of phthisis, in miliaria, and in those who have eaten of putrid fish. #seborrh[oe]a (eczema seborrhoicum).# _synonyms:_ (steatorrh[oe]a; acne sebacea; ichthyosis sebacea; dandruff.) #what is seborrh[oe]a?# seborrh[oe]a is a disease of the sebaceous glands, characterized by an excessive and abnormal secretion of sebaceous matter, appearing on the skin as an oily coating, crusts, or scales. in many cases the sweat-glands are likewise implicated, and the process may also be distinctly, although usually mildly, inflammatory. #at what age is seborrh[oe]a usually observed?# between fifteen and forty. it may, however, occur at any age. #name the parts most commonly affected.# the scalp, face, and (less frequently) the sternal and interscapular regions of the trunk. it is sometimes seen on other parts. #what varieties of seborrh[oe]a are encountered?# seborrh[oe]a oleosa and seborrh[oe]a sicca; not infrequently the disease is of a mixed type. #what are the symptoms of seborrh[oe]a oleosa?# the sole symptom is an unnatural oiliness, variable as to degree. its most common sites are the regions of the scalp, nose, and forehead. in many instances mild rosacea coexists with oily seborrh[oe]a of the nose. #give the symptoms of seborrh[oe]a sicca.# a variable degree of greasy scalines, which may be seated upon a pale, hyperæmic or mildly inflammatory surface. the parts affected are covered scantily or more or less abundantly with somewhat greasy, grayish, or brownish-gray scales. if upon the scalp (_dandruff_, _pityriasis capitis_), small particles of scales are found scattered through the hair, and when the latter is brushed or combed, fall over the shoulders. if upon the face, in addition to the scaliness, the sebaceous ducts are usually seen to be enlarged and filled with sebaceous matter. #describe the symptoms of the ordinary or mixed type.# it is common upon the scalp. the skin is covered with irregularly diffused, greasy, grayish or brownish scales and crusts, in some cases moderate in quantity, in others so great that large irregular masses are formed, pasting the hair to the scalp. if removed, the scales and crusts rapidly re-form. the skin beneath is found slate-colored, hyperæmic or mildly inflammatory, and exceptionally it has in places an eczematous aspect (_eczema seborrhoicum_). extraneous matter, such as dust and dirt, collects upon the parts, and the whole mass may become more or less offensive. there is a strong tendency to falling-out of the hair. itching may or may not be present. [illustration: seborrh[oe]a (eczema seborrhoicum).] #describe the symptoms of seborrh[oe]a of the trunk and other parts.# [illustration: fig. . a normal sebaceous gland in connection with a lanugo hair. (_after neumann._) _a_, capsule; _b_, fatty secretion; _c_, _h_, secreting cells; _d_, root of lanugo hair; _e_, hair-sac; _f_, hair-shaft; _g_, acini of sebaceous gland.] seborrh[oe]a corporis differs in a measure, in its symptoms, from seborrh[oe]a of the scalp and is usually illustrative of the variety known as eczema seborrhoicum; it occurs as one or several irregular or circinate, slightly hyperæmic or moderately inflammatory patches, covered with dirty or grayish-looking greasy scales or crusts, usually moderate in quantity, and upon removal are found to have projections into the sebaceous ducts. it is commonly seen upon the sternal and interscapular regions. it rarely exists independently in these regions, being usually associated with and following the disease on the scalp. it may also invade the axillæ, genitocrural, and other regions. #what is the usual course of seborrh[oe]a?# essentially chronic, the disease varying in intensity from time to time. in occasional instances it disappears spontaneously. #give the cause or causes of seborrh[oe]a.# general debility, anæmia, chlorosis, dyspepsia, and similar conditions are to be variously looked upon as predisposing. in some instances, however, the disease seems to be purely local in character, and to be entirely independent of any constitutional or predisposing condition. the view recently advanced that the disease is of parasitic nature and contagious has been steadily gaining ground. #what is the pathology of seborrh[oe]a?# seborrh[oe]a is a disease of the sebaceous glands, and probably often involving the sweat-glands also; its products, as found upon the skin, consisting of the sebaceous secretion, epithelial cells from the glands and ducts, and more or less extraneous matter. not infrequently evidences of superficial inflammatory action are also to be found, and it is especially for this type that the name eczema seborrhoicum is most appropriate. in long-continued and neglected cases slight atrophy of the gland-structures may occur. #with what diseases are you likely to confound seborrh[oe]a?# upon the scalp, with eczema and psoriasis; upon the face, with lupus erythematosus and eczema; and upon the trunk, with psoriasis and ringworm. as a rule, the clinical features of seborrh[oe]a are sufficiently characteristic to prevent error. #what are the differential points?# eczema, psoriasis, and lupus erythematosus are diseases in which there are distinct _inflammatory symptoms_, such as thickening and infiltration and redness; moreover, psoriasis, and this holds true as to ringworm also, occurs in sharply-defined, circumscribed patches, and lupus erythematosus has a peculiar violaceous tint and an elevated and marginate border. a microscopic examination of the epidermic scrapings would be of crucial value in differentiating from ringworm. quite frequently, especially in the interscapular and sternal regions, the segmental configuration constitutes an important feature of seborrh[oe]a--of the eczema seborrhoicum variety. #what is the prognosis in seborrh[oe]a?# favorable. all types are curable, and when upon the non-hairy regions, usually readily so; upon the scalp it is often obstinate. relapses are not uncommon. in those cases of seborrh[oe]a capitis which have been long-continued or neglected, and attended with loss of hair, this loss may be more or less permanent, although ordinarily much can be done to promote a regrowth (see _treatment of alopecia_). #how would you treat seborrh[oe]a of the scalp?# by constitutional (if indicated) and local remedies; the former having in view correction or modification of the predisposing factor or factors, and the latter removal of the sebaceous accumulations and the application of mildly stimulating antiseptic ointments or lotions. #what constitutional remedies are commonly employed?# the various tonics, such as iron, quinine, strychnia, cod-liver oil, arsenic, the vegetable bitters, laxatives, malt and similar preparations. the line of treatment is to be based upon indications. #how do you free the scalp of the sebaceous accumulations?# in mild types of the disease shampooing with simple castile soap (or any other good toilet soap) and hot water will suffice; in those cases in which there is considerable scale-and crust-formation the tincture of green soap (tinct. saponis viridis) is to be employed in place of the toilet soap, and in some of these latter cases it may be necessary to soften the crusts with a previous soaking with olive oil. the frequency of the shampoo depends upon the conditions. in mild cases once in five or ten days will be sufficiently frequent to keep the parts clean, but in those cases in which there is rapid scale-or crust-production once daily or every second day may at first be demanded. #name the most effectual applications in seborrh[oe]a capitis.# sulphur, ammoniated mercury, salicylic acid, resorcin, and carbolic acid. sulphur is used in the form of an ointment, from twenty grains to one drachm in the ounce. ammoniated mercury, in the form of an ointment, ten to sixty grains to the ounce. salicylic acid, either alone as an ointment, ten to thirty grains to the ounce; or it may often be added with advantage, in the same proportion, to the sulphur or ammoniated mercury ointment above named. resorcin, either as an ointment, ten to thirty grains to the ounce, or as an alcoholic or aqueous lotion, as the following:-- [rx] resorcini ............................ [dram]j-[dram]iss. ol. ricini ........................... [minim]xxx-f[dram]ij. alcoholis ............................ f[oz]iv. m. carbolic acid, to the amount of ten to thirty grains, can be added to this. if an aqueous lotion is desirable, then in the above formula the oleum ricini is replaced with glycerine, and the alcohol with water; three to five minims of glycerine in each ounce is usually sufficient, as a greater quantity makes the resulting lotion sticky. petrolatum alone, or with to per cent. lanolin, is usually the most satisfactory base for the ointments. in some cases of the inflammatory variety the skin is found quite irritable, and the mildest applications are at first only admissible. #how are the remedies to be applied?# a small quantity of the lotion, ointment, or oil is gently applied to the skin; when to the scalp, a lotion or oil can be conveniently applied by means of an eye-dropper. in the beginning of the treatment an application once or twice daily is ordered; later, as the disease becomes less active, once every second or third day. #how is seborrh[oe]a upon other parts to be treated?# in the same general manner as seborrh[oe]a of the scalp, except that the local applications must be somewhat weaker. the several sulphur lotions employed in the treatment of acne (_q. v._) may also be used when the disease is upon these parts. in obstinate patchy cases occasional paintings with a to per cent alcoholic solution of resorcin is curative; following the painting a mild salve should be used. #comedo.# (_synonyms:_ blackheads; flesh-worms.) #what is comedo?# comedo is a disorder of the sebaceous glands, characterized by yellowish or blackish pin-point or pin-head-sized puncta or elevations corresponding to the gland-orifices. #at what age and upon what parts are comedones found?# usually between fifteen and thirty, and upon the face and upper part of the trunk, where they may exist sparsely or in great numbers. they are occasionally associated with oily seborrh[oe]a, the parts presenting a greasy or soiled appearance. exceptionally they occur as distinct, and usually symmetrical, groups upon the forehead or the cheeks. on the upper trunk so-called double and multiple comedo have been noted--the two, three, or even four closely-contiguous blackheads are, beneath the surface, intercommunicable, the dividing duct-walls having apparently disappeared by fusion. #describe an individual lesion.# it is pin-point to pin-head in size, dark yellowish, and usually with a central blackish point (hence the name _blackheads_). there is scarcely perceptible elevation, unless the amount of retained secretion is excessive. upon pressure this may be ejected, the small, rounded orifice through which it is expressed giving it a thread-like shape (hence the name _flesh-worms_). #what is the usual course of comedo?# chronic. the lesions may persist indefinitely or the condition may be somewhat variable. in many instances, either as a result of pressure or in consequence of chemical change in the sebaceous plugs or of the addition of a microbic factor, inflammation is excited and acne results. the two conditions are, in fact, usually associated. [illustration: fig. . demodex folliculorum, x . ventral surface. (_after simon._)] #to what may comedo often be ascribed?# to disorders of digestion, constipation, chlorosis, menstrual disturbance, lack of tone in the muscular fibres of the skin, the infrequent use of soap, and working in a dirty or dusty atmosphere. a small parasite (_demodex folliculorum_, _acarus folliculorum_) is sometimes found in the sebaceous mass, but its presence is without etiological significance, as it is also found in healthy follicles. a microbacillus has been found by several observers, and credited with etiological influence. #what is the pathology of comedo?# the sebaceous ducts or glands, or both, become blocked up with retained secretion and epithelial cells. the dark points which usually mark the lesions are probably due to accumulation of dirt, but may, as some writers maintain, be due to the presence of pigment-granules resulting from chemical change in the sebaceous matter. #is there any difficulty in the diagnosis of comedo?# no. it can scarcely be confounded with milium, as in this latter disease the lesion has no open outlet, no black point, and the contents cannot be squeezed out. #give the prognosis of comedo.# the result of treatment is usually favorable, although the disease is often rebellious. relapses are not uncommon. #how would you treat a case of comedo?# by systemic (if indicated) and local measures. the constitutional treatment aims at correction or palliation of the predisposing conditions, and the external applications have in view a removal of the sebaceous plugs and stimulation of the glands and skin to healthy action. [illustration: fig. . comedo extractor.] #name the systemic remedies commonly employed.# cod-liver oil, iron, quinine, arsenic, nux vomica and other tonics; ergot in those cases in which there is lack of muscular tone, salines and aperient pills in constipation. the digestion is to be looked after and the bowels kept regular; indigestible food of all kinds is to be interdicted. hygienic measures, such as general and local bathing, local massage, calisthenics, and open-air exercise, are of service. #describe the local treatment.# steaming the face or prolonged applications of hot water; washing with ordinary toilet soap and hot water, or, in sluggish cases, using tincture of green soap (tinct. saponis viridis) instead of the toilet soap; removal of the sebaceous plugs by mechanical means, such as lateral pressure with the finger ends or perpendicular pressure with a watch-key with rounded edges, or with an instrument specially contrived for this purpose; and after these preliminary measures, which should be carried out every night, a stimulating sulphur ointment or lotion, such as employed in the treatment of acne (_q. v._), is to be thoroughly applied. the following is valuable:-- [rx] zinci sulphatis, potassi sulphureti, . [=a][=a] ....... [dram]j-[dram]iv. alcoholi ............................. f[oz]ss. aquæ, ................. q.s. ad ...... f[oz]iv. m. should slight scaliness or a mild degree of irritation of the skin be brought about, active external treatment is to be discontinued for a few days and soothing applications made. resorcin, in lotion, to per cent strength, is through the exfoliation it provokes, frequently of value; the resorcin paste referred to in acne can also be used for this purpose. moderately strong applications of the faradic current, repeated once or twice weekly, are sometimes of service; also weak to moderately strong applications of the continuous and high-frequency currents. röntgen-ray treatment can also be resorted to in extremely obstinate cases. in occasional instances sulphur preparations not only fail to do good, but materially aggravate the condition. in such cases, if resorcin preparations also fail, the mercurial lotion and ointment employed in acne may be prescribed. mercurial and sulphur applications should not be used, it need scarcely be said, within a week or ten days of each other, otherwise an increase in the comedones and a slight darkening of the skin result from the formation of the black sulphuret of mercury. #milium.# (_synonyms:_ grutum; strophulus albidus.) #what is milium?# milium consists in the formation of small, whitish or yellowish, rounded, pearly, non-inflammatory elevations situated in the upper part of the corium. #describe the clinical appearances.# the lesions are usually pin-head in size, whitish or yellowish, seemingly more or less translucent, rounded or acuminated, without aperture or duct, are superficially seated in the skin, and project slightly above the surface. they appear about the face, especially about the eyelids; they may occur also, although rarely, upon other parts. but one or several may be present, or they may exist in numbers. #what is the course of milium?# the lesions develop slowly, and may then remain stationary for years. their presence gives rise to no disturbance, and, unless they are large in size or exist in numbers, causes but slight disfigurement. [illustration: fig. . milium needle.] in rare instances they may undergo calcareous metamorphosis, constituting the so-called _cutaneous calculi_. #what is the anatomical seat of milium?# the sebaceous gland (probably one or several of the superficially-situated acini), the duct of which is in some manner obliterated, the sebaceous matter collects, becomes inspissated and calcareous, forming the pin-head lesion. the epidermis is the external covering. #what is the treatment?# the usual plan is to prick or incise each lesion and press out the contents. in some milia it may be necessary also, in order to prevent a return, to touch the base of the excavation with tincture of iodine or with silver nitrate. electrolysis is also effectual. in those cases where the lesions are numerous the production of exfoliation of the epiderm by means of resorcin applications (see acne) is a good plan. #steatoma.# (_synonyms:_ sebaceous cyst; sebaceous tumor; wen.) #describe steatoma.# steatoma, or sebaceous cyst, appears as a variously-sized, elevated, rounded or semi-globular, soft or firm tumor, freely movable and painless, and having its seat in the corium or subcutaneous tissue. the overlying skin is normal in color, or it may be whitish or pale from distention; in some a gland-duct orifice may be seen, but, as a rule, this is absent. #what are the favorite regions for the development of steatoma?# the scalp, face and back. one or several may be present. #what is the course of sebaceous cysts?# their growth is slow, and, after attaining a variable size, may remain stationary. they may exist indefinitely without causing any inconvenience beyond the disfigurement. exceptionally, in enormously distended growths, suppuration and ulceration result. #what is the pathology?# a steatoma is a cyst of the sebaceous gland and duct, produced by retained secretion. the contents may be hard and friable, soft and cheesy, or even fluid, of a grayish, whitish or yellowish color, and with or without a fetid odor; the mass consisting of fat-drops, epidermic cells, cholesterin, and sometimes hairs. #are sebaceous cysts likely to be confounded with gummata?# no. gummata grow more rapidly, are usually painful to the touch, are not freely movable, and tend to break down and ulcerate. #describe the treatment of steatoma.# a linear incision is made, and the mass and enveloping sac dissected out. if the sac is permitted to remain, reproduction almost invariably takes place. #class ii.--inflammations.# #erythema simplex.# #what do you understand by erythema simplex?# erythema simplex is a hyperæmic disorder characterized by redness, occurring in the form of variously-sized and shaped, diffused or circumscribed, non-elevated patches. #name the two general classes into which the simple erythemata are divided.# idiopathic and symptomatic. #what do you include in the idiopathic class?# those erythemas due to external causes, such as cold and heat (_erythema caloricum_), the action of the sun (_erythema solare_), traumatism (_erythema traumaticum_), and the various poisons or chemical irritants (_erythema venenatum_). #what do you include in the symptomatic class?# those rashes often preceding or accompanying certain of the systemic diseases, and those due to disorders of the digestive tract, stomachic and intestinal toxins, to the ingestion of certain drugs, and to use of the therapeutic serums. #describe the symptoms of erythema simplex.# the essential symptom is redness--simple hyperæmia--without elevation or infiltration, disappearing under pressure, and sometimes attended by slight heat or burning; it may be patchy or diffused. in the idiopathic class, if the cause is continued, dermatitis may result. #what is to be said about the distribution of the simple erythemata?# the idiopathic rashes, as inferred from the nature of the causes, are usually limited. the symptomatic erythemas are more or less generalized; desquamation sometimes follows. #describe the treatment of the simple erythemata.# a removal of the cause in idiopathic rashes is all that is needed, the erythema sooner or later subsiding. the same may be stated of the symptomatic erythemata, but in these there is at times difficulty in recognizing the etiological factor; constitutional treatment, if necessary, is to be based upon general principles. intestinal antiseptics are useful in some instances. local treatment, which is rarely needed, consists of the use of dusting-powders or mild cooling and astringent lotions, such as are employed in the treatment of acute eczema (q. v.). #erythema intertrigo.# (_synonym:_ chafing.) #what do you understand by erythema intertrigo?# erythema intertrigo is a hyperæmic disorder occurring on parts where the natural folds of the skin come in contact, and is characterized by redness, to which may be added an abraded surface and maceration of the epidermis. #describe the symptoms of erythema intertrigo.# the skin of the involved region gradually becomes hyperæmic, but is without elevation or infiltration; a feeling of heat and soreness is usually experienced. if the condition continue, the increased perspiration and moisture of the parts give rise to maceration of the epidermis and a mucoid discharge; actual inflammation may eventually result. #what is the course of erythema intertrigo?# the affection may pass away in a few days or persist several weeks, the duration depending, in a great measure, upon the cause. #mention the causes of erythema intertrigo.# the causes are usually local. it is seen chiefly in children, especially in fat subjects, in whom friction and moisture of contiguous parts of the body, usually the region of the neck, buttocks and genitalia, are more common; in such, uncleanliness or the too free use of soap washings will often act as the exciting factor. disorders of the stomach or intestinal canal apparently have a predisposing influence. #what treatment would you advise in erythema intertrigo?# the folds or parts are to be kept from contact by means of lint or absorbent cotton; thin, flat bags of cheese cloth or similar material partly filled with dusting-powder, and kept clean by frequent changes, are excellent for this purpose, and usually curative. cleanliness is essential, but it is to be kept within the bounds of common sense. dusting-powders and cooling and astringent lotions, such as are employed in the treatment of acute eczema (_q. v._), can also be advised. the following lotion is valuable:-- [rx] pulv. calaminæ, pulv. zinci oxidi, .. [=a][=a] ...... [dram]iss. glycerinæ, .......................... [minum]xxx alcoholis, .......................... f[dram]ij aquæ, ............................... oss. m. exceptionally a mild ointment, alone or supplementary to a lotion, acts more satisfactorily. in persistent or obstinate cases attention should also be directed to the state of the general health, especially as regards the digestive tract. #erythema multiforme.# #what is erythema multiforme?# erythema multiforme is an acute, inflammatory disease, characterized by reddish, more or less variegated macules, papules, and tubercles, occurring as discrete lesions or in patches of various size and shape. #upon what parts of the body does the eruption appear?# usually upon the extremities, especially the dorsal aspect, from the knees and elbows down, and about the face and neck; it may, however, be more or less general. #describe the symptoms of erythema multiforme.# with or without precursory symptoms of malaise, gastric uneasiness or rheumatic pains, the eruption suddenly makes its appearance, assuming an erythematous, papular, tubercular or mixed character; as a rule, one type of lesion predominates. the lesions tend to increase in size and intensity, remain stationary for several days or a week, and then gradually fade; during this time there may have been outbreaks of new lesions. in color they are pink, red, or violaceous. slight itching may or may not be present. exceptionally, in general cases, the eruption partakes of the nature of both urticaria and erythema multiforme, and itching may be quite a decided symptom. in some instances there is preceding and accompanying febrile action, usually slight in character; in others there may be some rheumatic swelling of one or more joints. [illustration: fig. . erythema multiforme, in which many of the lesions have become bullous--erythema bullosum.] #what type of the eruption is most common?# the papular, appearing usually upon the backs of the hands and forearms, and not infrequently, also, upon the face, legs and feet. the papules are usually pea-sized, flattened, and of a dark red or violaceous color. #describe the various shapes which the erythematous lesions may assume.# often the patches are distinctly ring-shaped, with a clear centre--_erythema annulare_; or they are made up of several concentric rings, presenting variegated coloring--_erythema iris_; or a more or less extensive patch may spread with a sharply-defined border, the older part tending to fade--_erythema marginatum_; or several rings may coalesce, with a disappearance of the coalescing parts, and serpentine lines or bands result--_erythema gyratum_. #does the eruption of erythema multiforme ever assume a vesicular or bullous character?# yes. in exceptional instances, the inflammatory process may be sufficiently intense to produce vesiculation, usually at the summits of the papules--_erythema vesiculosum_; and in some instances, blebs may be formed--_erythema bullosum_. a vesicular or bullous lesion may become immediately surrounded by a ring-like vesicle or bleb, and outside of this another form; a patch may be made up of as many as several such rings--_herpes iris_. in the vesicular and bullous cases the lips and the mucous membranes of the mouth and nose also may be the seat of similar lesions. #what is the course of erythema multiforme?# acute, the symptoms disappearing spontaneously, usually in one to three or four weeks. in some instances the recurrences take place so rapidly that the disease assumes a chronic aspect; it is possible that such cases are midway cases between this disease and dermatitis herpetiformis. #mention the etiological factors in erythema multiforme.# the causes are obscure. digestive disturbance, rheumatic conditions, and the ingestion of certain drugs are at times influential. intestinal toxins are doubtless important etiological factors in some cases. certain foods, such as are apt to undergo rapid putrefactive or fermentative change, especially pork meats, oysters, fish, crabs, lobsters, etc., are, therefore, not infrequently of apparent causative influence. it is most frequently observed in spring and autumn months, and in early adult life. the disease is not uncommon. #what is the pathology of erythema multiforme?# it is a mildly inflammatory disorder, somewhat similar to urticaria, and presumably due to vasomotor disturbance; the amount of exudation, which is variable, determines the character of the lesions. #name the diagnostic points of erythema multiforme.# the multiformity of the eruption, the size of the papules, often its limitation to certain parts, its course and the entire or comparative absence of itching. it resembles urticaria at times, but the lesions of this latter disease are evanescent, disappearing and reappearing usually in the most capricious manner, are commonly seated about the trunk, and are exceedingly itchy. in the vesicular and bullous types the acute character of the outbreak, the often segmental and ring-like shape, their frequent origin from erythematous papules, and the distribution and association with the more common manifestations, are always suggestive. #what prognosis would you give in erythema multiforme?# always favorable; the eruption usually disappears in ten days to three weeks, although in rare instances new crops may appear from day to day or week to week, and the process last one or two months. one or more recurrences in succeeding years are not uncommon. those rare cases in which vesicular or bullous lesions are also seen on the lips and in the mouth, are more prone to longer duration and to more frequent recurrences. #what remedies are commonly prescribed in erythema multiforme?# quinin, and, if constipation is present, saline laxatives. calcined magnesia is valuable as a laxative. intestinal antiseptics, such as salol, thymol, and sodium salicylate, are valuable in cases probably due to intestinal toxins. in those exceptional instances in which there may be associated febrile action and rheumatic swelling of the joints, the patient should be kept in bed till these symptoms subside. local applications are rarely required, but in those exceptional cases in which itching or burning is present, cooling lotions of alcohol and water or vinegar and water are to be prescribed. the vesicular and bullous types demand mild protective applications, such as used in eczema and pemphigus. #erythema nodosum.# (_synonym:_ dermatitis contusiformis.) #what is erythema nodosum?# erythema nodosum is an inflammatory affection, of an acute type, characterized by the formation of variously-sized, roundish, more or less elevated erythematous nodes. #is there any special region of predilection for the eruption of erythema nodosum?# yes. the tibial surfaces, to which the eruption is often limited; not infrequently, however, other parts may be involved, more especially the arms and forearms. #describe the symptoms of erythema nodosum.# the eruption makes its appearance suddenly, and is usually ushered in with febrile disturbance, gastric uneasiness, malaise, and rheumatic pains and swelling about the joints. the lesions vary in size from a cherry to a hen's egg, are rounded or ovalish, tender and painful, have a glistening and tense look, and are of a bright red, erysipelatous color which merges gradually into the sound skin. at first they are somewhat hard, but later they soften and appear as if about to break down, but this, however, never occurs, absorption invariably taking place. in occasional instances they are hemorrhagic. exceptionally the lesions of erythema multiforme are also present. lymphangitis is sometimes observed. in rare instances symptoms pointing to visceral involvement, to cerebral invasion, and to heart complications have been observed. #are the lesions in erythema nodosum usually numerous?# no. as a rule not more than five to twenty nodes are present. #what is the course of erythema nodosum?# acute. the disease terminating usually in one to three weeks. as the lesions are disappearing they present the various changes of color observed in an ordinary bruise. #what is known in regard to the etiology?# the affection is closely allied to erythema multiforme, and is, indeed, by some considered a form of that disease. it occurs most frequently in children and young adults, and usually in the spring and autumn months. intestinal toxins are thought responsible in some cases. digestive disturbance and rheumatic pain and swellings are often associated with it. by many the malady is thought to be a specific infection. #what is the pathology of erythema nodosum?# the disease is to be viewed as an inflammatory [oe]dema, probably resulting, in some instances at least, from an inflammation of the lymphatics or an embolism of the cutaneous vessels. #what diseases may erythema nodosum resemble?# bruises, abscesses, and gummata. #how are the lesions of erythema nodosum to be distinguished from these several conditions?# by the bright red or rosy tint, the apparently violent character of the process, the number, situation and course of the lesions. #state the prognosis of erythema nodosum.# favorable, recovery usually taking place in ten days to several weeks. #state the treatment to be advised in erythema nodosum.# rest, relative or absolute, depending upon the severity of the case, and an unstimulating diet; internally intestinal antiseptics, quinin and saline laxatives, and locally applications of lead-water and laudanum. #erythema induratum.# (_synonym:_ erythema induratum scrofulosorum.) #what do you understand by erythema induratum?# a rare disease characterized in the beginning by one or more usually deep-seated nodules, and, as a rule, seated in the legs, especially the calf region. the nodules gradually enlarge, the skin becomes reddish, violaceous or livid in color. absorption may take place slowly, or the indurations may break down, resulting in an indolent, rather deep-seated ulcer, closely resembling a gummatous ulcer. the disease is slow and persistent, and is commonly met with in girls and young women, usually of strumous type. it suggests a tuberculous origin. treatment consists in administration of cod-liver oil, phosphorus and other tonics. rest is of service. locally antiseptic applications, and support with roller bandage are to be advised. #urticaria.# (_synonyms:_ hives; nettlerash.) #give a definition of urticaria.# urticaria is an inflammatory affection characterized by evanescent whitish, pinkish or reddish elevations, or wheals, variable as to size and shape, and attended by itching, stinging or pricking sensations. #describe the symptoms of urticaria.# the eruption, erythematous in character and consisting of isolated pea or bean-sized elevations or of linear streaks or irregular patches, limited or more or less general, and usually intensely itchy, makes its appearance suddenly, with or without symptoms of preceding gastric derangement. the lesions are soft or firm, reddish or pinkish-white, with the peripheral portion of a bright red color, and are fugacious in character, disappearing and reappearing in the most capricious manner. in many cases simply drawing the finger over the skin will bring out irregular and linear wheals. in exceptional cases this peculiar property is so pronounced and constant that at any time letters and other symbols may be produced at will, even when such subjects are free from the ordinary urticarial lesions (_urticaria factitia_, _dermatographism_, _autographism_). the mucous membrane of the mouth and throat may also be the seat of wheals and urticarial swellings. #what is the ordinary course of urticaria?# acute. the disease is usually at an end in several hours or days. #does urticaria always pursue an acute course?# no. in exceptional instances the disease is chronic, in the sense that new lesions continue to appear and disappear irregularly from time to time for months or several years, the skin rarely being entirely free (_chronic urticaria_). [illustration: fig. . dermatographism. (_after c.n. davis._)] #are subjective symptoms always present in urticaria?# yes. itching is commonly a conspicuous symptom, although at times pricking, stinging or a feeling of burning constitutes the chief sensation. #in what way may the eruption be atypical?# exceptionally the wheals, or lesions, are peculiar as to formation, or another condition or disease may be associated, hence the varieties known as urticaria papulosa, urticaria hæmorrhagica, urticaria tuberosa, and urticaria bullosa. #describe urticaria papulosa.# urticaria papulosa (formerly called _lichen urticatus_) is a variety in which the lesions are small and papular, developing usually out of the ordinary wheals. they appear as a rule suddenly, rarely in great numbers, are scattered, and after a few hours or, more commonly, days gradually disappear. the itching is intense, and in consequence their apices are excoriated. sometimes the papules are capped with a small vesicle (vesicular urticaria). it is seen more particularly in ill-cared for and badly-nourished young children. #describe urticaria hæmorrhagica.# urticaria hæmorrhagica is characterized by lesions similar to ordinary wheals, except that they are somewhat hemorrhagic, partaking, in fact, of the nature of both urticaria and purpura. #describe urticaria tuberosa.# in urticaria tuberosa the lesions, instead of being pea- or bean-sized, as in typical urticaria, are large and node-like (also called _giant urticaria_). #what is acute-circumscribed [oe]dema?# in rare instances there occurs, along with the ordinary lesions of the disease or as its sole manifestation, sudden and evanescent swelling of the eyelids, ears, lips, tongue, hands, fingers, or feet (_urticaria [oe]dematosa_, _acute_ _circumscribed [oe]dema_, _angioneurotic [oe]dema_). one or several of these parts only may be affected at the one attack; in recurrences, so usual in this variety, the same or other parts may exhibit the manifestation. (these [oe]dematous swellings occurring alone might be looked upon, as they are by most observers, as an independent affection, but its close relationship to ordinary urticaria is often evident.) #describe urticaria bullosa.# urticaria bullosa is a variety in which the inflammatory action has been sufficiently great to give rise to fluid exudation, the wheals resulting in the formation of blebs. #what is the etiology of urticaria?# any irritation from disease, functional or organic, of any internal organ, may give rise to the eruption in those predisposed. gastric derangement from indigestible or peculiar articles of food, intestinal toxins, and the ingestion of certain drugs are often provocative. the so-called "shell-fish" group of foods play an important etiological part in some cases. idiosyncrasy to certain articles of food is also responsible in occasional instances. various rheumatic and nervous disorders are not infrequently associated with it, and are doubtless of etiological significance. external irritants, also, in predisposed subjects, are at times responsible. #what is the pathology of urticaria?# anatomically a wheal is seen to be a more or less firm elevation consisting of a circumscribed or somewhat diffused collection of semi-fluid material in the upper layers of the skin. the vasomotor nervous system is probably the main factor in its production; dilatation following spasm of the vessels results in effusion, and in consequence, the overfilled vessels of the central portion are emptied by pressure of the exudation and the central paleness results, while the pressed-back blood gives rise to the bright red periphery. #from what diseases is urticaria to be differentiated?# from erythema simplex, erythema multiforme, erythema nodosum, and erysipelas. #mention the diagnostic points of urticaria.# the acuteness, character of the lesions, their evanescent nature, the irregular or general distribution, and the intense itching. #what is the prognosis in urticaria?# the acute disease is usually of short duration, disappearing spontaneously or as the result of treatment, in several hours or days; it may recur upon exposure to the exciting cause. the prognosis of chronic urticaria is to be guarded, and will depend upon the ability to discover and remove or modify the predisposing condition. #what systemic measures are to be prescribed in acute urticaria?# removal of the etiological factor is of first importance. this will be found in most cases to be gastric disturbance from the ingestion of improper or indigestible food, and in such cases a saline purgative is to be given, probably the best for this purpose being the laxative antacid, magnesia; or if the case is severe and food is still in the stomach, an emetic, such as mustard or ipecac, will act more promptly. alkalies, especially sodium salicylate, and intestinal antiseptics are useful. calcium chloride in doses of five to twenty grains should be tried in obstinate cases. the diet should be, for the time, of a simple character. #what systemic measures are to be prescribed in chronic and recurrent urticaria?# the cause must be sought for and treatment directed toward its removal or modification. treatment will, therefore, depend upon indications. in obscure cases, quinine, sodium salicylate, arsenic, pilocarpine, _atropia_, potassium bromide, calcium chloride, and ichthyol are to be variously tried; general galvanization is at times useful, as is also a change of scene and climate. a proper dietary and the maintenance of free action of the bowels, preferably, as a rule, with a saline laxative, is of great importance in these chronic cases. in acute circumscribed [oe]dema treatment is essentially that of urticaria, the diet being given special attention. #what external applications would you advise for the relief of the subjective symptoms?# cooling lotions of alcohol and water or vinegar and water; lotions of carbolic acid, one to three drachms to the pint; of thymol, one-fourth to one drachm to the pint of alcohol and water; of liquor carbonis detergens, one to three ounces to the pint of water, or the following:-- [rx] acidi carbolici, ..................... [dram]j-[dram]iij acidi borici, ........................ [dram]iv glycerinæ, ........................... f[dram]j alcoholis, ........................... f[oz]ij aquæ, ................................ f[oz]xiv. m. alkaline baths are also useful, and may advantageously be followed by dusting-powders of starch and zinc oxide. #urticaria pigmentosa.# (_synonym:_ xanthelasmoidea.) #describe urticaria pigmentosa.# urticaria pigmentosa is a rare disease, variously viewed as an unusual form of urticaria and as an urticaria-like eruption in which there is an element of new growth in the lesions. it begins usually in infancy or early childhood and continues for months or years, and is characterized by slightly, moderately, or intensely itchy, wheal-like elevations, which are more or less persistent and leave yellowish, orange-colored, greenish or brownish stains. exceptionally subjective symptoms are almost entirely absent. anatomical studies show that the lesion has in some respects the structure of an ordinary wheal, with [oe]dema and pigment deposit in the epidermal portion, and cellular infiltration made up principally of mast-cells. [illustration: fig. . urticaria pigmentosa.] the nature of the disease is obscure and treatment unsatisfactory. ordinarily as early youth or adult life is reached it spontaneously disappears. the treatment advised is usually on the same lines as that of chronic urticaria. #dermatitis.# #what is implied by the term dermatitis?# dermatitis, or inflammation of the skin, is a term employed to designate those cases of cutaneous disturbance, usually acute in character, which are due to the action of irritants. #mention some examples of cutaneous disturbance to which this term is applied.# the dermatic inflammation due to the action of excessive heat or cold, to caustics and other chemical irritants, and to the ingestion of certain drugs. #what several varieties are commonly described?# dermatitis traumatica, dermatitis calorica, dermatitis venenata, and dermatitis medicamentosa. #describe dermatitis traumatica.# under this head are included all forms of cutaneous inflammation due to traumatism. to the dermatologist the most common met with is that produced by the various animal parasites and from continued scratching; in such, if the cause has been long-continued and persistent, a variable degree of inflammatory thickening of the skin and pigmentation result, the latter not infrequently being more or less permanent. the inflammation due to tight-fitting garments, bandages, to constant pressure (as bed-sores), etc., also illustrates this class. #what is the treatment of dermatitis traumatica?# removal of the cause, and, if necessary, the application of soothing ointments or lotions; in bed-sores, soap plaster, plain or with one to five per cent. of ichthyol. #what is dermatitis calorica?# cutaneous inflammation, varying from a slight erythematous to a gangrenous character, produced by excessive heat (_dermatitis ambustionis_, _burns_) or cold (_dermatitis congelationis_, _frostbite_). #give the treatment of dermatitis calorica.# in burns, if of a mild degree, the application of sodium bicarbonate, as a powder or saturated solution, is useful; in the more severe grade, a two- to five-per-cent. solution will probably be found of greater advantage. other soothing applications may also be employed. in recent years a one-per-cent. solution of picric acid has been commended for the slighter burns of limited extent. upon the whole, there is nothing yet so generally useful and soothing in these cases as the so-called carron oil; in some cases more valuable with / to minim of carbolic acid added to each ounce. in frostbite, seen immediately after exposure, the parts are to be brought gradually back to a normal temperature, at first by rubbing with snow or applying cold water. subsequently, in ordinary chilblains, stimulating applications, such as oil of turpentine, balsam of peru, tincture of iodine, ichthyol, and strongly carbolized ointments are of most benefit. if the frostbite is of a vesicular, pustular, bullous, or escharotic character, the treatment consists in the application of soothing remedies, such as are employed in other like inflammatory conditions. #what do you understand by dermatitis venenata?# all inflammatory conditions of the skin due to contact with deleterious substances such as caustic, chemical irritants, iodoform, etc., are included under this head, but the most common causes are the rhus plants--_poison ivy_ (or _poison oak_) and _poison sumach_ (_poison dogwood_). mere proximity to these plants will, in some individuals, provoke cutaneous disturbance (_rhus poisoning_, _ivy poisoning_), although they may be handled by others with impunity. many other plants are also known to produce cutaneous irritation in certain subjects; among these may be mentioned the nettle, primrose, cowhage, smartweed, balm of gilead, oleander, and rue. the local action of iodoform (_iodoform dermatitis_) in some individuals is that of a decided irritant, bringing about a dermatitis, which often spreads much beyond the parts of application, and which in those eczematously inclined may result in a veritable and persistent eczema. #describe the symptoms of rhus poisoning.# the symptoms appear usually soon after exposure, and consist of an inflammatory condition of the skin of an eczematous nature, varying in degree from an erythematous to a bullous character, and with or without [oe]dema and swelling. as a rule, marked itching and burning are present. the face, hands, forearms and genitalia are favorite parts, although it may in many instances involve a greater portion of the whole surface. #what is the course of rhus poisoning?# it runs an acute course, terminating in recovery in one to six weeks. in those eczematously inclined, however, it may result in a veritable and persistent form of that disease. #how would you treat rhus poisoning?# by soothing and astringent applications, such as are employed in acute eczema (_q. v._), which are to be used freely. among the most valuable are: a lotion of fluid extract of grindelia robusta, one to two drachms to four ounces of water; lotio nigra, either alone or followed by the oxide-of-zinc ointment; a saturated solution of boric acid, with a half to two drachms of carbolic acid to the pint; a lotion of zinc sulphate, a half to four grains to the ounce; weak alkaline lotions; cold cream, petrolatum, and oxide-of-zinc ointments. #how would you treat the dermatitis due to other deleterious substances of this class?# by applications of a soothing and protective character, similar to those used in eczema and burns. #dermatitis medicamentosa.# #what do you understand by dermatitis medicamentosa?# under this head are included all eruptions due to the ingestion or absorption of certain drugs. in rare instances one dose will have such effect; commonly, however, it results only after several days' or weeks' continued administration. with some drugs such effect is the rule, with others it is exceptional, nor are all individuals equally susceptible. #how is the eruption produced in dermatitis medicamentosa?# in some instances it is probably due to the elimination of the drug through the cutaneous structures; in others, to the action of the drug upon the nervous system. the view that the drug acts as a toxin or generates some toxin or irritant material in the blood, to which the eruptive phenomena may be due, has also been advanced. [illustration: dermatitis medicamentosa. bullous dermatitis from iodide of potassium.] #what is the character of the eruption in dermatitis medicamentosa?# it may be erythematous, papular, urticarial, vesicular, pustular or bullous, and, if the administration of the drug is continued, even gangrenous. #name the more common drugs having such action.# antipyrin, arsenic, atropia (or belladonna), bromides, chloral, copaiba, cubebs, digitalis, iodides, mercury, opium (or morphia), quinine, salicylic acid, stramonium, acetanilid, sulphonal, phenacetin, turpentine, many of the new coal-tar derivatives, etc. #state frequency and types of eruption due to the ingestion of antipyrin.# not uncommon. _erythematous_, morbilliform and erythemato-papular; itching is usually present and moderate desquamation may follow. acetanilid, sulphonal, phenacetin, and other drugs of this class may provoke like eruptions. #mention frequency and types of eruption due to the ingestion of arsenic.# rare. erythematous, erythemato-papular; exceptionally, herpetic, and pigmentary. herpes zoster has been thought to follow its use. keratosis of the palms and soles has also been occasionally observed, which, in rare instances, has developed into epithelioma. #mention frequency and types of eruption due to the ingestion of atropia (or belladonna).# not uncommon. _erythematous_ and _scarlatinoid_; usually no febrile disturbance, and desquamation seldom follows. #give frequency and types of cutaneous disturbance following the administration of the bromides (bromine).# common. _pustular_, sometimes furuncular and carbuncular and superficially ulcerative. in exceptional instances papillomatous or vegetating lesions have been observed. co-administration of arsenic or potassium bitartrate is thought to have a preventive influence in some cases. #state frequency and types of cutaneous disturbance due to the administration of chloral.# occasional. scarlatinoid and urticarial, and exceptionally purpuric; in rare instances, if drug is continued, eruption becomes vesicular, hemorrhagic, ulcerative and even gangrenous. #state frequency and types of eruption following the administration of copaiba.# not uncommon. _urticarial_, erythemato-papular and _scarlatinoid_. #mention frequency and types of eruption resulting from the ingestion of cubebs.# uncommon. erythematous and small papular. [illustration: fig. . a somewhat rare form of eruption from the ingestion of iodine compounds. (_after j.c. mcguire._)] #mention frequency and types of eruption resulting from the administration of digitalis.# exceptional. scarlatinoid and papular. #state frequency and types of eruption resulting from the iodides (iodine).# common. _pustular_, but may be erythematous, papular, vesicular, bullous, tuberous, purpuric and hemorrhagic. co-administration of arsenic or potassium bitartrate is thought to have a preventive influence in some cases. #give the frequency and types of eruption observed to follow the administration of mercury.# exceptional. erythematous and erysipelatous. #give the frequency and types of the cutaneous disturbance following the ingestion of opium (or morphia).# not uncommon. erythematous and _scarlatinoid_, and sometimes urticarial. #mention the frequency and the types of eruption following the administration of quinine.# not infrequent. usually _erythematous_, but may be urticarial, erythemato-papular, and even purpuric. there is, in some instances, preceding or accompanying systemic disturbance. furfuraceous or lamellar desquamation often follows. #state frequency and types of eruption resulting from the ingestion of salicylic acid.# not common. erythematous and urticarial; exceptionally, vesicular, pustular, bullous, and ecchymotic. #give frequency and type of cutaneous disturbance due to the administration of stramonium.# not common. erythematous. #state frequency and types of eruption resulting from the administration of turpentine.# not uncommon. _erythematous_, and small-papular; exceptionally vesicular. #x-ray dermatitis.# #what several grades of x-ray dermatitis (x-ray burns, rontgen-ray burns) are observed?# three grades are usually described: erythema, superficial vesication, and necrosis. the first and second may come on shortly--a few hours to several days--after exposure; occasionally later. the third grade may present also in the first several days, but in many cases one to several weeks may elapse before it appears; it is quite commonly preceded by erythema and vesication. the necrosis may be superficial or deep, and quite usually results in a persistent ulcer covered by a leathery coating; it is usually painful. [illustration: fig. . _x_-ray burn] #give the prognosis and treatment of x-ray dermatitis.# the first grade--the erythematous--usually disappears in one to ten days; the second grade requires one to several weeks, and may be quite sore and tender; the severe or necrotic burns are persistent, sometimes lasting for months and several years, with little tendency to spontaneous disappearance, and rebellious to treatment. treatment of the milder types is that of erythema (_q. v._); the necrotic type occasionally demands thorough curetting and skin-grafting before it will heal. #dermatitis factitia.# (_synonym:_ feigned eruptions.) #what do you understand by feigned eruptions?# feigned, or artificial, eruptions, occasionally met with in hysterical females and in others, are produced, for the purpose of exciting sympathy or of deception, by the action of friction, cantharides, acids or strong alkalies; the cutaneous disturbance may, therefore, be erythematous, vesicular, bullous, or gangrenous. it is usually limited in extent, and, as a rule, seen only on parts easily reached by the hands. [illustration: fig. . dermatitis factitia--note the unusually uniform and regular character and arrangement of the lesions.] #dermatitis gangrænosa.# #what do you understand by dermatitis gangrænosa?# dermatitis gangrænosa (_erythema gangrænosum_, _raynaud's disease_, _spontaneous gangrene_) is an exceedingly rare affection, characterized by the formation of gangrenous spots and patches. it may be idiopathic or symptomatic. some of these cases, especially in hysterical subjects, belong under the "feigned eruptions," being self-produced. as an idiopathic disease, it begins as erythematous, dark-red spots--usually preceded and accompanied by mild or grave systemic disturbance--which gradually pass into gangrene and sloughing; the eventual termination may be fatal, or recovery may take place. as a symptomatic disease, it is occasionally met with in diabetes and in grave cerebral and spinal affections. in raynaud's disease (symmetric gangrene) the parts affected are the extremities, such as fingers and toes, the ears and nose, only occasionally other parts. the first symptoms observed are coldness and paleness of the part; followed sooner or later by congestion of a dark red, livid, or bluish color, with sometimes swelling, and tenderness and shooting pains. the termination is usually in gangrene of a dry character, with, in some instances, vesicles and blebs along the edges; in other cases the parts become atrophied, withered, and indurated. treatment is based upon general principles. #erysipelas.# #what is erysipelas?# erysipelas is an acute specific inflammation of the skin and subcutaneous tissue, commonly of the face, characterized by shining redness, swelling, [oe]dema, heat, and a tendency in some cases to vesicle- and bleb-formation, and accompanied by more or less febrile disturbance. #describe the symptoms and course of erysipelas.# a decided rigor or a feeling of chilliness followed by febrile action usually ushers in the cutaneous disturbance. the skin at a certain point or part, commonly where there is a lesion of continuity, becomes bright red and swollen; this spreads by peripheral extension, and in the course of several hours involves a portion or the whole region. the parts are shining red, swollen, of an elevated temperature, and sharply defined against the sound skin. after several days or a week, during which time there is usually continued mild or severe febrile action, the process begins to subside, and is followed by epidermic desquamation. in some cases vesicles and blebs may be present; in other cases the disease seriously involves the deeper parts, and is accompanied by grave constitutional symptoms. in exceptional instances sloughing takes place. a mild, transitory, limited, and often recurrent erysipelatous condition of the outlet and immediate neighborhood of one or both nostrils is met with, taking its origin from an inflammation of the hair-follicles just inside the margin of the nose; constitutional symptoms are usually wanting. somewhat similar, doubtless, is the erysipelatous inflammation (_erysipeloid_) observed on the fingers and hands of butchers, etc., starting from a wound, apparently as a result of infection from putrid meat or fish. #what is erysipelas migrans (or erysipelas ambulans)?# a variety of erysipelas which, after a few hours or days, disappears at one region and appears at another, and so continues for one or several weeks. #what is the cause of erysipelas?# the disease is due to a specific streptococcus--the streptococcus of fehleisen. depression of the vital forces and local abrasions are predisposing factors. #state the diagnostic points.# the character of the onset, the shining redness and swelling, the sharply-defined border, and the accompanying febrile disturbance. #what is the prognosis in erysipelas?# in most instances the disease runs a favorable course, terminating in recovery in one to three weeks. exceptionally, in severe cases, a fatal termination ensues. #what is the treatment of erysipelas?# _internally_, a purge, followed by the tincture of the chloride of iron and quinia, and stimulants if needed. _locally_, one to three per cent. carbolic-acid lotion or ointment, a saturated solution of boric acid, or a ten- to twenty-per-cent. aqueous solution or ointment of ichthyol may be employed. in some cases the spread of the disease is apparently controlled by painting the bordering healthy skin with a ring of tincture of iodine or strong solution of nitrate of silver. #phlegmona diffusa.# #what do you understand by phlegmona diffusa?# phlegmona diffusa is a more or less extensive inflammation of the cutaneous and subcutaneous tissues presenting symptoms partaking of the nature of both deep erysipelas and flat carbuncles, and usually attended with varying constitutional disturbance. suppuration at several points takes place, and sloughing may ensue. recovery usually finally results, but a fatal issue is possible. treatment is based upon general principles. #furunculus.# (_synonyms:_ furuncle; boil.) #define furunculus.# furunculus, or boil, is an acute, deep-seated, inflammatory, circumscribed, rounded or more or less acuminated, firm, painful formation, usually terminating in central suppuration. #describe the symptoms and course.# a boil begins as a small, rounded or imperfectly defined reddish spot, or as a small, superficial pustule; it increases in size, and when well advanced appears as a pea or cherry-sized, circumscribed, reddish elevation, with more or less surrounding hyperæmia and swelling; it is painful and tender, and ends, in the course of several days or a week, in the formation of a central slough or "_core_," which finally involves the central overlying skin (_pointing_). one or several may be present, gradually maturing and disappearing. insignificant scarring may remain. in some cases sympathetic constitutional disturbance is noticed. #what is a blind boil?# a sluggish boil exhibiting little, if any, tendency to point or break. #what is furunculosis?# furunculosis is that condition in which boils, singly or in crops, continue to appear, irregularly, for weeks or months. #state the etiology of furuncle.# a depraved state of the general health is often to be considered as a predisposing factor. persistent furunculosis is not infrequent in diabetes mellitus. the immediate exciting cause is the entrance into the follicle of a microbe, the staphylococcus pyogenes aureus. it is not improbable, however, that boils may also be due to other pus-producing organisms. workmen in paraffin oils or other petroleum products often present numerous furuncles and cutaneous abscesses. conditions favoring a persistent miliaria have also a causative influence, especially observed in infants and young children. in these latter, especially among the poorer classes, sluggish boils or subcutaneous abscesses about the scalp in hot weather, are not at all infrequent. #what is the pathology of furuncle?# a boil is an inflammatory formation having its starting point in a sebaceous-gland, sweat-gland, or hair-follicle. the core, or central slough, is composed of pus and of the tissue of the gland in which it had its origin. #how would you distinguish a boil from a carbuncle?# a boil is comparatively small, rounded or acuminate, and has but one point of suppuration; a carbuncle is large, flattened, intensely painful, often with grave systemic disturbance, and has, moreover, several centres of suppuration. #state the prognosis.# when occurring in crops (furunculosis) the affection is often rebellious; recovery, however, finally resulting. #what is the method of treatment of furunculus?# if there be but one lesion, with no tendency to the appearance of others, local treatment alone is usually employed. if, however, several or more are present, or if there is a tendency to successive development, both constitutional and local measures are demanded. #name the internal remedies employed.# such nutrients and tonics as cod-liver oil, malt, quinine, strychnia, iron and arsenic; in some instances calx sulphurata, one-tenth- to one-fourth-grain doses every three or four hours has been thought to be of service. brewers' yeast has been recently again brought forward as a remedy of value. #what is the external treatment?# local treatment consists in the beginning, with the hope of aborting the lesion, of the application of carbolic acid to the central portion, or the use of a twenty-five-per-cent. ointment of ichthyol applied as a plaster:-- [rx] ichthyol, ............................ [dram]j emp. plumbi, ........................... [dram]ij emp. resinæ, ........................... [dram]j. m. or the injection of a five-per-cent. solution of carbolic acid into the apex of the boil may be tried if the formation is more advanced. if suppuration is fully established, evacuation of the contents, followed by antiseptic applications, constitutes the best method. a saturated solution of boric acid or a lotion of corrosive sublimate (one to three grains to the ounce) applied to the immediate neighborhood of the boil or boils tends to prevent the formation of new lesions. frequent washing of the parts with soap and water or tincture of green soap and water is also a preventive measure of value. in repeatedly infected areas, mild exposures to _x_-rays, at intervals of a few days, will often prove of curative value. #carbunculus.# (_synonyms:_ anthrax; carbuncle.) #what is carbuncle?# a carbuncle is an acute, usually egg to palm-sized, circumscribed, phlegmonous inflammation of the skin and subcutaneous structures, terminating in a slough. #at what age and upon what parts is carbuncle usually observed?# in middle and advanced life, and more commonly in men. it is seen most frequently at the nape of the neck and upon the upper part of the back. #what are the symptoms and course of carbuncle?# there is rarely more than one lesion present. it begins, usually with preceding and accompanying malaise, chilliness and febrile disturbance, as a firm, flat, inflammatory infiltration in the deeper skin and subcutaneous tissue, spreading laterally and finally involving an area of one to several inches in diameter. the infiltration and swelling increase, the skin becomes of dark red color, and sooner or later, usually at the end of ten days or two weeks, softening and suppuration begin to take place, the skin finally giving away at several points, through which sanious pus exudes; the whole mass finally sloughs away either in portions or in its entirety, resulting in a deep ulcer, which slowly heals and leaves a permanent cicatrix. in some cases, especially in old people, constitutional disturbance of a grave character is noted, septicæmia is developed, and a fatal result may ensue. #what is the cause of carbuncle?# the same causes are considered to be operative in carbunculus as in furuncle; general debility and depression, from whatever cause, predisposing to its formation, and the introduction of a microbe, probably the same as in furunculus, being at present looked upon as the exciting factor. #what is the pathology?# the inflammation starts simultaneously from numerous points, from the hair-follicles, sweat-glands or sebaceous glands. the inflammatory centres break down, and the pus finds its way to the surface; finally the process ends in gangrene of the whole area. #how would you distinguish carbuncle from a boil?# by its flat character, greater size, and multiple points of suppuration. #what is the prognosis of carbuncle?# occurring in those greatly debilitated or in late life, and in those cases in which two or more lesions exist, or when seated about the head, the prognosis is always to be guarded, as a fatal result is not uncommon. in fact, in every instance the disease is to be considered of possible serious import. #what constitutional treatment is usually employed in carbuncle?# a full nutritious diet, the use of such remedies as iron, quinia, nux vomica, with malt and stimulants, if indicated. calx sulphurata, one-tenth to one-fourth grain every two or three hours, appears, in some instances, to have a beneficial effect. if the pain is severe, morphia or chloral should be given. #what external measures are employed?# in the early part of the formation, injection of a five or ten per cent. carbolic acid solution, or covering the whole area with a twenty-five per cent. ichthyol ointment, may be employed. when it has broken down the pus may be drawn out with a cupping-glass, and carbolized glycerine or carbolized water introduced into each opening, and the ichthyol ointment superimposed. if the whole part has sloughed, it should be removed as rapidly as possible, and antiseptic dressings used. or, if its progress is slow, and grave systemic disturbance be present, the whole part may be incised and curetted, and then treated antiseptically. mild exposure to the _x_-rays is also to be commended. #pustula maligna.# (_synonyms:_ anthrax; malignant pustule.) #what is malignant pustule?# malignant pustule is a furuncle- or carbuncle-like lesion resulting from inoculation of the virus generated in animals suffering from splenic fever, or "charbon," and is accompanied by constitutional symptoms of more or less gravity. a fatal termination is not unusual. #what is the cause of pustula maligna?# the disease is due to the presence of the bacillus anthracis. #what is the treatment of malignant pustule?# early excision or destruction with caustic potash, with subsequent antiseptic dressings; and internally the free use of stimulants and tonics. #post-mortem pustule.# (_synonym:_ dissection wound.) #describe post-mortem pustule.# post-mortem pustule develops at the point of inoculation, beginning as an itchy red spot, becoming vesico-pustular, and later pustular, with usually a broad inflammatory base, and accompanied with more or less pain and redness and not infrequently lymphangitis, erysipelatous swelling, and slight or severe sympathetic constitutional disturbance. #what is the treatment of post-mortem pustule?# treatment consists in opening the pustule and thorough cauterization, and the subsequent use of antiseptic applications or dressings. _internally_ quinia and stimulants if indicated. #framb[oe]sia.# (_synonyms:_ yaws; pian.) #describe framb[oe]sia.# framb[oe]sia is an endemic, contagious disease met with in tropical countries, characterized by the appearance of variously-sized papules, tubercles, and tumors, which, when developed, resemble currants and small raspberries, and finally break down and ulcerate. it is accompanied by constitutional symptoms of variable severity. hygienic measures, good food, tonics, and antiseptic and stimulating applications are curative. #verruga peruana.# (_synonyms:_ peruvian warts; carrion's disease; oroya fever.) #describe verruga peruana.# a specific inoculable affection endemic in some valleys of the western andes, in peru, and characterized by a prodromal febrile period and subsequent outbreak of peculiar pin-head- to pea-sized, or larger, bright reddish, rounded, wart-like elevations. the prodromal symptoms, of an irregular malarial or typhoid type, with associated rheumatic and muscular pains, may last for weeks or several months, usually abating when eruption presents. the lesions may be crowded together in great bunches. the face and limbs are favorite localities. the disease is inoculable and thought to be due to a bacillus. the fatality varies between and per cent. tonics and stimulants are prescribed. #equinia.# (_synonyms:_ farcy; glanders.) #what is equinia, or glanders?# a rare contagious specific disease of a malignant type, derived from the horse, and characterized by grave constitutional symptoms, inflammation of the nasal and respiratory passages, and a deep-seated papulo-pustular, or tubercular, nodular (_farcy buds_), ulcerative eruption. a fatal issue is not uncommon. it is due to a micro-organism. treatment, both local and constitutional, is based upon general principles. #miliaria.# (_synonyms:_ prickly heat; heat rash; lichen tropicus; red gum; strophulus.) #what do you understand by miliaria?# an acute mildly inflammatory disorder of the sweat-glands, characterized by the appearance of minute, discrete but closely crowded papules, vesico-papules, and vesicles. #describe the symptoms of miliaria.# the eruption, consisting of pin-point to millet-seed-sized papules, vesico-papules, vesicles, or a mixture of these lesions, discrete but usually numerous and closely crowded, appears suddenly, occurring upon a limited portion of the surface, or, as commonly observed, involving a greater part or the whole integument. the trunk is a favorite locality. the papular lesions are pinkish or reddish, and the vesicles whitish or yellowish, surrounded by inflammatory areola, thus giving the whole eruption a bright red appearance--_miliaria rubra_. later, the areolæ fade, the transparent contents of the vesicles become somewhat opaque and yellowish-white, and the eruption has a whitish or yellowish cast--_miliaria alba_. in long-continued cases, especially in children, boils and cutaneous abscesses sometimes develop; and it may also develop into a true eczema. itching, or a feeling of burning, slight or intense, is usually present. #what is the course of the eruption?# the vesicles show no disposition to rupture, but dry up in a few days or a week, disappearing by absorption and with slight subsequent desquamation; the papular lesions gradually fade away, and the affection, if the exciting cause has ceased to act, terminates. #what is the cause of miliaria?# excessive heat. debilitated individuals, especially children, are more prone to an attack. being too warmly clad is often causative. #what is the nature of the disease?# the affection is considered to be due to sweat-obstruction, with mild inflammatory symptoms as a cause or consequence, congestion and exudation taking place about the ducts, giving rise to papules or vesicles, according to the intensity of the process. #how would you distinguish miliaria from papular and vesicular eczema, and from sudamen?# the papules of eczema are larger, more elevated, firmer, slower in their evolution, of longer duration, and are markedly itchy. the vesicles of eczema are usually larger, tend to become confluent, and also to rupture and become crusted; there is marked itchiness, and the inflammatory action is usually severe and persistent. in sudamen there is absence of inflammatory symptoms. #what is the prognosis of miliaria?# the affection, under favorable circumstances, disappears in a few days or weeks. if the cause persists, as for instance, in infants or young children too warmly clad, it may result in eczema. #what is the treatment of miliaria?# removal of the cause, and in debilitated subjects the administration of tonics; together with the application of cooling and astringent lotions, as the following:-- [rx] aeidi carbolici, ..................... [dram]ss-[dram]j acidi borici, ........................ [dram]iv glycerinæ, ........................... f[dram]j alcoholis, ........................... f[oz]ij aquæ, ................................ [oz]xiv. m. this is sometimes more efficient if zinc oxide, six to eight drachms, is added. lotions of alcohol and water or vinegar and water, and also the various lotions used in acute eczema, are often employed with relief. dusting-powders of starch, boric acid, lycopodium, talc, and zinc oxide are also valuable; the following combination is satisfactory:-- [rx] pulv. acidi borici, pulv. talci veneti, pulv. zinci oxidi, pulv. amyli, .............[=a][=a].....[dram]ij. m. probably the best plan is to use a lotion and a dusting-powder conjointly; dabbing on the wash freely, allowing it to dry, and then dusting over with the powder. #pompholyx.# (_synonyms:_ dysidrosis; cheiro-pompholyx.) #what is pompholyx?# pompholyx is a rare disease of the skin of a vesicular and bullous character, and limited to the hands and feet. #describe the symptoms of pompholyx.# in most instances the hands only are affected. it begins usually with a feeling of burning, tingling or tenderness of the parts, followed rapidly by the appearance of deeply-seated vesicles, especially between the fingers and on the palmar aspect. these beginning lesions look not unlike sago grains imbedded in the skin. in some instances the disease does not extend beyond this stage, the vesicles disappearing after a few days or weeks by absorption, and usually without desquamation. ordinarily, however, the lesions increase in size, new ones arise, become confluent, and blebs result, the skin in places appearing as if undermined with serous exudation. the parts are commonly inflamed to a slight or marked degree. the skin comes off in flakes, new lesions may appear for several days or two or three weeks, and the process then declines, recovery gradually taking place. there are no constitutional symptoms, although it is usually noticed that the general health is below par. #what is the character of the subjective symptoms in pompholyx?# the subjective symptoms consist of a feeling of tension, burning and tenderness, and sometimes itching. not infrequently, also there is neuralgic pain. #what is the cause of pompholyx?# the eruption is thought to be due to a depressed state of the nervous system. it is more common in women, and is met with chiefly in adult and middle life. #what is the pathology?# opinion is divided; some considering it a disease of the sweat-glands and others an inflammatory disease independent of these structures. #state the diagnostic features of pompholyx.# the distribution and the peculiar characters and course of the eruption. it is to be differentiated from eczema. #what is the prognosis?# for the immediate attack, favorable, recovery taking place in several weeks or a few months. recurrences at irregular intervals are not uncommon. #what is the treatment of pompholyx?# the general health is to be looked after, and the patient placed under good hygienic conditions. remedies of a tonic nature, directed especially toward improving the state of the nervous system, are to be prescribed. _locally_, soothing and anodyne applications, such as lead-water and laudanum, boric-acid lotion, oxide-of-zinc, boric-acid and diachylon ointments, are most suitable; or the parts may be enveloped with the following:-- [rx] pulv. ac. salicylici, ................ gr. x pulv. ac. borici, pulv. amyli, .......... [=a][=a] ..... [dram]ij petrolati, ........................... [dram]iv. m. in fact, the external treatment is similar to that employed in acute eczema. #herpes simplex.# (_synonym:_ fever blisters.) #what is herpes simplex?# an acute inflammatory disease, characterized by the formation of pin-head to pea-sized vesicles, arranged in groups, and occurring for the most part about the face and genitalia. #describe the symptoms of herpes simplex.# in severe cases, malaise and pyrexia may precede the eruption, but usually it appears without any precursory or constitutional symptoms. a feeling of heat and burning in the parts is often complained of. the vesicles, which are commonly pin-head in size, are usually upon a hyperæmic or inflammatory base, and tend to occur in groups or clusters. their contents are usually clear, subsequently becoming more or less milky or puriform. there is no tendency to spontaneous rupture, but should they be broken a superficial excoriation results. in a short time they dry to crusts which soon fall off, leaving no permanent trace. #is the eruption in herpes simplex abundant?# no. as a rule not more than one or two clusters or groups are observed. #upon what parts does the eruption occur?# usually about the face (_herpes facialis_), and most frequently about the lips (_herpes labialis_); on the genitalia (_herpes progenitalis_), the lesions are commonly found on the prepuce (_herpes præputialis_) in the male, and on the labia minora and labia majora in the female. #state the causes of herpes simplex.# herpes facialis is often observed in association with colds and febrile and lung diseases. malaria, digestive disturbance, and nervous disorders are not infrequently predisposing factors. herpes progenitalis is said to occur more frequently in those who have previously had some venereal disease, especially gonorrh[oe]a, but this is questionable. it is probably often purely neurotic. #what are the diagnostic points?# the appearance of one or several vesicular groups or clusters about the face, and especially about the lips, is usually sufficiently characteristic. the same holds true ordinarily when the eruption is seen on the prepuce or other parts of the genitalia; it is only when the vesicles become rubbed or abraded and irritated that it might be mistaken for a venereal sore, but the history, course and duration will usually serve to differentiate. #give the prognosis.# the eruption will usually disappear in several days or one or two weeks without treatment. remedial applications, however, exert a favorable influence. herpes progenitalis exhibits a strong disposition to recurrence. #what is the treatment of herpes facialis?# anointing the parts with camphorated cold cream, with spirits of camphor or similar evaporating and stimulating applications will at times afford relief to the burning, and shorten the course. #what is the treatment of herpes progenitalis?# in herpes about the genitalia cleanliness is of first importance. a saturated solution of boric acid, a dusting-powder of calomel or oxide of zinc, and the following lotion, containing calamine and oxide of zinc, are valuable:-- [rx] zinci oxidi, calaminæ, .......... [=a][=a] ........ gr. v glycerinæ, alcoholis, ......... [=a][=a] ........ [minim]vj aquæ, ................................ [oz]j m. in obstinate recurrent cases, frequent applications of a mild galvanic current will have a favorable influence. #hydroa vacciniforme.# (_synonyms:_ recurrent summer eruption; hydroa puerorum; hydroa aestivale.) #describe hydroa vacciniforme.# it is a rare vesicular disease usually seen in boys (only two or three exceptions), occurring upon uncovered parts, especially the nose, cheeks, and ears. the lesions begin as red spots, discrete or in groups, rapidly exhibit vesiculation, and later umbilication; the contents become milky, dry to crusts, which fall off and leave small pit-like scars. fresh outbreaks may take place almost continuously, and the process go on indefinitely, at least up to youth or manhood, when the tendency subsides. its activity is usually limited to the warm season. arthritic symptoms and general disturbance are sometimes noted in severe cases. it is doubtless a vasomotor neurosis. exposure to sun and wind is an important, if not essential, etiological factor. primarily the lesion begins in the rete middle layers, and is purely vesicular in character; later, necrosis of the rete and extending deep in the corium is observed. treatment so far has only been palliative, consisting of the applications employed in similar conditions. constitutional medication is based upon general principles. the patient should avoid exposure to the sun, strong wind and excessive artificial heat. #epidermolysis bullosa.# #describe epidermolysis bullosa.# this is a rare, usually hereditary, disease or condition, characterized by the formation of vesicles and blebs on any part subjected to slight rubbing or irritation. no scarring is left, and no pigmentation noted. the predisposition to these lesions persists indefinitely. the general health is not involved. the nature of the disease is obscure. treatment has no influence in modifying or lessening this tendency. the vulnerable parts should so far as possible be protected from knocks and undue friction. #dermatitis repens.# #what do you understand by dermatitis repens?# it is a rare spreading dermatitis starting from an injury, extending by a serous undermining of the epidermis, and usually occurring upon the upper extremities. it usually begins shortly after an injury, and, as a rule, presents itself by redness and serous exudation. the overlying epidermis breaks, and the area of disease gradually progresses by an extension of the serous undermining process, the denuded part looking red and raw, with usually an oozing surface. as the disease spreads the oldest part becomes dry and heals, the new epidermal covering being thin and atrophic in appearance. its most usual beginning is on some part of the hand, and from here it may spread up the arm and involve considerable area. the injury from which it starts may be extremely insignificant, apparently affording an opening for the introduction of the causative factor, doubtless parasitic. beyond a feeling of soreness there seem to be no special subjective symptoms. #give the prognosis and treatment.# the malady shows but little tendency to spontaneous cure. the frequent or constant application of a mild antiseptic lotion, such as boric acid and resorcin, or of a mild parasiticide ointment will generally bring the disease gradually to an end. #herpes zoster.# (_synonyms:_ zoster; zona; shingles.) #give a definition of herpes zoster.# herpes zoster is an acute, self-limited, inflammatory disease, characterized by groups of vesicles upon inflammatory bases, situated over or along a nerve tract. #upon what parts of the body may the eruption appear?# it may appear upon any part, following the course of a nerve; it is therefore always limited in extent, and confined to one side of the body. it is probably most common about the intercostal, lumbar and supra-orbital regions. in rare instances the eruption has been observed to be bilateral. #are there any subjective or constitutional symptoms?# yes; there is, as a rule, neuralgic pain preceding, during and following the eruption; and in some cases, also, there may be in the beginning mild febrile disturbance. there is also a variable degree of tenderness and pain. #what are the characters of the eruption?# several or more hyperæmic or inflammatory patches over a nerve course appear, upon which are seated vesico-papules irregularly grouped; these vesico-papules become distinct vesicles, of size from a pin-head to a pea, and soon dry and give rise to thin, yellowish or brownish crusts, which drop off, leaving in most instances no permanent trace, in others more or less scarring. in some cases the lesions may become pustular and, on the other hand, the eruption may be abortive, stopping short of full vesiculation. #what is known in regard to the nature of the disease?# an inflamed and irritable state of the spinal ganglia, nerve tract, or peripheral branches is directly responsible for the eruption, and this state may be due to atmospheric changes, cold, nerve-injuries and similar influences. the view has also been advanced that the disease is of specific and infectious character. #give the chief diagnostic features of herpes zoster.# the prodromic neuralgic pain, the appearance of grouped vesicles upon inflammatory bases following the course of a nerve tract, and the limitation of the eruption to one side of the body. #what is the prognosis?# favorable; the symptoms usually disappearing in two to four weeks. in some instances, however, the neuralgic pains may be persistent, and in zoster of the supra-orbital region the eye may suffer permanent damage. #how would you treat herpes zoster?# _constitutional treatment_, usually tonic in character, is to be based upon general principles; moderate doses of quinia, with one-sixth grain of zinc phosphide, four or five times daily, appear in some cases to have a special value. the accompanying neuralgic pain may be so intense as to require anodynes. _local treatment_ should be of a soothing and protective character. a dusting-powder of oxide of zinc and starch (to the ounce of which twenty to thirty grains of camphor may be added) proves useful; and over this, in order that the parts be further protected, a bandage or a layer of cotton batting. oxide-of-zinc ointment, and in those cases in which there is much pain, ointments containing powdered opium or belladonna, or orthoform, may be used. a mild galvanic current applied daily to the parts is often of great advantage, both in its influence upon the course of the eruption and upon the neuralgic pain. the plan, so often advised, of painting the parts with flexible collodion is not to be commended. #dermatitis herpetiformis.# (_synonyms:_ hydroa herpetiforme (tilbury fox); herpes gestationis (bulkley); pemphigus prurigiuosus; duhring's disease.) #give a definition of dermatitis herpetiformis.# dermatitis herpetiformis is a somewhat rare inflammatory disease, characterized by an eruption of an erythematous, papular, vesicular, pustular, bullous or mixed type, with a decided disposition toward grouping, accompanied by itching and burning sensations, with, as a rule, more or less consequent pigmentation, and pursuing usually a chronic course with remissions. #describe the erythematous type of dermatitis herpetiformis.# the character of the eruption in the erythematous type resembles closely that of erythema multiforme and of urticaria, especially the former. the efflorescences usually make their appearance in crops, and are more or less persistent; fading sooner or later, however, and giving place to new outbreaks. vesicles are often intermingled, developing from erythematous and erythemato-papular lesions or arising from apparently normal skin. it may continue in the same type, or change to the vesicular, bullous or other variety. #describe the papular type of dermatitis herpetiformis.# this is rarely seen as consisting purely of papular lesions, but is commonly associated with the erythematous and vesicular varieties. in a measure it resembles the papular manifestations of erythema multiforme, with a distinct disposition toward group formation. the papules tend, sooner or later, to develop into vesicles, new papular outbreaks occurring from time to time; or the whole eruption changes to the vesicular or other type of the disease. it is not a common type. #describe the vesicular type of dermatitis herpetiformis.# this is the common clinical type of the disease, and is characterized by pin-head to pea-sized, rounded or irregularly-shaped, distended or flattened and stellate vesicles, occurring, for the most part, in irregular and segmental groups of three or more lesions, seated either upon apparently normal integument or upon hyperæmic or inflammatory skin. they exhibit no tendency to spontaneous rupture, but after remaining a shorter or longer time, are broken or disappear by absorption. the lesions tend to appear in crops. it may, as it not infrequently does, continue in the same type, or it may become more or less erythematous or bullous in character. in not a few instances pustules, few or in numbers, are at times intermingled. #describe the pustular type of dermatitis herpetiformis.# this is rare. it is similar in its clinical characters to the vesicular type, except that the lesions are pustular. it is met with, as a rule, in association with the vesicular and bullous varieties of the disease. #describe the bullous type of dermatitis herpetiformis.# the bullous expression of the disease is usually of a markedly inflammatory nature, often innumerable blebs, small and large, appearing almost continuously, and in some instances involving the greater part of the surface. the lesions arise from erythematous skin, from preëxisting vesicles or vesicular groups, or from apparently normal integument. there is a marked disposition to appear in clusters. a change of type to the erythematous or vesicular varieties is not unusual. #describe the mixed type of dermatitis herpetiformis.# in this type the eruption is made up of erythematous patches, vesicles, bullæ, and often with pustules intermingled, appearing irregularly or in crops, and with a tendency to patch or group formation. #describe the characters of the vesicles, pustules and blebs.# as a rule, these several lesions, especially the vesicles and blebs, are somewhat peculiar: they are usually of a strikingly irregular outline, oblong, stellate, quadrate, and when drying are apt to have a puckered appearance. they are herpetic in that they show little disposition to spontaneous rupture, occur in groups, and are usually seated upon erythematous or inflammatory skin--in some respects similar to the groups of simple herpes and herpes zoster. #what is to be said in regard to the subjective symptoms?# the subjective symptoms are usually the most troublesome feature of the disease, consisting of intense and persistent itching and a feeling of heat and burning. #are there any constitutional symptoms in dermatitis herpetiformis?# as a rule, not, excepting the distress and depression necessarily consequent upon the intense itchiness and loss of sleep. in the pustular and bullous varieties there may be mild or grave systemic symptoms, but even in these types the constitutional involvement is, in most instances, slight in comparison to the intensity of the cutaneous disturbance. #what is the course of dermatitis herpetiformis?# extremely chronic, in most instances lasting, with remissions, indefinitely. the skin is rarely entirely free. from time to time the type of the disease may undergo change. from the continued irritation and scratching more or less pigmentation results. #what is to be said in regard to the etiology?# the disease is in many instances essentially neurotic, and in exceptional instances septicæmic. pregnancy and the parturient state are factors in some instances (so-called herpes gestationis). it is possible in some instances that the eruption may be an expression of a mild toxemia of gastro-intestinal origin. in some cases no cause can be assigned. in the majority of patients the general health, considering the violence of the eruptive phenomena, remains comparatively undisturbed. nervous shock and mental worry are factors in some cases. polyuria, with sugar in the urine, has occasionally been noted. eosinophile cells have been found both in the vesicles and the blood. in some instances--exceptionally, it is true--the disease has appeared shortly after vaccination. #mention the diagnostic features of dermatitis herpetiformis.# the multiformity of the eruption, the characters of the lesions, the disposition to grouping, the absence of tendency to form solid sheets of eruption (as in eczema), the intense itching, history, chronicity and course. in doubtful cases, an observation of several weeks will always suffice to distinguish it from eczema, erythema multiforme, herpes iris and pemphigus, diseases to which it at times bears strong resemblance. #give the prognosis of dermatitis herpetiformis.# an opinion as to the outcome of the disease should be guarded. it is exceedingly rebellious to treatment, and relapses are the rule. exceptionally the bullous and pustular varieties prove eventually fatal. the erythematous and vesicular varieties are the most favorable. #state the treatment to be advised.# there are no special remedies. constitutional treatment must be conducted upon general principles. a free action of the bowels is to be maintained. in occasional instances arsenic in progressive doses seems of value. externally protective and antipruritic applications, such as are employed in the treatment of eczema and pemphigus, are to be employed:-- [rx] ac. carbolici, ....................... [dram]j-[dram]ij thymol, .............................. gr. xvj. glycerinæ, ........................... [oz]ss-[oz]j alcoholis, ........................... f[oz]ij aquæ, q.s., ......... ad ............. oj. m. other valuable applications are: lotions of carbolic acid, of liquor carbonis detergens, of boric acid; alkaline baths, mild sulphur ointment and carbolized oxide-of-zinc ointment, and dusting-powders of starch, zinc oxide, talc and boric acid. a two- to ten-per-cent. ichthyol lotion or ointment is sometimes of advantage; thiol employed in the same manner has also been commended. #psoriasis.# #give a definition of psoriasis.# psoriasis is a chronic, inflammatory disease, characterized by dry, reddish, variously-sized, rounded, sharply-defined, more or less infiltrated, scaly patches. [illustration: psoriasis.] #at what age does psoriasis usually first make its appearance?# most commonly between the ages of fifteen and thirty. it is rarely seen before the tenth year, and a first attack is uncommon after the age of forty. #has psoriasis any special parts of predilection?# the extensor surfaces of the limbs, especially the elbows and knees, are favorite localities, and even when the eruption is more or less general, these regions are usually most conspicuously involved. the face often escapes, and the palms and soles, likewise the nails, are rarely involved. in exceptional instances, the eruption is limited almost exclusively to the scalp. #are there any constitutional or subjective symptoms in psoriasis?# there is no systemic disturbance; but a variable amount of itching may be present, although, as a rule, it is not a troublesome symptom. #describe the clinical appearances of a typical, well developed case.# twenty or a hundred or more lesions, varying in size from a pin-head to a silver dollar, are usually present. they are sharply defined against the sound skin, are reddish, slightly elevated and infiltrated, and more or less abundantly covered with whitish, grayish or mother-of-pearl colored scales. the patches are usually scattered over the general surface, but are frequently more numerous on the extensor surfaces of the arms and legs, especially about the elbows and knees. several closely-lying lesions may coalesce and a large, irregular patch be formed; some of the patches, also, may be more or less circinate, the central portion having, in a measure or completely, disappeared. #give the development and history of a single lesion.# every single patch of psoriasis begins as a pin-point or pin-head-sized, hyperæmic, scaly, slightly-elevated lesion; it increases gradually, and in the course of several days or weeks usually reaches the size of a dime or larger, and then may remain stationary; or involution begins to take place, usually by a disappearance, partially or completely, of the central portion, and finally of the whole patch. #describe the so-called clinical varieties of psoriasis.# as clinically met with, the patches present are, as a rule, in all stages of development. in some instances, however, the lesions, or the most of them, progress no further than pin-head in size, and then remain stationary, constituting _psoriasis punctata_; in other cases, they may stop short after having reached the size of drops--_psoriasis guttata_; in others (and this is the usual clinical type) the patches develop to the size of coins--_psoriasis nummularis_. in some cases there is a strong tendency for the central part of the lesions to disappear, and the process then remain stationary, the patches being ring-shaped--_psoriasis circinata_; and occasionally several such rings coalesce, the coalescing portions disappearing and the eruption be more or less serpentine--_psoriasis gyrata_. or, in other instances, several large contiguous lesions may coalesce and a diffused, infiltrated patch covering considerable surface results--_psoriasis diffusa, psoriasis inveterata_. [illustration: fig. . psoriasis.] #is the eruption of psoriasis always dry?# yes. #what course does psoriasis pursue?# as a rule, eminently chronic. patches may remain almost indefinitely, or may gradually disappear and new lesions appear elsewhere, and so the disease may continue for months and, sometimes, for years; or, after continuing for a longer or shorter period, may subside and the skin remain free for several months or one or two years, and, in rare instances, may never return. [illustration: fig. . psoriasis.] #is the course of psoriasis influenced by the seasons?# as a rule, yes; there is a natural tendency for the disease to become less active or to disappear altogether during the warm months. #what is known in regard to the etiology of psoriasis?# the causes of the disease are always more or less obscure. there is often a hereditary tendency, and the gouty and rheumatic diathesis must occasionally be considered potential. in some instances it is apparently influenced by the state of the general health. it is a rather common disease and is met with in all walks of life. #is psoriasis contagious?# no. in recent years the fact of its exhibiting a family tendency has been thought as much suggestive of contagiousness as of heredity. #what is the pathology?# according to modern investigations, it is an inflammation induced by hyperplasia of the rete mucosum; and it is beginning to be believed that this hyperplasia may have a parasitic factor as the starting-cause. #with what diseases are you likely to confound psoriasis?# chiefly with squamous eczema and the papulo-squamous syphiloderm; and on the scalp, also with seborrh[oe]a. it can scarcely be confounded with ringworm. #how is psoriasis to be distinguished from squamous eczema?# by the sharply-defined, circumscribed, scattered, scaly patches, and by the history and course of the individual lesions. #in what respects does the papulo-squamous syphiloderm differ from psoriasis?# the scales of the squamous syphilide are usually dirty gray in color and more or less scanty; the patches are coppery in hue, and usually several or more characteristic scaleless, infiltrated papules are to be found. the face, palms, and soles are often the seat of the syphilitic eruption; and, moreover, _concomitant symptoms of syphilis_, such as sore throat, mucous patches, glandular enlargement, rheumatic pains, falling out of the hair, together with the history of the initial lesion, are one, several, or all usually present. #how does seborrh[oe]a differ from psoriasis?# seborrh[oe]a of the scalp is usually diffused, with but little redness and no infiltration; moreover, the scales of seborrh[oe]a are greasy, dirty gray or brownish, while those of psoriasis are dry and comonly whitish or mother-of-pearl colored. psoriasis of the scalp rarely exists independently of other patches elsewhere on the general surface. that variety of seborrh[oe]a, commonly known as eczema seborrhoicum, presents at times, both on scalp and general surface, a strong resemblance to psoriasis, but the character of the scales and distribution of psoriasis, as above stated, are distinguishing points; seborrh[oe]a, moreover, favors hairy surfaces and in extensive examples the scalp, eyebrows, sternal, and pubic regions rarely escape. #how does psoriasis differ from ringworm?# by its greater scaliness, by its higher degree of inflammatory action, and by its larger number of patches, as also by its history. in ringworm _all_ the patches tend to clear up in the centre; in psoriasis this is rarely, if ever, so. if there is still any doubt, microscopic examination of the scrapings will determine. #give the prognosis of psoriasis.# the prognosis is usually favorable, so far as concerns the immediate eruption, but as to recurrences, nothing positive can be stated. in rare instances, however, the cure remains permanent. #how is psoriasis treated?# both constitutional and local remedies are demanded in most cases. #do dietary measures exert any influence?# as a rule, no; but the food should be plain, and an excess of meat avoided. #name the important constitutional remedies usually employed in psoriasis.# _arsenic_ is of first importance. it is not suitable in acute or markedly inflammatory types; but is most useful in the sluggish, chronic forms of the disease. the dose should never be pushed beyond slight physiological action. it may be given as arsenious acid in pill form, one-fiftieth to one-tenth of a grain three times daily, or as fowler's solution, three to ten minims at a dose. _alkalies_, of which liquor potassæ is the most eligible. it is to be given in ten to twenty minim doses, largely diluted. it is valuable in robust, plethoric, rheumatic or gouty individuals with psoriasis of an acute or markedly inflammatory type; it is not to be given to debilitated or anæmic subjects. _salicin_, sodium salicylate, and salophen in moderately full doses act well in some cases. occasionally thyroid preparations have a good effect. _potassium iodide_, in doses of thirty to one hundred grains, t.d., acts favorably in some instances; there are no special indications pointing toward its selection, unless it be the existence of a gouty or rheumatic diathesis. oil of copaiba, potassium acetate, oil of turpentine, oil of juniper, and other diuretics are valuable in some instances, and, while often failing, sometimes exert a rapid influence, especially in those cases in which the disease is extensive and inflammatory. wine of antimony, given cautiously, is also sometimes of service in the acute inflammatory type in robust subjects. #are such remedies as iron, quinine, nux vomica and cod-liver oil ever useful in psoriasis?# yes. in debilitated subjects the administration of such remedies is at times attended with improvement in the cutaneous eruption. #what are the indications as regards the external measures?# removal of the scales, and the use of soothing or stimulating applications, according to the individual case. #how are the scales removed?# in ordinary cases, either by warm, plain, or alkaline baths, or hot-water-and-soap washings; in those cases in which the scaling is abundant and adherent, washing with sapo viridis and hot water may be required. baths of sal ammoniac, two to six ounces to the bath are also valuable in removing the scaliness. the tincture of green soap (tinctura saponis viridis) is especially valuable for cleansing purposes in psoriasis of the scalp. the hot vapor bath once or twice weekly is serviceable in keeping the scaliness in abeyance, and has, moreover, in some cases, a therapeutic value. the frequency of the baths or washings will depend upon the rapidity with which the scales are reproduced. #are soothing applications often demanded in psoriasis?# in exceptional cases; in those in which the disease is acute, markedly inflammatory and rapidly progressing, mild, soothing applications must be temporarily employed, such as plain or bran baths, with the use of some bland oil or ointment. as a rule, however, the conditions, when coming under observation, are such as to permit of stimulating applications from the start. the most efficient soothing applications are the mild lotions and ointments employed in eczema of acute type. #how are the stimulating remedies employed in psoriasis applied?# as ointments, oils, and paints (pigmenta). an ointment, if employed, is to be thoroughly rubbed in the diseased areas once or twice daily. the same may be said of the oily applications. the paints (medicated collodion and gutta-percha solution) are applied with a brush, once daily, or every second or third day, depending mainly upon the length of time the film remains intact and adherent. #name the several important external remedies.# chrysarobin, pyrogallol, tar, ammoniated mercury, [beta]-naphthol, and resorcin. #are these several external remedies equally serviceable in all cases?# no. their action differs slightly or greatly according to the case and individual. a change from one to another is often necessary. #in what forms and strength are these remedies to be applied?# _chrysarobin_ is applied in several ways: as an ointment, twenty to sixty grains to the ounce, rubbed in once or twice daily; this is the most rapid but least cleanly and eligible method. as a pigment, or paint, as in the following:-- [rx] chrysarobini, ........................ [dram]j acidi salicylici, .................... gr. xx etheris, ............................. f[dram]j ol. ricini, .......................... [minim]x collodii, ............................ f[dram]vij. m. or it may be used in liquor gutta-perchæ (traumaticin), a drachm to the ounce. it may also be employed in chloroform, a drachm to the ounce; this is painted on, the chloroform evaporating, leaving a thin film of chrysarobin; over this is painted flexible collodion. if the patches are few and large, chrysarobin rubber-plaster may be used. chrysarobin is usually rapid in its effect, but it has certain disadvantages; it may cause an inflammation of the surrounding skin, and, if used near the eyes, may give rise to conjunctivitis. as a rule, it should not be employed about the head. moreover, it stains the linen permanently and the skin temporarily. _pyrogallol_ is valuable, and is employed in the same manner and strength as chrysarobin. in collodion it should at first not be used of greater strength than three to four per cent., as in this form pyrogallol sometimes acts with unexpected energy. it is less rapid than chrysarobin, but it rarely inflames the surrounding integument. it stains the linen a light brown, however, and is not to be used over an extensive surface for fear of absorption and toxic effect. oxidized pyrogallic acid, a somewhat milder drug in its effect, has been highly commended, and has the alleged advantage of being free from toxic action. _tar_ is, all things considered, the most important external remedy. it is comparatively slow in its action, but is useful in almost all cases. as employed usually it is prescribed in ointment form, either as the official tar ointment, full strength or weakened with lard or petrolatum. it may also be used as pix liquida, with equal part of alcohol. or the tar oils, oil of cade (ol. cadini), and oil of birch (ol. rusci) may be employed, either as oily applications or incorporated with ointment or with alcohol. liquor carbonis detergens, in ointment, one to three drachms to the ounce of simple cerate and lanolin is a mild tarry application which is often useful. in stubborn patches an occasional thorough rubbing with a mixture of equal parts of liquor carbonis detergens and vleminckx's solution, followed by a mild ointment, sometimes proves of value. in whatsoever form tar is employed it should be thoroughly rubbed in, once or twice daily, the excess wiped off, and the parts then dusted with starch or similar powder. _ammoniated mercury_ is applied in ointment form, twenty to sixty grains to the ounce. compared to other remedies it is clean and free from staining, although, as a rule, not so uniformly efficacious. it is especially useful for application to the scalp and exposed parts. it should not be used over extensive surface for fear of absorption. _[beta]-naphthol_ and _resorcin_ are applied as ointments, thirty to sixty grains to the ounce, and as they are (especially the former) practically free from staining, may be used for exposed surfaces. gallacetophenone and aristol also act well in some cases, applied in five- to ten-per-cent. strength, as ointments. in obstinate patches the _x_-ray may be resorted to, employing it with caution and in the same manner as in other diseases. #pityriasis rosea.# (_synonym:_ pityriasis maculata et circinata.) #what do you understand by pityriasis rosea?# pityriasis rosea is a disease of a mildly inflammatory nature, characterized by discrete, and later frequently confluent, variously sized, slightly raised scaly macules of a pinkish to rosy-red, often salmon-tinged, color. #upon what part of the body is the eruption usually found?# the trunk is the chief seat of the eruption, although not infrequently it is more or less general. #describe the symptoms of pityriasis rosea.# the lesions, which appear rapidly or slowly, are but slightly elevated, somewhat scaly, usually rounded, except when several coalesce, when an irregularly outlined patch results. at first they are pale or bright pink or reddish, later a salmon tint (which is often characteristic) is noticed. the scaliness is bran-like or flaky, of a dirty gray color, and, as a rule, less marked in the central portion; it is never abundant. the skin is rarely thickened, the process being usually exceedingly superficial. #what course does pityriasis rosea pursue?# the eruption makes its appearance, as a rule, somewhat rapidly, usually attaining its full development in the course of one or two weeks, and then begins gradually to decline, the whole process occupying one or two months. #to what is pityriasis rosea to be attributed?# the cause is not known; it is variously considered as allied to seborrh[oe]a (eczema seborrhoicum), as being of a vegetable-parasitic origin, and as a mildly inflammatory affection somewhat similar to psoriasis. it is not a frequent disease. #how is pityriasis rosea distinguished from ringworm, psoriasis and the squamous syphiloderm?# from ringworm, by its rapid appearance, its distribution, the number of patches, and, if necessary, by microscopic examination of the scrapings. psoriasis is a more inflammatory disease, is seen usually more abundantly upon the limbs, the scales are profuse and silvery, and the underlying skin is red and has a glazed look; moreover, psoriasis, as a rule, appears slowly and runs a chronic course. the squamous syphiloderm differs in its history, distribution, and above all, by the presence of concomitant symptoms of syphilis, such as glandular enlargement, sore throat, mucous patches, rheumatic pains, and falling out of the hair. #state the prognosis of pityriasis rosea.# it is favorable, the disease tending to spontaneous disappearance, usually in the course of several weeks or one or two months. #what treatment is to be advised in pityriasis rosea?# laxatives and intestinal antiseptics, and ointments of salicylic acid ( - grains to the ounce), of sulphur ( - grains to the ounce); or a compound ointment containing both these ingredients can be prescribed. the ointment base can be equal parts of white vaselin and cold cream; in some instances lassar's paste (starch powder, zinc oxid powder, each, [dram]ij; vaselin, [dram]iv) seems more satisfactory. #dermatitis exfoliativa.# (_synonyms:_ general exfoliative dermatitis; recurrent exfoliative dermatitis; desquamative scarlatiniform erythema; acute general dermatitis; recurrent exfoliative erythema; pityriasis rubra.) #describe dermatitis exfoliativa.# dermatitis exfoliativa is an inflammatory disease of an acute type, characterized by a more or less general erythematous inflammation, in exceptional instances vesicular or bullous, with epidermic desquamation or exfoliation accompanying or following its development. constitutional disturbance, which may be of a serious character, is sometimes present. it is a rare and obscure affection, running its course usually in several weeks or months, but exhibiting a decided tendency to relapse and recurrence. in many cases it is persistently chronic, with exacerbations and remissions. in some instances it develops from a long-continued and more or less generalized eczema or psoriasis, and in exceptional cases it is started by the careless use of mercurial ointment and of chrysarobin ointment. [illustration: fig. . dermatitis exfoliativa.] in another type of the disease, formerly described as _pityriasis rubra_, the skin is pale red or violaceous-red, but is rarely thickened, continued exfoliation in the form of thin plates taking place. its course is variable, lasting for years, with remissions. an exfoliating generalized dermatitis is exceptionally observed in the first weeks of life (_dermatitis exfoliativa neonatorum_), lasting some weeks, and in most cases followed by recovery. there are no special constitutional symptoms, the fatal cases usually dying of marasmus. as will be seen dermatitis exfoliativa varies considerably in degree; it may be extremely mild, resembling in appearance the scarlet-fever eruption (erythema scarlatiniforme) and running a rapid course; or the skin-condition and the systemic symptoms may be of grave and persistent character. #give the treatment of dermatitis exfoliativa.# general treatment is based upon indications, and externally soothing applications, such as are employed in acute and subacute eczema, are to be used. #lichen planus.# #what is lichen planus?# lichen planus is an inflammatory disease characterized by small, flat and angular, smooth and shining, or scaly, discrete or confluent, red or violaceous-red papules, having a distinctly papular or papulo-squamous course, and attended with more or less itching. #describe the symptoms of lichen planus.# the eruption, as a rule, begins slowly, usually showing itself upon the extremities; the forearms, wrists and legs being favorite localities. it may appear as one or more groups or in the form of short or long bands. occasionally its evolution is rapid and a considerable part of the surface may be invaded. the lesions are pin-head to small pea-sized, irregularly grouped or so closely crowded together as to form solid patches; they are quadrangular or polygonal in shape, usually flat, with central depression or umbilication, and are reddish or violaceous in color. at first they have a glazed or shining appearance; later, becoming slightly scaly, the scaliness being more marked where solid patches have resulted. new papules may appear from time to time, the older lesions disappearing and leaving persistent reddish or brownish pigmentation. exceptionally the eruption presents in bands or lines, like rows of beads (_lichen moniliformis_). very exceptionally a vesicular or bleb tendency in some of the lesions has been noted; doubtless, in most instances at least, this has been due to the arsenic so generally administered in this disease. in rare instances lichen planus lesions are also seen on the glans penis and on the buccal mucous membrane. in some cases, especially in the region of the ankle, the papules become quite large (_lichen planus hypertrophicus_), and in occasional cases there is a tendency in some of the lesions or patches to clear up centrally. there is, as a rule, considerable itching. there are no constitutional symptoms. #what is the etiology of lichen planus?# in some cases the disease is distinctly neurotic in character, in others no cause can be assigned. it is more especially met with at middle age, and among the wealthier, professional, and luxurious classes. pathologically the first change noted in the epidermis is thought to be an acanthosis, followed by epithelial atrophy, and a hyperkeratosis, intercellular edema, and colloid degeneration of the prickle cells. #does the disease bear any resemblance to the miliary papular syphilide, psoriasis, and papular eczema?# in some instances it does, but the irregular and angular outline, the slightly-umbilicated, flattened, smooth or scaly summits, and the dull-red or violaceous color, the history and course, of lichen planus, will serve to differentiate. #state the prognosis.# under proper management the eruption, although often obstinate, yields to treatment. #what treatment would you prescribe in lichen planus?# a general tonic plan of medication is indicated in most cases, with such remedies as iron, quinine, nux vomica, and cod-liver oil and other nutrients. in many instances arsenic exerts a special influence, and should always be tried. mercurials in moderate dosage have also a favorable action in most cases. locally, antipruritic and stimulating applications, such as are used in the treatment of eczema, are to be employed, alkaline baths and tarry applications deserving special mention. liquor carbonis detergens, applied weakened with several parts water, is a valuable application. in some cases, particularly if the disease is limited, external applications alone often suffice to bring about a cure. #pityriasis rubra pilaris.# (_synonyms:_ lichen ruber; lichen ruber acuminatus.) #describe pityriasis rubra pilaris.# pityriasis rubra pilaris is an extremely rare disease, usually of a mildly inflammatory nature, characterized by grayish, pale-red or reddish-brown follicular papules with somewhat hard or horny centres; discrete and confluent, and covering a part or the entire surface. the skin is harsh, dry and rough, feeling to the touch somewhat like the surface of a nutmeg-grater or a coarse file. more or less scaliness is usually present in the confluent patches and on the palms and soles; in these latter regions the papules are rarely seen. the duration of the disease is variable, and relapses are common. it bears resemblance at times to keratosis pilaris, ichthyosis, dermatitis exfoliativa; it is considered identical with the lichen ruber acuminatus of kaposi, and by many also with the lichen ruber of hebra. the etiology is obscure. treatment, both constitutional and local, is to be based upon general principles; stimulating applications, with frequent baths, such as are advised in psoriasis, are the most satisfactory. it is rebellious, and not much more than palliation can be effected in some cases, in others the outlook is more hopeful. #lichen scrofulosus.# #describe lichen scrofulosus.# lichen scrofulosus is a chronic, inflammatory disease, characterized by millet-seed-sized, rounded or flat, reddish or yellowish, more or less grouped, desquamating papules. the lesions have their start about the hair-follicles, occur usually upon the trunk, tend to group and form patches, and sooner or later become covered with minute scales. as a rule, there is no itching. it is a rare disease, and but seldom met with in america; it is seen chiefly in children and young people of a scrofulous diathesis. scarring, slight in character, may or may not follow. #what is the treatment of lichen scrofulosus?# the condition responds to tonics and anti-strumous remedies. #eczema.# (_synonym:_ tetter; salt rheum.) #what is eczema?# an acute, subacute or chronic inflammatory disease, characterized in the beginning by the appearance of erythema, papules, vesicles or pustules, or a combination of these lesions, with a variable amount of infiltration and thickening, terminating either in discharge with the formation of crusts, in absorption, or in desquamation, and accompanied by more or less intense itching and a feeling of heat or burning. #what are the several primary types of eczema?# erythematous, papular, vesicular and pustular; all cases begin as one or more of these types, but not infrequently lose these characters and develop into the common clinical or secondary types--eczema rubrum and eczema squamosum. [illustration: fig. . papular eczema (leg).] #what other types are met with clinically?# eczema rubrum, eczema squamosum, eczema fissum, eczema sclerosum and eczema verrucosum. eczema seborrhoicum is probably a closely allied disease, occupying a middle position between ordinary eczema and seborrh[oe]a. #describe the symptoms of erythematous eczema.# erythematous eczema (_eczema erythematosum_) begins as one or more small or large, irregularly outlined hyperæmic macules or patches, with or without slight or marked swelling, and with more or less itching or burning. at first it may be ill-defined, but it tends to spread and its features to become more pronounced. it may be limited to a certain region, or it may be more or less general. when fully developed, the skin is harsh and dry, of a mottled, reddish or violaceous color, thickened, infiltrated and usually slightly scaly, with, at times, a tendency toward the formation of oozing areas. punctate and linear scratch-marks may usually be seen scattered over the affected region. [illustration: fig. . eczema rubrum.] its most common site is the face, but it is not infrequent upon other parts. #what course does erythematous eczema pursue?# it tends to chronicity, continuing as the erythematous form, or the skin may become considerably thickened and markedly scaly, constituting eczema squamosum; or a moist oozing surface, with more or less crusting, may take its place--eczema rubrum. #describe the symptoms of papular eczema.# papular eczema (_eczema papulosum_) is characterized by the appearance, usually in numbers, of discrete, aggregated or closely-crowded, reddish, pin-head-sized acuminated or rounded papules. vesicles and vesico-papules are often intermingled. the itching is commonly intense, as often attested by the presence of scratch-marks and blood crusts. [illustration: fig. . eczema squamosum et tissum.] it is seen most frequently upon the extremities, especially the flexor surfaces. #what course does papular eczema pursue?# the lesions tend, sooner or later, to disappear, but are usually replaced by others, the disease thus persisting for weeks or months; in places where closely crowded, a solid, thickened, scaly sheet of eruption may result--eczema squamosum. #describe the symptoms of vesicular eczema.# vesicular eczema (_eczema vesiculosum_) usually appears, on one or several regions, as more or less diffused inflammatory reddened patches, upon which rapidly develop numerous closely-crowded pin-point to pin-head-sized vesicles, which tend to become confluent and form a solid sheet of eruption. the vesicles soon mature and rupture, the discharge drying to yellowish, honeycomb-like crusts. the oozing is usually more or less continuous, or the disease may decline, the crusts be cast off, to be quickly followed by a new crop of vesicles. in those cases in which the process is markedly acute, considerable swelling and [oe]dema are present. scattered papules, vesico-papules and pustules may usually be seen upon the involved area or about the border. the face in infants (_crusta lactea_, or _milk crust_, of older writers), the neck, flexor surfaces and the fingers are its favorite localities. #what course does vesicular eczema pursue?# usually chronic, with acute exacerbations. not infrequently it passes into eczema rubrum. #describe the symptoms of pustular eczema.# pustular eczema (_eczema pustulosum_, _eczema impetiginosum_) is probably the least common of all the varieties. it is similar, although usually less actively inflammatory, in its symptoms to eczema vesiculosum, the lesions being pustular from the start or developing from preëxisting vesicles; not infrequently the eruption is mixed, the pustules predominating. there is a marked tendency to rupturing of the lesions, the discharge drying to thick, yellowish, brownish or greenish crusts. its most common sites are the scalp and face, especially in young people and in those who are ill-nourished and strumous. #what course does pustular eczema pursue?# usually chronic, continuing as the same type, or passing into eczema rubrum. #describe the symptoms of squamous eczema.# squamous eczema (_eczema squamosum_) may be defined as a clinical variety, the chief symptoms of which are a variable degree of scaliness, more or less thickening, infiltration, and redness, with commonly a tendency to cracking or fissuring of the skin, especially when the disease is seated about the joints. it is developed, as a rule, from the erythematous or papular type. itching is slight or intense. the disease is not uncommon upon the scalp. #what is the course of squamous eczema?# essentially chronic. [illustration: fig. . eczema of the face and scalp.] #describe the symptoms of eczema rubrum.# eczema rubrum is characterized by a red, raw-looking, weeping, oozing or discharging surface, attended with more or less inflammatory thickening, infiltration and swelling; the exudation, consisting of serum, sometimes bloody, dries into thick yellowish or reddish-brown crusts. at one time the whole diseased area may be hidden under a mass of crusting, at other times a red, raw-looking, weeping surface (_eczema madidans_) is the most striking feature. itching is slight or intense, or the subjective symptom may be a feeling of burning. it is an important clinical type, usually developing from the vesicular, pustular or other primary variety. it is common about the face and scalp in children, and the middle and lower part of the leg in elderly people. #what is the course of eczema rubrum?# chronic, varying in intensity from time to time. #describe the symptoms of fissured eczema.# the conspicuous symptom is a marked tendency to fissuring or cracking of the skin (_eczema fissum_; _eczema rimosum_). this tendency is usually a part of an erythematous or squamous eczema, the fissuring constituting the most conspicuous and troublesome symptom. _chapping_ is an extremely mild but familiar example of this type. it is especially common about the hands and fingers. #what is the course of fissured eczema?# it is more or less persistent, the tendency to fissuring varying considerably according to the state of the weather, often disappearing spontaneously in the summer months. #describe eczema sclerosum and eczema verrucosum.# in eczema sclerosum the skin is thickened, infiltrated, hard, and almost horny. eczema verrucosum presents similar conditions, but, in addition, displays a tendency to papillary or wart-like hypertrophy. in both varieties the disease is usually seated about the ankle or the foot, developing from the papular or squamous type. they are uncommon, and obstinately chronic. #state the nature of the subjective symptoms in eczema.# itching, commonly intense, is usually a conspicuous symptom; it may be more or less paroxysmal. in some cases burning and heat constitute the main subjective phenomena. #is eczema accompanied by febrile or systemic symptoms?# no. in rare instances, in acute universal eczema, slight febrile action, or other systemic disturbance, may be noted at the time of the outbreak. #is the eczematous eruption (patch or patches) sharply defined against the neighboring sound skin?# no. in almost all instances the diseased area merges gradually and imperceptibly into the surrounding healthy integument. #what is the character of eczema as regards the degree of inflammatory action?# the inflammatory action may be acute, subacute or sluggish in character, and may be so from the start and so continue throughout its whole course; or it may, as is usually the case, vary in intensity from time to time. #state the character of eczema as regards duration.# as a rule, it is a persistent disease, showing little, if any, tendency to spontaneous disappearance. #is eczema influenced by the seasons?# yes. with comparatively few exceptions the disease is most common and much worse in cold, windy, winter weather. #to what may eczema be ascribed?# eczema may be due to constitutional or local causes, or to both. it may be considered, in fact, as a reaction of the skin tissues against some irritant, and the latter may have its origin from within or without. #name some of the important constitutional or predisposing causes.# gouty diathesis, rheumatic diathesis, disorders of the digestive tract, general debility or lack of tone, an exhausted state of the nervous system, dentition and struma. #is a constitutional cause sufficient to provoke an attack?# yes; but often the attack is brought about in those so predisposed by some local or external irritant. #mention some of the external causes.# heat and cold, sharp, biting winds, excessive use of water, strong soaps, vaccination, dyes and dyestuffs, chemical irritants, and the like. there is a growing belief that some cases presenting eczematous aspects are probably parasitic in origin. in fact, some observers hold to the microbic view of all cases of eczema. contact with the rhus plants, while producing a peculiar dermatitis, usually running an acute course terminating in recovery, may, in those predisposed, provoke a veritable and persistent eczema. in fact, in our examination as to causes in a given case, especially of the hands and face, all possible exciting factors should be inquired into, such as the handling of plants, chemicals, dyes, etc. [illustration: fig. . eczema of face.] #is eczema contagious?# no. the acceptance of a parasitic cause for the disease, however, necessarily carries with it the possibility of contagiousness under favoring conditions. such is not supported, however, by practical experience. #what is the pathology?# the process is an inflammatory one, characterized in all cases by hyperæmia and exudation, varying in degree according to the intensity and duration of the disease. the rete and papillary layer are especially involved, although in severe and chronic cases the lower part of the corium and even the subcutaneous tissue may share in the process. #do the cutaneous manifestations of the eruptive fevers bear resemblance to the erythematous type of eczema?# scarlatina and erysipelas may, to a slight extent, but the presence or absence of febrile and other constitutional symptoms will usually serve to differentiate. #what common skin diseases resemble some phases of eczema?# psoriasis, seborrh[oe]a, sycosis, scabies and ringworm. #how would you exclude psoriasis in a suspected case of eczema (squamous eczema)?# psoriasis occurs in variously-sized, rounded, _sharply-defined_ patches, usually scattered irregularly over the general surface, with special predilection for the elbows and knees. they are covered more or less abundantly with whitish, silvery or mother-of-pearl colored imbricated scales. the patches are always dry, and itching is, as a rule, slight, or may be entirely absent. eczema, on the contrary, is often localized, appearing as one or more large, irregularly diffused patches; it merges imperceptibly into the sound skin, and there is often a history of characteristic serous or gummy oozing; the scaling is usually slight and itching almost invariably a prominent symptom. #how would you exclude seborrh[oe]a (eczema seborrhoicum) in a suspected case of eczema?# seborrh[oe]a of the scalp is more commonly over the whole of that region and is relatively free from inflammatory symptoms; the scales are of a greasy character and the itching is usually slight or nil. on the other hand, in eczema of this region the parts are rarely invaded in their entirety; there may be at times the characteristic serous or gummy oozing; inflammatory symptoms are usually well-marked, the scales are dry and the itching is, as a rule, a prominent symptom. these same differences serve to differentiate the diseases in other regions. #how does scabies differ from eczema?# scabies differs from eczema in its peculiar distribution, the presence of the burrows, the absence of any tendency to patch formation, and usually by a clear history of contagion. #how would you exclude ringworm in a suspected case of eczema?# ringworm is to be distinguished by its circular form, its fading in the centre, and in doubtful cases by microscopic examination of the scrapings. #how does eczema differ from sycosis?# sycosis is limited to the hairy region of the face, is distinctly a follicular inflammation, and is rarely very itchy; eczema is diffused, usually involves other parts of the face, and itching is an annoying symptom. #state the general prognosis of eczema.# the disease is, under favorable circumstances, curable, some cases yielding more or less readily, others proving exceedingly rebellious. the length of time to bring about a result is always uncertain, and an opinion on this point should be guarded. #upon what would you base your prognosis in the individual case?# the extent of disease, its duration and previous behavior, the removability of the exciting and predisposing causes, and the attention the patient can give to the treatment. in eczema involving the lips, face, scrotum, and leg, and especially when this last-named exhibits a varicose condition of the veins, a cure is effected, as a rule, only through persistent and prolonged treatment. #does eczema ever leave scars?# no. upon the legs, in long-continued cases, more or less pigmentation usually remains. #how is eczema treated?# as a rule, eczema requires for its removal both constitutional and external treatment. certain cases, however, seem to be entirely local in their nature, and in these cases external treatment alone will have satisfactory results. #what general measures as to hygiene and diet are commonly advisable?# fresh air, exercise, moderate indulgence in calisthenics, regular habits, a plain, nutritious diet; abstention from such articles of food as pork, salted meat, acid fruits, pastry, gravies, sauces, cheese, pickles, condiments, excessive coffee or tea drinking, etc. as a rule, also, beer, wine, and other stimulants are to be interdicted. #upon what grounds is the line or plan of constitutional treatment to be based?# upon indications in the individual case. a careful examination into the patient's general health will usually give the cue to the line of treatment to be adopted. #mention the important remedies variously employed in the constitutional treatment.# _tonics_--such as cod-liver oil, quinine, nux vomica, the vegetable bitters, iron, arsenic, malt, etc. _alkalies_--sodium salicylate, potassium bicarbonate, liquor potassæ, and lithium carbonate. _alteratives_--calomel, colchicum, arsenic, and potassium iodide. _diuretics_--potassium acetate, potassium citrate, and oil of copaiba. _laxatives_--the various salines, aperient spring waters, castor oil, cascara sagrada, aloes and other vegetable cathartics. _digestives_--pepsin, pancreatin, muriatic acid and the various bitter tonics. #are there any remedies which have a specific influence?# no; although arsenic, in exceptional instances, seems to exert a special action. cod-liver oil is also of great value in some cases. upon the whole the most important remedies are those which keep in view the maintenance of a proper and healthful condition of the gastro-intestinal tract, and especially with regular and rather free action of the bowels. #in what class of cases does arsenic often prove of service?# in the sluggish, dry, erythematous, scaly and papular types. #in what cases is arsenic usually contraindicated?# it should never be employed in acute cases; nor in any instance (unless its action is watched), in which the degree of inflammatory action is marked, as an aggravation of the disease usually results. #what should be the character of the external treatment?# it depends mainly upon the degree of inflammatory action; but the stage of the disease, the extent involved, and the ability of the patient to carry out the details of treatment, also have a bearing upon the selection of the plan to be advised. #what is to be said about the use of soap and water in eczema?# in acute and subacute conditions soap and water are to be employed, as a rule, as infrequently and as sparingly as possible, as the disease is often aggravated by their too free use. washing is necessary, however, for cleanliness and occasionally, also, for the removal of the crusts. on the other hand, in chronic, sluggish types the use of soap and water frequently has a therapeutic value. #how often should remedial applications be made?# usually twice daily, although in some case, and especially those of an acute type, applications should be made every few hours. #mention several remedies or plans of treatment to be used in the acute or actively inflammatory cases.# black wash and oxide-of-zinc ointment conjointly, the wash thoroughly dabbed on, allowed to dry, the parts gently smeared with ointment; or the ointment may be applied spread on lint as a plaster. boric-acid wash ( grains to the ounce) and oxide-of-zinc ointment, applied in the same manner as the above. a lotion containing calamine and zinc oxide, the sediment drying and coating over the affected surface:-- [rx] calaminæ, zinci oxidi, ... [=a][=a] ......... [dram]ij-[dram]iij glycerinæ, alcoholis, ..... [=a][=a] ......... f[dram]ss liq. calcis, ...................... f[oz]ij aquæ, .......... q.s. ad .......... f[oz]vj. m. another excellent lotion somewhat similar to the last, but of oily character, is made up of three drachms each of calamine and zinc oxide, one drachm of boric acid, ten to thirty drops of carbolic acid, and three ounces each of lime-water and oil of sweet almonds. carbolic-acid lotion, about two drachms to the pint of water, to which may be added two or three drachms each of glycerin and alcohol; or, if there is intense itching, carbolic acid may be added to the several washes already mentioned. a lotion made of one or two drachms of liquor carbonis detergens[a] to four ounces of water. the following wash, especially in the dry form of the disease:-- [rx] ac. borici, .......................... [dram]iv ac. carbolici, ....................... [dram]j glycerinæ, ........................... [dram]ij alcoholis, ........................... [dram]ij aquæ, ............. q.s. ad .......... oj. m. [footnote a: liquor carbonis detergens is made by mixing together nine ounces of tincture soap bark and four ounces of coal tar, allowing to digest for eight days, and filtering. the tincture of soap bark used is made with one pound of soap bark to one gallon of per cent. alcohol, digesting for a week or so. instead of the proprietary name above, prof. duhring has suggested that of tinctura picis mineralis comp.] dusting-powders, of starch, zinc oxide and venetian talc, alone or severally combined, applied freely and often, so as to afford protection to the inflamed surface:-- [rx] talci venet, zinci oxidi, ....... [=a][=a] ........ [dram]iv amyli, ............................... [oz]j m. if washes or dusting-powders should disagree or are not desirable or practicable, ointments may be employed, such as-- oxide-of-zinc ointment, cold cream, petrolatum, plain or carbolated, diachylon ointment (if fresh and well prepared), and a paste-like ointment, as the following, usually called "salicylic-acid paste"; in markedly itchy cases, five to fifteen grains of carbolic may be added to each ounce: [rx] ac. salicylici, ...................... gr. v-x pulv. amyli, pulv. zinci oxidi, .... [=a][=a] ..... [dram]ij petrolati, ........................... [dram]iv m. or the following ointment:-- [rx] calaminæ, ............................ [dram]j ungt. zinci oxidi, ................... [dram]vij. m. #name several external remedies and combinations useful in eczema of a subacute or mildly inflammatory type.# the various remedies and combinations useful when the symptoms are acute or markedly inflammatory (mentioned above), and more especially the several following:-- [rx] zinci oxidi, ......................... [dram]ij liq. plumbi subacetat. dilut., ....... f[dram]vj glycerinæ, ........................... f[dram]ij infus. picis liq., ................... f[oz]iij m. a lotion containing resorcin, five to thirty grains to the ounce. solution of zinc sulphate, one-half to three grains to the ounce. an ointment containing calomel or ammoniated mercury, as in the annexed formula:-- [rx] hydrargyri ammoniat. seu hydrargyri chloridi mit., ................... gr. x-xxx ac. carbolici, ..................... gr. v-x ungt. zinci oxidi, ................. [oz]j m. another formula, more especially useful in eczema of the hands and legs, is the following:-- [rx] ac. salicylici, ...................... gr. xxx emp. plumbi, emp. saponis, petrolati, ...... [=a][=a] ........... [oz]j. m. (this is to be applied as a plaster, spread on strips of lint, and changed every twelve or twenty-four hours.) the paste-like ointment, referred to as useful in acute eczema, may also be used with a larger proportion ( to grains to the ounce) of salicylic acid. the following, containing tar, may often be employed with advantage:-- [rx] ungt. picis liq., .................... [dram]j ungt. zinci oxidi, ................... [dram]vij. m. #what is to be said in regard to the use of tarry applications?# ointments or lotions containing tar should always be tried at first upon a limited surface, as occasionally skins are met with upon which this remedy acts as a more or less violent irritant. the coal tar lotion (liquor carbonis detergens) is the least likely to disagree and may be used as a mild ointment, one or two drachms to the ounce, or it may be diluted and used as a weak lotion as already referred to. #what external remedies are to be employed in eczema of a sluggish type?# the various remedies and combinations (mentioned above) useful in acute and subacute eczema may often be employed with benefit, but, as a rule, stronger applications are necessary, especially in the thick and leathery patches. the following are the most valuable:-- an ointment of calomel or ammoniated mercury; forty to sixty grains to the ounce. strong salicylic-acid ointment; a half to one drachm of salicylic acid to the ounce of lard. tar ointment, official strength; or the various tar oils, alone or with alcohol, as a lotion, or in ointment form. liquor picis alkalinus[b] is a valuable remedy in chronic _thickened_, _hard_ and _verrucous_ patches, but is a strong preparation and must be used with caution. it is applied diluted, one part with from eight to thirty-two parts of water; or in ointment, one or two drachms to the ounce. in such cases, also, the following is useful:-- [rx] saponis viridis, picis liq., alcoholis, .......... [=a][=a] ....... [dram]iij. m. sig. to be well rubbed in. [footnote b: [rx] potassæ, ............................. [dram]j picis liq., .......................... [dram]ij aquæ, ................................ [dram]v. dissolve the potash in the water, and gradually add to the tar in a mortar, with thorough stirring.] in similar cases, also, the parts may be thoroughly washed or scrubbed with sapo viridis and hot water until somewhat tender, rinsed off, dried, and a mild ointment applied as a plaster. lactic acid, applied with one to ten or more parts of water is also of value in the sclerous and verrucous types. caustic potash solutions, used cautiously, may also be occasionally employed to advantage in these cases. another remedy of value in these cases, as well as in others of more or less limited nature, is the _x_-ray. exposures every few days, of short duration and to inches distance, with medium vacuum tube. this method has served me well in occasional cases; caution is necessary, and it should not be pushed further than the production of the mildest reaction. the repeated application of a high-frequency current, by means of the vacuum electrodes, is a safer and sometimes an equally beneficial method. #is there any method of treating eczema with fixed dressings?# several plans have been advised from time to time; some are costly, and some require too great attention to details, and are therefore impracticable for general employment. the following are those in more common use:-- the _gelatin dressing_, as originally ordered, is made by melting over a water-bath one part of gelatin in two parts of water--quickly painting it over the diseased area; it dries rapidly, and to prevent cracking glycerine is brushed over the surface. or the glycerine may be incorporated with the gelatin and water in the following proportion: glycerine, one part; gelatin, four parts, and water eight parts. medicinal substances may be incorporated with the gelatin mixture. a good formula is the following:-- [rx] gelatin, ............................. [oz]j zinci oxidi, ......................... [oz]ss glycerini, ........................... [oz]iss aquæ, ................................ [oz]ii-[oz]iij. this should be prepared over a water-bath, and two per cent. ichthyol added. a thin gauze bandage can be applied to the parts over which this dressing is painted, before it is completely dry; it makes a comfortable fixed dressing and may remain on several days. _plaster-mull_ and _gutta-percha plaster_. the plaster-mull, consisting of muslin incorporated with a layer of stiff ointment, and the gutta-percha plaster, consisting of muslin faced with a thin layer of india-rubber, the medication being spread upon the rubber coating. _rubber plasters._ these are medicated with the various drugs used in the external treatment of skin diseases, and are often of service in chronic patches. two new excipients for fixed dressings have recently been introduced--bassorin and plasment; the former is made from gum tragacanth, and the latter from irish moss. the following is a satisfactory formula for a tragacanth dressing: [rx] tragacanth, .......................... gr. lxxv glycerini, ........................... [minim] xxx ac. carbolici, ....................... gr. x-xx zinci oxidi, ......................... [dram]iss-[dram]iiss. m. this is painted over the parts and allowed to dry, and a mild dusting powder sprinkled over. it cannot be used in warm weather or in folds, as it is apt to get sticky. the following is a bassorin paste which may be variously medicated. [rx] bassorin, ............................ [dram]x dextrin, ............................. [dram]vj glycerini, ........................... [oz]ij. aquæ, ....................... q.s. ad. [oz]iij. it should be prepared cold. another "drying dressing" which may be used in cool weather is: [rx] zinci oxidi, ......................... [oz]j glycerini, ........................... [oz]ss mucilag. acaciæ, ..................... [oz]ii-[oz]iv. it may be variously medicated. the plaster-mull is used in all types, especially the acute; the gelatin dressing, and the gutta-percha plaster, in the subacute and chronic; and the rubber plaster in chronic, sluggish patches only. acacia, tragacanth, bassorin and plasment applications are used in cases of a subacute and chronic character. #prurigo.# #define prurigo.# prurigo is a chronic, inflammatory disease, characterized by discrete, pin-head- to small pea-sized, solid, firmly-seated, slightly raised, pale-red papules, accompanied by itching and more or less general thickening of the affected skin. #describe the symptoms and course of prurigo.# the disease first appears upon the tibial regions, and its earliest manifestation may be urticarial, but there soon develop the characteristic small, millet-seed-sized, or larger, firm elevations, which may be of the natural color of the skin or of a pinkish tinge. the lesions, whilst discrete, are in great numbers, and closely crowded. the overlying skin is dry, rough and harsh; itching is intense, and, as a result of the scratching, excoriations and blood crusts are commonly present. in consequence of the irritation, the inguinal glands are enlarged. sooner or later the integument becomes considerably thickened, hard and rough. eczematous symptoms may be superadded. in severe cases the entire extensor surfaces of the legs and arms, and in some instances the trunk also, are invaded. it is worse in the winter season. #what is known in regard to etiology and pathology?# it is a disease of the ill-fed and neglected, usually developing in early childhood, and persisting throughout life. it is extremely rare, even in its milder types, in this country. clinically and pathologically it bears some resemblance to papular eczema. #give the prognosis and treatment of prurigo.# the disease, in its severer types is, as a rule, incurable, but much can be done to alleviate the condition. good, nourishing food, pure air and exercise are of importance. tonics and cod-liver oil are usually beneficial. the local management is similar to that employed in chronic eczema. an ointment of [beta]-naphthol, one-half to five per cent. strength, is highly extolled. #acne.# #give a definition of acne.# acne is an inflammatory, usually chronic, disease of the sebaceous glands, characterized by papules, tubercles, or pustules, or a mixture of these lesions, and seated usually about the face. #at what age does acne usually occur?# between the ages of fifteen and thirty, at which time the glandular structures are naturally more or less active. #describe the symptoms of acne.# irregularly scattered over the face, and in some cases also over the neck, shoulders and upper part of the trunk, are to be seen several, fifty or more, pin-head- to pea-sized papules, tubercles or pustules; commonly the eruption is of a mixed type (_acne vulgaris_), the several kinds of lesions in all stages of evolution and subsidence presenting in the single case. interspersed may generally be seen blackheads, or comedones. the lesions may be sluggish in character, or they may be markedly inflammatory, with hard and indurated bases. in the course of several days or weeks, the papules and tubercles tend gradually to disappear by absorption; or, and as commonly the case, they become pustular, discharge their contents, or dry and slowly or rapidly disappear, with or without leaving a permanent trace, new lesions arising, here and there, to take their place. in exceptional instances the eruption is limited to the back, and in these cases the eruption is usually extensive and persistent, and not infrequently leaves scars. #what do you understand by acne punctata, acne papulosa, acne pustulosa, acne indurata, acne atrophica, acne hypertrophica, and acne cachecticorum?# these several terms indicate that the lesions present are, for the most part, of one particular character or variety. #describe the lesions giving rise to the names of these various types.# blocking up of the outlet of the sebaceous gland (comedo), which is usually the beginning of an acne lesion, may cause a moderate degree of hyperæmia and inflammation, and a slight elevation, with a central yellowish or blackish point results--the lesion of _acne punctata_; if the inflammation is of a higher grade or progresses, the elevation is reddened and more prominent--_acne papulosa_; if the inflammatory action continues, the interior or central portion of the papule suppurates and a pustule results--_acne pustulosa_; the pustule, in some cases, may have a markedly inflammatory and hard base--_acne indurata_; and not infrequently the lesions in disappearing may leave a pit-like atrophy or depression--_acne atrophica_; or, on the contrary, connective-tissue new growth may follow their disappearance--_acne hypertrophica_; and, in strumous or cachectic individuals, the lesions may be more or less furuncular in type, often of the nature of dermic abscesses, usually of a cold or sluggish character, and of more general distribution--_acne cachecticorum_. #what is acne artificialis?# acne artificialis is a term applied to an acne or acne-like eruption produced by the ingestion of certain drugs, as the bromides and iodides, and by the external use of tar; this is also called _tar acne_. #what course does acne pursue?# essentially chronic. the individual lesions usually run their course in several days or one or two weeks, but new lesions continue to appear from time to time, and the disease thus persists, with more or less variation, for months or years. in many cases there is, toward the age of twenty-five or thirty, a tendency to spontaneous disappearance of the disease. [illustration: acne.] #is the eruption in acne usually abundant?# it varies in different cases and at different periods in the same case. in some instances, not more than five or ten papules and pustules are present at one time; in others they may be numerous. not infrequently several lesions make their appearance, gradually run their course, and the face continues free for days or one or two weeks. #does the eruption in acne disappear without leaving a trace?# in many instances no permanent trace remains, but in others slight or conspicuous scarring is left to mark the site of the lesions. #are there any subjective symptoms in acne?# as a rule, not; but markedly inflammatory lesions are painful. #state the immediate or direct cause of an acne lesion.# hypersecretion or retention of sebaceous matter. recent investigations point to the possibility of a special bacillus being the exciting cause, in some instances at least. the pyogenic cocci are added factors in the pustular and furuncular cases. #name the indirect or predisposing causes of acne.# digestive disturbance, constipation, menstrual irregularities, chlorosis, general debility, lack of tone in the muscular fibres of the skin, scrofulosis; and medicinal substances such as the iodides and bromides internally, and tar externally. working in a dusty or dirty atmosphere is often influential, resulting in a blocking-up of the gland ducts. workmen in paraffin oils or other petroleum products often present a furuncle-like acne. the disease is more common in individuals of light complexion. #is there any difficulty in the diagnosis of acne?# not if it be remembered that acne eruption is limited to certain parts and is always follicular, and that the several stages, from the comedo to the matured lesion, are usually to be seen in the individual case. #in what respect does the pustular syphiloderm differ from acne?# by its general distribution, the longer duration of the individual lesions, the darker color, and the presence of concomitant symptoms of syphilis. #what is the pathology of acne?# primarily, acne is a folliculitis, due to retention or decomposition of the sebaceous secretion or to the introduction of a micro-organism; subsequently, the tissue immediately surrounding becoming involved, with the possible destruction of the sebaceous follicle as a result. the degree of inflammatory action determines the character of the lesions. #state the prognosis of acne.# it is usually an obstinate disease, but curable. some cases yield readily, others are exceedingly rebellious, especially acne of the back. success depends in a great measure upon a recognition and removal of the predisposing condition. treatment is ordinarily a matter of months. #what measures of treatment are usually demanded in acne?# constitutional and local measures; the former when indicated, the latter always. #upon what is the constitutional treatment based?# upon indications. diet and hygienic measures are important. in dyspepsia and constipation, bitter tonics, alkalies, acids, pepsin, saline and vegetable laxatives, are variously prescribed. special mention may be made of the following:-- [rx] ext. rhamni pursh. fl., .............. f[dram]ij-f[dram]iv tinct. nucis vom., ................... f[dram]iij tinct. cardamomi comp., .......q.s. ad [oz]iij. m. sig.--f[dram]t.d. or hunyadi janos or friedrichshall water may be employed for a laxative purpose. in chlorotic and anæmic cases the ferruginous preparations are of advantage. cod-liver oil is often a remedy of great value, and is especially useful in strumous and debilitated subjects. calx sulphurata in pill form, one-tenth to one-fourth grain four or five times daily, is said, acts well in the pustular variety. in some instances, more particularly in sluggish papular acne, arsenic, especially the sulphide of arsenic, acts favorably. upon the whole, the line of treatment that keeps in view proper and healthy action of the gastro-intestinal canal is the most successful. [illustration: acne of back.] in inflammatory cases occurring in robust individuals the following is often of service:-- [rx] potassii acetat., .................... [dram]iv liq. potassæ, ........................ f[dram]ij liq. ammonii acetat., .... q.s. ad ... f[oz]iij. m. sig.--f[dram]j-f[dram]ij t.d., largely diluted. #state the character of the local treatment in acne.# this must vary somewhat with the local conditions. cases which are acute in character, in the sense that the lesions are markedly hyperæmic, tender and painful, require milder applications, and in exceptional instances soothing remedies are to be prescribed. as a rule, however, stimulating applications may be employed from the start. the remedies are, for obvious reasons, most conveniently applied at bedtime. #what preliminary measures are to be advised in ordinary acne cases?# washing the parts gently or vigorously, according to the irritability of the skin, with warm water and soap; subsequently rinsing, and sponging for several minutes with hot water, and rubbing dry with a soft towel; after which the remedial application is made. in sluggish and non-irritable cases sapo viridis or its tincture may often be advantageously used in place of the ordinary toilet soap. the blackheads, so far as practicable, are to be removed by pressure with the fingers or with a suitable instrument (see comedo), and the superficial pustules punctured and the contents pressed out. scraping the affected parts with a blunt curette is a valuable measure, but is temporarily disfiguring. as a rule, however, cases do just as well without puncturing and scraping, and these methods sometimes leave behind scarring. #state the methods of external medication commonly employed.# by ointments and lotions. if an ointment is used, it is to be thoroughly rubbed in, in small quantity; if a lotion is employed, it is to be well shaken, the parts freely dabbed with it for several minutes and then allowed to dry on. #state the object in view in local medication.# to hasten the maturation and disappearance of the existing lesions, and to stimulate the skin and glands to healthy action. if slight irritation or scaliness results, the application is to be intermitted one or two nights; in the meantime nothing except the hot-water sponging, with or without the application of a mild soothing ointment, is to be employed. #is it usually necessary to change from one external remedy to another in the course of treatment?# yes. after a certain time one remedy, as a rule, loses its effect, and a change from lotion to ointment or the reverse, and from one lotion or ointment to another, will often be found necessary in order to bring about continuous improvement. #name the various important remedies and combinations employed in the external treatment of acne.# sulphur is the most valuable. it may often be applied with benefit as a simple ointment:-- [rx] sulphur, præcip., .................... [dram]ss-[dram]j adipis benz. lanolin, ............ [=a][=a] ....... [dram]ij. or it may be used as a lotion, as in the annexed formula:-- [rx] sulphur, præcip., .................... [dram]iss pulv. tragacanthæ, ................... gr. x pulv. camphoræ, ...................... gr. xx liq. calcis, ........ q.s. ad ........ f[oz]iv. m. another lotion, especially useful in those cases in which an oily condition of the skin is present, is the following:-- [rx] sulphur, præcip., .................... [dram]iss etheris, ............................. f[dram]iv alcoholis, ........................... f[oz]iijss. m. a compound lotion containing sulphur in one of its combinations is also valuable in many cases:-- [rx] zinci sulphatis, potassii sulphureti, .... [=a][=a] ... [dram]ss-[dram]iv aquæ, ................................ [oz]iv. m. (the salts should be dissolved separately and then mixed; reaction takes place and the resulting lotion, when shaken, is milky in appearance, and free from odor; allowed to stand the particles settle, the sediment constituting about one-fourth to three-fourths of the whole bulk). at times the addition to this formula of several drachms of alcohol and of five to ten minims of glycerin is of advantage. an external remedy, often valuable, is ichthyol. it is thus prescribed:-- [rx] ichthyol, ............................ [dram]ss-[dram]j cerat. simp., ........................ [dram]iv. m. the various mercurial ointments, especially one of white precipitate, five to fifteen per cent. strength, are sometimes beneficial. a compound lotion, containing mercury, which frequently proves serviceable, is:-- [rx] hydrarg. chlorid. corros., ........... gr. ii-viij zinci sulphatis, ..................... gr. x-xx tinct. benzoini, ..................... f[dram]ij aquæ, ............ q.s. ad ........... f[oz]iv. in extremely sluggish cases the following, used cautiously, is of value:-- [rx] ichthyol, saponis viridis, sulphur, præcip., lanolin, ............. [=a][=a] ...... [dram]j. in such instances the application of a strong alcoholic resorcin lotion, ten to twenty-five per cent. strength, repeated several times daily till marked irritation and exfoliation occur (a matter usually of one to three days), will sometimes be followed by marked improvement. acne of the back is treated with the same applications, but usually stronger; in this region applications of vleminckx's solution and formaldehyde solution, weakened considerably, at first at least, prove of value. _obstinate and indurated lesions_ may be incised, the contents pressed out, and the interior touched with carbolic acid by means of a pointed stick. the _x_-ray has proved a most valuable addition to our resources in the treatment of acne, and is especially serviceable in extensive and obstinate cases. an exposure should be made about twice weekly, at a distance of five to ten inches and for from three to ten minutes, and a tube of medium vacuum used. it must be used with great caution and never beyond the production of the mildest erythema. the hair, eyes, and lips should be protected. the _x_-ray treatment is best reserved for obstinate cases, and then used mildly, and rather as an adjuvant to the ordinary methods than as the sole measure. #what precaution is to be taken in advising a change from a sulphur to a mercurial preparation or the reverse?# several days should be allowed to intervene, otherwise a disagreeable, although temporary, staining or darkening of the skin results--from the formation of the black sulphuret of mercury. #acne rosacea.# #give a descriptive definition of acne rosacea.# acne rosacea is a chronic, hyperæmic or inflammatory disease, limited to the face, especially to the nose and cheeks, characterized by redness, dilatation and enlargement of the bloodvessels, more or less acne and hypertrophy. #describe the symptoms of acne rosacea.# the disease may be slight or well-marked. redness, capillary dilatation, and acne lesions seated on the nose and cheeks, and sometimes on chin and forehead also, constitute in most cases the entire symptomatology. a mild variety consists in simple redness or hyperæmia, involving the nose chiefly and often exclusively, and is to be looked upon as a passive congestion; this is not uncommon in young adults and is often associated with an oily seborrh[oe]a of the same parts. in many cases the condition does not progress beyond this stage. in other cases, however, sooner or later the dilated capillaries become permanently enlarged (_telangiectasis_) and acne lesions are often present--constituting the middle stage or grade of the disease; this is the type most frequently met with. in exceptional instances, still further hypertrophy of the bloodvessels ensues, the glands are enlarged, and a variable degree of connective-tissue new growth is added; this latter is usually slight, but may be excessive, the nose presenting an enlarged and lobulated appearance (_rhinophyma_). [illustration: fig. . acne rosacea.] #are there any subjective symptoms in acne rosacea?# as a rule, no. some of the acne lesions may be tender and painful, and at times there is a feeling of heat and burning. #what do you know in regard to the etiology?# in many cases the causes are obscure. chronic digestive and intestinal disorders, anæmia, chlorosis, continued exposure to heat or cold, menstrual and uterine irregularities, and the too free use of spirituous liquors, tea, etc. are often responsible factors. it is essentially a disease of adult life, common about middle age, occurring in both sexes, but rarely reaching the same degree of development in women as observed at times in men. #is acne rosacea easily recognized?# yes. the redness, acne lesions, dilated capillaries, and, at times, the glandular and connective-tissue hypertrophy; the limitation of the eruption to the face, especially the region of the nose; the evident involvement of the sebaceous glands, the absence of ulceration, taken with the history of the case, are characteristic. it is to be distinguished from the tubercular syphiloderm and lupus vulgaris, diseases to which it may bear rough resemblance. #state the prognosis of acne rosacea.# all cases may be favorably influenced by treatment; the mild and moderately-developed types are, as a rule, curable, but usually obstinate. it is a persistent disease, showing little, if any, tendency to disappear spontaneously. #what is the method of treatment?# both constitutional and local measures are demanded in most cases. #upon what is the constitutional treatment to be based?# the constitutional treatment, beyond a regulation of the diet, is to be based upon a correct appreciation of the etiological factors in the individual case. there are no special remedies. iron, cod-liver oil, tonics, ergot, alkalies, saline laxatives, and similar drugs are to be variously prescribed. #what is the external treatment?# in many respects, both as to the preliminary measures and remedies, essentially the same as that employed in the treatment of simple acne (_q. v._). the _x_-ray treatment is not so efficient in this disease, however, as in acne. in addition to the treatment there found, several other applications deserve mention:-- in many cases _vleminckx's solution_[c] is valuable, applied diluted with one to ten parts of water. also, a mucilaginous paste containing sulphur:-- [rx] mucilag. acaciæ, ..................... f[dram]iij glycerinæ, ........................... f[dram]ij sulphur, præcip., .................... [dram]iij. m. [footnote c: [rx] calcis, .............................. [oz]ss sulph. sublimat., .................... [oz]j aquæ, ................................ [oz]x. to be boiled down to [oz]vj and filtered.] or a similar paste with the glycerine in the foregoing replaced with ichthyol may be used. #in what manner are the dilated bloodvessels and connective-tissue hypertrophy to be treated?# the enlarged capillaries are to be destroyed by incision or by electrolysis. properly managed the vessels may be thus destroyed, but unless the predisposing causes have disappeared or have been remedied, a new growth may take place. if the knife is employed, the vessels are either slit in their length or cut transversely at several points. the method by electrolysis is the same as used in the removal of superfluous hair (_q. v._).; the needle may, if the vessel is short, be inserted along its calibre, or if long, may be inserted at several points in its length. excessive connective-tissue growth, exceptionally met with, is to be treated by ablation with the scissors or knife. #acne varioliformis.# (_synonyms:_ acne frontalis; acne rodens; acne necrotica; lupoid acne; necrotic granuloma.) #describe acne varioliformis.# acne varioliformis is characterized by lesions of a moderately superficial papulo-pustular type, which in disappearing leave slight or pit-like scars. the forehead and scalp are the favorite sites, but they may also occur elsewhere. the eruption is rather scanty as a rule, consisting usually of ten to thirty lesions. they begin as small maculo-papules, as papules, or as minute nodules in or on the skin, and gradually become small pea-sized, with a tendency to slight vesiculation or pustulation at the central part. the lesion is sluggish in its course, drying to a thin crust, which finally falls off, leaving a depressed variola-like scar. new lesions arise from time to time, and the disease thus continues almost indefinitely. there may or may not be itching. in what appears to be a variety of this disease, known usually as _acne urticata_, there is considerable itching just at the time the lesion is appearing. the malady is not frequent, but occurs in both sexes, usually in those between the ages of twenty and fifty. it seems probable that the eruption is parasitic in origin. the maladies variously known as hydradenitis suppurativa, acnitis, spiradenitis, folliclis, granuloma necroticum, etc., in which the lesions, primarily at least, are somewhat deeper seated, sluggish in their course, and followed by scarring, could be also included under this head. #give the prognosis and treatment.# the disease is rebellious and tends to recur. the most efficient applications are those of sulphur and resorcin, the same as prescribed in ordinary acne. #sycosis.# (_synonyms:_ sycosis vulgaris; sycosis non-parasitica; folliculitis barbæ; sycosis coccogenica.) #what do you understand by sycosis?# sycosis is a chronic, inflammatory affection involving the hair-follicles, usually of the moustache and bearded regions only, and characterized by papules, tubercles, and pustules perforated by hairs. #describe the symptoms of sycosis.# sycosis begins by the formation of papules and pustules about the hair-follicles; the lesions occur in numbers, in close proximity, and together with the accompanying inflammation, make up a small or large area. the pustules are small, rounded, flat or acuminated, discrete, and yellowish in color; they are perforated by hairs, show no tendency to rupture, and are apt to occur in crops, drying to thin yellowish or brownish crusts. papules and tubercles are often intermingled. more or less swelling and infiltration are noticeable. [illustration: fig. . sycosis--not infrequently begins in, and sometimes limited to, this region.] the disease is seen, as a rule, only on the bearded part of the face, either about the cheeks, chin or upper lip, involving a small portion or the whole of these parts. it is also sometimes met with involving the hair follicles just within the nasal orifice, and may even be limited to this region. occasionally a sycosiform eruption, usually of the side of the bearded region, leaves behind a smooth or keloidal scar, the disease gradually extending--_ulerythema sycosiforme_ (lupoid sycosis). an inflammation of the hair-follicles of the scalp apparently sycosiform in character, occurring as discrete or aggregated lesions, is sometimes observed, the follicles being destroyed and atrophy or slight scarring resulting--_folliculitis decalvans_. #does conspicuous hair loss occur in sycosis?# ordinarily not; the hairs are, especially at first, usually firmly seated, but in those cases in which suppuration is active, and has involved the follicles, they may, as a rule, be easily extracted. in some cases destruction of the follicles ensues and slight scarring and permanent hair loss result. #state the character of the subjective symptoms.# pain and itching and a sense of burning, variable as to degree, may be present. #what is the course of the disease?# essentially chronic, the inflammatory action being of a subacute or sluggish character, with acute exacerbations. #state the causes of sycosis.# upon the upper lip it may have its origin in a nasal catarrh. entrance into the follicles of pyogenic micrococci is now regarded as the essential factor. this view being accepted, carries with it the possibility of contagiousness. it is seen in the male sex only, usually in those between the ages of twenty-five and fifty; and is met with in those in good and bad health, and among rich and poor. it is comparatively infrequent. #what is the pathology of sycosis?# the disease is primarily a perifolliculitis, the follicle and its sheath subsequently becoming involved in the inflammatory process. #how would you distinguish sycosis from eczema?# eczema is rarely sharply limited to the bearded region, but is apt to involve other parts of the face; moreover, the lesions are usually confluent, and there is either an oozing, red crusted surface, or it is dry and scaly. #how would you exclude tinea sycosis in the diagnosis?# in tinea sycosis, or ringworm sycosis, the history of the case is different. the parts are distinctly lumpy and nodular; the hairs are soon involved and become dry, brittle, loose, and fall out, or they may be readily extracted. the superficial type of ringworm sycosis is readily distinguished by the ring-like character of the patches. in doubtful cases, microscopic examination of the hairs may be resorted to. #give the prognosis of sycosis.# the disease is curable, but almost invariably obstinate and rebellious to treatment. the duration, extent, and character of the inflammatory process must all be considered. an expression of an opinion as to the length of time required for a cure should always be guarded. ulerythema sycosiforme is extremely obstinate. folliculitis decalvans is also rebellious. #how is sycosis to be treated?# mainly, and often exclusively, by external applications. [illustration: fig. . sycosis.] #is constitutional treatment of no avail in sycosis?# in some instances; but, as a rule, it is negative. if indicated, such remedies as tonics, alteratives, cod-liver oil and the like are to be prescribed. #describe the external treatment.# crusting, if present, is to be removed by warm embrocations. if the inflammation is of a high grade, and the parts tender and painful, soothing applications, such as bland oils, black wash and oxide-of-zinc ointment, cold cream and petrolatum, are to be used; boric-acid solution, fifteen grains to the ounce, may be advised in place of black wash. in most cases, however, astringent and stimulating remedies are demanded from the start, such as: diachylon ointment, alone or with ten to thirty grains of calomel to the ounce; oleate of mercury, as a five- to twenty-per-cent. ointment; precipitated sulphur, one to three drachms to the ounce of benzoated lard, or lard and lanolin; a ten- to twenty-five-per-cent. ichthyol ointment; and resorcin lotion or ointment, ten to twenty per cent. strength. [illustration: fig. . sycosis.] a change from one application to another will be found necessary in almost all cases. in obstinate cases the x-ray treatment can be used, as it has proved itself valuable in some instances; as in other diseases, it should be employed cautiously. #what would you advise in regard to shaving?# when bearable (and after a few days' application of soothing remedies it almost always is), it is to be advised in all cases, as it materially aids in the treatment. after a cure is effected it should be continued for some months, until the healthy condition of the parts is thoroughly established. #when is depilation advisable as a therapeutic measure?# when the suppurative process is active, in order to save the follicles from destruction; incising or puncturing the pustules will often accomplish the same end. depilation is in all cases a valuable therapeutic measure, but it is painful; as a routine practice, shaving is less objectionable and, upon the whole, is probably as satisfactory. those who make free use of the x-ray commonly push it to the point of producing depilation. #dermatitis papillaris capillitii.# (_synonym:_ acne keloid.) [illustration: fig. . dermatitis papillaris capillitii.] #describe dermatitis papillaris capillitii.# this is a peculiar, mildly inflammatory, sycosiform, keloidal, acne-like disease of the hairy border of the back of the neck, often extending upward to the occipital region; partaking, especially later in its course, somewhat of the nature of keloid. several or more acne-like lesions, papular and pustular, closely grouped or bunched, appear, developing slowly, usually to the size of peas; are red, pale red, or whitish, often enveloping small tufts of hair, and attended with more or less hair loss. its course is gradual and persistent. it is an exceedingly rare condition, the exact nature of which is still obscure. #give the treatment.# treatment, which is usually unsatisfactory, consists of stimulating applications--the same, in fact, as employed in sycosis, sulphur and ichthyol deserving special mention. depilation is essential. #impetigo contagiosa.# #give a descriptive definition of impetigo contagiosa.# impetigo contagiosa is an acute, contagious, inflammatory disease, characterized by the formation of discrete, superficial, flat, rounded, or ovalish vesicles or blebs, soon becoming vesico-pustular, and drying to thin yellowish crusts. #upon what parts does the eruption commonly appear?# upon the face, scalp, and hands, and exceptionally upon other regions. #describe the symptoms of impetigo contagiosa.# one, several or more small pin-head-sized papulo-vesicles or vesicles make their appearance, usually upon the face and fingers. in the male adult the region of the neck and beard is a favorite situation. they increase in size by extending peripherally, but are more or less flattened and umbilicated, and are without conspicuous areola. the lesions may attain the size of a dime or larger, and when close together may coalesce and form a large patch. in some cases distinct blebs result, and a picture of pemphigus eruption presented; it is probable that many of the cases of "contagious pemphigus" belong to this class. new lesions may appear for several days, but finally, in the course of a week or ten days, they have all dried to thin, wafer-like crusts, of a straw or light-yellow color, but slightly adherent, and appearing as if stuck on; these soon drop off, leaving faint reddish spots, which gradually fade. in some cases there is so decided a tendency to clear and dry up centrally while spreading peripherally that the eruption has a ring-like aspect; this seems especially so in the bearded region of the male adult. instead of presenting as described, it may occur as one or more pea- or finger-nail-sized, rounded and elevated, usually firm, discrete pustules, scattered over one part, or more commonly over various regions, such as the face, hands, feet and lower extremities. the pustules are such from the beginning, and when developed are usually of the size of a pea or finger-nail, elevated, semi-globular or rounded, with somewhat thick and tough walls, and of a whitish or yellowish color; at first there may be a slight inflammatory areola, but as the lesion matures this almost, if not entirely, disappears. the pustules show no disposition to umbilication, rupture or coalescence; drying in the course of several days or a week to yellowish or brownish crusts, which soon drop off, leaving no permanent trace. this variety was formerly thought to be a distinct disease, and was described under the name of _impetigo simplex_. as a rule there are no constitutional symptoms, but in the more severe cases the eruption may be preceded by febrile disturbance and malaise. itching may or may not be present. #state the cause of the disease.# it is contagious, the contents of the lesions being inoculable and auto-inoculable. at times it seems to prevail in epidemic form. pyogenic microörganisms are now regarded as causative. a relationship to vaccination has been alleged by some observers. it is more commonly observed in infants and young children. #from what diseases is impetigo contagiosa to be differentiated?# from eczema, pemphigus, and ecthyma. #how does impetigo contagiosa differ from these several diseases?# by the character of the lesions, their growth, their superficial nature, their course, the absence of an inflammatory base and areola, the thin, yellowish, wafer-like crusts, and usually a history of contagion. #state the prognosis.# the effect of treatment is usually prompt. the disease, indeed, tends to spontaneous disappearance in two to four weeks; in exceptional instances, more especially in those cases in which itching is present, the excoriations or scratch-marks become inoculated, and in this way it may persist several weeks. #what is the treatment of impetigo contagiosa?# treatment consists in the destruction of the auto-inoculable properties of the contents of the lesions; this is effected by removing the crusts by means of warm water-and-soap washings, and subsequently rubbing in an ointment of ammoniated mercury, ten to twenty grains to the ounce. some cases respond more rapidly to the use of a drying ointment, such as lassar's paste, with ten to twenty grains of white precipitate or sulphur to the ounce. in itching cases, a saturated solution of boric acid, or a carbolic-acid lotion, one to two drachms to the pint, is to be employed for general application. #impetigo herpetiformis.# #describe impetigo herpetiformis.# impetigo herpetiformis is an extremely rare disease, observed usually in pregnant women, and is characterized by the appearance of numerous isolated and closely-crowded pin-head-sized superficial pustules, which show a decided disposition to the formation of circular groups or patches. the central portion of these groups dries to crusts, while new pustules appear at the peripheral portion. they tend to coalesce, and in this manner a greater part of the whole surface may, in the course of weeks or months, become involved. profound constitutional disturbance, usually of a septic character, precedes and accompanies the disease; in almost every instance a fatal termination sooner or later results. it is possibly a grave type of dermatitis herpetiformis. #ecthyma.# #give a descriptive definition of ecthyma.# ecthyma is a disease characterized by the appearance of one, several or more discrete, finger-nail-sized, flat, usually markedly inflammatory pustules. #describe the symptoms and course of ecthyma.# the lesions begin as small, usually pea-sized, pustules; increase somewhat in area, and when fully developed are dime-sized, or larger, somewhat flat, with a markedly inflammatory base and areola. at first yellowish they soon become, from the admixture of blood, reddish, and dry to brownish crusts, beneath which will be found superficial excoriations. the individual pustules are usually somewhat acute in their course, but new lesions may continue to appear from day to day or week to week. as a rule, not more than five to twenty are present at one time, and in most cases they are seated on the legs. more or less pigmentation, and sometimes superficial scarring, may remain to mark the site of the lesions. itching is rarely present, but there may be more or less pain and tenderness. #what is the cause of ecthyma?# it is essentially a disease of the poorly cared-for and ill-fed; the direct exciting cause is the introduction of pyogenic microörganisms into the follicular openings. it is closely allied to impetigo contagiosa, and may in fact be regarded as a markedly inflammatory form of the latter affection. it seems much less contagious, however. it is commonly observed in male adults. #from what diseases is ecthyma to be differentiated?# from impetigo contagiosa, and the flat pustular syphiloderm. #how is it distinguished from these several diseases?# the size, shape, inflammatory action, and the depraved general condition, the distribution and lesser-contagiousness will distinguish it from impetigo contagiosa; and the absence of concomitant symptoms of syphilis, and of positive ulceration, as well as its distribution and more rapid and inflammatory course, will exclude the pustular syphiloderm. #state the prognosis.# the disease is readily curable, disappearing upon the removal of the predisposing cause and the employment of local antiseptic applications. #what treatment is to be advised?# good food, proper hygiene and tonic remedies; and, locally, removal of the crusts and stimulation of the underlying surface with an ointment of ammoniated mercury, ten to thirty grains to the ounce. the following mild antiseptic lotion, which materially lessens the tendency to the formation of new lesions, may be applied to the affected region two or three times daily:-- [rx] acidi borici, ........................ [dram]iv resorcini, ........................... [dram]ij glycerinæ, ........................... f[dram]ij alcoholis, ........................... f[oz]j aquæ, ........... q.s. ad ............ oj. m. a weak lotion of thymol, corrosive sublimate or ichthyol would doubtless be equally effectual. #pemphigus.# #what do you understand by pemphigus?# pemphigus is an acute or chronic disease characterized by the successive formation of irregularly-scattered, variously-sized blebs. #name the varieties met with.# two varieties are usually described--pemphigus vulgaris and pemphigus foliaceus. #describe the symptoms and course of pemphigus vulgaris.# with or without precursory symptoms of systemic disturbance, irregularly scattered blebs, few or in numbers, make their appearance, arising from erythematous spots or from apparently normal skin. they vary in size from a pea to a large egg, are rounded or ovalish, usually distended, and contain a yellowish fluid which, later, becomes cloudy or puriform. if ruptured, the rete is exposed, but the skin soon regains its normal condition; if undisturbed, the fluid usually disappears by absorption. each lesion runs its course in several days or a week. a grave type of pemphigus is exceptionally observed in the newborn--_pemphigus neonatorum_. #what course does pemphigus vulgaris pursue?# usually chronic. the disease may subside in several months and the process come to an end, constituting the acute type. as a rule, however, the disease is chronic, new blebs continuing to appear from time to time for an indefinite period. [illustration: fig. . pemphigus (mulatto).] #in what respects does the severe form of pemphigus vulgaris differ from the ordinary type?# in the severe or malignant type the eruption is more profuse; there is marked, and often grave, systemic depression, and the lesions are attended with ulcerative action. #describe the symptoms and course of pemphigus foliaceus.# in this, the grave type of the disease, the blebs are loose and flaccid, with milky or puriform contents, rupturing and drying to crusts, which are cast off, disclosing the reddened corium. new blebs appear on the sites of disappearing or half-ruptured lesions, and the whole surface may be thus involved and the disease continue for years, compromising the general health and eventually ending fatally. in some cases of pemphigus (pemphigus vegetans) a vegetating or papillomatous condition develops from the base of the lesion, with an offensive discharge; it is usually a grave type of the malady. exceptionally cases (dermatitis vegetans) are met with which have a close similarity in their symptoms to pemphigus vegetans, but in which the eruption is more or less limited to the genitocrural region. the disorder is not malignant and usually yields to cleanliness and antiseptics. #what is the character of the subjective symptoms in pemphigus?# the subjective symptoms consist variously of heat, tenderness, pain, burning and itching, and may be slight or troublesome. #what is known in regard to the etiology of pemphigus?# the causes are obscure; general debility, overwork, shock, nervous exhaustion, and septic conditions (microörganisms) are thought to be of influence. there seems no doubt that those who have to do with cattle products, especially butchers, are subjects of acute and usually grave pemphigus. vaccination has exceptionally been responsible for the disease, probably through some coincidental infection. the disease is not contagious, nor is it due to syphilis. it may occur at any age. it is a rare disease, especially in this country. most of the cases diagnosed as pemphigus by the inexperienced are examples of bullous urticaria, bullous erythema multiforme, and impetigo contagiosa. #what is the pathology?# the lesions are superficially seated, usually between the horny layer and upper part of the rete. round-cell infiltration and dilated blood vessels are found about the papillæ and in the subcutaneous tissue. the contents of the blebs, always of alkaline reaction, are at first serous, later containing blood corpuscles, pus, fatty-acid crystals, epithelial cells, and occasionally uric acid crystals and free ammonia. #from what diseases is pemphigus to be differentiated?# from herpes iris, the bullous syphiloderm, impetigo contagiosa and dermatitis herpetiformis. #how do these several diseases differ from pemphigus?# the acute course, small lesions, concentric arrangement, variegated colors, and distribution, in herpes iris; the thick, bulky, greenish crusts, the underlying ulceration, the course, history, and the presence of concomitant symptoms of syphilis, in the bullous syphiloderm; the history, course, distribution, the character of the crusting, and the contagious and auto-inoculable properties of the contents of the lesions, in impetigo contagiosa; the tendency to appear in groups, the smaller lesions, the intense itchiness, course, multiform characters of the eruption and the disposition to change of type in dermatitis herpetiformis,--will serve as differential points. #state the prognosis of pemphigus.# its duration is uncertain, and the issue may in severe cases be fatal. in the milder types, after months or several years, recovery may take place. the extent and severity of the disease and the general condition of the patient are always to be considered before an opinion is expressed. pemphigus neonatorum usually ends fatally. #give the treatment of pemphigus.# both constitutional and local measures are demanded. good nutritious food and hygienic regulations are essential. arsenic and quinia are the most valuable remedies. the former, in occasional instances, seems to have a specific influence, and should always be tried, beginning with small doses and increasing gradually to the point of tolerance and continued for several weeks or longer. the remedy should not be set aside as long as there are signs of improvement, unless the supervention of stomachic, intestinal or other disturbance demand its discontinuance. other tonics, such as iron, strychnia and cod-liver oil, are also at times of service. the blebs should be opened and the parts anointed or covered with a mild ointment. in more general cases bran, starch and gelatin baths, and in severe cases the continuous bath, if practicable, are to be used. #class iii.--hemorrhages.# #purpura.# #define purpura.# purpura is a hemorrhagic affection characterized by the appearance of variously-sized, usually non-elevated, smooth, reddish or purplish spots or patches, not disappearing under pressure. #name the several varieties met with.# three--purpura simplex, purpura rheumatica and purpura hæmorrhagica; denoting, respectively, the mild, moderate and severe grade of the disease. the division is, to a great extent, an arbitrary one. #describe the clinical appearance and course of an individual lesion of purpura.# the spot, which may be pin-head, pea-, bean-sized or larger, appears suddenly, and is of a bright red or purplish red color. its brightness gradually fades, the color changing to a bluish, bluish-green, bluish- or greenish-yellow, dirty yellowish, yellowish-white, and finally disappearing; varying in duration from several days to several weeks. #describe the symptoms of purpura simplex.# purpura simplex, or the mild form, shows itself as pin-point to pea- or bean-sized, bright or dark-red spots, limited, as a rule, to the limbs, especially the lower extremities; fading gradually away and coming to an end in a few weeks, or new crops appearing irregularly for several months. there is rarely any systemic disturbance, and, as a rule, no subjective symptoms; in exceptional cases an urticarial element is added--_purpura urticans_. #describe the symptoms of purpura rheumatica.# purpura rheumatica (also called _peliosis rheumatica_) is usually preceded by symptoms of malaise, rheumatic pains and sometimes swelling about the joints; these phenomena abate and frequently disappear upon the outbreak of the eruption. the lesions are pea- to dime-sized, smooth, non-elevated, or slightly raised, and of a reddish or purplish color; the eruption may be more or less generalized, most abundant upon the limbs, or it may be limited to these parts. it may end in a few weeks, or may persist for several months, new spots appearing irregularly or in the form of crops. as somewhat allied to this is another form (_schönlein's disease_), quite alarming in its symptoms. it is rare. it is characterized by symptoms partaking of the nature of rheumatism, purpuric spots, blotches and ecchymoses, erythema multiforme, and often associated with considerable edema. the throat is also usually invaded, and indeed the first symptom is commonly in this region. considerable constitutional disturbance, of a threatening character, is commonly observed. recovery usually takes place. _henoch's purpura_, observed chiefly in children, resembles the above, with the erythema multiforme character and the [oe]dematous swellings more pronounced, while the actual purpuric symptoms are less conspicuous. gastric and intestinal symptoms and hemorrhages from the mucous membrane are commonly noted. it is fatal in about per cent. of the cases. #describe the symptoms of purpura hæmorrhagica.# purpura hæmorrhagica (also called _land scurvy_) is characterized usually by premonitory, and frequently accompanying, symptoms of general distress, and by the appearance of coin to palm-sized, red or purplish hemorrhagic spots or patches, smooth, non-elevated or raised. hemorrhage from the mouth, gums and other parts, slight or serious in character, may occur. new lesions continue to appear for several days or weeks; and in exceptional instances, repeated relapses take place, and the disease thus persists for months. it may end fatally. #state the etiology of purpura.# in most instances no cause can be assigned. the disease occurs at all ages from childhood to advanced life, and in individuals, apparently, in good and bad health alike. the hemorrhagic type is oftener seen in subjects debilitated or in a depraved state of health. a microörganism is also looked upon as a factor by some observers, especially in the grave type of disease. #state the diagnostic characters of purpura.# the appearance, irregularly or in crops, of bright-red or purplish spots, evidently of hemorrhagic nature, and not _disappearing upon pressure_, and as they are fading, going through the several changes of color usually observed in any ecchymosis. #how does scurvy (scorbutus) differ from purpura?# scurvy, which may resemble the severe grade of purpura, has a different history, a recognizable cause, usually a peculiar distribution, and is accompanied with general weakness and a spongy, soft and bleeding condition of the gums. #what is the pathology of purpura?# the lesion of purpura consists essentially of a hemorrhage into the cutaneous tissues. the blood is subsequently absorbed, the hæmatin undergoing changes of color from a red to greenish and pale yellow, and finally fading away. #state the prognosis# the milder varieties disappear in the course of several weeks or months, and are rarely of serious import; the outcome of purpura hæmorrhagica is somewhat uncertain; although usually favorable, a fatal result from internal hemorrhage is possible. the variety known as schönlein's disease is alarming, but seldom fatal. henoch's disease is, however, always of grave import. #what is the treatment of purpura?# hygienic and dietary measures, the administration of tonics and astringents, and, in severe cases, by relative or absolute rest. the drugs commonly prescribed are: ergot, oil of erigeron, oil of turpentine, quinia, strychnia, iron, mineral acids, and gallic acid. _external_ treatment is rarely called for, but if deemed advisable, astringent lotions may be employed. #scorbutus.# (_synonyms:_ scurvy; sea scurvy; purpura scorbutica.) #describe scorbutus.# scurvy is a peculiar constitutional state, developed in those living under bad hygienic conditions, and is characterized by emaciation, general febrile and asthenic symptoms, a more or less swollen, turgid and spongy and even gangrenous condition of the gums; and concomitantly, or sooner or later, by the appearance, usually upon the lower portion of the legs only, of dark-colored hemorrhagic patches or blotches. the skin of the affected part may become brawny and slightly scaly, and not infrequently may break down and ulcerate. hemorrhages from the various mucous surfaces, slight or grave, may also take place. #state the etiology of scurvy.# it is due to long-continued deprivation of proper food, especially of fruits and vegetables. other bad hygienic conditions favor its development. it is seen most commonly in sailors and others taking long voyages. #how is scurvy to be distinguished from purpura?# by the asthenic and emaciated general condition and the peculiar puffy, spongy state of the gums. the cutaneous manifestation is more diffused, forming usually large palm-sized patches, and, as a rule, limited to the region of the ankles or lower part of the legs. #give the prognosis of scurvy.# the disease is remediable, and usually rapidly so. in those instances in which the same bad hygienic conditions and the ingestion of improper food are continued, death finally results. #what treatment would you advise in scurvy?# proper food, with an abundance of fruit and vegetables. lemon or lime juice is especially valuable, and is to be taken freely. if indicated, tonics and stimulants are also to be prescribed. for the relief of the tumid, spongy condition of the gums, astringent and antiseptic mouth washes are to be employed. the cutaneous manifestations, when tending to ulceration, are to be treated upon general principles. #class iv.--hypertrophies.# #lentigo.# (_synonym:_ freckle.) #describe lentigo.# lentigo, or freckle, is characterized by round or irregular, pin-head to pea-sized, yellowish, brownish or blackish spots, occurring usually about the face and the backs of the hands. it is a common affection, varying somewhat in the degree of development; the freckles present may be few and insignificant, or they may exist in profusion and be quite disfiguring. heat and exposure favor their development. those of light complexion, especially those with red hair, are its most common subjects. the color of the lesion is usually a yellowish-brown. it is common to all ages, but is generally seen in its greatest development during adolescence, the disposition to its appearance becoming less marked as age advances. #what is the pathology of lentigo?# lentigo consists simply of a circumscribed deposit of pigment granules--merely a localized increase of the normal pigment, differing from chloasma (_q. v._) only in the size and shape of the pigmentation. #state the prognosis.# the blemishes can be removed by treatment, but their return is almost certain. #name the several applications commonly employed for their removal.# an aqueous or alcoholic solution of corrosive sublimate, one-half to three grains to the ounce; lactic acid, one part to from six to twenty parts of water; and an ointment containing a drachm each of bismuth subnitrate and ammoniated mercury to the ounce. the applications, which act by removing the epidermal and rete cells and with them the pigment, are made two or three times daily, and their use intermitted for a few days as soon as the skin becomes irritated or scaly. touching each freckle for a few seconds with the electric needle, just pricking the epidermis, will occasionally remove the blemish. #chloasma.# #what do you understand by chloasma?# chloasma consists of an abnormal deposit of pigment, occurring as variously-sized and shaped, yellowish, brownish or blackish patches. #describe the clinical appearances of chloasma.# chloasma appears either in ill-defined patches, as is commonly the case, or as a diffuse discoloration. its appearance is rapid or gradual, generally the latter. the patches are rounded or irregular, and usually shade off into the sound skin. one, several or more may be present, and coalescence may take place, resulting in a large irregular pigmented area. the color is yellowish, or brownish, and may even be blackish (_melasma_, _melanoderma_). the skin is otherwise normal. the face is the most common site. #into what two general classes may the various examples of chloasma be grouped?# idiopathic and symptomatic. #what cases of chloasma are included in the idiopathic group?# all those cases of pigmentation caused by external agents, such as the sun's rays, sinapisms, blisters, continued cutaneous hyperæmia from scratching or any other cause, etc. #what cases of chloasma are included in the symptomatic group?# all forms of pigment deposit which occur as a consequence of various organic and systemic diseases, as the pigmentation, for instance, seen in association with tuberculosis, cancer, malaria, addison's disease, uterine affections, and the like. in such cases, with few exceptions, the pigmentation is usually more or less diffuse. #what is chloasma uterinum?# chloasma uterinum is a term applied to the ill-defined patches of yellowish-brown pigmentation appearing upon the faces of women, usually between the ages of twenty-five and fifty. it is most commonly seen during pregnancy, but may occur in connection with any functional or organic disease of the utero-ovarian apparatus. #what is argyria?# argyria is the term applied to the slate-like discoloration which follows the prolonged administration of silver nitrate. #state the pathology of chloasma.# the sole change consists in an increased deposit of pigment. #give the prognosis of chloasma.# unless a removal of the exciting or predisposing cause is possible, the prognosis is, as a rule, unfavorable, and the relief furnished by local applications usually but temporary. #if constitutional treatment is advisable, upon what is it to be based?# upon general principles; there are no special remedies. #how do external remedies act?# mainly by removing the rete cells and with them the pigmentation; and partly, also, by stimulating the absorbents. #are all external remedies which tend to remove the upper layers of the skin equally useful for this purpose?# no; on the contrary some such applications are followed by an increase in the pigment deposit. #name the several applications commonly employed.# corrosive sublimate in solution, in the strength of one to four grains to the ounce of alcohol and water; a lotion made up as follows:-- [rx] hydrargyri chlorid. corros., ......... gr. iij-viij ac. acet. dilut., .................... f[dram]ij sodii borat., ........................ [scruple]ij aquæ rosæ, ........................... f[oz]iv. m. and also the following:-- [rx] hydrargyri chlorid. corros., ......... gr. iij-viij zinci sulphat., plumbi acetat., ...... [=a][=a] ...... [dram]ss aquæ, ................................ f[oz]iv. m. and lactic acid, with from five to twenty parts of water; and an ointment containing a drachm each of bismuth subnitrate and white precipitate to the ounce. hydrogen peroxide occasionally acts well. trichloracetic acid, usually weakened with one or two parts water, may be cautiously tried. the application of a strong alcoholic solution of resorcin, twenty to fifty per cent. strength, is also valuable, as is also a two to ten per cent. alcoholic solution of salicylic acid. (applications are made two or three times daily, and as soon as slight scaliness or irritation is produced are to be discontinued for one or two days.) _tattoo-marks_ are difficult to remove. excision is the surest method. electrolysis, applying the needle at various points, somewhat close together, and using a fairly strong current--three to eight milliampères--will exceptionally, especially when repeated several times, produce a reactive inflammation and casting-off of the tissue containing the pigment; a scar is left. several writers claim good results with glycerole of papain, pricking it in in the same manner as in tattooing. _gun-powder marks._ if recent, but a day or so after their occurrence, the larger specks may be picked or scraped out. later, electrolysis, using a fairly strong current, may result in their removal. their removal may also be satisfactorily effected with a minute cutaneous trephine. #keratosis pilaris.# (_synonyms:_ pityriasis pilaris; lichen pilaris.) #what is meant by keratosis pilaris?# keratosis pilaris may be defined as a hypertrophic affection characterized by the formation of pin-head-sized, conical, epidermic elevations seated about the apertures of the hair follicles. #describe the clinical appearances of keratosis pilaris.# the lesions are usually limited to the extensor surfaces of the thighs and arms, especially the former. they appear as pin-head-sized, whitish or grayish elevations, consisting of accumulations of epithelial matter about the apertures of the hair follicles. each elevation is pierced by a hair, or the hair may be twisted and imprisoned within the epithelial mass; or it may be broken off just at the point of emergence at the apex of the papule, in which event it may be seen as a dark, central speck. the skin is usually dry, rough and harsh, and in marked cases, to the hand passing over it, feels not unlike a nutmeg-grater. the disease varies in its development, in most cases being so slight as to escape attention. as a rule, it is free from itching. #what course does keratosis pilaris pursue?# it is sluggish and chronic. #mention some of the etiological factors.# it is not an uncommon disease, and is seen usually in those who are unaccustomed to frequent bathing, being most frequently met with during the winter months. it is chiefly observed during early adult life. #is there any difficulty in the diagnosis?# no. it is thought at times to bear some resemblance to goose-flesh (cutis anserina), the miliary papular syphiloderm in its desquamating stage, and lichen scrofulosus. in goose-flesh the elevations are evanescent and of an entirely different character; the papules of the syphiloderm are usually generalized, of a reddish color, tend to group, are more solid and deeply-seated, less scaly and are accompanied with other symptoms of syphilis; in lichen scrofulosus the papules are larger, incline to occur in groups, and appear usually upon the abdomen. #state the prognosis.# the disease yields readily to treatment. #give the treatment of keratosis pilaris.# frequent warm baths, with the use of a toilet soap or sapo viridis, will usually be found curative. alkaline baths are also useful. in obstinate cases the ordinary mild ointments, glycerine, etc., are to be advised in conjunction with the baths. #keratosis follicularis.# #describe keratosis follicularis.# keratosis follicularis (_darier's disease_, _ichthyosis follicularis_, _ichthyosis sebacea cornea_, _psorospermosis_) is a rare disease characterized by pin-head to pea-sized pointed, rounded, or irregularly-shaped grayish, brownish, red or even black, horny papules or elevations, arising from the sebaceous or hair-follicles. they are, for the most part, discrete, with a tendency here and there to form solid aggregations or areas. many of them contain projecting cornified plugs which may be squeezed out, leaving pit-like depressions. the face, scalp, lower trunk, groins and flanks are the parts chiefly affected. the view advanced by darier, that the malady was due to psorosperms, is now denied, the bodies thought to be such having been demonstrated to be due to cell transformation. as to treatment, in one instance the induction of a substitutive dermatic inflammation had a favorable influence. #molluscum epitheliale.# (_synonyms:_ molluscum contagiosum; molluscum sebaceum; epithelioma molluscum.) #give a definition of molluscum epitheliale.# molluscum epitheliale is characterized by pin-head to pea-sized, rounded, semi-globular, or flattened, pearl-like elevations, of a whitish or pinkish color. #describe the symptoms and course of molluscum epitheliale.# the usual seat is the face; not infrequently, however, the growths occur on other parts. the lesions begin as pin-head, waxy-looking, rounded or acuminated elevations, gradually attaining the size of small peas. they have a broad base or occasionally may tend to become pedunculated. they rarely exist in profusion, in most cases three to ten or twelve lesions being present. when fully developed they are somewhat flattened and umbilicated, with a central, darkish point representing the mouth of the follicle. they are whitish or pinkish, and look not unlike drops of wax or pearl buttons. at first they are firm, but eventually, in most cases, tend to become soft and break down. not infrequently, however, the lesions disappear slowly by absorption, without apparent previous softening. their course is usually chronic. the contents, a cheesy-looking mass, may commonly be pressed out without difficulty. #what is the cause of molluscum epitheliale?# it is now generally accepted that the disease is mildly contagious. it occurs chiefly in children, and especially among the poorer classes. the belief in the parasitic nature of the disease is gaining ground; recently the opinion has been advanced that it is due to psorosperms (psorospermosis); but further investigations have indicated that these bodies were degenerated epithelia. #state the pathology.# [illustration: fig. . molluscum epitheliale.] according to recent investigations, molluscum epitheliale is to be regarded as a hyperplasia of the rete, the growth probably beginning in the hair-follicles; the so-called molluscum bodies--peculiar, rounded or ovoidal, sharply-defined, fatty-looking bodies found in microscopical examination of the growth--are to be viewed as a form of epithelial degeneration. #what are the diagnostic points in molluscum epitheliale?# the size of the lesions, their waxy or glistening appearance, and the presence of the central orifice. it is to be differentiated from molluscum fibrosum, warts and acne. #state the prognosis.# the growths are amenable to treatment. in some instances the disease, after existing some weeks, tends to disappear spontaneously. #what is the treatment of molluscum epitheliale?# incision and expression of the contents, and touching the base of the cavity with silver nitrate. pedunculated growths may be ligated. in some cases an ointment of ammoniated mercury, twenty to forty grains to the ounce, applied, by gently rubbing, once or twice daily, will bring about a cure. #callositas.# (_synonyms:_ tylosis; tyloma; callus; callous; callosity; keratoma.) #what do you understand by callositas?# a hard, thickened, horny patch made up of the corneous layers of the epidermis. #describe the clinical appearances.# callosities are most common about the hands and feet, and consist of small or large patches of dry, grayish-yellow looking, hard, slight or excessive epidermic accumulations. they are somewhat elevated, especially at the central portion, and gradually merge into the healthy skin. the natural surface lines are in a great measure obliterated, the patches usually being smooth and horn-like. _keratosis palmaris et plantaris_ (symmetric keratodermia), as regards the local condition, is a somewhat similar affection. it consists of hypertrophy of the corneous layer of the palm and soles, usually of a more or less horny and plate-like character, but is congenital or hereditary, and not necessarily dependent upon local friction or pressure. #are there any inflammatory symptoms in callositas?# no; but exceptionally, from accidental injury, the subjacent corium becomes inflamed, suppurates, and the thickened mass is cast off. #state the causes of callositas.# pressure and friction; for example, on the hands, from the use of various tools and implements, and on the feet from ill-fitting shoes. it is, indeed, often to be looked upon as an effort of nature to protect the more delicate corium. in exceptional instances it arises without apparent cause. #what is the pathology?# the epidermis alone is involved; it consists, in fact, of a hyperplasia of the horny layer. #state the prognosis of callositas.# if the causes are removed, the accumulation, as a rule, gradually disappears. the effect of treatment is always rapid and positive, but unless the etiological factors have ceased to act, the result is usually but temporary. #how is callositas treated?# when treatment is deemed advisable, it consists in softening the parts with hot-water soakings or poultices, and subsequently shaving or scraping off the callous mass. the same result may also be often effected by the continuous application, for several days or a week, of a to per cent. salicylated plaster, or the application of a salicylated collodion, same strength; it is followed up by hot-water soaking, the accumulation, as a rule, coming readily away. #clavus.# (_synonym:_ corn.) #what is clavus?# clavus, or corn, is a small, circumscribed, flattened, deep-seated, horny formation usually seated about the toes. #describe the clinical appearances.# ordinarily a corn has the appearance of a small callosity; the skin is thickened, polished and horny. exceptionally, however, occurring on parts that are naturally more or less moist, as between the toes, maceration takes place, and the result is the so-called _soft corn_. the dorsal aspect of the toes is the common site for the ordinary variety. the usual size is that of a small pea. they are painful on pressure, and, at times, spontaneously so. #state the causes.# corns are caused by pressure and friction, and may usually be referred to improperly fitting shoes. #what is the pathology of clavus?# it is a hypertrophy of the epiderm. its shape is conical, with the base external and the apex pressing upon the papillæ. it is, in fact, a peculiarly-shaped callosity, the central portion and apex being dense and horny, forming the so-called core. #give the treatment of clavus.# a simple method of treatment consists in shaving off, after a preliminary hot-water soaking, the outer portion, and then applying a ring of felt or like material, with the hollow part immediately over the site of the core; this should be worn for several weeks. it is also possible in some cases to extract the whole corn by gently dissecting it out; the after-treatment being the same as the above. another method is by means of a ten- to fifteen-per-cent. solution of salicylic acid, in alcohol or collodion, or the following:-- [rx] ac. salicylici, ...................... gr. xxx ext. cannabis ind., .................. gr. x collodii, ............................ f[dram]iv. m. this is painted on the corn night and morning for several days, at the end of which time the parts are soaked in hot water, and the mass or a greater part of it, will be found, as a rule, to come readily away; one or two repetitions may be necessary. lactic acid, with one to several parts of water, applied once or twice daily, acts in a similar manner. soft corns, after the removal of pressure, may be treated with the solid stick of nitrate of silver, or by any of the methods already mentioned. in order that treatment be permanently successful, the feet are to be properly fitted. if pressure is removed, corns will commonly disappear spontaneously. #cornu cutaneum.# (_synonyms:_ cornu humanum; cutaneous horn.) #what is cornu cutaneum?# a cutaneous horn is a circumscribed hypertrophy of the epidermis, forming an outgrowth of horny consistence and of variable size and shape. #at what age and upon what parts are cutaneous horns observed?# they are usually met with late in life, and are mostly seated upon the face and scalp. [illustration: fig. . cutaneous horns. showing beginning epitheliomatous degeneration of the base. (_after pancoast._)] #describe the clinical appearances.# in appearance cutaneous horns resemble those seen in the lower animals, differing, if at all, but slightly. they are hard, solid, dry and somewhat brittle; usually tapering, and may be either straight, curved or crooked. their surface is rough, irregular, laminated or fissured, the ends pointed, blunt or clubbed. the color varies; it is usually grayish-yellow, but may be even blackish. as commonly seen they are small in size, a fraction of an inch or an inch or thereabouts in length, but exceptionally attain considerable proportions. the base, which rests directly upon the skin, may be broad, flattened, or concave, with the underlying and adjacent tissues normal or the papillæ hypertrophied; and in some cases there is more or less inflammation, which may be followed by suppuration. they are usually solitary formations. they are not, as a rule, painful, unless knocked or irritated. #what course do cutaneous horns pursue?# their growth is usually slow, and, after having attained a certain size, they not infrequently become loose and fall off; they are almost always reproduced. #what is the cause of these horny growths?# the cause is not known; appearing about the genitalia, they usually develop from acuminated warts. they are rare formations. #state the pathology of cornu cutaneum.# horns consist of closely agglutinated epidermic cells, forming small columns or rods; in the columns themselves the cells are arranged concentrically. in the base are found hypertrophic papillæ and some bloodvessels. they have their starting-point in the rete mucosum, either from that lying above the papillæ or that lining the follicles and glands. #does epitheliomatous degeneration of the base ever occur?# yes. #state the prognosis.# cutaneous horns may be readily and permanently removed. #what is the treatment?# treatment consists in detachment, and subsequent destruction of the base; the former is accomplished by dissecting the horn away from the base or forcibly breaking it off, the latter by means of any of the well-known caustics, such as caustic potash, chloride of zinc and the galvano-cautery. another method is to excise the base, the horn coming away with it; this necessitates, however, considerable loss of tissue. #verruca.# (_synonym:_ wart.) #what is verruca?# verruca, or wart, is a hard or soft, rounded, flat, acuminated or filiform, circumscribed epidermal and papillary growth. #name the several varieties of warts met with.# verruca vulgaris, verruca plana, verruca plana juvenilis, verruca digitata, verruca filifortnis and verruca acuminata. #describe verruca vulgaris.# this is the common wart, occurring mostly upon the hands. it is rounded, elevated, circumscribed, hard and horny, with a broad base, and usually the size of a pea. at first it is smooth and covered with slightly thickened epidermis, but later this disappears to some extent, the hypertrophied papillæ, appearing as minute elevations, making up the growth. one, several or more may be present. #describe verruca plana.# this is the so-called flat wart, and occurs commonly upon the back, especially in elderly people (_verruca senilis_, _keratosis pigmentosa_). it is, as a rule, but slightly elevated, is usually dark in color, and of the size of a pea or finger-nail. #describe verruca plana juvenilis.# the warts are mostly pin-head in size, flat, but slightly elevated, rounded, irregular or square-shaped, and of a light yellowish-brown color. they bear resemblance to lichen planus papules. they are apt to be numerous, often becoming aggregated or fused, and occur usually in young children, and, as a rule, on the face and hands. #describe verruca filiformis.# this is a thread-like growth about an eighth or fourth of an inch long, and occurring commonly about the face, eyelids and neck. it is usually soft to the touch and flexible. #describe verruca digitata.# this is a variety of wart, which, especially about the edges, is marked by digitations, extending nearly or quite down to the base. it is commonly seen upon the scalp. #describe verruca acuminata.# this variety (_venereal wart_, _pointed wart_, _pointed condyloma_), usually occurs about the genitalia, especially upon the mucous and muco-cutaneous surfaces. it consists of one or more groups of acuminated, pinkish or reddish, raspberry-like elevations, and, according to the region, may be dry or moist; if the latter, the secretion, which is usually yellowish and puriform, from rapid decomposition, develops an offensive and penetrating odor. the formation may be the size of a small pea, or may attain the dimensions of a fist. #what is the cause of warts?# the etiology is not known. they are more common in adolescent and early adult life. irritating secretions are thought to be causative in the acuminated variety. it is highly probable that a parasitic factor will finally be demonstrated. they are doubtless mildly contagious. [illustration: fig. . verruca acuminata--about the anus. (_after ashton._)] #state the pathology of warts.# a wart consists of both epidermic and papillary hypertrophy, the interior of the growth containing a vascular loop. in the acuminated variety there are marked papillary enlargement, excessive development of the mucous layer, and an abundant vascular supply. #give the treatment of warts.# for ordinary warts, excision or destruction by caustics. the repeated application of a saturated alcoholic solution of salicylic acid is often curative, the upper portion being pared off from time to time. the filiform and digitate varieties may be snipped off with the scissors, and the base touched with nitrate of silver; or a ligature may be used. curetting is a valuable operative method. the growths may also be removed by electrolysis. when warts are numerous and close together parasiticide applications can be daily made to the whole affected region. for this purpose a boric acid solution, containing five to thirty grains of resorcin to the ounce, and vleminckx's solution, at first diluted, prove the most valuable. verruca acuminata is to be treated by maintaining absolute cleanliness, and the application of such astringents as liquor plumbi subacetatis, tincture of iron, powdered alum and boric acid. the salicylic acid solution may also be used. in obstinate cases, glacial acetic acid or chromic acid may be cautiously employed. #nævus pigmentosus.# (_synonym:_ mole.) #describe nævus pigmentosus.# nævus pigmentosus, commonly known as mole, may be defined as a circumscribed increase in the pigment of the skin, usually associated with hypertrophy of one or all of the cutaneous structures, especially of the connective tissue and hair. it occurs singly or in numbers; is usually pea-, bean-sized or larger, rounded or irregular, smooth or rough, flat or elevated, and of a color varying from a light brown to black; the hair found thereon may be either colorless or deeply pigmented, coarse and of considerable length. it is, as a rule, a permanent formation. #name the several varieties of nævus pigmentosus met with.# nævus spilus, nævus pilosus, nævus verrucosus, and nævus lipomatodes. so-called linear nævus might also be considered as belonging in this group. #what is nævus spilus?# a smooth and flat nævus, consisting essentially of augmented pigmentation alone. [illustration: fig. . linear nævus.] #what is nævus pilosus?# a nævus upon which there is an abnormal growth of hair, slight or excessive. #what is nævus verrucosus?# a nævus to which is added hypertrophy of the papillæ, giving rise to a furrowed and uneven surface. #what is linear nævus?# linear nævus is a formation usually of a verrucous character, more or less pigmented, sometimes slightly scaly, occurring in band-like or zoster-like areas, and, as a rule, unilaterally. #what is nævus lipomatodes?# a nævus with excessive fat and connective-tissue hypertrophy. #state the etiology of nævus pigmentosus.# the causes are obscure. the growths are usually congenital; but the smooth, non-hairy moles may be acquired. #give the pathology of nævus pigmentosus.# microscopical examination shows a marked increase in the pigment in the lowest layers of the rete mucosum, as well as more or less pigmentation in the corium usually following the course of the bloodvessels; in the verrucous variety the papillæ are greatly hypertrophied, in addition to the increased pigmentation. there is, as a rule, more or less connective-tissue hypertrophy. #what is the treatment of nævus pigmentosus?# in many instances interference is scarcely called for, but when demanded consists in the removal of the formation either by the knife, by caustics, or by electrolysis. this last is, in the milder varieties at least, perhaps the best method, as it is less likely to be followed by disfiguring cicatrices. in nævus pilosus the removal of the hairs alone by electrolysis is not infrequently followed by a decided diminution of the pigmentation. in recent years both liquid air and carbon dioxide have also been used successfully in the removal of these growths. pigmented nævi, which show the least tendency to growth or degenerative change, should be radically removed, as they not infrequently lead to carcinomatous and sarcomatous growths. #ichthyosis.# (_synonym:_ fish-skin disease.) #give a descriptive definition of ichthyosis.# ichthyosis is a chronic, hypertrophic disease, characterized by dryness and scaliness of the skin, with a variable amount of papillary growth. #at what age is ichthyosis first observed?# it is first noticed in infancy or early childhood. in rare instances it is congenital (ichthyosis congenita), and in such cases it is usually severe, and of a grave type; the children are, as a rule, prematurely born, and frequently do not survive many days or weeks. #what extent of surface is involved?# usually the whole surface, but it is most marked upon the extensor surfaces of the arms and legs, especially at the elbows and knees; the face and scalp, in mild cases, often remain free. #name the two varieties of ichthyosis usually described.# ichthyosis simplex and ichthyosis hystrix, terms commonly employed to designate the mild and severe forms respectively. #describe the clinical appearances of ichthyosis.# the milder forms of the disease may be so slight as to give rise to simple dryness or harshness of the skin (_xeroderma_); but as commonly met with it is more developed, more or less marked scaliness in the form of thin or somewhat thick epidermal plates being present. the papillæ of the skin are often slightly hypertrophied. in slight cases the color of the scales is usually light and pearly; in the more marked examples it is dark gray, olive green or black. in the severe variety--ichthyosis hystrix--in addition to scaliness there is marked papillary hypertrophy, forming warty or spinous patches. this type is rare, and, as a rule, the surface involved is more or less limited. #are there any inflammatory symptoms in ichthyosis?# no. in fact, beyond the disfigurement, the disease causes no inconvenience; in those well-marked cases, however, in which the scales are thick and more or less immovable, the natural mobility of the parts is compromised and fissuring often occurs. in the winter months, in the severer cases, exposed parts may become slightly eczematous. #does ichthyosis vary somewhat with the season?# yes. in all cases the disease is better in the warm months, and in the mild forms may entirely disappear during this time. this favorable change is purely mechanical--due to the maceration to which the increased activity of the sweat glands gives rise. #is the general health affected in ichthyosis?# no. #what course does ichthyosis pursue?# chronic. beginning in early infancy or childhood, it usually becomes gradually more marked until adult age, after which time it, as a rule, remains stationary. #what is the etiology?# beyond a hereditary influence, which is often a positive factor, the causes are obscure. it is not a common disease. #state the pathology.# anatomically the essential feature is epidermic hypertrophy, with usually a varying degree of papillary hypertrophy also. #mention the diagnostic features of ichthyosis.# the harsh, dry skin, epidermic and papillary hypertrophy, the furfuraceous or plate-like scaliness, the greater development upon the extensor surfaces, a history of the affection dating from early childhood, and the absence of inflammatory symptoms. #how is ichthyosis to be distinguished from eczema, psoriasis, and other scaly inflammatory diseases?# by the absence of the inflammatory element. #what is the outlook for a case of ichthyosis?# the prognosis is unfavorable as regards a cure, but the process may usually be kept in abeyance or rendered endurable by proper measures. #what treatment would you prescribe for ichthyosis?# treatment that has in view removal of the scaliness and the maintenance of a soft and flexible condition of the skin. in mild cases frequent warm baths, simple or alkaline, will suffice; in others an application of an oily or fatty substance, such as the ordinary oils or ointments, made several hours or immediately before the bath may be necessary. in moderately developed cases the skin is to be washed energetically with sapo viridis and hot water, followed by a warm bath, after which an oily or fatty application is made. in some of the more severe cases the following plan is often useful: the parts are first rubbed with a soapy ointment consisting of one part of precipitated sulphur and seven parts of sapo viridis; a bath is then taken, the skin wiped dry, and a one to five per cent. ointment of salicylic acid gently rubbed in. glycerine lotions, one or two drachms to the ounce of water, are also beneficial; as also the following:-- [rx] ac. salicylici, ...................... gr. x-xl glycerini, ........................... [dram]ss-[dram]j lanolin, petrolati, .................. [=a][=a] [oz]ss in severe cases of ichthyosis hystrix it may be necessary, also, to employ caustics or the knife. #what systemic treatment would you prescribe?# constitutional remedies are practically powerless; occasionally some good is accomplished by the internal administration of linseed oil and jaborandi. #onychauxis.# (_synonym:_ hypertrophy of the nail.) #describe onychauxis.# onychauxis, or hypertrophy of the nail, may take place in one or all directions, and this increase may be, and often is, accompanied by changes in shape, color, and direction of growth. one or all the nails may share in the process. as the result of lateral deviation of growth, the nail presses upon the surrounding tissues, producing a varying degree of inflammation--_paronychia_. #what is the etiology of hypertrophy of the nail?# the condition may be either congenital or acquired. in the latter instances it is usually the result of the extension to the matrix of such cutaneous diseases as psoriasis and eczema; or it is produced by constitutional maladies, such as syphilis. #give the treatment of hypertrophy of the nail.# treatment consists in the removal of the redundant nail-tissue by means of the knife or scissors; and, when dependent upon eczema or psoriasis, the employment of remedies suitable for these diseases. when it is the result of syphilis, the medication appropriate to this disease is to be employed. in paronychia the nail should be frequently trimmed and a pledget of lint or cotton be interposed between the edge of the nail and the adjacent soft parts; astringent powders and lotions may often be employed with advantage; and in severe and persistent cases excision of the nail, partial or complete, may be found necessary. #hypertrichosis.# (_synonyms:_ hirsuties; hypertrophy of the hair; superfluous hair.) #what is meant by hypertrichosis?# hypertrichosis is a term applied to excessive growth of hair, either as regards region, extent, age or sex. #describe the several conditions met with.# the unnatural hair growth may be slight, as, for instance, upon a nævus (_nævus pilosus_); or it may be excessive, as in the so-called hairy people (_homines pilosi_); or it may also appear on the face, arms and other parts in females, resulting from a hypertrophy of the natural lanugo hairs. #state the causes of hypertrichosis.# hereditary influence is often a factor; the condition may also be congenital. if acquired, the tendency manifests itself usually toward middle life. in women, it is not infrequently associated with diseases of the utero-ovarian system; in many instances, however, there is no apparent cause. local irritation or stimulation has at times a causative influence. #how is hypertrichosis to be treated?# for general hypertrichosis there is no remedy. small hairy nævi may be excised, or, as also in the larger hairy moles, the hairs may be removed by electrolysis. on the faces of women, if the hairs are coarse or large, electrolysis constitutes the only satisfactory method; if the hairs are small and lanugo-like, the operation is not to be advised. it is somewhat painful, but never unbearable. in the past several years the _x_-ray has been advocated by several writers, but it requires usually numerous exposures pushed to the point of producing erythema; it is not without risk, and the hairs are said to return in some months. #what temporary methods are usually resorted to for the removal of superfluous hair?# shaving, extraction of the hairs and the use of depilatories. as a depilatory, a powder made up of two drachms of barium sulphide and three drachms each of zinc oxide and starch, is commonly (and cautiously) employed; at the time of application enough water is added to the powder to make a paste, and it is then spread thinly upon the parts, allowed to remain five to fifteen minutes, or until heat of skin or a burning sensation is felt, washed off thoroughly, and a soothing ointment applied. this preparation must be well prepared to be efficient. #describe the method of removal of superfluous hair by electrolysis.# a fine needle in a suitable handle is attached to the _negative_ pole of a _galvanic_ battery, introduced into the hair-follicle to the depth of the papilla, and the circuit completed by the patient touching the positive electrode; in several seconds slight blanching and frothing usually appear at the point of insertion; a few seconds later the current is broken by release of the positive electrode, and the needle is then withdrawn. sometimes a wheal-like elevation arises, remains several minutes or hours, and then disappears; or occasionally, probably from secondary infection, it develops into a pustule. a strength of current of a half to two milliamperes is usually sufficient; the time necessary for the destruction of the papilla varying from several to thirty seconds. #how are you to know if the papilla has been destroyed?# the hair will readily come out with but little, if any, traction. #what is the result if the current has been too strong or too long continued?# the follicle suppurates and a scar results. #why should contiguous hairs not be operated upon at the same sitting?# in order that the chances of marked inflammatory action and scarring (always possibilities) may be reduced to a minimum. #in case of failure to destroy an individual papilla, should a second attempt be made at the same sitting?# as a rule not, in order to avoid the possibility of too much destructive action, and consequent scarring. #can scarring always be prevented?# in the average case, with skill and care, the use of an exceedingly fine needle and the avoidance of too strong a current, _perceptible_ scarring (scarring perceptible to the ordinary observer or at ordinary distance) need rarely occur. #what measures are to be advised for the irritation produced by the operation?# hot-water applications and the use of an ointment made of two drachms cold cream and ten grains of boric acid are of advantage not only in reducing the resulting hyperæmia, but also in preventing suppuration and consequent scarring. to lessen the chances of the latter, cleansing the parts with alcohol just before and after the operation is also of service. #[oe]dema neonatorum.# #describe [oe]dema neonatorum.# the essential symptoms are [oe]dema and a variable degree of hardness and induration. it develops in the first few days of life, and usually upon the extremities, especially the lower. it may remain more or less limited to these parts, but, as a rule, slowly extends. the skin is of a yellowish, dusky, or livid color, and sometimes glossy or shining. there are general symptoms of drowsiness, subnormal temperature, weakened circulation, and impaired respiration, which gradually increase, and in eighty to ninety per cent. of the cases lead to death. it is believed to be similar to anasarca in the adult and to be due to like causes. treatment consists in maintaining the body-heat, sufficient and proper nourishment and stimulation. #sclerema neonatorum.# (_synonyms:_ scleroderma neonatorum; sclerema of the newborn.) #what is sclerema neonatorum?# sclerema neonatorum is a disease of infancy, showing itself usually at or shortly after birth, and is characterized by a diffuse stiffness and rigidity of the integument, accompanied by coldness, [oe]dema, discoloration, lividity and general circulatory disturbance. #describe the symptoms, course, nature and treatment of sclerema neonatorum.# as a rule the disease first manifests itself upon the lower extremities, and then gradually, but usually rapidly, invades the trunk, arms and face. the surface is cold. the skin, which is noted to be reddish, purplish or mottled, is [oe]dematous, stiff and tense; in consequence the infant is unable to move, respires feebly and usually perishes in a few days or weeks. in extremely exceptional instances the disease, after involving a small part, may retrogress and recovery take place. the disease is rare, and in most cases is found associated with pneumonia and with affections of the circulatory apparatus. treatment should be directed toward maintaining warmth and proper alimentation. #scleroderma.# (_synonyms:_ sclerema; scleriasis; dermatosclerosis; morph[oe]a; keloid of addison.) #what is scleroderma?# scleroderma is an acute or chronic disease of the skin characterized by a localized or general, more or less diffuse, usually pigmented, rigid, stiffened, indurated or hide-bound condition. morph[oe]a, by some formerly thought to be a distinct affection, is now believed to be a form of scleroderma; as typically met with it is characterized by one or more rounded, oval, or elongate, coin- to palm-sized, pinkish, or whitish ivory-looking patches. in some instances such patches are seen in association with the more classic type of scleroderma just defined. #describe the symptoms of ordinary scleroderma.# the disease may be acute or chronic, usually the latter. a portion or almost the entire surface may be involved, or it may occupy variously sized and shaped areas. the integument becomes more or less rigid and indurated, hard to the touch, hide-bound, and in marked cases immobile. [oe]dema may, especially in the more acute cases, precede the induration. pigmentation, of a yellowish or brownish color, is often a precursory and accompanying symptom. the skin feels tight and contracted, and in some instances numbness and cramp-like pains are complained of. #describe the variety known as morph[oe]a.# the patches (one, several, or more), occurring most frequently about the trunk, are in the beginning usually slightly hyperæmic, later becoming pale-yellowish or white, and having a pinkish or lilac border made up of minute capillaries. they are, as a rule, sharply defined, with a smooth, often shining and atrophic-looking surface; are soft, fine or leathery to the touch, on a level or somewhat depressed, and appearing not unlike a piece of bacon or ivory laid in the skin. occasionally the patches are noted to occur over nerve-tracts. the adjacent skin may be normal or there may be more or less yellowish or brownish mottling. the subjective symptoms of tingling, itching, numbness, and even pain, may or may not be present. #what is the course of the disease?# sooner or later, usually after months or years, the disease ends in resolution and recovery, or in marked atrophic changes, causing contraction and deformity. as a rule, the general health remains good. #state the causes of scleroderma.# the condition is to be considered as probably of neurotic origin. exposure and shock to the nervous system are to be looked upon as influential. it is a rare disease, observed usually in early adult or middle life, and is more frequent in women than in men. #what is the pathology?# in typical and advanced cases both the true skin and the subcutaneous connective tissue show a marked increase of connective tissue-element, with thickening and condensation of the fibers. #is there any difficulty in reaching a diagnosis in scleroderma?# as a rule, no. the characters--rigidity, stiffness, hardness, and hide-bound condition of the skin--are always distinctive. the peculiar appearance, the course and character of the patches, of morph[oe]a are quite distinctive. #give the prognosis of scleroderma.# it should always be guarded. in many instances recovery takes place, whilst in others the disease is rebellious, lasting indefinitely. the prognosis of the variety known as morph[oe]a is less unfavorable than general scleroderma, and recovery more frequent. #what is the treatment of scleroderma?# tonics, such as arsenic, quinia, nux vomica, and cod-liver oil; conjointly with the local employment of stimulating, oily or fatty applications, friction, and electricity. röntgen-ray treatment is often of value, more especially in the morph[oe]a type. #elephantiasis.# (_synonyms:_ elephantiasis arabum; pachydermia; barbadoes leg; elephant leg.) #give a descriptive definition of elephantiasis.# elephantiasis is a chronic hypertrophic disease of the skin and subcutaneous tissue characterized by enlargement and deformity, lymphangitis, swelling, [oe]dema, thickening, induration, pigmentation, and more or less papillary growth. [illustration: fig. . elephantiasis of moderate development.] #what parts are commonly involved in elephantiasis?# usually one or both legs; occasionally the genitalia; other parts are seldom affected. #describe the symptoms of elephantiasis.# the disease usually begins with recurrent (at intervals of months or years) erysipelatous inflammation, with swelling, pain, heat, redness and lymphangitis; after each attack the parts remain somewhat increased in size, although at first not noticeably so. after months or one or two years the enlargement or hypertrophy becomes conspicuous, the part is chronically swollen, [oe]dematous and hard; the skin is thickened, the normal lines and folds exaggerated, the papillæ enlarged and prominent, and with more or less fissuring and pigmentation. #what is the further course of the disease?# there is gradual increase in size, the parts in some instances reaching enormous proportions; the skin becomes rough and warty, eczematous inflammation is often superadded, and, sooner or later, ulcers, superficial or deep, form--which, together with the crusting and moderate scaliness, present a striking picture. there may be periods of comparative inactivity, or, after reaching a certain development, the disease may, for a time at least, remain stationary. #are there any subjective symptoms?# a variable degree of pain is often noted, especially marked during the inflammatory attacks. the general health is not involved. #state the cause of elephantiasis.# the etiology is obscure. the disease rarely occurs before puberty. it is most common in tropical countries, more especially among the poor and neglected. it is not hereditary, nor can it be said to be contagious. inflammation and obstruction of the lymphatics, probably due, according to late investigations, to the presence of large numbers of filaria (microscopic thread-worms) in the lymph channels and bloodvessels, is to be looked upon as the immediate cause. #what is the pathology?# all parts of the skin and subcutaneous connective-tissue are hypertrophied, the lymphatic glands are swollen, the lymph channels and bloodvessels enlarged, and there is more or less inflammation, with [oe]dema. secondarily, from pressure, atrophy and destruction of the skin-glands, and atrophic degeneration of the fat and muscles result. #what are the diagnostic characters of beginning elephantiasis?# recurrent erysipelatous inflammation, attended with gradual enlargement of the parts. the appearances, later in the course of the disease, are so characteristic that a mistake is scarcely possible. #give the prognosis of elephantiasis.# if the case comes under treatment in the first months of its development, the process may probably be checked or held in abeyance; when well established, rarely more than palliation is possible. #what is the treatment of elephantiasis?# the inflammatory attacks are to be treated on general principles. quinia, potassium iodide, iron and other tonics are occasionally useful; and, especially in the earlier stages, climatic change is often of value. between the inflammatory attacks the parts are to be rubbed with an ointment of iodine or mercury, together with galvanization of the involved part. in elephantiasis of the leg, a roller or rubber bandage, or the gum stocking, is to be worn; compression and ligation of the main artery, and even excision of the sciatic nerve, have all been employed, with more or less diminution in size as a result. in elephantiasis of the genitalia, if the disease is well advanced, excision or amputation of the parts is to be practised. eczematous inflammation, if present, is to be treated with the ordinary remedies. #dermatolysis.# (_synonym:_ cutis pendula.) #give a descriptive definition of dermatolysis.# dermatolysis is a rare disease, consisting of hypertrophy and looseness of the skin and subcutaneous connective tissue, with a tendency to hang in folds. #describe the symptoms and course of dermatolysis.# it may be congenital or acquired, and maybe limited to a small or large area, or develop simultaneously at several regions. all parts of the skin, including the follicles, glands and subcutaneous connective and areolar tissue, share in the hypertrophy; and this in exceptional instances may be so extensive that the integument hangs in folds. the enlargement of the follicles, natural folds and rugæ gives rise to an uneven surface, but the skin remains soft and pliable. there is also increased pigmentation, the integument becoming more or less brownish. #what course does dermatolysis pursue?# its development is slow and usually progressive. it gives rise to no further inconvenience than its weight and consequent discomfort. #give the etiology.# the etiology is obscure. it is considered by some authors as allied to molluscum fibrosum, and, in fact, as a manifestation of that disease, ordinary molluscum tumors sometimes being associated with it. it is not malignant. #what is the pathology?# the disease consists of a simple hypertrophy of all the skin structures and the subcutaneous connective tissue. #what is the treatment of dermatolysis?# excision when advisable and practicable. #class v.--atrophies.# #albinismus.# #what do you understand by albinismus?# congenital absence, either partial or complete, of the pigment normally present in the skin, hair and eyes. #describe complete albinismus.# in complete albinismus the skin of the entire body is white, the hair very fine, soft and white or whitish-yellow in color, the irides are colorless or light blue, and the pupils, owing to the absence of pigment in the choroid, are red; this absence of pigment in the eyes gives rise to photophobia and nystagmus. _albinos_--a term applied to such individuals--are commonly of feeble constitution, and may exhibit imperfect mental development. #describe partial albinismus.# partial albinismus is met with most frequently in the colored race. in this form of the affection the pigment is absent in one, several or more variously-sized patches; usually the hairs growing thereon are likewise colorless. #is there any structural change in the skin?# no. the functions of the skin are performed in a perfectly natural manner, and microscopical examination shows no departure from normal structure save the complete absence of pigment. #what is known in regard to the etiology?# nothing is known of the causes producing albinismus beyond the single fact that it is frequently hereditary. #does albinismus admit of treatment?# no; the condition is without remedy. #vitiligo.# (_synonyms:_ leucoderma; leucopathia.) #give a definition of vitiligo.# vitiligo may be defined as a disease involving the pigment of the skin alone, characterized by several or more progressive, milky-white patches surrounded by increased pigmentation. #describe the symptoms of vitiligo.# the disease may begin at one or more regions, the backs of the hands, trunk and face being favorite parts; its appearance is usually insidious, and the spots may not be especially noticeable until they are the size of a pea or larger. the patches grow slowly, are milky or dead white, smooth, non-elevated, and of rounded outline; the bordering skin is darker than normal, showing increased pigmentation. several contiguous spots may coalesce and form a large, irregularly-shaped patch. hair growing on the involved skin may or may not be blanched. there are no subjective symptoms. #what course does vitiligo pursue?# the course of the disease is slow, months and sometimes years elapsing before it reaches conspicuous development. it may after a time remain stationary, or, in rare instances, retrogress; as a rule, however, it is progressive. exceptionally, the greater part, or even the whole surface may eventually be involved. #give the etiology of vitiligo.# disturbed innervation is thought to be influential. the disease develops often without apparent cause. alopecia areata and morph[oe]a have been observed associated with it. [illustration: fig. . vitiligo.] #state the pathology of vitiligo.# the disease consists, anatomically, of both a diminution and increase of the pigment--the white patch resulting from the former, and the pigmented borders from the latter. there is no textural change, the skin in other respects being normal. #from what diseases is vitiligo to be differentiated?# from morph[oe]a and from the anæsthetic patches of leprosy. #in what respects do these diseases differ from vitiligo?# in morph[oe]a there is textural change, and in leprosy both textural change and constitutional or other symptoms. #what prognosis is to be given?# it should always be guarded, the disease in almost all cases being irresponsive to treatment. #what is the treatment of vitiligo?# the general health is to be looked after, and remedies directed especially toward the nervous system to be employed. arsenic, in small and continued doses, seems at times to have an influence; when there is lack of general tone it may be prescribed as follows:-- [rx] liq. potassii arsenitis, ............. f[dram]j tinct. nucis vom., ................... f[dram]iij elix. calisayæ, ....... q. s. ad ..... f[oz]iv. m. sig.--f[dram]j t. d. suprarenal-gland preparations in moderate dosage long continued has appeared in a few instances to be of some benefit. when upon exposed parts, stimulation of the patches, with the view of producing hyperæmia and consequent pigment deposit; conjoined with suitable applications to the surrounding pigmented skin, with a view to lessen the coloration (see _treatment of chloasma_), will be of aid in rendering the disease less conspicuous. or the condition may be, in a measure, masked by staining the patches with walnut juice or similar pigment. #canities.# (_synonym:_ grayness of the hair.) #describe canities.# canities, or graying of the hair, may occur in localized areas or it may be more or less general; the blanching may be slight, scarcely amounting to slight grayness, or it may be complete. it is common to advancing years (_canities senilis_); it is seen also exceptionally in early life (_canities præmatura_). the condition is usually permanent. the loss of pigment takes place, as a rule, slowly, but several apparently authentic cases have been reported in which the change occurred in the course of a night or in a few days. #what is the etiology of canities?# the causes are obscure. heredity is usually an influential factor, and conditions which impair the general nutrition have at times an etiological bearing. intense anxiety, fright, and other profound nervous shock are looked upon as causative in sudden graying of the hair. #give the treatment.# canities is without remedy. dyeing, although not to be advised, is often practised, and the condition thus masked. #alopecia.# (_synonym:_ baldness.) #what do you understand by alopecia?# by alopecia is meant loss of hair, either partial or complete. #name the several varieties of alopecia.# the so-called varieties are based mainly upon the etiology, and are named congenital alopecia, premature alopecia and senile alopecia. #describe congenital alopecia.# congenital alopecia is a rare condition, in which the hair-loss is usually noted to be patchy, or the general hair-growth may simply be scanty. in rare instances the hair has been entirely wanting; in such cases there is usually defective development of other structures, such as the teeth. #describe premature alopecia.# loss of hair occurring in early and middle adult life is not uncommon, and may consist of a simple thinning or of more or less complete baldness of the whole or greater part of the scalp. it usually develops slowly, some months or several years passing before the condition is well established. it is often idiopathic, and without apparent cause further than probably a hereditary predisposition. it may also be symptomatic, as, for example, the loss of hair, usually rapid (_defluvium capillorum_), following systemic diseases, such as the various fevers, and syphilis; or as a result of a long-continued seborrh[oe]a or seborrh[oe]ic eczema (_alopecia furfuracea_). #describe senile alopecia.# this is the baldness so frequently seen developing with advancing years, and may consist merely of a general thinning, or, more commonly a general thinning with a more or less complete baldness of the temporal and anterior portion or of the vertex of the scalp. #what is the prognosis in the various varieties of alopecia?# in those cases in which there is a positive cause, as, for instance, in symptomatic alopecia, the prognosis is, as a rule, favorable, especially if no family predisposition exists. in the congenital and senile varieties the condition is usually irremediable. in idiopathic premature alopecia, the prognosis should be extremely guarded. #how would you treat alopecia?# by removing or modifying the predisposing factors by appropriate constitutional remedies, and by the external use of stimulating applications. #name several remedies or combinations usually employed in the local treatment.# sulphur ointment, full strength or weakened with lard or vaseline; a lotion of resorcin consisting of one or two drachms to four ounces of alcohol, to which is added ten to thirty minims of castor oil; and a lotion made up as follows:-- [rx] tinct. cantharidis, .................. f[dram]iv tinct. capsici, ...................... f[oz]j ol. ricini, .......................... f[dram]ss-f[dram]j alcoholis, .... q. s. ad ............. f[oz]iv. m. the following is sometimes beneficial:-- [rx] resorcin, ............................ gr. lxxx quininæ (alkaloid), .................. gr. xv ol. ricini, .......................... [minim]v-[minim]xx alcoholis, ........................... f[oz]iv.--m. another excellent formula is: [rx] resorcin, ............................ gr. lxxx-cxx ac. carbolici cryst., ................ gr. xx spts. myrciæ, ........................ f[oz]iv.--m. and also the various other stimulating applications employed in alopecia areata (_q. v._). other measures of value are: faradic electricity applied daily for five minutes with a metallic brush or comb; daily massage, with the object of loosening the skin and giving more freedom to cutaneous and subcutaneous circulation; and the application, two or three times weekly, of static electricity by means of the static crown electrode. (the application selected should be gently--not rubbing--applied daily or every second or third day, according to the case; if a lotion, moistening the parts with it; if an ointment, merely greasing the parts. shampooing every one to three weeks, according to circumstances.) #alopecia areata.# (_synonyms:_ area celsi; alopecia circumscripta.) #what do you understand by alopecia areata?# [illustration: fig. . alopecia areata.] alopecia areata is an affection of the hairy system, in which occur one or more circumscribed, round or oval patches of complete baldness unattended by any marked alteration in the skin. #upon what parts and at what age does the disease occur?# in the large majority of cases the disease is limited to the scalp; but it may invade other portions of the body, as the bearded region, eyebrows, eyelashes, and, in rare instances, the entire integument. it is most common between the ages of ten and forty. #describe the symptoms of alopecia areata.# the disease begins either suddenly, without premonitory symptoms, one or several patches being formed in a few hours; or, and as is more usually the case, several days or weeks elapse before the bald area or areas are sufficiently large to become noticeable. the patches continue to extend peripherally for a variable period, and then remain stationary, or several gradually coalesce and form a large, irregular area involving the entire or a greater portion of the scalp. the skin of the affected regions is smooth, faintly pink or milky white, and at first presents no departure from the normal; sooner or later, however, the follicles become less prominent, and slight atrophy or thinning may occur, the bald plaques being slightly depressed. [illustration: fig. . alopecia areata--complete hair loss.] occasionally, usually about the periphery and in the early stages, a few hair-stumps may be seen. #what course does alopecia areata pursue?# almost invariably chronic. after the lapse of a variable period the patches cease to extend, the hairs at the margins of the bald areas being firmly fixed in the follicles; sooner or later a fine, colorless lanugo or down shows itself, which may continue to grow until it is about a half-inch or so in length and then drop out; or it may remain, become coarser and pigmented, and the parts resume their normal condition. not infrequently, however, after growing for a time, the new hair falls out, and this may happen several times before the termination of the disease. #are there any subjective symptoms in alopecia areata?# as a rule, not; but occasionally the appearance of the patches is preceded by severe headache, itching or burning, or other manifestations of disturbed innervation. #state the cause of alopecia areata.# the etiology is obscure. two theories as to the cause of the disease exist: one of these regards it as parasitic, and the other considers it to be trophoneurotic. doubtless both are right, as a study of the literature would indicate that there are, as regards etiology, really two varieties--the contagious and the non-contagious. in america examples of the contagious variety are uncommon. #does the skin undergo any alterative or destructive changes?# microscopical examination of the skin of the diseased area shows little or no alteration in its structure beyond slight thinning. #how do you distinguish alopecia areata from ringworm?# the plaques of alopecia areata are smooth, often completely devoid of hair, and free from scales; while those of ringworm show numerous broken hairs and stumps, desquamation, and usually symptoms of mild inflammatory action. in doubtful cases recourse should be had to the microscope. #what is the prognosis in alopecia areata?# the disease is often rebellious, but in children and young adults the prognosis is almost invariably favorable, permanent loss of hair being uncommon. the same holds true, but to a much less extent, with the disease as occurring in those of more advanced age. in extensive cases--those in which the hair of the entire scalp finally entirely disappears, and sometimes involves all hairy parts--the prognosis is unfavorable. only exceptionally does recovery ensue in such instances. the uncertain duration, however, must be borne in mind; months, and in some instances several years, may elapse before complete restoration of hair takes place. relapses are not uncommon. #how is alopecia areata treated?# by both constitutional and local measures, the former having in view the invigoration of the nervous system, and the latter a stimulating and parasiticidal action of the affected areas. #give the constitutional treatment.# arsenic is perhaps the most valuable remedy, while quinine, nux vomica, pilocarpine, cod-liver oil and ferruginous tonics may, in suitable cases, often be administered with benefit. #name several remedies or combinations employed in the external treatment of alopecia areata.# ointments of tar and sulphur of varying strength; the various mercurial ointments; the tar oils, either pure or with alcohol; stimulating lotions, containing varying proportions, singly or in combination, of tincture of capsicum, tincture of cantharides, aqua ammoniæ, and oil of turpentine. the following is a safe formula, especially in dispensary and ignorant class practice: [rx] [beta]-naphthol, ..................... [dram]ss-[dram]j ol. cadini, .......................... [dram]j ungt. sulphuris, .......... q. s. ad ... [oz]j m. the cautious use of a five to twenty per cent. chrysarobin ointment is of value. painting the patches with pure carbolic acid or trikresol every ten days or two weeks sometimes acts well; it should not be applied over large areas nor used in young children. galvanization or faradization of the affected parts may also be employed, and with, occasionally, beneficial effect. stimulation with the high-frequency current by means of the vacuum electrode is also of value. when practicable, the finsen light can be applied with hope of benefit and cure. #atrophia pilorum propria.# (_synonym:_ atrophy of the hair.) #what do you understand by atrophy of the hair?# an atrophic, brittle, dry condition of the hair, and which may be either symptomatic or idiopathic. #describe the several conditions met with.# as a symptomatic affection, the dry, brittle condition of the hair met with in seborrh[oe]a, in severe constitutional diseases, and in the various vegetable parasitic affections, may be referred to. as an idiopathic disease it is rare, consisting simply of a brittleness and an uneven and irregular formation of the hair-shaft, with a tendency to split up into filaments (_fragilitas crinium_); or there may be localized swelling and bursting of the hair-shaft, the nodes thus produced having a shining, semi-transparent appearance (_trichorrhexis nodosa_). this latter usually occurs upon the beard and moustache. #state the causes of atrophy of the hair.# the causes of the symptomatic variety are usually evident; the etiology of idiopathic atrophy is obscure, but by many is thought due to parasitism. [illustration: fig. . trichorrhexis nodosa. (_after michelson._)] #what would be your prognosis and treatment in atrophy of the hair?# symptomatic atrophy usually responds to proper measures, but always slowly; treatment is based upon the etiological factors. for the idiopathic disease little, as a rule, can be done; repeated shaving or cutting the hair has, in exceptional instances, been followed by favorable results. #atrophia unguis.# (_synonyms:_ atrophy of the nails; onychatrophia.) #describe atrophy of the nails.# the nails are soft, thin and brittle, splitting easily, and are often opaque and lustreless, and may have a worm-eaten appearance. several or more are usually affected. #state the causes of atrophy of the nails.# the condition may be congenital or acquired, usually the latter. it may result from trauma, or be produced by certain cutaneous diseases, notably eczema and psoriasis; or it may follow injuries or diseases of the nerves. syphilis and chronic wasting constitutional diseases may also interfere with the normal growth of the nail-substance, producing varying degrees of atrophy. the fungi of tinea trichophytina and tinea favosa at times invade these structures and lead to more or less complete disintegration--_onychomycosis_. [illustration: fig. . atrophy of the nails.] #what is the treatment of atrophy of the nails?# treatment will depend upon the cause. when it is due to eczema or psoriasis, appropriate constitutional and local remedies should be prescribed. if it is the result of syphilis, mercury and potassium iodide are to be advised. in onychomycosis--an exceedingly obstinate affection--the nails should be kept closely cut and pared, and a one- to five-grain solution of corrosive sublimate applied several times a day; a lotion of sodium hyposulphite, a drachm to the ounce, is also a valuable and safe application. #atrophia cutis.# (_synonyms:_ atrophoderma; atrophy of the skin.) #what do you understand by atrophy of the skin?# by atrophy of the skin is meant an idiopathic or symptomatic wasting or degeneration of its component elements. #state the several conditions met with.# glossy skin, general idiopathic atrophy of the skin, parchment skin, atrophic lines and spots, senile atrophy, and the atrophy following certain cutaneous diseases. #describe glossy skin (atrophoderma neuriticum), and state the treatment.# glossy skin is a rare condition following an injury or disease of the nerve. it is usually seen about the fingers. the skin is hairless, faintly reddish, smooth and shining, with a varnished and thin appearance, and with a tendency to fissuring. more or less severe and persistent burning pain precedes and accompanies the atrophy. protective applications are called for, the disease tending slowly to spontaneous disappearance. #describe general idiopathic atrophy of the skin, and give the treatment.# general idiopathic atrophy of the skin is extremely rare, and is characterized by a gradual, more or less general, degenerative and quantitative atrophy of the skin structures, accompanied usually with more or less discoloration and pigmentation. treatment is palliative and based upon indications. #describe parchment skin, and state the treatment.# parchment skin (_xeroderma pigmentosum_, _angioma pigmentosum et atrophicum_) is a rare disease, the exact nature of which is not understood. it is characterized by the appearance of numerous disseminated, freckle-like pigment-spots, telangiectases, atrophied muscles, more or less shrinking and contraction of the integument, and followed, in most instances, by epitheliomatous tumors and ulceration, and finally death. it is usually slow in its course, beginning in childhood and lasting for years. it is not infrequently seen in several children of the same family. treatment is palliative, consisting, if necessary, of the use of protective applications and of the administration of tonics and nutrients. #describe atrophic lines and spots.# atrophic lines and spots (_striæ et maculæ atrophicæ_) may be idiopathic or symptomatic, the lesions consisting of scar-like or atrophic-looking, whitish lines and macules, most commonly seen on the trunk. they are smooth and glistening. slight hyperæmia usually precedes their formation. as an idiopathic disease its course is insidious and slow, and its progress eventually stayed. the so-called _lineæ albicantes_, resulting from the stretching of the skin produced by pregnancy or tumors, and from rapid development of fat, may be mentioned as illustrating the symptomatic variety. in course of time the atrophy becomes less conspicuous. #describe senile atrophy.# senile atrophy is not uncommon, the atrophy resulting, as the name inferentially implies, from advancing age. it is characterized by thinning and wasting, dryness, and a wrinkled condition, with more or less pigmentation and loss of hair. circumscribed pigmentary deposits and seborrh[oe]a, with degeneration, are also noted. #what several diseases of the skin are commonly followed by atrophic changes?# favus, lupus, syphilis, leprosy, scleroderma and morph[oe]a. #class vi.--new growths.# #keloid.# (_synonyms:_ keloid of alibert; cheloid.) #give a descriptive definition of keloid.# keloid is a fibro-cellular new growth of the corium appearing as one or several variously-sized, irregularly-shaped, elevated, smooth, firm, pinkish or pale-reddish cicatriform lesions. #describe the clinical appearance of keloid.# the growth begins as a small, hard, elevated, pinkish or reddish tubercle, increasing gradually, several months or years usually elapsing before the tumor reaches conspicuous size. when developed, it is one or more inches in diameter, is sharply defined, elevated, hard, rounded or oval, fungoid or crab-shaped, and firmly implanted in the skin. it is usually pinkish, pearl-white, or reddish, commonly devoid of hair, with no tendency to scaliness, and with, usually, several vessels coursing over it. in some instances it is tender, and it may be spontaneously painful. the breast, especially over the sternal region, is a favorite site for its appearance. one, several or more may be present in the single case. #what course does keloid pursue?# chronic; usually lasting throughout life. in rare instances spontaneous involution takes place. #state the etiology of keloid.# the causes are obscure. the growth usually takes its start from some injury or lesion of continuity; for instance, at the site of burns, cuts, acne and smallpox scars, etc.--_cicatricial keloid, false keloid_; or it may also, so it is thought, originate in normal skin--_spontaneous keloid, true keloid_. #what is the pathology of keloid?# the lesion is a connective-tissue new growth having its seat in the corium. #is there any difficulty in the diagnosis of keloid?# no. it resembles hypertrophic scar; but this latter, which is essentially keloidal, never extends beyond the line of injury. #give the prognosis.# the growth is persistent and usually irresponsive to treatment. in some cases, however, there is eventually a tendency to spontaneous retrogression, up to a certain point at least. #what is the treatment of keloid?# usually palliative, consisting of the continuous application of an ointment such as the following:-- [rx] acidi salicylici, .................... gr. x-xx emplast. plumbi, emplast. saponis, ... [=a][=a] ....... [dram]iij petrolati, ........................... [dram]ij. m. an ointment of ichthyol, twenty-five per cent. strength, rubbed in once or twice daily, is sometimes beneficial. operative measures, such as punctate and linear scarification, electrolysis and excision, are occasionally practised, but the results are rarely satisfactory and permanent; not infrequently, indeed, renewed activity in the progress of the growth is noted to follow. the _x_-ray can be tried with some hope of improvement. the administration of thyroid has been thought to have a possible influence in some instances. #fibroma.# (_synonyms:_ molluscum fibrosum; fibroma molluscum.) #what do you understand by fibroma?# fibroma is a connective-tissue new growth characterized by one or more sessile or pedunculated, pea- to egg-sized or larger, soft or firm, rounded, painless tumors, seated beneath and in the skin. #describe the clinical appearances of fibroma.# the growth may be single, in which case it is apt to be pedunculated or pendulous, and attain considerable dimensions; as a result of weight or pressure surface-ulceration may occur. or, as commonly met with, the lesions are numerous, scattered over large surface, and vary in size from a pea to a cherry; the overlying skin being normal, pinkish or reddish, loose, stretched, hypertrophied or atrophied. the tumors are painless. the general health is not involved. [illustration: fig. . fibroma. (_after octerlony._)] #what is the course of fibroma?# chronic and persistent. #what is the etiology of fibroma?# the cause is not known. heredity is often noted. the affection is not common. #state the pathology of fibroma.# the growths are variously thought to have their origin in the connective tissue of the corium, or in that of the walls of the hair-sac, or in the connective-tissue framework of the fatty tissue. recent tumors are composed of gelatinous, newly-formed connective tissue, and the older growths of a dense, firmly-packed, fibrous tissue. #from what growths is fibroma to be differentiated?# from molluscum contagiosum, neuroma and lipoma; the first is differentiated by its central aperture or depression, neuroma by its painfulness, and lipoma by its lobulated character and soft feel. #give the prognosis of fibroma.# the disease is persistent, and irresponsive to all treatment save operative measures. #what is the treatment of fibroma?# treatment consists, when desired and practicable, in the removal of the growths by the knife, or in large and pedunculated tumors by the ligature or by the galvano-cautery. #neuroma.# #describe neuroma.# neuroma of the skin is an exceedingly rare disease, characterized by the formation of variously-sized, usually numerous, firm, immovable and elastic fibrous tubercles containing new nerve-elements, and accompanied by violent, paroxysmal pain. their growth is slow and usually progressive. later they are painful upon pressure. they are limited to one region. the tumors are seated in the corium, extending into the deeper structure, and consist of nerve-fibres, yellow elastic tissue, blood vessels and lymphoid cells. in the two cases reported, excision of the nerve-trunk gave, in one instance, permanent relief; in the other the effect was only temporary. #xanthoma.# (_synonyms:_ vitiligoidea; xanthelasma.) #what is xanthoma?# xanthoma is a connective-tissue new growth characterized by the formation of yellowish, circumscribed, irregularly-shaped, variously-sized, non-indurated, flat or raised patches or tubercles. #name the two varieties met with.# the macular or flat (_xanthoma planum_) and the tubercular (_xanthoma tuberculatum_ or _tuberosum_). in some instances both varieties (_xanthoma multiplex_) are seen in the same individual. #describe the clinical appearances of xanthoma planum.# the macular or flat variety is usually seen about the eyelids. it consists of one, several or more small or large, smooth, opaque, sharply-defined, often slightly raised, yellowish patches, looking not unlike pieces of chamois-skin implanted in the skin. #describe the clinical appearances of xanthoma tuberosum.# the tubercular variety is commonly met with upon the neck, trunk and extremities. it occurs as small, raised, isolated, yellowish nodules, or as patches made up of aggregations of millet-seed-sized or larger tubercles. the lesions may be few or they may exist in great numbers. #what is the course of xanthoma?# extremely slow; after reaching a certain development the growths may remain stationary. #state the etiology of xanthoma.# the causes are obscure. jaundice not infrequently precedes and accompanies its development, especially in the tubercular variety. the disease is uncommon, and is usually seen in middle and advanced life, and more frequently in women. in some cases (_xanthoma diabeticorum_) of general xanthoma diabetes is the causative factor. #what is the pathology of xanthoma?# it is a benign, connective-tissue new growth, with concomitant or subsequent, but usually partial, fatty degeneration. #give the prognosis of xanthoma.# the condition is persistent, and usually irresponsive to all treatment save destructive or operative measures. #what is the treatment of xanthoma?# treatment consists, in suitable cases, of excision; in some instances, electrolysis is serviceable. applications of trichloracetic acid cautiously made are sometimes of value. in that form of general xanthoma due to diabetes the treatment of this latter condition will materially and sometimes completely remove the eruption. #myoma.# (_synonyms:_ myoma cutis; dermatomyoma; liomyoma cutis.) #describe myoma.# the disease is rare, and consists usually of one or several (exceptionally numerous), variously-sized tumors of the skin, made up of smooth muscular fibres. they are flat, rounded, oval or pedunculated, and have a smooth surface and a pale-red color; as a rule, they are painless. the growth is benign, and consists essentially of a new formation of unstriped muscular fibres; but it may also be composed largely of connective tissue (_fibromyoma_); or it may contain an abundance of bloodvessels (_myoma telangiectodes_, _angiomyoma_); or there may be lymphatic involvement (_lymphangiomyoma_). #angioma.# (_synonyms:_ nævus vasculosus; nævus sanguineus.) #give a definition of angioma.# angioma is a congenital hypertrophy of the vascular tissues of the corium and subcutaneous tissue. exceptionally it makes its appearance a few weeks or a month after birth. #into what two classes may angiomata be roughly grouped?# the flat (or non-elevated) and the prominent (or elevated). #describe the flat, or non-elevated, variety of angioma.# the flat, or non-elevated, angioma (_nævus flammeus_, _nævus simplex_, _angioma simplex_, _capillary nævus_) may be pin-head- to bean-sized; or it may involve an area of several inches in diameter, and, exceptionally, a whole region. it is of a bright- or dark-red color, and is met with most frequently about the face. in some instances it extends after birth, reaches a certain size and then remains stationary; occasionally, when involving a small area, it undergoes involution and disappears. the so-called _port-wine mark_ is included in this group. #describe the prominent, or elevated, variety of angioma.# the prominent variety (_venous n[oe]vus_, _angioma cavernosum_, _n[oe]vus tuberosus_) is variously-sized, often considerably elevated, clearly-defined, compressible, smooth or lobulated, and of a dark, purple color; it may, also, be erectile and pulsating. the growth is usually a single formation, and is met with upon all parts of the body. #what is the pathology of angioma?# it is a new growth, consisting of a variable hypertrophy of the cutaneous and subcutaneous arterial and venous bloodvessels, with or without an increase of the connective tissue. #give the treatment of angioma.# in some instances, especially in infants, painting the parts repeatedly with collodion or liquor plumbi subacetatis will act favorably. for well-established, small, capillary nævi electrolysis or puncturing with a red-hot needle or with a needle charged with nitric acid may be employed; for "port-wine mark" frequent and closely contiguous electrolytic punctures are occasionally followed by a slight diminution in color. for the _prominent growths_, vaccination, the ligature, puncturing with the galvano-cautery, and excision are variously resorted to. in recent years applications of liquid air and carbon dioxide have proved of service in some cases. #telangiectasis.# #describe telangiectasis.# telangiectasis consists of a new growth or enlargement of the cutaneous capillaries, usually appearing during middle adult life, and seated, for the most part, about the face. #to what extent may telangiectasis develop?# it may be limited to a red dot or point, with several small radiating capillaries (_nævus araneus_, _spider nævus_), or a whole region, usually the face, may show numerous scattered or closely-set capillary enlargements or new formations (_rosacea_). the latter is frequently associated with acne (_acne rosacea_). the etiology is obscure. #what is the treatment of telangiectasis?# destruction of the vessels by electrolysis or by the knife. (see treatment of acne rosacea.) #lymphangioma.# (_synonym:_ lymphangiectodes.) #describe lymphangioma.# lymphangioma is a rare disease, consisting of localized dilatations of the lymphatic vessels, appearing as discrete or aggregated pin-head or pea-sized, compressible, hollow, tubercle-like elevations, of a pinkish or faint lilac color, and occurring for the most part about the trunk. it is of slow but usually progressive development, and is unaccompanied by subjective symptoms. a rare condition, kaposi described as lymphangioma tuberosum multiplex, characterized by more or less solid, somewhat cystic, pearly to pinkish red, sometimes crowded lesions, is now known to be "benign cystic epithelioma"; its most common site is the face. while called "benign," ulcerative action may eventually ensue. treatment, when demanded, consists of operative measures. #rhinoscleroma.# #describe rhinoscleroma.# rhinoscleroma is a rare and obscure disease, slow but progressive in its course, characterized by the development of an irregular, dense and hard, flattened, tubercular, non-ulcerating, cellular new growth, having its seat about the nose and contiguous parts. the overlying skin is normal in color, or it may be light- or dark-brown or reddish. marked disfigurement and closure, partial or complete, of the nasal orifices gradually results. it is met with chiefly in austria and germany. treatment, consisting of partial or complete extirpation, is rarely permanent in its results, the disease tending to recur. #lupus erythematosus.# (_synonyms:_ lupus erythematodes; lupus sebaceus; seborrh[oe]a congestiva.) #what is lupus erythematosus?# lupus erythematosus may be roughly defined as a mildly to moderately inflammatory superficial new-growth formation, characterized by one, several, or more circumscribed, variously sized and shaped, pinkish or dark red patches, covered slightly, and more or less irregularly, with adherent grayish or yellowish scales. #upon what parts is lupus erythematosus observed?# its common site is the face, usually the nose and cheeks, with a tendency toward symmetry; it is often limited to these parts, but may occasionally be seen upon other regions, more especially the lips, ears, and scalp. in rare instances a great part of the general surface may become involved. #describe the symptoms of lupus erythematosus.# usually the disease begins as one or several rounded, circumscribed, pin-head- to pea-sized lesions; slightly scaly, somewhat elevated, and of a pinkish, reddish or violaceous color. they slowly, or somewhat rapidly, increase in area, and after attaining variable size remain stationary; or they may progress and coalesce, and in this manner sooner or later involve considerable surface. the patches are sharply defined against the sound skin by an elevated border, while the central portion is somewhat depressed and usually atrophic. more or less thickening and infiltration are observed. _there is no tendency to ulceration_. the scaliness is, as a rule, scanty. the gland-ducts are enlarged, patulous or plugged with sebaceous and epithelial matter. the subjective symptoms of burning and itching are usually slight and often wanting. #what course does lupus erythematosus pursue?# as a rule, the disease is persistent, although somewhat variable. at times the patches retrogress, involution taking place with or without slight sieve-like atrophy or scarring. #state the causes of lupus erythematosus.# the etiology is obscure. some observers believe it to be a variety of cutaneous tuberculosis. it is essentially a disease of adult and middle age; is more common in women, and more frequent in those having a tendency to disorders of the sebaceous glands. it may, in fact, begin as a seborrh[oe]a. #what is the pathology?# it was formerly considered a new growth, but recent opinion tends toward regarding it as a chronic inflammation of the cutis, superinducing degenerative and atrophic changes. variable [oe]dema of the prickle layer and of the cutis is found. there is no tendency to pus formation. [illustration: fig. . lupus erythematosus.] #is there any difficulty in the diagnosis of lupus erythematosus?# as a rule, not, as the features of the disease--the sharply circumscribed outline, the reddish or violaceous color, the elevated border, the tendency to central depression and atrophy, the plugged up or patulous sebaceous ducts, the adherent grayish or yellowish scales, together with the region attacked (usually the nose and cheeks)--are characteristic. #state the prognosis of lupus erythematosus.# the disease is often capricious and extremely rebellious to treatment; some cases, up to a certain point at least, yield readily, and occasionally a tendency to spontaneous disappearance is observed; a complete cure is, however, it must be confessed, rather rare. the disease in nowise compromises the general health. in those rare instances of generalized disease the patient has usually died from an intercurrent tuberculosis. #how is lupus erythematosus to be treated?# the general health is to be looked after and systemic treatment prescribed, if indicated. as a rule, constitutional remedies exert little, if any, influence, but exceptionally, cod-liver oil, arsenic, phosphorus, salicin, quinine, or potassium iodide proves of service. locally, according to the case, soothing remedies, stimulating applications and destruction of the growth by caustics or operative measures are to be employed. (_try the milder applications first._) #mention the stimulating applications commonly employed.# washing the parts energetically with tincture of sapo viridis, rinsing and applying a soothing ointment, such as cold cream or vaseline. a lotion containing zinc sulphate and potassium sulphuret thoroughly dabbed on the parts morning and evening:-- [rx] zinci sulphatis, potassii sulphurati, .... [=a][=a] ... [dram]i-[dram]iv glycerinæ, ........................... [minim]iv aquæ, ................................ f[oz]iv. m. the calamine-and-zinc oxide lotion used in acute eczema is also often extremely valuable. lotions of ichthyol and of resorcin, five to sixty grains to the ounce; ichthyol in ointment, five- to twenty-per-cent. strength, is also useful. painting the patches with pure carbolic acid; repeating a day or two after the crusts have fallen off. the continuous application of mercurial plaster. sulphur and tar ointments, officinal strength or weakened with lard, and also the following:-- [rx] ol. cadini, alcoholis, saponis viridis, ..... [=a][=a] ...... [dram]iiss. m. (this is to be rubbed in, in small quantity, once or twice daily, and later a soothing remedy applied.) in recent years both the _x_-ray and finsen light have been used with variable success. repeated applications of the high-frequency current, with the vacuum electrode, have also proved serviceable. cautious applications of liquid air or carbon dioxide have also been used with some success in the past few years. #when are destructive and operative measures justifiable?# in obstinate, sluggish, and long-persistent patches, and then only after other methods of treatment have failed. (remember that a patch or patches of the disease _may_ disappear in course of time spontaneously, and occasionally _without leaving a scar_.) #state the methods of treatment commonly used in obstinate, sluggish and persistent patches of lupus erythematosus.# cauterization--with nitrate of silver, with applications of pyrogallic acid in ointment or in liquor gutta-perchæ, fifteen to thirty per cent. strength, and with solutions (cautiously employed) of caustic potash, and exceptionally with the galvano-cautery. [illustration: fig. . single scarifier.] [illustration: fig. . multiple scarifier. (_as modified by van harlingen._)] operative--scarification, either punctate or linear, and erosion with the curette. (see treatment of lupus vulgaris.) #lupus vulgaris.# (_synonyms:_ lupus; lupus exedens; lupus vorax; tuberculosis of the skin.) #what do you understand by lupus vulgaris?# lupus vulgaris is a cellular new growth, characterized by variously-sized, soft, reddish-brown, papular, tubercular and infiltrated patches, usually terminating in ulceration and scarring. #upon what region is lupus vulgaris usually observed?# the face, especially the nose, but any part may be invaded. the area involved may be small or quite extensive, usually the former. #at what age is the disease noted?# in many cases it begins in childhood or early adult life, but as it is persistent and tends to relapse, it may be met with at any age. #describe the earlier symptoms of lupus vulgaris.# the disease begins by the development of several or more pin-head to small pea-sized, deep-seated, brownish-red or yellowish tubercles, having their seat in the deeper part of the corium, and which are somewhat softer and looser in texture than normal tissue. as the disease progresses, variously-sized and shaped aggregations or patches result, covered with thin and imperfectly-formed epidermis. #what changes do the lupus tubercles or infiltrations undergo?# the lesions, having attained a certain size or development, may remain so for a time, but sooner or later retrogressive changes occur: the matured papules or tubercles, or infiltrated patches, slowly disappear by absorption, fatty degeneration, and exfoliation, leaving a yellowish or brownish pigmentation, usually with more or less atrophy or cicatricial-tissue formation--_lupus exfoliativus_; or disintegration and destruction result, terminating in ulceration--_lupus exedens, lupus exulcerans_. this latter is the more usual course. #describe the clinical appearances and behavior of the lupus ulcerations.# they are rounded, shallow excavations, with soft and reddish borders. in exceptional instances exuberant granulations appear--_lupus hypertrophicus_; or papillary outgrowths are noted--_lupus verrucosus_. the ulcerations secrete a variable amount of pus, usually slight in quantity, which leads to more or less crust formation; later, however, cicatricial tissue, generally of a _firm and fibrous_ character, results. [illustration: fig. . lupus of arm.] #in what manner does the disease spread?# the patches spread by the appearance of new tubercles, or infiltrations at the peripheral portion. new islets and areas of disease may continue to make their appearance from time to time, usually upon contiguous parts. #are the mucous membranes of the mouth, throat and larynx ever involved?# in some instances, and either primarily or secondarily. [illustration: lupus vulgaris.] [illustration: lupus vulgaris.] #is the bone tissue ever involved in lupus vulgaris?# no. #what course does lupus vulgaris pursue?# it is slowly but, as a rule, steadily progressive. several years or more may elapse before the area of disease is conspicuous. #what is the cause of lupus vulgaris?# it is now known to be due to the invasion of the cutaneous structures by the tubercle bacillus; in short, a tuberculosis of the skin. it is not infrequently observed in the strumous and debilitated. it is entirely independent of syphilis. #what is the pathology of lupus vulgaris?# according to recent investigations, the infiltrations of lupus are due chiefly to cell-proliferation and outgrowth from the protoplasmic walls and adventitia of the bloodvessels and lymphatics. the fibrous-tissue network, vessels and a portion of the cell infiltration are thus produced, the fixed and wandering connective-tissue cells of the inflamed stroma of the cutis being responsible for the other portion of the new growth (robinson). #state the diagnostic features of lupus vulgaris.# in a typical, developed patch of lupus are to be seen:--cicatricial formation, usually of a fibrous and tough character; ulcerations; the yellowish-brown tubercles and infiltration; and the characteristic soft, small, yellowish or reddish-brown, cutaneous and subcutaneous points and tubercles. #how does the tubercular syphiloderm differ from lupus vulgaris?# the tubercular syphiloderm is much more rapid in its course, the ulceration is deeper and the discharge copious and often offensive; the scarring is soft, and, compared to the amount of ulceration, but slightly disfiguring; and it is, for obvious reasons, a disease of adult or late life. the history, together with other evidences of previous or concomitant symptoms of syphilis, will often aid in the differentiation. #how does epithelioma differ from lupus vulgaris?# the edges of the epitheliomatous ulcer are hard, elevated and waxy; the base is uneven, the secretion thin, scanty and apt to be streaked with blood; the ulceration usually starts from one point, and is often painful; the tissue destruction may be considerable; there is little, if any, tendency to the formation of cicatricial tissue; and, finally, it is usually a disease of advanced age. #in what respects does lupus erythematosus differ from lupus vulgaris?# lupus erythematosus has no papules, tubercles or ulceration. #how does acne rosacea differ from lupus vulgaris?# acne rosacea is characterized by hyperæmia, dilated vessels, papules, pustules, the absence of ulceration, and a different history. #state the prognosis of lupus vulgaris.# lupus vulgaris is always a chronic disease, often exceedingly rebellious to treatment, and one that calls for a guarded opinion. relapses are not uncommon. [illustration: fig. . galvano-cautery needle, knife and spiral points. (_as devised by bésnier._)] the general health usually remains good, but in some instances death by tuberculosis of the lungs has been noted. #is external or internal treatment called for in lupus vulgaris?# always external, and not infrequently constitutional also. #what is the constitutional treatment?# the general health must be cared for; good, nutritious food, fresh air and out-door exercise, together with, in many cases, the administration of such remedies as cod-liver oil, potassium iodide, iron and quinine, are of therapeutic importance. tuberculin may be tried in severe and obstinate cases, but its use is not without danger. #state the object of local treatment.# the destruction or removal of the diseased tissue. #may milder methods of treatment sometimes prove beneficial and even curative?# exceptionally, mercurial plaster, corrosive-sublimate lotion and ointment (gr. j to [oz]j), a plaster containing five to fifteen per cent. of salicylic acid and creasote, repeated paintings with carbolic acid, and the constant application of lead plaster containing twenty per cent. of ichthyol, are valuable. [illustration: fig. . double curette.] of the milder methods, those most in vogue to-day are the _finsen light_ and _x-ray_. either proves extremely valuable in some cases, but the finsen method is the favorite method. #what methods are commonly employed for the rapid removal or destruction of lupus tissue?# cauterization, scarification, erasion and excision are variously practised; the particular method depending, in great measure, upon the extent of the disease, the part involved, and other circumstances. #name the several caustics, and state how they are employed.# _pyrogallic acid_, used as an ointment:-- [rx] ac. pyrogallici, ..................... [dram]ij emplast. plumbi, ..................... [dram]j cerat. resinsæ, ...................... [dram]v. m. it is applied for one or two weeks. every several days the parts are poulticed, the slough thus removed, and the ointment reapplied, and so on until the diseased tissue has been destroyed. it is useful in those cases in which a mild and comparatively painless caustic is advisable. in most cases several repetitions of this plan are necessary. _arsenious acid_, employed as an ointment-- [rx] ac. arseniosi, ...................... gr. xx hydrarg. sulphid. rub., ............. gr. lx ungt. aquæ rosæ, .................... [oz]i.--m. it is painful but thorough; it is spread on lint and renewed daily. the action is usually sufficient in three days, and the parts are then poulticed until the slough comes away, after which a simple dressing is employed. its application is advisable for a small area only--not more than four square inches--as absorption is possible. _galvano-cautery._--the diseased tissue is destroyed by numerous punctures with a red-heated point or by linear incision with a red-heated knife. it is often a practicable and satisfactory method. the paquelin cautery and liquid air and carbon dioxide also have their advocates. #describe the operative measures employed in the removal of lupus tissue.# _linear scarification._--the parts are thoroughly cross-tracked, cutting through the diseased tissue, and subsequently a simple salicylated ointment applied. the operation is repeated from time to time, and as a result the new growth undergoes retrogressive changes, and cicatrization takes place. _punctate scarification._--by means of a simple or multiple-pointed instrument numerous closely-set punctures are made, and repeated from time to time, usually with the same action and result as from linear scarification. _erasion._--the parts are thoroughly scraped with a curette, and a supplementary caustic application made, either with caustic potash or several days' use of the pyrogallic-acid ointment. the result is usually satisfactory. the dental-burr is also useful in breaking up discrete tubercles. _excision._--this is an effective method if the disease consists of a small pea- or bean-sized circumscribed patch. of these various operative methods those now most favored are erasion and excision, punctate and linear scarification methods are now rarely employed. #tuberculosis cutis.#[d] (_synonym:_ scrofuloderma.) [footnote d: the most important clinical variety of this class is lupus vulgaris, which is considered above, separately, at some length.] #what do you understand by tuberculosis cutis?# the term is applied to those peculiar suppurative and ulcerative conditions of the skin due to the tubercle bacilli. #how does the common type of tuberculosis cutis begin?# the most common type of tuberculous ulceration or involvement of the skin usually results by extension from an underlying caseating and suppurating lymphatic gland; or it may have its origin as subcutaneous tubercles independently of these structures. it tends to spread, and may involve an area of one or several inches. [illustration: fig. . tuberculosis verrucosa cutis (negro).] #what are the clinical appearances and behavior of this type of tuberculous ulceration?# it is usually superficial, has thin, red, undermined edges of a violaceous color, and an irregular base with granulations covered scantily with pus. as a rule, it spreads gradually as a simple ulceration, with but slight, if any, outlying infiltration. subjective symptoms of a painful or troublesome character are rarely present. its course is usually progressive but slow and chronic. other symptoms of tuberculosis are commonly to be found. #are other forms of tuberculosis cutis met with?# a papulo-pustular eruption is sometimes observed, especially on the upper extremities and face; sluggish and chronic in character and leaving small pit-like scars; has been known as the _small pustular scrofuloderma_. [illustration: fig. . tuberculosis verrucosa cutis (patient had a coexistent pulmonary tuberculosis).] an ulcerative papillomatous or verrucous tuberculosis of the skin (tuberculosis verrucosa cutis) is also occasionally noted, most commonly seated upon the lower leg or the back of the hand. it may be slight or extensive. its mildest phase is the so-called verruca necrogenica. #describe verruca necrogenica.# verruca necrogenica is a rare, localized, papillary or wart-like formation, occurring usually about the knuckles or other parts of the hand. it begins, as a rule, as a small, papule-like growth, increasing gradually in area, and when well advanced appears as a pea, dime-sized or larger, somewhat inflammatory, elevated, flat, warty mass, with usually a tendency to slight pus-formation between the hypertrophied papillæ; the surface may be horny or it may be crusted. it tends to enlarge slowly and is usually persistent, but it at times undergoes involution. [illustration: fig. . tuberculosis cutis (verruca necrogenica). (_after model in guy's museum._)] #state the etiology.# heredity, insufficient and unwholesome food, impure air, and the like are predisposing. the tubercle bacillus is the immediate exciting cause. the disease usually appears in childhood or early adult life, and not infrequently follows in the wake of some severe systemic disease. etiologically it is identical in nature with lupus. #how is the tuberculous ulcer to be differentiated from syphilis?# by the peculiar character of the tuberculous ulceration, the absence of outlying tubercles and infiltration, together with its history, course, and often the presence of other tuberculous symptoms. #state the prognosis.# these various types of tuberculosis cutis are, as a rule, more amenable to treatment than that form known as lupus vulgaris (_q. v._). #what is the treatment of these forms of tuberculosis cutis?# constitutional remedies, such as cod-liver oil, iodide of iron or other ferruginous tonics, together with good food and pure air; phosphorus one-hundredth to one-fiftieth of a grain three times daily is also of benefit in some cases. the local treatment consists in thorough curetting and the subsequent application of a mildly stimulating ointment. the several other plans of external treatment employed in lupus (_q. v._) are also variously practised. in recent years the _x_-ray and finsen light plans have, in a measure, supplanted the previous methods of treatment. they are slow, however, and might be, especially the _x_-ray, more satisfactorily employed as a supplementary measure. #ainhum.# #describe ainhum.# ainhum is a disease of the african race, met with chiefly in brazil, the west indies, and africa, and consists of a slow but gradual linear strangulation of one or more of the toes, especially the smallest, resulting, eventually, in spontaneous amputation. the affected toes themselves undergo fatty degeneration, often with increase in size, and are, when strangulation is well advanced, considerably misshapen. the nature of the disease is obscure. _treatment_ consists, in the early stages, of incision through the constricting band; when the disease is well advanced, amputation is the sole recourse. #mycetoma.# (_synonyms:_ fungous foot of india; madura foot; podelcoma.) #decribe mycetoma.# it is a disease involving usually the foot, and is met with chiefly in india. it is characterized by swelling and the formation of tubercular or nodular lesions which break down and form the external openings of sinuses which lead to the interior of the affected part. these discharge, and are studded with, whitish granules or black, roe-like masses, mixed with a sanious or sero-purulent fluid. the whole part is gradually disintegrated, the process lasting indefinitely. its nature is obscure; it is thought to be due to a fungus. _treatment_ consists in the early stages, when the disease is limited, of thorough curetting and cauterization; later, after the part is more or less involved, amputation, at a point well up beyond the disease, becomes necessary. potassium iodide internally may exert a favorable influence. #perforating ulcer of the foot.# #describe perforating ulcer of the foot.# perforating ulcer of the foot is a rare disease, consisting of an indolent and usually painless sinus leading down to diseased bone. the external opening, which is through the centre of a corn-like formation, is small, and may or may not show the presence of granulations. the affected part is commonly more or less anæsthetic and of subnormal temperature. one or several may be present, either on one or both feet. the most common site is over the articulation of the metatarsal bone with the phalanx of the first or last toe. the disease is dependent upon impairment or degeneration of the central, truncal or peripheral nerves. #what is to be said in regard to the prognosis and treatment?# treatment, which is, as a rule, unsatisfactory, consists in the maintenance of absolute rest, and the use of antiseptic and stimulating applications. amputation is also resorted to, but even this is at times futile, as a new sinus may appear upon the stump. #syphilis cutanea.# (_synonyms:_ syphiloderma; dermatosyphilis; syphilis of the skin.) #in what various types may syphilis manifest itself upon the integument?# syphilis may show itself as a macular, papular (rarely vesicular), pustular, bullous, tubercular and gummatous eruption; or the eruption may be, in a measure, of a mixed type. #in what respects do the early (or secondary) eruptions of syphilis differ from those following several years or more after the contraction of the disease?# the early or secondary eruptions are more or less generalized, with rarely any attempt at special configuration. their appearance is often preceded by symptoms of systemic disturbance, such as fever, loss of appetite, muscular pains and headache; and accompanied by concomitant signs of the disease, such as enlargement of the lymphatic glands, sore throat, mucous patches, falling of the hair and rheumatic pains. #state the distinguishing characters of the late eruptions.# the late eruptions (those following one or more years after the contraction of the disease) are usually of tubercular, gummatous or ulcerative type; are limited in extent, and have a marked tendency to appear in circular, semicircular or crescentic forms or groups. pain in the bones, bone lesions and other symptoms may or may not be present. #what is the color of syphilitic lesions?# usually, a dull brownish-red or ham-red, with at times a yellowish cast. #are there any subjective symptoms in syphilitic eruptions?# as a rule, no; but in exceptional instances of the generalized eruptions, more especially in negroes, there may be slight itching. #describe the macular, or erythematous, eruption of syphilis.# the _macular syphiloderm_ is a general eruption, showing itself usually six or eight weeks after the appearance of the chancre. it consists of small or large, commonly pea- or bean-sized, rounded or irregularly-shaped, not infrequently slightly raised, macules. when well established they do not entirely disappear under pressure. at first a pale-pink or dull, violaceous red, they later become yellowish or coppery. the eruption is generally profuse; the face, backs of the hands and feet may escape. it persists several weeks or one or two months; as a rule, it is rapidly responsive to treatment. #how would you distinguish the macular syphiloderm from measles, rötheln and tinea versicolor?# measles is to be differentiated by its catarrhal symptoms, fever, form and situation of the eruption; rötheln, by its small, roundish, confluent pinkish or reddish patches, its precursory pyrexic symptoms, its epidemic nature, and short duration; tinea versicolor by its scaliness, peripheral growth, distribution and history. and, finally, by the absence or presence of other symptoms of syphilis. [illustration: fig. . macular syphiloderm.] #what several varieties of the papular eruption of syphilis are met with?# there are two forms of the papular eruption--the small and large; those of the latter type may undergo various modifications. #describe the small-papular eruption of syphilis.# the _small-papular syphiloderm_ (_miliary papular syphiloderm_) usually shows itself in the third or fourth month of the disease, and consists of a more or less generalized eruption of disseminated or grouped, firm, rounded or acuminated pin-head to millet-seed-sized papules, with smooth or slightly scaly summits, and in some lesions showing pointed pustulation. scattered minute pustules and some large papules are usually present. the eruption is profuse, most abundant upon the trunk and limbs; and in the early part of the outbreak is of a bright- or dull-red color, later assuming a violaceous or brownish tint. it runs a chronic course, is somewhat rebellious to treatment, and displays a tendency to relapse. [illustration: fig. . moist papules. (_after miller._)] #how would you distinguish the small-papular syphiloderm from keratosis pilaris, psoriasis punctata, papular eczema, and lichen ruber?# the distribution and extent of the eruption, the color, the grouping, with usually the presence of pustules and large papules and other concomitant symptoms of syphilis, are points of difference. pustules never occur in the several diseases named, except in eczema. #describe the large-papular eruption of syphilis.# the _large-papular syphiloderm_ (or _lenticular syphiloderm_) is a common form of cutaneous syphilis, appearing usually in the first six or eight months, and consists of a more or less generalized eruption of pea- to dime-sized or larger, flat, rounded or oval, firmly seated, more or less raised, dull-red papules; with at first a smooth surface, which later usually becomes covered with a film of exfoliating epidermis. the papules, as a rule, develop slowly, remain stationary several weeks or a few months, and then pass away by absorption, leaving slight pigmentation, which gradually fades; or they may undergo certain modifications. in most cases it responds rapidly to treatment. [illustration: small-papular syphiloderm.] [illustration: fig. . palmar syphiloderm.] #what modifications do the papules of the large-papular syphiloderm sometimes undergo?# they may change into the moist papule and squamous papule. #describe the moist papule of syphilis.# the change into the moist papule (also called _mucous patch, flat condyloma_) is not uncommon where opposing surfaces and natural folds of skin are subjected to more or less contact, as about the anus, the scroto-femoral regions, umbilicus, axillæ and beneath the mammæ. the dry, flat papules gradually become moist and covered with a grayish, sticky, mucoid secretion; several may coalesce and form large, flat patches. they may so remain, or they may become hypertrophic, warty or papillomatous, with more or less crust formation (_vegetating syphiloderm_). [illustration: fig. . annular syphiloderm. (_after i.e. atkinson._)] #describe the squamous papule of syphilis.# this tendency of the large-papular eruption to become scaly, when exhibited, is more or less common to all papules, and constitutes the _squamous_ or _papulo-squamous syphiloderm_ (improperly called _psoriasis syphilitica_). the papules become somewhat flattened and are covered with dry, grayish or dirty-gray, somewhat adherent scales. the scaling, as compared to that of psoriasis, is, as a rule, relatively slight. the eruption may be general, as usually the case in the earlier months of the disease, or it may appear as a relapse or a later manifestation, and be limited in extent. as a limited eruption it is most frequently seen on the palms and soles--the _palmar and plantar syphiloderm_. occurring on these parts it is often rebellious to treatment. [illustration: maculo-papular syphiloderm.] #how are you to distinguish the papulo-squamous syphiloderm from psoriasis?# in psoriasis the eruption is more inflammatory, and usually bright red; the scales whitish or pearl-colored and, as a rule, abundant. it is generally seen in greater profusion upon certain parts, as, for instance, the extensor surfaces, especially of the elbows and knees. it is not infrequently itchy, and, moreover, presents a different history. in the syphilitic eruption some of the papules almost invariably remain perfectly free from any tendency to scale formation; there is distinct deposit or infiltration, and the lesions are of a dark, sluggish red or ham tint; and, moreover, concomitant symptoms of syphilis are usually present. #describe the annular eruption of syphilis.# the _annular syphiloderm_ (_circinate syphiloderm_) is observed usually in association with the large-papular eruption, and consists of several or more variously sized, ring-like lesions, with a distinctly elevated solid ridge or wall peripherally and a more or less flattened centre. it is commonly seen about the mouth, forehead and neck. the lesion appears to have its origin from an ordinary, usually scaleless or slightly scaly, large papule, the central portion of which has been incompletely formed or has become sunken and flattened. the manifestation is rare, and is seen most frequently in the negro. #what several varieties of the pustular syphiloderm are met with?# the small acuminated-pustular syphiloderm, the large acuminated-pustular syphiloderm, the small flat-pustular syphiloderm, and the large flat-pustular syphiloderm. #describe the small acuminated-pustular eruption of syphilis.# the _small acuminated-pustular syphiloderm_ (_miliary pustular syphiloderm_) is an early or late secondary eruption, commonly encountered in the first six or eight months of the disease. it consists of a more or less generalized, disseminated or grouped, millet-seed-sized, acuminated pustules, usually seated upon dull-red, papular elevations. the eruption is, as a rule, profuse, and usually involves the hair-follicles. the pustules dry to crusts, which fall off and are often followed by a slight, fringe-like exfoliation around the base, constituting a grayish ring or collar. minute pin-point atrophic depressions or stains are left, which gradually become less distinct. scattered large pustules, and sometimes papules, are not infrequently present. #describe the large acuminated-pustular eruption of syphilis.# the _large acuminated-pustular syphiloderm_ (_acne-form syphiloderm_, _variola-form syphiloderm_) is a more or less generalized eruption, occurring usually in the first six or eight months of the disease. it consists of small or large pea-sized, disseminated or grouped, acuminated or rounded pustules, resembling the lesions of acne and variola. they develop slowly or rapidly, and at first may appear more or less papular. they dry to somewhat thick crusts, and are seated upon superficially ulcerated bases. it pursues, as a rule, a comparatively rapid and benign course. in relapses the eruption is usually more or less localized. #how would you distinguish the large acuminated-pustular syphiloderm from acne and variola?# in acne the usual limitation of the lesions to the face or face and shoulders, the origin, more rapid formation and evolution of the individual lesions, and the chronic character of the disease, are usually distinctive points. in variola, the intensity of the general symptoms, the shot-like beginning of the lesions, their course, the umbilication, and the definite duration, are to be considered. the presence or absence of other symptoms of syphilis has, in obscure cases, an important diagnostic bearing. #describe the small flat-pustular eruption of syphilis.# the _small flat-pustular syphiloderm_ (_impetigo-form syphiloderm_) consists of a more or less generalized, pea-sized, flat or raised, discrete, irregularly-grouped, or in places confluent, pustules, appearing usually in the first year of the disease. the pustules dry rapidly to yellow, greenish-yellow, or brownish, more or less adherent, thick, uneven, somewhat granular crusts, beneath which there may be superficial or deep ulceration; where the lesions are confluent a continuous sheet of crusting forms. the eruption is often scanty. it is most frequently observed about the nose, mouth, hairy parts of the face and scalp, and about the genitalia, frequently in association with papules on other parts. #are you likely to mistake the small flat-pustular syphiloderm for any other eruption?# scarcely; but when upon the scalp, it may bear rough resemblance to pustular eczema, but the erosion or ulceration will serve to differentiate. moreover, concomitant symptoms of syphilis are to be looked for. #describe the large flat-pustular eruption of syphilis.# the _large flat-pustular syphiloderm_ (_ecthyma-form syphiloderm_) consists of a more or less generalized, scattered eruption, of large pea- or dime-sized, flat pustules. they dry rapidly to crusts. the bases of the lesions are a deep-red or copper color. two types of the eruption are met with. in one type--the superficial variety--the crust is flat, rounded or ovalish, of a yellowish-brown or dark-brown color, and seated upon a superficial erosion or ulcer. the lesions are usually numerous, and most abundant on the back, shoulders and extremities. it appears, as a rule, within the first year, and generally runs a benign course. [illustration: fig. . rupia. (_after tilbury fox._)] in the other type--the deep variety--the crust is greenish or blackish, is raised and more bulky, often conical and stratified, like an oyster shell--_rupia_; beneath the crusts may be seen rounded or irregular-shaped ulcers, having a greenish-yellow, puriform secretion. it is usually a late and malignant manifestation. #how would you differentiate the large flat-pustular syphiloderm from ecthyma?# the syphilitic lesions are more numerous, are scattered, are attended with superficial or deep ulceration, and followed by more or less scar-formation. moreover, the history, and presence or absence of other symptoms of syphilis have an important diagnostic value. [illustration: fig. . ulcerating tubercular syphiloderm.] #describe the bullous eruption of syphilis.# the _bullous syphiloderm_, (of acquired syphilis) is a rare and usually late eruption, appearing in the form of discrete, disseminated, rounded or ovalish, pea- to walnut-sized, partially or fully distended, blebs. the serous contents soon become cloudy and puriform. in some cases the lesions are distinctly pustular from the beginning. the crust, which soon forms, is of a yellowish-brown or dark green color, and may be thick and stratified (_rupia_), as in the deep variety of the large flat-pustular syphiloderm. the erosions or ulcers beneath the crusts secrete a greenish-yellow fluid. it is a malignant type of eruption, and is usually seen in broken-down subjects. it is not an uncommon manifestation of hereditary syphilis (_q. v._) in the newborn. [illustration: fig. . tubercular syphiloderm.] #how is the bullous syphiloderm to be differentiated from other pemphigoid eruptions?# by the gravity of the disease, the accompanying ulceration, the course and history; and by other evidences, past or present, of syphilis. #describe the tubercular eruption of syphilis.# the _tubercular syphiloderm_ (_syphiloderma tuberculosum_) may exceptionally occur within the first year as a more or less generalized eruption. as a rule, however, it is a late manifestation, at times appearing many years after the initial lesion; is limited in extent, and shows a decided tendency to occur in groups, often forming segments of circles and circular areas, clearing in the centre and spreading peripherally. it consists (as a late, limited manifestation) of several or more firm, circumscribed, deeply-seated, smooth, glistening or slightly scaly elevations; rounded or acuminated in shape, of a yellowish-red, brownish-red or coppery color and usually of the size of small or large peas. several groups may coalesce, and a serpiginous tract result (_serpiginous tubercular syphiloderm_). the lesions develop slowly, and are sluggish in their course, remaining, at times, for weeks or months, with but little change. as a rule, however, they terminate sooner or later, either by absorption, leaving a more or less permanent pigment stain with or without slight atrophy (_non-ulcerating tubercular syphiloderm_), or by ulceration (_ulcerating tubercular syphiloderm_). [illustration: fig. . ulcerating tubercular syphiloderm.] #describe the ulcerating tubercular syphiloderm.# the ulceration may be superficial or deep in character, and involve several or all of the lesions forming the group. the patch may consist, therefore, of small, discrete, punched-out ulcers, or of one or more continuous ulcers, segmented, crescentic or serpiginous in shape. they are covered with a gummy, grayish-yellow deposit or they may be crusted. as the ulcerative changes take place, new lesions, especially about the periphery of the group or patch, may appear from time to time. [illustration: tubercular syphiloderm.] [illustration: large-pustular syphiloderm.] in some instances, more especially about the scalp, the surface of the ulcerations becomes papillary or wart-like, with an offensive, yellowish, puriform secretion (_syphilis cutanea papillomatosa_). #from what diseases is the tubercular syphiloderm to be differentiated?# from tubercular leprosy, epithelioma and lupus vulgaris, especially the last-named. #what are the chief diagnostic characters of the tubercular syphiloderm?# the tendency to form segments, crescents and circles, the color, the pigmentation and ulceration, the history, and not infrequently marks or scars of former eruptions. [illustration: fig. . tubercular syphiloderm.] #describe the gummatous eruption of syphilis.# the _gummatous syphiloderm_ (_syphiloderma gummatosum_, _gumma_, _syphiloma_) is usually a late manifestation, showing itself as one, several or more painless or slightly painful, rounded or flat, more or less circumscribed tumors; they are slightly raised, moderately firm, and have their seat in the subcutaneous tissue. they tend to break down and ulcerate. the lesion begins usually as a pea-sized deposit or infiltration, and grows slowly or rapidly; when fully developed it may be the size of a walnut, or even larger. the overlying skin becomes gradually reddish. at first firm, it is later soft and doughy. it may, even when well advanced, disappear by absorption, but usually tends to break down, terminating in a small or large, deep, punched-out ulcer. [illustration: fig. . tubercular syphiloderm.] #does the gummatous syphiloderm invariably appear as a rounded well-defined tumor?# no. exceptionally, instead of a well-defined tumor, it may appear as a more or less diffused patch of infiltration, leading eventually to extensive superficial or deep ulceration. #from what formations is the gummatous syphiloderm to be differentiated?# from furuncle, abscess, and sebaceous, fatty and fibroid tumors. attention to the origin, course, and behavior of the lesion, together with a history, must all be considered in doubtful cases. [illustration: fig. . large pustular syphiloderm.] #what is to be said in regard to the character and time of appearance of the cutaneous manifestations of hereditary syphilis?# in a great measure the cutaneous manifestations of hereditary syphilis are essentially the same as observed in acquired syphilis. they are usually noted to occur within the first three months of extra-uterine life. the macular, papular, and bullous eruptions are most common. #describe these several cutaneous manifestations of hereditary syphilis.# the _macular_ (erythematous) eruption begins as large or small, bright- or dark-red macules, later presenting a ham or café-au-lait appearance. at first they disappear upon pressure. the lesions are more or less numerous, usually become confluent, especially about the folds of the neck, about the genitalia and buttocks; in these regions resembling somewhat erythema intertrigo. the _papular_ eruption is observed in conjunction with the erythematous manifestation, or it occurs alone. the lesions are but slightly elevated, and seem to partake of the nature of both macules and papules. they are usually discrete, and rarely abundant; they may become decked with a film-like scale, and at the various points of junction of skin and mucous membrane, and in the folds, they become abraded and macerated, developing into _moist papules_. the _bullous_ eruption consists of variously-sized, more or less purulent blebs, and is usually met with at or immediately following birth. it is most abundant about the hands and feet. macules and papules are often interspersed. there may be superficial or deep ulceration underlying the bullæ. #what other symptoms in addition to the cutaneous manifestations are noted in hereditary syphilis in the newborn?# mucous patches, and sometimes ulcers, in the mouth and throat; hoarseness, as shown by the peculiar cry, and indicating involvement of the larynx; snuffles, a sallow and dirty appearance of the skin, loss of flesh and often a shriveled or senile look. #what is the pathology of cutaneous syphilis?# the syphilitic deposit consists of round-cell infiltration. the mucous layer, the corium, and in the deep lesions the subcutaneous connective tissues also, are involved in the process. the infiltration disappears by absorption or ulceration. the factor now believed to be responsible for the disease and the pathological changes is the spirochæta pallida, discovered by schaudinn and hoffmann, and usually found in numbers in the tissues. #give the prognosis of cutaneous syphilis.# in _acquired syphilis_, favorable; sooner or later, unless the whole system is so profoundly affected by the syphilitic poison that a fatal ending ensues, the cutaneous manifestations disappear, either spontaneously or as the result of treatment. the earlier eruptions will often pass away without medication, but treatment is of material aid in moderating their severity and hastening their disappearance, and is to be looked upon as essential; in the late syphilodermata treatment is indispensable. in the large pustular, the tubercular and gummatous lesions, considerable destruction of tissue may take place, and in consequence scarring result. ill-health from any cause predisposes to a relapse, and also adds to the gravity of the case. in _hereditary infantile syphilis_, the prognosis is always uncertain: the more distant from the time of birth the manifestations appear the more favorable usually is the outcome. #how is cutaneous syphilis to be treated?# always with constitutional remedies; and in the graver eruptions, and especially in those more or less limited, with local applications also. #what constitutional and local remedies are commonly employed in cutaneous syphilis?# _constitutional remedies._--mercury and potassium iodide; tonics and nutrients are necessary in some cases. _local remedies._--mercurial ointments, lotions and baths, and iodol in ointment or in (and also calomel) powder form. #give the constitutional treatment of the earlier, or secondary, eruptions of syphilis.# in secondary or early eruptions mercury alone in almost every case; with tonics, if called for. if mercury is contraindicated (extremely rare), potassium iodide may be substituted. #how is mercury usually administered in the eruptions of secondary syphilis?# by the mouth, chiefly as the protiodide, calomel and blue mass, in dosage just short of mild physiological action; by _inunction_, in the form of blue ointment; by _hypodermic injection_, usually as corrosive sublimate solution. the method by _fumigation_, with calomel or bisulphuret, is now rarely employed. the method by the mouth is the common one, and it is only in rare instances that any other method is necessary or advisable. #what local applications are usually advised in the eruptions of secondary syphilis?# if the eruption is extensive, and more especially in the pustular types, baths of corrosive sublimate ([dram ii-dram-iv] to cong. xxx) may be used; and ointment of ammoniated mercury, twenty to sixty grains to the ounce, blue ointment, and the ten per cent. oleate of mercury alone or with an equal quantity of any ointment base. the same applications or a dusting powder of calomel may also be used on moist papules. #how long is mercury to be actively continued in cases of early (secondary) syphilis?# until one or two months after all manifestations (cutaneous or other) have disappeared, and then, as a general rule, continued, as a small daily dose (about one-quarter to one-third of that prescribed during the active treatment) for a period of two or three months; then another cycle of the active dosage for a period of four to six weeks; then a resumption of the smaller daily dose for another two or three months; and so on, for a period of at least two years. (almost all authorities are agreed as to the importance of prolonged treatment, but differ somewhat on the question of intermittent or uninterrupted administration.) #give the constitutional treatment of the late, or localized, syphilodermata.# mercury always, usually in small or moderate dosage, as the biniodide or corrosive chloride, and potassium iodide; the latter in dose varying from two grains to two drachms or more, t.d., depending upon its action and the urgency of the case. #how long is constitutional treatment to be continued in cases of the late syphilodermata?# actively for several weeks after the disappearance of all symptoms, and then (especially the mercury) continued in smaller dosage (about one-third) for several months longer. #what applications are usually advised in the late, or localized, syphilodermata?# ointment of ammoniated mercury, twenty to sixty grains to the ounce; oleate of mercury, five to ten per cent. strength; mercurial plaster, full strength or weakened with lard or petrolatum; a two to twenty per cent. ointment of iodol; resorcin, twenty to sixty grains to the ounce of ointment base; and lotions of corrosive sublimate, one-half to three grains to the ounce. the following is valuable in offensive and obstinate ulcerations:-- [rx] hydrarg. chlorid. corros., ........... gr. iv-gr. viij ac. carbolici, ....................... gr. x-xx alcoholis, ........................... f[dram]iv glycerinæ, ........................... f[dram]j aquæ, ............ q.s. ad ........... [oz]iv. m. ointments are to be rubbed in or applied as a plaster; lotions, employed chiefly in ulcers and ulcerations, are to be thoroughly dabbed on, and usually supplemented by the application of an ointment. iodol may also be applied to ulcers as a dusting-powder, usually mixed with one to several parts of zinc oxide or boric acid. #give the treatment of hereditary infantile syphilis.# it is essentially the same (but much smaller dosage) as employed in acquired syphilis. attention to proper feeding and hygiene is of first importance. mercury may be given by the mouth, as mercury with chalk (gr. ss-gr. ij, t.d.); as calomel (gr. / -gr. / , t.d.); and as a solution of corrosive sublimate (gr. ss-[oz]vj, [dram]j, t.d.). if mercury is not well borne by the stomach, it may be administered by inunction; for this purpose, blue ointment is mixed with one or two parts of lard and spread (about a drachm) upon an abdominal bandage and applied, being renewed daily. treatment by means of baths (gr. x-xxx to the bath) of corrosive sublimate is, at times, a serviceable method. potassium iodide, if exceptionally deemed preferable, may be given in the dose of a fractional part of a grain to two or three grains three times daily. #what local measures are to be advised in cutaneous syphilis of the newborn?# if demanded, applications similar to those employed in eruptions of acquired syphilis, but not more than one-third to one-half the strength. #lepra.# (_synonyms:_ leprosy; elephantiasis græcorum.) #what do you understand by leprosy?# lepra, or leprosy, is an endemic, chronic, malignant constitutional disease, characterized by alterations in the cutaneous, nerve, and bone structures; varying in its morbid manifestations according to whether the skin, nerves or other tissues are predominantly involved. #what is the nature of the premonitory symptoms of leprosy?# in some instances the active manifestations appear without premonition, but in the majority of cases symptoms, slight or severe in character, pointing toward profound constitutional disturbance, such as mental depression, malaise, chills, febrile attacks, digestive derangements and bone pains, are noticed for weeks, months, or several years preceding the outbreak. #what several varieties of leprosy are observed?# two definite forms are usually described--the tubercular and the anæsthetic. a sharp division-line cannot, however, always be drawn; not infrequently the manifestations are of a mixed type, or one form may pass into or gradually present symptoms of the other. [illustration: fig. . tubercular leprosy. (_after stoddard._)] #describe the symptoms of tubercular leprosy.# the formation of tubercles and tubercular masses of infiltration, usually of a yellowish-brown color, with subsequent ulceration, constitute the important cutaneous symptoms. along with, or preceding these characteristic lesions, blebs and more or less infiltrated, hyperæsthetic or anæsthetic, pinkish, reddish or pale-yellowish macules make their appearance from time to time; subsequently fading away or remaining permanently (_lepra maculosa_). when well advanced, the tubercular or nodular masses give rise to great deformity; the face, a favorite locality, becomes more or less leonine in appearance (_leontiasis_). the tubercles persist almost indefinitely without material change, or undergo absorption or ulceration; this last takes place most commonly about the fingers and toes. the mucous membrane of the mouth, pharynx and other parts may also become involved. [illustration: fig. . anæsthetic leprosy.] #describe the symptoms of anæsthetic leprosy.# following or along with precursory symptoms denoting general systemic disturbance, or independently of any prodromal indications, a hyperæsthetic condition, in localized areas or more or less general, is observed. lancinating pains along the nerves and an irregular pemphigoid eruption are also commonly noted. there soon follows the special eruption, coming out from time to time, and consisting of several or more, usually non-elevated, well-defined, pale-yellowish patches, one or two inches in diameter. as a rule, they are at first neither hyperæsthetic nor anæsthetic, but may be the seat of slight burning or itching. they spread peripherally, and tend to clear in the centre. the patches eventually become markedly anæsthetic, and the overlying skin, and the skin on other parts as well, becomes atrophic and of a brownish or yellowish color. the subcutaneous tissues, muscle, hair and nails undergo atrophic or degenerative changes, and these changes are especially noted about the hands and feet. these parts become crooked, the bone tissues are involved, the phalanges dropping off or disappearing by disintegration or absorption (_lepra mutilans_). sooner or later various paralytic symptoms, showing more active involvement of the nerve trunks, present themselves. #state the cause of leprosy.# present knowledge points to a peculiar bacillus as the active factor, while climate, soil, heredity, food and habits exert a predisposing influence. #is leprosy contagious?# the consensus of opinion points to the acceptance of the possible contagiousness of leprosy; probably by inoculation, but only under certain unknown favoring conditions. #what are the pathological changes?# the lesions consist essentially of a new growth, made up of numerous small, more or less aggregated round cells, beginning in the walls of the bloodvessels. in this way the tubercular masses and various other lesions are formed. as yet, positive involvement ot the central nervous system has not been shown, but some of the nerve trunks are found to be inflamed and swollen, with a tendency toward hardening. #what several diseases are to be eliminated in the diagnosis of leprosy?# syphilis, morph[oe]a, vitiligo, lupus, and syringomyelia. when well advanced, the aggregate symptoms of leprosy form a picture which can scarcely be confused with that of any other disease. in doubtful cases microscopical examinations of the involved tissues, for the bacilli, should be made. #state the prognosis of leprosy.# unfavorable; a fatal termination is the rule, but may not be reached for a number of years. the tubercular form is the most grave, the mixed variety next, and the anæsthetic the least. patients are not infrequently carried off by intercurrent disease. proper management will often delay the fatal ending, and exceptionally, in the anæsthetic variety, stay the progress of the disease. #what is the treatment of leprosy?# hygienic measures are important. chaulmoogra oil and gurjun oil internally and externally are in some instances of service. strychnia alone, or with either of these oils, is ofttimes beneficial. ichthyol internally, and external applications of the same drug, and of resorcin, chrysarobin, and pyrogallic acid, have been extolled. change of climate, especially to a region where the disease does not prevail, is often of great advantage. #pellagra.# (_synonym:_ lombardian leprosy.) #describe pellagra.# pellagra is a slow but usually progressive disease occurring chiefly in italy, due, it is thought, to the continued ingestion of decomposed or fermented maize. it is characterized by cutaneous symptoms, at first upon exposed parts, of an erythematous, desquamative, vesicular and bullous character, and by general constitutional disturbance of a markedly neurotic type. a fatal ending, if the disease is at all severe or advanced, is to be expected. treatment is based upon general principles. #epithelioma.# (_synonyms:_ skin cancer; epithelial cancer; carcinoma epitheliale.) #what several varieties of epithelioma are met with?# three--the superficial, the deep-seated, and the papillomatous. #describe the clinical appearances and course of the superficial variety of epithelioma.# the superficial, or flat variety (_rodent ulcer_), begins, usually on the face, as a minute, firm, reddish or yellowish tubercle, as an aggregation of such, as a warty excrescence, or as a localized degenerative seborrh[oe]ic patch. the latter lesion (known also as keratosis senilis, old-age atrophic patches), consisting of a yellowish or yellowish-brown greasy or hardened scurfy spot or patch is quite frequently the starting-point of epithelial growths. sooner or later, commonly after months or several years, the surface becomes slightly excoriated, and an insignificant, yellowish or brownish crust is formed. the excoriation gradually develops into superficial ulceration, and the diseased area becomes slowly larger and larger. new lesions may continue, from time to time, to appear about the edges and go through the same changes. [illustration: fig. . epithelioma. (_after d. lewis._)] the ulcer has usually an uneven surface, secretes a thin, scanty, viscid fluid, which dries to a firm, adherent crust. it is usually defined against the healthy skin by a slightly elevated, hard, roll-like, waxy-looking border. in rare instances there is a disposition, at points, to spontaneous involution and scar formation; as a rule, however, the ulcerative action slowly progresses. the general health is unimpaired, the neighboring lymphatic glands are not involved, and the local condition, beyond the disfigurement, gives rise to little trouble, unless, as occasionally happens, it passes into the more malignant, deep-seated variety. #describe the clinical appearances and course of the deep-seated variety of epithelioma.# the deep-seated variety starts from the superficial form, or it begins as a tubercle or nodule in the skin. when typically developed, a reddish, shining tubercle or nodule, or area of infiltration, forms in the skin or subcutaneous tissue. in the course of weeks or months superficial or deep-seated ulceration takes place; the ulcer having hardened, and, as a rule, everted edges. the surface is reddish and granular, and secretes an ichorous discharge. the infiltration spreads, the ulcer enlarges both peripherally and in depth--muscle, cartilage and bone often becoming invaded. the neighboring lymphatic gland may become implicated, pains of a burning or neuralgic type are experienced, and from septicæmia, marasmus, or involvement of vital parts, death eventually ensues. #describe the clinical appearances and course of the papillomatous variety of epithelioma.# the papillomatous type usually arises from the superficial or deep-seated variety, or it may begin as a papillary or warty growth. when fully developed, it presents an ulcerated, fissured and papillomatous surface, with an ichorous discharge which dries to crusts. it is slowly progressive, and sooner or later may develop a malignant tendency. #upon what parts is epithelioma commonly observed?# about the face, especially the nose, eyelids and lips; and also about the genitalia. it may involve any part. #at what age is epithelioma usually noted?# it is essentially a disease of middle and late life, although it is exceptionally met with in the young. #what is the cause of epithelioma?# the etiology is obscure. it is not, as a rule, inherited. any locally irritated tissue may be the starting point of the disease. #state the pathology.# the process consists in the proliferation of epithelial cells from the mucous layer; the cell-growth takes place downward, in the form of finger-like prolongations or columns, or it may spread out laterally, so as to form rounded masses, the centres of which usually undergo horny transformation, resulting in the formation of onion-like bodies, the so-called cell-nests or globes. the rapid cell-growth requires increased nutriment, and hence the bloodvessels become enlarged; moreover, the pressure of the cell-masses gives rise to irritation and inflammation, with corresponding serous and round-cell infiltration. #how would you distinguish epithelioma from syphilitic ulceration, wart, and lupus vulgaris?# from syphilis it is to be differentiated by the history, duration, character of the base and edges, its comparative slow progress, its usually slight, viscid discharge, often streaked with blood, and, if necessary, by the therapeutic test. wart or warty growths are to be differentiated by attention to their history and course. long-continued observation may be necessary before a positive opinion is warrantable. the appearance of any tendency to crusting, to break down or ulcerate is significant of epitheliomatous degeneration. in lupus vulgaris the deposits are peculiar and multiple, the ulcerations are of different character, the tendency to scar-formation constant; and, with few exceptions, it has, moreover, its beginning in childhood or early adult life. #what factors are to be considered in giving a prognosis in epithelioma?# the variety, extent, and rapidity of the process. the superficial form may exist for years, and give rise to no alarm; whereas the deeper-seated varieties are always to be viewed as serious, and are, indeed, often fatal. involving the genitalia, its course is often strikingly rapid. relapses, after removal, are not uncommon. #what is the special object in view in the treatment of epithelioma?# thorough destruction or removal of the epitheliomatous tissue. #how is the destruction or removal of the epitheliomatous tissue effected?# by the use of such caustics as caustic potash, chloride-of-zinc paste, pyrogallic acid, arsenic, and the galvano-cautery; and by operative measures, such as excision and erasion with the dermal curette, and by the _x_-ray. (see treatment of lupus vulgaris.) in small lesions the use of an arsenical paste is a most admirable method of treatment, although somewhat painful. the paste is made of one part powdered acacia and one to two parts arsenious acid; at the time of application sufficient water is added to make a paste. this is applied thickly, and a piece of lint superimposed. a good deal of pain and inflammatory swelling ensue; at the end of twenty-four hours the part is poulticed till the slough comes away; the ulcer is then treated as a simple ulcer, under which healing takes place. occasionally a second application is found necessary. upon the whole, the best method in the average case is to curette thoroughly, and supplement with momentary cauterization, with caustic potash, or with several days' use of the pyrogallic acid ointment. during the healing process, short exposures to the röntgen ray--about every three to five days--is good practice. the degenerative changes in the beginning of scurfy, seborrh[oe]ic spots or patches seen in old people can frequently be lessened or wholly stopped by the daily application of an ointment containing to per cent. of sulphur and to per cent. of salicylic acid. #what can be said of the value of the x-ray in epithelioma?# the _x_-ray method is now much in vogue, and proves curative in many superficial cases, and of benefit in some of the deeper-seated varieties. in most cases it must be pushed to the point of producing a mild _x_-ray erythema; and in some instances benefit or cure only occurs after more active exposure, sufficient to cause an _x_-ray burn of the second degree. the method is not attended with much risk if properly used. the healthy parts should be protected by lead-foil. exposure should be two to five times weekly, at a distance of three to eight inches, and from five to twenty minutes, employing a tube of medium vacuum. unfortunately the method is usually slow. the radium treatment is essentially similar to that by the _x_-ray. the much better plan, as already intimated, is to employ one of the several operative or caustic methods, and supplementing, while healing, with the _x_-ray. #paget's disease of the nipple.# (_synonyms:_ malignant papillary dermatitis; paget's disease.) #what do you understand by paget's disease of the nipple?# paget's disease is a rare, inflammatory-looking, malignant disease of the nipple and areola in women, usually of advancing years, eventually terminating in cancerous involvement of the entire gland. #describe the symptoms of paget's disease.# the first symptoms, which usually last for months or years, are apparently eczematous, accompanied with more or less burning, itching and tingling. gradually, the diseased area, which is sharply-defined, and feels like a thin layer of indurated tissue, presents a florid, intensely red, very finely-granular, raw surface, attended with a more or less copious viscid exudation. sooner or later retraction and destruction of the nipple, followed by gradual scirrhous involvement of the whole breast, takes place. #what is the pathology of paget's disease?# although it was thought at one time to be a cancerous disease resulting from a continued eczematous inflammation of the parts, there is now but little doubt that it is of malignant nature from the earliest stages. the psorosperm-like bodies found, to the presence of which the disease has by some authorities been attributed (psorospermosis), are now known to be merely changed and degenerated epithelia. the morbid changes consist of an inflammation of the papillary region of the derma, leading to [oe]dema and vacuolation of the constituent cells of the epidermis, followed by their complete destruction in places and their abnormal proliferation in others (fordyce). #state the diagnostic features of paget's disease.# the age of the patient; the sharp limitation; the well-defined, indurated film of infiltration; the peculiar, red, raw, granulating appearance; and, later, the retraction of the nipple; and, finally, the involvement of the deeper parts. #what is the prognosis?# if the disease is recognized early, and properly treated, a cure may be anticipated; later the outlook is that of scirrhus of the breast. #what is the treatment of paget's disease?# thorough cauterization by means of caustic potash or the galvano-cautery; or, its extirpation by means of the curette or excision. after extirpation or cauterization, supplementary treatment by the _x_-ray is advisable as an additional measure of precaution against relapse. until the diagnosis is thoroughly established, soothing applications, such as are employed in acute eczema, are to be advised. #sarcoma.# (_synonyms:_ sarcoma cutis; sarcoma of the skin.) #describe the several varieties of sarcoma.# sarcoma of the skin is a more or less malignant new growth, of rapid or slow progress, characterized by the appearance of single or multiple, variously-shaped, discrete, non-pigmented or pigmented tubercles or tumors, of size varying from that of a shot to a hazelnut or larger. as a rule the growths are smooth, firm and elastic, somewhat painful upon pressure, and exhibit a tendency to ulcerate. the overlying skin is at first normal and somewhat movable, but as the growths approach the surface it becomes reddened and adherent; or, if the disease is of the pigmented variety, it acquires a bluish-black color. it is now generally believed that the most of the pigmented cases formerly thought to be of sarcomatous nature are really carcinomatous in character. the multiple pigmented sarcoma (_melano-sarcoma_) appears first, usually on the soles and dorsal surfaces of the feet, and later on the hands. there is more or less diffuse thickening of the integument. the lesions themselves manifest a disposition to bleed. #state the prognosis and treatment of sarcoma.# the disease is always more or less malignant and, as a rule, sooner or later a fatal termination takes place. it is usually slow in its course. excision or extirpation, _x_-ray exposures, and the administration of arsenic in increasing dosage (preferably by hypodermic injection) now are generally considered the most promising in this usually hopeless malady. #granuloma fungoides.# #describe granuloma fungoides.# a rare form of disease, heretofore looked upon as sarcomatous, but now generally recognized as granuloma, and formerly described under the names _mycosis fungoides_, _inflammatory fungoid neoplasm_, and several others. it is characterized usually by symptoms of an eczematous, urticarial, and erysipelatous nature, and by the sudden or gradual appearance of pinkish or reddish, tubercular, nodular, lobulated, or furrowed tumors or flat infiltrations, which may disappear by involution or may be followed by ulceration; several or a larger number of the growths present a mushroom, papillomatous, or fungoid appearance, sometimes roughly resembling the cut part of a tomato. in most cases the tumor stage of the malady is not reached for two or more years; in exceptional instances, however, they appear in the first few months. the lesions, especially in their early stages, are, as a rule, accompanied with more or less burning and itching. #state the prognosis and treatment of granuloma fungoides.# the malady may last for several years or much longer, a fatal termination, with rare exceptions, sooner or later taking place. after the tumor stage is well established, the patient usually succumbs in from several months to one or two years. [illustration: fig. . granuloma fungoides.] treatment consists of tonics, if indicated, and the administration of arsenic, preferably hypodermically, and röntgen-ray exposures, along with the application of mild antiseptics, and operative interference when necessary or advisable. #class vii.--neuroses.# #hyperæsthesia.# #what is hyperæsthesia?# by hyperæsthesia is meant increased cutaneous sensibility. it is usually more or less localized, and is met with as a symptom in functional and organic nervous diseases. #dermatalgia.# (_synonyms:_ neuralgia of the skin; rheumatism of the skin; dermalgia.) #what do you understand by dermatalgia?# by dermatalgia is meant a tender or painful condition of the skin unattended by structural change. it is commonly limited to a small area, and is usually symptomatic of functional or organic nervous disease. as an idiopathic affection it is looked upon as of a rheumatic origin. treatment depends upon the cause. #anæsthesia.# #what is anæsthesia?# anæsthesia is a diminution, comparative or complete, of cutaneous sensibility. it is usually localized, and is met with in the course of certain nervous affections. it is also encountered in leprosy, morph[oe]a and like diseases. #pruritus.# #what do you understand by pruritus?# pruritus is a functional disease of the skin, the sole symptom of which is itching, there being no structural change. #describe the symptoms of pruritus.# the sole and essential symptom is itchiness, usually more or less paroxysmal, and worse at night. there are no primary structural lesions, but in severe and persistent cases the parts become so irritated by continued scratching that secondary lesions, such as papules and slight thickening and infiltration, may result. it is much more common in advanced life--_pruritus senilis_. in such cases, as well as in those cases in younger and middle-aged individuals in which the itchiness develops at the approach of cold weather and disappears upon the coming of the warm season (_pruritus hiemalis_), the pruritus is usually more or less generalized, although not infrequently in the latter the legs are specially involved. in some individuals an attack of pruritus, of variable intensity, lasting from five to thirty minutes, comes on immediately after a bath (_bath-pruritus_). it is usually confined to the legs from the hips down. #is pruritus always more or less generalized?# no; not infrequently the itching is limited to the genital region (_pruritus scroti_, _pruritus vulvæ_) or to the anus (_pruritus ani_). #to what may pruritus often be ascribed?# to digestive and intestinal derangements, hepatic disorders, the uric acid diathesis, gestation, diabetes mellitus, and a depraved state of the nervous system. pruritus vulvæ is at times due to irritating discharges, and pruritus ani occasionally to hemorrhoids and seat-worms. #is there any difficulty in the diagnosis of pruritus?# no. the subjective symptom of itching without the presence of structural lesions is diagnostic. in those severe and persistent cases in which excoriations and papules have resulted from the scratching, the history of the case, together with its course, must be considered. care should be taken not to confound it with pediculosis. in this latter the excoriations usually have a somewhat peculiar distribution, being most abundant on those parts of the body with which the clothing lies closely in contact. (see pediculosis corporis.) in pruritus of the genitocrural region the possibility of pediculi being the cause must be kept in mind; an examination of the parts for the parasite or for ova (attached to the hairs) would prevent error. (see pediculosis pubis.) #what prognosis would you give in pruritus?# in the majority of cases the condition responds to proper treatment, but in others it proves rebellious. the prognosis depends, in fact, upon the removability of the cause. temporary relief may always be given by external applications. #how would you treat pruritus?# with systemic remedies directed toward a removal or modification of the etiological factors, and, for the temporary relief of the itching, suitable antipruritic applications. in obscure cases, quinia, salophen, lithia salts, calcium chloride, belladonna, nux vomica, arsenic, pilocarpine, and general galvanization may be variously tried. alkalies prove useful in many cases. exceptionally, the relief furnished by external treatment is more or less permanent. #name the important antipruritic applications.# alkaline baths; lotions of carbolic acid ([dram]j-[dram]iij to oj), of resorcin ([dram]j-[dram]iv to oj), of liquor carbonis detergens ([oz]j-[oz]iv to oj), and liquor picis alkalinus ([dram]j-[dram]iv to oj), used cautiously. one or several ounces of alcohol and one or two drachms of glycerin in each pint of these lotions will often be of advantage, as the following:-- [rx] ac. carbolici, ....................... [dram]j-[dram]iij gylcerinæ, ........................... f[dram]ij alcoholis, ........................... f[oz]ij aquæ, ......... q.s. ad .............. oj. m. various dusting-powders, alone or in conjunction with the lotions. and in some cases, especially those in which the skin is unnaturally dry, ointments may be used, such as equal parts of lard, lanolin, and petrolatum, to the ounce of which may be added from five to thirty grains of carbolic acid, three to twenty grains of thymol, ten to thirty minims of chloroform, or two to ten grains of menthol. #what external applications are to be used in the local varieties of pruritus?# in _pruritus ani_ and _pruritus vulvæ_, in addition to the various applications above, a cocaine ointment, one to ten grains to the ounce, a strong solution of the same (gr. v-xx to [oz]j), and an ointment containing ten to thirty minims of the oil of peppermint to the ounce; sponging with hot water, often affords temporary relief. in pruritus vulvæ, moreover, astringent applications and injections of zinc sulphate, alum, tannic or acetic acid, in the strength commonly employed for vaginal injections, are at times curative. in bath-pruritus weak glycerine lotions, and an ointment containing a few grains of thymol and menthol to the ounce sometimes give moderate relief. turkish baths are sometimes free from subsequent pruritus. #class viii.--parasitic affections.# #tinea favosa.# (_synonym:_ favus.) #what is tinea favosa?# tinea favosa, or favus, is a contagious vegetable-parasitic disease of the skin, characterized by pin-head to pea-sized, friable, umbilicated, cup-shaped yellow crusts, each usually perforated by a hair. #upon what parts and at what age is favus observed?# it is usually met with upon the scalp, but it may occur upon any part of the integument. occasionally the nails are invaded. it is seen at all ages, but is much more common in children. #describe the symptoms of favus of the scalp.# the disease begins as a superficial inflammation or hyperæmic spot, more or less circumscribed, slightly scaly, and which is soon followed by the formation of yellowish points about the hair follicles, surrounding the hair shaft. these yellowish points or crusts increase in size, become usually as large as small peas, are cup-shaped, with the convex side pressing down upon the papillary layer, and the concave side raised several lines above the level of the skin; they are umbilicated, friable, sulphur-colored, and usually each cup or disc is perforated by a hair. upon removal or detachment, the underlying surface is found to be somewhat excavated, reddened, atrophied and sometimes suppurating. as the disease progresses the crusting becomes more or less confluent, forming irregular masses of thick, yellowish, mortar-like crusts or accumulations, having a peculiar, characteristic odor--that of mice, or stale, damp straw. the hairs are involved early in the disease, become brittle, lustreless, break off and fall out. in some instances, especially near the border of the crusts, are seen pustules or suppurating points. _atrophy_ and more or less actual _scarring_ are sooner or later noted. itching, variable as to degree, is usually present. #what is the course of favus of the scalp?# persistent and slowly progressive. [illustration: fig. . achorion schönleinii x . (_after duhring._) showing simple mycelium, in various stages of development, and free spores.] #what are the symptoms of favus when seated upon the general surface?# the symptoms are essentially similar to those upon the scalp, modified somewhat by the anatomical differences of the parts. the _nails_, when affected, become yellowish, more or less thickened, brittle and opaque (_tinea favosa unguium_, _onychomycosis favosa_). #to what is favus due?# solely to the invasion of the cutaneous structures, especially the epidermal portion, by the vegetable parasite, the _achorion schönleinii_. it is contagious. it is a somewhat rare disease in the native-born, being chiefly observed among the foreign poor. the nails are rarely affected primarily. it is also met with in the lower animals, from which it is doubtless not infrequently communicated to man. #what are the diagnostic features of favus?# the yellow, and often cup-shaped, crusts, brittleness and loss of hair, atrophy, and the history. [illustration: fig. . epilating forceps.] #how would you distinguish favus from eczema and ringworm?# from eczema by the condition of the affected hair, the atrophic and scar-like areas, the odor, and the history. from ringworm by the crusting and the atrophy. in this latter disease there is usually but slight scaliness, and rarely any scarring. finally, if necessary, a microscopic examination of the crusts may be made. #state the method of examination for fungus.# a portion of the crust is moistened with liquor potassæ and examined with a power of three to five hundred diameters. the fungus, (achorion schönleinii), consisting of mycelium and spores, is luxuriant and is readily detected. #state the prognosis of favus.# upon the scalp, favus is extremely chronic and rebellious to treatment, and a cure in six to twelve months may be considered satisfactory; in neglected cases permanent baldness, atrophy, and scarring sooner or later result. although favus of the scalp persists into adult life, it becomes less active and, finally, as a rule, gradually disappears, leaving behind scarred or atrophic bald areas. upon the general surface it usually responds readily to treatment, excepting favus of the nails, which is always obstinate. #how is favus of the scalp treated?# treatment is entirely local and consists in keeping the parts free from crusts, in epilation and applications of a parasiticide. the crusts are removed by oily applications and soap-and-water washings. the hair on and around the diseased parts is to be kept closely cut, and, when practicable, depilation, or extraction of the affected hairs, is advised; this latter is, in most cases, essential to a cure. remedial applications--the so-called parasiticides--are, as a rule, to be made twice daily. if an ointment is used, it is to be thoroughly rubbed in; if a lotion, it is to be dabbed on for several minutes and allowed to soak in. #name the most important parasiticides.# corrosive sublimate, one to four grains to an ounce of alcohol and water; carbolic acid, one part to three or more parts of glycerine; a ten per cent. oleate of mercury; ointments of ammoniated mercury, sulphur and tar; and sulphurous acid, pure or diluted. the following is valuable:-- [rx] sulphur, præcip., .................... [dram]ij saponis viridis, ol. cadini, ....... [=a][=a] ......... [dram]j adipis, .............................. [oz]ss. m. chrysarobin is a valuable remedy, but must be used with caution; it may be employed as an ointment, five to ten per cent. strength, as a rubber plaster, or as a paint, a drachm to an ounce of gutta-percha solution. formalin, weakened or full strength, has been extolled. some observers have experimentally tried the effect of _x_-ray exposure with alleged good results, pushing the treatment to the point of producing depilation; if used great caution should be exercised. #how is favus upon the general surface to be treated?# in the same general manner as favus of the scalp, but the remedies employed should be somewhat weaker. in favus of the nail frequent and close paring of the affected part and the application, twice daily, of one of the milder parasiticides, will eventually lead to a good result. #is constitutional treatment of any value in favus?# it is questionable, but in debilitated subjects tonics, especially cod-liver oil, may be prescribed with the hope of aiding the external applications. #tinea trichophytina.# (_synonym:_ ringworm.) #what is tinea trichophytina?# tinea trichophytina, or ringworm, is a contagious, vegetable-parasitic disease due to the invasion of the cutaneous structures by the vegetable parasite, the trichophyton, or the microsporon audouinii. #do the clinical characters of ringworm vary according to the part affected?# yes, often considerably; thus upon the scalp, upon the general surface, and upon the bearded region, the disease usually presents totally different appearances. #describe the symptoms of ringworm as it occurs upon non-hairy portions of the body.# ringworm of the general surface (_tinea trichophytina corporis_, _tinea circinata_) appears as one or more small, slightly-elevated, sharply-limited, somewhat scaly, hyperæmic spots, with, rarely, minute papules, vesico-papules, or vesicles, especially at the circumference. the patch spreads in a uniform manner peripherally, is slightly scaly, and tends to clear in the centre, assuming a ring-like appearance. when coming under observation, the patches are usually from one-half to one inch in diameter, the central portion pale or pale red, and the outer portion more or less elevated, hyperæmic and somewhat scaly. as commonly noted one, several or more patches are present. after reaching a certain size they may remain stationary, or in exceptional cases may tend to spontaneous disappearance. at times when close together, several may merge and form a large, irregular, gyrate patch. itching, usually slight, may or may not be present. exceptionally ringworm appears as a markedly inflammatory pustular circumscribed patch, formerly thought to be a distinct affection and described under the name of _conglomerate pustular folliculitis_. it consists of a flat carbuncular or kerion-like inflammation, somewhat elevated, and usually a dime to silver dollar in area. the most common seats are the back of the hands and the buttocks. the surface is cribriform, and a purulent secretion may be pressed out from follicular openings. [illustration: fig. . tinea trichophytina cruris--so-called eczema marginatum--of unusually extensive development. (_after piffard._)] #describe the symptoms of ringworm when occurring about the thighs and scrotum.# in adults, more especially males, the inner portion of the upper part of the thighs and scrotum (_tinea trichophytina cruris_, so-called _eczema marginatum_) may be attacked, and here the affection, favored by heat and moisture, develops rapidly and may soon lose its ordinary clinical appearances, the inflammatory symptoms becoming especially prominent. the whole of this region may become involved, presenting all the symptoms of a true eczema; the border, however, is sharply defined, and usually one or more outlying patches of the ordinary clinical type of the disease may be seen. #describe the symptoms of ringworm when involving the nails.# in ringworm of the nails (_tinea trichophytina unguium_) these structures become soft or brittle, yellowish, opaque and thickened the changes taking place mainly about the free borders. ringworm on other parts usually coexists. #describe the symptoms of ringworm as it occurs upon the scalp.# ringworm of the scalp (_tinea trichophytina capitis_, _tinea tonsurans_) begins usually in the same manner as that upon the general surface, but, as a rule, much more insidiously. sooner or later, however, the hair and follicles are invaded by the fungus, and in consequence the hair falls out or becomes brittle and breaks off. the follicles, except in long-standing cases, are slightly elevated and prominent, and the patch may have a puffed or goose-flesh appearance. in addition, there is slight scaliness. #describe the appearances of a typical patch of ringworm of the scalp.# the patch is rounded, grayish, somewhat scaly, and slightly elevated; the follicles are somewhat prominent; there is more or less alopecia, with here and there broken, gnawed-off-looking hairs, some of which may be broken off just at the outlet of the follicles and more or less surrounded by a whitish or grayish-white dust. this type is produced by the small-spore fungus--microsporon. #does ringworm of the scalp always present typical appearances?# not invariably. in some cases the patch or patches may become almost completely bald, and in others a tendency to the formation of pustules, with more or less crust-formation, may be seen. the affection may also appear as small scattered spots or points. [illustration: fig. . ringworm (rather inflammatory type, and produced by the trichophyton).] the markedly inflammatory and pustular types are produced by the large-spore fungus--trichophyton. #what is tinea kerion?# tinea kerion (_kerion_) is a markedly inflammatory type of ringworm of the scalp involving the deeper tissues, appearing as a more or less bald, rounded, inflammatory, [oe]dematous, boggy, honeycombed tumor, discharging from the follicular openings a mucoid secretion. #does ringworm of the scalp ever occur in adults?# no. (extremely rare exceptions.) [illustration: fig. . ringworm fungus (trichophyton) x . (_after duhring._) as found in epidermic scrapings of ringworm, showing mycelium and spores.] #describe the symptoms of ringworm of the bearded region.# ringworm of the bearded region (_tinea trichophytina barbæ_, _tinea sycosis_, _parasitic sycosis_, _barber's itch_) begins usually in the same manner as ringworm on other parts, as one or more rounded, slightly scaly, hyperæmic patches. in rare instances the disease may persist as such, with very little tendency to involve the hairs and follicles; but, as a rule, the hairy structures are soon invaded, many of the hairs breaking off, and many falling out. from involvement of the follicles, more or less subcutaneous swelling ensues, the parts assuming a distinctly _lumpy and nodular_ condition. the skin is usually considerably reddened, often having a glossy appearance, and studded with few or numerous pustules. the nodules tend, ordinarily, to break down and discharge, at one or more of the follicular openings, a glairy, glutinous, purulent material, which may dry to thick, adherent crusts. [illustration: fig. . ringworm fungus (microsporon) x . (_after duhring._) short, broken-off hair of scalp invaded with masses of free spores.] the disease may be limited to one patch, or a large area, even to the extent of the whole bearded region, becomes involved. the upper lip is rarely invaded. ringworm of the bearded region is due to the trichophyton. [illustration: fig. . ringworm fungus (trichophyton) x . (_after duhring._) short, stout hair of beard, with the root-sheath attached, showing free spores and chains of spores.] #to what is ringworm due?# to the presence and growth in the cutaneous structures of a vegetable parasite. although the disease is contagious, individuals differ considerably as to susceptibility. it is much more common in children than in those past the age of puberty, ringworm of the scalp being limited to the former (rare exceptions), and tinea sycosis being a disease of the male adult. until recently the ringworm was thought to be due to but one fungus--the trichophyton; it is now known that there are several forms of fungi, the main forms being the small-spored (microsporon audouini) and the large-spored (trichophyton). of this latter there are two main subvarieties--endothrix and ectothrix. the small-spored fungus is found as the cause in the majority of scalp cases; the endothrix also commonly invades the scalp integument. the ectothrix variety is usually derived directly or indirectly from domestic animals, and is chiefly responsible for body-ringworm, and for suppurative ringworm, whether upon the bearded region or elsewhere. #what is the pathology of ringworm?# on the general surface the fungus has its seat in the epidermis, especially in the corneous layer; upon the scalp and bearded region the epidermis, hair-shaft, root and follicle are invaded. the inflammatory action may vary considerably in different cases, and at different times in the same case. the fungus consists of mycelium and spores. in the epidermic scrapings it is never to be found in abundance, and the mycelium predominates, while in affected hairs the spores and chains of spores are almost exclusively seen, and are usually present in great profusion. #how do you examine for the fungus?# the scrapings or hair should be moistened with liquor potassæ, and examined with a power from three hundred diameters upward. #how is ringworm of the general surface to be distinguished from eczema, psoriasis and seborrh[oe]a?# by the growth and characters of the patch, the slight scaliness, the tendency to disappear in the centre, by the history, and, if necessary, by a microscopic examination of the scales. #how is ringworm of the scalp to be distinguished from alopecia areata, favus, eczema, seborrh[oe]a, and psoriasis?# by the peculiar clinical features of ringworm on this region--the slight scaliness, broken hair and hair stumps, with a certain amount of baldness--and in doubtful cases by a microscopical examination of the hairs. in favus, although the same condition of the hair is noted, the yellow, cup-shaped crusts, and the presence of the atrophic areas in that disease are pathognomonic. #how is ringworm of the bearded region to be distinguished from eczema and sycosis?# by the peculiar lumpiness of the parts, the brittleness of the hair, more or less hair loss, and the history. the superficial type of ringworm sycosis--those cases in which the disease remains a surface disease--is readily distinguished, as the symptoms are essentially the same as ringworm of non-hairy parts, except that some of the hairs in the areas may become invaded and break off or fall out. in doubtful cases recourse may be had to microscopical examination. #what is the prognosis of ringworm of these several parts?# when upon the general surface, the disease usually responds rapidly to therapeutical applications; upon the scalp it is always a stubborn affection, and, as a rule, requires several months to a year of energetic treatment to effect a cure. in this latter region the disease will disappear spontaneously as the age of fifteen or sixteen is reached. tinea sycosis yields in most instances in the course of several weeks or a few months. #is ringworm of these several parts treated with the same remedies?# as a rule, yes; but the strength must be modified. the scalp will stand strong applications, as will likewise the bearded region; upon non-hairy portions the remedies should be used somewhat weaker. they should be applied twice daily; ointments, if used, being well rubbed in, and lotions thoroughly dabbed on. #how would you treat ringworm of the general surface?# by applications of the milder parasiticides, such as a ten to fifteen per cent. solution of sodium hyposulphite; carbolic acid, five to thirty grains to the ounce of water, or lard; a saturated solution of boric acid; ointments of tar, sulphur and mercury, official strength or weakened with lard; and tincture of iodine, pure or diluted. when occurring upon the upper and inner part of the thighs (so-called eczema marginatum), the same remedies are to be employed, but usually stronger. deserving of special mention is a lotion of corrosive sublimate, one to four grains to the ounce; or the same remedy, in the same proportion, may be used in tincture of myrrh or benzoin, and painted on the parts. #how would you treat ringworm of the scalp?# by occasional soap-and-hot-water washing; by extraction of the involved hairs, when practicable; by carbolic acid or boric acid lotions to the whole scalp, so as to limit, as much as possible, the spread of the disease; and by daily (or twice daily) applications to the patches and involved areas of a parasiticide. the following are the most valuable: the oleate of mercury, with lard or lanolin, in varying strength, from ten to twenty per cent.; carbolic acid, with one to three or more parts of glycerine or oil; corrosive sublimate, in solution in alcohol and water, one to four grains to the ounce; sulphur ointment; and citrine ointment, with one or two parts of lard. chrysarobin is a valuable remedy, but is to be employed with care; it may be prescribed as a rubber plaster, or in a solution of gutta-percha, or as an ointment, ten to fifteen per cent. strength. [beta]-naphthol in ointment form, five to fifteen per cent. strength, is also useful. an excellent application for beginning areas on the scalp is a solution of the red iodide of mercury in iodine tincture, one to three grains to an ounce. a compound ointment, containing several of the active remedies named, is convenient for dispensary practice, such as:-- [rx] [beta]-naphthol, ................. [dram]ss-[dram]j ol. cadini, ......................... [dram]j ungt. sulphuris, ............ q.s. ad [oz]j. m. in that form known as tinea kerion mild applications are demanded at first; later the same treatment as in the ordinary type. #how is ringworm of the bearded region to be treated?# on the same general plan and with the same remedies (excepting chrysarobin) as in ringworm of the scalp. depilation is to be practised as an essential part of the treatment. special mention may be made of an ointment of oleate of mercury, sulphur ointment, a lotion of sodium hyposulphite ([dram]j-[oz]j), and a lotion of corrosive sublimate (gr. j-iv to [oz]j). the _x_-ray has been used in ringworm of this region with alleged success, pushing it to the production of a mild erythema and depilation. the above methods are, however, usually successful, and are without risk of damage. #how is the certainty of an apparent cure in ringworm of the scalp or bearded region to be determined?# by the continued absence of roughness and of broken hairs and stumps, and by microscopical examination of the new-growing hairs from time to time for several weeks after discontinuance of treatment. cure of ringworm of the general surface is usually self-evident. #is systemic treatment of aid in the cure of ringworm?# it is doubtful, although in children in a depraved state of health the disease is often noted to be especially stubborn, and in such cod-liver oil and similar remedies may at times prove of benefit. #tinea imbricata.# (_synonym:_ tokelau ringworm.) #what is tinea imbricata?# a vegetable parasitic disease of moist tropical countries, characterized by the formation of patches composed of concentrically arranged, imbricated, scaly rings. it may begin at one or several points as a brownish, slightly raised spot, spreading peripherally; the renewed epidermis of the central part of the patch goes again through the same process; the result is a small or large area of concentrically arranged, imbricated, slightly scaly eruption. several such areas fusing together may cover a large part of the surface, the ring-like arrangement being sometimes more or less completely lost. the malady is chronic. there may be a variable degree of itching. the cause of the disease, which is of a contagious nature, is a vegetable parasite closely similar to the trichophyton. the treatment is by the parasiticides, being essentially the same, in fact, as ringworm. #tinea versicolor.# (_synonyms:_ pityriasis versicolor; chromophytosis.) #what is tinea versicolor?# tinea versicolor is a vegetable-parasitic disease of the skin, characterized by variously-sized and shaped, slightly scaly, macular patches of a yellowish-fawn color, and occurring for the most part upon the upper portion of the trunk. #describe the symptoms of tinea versicolor.# the disease begins as one or more yellowish macular points; these, in the course of weeks or months, gradually extend, and, together with other patches that arise, may form a more or less continuous sheet of eruption. there is slight scaliness, always insignificant and furfuraceous in character, and at times, except upon close inspection, scarcely perceptible. the color of the patches is pale or brownish-yellow; in rare instances, in those of delicate skin, there may be more or less hyperæmia, and in consequence the eruption is of a reddish tinge. the number of patches varies; there may be but a few, or, on the other hand, a profusion. slight itching, especially when the parts are warm, is usually present. #does the eruption of tinea versicolor show predilection for any special region?# yes; the upper part of the trunk, especially anteriorly, is the usual seat of the eruption, but in exceptional instances the neck, axillæ, the arms, the whole trunk, the genitocrural region and poplitea, and in rare cases even the lower part of the face, may become invaded. #what course does tinea versicolor pursue?# persistent, but somewhat variable; as a rule, however, slowly progressive and lasting for years. #to what is tinea versicolor due?# to a vegetable fungus--the _microsporon furfur_. the affection is tolerably common, and occurs in all parts of the world. with rare exceptions, it is a disease of adults, and while looked upon as contagious, must be so to an extremely slight degree. [illustration: fig. . microsporon furfur x . (_after duhring._) showing mycelium in various stages of development, groups of spores and free spores.] #what is the pathology?# the fungus, consisting of mycelium and spores, the latter showing a marked tendency to aggregate, invades the superficial portion of the epidermis. #is tinea versicolor readily diagnosticated?# yes; if the color, peculiar characters and distribution of the eruption are kept in mind. it is not to be confounded with vitiligo, chloasma, or the macular syphiloderm. if in doubt, have recourse to the microscope. #state the method of examination for fungus.# the scrapings are taken from a patch, moistened with liquor potassæ, and examined with a power of three to five hundred diameters. #state the prognosis of tinea versicolor.# with proper management the disease is readily curable. relapses are not uncommon. [illustration: fig. . tinea versicolor.] #what is the treatment of tinea versicolor?# it consists in daily washing with soap and hot water (and in obstinate cases with sapo viridis instead of the ordinary soap) and application of a lotion of--sulphite or hyposulphite of sodium, a drachm to the ounce; sulphurous acid, pure or diluted; carbolic acid, or resorcin, ten to twenty grains to the ounce of water and alcohol; or corrosive sublimate, one to three grains to the ounce of water. sulphur and ammoniated-mercury ointments are also serviceable. the following used alone, simply as a soap, or in conjunction with a lotion, is often of special value:-- [rx] sulphur, præcip., .................... [dram]iv saponis viridis, ..................... [dram]xii. m. after the disease is apparently cured, an occasional remedial application should be made for several months, in order to guard against the possibility of a relapse. #erythrasma.# #describe erythrasma.# erythrasma is an extremely rare disease, due to the presence and growth in the epidermic structures of the vegetable parasite--the _microsporon minutissimum_. it is characterized by small and large, slightly furfuraceous, reddish-yellow or reddish-brown patches, occurring usually on warm and moist parts, such as the axillary, inguinal, anal and genitocrural regions. it is slowly progressive and persistent, but is without disturbing symptoms other than occasional slight itching. [illustration: fig. . microsporon minutissimum x . (_after riehl._)] treatment, which is rapidly effective, is the same as that employed in tinea versicolor. #dhobie itch.# dhobie itch is a name used in certain tropical countries to designate a somewhat peculiar itching eruption of the genitocrural and axillary regions, and by some also a similar eruption about the feet. it consists of a dermatitis of variable degree, usually with a festooned, irregular border, with considerable itching. it is believed that such cases are variously due to the trichophyton of ringworm, to the microsporon furfur of tinea versicolor, to the microsporon minutissimus of erythrasma, and to other parasites. #actinomycosis.# #describe actinomycosis.# actinomycosis of the skin is an affection due to the ray fungus, and characterized by a sluggish, red, nodular, or lumpy infiltration, usually with a tendency to break down and form sinuses. the affection may involve almost any part, but its most common site is about the jaw, neck, and face. as a rule, the first evidence is a hard subcutaneous swelling or infiltration, which may increase slightly or considerably. the overlying skin gradually becomes of a sluggish or dark-red color. softening ensues, and the diseased area breaks down at one or more points, from which there oozes a discharge of a sero-purulent, purulent, or sanguinolent character. in this discharge can be usually noted minute, friable, yellowish or yellowish-gray bodies representing conglomerate collections of the causative fungus. the course of the malady is commonly slow and insidious. unless systemic pyemic infection occurs or the fungus elements find their way to the deeper organs or structures the general health remains apparently undisturbed. #what is the treatment?# the administration of moderate to large doses of potassium iodide, conjointly with curetting or excision of the diseased mass. local applications of iodine solution can also be tried. #blastomycetic dermatitis.# #what do you understand by blastomycetic dermatitis?# blastomycetic dermatitis is a rare disease beginning usually as a small papule or nodule, enlarging slowly, breaking down and developing into a verrucous or papillomatous-looking area, similar in appearance to tuberculosis cutis verrucosa. a muco-purulent or purulent secretion can visually be pressed out from between the papillomatous elevations. it may also present the appearance of a serpiginous lupus vulgaris or syphiloderm. as a rule it is slow in its course. furuncular or abscess-like formations may develop, usually from secondary infection. the disease is due to the invasion of the cutaneous tissues by the blastomyces. [illustration: blastomycetic dermatitis.] treatment consists in administration of moderate to large doses of potassium iodide, and in the employment of antiseptic and parasiticide applications; usually, however, radical treatment, such as employed in lupus vulgaris, may be necessary. #scabies.# (_synonym:_ the itch.) #what is scabies?# scabies, or itch, is a contagious animal-parasitic disease characterized by a multiform eruption of a somewhat peculiar distribution, attended by intense itching. #describe the symptoms of scabies.# the penetration and presence of the parasites within the cutaneous structures besides often giving rise to several or more complete or imperfectly formed _burrows_, excite varying degrees of irritation, and in consequence the formation of vesicles, papules and pustules, accompanied with more or less intense itching. secondarily, crusting, and at times a mild or severe grade of dermatitis, may be brought about. the parasite seeks preferably tender and protected situations, as between the fingers, on the wrists, especially the flexor surface, in the folds of the axilla, on the abdomen, about the anal fissure, about the genitalia, and in females also about the nipples, and hence the eruption is most abundant about these regions. the inside of the thighs and the feet are also attacked, as, indeed, may be almost every portion of the body. the scalp and face are not involved; exceptionally, however, these parts are invaded in infants and young children. #is the grade of cutaneous irritation the same in all cases of scabies?# no; in those of great cutaneous irritability, especially in children, the skin being more tender, the type of the eruption is usually much more inflammatory. in those predisposed a true eczema may arise, and then, in addition to the characteristic lesions of scabies, eczematous symptoms are superadded; in long-persistent cases, indeed, the burrows and other consequent lesions may be more or less completely masked by the eczematous inflammation, and the true nature of the disease be greatly obscured. #what do you mean by burrows?# burrows, or _cuniculi_, are tortuous, straight or zigzag, dotted, slightly elevated, dark-gray or blackish thread-like linear formations, varying in length from an eighth to a half an inch. [illustration: fig. . burrow, or cuniculus, greatly magnified. (_after kaposi._) showing the mite, ova, empty shells and excrement.] #how is a burrow formed?# by the impregnated female parasite, which penetrates the epidermis obliquely to the rete, depositing as it goes along ten or fifteen ova, forming a minute passage or burrow. #upon what parts are burrows most commonly to be found?# in the interdigital spaces, on the flexor surface of the wrists, about the mammæ in the female, and on the shaft of the penis in the male. #are burrows usually present in numbers?# no. several may be found in a single case, but they are rarely numerous, as the irritation caused by the penetration of the parasites leads either to violent scratching and their destruction, or gives rise to the formation of vesicles and pustules, and consequently their formation is prevented. #what course does scabies pursue?# chronic and progressive, showing no tendency to spontaneous disappearance. #to what is scabies due?# to the invasion of the cutaneous structures by an animal parasite, the sarcoptes scabiei (_acarus scabiei_). the male mite is never found in the skin and apparently takes no direct part in the production of the symptoms. [illustration: fig. . fig. . sarcoptes scabiei x . (_after duhring._) female. ventral surface. male.] the disease is contagious to a marked degree, and is most commonly contracted by sleeping with those affected, or by occupying a bed in which an affected person has slept. it occurs, for obvious reasons, usually among the poor, although it is now quite frequently met with among the better classes. #state the diagnostic features of scabies.# the burrows, the peculiar distribution and the multiformity of the eruption, the progressive development, and usually a history of contagion. #how do vesicular and pustular eczema differ from scabies?# eczema is usually limited in extent, or irregularly distributed, is distinctly patchy, with often the formation of large diffused areas; it is variable in its clinical behavior, better and worse from time to time, and differs, moreover, in the absence of burrows and of a history of contagion. #how does pediculosis corporis differ from scabies?# in the distribution of the eruption. the pediculi live in the clothing and go to the skin solely for nourishment, and hence the eruption in that condition is upon covered parts, especially those parts with which the clothing lies closely in contact, as around the neck, across the upper part of the back, about the waist and down the outside of the thighs; _the hands are free_. #state the prognosis of scabies.# it is favorable. the disease is readily cured, and, as soon as the parasites and their ova are destroyed, the itching and the secondary symptoms, as a rule, rapidly disappear. #how is scabies treated?# treatment is entirely external, and consists of a preliminary soap-and-hot-water bath, an application, twice daily for three days, of a remedy destructive to the parasites and ova, and finally another bath. inquiry as to others of the family should be made, and, if affected, treated at the same time. the wearing apparel should be looked after--boiled, baked, or sulphur-fumigated. #what remedial applications are employed in scabies?# sulphur, balsam of peru, styrax, and [beta]-naphthol, singly or severally combined. in children, or in those of sensitive skin, the following:-- [rx] sulphur. præcip., .................... [dram]iv balsam. peruv., ...................... [dram]ij adipis, petrolati, ......... [=a][=a] ........ [oz]iss. m. and in adults, or those of non-irritable skin:-- [rx] sulphur, præcip., .................... [oz]j balsam. peruv., ...................... [oz]ss [beta]-naphthol, ..................... [dram]ij adipis, petrolati, ... [=a][=a] ... q.s. ad .. [oz]iv. m. styrax is a remedy of value and is commonly employed as an ointment in the strength of one part to two or three parts of lard. #is one such course of treatment sufficient to bring about a cure?# yes, in ordinary cases, if the applications have been carefully and thoroughly made; exceptionally, however, some parasites and ova escape destruction, and consequently itching will again begin to show itself at the end of a week or ten days, and a repetition of the treatment become necessary. #does the secondary dermatitis which is always present in severe cases require treatment?# only when it is unusually persistent or severe; in such cases the various soothing applications, lotions or ointments employed in acute eczema are to be prescribed. #is a dermatitis due to too active and prolonged treatment ever mistaken for persistence of the scabies?# yes. #pediculosis.# (_synonyms:_ phtheiriasis; lousiness.) #define pediculosis.# pediculosis is a term applied to that condition of local or general cutaneous irritation due to the presence of the animal parasite, the pediculus, or louse. #name the several varieties met with.# three varieties are presented, named according to the parts involved, pediculosis capitis, pediculosis corporis, and pediculosis pubis; the parasite in each being a distinct species of pediculus. #pediculosis capitis.# #describe the symptoms of pediculosis capitis.# pediculosis capitis (_pediculosis capillitii_), due to the presence of the pediculus capitis, occurs much more frequently in children than in adults. it is characterized by marked itching, and the formation of various inflammatory lesions, such as papules, pustules and excoriations--resulting from the irritation produced by the parasites and from the scratching to which the intense pruritus gives rise. in fact, an eczematous eruption of the pustular type soon results, attended with more or less crust formation. in consequence of the cutaneous irritation the neighboring lymphatic glands may become inflamed and swollen, and in rare cases suppurate. the occipital region is the part which is usually most profusely infested, more especially in young girls and women. in those of delicate skin, especially in children, scattered papules, vesico-papules, pustules, and excoriations may often be seen upon the forehead and neck. in some instances, however, especially in boys, there may be many pediculi present, with but little cutaneous disturbance, the itching being the sole symptom. [illustration: fig. . pediculus capitis x . (_after duhring._) female. dorsal surface.] in addition to the pediculi, which, as a rule, may be readily found, their _ova_, or _nits_, are always to be seen upon the shaft of the hairs, quite firmly attached. #describe the appearance of the ova.# they are dirty-white or grayish looking, minute, pear-shaped bodies, visible to the naked eye, and fastened upon the shaft of the hairs with the small end toward the root. [illustration: fig. . ova of the head-louse attached to a hair. magnified. (_after kaposi._)] #is there any difficulty in the diagnosis of pediculosis capitis?# no. the diagnosis is readily made, as the pediculi are usually to be found without difficulty, and even when they exist in small numbers and are not readily discovered, _the presence of the ova_ will indicate the nature of the affection. pustular eruptions upon the scalp, especially posteriorly, should always arouse a suspicion of pediculosis. the possibility of the pediculosis being secondary to eczema must not be forgotten. #what is the treatment of pediculosis capitis?# treatment consists in the application of some remedy destructive to the pediculi and their ova. crude petroleum is effective, one or two thorough applications over night being usually sufficient; in order to lessen its inflammability, and also to mask its somewhat disagreeable odor, it may be mixed with an equal part of olive oil and a small quantity of balsam of peru added. tincture of cocculus indicus, pure or diluted, may also be applied with good results. when the parts are markedly eczematous, an ointment of ammoniated mercury or [beta]-naphthol, thirty to sixty grains to the ounce may be used. daily shampooing with soap and water, and the twice daily application of a five per cent. carbolic acid lotion, together with the use of a fine-toothed comb, is a safe and efficient method for dispensary practice; as it is, indeed, for any class of patients. #how are the ova or their shells to be removed from the hair?# by the frequent use of acid or alkaline lotions, such as dilute acetic acid and vinegar, or solutions of sodium carbonate and borax. #pediculosis corporis.# #describe the symptoms of pediculosis corporis.# pediculosis corporis is dependent upon the presence of the pediculus corporis (_pediculus vestimenti_), a larger variety than that infesting the scalp. it is characterized by more or less general itching, together with various inflammatory lesions and excoriations. as the parasites are to be found chiefly in the folds and seams of the clothing, visiting the skin for the purpose of feeding, the various symptoms--the minute hemorrhagic puncta showing the points at which they have been sucking, and the consequent papules, pustules and excoriations--are, therefore, to be found most abundantly on those parts with which the clothing comes closely in contact, as, for instance, around the neck, across the shoulders, around the waist, and down the outside of the thighs. it is uncommon in children. [illustration: fig. . pediculus corporis x . (_after duhring._) female. dorsal surface.] #state the diagnostic characters of pediculosis corporis.# the presence of the minute hemorrhagic puncta, the multiform character and peculiar distribution of the eruption. careful search will almost invariably disclose one or more pediculi. #what is the treatment of pediculosis corporis?# the clothing and bed-coverings are to be thoroughly baked or boiled, the pediculi and their ova being in this manner destroyed; a thymol or carbolized boric-acid lotion may be used to relieve the cutaneous irritation. when attention to the wearing apparel is not immediately practicable, ointments of sulphur and staphisagria, and lotions of carbolic acid, may be advised as temporary measures. the wearing of a bag of loosely woven texture containing some lump sulphur next to the skin is useful in such cases; at the temperature of the body the sulphur undergoes slow oxidation. in hairy individuals the malady is often persistent, due to the fact that ova have become attached to the hair and a new progeny soon hatched out. continued treatment over a few weeks will usually suffice to rid the patient of their presence. #pediculosis pubis.# #describe the symptoms of pediculosis pubis.# pediculosis pubis is a condition due to the presence of the pediculus pubis, or crab-louse. it is characterized by more or less itching about the genitalia, together with papules, excoriations, and other inflammatory lesions. the amount of irritation varies; it may be slight, or, on the other hand, severe. the parasite, which is the smallest of the three varieties, may be discovered upon close examination seated near the roots of the hairs, clutching the hair, with its head downward and buried in the follicle. the ova may be seen attached to the hair-shafts. it infests adults chiefly, being in many instances probably contracted through sexual intercourse. #is the pediculus pubis found upon any other part of the body?# yes. although its favorite habitat is the region of the pubes, it may, in exceptional instances, also infest the axillæ, the sternal region of the male, the beard, eyebrows, and even the eyelashes. #state the diagnostic characters of pediculosis pubis.# the region involved, itching, variable amount of irritation, and, above all, the presence of the pediculi and their ova. [illustration: fig. . pediculus pubis x . (_after duhring._) female. dorsal surface.] #name several applications prescribed for pediculosis pubis.# a lotion of corrosive sublimate, one to four grains to the ounce; infusion of tobacco; a ten to twenty per cent. ointment of oleate of mercury; ammoniated mercury ointment, and a five to ten per cent. [beta]-naphthol ointment. repeated washings with vinegar or dilute acetic acid, or with alkaline lotions, will free the hairs of the ova. #cysticercus cellulosæ.# #describe the cutaneous disturbance produced by the cysticercus cellulosæ.# the presence of cysticerci in the skin and subcutaneous tissue gives rise to pea to hazelnut-sized, rounded, firm, movable tumors which, when developed, may remain unchanged for months. the parasites are disclosed by microscopic examination. most of the cases have been observed in germany. #filaria medinensis.# (_synonym:_ guinea-worm.) #state the character of the lesions produced by the filaria medinensis.# the young microscopic worm penetrates the skin or deeper tissue, where it grows gradually, finally reaching several inches or more in length and about a half-line in thickness; inflammation is excited and a tumor-like swelling makes its appearance, which, sooner or later, breaks, disclosing the worm. it may also present a cord-like appearance. it is rarely met with outside of tropical countries. treatment consists in gradual extraction, or in the injection of a corrosive sublimate solution ( : ) into the forming tumor. asafetida internally has been found to be curative, the parasite being destroyed and subsequently absorbed or discharged. #ixodes.# (_synonym:_ wood-tick.) #state the character of the cutaneous disturbance produced by the ixodes.# the tick sticks its proboscis into the skin and sucks blood until it is several times its natural size, and then falls off; an urticarial lesion results. if caught in the act the animal should not be forcibly extracted, as its proboscis may be thus broken off and remain in the skin, and give rise to pain and inflammation. it may be made to relinquish its hold by placing on it a drop of an essential oil. a thymol or carbolized boric-acid lotion will relieve the irritation. #leptus.# (_synonym:_ harvest-mite.) #state the characters of the lesion produced by the leptus.# this minute brick-red mite buries itself in the skin, especially about the ankles and feet, giving rise to papules, vesicles and pustules. treatment consists of the use of a mild sulphur ointment or of a carbolic-acid lotion. #[oe]strus.# (_synonym:_ gad, or bot-fly.) #describe the cutaneous disturbance produced by the [oe]strus.# the ova are deposited in the skin, develop and give rise to the formation of furuncle-like tumors with central aperture, through which a sanious discharge exudes; or as the result of the burrowing of the larvæ, irregular serpiginous lines or wheals are produced. it is chiefly met with in central and south america. _larva migrant_, or _creeping disease_, is doubtless in this same class. it is characterized by a thread-like linear formation of an erythematous, erythemato-papular, or vesicular nature that gradually extends, the older part disappearing; considerable surface may be covered before the parasite disappears or dies. the treatment consists in endeavoring to destroy the organism by means of excision or caustic applications at the point of its suspected site which is just ahead of the extending line. #pulex penetrans.# (_synonyms:_ sand flea; jigger.) #describe the cutaneous disturbance produced by the pulex penetrans.# this microscopic animal penetrates the skin, especially about the toes, producing an inflammatory swelling, vesicle or pustule, or even ulceration. it is met with in warm and tropical countries. treatment consists in extraction. essential oils are used as a preventive. a carbolic-acid or alkaline lotion relieves irritation. #cimex lectularius.# (_synonym:_ bed-bug.) #describe the characters of a bed-bug bite.# an inflammatory papule or wheal-like lesion results, somewhat hemorrhagic; the purpuric or hemorrhagic point or spot remains after the swelling subsides, but finally, in the course of several days or a few weeks, disappears. treatment consists in the application of alkaline or acid lotions. #culex.# (_synonym:_ gnat; mosquito.) #describe the cutaneous disturbance produced by the culex.# it consists of an erythematous spot or a wheal-like lesion. alkaline or acid lotions usually give relief. #pulex irritans.# (_synonym:_ common flea.) #describe the cutaneous disturbance produced by the pulex irritans.# it consists of an erythematous spot with a minute central hemorrhagic point. in irritable skin, a wheal-like lesion may result. treatment consists of applications of camphor or ammonia-water; carbolic acid and thymol lotions are also useful. relative frequency of the various diseases of skin as shown by the statistics ( , cases) of the american dermatological association for ten years, - . -------------------------+-------+-------+ classification of | no. | % | diseases. | cases | cases | -------------------------+-------+-------+ class i. disorders of the| | | glands. | | | . of the sweat glands.| | | hyperidrosis | | . | sudamen | | . | anidrosis | | . | bromidrosis | | . | chromidrosis | | . | uridrosis | ... | .... | . of the sebaceous | | | glands | | . | seborrh[oe]a: | | . | a. oleosa | | . | b. sicca | | . | comedo | | . | cyst: | | . | a. milium | | . | b. steatoma | | . | asteatosis | | . | | | | class ii. inflammations. | | | exanthemata | | . | erythema simplex | | . | erythema multiforme: | | . | a. papulosum | | . | b. bullosum | | . | c. nodosum | | . | urticaria | | . | pigmentosa | | . | [e]dermatitis: | | . | a. traumatica | | . | b. venenata | | . | c. calorica | | . | d. medicamentosa | | . | e. gangrænosa | | . | erysipelas | | . | furunculus | | . | anthrax | | . | phlegmona diffusa | | . | pustula maligna | | . | herpes simplex | | . | herpes zoster | | . | dermatitis | | | herpetiformis | | . | psoriasis | | . | pityriasis maculuta | | | et circinata | | . | dermatitis | | | exfoliativa | | . | pityriasis rubra | | . | lichen: | | . | a. planus | | . | b. ruber | | . | eczema: | | . | a. erythematosum | .... | .... | b. papulosum | .... | .... | c. vesiculosum | .... | .... | d. madidans | .... | .... | e. pustulosum | .... | .... | f. rubrum | .... | .... | g. squamosum | .... | .... | prurigo | | . | acne | | . | acne rosacea | | . | sycosis | | . | impetigo | | . | impetigo contagiosa | | . | impetigo | | | herpetiformis | | . | ecthyma | | . | pemphigus | | . | ulcers | | . | | | | class iii. hemorrhages. | | | purpura: | | . | a. simplex | | . | b. hæmorrhagica | | . | | | | class iv. hypertrophies. | | | . of pigment. | | | lentigo | | . | chloasma | | . | . of epidermal and | | | papillary layers. | | | keratosis: | | . | a. pilaris | | . | b. senilis | | . | molluscum epitheliale| | . | callositas | | . | clavus | | . | cornu cutaneum | | . | verruca | | . | verruca necrogenica | | . | nævus pigmentosus | | . | xerosis | | . | ichthyosis | | . | onychauxis | | . | hypertrichosis | | . | . of connective | | | tissue. | | | sclerema neonatorum | .... | .... | scleroderma | | . | morph[oe]a | | . | elephantiasis | | . | rosacea: | | . | a. erythematosa | | . | b. hypertrophica | | . | framb[oe]sia | | . | | | | class v. atrophies. | | | . of pigment. | | | leucoderma | | . | albinismus | | . | vitiligo | | . | canities | | . | . of hair. | | | alopecia | | . | alopecia furfuracea | | . | alopecia areata | | . | atrophia pilorum | | | propria | | . | trichorexis nodosa | | . | . of nail | | . | atrophia unguis | | . | . of cutis | | . | atrophia senilis | | . | atrophia maculosa et | | | striata | | . | | | | class vi. new growths. | | | . of connective | | | tissue. | | . | keloid | | . | cicatrix | | . | fibroma | | . | neuroma | | . | xanthoma | | . | . of muscular tissue. | | | myoma | | . | . of vessels. | | | angioma | | . | angioma pigmentosum | | | et atrophicum | | . | angioma cavernosum | | . | lymphangioma | | . | . mycosis fongoide | | . | rhinoscleroma | | . | lupus erythematosus | | . | lupus vulgaris | | . | scrofuloderma | | . | syphiloderma: | | . | a. erythematosum | .... | .... | b. papulosum | .... | .... | c. pustulosum | .... | .... | d. tuberculosum | .... | .... | e. gummatosum | .... | .... | lepra: | | . | a. tuberosa | | . | b. maculosa | | . | c. anæsthetica | | . | carcinoma | | . | sarcoma | | . | | | | class vii. neuroses. | | | hyperæsthesia: | | . | a. pruritus | | . | b. dermatalgia | | . | anæsthesia | | . | | | | class viii. parasitic | | | affections. | | | . vegetable. | | | tinea favosa | | . | tinea trichophytina: | | . | a. circinata | | . | b. tonsurans | | . | c. sycosis | | . | tinea versicolor | | . | . animal. | | | scabies | | . | pediculosis | | | capillitii | | . | pediculosis corporis | | . | pediculosis pubis | | . | -------------------------+-------+-------+ total [footnote e: indicating affections of this class not properly included under other titles.] #index.# acarus folliculorum, scabiei, achorion schönleinii, acne, - artificialis, atrophica, cachecticorum, frontalis, hypertrophica, indurata, keloid, lupoid, necrotica, papulosa, punctata, pustulosa, rodens, rosacea, - , sebacea, tar, urticata, varioliformis, vulgaris, acnitis, actinomycosis, addison's disease, pigmentation of the skin in, keloid, ainhum, albinismus, albinos, alopecia, - areata, - circumscripta, congenital, furfuracea, premature, senile, anæsthesia, anatomy of the skin, - , angioma, , cavernosum, pigmentosum et atrophicum, simplex, angiomyoma, angioneurotic [oe]dema, anidrosis, anthrax, , antipruritic applications, antipyrin, eruptions from, area celsi, argyria, arsenic, eruptions from, artificial eruptions (feigned eruptions), atrophia cutis, , pilorum propria, unguis, , atrophic lines and spots, atrophies, - atrophoderma, neuriticum, atrophy of the hair, of the nails, of the skin, general idiopathic, senile, atropia, eruptions from, autographism, baldness, barbadoes leg, barbers' itch, bath-pruritis, bed-bug, bed-sores, belladonna, eruptions from, blackheads, - blanching of the hair, blastomycetic dermatitis, blebs, blood-vessels, boil, bot-fly, bromides, eruptions from, bromidrosis, bullæ, burns, burrows, calculi, cutaneous, callositas, , callosity, callous, callus, cancer, epithelial, skin, canities, prematura, senilis, carbuncle, carbunculus, - carcinoma epitheliale, carrion's disease, chafing, chapping, charbon, cheiro-pompholyx, cheloid, chloasma, - uterinum, chloral, eruptions from, chromidrosis, red, chromophytosis, chrysarobin, chrysophanic acid (chrysarobin), cicatrices, cimex lectularius, clavus, , comedo, - extractor, condyloma, flat (or broad), pointed, configuration, conglomerate pustular folliculitis, contagious impetigo, contagiousness, copaiba, eruptions from, corn, cornu cutaneum, , humanum, crab-louse, creeping disease, crusta lactea, crustæ, crusts, cubebs, eruptions from, culex, cuniculus, curette, cutaneous calculi, horn, cutis anserina, pendula, cyst, sebaceous, cysticercus cellulosæ, dandruff, , darier's disease, defluvium capillorum, demodex folliculorum, depilatories, dermalgia, dermatalgia, dermatitis, - acute general, ambustionis, blastomycetic, calorica, congelationis, contusiformis, exfoliativa, , general, neonatorum, recurrent, factitia, gangrænosa, herpetiformis, - iodoform, malignant papillary, medicamentosa, papillaris capillitii, repens, traumatica, vegetans, venenata, _x_-ray, dermatographism, dermatolysis, dermatomyoma, dermatosclerosis, dermatosyphilis, dhobi itch, digitalis, eruptions from, disorders of the glands, - dissection wound, distribution and configuration, - drug eruptions (dermatitis medicamentosa), duhring's disease, dysidrosis, ecthyma, , eczema, - erythematosum, fissum, impetiginosum, madidans, marginatum, papulosum, pustulosum, rimosum, rubrum, sclerosum, seborrhoicum, , , , , squamosum, verrucosum, vesiculosum, electrolysis in removal of hair, elephant leg, elephantiasis, - arabum, græcorum, epidermis, epidermolysis bullosa, epilating forceps, epithelial cancer, epithelioma, - benign cystic, molluscum, equinia, erasion, eruptions, feigned (artificial), medicinal (dermatitis medicamentosa), erysipelas, , ambulans, migrans, erysipeloid, erythema, annulare, bullosum, caloricum, desquamative scarlatiniform, gangrenosum, gyratum, induratum, scrofulosorum, intertrigo, , iris, marginatum, multiforme, nodosum, , recurrent exfoliative, simplex, solare, traumaticum, venenatum, vesiculosum, erythrasma, excessive sweating (hyperidrosis), excoriationes, excoriations, farcy, favus, of general surface, of nails, of scalp, feigned eruptions, fever blisters, fibroma, - molluscum, fibromyoma, filaria, medinensis, fish-skin disease, fissures, flea, common, sand, flesh worms, - folliclis, folliculitis barbæ, decalvans, pustular, conglomerate, forceps, epilating, fragilitas crinium, framb[oe]sia, freckle, frost-bite, fungous foot of india, furuncle, furunculosis, furunculus, - gad-fly, galvano-cautery, instruments, gangrene of the skin (dermatitis gangrænosa), spontaneous, symmetric, gelatin dressing, giant urticaria, glanders, glands, sebaceous, sweat, glossy skin, gnat, goose-flesh, granuloma fungoides, necroticum, grayness of the hair, grutum, guinea-worm, gumma, gun-powder marks, gutta-percha plaster, hair, atrophy of, graying of, hypertrophy of, superfluous, hair-follicle, hairy people, harvest mite, heat rash, hemorrhages, - henoch's purpura, , hereditary infantile syphilis, cutaneous manifestations of, herpes, facialis, gestationis, iris, labialis, præputialis, progenitalis, simplex, - zoster, - hirsuties, hives, homines pilosi, horn, cutaneous, hydradenitis suppurativa, hydroa æstivale, herpetiforme, puerorum, vacciniforme, hydrocystoma, hyperesthesia, hyperidrosis, - hypertrichosis, - hypertrophic scar, hypertrophies, - hypertrophy of the hair, of the nail, ichthyosis, - congenita, follicularis, hystrix, sebacea, cornea, simplex, impetigo contagiosa, , herpetiformis, simplex, infantile syphilis, hereditary, inflammations, - inflammatory fungoid neoplasm, iodides, eruptions from, iodoform dermatitis, itch, barbers', dhobie, mite, ivy poisoning, ixodes, jigger, keloid, , cicatricial, false, of addison, of alibert, spontaneous, true, keratodermia, symmetric, keratoma, keratosis follicularis, palmaris et plantaris, pigmentosa, pilaris, , senilis, kerion, land scurvy, larva nigrans, lentigo, leontiasis, lepra, - leprosy, anæsthetic, lombardian, tubercular, leptus, lesions, configuration of, consecutive, distribution of, elementary, primary, secondary, leucoderma, leucopathia, lichen moniliformis, pilaris, planus, hypertrophicus, ruber, acuminatus, scrofulosus, tropicus, urticatus, linæ albicantes, linear nævus, scarification, liomyoma cutis, liquor carbonic detergens, picis alkalinus, lombardian leprosy, louse, body (pediculus corporis), clothes (pediculus corporis), crab, head (pediculus capitis), lousiness, lupoid acne, sycosis, lupus, erythematodes, erythematosus, - exedens, exfoliativus, exulcerans, hypertrophicus, sebaceous, ulcerations, verrucosus, vorax, vulgaris, - lymphangiectodes, lymphangioma, tuberosum multiplex, lymphangiomyoma, maculæ, et striæ atrophicæ, macules, madura foot, malignant papillary dermatitis, pustule, medicinal eruptions (dermatitis medicamentosa), melanoderma, melanosarcoma, melasma, mercury, eruptions from, microsporon audouini, microsporon furfur, minutissimum, miliaria, - alba, crystallina, rubra, milium, , needle, milk crust, mite, harvest, itch, moist papule, , mole, molluscum contagiosum, epitheliale, - fibrosum, sebaceum, morphia, eruptions from, morph[oe]a, mosquito, mucous patch, mycetoma, mycosis fungoides, myoma, cutis, telangiectodes, nævus araneus, capillary, flammeus, linear, lipomatodes, pigmentosus, pilosus, , sanguineus, simplex, spider, spilus, tuberosus, vasculosus, venous, verrucosus, nail, atrophy of, hypertrophy of, necrotic granuloma, neoplasm, inflammatory fungoid, neoplasmata (new growths), , nettlerash, neuralgia of the skin, neuroma, neuroses, - new growths, - nits, objective symptoms, [oe]dema, acute circumscribed, neonatorum, [oe]strus, ointment bases, onychatrophia, onychauxis, , onychomycosis, favosa, opium, eruptions from, oroya fever, osmidrosis, ova of pediculi, pachydermia, paget's disease of the nipple, papillæ, nervous and vascular, papulæ, papule, moist, , papules, parasitic affections, - sycosis, parasiticides, , parchment skin, paronychia, patch, mucous, pediculosis, capillitii, capitis, , corporis, , pubis, , pediculus capitis, corporis, pubis, vestimenti, peliosis rheumatica, pellagra, pemphigus, - foliaceus, neonatorum, pruriginosus, vegetans, vulgaris, perforating ulcer of the foot, peruvian warts, phlegmona diffusa, phosphorescent sweat, phosphoridrosis, phtheiriasis, plan, pityriasis capitis, maculata et circinata, pilaris, rosea, , rubra, pityriasis rubra pilaris, versicolor, plasment, plaster-mull, podelcoma, poison dogwood, dermatitis from, ivy, dermatitis from, sumach, dermatitis from, vine, dermatitis from, pomphi, pompholyx, - port-wine mark, post-mortem pustule, prickly heat, primary lesions, , prurigo, , pruritus, - ani, hiemalis, scroti, senilis, vulvæ, pseudochromidrosis, psoriasis, - circinata, diffusa, guttata, gyrata, inveterata, nummularis, punctata, syphilitica, psorospermosis, , , pulex irritans, penetrans, punctate scarification, purpura, - hæmorrhagica, henoch's, , rheumatica, scorbutica, simplex, urticans, pustula maligna, pustulæ, pustules, quinine, eruptions from, rapidity of cure, raynaud's disease, recurrent summer eruption, red chromidrosis, gum, relative frequency, rhagades, rheumatism of the skin, rhinophyma, rhinoscleroma, , rhus poisoning, ringworm, of bearded region, of general surface, of the nail, of the scalp, of the thighs and scrotum, tokelau, rodent ulcer, rosacea, acne, rubber plaster, rupia, , salicylic acid, eruptions from, paste, salt rheum, sand flea, sarcoma, , cutis, sarcoptes scabiei, scabies, - scales, scarification, linear, punctate, scarifier, multiple, single, scars, hypertrophic, schönlein's disease, , sclerema, neonatorum, of the newborn, scleriasis, scleroderma, , neonatorum, scorbutus, scrofuloderma, pustular, small, scurvy, land, sea, sebaceous cyst, gland, tumor, seborrh[oe]a, - congestiva, oleosa, sicca, secondary lesions, , shingles, skin, anatomy of, cancer, general idiopathic atrophy of, glossy, looseness of, skin, parchment, spider nævus, spiradenitis, spontaneous gangrene, spots, squamæ, stains, statistics, , steatoma, steatorrh[oe]a, stramonium, eruptions from, striæ et maculæ atrophicæ, strophulus, albidus, subjective symptoms, sudamen, , superfluous hair, sweat, colored (chromidrosis), glands, phosphorescent, sweating, excessive, sycosis, - coccogenica, non-parasitica, parasitic, vulgaris, symmetric gangrene, keratodermia, symptomatology, - symptoms, objective, subjective, systemic, syphilis cutanea, - early eruptions of, late eruptions of, papillomatosa, hereditary, eruptions of, of the skin, - syphiloderm, acne-form, annular, bullous, , circinate, ecthyma-form, erythematous, , gummatous, impetigo-form, large acuminated-pustular, flat-pustular, papular, lenticular, macular, , miliary papular, pustular, non-ulcerating tubercular, palmar, , papular, , papulo-squamous, plantar, pustular, serpiginous tubercular, small acuminated-pustular, flat-pustular, papular, squamous, tubercular, , ulcerating tubercular, variola-form, vegetating, syphiloderma, syphiloma, tar acne, tattoo-marks, removal of, telangiectasis, , , tetter, tinea circinata, favosa, - fungus of, unguium, imbricata, kerion, sycosis, tonsurans, trichophytina, - barbæ, capitis, corporis, cruris, fungus of, unguium, versicolor, - fungus of, tokelau ringworm, traumaticin, trichophyton, trichorrhexis nodosa, tubercles, tubercula, tuberculosis cutis, - of the skin, tuberculosis verrucosa cutis, , tumor, sebaceous, tumors, turpentine, eruptions from, tyloma, tylosis, ulcer, perforating, of foot, rodent, ulcera, ulerythema sycosiforme, uridrosis, urticaria, - bullosa, chronic, factitia, hæmorrhagica, [oe]dematosa, papulosa, tuberosa, giant, pigmentosa, vesicular, venereal wart, verruca, - acuminata, digitata, filiformis, necrogenica, plana, juvenilis, senilis, vulgaris, verruga peruana, vesicles, vesiculæ, vitiligo, - vitiligoidea, vleminckx's solution, wart, peruvian, pointed, venereal, wen, wheals, wood-tick, wound dissection, xanthelasma, xanthelasmoidea, xanthoma, , diabeticorum, multiplex, planum, tuberculatum, tuberosum, xeroderma, xeroderma pigmentosum, _x_-ray dermatitis, yaws, zona, zoster, saunders' books --------- on --------- gynecology and obstetrics * * * * * w. b. saunders company walnut street philadelphia , henrietta street covent garden, london ========================================================================= saunders' text-books continue to gain the list of text-books recommended in the various colleges again shows a #decided gain for the saunders publications#. during the present college year, in the list of recommended books published by colleges (the other have not published lists), the saunders books are mentioned times, as against the previous year--#an increase of #. in other words, in each of the medical colleges in this country an average of ( - / the previous year) of the teaching books employed are publications issued by w. b. saunders company. that this increase is not due alone to the publication of new text-books, but rather to a most gratifying increase in the recommendation of text-books recognized as standards, is at once evident from the following: ashton's gynecology shows an increase of ; dacosta's surgery, an increase of ; hirst's obstetrics, ; howell's physiology, ; jackson on the eye, ; sahli's diagnostic methods, ; scudder's fractures, ; stengel's pathology, ; stelwagon on the skin, . these are but examples of similar remarkable gains throughout the entire list, and is undoubted evidence that the #saunders text-books are recognized as the best#. #a complete catalogue of our publications will be sent upon request# bandler's medical gynecology * * * * * #medical gynecology#. by s. wyllis bandler, m.d., adjunct. professor of diseases of women, new york post-graduate medical school and hospital. octavo of pages, with original illustrations. cloth, $ . net; half morocco, $ . net. #just ready--exclusively medical gynecology# this new work by dr. bandler is just the book that the physician engaged in general practice has long needed. it is truly _the practitioner's gynecology_--planned for him, written for him, and illustrated for him. there are many gynecologic conditions that do not call for operative treatment; yet, because of lack of that special knowledge required for their diagnosis and treatment, the general practitioner has been unable to treat them intelligently. this work gives just the information the practitioner needs. it not only deals with those conditions amenable to non-operative treatment, but it also tells how to recognize those diseases demanding operative treatment, so that the practitioner will be enabled to advise his patient at a time when operation will be attended with the most favorable results. the chapter on pessaries is especially full and excellent, the proper manner of introducing the pessary being clearly described and illustrated with original pictures that show plainly the correct technic of this procedure. the chapters on vaginal and abdominal massage, and particularly that on artificial hyperemia and anemia, are extremely valuable to the practitioner. they express the very latest advances in these methods of treatment. hydrotherapy, especially the ferguson and nauheim baths, are treated _in extenso_, and electrotherapy receives the full consideration its importance merits. pain as a symptom and its alleviation is dealt with in an unusually practical way, its value as an aid in diagnosis being emphasized. gonorrhea and syphilis and their many complications are treated in detail, every care being taken to have these sections--of special interest to the practitioner--complete in every particular. other chapters of great importance are those on constipation, sterility, associated nervous conditions in gynecology, and pregnancy and abortion. kelly and noble's gynecology and abdominal surgery #gynecology and abdominal surgery#. edited by howard a. kelly, m.d., professor of gynecology in johns hopkins university; and charles p. noble, m.d., clinical professor of gynecology in the woman's medical college, philadelphia. two imperial octavo volumes of pages each, containing illustrations, mostly original. per volume: cloth, $ . net; half morocco, $ . net. both volumes now ready with original illustrations by hermann becker and max brÖdel in view of the intimate association of gynecology with abdominal surgery the editors have combined these two important subjects in one work. for this reason the work will be doubly valuable, for not only the gynecologist and general practitioner will find it an exhaustive treatise, but the surgeon also will find here the latest technic of the various abdominal operations. it possesses a number of valuable features not to be found in any other publication covering the same fields. it contains a chapter upon the bacteriology and one upon the pathology of gynecology, dealing fully with the scientific basis of gynecology. in no other work can this information, prepared by specialists, be found as separate chapters. there is a large chapter devoted entirely to _medical gynecology_, written especially for the physician engaged in general practice. heretofore the general practitioner was compelled to search through an entire work in order to obtain the information desired. _abdominal surgery_ proper, as distinct from gynecology, is fully treated, embracing operations upon the stomach, upon the intestines, upon the liver and bile-ducts, upon the pancreas and spleen, upon the kidney, ureter, bladder, and the peritoneum. special attention has been given to _modern technic_ and illustrations of the very highest order have been used to make clear the various steps of the operations. indeed, the illustrations are truly magnificent, being the work of _mr. hermann becker_ and _mr. max brödel_, of the johns hopkins hospital. ashton's practice of gynecology * * * * * #the practice of gynecology#. by w. easterly ashton, m.d., ll.d., professor of gynecology in the medico-chirurgical college, philadelphia. handsome octavo volume of pages, containing original line drawings. cloth, $ . net; half morocco, $ . net. recently issued--new ( d) edition three editions in eighteen months three editions of this work have been demanded in eighteen months. among the new additions are: colonic lavage and flushing, hirst's treatment for vaginismus, dudley's treatment of cystocele, montgomery's round ligament operation, chorio-epithelioma of the uterus, passive incontinence of the urine, and moynihan's methods in intestinal anastomosis. nothing is left to be taken for granted, the author not only telling his readers in every instance what should be done, but also precisely _how to do it_. a distinctly original feature of the book is the illustrations, numbering about one thousand line drawings made especially under the author's personal supervision from actual apparatus, living models, and dissections on the cadaver. these line drawings show in detail the procedures and operations without obscuring their purpose by unnecessary and unimportant anatomic surroundings. #howard a. kelly, m.d.# _professor of gynecology, johns hopkins university._ "it is different from anything that has as yet appeared. the illustrations are particularly clear and satisfactory. one specially good feature is the pains with which you describe so many _details_ so often left to the imagination." #charles b. penrose, m.d.,# _formerly professor of gynecology, university of pennsylvania._ "i know of no book that goes so thoroughly and satisfactorily into all the _details_ of everything connected with the subject. in this respect your book differs from the others." #george m. edebohls, m.d.# _professor of diseases of women, new york post-graduate medical school._ "i have looked it through and must congratulate you upon having produced a text-book most admirably adapted to _teach_ gynecology to those who must get their knowledge, even to the minutest and most elementary details, from books." webster's diseases _of_ women * * * * * #diseases of women.# by j. clarence webster, m.d. (edin.), f.r.c.p.e., professor of gynecology and obstetrics in rush medical college. octavo of pages, with illustrations. cloth, $ . net; half morocco, $ . net. recently issued--for the practitioner dr. webster has written this work _especially for the general practitioner_, discussing the clinical features of the subject in their widest relations to general practice rather than from the standpoint of specialism. the magnificent illustrations, three hundred and seventy-two in number, are nearly all original. drawn by expert anatomic artists under dr. webster's direct supervision, they portray the anatomy of the parts and the steps in the operations with rare clearness and exactness. #howard a. kelly, m.d.#, _professor of gynecology, johns hopkins university._ "it is undoubtedly one of the best works which has been put on the market within recent years, showing from start to finish dr. webster's well-known thoroughness. the illustrations are also of the highest order." * * * * * #webster's obstetrics# #a text-book of obstetrics#. by j. clarence webster, m.d. (edin.), professor of obstetrics and gynecology in rush medical college. octavo of pages, illustrated. cloth, $ . net; half morocco, $ . net. recently issued #medical record, new york# "the author's remarks on asepsis and antisepsis are admirable, the chapter on eclampsia is full of good material, and ... the book can be cordially recommended as a safe guide." cullen's uterine adenomyoma * * * * * #uterine adenomyoma#. by thomas s. cullen, m.d., associate professor of gynecology, johns hopkins university. octavo of pages, with original illustrations by hermann becker and august horn. cloth, $ . net. just ready dr. cullen's large clinical experience and his extensive original work along the lines of gynecologic pathology have enabled him to present his subject with originality and precision. the work gives the early literature on adenomyoma, traces the disease through its various stages, and then gives the detailed findings in a large number of cases personally examined by the author. formerly the physician and surgeon were unable to determine the cause of uterine bleeding, but after following closely the clinical course of the disease, dr. cullen has found that the majority of these cases can be diagnosed clinically. the results of these observations he presents in this work. the entire subject of adenomyoma is dealt with from the standpoint of the pathologist, the clinician, and the surgeon. the superb illustrations are the work of mr. hermann becker and mr. august horn, of the johns hopkins hospital. * * * * * the american text-book _of_ obstetrics recently issued--new ( d) edition #the american text-book of obstetrics#. in two volumes. edited by richard c. norris, m.d.; art editor, robert l. dickinson, m.d. two octavos of about pages each; nearly illustrations, including colored and half-tone plates. per volume: cloth, $ . net; half morocco, $ . net. #american journal of the medical sciences# "as an authority, as a book of reference, as a 'working book' for the student or practitioner, we commend it because we believe there is no better." hirst's diseases of women * * * * * #a text-book of diseases of women#. by barton cooke hirst, m.d., professor of obstetrics, university of pennsylvania; gynecologist to the howard, the orthopedic, and the philadelphia hospitals. octavo of pages, illustrations, many in colors. cloth, $ . net; half morocco, $ . net. recently issued--new ( d) edition with original illustrations the new edition of this work has just been issued after a careful revision. as diagnosis and treatment are of the greatest importance in considering diseases of women, particular attention has been devoted to these divisions. to this end, also, the work has been magnificently illuminated with illustrations, for the most part original photographs and water-colors of actual clinical cases accumulated during the past fifteen years. the palliative treatment, as well as the radical operative, is fully described, enabling the general practitioner to treat many of his own patients without referring them to a specialist. the author's extensive experience renders this work of unusual value. * * * * * opinions of the medical press * * * * * #medical record, new york# "its merits can be appreciated only by a careful perusal.... nearly one hundred pages are devoted to technic, this chapter being in some respects superior to the descriptions in many text-books." #boston medical and surgical journal# "the author has given special attention to diagnosis and treatment throughout the book, and has produced a practical treatise which should be of the greatest value to the student, the general practitioner, and the specialist." #medical news, new york# "office treatment is given a due amount of consideration, so that the work will be as useful to the non-operator as to the specialist." hirst's text-book of obstetrics new ( th) edition, revised * * * * * #a text-book of obstetrics#. by barton cooke hirst, m.d., professor of obstetrics in the university of pennsylvania. handsome octavo, pages, with illustrations, in colors. cloth, $ . net; sheep or half morocco, $ . net. recently issued immediately on its publication this work took its place as the leading text-book on the subject. both in this country and abroad it is recognized as the most satisfactorily written and clearly illustrated work on obstetrics in the language. the illustrations form one of the features of the book. they are numerous and the most of them are original. in this edition the book has been thoroughly revised. more attention has been given to the diseases of the genital organs associated with or following childbirth. many of the old illustrations have been replaced by better ones, and there have been added a number entirely new. the work treats the subject from a clinical standpoint. * * * * * opinions of the medical press * * * * * #british medical journal# "the popularity of american text-books in this country is one of the features of recent years. the popularity is probably chiefly due to the great superiority of their illustration over those of the english text-books. the illustrations in dr. hirst's volume are far more numerous and far better executed, and therefore more instructive, than those commonly found in the works of writers on obstetrics in our own country." #bulletin of johns hopkins hospital# "the work is an admirable one in every sense of the word, concisely but comprehensively written." #the medical record, new york# "the illustrations are numerous and are works of art, many of them appearing for the first time. the author's style, though condensed, is singularly clear, so that it is never necessary to re-read a sentence in order to grasp the meaning. as a true model of what a modern text-book on obstetrics should be, we feel justified in affirming that dr. hirst's book is without a rival." penrose's diseases of women sixth revised edition * * * * * #a text-book of diseases of women#. by charles b. penrose, m.d., ph.d., formerly professor of gynecology in the university of pennsylvania; surgeon to the gynecean hospital, philadelphia. octavo volume of pages, with fine original illustrations. cloth $ . net. just issued regularly every year a new edition of this excellent text-book is called for, and it appears to be in as great favor with physicians as with students. indeed, this book has taken its place as the ideal work for the general practitioner. the author presents the best teaching of modern gynecology, untrammeled by antiquated ideas and methods. in every case the most modern and progressive technique is adopted, and the main points are made clear by excellent illustrations. the new edition has been carefully revised, much new matter has been added, and a number of new original illustrations have been introduced. in its revised form this volume continues to be an admirable exposition of the present status of gynecologic practice. * * * * * personal and press opinions * * * * * #howard a. kelly, m.d.,# _professor of gynecology and obstetrics, johns hopkins university, baltimore._ "i shall value very highly the copy of penrose's 'diseases of women' received. i have already recommended it to my class as the best book." #l.e. montgomery, m.d.,# _professor of gynecology, jefferson medical college, philadelphia._ "the copy of 'a text-book of diseases of women' by penrose received to-day. i have looked over it and admire it very much. i have no doubt it will have a large sale, as it justly merits." #bristol medico-chirurgical journal# "this is an excellent work which goes straight to the mark.... the book may be taken as a trustworthy exposition of modern gynecology." get the new the best american standard illustrated dictionary recently issued--new ( th) edition * * * * * #the american illustrated medical dictionary#. a new and complete dictionary of the terms used in medicine, surgery, dentistry, pharmacy, chemistry, and kindred branches; with over new and elaborate tables and many handsome illustrations. by w.a. newman dorland, m.d., editor of "the american pocket medical dictionary." large octavo, pages, bound in full flexible leather. price, $ . net; with thumb index, $ . net. gives a maximum amount of matter in a minimum space, and at the lowest possible cost with new terms the immediate success of this work is due to the special features that distinguish it from other books of its kind. it gives a maximum of matter in a minimum space and at the lowest possible cost. though it is practically unabridged, yet by the use of thin bible paper and flexible morocco binding it is only - / inches thick. in this new edition the book has been thoroughly revised, and upward of two thousand new terms have been added, thus bringing the book absolutely up to date. the book contains hundreds of terms not to be found in any other dictionary, over original tables, and many handsome illustrations. * * * * * personal opinions * * * * * #howard a. kelly, m.d.,# _professor of gynecology, johns hopkins university, baltimore._ "dr. borland's dictionary is admirable. it is so well gotten up and of such convenient size. no errors have been found in my use of it." #j. collins warren, m.d., ll.d., f.r.c.s. (hon.)# _professor of surgery, harvard medical school._ "i regard it as a valuable aid to my medical literary work. it is very complete and of convenient size to handle comfortably. i use it in preference to any other." garrigues' diseases of women third edition, thoroughly revised * * * * * #a text-book of diseases of women#. by henry j. garrigues, a.m., m.d., gynecologist to st. mark's hospital and to the german dispensary, new york city. handsome octavo, pages, with engravings and colored plates. cloth, $ . net; sheep or half morocco, $ . net. the first two editions of this work met with a most appreciative reception by the medical profession both in this country and abroad. in this edition the entire work has been carefully and thoroughly revised, and considerable new matter added, bringing the work precisely down to date. many new illustrations have been introduced, thus greatly increasing the value of the book both as a text-book and book of reference. #thad. a. reamy, m.d.,# _professor of gynecology, medical college of ohio._ "one of the best text-books for students and practitioners which has been published in the english language; it is condensed, clear, and comprehensive. the profound learning and great clinical experience of the distinguished author find expression in this book." * * * * * american text-book of gynecology #american text-book of gynecology#. medical and surgical. edited by j.m. baldy, m.d., professor of gynecology, philadelphia polyclinic. imperial octavo of pages, with text-illustrations and plates. cloth, $ . net; half morocco, $ . net. second revised edition this volume is thoroughly practical in its teachings, and is intended to be a working text-book for physicians and students. many of the most important subject are considered from an entirely new standpoint, and are grouped together in a manner somewhat foreign to the accepted custom. #boston medical and surgical journal# "the most complete exponent of gynecology that we have. no subject seems to have been neglected." dorland's modern obstetrics * * * * * #modern obstetrics: general and operative#. by w.a. newman dorland, a.m., m.d., assistant instructor in obstetrics, university of pennsylvania; associate in gynecology in the philadelphia polyclinic. handsome octavo volume of pages, with illustrations. cloth, $ . net. second edition, revised and greatly enlarged in this edition the book has been entirely rewritten and very greatly enlarged. among the new subjects introduced are the surgical treatment of puerperal sepsis, infant mortality, placental transmission of diseases, serum-therapy of puerperal sepsis, etc. #journal of the american medical association# "this work deserves commendation, and that it has received what it deserves at the hands of the profession is attested by the fact that a second edition is called for within such a short time. especially deserving of praise is the chapter on puerperal sepsis." * * * * * davis' obstetric and gynecologic nursing #obstetric and gynecologic nursing#. by edward p. davis, a.m., m.d., professor of obstetrics in the jefferson medical college and philadelphia polyclinic; obstetrician and gynecologist, philadelphia hospital. mo of pages, illustrated. buckram, $ . net. just issued--third revised edition this volume gives a very clear and accurate idea of the manner to meet the conditions arising during obstetric and gynecologic nursing. the third edition has been thoroughly revised. #the lancet, london# "not only nurses, but even newly qualified medical men, would learn a great deal by a perusal of this book. it is written in a clear and pleasant style, and is a work we can recommend." schäffer _and_ edgar's labor and operative obstetrics * * * * * #atlas and epitome of labor and operative obstetrics#. by dr. o. schäffer, of heidelberg. _from the fifth revised and enlarged german edition._ edited, with additions, by j. clifton edgar, m.d., professor of obstetrics and clinical midwifery, cornell university medical school, new york. with lithographic plates in colors, other illustrations, and pages of text. cloth, $ . net. _in saunders' hand-atlas series._ this book presents the act of parturition and the various obstetric operations in a series of easily understood illustrations, accompanied by a text treating the subject from a practical standpoint. #american medicine# "the method of presenting obstetric operations is admirable. the drawings, representing original work, have the commendable merit of illustrating instead of confusing." * * * * * schäffer _and_ edgar's obstetric diagnosis and treatment #atlas and epitome of obstetric diagnosis and treatment#. by dr. o. schäffer, of heidelberg. _from the second revised german edition._edited, with additions, by j. clifton edgar, m.d., professor of obstetrics and clinical midwifery, cornell university medical school, n.y. with colored figures on plates, text-cuts, and pages of text. cloth, $ . net. _in saunders' hand-atlas series._ this book treats particularly of obstetric operations, and, besides the wealth of beautiful lithographic illustrations, contains an extensive text of great value. this text deals with the practical, clinical side of the subject. #new york medical journal# "the illustrations are admirably executed, as they are in all of these atlases, and the text can safely be commended, not only as elucidatory of the plates, but as expounding the scientific midwifery of to-day." schäffer and norris' gynecology * * * * * #atlas and epitome of gynecology#. by dr. o. schäffer, of heidelberg. _from the second revised and enlarged german edition._ edited, with additions, by richard c. norris, a.m., m.d., assistant professor of obstetrics in the university of pennsylvania. colored figures on plates, text-cuts, and pages of text. cloth, $ . net. _in saunders' hand-atlas series._ american journal of the medical sciences "of the illustrations it is difficult to speak in too high terms of approval. they are so clear and true to nature that the accompanying explanations are almost superfluous. we commend it most earnestly." * * * * * galbraith's four epochs of woman's life second revised edition--recently issued #the four epochs of woman's life:# a study in hygiene. by anna m. galbraith, m.d., fellow of the new york academy of medicine, etc. with an introductory note by john m. musser, m.d. professor of clinical medicine, university of pennsylvania. mo of pages. cloth $ . net. maidenhood, marriage, maternity, menopause in this instructive work are stated, in a modest, pleasing, and conclusive manner, those truths of which every woman should have a thorough knowledge. written, as it is, for the laity, the subject is discussed in language readily grasped even by those most unfamiliar with medical subjects. #birmingham medical review, england# "we do not as a rule care for medical books written for the instruction of the public. but we must admit that the advice in dr. galbraith's work is in the main wise and wholesome." schäffer and webster's operative gynecology #atlas and epitome of operative gynecology#. by dr. o. schäffer, of heidelberg. edited, with additions, by j. clarence webster, m.d. (edin.), f.r.c.p.e., professor of obstetrics and gynecology in rush medical college, in affiliation with the university of chicago. colored lithographic plates, many text-cuts, a number in colors, and pages of text. _in saunders' hand-atlas series._ cloth, $ . net. recently issued much patient endeavor has been expended by the author, the artist, and the lithographer in the preparation of the plates for this atlas. they are based on hundreds of photographs taken from nature, and illustrate most faithfully the various surgical situations. dr. schäffer has made a specialty of demonstrating by illustrations. #medical record, new york# "the volume should prove most helpful to students and others in grasping details usually to be acquired only in the amphitheater itself." * * * * * delee's obstetrics for nurses #obstetrics for nurses#. by joseph b. delee, m.d., professor of obstetrics in the northwestern university medical school, chicago; lecturer in the nurses' training schools of mercy, wesley, provident, cook county, and chicago lying-in hospitals. mo of pages, fully illustrated. cloth, $ . net. just issued--new ( d) edition while dr. delee has written his work especially for nurses, the practitioner will also find it useful and instructive, since the duties of a nurse often devolve upon him in the early years of his practice. the illustrations are nearly all original and represent photographs taken from actual scenes. the text is the result of the author's many years' experience in lecturing to the nurses of five different training schools. #j. clifton edgar, m.d.,# _professor of obstetrics and clinical midwifery, cornell university, new york._ "it is far and away the best that has come to my notice, and i shall take great pleasure in recommending it to my nurses, and students as well." #american pocket dictionary# recently issued-- th ed. the american pocket medical dictionary. edited by w.a. newman dorland, a.m., m.d., assistant obstetrician to the hospital of the university of pennsylvania; fellow of the american academy of medicine. with pages. full leather, limp, with gold edges, $ . net; with patent thumb index, $ . net. #james w. holland. m.d.,# _professor of chemistry and toxicology, at the jefferson medical college, philadelphia._ "i am struck at once with admiration at the compact size and attractive exterior. i can recommend it to our students without reserve." #cragin's gynecology# recently issued--new ( th) ed. essentials of gynecology. by edwin b. cragin, m.d., professor of obstetrics, college of physicians and surgeons, new york. crown octavo, pages, illustrations. cloth, $ . net. _in saunders' question-compend series._ #the medical record, new york# "a handy volume and a distinct improvement on students' compends in general. no author who was not himself a practical gynecologist could have consulted the student's needs so thoroughly as dr. cragin has done." #boisliniere's obstetric accidents, emergencies, and operations# obstetric accidents, emergencies, and operations. by the late l. ch. boisliniere, m.d., emeritus professor of obstetrics, st. louis medical college; consulting physician, st. louis female hospital. pages, illustrated. cloth, $ . net. #british medical journal# "it is clearly and concisely written, and is evidently the work of a teacher and practitioner of large experience. its merit lies in the judgment which comes from experience." #ashton's obstetrics# recently issued--new ( th) ed. essentials of obstetrics. by w. easterly ashton, m.d., professor of gynecology in the medico-chirurgical college, philadelphia. crown octavo, pages, illustrations. cloth, $ . net. _in saunders' question-compend series._ #southern practitioner# "an excellent little volume, containing correct and practical knowledge. an admirable compend, and the best condensation we have seen." #barton and wells' medical thesaurus# a thesaurus of medical words and phrases. by wilfred m. barton, m.d., assistant to professor of materia medica and therapeutics, georgetown university, washington, d.c.; and walter a. wells, m.d., demonstrator of laryngology, georgetown university, washington, d.c. mo of pages. flexible leather, $ . net; with thumb index, $ . net. * * * * * transcriber's note: changed "dioxid" to "dioxide" in several places made hyphenation of various words consistent page : corrected misspelling of phlegmona page : corrected misspelling of quantity page : changed ',' to '.' at end of sentence page : aquæ rosae changed to aquæ rosæ page : fixed typographical error "symptyms" into "symptoms" page : fixed typographical error "decribe mycetoma" into "describe mycetoma" page : fixed typographical error "iodid" into "iodide" u. s. department of agriculture, bureau of animal industry. a. d. melvin, chief of bureau. * * * * * special report on diseases of the horse. by drs. pearson, michener, law, harbaugh, trumbower, liautard, holcombe, huidekoper, mohler, eichhorn, hall, and adams. * * * * * revised edition, . [illustration] washington: government printing office. . department of agriculture, _washington, march , ._ * * * * * transcriber's note: the italic markup for single italized letters are deleted for easier reading. minor typos have been corrected and footnotes moved to the end of the sections. * * * * * this edition of the special report on diseases of the horse has been prepared in compliance with house concurrent resolution no. , passed february , , as follows: _resolved by the house of representatives (the senate concurring)_, that there be printed and bound in cloth one hundred thousand copies of the special report on the diseases of the horse, the same to be first revised and brought to date, under the supervision of the secretary of agriculture; seventy thousand copies for the use of the house of representatives and thirty thousand for use of the senate. since the original edition issued by the department in several editions have been printed by order of congress. the work was reprinted in , and revised and reprinted in , , and . in accordance with the foregoing resolution it again has been revised so as to embody the latest practical development of knowledge of the subject. d. f. houston, _secretary._ contents. page. the examination of a sick horse. by leonard pearson fundamental principles of disease. by rush shippen huidekoper methods of administering medicines. by ch. b. michener diseases of the digestive organs. by ch. b. michener diseases of the respiratory organs. by w. h. harbaugh diseases of the urinary organs. by james law diseases of the generative organs. by james law diseases of the nervous system. by m. r. trumbower diseases of the heart, blood vessels, and lymphatics. by m. r. trumbower diseases of the eye. by james law lameness. by a. liautard diseases of the fetlock, ankle, and foot. by a. a. holcombe diseases of the skin. by james law wounds and their treatment. by ch. b. michener infectious diseases. by rush shippen huidekoper shoeing. by john w. adams index illustrations. plates. page. plate i. inflammation ii. inflammation iii. digestive apparatus iv. age of horses as indicated by teeth v. intestinal worms vi. bots vii. position of the left lung viii. longitudinal section through kidney ix. microscopic anatomy of kidney x. microscopic anatomy of kidney xi. calculi and instrument for removal xii. normal presentation xiii. some factors in difficult labor xiv. instruments used in difficult labor xv. abnormal presentations xvi. abnormal presentations xvii. abnormal presentations xviii. abnormal presentations xix. the nervous system xx. interior of chest, showing position of heart and diaphragm xxi. circulatory apparatus xxii. diagrammatic vertical section through horse's eye xxiii. skeleton of horse xxiv. superficial layer of muscles xxv. splint xxvi. ringbone xxvii. various types of spavin xxviii. bone spavin xxix. bone spavin xxx. dislocation of shoulder and elbow, bourgelat's apparatus xxxi. the sling in use xxxii. anatomy of foot xxxiii. anatomy of foot xxxiv. anatomy and diseases of foot xxxv. sound and contracted feet xxxvi. quarter crack and remedies xxxvii. foundered feet xxxviii. the skin and its diseases xxxix. mites that infest the horse xl. glanders xli. glanders xlii. glanders text figures. page. fig. . ground surface of a right fore hoof of the "regular" form . pair of fore feet of regular form in regular standing position . pair of fore feet of base-wide form in toe-wide standing position . pair of fore feet of base-narrow form in toe-narrow standing position . side view of an acute-angled fore foot, of a regular fore foot, and of a stumpy fore foot . side view of foot with the foot-axis broken backward as a result of too long a toe . left fore hoof of a regular form, shod with a plain fullered shoe . side view of hoof and fullered shoe . an acute-angled left fore hoof shod with a bar shoe . a fairly formed right fore ice shoe for a roadster . left fore hoof of regular form shod with a rubber pad and "three-quarter" shoe . a narrow right fore hoof of the base-wide standing position shod with a plain "dropped crease" shoe . hoof surface of a right hind shoe to prevent interfering . ground surface of shoe shown in fig. . side view of a fore hoof shod so as to quicken the "breaking over" in a "forger" . side view of a short-toed hind hoof of a forger . a toe-weight shoe to increase the length of stride of fore feet . most common form of punched heel-weight shoe to induce high action in fore feet special report on diseases of the horse. the examination of a sick horse. by leonard pearson, b. s., v. m. d. in the examination of a sick horse it is important to have a method or system. if a definite plan of examination is followed one may feel reasonably sure, when the examination is finished, that no important point has been overlooked and that the examiner is in a position to arrive at an opinion that is as accurate as is possible for him. of course, an experienced eye can see, and a trained hand can feel, slight alterations or variations from the normal that are not perceptible to the unskilled observer. a thorough knowledge of the conditions that exist in health is of the highest importance, because it is only by a knowledge of what is right that one can surely detect a wrong condition. a knowledge of anatomy, or of the structure of the body, and of physiology, or the functions and activities of the body, lie at the bottom of accuracy of diagnosis. it is important to remember that animals of different races or families deport themselves differently under the influence of the same disease or pathological process. the sensitive and highly organized thoroughbred resists cerebral depression more than does the lymphatic draft horse. hence a degree of fever that does not produce marked dullness in a thoroughbred may cause the most abject dejection in a coarsely bred, heavy draft horse. this and similar facts are of vast importance in the diagnosis of disease and in the recognition of its significance. the order of examination, as given hereafter, is one that has proved to be comparatively easy of application and sufficiently thorough for the purpose of the readers of this work, and is recommended by several writers. history. it is important to know, first of all, something of the origin and development of the disease; therefore the cause should be looked for. the cause of a disease is important, not only in connection with diagnosis, but also in connection with treatment. the character of feed that the horse has had, the use to which he has been put, and the kind of care he has received should all be closely inquired into. it may be found by this investigation that the horse has been fed on damaged feed, such as brewers' grains or moldy silage, and this may be sufficient to explain the profound depression and weakness that are characteristic of forage poisoning. if it is learned that the horse has been kept in the stable without exercise for several days and upon full rations, and that he became suddenly lame in his back and hind legs, and finally fell to the ground from what appeared to be partial paralysis, this knowledge, taken in connection with a few evident symptoms, will be enough to establish a diagnosis of azoturia (excess of nitrogen in the urine). if it is learned that the horse has been recently shipped in the cars or has been through a dealer's stable, we have knowledge of significance in connection with the causation of a possible febrile disease, which is, under these conditions, likely to prove to be influenza, or edematous pneumonia. it is also important to know whether the particular horse under examination is the only one in the stable, or on the premises, that is similarly afflicted. if it is found that several horses are afflicted much in the same way, we have evidence of a common cause of disease which may prove to be of an infectious nature. another item of importance in connection with the history of the case relates to the treatment that the horse may have had before he is examined. it sometimes happens that medicine given in excessive quantities produces symptoms resembling those of disease, so it is important that the examiner be fully informed as to the medication that has been employed. attitude and general condition. before beginning the special examination, attention should be paid to the attitude and general condition of the animal. sometimes horses assume positions that are characteristic of a certain disease. for example, in tetanus (lockjaw) the muscles of the face, neck, and shoulders are stiff and rigid, as well as the muscles of the jaw. this condition produces a peculiar attitude, that once seen is subsequently recognized as rather characteristic of the disease. a horse with tetanus stands with his muscles tense and his legs in a somewhat bracing position, as though he were gathered to repel a shock. the neck is stiff and hard, the head is slightly extended upon it, and the face is drawn, and the nostrils are dilated. the tail is usually held up a little, and when pressed down against the thighs it springs back to its previous position. in inflammation of the throat, as in pharyngolaryngitis, the head is extended upon the neck and the angle between the jaw and the lower border of the neck is opened as far as possible to relieve the pressure that otherwise would fall upon the throat. in dumminess, or immobility, the hanging position of the head and the stupid expression are rather characteristic. in pleurisy, peritonitis, and some other painful diseases of the internal organs, the rigid position of the body denotes an effort of the animal to avoid pressure upon and to protect the inflamed sensitive region. the horse may be down in the stall and unable to rise. this condition may result from paraplegia (paralysis), from azoturia, from forage poisoning, from tetanus, or from painful conditions of the bones or feet, such as osteoporosis or founder. lying down at unusual times or in unusual positions may indicate disease. the first symptom of colic may be a desire on the part of the horse to lie down at an unusual or inappropriate time or place. sometimes disinclination to lie down is an indication of disease. when there is difficulty in breathing, the horse knows that he can manage himself better upon his feet than upon his breast or his side. it happens, therefore, that in nearly all serious diseases of the respiratory tract he stands persistently, day and night, until recovery has commenced and breathing is easier, or until the animal falls from sheer exhaustion. if there is stiffness and soreness of the muscles, as in rheumatism, inflammation of the muscles from overwork, or of the bones in osteoporosis, or of the feet in founder, or if the muscles are stiff and beyond control of the animal, as in tetanus, a standing position is maintained, because the horse seems to realize that when he lies down he will be unable to rise. abnormal attitudes are assumed in painful diseases of the digestive organs (colic). a horse with colic may sit upon his haunches, like a dog, or may stand upon his hind feet and rest upon his knees in front, or he may endeavor to balance himself upon his back, with all four feet in the air. these positions are assumed because they give relief from pain by lessening pressure or tension upon the sensitive structures. under the general condition of the animal it is necessary to observe the condition or state of nutrition, the conformation, so far as it may indicate the constitution, and the temperament. by observing the condition of nutrition one may be able to determine to a certain extent the effect that the disease has already had upon the animal and to estimate the amount of strength that remains and that will be available for the repair of the diseased tissues. a good condition of nutrition is shown by the rotundity of the body, the pliability and softness of the skin, and the tone of the hair. if the subcutaneous fat has disappeared and the muscles are wasted, allowing the bony prominences to stand out; if the skin is tight and inelastic and the coat dry and harsh, we have evidence of a low state of nutrition. this may have resulted from a severe and long-continued disease or from lack of proper feed and care. when an animal is emaciated--that is, becomes thin--there is first a loss of fat and later the muscles shrink. by observing the amount of shrinkage in the muscles one has some indication as to the duration of the unfavorable conditions under which the animal has lived. by constitution we understand the innate ability of the animal to withstand disease or unfavorable conditions of life. the constitution depends largely upon the conformation. the type of construction that usually accompanies the best constitution is deep, broad chest, allowing plenty of room for the lungs and heart, indicating that these vital organs are well developed; capacious abdomen, allowing sufficient space for well-developed organs of digestion; the loins should be short--that is, the space should be short between the last rib and the point of the hip; the head and neck should be well molded, without superfluous or useless tissue; this gives a clear-cut throat. the ears, eyes, and face should have an expression of alertness and good breeding. the muscular development should be good; the shoulders, forearms, croup, and thighs must have the appearance of strength. the withers are sharp, which means that they are not loaded with useless, superfluous tissue; the legs are straight and their axes are parallel; the knees and hocks are low, which means that the forearms and thighs are long and the cannons relatively short. the cannons are broad from in front to behind and relatively thin from side to side. this means that the bony and tendinous structures of the legs are well developed and well placed. the hoofs are compact, tense, firm structures, and their soles are concave and frogs large. such a horse is likely to have a good constitution and to be able to resist hard work, fatigue, and disease to a maximum degree. on the other hand, a poor constitution is indicated by a shallow, narrow chest, small bones, long loins, coarse neck and head, with thick throat, small, bony, and muscular development, short thighs and forearms, small joints, long, round cannons, and hoofs of open texture with flat soles. the temperament is indicated by the manner in which the horse responds to external stimuli. when the horse is spoken to, or when he sees or feels anything that stimulates or gives alarm, if he responds actively, quickly, and intelligently, he is said to be of lively, or nervous, temperament. on the other hand, if he responds in a slow, sluggish manner, he is said to have a sluggish, or lymphatic, temperament. the temperament is indicated by the gait, by the expression of the face, and by the carriage of the head and ears. the nature of the temperament should be taken into consideration in an endeavor to ascertain the severity of a given case of illness, because the general expression of an animal in disease as well as in health depends to a large extent on the temperament. the skin and the visible mucous membranes. the condition of the skin is a fair index to the condition of the animal. the effect of disease and emaciation upon the pliability of the skin have been referred to above. there is no part of the body that loses its elasticity and tone as a result of disease sooner than the skin. the practical herdsman or flockmaster can gain a great deal of information as to the condition, of an animal merely by grasping the coat and looking at and feeling the skin. similarly, the condition of the animal is shown to a certain extent by the appearance of the mucous membranes. for example, when the horse is anemic as a result of disease or of inappropriate feed the mucous membranes become pale. this change in the mucous membranes can be seen most readily in the lining of the eyelids and in the lining of the nostril. for convenience of examination the eyelids can readily be everted. paleness means weak circulation or poor blood. increased redness occurs physiologically in painful conditions, excitement, and following severe exertion. under such conditions the increase of circulation is transitory. in fevers there is an increased redness in the mucous membrane, and this continues so long as the fever lasts. in some diseases red spots or streaks form in the mucous membrane. this usually indicates an infectious disease of considerable severity, and occurs in blood poisoning, purpura hemorrhagica, hemorrhagic septicemia, and in urticaria. when the liver is deranged and does not operate, or when the red-blood corpuscles are broken down, as in serious cases of influenza, there is a yellowish discoloration of the mucous membrane. the mucous membranes become bluish or blue when the blood is imperfectly oxidized and contains an excess of carbon dioxid. this condition exists in any serious disease of the respiratory tract, as pneumonia, and in heart failure. the temperature of the skin varies with the temperature of the body. if there is fever the temperature of the skin is likely to be increased. sometimes, however, as a result of poor circulation and irregular distribution of the blood, the body may be warmer than normal, while the extremities (the legs and ears) may be cold. where the general surface of the body becomes cold it is evident that the small blood vessels in the skin have contracted and are keeping the blood away, as during a chill, or that the heart is weak and is unable to pump the blood to the surface, and that the animal is on the verge of collapse. the skin is moist, to a certain degree, at all times in a healthy horse. this moisture is not in the form of a perceptible sweat, but it is enough to keep the skin pliable and to cause the hair to have a soft, healthy feel. in some chronic diseased conditions and in fever, the skin becomes dry. in this case the hair has a harsh feel that is quite different from the condition observed in health, and from the fact of its being so dry the individual hairs do not adhere to one another, they stand apart, and the animal has what is known as "a staring coat." when, during a fever, sweating occurs, it is usually an indication that the crisis is passed. sometimes sweating is an indication of pain. a horse with tetanus or azoturia sweats profusely. horses sweat freely when there is a serious impediment to respiration; they sweat under excitement, and, of course, from the well-known physiological causes of heat and work. local sweating, or sweating of a restricted area of the body, denotes some kind of nerve interference. swellings of the skin usually come from wounds or other external causes and have no special connection with the diagnosis of internal diseases. there are, however, a number of conditions in which the swelling of the skin is a symptom of a derangement of some other part of the body. for example, there is the well-known "stocking," or swelling of the legs about the fetlock joints, in influenza. there is the soft swelling of the hind legs that occurs so often in draft horses when standing still and that comes from previous inflammation (lymphangitis) or from insufficient heart power. dropsy, or edema of the skin, may occur beneath the chest or abdomen from heart insufficiency or from chronic collection of fluid in the chest or abdomen (hydrothorax, ascites, or anemia). in anasarca or purpura hemorrhagica large soft swellings appear on any part of the skin, but usually on the legs, side of the body, and about the head. gas collects under the skin in some instances. this comes from a local inoculation with an organism which produces a fermentation beneath the skin and causes the liberation of gas which inflates the skin, or the gas may be air that enters through a wound penetrating some air-containing organ, as the lungs. the condition here described is known as emphysema. emphysema may follow the fracture of a rib when the end of a bone is forced inward and caused to penetrate the lung, or it may occur when, as a result of an ulcerating process, an organ containing air is perforated. this accident is more common in cattle than it is in horses. emphysema is recognized by the fact that the swelling that it causes is not hot or sensitive on pressure. it emits a peculiar crackling sound when it is stroked or pressed upon. wounds of the skin may be of importance in the diagnosis of internal disease. wounds over the bony prominence, as the point of the hip, the point of the shoulder, and the greatest convexity of the ribs, occur when a horse is unable to stand for a long time and, through continually lying upon his side, has shut off the circulation to the portion of the skin that covers parts of the body that carry the greatest weight, and in this way has caused them to mortify. little, round, soft, doughlike swellings occur on the skin and may be scattered freely over the surface of the body when the horse is afflicted with urticaria. similar eruptions, but distributed less generally, about the size of a silver dollar, may occur as a symptom of dourine, or colt distemper. hard lumps, from which radiate welt-like swellings of the lymphatics, occur in glanders, and blisterlike eruptions occur around the mouth and pasterns in horsepox. the organs of circulation. the first item in this portion of the examination consists in taking the pulse. the pulse may be counted and its character may be determined at any point where a large artery occupies a situation close to the skin and above a hard tissue, such as a bone, cartilage, or tendon. the most convenient place for taking the pulse of the horse is at the jaw. the external maxillary artery runs from between the jaws, around the lower border of the jawbone, and up on the outside of the jawbone to the face. it is located immediately in front of the heavy muscles of the cheek. its throb can be felt most distinctly just before it turns around the lower border of the jawbone. the balls of the first and second or of the second and third fingers should be pressed lightly on the skin over this artery when its pulsations are to be studied. the normal pulse of the healthy horse varies in frequency as follows: stallion to beats per minute. gelding to beats per minute. mare to beats per minute. foal to years old to beats per minute. foal to months old to beats per minute. foal to weeks old to beats per minute. the pulse is accelerated by the digestion of rich food, by hot weather, exercise, excitement, and alarm. it is slightly more rapid in the evening than it is in the morning. well-bred horses have a slightly more rapid pulse than sluggish, cold-blooded horses. the pulse should be regular; that is, the separate beats should follow each other after intervals of equal length, and the beats should be of equal fullness, or volume. in disease, the pulse may become slower or more rapid than in health. slowing of the pulse may be caused by old age, great exhaustion, or excessive cold. it may be due to depression of the central nervous system, as in dumminess, or be the result of the administration of drugs, such as digitalis or strophantus. a rapid pulse is almost always found in fever, and the more severe the infection and the weaker the heart the more rapid is the pulse. under these conditions, the beats may rise to , , or even per minute. when the pulse is above per minute the outlook for recovery is not promising, and especially if this symptom accompanies high temperature or occurs late in an infectious disease. in nearly all of the diseases of the heart and in anemia the pulse becomes rapid. the pulse is irregular in diseases of the heart, and especially where the valves are affected. the irregularity may consist in varying intervals between the beats or the dropping of one or more beats at regular or irregular intervals. the latter condition sometimes occurs in chronic diseases of the brain. the pulse is said to be weak, or soft, when the beats are indistinct, because little blood is forced through the artery by each contraction of the heart. this condition occurs when there is a constriction of the vessels leading from the heart and it occurs in certain infectious and febrile diseases, and is an indication of heart weakness. in examining the heart itself it is necessary to recall that it lies in the anterior portion of the chest slightly to the left of the median line and that it extends from the third to the sixth rib. it extends almost to the breastbone, and a little more than half of the distance between the breastbone and the backbone. in contracting, it rotates slightly on its axis, so that the point of the heart, which lies below, is pressed against the left chest wall at a place immediately above the point of the elbow. the heart has in it four chambers--two in the left and two in the right side. the upper chamber of the left side (left auricle) receives the blood as it comes from the lungs, passes it to the lower chamber of the left side (left ventricle), and from here it is sent with great force (for this chamber has very strong, thick walls) through the aorta and its branches (the arteries) to all parts of the body. the blood returns through the veins to the upper chamber of the right side (right auricle), passes then to the lower chamber of the right side (right ventricle), and from this chamber is forced into the lungs to be oxidized. the openings between the chambers of each side and into the aorta are guarded by valves. if the horse is not too fat, one may feel the impact of the apex of the heart against the chest wall with each contraction of the heart by placing the hand on the left side back of the fifth rib and above the point of the elbow. the thinner and the better bred the horse is the more distinctly this impact is felt. if the animal is excited, or if he has just been exercised, the impact is stronger than when the horse is at rest. if the horse is weak, the impact is reduced in force. the examination of the heart with the ear is an important matter in this connection. certain sounds are produced by each contraction of the normal heart. it is customary to divide these into two, and to call them the first and second sounds. these two sounds are heard during each pulsation, and any deviation of the normal indicates some alteration in the structure or the functions of the heart. in making this examination, one may apply the left ear over the heavy muscles of the shoulder back of the shoulder joint, and just above the point of the elbow, or, if the sounds are not heard distinctly, the left fore leg may be drawn forward by an assistant and the right ear placed against the lower portion of the chest wall that is exposed in this manner. the first sound of the heart occurs while the heart muscle is contracting and while the blood is being forced from the heart and the valves are rendered taut to prevent the return of the blood from the lower to the upper chambers. the second sound follows quickly after the first and occurs during rebound of blood in the arteries, causing pressure in the aorta and tensions of the valves guarding its opening into the left ventricle. the first sound is of a high pitch and is longer and more distinct than the second. under the influence of disease these sounds may be altered in various ways. it is not profitable, in a work such as this, to describe the details of these alterations. those who are interested will find this subject fully discussed in the veterinary textbooks. temperature. the temperature of the horse is determined roughly by placing the fingers in the mouth or between the thighs or by allowing the horse to exhale against the cheek or back of the hand. in accurate examination, however, these means of determining temperature are not relied upon, but recourse is had to the use of the thermometer. the thermometer used for taking the temperature of a horse is a self-registering clinical thermometer, similar to that used by physicians, but larger, being from to inches long. the temperature of the animal is measured in the rectum. the normal temperature of the horse varies somewhat under different conditions. it is higher in the young animal than in the old, and is higher in hot weather than in cold. the weather and exercise decidedly influence the temperature physiologically. the normal temperature varies from . ° to ° f. if the temperature rises to . ° the horse is said to have a low fever; if the temperature reaches ° the fever is moderate; if it reaches ° it is high, and above this point it is regarded as very high. in some diseases, such as tetanus or sunstroke, the temperature goes as high as ° or °. in the ordinary infectious diseases it does not often exceed °. a temperature of . ° and above is very dangerous and must be reduced promptly if the horse is to be saved. the organs of respiration. in examining this system of organs and their functions it is customary to begin by noting the frequency of the respiratory movements. this point can be determined by observing the motions of the nostrils or of the flanks; on a cold day one can see the condensation of the moisture of the warm air as it comes from the lungs. the normal rate of respiration for a healthy horse at rest is from to per minute. the rate is faster in young animals than in old, and is increased by work, hot weather, overfilling of the stomach, pregnancy, lying upon the side, etc. acceleration of the respiratory rate where no physiological cause operates is due to a variety of conditions. among these is fever; restricted area of active lung tissue, from filling of portions of the lungs with inflammatory exudate, as in pneumonia; compression of the lungs or loss of elasticity; pain in the muscles controlling the respiratory movements; excess of carbon dioxid in the blood; and constriction of the air passages leading to the lungs. difficult or labored respiration is known as dyspnea. it occurs when it is difficult, for any reason, for the animal to obtain the amount of oxygen that it requires. this may be due to filling of the lungs, as in pneumonia; to painful movements of the chest, as in rheumatism or pleurisy; to tumors of the nose and paralysis of the throat, swellings of the throat, foreign bodies, or weakness of the respiratory passages, fluid in the chest cavity, adhesions between the lungs and chest walls, loss of elasticity of the lungs, etc. where the difficulty is great the accessory muscles of respiration are brought into play. in great dyspnea the horse stands with his front feet apart, with his neck straight out, and his head extended upon his neck. the nostrils are widely dilated, the face has an anxious expression, the eyeballs protrude, the up-and-down motion of the larynx is aggravated, the amplitude of the movement of the chest walls increased, and the flanks heave. the expired air is of about the temperature of the body. it contains considerable moisture, and it should come with equal force from each nostril and should not have an unpleasant odor. if the stream of air from one nostril is stronger than from the other, there is an indication of an obstruction in a nasal chamber. if the air possesses a bad odor, it is usually an indication of putrefaction of a tissue or secretion in some part of the respiratory tract. a bad odor is found where there is necrosis of the bone in the nasal passages or in chronic catarrh. an ulcerating tumor of the nose or throat may cause the breath to have an offensive odor. the most offensive breath occurs where there is necrosis, or gangrene, of the lungs. in some diseases there is a discharge from the nose. in order to determine the significance of the discharge it should be examined closely. one should ascertain whether it comes from one or both nostrils. if but from one nostril, it probably originates in the head. the color should be noted. a thin, watery discharge may be composed of serum, and it occurs in the earlier stages of coryza, or nasal catarrh. an opalescent, slightly tinted discharge is composed of mucus and indicates a little more severe irritation. if the discharge is sticky and puslike, a deeper difficulty or more advanced irritation is indicated. if the discharge contains flakes and clumps of more or less dried, agglutinated particles, it is probable that it originates within a cavity of the head, as the sinuses or guttural pouches. the discharge of glanders is of a peculiar sticky nature and adheres tenaciously to the wings of the nostrils. the discharge of pneumonia is of a somewhat red or reddish brown color and, on this account has been described as a prune-juice discharge. the discharge may contain blood. if the blood appears as clots or as streaks in the discharge, it probably originates at some point in the upper part of the respiratory tract. if the blood is in the form of a fine froth, it comes from the lungs. in examining the interior of the nasal passage one should remember that the normal color of the mucous membrane is a rosy pink and that its surface is smooth. if ulcers, nodules, swellings, or tumors are found, these indicate disease. the ulcer that is characteristic of glanders is described fully in connection with the discussion of that disease. between the lower jaws there are several clusters of lymphatic glands. these glands are so small and so soft that it is difficult to find them by feeling through the skin, but when a suppurative disease exists in the upper part of the respiratory tract these glands become swollen and easy to feel. they may become soft and break down and discharge as abscesses; this is seen constantly in strangles. on the other hand, they may become indurated and hard from the proliferation of connective tissue and attach themselves to the jawbone, to the tongue, or to the skin. this is seen in chronic glanders. if the glands are swollen and tender to pressure, it indicates that the disease causing the enlargement is acute; if they are hard and insensitive, the disease causing the enlargement is chronic. the manner in which the horse coughs is of importance in diagnosis. the cough is a forced expiration, following immediately upon a forcible separation of the vocal cords. the purpose of the cough is to remove some irritant substance from the respiratory passages, and it occurs when irritant gases, such as smoke, ammonia, sulphur vapor, or dust, have been inhaled. it occurs from inhalation of cold air if the respiratory passages are sensitive from disease. in laryngitis, bronchitis, and pneumonia, cough is very easily excited and occurs merely from accumulation of mucus and inflammatory product upon the irritated respiratory mucous membrane. if one wishes to determine the character of the cough, it can easily be excited by pressing upon the larynx with the thumb and finger. the larynx should be pressed from side to side and the pressure removed the moment the horse commences to cough. a painful cough occurs in pleurisy, also in laryngitis, bronchitis, and bronchial pneumonia. pain is shown by the effort the animal exerts to repress the cough. the cough is not painful, as a rule, in the chronic diseases of the respiratory tract. the force of the cough is considerable when it is not especially painful and when the lungs are not seriously involved. when the lungs are so diseased that they can not be filled with a large volume of air, and in heaves, the cough is weak, as it is also in weak, debilitated animals. if mucus or pus is coughed out, or if the cough is accompanied by a gurgling sound, it is said to be moist; it is dry when these characteristics are not present--that is, when the air in passing out passes over surface not loaded with secretion. in the examination of the chest we resort to percussion and auscultation. when a cask or other structure containing air is tapped upon, or percussed, a hollow sound is given forth. if the cask contains fluid, the sound is of a dull and of quite a different character. similarly, the amount of air contained in the lungs can be estimated by tapping upon, or percussing, the walls of the chest. percussion is practiced with the fingers alone or with the aid of a special percussion hammer and an object to strike upon known as a pleximeter. if the fingers are used, the middle finger of the left hand should be pressed firmly against the side of the horse and should be struck with the ends of the fingers of the right hand bent at a right angle so as to form a hammer. the percussion hammer sold by instrument makers is made of rubber or has a rubber tip, so that when the pleximeter, which is placed against the side, is struck the impact will not be accompanied by a noise. after experience in this method of examination one can determine with a considerable degree of accuracy whether the lung contains a normal amount of air or not. if, as in pneumonia, air has been displaced by inflammatory product occupying the air space, or if fluid collects in the lower part of the chest, the percussion sound becomes dull. if, as in emphysema, or in pneumothorax, there is an excess of air in the chest cavity, the percussion sound becomes abnormally loud and clear. auscultation consists in the examination of the lungs with the ear applied closely to the chest wall. as the air goes in and out of the lungs a certain soft sound is made which can be heard distinctly, especially upon inspiration. this sound is intensified by anything that accelerates the rate of respiration, such as exercise. this soft, rustling sound is known as vesicular murmur, and wherever it is heard it signifies that the lung contains air and is functionally active. the vesicular murmur is weakened when there is an inflammatory infiltration of the lung tissue or when the lungs are compressed by fluid in the chest cavity. the vesicular murmur disappears when air is excluded by the accumulation, of inflammatory product, as in pneumonia, and when the lungs are compressed by fluid in the chest cavity. the vesicular murmur becomes rough and harsh in the early stages of inflammation of the lungs, and this is often the first sign of the beginning of pneumonia. by applying the ear over the lower part of the windpipe in front of the breastbone a somewhat harsh, blowing sound may be heard. this is known as the bronchial murmur and is heard in normal conditions near the lower part of the trachea and to a limited extent in the anterior portions of the lungs after sharp exercise. when the bronchial murmur is heard over other portions of the lungs, it may signify that the lungs are more or less solidified by disease and the blowing bronchial murmur is transmitted through this solid lung to the ear from a distant part of the chest. the bronchial murmur in an abnormal place signifies that there exists pneumonia or that the lungs are compressed by fluid in the chest cavity. additional sounds are heard in the lungs in some diseased conditions. for example, when fluid collects in the air passages and the air is forced through it or is caused to pass through tubes containing secretions or pus. such sounds are of a gurgling or bubbling nature and are known as mucous râles. mucous râles are spoken of as being large or small as they are distinct or indistinct, depending upon the quantity of fluid that is present and the size of the tube in which this sound is produced. mucous râles occur in pneumonia after the solidified parts begin to break down at the end of the disease. they occur in bronchitis and in tuberculosis, where there is an excess of secretion. sometimes a shrill sound is heard, like the note of a whistle, fife, or flute. this is due to a dry constriction of the bronchial tubes and it is heard in chronic bronchitis and in tuberculosis. a friction sound is heard in pleurisy. this is due to the rubbing together of roughened surfaces, and the sound produced is similar to a dry rubbing sound that is caused by rubbing the hands together or by rubbing upon each other two dry, rough pieces of leather. the examination of the digestive tract. the first point in connection with the examination of the organs of digestion is the appetite and the manner of taking food and drink. a healthy animal has a good appetite. loss of appetite does not point to a special diseased condition, but comes from a variety of causes. some of these causes, indeed, may be looked upon as being physiological. excitement, strange surroundings, fatigue, and hot weather may all cause loss of appetite. where there is cerebral depression, fever, profound weakness, disorder of the stomach, or mechanical difficulty in chewing or swallowing, the appetite is diminished or destroyed. sometimes there is an appetite or desire to eat abnormal things, such as dirty bedding, roots of grass, soil, etc. this desire usually comes from a chronic disturbance of nutrition. thirst is diminished in a good many mild diseases unaccompanied by distinct fever. it is seen where there is great exhaustion or depression or profound brain disturbance. thirst is increased after profuse sweating, in diabetes, diarrhea, in fever, at the crises of infectious diseases, and when the mouth is dry and hot. some diseases of the mouth or throat make it difficult for the horse to chew or swallow his feed. where difficulty in this respect is experienced, the following named conditions should be borne in mind and carefully looked for: diseases of the teeth, consisting in decay, fracture, abscess formation, or overgrowth; inflammatory conditions, or wounds or tumors of the tongue, cheeks, or lips; paralysis of the muscles of chewing or swallowing; foreign bodies in upper part of the mouth between the molar teeth; inflammation of throat. difficulty in swallowing is sometimes shown by the symptom known as "quidding." quidding consists in dropping from the mouth well-chewed and insalivated boluses of feed. a mouthful of hay, for example, after being ground and masticated, is carried to the back part of the mouth. the horse then finds that from tenderness of the throat, or from some other cause, swallowing is difficult or painful, and the bolus is then dropped from the mouth. another quantity of hay is similarly prepared, only to be dropped in turn. sometimes quidding is due to a painful tooth, the bolus being dropped from the mouth when the tooth is struck and during the pang that follows. quidding may be practiced so persistently that a considerable pile of boluses of feed accumulate in the manger or on the floor of the stall. in pharyngitis one of the symptoms is a return through the nose of fluid that the horse attempts to swallow. in some brain diseases, and particularly in chronic internal hydrocephalus, the horse has a most peculiar manner of swallowing and of taking feed. a similar condition is seen in hyperemia of the brain. in eating the horse will sink his muzzle into the grain in the feed box and eat for a while without raising the head. long pauses are made while the feed is in the mouth. sometimes the horse will eat very rapidly for a little while and then slowly; the jaws may be brought together so forcibly that the teeth gnash. in eating hay the horse will stop at times with hay protruding from the mouth and stand stupidly, as though he has forgotten what he was about. in examining the mouth one should first look for swellings or for evidence of abnormal conditions upon the exterior; that is, the front and sides of the face, the jaws, and about the muzzle. by this means wounds, fractures, tumors, abscesses, and disease accompanied by eruptions about the muzzle may be detected. the interior of the mouth is examined by holding the head up and inserting the fingers through the interdental space in such a way as to cause the mouth to open. the mucous membrane should be clean and of a light-pink color, excepting on the back of the tongue, where the color is a yellowish gray. as abnormalities of this region, the chief are diffuse inflammation, characterized by redness and catarrhal discharge; local inflammation, as from eruptions, ulcers, or wounds; necrosis of the lower jawbone in front of the first back tooth; and swellings. foreign bodies are sometimes found embedded in the mucous membrane lining of the mouth or lodged between the teeth. the examination of the pharynx and of the esophagus is made chiefly by pressing upon the skin covering these organs in the region of the throat and along the left side of the neck in the jugular gutter. sometimes, when a more careful examination is necessary, an esophageal tube or probang is passed through the nose or mouth down the esophagus to the stomach. vomiting is an act consisting in the expulsion of all or part of the contents of the stomach through the mouth or nose. this act is more difficult for the horse than for most of the other domestic animals, because the stomach of the horse is small and does not lie on the floor of the abdominal cavity, so that the abdominal walls in contracting do not bring pressure to bear upon it so directly and forcibly, as is the case in many other animals. beside this, there is a loose fold of mucous membrane at the point where the esophagus enters the stomach, and this forms a sort of valve which does not interfere with the passage of food into the stomach, but does interfere with the exit of food through the esophageal opening. still, vomiting is a symptom that is occasionally seen in the horse. it occurs when the stomach is very much distended with food or with gas. distention stretches the mucous membrane and eradicates the valvular fold referred to, and also makes it possible for more pressure to be exerted upon the stomach through the contraction of the abdominal muscles. since the distention to permit vomiting must be extreme, it not infrequently happens that it leads to rupture of the stomach walls. this has caused the impression in the minds of some that vomiting can not occur in the horse without rupture of the stomach, but this is incorrect, since many horses vomit and afterwards become entirely sound. after rupture of the stomach has occurred vomiting is impossible. in examination of the abdomen one should remember that its size depends largely upon the breed, sex, and conformation of the animal, and also upon the manner in which the animal has been fed and the use to which it has been put. a pendulous abdomen may be the result of an abdominal tumor or of an accumulation of fluid in the abdominal cavity; or, on the other hand, it may merely be an indication of pregnancy, or of the fact that the horse has been fed for a long time on bulky and innutritious food. pendulous abdomen occurring in a work horse kept on a concentrated diet is an abnormal condition. the abdomen may increase suddenly in volume from accumulation of gas in tympanic colic. the abdomen becomes small and the horse is said to be "tucked up" from long-continued poor appetite, as in diseases of the digestive tract and in fever. this condition also occurs in tetanus from the contraction of the abdominal walls and in diarrhea from emptiness. in applying the ear to the flank, on either the right or left side, certain bubbling sounds may be heard that are known as peristaltic sounds, because they are produced by peristalsis, or wormlike contraction of the intestines. these sounds are a little louder on the right side than on the left on account of the fact that the large intestines lie in the right flank. absence of peristaltic sounds is always an indication of disease, and suggests exhaustion or paralysis of the intestines. this may occur in certain kinds of colic and is an unfavorable symptom. increased sounds are heard where the intestines are contracted more violently than in health, as in spasmodic colic, and also where there is an excess of fluid or gas in the intestinal canal. the feces show, to a certain extent, the thoroughness of digestion. they should show that the feed has been well ground, and should, in the horse, be free from offensive odor or coatings of mucus. a coating of mucus shows intestinal catarrh. blood on the feces indicates severe inflammation. very light color and bad odor may come from inactive liver. parasites are sometimes in the dung. rectal examination consists in examination of the organs of the pelvic cavity and posterior portion of the abdominal cavity by the hand inserted into the rectum. this examination should be attempted by a veterinarian only, and is useless except to one who has a good knowledge of the anatomy of the parts concerned. the examination of the nervous system. the great brain, or cerebrum, is the seat of intelligence, and it contains the centers that control motion in many parts of the body. the front portion of the brain is believed to be the region that is most important in governing the intelligence. the central and posterior portions of the cerebrum contain the centers for the voluntary motions of the face and of the front and hind legs. the growth of a tumor or an inflammatory change in the region of a center governing the motion of a certain part of the body has the effect of disturbing motion in that part by causing excessive contraction known as cramps, or inability of the muscles to contract, constituting the condition known as paralysis. the nerve paths from the cerebrum, and hence from these centers to the spinal cord and thence to the muscles, pass beneath the small brain, or the cerebellum, and through the medulla oblongata to the spinal cord. interference with these paths has the effect of disturbing motion of the parts reached by them. if all of the paths on one side are interfered with, the result is paralysis of one side of the body. the small brain, or cerebellum, governs the regularity, or coordination, of movements. disturbances of the cerebellum cause a tottering, uncertain gait. in the medulla oblongata, which lies between the spinal cord and the cerebellum, are the centers governing the circulation and breathing. the spinal cord carries sensory messages to the brain and motor impressions from the brain. the anterior portions of the cord contain the motor paths, and the posterior portions of the cord contain the sensory paths. paralysis of a single member or a single group of muscles is known as monoplegia and results from injury to the motor center or to a nerve trunk leading to the part that is involved. paralysis of one-half of the body is known as hemiplegia and results from destruction or severe disturbances of the cerebral hemisphere of the opposite side of the body or from interference with nerve paths between the cerebellum, or small brain, and the spinal cord. paralysis of the posterior half of the body is known as paraplegia and results from derangement of the spinal cord. if the cord is pressed upon, cut, or injured, messages can not be transmitted beyond that point, and so the posterior part becomes paralyzed. this is seen when the back is fractured. abnormal mental excitement may be due to congestion of the brain or to inflammation. the animal so afflicted becomes vicious, pays no attention to commands, cries, runs about in a circle, stamps with the feet, strikes, kicks, etc. this condition is usually followed by a dull, stupid state, in which the animal stands with his head down, dull and irresponsive to external stimuli. cerebral depression also occurs in the severe febrile infectious diseases, in chronic hydrocephalus, in chronic diseases of the liver, in poisoning with a narcotic substance, and with chronic catarrh of the stomach and intestines. fainting is a symptom that is not often seen in horses. when it occurs it is shown by unsteadiness of gait, tottering, and, finally, inability to stand. the cause usually lies in a defect of the small brain, or cerebellum. this defect may be merely in respect of the blood supply, to congestion, or to anemia, and in this case it is likely to pass away and may never return, or it may be due to some permanent cause, as a tumor or an abscess, or it may result from a hemorrhage, from a defect of the valves of the heart, or from poisoning. loss of consciousness is known as coma. it is caused by hemorrhage in the brain, by profound exhaustion, or may result from a saturation of the system with the poison of some disease. coma may follow upon cerebral depression, which occurs as a secondary state of inflammation of the brain. where the sensibility of a part is increased the condition is known as hyperesthesia, and where it is lost--that is, where there is no feeling or knowledge of pain--the condition is known as anesthesia. the former usually accompanies some chronic disease of the spinal cord or the earlier stages of irritation of a nerve trunk. hyperesthesia is difficult to detect in a nervous, irritable animal, and sometimes even in a horse of less sensitive temperament. an irritable, sensitive spot may be found surrounded by skin that is not sensitive to pressure. this is sometimes a symptom of beginning of inflammation of the brain. anesthesia occurs in connection with cerebral and spinal paralysis, section of a nerve trunk leading to a part, in severe mental depression, and in narcotic poisoning. urinary and sexual organs. in considering the examination of the urinary and sexual organs we may consider, at the beginning, a false impression that prevails to an astonishing extent. many horsemen are in the habit of pressings upon the back of a horse over the loins or of sliding the ends of the fingers along on either side of the median line of this region. if the horse depresses his back it is at once said "his kidneys are weak." nothing could be more absurd or further from the truth. any healthy horse--any horse with normal sensation and with a normally flexible back--will cause it to sink when manipulated in this way. if the kidneys are inflamed and sensitive, the back is held more rigidly and is not depressed under this pressure. to examine the kidneys by pressure the pressure should be brought to bear over these organs. the kidneys lie beneath the ends of the transverse processes of the vertebræ of the loins and beneath the hind-most ribs. if the kidneys are actually inflamed and especially sensitive, pressure or light blows applied here may cause the horse to shrink. the physical examination of the sexual and generative organs is made in large part through the rectum, and this portion of the examination should be carried out by a veterinarian only. by this means it is possible to discover or locate cysts of the kidneys, urinary calculi in the ureters, bladder, or upper urethra, malformations, and acute inflammations accompanied by pain. the external genital organs are swollen, discolored, or show a discharge as a result of local disease or from disease higher in the tract. the manner of urinating is sometimes of considerable diagnostic importance. painful urination is shown by frequent attempts, during which but a small quantity of urine is passed; by groaning, by constrained attitude, etc. this condition comes from inflammation of the bladder or urethra, urinary calculi (stones of the bladder or urethra), hemorrhage, tumors, bruises, etc. the urine is retained from spasms of the muscle at the neck of the bladder, from calculi, inflammatory growths, tumors, and paralysis of the bladder. the urine dribbles without control when the neck of the bladder is weakened or paralyzed. this condition is seen after the bladder is weakened from long-continued retention and where there is a partial paralysis of the hind quarters. horses usually void urine five to seven times a day, and pass from to quarts. disease may be shown by increase in the number of voidings or of the quantity. frequent urination indicates an irritable or painful condition of the bladder or urethra or that the quantity is excessive. in one form of chronic inflammation of the kidneys (interstitial nephritis) and in polyuria the quantity may be increased to or quarts daily. diminution in the quantity of urine comes from profuse sweating, diarrhea, high fever, weak heart, diseased and nonsecreting kidneys, or an obstruction to the flow. the urine of the healthy horse is a pale or at times a slightly reddish yellow. the color is less intense when the quantity is large, and is more intense when the quantity is diminished. dark-brown urine is seen in azoturia and in severe acute muscular rheumatism. a brownish-green color is seen in jaundice. red color indicates admixture of blood from a bleeding point at some part of the urinary tract, usually in the kidneys. the urine of the healthy horse is not clear and transparent. it contains mucus, which causes it to be slightly thick and stringy, and a certain amount of undissolved carbonates, causing it to be cloudy. a sediment collects when the urine is allowed to stand. the urine of the horse is normally alkaline. if it becomes acid the bodies in suspension are dissolved and the urine is made clear. the urine may be unusually cloudy from the addition of abnormal constituents, but to determine their character a chemical or microscopic examination is necessary. red or reddish flakes or clumps in the urine are always abnormal, and denote a hemorrhage or suppuration in the urinary tract. the normal specific gravity of the urine of the horse is about . . it is increased when the urine is scanty and decreased when the quantity is excessive. acid reaction of the urine occurs in chronic intestinal catarrh, in high fever, and during starvation. chemical and microscopic tests and examinations are often of great importance in diagnosis, but require special apparatus and skill. other points in the examination of a sick horse require more discussion than can be afforded in this connection, and require special training on the part of the examiner. among such points may be mentioned the examination of the organs of special sense, the examination of the blood, the microscopic examination of the secretions and excretions, bacteriological examinations of the secretions, excretions, and tissues, specific reaction tests, and diagnostic inoculation. fundamental principles of disease. by rush shippen huidekoper, m. d., vet. [revised by leonard pearson, b. s., v. m. d.] animal tissues. the nonprofessional reader may regard the animal tissues, which are subject to inflammation, as excessively simple structures, as similar, simple, and fixed in their organization as the joists and boards which frame a house, the bricks and iron coils of pipe which build a furnace, or the stones and mortar which make the support of a great railroad bridge. yet while the principles of structure are thus simple, for the general understanding by the student who begins their study the complete appreciation of the shades of variation, which differentiate one tissue from another, which define a sound tendon or a ligament from a fibrous band--the result of disease filling in an old lesion and tying one organ with another--is as complicated as the nicest jointing of chinese woodwork, the building of a furnace for the most difficult chemical analysis, or the construction of a bridge which will stand for ages and resist any force or weight. all tissues are composed of certain fundamental and similar elements which are governed by the same rules of life, though at first glance they may appear to be widely different. these are (a) amorphous substances, (b) fibers, and (c) cells. (a) amorphous substances may be in liquid form, as in the fluid of the blood, which holds a vast amount of salts and nutritive matter in solution; or they may be in a semiliquid condition, as the plasma which infiltrates the loose meshes of connective tissue and lubricates the surface of some membranes; or they may be in the form of a glue or cement, fastening one structure to another, as a tendon or muscle end to a bone; or, again, they hold similar elements firmly together, as in bone, where they form a stiff matrix which becomes impregnated with lime salts. amorphous substances, again, form the protoplasm or nutritive element of cells or the elements of life. (b) fibers are formed of elements of organic matter which have only a passive function. they can be assimilated to little strings, or cords, tangled one with another like a mass of waste yarn, woven regularly like a cloth, or bound together like a rope. they are of two kinds--white connective tissue fibers, only slightly extensible, pliable, and very strong, and yellow elastic fibers, elastic, curly, ramified, and very dense. these fibers once created require the constant presence of fluids around them in order to retain their functional condition, as a piece of harness leather demands continual oiling to keep its strength, but they undergo no change or alteration in their form until destroyed by death. (c) cells, which may even be regarded as low forms of life, are masses of protoplasm or amorphous living matter, with a nucleus and frequently a nucleolus, which are capable of assimilating nutriment or food, propagating themselves either into others of the same form or into fixed cells of another outward appearance and different function but of the same constitution. it is simply in the mode of the grouping of these elements that we have the variation in tissues, as ( ) loose connective tissue, ( ) aponeurosis and tendons, ( ) muscles, ( ) cartilage, ( ) bones, ( ) epithelia and endothelia, ( ) nerves. ( ) loose connective tissue forms the great framework, or scaffolding, of the body, and is found under the skin, between the muscles surrounding the bones and blood vessels, and entering into the structures of almost all the organs. in this the fibers are loosely meshed together like a sponge, leaving spaces in which the nutrient fluid and cells are irregularly distributed. this tissue we find in the skin, in the spaces between the organs of the body where fat accumulates, and as the framework of all glands. ( ) aponeurosis and tendons are structures which serve for the termination of muscles and for their contention, and for the attachment of bones together. in these the fibers are more frequent and dense, and are arranged with regularity, either crossing each other or lying parallel, and here the cells are found in minimum quantity. ( ) in the muscles the cells lie end to end, forming long fibers which have the power of contraction, and the connective tissue is in small quantity, serving the passive purpose of a band around the contractile elements. ( ) in cartilage a mass of firm amorphous substance, with no vascularity and little vitality, forms the bed for the chondroplasts, or cells of this tissue. ( ) bone differs from the above in having the amorphous matter impregnated with lime salts, which gives it its rigidity and firmness. ( ) epithelia and endothelia, or the membranes which cover the body and line all its cavities and glands, are made up of single or stratified and multiple layers of cells bound together by a glue of amorphous substance and resting on a layer composed of fibers. when the membrane serves for secreting or excreting purposes, as in the salivary glands or the kidneys, it is usually simple; when it serves the mechanical purpose of protecting a part, as over the tongue or skin, it is invariably multiple and stratified, the surface wearing away while new cells replace it from beneath. ( ) in nerves, stellate cells are connected by their rays to each other, or to fibers which conduct the nerve impressions, or they act as receptacles, storehouses, and transmitters for them, as the switch-board of a telephone system serves to connect the various wires. all these tissues are supplied with blood in greater or less quantity. the vascularity depends upon the function which the tissue is called upon to perform. if this is great, as in the tongue, the lungs, or the sensitive part of the hoof, a large quantity of blood is required; if the labor is a passive one, as in cartilage, the membrane over the withers, or the tendons of the legs, the vessels only reach the periphery, and nutrition is furnished by imbibition of the fluids brought to their surface by the blood vessels. blood is brought to the tissues by arterioles, or the small terminations of the arteries, and is carried off from them by the veinlets, or the commencement of the veins. between these two systems are small, delicate networks of vessels called capillaries, which subdivide into a veritable lacework so as to reach the neighborhood of every element. in health the blood passes through these capillaries with a regular current, the red cells or corpuscles floating rapidly in the fluid in the center of the channel, while the white or ameboid cells are attracted to the walls of the vessels and move very slowly. the supply of blood is regulated by the condition of repose or activity of the tissue, and under normal conditions the outflow exactly compensates the supply. the caliber of the blood vessels, and consequently the quantity of blood which they carry, is governed by nerves of the sympathetic system in a healthy body with unerring regularity, but in a diseased organ the flow may cease or be greatly augmented. in health a tissue or organ receives its proper quantity of blood; the nutritive elements are extracted for the support of the tissue and for the product, which the function of the organ forms. the force required in the achievement of this is furnished by combustion of the hydrocarbons and oxygen brought by the arterial blood, then by the veins this same fluid passes off, less its oxygen, loaded with the waste products, which are the result of the worn-out and disintegrated tissues, and of those which have undergone combustion. the foregoing brief outline indicates the process of nutrition of the tissues. hypernutrition, or excessive nutrition of a tissue, may be normal or morbid. if the latter, the tissue becomes congested or inflamed. congestion. congestion is an unnatural accumulation of blood in a part. excessive accumulation of blood may be normal, as in blushing or in the red face which temporarily follows a violent muscular effort, or, as in the stomach or liver during digestion, or in the lungs after severe work, from which, in the latter case, it is shortly relieved by a little rapid breathing. the term congestion, however, usually indicates a morbid condition, with more or less lasting effects. congestion is active or passive. the former is produced by an increased supply of blood to the part, the latter by an obstacle preventing the escape of blood from the tissue. in either case there is an increased supply of blood, and as a result increased combustion and augmented nutrition. active congestion. active congestion is caused by-- ( ) _functional activity._--any organ which is constantly or excessively used is habituated to hold an unusual quantity of blood; the vessels become dilated; if overstrained the walls become weakened, lose their elasticity, and any sudden additional quantity of blood engorges the tissues so that they can not contract, and congestion results. example: the lungs of a race horse, after an unusual burst of speed or severe work, in damp weather. ( ) _irritants._--heat and cold, chemical or mechanical. any of these, by threatening the vitality of a tissue, induce immediately an augmented flow of blood to the part to furnish the means of repair--a hot iron, frostbites, acids, or a blow. ( ) _nerve influence._--this may produce congestion either by acting on the part reflexly or as the result of some central nerve disturbance affecting the branch which supplies a given organ. ( ) _plethora and sanguinary temperament._--full-blooded animals are much more predisposed to congestive diseases than those of a lymphatic character or those in an anemic condition. the circulation in them is forced to all parts with much greater force and in large quantities. a well-bred, full-blooded horse is much more subject to congestive diseases than a common, coarse, or old, worn-out animal. ( ) _fevers._--in fever the heart works more actively and forces the current of blood more rapidly; the tissues are weakened, and it requires but a slight local cause at any part to congest the structures already overloaded with blood. again, in certain fevers, we find alteration of the blood itself, rendering it less or more fluid, which interferes with its free passage through the vessels and induces a local predisposition to congestion. ( ) _warm climate and summer heat._--warmth of the atmosphere relaxes the tissues; it demands of the animals less blood to keep up their own body temperature, and the extra quantity accumulates in the blood-vessel system. it causes sluggishness in the performance of the organic functions, and in this way it induces congestion, especially of the internal organs. so we find founders, congestive colics, and staggers more frequent in summer than in winter. ( ) _previous congestion._--whether the previous congestion of any organ has been a continuous normal one--that is, a repeated functional activity--or has been a morbid temporary overloading, it always leaves the walls of the vessels weakened and more predisposed to recurrent attacks from accidental causes than are perfectly healthy tissues. thus a horse which has had a congestion of the lungs from a severe drive is liable to have another attack from even a lesser cause. the alterations of congestion are distention of the blood vessels, accumulation of the cellular elements of the blood in them, and effusion of a portion of the liquid of the blood into the fibrous tissues which surround the vessels. when the changes produced by congestion are visible, as in the eye, the nostril, the mouth, the genital organs, and on the surface of the body in white or unpigmented animals, the part appears red from the increase of blood; it becomes swollen from the effusion of liquid into the spongelike connective tissues; it is at times more or less hot from the increased combustion; the part is frequently painful to the animal from pressure of the effusion on the nerves, and the function of the tissue is interfered with. the secretion or excretion of glands may be augmented or diminished. muscles may be affected with spasms or may be unable to contract. the eyes and ears may be affected with imaginary sights and sounds. passive congestion. passive congestion is caused by interference with the return of the current of blood from a part. old age and debility weaken the tissues and the force of the circulation, especially in the veins, and retard the movement of the blood. we then see horses of this class with stocked legs, swelling of the sheath of the penis or of the milk glands, and of the under surface of the belly. we find them also with effusions of the liquid parts of the blood into the lymph spaces of the posterior extremities and organs of the pelvic cavity. tumors or other mechanical obstructions, by pressing on the veins, retard the flow of blood and cause it to back up in distal parts of the body causing passive congestion. the alterations of passive congestion, as in active congestion, consist of an increased quantity of blood in the vessels and an exudation of its fluid into the tissues surrounding them, but in passive congestion we have a dark, thick blood which has lost its oxygen, instead of the rich, combustible blood rich in oxygen which is found in active congestion. the termination of congestion is by resolution or inflammation. in the first case, the choked-up blood vessels find an outlet for the excessive quantity of blood and are relieved; the transuded serum or fluid of the blood is reabsorbed, and the part returns almost to its normal condition, with, however, a tendency to weakness predisposing to future trouble of the same kind. in the other case further alterations take place, and we have inflammation. inflammation. (plates i and ii.) inflammation is a hypernutrition of a tissue. it is described by dr. agnew, the surgeon, as "a double-edged sword, cutting either way for good or for evil." the increased nutrition may be moderate and cause a growth of new tissue, a simple increase of quantity at first; or it may produce a new growth differing in quality; or it may be so great that, like luxuriant, overgrown weeds, the elements die from their very haste of growth, and we have immediate destruction of the part. according to the rapidity and intensity of the process of structural changes which takes place in an inflamed tissue, inflammation is described as acute or chronic, with a vast number of intermediate forms. when the phenomena are marked it is termed sthenic; when less distinct, as the result of a broken-down and feeble constitution in the animal, it is called asthenic. certain inflammations are specific, as in strangles, the horsepox, glanders, etc., where a characteristic or specific cause or condition is added to the origin, character of phenomena, or alterations which result from an ordinary inflammation. an inflammation may be circumscribed or limited, as in the abscess on the neck caused by the pressure of a collar, in pneumonia, in glanders, in the small tumors of a splint or a jack; or it may be diffuse, as in severe fistulas of the withers, in an extensive lung fever, in the legs in a case of grease, or in the spavins which affect horses with poorly nourished bones. the causes of inflammation are practically the same as those of congestion, which is the initial step of all inflammation. the temperament of a horse predisposes the animal to inflammation of certain organs. a full-blooded animal, whose veins show on the surface of the body, and which has a strong, bounding heart pumping large quantities of blood into the vascular organs like the lungs, the intestines, and the laminæ of the feet, is more liable to have pneumonia, congestive colics, and founder, than lymphatic, cold-blooded animals which have pleurisies, inflammation of the bones, spavins, ringbones, inflammation of the glands of the less vascular skin of the extremities, greasy heels, thrush, etc. [illustration: plate i. inflammation. --_uninflamed wing of the bat._ --_inflamed wing of the bat._] [illustration: plate ii. inflammation. --_non-inflamed mesentery of the frog, diameters, reduced / : a, a, venule with red and white corpuscles; b, b, gelatinous nerve fibre; c, capillary; d, d, dark-bordered nerve fibre; e, e, connective tissue with connective tissue corpuscles and leucocytes scattered sparsely through it._ --_inflamed mesentery of the frog, diameters, reduced / : a, a, venule filled with red and white corpuscles, the red in the centre and the white crowding along the walls; c, c, capillary, distended with red and white corpuscles, number of the white much decreased; d, d, connective tissue between venule and capillary filled with migrated leucocytes; e, e, connective tissue with less infiltration; f, dark-bordered nerve fibre; g, number of nuclei, in sheaths increased._] young horses have inflammation of the membranes lining the air passages and digestive tract, while older animals are more subject to troubles in the closed serous sacs and in the bones. the work to which a horse is put (saddle or harness, speed or draft) will influence the predisposition of an animal to inflammatory diseases. as in congestion, the functional activity of a part is an important factor in localizing this form of disease. given a group of horses exposed to the same draft of cold air or other exciting cause of inflammation, the one which has just been eating will be attacked with an inflammation of the bowels; the one that has just been working so as to increase its respiration will have an inflammation of the throat, bronchi, or lungs; the one that has just been using its feet excessively will have a founder or inflammation of the laminæ of the feet. the direct cause of inflammation is usually an irritant of some form. this may be a pathogenic organism--a disease germ--or it may be mechanical or chemical, external or internal. cuts, bruises, injuries of any kind, parasites, acids, blisters, heat, cold, secretions, such as an excess of tears over the cheek or urine on the legs, all cause inflammation by direct injury to the part. strains or wrenches of joints, ligaments, and tendons cause trouble by laceration of the tissue. inflammations of the internal organs are caused by irritants as above, and by sudden cooling of the surface of the animal, which drives the blood to that organ which at the moment is most actively supplied with blood. this is called repercussion. a horse which has been worked at speed and is breathing rapidly is liable to have pneumonia if suddenly chilled, while an animal which has just been fed is more liable to have a congestive colic if exposed to the same influence, the blood in this case being driven from the exterior to the intestines, while in the former it was driven to the lungs. _symptoms._--the symptoms of inflammation are, as in congestion, change of color, due to an increased supply of blood; swelling, from the same cause, with the addition of an effusion into the surrounding tissues; heat, owing to the increased combustion in the part; pain, due to pressure on the nerves, and altered function. this latter may be augmented or diminished, or first one and then the other. in addition to the local symptoms, inflammation always produces more or less constitutional disturbance or fever. a splint or small spavin will cause so little fever that it is not appreciable, while a severe spavin, an inflamed joint, or a pneumonia may give rise to a marked fever. the alterations in an inflamed tissue are first those of congestion, distention of the blood vessels, and exudation of the fluid of the blood into the surrounding fibers, with, however, a more nearly complete stagnation of the blood; fibrin, or lymph, a plastic substance, is thrown out as well, and the cells, which we have seen to be living organisms in themselves, no longer carried in the current of the blood, migrate from the vessels and, finding proper nutriment, proliferate or multiply with greater or lesser rapidity. the cells which lie dormant in the meshes of the surrounding fibers are awakened into activity by the nutritious lymph which surrounds them, and they also multiply. whether the cell in an inflamed part is the white ameboid cell of the blood or the fixed connective tissue embedded in the fibers, it multiplies in the same way. the nucleus in the center is divided into two, and then each again into two, ad infinitum. if the process is slow, each new cell may assimilate nourishment and become, like its ancestor, an aid in the formation of new tissues; if, however, the changing takes place rapidly, the brood of young cells have not time to grow or use up the surrounding nourishment, and, but half developed, they die, and we then have destruction of tissue, and pus or matter is formed, a material made up of the imperfect dead elements and the broken-down tissue. between the two there is an intermediate form, where we have imperfectly formed tissues, as in "proud flesh," large, soft splints; fungous growths, greasy heels, and thrush. whether the inflamed tissue is one like the skin, lungs, or intestines, very loose in their texture, or a tendon or bone, dense in structure, and comparatively poor in blood vessels, the principle of the process is the same. the effects, however, and the appearance may be widely different. after a cut on the face or an exudation into the lungs, the loose tissues and multiple vessels allow the proliferating cells to obtain rich nourishment; absorption can take place readily, and the part regains its normal condition entirely, while a bruise at the heel or at the withers finds a dense, inextensible tissue where the multiplying elements and exuded fluids choke up all communication, and the parts die (necrose) from want of blood and cause a serious quittor, or fistula. this effect of structure of a part on the same process shows the importance of a perfect knowledge in the study of a local trouble, and the indispensable part which such knowledge plays in judging of the gravity of an inflammatory disease, and in formulating a prognosis or opinion of the final termination of it. it is this which allows the veterinarian, through his knowledge of the intimate structure of a part and the relations of its elements, to judge of the severity of a disease, and to prescribe different modes of treatment in two animals for troubles which, to the less experienced observer, appear to be absolutely identical. _termination of inflammation._--like congestion, inflammation may terminate by resolution. in this case the exuded lymph undergoes chemical change, and the products are absorbed and carried off by the blood vessels and lymphatics, to be thrown out of the body by the kidneys, liver, the glands of the skin, and the other excretory organs. the cells, which have wandered into the neighboring tissues from the blood vessels, gradually disappear or become transformed into fixed cells. those which are the result of the tissue cells, wakened into active life, follow the same course. the vessels themselves contract, and, having resumed their normal caliber, the part apparently reassumes its normal condition; but it is always weakened, and a new inflammation is more liable to reappear in a previously inflamed part than in a sound one. the alternate termination is necrosis, or mortification. if the necrosis, or death of a part, is gradual, by small stages, each cell losing its vitality after the other in more or less rapid succession, it takes the name of ulceration. if it occurs in a considerable part at once, it is called gangrene. if this death of the tissues occurs deep in the organism, and the destroyed elements and proliferated and dead cells are inclosed in a cavity, the result of the process is called an abscess. when it occurs on a surface, it is an ulcer, and an abscess by breaking on the exterior becomes then also an ulcer. proliferating and dying cells, and the fluid which exudes from an ulcerating surface and the débris of broken-down tissue is known as pus, and the process by which this is formed is known as suppuration. a mass of dead tissue in a soft part is termed a slough, while the same in bone is called a sequestrum. such changes are especially liable to occur when the part becomes infected with microorganisms that have the property of destroying tissue and thus causing the production of pus. these are known as pyogenic microorganisms. there are also bacilli that are capable of multiplying in tissues and so irritating them as to cause them to die (necrose) without forming pus. _treatment of inflammation._--the study of the causes and pathological alterations of inflammation has shown the process to be one of hypernutrition, attended by excessive blood supply, so this study will indicate the primary factor to be employed in the treatment of it. any agent which will reduce the blood supply and prevent the excessive nutrition of the elements of the part will serve as a remedy. the means employed may be used locally to the part, or they may be constitutional remedies, which act indirectly. _local treatment._--removal of the cause will frequently allow the part to heal at once. among causes of inflammation may be mentioned a stone in the frog, causing a traumatic thrush; a badly fitting harness or saddle, causing ulcers of the skin; decomposing manure and urine in a stable, which, by their vapors, irritate the air tubes and lungs and cause a cough. motion stimulates the action of the blood, and thus feeds an inflamed tissue. this is alike applicable to a diseased point irritated by movement to an inflamed pair of lungs surcharged with blood by the use demanded of them in a working animal, or to an inflamed eye exposed to light, or an inflamed stomach and intestines still further fatigued by feed. rest, absolute quiet, a dark stable, and small quantities of easily digested feed will often cure serious inflammatory troubles without further treatment. the application of ice bags or cold water by bandages, douching with a hose, or irrigation with dripping water, contracts the blood vessels, acts as a sedative to the nerves, and lessens the vitality of a part; it consequently prevents the tissue change which inflammation produces. either dry or moist heat acts as a derivative. it quickens the circulation and renders the chemical changes more active in the surrounding parts; it softens the tissues and attracts the current of blood from the inflamed organ; it also promotes the absorption of the effusion and hastens the elimination of the waste products in the part. heat may be applied by hand rubbing or active friction and the application of warm coverings (bandages) or by cloths wrung out of warm water; or steaming with warm, moist vapor, medicated or not, will answer the same purpose. the latter is especially applicable to inflammatory troubles in the air passages. local bleeding frequently affords immediate relief by carrying off the excessive blood and draining the effusion which has already occurred. it affords direct mechanical relief, and, by a stimulation of the part, promotes the chemical changes necessary for bringing the diseased tissues to a healthy condition. local blood-letting can be done by scarifying, or making small punctures into the inflamed part, as in the eyelid of an inflamed eye, or into the sheath of the penis, or into the skin of the latter organ when congested, or the leg when acutely swelled. counterirritants are used for deep inflammations. they act by bringing the blood to the surface and consequently lessening the blood pressure within. the derivation of the blood to the exterior diminishes the amount in the internal organs and is often very rapid in its action in relieving a congested lung or liver. the most common counterirritant is mustard flour. it is applied as a soft paste mixed with warm water to the under surface of the belly and to the sides, where the skin is comparatively soft and vascular. colds in the throat or inflammations at any point demand the treatment applied in the same manner to the belly and sides and not to the throat or on the legs, as so often used. blisters, iodin, and many other irritants are used in a similar way. _constitutional treatment_ in inflammation is designed to reduce the current of blood, which is the fuel for the inflammation in the diseased part, to quiet the patient, and to combat the fever or general effects of the trouble in the system, and to favor the neutralization or elimination of the products of the inflammation. reduction of blood is obtained in various ways. the diminution of the quantity of the blood lessens the amount of pressure on the vessels, and, as a sequel, the volume of it which is carried to the point of inflammation; it diminishes the body temperature or fever; it numbs the nervous system, which plays an important part as a conductor of irritation in diseases. blood-letting is the most rapid means, and frequently acts like a charm in relieving a commencing inflammatory trouble. one must remember, however, that the strength of the body and repair depend on the blood; hence blood-letting should be practiced only in full-blooded, well-nourished animals and in the early stages of the disease. cathartics act by drawing off a large quantity of fluid from the blood through the intestines, and have the advantage over the last remedy of removing only the watery and not the formed elements from the circulation. the blood cells remain, leaving the blood as rich as it was before. again, the glands of the intestines are stimulated to excrete much waste matter and other deleterious material which may be acting as a poison in the blood. diuretics operate through the kidneys in the same way. diaphoretics aid depletion of the blood by pouring water in the form of sweat from the surface of the skin and stimulating the discharge of waste material out of its glands, which has the same effect on the blood pressure. antipyretics are remedies to reduce the temperature. this may be accomplished by depressing the center in the brain that controls heat production. some coal-tar products are very effective in this way, but they have the disadvantage of depressing the heart, which should always be kept as strong as possible. if they are used it must be with knowledge of this fact, and it is well to give heart tonics or stimulants with them. the temperature of the body may be lowered by cold packs or by showering with cold water. this is a most useful procedure in many diseases. depressants are drugs which act on the heart. they slow or weaken the action of this organ and reduce the quantity and force of the current of the blood which is carried to the point of local disease; they lessen the vitality of the animal, and for this reason are now used much less than formerly. anodynes quiet the nervous system. pain in the horse, as in the man, is one of the important factors in the production of fever, and the dulling of the former often prevents, or at least reduces, the latter. anodynes produce sleep, so as to rest the patient and allow recuperation for the succeeding struggle of the vitality of the animal against the exhausting drain of the disease. the diet of an animal suffering from acute inflammation is a factor of the greatest importance. an overloaded circulation can be starved to a reduced quantity and to a less rich quality of blood by reducing the quantity of feed given to the patient. feeds of easy digestion do not tire the already fatigued organs of an animal with a torpid digestive system. nourishment will be taken by a suffering brute in the form of slops and cooling drinks when it would be totally refused if offered in its ordinary form, as hard oats or dry hay, requiring the labor of grinding between the teeth and swallowing by the weakened muscles of the jaws and throat. tonics and stimulants are remedies which are used to meet special indications, as in the case of a feeble heart, and which enter into the after treatment of inflammatory troubles as well as into the acute stages of them. they brace up weakened and torpid glands; they stimulate the secretion of the necessary fluids of the body, and hasten the excretion of the waste material produced by the inflammatory process; they regulate the action of a weakened heart; they promote healthy vitality of diseased parts, and aid the chemical changes needed for returning the altered tissues to their normal condition. fevers. fever is a general condition of the animal body in which there is an elevation of the animal body temperature, which may be only a degree or two or may be ° f. the elevation of the body temperature, which represents tissue change or combustion, is accompanied with an acceleration of the heart's action, a quickening of the respiration, and an aberration in the functional activity of the various organs of the body. these organs may be stimulated to the performance of excessive work, or they may be incapacitated from carrying out their allotted tasks, or, in the course of a fever, the two conditions may both exist, the one succeeding the other. fever as a disease is usually preceded by chills as an essential symptom. fevers are divided into essential fevers and symptomatic fevers. in symptomatic fever some local disease, usually of an inflammatory character, develops first, and the constitutional febrile phenomena are the result of the primary point of combustion irritating the whole body, either through the nervous system or directly by means of the waste material which is carried into the circulation and through the blood vessels, and is distributed to distal parts. essential fevers are those in which there is from the outset a general disturbance of the whole economy. this may consist of an elementary alteration in the blood or a general change in the constitution of the tissues. fevers of the latter class are usually due to some infecting agent and belong, therefore, to the class of infectious diseases. essential fevers are subdivided into ephemeral fevers, which last but a short time and terminate by critical phenomena; intermittent fevers, in which there are alterations of exacerbations of the febrile symptoms and remissions, in which the body returns to its normal condition or sometimes to a depressed condition, in which the functions of life are but badly performed; and continued fevers, which include contagious diseases, such as glanders, influenza, etc., the septic diseases, such as pyemia, septicemia, etc., and the eruptive fevers, such as variola, etc. whether the cause of the fever has been an injury to the tissues, such as a severe bruise, a broken bone, an inflamed lung, or excessive work, which has surcharged the blood with the waste products of the combustion of the tissues, which were destroyed to produce force, or the toxins of influenza in the blood, or the presence of irritating material, either in the form of living organisms or of their products, as in glanders or tuberculosis--the general train of symptoms are much the same, varying as the amount of the irritant differs in quantity, or when some special quality in them has a specific action on one or another tissue. there is in fever at first a relaxation of the small blood vessels, which may have been preceded by a contraction of the same if there was a chill, and as a consequence there is an acceleration of the current of the blood. there is, then, an elevation of the peripheral temperature, followed by a lowering of tension in the arteries and an acceleration in the movement of the heart. these conditions may be produced by a primary irritation of the nerve centers of the brain from the effects of heat, as is seen in thermic fever, or sunstroke, or by the entrance into the blood stream of disease-producing organisms or their chemical products, as in anthrax, rinderpest, influenza, etc. there are times when it is difficult to distinguish between the existence of fever as a disease and a temporary feverish condition which is the result of excessive work. like the condition of congestion of the lungs, which is normal up to a certain degree in the lungs of a race horse after a severe race, and morbid when it produces more than temporary phenomena or when it causes distinct lesions, the temperature may rise from physiological causes as much as four degrees, so fever, or, as it is better termed, a feverish condition, may follow any work or other employment of energy in which excessive tissue change has taken place; but if the consequences are ephemeral, and no recognizable lesion is apparent, it is not considered morbid. this condition, however, may predispose to severe organic disturbance and local inflammations which will cause disease, as an animal in this condition is liable to take cold and develop lung fever or a severe enteritis, if chilled or otherwise exposed. fever in all animals is characterized by the same general phenomena, but we find the intensity of the symptoms modified by the species of animals affected, by the races which subdivide the species, by the families which form groups of the races, and by certain conditions in individuals themselves. for example, a pricked foot in a thoroughbred may cause intense fever, while the same injury in the foot of a clydesdale may scarcely cause a visible general symptom. in the horse, fever produces the following symptoms: the normal body temperature, which varies from ° to ° f., is elevated from ° to °. a temperature of ° or ° f. is moderate fever, ° to ° f. is high, and ° f. and over is excessive. the temperature is accurately measured by means of a clinical thermometer inserted in the rectum. this elevation of temperature can readily be felt by the hand placed in the mouth of the animal, or in the rectum, and in the cleft between the hind legs. it is usually appreciable at any point over the surface of the body and in the expired air emitted from the nostrils. the ears and cannons are often as hot as the rest of the body, but are sometimes cold, which denotes a debility in the circulation and irregular distribution of the blood. the pulse, which in a healthy horse is felt beating about to times in the minute, is increased to , , , or even . the respirations are increased from or to , , , or even more. with the commencement of a fever the horse usually has diminished appetite, or it may have total loss of appetite if the fever is excessive. there is, however, a vast difference among horses in this regard. with the same degree of elevation of temperature one horse may lose its appetite entirely, while another, usually of the more common sort, will eat at hay throughout the course of the fever, and will even continue to eat oats or other grains. thirst is usually increased, but the animal desires only a small quantity of water at a time, and in most cases of fever a bucket of water should be kept standing before the patient, which may be allowed to drink ad libitum. the skin becomes dry and the hairs stand on end. sweating is almost unknown in the early stage of fevers, but frequently occurs later in their course, when an outbreak of warm sweat is often a most favorable symptom. the mucous membranes, which are most easily examined in the conjunctivæ of the eyes and inside of the mouth, change color if the fever is an acute one; without alteration of blood the mucous membranes become of a rosy or deep-red color at the outset; if the fever is attended with distinct alteration of the blood, as in influenza, and at the end of two or three days in severe cases of pneumonia or other extensive inflammatory troubles the mucous membranes are tinged with yellow, which may even become a deep ocher in color, the result of the decomposition of the blood corpuscles and the freeing of their coloring matter, which acts as a stain. at the outset of a fever the various glands are checked in their secretions, the salivary glands fail to secrete the saliva, and we find the surface of the tongue and inside of the cheeks dry and covered with a brownish, bad-smelling deposit. the excretion from the liver and intestinal glands is diminished and produces an inactivity of the digestive organs which causes a constipation. if this is not remedied at an early period, the undigested material acts as an irritant, and later we may have it followed by an inflammatory process, producing a severe diarrhea. the excretion from the kidneys is sometimes at first entirely suppressed. it is always considerably diminished, and what urine is passed is dark in color, undergoes ammoniacal change rapidly, and deposits quantities of salts. at a later period the diminished excretion may be replaced by an excessive excretion, which aids in carrying off waste products and usually indicates an amelioration of the fever. while the ears, cannons, and hoofs of a horse suffering from fever are usually found hot, they may frequently alternate from hot to cold, or be much cooler than they normally are. this latter condition usually indicates great weakness on the part of the circulatory system. it is of the greatest importance, as an aid in diagnosing the gravity of an attack of fever and as an indication in the selection of its mode of treatment, to recognize the exact cause of a febrile condition in the horse. in certain cases, in very nervous animals, in which fever is the result of nerve influence, a simple anodyne, or even only quiet with continued care and nursing, will sometimes be sufficient to diminish it. when fever is the result of local injury, the cure of the cause produces a cessation in the constitutional symptoms. when it is the result of a pneumonia or other severe parenchymatous inflammation, it usually lasts for a definite time, and subsides with the first improvement of the local trouble, but in these cases we constantly have exacerbations of fever due to secondary inflammatory processes, such as the formation of small abscesses, the development of secondary bronchitis, or the death of a limited quantity of tissue (gangrene). in specific cases, such as influenza, strangles, and septicemia, there is a definite poison in the blood-vessel system and carried to the heart and to the nervous system, which produces a peculiar irritation, usually lasting for a specific period, during which the temperature can be but slightly diminished by any remedy. in cases attended with complications, the diagnosis at times becomes still more difficult, as at the end of a case of influenza which becomes complicated with pneumonia. the high temperature of the simple inflammatory disease may be grafted on that of the specific trouble, and the determination of the cause of the fever, as between the two, is therefore frequently a difficult matter but an important one, as upon it depends the mode of treatment. any animal suffering from fever, whatever the cause, is much more susceptible to attacks of local inflammation, which become complications of the original disease, than are animals in sound health. in fever we have the tissues and the walls of the blood vessels weakened, we have an increased current of more or less altered blood flowing through the vessels and stagnating in the capillaries, which need but an exciting cause to transform the passive congestion of fever into an active congestion and acute inflammation. these conditions become still more distinct when the fever is accompanied with a decided deterioration in the blood itself, as is seen in influenza, septicemia, and at the termination of severe pneumonias. fever, with its symptoms of increased temperature, acceleration of the pulse, acceleration of respiration, dry skin, diminished secretions, etc., must be considered as an indication of organic disturbance. this organic disturbance may be the result of local inflammation or other irritants acting through the nerves on nerve centers, alterations of the blood, in which a poison is carried to the nerve centers, or direct irritants to the nerve centers themselves, as in cases of heat stroke, injury to the brain, etc. the treatment of fever depends upon its cause. one of the important factors in treatment is absolute quiet. this may be obtained by placing a sick horse in a box stall, away from other animals and extraneous noises and sheltered from excessive light and drafts of air. anodynes, belladonna, hyoscyamus, and opium act as antipyretics simply by quieting the nervous system. as an irritant exists in the blood in most cases of fever, any remedy which will favor the excretion of foreign elements from it will diminish this cause. we therefore use diaphoretics to stimulate the sweat and excretions from the skin; diuretics to favor the elimination of matter by the kidneys; cholagogues and laxatives to increase the action of the liver and intestines, and to drain from these important organs all the waste material which is aiding to choke up and congest their rich plexuses of blood vessels. the heart becomes stimulated to increased action at the outset of a fever, but this does not indicate increased strength; on the contrary, it indicates the action of an irritant to the heart that will soon weaken it. it is, therefore, irrational further to depress the heart by the use of such drugs as aconite. it is better to strengthen it and to favor the elimination of the substance that is irritating it. the increased blood pressure throughout the body may be diminished by lessening the quantity of blood. this is obtained in some cases with advantage when the disease is but starting and the animal is plethoric by direct abstraction of blood, as in bleeding from the jugular or other veins; or by derivatives, such as mustard, turpentine, or blisters applied to the skin; or by setons, which draw to the surface the fluid of the blood, thereby lessening its volume without having the disadvantage of impoverishing the elements of the blood found in bleeding. in many cases antipyretics given by the mouth and cold applied to the skin are most useful. when the irritation which is the cause of fever is a specific one, either in the form of bacteria (living organisms), as in glanders, tuberculosis, influenza, septicemia, etc., or in the form of a foreign element, as in rheumatism, gout, hemaglobinuria, and other so-called diseases of nutrition, we employ remedies which have been found to have a direct specific action on them. among the specific remedies for various diseases are counted quinin, carbolic acid, salicylic acid, antipyrene, mercury, iodin, the empyreumatic oils, tars, resins, aromatics, sulphur, and a host of other drugs, some of which are of known effect and others of which are theoretical in action. certain remedies, like simple aromatic teas, vegetable acids, such as vinegar, lemon juice, etc., alkalines in the form of salts, sweet spirits of niter, etc., which are household remedies, are always useful, because they act on the excreting organs and ameliorate the effects of fever. other remedies, which are to be used to influence the cause of fever, must be selected with judgment and from a thorough knowledge of the nature of the disease. methods of administering medicines. by ch. b. michener, v. s. [revised by leonard pearson, b. s., v. m. d.] medicine may enter the body through any of the following designated channels: first, by the mouth; second, by the air passages; third, by the skin; fourth, by the tissue beneath the skin (hypodermic methods); fifth, by the rectum; sixth, by the genito-urinary passages; and, seventh, by the blood (intravenous injections). by the mouth.--medicines can be given by the mouth in the form of solids, as powders or pills; liquids, and pastes, or electuaries. _powders._--solids administered as powders should be as finely pulverized as possible, in order to obtain rapid solution and absorption. their action is in this way facilitated and intensified. powders must be free from any irritant or caustic action upon the mouth. those that are without any disagreeable taste or smell are readily eaten with the feed or taken in the drinking water. when placed with the feed they should first be dissolved or suspended in water and thus sprinkled on the feed. if mixed dry the horse will often leave the medicine in the bottom of his manger. nonirritant powders may be given in capsules, as balls are given. _pills, or "balls"_ when properly made, are cylindrical in shape, inches in length and about three-fourths of an inch in diameter. they should be fresh, but if necessary to keep them some time they should be made up with glycerin, or some such agent, to prevent their becoming too hard. very old, hard balls are sometimes passed whole with the manure without being acted upon at all. paper is sometimes wrapped around balls when given, if they are so sticky as to adhere to the fingers or the balling gun. paper used for this purpose should be thin but firm, as the tougher tissue papers. balls are preferred to drenches when the medicine is extremely disagreeable or nauseating; when the dose is not too large; when the horse is difficult to drench; or when the medicine is intended to act slowly. certain medicines can not or should not be made into balls, as medicines requiring to be given in large doses, oils, caustic substances, unless in small dose and diluted and thoroughly mixed with the vehicle, deliquescent, or efflorescent salts. substances suitable for balls can be made up by the addition of honey, sirup, soap, etc., when required for immediate use. gelatin capsules of different sizes are now obtainable and are a convenient means of giving medicines in ball form. when balls are to be given we should observe the following directions: in shape they should be cylindrical, of the size above mentioned, and soft enough to be easily compressed by the fingers. if made round or egg-shaped, if too long or too hard, they are liable to become fixed in the gullet and cause choking. balls may be given with the "balling gun" (obtainable at any veterinary instrument maker's) or by the hand. if given by the hand a mouth speculum or gag may be used to prevent the animal from biting the hand or crushing the ball. always loosen the horse before attempting to give a ball; if tied he may break his halter and injure himself or the one giving the ball. with a little practice it is much easier to give a ball without the mouth gag, as the horse always fights more or less against having his mouth forced open. the tongue must be firmly grasped with the left hand and gently pulled forward; the ball, slightly moistened, is then to be placed with the tips of the fingers of the right hand as far back into the mouth as possible; as the tongue is loosened it is drawn back into the mouth and carries the ball backward with it. the mouth should be kept closed for a minute or two. we should always have a pail of water at hand to offer the horse after balling. this precaution will often prevent him from coughing out the ball or its becoming lodged in the gullet. _pastes or electuaries_ are medicines mixed with licorice-root powder, ground flaxseed, molasses, or sirup to the consistency of honey, or a "soft solid." they are intended, chiefly, to act locally upon the mouth and throat. they are given by being spread upon the tongue, gums, or teeth with a wooden paddle or strong, long-handled spoon. _liquids._--it is, very often, impossible to get balls properly made, or to induce owners or attendants to attempt to give them, and for these reasons medicines by the mouth are mostly given in the form of liquids. liquids may be given as drenches when the dose is large, or they may, when but a small quantity is administered, be injected into the mouth with a hard-rubber syringe or be poured upon the tongue from a small vial. when medicine is to be given as a drench we must be careful to use water or oil enough to dissolve or dilute it thoroughly; more than this wakes the drench bulky and is unnecessary. insoluble medicines, if not irritant or corrosive, may be given simply suspended in water, the bottle to be well shaken immediately before giving the drench. the bottle used for drenching purposes should be clean, strong, and smooth about its neck; it should be without shoulders, tapering, and of a size to suit the amount to be given. a horn or tin bottle may be better, because it is not so easily broken by the teeth. if the dose is a small one the horse's head may be held up by the left hand, while the medicine is poured into the mouth by the right. the left thumb is to be placed in the angle of the lower jaw, and the fingers spread out in such manner as to support the lower lip. should the dose be large, the horse ugly, or the attendant unable to support the head as directed above, the head is then to be held up by running the tines of a long-handled wooden fork under the noseband of the halter or the halter strap or a rope may be fastened to the noseband and thrown over a limb, beam, or through a pulley suspended from the ceiling. another way of supporting the head is to place a loop in the end of a rope, and introduce this loop into the mouth just behind the upper front teeth or tusks of the upper jaw, the free end to be run through a pulley, as before described, and held by an assistant. it is never to be fastened, as the horse might in that case do himself serious injury. the head is to be elevated just enough to prevent the horse from throwing the liquid out of his mouth. the line of the face should be horizontal, or only the least bit higher. if the head is drawn too high the animal can not swallow with ease or even with safety. (if this is doubted, just fill your mouth with water, throw-back the head as far as possible, and then try to swallow.) the person giving the drench should stand on some object in order to reach the horse's mouth--on a level, or a little above it. the bottle or horn is then to be introduced at the side of the mouth, in front of the molar teeth, in an upward direction. this will cause the horse to open his mouth, when the base of the bottle is to be elevated, and about ounces of the liquid allowed to escape on the tongue as far back as possible, care being taken not to get the neck of the bottle between the back teeth. the bottle is to be immediately removed, and if the horse does not swallow this can be encouraged by rubbing the fingers or neck of the bottle against the roof of the mouth, occasionally removing them. as soon as this is swallowed repeat the operation until he has taken all the drench. if coughing occurs, or if, by any mishap, the bottle should be crushed in the mouth, lower the head immediately. do not rub, pinch, or pound the throat nor draw out the tongue when giving a drench. these processes in no way aid the horse to swallow and oftener do harm than good. in drenching, swallowing may be hastened by pouring into the nose of the horse, while the head is high, a few teaspoonfuls of clean water, but _drenches must never be given through the nose_. large quantities of medicine given by pouring into the nose are liable to strangle the animal, or, if the medicine is irritating, it sets up an inflammation of the nose, fauces, windpipe, and sometimes the lungs. by the air passages.--medicines are administered to the lungs and upper air passages by insufflation, inhalation, injection, and nasal douche. _insufflation_ consists in blowing an impalpable powder directly into the nose. it is but rarely resorted to. _inhalation._--gaseous and volatile medicines are given by inhalation, as is also medicated steam or vapor. of the gases used there may be mentioned, as the chief ones, sulphurous acid gas and, occasionally, chlorin. the animal or animals are to be placed in a tight room, where these gases are generated until the atmosphere is sufficiently impregnated with them. volatile medicines--as the anesthetics (ether, chloroform, etc.)--are to be given by the attending surgeon only. medicated vapors are to be inhaled by placing a bucket containing hot water, vinegar and water, scalded hay or bran, to which carbolic acid, iodin, compound tincture of benzoin, or other medicines have been added, in the bottom of a long grain bag. the horse's nose is to be inserted into the top of the bag, and he thus inhales the "medicated steam." care must be taken not to have it hot enough to scald the animal. the vapor from scalding bran or hay is often thus inhaled to favor discharges in sore throat or "distemper." _injections_ are made into the trachea by means of a hypodermic syringe. this method of medication is used for the purpose of treating local diseases of the trachea and upper bronchial tubes. it has also been used as a mode of administering remedies for their constitutional effect, but is now rarely used for this purpose. _the nasal douche_ is employed by the veterinarian in treating some local diseases of the nasal chambers. special appliances and professional knowledge are necessary when using liquid medicines by this method. it is not often resorted to, even by veterinary surgeons, since, as a rule, the horse objects very strongly to this mode of medication. by the skin.--medicines are often administered to our hair-covered animals by the skin, yet care must be taken in applying some medicines--as tobacco water, carbolic-acid solutions, strong creolin solutions, mercurial ointment, etc.--over the entire body, as poisoning and death follow in some instances from absorption through the skin. for the same reasons care must also be exercised and poisonous medicines not applied over very large raw or abraded surfaces. with domestic animals medicines are only to be applied by the skin to allay local pain or cure local disease. by the tissue beneath the skin (hypodermatic method).--medicines are frequently given by the hypodermic syringe under the skin. it is not safe for any but medical or veterinary practitioners to use this form of medication, since the medicines thus given are powerful poisons. there are many precautions to be observed, and a knowledge of anatomy is indispensable. one of the chief precautions has to do with the sterilization of the syringe. if it is not sterile an abscess may be produced. by the rectum.--medicines may be given by the rectum when they can not be given by the mouth, or when they are not retained in the stomach; when we want a local action on the last gut; when it is desired to destroy the small worms infesting the large bowels or to stimulate the peristaltic motion of the intestines and cause evacuation. medicines are in such cases given in the form of suppositories or as liquid injections (enemas.) foods may also be given in this way. _suppositories_ are conical bodies made up of oil of theobroma and opium (or whatever medicine is indicated in special cases), and are introduced into the rectum or vagina to allay irritation and pain of these parts. they are not much used in treating horses. _enemas_, when given for absorption, should be small in quantity, neutral or slightly acid in reaction, and of a temperature of from ° to ° f. these, like feeds given by the rectum, should be introduced only after the last bowel has been emptied by the hand or by copious injections of tepid water. enemas, or clysters, if to aid the action of physics, should be in quantities sufficient to distend the bowel and cause the animal to eject them. simple water, salt and water, or soap and water, in quantities of a gallon or more, may be given every half hour. it is best that the horse retain them for some little time, as the liquid serves to moisten the dung and favors a passage. stimulating enemas, as glycerin, should be administered after those already mentioned have emptied the last bowel, with the purpose of still further increasing the natural motion of the intestines and aiding the purging medicine. liquids may be thrown into the rectum by the means of a large syringe or a pump. a very good "irrigator" can be bought of any tinsmith at a trifling cost, and should be constantly at hand on every stock farm. it consists of a funnel about inches deep and inches in diameter, which is to be furnished with a prolongation to which a piece of rubber hose, such as small garden hose, feet long may be attached. the hose, well oiled, is to be inserted gently into the rectum about feet. the liquid to be injected may then be poured in the funnel and the pressure of the atmosphere will force it into the bowels. this appliance is better than the more complicated and expensive ones. ordinary cold water or even ice-cold water is highly recommended by many as a rectal injection for horses overcome by the excessive heat of summer, and may be given by this simple pipe. by the genito-urinary passages.--this method of medication is especially useful in treating local diseases of the genito-urinary organs. it finds its chief application in the injection and cleansing of the uterus and vagina. for this purpose a large syringe or the irrigator described above may be used. by the blood.--injections directly into veins are to be practiced by medical or veterinary practitioners only, as are probably some other means of giving medicines--intratracheal injections, etc. [illustration: plate iii. digestive apparatus. . mouth. . pharynx. . esophagus. . diaphragm. . spleen. . stomach. . duodenum. . liver, upper extremity. . large colon. . cecum. . small intestine. . floating colon. . rectum. . anus. . left kidney and its ureter. . bladder. . urethra.] diseases of the digestive organs. by ch. b. michener, v. s. [revised by john r. mohler, v. m. d.] it is not an easy task to write "a plain account of the common diseases, with directions for preventive measures, hygienic care, and the simpler forms of medical treatment," of the digestive organs of the horse. being limited as to space, the endeavor has been made to give simply an outline--to state the most important facts--leaving many gaps, and continually checking the disposition to write anything like a full description as to cause, prevention, and modes of treatment of diseases. water. it is generally held, at least in practice, that any water that stock can be induced to drink is sufficiently pure for their use. this practice occasions losses that would startle us if statistics were at hand. water that is impure from the presence of decomposing organic matter, such as is found in wells and ponds in close proximity to manure heaps and cesspools, is frequently the cause of diarrhea, dysentery, and many other diseases of stock, while water that is impregnated with different poisons and contaminated in very many instances with specific media of contagion produces death. considering first the quantity of water required by the horse, it may be stated that when our animals have access to water continually they never drink to excess. were the horse subjected to ship voyages or any other circumstances where he must depend upon his attendant for the supply of water, it may be roughly stated that he requires a daily average of about gallons of water. this varies somewhat upon the character of his feed; if upon green feed, less water will be needed than when fed upon dry hay and grain. the time of giving water should be carefully studied. at rest, the horse should receive it at least three times a day; when at work, more frequently. the rule should be to give it in small quantities and often. there is a popular fallacy that if a horse is warm he should not be allowed to drink, many asserting that the first swallow of water "founders" the animal or produces colic. this is erroneous. no matter how warm a horse may be, it is always entirely safe to allow him from six to ten swallows of water. if this is given on going into the stable, he should have at once a pound or two of hay and allowed to rest about an hour before feeding. if water is now offered him it will in many cases be refused, or at least he will drink but sparingly. the danger, then, is not in the "first swallow" of water, but is due to the excessive quantity that the animal will take when warm if he is not restrained. ice-cold water should never be given to horses. it may not be necessary to add hot water, but we should be careful in placing water troughs about our barns to have them in such position that the sun may shine upon the water during the winter mornings. water, even though it is thus cold, seldom produces serious trouble if the horse has not been deprived for a too great length of time. in reference to the purity of water, smith, in his "veterinary hygiene," classes spring water, deep-well water, and upland surface water as wholesome; stored rain water and surface water from cultivated land as suspicious; river water to which sewage gains access and shallow-well water as dangerous. the water that is used so largely for drinking purposes for stock throughout some states can not but be impure. i refer to those sections where there is an impervious clay subsoil. it is the custom to scoop, or hollow out, a large basin in the pastures. during rains these basins become filled with water. the clay subsoil, being almost impervious, acts as a jug, and there is no escape for the water except by evaporation. such water is stagnant, but would be kept comparatively fresh by subsequent rains were it not for the fact that much organic matter is carried into it by surface drainage during each succeeding storm. this organic matter soon undergoes decomposition, and, as the result, we find diseases of different kinds much more prevalent where this water is drunk than where the water supply is wholesome. again, it must not be lost sight of that stagnant surface water is much more certainly contaminated than is running water by one diseased animal of the herd, thus endangering the remainder. the chief impurities of water may be classified as organic and inorganic. the organic impurities are either animal or vegetable substances. the salts of the metals are the inorganic impurities. lime causes hardness of water, and occasion will be taken to speak of this when describing intestinal concretions. salts of lead, iron, and copper are also frequently found in water; they also will be referred to. about the only examination of water that can be made by the average stock raiser is to observe its taste, color, smell, and clearness. pure water is clear and is without taste or smell. chemical and microscopic examination will frequently be necessary in order to detect the presence of certain poisons, bacteria, etc., and can, of course, be conducted by experts only. feeds and feeding. in this place one can not attempt anything like a comprehensive discussion of the subject of feeds and feeding, and i must content myself with merely giving a few facts as to the different kinds of feed, preparation, digestibility, proper time of feeding, quality, and quantity. improper feeding and watering will doubtless account for more than one-half the digestive disorders met with in the horse, and hence the reader can not fail to see how very important it is to have some proper ideas concerning these subjects. kinds of feed. in this country horses are fed chiefly upon hay, grass, corn fodder, roots, oats, corn, wheat, and rye. many think that they could be fed on nothing else. stewart, in "the stable book," gives the following extract from loudon's encyclopedia of agriculture, which is of interest at this point: in some sterile countries they [horses] are forced to subsist on dried fish, and even on vegetable mold; in arabia, on milk, flesh balls, eggs, broth. in india horses are variously fed. the native grasses are judged very nutritious. few, perhaps no, oats are grown; barley is rare, and not commonly given to horses. in bengal a vetch, something like the tare, is used. on the western side of india a sort of pigeon pea, called gram (_cicer arietinum_), forms the ordinary food, with grass while in season, and hay all the year round. indian corn or rice is seldom given. in the west indies maize, guinea corn, sugar-corn tops, and sometimes molasses are given. in the mahratta country salt, pepper, and other spices are made into balls, with flour and butter, and these are supposed to produce animation and to fine the coat. broth made from sheep's head is sometimes given. in france, spain, and italy, besides the grasses, the leaves of limes, vines, the tops of acacia, and the seeds of the carob tree are given to horses. we can not, however, leave aside entirely here a consideration of the digestibility of feeds; and by this we mean the readiness with which they undergo those changes in the digestive canal that fit them for absorption and deposition as integral parts of the animal economy. the age and health of the animal will, of course, modify the digestibility of feeds, as will also the manner and time of harvesting, preserving, and preparing. in the horse digestion takes place principally in the intestines, and here, as in all other animals and with all feeds, it is found that a certain part only of the provender is digested; another portion is undigested. this proportion of digested and undigested feed must claim passing notice at least, for if the horse receives too much feed, or bulky feed containing much indigestible waste, a large portion of it must pass out unused, entailing not only the loss of this unused feed, but also calling for an unnecessary expenditure of vital force on the part of the digestive organs of the horse. it is thus that, in fact, too much feed may make an animal poor. in selecting feed for the horse we should remember the anatomical arrangement of the digestive organs, as well as the physiological functions performed by each one of them. feeds must be wholesome, clean, and sweet, the hours of feeding regular, the mode of preparation found by practical experience to be the best must be adhered to, and cleanliness in preparation and administration must be observed. the length of time occupied by stomach digestion in the horse varies with the different feeds. hay and straw pass out of the stomach more rapidly than oats. it would seem to follow, then, that oats should be given after hay, for if reversed the hay would cause the oats to be sent onward into the intestines before being fully acted upon by the stomach, and as a result produce indigestion. experience confirms this. there is another good reason why hay should be given first, particularly if the horse is very hungry or if exhausted from overwork, namely, it requires more time in mastication (insuring proper admixture of saliva) and can not be bolted, as are the grains. in either instance water must not be given soon after feeding, as it washes or sluices the feed from the stomach before it is fitted for intestinal digestion. the stomach begins to empty itself very soon after the commencement of feeding, and continues rapidly while eating. afterwards the passage is slower, and several hours are required before the stomach is entirely empty. the nature of the work required of the horse must guide us in the selection of his feed. rapid or severe labor can not be performed on a full stomach. for such labor feed must be given in small quantity and about two hours before going to work. even horses intended for slow work must never be engorged with bulky, innutritious feed immediately before going to labor. the small stomach of the horse would seem to lead us to the conclusion that he should be fed in small quantities and often, which, in reality, should be done. the disproportion between the size of the stomach and the quantity of water drunk tells us plainly that the horse should always be watered before feeding. one of the common errors of feeding, and the one that produces more digestive disorders than any other, is _to feed too soon after a hard day's work_. this must never be done. if a horse is completely jaded, it will be found beneficial to give him an alcoholic stimulant on going into the stable. a small quantity of hay may then be given, but his grain should be withheld for one or two hours. these same remarks will apply with equal force to the horse that for any reason has been fasting for a long time. after a fast, feed less than the horse would eat, for if allowed too much the stomach becomes engorged, its walls paralyzed, and "colic" is almost sure to follow. the horse should be fed three or four times a day. it will not do to feed him entirely upon concentrated feed. bulky feed must be given to detain the grains in their passage through the intestinal tract; bulk also favors distention, and thus mechanically aids absorption. for horses that do slow work the greater part of the time, chopped or cut hay fed with crushed oats, ground corn, etc., is the best manner of feeding, as it gives the required bulk, saves time, and half the labor of feeding. sudden changes of diet are always dangerous. when desirous of changing, do so very gradually. if a horse is accustomed to oats, a sudden change to a full meal of corn will almost always sicken him. if we merely intend to increase the quantity of the _usual_ feed, this also must be done gradually. the quantity of feed given must always be in proportion to the amount of labor to be performed. if a horse is to do a small amount of work, or rest entirely from work for a few days, he should receive a proportionate quantity of feed. if this should be observed even on saturday night and sunday, there would be fewer cases of "monday morning sickness," such as colics and lymphangitis. feeds should also be of a more laxative nature when the horse is to stand for several days. musty or moldy feeds.--above all things, avoid feeding musty or moldy feeds. they are very frequent causes of disease of different kinds. lung trouble, such as bronchitis and "heaves," often follows their use. the digestive organs always suffer from moldy or musty feeds. musty hay is generally considered to produce disorder of the kidneys, and all know of the danger from feeding pregnant animals upon ergotized grasses or grains. it has often been said to produce that peculiar disease known variously as cerebrospinal meningitis, putrid sore throat, or choking distemper. hay.--the best hay for horses is timothy. it should be about one year old, of a greenish color, crisp, clean, fresh, and possessing a sweet, pleasant aroma. even this good hay, if kept too long, loses part of its nourishment, and, while it may not be positively injurious, it is hard, dry, and indigestible. new hay is difficult to digest, produces much salivation (slobbering), and occasional purging and irritation of the skin. if fed at all it should be mixed with old hay. _second crop, or aftermath._--this is not considered good hay for horses, but it is prized by some farmers as good for milch cows, the claim being made that it increases the flow of milk. the value of hay depends upon the time of cutting, as well as care in the curing. hay should be cut when in full flower, but before the seeds fall; if left longer it becomes dry, woody, and lacks in nutrition. an essential point in making hay is that when the crop is cut it should remain in the field as short a time as possible. if left too long in the sun it loses color, flavor, and dries or wastes. smith asserts that one hour more than is necessary in the sun causes a loss of to per cent in the feeding value of hay. it is impossible to state any fixed time that hay must have to cure, this depending, of course, upon the weather, thickness of the crop, and many other circumstances; but it is well known that in order to preserve the color and aroma of hay it should be turned or tedded frequently and cured as quickly as possible. on the other hand, hay spoils in the mow if harvested too green or when not sufficiently dried. mow-burnt hay produces disorder of the kidneys and bowels and causes the horse to fall off in condition. the average horse on grain should be allowed from to pounds of good hay a day. it is a mistake of many to think that horses at light work can be kept entirely on hay. such horses soon become potbellied, fall off in flesh, and do not thrive. the same is true of colts; unless the latter are fed with some grain they grow up to be long, lean, gawky creatures, and never make so good horses as those accustomed to grain with, or in addition to, their hay. straw.--the straws are not extensively fed in this country, and when used at all they should be cut and mixed with hay and ground or crushed grain. wheat, rye, and oat straw are the ones most used; of these, oat straw is most easily digested and contains the most nourishment. pea and bean straw are occasionally fed to horses, the pea being preferable, according to most writers. chaff.--wheat and rye chaff should never be used as a feed for horses. the beards frequently become lodged in the mouth or throat and are productive of more or less serious trouble. in the stomach and intestines they often serve as the nucleus of the "soft concretions," which are to be described when treating of obstructions of the digestive tract. oat chaff, if fed in small quantities and mixed with cut hay or corn fodder, is very much relished by horses. it is not to be given in large quantities, as i have repeatedly witnessed a troublesome and sometimes fatal diarrhea following the practice of allowing horses or cattle free access to a pile of oat chaff. grains.--oats take precedence of all grains as a feed for horses, as the ingredients necessary for the complete nutrition of the body exist in them in the best proportions. oats are, besides, more easily digested and a larger proportion absorbed and converted into the various tissues of the body. care must be taken in selecting oats. according to stewart, the best oats are one year old, plump, short, hard, clean, bright, and sweet. new oats are indigestible. kiln-dried oats are to be refused, as a rule, for even though originally good this drying process injures them. oats that have sprouted or fermented are injurious and should never be fed. oats are to be given either whole or crushed--whole in the majority of instances; crushed to old horses and those having defective teeth. horses that bolt their feed are also best fed upon crushed oats and out of a manger large enough to permit of spreading the grain in a thin layer. in addition to the allowance of hay above mentioned, the average horse requires about quarts of good oats daily. the best oats are those cut about one week before they are fully ripe. not only is the grain richer in nutritive materials at this time, but there is also less waste from "scattering" than if left to become dead ripe. moldy oats, like hay and straw, not only produce serious digestive disorders but have been the undoubted cause of outbreaks of that dread disease in horses, already referred to, characterized by inability to eat or drink, sudden paralysis, and death. wheat and rye.--these grains are not to be used for horses except in small quantities, bruised or crushed, and fed mixed with other grains or hay. if fed alone, in any considerable quantities, they are almost certain to produce digestive disorders, laminitis (founder), and similar troubles. they should never constitute more than one-fourth the grain allowance, and should always be ground or crushed. bran.--the bran of wheat is the one most used, and its value as a feeding stuff is variously estimated. it is not to be depended upon if given alone, but may be fed with other grains. it serves to keep the bowels open. sour bran is not to be given, for it disorders the stomach and intestines and may even produce serious results. maize (corn).--this grain is not suitable as an exclusive feed for young horses, as it is deficient in salts. it is fed whole or ground. corn on the cob is commonly used for horses affected with "lampas." if the corn is old and is to be fed in this manner it should be soaked in pure, clean water for or hours. corn is better given ground, and fed in quantities of from to quarts at a meal, mixed with crushed oats or wheat bran. great care should be taken in giving corn to a horse that is not accustomed to its use. it must be commenced in small quantities and very gradually increased. i know of no grain more liable to produce what is called acute indigestion than corn if these directions are not observed. linseed.--ground linseed is occasionally fed with other feeds to keep the bowels open and to improve the condition of the skin. it is of particular service during convalescence, when the bowels are sluggish in their action. linseed tea is very often given in irritable or inflamed conditions of the digestive organs. potatoes.--these are used as an article of feed for the horse in many sections. if fed raw and in large quantities they often produce indigestion. their digestibility is increased by steaming or boiling. they possess, in common with other roots, slight laxative properties. beets.--these are not much used as feed for horses. carrots.--these make a most excellent feed, particularly during sickness. they improve the appetite and slightly increase the action of the bowels and kidneys. they possess also certain alterative properties, making the coat smooth and glossy. some veterinary writers assert that chronic cough is cured by giving carrots for some time. the roots may be considered, then, as an adjunct to the regular regimen, and if fed in small quantities are highly beneficial. grasses.--grass is the natural food of horses. it is composed of a great variety of plants, differing widely as to the amount of nourishment contained, some being almost entirely without value and only eaten when nothing else is obtainable, while others are positively injurious, or even poisonous. none of the grasses are sufficient to keep the horse in condition for work. horses thus fed are "soft," sweat easily, purge, and soon tire on the road or when at hard work. grass is indispensable to growing stock, and there is little or no doubt that it acts as an alterative when given to horses accustomed to grain and hay. it must be given to such horses in small quantities at first. the stomach and intestines undergo rest, and recuperate if the horse is turned to grass for a time each year. it is also certain that during febrile diseases grass acts almost as a medicine, lessening the fever and favoring recovery. wounds heal more rapidly than when the horse is on grain, and some chronic disorders (chronic cough, for instance) disappear entirely when at grass. in my experience, grass does more good when the horse crops it himself. this may be due to the sense of freedom he enjoys at pasture, to the rest to his feet and limbs, and for many other similar reasons. when cut for him it should be fed fresh or when but slightly wilted. silage.--regarding silage as a feed for horses, rommel in farmers' bulletin writes as follows: silage has not been generally fed to horses, partly on account of a certain amount of danger which attends its use for this purpose, but still more, perhaps, on account of prejudice. in many cases horses have been killed by eating moldy silage, and the careless person who fed it at once blamed the silage itself, rather than his own carelessness and the mold which really was the cause of the trouble. horses are peculiarly susceptible to the effects of molds, and under certain conditions certain molds grow on silage which are deadly poisons to both horses and mules. molds must have air to grow, and therefore silage which is packed air-tight and fed out rapidly will not become moldy. if the feeder watches the silage carefully as the weather warms up he can soon detect the presence of mold. when mold appears, feeding to horses or mules should stop immediately. it is also unsafe to feed horses frozen silage on account of the danger of colic. * * * to summarize, silage is safe to feed to horses and mules only when it is made from fairly mature corn, properly stored in the silo. when it is properly stored and is not allowed to mold, no feed exceeds it as a cheap winter ration. it is most valuable for horses and mules which are not at heavy work, such as brood mares and work horses during the slack season. with plenty of grain on the cornstalks, horses will keep in good condition on a ration of pounds of silage and pounds of hay for each , pounds of live weight. preparation of feeds. feed is prepared for any of the following reasons: to render it more easily eaten; to make it more digestible; to economize in amount; to give it some new property; and to preserve it. we have already spoken of the preparation of drying, and need not revert to this again, as it only serves to preserve the different feeds. drying does, however, change some of the properties of feed, _i. e._, removes the laxative tendency of most of them. the different grains are more easily eaten when ground, crushed, or even boiled. rye or wheat should never be given whole, and even of corn it is found that there is less waste when ground, and, in common with all other grains, it is more easily digested than when fed whole. hay and fodder are economized when cut in short pieces. not only will the horse eat the necessary quantity in a shorter time, but it will be found that there is less waste, and the mastication of the grains (whole or crushed) fed with them is insured. reference has already been made to those horses that bolt their feed, and we need only remark here that the consequences of such ravenous eating may be prevented if the grains are fed with cut hay, straw, or fodder. long or uncut hay should also be fed, even though a certain quantity of hay or straw is cut and fed mixed with grain. one objection to feeding cut hay mixed with ground or crushed grains, and wetted, must not be overlooked during the hot months. such feed is liable to undergo fermentation if not fed directly after it is mixed; even the mixing trough, unless frequently scalded and cleaned, becomes sour and enough of its scrapings are given with the feed to produce flatulent (wind) colic. a small quantity of salt should always be mixed with such feed. bad hay should never be cut simply because it insures a greater consumption of it; bad feeds are dear at any price, and should never be fed. the advantage of boiling roots has been mentioned. not only does this render them less liable to produce digestive disorders, but it also makes them clean. boiling or steaming grains is to be recommended when the teeth are poor, or when the digestive organs are weak. diseases of the teeth. _dentition._--this covers the period during which the young horse is cutting his teeth--from birth to the age of years. with the horse more difficulty is experienced in cutting the second or permanent teeth than with the first or milk teeth. there is a tendency among farmers and many veterinarians to pay too little attention to the teeth of young horses. percivall relates an instance illustrative of this that is best told in his own words: i was requested to give my opinion concerning a horse, then in his fifth year, who had fed so sparingly for the last fortnight, and so rapidly declined in condition in consequence, that his owner, a veterinary surgeon, was under no light apprehensions about his life. he had himself examined his mouth without having discovered any defect or disease, though another veterinary surgeon was of opinion that the difficulty or inability manifested in mastication, and the consequent cudding, arose from preternatural bluntness of the surfaces of the molar teeth, which were, in consequence, filed, but without beneficial result. it was after this that i saw the horse, and i confess i was, at my first examination, quite as much at a loss to offer any satisfactory interpretation as others had been. while meditating, however, after my inspection, on the apparently extraordinary nature of the case, it struck me that i had not seen the tusks. i went back into the stable and discovered two little tumors, red and hard, in the situation of the inferior tusks, which, when pressed, gave the animal insufferable pain. i instantly took out my pocketknife and made crucial incisions through them both, down to the coming teeth, from which moment the horse recovered his appetite and, by degrees, his wonted condition. the mouths of young horses should be examined from time to time to see whether one or more of the milk teeth are not remaining too long, causing the second teeth to grow in crooked, in which case the first teeth should be removed with the forceps. _irregularities of teeth._--there is a fashion of late years, especially in large cities, to have horses' teeth regularly "floated," or "rasped," by "veterinary dentists." in some instances this is very beneficial, while in most cases it is entirely unnecessary. from the character of the feed, the rubbing, or grinding, surface of the horse's teeth should be rough. still, we must remember that the upper jaw is somewhat wider than the lower, and that, from the fact of the teeth not being perfectly apposed, a sharp ridge is left unworn on the inside of the lower molars and on the outside of the upper, which may excoriate the tongue or cheeks to a considerable extent. this condition may readily be felt by the hand, and these sharp ridges when found should be rasped down by a guarded rasp. in some instances the first or last molar tooth is unnaturally long, owing to the fact that its fellow in the opposite jaw has been lost or does not close perfectly against it. should it be the last molar that is thus elongated, it will require the aid of the veterinary surgeon, who has the necessary forceps or chisel for cutting it. the front molar may be rasped down, if much patience is taken. in decay of the teeth it is quite common to find the tooth corresponding to the decayed one on the opposite jaw very much elongated, sometimes to such an extent that the mouth can not be perfectly closed. such teeth must also be shortened by the tooth forceps, chisel, tooth saw, or rasp. in all instances in which horses "quid" their feed, if they are slobbering, or evince pain in mastication, shown by holding the head to one side while chewing, the teeth should be carefully examined. horses whose teeth have unduly sharp edges are liable to drive badly; they pull to one side, do not bear on the bit, or bear on too hard and "big," toss the head, and start suddenly when a tender spot is touched. if, as is mostly the case, all the symptoms are referable to sharp corners or projections, these must be removed by the rasp. if decayed teeth ere found, or other serious difficulty detected, or if the cause of the annoying symptoms is not discovered, an expert should be called. [illustration: plate iv. age of horses as indicated by teeth. longitudinal section of left central lower incisor and cross sections of same tooth showing table surfaces as they appear at the ages of , , , , , and years. _c_, cement; _d_, dentine; _e_, enamel; _i_, infundibulum; _k_, cup; _p_, pulp cavity; _s_, star.] _toothache._--this is rare in the horse and is mostly witnessed when there is decay of a tooth or inflammation about its root. toothache is to be discovered in the horse by the pain expressed by him while feeding or drinking cold water. i have seen horses, affected with toothache, that would suddenly stop chewing, throw the head to one side, and slightly open the mouth. they behave as though some sharp body had punctured the mouth. if upon examination, no foreign body is found, we must then carefully examine each tooth. if this can not be done with the hand in the mouth, we can, in most instances, discover the aching tooth by pressing each tooth from without. by tapping the teeth in succession with a hard object, such as a small hammer, the one that is tender may be identified. the horse will flinch when the sore tooth is pressed or tapped upon. in most cases there is nothing to be done but extract the decayed tooth, and this, of course, is to be attempted by the veterinarian only. _deformity._--there is a deformity, known as parrot-mouth, that interferes with prehension, mastication, and, indirectly, with digestion. the upper incisors project in front of and beyond the lower ones. the teeth of both jaws become unusually long, as they are not worn down by friction. such horses experience much difficulty in grazing. little can be done except to examine the teeth occasionally, and if those of the lower jaw become so long that they bruise the "bars" of the upper jaw, they must be shortened by the rasp or saw. horses with this deformity should never be left entirely at pasture. the method of determining the age of a horse by the teeth is illustrated in plate iv. diseases of the mouth. lampas. lampas is the name given to a swelling of the mucous membrane covering the hard palate and projecting in a more or less prominent ridge immediately behind the upper incisors. the hard palate is composed of spongy tissue that fills with blood when the horse is feeding, which causes the ridges to become prominent, and they then help to keep feed from dropping from the mouth. this swelling is entirely natural and occurs in every healthy horse. where there is some irritation in the mouth, as in stomatitis or during teething, the prominence of the hard palate may persist, owing to the increased blood supply. in such cases the cause of the irritation should be nought for and removed. by way of direct treatment, slight scarification is the most that will be required. burning the lampas is barbarous and injurious, and it should never be tolerated. it is a quite common opinion among owners of horses and stablemen that lampas is a disease that very frequently exists. in fact whenever a horse fails to eat, and if he does not exhibit very marked symptoms of a severe illness, they say at once "he has the lampas." it is almost impossible to convince them to the contrary; yet it is not the case. it may be put down, then, as an affliction of the stable-man's imagination rather than of the horse's mouth. stomatitis. stomatitis is an inflammation of the mucous membrane lining the mouth and is produced by irritating medicines, feeds, or other substances. the symptoms are swelling of the mouth, which is also hot and painful to the touch; there is a copious discharge of saliva; the mucous membrane is reddened, and in some cases vesicles or ulcers in the mouth are observed. the treatment is simple, soft feed alone often being all that is necessary. a bucket of fresh, cold water should be kept constantly in the manger so that the horse may drink or rinse his mouth at will. in some instances, it may be advisable to use a wash of chlorate of potash, borax, or alum, about one-half ounce to a pint of water. hay, straw, or oats should not be fed unless steamed or boiled. a form of contagious stomatitis, characterized by the formation within the mouth of small vesicles, or blisters, sometimes occurs. in this disease the horse should be isolated from other horses, and his stall, especially the feed box, and his bit should be disinfected. glossitis (inflammation of the tongue). glossitis, or inflammation of the tongue, is very similar to stomatitis, and mostly exists with it and is due to the same causes. injuries to the tongue may produce this simple inflammation of its covering membrane, or, if severe, may produce lesions much more extensive, such as lacerations, abscesses, etc. these latter would require surgical treatment, but for the simpler forms of inflammation of the tongue the treatment recommended for stomatitis should be followed. salivation (ptyalism). ptyalism, or salivation, consists in an abnormal and excessive secretion of saliva. this is often seen as a symptom of irregular teeth; inflammation of the mouth or tongue, or of the use of such medicines as lobelia, mercury, and many others. some feeds, such as clover, and particularly second crop, produce it; foreign bodies, such as nails, wheat chaff, and corncobs becoming lodged in the mouth, also are causes. if the cause is removed no further attention is necessary, as a rule. astringent washes may be applied to the mouth as a gargle or by means of a sponge. pharyngitis. pharyngitis is an inflammation of the mucous membrane lining of the pharynx or throat. it rarely exists unless accompanied with stomatitis or laryngitis, especially the latter. in those rare instances in which the inflammation is mostly confined to the pharynx are noticed febrile symptoms--difficulty of swallowing either liquids or solids; there is but little cough except when trying to swallow; there is no soreness on pressure over larynx (head of the windpipe). increased flow of saliva, difficulty of swallowing liquids in particular, and cough only when attempting to swallow, are the symptoms best marked in pharyngitis. in some cases the throat becomes gangrenous and the disease ends in death. for treatment a wet sheet should be wrapped around the throat and covered with rubber sheeting and a warm blanket. this should be changed three times daily; or the region of the throat may be rubbed with mercurial ointment twice daily until the skin becomes irritated, but no longer; chlorate of potash may be given in -dram doses four times daily, mixed with flaxseed meal or licorice-root powder and honey, as an electuary. soft feeds should be given, and fresh water should be constantly before the horse. paralysis of the pharynx. paralysis of the pharynx, or, as it is commonly called, "paralysis of the throat," is a rare but very serious disease. the symptoms are as follows: the horse will constantly try to eat or drink, but will be unable to do so; if water is offered him from a pail he will apparently drink with avidity, but the quantity of water in the pail will remain about the same; he will continue by the hour to try to drink; if he can get any fluid into the back part of the mouth it will come out at once through the nose. feeds also return through the nose, or are dropped from the mouth, quidded. an examination of the mouth by inserting the hand fails to find any obstruction or any abnormal condition. these cases go on from bad to worse; the horse constantly and rapidly loses in condition, becomes very much emaciated, the eyes are hollow and lusterless, and death occurs from inanition. treatment is very unsatisfactory. a severe blister should be applied behind and under the jaw; the mouth is to be frequently swabbed out with alum or chlorate of potash, ounce to a pint of water, by means of a sponge fastened to the end of a stick. strychnia may be given in -grain doses two or three times a day. this disease may be mistaken at times for foreign bodies in the mouth or for the so-called cerebrospinal meningitis. it is to be distinguished from the former, upon a careful examination of the mouth, by the absence of any offending body and by the flabby feel of the mouth, and from the latter by the animal appearing in perfect health in every particular except this inability to eat or drink. abscesses. abscesses sometimes form back of the pharynx and give rise to symptoms resembling those of laryngitis or distemper. interference with breathing that is of recent origin and progression, without any observable swelling or soreness about the throat, will make one suspect the formation of an abscess in this location. but little can be done in the way of treatment, save to hurry the ripening of the abscess and its discharge by steaming with hops, hay, or similar substances and by poulticing the throat. the operation for opening an abscess in this region necessitates an intimate knowledge of the complex anatomy of the throat region. diseases of the esophagus or gullet. it is rare to find diseases of this organ, except as a result of the introduction of foreign bodies too large to pass or to the administering of irritating medicines. in the administration of irritant or caustic medicines great care should be taken that they be thoroughly diluted. if this is not done, erosions and ulcerations of the throat ensue, and this again is prone to be followed by constriction (narrowing) of the gullet. choking. the mechanical trouble of choking is quite common. it may occur when the animal is suddenly startled while eating apples or roots, and we should be careful never to approach suddenly or put a dog after horses or cows that are feeding upon such substances. if left alone these animals very rarely attempt to swallow the object until it is sufficiently masticated. choking also arises from feeding oats in a deep, narrow manger to such horses as eat very greedily or bolt their feed. wheat chaff is also a frequent cause of choke. this accident may result from the attempts to force eggs down without breaking or from giving balls that are too large or not of the proper shape. whatever object causes the choking, it may lodge in the upper part of the esophagus, at its middle portion, or close to the stomach, giving rise to the designations of pharyngeal, cervical, and thoracic choke. in some cases where the original obstruction is low we find all that part of the gullet above it to be distended with feed. _symptoms._--the symptoms vary somewhat according to the position of the body causing choke. in pharyngeal choke the object is lodged in the upper portion of the esophagus. the horse will present symptoms of great distress, hurried breathing, frequent cough, excessive flow of saliva, sweating, trembling, or stamping with the fore feet. the abdomen rapidly distends with gas. the diagnosis is completed by manipulating the upper part of the throat from without and by the introduction of the hand into the back part of the mouth, finding the body lodged here. in cervical choke (where the obstruction is situated at any point between the throatlatch and the shoulder) the protrusion caused by the object can be seen and the object can be felt. the symptoms here are not so severe; the horse will be seen occasionally to draw himself up, arch his neck, and make retching movements as though he wished to vomit. the abdomen may be tympanitic. should there be any question as to the trouble, a conclusion may be reached by pouring water into the throat from a bottle. if the obstruction is complete, by standing on the left side of the horse and watching the course of the esophagus, you can see the gullet, just above the windpipe, become distended with each bottle of water. this is not always a sure test, as the obstruction may be an angular body, in which case liquids would pass it. solids taken would show in these cases; solids should not, however, be given, as they serve to increase the trouble by rendering the removal of the body more difficult. in thoracic choke the symptoms are less severe. feed or water may be ejected through the nose or mouth after the animal has taken a few swallows. there will be some symptoms of distress, fullness of the abdomen, cough, and occasionally retching movements. sometimes a choking horse is heard to emit groans. the facial expression always denotes great anxiety and the eyes are bloodshot. the diagnosis is complete if, upon passing the probang (a flexible tube made for this purpose), an obstruction is encountered. _treatment._--if the choke is at the beginning of the gullet (pharyngeal) an effort must be made to remove the obstacle through the mouth. a mouthgag, or speculum, is to be introduced into the mouth to protect the hand and arm of the operator. then, while an assistant, with his hands grasped tightly _behind_ the object, presses it upward and forward with all his force, the operator must pass his hand into the mouth until he can seize the obstruction and draw it outward. this mode of procedure must not be abandoned with the first failure, as by continued efforts we may get the obstacle farther toward the mouth. if we fail with the hand, forceps may be introduced through the mouth and the object seized when it is just beyond the reach of the fingers. should our efforts entirely fail, we must then endeavor to force the obstruction downward by means of the probang. this instrument, which is of such signal service in removing choke in cattle, is decidedly more dangerous to use for the horse, and i can not pass this point without a word of caution to those who have been known to introduce into the horse's throat such objects as whipstalks, shovel handles, etc. these are always dangerous, and more than one horse has been killed by such barbarous treatment. in cervical as well as in thoracic choke we must first of all endeavor to soften or lubricate the obstruction by pouring oil or mucilaginous drinks down the gullet. after this has been done endeavor to move the object by gentle manipulations with the hands. if choked with oats or chaff (and these are the objects that most frequently produce choke in the horse), begin by gently squeezing the lower portion of the impacted mass and endeavor to work it loose a little at a time. this is greatly favored at times if we apply hot fomentations immediately about the obstruction. persist in these efforts for at least an hour before deciding to resort to other and more dangerous modes of treatment. if unsuccessful, however, the probang may be used. in the absence of the regular instrument, a piece of inch hose feet long or a piece of new three-quarter-inch manila rope well wrapped at the end with cotton twine and thoroughly greased with tallow should be used. the mouth is to be kept open by a gag of wood or iron and the head slightly raised and extended. the probang is then to be carefully guided by the hand into the upper part of the gullet and gently forced downward until the obstruction is reached. pressure must then be gradual and firm. at first too much force should not be used, or the esophagus will be ruptured. firm, gentle pressure should be kept up until the object is felt to move, after which it should be followed rapidly to the stomach. if this mode of treatment is unsuccessful, a veterinarian or a physician should be called, who can remove the object by cutting down upon it. this should scarcely be attempted by a novice, as a knowledge of the anatomy of the parts is essential to avoid cutting the large artery, vein, and nerve that are closely related to the esophagus in its cervical portion. thoracic choke can be treated only by means of the introduction of oils and mucilaginous drinks and the careful use of the probang. stricture of the esophagus. this is due to corrosive medicines, previous choking (accompanied with lacerations, which, in healing, narrow the passage), or pressure on the gullet by tumors. in the majority of cases of stricture, dilatation of the gullet in front of the constricted portion soon occurs. this dilatation is the result of the frequent accumulation of solid feed above the constriction. little can be done in either of these instances except to give sloppy or liquid feed. sacular dilatation of the esophagus. this follows choking, and is due to stretching or rupture of the muscular coat of the gullet, allowing the internal, or mucous, coat to protrude through the lacerated muscular walls. such a dilatation, or pouch, may gradually enlarge from the frequent imprisonment of feed. when liquids are taken, the solid materials are partially washed out of the pouch. the symptoms are as follows: the horse is able to swallow a few mouthfuls without apparent difficulty; then he will stop feeding, paw, contract the muscles of his neck, and eject a portion of the feed through his nose or mouth, or it will gradually work down to the stomach. as the dilatation thus empties itself the symptoms gradually subside, only to reappear when he has again taken solid feed. liquids pass without any, or but little, inconvenience. should this dilatation exist in the cervical region, surgical interference may sometimes prove effectual; if in the thoracic portion, nothing can be done, and the patient rapidly passes from hand to hand by "swapping," until, at no distant date, the contents of the sac become too firm to be dislodged as heretofore, and the animal succumbs. diseases of the stomach and intestines. as a rule it is most difficult to distinguish between diseases of the stomach and of the intestines of the horse. the reason for this is that the stomach is relatively small. it lies away from the abdominal wall, and so pressure from without can not be brought to bear upon it to reveal sensitiveness or pain. nor does enlargement, or distention, of the stomach produce visible alteration in the form of the abdomen of the horse. moreover, it is a rule to which there are few exceptions, that an irritant or cause of disease of the stomach acts likewise upon the intestines, so that it is customary to find them similarly deranged. for these reasons it is logical to discuss together the diseases of the stomach and intestines and to point out such localizations in one organ or another as are of importance in recognizing and treating the diseases of the digestive organs of the horse. it should be understood that gastritis signifies an inflammation of the stomach and enteritis an inflammation of the intestines. the two terms may be used together to signify a disease of the stomach and intestines, as gastro-enteritis. colic. the disease of the horse that is most frequently met with is what is termed "colic," and many are the remedies that are reputed to be "sure cures" for this disease. let us discover, then, what the word "colic" means. this term is applied loosely to almost all diseases of the organs of the abdomen that are accompanied with pain. if the horse evinces abdominal pain, he probably will be considered as suffering with colic, no matter whether the difficulty is a cramp of the bowel, an internal hernia, overloading of the stomach, or a painful disease of the bladder or liver. since these conditions differ so much in their causation and their nature, it is manifestly absurd to treat them alike and to expect the same drugs or procedures to relieve them all. therefore, it is important that, so far as possible, the various diseased states that are so roughly classed together as colic shall be separated and individualized in order that appropriate treatments may be prescribed. with this object in view, colics will be considered under the following headings: ( ) engorgement colic, ( ) obstruction colic, ( ) flatulent or tympanitic colic, ( ) spasmodic colic. worm colic is discussed under the heading "gastrointestinal parasites," page . the general symptoms of abdominal pain, and therefore of colic, are restlessness, cessation of whatever the horse is about, lying down, looking around toward the flank, kicking with the hind feet upward and forward toward the belly, jerky switching of the tail, stretching as though to urinate, frequent change of position, and groaning. in the more intense forms the horse plunges about, throws himself, rolls, assumes unnatural positions, as sitting on the haunches, and grunts loudly. usually the pain is not constant, and during the intermissions the horse may eat and appear normal. during the period of pain sweat is poured out freely. sometimes the horse moves constantly in a circle. the respirations are accelerated, and usually there is no fever. engorgement colic.--this form of colic consists in an overloading of the stomach with feed. the horse may have been overfed or the feed may have collected in the stomach through failure of this organ to digest it and pass it backward into the intestines. even a normal quantity of feed that the horse is unaccustomed to may cause disease. hence a sudden change of feed may produce engorgement colic. continued full rations while the horse is resting for a day or two or working too soon after feeding may serve as a cause. new oats, corn, or hay, damaged feed, or that which is difficult of digestion, such as barley or beans, may incite engorgement colic. this disease may result from having fed the horse twice by error or from its having escaped and taken an unrestricted meal from the grain bin. ground feeds that pack together, making a sort of dough, may cause engorgement colic if they are not mixed with cut hay. greedy eaters are predisposed to this disease. _symptoms._--the horse shows the general signs of abdominal pain, which may be long continued or of short duration. retching or vomiting movements are made; these are shown by labored breathing, upturned upper lip, contraction of the flank, active motion at the throat, and drawing in of the nose toward the breast, causing high arching of the neck. the horse may assume a sitting position like a dog. at times the pain is very great and the horse makes the most violent movements, as though mad. at other times there is profound mental depression, the horse standing in a sleepy, or dazed, way, with the head down, the eyes closed, and leaning his head against the manger or wall. there is, during the struggles, profuse perspiration. following retching, gas may escape from the mouth, and this may be followed by a sour froth and some stomach contents. the horse can not vomit except when the stomach is violently stretched, and, if the accumulation of feed or gas is great enough to stretch the stomach so that vomiting is possible, it may be great enough to rupture that organ. so it happens not infrequently that a horse dies from ruptured stomach after vomiting. after the stomach ruptures, however, vomiting is impossible. the death rate in this form of colic is high. _treatment._--the bowels should be stimulated to contraction by the use of clysters of large quantities of water and of glycerin. veterinarians use hypodermic injections of eserin or arecolin or intravenous injections of barium chlorid, but they must be employed with great caution. it is not profitable to give remedies by the stomach, for they can not be absorbed. but small doses of morphin ( grains) or of the fluid extract of indian hemp ( drams) may be placed in the mouth and are absorbed in part, at least, without passing to the stomach. these drugs lessen pain and thus help to overcome the violent movements that are dangerous, because they may be the means of causing rupture of the diaphragm or stomach. if facilities are available, relief may be afforded by passing an esophageal tube through which some of the gaseous and liquid contents of the stomach may escape. _rupture of the stomach._--this mostly occurs as a result of engorged or tympanitic stomach (engorgement colic) and from the horse violently throwing himself when so affected. it may result from disease of the coats of the stomach, gastritis, stones (calculi), tumors, or anything that closes the opening of the stomach into the intestines, and very violent pulling or jumping immediately after the animal has eaten heartily of bulky feed. these or similar causes may lead this accident. the symptoms of rupture of the stomach are not constant or always reliable. always make inquiry as to what and how much the horse has been fed at the last meal. vomiting may precede rupture of this organ, as stated above. this accident appears to be most liable to occur in heavy draft horses. a prominent symptom observed (though it may also occur in diaphragmatic hernia) is when the horse, if possible, gets the front feet on higher ground than the hind ones or sits on his haunches, like a dog. this position affords relief to some extent, and it will be maintained for several minutes; it is also quickly regained when the horse has changed it for some other. colicky symptoms, of course, are present, which vary much and present no diagnostic value. as the case progresses the horse will often stretch forward the fore legs, lean backward and downward until the belly nearly touches the ground, and then rise up again with a groan, after which the fluid from his nostrils is issued in increased quantity. the pulse is fast and weak, breathing hurried, body bathed in a clammy sweat, limbs tremble violently, the horse reels or staggers from side to side, and death quickly ends the scene. in the absence of any pathognomonic symptom we must consider the history of the case; the symptoms of colic that cease suddenly and are succeeded by cold sweats and tremors; the pulse quick and small and thready, growing weak and more frequent, and at length running down and becoming altogether imperceptible; looking back at the flank and groaning; sometimes crouching with the hind quarters; with or without eructation and vomiting. there is no treatment that can be of any use whatever. could we be sure of our diagnosis it would be better to destroy the animal at once. since, however, there is always the possibility of a mistake in diagnosis, we may give powdered opium in -dram doses every two or three hours, with the object of keeping the stomach as quiet as possible. obstruction colic.--the stomach or bowels may be obstructed by accumulations of partly digested feed (fecal matter), by foreign bodies, by displacements, by paralysis, or by abnormal growths. _impaction of the large intestines._--this is a very common bowel trouble and one which, if not promptly recognized and properly treated, results in death. it is caused by overfeeding, especially of bulky feed containing an excess of indigestible residue; old, dry, hard hay, or stalks when largely fed; deficiency of secretions of the intestinal tracts; lack of water; want of exercise, medicines, etc. impaction of the large bowels is to be diagnosed by a slight abdominal pain, which may disappear for a day or two to reappear with more violence. the feces are passed somewhat more frequently, but in smaller quantities and drier; the abdomen is full, but not distended with gas; the horse at first is noticed to paw and soon begins to look back at his sides. probably one of the most characteristic symptoms is the position assumed when down. he lies flat on his side, head and legs extended, occasionally raising his head to look toward his flank; he remains on his side for from five to fifteen minutes at a time. evidently this position is the one giving the most freedom from pain. he rises at times, walks about the stall, paws, looks at his sides, backs up against the stall, which he presses with his tail, and soon lies down again, assuming his favored position. the intestinal sounds, as heard by applying the ear to the flank, are diminished, or there is no sound, indicating absence of motion of the bowels. the bowels may cease entirely to move. the pressure of the distended intestine upon the bladder may cause the horse to make frequent attempts to urinate. the pulse is but little changed at first, being full and sluggish; later, if this condition is not overcome, it becomes rapid and feeble. horses may suffer from impaction of the bowels for a week, yet eventually recover, and cases extending two or even three weeks have ended favorably. as a rule, however, they seldom last more than four or five days, many, in fact, dying sooner than this. the treatment consists of efforts to produce movement of the bowels and to prevent inflammation of the same from arising. a large cathartic is to be given as early as possible. either of the following is recommended: powdered barbados aloes ounce, calomel drams, and powdered nux vomica dram; or linseed oil pint and croton oil drops; or from pint to quart of castor oil may be given. some favor the administration of epsom or glauber's salt, pound, with one-quarter pound of common salt, claiming that this causes the horse to drink largely of water, thus mechanically softening the impacted mass and favoring its expulsion. whichever physic is selected, it is essential that a full dose be given. this is much better than small and repeated doses. it must be borne in mind that horses require about twenty-four hours in which to respond to a physic, and under no circumstances is it to be repeated sooner. if aloes has been given and has failed to operate at the proper time, oil or some different cathartic should then be administered. allow the horse all the water he will drink. calomel may be administered in half-dram doses, the powder being placed on the tongue, one dose every two hours until four doses are given. enemas of glycerin, to ounces, are often beneficial. rubbing or kneading of the abdominal walls and the application of stimulating liniments or strong mustard water also, at times, favor the expulsion of this mass. walking exercise must occasionally be given. if this treatment is faithfully carried out from the start the majority of cases will terminate favorably. when relief is not obtained inflammation of the bowels may ensue and cause death. _constipation, or costiveness._--this is often witnessed in the horse, and particularly in the foal. many colts die every year from failure on the part of the attendant to note the condition of the bowels soon after birth. whenever the foal fails to pass any feces, and in particular if it presents any signs of colicky pains--straining, etc.--immediate attention must be given it. as a rule, it will be necessary only to give a few injections of soapy water in the rectum and to introduce the finger through the anus to break down any hardened mass of dung found there. if this is not effective a purgative must be given. oils are the best for these young animals, and preferably castor oil, giving from to ounces. the foal should always get the first of the mother's milk, which, for a few days, possesses decidedly laxative properties. if a mare, while suckling, is taking laudanum, morphin, atropia, or similar medicines, the foal during this time should be fed by hand and the mare milked upon the ground. constipation in adult horses is often the result of long feeding on dry, innutritious feed, deficiency of intestinal secretions, scanty water supply, or lack of exercise. if the case is not complicated with colicky symptoms a change to light, sloppy diet, linseed gruel or tea, with plenty of exercise, is all that is required. if colic exists a cathartic is needed. in very many instances the constipated condition of the bowels is due to lack of intestinal secretions, and when so caused may be treated by giving fluid extract of belladonna in -dram doses three times a day and handful doses of epsom salt daily in the feed. it is always best, when possible, to overcome this trouble by a change of diet rather than by the use of medicines. for the relief of constipation such succulent feeds as roots, grass, or green forage are recommended. silage, however, should be fed sparingly, and not at all unless it is in the very best condition. moldy silage may cause fatal disease. _foreign bodies (calculi, stones) in the stomach._--there are probably but few symptoms exhibited by the horse that will lead one to suspect the presence of gastric calculi, and possibly none by which we can unmistakably assert their presence. they have been found most frequently in millers' horses fed sweepings from the mills. a depraved and capricious appetite is common in horses that have a stone forming in the stomachs. there is a disposition to eat the woodwork of the stable, earth, and, in fact, almost any substance within their reach. this symptom must not, however, be considered as pathognomonic, since it is observed when calculi are not present. occasional colics may result from these "stomach stones," and when the latter lodge at the outlet of the stomach they may give rise to symptoms of engorged stomach, already described. there is, of course, no treatment that will prove effective. remedies to move the bowels, to relieve pain, and to combat inflammation should be given. _intestinal concretions (calculi or stones in the intestines)._--these concretions are usually found in the large bowels, though they are occasionally seen in the small intestines. they are of various sizes, weighing from ounce to pounds; they may be single or multiple, and differ in composition and appearance, some being soft (composed mostly of animal or vegetable matter), while others are porous, or honeycombed (consisting of animal and mineral matter), and others are entirely hard and stonelike. the hair balls, so common to the stomach and intestines of cattle, are very rare in horses. intestinal calculi form around some foreign body, as a rule--a nail or piece of wood--whose shape they may assume to a certain extent. layers are arranged concentrically around such nucleus until the sizes above spoken of are attained. these stones are also often found in millers' horses, as well also as in horses in limestone districts, where the water is hard. when the calculi attain a sufficient size and become lodged or blocked in some part of the intestines, they cause obstruction, inflammation of the bowels, colicky symptoms, and death. there are no certain signs or symptoms that reveal them. recurring colics of the type of impaction colic, but more severe, may lead one to suspect the existence of this condition. examination through the rectum may reveal the calculus. the symptoms will be those of obstruction of the bowels. upon post-mortem examinations these stones will be discovered mostly in the large bowels; the intestines will be inflamed or gangrenous about the point of obstruction. sometimes calculi have been expelled by the action of a physic, or they may be removed by the hand when found to occupy the rectum. as in concretions of the stomach, but little can be done in the way of treatment more than to overcome spasm (if any exists), and to give physics with the hope of dislodging the stone or stones and carrying them on and outward. _intussusception, or invagination._--this is the slipping of a portion of the intestine into another portion immediately adjoining, like a partially turned glove finger. this may occur at any part of the bowels, but is most frequent in the small guts. the invaginated portion may be slight-- or inches only--or extensive, measuring as many feet. in intussusception, the inturned bowel is in the direction of the anus. there are adhesions of the intestines at this point, congestion, inflammation, or even gangrene. this accident is most liable to occur in horses that are suffering from spasm of the bowel, or in those in which a small portion of the gut is paralyzed. the natural wormlike or ringlike contraction of the gut favors the passage of the contracted or paralyzed portion into that immediately behind it. it may occur during the existence of almost any abdominal trouble, as diarrhea, inflammation of the bowels, or from injuries, exposure to cold, etc. a fall or leaping may give the initial maldirection. foals are most likely to be thus afflicted. unless the invaginated portion of the gut becomes strangulated, probably no symptoms except constipation will be appreciable. strangulation of the bowel may take place suddenly, and the horse die within hours, or it may occur after several days--a week even--and death then follow. there are no symptoms positively diagnostic. colicky pains, more or less severe and continuous, are observed, and at first there may be diarrhea, followed by constipation. severe straining occurs in some instances of intussusception, and when this occurs it should receive due credit. as death approaches, the horse sweats profusely, sighs, presents an anxious countenance, the legs and ears become cold, and there is often freedom from pain immediately before death. in some rare instances he recovers, even though the invaginated portion of the gut has become strangulated. in this case the imprisoned portion sloughs away so gradually that a union has taken place between the intestines at the point where one portion has slipped into that behind it. the piece sloughing off is found passed with the manure. such cases are exceedingly rare. nonirritating laxatives, such as castor oil, sweet oil, or calomel in small doses, should be given. soft feed and mucilaginous and nourishing drinks should be given during these attacks. e. mayhew michener has operated successfully on a foal with intussusception by opening the abdomen and releasing the imprisoned gut. _volvulus, gut tie, or twisting of the bowels._--these are the terms applied to the bowels when twisted or knotted. this accident is rather a common one, and frequently results from the violent manner in which a horse throws himself about when attacked by spasmodic colic. the symptoms are the same as those of intussusception and obstructions of the bowels; the same directions as to treatment are therefore to be observed. _paralysis of the intestine._--this occurs in old, debilitated animals that have been fed on coarse, innutritious fodder. this produces a condition of dilatation so pronounced as to make it impossible for the intestine to advance its contents, and so obstruction results. the symptoms are as in other forms of obstruction colic. the history of the case is of much service in diagnosing the trouble. the treatment consists in the administration of laxatives. one may give quart of raw linseed oil and follow it the next day with pound of glauber's salt dissolved in a quart of warm water. strychnia may be given in doses of grain two or three times daily. if the stagnant mass of feces is in the rectum, it must be removed with the hand. _abnormal growths_, such as tumors or fibrous tissue, producing contraction or stricture, may be causes of obstruction. the colic caused by these conditions is chronic. the attacks occur at gradually shortening intervals and become progressively more severe. relief is afforded by the use of purgatives that render the feces soft and thin and thus enable them to pass the obstruction, but in time the contracted place is liable to close so far that passage is impossible and the horse will die. flatulent colic (tympanitic colic, wind colic, or bloat).--among the most frequent causes of this form of colic are to be mentioned sudden changes of feed, too long fasting and feed then given while the animal is exhausted, new hay or grain, large quantities of feed that is green or that has lain in the manger for some time and become sour, indigestible feed, irregular teeth, crib biting, and, in fact, anything that produces indigestion may produce flatulent colic. _symptoms._--the symptoms of wind colic are not so suddenly developed nor so severe as those of cramp colic. at first the horse is noticed to be dull, paws slightly, and may or may not lie down. the pains from the start are continuous. the belly enlarges, and by striking it in front of the haunches a drumlike sound results. if not soon relieved the above symptoms are aggravated, and in addition difficult breathing, bloodshot eyes, and red mucous membranes, loud tumultuous heart beat, profuse perspiration, trembling of front legs, sighing respiration, staggering from side to side are noticed, and, finally, plunging forward dead. the diagnostic symptom of flatulent colic is the distention of the bowels with gas, detected by the bloated appearance and resonance on percussion. _treatment._--the treatment for wind colic differs very greatly from that of cramp colic. absorbents are of some service, and charcoal may be given in any quantity. relaxants and antispasmodics are also beneficial in this form of colic. chloral hydrate not only possesses these qualities, but it also is an antiferment and a pain reliever. it is, then, particularly well adapted to the treatment of wind colic, and should be given in the same-sized doses and in the manner directed for spasmodic colic. diluted alcohol or whisky may be given, or aromatic spirits of ammonia in -ounce doses at short intervals. a physic should always be given as early as possible in flatulent colic, the best being barbados aloes in the dose already mentioned. injections, per rectum, of turpentine to ounces, linseed oil ounces, may be given frequently to stimulate the peristaltic motion of the bowels and to favor the escape of wind. blankets wrung out of hot water do much to afford relief; they should be renewed every or minutes and covered with a dry woolen blanket. this form of colic is much more fatal than cramp colic, and requires prompt and persistent treatment. it is entirely unsafe to predict the result, some apparently mild attacks going on to speedy death, while others that at the onset appear to be very severe yielding rapidly to treatment. no efforts should be spared until the animal is known to be dead. in these severe cases puncturing of the bowels in the most prominent (distended) part by means of a small trocar and cannula or with a needle of a hypodermic syringe, thus allowing the escape of gas, has often saved life, and such punctures, if made with a clean, sharp instrument that is not allowed to remain in the horse too long, are accompanied with little danger and do more to relieve the patient quickly than any other treatment. spasmodic or cramp colic.--this is the name given to that form of colic produced by contraction, or spasm, of a portion of the small intestines. it is produced by indigestible feed; large drinks of cold water when the animal is warm; driving a heated horse through deep streams; cold rains; drafts of cold air, etc. unequal distribution of or interference with the nervous supply here produces cramp of the bowels, the same as external cramps are produced. spasmodic colic is much more frequently met with in high-bred, nervous horses than in coarse, lymphatic ones. _symptoms._--these should be carefully studied in order to diagnose this from other forms of colic requiring quite different treatment. spasmodic colic always begins suddenly. if feeding, the horse is seen to stop abruptly, stamp impatiently, and probably look back. he soon evinces more acute pain, shown by pawing, suddenly lying down, rolling, and getting up. during the period of pain the intestinal sounds, as heard by applying the ear over the flank, are louder than in health. there is then an interval of ease; he will resume feeding and appear to be entirely well. in a little while, however, the pains return and are increased in severity, only to pass off again for a time. as the attack progresses these intervals of ease become shorter and shorter, and pain may be continuous, though even then there are exacerbations of pain. animals suffering from this form of colic evince the most intense pain; they throw themselves, roll over and over, jump up, whirl about, drop down again, paw, or strike rather, with the front feet, steam and sweat, and make frequent attempts to pass their urine. only a small quantity of water is passed at a time; this is due to the bladder being so frequently emptied. these attempts to urinate are often regarded by horsemen as symptoms of trouble of the kidneys or bladder. in reality they are only one of the many ways in which the horse expresses the presence of pain. as a matter of fact, diseases of the bladder or kidneys of the horse are exceedingly rare. to recapitulate the symptoms of spasmodic colic: the history of the case, the type of horse, the suddenness of the attack, the increased intestinal sounds, the intervals of ease (which become of shorter duration as the case progresses), the violent pain, the normal temperature and pulse during the intervals of ease, the frequent attempts to urinate, etc., should be kept in mind, and there is then but little danger of confounding this with other forms of colic. _treatment._--since the pain is due to spasm or cramp of the bowels, medicines that overcome spasms--antispasmodics--are the ones indicated. chloral hydrate may be used. this is to be given in a dose of ounce in a pint of water as a drench. as this drug is irritant to the throat and stomach, it has to be well diluted. a common and good remedy is sulphuric ether and laudanum, of each ounces, in a half pint of linseed oil. another drench may be composed of ounces each of sulphuric ether and alcohol in ounces of water. if nothing else is at hand give whisky, one-half pint in hot water. jamaica ginger is useful. if relief is not obtained in one hour from any of the above doses, they may then be repeated. the body should be warmly clothed and perspiration induced. blankets dipped in very hot water to which a small quantity of turpentine has been added should be placed around the belly and covered with dry blankets or the abdomen may be rubbed with stimulating liniments or mustard water. the difficulty, however, of applying hot blankets and keeping them in place forces us in most instances to dispense with them. if the cramp is due to irritants in the bowels, a cure is not complete until a cathartic of ounce of aloes or pint of linseed oil is given. injections of warm, soapy water or salt and water into the rectum aid the cure. rectal injections, clysters, or enemas as a rule should be lukewarm, and from to quarts are to be given at a time. they may be repeated every half hour if necessary. great care is to be taken not to injure the rectum in giving such injections. a large syringe or a piece of rubber hose or feet long, with a funnel attached at one end, affords the best means by which to give them. the pipe of the syringe or the hose introduced into the rectum must be blunt, rounded, and smooth; it is to be thoroughly oiled and then carefully pushed through the anus in a slightly upward direction. much force must be avoided, for the rectum may be lacerated and serious complications or even death result. exercise will aid the action of the bowels in this and similar colicky troubles, but severe galloping or trotting is to be avoided. if the horse can have a loose box or paddock, it is the best, as he will then take what exercise he wants. if the patient is extremely violent, it is often wise to restrain him by leading him with a halter, since rupture of the stomach or displacement of the bowels may result and complicate the trouble. indigestion or gastrointestinal catarrh. from the facts that they merge insensibly into each other and usually occur simultaneously, there is ample reason for considering these conditions together. this condition may be acute--that is, of sudden onset--or it may be chronic. the changes of structure produced by this disease occur in the mucous membrane lining of the stomach and intestines. this membrane becomes red from increased blood supply or from hemorrhage into it, is swollen, and is covered by a coating of slimy mucus. in some especially severe cases the membrane is destroyed in spots, causing the appearance of ulcers or of erosions. the causes of indigestion are numerous, but nearly all are the result of errors in feeding. some horses are naturally endowed with weak digestive organs, and such are predisposed to this condition. anything that irritates the stomach or intestines may cause this disease. feeds that the animal is unaccustomed to, sudden changes of diet, imperfectly cured, unripe, or damaged feeds are all fruitful causes, and so are worms. in suckling foals this condition may come from some disease of the dam that renders her milk indigestible, or from overexertion or overheating of the mare. another prolific cause is bad teeth, making mastication imperfect, and thus causing the horse to swallow his feed in a condition unfit for the action of the digestive juices. working a horse too soon or too hard after feeding may cause either colic or indigestion. any condition that reduces the vitality, such as disease, overwork, poor feed, or lack of care, may directly bring on indigestion by weakening the digestive organs. _symptoms._--indigestion is characterized by irregular appetite; refusing all feed at times, and at others eating ravenously; the appetite is not only irregular, but is often depraved; there is a disposition on the part of the horse to eat unusual substances, such as wood, soiled bedding, or even his own feces; the bowels are irregular to-day, loose and bad smelling, to-morrow bound; whole grain is often passed in the feces, and the hay passed in balls or impacted masses, undergoing but little change; the horse frequently passes considerable quantities of sour-smelling wind. the animal loses flesh, the skin presents a hard, dry appearance and seems very tight (hidebound). if the stomach is very seriously involved, the horse may yawn by stretching the head forward and upward and by turning the upper lip outward. there may be more or less colicky pain. in the chronic cases there is mental depression; the horse is sluggish and dull. the abdomen gradually becomes small, giving a "tucked up" appearance, or, on the other hand, it becomes flaccid and pendulous. _treatment._--one should commence with the feed--its quality, quantity, and time of feeding; examine the water supply, and see, besides, that it is given before feeding; then carefully observe the condition of the mouth and teeth; and, continuing the observations as best we may, endeavor to find the seat of the trouble. if the teeth are sharp or irregular they must be rasped down; if any are decayed they must be extracted; if indigestion is due to ravenous eating or bolting, the feed must then be given from a large manger where the grain can be spread and the horse thus compelled to eat slowly. any irritation, such as worms, undigested feed, etc., that is operating as a cause is to be removed by appropriate treatment, as advised elsewhere. if there is a tendency to distention of the stomach and bowels, with gas, during indigestion, the following may be used: baking soda, powdered ginger, and powdered gentian, equal parts. these are to be thoroughly mixed and given in heaping tablespoonful doses, twice a day, before feeding. this powder is best given by dissolving the above-named quantity in a half pint of water and given as a drench. as a digestive tonic the following is good: glauber's salt, pounds; common salt, pound; baking soda, one-half pound. of this a heaping tablespoonful may be given in each feed. if diarrhea exists, the treatment advised below may be used. diarrhea. diarrhea is due to indigestion or intestinal catarrh or to irritation of the bowels from eating moldy or musty feed, drinking stagnant water, diseased condition of the teeth, eating irritating substances, to being kept on low, marshy pastures, and to exposure during cold nights, or in low, damp stables. some horses are predisposed to scour and are called "washy" by horsemen; they are those with long bodies, long legs, and narrow, flat sides. horses of this build are almost sure to scour if fed or watered immediately before being put to work. fast or road work, of course, aggravates this trouble. diarrhea may exist as a complication of other diseases, as pneumonia and influenza, for instance, and again during the diseases of the liver. the symptoms are the frequent evacuations of liquid stools, with or without pronounced abdominal pain, loss of appetite, emaciation, etc. _treatment_ is at times very simple, but requires the utmost care and judgment. if due to faulty feed or water it is sufficient to change these. if it results from some irritant in the intestines this is best gotten rid of by the administration of an oleaginous purge, for which nothing is better than castor oil, although raw linseed oil may be used if the case is not severe. the diarrhea often disappears with the cessation of the operation of the medicine. if, however, purging continues it may be checked by giving wheat flour in water, starch water, white-oak bark tea, chalk, opium, or half-dram doses of sulphuric acid in one-half pint of water twice or thrice daily. good results follow the use of powdered opium drams and subnitrate of bismuth ounce, repeated three times a day. in all cases it should be remembered to look to the water and feed the horse is receiving. if either of these is at fault it is at once to be discontinued. we should feed sparingly of good, easily digested feeds. with that peculiar build of nervous horses that scour on the road but little can be done as a rule. they should be watered and fed as long as possible before going on a drive. if there is much flatulency accompanying diarrhea baking soda or other alkaline medicines may effect a cure, while if the discharges have a very disagreeable odor it may be corrected by ounce of sulphite of soda or dram doses of creolin in water, repeated twice a day. be slow to resort to either the vegetable or mineral astringents, since the majority of cases will yield to change of feed and water or the administration of oils. afterwards feed upon wheat-flour gruel or other light feeds. the body should be warmly clothed. superpurgation.--this is the designation of that diarrhea, or flux from the bowels, that, at times, is induced by and follows the action of a physic. it is accompanied with much irritation or even inflammation of the bowels and is always of a serious character. although in rare instances it follows from a usual dose of physic and where every precaution has been taken, it is most likely to result under the following circumstances: too large a dose of physic; giving physics to horses suffering from pneumonia, influenza, or other debilitating diseases; riding or driving a horse when purging; exposure or drafts of cold air; or giving large quantities of cold water while the physic is operating. there is always danger of superpurgation if a physic is given to a horse suffering from diseases of the respiratory organs. small and often-repeated physics are also to be avoided, as they produce debility and great depression of the system and predispose to this disorder. when a physic is to be given one should rest the horse and give him sloppy feed until the medicine begins to operate; clothe the body with a warm blanket; keep out of drafts; give only warm water in small quantities. after a horse has purged from twelve to twenty-four hours it can mostly be stopped, or "set," as horsemen say, by feeding on dry oats and hay. should the purging continue, however, it is best treated by giving demulcent drinks--linseed tea and oatmeal or wheat-flour gruel. after this the astringents spoken of for diarrhea may be given. besides this the horse is to receive brandy in doses of from to ounces, with milk and eggs, four or five times a day. laminitis ("founder") is a frequent sequel of superpurgation and is to be guarded against by removing the shoes and standing the horse on moist sawdust or some similar bedding. dysentery. this disease, sometimes called "bloody flux," is an intestinal disease attended with fever, occasional abdominal pains, and fluid discharges mingled with blood. discharges in dysentery are coffee colored or bloody, liquid, and very offensive in odor, and passed with much straining. it is rare in the horse, but is sometimes quite prevalent among foals. _causes._--probably the most common cause is keeping young horses in particular for a long time on low, wet, marshy pastures, without other feed (a diarrhea of long standing sometimes terminates in dysentery); exposure during cold, wet weather; decomposed feeds; stagnant water that contains large quantities of decomposing vegetable matter; low, damp, and dark stables, particularly if crowded; the existence of some disease, as tuberculosis of the abdominal form. in suckling foals it may come from feeding the dam on irritant feeds or from disease of the udder. in other foals it may be produced by exposure to cold and damp, to irritant feed, or to worms. _symptoms._--the initial symptom is a chill, which probably escapes notice in the majority of instances. the discharges are offensive and for the most part liquid, although it is common to find lumps of solid fecal matter floating in this liquid portion; shreds of mucous membrane and blood may be passed or the evacuations may be mucopurulent; there is much straining, and, rarely, symptoms of abdominal pain; the subject lies down a great deal; the pulse is quickened and the temperature elevated. thirst is a prominent symptom. in the adult, death rarely follows under two to three weeks, but in foals the disease may end in death after a few days. _treatment._--this is most unsatisfactory, and i am inclined to place more dependence upon the care and feed than any medication that may be adopted. first of all the horse must be placed in a dry, warm, yet well-ventilated stable; the skin is to receive attention by frequent rubbings of the surface of the body, with blankets, and bandages to the legs. the water must be pure and given in small quantities; the feed, that which is light and easily digested. medicinally, give at first a light dose of castor oil, about one-half pint, to which has been added ounces of laudanum. the vegetable or mineral astringents are also to be given. starch injections containing laudanum often afford great relief. the strength must be kept up by milk punches, eggs, beef tea, oatmeal gruel, etc. in spite of the best care and treatment, however, dysentery is likely to prove fatal. in the case of nurslings, the dam should be placed in a healthy condition or, failing in this, milk should be had from another mare or from a cow. gastroenteritis. this condition consists in an inflammation of the stomach and intestines. instead of being confined to the mucous, or lining, membrane, as in gastrointestinal catarrh, the inflammatory process extends deeper and may even involve the entire thickness of the wall of the organ. this disease may be caused by irritant feed, hot drinks, sudden chilling, moldy or decayed feeds, foul water, parasites, or by chemical poisons. it may also complicate some general diseases, especially infectious diseases, as anthrax, influenza, rabies, or petechial fever. long-continued obstruction of the bowels or displacement resulting in death are preceded by enteritis. _symptoms._--the symptoms differ somewhat with the cause and depend also, to some extent, upon the chief location of the inflammation. in general the animal stops eating or eats but little; it shows colicky pain; fever develops; the pulse and respiration become rapid; the mucous membrane becomes red; the mouth is hot and dry. pressure upon the abdomen may cause pain. intestinal sounds can not be heard at the flank. there is constipation in the earlier stages that is, followed later by diarrhea. the extremities become cold. sometimes the feces are coated with or contain shreds of fibrin, looking like scraps of dead membrane, and they have an evil, putrid odor. if the disease is caused by moldy or damaged feed there may be great muscular weakness, with partial paralysis of the throat, as shown by inability to swallow. if chemical poisons are the cause, this fact may be shown by the sudden onset of the disease, the history of the administration of a poison or the entire absence of known cause, the rapid development of threatening symptoms, the involvement of a series of animals in the absence of a contagious disease, and the special symptoms and alterations known to be produced by certain poisons. to make this chain of evidence complete, the poison may be discovered in the organs of the horse by chemical analysis. in nearly all cases of gastro-enteritis there is nervous depression. the poisons that are most irritant to the digestive tract are arsenic, corrosive sublimate, sugar of lead, sulphate of copper, sulphate or chlorid of zinc, lye, or other strong alkalies, mineral acids, and, among the vegetable poisons, tobacco, lobelia, and water hemlock. _treatment._--the treatment will depend upon the cause, but if this can not be detected, certain general indications may be observed. in all cases feed should be given in small amounts and should be of the most soothing description, as oatmeal gruel, flaxseed tea, hay tea, fresh grass, or rice water. the skin should be well rubbed with alcohol and wisps of straw, to equalize the distribution of the blood; the legs, after being rubbed until warm, should be bandaged in raw cotton or with woolen bandages. the horse should be warmly blanketed. it is well to apply to the abdomen blankets wrung out of hot water and frequently changed; or mustard paste may be rubbed on the skin of the belly. internally, opium is of service to allay pain, check secretion, and soothe the inflamed membrane. the dose is from to drams, given every three of four hours. if there is constipation, the opium should be mixed with grains of calomel. subnitrate of bismuth may be given with the opium or separately in -dram doses. stimulants, such as alcohol, aromatic spirits of ammonia, or camphor may be given in -ounce doses, mixed with warm water to make a drench. if putrid feed has been consumed, creolin may be administered in doses of drams, mixed with pint of warm water or milk. if there is obstinate constipation and if a laxative must be employed, it should be sweet or castor oil, from pint to quart. _antidotes for poisons._--for the various poisons the remedies are as follows: arsenic: oxyhydrate of iron solution, pint to quart; or calcined magnesia, one-half ounce in pint of water. corrosive sublimate (bichlorid of mercury): the whites of a dozen eggs, or ounces of flowers of sulphur. sugar of lead: glauber's salt, pound in quart of warm water; to be followed with iodid of potash, drams at a dose, in water, three times daily for five days. sulphate of copper: milk, the whites of eggs, or reduced iron. sulphate or chlorid of zinc: milk, the whites of eggs, or calcined magnesia. lye or alkalies, as caustic potash or soda: vinegar, dilute sulphuric acid, and linseed tea, with opium, drams. mineral acids: chalk, or calcined magnesia, or baking soda; later give linseed tea and opium. hemorrhoids, or piles. these are rare, comparatively, in horses. they are diagnosed by the appearance of bright-red irregular tumors after defecation, which may remain visible at all times or be seen only when the horse is down or after passing his manure. they are mostly due to constipation, irritation, or injuries, or follow from the severe straining during dysentery. i have observed them to follow from severe labor pains in the mare. _treatment._--attention must be paid to the condition of the bowels; they should be soft, but purging is to be avoided. the tumors should be washed in warm water and thoroughly cleansed, after which scarify them and gently but firmly squeeze out the liquid that will be seen to follow the shallow incisions. after thus squeezing these tumors and before replacing through the anus, bathe the parts with some anodyn wash. for this purpose the glycerite of tannin and laudanum in equal parts is good. mucilaginous injections into the rectum may be of service for a few days. hernia, or rupture. there are several kinds or hernias that require notice, not all of which, however, produce serious symptoms or results. abdominal hernias, or ruptures, are divided into reducible, irreducible, and strangulated, according to condition; and into inguinal, scrotal, ventral, umbilical, and diaphragmatic, according to their situation. a hernia is reducible when the displaced organ can be returned to its natural location. it consists of a soft swelling, without heat, pain, or any uneasiness, generally larger on full feed, and decreases in size as the bowels become empty. an irreducible hernia is one that can not be returned into the abdomen, and yet does not cause any pain or uneasiness. strangulated hernia is one in which the contents of the sac are greatly distended, or when from pressure upon the blood vessels of the imprisoned portion the venous circulation is checked or stopped, thereby causing congestion, swelling, inflammation, and, if not relieved, gangrene of the part and death of the animal. according to the time or mode of origin, hernias may be congenital or acquired. congenital scrotal hernia.--not a few foals are noticed from birth to have an enlarged scrotum, which gradually increases in size until about the sixth month, sometimes longer. sometimes the scrotum of a six-months-old colt is as large as that of an adult stallion, and operative treatment is considered. this is unnecessary in the great majority of cases, as the enlargement often disappears by the time the colt has reached his second year. any interference, medicinal or surgical, is worse than useless. if the intestine contained within the scrotum should at any time become strangulated, it must then be treated the same as in an adult horse. scrotal hernia is caused by dilatation of the sheath of the testicle, combined with relaxation of the fibrous tissues surrounding the inguinal ring, thus allowing the intestine to descend to the scrotum. at first this is intermittent, appearing during work and returning when the horse is at rest. for a long time this form of hernia may not cause the least uneasiness or distress. in course of time, however, the imprisoned gut becomes filled with feces, its return into the abdominal cavity is prevented, and it becomes strangulated. while the gut is thus filling the horse often appears dull, is disinclined to move, appetite is impaired, and there is rumbling and obstruction of the bowels. colicky symptoms now supervene. strangulation and its consequent train of symptoms do not always follow in scrotal hernia, for often horses have this condition for years without suffering inconvenience. inguinal hernia is but an incomplete scrotal hernia, and, like the latter, may exist and cause no signs of distress, or, again, it may become strangulated and cause death. inguinal hernia is seen mostly in stallions, next in geldings, and very rarely in the mare. bearing in mind that scrotal hernia is seen only in entire horses, we may proceed to detail the symptoms of strangulated, inguinal, and scrotal hernia at the same time. when, during the existence of colicky symptoms, we find a horse kicking with his hind feet while standing or lying upon his back, we should look to the inguinal region and scrotum. if scrotal hernia exists, the scrotum will be enlarged and lobulated; by pressure we may force a portion of the contents of the gut back into the abdomen, eliciting a gurgling sound. if we take a gentle but firm hold upon the enlarged scrotum and then have an assistant cause the horse to cough, the swelling will be felt to expand and as quickly contract again. the history of these cases will materially aid us, as the owner can often assure us of preceding attacks of "colic," more or less severe, that have been instantaneously relieved in some (to him) unaccountable manner. the colicky symptoms of these hernias are not diagnostic, but, probably, more closely resemble those of enteritis than any other bowel diseases. in many cases the diagnosis can be made only by a veterinarian, when he has recourse to a rectal examination; the bowels can here be felt entering the internal abdominal ring. _treatment of inguinal hernia._--if the reader is sure of the existence of hernia, he should secure the horse upon its back, and, with a hand in the rectum, endeavor to catch hold of the wandering bowel and pull it gently back into the cavity of the abdomen. pressure should be made upon the scrotum during this time. if this fails, a veterinarian must be called to reduce the hernia by means of incising the inguinal ring, replacing the intestines, and to castrate, using clamps and performing the "covered operation." ventral hernia.--in this form of hernia the protrusion is through some accidental opening or rupture of the abdominal wall. it may occur at any part of the belly except at the umbilicus, and is caused by kicks, blows, hooks, severe jumping or pulling, etc. ventral hernia is most common in pregnant mares, and is here due to the weight of the fetus or to some degenerative changes taking place in the abdominal coats. it is recognized by the appearance of a swelling, at the base of which can be felt the opening or rent in the abdominal tunics, and from the fact that the swelling containing the intestines can be made to disappear when the animal is placed in a favorable position. _treatment of ventral hernia._--in many instances there is no occasion for treatment, and again, where the hernial sac is extensive, treatment is of no avail. if the hernia is small, a cure may be attempted by the methods to be described in treating of umbilical hernia. if one is fortunate enough to be present when the hernia occurs, and particularly if it is not too large, he may, by the proper application of a pad and broad bandage, effect a perfect cure. umbilical hernia is the passing of any portion of the bowel or omentum ("caul") through the navel, forming a "tumor" at this point. this is often congenital in our animals, and is due to the imperfect closure of the umbilicus and to the position of the body. many cases of umbilical hernia, like inguinal and scrotal of the congenital kind, disappear entirely by the time the animal reaches its second or third year. advancing age favors cure in these cases from the fact that the omentum (swinging support of the bowels) is proportionally shorter in adults than in foals, thus lifting the intestines out of the hernial sac and allowing the opening in the walls to close. probably one of the most frequent causes of umbilical hernia in foals is the practice of keeping them too long from their dams, causing them to fret and worry, and to neigh, or cry, by the hour. the contraction of the abdominal muscles and pressure of the intestines during neighing seem to open the umbilicus and induce hernia. accidents may cause umbilical hernia in adults in the same manner as ventral hernia is produced, though this is very rare. _treatment of umbilical hernia._--in the treatment of umbilical hernia it should be remembered that congenital hernias are often removed with age, but probably congenital _umbilical hernias_ less frequently than others. among the many plans of treatment are to be mentioned the application of a pad over the tumor, the pad being held in place by a broad, tight bandage placed around the animal's body. the chief objection to this is the difficulty in keeping the pad in its place. blisters are often applied over the swelling, and, as the skin hardens and contracts by the formation of scabs, an artificial bandage or pressure is produced that at times is successful. another treatment that has gained considerable repute of late years consists in first clipping off the hair over the swelling. nitric acid is then applied with a small brush, using only enough to moisten the skin. this sets up a deep-seated, adhesive inflammation, which, in very many cases, closes the opening in the navel. still another plan is to inject a solution of common salt by means of the hypodermic syringe at three or four points about the base of the swelling. this acts in the same manner as the preceding, but may cause serious injury if the syringe or solution is not sterile. others, again, after keeping the animal fasting for a few hours, cast and secure it upon its back; the bowel is then carefully returned into the abdomen. the skin over the opening is pinched up and one or two skewers are run through the skin from side to side as close as possible to the umbilical opening. these skewers are kept in place by passing a cord around the skin between them and the abdomen and securely tying it. great care must be taken not to draw these cords too tight, as this would cause a speedy slough of the skin, the intestines would extrude, and death result. if properly applied, an adhesion is established between the skin and the umbilicus, which effectually closes the orifice. special clamps are provided for taking up the fold of the skin covering the hernial sac and holding it until the adhesion is formed. diaphragmatic hernia.--this consists of the passage of any of the abdominal viscera through a rent in the diaphragm (midriff) into the cavity of the thorax. it is a rather rare accident, and one often impossible to diagnose during life. colicky symptoms, accompanied with great difficulty in breathing, and the peculiar position so often assumed (that of sitting upon the haunches), are somewhat characteristic of this trouble, though these symptoms, as we have already seen, may be present during diseases of the stomach or anterior portion of the bowels. even could we diagnose with certainty this form of hernia, there is little or nothing that can be done. leading the horse up a very steep gangway or causing him to rear up may possibly cause the hernial portion to return to its natural position. this is not enough, however; it must be kept there. peritonitis. peritonitis is an inflammation of the serous membrane lining the cavity of and covering the viscera contained within the abdomen. it is very rare to see a case of primary peritonitis. it is, however, somewhat common as a secondary disease from extension of the inflammatory action involving organs covered by the peritoneum. peritonitis is often caused by injuries, as punctured wounds of the abdomen, severe blows or kicks, or, as is still more common, following the operation of castration. it follows strangulated hernia, invagination, or rupture of the stomach, intestines, liver, or womb. _symptoms._--peritonitis is mostly preceded by a chill; the horse is not disposed to move, and, if compelled to do so, moves with a stiff or sore gait; he paws with the front feet and may strike at his belly with the hind ones; lies down very carefully; as the pain is increased while down, he maintains the standing position during most of the time; he walks uneasily about the stall. constipation is usually present. pressure on the belly causes acute pain, and the horse will bite, strike, or kick if so disturbed; the abdomen is tucked up; the extremities are fine and cold. the temperature is higher than normal, reaching from ° to ° f. the pulse in peritonitis is rather characteristic; it is quickened, beating from to beats a minute, and is hard and wiry. this peculiarity of the pulse occurs in inflammation of the serous membrane, and if accompanied with colicky symptoms, and, in particular, if following any injuries, accidental or surgical, of the peritoneum, there is reason to think that peritonitis is present. peritonitis in the horse is mostly fatal when it is at all extensive. if death does not occur in a short time, the inflammation assumes a chronic form, in which there is an extensive effusion of water in the cavity of the belly, constituting what is known as ascites, and which, as a rule, results in death. _treatment._--the treatment of peritonitis is somewhat like that of enteritis. opium in powder, to drams, with calomel, one-half dram, is to be given every two, three, or four hours, and constitutes the main dependence in this disease. extensive counterirritants over the belly, consisting of mustard plasters, applications of mercurial ointment, turpentine stupes, or even mild blisters, are recommended. purgatives must never be given during this complaint. should we desire to move the bowels, it can be done by gentle enemas, though it is seldom necessary to resort even to this. ascites, or dropsy of the abdomen. this is seen as a result of subacute or chronic peritonitis, but may be due to diseases of the liver, kidneys, heart, or lungs. there will be found, on opening the cavity of the belly, a large collection of yellowish or reddish liquid; from a few quarts to several gallons may be present. it may be clear in color, though generally it is yellowish or of a red tint, and contains numerous loose flakes of coagulable lymph. _symptoms._--there is slight tenderness on pressure; awkward gait of the hind legs; the horse is dull, and may have occasional very slight colicky pains, shown by looking back and striking at the belly with the hind feet. oftener, however, these colicky symptoms are absent. diarrhea often precedes death, but during the progress of the disease the bowels are alternately constipated and loose. on percussing the abdominal walls we find that dullness exists to the same height on both sides of the belly; by suddenly pushing or striking the abdomen we can hear the rushing or flooding of water. if the case is an advanced one, the horse is potbellied in the extreme, and dropsical swellings are seen under the belly and upon the legs. treatment is, as a rule, unsatisfactory. saline cathartics, as epsom or glauber's salt, and diuretics, ounce doses of saltpeter, may be given. if a veterinarian is at hand he will withdraw the accumulation of water by tapping and then endeavor to prevent its recurrence (though this is almost sure to follow) by giving three times a day saltpeter ounce and iodid of potash dram, and by the application of mustard or blisters over the abdominal walls. tonics, mineral and vegetable, are also indicated. probably the best tonic is one consisting of powdered sulphate of iron, gentian, and ginger in equal parts; a heaping tablespoonful of the mixture is given as a drench or mixed with the feed, twice a day. good nutritious feeds and gentle exercise complete the treatment. diseases of the liver. in the united states the liver of the horse is but rarely the seat of disease, and when we consider how frequently the liver of man is affected this can not but appear strange. the absence of the gall bladder may account to a certain extent for his freedom from liver diseases, as overdistention of this and the presence in it of calculi (stones) in man is a frequent source of trouble. in domestic animals, as in man, hot climates tend to produce diseases of the liver, just as in cold climates lung diseases prevail. not only are diseases of the liver rare in horses in temperate climates, but they are also very obscure, and in many cases pass totally unobserved until after death. there are some symptoms, however, which, when present, should make us examine the liver as carefully as possible. these are jaundice (yellowness of the mucous membranes of the mouth, nose, and eyes) and the condition of the dung, it being light in color and pasty in appearance. hepatitis, or inflammation of the liver. this disease may be general or local, and may assume an acute or chronic form. _symptoms._--the symptoms of acute hepatitis are: dullness; the horse is suffering from some internal pain, but not of a severe type; constipated and clay-colored dung balls; scanty and high-colored urine; and general febrile symptoms. if lying down, he is mostly found on the left side; looks occasionally toward the right side, which, upon close inspection, may be found to be slightly enlarged over the posterior ribs, where pain upon pressure is also evinced. obscure lameness in front, of the right leg mostly, may be a symptom of hepatitis. the horse, toward the last, reels or staggers in his gait and falls backward in a fainting fit, during one of which he finally succumbs. death is sometimes due to rupture of the enveloping coat of the liver or of some of its blood vessels. _causes._--among the causes that lead to this disease we must mention first the stimulating effect of overfeeding, particularly during hot weather. horses that are well fed and receive but little exercise are the best subjects for diseases of this organ. we must add to these causes the more mechanical ones, as injuries on the right side over the liver, worms in the liver, gallstones in the biliary ducts, foreign bodies--as needles or nails that have been swallowed and in their wanderings have entered the liver--and, lastly, in some instances, the extension of inflammation from neighboring parts, thus involving this organ. acute hepatitis may terminate in chronic inflammation, abscesses, rupture of the liver, or may disappear, leaving behind no trace of disease whatever. _treatment._--this should consist, at first, of the administration of ounce of barbados aloes or other physic. general blood-letting, if had recourse to early, must prove of much benefit in acute inflammation of the liver. the vein in the neck (jugular) must be opened, and from to quarts of blood may be drawn. saline medicines, as glauber's salt or the artificial carlsbad salt, are indicated. these may be given with the feed in tablespoonful doses. the horse is to be fed sparingly on soft feed, bran mashes chiefly. if treatment proves successful and recovery takes place, see to it that the horse afterwards gets regular exercise and that his feed is not of a too highly nutritious character and not excessive. jaundice, icterus, or the yellows. this is a condition caused by the retention and absorption of bile into the blood. it was formerly considered to be a disease of itself, but is now regarded as a symptom of disorder of the liver. "the yellows" is observed by looking at the eyes, nose, and mouth, when it will be seen that these parts are yellowish instead of the pale-pink color of health. in white or light-colored horses the skin even may show this yellow tint. the urine is saffron colored, the dung is of a dirty-gray color, and constipation is usually present. jaundice may be present as a symptom of almost any inflammatory disease. we know that when an animal has fever the secretions are checked, the bile may be retained and absorbed throughout the system, and yellowness of the mucous membranes follows. jaundice may also exist during the presence of simple constipation, hepatitis, biliary calculi, abscesses, hardening of the liver, etc. _treatment._--when jaundice exists we must endeavor to rid the system of the excess of bile, and this is best accomplished by giving purgatives that act upon the liver. calomel, drams, with aloes, drams, should be given. glauber's salt in handful doses once or twice a day for a week is also effective. may apple, rhubarb, castor oil, and other cathartics that act upon the first or small bowels may be selected. we must be careful to see that the bowels are kept open by avoiding hard, dry, bulky feeds. rupture of the liver. this is known to occur at times in the horse, most frequently in old, fat horses and those that get but little exercise. horses that have suffered from chronic liver disease for years eventually present symptoms of colic and die quite suddenly. upon post-mortem examination we discover that the liver has ruptured. the cicatrices, or scars, that are often found upon the liver indicate that this organ may suffer _small_ rupture and yet the horse may recover from it. this can not be the result, however, if the rent or tear is extensive, since in such cases death must quickly follow from hemorrhage, or, later, from peritonitis. enlarged liver is particularly liable to rupture. the immediate causes of rupture appear to be excessive muscular exertion, as leaping a fence, a fall, a blow from a collision, a kick from a horse, or sudden distention of the abdomen with gas. the symptoms of rupture of the liver will depend upon the extent of the laceration. if slight, there will be simply the symptoms of abdominal pain, looking back to the sides, lying down, etc.; if extensive, the horse is dull and dejected, has no appetite, breathing becomes short and catching, he sighs or sobs, visible mucous membranes are pale, extremities cold, pulse fast, small, and weak or running down. countenance now shows much distress, he sweats profusely, totters in his gait, props his legs wide apart, reels, staggers, and falls. he may get up again, but soon falls dead. the rapid running-down pulse, paleness of the eyes, nose, and mouth, sighing, stertorous breathing, tottering gait, etc., are symptoms by which we know that the animal is dying from internal hemorrhage. _treatment._--but little can be done in the way of treatment. opium in powder, in doses of drams every two or three hours, may be given, with the idea of preventing as much as possible all movements of internal organs. if there is reason to suspect internal bleeding, we should give large and frequent doses of white-oak bark tea, dram doses of tannic or gallic acid, or the same quantity of sugar of lead, every half hour or hour. fluid extract of ergot or tincture of the chlorid of iron, in ounce doses, may be selected. cold water dashed upon the right side or injected into the rectum is highly spoken of as a means of checking the hemorrhage. biliary calculi, or gallstones. these are rarely found in the horse, but may occupy the hepatic ducts, giving rise to jaundice and to colicky pains. there are no absolutely diagnostic symptoms, but should one find a horse that suffers from repeated attacks of colic, accompanied with symptoms of violent pain, and that during or following these attacks the animal is jaundiced, it is possible that gallstones are present. there is little or nothing to be done except to give medicines to overcome pain, trusting that these concretions may pass on to the bowels, where, from their small size, they will not occasion any inconvenience. diseases of the pancreas and spleen. diseases of the pancreas and spleen are so rare, or their symptoms so little understood, that it is impossible to write anything concerning either of these organs and their simple diseases that will convey to the reader information of practical value. gastrointestinal parasites. [by maurice c. hall, ph. d., d. v. m.] horses are subject to infestation by a number of species of worms, these worms being especially numerous at certain points in the alimentary canal. the tapeworms of the horse are relatively unimportant and not very common. there are three species, the smallest about two inches long and the largest about eight inches long. these two occur in the small intestine; a form intermediate in size may also be found in the cecum and colon. these are flat, segmented worms with the head at the smaller end. flukes occur in horses elsewhere, but have apparently never been reported in the united states. roundworms, or nematodes, constitute the most important group of parasitic worms in the horse. the more important of these are as follows: roundworm (_ascaris equorum_).--this is the common large, yellowish roundworm (pl. v, fig. ), about the size of a lead pencil or larger, which may be found in horses almost anywhere in the united states. it occurs in the intestine and probably occasions little damage as a rule, except when present in large numbers, in which case it will probably be found in the droppings. the symptoms occasioned by it are rather obscure and are such as might arise from a number of other causes, namely, colicky pains, depraved appetite, diarrhea or constipation, and general unthriftiness. in a general way, the presence of parasites may be suspected when an animal shows no fever but is unthrifty, debilitated, and shows disordered bowel movements in cases where there is no evident explanation in the way of feed, care, and surroundings. _treatment_ for the removal of this worm consists in the use of anthelmintics such as tartar emetic, turpentine, and carbon bisulphid, but as these remedies are essentially poisons intended to kill the worm, and as their use by persons unused to determining conditions unfavorable for their use is dangerous and likely to result in the death of the animal or in permanent injury to the kidneys or other organs, it is advisable to call in a veterinarian in such cases. pinworm (_oxyuris equi_).--this is a rather large worm (pl. v, fig. ), somewhat smaller than the foregoing and readily distinguishable from it by the presence of a long, slender tail. it also occurs generally throughout the united states, and except when present in large numbers probably does very little damage. it inhabits the large intestine and hence is difficult to reach with medicines administered by the mouth. the use of a half ounce of gentian on the feed night and morning for a week has been recommended, but the use of rectal enemas will give more prompt and perhaps more certain results. these enemas may be made up with one or two tablespoonfuls of salt to the pint, or infusions of quassia chips, a half pound to the gallon of water, and injected into the rectum once or twice a day. stomach worms of the horse (_habronema_ spp.).--these worms (pl. v, fig. ) occur in nodules in the mucous lining of the horse's stomach and are credited with doing more or less damage. their presence is not likely to be diagnosed in the present state of our knowledge, but in case their presence is determined or suspected in connection with the summer sores noted later, tartar emetic is recommended. at least one of these worms has an intermediate stage in the ordinary housefly, the fly becoming infested while it is a larva developing in horse manure. obviously, therefore, any measures looking toward the eradication of the fly or the proper disposal of manure will aid in the control and eradication of this worm. the united states bureau of entomology has shown that fly maggots travel downward through a manure pile as it comes time for the maggot to enter the ground and pupate, and an excellent maggot trap, consisting of an exposed manure platform raised on posts which are set in a concrete basin extending under the platform and filled with three or four inches of water, has been devised. as maggots work down they come to the platform and escape through the spaces between the boards, left open for the purpose, to the water in the concrete basin, where they are drowned. in this way the exposed manure pile serves to attract flies with a deceptive proffer of a breeding place. apparently it is the young forms of these stomach worms which develop at times on the skin, causing a cutaneous habronemiasis known as summer sores. this is discussed under diseases of the skin. strongyles (_strongylus_ spp. and _cylicostomum_ spp.).--these worms (pl. v, figs. and ) live in the large intestines of the horse as adult worms and are often present in enormous numbers. many of them are very small, and the largest are less than two inches long. the adult worms do considerable damage, but the immature or larval worms do even more. the larva of _strongylus vulgaris_ enters the blood vessels of the intestinal wall and finally attaches in the great mesenteric artery, where it causes aneurisms; here it transforms to an adult without sexual organs, which passes to the walls of the cecum and encysts, giving rise to small cysts or abscesses; these cysts finally discharge to the interior of the cecum, setting the worms, now mature, at liberty in the lumen of the intestines. the larvæ of _strongylus equinus_ are found principally in the liver, lungs, and pancreas. the larvæ of _strongylus edentatus_ may be met with almost anywhere, especially under the serous membranes, the pleura and peritoneum. the embryos and larvæ of species of _cylicostomum_ are found in the mucosa of the large intestine. aneurisms impede the circulation of the blood, and may give rise to intermittent lameness. the aneurism may rupture, since it constitutes a weak place in the wall of the blood vessel, and the horse die of the resulting hemorrhage. particles of blood clots in the aneurisms may break off and plug a blood vessel at the point where they lodge, thereby causing the death of the part from which the blood is shut off and occasioning a type of colic which often terminates fatally. the larvæ of _cylicostomum_ form cysts in the walls of the large intestine, and when these open they give rise to small sores; when they are numerous they cause a thickening and hardening which impair the proper functioning of the intestine. abscesses sometimes perforate, causing death. the adult worm attacks the intestinal wall, causing bleeding which results in anemia. the numerous small sores thus caused allow bacteria to get into the circulation, sometimes resulting in localized abscesses or in septic arthritis or joint disease. [illustration: plate v. intestinal worms. oxyuris equi strongylus equinus. habronema microstoma cylichnostomum sp. ascaris equorum] [illustration: plate vi. bots . bots in the stomach. . bots in the duodenum.] the disease due to these worms is quite common. the worms enter the body as immature forms in the spring, when the animal is turned out on pasture. the first symptoms show in november or december, the disease being in a latent stage during the development of the worms. the first symptoms are diarrhea, loss of appetite, and emaciation. the animal becomes anemic. secondary symptoms are edema and such complications as joint infection, colic due to embolism, and accidents from falls, hemorrhage from ruptured aneurisms, or perforation at the site of abscess. the animal may die, recover, or become a chronic sufferer, the internal injuries failing to make a satisfactory recovery even with the removal of the worms in chronic cases. _treatment_ calls for the expulsion of the adult worms from the intestine, the development of the body resistance to repair the damage wrought by the developing worms, and the combating of complications. for the expulsion of the worms the use of carbon bisulphid in gelatin capsules, to grams, according to the size of the patient, for five days, followed by magnesium sulphate the sixth day, has been recommended. owing to the difficulty and danger in the administration of carbon bisulphid in capsule, it is advisable to call in a veterinarian. tonic treatment consists in the subcutaneous administration of artificial serum and caffein. the various complications of bacterial infection, colic, heart depression, etc., call for the attention of a veterinarian. preventive measures consist in avoiding reinfection with worms so far as possible by using dry upland pasture in preference to low, wet land, and by rotating pastures or rotation of the stock on a given pasture. horses may be alternated with cattle, sheep, or hogs to advantage, so far as parasites are concerned. another feature, always of importance, is the provision of a pure, potable drinking water. bots (_gastrophilus_ spp.).--bots (pl. vi) are quite common in the stomach and upper part of the small intestine of the horse anywhere in the united states, one kind being occasionally found in the rectum. they attach to that portion of the mucous lining of the stomach nearest the esophagus or sometimes around the pyloric opening to the intestine or even in the upper intestine, and undoubtedly interfere with the proper functioning of the stomach and the health of the animal to a certain extent. the symptoms are rather vague as a rule, but the general result is a condition of unthriftiness. a treatment which has been found effective consists in feeding lightly on the day preceding treatment, withholding food in the evening and giving an ounce of barbados aloes or a pint of linseed oil. the next day give drams of carbon bisulphid in a gelatin capsule at o'clock, repeat the dose at o'clock, and again at o'clock, making a total of drams altogether for an adult horse; half that amount will be sufficient for a yearling colt. as previously noted, there is some little difficulty and danger of accident in the administration of treatments of this character and it is advisable to call in a veterinarian. unless destroyed by treatment, the bots in the stomach of the horse pass out in the manure in the spring and burrow down into the soil an inch or two. here they undergo a certain amount of development and finally emerge as adult flies. these bot flies mate and during the summer the eggs are deposited by the female on the forelegs and shoulders or around the chin, mouth and nostrils of the horse, the location and appearance of the eggs varying somewhat with different species of bot flies. these eggs or the young maggots escaping from them are ingested by the horse in licking the portions irritated by the movement of the escaping maggots, and when swallowed develop to form bots in the stomach. careful currying, especially around the forequarters, is an aid in keeping down bot infestation, but this is not commonly feasible with horses on pasture, the ones most liable to become infested. diseases of the respiratory organs. by w. s. harbaugh, v. s. [revised by leonard pearson, b. s., v. m. d.] the organs pertaining to the respiratory function may be enumerated in natural order as follows: the nasal openings, or nostrils; the nasal chambers, through which the air passes in the head; the sinuses in the head, communicating with the nasal chambers; the pharynx, common to the functions of breathing and swallowing; the larynx, at the top of the windpipe; the trachea, or windpipe; the bronchi (into which the windpipe divides), two tubes leading from the windpipe to the right and left lungs, respectively; the bronchial tubes, which penetrate and convey air to all parts of the lungs; the lungs. the pleura is a thin membrane that envelops the lung and lines the walls of the thoracic cavity. the diaphragm is a muscular structure, completely separating the contents of the thoracic cavity from those of the abdominal cavity. it is essentially a muscle of inspiration, and the principal one. other muscles aid in the mechanism of respiration, but the diseases or injuries of them have nothing to do with the diseases under consideration. just within the nasal openings the skin becomes gradually but perceptibly finer, until it is succeeded by the mucous membrane. near the junction of the skin and membrane is a small hole, presenting the appearance of having been made with a punch; this is the opening of the lachrymal duct, a canal that conveys the tears from the eyes. within and above the nasal openings are the cavities, or fissures, called the false nostrils. the nasal chambers are completely separated, the right from the left, by a cartilaginous partition, the nasal septum. each nasal chamber is divided into three continuous compartments by two thin, scroll-like turbinated bones. the mucous membrane lining the nasal chambers, and, in fact, the entire respiratory tract, is much more delicate and more frequently diseased that the mucous membrane of any other part of the body. the sinuses of the head are compartments which communicate with the nasal chambers and are lined with a continuation of the same membrane that lines the nasal chambers; their presence increases the volume and modifies the form of the head without increasing its weight. the horse, in a normal condition, breathes exclusively through the nostrils. the organs of respiration are quite liable to become diseased, and, as many of the causes which lead to these attacks can be avoided, it is both important and profitable to know and study the causes. causes of diseases of respiratory organs. the causes of many of the diseases of these organs may be given under a common head, because even a simple cold, if neglected or badly treated, may run into the most complicated lung disease and terminate fatally. in the spring and fall, when the animals are changing their coats, there is a marked predisposition to contract disease, and consequently at those periods care should be taken to prevent other exciting causes. badly ventilated stables are a frequent source of disease. it is a mistake to think that country stables necessarily have purer air than city stables. stables on some farms are so faultily constructed that it is almost impossible for the foul air to gain an exit. all stables should have a sufficient supply of pure air, and be so arranged that strong drafts can not blow directly on the animals. in ventilating a stable, it is best to arrange to remove air from near the floor and admit it through numerous small openings near the ceiling. the reason for this is that the coldest and most impure air in the stable is near the floor, while that which is warmest and purest, and therefore can least be spared, is near the top of the room. in summer, top exits and cross currents should be provided to remove excessive heat. hot stables are almost always poorly ventilated, and the hot stable is a cause of disease on account of the extreme change of temperature that a horse is liable to when taken out, and extreme changes of temperature are to be avoided as certain causes of disease. a cold, close stable is invariably damp, and is to be avoided as much as the hot, close, and foul one. horses changed from a cold to a warm stable are more liable to contract cold than when changed from a warm to a cold one. pure air is more essential than warmth, and this fact should be especially remembered when the stable is made close and foul to gain the warmth. it is more economical to keep the horse warm with blankets than to prevent the ingress of pure air in order to make the stable warm. stables should be well drained and kept clean. some farmers allow large quantities of manure to accumulate in the stable. this is a pernicious practice, as the decomposing organic matter evolves gases that are predisposing or exciting causes of disease. when a horse is overheated, it is not safe to allow him to dry by evaporation; rubbing him dry and gradually cooling him out is the wisest treatment. when a horse is hot--covered with sweat--it is dangerous to allow him to stand in a draft; it is the best plan to walk him until his temperature moderates. in such cases a light blanket thrown over the animal may prevent a cold. overwork or overexertion often causes the greater number of fatal cases of congestion of the lungs. avoid prolonged or fast work when the horse is out of condition or unaccustomed to it. animals that have been working in cold rains should be dried and cooled out and not left to dry by evaporation. when the temperature of the weather is at the extreme, either of heat or cold, diseases of the organs of respiration are most frequent. it is not to be supposed that farmers can give their horses the particular attention given to valuable racing and pleasure horses, but they can most assuredly give them common-sense care, and this may often save the life of a valuable animal. if the owner properly considers his interests, he will study the welfare of his horses so that he may be able to instruct the servant in details of stable management. wounds about the nostrils. wounds in this neighborhood are common, and are generally caused by snagging on a nail or splinter or by the bite of another horse; or by getting "run into," or by running against something. occasionally the nostril is so badly torn and lacerated that it is impossible to effect a cure without leaving the animal blemished for life, but in the majority of instances the blemish, or scar, is the result of want of conservative treatment. as soon as possible after the accident the parts should be brought together and held there by stitches. if too much time is allowed to elapse, the swelling of the parts will considerably interfere. never cut away any skin that may be loose and hanging, or else a scar will certainly remain. bring the parts in direct apposition and place the stitches from a quarter to a half-inch apart, as circumstances may demand. it is not necessary to have special surgeons' silk and needles for this operation; good linen thread or ordinary silk thread will answer. the wound afterwards only requires to be kept clean. for this purpose it should be cleansed and discharges washed away daily with a solution made of carbolic acid part in parts of water. if on account of the irritability the horse is inclined to rub the wound against some object, his head should be tied by means of two halter ropes attached to the opposite sides of the stall to prevent him from opening the wound. except when at work or eating, the head should be so tied about days. tumors within the nostrils. a small, globular tumor is sometimes found within the false nostril, under that part of the skin that is seen to puff or rise and fall when a horse is exerted and breathing hard. these tumors contain matter of a cheesy consistency. _treatment._--if the tumor is well opened and the matter squeezed out, nature will perform a cure. if the opening is made from the outside through the skin, it should be at the most dependent part, but much the best way to open the tumor is from the inside. quiet the animal, gently insert your finger up in the direction of the tumor, and you will soon discover that it is much larger inside than it appears to be on the outside. if necessary put a twitch on the ear of the horse to quiet him; run the index finger of your left hand against the tumor; now, with the right hand, carefully insert the knife by running the back of the blade along the index finger of the left hand until the tumor is reached; with the left index finger guide the point of the blade quickly and surely into the tumor; make the opening large. a little blood may flow for a while, but it is of no consequence. squeeze out the matter and keep the part clean. cold in the head, or nasal catarrh. catarrh is an inflammation of a mucous membrane. it is accompanied with excessive secretion. in nasal catarrh the inflammation may extend from the membrane lining the nose to the throat, the inside of the sinuses, and to the eyes. the causes are the general causes of respiratory disease enumerated above. it is especially common in young horses and in horses not acclimated. _symptoms._--the membrane at the beginning of the attack is dry, congested, and irritable; it is of a deeper hue than natural, pinkish red or red. soon a watery discharge from the nostrils makes its appearance; the eyes may also be more or less affected and tears flow over the cheeks. the animal has some fever, which may be easily detected by means of a clinical thermometer inserted in the rectum or, roughly, by placing the finger in the mouth, as the feeling of heat conveyed to the finger will be greater than natural. to become somewhat expert in ascertaining the changes of temperature in the horse it is only necessary to place the finger often in the mouths of horses known to be healthy. after you have become accustomed to the warmth of the mouth of the healthy animal you will have no difficulty in detecting a marked increase of the temperature. the animal may be dull; he sneezes or snorts, but does not cough unless the throat is affected; he expels the air forcibly through his nostrils, very often in a manner that may be aptly called "blowing his nose." a few days after the attack begins the discharge from the nostrils changes from a watery to that of a thick, mucilaginous state, of a yellowish-white color, and may be more or less profuse. often the appetite is lost and the animal becomes debilitated. _treatment._--this disease is not serious, but inasmuch as neglect or bad treatment may cause it to lead to something worse or become chronic it should receive proper attention. the animal should not be worked for a time. a few days of rest, with pure air and good feed, will be of greater benefit than most medication. the value of pure air can not be overestimated, but drafts must be avoided. the benefit derived from the inhalation of steam is considerable. this is effected by holding the horse's head over a bucketful of boiling water, so that the animal will be compelled to inhale steam with every inhalation of air. stirring the hot water with a wisp of hay causes the steam to arise in greater abundance. one may cause the horse to put his nose in a bag containing cut hay upon which hot water has been poured, the bottom of the bag being stood in a bucket, but the bag must be of loose texture, as gunny sack, or, if of canvas, holes must be cut in the side to admit fresh air. the horse may be made to inhale steam four or five times a day, about or minutes each time. particular attention should be paid to the diet. give bran mashes, scalded oats, linseed gruel, and grass, if in season. if the horse evinces no desire for this soft diet, it is better to allow any kind of feed he will eat, such as hay, oats, corn, etc., than to keep him on short rations. if the animal is constipated, relieve this symptom by injections (enemas) of warm water into the rectum three or four times a day, but do not administer purgative medicines, except of a mild character. for simple cases the foregoing is all that is required, but if the appetite is lost and the animal appears debilitated and dull, give ounces of the solution of acetate of ammonia and drams of powdered chlorate of potassium diluted with a pint of water three times a day as a drench. be careful when giving the drench; do not pound the horse on the gullet to make him swallow; be patient, and take time, and do it right. if the weather is cold, blanket the animal and keep him in a comfortable stall. if the throat is sore, treat as advised for that ailment, to be described hereafter. if, after days or weeks, the discharge from the nostrils continues, give one-half dram of reduced iron three times a day. this may be mixed with damp feed. common cold should be thoroughly understood and intelligently treated in order to prevent more dangerous diseases. chronic catarrh (or nasal gleet, or collection in the sinuses). this is a subacute or chronic inflammation of some part of the membrane affected in common cold, the disease just described. it is manifested by a persistent discharge of a thick white or yellowish-white matter from one or both nostrils. the commonest cause is a neglected or badly treated cold, and it usually follows those cases where the horse has suffered exposure, been overworked, or has not received proper feed, and, as a consequence, has become debilitated. it may occur as a sequel to influenza. other but less frequent causes for this affection are: fractures of the bones that involve the membrane of the sinuses, and even blows on the head over the sinuses. diseased teeth often involve a sinus and cause a fetid discharge from the nostril. violent coughing is said to have forced particles of feed into the sinus, which acted as a cause of the disease. tumors growing in the sinuses are known to have caused it. it is also attributed to disease of the turbinated bones. absorption of the bones forming the walls of the sinuses has been caused by the pressure of pus collecting in them and by tumors filling up the cavity. _symptoms._--great caution must be exercised when examining these cases, for the horse may have glanders, while, on the other hand, horses have been condemned as glandered when really there was nothing ailing them but nasal gleet. this is not contagious, but may stubbornly resist treatment and last for a long time. in most cases the discharge is from one nostril only, which may signify that the sinuses on that side of the head are affected. the discharge may be intermittent; that is, quantities may be discharged at times and again little or none for a day or so. such an intermittent discharge usually signifies disease of the sinuses. the glands under and between the bones of the lower jaw may be enlarged. the peculiar ragged-edged ulcer of glanders is not to be found on the membrane within the nostrils, but occasionally sores are to be seen there. if there is any doubt about it, the symptoms of glanders should be well studied in order that one may be competent to form a safe opinion. the eye on the side of the discharging nostril may have a peculiar appearance and look smaller than its fellow. there may be an enlargement, having the appearance of a bulging out of the bone over the part affected, between or below the eyes. the breath may be offensive, which indicates decomposition of the matter or bones or disease of the teeth. a diseased tooth is further indicated by the horse holding his head to one side when eating, or by dropping the feed from the mouth after partly chewing it. when the bones between the eyes, below the eyes, and above the back teeth of the upper jaw are tapped on, a hollow, drumlike sound is emitted, but if the sinus is filled with pus or contains a large tumor the sound emitted will be the same as if a solid substance were struck; by this means the sinus affected may be located in some instances. the hair may be rough over the affected part, or even the bone may be soft to the touch and the part give somewhat to pressure or leave an impression where it is pressed upon with the finger. _treatment._--the cause of the trouble must be ascertained before treatment is commenced. in the many cases in which the animal is in poor condition (in fact, in all cases) he should have the most nutritive feed and regular exercise. the feed, or box containing it, should be placed on the ground, as the dependent position of the head favors the discharge. the cases that do not require a surgical operation must, as a rule, have persistent medical treatment. mineral tonics and local medication are of the most value. for eight days give the following mixture: reduced iron, ounces; powdered nux vomica, ounce. mix and make into powders; one powder should be mixed with the feed twice a day. arsenious acid (white arsenic) in doses of from to grains three times daily is a good tonic for such cases. sulphur burnt in the stable while the animal is there to inhale its fumes is also a valuable adjunct. care should be taken that the fumes of the burning sulphur are sufficiently diluted with air so as not to suffocate the horse. chlorid of lime sprinkled around the stall is good. also keep a quantity of it under the hay in the manger so that the gases will be inhaled as the horse holds his head over the hay while eating. keep the nostrils washed and the discharge cleaned away from the manger and stall. the horse may be caused to inhale the vapor of compound tincture of benzoin by pouring ounces of this drug into hot water and fumigating in the usual way. if the nasal gleet is the result of a diseased tooth, the latter must be removed. trephining is the best possible way to remove it in such cases, as the operation immediately opens the cavity, which can be attended to direct. in all those cases of nasal gleet in which sinuses contain either tumors or collections of pus the only relief is by the trephine; and, no matter how thoroughly described, this is an operation that will be seldom attempted by the nonprofessional. it would therefore be a waste of time to give the modus operandi. an abscess involving the turbinated bones is similar to the collection of pus in the sinuses and must be relieved by trephining. thickening of the nasal membrane. this is sometimes denoted by a chronic discharge, a snuffling in the breathing, and a contraction of the nostril. it is a result of common cold and requires the same treatment as prescribed for nasal gleet, namely, the sulphate of iron, sulphate of copper, iodid of potassium, etc. the membranes of both sides may be affected, but one side only is the rule; the affected side may be easily detected by holding the hand tightly over one nostril at a time. when the healthy side is closed in this manner the breathing through the affected side will demonstrate a decreased caliber or an obstruction. nasal polypus. tumors with narrow bases (somewhat pear-shaped) are occasionally found attached to the membrane of the nasal chambers, and are obstructions to breathing through the side in which they are located. they vary much in size; some are so small that their presence is not manifested, while others almost completely fill the chamber, thereby causing a serious obstruction to the passage of air. the stem, or base, of the tumor is generally attached high in the chamber, and usually the tumor can not be seen, but occasionally it increases in size until it can be observed within the nostril. sometimes, instead of hanging down toward the nasal opening, it falls back into the pharynx. it causes a discharge from the nostril, a more or less noisy snuffling sound in breathing, according to its size, a discharge of blood (if it is injured), and sneezing. the side that it occupies can be detected in the same way as described for the detection of the affected side when the breathing is obstructed by a thickened membrane. the only relief is removal of the polypus, which, like all other operations, should be done by an expert when it is possible to obtain one. the operation is performed by grasping the base of the tumor with suitable forceps and twisting it round and round until it is torn from its attachment, or by cutting it off with a noose of wire. the resulting hemorrhage is checked by the use of an astringent lotion, such as a solution of the tincture of iron, or by packing the nostrils with surgeon's gauze. pharyngeal polypus. this is exactly the same kind of tumor described as nasal polypus, the only difference being in the situation. indeed, the stem of the tumor may be attached to the membrane of the nasal chamber, as before explained, or it may be attached in the fauces (opening of the back part of the mouth), and the body of the tumor then falls into the pharynx. in this situation it may seriously interfere with breathing. sometimes it drops into the larynx, causing the most alarming symptoms. the animal coughs, or tries to cough, saliva flows from the mouth, the breathing is performed with the greatest difficulty and accompanied with a loud noise; the animal appears as if strangled and often falls exhausted. when the tumor is coughed out of the larynx the animal regains quickly and soon appears as if nothing were ailing. these sudden attacks and quick recoveries point to the nature of the trouble. the examination must be made by holding the animal's mouth open with a balling iron or speculum and running the hand back into the mouth. if the tumor is within reach, it must be removed in the same manner as though it were in the nose. bleeding from the nose. this often occurs during the course of certain diseases, namely, influenza, bronchitis, purpura hemorrhagica, glanders, etc. but it also occurs independently of other affections and, as before mentioned, is a symptom of polypus, or tumor, in the nose. injuries to the head, exertion, violent sneezing--causing a rupture of a small blood vessel--also induce it. the bleeding is almost invariably from one nostril only, and is never very serious. the blood escapes in drops (seldom in a stream) and is not frothy, as when the hemorrhage is from the lungs. (see bleeding from the lungs, p. .) in most cases bathing the head and washing out the nostril with cold water are all that is necessary. if the cause is known, you will be guided according to circumstances. if the bleeding continues, pour ice-cold water over the face, between the eyes and down over the nasal chambers. a bag containing ice in small pieces applied to the head is often efficient. if in spite of these measures the hemorrhage continues, plugging the nostrils with cotton, tow, or oakum, should be tried. a string should be tied around the plug before it is pushed up into the nostril, so that it can be safely withdrawn after or hours. if both nostrils are bleeding, only one nostril at a time should be plugged. if the hemorrhage is profuse and persistent, a drench composed of dram of acetate of lead dissolved in pint of water, or ergot, ounce, should be given. inflammation of the pharynx. as already stated, the pharynx is common to the functions of both respiration and alimentation. from this organ the air passes into the larynx and thence onward to the lungs. in the posterior part of the pharynx is the superior extremity of the gullet, the canal through which the feed and water pass to the stomach. inflammation of the pharynx is a complication of other diseases--namely, influenza, strangles, etc.--and is probably always more or less complicated with inflammation of the larynx. that it may exist as an independent affection there is no reason to doubt, and it is discussed as such with the diseases of the digestive tract. sore throat, or laryngitis. the larynx is situated in the space between the lower jawbones just back of the root of the tongue. it may be considered as a box (somewhat depressed on each side), composed principally of cartilages and small muscles, and lined on the inside with a continuation of the respiratory mucous membrane. posteriorly it opens into and is continuous with the windpipe. it is the organ of the voice, the vocal cords being situated within it; but in the horse this function is of little consequence. it dilates and contracts to a certain extent, thus regulating the volume of air passing through it. the mucous membrane lining it internally is so highly sensitive that if the smallest particle of feed happens to drop into it from the pharynx violent coughing ensues instantly and is continued until the source of irritation is ejected. this is a provision of nature to prevent foreign substances gaining access to the lungs. that projection called adam's apple in the neck of man is the prominent part of one of the cartilages forming the larynx. inflammation of the larynx is a serious and sometimes fatal disease, and, as before stated, is usually complicated with inflammation of the pharynx, constituting what is popularly known as "sore throat." the chief causes are chilling and exposure. _symptoms._--about the first symptom noticed is cough, followed by difficulty in swallowing, which may be due to soreness of the membrane of the pharynx, over which the feed or water must pass, or from the pain caused by the contraction of the muscles necessary to impel the feed or water onward to the gullet; or this same contraction of the muscles may cause a pressure on the larynx and produce pain. in many instances the difficulty in swallowing is so great that water, and in some cases feed, is returned through the nose. this, however, does not occur in laryngitis alone, but only when the pharynx is involved in the inflammation. the glands between the lower jawbones and below the ears may be swollen. pressure on the larynx induces coughing. the head is more or less "poked out," and has the appearance of being stiffly carried. the membrane in the nose becomes red. a discharge from the nostrils soon appears. as the disease advances, the breathing may assume a more or less noisy character; sometimes a harsh, rasping snore is emitted with every respiration, the breathing becomes hurried, and occasionally the animal seems threatened with suffocation. _treatment._--in all cases steam the nostrils, as has been advised for cold in the head. in bad cases cause the steam to be inhaled continuously for hours--until relief is afforded. have a bucketful of fresh boiling water every fifteen or twenty minutes. in each bucketful of water put a tablespoonful of oil of turpentine, or compound tincture of benzoin, the vapor of which will be carried along with the steam to the affected parts and have a beneficial effect. in mild cases steaming the nostrils five, six, or seven times a day will suffice. the animal should be placed in a comfortable, dry stall (a box stall preferred), and should have pure air to breathe. the body should be blanketed, and bandages applied to the legs. the diet should consist of soft feed--bran mashes, scalded oats, linseed gruel, and, best of all, fresh grass, if in season. the manger, or trough, should neither be too high nor too low, but a temporary one should be constructed at about the height he carries his head. having to reach too high or too low may cause so much pain that the animal would rather forego satisfying what little appetite he may have than inflict pain by craning his head for feed or water. a supply of fresh water should be before him all the time; he will not drink too much, nor will the cold water hurt him. constipation (if present) must be relieved by enemas of warm water, administered three or four times during the twenty-four hours. a liniment composed of ounces of olive oil and each of solution of ammonia and tincture of cantharides, well shaken together, may be thoroughly rubbed in about the throat from ear to ear, and about inches down over the windpipe, and in the space between the lower jaws. this liniment should be applied once a day for two or three days. if the animal is breathing with great difficulty, persevere in steaming the nostrils, and dissolve drams of chlorate of potassium in every gallon of water he will drink; even if he can not swallow much of it, and even if it is returned through the nostrils, it will be of some benefit to the pharynx as a gargle. an electuary of acetate of potash, drams, honey, and licorice powder may be spread on the teeth with a paddle every few hours. if the pain of coughing is great, or grains of morphin may be added to the electuary. when the breathing begins to be loud, relief is afforded in some cases by giving a drench composed of drams of fluid extract of jaborandi in half a pint of water. if benefit is derived, this drench may be repeated four or five hours after the first dose is given. it will cause a free flow of saliva from the mouth. in urgent cases, when suffocation seems inevitable, the operation of tracheotomy must be performed. to describe this operation in words that would make it comprehensible to the general reader is a more difficult task than performing the operation, which, in the hands of the expert, is simple and attended with little danger. the operator should be provided with a tracheotomy tube (to be purchased from any veterinary instrument maker) and a sharp knife, a sponge, and a bucket of clean cold water. the place to be selected for opening the windpipe is that part which is found, upon examination, to be least covered with muscles, about or inches below the throat. right here, then, is the place to cut through. have an assistant hold the animal's head still. grasp your knife firmly in the right hand, select the spot and make the cut from above to below directly on the median line on the anterior surface of the windpipe. make the cut about inches long in the windpipe; this necessitates cutting three or four rings. one bold stroke is usually sufficient, but if it is necessary to make several other cuts to finish the operation, do not hesitate. your purpose is to make a hole in the windpipe sufficiently large to admit the tracheotomy tube. it is quickly manifested when the windpipe is severed; the hot air rushes out, and when air is taken in it is sucked in with a noise. a slight hemorrhage may result (it never amounts to much), which is easily controlled by washing the wound with a sponge and cold water, but use care not to get any water in the windpipe. do not neglect to instruct your assistant to hold the head down immediately after the operation, so that the neck will be in a horizontal line. this will prevent the blood from getting into the windpipe and will allow it to drop directly on the ground. if you have the self-adjustable tube, it retains its place in the wound without further trouble after it is inserted. the other kind requires to be secured in position by means of two tapes or strings tied around the neck. after the hemorrhage is somewhat abated, sponge the blood away and see that the tube is thoroughly clean, then insert it, directing the tube downward toward the lungs. the immediate relief this operation affords is gratifying to behold. the animal, a few minutes before on the verge of death from suffocation, emitting a loud wheezing sound with every breath, with haggard countenance, body swaying, pawing, gasping, fighting for breath, now breathes tranquilly, and may be in search of something to eat. the tube should be removed once a day and cleaned with carbolic-acid solution ( to ), and the discharge washed away from the wound with a solution of carbolic acid, part to parts water. several times a day the hand should be held over the opening in the tube to test the animal's ability to breathe through the nostrils, and as soon as it is demonstrated that breathing can be performed in the natural way the tube should be removed, the wound thoroughly cleansed with carbolic-acid solution ( to ), and closed by inserting four or five stitches through the skin and muscle. do not include the cartilages of the windpipe in the stitches. apply the solution to the wound three or four times a day until healed. when the tube is removed to clean it the lips of the wound may be pressed together to ascertain whether or not the horse can breathe through the larynx. the use of the tube should be discontinued as soon as possible. it is true that tracheotomy tubes are seldom to be found on farms, and especially when most urgently required. in such instances there is nothing left to be done but, with a strong needle, pass a waxed end or other strong string through each side of the wound, including the cartilage of the windpipe, and keep the wound open by tying the strings over the neck. during the time the tube is used the other treatment advised must not be neglected. after a few days the discharge from the nostrils becomes thicker and more profuse. this is a good symptom and signifies that the acute stage has passed. at any time during the attack, if the horse becomes weak, give whisky or aromatic spirits of ammonia, ounces in water. do not be in a hurry to put the animal back to work, but give plenty of time for a complete recovery. gentle and gradually increasing exercise may be given as soon as the horse is able to stand it. the feed should be carefully selected and of good quality. tonics, as iron or arsenic, may be employed. if abscesses form in connection with the disease they must be opened to allow the escape of pus, but do not rashly plunge a knife into swollen glands; wait until you are certain the swelling contains pus. the formation of pus may be encouraged by the constant application of poultices for hours at a time. the best poultice for the purpose is made of linseed meal, with sufficient hot water to make a thick paste. if the glands remain swollen for some time after the attack, rub well over them an application of the following: biniodid of mercury, dram; lard, ounce; mix well. this may be applied once every day until the part is blistered. sore throat is also a symptom of other diseases, such as influenza, strangles, purpura hemorrhagica, etc., which diseases may be consulted under their proper headings. after a severe attack of inflammation of the larynx the mucous membrane may be left in a thickened condition, or an ulceration of the part may ensue, either of which is liable to produce a chronic cough. for the ulceration it is useless to prescribe, because it can neither be diagnosed nor topically treated by the nonprofessional. if a chronic cough remains after all the other symptoms have disappeared, it is advisable to give dram of iodid of potassium dissolved in a bucketful of drinking water, one hour before feeding, three times a day for a month if necessary. also rub in well the preparation of iodid of mercury (as advised for the swollen glands) about the throat, from ear to ear, and in the space between the lower jawbones. the application may be repeated every third day until the part is blistered. spasm of the larynx. the symptoms are as follows: sudden seizure by a violent fit of coughing; the horse may reel and fall, and after a few minutes recover and be as well as ever. the treatment recommended is this: three drams of bromid of potassium three times a day, dissolved in the drinking water, or give as a drench in about a half pint of water for a week. then give dram of powdered nux vomica (either on the food or shaken with water as a drench) once a day for a few weeks. croup and diphtheria. neither of these diseases affects the horse, but these names are sometimes wrongly applied to severe laryngitis or pharyngitis, or to forage poisoning, in which the throat is paralyzed and becomes excessively inflamed and gangrenous. thick wind and roaring. horses that are affected with chronic disease that causes a loud, unnatural noise in breathing are said to have thick wind, or to be roarers. this class does not include those affected with severe sore throat, as in these cases the breathing is noisy only during the attack of the acute disease. thick wind is caused by an obstruction to the free passage of the air in some part of the respiratory tract. nasal polypi, thickening of the membrane, pharyngeal polypi, deformed bones, paralysis of the wing of the nostril, etc., are occasional causes. the noisy breathing of horses after having been idle and put to sudden exertion is not due to any disease and is only temporary. very often a nervous, excitable horse will make a noise for a short time when started off, generally caused by the cramped position in which the head and neck are forced in order to hold him back. many other causes may occasion temporary, intermittent, or permanent noisy respiration, but chronic roaring is caused by paralysis of the muscles of the larynx; and almost invariably it is the muscles of the left side of the larynx that are affected. in chronic roaring the noise is made when the air is drawn into the lungs; only when the disease is far advanced is a sound produced when the air is expelled, and even then it is not nearly so loud as during inspiration. in a normal condition the muscles dilate the aperture of the larynx by moving the cartilage and vocal cord outward, allowing a sufficient volume of air to rush through. but when the muscles are paralyzed the cartilage and vocal cord that are normally controlled by the affected muscles lean into the tube of the larynx, so that when the air rushes in it meets this obstruction and the noise is produced. when the air is expelled from the lungs its very force pushes the cartilage and vocal cords out, and consequently noise is not produced in the expiratory act. the paralysis of the muscles is due to derangement of the nerve that supplies them with energy. the muscles of both sides are not supplied by the same nerve; there is a right and a left nerve, each supplying its respective side. the reason why the muscles on the left side are the ones usually paralyzed is owing to the difference in the anatomical arrangement of the nerves. the left nerve is much longer and more exposed to interference than the right nerve. in chronic roaring there is no evidence of any disease of the larynx other than the wasted condition of the muscles in question. the disease of the nerve is generally far from the larynx. disease of parts contiguous to the nerve along any part of its course may interfere with its proper function. enlargement of lymphatic glands within the chest through which the nerve passes on its way back to the larynx is the most frequent interruption of nervous supply, and consequently roaring. when roaring becomes confirmed, medical treatment is entirely useless, as it is impossible to restore the wasted muscle and at the same time remove the cause of the interruption of the nervous supply. before roaring becomes permanent the condition may be benefited by a course of iodid of potassium, if caused by disease of the lymphatic glands. electricity has been used with indifferent success. blistering or firing over the larynx is, of course, not worthy of trial if the disease is due to interference of the nerve supply. the administration of strychnia (nux vomica) on the ground that it is a nerve tonic with the view of stimulating the affected muscles is treating only the result of the disease without considering the cause, and is therefore useless. the operation of extirpating the collapsed cartilage and vocal cord is believed to be the only relief, and, as this operation is critical and can be performed only by the skillful veterinarian, it will not be described here. from the foregoing description of the disease it will be seen that the name "roaring," by which the disease is generally known, is only a symptom and not the disease. chronic roaring is also in many cases accompanied with a cough. the best way to test whether a horse is a "roarer" is either to make him pull a load rapidly up a hill or over a sandy road or soft ground; or, if he is a saddle horse, gallop him up a hill or over soft ground. the object is to make him exert himself. some horses require a great deal more exertion than others before the characteristic sound is emitted. the greater the distance he is forced, the more he will appear exhausted if he is a roarer; in bad cases the animal becomes utterly exhausted, the breathing is rapid and difficult, the nostrils dilate to the fullest extent, and the animal appears as if suffocation was imminent. an animal that is a roarer should not be used for breeding purposes. the taint is transmissible in many instances. _grunting._--a common test used by veterinarians when examining "the wind" of a horse is to see if he is a "grunter." this is a sound emitted during expiration when the animal is suddenly moved, or startled, or struck at. if he grunts he is further tested for roaring. grunters are not always roarers, but, as it is a common thing for a roarer to grunt, such an animal must be looked upon with suspicion until he is thoroughly tried by pulling a load or galloped up a hill. the test should be a severe one. horses suffering with pleurisy, pleurodynia, or rheumatism, and other affections accompanied with much pain, will grunt when moved, or when the pain is aggravated, but grunting under these circumstances does not justify the term of "grunter" being applied to the horse, as the grunting ceases when the animal recovers from the disease that causes the pain. _high blowing._--this term is applied to a noisy breathing made by some horses. it is distinctly a nasal sound, and must not be confounded with "roaring." the sound is produced by the action of the nostrils. it is a habit and not an unsoundness. contrary to roaring, when the animal is put to severe exertion the sound ceases. an animal that emits this sound is called a "high blower." some horses have naturally very narrow nasal openings, and they may emit sounds louder than usual in their breathing when exercised. _whistling_ is only one of the variations of the sound emitted by a horse called a "roarer," and therefore needs no further notice, except to remind the reader that a whistling sound may be produced during an attack of severe sore throat or inflammation of the larynx, which passes away with the disease that causes it. chronic bronchitis. this may be due to the same causes as acute bronchitis or it may follow the latter disease. an attack of the chronic form is liable to be converted into acute bronchitis by a very slight cause. this chronic affection in most instances is associated with thickening of the walls of the tubes. its course is slower, it is less severe, and is not accompanied with so much fever as the acute form. if the animal is exerted, the breathing becomes quickened and he soon shows signs of exhaustion. in many instances the animal keeps up strength and appearances moderately well, but in other cases the appetite is lost, flesh gradually disappears, and he becomes emaciated and debilitated. it is accompanied with a persistent cough, which in some cases is husky, smothered, or muffled, while in others it is hard and clear. a whitish matter, which may be curdled, is discharged from the nose. if the ear is placed against the chest behind the shoulder blade, the rattle of the air passing through the mucus can be heard within. _treatment._--rest is necessary, as even under the most favorable circumstances a cure is difficult to effect. the animal can not stand exertion and should not be compelled to undergo it. it should have much the same general care and medical treatment prescribed for the acute form. arsenious acid in tonic doses ( to grains) three times daily may be given. as arsenic is irritant, it must be mixed with a considerable bulk of moist feed and never given alone. arsenic may be given in the form of fowler's solution, ounce three times daily in the drinking water. an application of mustard applied to the breast is a beneficial adjunct. the diet should be the most nourishing. bulky feed should not be given. linseed mashes, scalded oats, and, if in season, grass and green-blade fodder are the best diet. the lungs. the lungs (see pl. vii) are the essential organs of respiration. they consist of two (right and left) spongy masses, commonly called the "lights," situated entirely within the thoracic cavity. on account of the space taken up by the heart, the left lung is the smaller. externally, they are completely covered by the pleura. the structure of the lung consists of a light, soft, but very strong and remarkably elastic tissue, which can be torn only with difficulty. each lung is divided into a certain number of lobes, which are subdivided into numberless lobules (little lobes). a little bronchial tube terminates in every one of these lobules. the little tube then divides into minute branches which open into the air cells (pulmonary vesicles) of the lungs. the air cells are little sacs having a diameter varying from one-seventieth to one two-hundredth of an inch; they have but one opening, the communication with the branches of the little bronchial tubes. small blood vessels ramify in the walls of the air cells. the air cells are the consummation of the intricate structures forming the respiratory apparatus. they are of prime importance, all the rest being complementary. it is here that the exchange of gases takes place. as before stated, the walls of the cells are very thin; so, also, are the walls of the blood vessels. through these walls escapes from the blood the carbonic acid gas that has been absorbed by the blood in its circulation through the different parts of the body; through these walls also the oxygen gas, which is the life-giving element of the atmosphere, is absorbed by the blood from the air in the air cells. congestion of the lungs. congestion is essentially an excess of blood in the vessels of the parts affected. congestion of the lungs in the horse, when it exists as an independent affection, is generally caused by overexertion when the animal is not in a fit condition to undergo more than moderate exercise. very often what is recognized as congestion of the lungs is but a symptom of exhaustion or dilatation of the heart. the methods practiced by the trainers of running and trotting horses will give an idea of what is termed "putting a horse in condition" to stand severe exertion. the animal at first gets walking exercises, then after some time he is made to go faster and farther each day; the amount of work is daily increased until he is said to be "in condition." an animal so prepared runs no risk of being affected with congestion of the lungs, if he is otherwise healthy. on the other hand, if the horse is kept in the stable for the purpose of laying on fat or for want of something to do, the muscular system becomes soft, and the horse is not in condition to stand the severe exertion of going fast or far, no matter how healthy he may be in other respects. if such a horse be given a hard ride or drive, he may start off in high spirits, but soon becomes exhausted, and if he is pushed he will slacken his pace, show a desire to stop, and may stagger or even fall. examination will show the nostrils dilated, the flanks heaving, the countenance haggard, and the appearance of suffocation. the heart and muscles were not accustomed to the sudden and severe strain put upon them; the heart became unable to perform its work; the blood accumulated in the vessels of the lungs, which eventually became engorged with the stagnated blood, constituting congestion of the lungs. the animal, after having undergone severe exertion, may not exhibit alarming symptoms until returned to the stable; then he will be noticed standing with his head down, legs spread out, the eyes wildly staring or dull and sunken. the breathing is very rapid and almost gasping; in most cases the body is covered with perspiration, which, however, may soon evaporate, leaving the surface of the body and the legs and ears cold; the breathing is both abdominal and thoracic; the chest rises and falls and the flanks are powerfully brought into action. if the pulse can be felt at all it will be found beating very frequently, one hundred or so to a minute. the heart may be felt tumultuously thumping if the hand is placed against the chest behind the left elbow, or it may be scarcely perceptible. the animal may tremble all over. if the ear is placed against the side of the chest a loud murmur will be heard and perhaps a fine, crackling sound. one can scarcely fail to recognize a case of congestion of the lungs when brought on by overexertion, as the history of the case indicates the nature of the ailment. in all cases of suffocation the lungs are congested. it is also seen in connection with other diseases. _treatment._--if the animal is attacked by the disease while on the road, stop him immediately. do not attempt to return to the stables. if he is in the stable, make arrangements at once to insure an unlimited supply of pure air. if the weather is warm, out in the open air is the best place, but if too cold let him stand with head to the door. let him stand still; he has all he can do, if he obtains sufficient pure air to sustain life. if he is encumbered with harness or saddle, remove it at once and rub the body with cloths or wisps of hay or straw. this stimulates the circulation in the skin, and thus aids in relieving the lungs of the extra quantity of blood that is stagnated there. if you have three or four assistants, let them rub the body and legs well until the skin feels natural; rub the legs until they are warm, if possible. when the circulation is reestablished, put bandages on the legs from the hoofs up as far as possible. throw a blanket over the body and let the rubbing be done under the blanket. diffusible stimulants are the medicines indicated--brandy, whisky (or even ale or beer if nothing else is at hand), ether, and aromatic spirits of ammonia. a drench of ounces each of spirits of nitrous ether and alcohol, diluted with a pint of water, every hour until relief is afforded, is among the best remedies. or, give a quarter of a pint of whisky in a pint of water every hour, or the same quantity of brandy as often, or a quart of ale every hour, or ounce of tincture of arnica in a pint of water every hour until five or six doses have been given. if none of these remedies are at hand, ounces of oil of turpentine, shaken with a half pint of milk, may be given once, but not repeated. the animal may be bled from the jugular vein. do not take more than or quarts from the vein, and do not repeat the bleeding. the blood thus drawn will have a tarry appearance. [illustration: plate vii. position of the left lung.] when the alarming symptoms have subsided active measures may be stopped, but care must be used in the general treatment of the animal for several days, for it must be remembered that congestion may be followed by pneumonia. the animal should have a comfortable stall, where he will not be subjected to drafts or sudden changes of temperature; he should be blanketed and the legs kept bandaged. the air should be pure, a plentiful supply of fresh, cold water always in the stall; and a diet composed principally of bran mashes, scalded oats, and, if in season, grass. when ready for use again the horse should at first receive only moderate exercise, which may be daily increased until he may safely be put to regular work. pneumonia, or lung fever. pneumonia is inflammation of the lungs. the chief varieties of pneumonia are catarrhal--later discussed in connection with bronchitis, under the name of broncho-pneumonia--and the fibrinous or croupous variety. the latter form receives its names from the fact that the air spaces are choked with coagulated fibrin thrown out from the blood. this causes the diseased portions of the lungs to become as firm as liver, in which condition they are said to be hepatized. as air is excluded by the inflammatory product, the diseased lung will not float in water. the inflammation usually begins in the lower part of the lung and extends upward. the first stage of the disease consists of congestion, or engorgement, of the blood vessels, followed by leakage of serum containing fibrin from the blood vessels into the air passages. the fluids thus escaping into the air cells and in the minute branches of the little bronchial tubes become coagulated. the pleura covering the affected parts may be more or less inflamed. a continuance of the foregoing phenomena is marked by a further escape of the constituents of the blood, and a change in the membrane of the cells, which becomes swollen. the exudate that fills the air cells and minute bronchial branches undergoes disintegration and softening when healing commences. the favorable termination of pneumonia is in resolution that is, a restoration to health. this is gradually brought about by the exuded material contained in the air cells and lung tissues being broken down and softened and absorbed or expectorated through the nostrils. the blood vessels return to their natural state, and the blood circulates in them as before. in the cases that do not terminate so happily the lung may become gangrenous (or mortified), an abscess may form, or the disease may be merged into the chronic variety. pneumonia may be directly induced by any of the influences named as general causes for diseases of the organs of respiration, but in many instances it is from neglect. a common cold or sore throat may be followed by pneumonia if neglected or improperly treated. an animal may be debilitated by a cold, and when in this weakened state may be compelled to undergo exertion beyond his strength; or he may be kept in a badly ventilated stable, where the foul gases are shut in and the pure air is shut out; or the stable may be so open that parts of the body are exposed to drafts of cold air. an animal is predisposed to pneumonia when debilitated by any constitutional disease, and especially during convalescence if exposed to any of the exciting causes. foreign bodies, such as feed accidentally getting into the lungs by way of the windpipe, as well as the inhalation of irritating gases and smoke, ofttimes produce fatal attacks of inflammation of the lung and bronchial tubes. pneumonia is frequently seen in connection with other diseases, such as influenza, purpura hemorrhagica, strangles, glanders, etc. pneumonia and pleurisy are most common during cold, damp weather, and especially during the prevalence of the cold north or northeasterly winds. wounds puncturing the thoracic cavity may cause pneumonia. _symptoms._--pneumonia, when a primary disease, is ushered in by a chill, more or less prolonged, which in many cases is seen neither by the owner nor the attendant, but is overlooked. the breathing becomes accelerated, and the animal hangs its head and has a very dull appearance. the mouth is hot and has a sticky feeling to the touch; the heat conveyed to the finger in the mouth demonstrates a fever; if the thermometer is placed in the rectum the temperature will be found to have risen to ° f. or higher. the pulse is frequent, beating from fifty or sixty to eighty or more a minute. there is usually a dry cough from the beginning, which, however, changes in character as the disease advances; for instance, it may become moist, or if pleurisy sets in, the cough will be peculiar to the latter affection; that is, cut short in the endeavor to suppress it. in some cases the discharge from the nostrils is tinged with blood, while in other cases it has the appearance of muco-pus. the appetite is lost to a greater or less extent, but the desire for water is increased, particularly during the onset of the fever. the membrane within the nostrils is red and at first dry, but sooner or later becomes moist. the legs are cold. the bowels are more or less constipated, and what dung is passed is usually covered with a slimy mucus. the urine is passed in smaller quantities than usual and is of a darker color. the animal prefers to have the head where the freshest air can be obtained. when affected with pneumonia a horse does not lie down, but persists in standing from the beginning of the attack. if pneumonia is complicated with pleurisy, however, the horse may appear restless and lie down for a few moments to gain relief from the pleuritic pains, but he soon rises. in pneumonia the breathing is rapid and difficult, but when the pneumonia is complicated with pleurisy the ribs are kept as still as possible and the breathing is abdominal; that is, the abdominal muscles are now made to do as much of the work as they can perform. if pleurisy is not present there is little pain. to the ordinary observer the animal may not appear dangerously ill, as he does not show the seriousness of the ailment by violence, as in colic, but a careful observer will discover at a glance that the trouble is something more serious than a cold. by percussion it will be shown that some portions of the chest are less resonant than in health, indicating exclusion of air. if the air is wholly excluded the percussion is quite dull, like that elicited by percussion over the thigh. by auscultation important information may be gained. when the ear is placed against the chest of a healthy horse, the respiratory murmur is heard more or less distinctly, according to the part of the chest that is beneath the ear. in the very first stage of pneumonia this murmur is louder and hoarser; also, there is a fine, crackling sound something similar to that produced when salt is thrown in a fire. after the affected part becomes solid there is an absence of sound over that particular part. after absorption begins one may again hear sounds that are of a more or less moist character and resemble bubbling or gurgling, which gradually change until the natural sound is heard announcing return to health. when a fatal termination is approaching all the symptoms become intensified. the breathing becomes still more rapid and difficult; the flanks heave; the animal stares wildly about as if seeking aid to drive off the feeling of suffocation; the body is bathed with sweat; the horse staggers, but quickly recovers his balance; he may now, for the first time during the attack, lie down; he does so, however, in the hope of relief, which he fails to find, and with difficulty struggles to his feet; he pants; the nostrils flap; he staggers and sways from side to side and backward and forward, but still tries to retain the standing position, even by propping himself against the stall. it is no use, as after an exhausting fight for breath he goes down; the limbs stretch out and become rigid. in fatal cases death usually occurs in from to days after the beginning of the attack. on the other hand, when the disease is terminating favorably the signs are obvious. the fever abates and the animal gradually improves in appetite; he takes more notice of things around him; his spirits improve; he has a general appearance of returning health, and he lies down and rests. in the majority of cases pneumonia, if properly treated, terminates in recovery. _treatment._--the comfort and surroundings of the patient must be attended to first. the quarters should be the best that can be provided. pure air is essential. avoid placing the animal in a stall where he may be exposed to drafts of cold air and sudden changes of temperature. it is much better for the animal if the air is cold and pure than if it is warm and foul. it is better to make the animal comfortable with warm clothing than to make the stable warm by shutting off the ventilation. from the start the animal should have an unlimited supply of fresh, cold drinking water. blanket the body. rub the legs until they are warm and then put bandages on them from the hoofs up to the knees and hocks. if warmth can not be reestablished in the legs by hand rubbing alone, apply dry, ground mustard and rub well in. the bandages should be removed once or twice every day, the legs well rubbed, and the bandages replaced. much harm is often done by clipping off hair and rubbing in powerful blistering compounds. they do positive injury and retard recovery, and should not be allowed. much benefit may be derived from hot application to the sides of the chest if the facilities are at hand to apply them. if the weather is not too cold, and if the animal is in a comfortable stable, the following method may be tried: have a tub of hot water handy to the stable door; soak a woolen blanket in the water, then quickly wring as much water as possible out of it and wrap it around the chest. see that it fits closely to the skin; do not allow it to sag so that air may get between it and the skin. now wrap a dry blanket over the wet hot one and hold in place with three girths. the hot blanket should be renewed every half hour, and while it is off being wetted and wrung the dry one should remain over the wet part of the chest to prevent reaction. the hot applications should be kept up for three or four hours, and when stopped the skin should be quickly rubbed as dry as possible, an application of alcohol rubbed over the wet part, and a dry blanket snugly fitted over the animal. if the hot applications appear to benefit, they may be tried on three or four consecutive days. unless every facility and circumstance favors the application of heat in the foregoing manner, it should not be attempted. if the weather is very cold or any of the details are omitted, more harm than good may result. mustard may be applied by making a paste with a pound of freshly ground mustard mixed with warm water. this is to be spread evenly over the sides back of the shoulder blades and down to the median line below the chest. care should be taken to avoid rubbing the mustard upon the thin skin immediately back of the elbow. the mustard-covered area should be covered with a paper and this with a blanket passed up from below and fastened over the back. the blanket and paper should be removed in from one to two hours. when pneumonia follows another disease, the system is always more of less debilitated and requires the careful use of stimulants from the beginning. to weaken the animal still further by bleeding him is one of the most effectual methods of retarding recovery, even if it does not hasten a fatal termination. another and oftentimes fatal mistake made by the nonprofessional is the indiscriminate and reckless use of aconite. this drug is one of the most active poisons, and should not be handled by anyone who does not thoroughly understand its action and uses. it is only less active than prussic acid in its poisonous effects. it is a common opinion, often expressed by nonprofessionals, that aconite is a stimulant. nothing could be more erroneous; in fact, it is just the reverse. it is one of the most powerful sedatives used in the practice of medicine. in fatal doses it kills by paralyzing the very muscles used in breathing; it weakens the action of the heart, and should not be used. do not give purgative medicines. if constipation exists, overcome it by an allowance of laxative diet, such as scalded oats, bran, and linseed mashes; also, grass, if in season. if the costiveness is not relieved by the laxative diet, give an enema of about a quart of warm water three or four times a day. a diet consisting principally of bran mashes, scalded oats, and, when in season, grass or corn fodder is preferable if the animal retains an appetite; but if no desire is evinced for feed of this particular description, then the animal must be allowed to eat anything that will be taken spontaneously. hay tea, made by pouring boiling water over good hay in a large bucket and allowing it to stand until cool, then straining off the liquid, will sometimes create a desire for feed. the animal may be allowed to drink as much of it as he desires. corn on the cob is often eaten when everything else is refused. bread may be tried; also apples or carrots. if the animal can be persuaded to drink milk, it may be supported by it for days. three or four gallons of sweet milk may be given during the day, in which may be stirred three or four fresh eggs to each gallon. some horses will drink milk, while others will refuse to touch it. it should be borne in mind that all feed must be taken by the horse as he desires it; none should be forced down him. if he will not eat, you will only have to wait until a desire is shown for feed. all kinds may be offered, first one thing and then another, but feed should not be allowed to remain long in trough or manger; the very fact of its constantly being before him will cause him to loathe it. when the animal has no appetite for anything the stomach is not in a proper state to digest food, and if it is poured or drenched into him it will only cause indigestion and aggravate the case. it is a good practice to do nothing when there is nothing to be done that will benefit. this refers to medicine as well as feed. nothing is well done that is overdone. there are many valuable medicines used for the different stages and different types of pneumonia, but in the opinion of the writer it is useless to refer to them here, as this work is intended for the use of those who are not sufficiently acquainted with the disease to recognize its various types and stages; therefore they would only confuse. if you can administer a ball or capsule, or have anyone at hand who is capable of doing it, a dram of sulphate of quinin in a capsule, or made into a ball, with sufficient linseed meal and molasses, given every three hours during the height of the fever, will do good in many cases. the ball of carbonate of ammonia, as advised in the treatment of bronchitis, may be tried if the animal is hard to drench. the heart should be kept strong by administering digitalis in doses of drams of the tincture every three hours, or strychnia grain, made into a pill with licorice powder, three times daily. if the horse becomes very much debilitated, stimulants of a more pronounced character are required. the following drench is useful: rectified spirits, ounces; spirits of nitrous ether, ounces; water, pint. this may be repeated every four or five hours if it seems to benefit; or ounces of good whisky diluted with a pint of water may be given as often, instead of the foregoing. during the period of convalescence good nutritive feed should be allowed in a moderate quantity. tonic medicines should be substituted for those used during the fever. the same medicines advised for the convalescing period of bronchitis are equally efficient in this case, especially the iodid of potash; likewise, the same general instructions apply here. the chief causes of death in pneumonia are heart failure from exhaustion, suffocation, or blood poisoning from death (gangrene) of lung tissue. the greater the area of lung tissue diseased the greater the danger; hence double pneumonia is more fatal than pneumonia of one lung. the windpipe. the windpipe, or trachea as it is technically called, is the flexible tube that extends from, the larynx, which it succeeds at the throat, to above the base of the heart in the chest, where it terminates by dividing into the right and left bronchi--the tubes going to the right and left lung, respectively. the windpipe is composed of about fifty incomplete rings of cartilage united by ligaments. a muscular layer is situated on the superior surface of the rings. internally the tube is lined with a continuation of the mucous membrane that lines the entire respiratory tract, which here has very little sensibility in contrast to that lining the larynx, which is endowed with exquisite sensitiveness. the windpipe is not subject to any special disease, but is more or less affected during laryngitis (sore throat), influenza, bronchitis, etc., and requires no special treatment. the membrane may be left in a thickened condition after these attacks. one or more of the rings may be accidentally fractured, or the tube may be distorted or malformed as the result of violent injury. after the operation of tracheotomy it is not uncommon to find a tumor or malformation as a result, or sequel, of the operation. in passing over this section attention is merely called to these defects, as they require no particular attention in the way of treatment. it may be stated, however, that any one of the before-mentioned conditions may constitute one of the causes of noisy respiration described as "thick wind." guttural pouches. these two sacs are situated above the throat, and communicate with the pharynx, as well as with the cavity of the tympanum of the ear. they are peculiar to solipeds. normally, they contain air. their function is unknown. one or both guttural pouches may contain pus. the symptoms are as follows: swelling on the side below the ear and an intermittent discharge of matter from one or both nostrils, especially when the head is depressed. the swelling is soft, and, if pressed upon, matter will escape from the nose if the head is depressed. as before mentioned, these pouches communicate with the pharynx, and through this small opening matter may escape. a recovery is probable if the animal is turned out to graze, or if he is fed from the ground, as the dependent position of the head favors the escape of matter from the pouches. in addition to this, give the tonics recommended for nasal gleet. if this treatment fails, an operation must be performed, which should not be attempted by any one unacquainted with the anatomy of the part. bronchitis and broncho-pneumonia. bronchitis is an inflammation of the bronchial tubes. when this inflammation extends to the air sacs at the termini of the smallest branches of the bronchial tubes, the disease is broncho-pneumonia. bronchitis affecting the larger tubes is less serious than when the smaller are involved. the disease may be either acute or chronic. the causes are generally much the same as for other diseases of the respiratory organs, noticed in the beginning of this article. the special causes are these: the inhalation of irritating gases and smoke and fluids or solids gaining access to the parts. bronchitis is occasionally associated with influenza and other specific fevers. it also supervenes on common cold or sore throat. _symptoms._--the animal appears dull; the appetite is partially or wholly lost; the head hangs; the breathing is quickened; the cough, at first dry, and having somewhat the character of a "barking cough," is succeeded in a few days by a moist, rattling cough; the mouth is hot; the visible membranes in the nose are red; the pulse is frequent, and during the first stage is hard and quick, but as the disease advances becomes smaller and more frequent. there is a discharge from the nostrils that is at first whitish, but later becomes creamy or frothy, still later it is sometimes tinged with blood, and occasionally it may be of a brownish or rusty color. by auscultation, or placing the ear to the sides of the chest, unnatural sounds can now be heard. the air passing through the diseased tubes causes a wheezing sound when the small tubes are affected, and a hoarse, cooing, or snoring sound when the larger tubes are involved. after one or two days the dry stage of the disease is succeeded by a moist state of the membrane. the ear now detects a different sounds caused by the bursting of the bubbles as the air passes through the fluid, which is the exudate of inflammation and the augmented mucous secretions of the membrane. the mucus may be secreted in great abundance, which, by blocking up the tubes, may cause a collapse of a large extent of breathing surface. usually the mucus is expectorated; that is, discharged through the nose. the matter is coughed up, and when it reaches the larynx much of it may be swallowed, and some is discharged from the nostrils. the horse can not spit, like the human being, nor does the matter coughed up gain access to the mouth. if in serious cases all the symptoms become aggravated, the breathing is labored, short, and quick, it usually indicates that the inflammation has reached the breathing cells and that catarrhal pneumonia is established. in this case the ribs rise and fall much more than natural. this fact alone is enough to exclude the idea that the animal may be affected with pleurisy, because in that disease the ribs are as nearly fixed as it is in the power of the animal to do so, and the breathing is accomplished to a great extent by aid of the abdominal muscles. the horse persists in standing throughout the attack. he prefers to stand with head to a door or window to gain all the fresh air possible, but if not tied may occasionally wander listlessly about the stall. the bowels most likely are constipated; the dung is covered with slimy mucus. the urine is decreased in quantity and darker in color than usual. the animal shows more or less thirst; in some cases the mouth is full of saliva. the discharge from the nose increases in quantity as the disease advances and inflammation subsides. this is rather a good symptom, as it shows that one stage has passed. the discharge then gradually decreases, the cough becomes less rasping, but of more frequent occurrence, until it gradually disappears with the return of health. bronchitis, affecting the smaller tubes, is one of the most fatal diseases, while that of the larger tubes is never very serious. it must be stated, however, that it is an exceedingly difficult matter for a nonexpert to discriminate between the two forms, and, further, it may as well be said here that he will have difficulty in discriminating between bronchitis and pneumonia. _treatment._--the matter of first importance is to insure pure air to breathe, and next to make the patient's quarters as comfortable as possible. a well-ventilated box stall serves best for all purposes. cover the body with a blanket, light or heavy, as the season of the year demands. hand-rub the legs until they are warm, then wrap them in cotton and apply flannel or derby bandages from the hoofs to the knees and hocks. if the legs can not be made warm with hand rubbing alone, apply dry mustard. rub in thoroughly and then put the bandages on; also rub mustard paste well over the side of the chest, covering the space beginning immediately behind the shoulder blade and running back about eighteen inches, and from the median line beneath the breast to within ten inches of the ridge of the backbone. repeat the application to the side of the chest about three days after the first one is applied. compel the animal to inhale steam from a bucketful of boiling water containing a tablespoonful of oil of turpentine and spirits of camphor, as advised for cold in the head. in serious cases the steam should be inhaled every hour, and in any case the oftener it is done the greater will be the beneficial results. three times a day administer an electuary containing acetate of potash ( drams), with licorice and molasses or honey. it is well to keep a bucketful of cold water before the animal all the time. if the horse is prostrated and has no appetite, give the following drench: spirits of nitrous ether, ounces; rectified spirits, ounces; water, pint. repeat the dose every four or five hours if it appears to benefit. when the horse is hard to drench, give the following: pulverized carbonate of ammonia, drams; linseed meal and molasses sufficient to make the whole into a stiff mass; wrap it with a small piece of tissue paper and give as a ball. this ball may be repeated every four or five hours. when giving the ball care should be taken to prevent its breaking in the mouth, as in case of such accident it will make the mouth sore and prevent the animal from eating. if the bowels are constipated, give enemas of warm water. do not give purgative medicines. do not bleed the animal. if the animal retains an appetite, a soft diet is preferable, such as scalded oats, bran mashes, and grass, if in season. if he refuses cooked feed, allow in small quantities anything he will eat. hay, cob corn, oats, bread, apples, and carrots may be tried in turn. some horses will drink sweet milk when they refuse all other kinds of feed, and especially is this the case if the drinking water is withheld for a while. one or gallons at a time, four or five times a day, will support life. bear in mind that when the disease is established recovery can not occur in less than two or three weeks, and more time may be necessary. good nursing and patience are required. when the symptoms have abated and nothing remains of the disease except the cough and a white discharge from the nostrils, all other medicines should be discontinued and a course of tonic treatment pursued. give the following mixture: reduced iron, ounces; powdered gentian, ounces; mix well together and divide into sixteen powders. give a powder every night and morning mixed with bran and oats, if the animal will eat it, or shaken with about a pint of flaxseed tea and administered as a drench. if the cough remains after the horse is apparently well, give dram of iodid of potassium dissolved in a bucketful of drinking water one hour before each meal for two or three weeks if necessary. do not put the animal to work too soon after recovery. allow ample time to regain strength. this disease is prone to become chronic and may run into an incurable case of thick wind. pleurisy. the thoracic cavity is divided into two lateral compartments, each containing one lung and a part of the heart. each lung has its separate pleural membrane, or covering. the pleura is the thin, glistening membrane that covers the lung and also completely covers the internal walls of the chest. it is very thin, and to the ordinary observer appears to be part of the lung, which, in fact, it is for all practical purposes. the smooth, shiny surface of the lung, as well as the smooth, shiny surface so familiar on the rib, is the pleura. in health this surface is always moist. a fluid is thrown off by the pleura, which causes the surface to be constantly moist. this is to prevent the effects of friction between the lungs and the walls of the chest and other contiguous parts which come in contact. it must be remembered that the lungs are dilating each time a breath is taken in, and contracting each time a breath of air is expelled. it may be readily seen that if it were not for the moistened state of the surface of the pleura the continual dilatation and contraction and the consequent rubbing of the parts against each other would cause serious friction. inflammation of this membrane is called pleurisy. being so closely united with the lung, it can not always escape participation in the disease when the latter is inflamed. pleurisy may be due to the same predisposing and exciting causes as mentioned in the beginning of this work as general causes for diseases of the organs of respiration, such as exposure to sudden changes of temperature, confinement in damp stables, etc. it may be caused also by wounds that penetrate the chest, for it must be remembered that such wounds must necessarily pierce the pleura. a fractured rib may involve the pleura. the inflammation following such wounds may be circumscribed; that is, confined to a small area surrounding the wound, or it may spread from the wound and involve a large portion of the pleura. the pleura may be involved secondarily when the heart or its membrane is the primary seat of the disease. it may occur in conjunction with bronchitis, influenza, and other diseases. diseased growths that interfere with the pleura may induce pleurisy. the most frequent cause of pleurisy is an extension of inflammation from adjacent diseased lung. it is a common complication of pneumonia. pleurisy will be described here as an independent affection, although it should be remembered that it is very often associated with the foregoing diseases. the first lesion of pleurisy is overfilling of the blood vessels that ramify in this membrane and dryness of the surface. this is followed by the formation of a coating of coagulated fibrin on the diseased pleura and the transudation of serum which collects in the chest. this serum may contain flakes of fibrin and it may be straw colored or red from an admixture of blood. the quantity of this accumulation may amount to several gallons. _symptoms._--when the disease exists as an independent affection it is ushered in by a chill, but this is usually overlooked. about the first thing noticed is the disinclination of the animal to move or turn around. when made to do so he grunts or groans with pain. he stands stiff; the ribs are fixed--that is, they move very little in the act of breathing--but the abdomen works more than natural; both the fore feet and elbows may be turned out; during the onset of the attack the animal may be restless and act as if he had a slight colic; he may even lie down, but does not remain long down, for when he finds no relief he soon gets up. after effusion begins these signs of restlessness disappear. every movement of the chest causes pain; therefore the cough is peculiar; it is short and suppressed and comes as near being no cough as the animal can make it in his desire to suppress it. the breathing is hurried, the mouth is hot, the temperature being elevated from ° or ° to ° f. symptoms that usually accompany fever are present, such as costiveness, scanty, dark-colored urine, etc. the pulse is frequent, perhaps or more a minute, and is hard and wiry. the legs and ears are cold. percussion is of valuable service in this affection. after effusion occurs the sound produced by percussing over the lower part of the chest is dull. by striking different parts one may come to a spot of greater or less extent where the blows cause much pain to be evinced. the animal may grunt or groan every time it is struck. another method of detecting the affected part is to press the fingers between the ribs, each space in succession, beginning behind the elbow, until a place where the pressure causes more flinching than at any other part is reached. auscultation is also useful. in the first stage, when the surfaces are dry and rough, one may hear, immediately under the ear, a distinct sound very much like that produced by rubbing two pieces of coarse paper together. no such friction sound occurs when the membrane is healthy, as the natural moisture, heretofore mentioned, prevents the friction. in many cases this friction is so pronounced that it may be felt by placing the hand over the affected part. when the dry stage is succeeded by the exudation of fluid this friction sound disappears. after the effusion into the cavity takes place sometimes there is heard a tinkling or metallic sound, due to dropping of the exudate from above into the collected fluid in the bottom of the cavity, as the collected fluid more of less separates the lung from the chest walls. within two or three days the urgent symptoms may abate owing to the exudation of the fluid, and the subsidence of the pain. the fluid may now undergo absorption, and the case may terminate favorably within a week or days. if the quantity of the effusion is large its own volume retards the process of absorption to a great extent, and consequently convalescence is delayed. in severe cases the pulse becomes more frequent, the breathing more hurried and labored, the flanks work like bellows, the nostrils flap, the eyes stare wildly, the countenance expresses much anxiety, and general signs of dissolution are plain. after a time swellings appear under the chest and abdomen and down the legs. the accumulation in the chest is called hydrothorax, or dropsy of the chest. when this fluid contains pus the case usually proves fatal. the condition of pus within the cavity is called empyema. pleurisy may affect only a small area of one side or it may affect both sides. it is oftener confined to the right side. _treatment._--the instructions in regard to the general management of bronchitis and pneumonia must be adhered to in the treatment of pleurisy. comfortable quarters, pure air, warm clothing to the body and bandages to the legs, a plentiful supply of pure cold water, the laxative feed, etc., in this case are equally necessary and efficacious. the hot applications applied to the chest, as directed in the treatment of pneumonia, are very beneficial in pleurisy, and should be kept up while the symptoms show the animal to be in pain. during the first few days, when pain is manifested by restlessness, apply hot packs to the sides diligently. after four or five days, when the symptoms show that the acute stage has somewhat subsided, mustard may be applied as recommended for pneumonia. from the beginning the following drench may be given every six hours, if the horse takes it kindly: solution of the acetate of ammonia, ounces; spirits of nitrous ether, ounce; bicarbonate of potassium, drams; water, pint. if the patient becomes debilitated, the stimulants as prescribed for pneumonia should be used according to the same directions. the same attention should be given to the diet. if the animal will partake of the bran mashes, scalded oats, and grass, it is the best; but if he refuses the laxative diet, then he should be tried with different kinds of feed and allowed whichever kind he desires. in the beginning of the attack, if the pain is severe, causing the animal to lie down or paw, morphin may be given by the mouth in -grain doses, or the fluid extract of _cannabis indica_ may be used in doses of to drams. if the case is not progressing favorable in ten or twelve days after the beginning of the attack, convalescence is delayed by the fluid in the chest failing to be absorbed. the animal becomes dull and weak and evinces little or no desire for feed. the breathing becomes still more rapid and difficult. an effort must now be made to excite the absorption of the effusion. an application of liniment or mild blister should be rubbed over the lower part of both sides and the bottom of the chest. the following drench may be given three times a day, for seven or eight days, if it is necessary and appears to benefit: tincture of the perchlorid of iron, ounce; tincture of gentian, ounces; water, pint. also give dram of iodid of potassium, dissolved in the drinking water, an hour before feeding every night and morning for a week or two. _hydrothorax_ is sometimes difficult to overcome by means of the use of medicines alone, when the operation of tapping the chest is performed to allow an escape for the accumulated fluid. the operation is performed with a combined instrument called the trocar and cannula. the puncture is made in the lower part of the chest, in the space between the eighth and ninth ribs. wounding of the intercostal artery is avoided by inserting the instrument as near as possible to the anterior edge of the rib. if the operation is of benefit, it is only so when performed before the strength is lowered beyond recovery. the operation merely receives a passing notice here, as it is not presumed that the nonprofessional will attempt it, although in the hands of the expert it is attended with little danger or difficulty. we have described here bronchitis, pneumonia, and pleurisy mainly as they occur as independent diseases, but it should be remembered that they merge into each other and may occur together at one time. while it is true that much more might have been said in regard to the different stages and types of the affections, and also in regard to the treatment of each stage and each particular type, the plan adopted of advising plain, conservative treatment is considered the wisest on account of simplifying as much as possible a subject of which the reader is supposed to know very little. pleuropneumonia. this is the state in which an animal is affected with pleurisy and pneumonia combined, which is not infrequently the case. at the beginning of the attack only one of the affections may be present, but the other soon follows. it has already been stated that the pleura is closely adherent to the lung. the pleura on this account is frequently more or less affected by the spreading of the inflammation from the lung tissue. there is a combination of the symptoms of both diseases, but to the ordinary observer the symptoms of pleurisy are the most obvious. the course of treatment to be pursued differs in no manner from that given for the affections when they occur independently. the symptoms will be the guide as to the advisability of giving oil and laudanum for the pain if the pleurisy is very severe. it should not be resorted to unless it is necessary to allay the pain. broncho-pleuropneumonia. this is the term or terms applied when bronchitis, pleurisy, and pneumonia all exist at once. it is impossible for one who is not an expert to diagnose the state with certainty. the apparent symptoms are the same as when the animal is affected with pleuropneumonia. suppuration and abscess in the lung. there are instances, and especially when the surroundings of the patient have been bad or the disease is of an especially severe type, when pneumonia terminates in an abscess in the lung. sometimes, when the inflammation has been extreme, suppuration in a large portion of the lung takes place. impure air, the result of improper ventilation, is among the most frequent causes of this termination. the symptoms of suppuration in the lung are chronic pneumonia, a solidified area of lung tissue, continued low fever, and, in some cases, offensive smell of the breath, and the discharge of the matter from the nostrils. mortification. gangrene, or mortification, means the death of the part affected. occasionally, owing to the intensity of the inflammation or bad treatment, pneumonia and pleuropneumonia terminate in mortification, which is soon followed by the death of the animal. perhaps the most common cause of this complication is the presence of a foreign body in the lung, as food particles or medicine. rough drenching or drenching through the nostrils may cause this serious condition. hemoptysis, or bleeding from the lungs. bleeding from the lungs may occur during the course of congestion of the lungs, bronchitis, pneumonia, influenza, purpura hemorrhagica, or glanders. an accident or exertion may cause a rupture of a vessel. plethora and hypertrophy of the heart predispose to it. following the rupture of a vessel the blood may escape into the lung tissue and cause a serious attack of pneumonia, or it may fill up the bronchial tubes and prove fatal by suffocating the animal. when the hemorrhage is from the lung it is accompanied with coughing; the blood is frothy, of a bright red color, and comes from both nostrils; whereas when the bleeding is merely from a rupture of a vessel in some part of the head (heretofore described as bleeding from the nose) the blood is most likely to issue from one nostril only, and the discharge is not accompanied with coughing. the ear may be placed against the windpipe along its course, and if the blood is from the lungs a gurgling or rattling sound will be heard. when it occurs in connection with another disease it seldom requires special treatment. when caused by accident or overexertion the animal should be kept quiet. if the hemorrhage is profuse and continues for several hours, dram of the acetate of lead dissolved in a pint of water may be given as a drench, or ounce of the tincture of the perchlorid of iron, diluted with a pint of water, may be given instead of the lead. it is rare that the hemorrhage is so profuse as to require internal remedies. but hemorrhage into the lung may occur and cause death by suffocation without the least manifestation of it by the discharge of blood from the nose. tuberculosis of the lungs. pulmonary consumption or tuberculosis has been recognized in the horse in a number of instances. the symptoms are as of chronic pneumonia or pleurisy. there is no treatment for the disease. heaves, broken wind, or asthma. much confusion exists in the popular mind in regard to the nature of heaves. many horsemen loosely apply the term to all ailments where the breathing is difficult or noisy. scientific veterinarians are well acquainted with the phenomena and locality of the affection, but there is a great diversity of opinion as regards the exact cause. asthma is generally thought to be caused by spasm of the small circular muscles that surround the bronchial tubes. the continued existence of this affection of the muscles leads to a paralysis of them, and the forced breathing to emphysema, which always accompanies heaves. heaves is usually associated with disorder of the function of digestion or to an error in the choice of feed. feeding on clover hay or damaged hay or straw, too bulky and innutritious feed, and keeping the horse in a dusty atmosphere or a badly ventilated stable produce or predispose to heaves. horses brought from a high to a low level are predisposed. in itself broken wind is not a fatal disease, but death is generally caused by an affection closely connected with it. after death, if the organs are examined, the lesions found depend much upon the length of time broken wind has affected the animal. in recent cases very few changes are noticeable, but in animals that have been broken-winded for a long time the changes are well-marked. the lungs are paler than natural, and of much less weight in proportion to the volume, as evidenced by floating them in water. the walls of the small bronchial tubes and the membrane of the larger tubes are thickened. the right side of the heart is enlarged and its cavities dilated. the stomach is enlarged and its walls stretched. the important change found in the lungs is a condition technically called pulmonary emphysema. this is of two varieties: first, what is termed "vesicular emphysema," which consists of an enlargement of the capacity of the air cells (air vesicles) by dilation of their walls. the second form is called interlobular, or interstitial, emphysema, and follows the first. in this variety the air finds its way into the lung tissue between the air cells or the tissue between the small lobules. _symptoms._--almost every experienced horseman is able to detect heaves. the peculiar movement of the flanks and abdomen point out the ailment at once. in recent cases, however, the affected animal does not always exhibit the characteristic breathing unless exerted to a certain extent. the cough which accompanies this disease is peculiar to it. it is difficult to describe, but the sound is short and something like a grunt. when air is inspired--that is, taken in--it appears to be done in the same manner as in health; it may possibly be done a little quicker than natural, but not enough to attract any notice. it is when the act of expiration (or expelling the air from the lungs) is performed that the great change in the breathing is perceptible. it must be remembered that the lungs have lost much of their elasticity, and in consequence of their power of contracting on account of the degeneration of the walls of the air cells, and also on account of the paralysis of muscular tissue before mentioned. the air passes into them freely, but the power to expel it is lost to a great extent by the lungs; therefore the abdominal muscles are brought into play. these muscles, especially in the region of the flank, are seen to contract, then pause for a moment, then complete the act of contracting, thus making a double bellowslike movement at each expiration, a sort of jerky motion with every breath. the double expiratory movement may also be detected by allowing the that the expiratory current is not continuous, but is broken into two jets. when the animal is exerted a wheezing noise accompanies the breathing. this noise may be heard to a less extent when the animal is at rest if the ear is applied to the chest. as before remarked, indigestion is often present in these cases. the animal may have a depraved appetite, as shown by a desire to eat dirt and soiled bedding, which he often devours in preference to the clean feed in the trough or manger. the stomach is liable to be overloaded with indigestible feed. the abdomen may assume that form called "potbellied." the animal frequently passes wind of a very offensive odor. when first put to work dung is passed frequently; the bowels are often loose. the animal can not stand much work, as the muscular system is soft. round-chested horses are said to be predisposed to the disease, and it is certain that in cases of long standing the chest usually becomes rounder than natural. certain individuals become very expert in managing a horse affected with heaves in suppressing the symptoms for a short time. they take advantage of the fact that the breathing is much easier when the stomach and intestines are empty. they also resort to the use of medicines that have a depressing effect. when the veterinarian is examining a horse for soundness, and he suspects that the animal has been "fixed," he usually gives the horse as much water as he will drink and then has him ridden or driven rapidly up a hill or on a heavy road. this will bring out the characteristic breathing of heaves if the horse is so afflicted, but will not cause the symptoms of heaves in a healthy horse. all broken-winded horses have the cough peculiar to the affection, but it is not regular. a considerable time may elapse before it is heard and then it may come on in paroxysms, especially when first brought out of the stable into the cold air, or when excited by work, or after a drink of cold water. the cough is usually the first symptom of the disease. _treatment._--when the disease is established there is no cure for it. proper attention paid to the diet will relieve the distressing symptoms to a certain extent, but they will undoubtedly reappear in their intensity the first time the animal overloads the stomach or is allowed food of bad quality. clover hay or bulky feed which contains but little nutriment have much to do with the cause of the disease, and therefore should be entirely omitted when the animal is affected, as well as before. it has been asserted that the disease is unknown where clover hay is never used. the diet should be confined to feed of the best quality and in the smallest quantity. the bad effect of moldy or dusty hay, fodder, or feed of any kind can not be overestimated. a small quantity of the best hay once a day is sufficient. this should be cut and dampened. the animal should invariably be watered before feeding; never directly after a meal. the animal should not be worked immediately after a meal. exertion, when the stomach is full, invariably aggravates the symptoms. turning on pasture gives relief. carrots, potatoes, or turnips chopped and mixed with oats or corn are a good diet. half a pint to a pint of thick, dark molasses with each feed is useful. arsenic is efficacious in palliating the symptoms. it is best administered in the form of a solution of arsenic, as fowler's solution or as the white powdered arsenious acid. of the former the dose is ounce to the drinking water three times daily; of the latter one may give grains in each feed. these quantities may be cautiously increased as the animal becomes accustomed to the drug. if the bowels do not act regularly, a pint of raw linseed oil may be given once or twice a month, or a handful of glauber's salt may be given in the feed twice daily, so long as necessary. it must, however, be borne in mind that all medicinal treatment is of secondary consideration; careful attention paid to the diet is of greatest importance. broken-winded animals should not be used for breeding purposes. a predisposition to the disease may be inherited. chronic cough. a chronic cough may succeed the acute disease of the respiratory organs, such as pneumonia, bronchitis, laryngitis, etc. it accompanies chronic roaring, chronic bronchitis, broken wind; it may succeed influenza. as previously stated, cough is but a symptom and not a disease in itself. chronic cough is occasionally associated with diseases other than those of the organs of respiration. it may be a symptom of chronic indigestion or of worms. in such cases it is caused by a reflex nervous irritation. the proper treatment in all cases of chronic cough is to ascertain the nature of the disease of which it is a symptom, and then cure the disease if possible and the cough will cease. the treatment of the affections will be found under their appropriate heads, to which the reader is referred. pleurodynia. this is a form of rheumatism that affects the intercostal muscles; that is, the muscles between the ribs. the apparent symptoms are very similar to those of pleurisy. the animal is stiff and not inclined to turn round; the ribs are kept in a fixed state as much as possible. if the head is pulled round suddenly, or the affected side struck with the hand, or if the spaces between the ribs are pressed with the fingers, the animal will flinch and perhaps emit a grunt or groan expressive of much pain. it is distinguished from pleurisy by the absence of fever, cough, the friction sound, the effusion into the chest, and by the existence of rheumatism in other parts. the treatment for this affection is the same as for rheumatism affecting other parts. wounds penetrating the walls of the chest. a wound penetrating the wall of the chest admits air into the thoracic cavity outside the lung. this condition is known as pneumothorax and may result in collapse of the lung. the wound may be so made that when the walls of the chest are dilating a little air is sucked in, but during the contraction of the wall the contained air presses against the torn part in such manner as entirely to close the wound; thus a small quantity of air gains access with each inspiration, while none is allowed to escape until the lung is pressed into a very small compass and forced into the anterior part of the chest. the same thing may occur from a broken rib inflicting a wound in the lung. in this form the air gains access from the lung, and there may not be even an opening in the walls of the chest. in such cases the air may be absorbed, when a spontaneous cure is the result, but when the symptoms are urgent it is recommended that the air be removed by a trocar and cannula or by an aspirator. it is evident that the treatment of wounds that penetrate the thoracic cavity should be prompt. it should be quickly ascertained whether or not a foreign body remains in the wound; then it should be thoroughly cleaned with a solution of carbolic acid, part in parts of water. the wound should then be closed immediately. if it is an incised wound, it should be closed with sutures or with adhesive plasters; if torn or lacerated, adhesive plaster may be used or a bandage around the chest over the dressing. at all events, air must be prevented from getting into the chest as soon and as effectually as possible. the after treatment of the wound should consist principally in keeping the parts clean with a solution of carbolic acid, and applying fresh dressing as often as required to keep the wound in a healthy condition. care should be taken that the discharges from the wound have an outlet in the most dependent part. (see wounds and their treatment, p. .) if pleurisy supervenes, it should be treated as advised under that head. thumps, or spasm of the diaphragm. "thumps" is generally thought by the inexperienced to be a palpitation of the heart. while it is true that palpitation of the heart is sometimes called "thumps," it must not be confounded with the affection under consideration. in the beginning of this article on the diseases of the organs of respiration, the diaphragm was briefly referred to as the principal and essential muscle of respiration. spasmodic or irregular contractions of it in man are manifested by what is familiarly known as hiccoughs. thumps in the horse is similar to hiccoughs in man although in all cases the peculiar noise is not made in the throat of the horse. there should be no difficulty in distinguishing this affection from palpitation of the heart. the jerky motion affects the whole body, and is not confined to the region of the heart. if one hand is placed on the body at about the middle of the last rib, while the other hand is placed over the heart behind the left elbow, it will be easily demonstrated that there is no connection between the thumping or jerking of the diaphragm and the beating of the heart. in fact, when the animal is affected with spasms of the diaphragm the beating of the heart is usually much weaker and less perceptible than natural. thumps is produced by causes similar to those that produce congestion of the lungs and dilatation or palpitation of the heart, and may occur in connection with these conditions. if not relieved, death usually results from congestion or edema of the lungs, as the breathing is interfered with by the inordinate action of this important muscle of inspiration so much that proper aeration of the blood can not take place. the treatment should be as prescribed for congestion of the lungs, and, in addition, antispasmodics, such as ounce of sulphuric ether in warm water or drams of asafetida. rupture of the diaphragm. post-mortem examinations after colic or severe accident sometimes reveal rupture of the diaphragm. this may take place after death, from the generation of gases in the decomposing carcass, which distend the intestines so that the diaphragm is ruptured by the great pressure against it. the symptoms are intensely difficult respiration and great depression. there is no treatment. diseases of the urinary organs. by james law, f. r. c. v. s., _formerly professor of veterinary science, etc., in cornell university._ uses of the urinary organs. the urinary organs constitute the main channel through which are excreted the nitrogenous or albuminoid principles, whether derived directly from the feed or from the muscular and other nitrogenized tissues of the body. they constitute, besides, the channel through which are thrown out most of the poisons, whether taken in by the mouth or skin or developed in connection with faulty or natural digestion, blood-forming, nutrition, or tissue destruction; or, finally, poisons that are developed within the body, as the result of normal cell life or of the life of bacterial or other germs that have entered the body from without. bacteria themselves largely escape from the body through the kidneys. to a large extent, therefore, these organs are the sanitary scavengers and purifiers of the system, and when their functions are impaired or arrested the retained poisons quickly show their presence in resulting disorders of the skin and connective tissue beneath it, of the nervous system, or other organs. nor is this influence one-sided. scarcely an important organ of the body can suffer derangement without entailing a corresponding disorder of the urinary system. nothing can be more striking than the mutual balance maintained between the liquid secretions of the skin and kidneys during hot and cold weather. in summer, when so much liquid exhales through the skin as sweat, comparatively little urine is passed, whereas in winter, when the skin is inactive, the urine is correspondingly increased. this vicarious action of skin and kidneys is usually kept within the limits of health, but at times the draining off of the water by the skin leaves too little to keep the solids of the urine safely in solution, and these are liable to crystallize out and form stone and gravel. similarly the passage, in the sweat, of some of the solids that normally leave the body, dissolved in the urine, serves to irritate the skin and produce troublesome eruptions. prominent causes of urinary disorders. a disordered liver contributes to the production under different circumstances of an excess of biliary coloring matter which stains the urine; of an excess of hippuric acid and allied products which, being less soluble than urea (the normal product of tissue change), favor the formation of stone, of taurocholic acid, and other bodies that tend when in excess to destroy the blood globules and to cause irritation of the kidneys by the resulting hemoglobin excreted in the urine, and of glycogen too abundant to be burned up in the system, which induces saccharine urine (diabetes). any disorder leading to impaired functional activity of the lungs is causative of an excess of hippuric acid and allied bodies, of oxalic acid, of sugar, etc., in the urine, which irritate the kidneys, even if they do not produce solid deposits in the urinary passages. diseases of the nervous system, and notably of the base of the brain and of the spinal cord, induce various urinary disorders, prominent among which are diabetes, chylous urine, and albuminuria. certain affections, with imperfect nutrition or destructive waste of the bony tissues, tend to charge the urine with phosphates of lime and magnesia and endanger the formation of stone and gravel. in all extensive inflammations and acute fevers the liquids of the urine are diminished, while the solids (waste products), which should form the urinary secretion, are increased, and the surcharged urine proves irritant to the urinary organs or the retained waste products poison the system at large. diseases of the heart and lungs, by interfering with the free, onward flow of the blood from the right side of the heart, tend to throw that liquid back on the veins, and this backward pressure of venous blood strongly tends to disorders of the kidneys. certain poisons taken with the feed and water, notably that found in magnesian limestone and those found in irritant, diuretic plants, are especially injurious to the kidneys, as are also various cryptogams, whether in musty hay or oats. the kidneys may be irritated by feeding green vegetables covered with hoar frost or by furnishing an excess of feed rich in phosphates (wheat bran, beans, peas, vetches, lentils, rape cake, cottonseed cake) or by a privation of water, which entails a concentrated condition and high density of the urine. exposure in cold rain or snow storms, cold drafts of air, and damp beds are liable to further disorder an already overworked or irritable kidney. finally, sprains of the back and loins may cause bleeding from the kidneys or inflammation. the right kidney, weighing - / ounces, is shaped like a french bean, and extends from the loins forward to beneath the heads of the last two ribs. the left kidney (pl. viii) resembles a heart of cards, and extends from the loins forward beneath the head of the last rib only. each consists of three distinct parts--(a) the external (cortical), or vascular part, in which the blood vessels form elaborate capillary networks within the dilated globular sacs which form the beginnings of the secreting (uriniferous) tubes and on the surface of the sinuous, secreting tubes leading from the sacs inward toward the second, or medullary, part of the organ; (b) the internal (medullary) part, made up in the main of blood vessels, lymphatics, and nerves extending between the notch on the inner border of the kidney to and from the outer vascular portion, in which the secretion of urine is almost exclusively carried on; and (d) a large, saccular reservoir in the center of the kidney, into which all uriniferous tubes pour their secretions and from which the urine is carried away through a tube g (ureter), which passes out of the notch at the inner border of the kidney and which opens by a valve-closed orifice into the roof of the bladder just in front of its neck. the bladder is a dilatable reservoir for the retention of the urine until the discomfort of its presence causes its voluntary discharge. it is kept closed by circular, muscular fibers surrounding its neck or orifice, and is emptied by looped, muscular fibers extending in all directions forward from the neck around the blind anterior end of the sac. from the bladder the urine escapes through a dilatable tube (urethra) which extends from the neck of the bladder backward on the floor of the pelvis, and in the male through the penis to its free end, where it opens through a pink, conical papilla. in the mare the urethra is not more than an inch in length, and is surrounded by the circular, muscular fibers closing the neck of the bladder. its opening may be found directly in the median line of the floor of the vulva, about - / inches from its external opening. general symptoms of disease. these apply especially to acute inflammations and the irritation caused by stone. the animal moves stiffly on the hind limbs, straddles, and makes frequent attempts to pass urine, which may be in excess, deficient in amount, liable to sudden arrest in spite of the straining, passed in driblets, or entirely suppressed. again, it may be modified in density or constituents. difficulty in making a sharp turn, or in lying down and rising with or without groaning, dropping the back when mounted or when pinched on the loins is suggestive of kidney disease, and so to a less extent are swelled legs, dropsy, and diseases of the skin and nervous system. the oiled hand introduced through the rectum may feel the bladder beneath and detect any overdistention, swelling, tenderness, or stone. in ponies the kidneys even may be reached. examination of the urine. in some cases the changes in the urine are the sole sign of disease. in health the horse's urine is of a deep amber color and has a strong odor. on a feed of grain and hay it may show a uniform transparency, while on a green ration there in an abundant white deposit of carbonate of lime. of its morbid changes the following are to be looked for: ( ) _color_: white from deposited salts of lime; brown or red from blood clots or coloring matter; yellow or orange from bile or blood pigment; pale from excess of water; or variously colored from vegetable ingredients (santonin makes it red; rhubarb or senna, brown; tar or carbolic acid, green). ( ) _density_: the horse's urine may be . or . , but it may greatly exceed this in diabetes and may sink to . in diuresis. ( ) _chemical reaction_, as ascertained by blue litmus or red test papers. the horse on vegetable diet has alkaline urine turning red test papers blue, while in the sucking colt and the horse fed on flesh or on his own tissue (in starvation or abstinence during disease) it is acid, turning blue litmus red. ( ) _organic constituents_, as when glairy from albumen coagulable by strong nitric acid and boiling, when charged with microscopic casts of the uriniferous tubes, with the eggs or bodies of worms, with sugar, blood, or bile. ( ) _in its salts_, which may crystallize out spontaneously, or on boiling, or on the addition of chemical reagents. [illustration: plate viii. longitudinal section through kidney.] [illustration: plate ix. microscopic anatomy of kidney.] [illustration: plate x. microscopic anatomy of kidney.] albuminous urine in the horse is usually glairy, so that it may be drawn out in threads, but its presence can always be tested as follows: if the liquid is opaque, it may be first passed through filter paper; if very dense and already precipitating its salts, it may be diluted with distilled water; add to the suspected liquid acetic acid drop by drop until it reddens the blue litmus paper; then boil gently in a test tube; if a precipitate is thrown down, set the tube aside to cool and then add strong nitric acid. if the precipitate is not dissolved, it is albumen; if dissolved it is probably urate or hippurate of ammonia. albumen is normally present in advanced gestation; abnormally it is seen in diseases in which there occurs destruction of blood globules (anthrax, low fevers, watery states of the blood, dropsies), in diseases of the heart and liver which prevent the free escape of blood from the veins and throw back venous pressure on the kidneys, in inflammation of the lungs and pleuræ, and even tympany (bloating), doubtless from the same cause, and in all congestive or inflammatory diseases of the kidneys, acute or chronic. casts of the uriniferous tubes can be seen only by placing the suspected urine under the microscope. they are usually very elastic and mobile, waving about in the liquid when the cover glass is touched, and showing a uniform, clear transparency (waxy) or entangled circular epithelial cells or opaque granules or flattened, red-blood globules or clear, refrangent oil globules. they may be even densely opaque from crystals of earthy salts. pus cells may be found in the urine associated with albumen, and are recognized by clearing up, when treated with acetic acid, so that each cell shows two or three nuclei. diuresis (polyuria, diabetes insipidus, or excessive secretion of urine). this consists in an excessive secretion of a clear, watery urine of a low specific gravity ( . ) with a correspondingly ardent thirst, a rapidly advancing emaciation, and great loss of strength and spirit. _causes._--its causes may be any agent--medicinal, alimentary, or poisonous--which unduly stimulates the kidneys; the reckless administration of diuretics, which form such a common constituent of quack horse powders; acrid diuretic plants in grass or hay; new oats still imperfectly cured; an excess of roots or other very watery feed; a full allowance of salt to animals that have become inordinately fond of it; but, above all, feeding on hay, grain, or bran which has not been properly dried and has become musty and permeated by fungi. thus hay, straw, or oats obtained in wet seasons and heating in the rick or stack is especially injurious. hence this malady, like coma somnolentum (sleepy staggers), is widespread in wet seasons, and especially in rainy districts. _symptoms._--the horse drinks deep at every opportunity and passes urine on every occasion when stopped, the discharge being pale, watery, of a low density, and inodorous; in short, it contains a great excess of water and a deficiency of the solid excretions. so great is the quantity passed, however, that the small amount of solids in any given specimen amounts in hours to far more than the normal--a fact in keeping with the rapid wasting of the tissues and extreme emaciation. the flanks become tucked up, the fat disappears, the bones and muscles stand out prominently, the skin becomes tense and hidebound, and the hair erect, scurfy, and deficient in luster. the eye becomes dull and sunken, the spirits are depressed, the animal is weak and sluggish, sweats on the slightest exertion, and can endure little. the subject may survive for months, or may die early of exhaustion. in the slighter cases, or when the cause ceases to operate, a somewhat tardy recovery may be made. _treatment_ consists in stopping the ingestion of the faulty drugs, poisons, or feed, and supplying sound hay and grain free from all taint of heating or mustiness. a liberal supply of boiled flaxseed in the drinking water at once serves to eliminate the poison and to sheathe and protect the irritated kidneys. tonics like sulphate or phosphate of iron ( drams morning and evening) and powdered gentian or peruvian bark ( drams) help greatly by bracing the system and hastening repair. to these may be added agents calculated to destroy the fungus and eliminate its poisonous products. in that form which depends on musty food nothing acts better than large doses of iodid of potassium ( drams), while in other cases creosote, carbolic acid ( dram), or oil of turpentine ( drams), properly diluted, may be resorted to. saccharine diabetes (diabetes mellitus, glycosuria, or inosuria). this is primarily a disease of the nervous system or liver rather than of the kidneys, yet, as the most prominent symptom is the sweet urine, it may be treated here. _causes._--its causes are varied, but resolve themselves largely into disorder of the liver or disorder of the brain. one of the most prominent functions of the liver is the formation of glycogen, a principle allied to grape sugar, and passing into it by further oxidation in the blood. this is a constant function of the liver, but in health the resulting sugar is burned up in the circulation and does not appear in the urine. on the contrary, when the supply of oxygen is defective, as in certain diseases of the lungs, the whole of the sugar does not undergo combustion and the excess is excreted by the kidneys. also in certain forms of enlarged liver the quantity of sugar produced is more than can be disposed of in the natural way, and it appears in the urine. a temporary sweetness of the urine often occurs after a hearty meal on starchy feed, but this is due altogether to the super-abundant supply of the sugar-forming feed, lasts for a few hours only, and has no pathological significance. in many cases of fatal glycosuria the liver is found to be enlarged, or at least congested, and it is found that the disorder can be produced experimentally by agencies which produce an increased circulation through the liver. thus bernard produced glycosuria by pricking the oblong medulla at the base of the brain close to the roots of the pneumogastric nerve, which happens to be also the nerve center (vasomotor) which presides over the contractions of the minute blood vessels. the pricking and irritation of this center leads to congestion of the liver and the excessive production of sugar. irritation carried to this point through the pneumogastric nerve causes saccharine urine, and, in keeping with this, disease of the pancreas has been found in this malady. the complete removal of the pancreas, however, determines glycosuria, the organ having in health an inhibitive action on sugar production by the liver. the same result follows the reflection of irritation from other sources, as from different ganglia (corpora striata, optic thalami, pons, cerebellum, cerebrum) of the brain. similarly it is induced by interruption of the nervous control along the vasomotor tracts, as in destruction of the upper or lower cervical sympathetic ganglion, by cutting the nervous branch connecting these two, in injury to the spinal marrow in the interval between the brain and the second or fourth dorsal vertebra, or in disease of the celiac plexus, which directly presides over the liver. certain chemical poisons also cause saccharine urine, notably woorara, strychnia, morphia, phosphoric acid, alcohol, ether, quinia, chloroform, ammonia, arsenic, and phlorizin. _symptoms._--the symptoms are ardent thirst and profuse secretion of a pale urine of a high density ( . and upward), rapid loss of condition, scurfy, unthrifty skin, costiveness or irregularity of the bowels, indigestion, and the presence, in the urine, of a sweet principle--grape sugar or inosite, or both. this may be most promptly detected by touching the tip of the tongue with a drop. sugar may be detected simply by adding a teaspoonful of liquid yeast to ounces of the urine and keeping it lightly stopped at a temperature of ° to ° f. for hours, when the sugar will be found to have been changed into alcohol and carbon dioxid. the loss of density will give indication of the quantity of sugar transformed; thus a density of . in a urine which was formerly . would indicate about grains of sugar to the fluid ounce. inosite, or muscle sugar, frequently present in the horse's urine, and even replacing the glucose, is not fermentable. its presence may be indicated by its sweetness and the absence of fermentation or by gallois's test. evaporate the suspected urine at a gentle heat almost to dryness, then add a drop of a solution of mercuric nitrate and evaporate carefully to dryness, when a yellowish residue is left that is changed on further cautious heating to a deep rose color, which disappears on cooling and reappears on heating. in advanced diabetes, dropsies in the limbs and under the chest and belly, puffy, swollen eyelids, cataracts, catarrhal inflammation of the lungs, weak, uncertain gait, and drowsiness may be noted. _treatment_ is most satisfactory in cases dependent on some curable disease of liver, pancreas, lungs, or brain. thus, in liver diseases, a run at pasture in warm weather, or in winter a warm, sunny, well-aired stable, with sufficient clothing and laxatives (sulphate of soda, ounce daily) and alkalies (carbonate of potassium, one-fourth ounce) may benefit. to this may be added mild blistering, cupping, or even leeching over the last ribs. diseases of the brain or pancreas may be treated according to their indications. the diet should be mainly albuminous, such as wheat bran or middlings, peas, beans, vetches, and milk. indeed, an exclusive milk diet is one of the very best remedial agencies. it may be given as skimmed milk or butter-milk, and in the last case combines an antidiabetic remedy in the lactic acid. under such an exclusive diet recent and mild cases are often entirely restored, though at the expense of an attack of rheumatism. codeia, one of the alkaloids of opium, is strongly recommended by tyson. the dose for the horse would be to grains thrice daily. in cases in which there is manifest irritation of the brain, bromid of potassium, drams, or ergot one-half ounce, may be resorted to. salicylic acid and salicylate of sodium have proved useful in certain cases; also phosphate of sodium. bitter tonics (especially nux vomica one-half dram) are useful in improving the digestion and general health. hematuria (bloody urine). _cause._--as seen in the horse, bloody urine is usually the direct result of mechanical injuries, as sprains and fractures of the loins, lacerations of the sublumbar muscles (psoas), irritation caused by stone in the kidney, ureter, bladder, or urethra. it may, however, occur with acute congestion of the kidney, with tumors in its substance, or with papilloma or other diseased growth in the bladder. acrid diuretic plants present in the feed may also lead to the escape of blood from the kidney. the predisposition to this affection is, however, incomparably less than in the case of the ox or the sheep, the difference being attributed to the greater plasticity of the horse's blood in connection with the larger quantity of fibrin. the blood may be present in small clots or in more or less intimate admixture with the urine. its condition may furnish some indication as to its source; thus, if from the kidneys it is more liable to be uniformly diffused through the urine, while as furnished by the bladder or passages clots are more liable to be present. again, in bleeding from the kidney, minute, cylindrical clots inclosing blood globules and formed in the uriniferous tubes can be detected under the microscope. precision also may be approximated by observing whether there is coexisting fracture, sprain of the loins, or stone or tumor in the bladder or urethra. _treatment._--the disease being mainly due to direct injury, treatment will consist, first, in removing such cause whenever possible, and then in applying general and local styptics. irritants in feed must be avoided, sprains appropriately treated, and stone in bladder or urethra removed. then give mucilaginous drinks (slippery elm, linseed tea) freely, and styptics (tincture of chlorid of iron drams, acetate of lead one-half dram, tannic acid one-half dram, or oil of turpentine ounce). if the discharge is abundant, apply cold water to the loins and keep the animal perfectly still. hemoglobinuria (azoturia, azotemia, poisoning by albuminoids). like diabetes, this is rather a disease of the liver and blood-forming functions than of the kidney, but as prominent symptoms are loss of control over the hind limbs and the passage of ropy and dark-colored urine, the vulgar idea is that it is a disorder of the urinary organs. it is a complex affection directly connected with a plethora in the blood of nitrogenized constituents, with extreme nervous and muscular disorder and the excretion of a dense reddish or brownish urine. it is directly connected with high feeding, especially on highly nitrogenized feed (oats, beans, peas, vetches, cottonseed meal), and with a period of idleness in the stall under full rations. the disease is never seen at pasture, rarely under constant daily work, even though the feeding is high, and the attack is usually precipitated by taking the horse from the stable and subjecting it to exercise or work. the poisoning is not present when taken from the stable, as the horse is likely to be noticeably lively and spirited, but he will usually succumb under the first hundred yards or half mile of exercise. it seems as if the aspiratory power of the chest under the sudden exertion and accelerated breathing speedily drew from the gorged liver and abdominal veins (portal) the accumulated store of nitrogenous matter in an imperfectly oxidized or elaborated condition, and as if the blood, surcharged with these materials, were unable to maintain the healthy functions of the nerve centers and muscles. it has been noticed rather more frequently in mares than horses, attributable, perhaps, to the nervous excitement attendant on heat, and to the fact that the unmutilated mare is naturally more excitable than the docile gelding. lignières has found in hemoglobinuria a streptococcus which produced nephritis, bloody urine, and paraplegia in experimental animals, including horses. _symptoms._--in the milder forms this affection may appear as a lameness in one limb, from indefinite cause, succeeding to some sudden exertion and attended by a dusky-brown color of the membranes of the eye and nose and some wincing when the last ribs are struck. the severe forms come on after one or two days of rest on a full ration, when the animal has been taken out and driven one hundred paces or more: the fire and life with which he had left the stable suddenly give place to dullness and oppression, as shown in heaving flanks, dilated nostrils, pinched face, perspiring skin, and trembling body. the muscles of the loins or haunch become swelled and rigid, the subject moves stiffly or unsteadily, crouches behind, the limbs being carried semiflexed, and he soon drops, unable to support himself. when down, the body and limbs are moved convulsively, but there is no power of coordination of movement in the muscles. the pulse and breathing are accelerated, the eyes red with a tinge of brown, and the urine, if passed, is seen to be highly colored, dark brown, red, or black, but it contains neither blood clots nor globules. the color is mainly due to hemoglobin and other imperfectly elaborated constituents of the blood. it may end fatally in a few hours or days, or a recovery may ensue, which is usually more speedy and perfect if it has set in at an early stage. in the late and tardy recoveries a partial paralysis of the hind limbs may last for months. a frequent sequel of these tardy cases is an extensive wasting of the muscles leading up from the front of the stifle (those supplied by the crural nerve) and a complete inability to stand. _prevention._--the prevention of this serious affection lies in restricting the diet and giving daily exercise when the animal is not at work. a horse that has had one attack should never be left idle for a single day in the stall or barnyard. when a horse has been condemned to absolute repose on good feeding he may have a laxative (one-half to pound glauber's salt), and have graduated exercise, beginning with a short walk and increasing day by day. _treatment._--the treatment of the mild cases may consist in a laxative, graduated daily exercise, and a daily dose of saltpeter ( ounce). sudden attacks will sometimes promptly subside if taken on the instant and the subject kept still and calmed by a dose of bromid of potassium ( drams) and sweet spirits of niter ( ounce). the latter has the advantage of increasing the secretion of the kidneys. iodid of potassium in one-half ounce doses every four hours has succeeded well in some hands. in severe cases, as a rule, it is desirable to begin treatment by a dose of aloes ( to drams) with the above-named dose of bromid of potassium, and this latter may be continued at intervals of four or six hours, as may be requisite to calm the nervous excitement. fomentations with warm water over the loins are always useful in calming the excitable conditions of the spinal cord, muscles, liver, and kidneys, and also in favoring secretion from the two latter. on the second day diuretics may be resorted to, such as saltpeter one-half ounce, and powdered colchicum, one-half dram, to be repeated twice daily. a laxative may be repeated in three or four days should the bowels seem to demand it, and as the nervous excitement disappears any remaining muscular weakness or paralysis may be treated by one-half dram doses of nux vomica twice a day and a stimulating liniment (aqua ammonia and sweet oil in equal proportions) rubbed on the torpid muscles. during the course of the disease friction to the limbs is useful, and in the advanced paralytic stage the application of electricity along the line of the affected muscles. when the patient can not stand he must have a thick, soft bed, and should be turned from side to side at least every twelve hours. as soon as he can be made to stand he may be helped up and even supported in a sling. acute inflammation of the kidneys, or acute nephritis. inflammations of the kidneys have been differentiated widely, according as they were acute or chronic, parenchymatous or tubal, suppurative or not, with increased or shrunken kidney, etc. in a work like the present, however, utility will be consulted by classing all under acute or chronic inflammation. _causes._--the causes of inflammation of the kidneys are extremely varied. congestion occurs from the altered and irritant products passed through these organs during recovery from inflammations of other organs and during fevers. this may last only during the existence of its cause, or may persist and become aggravated. heart disease, throwing the blood pressure back on the veins and kidneys, is another cause. disease of the ureter or bladder, preventing the escape of urine from the kidney and causing increased fullness and tension in its pelvis and tubes, will determine inflammation. decomposition of the detained urine in such cases and the production of ammonia and other irritants must also be named. in elimination of bacteria through the kidney, the latter is liable to infection with consequent inflammation. the advance of bacteria upward from the bladder to the kidneys is another cause. the consumption in hay or other fodder of acrid or irritant plants, including fungi, the absorption of cantharidine from a surface blistered by spanish flies, the reckless administration of diuretics, the presence of stones in the kidney, exposure of the surface to cold and wet, and the infliction of blows or sprains on the loins, may contribute to its production. liver disorders which throw on the kidneys the work of excreting irritant products, diseases of the lungs and heart from which clots are carried, to be arrested in the small blood vessels of the kidney, and injuries and paralysis of the spinal cord, are additional causes. _symptoms._--the symptoms are more or less fever, manifest stiffness of the back and straddling gait with the hind limbs, difficulty in lying down and rising, or in walking in a circle, the animal sometimes groaning under the effort, arching of the loins and tucking up of the flank, looking back at the abdomen as if from colicky pain, and tenderness of the loins to pinching, especially just beneath the bony processes inches to one side of the median line. urine is passed frequently, a small quantity at a time, of a high color, and sometimes mixed with blood or even pus. under the microscope it shows the microscopic casts referred to under general symptoms. if treated by acetic acid, boiling and subsequent addition of strong nitric acid, the resulting and persistent precipitate indicates the amount of albumen. the legs tend to swell from the foot up, also the dependent parts beneath the belly and chest, and effusions of liquid may occur within the chest or abdomen. in the male the alternate drawing up and relaxation of the testicles in the scrotum are suggestive, and in small horses the oiled hand introduced into the rectum may reach the kidney and ascertain its sensitiveness. _treatment_ demands, first, the removal of any recognized cause. then, if the suffering and fever are high, to quarts of blood may be abstracted from the jugular vein; in weak subjects or unless in high fever this should be omitted. next relieve the kidneys so far as possible by throwing their work on the bowels and skin. a pint of castor oil is less likely than either aloes or salts to act on the kidneys. to affect the skin a warm stall and heavy clothing may be supplemented by dram doses of dover's powder. pain may be soothed by dram doses of bromid of potassium. boiled flaxseed may be added to the drinking water, also thrown into the rectum as an injection, and blankets saturated with hot water should be persistently applied to the loins. this may be followed by a very thin pulp of the best ground mustard made with tepid water, rubbed in against the direction of the hair and covered with paper and a blanket. this may be kept on for an hour, or until the skin thickens and the hair stands erect. it may then be rubbed or sponged off and the blanket reapplied. when the action of the bowels has been started it may be kept up by a daily dose of or ounces of glauber's salt. during recovery a course of bitter tonics (nux vomica scruple, ground gentian root drams) should be given. the patient should also be guarded against cold, wet, and any active exertion for some time after all active symptoms have subsided. chronic inflammation of the kidneys. _causes._--chronic inflammation of the kidneys is more commonly associated with albumen and casts in the urine than the acute form, find in some instances these conditions of the urine may be the only prominent symptoms of the disease. though it may supervene on blow, injuries, and exposures, it is much more commonly connected with faulty conditions of the system--as indigestion, heart disease, lung or liver disease, imperfect blood formation, or assimilation; in short, it is rather the attendant on a constitutional infirmity than on a simple local injury. it may be associated with various forms of diseased kidneys, as shrinkage (atrophy), increase (hypertrophy), softening, red congestion, white enlargement, etc., so that it forms a group of diseases rather than a disease by itself. _symptoms._--the symptoms may include stiffness, weakness, and increased sensibility of the loins, and modified secretion of urine (increase or suppression), or the flow may be natural. usually it contains albumen, the quantity furnishing a fair criterion of the gravity of the affection, and microscopic casts, also most abundant in bad cases. dropsy, manifested in swelled legs, is a significant symptom, and if the effusion takes place along the lower line of the body or in chest or abdomen, the significance is increased. a scurfy, unthrifty skin, lack-luster hair, inability to sustain severe or continued exertion, poor or irregular appetite, loss of fat and flesh, softness of the muscles, and pallor of the eyes and nose are equally suggestive. so are skin eruptions of various kinds. any one or more of these symptoms would warrant an examination of the urine for albumen and casts, the finding of which signifies renal inflammation. _treatment_ of these cases is not always satisfactory, as the cause is liable to be maintained in the disorders of important organs elsewhere. if any such coincident disease of another organ or function can be detected, that should be treated first or simultaneously with this affection of the kidneys. in all cases the building up of the general health is important. hence a course of tonics may be given (phosphate of iron drams, nux vomica grains, powdered gentian root drams, daily) or drops of sulphuric acid or nitrohydrochloric acid may be given daily in the drinking water. if there is any elevated temperature of the body and tenderness of the loins, fomentations may be applied, followed by a mustard pulp, as for acute inflammation, and even in the absence of these indications the mustard may be resorted to with advantage at intervals of a few days. in suppression of urine, fomentations with warm water or with infusion of digitalis leaves is a safer resort than diuretics, and cupping over the loins may also benefit. to apply a cup, shave the skin and oil it; then take a narrow-mouthed glass, rarify the air within it by introducing a taper in full flame for a second, withdraw the taper and instantly apply the mouth of the glass to the skin and hold it closely applied till the cooling tends to form a vacuum in the glass and to draw up the skin, like a sucker. as in the acute inflammation, every attention must be given to secure warm clothing, a warm stall, and pure air. tumors of the kidneys. tumors, whether malignant or simple, would give rise to symptoms resembling some form of inflammation, and are not liable to be recognized during life. parasites. to parasites of the kidney belong the echinococcus, the larval, or bladder worm, stage of the small echinococcus tapeworm of the dog. _dioctophyme renale_, the largest of roundworms, has been found in the kidney of the horse. its presence can be certified only by the passage of its microscopic eggs or of the entire worm. immature stages of roundworms, either _strongylus equinus_ or a related species, may be found in the renal artery or in the kidney itself. spasm of the neck of the bladder. this affection consists in spasmodic closure of the outlet from the bladder by tonic contraction of the circular muscular fibers. it may be accompanied with a painful contraction of the muscles on the body of the bladder; or, if the organ is already unduly distended, these will be affected with temporary paralysis. it is most frequent in the horse, but by no means unknown in the mare. _causes._--the causes are usually hard and continuous driving without opportunity for passing urine, cold rainstorms, drafts of cold air when perspiring and fatigued, the administration of spanish fly or the application of extensive blisters of the same, abuse of diuretics, the presence of acrid, diuretic plants in the fodder, and the presence of stone in the bladder. as most mares refuse to urinate while in harness, they should be unhitched at suitable times for urination. spasms of the bowels are always attended by spasm of the bladder, hence the free passage of water is usually a symptom of relief. _symptoms._--the symptoms are frequent stretching and straining to urinate, with no result or a slight dribbling only. these vain efforts are attended by pain and groaning. on resuming his natural position the animal is not freed from the pain, but moves uneasily, paws, shakes the tail, kicks at the abdomen with his hind feet, looks back to the flank, lies down and rises, arches the back, and attempts to urinate as before. if the oiled hand is introduced into the rectum the greatly distended bladder may be felt beneath, and the patient will often shrink when it is handled. it is important to notice that irritation of the urinary organs is often present in impaction of the colon with solid matters, because the impacted intestine under the straining of the patient is forced backward into the pelvis and presses upon and irritates the bladder. in such cases the horse stands with his fore limbs advanced and the hind ones stretched back beyond the natural posture and makes frequent efforts to urinate, with varying success. unpracticed observers naturally conclude that the secondary urinary trouble is the main and only one, and the intestinal impaction and obstruction is too often neglected until it is irremediable. in cases in which the irritation has caused spasm of the neck of the bladder and overdistention of that organ, the mistake is still more easily made; hence it is important in all cases to examine for the impacted bowel, forming a bend or loop at the entrance of the pelvis and usually toward the left side. the impacted intestine feels soft and doughy and is easily indented with the knuckles, forming a marked contrast with the tense, elastic, resilient, overdistended bladder. it remains to be noted that similar symptoms may be determined by a stone or sebaceous mass, or stricture obstructing the urethra, or in the newborn by thickened mucus in that duct and by the pressure of hardened, impacted feces in the rectum. in obstruction, the hard, impacted body can usually be felt by tracing the urethra along the lower and posterior surface of the penis and forward to the median line of the floor of the pelvis to the neck of the bladder. that part of the urethra between the seat of obstruction and the bladder is usually distended with urine and feels enlarged, elastic, and fluctuating. _treatment._--treatment may be begun by taking the animal out of harness. this failing, spread clean litter beneath the belly or turn the patient out on the dung heap. some seek to establish sympathetic action by pouring water from one vessel into another with dribbling noise. others soothe and distract the attention by slow whistling. friction of the abdomen with wisps of straw may succeed, or it may be rubbed with ammonia and oil. these failing, an injection of ounces of laudanum or of an infusion of ounce of tobacco in water may be tried. in the mare the neck of the bladder is easily dilated by inserting two oiled fingers and slightly parting them. in the horse the oiled hand introduced into the rectum may press from before backward on the anterior or blind end of the bladder. finally, a well-oiled gum-elastic catheter may be entered into the urethra through the papilla at the end of the penis and pushed on carefully until it has entered the bladder. to effect this the penis must first be withdrawn from its sheath, and when the advancing end of the catheter has reached the bend of the urethra beneath the anus it must be guided forward by pressure with the hand, which guidance must be continued onward into the bladder, the oiled hand being introduced into the rectum for this purpose. the horse catheter, - / feet long and one-third inch in diameter, may be bought of a surgical-instrument maker. paralysis of the bladder. paralysis of the body of the bladder with spasm of the neck has been described under the last heading, and may occur in the same way from overdistention in tetanus, acute rheumatism, paraplegia, and hemiplegia, in which the animal can not stretch himself to urinate, and in cystitis, affecting the body of the bladder but not the neck. in all these cases the urine is suppressed. it also occurs as a result of disease of the posterior end of the spinal marrow and with broken back, and is then associated with palsy of the tail, and, it may be, of the hind limbs. _symptoms._--the symptoms are a constant dribbling of urine when the neck is involved, the liquid running down the inside of the thighs and irritating the skin. when the neck is unaffected the urine is retained until the bladder is greatly overdistended, when it may be expelled in a gush by the active contraction of the muscular walls of the abdomen; this never empties the bladder, however, and the oiled hand introduced through the rectum may feel the soft, flabby organ still half full of urine. this retained urine is liable to decompose and give off ammonia, which dissolves the epithelial cells, exposing the raw, mucous membrane and causing the worst type of cystitis. suppression and incontinence of urine are common also to obstruction of the urethra by stone or otherwise; hence this source of fallacy should be excluded by manual examination along the whole course of that duct. _treatment._--treatment is only applicable in cases in which the determining cause can be abated. in remedial sprains of the back or disease of the spinal cord these must have appropriate treatment, and the urine must be drawn off frequently with a catheter to prevent overdistention and injury to the bladder. if the paralysis persists after recovery of the spinal cord, or if it continues after relief of spasm of the neck of the bladder, apply a pulp of mustard and water over the back part of the belly in front of the udder, and cover with a rug until the hair stands erect. in the male the mustard may be applied between the thighs from near the anus downward. daily doses of drams extract of belladonna or of grains powdered spanish fly may serve to rouse the lost tone. these failing, a mild current of electricity daily may succeed. inflammation of the bladder (cystitis, or urocystitis). cystitis may be slight or severe, acute or chronic, partial or general. it may be caused by abuse of diuretics, especially such as are irritating (cantharides, turpentine, copaiba, resin, etc.), by the presence of a stone or gravel in the bladder, the irritation of a catheter or other foreign body introduced from without, the septic ferment (bacterium) introduced on a filthy catheter, the overdistention of the bladder by retained urine, the extrication of ammonia from retained decomposing urine, resulting in destruction of the epithelial cells and irritation of the raw surface, and a too concentrated and irritating urine. the application of spanish flies or turpentine over a too extensive surface, sudden exposure of a perspiring and tired horse to cold or wet, and the presence of acrid plants in the fodder may cause cystitis, as they may nephritis. finally, inflammation may extend from a diseased vagina or urethra to the bladder. _symptoms._--the symptoms are slight or severe colicky pains; the animal moves his hind feet uneasily or even kicks at the abdomen, looks around at his flank, and may even lie down and rise frequently. more characteristic are frequently repeated efforts to urinate, resulting in the discharge of a little clear, or red, or more commonly flocculent urine, always in jets, and accompanied with signs of pain, which persist after the discharge, as shown in continued straining, groaning, and perhaps in movements of the feet and tail. the penis hangs from the sheath, or in the mare the vulva is frequently opened and closed, as after urination. the animal winces when the abdomen is pressed in the region of the sheath or udder, and the bladder is found to be sensitive and tender when pressed with the oiled hand introduced through the rectum or vagina. in the mare the thickening of the walls of the bladder may be felt by introducing one finger through the urethra. the discharged urine, which may be turbid or even oily, contains an excess of mucus, with flat shreds of membrane, with scaly epithelial cells, and pus corpuscles, each showing two or more nuclei when treated with acetic acid, but there are no microscopic tubular casts, as in nephritis. if due to stone in the bladder, that will be found on examination through rectum or vagina. _treatment_ implies, first, the removal of the cause, whether poisons in feed or as medicine, the removal of spanish flies or other blistering agents from the skin, or the extraction of stone or gravel. if the urine has been retained and decomposed it must be completely evacuated through a clean catheter, and the bladder thoroughly washed out with a solution of dram of borax in a quart of water. this must be repeated twice daily until the urine no longer decomposes, because so long as ammonia is developed in the bladder the protecting layer of epithelial cells will be dissolved and the surface kept raw and irritable. the diet must be light (bran mashes, roots, fresh grass), and the drink impregnated with linseed tea, or solution of slippery elm or marsh mallow. the same agents may be used to inject into the rectum, or they may even be used along with borax and opium to inject into bladder (gum arabic dram, opium dram, tepid water pint). fomentations over the loins are often of great advantage, and these may be followed or alternated with the application of mustard, as in paralysis; or the mustard may be applied on the back part of the abdomen below or between the thighs from the anus downward. finally, when the acute symptoms have subsided, a daily dose of buchu dram and nux vomica one-half dram will serve to restore lost tone. irritable bladder. some horses, and especially mares, show an irritability of the bladder and nerve centers presiding over it by frequent urination in small quantities, though the urine is not manifestly changed in character and no more than the natural quantity is passed in the twenty-four hours. the disorder appears to have its source quite as frequently in the generative or nervous system as in the urinary. a troublesome and dangerous form is seen in mares, which dash off and refuse all control by the rein if driven with a full bladder, but usually prove docile if the bladder has been emptied before hitching. in other cases the excitement connected with getting the tail over the reins is a powerful determining cause. the condition is marked in many mares during the period of heat. an oleaginous laxative (castor oil pint) will serve to remove any cause of irritation in the digestive organs, and a careful dieting will avoid continued irritation by acrid vegetable agents. the bladder should be examined to see that there is no stone or other cause of irritation, and the sheath and penis should be washed with soapsuds, any sebaceous matter removed from the bilocular cavity at the end of the penis, and the whole lubricated with sweet oil. irritable mares should be induced to urinate before they are harnessed, and those that clutch the lines under the tail may have the tail set high by cutting the cords on its lower surface, or it may be prevented from getting over the reins by having a strap carried from its free end to the breeching. those proving troublesome when "in heat" may have -dram doses of bromid of potassium, or they may be served by the male or castrated. sometimes irritability may be lessened by daily doses of belladonna extract ( dram), or a better tone may be given to the parts by balsam copaiba ( dram). diseased growths in the bladder. these may be of various kinds, malignant or simple. in the horse i have found villous growths from the mucous membrane especially troublesome. they may be attached to the mucous membrane by a narrow neck or by a broad base covering a great part of the organ. _symptoms._--the symptoms are frequent straining, passing of urine and blood with occasionally gravel. an examination of the bladder with the hand in the rectum will detect the new growth, which may be distinguished from a hard, resistant stone. in mares, in which the finger can be inserted into the bladder, the recognition is still more satisfactory. the polypi attached by narrow necks may be removed by surgical operation, but for those with broad attachments treatment is eminently unsatisfactory. discharge of urine by the navel, or persistent urachus. this occurs only in the newborn, and consists in the nonclosure of the natural channel (urachus), through which the urine is discharged into the outer water bag (allantois) in fetal life. at that early stage of the animal existence the bladder resembles a long tube, which is prolonged through the navel string and opens into the outermost of the two water bags in which the fetus floats. in this way the urine is prevented from entering the inner water bag (amnion), where it would mingle with the liquids, bathing the skin of the fetus and cause irritation. at birth this channel closes up, and the urine takes the course normal to extra-uterine life. imperfect closure is more frequent in males than in females, because of the great length and small caliber of the male urethra and its consequent tendency to obstruction. in the female there may be a discharge of a few drops only at a time, while in the male the urine will be expelled in strong jets coincidently with the contractions of the bladder and walls of the abdomen. the first care is to ascertain whether the urethra is pervious by passing a human catheter. this determined, the open urachus may be firmly closed by a stout, waxed thread, carried with a needle through the tissues back of the opening and tied in front of it so as to inclose as little skin as possible. if a portion of the naval string remains, the tying of that may be all sufficient. it is important to tie as early as possible so as to avoid inflammation of the navel from contact with the urine. in summer a little carbolic-acid water or tar water may be applied to keep the flies off. eversion of the bladder. this can occur only in the female. it consists in the turning of the organ outside in through the channel of the urethra, so that it appears as a red, pear-shaped mass hanging from the floor of the vulva and protruding externally between its lips. it may be a mass like the fist, or it may swell up to the size of an infant's head. on examining its upper surface the orifices of the urethra maybe seen, one on each side, a short distance behind the neck, with the urine oozing from them drop by drop. this displacement usually supervenes on a flaccid condition of the bladder, the result of paralysis, overdistention, or severe compression during a difficult parturition. the protruding organ may be washed with a solution of ounce of laudanum and a teaspoonful of carbolic acid in a quart of water, and returned by pressing a smooth, rounded object into the fundus and directing it into the urethra, while careful pressure is made on the surrounding parts with the other hand. if too large and resistant it may be wound tightly in a strip of bandage about inches broad to express the great mass of blood and exudate and diminish the bulk of the protruded organ so that it can be easily pushed back. this method has the additional advantage of protecting the organ against bruises and lacerations in the effort made to return it. after the return, straining may be kept in check by giving laudanum ( to ounces) and by applying a truss to press upon the lips of the vulva. (see eversion of the womb.) the patient should be kept in a stall a few inches lower in front than behind, so that the action of gravity will favor retention. [illustration: plate xi. calculi and instrument for removal.] inflammation of the urethra (urethritis, or gleet). this affection belongs quite as much to the generative organs, yet it can not be entirely overlooked in a treatise on urinary disorders. it may be induced by the same causes as cystitis (which see); by the passage and temporary arrest of small stones, or gravel; by the irritation caused by foreign bodies introduced from without; by blows on the penis by sticks, stones, or by the feet of a mare that kicks while being served; by an infecting inflammation contracted from a mare served in the first few days after parturition or one suffering from leucorrhea; by infecting matter introduced on a dirty catheter, or by the extension of inflammation from an irritated, bilocular cavity filled with hardened sebaceous matter, or from an uncleansed sheath. _symptoms._--the symptoms are swelling, heat, and tenderness of the sheath and penis; difficulty, pain, and groaning in passing urine, which is liable to sudden temporary arrests in the course of micturition, and later a whitish, mucopurulent oozing from the papilla on the end of the penis. there is a tendency to erection of the penis, and in cases contracted from a mare the outer surface of that organ will show more or less extensive sores and ulcers. stallions suffering in this way will refuse to mount or, having mounted, will fail to complete the act of coition. if an entrance is effected, infection of the mare is liable to follow. _treatment_ in the early stages consists in a dose of physic (aloes drams) and fomentations of warm water to the sheath and penis. if there is reason to suspect the presence of infection, inject the urethra twice daily with borax dram, tepid water quart. when the mucopurulent discharge indicates the supervention of the second stage a more astringent injection may be used (nitrate of silver grains, water quart), and the same may be applied to the surface of the penis and inside the sheath. balsam of copaiba ( dram daily) may also be given with advantage after the purulent discharge has appeared. every stallion suffering from urethritis should be withheld from service, as should mares with leucorrhea. stricture of the urethra. this is a permanent narrowing of the urethra at a given point, the result of previous inflammation, caused by the passage or arrest of a stone, or gravel, by strong astringent injections in the early nonsecreting stage of urethritis, or by contraction of the lining membrane occurring during the healing of ulcers in neglected inflammations of that canal. the trouble is shown by the passage of urine in a fine stream, with straining, pain, and groaning, and by frequent painful erections. it must be remedied by mechanical dilatation, with catheters just large enough to pass with gentle force, to be inserted once a day, and to be used of larger size as the passage will admit them. the catheter should be kept perfectly clean and washed in a borax solution and well oiled before it is introduced. urinary calculi (stone, or gravel). these consist in some of the solids of the urine that have been precipitated from the urine in the form of crystals, which remain apart as a fine, powdery mass, or magma, or aggregate into calculi, or stones, of varying size. (see pl. xi.) their composition is therefore determined in different animals by the salts or other constituents found dissolved in the healthy urine, and by the additional constituents which may be thrown off in solution in the urine in disease. in this connection it is important to observe the following analysis of the horse's urine in health: water . urea . uric acid and urates . hippuric acid . lactic acid and lactates . mucus and organic matter . sulphates (alkaline) . phosphates (lime and soda) . chlorids (sodium) . carbonates (potash, magnesia, lime) . ----- . the carbonate of lime, which is present in large quantity in the urine of horses fed on green fodder, is practically insoluble, and therefore forms in the passages after secretion, and its microscopic rounded crystals give the urine of such horses a milky whiteness. it is this material which constitutes the soft, white, pultaceous mass that sometimes fills the bladder to repletion and requires to be washed out. in hay-fed horses carbonates are still abundant, while in those mainly grain-fed they are replaced by hippurates and phosphates--the products of the wear of tissues--the carbonates being the result of oxidation of the vegetable acids in the feed. carbonate of lime, therefore, is a very common constituent of urinary calculi in herbivora, and in many cases is the most abundant constituent. oxalate of lime, like carbonate of lime, is derived from the burning up of the carbonaceous matter of the feed in the system, one important factor being the less perfect oxidation of the carbon. indeed, füstenberg and schmidt have demonstrated on man, horse, ox, and rabbit that under the full play of the breathing (oxidizing) forces oxalic acid, like other organic acids, is resolved into carbonic acid. in keeping with this is the observation of lehmann, that in all cases in which man suffered from interference with the breathing oxalate of lime appeared in the urine. an excess of oxalate of lime in the urine may, however, claim a different origin. uric and hippuric acids are found in the urine of carnivora and herbivora, respectively, as the result of the healthy wear (disassimilation) of nitrogenous tissues. if these products are fully oxidized, however, they are thrown out in the form of the more soluble urea rather than as these acids. when uric acid out of the body is treated with peroxid of lead it is resolved into urea, allantoin, and oxalic acid, and woehler and frerrichs found that the administration of uric acid not only increased the excretion of urea but also of oxalic acid. it may therefore be inferred that oxalic acid is not produced from the carbonaceous feed alone but also from the disintegration of the nitrogenous tissues of the body. an important element of its production is, however, the imperfect performance of the breathing functions, and hence it is liable to result from diseases of the chest (heaves, chronic bronchitis, etc.). this is, above all, liable to prove the case if the subject is fed to excess on highly carbonaceous feeds (grass and green feed generally, potatoes, etc.). carbonate of magnesia, another almost constant ingredient of the urinary calculi of the horse, is formed the same way as the carbonate of lime--from the excess of carbonaceous feed (organic acids) becoming oxidized into carbon dioxid, which unites with the magnesia derived from the feed. the phosphates of lime and magnesia are not abundant in urinary calculi of the horse, the phosphates being present to excess in the urine in only two conditions--(a) when the ration is excessive and especially rich in phosphorus (wheat, bran, beans, peas, vetches, rape cake, oil cake, cottonseed cake); and (b) when, through the morbid, destructive changes in the living tissues, and especially of the bones, a great quantity of phosphorus is given off as a waste product. under these conditions, however, the phosphates may contribute to the formation of calculi, and this, above all, is liable if the urine is retained in the bladder until it has undergone decomposition and given off ammonia. the ammonia at once unites with the phosphate of magnesia to form a double salt--phosphate of ammonia and magnesia--which, being insoluble, is at once precipitated. the precipitation of this salt is, however, rare in the urine of the horse, though much more frequent in that of man and sheep. these are the chief mineral constituents of the urine which form ingredients in the horse's calculi, for though iron and manganese are usually present it is only in minute quantities. the excess of mineral matter in a specimen of urine unquestionably contributes to the formation of calculi, just as a solution of such matters out of the body is increasingly disposed to throw them down in the form of crystals as it becomes more concentrated and approaches nearer to the condition of saturation. hence, in considering the causes of calculi we can not ignore the factor of an excessive ration, rich in mineral matters and in carbonaceous matters (the source of carbonates and much of the oxalates), nor can we overlook the concentration of the urine that comes from dry feed and privation of water, or from the existence of fever which causes suspension of the secretion of water. in these cases, at least the usual quantity of solids is thrown off by the kidneys, and as the water is diminished there is danger of its approaching the point of supersaturation, when the dissolved solids must necessarily be thrown down. hence, calculi are more common in stable horses fed on dry grain and hay, in those denied a sufficiency of water or that have water supplied irregularly, in those subjected to profuse perspiration (as in summer), and in those suffering from a watery diarrhea. on the whole, calculi are most commonly found in winter, because the horses are then on dry feeding, but such dry feeding is even more conducive to them in summer when the condition is aggravated by the abundant loss of water by the skin. in the same way the extreme hardness of the water in certain districts must be looked upon as contributing to the concentration of the urine and correspondingly to the production of stone. the carbonates, sulphates, etc., of lime and magnesia taken in the water must be again thrown out, and just in proportion as these add to the solids of the urine they dispose it to precipitate its least soluble constituents. thus the horse is very subject to calculi on certain limestone soils, as over the calcareous formations of central and western new york, pennsylvania, and ohio, in america; of norfolk, suffolk, derbyshire, shropshire, and gloucestershire, in england; of poitou and landes, in france; and munich, in bavaria. the saturation of the urine from any or all of these conditions can only be looked on as an auxiliary cause, however, and not as in itself an efficient one, except on the rarest occasions. for a more direct and immediate cause we must look to the organic matter which forms a large proportion of all urinary calculi. this consists of mucus, albumen, pus, hyaline casts of the uriniferous tubes, epithelial cells, blood, etc., mainly agents that belong to the class of colloid or noncrystalline bodies. a horse may live for months and years with the urine habitually of a high density and having the mineral constituents in excess without the formation of stone or gravel; again, one with dilute urine of low specific gravity will have a calculus. rainey, ord, and others furnish the explanation. they not only show that a colloid body, like mucus, albumen, pus, or blood, determined the precipitation or the crystalline salts in the solution, but they determined the precipitation in the form of globules, or spheres, capable of developing by further deposits into calculi. heat intensifies this action of the colloids, and a colloid in a state of decomposition is specially active. the presence, therefore, of developing fungi and bacteria must be looked upon as active factors in causing calculi. in looking, therefore, for the immediate causes of calculi we must consider especially all those conditions which determine the presence of albumen, blood, and excess of mucus, pus, etc., in the urine. thus diseases of distant organs leading to albuminuria, diseases of the kidneys and urinary passages causing the escape of blood or the formation of mucus or pus, become direct causes of calculi. foreign bodies of all kinds in the bladder or kidney have long been known as determining causes of calculi and as forming the central nucleus. this is now explained by the fact that these bodies are liable to carry bacteria into the passages and thus determine decomposition, and they are further liable to irritate the mucous membrane and become enveloped in a coating of mucus, pus, and perhaps blood. the fact that horses, especially on the magnesian limestones, the same districts in which they suffer from goiter, appear to suffer from calculi may be similarly explained. the unknown poison which produces goiter presumably leads to such changes in the blood and urine as will furnish the colloid necessary for precipitation of the urinary salts in the form of calculi. classification of urinary calculi. these have been named according to the place where they are found, renal (kidney), ureteric (ureter), vesical (bladder), urethral (urethra), and preputial (sheath, or prepuce). they have been otherwise named according to their most abundant chemical constituent, carbonate of lime, oxalate of lime, and phosphate of lime calculi. the stones formed of carbonates or phosphates are usually smooth on the surface, though they may be molded into the shape of the cavity in which they have been formed; thus those in the pelvis of the kidney may have two or three short branchlike prolongations, while those in the bladder are round, oval, or slightly flattened upon each other. calculi containing oxalate of lime, on the other hand, have a rough, open, crystalline surface, which has gained for them the name of mulberry calculi, from a supposed resemblance to that fruit. these are usually covered with more or less mucus or blood, produced by the irritation of the mucous membrane by their rough surfaces. the color of calculi varies from white to yellow and deep brown, the shades depending mainly on the amount of the coloring matter of blood, bile, or urine which they may contain. _renal calculi._--these may consist of minute, almost microscopic, deposits in the uriniferous tubes in the substance of the kidney, but more commonly they are large masses and lodged in the pelvis. the larger calculi, sometimes weighing to ounces, are molded in the pelvis of the kidney into a cylindroid mass, with irregular rounded swellings at intervals. some have a deep brown, rough, crystalline surface of oxalate of lime, while others have a smooth, pearly white aspect from carbonate of lime. a smaller calculus, which has been called coralline, is also cylindroid, with a number of brown, rough, crystalline oxalate of lime branches and whitish depressions of carbonate. these vary in size from grains to nearly ounces. less frequently are found masses of very hard, brownish white, rounded, pealike calculi. these are smoother, but on the surface crystals of oxalate of lime may be detected with a lens. some renal calculi are formed of more distinct layers, more loosely adherent to one another, and contain an excess of mucus, but no oxalate of lime. finally, a loose aggregation of small masses, forming a very friable calculus, is found of all sizes within the limits of the pelvis of the kidney. these, too, are in the main carbonate of lime ( to per cent) and without oxalate. symptoms of renal calculi are violent, colicky, pains, appearing suddenly, very often in connection with exhausting work or the drawing of specially heavy loads, and in certain cases disappearing with equal suddenness. the nature of the colic becomes more manifest if it is associated with stiffness of the back and hind limbs, frequent passage of urine, and, above all, the passage of gravel with the urine, especially at the time of the access of relief. the passage of blood and pus in the urine is equally significant. if the irritation of the kidney goes on to active inflammation, then the symptoms of nephritis are added. _ureteric calculi._--these are so called because they are found in the passage leading from the kidney to the bladder. they are simply small, renal calculi which have escaped from the pelvis of the kidney and have become arrested in the ureter. they give rise to symptoms almost identical with those of renal calculi, with this difference, that the colicky pains, caused by the obstruction of the ureter by the impacted calculus, are more violent, and if the calculus passes on into the bladder the relief is instantaneous and complete. if the ureter is completely blocked for a length of time, the retained urine may give rise to destructive inflammation in the kidney, which may end in the entire absorption of that organ, leaving only a fibrous capsule containing an urinous fluid. if both the ureters are similarly blocked, the animal will die of uremic poisoning. _treatment of renal and ureteric calculi._--treatment is unsatisfactory, as it is only the small calculi that can pass through the ureters and escape into the bladder. this may be favored by agents which will relax the walls of the ureters by counteracting their spasm and even lessening their tone, and by a liberal use of water and watery fluids to increase the urine and the pressure upon the calculus from behind. one or two ounces of laudanum, or drams of extract of belladonna, may be given and repeated as it may be necessary, the relief of the pain being a fair criterion of the abating of the spasm. to the same end use warm fomentations across the loins, and these should be kept up persistently until relief is obtained. these act not only by soothing and relieving the spasm and inflammation, but they also favor the freer secretion of a more watery urine, and thus tend to carry off the smaller calculi. to accomplish this object further give cool water freely, and let the feed be only such as contains a large proportion of liquid, gruels, mashes, turnips, beets, apples, pumpkins, ensilage, succulent grasses, etc. if the acute stage has passed and the presence of the calculus is manifested only by the frequent passage of urine with gritty particles, by stiffness of the loins and hind limbs, and by tenderness to pressure, the most promising resort is a long run at pasture where the grasses are fresh and succulent. the long-continued secretion of a watery urine will sometimes cause the breaking down of a calculus, as the imbibition of the less dense fluid by the organic, spongelike framework of the calculus causes it to swell and thus lessens its cohesion. the same end is sought by the long-continued use of alkalies (carbonate of potassium), and of acids (muriatic), each acting in a different way to alter the density and cohesion of the stone. it is only exceptionally, however, that any one of these methods is entirely satisfactory. if inflammation of the kidneys develops, treat as advised under that head. _stone in the bladder (vesical calculus, or cystic calculus)._--these may be of any size up to over a pound in weight. one variety is rough and crystalline and has a yellowish-white or deep-brown color. these contain about per cent carbonate of lime, the remainder being carbonate of magnesia, oxalate of lime, and organic matter. the phosphatic calculi are smooth, white and formed of thin, concentric layers of great hardness extending from the nucleus outward. besides the phosphate of lime they contain the carbonates of lime and magnesia and organic matter. in some cases the bladder contains and may be even distended by a soft, pultaceous mass made up of minute, round granules of carbonates of lime and magnesia. this, when removed and dried, makes a firm, white, and stony mass. sometimes this magma is condensed into a solid mass in the bladder by reason of the binding action of the mucus and other organic matter, and then forms a conglomerate stone of nearly uniform consistency and without stratification. _symptoms of stone in the bladder._--the symptoms of stone in the bladder are more obvious than those of renal calculus. the rough, mulberry calculi especially lead to irritation of the mucous membrane and frequent passing of urine in small quantities and often mingled with mucus or blood or containing minute, gritty particles. at times the flow is suddenly arrested, though the animal continues to strain and the bladder is not quite emptied. in the smooth, phosphatic variety the irritation is much less marked and may even be altogether absent. with the pultaceous deposit in the bladder there is incontinence of urine, which dribbles away continually and keeps the hair on the inner side of the thighs matted with soft magma. in all cases alike the calculus may be felt by the examination of the bladder with the oiled hand in the rectum. the pear-shaped outline of the bladder can be felt beneath, and within it the solid, oval body. it is most easily recognized if the organ is half full of liquid, as then it is not grasped by the contracting walls of the bladder, but may be made to move from place to place in the liquid. if a pultaceous mass is present it has a soft, doughy feeling, and when pressed an indentation is left. in the mare the hard stone may be touched by the finger introduced through the short urethra. _treatment of stone in the bladder._--the treatment of stone in the bladder consists in the removal of the offending body; in the mare this is easily effected with the lithotomy forceps. these are slightly warmed and oiled, and carried forward along the floor of the passage of the vulva for inches, when the orifice of the urethra will be felt exactly in the median line. through this the forceps are gradually pushed with gentle, oscillating movement until they enter the bladder and strike against the hard surface of the stone. the stone is now grasped between the blades, care being taken to include no loose fold of the mucous membrane, and it is gradually withdrawn with the same careful, oscillating motions as before. facility and safety in seizing the stone will be greatly favored by having the bladder half full of liquid, and if necessary one oiled hand may be introduced into the rectum or vagina to assist. the resulting irritation may be treated by an injection of laudanum, ounce in a pint of tepid water. the removal of the stone in the horse is a much more difficult proceeding. it consists in cutting into the urethra just beneath the anus and introducing the lithotomy forceps from this forward into the bladder, as in the mare. it is needful to distend the urethra with tepid water or to insert a sound or catheter to furnish a guide upon which the incision may be made, and in case of a large stone it may be needful to enlarge the passage by cutting in a direction upward and outward with a probe-pointed knife, the back of which is slid along in the groove of a director until it enters the bladder. the horse may be operated upon in the standing position, being simply pressed against the wall by a pole passed from before backward along the other side of the body. the tepid water is injected into the end of the penis until it is felt to fluctuate under the pressure of the finger, in the median line over the bone just beneath the anus. the incision is then made into the center of the fluctuating canal, and from above downward. when a sound or catheter is used as a guide it is inserted through the penis until it can be felt through the skin at the point where the incision is to be made beneath the anus. the skin is then rendered tense by the thumb and fingers of the left hand pressing on the two sides of the sound, while the right hand, armed with a scalpel, cuts downward onto the catheter. this vertical incision into the canal should escape wounding any important blood vessel. it is in making the obliquely lateral incision in the subsequent dilatation of the urethra and neck of the bladder that such danger is to be apprehended. if the stone is too large to be extracted through the urethra, it may be broken down with the lithotrite and extracted piecemeal with the forceps. the lithotrite is an instrument composed of a straight stem bent for an inch or more to one side at its free end so as to form an obtuse angle, and having on the same side a sliding bar moving in a groove in the stem and operated by a screw so that the stone may be seized between the two blades at its free extremity and crushed again and again into pieces small enough to extract. extra care is required to avoid injury to the urethra in the extraction of the angular fragments, and the gravel or powder that can not be removed in this way must be washed out, as advised below. when a pultaceous magma of carbonate of lime accumulates in the bladder it must be washed out by injecting water through a catheter by means of a force pump or a funnel, shaking it up with the hand introduced through the rectum and allowing the muddy liquid to flow out through the tube. this is to be repeated until the bladder is empty and the water come away, clear. a catheter with a double tube is sometimes used, the injection passing in through the one tube and escaping through the other. the advantage is more apparent than real, however, as the retention of the water until the magma has been shaken up and mixed with it hastens greatly its complete evacuation. to prevent the formation of a new deposit any fault in feeding (dry grain and hay with privation of water, excess of beans, peas, wheat bran, etc.) and disorders of stomach, liver, and lungs must be corrected. give abundance of soft drinking water, encouraging the animal to drink by a handful of salt daily. let the feed be laxative, consisting largely of roots, apples, pumpkins, ensilage, and give daily in the drinking water a dram of either carbonate of potash or soda. powdered gentian root ( drams daily) will also serve to restore the tone of the stomach and system at large. _urethral calculus (stone in the urethra)._--this is less frequent in horses than in cattle and sheep, owing to the larger size of the urethra in the horse and the absence of the <b>s</b>-shaped curve and vermiform appendix. the calculi arrested in the urethra are never formed there, but consist of cystic calculi which have been small enough to pass through the neck of the bladder, but are too large to pass through the whole length of the urethra and escape. such calculi therefore are primarily formed either in the bladder or kidney, and have the chemical composition of the other calculi found in those organs. they may be arrested at any point of the urethra, from the neck of the bladder back to the bend of the tube beneath the anus, and from that point down to the extremity of the penis. i have found them most frequently in the papilla on the extreme end of the penis, and immediately behind this. _symptoms of urethral calculus._--the symptoms are violent straining to urinate, but without any discharge, or with the escape of water in drops only. examination of the end of the penis will detect the swelling of the papilla or the urethra behind it, and the presence of a hard mass in the center. a probe inserted into the urethra will strike against the gritty calculus. if the stone has been arrested higher up, its position may be detected as a small, hard, sensitive knot on the line of the urethra, in the median line of the lower surface of the penis, or on the floor of pelvis in the median line from the neck of the bladder back to the bend of the urethra beneath the anus. in any case the urethra between the neck of the bladder and the point of obstruction is liable to be filled with fluid, and to feel like a distended tube, fluctuating on pressure. _treatment of urethral calculus_ may be begun by an attempt to extract the calculi by manipulation of the papilla on the end of the penis. this failing, the calculus may be seized with a pair of fine-pointed forceps and withdrawn from the urethra; or, if necessary, a probe-pointed knife may be inserted and the urethra slightly dilated, or even laid open, and the stone removed. if the stone has been arrested higher up it must be extracted by a direct incision through the walls of the urethra and down upon the nodule. if in the free (protractile) portion of the penis, that organ is to be withdrawn from its sheath until the nodule is exposed and can be incised. if behind the scrotum, the incision must be made in the median line between the thighs and directly over the nodule, the skin having been rendered tense by the fingers and thumb of the left hand. if the stone has been arrested in the intrapelvic portion of the urethra, the incision must be made beneath the anus and the calculus extracted with forceps, as in stone in the bladder. the wound in the urethra may be stitched up, and usually heals slowly but satisfactorily. healing will be favored by washing two or three times daily with a solution of a teaspoonful of carbolic acid in a pint of water. _preputial calculus (calculus in the sheath, or bilocular cavity)._--these are concretions in the sheath, though the term has been also applied to the nodule of sebaceous matter which accumulates in the blind pouches (bilocular cavity) by the sides of the papilla on the end of the penis. within the sheath the concretion may be a soft, cheesy-like sebaceous matter, or a genuine calculus of carbonate, oxalate, phosphate and sulphate of lime, carbonate of magnesia, and organic matter. these are easily removed with the fingers, after which the sheath should be washed out with castile soap and warm water and smeared with sweet oil. diseases of the generative organs. by james law, f. r. c. v. s., formerly professor of veterinary science, etc., in cornell university. congestion and inflammation of the testicles, or orchitis. in the prime of life, in vigorous health, and on stimulating feed, stallions are subject to congestion of the testicles, which become swollen, hot, and tender, but without any active inflammation. a reduction of the grain in the feed, the administration of or ounces of glauber's salt daily in the feed, and the bathing of the affected organs daily with tepid water or alum water will usually restore them to a healthy condition. when the factors producing congestion are extraordinarily potent, when there has been frequent copulation and heavy grain feeding, when the weather is warm and the animal has had little exercise, and when the proximity of other horses or mares excites the generative instinct without gratification, this congestion may grow to actual inflammation. among the other causes of orchitis are blows and penetrating wounds implicating the testicles, abrasions of the scrotum by a chain or rope passing inside the thigh, contusions and frictions on the gland under rapid paces or heavy draft, compression of the blood vessels of the spermatic cord by the inguinal ring under the same circumstances, and, finally, sympathetic disturbance in cases of disease of the kidneys, bladder, or urethra. stimulants of the generative functions, like rue, savin, tansy, cantharides, and damiana, may also be accessory causes of congestion and inflammation. finally, certain specific diseases, like dourine, glanders, and tuberculosis, localized in the testicles, will cause inflammation. _symptoms._--apart from actual wounds of the parts, the symptoms of orchitis are swelling, heat, and tenderness of the testicles, straddling with the hind legs alike in standing and walking, stiffness and dragging of the hind limbs or of the limb on the affected side, arching of the loins, abdominal pain, manifested by glancing back at the flank, more or less fever, elevated body temperature, accelerated pulse and breathing, lack of appetite, and dullness. in bad cases the scanty urine may be reddish and the swelling may extend to the skin and envelopes of the testicle, which may become thickened and doughy, pitting on pressure. the swelling may be so much greater in the convoluted excretory duct along the upper border of the testicle as to suggest the presence of a second stone. even in the more violent attacks the intense suffering abates somewhat on the second or third day. if it lasts longer, it is liable to give rise to the formation of matter (abscess). in exceptional cases the testicle is struck with gangrene, or death. improvement may go on slowly to complete recovery, or the malady may subside into a subacute and chronic form with induration. matter (abscess) may be recognized by the presence of a soft spot, where pressure with two fingers will detect fluctuation from one to the other. when there is liquid exudation into the scrotum, or sac, fluctuation may also be felt, but the liquid can be made out to be around the testicle and can be pressed up into the abdomen through the inguinal canal. when abscess occurs in the cord the matter may escape into the scrotal sac and cavity of the abdomen and pyemia may follow. _treatment_ consists in perfect rest and quietude, the administration of a purgative ( to - / pounds glauber's salt), and the local application of an astringent lotion (acetate of lead drams, extract of belladonna drams, and water quart) upon soft rags or cotton wool, kept in contact with the part by a suspensory bandage. this bandage, of great value for support, may be made nearly triangular and tied to a girth around the loins and to the upper part of the same surcingle by two bands carried backward and upward between the thighs. in severe cases scarifications one-fourth inch deep serve to relieve vascular tension. when abscess is threatened its formation may be favored by warm fomentations or poultices, and on the occurrence of fluctuation the knife may be used to give free escape to the pus. the resulting cavity may be injected daily with a weak carbolic-acid lotion, or salol may be introduced. the same agents may be used on a gland threatened with gangrene, but its prompt removal by castration is to be preferred, antiseptics being applied freely to the resulting cavity. sarcocele. this is an enlarged and indurated condition of the gland, resulting from chronic inflammation, though it is often associated with a specific deposit, like glanders. in this condition the natural structure of the gland has given place to embryonal tissue (small, round cells, with a few fibrous bundles), and its restoration to health is very improbable. apart from active inflammation, it may increase very slowly. the diseased testicle is enlarged, firm, nonelastic, and comparatively insensible. the skin of the scrotum is tense, and it may be edematous (pitting on pressure), as are the deeper envelopes and spermatic cord. if liquid is present in the sac, the symptoms are masked somewhat. as it increases it causes awkward, straddling, dragging movement of the hind limbs, or lameness on the affected side. the spermatic cord often increases at the same time with the testicle, and the inguinal ring being thereby stretched and enlarged, a portion of intestine may escape into the sac, complicating the disease with hernia. the only rational and effective treatment is castration, and when the disease is specific (glanders, tuberculosis), even this may not succeed. hydrocele, or dropsy of the scrotum. this may be merely an accompaniment of dropsy of the abdomen, the cavity of which is continuous with that of the scrotum in horses. it may be the result, however, of local disease in the testicle, spermatic cord, or walls of the sac. _symptoms._--the symptoms are enlargement of the scrotum, and fluctuation under the fingers, the testicle being recognized as floating in water. by pressure the liquid is forced, in a slow stream and with a perceptible thrill, into the abdomen. sometimes the cord or the scrotum is thickened and pits on pressure. _treatment_ may be the same as for ascites, yet when the effusion has resulted from inflammation of the testicle or cord, astringent applications (chalk and vinegar) may be applied to these. then, if the liquid is not reabsorbed under diuretics and tonics, it may be drawn off through the nozzle of a hypodermic syringe which has been first passed through carbolic acid. in geldings it is best to dissect out the sacs. varicocele. this is an enlargement of the venous network of the spermatic cord, and gives rise to general thickening of the cord from the testicle up to the ring. the same astringent dressings may be tried as in hydrocele, and, this failing, castration may be resorted to. abnormal number of testicles. sometimes one or both testicles are wanting; in most such cases, however, they are merely partially developed, and retained in the inguinal canal or abdomen (cryptorchid). in rare cases there may be a third testicle, the animal becoming to this extent a double monster. teeth, hair, and other indications of a second fetus have likewise been found in the testicle or scrotum. degeneration of the testicles. the testicles may become the seat of fibrous, calcareous, fatty, cartilaginous, or cystic degeneration, for all which the appropriate treatment is castration. they also become the seat of cancer, glanders, or tuberculosis, and castration is requisite, though with less hope of arresting the disease. finally, they may become infested with cystic tapeworms or the agamic stage of a strongyle (_strongylus edentatus_). warts on the penis. these are best removed by twisting them off, using the thumb and forefinger. they may also be cut off with scissors and the roots cauterized with nitrate of silver. degeneration of penis (papilloma, or epithelioma). the penis of the horse is subject to great cauliflower-like growths on its free end, which extend back into the substance of the organ, obstruct the passage of urine, and cause very fetid discharges. the only resort is to cut them off, together with whatever portion of the penis has become diseased and indurated. the operation, which should be performed by a veterinary surgeon, consists in cutting through the organ from its upper to its lower aspect, twisting or tying the two dorsal arteries, and leaving the urethra longer by half an inch to inch than the adjacent structures. extravasation of blood in the penis. as the result of kicks, blows, or of forcible striking of the penis on the thighs of the mare which it has failed to enter, the penis may become the seat of effusion of blood from one or more ruptured blood vessels. this gives rise to a more or less extensive swelling on one or more sides, followed by some heat and inflammation, and on recovery a serious curving of the organ. the treatment in the early stages may be the application of lotions, of alum, or other astringents, to limit the effusion and favor absorption. the penis should be suspended in a sling. paralysis of the penis. this results from blows and other injuries, and also in some cases from too frequent and exhausting service. the penis hangs from the sheath, flaccid, pendulous, and often cold. the passage of urine occurs with lessened force, and especially without the final jets. in cases of local injury the inflammation should first be subdued by astringent and emollient lotions, and in all cases the system should be invigorated by nourishing diet, while -grain doses of nux vomica are given twice a day. finally, a weak current of electricity sent through the penis from just beneath the anus to the free portion of the penis, continued for or minutes and repeated daily, may prove successful. self-abuse, or masturbation. some stallions acquire this vicious habit, stimulating the sexual instinct to the discharge of semen by rubbing the penis against the belly or between the fore limbs. the only remedy is a mechanical one, the fixing of a net under the penis in such fashion as to prevent the extension of the penis or so prick the organ as to compel the animal to desist through pain. dourine. this disease is discussed in the chapter on "infectious diseases." castration. castration of stallions. this is usually done at year old, but may be accomplished at a few weeks old at the expense of an imperfect development of the fore parts. the simplicity and safety of the operation are greatest in the young. the delay till , , or years old will secure a better development and carriage of the fore parts. the essential part of castration is the safe removal or destruction of the testicle and the arrest or prevention of bleeding from the spermatic artery round in the anterior part of the cord. into the many methods of accomplishing this limited space forbids us to enter here, so that only the method most commonly adopted, castration by clamps, will be noticed. the animal having been thrown on his left side, and the right hind foot drawn up on the shoulder, the exposed scrotum, penis, and sheath are washed with soap and water, any concretion of sebum being carefully removed from the bilocular cavity in the end of the penis. the left spermatic cord, just above the testicle, is now seized in the left hand, so as to render the skin tense over the stone, and the right hand, armed with the knife, makes an incision from before backward, about three-fourths of an inch from and parallel to the median line between the thighs, deep enough to expose the testicle and long enough to allow that organ to start out through the skin. at the moment of making this incision the left hand must grasp the cord very firmly, otherwise the sudden retraction of the testicle by the cremaster muscle may draw it out of the hand and upward through the canal and even into the abdomen. in a few seconds, when the struggle and retraction have ceased, the knife is inserted through the cord, between its anterior and posterior portions, and the latter, the one which the muscle retracts, is cut completely through. the testicle will now hang limp, and there is no longer any tendency to retraction. it should be pulled down until it will no longer hang loose below the wound and the clamps applied around the still attached portion of the cord, close up to the skin. the clamps, which may be made of any tough wood, are grooved along the center of the surfaces opposed to each other, thereby fulfilling two important indications--(a) enabling the clamps to hold more securely and (b) providing for the application of an antiseptic to the cord. for this purpose a dram of sulphate of copper may be mixed with an ounce of vaseline and pressed into the groove in the face of each clamp. in applying the clamp over the cord it should be drawn so close with pincers as to press out all blood from the compressed cord and destroy its vitality, and the cord applied upon the compressing clamps should be so hard-twined that it will not stretch later and slacken the hold. when the clamp has been fixed the testicle is cut off one-half to inch below it, and the clamp may be left thus for hours; then, by cutting the cord around one end of the clamp, the latter may be opened and the stump liberated without any danger of bleeding. should the stump hang out of the wound it should be pushed inside with the finger and left there. the wound should begin to discharge white matter on the second day in hot weather or the third in cold, and from that time a good recovery may be expected. the young horse suffers less from castration than the old, and very rarely perishes. good health in the subject is all important. castration should never be attempted during the prevalence of strangles, influenza, catarrhal fever, contagious pleurisy, bronchitis, pneumonia, purpura hemorrhagica, or other specific disease, nor on subjects that have been kept in close, ill-ventilated, filthy buildings, where the system is liable to have been charged with putrid bacteria or other products. warm weather is to be preferred to cold, but the fly time should be avoided or the flies kept at a distance by the application of a watery solution of tar, carbolic acid, or camphor to the wound. castration of cryptorchids (ridglings). this is the removal of a testicle or testicles that have failed to descend into the scrotum, but have been detained in the inguinal canal or inside the abdomen. the manipulation requires an accurate anatomical knowledge of the parts, and special skill, experience, and manual dexterity, and can not be made clear to the unprofessional mind in a short description. it consists, however, in the discovery and removal of the missing gland by exploring through the natural channel (the inguinal canal), or, in case it is absent, through the inguinal ring or through an artificial opening made in front and above that channel between the abdominal muscles and the strong fascia on the inner side of the thigh (poupart's ligament). whatever method is used, the skin, hands, and instruments should be rendered aseptic with a solution of mercuric chlorid part, water , parts (a carbolic-acid lotion for the instruments), and the spermatic cord is best torn through by the écraseur. in many such cases, too, it is desirable to sew up the external wound and keep the animal still, to favor healing of the wound by adhesion. conditions following castration. _pain after castration._--some horses are pained and very restless for several hours after castration, and this may extend to cramps of the bowels and violent colic. this is best kept in check by carefully rubbing the patient dry when he rises from the operation, and then leading him in hand for some time. if the pain still persists a dose of laudanum ( ounce for an adult) may be given. _bleeding after castration._--bleeding from the wound in the scrotum and from the little artery in the posterior portion of the spermatic cord always occurs, and in warm weather may appear to be quite free. it scarcely ever lasts, however, more than minutes, and is easily checked by dashing cold water against the part. bleeding from the spermatic artery in the anterior part of the cord may be dangerous when due precaution has not been taken to prevent it. in such case the stump of the cord should be sought for and the artery twisted with artery forceps or tied with a silk thread. if the stump can not be found, pledgets of tow wet with tincture of muriate of iron may be stuffed into the canal to favor the formation of clot and the closure of the artery. _strangulated spermatic cord._--if in castration the cord is left too long, so as to hang out of the wound, the skin wound in contracting grasps and strangles it, preventing the free return of blood and causing a steadily advancing swelling. in addition the cord becomes adherent to the lips of the wound in the skin, whence it derives an increased supply of blood, and is thereby stimulated to more rapid swelling. the subject walks stiffly, with a straddling gait, loses appetite, and has a rapid pulse and high fever. examination of the wound discloses the partial closure of the skin wound and the protrusion, from its lips, of the end of the cord, red, tense, and varying in size from a hazelnut upward. if there is no material swell and little protrusion, the wound may be enlarged with the knife and the end of the cord broken loose from any connection with the skin and pushed up inside. if the swelling is larger, the mass constitutes a tumor and must be removed. (see below.) _swelling of the sheath, penis, and abdomen._--this occurs in certain unhealthy states of the system, in unhealthful seasons, as the result of operating without cleansing the sheath and penis, or of keeping the subject in a filthy, impure building, as the result of infecting the wound by hands or instruments bearing septic bacteria, or as the result of premature closure of the wound, and imprisonment of matter. pure air and cleanliness of groin and wound are to be obtained. antiseptics, like the mercuric-chlorid lotion ( part to , ) are to be applied to the parts; the wound, if closed, is to be opened anew, any accumulated matter or blood washed out, and the antiseptic liquid freely applied. the most tense or dependent parts of the swelling in sheath or penis, or beneath the belly, should be pricked at intervals of or inches to a depth of half an inch, and antiseptics freely applied to the surface. fomentations with warm water may also be used to favor oozing from the incisions and to encourage the formation of white matter in the original wounds, which must not be allowed to close again at once. a free, creamlike discharge implies a healthy action in the sore, and is the precursor of recovery. _phymosis and paraphymosis._--in cases of swelling, as above, the penis may be imprisoned within the sheath (phymosis) or protruded and swollen so that it can not be retracted into it (paraphymosis). in these cases the treatment indicated above, and especially the scarifications, will prove a useful preliminary resort. the use of astringent lotions is always desirable, and in case of the protruded penis the application of an elastic or simple linen bandage, so as to press the blood and accumulated fluid out, will enable the operator to return it. _tumors on the spermatic cord._--these are due to rough handling or dragging upon the cord in castration, to strangulation of unduly long cords in the external wound, to adhesion of the end of the cord to the skin, to inflammation of the cord succeeding exposure to cold or wet, or to the presence of infection (_staphylococcus botriomyces_). these tumors give rise to a stiff, straddling gait, and may be felt as hard masses in the groin connected above with the cord. they may continue to grow slowly for many years until they reach a weight of or pounds, and contract adhesions to all surrounding parts. if disconnected from the skin and inguinal canal they may be removed in the same manner as the testicle, while if larger and firmly adherent to the skin and surrounding parts generally, they must be carefully dissected from the parts, the arteries being tied as they are reached and the cord finally torn through with an écraseur. when the cord has become swollen and indurated up into the abdomen such removal is impossible, though a partial destruction of the mass may still be attempted by passing white-hot, pointed irons upward toward the inguinal ring in the center of the thickened and indurated cord. castration by the covered operation. this is only required in case of hernia or protrusion of bowels or omentum into the sac of the scrotum, and consists in the return of the hernia and the application of the caustic clamps over the cord and inner walls of the inguinal canal, so that the walls of the latter become adherent above the clamps, the canal is obliterated, and further protrusion is hindered. for the full description of this and of the operation for hernia for geldings, see remarks on hernia. castration of the mare. castration is a much more dangerous operation in the mare than in the females of other domesticated quadrupeds and should never be resorted to except in animals that become unmanageable on the recurrence of heat and that will not breed or that are utterly unsuited to breeding. formerly the operation was extensively practiced in europe, the incision being made through the flank, and a large proportion of the subjects perished. by operating through the vagina the risk can be largely obviated, as the danger of unhealthy inflammation in the wound is greatly lessened. the animal should be fixed in a trevis, with each foot fixed to a post and a sling placed under the body, or it may be thrown and put under chloroform. the manual operation demands special professional knowledge and skill, but it consists essentially in making an opening through the roof of the vagina just above the neck of the womb, then following with the hand each horn of the womb until the ovary on that side is reached and grasped between the lips of forceps and twisted off. it might be torn off by an écraseur especially constructed for the purpose. the straining that follows the operation may be checked by ounce doses of laudanum, and any risk of protrusion of the bowels may be obviated by applying the truss advised to prevent eversion of the womb. to further prevent the pressure of the abdominal contents against the vaginal wound the mare should be tied short and high for twenty-four or forty-eight hours, after which i have found it best to remove the truss and allow the privilege of lying down. another important point is to give bran mashes and other laxative diet only, and in moderate quantity, for a fortnight, and to unload the rectum by copious injections of warm water in case impaction is imminent. sterility. sterility may be in the male or in the female. if due to the stallion, then all the mares put to him remain barren; if the fault is in the mare, she alone fails to conceive, while other mares served by the same stallion get in foal. in the stallion sterility may be due to the following causes: (a) imperfect development of the testicles, as in cases in which they are retained within the abdomen; (b) inflammation of the testicles, resulting in induration; (c) fatty degeneration of the testicles, in stallions liberally fed on starchy feed and not sufficiently exercised; (d) fatty degeneration of the excretory ducts of the testicles (_vasa deferentia_); (e) inflammation or ulceration of these ducts; (f) inflammation or ulceration of the mucous membrane covering the penis; (g) injuries to the penis from blows (often causing paralysis); (h) warty growths on the end of the penis; (i) tumors of other kinds (largely pigmentary), affecting the testicles or penis; (j) nervous diseases which abolish the sexual appetite or that control the muscles which are essential to the act of coition; (k) azoturia with resulting weakness or paralysis of the muscles of the loins or the front of the thigh (above the stifle); (l) ossification (_anchylosis_) of the joints of the back or loins, which render the animal unable to rear or mount; (m) spavins, ringbones, or other painful affections of the hind limbs, the pain of which in mounting causes the animal to suddenly stop short in the act. in the first three of these only (a, b, and c) is there real sterility in the sense of the nondevelopment or imperfect development of the male vivifying element (spermatozoa). in the other examples the secretion may be imperfect in kind and amount, but as copulation is prevented it can not reach and impregnate the ovum. in the mare barrenness is equally due to a variety of causes. in a number of breeding studs the proportion of sterile mares has varied from to per cent. it may be due to: (a) imperfect development of the ovary and nonmaturation of ova; (b) cystic or other tumors of the ovary; (c) fatty degeneration of the ovary in very obese, pampered mares; (d) fatty degeneration of the excretory tubes of the ovaries (fallopian tubes); (e) catarrh of the womb, with mucopurulent discharge; (f) irritable condition of the womb, with profuse secretion, straining, and ejection of the semen; (g) nervous irritability, leading to the same expulsion of the male element; (h) high condition (plethora), with profuse secretion and excitement; (i) low condition, with imperfect maturation of the ova and lack of sexual desire; (j) poor feeding, overwork, and chronic debilitating diseases, as leading to the condition just named; (k) closure of the neck of the womb, temporarily by spasm or permanently by inflammation and induration; (l) closure of the entrance to the vagina through imperforate hymen, a rare, though not unknown, condition in the mare; (m) acquired indisposition to breed, seen in old, hard-worked mares which are first put to the stallion when aged; (n) change of climate has repeatedly been followed by barrenness; (o) hybridity, which in male and female alike usually entails sterility. _treatment._--the treatment of the majority of these conditions will be found dealt with in other parts of this work, so that it is only necessary here to name them as causes. some, however, must be specially referred to in this place. stallions with undescended testicles are beyond the reach of medicine, and should be castrated and devoted to other uses. indurated testicles may sometimes be remedied in the early stages by smearing with a weak iodin ointment daily for a length of time, and at the same time invigorating the system by liberal feeding and judicious work. fatty degeneration is best met by an albuminoid diet (wheat bran, cottonseed meal, rape cake) and constant, well-regulated work. saccharine, starchy, and fatty food (potatoes, wheat, corn, etc.) are to be specially avoided. in the mare one diseased and irritable ovary should be removed, to do away with the resulting excitability of the remainder of the generative organs. an irritable womb, with frequent straining and the ejection of a profuse secretion, may sometimes be corrected by a restricted diet and full but well-regulated work. even fatigue will act beneficially in some such cases, hence the practice of the arab riding his mare to exhaustion just before service. the perspiration in such case, like the action of a purgative or the abstraction of blood just before service, benefits, by rendering the blood vessels less full, by lessening secretion in the womb and elsewhere, and thus counteracting the tendency to the ejection and loss of semen. if these means are ineffectual, a full dose of camphor ( drams) or of salicin may at times assist. low condition and anemia demand just the opposite kind of treatment--rich, nourishing, albuminoid feed, bitter tonics (gentian), sunshine, gentle exercise, liberal grooming, and supporting treatment generally are here in order. spasmodic closure of the neck of the womb is common and is easily remedied in the mare by dilatation with the fingers. the hand, smeared with belladonna ointment and with the fingers drawn into the form of a cone, is introduced through the vagina until the projecting, rounded neck of the womb is felt at its anterior end. this is opened by the careful insertion of one finger at a time, until the fingers have been passed through the constricted neck into the open cavity of the womb. the introduction is made with a gentle, rotary motion, and all precipitate violence is avoided, as abrasion, laceration, or other cause of irritation is likely to interfere with the retention of the semen and consequently with impregnation. if the neck of the womb is rigid and unyielding from the induration which follows inflammation--a rare condition in the mare, though common in the cow--more force will be requisite, and it may even be needful to incise the neck to the depth of one-sixth of an inch in four or more opposite directions prior to forcible dilatation. the incision may be made with a probe-pointed knife, and should be done by a professional man if possible. the subsequent dilatation may be best effected by the slow expansion of sponge or seaweed tents inserted into the narrow canal. in such cases it is best to let the wounds of the neck heal before putting to horse. an imperforate hymen may be freely incised in a crucial manner until the passage will admit the human hand. an ordinary knife may be used for this purpose, and after the operation the stallion may be admitted at once or only after the wounds have healed. pregnancy. indications of pregnancy. as the mere fact of service by the stallion does not insure pregnancy, it is important that the result should be determined to save the mare from unnecessary and dangerous work or medication when actually in foal and to obviate wasteful and needless precautions when she is not. the cessation and nonrecurrence of the symptoms of heat (horsing) are most significant, though not an infallible, sign of conception. if the sexual excitement speedily subsides and the mare persistently refuses the stallion for a month, she is probably pregnant. in very exceptional cases a mare, though pregnant, will accept a second or third service after weeks or months, and some mares will refuse the horse persistently, though conception has not taken place, and this in spite of warm weather, good condition of the mare, and liberal feeding. the recurrence of heat in the pregnant mare is most liable to take place in hot weather. if heat merely persists an undue length of time after service, or if it reappears shortly after, in warm weather and in a comparatively idle mare, on good feeding, it is less significant, while the persistent absence of heat under such conditions may be usually accepted as proof of conception. an unwonted gentleness and docility on the part of a previously irritable or vicious mare, and supervening on service, is an excellent indication of pregnancy, the generative instinct which caused the excitement having been satisfied. an increase of fat, with softness and flabbiness of muscle, a loss of energy, indisposition for active work, a manifestation of laziness, indeed, and of fatigue early and easily induced, when preceded by service, will usually imply conception. enlargement of the abdomen, especially in its lower third, with slight falling in beneath the loins and hollowness of the back are significant symptoms, though they may be entirely absent. swelling and firmness of the udder, with the smoothing out of its wrinkles, is a suggestive sign, even though it appears only at intervals during gestation. a steady increase in weight ( - / pounds daily) about the fourth or fifth month is a useful indication of pregnancy. so is a swollen and red or bluish-red appearance of the vaginal mucous membrane. from the seventh or eighth month onward the foal may be felt by the hand (palm or knuckles) pressed into the abdomen in front of the left stifle. the sudden push displaces the foal toward the opposite side of the womb, and as it floats back its hard body is felt to strike against the hand. if the pressure is maintained the movements of the live foal are felt, and especially in the morning and after a drink of cold water or during feeding. a drink of cold water will often stimulate the fetus to movements that may be seen by the eye, but an excess of iced water may prove injurious, even to the causing of abortion. cold water dashed on the belly has a similar effect on the fetus and is equally provocative of abortion. examination of the uterus with the oiled hand introduced into the rectum is still more satisfactory, and, if cautiously conducted, no more dangerous. the rectum must be first emptied and then the hand carried forward until it reaches the front edge of the pelvic bones below, and pressed downward to ascertain the size and outline of the womb. in the unimpregnated state the vagina and womb can be felt as a single rounded tube, dividing in front to two smaller tubes (the horns of the womb). in the pregnant mare not only the body of the womb is enlarged, but still more so one of the horns (right or left), and on compression the latter is found to contain a hard, nodular body, floating in a liquid, which in the latter half of gestation may be stimulated by gentle pressure to manifest spontaneous movements. by this method the presence of the fetus may be determined as early as the third month. if the complete, natural outline of the virgin womb can not be made out, careful examination should always be made on the right and left side for the enlarged horn and its living contents. should there still be difficulty the mare should be placed on an inclined plane, with her hind parts lowest, and two assistants, standing on opposite sides of the body, should raise the lower part of the abdomen by a sheet passed beneath it. finally the ear or stethoscope applied on the wall of the abdomen in front of the stifle may detect the beating of the fetal heart (one hundred and twenty-five a minute) and a blowing sound (the uterine sough), much less rapid and corresponding to the number of the pulse of the dam. it is heard most satisfactorily after the sixth or eighth month and in the absence of active rumbling of the bowels of the dam. duration of pregnancy. mares usually go about eleven months with young, though first pregnancies often last a year. foals have lived when born at the three hundredth day, so with others carried till the four hundredth day. with the longer pregnancies there is a greater probability of male offspring. hygiene of the pregnant mare. the pregnant mare should not be exposed to teasing by a young and ardent stallion, nor should she be overworked or fatigued, particularly under the saddle or on uneven ground. yet exercise is beneficial to both mother and offspring, and in the absence of moderate work the breeding mare should be kept in a lot where she can take exercise at will. the feed should be liberal, but not fattening--oats, bran, sound hay, and other feeds rich in the principles which form flesh and bone being especially indicated. all aliments that tend to indigestion are to be especially avoided. thus rank, aqueous, rapidly growing grasses and other green feed, partially ripe rye grass, millet, hungarian grass, vetches, peas, beans, or maize are objectionable, as is overripe, fibrous, innutritious hay, or that which has been injured and rendered musty by wet, or that which is infested with smut or ergot. feed that tends to costiveness should be avoided. water given often, and at a temperature considerable above freezing, will avoid the dangers of indigestion and abortion which result from taking too much ice-cold water at one time. very cold or frozen feed is objectionable in the same sense. severe surgical operations and medicines that act violently on the womb, bowels, or kidneys are to be avoided as being liable to cause abortion. constipation should be corrected, if possible, by bran mashes, carrots, or beets, seconded by exercise, and if a medicinal laxative is required it should be olive oil or other equally bland agent. the stall of the pregnant mare should not be too narrow, so as to cramp her when lying down or to entail violent effort in getting up, and it should not slope too much from the front backward, as this throws the weight of the uterus back on the pelvis and endangers protrusions and even abortion. violent mental impressions are to be avoided, for though most mares are not affected thereby, yet a certain number are so profoundly impressed that peculiarities and distortions are entailed on the offspring; hence, there is wisdom shown in banishing particolored or objectionably tinted animals, and those that show deformities or faulty conformation. hence, too, the importance of preventing prolonged, acute suffering by the pregnant mare, as certain troubles of the eyes, feet, and joints in the foals have been clearly traced to the concentration of the mother's mind on corresponding injured organs in herself. sire and dam alike tend to reproduce their individual defects which predispose to disease, but the dam is far more liable to perpetuate the evil in her progeny which was carried while she was individually enduring severe suffering caused by such defects. hence, an active bone spavin or ringbone, causing lameness, is more objectionable than that in which the inflammation and lameness have both passed, and an active ophthalmia is more to be feared than even an old cataract. for this reason all active diseases in the breeding mare should be soothed and abated as early as possible. extra-uterine gestation. it is rare in the domestic animals to find the fetus developed elsewhere than in the womb. the exceptional forms are those in which the sperm of the male, making its way through the womb and fallopian tubes, impregnates the ovum prior to its escape, and in which the now vitalized and growing ovum, by reason of its gradually increasing size, becomes imprisoned and fails to escape into the womb. the arrest of the ovum may be in the substance of the ovary itself (ovarian pregnancy), in the fallopian tube (tubal pregnancy), or when by its continuous enlargement it has ruptured its envelopes so that it escapes into the cavity of the abdomen, it may become attached to any part of the serous membrane and draw its nourishment directly from that (abdominal pregnancy). in all such cases there is an increase and enlargement of the capillary blood vessels at the point to which the embryo has attached itself so as to furnish the needful nutriment for the growing offspring. all appreciable symptoms are absent, unless from the death of the fetus, or its interference with normal functions, general disorder and indications of parturition supervene. if these occur later than the natural time for parturition, they are the more significant. there may be general malaise, loss of appetite, elevated temperature, accelerated pulse, with or without distinct labor pains. examination with the oiled hand in the rectum will reveal the womb of the natural, unimpregnated size and shape and with both horns of one size. further exploration may detect an elastic mass apart from the womb, in the interior of which may be felt the characteristic solid body of the fetus. if the latter is still alive and can be stimulated to move, the evidence is even more perfect. the fetus may die and be carried for years, its soft structures becoming absorbed so as to leave only the bones, or by pressure it may form a fistulous opening through the abdominal walls, or less frequently through the vagina or rectum. in the latter cases the best course is to favor the expulsion of the foal and to wash out the resulting cavity with a solution of carbolic acid part to water parts. this may be repeated daily. when there is no spontaneous opening it is injudicious to interfere, as the danger from the retention of the fetus is less than that from septic fermentation in the enormous fetal sac when that has been opened to the air. moles, or anidian monsters. these are evidently products of conception, in which the impregnated ovum has failed to develop naturally, and presents only a chaotic mass of skin, hair, bones, muscles, etc., attached to the inner surface of the womb by an umbilical cord, which is itself often shriveled and wasted. they are usually accompanied with a well-developed fetus, so that the mole may be looked upon as a twin which has undergone arrest and vitiation of development. they are expelled by the ordinary process of parturition, and usually at the same time with the normally developed offspring. cystic disease of the walls of the womb, or vesicular mole. this condition appears to be attributable to hypertrophy (enlargement) of the villi on the inner surface of the womb, which become greatly increased in number and hollowed out internally into a series of cysts, or pouches, containing liquid. unlike the true mole, therefore, they appear to be disease of the maternal structure of the womb rather than of the product of conception. rodet, in a case of this kind, which had produced active labor pains, quieted the disorder with anodynes and effected a recovery. when this can not be done, attempts may be made to remove the mass with the écraseur or otherwise, following it up with antiseptic injections, as advised under the last heading. dropsy of the womb. this appears as a result of some disease of the walls of the womb, but has been frequently observed as the result of infection after sexual congress, and has, therefore, been confounded with pregnancy. the symptoms are those of pregnancy, but without any movements of the fetus and without the detection of any solid body in the womb when examined with the oiled hand in the rectum. at the end of four or eight months there are signs of parturition or of frequent straining to pass urine, and after a time the liquid is discharged clear and watery, or muddy, thick, and fetid. the hand introduced into the womb can detect neither fetus nor fetal membrane. if the neck of the womb closes, the liquid may accumulate a second time, or even a third, if no means are taken to disinfect it or to correct the tendency. the best resort is to remove any diseased product that may be found attached to the walls of the womb and to inject it daily with a warm solution of carbolic acid drams, chlorid of zinc one-half dram, water quart. a course of bitter tonics (gentian drams, sulphate of iron drams, daily) should be given, and a nutritious, easily digested, and slightly laxative diet allowed. dropsy of the amnion. this differs from simple dropsy of the womb in that the fluid collects in the inner of the two water bags (that in which the foal floats) and not in the otherwise void cavity of the womb. this affection can occur only in the pregnant animal, while dropsy of the womb occurs in the unimpregnated. the blood of the pregnant mare contains an excess of water and a smaller proportion of albumen and red globules, and when this condition is still further aggravated by poor feeding and other unhygienic conditions there is developed the tendency to liquid transudation from the vessels and dropsy. as the watery condition of the blood increases with advancing pregnancy, so dropsy of the amnion is a disease of the last four or five months of gestation. the abdomen is large and pendulous, and the swelling fluctuates under pressure, though the solid body of the fetus can still be felt to strike against the hand pressed into the swelling. if the hand is introduced into the vagina, the womb is found to be tense and round, with the projecting rounded neck effaced, while the hand in the rectum will detect the rounded, swollen mass of the womb so firm and tense that the body of the fetus can not be felt within it. the mare moves weakly and unsteadily on her limbs, having difficulty in supporting the great weight, and in bad cases there may be loss of appetite, stocking (dropsy) of the hind limbs, difficult breathing, and colicky pains. the tension may lead to abortion, or a slow, laborious parturition may occur at the usual time. _treatment_ consists in relieving the tension and accumulation by puncturing the fetal membrane with a cannula and trocar introduced through the neck of the womb and the withdrawal of the trocar so as to leave the cannula in situ, or the membranes may be punctured with the finger and the excess of liquid allowed to escape. this may bring on abortion, or the womb may close and gestation continue to the full term. a course of tonics (gentian root drams, sulphate of iron drams, daily) will do much to fortify the system and counteract further excessive effusion. dropsy of the limbs, perineum, and abdomen. the disposition to dropsy often shows itself in the hind and even in the fore limbs, around and beneath the vulva (perineum), and beneath the abdomen and chest. the affected parts are swollen and pit on pressure, but are not especially tender, and subside more or less perfectly under exercise, hand rubbing, and bandages. in obstinate cases rubbing with the following liniment may be resorted to: compound tincture of iodin, ounces; tannic acid, one-half dram; water, ounces. it does not last more than a day or two after parturition. cramps of the hind limbs. the pressure of the distended womb on the nerves and blood vessels of the pelvis, besides conducing to dropsy, occasionally causes cramps of the hind limbs. the limb is raised without flexing the joints, the front of the hoof being directed toward the ground, or, the spasms occurring intermittently, the foot is kicked violently against the ground several times in rapid succession. the muscles are felt to be firm and rigid. the cramp may be promptly relieved by active rubbing or by walking the animal about, and it does not reappear after parturition. constipation. this may result from compression by gravid womb, and is best corrected by a graduated allowance of boiled flaxseed. paralysis. the pressure on the nerves of the pelvis is liable to cause paralysis of the hind limbs or of the nerve of sight. these are obstinate until after parturition, when they recover spontaneously, or under a course of nux vomica and (local) stimulating liniments. prolonged retention of the fetus (foal). though far less frequently than in the case of the cow, parturition may not be completed at term, and the mare, to her serious and even fatal injury, may carry the foal in the womb for a number of months. hamon records one case in which the mare died after carrying the fetus for months, and caillier a similar result after it had been carried months. in these cases the fetus retained its natural form, but in one reported by gohier the bones only were left in the womb amid a mass of apparently purulent matter. _cause._--the cause may be any effective obstruction to the act of parturition, such as lack of contractile power in the womb, unduly strong (inflammatory) adhesions between the womb and the fetal membranes, wrong presentation of the fetus, contracted pelvis (from fracture or disease of the bones), or disease and induration of the neck of the womb. the mere prolongation of gestation does not necessarily entail the death of the foal; hence the latter has been born alive at the four hundredth day. even when the foal has perished putrefaction does not set in unless the membranes (water bags) have been ruptured and septic bacteria have been admitted to the interior of the womb. in the latter case a fetid decomposition advances rapidly, and the mare usually perishes from poisoning with the putrid matters absorbed. at the natural period of parturition preparations are apparently made for that act. the vulva swells and discharges much mucus, the udder enlarges, the belly becomes more pendent, and the animal strains more or less. no progress is made, however; there is not even opening of the neck of the womb, and after a time the symptoms subside. the mare usually refuses the male, yet there are exceptions to this rule. if the neck of the womb has been opened and putrefying changes in its contents have set in, the mare loses appetite and condition, pines, discharges an offensive matter from the generative passages, and dies of inflammation of the womb and putrid infection. in other cases there is a slow wearing out of the strength, and she finally dies of exhaustion. the treatment is such as will facilitate the expulsion of the fetus and its membranes and the subsequent washing out of the womb with disinfectants. so long as the mouth of the womb is closed time should be allowed for its natural dilatation, but if this does not come about after a day or two of straining, the opening may be smeared with extract of belladonna, and the oiled hand, with the fingers and thumb drawn into the form of a cone, may be inserted by slow oscillating movements into the interior of the womb. the water bags may now be ruptured, any malpresentation rectified (see "difficult parturition"), and delivery effected. after removal of the membranes wash out the womb first with tepid water and then with a solution of ounces of borax in half a gallon of water. this injection may have to be repeated if a discharge sets in. the same course may be pursued even after prolonged retention. if the soft parts of the fetus have been absorbed and the bones only left, these must be carefully sought for and removed, and subsequent daily injections will be required for some time. in such cases, too, a course of iron tonics (sulphate of iron, drams daily) will be highly beneficial in restoring health and vigor. abortion. abortion is, strictly speaking, the expulsion of the impregnated ovum at any period from the date of impregnation until the foal can survive out of the womb. if the foal is advanced enough to live, it is premature parturition, and in the mare this may occur as early as the tenth month (three hundredth day). the mare may abort by reason of almost any cause that very profoundly disturbs the system; hence, very violent inflammations of important internal organs (bowels, kidneys, bladder, lungs) may induce abortion. profuse diarrhea, whether occurring from the reckless use of purgatives, the consumption of irritants in the feed, or a simple indigestion, is an effective cause. no less so is acute indigestion with evolution of gas in the intestines (bloating). the presence of stone in the kidneys, uterus, bladder, or urethra may induce so much sympathetic disorder in the womb as to induce abortion. in exceptional cases wherein mares come in heat during gestation, service by the stallion may cause abortion. blows or pressure on the abdomen, rapid driving or riding of the pregnant mare, especially if she is soft and out of condition from idleness, the brutal use of the spur or whip, and the jolting and straining of travel by rail or boat are prolific causes. bleeding the pregnant mare, a painful surgical operation, and the throwing and constraint resorted to for an operation are other causes. traveling on heavy, muddy roads, slips and falls on ice, and jumping must be added. the stimulation of the abdominal organs by a full drink of iced water may precipitate a miscarriage, as may exposure to a cold rainstorm or a very cold night after a warm day. irritant poisons that act on the urinary or generative organs, such as spanish flies, rue, savin, tansy, cotton-root bark, ergot of rye or other grasses, the smut of maize and other grain, and various fungi in musty fodder are additional causes. frosted or indigestible feed, and, above all, green succulent vegetables in a frozen state, have proved effective factors, and filthy, stagnant water is dangerous. low condition in the dam and plethora have in opposite ways caused abortion, and hot, relaxing stables and lack of exercise strongly conduce to it. the exhaustion of the sire by too frequent service, entailing debility of the offspring and disease of the fetus or of its envelopes, must be recognized as a further cause. the symptoms vary mainly according as the abortion is early or late in pregnancy. in the first month or two of pregnancy the mare may miscarry without observable symptoms, and the fact appears only by her coming in heat. if more closely observed a small clot of blood may be found behind her, in which a careful search reveals the rudiments of the foal. if the occurrence is somewhat later in gestation, there will be some general disturbance, loss of appetite, neighing, and straining, and the small body of the fetus is expelled, enveloped in its membranes. abortions during the later stages of pregnancy are attended with greater constitutional disturbance, and the process resembles normal parturition, with the aggravation that more effort and straining is requisite to force the fetus through the comparatively undilatable mouth of the womb. there is the swelling of the vulva, with mucus or even bloody discharge; the abdomen droops, the flanks fall in, the udder fills, the mare looks at her flanks, paws with the fore feet and kicks with the hind, switches the tail, moves around uneasily, lies down and rises, strains, and, as in natural foaling, expels first mucus and blood, then the waters, and finally the fetus. this may occupy an hour or two, or it may be prolonged for a day or more, the symptoms subsiding for a time, only to reappear with renewed energy. if there is malpresentation of the fetus it will hinder progress until rectified, as in difficult parturition. abortion may also be followed by the same accidents, as flooding, retention of the placenta, and leucorrhea. the most important object in an impending abortion is to recognize it at as early a stage as possible, so that it may, if possible, be cut short and prevented. any general, indefinable illness in a pregnant mare should lead to a close examination of the vulva as regards swelling, vascularity of its mucous membrane, and profuse mucus secretion, and, above all, any streak or staining of blood; also the condition of the udder, if that is congested and swollen. any such indication, with colicky pains, straining, however little, and active movement of the fetus or entire absence of movement, are suggestive symptoms and should be duly counteracted. the changes in the vulva and udder, with a soiled and bloody condition of the tail, may suggest an abortion already accomplished, and the examination with the hand in the vagina may detect the mouth of the womb soft and dilatable and the interior of the organ slightly filled with a bloody liquid. _treatment_ should be preventive if possible, and would embrace the avoidance of all causes mentioned, and particularly of such as may seem to be particularly operative in the particular case. if abortions have already occurred in a stud, the especial cause in the matter of feed, water, exposure to injuries, overwork, lack of exercise, etc., may often be identified and removed. a most important point is to avoid all causes of constipation, diarrhea, indigestion, bloating, violent purgatives, diuretics or other potent medicines, painful operations, and slippery roads, unless well frosted. when abortion is imminent, the mare should be placed alone in a roomy, dark, quiet stall, and have the straining checked by some sedative. laudanum is usually at hand and may be given in doses of or ounces, according to size, and repeated after two or three hours, and even daily if necessary. chloroform or chloral hydrate, drams, may be substituted if more convenient. these should be given in a pint or quart of water, to avoid burning the mouth and throat. or _viburnum prunifolium_ (black haw), ounce, may be given and repeated if necessary to prevent straining. when all measures fail and miscarriage proceeds, all that can be done is to assist in the removal of the fetus and its membranes, as in ordinary parturition. as in the case of retention of the fetus, it may be necessary after delivery to employ antiseptic injections into the womb to counteract putrid fermentation. this, however, is less necessary in the mare than in the cow, in which the prevalent contagious abortion must be counteracted by the persistent local use of antiseptics. after abortion a careful hygiene is demanded, especially in the matter of pure air and easily digestible feed. the mare should not be served again for a month or longer, and in no case until after all discharge from the vulva has ceased. infectious abortion in mares. this disease is discussed in the chapter on "infectious diseases." parturition. symptoms of parturition. as the period of parturition approaches, the swelling of the udder bespeaks the coming event, the engorgement in exceptional cases extending forward on the lower surface of the abdomen and even into the hind limbs. for about a week a serous fluid oozes from the teat and concretes as a yellow, waxlike mass around its orifice. about hours before the birth this gives place to a whitish, milky liquid, which falls upon and mats the hairs on the inner sides of the legs. another symptom is enlargement of the vulva, with redness of its lining membrane, and the escape of glairy mucus. the belly droops, the flanks fall in, and the loins may even become depressed. finally the mare becomes uneasy, stops feeding, looks anxious, whisks her tail, and may lie down and rise again. in many mares this is not repeated, but they remain down; violent contractions of the abdominal muscles ensue; after two or three pains the water bags appear and burst, followed by the fore feet of the foal, with the nose between the knees, and by a few more throes the fetus is expelled. in other cases the act is accomplished standing. the whole act may not occupy more than or minutes. this, together with the disposition of the mare to avoid observation, renders the act one that is rarely seen by the attendants. the navel string, which connects the foal to the membranes, is ruptured when the fetus falls to the ground, or when the mare rises, if she has been down, and the membranes are expelled a few minutes later. natural presentation. when there is a single foal, the common and desirable presentation is with the fore feet first, the nose between the knees, and with the front of the hoofs and knees and the forehead directed upward toward the anus, tail, and croup. (plate xii, fig. .) in this way the natural curvature of the body of the fetus corresponds to the curve of the womb and genital passages, and particularly of the bony pelvis, and the foal passes with much greater ease than if placed with its back downward toward the udder. when there is a twin birth the second foal usually comes with its hind feet first, and the backs of the legs, the points of the hocks, and the tail and croup are turned upward toward the anus and tail of the mare. (plate xii, fig. .) in this way, even with a posterior presentation, the curvature of the body of the foal still corresponds to that of the passages, and its expulsion may be quite as easy as in anterior presentation. any presentation aside from these two may be said to be abnormal and will be considered under "difficult parturition." premature labor pains. these may be brought on by, any violent exertion, use under the saddle, or in heavy draft, or in rapid paces, or in travel by rail or sea, blows, kicks, crushing by other animals in a doorway or gate. excessive action of purgative or diuretic agents, or of agents that irritate the bowels or kidneys, like arsenic, paris green, all caustic salts and acids, and acrid and narcotico-acrid vegetables, is equally injurious. finally, the ingestion of agents that stimulate the action of the gravid womb (ergot of rye or of other grasses, smut, various fungi of fodders, rue, savin, cotton root, etc.) may bring on labor pains prematurely. besides the knowledge that parturition is not yet due, there will be less enlargement, redness, and swelling of the vulva, less mucous discharge, less filling of the udder, and fewer appearances of wax and probably none of milk from the ends of the teats. the oiled hand introduced into the vulva will not enter with the ease usual at full term, and the neck of the womb will be felt not only closed, but with its projecting papillæ, through which it is perforated, not yet flattened down and effaced, as at full term. the symptoms are, indeed, those of threatened abortion, but at such an advanced stage of gestation as is compatible with the survival of the offspring. _treatment._--the treatment consists in the separation of the mare, in a quiet, dark, secluded place, from all other animals, and the free use of antispasmodics and anodynes. opium in dram doses every two hours, or laudanum in ounce doses at similar intervals, will often suffice. when the more urgent symptoms have subsided these doses may be repeated thrice a day till all excitement passes off or until the passages have become relaxed and prepared for parturition. _viburnum prunifolium_ (black haw), in ounce doses, may be added if necessary. should parturition become inevitable, it may be favored and any necessary assistance furnished. difficult parturition. with natural presentation this is a rare occurrence. the great length of the fore limbs and face entail, in the anterior presentation, the formation of a long cone, which dilates and glides through the passages with comparative ease. even with the hind feet first a similar conical form is presented, and the process is rendered easy and quick. difficulty and danger arise mainly from the act being brought on prematurely before the passages are sufficiently dilated, from narrowing of the pelvic bones or other mechanical obstruction in the passages, from monstrous distortions or duplications in the fetus, or from the turning back of one of the members so that the elongated conical or wedge-shaped outline is done away with. prompt as is the normal parturition in the mare, however, difficult and delayed parturitions are surrounded by special dangers and require unusual precautions and skill. from the proclivity of the mare to unhealthy inflammations of the peritoneum and other abdominal organs, penetrating wounds of the womb or vagina are liable to prove fatal. the contractions of the womb and abdominal walls are so powerful as to exhaust and benumb the arm of the assistant and to endanger penetrating wounds of the genital organs. by reason of the looser connection of the fetal membranes with the womb, as compared with those of ruminants, the violent throes early detach these membranes throughout their whole extent, and the foal, being thus separated from the mother and thrown on its own resources, dies at an early stage of any protracted parturition. the foal rarely survives four hours after the onset of parturient throes. from the great length of the limbs and neck of the foal it is extremely difficult to secure and bring up limb or head which has been turned back when it should have been presented. when assistance must be rendered, the operator should don a thick woolen undershirt with the sleeves cut out at the shoulders. this protects the body and leaves the whole arm free for manipulation. before inserting the arm it should be smeared with lard. this protects the skin against septic infection and favors the introduction of the hand and arm. the hand should be inserted with the thumb and fingers drawn together like a cone. whether standing or lying, the mare should be turned with head downhill and hind parts raised as much as possible. the contents of the abdomen gravitating forward leave much more room for manipulation. whatever part of the foal is presented (head, foot) should be secured with a cord and running noose before it is pushed back to search for the other missing parts. even if a missing part is reached, no attempt should be made to bring it up during a labor pain. pinching the back will sometimes check the pains and allow the operator to secure and bring up the missing member. in intractable cases a large dose of chloral hydrate ( ounce in a quart of water) or the inhalation of chloroform and air (equal proportions) to insensibility may secure a respite, during which the missing members may be replaced. if the waters have been discharged and the mucus dried up, the genital passages and body of the fetus should be lubricated with lard or oil before any attempt at extraction is made. when the missing member has been brought up into position and presentation has been rendered natural, traction on the fetus must be made only during a labor pain. if a mare is inclined to kick, it may be necessary to apply hobbles to protect the operator. difficult parturition from narrow pelvis.--a disproportion between the fetus got by a large stallion and the pelvis of a small dam is a serious obstacle to parturition, sometimes seen in the mare. this is not the rule, however, as the foal up to birth usually accommodates itself to the size of the dam, as illustrated in the successful crossing of percheron stallions on mustang mares. if the disproportion is too great the only resort is embryotomy. fractured hip bones.--more commonly the obstruction comes from distortion and narrowing of the pelvis as the result of fractures. (plate xiii, fig. .) fractures at any point of the lateral wall or floor of the pelvis are repaired with the formation of an extensive bony deposit bulging into the passage of the pelvis. the displacement of the ends of the broken bone is another cause of constriction, and between the two conditions the passage of the fetus may be rendered impossible without embryotomy. fracture of the sacrum (the continuation of the backbone forming the croup) leads to the depression of the posterior part of that bone in the roof of the pelvis and the narrowing of the passage from above downward by a bony ridge presenting its sharp edge forward. in all cases in which there has been injury to the bones of the pelvis the obvious precaution is to withhold the mare from breeding and to use her for work only. if a mare with a pelvis thus narrowed has got in foal inadvertently, abortion may be induced in the early months of gestation by slowly introducing the oiled finger through the neck of the womb and following this by the other fingers until the whole hand has been introduced. then the water bags may be broken, and with the escape of the liquid the womb will contract on the solid fetus and labor pains will ensue. the fetus being small will pass easily. tumors in the vagina and pelvis.--tumors of various kinds may form in the vagina or elsewhere within the pelvis, and when large enough will obstruct or prevent the passage of the fetus. gray mares, which are so subject to black pigment tumors (melanosis) on the tail, anus, and vulva, are the most liable to suffer from this. still more rarely the wall of the vagina becomes relaxed, and being pressed by a mass of intestines will protrude through the lips of the vulva as a hernial sac, containing a part of the bowels. if a tumor is small it may only retard and not absolutely prevent parturition. a hernial protrusion of the wall of the vagina may be pressed back and emptied, so that the body of the fetus engaging in the passage may find no further obstacle. when a tumor is too large to allow delivery the only resort is to remove it, but before proceeding it must be clearly made out that the obstruction is a mass of diseased tissue, and not a sac containing intestines. if the tumor hangs by a neck it can usually be most safely removed by the écraseur, the chain being passed around the pedicel and gradually tightened until that is torn through. hernia of the womb.--the rupture of the musculo-fibrous floor of the belly and the escape of the gravid womb into a sac formed by the peritoneum and skin hanging toward the ground is described by all veterinary obstetricians, yet it is very rarely seen in the mare. the form of the fetus can be felt through the walls of the sac, so that it is easy to recognize the condition. its cause is usually external violence, though it may start from an umbilical hernia. when the period of parturition arrives, the first effort should be to return the fetus within the proper abdominal cavity, and this can sometimes be accomplished with the aid of a stout blanket gradually tightened around the belly. this failing, the mare may be placed on her side or back and gravitation brought to the aid of manipulation in effecting the return. even after the hernia has been reduced the relaxed state of the womb and abdominal walls may serve to hinder parturition, in which case the oiled hand must be introduced through the vagina, the fetus brought into position, and traction coincident with the labor pains employed to produce delivery. twisting of the neck of the womb.--this condition is very uncommon in the mare, though occasionally seen in the cow, owing to the greater laxity of the broad ligaments of the womb in that animal. it consists in a revolution of the womb on its own axis, so that its right or left side will be turned upward (quarter revolution), or the lower surface may be turned upward and the upper surface downward (half revolution). the effect is to throw the narrow neck of the womb into a series of spiral folds, turning in the direction in which the womb has revolved, closing the neck and rendering distention and dilatation impossible. the period and pains of parturition arrive, but in spite of continued efforts no progress is made, neither water bags nor liquids appearing. the oiled hand introduced into the closed neck of the womb will readily detect the spiral direction of the folds on its inner surface. the method of relief which i have successfully adopted in the cow may be equally effective in the mare. the dam is placed (with her head uphill) on her right side if the upper folds of the spiral turn toward the right, and on her left side if they turn toward the left, and the oiled hand is introduced through the neck of the womb and a limb or other part of the body of the fetus is seized and pressed against the wall of the womb, while two or three assistants turn the animal over on her back toward the other side. the object is to keep the womb stationary while the animal is rolling. if success attends the effort, the constriction around the arm is suddenly relaxed, the spiral folds are effaced, and the water bags and fetus press forward into the passage. if the first attempt does not succeed, it may be repeated again and again until success crowns the effort. among my occasional causes of failure have been the prior death and decomposition of the fetus, with the extrication of gas and overdistention of the womb, and the supervention of inflammation and inflammatory exudation around the neck of the womb, which hinders untwisting. the first of these conditions occurs early in the horse from the detachment of the fetal membranes from the wall of the womb; and as the mare is more subject to fatal peritonitis than the cow, it may be concluded that both these sources of failure are more probable in the former subject. when the case is intractable, though the hand may be easily introduced, the instrument shown in plate xiv, figure , may be used. each hole at the small end of the instrument has passed through it a stout cord with a running noose, to be passed around two feet or other portion of the fetus which it may be possible to reach. the cords are then drawn tight and fixed around the handle of the instrument; then, by using the cross handle as a lever, the fetus and womb may be rotated in a direction opposite to that causing the obstruction. during this process the hand must be introduced to feel when the twist has been undone. this method may be supplemented, if necessary, by rolling the mare as described above. effusion of blood in the vaginal walls.--this is common as a result of difficult parturition, but it may occur from local injury before that act, and may seriously interfere with it. this condition is easily recognized by the soft, doughy swelling so characteristic of blood clots, and by the dark-red color of the mucous membrane. i have laid open such swellings with the knife as late as days before parturition, evacuated the clots, and dressed the wound daily with an astringent lotion (sulphate of zinc dram, carbolic acid dram, water quart). a similar resort might be had, if necessary, during parturition. calculus (stone) and tumor in the bladder.--the pressure upon the bladder containing a stone or a tumor may prove so painful that the mare will voluntarily suppress the labor pains. examination of the bladder with the finger introduced through the urethra will detect the offending agent. a stone should be extracted with forceps. (see "lithotomy.") the large papillary tumors which i have met with in the mare's bladder have been invariably delicate in texture and could be removed piecemeal by forceps. fortunately, mares affected in this way rarely breed. fecal impaction of the rectum.--in some animals, with more or less paralysis or weakness of the tail and rectum, the rectum may become so impacted with solid feces that the mare is unable to discharge them, and the accumulation both by reason of the mechanical obstruction and the pain caused by pressure upon it will impel the animal to cut short all labor pains. the rounded swelling surrounding the anus will at once suggest the condition, when the obstruction may be removed by the well-oiled or well-soaped hand. spasm of the neck of the womb.--this occurs in the mare of specially excitable temperament, or under particular causes of irritation, local or general. labor pains, though continuing for some time, produce no dilatation of the neck of the womb, which will be found firmly closed so as to admit but one or two fingers; this, although the projection at the mouth of the womb may have been entirely effaced, so that a simple round opening is left, with rigid margins. the simplest treatment consists in smearing this part with solid extract of belladonna, and after an interval inserting the hand with fingers and thumb drawn into the form of a cone, rupturing the membranes and bringing the fetus into position for extraction, as advised under "prolonged retention of the fetus." another mode is to insert through the neck of the womb an ovoid rubber bag, empty, and furnished with an elastic tube feet long. carry the free end of this tube upward to a height of , , or feet, insert a filler into it, and proceed to distend the bag with tepid or warm water. fibrous bands constricting or crossing the neck of the womb.--these, occurring as the result of disease, have been several times observed in the mare. they may exist in the cavity of the abdomen and compress and obstruct the neck of the womb, or they may extend from side to side of the vagina across and just behind the neck of the womb. in the latter position they may be felt and quickly remedied by cutting them across. in the abdomen they can be reached only by incision, and two alternatives are presented: ( ) to perform embryotomy and extract the fetus piecemeal, and ( ) to make an incision into the abdomen and extract by the cæsarean operation, or simply to cut the constricting band and attempt delivery by the usual channel. fibrous constriction of vagina or vulva.--this is probably always the result of direct mechanical injury and the formation of rigid cicatrices which fail to dilate with the remainder of the passages at the approach of parturition. the presentation of the fetus in the natural way and the occurrence of successive and active labor pains without any favorable result will direct attention to the rigid and unyielding cicatrices which may be incised at one, two, or more points to a depth of half an inch or more, after which the natural expulsive efforts will usually prove effective. the resulting wounds may be washed frequently with a solution of part of carbolic acid to parts of water, or of part of mercuric chlorid to , parts of water. fetus adherent to the walls of the womb.--in inflammation of the mucous membrane lining the cavity of the womb and implicating the fetal membranes the resulting embryonic tissue sometimes establishes a medium of direct continuity between the womb and fetal membranes; the blood vessels of the one communicate freely with those of the other and the fibers of the one are prolonged into the other. this causes retention of the membranes after birth, and a special risk of bleeding from the womb, and of septic poisoning. in exceptional cases the adhesion is more extensive and binds a portion of the body of the foal firmly to the womb. in such cases it has repeatedly been found impossible to extract the foal until such adhesions were broken down. if they can be reached with the hand and recognized, they may be torn through with the fingers or with a blunt hook, after which delivery may be attempted with hope of success. excessive size of fetus.--it would seem that a small mare may usually be safely bred to a large stallion, yet this is not always the case; and when the small size is an individual rather than a racial characteristic or the result of being very young, the rule can not be expected to hold. there is always great danger in breeding the young, small, and undeveloped female, and the dwarfed representative of a larger breed, as the offspring tend to partake of the large race characteristics and to show them even prior to birth. when impregnation has occurred in the very young or in the dwarfed female there are two alternatives--to induce abortion or to wait until there are attempts at parturition and to extract by embryotomy if impracticable otherwise. constriction of a member by the navel string.--in man and animals alike the winding of the umbilical cord around a member of the fetus sometimes leads to the amputation of the latter. it is also known to get wound around the neck or a limb at birth, but in the mare this does not seriously impede parturition, as the loosely attached membranes are easily separated from the womb and no strangulation or retarding occurs. the foal may, however, die from the cessation of the placental circulation unless it is speedily delivered. water in the head (hydrocephalus) of the foal.--this consists in the excessive accumulation of liquid in the ventricles of the brain so that the cranial cavity is enlarged and constitutes a great, projecting, rounded mass occupying the space from the eyes upward. (see plate xiii, fig. .) with an anterior presentation (fore feet and nose) this presents an insuperable obstacle to progress, as the diseased cranium is too large to enter the pelvis at the same time with the fore arms. with a posterior presentation (hind feet) all goes well until the body and shoulders have passed out, when progress is suddenly arrested by the great bulk of the head. in the first case, the oiled hand introduced along the face detects the enormous size of the head, which may be diminished by puncturing it with a knife or trocar and cannula in the median line, evacuating the water and pressing in the thin, bony walls. with a posterior presentation, the same course must be followed; the hand passed along the neck will detect the cranial swelling, which may be punctured with a knife or trocar. oftentimes with an anterior presentation the great size of the head leads to its displacement backward, and thus the fore limbs alone engage in the passages. here the first object is to seek and bring up the missing head, and then puncture it as above suggested. [illustration: plate xii. normal presentations.] [illustration: plate xiii. some factors in difficult labor.] [illustration: plate xiv. instruments used in difficult labor.] ascites, or dropsy of the abdomen in the foal.--the accumulation of liquid in the abdominal cavity of the fetus is less frequent, but when present it may arrest parturition as completely as will hydrocephalus. with an anterior presentation the foal may pass as far as the shoulders, but behind this all efforts fail to effect a further advance. with a posterior presentation the hind legs as far as the thighs may be expelled, but at this point all progress ceases. in either case the oiled hand, passed inward by the side of the foal, will detect the enormous distension of the abdomen and its soft, fluctuating contents. the only course is to puncture the cavity and evacuate the liquid. with the anterior presentation this may be done with a long trocar and cannula, introduced through the chest and diaphragm, or with a knife an incision may be made between the first two ribs and the lungs and heart cut or torn out, when the diaphragm will be felt projecting strongly forward, and may be easily punctured. should there not be room to introduce the hand through the chest, the oiled hand may be passed along beneath the breast bone and the abdomen punctured. with a posterior presentation the abdomen must be punctured in the same way, the hand, armed with a knife protected in its palm, being passed along the side of the flank or between the hind limbs. it should be added that moderate dropsy of the abdomen is not incompatible with natural delivery, the liquid being at first crowded back into the portion of the belly still engaged in the womb, and passing slowly from that into the advanced portion as soon as that has cleared the narrow passage of the pelvis and passed out where it can expand. general dropsy of the fetus.--in this case the tissues generally are distended with liquid, and the skin is found at all points tense and rounded, and pitting on pressure with the fingers. in some such cases delivery may be effected after the skin has been punctured at narrow intervals to allow the escape of the fluid and then liberally smeared with fresh lard. more commonly, however, it can not be reached at all points to be so punctured nor sufficiently reduced to be extracted whole, and resort must be had to embryotomy. emphysema, or swelling of the fetus with gas.--this has been described as occurring in a living fetus, but i have met with it only in the dead and decomposing foal after futile efforts had been made for several days to effect delivery. these cases are very difficult, as the foal is inflated to such extent that it is impossible to advance it into the passages, and the skin of the fetus and the walls of the womb and vagina have become so dry that it is impracticable to cause the one to glide on the other. the hair comes off any part that may be seized, and the case is rendered the more offensive and dangerous by the very fetid liquids and gases. the only resort is embryotomy, by which i have succeeded in saving a valuable mare that had carried a colt in this condition for four days. contractions of muscles.--the foal is not always developed symmetrically, but certain groups of muscles are liable to remain short, or to shorten because of persistent spasmodic contraction, so that even the bones become distorted and twisted. this is most common in the neck. the bones of this part and even of the face are drawn to one side and shortened, the head being held firmly to the flank and the jaws being twisted to the right or left. in other cases the flexor muscles of the fore limbs are contracted so that the latter are strongly bent at the knee. in neither of these cases can the distorted part be extended and straightened, so that body or limbs must necessarily present double, and natural delivery is rendered impossible. the bent neck may sometimes be straightened after the muscles have been cut on the side to which it is turned, and the bent limbs after the tendons on the back of the shank bone have been cut across. failing to accomplish this, the next resort is embryotomy. inclosed ovum, or tumors of the fetus.--tumors or diseased growths may form on any part of the foal, internal or external, and by their size impede or hinder parturition. in some cases what appears as a tumor is an imprisoned and undeveloped ovum which has grafted itself on the fetus. these are usually sacculated, and may contain skin, hair, muscle, bone, and other natural tissues. the only course to be pursued in such cases is to excise the tumor, or, if this is not feasible, to perform embryotomy. monstrosities.--monstrosity in the foal is an occasional cause of difficult parturition, especially such monsters as show excessive development of some part of the body, a displacement or distortion of parts, or a redundancy of parts, as in double monsters. monsters may be divided into-- ( ) monsters with absence of parts--absence of head, limb, or other organ. ( ) monsters with some part abnormally small--dwarfed head, limb, trunk, etc. ( ) monsters through unnatural division of parts--cleft head, trunk, limbs, etc. ( ) monsters through absence of natural divisions--absence of mouth, nose, eyes, anus, confluent digits, etc. ( ) monsters through fusion of parts--one central eye, one nasal opening, etc. ( ) monsters through abnormal position or form of parts--curved spine, face, limb, etc. ( ) monsters through excess of formation--enormous head, supernumerary digits, etc. ( ) monsters through imperfect differentiation of sexual organs--hermaphrodites. ( ) double monsters--double-headed, double-bodied, extra limbs, etc. _causes._--the causes of monstrosities appear to be very varied. some monstrosities, like extra digits, absence of horns or tail, etc., run in families and are produced almost as certainly as color or form. others are associated with too close breeding, the powers of symmetrical development being interfered with, just as in other cases a sexual incompatibility is developed, near relatives failing to breed with each other. mere arrest of development of a part may arise from accidental disease of the embryo; hence vital organs are left out, or portions of organs, like the dividing walls of the heart, are omitted. sometimes an older fetus is inclosed in the body of another, each having started independently from a separate ovum, but the one having become embedded in the semifluid mass of the other and having developed there simultaneously with it, but not so largely nor perfectly. in many cases of redundance of parts the extra part or member has manifestly developed from the same ovum and nutrient center with the normal member to which it remains adherent, just as a new tail will grow out in a newt when the former has been cut off. in the early embryo, with its great powers of development, this factor can operate to far greater purpose than in the adult animal. its influence is seen in the fact pointed out by st. hilaire that such redundant parts are nearly always connected with the corresponding portions in the normal fetus. thus superfluous legs or digits are attached to the normal ones, double heads or tails are connected to a common neck or rump, and double bodies are attached to each other by corresponding points, navel to navel, breast to breast, back to back. all this suggests the development of extra parts from the same primary layer of the impregnated and developing ovum. the effect of disturbing conditions in giving such wrong directions to the developmental forces is well shown in the experiments of st. hilaire and valentine in varnishing, shaking, and otherwise breaking up the natural connections in eggs, and thereby determining the formation of monstrosities at will. so, in the mammal, blows and other injuries that detach the fetal membranes from the walls of the womb or that modify their circulation by inducing inflammation are at times followed by the development of a monster. the excitement, mental and physical, attendant on fright occasionally acts in a similar way, acting probably through the same channels. the monstrous forms liable to interfere with parturition are such as, from contracted or twisted limbs or spine, must be presented double; where supernumerary limbs, head, or body must approach the passages with the natural ones; where a head or other member has attained to an unnatural size; where the body of one fetus has become inclosed in or attached to another, etc. extraction is sometimes possible by straightening the members and obtaining such a presentation as will reduce the presenting mass to its smallest and most wedgelike dimensions. to effect this it may be needful to cut the flexor tendons of bent limbs or the muscles on the side of a twisted neck or body; one or more of the manipulations necessary to secure and bring up a missing member may be required. in most cases of monstrosity by excess, however, it is needful to remove the superfluous parts, in which case the general principles employed for embryotomy must be followed. the cæsarean section, by which the fetus is extracted through an incision in the walls of the abdomen and womb, is inadmissible, as it practically entails the sacrifice of the mare, which should never be done for the sake of a monster. (see "embryotomy," p. .) entrance of twins into the passage at once.--twins are rare in the mare, and still more rare is the impaction of both at once into the pelvis. the condition would be easily recognized by the fact that two fore limbs and two hind would occupy the passage at once, the front of the hoofs of the fore feet being turned upward and those of the hind feet downward. if both belonged to one foal, they would be turned in the same direction. once recognized, the condition is easily remedied by passing a rope with a running noose round each foot of the foal that is furthest advanced or that promises to be most easily extracted, and to push the members of the other fetus back into the depth of the womb. as soon as the one fetus is fully engaged into the passage it will hold its place and its delivery will proceed in the natural way. abnormal presentations. (pls. xv-xviii.) abnormal presentations may be tabulated as follows: { {incompletely extended. { { flexor tendons shortened. {fore limbs {crossed over the neck. { {bent back at the knee. { {bent back from the shoulder. anterior presentations: { { {bent downward on the neck. { {head and neck turned back { { beneath the breast. {head {turned to one side. { {turned upward and backward { { on the back. { {hind limbs hind feet engaged in the pelvis. { {transverse back of foal to side of pelvis. { {inverted back of foal to floor of pelvis. {hind limbs {bent on itself at the hock. posterior presentations { {bent at the hip. { {transverse back of foal to side of pelvis. { {inverted back of foal to floor of pelvis. {with back and loins presented. transverse presentation of body {with breast and belly presented. fore limbs incompletely extended.--in cases of this kind, not only are the back tendons behind the knee and shank bone unduly short, but the sinew extending from the front of the shoulder blade over the front of the elbow and down to the head of the shank bone is also shortened. the result is that the fore limb is bent at the knee and the elbow is also rigidly bent. the condition obstructs parturition by the feet becoming pressed against the floor of the pelvis or by the elbow pressing on its anterior brim. relief is to be obtained by forcible extension. a rope with a running noose is passed around each fetlock and a repeller (see plate xiv) planted in the breast is pressed in a direction upward and backward while active traction is made on the ropes. if the feet are not thereby raised from the floor of the pelvis the palm of the hand may be placed beneath them to protect the mucous membrane until they have advanced sufficiently to obviate this danger. in the absence of a repeller, a smooth rounded fork handle may be employed. if the shortening is too great to allow of the extension of the limbs in this way, the tense tendons may be cut across behind the shank bone and in front of the elbow, and the limb will be easily straightened out. this is most easily done with an embryotomy knife furnished with a ring for the middle finger, so that the blade may be protected in the palm of the hand. (see plate xiii, fig. .) fore limb crossed over back of neck.--with the long fore limbs of the foal this readily occurs, and the resulting increase in thickness, both at the head and shoulder, offers a serious obstacle to progress. (see plate xv, fig. .) the hand introduced into the passage detects the head and one fore foot, and farther back on the same side of the head the second foot, from which the limb may be traced obliquely across the back of the neck. if parturition continues to make progress the displaced foot may bruise and lacerate the vagina. by seizing the limb above the fetlock it may be easily pushed over the head to the proper side, when parturition will proceed normally. fore limb bent at knee.--the nose and one fore foot present, and on examination the knee of the missing fore limb is found farther back. (plate xv, fig. .) first place a noose each on the presenting pastern and lower jaw, and push back the body of the fetus with a repeller, while the operator seizing the shank of the bent limb extends it so as to press back the knee and bring forward the fetlock and foot. as progress is made little by little the hand is slid down from the region of the knee to the fetlock, and finally that is secured and brought up into the passage, when parturition will proceed without hindrance. if both fore limbs are bent back the head must be noosed and the limbs brought up as above, one after the other. it is usually best to employ the left hand for the right fore limb, and the right hand for the left fore limb. fore limb turned back from shoulders.--in this case, on exploration by the side of the head and presenting limb, the shoulder only can be reached at first. (plate xv, fig .) by noosing the head and presenting fore limb, they may be drawn forward into the pelvis, and the oiled hand being carried along the shoulder in the direction of the missing limb is enabled to reach and seize the forearm just below the elbow. the body is now pushed back by the assistants pressing on the head and presenting limb or on a repeller planted in the breast until the knee can be brought up into the pelvis, after which the procedure is the same as described in the last paragraph. head bent down between fore limbs.--this may be so that the poll or nape of the neck, with the ears, can be felt far back between the fore limbs, or so that only the upper border of the neck can be reached, head and neck being bent back beneath the body. with the head only bent on the neck, noose the two presenting limbs, then introduce the hand between them until the nose can be seized in the palm of the hand. next have the assistants push back the presenting limbs, while the nose is strongly lifted upward over the brim of the pelvis. this accomplished, it assumes the natural position and parturition is easy. when both head and neck are bent downward it may be impossible to reach the nose. if, however, the labor has only commenced, the limbs may be drawn upon until the operator can reach the ear, by dragging on which the head may be so far advanced that the fingers may reach the orbit; traction upon this while the limbs are being pushed back may bring the head up so that it bends on the neck only, and the further procedure will be as described in the last paragraph. if the labor has been long in progress and the fetus is jammed into the pelvis, the womb emptied of the waters, and firmly contracted on its solid contents, the case is incomparably more difficult. the mare may be chloroformed and turned on her back with hind parts elevated, and the womb may be injected with sweet oil. then, if the ear can be reached, the correction of the malpresentation may be attempted as above described. should this fail, one or more sharp hooks may be inserted in the neck as near the head as can be reached, and ropes attached to these may be dragged on, while the body of the foal is pushed back by the fore limbs or by a repeller. such repulsion should be made in a direction obliquely upward toward the loins of the mother, so as to rotate the fetus in such a way as to bring the head up. as this is accomplished a hold should be secured nearer and nearer to the nose, with hand or hook, until the head can be straightened out on the neck. all means failing; it becomes necessary to remove the fore limbs (embryotomy) so as to make more space for bringing up the head. if, even then, this can not be accomplished, it may be possible to push the body backward and upward with the repeller until the hind limbs are brought to the passage, when they may be noosed and delivery effected with the posterior presentation. head turned on shoulders.--in this case the fore feet present, and the oiled hand passed along the fore arms in search of the missing head finds the side of the neck turned to one side, the head being perhaps entirely out of reach. (plate xviii, fig. .) to bring the head forward it may be desirable to lay the mare on the side opposite to that to which the head is turned, and even to give chloroform or ether. then the feet being noosed, the body of the fetus is pushed by the hand or repeller forward and to the side opposite to that occupied by the head until the head comes within reach, near the entrance of the pelvis. if such displacement of the fetus is difficult, it may be facilitated by a free use of oil or lard. when the nose can be seized it can be brought into the passage, as when the head is turned down. if it can not be reached, the orbit may be availed of to draw the head forward until the nose can be seized or the lower jaw noosed. in very difficult cases a rope may be passed around the neck by the hand or with the aid of a curved carrier (plate xiv), and traction may be made upon this while the body is being rotated to the other side. in the same way in bad cases a hook may be fixed in the orbit or even between the bones of the lower jaw to assist in bringing the head up into position. should all fail, the amputation of the fore limbs may be resorted to, as advised under the last heading. head turned upward on back.--this differs from the last malpresentation only in the direction of the head, which has to be sought above rather than at one side, and is to be secured and brought forward in a similar manner. (plate xviii, fig. .) if a rope can be passed around the neck it will prove most effectual, as it naturally slides nearer to the head as the neck is straightened and ends by bringing the head within easy reach. hind feet engaged in pelvis.--in this case fore limbs and head present naturally, but the hind limbs bent forward from the hip and the loins arched allow the hind feet also to enter the passages, and the further labor advances the more firmly does the body of the foal become wedged into the pelvis (plate xvii, fig. .) the condition is to be recognized by introducing the oiled hand along the belly of the fetus, when the hind feet will be felt advancing. an attempt should at once be made to push them back, one after the other, over the brim of the pelvis. failing in this, the mare may be turned on her back, head downhill, and the attempt renewed. if it is possible to introduce a straight rope carrier, a noose passed through this may be put on the fetlock and the repulsion thereby made more effective. in case of continued failure the anterior presenting part of the body may be skinned and cut off as far back toward the pelvis as possible (see "embryotomy"); then nooses are placed on the hind fetlocks and traction is made upon these while the quarters are pushed back into the womb. then the remaining portion is brought away by the posterior presentation. anterior presentation with back turned to one side.--the diameter of the axis of the foal, like that of the pelvic passages, is from above downward, and when the fetus enters the pelvis with this greatest diameter engaged transversely or in the narrow diameter of the pelvis, parturition is rendered difficult or impossible. in such a case the pasterns and head may be noosed, and the passages and engaged portion of the foal freely lubricated with lard, the limbs may be crossed over each other and the head, and a movement of rotation effected in the fetus until its face and back are turned up toward the croup of the mother; then parturition becomes natural. back of foal turned to floor of pelvis.--in a roomy mare this is not an insuperable obstacle to parturition, yet it may seriously impede it, by reason of the curvature of the body of the foal being opposite to that of the passages, and the head and withers being liable to arrest against the border of the pelvis. lubrication of the passage with lard and traction of the limbs and head will usually suffice with or without the turning of the mare on her back. in obstinate cases two other resorts are open: first, to turn the foal, pushing back the fore parts and bringing up the hind so as to make a posterior presentation, and, second, the amputation of the fore limbs, after which extraction will usually be easy. [illustration: plate xv. abnormal presentations.] [illustration: plate xvi. abnormal presentations.] [illustration: plate xvii. abnormal presentations.] [illustration: plate xviii. abnormal presentations.] hind presentation with leg bent at hock.--in this form the quarters of the foal with the hind legs bent up beneath them present, but can not advance through the pelvis by reason of their bulk. (plate xv, fig. .) the oiled hand introduced can recognize the outline of the buttocks, with the tail and anus in the center and the sharp points of the hocks beneath. first pass a rope around each limb at the hock, then with hand or repeller push the buttocks backward and upward, until the feet can be brought up into the passages. to this the great length of the shank and pastern in the foal is a serious obstacle, and in all cases the foot should be protected in the palm of the hand while being brought up over the brim of the pelvis; otherwise the womb may be torn. when the pains are too violent and constant to allow effective manipulation, some respite may be obtained by the use of chloroform or morphin and by turning the mare on her back, but too often the operator fails and the foal must be sacrificed. two courses are still open: first, to cut through the cords behind and above the hock and extend the upper part of the limb, leaving the hock bent, and extract in this way, and, second, to amputate the hind limbs at the hip joint and remove them separately, after which the body may be extracted. hind presentation with legs bent forward from hip.--this is merely an aggravated form of the presentation last described. (plate xvii, fig. .) if the mare is roomy, a rope may be passed around each thigh and the body pushed upward and forward, so as to bring the hocks and heels upward. if this can be accomplished, nooses are placed on the limb further and further down until the fetlock is reached and brought into position. if failure is met with, then amputation at the hips is the last resort. hind presentations with back turned sideways or downward.--these are the counterparts of similar anterior presentations and are to be managed in the same way. presentation of the back.--this is rare, yet not unknown, the foal being bent upon itself with the back, recognizable by its sharp row of spines, presented at the entrance of the pelvis and the head and all four feet turned back into the womb. (plate xvi, fig. .) the body of the fetus may be extended across the opening transversely, so that the head corresponds to one side (right or left), or it may be vertical, with the head above or below. in any such position the object should be to push the body of the fetus forward and upward or to one side, as may best promise to bring up the fore or hind extremities, and bring the latter into the passage so as to constitute a normal anterior or posterior presentation. this turning of the fetus may be favored by a given position of the mother, by the free use of oil or lard on the surface of the fetus, and by the use of a propeller. presentation of breast and abdomen.--this is the reverse of the back presentation, the foal being extended across in front of the pelvic opening, but with the belly turned toward the passages and with all four feet engaged in the passage. (plate xvi, fig. .) the most promising course is to secure the hind feet with nooses and then push the fore feet forward into the womb. as soon as the fore feet are pushed forward clear of the brim of the pelvis, traction is made on the hind feet so as to bring the thighs into the passage and prevent the reentrance of the fore limbs. if it proves difficult to push the fore limbs back, a noose may be passed around the fetlock of each and the cord drawn through the eye of a rope carrier, by means of which the members may be easily pushed back. embryotomy. embryotomy consists in the dissection of the fetus, so as to reduce its bulk and allow of its exit through the pelvis. the indications for its adoption have been furnished in the foregoing pages. the operation will vary in different cases according to the necessity for the removal of one or more parts in order to secure the requisite reduction in size. thus it may be needful to remove head and neck, one fore limb or both, one hind limb or both, to remove different parts of the trunk, or to remove superfluous (monstrous) parts. some of the simplest operations in embryotomy (incision of the head in hydrocephalus, incision of the belly in dropsy) have already been described. it remains to notice the more difficult procedures which can be best undertaken by the skilled anatomist. amputation of the head.--this is easy when both fore limbs are turned back and the head alone has made its exit in part. it is more difficult when the head is still retained in the passages or womb, as in double-headed monsters. the head is secured by a hook in the lower jaw, or in the orbit, or by a halter, and the skin is divided circularly around the lower part of the face or at the front of the ears, according to the amount of head protruding. then an incision is made backward along the line of the throat, and the skin dissected from the neck as far back as possible. then the muscles and other soft parts of the neck are cut across, and the bodies of two vertebra (neck bones) are severed by cutting completely across the cartilage of the joint. the bulging of the ends of the bones will serve to indicate the seat of the joint. the head and detached portion of the neck may now be removed by steady pulling. if there is still an obstacle, the knife may be again used to sever any obstinate connections. in the case of a double-headed monster, the whole of the second neck must be removed with the head. when the head has been detached, a rope should be passed through the eyeholes, or through an artificial opening in the skin, and tied firmly around the skin, to be employed as a means of traction when the missing limbs or the second head have been brought up into position. amputation of the hind limb.--this may be required when there are extra hind limbs or when the hind limbs are bent forward at hock or hip joint. in the former condition the procedure resembles that for removal of a fore limb, but requires more anatomical knowledge. having noosed the pastern, a circular incision is made through the skin around the fetlock, and a longitudinal one from that up to the groin, and the skin is dissected from the limb as high up as can be reached, over the croup, if possible. then cut through the muscles around the hip joint, and, if possible, the two interarticular ligaments of the joint (pubofemoral and round), and extract the limb by strong dragging. amputation of the fore limbs.--this may usually be begun on the fetlock of the limb projecting from the vulva. an embryotomy knife is desirable. this knife consists of a blade with a sharp, slightly hooked point, and one or two rings in the back of the blade large enough to fit on the middle finger, while the blade is protected in the palm of the hand. (see plate xiii, fig. .) another form has the blade inserted in a mortise in the handle, from which it is pushed out by a movable button when wanted. first place a noose around the fetlock of the limb to be amputated, cut the skin circularly entirely around the fetlock, then make an incision on the inner side of the limb from the fetlock up to the breastbone. next dissect the skin from the limb, from the fetlock up to the breastbone on the inner side, and as far up on the shoulder blade as possible on the outer side. finally, cut through the muscles attaching the limb to the breastbone, and employ strong traction on the limb, so as to drag out the whole limb, shoulder blade included. the muscles around the upper part of the shoulder blade are easily torn through and need not be cut, even if that were possible. in no case should the fore limb be removed unless the shoulder blade is taken with it, as that furnishes the greatest obstruction to delivery, above all when it is no longer advanced by the extension of the fore limb, but is pressed back so as to increase the already thickest posterior portion of the chest. the preservation of the skin from the whole limb is advantageous in various ways; it is easier to cut it circularly at the fetlock than at the shoulder; it covers the hand and knife in making the needful incisions, thus acting as a protection to the womb; and it affords a means of traction on the body after the limb has been removed. in dissecting the skin from the limb the knife is not needful at all points; much of it may be stripped off with the fingers or knuckles, or by a blunt, iron spud, pushed up inside the hide, which is meanwhile held tense to render the spud effective. in case the limb is bent forward at the hock, a rope is passed round that and pulled so as to bring the point of the hock between the lips of the vulva. the hamstring and the lateral ligaments of the hock are now cut through, and the limbs extended by a rope tied round the lower end of the long bone above (tibia). in case it is still needful to remove the upper part of the limb, the further procedure is the same as described in the last paragraph. in case the limb is turned forward from the hip, and the fetus so wedged into the passage that turning is impossible, the case is very difficult. i have repeatedly succeeded by cutting in on the hip joint and disarticulating it, then dissecting the muscles back from the upper end of the thigh bone. a noose was placed around the neck of the bone and pulled on forcibly, while any unduly resisting structures were cut with the knife. cartwright recommends to make free incisions round the hip joints and tear through the muscles when they can not be cut; then with cords round the pelvic bones, and hooks inserted in the openings in the floor of the pelvis to drag out the pelvic bones; then put cords around the heads of the thigh bones and extract them; then remove the intestines; finally, by means of the loose, detached skin, draw out the body with the remainder of the hind limbs bent forward beneath it. reuff cuts his way into the pelvis of the foal, and with a knife separates the pelvic bones from the loins, then skinning the quarter draws out these pelvic bones by means of ropes and hooks, and along with them the hind limbs. the hind limbs having been removed by one or the other of these procedures, the loose skin detached from the pelvis is used as a means of traction and delivery is effected. in case of a monstrosity with extra hind limbs, it may be possible to bring these up into the passage and utilize them for traction. _removal of the abdominal viscera._--in case the belly is unduly large, from decomposition, tumors, or otherwise, it may be needful to lay it open with the knife and cut or tear out the contents. _removal of the thoracic viscera._--to diminish the bulk of the chest it has been found advisable to cut out the breastbone, remove the heart and lungs, and allow the ribs to collapse with the lower free ends overlapping each other. _dissection of the trunk._--in case it becomes necessary to remove other portions of the trunk, we should follow the general rule of preserving the skin so that all manipulations can be made inside this as a protector, that it may remain available as a means of exercising traction on the remaining part of the body, and as a covering to protect the vaginal walls against injuries from bones while such part is passing. flooding, or bleeding from the womb. this is rare in the mare, but not unknown, in connection with a failure of the womb to contract on itself after parturition, or with eversion of the womb (casting the withers), and congestion or laceration. if the blood accumulates in the flaccid womb, the condition may be suspected only by reason of the rapidly advancing weakness, swaying, unsteady gait, hanging head, paleness of the eyes and other mucous membranes, and weak, small, failing pulse. the hand introduced into the womb detects the presence of the blood partly clotted. if the blood escapes by the vulva, the condition is evident. _treatment_ consists in evacuating the womb of its blood clots, giving a large dose of powdered ergot of rye, and in the application of cold water or ice to the loins and external generative organs. besides this, a sponge impregnated with a strong solution of alum, or, still better, with tincture of muriate of iron, may be introduced into the womb and squeezed so as to bring the liquid in contact with the walls generally. eversion of the womb. if the womb fails to contract after difficult parturition, the after-pains will sometimes lead to the fundus passing into the body of the organ and passing through that and the vagina until the whole inverted organ appears externally and hangs down on the thighs. the result is rapid engorgement and swelling of the organ, impaction of the rectum with feces, and distention of the bladder with urine, all of which conditions seriously interfere with the return of the mass. in returning the womb the standing is preferable to the recumbent position, as the abdomen is more pendent and there is less obstruction to the return. it may, however, be necessary to put hobbles on the hind limbs to prevent the mare from kicking. a clean sheet should be held beneath the womb, and all filth, straw, and foreign bodies washed from its surface. then with a broad, elastic (india-rubber) band, or in default of that a long strip of calico or inches wide, wind the womb as tightly as possible, beginning at its most dependent part (the extremity of the horn). this serves two good ends. it squeezes out into the general circulation the enormous mass of blood which engorged and enlarged the organ, and it furnishes a strong protective covering for the now delicate, friable organ, through which it may be safely manipulated without danger of laceration. the next step may be the pressure on the general mass while those portions next the vulva are gradually pushed in with the hands; or the extreme lowest point (the end of the horn) may be turned within itself and pushed forward into the vagina by the closed fist, the return being assisted by manipulations by the other hand, and even by those of assistants. by either mode the manipulations may be made with almost perfect safety so long as the organ is closely wrapped in the bandage. once a portion has been introduced into the vagina the rest will usually follow with increasing ease, and the operation should be completed with the hand and arm extended the full length within the womb and moved from point to point so as to straighten out all parts of the organ and insure that no portion still remain inverted within another portion. should any such partial inversion be left it will give rise to straining, under the force of which it will gradually increase until the whole mass will be protruded as before. the next step is to apply a truss as an effectual mechanical barrier to further escape of the womb through the vulva. the simplest is made with two -inch ropes, each about feet long, each doubled and interwoven at the bend, as seen in plate xiv, figure . the ring formed by the interlacing of the two ropes is adjusted around the vulva, the two ends of the one rope are carried up on the right and left of the tail and along the spine, being wound around each other in their course, and are finally tied to the upper part of the collar encircling the neck. the remaining two ends, belonging to the other rope, are carried downward and forward between the thighs and thence forward and upward on the sides of the belly and chest to be attached to the right and left sides of the collar. these ropes are drawn tightly enough to keep closely applied to the opening without chafing, and will fit still more securely when the mare raises her back to strain. it is desirable to tie the mare short so that she may be unable to lie down for a day or two, and she should be kept in a stall with the hind parts higher than the fore. violent straining may be checked by full doses of opium (one-half dram), and any costiveness or diarrhea should be obviated by a suitable laxative or binding diet. in some mares the contractions are too violent to allow of the return of the womb, and full doses of opium one-half dram, laudanum ounces, or chloral hydrate ounce, may be demanded, or the mare must be rendered insensible by ether or chloroform. rupture, or laceration, of the womb. this may occur from the feet of the foal during parturition, or from ill-directed efforts to assist, but it is especially liable to take place in the everted, congested, and friable organ. the resultant dangers are bleeding from the wound, escape of the bowels through the opening and their fatal injury by the mare's feet or otherwise, and peritonitis from the extension of inflammation from the wound and from the poisonous action of the septic liquids of the womb escaping into the abdominal cavity. the first object is to close the wound, but unless in eversion of the womb this is practically impossible. in the last-named condition the wound must be carefully and accurately sewed up before the womb is returned. after its return, the womb must be injected daily with an antiseptic solution (borax, one-half ounce, or carbolic acid, drams to a quart of tepid water). if inflammation threatens, the abdomen may be bathed continuously with hot water by means of a heavy woolen rag, and large doses of opium (one-half dram) may be given twice or thrice daily. ruptures of the vagina. these are attended with dangers similar to those belonging to rupture of the womb, and in addition by the risk of protrusion of the bladder, which appears through the lips of the vulva as a red, pyriform mass. sometimes such lacerations extend downward into the bladder, and in others upward into the terminal gut (rectum). in still other cases the anus is torn so that it forms one common orifice with the vulva. too often such cases prove fatal, or at least a recovery is not attained, and urine or feces or both escape freely into the vagina. the simple laceration of the anus is easily sewed up, but the ends of the muscular fibers do not reunite and the control over the lower bowel is never fully reacquired. the successful stitching up of the wound communicating with the bladder or the rectum requires unusual skill and care, and though i have succeeded in a case of the latter kind, i can not advise the attempt by unprofessional persons. blood clots in the walls of the vagina. (see "effusion of blood in the vaginal walls," p. .) laminitis, or founder, following parturition. this sometimes follows on inflammation of the womb, as it frequently does on disorder of the stomach. its symptoms agree with those of the common form of founder, and treatment need not differ. inflammation of the womb and peritoneum. these may result from injuries sustained by the womb during or after parturition, from exposure to cold or wet, or from the irritant infective action of putrid products within the womb. under the inflammation the womb remains dilated and flaccid, and decomposition of its secretions almost always occurs, so that the inflammation tends to assume a putrid character and general septic infection is likely to occur. _symptoms._--the symptoms are ushered in by shivering, staring coat, small, rapid pulse, elevated temperature, accelerated breathing, loss of appetite, with arched back, stiff movement of the body, looking back at the flanks, and uneasy motions of the hind limbs, discharge from the vulva of a liquid at first watery, reddish, or yellowish, and later it may be whitish or glairy, and fetid or not in different cases. tenderness of the abdomen shown on pressure is especially characteristic of cases affecting the peritoneum or lining of the belly, and is more marked lower down. if the animal survives, the inflammation tends to become chronic and attended by a whitish mucopurulent discharge. if, on the contrary, it proves fatal, death is preceded by extreme prostration and weakness from the general septic poisoning. _treatment._--in treatment the first thing to be sought is the removal of all offensive and irritant matters from the womb through a caoutchouc tube introduced into the womb, and into which a funnel is fitted. warm water should be passed until it comes away clear. to insure that all the womb has been washed out, the oiled hand may be introduced to carry the end of the tube into the two horns successively. when the offensive contents have been thus removed, the womb should be injected with a quart of water holding in solution dram permanganate of potash, or, in the absence of the latter, teaspoonfuls of carbolic acid, twice daily. fomentation of the abdomen, or the application of a warm flaxseed poultice, may greatly relieve. acetanilid, in doses of half an ounce, twice or thrice a day, or sulphate of quinia in doses of one-third ounce, may be employed to reduce the fever. if the great prostration indicates septic poisoning, large doses (one-half ounce) bisulphite of soda, or salicylate of soda, or sulphate of quinin may be resorted to. leucorrhea. this is a white, glutinous, chronic discharge, the result of a continued, subacute inflammation of the mucous membrane of the womb. like the discharge of acute inflammation, it contains many forms of bacteria, by some of which it is manifestly inoculable on the penis of the stallion, producing ulcers and a specific, gonorrheal discharge. _treatment_ may consist in the internal use of tonics (sulphate of iron, drams, daily) and the washing out of the womb, as described under the last heading, followed by an astringent antiseptic injection (carbolic acid, teaspoonfuls; tannic acid, / dram; water, quart). this may be given two or three times a day. diseases of the udder and teats. congestion and inflammation of the udder. this is comparatively rare in the mare, though in some cases the udder becomes painfully engorged before parturition, and a doughy swelling, pitting on pressure, extends forward on the lower surface of the abdomen. when this goes on to active inflammation, one or both of the glands becomes enlarged, hot, tense, and painful; the milk is dried up or replaced by a watery or reddish, serous fluid, which at times becomes fetid; the animal walks lame, loses appetite, and shows general disorder and fever. the condition may end in recovery, in abscess, induration, or gangrene, and, in some cases, may lay the foundation for a tumor of the gland. _treatment._--the treatment is simple so long as there is only congestion. active rubbing with lard or oil, or, better, camphorated oil, and the frequent drawing off of the milk, by the foal or with the hand, will usually bring about a rapid improvement. when active inflammation is present, fomentation with warm water may be kept up for an hour and followed by the application of the camphorated oil, to which has been added some carbonate of soda and extract of belladonna. a dose of laxative medicine ( drams barbados aloes) will be of service in reducing fever, and one-half ounce saltpeter daily will serve a similar end. in case the milk coagulates in the udder and can not be withdrawn, or when the liquid becomes fetid, a solution of grains carbonate of soda and drops carbolic acid dissolved in an ounce of water should be injected into the teat. in doing this it must be noted that the mare has three separate ducts opening on the summit of each teat and each must be carefully injected. to draw off the fetid product it may be needful to use a small milking tube, or spring teat dilator designed by the writer. (plate xiv, figs. and .) when pus forms and points externally and can not find a free escape by the teat, the spot where it fluctuates must be opened freely with the knife and the cavity injected daily with the carbolic-acid lotion. when the gland becomes hard and indolent, it may be rubbed daily with iodin ointment part, vaseline parts. tumors of the udder. as the result of inflammation of the udder it may become the seat of an indurated diseased growth, which may go on growing and seriously interfere with the movement of the hind limbs. if such swellings do not give way in their early stages to treatment by iodin, the only resort is to cut them out with a knife. as the gland is often implicated and has to be removed, such mares can not in the future suckle their colts and therefore should not be bred. sore teats, scabs, cracks, warts. by the act of sucking, especially in cold weather, the teats are subject to abrasions, cracks, and scabs, and as the result of such irritation, or independently, warts sometimes grow and prove troublesome. the warts should be clipped off with sharp scissors and their roots burned with a solid pencil of lunar caustic. this is best done before parturition to secure healing before suckling begins. for sore teats use an ointment of vaseline ounce, balsam of tolu grains, and sulphate of zinc grains. diseases of the nervous system. by m. r. trumbower, v. s. [revised by john r. mohler, a. m., v. m. d.] anatomy and physiology of the brain and nervous system. (pl. xix.) the nervous system may be regarded as consisting of two sets of organs, peripheral and central, the function of one being to establish a communication between the centers and the different parts of the body, and that of the other to generate nervous force. the whole may be arranged under two divisions: first, the cerebrospinal system; second, the sympathetic or ganglionic system. each is possessed of its own central and peripheral organs. in the first, the center is made up of two portions--one large and expanded (the brain) placed in the cranial cavity; the other elongated (spinal cord), continuous with the brain, and lodged in the canal of the vertebral column. the peripheral portion of this system consists of the cerebrospinal nerves, which leave the axis in symmetrical pairs and are distributed to the skin, the voluntary muscles, and the organs. in the second, the central organ consists of a chain of ganglia, connected by nerve cords, which extends on each side of the spine from the head to the rump. the nerves of this system are distributed to the involuntary muscles, mucous membrane, viscera, and blood vessels. the two systems have free intercommunication, ganglia being at the junctions. two substances, distinguishable by their color, namely, the white or medullary and the gray or cortical substance, enter into the formation of nervous matter. both are soft, fragile, and easily injured, in consequence of which the principal nervous centers are well protected by bony coverings. the nervous substances present two distinct forms--nerve fibers and nerve cells. an aggregation of nerve cells constitutes a nerve ganglion. the nerve fibers represent a conducting apparatus and serve to place the central nervous organs in connection with peripheral end organs. the nerve cells, however, besides transmitting impulses, act as physiological centers for automatic, or reflex, movements, and also for the sensory, perceptive, trophic, and secretory functions. a nerve consists of a bundle of tubular fibers, held together by a dense areolar tissue, and inclosed in a membranous sheath--the neurilemma. nerve fibers possess no elasticity, but are very strong. divided nerves do not retract. nerves are thrown into a state of excitement when stimulated, and are, therefore, said to possess excitable or irritable properties. the stimuli may be applied to, or may act upon, any part of the nerve. nerves may be paralyzed by continuous pressure being applied. when the nerves divide into branches, there is never any splitting up of their ultimate fibers, nor yet is there ever any coalescing of them; they retain their individuality from their source to their termination. nerves which convey impressions to the centers are termed sensory, or centripetal, and those which transmit stimulus from the centers to organs of motion are termed motor, or centrifugal. the function of the nervous system may, therefore, be defined in the simplest terms, as follows: it is intended to associate the different parts of the body in such a manner that stimulus applied to one organ may excite or depress the activity of another. the brain is that portion of the cerebrospinal axis within the cranium, which may be divided into four parts--the medulla oblongata, the cerebellum, the pons varolii, and the cerebrum--and it is covered by three membranes, called the meninges. the outer of these membranes, the dura mater, is a thick, white, fibrous membrane which lines the cavity of the cranium, forming the internal periosteum of the bones; it is continuous with the spinal cord to the extremity of the canal. the second, the arachnoid, is a delicate serous membrane, and loosely envelops the brain and spinal cord; it forms two layers, having between them the arachnoid space which contains the cerebrospinal fluid, the use of which is to protect the spinal cord and brain from pressure. the third, or inner, the pia mater, is closely adherent to the entire surface of the brain, but is much thinner and more vascular than when it reaches the spinal cord, which it also envelops, and is continued to form the sheaths of the spinal nerves. the medulla oblongata is the prolongation of the spinal cord, extending to the pons varolii. this portion of the brain is very large in the horse: it is pyramidal in shape, the narrowest part joining the cord. the pons varolii is the transverse projection on the base of the brain, between the medulla oblongata and the peduncles of the cerebrum. the cerebellum is lodged in the posterior part of the cranial cavity, immediately above the medulla oblongata; it is globular or elliptical in shape, the transverse diameter being greatest. the body of the cerebellum is composed of gray matter externally and of white matter in the center. the cerebellum has the function of co-ordinating movements; that is, of so associating them as to cause them to accomplish a definite purpose. injuries to the cerebellum cause disturbances of the equilibrium but do not interfere with the will power or intelligence. the cerebrum, or brain proper, occupies the anterior portion of the cranial cavity. it is ovoid in shape, with an irregular, flattened base, and consists of lateral halves or hemispheres. the greater part of the cerebrum is composed of white matter. the hemispheres of the cerebrum are usually said to be the seat of all psychical activities. only when they are intact are the process of feeling, thinking, and willing possible. after they are destroyed the organism comes to be like a complicated machine, and its activity is only the expression of the internal and external stimuli which act upon it. the spinal cord, or spinal marrow, is that part of the cerebrospinal system which is contained in the spinal canal of the backbone, and extends from the medulla oblongata to a short distance behind the loins. it is an irregularly cylindrical structure, divided into two lateral, symmetrical halves by fissures. the spinal cord terminates posteriorly in a pointed extremity, which is continued by a mass of nerve trunks--cauda equinæ. a transverse section of the cord reveals that it is composed of white matter externally and of gray matter internally. the spinal cord does not fill the whole spinal canal. the latter contains, besides, a large venous sinus, fatty matter, the membranes of the cord, and the cerebrospinal fluid. the spinal nerves, forty-two or forty-three in number, arise each by two roots, a superior or sensory, and an inferior or motor. the nerves originating from the brain are twenty-four in number, and arranged in pairs, which are named first, second, third, etc., counting from before backward. they also receive special names, according to their functions or the parts to which they are distributed, viz: . olfactory. . optic. . oculo-motor. . pathetic. . trifacial. . abducens. . facial. . auditory. . glossopharyngeal. . pneumogastric. . spinal accessory. . hypoglossal. inflammation of the brain and its membranes (encephalitis, meningitis, cerebritis). inflammation may attack these membranes singly, or any one of the anatomical divisions of the nerve matter, or it may invade the whole at once. practical experience, however, teaches us that primary inflammation of the dura mater is of rare occurrence, except in direct mechanical injuries to the head or diseases of the bones of the cranium. neither is the arachnoid often affected with acute inflammation, except as a secondary result. the pia mater is most commonly the seat of inflammation, acute and subacute, but from its intimate relation with the surface of the brain the latter very soon becomes involved in the morbid changes. practically, we can not separate inflammation of the pia mater from that of the brain proper. inflammation may, however, exist in the center of the great nerve masses--the cerebrum, cerebellum, pons varolii, or medulla at the base of the brain--without involving the surface. when, therefore, inflammation invades the brain and its enveloping membranes it is properly called encephalitis; when the membranes alone are affected it is called meningitis, or the brain substance alone cerebritis. since all the conditions merge into one another and can scarcely be recognized separately during the life of the animal, they may here be considered together. _causes._--exposure to extreme heat or cold, sudden and extreme changes of temperature, excessive continued cerebral excitement, too much nitrogenous feed, direct injuries to the brain, such as concussion, or from fracture of the cranium, overexertion, sometimes as sequelæ to influenza, pyemia, poisons having a direct influence upon the encephalic mass, extension of inflammation from neighboring structures, food poisoning, tumors, parasites, metastatic abscesses, etc. _symptoms._--the diseases here grouped together are accompanied with a variety of symptoms, almost none of which, however, are associated so definitely with a special pathological process as to point unmistakably to a given lesion. usually the first symptoms indicate mental excitement, and are followed by symptoms indicating depression. acute encephalitis may be ushered in by an increased sensibility to noises, with more or less nervous excitability, contraction of the pupils of the eyes, and a quick, hard pulse. in very acute attacks these symptoms, however, are not always noted. this condition will soon be followed by muscular twitchings, convulsive or spasmodic movements, eyes wide open with shortness of sight. the animal becomes afraid to have his head handled. convulsions and delirium will develop, with inability of muscular control, or stupor and coma may supervene. when the membranes are greatly implicated, convulsions and delirium with violence may be expected, but if the brain substances are principally affected stupor and coma will be the prominent symptoms. in the former condition the pulse will be quick and hard; in the latter, soft and depressed, with often a dilatation of the pupils, and deep, slow, stertorous breathing. the symptoms may follow one another in rapid succession, and the disease approach a fatal termination within hours. in subacute attacks the symptoms are better defined, and the animal seldom dies before the third day. within three or four days gradual improvement may become manifest, or cerebral softening with partial paralysis may occur. in all cases of encephalitis there is a marked rise in temperature from the very onset of the disease, with a tendency to increase until the most alarming symptoms develop, succeeded by a decrease when coma becomes manifest. the violence and character of the symptoms greatly depend upon the extent and location of the structures involved. thus, in some cases there may be marked paralysis of certain muscles, while in others there may be spasmodic rigidity of muscles in a certain region. very rarely the animal becomes extremely violent early in the attack, and by rearing up, striking with the fore feet, or falling over, may do himself great injury. usually, however, the animal maintains the standing position, propping himself against the manger or wall, until he falls from inability of muscular control, or from unconsciousness. occasionally, in his delirium, he may go through a series of automatic movements, such as trotting or walking, and, if loose in a stall, will move around persistently in a circle. early and persistent constipation of the bowels is a marked symptom in nearly all acute affections of the brain; retention of the urine, also, is frequently observed. following these symptoms there are depression, loss of power and consciousness, lack of ability or desire to move, and usually fall of temperature. at this stage the horse stands with legs propped, the head hanging or resting on the manger, the eyes partly closed, and does not respond when spoken to or when struck with a whip. chronic encephalitis or meningitis may succeed the acute stage, or may be due to stable miasma, blood poison, narcotism, lead poisoning, etc. this form may not be characterized in its initial stages by excitability, quick and hard pulse, and high fever. the animal usually appears at first stupid; eats slowly; the pupil of the eye does not respond to light quickly; the animal often throws his head up or shakes it as if suffering sudden twinges of pain. he is slow and sluggish in his movements, or there may be partial paralysis of one limb, one side of the face, neck, or body. these symptoms, with some variations, may be present for several days and then subside, or the disease may pass into the acute stage and terminate fatally. chronic encephalitis may effect an animal for ten days or two weeks without much variation in the symptoms before the crisis is reached. if improvement commences, the symptoms usually disappear in the reverse order to that in which they developed, with the exception of the paralytic effects, which remain intractable or permanent. paralysis of certain sets of muscles is a very common result of chronic, subacute, and acute encephalitis, and is due to softening of the brain or to exudation into the cavities of the brain or arachnoid space. softening and abscess of the brain are terminations of cerebritis. it may also be due to an insufficient supply of blood as a result of diseased cerebral arteries and of apoplexy. the symptoms are drowsiness, vertigo, or attacks of giddiness, increased timidity, or fear of familiar objects, paralysis of one limb, hemiplegia, imperfect control of the limbs, and usually a weak, intermittent pulse. in some cases the symptoms are analogous to those of apoplexy. the character of the symptoms depends upon the seat of the softening or abscess within the brain. cerebral sclerosis sometimes follows inflammation in the structure of the brain affecting the connective tissues, which eventually become hypertrophied and press upon nerve cells and fibers, causing their ultimate disappearance, leaving the parts hard and indurated. this condition gives rise to a progressive paralysis and may extend along a certain bundle of fibers into the spinal cord. complete paralysis almost invariably supervenes and causes death. _lesions._--on making post-mortem examinations of horses which have died in the first stages of either of these diseases we find an excessive engorgement of the capillaries and small blood vessels, with correspondingly increased redness and changes in both the contents and the walls of the vessels. if death has occurred at a later period of the disease, it will be found that, in addition to the redness and engorgement, an exudation of the contents of the blood vessels into the tissues and upon the surfaces of the inflamed parts has supervened. if the case has been one of encephalitis, there will usually be found more or less watery fluid in the ventricles (natural cavities in the brain), in the subarachnoid space, and a serous exudation between the convolutions and interstitial spaces of the gray matter under the membranes of the brain. the quantity of fluid varies in different cases. exudations of a membranous character may be present, and are found attached to the surfaces of the pia mater. in meningitis, especially in chronic cases, in addition to the serous effusion, there are changes which may be regarded as characteristic in the formation of a delicate and highly vascular layer or layers of membrane or organized structure on the surface of the dura mater, and also indications of hemorrhages in connection with the membranous formations. hematoma, or blood tumors, may be found embedded in this membrane. in some cases the hemorrhages are copious, causing paralysis or apoplexy, followed by speedy death. the meningitis may be suppurative. in this case a puslike exudate is found between the membranes covering the brain. in cerebritis, or inflammation of the interior of the brain, there is a tendency to softening and suppuration and the formation of abscesses. in some cases the abscesses are small and numerous, surrounded with a softened condition of the brain matter, and sometimes we may find one large abscess. in cases of recent development the walls of the abscesses are fringed and ragged and have no lining membrane. in older or chronic cases the walls of the abscesses are generally lined with a strong membrane, often having the appearance of a sac or cyst, and the contents have a very offensive odor. _treatment._--in all acute attacks of inflammation involving the membranes or cerebral masses, it is the pressure from the distended and engorged blood vessels and the rapid accumulation of inflammatory products that endangers the life of the animal in even the very early stage of the disease. the earlier the treatment is commenced to lessen the danger of fatal pressure from the engorged blood vessels, the less effusion and smaller number of inflammatory products we have to contend with later. the leading object, then, to be accomplished in the treatment of the first stage of encephalitis, meningitis, or cerebritis, and before a dangerous degree of effusion or exudation has taken place, is to relieve the engorgement of the blood vessels and thereby lessen the irritation or excitability of the affected structures. if the attempt to relieve the engorgement in the first stage has been only partially successful, and the second stage, with its inflammatory products and exudations, whether serous or plastic, has set in, then the main objects in further treatment are to keep up the strength of the animal and hasten the absorption of the exudative products as much as possible. to obtain these results, when the animal is found in the initial stage of the disease, if there is unnatural excitability or stupor with increase of temperature and quickened pulse, we should apply cold to the head in the form of cold water or ice. for this purpose cloths or bags may be used, and they should be renewed as often as necessary. if the disease is still in its early stages and the animal is strong, bleeding from the jugular vein may be beneficial. good results are to be expected only during the stage of excitement, while there is a strong, full pulse and the mucous membranes of the head are red from a plentiful supply of blood. the finger should be kept on the pulse and the blood allowed to flow until there is distinct softening of the pulse. as soon as the animal recovers somewhat from the shock of the bleeding the following medicine should be made into a ball or dissolved in a pint of warm water and be given at one dose: barbados aloes, drams; calomel, drams; powdered ginger, dram; tincture of aconite, drops. the animal should be placed in a cool, dark place, as free from noise as possible. when the animal becomes thirsty half an ounce of bromid of potash may be dissolved in the drinking water every six hours. injections of warm water into the rectum may facilitate the action of the purgative. norwood's tincture of veratrum viride, in -drop doses, should be given every hour and dram of solid extract of belladonna every four hours until the symptoms become modified and the pulse regular and full. [illustration: plate xix. the nervous system.] if this treatment fails to give relief, the disease will pass into the advanced stages, or, if the animal has been neglected in the early stages, the treatment must be supplanted with the hypodermic injection of ergotin, in -grain doses, dissolved in dram of water, every six hours. the limbs may be poulticed above the fetlocks with mustard. warm blanketing, to promote perspiration, is to be observed always when there is no excessive perspiration. if the disease becomes chronic (encephalitis or meningitis), we must place our reliance upon alteratives and tonics, with such incidental treatment as special symptoms may demand. iodid of potassium in -dram doses should be given three times a day and dram of calomel once a day to induce absorption of effusions or thickened membranes. tonics, in the form of iodid of iron in -dram doses, to which is added drams of powdered hydrastis, may also be given every six or eight hours, as soon as the active fever has abated. after the disappearance of the acute symptoms, blisters (cantharides ointment) may be applied behind the poll. when paralytic effects remain after the disappearance of all other symptoms, sulphate of strychnia in -grain doses, in combination with the other tonics, may be given twice a day and be continued until it produces muscular twitching. in some cases of paralysis, as of the lips or throat, benefit may be derived from the moderate use of the electric battery. many of the recoveries will, however, under the most active and early treatment, be but partial, and in all cases the animals become predisposed to subsequent attacks. a long time should be allowed to pass before the animal is exposed to severe work or great heat. when the disease depends upon mechanical injuries, they have to be treated and all causes of irritation to the brain removed. if it is due to stable miasma, uremic poisoning, pyemia, influenza, rheumatism, toxic agents, etc., they should receive prompt attention for their removal or mitigation. cerebral softening, abscess, and sclerosis are practically inaccessible to treatment, otherwise than such relief as may be afforded by the administration of opiates and general tonics, and, in fact, the diagnosis is largely presumptive. congestion of the brain, or megrims. congestion of the brain consists in an accumulation of blood in the vessels, also called hyperemia, or engorgement. it may be active or passive--active when there is an undue accumulation of blood or diminished arterial resistance, and passive when it accumulates in the vessels of the brain, owing to some obstacle to its return by the veins. _causes._--active cerebral congestion may be from hypertrophy of the left ventricle of the heart, excessive exertion, the influence of extreme heat, sudden and great excitement, artificial stimulants, etc. passive congestion may be produced by any mechanical obstruction which prevents the proper return of blood through the veins to the heart, such as a small or ill-fitting collar, which often impedes the blood current, tumors or abscesses pressing on the vein in its course, and organic lesions of the heart with regurgitation. extremely fat animals with short, thick necks are peculiarly subject to attacks of cerebral congestion. simple congestion, however, is merely a functional affection, and in a slight or moderate degree involves no immediate danger. extreme engorgement, on the contrary, may be followed by rupture of previously weakened arteries and capillaries and cause immediate death, designated then as a stroke of apoplexy. _symptoms._--congestion of the brain is usually sudden in its manifestation and of short duration. the animal may stop very suddenly and shake its head or stand quietly braced, then stagger, make a plunge, and fall. the eyes are staring, breathing hurried and stertorous, and the nostrils widely dilated. this may be followed by coma, violent convulsive movements, and death. generally, however, the animal gains relief in a short time, but may remain weak and giddy for several days. if it is due to organic change of the heart or the disease of the blood vessels in the brain, then the symptoms may be of slow development, manifested by drowsiness, dimness or imperfect vision, difficulty in voluntary movements, diminished sensibility of the skin, loss of consciousness, delirium, and death. in milder cases effusion may take place in the arachnoid spaces and ventricles of the brain, followed by paralysis and other complications. _pathology._--in congestion of the brain the cerebral vessels are loaded with blood, the venous sinuses distended to an extreme degree, and the pressure exerted upon the brain constitutes actual compression, giving rise to the symptoms just mentioned. on post-mortem examinations this engorgement is found universal throughout the brain and its membranes, which serves to distinguish it from inflammations of these structures, in which the engorgements are confined more or less to circumscribed portions. a prolonged congestion may, however, lead to active inflammation, and in that case we find serous and plastic exudations in the cavities of the brain. in addition to the intensely engorged condition of the vessels we find the gray matter of the brain redder than natural. in cases in which several attacks have occurred the blood vessels are often found permanently dilated. _treatment._--the animal should be taken out of harness at once, with prompt removal of all mechanical obstructions to the circulation. if it is caused by venous obstruction by too tight a collar, the loosening of the collar will give immediate relief. the horse should be bled freely from the jugular vein. if due to tumors or abscesses, a surgical operation becomes necessary to afford relief. to revive the animal if it becomes partially or totally unconscious, cold water should be dashed on the head. give a purge of glauber's salt. if the limbs are cold, tincture of capsicum or strong mustard water should be applied to them. if symptoms of paralysis remain after two or three days, an active cathartic and iodid of potassium will be indicated, to be given as prescribed for inflammation of the brain. in confirmed cases, treatment is not advisable, as there is considerable danger to the owner should an attack occur in a crowded street. _prevention._--well-adjusted collar, with strap running from the collar to the girth, to hold down the collar when pulling upgrade; regular feed and exercise, without allowing the animal to become excessively plethoric; moderate checking, allowing a free-and-easy movement of the head; well-ventilated stabling, proper cleanliness, pure water, etc. sunstroke, heat stroke, or heat exhaustion. the term sunstroke is applied to affections occasioned not exclusively by exposure to the sun's rays, as the word signifies, but by the action of great heat combined generally with humid atmosphere. exhaustion produced by long-continued heat is often the essential factor, and is called heat exhaustion. horses on the race track undergoing protracted and severe work in hot weather often succumb to heat exhaustion. draft horses which do not receive proper care in watering, feeding, and rest in shady places and are exposed for many hours to the direct rays of the sun suffer very frequently from sunstroke. _symptoms._--sunstroke is manifested suddenly. the animal stops, drops his head, begins to stagger, and soon falls to the ground unconscious. the breathing is marked with great stertor, the pulse is very slow and irregular, cold sweats break out in patches on the surface of the body, and the animal often dies without having recovered consciousness. the temperature becomes very high, reaching ° to ° f. in heat exhaustion the animal usually requires urging for some time prior to the appearance of any other symptoms, generally perspiration is checked, and then the horse becomes weak in its gait, the breathing hurried or panting, eyes watery or bloodshot, nostrils dilated and highly reddened, assuming a dark, purple color; the pulse is rapid and weak, the heart bounding, followed by unconsciousness and death. if recovery takes place, convalescence extends over a long period of time, during which incoordination of movement may persist. _pathology._--sunstroke, virtually active congestion of the brain, often accompanied with effusion and blood extravasation, characterizes this condition, with often rapid and fatal lowering of all the vital functions. in many instances the death may be due to the complete stagnation in the circulation of the brain, inducing anemia, or want of nourishment of that organ. in other cases it may be directly due to the excessive compression of the nerve matter controlling the heart's action, and cause paralysis of that organ. there are also changes in the composition of the blood. _treatment._--the animal should be placed in shaded surroundings. under no circumstances is blood-letting permissible in sunstroke. ice or very cold water should be applied to the head and along the spine, and half an ounce of carbonate of ammonia or ounces of whisky should be given in pint of water. cold water may be used as an enema and should also be showered upon the body of the horse from the hose or otherwise. this should be continued until the temperature is down to ° f. brisk friction of the limbs and the application of spirits of camphor often yields good results. the administration of the stimulants should be repeated in one hour if the pulse has not become stronger and slower. in either case, when reaction has occurred, preparations of iron and general tonics may be given during convalescence: sulphate of iron, dram; gentian, drams; red cinchona bark, drams; mix and give in feed morning and evening. _prevention._--in very hot weather horses should have wet sponges or light sunshades on the head when at work, or the head may be sponged with cold water as many times a day as possible. proper attention should be given to feeding and watering, never in excess. during the warm months all stables should be cool and well ventilated, and if an animal is debilitated from exhaustive work or disease it should receive such treatment as will tend to build up the system. horses should be permitted to drink as much water as they want while they are at work during hot weather. an animal which has been affected with sunstroke is very liable to have subsequent attacks when exposed to the necessary exciting causes. apoplexy or cerebral hemorrhage. apoplexy is often confounded with cerebral congestion, but true apoplexy always consists in rupture of cerebral blood vessels, with blood extravasation and formation of blood clot. _causes._--two causes are involved in the production of apoplexy, the predisposing and the exciting. the predisposing cause is degeneration, or disease which weakens the blood vessel; the exciting cause is any one which tends to induce cerebral congestion. _symptoms._--apoplexy is characterized by a sudden loss of sensation and motion, profound coma, and stertorous, difficult breathing. the action of the heart is little disturbed at first, but soon becomes slower, then quicker and feebler, and after a little time ceases. if the rupture is one of a small artery and the extravasation limited, sudden paralysis of some part of the body is the result. the extent and location of the paralysis depend upon the location within the brain which is functionally deranged by the pressure of the extravasated blood; hence these conditions are very variable. in the absence of any premonitory symptoms or an increase of temperature in the early stage of the attack, we may be reasonably certain in making the distinction between this disease and congestion of the brain, or sunstroke. _pathology._--in apoplexy there is generally found an atheromatous condition of the cerebral vessels, with weakening and degeneration of their walls. when a large artery has been ruptured it is usually followed by immediate death, and large rents may be found in the cerebrum, with great destruction of brain tissue, induced by the forcible pressure of the liberated blood. in small extravasations producing local paralysis without marked general disturbance the animal may recover after a time; in such cases gradual absorption of the clot takes place. in large clots atrophy of the brain substances may follow, or softening and abscess from want of nutrition may result, and render the animal worthless, ultimately resulting in death. _treatment._--place the animal in a quiet, cool place and avoid all stimulating feed. administer, in the drinking water or feed, drams of the iodid of potassium twice a day for several weeks if necessary. medical interference with sedatives or stimulants is more liable to be harmful than of benefit, and blood-letting in an apoplectic fit is extremely hazardous. from the fact that cerebral apoplexy is due to diseased or weakened blood vessels, the animal remains subject to subsequent attacks. for this reason treatment is very unsatisfactory. compression of the brain. _causes._--in injuries from direct violence a piece of broken bone may press upon the brain, and, according to its size, the brain is robbed of its normal space within the cranium. it may also be due to an extravasation of blood or to exudation in the subdural or arachnoid spaces. death from active cerebral congestion results through compression. the occurrence may sometimes be traced to the direct cause, which will give assurance for the correct diagnosis. _symptoms._--impairment of all the special senses and localized paralysis. all the symptoms of lessened functional activity of the brain are manifested to some degree. the paralysis remains to be our guide for the location of the cause, for it will be found that the paralysis occurs on the opposite side of the body from the location of the injury, and the parts suffering paralysis will denote, to an expert veterinarian or physician, the part of the brain which is suffering compression. _treatment._--trephining, by a skillful operator, for the removal of the cause when due to depressed bone or the presence of foreign bodies. when the symptoms of compression follow other acute diseases of the brain, apoplectic fits, etc., the treatment must be such as the exigencies of the case demands. concussion of the brain. this is generally caused by falling over backward and striking the poll, or perhaps falling forward on the nose, by a blow on the head, etc. train accidents during shipping often cause concussion of the brain. _symptoms._--concussion of the brain is characterized by giddiness, stupor, insensibility, or loss of muscular power, succeeding immediately upon a blow or severe injury involving the cranium. the animal may rally quickly or not for hours; death may occur on the spot or after a few days. when there is only slight concussion or stunning, the animal soon recovers from the shock. when more severe, insensibility may be complete and continue for a considerable time; the animal lies as if in a deep sleep; the pupils are insensible to light; the pulse fluttering or feeble; the surface of the body cold, muscles relaxed, and the breathing scarcely perceptible. after a variable interval partial recovery may take place, which is marked by paralysis of some parts of the body, often of a limb, the lips, ear, etc. convalescence is usually tedious, and frequently permanent impairment of some organs remains. _pathology._--concussion produces laceration of the brain, or at least a jarring of the nervous elements, which, if not sufficiently severe to produce sudden death, may lead to softening or inflammation, with their respective symptoms of functional derangement. _treatment._--the first object in treatment will be to establish reaction or to arouse the feeble and weakening heart. this can often be accomplished by dashing cold water on the head and body of the animal; frequent injections of weak ammonia water, ginger tea, or oil and turpentine should be given per rectum. in the majority of cases this will soon bring the horse to a state of consciousness. in more severe cases mustard poultices should be applied along the spine and above the fetlocks. as soon as the animal gains partial consciousness stimulants, in the form of whisky or capsicum tea, should be given. owing to severity of the structural injury to the brain or the possible rupture of blood vessels and blood extravasation, the reaction may often be followed by encephalitis or cerebritis, and will then have to be treated accordingly. for this reason the stimulants should not be administered too freely, and they must be abandoned as soon as reaction is established. there is no need for further treatment unless complications develop as a secondary result. bleeding, which is so often practiced, proves almost invariably fatal in this form of brain affection. we should also remember that it is never safe to drench a horse with large quantities of medicine when he is unconscious, for he is very liable to draw the medicine into the lungs in inspiration. _prevention._--young horses, when harnessed or bitted for the first few times, should not have their heads checked high, for it frequently causes them to rear up, and, being unable to control their balance, they are liable to fall over sideways or backwards, thus causing brain concussion when they strike the ground. anemia of the brain. this is a physiological condition in sleep. it is considered a disease or may give rise to disease when the circulation and blood supply of the brain are interfered with. in some diseases of the heart the brain becomes anemic, and fainting fits occur, with temporary loss of consciousness. tumors growing within the cranium may press upon one or more arteries and stop the supply of blood to certain parts of the brain, thus inducing anemia, ultimately atrophy, softening, or suppuration. probably the most frequent cause is found in plugging, or occlusion, of the arteries by a blood clot. _symptoms._--imperfect vision, constantly dilated pupils, frequently a feeble and staggering gait, and occasionally cramps, convulsions, or epileptic fits occur. _pathology._--the exact opposite of cerebral hyperemia. the blood vessels are found empty, the membranes blanched, and the brain substance softened. _treatment._--removal of the remote cause when possible. general tonics, nutritious feed, rest, and removal from all causes of nervous excitement. hydrocephalus, or dropsy of the brain. this condition consists in an unnatural collection of fluid about or in the brain. depending upon the location of the fluid, we speak of external and internal hydrocephalus. external hydrocephalus is seen chiefly in young animals. it consists in a collection of fluid under the meninges, but outside the brain proper. this defect is usually congenital. it is accompanied with an enlargement of the skull, especially in the region of the forehead. the pressure of the fluid may cause the bones to soften. the disease is incurable and usually fatal. internal hydrocephalus is a disease of mature horses, and consists in the accumulation of an excessive quantity of fluid in the cavities or ventricles of the cerebrum. the cause of this accumulation may be a previous inflammation, a defect in the circulation of blood through the brain, heat stroke, overwork, excessive nutrition, or long-continued indigestion. common, heavy-headed draft horses are predisposed to this condition. _symptoms._--the symptoms are an expression of dullness and stupidity, and from their nature this disease is sometimes known as "dumminess" or "immobility." a horse so afflicted is called a "dummy." among the symptoms are loss of intelligence, stupid expression, poor memory, etc. the appetite is irregular; the horse may stop chewing with a wisp of hay protruding from his lips; he seems to forget that it is there. unnatural positions are sometimes assumed, the legs being placed in clumsy and unusual attitudes. such horses are difficult to drive, as they do not respond readily to the word, to pressure of the bit, or to the whip. gradually the pulse becomes weaker, respiration becomes faster, and the subject loses weight. occasionally there are periods of great excitement due to temporary congestion of the brain. at such times the horse becomes quite uncontrollable. a horse so afflicted is said to have "staggers." the outlook for recovery is not good. treatment is merely palliative. regular work or exercise and nutritious feed easy of digestion, with plenty of fresh water, are strongly indicated. intensive feeding should not be practiced. the bowels should be kept open by the use of appropriate diet or by the use of small regular doses of glauber's salt. tumors within the cranium. tumors within the cranial cavity and the brain occur not infrequently, and give rise to a variety of symptoms, imperfect control of voluntary movement, local paralysis, epilepsy, etc. among the more common tumors are the following: osseous tumors, growing from the walls of the cranium, are not very uncommon. dentigerous cysts, containing a formation identical to that of a tooth, growing from the temporal bone, sometimes are found lying loose within the cranium. tumors of the choroid plexus, known as brain sand, are frequently met with on post-mortem examinations, but seldom give rise to any appreciable symptoms during life. they are found in horses at all ages, and are slow of development. they are found in one or both of the lateral ventricles, enveloped in the folds of the choroid plexus. melanotic tumors have been found in the brain and meninges in the form of small, black nodules in gray horses, and in one instance are believed to have induced the condition known as stringhalt. fibrous tumors may develop within or from the meningeal structures of the brain. gliomatous tumor is a variety of sarcoma very rarely found in the structure of the cerebellum. treatment for tumors of the brain is impossible. spasms, or cramps. spasm is a marked symptom in many diseases of the brain and of the spinal cord. spasms may result from irritation of the motor nerves as conductors, or may result from irritation of any part of the sympathetic nervous system, and they usually indicate an excessive action of the reflex motor centers. spasms may be induced by various medicinal agents given in poisonous doses, or by effete materials in the circulation, such as nux vomica or its alkaloid strychnia, lead preparations, or an excess of the urea products in the circulation, etc. spasms may be divided into two classes: tonic spasm, when the cramp is continuous or results in persistent rigidity, as in tetanus; clonic spasm, when the cramping is of short duration, or is alternated with relaxations. spasms may affect involuntary as well as the voluntary muscles, the muscles of the glottis, intestines, and even the heart. they are always sudden in their development. _spasm of the glottis._--this is manifested by a strangling respiration; a wheezing noise is produced in the act of inspiration; extreme anxiety and suffering for want of air. the head is extended, the body profusely perspiring; pulse very rapid; soon great exhaustion becomes manifest; the mucous membranes become turgid and very dark colored, and the animal thus may suffocate in a short time. _spasm of the intestines._--(see "cramp colic," p. .) _spasm of the neck of the bladder._--this may be due to spinal irritation or a reflex from intestinal irritation, and is manifested by frequent but ineffectual attempts to urinate. _spasm of the diaphragm, or thumps._--spasmodic contraction of the diaphragm, the principal muscle used in respiration, is generally occasioned by extreme and prolonged speeding on the race track or road. the severe strain thus put upon this muscle finally induces irritation of the nerves controlling it, and the contractions become very forcible and violent, giving the jerking character known among horsemen as "thumps." this condition may be distinguished from violent beating of the heart by feeling the pulse beat at the angle of the jaw, and at the same time watching the jerking movement of the body, when it will be discovered that the two bear no relation to each other. (see "palpitation of the heart," p. .) _spasm of the thigh, or cramp of a hind limb._--this is frequently witnessed in horses that stand on sloping plank floors--generally in cold weather--or it may come on soon after severe exercise. it is probably due to an irritation of the nerves of the thigh. in cramps of the hind leg the limb becomes perfectly rigid, and attempts to flex are unsuccessful; the animal stands on the affected limb, but is unable to move it; it is unnaturally cold; it does not, however, appear to cause much suffering unless attempts are made to change position. this cramp may be of short duration--a few minutes--or it may persist for several days. this condition is often taken for a dislocation of the stifle joint. in the latter the foot is extended backward, and the horse is unable to advance it, but drags the limb. an examination of the joint also reveals a change in form. spasms may affect the eyelids, by closure or by retraction. spasm of the sterno-maxillaris muscle has been witnessed, and the animal was unable to close the jaws until the muscle became relaxed. _treatment of spasms._--an anodyne liniment, composed of chloroform part and soap liniment parts, applied to cramped muscles will usually cause relaxation. this may be used when single external muscles are affected. in spasms of the glottis, inhalation of sulphuric ether will give quick relief. in spasm of the diaphragm, rest and the administration of half an ounce of chloroform in ounces of whisky, with a pint of water added, will generally suffice to bring relief, or if this fails give grains of sulphate of morphia by hypodermic injection. if spasms result from organic disease of the nervous system, the latter should receive such treatment as its character demands. in cramp of the leg, compulsory movement usually causes relaxation very quickly; therefore the animal should be led out of the stable and be forced to run or trot. sudden, nervous excitement caused by a crack of the whip or smart blow will often bring about immediate relief. should this fail, the anodyne liniment may be used along the inside of the thigh, and chloroform, ether, or laudanum given internally. an ounce of the chloral hydrate will certainly relieve the spasm when given internally, but the cramp may return soon after the effect has passed off, which in many cases it does very quickly. _convulsions._--although there is no disease of the nervous system which can be properly termed convulsive, or justify the use of the word convulsion to indicate any particular disease, yet it is often such a prominent symptom that a few words may not be out of place. general, irregular muscular contractions of various parts of the body, with unconsciousness, characterize what we regard as convulsions, and like ordinary spasms are dependent upon some disease or irritation of the nervous structures, chiefly of the brain. no treatment is required; in fact, a general convulsion must necessarily be self-limited in its duration. suspending, as it does, respiratory movements, checking the oxygenation and decarbonization of the blood, the rapid accumulation of carbonic-acid gas in the blood and the exclusion of oxygen quickly puts the blood in a condition to produce the most reliable and speedy sedative effect upon the nerve excitability that could be found, and consequently furnishes its own remedy so far as the continuance of the convulsive paroxysm is concerned. whatever treatment is instituted must be directed toward a removal of the cause of the convulsive paroxysm. chorea, or st. vitus's dance. chorea is characterized by involuntary contractions of voluntary muscles. this disease is an obscure disorder, which may be from pressure upon a nerve, cerebral or spinal sclerosis, small aneurisms in the brain, etc. choreic symptoms have been produced by injecting granules of starch into the arteries entering the brain. epilepsy and other forms of convulsions simulate chorea in appearance. stringhalt is by some termed "chorea." this is manifested by a sudden jerking up of one or both hind legs when the animal is walking. this symptom may be very slight in some horses, but has a tendency to increase with age. in some the catching up of the affected leg is very violent, and when it is lowered to the ground the motion is equally sudden and forcible, striking the foot to the ground like a pile driver. very rarely chorea may be found to affect one of the fore legs, or the muscles of one side of the neck or the upper part of the neck. involuntary jerking of the muscles of the hip or thigh is seen occasionally, and is termed "shivering" by horsemen. chorea is often associated with a nervous disposition, and is not so frequent in animals with a sluggish temperament. the involuntary muscular contractions cause no pain, and do not appear to produce much exhaustion of the affected muscles, although the jerking may be regular and persistent whenever the animal is in motion. _treatment._--in a few cases, early in the appearance of this affection, general nerve tonics may be of benefit, viz, iodid of iron, dram; pulverized nux vomica, dram; pulverized scutellaria (skull-cap), ounce. mix and give in the feed once a day for two weeks. arsenic in the form of fowler's solution is often beneficial. if the cause is connected with organic brain lesions, treatment is usually unsuccessful. epilepsy, or falling fits. the cause of epilepsy is seldom traceable to any special brain lesions. in a few cases it accompanies disease of the pituitary body, which is located in the under surface of the brain. softening of the brain may give rise to this affection. attacks may occur only once or twice a year or they may be of frequent recurrence. _symptoms._--no premonitory symptoms precede an epileptic fit. the animal suddenly staggers; the muscles become cramped; the jaws may be spasmodically opened and closed, and the tongue become lacerated between the teeth; the animal foams at the mouth and falls in a spasm. the urine flows involuntarily, and the breathing may be temporarily arrested. the paroxysm soon passes off, and the animal gets on its feet in a few minutes after the return of consciousness. _treatment._--dashing cold water on the head during the paroxysm. after the recovery dram of oxid of zinc may be given in the feed twice a day for several weeks, or benefit may be derived from the tonic prescribed for chorea. paralysis, or palsy. paralysis is a weakness or cessation of the muscular contraction by diminution of loss of the conducting power or stimulation of the motor nerves. paralytic affections are of two kinds, the complete and the incomplete. the former includes those in which both motion and sensibility are affected; the latter those in which only one or the other is lost or diminished. paralysis may be general or partial. the latter is divided into hemiplegia and paraplegia. when only a small portion of the body is affected, as the face, a limb, the tail, it is designated by the term local paralysis. when the irritation extends from the periphery of the center it is termed reflex paralysis. causes are much varied. most of the acute affections of the brain and spinal cord may lead to paralysis. injuries, tumors, disease of the blood vessels of the brain, etc., all have a tendency to produce suspension of the conducting motive power to the muscular structures. pressure upon, or the severing of, a nerve causes a paralysis of the parts to which such a nerve is distributed. apoplexy may be termed a general paralysis, and in nonfatal attacks is a frequent cause of the various forms of palsy. general paralysis.--this can not take place without producing immediate death. the term is, however, usually applied to paralysis of the four extremities, whether any other portions of the body are involved or not. this form of palsy is due to compression of the brain by congestion of its vessels, large clot formation in apoplexy, concussion, or shock, or any disease in which the whole brain structure is involved in functional disturbance. hemiplegia (paralysis of one side or half of the body).--hemiplegia is frequently the result of a tumor in the lateral ventricles of the brain, softening of one hemisphere of the cerebrum, pressure from extravasated blood, fracture of the cranium, or it may be due to poisons in the blood or to reflex origin. when hemiplegia is due to or the result of a prior disease of the brain, especially of an inflammatory character, it is seldom complete; it may affect only one limb and one side of the head, neck, or muscles along the back, and may pass off in a few days after the disappearance of all the other evidences of the primary affection. in most cases, however, hemiplegia arises from emboli obstructing one or more blood vessels of the brain, or the rupture of some vessel the wall of which had become weakened by degeneration and the extravasation of blood. sensibility in most cases is not impaired, but in some there is a loss of sensibility as well as of motion. in some cases the bladder and rectum are involved in the paralysis. _symptoms._--in hemiplegia the attack may be very sudden, and the animal fall, powerless to move one side of the body; one side of the lips will be relaxed; the tongue may hang out on one side of the mouth; the tail curved around sideways; an inability to swallow feed or water may be present, and often the urine dribbles away as fast as it collects in the bladder. sensibility of the affected side may be entirely lost or only partial; the limbs may be cold and sometimes unnaturally warm. in cases wherein the attack is not so severe the animal may be able to maintain the standing position, but will have great difficulty in moving the affected side. in such cases the animal may recover from the disability. in the more severe, in which there is complete loss of power of movement, recoveries are rare. paraplegia (transverse paralysis of the hind extremities).--paralysis of the hind extremities is usually due to some injury or inflammation affecting the spinal cord. (see "spinal meningitis," p. , and "myelitis," p. .) it may also be due to a reflex irritation from disease of peripheral nerves, to spinal irritation or congestion caused by blood poisons, etc. _symptoms._--when due to mechanical injury of the spinal cord, from a broken back or spinal hemorrhage, it is generally progressive in its character, although it may be sudden. when it is caused by agents in the blood, it may be intermittent or recurrent. paraplegia is not difficult to recognize, for it is characterized by a weakness and imperfect control of the hind legs and powerless tail. the urine usually dribbles away as it is formed and the manure is pushed out, ball by ball, without any voluntary effort, or the passages may cease entirety. when paraplegia is complete, large and ill-conditioned sores soon form on the hips and thighs from chafing and bruising, which have a tendency quickly to weaken the animal and necessitate his destruction. locomotor ataxia, or incoordination of movement.--this is characterized by an inability to control properly the movement of the limbs. the animal appears usually perfectly healthy, but when he is led out of his stall his legs have a wobbly movement and he will stumble or stagger, especially in turning. when this is confined to the hind parts it may be termed a modified form of paraplegia, but often it may be seen to affect nearly all the voluntary muscles when they are called into play, and must be attributed to some pressure exerted on the base of the brain. local paralysis.--this is frequently met with in horses. it may affect many parts of the body, even vital organs, and it is very frequently overlooked in diagnosis. facial paralysis.--this is a frequent type of local paralysis, and is due to impairment of function of the motor nerve of the facial muscles, the portio dura. the cause may exist at the base of the brain, compression along its course after it leaves the medulla oblongata, or to a bruise after it spreads out on the great masseter muscle. _symptoms._--a flaccid condition of the cheek muscles, pendulous lips, inability to grasp the feed, often a slow and weak movement in chewing, and difficulty and slowness in drinking. laryngismus paralyticus, or roaring.--this condition is characterized by roaring, and is usually caused by an inflamed or hypertrophied bronchial gland pressing against the left recurrent laryngeal nerve, which interferes with its conducting power. a similar condition is occasionally induced in acute pleurisy, when the recurrent nerve becomes involved in the diseased process or compressed by plastic exudation. paralysis of the rectum and tail.--this is generally the result of a blow or fall on the rump, which causes a fracture of the sacrum bone and injury to the nerves supplying the tail and part of the rectum and muscles belonging thereto. this fracture would not be suspected were it not for the loss of motion of the tail. intestinal paralysis.--characterized by persistent constipation; frequently the strongest purgatives have no effect whatever on the movement of the bowels. in the absence of symptoms of indigestion, or special diseases implicating the intestinal canal, torpor of the bowels must be attributed to deficient innervation. this condition may depend upon brain affections or be due to reflex paralysis. sudden checks of perspiration may induce excessive action of the bowels or paralysis. paralysis of the bladder.--this usually affects the neck of the bladder, and is characterized by incontinence of urine; the urine dribbles away as fast as it is secreted. the cause may be of reflex origin, disease of the rectum, tumors growing within the pelvic cavity, injury to the spinal cord, etc. paralysis of the optic nerve (amaurosis).--a paralysis of eyesight may occur very suddenly from rupture of a blood vessel in the brain, acute local congestion of the brain, the administration of excessive doses of belladonna or its alkaloid atropia, etc. in amaurosis the pupil is dilated to its full extent; the eye looks clear, but does not respond to light. paralysis of hearing, of the external ear, of the eyelid, partial paralysis of the heart and organs of respiration, of the blood vessels from injury to the vasomotor nerves of the esophagus, or loss of deglutition, palsy of the stomach, all may be manifested when the supply of nervous influence is impaired or suspended. treatment for paralysis.--in all paralytic affections there may be anesthesia, or impairment of sensibility, in addition to the loss of motion, or there may be hyperesthesia, or increased sensibility, in connection with the loss of motion. these conditions may call for special treatment in addition to that for loss of motion. if hyperesthesia is well marked local anodynes may be needed to relieve suffering. chloroform liniment or hypodermic injections of from to grains of sulphate of morphia will allay local pain. if there is marked anesthesia, or loss of sensibility, it may become necessary to secure the animal in such way that he can not suffer serious injury from accidents which he can not avoid or feel. in the treatment of any form of paralysis we must always refer to the cause, and attempt its removal if it can be discovered. in cases in which the cause can not be determined we have to rely solely upon a general external and internal treatment. externally, fly blisters or strong, irritant liniments may be applied to the paralyzed parts. in hemiplegia they should be applied along the bony part of the side of the neck; in paraplegia, across the loins. in, some cases hot-water cloths will be beneficial. internally, it is well to administer dram of powdered nux vomica or grains of sulphate of strychnia twice a day until twitching of some of the voluntary muscles occurs; then discontinue it for several days, and then commence again with a smaller dose, gradually increasing it until twitching recurs. iodid of potassium in to dram doses two or three times daily may be used with the hope that it will favor the absorption of the clot or obstruction to the nervous current. in some cases fowler's solution of arsenic in teaspoonful doses twice a day in the drinking water proves beneficial. occasionally benefit may be derived from the application of the electric current, especially in cases of roaring, facial paralysis, paralysis of the eyelid, etc. nutritious but not too bulky feed, good ventilation, clean stabling, moderate exercise if the animal is capable of taking it, good grooming, etc., should be observed in all cases. spinal meningitis, or inflammation of the membranes enveloping the spinal cord. this may be induced by the irritant properties of blood poisons, exhaustion and exposure, spinal concussion, all forms of injury to the spine, tumors, caries of the vertebræ, rheumatism, etc. _symptoms._--a chill may be the precursor, a rise in temperature, or a general weakness and shifting of the legs. soon a painful, convulsive twitching of the muscles sets in, followed by muscular rigidity along the spine, in which condition the animal will move very stiffly and evince great pain in turning. evidences of paralysis or paraplegia develop, retention or incontinence of urine, and oftentimes sexual excitement is present. the presence of marked fever at the beginning of the attack, associated with spinal symptoms, should lead us to suspect spinal meningitis or myelitis. these two conditions usually appear together, or myelitis follows inflammation of the meninges so closely that it is almost impossible to separate the two; practically it does not matter much, for the treatment will be about the same in both cases. spinal meningitis generally becomes chronic, and is then marked principally by paralysis of that portion, or parts of it, posterior to the seat of the disease. _pathology._--in spinal meningitis we find essentially the same condition as in cerebral meningitis; there is an effusion of serum between the membranes, and often a plastic exudation firmly adherent to the pia mater serves to maintain a state of paralysis for a long time after the acute symptoms have disappeared by compressing the cord. finally, atrophy, softening, and even abscess may develop within the cord. unlike in man, it is usually found localized in horses. _treatment._--bags filled with ice should be applied along the spine, to be followed later by strong blisters. the fever should be controlled as early as possible by giving drops of norwood's tincture of veratrum viride every hour until the desired result is obtained. one dram of the fluid extract of belladonna, to control pain and vascular excitement of the spinal cord, may be given every five or six hours until the pupils of the eyes become pretty well dilated. if the pain is very intense grains of sulphate of morphia should be injected hypodermically. the animal must be kept as free from excitement as possible. if the urine is retained in the bladder it must be drawn off every four or six hours. in very acute attacks the disease generally proves fatal in a few days. if, however, the animal grows better, some form of paralysis is liable to remain for a long time, and the treatment will have to be directed then toward a removal of the exudative products and a strengthening of the system and stimulation of the nervous functions. to induce absorption, iodid of potassium in -dram doses, dissolved in the drinking water, may be given twice a day. to strengthen the system, iodid of iron dram twice a day and dram of nux vomica once a day may be given in the feed. electricity to the paralyzed and weakened muscles is advisable; the current should be weak, but be continued for half an hour two or three times daily. if the disease is due to a broken back, caries of the vertebræ, or some other irremediable cause, the animal should be destroyed at once. myelitis, or inflammation of the substance of the spinal cord. this is a rare disease, except as a secondary result of spinal meningitis or injuries to the spine. poisoning by lead, arsenic, mercury, phosphorus, carbonic-acid gas, etc., has been known to produce it. myelitis may be confined to a small spot in the cord or may involve the whole for a variable distance. it may lead to softening abscess or degeneration. _symptoms._--the attack may begin with a chill or convulsion; the muscles twitch or become cramped very early in the disease, and the bladder usually is affected at the outset, in which there may be either retention or incontinence of urine. these conditions are followed by complete or partial paralysis of the muscles posterior to the locality of the inflamed cord, and the muscles begin to waste away rapidly. the paralyzed limb becomes cold and dry, due to the suspension of proper circulation; the joints may swell and become edematous; vesicular eruptions appear on the skin; and frequently gangrenous sloughs form on the paralyzed parts. it is exceedingly seldom that recovery takes place. in a few instances it may assume a chronic type, when all the symptoms become mitigated, and thus continue for some time, until septicemia, pyemia, or exhaustion causes death. _pathology._--the inflammation may involve nearly the whole length of the cord, but generally it is more intense in some places than others; when due to mechanical injury, the inflammation may remain confined to a small section. the cord is swollen and congested, reddened, often softened and infiltrated with pus cells, and the nerve elements are degenerated. _treatment._--similar to that of spinal meningitis. spinal congestion. this condition consists in an excess of blood. as the blood vessels of the pia mater are the principal source of supply to the spinal cord, hyperemia of the cord and of the meninges usually go together. the symptoms are, therefore, closely allied to those of spinal meningitis and congestion. when the pia mater is diseased, the spinal cord is almost invariably affected also. _cause._--sudden checking of the perspiration, violent exercise, blows, and falls. _symptoms._--the symptoms may vary somewhat with each case, and closely resemble the first symptoms of spinal meningitis, spinal tumors, and myelitis. first, some disturbance in movement, lowering the temperature, and partial loss of sensibility posterior to the seat of the congestion. if in the cervical region, it may cause interference in breathing and the action of the heart. when in the region of the loins, there may be loss of control of the bladder. when the congestion is sufficient to produce compression of the cord, paraplegia may be complete. usually fever, spasms, muscular twitching, or muscular rigidity are absent, which will serve to distinguish spinal congestion from spinal meningitis. _treatment._--hot-water applications to the spine, -dram doses fluid extract of belladonna repeated every four hours, and tincture of aconite root drops every hour until the symptoms become ameliorated. if no inflammatory products occur, the animal is likely to recover. spinal anemia. this may be caused by extreme cold, exhausting diseases, spinal embolism or plugging of a spinal blood vessel, an interference with the circulation through the abdominal aorta, from compression, thrombosis, or aneurism of that vessel; the spinal vessels may be caused to contract through vasomotor influence, a result of peripheral irritation of some nerve. spinal anemia causes paralysis of the muscles used in extending the limbs. when the bladder is affected, it precedes the weakness of motion, while in spinal congestion it follows, and increased sensibility, in place of diminished sensibility, as in spinal congestion, is observed. pressure along the spine causes excessive pain. if the exciting cause can be removed, the animal recovers; if this fails, the spinal cord may undergo softening. spinal compression. when caused by tumors or otherwise, when pressure is slight, it produces a paralysis of the muscles used in extending a limb and contraction of those which flex it. when compression is great it causes complete loss of sensibility and motion posterior to the compressed part of the cord. compression of a lateral half of the cord produces motor paralysis, disturbance of the circulation, and difficulty of movement, an increased sensibility on the side corresponding to the compressed section, and a diminished sensibility and some paralysis on the opposite side. _treatment._--when it occurs as a sequence of a preceding inflammatory disease, iodid of potassium and general tonics are indicated. when due to tumors growing within the spinal canal, or to pressure from displaced bone, no form of treatment will result in any benefit. spinal hemorrhage. this may occur from changes in the wall of the blood vessels, in connection with tumors, acute myelitis, traumatic injuries, etc. the blood may escape through the pia mater into the subarachnoid cavity, and large clots be formed. _symptoms._--the symptoms are largely dependent upon the seat and extent of the hemorrhage, as they are principally owing to the compression of the cord. a large clot may produce sudden paraplegia, accompanied with severe pain along the spine; usually, however, the paralysis of both motion and sensation is not very marked at first; on the second or third day fever is liable to appear, and increased or diminished sensibility along the spine posterior to the seat of the clot. when the bladder and rectum are involved in the symptoms it indicates that the spinal cord is compressed. _treatment._--in the occurrence of injuries to the back of a horse, whenever there is any evidence of paralysis, it is always advisable to apply bags of ice along the spine to check or prevent hemorrhage or congestion, and drams of the fluid extract of ergot and drops of tincture of digitalis may be given every hour until three doses have been taken. subsequently tincture of belladonna in half-ounce doses may be given three times a day. if there is much pain, grains of sulphate of morphia, injected under the skin, will afford relief and lessen the excitability of the animal. in all cases the animal should be kept perfectly quiet. spinal concussion. this is rarely observed in the horse, and unless it is sufficiently severe to produce well-marked symptoms it would not be suspected. it may occur in saddle horses from jumping, or it may be produced by falling over an embankment, or a violent fall upon the haunches may produce it. concussion may be followed by partial paralysis or spinal hemorrhage; generally, however, it is confined to a jarring and some disturbance of the nerve elements of the cord, and the paralytic effect which ensues soon passes off. treatment consists in rest until the animal has completely recovered from the shock. if secondary effects follow from hemorrhage or compression, they have to be treated as heretofore directed. spinal tumors. within the substance of the cord glioma or the mixed gliosarcomata are found to be the most frequent, tumors may form from the meninges and the vertebræ, being of a fibrous or bony nature, and affect the spinal cord indirectly by compression. in the meninges we may find glioma, cancers, and psammoma, fibromata; aneurisms of the spinal arteries have been discovered in the spinal canal. _symptoms._--tumors of the spinal canal cause symptoms of spinal irritation or compression of the cord. the gradual and slow development of symptoms of paralysis of one or both hind limbs or certain muscles may lead to a suspicion of spinal tumors. the paralysis induced is progressive, but not usually marked with atrophy of the muscles or increased sensibility along the spine. when the tumor is within the spinal cord itself all the symptoms of myelitis may be present. _treatment._--general tonics and -dram doses of nux vomica may be given; iodid of iron or iodid of potassium in -dram doses, three times a day in feed, may, in a very few cases, give some temporary benefit. usually the disease progresses steadily until it proves fatal. neuritis, or inflammation of a nerve. this is caused by a bruise or wound of a nerve or by strangulation in a ligature when the nerve is included in the ligation of an artery. the changes in an inflamed nerve are an enlargement, reddening of the nerve sheath, spots of extravasated blood, and sometimes an infiltration of serum mixed with pus. _symptoms._--acute pain of the parts supplied by the nerve and absence of swelling or increased heat of the part. _treatment._--hypodermic injections of from to grains of morphia to relieve pain, hot fomentations, and rest. if it is due to an inclusion of a ligature, the nerve should be divided above and below the ligature. neuroma, or tumor of a nerve. neuroma may be from enlargement of the end of a divided nerve or due to fibrous degeneration of a nerve which has been bruised or wounded. its most frequent occurrence is found after the operation of neurotomy for foot lameness, and it may appear after the lapse of months or even years. neuroma usually develops within the sheath of the nerve with or without implicating the nerve fibers. it is oval, running lengthwise with the direction of the nerve. _symptoms._--pain of the affected limb or part is manifested, more especially after resting a while, and when pressure is made upon the tumor it causes extreme suffering. _treatment._--excision of the tumor, including part of the nerve above and below, and then treat it like any other simple wound. injuries to nerves. these may consist in wounding, bruising, laceration, stretching, compression, etc. the symptoms which are produced will depend upon the extent, seat, and character of the injury. recovery may quickly take place, or it may lead to neuritis, neuroma, or spinal or cerebral irritation, which may result in tetanus, paralysis, and other serious derangements. in all diseases, whether produced by some form of external violence or intrinsic causes, the nerves are necessarily involved, and sometimes it is to a primary injury of them that the principal fault in movement or change of nutrition of a part is due. it is often difficult or impossible to discover that an injury to a nerve has been inflicted, but whenever this is possible it may enable us to remedy that which otherwise would result in permanent evil. treatment should consist in relieving compression, in hot fomentations, the application of anodyne liniments, excision of the injured part, and rest. forage poisoning, or so-called cerebrospinal meningitis. this disease prevails among horses in nearly all parts of the united states. its appearance in america is by no means of recent occurrence, for the malady was reported by large in , by michener in , and by liautard in as appearing in both sporadic and enzootic form in several of the eastern states. since then the disease has occurred periodically in many states in all sections of the country, and has been the subject of numerous investigations and publications by a number of the leading men of the veterinary profession. it is prevalent with more or less severity every year in certain parts of the united states, and during the year the bureau of animal industry received urgent requests for help from colorado, georgia, iowa, kansas, kentucky, louisiana, maryland, missouri, nebraska, new jersey, north carolina, oregon, south carolina, south dakota, virginia, and west virginia. while in the brunt of the disease seemed to fall on kansas and nebraska, other states were also seriously afflicted. in previous years, for instance in , as well as in , the horses of southeastern texas were reported to have died by the thousand, and in the following year the horses of iowa were said to have "died like rats." however, kansas seems to have had more than her share of this trouble, as a severe outbreak that extended over almost the entire state occurred in , while in and again in the disease recurred with equal severity in various portions of the state. this condition consists in a poisoning and depression of the nervous system from eating or drinking feed or water containing poison generated by mold or bacteria. it has been shown to be owing to eating damaged ensilage, corn, brewers' grains, oats, etc., or to drinking stagnant pond water or water from a well contaminated by surface drainage. horses at pasture may contract the disease when the growth of grass is so profuse that it mats together and the lower part dies and ferments or becomes moldy. in england a similar disease has been called "grass staggers," due to eating rye grass when it is ripening or when it is cut and eaten while it is heating and undergoing fermentation. in eastern pennsylvania it was formerly known by the name of "putrid sore throat" and "choking distemper." a disease similar in many respects which is very prevalent in virgina, especially along the eastern border, is commonly known by the name of "blind staggers," and in many of the southern states this has been attributed to the consumption of worm-eaten, corn. horses of all ages and mules are subject to this disease. _symptoms and lesions._--the symptoms which typify sporadic or epidemic cerebrospinal meningitis in man are not witnessed among horses, namely, excessive pain, high fever, and early muscular rigidity. in the recognition of the severity of the attack we may divide the symptoms into three grades. in the most rapidly fatal attacks the animal may first indicate it by weak, staggering gait, partial or total inability to swallow solids or liquids, impairment of eyesight; twitching of the muscles and slight cramps may be observed. as a rule, the temperature is not elevated--indeed, it is sometimes below normal. this is soon followed by a paralysis of the whole body, inability to stand, delirium in which the animal sometimes goes through a series of automatic movements as if trotting or running; the delirium may become very violent and the unconscious animal may bruise his head very seriously in his struggles; but usually a deep coma renders him quiet until he expires. death in these cases usually takes place in from to hours from the time the first symptoms become manifest. the pulse is variable during the progress of the disease; it may be almost imperceptible at times, and then again very rapid and irregular; the respirations generally are quick and catching. in the next form in which this disease may develop it first becomes manifest by a difficulty in swallowing and slowness in mastication, and a weakness which may be first noticed in the strength of the tail; the animal will be unable to switch it or to offer resistance when we bend it up over the croup. the pulse is often a little slower than normal. there is no evidence of pain; the respirations are unchanged, and the temperature little less than normal; the bowels may be somewhat constipated. these symptoms may remain unchanged for two or three days and then gradual improvement may take place, or the power to swallow may become entirely lost and the weakness and uncertainty in gait more and more perceptible; then sleepiness or coma may appear; the pulse becomes depressed, slow, and weak, the breathing stertorous, and paroxysms of delirium develop, with inability to stand, and some rigidity of the spinal muscles or partial cramp of the neck and jaws. in such cases death may occur in from to days from the commencement of the attack. in many cases there is no evidence of pain, spasm, or fever at any time during the progress of the disease, and finally profound coma develops and death follows, painless and without a struggle. in the last or mildest form the inability of voluntary control of the limbs becomes but slightly marked, the power of swallowing never entirely lost, and the animal has no fever, pain, or unconscious movements. generally the animal will begin to improve about the fourth day and recovers. in a few cases the spinal symptoms, manifested by paraplegia, may be the most prominent symptoms; in others they may be altogether absent and the main symptoms may be difficulty in mastication and swallowing; rarely it may affect one limb only. in all cases in which coma remains absent for six or seven days the animal is likely to recover. when changes toward recovery take place, the symptoms usually leave in the reverse order to that in which they developed, but local paralysis may remain for some time, rarely persistent. on post-mortem the number of lesions observable to the naked eye is in marked contrast to the severity of the symptoms noted. the pharynx and larynx are inflamed in many cases, and sometimes coated with a yellowish-white glutinous deposit, extending at times over the tongue and occasionally a little way down the trachea. the lungs are normal, except from complications following drenching or recumbence for a long period. the heart is usually normal in appearance, except an occasional cluster of hemorrhagic points on the outer surface, while the blood is dark and firmly coagulated. the lining of the stomach indicates a subacute gastritis, while occasionally an erosion is noted. an edema is observed in the submucosa of such cases. the first few inches of the small intestines likewise may show slight inflammation in certain cases, while in others it is quite severe; otherwise the digestive tract appears normal, excluding the presence of varying numbers of bots, _strongylus vulgatus_, and a few other nematodes. the liver is congested and swollen in some cases, while it appears normal in others. the spleen is, as a rule, normal, and at times the kidneys are slightly congested. the bladder is often distended with dark-colored urine, and occasionally a marked cystitis has been observed. the adipose tissue throughout the carcass may show a pronounced icteric appearance in certain cases. on removing the bones of the skull the brain appears to be normal macroscopically in a few instances, but in most cases the veins and capillaries of the meninges of the cerebrum, cerebellum, and occasionally the medulla is distinctly dilated and engorged, and in a few cases there are pronounced lesions of a leptomeningitis. an excessive quantity of cerebrospinal fluid is present in most of the cases. on the floor of the lateral ventricles of several brains there was noted a slight softening caused by hemorrhages into the brain substance. there is always an abundance of fluid in the subarachnoid spaces, ventricles, and at the base of the brain, usually of the color of diabetic urine, and containing a limited number of flocculi, but in a few cases it was slightly blood tinged. the spinal cord was not found involved in the few cases examined. _treatment._--one attack of the disease does not confer immunity. horses have been observed which have recovered from two attacks, and still others that recovered from the first but died as a result of the second attack. inasmuch as a natural immunity does not appear after an attack of cerebrospinal meningitis, it might be anticipated that serum of recovered cases would possess neither curative nor prophylactic qualities. nevertheless, experiments have been made along these lines with serum from recovered cases, but without any positive results. similar investigations have been conducted by others in europe with precisely the same results. with the tendency of the disease to produce pathological lesions in the central nervous system, it seems scarcely imaginable that a medicinal remedy will be found to heal these foci, and even when recovery takes place considerable disturbance in the functions, as blindness, partial paralysis, dumbness, etc., is liable to remain. indeed, when the disease once becomes established in an animal, drugs seem to lose their physiological action. therefore, with all the previously mentioned facts before us, it is evident that the first principle in the treatment of this disease is prevention, which consists in the exercise of proper care in feeding only clean, well-cured forage and grain and pure water. these measures when faithfully carried out check the development of additional cases of the disease upon the affected premises. while medicinal treatment has proved unsatisfactory in most cases, nevertheless the first indication is to clean out the digestive tract thoroughly, and to accomplish this prompt measures must be used early in the disease. active and concentrated remedies should be given, preferably subcutaneously or intravenously, owing to the great difficulty in swallowing, even in the early stage. arecolin in one-half grain doses, subcutaneously, has given as much satisfaction as any other drug. after purging the animal the treatment is mostly symptomatic. intestinal disinfectants, particularly calomel, salol, and salicylic acid, have been recommended, and mild, antiseptic mouth washes are advisable. antipyretics are of doubtful value, as better results are obtained, if the temperature is high, by copious cold-water injections. an ice pack applied to the head is beneficial in case of marked psychic disturbance. one-ounce doses of chloral hydrate per rectum should be given if the patient is violent or if muscular spasms are severe. if the temperature becomes subnormal, the animal should be warmly blanketed, and if much weakness is shown this should be combated with stimulants, such as strychnin, camphor, alcohol, atropin, or aromatic spirits of ammonia. early in the disease urotropin (hexamethylenamin) in doses of grains, dissolved in water and given by the mouth every two hours, appeared to have been responsible for the recovery of some cases of the malady. during convalescence tonic treatment is indicated. _hygienic measures needful._--whenever this disease appears in a stable all the animals should be removed as soon as possible. they should be provided with clean, well-ventilated, and well-drained stables, and each animal should receive a laxative and be fed feed and given water from a new, clean source. the abandoned stable should be thoroughly cleansed from all waste matters, receive a coat of whitewash containing ounces of carbolic acid to the gallon of water and should have time to dry thoroughly before the horses are replaced. a complete change of feed is of the very greatest importance on account of the belief that the cause resides in diseased grain, hay, and grass. tetanus, or lockjaw. this disease is characterized by spasms affecting the muscles of the face, neck, body, and limbs and of all muscles supplied by the cerebrospinal nerves. the spasms or muscular contractions are rigid and persistent, yet mixed with occasional more intense contractions of convulsive violence. _causes._--this disease is caused by a bacillus that is often found in the soil, in manure, and in dust. this germ forms spores at the end of the organism and grows only in the absence of oxygen. it produces a powerful nerve poison, which causes the symptoms of tetanus. the germ itself multiplies at the point where it is introduced, but its poison is absorbed and is carried by the blood to all parts of the body, and thus the nervous system is poisoned. deep wounds infected by this germ are more dangerous than superficial wounds, because in them the germ is more remote from the oxygen of the air. hence, nail pricks, etc., are especially dangerous. in the majority of instances the cause of tetanus can be traced to wounds, especially pricks and wounds of the feet or of tendinous structures. it sometimes follows castration, docking, the introduction of setons, inclusion of a nerve in a ligature, etc. it may come on a long time after the wound is healed--three or four months. horses with a nervous, excitable disposition are more predisposed than those of a more sluggish nature. stallions are more subject to develop tetanus as the result of wounds than geldings, and geldings more than mares. _symptoms._--the attacks may be acute or subacute. in an acute attack the animal usually dies within four days. the first symptoms which attract the attention of the owner is difficulty in chewing and swallowing, an extension of the head and protrusion over the inner part of the eye of the membrana nictitans, or haw. an examination of the mouth will reveal an inability to open the jaws to their full extent, and the endeavor to do so will produce great nervous excitability and increased spasm of the muscles of the jaw and neck. the muscles of the neck and along the spine become rigid and the legs are moved in a stiff manner. the slightest noise or disturbance throws the animal into increased spasm of all the affected muscles. the tail is usually elevated and held immovable; the bowels become constipated early in the attack. the temperature and pulse are not much changed. these symptoms in the acute type become rapidly aggravated until all the muscles are rigid--in a state of tonic spasm--with a continuous tremor running through them; a cold perspiration breaks out on the body; the breathing becomes painful from the spasm of the muscles used in respiration; the jaws are completely set, eyeballs retracted, lips drawn tightly over the teeth, nostrils dilated, and the animal presents a picture of the most extreme agony until death relieves him. the pulse, which at first was not much affected, will become quick and hard, or small and thready when the spasm affects the muscles of the heart. in the subacute cases the jaws may never become entirely locked; the nervous excitability and rigidity of the muscles are not so great. there is, however, always some stiffness of the neck or spine manifest in turning; the haw is turned over the eyeball when the nose is elevated. it is not uncommon for owners to continue such animals at their work for several days after the first symptoms have been observed. all the symptoms may gradually increase in severity for a period of ten days, and then gradually diminish under judicious treatment, or they may reach the stage wherein all the characteristics of acute tetanus become developed. in some cases, however, we find the muscular cramps almost solely confined to the head or face, perhaps involving those of the neck. in such cases we have complete trismus (lockjaw), and all the head symptoms are acutely developed. on the contrary, we may find the head almost exempt in some cases, and have the body and limbs perfectly rigid and incapable of movement without falling. tetanus may possibly be confounded with spinal meningitis, but the character of the spasm-locked jaw, retraction of the eyeballs, the difficulty in swallowing due to spasms of the muscles of the pharynx, and above all, the absence of paralysis, should serve to make the distinction. _prevention._--when a valuable horse has sustained a wound that it is feared may be followed by tetanus, it is well to administer a dose of tetanus antitoxin. this is injected beneath the skin with a hypodermic syringe. a very high degree of protection may in this way be afforded. this antitoxin should be administered only by a competent veterinarian. _treatment._--the animal should be placed in a box stall without bedding, as far as possible from other horses. if in a country district, the animal should be put into an outbuilding or shed, where the noise of other animals will not reach it; if the place is moderately dark, it is all the better; in fly time it should be covered with a light sheet. the attendant must be very careful and quiet to prevent all unnecessary excitement and increase of spasm. tetanus antitoxin appears to be useful as a remedy in some cases, if given in very large quantities early in the disease; otherwise it is useless. subcutaneous injections of carbolic acid in glycerin and water (carbolic acid grains, glycerin and water each ounce) appear to be useful in some cases. injections should be given twice daily. a cathartic, composed of barbados aloes to drams, with which may be mixed drams of the solid extract of belladonna, should be given at once. this is best given in a ball form; if, however, the animal is greatly excited by the attempt or can not swallow, the ball may be dissolved in ounces of olive oil and thrown on the back of the tongue with a syringe. if the jaws are set, or nearly so, an attempt to administer medicine by the mouth should not be made. in such cases one-quarter of a grain of atropia, with grains of sulphate of morphia, should be dissolved in dram of pure water and injected under the skin. this should be repeated sufficiently often to keep the animal continually under its effect. this will usually mitigate the severity of the spasmodic contraction of the affected muscles and lessen sensibility to pain. good results may be obtained sometimes by the rectal injection of the fluid extract of belladonna and of cannabis indica, of each dram, every four or six hours. this may be diluted with a quart of milk. when the animal is unable to swallow liquids, oatmeal gruel and milk should be given by injection per rectum to sustain the strength of the animal. a pailful of cool water should be constantly before him, placed high enough for him to reach it without special effort; even if drinking is impossible, the laving of the mouth is refreshing. excellent success frequently may be obtained by clothing the upper part of the head, the neck, and greater part of the body in woolen blankets kept saturated with very warm water. this treatment should be continued for six or eight hours at a time. it often relaxes the cramped muscles and gives them rest and the animal almost entire freedom from pain; but it should be used every day until the acute spasms have permanently subsided in order to be of any lasting benefit. recently subcutaneous injections of brain emulsion have been recommended. it is thought that the tetanus toxin will attach itself to the brain cells so injected and thus free the system of this poison. when it is due to a wound, the wound should be thoroughly cleaned and disinfected with carbolic acid. if from a wound which has healed, an excision of the cicatrix may be beneficial. in all cases it is not uncommon to have a partial recovery followed by relapse when the animal becomes excited from any cause. rabies, hydrophobia, or madness. this disease does not arise spontaneously among horses, but is the result of a bite from a rabid animal--generally a dog or cat. the development of the disease follows the bite in from three weeks to three months--very rarely in two weeks. (see also p. .) _symptoms._--the first manifestation of the development of this disease may be an increased excitability and viciousness; very slight noises or the approach of a person incites the animal to kick, strike, or bite at any near object. very often the horse will bite his own limbs or sides, lacerating the flesh and tearing the skin. the eyes appear staring, bloodshot; the ears are on the alert to catch all sounds; the head is held erect. in some cases the animal will continually rub and bite the locality of the wound inflicted by the rabid animal. this symptom may precede all others. generally the bowels become constipated and the animal makes frequent attempts at urination, which is painful, and the urine very dark colored. the furious symptoms appear in paroxysms; at other times the animal may eat and drink, although swallowing appears to become painful toward the latter stage of the disease, and may cause renewed paroxysms. the muscles of the limbs or back may be subject to intermittent spasms, or spasmodic tremors; finally, the hind limbs become paralyzed, breathing very difficult, and convulsions supervene, followed by death. the pulse and respirations are increased in frequency from the outset of the attack. rabies may possibly be mistaken for tetanus. in the latter disease we find tonic spasms of the muscles of the jaws, or stiffness of the neck or back very early in the attack, and evidence of viciousness is absent. _treatment._--as soon as the true nature of the disease is ascertained the animal should be killed. _prevention._--when a horse is known to have been bitten by a rabid animal, immediate cauterization of the wound with a red-hot iron may possibly destroy the virus before absorption of it takes place. plumbism, or lead poisoning. this disease is not of frequent occurrence. it may be due to the habitual drinking of water which has been standing in leaden conductors or in old paint barrels, etc. it has been met with in enzootic form near smelting works, where, by the fumes arising from the works, lead in the form of oxid, carbonate, or sulphate was deposited on the grass and herbage which the horses ate. _symptoms._--lead poisoning produces derangement of the functions of digestion and locomotion, or it may affect the lungs principally. in whatever system of organs the lead is mostly deposited there we have the symptoms of nervous debility most manifest. if in the lungs, the breathing becomes difficult and the animal gets out of breath very quickly when compelled to run. roaring, also, is very frequently a symptom of lead poisoning. when it affects the stomach, the animal gradually falls away in flesh, the hair becomes rough, the skin tight, and colicky symptoms develop. when the deposit is principally in the muscles, partial or complete paralysis gradually develops. when large quantities of lead have been taken in and absorbed, symptoms resembling epilepsy may result, or coma and delirium develop and prove fatal. in lead poisoning there is seldom any increase in temperature. a blue line forms along the gums of the front teeth, and the breath assumes a peculiarly offensive odor. lead can always be detected in the urine by chemical tests. _treatment._--the administration of -dram doses of iodid of potassium three times a day is indicated. this will form iodid of lead in the system, which is rapidly excreted by the kidneys. if much muscular weakness or paralysis is present, sulphate of iron in -dram doses and strychnia in -grain doses may be given twice a day. in all cases of suspected lead poisoning all utensils which have entered into the supply of feed or water should be examined for the presence of soluble lead. if it occurs near lead works, great care must be given to the supply of uncontaminated fodder, etc. uremia. uremic poisoning may affect the brain in nephritis, acute albuminuria, or when, from any cause, the functions of the kidneys become impaired or suppressed and urea (a natural product) is no longer eliminated from these organs, causing it to accumulate in the system and give rise to uremic poisoning. uremic poisoning is usually preceded by dropsy of the limbs or abdomen; a peculiar, fetid breath is often noticed; then drowsiness, attacks of diarrhea, and general debility ensue. suddenly extreme stupor or coma develops; the surface of the body becomes cold; the pupils are insensible to light; the pulse slow and intermitting; the breathing labored, and death supervenes. the temperature throughout the disease is seldom increased, unless the disease becomes complicated with acute, inflammatory disease of the brain or respiratory organs, which often occur as a result of the urea in the circulation. albumen and tube casts may frequently be found in the urine. the disease almost invariably proves fatal. treatment must be directed to a removal of the cause. electric shock. electric shock, from coming in contact with electric wires, is becoming a matter of rather frequent occurrence, and has a similar effect upon the animal system as a shock from lightning. two degrees of electric or lightning shock may be observed, one producing temporary contraction of muscles and insensibility, from which recovery is possible, the other killing directly, by producing a condition of nervous and general insensibility. in shocks which are not immediately fatal the animal is usually insensible, the respiration slow, labored, or gasping, the pulse slow, feeble, and irregular, and the pupils dilated and not sensitive, or they may be contracted and sensitive. the temperature is lowered. there may be a tendency to convulsions or spasms. the predominating symptoms are extreme cardiac and respiratory depression. _treatment._--sulphate of atropia should be given hypodermically in one-quarter grain doses every hour or two hours until the heart beats are invigorated, the number and fullness of the respirations increased, and consciousness returns. stimulating injections per rectum may also be useful in arousing the circulation; for this purpose whisky or ammonia water may be used. diseases of the heart, blood vessels, and lymphatics. by m. r. trumbower, v. s. [revised by leonard pearson, b. s., v. m. d.] anatomy and physiology of the heart and blood vessels. (pls. xx and xxi.) the heart is a hollow, muscular organ, situated a little to the left of the center of the chest. its impulse is felt on the left side on account of its location and from the rotary movement of the organ in action. it is cone-shaped, with the base upward; the apex points downward, backward, and to the left side. it extends from about the third to the sixth ribs, inclusive. the average weight is about to pounds. in horses used for speed the heart is relatively larger, according to the weight of the animal, than in horses used for slow work. it is suspended from the spine by the large blood vessels and held in position below by the attachment of the pericardium to the sternum. it is inclosed in a sac, the pericardium, which is composed of a dense fibrous membrane lined by a delicate serous membrane, which is reflected over the heart; the inner layer is firmly adherent to the heart, the outer to the fibrous sac, and there is an intervening space, known as the pericardial space, in which a small amount of serum--a thin translucent liquid--is present constantly. the heart is divided by a shallow fissure into a right and left side; each of these is again subdivided by a transverse partition into two compartments which communicate. thus there are four cardiac cavities--the superior, or upper, ones called the auricles; the inferior, or lower, ones the ventricles. these divisions are marked on the outside by grooves, which contain the cardiac blood vessels, and are generally filled with fat. the right side of the heart may be called the venous side, the left the arterial side, named from the kind of blood which passes through them. the auricles are thin-walled cavities placed at the base, and are connected with the great veins--the venæ cavæ and pulmonary veins--through which they receive blood from all parts of the body. the auricles communicate with the ventricles each by a large aperture, the auriculo-ventricular orifice, which is furnished with a remarkable mechanism of valves, allowing the transmission of blood from the auricles into the ventricles, but preventing a reverse course. the ventricles are thick-walled cavities, forming the more massive portion of the heart toward the apex. they are separated by a partition, and are connected with the great arteries--the pulmonary artery and the aorta--by which they send blood to all parts of the body. at the mouth of the aorta and at the mouth of the pulmonary artery is an arrangement of valves in each case which prevents the reflux of blood into the ventricles. the auriculo-ventricular valve in the left side is composed of two flaps, hence it is called the bicuspid valve; in the right side this valve has three flaps and is called the tricuspid valve. the flaps which form these valves are connected with a tendinous ring between the auricles and ventricles; and each flap of the auriculo-ventricular valves is supplied with tendinous cords, which are attached to the free margin and under-surface, so as to keep the valves tense when closed--a condition which is produced by the shortening of muscular pillars with which the cords are connected. the arterial openings, both on the right and on the left side, are provided with three-flapped semilunar-shaped valves, to prevent the regurgitation of blood when the ventricles contract. the veins emptying into the auricles are not capable of closure, but the posterior vena cava has an imperfect valve at its aperture. the inner surface of the heart is lined by a serous membrane, the endocardium, which is smooth and firmly adherent to the muscular structure of the heart. this membrane is continuous with the lining membrane of the blood vessels, and it enters into the formation of the valves. the circulation through the heart is as follows: the venous blood is carried into the right auricle by the anterior and posterior venæ cavæ. it then passes through the right auriculo-ventricular opening into the right ventricle, thence through the pulmonary artery to the lungs. it returns by the pulmonary veins to the left auricle, then is forced through the auriculo-ventricular opening into the left ventricle, which propels it through the aorta and its branches into the system, the veins returning it again to the heart. the circulation, therefore, is double, the pulmonary, or lesser, being performed by the right side, and the systemic, or greater, by the left side. as the blood is forced through the heart by forcible contractions of its muscular walls, it has the action of a force pump, and gives the impulse at each beat, which we call the pulse--the dilatation of the arteries throughout the system. the contraction of the auricles is quickly followed by that of the ventricles, and then a slight pause occurs; this takes place in regular rhythmical order during health. [illustration: plate xx. interior of chest showing position of heart and diaphragm.] [illustration: plate xxi. heart. right half, red. left half, blue. auricles, at upper end. ventricles, at lower end. arteries, red. veins, blue. . left carotid artery. . left jugular vein. . portal system. . vessels of the liver. . arteries of the stomach. (cæliac axis). . vessels of the large intestine. . vessels of the small intestine. . artery of left kidney. circulatory apparatus.] the action of the heart is governed and maintained by the pneumogastric nerve (tenth pair of cranial nerves); it is the inhibitory nerve of the heart, and regulates, slows, and governs its action. when the nerve is cut, the heartbeats increase rapidly, and, in fact, the organ works without control. when the nerve is unduly irritated the holdback, or inhibitory force, is increased, and the heart slows up in the same measure. the left cavities of the heart, the pulmonary veins, and the aorta, or systemic artery, contain red or florid blood, fit to circulate through the body. the right cavities of the heart, with the venæ cavæ, or systemic veins, the pulmonary artery, contain dark blood, which must be transmitted through the lungs for renovation. the arteries, commencing in two great trunks, the aorta and the pulmonary artery, undergo division, as in the branching of a tree. their branches mostly come off at acute angles, and are commonly of uniform diameter in each case, but successively diminish after and in consequence of division, and in this manner gradually merge into the capillary system of blood vessels. as a general rule, the combined area of the branches is greater than that of the vessels from which they emanate, and hence the collective capacity of the arterial system is greatest at the capillary vessels. the same rule applies to the veins. the effect of the division of the arteries is to make the blood move more slowly along their branches to the capillary vessels, and the effect of the union of the branches of the veins is to accelerate the speed of the blood as it returns from the capillary vessels to the venous trunks. in the smaller vessels a frequent running together, or anastomosis, occurs. this admits of a free communication between the currents of blood, and must tend to promote equability of distribution and of pressure, and to obviate the effects of local interruption. the arteries are highly elastic, being extensile and retractile both in length and breadth. during life they are also contractile, being provided with muscular tissue. when cut across they present, although empty, an open orifice; the veins, on the other hand, collapse. in most parts of the body the arteries are inclosed in a sheath formed of connective tissue, but are connected so loosely that, when the vessel is cut across, its ends readily retract some distance within the sheath. independently of this sheath, arteries are usually described as being formed of three coats, named, from the relative positions, external, middle, and internal. this applies to their structure so far as it is discernible by the naked eye. the internal, serous, or tunica intima, is the thinnest, and is continuous with the lining membrane of the heart. it is made up of two layers--an inner, consisting of a layer of epithelial scales, and an outer, transparent, whitish, highly elastic, and perforated. the middle coat, tunica media, is elastic, dense, and of a yellow color, consisting of nonstriated muscular and elastic fibers, thickest in the largest arteries and becoming thinner in the smaller. in the smallest vessels it is almost entirely muscular. the external coat, tunica adventitia, is composed mainly of fine and closely woven bundles of white connective tissue, which chiefly run diagonally or obliquely around the vessel. in this coat the nutrient vessels, the vasa vasorum, form a capillary network, from which a few penetrate as far as the muscular coat. the veins differ from arteries in possessing thinner walls, less elastic and muscular tissue, and for the most part a stronger tunica adventitia. they collapse when cut across or when they are empty. the majority of veins are provided with valves; these are folds of the lining membrane, strengthened by fibrous tissue. they favor the course of the blood and prevent its reflux. the nerves which supply both the arteries and the veins come from the sympathetic system. the smaller arteries terminate in the system of minute vessels known as the capillaries, which are interposed between the termination of the arteries and the commencement of the veins. their average diameter is about one three-thousandth of an inch. diseases of the heart and blood vessels. in considering diseases of the heart we meet with many difficulties, depending much upon the position which this organ occupies in the animal. the shoulders cover so much of the anterior portion of the chest, and often in very heavy-muscled horses the chest walls are so thick that a satisfactory examination of the heart is attended with difficulty. diseases of the heart are not uncommon among horses; the heart and its membranes are frequently involved in diseases of the respiratory organs, diseases of the kidneys, rheumatism, influenza, etc. some of the diseases of this organ are never suspected by the ordinary observer during life, and are so difficult to diagnose with any degree of certainty that we will have to confine ourselves to a general outline, giving attention to such symptoms as may serve to lead to a knowledge of their existence, with directions for treatment, care, etc. nervous affections often produce prominent heart symptoms by causing functional disturbance of that organ, which, if removed, will leave the heart restored to perfect vigor and normal action. organic changes involving the heart or valves, however, usually grow worse and eventually prove fatal. therefore it is necessary that we arrive at an appreciation of the true nature and causes so that we may be able to form a true estimate of the possibilities for recovery or encouragement for medical treatment. disease of the heart may occur at any age, but it is witnessed most frequently in young horses, which, when being trained for fast work, are often subjected to excessive hardship and fatigue. nervous or timid animals also suffer from such diseases more frequently than those of a sluggish disposition. any cause which induces a violent or sudden change in the circulation may result in injury to the heart. symptoms which may frequently denote disease of the heart are difficult breathing or short-windedness, dropsies of the limbs, habitual coldness of the extremities, giddiness or fainting attacks, inability to stand work, although the general appearance would indicate strength and ability, etc. myocarditis, or inflammation of the muscular structure of the heart. the heart muscle sometimes becomes inflamed as a complication or result of the existence of general or febrile and of infectious diseases. severe influenza or infectious pneumonia is not infrequently followed by myocarditis. by extension of inflammation of the endocardium or pericardium the muscle of the heart may become involved. overexertion or especially hard work continued for a long time may cause this muscle to become inflamed. _symptoms._--inflammation of the heart muscle is shown by inability to contract forcibly. this results in a rapid but weak, soft pulse and irregular heart sounds. the pulse may be quite irregular as a result of the irregular, tumultuous action of the heart. there is great general weakness, shortness of breath, and rapid respiratory movements. in some cases, where the muscle is very much softened and weakened, or, perhaps when an abscess forms in the wall of the heart, the course of the disease is very rapid and terminates suddenly from paralysis or rupture of the heart. _alterations._--the heart muscle has a brownish or yellowish, boiled appearance, and is so brittle that it tears easily. there may be a spotted appearance of the muscle from the intense changes in structure in small areas. these small areas may be due to suppuration, in which case they have the characteristics of small abscesses. this last condition is seen in pyemia (blood poisoning). if the disease is of long duration, the fibrous tissue in the wall of the heart may increase to such an extent as to produce an unnatural hardness of the wall. _treatment._--in this disease the nutrition and strength of the heart should be kept up as much as possible with good food, good care, and heart tonics and stimulants. the horse should be tempted to eat such foods as he will take; he should be kept in an airy box stall; his legs should be well rubbed as often as necessary to keep them warm and bandaged loosely with flannel bandages. internally the horse may have strychnia, in -grain doses twice daily, whisky in -ounce doses every two to four hours, digitalis in the form of the tincture in doses of dram every three to six hours. artificial carlsbad salts in heaping tablespoonful doses in the feed may be given three times daily for a couple of weeks. rest is of the greatest importance and should be allowed for a few weeks after recovery seems to be complete. endocarditis, or inflammation of the lining membrane of the heart. endocarditis frequently occurs as a complication of rheumatism, some of the specific or zymotic fevers, specific poisoning, etc. this is a more frequent disease among horses than is generally known, and often gives rise to symptoms which at first are obscure and unnoticed. in influenza we may find the heart becoming involved in the disease, in consequence of the morbid material conveyed through the heart in the blood stream. in view of the fact that many affections in even remote portions of the body may be traced directly to a primary endocardial disease, we shall feel justified in inviting special attention to this disease. endocarditis may be acute, subacute, or chronic. in acute inflammation we find a thickening and a roughened appearance of the endocardium throughout the cavities of the heart. this condition may be followed by a coagulation of fibrin upon the inflamed surface, which adheres to it, and by attrition soon becomes worked up into shreddy-like granular elevations. this may lead to a formation of fibrinous clots in the heart and sudden death early in the disease the second or third day. subacute endocarditis, which is the most common form, may not become appreciable for several days after its commencement. it is characterized by being confined to one or more anatomical divisions of the heart, and all the successive morbid changes follow each other in a comparatively slow process. often we would not be led to suspect heart affection were it not for the distress in breathing, which it generally occasions when the animal is exercised, especially if the valves are much involved. when coagula or vegetations form upon the inflamed membrane, either in minute shreds or patches, or when formation of fibrinous clots occurs in the cavity affected, some of these materials may be carried from the cavity of the heart by the blood current into remote organs, constituting emboli that are liable to suddenly plug vessels and thereby interrupt important functions. in the great majority of either acute or subacute grades of endocarditis, whatever the exciting cause, the most alarming symptoms disappear in a week or days, often leaving, however, such changes in the interior lining or valvular structures as to cause impairment in the circulation for a much longer period of time. these changes usually consist of thickening or induration of the inflamed structures. but while the effects of the inflammation in the membrane lining the walls of the ventricles may subside to such a degree as to cause little or no inconvenience, or even wholly disappear, yet after the valvular structures have been involved, causing them to be thicker, less flexible than normal, they usually remain, obstructing the free passage of the blood through the openings of the heart, thereby inducing secondary changes, which take place slowly at first, but ultimately seriously impair the animal's usefulness. what was but a slight obstruction to the circulation during the first few weeks after the subsidence of the cardiac inflammatory attack becomes in process of time so much increased as to induce increased growth in the muscular structure of the heart, constituting hypertrophy of the walls of the ventricles, more particularly of the left, with corresponding fullness of the left auricle and pulmonary veins, thereby producing fullness of the capillaries in the lungs, pressure upon the air cells, difficult or asthmatic breathing--greatly increased in attempts to work--until in a few months many of these cases become entirely disabled for work. sometimes, too, dropsical effusions in the limbs or into the cavities of the body result from the irregular and deficient circulation. derangement of the urinary secretion, with passive congestion of the kidneys, may also appear. endocardial inflammation is seldom fatal in its early stages, but in many cases the recovery is incomplete, for a large proportion is left with some permanent thickening of the valves, which constitutes the beginning of valvular disease. _symptoms._--endocarditis may be ushered in by a chill, with sudden and marked rise in temperature. the pulse rapidly decreases in strength or may become irregular, while the heart beats more or less tumultuously. in the early stages soft-blowing sounds may be heard by placing the ear over the heart on the left side, which correspond in number and rhythm to the heart's action. excessive pain, though not so great as in acute pleuritis, is manifested when the animal is compelled to trot; very often difficulty in breathing, or shortness of breath, on the slightest exertion develops early in the attack. when the valves are involved in the inflammatory process the visible mucous membranes become either very pale or very dark colored, and fainting may occur when the head is suddenly elevated. when the valves of the right side are affected we may find a regurgitant pulsation in the jugular vein. occasionally it happens that the heart contracts more frequently than the pulse beats--that is, there may be twice as many contractions of the heart in a minute as there are pulse waves in the arteries. the pulse is always very fast. in some cases we find marked lameness of the left shoulder, and when the animal is turned short to the left side he may groan with pain, and the heart's action become violently excited, although pressure against the chest wall will not produce pain unless roughly applied. the animal is not disposed to eat or drink much; the surface of the body and legs are cold--rarely excessively hot--and frequently the body of the animal is in a subdued tremor. in nearly all cases there is partial suppression of the urinary secretion. the symptoms may continue with very little modification for three or four days, sometimes seven days, without any marked changes. if large fibrinous clots form in the heart the change will be sudden and quickly prove fatal unless they become loosened and are carried away in the circulation; then apoplexy may result from the plugging of arteries too small to give further transmission. if the animal manifests symptoms of improvement, the changes usually are slow and steady until he feels apparently as well as ever, eats well, and moves freely in his stall or yard. when he is taken out, however, the seeming strength often proves deceptive, as he may quickly weaken if urged into a fast gait, the breathing becomes quickened with a double flank movement as in heaves, and all the former symptoms reappear in a modified degree. an examination at this stage may reveal valvular insufficiency, cardiac hypertrophy, or pulmonary engorgement. in fatal cases of endocarditis death often occurs about the fourth day, from the formation of heart clot or too great embarrassment of the circulation. endocarditis may be suspected in all cases where plain symptoms of cardiac affection are manifested in animals affected with influenza, rheumatism, or any disease in which the blood may convey septic matter. acute endocardial inflammation may be distinguished from pleuritis by the absence of any friction murmur, absence of pain when the chest wall is percussed, and the absence of effusion in the cavity of the chest. it may be distinguished from pericarditis by the absence of the friction sounds and want of an enlarged area of dullness on percussion. _treatment._--the objects to be attained by treatment will be to remove or mitigate as much as possible the cause inducing the disease; to find a medicine which will lessen the irritability of the heart without weakening it; and, last, to maintain a free urinary secretion and prevent exudation and hypertrophy. so long as there is an increase of temperature, with some degree of scantiness of the urine, it may be safe to believe that there is some degree of inflammatory action existing in the cardiac structures, and as long as any evidence of inflammatory action remains, however moderate in degree, there is a tendency to increase or hypertrophy of the connective tissue of the heart or valves, thereby rendering it almost certain that the structural changes will become permanent unless counteracted by persistent treatment and complete rest. the tincture of digitalis, in -drop doses, repeated every hour, is perhaps the most reliable agent we know to control the irritability of the heart, and this also has a decided influence upon the urinary secretion. after the desired impression upon the heart is obtained the dose may be repeated every two or three hours, or as the case may demand. tincture of strophanthus, in -dram doses, will quiet the tumultuous action of the heart in some cases where the digitalis fails. bleeding, blistering, and stimulating applications to the chest should be avoided. they serve to irritate the animal and can do no possible good. chlorate of potassium in -dram doses may be given in the drinking water every four hours for the first five or six days, and then be superseded by the nitrate of potassium in half-ounce doses for the following week or until the urinary secretion becomes abnormally profuse. where the disease is associated with rheumatism, -dram doses of salicylate of soda may be substituted for the chlorate of potassium. to guard against chronic induration of the valves, the iodid of potassium, in to dram doses, should be given early in the disease and may be repeated two or three times a day for several weeks. when chronic effects remain after the acute stage has passed this drug becomes indispensable. when dropsy of the limbs develops, it is due to weakened circulation or functional impairment of the kidneys. when there is much weakness in the action of the heart, or general debility is marked, the iodid of iron, in -dram doses, combined with hydrastis, drams, may be given three times a day. arsenic, in -grain doses twice a day, will give excellent results in some cases of weak heart associated with difficult breathing. in all cases absolute rest and warm stabling, with comfortable clothing, become necessary, and freedom from work should be allowed for a long time after all symptoms have disappeared. pericarditis, or inflammation of the sac inclosing the heart. _causes._--pericarditis may be induced by cold and damp stabling, exposure and fatigue, from wounds caused by broken ribs, etc. generally, however, it is associated with an attack of influenza, rheumatism, pleuritis, etc. _symptoms._--usually the disease manifests itself abruptly by a brief stage of chills coincident with pain in moving, a short painful cough, rapid and short breathing, and high temperature, with a rapid and hard pulse. in the early stages of the disease the pulse is regular in beat; later, when there is much exudation present in the pericardial sac, the heartbeat becomes muffled, and may be of a double or rebounding character. by placing the ear against the left side of the chest behind the elbow a rasping sound may be heard, corresponding to the frequency of the heartbeat. this is known as a friction sound. between the second and fourth days this sound may disappear, due to a distension of the pericardium by an exudate or serous effusion. as soon as this effusion partly fills the pericardium, percussion will reveal an abnormally increased area of dullness over the region of the heart, the heartbeats become less perceptible than in health, and in some cases a splashing or flapping sound may become audible. if the effusion becomes absorbed, the friction sound usually recurs for a short time; this friction may often be felt by applying the hand to the side of the chest. in a few cases clonic spasms of the muscles of the neck may be present. in acute pericarditis, when the effusion is rapid and excessive, the animal may die in a few days or recovery may begin equally as early. in subacute or in chronic cases the effusion may slowly become augmented until the pressure upon the lungs and interference with the circulation become so great that death will result. whether the attack is acute, subacute, or chronic, the characteristic symptoms which will guide us to a correct diagnosis are the friction sound, which is always synchronous with the heart's action, the high temperature with hard, irritable pulse, and, in cases of pericardial effusion, the increased area of dullness over the cardiac region. when the disease is associated with influenza or rheumatism, some of the symptoms may be obscure, but a careful examination will reveal sufficient evidence upon which to base a diagnosis. when pericarditis develops as a result of or in connection with pleuritis, the distinction may not be very clearly definable, neither will many recover. when it results from a wound or broken rib, it almost invariably proves fatal. _pathology._--pericarditis may at all times be regarded as a very serious affection. at first we will find an intense injection or accumulation of blood in the vessels of the pericardium, giving it a red and swollen appearance, during which we have the friction sound. in to hours this engorgement is followed by an exudation of sero-fibrinous fluid, the fibrinous portion of which may soon form a coating over the internal surface of the pericardial sac, and may ultimately form a union of the opposing surfaces. generally this adhesion will only be found to occupy a portion of the surfaces. as the serous or watery portion of this effusion is absorbed, the distinctness of the friction sound recurs, and may remain perceptible in a varied degree for a long time. when the serous effusion is very great, the pressure exerted upon the heart weakens its action, and may produce death soon; when it is not so great, it may cause dropsies of other portions of the body. when the adhesions of the pericardial sac to the body of the heart are extensive, they generally lead to increased growth, or hypertrophy, of the heart, with or without dilatation of its cavities; when they are but slight, they may not cause any inconvenience. _treatment._--in acute or subacute pericarditis the tincture of digitalis may be given in to drop doses every hour until the pulse and temperature become reduced. whisky or carbonate of ammonia may be given regularly as stimulants. bandages should be applied to the legs; if the legs are very cold, tincture of capsicum should be first applied; the body should be warmly clothed in blankets, to promote perspiration. when the suffering from pain is very severe, grains of morphin may be given by the mouth once or twice a day; nitrate of potassium, half an ounce, in drinking water, every six hours; after the third day, iodid of potassium, in -dram doses, may be substituted. cold packs to the chest in the early stages of the disease may give marked relief, or, late in the disease, smart blisters may be applied to the sides of the chest with benefit. if the disease becomes chronic, iodid of iron and gentian to support the strength will be indicated, but the iodid of potassium, in or dram doses, two or three times a day, must not be abandoned so long as there is an evidence of effusion or plastic exudate accumulating in the pericardial sac. where the effusion is great and threatens the life of the patient, tapping by an expert veterinarian may save the animal. valvular disease of the heart. acute valvular disease can not be distinguished from endocarditis, and chronic valvular affections are generally the result of endocardial inflammation. the valves of the left side are the most subject--the bicuspid or mitral and the aortic or semilunar. the derangement may consist of mere inflammation and swelling, or the edges of the valves may become covered by the organization of the exudation, thus narrowing the passage. valvular obstruction and adhesions may occur or the tendinous cords may be lengthened or shortened, thus obstructing the orifices and permitting the regurgitation of blood. in protected cases the fibrous tissue of the valves may be transformed into fibro-cartilage or bone, or there may be deposits of salts of lime beneath the serous membrance, which may terminate in ulceration, rupture, or fissures. sometimes the valves become covered by fibrinous, fleshy, or hard vegetations, or excrescences. in cases of considerable dilatation of the heart there may be atrophy and shrinking of the valves. _symptoms._--valvular disease may be indicated by a venous pulse, jerking pulse, intermittent pulse, irregular pulse; palpitation; constant abnormal fullness of the jugular veins; difficulty of breathing when the animal becomes excited or is urged out of a walk or into a fast trot; attacks of vertigo; congestion of the brain; dropsical swelling of the limbs. a blowing, cooing, or bubbling murmur may sometimes be heard by placing the ear over the heart on the left side of the chest. hypertrophy, or dilatation, or both, usually follow valvular disease. _treatment._--when the pulse is irregular or irritable, tonics, such as preparations of iron, gentian, and ginger, may be given. when the action of the heart is jerking or violent, to drop doses of tincture of digitalis or of veratrum viride may be given until these symptoms abate. as the disease nearly always is the result of endocarditis, the iodid of potassium and general tonics, sometimes stimulants, when general debility supervenes, may be of temporary benefit. very few animals recover or remain useful for any length of time after once marked organic changes have taken place in the valvular structure of the heart. adventitious growths in the heart. fibrous, cartilaginous, and bony formations have been observed in some rare instances in the muscular tissue. isolated calcareous masses have sometimes been embedded in the cardiac walls. fibrinous coagula and polypous concretions may be found in the cavities of the heart. the former consist of coagulated fibrin, separated from the mass of blood, of a whitish or yellowish white color, translucent, of a jellylike consistence, and having a nucleus in the center. they may slightly adhere to the surface of the cavity, from which they can easily be separated without altering the structure of the endocardium. they probably result from an excess of coagulability of fibrin, which is produced by an organization of the lymph during exudation. they are usually found in the right auricle and ventricle. polypous concretions are firmer than in the preceding, more opaque, of a fibrous texture, and may be composed of successive layers. in some instances they are exceedingly minute, while in others they almost fill one or more of the cavities. their color is usually white, but occasionally red from the presence of blood. they firmly adhere to the endocardium, and when detached from it give it a torn appearance. occasionally, a vascular communication seems to exist between them and the substance of the heart. they may be the result of fibrinous exudation from inflammation of the inner surface of the heart or the coagulation of a portion of the blood which afterwards contracts adhesion with the heart. these concretions prove a source of great inconvenience and often danger, no matter how formed. they cause a diminution in the cavity in which they are found, thus narrowing the orifice through which the blood passes, or preventing a proper coaptation of the valves, which may produce most serious valvular disease. _symptoms._--these are frequently uncertain; they may, however, be suspected when the action of the heart suddenly becomes embarrassed with irregular and confused pulsations, great difficulty of breathing, and the usual signs dependent upon the imperfect arterialization of the blood. _treatment._--stimulants, whisky, or carbonate of ammonia may be of service. palpitation of the heart. this is a tumultuous and usually irregular beating of the heart. it may be due to a variety of causes, both functional and organic. it may occur as a result of indigestion, fright, increased nervousness, sudden excitement, excessive speeding, etc. (see "thumps," p. .) _symptoms._--the heart may act with such violence that each beat may jar the whole body of the animal; very commonly it may be heard at a short distance away from the animal. it can usually be traced very readily to the exciting cause, which we may be able to avoid or overcome in the future and thereby obviate subsequent attacks. rest, a mild stimulant, or a dose or two of tincture of digitalis or opium will generally give prompt relief. when it is due to organic impairment of the heart it must be regarded as a symptom, not as a matter of primary specific treatment. syncope, or fainting. actual fainting rarely occurs among horses. it may, however, be induced by a rapid and great loss of blood, pain of great intensity, a mechanical interference with the circulation of the brain, etc. _symptoms._--syncope is characterized by a decrease or temporary suspension of the action of the heart and respiration, with partial or total loss of consciousness. it generally occurs suddenly, though there may be premonitory symptoms, as giddiness, or vertigo, dilated pupil, staggering, blanching of the visible mucous membranes, a rapidly sinking pulse, and dropping to the ground. the pulse is feeble or ceases to beat; the surface of the body turns cold; breathing is scarcely to be perceived, and the animal may be entirely unconscious. this state is uncertain in duration--generally it lasts only a few minutes; the circulation becomes restored, breathing becomes more distinct, and consciousness and muscular strength return. in cases attended with much hemorrhage or organic disease of the heart, the fainting fit may be fatal; otherwise it will prove but a transient occurrence. in paralysis of the heart the symptoms may be exactly similar to syncope. syncope may be distinguished from apoplexy by the absence of stertorous breathing and lividity of the visible mucous membranes. _treatment._--dash cold water on the head; administer a stimulant-- ounces of whisky or half an ounce of carbonate of ammonia. prevent the animal from getting up too soon, or the attack may immediately recur. afterwards, if the attack was due to weakness from loss of blood, impoverished blood, or associated with debility, general tonics, rest, and nourishing food are indicated. hypertrophy of the heart, or cardiac enlargement. hypertrophy of the heart implies augmentation of bulk in its muscular substance, with or without dilatation or contraction of its cavities. it may exist with or without other cardiac affections. in valvular disease or valvular insufficiency hypertrophy frequently results as a consequence of increased demand for propelling power. the difficulties with which it is most frequently connected are dilatation and ossification of the valves. it may also occur in connection with atrophied kidneys, weak heart, etc. it may be caused by an increased determination of blood to the organ or from a latent form of myocarditis, and it may arise from a long-continued increase of action dependent upon nervous disease. all the cavities of the heart may have their walls hypertrophied or the thickening may involve one or more. while the wall of a ventricle is thickened, its cavity may retain its normal size (simple hypertrophy) or be dilated (eccentric hypertrophy), or it may be contracted (concentric hypertrophy). hypertrophy of both ventricles increases the length and breadth of the heart. hypertrophy of the left ventricle alone increases its length; of the right ventricle alone increases its breadth toward the right side. hypertrophy with dilatation may affect the chambers of the heart conjointly or separately. this form is by far the most frequent variety of cardiac enlargement. when the entire heart is affected, it assumes a globular appearance, the apex being almost obliterated and situated transversely in the chest. the bulk may become three or four times greater than the average heart. _symptoms._--in hypertrophy of the heart, in addition to the usual symptoms manifested in organic diseases of the heart, there is a powerful and heaving impulse at each beat, which may be felt on the left side, often also on the right. these pulsations are regular, and when full and strong at the jaw there is a tendency to active congestion of the capillary vessels, which frequently give rise to local inflammation, active hemorrhage, etc. if the pulse is small and feeble at the jaw, we may conclude that there is some obstacle to the escape of the blood from the left ventricle into the aorta, which has given rise to the hypertrophy. in case of hypertrophy with dilatation, the impulse is not only powerful and heaving, but it is diffused over the whole region of the heart, and the normal sounds of the heart are greatly increased in intensity. percussion reveals an enlarged area of dullness, while the impulse is usually much stronger than normal. dropsy of the pericardium will give the same wide space of dullness, but the impulse and sound are lessened. an animal with a moderate degree of enlargement may possibly live a number of years and be capable of ordinary work; it depends largely upon concomitant disease. as a rule, an animal affected with hypertrophy of the heart will soon be incapacitated for work, and becomes useless and incurable. _treatment._--if the cause can be discovered and is removable, it should be done. the iodid of potassium, in cases of valvular thickening, may be of some benefit if continued for a sufficient length of time; it may be given in -dram doses, twice a day, for a month or more. the tincture of digitalis may be given, in cases where the pulse is weak, in doses of teaspoonfuls three times daily. this remedy should not be continued if the pulse becomes irregular. general tonics, freedom from excitement or fatigue, avoidance of bulky food, good ventilation, etc., are indicated. dilatation of the heart. this is an enlargement, or stretching, of the cavities of the heart, and may be confined to one or extend to all. two forms of dilatation may be mentioned--simple dilatation, where there is normal thickness of the walls, and passive, or attenuated, dilatation, where the walls are simply distended or stretched out without any addition of substance. _causes._--any cause producing constant and excessive exertion of the heart may lead to dilatation. valvular disease is the most frequent cause. general anemia predisposes to it by producing relaxation of muscular fiber. changes in the muscular tissue of the heart walls, serous infiltration from pericarditis, myocarditis, fatty degeneration and infiltration, and atrophy of the muscular fibers may all lead to dilatation. _symptoms._--the movements of the heart are feeble and prolonged, a disposition to staggering or vertigo, dropsy of the limbs, very pale or very dark-colored membranes, and difficult breathing on the slightest excitement. _treatment._--general tonics, rich feed, and rest. fatty degeneration of the heart. fatty degeneration may involve the whole organ, or may be limited to its walls, or even to circumscribed patches. the latter is situated at the exterior, and gives it a mottled appearance. when generally involved it is flabby or flaccid, and in extreme cases collapses when emptied or cut. upon dissection the interior of the ventricles is observed to be covered with buff-colored spots of a singular zigzag form. this appearance may be noticed beneath the pericardium, and pervading the whole thickness of the ventricular walls, and in extreme cases those of the fleshy columns in the interior of the heart. these spots are found to be degenerated muscular fibers and colonies of oil globules. fatty degeneration is often associated with other morbid conditions of the heart, such as obesity, dilatation, rupture, aneurism, etc. it may be connected with fatty diseases of other organs, such as the liver, kidneys, etc. when it exists alone its presence is seldom suspected previous to death. it may be secondary to hypertrophy of the heart, to myocarditis, or to pericarditis. it may be due to deteriorated conditions of the blood in wasting diseases, excessive hemorrhages, etc., or to poisoning with arsenic and phosphorus. _symptoms._--the most prominent symptoms of fatty degeneration are a feeble action of the heart, a remarkably slow pulse, general debility, and attacks of vertigo. it may exist for a long time, but is apt to terminate suddenly in death upon the occurrence of other diseases, surgical operations, etc. it may involve a liability to sudden death from rupture of the ventricular walls. _treatment._--confinement in feed to oats, wheat or rye bran, and timothy hay. twenty drops of sulphuric acid may be given in drinking water three times a day, and hypophosphite of iron in -dram doses, mixed with the feed, twice a day. other tonics and stimulants as they may be indicated. rupture of the heart. this may occur as the result of some previous disease, such as fatty degeneration, dilatation with weakness of the muscular walls, etc. it may be caused by external violence, a crushing fall, pressure of some great weight, etc. usually death follows a rupture very quickly, though an animal may live for some time when the rent is not very large. weakness of the heart. this may arise from general debility, the result of exhausting disease, overwork, or heart strain, or loss of blood. it is indicated by a small, feeble, but generally regular pulse, coldness of the body, etc. treatment should be directed to support and increase the strength of the animal by tonics, rest, and nutritious feed. carbonate of ammonia may be given to stimulate the heart's action and to prevent the formation of heart clot. congestion of the heart congestion, or an accumulation of the blood in the cavities of the heart, may occur in consequence of fibrinous deposits interfering with the free movements of the valves, usually the product of endocarditis or as a result of excessive muscular exertion. symptoms are great difficulty of breathing, paleness of the visible mucous membranes, great anxiety, frequently accompanied by a general tremor and cold perspiration, followed by death. it usually results in death very quickly. cyanosis of newborn foals. this is a condition sometimes found in foals immediately after birth, and is due to nonclosure of the foramen ovale, which allows a mixture of the venous with the arterial blood in the left cavities of the heart. it is characterized by a dark purple or bluish color of the visible mucous membranes, shortness of breath, and a general feebleness. foals thus affected generally live only a few hours after birth. diseases of arteries, or arteritis and endarteritis. inflammation of arteries is rarely observed in the horse as a primary affection. direct injuries, such as blows, may produce a contusion and subsequent inflammation of the wall of an artery; severe muscular strain may involve an arterial trunk; hypertrophy of the heart, by increasing arterial tension, may result in the production of a general endarteritis. septic infection may affect the inner coat and ultimately involve all three, or it may be the result of an inflammation in the vicinity of the vessels, etc. inflammation of arteries, whatever the cause may be, often leads to very serious results in the development of secondary changes in their walls. arteritis may be acute, subacute, or chronic; when the inner coat alone is affected it is known as endarteritis. _symptoms._--arteritis is characterized by a painful swelling along the inflamed vessel, throbbing pulse, coldness of the parts supplied by the inflamed vessel, sometimes the formation of gangrenous sloughs, suppuration, abscess, etc. in an inflammation of the iliac arteries we find coldness and excessive lameness or paralysis of one or both hind limbs. _pathology._--in acute arteritis we find swelling along the vessel, loss of elasticity, friability, and thickening of the walls; a roughness and loss of gloss of the inner coat, with the formation of coagula or pus in the vessel. subacute or chronic arteritis may affect only the outer coat (periarteritis), both the outer and middle coat, or the inner coat alone (endarteritis); and by weakening the respective coats leads to rupture, aneurism, or to degenerations, such as bony, calcareous, fatty, atheromatous, etc. it may also lead to sclerosis or increase of fibrous tissue, especially in the kidneys, when it may result in the condition known as arterio-capillary fibrosis. chronic endarteritis is fruitful in the production of thrombus and atheroma. arteritis may be limited to single trunks or it may affect, more or less, all the arteries of the body. arteries which are at the seat of chronic endarteritis are liable to suffer degenerative changes, consisting chiefly of fatty degeneration, calcification, or the breaking down of the degenerated tissue, and the formation of erosions or ulcerlike openings in the inner coat. these erosions are frequently called atheromatous ulcers, and fragments of tissue from these ulcers may be carried into the circulation, forming emboli. fibrinous thrombi are apt to form upon the roughened surface of the inner coat or upon the surface of the erosions. fatty degeneration and calcification of the middle and outer coats may occur, and large, hard, calcareous plates project inward, upon which thrombi may form or may exist in connection with atheroma of the inner coat. when there is much thickening and increase of new tissue in the wall of the affected artery it may encroach upon the capacity of the vessel, and even lead to obliteration. this is often associated with interstitial inflammation of glandular organs. _treatment._--carbonate of potassium in -dram doses, to be given in ounces liquor acetate of ammonia every six hours; scalded bran sufficient to produce loosening of the bowels, and complete rest; externally, applications of hot water or hot hop infusion. atheroma. atheroma is a direct result of an existing chronic endarteritis, the lining membrane of the vessels being invariably involved to a greater or less degree. it is most frequently found in the arteries, although the veins may develop an atheromatous condition when exposed to any source of prolonged irritation. atheroma may affect arteries in any part of the body; in some instances almost every vessel is diseased, in others only a few, or even parts of one vessel. it is a very common result of endocarditis extending into the aorta, which we find perhaps the most frequent seat of atheroma. as a result of this condition the affected vessel becomes impaired in its contractile power, loses its natural strength, and, in consequence of its inability to sustain its accustomed internal pressure, undergoes in many cases dilatation at the seat of disease, constituting aneurism. in an atheromatous vessel, calcareous deposits soon occur, which render it rigid, brittle, and subject to ulceration or rupture. in such vessels the contractility is destroyed, the middle coat atrophied and beyond repair. atheroma in the vessels of the brain is a frequent cause of cerebral apoplexy. no symptoms are manifested by which we can recognize this condition during life. constriction of an artery. this is usually the result of arteritis, and may partly or wholly be impervious to the flow of blood. when this occurs in a large vessel it may be followed by gangrene of the parts; usually, however, collateral circulation will be established to nourish the parts previously supplied by the obliterated vessel. in a few instances constriction of the aorta has produced death. aneurism. aneurism is usually described as true or false. true aneurism is a dilatation of the coats of an artery over a larger or smaller part of its course. such dilatations are usually due to chronic endarteritis and atheroma. false aneurism is formed after a puncture of an artery by a dilatation of the adhesive lymph by which the puncture was united. _symptoms._--if the aneurism is seated along the neck or a limb it appears as a tumor in the course of an artery and pulsating with it. the tumor is round, soft, and compressible, and yields a peculiar fluctuation upon pressure. by applying the ear over it a peculiar purring or hissing sound may sometimes be heard. pulsation, synchronous with the action of the heart, is the diagnostic symptom. it is of a slow, expansive, and heavy character, as if the whole tumor were enlarging under the hand. aneurisms seated internally may occupy the cavity of the cranium, chest, or abdomen. as regards the first, little is known during life, for all the symptoms which they produce may arise from other causes. aneurism of the anterior aorta may be situated very closely to the heart or in the arch, and it is very seldom that we can distinguish it from disease of the heart. the tumor may encroach upon the windpipe and produce difficulty in breathing, or it may produce pressure upon the vena cava or the thoracic duct, obstructing the flow of blood and lymph. in fact, whatever parts the aneurism may reach or subject to its pressure, may have their functions suspended or disturbed. when the tumor in the chest is large, we generally find much irregularity in the action of the heart; the superficial veins of the neck are distended, and there is usually dropsical swelling under the breast and of the limbs. there may be a very troublesome cough without any evidence of lung affection. sometimes pulsation of the tumor may be felt at the lower part of the neck where it joins the chest. when the aneurism occurs in the posterior aorta no diagnostic symptoms are appreciable; when it occurs in the internal iliac arteries an examination per rectum will reveal it. there is one form of aneurism which is not infrequently overlooked, affecting the anterior mesenteric artery, primarily induced by a worm--_strongylus vulgaris_. this worm produces an arteritis, with atheroma, degeneration, and dilatation of the mesenteric arteries, associated with thrombus and aneurism. the aneurism gives rise to colic, which appears periodically in a very violent and often persistent type. ordinary colic remedies have no effect, and after a time the animal succumbs to the disease. in all cases of animals which are habitually subject to colicky attacks, parasitic aneurism of the anterior mesenteric artery may be suspected. (see p. .) _pathology._--aneurisms may be diffuse or sacculated. the diffuse consists in a uniform dilatation of all the coats of an artery, so that it assumes the shape of a cylindrical swelling. the wall of the aneurism is atheromatous, or calcified; the middle coat may be atrophied. the sacculated, or circumscribed, aneurism consists either in a dilatation of the entire circumference of an artery over a short portion of its length, or in a dilatation of only a small portion of one side of the wall. aneurism may become very large; as it increases in size it presses upon and causes the destruction of neighboring tissues. the cavity of the aneurismal sac is filled with fluid or clotted blood or with layers of fibrin which adhere closely to its wall. death is produced usually by the pressure and interference of the aneurism with adjoining organs or by rupture. in worm aneurism we usually find large thrombi within the aneurismal dilatation of the artery, which sometimes plug the whole vessel or extend into the aorta. portions of this thrombus, or clot, may be washed away and produce embolism of a smaller artery. the effect in either case is to produce anemia of the intestinal canal, serous or bloody exudation in its walls, which leads to paralysis of the intestine and resultant colicky symptoms. _treatment._--the only treatment advisable is to extirpate or ligate the tumor above and below. rupture of an artery. endarteritis, with its subsequent changes in the walls of arteries, is the primary cause of rupture in the majority of instances. the rupture may be partial, involving only one or two coats, and will then form an aneurism. if complete, it may produce death when it involves a large vessel, especially if it is situated in one of the large cavities permitting an excessive escape of blood. rupture may be produced by mechanical violence or accident. _symptoms._--in fatal rupture, associated with profuse bleeding, the animal becomes weak, the visible mucous membranes become blanched, the breathing hurried or gasping, pupils dilated, staggering in gait, syncope, death. when the hemorrhage is limited the symptoms may not become noticeable; if it is near the surface of the body a round or diffuse swelling or tumor may form, constituting a hygroma. if the rupture is associated with an external wound, the bleeding artery should be ligated, or where a bandage is applicable, pressure may be applied by tight bandaging. as a secondary result of rupture of an artery we may have formation of abscess, gangrene of a part, etc. _treatment._--when rupture of a deep-seated artery is suspected, large doses of fluid extract of ergot may be given to produce contraction of the blood vessels. tannin and iron are also useful. the animal should be allowed to have as much water as he desires. afterwards stimulants and nourishing feed are indicated. thrombus and embolism. by thrombosis is generally understood the partial or complete closure of a vessel by a morbid product developed at the site of the obstruction. the coagulum, which is usually fibrinous, is known as a thrombus. the term "embolism" designates an obstruction caused by any body detached and transported from the interior of the heart or of some vessel. thrombi occur as the result of an injury to the wall of the vessel or may follow its compression or dilatation; they may result from some alteration of the wall of the vessel by disease or by the retardation of the circulation. these formations may occur during life, in the heart, arteries, veins, or in the portal system. when a portion of fibrin coagulates in one of the arteries and is carried along by the circulation, it will be arrested, of course, in the capillaries, if not before; when in the veins, it may not be stopped until it reaches the lungs; and when in the portal system the capillaries of the liver will prevent its further progress. the formation of thrombi may act primarily by causing partial or complete obstruction, and, secondarily, either by larger or smaller fragments becoming detached from their end and by being carried along by the circulation of the blood to remote vessels, embolism; or by the coagulum becoming softened and converted into pus, constituting suppurative phlebitis. these substances occur most frequently in those affections characterized by great exhaustion or debility, such as pneumonia, purpura hemorrhagica, endocarditis, phlebitis, puerperal fever, hemorrhages, etc. these concretions may form suddenly and produce instantaneous death by retarding the blood current, or they may arise gradually, in which case the thrombi may be organized and attached to the walls of the heart, or they may soften, and fragments of them (emboli) may be carried away. the small, wartlike excrescences occurring sometimes in endocarditis may occasionally form a foundation on which a thrombi may develop. _symptoms._--when heart clot, or thrombus, exists in the right side, the return of blood from the body and the aeration in the lungs is impeded, and if death occurs, it is owing to syncope rather than to strangulation in pulmonary respiration. there will be hurried and gasping breathing, paleness and coldness of the surface of the body, a feeble and intermittent or fluttering pulse, and fainting. when a fibrinous coagulum is carried into the pulmonary artery from the right side of the heart, the indications are a swelling and infiltration of the lungs and pulmonary apoplexy. when the clot is situated in the left cavities of the heart or in the aorta, death, if it occurs, takes place either suddenly or at the end of a few hours from coma. _pathology._--when a coagulum is observed in the heart it may become a question whether it was formed during life or after death. the loose, dark coagula so often found after death are polypi. if the deposition has taken place during the last moments of life, the fibrin will be isolated and soft, but not adherent to the walls; if it be isolated, dense, and adherent or closely intertwined with the muscles of the papillæ and tendinous cords, the deposition has occurred more or less remote from the act of dying. occasionally the fibrin may be seen lining one of the cavities of the heart, like a false endocardium, or else forming an additional coat to the aorta or other large vessels without producing much obstruction. thrombi, in some instances, soften in their centers, and are then observed to contain a puslike substance. if this softening has extended considerably, an outer shell, or cyst, only may remain. the sources of danger exist not only in the interruption of the circulation of the blood, but also in a morbid state of the system, produced by the disturbed nutrition of a limb or organ, as well as the mingling of purulent and gangrenous elements with the blood. _treatment._--the urgent symptoms should be relieved by rest, stimulants, and the use of agents which will act as solvents to the fibrinous clots. alkalis are specially useful for this purpose. carbonate of ammonia may be administered in all cases of thrombus, and should be continued for a long time in small doses several times a day. in cases of great debility associated with a low grade of fever, stimulants and tonics, and nitro-muriatic acid as an antiseptic, may be beneficial. diseases of veins, or phlebitis. inflammation of veins may be simple or diffuse. in simple phlebitis the disease of the vein is confined to a circumscribed or limited portion of a vein; in diffuse it involves the vein for a long distance; it may even extend from a limb or foot to the heart. _causes._--phlebitis may be induced by contusions or direct injuries, an extension of inflammation from surrounding tissue, such as in abscess, formation of tumor, or malignant growth. it is often due to embolism of infective material, gangrenous matter, etc. blood-letting from the jugular vein is occasionally followed by dangerous phlebitis. _symptoms._--the symptoms vary according to the extent and severity of the inflammation. in most cases the vein is swollen, thickened, and indurated to such a degree as to resemble an artery. a diffused swelling, with great tenderness, may extend along the affected vessel and the animal manifest all the symptoms connected with acute fever and general functional disturbance. _pathology._--the disease is only serious when large veins are affected. the coats undergo the same changes as in arteritis; clots of blood and lymph plug the inflamed vessel, and, if the inflammatory process continues, these are converted into pus, which ruptures the vessel and produces a deep abscess; or it may be carried away in the circulation and produce metastatic abscess in the lungs or other remote organs. in mild cases the clots may become absorbed and the vessel restored to health. phlebitis in the course of the veins of the limbs frequently leads to numerous abscesses, which may be mistaken for farcy ulcerations. a very common result of phlebitis is an obliteration of the affected portion of the vein, but as collateral circulation is readily established this is seldom of any material inconvenience. _treatment._--phlebitis should be treated by the application of a smart blister along the course of the inflamed vessel; early opening of any abscesses which may form; the animal should have complete rest, and the bowels be kept loose with bran mashes. when the fever runs high, half-ounce doses of nitrate of potassium may be given in the drinking water, which may be changed in two or three days for -dram doses of the iodid of potassium. if the animal becomes debilitated, carbonate of ammonia, dram, and powdered gentian, drams, may be given every six hours. varicose veins, varix, or dilatation of veins. this may be a result of weakening of the coats from inflammatory disease and degeneration. it may also be due to mechanical obstruction from internal or external sources. it is sometimes found in the vein which lies superficial over the inside of the hock joint, and may be due to the pressure of a spavin. occasionally it may be observed in stallions, which are more or less subject to varicocele, or dilatation of the veins of the testicular cord. hemorrhoidal veins, or piles, are occasionally met with, generally in horses which run at pasture. varicose veins may ulcerate and form an abscess in the surrounding tissues, or they may rupture from internal blood pressure and the blood form large tumors where the tissues are soft. _treatment._--stallions which manifest a tendency to varicocele should wear suspensory bags when they are exercised. piles may often be reduced by astringent washes--tea made from white-oak bark or a saturated solution of alum. the bowels should be kept loose with bran mashes and the animal kept quiet in the stable. when varicose veins exist superficially and threaten to produce inconvenience, they may be ligated above and below and thus obliterated. sometimes absorption may be induced by constant bandages. air in veins, or air embolism. it was formerly supposed that the entrance of air into a vein at the time of the infliction of a wound or in blood-letting was extremely dangerous and very often produced sudden death by interfering with the circulation of the blood through the heart and lungs. danger from air embolism is exceedingly doubtful, unless great quantities were forced into a large vein by artificial means. purpura hemorrhagica. purpura hemorrhagica usually occurs as a sequel to debilitating diseases, such as strangles, influenza, etc. it may, however, arise in the absence of any previous disease in badly ventilated stables, among poorly fed horses, and in animals subject to exhausting work and extreme temperatures. the disease is probably due to some as yet undiscovered infectious principle. its gravity does not depend so much upon the amount of blood extravasated as it does upon the disturbance or diminished action of the vasomotor centers. _symptoms._--this disease becomes manifested by the occurrence of sudden swellings on various parts of the body, on the head or lips, limbs, abdomen, etc. these swellings may be diffused or very markedly circumscribed, though in the advanced stages they cover large areas. they pit on pressure and are but slightly painful to the touch. the limbs may swell to a very large size, the nostrils may become almost closed, and the head and throat may swell to the point of suffocation. the swellings not infrequently disappear from one portion of the body and develop on another, or may recede from the surface and invade the intestinal mucous membrane. the mucous lining of the nostrils and mouth show more or less dark-red or purple spots. there may be a discharge of blood-colored serum from the nostrils; the tongue may be swollen so as to prevent eating or closing of the jaws. in the most intense cases, within from twenty-four to forty-eight hours bloody serum may exude through the skin over the swollen parts, and finally large gangrenous sloughs may form. the temperature is never very high, the pulse is frequent and compressible, and becomes feebler as the animal loses strength. a cough is usually present. the urine is scanty and high colored, and when the intestines are much affected a bloody diarrhea may set in, with colicky pains. some of the internal organs become implicated in the disease, the lungs may become edematous, extravasation may occur in the intestinal canal, or effusion of serum into the cavity of the chest or abdomen; occasionally the brain becomes affected. a few cases run a mild course and recovery may commence in three or four days; generally, however, the outlook is unfavorable. in severe cases septic poisoning is liable to occur, which soon brings the case to a fatal issue. _pathology._--on section we find the capillaries dilated, the connective tissue filled with a coagulable or coagulated lymph, and frequently we may discover gangrenous spots beneath the skin or involving the skin. the lymphatic glands are swollen and inflamed. extensive extravasations of blood may be found embedded between the coats of the intestines, or excessive effusion into the substance of the lungs. _treatment._--diffusible stimulants and tonics should be given from the start. carbonate of ammonia, dram, fluid extract of red cinchona bark, drams, and tincture of ginger half an ounce, with half a pint of water; thin gruel or milk should be given every four or six hours. but especial care should be exercised to avoid injury by drenching. if the horse has difficulty in getting the head up and swallowing, smaller doses must be given with a small hard-rubber syringe. sulphate of iron in -dram doses may be dissolved in water and given every six hours. chlorate of potassium, in -ounce doses, may be given every eight or twelve hours. colloidal silver may be administered intravenously in doses of from to grains. washings with lead and alum water are useful and may be repeated several times each day. if the swellings are very great, they may be incised freely and the resulting wounds should be washed at least twice daily with a warm per cent solution of carbolic acid or other good antiseptic. tracheotomy may be necessary. complications, when they arise, must be treated with proper circumspection. diseases of the lymphatic system. the lymphatic, or absorbent, system is connected with the blood-vascular system, and consists of a series of tubes which absorb and convey to the blood certain fluids. these tubes lead to lymphatic glands, through which the fluids pass to reach the right lymphatic vein and thoracic duct, both of which enter the venous system near the heart. through the excessively thin walls of the capillaries the fluid part of the blood transudes to nourish the tissues outside the capillaries; at the same time fluid passes from the tissues into the blood. the fluid, after it passes into the tissues, constitutes the lymph, and acts like a stream irrigating the tissue elements. much of the surplus of this lymph passes into the lymph vessels, which in their commencement can hardly be treated as independent structures, since their walls are so closely joined with the tissues through which they pass, being nothing more than spaces in the connective tissue until they reach the larger lymph vessels, which finally empty into lymph glands. these lymph glands are structures so placed that the lymph flowing toward the larger trunks passes through them, undergoing a sort of filtration. from the fact of this arrangement lymph glands are subject to inflammatory diseases in the vicinity of diseased structures, because infective material being conveyed in the lymph stream lodges in the glands and produces irritation. local inflammation and abscess of lymphatic glands. acute inflammation of the lymph glands usually occurs in connection with some inflammatory process in the region from which its lymph is gathered. several or all of the glands in a cluster may become affected, as in strangles, nasal catarrh, or nasal gleet, diseased or ulcerated teeth, the lymph glands between the branches of the lower jaw almost invariably become affected, which may lead to suppuration or induration. similar results obtain in other portions of the body; in pneumonia the bronchial glands become affected; in pharyngitis the postpharyngeal glands lying above the trachea become affected, etc. _symptoms._--the glands swell and become painful to the touch, the connective tissue surrounding them becomes involved, suppuration usually takes place, and one or more abscesses form. if the inflammation is of a milder type, resolution may take place and the swelling recede, the exudative material being absorbed, and the gland restored without the occurrence of suppuration. in the limbs a whole chain of the glands along the lymphatic vessels may become affected, as in farcy, phlebitis, or septic poisoning. _treatment._--fomentation with hot water and the application of camphorated soap liniment or camphorated oil may produce a revulsive action and prevent suppuration. if there is any indication of abscess forming, poultices of linseed meal and bran made into a paste with hot water should be applied, or a mild blistering ointment rubbed in over the swollen gland. as soon as fluctuation can be felt a free opening must be made for the escape of the contained pus. the wound may subsequently be washed out with a solution of chlorid of zinc, grains to the ounce of water, three times a day. lymphangitis. specific inflammation of the lymphatic structures usually affects the hind legs; very seldom a fore leg. this disease is very sudden in its attack, exceedingly painful, accompanied by a high temperature and great general disturbance. _causes._--horses of lymphatic or sluggish temperament are predisposed to this affection. it usually attacks well-fed animals, and in such cases may be due to an excess of nutritive elements in the blood. sudden changes in work or in the habits of the animal may induce an attack. _symptoms._--it is usually ushered in by a chill, rise in temperature, and some uneasiness; in a very short time this is followed by lameness in one leg and swelling on the inside of the thigh. the swelling gradually surrounds the whole limb and continues on downward until it reaches the foot. the limb is excessively tender to the touch, the animal perspires, the breathing is accelerated, pulse hard and quick, and the temperature may reach ° f. the bowels early become very constipated and urine scanty. the symptoms usually are on the increase for about two days, then they remain stationary for the same length of time; the fever then abates; the swelling recedes and becomes less painful. it is very seldom, though, that all the swelling leaves the leg; generally it leaves some permanent enlargement, and the animal becomes subject to recurrent attacks. occasionally the inguinal lymphatic glands (in the groin) undergo suppuration, and pyemia may supervene and prove fatal. in severe cases the limb becomes denuded of hair in patches, and the skin remains indurated with a fibrous growth, which is known by the name of elephantiasis. _treatment._--the parts should be bathed freely and frequently with water as hot as the hand can bear and then fomented with vinegar and water, equal parts, to which add ounces of nitrate of potassium for each gallon. this should be applied frequently, after the hot water, for the first day. afterwards the leg may be dried with a woolen cloth and bathed with camphorated soap liniment. internally administer artificial carlsbad salts in to ounce doses three times daily. feed lightly and give complete rest. this treatment, if instituted early in the attack, very frequently brings about a remarkable change within hours. diseases of the eye. by james law, f. r. c. v. s., _formerly professor of veterinary science, etc., cornell university_. we can scarcely overestimate the value of sound eyes in the horse, and hence all diseases and injuries which seriously interfere with vision are matters of extreme gravity and apprehension, for should they prove permanent they invariably depreciate the selling price to a considerable extent. a blind horse is always dangerous in the saddle or in single harness, and he is scarcely less so when, with partially impaired vision, he sees things imperfectly, in a distorted form or in a wrong place, and when he shies or avoids objects which are commonplace or familiar. when we add to this that certain diseases of the eyes, like recurring inflammation (moon blindness), are habitually transmitted from parent to offspring, we can realize still more fully the importance of these maladies. again, as a mere matter of beauty, a sound, full, clear, intelligent eye is something which must always add a high value to our equine friends and servants. structure of the eye. (pl. xxii.) the eyeball. a full description of the structure of the eye is incompatible with our prescribed limits, and yet a short description is absolutely essential to the clear understanding of what is to follow. the horse's eye is a spheroidal body, flattened behind, and with its posterior four-fifths inclosed by an opaque, white, strong fibrous membrane (the sclerotic), on the inner side of which is laid a more delicate, friable membrane, consisting mainly of blood vessels and pigment cells (the choroid), which in its turn is lined by the extremely delicate and sensitive expansion of the nerve of sight (the retina). the anterior fifth of the globe of the eye bulges forward from what would have been the direct line of the sclerotic, and thus forms a segment of a much smaller sphere than is inclosed by the sclerotic. its walls, too, have in health a perfect translucency, from which it has derived the name of transparent cornea. this transparent coat is composed, in the main, of fibers with lymph interspaces, and it is to the condition of these and their condensation and compression that the translucency is largely due. this may be shown by compressing with the fingers the eye of an ox which has just been killed, when the clear transparent cornea will suddenly become clouded over with a whitish-blue opacity, and this will remain until the compression is interrupted. the interior of the eye contains three transparent media for the refraction of the rays of light on their way from the cornea to the visual nerve. of these media the anterior one (aqueous humor) is liquid, the posterior (vitreous humor) is semisolid, and the intermediate one (crystalline lens) is solid. the space occupied by the aqueous humor corresponds nearly to the portion of the eye covered by the transparent cornea. it is, however, divided into two chambers, anterior and posterior, by the iris, a contractile curtain with a hole in the center (the pupil), and which may be looked on as in some sense a projection inward of the vascular and pigmentary coat from its anterior margin at the point where the sclerotic or opaque outer coat becomes continuous with the cornea or transparent one. this iris, or curtain, besides its abundance of blood vessels and pigment, possesses two sets of muscular fibers, one set radiating from the margin of the pupil to the outer border of the curtain at its attachment to the sclerotic and choroid, and the other encircling the pupil in the manner of a ring. the action of the two sets is necessarily antagonistic, the radiating fibers dilating the pupil and exposing the interior of the eye to view, while the circular fibers contract this opening and shut out the rays of light. the form of the pupil in the horse is ovoid, with its longest diameter from side to side, and its upper border is fringed by several minute, black bodies (corpora nigra) projecting forward and serving to some extent the purpose of eyebrows in arresting and absorbing the excess of rays of light which fall upon the eye from above. these pigmentary projections in front of the upper border of the pupil are often mistaken for the products of disease or injury in place of the normal and beneficent protectors of the nerve of sight which they are. like all other parts, they may become the seat of disease, but so long as they and the iris retain their clear, dark, aspect, without any tints of brown or yellow, they may be held to be healthy. the vitreous or semisolid refracting medium occupies the posterior part of the eye--the part corresponding to the sclerotic, choroid, and retina--and has a consistency corresponding to that of the white of an egg, and a power of refraction of the light rays correspondingly greater than the aqueous humor. the third or solid refracting medium is a biconvex lens, with its convexity greatest on its posterior surface, which is lodged in a depression in the vitreous humor, while its anterior surface corresponds to the opening of the pupil. it is inclosed in a membranous covering (capsule) and is maintained in position by a membrane (suspensory ligament) which extends from the margin of the lens outward to the sclerotic at the point of junction of the choroid and iris. this ligament is, in its turn, furnished with radiating, muscular fibers, which change the form or position of the lens so as to adapt it to see with equal clearness objects at a distance or close by. another point which strikes the observer of the horse's eye is that in the darkness a bright, bluish tinge is reflected from the widely dilated pupil. this is owing to a comparative absence of pigment in the choroid coat inside the upper part of the eyeball, and enables the animal to see and advance with security in darkness where the human eye would be of little use. the lower part of the cavity of the horse's eye, into which the dazzling rays fall from the sky, is furnished with an intensely black lining, by which the rays penetrating the inner nervous layer are instantly absorbed. muscles of the eye. these consist of four straight muscles, two oblique, and one retractor. the straight muscles pass from the depth of the orbit forward on the inner, outer, upper, and lower sides of the eyeball, and are fixed to the anterior portion of the fibrous (sclerotic) coat, so that in contracting singly they respectively turn the eye inward, outward, upward, and downward. when all act together they draw the eyeball deeply into its socket. the retractor muscle also consists of four muscular slips, repeating the straight muscles on a smaller scale, but as they are only attached on the back part of the eyeball they are less adapted to roll the eye than to draw it down into its socket. the two oblique muscles rotate the eye on its own axis, the upper one turning its outer surface upward and inward, and the lower one turning it downward and inward. the haw (the winking cartilage, or cartilago nictitans). this is a structure which, like the retractor muscle, is not found in the eye of man, but it serves in the lower animals to assist in removing foreign bodies from the front of the eyeball. it consists, in the horse, of a cartilage of irregular form, thickened inferiorly and posteriorly where it is intimately connected with the muscles of the eyeball and the fatty material around them, and expanded and flattened anteriorly where its upper surface is concave, and, as it were, molded on the lower and inner surface of the eyeball. externally it is covered by the mucous membrane which lines the eyelids and extends over the front of the eye. in the ordinary restful state of the eye the edge of this cartilage should just appear as a thin fold of membrane at the inner angle of the eye, but when the eyeball is drawn deeply into the orbit the cartilage is pushed forward, outward, and upward over it until the entire globe may be hidden from sight. this protrusion of the cartilage so as to cover the eye may be induced in the healthy eye by pressing the finger and thumb on the upper and lower lids, so as to cause retraction of the eyeball into the socket. when foreign bodies, such as sand, dust, and chaff, or other irritants, have fallen on the eyeball or eyelids it is similarly projected to push them off, their expulsion being further favored by a profuse flow of tears. [illustration: plate xxii. diagrammatic vertical section through horse's eye.] this is seen, to a lesser extent, in all painful inflammations of the eye, and to a very marked degree in lockjaw, when the spasm of the muscles of the eyeball draws the latter deeply into the orbit and projects forward the masses of fat and the cartilage. the brutal practice of cutting off this apparatus whenever it is projected necessitates this explanation, which it is hoped may save to many a faithful servant a most valuable appendage. that the cartilage and membrane may become the seat of disease is undeniable, but so long as its edge is thin and even and its surface smooth and regular the mere fact of its projection over a portion or the whole of the eyeball is no evidence of disease in its substance, nor any warrant for its removal. it is usually but the evidence of the presence of some pain in another part of the eye, which the suffering animal endeavors to assuage by the use of this beneficent provision. for the diseases of the cartilage itself, see "encephaloid cancer." lacrimal apparatus. this consists, first, of a gland for the secretion of the tears, and, second, of a series of canals for the conveyance of the superfluous tears into the cavity of the nose. the gland is situated above the outer part of the eyeball, and the tears which have flowed over the eye and reached the inner angle are there directed by a small, conical papilla (lacrimal caruncle) into two minute orifices, and thence by two ducts (lacrimal) to a small pouch (lacrimal sac) from which a canal leads through the bones of the face into the nose. this opens in the lower part of the nose on the floor of the passage and a little outside the line of union of the skin which lines the false nostril with the mucous membrane of the nose. in the ass and mule this opening is situated on the roof instead of the floor of the nose, but still close to the external opening. examination of the eye. to avoid unnecessary repetition the following general directions are given for the examination of the eye: the eye, and to a certain extent the mucous membrane lining the eyelids, may be exposed to view by gently parting the eyelids with the thumb and forefinger pressed on the middle of the respective lids. the pressure, it is true, causes the protrusion of the haw over a portion of the lower and inner part of the eye, but by gentleness and careful graduation of the pressure this may be kept within bounds, and oftentimes even the interior of the eye can be seen. as a rule it is best to use the right hand for the left eye, and the left hand for the right, the finger in each case being pressed on the upper lid while the thumb depresses the lower one. in cases in which it is desirable to examine the inner side of the eyelid further than is possible by the above means, the upper lid may be drawn down by the eyelashes with the one hand and then everted over the tip of the forefinger of the other hand, or over a probe laid flat against the middle of the lid. when the interior of the eye must be examined it is useless to make the attempt in the open sunshine or under a clear sky. the worst cases, it is true, can be seen under such circumstances, but for the slighter forms the horse should be taken indoors, where all light from above will be shut off, and should be placed so that the light may fall on the eye from the front and side. then the observer, placing himself in front of the animal, will receive the reflected rays from the cornea, the front of the lens and the back, and can much more easily detect any cloudiness, opacity, or lack of transparency. the examination can be made much more satisfactory by placing the horse in a dark chamber and illuminating the eye by a lamp placed forward and outward from the eye which is to be examined. any cloudiness is thus easily detected, and any doubt may be resolved by moving the lamp so that the image of the flame may be passed in succession over the whole surface of the transparent cornea and of the crystalline lens. three images of the flame will be seen, the larger one upright, reflected from the anterior surface of the eye; a smaller one upright, reflected from the anterior surface of the lens; and a second small one inverted from the back surface of the lens. so long as these images are reflected from healthy surfaces they will be clear and perfect in outline, but as soon as one strikes on an area of opacity it will become diffused, cloudy, and indefinite. thus, if the large, upright image becomes hazy and imperfect over a particular spot of the cornea, that will be found to be the seat of disease and opacity. should the large image remain clear, but the small upright one become diffuse and indefinite over a given point, it indicates opacity on the front of the capsule of the lens. if both upright images remain clear while the inverted one becomes indistinct at a given point, then the opacity is in the substance of the lens itself or in the posterior part of its capsule. if in a given case the pupil remains so closely contracted that the deeper parts of the eye can not be seen, the eyelids may be rubbed with extract of belladonna, and in a short time the pupil will be found widely dilated. diseases of the eyelids. congenital disorders. some faulty conditions of the eyelids are congenital, as division of an eyelid in two, after the manner of harelip, abnormally small opening between the lids, often connected with imperfect development of the eye, and closure of the lids by adhesion. the first is to be remedied by paring the edges of the division and then bringing them together, as in torn lids. the last two, if remediable at all, require separation by the knife, and subsequent treatment with a cooling astringent eyewash. nervous disorders. spasm of eyelids may be owing to constitutional susceptibility, or to the presence of local irritants (insects, chemical irritants, sand, etc.) in the eye, to wounds or inflammation of the mucous membrane, or to disease of the brain. when due to local irritation it may be temporarily overcome by instilling a few drops of a per cent solution of cocaine into the eye, when the true cause may be ascertained and removed. the nervous or constitutional disease must be treated according to its nature. drooping eyelids, or ptosis.--this is usually present in the upper lid, or is at least little noticed in the lower. it is sometimes but a symptom of paralysis of one-half of the face, in which case the ear, lips, and nostrils on the same side will be found soft, drooping, and inactive, and even the half of the tongue may partake of the palsy. if the same condition exists on both sides, there is difficult, snuffling breathing, from the air drawing in the flaps of the nostrils in inspiration, and all feed is taken in by the teeth, as the lips are useless. in both there is a free discharge of saliva from the mouth during mastication. this paralysis is a frequent result of injury, by a poke, to the seventh nerve, as it passes over the back of the lower jaw. in some cases the paralysis is confined to the lid, the injury having been sustained by the muscles which raise it, or by the supraorbital nerve, which emerges from the bone just above the eye. such injury to the nerve may have resulted from fracture of the orbital process of the frontal bone above the eyeball. the condition may, however, be due to spasm of the sphincter muscle, which closes the lids, or to inflammation of the upper lid, usually a result of blows on the orbit. in the latter case it may run a slow course with chronic thickening of the lid. the paralysis due to the poke may be often remedied, first, by the removal of any remaining inflammation by a wet sponge worn beneath the ear and kept in place by a bandage; secondly, when all inflammation has passed, by a blister on the same region, or by rubbing it daily with a mixture of olive oil and strong aqua ammonia in equal proportions. improvement is usually slow, and it may be months before complete recovery ensues. in paralysis from blows above the eyes the same treatment may be applied to that part. thickening of the lid may be treated by painting with tincture of iodin, and that failing, by cutting out an elliptical strip of the skin from the middle of the upper lid and stitching the edges together. inflammation of the eyelids. the eyelids suffer more or less in all severe inflammations of the eye, whether external or internal, but inasmuch as the disease sometimes starts in the lids and at other times is exclusively confined to them, it deserves independent mention. among the causes may be named: exposure to drafts of cold air, or to cold rain or snow storms; the bites or stings of mosquitoes, flies, or other insects; snake bites, pricks with thorns, blows of whip or club; accidental bruises against the stall or ground, especially during the violent struggles of colic, enteritis, phrenitis (staggers), and when thrown for operations. it is also a result of infecting inoculations, as of erysipelas, anthrax, boil, etc., and is noted by leblanc as especially prevalent among horses kept on low, marshy pastures. finally, the introduction of sand, dust, chaff, beards of barley and seeds of the finest grasses, and the contact with irritant, chemical powders, liquids, and gases (ammonia from manure or factory, chlorin, strong sulphur fumes, smoke, and other products of combustion, etc.) may start the inflammation. the eyelids often undergo extreme inflammatory and dropsical swelling in urticaria (nettlerash, surfeit) and in the general inflammatory dropsy known as purpura hemorrhagica. the affection will, therefore, readily divide itself into ( ) inflammations due to constitutional causes; ( ) those due to direct injury, mechanical or chemical; and ( ) such as are due to inoculation with infecting material. ( ) inflammations due to constitutional causes are distinguished by the absence of any local wound, and the history of a low, damp pasture, exposure, indigestion from unwholesome feed, or the presence elsewhere on the limbs or body of the general, doughy swellings of purpura hemorrhagica. the lids are swollen and thickened; it may be slightly or it may be so extremely that the eyeball can not be seen. if the lid can be everted to show its mucous membrane, that is seen to be of a deep-red color, especially along the branching lines of the blood vessels. the part is hot and painful, and a profuse flow of tears and mucus escapes on the side of the face, causing irritation and loss of the hair. if improvement follows, this discharge becomes more tenacious, and tends to cause adhesion to the edges of the upper and lower lids and to mat together the eyelashes in bundles. this gradually decreases to the natural amount, and the redness and congested appearance of the eye disappears, but swelling, thickening, and stiffness of the lids may continue for a time. there may be more or less fever according to the violence of the inflammation, but so long as there is no serious disease of the interior of the eye or of other vital organ, it is usually moderate. the local treatment consists in astringent, soothing lotions (sugar of lead grains, laudanum teaspoonfuls, rain water--boiled and cooled-- pint), applied with a soft cloth kept wet with the lotion, and hung over the eye by tying it to the headstall of the bridle on the two sides. if the mucous membrane lining of the lids is the seat of little red granular elevations, a drop of solution of grains of nitrate of silver in an ounce of distilled water should be applied with the soft end of a clean feather to the inside of the lid twice a day. the patient should be removed from all such conditions (pasture, faulty feed, exposure, etc.) as may have caused or aggravated the disease, and from dust and irritant fumes and gases. he should be fed from a manger high enough to favor the return of blood from the head, and should be kept from work, especially in a tight collar which would prevent the descent of blood by the jugular veins. the diet should be laxative and nonstimulating (grass, bran mashes, carrots, turnips, beets, potatoes, or steamed hay), and any costiveness should be corrected by a mild dose of raw linseed oil ( to - / pints). in cold weather warm blanketing may be needful, and even loose flannel bandages to the limbs, but heat should never be sought at the expense of pure air. ( ) in inflammations due to local irritants of a noninfective kind a careful examination will usually reveal their presence, and the first step must be their removal with a pair of blunt forceps or the point of a lead pencil. subsequent treatment will be in the main the local treatment advised above. ( ) in case of infective inflammation there will often be found a prick or tear by which the septic matter has entered, and in such case the inflammation will for a time be concentrated at that point. a round or conical swelling around an insect bite is especially characteristic. a snake bite is marked by the double prick made by the two teeth and by the violent and rapidly spreading inflammation. erysipelas is attended with much swelling, extending beyond the lids and causing the mucous membrane to protrude beyond the edge of the eyelid (chemosis). this is characterized by a bright, uniform, rosy red, disappearing on pressure, or later by a dark, livid hue, but with less branching redness than in noninfecting inflammation and less of the dark, dusky, brownish or yellowish tint of anthrax. little vesicles may appear on the skin, and pus may be found without any distinct limiting membrane, as in abscess. it is early attended with high fever and marked general weakness and inappetence. anthrax of the lids is marked by a firm swelling, surmounted by a blister, with bloody serous contents, which tends to burst and dry up into a slough, while the surrounding parts become involved in the same way. or it may show as a diffuse, dropsical swelling, with less of the hard, central sloughing nodule, but, like that, tending to spread quickly. in both cases alike the mucous membrane and the skin, if white, assumes a dusky-brown or yellowish-brown hue, which is largely characteristic. this may pass into a black color by reason of extravasation of blood. great constitutional disturbance appears early, with much prostration and weakness and generalized anthrax symptoms. _treatment._--the treatment will vary according to the severity. insect bites may be touched with a solution of equal parts of glycerin and aqua ammonia, or a per cent solution of carbolic acid in water. snake bites may be bathed with aqua ammonia, and the same agent given in doses of teaspoonfuls in a quart of water, or alcohol may be given in pint or quart doses, according to the size of the animal. in erysipelas the skin may be painted with tincture of chlorid of iron, or with a solution of grains of iodin in an ounce of carbolic acid, and one-half an ounce of tincture of chlorid of iron may be given thrice daily in a bottle of water. in anthrax the swelling should be painted with tincture of iodin, or of the mixture of iodin and carbolic acid, and if very threatening it may have the tincture of iodin injected into the swelling with a hypodermic syringe, or the hard mass may be freely incised to its depth with a sharp lancet and the lotion applied to the exposed tissues. internally, iodid of potassium may be given in doses of drams thrice a day, or tincture of the chlorid of iron every four hours. sty, or furuncle (boil) of the eyelid. this is an inflammation of limited extent, advancing to the formation of matter and the sloughing out of a small mass of the natural tissue of the eyelid. it forms a firm, rounded swelling, usually near the margin of the lid, which suppurates and bursts in four or five days. its course may be hastened by a poultice of camomile flowers, to which have been added a few drops of carbolic acid, the whole applied in a very thin muslin bag. if the swelling is slow to open after having become yellowish white, it may be opened by a lancet, the incision being made at right angles to the margin of the lid. entropion and ectropion, or inversion and eversion of the eyelid. these are respectively caused by wounds, sloughs, ulcers, or other causes of loss of substance of the mucous membrane on the inside of the lid and of the skin on the outside; also of tumors, skin diseases, or paralysis which leads to displacement of the margin of the eyelid. as a rule, they require a surgical operation, with removal of an elliptical portion of the mucous membrane or skin, as the case may be, but which requires the skilled and delicate hand of the surgeon. trichiasis. this consists in the turning in of the eyelashes so as to irritate the front of the eye. if a single eyelash, it may be snipped off with scissors close to the margin of the eyelid or pulled out by the root with a pair of flat-bladed forceps. if the divergent lashes are more numerous, the treatment may be as for entropion, by excising an elliptical portion of skin opposite the offending lashes and stitching the edges together, so as to draw outward the margin of the lid at that point. warts and other tumors of the eyelids. the eyelids form a favorite site for tumors, and above all, warts, which consist in a simple diseased overgrowth (hypertrophy) of the surface layers of the skin. if small, they may be snipped off with scissors or tied around the neck with a stout, waxed thread and left to drop off, the destruction being completed, if necessary, by the daily application of a piece of sulphate of copper (blue vitriol), until any unhealthy material has been removed. if more widely spread, the wart may still be clipped off with curved scissors or knife, and the caustic thoroughly applied day by day. a bleeding wart, or erectile tumor, is more liable to bleed, and is best removed by constricting its neck with the waxed cord or rubber band, or if too broad it may be transfixed through its base by a needle armed with a double thread, which is then to be cut in two and tied around the two portions of the neck of the tumor. if still broader, the armed needle may be carried through the base of the tumor at regular intervals, so that the whole may be tied in moderately sized sections. in gray and in white horses black, pigmentary tumors (melanotic) are common on the black portions of skin, such as the eyelids, and are to be removed by scissors or knife, according to their size. in the horse they do not usually tend to recur when thoroughly removed, but at times they prove cancerous (as is the rule in man), and then they tend to reappear in the same site or in internal organs with, it may be, fatal effect. encysted, honeylike (melicerous), sebaceous, and fibrous tumors of the lids all require removal with the knife. torn eyelids or wounds of eyelids. the eyelids are torn by attacks with horns of cattle, or with the teeth, or by getting caught on nails in stall, rack, or manger, on the point of stumps, fences, or fence rails, on the barbs of wire fences, and on other pointed bodies. the edges should be brought together as promptly as possible, so as to effect union without the formation of matter, puckering of the skin, and unsightly distortions. great care is necessary to bring the two edges together evenly without twisting or puckering. the simplest mode of holding them together is by a series of sharp pins passed through the lips of the wound at intervals of not more than a third of an inch, and held together by a thread twisted around each pin in the form of the figure , and carried obliquely from pin to pin in two directions, so as to prevent gaping of the wound in the intervals. the points of the pins may then be cut off with scissors, and the wound may be wet twice a day with a weak solution of carbolic acid. tumor of the haw, or caries of the cartilage. though cruelly excised for alleged "hooks," when itself perfectly healthy, in the various diseases which lead to retraction of the eye into its socket, the haw may, like other bodily structures, be itself the seat of actual disease. the pigmentary, black tumors of white horses and soft (encephaloid) cancer may attack this part primarily or extend to it from the eyeball or eyelids; hairs have been found growing from its surface, and the mucous membrane covering it becomes inflamed in common with that covering the front of the eye. these inflammations are but a phase of the inflammation of the external structures of the eye, and demand no particular notice nor special treatment. the tumors lead to such irregular enlargement and distortion of the haw that the condition is not to be confounded with the simple projection of the healthy structure over the eye when the lids are pushed apart with the finger and thumb, and the same remark applies to the ulceration, or caries, of the cartilage. in the latter case, besides the swelling and distortion of the haw, there is this peculiarity, that in the midst of the red inflamed mass there appears a white line or mass formed by the exposed edge of the ulcerating cartilage. the animal having been thrown and properly fixed, an assistant holds the eyelids apart while the operator seizes the haw with forceps or hook and carefully dissects it out with blunt-pointed scissors. the eye is then covered with a cloth, kept wet with an eyewash, as for external ophthalmia. obstruction of the lacrimal apparatus, or watering eye. the escape of tears on the side of the cheek is a symptom of external inflammation of the eye, but it may also occur from any disease of the lacrimal apparatus which interferes with the normal progress of the tears to the nose; hence, in all cases when this symptom is not attended with special redness or swelling of the eyelids, it is well to examine the lacrimal apparatus. in some instances the orifice of the lacrimal duct on the floor of the nasal chamber and close to its anterior outlet will be found blocked by a portion of dry mucopurulent matter, on the removal of which tears may begin to escape. this implies an inflammation of the canal, which may be helped by occasional sponging out of the nose with warm water, and the application of the same on the face. another remedy is to feed warm mashes of wheat bran from a nosebag, so that the relaxing effects of the water vapor may be secured. the two lacrimal openings, situated at the inner angle of the eye, may fail to admit the tears by reason of their deviation outward in connection with the eversion of the lower lid or by reason of their constriction in inflammation of the mucous membrane. the lacrimal sac, into which the lacrimal ducts open, may fail to discharge its contents by reason of constriction or closure of the duct leading to the nose, and it then forms a rounded swelling beneath the inner angle of the eye. the duct leading from the sac to the nose may be compressed or obliterated by fractures of the bones of the face, and in disease of these bones (osteosarcoma, so-called osteoporosis, diseased teeth, glanders of the nasal sinuses, abscess of the same cavities). the narrowed or obstructed ducts may be made pervious by a fine, silver probe passed down to the lacrimal sac, and any existing inflammation of the passages may be counteracted by the use of steaming mashes of wheat bran, by fomentations or wet cloths over the face, and even by the use of astringent eyewashes and the injection of similar liquids into the lacrimal canal from its nasal opening. the ordinary eyewash may be used for this purpose, or it may be injected after dilution to half its strength. the fractures and diseases of the bones and teeth must be treated according to their special demands when, if the canal is still left pervious, it may be again rendered useful. external ophthalmia, or conjunctivitis. in inflammation of the outer parts of the eyeball the exposed vascular and sensitive mucous membrane (conjunctiva) which covers the ball, the eyelids, the haw, and the lacrimal apparatus, is usually the most deeply involved, yet adjacent parts are more or less implicated, and when disease is concentrated on these contiguous parts it constitutes a phase of external opththalmia which demands a special notice. these have accordingly been already treated of. _causes._--the causes of external opththalmia are mainly those that act locally--blows with whips, clubs, and twigs, the presence of foreign bodies, like hayseed, chaff, dust, lime, sand, snuff, pollen of plants, flies attracted by the brilliancy of the eye, wounds of the bridle, the migration of the scabies (mange) insect into the eye, smoke, ammonia arising from the excretions, irritant emanations from drying marshes, etc. road dust containing infecting microbes is a common factor. a very dry air is alleged to act injuriously by drying the eye as well as by favoring the production of irritant dust; the undue exposure to bright sunshine through a window in front of the stall, or to the reflection from snow or water, also is undoubtedly injurious. the unprotected exposure of the eyes to sunshine through the use of a very short overdraw check is to be condemned, and the keeping of the horse in a very dark stall, from which it is habitually led into the glare of full sunlight, intensified by reflection from snow or white limestone, must be set down among the locally acting causes. exposure to cold and wet, to wet and snow storms, to cold drafts and wet lairs must also be accepted as causes of conjunctivitis, the general disorder which they produce affecting the eye, if that happens to be the weakest and most susceptible organ of the body, or if it has been subjected to any special local injury, like dust, irritant gases, or excess of light. again, external opththalmia is a constant concomitant of inflammation of the contiguous and continuous mucous membranes, as those of the nose and throat--hence the red, watery eyes that attend on nasal catarrh, sore throat, influenza, strangles, nasal glanders, and the like. in such cases, however, the affection of the eye is subsidiary and is manifestly overshadowed by the primary and predominating disease. _symptoms._--the symptoms are watering of the eye, swollen lids, redness of the mucous membrane exposed by the separation of the lids--it may be a mere pink blush with more or less branching redness, or it may be a deep, dark red, as from effusion of blood--and a bluish opacity of the cornea, which is normally clear and translucent. except when resulting from wounds and actual extravasation of blood, however, the redness is seen to be superficial, and if the opacity is confined to the edges, and does not involve the entire cornea, the aqueous humor behind is seen to be still clear and limpid. the fever is always less severe than in internal ophthalmia, and runs high only in the worst cases. the eyelids may be kept closed, the eyeball retracted, and the haw protruded over one-third or one-half of the ball, but this is due to the pain only and not to any excessive sensibility to light, as shown by the comparatively widely dilated pupil. in internal ophthalmia, on the contrary, the narrow, contracted pupil is the measure of the pain caused by the falling of light on the inflamed and sensitive optic nerve (retina) and choroid. if the affection has resulted from a wound of the cornea, not only is that the point of greatest opacity, forming a white speck or fleecy cloud, but too often blood vessels begin to extend from the adjacent vascular covering of the eye (sclerotic) to the white spot, and that portion of the cornea is rendered permanently opaque. again, if the wound has been severe, though still short of cutting into the anterior layers of the cornea, the injury may lead to ulceration that may penetrate more or less deeply and leave a breach in the tissue which, if filled up at all, is repaired by opaque fibrous tissue in place of the transparent cellular structure. pus may form, and the cornea assumes a yellowish tinge and bursts, giving rise to a deep sore which is liable to extend as an ulcer, and may be in its turn followed by bulging of the cornea at that point (staphyloma). this inflammation of the conjunctiva may be simply catarrhal, with profuse mucopurulent discharge; it may be granular, the surface being covered with minute reddish elevations, or it may become the seat of a false membrane (diphtheria). _treatment._--in treating external ophthalmia the first object is the removal of the cause. remove any dust, chaff, thorn, or other foreign body from the conjunctiva, purify the stable from all sources of ammoniacal or other irritant gas; keep the horse from dusty roads, and, above all, from the proximity of a leading wagon and its attendant cloud of dust; remove from pasture and feed from a rack which is neither so high as to drop seeds, etc., into the eyes nor so low as to favor the accumulation of blood in the head; avoid equally excess of light from a sunny window in front of the stall and excess of darkness from the absence of windows; preserve from cold drafts and rains and wet bedding, and apply curative measures for inflammation of the adjacent mucous membranes or skin. if the irritant has been of a caustic nature, remove any remnant of it by persistent bathing with tepid water and a soft sponge, or with water mixed with white of egg, or a glass filled with the liquid may be inverted over the eye so that its contents may dilute and remove the irritant. if the suffering is very severe, a lotion with a few grains of extract of belladonna or of morphia in an ounce of water may be applied, or, if it is available, a few drops of per cent solution of cocaine may be instilled into the eye. in strong, vigorous patients benefit will usually be obtained from a laxative, such as tablespoonfuls of glauber's salt daily, and if the fever runs high from a daily dose of half an ounce of saltpeter. as local applications, astringent solutions are usually the best, as grains of borax or of sulphate of zinc in a quart of water, to be applied constantly on a cloth, as advised under "inflammation of the eyelids." in the absence of anything better, cold water may serve every purpose. above all, adhesive and oily agents (molasses, sugar, fats) are to be avoided, as only adding to the irritation. by way of suggesting agents that may be used with good effect, salt and sulphate of soda may be named, in solutions double the strength of sulphate of zinc, or grains of nitrate of silver may be added to a quart of distilled water, and will be found especially applicable in granular conjunctivitis, diphtheria, or commencing ulceration. a cantharides blister ( part of spanish fly to parts lard) may be rubbed on the side of the face inches below the eye, and washed off next morning with soapsuds and oiled daily till the scabs are dropped. white specks and cloudiness of the cornea. as a result of external ophthalmia, opaque specks, clouds, or haziness are too often left on the cornea and require for their removal that they be daily touched with a soft feather dipped in a solution of grains nitrate of silver in ounce distilled water. this should be applied until all inflammation has subsided, and until its contact is comparatively painless. it is rarely successful with an old, thick scar following an ulcer, nor with an opacity having red blood vessels running across it. ulcers of the cornea. these may be treated with nitrate of silver lotion of twice the strength used for opacities. powdered gentian, one-half ounce, and sulphate of iron, one-fourth ounce, daily, may improve the general health and increase the reparatory power. internal ophthalmia (iritis, choroiditis, and retinitis). although inflammations of the iris, choroid, and retina--the inner, vascular, and nervous coats of the eye--occur to a certain extent independently of each other, yet one usually supervenes upon the other, and, as the symptoms are thus made to coincide, it will be best for our present purposes to treat the three as one disease. _causes._--the causes of internal ophthalmia are largely those of the external form only, acting with greater intensity or on a more susceptible eye. severe blows, bruises, punctures, etc., of the eye, the penetration of foreign bodies into the eye (thorns, splinters of iron, etc.), sudden transition from a dark stall to bright sunshine, to the glare of snow or water, constant glare from a sunny window, abuse of the overdraw checkrein, vivid lightning flashes, drafts of cold, damp air; above all, when the animal is perspiring, exposure in cold rain or snowstorms, swimming cold rivers; also certain general diseases like rheumatism, arthritis, influenza, and disorders of the digestive organs, may become complicated by this affection. from the close relation between the brain and eye--alike in the blood vessels and nerves--disorders of the first lead to affection of the second, and the same remark applies to the persistent irritation to which the jaws are subjected in the course of dentition. so potent is the last agency that we dread a recurrence of ophthalmia so long as dentition is incomplete, and hope for immunity if the animal completes its dentition without any permanent structural change in the eye. _symptoms._--the symptoms will vary according to the cause. if the attack is due to direct physical injury, the inflammation of the eyelids and superficial structures may be quite as marked as that of the interior of the eye. if, on the other hand, from general causes, or as a complication of some distant disease, the affection may be largely confined to the deeper structures, and the swelling, redness, and tenderness of the superficial structures will be less marked. when the external coats thus comparatively escape, the extreme anterior edge of the white or sclerotic coat, where it overlaps the border of the transparent cornea, is in a measure free from congestion, and, in the absence of the obscuring dark pigment, forms a whitish ring around the cornea. this is partly due to the fact that a series of arteries (ciliary) passing to the inflamed iris penetrate the sclerotic coat a short distance behind its anterior border, and there is therefore a marked difference in color between the general sclerotic occupied between these congested vessels and the anterior rim from which they are absent. unfortunately, the pigment is often so abundant in the anterior part of the sclerotic as to hide this symptom. in internal ophthalmia the opacity of the cornea may be confined to a zone around the outer margin of the cornea, and even this may be a bluish haze rather than a deep, fleecy white. in consequence it becomes impossible to see the interior of the chamber for the aqueous humor and the condition of the iris and pupil. the aqueous humor is usually turbid, and has numerous yellowish-white flakes floating on its substance or deposited in the lower part of the chamber, so as to cut off the view of the lower portion of the iris. the still visible portion of the iris has lost its natural, clear, dark luster, which is replaced by a brownish or yellowish sere-leaf color. this is more marked in proportion as the iris is inflamed, and less so as the inflammation is confined to the choroid. the quantity of flocculent deposit in the chamber of the aqueous humor is also in direct ratio to the inflammation of the iris. perhaps the most marked feature of internal ophthalmia is the extreme and painful sensitiveness to light. on this account the lids are usually closed, but when opened the pupil is seen to be narrowly closed, even if the animal has been kept in a darkened stall. exceptions to this are seen when inflammatory effusion has overfilled the globe of the eye, and by pressure on the retina has paralyzed it, or when the exudation into the substance of the retina itself has similarly led to its paralysis. then the pupil may be dilated, and frequently its margin loses its regular, ovoid outline and becomes uneven by reason of the adhesions which it has contracted with the capsule of the lens, through its inflammatory exudations. in the case of excessive effusion into the globe of the eye that is found to have become tense and hard so that it can not be indented with the tip of the finger, paralysis of the retina is liable to result. with such paralysis of the retina, vision is heavily clouded or entirely lost; hence, in spite of the open pupil, the finger may be approached to the eye without the animal's becoming conscious of it until it touches the surface, and if the nose on the affected side is gently struck and a feint made to repeat the blow the patient makes no effort to evade it. sometimes the edges of the contracted pupil become adherent to each other by an intervening plastic exudation, and the opening becomes virtually abolished. in severe inflammations pus may form in the choroid or iris, and escaping into the cavity of the aqueous humor show as a yellowish-white stratum below. in nearly all cases there is resulting exudation into the lens or its capsule, constituting a cloudiness or opacity (cataract), which in severe and old-standing cases appears as a white, fleecy mass behind a widely dilated pupil. in the slighter cases cataract is to be recognized by examination of the eye in a dark chamber, with an oblique side light, as described in the introduction to this article. cataracts that appear as a simple haze or indefinite, fleecy cloud are usually on the capsule (capsular), while those that show a radiating arrangement are in the lens (lenticular), the radiating fibers of which the exudate follows. black cataracts are formed by the adhesion of the pigment on the back of the iris to the front of the lens, and by the subsequent tearing loose of the iris, leaving a portion of its pigment adherent to the capsule of the lens. if the pupil is so contracted that it is impossible to see the lens, it may be dilated by applying to the front of the eye with a feather some drops of a solution of grains of atropia in an ounce of water. _treatment._--the treatment of internal ophthalmia should embrace, first, the removal of all existing causes or sources of aggravation of the disease, which need not be repeated here. special care to protect the patient against strong light, cold, wet weather, and active exertion must, however, be insisted on. a dark stall and a cloth hung over the eye are important, while cleanliness, warmth, dryness, and rest are equally demanded. if the patient is strong and vigorous, a dose of drams of barbados aloes may be given, and if there is any reason to suspect a rheumatic origin one-half a dram powdered colchicum and one-half ounce salicylate of soda may be given daily. locally the astringent lotions advised for external ophthalmia may be resorted to, especially when the superficial inflammation is well marked. more important, however, is to instill into the eye, a few drops at a time, a solution of grains of atropia in ounce of distilled water. this may be effected with the aid of a soft feather, and may be repeated at intervals of minutes until the pupil is widely dilated. as the horse is to be kept in a dark stall, the consequent admission of light will be harmless, and the dilation of the pupil prevents adhesion between the iris and lens, relieves the constant tension of the eye in the effort to adapt the pupil to the light, and solicits the contraction of the blood vessels of the eye and the lessening of congestion, exudation, and intraocular pressure. should atropia not agree with the case, it may be replaced by morphia (same strength) or cocaine in per cent solution. another local measure is a blister, which can usually be applied to advantage on the side of the nose or beneath the ear. spanish flies may be used as for external ophthalmia. in very severe cases the parts beneath the eye may be shaved and three or four leeches applied. setons are sometimes beneficial, and even puncture of the eyeball, but these should be reserved for professional hands. the diet throughout should be easily digestible and moderate in quantity--bran mash, middlings, grass, steamed hay, etc. even after the active inflammation has subsided the atropia lotion should be continued for several weeks to keep the eye in a state of rest in its still weak and irritable condition, and during this period the patient should be kept in semidarkness, or taken out only with a dark shade over the eye. for the same reason heavy drafts and, rapid paces, which would cause congestion of the head, should be carefully avoided. recurrent ophthalmia (periodic ophthalmia, or moon-blindness). this is an inflammatory affection of the interior of the eye, intimately related to certain soils, climates, and systems, showing a strong tendency to recur again and again, and usually ending in blindness from cataract or other serious injury. _causes._--its causes may be fundamentally attributed to soil. on damp clays and marshy grounds, on the frequently overflowed river bottoms and deltas, on the coasts of seas and lakes alternately submerged and exposed, this disease prevails extensively, and in many instances in france (reynal), belgium, alsace (zundel, miltenberger), germany, and england it has very largely decreased under land drainage and improved methods of culture. other influences, more or less associated with such soil, are potent causative factors. thus damp air and a cloudy, wet climate, so constantly associated with wet lands, are universally charged with causing the disease. these act on the animal body to produce a lymphatic constitution with an excess of connective tissue, bones, and muscles of coarse, open texture, thick skins, and gummy legs covered with a profusion of long hair. hence the heavy horses of belgium and southwestern france have suffered severely from the affection, while high, dry lands adjacent, like catalonia, in spain, and dauphiny, provence, and languedoc; in france, have in the main escaped. the rank, aqueous fodders grown on such soils are other causes, but these again are calculated to undermine the character of the nervous and sanguineous temperament and to superinduce the lymphatic. other feeds act by leading to constipation and other disorders of the digestive organs, thus impairing the general health. hence in any animal predisposed to this disease, heating, starchy feeds, such as maize, wheat, and buckwheat, are to be carefully avoided. it has been widely charged that beans, peas, vetches, and other leguminosæ are dangerous, but a fuller inquiry contradicts the statement. if these feeds are well grown, they invigorate and fortify the system, while, like any other fodder, if grown rank; aqueous, and deficient in assimilable principles, they tend to lower the health and open the way for the disease. the period of dentition and training is a fertile exciting cause, for though the malady may appear at any time from birth to old age, yet the great majority of victims are from to years old, and if a horse escapes the affection till after there is a reasonable hope that he will continue to resist it. the irritation about the head during the eruption of the teeth, and while fretting in the unwonted bridle and collar, the stimulating grain diet and the close air of the stable all combine to rouse the latent tendency to disease in the eye, while direct injuries by bridle, whip, or hay seeds are not without their influence. in the same way local irritants, like dust, severe rain and snow storms, smoke, and acrid vapors are contributing causes. it is evident, however, that no one of these is sufficient of itself to produce the disease, and it has been alleged that the true cause is a microbe, or the irritant products of a microbe, which is harbored in the marshy soil. the prevalence of the disease on the same damp soils which produce ague in man and anthrax in cattle has been quoted in support of this doctrine, as also the fact that, other things being equal, the malady is always more prevalent in basins surrounded by hills where the air is still and such products are concentrated, and that a forest or simple belt of trees will, as in ague, at times limit the area of its prevalence. another argument for the same view is found in the fact that on certain farms irrigated by town sewage this malady has become extremely prevalent, the sewage being assumed to form a suitable nidus for the growth of the germ. but on these sewage farms a fresh crop may be cut every fortnight, and the product is precisely that aqueous material which contributes to a lymphatic structure and a low tone of health. the presence of a definite germ in the system has not yet been proved, and in the present state of our knowledge we are only warranted in charging the disease to the deleterious emanations from the marshy soil in which bacterial ferments are constantly producing them. heredity is one of the most potent causes. the lymphatic constitution is of course transmitted and with it the proclivity to recurring ophthalmia. this is notorious in the case of both parents, male and female. the tendency appears to be stronger, however, if either parent has already suffered. thus a mare may have borne a number of sound foals, and then fallen a victim to the malady, and all foals subsequently borne have likewise suffered. so it is in the case of the stallion. reynal even quotes the appearance of the disease in alternate generations, the stallion offspring of blind parents remaining sound through life and yet producing foals which furnish numerous victims of recurrent ophthalmia. on the contrary, the offspring of diseased parents removed to high, dry regions and furnished with wholesome, nourishing rations will nearly all escape. hence the dealers take colts that are still sound or have had but one attack from the affected low pyrenees (france) to the unaffected catalonia (spain), with confidence that they will escape, and from the jura valley to dauphiny with the same result. yet the hereditary taint is so strong and pernicious that intelligent horsemen everywhere refuse to breed from either horse or mare that has once suffered from recurrent ophthalmia, and the french government studs not only reject all unsound stallions, but refuse service to any mare which has suffered with her eyes. it is this avoidance of the hereditary predisposition more than anything else that has reduced the formerly wide prevalence of this disease in the european countries generally. a consideration for the future of our horses would demand the disuse of all sires that are unlicensed, and the refusal of a license to any sire which has suffered from this or any other communicable constitutional disease. other contributing causes deserve passing mention. unwholesome feed and a faulty method of feeding undoubtedly predisposes to the disease, and in the same district the carefully fed will escape in far larger proportion than the badly fed; it is so also with every other condition which undermines the general health. the presence of worms in the intestines, overwork, and debilitating diseases and causes of every kind weaken the vitality and lay the system more open to attack. thierry long ago showed that the improvement of close, low, dark, damp stables, where the disease had previously prevailed, practically banished the affection. whatever contributes to strength and vigor is protective; whatever contributes to weakness and poor health is provocative of the disease in the predisposed subject. _symptoms._--the symptoms vary according to the severity of the attack. in some cases there is marked fever, and in some slighter cases it may be almost altogether wanting, but there is always a lack of vigor and energy, bespeaking general disorder. the local symptoms are in the main those of internal ophthalmia, in many cases with an increased hardness of the eyeball from effusion into its cavity. the contracted pupil does not expand much in darkness, nor even under the action of belladonna. opacity advances from the margin, over a part or whole of the cornea, but so long as it is transparent there may be seen the turbid, aqueous humor with or without flocculi, the dingy iris robbed of its clear, black aspect, the slightly clouded lens, and a greenish-yellow reflection from the depth of the eye. from the fifth to the seventh day the flocculi precipitate in the lower part of the chamber, exposing more clearly the iris and lens, and absorption commences, so that the eye may be cleared up in ten or fifteen days. the characteristic of the disease is, however, its recurrence again and again in the same eye until blindness results. the attacks may follow one another after intervals of a month, more or less, but they show no relation to any particular phase of the moon, as might be inferred from the familiar name, but are determined rather by the weather, the health, the feed, or by some periodicity of the system. from five to seven attacks usually result in blindness, and then the second eye is liable to be attacked until it also is ruined. in the intervals between the attacks some remaining symptoms betray the condition, and they become more marked after each successive access of disease. even after the first attack there is a bluish ring around the margin of the transparent cornea. the eye seems smaller than the other, at first because it is retracted in its socket, and often after several attacks because of actual shrinkage (atrophy). the upper eyelid, in place of presenting a uniform, continuous arch, has, about one-third from its inner angle, an abrupt bend, caused by the contraction of the levator muscle. the front of the iris has exchanged some of its dark, clear brilliancy for a lusterless yellow, and the depth of the eye presents more or less of the greenish-yellow shade. the pupil remains a little contracted, except in advanced and aggravated cases, when, with opaque lens, it is widely dilated. if, as is common, one eye only has suffered, the contrast in these respects with the sound eye is all the more characteristic. another feature is the erect, attentive carriage of the ear, to compensate to some extent for the waning vision. the attacks vary greatly in severity in different cases, but the recurrence is characteristic, and all alike lead to cataract and intraocular effusion, with pressure on the retina and abolition of sight. _prevention._--the prevention of this disease is the great object to be aimed at, and this demands the most careful breeding, feeding, housing, and general management, as indicated under "causes." much can also be done by migration to a high, dry location, but for this and malarious affections the improvement of the land by drainage and good cultivation should be the final aim. _treatment_ is not satisfactory, but is largely the same as for common internal ophthalmia. some cases, like rheumatism, are benefited by -scruple doses of powdered colchicum and -dram doses of salicylate of soda twice a day. in other cases, with marked hardness of the globe of the eye from intraocular effusion, aseptic puncture of the eye, or even the excision of a portion of the iris, has helped. during recovery a course of tonics ( drams oxid of iron, grains nux vomica, and ounce sulphate of soda daily) is desirable to invigorate the system and help to ward off another attack. the vulgar resort to knocking out the wolf teeth and cutting out the haw can only be condemned. the temporary recovery would take place in one or two weeks, though no such thing had been done, and the breaking of a small tooth, leaving its fang in the jaw, only increases the irritation. cataract. the common result of internal ophthalmia, as of the recurrent type, may be recognized as described under the first of these diseases. its offensive appearance may be obviated by extraction or depression of the lens, but as the rays of light would no longer be properly refracted, perfect vision would not be restored, and the animal would be liable to prove an inveterate shyer. if perfect blindness continued by reason of pressure on the nerve of sight, no shying would result. palsy of the nerve of sight, or amaurosis. _causes._--the causes of this affection are tumors or other disease of the brain implicating the roots of the optic nerve, injury to the nerve between the brain and eye, and inflammation of the optic nerve within the eye (retina), or undue pressure on the same from dropsical or inflammatory effusion. it may also occur from overloaded stomach, from a profuse bleeding, and even from the pressure of the gravid womb in gestation. _symptoms._--the symptoms are wide dilatation of the pupils, so as to expose fully the interior of the globe, the expansion remaining the same in light and darkness. ordinary eyes when brought to the light have the pupils suddenly contract and then dilate and contract alternately until they adapt themselves to the light. the horse does not swerve when a feint to strike is made unless the hand causes a current of air. the ears are held erect, turn quickly toward any noise, and the horse steps high to avoid stumbling over objects which it can not see. _treatment_ is only useful when the disease is symptomatic of some removable cause, like congested brain, overloaded stomach, or gravid womb. when recovery does not follow the termination of these conditions, apply a blister behind the ear and give one-half dram doses of nux vomica daily. tumors of the eyeball. a variety of tumors attack the eyeball--dermoid, papillary, fatty, cystic, and melanotic--but perhaps the most frequent in the horse is encephaloid cancer. this may grow in or on the globe, the haw, the eyelid, or the bones of the orbit, and can be remedied, if at all, only by early and thorough excision. it may be distinguished from the less dangerous tumors by its softness, friability, and great vascularity, bleeding on the slightest touch, as well as by its anatomical structure. staphyloma. this consists in a bulging forward of the cornea at a given point by the sacculate yielding and distention of its coats, and it may be either transparent or opaque and vascular. in the last form the iris has become adherent to the back of the cornea, and the whole structure is filled with blood vessels. in the first form the bulging cornea is attenuated; in the last it may be thickened. the best treatment is by excision of a portion of the rise so as to relieve the intraocular pressure. parasites in the eye. acari in the eye have been incidentally alluded to under inflammation of the lids. _filaria palpebralis_ is a white worm, one-half to inch long, which inhabits the lacrimal duct and the underside of the eyelids and haw in the horse, producing a verminous conjunctivitis. the first step in treatment in such cases is to remove the worm with forceps, then treat as for external inflammation. _setaria equina_ is a delicate, white, silvery-looking worm, which i have repeatedly found inches in length (a length as great as inches has been reported). it invades the aqueous humor, where its constant active movements make it an object of great interest, and it is frequently exhibited as a "snake in the eye."[ ] when present in the eye it causes inflammation and has to be removed through an incision made with the lancet in the upper border of the cornea close to the sclerotic, the point of the instrument being directed slightly forward to avoid injury to the iris. then cold water or astringent antiseptic lotions should be applied. _filaria conjunctivæ_, resembling _setaria equina_ very much in size and general appearance, is another roundworm which has been found in the eye of the horse. the echinococcus, the cystic or larval stage of the echinococcus tapeworm of the dog, has been found in the eye of the horse, and a cysticercus is also reported. footnotes: [ ] this worm is normally a parasite of the peritoneal cavity, and is probably transmitted from one horse to another by some biting insect which becomes infected by embryos in the blood.--m. c. hall. lameness: its causes and treatment. by a. liautard, m. d., v. m., _formerly principal of the american veterinary college, new york._ [revised by john r. mohler, a. m., v. m. d.] it is as living, organized, locomotive machines that the horse, camel, ox, and their burden-bearing companions are of practical value to man. hence the consideration of their usefulness and consequent value to their human masters ultimately and naturally resolves itself into an inquiry concerning the condition of that special portion of their organism which controls their function of locomotion. this is especially true in regard to the members of the equine family, the most numerous and valuable of all the beasts of burden, and it naturally follows that with the horse for a subject of discussion the special topic and leading theme of inquiry, by an easy lapse, will become an inquest into the condition and efficiency of his power for usefulness as a carrier or traveler. there is a great deal of abstract interest in the study of that endowment of the animal economy which enables its possessor to change his place at will and convey himself whithersoever his needs or his moods may incline him; how much greater, however, the interest that attaches to the subject when it becomes a practical and economic question and includes within its purview the various related topics which belong to the domains of physiology, pathology, therapeutics, and the entire round of scientific investigation into which it is finally merged as a subject for medical and surgical consideration--in a word, of actual disease and its treatment. it is not surprising that the intricate and complicated apparatus of locomotion, with its symmetry and harmony of movement and the perfection and beauty of its details and adjuncts, by students of creative design and attentive observers or nature and her marvelous contrivances and adaptations, should be admiringly denominated a living machine. of all the animal tribe the horse, in a state of domesticity, is the largest sharer with his master in his liability to the accidents and dangers which are among the incidents of civilized life. from his exposure to the missiles of war on the battlefield to his chance of picking up a nail from the city pavement there is no hour when he is not in danger of incurring injuries which for their repair may demand the best skill of the veterinary practitioner. this is true not alone of casualties which belong to the class of external and traumatic cases, but includes as well those of a kind perhaps more numerous, which may result in lesions of internal parts, frequently the most serious and obscure of all in their nature and effects. the horse is too important a factor in the practical details of human life and fills too large a place in the business and pleasure of the world to justify any indifference to his needs and physical comfort or neglect in respect to the preservation of his peculiar powers for usefulness. in entering somewhat largely, therefore, upon a review of the subject, and treating in detail of the causes, the symptoms, the progress, the treatment, the results, and the consequences of lameness in the horse, we are performing a duty which needs no word of apology or justification. the subject explains and justifies itself, and is its own vindication and illustration, if any are needed. the function of locomotion is performed by the action of two principal systems of organs, known in anatomical and physiological terminology as passive and active, the muscles performing the active and the bones the passive portion of the movement. the necessary connection between the cooperating parts of the organism is effected by means of a vital contact by which the muscle is attached to the bone at certain determinate points on the surface of the latter. these points of attachment appear sometimes as an eminence, sometimes as a depression, sometimes a border or an angle, or again as a mere roughness, but each perfectly fulfilling its purpose, while the necessary motion is provided for by the formation of the ends of the long bones into the requisite articulations, joints, or hinges. every motion is the product of the contraction of one or more of the muscles, which, as it acts upon the bony levers, gives rise to a movement of extension or flexion, abduction or adduction, rotation or circumduction. the movement of abduction is that which passes from and that of adduction that which passes toward the median line, or the center of the body. the movements of flexion and extension are too well understood to need defining. it is the combination and rapid alterations of these movements which produce the different postures and various gaits of the animal, and it is their interruption and derangement, from whatever causes, which constitute the pathological condition known as lameness. a concise examination of the general anatomy of these organs, however, must precede the consideration of the pathological questions pertaining to the subject. a statement, such as we have just given, containing only the briefest hint of matters which, though not necessarily in their ultimate scientific minutiæ, must be clearly comprehended in order to acquire a symmetrical and satisfactory view of the theme as a practical collation of facts to be remembered, analyzed, applied, and utilized. it was the great bacon who wrote: "the human body may be compared, from its complex and delicate organization, to a musical instrument of the most perfect construction, but exceedingly liable to derangement." in its degree the remark is equally applicable to the equine body, and if we would keep it in tune and profit by its harmonious action we must at least acquaint ourselves with the relations of its parts and the mode of their cooperation. anatomy. the bones, then, are the hard organs which in their connection and totality constitute the skeleton of an animal (see plate xxiii). they are of various forms, three of which--the long, the flat, and the small--are recognized in the extremities. these are more or less regular in their form, but present upon their surfaces a variety of aspects, exhibiting in turn, according to the requirement of each case, a roughened or smooth surface, variously marked with grooves, crests, eminences, and depressions, for the necessary muscular attachments, and, as before mentioned, are connected by articulations and joints, of which some are immovable and others movable. the substance of the bone is composed of a mass of combined earthy and animal matter surrounded by a fine, fibrous enveloping membrane (the periosteum) which is intimately adherent to the external surface of the bone, and is, in fact, the secreting membrane of the bony structure. the bony tissue proper is of two consistencies, the external portion being hard and "compact," and called by the latter term, while the internal, known as the "spongy" or "areolar tissue," corresponds to the descriptive terms. those of the bones that possess this latter consistency contain also, in their spongy portion, the medullary substance known as marrow, which is deposited in large quantities in the interior of the long bones, and especially where a central cavity exists, called, for that reason, the medullary cavity. the nourishment of the bones is effected by means of what is known as the nutrient foramen, an opening established for the passage of the blood vessels which convey the nourishment necessary to the interior of the organ. concerning the nourishment of the skeleton, there are other minutiæ, such as the venous arrangement and the classification of their arterial vessels into several orders, which, though of interest as an abstract study, are not of sufficient practical value to refer to here. the active organs of locomotion, the muscles (see plate xxiii), speaking generally, form the fleshy covering of the external part of the skeleton and surround the bones of the extremities. they vary greatly in shape and size, being flat, triangular, long, short, or broad, and are variously and capriciously named, some from their shape, some from their situation, others from their use; and thus we have abductors and adductors--the pyramidal, orbicular, the digastricus, the vastus, and so on. those which are under the control of the will, known as the voluntary muscles, appear in the form of fleshy structures, red in color, and with fibers of various degrees of fineness, and are composed of fasciculi, or bundles of fibers, united by connective or cellular tissue, each fasciculus being composed of smaller ones but united in a similar manner to compose the larger formations, each of which is enveloped by a structure of similar nature known as the sarcolemma. many of the muscles are united to the bones by the direct contact of their fleshy fibers, but in other instances the body of the muscle is more or less gradually transformed into a cordy or membranous structure known as the tendon or sinew, and the attachment is made by the very short fibrous threads through the medium of a long tendinous band, which, passing from a single one to several others of the bones, effects its object at a point far distant from its original attachment. in thus carrying its action from one bone to another, or from one region of a limb to another, these tendons must necessarily have smooth surfaces over which to glide, either upon the bones themselves or formed at their articulations, and this need is supplied by the secretion of the synovial fluid, a yellowish, unctuous substance, furnished by a peculiar tendinous synovial sac designed for the purpose. illustrations in point of the agency of the synovial fluid in assisting the sliding movements of the tendons may be found under their various forms at the shoulder joint, at the upper part of the bone of the arm, at the posterior part of the knee joint, and also at the fetlocks, on their posterior part. as the tendons, whether singly or in company with others, pass over these natural pulleys they are retained in place by strong, fibrous bands or sheaths, which are by no means exempt from danger of injury, as will be readily inferred from a consideration of their important special use as supports and reenforcements of the tendons themselves, with which they must necessarily share the stress of whatever force or strain is brought to bear upon both or either. we have referred to that special formation of the external surface of a bone by which it is adapted to form a joint or articulation, either movable or fixed, and a concise examination of the formation and structure of the movable articulations will here be in place. these are formed generally by the extremities of the long bones, or may exist on the surfaces of the short ones. the points or regions where the contact occurs are denominated the articular surface, which assumes from this circumstance a considerable variety of aspect and form, being in one case comparatively flat and another elevated; or as forming a protruding head or knob, with a distinct convexity; and again presenting a corresponding depression or cavity, accurately adapted to complete, by their coaptation, the ball-and-socket joint. the articulation of the arm and shoulder is an example of the first kind, while that of the hip with the thigh bone is a perfect exhibition of the latter. the structure whose office it is to retain the articulating surfaces in place is the ligament. this is usually a white, fibrous, inelastic tissue; sometimes, however, it is elastic in character and yellowish. in some instances it is funicular shaped or corded, serving to bind more firmly together the bones to which its extremities are attached; in others it consists of a broad membrane, wholly or partially surrounding the broad articulations, and calculated rather for the protection of the cavity from intrusion by the air than for other security. this latter form, known as capsular, is usually found in connection with joints which possess a free and extended movement. the capsular and funicular ligaments are sometimes associated, the capsular appearing as a membranous sac wholly or partially inclosing the joint, the funicular, here known as an interarticular ligament, occupying the interior, and thus securing the union of the several bones more firmly and effectively than would be possible for the capsular ligament unassisted. the universal need which pertains to all mechanical contrivances of motion has not been forgotten while providing for the perfect working of the interesting piece of living machinery which performs the function of locomotion, as we are contemplating it, and nature has consequently provided for obviating the evils of attrition and friction and insuring the easy play and smooth movement of its parts by the establishment of the secretion of the synovia, the vital lubricant of which we have before spoken, as a yellow, oily, or rather glairy secretion, which performs the indispensable office of facilitating the play of the tendons over the joints and certain given points of the bones. this fluid is deposited in a containing sac, the lining (serous) membrane of which forms the secreting organ. this membrane is of an excessively sensitive nature, and while it lines the inner face of the ligaments, both capsular and fascicular, it is attached only upon the edges of the bones, without extending upon their length, or between the layers of cartilage which lie between the bones and their articular surfaces. our object in thus partially and concisely reviewing the structure and condition of the essential organs of locomotion has been rather to outline a sketch which may serve as a reference chart of the general features of the subject than to offer a minute description of the parts referred to. other points of interest will receive proper attention as we proceed with the illustration of our subject and examine the matters which it most concerns us to bring under consideration. the foundation of facts which we have thus far prepared will be found sufficiently broad, we trust, to include whatever may be necessary to insure a ready comprehension of the essential matters which are to follow as our review is carried forward to completion. what we have said touching these elementary truths will probably be sufficient to facilitate a clear understanding of the requirements essential to the perfection and regularity which characterize the normal performance of the various movements that result in the accomplishment of the action of locomotion. so long as the bones, the muscles and their tendons, the joints with their cartilages, their ligaments, and their synovial structure, the nerves and the controlling influences which they exercise over all, with the blood vessels which distribute to every part, however minute, the vitalizing fluid which sustains the whole fabric in being and activity--so long as these various constituents and adjuncts of animal life preserve their normal exemption from disease, traumatism, and pathological change, the function of locomotion will continue to be performed with perfection and efficiency. on the other hand, let any element of disease become implanted in one or several of the parts destined for combined action, any change or irregularity of form, dimensions, location, or action occur in any portion of the apparatus--any obstruction or misdirection of vital power take place, any interference with the order of the phenomena of normal nature, any loss of harmony and lack of balance be betrayed--and we have in the result the condition of lameness. definition of lameness. _physiology._--comprehensively and universally considered, then, the term lameness signifies any irregularity or derangement of the function of locomotion, irrespective of the cause which produced it or the degree of its manifestation. however slightly or severely it may be exhibited, it is all the same. the nicest observation may be demanded for its detection, and it may need the most thoroughly trained powers of discernment to identify and locate it, as in cases in which the animal is said to be fainting, tender, or to go sore. on the contrary, the patient may be so far affected as to refuse utterly to use an injured leg, and under compulsory motion keep it raised from the ground, and prefer to travel on three legs rather than to bear any portion of his weight upon the afflicted member. in these two extremes, and in all the intermediate degrees, the patient is simply lame--pathognomonic minutiæ being considered and settled in a place of their own. this last condition of disabled function--lameness on three legs--and many of the lower degrees of simple lameness are very easy of detection, but the first, or mere tenderness or soreness, may be very difficult to identify, and at times very serious results have followed from the obscurity which has enveloped the early stages of the malady. for it may easily occur that in the absence of the treatment which an early correct diagnosis would have indicated, an insidious ailment may so take advantage of the lapse of time as to root itself too deeply into the economy to be subverted, and become transformed into a disabling chronic case, or possibly one that is incurable and fatal. hence the impolicy of depreciating early symptoms because they are not accompanied with distinct and pronounced characteristics, and from a lack of threatening appearances inferring the absence of danger. the possibilities of an ambush can never be safely ignored. an extra caution costs nothing, even if wasted. the fulfillment of the first duty of a practitioner, when introduced to a case, is not always an easy task, though it is too frequently expected that the diagnosis, or "what is the matter" verdict, will be reached by the quickest and surest kind of an "instantaneous process" and a sure prognosis, or "how will it end," guessed at instanter. usually the discovery that the animal is becoming lame is comparatively an easy matter to a careful observer. such a person will readily note the changes of movements which will have taken place in the animal he has been accustomed to drive or ride, unless they are indeed slight and limited to the last degree. but what is not always easy is the detection, after discovering the fact of an existing irregularity, of the locality of its point of origin, and whether its seat be in the near or off leg, or in the fore or the hind part of the body. these are questions too often wrongly answered, notwithstanding the fact that with a little careful scrutiny the point may be easily settled. the error, which is too often committed, of pronouncing the leg upon which the animal travels soundly as the seat of the lameness, is the result of a misinterpretation of the physiology of locomotion in the crippled animal. much depends upon the gait with which the animal moves while under examination. the act of walking is unfavorable for accurate observation, though, if the animal walks on three legs, the decision is easy to reach. the action of galloping will often, by the rapidity of the muscular movements and their quick succession, interfere with a nice study of their rhythm, and it is only under some peculiar circumstances that the examination can be safely conducted while the animal is moving with that gait. it is while the animal is trotting that the investigation is made with the best chances of an intelligent decision, and it is while moving with that gait, therefore, that the points should be looked for which must form the elements of the diagnosis. [illustration: plate xxiii. skeleton of horse.] [illustration: plate xxiv. superficial layer of muscles.] our first consideration should be the physiology of normal or healthy locomotion, that thence we may the more easily reach our conclusions touching lameness, or that which is abnormal, and by this process we ought to succeed in obtaining a clew to the solution of the first problem, to wit, in which leg is the seat of the lameness? a word of definition is here necessary, in order to render that which follows more easily intelligible. in veterinary nomenclature each two of the legs, as referred to in pairs, is denominated a biped. of the four points occupied by the feet of the animal while standing at rest, forming a square, the two fore legs are known as the anterior biped; the two hinder, the posterior; the two on one side, the lateral: and one of either the front or hind biped with the opposite leg of the hind or front biped will form the diagonal biped. considering, as it is proper to do, that in a condition of health each separate biped and each individual leg is required to perform an equal and uniform function and to carry an even or equal portion of the weight of the body, it will be readily appreciated that the result of this distribution will be a regular, evenly balanced, and smooth displacement of the body thus supported by the four legs, and that therefore, according to the rapidity of the motion in different gaits, each single leg will be required at certain successive moments to bear the weight which had rested upon its congener while it was itself in the air, in the act of moving; or, again, two different legs of a biped may be called upon to bear the weight of the two legs of the opposite biped while also in the air in the act of moving. to simplify the matter by an illustration, the weight of an animal may be placed at , pounds, of which each leg, in a normal and healthy condition, supports while at rest pounds. when one of the fore legs is in action, or in the air, and carrying no weight, its pounds share of the weight will be thrown upon its congener, or partner, to sustain. if the two legs of a biped are both in action and raised from the ground, their congeners, still resting in inaction, will carry the total weight of the other two, or pounds. and as the succession of movements continues, and the change from one leg to another or from one biped to another, as may be required by the gait, proceeds, there will result a smooth, even, and equal balancing of active movements, shifting the weight from one leg or one biped to another, with symmetrical precision, and we shall be presented with an interesting example of the play of vital machanics in a healthy organization. much may be learned from the accurate study of the action of a single leg. normally, its movements will be without variation or failure. when at rest it will easily sustain the weight assigned to it without showing hesitancy or betraying pain, and when it is raised from the ground in order to transfer the weight to its mate it will perform the act in such manner that when it is again placed upon the ground to rest it will be with a firm tread, indicative of its ability to receive again the burden to be thrown back upon it. in planting it upon the ground or raising it again for the forward movement while in action, and again replanting it upon the earth, each movement will be the same for each leg and for each biped, whether the act is that of walking or trotting, or even of galloping. in short, the regular play of every part of the apparatus will testify to the existence of that condition of orderly soundness and efficient activity eloquently suggestive of the condition of vital integrity which is simply but comprehensively expressed by the terms health and soundness. but let some change, though slight and obscure, occur among the elements of the case; some invisible agency of evil intrude among the harmonizing processes going forward; any disorder occur in the relations of cooperating parts; anything appear to neutralize the efficiency of vitalizing forces; any disability of a limb to accept and to throw back upon its mate the portion of the weight which belongs to it to sustain--present itself, whether as the effect of accident or otherwise; in short, let anything develop which tends to defeat the purpose of nature in organizing the locomotive apparatus and we are confronted at once by that which may be looked upon as a cause of lameness. not the least of the facts which it is important to remember is that it is not sufficient to look for the manifestation of an existing discordance in the action of the affected limb alone, but that it is shared by the sound one and must be searched for in that as well as the halting member, if the hazard of an error is to be avoided. the mode of action of the leg which is the seat of the lameness will vary greatly from that which it exhibited when in a healthy condition, and the sound leg will also offer important modifications in the same three particulars before alluded to, to wit, that of resting on the ground, that of its elevation and forward motion, and that of striking the ground again when the full action of stepping is accomplished. inability in the lame leg to sustain weight will imply excessive exertion by the sound one, and lack of facility or disposition to rest the lame member on the ground will necessitate a longer continuance of that action on the sound side. changes in the act of elevating the leg, or of carrying it forward, or in both, will present entirely opposite conditions between the two. the lame member will be elevated rapidly, moved carefully forward, and returned to the ground with caution and hesitancy, and the contact with the earth will be effected as lightly as possible, while the sound limb will rest longer on the ground, move boldly and rapidly forward, and strike the ground promptly and forcibly. all this is due to the fact that the sound member carries more than its normal, healthy share of the weight of the body, a share which may be in excess from to pounds, and thus bring its burden to a figure varying from to pounds, all depending upon the degree of the existing lameness, whether it is simply a slight tenderness or soreness, or whether the trouble has reached a stage which compels the patient to the awkwardness of traveling on three legs. that all this is not mere theory, but rests on a foundation of fact may be established by observing the manifestations attending a single alteration in the balancing of the body. in health the support and equilibrium of that mass of the body which is borne by the fore legs is equalized and passes by regular alternations from the right to the left side and vice versa. but if the left leg, becoming disabled, relieves itself by leaning, as it were, on the right, the latter becomes, consequently, practically heavier and the mass of the body will incline or settle upon that side. lameness of the left side, therefore, means dropping or settling on the right and vice versa. we emphasize this statement and insist upon it, the more from the frequency of the instances of error which have come under our notice, in which persons have insisted upon their view that the leg which is the seat of the lameness is that upon which he drops and which the animal is usually supposed to favor. how to detect the seat of lameness. properly appreciating the remarks which have preceded, and fully comprehending the modus operandi and the true pathology of lameness, but little remains to be done in order to reach an answer to the question as to which side of the animal is the seat of the lameness, except to examine the patient while in action. we have already stated our reasons for preferring the movement of trotting for this purpose. in conducting such an examination the animal should be unblanketed, and held by a plain halter in the hands of a man who knows how to manage his paces, and the trial should always be made over a firm, hard road whenever it is available. he is to be examined from various positions--from before, from behind, and from each side. watching him as he approaches, as he passes by, and as he recedes, the observer should carefully study that important action which we have spoken of as the dropping of the body upon one extremity or the other, and this can readily be detected by attending closely to the motions of the head and of the hip. the head drops on the same side on which the mass of the body will fall, dropping toward the right when the lameness is in the left fore leg, and the hip dropping in posterior lameness, also on the sound leg, the reversal of the conditions, of course, producing reversed effects. in other words, when the animal in trotting exhibits signs of irregularity of action, or lameness, and this irregularity is accompanied with dropping or nodding the head, or depressing the hip on the right side of the body, at the time the feet of the right side strike the ground, the horse is lame on the left side. if the dropping and nodding are on the near side the lameness is on the off side. in a majority of cases, however, the answer to the first question relating to the lameness of a horse is, after all, not a very difficult task. there are two other problems in the case more difficult of solution and which often require the exercise of a closer scrutiny, and draw upon all the resources of the experienced practitioner to settle satisfactorily. that a horse is lame in a given leg may be easily determined, but when it becomes necessary to pronounce upon the query as to what part, what region, what structure is affected, the easy part of the task is over, and the more difficult and important, because more obscure, portion of the investigation has commenced--except, of course, in cases of which the features are too distinctly evident to the senses to admit of error. it is true that by carefully noting the manner in which a lame leg is performing its functions, and closely scrutinizing the motions of the whole extremity, and especially of the various joints which enter into its structure; by minutely examining every part of the limb; by observing the outlines; by testing the change, if any, in temperature and the state of the sensibility--all these investigations may guide the surgeon to a correct localization of the seat of trouble, but he must carefully refrain from the adoption of a hasty conclusion, and, above all, assure himself that he has not failed to make the foot, of all the organs of the horse the most liable to injury and lesion, the subject of the most thorough and minute examination of all the parts which compose the suffering extremity. the greater liability of the foot than of any other part of the extremities to injury from casualties, natural to its situation and use, should always suggest the beginning of an inquiry, especially in an obscure case of lameness at that point. indeed the lameness may have an apparent location elsewhere when that is the true seat of the trouble, and the surgeon who, while examining his lame patient, discovers a ringbone, and convincing himself that he has encountered the cause of the disordered action suspends his investigation without subjecting the foot to a close scrutiny, at a later day when regrets will avail nothing, may deeply regret his neglect and inadvertence. as in human pathological experience, however, there are instances when inscrutable diseases will deliver their fatal messages, while leaving no mark and making no sign by which they might be identified and classified, so it will happen that in the humbler animals the onset and progress of mysterious and unrecognizable ailments will at times baffle the most skilled veterinarian, and leave our burden-bearing servants to succumb to the inevitable, and suffer and perish in unrelieved distress. diseases of bones. periostitis, ostitis, and exostosis. from the closeness and intimacy of the connection existing between the two principal elements of the bony structure while in health, it frequently becomes exceedingly difficult, when a state of disease has supervened, to discriminate accurately as to the part primarily affected and to determine positively whether the periosteum or the body of the bone is originally implicated. yet a knowledge of the fact is often of the first importance, in order to obtain a favorable result from the treatment to be instituted. it is, however, quite evident that in a majority of instances the bony growths which so frequently appear on the surface of their structure, to which the general term of exostosis is applied, have had their origin in an inflammation of the periosteum, or enveloping membrane, and known as periostitis. however this may be, we have as a frequent result, sometimes on the body of the bone, sometimes at the extremities, and sometimes involving the articulation itself, certain bony growths, or exostoses, known otherwise by the term of splint, ringbone, and spavin, all of which, in an important sense, may be finally referred to the periosteum as their nutrient source and support, at least after their formation, if not for their incipient existence. _cause._--it is certain that inflammation of the periosteum is frequently referable to wounds and bruises caused by external agencies, and it is also true that it may possibly result from the spreading inflammation of surrounding diseased tissues, but in any case the result is uniformly seen in the deposit of a bony growth, more or less diffuse, sometimes of irregular outline, and at others projecting distinctly from the surface from which it springs, as so commonly presented in the ringbone and the spavin. _symptoms._--this condition of periostitis is often difficult to determine. the signs of inflammation are so obscure, the swelling of the parts so insignificant, any increase of heat so imperceptible, and the soreness so slight, that even the most acute observer may fail to find the point of its existence, and it is often long after the discovery of the disease itself that its location is positively revealed by the visible presence of the exostosis. yet the first question had been resolved, in discovering the fact of the lameness, while the second and third remained unanswered, and the identification of the affected limb and the point of origin of the trouble remained unknown until their palpable revelation to the senses. _treatment._--when, by careful scrutiny, the ailment has been located, a resort to treatment must be had at once, in order to prevent, if possible, any further deposit of the calcareous structure and increase of the exostotic growth. with this view the application of water, either warm or cold, rendered astringent by the addition of alum or sugar of lead, will be beneficial. the tendency to the formation of the bony growth, and the increase of its development after its actual formation, may often be checked by the application of a severe blister of spanish fly. the failure of these means and the establishment of the diseased process in the form of chronic periostitis cause various changes in the bone covered by the disordered membrane, and the result may be softening, degeneration, or necrosis, but more usually it is followed by the formation of the bony growths referred to, on the cannon bone, the coronet, the hock, etc. splints. we first turn our attention to the splint, as certain bony enlargements that are developed on the cannon bone, between the knee or the hock and the fetlock joint, are called. (see plate xxv.) they are found on the inside of the leg, from the knee, near which they are frequently found, downward to about the lower third of the principal cannon bone. they are of various dimensions, and are readily perceptible both to the eye and to the touch. they vary considerably in size, ranging from that of a large nut downward to very small proportions. in searching for them they may be readily detected by the hand if they have attained sufficient development in their usual situation, but must be distinguished from a small, bony enlargement that may be felt at the lower third of the cannon bone, which is neither a splint nor a pathological formation of any kind, but merely the buttonlike enlargement at the lower extremity of the small metacarpal or splint bone. we have said that splints are to be found on the inside of the leg. this is true as a general statement, but it is not invariably so, for they occasionally appear on the outside. it is also true that they appear most commonly on the fore legs, but this is not exclusively the case, because they may at times be found on both the inside and outside of the hind leg. usually a splint forms only a true exostosis, or a single bony growth, with a somewhat diffuse base, but neither is this invariably the case. in some instances they assume more important dimensions, and pass from the inside to the outside of the bone, on its posterior face, between that and the suspensory ligament. this form is termed the pegged splint, and constitutes a serious and permanent deformity, in consequence of its interference with the play of the fibrous cord which passes behind it, becoming thus a source of continual irritation and consequently of permanent lameness. _symptoms._--a splint may thus frequently become a cause of lameness though not necessarily in every instance, but it is a lameness possessing features peculiar to itself. it is not always continuous, but at times assumes an intermittent character, and is more marked when the animal is warm than when cool. if the lameness is near the knee joint, it is very liable to become aggravated when the animal is put to work, and the gait acquires then a peculiar character, arising from the manner in which the limb is carried outward from the knees downward, which is done by a kind of abduction of the lower part of the leg. other symptoms, however, than the lameness and the presence of the splint, which is its cause, may be looked for in the same connection as those which have been mentioned as pertaining to certain evidences of periostitis, in the increase of the temperature of the part, with swelling and probably pain on pressure. this last symptom is of no little importance, since its presence or absence has in many cases formed the determining point in deciding a question of difficult diagnosis. _cause._--a splint being one of the results of periostitis, and the latter one of the effects of external hurts, it naturally follows that the parts which are most exposed to blows and collisions will be those on which the splint will most commonly be found, and it may not be improper, therefore, to refer to hurts from without as among the common causes of the lesion. but other causes may also be productive of the evil, and among these may be mentioned the over-straining of an immature organism by the imposition of excessive labor upon a young animal at a too early period of his life. the bones which enter into the formation of the cannon are three in number, one large and two smaller, which, during the youth of the animal, are more or less articulated, with a limited amount of mobility, but which become in maturity firmly joined by a rigid union and ossification of their interarticular surface. if the immature animal is compelled, then, to perform exacting tasks beyond his strength, the inevitable result will follow in the muscular straining, and perhaps tearing asunder of the fibers which unite the bones at their points of juncture, and it is difficult to understand how inflammation or periostitis can fail to develop as the natural consequence of such local irritation. if the result were deliberately and intelligently designed, it could hardly be more effectually accomplished. the splint is an object of the commonest occurrence--so common, indeed, that in large cities a horse which can not exhibit one or more specimens upon some portion of his extremities is one of the rarest of spectacles. though it is in some instances a cause of lameness, and its discovery and cure are sometimes beyond the ability of the shrewdest and most experienced veterinarians, yet as a source of vital danger to the general equine organization, or even of functional disturbance, or of practical inconvenience, aside from the rare exceptional cases which exist as mere samples of possibility, it can not be considered to belong to the category of serious lesions. the worst stigma that attaches to it is that in general estimation it is ranked among eyesores and continues indefinitely to be that and nothing different. the inflammation in which they originated, acute at first, either subsides or assumes the chronic form, and the bony growth becomes a permanence--more or less established, it is true, but doing no positive harm and not hindering the animal from continuing his daily routine of labor. all this, however, requires a proviso against the occurrence of a subsequent acute attack, when, as with other exostoses, a fresh access of acute symptoms may be followed by a new pathological activity, which shall again develop, as a natural result, a reappearance of the lameness. _treatment._--it is, of course, the consideration of the comparative harmlessness of splints that suggests and justifies the policy of noninterference, except as they become a positive cause of lameness. and a more positive argument for such noninterference consists in the fact that any active and irritating treatment may so excite the parts as to bring about a renewed pathological activity, which may result in a reduplication of the phenomena, with a second edition, if not a second and enlarged volume, of the whole story. for our part, our faith is firm in the impolicy of interference, and this faith is founded on an experience of many years, during which our practice has been that of abstention. of course, there will be exceptional conditions which will at times indicate a different course. these will become evident when the occasions present themselves, and extraordinary forms and effects of inflammation and growth in the tumors offer special indications. but our conviction remains unshaken that surgical treatment of the operative kind is usually useless, if not dangerous. we have little faith in the method of extirpation except under very special conditions, among which that of diminutive size has been named; this seems in itself to constitute a sufficient negative argument. even in such a case a resort to the knife or the gouge could scarcely find a justification, since no operative procedure is ever without a degree of hazard, to say nothing of the considerations which are always forcibly negative in any question of the infliction of pain and the unnecessary use of the knife. [illustration: plate xxv. splint.] [illustration: plate xxvi. sound foot. ringbone.] [illustration: plate xxvii. various types of spavin.] [illustration: plate xxviii. bone spavin. hocks, with skin removed.] [illustration: plate xxix. bone spavin.] if an acute periostitis of the cannon bone has been readily discovered, the treatment we have already suggested for that ailment is at once indicated, and the astringent lotions may be relied upon to bring about beneficial results. sometimes, however, preference may be given to a lotion possessing a somewhat different quality, the alterative consisting of tincture of iodin applied to the inflamed spot several times daily. if the lameness persists under this mild course of treatment, it must, of course, be attacked by other methods, and we must resort to the cantharides ointment or spanish-fly blister, as we have before recommended. besides this, and producing an analogous effect, the compounds of biniodid of mercury are favored by some. it is prepared in the form of an ointment, consisting of dram of the biniodid to ounce of either lard or vaseline. it forms an excellent blistering and alterative application, and is of special advantage in newly formed or recently discovered exostosis. it remains a pertinent query, however, and one which seems to be easily answered, whether a tumor so diminutive in size that it can be detected only by diligent search, and which is neither a disfigurement nor an obstruction to the motion of the limb, need receive any recognition whatever. other modes of treatment for splints are recommended and practiced which belong strictly to the domain of operative veterinary surgery; among these are to be reckoned actual cauterization, or the application of the fire iron and the operation of periosteotomy. these are frequently indicated in the treatment of splints which have resisted milder means. the mode of the development of their growth; their intimacy, greater or less, with both the large and the small cannon bones; the possibility of their extending to the back of these bones under the suspensory ligament; the dangerous complications which may follow the rough handling of the parts, with also a possibility, and, indeed, a probability, of their return after removal--these are the considerations which have influenced our judgment in discarding from our practice and our approval the method of removal by the saw or the chisel, as recommended by certain european veterinarians. ringbones. ringbone is the designation of the exostosis which is found on the coronet and in the digital and phalangeal regions. (see plate xxvi.) the name is appropriate, because the growth extends quite around the coronet, which it encircles in the manner of a ring, or perhaps because it often forms upon the back of that bone a regular osseous arch, through which the back tendons obtain a passage. the places where these growths are usually developed have caused their subdivision and classification into three varieties, with the designations of high, middle, and low, though much can be said as to the importance of the distinction. it is true that the ringbone or phalangeal exostosis may be found at various points on the foot, in one case forming a large bunch on the upper part and quite close to the fetlock joint; in another around the upper border of the hoof, or perhaps on the extreme front or on the very back of the coronet. the shape in which they commonly appear is favorable to their easy discovery, their form when near the fetlock usually varying too much from the natural outlines of the part when compared with those of the opposite side to admit of error in the matter. (see also page .) a ringbone, when on the front of the foot, even when not very largely developed, assumes the form of a diffused convex swelling. if situated on the lower part, it will form a thick ring, encircling that portion of the foot immediately above the hoof; when found on the posterior part, a small, sharp osseous growth somewhat projecting, sometimes on the inside and sometimes on the outside of the coronet, may comprise the entire manifestation. _cause._--as with splints, ringbones may result from severe labor in early life, before the process of ossification has been fully perfected; or they may be referred to bruises, blows, sprains, or other violence; injuries of tendons, ligaments, or joints also may be among the accountable causes. it is certain that they may commonly be traced to diseases and traumatic lesions of the foot, and their appearance may be reasonably expected among the sequelæ of an abscess of the coronet; or the cause may be a severe contusion resulting from calking, or a deep-punctured wound from picking up a nail or stepping upon any hard object of sufficiently irregular form to penetrate the sole. moreover, a ringbone may originate in heredity. this is a fact of no little importance in its relation to questions connected with the extensive interests of the stock breeder and purchaser. that the hereditary transmission of constitutional idiosyncrasies is an active cause with regard to diseases in general, it would be absurd to assert, but we do say that a predisposition to contract ringbone through faulty conformation, such as long, thin pasterns with narrow joints and steep fetlocks, may be inherited in many cases, and in a smaller proportion of cases this predisposition may act as a secondary cause in the formation of ringbone. the importance of this point when considered in reference to the policy which should be observed in the selection of breeding stock is obvious, and, as the whole matter is within the control of the owners and breeders, it will be their own fault if the unchecked transmission of ringbones from one equine generation to another is allowed to continue. it is our belief that among the diseases which are known for their tendency to perpetuate and repeat themselves by individual succession, those of the bony structures stand first, and the inference from such fact which would exclude every animal of doubtful soundness in its osseous apparatus from the stud list and the brood farm is too plain for argument. _symptoms._--periostitis of the phalanges is an ailment requiring careful exploration and minute inspection for its discovery, and is very liable to result in a ringbone of which lameness is the result. the mode of its manifestation varies according to the state of development of the diseased growth as affected by the circumstances of its location and dimensions. it is commonly of the kind which, in consequence of its intermittent character, is termed lameness when cool, having the peculiarity of exhibiting itself when the animal starts from the stable and of diminishing, if not entirely disappearing after some distance of travel, to return to its original degree, if not indeed a severer one, when he has again cooled off in his stable. the size of the ringbone does not indicate the degree to which it cripples the patient, but the position may, especially when it interferes with the free movement of the tendons which pass behind and in front of the foot. while a large ringbone will often interfere but little with the motion of the limb, a smaller growth, if situated under the tendon, may become the cause of considerable and continued pain. a ringbone is doubtless a worse evil than a splint. its growth, its location, its tendency to increased development, its exposure to the influence of causes of renewed danger, all tend to impart an unfavorable cast to the prognosis of a case and to emphasize the importance and the value of an early discovery of its presence and possible growth. even when the discovery has been made, it is often the case that the truth has come to light too late for effectual treatment. months may have elapsed after the first manifestation of the lameness before a discovery has been made of the lesion from which it has originated, and there is no recall for the lapsed time. and by the uncompromising seriousness of the discouraging prognosis must the energy and severity of the treatment and the promptness of its administration be measured. the periostitis has been overlooked; any chance that might have existed for preventing its advance to the chronic stage has been lost; the osseous formation is established; the ringbone is a fixed fact, and the indications are urgent and pressing. _treatment._--the preventive treatment consists in keeping colts well nourished and in trimming the hoof and shoeing to balance the foot properly and thus prevent an abnormal strain on the ligaments. even after the ringbone has developed, a cure may sometimes be occasioned by proper shoeing directed toward straightening the axis of the foot as viewed from the side by making the wall of the hoof from the coronet to the toe continuous with the line formed by the front of the pastern. so long as inflammation of the periosteum and ligaments remains, a sharp blister of biniodid of mercury and cantharides may do good if the animal is allowed to rest for four or five weeks. if this fails, some success may be accomplished by point firing in two or three lines over the ringbone. it is necessary to touch the hot iron well into the bone, as superficial firing does little good. when all these measures have failed to remove the lameness, or when the animal is not worth a long and uncertain treatment, a competent veterinarian should be engaged to perform double neurectomy, high or low, of the plantar nerves, or neurectomy of the median nerve as indicated by the seat of the lesion. sidebones. on each side of the bone of the hoof--the coffinbone--there are normally two supplementary organs which are called the cartilages of the foot. they are soft, and though in a degree elastic, yet somewhat resisting, and are implanted on the lateral wings of the coffinbone. evidently their office is to assist in the elastic expansion and contraction of the posterior part of the hoof, and their healthy and normal action doubtless contributes in an important degree to the perfect performance of the functions of that part of the leg. these organs are, however, liable to undergo a process of disease which results in an entire change in their properties, if not in their shape, by which they acquire a character of hardness resulting from the deposit of earthy substance in the intimate structure of the cartilage, and it is this change, when its consummation has been effected, that brings to our cognizance the diseased growth which has received the designation of sidebones. they are situated on one or both sides of the leg, bulging above the superior border of the hoof in the form of two hard bodies composed of ossified cartilage, irregularly square in shape and unyielding under the pressure of the fingers. _cause._--sidebones may be the result of a low inflammatory condition or of an acute attack as well, or may be caused by sprains, bruises, or blows; or they may have their rise in certain diseases affecting the foot proper, such as corns, quarter cracks, or quittor. the deposit of calcareous matter in the cartilage is not always uniform, the base of that organ near its line of union with the coffinbone being in some cases its limit, while at other times it is diffused throughout its substance, the size and prominence of the growth varying much in consequence. _symptoms._--it would naturally be inferred that the degree of interference with the proper functions of the hoof which must result from such a pathological change would be proportioned to the size of the tumor, and that as the dimensions increase the resulting lameness would be the greater in degree. this, however, is not the fact. a small tumor while in a condition of acute inflammation during the formative stage may cripple a patient more severely than a much larger one in a later stage of the disease. in any case the lameness is never wanting, and with its intermittent character may usually be detected when the animal is cooled off after labor or exercise. the class of animals in which this feature of the disease is most frequently seen is that of the heavy draft horse and others similarly employed. there is a wide margin of difference in respect to the degrees of severity which may characterize different cases of sidebone. while one may be so slight as to cause no inconvenience, another may develop elements of danger which may involve the necessity of severe surgical interference. _treatment._--the curative treatment should be similar to the prophylactic, and such means should be used as would tend to prevent the deposit of bony matters by checking the acute inflammation which causes it. the means recommended are the free use of the cold bath; frequent soaking of the feet, and at a later period treatment with iodin, either by painting the surface with the tincture several times daily or by applying an ointment made by mixing dram of the crystals with ounces of vaseline, rubbed in once a day for several days. if this proves to be ineffective, a spanish-fly blister to which a few grains of biniodid of mercury have been added will effect in a majority of cases the desired result and remove the lameness. if finally this treatment is ineffectual the case must be relegated to the surgeon for the operation of neurectomy, or the free and deep application of the firing iron. spavin. (pls. xxvii-xxix.) this affection, popularly termed bone spavin, is an exostosis of the hock joint. the general impression is that in a spavined hock the bony growth should be seated on the anterior and internal part of the joint, and this is partially correct, as such a growth will constitute a spavin in the most nearly correct sense of the term. but an enlargement may appear on the upper part of the hock also, or possibly a little below the inner side of the lower extremity of the shank bone, forming what is known as a high spavin; or, again, the growth may form just on the outside of the hock and become an outside or external spavin. and, finally, the entire under surface may become the seat of the osseous deposit, and involve the articular face of all the bones of the hock, which again is a bone spavin. there would seem, then, to be but little difficulty in comprehending the nature of a bone spavin, and there would be none but for the fact that there are similar affections which may confuse one if the diagnosis is not very carefully made. but the hock may be "spavined," while to all outward observation it still retains its perfect form. with no enlargement perceptible to sight or touch the animal may yet be disabled by an occult spavin, an anchylosis in fact, which has resulted from a union of several of the bones of the joint, and it is only those who are able to realize the importance of its action to the perfect fulfillment of the function of locomotion by the hind leg who can comprehend the gravity of the only prognosis which can be justified by the facts of the case--a prognosis which is essentially a sentence of serious import in respect to the future usefulness and value of the animal. for no disease, if we except those acute inflammatory attacks upon vital organs to which the patient succumbs at once, is more destructive to the usefulness and value of a horse than a confirmed spavin. serious in its inception, serious in its progress, it is an ailment which, when once established, becomes a fixed condition which there is no known means of dislodging. _cause._--the periostitis, of which it is nearly always a termination, is usually the effect of a traumatic cause operating upon the complicated structure of the hock, such as a sprain which has torn a ligamentous insertion and lacerated some of its fibers, or a violent effort in jumping, galloping, or trotting, to which the victim has been compelled by the torture of whip and spur while in use as a gambling implement by a sporting owner, under the pretext of "improving his breed"; the extra exertion of starting an inordinately heavy load, or an effort to recover his balance from a misstep, slipping upon an icy surface, or sliding with worn shoes upon a bad pavement, and other kindred causes. we can repeat here what we have before said concerning bones, in respect to heredity as a cause. from our own experience we know of equine families in which this condition has been transmitted from generation to generation, and animals otherwise of excellent conformation have been rendered valueless by the misfortune of a congenital spavin. _symptoms._--the evil is one of the most serious character for other reasons, among which may be specified the slowness of its development and the insidiousness of its growth. certain indefinite phenomena and alarming changes and incidents furnish usually the only portents of approaching trouble. among these signs may be mentioned a peculiar posture assumed by the patient while at rest, and becoming at length so habitual that it can not fail to suggest the action of some hidden disorder. the posture is due to the action of the adductor muscles, the lower part of the leg being carried inward, and the heel of the shoe resting on the toe of the opposite foot. then an unwillingness may be noticed in the animal to move from one side of the stall to the other. when driven he will travel, but stiffly, with a sort of sidelong gait between the shafts, and after finishing his task and resting again in his stall will pose with the toe pointing forward, the heel raised, and the hock flexed. considerable heat and inflammation soon appear. the slight lameness which appears when backing out of the stall ceases to be noticeable after a short distance of travel. a minute examination of the hock may then reveal the existence of a bony enlargement which may be detected just at the junction of the hock and the cannon bone, on the inside and a little in front, and tangible both to sight and touch. this enlargement, or bone spavin, grows rapidly and persistently and soon acquires dimensions which renders it impossible to doubt any longer its existence or its nature. once established, its development continues under conditions of progress similar to those to which we have before alluded in speaking of other like affections. the argument advanced by some that because these bony deposits are frequently found on both hocks they are not spavins is fallacious. if they are discovered on both hocks, it proves merely that they are not confined to a single joint. the characteristic lameness of bone spavin, as it affects the motion of the hock joint, presents two aspects. in one class of cases it is most pronounced when the horse is cool, in the other when he is at work. the first is characterized by the fact that when the animal travels the toe first touches the ground, and the heel descends more slowly, the motion of flexion at the hock taking place stiffly, and accompanied with a dropping of the hip on the opposite side. in the other case the peculiarity is that the lameness increases as the horse travels; that when he stops he seeks to favor the lame leg, and when he resumes his work soon after he steps much on his toe, as in the first variety. as with sidebones, though for a somewhat different reason, the dimensions of the spavin and the degree of the lameness do not seem to bear any determinate relation, the most pronounced symptoms at times accompanying a very diminutive growth. the distinction between the two varieties of cool and warm, however, may easily be determined by remembering the fact that in most cases the first, or cool, is due to a simple exostosis, while the second is generally connected with disease of the articulation, such as ulceration of the articular surface--a condition which, as we proceed further, will receive our attention when we reach the subject of stringhalt. an excellent test for spavin lameness, which may be readily applied, consists in lifting the affected leg from the ground for one or two minutes and holding the foot high so as to flex all the joints. an assistant, with the halter strap in his hand, quickly starts the animal off in a trot, when, if the hock joint is affected, the lameness will be so greatly intensified as to lead readily to a diagnosis. _prognosis._--having thus fully considered the history of bone spavin, we are prepared to give due weight to the reasons that exist for the adverse prognosis which we must usually feel compelled to pronounce when encountering it in practice, as well as to realize the importance of early discovery. it is but seldom, however, that the necessary advantage of this early knowledge can be obtained, and when the true nature of the trouble has become apparent it is usually too late to resort to the remedial measures which, if duly forewarned, a skillful practitioner might have employed. we are fully persuaded that but for the loss of the time wasted in the treatment of purely imaginary ailments very many cases of bone spavin might be arrested in their incipiency and their victims preserved for years of comfort for themselves and valuable labor to their owners. _treatment._--to consider a hypothetical case: an early discovery of lameness has been made; that is, the existence of an acute inflammation--of periostitis--has been detected. the increased temperature of the parts has been observed, with the stiffened gait and the characteristic pose of the limb, and the question is proposed for solution, what is to be done? even with only these comparatively doubtful symptoms--doubtful with the nonexpert--we should direct our treatment to the hock in preference to any other joint, since of all the joints of the hind leg it is this which is most liable to be attacked, a natural result from its peculiarities of structure and function. and in answer to the query, what is the first treatment indicated? we should answer _rest_--emphatically, and as an essential condition, _rest_. whether only threatened, suspected, or positively diseased, the animal must be wholly released from labor, and it must be no partial or temporary quiet of a few days. in all stages and conditions of the disease, whether the spavin is nothing more than a simple exostosis, or whether accompanied with the complication of arthritis, there must be a total suspension of effort until the danger is over. less than a month's quiet ought not to be thought of--the longer the better. good results may also be expected from local applications. the various lotions which cool the parts, the astringents which lower the tension of the blood vessels, the tepid fomentations which accelerate the circulation in the engorged capillaries, the liniments of various composition, the stimulants, the opiate anodynes, the sedative preparations of aconite, the alterative frictions of iodin--all these are recommended and prescribed by one or another. we prefer counterirritants, for the reason, among many others, that by the promptness of their action they tend to prevent the formation of the bony deposits. the lameness will often yield to the blistering action of cantharides, in the form of ointment or liniment, and to the alterative preparations of iodin or mercury. if the owner of a "spavined" horse really succeeds in removing the lameness, he has accomplished all that he is justified in hoping for; beyond this let him be well persuaded that a "cure" is impossible. for this reason, moreover, he will do well to be on his guard against the patented "cures" which the traveling horse doctor may urge upon him, and withhold his faith from the circular of the agent who will deluge him with references and certificates. it is possible that nostrums may in some exceptional instances prove serviceable, but the greater number of them are capable of producing only injurious effects. the removal of the bony tumor can not be accomplished by any such means, and if a trial of these unknown compounds should be followed by complications no worse than the establishment of one or more ugly, hairless cicatrices, it will be well for both the horse and his owner. rest and counterirritation, with the proper medicaments, constitute, then, the prominent points in the treatment designed for the relief of bone spavin. yet there are cases in which all the agencies and methods referred to seem to lack effectiveness and fail to produce satisfactory results. either the rest has been prematurely interrupted or the blisters have failed to modify the serous infiltration, or the case in hand has some undiscernible characteristics which seem to have rendered the disease neutral to the agencies used against it. an indication of more energetic means is then presented, and free cauterization with the firing iron becomes necessary. at this point a word of explanation in reference to this operation of firing may be appropriate for the satisfaction of any among our readers who may entertain an exaggerated idea of its severity and possible cruelty. the operation is one of simplicity, but is nevertheless one which, in order to secure its benefits, must be reserved for times and occasions of which only the best knowledge and highest discretion should be allowed to judge. it is not the mere application of a hot iron to a given part of the body which constitutes the operation of firing. it is the methodical and scientific introduction of heat into the structure with a view to a given effect upon a diseased organ or tissue by an expert surgeon. the first is one of the degrees of mere burning. the other is scientific cauterization, and is a surgical manipulation which should be committed exclusively to the practiced hand of the veterinary surgeon. either firing alone or stimulation with blisters is of great efficacy for the relief of lameness from bone spavin. failure to produce relief after a few applications and after allowing a sufficient interval of rest should be followed by a second or, if needed, a third firing. in case of further failure there is a reserve of certain special operations which have been tried and recommended, among which those of cunean tenotomy, periosteotomy, the division of nervous branches, etc., may be mentioned. these, however, belong to the peculiar domain of the veterinary practitioner, and need not now engage our attention. fractures. in technical language a fracture is a "solution of continuity in the structure or substance of a bone." it ranks among the most serious of the lesions to which the horse--or any animal--can be subject. it is a subject of special interest to veterinarians and horse owners in view of the fact that it occurs in such a variety of forms and subjects the patient to much loss of time, resulting in the suspension of his earning capacity. though of less serious consequence in the horse than in man, it is always a matter of grave import. it is always slow and tedious in healing and is frequently of doubtful and unsatisfactory result. this solution of continuity may take place in two principal ways. in the most numerous instances it includes the total thickness of the bone and is a complete fracture. in other cases it involves only a portion of the thickness of the bone, and for that reason is described as incomplete. if the bone is divided into two separate portions and the soft parts have received no injury, the fracture is a simple one, or it becomes compound if the soft parts have suffered laceration, and comminuted if the bones have been crushed or ground into fragments, many or few. the direction of the break also determines its further classification. broken at a right angle, it is transverse; at a different angle it becomes oblique, and it may be longitudinal or lengthwise. in a complete fracture, especially of the oblique kind, there is a condition of great importance in respect to its effect upon the ultimate result of the treatment in the fact that from various causes, such as muscular contractions or excessive motion, the bony fragments do not maintain their mutual coaptation, but become separated at the ends, which makes it necessary to add another descriptive term--with displacement. these words again suggest the negative and introduce the term without displacement, when the facts justify that description. furthermore, a fracture may be intra-articular or extra-articular, as it extends into a joint or otherwise, and, once more, intra-periosteal when the periosteum remains intact. finally, there is no absolute limit to the use of descriptive terminology in the case. the condition of displacement is largely influential in determining the question of treatment and as affecting the final result of a case of fracture. this, however, is dependent upon its location or whether its seat is in one or more of the axes of the bone, in its length, its breadth, its thickness, or its circumference. an incomplete fracture may also be either simple or comminuted. in the latter case the fragments are held together by the periosteum when it is intact; in that case the fracture belongs to the intra-periosteal class. at times, also, there is only a simple fissure or split in the bone, making a condition of much difficulty of diagnosis. _causes._--two varieties of originating cause may be recognized in cases of fracture. they are the predisposing and the occasional. as to the first, different species of animals differ in the degree of their liability. that of the dog is greater than that of the horse, and in horses the various questions of age, the mode of labor, the season of the year, the portion of the body most exposed, and the existence of ailments, local and general, are all to be taken into account. among horses, those employed in heavy draft work or that are driven over bad roads are more exposed than light-draft or saddle horses, and animals of different ages are not equally liable. dogs and young horses, with those which have become sufficiently aged for their bones to have acquired an enhanced degree of frangibility, are more liable than those which have not exceeded the time of their prime. the season of the year is undoubtedly, though in an incidental way, an important factor in the problem of the etiology of these accidents, for though they may be observed at all times, it is during the months when the slippery condition of the icy roads renders it difficult for both men and beasts to keep their feet that they occur most frequently. the long bones, those especially which belong to the extremities, are most frequently the seat of fractures, from the circumstance of their superficial position, their exposure to contact and collision, and the violent muscular efforts involved both in their constant, rapid movement and their labor in the shafts or at the pole of heavy and heavily laden carriages. the relation between sundry idiosyncrasies and diathesis and a liability to fractures is too constant and well-established a pathological fact to need more than a passing reference. the history of rachitis, of melanosis, and of osteoporosis, as related to an abnormal frangibility of the bones, is a part of our common medical knowledge. there are few persons who have not known of cases among their friends of frequent and almost spontaneous fractures, or at least of such as seem to be produced by the slightest and most inadequate violence, and there is no tangible reason for doubting an analogous condition in dividuals of the equine race. among local predisposing causes mention must not be omitted of such bony diseases as caries, tuberculosis, and others of the same class. exciting, occasional, or "efficient" causes of fracture are in most instances external traumatisms, as violent contacts, collisions, falls, etc., or sudden muscular contractions. these external accidents are various in their character, and are usually associated with quick muscular exertion. a violent, ineffectual effort to move too heavy a load; a semispasmodic bracing of the frame to avoid a fall or resist a pressure; a quick jump to escape a blow; stopping too suddenly after speeding; struggling to liberate a foot from a rail, perhaps to be thrown in the effort--all these are familiar and easy examples of accidents happening hourly by which our equine servants become sufferers. we may add to these the fracture of the bones of the vertebræ, occurring when casting a patient for the purpose of undergoing a surgical operation, quite as much as the result of muscular contraction as of a preexisting diseased condition of the bones. a fracture occurring under these circumstances may be called with propriety indirect, while one which has resulted from a blow or a fall differently caused is of the direct kind. _symptoms._--we now return to the first items in our classification of the varieties of fractures for the purpose of bringing them in turn under an orderly review, and our first examination will include those which belong to the first category, or the complete kind. irregularity in the performance of the functions of the apparatus to which the fractured bone belongs is a necessary consequence of the existing lesion, and this is lameness. if the broken bone belongs to one of the extremities, the impossibility of the performance of its natural function in sustaining the weight of the body and contributing to the act of locomotion is usually complete, though the degree of disability will vary according to the kind of fracture and the bone which is injured. for example, a fracture of the cannon bone without displacement, or of one of the phalanges, which are surrounded and sustained by a complex fibrous structure, is, in a certain degree, not incompatible with some amount of resting on the foot. on the contrary, if the shank bone, or that of the forearm is the implicated member, it would be very difficult for the leg to exercise any agency whatever in the support of the body, and in a fracture of the lower jaw it would be obviously unreasonable to expect it to contribute materially to the mastication of feed. it seldom happens that a fracture is not accompanied with a degree of deformity, greater or less, of the region or the leg affected. this is due to the exudation of the blood into the meshes of the surrounding tissues and to the displacement which occurs between the fragments of the bones, with subsequently the swelling which follows the inflammation of the surrounding tissues. the character of the deformity will mainly depend upon the manner in which the displacement occurs. in a normal state of things the legs perform their movements with the joints as their only centers or bases of action, with no participation of intermediate points, while with a fracture the flexibility and motion which will be observed at unnatural points are among the most strongly characteristic signs of the lesion. no one need be told that, when the shaft of a limb is seen to bend midway between the joints, with the lower portion swinging freely, the leg is broken. there are still some conditions, however, in which the excessive mobility is not easy to detect. such are the cases in which the fracture exists in a short bone, near a movable joint, or in a bone of a region where several short and small bones are united in a group, or even in a long bone the situation of which is such that the muscular covering prevents the visible manifestation of the symptom. if the situation of a fracture precludes its discovery by means of this abnormal flexibility, other modes of detection remain. there is one method which is absolute and positive and which can be applied in by far the most, though not in all cases. this is crepitation, or the peculiar effect which is produced by the friction of the fractured surfaces one against another. though discerned by the organs of hearing it can scarcely be called a sound, for the grating of the parts as the rubbing takes place is more felt than heard; however, there is no mistaking its import in cases favorable for the application of the test. the conditions in which it is not available are those of incomplete fracture, in which the mobility of the part is lacking, and those in which the whole array of phenomena are usually obscure. to obtain the benefit of this pathognomonic sign requires deliberate, careful, and gentle manipulation. sometimes the slightest of movements will be sufficient for its development, after much rougher handling has failed to discover it. perhaps the failure in the latter case is due to a sort of defensive spasmodic rigidity caused by the pain resulting from the rude interference. more or less reactive fever is a usual accompaniment of a fracture. ecchymosis in the parts is but a natural occurrence, and is more easily discovered in animals possessing a light-colored and delicate skin than in those of any other character. there are difficulties in the way of the diagnosis of an incomplete fracture, even sometimes when there is a degree of impairment in the function of locomotion, with evidences of pain and swelling at the seat of lesion. there should then be a careful examination for evidences of a blow or other violence sufficient to account for the fracture, though very often a suspicion of its existence can be converted into a certainty only by a minute history of the patient if it can be obtained up to the moment of the occurrence of the injury. a diagnosis ought not to be hastily pronounced, and where good ground for suspicion exists it ought not to be rejected upon any evidence less than the best. we too often read of serious and fatal complications following careless conclusions in similar cases, among which we may refer to one instance of a complete fracture manifesting itself in an animal during the act of rising in his stall after a decision had been pronounced that he had no fracture at all. fractures are of course liable to complications, especially those which are of a traumatic character, such as extensive lacerations, tearing of tissues, punctures, contusions, etc. unless these are in communication with the fracture itself the indication is to treat them simply as independent lesions upon other parts of the body. a traumatic emphysema at times causes trouble, and abscesses, more or less deep and diffused, may follow. in some cases small, bony fragments from a comminuted fracture, becoming loose and acting as foreign bodies, give rise to troublesome fistulous tracts. a frequent complication is hemorrhage, which often becomes of serious consequence. a fracture in close proximity to a joint may be accompanied with dangerous inflammations of important organs, and induce an attack of pneumonia, pleurisy, arthritis, etc., especially if near the chest; it may also cause luxations, or dislocations. gangrene, as a consequence of contusions or of hemorrhage or of an impediment to the circulation, caused by unskillfully applied apparatus, must not be overlooked among the occasional incidents; nor must lockjaw, which is not an uncommon occurrence. even founder, or laminitis, has been met with as the result of forced and long-continued immobility of the feet in the standing posture, as one of the involvements of unavoidably protracted treatment. when a simple fracture has been properly treated and the broken ends of the bone have been securely held in coaptation, one of two things will occur. either--and this is the more common event--there will be a union of the two ends by a solid cicatrix, the callus, or the ends will continue separated or become only partially united by an intermediate fibrous structure. in the first instance the fracture is consolidated or united; in the second there is a false articulation, or pseudarthrosis. the time required for a firm union or true consolidation of a fracture varies with the character of the bone affected, the age and constitution of the patient, and the general conditions of the case. the union will be perfected earlier in a young than in an adult animal, and sooner in the latter than in the aged, and a general healthy condition is, of course, in every respect, an advantage. the mode of cicatrization, or method of repair in lesions of the bones, has been a subject of much study among investigators in pathology, and has elicited various expressions of opinion from those high in authority. the weight of evidence and preponderance of opinion are about settled in favor of the theory that the law of reparation is the same for both the hard and the soft tissues. in one case a simple exudation of material, with the proper organization of newly formed tissue, will bring about a union by the first intention, and in another the work will be accompanied with suppuration, or union by the second intention, a process so familiar in the repair of the soft structures by granulation. considering the process in its simplest form, in a case in which it advances without interruption or complication to a favorable result, it may probably be correctly described in this wise: on the occurrence of the injury an effusion of blood takes place between the ends of the bone. the coagulation of the fluid soon follows, and this, after a few days, undergoes absorption. there is then an excess of inflammation in the surrounding structure, which soon spreads to the bony tissue, when a true ostitis is established, and the compact tissue of the bone becomes the seat of a new vascular organization, and of a certain exudation of plastic lymph, appearing between the periosteum and the external surface of the bone, as well as on the inner side of the medullary cavity. after a few days the ends of the bone thus surrounded by this exudate become involved in it, and the lymph, becoming vascular, is soon transformed into cartilaginous, and in due time into bony, tissue. thus the time required for the consolidation of the fractured segments is divisible into two distinct periods. in the first they are surrounded by an external bony ring, and the medullary cavity is closed by a bony plug or stopper, constituting the period of the provisional callus. this is followed by the period of permanent callus, during which the process of converting the cartilaginous into the osseous form is going forward. the restorative process is sooner completed in the carnivorous than in the herbivorous tribes. in the former the temporary callus may attain sufficient fineness of consistency for the careful use of the limb within four weeks, but with the latter a period of from six weeks to two months is not too long to allow before removing the supporting apparatus from the limb. this, in general terms, represents the fact when the resources of nature have not been thwarted by untoward accidents, such as a want of vigor in the constitution of the patient or a lack of skill on the part of the practitioner, and especially when, from any cause, the bony fragments have not been kept in a state of perfect immobility and the constant friction has prevented the osseous union of the two portions. failures and misfortunes are always more than possible, and instead of a solid and practicable bony union the sequel of the accident is sometimes a false joint, composed of mere flexible cartilage, a poor pseudarthrosis. the explanation of this appears to be that, first, the sharp edges of the ends of the bone disappear by becoming rounded at their extremities by friction and polishing against each other. then follows an exudation of a plastic nature which becomes transformed into a cartilaginous layer of a rough, articular aspect. in this bony nuclei soon appear, and the lymph secreted between the segments thus transformed, instead of becoming truly ossified, is changed into a sort of fibrocartilaginous pouch, or capsular sac, in which a somewhat albuminous secretion, or pseudo-synovia, permits the movement to take place. most commonly, however, in our animals, the union of the bony fragments is obtained wholly through the medium of a layer of fibrous tissue, and it is because the union has been accomplished by a ligamentous formation only that motion becomes practicable. _prognosis._--the prognosis in a case of fracture in an animal is one of the gravest vital import to the patient, and therefore of serious pecuniary concern to his owner. the period has not long elapsed when to have received such a hurt was quite equivalent to undergoing a sentence of death for the suffering animal, and perhaps to-day a similar verdict is pronounced in many cases in which the exercise of a little mechanical ingenuity, with a due amount of careful nursing, might secure a contrary result and insure the return of the patient to his former condition of soundness and usefulness. _treatment._--considered per se, a fracture in an animal is in fact no less amenable to treatment than the same description of injury in any other living being. but the question of the propriety and expediency of treatment is dependent upon certain specific points of collateral consideration. ( ) the nature of the lesion is a point of paramount importance. a simple fracture occurring in a bone where the ends can be firmly secured in coaptation presents the most favorable condition for successful treatment. if it is that of a long bone, it will be the less serious if situated at or near the middle of its length than if it were in close proximity to a joint, from the fact that perfect immobility can rarely, in the latter case, be secured without incurring the risk of subsequent rigidity of the joint. a simple is always less serious than a compound fracture. a comminuted is always more dangerous than a simple, and a transverse break is easier to treat than one which is oblique. the most serious are those which are situated on parts of the body in which it is difficult to obtain perfect immobility, and especially those which are accompanied with severe contusions and lacerations in the soft parts; the protrusion of fragments through the skin; the division of blood vessels by the broken ends of the bone; the existence of an articulation near the point to which inflammation is liable to extend; the luxation of a fragment of the bone; laceration of the periosteum; the presence of a large number of bony particles, the result of the crushing of the bone--all these are circumstances which discourage a favorable prognosis, and weigh against the hope of saving the patient for future usefulness. fractures which may be accounted curable are those which are not conspicuously visible, as those of the ribs, where displacements are either very limited or do not occur, the parts being kept in situ by the nature of their position, the shape of the bones, the articulations they form with the vertebra, the sternum, or their cartilages of prolongation; those of transverse processes of the lumbar vertebra; those of the bones of the face; those of the ilium; and that of the coffinbones. to continue the category, the following are evidently curable when their position and the character of the patient contribute to aid the treatment: those of the cranium, in the absence of cerebral lesions; those of the jaws; of the ribs, with displacement; of the hip; and those of the bones of the leg in movable regions, but where their vertical position admits of perfect coaptation. on the contrary, a compound, complicated, or comminuted, fracture, in whatever region it may be situated, may be counted incurable. in treating fractures time is an important element and "delays are dangerous." those of recent occurrence unite more easily and more regularly than older ones. ( ) as a general rule, fractures are less serious in animals of the smaller species than in those of more bulky dimensions. this influence of species will be readily appreciated when we realize that the difficulties involved in the treatment of the latter class have hardly any existence in connection with the former. the difference in weight and size, and consequent facility in handling and making the necessary applications of dressings and other appliances for the purpose of securing the indispensable immobility of the parts, and usually a less degree of uneasiness in the deportment of the patients are considerations in this connection of great weight. ( ) in respect to the utilization of the animal, the most obvious point in estimating the gravity of the case in a fracture accident is the certainty of the total loss of the services of the patient during treatment--certainly for a considerable period of time; perhaps permanently. for example, the fracture of the jaw of a steer just fattening for the shambles will involve a heavier loss than a similar accident to a horse. usually the fracture of the bones of the extremities in a horse is a very serious casualty, the more so proportionately as the higher region of the limb is affected. in working animals it is exceedingly difficult to treat a fracture in such manner as to restore a limb to its original perfection of movement. a fracture of a single bone of an extremity in a breeding stallion or mare will not necessarily impair the value of the animal as a breeder. other specifications under this head, though pertinent and more or less interesting, may be omitted. ( ) age and temper are important factors of cure. a young, growing, robust patient whose vis vitæ is active is amenable to treatment which one with a waning constitution and past mature energies would be unable to endure, and a docile, quiet disposition will act cooperatively with remedial measures which would be neutralized by the fractious opposition of a peevish and intractable sufferer. the fulfillment of three indications is indispensable in all fractures. the first is the reduction, or the replacement, of the parts as nearly as possible in their normal position. the second is their retention in that position for a period sufficient for the formation of the provisional callus, and the third, which, in fact, is but an incident of the second, the careful avoidance of any accidents or causes of miscarriage which might disturb the curative process. in reference to the first consideration, it must be remembered that the accident may befall the patient at a distance from his home, and his removal becomes the first duty to be attended to. of course, this must be done as carefully as possible. if he can be treated on the spot, so much the better, though this is seldom practicable, and the method of removal becomes the question calling for settlement. but two ways present themselves--he must either walk or be carried. if the first, it is needless to say that every caution must be observed in order to obviate additional pain and to avoid any aggravation of the injury. led slowly, and with partial support, if practicable, the journey will not always involve untoward results. if he is carried, it must be by means of a wagon, a truck, or an ambulance; the last being designed and adapted to the purpose, would, of course, be the most suitable vehicle. as a precaution which should never be overlooked, a temporary dressing should first be applied. this may be so done as for the time to answer all the purposes of the permanent adjustment and bandaging. without thus securing the patient, a fracture of an inferior degree may be transformed to one of the severest kind, and, indeed, a curable changed to an incurable injury. we recall a case in which a fast-trotting horse, after running away in a fright caused by the whistle of a locomotive, was found on the road limping with excessive lameness in the off fore leg, and walked with comparative ease some miles to a stable before being seen by a surgeon. his immediate removal in an ambulance was advised, but before that vehicle could be procured the horse lay down, and upon being made to get upon his feet was found with a well-marked comminuted fracture of the os suffraginis, with considerable displacement. the patient, however, after long treatment, made a comparatively good recovery and though with a large, bony deposit, a ringbone, was able to trot in the forties. the two obvious indications in cases of fracture are reduction, or replacement, and retention. in an incomplete fracture, where there is no displacement, the necessity of reduction does not exist. with the bone kept in place by an intact periosteum, and the fragments secured by the uninjured fibrous and ligamentous structure which surrounds them, there is no dislocation to correct. reduction is also at times rendered impossible by the seat of the fracture itself, by its dimensions, alone, or by the resistance arising from muscular contraction. that is illustrated even in small animals, as in dogs, by the exceeding difficulty encountered in bringing together the ends of a broken femur or humerus, the muscular contractions being even in these animals sufficiently forcible to renew the displacement. it is generally, therefore, only fractures of the long bones, and then at points not in close proximity to the trunk, that may be considered to be amenable to reduction. it is true that some of the more superficial bones, as those of the head, of the pelvis, and of the thoracic walls, may in some cases require special manipulations and appliances for their retention in their normal positions; hence the treatment of these and of a fractured leg can not be the same. the methods of accomplishing reduction vary with the features of each case, the manipulations being necessarily modified to meet different circumstances. if the displacement is in the thickness of the bone, as in transverse fracture, the manipulation of reduction consists in applying constant pressure upon one of the fragments, while the other is kept steady in its place, the object of the pressure being the reestablishment of the exact coincidence of the two bony surfaces. if the displacement has taken place at an angle it will be sufficient in order to effect the reduction to press upon the summit, or apex, of the angle until its disappearance indicates that the parts have been brought into coaptation. this method is often practiced in the treatment of a fractured rib. in a longitudinal fracture, or when the fragments are pressed together by the contraction of the muscles to which they give insertion until they so overlap as to correspond by certain points of their circumference, the reduction is to be accomplished by effecting the movements of extension, counter extension, and coaptation. extension is accomplished by making traction upon the lower portion of the limb. counter extension consists in firmly holding or confining the upper or body portion in such manner, that it shall not be affected by the traction applied to the lower part. in other words, the operator, grasping the limb below the fracture, draws it down or away from the trunk, while he seeks not to draw away, but simply to hold the upper portion still until the broken ends of bone are brought to their natural relative positions, when the coaptation, which is thus effected, has only to be made permanent by the proper dressings to perfect the reduction. in treating fractures in small animals the strength of the hand is usually sufficient for the required manipulations. in the fracture of the forearm of a dog, for example, while the upper segment is firmly held by one hand the lower may be grasped by the other and the bone itself made to serve the purpose of a lever to bring about the desired coaptation. in such case that is sufficient to overcome the muscular contraction and correct the overlapping or other malposition of the bones. if, however, the resistance can not be overcome in this way, the upper segment may be committed to an assistant for the management of the counter extension, leaving to the operator the free use of both hands for the further manipulation of the case. if the reduction of fractures in small animals is an easy task, however, it is far from being so when the patient is a large animal whose muscular force is largely greater than that of several men combined. in such case resort must be had not only to superior numbers for the necessary force, but in many cases to mechanical aids. a reference to the manner of proceeding in a case of fracture with displacement of the forearm of a horse will illustrate the matter. the patient is first to be carefully cast, on the uninjured side, with ropes or a broad, leather strap about feet long passed under and around his body and under the axilla of the fractured limb and secured at a point opposite to the animal and toward his back. this will form the mechanical means of counter extension. another rope will then be placed around the inferior part of the leg below the point of fracture, with which to produce extension, and this will sometimes be furnished with a block and pulleys, in order to augment the power when necessary; there is, in fact, always an advantage in their use, on the side of steadiness and uniformity, as well as of increased power. it is secured around the fetlock or the coronet or, what is better, above the knee and nearer the point of fracture, and is committed to assistants. the traction on this should be firm, uniform, and slow, without relaxing or jerking, while the operator carefully watches the process. if the bone is superficially situated he is able, by the eye, to judge of any changes that may occur in the form or length of the parts under traction, and discovering, at the moment of its happening, the restoration of symmetry in the disturbed region he gently but firmly manipulates the place until all appearance of severed continuity has vanished. sometimes the fact and the instant of restoration are indicated by a peculiar sound or "click" as the ends of the bones slip into contact, to await the next step of the restorative procedure. the process is the same when the bones are covered with thick muscular masses except that it is attended with greater difficulties from the fact that the finger must be substituted for the eye and taxis must take the place of sight. it frequently happens that perfect coaptation is prevented by the interposition, between the bony surfaces, of such substances as a small fragment of detached bone or a clot of blood; sometimes the extreme obliquity of the fracture, by permitting the bones to slip out of place, is the opposing cause. these are difficulties which can not always be overcome, even in small-sized animals, and still it is only when they are mastered that a correct consolidation can be looked for. without it the continuity between the fragments will be by a deformed callus, the union will leave a shortened, crooked, or angular limb, and the animal will be disabled. if timely assistance can be obtained, and the reduction accomplished immediately after the occurrence of the accident, that is the best time for it, but if it can not be attended to until inflammation has become established and the parts have become swollen and painful, time must be allowed for the subsidence of these symptoms before attempting the operation. a spasmodic, muscular contraction which sometimes interposes a difficulty may be easily overcome by subjecting the patient to general anesthesia, and need not, therefore, cause any loss of time. a tendency to this may also be overcome by the use of sedatives and antiphlogistic remedies. the reduction of the fracture having been accomplished, the problem which follows is that of retention. the parts which have been restored to their natural position must be kept there, without disturbance or agitation, until the perfect formation of a callus, and it is here that ample latitude exists for the exercise of ingenuity and skill by the surgeon in the contrivance of the necessary apparatus. one of the most important of the conditions which are available by the surgeon in treating human patients is denied to the veterinarian in the management of those which belong to the animal tribes. this is position. the intelligence of the human patient cooperates with the instructions of the surgeon, in the case of the animal sufferer there is a continual antagonism between the parties, and the forced extension and fatiguing position which must for a considerable period be maintained as a condition of restoration require special and effective appliances to insure successful results. to obtain complete immobility is scarcely possible, and the surgeon must be content to reach a point as near as possible to that which is unattainable. for this reason, as will subsequently be seen, the use of slings and the restraint of patients in very narrow stalls is much to be preferred to the practice sometimes recommended of allowing entire freedom of motion by turning them loose in box stalls. temporary and movable apparatus are not usually of difficult use in veterinary practice, but the restlessness of the patients and their unwillingness to submit quietly to the changing of the dressings render it obligatory to have recourse to permanent and immovable bandages, which should be retained without disturbance until the process of consolidation is complete. the materials composing the retaining apparatus consist of oakum, bandages, and splints, with an agglutinating compound which forms a species of cement by which the different constituents are blended into a consistent mass to be spread upon the surface covering the locality of the fracture. its components are black pitch, rosin, and venice turpentine, blended by heat. the dressing may be applied directly to the skin, or a covering of thin linen may be interposed. a putty made with powdered chalk and the white of egg is recommended for small animals, though a mixture of sugar of lead and burnt alum with the albumen is preferred by others. another formula is spirits of camphor, goulard's extract, and albumen. another recommendation is to saturate the oakum and bandages with an adhesive solution formed with gum arabic, dextrin, flour paste, or starch. this is advised particularly for small animals, as is also the silicate of soda. dextrin mixed while warm with burnt alum and alcohol cools and solidifies into a stony consistency, and is preferable to plaster of paris, which is less friable and has less solidity, besides being heavier and requiring constant additions as it becomes older. starch and plaster of paris form another good compound. in applying the dressing the leg is usually padded with a cushion of oakum thick and soft enough to equalize the irregularities of the surface and to form a bedding for the protection of the skin from chafing. over this the splints are placed. the material for these is, variously, pasteboard, thin wood, bark, laths, gutta-percha, strips of thin metal, as tin or perhaps sheet iron. they should be of sufficient length not only to cover the region of the fracture but to extend sufficiently above and below to render the immobility more nearly complete than in the surrounding joints. the splints, again, are covered with cloth bandages--linen preferably--soaked in a glutinous mixture. these bandages are to be carefully applied, with a perfect condition of lightness. they are usually made to embrace the entire length of the leg in order to avoid the possibility of interference with the circulation of the extremity as well as for the prevention of chafing. they should be rolled from the lower part of the leg upward and carefully secured against loosening. in some instances suspensory bandages are recommended, but except for small animals our experience does not justify a concurrence in the recommendation. these permanent dressings always need careful watching with reference to their immediate effect upon the region they cover, especially during the first days succeeding that of their application. any manifestation of pain, or any appearance of swelling above or below, or any odor suggestive of suppuration should excite suspicion, and a thorough investigation should follow without delay. the removal of the dressing should be performed with great care, and especially so if time enough has elapsed since its application to allow of a probability of a commencement of the healing process or the existence of any points of consolidation. with the original dressing properly applied in its entirety in the first instance, the entire extremity will have lost all chance of mobility, and the repairing process may be permitted to proceed without interference. there will be no necessity and there need be no haste for removal or change except under such special conditions as have just been mentioned, or when there is reason to judge that solidification has become perfect, or for the comfort of the animal, or for its readaptation in consequence of the atrophy of the limb from want of use. owners of animals are often tempted to remove a splint or bandage prematurely at the risk of producing a second fracture in consequence of the failure of the callus properly to consolidate. the method of applying the splints which we have described refers to the simple variety only. in a compound case the same rules must be observed, with the modification of leaving openings through the thickness of the dressing, opposite the wound, in order to permit the escape of pus and to secure access to the points requiring the application of treatment. fracture of cranial bones. fractures of the cranial bones in large animals are comparatively rare, though the records are not destitute of cases. when they occur, it is as the result of external violence, the sufferers being usually run-aways which have come in collision with a wall or a tree or other obstruction, or it may occur in those which in pulling upon the halter have broken it with a jerk and been thrown backward, as may occur in rearing too violently. under these conditions we have witnessed fractures of the parietal, of the frontal, and of the sphenoid bones. these fractures may be of both the complete and the incomplete kinds, which indeed is usually the case with those of the flat bones, and they are liable to be complicated with lacerations of the skin, in consequence of which they are easily brought under observation. when the fact is otherwise and the skin is intact, however, the diagnosis becomes difficult. _symptoms._--the incomplete variety may be unaccompanied with any special symptoms, but in the complete kind one of the bony plates may be so far detached as to press upon the cerebral substance with sufficient force to produce serious nervous complications. when the injury occurs at the base of the cranium hemorrhage may be looked for, with paralytic symptoms, and when these are present the usual termination is death. it may happen, however, that the symptoms of an apparently very severe concussion may disappear, resulting in an early and complete recovery, and the surgeon will therefore do well to avoid undue haste in venturing upon a prognosis. in fractures of the orbital or the zygomatic bones the danger is less pressing than with injuries otherwise located about the head. _treatment._--the treatment of cranial fractures is simple, though involving the best skill of an experienced surgeon. when incomplete hardly any interference is needed; even plain bandaging may usually be dispensed with. in the complete variety the danger to be combated is compression of the brain, and attention to this indication must not be delayed. the means to be employed are the trephining of the skull over the seat of the fracture and the elevation of the depressed bone or the removal of the portion which is causing the trouble. fragments of bone in comminuted cases, bony exfoliations, collections of fluid, or even protruding portions of the brain substance must be carefully cleansed away and a simple bandage so applied as to facilitate the application of subsequent dressings. fractures of the bones of the face. in respect to their origin--usually traumatic--these injuries rank with the preceding, and are commonly of the incomplete variety. they may easily be overlooked, and may even sometimes escape recognition until the reparative process has been well established and the wound is discovered owing to the prominence caused by the presence of the provisional callus which marks its cure. when the fracture is complete it will be marked by local deformity, mobility of the fragments, and crepitation. nasal hemorrhage, roaring, frequent sneezing, loosening or loss of teeth, difficulty of mastication, and inflammation of the cavities of the sinuses are varying complications of these accidents. the object of the treatment should be the restoration of the depressed bones as nearly as possible to their normal position and their retention in place by protecting splints, which should cover the entire facial region. special precautions should be observed to prevent the patient from disturbing the dressing by rubbing his head against surrounding objects, such as the stall, manger, rack, etc. clots of blood in the nasal passages must be washed out, collections of pus removed from the sinuses, and, if the teeth are loosened and liable to fall out, they should be removed. if roaring is threatened, tracheotomy is indicated. fractures of the premaxillary bone. these are mentioned by continental authors and are usually encountered in connection with fractures of the nasal bone, and may take place either in the width or the length of the bone. the deformity of the upper lip, which is drawn sidewise in this lesion, renders it easy of diagnosis. the abnormal mobility and the crepitation, with the pain manifested by the patient when undergoing examination, are concurrent symptoms. looseness of the teeth, abundant salivation, and entire inability to grasp the feed complete the symptomatology of these accidents. in the treatment splints of gutta-percha or leather are sometimes used, but they are of difficult application. our own judgment and practice are in favor of the union of the bones by means of metallic sutures. fractures of the lower jaw. a fracture here is not an injury of infrequent occurrence. it involves the body of the bone, at its symphysis, or back of it, and includes one or both of its branches, either more or less forward, or at the posterior part near the temporomaxillary articulation, at the coronoid process. falls, blows, or other external violence, or powerful muscular contractions during the use of the speculum, may be mentioned among the causes of this lesion. the fracture of the neck, or that portion formed by the juncture of the two opposite sides, and of the branches in front of the cheeks, causes the lower jaw, the true dental arch, to drop, without the ability to raise it again to the upper, and the result is a peculiar and characteristic physiognomy. the prehension and mastication of feed become impossible; there is an abundant escape of fetid and sometimes bloody saliva, especially if the gums have been wounded; there is excessive mobility of the lower end of the jawbone; and there is crepitation, and frequently paralysis of the under lip. although an animal suffering with a complete and often compound and comminuted fracture of the submaxilla presents at times a serious aspect, the prognosis of the case is comparatively favorable, and recovery is usually only a question of time. the severity of the lesion corresponds in degree to that of the violence to which it is due, also to the resulting complications and the situation of the wound. it is simple when at the symphysis, but becomes more serious when it affects one of the branches, and most aggravated when both are involved. fracture of the coronoid process becomes important principally as an evidence of the existence of a morbid diathesis, such as osteoporosis, or the like. the particular seat of the injury, with its special features, will, of course, determine the treatment. for a simple fracture, without displacement, provided there is no laceration of the periosteum, an ordinary supporting bandage will usually be sufficient, but when there is displacement the reduction of the fracture must first be accomplished, and for this special splints are necessary. in a fracture of the symphysis or of the branches the adjustment of the fragments by securing them with metallic sutures is the first step necessary, to be followed by the application of supports, consisting of splints of leather or sheets of metal, the entire front of the head being then covered with bandages prepared with adhesive mixtures. during the entire course of treatment a special method of feeding becomes necessary. the inability of the patient to appreciate the situation, of course, necessitates a resort to an artificial mode of introducing the necessary feed into his stomach; this is accomplished by forcing between the commissures of the lips, in a liquid form, by means of a syringe, the milk or nutritive gruels selected for his sustenance until the consolidation is sufficiently advanced to permit the ingestion of feed of a more solid consistency. the callus will usually be sufficiently hardened in two or three weeks to allow of a change of diet to mashes of cut hay and scalded grain, until the removal of the dressing restores the animal to its old habit of mastication. fractures of vertebrÃ�. these are not very common, but when they do occur the bones most frequently injured are those of the back and loins. _causes._--the ordinary causes of fracture are responsible here as elsewhere, such as heavy blows on the spinal column, severe falls while conveying heavy loads, and especially violent efforts in resisting the process of casting. although occurring more or less frequently under the latter circumstances, the accident is not always attributable to carelessness or error in the management. it may, of course, sometimes result from such a cause as a badly prepared bed, or the accidental presence of a hard body concealed in the straw, or to a heavy fall when the movements of the patient have not been sufficiently controlled by an effective apparatus and its skillful adaptation, but it is quite as liable to be caused by the violent resistance and the consequent powerful muscular contraction by the frightened patient. the simple fact of the overarching of the vertebral column, with excessive pressure against it from the intestinal mass, owing to the spasmodic action of the abdominal muscles, may account for it, and so also may the struggles of the animal to escape from the restraint of the hobbles while frantic under the pain of an operation without anesthesia. in these cases the fracture usually occurs in the body or the annular part, or both, of the posterior dorsal or the anterior lumbar vertebra. when the transverse processes of the last-named bones are injured, it is probably in consequence of the heavy concussion incident to striking the ground when cast. the diagnosis of a fracture of the body of a vertebra is not always easy, especially when quite recent, and more especially when there is no accompanying displacement. _symptoms._--there are certain peculiar signs accompanying the occurrence of the accident while an operation is in progress which should at once excite the suspicion of the surgeon. in the midst of a violent struggle the patient becomes suddenly quiet; the movement of a sharp instrument, which at first excited his resistance, fails to give rise to any further evidence of sensation; perhaps a general trembling, lasting for a few minutes, will follow, succeeded by a cold, profuse perspiration, particularly between the hind legs, and frequently there will be micturition and defecation. careful examination of the vertebral column may then detect a slight depression or irregularity in the direction of the spine, and there may be a diminution or loss of sensation in the posterior part of the trunk, while the anterior portion continues to be as sensitive as before. in making an attempt to get upon his feet, however, upon the removal of the hobbles, only the fore part of the body will respond to the effort, a degree of paraplegia being present, and while the head, neck, and fore part of the body will be raised, the hind quarters and hind legs will remain inert. the animal may perhaps succeed in rising and probably may be removed to his stall, but the displacement of the bone will follow, converting the fracture into one of the complete kind, either through the exertion of walking or by a renewed attempt to rise after another fall before reaching his stall. by this time the paralysis is complete, and the extension of the meningitis, which has become established, is a consummation soon reached. to say that the prognosis of fracture of the body of the vertebra is always serious is to speak very mildly. it would be better, perhaps, to say that _occasionally_ a case _may_ recover. fractures of the transverse processes are less serious. _treatment._--instead of stating the indication in this class of cases as if assuming them to be amenable to treatment, the question naturally would be: can any treatment be recommended in a fracture of the body of a vertebra? the only indication in such a case, in our opinion, is to reach the true diagnosis in the shortest possible time and to act accordingly. if there is displacement, and the existence of serious lesions may be inferred from the nervous symptoms, the destruction of the suffering animal appears to suggest itself as the one conclusion in which considerations of policy, humanity, and science at once unite. if, however, it is fairly evident that no displacement exists; that pressure upon the spinal cord is not yet present; that the animal with a little assistance is able to rise upon his feet and to walk a short distance--it may be well to experiment upon the case to the extent of placing the patient in the most favorable circumstances for recovery and allow nature to operate without further interference. this may be accomplished by obtaining immobility of the whole body as much as possible, and especially of the suspected region, by placing the patient in slings, in a stall sufficiently narrow to preclude lateral motion, and covering the loins with a thick coat of agglutinative mixture. developments should be watched and awaited. fracture of the ribs. the different regions of the chest are not equally exposed to the violence that causes fractures of the ribs, and they are therefore either more common or more easily discovered during life at some points than at others. the more exposed regions are the middle and the posterior, while the front is largely covered and defended by the shoulder. a single rib may be the seat of fracture, or a number may be involved, and there may be injuries on both sides of the chest at the same time. it may take place lengthwise, in any part of the bone, though the middle, being the most exposed, is the most frequently hurt. incomplete fractures are usually lengthwise, involving a portion only of the thickness of one or other of the surfaces. the complete kind may be either transverse or oblique, and are most commonly denticulated. the fracture may be comminuted, and a single bone may show one of the complete and one of the incomplete kind at different points. the extent of surface presented by the thoracic region, with its complete exposure at all points, explains the liability of the ribs to suffer from all the forms of external violence. _symptoms._--in many instances fractures, especially the incomplete variety, of these bones continue undiscovered, without displacement, though the evidences of local pain, a certain amount of swelling, and a degree of disturbance of the respiration, if noticed during the examination of a patient, may suggest a suspicion of their existence. abnormal mobility and crepitation are difficult of detection, even when present, and they are not always present. when there is displacement the deformity which it occasions will betray the fact, and when such an injury exists the surgeon, in view of possible and probable complications of thoracic trouble, of course will become vigilant and prepare himself for an encounter with a case of traumatic pleuritis or pneumonia. fatal injuries of the heart are recorded. subcutaneous emphysema is a common accompaniment of broken ribs, and i recall the death, from this cause, of a patient of my own which had suffered a fracture of two ribs in the region of the withers, under the cartilages of the shoulder, and of which the diagnosis was made only after the fatal ending of the case. these hurts are not often of a very serious character, though the union is never so solid and complete as in other fractures, the callus being usually imperfect and of a fibrous character, with an amphiarthrosis formation. still, complications occur which may impart gravity to the prognosis. _treatment._--fractures with but a slight or no displacement need no reduction. all that is necessary is a simple application of a blistering nature as a preventive of inflammation or for its subjugation when present, and in order to excite an exudation which will tend to aid in the support and immobilization of the parts. at times, however, a better effect is obtained by the application of a bandage placed firmly around the chest, although, while this limits the motion of the ribs, it is liable to render the respiration more labored. if there is displacement, with much accompanying pain and evident irritation of the lungs, the fracture must be reduced without delay. the means of effecting this vary according to whether the displacement is outward or inward. in the first case the bone may be straightened by pressure from without, while in the second the end of it must be raised by a lever, for the introduction of which a small incision through the skin and intercostal spaces will be necessary. when coaptation has been effected it must be retained by the external application of an adhesive mixture, with splints and bandages around the chest. fractures of the bones of the pelvis. these fractures will be considered under their separate denominations, as those of the sacrum and the os innominatum, or hip, which includes the subdivisions of the ilium, the pubes, and the ischium. _the sacrum._--fractures of this bone are rarely met with among solipeds. among cattle, however, it is of common occurrence, being attributed not only to the usual varieties of violence, as blows and other external hurts, but to the act of coition and violent efforts in parturition. it is generally of the transverse kind and may be recognized by the deformity which it occasions. this is due to the dropping of the bone, with a change in its direction and a lower attachment of the tail, which also becomes more or less paralyzed. the natural and spontaneous relief which usually interposes in these cases has doubtless been observed by the extensive cattle breeders of the west, and their practice and example fully establish the inutility of interference. still, cases may occur in which reduction may be indicated, and it then becomes a matter of no difficulty. it is effected by the introduction of a round, smooth piece of wood into the rectum as far as the fragment of bone and using it as a lever, resting upon another as a fulcrum placed under it outside. the bone, having been thus returned, may be kept in place by the ordinary external means in use. _the os innominatum._--fracture of the ilium may be observed either at the angle of the hip or at the neck of the bone; those of the pubes may take place at the symphysis, or in the body of the bone; those of the ischium on the floor of the bone, or at its posterior external angle. or, again, the fracture may involve all three of these constituent parts of the hip bone by having its situation in the articular cavity--the acetabulum by which it joins the femur or thigh bone. _symptoms._--some of these fractures are easily recognized, while others are difficult to identify. the ordinary deformity which characterizes a fracture of the external angle of the ilium, its dropping and the diminution of that side of the hip in width, unite in indicating the existence of the condition expressed by the term "hipped." an incomplete fracture, however, or one that is complete without displacement, or even one with displacement, often demands the closest scrutiny for its discovery. the lameness may be well marked, and an animal may show it but little while walking, though upon being urged into a trot will manifest it more and more, until presently it will cease to use the crippled limb altogether, and travel entirely on three legs. the acute character of the lameness will vary in degree as the seat of the lesion approximates the acetabulum. in walking, the motion at the hip is very limited, and the leg is dragged; while at rest it is relieved from bearing its share in sustaining the body. an intelligent opinion and correct conclusion will depend largely upon a knowledge of the history of the case, and while in some instances that will be but a report of the common etiology of fractures, such as blows, hurts, and other external violence, the simple fact of a fall may furnish in a single word a satisfactory solution of the whole matter. with the exception of the deformity of the ilium in a fracture of its external angle, and unless there has been a serious laceration of tissues and infiltration of blood, or excessive displacement, there are no very definite external symptoms in a case of a fracture of the hip bone. there is one, however, which, in a majority of cases, will not fail--it is crepitation. this evidence is attainable by both external and internal examination--by manipulation of the gluteal surface and by rectal taxis. very often a lateral motion, or balancing of the hinder parts by pressing the body from one side to the other, will be sufficient to render the crepitation more distinct--a slight sensation of grating, which may be perceived even through the thick coating of muscle which covers the bone--and the sensation may not only be felt, but to the expert may even become audible. this external manifestation is, however, not always sufficient in itself, and should invariably be associated with the rectal taxis for corroboration. it is true that this may fail to add to the evidence of fracture, but till then the simple testimony afforded by the detection of crepitation from the surface, though a strong confirmatory point, is scarcely sufficiently absolute to establish more than a reasonable probability or strong suspicion in the case. in addition to the fact that the rectal examination brings the exploring hand of the surgeon into near proximity to the desired point of search, and to an accurate knowledge of the situation of parts, both pro and con as respects his own views, there is another advantage attendant upon it which is well entitled to appreciation. this is the facility with which he can avail himself of the help of an assistant, who can aid him by manipulating the implicated limb and placing it in various positions, so far as the patient will permit, while the surgeon himself is making explorations and studying the effect from within. by this method he can hardly fail to ascertain the character of the fracture and the condition of the bony ends. by the rectal taxis, as if with eyes in the finger ends, he will "see" what is the extent of the fracture of the ilium or of the neck of that bone; to what part of the central portion of the bone (the acetabulum) it reaches; whether this is free from disease or not, and in what location on the floor of the pelvis the lesion is situated. by this method we have frequently been able to detect a fracture at the symphysis, which, from its history and symptoms and an external examination, could only have been guessed at. yet, with all its advantages, the rectal examination is not always necessary, as, for example, when the fracture is at the posterior and external angle of the ischium, when by friction of the bony ends the surgeon may discern the crepitation without it. every variety of complication, including muscular lacerations with the formation of deep abscesses and injuries to the organs of the pelvic cavity, the bladder, the rectum, and the uterus, may be associated with fractures of the hip bone. _prognosis._--the prognosis of these lesions will necessarily vary considerably. a fracture of the most superficial part of the bone of the ilium or of the ischium, especially if there is little displacement, will unite rapidly, leaving a comparatively sound animal often quite free from subsequent lameness. if there is much displacement, however, only a ligamentous union will take place, with much deformity and more or less irregularity in the gait. other fractures may be followed by complete disability of the patient, as, for example, when the cotyloid cavity is involved, or when the reparatory process has left bony deposits in the pelvic cavity at the seat of the union, which may, in the case of the female, interfere with the steps of parturition, or induce some local paralysis by pressure upon the nerves which govern the muscles of the hind legs. this is a condition not infrequently observed when the callus has been formed on the floor of the pelvis near the obturator foramen, pressing upon the course or involving the obturator nerve. _treatment._--in our estimation, the treatment of all fractures of the hip bone should be of the simplest kind. rendered comparatively immovable by the thickness of the muscles by which the region is enveloped, one essential indication suggests itself, and that is to place the animal in a position which, so far as possible, will be fixed and permanent. for the accomplishment of this purpose the best measure, as we consider it, is to place the horse in a stall of just sufficient width to admit him, and to apply a set of slings, snugly, but comfortably. (see plate xxxi.) this will fulfill the essential conditions of recovery--rest and immobility. blistering applications would be injurious, though the adhesive mixture might prove in some degree beneficial. the minimum period allowable for solid union in a fractured hip is, in our judgment, two months, and we have known cases in which that was too short a time. as we have said before, there may be cases in which the treatment for fracture at the floor of the pelvis has been followed by symptoms of partial paralysis, the animal, when lying down, being unable to regain his feet, but moving freely when placed in an upright position. this condition is owing to the interference of the callus with the functions of the obturator nerve, which it presses upon or surrounds. by my experience in similar cases i feel warranted in cautioning owners of horses in this condition to exercise due patience, and to avoid a premature sentence of condemnation against their invalid servants; they are not all irrecoverably paralytic. with alternations of moderate exercise, rest in the slings, and the effect of time while the natural process of absorption is taking effect upon the callus, with other elements of change that may be so operating, the horse in due time may become able once more to earn his subsistence and serve his master. fracture of the scapula. this bone is seldom fractured, its comparative exemption being due to its free mobility and the protection it receives from the superimposed soft tissues. only direct and powerful causes are sufficient to effect the injury, and when it occurs the large rather than the smaller animals are the subjects. _cause._--the causes are heavy blows or kicks and violent collisions with unyielding objects. those which are occasioned by falls are generally at the neck of the bone, and of the transverse and comminuted varieties. _symptoms._--the diagnosis is not always easy. the symptoms are inability to rest the leg on the ground and to carry weights, and they are present in various degrees from slight to severe. the leg rests upon the toe, seems shortened, and locomotion is performed by jumps. moving the leg while examining it and raising the foot for inspection seem to produce much pain and cause the animal to rear. crepitation is readily felt with the hand upon the shoulder when the leg is moved. if the fracture occurs in the upper part of the bone, overlapping of the fragments and displacement will be considerable. the fracture of this bone is usually classed among the more serious accidents, though cases may occur which are followed by recovery without very serious ultimate results, especially when the seat of the injury is at some of the upper angles of the bone or about the acromion crest. but if the neck and the joint are the parts involved, complications which are likely to disable the animal for life are liable to be present. _treatment._--if there is no displacement, a simple adhesive dressing to strengthen and immobilize the parts will be sufficient. a coat of black pitch dissolved with wax and venice turpentine, and kept in place over the region with oakum or linen bands, will be all the treatment required, especially if the animal is kept quiet in the slings. displacement can not be remedied, and reduction is next to impossible. sometimes an iron plate is applied over the parts and retained by bandages, as in the dressing of bourgelat (plate xxx); this may be advantageously replaced by a pad of thick leather. in smaller animals the parts are retained by figure- bandages, embracing both the normal and the diseased shoulders, crossing each other in the axilla and covered with a coating of adhesive mixture. fractures of the humerus. these are more common in small than in large animals, and are always the result of external traumatism, such as falls, kicks, and collisions. they are generally very oblique, are often comminuted, and though more usually involving the shaft of the bone will in some cases extend to the upper end and into the articular head. _symptoms._--there is ordinarily considerable displacement in consequence of the overlapping of the broken ends of the bone, and this of course causes more or less shortening of the limb. there will also be swelling, with difficulty of locomotion, and crepitation will be easy of detection. this fracture is always a serious damage to the patient, leaving him with a permanently shortened limb and an incurable, lifelong lameness. _treatment._--if treatment is determined on, it will consist in the reduction of the fracture by means of extension and counter extension, to accomplish which the animal must be thrown. if successful in the reduction, then follows the application and adjustment of the apparatus of retention, which must be of the most perfect and efficient kind. finally, this, however skillfully contrived and carefully adapted, will often fail to effect any good purpose whatever. fractures of the forearm. a fracture in this region may also involve the radius or the ulna, the latter being broken at times in its upper portion above the radio-ulnar arch at the olecranon. if the fracture occurs at any part of the forearm from the radio-ulnar arch down to the knee, it may involve either the radius alone or the radius and the cubitus, which are there intimately united. _cause._--besides having the same etiology with most of the fractures, those of the forearm are, nevertheless, more commonly due to kicks from other animals, especially when crowded together in large numbers in insufficient space. it is a matter of observation that under these circumstances fractures of the incomplete kind are those which occur on the inside of the leg, the bone being in that region almost entirely subcutaneous, while those of the complete class are either oblique or transverse. the least common are the longitudinal, in the long axis of the bone. _symptoms._--this variety of fracture is easily recognized by the appearance of the leg and the different changes it undergoes. there is inability to use the limb; impossibility of locomotion; mobility below the injury; the ready detection of crepitation--in a word, the assemblage of all the signs and symptoms which have been already considered as associated with the history of broken bones. the fracture of the ulna alone, principally above the radio-ulnar arch, may be ascertained by the aggravated lameness, the excessive soreness on pressure, and perhaps a certain increase of motion, with a very slight crepitation if tested in the usual way. displacement is not likely to take place except when it is well up toward the olecranon or its tuberosity, the upper segment of the bone being in that case likely to be drawn upward. for a simple fracture of this region there is a fair chance of recovery, but in a case of the compound and comminuted class there is less ground for a favorable prognosis, especially if the elbow joint has suffered injury. a fracture of the ulna alone is not of serious importance, except when the same conditions prevail. a fracture of the olecranon is less amenable to treatment, and promises little better than a ligamentous union. _treatment._--considering all the various conditions involving the nature and extent of these lesions, the position and direction of the bones of the forearm are such as to render the chances for recovery from fracture as among the best. the reduction, by extension and counterextension; the maintenance of the coaptation of the segments; the adaptation of the dressing by splints, oakum, and agglutinative mixtures; in fact, all the details of treatment may be here fulfilled with a degree of facility and precision not attainable in any other part of the organism. an important, if not an essential, point, however, must be emphasized in regard to the splints. whether they are of metal, wood, or other material, they should reach from the elbow joint to the ground, and should be placed on the posterior face and on both sides of the leg. this is then to be so confined in a properly constructed box as to preclude all possibility of motion, while yet it must sustain a certain portion of the weight of the body. the iron splint (represented in plate xxx) recommended by bourgelat is designed for fractures of the forearm, of the knee, and of the cannon bone, and will prove to be an appliance of great value. for small animals the preference is for an external covering of gutta-percha, embracing the entire leg. a sheet of this substance of suitable thickness, according to the size of the animal, softened in lukewarm water, is, when sufficiently pliable, molded on the outside of the leg, and when suddenly hardened by the application of cold water forms a complete casing sufficiently rigid to resist all motion. patients treated in this manner have been able to use the limb freely, without pain, immediately after the application of the dressing. the removal of the splint is easily effected by cutting it away, either wholly or in sections, after softening it by immersing the leg in a warm bath. fracture of the knee. this accident, happily, is of rare occurrence, but when it takes place is of a severe character, and always accompanied with synovitis, with disease of the joint. _cause._--it may be caused by falling upon a hard surface, and is usually compound and comminuted. healing seldom occurs, and when it does there is usually a stiffness of the joint from arthritis. _symptoms._--as a result of this fracture there is inability to bear weight on the foot. the leg is flexed as in complete radial paralysis, or fracture of the ulna. there is abnormal mobility of the bones of the knee, but crepitation is usually absent. _prognosis._--healing is hard to effect, as one part of the knee is drawn upward by the two flexor muscles which separate it from the lower part. the callus which forms is largely fibrous, and if the animal is put to work too quickly this callus is liable to rupture. in favorable cases healing takes place in two or three months. many horses during the treatment develop founder, with consequent drop sole in the sound leg, as a result of pressure due to continuous standing. _treatment._--place the animal in the slings, bring the pieces of bone together if possible, and try to keep them in place by a tight plaster-of-paris dressing about the leg, extending down to the fetlock. place the animal in a roomy box stall well provided with bedding so that he can lie down, to prevent founder. fracture of the femur. the protection which this bone receives from the large mass of muscles in which it is enveloped does not suffice to invest it with immunity in regard to fractures. _cause._--it contributes its share to the list of accidents of this description, sometimes in consequence of external violence and sometimes as the result of muscular contraction; sometimes it takes place at the upper extremity of the bone; sometimes at the lower; sometimes at the head, when the condyles become implicated; but it is principally found in the body or diaphysis. the fracture may be of any of the ordinary forms, simple or compound, complete or incomplete, transverse or oblique, etc. a case of the comminuted variety is recorded in which fragments of bone were counted and removed. the thickness of the muscular covering sometimes renders the diagnosis difficult by interfering with the manipulation, but the crepitation test is readily available, even when the swelling is considerable, and which is liable to be the case as the result of the interstitial hemorrhage which naturally follows the laceration of the blood vessels of the region involved. _symptoms._--if the fracture is at the neck of the bone the muscles of that region (the gluteal) are firmly contracted, and the leg seems to be shortened in consequence. locomotion is impossible. there is intense pain and violent sweating at first. crepitation may in some cases be discerned by rectal examination, with one hand resting over the coxo-femoral (hip) articulation. fractures of the tuberosities of the upper end of the bone, the great trochanter, may be identified by the deformity, the swelling, the impossibility of rotation, and the dragging of the leg in walking. fracture of the body is always accompanied with displacement, and as a consequence a shortening of the leg, which is carried forward. the lameness is excessive, the foot being moved, both when raising it from the ground and when setting it down, very timidly and cautiously. the manipulations for the discovery of crepitation always cause much pain. lesions of the lower end of the bone are more difficult to diagnosticate with certainty, though the manifestation of pain while making heavy pressure upon the condyles will be so marked that only crepitation will be needed to turn a suspicion into a certainty. _treatment._--the question as to treatment in fractures of this description resolves itself into the query whether any treatment can be suggested that will avail anything practically as a curative measure; whether, upon the hypothesis of reduction as an accomplished fact, any permanent or efficient device as a means of retention is within the scope of human ingenuity. if the reduction were successfully performed, would it be possible to keep the parts in place by any known means at our disposal? at the best the most favorable result that could be anticipated would be a reunion of the fragments with a considerable shortening of the bone and a helpless, limping, crippled animal to remind us that for human achievement there is a "thus far and no farther." in small animals, such as dogs and cats, however, attempts at treatment are justifiable, and we are convinced that in many cases of difficulty in the application of splints and bandages a patient may be placed in a condition of undisturbed quiet and left to the processes of nature for "treatment" as safely and with as good an assurance of a favorable result as if he had been subjected to the most heroic secundum artem doctoring known to science. as a case in point, mention may be made of the case of a pregnant bitch which suffered a fracture of the upper end of the femur by being run over by a light wagon. her "treatment" consisted in being tied up in a large box and let alone. in due time she was delivered of a family of puppies, and in three weeks she was running in the streets, limping very slightly, and nothing the worse for her accident. fracture of the patella. this, fortunately, is a rare accident, and can result only from direct violence, as a kick or other blow. the lameness which follows it is accompanied with enormous tumefaction of the joint, pain, inability to bear weight upon the foot, and finally disease of the articulation. crepitation is absent, because the hip muscles draw away the upper part of the bone. the prognosis is unavoidably adverse, destruction being the only termination of this incurable and very painful injury. most of the reported cases of cures are based upon a wrong diagnosis. fractures of the tibia. of all fractures these are probably more frequently encountered than any others among the class of accidents we are considering. as with injuries of the forearm of a like character, they may be complete or incomplete; the former when the bone is broken in the middle or at the extremities, and transverse, oblique, or longitudinal. the incomplete kind are more common in this bone than in any other. _symptoms._--complete fractures are easy to recognize, either with or without displacement. the animal is very lame, and the leg is either dragged or held clear from the ground by flexion at the stifle, while the lower part hangs down. carrying weight or moving backward is impossible. there is excessive mobility below the fracture, and well-marked crepitation. if there is much displacement, as in an oblique fracture, there will be considerable shortening of the leg. while incomplete fractures can not be recognized in the tibia with any greater degree of certainty than in any other bone, there are some facts associated with them by which a diagnosis may be justified. the hypothetical history of a case may serve as an illustration: an animal has received an injury by a blow or a kick on the inside of the bone, perhaps without showing any mark. becoming very lame immediately afterwards, he is allowed a few days' rest. if taken out again, he seems to have recovered his soundness, but within a day or two he betrays a little soreness, and this increasing he becomes very lame again, to be furloughed once more, with the result of a temporary improvement, and again a return to labor and again a relapse of the lameness; and this alternation seems to be the rule. the leg being now carefully examined, a local periostitis is readily discovered at the point of the injury, the part being warm, swollen, and painful. what further proof is necessary? is it not evident that a fracture has occurred, first superficial--a mere split in the bony structure, which, fortunately, has been discovered before some extra exertion or a casual misstep had developed it into one of the complete kind, possibly with complications? what other inference can such a series of symptoms thus repeated establish? the prognosis of fracture of the tibia, as a rule, must be unfavorable. _treatment._--the difficulty of obtaining a union without shortening, and consequently without lameness, is proof of the futility of ordinary attempts at treatment, but though this may be true in respect to fractures of the complete kind, it is not necessarily so with the incomplete variety, and with this class the simple treatment of the slings is all that is necessary to obtain consolidation. a few weeks of this confinement will be sufficient. with dogs and other small animals there are cases which may be successfully treated. if the necessary dressings can be successfully applied and retained, a cure will follow. fractures of the hock. injuries of the astragalus which had a fatal termination have been recorded. fractures of the os calcis have also been observed, but never with a favorable prognosis, and attempts to induce recovery, as might have been expected, have proved futile. fractures of the cannon bones. whether these occur in the fore or hind legs, they appear either in the body or near their extremities. if in the body as a rule the three metacarpal or metatarsal bones are affected, and the fracture is generally transverse and oblique. on account of the absence of soft tissue and tightness of the skin, the broken bones pierce the skin and render the fracture a complicated one. the diagnosis is easy when all the bones are completely broken, but the incomplete fracture can be only suspected. _symptoms._--there is no displacement, but excessive mobility, crepitation, inability to sustain weight, and the leg is kept off the ground by the flexion of the upper joint. no region of the body affords better facilities for the application of treatment, and the prognosis on this account is usually favorable. we recall a case, however, which proved fatal, though under exceptional circumstances. the patient was a valuable stallion of highly nervous organization, with a compound fracture of one of the cannon bones, and his unconquerable resistance to treatment, excited by the intense pain of the wound, precluded all chance of recovery, and ultimately caused his death. _treatment._--the general form of treatment for these lesions will not differ from that which has been already indicated for other fractures. reduction, sometimes necessitating the casting of the patient; coaptation, comparatively easy by reason of the subcutaneous situation of the bone; retention, by means of splints and bandages--applied on both sides of the region, and reaching to the ground as in fractures of the forearm--these are always indicated. we have obtained excellent results by the use of a mold of thick gutta-percha, composed of two sections and made to surround the entire lower part of the leg as in an inflexible case. fracture of the first phalanx. the hind extremity is more liable than the fore to this injury. it is usually the result of a violent effort, or of a sudden misstep or twisting of the leg, and may be transverse, or, as has usually been the case in our experience, longitudinal, extending from the upper articular surface down to the center of the bone, and generally oblique and often comminuted. the symptoms are the swelling and tenderness of the region, possibly crepitation; a certain abnormal mobility; an excessive degree of lameness, and in some instances a dropping back of the fetlock, with perhaps a straightened or upright condition of the pastern. the difficulty of reduction and coaptation in this accident, and the probability of bony deposits, as of ringbones, resulting in lameness, are circumstances which tend to discourage a favorable prognosis. the treatment is that which has been recommended for all fractures, so far as it can be applied. the iron splint which has been mentioned gives excellent results in many instances, but if the fracture is incomplete and without displacement, a form of treatment less energetic and severe should be attempted. one case is within our knowledge in which the owner lost his horse by his refusal to subject the animal to treatment, the post-mortem revealing only a simple fracture with very slight displacement. fractures of the second phalanx (coronet). though these are generally of the comminuted kind, there are often conditions associated with them which justify the surgeon in attempting their treatment. though crepitation is not always easy to detect, the excessive lameness, the soreness on pressure, the inability to carry weight, the difficulty experienced in raising the foot, all these suggest, as the solution of the question of diagnosis, the fracture of the coronet, with the accompanying realization of the fact that there is yet, by reason of the situation of the member, immobilized as it is by its structure and its surroundings, room left for a not unfavorable prognosis. only a slight manipulation will be needed in the treatment of this lesion. to render the immobility of the region more fixed, to support the bones in their position by bandaging, and to establish forced immobility of the entire body with the slings is usually all that is required. ringbone, being a common sequela of the reparative process, must receive due attention subsequently. one of the severest complications liable to be encountered is an immobile joint (anchylosis). neurectomy of the median nerve may relieve lameness after a fracture of the phalanges. fractures of the third phalanx (os pedis). these lesions may result from a penetrating street nail, or follow plantar or median neurectomy. in the latter instance it is caused by the animal setting the foot down carelessly and too violently, and partly due to degeneration of bone tissue which follows nerving. though these fractures are not of very rare occurrence, their recognition is not easy, and there is more of speculation than of certainty pertaining to their diagnosis. the animal is very lame and spares the injured foot as much as possible, sometimes resting it upon the toe alone and sometimes holding it from the ground. the foot is very tender, and the exploring pinchers of the examining surgeon cause much pain. during the first hours there is no increased pulsation in the digital and plantar arteries, but on the second day it is apparent. there is nothing to encourage a favorable prognosis, and a not unusual termination is an anchylosis with either the navicular bone or the coronet. no method of treatment needs to be suggested here, the hoof performing the office of retention unaided. local treatment by baths and fomentations will do the rest. it may be months before there is any mitigation of the lameness. an ultimate recovery depends to a great extent upon whether the other foot can support the weight during the healing process without causing a drop sole in the supporting foot. fracture of the sesamoid bones. this lesion has been considered by veterinarians, erroneously, we think, as one of rare occurrence. we believe it to be more frequent than has been supposed. many observations and careful dissections have convinced us that fractures of these little bones have been often mistaken for specific lesions of the numerous ligaments that are implanted upon their superior and inferior parts, and which have been described as a "giving way" or "breaking down" of these ligaments. in my post-mortem examinations i have always noted the fact that when the attachments of the ligaments were torn from their bony connections minute fragments of bony structure were also separated, though we have failed to detect any diseased process of the fibrous tissue composing the ligamentous substance. _cause._--from whatever cause this lesion may arise, it can hardly be considered as of a traumatic nature, no external violence having any apparent agency in producing it, and it is our belief that it is due to a peculiar degeneration or softening of the bones themselves, a theory which acquires plausibility from the consideration of the spongy consistency of the sesamoids. the disease is a peculiar one, and the suddenness with which different feet are successively attacked, at short intervals and without any obvious cause, seems to prove the existence of some latent, morbid cause which has been unsuspectedly incubating. it is not peculiar to any particular class of horses, nor to any special season of the year, having fallen under our observation in each of the four seasons. _symptoms._--the general fact is reported in the history of most cases that it makes its appearance without premonition in animals which, after enjoying a considerable period of rest, are first exercised or put to work, though in point of fact it may manifest itself while the horse is still idle in his stable. a hypothetical case, in illustration, will explain our theory: an animal which has been at rest in his stable is taken out to work, and it will be presently noticed that there is something unusual in his movement. his gait is changed, and he travels with short, mincing steps, without any of his accustomed ease and freedom. this may continue until his return to the stable, and then, after being placed in his stall, he will be noticed shifting his weight from side to side and from one leg to another, continuing the movement until rupture of the bony structure takes place. but it may happen that the lameness in one or more of the extremities, anterior or posterior, suddenly increases, and it becomes evident that the rupture has taken place in consequence of a misstep or a stumble while the horse is at work. then, upon coming to a standstill, he will be found with one or more of his toes turned up; he is unable to place the affected foot flat on the ground. the fetlock has dropped and the leg rests upon this part, the skin of which may have remained intact or may have been more or less extensively lacerated. it seldom happens that more than one toe at a time will turn up, yet still the lesion in one will be followed by its occurrence in another. commonly two feet, either the anterior or posterior, are affected, and we recall one case in which the two fore and one of the hind legs were included at the same time. the accident, however, is quite as liable to happen while the horse is at rest in his stall, and he may be found in the morning standing on his fetlocks. one of the earliest of the cases occurring in my own experience had been under care for several weeks for suspected disease of the fetlocks, the nature of which had not been made out, when, apparently improved by the treatment which he had undergone, the patient was taken out of the stable to be walked a short distance into the country, but had little more than started when he was called to a halt by the fracture of the sesamoids of both fore legs. while there are no positive premonitory symptoms of these fractures known, we believe that there are signs and symptoms which come but little short of being so, and the appearance of which will always justify a strong suspicion of the truth of the case. these have been indicated when referring to the soreness in standing, the short, mincing gait, and the tenderness betrayed when pressure is made over the sesamoids on the sides of the fetlock, with others less tangible and definable. _prognosis._--these injuries can never be accounted less than serious, and in our judgment will never be other than fatal. if our theory of their pathology is the correct one, and the cause of the lesions is truly the softening of the sesamoidal bony structure and independent of any changes in the ligamentous fibers, the possibility of a solid osseous union can hardly be considered admissible. _treatment._--in respect to the treatment to be recommended and instituted it can be employed only with any rational hope of benefit during the incubation, and with the anticipatory purpose of prevention. it must be suggested by a suspicion of the verities of the case, and applied before any rupture has taken place. to prevent this and to antagonize the causes which might precipitate the final catastrophe--the elevation of the toes--resort must be had to the slings and to the application of firm bandages or splints, perhaps of plaster of paris, with a high shoe, as about the only indications which science and nature are able to offer. when the fracture is an occurred event, and the toes, one or more, are turned up, any further resort to treatment will be futile. diseases of joints. three classes of injury will be considered under this head. these are, affections of the synovial sacs, those of the joint structures, or of the bones and their articular surfaces, and those forms of solution of continuity known as dislocations or luxations. diseases of the synovial sacs. two forms of affection here present themselves, one being the result of an abnormal secretion which induces a dropsical condition of the sac without any acute, inflammatory action, while the other is characterized by excessive inflammatory symptoms, with their modifications, constituting synovitis. synovial dropsies. we have already considered in a general way the presence of these peculiar oil bags in the joints, and in some regions of the legs where the passage of the tendons takes place, and have noticed the similarity of structure and function of both the articular and the tendinous bursæ, as well as the etiology of their injuries and their pathological history, and we will now treat of the affections of both. windgalls. this name is given to the dilated bursæ found at the posterior part of the fetlock joint. they have their origin in a dropsical condition of the bursæ of the joint itself, also of the tendon which slides behind it, and are therefore further known by the designations of articular and tendinous windgalls, or puffs. (see also p. .) they appear in the form of soft and somewhat symmetrical tumors, of varying dimensions, and generally well defined in their circumference. they are more or less tense, according to the quantity of secretion they contain, apparently becoming softer as the foot is raised and the fetlock flexed. usually they are painless and only cause lameness under certain conditions, as when they begin to develop themselves under the stimulus of inflammatory action, or when large enough to interfere with the functions of the tendons, or again when they have undergone certain pathological changes, such as calcification, which is among their tendencies. _cause._--windgalls may be attributed to external causes, such as severe labor or strains resulting from heavy pulling, fast driving, or jumping, or they may be among the sequelæ of internal disorders, such as strangles or the resultants of a pleuritic or pneumonic attack. unnecessary anxiety is sometimes experienced respecting these growths, with much questioning touching the expediency of their removal, all of which might be spared, for, while they constitute a blemish, their unsightliness will not hinder the usefulness of the animal, and in any case they rarely fail to show themselves easily amenable to treatment. _treatment._--when in their acute stage, and when the dropsical condition is not excessive, the inflammation may be checked during the day by continuous, cold-water irrigation by means of a hose or soaking tub and at night by applying a moderately tight-roller bandage. later absorption may be promoted by a priessnitz bandage,[ ] pressure by roller bandages, sweating, the use of liniments, or if necessary by a sharp blister of biniodid of mercury. this treatment should subdue the inflammation, abate the soreness, absorb the excess of secretion, strengthen the walls of the sac, and finally cause the windgalls to disappear, provided the animal is not too quickly returned to labor and exposed to the same factors that occasioned them at first. if the inflammation has become chronic, however, and the enlargement has been of considerable duration, the negative course will be the wiser one. if any benefit results from treatment it will be of only a transient kind, the dilatation returning when the patient is again subjected to labor, and it will be a fortunate circumstance if inflammation has not supervened. notwithstanding the generally benignant nature of the swelling there are exceptional cases, usually when it is probably undergoing certain pathological changes, which may result in lameness and disable the animal, in which case surgical treatment will be indicated, especially if repeated blisters have failed to improve the symptoms. line firing is then a preeminent suggestion, and many a useful life has received a new lease as the result of this operation timely performed. another method of firing, which consists in emptying the sac by means of punctures through and through, made with a red-hot needle or wire, and the subsequent injection of certain irritating and alterative compounds into the cavity, designed to effect its closure by exciting adhesive inflammation, such as tincture of iodin, may be commended. but they are all too active and energetic in their effects and require too much special attention and intelligent management to be trusted to any hands other than those of an expert veterinarian. blood spavin, bog spavin, and thoroughpin. the blood spavin is situated in front and to the inside of the hock and is merely a varicose or dilated condition of the saphena vein. it occurs directly over the point where the bog spavin is found, and has thus been frequently confused with the latter. the complicated arrangement of the hock joint, and the powerful tendons which pass on the posterior part, are lubricated with the product of secretion from one tendinous synovial and several articular synovial sacs. a large articular sac contributes to the lubrication of the shank bone (the tibia) and one of the bones of the hock (the astragalus). the tendinous sac lies back of the articulation itself and extends upward and downward in the groove of that joint through which the flexor tendons slide. the dilatation of this articular synovial sac is what is denominated bog spavin, the term thoroughpin being applied to the dilatation of the tendinous capsule. the bog spavin is a round, smooth, well-defined, fluctuating tumor situated in front and a little inward of the hock. on pressure it disappears at this point to reappear on the outside and just behind the hock. if pressed to the front from the outside it will then appear on the inside of the hock. on its outer surface it presents a vein which is quite prominent, running from below upward, and it is to the preternatural dilatation of this blood vessel that the term blood spavin is applied. the thoroughpin is found at the back and on the top of the hock in that part known as the "hollows," immediately behind the shank bone. it is round and smooth, but not so regularly formed as the bog spavin, and is most apparent when viewed from behind. the swelling is usually on both sides and a little in front of the so-called hamstring, but may be more noticeable on the inside or on the outside. in their general characteristics bog spavins and thoroughpins are similar to windgalls, and one description of the origin, symptoms, pathological changes, and treatment will serve for all equally, except that it is possible for a bog spavin to cause lameness, and thus to involve a verdict of unsoundness in the patient, a circumstance which will, of course, justify its classification by itself as a severer form of a single type of disease. we have already referred to the subject of treatment and the means employed--rest, of course--with liniments, blisters, etc., and what we esteem as the most active and beneficial of any, early, deep, and well-performed cauterization. there are, besides, commendatory reports of a form of treatment by the application of pressure pads and peculiar bandages upon the hocks, and it is asserted that the removal of the tumors has been effected by their use. our experience with this apparatus, however, has not been accompanied with such favorable results as would justify our indorsement of the flattering representations which have sometimes appeared in its behalf. open joints, broken knees, synovitis, and arthritis. the close relationship which exists among these several affections, their apparently possible connection as successive developments of a similar, if not an essentially identical, origin, together with the advantage gained by avoiding frequent repetitions in the details of symptoms, treatment, etc., are our reasons for treating under a single head the ailments we have grouped together in the present section. _cause._--the great, comprehensive, common cause of, sometimes permanent, sometimes only transient, disability of the horse is external traumatism. blows, bruises, hurts by nearly every known form of violence, falls, kicks, lacerations, punctures--we may add compulsory speed in racing and cruel overloading of draft animals--cover the entire ground of causation of the diseases and injuries of the joints now receiving our consideration. in one case, a working horse making a misstep stumbles, and falling on his knees receives a hurt, variously severe, from a mere abrasion of the skin to a laceration, a division of the tegument, a slough, mortification, and the escape of the synovial fluid, with or without exposure of the bones and their articular cartilages. in another case, an animal, from one cause or another, perhaps an impatient temper, has formed the habit of striking or pawing his manger with his fore feet until inflammation of the knee joint is induced, first as a little swelling, diffused, painless; then as a periostitis of the bones of the knee; later as bony deposits, then lameness, and finally the implication of the joint, with all the various sequelæ of chronic inflammation of the knee joint. in another case, a horse has received a blow with a fork from a careless hostler on or near a joint, or has been kicked by a stable companion, with the result of a punctured wound, at first mild-looking, painless, apparently without inflammation, and not yet causing lameness, but which, in a few hours, or it may be only after a few days, becomes excessively painful, grows worse, the entire joint swells, presently discharges, and at last a case of suppurative synovitis is presented, with perhaps disease of the joint proper, and arthritis as a climax. the symptoms of articular injuries vary not only in the degrees of the hurt but in the nature of the lesion. or the condition of broken knees, resulting as we have said, may have for its starting point a mere abrasion of the skin--a scratch, apparently, which disappears without a scar. the injury may, however, have been more severe, the blow heavier, the fall aggravated by occurring upon an irregular surface, or sharp or rough object, with tearing or cutting of the skin, and this laceration may remain. a more serious case than the first is now brought to our notice. another time, immediately following the accident, or possibly as a sequel of the traumatism, the tendinous sacs may be opened, with the escape of the synovia, or, worse, the tendons which pass in front of the knee are torn, the inflammation spreads, the joint and leg are swollen, the animal is becoming very lame; synovitis has set in. with this the danger becomes very great, for soon suppuration will be established, then the external coat of the articulation proper becomes ulcerated, if it is not already in that state, and we find ourselves in the presence of an open joint with suppurative synovitis--that is, with the worst among the conditions of diseased processes, because of the liability of the suppuration to become infiltrated into every part of the joint, macerating the ligaments and irritating the cartilages, soon to be succeeded by their ulceration, with the destruction of the articular surface--or the lesion of ulcerative arthritis, one of the gravest among all the disorders known to the animal economy. ulcerative arthritis and suppurative synovitis may be developed otherwise than in connection with open joints; the simplest and apparently most harmless punctures may prove to be sufficient cause. for example, a horse may be kicked, perhaps, on the inside of the hock; there is a mark and a few drops of blood to indicate the spot; he is put to work apparently free from pain or lameness and performs his task with his usual ease and facility. on the following morning, however, the hock is found to be a little swollen and there is some stiffness. a little later on he betrays a degree of uneasiness in the leg, and shrinks from resting his weight upon it, moving it up and down for relief. the swelling has increased and is increasing; the pain is severe; and finally, at the spot where the kick inpinged, there is an oozing of an oily liquid mixed with whitish drops of suppuration. the mischief is done; a simple, harmless, punctured wound has expanded into a case of ulcerative arthritis and suppurative synovitis. _prognosis._--from ever so brief and succinct description of this traumatism of the articulations, the serious and important character of these lesions, irrespective of which particular joint is affected, will be readily understood. yet there will be modifications in the prognosis in different cases, in accordance with the peculiarities of structure in the joint specially involved, as, for example, it is obvious that a better result may be expected from treatment when but a single joint, with only its plain articular surfaces, is the place of injury, than in one which is composed of several bones, united in a complex formation, as in the knee or hock. as severe a lesion as suppurative synovitis always is, and as frequently fatal as it proves to be, still cases arise in which, the inflammation assuming a modified character and at length subsiding, the lesion terminates favorably and leaves the animal with a comparatively sound and useful joint. there are cases, however, which terminate in no more favorable a result than the union of the bones and occlusion of the joint, to form an anchylosis, which is scarcely a condition to justify a high degree of satisfaction, as it insures a permanent lameness with very little capacity for usefulness. appreciating now the dangers associated with all wounds of articulations, however simple and apparently slight, and how serious and troublesome are the complications which are liable to arise during their progress and treatment, we are prepared to understand and realize the necessity and the value of early and prompt attention upon their discovery and diagnosis. _treatment._--for simple bruises, like those which appear in the form of broken knees or of carpitis, simple remedies, such as warm fomentations or cold-water applications and compresses of astringent mixtures, suggest themselves at once. injuries of a more complicated character, as lacerations of the skin or tearing of soft structures, will also be benefited by simple dressings with antiseptic mixtures, as those of the carbolic-acid order. the escape of synovia should suggest the prompt use of collodion dressings to check the flow and prevent the further escape of the fluid. but if the discharge is abundant and heavily suppurative, little can be done more than to put in practice the "expectant" method with warm fomentations, repeatedly applied, and soothing, mucilaginous poultices. improvement, if any is possible, will be but slow to manifest itself. the most difficult of all things to do, in view of varying interests and opinions--that is, in a practical sense--is to abstain from "doing" entirely, and yet in the cases we are considering we are firmly convinced that noninterference is the best and wisest policy. in cases which are carried to a successful result the discharge will diminish by degrees, the extreme pain will gradually subside, the convalescent will begin timidly to rest his foot upon the ground, and presently to bear weight upon it, and perhaps, after a long and tedious process of recuperation, he may be returned to his former and normal condition of usefulness. when the discharge has wholly ceased and the wounds are entirely healed, a blister covering the whole of the joint for the purpose of stimulating the absorption of the exudation will be of great service. if, on the contrary, there is no amelioration of symptoms and the progress of the disease resists every attempt to check it; if the discharge continues to flow not only without abatement but in an increased volume, and not alone by a single opening but by a number of fistulous tracts which have successively formed; if it seems evident that this drainage is rapidly and painfully sapping the suffering animal's vitality, and a deficient _vis vitæ_ fails to cooperate with the means of cure--all rational hope of recovery may be finally abandoned. any further waiting for chances, or time lost in experimenting, will be mere cruelty and there need be no hesitation concerning the next step. the poor beast is under sentence of death, and every consideration of interest and of humanity demands an anticipation of nature's evident intent in the quick and easy execution of the sentence. [illustration: plate xxx. dislocation of shoulder and elbow bourgelat's apparatus] [illustration: plate xxxi. the sling in use] one of the essentials of treatment, and probably an indispensable condition when recovery is in any wise attainable, is the suspension of the patient in slings. he should be continued in them so long as he can be made to submit quietly to their restraint. dislocations. dislocations and luxations are interchangeable terms, meaning the separation and displacement of the articulating surfaces of the bones entering into the formation of a joint. this injury is rarely encountered in our large animals on account of the combination of strength and solidity in the formation of their joints. it is met with but seldom in cattle and less so in horses, while dogs and smaller animals are more often the sufferers. _cause._--the accident of a luxation is less often encountered in the animal races than in man. this is not because the former are less subject to occasional violence involving powerful muscular contractions, or are less often exposed to casualties similar to those which result in luxations in the human skeleton, but because it requires the cooperation of conditions--anatomical, physiological, and perhaps mechanical--present in the human race and lacking in the others, which, however, can not in every case be clearly defined. perhaps the greater relative length of the bony levers in the human formation may constitute a cause of the difference. among the predisposing causes in animals may be enumerated caries of articular surfaces, articular abscesses, excessive dropsical conditions, degenerative softening of the ligaments, and any excessive laxity of the soft structures. _symptoms and diagnosis._--three signs of dislocation must usually be taken into consideration. they are: ( ) an alteration in the shape of the joint and in the normal relationship of the articulating surfaces; ( ) an alteration in the length of the limb, either shortening or lengthening; ( ) an alteration in the movableness of the joint, usually an unnatural immobility. only the first, however, can be relied upon as essential. luxations are not always complete; they may be partial; that is, the articulating surfaces may be displaced but not separated. in such cases several symptoms may not be present. and not only may the third sign be absent, but the mobility of the first be greatly increased when the character of the injury has been such as to produce extensive lacerations of the articular ligaments. in addition to the above signs, a luxation is usually characterized by pain, swelling, hemorrhage beneath the skin from damaged or ruptured blood vessels, and even paralysis, when important nerves are pressed on by the displaced bones. sometimes a bone is fractured in the immediate vicinity of a joint. the knowledge of this fact requires us to be able to diagnose between a dislocation and such a fracture. in this we generally have three points to assist us: ( ) the immobility of a dislocated joint as against the apparently remarkable freedom of movement in fracture; ( ) in a dislocation there is no true crepitus--that peculiar grating sensation heard as well as felt on rubbing together the rough ends of fractured bones; however, it must be remembered that in a dislocation two or three days old the inflammatory changes around the joint may give rise to a crackling sensation similar to that in fracture; ( ) as a rule, in luxations, if the ligamentous and muscular tissues about the joint are not badly torn, the displacement, when reduced, does not recur. _prognosis._--the prognosis of a luxation is comparatively less serious than that of a fracture, though at time the indications of treatment may prove to be so difficult to apply that complications of a very severe character may arise. _treatment._--the treatment of luxations must, of course, be similar to that of fractures. reduction, naturally, will be the first indication in both cases, and the retention of the replaced parts must follow. the reduction involves the same steps of extension and counter extension, performed in the same manner, with the patient subdued by anesthetics. the difference between the reduction of a dislocation and that of a fracture consists in the fact that in the former the object is simply to restore the bones to their true, normal position, with each articular surface in exact contact with its companion surface, the apparatus necessary afterwards to keep them in situ being similar to that which is employed in fracture cases, and which will usually require to be retained for a period of from to days, if not longer, before the ruptured retaining ligaments are sufficiently firm to be trusted to perform their office unassisted. a variety of manipulations are to be used by the surgeon, consisting in pushing, pulling, pressing, rotating, and, indeed, whatever movement may be necessary, until the bones are forced into such relative positions that the muscular contraction, operating in just the right directions, pulls the opposite matched ends together in true coaptation--a head into a cavity, an articular eminence into a trochlea, as the case may be. the "setting" is accompanied with a peculiar, snapping sound, audible and significant, as well as a visible return of the surface to its normal symmetry. _special dislocations._--while all the articulations of the body are liable to this form of injury, there are three in the large animals which may claim a special consideration, viz: the shoulder joint. we mention this displacement without intending to imply the practicability of any ordinary attempt at treatment, which is usually unsuccessful, the animal whose mishap it has been to become a victim to it being disabled for life. the superior head of the arm bone as it is received into the lower cavity of the shoulder blade is so situated as to be liable to be forced out of place in four directions. it may escape from its socket, according to the manner in which the violence affects it--outward, inward, backward, or forward--and the deformity which results and the effects which follow will correspondingly differ. we have said that treatment is generally unsuccessful. it may be added that the difficulties which interpose in the way of reduction are nearly insurmountable, and that the application of means for the retention of the parts after reduction would be next to impossible. the prognosis, from any point of view, is sufficiently grave for the luckless animal with a dislocated shoulder. the hip joint. this joint partakes very much of the characteristics of the humero-scapular articulation, but is more strongly built. the head of the thigh bone is more separated, or prominent and rounder in form, and the cup-like cavity, or socket, into which it fits is much deeper, forming together a deep, true ball-and-socket joint, which is, moreover, reenforced by two strong cords of funicular ligaments, which unite them. it will be easily comprehended, from this hint of the anatomy of the region, that a luxation of the hip joint must be an accident of comparatively rare occurrence; yet cases are recorded in which the head of the bone has been affirmed to slip out of its cavity and assume various positions--inward, outward, forward, or backward. the indications of treatment are those of all cases of dislocation. when the reduction is accomplished the surgeon will be apprised of the fact by the peculiar, snapping sound usually heard on such occasions. pseudo-luxations of the patella. this is not a true dislocation. the stifle bone is so peculiarly articulated with the thigh bone that the means of union are of sufficient strength to resist the causes which usually give rise to luxations, yet there is sometimes discovered a peculiar, pathological state in the hind legs of animals, the effect of which is closely to simulate the manifestation of many of the general symptoms of dislocations. this condition originates in muscular cramps, the action of which is seen in a certain change in the coaptation of the articular surfaces of the stifle and thigh bone, resulting in the exhibition of a sudden and alarming series of symptoms which have suggested the phrase of "stifle out" as a descriptive term. _symptoms._--the animal so affected stands quietly and firmly in his stall, or perhaps with one of his hind legs extended backward, and resists every attempt to move him backward. if urged to move forward he will either refuse or comply with a jump, with the toe of the disabled leg dragging on the ground and brought forward by a second effort. there is no flexion at the hock and no motion at the stifle, while the circular motion of the hip is quite free. the leg appears to be much longer than the other, owing to the straightened position of the thigh bone, which forms almost a straight line with the tibia from the hip joint down. the stifle joint is motionless, and the motions of all the joints below it are more or less interfered with. external examination of the muscles of the hip and thigh reveals a certain degree of rigidity, with perhaps some soreness, and the stifle bone may be seen projecting more or less on the outside and upper part of the joint. this state of things may continue for some time and until treatment is applied, or it may spontaneously and suddenly terminate, leaving everything in its normal condition, but perhaps to return again. _cause._--pseudo-dislocation of the patella is liable to occur under many of the conditions which cause actual dislocation, and yet it may often occur in animals which have not been exposed to the ordinary causes, but which have remained at rest in their stables. sometimes these cases are assignable to falls in a slippery stall, or perhaps slipping when endeavoring to rise; sometimes to weakness in convalescing patients; sometimes to lack of tonicity of structure and general debility; sometimes to relaxation of tissues from want of exercise or use. a straight leg, sloping croup, and the young are predisposed to this dislocation. _treatment._--the reduction of these displacements of the patella is not usually attended with difficulty. a sudden jerk or spasmodic action will often be all that is required to spring the patella into place, when the flexion of the leg at the hock ends the trouble for the time. but this is not always sufficient, and a true reduction may still be indicated. to effect this the leg must be drawn well forward by a rope attached to the lower end, and the patella, grasped with the hand, forcibly pushed forward and inward and made to slip over the outside border of the trochlea of the femur. the bone suddenly slips into position, the excessive rigor of the leg ceases with a spasmodic jerk, and the animal may walk or trot away without suspicion of lameness. though this may end the trouble for the time, and the restoration seem to be perfect and permanent, a repetition of the entire transaction may subsequently take place, and perhaps from the loss of some proportion of tensile power which would naturally follow the original attack in the muscles involved the lesion might become a habitual weakness. warm fomentations and douches with cold water will often promote permanent recovery, and liberty in a box stall or in the field will in many cases insure constant relief. the use of a high-heeled shoe is recommended by european veterinarians. the use of stimulating liniments, with frictions, charges, or even severe blisters, may be resorted to in order to prevent the repetition of the difficulty by strengthening and toning up the parts. diseases of muscles and tendons. sprains. this term expresses a more or less complete laceration or yielding of the fibers of the muscles, tendons, or the sheaths surrounding and supporting them. the usual cause of a sprain is external violence, such as a fall or a powerful exertion of strength, with following symptoms of soreness, heat, swelling, and a suspension of function. their termination varies from simple resolution to suppuration, and commonly fibrinous exudation difficult to remove. none of the muscles or tendons of the body are exempt from liability to this lesion, though naturally from their uses and the exposure of their situation the extremities are more liable than other regions to become their seat. the nature of the prognosis will be determined by a consideration of the seat of the injury and the complications likely to arise. _treatment._--the treatment will resolve itself into the routine of local applications, including warm fomentations, stimulating liniments, counterirritation by blistering, and in some cases even firing. rest, in the stable or in a box stall, will be of advantage by promoting the absorption of whatever fibrinous exudation may have formed, or absorption may be stimulated by the careful persevering application of iodin in the form of ointments of various degrees of strength. there are many conditions in which not only the muscular and tendinous structures proper are affected by a strain, but, by contiguity of parts, the periosteum of neighboring bones may become involved, with a complication of periostitis and its sequelæ. lameness of the shoulder. the frequency of the occurrence of lameness in the shoulder from sprains entitles it to precedence of mention in the present category, for, though so well covered with its muscular envelope, it is often the seat of injuries which, from the complex structure of the region, become difficult to diagnosticate with satisfactory precision and facility. the flat bone which forms the skeleton of that region is articulated in a comparatively loose manner with the bone of the arm, but the joint is, notwithstanding, rather solid, and is powerfully strengthened by tendons passing outside, inside, and in front of it. still, shoulder lameness or sprain may exist, originating in lacerations of the muscles, the tendons or the ligaments of the joint, or perhaps in diseases of the bones themselves. "slip of the shoulder" is a phrase frequently applied to such lesions. the identification of the particular structures involved in these lesions is of much importance, in view of its bearing upon the question of prognosis. for example, while a simple superficial injury of the spinatus muscles, or the muscles by which the leg is attached to the trunk, may not be of serious import and may readily yield to treatment, or even recover spontaneously and without interference, the condition is quite changed in a case of tearing of the flexor brachii, or of its tendons as they pass in front of the articulation, or, what is still more serious, if there is inflammation or ulceration in the groove over which this tendon slides, or upon the articular surfaces or their surroundings, or periostitis at any point adjacent. _causes._--the frequency of attacks of shoulder lameness is not difficult to account for. the superficial and unprotected position of the part and the numerous movements of which it is capable, and which, in fact, it performs, render it both subjectively and objectively preeminently liable to accident or injury. it would be difficult and would not materially avail to enumerate all the forms of violence by which the shoulder may be crippled. a fall, accompanied with powerful concussion; a violent muscular contraction in starting a heavily loaded vehicle from a standstill; a misstep following a quick muscular effort; a jump accompanied with miscalculated results in alighting; a slip on a smooth, icy road; balling the feet with snow; colliding with another horse or other object--indeed, the list may be indefinitely extended, but without profit or utility. _symptoms._--some of the symptoms of shoulder lameness are peculiar to themselves, and yet the trouble is frequently mistaken for other affections--navicular disease more often than any other. the fact that in both affections there are instances when the external symptoms are but imperfectly defined, and that one of them especially is very similar in both, is sufficient to mislead careless or inexperienced observers and to occasion the error which is sometimes committed of applying to one disease the name of the other, erring both ways in the interchange. the true designation of pathological lesions is very far at times from being of certain and easy accomplishment, and, owing to the massive structure of the parts we are considering, this is especially true in the present connection. still there are many cases in which there is really no reasonable excuse for an error in diagnosis by an average practitioner. shoulder lameness will, of course, manifest itself by signs and appearances more or less distinct and pronounced, according to the nature of the degrees and the extent of the originating cause. we summarize some of these signs and appearances: the lameness is not intermittent, but continued, the disturbance of motion gaging the severity of the lesion and its extent. it is more marked when the bones are diseased than when the muscles alone are affected. when in motion the two upper bony levers--the shoulder blade and the bone of the upper arm--are reduced to nearly complete immobility and the walking is performed by the complete displacement of the entire mass, which is dragged forward without either flexion of extension. the action of the joint below, as a natural consequence, is limited in its flexion. in many instances there is a certain degree of swelling at the point of injury--at the joint, or, more commonly, in front of it, or on the surface of the spinatus muscle. again, instead of swelling there will be muscular atrophy, though, while this condition of loss of muscular power may interfere with perfect locomotion, it is not in itself usually a cause of shoulder lameness. "sweenied" shoulders are more often due to disease below the fetlock than to affections above the elbow. during rest the animal often carries his leg forward, somewhat analogous to the "pointing" position of navicular disease, though in some cases the painful member drops at the elbow in a semiflexed position. the backing is sometimes typical, the animal when performing it, instead of flexing his shoulder, dragging the whole leg without motion in the upper segment of the extremity. the peculiar manner in which the leg is brought forward in the air for another step in the act of walking or trotting is in some instances characteristic of injuries of the shoulder. the lameness also manifests itself in bringing the leg forward with a circumflex swinging motion and a shortening in the extension of the step. the foot is carried close to the ground and stumbling is frequent, especially on an uneven road. with the utmost scrutiny and care the vagueness and uncertainty of the symptoms will contribute to perplex and discredit the diagnosis and embarrass the surgeon, and sometimes the expedient is tried of aggravating the symptoms by way of intensifying their significance, and thus rendering them more intelligible. this has been sought by requiring the patient to travel on hard or very soft ground and compelling him to turn on the sound leg as a pivot, with other motions calculated to betray the locality of the pain. _treatment._--it is our conviction that lameness of the shoulder will in many cases disappear with no other prescription than that of rest. provided the lesions occasioning it are not too severe, time is all that is required. but the negation of letting alone is seldom accepted as a means of doing good, in the place of the active and the positive forms of treatment. this is in accordance with a trait of human nature which is universal, and is unlimited in its applications; hence something must be done. in mild cases of shoulder lameness, then, the indications are water, either in the cold douche or by showering, or by warm fomentations. warm, wet blankets are of great service; in addition, or as alternative, anodyne liniments, camphor, belladonna, either in the form of tincture or the oils, are of benefit, and at a later period stimulating friction with suitable mixtures, sweating liniments, blistering compounds, subcutaneous injections over the region of the muscle of - / grains of veratrin (the variety insoluble in water) mixed in drams of water, etc., will find their place, and finally, when necessity demands it, the firing iron and the seton. the duration of the treatment must be determined by its effects and the evidence that may be offered of the results following the action of the reparative process. but the great essential condition of cure, and the one without which the possibility of relapse will always remain as a menace, is, as we have often reiterated in analogous cases, _rest_, imperatively rest, irrespective of any other prescriptions with which it may be associated. sprain of the elbow muscles. _causes._--this injury, which fortunately is not very common, is mostly encountered in cities among heavy draft horses or rapidly driven animals which are obliged to travel, often smooth shod, upon slippery, icy, or greasy pavements, where they are easily liable to lose their foothold. the region of the strain is the posterior part of the shoulder, and the affected muscles are those which occupy the space between the posterior border of the scapula and the posterior face of the arm. it is the muscles of the olecranon which give way. _symptoms._--the symptoms are easily recognized, especially when the animal is in action. while at rest the attitude may be normal, or by close scrutiny a peculiarity may perhaps be detected. the leg may seem to drop; the elbow may appear to be lower than its fellow, with the knee and lower part of the leg flexed and the foot resting on the toe, with the heel raised. such an attitude, however, may be occasionally assumed by an animal without having any special significance, but when it becomes more pronounced in motion the fact acquires a symptomatic value, and this is the case in the present instance. a rapid gait becomes quite impossible, and the walk, as in some few other diseases, becomes sufficiently characteristic to warrant a diagnosis even when observed from a distance. an entire dropping of the anterior part of the trunk becomes manifest, and no weight is carried on the disabled side in consequence of the loss of action in the suspensory muscles. there are often heat, pain, and swelling in the muscular mass at the elbow, though at times a hollow, or depression, may be observed near the posterior border of the scapula, which is probably the seat of injury. these hurts are of various degrees of importance, varying from mere minor casualties of quick recovery to lesions which are of sufficient severity to render an animal useless and valueless for life. _treatment._--the prime elements of treatment, which should be strictly observed, are rest and quiet. prescriptions of all kinds, of course, have their advocates. among them are ether, chloroform, camphor, alcoholic frictions, warm fomentations, blisters, setons, etc. unless the conclusions of experience are to be ignored, my own judgment is decisive in favor of rest, judiciously applied, however, and my view of what constitutes a judicious application of rest has been more than once presented in these pages. there are degrees of this rest. one contemplates simple immobility in a narrow stall. another means the enforced mobility of the slings and a narrow stall as well. another a box stall, with ample latitude as to posture and space, and option to stand or lie down. as wide as this range may appear to be, radical recovery has occurred under all of these modified forms of _letting our patients alone._ hip lameness. the etiology of injuries and diseases of the hip is one and the same with that of the shoulder. the same causes operate and the same results follow. the only essential change, with an important exception, which would be necessary in passing from one region to the other in a description of its anatomy, its physiology, and its pathology would be a substitution of anatomical names in reference to certain bones, articulations, muscles, ligaments, and membranes concerned in the injuries and diseases described. it would be only a useless repetition to cover again the ground over which we have so recently passed in recital of the manner in which certain forms of external violence (falls, blows, kicks, etc.) result in other certain forms of lesion (luxation, fracture, periostitis, ostitis, etc.), and to recapitulate the items of treatment and the names of the medicaments proper to use. the same rules of diagnosis and the same indications and prognosis are applicable equally to every portion of the organism, with only such modifications in applying dressings and apparatus as may be required by differences of conformation and other minor circumstances, which must suggest themselves to the judgment of every experienced observer when the occasion arrives for its exercise. an exception is to be made, while considering the subject in connection with the region now under advisement, in respect to the formidable affection known as morbus coxarius, or hip-joint disease; and leaving the detail of other lesions to take their place under other heads, that relating to the shoulder, for instance, we turn to the hip joint and its ailments as the chief subject of our present consideration. _symptoms._--in investigating for morbus coxarius, let the observer first examine the lame animal by scanning critically the outlines of the joint and the region adjacent for any difference of size or disturbance of symmetry in the parts, any prominence or rotundity, and on both sides. the lame side will probably be warmer, more developed, and fuller, both to the touch and to the eye. let him then grasp the lower part of the leg (as he would in examining a case of shoulder lameness) and endeavor to produce excessive passive motion. this will probably cause pain when the leg is made to assume a given position. let him push the thigh forcibly against the hip bone, and the contact will again probably cause a manifestation of pain. if the horse is trotted, the limited action of the hip joint proper and the excessive dropping and rising of the hip of the opposite side will be easily recognized. usually the animal does not extend the foot so far as customarily and picks it up much sooner. the abductive or circumflex motion observed in shoulder lameness is also present in hip lameness, but under special conditions, and the test of the difficulty, either by traveling on soft ground or in turning the horse in a circle, may here also contribute to the diagnosis, as in testing for lameness in the anterior extremity. _prognosis._--the prognosis of hip lameness is at times quite serious, not only on account of the long duration of treatment required to effect good results, and because of the character which may be assumed by the disease, but of the permanence of the disability resulting from it. exostosis and ulcerative arthritis are sequelæ which often resist every form of treatment. _treatment._--as before intimated, this is little more than a repetition of the remarks upon the lameness of the shoulder, with slight modifications occasioned by the muscular structure of the hip, and we are limited to the same recommendations of treatment. the advantages of rest must be reaffirmed, with local applications, of which, however, it may be said that they are more distinctly indicated and likely to be more effective in their results than in shoulder lameness, and may be more freely employed, whether in the form of liniments, blisters (singly or repeated), firing, or setoning. sprains of suspensory ligaments and of flexor tendons or their sheaths. the fibrous structure situated behind the cannon bones, both in the fore and hind legs, is often the seat of lacerations or sprains resulting from violent efforts or sudden jerks. _cause._--the injury may be considered serious or trifling, according to the circumstances of each case as judged by its own history. among the predisposing causes are a long, thin fetlock and a narrow knee or hock as viewed from the side, with the flexor muscles tied in just below the joint. the longer and more oblique the pastern the greater is the strain on the flexor tendons and suspensory ligaments; hence a low quarter, a toe calk, and no heel calks, or a thin calk placed at the tip under the toe, and leaving the quarters long abnormally stretches the back tendons and causes a great strain upon them just before the weight is shifted from the foot in locomotion. in runners and hunters the disease is liable to be periodic. in driving horses it is most common in well-bred animals of nervous temperament. draft horses suffer most frequently in the hind legs. _symptoms._--the injury is readily recognized by the changed aspect of the region and the accompanying local symptoms. the parts which in health are well defined, with the outlines of the tendons and ligaments well marked, become the seat of a swelling, more or less developed, from a small spot on the middle of the back of the tendon to a tumefaction reaching from the knee down to and even involving the fetlock itself. it is always characterized by heat, and it is variously sensitive, ranging from a mere tenderness to a degree of soreness which shrinks from the lightest touch. the degree of the lameness varies, and it has a corresponding range with the soreness, sometimes showing only a slight halting and at others the extreme of lameness on three legs, with intermediate degrees. the lameness is always worse when the weight is thrown on the foot and is most marked toward the end of the phase of contact with the ground. either passive irritation of the leg or turning the animal in a circle causes pain as in diseases of the joints. sometimes the horse likes to get the heels on a stone or some elevation so as to relieve the weight from the flexor tendons. finally, in cases of long standing, a shortening of the tendons occurs, resulting in the abnormal flexion of the foot known by horsemen as "broken down," or a more upright position of the foot may follow, producing perhaps knuckling or the so-called clubfoot. _prognosis._--it may be safely assumed on general principles that a leg which has received such injuries seldom returns to a perfect condition of efficiency and soundness, and that as a fact a certain absolute amount of thickening and deformity will remain permanent, even when the lameness has entirely disappeared. _treatment._--the injured member should receive the earliest attention possible, not only when the inflammatory condition is present, but when it is subsiding and there is only the thickening of the ligaments, the tendons, or the sheath. the most important remedy is rest, and the shoes should always be removed. during the first three days cold in the form of immersion or continuous irrigation is indicated. then warm moisture and continuous pressure are advised. the latter is best applied by placing two padded splints about the thickness of the thumb along the two sides of the tendon and binding them in place with even pressure by bandage. frequent bathing with warm soap suds is also beneficial. the absorption of the exudate may be promoted and the work of restoration effected by frictions with alcohol, tincture of soap, spirits of camphor, mild liniments, strong, sweating liniments, and blisters. an excellent ointment to apply with massage consists of equal parts of blue ointment and green soap, with double the quantity of vaseline. the action of blisters in these cases depends chiefly upon the massage used in applying them and upon the continuous pressure of the swollen skin on the inflamed tendons. in old cases more beneficial results will follow line firing. in these cases shoeing is very important. leave the quarters long, shorten the toe, give the shoe rolling motion, and either put short heel calks on the branches or thicken the branches. although this line of treatment is efficacious in many cases, there are others in which the thickening of the tendons refuses to yield and the changed tissues remain firmly organized, leaving them in the form of a thick mass resting upon the back part of the cannon bone. knuckling of fetlock. as a consequence of the last-mentioned lesion of the tendons, a new condition presents itself in the articular disposition, constituting the deformity known as the knuckling fetlock. (see also p. .) by this is meant a deformity of the fetlock joint by which the natural angle is changed from that which pertains to the healthy articulation. the first pastern, or suffraginis, loses its oblique direction and assumes another, which varies from the upright to the oblique, from before backward, and from above downward; in other words, forming an angle with its apex in front. _causes._--this condition, as we have seen, may be the result of chronic disease producing structural changes in the tendons, and it may also occur as the result of other affections or some peculiarity independent of this and situated below the fetlock, such as ringbones, sidebones, or traumatic disease of the foot proper. animals are sometimes predisposed to knuckling, such, for example, as are naturally straight in their pasterns, or animals which are compelled to labor when too young. the hind legs are more predisposed than the fore to this deformity, in consequence of the greater amount of labor they are required to perform as the propelling levers of the body. _symptoms._--the symptoms of knuckling are easily recognized. the changes in the direction of the bones vary more or less with the degree of the lesion, sometimes assuming such a direction that it almost becomes a true dislocation of the pastern. the effect of knuckling upon the gait also varies according to the degree of the deformity. as the different degrees of the shortening of the leg affect the motion of the fetlock, the lameness may be very slight or quite extreme. another consequence of this shortening is such a change in the position of the foot that the heels cease to come in contact with the ground and assume a greater elevation, and the final result of this is soon witnessed in the development of a clubfoot. _treatment._--to whatever cause the knuckling may be ascribed, it is always a severe infirmity, and there is but little room for hoping to overcome it unless it be during the very first stages of the trouble, and the hope dwindles to still smaller dimensions when it is secondary to other diseases below the fetlock. if it is caused by overworking the animal, the first indication, of course, will be rest. line firing has proved very efficacious in these cases. the animal must be turned loose and left unemployed. careful attention should be given to the condition of his feet and to the manner of shoeing, while time is allowed for the tendons to become restored to their normal state and the irritation caused by excessive stretching has subsided. a shoe with a thick heel will contribute to this. if no improvement can be obtained, however, and the tendons though retracted have yet been relieved of much of their thickening, the case is not a desperate one, and may yet be benefited by the operation of tenotomy, single or double--an operative expedient which must be committed to the experienced surgeon for its performance. sprung knees. though not positively the result of diseases of the tendons acting upon the knees, we venture to consider this deformity in connection with that which we have just described. it consists in such an alteration in the direction and articulation of the bones which form the various carpal joints that instead of forming a vertical line from the lower end of the forearm to the cannon bone they are so united that the knee is more or less bent forward, presenting a condition caused by the retraction of two of the principal muscles by which the cannon bone is flexed. _cause._--this flexion of the knee may be a congenital deformity and have continued from the foaling of the animal; or, like clubfoot, it may be the result of heavy labor which the animal has been compelled to perform when too young. it may also be due to other diseases existing in parts below the knee joint. _symptoms._--this change of direction largely influences the movement of the animal by detracting from its firmness and practically weakening the entire frame, even to the extent of rendering him insecure on his feet and liable to fall. this condition of weakness is sometimes so pronounced that he is exposed to fall even when standing at rest and unmolested, the knees being unable even to bear their portion of the mere weight of the frame. this results in another trouble--that of being unable to keep permanently upright. he is liable to fall on his knees, and by this act becomes presently a sufferer from the lesion known by the term of "broken knees." _treatment._--whatever may be the originating cause of this imperfection, it detracts very largely from the usefulness and value of a horse, disqualifying him for ordinary labor and wholly unfitting him for service under the saddle without jeopardizing the safety of his rider. if, however, the trouble is known from the start, and is not the result of congenital deformity or weakness of the knee joint, or secondary to other diseases, rest, with fortifying frictions, may sometimes aid in strengthening the joints; and the application of blisters on the posterior part of the knee, from a short distance above to a point a little below the joint, may be followed by some satisfactory results; but with this trouble, as with knuckling fetlocks, the danger of relapse must be kept in mind as a contingency always liable to occur. curb. this lesion is the bulging backward of the posterior part of the hock, where in the normal state there should be a straight line, extending from the upper end of the point of the hock down to the fetlock. _cause._--the cause may be a sprain of the tendon which passes on the posterior part of the hock, or of one of its sheaths, or of the strong ligament situated on the posterior border of the os calcis. hocks of a certain conformation seems to possess a greater liability to curb than others. they are overbent, coarse, and thick in appearance, or may be too narrow from front to back across the lower portion. this condition may therefore result as a sequence to congenital malformation, as in the case of horses that are "saber-legged." it often occurs, also, as the result of violent efforts, of heavy pulling, of high jumping, or of slipping; in a word, it may result from any of the causes heretofore considered as instrumental in producing lacerations of muscular, tendinous, or ligamentous structure. _symptoms._--a hock affected with curb will present at the outset a swelling more or less diffuse on its posterior portion, with varying degrees of heat and soreness, and these will be accompanied with lameness of a permanent character. at a later period, however, the swelling will become better defined, the deformity more characteristic, the prominent, curved line readily detected, and the thickness of the infiltrated tissue easily determined by the fingers. at this time, also, there may be a condition of lameness, varying in degree, while at others, again, the irregularity of action at the hock will be so slight as to escape detection, the animal betraying no appearance of its existence. a curb constitutes, by a strict construction of the term, an "unsoundness," since the hock thus affected is less able to endure severe labor, and is more liable to give way with the slightest effort. yet the prognosis of a curb can not be considered to be serious, as it generally yields to treatment, or at least the lameness it may occasion is generally easily relieved, though the loss of contour caused by the bulging will always constitute a blemish. _treatment._--on the first appearance of a curb, when it exhibits the signs of an acute inflammation, the first indication is to subdue it by the use of cold applications, as intermittent or constant irrigation or an ice poultice; when these have exhausted their effect and the swelling has assumed better defined boundaries, and the infiltration of the tendons or of the ligaments is all that remains of a morbid state, then every effort must be directed to the object of effecting its absorption and reducing its dimensions by pressure and other methods. the medicaments most to be trusted are blisters of cantharides and frictions with ointments of iodin, or, preferably, biniodid of mercury. mercurial agents alone, by their therapeutic properties or by means of the artificial bandages which they furnish by their incrustations when their vesicatory effects are exhausted, will give good results in some instances by a single application, and often by repeated applications. the use of the firing iron must, however, be frequently resorted to, either to remove the lameness or to stimulate the absorption. we believe that its early application ought to be resorted to in preference to waiting until the exudation is firmly organized. firing in dull points or in lines will prove as beneficial in curb as in any other disease of a similar nature. lacerated tendons. this form of injury, whether of a simple or of a compound character, may become a lesion of a very serious nature, and will usually require long and careful treatment, which may yet prove unavailing in consequence either of the intrinsically fatal character of the wound itself or the complications which have rendered it incurable. _cause._--like all similar injuries, they are the result of traumatic violence, such as contact with objects either blunt or sharp; a curb-stone in the city; in the country, a tree stump or a fence, especially one of wire. it may easily occur to a runaway horse when he is "whipped" with fragments of harness or "flogged" by fragments of splintered shafts "thrashing" his legs, or by the contact of his legs with the wagon he has overturned and shattered with his heels while disengaging himself from the wreck. _symptoms._--it is not always necessary that the skin be involved in this form of injury. on the contrary, the tegument is frequently left entirely intact, especially when the injury follows infectious diseases or occurs during light exercise after long periods of rest in the stable. again, the skin may be cut through and the tendons nearly severed. a point a little above the fetlock is usually the seat of the injury. but irrespective of this, and whether the skin is or is not implicated, the symptoms resemble very much those of a fracture. there is excessive mobility, at least more than in a normal state, with more or less inability to carry weight. there may be swelling of the parts, and on passing the hands carefully along the tendon to the point of division the stumps of the divided structure will be felt more or less separated, perhaps wholly divided. the position of the animal while at rest and standing is peculiar and characteristic. while the heels are well placed on the ground, the toe is correspondingly elevated, with a tendency to turn up--a form of breaking down which was described when speaking of the fracture of the sesamoids. carrying weight is done only with considerable difficulty, but with comparatively little pain, and the animal will unconsciously continue to move the leg as if in great suffering, notwithstanding the fact that his general condition may be very good and his appetite unimpaired. the effect upon the general organism of compound lacerated wounds of tendinous structures, or those which are associated with injuries of the skin, are different. the wound becomes in a short time the seat of a high degree of inflammation, with abundant suppuration filling it from the bottom; the tendon, whether as the result of the bruise or of the laceration, or of maceration in the accumulated pus, undergoes a process of softening, and necrosis and sloughing ensue. this complicates the case and probably some form of tendinous synovitis follows, running into suppurative arthritis, to end, if close to a joint, with a fatal result. _prognosis._--the prognosis of lacerated tendons should be very conservative. under the most favorable circumstances a period of from six weeks to two months will be necessary for the treatment, before the formation of the cicatricial callus and the establishment of a firm union between the tendinous stumps. _treatment._--as with fractures, and even in a greater degree, the necessity is imperative, in the treatment of lacerated tendons, to obtain as perfect a state of immobility as can be obtained compatibly with the disposition of the patient; the natural opposition of the animal, sometimes ill-tempered and fractious at best, under the necessary restraint causing at times much embarrassment to the practitioner in applying the necessary treatment. without the necessary immobility there can be no close connection of the ends of the tendons. to fulfill this necessary condition the posterior part of the foot and the fetlock must be supported and the traction performed by them relieved, an object which can be obtained by the use of the high-heeled and bar shoe, or possibly better accomplished with a shoe of the same kind extending about or - / inches back of the heels. the perfect immobility of the legs is obtained in the same way as in the treatment of fracture, with splints, bandages, iron apparatus, plaster of adhesive mixtures, and similar means. so long as the dressings remain in place undisturbed and no chafing or other evidence of pain is present, the dressings may be continued without changing, the patient being kept in the slings for a period sufficient to insure the perfect union of the tendons. for a compound lesion when there is laceration of the skin some special care is necessary. the wound must be carefully watched and the dressings removed at intervals of a few days or as often as may be needful, all of which additional manipulation and extra nursing, however indispensable, still adds to the gravity of the case and renders the prognosis more and more serious. when the tendons have sloughed in threads of various dimensions, or if in the absence of this process of mortification healthy granulations should form and fill up the wound, still very careful attention will be required, the granulating ends of the tendons having a tendency to bulge between the edges of the skin and to assume large dimensions, forming bulky excrescences or growths of a warty or cauliflower appearance, the removal of which becomes a troublesome matter. the union of the tendons will at times leave a thickening of varying degree near the point of cicatrization, the absorption of which becomes an object of difficult and doubtful accomplishment, but which may be promoted by moderate blistering and the use of alterative and absorbent mixtures or perhaps the fire iron. a shoe with heels somewhat higher than usual will prove a comfort to the animal and aid in moderating and relieving the tension of the tendons. rupture of the flexor metatarsi. this is a muscle of the anterior part of the shank. it is situated in front of the tibia, and is of peculiar formation, being composed of a muscular portion with a very powerful tendon, which are at first distinct and separate, to be intimately united lower down, and terminating at the lower end by a division into four tendinous bands. it is a powerful muscle of the hinder shank bone, and also acts as a strong means of support for the stifle joint; that is, of the articulation of the thigh and shank bone, in front and outside of which it passes. its situation and its use cause it to be liable to severe stretching and straining, and a rupture of some of its fibers is sometimes the consequence. _cause._--this injury may be the result of a violent effort of the animal in leaping over a high obstacle; in missing his foothold and suddenly slipping backward while powerfully grasping the ground with the feet in striving to start a heavily loaded vehicle; in making a violent effort to prevent a probable fall; or in attempting to lift the feet from miry ground. _symptoms._--the accident is immediately followed by disability which will vary according to the true seat of the injury and the period of its duration. this rupture will not prevent the horse from standing perfectly and firmly on his feet when kept at rest, and while no muscular efforts are required from him there is no appearance of any lesion or unsoundness. an attempt to move him backward, however, will cause him to throw all his weight upon his hind-quarters, and he will refuse to raise his foot from the ground. if compelled to do so, or required to move forward, the hock being no longer capable of flexion, the muscle which effects that movement being the injured one, the opposite muscles, the extensors, acting freely, the entire lower part of the leg, from the hock down, will be suddenly, with a jerk, extended on the tibia or shank bone, and simultaneously with this the tendo achillis, the cord of the hock, the tendons of the extensors of the hock will be put in a wrinkled and relaxed condition. the leg is behind the animal and the toe rests on the ground. examination of the fore part of the shank from the stifle down to the hock may reveal soreness, and possibly some swelling and heat at the seat of the lesion. _treatment._--our experience with injuries of this form convinces us that, generally speaking, they are amenable to treatment. provided a sufficient time has been allowed for union to take place, very few instances in which radical recovery has not been effected have come to our knowledge. the more flexed the leg can be kept, the quicker will it heal. in these cases, as in those of simple laceration of tendons, already considered, the indications resemble those which apply in the treatment of fractures, as near as coaptation of the lacerated ends is possible, with immobility, being the necessary conditions to secure. the first is a matter of very difficult accomplishment, by bandaging alone, and some have recommended instead the application of charges or blisters in order to compel the animal to keep more quiet. to secure the necessary immobility the animal should be placed in slings snugly applied, and kept in a narrow stall. he should also be tied short, and restrained from any backward movement by ropes or boards, and should, moreover, be kept in as quiet a temper as possible by the exclusion of all causes of irritation or excitement. weeks must then elapse, not less, but frequently more than six, often eight, before he can be considered out of danger and able to return to his labor, which should for a time be light and easy, and gradually, if ever, increased to the measure of a thoroughly sound and strong animal. if he is used too soon the newly formed tissue between the ends of the muscle will be liable to stretch and leave the flexor muscle too long and permanently displaced. sundry additional affections of the extremities. among these there are three which will principally occupy our attention, and, which may be considered as forming a single group. in some parts of the legs may be found certain peculiar little structures of a saclike formation, containing an oily substance designed for the lubrication of the parts upon which they are placed for the purpose of facilitating the movements of the tendons which pass over them. these little sacs or muco-synovial capsules, under peculiar conditions of traumatism, are liable to become subject to a diseased process, which consists principally in a hypersecretion of their contents and an increase in dimensions, and they may undergo peculiar pathological changes of such character as to disable an animal, and in many instances to cause serious blemishes which can but depreciate its value. these growths, which are known as hygromata, may result from external violence, as blows or bruises, and may appear in the form of small, soft tumors, painless and not inflammatory in character, but, by a repetition of the cause or renewal of violence, liable to acquire increased severity. severe inflammation, with suppuration, may follow, which, filling up the cavity, the walls will become thickened and hard, resulting in the formation of a tumor. the elbow, the knee, and the hock are the parts of the body where these lesions are ordinarily found, and on account of their peculiar shape and the position they occupy they have received the denomination "capped." they will be considered in their peculiar aspect. capped elbow. capped elbow, or "shoe boil," is a term applied to an enlargement often found at the point of the elbow. _cause._--this lesion is due to injury or pressure of the part while it is resting on the ground. the horse, unlike the cow, does not rest directly on the under surface of the sternum, or breastbone, on account of its sharp, ridge-like formation. he rests more on the side of the breastbone and chest, and consequently the leg which is flexed under the body is subject to considerable pressure. if the leg is flexed under the body so that the hoof or shoe is directly in contact with the elbow, which may occur in horses having an extremely long cannon bone or excessive length in the shoes, the greater part of the weight of the chest is concentrated at this point and the pressure may cause a bruise or an inflammation. _symptoms._--under these conditions the point of the elbow may become swollen and tender and exhibit heat and pain. this swelling may not only cover the point of the elbow, but sometimes reaches the axilla and assumes such proportions that there is great difficulty in using the leg, the animal showing signs of lameness even to the extent of the circumflex step, as in shoulder lameness. this edematous condition, however, does not remain stationary. it may by degrees subside or perhaps disappear. in the first instance it will become more distinctly defined, with better marked boundaries, until it is reduced to a soft, round, fluctuating tumor, with or without heat or pain. there is then either a bloody or serous tumor or a purulent collection, and following the puncture of its walls with the knife there will be an escape of blood, serum, or pus, as the case may be, in variable quantities. in either case, but principally in that of the cystic form, the tumor will be found to be subdivided by septa, or bands running in various directions. various changes will follow the opening of the tumor and the escape of its contents. in a majority of cases the process of cicatrization will take place, and the cavity fill up by granulation, the discharge, at first abundant, gradually diminishing and the wound closing, usually without leaving any mark. at times, however, and especially if the disease has several times repeated its course, there may remain a pendulous sac, partly obliterated, which a sufficient amount of excitement or irritation may soon restore to its previous dimensions and condition. in other cases an entirely different process takes place. the walls of the cavity, cyst, or abscess become ulcerated and thickened, the granulations of the sac become fibrous in their structure and fill up the cavity, and it assumes the character of a hard tumor on the back of the elbow, sometimes partly and sometimes entirely covered by the skin. it is fibrous in its nature, painless to the touch, well defined in its contour, and may vary in size from that of a small apple to that of a child's head. this last form of capped elbow is the most serious of any, resisting all known forms of mild treatment, and removable by the knife only. the other forms, even that with the inflammatory aspect and its large edematous swelling which interferes with the work of the animal, may justify a much milder prognosis, and, aside from their liability to recur, may be ranked with the comparatively harmless affections. _treatment._--so long as the danger of recurrence is the principal bad feature of capped elbow the most important consideration is that of devising a means for its prevention. to prevent the animal from lying down is evidently the simplest method of keeping the heels and the elbow apart; but the impracticability of this prescription is apparent, since most animals are obliged to lie down when they sleep, though it is true that a few take their sleep on their feet. the question of shoeing here enters into the discussion. the shortening of the inside branch of the shoe, which is the one with which the pressure is made, may be of advantage, and especially if the truncated end of the shoe is smooth and filed over to remove all possibility of pressure and contusion upon the skin. the protection of the skin of the elbow by interposing soft tissues between that and the shoe, or by bandaging the heel with bags or covering it with boots, is considered by many the best of the preventive methods, and the advantage to be obtained by resorting to it can not be overlooked when the number of horses which develop shoe boil whenever the use of the boot is intermitted is considered. in order to prevent the animal from assuming the sternal decubitus, many give preference to the plan of fastening a piece of wood across the stall at some distance from the front wall or manger. it is a simple expedient, primitive, perhaps, but nevertheless practical, and followed by good results. the therapeutic treatment is also important. the edematous swelling, when recognized by its external appearance and the existing inflammation, should be treated without delay. warm fomentations, repeated several times daily, are then indicated, the degree of warmth being as high as can be borne comfortably. they are easily applied and often yield decided relief in a few hours. in some cases, however, astringents, in the form of poultices or pastes, are used in preference; these are made to cover the entire swelling and allowed to remain, drying after a short time, it is true, and perhaps falling off, but are easily renewed and reapplied. an excellent astringent for these cases is a putty made of powdered chalk and vinegar (acetate of lime), and the whole swelling is then covered with a thick coating of soft clay made into a mass with water. these simple remedies are often all that is required. under their use the swelling passes off by degrees and after a short interval the animal is fit for work again, but not uncommonly instead a swelling develops, puffy, not painful, and perhaps giving a sensation of crepitation when pressure is applied with the finger. it is soft, evidently contains a liquid, and when freely opened with a good-sized incision discharges a certain quantity of blood, partly liquid and partly coagulated, and perhaps a little hemorrhage will follow. the cavity should then be well washed out and a plug of oakum introduced, leaving a small portion protruding through the cut to prevent it from closing prematurely. it may be taken off the next day, and a daily cleansing will then be all that is necessary. in another case the tumor becomes very soft in its whole extent, with evident fluctuation and a well-defined form. the discharge of the fluid is then indicated, and a free incision will be followed by the escape of a quantity of thin yellowish liquid from a single sac. the wound should be kept clean and dressed frequently, in order to insure prompt healing. but if the cavity is found to be subdivided in its interior by numerous bands and the cyst proves to be multilocular the partitions should be torn out with the fingers and the cavity then treated in the same manner as the unilocular sac. in still another case the swelling may be warm and painful with indistinct fluctuation, or fluctuation only at a certain point. this indicates an abscess, and necessitates an incision to drain the pus, followed by the careful cleansing and dressing of the wound. but cases occur in which all the treatment that has been described fails to effect a full recovery, and instead a fibrous tumor begins to develop. a change of treatment is, of course, then in order. the inflammation being chronic will necessitate stimulating treatment of the part in order to increase the process of absorption. we must again draw upon the resources of experience in the form of blisters, the fomentations, the iodin, and the mercurial ointments, as heretofore mentioned. good results may always be insured from their judicious and timely administration. in applying the powerful mineral inunctions much patience and wisdom are required. it should be done by carefully and perseveringly rubbing in small quantities daily; it should be done softly and gently, not with force, nor with the expectation of producing an astonishing effect by heavy dosing and main strength in a few hours; it should be after the manner of a siege rather than that of a charge. the object is to induce the drugs to permeate the affected part until the entire mass is penetrated. of course cases will be encountered which resist all forms of medical treatment. the tumor remains as a fixed fact; it continues to grow; it is large and pendulous at the elbow; its weight is estimated in pounds; it is not an eyesore merely, but an uncomfortable, burdensome mass, excoriating all the surrounding parts and being itself excoriated in turn; mild treatment has failed and is no longer to be relied on. resort must now be made to surgical methods, and here again we must choose between the ligature, the cautery, and the knife. each has its advocates among practitioners. in a case like the present, one of the difficulties arises in connection with the application and retention of bandages and other dressings after the amputation has been performed. it is a somewhat difficult problem, owing to the conformation and proportions of the body of the patient, and involves the exercise of considerable practical ingenuity to adjust and retain the appliances necessary to insure a good final result. in the long description of the treatment of the varieties of capped elbow i have thus far omitted any mention of one method which is practiced and commended by not a few. i refer to the use of setons, introduced through the tumor. my own experience and the observation of many failures from this method led me to abandon it. capped knee. the passage of the tendons of the extensor muscle of the cannon, as it glides in front of the knee joint, is assisted by one of the little bursæ before mentioned, and when this becomes the seat of dropsical collection a hygroma is formed and the knee is "capped." though in its history somewhat analogous to the capped elbow, there are points of difference between them. their development may prove a source of great annoyance from the fact of the blemish which they constitute. _cause._--the capped knee presents itself under various conditions. it is sometimes the result of a bruise or contusion, often repeated, inflicted upon himself by a horse addicted to the habit of pawing while in the stable and striking the front of the stall with his knees. another class of patients is formed of those weak-kneed animals which are subject to falling and bruising the front of the joint against the ground, the results not being always of the same character. _symptoms._--the lesion may be a simple bruise, or it may be a severe contusion with swelling, edema, heat, and pain. the joint becomes so stiff and rigid that it interferes with locomotion and yet under careful simple treatment the trouble may disappear. again, instead of altogether passing off, the edema may diminish in extent, becoming more defined in form and may remain as a swelling on the front part of the knee. resulting from the crushing of small blood vessels, this is necessarily full of blood. the swelling is somewhat soft, diffuse, not painful, more or less fluctuating, and after a few days becomes crepitant under the pressure of the hand. instead of being filled with blood the swelling may be full of serum, as often occurs when violence, though perhaps slight, has been frequently repeated. in that case the swelling is generally well defined, soft, and painless, with more or less fluctuation, and it may even become pendulous. in other cases the swelling may be of an acute, inflammatory nature, with heat and pain, accompanied with stiffness of the joint. this leads to the formation of an abscess. whatever the nature of these swellings may be, either full of blood, serum, or pus, some blemish usually remains after treatment. _prognosis._--though simple bruises of the knee without extensive lesions are usually of trifling account, a different prognosis must be pronounced when the lesion assumes more important dimensions, and though a capped knee may be comparatively of little importance we have seen cases in which not only extensive blemishes were left to disfigure the patient, but the animals had become worthless in consequence of the extension of the diseased process to the various elements composing the joint, and giving rise to the most complicated cases of carpitis. _treatment._--usually the first symptom of trouble is the edematous swelling on the front of the "knee." the prevention of the inflammation and consequently of the abscess, is the prime object in view, and it may be realized by the use of warm-water fomentations or compresses applied over the swelling, which may be used either in a simple form or combined with astringents, such as goulard's extract, alum, or sulphate of zinc. the application of warm poultices of oil meal or ground flaxseed, enveloping the whole joint and kept in place by bandages, is often followed by absorption of the swelling, or, if the abscess is in process of formation, by the active excretion of pus. if an abscess forms in spite of these precautions it may be treated surgically in several ways. in one it should be done by a careful incision, which will allow the escape of the blood or the serum, or of the pus which is inclosed in the sac; in another it may be by means of a seton, in order that the discharge may be maintained and allowed to escape; for another we may adopt the more cautious manner of emptying the cavity by means of punctures with small trocars or aspirators. the danger attending this last method arises from the possible sloughing of large portions of the skin, while that attending the first is the hazard of the possibility of the extension of the inflammation to the capsular ligament of the knee, with the possibility of an open joint in prospect. as we have remarked, the cavity after being emptied may rapidly close and leave in a short time but slight traces of its previous existence. but in many, if not in most cases, there will remain, after the cicatrization is complete, a thickening or organized exudation at one time round and well defined, at another spreading by a diffused infiltration, to which it will be necessary to give immediate attention, from the fact of its tendency to form into an organized and permanent body. to stimulate inflammation in this diseased structure, blisters are recommended, but chiefly for the purpose of promoting the process of absorption. if this treatment fails, the use of iodin and mercurial preparations is recommended. plain mercurial or plain iodin ointment, or both in combination as iodid of mercury, are commonly used, and may be applied either moderately and by gentle degrees, as we have suggested, or more freely and vigorously with a view to more immediate effects, which, however, will also be more superficial. the use of the firing iron applied deeply with fine points is then to be strongly recommended, to be followed by blisters and various liniments. this course may generally be relied on as quite sure to be followed by satisfactory results. while the treatment is in progress it will, of course, be necessary to secure the animal in such manner that a recurrence of the injury will be impossible from similar causes to those which were previously responsible. capped hock. a bad habit of rubbing or striking the partitions of their stalls with their hocks prevails among some horses, with the result of an injury which shows itself on the upper points of those bones, the summit of the os calcis. from its analogy to the condition of capped elbow the designation of capped hock has been applied to this condition. _symptoms._--a capped hock is therefore but the development of a bruise at the point of the hock, which if many times repeated may excite an inflammatory process, with all its usual external symptoms of swelling, heat, soreness, and the rest of the now-familiar phenomena. the swelling is at first diffused, extending more or less on the exterior part of the hock, and in a few instances running up along the tendons and muscles of the back of the shank. soon, however, unless the irritating causes are continued and repeated, the edema diminishes, and, becoming more defined in its external outlines, leaves the hock capped with a hygroma. the hygroma, at the very beginning of the trouble, contains a bloody serosity which soon becomes strictly serum, and this, through the influence of an acute inflammatory action, is liable to undergo a change which converts it into the usual purulent product of suppuration. the external appearance ought to be sufficient to determine the diagnosis, but there are a few signs which may contribute toward a nicer identification of the lesion. the capped hock, whether under the appearance of an acute, edematous swelling, or as a bloody serous collection, or as a simple serous cyst, does not give rise to any remarkable local manifestation other than such as have already passed under our survey in considering similar cases, nor will it be liable to interfere with the functions which belong to the member in question, unless it assumes very large dimensions and on each side of the tendons, as well as on the summit of the bone. but if the inflammation is quite high, if suppuration is developing, if there is a true abscess, or--and this is a common complication--especially when the kicking or rubbing of the animal is frequently recurring, then, besides the local trouble of the cyst or of the abscess, the bones become diseased and the periosteum inflamed; perhaps the superior ends of the bone and its fibro-cartilage become affected, and a simple lesion or bruise, whatever it may have been, becomes complicated with periostitis and ostitis, and is naturally accompanied with lameness, developed in a greater or less degree, which in some cases may be permanent and in others increased by work. these complications, however, are not common or frequent. _treatment._--capped hocks are in many cases amenable to treatment, and yet they often become the opprobrium of the practioner by remaining, as they frequently do, an eyesore on the top of the hock; they do not interfere, it is true, with the work of the horse, but fixing upon him the stigma of what, in human estimation, is a most unreliable and objectionable reputation, to wit, that of being an habitual "kicker," and, worse than all, one that kicks when fed. the maxim that "an ounce of prevention is worth a pound of cure" fits the present case very neatly. a horse whose hocks have a somewhat puffy look and whose skin on the front of the hock is loose and flabby, justly subjects himself to a suspicion of addictedness to this bad habit, but a little watching will soon establish the truth. if, then, the verdict is one of conviction, precautions should be immediately adopted against a continuance of the evil. the padding of the sides of the stall with straw mats or mattresses and covering the posts with similar material, in such manner as to expose no hard surface with which to come in contact, will reduce the evil to its minimum. the animal may jar his frame when he kicks, but even then there will be less force in the concussion than if it impinged upon the solid plank, and cuts and abrasions can not be inflicted by a properly made cushion. hobbles are also rightly recommended with a view to the required restraint of motion, so applied as to secure the leg with which the kicking is performed, or even both hind legs, in such manner as not to interfere with the movement of lying down and rising again and yet preventing that of kicking backward. boots similar in pattern to those which are used for the prevention of shoe boil are also prescribed. these are placed above the hock and retained by straps tightly fastened. we apprehend, however, that the difficulty of retaining them in the proper place without the danger of chafing from the tightness of the straps may form an objection to their use. notwithstanding all precautions, hocks will be capped in the future as in the past, and the study of their treatment will always be in order. the mode of dealing with them will, of course, be greatly influenced by the condition of the parts. when the inflammation is excessive and the swelling large, hot, and painful to the touch, the application of warm water will be very painful. the leg should be well fomented several times a day, for from to minutes each time, a strong decoction of marsh-mallow leaves being added to the water, and after each application swathed with flannel bandages soaked in the same warm mixture. a few days of this treatment will usually effect a resolution of the inflammation; if not complete, at least sufficiently so to disclose the correct outlines of the hygroma and exhibit its peculiar and specific symptoms. the expediency of its removal and the method of accomplishing it are then to be considered, with the question of opening it to give exit to its contents. if the fluid is of a purulent character, the indication is in favor of its immediate discharge. no time should be lost, and it should be by means of a small opening made with a narrow bistoury. if, however, the fluid is a serosity, we prefer to remove it by punctures with a very small trocar. our reason for special caution in these cases is our fear of the possibility of the existence of diseased conditions of a severe character in the pseudo joint. for the same reason we prefer the treatment of those growths by external applications. in the first stages of the disease a severe and stiff blister, such as the cantharidate of collodium, entirely covering the cyst, perhaps not yet completely formed, when the inflammation has subsided, will be of great benefit by its stimulating effect, the absorption it may excite, and the pressure which, when dry, it will maintain upon the tumor. if, however, the thickening of the growth fails to diminish, it should be treated with some of the iodin preparations in the form of ointments, pure or in combination with potassium, mercury, etc., of various strengths and in various proportions. my opinion of setons is not favorable, but the actual cautery, by deep and fine firing, in points--needle cauterization--i believe to be the best mode of treatment, and especially when applied early. a very satisfactory way to treat these cases is to burst the swelling by pressure from without. a strap or strong linen bandage is placed about the hock, pressing on the bursa, while the affected leg is on the ground, the other hind foot being lifted up. when the bandage is in place the leg should be released, and the horse will violently flex the bandaged limb and produce pressure on the bursa, with consequent bursting and discharging of its contents. whatever treatment may be adopted for capped hock, patience must be one of the ingredients. in these parts absorption is slow, the skin is very thick, and its return to a soft, pliable, natural condition, if effected at all, will take place only after weeks added to other weeks of medical treatment and patient waiting. interfering, and speedy cuts. these designations belong to certain special injuries of the extremities, produced by similar causes, giving rise to kindred pathological lesions with allied phenomena, requiring about the same treatment and often followed by the same results, to wit, a blemish which may not only subject the animal to a suspicion of unsoundness, but in some special circumstances may interfere with his ability to labor. it is known as "interfering" when the location of the trouble is the inside of the fetlock of either the fore or hind leg. it is called "speedy cut" when it occurs on the inside of the fore leg, a little below the knee, at the point of contact of that joint with the cannon. it is always the result of a blow, self-inflicted, of varying severity, and giving rise to various lesions. (see also p. .) _symptoms._--at times the injury is too slight to be seriously noticed, the hair being scarcely cut and the skin unmarked. at other times the skin will be cut through, partly or wholly, and it may for the time cause sufficient pain to check the motion of the animal and induce him to suspend his labor through his inability to use the wounded limb, traveling meanwhile for a short space on three legs only. sometimes a single blow will suffice, or again there will be a repetition of lighter strokes. in the latter case the parts will become much swollen, hot, and so painful to the touch that the motion of the knee or the fetlock will be sufficiently disturbed to cause lameness of a degree of severity corresponding to that of the lesion. following the subsidence of this diffused and edematous swelling is sometimes the formation of a tumor, either at the knee or the fetlock. this may be soft at first or become so by degrees, with fluctuation, its contents being at first extravasated blood, and later a serosity; or, if there has been a sufficient degree of inflammation, it may become suppurative. the result of the fault of interfering may thus be exhibited, whether at the knee or at the fetlock, as characterized by all the pathological conditions which have appeared as accompaniments of capped knee or capped hock. if, in consequence of the force of the blow or blows, the inflammation has been usually severe, a mortification of the skin may become one of the consequences, a slough taking-place, succeeded by a cutaneous ulcer on the inside of the fetlock or when the greater number of the original wounds are inflicted. if the interfering has been often repeated it may be followed by another condition, which has been considered in our remarks upon other affections. it is a plastic exudation or thickening of the parts, which are commonly said to have become "callous," and the effect of it is to destroy the regularity of the outlines of the joint to an extent which constitutes a serious blemish, which will be permanent, and according to the degree of the aberration from the natural and symmetrical lines will inevitably depreciate the commercial value of the animal. an animal in interfering may thus exhibit a range of symptoms which from the simplest form of a mere "touching," may successively assume the serious characters of an ugly cicatrix, a hard, plastic swelling, or perhaps, as witnessed at the knee, of periostitis with its sequelæ. if a single and constantly recurring cause--a blow--is the starting point in interfering, we may now consider the subject of the predisposition which brings such serious results upon the suffering animal, and the conditions which lead to and accompany it. these are numerous, but the first in frequency and importance is peculiarity of conformation in the animals addicted to it. the first class will include horses, whose chests are narrow and whose legs do not stand straight and upright, but are crooked and pigeon-toed in and out. the second class includes those whose legs are weak, either from youth or hard labor, or from severe attacks of sickness. another class is made up of those having abnormally developed feet, or which have been badly shod with unnecessarily wide or heavy shoes. another class consists of those that are affected with swollen fetlocks or chronic, edematous swelling of the leg. another is formed of animals with a peculiar action, as those whose knee action is very high, and it is these that furnish most of the cases of speedy cut. _prognosis._--the prognosis of interfering is never a very serious one. however violent the blow may be it is rarely that subsequent complications of a troublesome nature occur. the principal evil attending it is a liability to be followed by a thickened or callous deposit which is not only an eyesore and a blemish, but constitutes a new and increased predisposition. the remark that "an animal which has interfered once is always liable to interfere," is often confirmed and sanctioned by a recurrence of the trouble. _treatment._--another point in which there is a resemblance between this lesion and others which we have considered is in its responsiveness to the same treatment with them. indeed, the prescription of warm fomentations, soothing applications, and astringent and resolvent mixtures, in a majority of cases, is the first that occurs all through the list. if the swelling assumes the character of a serous collection, pressure, cold water, and bandages will contribute to its removal. if suppuration seems to be established and the swelling assumes the character of a developing abscess, hot poultices of flaxseed or of boiled vegetables and the embrocations of sedative ointments, those of basilicon, or vaseline, impregnated with preparations of opium or belladonna--all these recommend themselves by their general adaptation and the beneficial results which have followed their administration, not less in one case than in another. when an abscess has formed and is fluctuating, it should be carefully but fully opened to evacuate the pus. if it is a serous cyst, some care is necessary in emptying it, and the possibility of the extension of the inflammation to the joint must be taken into consideration. when the cavities have been emptied and have closed by filling up with granulations, or if, not being opened, the contents have been reabsorbed, and there remains in either case a plastic exudation and a tendency to the callous organization that may yet exist, blisters under their various forms, including those of cantharides, of mercury, and of iodin, are then indicated, principally in the early stages, as it is then that their effects will prove most satisfactory. the use of the actual cautery, with fine points, penetrating deeply throughout the enlargement, has in our hands, when used in the very early stages of its formation, nearly always brought on a radical recovery with complete absorption of the thickening. stringhalt. this is an involuntary movement of one or both hind legs, in which the foot is suddenly and spasmodically lifted from the ground much higher than it is normally carried, with excessive flexion of one bone upon the other. this peculiarity is usually prominent, although it may disappear with work, only to reappear after a short rest. sometimes it is most apparent at a trot, sometimes at a walk, and other times only when turned around; or it may not be affected by the gait of the horse. it does not seem to be influenced by the horse's age, young and old being alike affected. its first manifestations are sometimes very slight. it has been noticed as occurring in an animal when backing out of his stable and ceasing immediately after. in some animals it is best seen when the animal is turning around on the affected leg, and it is not noticed when he moves straight forward. that this peculiar action interferes with facility of locomotion and detracts from a horse's claim to soundness can not for a moment be denied. _cause._--veterinarians and pathologists are yet in doubt in respect to the cause of this affection, as well as to its essential nature. whether it results from disease of the hock, of an ulcerative character; whether it springs from a malformation; whether it is a shortening of the ligaments, a chronic inflammation of the sciatic nerve, or a disease of the spinal cord; whether it is purely a muscular or purely a nervous lesion, or a compound of both--it still continues, if an etiologist is bound to possess universal knowledge within the scope of his special studies, to be his reproach and his puzzle. _treatment._--when there is a known or suspected cause the treatment should be directed toward this factor. if due to local inflammation of the hock or foot, only this local lesion should be treated. if it remains after the local lesion has healed, or if we have no assignable cause, the best results have followed the sectioning of the lateral extensor of the foot. a competent veterinarian alone should undertake this operation. thrombosis. there are certain forms of lameness which are very peculiar in their manifestation, and which to the nonprofessional mind must appear to belong to the domain of mystery or theory instead of occupying a well-established position among the subjects of equine pathology. yet they are no less susceptible of actual demonstration and of positive comprehension than many facts which, plain and familiar to the general understanding now, were once ranked among things occult and unsearchable. a thrombus, considered as a cause of lameness, may find a place among these understood mysteries. _cause._--under certain peculiar conditions of inflammation of the blood vessels, and also in aneurisms, clots of blood are sometimes formed in the arteries and find their way in the general circulation. at first, while very small, or sufficiently so to pass from one vessel to another, they move from a small vessel to a larger, and from that to one still larger, constantly increasing in size until at some given point, from their inability to enter smaller vessels, their movement is finally arrested. the artery is thus effectually dammed, and the clot in a short time cuts off completely the supply of blood from the parts beyond. this is thrombosis, and it often gives rise to sudden and excessive lameness of a very painful character. _symptoms._--thrombi may form in any of the arteries, and doubtless have been the cause of many cases of lameness which could never be accounted for. if they exist in small arteries their diagnosis will probably fail to be made out with certainty, but when situated in the larger trunks a strong suspicion of their presence may be excited. in some cases they may even be recognized with positive accuracy, as when the vessels which supply the posterior extremities are affected by the blocking up of the posterior aorta or its ramifications. the existence of thrombosis of the arteries of the hind leg may always be suspected when the following history is known: the general health of the animal is good, but symptoms of lameness in one of the legs have been developed, becoming more marked as he is worked, and especially when driven at a fast gait. but the disturbance is not permanent, and the lameness disappears almost immediately after a rest. there is an increase of the difficulty, however, and, though the animal may walk normally, he will, when made to trot, very soon begin to slacken his pace and to show signs of the trouble, and if urged to increase his speed will become lamer and lamer; an abundant perspiration will break out; he will refuse to go, and if forced he shows weakness behind, seems ready to fall, and perhaps does fall. while on his feet the leg is kept in constant motion, up and down, and is kept from the ground as if the contact were too painful to bear. if undisturbed this series of symptoms will gradually subside, sometimes very soon, and occasionally after a few hours he will return to an apparently perfect condition. a return to labor will lead to a renewal of the same incidents. a history like this suggests a strong suspicion of a thrombus in an artery of the hind leg, and this suspicion will be confirmed by the external symptoms exhibited by the animal. the total absence of any other disease which might account for the lameness, and a manifest diminution of heat over a part or the whole of the extremity, when compared with the opposite side or with any other portion of the body; a sensation of cold attendant on the pain, but gradually subsiding as the pain subsides, and the circulation, quickened by the rest, has been reestablished throughout the extremity; all these are confirmatory circumstances. still, it is thus far only a suspicion, and absolute certainty is yet wanting. to establish the truth of the case the rectal exploration must be resorted to. the hands then, well prepared and carefully introduced into the rectum, must explore for the truth, first feeling for the large blood vessels which, divided at the aorta, separate to supply the right and left legs. these must be compared in respect to the pulsation and other particulars. the artery which is healthy will, of course, exhibit all the proper conditions of that state. on the other hand, if the vessel appears to the feel hard, more or less cordy, and pulseless, or giving a sensation of fluttering, as of a small volume of blood with a trickling motion passing through a confined space, the difference between the sides will make the case plain. the first will be the full flow of the circulation through an unobstructed channel, the other a forced passage of the fluid between the thrombus and the coats of the artery. in such case the prognosis is necessarily a grave one and the disease is more liable to grow worse than better. _treatment._--no form of treatment can be advised; the suffering or a helpless and useless animal can only be terminated by that which ends all. cases occur, however, where this condition of the blood vessels exists in a much less degree, and the diseased condition is not sufficiently pronounced for final condemnation. there may even be a possibility of the absorption of the clot, or that an increase of the collateral circulation may be sufficient to supply the parts with blood. in such cases spontaneous recovery may follow moderate exercise in the pasture, field, or stable, or continuous light work may be given, but too much hope should not be placed in such treatment. sprains of the loins. this is an affection which suggests to the mind the idea of muscular injury, and is difficult to distinguish from many similar cases. if the animal shrinks from the slightest pressure or pinching of the spine in the region of the loins, he is by many pronounced to be "lame in the loins," or "sprained in the loins," or "weak in the kidneys." this is a grave error, as in fact this simple and gentle yielding to such a pressure is not a pathological sign, but is normal and significant of health. yet there are several conditions to which the definition of "sprains of the loins" may apply which are not strictly normal. _cause._--the muscles of the back and those of the loins proper, as the psoas, may have been injured, or again there may be trouble of a rheumatic nature, perhaps suggestive of lumbago. diseases of the bones of the vertebral column, or even those of the organs of circulation, may give rise to an exhibition of similar symptoms. _symptoms._--the symptoms are characteristic of a loss of rigidity or firmness of the vertebral column, both when the animal is at rest and in action. in the former condition, or when at rest, there is an arched condition of the back and a constrained posture in standing, with the hind legs separated. in the latter there is a lateral, balancing movement at the loins, principally noticeable while the animal is in the act of trotting--a peculiar motion, sometimes referred to as a "crick in the back," or what the french call a "tour de bateau." if, while in action, the animal is suddenly made to halt, the act is accompanied with much pain, the back suddenly arching or bending laterally, and perhaps the hind legs thrown under the body, as if unable to perform their functions in stopping, and sometimes it is only accomplished at the cost of a sudden and severe fall. this manifestation is also exhibited when the animal is called upon to back, when a repetition of the same symptoms will also occur. if a slight pressure on the back or the loins is followed by a moderate yielding of the animal, it is, as before remarked, a good sign of health. with a sprain of the loins pressure of any kind is painful, and will cause the animal to bend or to crouch under it more or less, according to the weight of the pressure. heavy loads, and even heavy harnessing, will develop this tenderness. in lying down he seems to suffer much discomfort, and often accompanies the act with groaning, and when compelled to rise does so only with great difficulty and seldom succeeds without repeated efforts. sprains of muscles proper, when recent, will always be accompanied with this series of symptoms, and the fact of their exhibition, with an excessive sensibility of the parts, and possibly with a degree of swelling, will always justify a diagnosis of acute muscular lesion, and especially so if accompanied with a history of violent efforts, powerful muscular strains, falls, heavy loading, etc., connected with the case. if the symptoms have been of slow development and gradual increase, it becomes a more difficult task to determine whether the diagnosis points to pathological changes in the structure of the muscles or of the bones, the nervous centers, or the blood vessels of the region. and yet it is important to decide as to which particular structure is affected in reference to the question of prognosis, as the degree of gravity of the lesion will depend largely upon whether the disabled condition of the animal is due to an acute or a chronic disease. _treatment._--the prescription which will necessarily first of all suggest itself for sprains of the loins is rest. an animal so affected should be immediately placed in slings, and none of his efforts to release himself should be allowed to succeed. hot compresses, cold-water douches, sweating applications, stimulating frictions, strengthening charges, blistering ointments of cantharides and the actual cautery, all have their advocates, but in no case can the immobility obtained by the slings be dispensed with. in many cases in which the weakness of the hind quarters was caused by disease of the nervous centers electricity has also yielded good results. footnotes: [ ] this bandage consists of a cloth drenched in warm water or a dripping bandage laid around the diseased part, then covered by several layers of woolen blanket or cloth, which is in turn covered by parchment paper, rubber cloth, or other impervious material. heat, moisture, and pressure are obtained by such a bandage if water is poured upon it several times daily. diseases of the fetlock, ankle, and foot. by a. a. holcombe, d. v. s., _veterinary inspector, bureau of animal industry._ anatomical review of the foot. in a description of the foot of the horse it is customary to include only the hoof and its contents, yet, from a zoological standpoint, the foot includes all the leg from the knee and the hock down. the foot of the horse is undoubtedly the most important part of the animal, so far as veterinary surgery is concerned, for the reason that it is subject to so many injuries and diseases which in part or in whole render the patient unfit for the labor demanded of him. the old aphorism "no foot no horse" is as true to-day as when first expressed; in fact, domestication, coupled with the multiplied uses to which the animal is put, and the constant reproduction of hereditary defects and tendencies, has largely transformed the ancient "companion of the wind" into a very common piece of machinery which is often out of repair, and at best is but shortlived in its usefulness. since the value of the horse depends largely or even entirely upon his ability to labor, it is essential that his organs of locomotion be kept sound. to accomplish this end it is necessary not only to know how to cure all diseases to which these organs are liable but, better still, how to prevent them. an important prerequisite to the detection and cure of disease is a knowledge of the construction and function of the parts which may be involved in the diseased process. hence, first of all, the anatomical structures must be understood. (see also p. .) the bones of the fetlock and foot constitute the skeleton on which the other structures are built and comprise the lower end of the cannon bone (the metacarpus in the fore leg, the metatarsus in the hind leg), the two sesamoids, the large pastern or os suffraginis, the small pastern or coronet, the small sesamoid or navicular bone, and the coffin bone or os pedis. (plate xxxiv, fig. .) the cannon bone extends from the knee or hock to the fetlock, is cylindrical in shape, and stands nearly or quite perpendicular. the sesamoids occur in pairs, are small, shaped like a three-faced pyramid, and are set behind the fetlock joint, at the upper end of the large pastern, with the base of the pyramid down. the large pastern is a very compact bone, set in an oblique direction downward and forward, and extends from the cannon bone to the coronet. the coronet is a short, cube-shaped bone, set between the large pastern and coffin bone, in the same oblique direction. the navicular bone is short, flattened above and below, and is attached to the coffin bone behind. the coffin bone forms the end of the foot and is shaped like the horny box in which it is inclosed. all these bones are covered on the surfaces which go to make up the joints with a cartilage of incrustation, while the portions between are covered with a fibrous membrane called the periosteum. the joints of the legs are of especial importance, since any interference with their function very largely impairs the value of the animal for most purposes. as the joints of the foot and ankle are at the point of greatest concussion they are the ones most subject to injury and disease. there are three of these joints--the fetlock, pastern, and coffin. they are made by the union of two or more bones, held together by ligaments of fibrous tissue, and are lubricated by a thick, viscid fluid, called synovia, which is secreted by a special membrane inclosing the joints. the fetlock joint is made by the union of the lower end of the cannon and the upper end of the large pastern bones, supplemented by the two sesamoids, so placed behind the upper end of the pastern that the joint is capable of a very extensive motion. these bones are held together by ligaments, only one of which--the suspensory--demands special mention. the suspensory ligament of the fetlock starts from the knee, extends down behind the cannon, lying behind the two splint bones, until near the fetlock, where it divides and sends a branch on each side of the joint, downward and forward, to become attached on the sides of the extensor tendon at the lower end of the pastern bone. as it crosses the sesamoids, on the posterior borders of the fetlock, it throws out fibers which hold it fast to these bones. (plate xxxiv, fig. .) the pastern joint is made by the union of the two pastern bones. the coffin joint is made by the union of the small pastern, coffin, and small sesamoid, or navicular bones, the latter being set behind and beneath the joint surface of the coffin bone in such way as to receive largely the weight of the small pastern. three tendons serve to move the bones of the foot one on another. two of these flex, or bend, the joints, while the other extends, or straightens, the column of bones. (plate xxxiii, fig. .) the flexor pedis perforans, or deep flexor of the foot, passes down behind the cannon bone, lying against the suspensory ligament in front, crosses the fetlock joint in the groove made by the union of the two sesamoids, and is attached to the bottom on the coffin bone, after covering the navicular, by a wide expansion of its fibers. it is the function of this tendon to flex the coffin bone and, with it, the horny box. the flexor pedis perforatus, or superficial flexor of the foot, follows the course of the preceding tendon and is attached to the middle of the ankle. the function of this tendon is to flex the foot at the fetlock. the extensor pedis runs down in front of the leg, is attached on the most prominent point of the coffin bone, and has for function the straightening of the bones of the ankle and foot. the bones, ligaments, and tendons are covered by a loose connective tissue, which gives a symmetry to the parts by filling up and rounding off, and all are protected by the skin and hoof. the skin of the fetlock and ankle is generally characterized by its thickness and the length of its hairs, especially around the hind parts of the fetlock joint in certain breeds of horses. the most important part of this envelope is that known as the coronary band. the coronary band is that portion of the skin which secretes the horn of which the wall of the hoof is made. this horn much resembles the nail which grows on the fingers and toes of man. it is composed of cylindrical tubes, which are held together by a tenacious, opaque matter. the horn extends from the coronary band to the lower border of the hoof. (plate xxxii, fig. .) the hoof is a box of horn, consisting of a wall, sole, and frog, and contains, besides the coffin, navicular, and part of the small pastern bones, the sensitive laminæ, plantar cushion, and the lateral cartilages. (plate xxxiii, fig. .) the sole of the foot incloses the box on the ground surface, is shaped like the circumference of the foot, except that a v-shaped opening is left behind for the reception of the frog, and is concave on the lower surface. the sole is produced by the velvety tissue, a thin membrane covering the plantar cushion and other soft tissues beneath the coffin bone. the horn of the sole differs from the horn of the wall in that its tubes are not straight and from the fact that it scales off in pieces over the whole surface. the frog is a triangular-shaped body, divided into two equal parts by a deep fissure, extending from its apex in front to the base. it fills the triangular space in the sole, to which it is intimately attached by its borders. the horn of the frog is produced in the same manner as the sole; but it differs from both the wall and sole in that the horn is soft, moist, and elastic to a remarkable degree. it is the function of the frog to destroy shock and to prevent slipping. the sensitive laminæ are thin plates of soft tissue covering the entire anterior surface of the coffin bone. they are present in great numbers, and by fitting into corresponding grooves on the inner surface of the horn of the wall the union of the soft and horny tissues is made complete. (plate xxxii, fig. .) the plantar cushion is a thick pad of fibrous tissue placed behind and under the navicular and coffin bones and resting on the sole and frog, for the purpose of receiving the downward pressure of the column of bones and to destroy shock. (plate xxxii, fig. .) the lateral cartilages are attached, one on each side, to the wings of the coffin bone by their inferior borders. they are thin plates of fibro-cartilage, and their function is to assist the frog and adjacent structures to regain their proper position after having been displaced by the weight of the body while the foot rested on the ground. (plate xxxii, fig. .) faults of conformation. a large percentage of horses have feet which are not perfect in conformation, and as a consequence they are especially predisposed to certain injuries and diseases. _flatfoot_ is that condition in which the sole has little or no convexity. it is a peculiarity common to some breeds, especially heavy, lymphatic animals raised on low, marshy soils. it is confined to the fore feet, which are generally broad, low-heeled, and with a wall less upright than is seen in the perfect foot. in flatfoot there can be little or no elasticity in the sole, for the reason that it has no arch, and the weight of the animal is received on he entire plantar surface, as it rests upon the ground instead of on the wall. for these reasons such feet are particularly liable to bruises of the sole, corns, pumiced sole, and excessive suppuration when the process is once established. horses with flatfoot should be shod with a shoe having a wide web, pressing on the wall only, while the heels and frog are never to be pared. flatfoot generally has weak walls, and as a consequence the nails of the shoe are readily loosened and the shoe cast. _clubfoot_ is a term applied to such feet as have the walls set nearly perpendicular. when this condition is present the heels are high, the fetlock joint is thrown forward, or knuckles, and the weight of the animal is received on the toes. many mules are clubfooted, especially behind, where it seems to cause little or no inconvenience. severe cases of clubfoot may be cured by cutting the tendons, but as a rule special shoeing is the only measure of relief that can be adopted. the toe should not be pared, but the heels are to be lowered as much as possible and a shoe put on with a long, projecting toe piece, slightly turned up, while the heels of the shoe are to be made thin. _crookedfoot_ is that condition in which one side of the wall is higher than the other. if the inside wall is the higher, the ankle is thrown outward, so that the fetlock joints are abnormally wide apart and the toes close together. animals with this deformity are "pigeon-toed," and are prone to interfere, the inside toe striking the opposite fetlock. if but one foot is affected, the liability to interfere is still greater, for the reason that the fetlock of the perfect leg is nearer the center plane. when the outside heel is the higher the ankle is thrown in and the toe turns out. horses with such feet interfere with the heel. if but one foot is so affected, the liability to interfere is less than when both feet are affected, for the reason that the ankle of the perfect leg is not so near to the center plane. such animals are especially liable to stumbling and to lameness from injury to the ligaments of the fetlock joints. this deformity is to be overcome by such shoeing as will equalize the disparity in length of walls, and by proper boots to protect the fetlocks from interfering. interfering. an animal is said to interfere when one foot strikes the opposite leg, as it passes by, during locomotion. the inner surface of the fetlock joint is the part most subject to this injury, although, under certain conditions, it may happen to any part of the ankle. it is seen more often in the hind than in the fore legs. interfering causes a bruise of the skin and deeper tissues, generally accompanied with an abrasion of the surface. it may cause lameness, dangerous tripping, and thickening of the injured parts. (see also p. .) _causes._--faulty conformation is the most prolific cause of interfering. when the bones of the leg are so united that the toe of the foot turns in (pigeon-toed), or when the fetlock joints are close together and the toe turns out, when the leg is so deformed that the whole foot and ankle turn either in or out, interfering is almost sure to follow. it may happen, also, when the feet grow too long, from defective shoeing, rough or slippery roads, from the exhaustion of labor or sickness, swelling of the leg, high knee action, fast work, and because the chest or hips are too narrow. _symptoms._--generally, the evidences of interfering are easily detected, for the parts are tender, swollen, and the skin broken. but very often, especially in trotters, the flat surface of the hoof strikes the fetlock without evident injury, and attention is directed to these parts only by the occasional tripping and unsteady gait. in such cases proof of the cause may be had by walking and trotting the animal, after first painting the inside toe and quarter of the suspected foot with a thin coating of chalk, charcoal, mud, or paint. _treatment._--when the trouble is due to deformity or faulty conformation it may not be possible to overcome the defect. in such cases, and as well in those due to exhaustion or fatigue, the fetlock or ankle boot must be used. in many instances interfering may be prevented by proper shoeing. the outside heel and quarter of the foot on the injured leg should be lowered sufficiently to change the relative position of the fetlock joint by bringing it farther away from the center plane of the body, thereby permitting the other foot to pass by without striking. a very slight change is often sufficient to effect this result. at the same time the offending foot should be so shod that the shoe may set well under the hoof at the point responsible for the injury. the shoe should be reset every three or four weeks. when the cause has been removed, cold-water bandages to the injured parts will soon remove the soreness and swelling, especially in recent cases. if, however, the fetlock has become calloused from long-continued bruising, a spanish-fly blister over the parts, repeated in two or three weeks if necessary, will aid in reducing the leg to its natural condition. knuckling, or cocked ankles. knuckling is a partial dislocation of the fetlock joint, in which the relative position of the pastern bone to the cannon and coronet bones is changed, the pastern becoming more nearly perpendicular, with the lower end of the cannon bone resting behind the center line of the large pastern, while the lower end of this bone rests behind the center line of the coronet. while knuckling is not always an unsoundness, it nevertheless predisposes to stumbling and to fracture of the pastern. _causes._--young foals are quite subject to this condition, but in the great majority of cases it is only temporary. it is largely due to the fact that before birth the legs were flexed, and time is required after birth for the ligaments, tendons, and muscles to adapt themselves to the function of sustaining the weight of the body. as they grow old, horses with erect pasterns are very prone to knuckle, especially in the hind legs. all kinds of heavy work, particularly in hilly districts, and fast work on hard race tracks or roads are exciting causes of knuckling. it is also commonly seen as an accompaniment of that faulty conformation called clubfoot, in which the toe of the wall is perpendicular and short, and the heels high--a condition most often seen in the mule, especially in the hind feet. [illustration: plate xxxii. anatomy of foot.] [illustration: plate xxxiii. anatomy of foot.] [illustration: plate xxxiv. anatomy and diseases of the foot.] [illustration: plate xxxv. sound and contracted feet.] lastly, knuckling is produced by disease of the suspensory ligament or of the flexor tendons, whereby they are shortened, and by disease of the fetlock joints. (see p. .) _treatment._--in young foals no treatment is necessary, unless there is some deformity present, since the legs straighten up without interference in the course of a few weeks. when knuckling has commenced, the indications are to relieve the tendons and ligaments by proper shoeing. the foot is to be prepared for the shoe by shortening the toe as much as possible, leaving the heels high; or if the foot is prepared in the usual way the shoe should be thin in front, with thick heels or high calks. for the hind feet a long-heeled shoe with calks seems to do best. of course, when possible, the causes of knuckling are to be removed; since this can not always be done, however, the time may come when the patient can no longer perform any service, particularly in those cases in which both fore legs are affected, and it becomes necessary either to destroy the animal or obtain relief by surgical interference. in such cases the tendons between the fetlock and knee may be divided for the purpose of obtaining temporary relief. firing and blistering the parts responsible for the knuckling may, in some instances, effect a cure; but a consideration of these measures belongs properly to the treatment of the disease in which knuckling appears simply as a sequel. windgall. joints and tendons are furnished with sacs containing a lubricating fluid called synovia. when these sacs are overdistended by reason of an excessive secretion of synovia, they are called windgalls. they form a soft, puffy tumor about the size of a hickory nut, and are most often found in the fore leg, at the upper part of the fetlock joint, between the tendon and the shin bone. when they develop in the hind leg it is not unusual to see them reach the size of a walnut. occasionally they appear in front of the fetlock on the border of the tendon. the majority of horses are not subject to them after colt-hood has passed. (see also p. .) _causes._--windgalls are often seen in young, overgrown horses, in which the body seems to have outgrown the ability of the joints to sustain the weight. in cart and other horses used to hard work, in trotters with excessive knee action, in hurdle racers and hunters, and in most cow ponies there is a predisposition to windgalls. street-car horses and others used to start heavy loads on slippery streets are the ones most liable to develop windgalls in the hind legs. _symptoms._--the tumor is more or less firm and tense when the foot is on the ground, but is soft and compressible when the foot is off the ground. in old horses windgalls generally develop slowly and cause no inconvenience. if they are caused by excessive tension of the joint the tumor develops rapidly, is tense, hot, and painful, and the animal is exceedingly lame. the patient stands with the joint flexed, and walks with short steps, the toe only being placed on the ground. when the tumor is large and situated upon the inside of the leg it may be injured by interfering, causing stumbling and inflammation of the sac. rest generally causes the tumor to diminish in size, only to fill up again after renewed labor. in old cases the tumors are hardened, and may become converted into bone by a deposit of the lime salts. _treatment._--the large, puffy joints of suckling colts, as a rule, require no treatment, for as the animal grows older the parts clean up and after a time the swelling entirely disappears. when the trouble is from an injury, complete rest is to be obtained by the use of slings and a high-heeled shoe. cold-water douches should be used once or twice a day, followed by cold-water bandages, until the fever has subsided and the soreness is largely removed, when a blister is to be applied. in old windgalls, which cause more or less stiffness, some relief may be had by the use of cold-compress bandages, elastic boots, or the red iodid of mercury blisters. opening the sacs, as recommended by some authors, is of doubtful utility, and should be adopted only by the surgeon capable of treating the wound he has made. enforced rest until complete recovery is effected should always be insisted upon, since a too early return to work is sure to be followed by relapse. sprain of the fetlock. sprain of the fetlock joint is most common in the fore legs, and, as a rule, affects but one at a time. horses doing fast work, as trotters, runners, steeplechasers, hunters, cow ponies, and those that interfere, are particularly liable to this injury. _causes._--horses knuckling at the fetlock, and all those with diseases which impair the powers of locomotion, such as navicular disease, contracted heels, sidebones, chronic laminitis, etc., are predisposed to sprains of the fetlock. it generally happens from a misstep, stumbling, or slipping, which results in the joint being extended or flexed to excess. the same result may happen where the foot is caught in a rut, a hole in a bridge, or in a car track, and the animal falls or struggles violently. direct blows and punctured wounds may also set up inflammation of the joint. _symptoms._--the symptoms of sprain of the fetlock vary with the severity of the injury. if slight, there may be no lameness, but simply a little soreness, especially when the foot strikes on uneven ground and the joint is twisted a little. in more severe cases the joint swells, is hot and puffy, and the lameness may be so intense as to compel the animal to hobble on three legs. while at rest the leg is flexed at the joint affected, and the toe rests on the ground. _treatment._--if the injury is slight, cold-water bandages and a few days' rest are sufficient to effect recovery. when there is an intense lameness, swelling, etc., the leg should be placed under a constant stream of cold water, as described in the treatment for quittor. when the inflammation has subsided, a blister to the joint should be applied. in some cases, especially in old horses long accustomed to fast work, the ligaments of the joints are ruptured, in whole or in part, and the lameness may last a long time. in these cases the joint should be kept completely at rest; this condition is best obtained by the application of plaster of paris bandages, as in cases of fracture. as a rule, patients take kindly to this bandage, and, while wearing it, may be given the freedom of a roomy box or yard. if they are disposed to tear it off, or if sufficient rest can not otherwise be obtained, the patient must be kept in slings. in the majority of instances the plaster bandage should remain on from two to four weeks. if the lameness returns when the bandage is removed, a new one should be put on. the swellings which always remains after the other evidences of the disease have disappeared, may be largely dissipated and the joint strengthened by the rise of the firing iron and blisters. a joint once injured by a severe sprain never entirely regains its original strength, and is ever after particularly liable to a repetition of the injury. rupture of the suspensory ligament. sprain with or without rupture of the suspensory ligament may happen in either the fore or hind legs, and is occasionally seen in horses of all classes and at all ages. old animals, however, and especially hunters, runners, and trotters, are the most subject to this injury, and with them the seat of the trouble is nearly always in one or both the fore legs. horses used for heavy draft are more liable to have the ligament of the hind legs affected. when the strain upon the suspensory ligament becomes too great, one or both of the branches may be torn from the sesamoid bones, one or both of the branches may be torn completely across, or the ligament may rupture above the point of division. _symptoms._--the most common injury to the suspensory ligament is sprain of the internal branch in one of the fore legs. the trouble is indicated by lameness, heat, swelling, and tenderness of the affected branch, beginning just above the sesamoid bone and extending obliquely downward and forward to the front of the ankle. if the whole ligament is involved, the swelling comes on gradually, and is found above the fetlock and in front of the flexor tendons. the patient stands or walks upon the toe as much as possible, keeping the fetlock joint flexed so as to relieve the ligament of tension. when both branches are torn from their attachments to the sesamoids, or both are torn across, the lameness comes on suddenly and is most intense; the fetlock descends, the toe turns up, and, as the animal attempts to walk, the leg has the appearance of being broken off at the fetlock. these symptoms, followed by heat, pain, and swelling of the parts at the point of injury, will enable anyone to make a diagnosis. _treatment._--sprain of the suspensory ligament, no matter how mild it may be, should always be treated by enforced rest of at least a month, and the application of cold douches and cold-water bandages, firmly applied until the fever has subsided, when a cantharides blister should be put on and repeated in two or three weeks if necessary. when rupture has taken place the patient should be put into slings and a constant stream of cold water allowed to trickle over the seat of injury until the fever is reduced. in the course of a week or ten days a plaster of paris splint, such as is used in fractures, is to be applied and left on for a month or six weeks. when this is taken off, blisters may be used to remove the remaining soreness; but it is useless to expect a removal of all the thickening, for, in the process of repair, new tissue has been formed which will always remain. in old cases of sprain the firing iron may often be used with good results. as a rule, severe injuries to the suspensory ligament incapacitate the subject for anything but slow, light work. overreach. when the shoe of the hind foot strikes and injures the heel or quarter of the forefoot the horse is said to overreach. it rarely happens except when the animal is going fast; hence is most common in trotting and running horses. in trotters the accident generally happens when the animal breaks from a trot to a run. the outside heels and quarters are most liable to the injury. _symptoms._--the coronet at the heel or quarter is bruised or cut, the injury in some instances involving the horn as well. when the hind foot strikes well back on the heel of the fore foot--an accident known among horsemen as "grabbing"--the shoe may be torn from the forefoot or the animal may fall to its knees. horses accustomed to overreaching are often "bad breakers," for the reason that the pain of the injury so excites them that they can not readily be brought back to the trotting gait. _treatment._--if the injury is but a slight bruise, cold-water bandages applied for a few days will remove all the soreness. if the parts are deeply cut, more or less suppuration will follow, and, as a rule, it is well to poultice the parts for a day or two, after which cold baths may be used, or the wounds dressed with tincture of aloes, oakum, and a roller bandage. when an animal is known to be subject to overreaching, he should never be driven fast without quarter boots, which are specially made for the protection of the heels and quarters. if there is a disposition to "grab" the forward shoes, the trouble may be remedied by having the heels of these shoes made as short as possible, while the toe of the hind foot should project well over the shoe. when circumstances permit of their use, the fore feet may be shod with the "tips" instead of the common shoe, as described in treatment for contracted heels. calk wounds. horses wearing shoes with sharp calks are liable to wounds of the coronary region, either from trampling on themselves or on each other. these injuries are most common in heavy draft horses, especially on rough roads and slippery streets. the fore feet are more liable than the hind ones, and the seat of injury is commonly on the quarters. in the hind feet the wound often results from the animal resting with the heel of one foot set directly over the front of the other. in these cases the injury is generally close to the horn, and often involves the coronary band, the sensitive laminæ, the extensor tendon, and even the coffin bone. _treatment._--preventive measures include the use of boots to protect the coronet of the hind foot and of a blunt calk on the outside heel of the fore shoe, since this is generally the offending instrument when the fore feet are injured. if the wound is not deep and the soreness slight, cold-water bandages and a light protective dressing, such as carbolized cosmoline, will be all that is needed. when the injury is deep, followed by inflammation and suppuration of the coronary band, lateral cartilages, sensitive laminæ, etc., active measures must be resorted to. cold, astringent baths, made by adding ounces of sulphate of iron to gallon of water, should be used, followed by poultices, if it is necessary to hasten the cleansing of the wound by stimulating the sloughing process. if the wound is deep between the horn and the skin, especially over the anterior tendon, the horn should be cut away so that the injured tissues may be exposed. the subsequent treatment in these cases should follow the directions given in the article on toe cracks. frostbites. excepting the ears, the feet and legs are about the only parts of the horse liable to become frostbitten. the cases most commonly seen are found in cities, especially among car horses, where salt is used for the purpose of melting the snow on curves and switches. this mixture of snow and salt is splashed over the feet and legs, rapidly lowering the temperature of the parts to the freezing point. in mountainous districts, where the snowfall is heavy and the cold often intense, frostbites are not uncommon, even among animals running at large. _symptoms._--when the frosting is slight the skin becomes pale and bloodless, followed soon after by intense redness, heat, pain, and swelling. in these cases the hair may fall out and the epidermis peel off, but the inflammation soon subsides, the swelling disappears, and only an increased sensitiveness to cold remains. in more severe cases irregular patches of skin are destroyed and after a few days slough away, leaving slow-healing ulcers behind. if produced by low temperatures and deep snow, the coronary band is the part most often affected. in many instances there is no destruction of the skin, but simply a temporary suspension of the horn-producing function of the coronary band. the fore feet are more often affected than the hind ones, and the heels and quarters are less often involved than the front part of the foot. the coronary band becomes hot, swollen, and painful, and after two or three days the horn separates from the band and slight suppuration follows. for a few days the animal is lame, but as the suppuration disappears the lameness subsides. new horn, often of an inferior quality, is produced by the coronary band, and in time the cleft is grown off and complete recovery is effected. the frog is occasionally frostbitten and may slough off, exposing the soft tissues beneath and causing severe lameness for a time. _treatment._--simple frostbites are best treated by cold fomentations followed by applications of a per cent solution of carbolized oil. when portions of the skin are destroyed, their early separation should be hastened by warm fomentations and poultices. ulcers are to be treated by the application of stimulating dressings, such as carbolized oil, a per cent solution of nitrate of silver or of chlorid of zinc, with pads of oakum and flannel bandages. in many of these cases recovery is exceedingly slow. the new tissue by which the destroyed skin is replaced always shrinks in healing, and, as a consequence, unsightly scars are unavoidable. when the coronary band is involved it is generally advisable to blister the coronet over the seat of injury as soon as the suppuration ceases, for the purpose of stimulating the growth of new horn. where a crevasse is formed between the old and the new horn no serious trouble is liable to be met with until the cleft is nearly grown out, when the soft tissues may be exposed by a breaking off of the partly detached horn. but even if this accident happens final recovery is effected by poulticing the foot until a sufficient growth of horn protects the parts from injury. quittor. quittor is a term applied to various affections of the foot wherein the tissues which are involved undergo a process of degeneration that results in the formation of a slough followed by the elimination of the diseased structures by means of a more or less extensive suppuration. for convenience of consideration quittors may be divided into four classes, as suggested by girard: ( ) cutaneous quittor, which is known also as simple quittor, skin quittor, and carbuncle of the coronet; ( ) tendinous quittor; ( ) subhorny quittor; and ( ) cartilaginous quittor. cutaneous quittor. simple quittor consists in a local inflammation of the skin and subcutaneous connective tissue on some part of the coronet, followed by a slough and the formation of an ulcer which heals by suppuration. it is an extremely painful disease, owing to the dense character of the tissues involved; for in all dense structures the swelling which accompanies inflammation always produces intense pressure. this pressure not only adds to the patient's suffering but may at the same time endanger the life of the affected parts by strangulating the blood vessels. it is held by some writers that simple quittor is most often met with in the hind feet, but in my experience more than two-thirds of the cases have developed in the fore feet. while any part of the coronet may become the seat of attack, the heels and quarters are undoubtedly most liable. _causes._--bruises and other wounds of the coronet are often the cause of cutaneous quittor, yet there can be no question that in the great majority of cases the disease develops without any known cause. for some reason not yet satisfactorily explained most cases happen in the fall of the year. one explanation of this fact has been attempted in the statement that the disease is due to the injurious action of cold and mud. this claim, however, seems to lose force when it is remembered that in many parts of this country the most mud, accompanied with freezing and thawing weather, is seen in the early springtime without a corresponding increase of quittor. furthermore, the serious outbreaks of this disease in the mountainous regions of colorado, wyoming, and montana are seen in the fall and winter seasons, when the weather is the driest. it may be claimed, and perhaps with justice, that during these seasons, when the water is low, animals are compelled to wade through more mud to drink from lakes and pools than is necessary at other seasons of the year, when these lakes and pools are full. add to these conditions the further fact that much of this mud is impregnated with alkaline salts which, like the mineral substances always found in the mud of cities, are more or less irritating, and it seems fair to conclude that under certain circumstances mud may become an important factor in the production of quittor.[ ] while this disease attacks any and all classes of horses, it is the large, common breeds, with thick skins, heavy coats, and coarse legs that are most often affected. horses well groomed and cared for in stables seem to be less liable to the disease than those running at large or than those which are kept and worked under adverse circumstances. _symptoms._--lameness, lasting from one to three or four days, nearly always precedes the development of the strictly local evidences of quittor. the next sign is the appearance of a small, tense, hot, and painful tumor in the skin of the coronary region. if the skin of the affected foot is white, the inflamed portion will present a dark-red or even a purplish appearance near the center. within a few hours the ankle, or even the whole leg as high as the knee or hock, becomes much swollen. the lameness is now so great that the patient refuses to use the foot at all, but carries it if compelled to move. as a consequence, the opposite leg is required to do the work of both, and if the animal persists in standing a greater part of the time it, too, becomes swollen. in many of these cases the suffering is so intense during the first few days as to cause general fever, dullness, loss of appetite, and increased thirst. generally the tumor shows signs of suppuration within to hours after its first appearance; the summit softens, a fluctuating fluid is felt beneath the skin, which soon ulcerates completely through, causing the discharge of a thick, yellow, bloody pus, containing shreds of dead tissue which have sloughed away. the sore is now converted into an open ulcer, generally deep, nearly or quite circular in outline, and with hardened base and edges. in exceptional cases large patches of skin, varying from to - / inches in diameter, slough away at once, leaving an ugly superficial ulcer. these sores, especially when deep, suppurate freely, and if there are no complications they tend to heal rapidly as soon as the degenerated tissue has softened and is entirely removed. when suppuration is fully established, the lameness and general symptoms subside. when but a single tumor and abscess form, the disease progresses rapidly, and recovery, under proper treatment, may be effected in from two to three weeks; but when two or more tumors are developed at once, or if the formation of one tumor is rapidly succeeded by another for an indefinite time, the sufferings of the patient are greatly increased, the case is more difficult to treat, and recovery is more slow and less certain. this form of quittor is often complicated with the tendinous and subhorny quittors by an extension of the sloughing process. _treatment._--the first step in the treatment of an outbreak of quittor should be the removal of all exciting causes. crowding animals into small corrals and stables, where injuries to the coronet are likely to happen from trampling, especially among unbroken range horses, must be avoided as much as possible. watering places accessible without having to wade through mud should be provided. in towns, where the mud or dust is largely impregnated with mineral products, it is not possible to adopt complete preventive measures. much can be done, however, by careful cleansing of the feet and legs as soon as the animal returns from work. warm water should be used to remove the mud and dirt, after which the parts are to be thoroughly dried with soft cloths. the means which are to be adopted for the cure of cutaneous quittor vary with the stage of the disease at the time the case is presented for treatment. if the case is seen early--that is, before any of the signs of suppuration have developed--the affected foot is to be placed under a constant stream of cold water, with the object of arresting a further extension of the inflammatory process. to accomplish this, put the patient in slings in a narrow stall having a slat or open floor. bandage the foot and leg to the knee or hock, as the case may be, with flannel bandages loosely applied. set a tub or barrel filled with cold water above the patient, and by the use of a small rubber hose of sufficient length make a siphon which will carry the water from the bottom of the tub to the leg at the top of the bandage. the stream of water should be quite small, and is to be continued until the inflammation has entirety subsided or until the presence of pus can be detected in the tumor. when suppuration has commenced, the process should be aided by the use of warm baths and poultices of lineseed meal or boiled turnips. if the tumor is of rapid growth, accompanied with intense pain, relief is obtained and sloughing largely limited by a free incision of the parts. the incision should be vertical and deep into the tumor, care being taken not to divide the coronary band entirely. if the tumor is large, more than one incision may be necessary. the foot should now be placed in a warm bath for half an hour or longer and then poulticed. the hemorrhage produced by the cutting and encouraged by the warm bath is generally very copious and soon gives relief to the overtension of the parts. in other cases it will be found that suppuration is well under way, so that the center of the tumor is soft when the patient is first presented for treatment. it is always good surgery to relieve the tumor of pus whenever its presence can be detected; hence, in these cases a free incision must be made into the softened parts, the pus evacuated, and the foot poulticed. by surgical interference the tumor is now converted into an open sore or ulcer, which, after it has been well cleaned by warm baths and poultices applied for two or three days, needs to be protected by proper dressings. the best of all protective dressings is made of small balls, or pledgets, of oakum, carefully packed into the wound and held in place by a roller bandage yards long, from to inches wide, made of common bedticking and skillfully applied. the remedies which may be used to stimulate the healing process are many, and, as a rule, they are applied in the form of solutions or tinctures. in my own practice i prefer a solution of bichlorid of mercury part, water parts, with a few drops of muriatic acid or a few grains of muriate of ammonia added to dissolve the mercury. the balls of oakum are wet with this solution before they are applied to the wound. among the other remedies which may be used, and perhaps with equally as good results, will be noted the sulphate of copper, iron, and zinc, grains of either to the ounce of water; chlorid of zinc, grains to the ounce; carbolic acid, drops dissolved in an equal quantity of glycerin and added to ounce of water; and nitrate of silver, grains to the ounce of water. if the wound is slow to heal, it will be found of advantage to change the remedies every few days. if the wound is pale in color, the granulations transparent and glistening, the tincture of aloes, tincture of gentian, or the spirits of camphor may do best. when the sore is red in color and healing rapidly, an ointment made of part of carbolic acid to parts of cosmoline or vaseline is all that is needed. if the granulations continue to grow until a tumor is formed which projects beyond the surrounding skin, it should be cut off with a sharp, clean knife, and the foot poulticed for twenty-four hours, after which the wound is to be well cauterized daily with lunar caustic and the bandages applied with great firmness. the question as to how often the dressings should be renewed must be determined by the condition of the wound, etc. if the sore is suppurating freely, it will be necessary to renew the dressing every or hours; if the discharge is small in quantity and the patient comfortable, the dressing may be left on for several days; in fact, the less often the wound is disturbed, the better, so long as the healing process is healthy. when the sore commences to "skin over," the edges should be lightly touched with lunar caustic at each dressing. the patient may now be given a little exercise daily, but the bandages must be kept on until the wound is entirely healed. tendinous quittor. this form of quittor differs from the cutaneous in that it not only affects the skin and subcutaneous tissues, but involves also the tendons of the leg, the ligaments of the joints, and, in many cases, the bones of the foot as well. fortunately, this form of quittor is less common than the preceding, yet any case beginning as simple cutaneous quittor may at any time during its course become complicated by the death of some part of the tendons, by gangrene of the ligaments, sloughing of the coronary band, caries of the bones, or inflammation and suppuration of the synovial sacs and joints, thereby converting a simple quittor into one which will, in all probability, either destroy the patient's life or maim him for all time. _causes._--tendinous quittor is caused by the same injuries and influences that produce the simple form. zundel believes it to be a not infrequent accompaniment of distemper. in my own experience i have seen nothing to verify this belief, but i am convinced that young animals are more liable to have tendinous quittor than older ones, and that they are much more likely to make a good recovery. _symptoms._--when a case of simple quittor is transformed into the tendinous variety the change is announced by a sudden increase in the severity of all the symptoms. on the other hand, if the attack primarily is one of tendinous quittor, the earliest symptom seen is a well-marked lameness. in those cases due to causes other than injuries this lameness is at first very slight, and the animal limps no more in trotting than in walking; later on, generally during the next hours, the lameness increases to such extent that the patient often refuses to use the leg at all. an examination made during the first two days rarely discloses any cause for this lameness; it may not be possible even to say with certainty that the foot is the seat of the trouble. on the third or fourth day, sometimes as late as the fifth, a doughy-feeling tumor will be found forming on the heel or quarter. this tumor grows rapidly, feels hot to the touch, and is extremely painful. as the tumor develops, all the other symptoms increase in intensity; the pulse is rapid and hard; the breathing quick; the temperature elevated ° or °; the appetite is gone; thirst increased; and the lameness so great that the foot is carried if locomotion is attempted. at this stage of the disease the patient generally seeks relief by lying upon the broad side, with outstretched legs; the coat is bedewed with a clammy sweat, and every respiration is accompanied with a moan. the leg soon swells to the fetlock; later this swelling gradually extends to the knee or hock, and in some cases reaches the body. as a rule, several days elapse before the disease develops a well-defined abscess, for, owing to the dense structure of the bones, ligaments, and tendons, the suppurative process is a slow one, and the pus is prevented from readily collecting in a mass. i made a post-mortem examination on a typical case of this disease, in which the animal had died on the fourth day after being found on the range slightly lame. the suffering had been intense, yet the only external evidences of the disease consisted in the shedding of the hoof from the right fore foot and a limited swelling of the leg to the knee. the sloughing of the hoof took place two or three hours before death, and was accompanied with but little suppuration and no hemorrhage. the skin from the knee to the foot was thickened from watery infiltration (edema), and on the inside quarter three holes, each about one-half inch in diameter, were found. all had ragged edges, while but one had gone deep enough to perforate the coronary band. the loose connective tissue beneath the skin was distended, with a gelatinous infiltration over the whole course of the flexor tendons and to the fetlock joint over the tendon in front. the soft tissues covering the coffin bone were loosened in patches by collections of pus which had formed beneath the sensitive laminæ. the coffin and pastern joints were inflamed, as were also the coffin, navicular, and coronet bones, while the outside toe of the coffin bone had become softened from suppuration until it readily crumbled between the fingers. the coronary band was largely destroyed and completely separated from the other tissues of the foot. the inner lateral cartilage was gangrenous, as was also a small spot on the extensor tendon near its point of attachment on the coffin bone. several small collections of pus were found deep in the connective tissue of the coronary region; along the course of the sesamoid ligaments; in the sheath of the flexor tendons; under the tendon just below the fetlock joint in front; and in the coffin joint. but all cases of tendinous quittor are by no means so complicated as this one was. in rare instances the swelling is slight, and after a few days the lameness and other symptoms subside, without any discharge of pus from an external opening. in most cases, however, from one to half a dozen or more soft points arise on the skin of the coronet, open, and discharge slowly a thick, yellow, fetid, and bloody matter. in other cases the suppurative process is largely confined to the sensitive laminæ and plantar cushion, when the suffering is intense until the pus finds an avenue of escape by separating the hoof from the coronary band, at or near the heels, without causing a loss of the whole horny box. when the flexor tendon is involved deep in the foot, the discharge of pus usually takes place from an opening in the follow of the heel; if the sesamoid ligament or the sheath of the flexors are affected, the opening is nearer the fetlock joint, although in most of these cases the suppuration spreads along the course of the tendons until the navicular joint is involved, and extensive sloughing of the deeper parts follows. _treatment._--the treatment of tendinous quittor is to be directed toward the saving of the foot. first of all an effort must be made to prevent suppuration; if the patient is seen at the beginning, cold irrigation, recommended in the treatment for cutaneous quittor, is to be resorted to. later, when the tumor is forming on the coronet, the knife must be used, and a free and deep incision made into the swelling. whenever openings appear, from which pus escapes, they should be carefully probed; in all instances these fistulous tracts lead down to dead tissue which nature is trying to remove by the process of sloughing. if a counter opening can be made, which will enable a more ready escape of the pus, it should be done at once; for instance, if the probe shows that the discharge originates from the bottom of the foot, the sole must be pared through over the seat of trouble. whenever suppuration has commenced the process is to be stimulated by the use of warm baths and poultices. the pus which accumulates in the deeper parts, especially along the tendons, around the joints, and in the hoof, is to be removed by pressure and injections made with a small syringe, repeated two or three times a day. as soon as the discharge assumes a healthy character and diminishes in quantity, stimulating solutions are to be injected into the open wounds. when the tendons, ligaments, and other deeper parts are affected, a strong solution of carbolic acid-- to --should be used at first; or strong solutions of tincture of iodin, sulphate of iron, sulphate of copper, bichlorid of mercury, etc., may be used in place of the carbolic; after this the remedies and dressings directed for use in simple quittor are to be used. in those cases in which the fistulous tracts refuse to heal it is often necessary to burn them out with a saturated solution of caustic soda, equal parts of muriatic acid and water, or, better still, with a long, thin iron, heated white hot. but no matter what treatment is adopted, a large percentage of the cases of tendinous quittor fail to make good recoveries. if the entire hoof sloughs away, the growth of a new, but soft and imperfect hoof may be obtained by carefully protecting the exposed tissues with proper bandages. when the joints are opened by deep sloughing, recovery may eventually take place, but the joint remains immovable ever after. if caries of a small part of the coffin bone takes place, it may be removed by an operation; but if much of the bone is affected, or if the navicular and coronet bones are involved in the carious process, the only hope for a cure is in the amputation of the foot. this operation is advisable only when the animal is valuable for breeding purposes. in all other cases in which there is no hope for recovery the patient's suffering should be relieved by death. in tendinous quittor much thickening of the coronary region, and sometimes of the ankle and fetlock, remains after suppuration has ceased and the fistulous tracts have healed. to stimulate the reabsorption of this new and unnecessary tissue, the parts should be fired with the hot iron, or, in its absence, repeated blistering with the biniodid of mercury ointment may largely accomplish the same results. subhorny quittor. this is the most common form of the disease. it is generally seen in but one foot at a time, and more often in the fore than in the hind feet. it nearly always attacks the inside quarter, but may affect the outside, the band in front, or the heel, where it is of but little consequence. it consists in the inflammation of a small part of the coronary band and adjacent skin, followed by sloughing and suppuration, which in most cases extends to the neighboring sensitive laminæ. _causes._--injuries to the coronet, such as bruises, overreaching, and calk wounds, are considered as the common causes of this disease. still, cases occur in which there appears to be no existing cause, just as in the other forms of quittor, and it seems fair to conclude that subhorny quittor may also be produced by internal causes. _symptoms._--at the outset the lameness is always severe, and the patient often refuses to use the affected foot. swelling of the coronet close to the top of the hoof causes the quarter to protrude beyond the wall. this tumor is extremely sensitive, and the whole foot is hot and painful. after a few days a small spot in the skin, over the most elevated part of the tumor, softens and opens or the hoof separates from the coronary band at the quarter or well back toward the heel. from this opening, wherever it may be, a thin, watery, often dark, offensive discharge escapes, at times mixed with blood and always containing a considerable percentage of pus. probing will now disclose a fistulous tract leading to the bottom of the diseased tissues. if the opening is small, there is a tendency upon the part of the suppurative process to spread downward; the pus gradually separates the hoof from the sensitive laminæ until the sole is reached, and even a portion of this may be undermined. as a rule, the slough in this form of quittor is not deep, and if the case receives early and proper treatment complications are generally avoided; but if the case is neglected, and, occasionally, even in spite of the best treatment, the disease spreads until the tendon in front, the lateral cartilage, or the coffin bone and joint as well are involved. in all cases of subhorny quittor much relief is experienced when the slough comes away, and rapid recovery is made. if, however, after the lapse of a few days, the lameness remains and the wound continues to discharge a thin, unhealthy matter, the probabilities are that the disease is spreading, and pus collecting in the deeper parts of the foot. in zundel's opinion, if the use of the probe now detects a pus cavity below the opening, a cartilaginous quittor is in the course of development. _treatment._--hot baths and poultices are to be used until the presence of pus can be determined, when the tumor is to be opened with a knife or sharp-pointed iron heated white hot. the hot baths and poultices are now continued for a few days or until the entire slough has come away and the discharge is diminished, when dressings recommended in the treatment for cutaneous quittor are to be used until recovery is completed. in cases in which the discharge comes from a cleft between the upper border of the hoof and the coronary band, always pare away the loosened horn, so that the soft tissues beneath are fully exposed, care being taken not to injure the healthy parts. this operation permits of a thorough inspection of the diseased parts, the easy removal of all gangrenous tissue, and a better application of the necessary remedies and dressings. the only objection to the operation is that the patient is prevented from being early returned to work. when the probe shows that pus has collected under the coffin bone the sole must be pared through, and, if caries of the bone is present, the dead parts cut away. after either of these operations the wound is to be dressed with the oakum balls, saturated in the bichlorid of mercury solution, as previously directed, and the bandages tightly applied. generally the discharge for the first two or three days is so great that the dressings need to be changed every hours; but when the discharge diminishes, the dressing may be left on from one to two weeks. before the patient is returned to work, a bar shoe should be applied, since the removed quarter or heel can only be made perfect again by a new growth from the coronary band. tendinous or cartilaginous complications are to be treated as directed under those headings. cartilaginous quittor. this form of quittor may commence as a primary inflammation of the lateral cartilage, but in the great majority of cases it appears as a sequel to cutaneous or subhorny quittor. it may affect either the fore or hind feet, but is most commonly seen in the former. as a rule, it attacks but one foot at a time, and but one of the cartilages, generally the inner one. it is always a serious affection for the reason that, in many cases, it can only be cured by a surgical operation, requiring a thorough knowledge of the anatomy of the parts involved, and much surgical skill. _causes._--direct injuries to the coronet, such as trampling, pricks, burns, and the blow of some heavy falling object which may puncture, bruise, or crush the cartilage, are the common direct causes of cartilaginous quittor. besides being a sequel to the other forms of quittor, it sometimes develops as a complication in suppurative corn, canker, grease, laminitis, and punctured wounds of the foot. animals used for heavy draft, and those with flat feet and low heels, are more liable to the disease than others, for the reason that they are more exposed to injury. rough roads also predispose to the disease by increasing liability to injury. _symptoms._--when the disease commences as a primary inflammation of the cartilage, lameness develops with the formation of a swelling on the side of the coronet over the quarter. the severity of this lameness depends largely upon the part of the cartilage which is diseased, for if the disease is situated in that part of the cartilage nearest the heel, where the surrounding tissues are soft and spongy, the lameness may be very slight, especially if the patient is required to go no faster than a walk; but when the middle and anterior parts of the cartilage are diseased, the pain and consequent lameness are much greater, for the tissues are less elastic and the coffin joint is more liable to become affected. except in the cases to be noted hereafter, one or more fistulous openings finally appear in the tumor on the coronet. these openings are surrounded by a small mass of granulations which are elevated above the adjacent skin and bleed readily if handled. a probe shows these fistulous tracts to be more or less sinuous, but always leading to one point--the gangrenous cartilage. when cartilaginous quittor happens as a complication of suppurative corn, or from punctured wounds of the foot, the fistulous tract may open alone at the point of injury on the sole. the discharge in this form of quittor is generally thin, watery, and contains pus enough to give it a pale-yellow color; it is offensive to the sense of smell, due to the detachment of small flakes of cartilage which have become gangrenous and are seen in the discharge as small, greenish-colored particles. in old cases it is not unusual to find some of the fistulous openings heal at the surface; this is followed by the gradual collection of pus in the deeper parts, forming an abscess, which in a short time opens at a new point. the wall of the hoof, over the affected quarter and heel, in very old cases becomes rough and wrinkled like the horn of a ram, and generally it is thicker than the corresponding quarter, owing to the stimulating effect which the disease has upon the coronary band. complications may arise by an extension of the disease to the lateral ligament of the coffin joint, to the joint itself, to the plantar cushion, and by caries of the coffin bone. _treatment._--before recovery can take place all the dead cartilage must be removed. in rare instances this is effected by nature without assistance. usually, however, the disease does not tend to recovery, and active curative measures must be adopted. the best and simplest treatment, in a majority of cases, is the injection of strong caustic solutions, which destroy the diseased cartilage and cause its discharge, along with the other products of suppuration. in favorable cases these injections will secure a healing of the wound in from two to three weeks. while the saturated solution of sulphate of copper, or a solution of parts of bichlorid of mercury to parts of water, has given the best results in my hands, equally as favorable success has been secured by others from the use of caustic soda, nitrate of silver, sulphate of zinc, tincture of iodin, etc. no matter which one of these remedies may be selected, however, it must be used at least twice a day for a time. the solution is injected into the various openings with force enough to drive it to the bottom of the wound, after which the foot is to be dressed with a pad of oakum, held in place by a roller bandage tightly applied. while it is not always necessary, it is often of advantage to relieve the pressure on the parts by rasping away the hoof over the seat of the cartilage; the coronary band and laminæ should not be injured in the operation. if the caustic injections prove successful, the discharge will become healthy and gradually diminish, so that by the end of the second week the fistulous tracts are closing up and the injections are made with much difficulty. if, on the other hand, there is but little or no improvement after this treatment has been used for three weeks, it may reasonably be concluded that the operation for the removal of the lateral cartilage must be resorted to for the cure of the trouble. as this operation can be safely undertaken only by an expert surgeon, it will not be described in this connection. thrush. thrush is characterized by an excessive secretion of unhealthy matter from the cleft of the frog. while all classes of horses are liable to this affection, it is more often seen in the common draft horse than in any other breed, owing to the conditions of servitude and not to the fault of the breed. country horses are much less subject to the disease, except in wet, marshy districts, than are the horses used in cities and towns. _causes._--the most common cause of thrush is the filthy condition of the stable in which the animal is kept. mares are more liable to contract the disease in the hind feet when filth is the cause, while the gelding and stallion are more liable to develop it in the fore feet. hard work on rough and stony roads may also induce the disease, as may a change from dryness to excessive moisture. the latter cause is often seen to operate in old track horses, whose feet are constantly soaked in the bathtub for the purpose of relieving soreness. muddy streets and roads, especially where mineral substances are plentiful, excite this abnormal condition of the frog. contracted heels, scratches, and navicular disease predispose to thrush, while by some a constitutional tendency is believed to exist among certain animals which otherwise present a perfect frog. _symptoms._--at first there is simply an increased moisture in the cleft of the frog, accompanied with an offensive smell. after a time a considerable discharge takes place--thin, watery, and highly offensive, changing gradually to a thicker puriform matter, which rapidly destroys the horn of the frog. only in old and severe cases is the patient lame and the foot feverish--cases in which the whole frog is involved in the diseased process. _treatment._--thrushes are to be treated by cleanliness, the removal of all exciting causes, and a return of the frog to its normal condition. as a rule, the diseased and ragged portions of horn are to be pared away and the foot poulticed for a day or two with boiled turnips, to which may be added a few drops of carbolic acid or a handful of powdered charcoal to destroy the offensive smell. the cleft of the frog and the grooves on its edges are then to be cleaned and well filled with dry calomel and the foot dressed with oakum and a roller bandage. if the discharge is profuse, the dressing should be changed daily; otherwise it may be left on two or three days. where a constitutional taint is supposed to exist, with swelling of the legs, grease, etc., a purgative, followed by dram doses of sulphate of iron, repeated daily, may be prescribed. in cases where the growth of horn seems too slow a spanish-fly blister applied to the heels is often followed by good results. feet in which the disease is readily induced may be protected in the stable with a leather boot. if the thrush is but a sequel to other disease, a permanent cure may not be possible. canker. canker of the foot is due to the rapid reproduction of a vegetable parasite. it not only destroys the sole and frog, but, by setting up a chronic inflammation in the deeper tissues, prevents the growth of a healthy horn by which the injury may be repaired. heavy cart horses are more often affected than those of any other class. _causes._--the essential element in the production of canker is the parasite; consequently the disease may be called contagious. as in all other diseases due to specific causes, however, the seeds of the disorder must find a suitable soil in which to grow before they are reproduced. it may be said, then, that the conditions which favor the preparation of the tissues for a reception of the seeds of this disease are simply predisposing causes. the condition most favorable to the development of canker is dampness--in fact, dampness seems indispensable to the existence and growth of the parasite; the disease is rarely, if ever, seen in high, dry districts, and is much more common in rainy than in dry seasons. filthy stables and muddy roads have been classed among the causes of canker; but it is very doubtful whether these conditions can do more than favor a preparation of the foot for the reception of the disease germ. all injuries to the feet, by exposing the soft tissues, may render the animal susceptible to infection; but neither the injury nor the irritation and inflammation of the tissues which follow are sufficient to induce the disease. for some unknown reason horses with lymphatic temperaments--thick skins, flat feet, fleshy frogs, heavy hair, and particularly with white feet and legs--are especially liable to canker. _symptoms._--usually, canker is confined to one foot; but it may attack two, three, or all of the feet at once; or, as is more commonly seen, the disease attacks first one then another, until all may have been successively affected. when the disease follows an injury which has exposed the soft tissues of the foot, the wound shows no tendency to heal, but instead there is secreted from the inflamed parts a profuse, thin, fetid, watery discharge, which gradually undermines and destroys the surrounding horn, until a large part of the sole and frog is diseased. the living tissues are swollen, dark colored, and covered at certain points with particles of new, soft, yellowish, thready horn, which are constantly undergoing maceration in the abundant liquid secretion by which they are immersed. as this secretion escapes to the surrounding parts, it dries and forms small, cheesy masses composed of partly dried horny matter, exceedingly offensive to the sense of smell. when the disease originates independently of an injury, the first evidences of the trouble are the offensive odor of the foot, the liquid secretion from the cleft and sides of the frog, and the rotting away of the horn of the frog and sole. in the earlier stages there is no interference with locomotion, but later the foot becomes sensitive, particularly if the animal is used on rough roads, and, finally, when the sole and frog are largely destroyed the lameness is severe. _treatment._--since canker does not destroy the power of the tissues to produce horn, but rather excites them to an excessive production of an imperfect horn, the indications for treatment are to restore the parts to a normal condition, when healthy horn may again be secreted. in my experience, limited though it has been, the old practice of stripping off the entire sole and deep cauterization, with either the hot iron or strong acids, is not attended with uniformly good results. i am of the opinion that recovery can generally be effected as surely and as speedily with measures which are less heroic and much less painful. true, the treatment of canker is likely to exhaust the patience, and sometimes the resources, of the attendant; but after all success depends more on the persistent application of simple remedies and great cleanliness than on the special virtues of any particular drug. first, then, clean the foot with warm baths and apply a poultice containing powdered charcoal or carbolic acid. a handful of the charcoal or a tablespoonful of the acid mixed with the poultice serves to destroy much of the offensive odor. the diseased portions of horn are to be carefully removed with sharp instruments, until only healthy horn borders the affected parts. the edges of the sound horn are to be pared thin, so that the swollen soft tissues may not overlap their borders. with sharp scissors cut off all the prominent points on the soft tissues, shorten the walls of the foot, and nail on a broad, plain shoe. the foot is now ready for the dressings, and any of the many stimulating and drying remedies may be used; but it will be necessary to change frequently from one to another, until finally all may be tried. the list from which a selection may be made comprises wood tar, gas tar, petroleum, creosote, phenic acid; sulphates of iron, copper, and zinc; chlorid of zinc, bichlorid of mercury, calomel, caustic soda, nitrate of silver, chlorid of lime; carbolic, nitric, and sulphuric acids. in practice i prefer to give the newly shod foot a bath for an hour or two in a solution of the sulphate of iron made by adding ounces of the powdered sulphate to a gallon of cold water. when the foot is removed from the bath it is dressed with oakum balls dipped in a mixture made of barbados tar part, oil of turpentine parts, to which is slowly added parts of sulphuric acid, and the mixture well stirred and cooled. the diseased parts being well covered with the balls, a pad of oakum sufficiently thick to cause considerable pressure is placed over them, and all are held in place by pieces of heavy tin fitted to slip under the shoe. the whole foot is now incased in a boot or folded gunny sack and the patient turned into a loose, dry box. the dressings are to be changed daily or even twice a day at first. when they are removed, all pieces of new horny matter which are now firmly adherent must be rubbed off with the finger or a tent of oakum. as the secretion diminishes, dry powders, such as calomel, sulphates of iron, copper, etc., may prove of most advantage. the sulphates should not be used pure, but are to be mixed with powdered animal charcoal in the proportion of one of the former to eight or ten of the latter. when the soft tissues are all horned over, the dressings should be continued for a time, weak solutions being used to prevent a recurrence of the disease. if the patient is run down in condition, bitter tonics, such as gentian, may be given in -dram doses twice a day and a liberal diet of grain allowed. corns. a corn is an injury to the living horn of the foot, involving the soft tissues beneath, whereby the capillary blood vessels are ruptured and a small quantity of blood escapes which, by permeating the horn in the immediate neighborhood, stains it a dark color. if the injury is continuously repeated, the horn becomes altered in character and the soft tissues may suppurate or a horny tumor develop. corns always appear in the sole in the angle between the bar and the outside wall of the hoof. in many cases the laminæ of the bar, of the wall, or of both, are involved at the same time. three kinds of corns are commonly recognized--the dry, the moist, and the suppurative--a division based solely on the character of the conditions which follow the primary injury. the fore feet are almost exclusively the subjects of the disease, for two reasons: first, because they support a greater part of the body; secondly, because the heel of the fore foot during progression is first placed upon the ground, whereby it receives much more concussion than the heel of the hind foot, in which the toe first strikes the ground. _causes._--it may be said that all feet are exposed to corns, and that even the best feet may suffer from them when conditions necessary to the production of the peculiar injury are present. the heavier breeds of horses generally used for heavy work on rough roads and streets seem to be most liable to this trouble. mules rarely have corns. among the causes and conditions which predispose to corns may be named high heels, which change the natural relative position of the bones of the foot and thereby increase the concussion to which these parts are subject; contracted heels, which in part destroy the elasticity of the foot, increase the pressure upon the soft tissues of the heel, and render lacerations more easy; long feet, which by removing the frog and heels too far from the ground deprive them of necessary moisture; this, in turn, reduces the elastic properties of the horn and diminishes the transverse diameter of the heels; weak feet, or those in which the horn of the wall is too thin to resist the tendency to spread, whereby the soft tissues are easily lacerated. wide feet with low heels are always accompanied with a flat sole whose posterior wings either rest upon the ground or the shoe, and as a consequence are easily bruised; at the same time the arch of the sole is so broad and flat that it can not support the weight of the body, and in the displacement which happens when the foot is rested upon the ground the soft tissues are liable to become bruised or torn. it is universally conceded that shoeing, either as a direct or predisposing cause, is most prolific in producing corns. one of the most serious as well as the most common of the errors in shoeing is to be found in the preparation of the foot. instead of seeking to maintain the integrity of the arch, the first thing done is to weaken it by freely paring away the sole; nor does the mutilation end here, for the frog, which is nature's main support to the branches of the sole and the heels, is also largely cut away. this not only permits of an excessive downward movement of the contents of the horny box, but it at the same time removes the one great means by which concussion of the foot is destroyed. as adjuncts to the foregoing errors must be added the faults of construction in the shoe and in the way it is adjusted to the foot. an excess of concavity in the shoe, extending it too far back on the heels, high calks, thin heels which permit the shoe to spring, short heels with a calk set under the foot, and a shoe too light for the animal wearing it or for the work required of him, are all to be avoided as causes of corns. a shoe so set so as to press upon the sole or one that has been on so long that the hoof has overgrown it until the heels rest upon the sole and bars becomes a direct cause of corns. indirectly the shoe becomes the cause of corns when small stones, hard, dry earth, or other objects collect between the sole and shoe. lastly, a rapid gait and excessive knee action, especially on hard roads, predispose to this disease of the feet. _symptoms._--ordinarily a corn induces sufficient pain to cause lameness. it may be intense, as seen in suppurative corn, or it may be but a slight soreness, such as that which accompanies dry corn. it is by no means unusual in chronic corns to see old horses apparently so accustomed to the slight pain which they suffer as not to limp at all. but they are generally very restless. they paw their bedding behind them at night and often refuse to lie down for a long rest. the lameness of this disease, however, can hardly be said to be characteristic, for the reason that it varies so greatly in intensity; but the position of the leg while the patient is at rest is generally the same in all cases. the foot is so advanced that it is relieved of all weight, and the fetlock is flexed until all pressure by the contents of the hoof is removed from the heels. in suppurative corn the lameness subsides or entirely disappears as soon as the abscess opens. when the injured tissues are much inflamed, as may happen in severe and recent cases, the heel of the affected side, or even the whole foot, is hot and tender to pressure. in dry corn and in most chronic cases all evidences of local fever are often wanting. it is in these cases that the patient goes well when newly shod, for the smith cuts away the sole over the seat of injury until all pressure by the shoe is removed and lowers the heels so that concussion is reduced to a minimum. if a corn is suspected, the foot should be examined for increased sensibility of the inside heel. tapping the heel of the shoe with a hammer and grasping the wall and bar between the jaws of pincers with moderate pressure will cause more or less flinching if the disease is present. for further evidence the shoe is removed and the heel cut away with the drawing knife. as the horn is pared out, not only the sole in the angle is found discolored, but in many instances the insensible laminæ of the bar and wall adjacent are also stained with the escaped blood. in moist and suppurative corns this discoloration is less marked than in dry corn and even may be entirely wanting. in these cases the horn is soft, often white, and stringy or mealy, as seen in pumiced sole resulting from founder. when the whole thickness of the sole is discolored and the horn dry and brittle it is generally evidence that the corn is an old one and that the exciting cause has existed continuously. a moist corn differs from the dry one in that the injury is more severe. the parts affected are more or less inflamed, and the horn of the sole in the angle is undermined by a citron-colored fluid, which often permeates the injured sole and laminæ, causing the horn to become somewhat spongy. a suppurative corn differs from others in that the inflammation ends in suppuration. the pus collects at the point of injury and finally escapes by working its way between the sensitive and insensible laminæ to the top of the hoof, where an opening is made between the wall and coronary band at or near the heels. this is the most serious form of corns, for the reason that it may induce gangrene of the plantar cushion, cartilaginous quittor, or caries of the coffin bone. _treatment._--since a diversity of opinion exists as to what measures must be adopted for the radical cure of corns, the author will advise the use of those which have proved most efficient in his hands. as in all other troubles, the cause must be discovered, if possible, and removed. in the great majority of cases the shoeing is at fault. while sudden changes in the method of shoeing are not advisable, it may be said that all errors, either in the preparation of the foot, in the construction of the shoe, or in its application may very properly be corrected at any time. circumstances may at times make it imperative that shoes be worn which are not free from objections; as, for instance, the shoe with a high calk; but in such cases it is considered that the injuries liable to result from the use of calks are less serious than those which are sure to happen for the want of them. for a sound foot perfectly formed, a flat shoe, with heels less thick than the toe, and which rests evenly on the wall proper, is the best. in flat feet it is often necessary to concave the shoe as much as possible on the upper surface, so that the sole may not be pressed upon. if the heels are very low the heels of the shoe may be made thicker. if the foot is very broad and the wall light toward the heels, a bar shoe resting upon the frog will aid to prevent excessive tension upon the soft tissues when the foot receives the weight of the body. a piece of leather placed between the foot and shoe serves largely to destroy concussion, and its use is absolutely necessary on some animals to enable them to work. last among the preventive measures may be mentioned those which serve to maintain the suppleness of the hoof. the dead horn upon the surface of the sole not only retains moisture for a long time, but protects the living horn beneath from the effects of evaporation; for this reason the sole should be pared as little as possible. stuffing the feet with flaxseed meal, wet clay, or other like substances, or damp dirt floors or damp bedding of tanbark, greasy hoof ointments, etc., are all means which may be used to keep the feet from becoming too dry and hard. as to the curative measures which are to be adopted much will depend upon the extent of the injury. if the case is one of chronic dry corn, with but slight lameness, the foot should be poulticed for a day or two and the discolored horn pared out, care being taken not to injure the soft tissues. the heel on the affected side is to be lowered until all pressure is removed and, if the patient's labor is required, the foot must be shod with a bar shoe or with one having stiff heels. care must be taken to reset the shoe before the foot has grown too long, else the shoe will no longer rest on the wall, but on the sole and bar. i believe in cutting moist corns out. if there is inflammation, cold baths and poultices should be used; when the horn is well softened and the fever allayed, pare out the diseased horn, lightly cauterize the soft tissues beneath, and poultice the foot for two or three days. when the granulations look red, dress the wound with oakum balls saturated in a weak solution of tincture of aloes or spirits of camphor and apply a roller bandage. change the dressing every two or three days until a firm, healthy layer of new horn covers the wound, when the shoe may be put on, as in dry corn, and the patient returned to work. in suppurative corns the loosened horn must be removed, so that the pus may freely escape. if the pus has worked a passage to the coronary band and escapes from an opening between the band and hoof, an opening must be made on the sole, and cold baths made astringent with a little sulphate of iron or copper are to be used for a day or two. when the discharge becomes healthy, the fistulous tracts may be injected daily with a weak solution of bichlorid of mercury, nitrate of silver, etc., and the foot dressed as after operation for moist corns. when complications arise, the treatment must be varied to meet the indications; if gangrene of the lateral cartilage takes place it must be treated as directed under the head of cartilaginous quittor; if the velvety tissue is gangrenous, it must be cut away; if the coffin bone is necrosed, it must be scraped, and the resulting wounds treated on general principles. after any of the operations for corns have been performed, in which the soft tissues have been laid bare, it is best to protect the foot by a sole of soft leather set beneath the shoe when the animal is returned to work. only in rare instances are the complications of corns so serious as to destroy the life or usefulness of the patient. it is the wide, flat foot with low heels and thin wall which is most liable to resist all efforts toward effecting a complete cure. bruise of the frog. when the frog is severely bruised the injury is followed by suppuration beneath the horn, and at times by partial gangrene of the plantar cushion. _causes._--a bruise of the frog generally happens from stepping on a rough stone or other hard object. it is more liable to take place when trotting, running, or jumping than when at a slower pace. a stone wedged in the shoe and pressing on the frog or between the sides of the frog and the shoe, if it remains for a time, produces the same results. a cut through the horny frog with some sharp instrument or a punctured wound by a blunt-pointed instrument may also cause suppuration and gangrene of the plantar cushion. broad, flat feet with low heels and a fleshy frog are most liable to these injuries. _symptoms._--lameness, severe in proportion to the extent of the bruise and the consequent suppuration, is always an early symptom. when the animal moves, the toe only is placed to the ground or the foot is carried and the patient hobbles along on three legs. when he is at rest, the foot is set forward with the toe on the ground and the leg flexed at the fetlock joint. as soon as the pus finds its way to the surface the lameness improves. if the frog is examined early the injured spot may usually be found; later, if no opening exists, the pus may be discovered working its way toward the heels. the horn is loosened from the deeper tissues, and, if pared through, a thin, yellow, watery and offensive pus escapes. in other cases a ragged opening is found in the frog, leading down to a mass of dead, sloughing tissues, which are pale green in color if gangrene of the plantar cushion has set in. in rare cases the coffin bone may be involved in the injury and a small portion of it may become carious. _treatment._--if the injury is seen at once, the foot should be placed in a bath of cold water to prevent suppuration. if suppuration has already set in, the horn of the frog, and of the bars and branches of the sole, if necessary, is to be pared thin so that all possible pressure may be removed, and the foot poulticed. when the pus has loosened the horn, all the detached portions are to be cut away. if the pus is discharging from an opening near the hair, the whole frog, or one-half of it, will generally be found separated from the plantar cushion, and is to be removed with the knife. after a few days the gangrenous portion of the cushion will slough off from the effects of the poultice; under rare circumstances only should the dead parts be removed by surgical interference. when the slough is all detached, the remaining wound is to be treated with simple stimulating dressings, such as tincture of aloes or turpentine, oakum balls, and bandages as directed in punctured wounds. when the lameness has subsided, and a thin layer of new horn has covered the exposed parts, the foot may be shod. cover the frog with a thick pad of oakum, held in place by pieces of tin fitted to slide under the shoe, and return to slow work. where caries of the coffin bone, etc., follow the injury the treatment recommended for these complications in punctured wounds of the foot must be resorted to. punctured wounds of the foot. of all the injuries to which the foot of the horse is liable, none are more common than punctured wounds, and none are more serious than these may be when involving the more important organs within the hoof. a nail is the most common instrument by which the injury is inflicted, yet wounds may happen from glass, wire, knives, sharp pieces of rock, etc. a wound of the foot is more serious when made by a blunt-pointed instrument than when the point is sharp, and the nearer the injury is to the center of the foot the more liable are disastrous results to follow. wounds in the heel and in the posterior parts of the frog are attended with but little danger, unless they are so deep as to injure the lateral cartilages, when quittor may follow. punctured wounds of the anterior parts of the sole are more dangerous, for the reason that the coffin bone may be injured, and the suppuration, even when the wound is not deep, tends to spread and always gives rise to intense suffering. the most serious of the punctured wounds are those which happen to the center of the foot, and which, in proportion to their depth, involve the plantar cushion, the plantar aponeurosis, the sesamoid sheath, the navicular bone, or the coffin joint. punctured wounds are more liable to be deep in flat or convex feet than in well-made feet, and as a rule, recovery is neither so rapid nor so certain. these wounds are less serious in animals used for heavy draft than in those required to do faster work; for the former may be useful, even if complete recovery is not effected. lastly, punctured wounds of the fore feet are more serious than of the hind feet, for the reason that in the former the instrument is liable to enter the foot in a nearly perpendicular line, and, consequently, is more liable to injure the deeper structures of the foot; in the hind foot, the injury is generally near the heels and the wound oblique and less deep. _symptoms._--a nail or other sharp instrument may penetrate the frog and remain for several days without causing lameness; in fact, in many cases of punctured wound of the frog the first evidence of the injury is the finding of the nail or the appearance of an opening where the skin and frog unite, from which more or less pus escapes. even when the sole is perforated, if the injury is not too deep, no lameness develops until suppuration is established. in all cases of foot lameness, especially if the cause is obscure, the foot should be examined for evidence of injury. the lameness from punctured wounds, accompanied with suppuration, is generally severe, the patient often refusing to use the affected member at all. the pain being lancinating in character, he stands with the injured foot at rest or constantly moves it back and forth. in other cases the patient lies down most of the time with the feet outstretched; the breathing is rapid, the pulse fast, the temperature elevated, and the body covered with patches of sweat. when the plantar aponeurosis is injured, the pus escapes with difficulty and the wound shows no signs of healing; the whole foot is hot and very painful. if the puncture involves the sesamoid sheath, the synovial fluid escapes. at first this fluid is pure, like joint water, but later becomes mixed with the products of suppuration and loses its clear, amber color. suppuration generally extends up the course of the flexor tendon, an abscess forms in the hollow of the heel, and finally opens somewhere below the fetlock joint. the whole coronet is more or less swollen, the discharge is profuse and often mixed with blood, yet the suffering is greatly relieved from the moment the abscess opens. if the puncture reaches the navicular bone the lameness is intense from the beginning; but the only certain way to determine the existence of this complication is by the use of the probe; and unless there is a free escape of synovia it must be used with the greatest of care, else the coffin joint may be opened. if the coffin joint has been penetrated, either by the offending instrument or by the process of suppuration, acute inflammation of the joint follows, accompanied with high fever, loss of appetite, etc. the ankle and coronet are now greatly swollen, and dropsy of the leg to the knee or hock, or even to the body, often follows. if the process of suppuration continues, small abscesses appear at intervals on different parts of the coronet, the patient rapidly loses flesh, and may die from intense suffering and blood poisoning. in other cases the suppuration soon disappears, and recovery is effected by the joint becoming stiff (anchylosis). when the wound is forward, near the toe, and deep enough to injure the coffin bone, caries always results. the presence of the dead pieces of bone can be determined by the use of the probe; the bone feels rough and gritty. furthermore, there is no disposition upon the part of the wound to heal. besides the complications above mentioned, others equally as serious may be met with. the tendons may soften and rupture, the hoof may slough off, quittors develop, or sidebones and ringbones grow. finally, laminatis of the opposite foot may happen if the patient persists in standing, or lockjaw may cause early death. _treatment._--in all cases the horn around the seat of injury should be thinned down, a free opening made for the escape of the products of suppuration, and the foot placed in a poultice. if the injury is not serious, recovery takes place in a few days. when the wound is deeper it is better to put the foot into a cold bath or under a stream of cold water, as advised in the treatment for quittor. if the bone is injured, cold baths, containing about ounces each of sulphate of copper and sulphate of iron, may be used until the dead bone is well softened, when it should be removed by an operation. the animal must be cast for this operation. the sole is pared away until the diseased bone is exposed, when all the dead particles are to be removed with a drawing knife, and the wound dressed with per cent compound cresol solution or a per cent solution of carbolic acid, oakum balls, and a roller bandage. wounds of the bone which are made by a blunt-pointed instrument, like the square-pointed cut nail, in which a portion of the surface is driven into the deeper parts of the bone, always progress slowly, and should be operated upon as soon as the conditions are favorable. even wounds of the navicular bone, accompanied with caries, may be operated on and the life of the patient saved; but the most skillful surgery is required and only the experienced operator should undertake their treatment. if there is an escape of pure synovial fluid from a wound of the sole, without injury to the bone, a small pencil of corrosive sublimate should be introduced to the bottom of the wound and the foot dressed as directed above. the other complications are to be treated as directed under their proper headings. after healing of the wounds has been effected, lameness, with more or less swelling of the coronary region, may remain. in such cases the coronet should be blistered or even fired with the actual cautery, and the patient turned to pasture. if the lameness still persists, and is not due to a stiff joint, unnerving may be resorted to in many cases with very good results. if the joint is anchylosed, no treatment can relieve it, and the patient must either be put to very slow work or kept for breeding purposes only. "_prick in shoeing_" is an injury which should be considered under the head of punctured wounds of the foot. the nails by which the shoe is fastened to the hoof may produce an injury followed by inflammation and suppuration in two days, by penetrating the soft tissues directly or by being driven so deep that the inner layers of the horn of the wall are pressed against the soft tissues with such force as to crush them. in either case, unless the injury is at the toe, the animal generally goes lame soon after shoeing, when the first evidence of the trouble may be the discharge of pus at the coronet. if lameness follows close upon the setting of the shoes, without other appreciable cause, each nail should be lightly struck with a hammer, when the one at fault will be detected by the flinching of the animal. treatment consists in drawing the nail, and if the soft tissues have been penetrated or suppuration has commenced, the horn must be pared away until the diseased parts are exposed. the foot is now to be poulticed for a day or two, or until the lameness and suppuration have ceased. if the discharge of pus from the coronet is the first evidence of the disease, the offending nail must be found and removed, the horn pared out, and a weak solution of carbolic acid or compound cresol injected at the coronet until the fistulous tract has healed. contracted heels, or hoofbound. contracted heels, or hoofbound, is a common disease among horses kept on hard floor in dry stables, and in such as are subject to much saddle work. it consists in an atrophy, or shrinking, of the tissues of the foot, whereby the lateral diameter of the heels is diminished. it affects the fore feet principally; but it is seen occasionally in the hind feet, where it is of less importance, for the reason that the hind foot first strikes the ground with the toe, and consequently less expansion of the heels is necessary than in the fore feet, where the weight is first received on the heels. any interference with the expansibility of this part of the foot interferes with locomotion and ultimately gives rise to lameness. usually but one foot is affected at a time, but when both are diseased the change is greater in one than in the other. occasionally but one heel, and that the inner one, is contracted; in these cases there is less liable to be lameness and permanent impairment of the animal's usefulness. according to the opinion of some of the french veterinarians, hoofbound should be divided into two classes--total contraction, in which the whole foot is shrunken in size, and contraction of the heels, when the trouble extends only from the quarters backward. (pl. xxxv, figs. and .) _causes._--animals raised in wet or marshy districts, when taken to towns and kept on dry floors, are liable to have contracted heels, not alone because the horn becomes dry, but because fever of the feet and wasting away of the soft tissues result from the change. another common cause of contracted heels is to be found in faulty shoeing, such as rasping the wall, cutting away the frog, heels, and bars; high calks and the use of nails too near the heels. contracted heels may happen as one of the results of other diseases of the foot; for instance, it often accompanies thrush, sidebones, ringbones, canker, navicular disease, corns, sprains of the flexor tendons, of the sesamoid and suspensory ligaments, and from excessive knuckling of the fetlock joint. _symptoms._--in contraction of the heels the foot has lost its circular shape, and the walls from the quarters backward approach to a straight line. the ground surface of the foot is now smaller than the coronary circumference; the frog is pinched between the inclosing heels, is much shrunken, and at times is affected with thrush. the sole is more concave than natural, the heels are higher, and the bars are long and nearly perpendicular. the whole hoof is dry and so hard that it can scarcely be cut; the parts toward the heels are scaly and often ridged like the horns of a ram, while fissures, more or less deep, may be seen at the quarters and heels following the direction of the horn fibers. (plate xxxvi, fig. .) when the disease is well advanced lameness is present, while in the earlier stages there is only an uneasiness evinced by frequent shifting of the affected foot. stumbling is common, especially on hard or rough roads. in most cases the animal comes out of the stable stiff and inclined to walk on the toe, but after exercise he may go free again. he wears his shoes off at the toe in a short time, no matter whether he works or remains in the stable. if the shoe is removed and the foot pared in old cases, a dry, mealy horn will be found where the sole and wall unite, extending upward in a narrow line toward the quarters. _treatment._--first of all, the preventive measures must be considered. the feet are to be kept moist and the horn from drying out by the use of damp sawdust or other bedding; by occasional poultices of boiled turnips, linseed meal, etc., and greasy hoof ointments to the sole and walls of the feet. the wall of the foot should be spared from the abuse of the rasp; the frog, heels, and bars are not to be mutilated with the knife, nor should calks be used on the shoe except when absolutely necessary. the shoes should be reset at least once a month to prevent the feet from becoming too long, and daily exercise must be insisted on. as to curative measures, a diversity of opinion exists. a number of kinds of special shoes have been invented, having for an object the spreading of the heels, and perhaps any of these, if properly used, would eventually effect the desired result. but a serious objection to most of these shoes is that they are expensive and often difficult to make and apply. the method of treatment which i have adopted is not only attended with good results, but is inexpensive, if the loss of the patient's services for a time is not considered a part of the question. it consists, first, in the use of poultices or baths of cold water until the horn is thoroughly softened. the foot is now prepared for the shoe in the usual way, except that the heels are lowered a little and the frog remains untouched. a shoe, called a "tip," is made by cutting off both branches at the center of the foot and drawing the ends down to an edge. the tapering of the branches should begin at the toe, and the shoe should be of the usual width, with both the upper and lower surfaces flat. this tip is to be fastened on with six or eight small nails, all set well forward, two being in the toe. with a common foot rasp begin at the heels, close to the coronet, and cut away the horn of the wall until only a thin layer covers the soft tissues beneath. cut forward until the new surface meets the old - / or inches from the heel. the same sloping shape is to be observed in cutting downward toward the bottom of the foot, at which point the wall is to retain its normal thickness. the foot is now blistered all round the coronet with spanish-fly ointment; when this is well set, the patient is to be turned to pasture in a damp field or meadow. the blister should be repeated in three or four weeks, and, as a rule, the patient can be returned to work in two or three months. the object of the tip is to throw the weight on the frog and heels, which are readily spread after the horn has been cut away on the sides of the wall. the internal structures of the foot at the heels, being relieved of excessive pressure, regain their normal condition if the disease is not of too long standing. the blister tends to relieve any inflammation which may be present, and stimulates a rapid growth of healthy horn, which, in most cases, ultimately forms a wide and normal heel. in old, chronic cases, with a shrunken frog and increased concavity of the sole, accompanied with excessive wasting of all the internal tissues of the foot, satisfactory results can not be expected and are rarely obtained. still, much relief, if not an entire cure, may be effected by these measures. when thrush is present as a complication, its cure must be sought by measures directed under that heading. if sidebones, ringbones, navicular disease, contracted tendons, or other diseases have been the cause of contracted heels, treatment will be useless until the cause is removed. sand cracks. a sand crank is a fissure in the horn of the wall of the foot. these fissures are quite narrow, and, as a general rule, they follow the direction of the horny fibers. they may occur on any part of the wall, but ordinarily are only seen directly in front, when they are called toe cracks; or on the lateral parts of the walls, when they are known as quarter cracks. (plate xxxvi.) toe cracks are most common in the hind feet, while quarter cracks nearly always affect the fore feet. the inside quarter is more liable to the injury than the outside, for the reason that this quarter is not only the thinner, but during locomotion receives a greater part of the weight of the body. a sand crack may be superficial, involving only the outer parts of the wall, or it may be deep, involving the whole thickness of the wall and the soft tissues beneath. the toe crack is most likely to be complete--that is, extending from the coronary band to the sole--while the quarter crack is nearly always incomplete, at least when of comparatively recent origin. sand cracks are most serious when they involve the coronary band in the injury. they may be complicated at any time by hemorrhage, inflammation of the laminæ, suppuration, gangrene of the lateral cartilage and of the extensor tendon, caries of the coffin bone, or the growth of a horny tumor known as a keraphyllocele. _causes._--relative dryness of the horn is the principal predisposing cause of sand cracks. excessive dryness is perhaps not a more prolific cause of cracks in the horn than alternate changes from damp to dry. it is even claimed that these injuries are more common in animals working on wet roads than those working on roads that are rough and dry; at least these injuries are not common in mountainous countries. animals used to running at pasture when transferred to stables with hard, dry floors are more liable to quarter cracks than those accustomed to stables. small feet, with thick, hard hoofs, and feet which are excessively large, are more susceptible to sand cracks than those of better proportion. a predisposition to quarter cracks exists in contracted feet, and in those where the toe turns out or the inside quarter turns under. heavy shoes, large nails, and nails set too far back toward the heels, together with such diseases as canker, quittor, grease, and suppurative corns, must be included as occasional predisposing causes of sand cracks. [illustration: plate xxxvi. quarter-crack and remedies.] [illustration: plate xxxvii. foundered feet.] fast work on hard roads, jumping, and blows on the coronet, together with calk wounds of the feet, are accidental causes of quarter cracks in particular. toe cracks are more likely to be caused by heavy pulling on slippery roads and pavements or on steep hills. _symptoms._--the fissure in the horn is ofttimes the only evidence of the disease; even this may be accidentally or purposely hidden from casual view by mud, ointments, tar, wax, putty, gutta-percha, or by the long hairs of the coronet. sand cracks sometimes commence on the internal face of the wall, involving its whole thickness excepting a thin layer on the outer surface. in these cases the existence of the injury may be suspected from a slight depression, which begins near the coronary band and follows the direction of the horny fibers; but the trouble can only be positively diagnosed by paring away the outside layers of horn until the fissure is exposed. in toe cracks the walls of the fissure are in close apposition when the foot receives the weight of the body, but when the foot is raised from the ground the fissure opens. in quarter crack the opposition is true; the fissure closes when the weight is removed from the foot. as a rule, sand cracks begin at the coronary band, and as they become older they not only extend downward, but they also grow deeper. in old cases, particularly in toe cracks, the horn on the borders of the fissure loses its vitality and scales off, sometimes through the greater part of its thickness, leaving behind a rough and irregular channel extending from the coronet to the end of the toe. in many cases of quarter crack, and in some cases of toe crack as well, if the edges remain close together, with but little motion, the fissure is dry; but in other cases a thin, offensive discharge issues from the crack and the ulcerated soft tissues, or a funguslike growth protrudes from the narrow opening. when the cracks are deep and the motion of their edges considerable, so that the soft tissues are bruised and pinched with every movement, a constant inflammation of the parts is maintained and the lameness is severe. ordinarily the lameness of sand crack is slight when the patient walks, but it is greatly aggravated when he is made to trot, and the harder the road the worse he limps. furthermore, the lameness is greater going downhill than up, for the reason that these conditions are favorable to an increased motion in the edges of the fissure. lastly, more or less hemorrhage accompanies the inception of a sand crack when the whole thickness of the wall is involved. subsequent hemorrhages may also take place from fast work, jumping, or a misstep. _treatment._--so far as preventive measures are concerned, but little can be done. the suppleness of the horn is to be maintained by the use of ointments, damp floor, bedding, etc. the shoe is to be proportioned to the weight and work of the animal; the nails holding it in place are to be of proper size and not driven too near the heels; sufficient calks and toe pieces must be added to the shoes of horses working on slippery roads; also, the evils of jumping, fast driving, etc., are to be avoided. when a fissure has made its appearance, means are to be adopted which will prevent it from growing longer or deeper; this can only be done by arresting all motion in the edges. the best and simplest artificial appliance for holding the borders of a toe crack together is the vachette clasp. these clasps and the instruments necessary for their application can be had of any prominent maker of veterinary instruments. (pl. xxxvi.) these instruments comprise a cautery iron, with which two notches are burned in the wall, one on each side of the crack, and forceps with which the clasps are closed into place in the bottom of the notches and the edges of the fissure brought close together. the clasps, being made of stiff steel wire, are strong enough to prevent all motion in the borders of the crack. before these clasps are applied the fissure should be thoroughly cleansed and dried, and if the injury is of recent origin the crack may be filled with a putty made of parts of gutta-percha and part of gum ammoniac. the number of clasps to be used is to be determined by the length of the crack, the amount of motion to be arrested, etc. generally the clasps are from one-half to three-quarters of an inch apart. the clasps answer equally as well in quarter crack if the wall is sufficiently thick and not too dry and brittle to withstand the strain. in the absence of these instruments and clasps a hole may be drilled through the horn across the fissure and the crack closed with a thin nail made of tough iron, neatly clinched at both ends. a plate of steel or brass is sometimes fitted to the parts and fastened on with short screws; while this appliance may prevent much gaping of the fissure, it does not entirely arrest motion of the edges, for the reason that the plate and screw can not be rendered immobile. if, for any reason, the measures above fail or can not be used, recourse must be had to an operation. the horn is softened by the use of warm baths and poultices, the patient cast, and the walls of the fissure entirely removed with the knife. the horn removed is in the shape of the letter v, with the base at the coronet. care must be taken not to injure the coronary band and the laminæ. the wound is to be treated with mild stimulant dressings, such as compound cresol solution, a weak solution of carbolic acid, tincture of aloes, etc., oakum balls, and a roller bandage. after a few days the wound will be covered with a new, white horn, and only the oakum and bandages will be needed. as the new quarter grows out, the lameness disappears, and the patient may be shod with a bar shoe and returned to work. in all cases of sand crack the growth of horn should be stimulated by cauterizing the coronary band or by the use of blisters. in simple quarter crack recovery will often take place if the coronet is blistered, the foot shod with a "tip," and the patient turned to pasture. the shoe in toe crack should have a clip on each side of the fissure and should be thicker at the toe than at the heels. the foot should be lowered at the heels by paring, and spared at the toe, except directly under the fissure, where it is to be pared away until it sets free from the shoe. when any of the complications referred to above arise, special measures must be resorted to. for the proper treatment of gangrene of the lateral cartilage and extensor tendon and caries of the coffin bone reference may be had to the articles on quittors. if the horny tumor, known as keraphyllocele, should develop, it is to be removed by the use of the knife. since this tumor develops on the inside of the horny box and may involve other important organs of the foot in disease, its removal should only be undertaken by a skillful surgeon. navicular disease. navicular disease is an inflammation of the sesamoid sheath, induced by repeated bruising or laceration, and complicated in many cases by inflammation and caries of the navicular bone. in some instances the disease undoubtedly begins in the bone, and the sesamoid sheath becomes involved subsequently by an extension of the inflammatory process. (plate xxxiv, fig. .) the thoroughbred horse is more commonly affected than any other, yet no class or breed of horses is entirely exempt. the mule, however, seems rarely, if ever, to suffer from it. for reasons which will appear when considering the causes of the disease, the hind feet are not liable to be affected. usually but one fore foot suffers from the disease, but if both should be attacked the trouble has become chronic in the first before the second shows signs of the disease. _causes._--to comprehend fully how navicular disease may be caused by conditions and usages common to nearly all animals, it is necessary to recall the peculiar anatomy of the parts involved in the process and the functions which they perform in locomotion. it must be remembered that the fore legs largely support the weight of the body when the animal is at rest, and that the faster he moves the greater is the shock which the fore feet must receive as the body is thrown forward by the propelling force of the hind legs. this shock could not be withstood by the tissues of the fore feet and legs were it not that it is largely dissipated by the elastic muscles which bind the shoulder to the body, the ease with which the arm closes on the shoulder blade, and the spring of the fetlock joint. even these means, however, are not sufficient within themselves to protect the foot from injury; so nature has further supplemented them by placing the coffin joint on the hind part of the coffin bone instead of directly on top of it, whereby a large part of the shock of locomotion is dispersed before it can reach the vertical column represented by the cannon, knee, and arm bones. a still further provision is made by placing a soft, elastic pad--the frog and plantar cushion--at the heels to receive the sesamoid expansion of the flexor tendon as it is forced downward by the pressure of the coronet bone against the navicular. extraordinary as these means may appear for the destruction of shock, and ample as they are when the animal is at a slow pace or unweighted by rider or load, they fail to relieve the parts completely from concussion and excessive pressure whenever the opposite conditions are present. the result, then, is that the coronet bone forces the navicular hard against the flexor tendon, which, in turn, presses firmly against the navicular as the force of the contracting muscles lifts the tendon into place. it is self-evident, then, that the more rapid the pace and the greater the load, the greater must these contending forces be, and the greater the liability to injury. for the same reason horses with excessive knee action are more liable to suffer from this disease than others, concussion of the foot and intense pressure on the tendon being common among such horses. besides the above-mentioned exciting causes must be considered those which predispose to the disease. most prominent among these is heredity. it may be claimed, however, that an inherited predisposition to navicular disease consists not so much in a special susceptibility of the tissues which are involved in the process as in a vice of conformation which, as is well known, is liable to be transmitted from parent to offspring. the faults of conformation most likely to be followed by the development of navicular disease are an insufficient plantar cushion, a small frog, high heels, excessive knee action, and contracted heels. finally, the environments of domestication and use, such as dry stables, heavy pulling, bad shoeing, punctured wounds, etc., all have their influence in developing this disease. _symptoms._--in the early stages of navicular disease the symptoms are generally very obscure. when the disease begins in inflammation of the navicular bone, the animal while at rest points the affected foot a time before any lameness is seen. while at work he apparently travels as well as ever, but when placed in the stable one foot is set out in front of the other, resting on the toe, with fetlock and knee flexed. after a time, if the case is closely watched, the animal takes a few lame steps while at work, but the lameness disappears as suddenly as it came, and the driver doubts whether the animal was really lame at all. later the patient has a lame spell which may last during a greater part of the day, but the next morning it is gone; he leaves the stable all right, but goes lame again during the day. in times he has a severe attack of lameness, which may last for a week or more, when a remission takes place and it may be weeks or months before another attack supervenes. finally, he becomes constantly lame, and the more he is used the greater the lameness. in the lameness from navicular disease the affected leg always takes a short step, and the toe of the foot first strikes the ground; so the shoe is most worn at this point. if the patient is made to move backward, the foot is set down with exceeding great care, and the weight rests upon the affected leg but a moment. when exercised he often stumbles, and if the road is rough he may fall on his knees. if he is lame in both feet the gait is stilty, the shoulders seem stiff, and, if made to work, he sweats profusely from intense pain. early in the development of the disease a careful examination will reveal some increased heat in the heels and frog, particularly after work; as the disease progresses this becomes more marked, until the whole foot is hot to the touch. at the same time there is an increased sensibility of the foot, for the patient flinches from the percussion of a hammer lightly applied to the frog and heels or from the pressure of the smith's pincers. the frog is generally shrunken, often of a pale-red color, and at times is affected with thrush. if the heels are pared away so that all the weight is received on the frog, or if the same result is attained by the application of a bar shoe, the animal is excessively lame. the muscles of the leg and shoulder shrink away and often tremble as the animal stands at rest. after months of lameness the foot is found to be shrunken in its diameter and apparently lengthened; the horn is dry and brittle and has lost its natural gloss, while circular ridges, developed most toward the heels, cover the upper part of the hoof. when both feet are affected the animal points first one foot then the other, and stands with the hind feet well forward beneath the body, so as to relieve the fore feet as much as possible from bearing weight. in old cases the wasting of the muscles and the knuckling at the fetlock become so great that the leg can not be straightened and locomotion can scarcely be performed. the disease generally makes a steady progress without inclining to recovery--the remission of symptoms in the earlier stages should not be interpreted as evidence that the process has terminated. the complications usually seen are ringbones, sidebones, thrush, contracted heels, quartercracks, and fractures of the navicular, coronet, and pastern bones. _treatment._--but few cases of navicular disease recover. in the early stages the wall of the heels should be rasped away, as directed in the treatment for contracted heels, until the horn is quite thin; the coronet should be well blistered with spanish-fly ointment, and the patient turned to grass in a damp field or meadow. after three or four weeks the blister should be repeated. this treatment is to be continued for two or three months. plane shoes are to be put on when the patient is returned to work. in chronic cases the animal should be put to slow, easy work. to relieve the pain, neurotomy may be performed--an operation in which the sense of feeling is destroyed in the foot by cutting out pieces of the nerve at the fetlock. this operation in nowise cures the disease, and, since it may be attended with serious results, can be advised only in certain favorable cases, to be determined by the veterinarian. sidebones. a sidebone consists in a transformation of the lateral cartilages found on the wings of the coffin bone into bony matter by the deposition of lime salts. the disease is a common one, especially in heavy horses used for draft, in cavalry horses, cow ponies, and other saddle horses, and in runners and trotters. sidebones are peculiar to the fore feet, yet they occasionally develop in the hind feet, where they are of little importance since they cause no lameness. in many instances sidebones are of slow growth and, being unaccompanied with acute inflammation, they cause no lameness until such time as, by reason of their size, they interfere with the action of the joint. (plate xxxiv, fig. .) _causes._--sidebones often grow in heavy horses without any apparent injury, and their development has been attributed to the over-expansion of the cartilages caused by the great weight of the animal. blows and other injuries to the cartilages may set up an inflammatory process which ends in the formation of these bony growths. high-heeled shoes, high calks, and long feet are always classed among the conditions which may excite the growth of sidebones. they are often seen in connection with contracted heels, ringbones, navicular disease, punctured wounds of the foot, quarter cracks, and occasionally as a sequel to founder. _symptoms._--in the earlier stages of the disease, if inflammation is present, the only evidence of the trouble to be detected is a little fever over the seat of the affected cartilage and a slight lameness. in the lameness of sidebones the toe of the foot first strikes the ground and the step is shorter than natural. the subject comes out of the stable stiff and sore, but the gait is more free after exercise. since the deposit of bony matter often begins in that part of the cartilage where it is attached to the coffin bone, the diseased process may exist for some time before the bony growth can be seen or felt. later, however, the cartilage can be felt to have lost its elastic character, and by standing in front of the animal a prominence of the coronary region at the quarters can be seen. occasionally these bones become so large as to bulge the hoof outward, and by pressing on the joint they so interfere with locomotion that the animal becomes entirely useless. _treatment._--so soon as the disease can be diagnosed active treatment should be adopted. cold-water bandages are to be used for a few days to relieve the fever and soreness. the improvement consequent on the use of these simple measures often leads to the belief that the disease has recovered; but with a return to work the lameness, fever, etc., reappears. for this reason the use of blisters, or, better still, the firing iron, should follow on the discontinuance of the cold bandages. but in many instances no treatment will arrest the growth of these bony tumors, and as a palliative measure neurotomy must be resorted to. generally this operation will so relieve the pain of locomotion that the patient may be used for slow work; but in animals used for fast driving or for saddle purposes, the operation is practically useless. some years ago at fort leavenworth i unnerved a number of cavalry horses that were suffering from sidebones, and the records show that in less than seven months all were more lame than ever. since a predisposition to develop sidebones may be inherited, animals suffering from this disease should not be used for breeding purposes unless the trouble is known to have originated from an accident. ringbone. a ringbone is the growth of a bony tumor on the ankle. this tumor is, in fact, not the disease, but simply the result of an inflammatory action set up in the periosteum and bone tissue proper of the pastern bones. (plate xxxiv, fig. .) (see also p. .) _causes._--injuries, such as blows, sprains, overwork in young, undeveloped animals, fast work on hard roads, jumping, etc., are among the principal exciting causes of ringbone. horses most disposed to this disease are those with short, upright pasterns, for the reason that the shock of locomotion is but imperfectly dissipated in the fore legs of these animals. improper shoeing, such as the use of high calks, a too great shortening of the toe and correspondingly high heels, predispose to this disease by increasing the concussion to the feet. _symptoms._--the first symptom of an actively developed ringbone is the appearance of a lameness more or less acute. if the bony tumor forms on the side or upper parts of the large pastern, its growth is generally unattended with acute inflammatory action, and consequently produces no lameness or evident fever. these are called "false" ringbones. but when the tumors form on the whole circumference of the ankle, or simply in front under the extensor tendon, or behind under the flexor tendons, or if they involve the joints between the two pastern bones, or between the small pastern and the coffin bone, the lameness is always severe. these constitute the true ringbone. besides lameness, the ankle of the affected limb presents more or less heat, and in many instances a rather firm, though limited, swelling of the deeper tissues over the seat of the inflammatory process. the lameness of ringbone is characteristic in that the heel is first placed on the ground when the disease is in a fore leg, and the ankle is kept as rigid as possible. in the hind leg, however, the toe strikes the ground first, when the ringbone is high on the ankle, just as in health, but the ankle is maintained in a rigid position. if the bony growth is under the front tendon of the hind leg, or if it involves the coffin joint, the heel is brought to the ground first. in the early stages of the disease it is not always easy to diagnose ringbone, but when the deposits have reached some size they can be felt and seen as well. the importance of a ringbone depends on its seat and often on its size. if it interferes with the joints or with the tendons it may cause an incurable lameness, even though small. if it is on the sides of the large pastern, the lameness generally disappears as soon as the tumor has reached its growth and the inflammation subsides. even when the pastern joint is involved, if complete anchylosis results, the patient may recover from the lameness with simply an imperfect action of the foot remaining, due to the stiff joint. _treatment._--before the bony growth has commenced the inflammatory process may be cut short by the use of cold baths and wet bandages, followed by one or more blisters. if the bony deposits have begun, the firing iron should always be used. even when the tumors are large and the pastern joint involved, firing often hastens the process of anchylosis and should always be tried. when the lower joint is involved, or if the tumor interferes with the action of the tendons, recovery is not to be expected. in many of these latter cases, however, the animal may be made serviceable by proper shoeing. if the patient walks with the toe on the ground, the foot should be shod with a high-heeled shoe and a short toe. on the other hand, if he walks on the heel, a thick-toed and thin-heeled shoe must be worn. since ringbone is considered to be one of the hereditary diseases, no animal suffering from this trouble should ever be used for breeding purposes. laminitis, or founder. laminitis is a simple inflammation of the sensitive laminæ of the feet, characterized by the general phenomena attending inflammation of the skin and mucous membranes, producing no constitutional disturbances except those dependent upon the local disease, and having a strong tendency, in severe cases, to destructive disorganization of the tissues affected. _causes._--the causes of laminitis are as wide and variable as in any of the local inflammations, and may be divided into two classes--the predisposing and the exciting. _predisposing causes._--from personal observation i do not know that any particular construction of foot or any special breed of horses is predisposed to this disease, neither can i find anything to warrant the assumption that it is in any way hereditary; so that while we may easily cultivate a predisposition to the disease, it does not originate without an exciting cause. like most other tissues, a predisposition to inflammation may be induced in the sensitive laminæ by any cause which lessens their power of withstanding the work imposed on them. it exists to an extent in those animals unaccustomed to work, particularly if they are plethoric, and in all that have been previous subjects of the disease, for the same rule holds good here that we find in so many diseases--i. e., that one attack impairs the functional activity of the affected tissues and renders them more easy of a subsequent inflammation. unusual excitement by determining an excessive blood supply, bad shoeing, careless paring of the feet by removing the sole support, and high calkings without corresponding toe pieces must be included under this head. _exciting causes._--the exciting causes of laminitis are many and varied. the most common are concussion, overexertion, exhaustion, rapid changes of temperature, ingestion of certain feeds, purgatives, and the oft-mentioned metastasis. ( ) concussion produces this disease by local overstimulation. the excessive excitement is followed by an almost complete exhaustion of the functional activity of the laminated tissues, the exhaustion by congestion, and eventually by inflammation. but congestion here, as in all other tissues, is not necessarily followed by inflammation; for, although the principal symptoms belonging to true laminitis are present, the congestion may be relieved before the processes of inflammation are fully established. this is the condition in the many so-called cases of laminitis which recover in from to hours. they should be called congestion of the laminæ. laminitis from concussion is common in trotting horses that are raced when not in condition, especially if they carry the obnoxious toe weights, and in green horses put to work on city pavements to which they are unaccustomed. concussion from long drives on dirt roads is at times productive of the same results, notably when the weather is extremely warm, or at least when the relative change of temperature is great. but the exhaustion of these circumstances must prove an exciting cause as well as the long-continued concussion. this combination of causes must also determine the disease at times in hunters, for the weight of the rider increases the demands made upon the function of these tissues, and their powers are the sooner exhausted. ( ) overexertion, as heavy pulling or rapid work, even when there is no immoderate concussion, occasionally results in this disease. here also exhaustion is a conjunctive cause, for overexertion can not be long continued without exhaustion. ( ) exhaustion is nearly as prolific a source of laminitis as is concussion, for when the physical strength is impaired, even though temporarily, some part of the economy is rendered more vulnerable to disease than others. to this cause we must ascribe those cases which follow a hard day's work, in which at no time has there been overexertion or immoderate concussion. the tendency to laminitis in horses on sea voyages results from the continual constrained position the animal maintains on account of the rocking motion of the vessel. if one foot has been blistered, or if one limb is incapacitated from any cause, the opposite member, doing double duty, soon becomes exhausted, and congestion, followed by inflammation, results. when one foot only becomes laminitic, it is customary to find the corresponding member participating at a later date; not always because of sympathy, but because one foot had to do the work of two. ( ) rapid changes of temperature act as an exciting cause of laminitis by impairing the normal blood supply. this change of temperature may be induced by drinking large quantities of cold water while in an overheated condition. here the internal heat is rapidly reduced, the neighboring tissues and blood vessels constrained, and the blood supply to these organs greatly diminished, while the quantity sent to the surface is correspondingly increased. true, in many cases there has not been sufficient labor performed to impair the powers of the laminæ, and laminitis is more readily induced than congestion or inflammation of the skin or other surface organs, because the laminæ can not relieve themselves of threatened congestion by the general safety valve of perspiration. a cold wind or relatively cold air allowed to play upon the body when heated and wet with sweat has virtually the same result, for it arrests evaporation and rapidly cools the external surface, thereby determining an excess of blood to such organs and tissues as are protected from this outside influence. in many instances this happens to be some of the internal organs, as the lungs, if the previous work has been rapid and their functional activity impaired; but in numerous other instances the determination is toward the feet, and that it is so depends upon two very palpable facts: first, that these tissues have been greatly excited and are already receiving as much blood as they can accommodate consistently with health; second, even though these tissues are classed with those of the surface, their protection from atmospheric influences by means of the thick box of horn incasing them renders them in this respect equivalent to internal organs. a more limited local action of cold may excite this disease, by driving through water or washing the feet and legs while the animal is warm or just in from work. here a very marked reaction takes place in the surface tissues of the limbs, and passive congestion of the foot results from an interference with the return flow of blood which is being sent to these organs in excess. these are more liable to be simple cases of congestion, soon to recover, yet they may become true cases of laminitis. ( ) why it is that certain kinds of grain will cause laminitis does not seem to be clearly understood. certainly they possess no specific action upon the laminæ, for all animals are not alike affected; neither do they always produce these results in the same animal. some of these feeds cause a strong tendency to indigestion, and the consequent irritation of the alimentary canal may be so great as to warrant the belief that the laminæ are affected through sympathy. in other instances there is no apparent interference with digestion nor evidence of any irritation of the mucous membranes, yet the disease is in some manner dependent upon the feed for its inception. barley, wheat, and sometimes corn are the grains most liable to cause this disease. with some horses there appears to be a particular susceptibility to this influence of corn, and the use of this grain is followed by inflammation of the feet, lasting from a few days to two weeks. in these animals, to all appearances healthy, the corn neither induces colic, indigestion, nor purging, and apparently no irritation whatever of the alimentary canal. ( ) fortunately purgative medicines rarely cause inflammation of the laminæ. that it is, then, the result of sympathetic action is no doubt more than hypothetical, for when there is no derangement of the alimentary canal a dose of cathartic medicine will at times bring on severe laminitis. ( ) almost all the older authorities were agreed that metastatic laminitis is a reality. in my opinion metastatic laminitis is nothing more nor less than concurrent laminitis, and presents little in any way peculiar outside the imperfectly understood exciting cause. the practitioner who allows the acute symptoms of the laminitis to mislead him, simply because their severity has overshadowed those of the primary disease, may lose his case through unguarded subsequent treatment. this form of laminitis is by no means commonly met with. it may be found in conjunction with pneumonia, according to youatt with inflammation of the bowels and eyes, and according to law and williams sometimes with bronchitis. _symptoms._--laminitis is characterized by a congregation of symptoms so well marked as scarcely to be misinterpreted by the most casual observer. they are nearly constant in their manifestations, modified by the number of feet affected, the cause which has induced the disease, the previous condition of the patient, and the various other influences which to some extent operate in all diseases. they may be divided into general symptoms, which are concomitants of all cases of the disease, subject to variations in degree only, and special symptoms, or those which serve to determine the feet affected and the complications which may arise. _general symptoms._--usually, the first symptom is the interference with locomotion. occasionally the other symptoms are presented first. as the lameness develops the pulse becomes accelerated, full, hard, and strikes the finger strongly; the temperature soon rises several degrees above the normal, reaching sometimes ° f.; it generally ranges between . ° and ° f. the respirations are rapid and panting in character, the nostrils widely dilated, and the mucous membranes highly injected. the facial expression is anxious and indicative of the most acute suffering, while the body is more or less bedewed with sweat. at first there may be a tendency to diarrhea, or it may appear later as the result of the medicines used. the urine is high colored, scant in quantity, and of increased specific gravity, owing to the water being eliminated by the skin instead of the kidneys. the appetite is impaired, sometimes entirely lost, but thirst is greatly increased. the affected feet are hot and dry, and as much as possible are relieved from bearing weight. rapping them with a hammer, or compelling the animal to stand upon one affected member, causes intense pain. the artery at the fetlock throbs beneath the finger. _special symptoms._--liability to affection varies in the different feet according to the exciting cause. any one or more of the feet may become the subject of this disease, although it appears more often in the fore feet than in the hind ones. this is due to the difference of the function, i. e., that the fore feet are the bases of the columns of support, receiving nearly all the body weight during progression and consequently most of the concussion, while the hind feet become simply the fulcra of the levers of progression, and are almost exempt from concussion. _one foot._--injuries and excessive functional performance are the causes of the disease in only one foot. the general symptoms, as a rule, are not severe, there being often no loss of appetite and no unusual thirst, while the pulse, temperature, and respiration remain about normal. the weight of the body is early thrown upon the opposite foot, and the affected one is extended, repeatedly raised from the floor, and then carefully replaced. when made to move forward the lame foot is either carried in the air while progression is accomplished by hopping with the healthy one, or else the heel of the first is placed upon the ground and receives little weight while the sound limb is quickly advanced. progression in a straight line is more easy than turning toward the lame side. _both fore feet._--when both fore feet are affected the symptoms are well marked. the lameness is excessive and the animal almost immovable. when standing the head hangs low down, or rests upon the manger as a means of support and to relieve the feet; the fore feet are well extended so that the weight is thrown upon the heels, where the tissues are least sensitive, least inflamed, and most capable of relief by free effusion. the hind feet are brought forward beneath the body to receive as much weight as possible, thereby relieving the diseased ones. if progression is attempted, which rarely happens voluntarily during the first three or four days, it is accomplished with very great pain and lameness at the starting, which usually subsides to an extent after a few minutes' exercise. during this exercise, if the animal happens to step upon a small stone or other hard substance, he stumbles painfully and is excessively lame in the offended member for a number of steps, owing to the acute pain which pressure upon the sole causes in the tissues beneath. the manner of the progression is pathognomonic of the complaint. sometimes the affected feet are simultaneously raised from the ground (the hind ones sustaining the weight), then advanced a short distance and carefully replaced; at almost the same moment the hind ones are quickly shuffled forward near to the center of gravitation. in other instances one foot at a time is advanced and placed with the heel upon the ground in the same careful manner, all causes of concussion being carefully avoided. in attempting to back the animal he is found to be almost stationary, simply swaying the body backward on the haunches and elevating the toes of the diseased feet as they rest upon their heels. in attempting to turn either to the right or left he allows his head to be drawn to the one side to its full extent before moving, then makes his hind feet the axis around which the forward ones describe a shuffling circle. in most of cases of laminitis in the fore feet the animal persists in standing until he is nearly recovered. in other cases he as persistently lies, standing only when necessity seems to compel it, and then for as short a time as possible. if the recumbent position is once assumed, the relief experienced tempts the patient to seek it again; so we often find him down a greater part of the time. but this is not true of all cases; sometimes he will make the experiment, then cautiously guard against a repetition. even in cases of enforced recumbency, he ofttimes takes advantage of the first opportunity and gets upon his feet, doggedly remaining there until again laid upon his side. how to explain this diversity of action i do not know; theoretically the recumbent position is the only appropriate one, except when complications exist, and the one which should give the most comfort, yet it is rejected by very many patients and, no doubt, for some good reason. it has been suggested as an explanation that when the animal gets upon his feet after lying for a time the suffering is so greatly augmented that the memory of this experience deters him from an attempted repetition. if this were true, the horse with the first attack must necessarily make the experiment before knowing the after effects of lying down, yet many remain standing without even an attempt at gaining this experimental knowledge. the most-favored position of the animal when down is on the broadside, with the feet and legs extended. while in this position the general symptoms greatly subside; the respirations and pulse become almost normal; the temperature falls and the perspiration dries. it is with difficulty that he is made to rise. when he attempts it he gets up rapidly and "all of a heap," as it were, shifting quickly from one to the other foot until they become accustomed to the weight thrown upon them. occasionally a patient will get up like a cow, rising upon the hind feet first. although enforced exercise relieves the soreness to some extent, it is but temporary, for after a few minutes' rest it returns with all its former severity. _both hind feet._--when only both hind feet are affected, they are, while standing, maintained in the same position as when only the fore ones are the subjects of the disease, but with an entirely different object in view. instead of being there to receive weight, they are so advanced that the heels only may receive what little weight is necessarily imposed on them; the fore feet at the same time are placed well back beneath the body, where they become the main supports; the animal standing, as williams describes it, "all of a heap." progression is even more difficult now than when the disease is confined to the anterior extremities. the fore feet are dubiously advanced a short distance and the hind ones brought forward with a sort of kangaroo hop that results in an apparent loss of equilibrium which the animal is a few moments in regaining. the general symptoms, or, in other words, the degree of suffering, seem more severe than when the disease affects the fore feet alone. the standing position is not often maintained, the patient seeking relief in recumbency. this fact is easily understood when we consider how cramped and unnatural is the position he assumes while standing and, if it were maintained for any considerable length of time, would, no doubt, excite the disease in the fore feet, as explained by d'arboval. _all four feet._--laminitis of all four feet is but uncommonly met with. the author has seen but three such cases. in all these the position assumed was nearly normal. all the feet were slightly advanced, and first one, then another, momentarily raised from the ground and carefully replaced, this action being kept up almost continually during the time the animal remained standing. the suffering is most acute, the appetite lost, and, although the patient lies most of the time, the temperature remains too high. the pulse and respirations are greatly accelerated, the body covered with sweat, and bed sores are unpleasant accompaniments. _course._--the course which laminitis takes varies greatly in different cases, being influenced more or less by the exciting cause, the animal's previous condition, the acuteness of the attack, and the subsequent treatment. the first symptoms rarely exhibit themselves while the animal is at his work, although we occasionally see the gait impaired by stumbling, the body covered with a profuse sweat, and the respirations become blowing in character as premonitions of the oncoming disease; but, as a rule, nothing amiss with the animal is noted until he has stood for some time after coming in from work, when, in attempting to move him, he is found very stiff. like all congestions, the early symptoms usually develop rapidly; yet this is not always the case, for often there appears to be no well-defined period of congestion, the disease seemingly commencing at a point and gradually spreading until a large territory is involved in the morbid process. _simple congestion._--those cases of simple congestion of the laminæ, which we erroneously call laminitis, are rapidly developed, the symptoms are but moderately severe, and but one to three days are required for recovery. there are no structural changes and but a moderate exudate. this is rapidly reabsorbed, leaving the parts in the same condition as they were previous to the attack. if the congestion has been excessive, a rupture of some of the capillaries will be found, a condition more liable to exist if the animal is made to continue work after a development of symptoms has begun. true, the majority of these last-described cases prove to be the laminitis in fact, yet the congestion may pass away and the extravasated blood be absorbed without inflammation sufficient to warrant calling it laminitis. the seat of greatest congestion will always be found in the neighborhood of the toe, because of the increased vascularity of that part, and, although at times it is limited to the podophyllous tissue alone, any or all parts of the keratogenous membrane may be affected by the congestion and followed finally by inflammation. _acute._--in the acute form of laminitis the symptoms may all develop rapidly, or it may commence by the appearance of a little soreness of the feet which in or hours develops into a well-marked case. this peculiarity of development is due to one of two causes. either the congestion is general, but takes place slowly, or it begins in one or more points and gradually spreads throughout the laminæ. these acute cases generally run their course in from one to two weeks. usually a culmination of the symptoms is reached, if the patient is properly treated, in from three to five days; then evidences of recovery are discernible in favorable cases. the lameness improves, the other symptoms gradually subside, and eventually health is regained. it is in these cases that a strong tendency to disorganization of a destructive character exists; hence it is we see so many recover imperfectly, with marked structural changes permanently remaining. _subacute._--subacute laminitis is most often seen as a termination of the acute form, although it may exist independent of or precede an acute attack. it is characterized by the mildness of its symptoms, slow course, and moderate tissue changes. it may be present a long time before any pathological lesions result other than those found in the acute form, and when these changes do take place they should be viewed rather as complications. _chronic._--chronic laminitis is a term used by many to designate any of the sequelæ of the acute and subacute forms of this disease. pure, chronic inflammation of the laminæ is not very commonly met with, but is most frequent in horses that have long done fast track work. they have "fever in the feet" at all times and are continually sore, both conditions being aggravated by work. like chronic inflammation of other parts, there is a strong tendency to the development of new connective tissue which, by its pressure upon the blood vessels, interferes with nutrition. wasting of the coffin bone and inflammation of its covering with caries is not unusual. the continued fever and impaired function of secretion result in the production of a horn deficient in elasticity, somewhat spongy in character, and inclined to crumble. in some cases of "soreness" in horses used to hard or fast work there is evident weakness of the coats of the vessels, brought on by repeated functional exhaustion. here slight work brings on congestion, which results in serous effusion and temporary symptoms similar to those of chronic laminitis. _complications._--complications concurrent with or supervening upon laminitis are frequent and varied, and are often dependent upon causes not fully understood. _excessive purgation_ is one of the simplest of these, and not usually attended with dangerous consequences. it rarely occurs unless induced by a purgative, and the excessive action of the medicine is probably to be explained upon the theory that the mucous membrane sympathizes with the diseased laminæ, is irritable, and readily becomes overexcited. the discharges are thin and watery, sometimes offensively odorous, and occasionally persist in spite of treatment. it may prove disastrous to the welfare of the patient by the rapid exhaustion which it causes, preventing resolution of the laminitis, and may even cause death. _septicemia and pyemia._--septicemia and pyemia are unusual complications and are seen only in the most severe cases in which bed sores are present or suppuration of the laminæ results. they die, as a rule, within three days after showing signs of the complication. _pneumonia._--the so-called metastatic--needs no special consideration, for in its lesions and symptoms it does not differ from ordinary pneumonia, although it may be overlooked entirely by the practitioner. examinations of the chest should be made every day, so as to detect the disease at its onset and render proper aid. _sidebones._--a rapid development of sidebones is one of the complications, or, perhaps better, a sequel of laminitis not often met with in practice. here the inflammatory process extends to the lateral cartilages, with a strong tendency to calcification. the deposition of the lime salts is sometimes most rapid, so that the "bones" are developed in a few weeks; in other instances they are deposited slowly and their growth is not noted until long after the subsidence of the laminitis, so that the exciting cause is not suspected. this change in the cartilages may commence as early as the first of the laminitis; and although the trouble in the laminæ is removed in the course of a fortnight the symptoms do not entirely subside, the animal retains the shuffling gait, the sidebones continue to grow, and the patient usually remains quite lame. this alteration of the cartilages generally prevents the patient from recovering his natural gait, and the practitioner receives unjust censure for a condition of affairs he could neither foresee nor prevent. the laminitic process occasionally extends to the covering of the coronet bone, or at least concurrent with and subsequent to laminitis the development of "low ringbone" is seen, and it is apparently dependent upon the disease of the laminæ for its exciting cause. the impairment of function and consequent symptoms are much less marked here than in sidebones. the coronet remains hot and sensitive and somewhat thickened after the laminitis subsides, and a little lameness is present. this lameness persists, and the deposits of new bone may readily be detected. _suppuration_ of the sensitive membrane is a somewhat common complication, and even when present in its most limited form is always a serious matter; but when it becomes extensive, and especially when the suppurative process extends to the periosteum, the results are liable to be fatal. when suppuration occurs the exudation does not appear to be excessive. it is rich in leucocytes and seems to have caused detachment of the sensitive tissues from the horn prior to the formation of pus in some instances; in others the tissues are still attached to the horn, and the suppuration takes place in the deeper tissues. limited suppuration may take place in any part of the sensitive tissues of the foot during laminitis, and may ultimately be reabsorbed instead of being discharged upon the surface, but generally the process begins in the neighborhood of the toe and spreads backward and upward toward the coronet, finally separating the horn from the coronary band at the quarters. at the same time it spreads over the sole and eventually the entire hoof is loosened and sloughs away, leaving the tissues beneath entirely unprotected. in other instances--and these are generally the cases not considered unusually severe--the suppuration begins at the coronary band. it extends but a short distance into the tissues, yet destroys the patient by separating the hoof from the coronary band, upon which it depends for support and growth. this form of the suppurative process usually begins in front. it is this part of the coronary band that is always most actively affected with inflammation, and consequently it is here that impairments first occur. suppuration of the sensitive sole is more common than of the sensitive laminæ and coronary band. it is present in the majority of cases in which there is a dropping of the coffin bone, and in other instances when the effusion at this point is so great as to arrest the production of horn and uncover the sensitive tissues. except when the result of injury it begins at the toe and spreads backward, and, if not relieved by opening the sole, escapes at the heel. suppuration of the sole is much less serious than in other parts of the foot. if the acute constitutional symptoms developed from sloughing of the foot do not result in death, a new hoof of very imperfect horn may be developed after a time; but unless the animal is to be kept for breeding purposes alone the foot will ever be useless for work and death should relieve the suffering. when only the sole sloughs, recovery takes place with proper treatment. _peditis._--this is the term that williams applies to that serious complication of laminitis in which not only the laminæ, but the periosteum membrane covering the bone and coffin bone also are subjects of the inflammatory process. neither is this all; in some of these cases of peditis acute inflammation of the coffin joint is present, and occasionally suppuration of the joint. a mild form of periostitis, in which the exudation is in the outer layer of the periosteum only, is a more common condition than is recognized generally by practitioners. intimate contiguity of structures is the predisposing cause, for the disease either spreads from the original seat or the complication occurs as one of the primary results of the exciting cause. in the severer cases in which the exudate separates the periosteum from the bone, suppuration, gangrene, and superficial caries are common results. if infiltration of the bone tissues is rapid the blood supply is cut off by pressure upon the vessels and death of the coffin bone follows. grave constitutional symptoms mark these changes, which soon prove fatal. in the mild cases of periostitis it is by no means easy positively to determine its presence, for there are no special symptoms by which it may be distinguished from pure laminitis. in a majority of acute cases, though, which show no signs of improvement by the fifth to seventh day, it is safe to suspect periostitis, particularly if the coronets are very hot, the pulse full and hard, and the lameness acute. in the fortunately rare cases in which the bone is affected with inflammation and suppuration the agony of the patient is intense; he occupies the recumbent position almost continually, never standing for more than a few minutes at a time; suffers from the most careful handling of the affected feet; maintains a rapid pulse and respiration, high temperature, loss of appetite, and great thirst. it is in these cases that the patient continually grows worse, and the appearance of suppuration at the top of the hoof in about two weeks after the inception of the disease proves the inefficiency of any treatment which may have been used and the hopelessness of the case. these patients die usually between the tenth and twentieth days either from exhaustion or pyemic infection. _gangrene_ occurs in the periosteum as the result of excessive detachment from the bone and compression due to excessive exudation. other parts of the sensitive tissues are subject occasionally to the same fate, and at times large areas will be found dead. _pumiced sole_ is that condition in which the horny sole in the neighborhood of the toe readily crumbles away and leaves the sensitive tissues more or less exposed. it is not a complication of laminitis only, for it is seen under other conditions. williams has described the horny tissue of pumiced sole as "weak, cheesy, or spongy, like macerated horn, or even grumous (thick, clotted)." crumbling horn, when critically examined, shows almost an entire absence of the cohesive matter which unites the healthy fibers, while the fibers themselves are irregular and granular in appearance. pumiced sole depends upon an impairment of the horn-secreting powers of the sensitive sole or upon a separation of the horny from the soft tissues which maintain its vitality. punctured wounds of the foot, accompanied with any considerable destruction of the soft tissues, present the same peculiarities of horn in the immediate neighborhood of the injury. bruises of the sole are followed by this change when the exudation has been excessive and has separated the horn from the living tissues. true, in these cases we rarely see the soft tissues laid bare, for the reason that new horn is constantly secreted and replaces that undergoing disintegration. laminitis presents three conditions under which pumiced sole may appear: first, when free exudation separates the horn from the other tissues, or when the process of inflammation arrests the production of horn by impairing or destroying the horn-secreting membrane; second, when depression of the coffin bone causes pressure upon and arrests the formation of horn; and, third, when the elevation of the sole compresses the soft tissues against the pedal bone and induces the same condition. pumiced sole, from simple exudation and separation of tissues, is of little importance for the reason given above in connection with bruises; but when suppuration occurs in restricted portions of the foot in conjunction with laminitis, it always lays bare the tissues beneath and temporarily impairs the animal's value. recovery takes place after a few weeks by the tissues "horning over," as in injuries attended by the same process. depression of the coffin bone is not sufficient within itself to cause pumiced sole; for, if the relative change in the bone takes place slowly, or if the horn is thin, the sole becomes convex from gradual pressure and the soft tissues adapt themselves to the change without having their function materially impaired. but when the dropping is sudden and the soft tissues are destroyed, the horn rapidly crumbles away and the toe of the bone comes through. in many of these cases the soft tissues remain uncovered for months. when they are eventually covered it is with a thin, slightly adherent horn that stands but little or no wear. the sole being now convex, the diseased tissues bear unusual weight by coming in contact with the ground, and hence it is that these animals are generally incurable cripples. in most cases in which the sole is raised to meet the pedal bone and pumiced sole occurs it is due not to pressure of the bone from within (for the tissues are capable of adapting themselves to the gradual change) but to impaired vitality of the sensitive tissues from the inflammation and to the constant concussion and pressure applied from without during progression. to this is to be added the paring away of the horn when applying the shoe, thereby keeping the sole at this point too thin. _turning up of the toe._--in many cases of laminitis which have become chronic it is found that the toe of the foot turns up; that the heels are longer than natural; while the hoof near the coronary band is circled with ridges like the horn of a ram. even in cases in which recovery has taken place, and in other diseases than laminitis, these ridges may be found in the wall of the foot. in such cases, however, the ridges are equally distant from one another all around the foot, while in turning up of the toe the ridges are wide apart at the heels and close together in front, as seen in the figure. (plate xxxvii, fig. .) these ridges are produced by periods of interference with the growth of horn alternating with periods during which a normal or nearly normal growth takes place. when the toe turns up it is because the coronary band in front produces horn very slowly, while at the heels it grows much faster, causing marked deformity. animals so affected always place the abnormally long heel first upon the ground, not alone because the heel is too long, nor as in acute or subacute laminitis to relieve the pain, but for the reason that the toe is too short and lifted away from its natural position. to bring the toe to the ground the leg knuckles at the fetlock joint. the pain and impairment of function in these cases always result in marked atrophy of the muscles of the forearm and shoulder, and to some extent of the pectorals, while the position of the fore legs advances the shoulder joints so far forward as to cause a sunken appearance of the breast, which the laity recognize as "chest founder." the lesions of turning up of the toe are permanent, and are the most interesting pathologically of all the complications of laminitis. _treatment._--the treatment of laminitis is probably more varied than of any other disease, and yet a large number of cases recover for even the poorest practitioner. _prevention._--to guard against and prevent disease, or to render an unpreventable attack less serious than it otherwise would be, is the highest practice of the healing art. in a disease so prone to result from the simplest causes, especially when the soundest judgment may not be able to determine the extent of the disease-resisting powers of the tissues which are liable to be affected, or of what shall in every instance constitute an overexcitement, it is not strange that horse owners find themselves in trouble from unintentional transgression. if the disease were dependent upon specific causes, or if the stability of the tissues were of a fixed or more nearly determinate quality, some measures might be instituted that would prove generally preventive; but the predisposing causes are common conditions and often can not be remedied. that which is gentle work in one instance may incite disease in another. that which is feed to-day may to-morrow prove disastrous to health. finally, necessary medical interference, no matter how judicious, may cause a more serious complaint than that which was being treated. notwithstanding these difficulties there are some general rules to be observed that will in part serve to prevent the development of an unusual number of cases. first of all the predisposing causes must be removed when possible; when impossible, unusual care must be taken not to bring an exciting cause into operation. under no circumstances should fat animals have hard work. if the weather is warm or the variation of temperature great, all horses should have but slow, gentle labor until they become inured to it, the tissues hardened, and their excitability reduced to a minimum. green horses should have moderate work, particularly when taken from the farm and dirt roads to city pavements; for under these circumstances increased concussion, changed hygienic conditions, and artificial living readily become active causes of the disease. army horses just out of winter quarters, track horses with insufficient preparation, and farmers' horses put to work in the spring are among the most susceptible classes, and must be protected by work that is easy and gradual. if long marches or drives are imperative, the incumbrances must be as light as possible and the journey interspersed with frequent rests, for this allows the laminæ to regain their impaired functional activity and to withstand much more work without danger. furthermore, it permits early detection of an attack, and prevents working after the disease begins, which renders subsequent medication more effective by cutting the process short at the stage of congestion. all animals when resting immediately after work should be protected from cold air or drafts. if placed in a stable that is warm and without draft, no covering is necessary; under opposite conditions blankets should be used until the excitement and exhaustion of labor have entirely passed away. it is still better that all animals coming in warm from work be "cooled out" by slow walking until the perspiration has dried and the circulation and respiration are again normal. animals stopped on the road even for a few moments should always be protected from rapid change of temperature by appropriate clothing. if it can be avoided, horses that are working should never be driven or ridden through water. if unavoidable, they should be cooled off before passing through, and then kept moving until completely dried. the same care is to be practiced with washing the legs in cold water when just in from work, for occasionally it proves to be the cause of a most acute attack of this disease. unusual changes in the manner of applying the shoes should not be hastily made. if a plane shoe has been worn, high heels or toes must not be substituted at once; but the change, if necessary, should gradually be made, so that the different tissues may adapt themselves to the altered conditions. if radical changes are imperative, as is sometimes the case, the work must be so reduced in quantity and quality that it can not excite the disease. laminitis from the effects of purgatives can scarcely be guarded against. i can not determine from the cases in which i have seen this result that there are any conditions present that would warn us of danger. the trouble does not seem to depend upon the size of the purgative, the length of time before purgation begins, or the activity and severity with which the remedy acts. medicines known to have unusually irritating effects on the alimentary canal should be used only when necessity demands it, and then in moderate doses. experience alone will determine what animals are liable to suffer from this disease through the use of feeds. when an attack can be ascribed to any particular feed it should be withheld, unless in small quantities. horses that have never been fed upon indian corn should receive but a little of it at a time, mixed with bran, oats, or other feed, until it has been determined that no danger exists. corn is less safe in warm than in cold weather, and for this reason it should always be fed with caution during spring and summer months. when an animal is excessively lame in one foot the shoe of the opposite member should be removed, and cold water frequently applied to the well foot. at the same time, if the subject remains standing, the slings should be used. horses should under no circumstances be overworked; to guard against this, previous work, nature of roads, state of weather, and various other influences must be carefully considered. watering while warm is a pernicious habit, and, unless the animal is accustomed to it, is liable to result in some disorder, ofttimes in laminitis. _curative measures._--in cases of simple congestion of the laminæ the body should be warmly clothed and warm drinks administered. the feet should be placed in a warm bath to increase the return flow of blood. in course of an hour the feet may be changed to cold water and kept there until recovery is completed. if the constitutional symptoms demand it, diuretics should be given. half-ounce doses of saltpeter three times a day in the water answer the purpose. in cases of active congestion the warm footbaths should be omitted and cold ones used from the commencement. subacute laminitis demands the same treatment, with laxatives if there is constipation, and the addition of low-heeled shoes. the diuretics may need to be continued for some time and their frequency increased. regarding acute laminitis, what has been called the "american treatment" is simple and efficient. it consists solely in the administration of large doses of nitrate of potash and the continued application to the feet and ankles of cold water. three to four ounces of saltpeter in a pint of water, repeated every six hours, is a proper dose. the laminitis frequently subsides within a week. these large doses may be continued for a week without danger. under no circumstances have i seen the kidneys irritated to excess or other unfavorable effects produced. the feet should be kept in a tub of water at a temperature of ° to ° f., unless the animal is lying down, when swabs are to be used and wet every half hour with the cold water. the water keeps the horn soft and moist and acts directly upon the inflamed tissues by reducing the temperature. cold maintains the vitality and disease-resisting qualities of the soft tissues, tones up the coats of the blood vessels, diminishes the supply of blood, and limits the exudation. furthermore, it has an anesthetic effect upon the diseased tissues and relieves the pain. aconite may be given in conjunction with the niter when the heart is greatly excited and beats strongly. ten-drop doses, repeated every hours for hours, are sufficient. the use of cathartics is dangerous, for they may excite superpurgation. usually the niter will relieve the constipation; yet if it should prove obstinate, laxatives may be carefully given. bleeding, both general and local, should be guarded against. the shoes must be early removed and the soles left unpared. paring of the soles presents two objections: first, while it may temporarily relieve the pain by relieving pressure, it favors greater exudation, which may more than counterbalance the good effects. secondly, it makes the feet tender and subject to bruises when the animal again goes to work. the shoes should be replaced when convalescence sets in and the animal is ready to take exercise. exercise should never be enforced until the inflammation has subsided; for although it temporarily relieves the pain and soreness it maintains the irritation, increases the exudation, and postpones recovery. if at the end of the fifth or sixth day prominent symptoms of recovery are not apparent, apply a stiff blister of cantharides around the coronet and omit the niter for about hours. when the blister is well set, the feet may again receive wet swabs. if one blister does not remove the soreness it may be repeated, or the actual cautery applied. the same treatment should be adopted where sidebones form or inflammation of the coronet bone follows. when the sole breaks through, exposing the soft tissues, the feet must be carefully shod with thin heels and thick toes if there is a tendency to walk on the heels, and the sole must be well protected with appropriate dressings and pressure over the exposed parts. when there is turning up of the toe, blistering of the coronet, _in front only_, sometimes stimulates the growth of horn, but as a rule judicious shoeing is the only treatment that will enable the animal to do light, slow work. when suppuration of the laminæ is profuse, it is better to destroy your patient at once and relieve his suffering: but if the suppuration is limited to a small extent of tissue, especially of the sole, treatment, as in acute cases, may induce recovery and should always be tried. if from bed sores or other causes septicemia or pyemia is feared, the bisulphite of soda, in half-ounce doses, may be given in conjunction with tonics and such other treatment as is indicated in these diseases. as to enforced recumbency i doubt the propriety of insisting on it in the majority of cases, for i think the patient usually assumes whatever position gives most comfort. no doubt recumbency diminishes the amount of blood sent to the feet, and may greatly relieve the pain, so that forcing the patient to lie down may be tried, yet should not be renewed if he thereafter persists in standing. when the animal persistently stands, or constant lying indicates it (to prevent extensive sores), the patient should be placed in slings. when all four feet are affected it may be impossible to use slings, for the reason that the patient refuses to support any of his weight and simply hangs in them. lastly, convalescent cases must not be returned to work too early, else permanent recovery may never be effected. diseases of the skin. by james law, f. r. c. v. s., _formerly professor of veterinary science, etc., cornell university._ as we find them described in systematic works, the diseases of the skin are very numerous and complex, which may be largely accounted for by the fact that the cutaneous covering is exposed to view at all points, so that shades of difference in inflammatory and other diseased processes are easily seen and distinguished from one another. in the horse the hairy covering serves to some extent to mask the symptoms, and hence the nonprofessional man is tempted to apply the term "mange" to all alike, and it is only a step further to apply the same treatment to all these widely different disorders. yet even in the hairy quadruped the distinction can be made in a way which can not be done in disorders of that counterpart and prolongation of the skin--the mucous membrane, which lines the air passages, the digestive organs, the urinary and generative apparatus. diseased processes, therefore, which in these organs it might be difficult or impossible to distinguish from one another, can usually be separated and recognized when appearing in the skin. nor is this differentiation unimportant. the cutaneous covering presents such an extensive surface for the secretion of cuticular scales, hairs, horn, sebaceous matter, sweat, and other excretory matters, that any extensive disorder in its functions may lead to serious internal disease and death. again, the intimate nervous sympathy of different points of the skin with particular internal organs renders certain skin disorders causative of internal disease and certain internal diseases causative of affections of the skin. the mere painting of the skin with an impermeable coating of glue is speedily fatal; a cold draft striking on the chest causes inflammation of the lungs or pleura; a skin eruption speedily follows certain disorders of the stomach, the liver, the kidneys, or even the lungs; simple burns of the skin cause inflammations of internal organs, and inflammation of such organs cause in their turn eruptions on the skin. the relations--nervous, secretory, and absorptive--between the skin and internal organs are most extensive and varied, and therefore a visible disorder in the skin may point at once and specifically to a particular fault in diet, to an injudicious use of cold water when the system is heated, to a fault in drainage, ventilation, or lighting of the stables, to indigestion, to liver disease, to urinary disorder, etc. [illustration: plate xxxviii. the skin and its diseases.] structure of the skin. the skin consists primarily of two parts: ( ) the superficial nonvascular (without blood vessels) layer, the cuticle, or epidermis; and ( ) the deep vascular (with blood vessels) layer, the corium, dermis, or true skin. (see pl. xxxviii, fig. .) the cuticle is made up of cells placed side by side and more or less modified in shape by their mutual compression and by surface evaporation and drying. the superficial stratum consists of the cells dried in the form of scales, which fall off continually and form dandruff. the deep stratum (the mucous layer) is formed of somewhat rounded cells with large central nuclei, and in colored skin containing numerous pigment granules. these cells have prolongations, or branches, by which they communicate with one another and with the superficial layer of cells in the true skin beneath. through these prolongations they receive nutrient liquids for their growth and increase, and pass on liquids absorbed by the skin into the vessels of the true skin beneath. the living matter in the cells exercises an equally selective power on what they shall take up for their own nourishment and on what they shall admit into the circulation from without. thus, certain agents, like iodin and belladonna, are readily admitted, whereas others, like arsenic, are excluded by the sound, unbroken epidermis. between the deep and superficial layers of the epidermis there is a thin, translucent layer (septum lucidum) consisting of a double stratum of cells, and forming a medium of transition from the deep spheroidal to the superficial scaly cuticle. the true skin, or dermis, has a framework of interlacing bundles of white and yellow fibers, large and coarse in the deeper layers, and fine in the superficial, where they approach the cuticle. between the fibrous bundles are left interspaces which, like the bundles, become finer as they approach the surface, and inclose cells, vessels, nerves, glands, gland ducts, hairs, and in the deeper layers fat. the superficial layer of the dermis is formed into a series of minute, conical elevations, or papillæ, projecting into the deep portion of the cuticle, from which they are separated by a very fine transparent membrane. this papillary layer is very richly supplied with capillary blood vessels and nerves, and is at once the seat of acute sensation and the point from which the nutrient liquid is supplied to the cells of the cuticle above. it is also at this point that the active changes of inflammation are especially concentrated; it is the immediately superposed cell layers (mucous) that become morbidly increased in the earlier stages of inflammation; it is on the surface of the papillary layer that the liquid is thrown out which raises the cuticle in the form of a blister, and it is at this point mainly that pus forms in the ordinary pustule. the fibrous bundles of the true skin contain plain, muscular fibers, which are not controlled by the will, but contract under the influence of cold and under certain nervous influences, as in some skin diseases and in the chill of a fever, and lead to contraction, tightening, or corrugation of the skin, contributing to produce the "hidebound" of the horseman. other minute, muscular filaments are extended from the surface of the dermis to the hair follicle on the side to which the hair is inclined, and under the same stimulating influences produce that erection of the hair which is familiarly known as "staring coat." besides these, the horse's skin is furnished with an expansion of red, voluntary muscle, firmly attached to the fibrous bundles, and by which the animal can not only dislodge insects and other irritants, but even shake off the harness. this fleshy envelope covers the sides of the trunk and the lower portions of the neck and head, the parts unprotected by the mane and tail, and serves to throw the skin of these parts into puckers, or ridges, in certain irritating skin diseases. the hairs are cuticular products growing from an enlarged papilla lodged in the depth of a follicle or sac, hollowed out in the skin and extending to its deepest layers. the hair follicle is lined by cells of epidermis, which at the bottom are reflected on the papilla and become the root of the hair. the hair itself is formed of the same kind of cells firmly adherent to one another by a tough, intercellular substance, and overlapping each other, like slates on a roof, in a direction toward the free end. the sebaceous glands are branching tubes ending in follicles or sacs and opening into the hair follicles, lined by a very vascular fibrous network representing the dermis, and an internal layer of cells representing the mucous layer of the cuticle. the oily secretion gives gloss to the hair and prevents its becoming dry and brittle, and keeps the skin soft and supple, protecting it at once against undue exhalation of water and undue absorption when immersed in that medium. besides those connected with the hair follicles there are numerous, isolated, sebaceous glands, opening directly on the surface of the skin, producing a somewhat thicker and more odorous secretion. they are found in large numbers in the folds of the skin, where chafing would be liable if the surface were dry, as on the sheath, scrotum, mammary glands, and inner side of the thigh, around the anus and vulva, in the hollow of the heel, beneath the fine horn of the frog, on the inner side of the elbow, on the lips, nostrils, and eyelids. when closed by dried secretion or otherwise these glands may become distended so as to form various-sized swellings on the skin, and when inflamed they may throw out offensive, liquid discharges, as in "grease," or produce red, tender fungous growths ("grapes.") the sweat glands of the horse, like those of man, are composed of simple tubes, which extend down through the cuticle and dermis in a spiral manner, and are coiled into balls in the deeper layer of the true skin. in addition to their importance in throwing offensive waste products out of the system, these glands tend to cool the skin and the entire economy of the animal through the evaporation of their watery secretion. their activity is therefore a matter of no small moment, as besides regulating the animal heat and excreting impurities, they influence largely the internal organs through the intimate sympathy maintained between them and the skin. diseases of the skin may be conveniently divided, according to their most marked features, into-- ( ) those in which congestion and inflammation are the most marked features, varying according to the grade or form into (a) congestion with simple redness, dryness, and heat, but no eruption (erythema); (b) inflammation with red-pointed elevations, but no blisters (papules); (c) inflammation with fine, conical elevations, each surmounted by a minute blister (vesicle); (d) inflammation with a similar eruption but with larger blisters, like half a pea and upwards (bullæ); (e) inflammation with a similar eruption, but with a small sac of white, creamy pus on the summit of each elevation (pustules); (f) the formation of pustules implicating the superficial layer of the true skin, a small portion of which dies and is thrown off as a slough, or "core" (boils); (g) the formation of round, nodular, transient swellings in the true skin (tubercles); and (h) the excessive production of scales, or dandruff (scaly or squamous affections). ( ) diseases in which there are only deranged sensations of itching, heat, tenderness, etc. (neurosis). ( ) diseased growths, such as warts, callosities, horny growths, cancer, etc. ( ) diseases from parasites, animal and vegetable. ( ) diseases connected with a specific poison, such as horsepox, erysipelas, anthrax, farcy, or cutaneous glanders, etc. ( ) physical injuries, like wounds, burns, scalds, etc. congestion (red efflorescence, or erythema). this is a congested or slightly inflamed condition of the skin, unattended with any eruption. the part is slightly swollen, hot, tender, or itchy, and dry, and if the skin is white there is redness. the redness is effaced by pressure, but reappears instantly when it is removed. except in transient cases the hairs are liable to be shed. it may be looked on as the first stage of inflammation, and therefore when it becomes aggravated it may merge in part or in whole into a papular, vesicular, or pustular eruption. erythema may arise from a variety of causes, and is often named in accordance with its most prominent cause. thus the chilling, or partial freezing, of a part will give rise to a severe reaction and congestion. when snowy or icy streets have been salted this may extend to severe inflammation, with vesicles, pustules, or even sloughs of circumscribed portions of the skin of the pastern (chilblain, frost-bite). heat and burning have a similar effect, and this often comes from exposure to the direct rays of the sun. the skin that does not perspire is the most subject, and hence the white face or white limb of a horse becoming dried by the intensity of the sun's rays often suffers to the exclusion of the rest of the body (white face and foot disease). the febrile state of the general system is also a potent cause; hence the white-skinned horse is rendered the more liable if kept on a heating ration of buckwheat, or even of wheat or maize. contact of the skin with oil of turpentine or other essential oils, with irritant liquids, vegetable or mineral, with rancid fats, with the acrid secretions of certain animals, like the irritating toad, with pus, sweat, tears, urine, or liquid feces, will produce congestion or even inflammation. chafing is a common cause, and is especially liable to affect the fat horse between the thighs, by the side of the sheath or scrotum, on the inner side of the elbow, or where the harness chafes on the poll, shoulder, back, breastbone, and under the tail. the accumulation of sweat and dust between the folds of the skin and on the surface of the harness, and the specially acrid character of the sweat in certain horses, contribute to chafing or "intertrigo." the heels often become congested owing to the irritation caused by the short, bristly hairs in clipped heels. again, congestion may occur from friction by halter, harness, or other foreign body under the pastern, or inside the thigh or arm, or by reason of blows from another foot (cutting, interfering, overreach). finally, erythema is especially liable to occur in spring, when the coat is being shed, and the hair follicles and general surface are exposed and irritable in connection with the dropping of the hairs. if due only to a local irritant, congestion will usually disappear when the cause has been removed, but when the feeding or system is at fault these conditions must be first corrected. while the coat is being shed the susceptibility will continue, and the aim should be to prevent the disease from developing and advancing so as to weaken the skin, render the susceptibility permanent, and lay the foundation of persistent or frequently recurring skin disease. therefore at such times the diet should be nonstimulating, any excess of grain, and above all of buckwheat, indian corn, or wheat, being avoided. a large grain ration should not be given at once on return from hard work, when the general system and stomach are unable to cope with it; the animal should not be given more than a swallow or two of cold water when perspiring and fatigued, nor should he be allowed a full supply of water just after his grain ration; he should not be overheated or exhausted by work, nor should dried sweat and dust be allowed to accumulate on the skin or on the harness pressing on it. the exposure of the affected heels to damp, mud, and snow, and, above all, to melting snow, should be guarded against; light, smooth, well-fitting harness must be obtained, and where the saddle or collar irritates an incision should be made in them above and below the part that chafes, and, the padding between having been removed, the lining should be beaten so as to make a hollow. a zinc shield in the upper angle of the collar will often prevent chafing in front of the withers. _treatment._--wash the chafed skin and apply salt water (one-half ounce to the quart), extract of witch-hazel, a weak solution of oak bark, or camphorated spirit. if the surface is raw use bland powders, such as oxid of zinc, lycopodium, starch, or smear the surface with vaseline, or with ounce of vaseline intimately mixed with one-half dram each of opium and sugar of lead. in cases of chafing rest must be strictly enjoined. if there is constitutional disorder or acrid sweat, ounce cream of tartar or a teaspoon of bicarbonate of soda may be given twice daily. congestion, with small pimples, or papules. in this affection there is the general blush, heat, etc., of erythema, together with a crop of elevations from the size of a poppy seed to a coffee bean, visible when the hair is reversed or to be felt with the finger where the hair is scanty. in white skins they vary from the palest to the darkest red. all do not retain the papular type, but some go on to form blisters (eczema, bullæ) or pustules, or dry up into scales, or break out into open sores, or extend into larger swellings (tubercles). the majority, however, remaining as pimples, characterize the disease. when very itchy the rubbing breaks them open, and the resulting sores and scales hide the true nature of the eruption. the general and local causes may be the same as for erythema, and in the same subject one portion of the skin may have simple congestion and another adjacent papules. as the inflammatory action is more pronounced, so the irritation and itching are usually greater, the animal rubbing and biting himself severely. this itching is especially severe in the forms which attack the roots of the mane and tail, and there the disease is often so persistent and troublesome that the horse is rendered virtually useless. the bites of insects often produce a papular eruption, but in many such cases the swelling extends wider into a buttonlike elevation, one-half to an inch in diameter. the same remarks apply to the effects of the poison ivy and poison sumac. _treatment._--in papular eruption first remove the cause, then apply the same general remedies as for simple congestion. in the more inveterate cases use a lotion of one-half ounce sulphid of potassium in quarts of water, to which a little castile soap has been added, or use a wash with one-half ounce oil of tar, ounces castile soap, and ounces water. inflammation with blisters, or eczema. in this the skin is congested, thickened, warm (white skins are reddened), and shows a thick crop of little blisters formed by effusions of a straw-colored fluid between the true skin and the cuticle. the blisters may be of any size from a millet seed to a pea, and often crack open and allow the escape of the fluid, which concretes as a slightly yellowish scab or crust around the roots of the hairs. this exudation and the incrustation are especially common where the hairs are long, thick, and numerous, as in the region of the pastern of heavy draft horses. the term eczema is now applied very generally to eruptions of all kinds that depend on internal disorders or constitutional conditions and that tend to recurrences and inveteracy. eczema may appear on any part of the body, but in horses it is especially common on the heels and the lower parts of the limbs, and less frequently on the neck, shoulder, and abdomen. the limbs appear to be especially liable because of their dependent position, all blood having to return from them against the action of gravity and congestions and swellings being common, because of the abundance of blood vessels in this part of the skin and because of the frequent contact with the irritant dung and urine and their ammoniacal emanations. the legs further suffer from contact with wet and mud when at work, from snow and ice, from drafts of cold air on the wet limbs, from washing with caustic soaps, or from the relaxing effects of a too deep and abundant litter. among other causes may be named indigestion and the presence of irritant matters in the blood and sweat, the result of patent medicated feeds and condition powders (aromatics, stimulants), green food, new hay, new oats, buckwheat, wheat, maize, diseased potatoes, smut, or ergot in grains, decomposing green feed, brewers' grains, or kitchen garbage. the excitement in the skin, caused by shedding the coat, lack of grooming, hot weather, hot, boiled, or steamed feed conduces to the eruption. lastly, any sudden change of feed may induce it. the blisters may in part go on to suppuration so that vesicles and pustules often appear on the same patch, and, when raw from rubbing, the true nature of the eruption may be completely masked. in well-fed horses, kept in close stables with little work, eczema of the limbs may last for months and years. it is a very troublesome affection in draft stallions. _treatment._--this disease is so often the result of indigestion that a laxative of pound glauber's salt in or quarts water or - / pints olive oil is often demanded to clear away irritants from the alimentary canal. following this, in recent and acute cases, give drams of acetate or bicarbonate of potash twice a day in the drinking water. if the bowels still become costive, give daily ounce sulphate of soda and grains of powdered nux vomica. in debilitated horses combine the nux vomica with one-half ounce powdered gentian root. as a wash for the skin use dram bicarbonate of soda and dram carbolic acid in a quart of water, after having cleansed the surface with tepid water. employ the same precautions as regards feeding, stabling, and care of harness as in simple congestion of the skin. in the more inveterate forms of eczema more active treatment is required. soak the scabs in fresh sweet oil, and in a few hours remove these with tepid water and castile soap; then apply an ointment of sulphur or iodid of sulphur day by day. if this seems to be losing its effect after a week, change for mercurial ointment or a solution of sulphid of potassium, or of hyposulphite of soda, drams to the quart of water. in these cases the animal may take a course of sulphur ( ounce daily), bisulphite of soda (one-half ounce daily), or of arsenic ( grains daily) mixed with dram bicarbonate of soda. inflammation with pustules. in this affection the individual elevations on the inflamed skin show in the center a small sac of white, creamy pus, in place of the clear liquid of a blister. they vary in size from a millet seed to a hazelnut. the pustules of glanders (farcy buds) are to be distinguished by the watery contents and the cordlike swelling, extending from the pustules along the line of the veins, and those of boils by the inflammation and sloughing out of a core of the true skin. the hair on the pustule stands erect, and is often shed with the scab which results. when itching is severe the parts become excoriated by rubbing, and, as in the other forms of skin disease, the character of the eruption may become indistinct. old horses suffer mainly at the root of the mane and tail and about the heels, and suckling foals around the mouth, on the face, inside the thighs, and under the tail. pustules, like eczema, are especially liable to result from unwholesome feed and indigestion, from a sudden change of feed--above all, from dry to green. in foals it may result from overheating of the mare and allowing the first milk after she returns, or by milk rendered unwholesome by faulty feeding of the dam. if a foal is brought up by hand the souring and other decompositions in the milk derange the digestion and cause such eruption. vetches and other plants affected with honeydew and buckwheat have been the cause of these eruptions on white portions of the skin. disorders of the kidneys or liver are common causes of this affection. _treatment._--apply soothing ointments, such as benzonated oxid of zinc, or vaseline with dram oxid of zinc in each ounce. or a wash of dram sugar of lead or drams hyposulphite of soda in a quart of water may be freely applied. if the skin is already abraded and scabby, smear thickly with vaseline for some hours, then wash with soapsuds and apply the above dressings. when the excoriations are indolent they may be painted with a solution of lunar caustic grains to ounce of distilled water. internally counteract costiveness and remove intestinal irritants by the same means as in eczema, and follow this with one-half ounce doses daily of hyposulphite of soda, and one-half ounce doses of gentian. inveterate cases may often be benefited by a course of sulphur, bisulphite of soda, or arsenic. in all, the greatest care must be taken with regard to feed, feeding, watering, cleanliness, and work. in wet and cold seasons predisposed animals should, so far as possible, be protected from wet, mud, snow, and melted snow--above all, from that which has been melted by salt. boils, or furuncles. these may appear on any part of the skin, but are especially common on the lower parts of the limbs, and on the shoulders and back where the skin is irritated by accumulated secretion and chafing with the harness. in other cases the cause is constitutional, or attended with unwholesome diet and overwork with loss of general health and condition. they also follow on weakening diseases, notably strangles, in which irritants are retained in the system from overproduction of poisons and effete matter during fever, and imperfect elimination. there is also the presence of a pyogenic bacterium, by which the disease may be maintained and propagated. while boils are pus producing, they differ from simple pustule in affecting the deepest layers of the true skin, and even the superficial layers of the connective tissues beneath, and in the death and sloughing out of the central part of the inflamed mass (core). the depth of the hard, indurated, painful swelling, and the formation of this central mass or core, which is bathed in pus and slowly separated from surrounding parts, serve to distinguish the boil alike from the pustule, from the farcy bud, and from a superficial abscess. _treatment._--to treat very painful boils a free incision with a lancet in two directions, followed by a dressing with one-half an ounce carbolic acid in a pint of water, bound on with cotton wool or lint, may cut them short. the more common course is to apply a warm poultice of linseed meal or wheat bran, and renew daily until the center of the boil softens, when it should be lanced and the core pressed out. if the boil is smeared with a blistering ointment of spanish flies and a poultice put over it, the formation of matter and separation of the core is often hastened. a mixture of sugar and soap laid on the boil is equally good. cleanliness of the skin and the avoidance of all causes of irritation are important items, and a teaspoonful of bicarbonate of soda once or twice a day will sometimes assist in warding off a new crop. nettlerash (surfeit, or urticaria). this is an eruption in the form of cutaneous nodules, in size from a hazelnut to a hickory nut, transient, with little disposition to the formation of either blister or pustule, and usually connected with shedding of the coat, sudden changes of weather, and unwholesomeness or sudden change in the feed. it is most frequent in the spring and in young and vigorous animals (good feeders). the swelling embraces the entire thickness of the skin and terminates by an abrupt margin in place of shading off into surrounding parts. when the individual swellings run together there are formed extensive patches of thickened integument. these may appear on any part of the body, and may be general; the eyelids may be closed, the lips rendered immovable, or the nostrils so thickened that breathing becomes difficult and snuffling. it may be attended with constipation or diarrhea or by colicky pains. the eruption is sudden, the whole skin being sometimes covered in a few hours, and it may disappear with equal rapidity or persist for six or eight days. _treatment._--this consists in clearing out the bowels by drams barbados aloes, or pound glauber's salt, and follow the operation of these by daily doses of one-half ounce powdered gentian and ounce glauber's salt. a weak solution of alum may be applied to the swellings. pityriasis, or scaly skin disease. this affection is characterized by an excessive production and detachment of dry scales from the surface of the skin (dandruff). it is usually dependent on some fault in digestion and an imperfect secretion from the sebaceous glands and is most common in old horses with spare habit of body. williams attributes it to feed rich in saccharine matter (carrots, turnips) and to the excretion of oxalic acid by the skin. he has found it in horses irregularly worked and well fed and advises the administration of pitch for a length of time and the avoidance of saccharine feed. otherwise the horse may take a laxative followed by dram doses of carbonate of potash, and the affected parts may be bathed with soft, tepid water and smeared with an ointment made with vaseline and sulphur. in obstinate cases sulphur may be given daily in the feed. pruritus, or nervous irritation of the skin. this is seen in horses fed to excess on grain and hay, kept in close stables, and worked irregularly. though most common in summer, it is often severe in hot, close stables in winter. pimples, vesicles, and abrasions may result, but as the itching is quite as severe on other parts of the skin, these may be the result of scratching merely. it is especially common and inveterate about the roots of the mane and tail. _treatment_ consists in a purgative (glauber's salt, pound), restricted, laxative diet, and a wash of water slightly soured with oil of vitriol and rendered sweet by carbolic acid. if obstinate, give daily ounce of sulphur and grains nux vomica. if the acid lotion fails, drams carbonate of potash and grains of cyanid of potassium in a quart of water will sometimes benefit. if from pinworms in the rectum, the itching of the tail may be remedied by an occasional injection of a quart of water in which chips of quassia wood have been steeped for hours. herpes. this name has been applied to a disease in which there is an eruption of minute vesicles in circular groups or clusters, with little tendency to burst, but rather to dry up into fine scabs. if the vesicles break, they exude a slight, gummy discharge which concretes into a small, hard scab. it is apparently noncontagious and not appreciably connected with any disorder of internal organs. it sometimes accompanies or follows specific fevers, and is, on the whole, most frequent at the seasons of changing the coat--spring and autumn. it is seen on the lips and pastern, but may appear on any part of the body. the duration of the eruption is two weeks or even more, the tendency being to spontaneous recovery. the affected part is very irritable, causing a sensitiveness and a disposition to rub out of proportion to the extent of the eruption. _treatment._--it may be treated by oxid of zinc ointment, and to relieve the irritation a solution of opium or belladonna in water, or of sugar of lead or oil of peppermint. a course of bitters (one-half an ounce of peruvian bark daily for a week) may be serviceable in bracing the system and producing an indisposition to the eruption. bleeding skin eruptions, or dermatorrhagia parasitica. in china, hungary, spain, and other countries horses frequently suffer from the presence of a threadworm (_filaria hæmorrhagica_ railliet, _f. multipapillosa_ condamine and drouilly) in the subcutaneous connective tissue, causing effusions of blood under the scurf skin and incrustations of dried blood on the surface. the eruptions, which appear mainly on the sides of the trunk, but may cover any part of the body, are rounded elevations about the size of a small pea, containing blood which bursts through the scurf skin and concretes like a reddish scab around the erect, rigid hairs. these swellings appear in groups, which remain out for several days, gradually diminishing in size; new groups appear after an interval of three or four weeks, the manifestation being confined to three or four months of spring and disappearing in winter. a horse will suffer for several years in succession and then permanently recover. a fatal issue is not unknown. to find the worm the hair is shaved from the part where the elevations are felt, and as soon as a bleeding point is shown the superficial layer is laid open with the knife, when the parasite will be seen drawing itself back into the parts beneath. the worm is about inches long and like a stout thread, thicker toward the head than toward the tail, and with numerous little conical elevations (papillæ) around the head. the young worms are numerous in the body of the adult female worm. the worm has become common in given localities, and probably enters the system with feed or water. _treatment_ is not satisfactory, but the affected surface should be kept clean by sponging, and the pressure of harness on any affected part must be avoided. thus rest may become essential. the part may be frequently washed with a strong solution of potassium sulphid. summer sores from filaria irritans. the summer sores of horses (dermatitis granulosa, boils) have been traced to the presence in the skin of another parasite, millimeters in length and extremely attenuated (_filaria irritans_ railliet). the sores may be seen as small as a millet seed, but more frequently the size of a pea, and may become an inch in diameter. they may appear on any point, but are especially obnoxious where the harness presses or on the lower parts of the limbs. they cause intense and insupportable itching, and the victim rubs and bites the part until extensive raw surfaces are produced. aside from such friction the sore is covered by a brownish-red, soft, pulpy material with cracks or furrows filled with serous pus. in the midst of the softened mass are small, firm, rounded granulations, fibrinous, and even caseated, and when the soft, pultaceous material has been scraped off, the surface bears a resemblance to the fine, yellow points of miliary tuberculosis in the lung. the worm or its débris is found in the center of such masses. these sores are very obstinate, resisting treatment for months in summer, and even after apparent recovery during the cold season they may appear anew the following summer. in bad cases the rubbing and biting may cause exposure of synovial sacs and tendons, and cause irremediable injury. even in winter, however, when the diseased process seems arrested, there remain the hard, firm, resistant patches of the skin with points in which the diseased product has become softened like cheese. the apparent subsidence of the disease in winter is attributed to the coldness and comparative bloodlessness of the skin, whereas in summer, with high temperature, active circulation, and rapid cell growth, inflammation is increased, itching follows, and from the animal rubbing the part the irritation is persistently increased. the hotter the climate the more troublesome the disease.[ ] _treatment_ consists, first, in placing the animal in a cool place and showering the surface with cold water. the parasite may be destroyed by rubbing the surface of the wound with iodoform and covering it with a layer of collodion, and repeating the applications very hours for days, or until the sores heal up. ether or chloroform, poured on cotton wool and applied to the sore for two minutes before painting it with collodion, may be used in place of iodoform.[ ] cracked heels (scratches, or chaps on knee and hock). this usually sets in with swelling, heat, and tenderness of the hollow of the heel, with erections of the hairs and redness (in white skins), with stiffness and lameness, which may be extreme in irritable horses. soon slight cracks appear transversely, and may gain in depth and width, and may even suppurate. more frequently they become covered at the edges or throughout by firm incrustations resulting from the drying of the liquids thrown out, and the skin becomes increasingly thick and rigid. a similar condition occurs behind the knee and in front of the hock (malanders and salanders), and may extend from these points to the hoof, virtually incasing that side of the limb in a permanent incrusting sheath. _causes._--besides a heavy lymphatic constitution, which predisposes to this affection, the causes are overfeeding on grain, unwholesome fodder, close, hot, dirty stables, constant contact with dung and urine and their emanations, working in deep, irritant mud; above all, in limestone districts, irritation by dry limestones or sandy dust in dry weather on dirt roads; also cold drafts, snow, and freezing mud, washing the legs with caustic soap, wrapping the wet legs in thick woolen bandages which soak the skin and render it sensitive when exposed next day, clipping the heels, weak heart and circulation, natural or supervening on overwork, imperfect nourishment, impure air, lack of sunshine, chronic exhausting, or debilitating diseases, or functional or structural diseases of the heart, liver, or kidneys. these last induce dropsical swelling of the limbs (stocking), weaken the parts, and induce cracking. finally the cicatrix of a preexisting crack, weak, rigid, and unyielding, is liable to reopen under any severe exertion; hence rapid paces and heavy draft are active causes. _treatment._--in treatment the first step is to ascertain and remove the cause whenever possible. if there is much local heat and inflammation, a laxative ( drams aloes or pound glauber's salt) may be given, and for the pampered animal the grain should be reduced or replaced altogether by bran mashes, flaxseed, and other laxative, nonstimulating feed. in the debilitated, on the other hand, nutritious food and bitter tonics may be given, and even a course of arsenic ( grains arsenic with dram bicarbonate of soda daily). when the legs swell, exercise on dry roads, hand rubbing, and evenly applied bandages are good, and mild astringents, like extract of witch-hazel, may be applied and the part subsequently rubbed dry and bandaged. if there is much heat but unbroken skin, a lotion of drams sugar of lead to quart of water may be applied on a thin bandage, covered in cold weather with a dry one. the same may be used after the cracks appear, or a solution of sulphurous acid part, glycerin part, and water part, applied on cotton and well covered by a bandage. in case these should prove unsuitable to the particular case, the part may be smeared with vaseline ounce, sugar of lead dram, and carbolic acid drops. inflammation of the heels with sebaceous secretion (grease, or canker). this is a specific affection of the heels of horses usually associated with the growth of a parasitic fungus, an offensive discharge from the numerous sebaceous glands, and, in bad cases, the formation of red, raw excrescences (grapes) from the surface. it is to be distinguished ( ) from simple inflammation in which the special fetid discharge and the tendency to the formation of "grapes" are absent; ( ) from horsepox, in which the abundant exudate forms a firm, yellow incrustation around the roots of the hair, and is embedded at intervals in the pits formed by the individual pocks, and in which there is no vascular excrescence; ( ) from foot scabies (mange), in which the presence of an acarus is distinctive; ( ) from lymphangitis, in which the swelling appears suddenly, extending around the entire limb as high as the hock, and on the inner side of the thigh along the line of the vein to the groin, and in which there is active fever, and ( ) from erysipelas, in which there is active fever (wanting in grease), the implication of the deeper layers of the skin and of the parts beneath giving a boggy feeling to the parts, the absence of the fetid, greasy discharge, and finally a tendency to form pus loosely in the tissues without any limiting membrane, as in abscess. another distinctive feature of grease is its tendency to implicate the skin which secretes the bulbs or heels of the horny frog and in the cleft of the frog, constituting the disease known as canker. _causes._--the predisposing causes of grease are essentially the same as those of simple inflammation of the heel, so that the reader may consult the preceding section. though a specific fungus and bacteria of different kinds are present, they tend mainly to aggravation of the disease, and are not proved to be essential factors in causation. _symptoms._--the symptoms vary according to whether the disease comes on suddenly or more tardily. in the first case there is a sudden swelling of the skin in the heel, with heat, tenderness, itching, and stiffness, which is lessened during exercise. in the slower forms there is seen only a slight swelling after rest, and with little heat or inflammation for a week or more. even at this early stage, a slight, serous oozing may be detected. as the swelling increases, extending up toward the hock or knees, the hairs stand erect, and are bedewed by moisture no longer clear and odorless, but grayish, milky, and fetid. the fetor of the discharge draws attention to the part whenever one enters the stable, and the swollen pastern and wet, matted hairs on the heel draw attention to the seat of the malady. if actively treated, the disease may not advance further, but if neglected the tense, tender skin cracks open, leaving open sores from which vascular bleeding growths grow up, constituting the "grapes." the hair is shed, and the heel may appear but as one mass of rounded, red, angry excrescences which bleed on handling and are covered with the now repulsively fetid, decomposing discharge. during this time there is little or no fever, the animal feeds well, and but for its local trouble it might continue at work. when the malady extends to the frog, there is a fetid discharge from its cleft or from the depressions at its sides, and this gradually extends to its whole surface and upon the adjacent parts of the sole. the horn meanwhile becomes soft, whitish, and fleshy in aspect, its constituent tubes being greatly enlarged and losing their natural cohesion; it grows rapidly above the level of the surrounding horn, and when pared is found to be penetrated to an unusual depth by the secreting papillæ, and that at intervals these have bulged out into a vascular fungous mass comparable to the "grapes." _treatment._--in treatment hygienic measures occupy a front rank, but are in themselves insufficient to establish a cure. all local and general conditions which favor the production and persistence of the disease must be guarded against. above all, cleanliness and purity of the stable and air must be obtained; also nourishing diet, regular exercise, and the avoidance of local irritants--septic, muddy, chilling, etc. at the outset benzoated oxid of zinc ointment may be used with advantage. a still better dressing is made with ounce vaseline, drams oxid of zinc, and drops iodized phenol. if the surface is much swollen and tender, a flaxseed poultice may be applied, over the surface of which has been poured some of the following lotion: sugar of lead, one-half ounce; carbolic acid, dram; water, quart. all the astringents of the pharmacopoeia have been employed with more or less advantage, and some particular one seems to suit particular cases or patients. to destroy the grapes, they may be rubbed daily with strong caustics (copperas, bluestone, lunar caustic), or each may be tied round its neck with a stout, waxed thread, or, finally and more speedily, they may be cut off by a black-smith's shovel heated to redness and applied with its sharp edge toward the neck of the excrescence, over a cold shovel held between it and the skin to protect the skin from the heat. the cold shovel must be kept cool by frequent dipping in water. after the removal of the grapes the astringent dressing must be persistently applied to the surface. when the frog is affected, it must be pared to the quick and dressed with dry caustic powders (quicklime, copperas, bluestone) or carbolic acid and subjected to pressure, the dressing being renewed every day at least. erysipelas. this is a specific contagious disease, characterized by spreading, dropsical inflammation of the skin and subcutaneous tissues, attended with general fever. it differs from most specific diseases in the absence of a definite period of incubation, a regular course and duration, and a conferring of immunity on the subject after recovery. on the contrary, one attack of erysipelas predisposes to another, partly, doubtless, by the loss of tone and vitality in the affected tissues, but also, perhaps, because of the survival of the infecting germ. _cause._--it is no longer to be doubted that the microbes found in the inflammatory product are the true cause of erysipelas, as by their means the disease can be successfully transferred from man to animals and from one animal to another. this transition may be direct or through the medium of infected buildings or other articles. yet from the varying severity of erysipelas in different outbreaks and localities it has been surmised that various different microbes are operative in this disease, and a perfect knowledge of them might perhaps enable us to divide erysipelas into two or more distinct affections. at present we must recognize it as a specific inflammation due to a bacterial poison and closely allied to septicemia. erysipelas was formerly known as surgical when it spread from a wound (through which the germ had gained access) and medical, or idiopathic, when it started independently of any recognizable lesion. depending as it does, however, upon a germ distinct from the body, the disease must be looked upon as such, no matter by what channel the germ found an entrance. erysipelas which follows a wound is usually much more violent than the other form, the difference being doubtless partly due to the lowered vitality of the wounded tissues and to the oxidation and septic changes which are invited on the raw, exposed surface. as apparently idiopathic cases may be due to infection through bites of insects, the small amount of poison inserted may serve to moderate the violence. this affection may attack a wound on any part of the horse's body, while, apart from wounds, it is most frequent about the head and the hind limbs. it is to be distinguished from ordinary inflammations by its gradual extension from the point first attacked, by the abundant liquid exudation into the affected part, by the tension of the skin over the affected part, by its soft, boggy feeling, allowing it to be deeply indented by the finger, by the abrupt line of limitation between the diseased and the healthy skin, the former descending suddenly to the healthy level instead of shading off slowly toward it, by the tendency of the inflammation to extend deeply into the subjacent tissues and into the muscles and other structures, by the great tendency to death and sloughing of portions of skin and of the structures beneath, by the formation of pus at various different points throughout the diseased parts without any surrounding sac to protect the surrounding structures from its destructive action, and without the usual disposition of pus to advance harmlessly toward the surface and escape; and, finally, by a low, prostrating type of fever, with elevated temperature of the body, coated tongue, excited breathing, and loss of appetite. the pus when escaping through a lancet wound is grayish, brownish, or reddish, with a heavy or fetid odor, and inter-mixed with shreds of broken-down tissues. the most destructive form, however, is that in which pus is deficient and gangrene and sloughing more speedy and extensive. _treatment_ resolves itself mainly into the elimination from the system of the poisonous products of the bacteria by laxatives and diuretics, the sustaining of the failing vitality by tonics and stimulants, above all those of the nature of antiferments, and the local application of astringent and antiseptic agents. internal treatment may consist in drams tincture of muriate of iron and one-half dram muriate of ammonia or chlorate of potash, given in a pint of water every two hours. to this may be added, liberally, whisky or brandy when the prostration is very marked. locally a strong solution of iron, alum, or of sulphate of iron and laudanum may be used; or the affected part may be painted with tincture of muriate of iron or with iodized phenol. in mild cases a lotion of drams sugar of lead and ounces laudanum in a quart of water may be applied. it is desirable to avoid the formation of wounds and the consequent septic action, yet when pus has formed and is felt by fluctuation under the finger to be approaching the surface it should be freely opened with a clean, sharp lancet, and the wound thereafter disinfected daily with carbolic acid part to water parts, with a saturated solution of hyposulphite of soda, or with powders of iodoform or salol. horsepox, anthrax, and cutaneous glanders (farcy). these subjects are discussed under the head of contagious diseases. callosities. these are simple thickening and induration of the cuticle by reason of continued pressure, notably in lying down on a hard surface. being devoid of hair, they cause blemishes; hence, smooth floors and good bedding should be provided as preventives. horny sloughs (sitfasts), or sloughing callosities. these are circumscribed sloughs of limited portions of the skin, the result of pressure by badly fitting harness or by irritating masses of dirt, sweat, and hairs under the harness. they are most common under the saddle, but may be found under collar or breeching as well. the sitfast is a piece of dead tissue which would be thrown off but that it has formed firm connections with the fibrous skin beneath, or even deeper with the fibrous layers (fascia) of the muscles, or with the bones, and is thus bound in its place as a persistent source of irritation. the hornlike slough may thus involve the superficial part of the skin only, or the whole thickness of the skin, and even of some of the structures beneath. the first object is to remove the dead irritant by dissecting it off with a sharp knife, after which the sore may be treated with simple wet cloths or a weak carbolic-acid lotion, like a common wound. if the outline of the dead mass is too indefinite, a linseed-meal poultice will make its outline more evident to the operator. if the fascia or bone has become gangrenous, the dead portion must be removed with the hornlike skin. during and after treatment the horse must be kept at rest or the harness must be so adjusted that no pressure can come near the affected parts. (see also page .) warts. these are essentially a morbid overgrowth of the superficial papillary layer of the skin and of the investing cuticular layer. they are mostly seen in young horses, about the lips, eyelids, cheeks, ears, beneath the belly, and on the sheath, but may develop anywhere. the smaller ones may be clipped off with scissors and the raw surface cauterized with bluestone. the larger may be sliced off with a sharp knife, or if with a narrow neck they may be twisted off and then cauterized. if very vascular they may be strangled by a wax thread or cord tied around their necks, at least three turns being made around and the ends being fixed by passing them beneath the last preceding turn of the cord, so that they can be tightened day by day as they slacken by shrinkage of the tissues. if the neck is too broad it may be transfixed several times with a double-threaded needle and then be tied in sections. very broad warts that can not be treated in this way may be burned down with a soldering bolt at a red heat to beneath the surface of the skin, and any subsequent tendency to overgrowth kept down by bluestone. black pigment tumors, or melanosis. these are common in gray and in white horses on the naturally black parts of the skin at the roots of the tail, around the anus, vulva, udder, sheath, eyelids, and lips. they are readily recognized by their inky-black color, which extends throughout the whole mass. they may appear as simple, pealike masses, or as multiple tumors aggregating many pounds, especially around the tail. in the horse these are usually simple tumors, and may be removed with the knife. in exceptional cases they prove cancerous, as they usually are in man. epithelial cancer, or epithelioma. this sometimes occurs on the lips at the angle of the mouth and elsewhere in the horse. it begins as a small, wartlike tumor, which grows slowly at first, but finally bursts open, ulcerates, and extends laterally and deeply in the skin and other tissues, destroying them as it advances (rodent ulcer). it is made up of a fibrous framework and numerous round, ovoid, or cylindrical cavities, lined with masses of epithelial cells, which may be squeezed out as a fetid, caseous material. early and thorough removal with the knife is the most successful treatment. vegetable parasites of the skin. (pl. xxxviii, figs. , , .) parasite: _trichophyton tonsurans._ malady: _tinea tonsurans, or circinate ringworm._--this is especially common in young horses coming into training and work, in low-conditioned colts in winter and spring after confinement indoors, during molting, in lymphatic rather than nervous subjects, and at the same time in several animals that have herded together. the disease is common to man, and among the domestic animals to horse, ox, goat, dog, cat, and in rare instances to sheep and swine. hence it is common to find animals of different species and their attendants suffering at once, the diseases having been propagated from one to the other. _symptoms._--in the horse the symptoms are the formation of a circular, scurfy patch where the fungus has established itself, the hairs of the affected spot being erect, bristly, twisted, broken, or split up and dropping off. later the spot first affected has become entirely bald, and a circular row of hairs around this are erect, bristly, broken, and split. these in turn are shed and a new row outside passes through the same process, so that the extension is made in more or less circular outline. the central bald spot, covered with a grayish scurf and surrounded by a circle of broken and split hairs, is characteristic. if the scurf and diseased hairs are treated with caustic-potash solution and put under the microscope, the natural cells of the cuticle and hair will be seen to have become transparent, while the groups of spherical cells and branching filaments of the fungus stand out prominently in the substance of both, dark and unchanged. the eruption usually appears on the back, loins, croup, chest, and head. it tends to spontaneous recovery in a month or two, leaving for a time a dappled coat from the spots of short, light-colored hair of the new growth. the most effective way of reaching the parasite in the hair follicles is to extract the hairs individually, but in the horse the mere shaving of the affected part is usually enough. it may then be painted with tincture of iodin twice a day for two weeks. germs about the stable may be covered up or destroyed by a whitewash of freshly burned quicklime, the harness, brushes, etc., may be washed with caustic soda, and then smeared with a solution of corrosive sublimate one-half dram and water pint. the clothing may be boiled and dried. parasite: _achorion schönleini._ malady: _favus, or honeycomb ringworm._--mégnin and goyau, who describe this in the horse, say that it loses its characteristic honeycomb or cup-shaped appearance, and forms only a series of closely aggregated, dry, yellowish crusts the size of hemp seed on the trunk, shoulders, flanks, or thighs. they are accompanied by severe itching, especially at night. the cryptogam, formed of spherical cells with a few filaments only, grows in the hair follicles and on the cuticle, and thus a crust often forms around the root of a hair. like the other cryptogams, their color, as seen under the microscope, is unaffected by acetic acid, alcohol, ether, or oil of turpentine, while the cells are turned bluish by iodin. for treatment, remove the hair and apply tincture of iodin or corrosive sublimate lotion, as advised under the last paragraph. parasite: _microsporon furfur._ malady: _parasitic pityriasis._--this attacks the horse's head where the harness presses, and leads to dropping of the hair, leaving bald patches covered with a branlike scurf, without any eruption, heat, tenderness, swelling, or rigidity of the skin. a lotion of carbolic acid dram and water - / ounces is usually applied to effect a cure. animal parasites of the skin.[ ] acariasis, or mange. this affection is due to the irritation of the skin caused by the presence of nearly microscopic acari, or mites. the disease varies, however, according to the species of acarus which infests the skin, so that we must treat of several different kinds of acariasis. parasite: _sarcoptes scabiei equi._ malady: _sarcoptic acariasis._--this is the special _sarcoptes_ of the horse, but under favorable conditions it can be transmitted to ass and mule, and even to man, and may live indefinitely on the human skin. the mite (pl. xxxix, fig. ) is nearly microscopical, but may be detected with a magnifying lens among moving scurf taken from the infected skin. like all _sarcoptes_, it burrows little galleries in and beneath the scurf skin, where it hides and lays its eggs and where its young are hatched. it is therefore often difficult to find the parasite on the surface, unless the skin has been heated by a temporary exposure to the sun or in a warm room. the mite may be detected more readily by placing scrapings on black cardboard and warming, or better by macerating scabs or scrapings in a solution of caustic soda or potash and then examining them microscopically. like other acari, this is wonderfully prolific, a new generation of fifteen individuals being possible every fifteen days, so that in three months the offspring of a single pair may produce generations aggregating , , young. the _sarcoptes_ have less vitality than the nonburrowing acari, as they die in an hour when kept apart from the skin in dry air at a heat of ° f. they live to days apart from the skin in the damp air of a stable. on a piece of damp hide they lived till the twenty-fourth day, when they began to die, and all were dead on the twenty-eighth. _symptoms._--the symptoms are an incessant, intolerable, and increasing itching of some part of the skin (head, mane, tail, back, etc.), the horse inclining himself toward the hand that scratches him, and moving his lips as if himself scratching. the hairs may be broken and rubbed off, but the part is never entirely bald, as in ringworm, and there may be papules or any kind of eruption or open sores from the energy of the scratching. scabs of any thickness may form, but the special features are the intense itching and the presence of the acarus. _treatment_ consists in the removal of the scabs by soapsuds, and, if necessary, a brush and the thorough application of tobacco - / ounces and water pints, prepared by boiling. this may be applied more than once, and should always be repeated after days, to destroy the new brood that may have been hatched in the interval. all harness and stable utensils should be similarly treated; blankets and rubbers may be boiled, and the stalls should be covered with a whitewash of quicklime, containing one-fourth pound of chlorid of lime to the gallon. when there are too many animals to treat by means of hand dressings, the lime-and-sulphur dip or the tobacco dip may be used and are very effective, though the cresol dips are fairly effective. these dips may be purchased and made up in the dilution called for on the container. the affected animals may be dipped when the number warrants it and facilities are available; otherwise the dips may be applied with a swab or a spray pump. directions for constructing a dipping vat may be obtained from the united states department of agriculture on application. any treatment used should be repeated in the course of to days. if the stables are not disinfected, animals should be removed after treatment and put in clean stables or on clean pasture for at least a month to allow the mites in the infested stables to die. otherwise the disease may recur. parasite: _psoroptes equi_ (_dermatocoptes equi_, _dermatodectes equi_). malady: _psoroptic acariasis._--psoroptic mange is less common than sarcoptic mange in horses, and as the parasite (pl. xxxix, fig. ) only bites the surface and lives among the crusts under the shelter of the hair, it is very easily discovered. it reproduces itself with equal rapidity and causes similar symptoms to those produced by the _sarcoptes_. the same treatment will suffice and is more promptly effectual. the purifying of the stable must be more thorough, as the _psoroptes_ will survive twenty to thirty days in the moist atmosphere of a stable, and may even revive after six or eight weeks when subjected to moist warmth. infested pastures will therefore prove dangerous to horses for that length of time, and, with rubbing posts, etc, should not be used. parasite: _chorioptes equi_ (_symbiotes equi_, _dermatophagus equi_, _chorioptes spathiferus_). malady: _foot mange._--the acarus (pl. xxxix, fig. ) attacks the heels and lower parts of the legs, especially the hind ones, and may be present for years without extending upon the body. like the _psoroptes_; it lives on the surface, on the hairs, and among the scabs. it gives rise to great itching, stamping, rubbing of the one leg with the other, and the formation of papules, wounds, ulcerous sores, and scabs. the intense itching will always suggest this parasite, and the discovery of the acarus will identify the disease. the treatment is the same as for the _sarcoptes_, but may be confined to the legs and the parts with which they come in contact. parasite: _dermanyssus gallinæ, or chicken acari._ malady: _poultry acariasis._--this is a large-sized acarus, though usually miscalled "hen louse," and the disease "poultry lousiness." the mite (pl. xxxix, fig. ) lives in droppings and in crevices of chicken houses, but temporarily passes on to the skin of man and of the horse and other quadrupeds, when occasion serves. it causes much irritation, with the eruption of papules or vesicles and the formation of sores and scabs. the examination of the skin is usually fruitless, as the attacks are mostly made at night and the effects only may be seen during the day. the proximity of hen manure swarming with the acari explains the trouble, and the removal of this and a white-washing with quicklime, with or without chlorid of lime, will prevent future attacks. the skin may still require bland ointments or lotions, as for congestion. parasite: _larva of a trombidium, leptus americanus, or harvest bug, misnamed jigger (chigoe)._ malady: _autumn mange._--this parasite is a brick-red acarus, visible to the naked eye on a dark ground, and living on green vegetation in many localities. it attacks man, and the horse, ox, dog, etc., burrowing under the skin and giving rise to small papules and intolerable irritation. this continues for two or three days only from a single invasion, but will last until cold weather sets in if there is a fresh invasion daily. horses at pasture suffer mainly on the lower part of the face. if kept indoors the disease will disappear, or if left at pasture a weak tar water or solution of tobacco may be applied to the face. [illustration: plate xxxix. mites that infest the horse.] ticks. the wood ticks are familiar to inhabitants of uncultivated lands, and prove troublesome parasites to man and beast alike. the tick lives on bushes, and attaches itself to the mammal only to secure a feast of blood, for when gorged it drops off to sleep off its debauch on the soil. the tick produces great irritation by boring into the skin with its armed proboscis. if pulled out, the head and thorax are often left in the skin. they may be covered with oil to shut out the air from their breathing pores, or by touching them with a hot penknife they will be impelled to let go their hold. grubs in skin. parasite: _hypoderma lineata_. malady: _larvæ_ (_grubs_) _under the skin_.--the larvæ of a fly (probably _hypoderma lineata_, whose larvæ in the skin of cattle are commonly known as "warbles") are occasionally found in little sacs beneath the skin of horses. the mature larva escapes in early summer and develops into a fly. in districts where they exist the grubs should be pressed out of the skin in the course of the winter and destroyed. larvÃ� (grubs) on the skin, or flyblow. the following flies, among others, deposit their eggs on open sores or on wet, filthy parts of the skin, where their larvæ or grubs give rise to serious trouble: _lucilia cæsar_ (bluebottle), _cochliomyia macellaria_ (screwworm fly), _musca vomitoria_ (meat fly), and _sarcophaga carnaria_ (flesh fly). to prevent their attacks, wet, filthy hair should be removed and wounds kept clean and rendered antiseptic by a lotion of carbolic acid part, water parts, or by a mixture of ounce oil of tar in ounces sweet oil, or by some other antiseptic. if the grubs are already present they should be picked off and one of these dressings freely applied. flies. a number of flies attack horses and suck their blood, producing great annoyance and in some instances death. these insects not only suck the blood, but also often instill an acid poison into the skin, and in exceptional cases transfer infectious germs from animal to animal by inoculation. various devices are resorted to to prevent the attacks, as to sponge the skin with a decoction of walnut or elder leaves, of tobacco, to dust with persian insect powder, to keep a light blanket or fly net on the horse, to close doors and windows with fine screens and destroy by pyrethrum any flies that have gained admission, to remove all manure heaps that would prove breeding places for flies, to keep the stalls clean, deodorize by gypsum, and to spread in them trays of dry chlorid of lime. for the poisoned bites apply ammonia, or a solution of part of carbolic acid in parts of sweet oil or glycerin, or one-fourth ounce bicarbonate of soda and dram of carbolic acid in a quart of water may be used. a large number of fly repellents have been recommended, but most of them must be applied daily in order to maintain the protective effect. among the things used are carbolic solutions, pine tar, oil of tar, fish oil, laurel oil, oil of citronella, oil of sassafras, oil of camphor, and cod-liver oil. these things must be used judiciously or they will result in poisoning or removal of the hair from the animal in some instances. ten per cent oil of tar in beaumont oil or in cottonseed oil was found to be safe and efficacious by graybill. the use of the fly-maggot trap noted under stomach worms of the horse, and of the various forms of the hodge flytrap, is recommended. fleas. the flea of man and those of poultry, when numerous, will bite the horse and give rise to rounded swellings on the skin. to dispose of them it is needful to clear the surroundings of the grublike larvæ as well as to treat the victim. the soil may be sprinkled with quicklime, carbolic acid, coal tar, or petroleum; the stalls may be deluged with boiling water and afterwards painted with oil of turpentine and littered with fresh pine sawdust, and all blankets should be boiled. the skin may be sponged with a solution of part carbolic acid in parts of water. other animals should be kept free from fleas or kept away from the vicinity of the stable. the chigoe (_pulex penetrans_) of the gulf coast is still more injurious, because it burrows under the surface and deposits its eggs to be hatched out slowly with much irritation. the tumor formed by it should be laid-open and the parasite extracted. if it bursts so that its eggs escape into the wound, they may be destroyed by introducing chloroform into the wound. lice, or pediculi. two kinds of lice attack the horse, one of which is furnished with narrow head and a proboscis for perforating the skin and sucking the blood, and the other--the broad-headed kind--with strong mandibles, by which it bites the skin only. the poor condition, itching, and loss of hair should lead to suspicion, and a close examination will detect the lice. they may be destroyed by rubbing the victim with sulphur ointment, or with sulphuret of potassium ounces, water gallon, or with tar water, or the skin may be sponged with benzine. the application should be repeated a week later to destroy all lice hatched from the nits in the interval. buildings, clothes, etc., should be treated as for fleas. stings of bees, wasps, and hornets. these are much more irritating than the bites of flies, partly because the barbed sting is left in the wound and partly because of the quantity and quality of the venom. when a swarm attacks an animal the result may prove fatal. _treatment_ consists in the application of wet clay, or of a lotion of soda or ammonia, or of carbolic acid, or permanganate of potash, grains to the ounce; or of sugar of lead drams, laudanum ounce, and water pint. the embedded stings should be extracted with fine forceps or even with the finger nails. tarantula and scorpion. the bite of the first and the sting of the second are poisonous, and may be treated like other insect venom, by carbolated glycerin, or a strong solution of ammonia, or permanganate of potash. snake bites. these are marked by the double incision caused by the two fangs, by the excessive doughy (dark red) swelling around the wounds, and in bad cases by the general symptoms of giddiness, weakness, and prostration. they are best treated by enormous doses of alcohol, whisky, or brandy, or by aqua ammonia very largely diluted in water, the object being to sustain life until the poison shall have spent its power. as local treatment, if the wound is in a limb, the latter may have a handkerchief or cord tied around it above the injury and drawn tight by a stick twisted into it. in this way absorption may be checked until the poison can be destroyed by the application, of a hot iron or a piece of nitrate of silver or other caustic. a poultice of tobacco leaves is a favorite remedy, and may be used to soothe the sore after cauterization. a treatment which has been highly recommended consists in prompt and vigorous scarification at the site of puncture and rubbing crystals of potassium permanganate into the wound. burns and scalds. these subjects are discussed in the following chapter. wounds of the skin. wounds of the skin are fully discussed in the next chapter. footnotes: [ ] an outbreak of quittor near cheyenne, wyo., which came under the author's observation, was caused by the mud through which the horses had to wade to reach the watering troughs. these troughs were furnished with water by windmills, and the mudholes were caused by the waste water. more than cases developed inside of two months, or during september and october. in these cases all forms of the disease and all possible complications were presented. during the rainy season at leadville, colo., outbreaks of quittor are common, and the disease is so virulent that it has long been known as the "leadville foot rot." the soil being rich in mineral matters is no doubt the cause of the outbreaks. in the city of montreal quittor is said to be very common in the early springtime, when the streets are muddy from the melting snow and ice. [ ] descazeaux has shown that the worms found in these summer sores are probably larval forms of the stomach worms of the horse, _habronema megastoma_, _h. microstoma_, and _h. muscæ_. ransom has shown that the larval stage of _h. muscæ_ develops in the common housefly, the fly becoming infested as a maggot in horse manure. infestation with the adult worms in the stomach of the horse (pl. v, fig. ) may take place through the ingestion of such infested flies, or by the escape of the larva from the proboscis of the fly as it feeds on the moist lips of the horse. in view of this it may be surmised that summer sores may arise as the result of flies so infested feeding on the moisture on the skin of the horse. in some forms of summer sores along the abdomen there are found immature stages of _habronema_ which apparently have just escaped from the egg and which are younger than some of the stages found in the fly. in this case it is surmised that these embryos from the manure enter the soiled skin of the horse, as it lies down on dirty bedding and manure, and develop in the skin as they would ordinarily in the fly. descazeaux calls these summer sores cutaneous habronemiasis. preventive measures consist in the removal of the adult worms from the stomach of the horse by the use of anthelmintics, the destruction of the embryos in the manure, fly-control measures, and the use of clean bedding.--m. c. hall. [ ] descazeaux recommends the application and injection of to per cent trypanblue, though he states that the only truly efficacious treatment is the early and complete ablation of the invaded tissue.--m. c. h. [ ] revised by m. c. hall. wounds and their treatment. by ch. b. michener, v. s. [revised by john r. mohler, v. m. d., a. m.] description of wounds. a wound is an injury to any part of the body involving a solution of continuity or disruption of the affected parts and is caused by violence, with or without laceration of the skin. in accordance with this definition we have the following varieties of wounds: incised, punctured, contused, lacerated, gunshot, and poisoned. they may further be classified as superficial, deep, or penetrating, and also as unclean, if hair, dirt, or splinters of wood are present; as infected when contaminated with germs, and as aseptic if the wound does not contain germs. an incised wound is a simple cut made with a sharp body, like a knife, producing merely a division of the tissues. the duller the body the more force is required, the more tissues destroyed, and a greater time will be required for healing. in a cut wound the edges are even and definite, while those of a lacerated wound are irregular and torn. three conditions are present as a result of an incised wound: ( ) pain, ( ) hemorrhage, ( ) gaping of the wound. the first pain is due to the crushing and tearing of the nerve fibers. in using a sharp knife and by cutting quickly, the animal suffers less pain and healing occurs more rapidly. the secondary pain is usually due to the action of the air and inflammatory processes. when air is kept from the wound pain ceases soon after the lesion is produced. hemorrhage is absent only in wounds of nonvascular tissues, as the cornea of the eye, the cartilage of joints, and other similar structures. bleeding may be from the arteries, veins, or capillaries. in the last form of bleeding the blood oozes from the part in drops. hemorrhage from the veins is dark red and issues in a steady stream without spurting. in arterial bleeding the blood is bright red and spurts with each heart beat. this latter variety of hemorrhage is the most dangerous, and should be stopped at once before attempting any further treatment. bleeding from small veins and capillaries ceases in a short time spontaneously, while larger vessels, especially arteries, require some form of treatment to cause complete stoppage of the hemorrhage. hemostasia. by this term is meant the checking of the flow of blood. it may be accomplished by several methods, such as compress bandages, torsion, hot iron, and ligatures. the heat from a hot iron will cause the immediate clotting of the blood in the vessels, and this clot is further supported by the production of a scab, or crust, over the portion seared. the iron should be at a red heat. if at a white heat, the tissue is charred, which makes it brittle and the bleeding is liable to be renewed. if the iron is at a black heat, the tissue will stick to the iron and will pull away from the surface of the wound. cold water and ice bags quickly stop capillary bleeding, while hot water is preferable in more excessive hemorrhages. some drugs, called styptics, possess the power of contracting the walls of blood vessels and also of clotting the blood. a solution of the chlorid of iron placed on a wound alone or by means of cotton drenched in the liquid produces a rapid and hard clot. tannic acid, alum, acetic acid, alcohol, and oil of turpentine are all more or less active in this respect. to check bleeding from large vessels compression may be adopted. when it is rapid and dangerous and from an artery, the fingers may be used for pressing between the wound and the heart (digital compression), but if from a vein, the pressure should be exerted on the other side of the wound. tourniquet may also be used by passing a strap around the part and tightening after placing a pad over the hemorrhage. the rubber ligature has now replaced the tourniquet and is bound tightly around the limb to arrest the bleeding. tampons, such as cotton, tow, or oakum, may be packed tightly in the wound and then sewed up. after remaining there for twenty-four or forty-eight hours they are removed. bleeding may sometimes be easily checked by passing a pin under the vessel and by taking a horsehair and forming a figure by running it above and below the pin, thus causing pressure on the vessel. torsion is the twisting of the blood vessel until the walls come together and form a barrier to the flow of blood. it may be accomplished by the fingers, forceps, or by running a pin through the vessel, turning it several times, and then running the point into the tissue to keep it in a fixed position. ligation is the third method for stopping a hemorrhage. the blood vessel should be seized with the artery forceps, a clean thread of silk passed around it, and tied about one-half inch from its end. the silk should be sterilized by placing it in an antiseptic solution so as not to impede the healing process or cause blood poisoning or lockjaw, which often follows the ligation of a vein with unsterilized material. sometimes it will be impossible to reach the bleeding vessel, so it is necessary to pass the ligature around a mass of tissue which includes the blood vessel. ligation is the most useful method of arresting hemorrhage, since it disturbs healing least and gives the greatest security against secondary hemorrhage. sutures. after the bleeding has been controlled and all foreign bodies removed from the wound, the gaping of the wound is noticeable. it is caused by the contraction of the muscles and elastic fibers, and its degree depends on the extent, direction, and nature of the cut. this gaping will hinder the healing process so that it must be overcome by bringing the edges together by some sort of sutures or pins or by a bandage applied from below upward. as suture material, ordinary cotton thread is good, if well sterilized, as are also horsehair, catgut, silk, and various kinds of wire. if the suture is made too tight the subsequent swelling may cause the stitch to tear out. in order to make a firm suture the depth of the stitch should be the same as the distance the stitch is from the edge of the wound. the deeper the suture the more tissue is embraced and the fewer the number of stitches required. in tying a suture the square or reef knot should be used. closure of wounds by means of adhesive plaster, collodion, and metal clamps is not practiced to any great extent in veterinary practice. process of healing. in those cases where perfect stoppage of bleeding, perfect coaptation of the edges of the wound, and perfect cleanliness are obtained, healing occurs within three days, without the formation of granulations, pus, or proud flesh, by what is termed first intention. if wounds do not heal in this manner they will gap somewhat and become warm and painful. healing then occurs by granulation or suppuration, which is termed healing by second intention. the sides of the wound become covered with granulation tissue which may fill the wound and sometimes overlap the lips, forming a fungoid growth called proud flesh. under favorable conditions the edges of the wound appear to grow together by the end of the first week, and the whole surface gradually becomes dry, and finally covered with pigmented skin, when the wound is healed. the cause of pus formation in wounds is usually the presence of germs. for this reason the utmost care should be adopted to keep clean wounds aseptic, or free from germs, and to make unclean wounds antiseptic by using antiseptic fluids to kill the microbes present in the wound. the less the injurious action of this fluid on the wound and the greater its power to kill germs, the more valuable it becomes. all antiseptics are not equally destructive, and some germs are more susceptible to one antiseptic than to another. the most important are ( ) bichlorid of mercury, which is to be preferred on horses. it becomes weakened in its action if placed in a wooden pail or on an oily or greasy surface. it is used in the strength of part of bichlorid to , to , parts of water, according to the delicacy of the tissue to which it is applied. ( ) carbolic acid in from to per cent solution is used on infected wounds and for cleaning instruments, dressings, and sponges. it unites well with oil and is preferred to the bichlorid on a greasy surface. a per cent solution in oil is often used under the name of carbolized oil. ( ) aluminum acetate is an efficient and cheap antiseptic, and is composed of part alum and parts acetate of lead, mixed in parts of water. ( ) boric acid is good, in a to per cent solution, to cleanse wounds and wash eyes. compound cresol may be used in a to per cent solution in water. iodoform is one of the most used of the antiseptics, and it also acts as an anodyne, stimulates granulation, and checks wound secretion. a very efficacious and inexpensive powder is made by taking parts of iodoform and parts of sugar, making what is called iodoform sugar. tannic acid is a useful drug in the treatment of wounds, as it arrests hemorrhage, checks secretion, and favors the formation of a scab. a mixture of part tannic acid and parts iodoform is good in suppurating wounds. iodol, white sugar, ground and roasted coffee, and powdered charcoal are all used as protectives and absorbents on suppurating surfaces. more depends on the care and the method of application of the drug than on the drug itself. on aseptic wounds use only those antiseptics that do not irritate the tissue. if care is used in the application of the antiseptic, corrosive sublimate or carbolic acid is to be recommended. in order to keep air from the wound and to absorb all wound secretions rapidly, a dressing should be applied. if the wound is aseptic, the dressing should be likewise, such as cotton gauze, sterile cotton, oakum, or tow. this dressing should be applied with uniform pressure at all times and secured by a bandage. allow it to remain for a week or ten days if the wound is aseptic or if the dressing does not become loose or misplaced or become drenched with secretions from the wound, or if pain, fever, or loss of appetite does not develop. the dressing should then be removed, the wound treated antiseptically, and a sterilized dressing applied. healing under a scab. this often occurs in small superficial wounds that have been kept aseptic. in order that a scab may form, the wound must not gap, secrete freely, or become infected with germs. the formation of scab is favored by astringents and styptics, such as tannic acid, iodoform, and per cent solution of zinc chlorid. in case of fistulous withers, open joints, or other large, hollow wounds that can not be dressed, antisepsis may be obtained by warm-water irrigation with or without an antiseptic fluid. it should continue day and night, and never be interrupted for more than eight hours, for germs will then have gained headway and will be difficult to remove. four or five days of irrigation will be sufficient, for granulations will then have formed and pus will remain on the outside if it forms. for permanent irrigation the stream should be very small, or drop by drop, but should play over the entire surface of the wound. it is always better to heal an infected wound under a scab, or treat it as an open wound, than it is to suture it, thus favoring the growth of the inclosed germs and retarding ultimate healing. in the latter case pus may develop in the wound, form pockets by sinking into the tissues, and cause various complications. the pockets should be well drained, either through incisions at the bottom or by drainage tubes or setons. they should then be frequently syringed out or continuously irrigated. in case proud flesh appears it should be kept down either by pressure or by caustics, as powdered bluestone, silver nitrate, chlorid of antimony, or by astringents, such as burnt alum. if they prove resistant to this treatment they may be removed by scissors, the knife, or by searing with the hot iron. the following rules for the treatment of wounds should be followed: ( ) see that the wound is clean, removing all foreign bodies. ( ) for this purpose use a clean finger rather than a probe. ( ) all hemorrhage should be arrested before closing the wound. ( ) antiseptics should only be used if you suspect the wound to be infected. ( ) when pus is present treat without closing the wound. ( ) this may be accomplished by drainage tubes, absorbent dressings, setons, or continuous irrigations. ( ) protect the wound against infection while healing. lacerated and contused wounds. lacerated and contused wounds may be described together although there is, of course, this difference, that in contused wounds there is no break or laceration of the skin. lacerated wounds, however, are, as a rule, also contused--the surrounding tissues are bruised to a greater or lesser extent. while at first sight such wounds may not appear to be as serious as incised wounds, they are commonly very much more so. lacerations and contusions, when extensive, are always to be regarded as dangerous. many horses die from septic infection or mortification as a result of these injuries. we find in severe contusions an infiltration of blood into the surrounding tissues: disorganization and mortification follow, and involve often the deeper seated structures. abscesses, single or multiple, may also result and call for special treatment. in wounds that are lacerated the amount of hemorrhage is mostly inconsiderable; even very large blood vessels may be torn apart without inducing a fatal result. the edges of the wound are ragged and uneven. these wounds are produced by barbed wire or some blunt object, as when a horse runs against fences, board piles, the corners of buildings, or when he is struck by the pole or shafts of another team, falling on rough, irregular stones, etc. contused wounds are caused by blunt instruments moving with sufficient velocity to bruise and crush the tissues, as kicks, running against objects, or falling on large, hard masses. _treatment._--in lacerated wounds great care must at first be exercised in examining or probing to the very bottom of the rent or tear, to see whether any foreign body is present. very often splinters of wood or bits of stone or dirt are thus lodged, and unless removed prevent the wound from healing; or if it should heal, the wound soon opens again, discharging a thin, gluey matter that is characteristic of the presence of some object in the part. after a thorough exploration these wounds are to be carefully and patiently fomented with warm water, to which has been added carbolic acid in the proportion of part to of water. rarely, if ever, are stitches to be inserted in lacerated wounds. the surrounding tissues and skin are so weakened in vitality and structure by the contusions that stitches will not hold; they only irritate the parts. it is better to endeavor to obtain coaptation by means of bandages, plasters, or collodion. one essential in the treatment of lacerated wounds is to provide a free exit for the pus. if the orifice of the wound is too high, or if pus is found to be burrowing in the tissues beneath the opening, we must then make a counter opening as low as possible. this will admit of the wound being thoroughly washed out, at first with warm water, and afterwards injected with some mild astringent and antiseptic wash, as chlorid of zinc, dram to a pint of water. a dependent opening must be maintained until the wound ceases to discharge. repeated hot fomentations over the region of lacerated wounds afford much relief and should be persisted in. bruises. bruises are nothing but contused wounds where the skin has not been ruptured. there is often considerable solution of continuity of the parts under the skin, subcutaneous hemorrhage, etc., which may result in local death (mortification) and slough of the bruised parts. if the bruise or contusion is not so severe, many cases are quickly cured by constant fomentation with hot water for from two to four hours. the water should be allowed about this time to become cool gradually and then cold. cold fomentation must then be kept up for another hour or two. the parts should be thoroughly and quickly dried and bathed freely with camphor ounce, sweet oil ounces, or with equal parts of lead water and laudanum. a dry, light bandage should then be applied, the horse allowed to rest, and if necessary the treatment may be repeated each day for two or three days. if, however, the wound is so severe that sloughing must ensue, we should encourage it by poultices made of linseed meal, wheat bran, turnips, onions, bread and milk, or hops. charcoal is to be sprinkled over the surface of the poultice when the wound is bad smelling. after the slough has fallen off the wound is to be dressed with warm washes of carbolic acid, chlorid of zinc, permanganate of potash, or other antiseptic. if granulating (filling up) too fast, use burnt alum or air-slaked lime. besides this local treatment, we find that the constitutional symptoms of fever and inflammation call for measures to prevent or control them. this is best done by placing the injured animal on soft or green feed. a physic of barbados aloes, ounce, should be given as soon as possible after the accident. sedatives, such as tincture of aconite root, drops, three times a day, or ounce doses of saltpeter every four hours, may also be administered. when the symptoms of fever are abated, and if the discharges from the wound are abundant, the strength of the patient must be supported by good feed and tonics. one of the best tonics is as follows: powdered sulphate of iron, powdered gentian, and powdered ginger, of each ounces. mix thoroughly and give a heaping tablespoonful twice a day, on the feed or as a drench. punctured wounds. punctured wounds are produced by the penetration of a sharp or blunt-pointed substance, such as a thorn, fork, nail, etc., and the orifice of these wounds is always small in proportion to their depth. in veterinary practice punctured wounds are much more common than the others. they involve the feet most frequently, next the legs, and often the head and face from nails protruding through the stalls and trough. they are not only the most frequent, but they are also the most serious, owing to the difficulty of obtaining thorough disinfection. another circumstance rendering them so is the lack of attention that they at first receive. the external wound is so small that but little or no importance is attached to it, yet in a short time swelling, pain, and acute inflammation, often of a serious character, are manifested. considering the most common of the punctured wounds, we must give precedence to those of the feet. horses worked in cities, about iron works, around building places, etc., are most likely to receive "nails in the feet." the animal treads upon nails, pieces of iron or screws, forcing them into the soles of the feet. if the nail, or whatever it is that has punctured the foot, is fast in some large or heavy body, and is withdrawn as the horse lifts his foot, lameness may last for only a few steps; but unless properly attended to at once he will be found in a day or two to be very lame in the injured member. if the foreign body remains in the foot, he gradually grows worse from the time of puncture until the cause is discovered and removed. if, when shoeing, a nail is driven into the "quick" (sensitive laminæ) and allowed to remain, the horse gradually evinces more pain from day to day; but if the nail has at once been removed by the smith, lameness does not, as a rule, show itself for some days; or, if the nail is simply driven "too close," not actually pricking the horse, he may not show any lameness for a week or even much longer. at this point it is due to the blacksmith to say that, considering how thin the walls of some feet are, the uneasiness of many horses while shoeing, the ease with which a nail is diverted from its course by striking an old piece of nail left in the wall, or from the nail itself splitting, the wonder is not that so many horses are pricked or nails driven "too close," but rather that many more are not so injured. it is not, by any means, always carelessness or ignorance on the part of the smith that is to account for this accident. bad and careless shoers we do meet with, but let us be honest and say that the rarity of these accidents points rather to the general care and attention given by these much-abused mechanics. from the construction of the horse's foot (being incased in an impermeable, horny box), and from the elasticity of the horn closing the orifice, punctured wounds of the feet are almost always productive of lameness. inflammation results, and as there is no relief afforded by swelling and no escape for the product of inflammation, this matter must and does burrow between the sole or wall and the sensitive parts within it until it generally opens "between hair and hoof." we can thus see why pain is so much more severe, why tetanus (lockjaw) more frequently follows wounds of the feet, and why, from the extensive, or at times complete, separation and "casting" of the hoof, these wounds must always be regarded with grave apprehension. _symptoms and treatment._--a practice which, if never deviated from--that of picking up each foot, cleaning the sole, and thoroughly examining the foot each and every time the horse comes into the stable--will enable us to reduce to the minimum the serious consequences of punctured wounds of the feet. if the wound has resulted from pricking, lameness follows soon after shoeing; if from the nails being driven too close, it usually appears from four to five days or a week afterwards. we should always inquire as to the time of shoeing, examine the shoe carefully, and see whether it has been partially pulled and the horse has stepped back upon some of the nails or the clip. the pain from these wounds is lancinating; the horse is seen to raise and lower the limb or hold it from the ground altogether; often he points the foot, flexes the leg, and knuckles at the fetlock. swelling of the fetlock and back tendons is also frequently seen and is liable to mislead us. the foot must be carefully examined, and this can not be properly done without removing the shoe. the nails should be drawn separately and carefully examined. if there is no escape of pus from the nail holes, or if the nails themselves are not moist, we must continue our examination of the foot by carefully pinching or tapping it at all parts. with a little practice we can detect the spot where pain is the greatest or discover the delicate line or scar left at the point of entrance of the foreign body. the entire sole is then to be thinned, after which we are carefully to cut down upon the point where pain is greatest upon pressure, and, finally, through the sole at this spot. when the matter has escaped, the sole, so far as it was undermined by pus, is to be removed. the foot must now be poulticed for one or two days and afterwards dressed with a compress of oakum saturated with carbolic-acid solution or other antiseptic dressing. if we discover a nail or other object in the foot, the principal direction, after having removed the offending body, is to cut away the sole, in a funnel shape, down to the sensitive parts beneath. this is imperative, and if a good free opening has been made and is maintained for a few days, and hot fomentations and antiseptic dressings applied, the cure is mostly easy, simple, quick, and permanent. the horse should be shod with a leather sole under the shoe, first of all applying tar and oakum to prevent any dirt from entering the wound. in some instances nails may puncture the flexor tendons, the coffin bone, or enter the coffin joint. such injuries are always serious, their recovery slow and tedious, and the treatment so varied and difficult that the services of a veterinarian will be necessary. punctured wounds of joints, or open joints. these wounds are more or less frequent. they are always serious, and often result in anchylosis (stiffening) of the joint or the death of the animal. the joints mostly punctured are the hock, fetlock, or knee, though other joints may, of course, suffer this injury. as the symptoms and treatment are much the same for all, only the accident as it occurs in the hock joint will be described. probably the most common mode of injury is from the stab of a fork, but it may result from the kick of another horse that is newly shod, or in many other ways. at first the horse evinces but slight pain or lameness. the owner discovers a small wound scarcely larger than a pea, and pays but little attention to it. in a few days, however, the pain and lameness become excessive; the horse can no longer bear any weight upon the injured leg; the joint is very much swollen and painful upon pressure; there are well-marked symptoms of constitutional disturbance--quick pulse, hurried breathing, high temperature, ° to ° f., the appetite is lost, thirst is present, the horse reeks with sweat, and his anxious countenance shows the pain he suffers. he may lie down, though mostly he persists in standing, and the opposite limb becomes greatly swollen from bearing the entire weight and strain for so long a time. the wound, which at first appeared so insignificant, is now constantly discharging a thin, whitish or yellowish fluid--joint oil or water, which becomes coagulated about the mouth of the wound and adheres to the part in clots like jelly, or resembling somewhat the white of an egg. not infrequently the joint opens at different places, discharging at first a thin, bloody fluid that soon assumes the character above described. _treatment_ of these wounds is most difficult and unsatisfactory. we can do much to prevent this array of symptoms if the case is seen early--within the first or hours after the injury; but when inflammation of the joint is once fairly established the case becomes one of grave tendencies. whenever a punctured wound of a joint is noticed, even though apparently of but small moment, we should apply without the least delay a strong cantharides blister over the entire joint, being even careful to fill the orifice of the wound with the blistering ointment. this treatment is almost always effectual. it operates to perform a cure in two ways--first, the swelling of the skin and tissues underneath it completely closes the wound and prevents the ingress of air; second, by the superficial inflammation established it acts to check and abate all deep-seated inflammation. in the great majority of instances, if pursued soon after the accident, this treatment performs a cure in about one week; but should the changes described as occurring later in the joint have already taken place, we must then treat by cooling lotions and the application to the wound of chlorid of zinc, grains to the ounce of water, or a paste made of flour and alum. a bandage is to hold these applications in place, which is only to be removed when swelling of the leg or increasing febrile symptoms demand it. in the treatment of open joints our chief aim must be to close the orifice as soon as possible. for this reason repeated probing or even injections are contraindicated. the only probing of an open joint that is to be sanctioned is on our first visit, when we should carefully examine the wound for foreign bodies or dirt, and after removing them the probe must not again be used. the medicines used to coagulate the synovial discharge are best simply applied to the surface of the wound, on pledgets of tow, and held in place by bandages. internal treatment is also indicated in those cases of open joints in which the suffering is great. at first we should administer a light physic and follow this up with sedatives and anodynes, as directed for contused wounds. later, however, we should give quinin or salicylic acid in -dram doses two or three times a day. wounds of the tendon sheaths. wounds of tendon sheaths are similar to open joints in that there is an escape of synovial fluid, "sinew water." where the tendons are simply punctured by a thorn, nail, or fork, we must, after a thorough exploration of the wound for any remaining foreign substance, treat with the flour-and-alum paste, bandages, etc., as for open joint. should the skin and tendons be divided the case is even more serious and is often incurable. there is always a large bed of granulations (proud flesh) at the seat of injury, and a thickening more or less pronounced remains. when the back tendons of the leg are severed we should apply at once a high-heel shoe (which is to be gradually lowered as healing advances) and bandage firmly with a compress moistened with a -grain chlorid of zinc solution. when proud flesh appears it is best kept under control by repeated applications of a red-hot iron. mares that are valuable as brood animals and stock horses should always be treated for this injury, as, even though blemished, their value is not seriously impaired. if the subject is old and comparatively valueless, the length of time required and the expense of treatment will cause us to hesitate in attempting a cure. gunshot wounds. these wounds vary in size and character, depending on the size and quality of the projectile and also the tissue injured. they are so seldom met with in our animals that an extended reference to them seems unnecessary. if a wound has been made by a bullet a careful examination should be made to ascertain whether the ball has passed through or out of the body. if it has not we must then probe for it, and if it can be located it is to be cut out when practicable to do so. oftentimes a ball may be so lodged that it can not be removed, and it then may become encysted and remain for years without giving rise to any inconvenience. it is often difficult to locate a bullet, as it is very readily deflected by resistances met with after entering the body. the entering wound is the size of the projectile, the edges are inverted and often scorched. the wound produced in case of the bullet's exit is larger than the projectile, the edges are turned out and ragged. a bullet heated by the friction of the barrel or air often softens and becomes flattened on striking a bone or other tissue. modern bullets that have an outer steel layer may pass through bone without splintering it. lead bullets may split, producing two exit wounds. spent bullets may only produce a bruise. should bones be struck by a ball they are sometimes shattered and splintered to such an extent as to warrant us in having the animal destroyed. a gunshot wound, when irreparable injury has not been done, is to be treated the same as punctured wounds, i. e., stop the hemorrhage, remove the foreign body if possible, and apply hot fomentations or poultices to the wound until suppuration is fairly established. anti-septic and disinfectant injections may then be used. should pus accumulate in the tissues, openings must be made at the most depending parts for its escape. wounds from shotguns fired close to the animals are serious. they are virtually lacerated and contused wounds. remove all the shot possible from the wound and treat as directed for contusions. when small shot strike the horse from a distance they stick in the skin or only go through it. the shot grains must be picked out, but as a rule this "peppering" of the skin amounts to but little. poisoned wounds. these injuries are the result of bites of snakes, rabid dogs, stings of bees, wasps, etc. a single sting is not dangerous, but an animal is often stung by a swarm of insects, when the chief danger occurs from the swelling produced. if stung about the head, the nostrils may be closed as a result of the swelling, causing labored breathing and possibly asphyxiation. intoxication may be produced by the absorption of this poison and is manifested by staggering gait, spreading of the legs, paralysis of the muscles, difficult respiration, and a rise of temperature. death may follow in five to ten hours. _treatment._--douse animal with cold water and apply any alkaline liquid, such as soapsuds, bicarbonate of soda, or weak solution of ammonia. internally give alcohol, ether, or camphor to strengthen the heart. in case of bites by rattlesnakes, moccasin, or other poisonous snakes, a painful swelling occurs about the bitten part, which is followed by labored breathing, weakness, retching, fever, and death from collapse. the animal usually recovers if it can be kept alive over the third day. in treating the animal, a tight ligature should be passed about the part above the wound to keep the poison from entering the general circulation. wash out the wound thoroughly with antiseptics and then apply a caustic, such as silver nitrate, or burn with a hot instrument. a subcutaneous injection of one-fourth dram of per cent solution of chromic acid above the wound is also beneficial. cold water may be applied to the wound to combat the inflammation. bites of rabid dogs produce an infected wound, and the virus of rabies introduced in this manner should be removed or destroyed in the wound. therefore produce considerable bleeding by incising the wound, wash out thoroughly with per cent solution of zinc chlorid, and then apply caustics or the actual cautery. harness galls (sitfasts). wounds or abrasions of the skin are frequently caused by ill-fitting harness or saddles. when a horse has been resting from steady work for some time, particularly after being idle in a stable on a scanty allowance of grain, as in winter, he is soft and tender and sweats easily when put to work again. in this condition he is liable to sweat and chafe under the harness, especially if it is hard and poorly fitted. this chafing is likely to cause abrasions of the skin, and thus pave the way for an abscess or for a chronic blemish, unless attended to very promptly. besides causing the animal considerable pain, chafing, if long continued, leads to the formation of a callosity. this may be superficial, involving only the skin, or it may be deep-seated, involving the subcutaneous fibrous tissue and sometimes the muscle and even the bone. this causes a dry slough to form, which is both inconvenient and unsightly. sloughs of this kind are commonly called "sitfasts" and, while they occur in other places, are most frequently found under the saddle. (see also p. .) _treatment._--abrasions are best prevented by bringing the animal gradually into working shape after it has had a prolonged rest, in order that the muscles may be hard and the skin tough. the harness should be well fitted, neither too large nor too small, and it should be cleaned and oiled to remove all dirt and to make it soft and pliable. saddles should be properly fitted so as to prevent direct pressure on the spine, and the saddle blankets should be clean and dry. parts of the horse where chafing is likely to occur, as on the back under the saddle, should be cleaned and brushed free of dirt. the remedies for simple harness galls are numerous. among them may be mentioned alcohol, pint, in which are well shaken the whites of two eggs; a solution of nitrate of silver, grains to the ounce of water; sugar of lead or sulphate of zinc, grains to an ounce of water; carbolic acid, part in parts of glycerin, and so on almost without end. any simple astringent wash or powder will effect a cure, provided the sores are not irritated by friction. if a sitfast has developed, the dead hornlike slough must be carefully dissected out and the wound treated carefully with antiseptics. during treatment it is always best to allow the animal to rest, but if this is inconvenient care should be taken to prevent injury to the abraded or wounded surface by padding the harness so that chafing can not occur. burns and scalds. these wounds of domestic animals are fortunately of rare occurrence; however, when they do occur, if at all extensive, they prove to be quite troublesome and in many cases are fatal. according to the severity of the burn we distinguish three degrees: first degree, where there is a simple reddening of the skin; second degree, where there is a formation of vesicles, or blisters; third degree, where there is a complete destruction of vitality of the tissues, such as would occur in charring from direct contact with flames or from escaping steam. besides the burns caused by flames and steam, there are other causative agents, such as chemicals (caustic alkalis and acids), lightning stroke, and occasionally the broken trolley wires of electric railways. when a large surface of the skin is burned or scalded, the animal (if it does not die at once from shock) will soon show signs of fever--shivering, coldness of the extremities, weakness, restlessness, quick and feeble pulse, and labored breathing. no matter which agent is a factor in the production of burns, the lesions are practically of the same nature. the extent and site of the burn should lead one in the determination and course of treatment. burns of the shoulder and those about the region of the elbow or other parts where there is much movement of the tissues are grave, and, if at all extensive, treatment should not be attempted, but the immediate destruction of the animal is advised. a burn of the third degree, where there is a destruction of the vitality of large areas of tissue, even on parts not subject to much motion, is extremely tedious to treat; in fact, it is questionable whether the treatment and keep of the animal will ever be compensated for, even though recovery does take place; this, in any event, will require at least six or eight weeks. burns caused by lightning stroke and trolley wires are liable to occur in irregular lines, and, unless death occurs at once, they generally are not serious. _treatment._--treatment should be prompt and effective. if the burns are extensive, the constitutional symptoms should be combated with whisky and milk and eggs, or ammonia carbonate, strychnin, caffein, or other stimulant to prevent shock. in the local treatment, to alleviate the pain, the application of cold water in some form and the hypodermic injection of morphine are to be recommended. in burns of the first degree, where there is only a superficial inflammation, lead carbonate (white lead) ointment is very good. carron oil (limewater and linseed oil, equal parts) is a standard remedy, but a modification of it known as stahl's liniment is perhaps better. this is composed of linseed oil and limewater each parts, bicarbonate of soda parts, and thymol part. the scorched surface should be covered with this liniment and then with a layer of borated gauze or absorbent cotton, to protect from the air. the application should be frequently renewed. carbolated vaseline may be used in place of the above. in case the burn is more extensive, the following solution may be used: picric acid parts, alcohol parts, water parts. the lesion should be thoroughly cleansed with this solution used on absorbent cotton. the vesicles, if any appear, should be opened with a clean needle, allowing the skin to remain. strips of gauze or absorbent cotton saturated with the solution should now be applied and renewed only occasionally. in burns of the second and third degrees more satisfactory results may be obtained with nonpoisonous, dry dressing powder, such as is used in ordinary open wounds, as tannic acid parts and iodoform part, or a salve made of this powder and a sufficient quantity of vaseline. when sloughing of the tissues takes place the wounds should be cleansed with a warm per cent solution of carbolic acid, all loose fragments of tissue removed, and either a dry, antiseptic dressing powder or carbolated vaseline ointment applied to exclude the air. granulation tissue (proud flesh) should be controlled by the application of silver nitrate in the form of a caustic pencil. burns due to mineral acids may be first treated by flushing the parts with a copious quantity of cold water or by the application of whiting or chalk. either use a large quantity of water at the start or use the chalk first, then wash with water. if the irritant has been a caustic alkali, such as potash, lye, ammonia, or soda, then vinegar should be the first application. stahl's liniment is probably the best general application for all burns for the first week; then this should be followed by the ordinary antiseptic wound dressings. gangrene. gangrene, or mortification, denotes the death of the affected part, and is mostly found attacking soft tissue near the surface of the body. gangrenous areas may occur as a result of shutting off their blood supply. constitutional diseases, such as ergotism, anthrax, and septicemia, predispose to gangrene. as external causes we have acids and alkalies, freezing and burning, contusions and continuous pressure that interrupt the circulation. there are two forms of gangrene--dry and moist. dry gangrene is most often seen in horses from continuous lying down (decubitus) or from uneven pressure of some portion of the harness. _symptoms._--there is a lack of sensation due to the death of nerves. in dry gangrene the skin is leathery and harsh, while in moist gangrene the tissues are soft, wrinkled, and friable; the hair is disturbed, and the skin is usually moist and soapy and sometimes covered with blebs. the tissue surrounding the moist gangrenous patch is usually inflamed, swollen, and hot, but this is less noticeable in the case of dry gangrene. moist gangrene often spreads and involves deeper tissue, sheaths of tendons and joints producing septic synovitis or septic arthritis leading to pyemia and death. dry gangrene is seldom dangerous, but the rapidity of its spread will indicate its virulence. _treatment._--the preventive treatment consists in avoiding all the influences that tend to disturb the nutrition of the tissues, such as excessive cold or heat or continuous pressure. gangrene following decubitus may be prevented by using soft bedding and frequently turning the animal from one side to the other. in dry gangrene moist heat in the form of poultices or anointing the tissue with oils and fats will be found beneficial in hastening the dead tissue to slough off. when the outer skin begins to suppurate, it should be removed with a pair of pincers, and the patch treated as an open wound. in moist gangrene the tissue should be thoroughly disinfected with a per cent solution of compound cresol, or particularly an alcoholic tincture of camphor. continuous irritation with antiseptic fluids prevents the accumulation and absorption of poisonous liquids. incisions into the dead tissue may be made, and when sloughing commences the tissue should be removed with forceps and the resulting wound treated as in dry gangrene. ulceration. an ulcer is a circumscribed area of necrosis occurring on the skin or mucous membrane and covered with granulation tissue. it is a process of destruction, and when this process is going on faster than regeneration can take place, we have a gnawing, or eating, ulcer. when such an ulcer increases rapidly in size it is termed a phagedenic ulcer. a fungoid ulcer is one in which the bottom of the ulcer projects beyond the edge of the skin. these ulcers secrete milky or bloody-white liquid called ichor. when the ulcer is of an ashen or leaden color, with the bottom and sides formed of dense, hard connective tissue, which gives but little discharge and is not sensitive, it is termed callous, torpid, or indolent ulcer. _causes._--as in the case of gangrene, disturbances of circulation are among the most frequent causes. a wound to a tissue with slight recuperative power may be followed by ulceration, as in tumors. certain germs may produce ulcers, as the glanders bacilli, which cause the ulcerations on the nasal septum in glanders. _treatment._--this consists in removing the exciting cause at once. the secretions of the ulcer should be washed off with antiseptic solutions and the formation of granulation tissues stimulated by antiseptic salves, such as carbolated vaseline, lead ointment, or by dressings of camphor. air should be kept from the ulcer by occlusive dressings. where the ulcers are inflamed, warm lead water or lead water and laudanum will be found efficacious. callous ulcers are best removed by a curette, knife, or hot iron and then treated like a common wound. mechanical irritation should be avoided. abscesses. these consist of accumulations of pus within circumscribed walls, at different parts of the body, and may be classed as acute and cold or chronic abscesses. when an abscess occurs about a hair follicle it is called a boil or furuncle; when several hair follicles are involved, resulting in the formation of more than one exit for the inflammatory products, it is called a carbuncle. acute abscesses. acute abscesses follow as the result of local inflammation in glands, muscular tissue, or even bones. they are very common in the two former. the abscesses most commonly met with in the horse (and the ones which will be here described) are those of the salivary glands, occurring during the existence of "strangles," or "colt distemper." the glands behind or under the jaw are seen to increase slowly in size, becoming firm, hard, hot, and painful. at first the swelling is uniformly hard and resisting over its entire surface, but in a little while becomes soft (fluctuating) at some portion, mostly in the center. from this time on the abscess is said to be "pointing," or "coming to a head," which is shown by a small elevated or projecting prominence, which at first is dry, but soon becomes moist with transuded serum. the hairs over this part loosen and fall off, and in a short time the abscess opens, the contents escape, and the cavity gradually fills up--heals by granulations. abscesses in muscular tissue are usually the result of bruises or injuries. in all cases in which abscesses are forming we should hurry the ripening process by frequent hot fomentations and poultices. when they are very tardy in their development a blister over their surface is advisable. it is a common rule with surgeons to open an abscess as soon as pus can be plainly felt, but this practice can scarcely be recommended indiscriminately to owners of stock, since this little operation frequently requires an exact knowledge of anatomy. it will usually be found the better plan to encourage the full ripening of an abscess and allow it to open of itself. this is imperative if the abscess is in the region of joints, etc. when open, we must not squeeze the walls of the abscess to any extent. they may be very gently pressed with the fingers at first to remove the clots--inspissated pus--but after this the orifice is simply to be kept open by the introduction of a clean probe, should it be disposed to heal too soon. if the opening is at too high a level another should be made into the lowest portion of the abscess so as to permit the most complete drainage. hot fomentations or poultices are sometimes required for a day or two after an abscess has opened, and are particularly indicated when the base of the abscess is hard and indurated. the cavity should be thoroughly washed with stimulating antiseptic solutions, such as per cent solution of carbolic acid, per cent solution of compound cresol, to , bichlorid of mercury, or per cent permanganate of potash solution. if the abscesses are foul and bad smelling, their cavities should first be syringed with part of hydrogen peroxid to parts of water and then followed by the injection of any of the above-mentioned antiseptics. cold abscesses. cold abscess is the term applied to those large, indolent swellings that are the result of a low or chronic form of inflammation, in the center of which there is a small collection of pus. they are often seen near the point of the shoulder, forming the so-called breast boil. the swelling is diffuse and of enormous extent, but slightly hotter than surrounding parts, and not very painful upon pressure. a pronounced stiffness, rather than pain, is evinced upon moving the animal. such abscesses have the appearance of a hard tumor, surrounded by a softer edematous swelling, involving the tissues to the extent of a foot or more in all directions from the tumor. this diffused swelling gradually subsides and leaves the large, hardened mass somewhat well defined. one of the characteristics of cold abscesses is their tendency to remain in the same condition for a great length of time. there is neither heat nor soreness; no increase nor lessening in the size of the tumor; it remains in statu quo. if, however, the animal should be put to work for a short time the irritation of the collar causes the surrounding tissues to assume again an edematous condition, which after a few days' rest disappears, leaving the tumor as before or but slightly larger. upon careful manipulation we may discover what appears to be a fluid deep seated in the center of the mass. the quantity of matter so contained is very small--often not more than a tablespoonful--and for this reason it can not, in all cases, be detected. cold abscesses are mostly, if not always, caused by the long-continued irritation of a loose and badly fitting collar. there is a slow inflammatory action going on, which results in the formation of a small quantity of matter inclosed in very thick and but partially organized walls that are not so well defined as is the circumference of fibrous tumors, which they most resemble. _treatment._--the means recommended to bring the acute abscess "to a head" are but rarely effectual with this variety; or, if successful, too much time has been occupied in the cure. we must look for other and more rapid methods of treatment. these consist, first of all, in carefully exploring the tumor for the presence of pus. the incisions must be made over the softest part and carried deep into the tumor--to its very bottom, if necessary--and the matter allowed to escape. after this, and whether we have found matter or not, we must induce an active inflammation of the tumor, in order to promote solution of the thick walls of the abscess. this may be done by inserting well into the incision a piece of oakum or cotton saturated with turpentine, carbolic acid, tincture of iodin, etc., or we may pack the incision with powdered sulphate of zinc and keep the orifice plugged for hours. these agents set up a destructive inflammation of the walls. suppuration follows, and this should now be encouraged by hot fomentations and poultices. the orifice must be kept open, and should it be disposed to heal we must again introduce some of the agents above described. a favored treatment with many, and it is probably the best, is to plunge a red-hot iron to the bottom of the incision and thoroughly sear all parts of the walls of the abscess. this is to be repeated after the first slough has taken place if the walls remain thickened and indurated. it is useless to waste time with fomentations, poultices, or blisters in the treatment of cold abscesses, since though apparently removed by such methods, they almost invariably return when the horse is put to work. extirpation by the knife is not practicable, as the walls of the tumor are not sufficiently defined. if treated as above directed, and properly fitted with a good collar after healing, there will not remain any track or trace of the large, unsightly mass. fistulas. _definition._--the word fistula is applied to any ulcerous lesion upon the external surface of the body which is connected by ducts, or passages, with some internal cavity. because of this particular formation the term fistulous tract is often used synonymously with the word fistula. fistulas may exist in any part of the body, but the name has come to be commonly accepted as applicable only to such lesions when found upon the withers. poll evil is a fistula upon the poll, and in no sense differs from fistulous withers except in location. the description of fistula will apply, then, in the main, to poll evil equally well. quittor presents the characteristic tubular passages of a fistula and may, therefore, be considered and treated as fistula of the foot. fistulous passages may also be developed upon the sides of the face, through which saliva is discharged instead of flowing into the mouth, and are called salivary fistulas. a dental fistula may arise from the necrosis of the root of a tooth. again, a fistula is sometimes noted at the umbilicus associated with hernia, and recto-vaginal fistulas have been developed in mares, following difficult parturition. fistulas may arise from wounds of glandular organs or their ducts, and thus we have the so-called mammary or lacrimal fistulas. fistulous tracts are lined with a false, or adventitious, membrane and show no disposition to heal. they constantly afford means of exit to the pus or ichorous material discharged by the unhealthy parts below. they are particularly liable to develop at the withers or poll because of the exposed positions which these parts occupy, and, having once become located there, they usually assert a tendency to further extension, because the vertical and laminated formation of the muscles and tendons of these parts allows the forces of gravitation to assist the pus in gaining the deeper-lying structures and also favors its retention among them. _causes._--fistulas follow as a result of abscesses, bruises, wounds, or long-continued irritation by the harness. among the more common causes of fistula of the poll (poll evil) are chafing by the halter or heavy bridle; blows from the butt end of the whip; the horse striking his head against the hayrack, beams of the ceiling, low doors, etc. fistulous withers are seen mostly in those horses that have thick necks as well as those that are very high in the withers; or, among saddle horses, those that are very low in the withers, the saddle here riding forward and bruising the parts. in either of these locations ulcers of the skin, or simple abscesses, if not properly and punctually treated, may become fistulas. they are often caused by bad-fitting collars or saddles, by direct injuries from blows, and from the horse rolling upon rough or sharp stones. the pus burrows and finds lodgment deep down between the muscles, and escapes only when the sinus becomes surcharged or when, during motion of the parts, the matter is forced to the surface. _symptoms._--these, of course, will vary according to the progress made by the fistula. following an injury we may often notice soreness or stiffness of the front legs, and upon careful examination of the withers we see small tortuous lines running from the point of irritation downward and backward over the region of the shoulder. these are superficial lymphatics, and are swollen and painful to the touch. in a day or two a swelling is noticed on one or both sides of the dorsal vertebræ, which is hot, painful, and rapidly enlarging. the stiffness of the limbs may disappear at this time, and the heat and soreness of the parts may become less noticeable, but the swelling remains and continues to enlarge. a fistulous ulcer of the poll may be first indicated by the opposition which the animal offers to the application of stable brush or bridle. at this time the parts are so sore and sensitive that there is some danger that unless handled with the greatest care the patient will acquire disagreeable stable habits. the disease in its early stages may be recognized as a soft, fluctuating tumor surrounded by inflammatory swelling, with the presence of enlarged lymphatic vessels and stiffness of the neck. later the inflammation of the surrounding tissues may disappear, leaving a prominent tumor. the swelling, whether situated upon the head or the withers, may open and form a running ulcer, or its contents may dry up and leave a tumor which gradually develops the common characteristics of a fibrous tumor. when the enlargement has opened we should carefully examine its cavity, as upon its condition will wholly depend our treatment. _treatment._--in the earliest stage, when there is soreness, enlarged lymphatics, but no well-marked swelling, the trouble may frequently be aborted. to do this requires both general and local treatment. a physic should be given, and the horse receive ounce of powdered saltpeter three times a day in his water or feed. if the fever runs high, -drop doses of tincture of aconite root every two hours may be administered. the local application of cold water to the inflamed spot for an hour at a time three or four times a day has often proved very beneficial, and has afforded great relief. cooling lotions, muriate of ammonia, or saltpeter and water; sedative washes, such as tincture of opium and aconite, chloroform liniment, or camphorated oil, are also to be frequently applied. should this treatment fail to check the progress of the trouble, the formation of pus should be hastened as rapidly as possible. hot fomentations and poultices are to be constantly used, and as soon as the presence of pus can be detected, the abscess wall is to be opened at its lowest point. in this procedure lies our hope of a speedy cure. as with any simple abscess, if drainage can be so provided that the pus will run off as fast as formed without remaining within the interstices of the tissues, the healing will be rapid and satisfactory. attention is again called to the directions given above as to the necessity of probing the cavity when opened. if upon a careful examination with the probe we find that there are no pockets, no sinuses, but a simple, regular abscess wall, the indication for treatment is to make an opening from below so that all the matter must escape. rarely is anything more needed than to keep the orifice open and to bathe or inject the parts with some simple antiseptic wash that is not irritant or caustic. a low opening and cleanliness constitute the essential and rational treatment. if the abscess has already opened, giving vent to a quantity of purulent matter, and the pipes and tubes leading from the opening are found to be extensive and surrounded with thick fungoid membranes, there is considerable danger that the internal ligaments or even some of the bones have become affected, in which case the condition has assumed a serious aspect. or, on the other hand, if the abscess has existed for some time without a rupture, its contents will frequently be found to consist of dried purulent matter, firm and dense, and the walls surrounding the mass will be found greatly thickened. in such a case we must generally have recourse to the application of caustics which will cause a sloughing of all of the unhealthy tissue, and will also stimulate a rapid increase of healthy organized material to replace that destroyed in the course of the development and treatment of the disease. threads or cords soaked in gum-arabic solution and rolled in powdered corrosive sublimate may be introduced into the canal and allowed to remain. the skin on all parts of the shoulder and leg beneath the fistula should be carefully greased with lard or oil, as this will prevent the discharge that comes from the opening after the caustic is introduced from irritating or blistering the skin over which it flows. in obstinate cases a piece of caustic potash (fused) to inches in length may be introduced into the opening and should be covered with oakum or cotton. the horse should then be secured so that he can not reach the part with his teeth. after the caustic plug has been in place for hours, it may be removed and hot fomentations applied. as soon as the discharge has become again established the abscess should be opened from its lowest extremity, and the passage thus formed may be kept open by the introduction of a seton. if the pipes become established in the deep tissues beneath the shoulder blade or among the spines of the vertebral column, it will often be found impossible to provide proper drainage for the abscess from below, and treatment must consist of caustic solutions carefully injected into all parts of the suppurating sinuses. a very effective remedy for this purpose consists of ounce of chlorid of zinc in half a pint of water, injected three times during a week, after which a weak solution of the same may be occasionally injected. injections of villate's solution or alcoholic solution of corrosive sublimate, strong carbolic acid, or possibly oil of turpentine will also prove beneficial. pressure should be applied from below, and endeavors made to heal the various pipes from the bottom. should the swelling become general, without forming a well-defined tumor, the placing of to grains of arsenious acid, wrapped in a single layer of tissue paper, in a shallow incision beneath the skin, will often produce a sloughing of the affected parts in a week or days, after which the formation of healthy tissue follows. the surrounding parts of the skin should be protected from any damage from escaping caustics by the application of lard or oil, as previously suggested. although the successful treatment of fistulas requires time and patience, the majority of cases are curable. the sinuses must be opened at their lowest extremity and kept open. caustic applications must be thoroughly used once or twice, after which mild astringent antiseptic washes should be persistently used until a cure is reached. it sometimes happens that the erosions have burrowed so deeply or in such a direction that the opening of a drainage passage becomes impracticable. in other cases the bones may be attacked in some inaccessible location, or the joints may be affected, and in these cases it is often best to destroy the horse at once. the reappearance of the fistula after it has apparently healed is not uncommon. the secondary attack in these cases is seldom serious. the lesion should be carefully cleaned and afterwards injected with a solution of zinc sulphate, grains to the ounce of water, every second or third day until a cure is effected. in fistula of the foot we see the same tendency toward the burrowing of pus downward to lower structures, or in some cases upward toward the coronet. prior to the development of a quittor there is always swelling at the coronet, accompanied with heat and pain. every effort should now be made to prevent the formation of an abscess at the point of injury. wounds caused by nails, gravel, or any other foreign body which may have lodged in the sole of the foot should be opened at once from below, so as to allow free exit to all purulent discharges. should the injury have occurred directly to the coronet the application of cold fomentations may prove efficient in preventing the formation of an abscess. when a quittor becomes fully established it should be treated precisely as a fistula situated in any other part of the body; that is, the sinuses should all be opened from their lowest extremities, so as to afford constant drainage. all fragments of diseased tissue should be trimmed away, antiseptic solutions injected, and, after covering the wound with a pad of oakum saturated with some good antiseptic wash, the whole foot may be carefully covered with clean bandages, which will afford valuable assistance to the healing process by excluding all dirt from the affected part. another form of treatment for this class of infections consists in the use of bacterial vaccines. such treatment appears to be well adapted for the purpose, and according to current veterinary literature has met with success. these vaccines are composed of several strains of the organisms usually found in these pustular infections of the horse. two kinds of vaccines are used: first, autogenic vaccines, which consist of heated (killed) cultures of the organism or organisms which are causing the trouble and which have been isolated from the lesions; second, stock vaccines, consisting of dead organisms of certain species generally found in these lesions and which are used in diseased conditions caused by one or the other of these germs. the vaccine is administered subcutaneously by means of a syringe, but the quantity of the vaccine to be injected and the number of doses to be used should be left to the judgment of a competent veterinarian. infectious diseases. by rush shippen huidekoper, m. d., vet. [revised by a. eichhorn, d. v. s.] general discussion. an infectious disease may be defined as any malady caused by the introduction into the body of minute organisms of the vegetable or animal kingdom which have the power to multiply indefinitely and set free certain peculiar poisons which are chiefly responsible for morbid changes. nearly all diseases of animals for which a definite cause may be attributed are caused by bacteria; such are tuberculosis, anthrax, blackleg, lockjaw, and others. there are some diseases, as, for instance, texas fever and rabies, which are caused by a minute animal parasite known as protozoa, while others again, like lumpy jaw and aspergillosis, are caused by fungi. besides there are infectious diseases in which the causative agents have never been successfully isolated, as they are so small that they can not be detected by the aid of the most powerful microscope, and accordingly they are termed as ultravisible viruses. hog cholera, foot-and-mouth disease, smallpox, and others belong to this group. bacteria may be defined as very minute unicellular organisms of plantlike character. they multiply either by simple division or by spore formation, the latter usually taking place when the conditions pertaining to the growth of the bacteria become unfavorable. the spores are much more resistant to destruction than the bacteria which produce them. another group of parasites producing disease is known as protozoa. these are more complex than bacteria, and their artificial cultivation is also much more difficult than is the case with the bacterial parasites. of the representatives of this group, causing disease in animals, are the trypanosomes, which are the causative factors of dourine and surra, and the piroplasma, which induce texas fever in cattle and malaria or biliary fever of horses. there are also disease-producing fungi which are responsible for certain affections in horses; among these the most important are mycotic lymphangitis, or sporotrichosis, and streptotrichosis. the introduction of the infection may take place in various ways. the most frequent method is by ingestion. further, the entrance of the germs may occur by inhalation, skin abrasions, wounds of any kind, through the genital organs, and at times also through the milk ducts of the teats. as a general rule infectious diseases have a period of incubation which comprises the time elapsing between the exposure to the infection and the actual appearance of the disease. this period varies in the different diseases. the treatment of infectious diseases is, as a rule, unsatisfactory. when the symptoms have once appeared a disease is liable to run its course in spite of treatment, and if it is one from which animals usually recover, all that can be done is to put them into the most favorable surroundings. many infectious diseases lead sooner or later to death; treatment is useless so far as the sick animals are concerned, and it may be worse than useless for those not yet affected. all animals suffering with infectious diseases are more or less directly a menace to all others. they represent for the time being manufactories of disease germs, and they are giving them off more or less abundantly during the period of disease. they may infect others directly or they may scatter the virus about and the surroundings may become the future source of infection. therefore, in the control of infectious diseases prevention is the most important procedure. the isolation or segregation of healthy animals from infected ones should be primarily considered, and if at any time an animal manifests the symptoms of an infectious disease it is essential to protect the others from such a source of danger. in some of the infectious diseases it may become advisable to kill the infected animals in order to avoid the spread of the disease. this is especially important in diseases which are slow in their course, such as tuberculosis. at times when diseases appear in a country where they have not been prevalent it becomes advisable and necessary to protect the healthy herds by the slaughter of all the infected animals. pursuance of this policy has resulted in control of the foot-and-mouth disease, and has proved to be a very satisfactory method of eradication. disinfection. disinfection is a very important phase in the control of infectious disease. this consists in the use of certain substances which possess the power to destroy bacteria or their spores, or both. the cheapest and most available for animal diseases are ordinary freshly slaked lime, or unslaked lime in powder form, chlorid of lime, crude carbolic acid, corrosive sublimate, formalin, formaldehyde, gas, cresol, etc. in the disinfection of stables and premises it is essential to execute the work in a most thorough manner. this may be satisfactorily accomplished by carrying out the following directions: . sweep ceilings, side walls, stall partitions, floors, and other surfaces until free from cobwebs and dust. . scrape away all accumulation of filth, and if woodwork has become decayed, porous, or absorbent, it should be removed, burned, and replaced with new material. . if floor is of earth, remove inches from the surface, and in places stained with urine a sufficient depth should be replaced to expose fresh earth. all earth removed should be replaced with earth from an uncontaminated source; it would be better still to lay a new floor of concrete, which is very durable and easily cleaned. . all refuse and material from stable and barnyard should be removed to a place not accessible to cattle or hogs. the manure should be spread on fields and turned under, while the wood should be burned. . the entire interior of the stable, especially the feeding troughs and drains, should be saturated with a disinfectant, as liquor cresolis compositus (u. s. p.), or carbolic acid, ounces to every gallon of water, to which ounces of chlorid of lime should be added. the best method of applying the disinfectant and the lime wash is by means of a strong spray pump, such as those used by orchardists. this method is efficient in disinfection against most of the contagious and infectious diseases of animals, and should be applied immediately following any outbreak, and, as a matter of precaution, it may be used once or twice yearly. . it is important that arrangements be made to admit a plentiful supply of sunlight and fresh air by providing an ample number of windows, thereby eliminating dampness, bad odor, and other insanitary conditions. good drainage is also very necessary. if the use of liquor cresolis compositus, carbolic acid, or other coal-tar products is inadmissible because of the readiness with which their odor is imparted to milk and other dairy products, bichlorid of mercury may be used in proportion of to , or pound of bichlorid to gallons of water. all portions of the stable soiled with manure, however, should first be thoroughly scraped and cleaned, as the albumin contained in manure would otherwise greatly diminish the disinfecting power of the bichlorid. disinfection with this material should be supervised by a veterinarian or other person trained in the handling of poisonous drugs and chemicals, as the bichlorid is a powerful, corrosive poison. the mangers and the feed boxes, after drying, following spraying with this material, should be washed out with hot water, as cattle are especially susceptible to mercurial poisoning. the bichlorid solution should be applied by means of a spray pump, as recommended for the liquor cresolis compositus. vaccination. in recent years vaccination for the prevention of certain infectious diseases has been successfully developed, and without a doubt the future has a great deal in store for this phase of prevention. at the present time vaccination has been found effective against blackleg, hog cholera, anthrax, lockjaw, strangles, rabies, hemorrhagic septicemia, white scours, etc. it is always essential, of course, that the products used for the vaccination be pure and potent; also they should be employed only with the advice of competent authorities and with proper care. the biological products prepared for the cure and prevention of infections are prepared by manufacturers who, in order to conduct an interstate business, are required to obtain a license from the united states department of agriculture for the manufacture of such preparations. since july , , the department of agriculture, by an act of congress of march , , has had control of the manufacture of biological products for the treatment of domestic animals. the numerous complaints which were received from time to time relative to the impotency of some of the preparations, and also the fact that in some instances the use of the products were directly responsible in causing outbreaks of disease, made the necessity for such control obvious. this supervision is no doubt of far-reaching importance, as it assures the users that the preparations are reliable. influenza. _synonyms._--pinkeye, typhoid fever, epizooty, epihippic fever, hepatic fever, bilious fever, etc.; flèvre typhoide, grippe (french); pferdestaupe (german); gastro-enteritis of vatel and d'arboval; febris erysipelatodes, zundel; typhus of delafond. _definition._--the term influenza is applied to a febrile, contagious, infectious disease of horses, which is characterized by a blood infection, with inflammation of the mucous membranes, which frequently involves the lungs. inflammatory complications also occur in the form of swellings of the subcutis, tendons, and tendinous sheaths and laminæ of the feet. the causative agent has not been satisfactorily established. one attack usually protects the animal from future ones of the same disease, but not always. an apparently complete recovery is sometimes followed by serious sequelæ of the nervous and blood-vessel systems. under certain conditions of the atmosphere or from unknown causes, the disease is very liable to assume an epizootic form, with tendency to complications of especial organs, as, at one period, the lungs, at another the intestines, etc. the first description of influenza is given by laurentius rusius in , when it spread over a considerable portion of italy, causing great loss among the war horses of rome and the surrounding district. later, in , an epizootic of this disease visited germany and spread to other parts of europe. in , under the name of "epidemica equorum," it followed the tracks of the great armies all over europe, causing immense losses among the horses, while rinderpest was scourging the cattle of the same regions. the two diseases were confounded with each other, and were, by the scientists of the day, supposed to be allied to the typhus, which was a plague to the human race at the same time. we find the first advent of this disease to the british islands in an epizootic among the horses of london and the southern counties of england in , which is described by gibson. in robert whytt recounts the devastation of the horses of the north of scotland from the same trouble. throughout the eighteenth century a number of epizootics occurred in hanover and other portions of germany and in france, which were renewed early in the present century, with complications of the intestinal tract, which obtained for it its name of gastro-enteritis. in it first attacked the horses in north america, but is not described as again occurring in a severe form until - , when it spread over the entire country, from canada south to ohio, and then eastward to the atlantic and westward to california. it is now a permanent disease in our large cities, selecting for the continuance of its virulence young or especially susceptible horses which pass through the large and ill-ventilated and uncleaned stables of dealers, and assumes from time to time an enzootic form, when from some reason its virulence increases. it assumes this form also when, from reasons of rural economy and commerce, large numbers of young and more susceptible animals are exposed to its contagion. _etiology._--the experiments of dieckerhoff many years ago proved that the disease may be transmitted to healthy animals by intravenous injection of warm blood from affected horses. further investigations revealed the fact that blood from affected horses, even when passed through porcelain filters, may transmit the disease, thereby proving that the causative agent belongs to the so-called filterable viruses. this has been further substantiated by gaffky, who showed in his recent experiments that the disease may be transmitted with defibrinated as well as with filtered blood, in which cases the typical form of influenza developed in inoculated animals in from five to six days. these findings were also substantiated by basset. further observations have also proved that apparently recovered animals may harbor the infection for a long time and still be capable of transmitting the disease. such virus carriers are no doubt responsible for numerous outbreaks of this disease when, in a locality free from the disease, it certainly appears after the introduction of an apparently healthy animal. as one attack is usually self-protective, numbers of old horses, having had an earlier attack, are not capable of contracting it again; but, aside from this, young horses, especially those about four or five years of age, are much more predisposed to be attacked, while the older ones, even if they have not had the disease, are less liable to it. again, the former age is that in which the horse is brought from the farm, where it has been free from the risk of exposure, and is sold to pass through the stables of the country taverns, the dirty, infected railway cars, and the foul stockyards and damp stables of dealers in our large cities. overfed, fat, young horses which have just come through the sales stables are much more susceptible to contagion than the same horses are after a few months of steady work. pilger, in , was the first to recognize infection as the direct cause of the disease. roll and others studied the contagiousness of influenza, and, finding it so much more virulent and permanent in old stables than elsewhere, classed it as a "stall miasm." the contagion will remain in the straw bedding and droppings of the animal and in the feed in an infected stable for a considerable time and if these are removed to other localities it may be carried in them. it may be carried in the clothing of those who have been in attendance on horses suffering from the disease. the drinking water in troughs and even running water may hold the virus and be a means of its communication to other animals, even at a distance. the studies of dieckerhoff, in , in regard to the contagion of influenza were especially interesting. he found that during a local enzootic, produced by the introduction of infected horses into an extensive stable otherwise perfectly healthy, the infection took place in what at first seemed to be a most irregular manner, but which was shown later to be dependent on the ventilation and currents of air through the various buildings. his experiments showed that the virus of influenza is excessively diffusible, and that it will spread rapidly to the roof of a building and pass by the apertures of ventilation to others in the neighborhood. the writer has seen cases that have appeared to spread through a brick wall and attack animals on the opposite side before others even in the same stable were affected. brick walls, old woodwork, and the dirt which is too frequently left about the feed boxes of a horse stall will hold the contagion for several days, if not weeks, and communicate it to susceptible animals when placed in the same locality. on two successive mornings a -year-old colt belonging to the writer stood for about minutes at the open door, fully feet from the stalls, of a stable in which two cases of influenza had broken out the day before: in six days the colt developed the disease. on the morning when the trouble in the colt was recognized it stood in an infirmary with a dozen horses that were being treated for various diseases, but was immediately isolated; within one week two-thirds of the other horses had contracted the disease. _symptoms._--after the exposure of a susceptible horse to infection a period of incubation of from four to seven days elapses, during which the animal seems in perfect health, before any symptom is visible. when the symptoms of influenza develop they may be intense, or so moderate as to occasion but little alarm, but the latter condition frequently exposes the animal to use and to the danger of the exciting causes of complications which would not have happened had it been left quietly in its stall in place of being worked or driven out to show to prospective purchasers. the disease may run a simple course as a specific fever, with alterations only of the blood, or at any period it may become complicated by local inflammatory troubles, the gravity of which is augmented by developing in an animal with an impoverished blood, an already irritated, rapid circulation, and defective nutritive and reparative functions. the first symptoms are those of a rapidly developing fever, which becomes intense within a very short period. the animal becomes dejected and inattentive to surrounding objects; stands with its head down, and not back on the halter as in serious lung diseases. in the flanks, the muscles of the croup and of the shoulders, or of the entire body it has chills lasting from to minutes, and frequently a grinding of the teeth which warns one that a severe attack may be expected. the hairs become dry and rough and stand on end. the body temperature increases to °, . °, and ° f., or even in severe cases to ° f., within the first twelve or eighteen hours. the horse becomes stupid, stands immobile with its head hanging, the ears listless, and it pays but little attention to the surrounding attendants or the crack of a whip. the stupor becomes rapidly more marked, the eyes become puffy and swollen with excessive lacrimation, so that the tears run from the internal canthus of the eye over the cheeks and may blister the skin in their course. the respiration becomes accelerated to or in a minute, and the pulse is quickened to , , or even , moderate in volume and in force. there is great depression of muscular force; the animal stands limp, as if excessively fatigued. there is diminution, or in some cases total loss, of sensibility of the skin, so that it may be pricked or handled without attracting the attention of the animal. on movement, the horse staggers and shows a want of coordination of all the muscles of its limbs. the senses of hearing, sight, and taste are diminished, if not entirely destroyed. the visible mucous membranes (as the conjunctiva), from which it received the name pinkeye, and the mouth, and the natural openings become of a deep saffron, ocher, or violet-red color. this latter is especially noticeable on the rim of the gums and is a condition not found in any other disease, so that it is an almost diagnostic symptom. in some outbreaks there is much more swelling of the lids and weeping from the eyes than in others. if the animal is bled at this period the blood is found more coagulable than normal, but at a later period it becomes of a dark color and less coagulable. there is great diminution or total loss of appetite, with an excessive thirst, but in many cases cold-blooded horses may retain a certain amount of appetite, eating slowly at hay, oats, or other feed. there is some irritation of the mucous membrane of the respiratory tract, as shown by discharge of mucus from the nose, and by cough. pregnant mares are liable to abort. we have, following the fever, a tumefaction, or edema, of the subcutaneous tissues at the fetlocks, of the under surface of the belly, and of the sheath of the penis, which may be excessive. the infiltration is noninflammatory in character and produces an insensibility of the skin like the excessive stocking which we see in debilitated animals after exposure to cold. in ordinary cases the temperature has reached its maximum of ° or ° f. in from to hours from the origin of the fever. it remains stationary for a period of from to days without so much variation between morning and evening temperature as we have in pneumonia or other serious diseases of the lungs. at the termination of the specific course of the disease, which is generally from to days, the fever abates, the swelling of the legs and under surface of belly diminishes, the appetite returns, the strength is rapidly regained, the mucous membranes lose their yellowish color, which they attain so rapidly at the commencement of the disease, and the animal convalesces promptly to its ordinary good condition and health, and rapidly regains the large amount of weight which it lost in the early part of the disease, a loss which frequently reaches , , or even pounds each hours. for the first three days of the high temperature there is a great tendency to constipation, which should be avoided if possible by the use of the means recommended below, for, if it has been marked, it may be followed by a troublesome diarrhea. _terminations._--the terminations of simple influenza may be death by extreme fever, with failure of the heart's action; from excessive coma, due generally to a rapid congestion of the brain; to the poisonous effects of the débris of the disintegrated blood corpuscles and the toxin of the disease; to an asphyxia, following congestion of the lungs; or the disease terminates by subsidence of the fever, return of the appetite and nutritive functions of the organs, and rapid convalescence; or, in an unfortunately large number of cases, the course of the disease is complicated by local inflammatory troubles, whose gravity is greater in influenza than it is when they occur as sporadic diseases. _complications._--the complications are congestions, followed by inflammatory phenomena in the various organs of the body, but they are most commonly located in the intestines, lungs, brain, or vascular laminæ of the feet. atmospheric influence or other surrounding influences of unknown quality seem to be an important factor in the determination of the local lesions. at certain seasons of the year, and in certain epizootics, we find and per cent or even a greater percentage of the cases rendered more serious by complication of the intestines; at other seasons of the year, or in other epizootics, we find the same percentage of cases complicated by inflammation of the lungs, while at the same time a small percentage of them are complicated by troubles of the other organs; inflammatory changes of the brain, of the laminæ, more rarely commence in epizootic form, but are to be found in a certain small percentage of cases in all epizootics. exciting causes are important factors in complicating individual cases of influenza, or in localizing special lesions, during either enzootics or epizootics. these exciting or determining causes act much as they would in sporadic inflammatory diseases, but in this case we find the animal much more susceptible and predisposed to be acted upon than ordinary healthy animals. with a temperature already elevated, with the heart's action driving the blood in increased quantity into the distended blood vessels, which become dilated and lose their contractility, with a congestion of all the vascular organs already established, it takes but little additional irritation to carry the congestion one step further and produce inflammation. _complication of the intestines._--when any cause acts as an irritant to the intestinal tract during the course of this specific fever it may produce inflammation of the organs belonging to it. this cause may be constipation, which can find relief only in a congestion which offers to increase the function of the glands and relieve the inertia caused by a temporary cessation of activity; or irritant medicines, especially any increased use of antimony, turpentine, or the more active remedies; the taking of indigestible feed, or of feed in too great quantities, or that has been altered in any way by fungus or other injurious alterations; the swallowing of too cold water; or any other irritant may cause congestion. this complication is ushered in by colics. the animal paws with the fore feet and evinces a great sensibility of the belly; it looks with the head from side to side, and may lie down and get up, not with violence, but with care for itself, perfectly protecting the surface of the belly from any violence. at first we find a decided constipation; the droppings if passed are small and hard, coated with a viscous varnish or even with false membranes. in from to hours the constipation is followed by diarrhea. the alimentary discharge becomes mixed with a sero-mucous exudation, which is followed by a certain amount of suppurative matter. the animal becomes rapidly exhausted and unstable, staggers on movement, losing the little appetite which may have remained, and has exacerbations of fever. the pulse becomes softer and weaker, the respiration becomes gradually more rapid, the temperature is about ° to . ° f. higher. if a fatal result is not produced by the extensive diarrhea the discharge is arrested in from to days and a rapid recovery takes place. _complication of the lungs._--if at any time during the course of the fever the animal is exposed to cold or drafts of air, or in any other way to the causes of repercussion, the lungs may become affected. in the majority of cases, however, after three, four, or five days of the fever, congestion of the lungs commences without any exposure or apparent exciting cause. unless this congestion of the lungs is soon relieved it is followed by an inflammation constituting pneumonia. this pneumonia, while it is in its essence the same, differs from an ordinary pneumonia at the commencement by an insidious course. the animal commences to breathe heavily, which is distinctly visible in the heaving of the flanks, the dilatation of the nostrils, and frequently in the swaying movement of the unsteady body. the respirations increase in number, what little appetite remained is lost, the temperature increases from ° to °, the pulse becomes more rapid, and at times, for a short period, more tense and full, but the previous poisoning of the specific disease has so weakened the tissues that it never becomes the characteristic full, tense pulse of a simple pneumonia. on percussion of the chest dullness is found over the inflamed areas; on auscultation at the base of the neck over the trachea a tubular murmur is heard. the crepitant râles and tubular murmurs of pneumonia are heard on the sides of the chest if the pneumonia is peripheral, but in pneumonia complicating influenza the inflamed portions are frequently disseminated in islands of variable size and are sometimes deep-seated, in which case the characteristic auscultory symptoms are sometimes wanting. from this time on the symptoms of the animal are those of an ordinary grave pneumonia, rendered more severe by occurring in a debilitated animal. the cough is at first hacky and aborted; later, more full and moist. there is discharge from the nostrils, which may be mucopurulent, purulent, or hemorrhagic. as in simple pneumonia, in the outset this discharge may be "rusty," owing to capillary hemorrhages. we find that the blood is thoroughly mixed with the matter, staining it evenly, instead of being mixed with it in the form of clots. at the commencement of the complication the animal may be subject to chills, which may again occur in the course of the disease, in which case, if severe, an unfavorable termination by gangrene may be looked for. if gangrene occurs it is shown by preliminary chills, a rapid elevation of temperature, a tumultuous heart, a flaky discharge from the nostrils, and a fetid breath; the symptoms are identical with those which occur in gangrene complicating other diseases. _complication of the brain._--at any time during the course of the disease congestion of the brain may occur; at an early period if the fever has been intense from the outset, but in ordinary cases more frequently after three or four days. the animal, which has been stupid and immobile, becomes suddenly restless, walks forward in the stall until it fastens its head in the corner. if in a box stall and it becomes displaced from its position, it follows the wall with the nose and eyes, rubbing it along until it reaches the corner and again fastens itself. it may become more violent and rear and plunge. if disturbed by the entrance of the attendant or any loud noise or bright light, it will stamp with its fore feet and strike with its hind feet, but is not definite in fixing the object which it is resisting, which is a diagnostic point between meningitis and rabies and which renders the animal with the former disease less dangerous to handle. if fastened by a rope to a stake or post, the animal will wander in a circle at the end of the rope. it wanders almost invariably in one direction. the pupils may be dilated or contracted, or we may find one condition in one eye and the opposite in the other. the period of excitement is followed by one of profound coma, in which the animal is immobile, the head hanging and placed against the corner of the stall, the body limp, and the motion, if demanded of the animal, unsteady. little or no attention is paid to the surrounding noises, the crack of a whip, or even a blow on the surface of the body. the respiration becomes slower, the pulsations are diminished, the coma lasts for variable time, to be followed by excesses of violence, after which the two alternate, but if severe the period of coma becomes longer and longer until the animal dies of spasms of the lungs or of heart failure. it may die from injuries which occur in the ungovernable attacks of violence. _complication of the feet._--the feet are the organs which are next in frequency predisposed to congestion. this congestion takes place in the laminæ (podophyllous structures) of the feet. the stupefied animal is roused from its condition by excessive pain in the feet and assumes the position of a foundered horse; that is, if the fore feet alone are affected, they are carried forward until they rest on the heels; and if the hind feet are affected, all the feet are carried forward, resting on their heels, the hind ones as near the center of gravity as possible. in some cases the stupor of the animal is so great that the pain is not felt, and little or no change of the position of the animal is noticeable. the foot is found hot to the touch, and after a given time the depressed convex sole of typical founder is recognized. _pleurisy._--this is a rare complication, but when it does occur it is ushered in by the usual symptoms of depression, rapid pulse, small respiration, elevation of the temperature, subcutaneous edema of the legs and under surface of the belly, and we find a line of dullness on either side of the chest and an abscess of respiratory murmur at the lower part. if it is severe, there may be an effusion filling one-fourth to one-third of the thoracic cavity in from to hours. _pericarditis_ is an occasional complication of influenza. it is ushered in by chills, elevation of the temperature; the pulse becomes rapid, thready, and imperceptible. the heart murmurs become indistinct or can not be heard. a venous pulse is seen on the line of the jugular veins along the neck. respiration becomes more difficult and rapid. if the animal is moved the symptoms become more marked or it may drop suddenly dead from heart failure. _peritonitis_, or inflammation of the membranes lining the belly and covering the organs contained in it, sometimes takes place. the general symptoms are similar to those of a commencing pericarditis. the local symptoms are those of pain, especially to pressure on side of the flanks and belly, distention of the latter, and sometimes the formation of flatus, or gas, and constipation. other occasional complications are nephritis, hepatitis, inflammation of the flexor tendons and rupture of them, and abscesses. _diagnosis._--the diagnosis of influenza is based upon continued fever, with great depression and symptoms of stupor and coma; the rapidly developing, dark-saffron, ocher, yellowish discoloration of the mucous membranes, swelling of the legs and soft tissues of the genitals. when these symptoms have become manifested the diagnosis of a local complication is based upon the same symptoms that are produced in the local diseases from other causes, but in influenza the local symptoms are frequently masked or even entirely hidden by the intense stupor of the animal, which renders it insensible to pain. the evidence of colic and congestion, which is followed by diarrhea, indicates enteritis. the rapid breathing or difficulty of respiration points to a complication of the lungs, but, as we have seen in the study of the symptoms, the local evidences of lung lesions are frequently hidden. again, we have seen that inflammation of the feet, or founder, complicating influenza is frequently not shown on account of the insensibility to pain on the part of the animal, which indicates the importance of running the hand daily over the hoofs to detect any sudden elevation of temperature on their surface. the diagnosis of brain trouble is based upon the excessive violence which occurs in the course of the disease, for during the intervening period or coma there is no means of determining that it is due to this complication. severe cases of influenza may simulate anthrax in the horse. in both we have stupor, the intense coloration of the mucous membranes of the eyes, and a certain amount of swelling of the legs and under surface of the belly. the diagnosis here can be made only by microscopic examination of the blood. in strangles, equine variola, and scalma we have an intensely red, rosy coloration of the mucous membranes, full, tense pulse, and although in these diseases we may have depression, we do not have the stupor and coma except in severe cases which have lasted for several days. in influenza we have no evidence of the formation of pus on the mucous membranes as in the other diseases, except sometimes in the conjunctivæ. in severe pneumonia (lung fever) we may find profound coma, dark-yellowish coloration of the mucous membranes, and swelling of the under surface of the belly and legs; but in pneumonia we have the history of the difficulty of breathing and an acute fever of a sthenic type from the outset, and the other symptoms do not occur for several days, while in influenza we have the history of characteristic symptoms for several days before the rapid breathing and difficulty of respiration indicate the appearance of the complication. without the history it is frequently difficult to diagnose a case of influenza of several days' standing, complicated by pneumonia, from a case of severe pneumonia of five or six days' standing, but from a prognostic point of view it is immaterial, as the treatment of both are identical. the fact that other horses in the same stable or neighborhood have influenza may aid in the diagnosis. _prognosis._--influenza is a serious disease chiefly on account of its numerous complications. uncomplicated influenza is a comparatively simple malady, and is fatal in but to per cent of all cases. in some outbreaks, however, complications of one kind or another preponderate; in such instances the rate of mortality is much increased. _alterations._--the chief alteration of influenza occurs in the digestive tract, and consists in hyperemia, infiltration, and swelling of the mucous membrane, and especially of the peyer's patches near the ileocecal valve. the tissues throughout the body are found stained, and of a more or less yellowish hue. there is always found a congested condition of all the organs, muscles, and interstitial tissues of the body. the coverings of the brain and spinal cord partake in the congested and discolored condition of the rest of the tissues. other alterations are dependent entirely upon the complications. if the lungs have been affected, we find effusions identical in their intimate nature with those of simple pneumonia, but they differ somewhat in their general appearance in not being so circumscribed in their area of invasion. the alterations of meningitis and laminitis are identical with those of sporadic cases of founder and inflammation of the brain. _treatment._--while the appetite remains the patient should have a moderate quantity of sound hay, good oats, and bran; or even a little fresh clover, if obtainable, can be given in small quantities. it is not so important that a special diet shall be observed as that the horse shall eat a moderate quantity of nourishing feed, and he may be tempted with any feed of good quality that he relishes. he should be placed in a well-ventilated box stall away from other horses. grass, roots, apples, and milk may be offered and, if relished, allowed freely. to reduce the temperature the safest simple plan is to inject large quantities of cold water into the rectum. antipyrene may be used with alcohol or strychnia. derivatives in the form of essential oils and mustard poultices, baths of alcohol, turpentine, and hot water, after which the animal must be immediately dried and blanketed, serve to waken the animal from the stupor and relieve the congestion of the internal organs. this treatment is especially indicated when complication by congestion of the lungs, intestines, or of the brain is threatened. quinin and salicylic acid in -dram doses will lower the temperature, but too continuous use of the former in some cases increases the depression. iodid of potash reduces the excessive nutrition of the congested organs and thereby reduces the temperature; again, this drug in moderate quantities is a stimulant to the digestive tract and acts as a diuretic, causing the elimination of waste matter by the kidneys. small doses of glauber's salt and bicarbonate of soda, used from the outset, stimulate the digestive tract and prevent constipation and its evil results. in cases of severe depression and weakness of the heart digitalis can be used with advantage. at the end of the fever, and when convalescence is established, alcohol in one-half pint doses and good ale in -pint doses may be given as stimulants. to these may be added -dram doses of turpentine. in complications of the intestines camphor and asafetida are most frequently used to relieve the pain causing the colics; diarrhea is also relieved by the use of bicarbonate of soda, nitrate of potash, and drinks made from boiled rice or starch, to which may be added small doses of laudanum. in complication of the lungs iodid of potash and digitalis are most frequently indicated, in addition to the remedies used for the disease itself. founder occurring as a complication of influenza is difficult to treat. it is, unfortunately, frequently not recognized until inflammatory changes have gone on for several days. if recognized at once, local bleeding and the use of hot or cold water, as the condition of the animal may permit, are most useful, but in the majority of cases the stupefied animal is unable to be moved satisfactorily or to have one foot lifted for local treatment; the only treatment consists in local bleeding above the coronary bands and the application of poultices. during convalescence small doses of alkalines may be kept up for a short time, but the greatest care must be used, while furnishing the animal with plenty of nutritious, easily digestible feed, not to over-load the intestinal tract, causing constipation and consequent diarrhea. special care must be taken for several weeks not to expose the animal to cold. _prevention._--in order to prevent the introduction of the disease it is advisable to isolate newly purchased animals for at least a week. further, the stabling of healthy horses in sales and feed stables should also be guarded against. at the beginning of an outbreak the disease may be checked by immediate isolation of the affected horses, by taking the temperatures of the healthy animals, and by the segregation of those showing a marked elevation. bacterial vaccines are now being prepared for the prevention of this disease and also for its cure, but to date the results are not convincing as to the beneficial action of these products. since the cause of the disease has not yet been satisfactorily determined it is difficult to conceive how immunity could be produced with the aid of the germs which enter into the preparation of these products. the reports would indicate, however, that vaccines exert a favorable influence upon the course of the disease, probably preventing severe complications which under ordinary conditions are the principal factors in determining the severity of the outbreak. contagious pneumonia. _synonyms._--edematous pneumonia; stable pneumonia; equine pleuropneumonia; influenza pectoralis equorum; pleuropneumonia; influenzal pneumonia; brustseuche (german). contagious pleuropneumonia is an acute contagious disease of horses manifesting itself either as a croupous pneumonia or a pleuropneumonia with complications in the form of serous infiltrations of the subcutaneous tissues and tendons. _etiology._--investigators of this disease incriminated various kinds of microorganisms as the cause of this affection. transmission experiments were usually negative with these organisms. this was also the case in attempts to transmit the disease by feeding with affected parts of the lungs, intestinal contents, and nasal discharge; likewise by intravenous or subcutaneous injections of blood and of emulsions made from nasal discharge, urine, the lung, and other organs. the most recent experimental results of gaffky and lüber proved that at least at the beginning of the disease the bronchial secretion contains the infection. upon killing horses affected with the typical forms of the disease on the third or fourth day of the affection the air passages are usually found to be filled with a yellowish, tenacious, germ-free secretion with which they succeeded in infecting healthy colts. the virus has not been isolated. the possibility of its being a protozoan is suggested by the above-named investigators through their observations of round or rod-shaped bodies in the round cells of the secretions. two organisms were formerly especially considered to play an important part in the cause of the disease, the _streptococcus pyogenes equi_, which has been isolated from most cases of the disease, and the _bacillus equisepticus_, which by some investigators was considered to be the cause of contagious pleuropneumonia. although there is no doubt as to the presence of these microorganisms in most of the cases, their association with the cause of this disease, however, is now doubted, especially since attempts to transmit the disease with pure cultures of these germs failed to reproduce the typical form of the disease. they, however, are of great significance in connection with the pathological changes occurring in connection with the infection and probably are the determining factor in the course of the disease. they exert their action after the animal has already been attacked by the true virus, and then produce the inflammatory changes attributed to these secondary invaders. this disease is the adynamic pneumonia of the older veterinarians, who did not recognize any essential difference in its nature from an ordinary inflammation of the lungs, except in the profound sedation of the force of the animal affected with it, which is a prominent symptom from the outset of the disease. again, this same prostration of the vital force of the animal, combined with the staggering movement and want of coordination of the muscles, caused it for a long time to be confounded with influenza, with which at certain periods it certainly has a strong analogy of symptoms, but from which, as from sporadic pneumonia, it can be separated very readily if the case can be followed throughout its whole course. infectious pneumonia is a specific inflammation of the lungs, accompanied with interstitial edema and inflammation of the tissues of these organs and a constitutional disturbance and fever. it causes a profound sedation of the nervous system, which may be so great as to cause death. it is sometimes attended with pleurisy, inflammation of the heart or septic complications, which also prove fatal. old, cold, damp, foul, unclean, and badly drained and ventilated stables allow rapid dissemination of the disease to other horses in the same stable and act as rich reservoirs for preserving the contagion, which may be retained for over a year. the virus is but moderately volatile, and in a stable seems rather to follow the lines of the walls and irregular courses than the direct currents of air and the tracts of ventilation. prof. dieckerhoff found that the contagion of influenza was readily diffusible throughout an entire stable and through any opening to other buildings, but he also found that the contagion of infectious pneumonia is not transmissible at any great distance, nor is it very diffusible in the atmosphere. a brick wall feet in height served, in one instance, to prevent the infection of other animals placed on the opposite side from a horse ill with the disease, while others placed on the same side and separated from the focus of contagion only by open bars in the stall were infected and developed the disease in its typical form. _symptoms._--the symptoms differ slightly from those of a frank, fibrinous pneumonia, but not so much by the introduction of new symptoms as by the want of or absence of the distinct evidences of local lesions which are found in the latter disease. all the pneumonias throughout the whole course of the trouble are less marked and less clearly defined. the symptoms may develop slowly or rapidly. if slowly, there is fever and the animal gives a rare cough which resembles that of a heavy horse affected with a slight chronic bronchitis; it becomes somewhat dejected and dull, at times somnolent, and has a diminished appetite. this condition lasts for several days, or the disease may begin with high fever, and the symptoms described below are severe and develop in rapid sequence. the respiration increases to , , or to the minute, and a small, running, soft pulse attains a rhythm of , , or even more beats in the sixty seconds. the heart, however, contrary to the debilitated condition of the pulse, is found beating violently and tumultuously, as it does in anthrax and septic intoxication. the mucous membranes of the eyes and mouth and of the genital organs are found somewhat edematous, and they rapidly assume a dirty, saffron color, at times approaching an ocher, but distinguishable from the similar coloration in influenza by the want of the luster belonging to the latter and by the muddy, dull tint, which is characteristic throughout the disease. suddenly, without the preliminary râles which precede grave lesions of the lungs in other diseases, the blowing murmur of pneumonia is heard over a variable area of the chest, usually, however, much more distinctly over the trachea at the base of the neck and directly behind the shoulder on each side of the chest. in some cases the evidence of lung lesion can be detected only over the trachea. the lesions of the lungs may be scattered throughout both lungs, involving numerous small areas, or they may be confined to and more or less fully occupy one or two lobes. occasionally there is a general involvement of both lungs. the body temperature has now reached ° or ° f., or in extreme cases even a degree higher. the debility of the animal is great without the stupefaction or evidence of cerebral trouble, which is constant with such grave constitutional phenomena in influenza or severe pneumonia. the animal is subject to occasional chills, and staggers in its gait. the yellow coloration of the visible mucous membrane is rendered pale by infiltration of the liquid of the blood into the tissues; the pulse may become so soft as to be almost imperceptible, the heart movement and sounds being at the same time exaggerated. the animal loses flesh rapidly, and dropsies of the extremities, of the under surface of the belly, or of the internal organs may show themselves. _terminations._--these symptoms may gradually subside after five to eight days, with an improved appetite the inanition may cease and the animal commence to nourish its impoverished blood and tissues; the pulse becomes stronger and the heart more regular and less tumultuous; the mucous membranes assume a brighter and more distinct color; the difficulty of respiration is removed, and the animal may make a recovery. when death occurs it is usually directly due to heart failure; in some cases it is caused by asphyxia, owing to the great amount of exudation into the lung tissue, rendering its further function impossible. _complications._--the pulmonary complications of infectious pneumonia are secondary inflammatory or necrotic changes in the lungs themselves. suppuration at times takes place in the bronchi and may extend to the lung tissue. in this case mucous râles develop which are most distinctly heard over the trachea and on the sides of the chest directly behind the shoulders. with the development of the mucous râles, to be heard on auscultation, we have a more purulent discharge from the nostrils, similar to that of a chronic or subacute bronchitis. if the inflammation has been of some standing, cavernous râles may be heard, indicating the destruction of a considerable portion of lung tissue and the formation of a cavity. the effects of this more acute inflammatory process are not appreciable in the general condition of the animal, except to weaken it still further and add to its debilitated and emaciated cachexia. gangrene sometimes occurs. a sudden rise of the body temperature of ° or °, with a more enfeebled pulse and a still more tumultous heart, develop simultaneously with the appearance of a discharge from the nostrils. this discharge is gray in color, serous or watery in consistency, mixed with the detritus of broken-down lung tissue, and sometimes contains clots of blood, or in more serious cases may be marked by a quantity of fluid blood from a hemorrhage, which proves fatal. the discharge is fetid to the smell. the animal emaciates rapidly. on examination of the lungs mucous râles are heard in the larger bronchi, cavities may be found at any part of these organs, and points of lobular pneumonia may be detected. a very serious complication is an inflammation of the heart muscle. this is shown by a very weak and rapid pulse, great prostration, some filling of the lungs. this complication nearly always terminates in death. other complications which may be mentioned are inflammation of the kidneys, blood poisoning, congestion of the brain, and inflammation of the tendinous sheaths and the tendons of the legs. _diagnosis._--as fever is the first symptom of infectious pneumonia, it is useful during an outbreak of this disease to make daily temperature measurements of the exposed horses, so that the first indication of disease may be discovered and the horse removed from contact with those that are sound. _prognosis._--the mortality in this disease may be as high as per cent, but it is usually not more than per cent. if there is a special tendency to complications of some sort, the mortality is increased. _alterations._--at the time of death from infectious pneumonia we frequently find septic changes and the evidences of putrefaction. the solidification of the lung tissue is found irregular in shape and high around the root of the lungs and the large bronchi, and is generally covered by sound lung tissue. the anterior lobes of the lungs are usually entirely affected. the diseased portion appears of a gray-yellowish color, somewhat watery, and tears readily. matter is found in the air tubes which form gutters through the jellylike mass of the diseased lung. abscesses from the size of a nut to larger masses may be found throughout the lungs. the blood is dark in color, fluid, or only clotted into soft, jellylike masses. masses of gangrenous or dead-black tissue may be present. _treatment._--bleeding is not to be used, because it would only still further weaken an already enfeebled animal; antimony or the alterants would increase the depression of a too-depraved constitution. there is in this disease no acute congestion of a particular organ to draw off by depletive measures, nor any violent blood current to be retarded, for fear of hypernutrition of any special part. revulsives do good, as they excite the nervous system and awaken the torpor of the weakened blood vessels, which aid in the reestablishment of the functions. as in other diseases, mustard poultices may be applied over the belly and sides of the chest, but caution must be used in the employment of blisters, as ugly ulcers may result from their action on a tissue of weakened vitality. setons are dangerous from the great tendency in this disease to septic complications. repeated friction of the legs by hand-rubbing and warmth by bandaging and by rubbing the surface of the body with turpentine and alcohol, which is immediately to be dried by rough towels, will excite the circulation and stimulate the emunctories of the skin. stimulants are given internally from the outset of the disease. turpentine in -dram doses regulates the heart and excites the kidneys to carry off waste matter, but if repeated too frequently may disturb the already delicate digestive system. alcohol rectifies the latter danger, and is a useful stimulant to the heart and digestive system, if given with care in small doses. it is an antiputrid, and is especially indicated when septic complications and gangrene are present. the aromatics and bitter tonics are useful; gentian and tea in warm decoction form a useful menstruum for other remedies. digitalis is a useful remedy. strychnin and quinin may be given throughout almost the whole course of the disease. the various preparations of iron are astringents and excitants to the digestive system. carbolic acid is an antiputrid which is of marked benefit in edematous pneumonia; it should be given in small doses diluted in alcohol. salicylic acid may be given in or dram doses every few hours. it is much used for troubles of the serous membranes, lowers the temperature, and is of value in this disease in preventing the exudation into the tissue of the lungs. the alkalines, as the sulphate and bicarbonate of soda, the nitrate of potash, and very small doses of the iodid of potash, should be employed to regulate the digestive tract, the kidneys, and the other excreting glands, and to stimulate absorption of the waste matter. the biological products enumerated under the treatment of the catarrhal form of influenza are also recommended for this disease. the bacterial vaccines in particular are being employed to a great extent, but the results are not uniformly satisfactory, especially with regard to prevention. they might, however, exert a beneficial influence against an attack of the secondary invaders and complications. a serum is also being prepared especially for the treatment of this disease, and since this is obtained from animals which have been highly immunized against the various organisms found in association with influenza it no doubt is beneficial, especially when the life of the animal is threatened. such serum, however, should be used in sufficiently large doses, as repeated experience has proved that small doses have no beneficial action on the disease. more recently salvarsan is being highly recommended for the treatment of the pneumonic form of influenza, and by many investigators it is considered as a specific for this affection. a single injection of this preparation is supposed to result in a rapid clearing of the lungs and the recovery of the animal is hastened. the cost of this product, however, at the present time, is exorbitant, and it should be considered only in the treatment of very valuable animals. the same procedure as given for influenza should be carried out in the prevention of this affection. the diet demands the strictest attention from the outset. in many of the fevers the feed has to be diminished in quantity and regulated in the quality of its heat-producing components during the acute part of the disease, so as to lessen the material for combustion in the inflamed organs. in edematous pneumonia, on the contrary, all the feed that can possibly be digested and assimilated must be given. choice must be made of the richest material which can be handled by the weakened stomach and intestines without fatiguing them. good, sound hay should be chopped short and dampened or partly boiled; in the latter case the hay tea can be reserved to use as a drink. oats may be preferred dry or in other cases are taken better scalded; in most cases, however, it is better to give slops of oatmeal, to which may be added a little bran, barley flour, or boiled milk and wheat flour. pure cow's milk, not too rich in fatty matter, may be given alone or with beaten eggs; frequently the horse has to be coaxed with the milk diluted with several parts of water at first, but will soon learn to drink the pure milk. apples and carrots cut up raw or boiled are useful, and fresh clover in small quantities will frequently stimulate the appetite. in other words, various feeds and combinations should be given to the horse. throughout the course of the disease and during convalescence the greatest attention must be taken to cleaning the coat thoroughly so as to keep the glands of the skin in working order, and light, warm covering must be used to protect the animal from cold or drafts of air. strangles. _synonyms._--distemper; colt-ill; catarrhal fever; one form of shipping fever; febris pyogenica. _definition._--strangles is an infectious disease of the horse, mule, and ass, seen most frequently in young animals, and usually leaving them immune from future trouble of the same kind. it appears as a fever lasting for a few days, and is usually associated with an abscess formation of lymph glands, especially those under the jaw, which have a tendency to break on the outside. it usually leaves the animal after convalescence perfectly healthy and as good as it was before, but sometimes leaves it a roarer or is followed by the development of deep-seated abscesses which may prove fatal. _causes._--the cause of strangles is infection by direct contact with an animal suffering from the disease, or indirectly through contact with the discharges from an infected animal, or by means of the atmosphere in which an infected animal has been. there are many predisposing causes which render some animals much more subject to contract the disease than others. early age, which has given it the popular name of colt-ill, offers many more subjects than the later periods of life do, for the animal can contract the disease but once, and the large majority of adult and old animals have derived an immunity from previous attacks. at , , or years of age the colt, which has been at home, safe on a meadow or in a cozy barnyard, far from all intercourse with other animals or sources of contagion, is first put to work and driven to the market town or county fairs to be exposed to an atmosphere or to stables contaminated by other horses suffering from disease and serving as infecting agents. if it fails to contract it there, it is sold and shipped in foul, undisinfected railway cars to dealers' stables, equally unclean, where it meets many opportunities of infection. if it escapes so far, it reaches the time for heavier work and daily contact on the streets of towns or large cities, with numerous other horses and mules, some of which are sure to be the bearers of the germs of this or some other infectious disease, and at last it succumbs. the period of the eruption of the last permanent teeth, or the end of the period of development from the colt to an adult horse, at which time the animals usually have a tendency to fatten and be excessively full-blooded, also seems to be a predisposing period for the contraction of this as well as of the other infectious diseases. thoroughbred colts are very susceptible, and frequently contract strangles at a somewhat earlier age than those of more humble origin. mules and asses are much less susceptible and are but rarely affected. other animals are not subject to this disease, but there is a certain analogy between it and distemper in dogs. after exposure to infection there is a period of incubation of the disease, lasting from two to four days, during which the animal enjoys its ordinary health. _symptoms._--the horse at first is a little sluggish if used, or when placed in its stable is somewhat dejected, paying but moderate attention to the various disturbing surroundings. its appetite is somewhat diminished in many cases, while in some cases the animal eats well throughout. thirst is increased, but not a great deal of water is taken at one time. if a bucket of water is placed in the manger the patient will dip its nose into it and swallow a few mouthfuls, allowing some of it to drip back and then stop, to return to it in a short time. the coat becomes dry and the hairs stand on end. at times the horse will have chills of one or the other leg, the fore quarters, or hind quarters, or in severe cases of the whole body, with trembling of the muscles and dryness of the skin. if the eyes and mouth are examined the membranes are found reddened to a bright rosy color. the pulse is quickened and the breathing may be slightly accelerated. at the end of two days a cough is heard and a discharge begins to come from the nostrils. this discharge is at first watery; it then becomes thicker, somewhat bluish in color, and sticky, and finally it assumes the yellowish color of matter and increases greatly in quantity. at the outset the colt may sneeze occasionally and a cough is heard. the cough is at first repeated and harsh, but soon becomes softer and moist as the discharge increases. again, the cough varies according to the source of the discharge, for in light cases this may be only a catarrh of the nasal canals, or it may be from the throat, the windpipe, or the air tubes of the lungs, or even from the lungs themselves. according to the organ affected the symptoms and character of cough are similar to those of a laryngitis, bronchitis, or lung fever caused by ordinary cold. shortly after the discharge is seen a swelling takes place under the jaw, or in the intermaxillary space. this is at first puffy, somewhat hot and tender, and finally becomes distinctly so, and an abscess is felt, or having broken itself the discharge is seen dripping from a small opening. when the discharge from the nostrils has fully developed the fever usually disappears and the animal regains its appetite, unless the swelling is sufficient to interfere with the function of the throat, causing pain on any attempt to swallow. at the end of four or six days the discharge lessens, the soreness around the throat diminishes, the horse regains its appetite, and in two weeks has regained its usual condition. old and strong horses may have the disease in so light a form that the fever is not noticeable; they may continue to eat and perform their ordinary work as usual and no symptom may be seen beyond a slight discharge from the nose and a rare cough, which is not sufficient to worry any but the most particular owner. but, on the other hand, the disease may assume a malignant form or become complicated so as to become a most serious disease, and even prove fatal in many cases. inflammation of the larynx and bronchi, if excessive, produce violent, harsh coughing, which may almost asphyxiate the animal. the large amount of discharge may be mixed with air by the difficult breathing, and the nostrils, the front of the animal, manger, and surrounding objects become covered with a white foam. the inflammation may be in the lung itself (lobular pneumonia) and cause the animal to breathe heavily, heave at the flanks, and show great distress. in this condition marked symptoms of fever are seen, the appetite is lost, the coat is dry, the horse stands back in its stall at the end of the halter strap with its neck extended and its legs propped apart to favor breathing. this condition may end by resolution, leaving the horse for some time with a severe cough, or the animal may die from choking up of the lungs (asphyxia). the swelling under the jaw may be excessive, and if the abscess is not opened it burrows toward the throat or to the side and causes inflammation of the parotid glands and breaks in annoying fistulas at the sides of the throat and even up as high as the ears. roaring may occur either during a moderately severe attack from inflammation of the throat (larynx), or at a later period as the result of continued lung trouble. abscesses may develop in other parts of the body, in the poll, in the withers, or in the spaces of loose tissue under the arms, in the fold of the thigh, and, in entire horses, in the testicles. during the course of the disease, or later, when the animal seems to be on the road to perfect recovery, abscesses may form in the internal organs and produce symptoms characteristic of disease of those parts. roaring, plunging, wandering in a circle, or standing with the head wedged in a corner of the stall indicate the collection of matter in the brain. sudden and severe lung symptoms, without previous discharge, point to an abscess between the lungs, in the mediastinum; colic, which is often continuous for days, is the result of the formation of an abscess in some part of the abdominal cavity, usually in the mesentery. _pathology._--the lesions of strangles are found on the surface of the mucous membranes, essentially of the respiratory system, and in the loose connective tissue fibers of the internal organs and glands, and consist of acute inflammatory changes, tending to the formation of matter. the blood is unaltered, though it is rich in fibrin, and if the animal has died of asphyxia it is found dark colored and uncoagulated when the body is first opened. if the animal has died while suffering from high fever the ordinary alterations throughout the body, which are produced by any fever not attended by alteration of blood, are found. _prevention._--healthy horses should be separated from the infected animals, and the stables in which the disease has occurred should be thoroughly disinfected. since the disease frequently occurs annually on infected premises, systematic disinfection should be practiced after an outbreak. the stables, as well as all utensils which might have come in contact with the infection, should be thoroughly disinfected. by such practices recurrences of the disease may be prevented. _treatment._--ordinary light cases require but little treatment beyond diet, warm washes, moistened hay, warm coverings, and protection from exposure to cold. the latter is urgently called for, as lung complications, severe bronchitis, and laryngitis are often the results of neglect of this precaution. if the fever is excessive, the horse may receive small quantities of glauber's salt (handful three times a day) as a laxative, bicarbonate of soda or niter in one-dram doses every few hours, and small doses of antimony, iodid of potash, aconite, or quinin. steaming the head with the vapor of warm water poured over a bucket of bran and hay, in which belladonna leaves or tar have been placed, will allay the inflammation of the mucous membranes and greatly ease the cough. the swelling of the glands should be promptly treated by flaxseed poultices and bathing with warm water, and as soon as there is any evidence of the formation of matter it should be opened. prompt action in this will often save serious complications. blisters and irritating liniments should _not_ be applied to the throat. when lung complications show themselves the horse should have mustard applied to the belly and to the sides of the chest. when convalescence begins great care must be taken not to expose the animal to cold, which may bring on relapses, and while exercise is of great advantage it must not be turned into work until the animal has entirely regained its strength. bacterial vaccines are now being extensively used for the prevention and treatment of this disease. they are prepared from the specific germ of the disease and frequently exert a very beneficial influence. a serum is also being prepared from horses, which is injected with gradually increasing doses of this germ. this serum possesses considerable curative value and may prove especially valuable in cases in which the animals have failed to respond to other forms of treatment, or when valuable animals are affected with the disease. purpura hemorrhagica. _synonyms._--anasarca; petechial fever; morbus maculosus. _definition._--this disease is a septic bacterial intoxication, acute and infectious in character, and is manifested by edematous swellings of the subcutaneous connective tissue, and hemorrhages on the mucous membrane and in the internal organs. a previous attack of influenza is a common predisposing cause of this disease, which appears most frequently a few weeks after convalescence is established. it occurs more frequently in those animals which have made a rapid convalescence and are apparently perfectly well than it does in those which have made a slower recovery. anasarca commences by symptoms which are excessively variable. the local lesions may be confined to a small portion of the animal's body and the constitutional phenomena be nil. the appearance and gravity of the local lesions may be so unlike, from difference of location, that they seem to belong to a separate disease, and complications may completely mask the original trouble. in the simplest form the first symptom noticed is a swelling, or several swellings, occurring on the surface of the body--on the forearm, the leg, the under surface of the belly, or the side of the head. the tumefaction is at first the size of a hen's egg; not hot, little sensitive, and distinctly circumscribed by a marked line from the surrounding healthy tissue. these tumors gradually extend until they coalesce, and in a few hours we have swelling of the legs, legs and belly, or the head, to an enormous size; they have always the characteristic constricted border, which looks as if it had been tied with a cord. in the nostrils are found small reddish spots, or petechiæ, which gradually assume a brownish and frequently a black color. examination of the mouth will frequently reveal similar lesions on the surface of the tongue, along the lingual gutter, and on the frænum. if the external swelling has been on the head, the petechiæ of the mucous membranes are liable to be more numerous and to coalesce into patches of larger size than when the dropsy is confined to the legs. the animal may be rendered stiff by the swelling of the legs, or be annoyed by an awkward swollen head, which at times may be so enormous as to resemble that of a hippopotamus rather than that of a horse. during this period the temperature remains normal; the pulse, if altered at all, is only a little weaker; the respiration is only hurried if the swelling of the head infringes on the caliber of the nostrils. the appetite remains normal. the animal is attentive to all that is going on, and, except for the swelling, apparently in perfect health. in from two to four days, in severe cases, the tissues can no longer resist the pressure of the exuded fluid. over the surface of the skin which covers the dropsy we find a slight serous sweating, which loosens the epidermis and dries so as to simulate the eruption of some cutaneous disease. if this is excessive we may see irritated spots which are suppurating. in the nasal fossæ the hemorrhagic spots have acted as irritants, and, inviting an increased amount of blood to the schneiderian membrane, produce a coryza or even a catarrh. we may now find some enlargement and peripheral edema of the lymphatic glands, which are fed from the affected part. the thermometer indicates a slight rise in the body temperature, while the pulse and respiration are somewhat accelerated. the appetite usually remains good. in the course of a few days the temperature may have reached °, °, or ° f. fever is established, not an essential or specific fever in any way, but a simple secondary fever produced by the dead material from the surface or superficial suppuration, and by the oxidization and absorption of the colloid mass contained in the tissues. the skin may suppurate or slough more or less over the areas of greatest tension or where it is irritated by blows or pressure. the great swelling about the head may by closure of the nostrils interfere seriously with breathing. internal edema may occur in the throat, lungs, or intestines. septicemia, or blood poisoning, may result from anasarca. _terminations._--the simple form of the disease most frequently terminates favorably on the eighth or tenth day by resolution or absorption of the effusion, with usually a profuse diuresis, and with or without diarrhea. the appetite remains good or is at times capricious. death may occur from mechanical asphyxia, produced by closure of the nostrils or closure of the glottis. metastasis to the lungs is almost invariably fatal, causing death by asphyxia, metastasis to the intestines may cause death from pain, enteritis, or hemorrhage. excessive suppuration, lymphangitis, and gangrene are causes of a fatal termination by exhaustion. mortal exhaustion is again produced by inability to swallow in cases of excessive swelling of the head. peritonitis may arise secondary to the enteric edema, or by perforation of the stomach or intestines by a gangrenous spot. septicemia terminates fatally with its usual train of symptoms. _alterations._--the essential alterations of anasarca are exceedingly simple; the capillaries are dilated, the lymphatic spaces between the fibers of the connective tissue are filled with serum, and the coagulable portion of the blood presents a yellowish or citrine mass, jellylike in consistency, which has stretched out the tissue like the meshes of a sponge. where the effusion has occurred between the muscles, as in the head, these are found dissected and separated from each other like those of a hog's head by the masses of fat. the surface of the skin is desquamated and frequently denuded of the hair. frequently there are traces of suppuration and of ulceration. the mucous membrane of the nose is found studded with small, hemorrhagic spots, sometimes red, more frequently brown or black, often coalesced with each other in irregular-sized patches and surrounded by a reddish zone, the product of irritation. if edema of the intestines has occurred, the membrane is found four or five times its normal thickness, reddish in color, with hemorrhages on the free surface. edema of the lungs leaves these organs distended. the secondary alterations vary according to the complications. there are frequently the lesions of asphyxia; externally we find ulcers, abscesses, and gangrenous spots and the deep ulcers resulting from the latter. the lymphatic cords and glands are found with all the lesions of lymphangitis. again are found the traces of excessive emaciation, or the lesions of septicemia. except from the complications the blood is not altered in anasarca. _diagnosis._--the diagnosis of anasarca must principally be made from farcy or glanders. in anasarca the swelling is nonsensitive, while sensitive in the acute swelling of farcy. the nodes of farcy are distinct and hard and never circumscribed, as in the other disease. the eruption of glanders on the mucous membranes is nodular, hard, and pelletlike. the redness disappears on pressure. in case of excessive swelling of the head in anasarca, there may occur an extensive sero-fibrinous exudation from the mucous membranes of the nose, poured out as a semifluid mass or as a cast of the nasal fossæ, never having the appearance or typical oily character which it has in glanders. the inflammation of the lymphatic cords and glands in anasarca does not produce the indurated character which is found in farcy. _prognosis._--while anasarca is not an excessively fatal disease, the prognosis must always be guarded. the majority of cases run a simple course and terminate favorably at the end of or days, or possibly, after one to two relapses, requiring several weeks for complete recovery. effusion into the head renders the prognosis much more grave from the possible danger of mechanical asphyxia. threatened mechanical asphyxia is especially dangerous on account of the risk of blood poisoning after an operation of tracheotomy. edema of the viscera is a most serious complication. the prognosis is based on the complications, their extent, and their individual gravity, existing, as they do here, in an already debilitated subject. _treatment._--the treatment of anasarca may be as variable as are the lesions. the indications are at once shown by the alterations and mechanism of the disease, which we have just studied. hygiene comes into play as the most important factor. oats, oat-and-hay tea, milk, eggs--anything which the stomach or rectum can be coaxed to take care of--must be employed to give the nutriment, which is the only thing that will permanently strengthen the tissues; they must be strengthened in order to keep the capillaries at their proper caliber. laxatives, diaphoretics, and diuretics must be used to stimulate the emunctories so that they may carry off the large amount of the products of decomposition which result from the stagnated effusions of anasarca. of these the sulphate of soda in small, repeated doses, the nitrate of potash and bicarbonate of soda in small quantity, or the chlorate of potash in single large doses will be found useful. williams cites the chlorate of potash as an antiputrid. stimulants and astringents are directly indicated. spirits of turpentine serves the double purpose of a cardiac stimulant and a powerful, warm diuretic, for the kidneys in this disease will stand a wonderful amount of work. camphor can be used with advantage. coffee and tea are two of the diffusible stimulants which are too much neglected in veterinary medicine; both are valuable adjuncts in treatment of anasarca, as they are during convalescence at the end of any grave disease which has tended to render the patient anemic. dilute sulphuric and hydrochloric acids are, perhaps, the best examples of a combination of stimulant, astringent, and tonic which can be employed. the simple astringents of mineral origin, sulphates of iron, copper, etc., are useful as digestive tonics; i doubt whether they have any constitutional effect. the vegetable astringents, tannic acid, etc., have not proved efficacious in my hands. iodid of potash in small doses serves the triple purpose of digestive tonic, denutritive for inflammation, and diuretic. among the newer forms of treatment are diluted lugol's solution injected into the trachea, anti-streptococcus serum and colloidal silver solution injected into the circulation. no one but a qualified veterinarian would be competent to apply these remedies. _externally._--sponging the swollen parts, especially the head, when the swelling occurs there, is most useful. the bath should be at an extreme of temperature--either ice cold to constrict the tissues or hot water to act as an emollient and to favor circulation. vinegar may be added as an astringent. when we have excessively denuded surfaces, suppuration, or open wounds, disinfectants should be added to the wash. in cases of excessive swelling, especially of the head, mechanical relief may be required. even in country practice, punctures of the part should be made with the hot iron, as no other disease so predisposes to septic contamination. when mechanical asphyxia is threatened tracheotomy may be demanded. with the first evidence of dyspnea, not due to closing of the nostrils or glottis, or with the first pawing which gives rise to a suspicion of colic, a mustard plaster should be applied over the whole belly and chest. the sinapism will draw the current of the circulation to the exterior, the metastasis to the lungs or intestines is prevented, and the enfeebled nervous system is stimulated to renewed vigor by the peripheral irritation. the organs are encouraged by it to renewed functional activity; the local inflammation produced by it favors absorption of the exudation. the objection to the use of blisters is their more severe action and the danger of mortification. septicemia, when occurring as a complication, requires the ordinary treatment for the putrid diseases, with little hope of a good result. after recovery the animal regains its ordinary health, and there is no predisposition to a return of the disease. horsepox, or equine variola. _synonyms._--variola equina; pustular grease; phlyctenold herpes. _definition._--horsepox is a specific, infectious fever of the horse, attended by an eruption of pustules, or pocks, over any part of the skin or on the mucous membranes lining the various cavities in the body, but chiefly, and often exclusively, upon the pasterns and fetlocks. the eruption may commence upon the lips, or about the nostrils or eyes. this disease was described by the early roman agricultural writers and by the veterinarians of the eighteenth century. it received its first important notice from the great jenner, who confounded it with grease in horses, since animals with this disease are very liable to have the eruption of variola appear on the fetlocks. he saw these cases transmit the disease to cattle in the byres and to the stablemen and milkmaids who attended them, and furnish the latter with immunity from smallpox, which led to the discovery of vaccination. horsepox is also frequently mistaken for the exanthemata attending some forms of venereal disease in horses. variola in the horse, while it is identical in principle, general course, complications, and lesions with variola in other animals, is a disease of the horse itself, and is not transmissible in the form of variola to any other animal; nor is the variola of any other animal transmissible to the horse. cattle and men, if inoculated from a case of horsepox, develop vaccinia, but vaccinia from the latter animals is not so readily reinoculated into the horse with success. if it does develop, it produces the original disease. _causes._--the direct cause of horsepox is infection. a large number of predisposing causes favor the development of the disease, as in the case of strangles, and this trouble, like almost all contagious diseases, renders the animal which has had one attack immune. the chief predisposing cause is youthfulness. old horses which have not been affected are less liable to become infected when exposed than younger ones. the exposure incident to shipment, through public stables, cars, etc., acts as a predisposing cause, as in the other infectious diseases. the period of final dentition is a time which renders it peculiarly susceptible. dupaul states that the infection is transmissible through the atmosphere for several hundred yards. the more common means of contagion is by direct contact or by means of fomites. feed boxes and bridles previously used by horses affected with variola are probably the most frequent carriers of the virus, and we find the lesions in the majority of cases developed in the neighborhood of the lips and nostrils. coition is a frequent cause. a stallion suffering from this disease may be the cause of a considerable epizootic, as he transmits it to a number of brood mares and they in turn return to the farms where they are surrounded by young animals to which they convey the contagion. the saddle and croup straps are frequent agents of infection. the presence of a wound greatly favors the inoculation of the disease, which is also sometimes carried by surgical instruments or sponges. trasbot recites a case in which a set of hobbles, which had been used on an animal suffering from variola, were used on a horse for a quittor operation and transmitted the disease, which developed on the edges of the wound. _symptoms._--there is a period of incubation, after an animal has been exposed, of from five to eight days, during which there is no appreciable alteration in the health. this period is shorter in summer than in winter. at the end of this time small nodes develop at the point of inoculation and the animal becomes feverish. the horse is dull and dejected, loses its appetite, and has a rough, dry coat with the hairs on end. there is moderate thirst. the respirations are somewhat quickened and the pulse becomes rapid and full. the body temperature is elevated, frequently reaching ° or ° f. within or hours from the appearance of the first symptoms. the visible mucous membranes, especially the conjunctivæ, are of a bright rosy red. in the lymphatic, cold-blooded, and more common horses these symptoms of fever are less marked; even with a comparatively high temperature the animal may retain its appetite and work comparatively well, but these cases, if worked and overheated, are liable to develop serious complications. at the end of from three and a half to four days the eruption breaks out, the fever abates, and the general symptoms improve. the eruption in severe cases may be generalized; it may be confined to the softer skin of the nose and lips, the genital organs, and the inside of the thighs, or it may be localized in the neighborhood of a wound or in the irritated skin of a pair of greasy heels. it consists of a varying number of little nodes which, on a mucous membrane, as in the nostrils or vagina, or on soft, unpigmented skin, appear red and feel at first like shot under the epidermis. these nodes soften and show a yellowish spot in the center when they become pustules. the epidermis is dissolved and the matter escapes as a viscid fluid at first citrine and later cloudy and purulent, which dries rapidly, forming scabs; if these fall off or are removed they leave a little shallow, concave ulcer which heals in the course of five or six days. in the softer skin if pigmented the cicatrices are white and frequently remain so for about a year, when the pigment returns. the lips or genital organs of a colored horse, if covered with a number of small white spots about the size of a pea, will usually indicate that the animal has been affected with the horsepox. at times the pustules may become confluent and produce large, superficial, serpentine ulcers on the membrane of the nostrils, around the lips or eyelids, or on the borders of wounds and in greasy heels; in this case the part becomes swollen, hot, painful, and is covered with a profuse discharge of matter. in this form there is frequently a secondary fever lasting for a day or two. in severe cases there may be a suppurative adenitis, or inflammation of the lymphatic glands which are fed from the affected part. if the eruption is around the nostrils and lips, the glands between the jaws (submaxillary) form abscesses as in a case of strangles; if the eruption is in a pair of greasy heels abscesses may form in the fold of the groin (inguinal). there may be so much tumefaction of the nostrils as to produce difficulty in breathing. _complications._--a case of horsepox may be attended with various complications of varying degrees of importance. adenitis, or suppuration of the glands, has just been mentioned. confluent eruptions irritate the part and induce the animal to rub the inflamed part against the manger or scratch it in other ways and thus produce troublesome ulcers, which may leave ugly scars. irritation of the mucous membrane of the nose causes severe coryza with purulent discharge. the eruption may occur in the throat or in the air tubes to the lungs, developing an acute laryngitis or bronchitis. if the animal is exposed to cold, or worked so as to engorge the lungs with blood at the termination of the specific fever, just when the eruption is about to localize, it may be determined to the lungs. in this case we have a short, dry cough, labored breathing, the development of a secondary fever of some gravity, and all the external symptoms of a pneumonia. this pneumonia differs, however, from an ordinary pneumonia in the symptoms furnished by the examination of the lungs themselves. in place of a large mass of the lung tissue being affected the inflammation is disseminated in smaller spots over the entire lung. _diagnosis._--the diagnosis of horsepox is to be based on the presence of a continuous fever, with rosy mucous membranes, for several days and the appearance of the characteristic eruption. if the eruption is in the nasal cavities, marked by a considerable discharge and attended with submaxillary abscesses, it may be confounded with strangles. if the throat is affected, it may be confounded with an angina (laryngitis or pharyngitis), but in the latter the local trouble precedes or is concomitant with the fever, while in the former the fever precedes the local trouble by several days. variola may be confounded with bronchitis or pneumonia if complicated with these troubles and the eruption is absent from the exterior, but it is of little moment, as the treatment for both is much the same. when the eruption is in the neighborhood of the genital organs the disease has been mistaken for dourine. in variola the eruption is a temporary one; the nodes and pustules are followed by shallow ulcers and rapid cicatrization unless continued in the vagina or on the penis by the rubbing of the walls and filth which accumulates; there are apt to be pustules at other parts of the body. in the venereal disease the local trouble commences as a papule and breaks into an ulcer without having formed a pustule. the ulcer has not the convex rosy appearance of that of the less serious discharge; the symptoms last for a longer period, by which time others aid in differentiating the two. in glanders the tubercle is hard and, after breaking into an ulcer, the indurated bottom remains, grayish or dirty white in color, ragged, and exuding a viscous, oily discharge. there is no disposition to suppuration of the neighboring glands. in variola the rosy shallow ulcer and healthy pus, with the acutely tumefied glands, should not be mistaken, at least after a day. i have seen in mules acute glanders which required a day's delay to differentiate from strangles; at that time the farcy buds appeared. _prognosis._--the average case of horsepox runs a course of dejection, loss of appetite, and more or less fever for about four days, followed by a rapid convalescence, and leaves the animal as well and as sound as before. if the eruption has been excessive or confluent, the ulcerations may act as irritants and render the animal unfit for use for several weeks. laryngitis, pharyngitis, bronchitis, and pneumonia in this disease are not of greater gravity than they are when occurring from other causes. the spots denuded of pigment left by the pustules on the lips and genitals may temporarily depreciate the value of the animal to a slight degree. _treatment._--as this is a disease unattended by alterations of the blood itself, although a specific fever, and is of a sthenic type, active remedies are admissible and indicated. the horse should be placed on a low diet (little or no oats)--bran mashes, a moderate quantity of good, sound hay, a few carrots or apples, which will act as laxatives; also slop feed. barley flour is more cooling for mashes than bran or oatmeal. water may be given as the animal desires it, but it should not be cold; if a half bucketful of water is kept in the manger, the horse will take but a few swallows at a time. one-dram doses of nitrate of potash or -ounce doses of sweet spirits of niter are useful in the drinking water. if the fever is high, the antipyretics are indicated: sulphate of quinin in -dram doses; iodid of potash in -dram doses; infusion of pine tops, of juniper leaves, of the aromatic herbs, or of english breakfast tea are useful in the later stages. if complications of the air passages or lungs are threatened, a large mustard poultice should be applied to the belly and sides of the chest. oxid of zinc ointment should be used on confluent eruptions, and if the ulceration is excessive it may have to be touched with caustic. great care must be taken to keep the animal protected from cold drafts of air or other exposure. blankets or sheets should be used on the body and bandages on the legs. after convalescence is established, nutritious feed of easy digestion and walking exercise are all that is needed, except perhaps a little glauber's salt to prevent constipation. _prophylactic treatment._--when horsepox breaks out among a large number of horses, especially on a farm where there are a number of colts, it may be assumed that the greater majority will contract the disease, and it is more economical that they should have it and be through with it at once. if the weather is moderate, all the animals which have not been affected can be inoculated, which will produce the disease in a mild form, with the eruption at a point of election, and render the danger of complication a minimum one. for inoculation the discharge from the pustules of a mild case should be selected and inoculated by scarification on the belly or the under surface of the neck. anthrax. _synonyms:_ carbuncle, splenic fever, splenic apoplexy, etc.; charbon, sang de rate (french); miltzbrand (german). _definition._--anthrax is a severe and usually fatal contagious disease, characterized by chills, great depression and stupor of the animal, and a profound alteration of the blood. it is caused by the entrance into the animal's body of a bacterium, known as the _bacillus anthracis_, or its spores. practically all animals are susceptible to anthrax. the herbivora are especially susceptible, in the following order: the sheep, the ox, and the horse. the guinea pig, the hog, the rabbit, mice, and other animals die quickly from its effects. man, the dog, and other omnivora and carnivora may be attacked by it in a constitutional form as fatal as in the herbivora, but fortunately in many cases develop from it only local trouble, followed by recovery. anthrax has been a scourge of the animals of the civilized world since the first written history we have of any of their diseases. in - extensive outbreaks of anthrax occurred in germany, hungary, and poland. in the first half of the nineteenth century it had become an extensively spread disease in russia, holland, and england, and for the last century has been gradually spreading in the americas, more so in south america than here. in , in the five governments of petersburg, novgorod, olonetz, twer, and jaroslaw, in russia, more than , horses and nearly , persons perished from the disease. _causes._--the causes of anthrax were for a long time attributed entirely to climatic influence, soil, and atmospheric temperature, and they are still recognized as predisposing factors in the development of the disease, for it is usually found, especially when outbreaks in a great number of animals occur, in low, damp, marshy countries during the warm seasons. it is more frequent in districts where marshy lands dry out during the heat of summer and are then covered with light rains. decaying vegetable matter seems most favorable for nourishing and preserving the virus. the direct cause of anthrax is always infection of a previously sound animal, either directly from a diseased animal or through various media which contain excretions or the débris from the body of one previously infected. the specific virus of anthrax was first discovered by davaine in . he recognized microscopic bodies in the form of little rods in the blood of animals suffering from anthrax. it was not, however, till a quarter of a century later that pasteur defined the exact nature of the bacillus, the mode of its propagation, and its exact relationship to anthrax as the sole cause of the disease. in the animal body the bacilli have a tendency to accumulate in the spleen, liver, and elsewhere, so that these organs are much more virulent than the muscles or less vascular tissues. when eliminated from the animal in the excretions, or when exposed to outside influences by the death of the animal and the disintegration of the tissues, the body of the rod is destroyed and the spores only remain. these spores, which may be called the seeds of the bacilli, retain their vitality for a long period; they resist ordinary putrefaction; they are unchanged by moisture; and they are not affected by moderate heat. if scattered with the débris of a dead animal on the surface of the ground, they may remain around the roots of the grass in a pasture or may be washed to the nearest low-lying ground or marsh. if buried in the body of an animal dead from anthrax, they may be washed deep into the ground, and in later years (in one proved case years) be brought to the surface and infect other animals. they are frequently brought to the surface of the earth, having been swallowed by earthworms, in the bodies of which they have been found. this accounts for the outbreaks at the time of the first rains after a dry season. during the latter the earthworm goes deep in the ground in search of moisture; it finds the spore which has been washed there in past years, swallows it, and afterwards brings it to the surface. the virus is carried with the wool from infected sheep and remains in it through the process of manufacture into cloth. the spores remain in the hides of animals which have died of anthrax and retain their vitality throughout months of soaking in the tanners' pits, the working of the harness maker or the cobbler, and after the oiling of the completed leather. the dried spores in the dust from any of these products may be carried by the atmosphere. infection of an animal takes place through inoculation or contact of the bacillus or its spores with an abraded surface or mucous membrane, on a sound animal. in an infected district horses may eat with impunity the rich pasturage of spring and early summer, but when grass gets low they crop it close to the ground, pull up the roots around which the virus may be lodged, and under these conditions the animals are more apt to have abrasions of the lips or tongue by contact with dried stubble and the dirt on the roots; this favors the introduction of the germs into the system. the virus may be introduced with feed and enter the blood-vessel system from the stomach and intestines. if in the dust, dried hay, or on the parched pasture of late summer, the virus may be inhaled and be absorbed from the lining of the lungs. if in harness leather, it needs but an abrasion of the skin, as the harness rubs it, to transfer the spore from the leather to the circulation of the animal. the writer saw a case of anthrax occur in a groom from the use of a new horse brush. the strap which passes over the back of the hand inoculated an abrasion on the knuckle of the first finger, and in hours a "pustule" had formed and the arm had become infected. _symptoms._--the symptoms of anthrax usually develop with extreme rapidity. the horse is dejected and falls into a state of profound stupor, attended with great muscular weakness. the feeble, indolent animal, if forced to move, drags its legs. there are severe chills, agitation of the muscles, symptoms of vertigo, and at times colicky pains. the mucous membranes turn a deep ocher or bluish-red color. the body temperature is rapidly elevated to ° or ° f. the breathing is increased to or respirations in the minute and the pulse is greatly accelerated, but while the arteries are soft and almost imperceptible, the heart beats can be felt and heard, violent and tumultuous. in some cases, when inoculation is through the skin, large subcutaneous swellings appear; these may involve a leg, a shoulder, one side of the body, or the neck or head. the swelling is at first hot and painful, but afterwards it becomes necrotic and sensation is lost. the symptoms last but two, three, or four days at most, when the case usually terminates fatally. an examination of the blood shows a dark fluid which will not clot, and which remains black after exposure to the air. after death the bodies putrefy rapidly and bloat up; the tissues are filled with gases, and a bloody foam exudes from the mouth, nostrils, and anus, and frequently the mucous membranes of the rectum protrude from the latter. the hairs detach from the skin. congestion of all the organs and tissues is found, with interstitial hemorrhages. the muscles are friable and are covered with ecchymotic spots. this is especially marked in the heart. the black, uncoagulated, and incoagulable blood shows an iridescent scum on its surface, which is due to the fat of the animal dissolved by the ammonia produced by the decomposed tissues. the serum oozes out of every tissue and contains broken-down blood, which, when examined microscopically, is found to have the red globules crenated and the leucocytes granular. a high power of the microscope also reveals the bacteria in the shape of little rodlike bodies of homogeneous texture with their brilliant spores. the lymphatic ganglia are increased four, five, six, or ten times their natural size, enlarged by the engorgement of blood. the spleen shows nodulated black spots containing a muddy blood, which is found teeming with the virus. this organ is much enlarged and is quite friable. the mucous membranes of the intestines are congested and reddish brown; the surface of the intestines is in many places denuded of its lining membrane, showing fissures and hemorrhagic spots. the liver has a cooked appearance; the kidneys are congested and friable; the urine is red; the pleura, lungs, and the meninges are congested, and the bronchi of the lungs contain a bloody foam. _treatment._--treatment of anthrax in animals by medicinal means has not proved satisfactory. in cases of local anthrax an incision of the swelling followed by the application of disinfectants sometimes causes good results. in such cases, however, the danger of disseminating the infection from the wounds tends to make this procedure inadvisable unless great care is taken. good results are obtained from the use of serum in the treatment of the disease. for this purpose to cubic centimeters should be administered subcutaneously or intravenously. if no improvement is noticed within hours the injection should be repeated. in a number of instances afforded to test the curative value of the serum in cases of anthrax in man and animals splendid results were obtained. the prophylactic treatment formerly consisted in the avoidance of certain fields and marshes which were recognized as contaminated during the months of august and september and had been occupied the years in which the outbreaks usually occurred. it underwent, however, a revolution after the discovery by pasteur of the possibility of a prophylactic inoculation or vaccination which granted immunity from future attacks of the disease similar to that granted by the recovery of an animal from an ordinary attack of the disease. this treatment consists in the use of a vaccine which is made by the artificial cultivation of the virus of anthrax in broth and in the treatment of it by means of continued exposure to a high temperature for a certain time, which weakens the virus to such extent that it is capable of producing only a very mild and not dangerous attack of anthrax in the animal in which it is inoculated, and thus protects it from inoculation of a stronger virus. the production of this virus, which is carried on in some countries at the expense of the governments and is furnished at a small cost to the farmers in regions where the disease prevails, in this country is made in private laboratories only. at the present time very good results are being obtained with vaccination consisting of an injection of highly potent anthrax serum on one side of the animal and a vaccine on the other side. this method of treatment requires only a single handling of the animals and further possesses advantages over the pasteur treatment in that it immediately makes animals immune. in the numerous applications of this form of treatment very good results have been obtained and the immunity produced thereby visually lasts at least one year. the vaccinated animals should be kept for a period of ten days to two weeks from exposure, since during that period they are at times even more susceptible to the disease, and therefore care should be taken not to reduce their vitality. _prevention._--in attempts to control the disease it is essential, aside from protective vaccination, to prevent the reinfection of localities. for this purpose it is essential, if possible, to drain thoroughly and keep under cultivation the infected areas before animals are permitted to pasture on them. the complete destruction of all anthrax carcasses is also very important. this is best accomplished by burning, but as this method of disposal is impracticable in many localities, deep burial may be found to be better. covering the carcasses within their graves with quicklime adds another valuable precaution against further dissemination of the infection. no animal dying from anthrax should ever be skinned or cut open, as the blood from these sources is one of the most dangerous means of spreading the infection, being charged, while in the animal, with great numbers of bacilli, which quickly turn into spores as soon as spread about upon the face of the ground. all discharges from the body openings should also be burned or buried deeply, as they are frequently of a virulent character. glanders and farcy. (pls. xl-xlii.) _definition._--let it be understood at the outset that glanders and farcy are one and the same disease, differing only in that the first term is applied to the disease when the local lesions predominate in the internal organs, especially in the nostrils, lungs, and air tubes, and that the second term is applied to it when the principal manifestation is an outbreak of the lesions on the exterior or skin of the animal. the term glanders applies to the disease in both forms, while the term farcy is limited to the visible appearance of external trouble only; but in the latter case internal lesions always exist, although they may not be evident. glanders is a contagious constitutional disease of the genus _equus_ (the horse, ass, and mule), readily communicable to man, the dog, the cat, the rabbit, and the guinea pig. it is transmitted with difficulty to sheep and goats, and cattle seem to be entirely immune. it runs a variable course and usually produces the death of the animal affected with it. it is characterized by the formation of neoplasms, or nodules, of connective tissue, which degenerate into ulcers, from which exude a peculiar discharge. it is accompanied with a variable degree of fever, according to the rapidity of its course. it is subject to various complications of the lymphatic glands, of the lungs, of the testicles, of the internal organs, and of the subcutaneous connective tissue. [illustration: plate xl. glanders. nasal septum of horse, right side, showing acute lesions.] [illustration: plate xli. glanders. middle region of nasal septum, left side, showing ulcers.] [illustration: plate xlii. glanders. posterior half of nasal septum, right side, showing cicatrices.] _history._--glanders is one of the oldest diseases of which we have definite knowledge in the history of medicine. absyrtus, the greek veterinarian in the army of constantine the great, described it with considerable accuracy and recognized the contagiousness of its character. another greek veterinarian, vegetius renatus, who lived in the time of theodosius ( a. d.), described, under the name of "malleus humidus," a disease of the horse characterized by a nasal discharge and accompanied by superficial ulcers. he recognized the contagious properties of the discharge of the external ulcers, and recommended that all animals sick with the disease be separated at once with the greatest care from the others and should be pastured in separate fields, for fear the other animals should become affected. in sollysel, the stable master of louis xiv, published an account of glanders and farcy, which he considered closely related to each other, although he did not recognize them as identical. he admitted the existence of a virus which communicated the disease from an infected animal to a sound one. he called special attention to the feed troughs and water buckets as being the media of contagion. he divided glanders into two forms--one malignant and contagious and the other benign--and he stated that there was always danger of infection. garsault in said that "as this disease is communicated very easily and can infect in a very short time a prodigious number of horses by means of the discharges which may be licked up, animals infected with glanders should be destroyed." bourgelat, the founder of veterinary schools, in his "elements of hippiatry," published in , establishes glanders as a virulent disease. extensive outbreaks of glanders are described as prevailing in the great armies of continental europe and england from time to time during the periods of all the wars of the last few centuries. glanders was imported into america at the close of the eighteenth century, and before the end of the first half of the last century had spread to a considerable degree among the horses of the middle and immediately adjoining southern states. this disease was unknown in mexico until carried there during the mexican war by the badly diseased horses of the united states army. during the first half of the last century a large body of veterinarians and medical men protested against the contagious character of the disease, and by their opinion prevailed to such an extent against the common opinion that several of the governments of europe undertook a series of experiments to determine the right between the contesting parties. at the veterinary school at alfort and at the farm of lamirault in france several hundred horses which had passed examination as sound had placed among them glandered horses under various conditions. the results of these experiments proved conclusively the contagious character of the disease. in bouchard, of the faculty of medicine in paris, assisted by capitan and charrin, undertook a series of experiments with matter taken from the farcy ulcer of a human being. they afterwards continued their experiments with matter taken from horses, and in succeeded in showing that glanders is caused by a bacterium which is capable of propagation and reproduction of others of its own kind if placed in the proper media. in the specific germ of glanders was first discovered and described by loeffler and schuetz in germany. when we come to study the etiology of glanders, the difference of susceptibility on the part of different species of animals, or even on the part of individuals of the same species, and when we come to find proof of the slow incubation and latent character of the disease as it exists in certain individuals, we understand how in a section of country containing a number of glandered animals others can seem to contract and develop the disease without having apparently been exposed to contagion. _causes._--the contagious nature of glanders, in no matter what form it appears, being to-day definitely demonstrated, we can recognize but one cause for all cases, and that is contagion by means of the specific virus of the disease. the causative organism is known as the _bacillus mallei_. in studying the writings of the older authors on glanders, and the works of those authors who contested the contagious nature of the disease, we find a large number of predisposing causes assigned as factors in the development of the malady. while a virus from a case of glanders if inoculated into an animal of the genus _equus_ will inevitably produce the disease, we find a vast difference in the contagious activity of different cases of glanders. we find a great variation in the manner and rapidity of the development of the disease in different individuals and that the contagion is much more liable to be carried to sound animals under certain circumstances than it is under others. only certain species of animals are susceptible of contracting the disease, and while some of these contract it as a general constitutional malady, in others it develops as only a local sore. in acute glanders the contagion is found in its most virulent form, as is shown by the inevitable infection of susceptible animals inoculated with the disease, while the discharge from chronic semilatent glanders and farcy may at times be inoculated with a negative result; again, in acute glanders, as we have a free discharge, a much greater quantity of virus-containing matter is scattered in the neighborhood of an infected horse to serve as a contagion to others than is found in the small amount of discharge of the chronic cases. the chances of contagion are much greater when sound horses, asses, or mules are placed in the immediate neighborhood of glandered horses, drink from the same bucket, stand in the next stall, or work in the same wagon, or are fed from feed boxes or mangers which have been impregnated by the saliva and soiled by the discharge of sick animals. transmission occurs by direct contact of the discharges of a glandered animal with the tissues of a sound one, either on the exterior, when swallowed mixed with feed into the digestive tract, or when dried and inhaled as dust. the stable attendants serve as one of the most common carriers of the virus. dried or fresh discharges are collected from the infected animals in cleaning, harnessing, feeding, and by means of the hands, clothing, the teeth of the currycomb, the sponge, the bridle, and the halter, and are thus carried to other animals. an animal affected with chronic glanders in a latent form is moved from one part of the stable to another, or works hitched with one horse and then with another, and may be an active agent in the spreading of the disease without the cause being recognized. glanders is found frequently in the most insidious forms, and we recognize that it can exist without being apparent; that is, it may affect a horse for a long period without showing any symptoms that will allow even the most experienced veterinarian to make a diagnosis. an old gray mare belonging to a tavern keeper was reserved for family use with good care and light work for a period of eight years, during which time other horses in the tavern stable were from time to time affected with glanders without an apparent cause. the mare, whose only trouble was an apparent attack of heaves, was sold to a huckster who placed her at hard work. want of feed and overwork and exposure rapidly developed a case of acute glanders, from which the animal died, and at the autopsy were found the lesions of an acute pneumonia of glanders grafted on chronic lesions, consisting of old nodules which had undoubtedly existed for years. in a case that once came under the care of the writer, a coach horse was examined for soundness and passed as sound by a prominent veterinarian, who a few months afterwards treated the horse for a skin eruption from which it recovered. twelve months afterwards it came into the hands of the writer, hidebound, with a slight cough and a slight eruption of the skin, which was attributed to clipping and the rubbing of the harness, but which had nothing suspicious in its character. the horse was placed on tonics and put to regular light driving. in six weeks it developed a bronchitis without having been specially exposed, and in two days this trouble was followed by a lobular pneumonia and the breaking of an abscess in the right lung. farcy buds developed on the surface of the body and the animal died. the autopsy showed the existence of a number of old glanderous nodules in the lungs which must have existed previous to purchase, more than a year before. public watering troughs and the feed boxes of boarding stables and the tavern stables of market towns are among the most common recipients for the virus of glanders, which is most dangerous in its fresh state, but cases have been known to be caused by feeding animals in the box or stall in which glandered animals had stood several months before. while the discharge from a case of chronic glanders is much less liable to contain many active bacilli than that from a case of acute glanders, the former, if it infects an animal, will produce the same disease as the latter. it may assume from the outset an acute or chronic form, according to the susceptibility of the animal infected, and this does not depend upon the character of the disease from which the virus was derived. the animals of the genus _equus_--the horse, the ass, and the mule--are those which are the most susceptible to contract glanders, but in these we find a much greater receptivity in the ass and mule than we do in the horse. in the ass and mule in almost all cases the period of incubation is short and the disease develops in an acute form. we find that the kind of horse infected has an influence on the character of the disease; in full-blooded, fat horses of a sanguinary temperament, the disease usually develops in an acute form, while in the lymphatic, cold-blooded, more common race of horses the disease usually assumes a chronic form. if the disease develops first in the chronic form in a horse in fair condition, starvation and overwork are liable to bring on an acute attack, but when the disease is inoculated into a debilitated and impoverished animal it is apt to start in the latent form. inoculation on the lips or the exterior of the animal is frequently followed by an acute attack, while infection by ingestion of the virus and inoculation by means of the digestive tract is often followed by the trouble in the chronic latent form. in the dog the inoculation of glanders may develop a constitutional disease with all the symptoms which are found in the horse, but more frequently the virus pullulates only at the point of inoculation, remaining for some time as a local sore, which may then heal, leaving a perfectly sound animal; but while the local sore is continuing to ulcerate, and specific virus exists in it, it may be the carrier of contagion to other animals. in man we find a greater receptivity to glanders than in the dog, and in many unfortunate cases the virus spreads from the point of inoculation to the entire system and destroys the wretched mortal by extensive ulcers of the face and hemorrhage or by destruction of the lung tissue; in other cases, however, glanders may develop, as in the dog, in local form only, not infecting the constitution and terminating in recovery, while the specific ulcer by proper treatment is turned into a simple one. in the feline species glanders is more destructive than in the dog. the point of inoculation ulcerates rapidly and the entire system becomes infected. while a student the writer saw a lion in the service of prof. trasbot, at alfort, which had contracted the disease by eating glandered meat and died with the lung riddled with nodules. a litter of kittens lapped the blood from the lungs of a glandered horse on which an autopsy was being made, and in four days almost their entire faces, including the nasal bones, were eaten away by rapid ulceration. nodules were found in the lungs. a pack of wolves in the philadelphia zoological garden died in days after being fed with the meat of a glandered horse. the rabbit, guinea pig, and mice are especially susceptible to the inoculation of glanders, and these animals are convenient witnesses and proofs of the existence of suspected cases of the glanders in other animals by the results of successful inoculations. the primary lesion in any form is a local point in which occurs a rapid proliferation of the cell elements which make up the animal tissue with formation of new connective tissue, with a crowding together of the elements until their own pressure on one another cuts off the circulation and nutrition, and death takes place in them in the form of ulceration or gangrene. following this primary lesion we have an extension of infection by means of the spread of the bacilli into those tissues immediately surrounding the first infected spot, which are most suitable for the development of simple inflammatory phenomena or the specific virus. the primary symptoms are the result of specific reaction at the point of inoculation, but at a later time the virus is carried by means of the blood vessels and lymphatic vessels to other parts of the body and becomes lodged at different places and develops in them; again, when the disease has existed in the latent form in the lungs of the animal and the virus is wakened into action from any cause, we have it carried to various parts of the body and developing in the most susceptible regions or organs. the points of development are most frequently determined by the activity of the circulation and the effects of exterior irritants. for example, if a horse which has been so slightly affected with the virus of glanders that no symptoms are visible is exposed to cold, rain, or sleet, or by the rubbing of the harness on the body and the irritation of mud on the legs, the disease is liable to develop on the exterior in the form of farcy, while a full-blooded horse which is employed at speed and has its lungs and respiratory tract gorged with blood from the extreme use of these organs will develop glanders as the local manifestation of the disease in the respiratory tract. the previous reference to the existence of glanders under the two forms more commonly differentiated as glanders and as farcy, and our reference to the various conditions in which it may exist as acute, chronic, and latent, show that the disease may assume several different phases. without for a moment losing sight of the fact that all these varied conditions are identical in their origin and in their essence, for convenience of study we may divide glanders into three classes--chronic farcy, chronic glanders, and acute glanders with or without farcy. chronic farcy. _symptoms._--in farcy the symptoms commence by formation of little nodes on the under surface of the skin, which rapidly infringe on the tissues of the skin itself. these nodes, which are known as farcy "buds" and farcy "buttons," are from the size of a bullet to the size of a walnut. they are hot, sensitive to the touch, at first elastic and afterwards become soft; the tissue is destroyed, and infringing on the substance of the skin the disease produces an ulcer, which is known as a chancre. this ulcer is irregular in shape, with ragged edges which overhang the sore; it has a gray, dirty bottom and the discharge is sometimes thin and sometimes purulent; in either case it is mixed with a viscous, sticky, yellowish material like the white of an egg in consistency and like olive oil in appearance. the discharge is almost diagnostic; it resembles somewhat the discharge which we have in greasy heels and in certain attacks of lymphangitis, but to the expert the specific discharge is characteristic. the discharge accumulates on the hair surrounding the ulcer and over its surface and dries, forming scabs which become thicker by successive deposits on the under surface until they fall off, to be replaced by others of the same kind; and the excess of discharge may drop on the hairs below and form similar brownish yellow crusts. the farcy ulcers may retain their specific form for a considerable time--days or even weeks--but eventually the discharge becomes purulent in character and assumes the appearance of healthy matter. the surface of the gangrenous bottom of the ulcer is replaced by rosy granulations, the ragged edges are beveled off, and the chancre is turned into a simple ulcer which rapidly heals. the farcy buttons occur most frequently on the sides of the lips, the sides of the neck, the lower part of the shoulders, the inside of the thighs, or the outside of the legs, but may occur on any part of the body. we have next an irritation of the lymphatic vessels in the neighborhood of the chancres. those become swollen and then indurated and appear like great ridges underneath the skin; they are hot to the touch and sensitive. the cords may remain for a considerable time and then gradually disappear, or they may ulcerate like a farcy bud itself, forming elongated, irregular, serpentine ulcers with a characteristic, dirty, gray bottom and ragged edges, and pour out a viscous, oily discharge like the chancres themselves. the essential symptoms of farcy are, as above described, the button, the chancre, the cord, and the discharge. we have in addition to these symptoms a certain number of accessory symptoms, which, while not diagnostic in themselves, are of great service in aiding the diagnosis in cases where the eruption takes place in small quantities, and when the ulcers are not characteristic. epistaxis, or bleeding from the nose without previous work or other apparent cause, is one of the frequent concomitant symptoms in glanders, and such hemorrhage from the nostrils should always be regarded with suspicion. the animal with farcy frequently develops a cough, resembling much that which we find in heaves--a short, dry, aborted, hacking cough, with little or no discharge from the nostrils. with this we find an irregular movement of the flanks, and on auscultation of the lungs we find sibilant or at times a few mucous râles. another common symptom is a sudden swelling of one of the hind legs; it is found suddenly swollen in the region of the cannon, the enlargement extending below to the pastern and above as high as the stifle. this swelling is hot and painful to the touch, and renders the animal stiff and lame. on pressure with the finger the swelling can be indented, but the pits so formed soon fill again on removal of the pressure. in severe cases we may have ulceration of the skin, and serum pours out from the surface, resembling the oozing which we have after a blister or in a case of grease. this swelling is not to be confounded with the stocking in lymphatic horses or the edema which we have in chronic heart or in kidney trouble, as in the last the swelling is cool, not painful, and the pitting on pressure remains for some time after the latter is withdrawn. it is not to be confounded with greasy heels. in these the disease commences in the neighborhood of the pastern and gradually extends up the leg, rarely passing beyond the neighborhood of the hock. the swollen leg in glanders almost invariably swells for the entire length in a single night or within a very short period. when greasy heels are complicated by lymphangitis we have a condition very much resembling that of farcy. the swelled leg in farcy is frequently followed by an outbreak of farcy buttons and ulcers over its surface. in the entire horse the testicles are frequently swollen and hot and sensitive to the touch, but they have no tendency to suppuration. the acute inflammation is rapidly followed by the specific induration, which corresponds to the local lesions in other parts of the body. chronic farcy in the ass and mule is an excessively rare condition, but sometimes occurs. chronic glanders. _symptoms._--in chronic glanders we find the same train of inflammatory phenomena, varying in appearance from those of chronic farcy only by the difference of the tissues in which they are situated. in chronic glanders there is first the nodule, from the size of a shot to that of a small pea, which forms in the mucous membranes of the respiratory tract. this may be just inside the wings of the nostrils or on the septum which divides the one nasal cavity from the other, and may be easily detected, or it may be higher in the nasal cavities on the turbinated bones, or it may form in the larnyx itself or on the surface of the trachea or deep in the lungs. the nodules, which are first red and hard and consist of new connective tissue, soon soften and become yellow; the yellow spots break and we have a small ulcer the size of the preceding nodule, which has a gray, dirty bottom and ragged edges and is known as a chancre. this ulcer pours from its surface a viscous, oily discharge similar to that which we have seen in the farcy ulcer. the irritation of the discharge may ulcerate the lining mucous membrane of the nose, causing serpentine gutters with bottoms resembling those of the chancres themselves. if the nodules have formed in large numbers, we may have them causing an acute inflammation of the schneiderian membrane, with a catarrhal discharge which may mark the specific discharge, or that which comes from the ulcers and resembles the discharge of strangles or simple inflammatory diseases. the eruption of the ulcers and discharge soon cause an irritation of the neighboring lymphatics; and in the intermaxillary space, deep inside of the jaws, we find an enlargement of the glands, which for the first few days may seem soft and edematous, but which rapidly becomes confined to the glands, these being from the size of an almond to that of a small bunch of berries, exceedingly hard and nodulated. this enlargement of the glands is found high on the inside of the jaws, firmly adherent to the base of the tongue. it is not to be confounded with the puffy, edematous swelling, which is not separated from the skin and subcutaneous connective tissues found in strangles, in laryngitis, and in other simple inflammatory troubles. these glands bear a great resemblance to the indurated glands which we find in connection with the collection of pus in the sinuses; but in the latter disease the glands have not the extreme nodulated feel which they have in glanders. with the glands we find indurated cords, feeling like balls of tangled wire or twine, fastening the glands together. the essential symptoms of glanders are the nodule, the chancre, the glands, and the discharge. with the development of the nodules in the respiratory tract, according to their number and the amount of eruption which they cause, we may find a cough which resembles that of a coryza, a laryngitis, a bronchitis, or a broncho-pneumonia, according to the location of the lesions. in chronic glanders we find the same accessory symptoms that occur in chronic farcy, the hemorrhage of the nose, the swelling of the legs, the chronic cough, and, in the entire horse, the swelling of the testicles. on healing, the chancres on the mucous membranes leave small, whitish, star-shaped scars, hard and indurated to the touch, and which remain for almost an indefinite time. the chancres heal and the other local symptoms disappear, with the exception of the enlargement of the glands, and we find these so diminished in size that they are scarcely perceptible on examination. during the subacute attacks, with a minimum quantity of local troubles, in chronic glanders and in chronic farcy the animal rarely shows any degree of fever, but does have a generally depraved appearance; it loses flesh and becomes hidebound; the skin becomes dry and the hairs stand on end. there is a cachexia, however, which resembles greatly that of any chronic, organic trouble, but is not diagnostic, although it has in it certain appearances and conditions which often render the animal suspicious to the eye of the expert veterinarian, while, without the presence of local lesions he would be unable to state on what he has based his opinion. acute glanders. _symptoms._--in the acute form of glanders we find the symptoms which we have just studied in chronic farcy and in chronic glanders in a more acute and aggravated form. there is a rapid outbreak of nodules in the respiratory tract which rapidly degenerate into chancres and pour out a considerable discharge from the nostrils. there is a cough of more or less severity according to the amount and site of the local eruption. over the surface of the body swellings occur which are rapidly followed by farcy buttons, which break into ulcers; we find the indurated cords and enlargement of the lymphatics. bleeding from the nose, sudden swelling of one of the hind legs, and the swelling of the testicles are liable to precede an acute eruption of glanders. as the symptoms become more marked the animal has difficulty of respiration, the flanks heave, the respiration becomes rapid, the pulse becomes quickened, and the temperature becomes elevated to °, °, or ° f. with the other symptoms of an acute fever the general appearance and station of the animal is that of one suffering from an acute pneumonia, but upon examination, while we may find sibilant and mucous râles over the side of the chest, and may possibly hear tubular murmurs at the base of the neck over the trachea, we fail to find the tubular murmur or the large area of dullness on percussion over the sides of the chest which belongs to simple pneumonia. _diagnosis._--when there is doubt as to the diagnosis, the mallein test, the inoculation test, or the complement-fixation test may be employed. the mallein test is made by injecting mallein (a sterilized extract from a culture of glanders bacilli) beneath the skin. if the horse has glanders there results a febrile reaction and a swelling at the point of injection. if the horse does not have glanders the mallein has no effect or, at most, it produces a slight swelling only at the point of injection. the inoculation test consists in the inoculation of a susceptible animal (usually a guinea pig) with some of the suspected discharge from the nose or a farcy ulcer. if the material is properly used, and if it contains bacilli of glanders, the experimental animal will develop the disease. the eye test is now universally accepted as a very satisfactory means of diagnosing glanders. this consists in dropping into an eye of a suspected animal a specially prepared solution of mallein, as a result of which in an infected animal the inflammation develops in the eye, resulting in a discharge which varies in intensity from a mucopurulent character to a thick, sticky pus. the eyelids may also swell and many times become glued together. the reaction usually appears in from to hours after the introduction of the mallein. neither of these tests should be put into use except by a competent veterinarian. the complement-fixation test is a highly specialized laboratory test and can be carried out only by one versed in laboratory technique. (see bureau of animal industry bulletin .) the post-mortem examination of the lungs shows that the pneumonia of glanders is a lobular, v-shaped pneumonia scattered throughout the lungs and caused by the specific inflammatory process taking place at the divergence of the smaller air tubes of the lungs. in some cases of acute glanders the formation of nodules may so irritate the mucous membrane of the respiratory tract and cause such a profuse discharge of mucopurulent or purulent matter that the specific character of the original discharge is entirely masked. in this case, too, for a few days the submaxillary space may so swell as to resemble the edematous, inflamed glands of strangles, equine variola, or laryngitis. this condition is especially liable to be marked in an acute outbreak of glanders in a drove of mules. cases of chronic farcy and glanders, if not destroyed, may live in a depraved condition until the animal dies from general emaciation and anemia, but in the majority of cases, from some sudden exposure to cold, it develops an acute pneumonia or other simple inflammatory trouble which starts the latent disease and the animal has acute glanders. in the ass, mule, and plethoric horses acute glanders usually terminates by lobular pneumonia. in other cases the general symptoms may subside. the symptoms of pneumonia gradually disappear, the temperature lowers, the pulse becomes slower, the ulcers heal, leaving small, indurated cicatrices, and the animal may return to apparent health, or may at least be able to do a small amount of work with but a few symptoms of the disease remaining in a chronic form. during the attack of acute glanders the inflammation of the nasal cavities frequently spreads into the sinuses or air cells, which are found in the forehead and in front of the eyes on either side of the face, and causes abscesses of these cavities, which may remain as the only visible symptom of the disease. an animal which has recovered from a case of acute glanders, like the animals which are affected by chronic glanders and chronic farcy, is liable to be affected with emphysema of the lungs (heaves), and to have a chronic cough. in this condition it may continue for a long period, serving as a dangerous source of contagion, the more so because the slight quantity of discharge does not serve as a warning to the owner or driver as profuse discharge does in the more acute cases. at the post-mortem examination of an animal which has been destroyed or has died of glanders we find evidences of the various lesions which we have studied in the symptoms. in addition to this, we find nodules similar to those which we have seen on the exterior throughout the various organs of the body. nodules may be found in the liver, in the spleen, and in the kidneys. we may find inflammation of the periosteum of the bones, and we have excessive alterations in the marrow in the interior of the bones themselves. both these conditions during the life of the animal may have been the cause of the lamenesses which were difficult to diagnose. in one case which came under the observation of the writer, a lame horse was destroyed and found to have a large abscess of the bone of the arm, with old nodules of the lungs. when an animal has died immediately after an attack of a primary, acute case of glanders, we find small v-shaped spots of acute pneumonia in the lungs. if the animal has made an apparent recovery from acute glanders, and in cases of chronic farcy and chronic glanders, no matter how few the external and visible symptoms may have been, there is a deposit of nodules--small, hard, indurated nodes--of new connective tissue to be found in the lungs. when these have existed for some time we may find a deposit of lime salts in them. these indurated nodules retain the virus and their power to give out contagion for almost an indefinite time, and predispose to the causes which we have studied as the common factors in developing a chronic case into an acute case; that is, an inflammatory process wakens their vitality and produces a reinfection of the entire animal. the blood of an animal suffering from chronic glanders and farcy is not virulent and is unaltered, but during the attack of acute glanders, while the animal has fever, the blood becomes virulent and remains so for a few days. _treatment._--almost the entire list of drugs in the pharmacopoeia has been tested in the treatment of glanders. good hygienic surroundings, good feed, with alteratives and tonics, frequently ameliorate the symptoms, and often do so to such an extent that the animal would pass the examination of any expert as a perfectly sound animal. while in this case the number of nodules of the lungs, which are invariably there, may be so few as not to cause sufficient disturbance in the respiration as to attract the attention of the examiner, yet they exist, and will remain there almost indefinitely, with the constant possibility of a return of acute symptoms. it is probable that some horses may recover from glanders if the infection is slight, but it will not do to depend upon this except under the most stringent veterinary supervision. with good care, good feed, good surroundings and little work, an animal affected with glanders may live for months or even years in a state of apparently perfect health, but with the first deprivation of feed, with a few days of severe hard work, with exposure to cold or with the attack of a simple fever or inflammatory trouble from other causes, the latent seeds of the disease break out and develop the trouble again in an acute form. in several celebrated cases horses which have been affected with glanders have been known to work for years and die from other causes without ever having had the return of symptoms; but allowing that these cases may occur, they are so few and far between, and the danger of infection of glanders to other horses and to the stable attendants is so great, that no animal which has once been affected with the disease should be allowed to live unless repeated mallein tests have shown him to have become free from taint of glanders. in all civilized countries, with the exception of some of the states in the united states, the laws are most stringent regarding the prompt declaration on the part of the owner and attending veterinarian at the first suspicion of a case of glanders, and they allow indemnity for the animal. when this is done, in all cases the animal is destroyed and the articles with which it has been in contact are thoroughly disinfected. when the attendants have attempted to hide the presence of the disease in a community, punishment is meted out to the owner, attending veterinarian, or other responsible parties. several states have passed excellent laws in regard to glanders, but these laws are not always carried out with the rigidity with which they should be. sporotrichosis (mycotic lymphangitis). by john r. mohler, v. m. d., _assistant chief, bureau of animal industry_. this disease has previously been known in this country as epizootic lymphangitis, or pseudo-farcy. it is a chronic, contagious disease, particularly of equines, caused by a specific organism, the _sporotrichum schenckii_, and characterized by a suppurative inflammation of the subcutaneous lymph vessels and the neighboring lymph glands. owing to the fact that this affection does not spread as an epizootic and that its causal factor is a fungus, the name sporotrichosis has been suggested. the disease in man was first described by schenck and by beurmann and gougerot. carougeau observed its occurrence among horses and mules in madagascar, while in the united states it was first observed by pearson in pennsylvania in , although it is probable that it had existed for many years in various parts of this country. page and frothingham were first to recognize its mycotic nature in the united states. more recently meyer has also made valuable contributions with regard to the existence of this affection. its presence has been definitely established in ohio, iowa, california, and north dakota, and there is a probability of its existence in indiana and several western states. _bacteriology._--the sporotrichum is microns thick, cylindrical and segmented, having more or less branching threads, which bear spores at the end. in the pus they occur as slightly ovoid bodies to microns long, which are somewhat pointed toward the poles, have a sharp double contour, and only on artificial cultivation at a temperature of over ° do they develop into the characteristic spore-carrying threads. the period of incubation varies greatly, extending from three days to four months, or even longer. in artificial inoculations with pus through wounds in the skin, inflammation and swelling of the lymph vessels may be noticed in ten to sixty days; these vessels show in their course a development of hard nodules, from which abscesses form. the natural infection without doubt is caused through superficial wounds, such as galls, barbed-wire cuts, or through various stable utensils, harness, bandages, insects, etc. solipeds are mostly susceptible, but cattle may also be infected. _symptoms._--the inflammation of the lymph vessels is usually first observed on the extremities, especially on one or both hind legs; it may also appear on the forelegs, shoulder, or neck, and more rarely on the rump, udder, and scrotum. the lesions, as a rule, develop in the tissue adjacent to the place of inoculation. in the early stages of the disease the lymph vessels appear very hard and thickened, and along their course hard nodules develop, ranging in size from a pea to a hen's egg. later these nodules soften, burst spontaneously, and discharge a thick, yellowish pus. the surface of the resulting ulcers or abscess cavities soon fills up with exuberant granulations which protrude beyond the surface of the skin, giving it a fungoid appearance. the affected extremities are considerably enlarged, similar to cases of simple lymphangitis. in rare cases the mucous membrane of the nostrils may also become affected, showing yellowish flat elevations and ulcerations, and these may extend by metastasis to internal organs. in cases in which the mucous membrane is affected, the submaxillary lymph gland may also become enlarged and suppurate. the constitutional symptoms accompanying this disease are not very marked and may be altogether absent. there is usually only a very slight fever, which seldom runs over ° f. the appetite is not impaired except in the advanced cases. _lesions._--the anatomical changes are most marked in the skin and the subcutaneous tissues. they may become to inches thick and indurated as the result of fibrous-tissue formation, owing to the inflammation present. on the baconlike cut surface suppurative areas and granulating sores may be noticed of various sizes, also enlarged lymph vessels filled with clotted lymph mixed with pus. the neighboring lymph glands are usually enlarged and frequently contain suppurating foci. rarely the internal organs may show metastatic abscesses. _diagnosis._--the diagnosis is based on the characteristic appearance of the ulcerations, which show exuberant granulation of a bright red color, inverted edges, and a thick, creamy, glutinous discharge. these manifestations differentiate the disease from glanders, in which the ulcers are craterlike, do contain exuberant granulations, and the discharge is of a viscous, oily character. the submaxillary and other nodes as well as the corded lymphatics in glanders are more firmly attached to the adjacent tissues, and are therefore less movable. in some chronic cases of sporotrichosis, however, the lesions may closely resemble those of farcy, and in these cases the microscopical examination of the pus will disclose the nature of the affection. in the pus the causative organism can be easily seen in the unstained specimen, and is recognized by its size, shape, and highly refractory double outline. furthermore, the injection of mallein in cases of sporotrichosis will be attended with negative results. _treatment._--at the onset of the disease treatment consists in entire extirpation of the nodules, in case the lesions are localized. in cases in which the nodules have formed abscesses, their opening is recommended, followed by the application of the actual cautery or a to solution of bichlorid of mercury. it must be borne in mind that the organism is quite resistant to antiseptics, and the best results will be obtained from the application of a solution of a strong antiseptic following the opening of the lesions. internally, potassium iodid is recommended in -dram doses, dissolved in drinking water, twice a day. in the most favorable cases recovery results in from five to seven weeks; as a rule, however, it requires several months. in order to prevent the spreading of the disease the affected animals should be isolated, the products of the disease should be destroyed, and the stable should be disinfected with very strong liquid disinfectants in consideration of the resistance of the causative organism. rabies, hydrophobia, or madness. rabies is a contagious disease, which is usually transmitted by a bite and by the introduction of a virus contained in the saliva of an affected animal. it may, however, be transmitted in other ways. it is characterized by symptoms of aberration of the nervous system and invariably terminates fatally. it is accompanied with lesions, inflammation, and degeneration in the central nervous system. it is a disease that is most common in the dog, but is transmitted to the horse, either from dogs or from any other animal affected with it. (see also remarks on page .) as a disease of the horse it is invariably the result of the bite of a rabid animal, usually a dog. perhaps no disease in medicine has been the object of more controversy than rabies. certain medical men of prominence have even doubted its existence, and many others have claimed for it a spontaneous origin. the experience of ages, however, has shown that contagion can be proved in the great majority of cases, and, by analogy with other contagious diseases, we may only believe that the development of one case requires the preexistence of a case from which the virus has been transmitted. pasteur has further added to our knowledge of the disease by showing that a virus capable of cultivation exists in the nervous system, especially in the lower part of the brain (medulla oblongata) and in the anterior part of the spinal column. he has further shown that that portion of the nervous system which contains the virus, the exact nature of which has not yet been demonstrated, will retain it for a very long time if kept at a very low temperature or if left surrounded by carbolic acid; but if the nerve matter, which is virulent at first, is exposed to the air and is kept from putrefaction by substances which will absorb the surrounding moisture, it will gradually lose its virulence and become inoffensive in about fifteen days. he has also further shown that the action of a weak virus on an animal will prevent the development of a stronger virus, and from this he has formulated his method of prophylactic treatment. this treatment consists in the successive inoculation of portions of the nerve matter containing the virus from a rabid animal which has been exposed to the atmosphere for thirteen days, ten days, seven days, and four days, until the virulent matter which will produce rabies in any unprotected animal can be inoculated with impunity. a curious result of the experiments of pasteur is that an animal which has first been inoculated with a virus of full strength can be protected by subsequent inoculations of attenuated virus repeated in doses of increasing strength. innumerable attempts have been made to discover the causative agent, and investigators have announced the finding of many of the lower forms of animal and vegetable life as the pathogenic factor. among the recently described causes, certain protozoanlike bodies found in the ganglionic cells in by negri, and termed negri bodies, are of a very suggestive nature. negri claims that these bodies are not only specific for rabies, but that they are protozoa and the cause of the disease. his work has been corroborated by investigators in all parts of the scientific world. an examination of the vitality of these bodies will show a striking resemblance to the vitality of an emulsion of the virulent tissue. thus, they have been found to be quite resistant to external agencies, such as putrefaction, drying, etc., and are about the last portion of the nerve cell to survive the advance of decomposition. they are also found in more than per cent of the cases of rabies examined, but have not been proved to exist in other diseases. valenti states, as his strongest evidence of the protozoan nature of the bodies, that the virus of rabies is neutralized in test tubes by quinin, while no other alkaloid has this property. as a result of the work performed in the new york city board of health laboratory, park claims that negri bodies are found in animals before the beginning of visible symptoms, and evidence is given that they may be found early enough to account for the infectiousness of the central nervous system. these bodies are now almost universally considered as diagnostic of rabies, and in the pathological laboratory of the bureau of animal industry their detection in the nerve cells of the brain suffices for a diagnosis of rabies without animal inoculations. in case these granular bodies are not found in a suspected animal, the plexiform ganglion is next examined, and should negative results still be obtained, the inoculation of rabbits is then made as a last resort. it is indeed rare that positive results are obtained from the latter method after the first two methods have been negative, but it has occurred occasionally in cases in which the animal had been killed in the early stages of the disease. _symptoms._--from the moment of inoculation by the bite of a rabid dog or other rabid animal or by other means, a variable time elapses before the development of any symptoms. this time may be eight days or it may be several months; it is usually about four weeks. the first symptom is an irritation of the original wound. this wound, which may have healed completely, commences to itch until the horse rubs or bites it into a new sore. the horse then becomes irritable and vicious, and it is especially susceptible to moving objects, excessive light, noises, the entrance of an attendant, or any other disturbance will cause the patient to be on the defensive. it apparently sees imaginary objects; the slightest noise is exaggerated into threatening violence; the approach of an attendant or another animal, especially a dog, is interpreted as an assault and the horse will strike and bite. the violence on the part of the rabid horse is not for a moment to be confounded with the fury of the same animal suffering from meningitis or any other trouble of the brain. but in rabies there is a volition, a premeditated method, in the attacks which the animal will make, which is not found in the other diseases. between the attacks of fury the animal may become calm for a variable period. the writer attended a case in which, after a violent attack of an hour, the horse was sufficiently calm to be walked miles and only developed violence again an hour after being placed in the new stable. in the period of fury the horse will bite at the reopened original wound; it will rear and attempt to break its halter and fastenings; it will bite at the woodwork and surrounding objects in the stable. if the animal lives long enough it shows paralytic symptoms and falls to the ground, unable to use two or more of its extremities, but in the majority of cases in its excesses of violence it does physical injury to itself. it breaks its jaws in biting at the manger or fractures other bones in throwing itself on the ground and dies of hemorrhage or internal injuries. at times throughout the course of the disease there is an excessive sensibility of the skin which, if irritated by the touch, will bring on attacks of violence. throughout the course of the disease the animal may have appetite and desire water, but on attempting to swallow has a spasm of the throat which renders the act impossible. this latter condition, which is common in all rabid animals, has given the disease the name of hydrophobia (fear of water). in a case under the care of the writer a horse, four weeks after being bitten on the forearm by a rabid dog, developed local irritation in the healed wound and tore it with its teeth into a large ulcer. this was healed by local treatment in days, and the horse was kept under surveillance for more than a month. on the advice of another practitioner the horse was taken home and put to work; within days it developed violent symptoms and had to be destroyed. _diagnosis._--the diagnosis of rabies in the horse is to be made from the various brain troubles to which the animal is subject; first by the history of a previous bite of a rabid animal or inoculation by other means; second, by the evident volition and consciousness on the part of the animal in its attacks, offensive and defensive, on persons, animals, or other disturbing surroundings. the irritation and reopening of the original wound or point of inoculation is a valuable factor in diagnosis. diagnosis after death may be made by microscopic examination for negri bodies or by the inoculation of rabbits, as already mentioned. recovery from rabies may be considered as a question of the correctness of the original diagnosis. rabies is always fatal. _treatment._--no remedial treatment has ever been successful. all the anodynes and anesthetics, opium, belladonna, bromid of potash, ether, chloroform, etc., have been used without avail. the prophylactic treatment of successive inoculations is being used on human beings, and has experimentally proved efficacious in dogs, but would be impracticable in the horse unless the conditions were quite exceptional. dourine. by john r. mohler, v. m. d., _assistant chief, bureau of animal industry_. dourine (also known as maladie du coït, equine syphilis, covering disease, breeding paralysis) is a specific infectious disease affecting under normal conditions only the horse and ass, transmitted from animal to animal by the act of copulation, and due to an animal parasite, the _trypanosoma equiperdum_. _history._--it is described as having existed as early as in the eastern hemisphere, and was more or less prevalent in several of the european countries, including france, germany, austria, and switzerland, during the first half of the nineteenth century. its presence was recognized for the first time in the united states in , when an outbreak occurred in illinois. since then the existence of the disease has been observed at irregular intervals in numerous other states, including nebraska, iowa, montana, wyoming, new mexico, north dakota, and south dakota. _symptoms._--there are many variations in the symptoms of dourine, and this is particularly true of the disease as it occurs in this country. two distinct stages may be noted which vary somewhat from those described in textbooks, but probably no more than could be expected when differences of climatic conditions and methods of handling are taken into consideration. the first stage chiefly concerns the sexual organs and therefore differs somewhat in the male and female. in the second stage the symptoms indicating an affection of the nervous system are more prominent and are not dependent upon the sex of the animal. following a variable period of incubation of from days to months, there is seen in the stallion an irritation and swelling about the penis and sheath. in a few days small vesicles or blisters may appear on the penis, which later break, discharging a yellowish, serous fluid and having irregular, raw ulcers. the ulcers show a tendency to heal rapidly, leaving scars which are permanent. there may be more or less continuous dripping from the urethra of a yellowish, serouslike fluid. stallions may show great excitement when brought in the vicinity of mares, but service is often impossible because of the fact that a complete erection of the penis does not occur. in the mare the first symptoms may be so slight as to be overlooked. the disease, being the result of copulation, usually begins with inflammation of the vulva and vagina. there may be a mucopurulent discharge, which may be slight or profuse in quantity, agglutinating the hairs of the tail. the mare may appear uneasy and urinate frequently. vesicles may appear on the external vulva and mucous membrane of the vulva and vagina which later rupture and form ulcers. on the dark skin of the external vulva the scars resulting from healing of the ulcers are white, more or less circular in outline, from one-eighth to half an inch in diameter, and pitlike. this depigmentation of the skin about the external genitals is permanent. urticarial eruptions or plaques which break out over various parts of the body are a frequent symptom seen in animals of either sex. these are sharply defined and edematous swellings of the skin about the size of a half dollar or may be even larger. the usual locations of these plaques are the croup, belly, and neck. the intensity of the symptoms mentioned which are significant of the early stage of the disease may vary to a wide extent and in many instances be so mild as to escape the attention of any but the most careful observer. they commonly disappear after a brief period. the apparent recovery, however, is not permanent, for such animals after a period of variable length manifest constitutional or nervous symptoms. these may not appear for several months or even years. they consist of a general nervous disorder with staggering, swaying gait, especially in the hind limbs. the animal generally becomes emaciated, the abdomen assuming a tucked-up appearance. the first indication of paralysis will be noted in traveling, when the animal fails to pick up one of the hind feet as freely as the other, or both may become affected at the same time, at which time knuckling is a common symptom. labored breathing is occasionally noted. when the paralysis of the hind limbs starts to appear the disease usually progresses rapidly. the horse goes down, is unable to rise, and dies in a short time from nervous exhaustion. the appetite usually remains good up to the last. although a case of dourine may now and then recover, as a rule the disease is present in the latent stage. bad weather, exposure, insufficient feed, and complicating diseases like influenza, distemper, or in fact any condition which tends to lower the vitality of the animal, may hasten the termination of the disease. _diagnosis._--the complement-fixation test furnishes by far the most reliable means of diagnosis and is especially valuable in a chronic affection of this character, when the symptoms manifested are variable and frequently so obscure as to escape observation. this is a laboratory test requiring special facilities and the services of a trained bacteriologist. _treatment._--little benefit can be obtained from medicinal treatment, nor is such treatment desirable in this country, where the disease has existed only in restricted areas, and where sanitary considerations demand its prompt eradication. infectious abortion in mares. infectious abortion (also known as contagious abortion, epizootic abortion, enzootic abortion, slinking of colts) is a disease of mares which from a specific cause results in the premature expulsion of the fetus and its membranes from the uterus. it is characterized by an inflammatory condition of the female reproductive organs. the contagious nature of the disease had not been recognized until recently, the disease being principally attributed to various conditions, such as traumatic influences, various infectious diseases, spoiled feed, drugs, and other factors. ostertag was the first to study premature births in mares, attributing as the cause of the same a streptococcus, which he was supposed to have been able to use successfully in artificially producing abortion, either by inoculations or feeding. his findings could not be substantiated by other investigators. the earliest appearance of the disease in this country was in , at which time it caused considerable damage to the horse-breeding industry in the mississippi valley. smith and kilbourne investigated an outbreak in pennsylvania in , at which time they incriminated another germ belonging to the paratyphus b group as the causative factor of the disease. these findings have been subsequently substantiated by many investigators abroad, as well as in this country, notably so by de jong, dassonville, and rivière, and by good and meyer. more recently very valuable information was contributed to our knowledge on this disease by schofield, of canada, especially with regard to the biological tests for diagnosis. good suggested "_bacillus abortivus equinus_" as the name for the specific organism. the causative agent of this disease is not identical with the germ causing abortion in cattle. it exerts its action, however, in a similar manner, and appears to have, under certain conditions, a predilection for the genital organs of the mare, where it induces certain morbid changes whereby a premature expulsion of the fetus is the result. the germ is usually present in the fetal membranes and also in the aborted fetus. mares may harbor the infection without disclosing any apparent ill effects. it appears to exert its influence mainly upon the female genital organs, where it may induce an inflammatory condition of the uterus. the infected animals may carry the fetus through the normal period of pregnancy, giving birth to either a normal or a weak colt, or again abortion may take place at any time during pregnancy, mostly, however, from the sixth to the ninth month. _symptoms._--the symptoms suggestive of abortion are frequently entirely absent. at times the abortion may be ushered in by symptoms of colicky pains, restlessness, and periodical straining; these, however, are by no means constant, especially if the abortion takes place in the early months of pregnancy. the genital organs are usually swollen, showing a mucous discharge. immediately before abortion the symptoms are more aggravated. following abortion the discharge is more characteristic, being of a dark-brown color, sometimes even bloody, and contains streaky or flaky pus. the fetal membranes in all cases are not expelled with the aborted fetus, but there is a tendency toward retention of these membranes, which frequently has serious consequences upon the health of the animal. at times it becomes necessary to resort to manual removal of the afterbirth, and the inflammation of the uterus and a chronic discharge usually follow such conditions. the expelled fetuses, as a rule, die soon after the abortion, and if the expulsion has taken place at a time close to its full term the fetuses are usually poorly developed and subject to various kinds of digestive and septic disorders. the fetuses do not disclose any particular abnormal appearance on external examination; in many cases, however, the post-mortem examination reveals inflammatory changes of various organs. the method of infection has not yet been satisfactorily established; nevertheless it is essential that we consider as the principal mode of infection the ways which have been proved for the contagious abortion in cattle. these are especially by ingestion; that is, by taking up the germs with the feed, water, or other means, which have become contaminated with the germs. the infection through the genital organs is probably not so frequent, but in this regard the stallion no doubt plays an important rôle in the spreading of the disease. schofield considers this method of infection as the principal source of spreading the disease. it must be considered that in infected stables the germs may be present throughout the premises, and by keeping animals which have aborted in such stables a contamination of feed and utensils may continually take place, since the aborted mares usually discharge a considerable quantity of material which is often heavily charged with the germs. the germ is taken up by the body with the feed or water, passing from the intestines into the blood, and from there is carried to the genital organs, where it finds suitable conditions for its development. milk from an infected mare may also contain the germ, and colts may become infected by sucking the milk of infected mothers. in such instances the infection may remain dormant until the colt develops and becomes pregnant, when the organism, finding a condition suitable for its development, produces the disease. on the other hand, stallions used in covering infected mares may be carriers of the germs, and when used for the breeding of healthy animals may in this manner readily transmit the disease to them. _diagnosis._--contagious abortion may be diagnosed by the changes which occur in the fetal membranes, and also in the expelled feces. in order, however, to substantiate a diagnosis with certainty, demonstration of the germ by microscopical examination is necessary. the occurrence of frequent abortions among the mares in a stable is also an additional evidence of the contagious character of the malady. it must be considered that at times infected mares may carry the fetus to full maturity, in which case the diagnosis is possible only by blood examinations in a laboratory. infected animals usually abort only once; however, in a certain proportion of cases they may abort even two, three, or four times in succession. animals which establish a tolerance for the infection, and carry the fetus to full maturity, may nevertheless remain a source of danger for spreading the disease. the tests used in laboratories for the diagnosis are the agglutination and complement-fixation tests, by which the disease may be diagnosed from a sample of blood from a suspected animal. such tests, however, have to be confined to the laboratories, which are equipped for such work. _treatment and prevention._--medicinal treatment is usually of no avail, and all efforts should be directed toward the prevention of the disease. various medicinal agents have been recommended and are being exploited for the treatment, but to the present time no satisfactory evidence has been established as to their merits. bacterial vaccines prepared from the specific organism have been given limited trials, but to date they can not be considered as entirely satisfactory, since it will require considerable experience with them before their usefulness can be definitely established. the prevention should consist largely in sanitary measures directed toward the disinfection of premises and animals. (for a method for disinfection of premises see article under that heading.) the following procedure is advised for the disinfection of animals: to prevent a stallion from carrying the infection from a diseased mare to a healthy one the sheath and the penis should be disinfected with a solution of / per cent of compound cresol solution, lysol, or trikresol, or a per cent carbolic acid or to , potassium permanganate solution in warm water. for this purpose it is advisable to use a soft-rubber tube with a large funnel attached to one end, or an ordinary syringe and tube would serve the purpose. the tube should be inserted into the sheath, and the foreskin held with the hand to prevent the immediate escape of the fluid. in addition to this the hair of the belly and inner side of the thighs should be sponged with an antiseptic. this disinfection should invariably precede and follow every service. with regard to the mares, a period of three months should elapse between abortion and a subsequent breeding, and especially if there is any evidence of a discharge the breeding of the animal should not be undertaken. the mare showing signs of abortion should be immediately isolated and the fetus and membranes should be burned. the fetus should never be dragged across a barnyard or stable, but should be removed by other means by which the contamination of the premises may be prevented. the stall in which the animal aborted should be thoroughly disinfected and the genital organs of the mare washed daily with a disinfectant. the antiseptic washing recommended for the treatment of the stallions prior to and after breeding should be also used for the irrigation of the uterus of mares which have aborted. this treatment should be continued daily until all evidence of discharge has ceased. the isolation of the animal should be carried out for at least one month after the evidence of a discharge has ceased. by carefully and persistently carrying out the sanitary measures it may be possible to control and finally eradicate the disease. navel ill of colts. navel ill of colts is also known as joint ill, omphalophlebitis, septic arthritis of sucklings, and pyosepticemia of the newly born. the unfavorable outlook after the appearance of the disease, together with the fact that the disease when present requires the attention of a veterinarian, demands that the breeder concern himself with its prevention. the disease is caused by a microorganism and several bacteria have been suspected of being responsible. every one of the suspected organisms is found abundantly in manure and objects contaminated with manure. the infective material gains entrance into the colt through the open umbilical cord as a result of its coming into contact with litter, floors, or discharges from its dam contaminated by one of the organisms which cause the trouble. there are cases on record in which the infection has taken place before birth, and while some investigators assert that this method is the principal mode of infection still, in a large number of cases, the prophylactic measures adopted to guard against the infection through the navel cord have given good results. since infection before birth can not be controlled satisfactorily, we are justified, for all practical purposes, in preventing navel ill by guarding against the infection through the cord at birth or soon afterwards. cleanliness of stables where pregnant mares are kept must be insisted upon. this is especially necessary where outbreaks of navel ill have been known to exist. mares in the last stages of gestation should be placed in a box stall which has previously been cleaned and disinfected. the bedding should be frequently renewed and the external genitals and neighboring tissues should be kept clean and disinfected with a per cent solution of carbolic acid or per cent liquor cresolis compositus, or any other reliable disinfecting agent. operations for opening abscesses and removal of afterbirths from cows should not be executed in the immediate vicinity of mares in an advanced stage of pregnancy. the foal when dropped should be placed on clean bedding. in any event the cord of the foal should be washed in a disinfectant solution and tied at about - / inches from the navel with a band or string which has previously been soaked in a disinfectant solution. with a sharp pair of scissors the navel cord is then severed about one-half inch below the band and again disinfected. the ligature should not be tightened, however, until pulsation of the vessels in the cord has ceased. the stump of the cord is then painted with strong carbolic-acid solution, tincture of iodin, or a mixture of equal parts of tincture of iodin and glycerin. the stump should be washed daily with a disinfectant and either painted with iodin mixture or carbolic acid or dusted with some reliable antiseptic healing powder. after five days the parchmentlike dried stump may be cut off and the navel wound washed with a disinfectant solution and dusted with powder until healed. the cases of navel ill resulting from infection before birth can not well be guarded against. by keeping mares, advanced in pregnancy, in good physical condition, the fetus will be expelled immediately upon the opening of the uterine cavity. once the infection of the navel cord has set in, the cord should not be ligated but should be washed in a disinfectant solution and a veterinarian called for the subsequent treatment. infectious anemia or swamp fever. by john r. mohler, v. m. d., _assistant chief, bureau of animal industry_. infectious anemia of horses, known also by a number of other names, as swamp fever, american surra, malarial fever, typhoid fever of horses, the unknown disease, no-name disease, plains paralysis, and pernicious anemia, has recently been the subject of much investigation. the cause of the disease has now been definitely determined as an invisible virus, which is capable of passing through the pores of the finest porcelain filters, like the infection of foot-and-mouth disease, rinderpest, hog cholera, and similar diseases. the disease is most prevalent in low-lying and badly drained sections of the country, although it has been found on marshy pastures during wet seasons in altitudes as high as , feet. therefore proper drainage of infected pastures is indicated as a preventive. it is also more prevalent during wet years than in dry seasons. it usually makes its appearance in june and increases in frequency until october, although the chronic cases may be seen in the winter, having been contracted during the warm season. _cause._--it has been conclusively proved that infectious anemia is produced by an invisible filterable organism which is transmissible to horses, mules, and asses by subcutaneous inoculation of blood serum. the virus which is present in the blood may be transmitted to a number of equines in a series of inoculations by injecting either the whole blood, the defibrinated blood, or the blood serum which has been passed through a fine pasteur filter, thus eliminating all the visible forms of organismal life, including bacteria, trypanosoma, piroplasma, etc. this virus has also been found to be active in the carcass of an affected animal hours after death. following the injection of the infectious principle there is a period of incubation which may extend from ten days to one and one-half months, at the end of which time the onset of the disease is manifested by a rise of temperature. if uncomplicated, the infection runs a chronic course, terminating in death in from two months to one and one-half years, or even longer. the probability of the virus being spread by an intermediate host, such as flies, mosquitoes, internal parasites, etc., is now receiving careful investigation. from experiments already conducted it appears that this disease, formerly supposed to be confined to manitoba and minnesota, is more or less prevalent in kansas, nebraska, colorado, wyoming, montana, north dakota, virginia, texas, and new york. it also occurs in europe, having been reported in germany under the name of infectious anemia and in france as infectious typho-anemia. _symptoms._--the disease is characterized by a progressive pernicious anemia, remittent fever, polyuria, and gradual emaciation in spite of a voracious appetite. it begins to manifest itself by a dull, listless appearance and by general weakness, the animal tiring very easily. this stage is followed closely by a staggering, swaying, uncertain gait, the hind legs being mostly affected. there is also noted a weakness and tenderness in the region of the loins, and at the same time the pulse, though weak, stringy, and intermittent, increases in rapidity and may run as high as . the temperature may rise to ° f. or higher, remaining high for several days, and then dropping to rise again irregularly. toward the end of the disease the temperature occasionally remains persistently high. the horse may improve for a time, but usually this improvement is followed by a more severe attack than the first. venous regurgitation is sometimes noticed in the jugular before death. the quantity of urine passed is enormous in some cases. death finally occurs from exhaustion or syncope. the blood shows a slight decrease in the number of white blood cells, while there is a gradual but marked diminution of red corpuscles, the count running as low as , , per cubic millimeter, the normal count being , , . if the blood is drawn from such an animal, the resulting red clot will be about one-fifth of the amount drawn. occasionally a slow dripping of blood-tinged serum from the nostrils is observed as a result of this very thin blood oozing from the mucous membranes. petechiæ, or small hemorrhagic points, are sometimes noticed on the nictitating membrane and conjunctiva, while paleness of the visible mucous membranes of the nose and mouth is usually in evidence, although they may have a yellow or mahogany tinge. often a fluctuating, pendulous swelling may appear on the lower lip, point of elbow, sheath, legs, under the belly, or on some other pendent portion, especially late in the disease, which is indicative of poor circulation, thinning of the blood, and consequent loss of capillary action. _lesions._--after death the carcass is found to be very much emaciated and anemic, the visible mucosa being very pale. this marked absence of adipose tissue makes the skinning of the animal a difficult task. subcutaneous and intermuscular edema and hemorrhages are frequently observed, although in many cases it is remarkable to see how few macroscopic lesions may be present. the predominating and most constant lesion is probably the petechiæ, so often observed in the muscle or on the serous membranes of the heart. the heart is generally enlarged and may be the only organ to show evidence of disease. in other cases the lungs may be studded with petechiæ, with a serous exudate present in the thoracic cavity. in addition to the petechiæ already noted, the pericardial sac generally contains an increased quantity of fluid. the abdominal cavity may show peritonitis and a hemorrhagic condition of the intestines, which probably result from overfeeding in consequence of the ravenous appetite. the liver, although usually normal, sometimes presents a few areas of degeneration. the spleen is at times found to be enlarged and covered with petechiæ. the kidneys may appear normal or anemic and flaccid, but microscopically they usually show a chronic parenchymatous degeneration. the lymph glands may be enlarged and hemorrhagic. _diagnosis._--the diagnosis of the disease is not difficult, especially in advanced stages. the insidious onset, remittent fever, progressive emaciation and anemia, unimpaired or ravenous appetite, staggering gait and polyuria are a train of symptoms which make the disease sufficiently characteristic to differentiate it from other diseases affecting horses in this country. the peculiar relapsing type of fever, the great reduction in the number of red blood cells, and the absence of eosinophila are sufficient to differentiate it from the anemias produced by internal parasites, while it may be readily distinguished from surra by the nonsusceptibility of cattle and by the great ease with which the trypanosoma may be found in the latter affection. _prognosis._--the prognosis of the disease is very unfavorable. veterinarians in different sections of the country where it is prevalent report a mortality of per cent or even higher. recovery takes place only when treatment is begun early or when the animal has a long convalescent period. _treatment._--the treatment of the disease has so far been far from satisfactory. the iodid, permanganate, and carbonate of potash have been used. arsenic, axytol, quinin, and silver preparations have been suggested, but all have been uniformly without success. intestinal antiseptics have been resorted to, and the results are encouraging but not altogether satisfactory. symptomatic treatment seems to be the most dependable. for instance, davison, of this bureau, was able to reduce greatly the mortality from this affection by giving an antipyretic of grains of quinin, drams of acetanilid, and grains of powdered nux vomica four times daily. in the late stages, with weak heart action, alcohol should be substituted for acetanilid. cold-water sponge baths may be given, and in addition frequent copious injections of cold water per rectum, which has a beneficial effect in reducing the temperature and in stimulating peristalsis of the bowels, which, as a result of the disease, show a tendency to become torpid during the fever. purgatives, on account of their debilitating effect, should not be given unless absolutely necessary, but laxatives and easily digested feeds should be given instead. not infrequently a dirty yellowish tinge of the visible mucous membranes has been observed, in which cases grains of calomel in from to drams of aloes in a ball, or -dram doses of fluid extract of podophyllin, may be given. following the subsidence of the fever, a tonic should be administered, composed of the following drugs in combination: arsenious acid grams powdered nux vomica do powdered cinchona bark do powdered gentian root do these should be well mixed and one-half teaspoonful given to the affected animal at each feed. as in the case of all other infectious diseases, the healthy should be separated from the sick horses and thorough disinfection of the infected stables, stalls, litter, and stable utensils should be carried out in order to prevent the recurrence of the disease. as a disinfectant the compound solution of cresol, carbolic acid, or chlorid of lime may be used, by mixing ounces of any one of these chemicals with gallon of water. one of the approved coal-tar sheep dips may also be used to advantage in a per cent solution ( ounces of dip to gallon of water). the disinfectant solution should be applied liberally to all parts of the stable, and sufficient lime may be added to the solution to make the disinfected area conspicious. investigations are now in progress with a view of producing a vaccine or serum that will protect horses that have been exposed to the disease. surra. by ch. wardell stiles, ph. d. _professor of zoology, united states public health service._ surra is not known to occur in the united states, but it is more or less common in the philippine islands and india. it is caused by a microscopic, flagellate animal parasite, known as _trypanosoma evansi_, to µ long by to µ broad, which lives in the blood and destroys the red blood corpuscles. in general the disease is very similar to and belongs in the same general class with tsetse-fly disease, or nagana, of africa and mal de caderas, of south america. surra is a wet-weather disease, occurring chiefly during or immediately after heavy rainfalls, floods, or inundations. surra attacks especially horses, asses, and mules, but it may occur in carabao, camels, elephants, cats, and dogs, and has been transmitted to cattle, buffaloes, sheep, goats, rabbits, guinea pigs, rats, and monkeys. no birds, reptiles, amphibia (frogs, etc.), or fish are known to suffer from it. it attacks both male and female animals, young and old. australian breeds of horses and white and gray mules are said to be more susceptible than animals of other breeds and color. surra in equines and camels is said to be an invariably fatal disease, but cattle occasionally recover from it. there is no history of a definite onset of the disease, and the condition is progressive, usually with a number of relapses. the period of incubation may vary somewhat; in experimental cases it is from to (usually to ) days, according to conditions. the duration varies with the species of animal attacked, their age, and general condition. the average duration in the horse is reported at less than two months, though some cases may terminate fatally in less than one to two weeks. _method of infection._--all evidence now available seems to indicate that surra is strictly a wound disease, namely, that the parasite may enter the body only through a wound of some kind. apparently by far the most common method is through wounds produced by biting flies whose mouth parts are moist with the infected blood of some animal bitten by the same flies immediately before biting the healthy animal. crows may also transmit the infection by pecking at sores on a diseased animal, soiling their beaks with blood, and transferring this infected blood to a healthy animal. likewise, if a scratch is made on a horse and then infected blood is rubbed on the scratch, the horse will become diseased. if, in experiment, infected blood is fed to a healthy animal, the latter may contract surra in case it has an abraded or wounded spot in the mouth; but if no part of the lining of the alimentary canal is wounded, infection does not take place. thus dogs and cats may contract the disease by wounding the lining of the mouth (as with splinters of bone) while feeding on the carcasses of surra subjects. all available evidence indicates that under normal conditions of pregnancy the disease is not transmitted from mother to fetus. there is a popular view that surra may be contracted by drinking stagnant water and by eating grass and other vegetation grown upon land subject to inundation, but there is no good experimental evidence to support this view: probably the correct interpretation of the facts cited in support of this theory is that biting flies are numerous around stagnant water and in inundated pastures; hence, that a great number of possible transmitters of the disease are present in these places. _symptoms._[ ]--the invasion of this disease when contracted naturally is usually marked by symptoms of a trivial character; the skin feels hot, and there may be more or less fever; there is also slight loss of appetite, and the animal appears dull and stumbles during action; early a symptom sometimes appears which may be the first intimation of the animal's indisposition, and which, as a guide to diagnosis, is of great importance; it is the presence of a general or localized urticarial eruption. if the blood is examined microscopically, it may be found to present a normal appearance; but in the majority of cases a few small, rapidly moving organisms will be observed, giving to the blood, as it passes among the corpuscles, a peculiar, vibrating movement, which if once observed will not easily be forgotten. if the parasite has not been discovered in the blood for several days, the symptoms mentioned above may be the only ones noticed, and, as a rule, when treated with febrifuges, the horse quickly improves in health and the appetite returns. this condition does not last for more than a few days, when the animal is again observed to present a dull and dejected appearance, and on examination well-marked symptoms are found; the skin is hot, the temperature more or less elevated-- . ° to ° f.; the pulse full and frequent-- to beats a minute; the visible mucous membranes may appear clean, but the conjunctival membranes, especially those covering the membrana nictitans, are usually the seat of dark-red patches of ecchymosis, varying in size in different animals. there is more or less thirst and slight loss of appetite; the animal eats its grain and green grass, but leaves all or a portion of the hay with which it has been supplied. at the same time there are slight catarrhal symptoms present, including lacrimation and a little mucous discharge from the nostrils. occasionally at this period of the disease the submaxillary glands may be found enlarged and perhaps somewhat tender on manipulation. one symptom is markedly absent, namely, the presence of rigors or the objective sign of chilliness. in addition, it will be noted that there is some swelling and edema of the legs, generally between the fetlock and the hock, which pits but is not painful on pressure, and in case of horses there may be also some swelling of the sheath at this stage of the disease. when the fever and concomitant symptoms have declared themselves for a short period, one thing becomes especially noticeable in every animal attacked, namely, the rapidity with which it loses flesh. if the blood has been examined microscopically during the second period of fever, at first a few parasites will have been observed in it, which day by day increase in number and reach a maximum, where they remain for a varying period, or at once suddenly or gradually disappear during the period of apyrexia. after the fever and the accompanying symptoms have for the second time been present for a few days--the period varying from one to six--the animal is found to have lost the dull, dejected appearance and to look bright. the temperature has fallen and, in some cases, has attained normal or even subnormal limits. the visible mucous membranes are clean, and the conjunctival petechiæ begin to fade; the pulse, however, will be found to be weak and thready in character, but the appetite excellent, and, in fact, if it were not for the loss of flesh and slight edema of the legs, there would be little to show that the animal was sick. unfortunately, however, this condition does not continue for any great length of time, for again the temperature is elevated; in the course of a few hours the thermometer registers a still higher degree, the animal is dull and dejected, and by the following day the visible mucous membranes present a yellow tinge; large ecchymoses, dark in color, appear on the conjunctival membranes, the action of the heart is irritable, the pulse full and quick, or at times intermittent, and regurgitation may be observed in the jugulars, the breathing is quickened, and the individual respirations are shallow. on watching an animal in this condition it may be noticed that it takes seven or eight very short inspirations, followed by a much more prolonged and sonorous one; at the same time the breathing is more abdominal than thoracic in character. on examination of the legs it will be found that the swelling and edema have increased considerably, and that on the under surface of the abdomen, where previously it was confined to the sheath, it has now commenced to spread forward along the subcutaneous tissue between the skin and the muscles. during the whole of this time the appetite will have varied little, and the evacuations will be only slightly, if at all, altered in character. in the blood a repetition of the previous events takes place, the parasites make their appearance and increase to a maximum and again suddenly or gradually disappear, according to the length of the fever period. these periods, alternating with and without fever, may go on for a considerable time. the progress of the disease is variable and greatly depends upon the condition of the animal attacked, the weak one succumbing very rapidly, but each return of the fever brings with it, as a rule, an increase in the severity of the symptoms. there is increased yellowness of the membranes, fresh crops of petechiæ on the conjunctiva, a collection of gelatinous material at the inner angle, which at times becomes red in color from an admixture of blood, and which on microscopic examination is found to contain a varying number of the surra parasites; increased swelling and edema of the extremities and abdomen, which now extends between the fore limbs and up the chest. during this time the wasting has been steadily progressive, especially of the muscles of the back and those surrounding the hip joint and the glutei. toward the termination of the disease it will be noticed that an animal is disinclined to move, and when made to do so there is manifest loss of power over the hind quarters, somewhat simulating a slight partial paralysis, and the hind quarters of the animal reel from side to side. in connection with this it may be noted that frequently there is paralysis of the sphincter ani and a dilated condition of the anus. these symptoms taken together point to some interference with the normal functions of the spinal cord in the lower dorsal and lumbar regions, and are probably owing to pressure caused by an exudation within the spinal membranes. in many cases shortly before death the heart's action becomes exceedingly violent, shaking the whole frame at each beat, so that the sound can be heard at some distance from the animal. in some of these cases the animal may suddenly drop dead; in others the emaciation and weakness become so pronounced that it falls to the ground, and, after a short struggle, succumbs to the disease. in other cases, again, the animal falls to the ground and appears to be suffering from acute pain, struggles violently, sweat covers the body, and respiration is very hurried. the struggles soon exhaust the patient's strength, and for a time it lies quiet; soon, however, the struggles commence again, continuing until death occurs. in some cases the appetite is voracious. the symptoms of the disease as observed in experimentally inoculated animals are as follows: twenty-four hours after the subcutaneous injection of a small quantity of surra blood, in the great majority of cases, a small circumscribed and somewhat raised swelling is noticed at the seat of the inoculation. after forty-eight hours the tumor has increased in size and is accompanied with some edema; it presents a certain amount of tension of the parts involved, and is generally tender on manipulation. these conditions continue to increase, until by the fourth day the tumor may measure or inches in; one direction by or in the other, and raised to the extent of an inch or an inch and a half above the surrounding tissues, or in some cases the tumor presents an almost circular form throughout. it will be also found that, if the tumor is firmly grasped, it is not fixed, but can be lifted up from the subcutaneous tissue. according to the nature and quantity of the inoculated blood, these symptoms rapidly present themselves, and either attain a maximum or are retarded until, varying from the fourth to the thirteenth day, the tumor at the seat of inoculation will be found to have lost a certain amount of its tension and tenderness. from this date the swelling and edema gradually begin to grow less, until finally, after a period of to days, the only sign left of the former swelling is a slight thickening of the skin over the point of the injection; but at the moment when the tension and tenderness of the parts at the seat of inoculation become suddenly decreased a symptom of the utmost clinical importance takes place, namely, at that moment the parasite of surra enters the blood of the general circulation. the temperature on the day of inoculation, and, in fact, for several days afterwards, may remain normal in character, there being only a few degrees difference between the morning and evening observations. in other cases there may be a slight rise from the first evening, and a gradual progressive rise until the swelling at the seat of inoculation shows signs of reduction in size, when the temperature generally takes a decided rise again, and may attain ° or . ° f. this elevation will last a varying period of from two to six days, and on the day following its onset the ordinary symptoms of fever will be noticed, and in addition there will be petechiæ on the conjunctival membranes, lacrimation, a slight mucous discharge from the nose, and in severe cases some edema of the lower portion of the legs, and perhaps of the sheath in horses. at the termination of the period of fever the temperature will be found to have fallen to normal or nearly so; the animal will present a brighter aspect, and there is every appearance of its return to health; in a few days, however, the animal again appears dull and half asleep; the temperature is elevated, a relapse takes place, and a repetition of all the symptoms in the primary paroxysm, including the reappearance of the parasite, is observed. _diagnosis._--a diagnosis may also be established by the complement-fixation or agglutination tests with the sera from suspected animals. this, however, can be carried out only in laboratories and requires special facilities for its execution. _treatment._--no satisfactory treatment is known. intravenous injections of fowler's solution of arsenic give temporary relief, but relapses occur. in view of the great economic importance of this disease, it would not be advisable to attempt to treat any sporadic cases should they occur in this country. on the contrary, the animals should be slaughtered immediately and their carcasses promptly burned. osteoporosis or bighead. by john r. mohler, v. m. d., _assistant chief, bureau of animal industry_. osteoporosis is a general disease of the bones which develops slowly and progressively and is characterized by the absorption of the calcareous or compact bony substance and the formation of enlarged, softened, and porous bone. it is particularly manifest in the bones of the head, causing enlargement and bulging of the face and jaws, thereby giving rise to the terms "bighead" and "swelled head," which are applied to it. the disease affects horses, mules, and asses of all ages, classes, and breeds, and of both sexes, and is found under all soil, dietetic, and climatic conditions. it may occur in sporadic form, but in certain regions, such as south africa, australia, madagascar, india, hawaii, and in this country it seems to be enzootic, several cases usually appearing in the same stable or on the same farm, and numerous animals being affected in the same district. in the united states the disease has been found in all the states bordering the delaware river and chesapeake bay, in some of the new england states, and in many of the southern states, especially in low regions along the coast. in europe the disease appears to be quite rare, and is usually described as a form of osteomalacia, a disease which is not uncommon among cattle of that continent. the opinion that bighead is only a form of osteomalacia, however, can not be accepted, nor can the infrequency of the former among european horses and the frequency of the latter among other live stock be conceded on the argument which has been presented, namely, that the better care which horses receive prevents them from becoming affected. in the southwest, where osteomalacia, or creeps, has not infrequently been observed among range cattle by the writer, no case of osteoporosis of the horses using the same range has been noted, although the latter animals are given no more attention than the cattle. the appropriate treatment of osteomalacia in cattle is so effective that if osteoporosis were a similar manifestation of disease a similar line of treatment should prove equally efficacious. however, this is not the fact. on the other hand, the occurrence of osteomalacia on old, worn-out soil, or on land deficient in lime salts, or from eating feed lacking in these bone-forming substances, or drinking water with a lime deficiency, is in perfect accord with our knowledge of the disease. but osteoporosis may occur on rich, fertile soil, in the most hygienic stables, and in animals receiving the best of care and of bone-forming feeds with a proper amount of mineral salts in the drinking water. _cause._--the cause of this disease still remains obscure, although various theories have been advanced, some entirely erroneous, others more or less plausible; but none of them has been established. thus the idea that feeding fodder and cereals poor in mineral salts and grazing in pastures where the soil is poor in lime and phosphates will cause the disease has been entirely disproved in many instances. others have considered that the disease starts as a muscular rheumatism which is followed by an inflammatory condition of the bones, terminating in osteoporosis. the idea that the disease is contagious has been advanced by many writers, although no causative agent has been isolated. numerous experiments have been made by inoculating the blood of an affected horse into normal horses without results. a piece of bone taken by pearson from the diseased lower jaw of a colt was transplanted into a cavity made for it in the jaw of a normal horse, but without reproducing the disease. pétrone believes that the _micrococcus nitrificans_ causes osteomalacia in man as a result of its producing nitrous acid, which dissolves the calcareous tissues, and when injected into dogs in pure culture a similar disease is produced. it is probable that if this work is confirmed a somewhat similar causative factor will be discovered for osteoporosis. elliott considers the latter disease to be of microbic origin, the result of climatic conditions, and divides the island of hawaii into two districts, in one of which the rainfall is inches annually, where bighead is very prevalent, and the second of which is dry and rarely visited by rain, where the disease is unknown. removal of animals from the wet to the dry district is followed by immediate improvement and frequently by recovery. in the wet district horses in both good and bad stables take the disease, but in the dry districts no unfavorable or unhygienic surroundings produce the affection. as both native and imported horses are equally susceptible, there is no indication of an acquired immunity to be observed. theiler has recently stated that his experiments in transfusing blood from diseased to normal horses were negative, and has suggested that the causative agent may be transmitted by an intermediate host only, as in the case of texas fever. he draws attention to this method of spreading east african coast fever, although blood inoculations, as in osteoporosis, are always without result. we know that coast fever is infectious, and that it can not be transmitted by blood inoculations, but is conveyed with remarkable ease by ticks from diseased cattle. that the cause has not been observed may be accounted for by its being invisible even to the high magnification of the microscope. on some farms and in some stables bighead is quite prevalent, a number of cases following one after another. on one farm of thoroughbreds in pennsylvania all the yearling colts and some of the aged horses were affected during one year, and on a similar farm in virginia a large proportion of the horses for several years were diseased, although the cows and sheep of this farm remained unaffected. _symptoms._--the commencement of the disease is usually unobserved by the owner, and these symptoms which do develop are generally not well marked or are misleading unless other cases have been noted in the vicinity. until the bones become enlarged the symptoms remain so vague as not to be diagnosed readily. the disease may be present itself under a variety of symptoms. if the bones of the hock become affected, the animal will first show a hock lameness. if the long bones are involved, symptoms of rheumatism will be the first observed, while if the dorsal or lumbar vertebræ are affected indications of a strain of the lumbar region are in evidence. probably the first symptom to be noticed is a loss of vitality combined with an irregular appetite or other digestive disturbance and with a tendency to stumble while in action. these earlier symptoms, however, may pass unobserved, and the appearance of an intermittent or migratory lameness without any visible cause may be the first sign to attract attention. this shifting and indefinite lameness, involving first one leg and then the other, is very suggestive, and is even more important when it is associated with a tendency to lie down frequently in the stall and the absence of a desire to get up, or the presence of evident pain and difficulty in arising. about this time, or probably before, swelling of the bones of the face and jaw, which is almost constantly present in this disease, will be observed. the bones of the lower jaw are the most frequently involved, and this condition is readily detected with the fingers by the bulging ridge of the bone outside and along the lower edge of the molar teeth. a thickening of the lower jawbone may likewise be identified by feeling on both sides of each branch at the same time and comparing it with the thinness of this bone in a normal horse. as a result mastication becomes difficult or impossible and the teeth become loose and painful. the imperfect chewing which follows causes balls of feed to form which drop out of the mouth into the manger. similar enlargements of the bones of the upper jaw may be seen, causing a widening of the face and a bulging of the bones about midway between the eyes and the nostrils. in some cases the nasal bones also become swollen and deformed, which, together with the bulging of the bones under the eyes, gives a good illustration of the reason for the application of the term bighead. other bones of the body will undergo similar changes, but these alterations are not so readily noted except by the symptoms they occasion. the alterations of the bones of the spinal column and the limbs, while difficult of observation, are nevertheless indicated by the reluctance of the animal to get up and the desire to remain lying for long periods of time. the animal easily tires, moves less rapidly, and if urged to go faster may sustain a fracture or have a ligament torn from its bony attachments, especially in the lower bones of the leg. an affected horse weighing , pounds was seen by the writer to fracture the large pastern bone from rearing during halter exercise. the animal becomes poor in flesh, the coat is rough and lusterless, and the skin tight and harsh, producing a condition termed "hidebound," with considerable "tucking up" of the abdomen. the horse shows a short, stilted, choppy gait, which later becomes stiffer and more restricted, while on standing a position simulating that in founder is assumed, with a noticeable drop to the croup. the animal at this stage usually lies down and remains recumbent for several days at a time. bed sores frequently arise and fractures are not uncommon in consequence of attempts to arise, which complications, in addition to emaciation, result in death. the disease may exist in this manner for variable periods extending from two or three months to two years. the termination of the disease is uncertain at best, but is likely to be favorable if treatment and a change of feed, water, and location is adopted in the early stages of the malady. _lesions._--as has been stated, the bones are the principal tissues involved. the nutrition of the bone is disturbed, as is indicated by the diminished density or rarefaction of the bony substances, the increase in the size or widening of the haversian canal and the medullary cavity, and the enlargement of the network of spaces in the spongy tissue, the absorptive changes following the course of the haversian system. in this process of absorption there are formed within the substance of the bone areas of erosion, indentations, or hollow spaces of irregular shape. these spaces increase in size and become confluent, causing an appearance resembling some varieties of coral. the affected bone may be readily incised with a knife, the cut surface appearing finely porous. this porous area is soft, pliable, and yields easily to the pressure of the finger. it has been shown by chemical analysis that the bone of an osteoporotic horse, when compared with that of a normal horse, shows a reduction in the amount of fat, phosphoric acid, lime, and soda, but a slight increase in organic matter and silicic acid. the bones lose their yellowish-white appearance, becoming gray and brittle. the affected bones may be those of any region or portion of the body. besides the change already noted in the bones of the face, the ends of the long bones, such as the ribs, are involved, and may be sectioned, though not so readily as the facial bones. the bones of the vertebræ are also frequently involved, necessitating great care in casting a horse, as the writer has seen several cases of broken backs in casting such animals for other operations. the marrow and cancellated tissue of the long bones may contain hemorrhages and soft gelatinous material or coagulated fibrin. the internal organs are usually normal, but a catarrhal condition of the gastrointestinal tract may be noted as the result of the improper mastication, resulting from the enlargement of the jaws and soreness of the teeth. _treatment._--the affected animal should be immediately placed under new conditions, both as to feed and surroundings. if the horse has been stable fed, it is advisable to turn it out on grass for two or three months, preferably in a higher altitude. if the disease has been contracted while running on pasture, place the animal in the stable or corral. in the early stages of the disease beneficial results have followed the supplemental use of lime given in the drinking water. one peck of lime slaked in a cask of water and additional water added from time to time is satisfactory and can be provided at slight expense. this treatment may be supplemented by giving a tablespoonful of powdered bone meal in each feed, with free access to a large piece of rock salt, or the bone meal may be given with four tablespoonfuls of molasses mixed with the feed. feeds containing mineral salts, such as beans, cowpeas, oats, and cottonseed meal, may prove beneficial in replenishing the bony substance that is being absorbed. cottonseed meal is one of the best feeds for this purpose, but it should be fed carefully. the animal should not be allowed to work at all during the active stage of the disease, nor should it be used for breeding purposes. footnotes: [ ] this summary of symptoms is based upon work by lingard. horseshoeing. by john w. adams, a. b., v. m., _professor of surgery and lecturer on shoeing, veterinary department, university of pennsylvania._ bad and indifferent shoeing so frequently leads to diseases of the feet and in irregularities of gait, which may render a horse unserviceable, that it has been thought appropriate to conclude this book with a brief chapter on the principles involved in shoeing healthy hoofs. in unfolding this subject in the limited space at my disposal, i can only hope to give the intelligent horse owner a sufficient number of facts, based on experience and upon the anatomy and physiology of the foot and leg, to enable him to avoid the more serious consequences of improper shoeing. let us first examine this vital mechanism, the foot, and learn something of its structure and of the natural movements of its component parts, that we may be prepared to recognize deviations from the normal and to apply the proper corrective. gross anatomy of the foot. (pls. xxxii-xxxiv.) the bones of the foot are four in number, three of which--the long pastern, short pastern, and coffin bone, placed end to end--form a continuous straight column passing downward and forward from the fetlock joint to the ground. a small accessory bone, the navicular, or "shuttle," bone, lies crosswise in the foot between the wings of the coffin bone and forms a part of the joint surface of the latter. the short pastern projects about -/ inches above the hoof and extends about an equal distance to it. (see also page .) the pastern and the coffin bone are held together by strong fibrous cords passing between each two bones and placed at the sides so as not to interfere with the forward and backward movement of the bones. the joints are therefore hinge joints, though imperfect, because, while the chief movements are those of extension and flexion in a single plane, some slight rotation and lateral movements are possible. the bones are still further bound together and supported by three long fibrous cords, or tendons. one, the extensor tendon of the toe, passes down the front of the pasterns and attaches to the coffin bone just below the edge of the hair; when pulled upon by its muscle this tendon draws the toe forward and enables the horse to place the hoof flat upon the ground. the other two tendons are placed behind the pasterns and are called flexors, because they flex, or bend, the pasterns and coffin bone backward. one of the tendons is attached to the upper end of the short pastern, while the other passes down between the heels, glides over the under surface of the navicular bone, and attaches itself to the under surface of the coffin bone. these two tendons not only flex, or fold up, the foot as the latter leaves the ground during motion, but at rest assist the suspensory ligament in supporting the fetlock joint. the foot-axis is an imaginary line passing from the fetlock joint through the long axes of the two pasterns and coffin bone. this imaginary line, which shows the direction of the pasterns and coffin bone, should always be straight--that is, never broken, either forward or backward when viewed from the side, or inward or outward when observed from in front. viewed from one side, the long axis of the long pastern, when prolonged to the ground, should be parallel to the line of the toe. viewed from in front, the long axis of the long pastern, when prolonged to the ground, should cut the hoof exactly at the middle of the toe. raising the heel or shortening the toe not only tilts the coffin bone forward and makes the hoof stand steeper at the toe, but slackens the tendon that attaches to the under surface of the coffin bone (perforans tendon), and therefore allows the fetlock joint to sink downward and backward and the long pastern to assume a more nearly horizontal position. the foot-axis, viewed from one side, is now broken forward; that is, the long pastern is less steep than the toe, and the heels are either too long or the toe is too short. on the other hand, raising the toe or lowering the heels of a foot with a straight foot-axis not only tilts the coffin bone backward and renders the toe more nearly horizontal, but tenses the perforans tendon, which then forces the fetlock joint forward, causing the long pastern to stand steeper. the foot-axis, seen from one side, is now broken backward--an indication that the toe is relatively too long or that the heels are relatively too low. the elastic tissues of the foot are preeminently the lateral cartilages and the plantar cushion. the lateral cartilages are two irregularly four-sided plates of gristle, one on either side of the foot, extending from the wings of the coffin bone backward to the heels and upward to a distance of an inch or more above the edge of the hair, where they may be felt by the fingers. when sound, these plates are elastic and yield readily to moderate finger pressure, but from various causes may undergo ossification, in which condition they are hard and unyielding. the plantar cushion is a wedge-shaped mass of tough, elastic, fibro-fatty tissue filling all the space between the lateral cartilages, forming the fleshy heels and the fleshy frog, and serving as a buffer to disperse shock when the foot is set to the ground. it extends forward underneath the navicular bone and perforans tendon, and protects these structures from injurious pressure from below. instantaneous photographs show that at speed the horse sets the heels to the ground before other parts of the foot--conclusive proof that the function of this tough, elastic structure is to dissipate and render harmless violent impact of the foot with the ground. the horn-producing membrane, or "quick," as it is commonly termed, is merely a downward prolongation of the "derm," or true skin, and may be conveniently called the pododerm (foot skin). the pododerm closely invests the coffin bone, lateral cartilages, and plantar cushion, much as a sock covers the human foot, and is itself covered by the horny capsule, or hoof. it differs from the external skin, or hair skin, in having no sweat or oil glands, but, like it, is richly supplied with blood vessels and sensitive nerves. and, just as the derm of the hair skin produces upon its outer surface layer upon layer of horny cells (epiderm), which protect the sensitive and vascular derm, so, likewise, in the foot the pododerm produces over its entire surface soft cells, which, pushed away by more recent cells forming beneath, lose moisture by evaporation and are rapidly transformed into the corneous material which we call the hoof. it is proper to regard the hoof as a greatly thickened epiderm having many of the qualities possessed by such epidermal structures as hair, feathers, nails, claws, etc. the functions of the pododerm are to produce the hoof and to unite it firmly to the foot. there are five parts of the pododerm, easily distinguishable when the hoof has been removed, namely: ( ) the perioplic band, a narrow ridge from one-sixteenth to one-eighth of an inch wide, running along the edge of the hair from one heel around the toe to the other. this band produces the perioplic horn, the thin varnishlike layer of glistening horn, which forms the surface of the wall or "crust," and whose purpose seems to be to retard evaporation of moisture from the wall. ( ) the coronary band, a prominent fleshy cornice encircling the foot just below and parallel to the perioplic band. at the heels it is reflected forward along the sides of the fleshy frog, to become lost near the apex of this latter structure. the coronet produces the middle layer of the wall, and the reflexed portions produce the "bars," which are, therefore, to be regarded merely as a turning forward of the wall. ( ) the fleshy leaves, to in number, parallel to one another, running downward and forward from the lower edge of the coronary band to the margin of the fleshy sole. they produce the soft, light-colored horny leaves which form the deepest layer of the wall, and serve as a strong bond of union between the middle layer of the wall and the fleshy leaves with which they dovetail. ( ) the fleshy sole, which covers the entire under surface of the foot, excepting the fleshy frog and bars. the horny sole is produced by the fleshy sole. ( ) the fleshy frog, which covers the under surface of the plantar cushion and produces the horny frog. the horny box or hoof consists of wall and bars, sole and frog. the wall is all that part of the hoof which is visible when the foot is on the ground (see fig. ). as already stated, it consists of three layers--the periople, the middle layer, and the leafy layer. the bars (see fig. c) are forward prolongations of the wall, and are gradually lost near the point of the frog. the angle between the wall and a bar is called the "buttress." each bar lies against the horny frog on one side and incloses a wing of the sole on the other, so that the least expansion or contraction of the horny frog separates or approximates the bars, and through them the lateral cartilages and the walls of the quarters. the lower border of the wall is called the "bearing edge," and is the surface against which the shoe bears. by dividing the entire lower circumference of the wall into five equal parts, a toe, two side walls, and two quarters will be exhibited. the "heels," strictly speaking, are the two rounded soft prominences of the plantar cushion, lying one above each quarter. the outer wall is usually more slanting than the inner, and _the more slanting half of a hoof is always the thicker_. in front hoofs the wall is thickest at the toe and gradually thins out toward the quarters, where in some horses it may not exceed one-fourth of an inch. in hind hoofs there is much less difference in thickness between the toe, side walls, and quarters. the horny sole, from which the flakes of old horn have been removed, is concave and about as thick as the wall at the toe. it is rough, uneven and often covered by flakes of dead horn in process of being loosened and cast off. behind the sole presents an opening into which are received the bars and horny frog. this opening divides the sole into a body and two wings. the periphery of the sole unites with the lower border of the wall and bars through the medium of the white line, which is the cross section of the leafy horn layer of the wall and of short plugs of horn which grow down from the lower ends of the fleshy leaves. this white line is of much importance to the shoer, since its distance from the outer border of the hoof is the thickness of the wall, and in the white line all nails should be driven. the frog, secreted by the pododerm covering the plantar cushion or fatty frog, and presenting almost the same form as the latter, lies as a soft and very elastic wedge between the bars and between the edges of the sole just in front of the bars. a broad and shallow depression in its center divides it into two branches, which diverge as they pass backward into the horny bulbs of the heel. in front of the middle cleft the two branches unite to form the body of the frog, which ends in the point of the frog. the bar of a bar shoe should rest on the branches of the frog. in unshod hoofs the bearing edge of the wall, the sole, frog, and bars are all on a level; that is, the under surface of the hoof is perfectly flat, and each of these structures assists in bearing the body weight. with respect to solidity, the different parts of the hoof vary widely. the middle layer of the wall is harder and more tenacious than the sole, for the latter crumbles away or passes off in larger or smaller flakes on its under surface, while no such spontaneous shortening of the wall occurs. the white line and the frog are soft-horn structures, and differ from hard horn in that their horn cells do not under natural conditions become hard and hornlike. they are very elastic, absorb moisture rapidly, and as readily dry out and become hard, brittle, and easily fissured. horn of good quality is fine grained and tough, while bad horn is coarse grained and either mellow and friable or hard and brittle. all horn is a poor conductor of heat, and the harder (drier) the horn the more slowly does it transmit extremes of temperature. the physiological movements of the hoof. a hoof while supporting the body weight has a different form, and the structures inclosed within the hoof have a different position than when not bearing weight. since the amount of weight borne by a foot is continually changing, and the relations of internal pressure are continuously varying, a foot is, from a physiological viewpoint, never at rest. the most marked changes of form of the hoof occur when the foot bears the greatest weight, namely, at the time of the greatest descent of the fetlock. briefly, these changes of form are: ( ) an expansion or widening of the whole back half of the foot from the coronet to the lower edge of the quarters. this expansion varies between one-fiftieth and one-twelfth of an inch. ( ) a narrowing of the front half of the foot, measured at the coronet. ( ) a sinking of the heels and a flattening of the wings of the sole. these changes are more marked in the half of the foot that bears the greater weight. the changes of form occur in the following order. when the foot is set to the ground the body weight is transmitted through the bones and sensitive and horny leaves to the wall. the coffin bone and navicular bone sink a little and rotate backward. at the same time the short pastern sinks backward and downward between the lateral cartilages and presses the perforans tendon upon the plantar cushion. this cushion being compressed from above and being unable to expand downward by reason of the resistance of the ground acting against the horny frog, acts like any other elastic mass and expands toward the sides, pushing before it the yielding lateral cartilages and the wall of the quarters. this expansion of the heels is assisted and increased by the simultaneous flattening and lateral expansion of the resilient horny frog, which crowds the bars apart. of course, when the lateral cartilages are ossified, not only is no expansion of the quarters possible, but frog pressure often leads to painful compression of the plantar cushion and to increase of lameness. frog pressure is therefore contraindicated in lameness due to sidebones (ossified cartilages). under the descent of the coffin bone the horny sole sinks a little; that is, the arch of the sole around the point of the frog and the wings of the sole become somewhat flattened. all these changes of form are most marked in sound unshod hoofs, because in them ground pressure on the frog and sole is pronounced; they are more marked in fore hoofs than in hind hoofs. the movement of the different structures within the foot and the changes of form that occur at every step are indispensable to the health of the hoof, so that these elastic tissues must be kept active by regular exercise, with protection against drying out of the hoof. long-continued rest in the stable, drying out of the hoof, and shoeing decrease or alter the physiological movements of the hoof and sometimes lead to foot diseases. since these movements are complete and spontaneous only in unshod feet, shoeing must be regarded as an evil, albeit a necessary one, and indispensable if we wish to keep horses continuously serviceable on hard, artificial roads. however, if in shoeing we bear in mind the structure and functions of the hoof and apply a shoe whose branches have a wide and level bearing surface, so as to interfere as little as may be with the expansion and contraction of the quarters, in so far as this is not hindered by the nails, we need not be apprehensive of trouble, provided the horse has reasonable work and his hoofs proper care. growth of the hoof. all parts of the hoof grow downward and forward with equal rapidity, the rate of growth being largely dependent upon the amount of blood supplied to the pododerm, or "quick." abundant and regular exercise, good grooming, moistness and suppleness of the hoof, going barefoot, plenty of good feed, and at proper intervals removing the overgrowth of hoof and regulating the bearing surface, by increasing the volume and improving the quality of the blood flowing into the pododerm, favor the rapid growth of horn of good quality; while lack of exercise, dryness of the horn, and excessive length of the hoof hinder growth. the average rate of growth is about one-third of an inch a month. hind hoofs grow faster than fore hoofs and unshod ones faster than shod ones. the time required for the horn to grow from the coronet to the ground, though influenced to a slight degree by the precited conditions, varies in proportion to the distance of the coronet from the ground. at the toe, depending on its height, the horn grows down in to months, at the side wall in to months, and at the heels in to months. we can thus estimate with tolerable accuracy the time required for the disappearance of such defects in the hoof as cracks, clefts, etc. irregular growth is not infrequent. the almost invariable cause of this is an improper distribution of the body weight over the hoof--that is, an unbalanced foot. colts running in soft pasture or confined for long periods in the stable are frequently allowed to grow hoofs of excessive length. the long toe becomes "dished"--that is, concave from the coronet to the ground--the long quarters curl forward and inward and often completely cover the frog and lead to contraction of the heels, or the whole hoof bends outward or inward, and a crooked foot, or, even worse, a crooked leg, is the result if the long hoof be allowed to exert its powerful and abnormally directed leverage for but a few months upon young plastic bones and tender and lax articular ligaments. all colts are not foaled with straight legs, but failure to regulate the length and bearing of the hoof may make a straight leg crooked and a crooked leg worse, just as intelligent care during the growing period can greatly improve a congenitally crooked limb. if breeders were more generally cognizant of the power of overgrown and unbalanced hoofs to divert the lower bones of young legs from their proper direction, and, therefore, to cause them to be moved improperly, with loss of speed and often with injury to the limbs, we might hope to see fewer knock-kneed, bow-legged, "splay-footed," "pigeon-toed," cow-hocked, interfering, and paddling horses. if in shortening the hoof one side wall is, from ignorance, left too long or cut down too low with relation to the other, the foot will be unbalanced, and in traveling the long section will touch the ground first and will continue to do so till it has been reduced to its proper level (length) by the increased wear which will take place at this point. while this occurs rapidly in unshod hoofs, the shoe prevents wear of the hoof, though it is itself more rapidly worn away beneath the high (long) side than elsewhere, so that by the time the shoe is worn out the tread of the shoe may be flat. if this mistake be repeated from month to month, the part of the wall left too high will grow more rapidly than the low side whose pododerm is relatively anemic as a result of the greater weight falling into this half of the hoof, and the ultimate result will be a "wry," or crooked foot. the care of unshod hoofs. the colt should have abundant exercise on dry ground. the hoofs will then wear gradually, and it will only be necessary from time to time to regulate any uneven wear with the rasp and to round off the sharp edge about the toe in order to prevent breaking away of the wall. colts in the stable can not wear down their hoofs, so that every four to six weeks they should be rasped down and the lower edge of the wall well rounded to prevent chipping. the soles and clefts of the frog should be picked out every few days and the entire hoof washed clean. plenty of clean straw litter should be provided. hoofs that are becoming "awry" should have the wall shortened in such a manner as to straighten the foot-axis. this will ultimately produce a good hoof and will improve the position of the limb. [illustration: fig. .--ground surface of a right fore hoof of the regular form: a, a, wall; a-a, the toe; a-b, the side walls; b-d, the quarters; c, c, the bars; d, d, the buttress; e, lateral cleft of the frog; f, body of the sole; g, g', g", leafy layer (white line) of the toe and bars; h, body of the frog; i, i, branches of the frog; k, k, horny bulbs of the heels; l, middle cleft of the frog.] characteristics of a healthy hoof. a healthy hoof (figs. and ) is equally warm at all parts, and is not tender under pressure with the hands or moderate compression with pincers. the coronet is soft and elastic at all points and does not project beyond the surface of the wall. the wall (fig. ) is straight from coronet to ground, so that a straightedge laid against the wall from coronet to ground parallel to the direction of the horn tubes will touch at every point. the wall should be covered with the outer varnishlike layer (periople) and should show no cracks or clefts. every hoof shows "ring formation," but the rings should not be strongly marked and should always run parallel to the coronary band. strongly marked ring-formation over the entire wall is an evidence of a weak hoof, but when limited to a part of the wall is evidence of previous local inflammation. the bulbs of the heels should be full, rounded, and of equal height. the sole (fig. ) should be well hollowed out, the white line solid, the frog well developed, the middle cleft of the frog broad and shallow, the spaces between the bars and the frog wide and shallow, the bars straight from the buttress toward the point of the frog, and the buttresses themselves so far apart as not to press against the branches of the frog. a hoof can not be considered healthy if it presents reddish discolored horn, cracks in the wall, white line, bars, or frog, thrush of the frog, contraction or displacement of the heels. the lateral cartilages should yield readily to finger pressure. [illustration: fig. .--pair of fore feet of regular form in regular standing position.] various forms of hoofs. as among a thousand human faces no two are alike, so among an equal number of horses no two have hoofs exactly alike. a little study of different forms soon shows us, however, that the form of every hoof is dependent in great measure on the direction of the two pastern bones as viewed from in front or behind, or from one side; and that all hoofs fall into three classes when we view them from in front and three classes when we observe them in profile. inasmuch as the form of every foot determines the peculiarities of the shoe that is best adapted to it, no one who is ignorant of, or who disregards the natural form of, a hoof can hope to understand physiological shoeing. [illustration: fig. .--pair of fore feet of base-wide form in toe-wide standing position.] forms of feet viewed from in front and in profile. whether a horse's feet be observed from in front or from behind, their form corresponds to, or at least resembles, either that of the regular position (fig. ), the base-wide or too-wide position (fig. ), or the base-narrow position (fig. ). by the direction of the imaginary line passing through the long axes of the two pasterns (figs. , , ) we determine whether or not the hoof and pasterns stand in proper mutual relation. in the regular standing position (fig. ) the foot-axis runs straight downward and forward; in the base-wide position (fig. ) it runs obliquely downward and outward, and in the base-narrow position (fig. ) it runs obliquely downward and inward. [illustration: fig. .--pair of fore feet of base-narrow form in toe-narrow standing position.] viewing the foot in profile, we distinguish the regular position (fig. b) and designate all forward deviations as acute-angled (long toe and low heel, fig. a), and all deviations backward from the regular (steep toe and high heel, fig. c) as steep-toed, or stumpy. when the body weight is evenly distributed over all four limbs, the foot-axis should be straight; the long pastern, short pastern, and wall at the toe should have the same slant. [illustration: fig. .--a, side view of an acute-angled fore foot (shod); b, side view of a regular fore foot, showing the most desirable degree of obliquity ( °); c, side view of a stumpy, or "upright," fore foot; obliquity above °. in a, b, c, note particularly the relation between the length of the slope and the overhanging of the heels. note also the toe roll of the shoes.] _a front hoof of the regular standing position._--the outer wall is a little more slanting and somewhat thicker than the inner. the lower border of the outer quarter describes the arc of a smaller circle--that is, is more sharply bent than the inner quarter. the weight falls near the center of the foot and is evenly distributed over the whole bottom of the hoof. the toe forms an angle with the ground of ° to ° and is parallel to the direction of the long pastern. the toe points straight ahead, and when the horse is moving forward in a straight line the hoofs are picked up and carried forward in a line parallel to the middle line of the body, and are set down flat. coming straight toward the observer the hoofs seem to rise and fall perpendicularly. _a hoof of the base-wide position_ is always awry. the outer wall is more slanting, longer, and thicker than the inner, the outer quarter more curved than the inner, and the outer half of the sole wider than the inner. the weight falls largely into the inner half of the hoof. in motion the hoof is moved in a circle. from its position on the ground it breaks over the inner toe, is carried forward and inward close to the supporting leg, thence forward and outward to the ground, which the hoof meets first with the outer toe. horses that are toe-wide ("splay-footed"--toes turned outward) show all these peculiarities of hoof-form and hoof-flight to a still more marked degree and are therefore more prone to "interfere" when in motion. _a hoof of the base-narrow position_ is awry, but not to so marked a degree as the base-wide hoof. the inner wall is usually a little more slanting than the outer, the inner half of the sole wider than the outer, and the inner quarter more curved than the outer. the outer quarter is often flattened and drawn in at the bottom. the weight falls largely into the outer half of the hoof. in motion the hoof breaks over the outer toe, is carried forward and outward at some distance from the supporting leg, thence forward and inward to the ground, which it generally meets with the outer toe. the foot thus moves in a circle, whose convexity is outward, a manner of flight called "paddling." a base-narrow horse, whose toes point straight ahead, frequently "interferes," while a toe-narrow (pigeon-toed) animal seldom does. _a regular hoof_ (fig. b), viewed from one side, has a straight foot-axis inclined to the horizon at an angle of ° to °. the weight falls near the center of the foot and there is moderate expansion of the quarters. _an acute-angled hoof_ (fig. a) has a straight foot-axis inclined at an angle less than ° to the horizon. the weight falls more largely in the back half of the hoof and there is greater length of hoof in contact with the ground and greater expansion of the heels than in the regular hoof. _upright or stumpy hoof._--in the upright or stumpy hoof (fig. c) the foot-axis is straight and more than ° steep. the hoof is relatively short from toe to heel, the weight falls farther forward, and there is less expansion of the heels than in the regular hoof. _wide and narrow hoofs._--finally, there are wide hoofs and narrow hoofs, dependent solely upon race and breeding. the wide hoof is almost circular on the ground surface, the sole but little concave, the frog large, and the quality of the horn coarse. the narrow hoof has a strongly "cupped" sole, a small frog, nearly perpendicular side walls, and fine-grained, tough horn. _hind hoofs_ are influenced in shape by different directions of their pasterns much as front feet are. a hind hoof is not round at the toe as a front hoof is, but is more pointed. its greatest width is two-thirds of the way back from toe to heel, the sole is more concave, the heels relatively wider, and the toe about ° steeper than in front hoofs. examination preliminary to shoeing. the object of the examination is to ascertain the direction and position of the limbs, the shape, character, and quality of the hoofs, the form, length, position, and wear of the shoe, the number, distribution, and direction of the nails, the manner in which the hoof leaves the ground, its line of flight, the manner in which it is set to the ground, and all other peculiarities, that at the next and subsequent shoeings proper allowances may be made and observed faults corrected. the animal must, therefore, be observed both at rest and in motion. at rest, the observer should stand in front and note the slant of the long pasterns. do they drop perpendicularly, or slant downward and outward (base-wide foot), or downward and inward (base-narrow foot)? whatever be the direction to the long pastern, an imaginary line passing through its long axis, when prolonged to the ground, should apparently pass through the middle of the toe. but if such line cuts through the inner toe the foot-axis is not straight, as it should be, but is broken inward at the coronet, an indication that either the outer wall of the hoof is too long (high) or that the inner wall is too short (low). on the contrary, if the center line of the long pastern falls through the outer toe the foot-axis is broken outward at the coronet, an indication that either the inner wall is too long or the outer wall too short. the observer should now place himself at one side, two or three paces distant, in order to view the limb and hoof in profile. note the size of the hoof in relation to the height and weight of the animal, and the obliquity of the hoof. is the foot-axis straight--that is, does the long pastern have the same slant as the toe, or does the toe of the hoof stand steeper than the long pastern (fig. c)? in which case the foot-axis is broken forward at the coronet, an indication, usually, that the quarters are either too high or that the toe is too short. if the long pastern stands steeper than the toe (fig. a) the foot-axis is broken backward, in which case the toe is too long or the quarters are too low (short). in figures a and c the dotted lines passing from toe to quarters indicate the amount of horn which must be removed in order to straighten the foot-axis, as shown in figure b. note also the length of the shoe. next, the feet should be raised and the examiner should note the outline of the foot, the conformation of the sole, form and quality of the frog, form of the shoe, wear of the shoe, and the number and distribution of the nails. does the shoe fully cover the entire lower border of the wall? or is it too narrow, or fitted so full on the inside that it has given rise to interfering? or has the shoe been nailed on crooked? or has it become loose and shifted? is it too short, or so wide at the ends of the branches as not to support the buttresses of the hoof? does the shoe correspond with the form of the hoof? are the nails distributed so as to interfere as little as possible with the expansion of the quarters? are there too many? are they too large? driven too "fine" or too high? these are questions which the observer should put to himself. [illustration: fig. .--a, side view of foot with the foot-axis broken backward as a result of too long a toe. the amount of horn to be removed from the toe in order to straighten the foot-axis is denoted by a dotted line; b, side view of a properly balanced foot, with a straight foot-axis of desirable slant; c, side view of stumpy foot with foot-axis broken forward, as a result of overgrowth of the quarters. the amount of horn to be removed in order to straighten the foot-axis is shown by a dotted line.] note carefully the wear of the old shoe. it is the unimpeachable evidence of the manner in which the hoof has been set to the ground since the shoe was nailed to it, and gives valuable "pointers" in leveling the hoof. wear is the effect of friction between the shoe and the ground at the moment of contact. since the properly leveled hoof is set flat to the ground, the "grounding wear" of a shoe should be uniform at every point, though the toe will always show wear due to scouring at the moment of "breaking over." everything which tends to lengthen the stride tends also to make the "grounding wear" more pronounced in the heels of the shoe, while all causes which shorten the stride--as stiffening of the limbs through age, overwork, or disease--bring the grounding wear nearer the toe. an exception should be noted, however, in founder, in which the grounding wear is most pronounced at the heels. if one branch of the shoe is found to be worn much thinner than the other, the thinner branch has either been set too near the middle line of the foot (fitted too close), where it has been bearing greater weight while rubbing against the ground, or, what is much more often the case, the section of wall above the thinner branch has been too long (too high), or the opposite section of wall has been too short (too low). "one-sided wear, uneven setting down of the feet, and an unnatural course of the wall are often found together." how much an old shoe can tell us, if we take time and pains to decipher its scars! the horse should next be observed at a walk and at a trot or pace, from in front, from behind, and from the side, and the "breaking over," the carriage of the feet, and the manner of setting them to the ground carefully noted and remembered. a horse does not always move just as his standing position would seem to imply. often there is so great a difference in the form and slant of two fore hoofs or two hind hoofs that we are in doubt as to their normal shape, when a few steps at a trot will usually solve the problem instantly by showing us the line of flight of the hoofs and referring them to the regular, base-wide, or base-narrow form. no man is competent either to shoe a horse or to direct the work till he has made the precited observations. preparation of the hoof for the shoe. after raising the clinches of the nails with a rather dull clinch cutter ("buffer") and drawing the nails one at a time, the old shoe is critically examined and laid aside. remaining stubs of nails are then drawn or punched out and the hoof freed of dirt and partially detached horn. the farrier has now to "dress" the overgrown hoof to receive the new shoe; in other words, he has to form a base of support so inclined to the direction of the pasterns that in motion this surface shall be set flat upon the ground. he must not rob the hoof nor leave too much horn; either mistake may lead to injury. if he has made a careful preliminary examination he knows what part of the wall requires removal and what part must be left, for he already knows the direction of the foot axis and the wear of the old shoe and has made up his mind just where and how much horn must be removed to leave the hoof of proper length and the foot axis straight. a greatly overgrown hoof may be quickly shortened with sharp nippers and the sole freed of semidetached flakes of horn. the concave sole of a thick-walled, strong hoof may be pared out around the point of the frog, but not so much as to remove all evidences of exfoliation. the wall should be leveled with the rasp till its full thickness, the white line, and an eighth of an inch of the margin of the sole are in one horizontal plane, called the "bearing surface of the hoof." the bars, if long, may be shortened, but _never pared on the side_. the branches of the sole in the angle between the bars and the wall of the quarters should be left a little lower than the wall, so as not to be pressed upon by the inner web of the shoe. "corns," or bruises of the pododerm, are usually a result of leaving a thick mass of dry, unyielding horn at this point. the frog should not be touched further than to remove tags or layers that are so loose as to form no protection. a soft frog will shorten itself spontaneously by the exfoliation of superficial layers of horn, while if the frog is dry, hard, and too prominent it is better to soften it by applying moisture in some form, and to allow it to wear away naturally than to pare it down. it is of advantage to have the frog project below the level of the wall an amount equal to the thickness of a plain shoe, though we rarely see frogs of such size except in draft horses. the sharp lower border of the wall should be rounded with the rasp to prevent its being bent outward and broken away. finally, the foot is set to the ground and again observed from all sides to make sure, that the lines bounding the hoof correspond with the direction of the long pastern. the shoe. the shoe is an artificial base of support, by no means ideal, because it interferes to a greater or less degree with the physiology of the foot, but indispensable except for horses at slow work on soft ground. since a proper surface of support is of the greatest importance in preserving the health of the feet and legs, it is necessary to consider the various forms of shoes best adapted to the different forms of hoofs. certain properties are common to all shoes and may be considered first. they are form, width, thickness, length, surfaces, borders, "fullering," nail holes, and clips. _form._--every shoe should have the form of the hoof for which it is intended, provided the hoof retains its proper shape; but for every hoof that has undergone change of form we must endeavor to give the shoe that form which the hoof originally possessed. front shoes and hind shoes, rights and lefts, should be distinctly different and easily distinguishable. _width._--all shoes should be wider at the toe than at the ends of the branches. the average width should be about double the thickness of the wall at the toe. _thickness._--the thickness should be sufficient to make the shoe last about four weeks and should be uniform except in special cases. _length._--this will depend upon the obliquity of the hoof viewed in profile. the acute-angled hoof (fig. a) has long overhanging heels, and a considerable proportion of the weight borne by the leg falls in the posterior half of the hoof. for such a hoof the branches of the shoe should extend back of the buttresses to a distance nearly double the thickness of the shoe. for a hoof of the regular form (figs. b and ) the branches should project an amount equal to the thickness of the shoe. in a stumpy hoof (fig. c) the shoe need not project more than one-eighth of an inch. in all cases the shoe should cover the entire "bearing surface" of the wall. _surfaces._--the surface that is turned toward the hoof is known as the "upper," or "hoof surface," of the shoe. that part of the hoof surface which is in actual contact with the horn is called the "bearing surface" of the shoe. the "bearing surface" should be perfectly horizontal from side to side, and wide enough to support the full thickness of the wall, the white line, and about an eighth of an inch of the margin of the sole. the bearing surface should also be perfectly flat, except that it may be turned up at the toe ("rolling-motion" shoe, fig. a, b, c.) the surface between the bearing surface and the inner edge of the shoe is often beaten down or concaved to prevent pressure too far inward upon the sole. this "concaving," or "seating," should be deeper or shallower as the horny sole is less or more concave. as a rule, strongly "cupped" soles require no concaving (hind hoofs, narrow fore hoofs). _borders._--the entire outer border should be beveled under the foot. such a shoe is not so readily loosened, nor is it so apt to lead to interfering. _fullering._--this is a groove in the ground surface of the shoe. it should pass through two-thirds of the thickness of the shoe, be clean, and of uniform width. it is of advantage in that it makes the shoe lighter in proportion to its width and, by making the ground surface somewhat rough, tends to prevent slipping. _nail holes._--the shoe must be so "punched" that the nail holes will fall directly on the white line. they should be confined to the fore half of front shoes, but may occupy the anterior two-thirds of hind shoes. for a medium-weight shoe three nail holes in each branch are sufficient, but for heavier shoes, especially those provided with long calks, eight holes are about right, though three on the inside and four on the outside may do. _clips._--these are half-circular ears drawn up from the outer edge of the shoe either at the toe or opposite the side wall. the height of a clip should equal the thickness of the shoe, though they should be even higher on hind shoes and when a leather sole is interposed between the shoe and hoof. clips secure the shoe against shifting. a side clip should always be drawn up on that branch of the shoe that first meets the ground in locomotion. special features and fitting the shoes. _a shoe for a regular hoof_ (figs. and ) fits when its outer border follows the wall closely in the region of the nail holes and from the last nail to the end of the branch gradually projects beyond the surface of the wall to an eighth of an inch and extends back of the buttresses an amount equal to the thickness of the shoe. the shoe must be straight, firm, air-tight, its nail holes directly over the white line, and its branches far enough from the branches of the frog to permit the passage of a foot pick. branches of the shoe must be of equal length. in fitting a shoe to a hoof of regular form we follow the form of the hoof, but in base-wide and base-narrow hoofs, which are of irregular form, we must pay attention not only to the form of the hoof but also to the direction of the pasterns and the consequent distribution of weight in the hoof, because where the most weight falls the surface of support of the foot must be widened, and where the least weight falls (opposite side of the hoof) the surface of support should be narrowed. in this way the improper distribution of weight within the hoof is evenly distributed over the surface of support. [illustration: fig. .--left fore hoof of regular form, shod with a plain "fullered" shoe. note the distribution of the nails, length of the fuller (crease), and the closeness of the ends of the shoe to the branches of the frog.] _a shoe for a base-wide hoof_ should be fitted full on the inner side of the foot and fitted close on the outer side, because the inner side bears the most weight. the nails in the outer branch are placed well back, but in the inner branch are crowded forward toward the toe. [illustration: fig. .--side view of hoof and shoe shown in fig. . note the straight toe, weak ring formation running parallel to the coronet, clinches low down and on a level, length of the shoe, and the under-bevel at the toe and heel.] _a shoe for a base-narrow hoof_ should be just the reverse of the preceding. the outer branch should be somewhat longer than the inner. _a shoe for an acute-angled hoof_ should be long in the branches, because most of the weight falls in the posterior half of the foot. the support in front should be diminished either by turning the shoe up at the toe or by beveling it under the toe (fig. a). _a shoe for a stumpy hoof_ should be short in the branches, and for pronounced cases should increase the support of the toe, where the most of the weight falls, by being beveled downward and forward. in many cases, especially in draft horses, where the hoofs stand very close together, the coronet of the outer quarter is found to stand out beyond the lower border of the quarter. in such cases the outer branch of the shoe from the last nail back must be fitted so full that an imaginary perpendicular dropped from the coronet will just meet the outer border of the shoe. the inner branch, on the other hand, must be fitted as "close" as possible. the principal thought should be to set the new shoe farther toward the more strongly worn side. such a practice will render unnecessary the widespread and popular fad of giving the outer quarter and heel calk of hind shoes an extreme outward bend. care should be taken, however, that in fitting the shoe "full" at the quarter the bearing surface of the hoof at the quarter be not left unsupported or incompletely covered, to be pinched and squeezed inward against the frog. this will be obviated by making the outer branch of the shoe sufficiently wide and punching it so coarse that the nails will fall upon the white line. _hot fitting._--few farriers have either the time or the skill necessary to adjust a cold shoe to the hoof so that it will fit, as we say, "air-tight." though the opponents of hot fitting draw a lurid picture of the direful consequences of applying a hot shoe to the hoof, it is only the abuse of the practice that is to be condemned. if a heavy shoe at a yellow heat be held tightly pressed against a hoof which has been pared too thin, till it embeds itself, serious damage may be done. but a shoe at a dark heat may be pressed against a properly dressed hoof long enough to scorch, and thus indicate to the farrier the portions of horn that should be lowered without appreciable injury to the hoof and to the ultimate benefit of the animal. _nailing._--the horse owner should insist on the nails being driven low. they should pierce the wall not above an inch and five-eighths above the shoe. a nail penetrating the white line and emerging low on the wall destroys the least possible amount of horn, has a wide and strong clinch, rather than a narrow one, which would be formed near the point of the nail, and, furthermore, has the strongest possible hold on the wall, because its clinch is pulling more nearly at a right angle to the grain (horn tubes) of the wall than if driven high. finally, do not allow the rasp to touch the wall above the clinches. the bar shoe. the bar shoe (fig. ) has a variety of uses. it enables us to give the frog pressure, to restore it to its original state of activity and development when, by reason of disuse, it has become atrophied. it gives the hoof an increased surface of support and enables us to relieve one or both quarters of undue pressure that may have induced inflammation and soreness. the bar of the shoe should equal the average width of the remainder of the shoe and should press but lightly on the branches of the frog. the addition of a leather sole with tar and oakum sole-packing allows us to distribute the weight of the body over the entire ground surface of the hoof. [illustration: fig. .--an acute-angled left fore hoof shod with a bar shoe. note the width and position of the bar and the fact that the nails are placed well toward the toe, so as not to interfere with the expansion of the quarters.] [illustration: fig. .--a fairly formed right fore ice shoe for a roadster. the top and outer-heel calks cut at right angles, and the inner-heel calk is slender and blunt. the back surface of the toe calk should be perpendicular.] the rubber pad. various forms of rubber pads, rubber shoes, rope shoes, fiber shoes, and other contrivances to diminish shock and prevent slipping on the hard and slippery pavements of our large cities are in use in different parts of the world. in germany the rope shoe (a malleable-iron shoe with a groove in its ground surface in which lies a piece of tarred rope) is extensively used with most gratifying results. it is cheap, durable, easily applied, and effective. in the large cities of england and the united states rubber pads are extensively used. they are rather expensive, but are quite efficient in preventing slipping on polished and gummy pavements, though not so effective on ice. figure is an illustration of one of the best of many rubber pads. the rubber is stitched and cemented to a leather sole and is secured by the nails of a three-quarter shoe. such a pad will usually last as long as two shoes. they may be used continuously, not only without injury to the hoof, but to its great benefit. the belief, unsupported by evidence, that rubber pads "draw the feet" keeps many from using them. a human foot encased in a rubber boot may eventually be blistered by the sweat poured upon the surface of the skin and held there by the impervious rubber till decomposition takes place with the formation of irritating fatty acids; but there is no basis for an analogy in the hoof of a horse. [illustration: fig. .--left fore hoof of regular form shod with a rubber pad and "three-quarter" shoe. (ground surface.)] [illustration: fig. .--a narrow right fore hoof of the base-wide (toe-wide) standing position, shod with a plain "dropped-crease" shoe to prevent the toe cutting (interfering). the dotted line at the inner toe indicates the edge of the wall which was rasped away in order to narrow the hoof along the striking section. note the inward bevel of the shoe at this point, the dropped crease, the distribution of the nails, the long "full" inner branch, and the short "close" outer branch.] other special forms. some drawings, designed to illustrate shoeing in connection with "interfering" and "forging," and other special conditions, are shown in figures to . [illustration: fig. .--hoof surface of a right hind shoe to prevent interfering. the inner branch has no nail holes and is fitted and beveled under the hoof. note the number and position of the nail holes, the clip on the outer side wall, and the narrowness and bend of the inner branch.] [illustration: fig. .--ground surface of shoe shown in the previous figure. the inner, nailless branch has the thickness of the outer branch plus its calk, so that the inner and outer quarters of the hoof are equidistant from the ground.] [illustration: fig. .--side view of a fore hoof shod so as to quicken the "breaking over" (quicken the action) in a "forger." note the short shoe, heel calks inclined forward, and the rolled toe.] [illustration: fig. .--side view of a short-toed hind hoof of a forger, shod to slow the action and to prevent injury to the fore heels by the toe of the hind shoe. note the elevation of the short toe by means of a toe calk and the projection of the toe beyond the shoe. when such a hoof has grown more toe, the toe calk can be dispensed with and the shoe set farther forward.] [illustration: fig. .--a toe-weight shoe to increase the length of stride of fore feet. the nails are placed too far back, and the shoe has no characteristic form but the weight is properly placed.] [illustration: fig. .--most common form of punched heel-weight shoe to induce high action in fore feet. the profile of the shoe shows a "roll" at the toe and "swelled" heels. the weight is well placed, but "rolling" the toe and raising the heels lower action. the shoe would be much more effective if of uniform thickness and with no roll at the toe.] index. abdomen-- dropsy, in foal, or ascites, description and treatment, dropsy, or ascites, description, symptoms, and treatment, limbs, and perineum, dropsy affecting, description and treatment, sheath, and penis, swelling, cause and treatment, abnormal presentations at birth, - abortion, description, cause, symptoms, and treatment, abscess-- and inflammation of lymphatic glands, descriptions, symptoms, treatment, in lung and suppuration, symptoms, abscesses-- acute, description and treatment, cold, description and treatment, description, in throat, treatment, _acari_, parasites of eye, acariasis, or mange, note, _achorion schönleini_, vegetable parasite of skin, description, adams, john w., chapter on "horseshoeing", - air embolism, or air in veins, note, albuminoid poisoning, hemoglobinuria, azoturia, azotemia, symptoms, prevention, and treatment, aloes, use against bots in horses, amaurosis, or palsy of nerve of sight, causes, symptoms, and treatment, , amnion, dropsy, description and treatment, anasarca, or purpura hemorrhagica, causes, symptoms, treatment, etc., , anatomy and physiology of brain and nervous system, anemia-- of brain, causes, symptoms, pathology, and treatment, spinal, symptoms and treatment, aneurism-- description, symptoms, pathology, and treatment, one form caused by _strongylus vulgaris_, anidian monsters, or moles, description, animal parasites, description of kinds, ankle-- and fetlock, skin, note, fetlock, and foot, diseases, chapter by a. a. holcombe, - ankles, cocked, or knuckling, description, causes, and treatment, anthrax-- definition, causes, symptoms, and treatment, - prevention by destruction of bacteria, vaccination as preventive, apoplexy, or cerebral hemorrhage, causes, symptoms, pathology, and treatment, arteries-- description, diseases, or arteritis, and endarteritis, description, symptoms, pathology, and treatment, artery-- constriction, description, rupture, description, symptoms, and treatment, arthritis, open joints, broken knees, and synovitis, cause and treatment, _ascaris equorum_, intestinal worm, note, ascites, or dropsy of abdomen, description, symptoms, and treatment, , asthma, heaves, or broken wind, definition, symptoms, and treatment, atheroma of veins and arteries, description, autogenic vaccines, description, autumn mange, description and treatment, azotemia, hemoglobinuria, azoturia, poisoning by albuminoids, symptom, prevention, and treatment, azoturia, hemoglobinuria, azotemia, poisoning by albuminoids, symptoms, prevention, and treatment, _bacillus equisepticus_, cause of pneumonia, bacteria, kinds responsible for pneumonia in horses, bacteria vaccines, kinds and uses, , balls, or pills, description and manner of administering, bar shoe, uses, bees, wasps, and hornets, stings, treatment, beets as feed, bichlorid, use in disinfection, bighead (osteoporosis)-- chapter by john r. mohler, - symptoms, lesions, and treatment, biliary calculi, or gallstones, symptoms and treatment, bilocular cavity, or calculus in sheath, or preputial calculus, description and treatment, birth, abnormal presentations at, - black pigment tumors, or melanosis, description and treatment, bladder-- calculus, or stone, and tumor affecting, diseases growths, symptoms and treatment, eversion, description and treatment, inflammation, cystitis, or urocystitis, symptoms and treatment, irritable, cause and treatment, neck, spasms affecting, causes, symptoms, and treatment, , paralysis, description and cause, paralysis, symptoms and treatment, stone, vesical calculus, or cystic calculus, description, symptoms, and treatment, worm of kidney, bleeding-- after castration, treatment, from lungs, or hemoptysis, causes, description, and treatment, from nose, causes and treatment, or flooding from womb, treatment, skin eruptions, or _dermatorrhagia parasitica_, description and treatment, blisters, inflammation, or eczema, description and treatment, bloat colic, cause, symptoms, and treatment, blood-- circulation of heart, description, clots in walls of vagina, medicine administered into veins, medium of disease transmission, of penis, extravasation, cause and treatment, spavin, bog spavin, and thoroughpin, description and treatment, blood vessels-- and heart, diseases, remarks, heart, and lymphatics, diseases, chapter by m. r. trumbower, - physiology and anatomy, bloody urine, or hematuria, cause and treatment, blowing, high, description, bluebottle (_lucilia cæsar_), note bog spavin, blood spavin, and thoroughpin, description and treatment, boil of eyelid, description and treatment, boils-- or _dermatitis granulosa_, or furuncles, description and treatment, bone-- hip, fracture, or on innominatum, description, symptoms, prognosis, and treatment, premaxillary, fractures, description and treatment, spavin. _see_ spavin bones-- cannon, fractures, description, symptoms, and treatment, , cranial, fractures, causes, symptoms, and treatment, diseases, description, dislocations and luxations, cause, symptoms, and treatment, of face, fractures, description, and treatment, of fetlock and foot, description, of hip, fractures, causes, one system of locomotion, , sesamoid, fractures, cause, symptoms, prognosis, and treatment, botfly, habits and treatment, bots, injury to horses, symptoms, and treatment, - bowels, twisting, volvulus, or gut-tie, cause, symptoms, and treatment, brain-- and membranes, inflammation, description, , and nervous system, anatomy, and physiology, anemia, causes, symptoms, pathology, and treatment, compression, causes, symptoms, and treatment, concussion, causes, symptoms, treatment, and prevention, congestion, or megrims, description, causes, symptoms, treatment, and prevention, description, dropsy, or hydrocephalus, causes, symptoms, and treatment, bran, value as feed, broken knee, open joints, synovitis, and arthritis, cause, prognosis, and treatment, broken wind, heaves, or asthma, definition, symptoms, and treatment, bronchitis-- and broncho-pneumonia, description, symptoms, and treatment, chronic, description and treatment, broncho-pleuropneumonia, description, broncho-pneumonia and bronchitis, description, symptoms, and treatment, bruise of frog, causes, symptoms, and treatment, burns and scalds, treatment, , calculi-- biliary, or gallstones, symptoms and treatment, or stones, in intestines, description, symptoms, and treatment, or stones, in stomach, symptoms and treatment, renal, description, symptoms, and treatment, ureteric, description and treatment, - urinary, classification, urinary, stone, or gravel, , calculus-- in sheath, or bilocular cavity, or preputial calculus, description, and treatment, or stone, and tumor in bladder, urethral, or stone in urethra, description, symptoms, and treatment, vesical, stone in bladder, or cystic calculus, description, symptoms, and treatment, calk wounds, description and treatment, callosities-- description, sloughing, horny sloughs, or sitfasts, description and treatment, , cancer, epithelial, or epithelioma, description and treatment, canker-- of foot, description, causes, symptoms, and treatment, or grease (inflammation of heels with sebaceous secretion), description, causes, symptoms, and treatment, cannon bone-- description, fractures, description, symptoms, and treatment, capped elbow, cause, symptoms, and treatment, capped hock, cause, symptoms, and treatment, capped knee, description, cause, treatment, etc., carbolic acid, use in disinfection, carbon disulphid, use against worms in horse, , cardiac enlargement, or hypertrophy of heart, description, symptoms, and treatment, caries of cartilage, or tumor of haw, description and treatment, carrots, value as feed, cartilaginous quittor, description, causes, symptoms, and treatment, cartilago nictitans, or winking cartilage (the haw), description, castration-- bleeding after operation, treatment, by covered operation, method, of cryptorchids, or ridglings, method, of mare, method, of stallions, method, pain after operation, treatment, successful method, cataract, remarks, catarrh-- chronic, nasal gleet or collection in sinuses, causes, symptoms, and treatment, gastrointestinal, or indigestion, cause, symptoms, and treatment, nasal, or cold in head, symptoms, and treatment, cerebral hemorrhage, or apoplexy, causes, symptoms, and treatment, cerebritis, causes, symptoms, and treatment, cerebrospinal meningitis, so called, or forage poisoning, causes, symptoms, and treatment, cervical choke, description, , chaff for feeding, chaps on knee and hock, scratches, or cracked heels, description, causes, and treatment, chest walls, wounds penetrating, description and treatment, chicken acari, or _dermanyssus gallinæ_, animal parasite of skin, chigoe, or jigger-- larvæ of _trombidium_, _leptus americanus_, animal parasite of skin, _pulex penetrans_, bite, treatment, choke-- cervical, description, , pharyngeal, cervical, and thoracic, symptoms and treatment, chorea, or st. vitus dance, description and treatment _chorioptes_-- _bovis_ (_symbiotes equi_, _dermatophagus equi_), animal parasite of skin, _spathiferus_, animal parasite of skin, choroiditis, cause, symptoms, and treatment, chronic bronchitis, description and treatment, circinate ringworm, or _tinea tonsurans_, description, symptoms, treatment, circulation organs, methods of examination, clubfoot, description, clysters, or enemas, description and manner of administering, cocked ankles, or knuckling, description, causes, and treatment, coffin joint, description, coffinbone, description, cold in head, or nasal catarrh, symptoms and treatment, colic-- bloat, cause, symptoms, and treatment, cramp, or spasmodic, cause, symptoms, and treatment, flatulent, cause, symptoms, and treatment, obstruction, caused by impaction of large intestine, symptoms, and treatment, specific forms, wind, cause, symptoms, and treatment, worms, description, symptoms, and treatment, - tympanitic, cause, symptoms, and treatment, colt. _see_ foal. compression of brain, causes, symptoms, and treatment concussion-- of brain, causes, symptoms, and treatment, spinal, causes and treatment, conformation-- of foot, faults, of horse, congenital scrotal hernia, description and treatment, congestion-- active, causes, and inflammation of skin, description of kinds, and inflammation of testicles, or orchitis, causes, symptoms, and treatment, description, of brain, or megrims, causes, symptoms, treatment, etc., of heart, description and symptoms, of lungs, description and treatment, of skin, red efflorescence, or erythema, description and treatment, of skin, with small pimples, or pauples, description and treatment, of spine, cause, symptoms, and treatment, passive, causes, conjunctives, or external ophthalmia, description, causes, symptoms, and treatment, constipation, or costiveness, cause and treatment, , constitution of horse, consumption, or tuberculosis, note, contagious pneumonia, discussion, - convulsions, description and treatment, cord-- spermatic, strangulated, cause and treatment, spermatic, tumors, causes and treatment, spinal, description, corn, or maize, how to feed, cornea-- ulcers, treatment, white specks and cloudiness, cause and treatment, corns, description, causes, symptoms, and treatment, coronary band, description, coronet-- description, fractures, symptoms and treatment, costiveness, or constipation, cause and treatment, , cough, chronic, description, cracked heels, or scratches, causes and treatment, cramp-- of hind limb, or spasm of thigh, description and treatment, or spasmodic, or colic, cause, symptoms, and treatment, cramps-- of hind limbs, cause and treatment, or spasms, causes and treatment, cranial bones, fractures, causes, symptoms, and treatment, cranium, tumor within, description of kinds, cresol, use in disinfection, crookedfoot, description, croup and diphtheria, mistakes in diagnosis, cryptorchids, or ridglings, castration, method, curb of hock, cause, symptoms, and treatment, currying, value as preventive of bots, cutaneous quittor, description, causes, symptoms, and treatment, cuticle, description, cyanosis of newborn foals, description, _cylicostomum_ spp., parasite, danger and remedies, - cystic calculus, or stone in bladder, description, symptoms, and treatment, cystic disease of wall of womb, or vesticular mole, description and treatment, _cysticercus_, parasite of eye, cystitis, inflammation of bladder, or urocystitis, symptoms and treatment, _dermanyssus gallinæ_, or chicken acari, animal parasite of skin, _dermatitis granulosa_, or boils, _dermatocoptes equi_, animal parasite of skin, _dermatodectes equi_, animal parasite of skin, _dermatophagus equi_, animal parasite of skin, _dermatorrhagia parasitica_, or bleeding skin eruptions, description and treatment, dermis, or true skin, description, descazeaux, study of summer sores, note, diabetes-- insipidous, diuresis, polyuria, or excessive secretion of urine, causes, symptoms, and treatment, mellitus, saccharine diabetes, glycosuria, or inosuria, causes, symptoms, and treatment, diaphragm-- rupture, cause and symptoms, spasm, or thumps, description and treatment, , diaphragmatic hernia, description, diarrhea, causes, symptoms, and treatment, dieckerhoff, experiments in disease transmission, note, digestive organs, diseases, chapter by ch. b. michener, - digestive tract, examination, dilatation-- of heart, description, causes, symptoms, and treatment, of veins, varicose, or varix, causes and treatment, _dioctophyme renale_, roundworm of kidney, diphtheria and cramp, mistakes in diagnosis, dips, use against mange in horses, diseases, fundamental principles of, chapter by rush shippen huidekoper, - disinfection, directions and materials, - dislocations and luxations of bones, causes, symptoms, treatment, etc., distemper, cause, symptoms, and treatment, - diuresis, polyuria, diabetes insipidus, or excessive secretion of urine, causes, symptoms, and treatment, douche, nasal, in administering medicines, dourine, or maladie du coït-- article by john r. mohler, - description and treatment, symptoms and treatment, - drench, methods, dropsies, synovial, remarks, dropsy-- general, of fetus, description and treatment, of abdomen in foal, or ascites, description and treatment, of abdomen, or ascites, description, symptoms, and treatment, of amnion, description and treatment, of brain, or hydrocephalus, causes, symptoms, and treatment, of limbs, perineum, and abdomen, description and treatment, of scrotum, or hydrocele, symptoms and treatment, of womb, cause, symptoms, and treatment, dysentery, description, causes, symptoms, and treatment, _echinococcus_-- parasite of eye, parasite of kidney, ectropion and entropion, or eversion and inversion of eyelid, causes and treatment, eczema, or inflammation with blisters, description and treatment, edematous pneumonia, definition, causes, symptoms, treatment, etc., - elbow-- capped, cause, symptoms, and treatment, muscles, sprains, causes, symptoms, and treatment, electric shock, causes, description, and treatment, electuries, or pastes, description, and manner of administering, embolism-- air, or air in veins, note, and thrombus, description, symptoms, and treatment, embryotomy of parts at abnormal births, emphysema, or swelling of fetus with gas, description and treatment, encephalitis, cause, symptoms, and treatment, endarteritis, and arteritis, description, symptoms, and treatment, endocarditis, or inflammation of lining membrane of heart, cause, symptoms, and treatment, enemas, or clysters, description, and manner of administering, engorgement colic, description, symptoms, and treatment, enteritis, definition, entropion and ectropion, or inversion and eversion of eyelid, causes and treatment, epilepsy, or falling fits, symptoms and treatment, epithelial cancer, or epithelioma, description and treatment, epithelioma-- degeneration of penis, or papilloma, or epithelial cancer, description and treatment, equine variola, or horsepox, causes, symptoms, treatment, etc., - eruptions, bleeding skin, or _dermatorrhagia parasitica_, description and treatment, erysipelas, description, cause, and treatment, erythema, congestion of skin, or red efflorescence, description and treatment, esophagus-- dilatation, causes, symptoms, and treatment, or gullet, treatment for foreign bodies, stricture, description and treatment, eversion-- and inversion of eyelid, or ectropion and entropion, causes and treatment, of bladder, description and treatment, or womb after difficult parturition, treatment, exostosis, cause, description, and treatment, extravasation of blood of penis, causes and treatment, eye-- diseases, chapter by james law, - examination, haw, or winking cartilage, description, lachrymal apparatus, muscles, description, palsy of nerve of sight, or amaurosis, causes, symptoms, and treatment, parasites, affecting, description of different kinds, watering, or obstruction of lachrymal apparatus, description and remedies, eyeball-- description, tumors affecting, eyelid-- diseases, description of different kinds, inflammation, causes and treatment, inversion and eversion, or entropion and ectropion, causes and treatment, sty, or furuncle (boil), affecting, description and treatment, torn, or wounds affecting, description and treatment, warts and tumors affecting, description and treatment, face bones, fractures, description and treatment, facial paralysis, cause and symptoms, fainting, or syncope, symptoms and treatment, farcy-- and glanders, definition, causes, etc., - chronic, symptoms, fatty degeneration of heart, causes, symptoms, and treatment, favus, or honeycomb ringworm, description and treatment, feces, impaction of rectum, feed-- kinds to give, musty and moldy, effect on digestive organs, preparation, feeding, corn, feet, interfering, causes, symptoms, and treatment, femur, fracture, cause, symptoms, and treatment, fetlock-- and ankle skin, note, and foot bones, description, ankle, and foot, diseases, chapter by a. a. holcombe, - joint, description, knuckling, causes, symptoms, and treatment, sprain, causes, symptoms, and treatment, fetus adherent to walls of womb, description, cause, and treatment, excessive size, general dropsy, description and treatment, or foal, prolonged retention, cause and treatment, swelling with gas, or emphysema, description and treatment, tumors, or inclosed ovum, description and treatment, fever, description, causes, and treatment, - fibrous bands constricting and crossing neck of womb, description and treatment, fibrous constriction of vagina or vulva, cause and treatment, _filaria_-- _conjunctivæ_, parasite of eye, _equina_, parasite of eye, _hæmorrhagica_, threadworm causing skin disease, _irritans_, parasite causing summer sores, description and treatment, _multipapillosa_, threadworm causing bleeding skin eruptions, _palpebralis_, parasite of eye, fistulas, causes, symptoms, and treatment, - fits, falling, or epilepsy, symptoms and treatment, flatfoot, description, flatulent colic, cause, symptoms, and treatment, flea, or pulex, prevention and treatment of bite, flesh fly (_sarcophaga carnaria_), note, flexor-- metatarsis, rupture, description, cause, symptoms, and treatment, pedis perforans, description, pedis perforatus, description, tendons or their sheath, and suspensory ligaments, sprains, cause, symptoms, and treatment, flies, method of attacking horses; prevention and treatment for bite, flooding, or bleeding from womb, treatment, flukes, occurrence in horses, note, flyblow, or grubs in skin, description and treatment, foal-- contractions of muscles, description and treatment, monstrosities, description of kinds, causes, and treatment, natural presentation, prolonged retention, cause and treatment, water in head, or hydrocephalus, description and treatment, foals, newborn, cyanosis affecting, description, foot-- anatomical review, , and fetlock bones, description, canker, causes, symptoms, and treatment, conformation, faults, fetlock, and ankle, diseases, chapter by a. a. holcombe, - mange, description and treatment, punctured wounds, description, symptoms, and treatment, sand-cracks, causes, symptoms, and treatment, sole description, _see also_ hoof. forage poisoning, or cerebrospinal meningitis, symptoms and treatment, forearm, fracture, description, cause, symptoms, and treatment, founder, or laminitis-- acute, subacute, and chronic, description, - complications, curative measures, description and causes, following parturition, cause, sequel of superpurgation, symptoms, treatment and prevention, fractures-- causes and symptoms, description of different kinds, of different bones, description, prognosis and treatment, frog-- bruises, causes, symptoms, and treatment, description, frostbites, description, symptoms, and treatment, furuncle-- or boil, description and treatment, or sty (boil), of eyelid, description and treatment, gaffky, investigation of pneumonia infection, note, galls, harness, or sitiasts, description and treatment, , gallstones, or biliary calculi, symptoms, and treatment, gangrene-- or mortification, causes, or mortification, description, symptoms, and treatment, gas, swelling of fetus, or emphysema, description and treatment, gastritis, definition, gastro-enteritis, description, symptoms, and treatment, gastrointestinal catarrh, or indigestion, description, cause, symptoms, and treatment, gastrointestinal parasites, description and treatment, discussion by maurice c. hall, - _gastrophilus_, spp., injury to horses, symptoms and treatment, - generative organs, diseases affecting, chapter by james law, - genito-urinary passages, method of medication, gentian, use against pinworms in horses, gestation, extra-uterine, description, symptoms, and treatment, glanders-- acute, symptoms, and farcy, definition, causes, etc., - chronic, symptoms, treatment, glands-- lymphatic, description, symptoms, and treatment, sebaceous, description, sweat, description, gleet-- inflammation of urethra, or urethritis, symptoms and treatment, nasal, chronic catarrh, or collection in sinuses, causes, symptoms, and treatment, - glossitis, description and treatment, - glottis, spasm, description, glycosuria, saccharine diabetes mellitus, or inosuria, causes, symptoms, and treatment, grains for feeding, grasses, important feed, gravel, urinary calculi, or stone, description, and causes, , grease or canker, causes, symptoms, and treatment, grubs-- or flyblow, description and treatment, under the skin, description and treatment, grunting, testing, gullet, or esophagus, treatment for foreign bodies, gunshot wounds, description and treatment, gut-tie, volvulus, or twisting of bowels, cause, symptoms, and treatment, guttural pouches, description and treatment, _habronema_, spp., cause of summer sores, etc., note, hairs on skin, description, harbaugh, w. h., chapter on "diseases of respiratory organs", - harness galls, or sitiasts, description and treatment, , harvest bug, larvæ of _trombidium_, _leptus americanus_, jigger (chigoe), animal parasite of skin, haw-- or winking cartilage of the eye, description, tumor, or caries of cartilage of the eye, description and treatment, hay, kinds for feeding, heart-- adventitious growths, description, symptoms, and treatment, anatomy and physiology, and blood vessels, diseases, remarks, blood vessels, and lymphatics, diseases, chapter by m. r. trumbower, - circulation of blood, description, congestion, description, and symptoms, dilatation, description, causes, symptoms, and treatment, fatty degeneration, description, causes, symptoms, and treatment, hypertrophy, or cardiac enlargement, description, symptoms, and treatment, inflammation of lining membrane, or endocarditis, cause, description, symptoms, and treatment, inflammation of muscular structure, or myocarditis, symptoms, alterations, and treatment, inflammation of sac inclosing, or pericarditis, causes, symptoms, and treatment, inflammatory diseases, description and treatment, palpitation, description, symptoms, and treatment, rupture, description and cause, valvular disease, description, symptoms, and treatment, weakness, causes, symptoms, and treatment, heat exhaustion, sunstroke, or heat stroke, symptoms, pathology, treatment, and prevention, heaves, broken wind, or asthma, definition, symptoms, and treatment, heels-- contracted, or hoofbound, description, causes, symptoms, and treatment, cracked, scratches, or chaps on knee and hock, description, causes, and treatment, inflammation, with sebaceous secretion, grease, or canker, description, causes, symptoms, and treatment, hematuria, or bloody urine, cause and treatment, hemiplegia, or paralysis of on side, or half the body, description and symptoms, hemoglobinuria, azoturia, azotemia, poisoning by albuminoids, symptoms, prevention, and treatment, hemoptysis, or bleeding from lungs, causes, description, and treatment, hemorrhage-- process of healing and method of treatment, spinal, symptoms and treatment, hemorrhoids, or piles, description and treatment, hemostasia, description and treatment, hepatitis, or inflammation of liver, symptoms, causes, and treatment, hernia-- congenital scrotal, description and treatment, diaphragmatic, description, inguinal, description, symptoms, and treatment, of womb, description and treatment, or rupture, description of different kinds, scrotal, cause, umbilical, description and treatment, ventral, description and treatment, herpes, description and treatment high blowing, description, hip-- bone, or os innominatum, description, symptoms, and treatment, bones, fractured, causes, joint, luxation, description and treatment lameness, description, symptoms, and treatment, hock-- and knee, chaps or scratches, description, causes, and treatment, capped, cause, symptoms, and treatment, curb, cause, symptoms, and treatment, fractures, note, holcombe, a. a., chapter on "diseases of ankle, fetlock, and foot", - honeycomb ringworm, or favus, description and treatment, hoof-- bound, or contracted heels, description, causes, symptoms, and treatment, description, growth, healthy, characteristics, physiological movements, preparation for the shoe, _see also_ foot. hoofs-- unshod, care, various forms, hornets, bees, and wasps, treatment for stings, horny sloughs (sitfasts), or sloughing callosities, description and treatment, , horse, sick-- attitude and general condition indicative of disease, conformation and constitution, danger from silage as feed, - examination, chapter by leonard pearson, - history of diseases necessary in examination, parasites, intestinal, and injuries from them, - horsepox, or equine variola, causes, symptoms, and treatment, - horses-- anatomy, description, danger from silage as feed, - horseshoes. _see_ shoe. huidekoper, rush shippen, chapter on "infectious diseases", - humerus, fractures, symptoms and treatment, hydrocele, or dropsy of scrotum, symptoms and treatment, hydrocephalus-- or dropsy of brain, causes, symptoms, and treatment, or water in head, of foal, description and treatment, hydrophobia. _see_ rabies. hydrothorax, treatment, hypertrophy of heart, or cardiac enlargement, description, symptoms, and treatment, _hypoderma-lineata_, note, icterus, jaundice, or yellows, description and treatment, impaction-- of large intestine, cause of obstruction colic, symptoms and treatment, of rectum with feces, indigestion, or gastrointestinal catarrh, description, causes, symptoms, and treatment, infectious anemia-- chapter by john r. mohler, - cause and localities infected, diagnosis and treatment, symptoms and lesions, infectious diseases-- chapter by rush shippen huidekoper, - general discussion, - inflammation-- acute, of kidneys, or acute nephritis, causes, symptoms, and treatment, and abscess of lymphatic glands, description, symptoms, and treatment, and congestion of skin, description of kinds, and congestion of teats and udder, symptoms and treatment, and congestion of testicles, or orchitis, causes, symptoms, and treatment, chronic, of kidneys, causes, symptoms, and treatment, description, symptoms, termination, and treatment, - local, and abscess of lymphatic glands, description, symptoms, and treatment, of bladder, cystitis, or urocystitis, symptoms and treatment, of brain and its membranes, description, , , of eyelids, causes and treatment, of heels, with sebaceous secretion, grease, or canker, description, causes, symptoms, and treatment, of lining membrane of heart, or endocarditis, cause, description, symptoms, and treatment, of liver, or hepatitis, symptoms, causes, and treatment, of membranes, a complication of influenza, of membranes of spinal cord, causes, symptoms, and treatment, of muscular structure of heart, or myocarditis, symptoms, alterations, and treatment, of nerve, or neuritis, cause, symptoms, and treatment, of pharynx, description, of sac inclosing heart, or pericarditis, causes, symptoms, pathology, and treatment, of substance of spinal cord, or myelitis, causes, symptoms, pathology, and treatment, of urethra, urethritis, or gleet, symptoms and treatment, of womb and peritoneum, symptoms and treatment, with blisters, or eczema, description and treatment, with pustules, description and treatment, inflammatory diseases of the heart, description and treatment, influenza, definition, symptoms, termination, complications, and treatment, - inguinal, hernia, description, symptoms, and treatment, inhalation, manner of administering medicines, injections, methods of administering medicines, inosuria, saccharine diabetes, diabetes mellitus, or glycosuria, causes, symptoms, and treatment, insufflation, description, interfering-- and speedy cuts, description, symptoms, prognosis, and treatment, of feet, causes, symptoms, and treatment, intestinal-- paralysis, cause, worm, or ascaris equorum, note, intestines-- and stomach, diseases, remarks, calculi, or stones, description, symptoms, and treatment, large, impaction, cause of obstruction colic, symptoms and treatment, paralysis, description and treatment, spasms, intussusception, or invagination, description, symptoms, and treatment, invagination, or intussusception, description, symptoms, and treatment. iritis, causes, symptoms, and treatment, irritation, nervous, of skin, or pruritus, description and treatment, jaundice, icterus, or yellows, description and treatment, jaw, lower, fracture, description, causes, and treatment, jigger, or chigoe, leptus americanus, animal parasite of skin, joint-- hip, luxation, description and treatment, shoulder, displacement, description and treatment, joints diseases, note, open, cause, prognosis, and treatment, kidneys-- acute inflammation, or acute nephritis, causes, symptoms, and treatment, chronic inflammation, causes, symptoms, and treatment, bladder worm and roundworm affecting, tumors, note, knee-- broken, cause, prognosis, and treatment, capped, description, cause, symptoms, prognosis, and treatment, fracture, cause, symptoms, prognosis, and treatment, or hock, chaps, scratches, or cracked heels, description, causes, and treatment, knees, sprung, cause, symptoms, and treatment, knuckling-- of fetlock, description, causes, symptoms, and treatment, or cocked ankles, description, causes, and treatment, labor pains, premature, cause, and treatment, lachrymal apparatus of eye-- description, obstruction, or watering eye, description and remedy, lameness-- definition, physiology and description, how to detect the seat, how to discover, its causes and treatment, chapter by a. a. liautard, - of hip, description, symptoms, prognosis, and treatment, of shoulder, description, causes, symptoms, and treatment, laminæ, sensitive, description, laminitis. _see_ founder. lampas, description and treatment, laryngismus paralyticus, or roaring, description and treatment, , laryngitis, or sore throat, description, symptoms and treatment, larynx, spasms, description and treatment, law, james-- chapter on "diseases of the eye", - chapter on "diseases of the generative organs", - chapter on "diseases of the skin", , chapter on "diseases of the urinary organs", - lead poisoning, or plumbism, causes, symptoms, and treatment, leptus americanus, or harvest bug, animal parasite of skin, leucorrhea, description and treatment, liautard, a., chapter on "lameness: its causes and treatment", lice, or pediculi, description and treatment for bite, ligament-- suspensory, description, suspensory, rupture, description, symptoms, and treatment, ligaments-- description and functions, suspensory, sprains, causes, symptoms, prognosis, and treatment, limbs-- hind, cramp, cause and treatment, perineum, and abdomen, dropsy, description and treatment, lime-and-sulphur dip, use against mange in horse, linseed, ground, value as laxative, liver-- diseases, remarks, inflammation, or hepatitis, symptoms, causes, and treatment, rupture, causes, symptoms, and treatment, lockjaw, or tetanus, causes, symptoms, prevention, and treatment, locomotor ataxia, or incoordination of movement, description, loins, sprains, description, cause, symptoms, and treatment, lüber, investigation of pneumonia infection, _lucilia cæsar_, or bluebottle, and _l. hominivorax_, or screwworm fly, note, lung-- abscess, and suppuration, symptoms, fever, or pneumonia, description, symptoms, and treatment, lungs-- bleeding, or hemoptysis, causes, description, and treatment, congestion, description and treatment, description, luxations and dislocations of bones, cause, symptoms, and treatment, lymphangitis, causes, symptoms, and treatment, lymphatic-- glands, local inflammation, and abscess affecting, description, symptoms, and treatment, system, diseases, description, lymphatics, heart, and blood vessels, diseases, chapter by m. r. trumbower, - madness, rabies, or hydrophobia, cause, symptoms, treatment, and prevention, , maize, or corn, how to feed _maladie de coït_, or dourine, description and treatment, mange-- autumn, and mange of foot, description and treatment, horse, treatment, or acariasis, note, mare-- castration, method, pregnant, hygiene, sterility, causes and treatment, masturbation, or self-abuse, remedy, meat fly, or _musca vomitoria_, note, medicines, methods of administering, chapter by ch. b. michener, - megrims, or congestion of brain, description, causes, symptoms, treatment, etc., melanosis, or black pigment tumor, description and treatment, membrane-- lining, of heart, inflammation, or endocarditis, cause, description, symptoms, and treatment, of nose, thickening, symptoms and treatment, membranes-- inflammation, a complication of influenza, mucous, visible, and skin may indicate disease, of brain, inflammation, description, , of spinal cord, inflammation, causes, symptoms, and treatment, meningitis-- causes, symptoms, and treatment, spinal, causes, symptoms, pathology, and treatment, metatarsi, flexor, rupture, description, cause, symptoms, and treatment, michener, ch. b.-- chapter on "diseases of the digestive organs", - chapter on "methods of administering medicines", - chapter on "wounds and their treatment," - _microsporon furfur_, vegetable parasite of skin mohler, john r.-- chapter on "dourine", - chapter on "infectious anemia", - chapter on "mycotic lymphangitis", - chapter on "osteoporosis, or bighead", - mold, silage, danger to horses, - mole, vesicular, or cystic disease of walls of womb, description and treatment, moles, or anidian monsters, description, monstrosities in foal, description of kinds, causes, and treatment, moonblindness, or periodic ophthalmia, causes, symptoms, treatment, mortification, or gangrene. _see_ gangrene. mouth, diseases, remarks, mucous membranes, visible, and skin may indicate disease, mules, danger from silage as feed, - _musca vomitoria_, or meat fly, note, muscles-- and tendons, diseases, contraction in foal, description and treatment, of elbow, sprain, causes, symptoms, and treatment, of eye, description, one system of locomotion, , mycotic lymphangitis-- and glanders, differentiation, chapter by john r. mohler, - diagnosis and treatment, symptoms and lesions, myelitis, or inflammation of substance of spinal cord, causes, symptoms, and treatment, myocarditis, or inflammation of muscular structure of heart, symptoms, alterations, and treatment, nasal-- catarrh, or cold in head, symptoms and treatment, douche, used in administering medicines, gleet, chronic catarrh, or collection in sinuses, causes, symptoms, and treatment, polypus, description and treatment, navel-- discharge of urine, or persistent urachus, description and treatment, string, constriction of a member, description, navicular-- bone, description, disease, description, causes, symptoms, and treatment, neck of womb, twisting, description and treatment, nephritis, acute, or acute inflammation of kidneys, causes, symptoms, and treatment, nerve-- inflammation, or neuritis, cause, symptoms, and treatment, tumor, or neuroma, cause, symptoms, and treatment, nerves-- injuries, description and treatment, spinal, designations, nervous system-- and brain, anatomy and physiology, diseases affecting, chapter by m. r. trumbower, - examination, nettlerash, surfeit, or urticaria, description and treatment, neuritis, or inflammation of a nerve, cause, symptoms, and treatment, neuroma, or tumor of a nerve, cause, symptoms, and treatment, nose-- bleeding, causes and treatment, membrane, thickening, symptoms and treatment, nostrils, tumors and wounds, treatment, obstruction colic, cause, open joints. _see_ joints. ophthalmia-- external, or conjunctivitis, description, causes, symptoms, and treatment, internal, causes, symptoms, and treatment, periodic, or moonblindness, causes, symptoms, and treatment, optic nerve, paralysis, or amaurosis, cause, orchitis, or congestion and inflammation of testicles, causes, symptoms, and treatment, os innominatum, or hip-bone fracture, description, symptoms, and treatment, os pedis, or third phalanx, fractures, cause and treatment, osteoporosis, or bighead, chapter by john r. mohler, - ostitis, cause, symptoms, and treatment, overreach, description, symptoms, and treatment, ovum, inclosed, or tumors of fetus, description and treatment, oxyurus equorum, parasite, symptoms and treatment for, palpitation of heart, description, symptoms, and treatment, palsy-- of nerve of sight, or amaurosis, causes, symptoms, and treatment, of paralysis, description and causes, pancreas and spleen, diseases, remarks, papilloma, epithelioma, or degeneration of penis, papules, or congestion of skin with small pimples, description and treatment, paralysis-- facial, symptoms and cause, general, cause, of bladder, description and cause, , of hind legs, cause and treatment, of intestines, cause, , of one side or half the body or hemiplegia, description and symptoms, of optic nerve, or amaurosis, cause, of penis, cause and treatment, of pharynx, description and treatment, of rectum and tail, cause, or palsy, description and causes, transverse, of hind extremities, or paraplegia, description and symptoms, treatment, paraphymosis and phymosis, description and treatment, paraplegia, or transverse paralysis of hind extremities, cause and treatment, parasites-- animal, of skin, description of kinds, causing worm colic, , , gastrointestinal, - in eye, description of kinds, specific kinds affecting urinary organs, vegetable, of skin, description of kinds, symptoms, and treatment, parasitic pityriasis, description and treatment, parturition-- different presentations, difficult, from narrow pelvis, cause and treatment, , symptoms, pastern joint, description, pastes, or electuaries, description and manner of administering, pasture, relation to worms in horses, patella-- fracture, description, pseudoluxations, descriptions, symptoms, cause, and treatment, pearson, leonard, chapter on "examination of a sick horse", - pediculi, or lice, description and treatment for bite, pelvis-- and vagina, tumors affecting, description and treatment, bones, fracture, different kinds, narrow, cause of difficult parturition, cause and treatment, penis-- degeneration, papilloma, or epithelioma, extravasation of blood and paralysis, cause and treatment, sheath, and abdomen, swelling, cause and treatment, warts, treatment, pericarditis-- a complication of influenza, or inflammation of sac inclosing the heart, causes, symptoms, and treatment, perineum, limbs, and abdomen, dropsy, description and treatment, periostitis, cause, symptoms, and treatment, peritoneum and womb, inflammation, symptoms and treatment, peritonitis-- a complication of influenza, description, symptoms, and treatment, phalanx, first, second, and third, fracture, cause, symptoms and treatment, , pharyngeal polypus, description and treatment, pharyngitis, description and treatment, pharynx-- inflammation, description, paralysis, description and treatment, phlebitis, or diseases of veins, description, causes, symptoms, and treatment, phymosis and paraphymosis, description and treatment, physiology and anatomy of brain and nervous system, piles, or hemorrhoids, description and treatment, pills, or balls, description and manner of administering, pimples, small, or congestion of skin, description and treatment, pinworm, description and treatment, pityriasis, or scaly skin disease, description and treatment, plantar cushion, description, pleurisy-- a complication of influenza, description, symptoms, and treatment, pleurodynia, symptoms and treatment, pleuropneumonia, description and treatment, plumbism, or lead poisoning, causes, symptoms, and treatment, pneumonia-- contagious, causes, symptoms, treatment, etc., - infection, transmission, - or lung fever, description, symptoms, and treatment, poisoning-- albuminoid, or azotemia, symptoms, prevention, and treatment, forage, or cerebrospinal meningitis, causes, symptoms, and treatment, lead, or plumbism, causes, symptoms, and treatment, poll evil, description, causes, symptoms, treatment, - polypus-- description and treatment, pharyngeal, description and treatment, polyuria, diuresis, diabetes insipidus, causes, symptoms, and treatment, pouches, guttural, description and treatment, poultry, acariasis, description and treatment, powders, manner of administering, pregnancy-- duration, mare, hygiene, medication, premaxillary bone, fracture, description and treatment, preputial calculus, calculus in sheath, description and treatment, presentations at birth, abnormal, - pruritis, or nervous irritation of skin, description and treatment, pseudoluxations of patella, description, symptoms, cause, and treatment, _psoroptes equi_, animal parasite of skin, psoroptic acariasis, description and treatment, ptyalism, or salivation, description and treatment, pulex-- or flea, prevention and treatment for bite, _penetrans_, or chigoe, bite, treatment, pulse, how to count, purpura hemorrhagica-- description, symptoms, and treatment, or anasarca, causes, symptoms, and treatment, pustules, inflammation, description and treatment, quittor, description of different kinds, rabies-- description, symptoms, and treatment, - , - fatality of, ransom, study of flies and worms, rectum-- and tail, paralysis, cause, impaction with feces, methods of administering medicines, red efflorescence, or erythema, description and treatment, renal calculi, description, symptoms, and treatment, respiratory organs-- description, diseases, chapter by w. h. harbaugh, - methods of examination, retinitis, causes, symptoms, and treatment, ribs, fractures, description, symptoms, and treatment, ridglings, or cryptorchids, castration method, ringbone, description, causes, symptoms, and treatment, , ringworm-- circinate, or _tinea tonsurans_, description, symptoms, and treatment, honeycomb, or favus, description and treatment, roaring and thick wind, description and treatment, , roundworm of kidney, roundworms, horse, dangers and treatment, - rubber pads in shoes, uses, rupture-- of an artery, description, symptoms, and treatment, of diaphragm, causes and symptoms, of flexor metatarsi, description, cause, symptoms, and treatment, of heart, description and cause, of liver, cause, symptoms, and treatment, of stomach, result of engorgement, colic, symptoms, and treatment, , of suspensory ligament, description, symptoms, and treatment, of vagina, description and treatment, or hernia, description of different kinds, or laceration of womb, causes and treatment, saccharine diabetes, diabetes mellitus, glycosuria, or inosuria, causes, symptoms, and treatment, sacrum, fractures, description and treatment, st. vitus dance, or chorea, description and treatment, salivation, or plyalism, description and treatment, sand-cracks of foot, description, causes, symptoms, and treatment, sarcocele, description and treatment, _sarcophaga carnaria_, or flesh fly, note, _sarcoptes_, _scabiei equi_, animal parasite of skin, sarcoptic acariasis, description, symptoms, and treatment, scalds and burns, treatment, , scaly skin disease, or pityriasis, description and treatment, scapula, fracture, cause, symptoms, and treatment, scorpion and tarantula, treatment for sting or bite, scratches, or chaps on knee and hock, or cracked heels, causes and treatment, screw-worm fly, or _lucilia hominivorax_, note, scrotal or congenital hernia, cause, description, and treatment, scrotum, dropsy, or hydrocele, symptoms and treatment, sebaceous glands, description, self-abuse, or masturbation, remedy, serum, use against strangles and anthrax, , sesamoid bones, fracture, cause, symptoms, treatment, etc., sesamoid sheath, inflammation, or navicular disease, description, symptoms, and treatment, sesamoids, description, sexual and urinary organs, examination, sheath-- calculus, or bilocular cavity, or preputial calculus, description and treatment, of flexor tendons, sprains, cause, symptoms, and treatment, penis, and abdomen, swelling, cause and treatment, shock, electric, description and treatment, shoe-- bar, uses, detailed description, hot fitting, shoeing-- chapter by john w. adams, - preliminary examination, preparation of the hoof, rubber pads, shoes, special peculiarities of chief classes, shoulder-- joint, displacement, description and treatment, lameness, description, causes, symptoms, and treatment, sick horse. _see_ horse, sick. sidebones, description, cause, symptoms, and treatment, , silage, use and danger as horse feed, - sinuses, collection in, chronic catarrh, or nasal gleet, causes, symptoms, and treatment, sitfasts-- horny sloughs, or sloughing callosities, description and treatment, or harness galls, description and treatment, skin-- and visible mucous membranes, may indicate disease, animal parasites affecting, description of kinds, bleeding eruptions, description and treatment, congestion, red efflorescence, or erythema, description and treatment, disease, scaly, or pityriasis, description and treatment, diseases, chapter by james law, - grubs under, description and treatment, hairs, description, inflammation and congestion, description of kinds, nervous irritation, or pruritis, description and treatment, of fetlock and ankle, note, parasites, - structure, divisions, true, or dermis, description vegetable parasites, description of kinds, symptoms and treatment, wounds, description of different kinds and treatment, - sloughs, horny, sitfasts, or sloughing callosities, description and treatment, , snake bites, treatment, sole of foot, description, sore throat, or laryngitis, description, symptoms, and treatment, sores, summer, caused by _filaria irritans_, treatment, , spasm-- of diaphragm, or thumps, description and treatment, , of glottis or intestines, description and treatment, of larynx, description and treatment, of neck of bladder, causes, symptoms, and treatment, , of neck of womb, description and treatment, of thigh, or cramp of hind limb, description and treatment, spasmodic or cramp colic, cause, symptoms, and treatment, spasms, or cramps, causes and treatment, spavin-- blood, bog spavin, and thorough pin, description and treatment, description, cause, symptoms, prognosis, and treatment, speedy cuts and interfering, description, symptoms, treatment, etc. spermatic cord-- strangulated, cause and treatment, tumors, causes and treatment, spinal-- anemia, symptoms and treatment, compression and concussion, cause, description, and treatment, concussion, causes, and treatment, congestion, cause, symptoms, and treatment, cord, description, cord, inflammation of membranes, causes, symptoms, treatment, etc., cord, inflammation of substance, or myelitis, causes, symptoms, treatment, hemorrhage, symptom and treatment, meningitis, causes, symptoms, pathology, and treatment, nerves, designation, tumors, symptoms and treatment, spleen and pancreas, diseases, remarks, splint, description, symptoms, cause, and treatment, sprain-- of elbow muscles, causes, symptoms, and treatment, of fetlock, causes, symptoms, and treatment, sprains-- description and treatment, - , - of loins, description, cause, symptoms, and treatment, of suspensory ligaments and of flexor tendons or their sheath, cause, symptoms, and treatment, - sprung knees, cause, symptoms, and treatment, staphyloma, or bulging cornea, description and treatment, stallion-- castration, methods, sterility, cause and treatment, sterility in mare and stallion, cause and treatment, stiles, ch. wardell, chapter on "surra", - stock vaccines, administration, stomach-- and intestines, diseases, remarks, calculi, or stones, symptoms and treatment, rupture, result of engorgement colic, symptoms and treatment worms, description, etc., - stomatitis, description and treatment, stone-- in bladder, vesical calculus, or cystic calculus, description, symptoms, and treatment, in urethra, or urethral calculus, description, symptoms, and treatment, or calculus, and tumor in bladder, urinary calculi, or gravel, description, , stones-- or calculi, in intestines, description, symptoms, and treatment, or calculi, in stomach, symptoms and treatment, strangles, definition, causes, symptoms, and treatment, - strangulated spermatic cord, cause and treatment, _streptococcus pyogenes equi_, cause of pneumonia, stricture-- of esophagus, description and treatment, of urethra, description and treatment, stringhalt, description, cause and treatment, , strongyles, injuries to horses, symptoms and treatment, - _strongylus_-- _equinum_, parasite of kidney, spp. injuries by and treatment, - _vulgaris_, worm causing one form of aneurism, sty, furuncle, or boil of eyelid, description and treatment, suffraginis, description, summer sores, caused by _filaria irritans_, description and treatment, , sunstroke, heat stroke, or heat exhaustion, symptoms, treatment, etc., superpurgation, description and treatment, suppositories, description and uses, suppuration and abscess in lung, symptoms, surfeit, nettlerash, or urticaria, description and treatment, surra-- chapter by ch. wardell stiles, - climatic conditions, animals affected, and lethality, diagnosis and treatment, method of infection, symptoms, suspensory ligament-- and flexor tendons, or their sheaths, sprains, cause, symptoms, treatment, - description, rupture, description, symptoms, and treatment, sutures, description and uses, swamp fever. _see_ infectious anemia. sweat glands, description, _symbiotes equi_, _dermatophagus equi_, or _chorioptes spathiferus_, animal parasite of skin, syncope, or fainting, symptoms and treatment, synovial-- dropsies, remarks, sacs, diseases, description, synovitis, cause, prognosis, and treatment, tail and rectum, paralysis, cause, tapeworms, horse, kind and injuries, tarantula and scorpion, treatment for bite and sting, teats, sore, scabs, cracks, warts, cause, and treatment, teeth-- diseases period of dentition, irregularities, remedies, temperament of horse, temperature, method of determining, tendon sheaths, wounds, description and treatment, tendons-- and muscles, diseases, flexor, or their sheath, sprains, cause, symptoms, and treatment, functions, lacerated, cause, symptoms, prognosis, and treatment, of foot, function, testicles-- abnormal number, causes of degeneration, or orchitis, congestion and inflammation, causes, symptoms, treatment, tetanus, or lockjaw, causes, symptoms, prevention, and treatment, thick wind and roaring, description and treatment, thigh, spasm, or cramp of hind limb, description and treatment, thoracic choke, description and treatment, , thoroughpin, blood spavin, and bog spavin, description and treatment, threadworms, cause of bleeding skin eruptions, throat-- abscesses affecting, treatment, sore, or laryngitis, description, symptoms, and treatment, thrombosis, description, cause, symptoms, and treatment, thrombus and embolism, description, symptoms, and treatment, thrush, description, causes, symptoms, and treatment, thumps, or spasm of diaphragm, description and treatment, , tibia, fractures, symptoms and treatment, ticks, description and treatment, timothy, best hay for feeding, _tinea tonsurans_, or circinate ringworm, description and treatment, tissues, description, tobacco dip, use against mange in horses, toothache, how to determine and treat, trichiasis, or turned eyelashes, description and treatment, _trichophyton tonsurans_, vegetable parasite of skin, trumbower, m. r.-- chapter on "diseases of heart, blood vessels, and lymphatics", - chapter on "diseases of nervous system", - _trypanosoma equiperdum_, cause of dourine, note, tuberculosis, or consumption, note, tumor-- and calculus, or stone in bladder, of haw, or caries of cartilage, description and treatment, of nerve, or neuroma, cause, symptoms, and treatment, on spermatic cord, causes and treatment, tumors-- and warts of eyelids, description and treatment, black pigment, or melanosis, description and treatment, in nostrils, treatment, in vagina and pelvis, description and treatment, of eyeball, remarks, of fetus, or inclosed ovum, description and treatment, of kidneys, note, of spine, symptoms and treatment, of udder, cause and treatment, of abnormal growths, cause of colic, within cranium, description of kinds, twins, remarks, tympanitic colic, cause, symptoms, and treatment, udder-- congestion and inflammation, symptoms and treatment, tumors, cause and treatment, ulceration, description, causes, and treatment, ulcers on cornea, treatment, umbilical hernia, description and treatment, urachus, persistent, or discharge of urine by navel, description and treatment, uremia, description, symptoms, and treatment, urethra-- inflammation, urethritis, or gleet, symptoms and treatment, stone, or urethral calculus, description, symptoms, and treatment, stricture, description and treatment, urethral calculi, description and treatment, urethral calculus, or stone in urethra, description, symptoms, and treatment, urethritis, inflammation of urethra, or gleet, symptoms, and treatment, urinary-- and sexual organs, examination, calculi, classification, calculi, stone, or gravel, description and causes, , disorders, causes, organs, diseases, chapter by james law, - organs, parasites affecting, organs, symptoms of disease, organs, uses, urine-- analysis, bloody, or hematuria, cause and treatment, discharge by navel, or persistent urachus, description and treatment, excessive secretion, diuresis, polyuria, diabetes insipidus, causes, symptoms, and treatment, how to examine, of healthy horse, description, urocystitis, inflammation of bladder, or cystitis, symptoms and treatment, urticaria, nettlerash, or surfeit, description and treatment, vaccination-- use against diseases and manufacture of material, use against strangles and anthrax, , vaccines, kinds and use, , vagina-- and pelvis, tumors affecting, description and treatment, rupture, description and treatment, vaginal walls, effusion of blood, valvular disease of heart, symptoms and treatment, varicocele, description and treatment, varicose veins, varix, or dilatation of veins, causes and treatment, variola, equine, or horsepox, causes, symptoms, and treatment, - veins-- description, dilatation, varicose veins, or varix, causes and treatment, diseases, or phlebitis, causes, symptoms, and treatment, ventral hernia, description and treatment, vertebra, fractures, causes, symptoms, and treatment, vesical calculus, stone in bladder, or cystic calculus, description, symptoms, and treatment, vesicular mole, or cystic disease of walls of womb, description and treatment, volvulus, gut-tie, or twisting of bowels, cause, symptoms, and treatment, vulva, or vagina, fibrous constriction, cause and treatment, warts-- and tumors of eyelids, description and treatment, description and treatment, on penis, treatment, wasps, bees, and hornets, stings, treatment, water-- impure, cause of disease, time to give, in head, or hydrocephalus of foal, description and treatment, watering eye, or obstruction of lachrymal apparatus, description and remedy, whistling, description, wind-- broken, heaves, or asthma, definition, symptoms, and treatment, colic, cause, symptoms, and treatment, windgalls, description, causes, symptoms, and treatment, , windpipe, description, winking cartilage, or cartilago nictitans, description, womb-- and peritoneum, inflammation, symptoms, and treatment, bleeding, or flooding, treatment, dropsy, cause, symptoms, and treatment, eversion, description and method of treatment, hernia, description and treatment, laceration, or rupture, causes and treatment, neck, twisting, description and treatment, worm colic, notes worms-- bladder, affecting kidneys, injuries by, and treatment, - strongyle, danger and treatment, - treatment with dips, wounds-- and their treatment, chapter by ch. b. michener, - gunshot, description and treatment, healing under a scab, treatment, in nostrils, cause and treatment, lacerated and contused, description and treatment, penetrating walls of chest, description and treatment, poisoned, description and treatment, punctured, description, symptoms, and treatment, , yellows, jaundice, or icterus, description and treatment, additional copies of this publication may be procured from the superintendent of documents government printing office washington. d.c. at $ . per copy an investigation into the nature of black phthisis; or ulceration induced by carbonaceous accumulation in the lungs of coal miners, and other operatives. by archibald makellar, m.d., f.r.s.s.a., fellow of the royal college of physicians of edinburgh; member of the medico-chirurgical society, of the harveian society, of the obstetrical society, etc. etc., and one of the physicians to the new town dispensary of edinburgh. reprinted from the monthly journal of medical science. edinburgh: sutherland & knox, princes street. . andrew jack, printer, edinburgh. preface. an abstract of the investigations into the nature of carbonaceous infiltration into the pulmonary tissues of coal miners, was read by dr makellar at a meeting of the medico-chirurgical society of edinburgh, wednesday, th july, , dr gairdner, president, in the chair. reference was made, in particular, to the east lothian coal-miners. the carbonaceous disease described, was stated to be caused by the inhalation of substances floating in the atmosphere of the coal-pit, such as the products of the combustion of gunpowder, the smoke from the miner's lamp, and the other foreign matters with which the air of the mines is heavily charged, in consequence of their defective ventilation. in the mines in which gunpowder is used, the disease is most severe in its character, and most rapid in destroying the pulmonary tissue. the carbon in some cases is expectorated in considerable quantity for some time previous to death; in others, it is retained, and accumulates to a great extent in the lungs. as the disease advances, the action of the heart becomes feeble; and the appearance of the blood indicates a carbonaceous admixture. the carbonaceous deposit seems to supersede or supplant the formation of other morbid bodies in the substance of the lungs--such as tubercle; for in individuals belonging to families in which there exists an undoubted phthisical diathesis, tubercle is never found on dissection. the views expressed in this communication called forth the following remarks. professor christison called attention to the new and important fact, of the carbonaceous matter being found in the circulating mass. he attached great importance to dr makellar's researches. professor allen thomson remarked, that the presence of this carbonaceous matter in the blood, by no means proved, that it was formed in, or from the blood. dr hughes bennett said, that the antagonism of this carbonaceous disease to tubercle, was a fact of great interest and importance, especially in connection with two other recent observations; viz. st, that the depositions of carbon in the lungs of old people, (which french pathologists describe,) are not found associated with tubercle; and, d, that under the supposed cicatrices of pulmonary tubercular cavities, a layer of carbonaceous matter is commonly found. dr makellar's paper called forth some interesting observations from the president, professor simpson, and others. black phthisis, or ulceration induced by carbonaceous accumulation in the lungs of coal-miners among the many diseases incident to the coal-miner, none come oftener under medical treatment, than affections of the respiratory and circulating organs. while the collier is subject--during his short but laborious life--to the other diseases which afflict the labouring classes in this country, such as inflammations, fevers, acute rheumatism, and the various eruptive diseases, he, at last, unavoidably, falls a victim to lesions within the cavity of the chest, arising from the nature of his employment. in the present communication, it is proposed to lay before the profession a series of remarks, which i have been enabled to put together, with a view to elucidate the cause and progress of that very peculiar pulmonary disease, incident to coal-miners, which i shall denominate black phthisis, or ulceration induced by carbonaceous accumulation in the lungs. the rise and progress of the malady may be thus sketched: a robust young man, engaged as a miner, after being for a short time so occupied, becomes affected with cough, inky expectoration, rapidly decreasing pulse, and general exhaustion. in the course of a few years, he sinks under the disease; and, on examination of the chest after death, the lungs are found excavated, and several of the cavities filled with a solid or fluid carbonaceous matter. during the last ten years, my attention has been much directed, in the course of my professional labours in the neighbourhood of the coal-mining district of haddingtonshire, to the above phenomena in the pathology of the lungs, which have not hitherto been brought so fully before the profession, as their importance demands. the subject presents a very interesting field of investigation to the physiologist and pathologist. when we consider the difficulties which the medical man has to encounter, in prosecuting his researches in morbid anatomy in a mining district, it is sufficiently explained why the peculiarly diseased structures in the body of the coal-miner should have been left so long uninvestigated. not many years ago, the obstacles in the way of _post mortem_ examinations among colliers were insurmountable, and consequently, till lately, few medical men could obtain permission to examine, after death, the morbid appearances within the chest of a collier. with the rapid advance in the general improvement which has been going on, the collier's position in society has become greatly elevated; and his deeply-rooted superstitious feelings have been, to a great extent, dissipated. let us hope that the school-master will find his way into every collier's dwelling, enlightening his too long uncultivated mind; and that the foolish prejudices shall cease, which have been hitherto the barriers to _post-mortem_ examinations in his community. the only medical writers, as far as i am aware, who have brought this subject before the notice of the profession, are, dr j. c. gregory, in the report of a case of peculiar black infiltration of the whole lungs, resembling "melanosis," (_edinburgh medical and surgical journal_, no. cix., october ); dr carsewell, in an article on "spurious melanosis," (_cyclopædia of practical medicine_, vol. iii); dr marshall, in a paper in _the lancet_ for , entitled "cases of spurious melanosis of the lungs;" dr william thomson, now professor of medicine in the university of glasgow, in two able essays (_medico-chirurgical transactions of london_, vols. xx. and xxi.), wherein he gives a number of very interesting cases, collected from various coal districts of scotland, illustrating different forms of the disease; dr pearson, in the _philosophical trans._ for , on the "inhalation of carbon into the pulmonary air cells;" and in a paper, by dr graham, in vol. xlii. of the _edinburgh medical and surgical journal_. recently, professional and other writers have directed attention to the influence of various occupations in the production of diseases of the chest. the pernicious employment of the needle-pointers, razor and knife-grinders of sheffield, and other manufacturing towns in england,[ ] have not only engaged the attention of the public at large, but science has been at work to ascertain, with as much accuracy as possible, the relative effects of the different avocations, on the constitutions of those occupied in these destructive employments. researches of this nature tend much to the well-being of society, as they make us acquainted with the maladies and sufferings peculiar to certain classes of our fellow-men; and point out, also, the causes of their early decay, and premature death. the coal-miners--those in whose behalf i would now solicit the intervention of science--are most valuable in their place, and their exhausting labours promote, in no small degree, our domestic comforts. some of the diseases of colliers have in past time been very much overlooked by the medical inquirer. there has been, within the last few years, a very searching investigation as to the employment of women and children in coal-mines; and by the laudable exertions of lord ashley--a nobleman whose name shall ever be honoured among miners, and by all who have the true interests of that community at heart--an act of the legislature has been passed, declaring it unlawful for any owner of any mine or colliery whatever, to allow any female to work therein; and also enacting, that no boy under the age of ten years can be employed in mines. it is to be regretted, however, that his lordship did not embody in his measure, provisions enforcing the free ventilation of mines under government inspection; for nothing would tend more to improve the health of those employed in them. in the course of the inquiry, which formed the prelude and basis of lord ashley's act, much valuable information regarding the diseases of colliers was elicited; and no one can peruse the voluminous parliamentary report pertaining to these investigations, without being struck with the very general prevalence of affections of the chest among miners. it is to be hoped, that the interesting facts in regard to disease, which this recent most necessary investigation has laid open, will be the means of directing the attention of scientific men to the subject, with a view to obviate, as far as human efforts can, the evils which have been exposed. it may at first appear difficult, to point out the means of removing effectually the causes of the pulmonary carbonaceous disease of miners, but, be the difficulties what they may, humanity encourages us to make the attempt. in the _first place_, let us endeavour to ascertain the cause, and _secondly_, to suggest means for the mitigation or prevention of this scourge. my present remarks do not refer to coal-miners in general, but to a district in scotland, in the lothians, east of the river forth, where the labour is hard, and where its severity is in many cases increased by a want of proper attention to the economy of mining operations. these operations, as at present carried on, are extremely unwholesome, and productive of diseases which have a manifest tendency to shorten life. i draw the materials of my description from what i saw in a part of that district referred to, where the various cases, hereafter to be adduced, came under my medical treatment, and where i had the privilege of examining the morbid appearances after death. the locality[ ] in which my observations were made, is that part of the lothians, extending from south to north, stretching from the foot of the lammermoors towards the sea-coast, including the coal-works of preston-hall, huntlaw, pencaitland, tranent, and blindwells. in this range of the coal-formation, the seam of coal is variable, but generally exceedingly thin, varying in thickness from eighteen inches, to three or four feet. it is with difficulty that mining operations can be prosecuted, from the extremely limited space in which the men have to move, and from the deficient ventilation. it appears, after thorough investigation, that in the majority of the coal mines above mentioned, ventilation is very much neglected, and that this neglect is partly caused, by the immunity of these mines from carburetted hydrogen gas, which exempts them from the danger of explosion. but though there be no explosive gas, there is generated, to a certain extent, in the more remote recesses of the pit, carbonic acid and other gases, producing the most injurious effects--impairing the constitution by slow degrees, and along with the more direct cause (the smoke from the lamp, candle, and the product of the combustion of gunpowder,) making progressive inroads on the health of the unfortunate miner. and how, i ask, can it be otherwise, in such circumstances? so long as it is possible for him to go on--so long as there is air enough to support the combustion of the lamp or candle, the labourer must proceed with his toil. i say, from there being no fire-damp, less attention is paid to ventilation, and it is a common occurrence with colliers in these localities, to be obliged to leave their work, from there not being a sufficiency of oxygen to keep their lights burning, and support respiration; and this temporary cessation of labour under such circumstances is regarded as a hardship by some proprietors, while the bodily sufferings of the miner, shut up and necessitated to labour in this situation, are little considered. after labouring beyond a given time in those confined situations, there is a much freer action of the respiratory apparatus, the oxygen is considerably exhausted, and to make up for this deficiency, the volume of air inspired, (impure though it be,) is much greater. every now and then, there is a disposition to draw a deep breath, followed by a peculiar and gradual decrease of strength. therefore, in these forcible expansions of the chest, it is to be expected that a considerable quantity of the floating carbon will be conveyed to the cellular tissue. the atmosphere of the coal mine at length becomes so vitiated, by the removal of the oxygen in breathing, and the substitution of carbonic acid, that the respiration becomes gradually more difficult, and the exhausted labourer has ultimately to retire from the pit, as there is no other mode by which the noxious air can be removed--owing to the underground apartments being so small--than by gradually allowing purer air to accumulate. the miner is thus enabled to return to his employment. it is about thirty years since miners in this district adopted the use of coarse linseed oil, instead of whale oil, to burn in their lamps; and it is very generally known, that the smoke from the former is immensely greater than that from the latter, and many old miners date the greater prevalence of black spit to the introduction of the _linseed_ oil. this change took place entirely on the score of economy. any one can conceive how hurtful to the delicate tissues of the respiratory organs, must be an atmosphere thickened by such a sooty exhalation. it is now known, that this disease originates in two principal causes, viz., _first_, the inhalation of lamp smoke with the carbonic acid gas[ ] generated in the pit, and that expired from the lungs; _second_, carbon, and the carburetted gases which float in the heated air after the ever-recurring explosions of gunpowder, which the occurrence of trap dykes renders necessary. to those acquainted with mining operations, an explanation of the coal and stone hewing process is unnecessary; but, for the sake of the uninitiated, i may be allowed to state, in explanation, that, previous to any coal hewing, it is needful to remove various strata of stone, to open up road-ways, and break down obstructing dykes, by the aid of gunpowder. all coal-miners are engaged exclusively with one or other kind of labour; that is either in removing stone or coal: and the peculiar disease to which each class is liable, varies considerably, according to the employment. for instance, the disease is more severe and more rapid in those who work in the stone, than in those engaged in what is strictly coal-mining, while, at the same time, both ultimately perish in consequence of it. the fact of the disease being more acute in stone-miners, i am disposed to attribute to the carbon and other products of the combustion of gunpowder, being more irritating and more destructive to the lungs. a very striking instance of this occurred, a few years ago, at the colliery of the messrs cadell of tranent. a very extensive coal level was carried through their coal field, where a great number of young, vigorous men were employed at stone-mining, or blasting, as it is called, every one of whom died before reaching the age of thirty-five years. they used gunpowder in considerable quantity:--and all expectorated carbon. it was long a very general belief with medical writers, that the various forms of discoloration in the pulmonary tissue was induced by some peculiar change taking place in the economy or function of secretion, independently of any direct influence from without. they were, therefore, usually supposed to belong to the class of melanotic formations, from presenting, as their distinguishing feature, a greater or less degree of blackness. but, by recent investigations, it has been proved, that the infiltrated carbon found in the bodies of coal miners is not the result of any original disease, or change taking place within the system,[ ] but is carbon, which has been conveyed into the minute pulmonary ramifications, in various forms, during respiration; and which, while lodged in these tissues, produces irritation, terminating in chronic ulcerative action of the parenchymatous substance. the very minute bronchial ramifications first become impacted with carbon, and consequently impervious to air; by gradual accumulation, this impacted mass assumes a rather consistent form, mechanically compressing and obliterating the air-cells, irritating the surrounding substance, and promoting the progressive extension of the morbid action, till the whole lobe is infiltrated with carbonaceous matter, which, sooner or later, ends in ulceration and general disorganisation of the part. it is evident, in tracing the disease through its various stages, up to that of disorganisation, that wherever there is an impacted mass in any part of the pulmonary structure, this is followed, sooner or later, by softening, from its irritating effects upon the tissues by which it is surrounded; and as this softening process advances, the innumerable sets of vessels[ ] composing the dense network of capillaries are broken down, extending the cyst, so that, as the cysts enlarge, they gradually approximate to each other, till all at last become merged in one great cavity. the majority of colliers, soon after they engage in their mining operations, become afflicted with bronchial disease to a greater or less extent. those who are hereditarily predisposed to pulmonary irritation, are, it is my decided belief, more liable to "black phthisis" than others; but i cannot suppose it possible, that any constitution, however robust and sound, could resist the morbid effects resulting from carbon deposited in the lungs. tubercular phthisis is not at all prevalent in any collier community with which i am acquainted, only occasional cases occurring, and that amongst females. it is my impression, that a phthisical person, engaged in the operations of a coal-pit, similar to those in haddingtonshire, would come under the influence of the carbonaceous disease, instead of the true phthisis; for, in all the _post-mortem_ examinations which i have conducted, connected with this pulmonary affection, i have never found tubercular deposit:--while other members of the same family, having a like predisposition, and who never entered a coal-pit, have died of phthisis. can carbon inhaled destroy a tubercular formation? i never knew or heard of a case of black spit in a female collier, and this is accounted for by the circumstance, that the women, when permitted to labour, previous to the late prohibitory enactment, were only occupied as carriers; and from their movements towards the pit shaft, in transporting the coals, were enabled to inhale at intervals a purer atmosphere. the boys also, who were employed as carriers to the pit shaft, continued to labour with like impunity, from their occasional change of situation; but the miner, lying on his side in a confined, smoky recess, under ground, gasping for breath, proceeding with his exhausting labour, cannot fail, in his deep inspirations, to draw in the deleterious vapour, to the most minute ramifications of the pulmonary structure, and, as he daily repeats his employment, so does he daily add to the accumulation of that foreign matter which shall ultimately disorganize the respiratory apparatus. in the first stage of the affection, there is an incessant dry cough, particularly at night, and all the prominent symptoms of bronchitis are present. indeed, from the time a man becomes a coal-digger, and inhales this noxious air,[ ] there is ever after a manifest irritation in the lining membrane of the respiratory passages, which is apparent before carbon in any quantity can be supposed to be lodged in the lungs. the mucous membrane of the air passages, by its continually pouring out a viscid fluid, has the power of removing any foreign matter that may be lodged in them. now, should this membrane, owing to previous irritation, lose to a certain degree this secretory power, then the foreign body adheres to it, and is retained, and this, i think, constitutes the preparatory stage of black deposit. in tracing the progress of the disease, it is my belief, that immediately after the carbon is established in the air-cells, the absorbents become actively engaged, and the glandular structure soon partakes of the foreign substance. one of the peculiar features, as we shall find, when we come to describe cases, is, that the secretory function is ever after so changed in its character, that the gland which formerly secreted mucus, to lubricate the passages, now performs the same service with muco-carbon, and continues to do so during the remainder of the patient's life--even, as i have often seen, long after he has desisted from the occupation of a coal-miner. in fact, it constitutes a striking peculiarity of this disease, that when the carbon is once conveyed into the cellular tissue of the lung, that organ commences the formation of carbon, thus increasing the amount originally deposited, as was strikingly exemplified in the case of duncan and others, to be afterwards detailed. duncan had not for fifteen years been engaged in mining operations, nor was there any possibility of his having inhaled more carbon: yet in him it was found to have increased to the greatest possible extent, leaving but a small portion of useful lung. i have been long impressed with the belief, that the carbon is contained in considerable quantity in the blood, particularly in the blood of those far advanced in the disease. this impression arises, not only from its dark and inky appearance, but from its sluggish flow, and non-stimulating effects on the heart and general system; and when we examine the morbid condition of the pulmonary structure,--ascertain the presence of carbon in the glandular system and minute lymphatic vessels of the lungs, and consider the relation existing between them and the circulating fluid, we cannot suppose it possible, that such a mass of foreign matter should be lodged in their parenchymatous substance without imparting a portion to the blood. i was never more struck with this, than in the case of duncan, where the blood was more like thick brownish ink than vital fluid. no one who has witnessed the economy of these pits, can doubt the inhalation, to a great degree, of lamp and gunpowder smoke into the pulmonary tissue. what may be its chemical action there, is a question for us to attend to as we proceed. if it be considered an established fact, that carbon is inhaled, possessing all the chemical qualities of that substance found floating in the air of the coal-mine, and either expectorated from the lungs during life, or retained in those organs till after death, we cannot but conclude, that the black matter is the result of an external cause, and that that cause is the sooty matter. another question arises here, in connection with this phenomenon, viz.--does the carbon increase in the pulmonary tissues after the collier has relinquished the occupation of a miner, and when there can be no further inhalation, and if so, whence comes this increase? it must be admitted, judging from several of the cases which follow, that it does considerably augment. from this remarkable fact, does it not appear probable, that when carbon is once lodged in the pulmonary structure by inhalation, there is created by it a disposing affinity for the carbon in the blood, by which there is caused an increase in the deposit of carbon, without any more being inhaled. _appearances on dissection._ in classifying the morbid appearances observed in the pulmonary structure, i arrange them according to divisions corresponding to three stages of the disease. _first_, where there exists extensive irritation of the mucous lining of the air passages; and the carbon being inhaled, is absorbed into the interlobular cellular substance, and minute glandular system, thereby impeding the necessary change upon the blood. _secondly_, where the irritative process, the result of this foreign matter in the lungs, has proceeded so far, as to produce a variety of small cysts, containing fluid and semi-fluid carbonaceous matter, following the course of the bronchial ramifications. _thirdly_, where the ulcerative process has advanced to such an extent, as to destroy the cellular texture, and produce extensive excavation of one or more lobes. _stethoscopic signs._--in the early stages, the sounds indicate a swollen state of the air-passages, and vary in character according to the part examined. the whistling and chirping sounds are loud and distinct in the large and small bronchial ramifications, and both from the absence of expectoration and the presence of the pulmonary bruit, the highly irritated state of the mucous linings is apparent. the affection ultimately assumes a chronic form, and continues present in the respirable portions of the organ during life. as the carbonaceous impaction advances, the sounds become exceedingly dull over the whole thoracic region, and in many of the cases no sound whatever can be distinguished. where the lungs are cavernous, it is very easy to discover pectoriloquy, from the contrast to the general dulness, and when pleuritic and pericardial effusion advance much, it is difficult to ascertain the cardiac action. such is a short account of the _cause_, _progress_, and _morbid appearances_ of this deadly malady, as they came under my notice. * * * * * from a variety of cases to which my attention was directed, i i have selected _ten_, with the _post-mortem_ appearances in nine of them. these cases extend over a period of eleven years, all of them exhibiting, with some slight variation, the same character of disease, and proceeding from the same cause--inhalation of carbonaceous matter. some of the cases occurred as far back as the years - , while the last case came under my notice within these twelve months. of the ten patients, six were engaged at one period with stone-mining, and four were entirely coal-miners; eight expectorated carbonaceous matter, and two did not show any indication of black infiltration from the sputum; six exhibited, on examination, most extensive excavations of the pulmonary structure; and three only general impaction of these tissues, with numerous small cysts containing black fluid; the body of the tenth, i regret to say, was not examined, owing to neglect in communicating in time the death of the patient, which took place a few weeks ago. these morbid appearances exhibit three stages of the disease in regular progression. the first is that where the carbon is confined to the interlobular cellular tissue, and minute air-cells, producing cough, dyspnoea, slight palpitation of the heart, and acceleration of pulse, while, at the same time, the patient continues able to prosecute his daily employment. the respiratory sounds, in this state of the chest, are loud and distinct. such a condition of the pulmonary structure is often found on examination in the carron _iron-moulder_, who has been killed by accident, or has died from some other disease, having been subjected in the course of his employment to the inhalation of carbonaceous particles. the second is that stage where the softening has commenced in the several impacted pulmonary lobular-formed small cysts throughout the substance of one or more lobes, the contents of which may either be expectorated or remain encysted, giving rise to most harassing cough, laborious breathing, and palpitations, dull resonance of chest, and obscure respiratory murmur. the third and last stage, is that in which the several cysts in one or more lobes have approximated each other, forming extensive excavations, the prominent symptoms of the disease becoming considerably aggravated, and the powers of the system sinking to the lowest degree of exhaustion. * * * * * case . george davidson, collier from his youth. when i first saw him professionally, in may , he was aged thirty-two. from his earliest years he was employed about the coal-works in pencaitland parish, and when very young, he went down the pit to assist in conveying coals to the shaft, and ultimately became a coal-miner. for a considerable length of time, he enjoyed good health, having neither cough, nor any other affection. he was well-formed, and robust in constitution. a few months previous to my seeing him, he had taken to the employment of stone-mining in the pit at huntlaw, where he was accustomed to labour, and soon after being so engaged, he began to complain of uneasiness in the chest, and troublesome short cough, quick pulse, especially at night and in the morning, for which he sought medical advice, and was treated for bronchial affection. he continued to prosecute the employment of stone-mining in this coal-pit so long as his strength would permit, which was a little more than two years, when (august ) he was entirely disabled, from general exhaustion. by this time his cough had much increased, and there was considerable dyspnoea, accompanied with sharp pain in the thoracic region, both in walking quickly, and when lying down. pulse . he expectorated bloody tough mucus without any tinge of black matter. all remedial means were adopted with a view to the removal of the irritation of the chest, without producing any very decided effect. the thoracic pain was occasionally subdued, but the cough became incessant; loss of appetite, rapid emaciation, and cold nocturnal sweats, with slow weak pulse, supervened. after a severe fit of coughing, during one of his bad nights, the black expectoration made its appearance, in considerable quantity, by which his sufferings were for a few days alleviated, when the cough returned in the same degree of severity, and was again mitigated by the black sputa, which was expectorated without difficulty, and from this time (october ) there was no interruption to a free carbonaceous expectoration. in the early part of this man's illness, the stomach, the alimentary canal, biliary and urinary secretions, continued unimpaired; but as the cough advanced, gastric irritation, which was followed by vomiting during the paroxysms, annoyed him; and for the last eight months of his life, he suffered occasionally from severe attacks of gastrodynia, which, when present, had the effect of considerably modifying the thoracic irritation, and allaying the cough. there was nothing very remarkable in the character of the urine; the quantity voided was small, and very high coloured, with occasionally a lithic deposit. the fæces were natural, and smeared with dark blue mucus. on examining the chest with the stethoscope, the crepitant ronchus was heard in the upper part of each lung. there was general dulness throughout the lower part of both, with the exception of a small space at the inferior angle of the left scapula, where pectoriloquy was distinctly heard, from which was concluded the cavernous state of a portion of that lung. the heart's action was languid, and often intermitting, producing vertigo and occasional syncope. the pulse was gradually becoming slower; and at this time, (nov. ,) it was _forty-three_ in the minute. i was informed by this man, that his chest affection first became manifest, after being engaged with a difficult job in a newly formed coal-pit at huntlaw, where he had very little room to conduct his mining operations, which were carried on with the help of gunpowder, and where he experienced a sensation of suffocation from the confined nature of the pit,[ ] which did not permit of the exit of the evolved carbon, and ever after, his cough and difficulty of breathing had been increasing rapidly. during the greater part of the period he was under my charge, he continued to expectorate black matter, of the consistency of treacle, mixed with mucus in considerable quantity, and i would suppose, taking the average of each week, that he expectorated from ten to twelve ounces daily of thick treacle-like matter. i had the curiosity, during my attendance on this patient, to separate the mucus from the carbon, by the simple process of diluting the sputa with water, and thereafter separating and drying the precipitated carbon. i was enabled by this means to procure about one and a-half drachms of a beautiful black powder daily, and in the course of a week, i had collected near to two ounces of the substance. this process i continued for some weeks, till such time as i had procured a sufficient stock of this remarkable product of the pulmonary structure, and i am certain that the same quantity, if not more, could have been obtained till his death, in dec. . it is undoubtedly a striking phenomenon, connected with the pathology of the chest, that the human lung can be converted into a manufactory of lamp black! towards the close of this poor man's existence, the countenance and surface of the body assumed a leaden hue, from the very general venous congestion, and as his system became more exhausted, and he was about to sink in death, the gastric irritation and nocturnal cold sweats which had been long present with him considerably increased, along with a cough so severe as actually to produce vomiting of the black sputa. his tongue and fauces became so coated with the expectoration, that a stranger viewing the patient would have said that he was vomiting black paint.[ ] this case resembled in many of its features, one of tubercular phthisis, more than is generally found in the disease before us, there being cough and expectoration, dyspnoea, sharp pain in the thoracic region, colliquative sweats,[ ] and great emaciation, while at the same time, the pulse was slow and weak, not exceeding thirty-six in the minute for a week before death. no hectic heat of skin, but an extraordinary depression of the arterial action, arising evidently from the redundancy of carbon deposited in the pulmonary tissue, preventing the proper oxygenation of the blood circulating in the organs, and thereby producing a morbid effect on the whole system, which sufficiently explains the cachectic condition of the body. _post-mortem examination, twenty-four hours after death._--in removing the anterior part of the thorax, the lungs appeared full and dilated, and of a very dark colour. both lungs were strongly attached to the pleura costalis, and a very considerable effusion of straw-coloured fluid was found in both cavities of the chest. a few irregularly situated dark glandular bodies were observed on the surface of the costal pleura at each side of the sternum, and on the mediastinum. the lungs were removed with difficulty on account of the strongly adhesive bands attaching them to the ribs, and in handling them they conveyed the impression of partial solidity:--several projecting, irregular firm bodies, were felt immediately beneath the surface of the pleura, and there was also present emphysematous inflation of the margins of the upper lobes. in transecting the upper lobe of the left lung, it was found considerably hollowed out, (to the degree of holding a large orange,) and containing a small quantity of semi-fluid carbon, resembling thick blacking, with the superior divisions of the left bronchus opening abruptly into it. many large blood-vessels crossed from one side of the cavity to the other, to which shreds of parenchymatous substance were attached. the inferior lobe was fully saturated with the thick black fluid, and it felt solid under the knife, and several small cysts containing the carbon in a more fluid state were dispersed throughout its substance, in which minute bronchial branches terminated, and by which this fluid was conveyed to the upper lobe, and thence to the trachea. in examining the right lung, the upper, and part of the middle lobe were pervious to air, and carried on, though defectively, the function of respiration, while the interlobular cellular tissue contained the infiltrated carbon. the inferior portion of the middle and almost the whole of the under lobe were densely impacted, so that on a small portion being detached, it sank in water. both lungs represented, in fact, a mass of moist soot, and how almost any blood could be brought under the influence of the oxygen, and the vital principle be so long maintained in a state of such disorganization, is a question of difficult solution. in tracing the various divisions of the bronchi, particularly in the inferior lobes, some of the considerable branches were found completely plugged up with solid carbon; and in prosecuting the investigation still farther, with the aid of a powerful magnifier, the smaller twigs, with the more minute structure of cells, were ascertained to contain the same substance, forming the most perfect _racemes_, some of them extending to the surface of the lung, and to be felt through the pleura. the lining membrane of the permeable bronchial ramifications, when washed and freed from the black matter, exposed an irritated and softened mucous surface, which was easily torn from the cartilaginous laminæ. the interior of the trachea and its divisions gave evidence of chronic inflammatory action of long standing which extended from about midway between the thyroid cartilage and bifurcation to the root of the lungs. a considerable number of lymphatic glands, filled with--to all appearance--the carbon, were situated along the sides, and particularly at the back part of the trachea; which, from their size, must have interfered by pressure both with respiration and expectoration. the mucous membrane of the left bronchus in particular was much swollen and partially ulcerated towards the root of the lung. in examining the heart after its removal from the body, it was found peculiarly large and flabby, its cavities considerably distended, especially the right auricle and ventricle, while the valvular structure seemed natural. the pericardium contained about ounces of straw-coloured fluid. after examining the organ particularly, i could discover nothing abnormal, but the enlarged and softened state alluded to. the liver was large and highly congested with dark thick blood, but otherwise it was healthy. the gall-bladder was empty, and the spleen large and congested. the stomach was smallish and empty. the mucous membrane was smeared with a blackish, tenacious fluid, which, upon removal, appeared to be a portion of the expectoration. the structure, as far as could be ascertained, was healthy. the small and great intestines contained fluid carbon (evidently swallowed), while no disease was manifest. the mesenteric glands were small and rather firm, but they contained no black matter; the mesentery was much congested with dark venous blood. the kidneys were apparently healthy, though soft. the bladder was small and contracted. the head was not examined, as i expected nothing but general congestion of the vessels. this case comes under the third division of the disease, where the lungs were cavernous, and where there was free expectoration of carbon. case . the following case is one of unsuspected carbonaceous accumulation in the lungs, the history of which proves the fact, that the disease, when once established in the pulmonary structure, continues to advance till it effects the destruction of the organs, although the patient has not been engaged in any mining operations for many years previous to his death. robert reid, aged forty-six at his death, had been a collier since his boyhood. he was a short, stout-made man, of very healthy constitution, and never knew what it was to have a cough. he spent the early part of his life at a coal-mine, near glasgow (airdrie), where he all along enjoyed good health. in , he removed from airdrie to the coal-work at preston-hall, mid-lothian, where he engaged in mining operations; and, from the time he made this change, he dated the affection of which he died, at the end of . two months after he removed to preston-hall colliery, he was seized with bronchial affection, giving rise to a tickling cough in the morning and when going to bed, accompanied by dyspnoea, with a quick pulse ( ), and palpitation of the heart. in the first stage of the affection, he had no expectoration of consequence; but soon after, a little tough mucus was coughed up, and when it was difficult to expectorate, the sputum was occasionally tinged with blood. at this period, the appetite continued to be good, and the strength little impaired. during the day, he felt in his usual health; and, therefore, he continued in full employment. at the end of the four months (jan. ), his cough had increased much, his palpitation of heart, dyspnoea, and bronchial irritation had become very oppressive, and general exhaustion had manifested itself. recourse was had at this period of the affection to bleeding, blisters, and expectorants, which relieved him only temporarily, and while under this treatment, he--having a large family dependent on his exertions for their support--continued to struggle on at his daily vocation so long as he was able to handle the pick-axe. at the close of , which completed three years of labour in this coal-mine, he was obliged to discontinue all work, and take refuge in medical treatment, with a severe cough, palpitation, annoying dyspnoea, small intermitting pulse, and sleepless nights. on inquiring as to his general habits and mode of life, i found that he had been all along a sober, regular-living man, that he never complained of ill health till he engaged in this coal-mine at preston-hall, where the work was difficult and the pit confined, he having only twenty-four inches of coal seam which obliged him to labour lying on his side or back.[ ] he was also at this time occasionally engaged as a stone-miner, and was consequently subjected not only to the inhalation of the smoke of linseed oil, but to that of gunpowder. for his chest complaint at this stage, he underwent a variety of medical treatment, which produced mere palliation in his symptoms, and though breathing a pure atmosphere in a country situation, he experienced a most painful sensation of want of air, or, as he himself expressed it, "a feeling as if he did not get enough down." by this time the countenance had become livid, the lips and eyelids dark and congested. after undergoing medical treatment in the country, without much relief, he was removed to the edinburgh infirmary, in july , in the hope of deriving benefit; but after being a patient in that hospital for some weeks, he returned home much worse. in addition to the aggravation of his other symptoms, there were present oedematous swelling of the extremities, which were generally cold and benumbed, gnawing pain in the right hypochondriac region, and almost total loss of appetite. on examining the right hypochondrium, which he described as swollen, there was evident indication of an enlarged liver, and he complained much of shooting pain in that region during a paroxysm of cough. hitherto the functions of the stomach and bowels had remained unimpaired; but at this period, (september ,) the former became irritated, and the latter obstructed. tonics and gentle purgatives were administered, and continued for a considerable time. the urinary secretion was all along scanty and high coloured; but, as the disease advanced, the quantity became exceedingly small, (almost none was voided for days together,) for which he was taking diuretics; and on examining it with the application of heat, i repeatedly found it coagulable. general anasarca was now rapidly increasing; and as the cellular effusion advanced, the breathing became more laborious. i understand, that at the commencement of this person's affection, the pulse was frequent, with some heat of skin at night, but from the time he became my patient, there was a tendency to languor in the circulation, and the _beat_ at the wrist, for some months previous to his death, was almost imperceptible. with a view to remove the enlargement of the liver, a slight mercurial course was proposed; but owing to debility, indicated at its commencement, it was discontinued, and no effect produced on the organ. all medical treatment having been given up, except mere palliatives, such as blisters and expectorants, this poor man lingered out a most miserable existence from his pectoral symptoms, and particularly from palpitation of heart. expectoration continued the same, of tough, ropy mucus, small in quantity, and got up with difficulty from the air-passages. in repeated examinations with the stethoscope, there was considerable dulness over the whole thoracic region, no bruit whatever could be discovered in the left side of the chest, no cavernous indication, although that side of the thorax was fully developed. the mucous râle was heard very strong in the upper lobe of the right lung, and some little crepitation at the inferior angle of the scapula on the same side. the action of the heart under the stethoscope gave rather an uncertain indication as to the state of that organ, for though the sound was evidently communicated to the ear, as being transmitted through a fluid, and not the heart striking the ribs, still, from the very general dulness in the left side of the chest, it was exceedingly difficult to decide whether this obscurity arose from effusion into the pericardium, or from effusion into the cavity of the chest. there was one remarkable symptom manifested in this case,--that though the heart's action was to the observer feeble, the patient's sensations were as if the pulsation was very strong, and painfully difficult to bear, and this peculiar feeling to a great extent prevented him from sleeping. i cannot record this case without the painful recollection of this poor man's sufferings. for six months previous to his death, the dyspnoea and palpitation attendant upon his disease were of such a severe character, as to prevent him at any time lying down; and his sensations would not even permit his maintaining the sitting position, for he found it necessary to get upon his hands and knees, as the only posture affording any alleviation to his uneasiness. this peculiarity in the cardiac action was such, that, as he expressed it, "he lived in continual dread of death," and this being ever present to his mind, he was for weeks known almost never to close his eyes. he died exhausted, in november ; and there being doubts entertained regarding some of the symptoms of his disease, he requested that his body should be examined, which was done twenty-six hours after his death. _post-mortem examination._--the general anasarca gave the body a bulky appearance. on raising the sternum, the ribs seemed very firm and unyielding. the lungs were of a dark blue colour, and seemed at first appearance to fill completely both sides of the chest. towards the sternal end of the ribs, on the left side, three or four of the substernal or mammary glands were found enlarged and filled with black fluid. the pleura pulmonalis had (where there wore no adhesions) interspersed over it patches of false exudation, _of a dark brown colour_. the lungs adhered extensively to the pleura costalis, and from the character of the adhesions, they were evidently of some years' standing. in both sides of the chest there was effusion to a considerable extent of a dark-coloured fluid, resembling porter in appearance. on removing the left lung, which was difficult, from the strong adhesive bands, it seemed, from its weight and softness, to contain a fluid; and on making a longitudinal section of both lobes, a large quantity of thick, black matter, similar to black paint, gushed from the opening, exposing an almost excavated interior of both lobes. the carbonaceous matter contained was in quantity about an english pint, and the lung, when emptied, became quite flaccid, and very light. the air-cells of this lung were entirely destroyed, or nearly so, and one of the divisions of the left bronchus opened abruptly into the cavity at the upper part. both lobes were so completely adherent to each other, from inflammatory action, as to form a continuous sac, containing the above fluid. on examining the internal structure of the cavity, the parenchymatous substance which formed its walls presented a rugged and irregular appearance, resembling a sponge hollowed out, and infiltrated with black paint. at different points, the large pulmonary blood-vessels crossed the cavity in the form of cords, with portions of structure attached, and though these fragments had a black appearance, they exhibited, to a considerable extent, their original cellular structure when washed in water. the process of carbonaceous ulceration had proceeded so far in this lung, that at some points the pleura pulmonalis, which was much thickened, was left the sole medium between the contents of the sac and the cavity of the chest; while in other parts it was thick and spongy. on examining more minutely with the magnifier, open-mouthed bronchial twigs, and very small blood-vessels, were seen plugged up with solid and fluid carbon, and, from the appearance of the morbid structure, it was manifest, that the ulcerative process had effected a complete disorganization of the _bronchial_ tubes of every calibre, while the smaller _arterial_ vessels had alone suffered, leaving the larger ones entire.[ ] along the margin of the inferior lobe, indurated accumulations were felt through the pleura, and, on being laid open, they were ascertained to be impacted lobules, which resisted the knife. previous to the division, both lungs weighed about six pounds. on examining the right lung, which seemed much similar in weight to the left, and on making a section throughout its three lobes, the morbid appearances varied in each. the upper lobe was infiltrated with carbon into the interlobular cellular tissue, leaving the bronchial ramifications respirable, and lubricated with frothy mucus. the middle lobe presented a solid appearance, and contained a mass of indurated black matter, of the size of a largish apple, and consistency of consolidated blacking. the surrounding parenchymatous substance was disorganized, and undergoing the process of softening. in dividing the indurated substance, its internal structure exhibited a variety of greyish lines, forming parallel and transverse ramifications, which resembled small check in appearance, and which, when more accurately examined, was ascertained to be the disorganised walls of the minute air-cells and cellular tissue. the inferior lobe presented a state of complete infiltration, with the air-cells generally entire, and on putting a piece of it into water, it showed its density by sinking. when we examine the morbid appearances in this case, and compare them with the symptoms--when we consider that nearly all the respiration carried on in this man's chest, was performed in the upper lobe of the right lung, we are not surprised at his sufferings, nor is there much difficulty in explaining the very painful dyspnoea, on his attempting the recumbent position; and as death was instantaneous, it was evident that the immediate cause was the bursting of the left pulmonary cyst into the corresponding bronchus; the fluid carbon thus finding its way to the trachea, produced suffocation. the liver was exceedingly large, projecting outwards and downwards from under the ribs, and pushing up the diaphragm. its substance was soft, engorged with dark blood, and easily torn. there was no carbonaceous deposit throughout its structure, and its weight was upwards of twelve pounds. there was a considerable quantity of very dark bile in the gall-bladder. the heart was large, soft, and pale. there was considerable attenuation of the walls of both auricles and ventricles. the coronary veins were much distended with dark blood. the columnæ carneæ of the right ventricle were exceedingly slender and bloodless; the tricuspid valve was much thickened, and studded on both sides with small cartilaginous granules; the other cavities of this organ were apparently healthy, though thin in substance. the pericardium, which was rough, and much distended, exhibited a variety of false membrane on its internal surface, of a dark brown colour, and contained about eight ounces of dark fluid, similar to that found in the cavity of the pleura. in tracing the bronchi from the lungs to the bifurcation, the mucous membrane, which was smeared with fluid carbon, appeared much irritated, and considerably thickened, diminishing the diameter of these passages; and there were found externally at the root of the lungs, and around the bronchi, several large glands, containing a fluid to all appearance carbonaceous. the trachea showed a similar irritated condition with that of the bronchi. a little above the bifurcation, and at the back part of the trachea, a cluster of lymphatic glands were found, some of them the size of a horse bean, filled with carbon. _the spleen_ was very large, and much darker than usual, highly congested with venous blood, easily torn with the fingers, and weighed about three pounds. kidneys small, pale, and soft; bladder small, and corrugated; large accumulation of light brown fluid into the cavity of the abdomen, to the extent of two scotch pints. the viscera were much compressed from effusion. there was a rough brown exudation upon the surface of the peritoneum and intestines. the stomach was contracted to a small size. the mucous membrane was soft, pultaceous, and easily removed, tinged with dark green bile. the lymphatic glands along both curvatures were small and flaccid, and contained no black matter. the intestines appeared empty and contracted. the duodenum showed the same softened state of its mucous membrane as was exhibited by the stomach. the mesenteric glands were free from any disease. the head, on removing skull-cap, dura mater found natural; serous effusion to small extent under the arachnoid; very general congestion of the pia mater, giving both hemispheres of the brain a blackish appearance. the superior longitudinal sinus was filled with dark, inky-looking blood. in removing the pia mater, the convolutions of the brain were firm, and appeared natural. there was a light brown effusion into both lateral ventricles to the extent of about an ounce. reid, when he first came to preston-hall, had inhaled the evolved smoke of the coal-mine, thereby laying a foundation of this infiltrated mass. it must be manifest to every one who follows out the history of this case, and attends to the morbid appearances found within the chest, that there was a progressive accumulation of carbonaceous matter going on in the substance of the lungs from the time the patient engaged in working this difficult seam of coal till his death. * * * * * case . d. s. was aged years at his death, in august . he had been engaged as a coal-miner so soon as he was able to undertake work. he was a tall, muscular man, and for a long time enjoyed excellent health. he first began mining operations at one of the pencaitland collieries, and continued to labour there for many years. about six years before his death, he was induced by an increase of wages, to undertake stone-mining in the same pit; and soon after engaging in this employment, he began to be troubled with a slight cough, accompanied by dyspnoea, palpitation, and oppressive headach, which symptoms rapidly increased in severity. he declared that his cough and general ailments first showed themselves after labouring for a considerable time at stone-work, with the aid of gunpowder, in a situation where the air became so impure, both from defective ventilation and carbonaceous particles floating in it, as materially to affect the breathing. although he repeatedly changed his place of labour from one coal-work to another more healthy in the same parish, he experienced no mitigation of his annoying cough. when i first saw this man for medical advice in july , he had then been about two years engaged as a stone-miner, the bronchial irritation was very general throughout the chest, he had severe cough, hurried breathing, little or no expectoration, and on applying the ear to the thorax, the sibilant and sonorous bronchi were distinctly heard, which indicated a swollen and irritated condition of the mucous linings of the air-passages, and this irritation was also manifest in the mucous membrane of the nostrils, which was much swollen, acutely tender, and impeding considerably the passage of the air. the pulse was rather frequent, about in the minute. there was present much heat of skin during the night, which subsided towards the morning. the remedial measures were blisters and expectorants, which relieved him considerably. the cough recurred in paroxysms, accompanied by severe headachs, with little frothy mucous expectoration, and there was occasionally observed a slight tinge of blood in the sputum. at this period, his appetite was good, and with the exception of his cough and difficulty of breathing at night and morning, he seemed usually very well. though labouring under his disease, he continued at his employment of stone-mining, and would not be convinced of its injurious effects. _july ._ there was considerable increase of the palpitation when he attempted the recumbent position, or moved hurriedly. the remedies ultimately seemed to produce little effect. his general exhaustion advanced rapidly, and obliged him to relinquish all mining occupation. at the end of the summer of , when i saw him more regularly, and was enabled to watch his symptoms with more attention, these having materially changed for the worse, percussion elicited dulness over the chest, with the exception of the upper part of both lungs, where the mucous râle was heard louder than usual. the heart's action was strong and irregular, particularly so for some time after a fit of coughing, when he suffered excessively from headach, succeeded by a tendency to drowsiness. the pulse was slow and languid, not exceeding in the minute. his countenance had assumed a greyish inanimate aspect, his eyes became sunk, his robust frame bent and so emaciated from this peculiar disease, that though his age did not exceed years, a stranger looking at him, supposed him to have attained the age of . no treatment seemed to have any effect in allaying the cough, nor was he permitted to lie down. from his feeling of dyspnoea and thoracic oppression, his nights were almost sleepless, his extremities oedematous, usually cold and bloodless. during the greater part of the time he was confined to the house, the bowels were constipated, requiring daily purgatives. the urinary secretion was small in quantity and high coloured, but in neither discharge was there any thing very unnatural. in this almost inanimate condition he lingered on, when about six months before his death, during a paroxysm of cough, he expectorated a mouthful of thick black matter, and continued so to do periodically, at intervals of about three weeks, seeming to experience relief after voiding the carbonaceous sputum. there was little change in the symptoms of this man till death. he took little or no food, from his appetite being almost entirely gone, and from gastric irritation being constantly present. his cough and dyspnoea continued severe, with drowsy headachs and difficulty in keeping the body warm. the arterial action was exceedingly low. the pulse was in the minute, and difficult to discern. the strongest stimulant produced no increase of action, the sitting position was the only one in which he was at all easy, and in which he remained day and night till he ceased to live. _post-mortem examination, twenty-four hours after death._--the body was much emaciated. the chest large, and integuments tightly drawn over it, the ribs unyielding. in removing the anterior part of the chest, the lungs adhered strongly to the ribs, and were covered very generally with patches of dark-red false membrane, corrugating the pleura. each side of the thorax contained fully a pint of light-brown fluid. in removing the left lung, it felt firm and developed, and in dividing it throughout its lobes, a variety of small cavities and indurated masses of carbon were found to pervade its substance, exhibiting a sooty appearance, extending throughout the whole structure. the indurated nuclei were ascertained to be impacted lobules, and the small cavities were these disorganized and softened, and communicating with the bronchial tubes. part of the upper, and the whole of the inferior lobe, were soaked with carbon, and felt indurated. the right lung was similarly disorganized with the left. the greater part of the superior lobe was permeable to air, and the interlobular tissue contained carbon, in small, hard granules. the middle and inferior lobes contained several hard, indurated bodies, progressing to a state of softening, and in separating a portion of the latter lobe, it was found to sink in water. there was emphysema of the margin of the inferior lobes. there appeared considerable irritation and softening of the mucous membrane of both bronchi, extending from the root of the lungs to beyond the bifurcation of the trachea. there were several enlarged bronchial glands at the apex of the lungs, containing black fluid. the pericardium contained about eight ounces of straw-coloured fluid. there was a light-brown exudation, extending over serous lamina of the pericardium and the surface of the heart. the heart was flaccid, the right auricle and ventricle were enlarged and attenuated, and both vena cava at their junction with the heart were much dilated, the valvular structure natural. the liver was large, soft, and easily torn. the abdominal viscera in general appeared healthy; slight effusion into the cavity of the peritoneum. in this case head not examined, but which no doubt would have shown marks of extensive congestion, as in other cases. the above case comes under the second division of this disease, where the irritative process resulting from the foreign body pervading the lungs, had advanced so far as to produce a variety of small cysts, and circumscribed, indurated masses, the former containing _fluid_, and the latter _solid_ carbon, and it is evident in tracing its progress, that there must have been a very rapid increase within the system in the carbon originally deposited in the pulmonary structure by inhalation. there was very limited black expectoration shortly before death, and this merely the contents of a few small cavities communicating with the bronchial ramifications, while both lungs were extensively infiltrated with that matter which, had the patient lived, would have produced general softening, and more extensive excavations by the coalition of the various indurated tubulæ. * * * * * case iv. j. t., aged when he died, may . he became a collier in early life, in the neighbourhood of glasgow, and came, at the age of years, to east lothian, to engage in collier labour at blind wells, near tranent. from his own account, he was rather of a delicate constitution, and ill-fitted for the work of a coal-pit, consequently, after labouring a few years, he was, at the age of ,--owing to cough and difficulty of breathing,--obliged to relinquish the employment of a miner. he left east lothian, and retired to the west of scotland, where he became a country merchant, and continued so occupied for upwards of fifteen years. during that time, he was occasionally troubled, particularly in the morning, with his cough and hurried breathing, which was increasing in severity, but at no period had he expectorated black matter, nor was there any indication that his sufferings arose from carbonaceous disease. on account of becoming reduced in circumstances, he was under the necessity, though labouring under chest affection, of returning to his former employment of coal-mining at blind wells, at the age of , august . he had not been long engaged as a miner, after his return to east lothian, when his cough increased considerably, with laborious breathing, palpitations, and overpowering headach. both now and formerly, he wrought solely as a coal-miner, and at no time of his life did he work as a _stone-miner_. having a family to provide for, he struggled on laboriously under much suffering from his chest affection, till general exhaustion compelled him to leave off work, and seek regular medical advice, july . from his statement regarding the cause of the disease, i was led to understand that his cough, which never left him from the time he was first seized, was induced, at an early period, by bad air generated in the coal-pit at black wells, from the work being ill ventilated, and from the general use of coarse linseed oil for the lamps. when i first saw this man professionally, he was labouring under general weakness; his pulse was not above in the minute, small and thready. he suffered from drowsy headach, anorexia, cold and slightly oedematous limbs. he had incessant cough, with tough mucous expectoration. during a severe paroxysm, he vomited a mouthful of black paint-like fluid, followed by considerable relief, and ever after till his death, he continued to expectorate the same substance in great quantity, often to the extent of oz. daily. in examining the chest with the ear, the sound, from the distinct pectoriloquy, indicated a cavernous state of both lungs; otherwise the bruit was obscure. the remedies were merely of a palliative character, knowing the patient to be rapidly sinking. in this exhausted state he remained for some months; his appetite was almost entirely gone; the oedema of limbs increasing. there was also a leaden hue over the surface of the body, which was constantly cold. at this stage, the quantity of urine voided was small and dark in colour. bowels obstinate; occasional vomiting. the pulse ranged from to . the lips and ears were livid, and his drowsiness became more overpowering as death approached. _post-mortem examination._--the body was much emaciated; the ribs were prominent and unyielding. on removing the anterior part of the thorax, the lungs were found firmly adhering to the pleura costalis, and of a dark blue colour. there was an effusion to the extent of about sixteen ounces of light-brown fluid, found in the cavities of the pleura. the greater part of the effusion was into the left side. the lining membrane of the chest was almost wholly covered with false membrane of a dark brown colour. the right lung filled almost completely the right cavity of the thorax, while the left lung appeared much contracted, particularly towards the apex. the pleura of both lungs was much puckered, and interspersed with dark red patches around the adhesions. three or four of the substernal glands were found considerably enlarged, and filled with black fluid, and a cluster of the anterior mediastinal and lymphatic glands contained fluid having the same appearance. the right lung appeared solid to the feel, when removed from the body. it was rough and irregular over its surface, from a variety of indurated substances projecting from beneath the pleura. in making a section of the whole lung, each lobe was almost completely saturated with thick inky fluid, and was observed to be here and there hard and granular, particularly in the course of the larger bronchi. portions of this lung were pervious to air and emphysematous, but the greater part was disorganized, and contained carbonaceous matter in a solid and fluid state. the left lung was light and flaccid, when compared to the right. the upper lobe was extensively excavated. the parenchymatous substance was found ragged and unrespirable, and many large blood-vessels crossing from either side of the cavity, pervious to blood. with the aid of the magnifier, a variety of open-mouthed bronchial twigs and minute blood-vessels were visible, communicating with the cavity. the upper part of the inferior lobe was partially excavated, and containing about four ounces of fluid carbon. the lower margin of this lobe was firmly impacted. the mucous membrane of the trachea and bronchial divisions appeared, when washed and freed from the black matter, red and softened. the lining membrane of larynx was partially ulcerated, and the rima glottidis slightly oedematous. there were various small lymphatic glands on the back part of the trachea, which contained black fluid. the pericardium considerably distended, and contained nearly twelve ounces of light-brown fluid. evident marks of inflammatory action were observed externally. on its internal surface it was thickly coated with false membrane of a brown colour. the heart was pale, soft, and attenuated. the right auricle was much dilated, and its walls exceedingly thin. there were no further morbid appearances. head,--external congestion of an inky colour was found on the surface of the brain, which was to all appearance otherwise healthy. there was an effusion into both lateral ventricles. the abdominal viscera were natural. the liver was much larger than usual, soft, and highly congested with inky-coloured blood.[ ] it is evident, from the symptoms and history of the above case, that the patient had contracted the disease of which he died at an early period of his life, and that during the fifteen years he refrained from mining operations, the pulmonary structure retained the carbon inhaled while labouring in the coal-pit, and this is one of the many cases which can be produced as examples of the fact that the foreign matter once deposited in that structure originates a process of accumulative impaction and ultimate softening of the organ, which is gradually carried on till it is entirely disorganized. this case comes under the third division of the morbid action, viz. where extensive excavation of the structure is produced. * * * * * case v. a. g., aged at his death. he was a collier from his boyhood, and wrought during the greater part of his life at penston colliery in the parish of gladsmuir. he was a short-set robust man, and while labouring at penston, he enjoyed usually good health, free from cough or any affection of the chest. when he had attained the age of years, ( ), he removed from the penston to the pencaitland coal-work, and about six months after making this change, he began to experience a slight difficulty of breathing, accompanied by a troublesome cough and feverish nights. the pulse was . various soothing remedies were administered, which relieved for a little the pectoral symptoms; and as he felt no decided physical debility, he continued as usual at underground work. in i saw him often, and found that his pulmonary symptoms were becoming more marked; his cough was excessively annoying in the morning and when going to bed; his expectoration was frothy mucus, with dyspepsia, palpitation, and occasional headach. the resonance of the chest on percussion was very slightly impaired, and the respiratory murmur was variable, being occasionally louder at one time than another, and often much obscured, from the mucous secretion. labouring under this chest affection he still continued his daily employment till the spring of , when he was entirely laid aside, being unable to go below ground, or to take the slightest fatigue, for the smallest exertion produced a fit of coughing; and during a paroxysm of this kind, he expectorated a few black sputa, which in a few days disappeared, and gave place to the usual frothy mucous expectoration. this bronchial discharge was accompanied by considerable relief to the cough and dyspnoea. by this time, (june ), on applying the ear to the chest, the resonance is dull, and respiratory murmur obscure. the action of the heart was slow when compared to its former state. the pulse not beyond in the minute. by the end of this year he appeared in a half dead state,--but a mere shadow in regard to flesh. he was expectorating at intervals of some weeks, when the cough became more severe, a few carbonaceous sputa, and suffering severely from gastric irritation.[ ] during the last week of his life, he expectorated considerable quantities of black fluid, and died exhausted, january . _post-mortem examination_, which was conducted hurriedly, exhibited extensive effusion into both sides of the chest. the adhesions of the pleura were strong, and evidently of long standing. there was very general carbonaceous infiltration throughout the lungs, without excavations to any extent. various empty cysts, which could contain a hazel-nut, were found in the superior and middle lobe of the right, and throughout the whole of the left lung; in which bronchial twigs terminated. the pericardium was distended, with limpid effusion. the right side of the heart was dilated, and filled with dark treacly-looking blood; and when washed, it appeared pale and bloodless. its walls were thin, various patches of brown exudation extending over both pleuræ. there were several enlarged lymphatic glands, found at the root of both lungs, filled with black fluid. in examining the head, the pia mater was found much congested; but there was no effusion discovered into any of the ventricles of the brain, nor any other indication of disease. in tracing the history of this patient, connected with the disease, it will be observed, that until he came to pencaitland colliery, he had no symptom whatever of chest affection. penston coal-work is exceedingly well ventilated, and the miners who labour there seldom, if ever, suffer from the black expectoration, owing to the evolved smoke of every kind being freely carried off from its underground works, while it is quite the contrary at pencaitland, where many colliers, on leaving penston, are seized with the disease. this case comes under the second division of the disease, where the irritative process, the result of the foreign matter in the lungs, has proceeded so far as to produce a variety of small cysts, containing fluid, or semi-fluid carbon, following the course of the bronchial ramifications. * * * * * case . d. l., aged twenty-six years at his death, in august . he was the son of a collier, at pencaitland, and engaged at an early age in putting the coals to his father; and when he was fit for full collier-work, in , he was employed at the same coal-work. he was a tall, well-formed, robust young man, and not at all liable to chest affection. for some time he wrought, as a coal-hewer, but latterly was induced, ( ), for higher wages, to become a stone-miner in the same coal-pit, where gunpowder was used extensively in the operations. about six months after he commenced stone-mining, he became affected with a short tickling cough, expectoration of pearly tenacious phlegm, hurried breathing, tightness across the chest, frequent pulse ( ), heat of skin during the night, and occasional throbbing in the head. being young, and fearless of any danger from the occupation, although warned of the consequences, he continued to prosecute it, and twelve months (may ) after he first began, the cough had increased much in severity. the expectoration was diminished, and had become more difficult to void from the bronchi, and the breathing was more oppressive, accompanied by a painful tightness across the chest in the morning. the body was considerably reduced in bulk to what it previously had been. the pulse ranged from to ; the appetite was impaired, and there was in the morning a tendency to retching. the nocturnal heat of skin continued, without any moisture, though his body was drenched with a clammy sweat during the hours of labour. the respiratory murmur was harsh and extensive at the upper part of both lungs, while the sibilant ronchus was heard occasionally in the lower lobes. the heart's action was regular, but impulse strong, on applying the hand to the cardiac region. the remedies resorted to were blisters, bleeding (at an early stage), expectorants, and tonics, which, to a certain degree, relieved the more urgent symptoms. in october , the disease having made rapid progress, all the symptoms had become more marked. the cough, from its frequency and severity, was extremely exhausting, and the expectoration had become more copious, and of a semi-black colour. the mucous râle was evident in the upper part of both lungs, while the inferior lobes were dull to the ear, and on percussion. the heart's action, at this stage, was less strong, but no peculiarity in its function could be discovered. the cardiac region exhibited every indication of effusion into the pericardium. his body was now considerably emaciated, and the anterior part of his chest was so much contracted, as to oblige him to stoop to a great degree. under this load of disease, he continued his employment of a stone-miner, gradually losing flesh, with a rapidly increasing black expectoration; and having several dependant on his exertions, he resolved to work, while he could keep on foot, which he did till september of the following year, ( ) when his once powerful body was so reduced, from disease, and his cough so incessant, that he was unable to move or speak without great fatigue. he preferred the sitting position, as giving him most freedom in breathing. the pulse was rather slow and small; the heart's action languid, and there was an evident increase of dulness upon percussion over cardiac region. at this, the closing period of the disease, (november ) he first complained of drowsiness, accompanied by headach. the countenance was pallid; the eyes sunk and inanimate, and the body tending to be cold; the urinary secretion of a dark brown colour, and precipitates a dark deposit. the bowels were exceedingly obstinate, with little change in any of the symptoms; he lingered till january . _post-mortem examination._--the body was much emaciated. the thorax was large, and well arched. on removing the anterior part of the chest, the lungs appeared to be fully developed, and of a dark blue colour. there were several very slight adhesions between the pleuræ, and the effusion into both cavities was small in quantity. the pleura costalis was almost free from any exudation, but there were a variety of small patches of false membrane throughout the pleura pulmonalis. the left lung exhibited general carbonaceous infiltration. the upper lobe was partially excavated. the pulmonary structure, internally, was ragged and easily torn, and these cavities communicated with the bronchial divisions, the walls of which formed various septa. the inferior lobe was almost impervious to air. the minute bronchial ramifications and corresponding lobules were impacted with dense carbon. there were several clusters of small cysts throughout this lobe, containing carbon in a fluid state. a portion of this lobe sank in water from its density, and when squeezed with the hand, thick fluid carbon, containing hardened particles, could be expressed from it. the right lung was similar in external appearance to the left. the upper lobe was crepitant, though infiltrated with carbon into the interlobular cellular tissue. the air-cells were gorged with tenacious mucus. the middle lobe was partially excavated. the cellular tissue was considerably disorganized, and similar in diseased structure to the upper lobe of the left lung, with the exception of a portion affected by vascular emphysema. the inferior lobe was much condensed, and loaded with carbon of a very bright black. the mucous membrane of the bronchial tubes was thickened, and slightly ulcerated. various lymphatic glands were found at the root of both lungs, containing black fluid. the pericardium was considerably distended from effusion of a straw-coloured fluid. the internal surface of the pericardium was rough, and both laminæ appeared thickened from inflammatory action. effusion into cavity of chest to the extent of twelve ounces. the heart was natural in appearance, but thin in substance. the tricuspid and mitral valves were thickened, and exhibiting minute granulations on their surface. the right auricle and ventricle were dilated considerably. aorta, and other vessels proceeding from heart, were natural. the stomach was small, and exceedingly spongy in its mucous lining. the intestines were healthy. the kidneys were small, and peculiarly yellow in the internal structure. the liver was large, and engorged with dark thick blood; several small carbonaceous cysts throughout its substance. the spleen was large, soft, and much congested. the mesenteric glands free from black matter. _head._--the arachnoid thickened and opaque; there was very general congestion of pia mater with dark black blood, and when removed, convolutions studded over with innumerable dark points. the surface of the brain was apparently healthy, with an effusion of a light pink-like fluid into the lateral ventricles. the internal substance of the brain natural. this case is interesting, as showing the very rapid course, in some instances, of the disease to a fatal termination, and also how soon the strongest man can be brought under its destructive influence. this is the only case in which carbon was discovered in any of the other organs, as exhibited in the liver. the above case comes under the third division, showing extensive excavation of the pulmonary structure. case vii. james r. aged at his death, . he was a large muscular man, and wrought as a coal-miner in early life at pencaitland, and, as far as could be ascertained, he had never been engaged at stone-mining. at the age of thirty he was obliged to desist work, on account of a difficulty in his breathing, which he considered to be asthma, and he was occupied above ground, as the engine-man, during the latter part of his life. the slightest exertion produced exhaustion and palpitation of the heart; his bowels were obstinate, and his urinary secretion small in quantity. his cough was particularly troublesome in the morning, and was relieved by a free expectoration of frothy mucus. in this condition he continued, with the cough gradually increasing, for nearly twenty years, as i understand, when he began to void black sputa, which daily augmented in quantity till his decease, august . for some weeks previous to his death, his pulse had become slow and thready, in the minute. the oedema of the upper and lower extremities was extensive; the dyspnoea increased considerably; the countenance was livid; and the body remarkably cold. stimulants in considerable quantity were administered without the smallest effect. drowsiness supervened; and he was for some days previous to dissolution in a torpid condition, while at the same time he was quite collected when roused. _post-mortem examination._--on examining the body, the chest was large and well formed. the effusion into the cellular substance was very general. the cartilages of ribs were ossified, and both lungs were adhering strongly to the pleura costalis. there was large effusion into both cavities of the chest, to the extent of three english pints in whole. the pleura pulmonalis was much thickened and rough, with false membrane, and many patches of puckering. several lymphatic glands in the anterior part of the mediastinum contained black fluid. the left lung was carbonaceous throughout its substance. the upper lobe partially excavated and ragged; the inferior lobe infiltrated and emphysematous. the right lung was of corresponding black appearance. the lower lobe had a firm and condensed feel, and when divided, exhibited a mass resembling indurated blacking. the middle lobe was in part permeable to air; and there were several small cysts containing liquid carbon, connected with minute bronchial ramifications. various indurated knotty bodies were extended throughout its substance. in the upper lobe, the carbon was confined principally to the interlobular cellular tissue, and when pressed in the hand, gave out thick, black, frothy serum. the mucous membrane of bronchial divisions, when freed from the black matter, was swollen and eroded as far up as the bifurcation of the trachea. at several parts these passages were considerably contracted. the heart was enlarged, and dilated in all its cavities. the valves of the right and left ventricles wore thickened, from congestion of very minute veins, and were granular to the feel. the substance of the heart was soft. there were eight ounces of effusion into the pericardium, resembling that formed in the cavities of the thorax. the liver and the spleen were large; the former peculiarly yellow and oily. several very large veins, containing inky-looking blood, were seen ramifying its substance. the spleen was very friable. the kidneys were small, and apparently healthy. brain not examined. this case comes under the third division of the disease. r.'s case is peculiarly striking, from the length of time (twenty years or more) that the carbon was concealed within the pulmonary tissue, and also because he had never been engaged, as far as known, as a stone-miner; so that this case, along with others, illustrates the fact, that where the morbid action is the result of lamp smoke, from the combustion of coarse oil, and not gunpowder smoke, the disease is much slower in its progress, but ultimately fatal. * * * * * case viii. r. d., aged , at his death, . he was the brother of george davidson, subject of the first case in this essay. he began to labour as a miner, with his brother, in early life, at pencaitland coal-work. he first began as a coal-miner, and after being so engaged for five or six years, he removed to penston coal-work, which adjoins. he continued healthy for a considerable length of time, and at his brother's death, december , he was free to all appearance from any affection of the chest. he returned, , to pencaitland coal-work, where he engaged as a stone-miner, knowing that such employment was destructive to life; and from that change he dated the commencement of his disease. cough, palpitation, dyspnoea, headach, quick pulse ( in the minute), made their appearance, soon after he began trap labour, and these symptoms gradually increased, till he was laid aside in the course of two years, ( ,) when he first expectorated black sputum.[ ] as his exhaustion advanced, the carbonaceous expectoration became more copious, and he discharged from the lungs at an average twelve ounces of fluid, resembling liquid blacking, daily; and he died in a manner similar to his brother, case no. . some weeks previous to his death, his pulse rapidly sank to about or , and became exceedingly feeble;--cold extremities, oedema of the legs and arms, lividity of lips, eyelids, and ears, preceding dissolution. _post-mortem examination._--the chest was contracted; the ribs unyielding, with extensive adhesions of the pleuræ. both lungs were of a dark-blue colour, much puckered from patches of false exudation. there was extensive effusion into both cavities of the chest; and the right lung showed carbonaceous infiltration throughout its whole extent. the superior lobe was excavated, so as to contain a small orange; and about six ounces of thick, black matter were found in it. the middle lobe was crepitant, though soaked with black fluid; several impacted lobules were scattered throughout its substance. the inferior lobe was indurated, resembling a piece of moist peat. the left lung was cavernous in both lobes, and the cysts were empty, the contents having been expectorated. a small portion of the upper lobe was pervious to air. there were several enlarged bronchial glands at the root of both lungs; and the tracheal glands contained black fluid. the liver was large, and its substance soft. _head._--there was extensive congestion of the blood-vessels of the brain, with effusion into the lateral ventricles. the viscera of the abdomen were extensively congested, with slight effusion into the peritoneal cavity. it will be observed in referring to the history of this case, that till the time this man became a stone-miner, and carried on his operations with the aid of gunpowder, he had no symptom of the disease of which he died, and it is evident that the disease, if commenced at all, had made little or no progress till after his return from penston colliery to pencaitland, and after he had inhaled the residuum of gunpowder combustion, therefore the disorganization of the pulmonary structure was to all appearance effected between the summer of and december , showing decidedly the very irritating character of gunpowder smoke upon the delicate tissue of the air-passages. case . j. d., aged , at his death, april . he was a well formed man, with a fully developed chest. at so early an age as seven years, he engaged in the labour of the coal-pit at preston-hall, mid-lothian, and he continued to prosecute that employment for a period of years, when he was obliged to relinquish the work on account of an affection of the chest, being, as he termed it, "touched in the breath." during the subsequent years of his life, he had never once entered a coal-pit, nor had he any connexion with coal-works, but earned his bread by the trade of a travelling merchant. he had suffered much in his wanderings, from his breathing,[ ] for more than two years continuously, while loss of appetite, and thoracic irritation, had rendered his physical frame as weak as that of a child. when i first saw this man, which was about a month before his death, he laboured under rending cough, with a scanty tough mucous expectoration--oppressive dyspnoea, ascites, general anasarca, occasional giddiness, and throbbing headach on motion, or on assuming the standing position. his countenance was of a light blue or slate colour, and his upper and lower extremities had much the same appearance. his lips, eyelids, ears, and nose, were swollen and livid, and his eye-balls effused, and apparently projecting from the sockets. his sight was impaired and hazy. there was continued feeling of cold, with occasional rigors, and difficulty in keeping the extremities warm. there was considerable exhaustion upon the slightest exertion. the half reclining posture was the only one in which he was comfortable. the pulse was exceedingly slow, not above in the minute, it was small, and often imperceptible at the wrist. there was considerable weight and feeling of oppressive fulness in the region of the heart, which was dull on percussion. on applying the ear to the chest, little or no râle whatever was discernible, and the action of the heart was almost inaudible. he had a sensation as of great weight in the head, and difficulty in raising it. ho suffered from restless nights, short hurried breathing, with a feeling and dread of suffocation, evident fulness and enlargement in the region of liver, and inability to turn to the right side. the urine was small in quantity, of a bluish colour, and coagulable, irritability of stomach, and the bowels were obstinate and difficult to move, even with drastic purgatives. the treatment was merely palliative, no stimulant seemed to have any effect in exciting the system. ascites and general anasarca were considerable, giving the body a large appearance. for some days previous to his dissolution, there was increased lividity of countenance, and little or no action of heart. he had at no time expectorated carbon, even during many severe paroxysms of cough. upon inquiry, i found that this man had been a companion in labour to r. r. (whose case no. , is fully reported,) at preston-hall colliery, and from the morbid appearances found in r.'s chest, and from the character of the coal-work in which both were engaged, i was induced to believe duncan's to be a similar case. in ascertaining his early history, i found him to be a robust powerful man, though troubled with a cough and hurried breathing from his first becoming a collier, circumstances very usual with those who engage in difficult mining operations, and which they erroneously attribute to want of air, nothing more. _post-mortem examination, twenty-four hours after death._--the body was much swollen from effusion. on removing the anterior part of the chest, both lungs were much compressed from an immense effusion of a light brown fluid into the cavities of the chest to the extent of a gallon. the lungs were of a deep black colour, and irregularly spotted with dark brown patches of exudation. there were considerable adhesions of the pleuræ, and marks of very general chronic inflammation and false membrane over the greater part of the pleura costalis. there were adhesions of the left lung to the pericardium, which was much thickened, and contained about ounces of a turbid fluid. on removing the left lung, it seemed large, and felt partially consolidated, and on dividing it throughout both lobes, it contained a mass of semi-fluid carbon, of a bright black colour, similar to paint. in this lung, the air-cells were almost entirely disorganized, unfitting it for the function of respiration. the upper lobe was divided into a variety of cysts, filled with carbonaceous matter in a fluid state, into which many of the smaller bronchi opened, and through which various blood-vessels passed uninjured. the inferior lobe, when emptied of its contents, was so much excavated that the parenchymatous substance felt light and flaccid. on dividing the right lung[ ] it exhibited a pure black mass, but not so fully disorganized as the left. portions of each lobe were permeable to air, while other parts formed cysts, containing fluid and solid carbon, the inferior lobe showed an almost solid mass. the mucous membrane of the respiratory passages was inflamed and spongy throughout the divisions, the small ramifications were irritated and choked up with tough, frothy phlegm. there were several large bronchial glands at the root of the left lung. in tracing the divisions of the bronchi more minutely, from the root of the lungs into their substance, clusters of glands were observed filled with inky fluid, and narrowing considerably the air-passages, and in washing carefully a portion of the upper lobe of the right lung, and removing as far as possible the carbonaceous matter, several lymphatic glands were seen with the aid of the magnifier, imbedded in the interlobular cellular tissue, resembling small black beads. the tracheal glands when examined, contained black fluid, similar in appearance to what was found in the bronchial glands. the mucous membrane of the trachea was soft and irritated, smeared with tough bloody mucus, the lining membrane of the rima glottidis was thickened and slightly granular. the heart was much enlarged, and soft, with spots indicating chronic inflammatory action on and about the right auricle. both auricle and ventricle on the left side of the heart contained a deep-dark blood. there were several large lymphatic glands imbedded around the great vessels proceeding from the base of the heart, containing black fluid, the other cavities appeared healthy, though attenuated in substance. the coronary veins were congested. none of the cervical glands contained black fluid, though several of them were enlarged. the cavity of the abdomen much distended from ascites; the contained fluid was to the extent of about six scotch pints of a straw colour; the viscera much compressed, and matted together, with light brown exudation. the peritoneum was rough, and coated with the same exudation. the stomach and all the intestines correspondingly contracted; the mesentery appeared healthy; the liver was much enlarged, and darker than usual; the inferior lobe extending downwards, near to crest of ileum; the whole organ loaded with inky-coloured blood; the substance easily torn. the kidneys presented a natural appearance; the adipose substance in which they were imbedded was oedematous; the medullary substance of each presented a yellowish colour. _head._--the integuments were oedematous. on exposing membranes, considerable effusion under arachnoid; very general venous congestion, extending over the convolutions, and to the base of the brain. effusion into the lateral ventricles of a light yellow; the choroid plexuses thickened, and of a dark venous appearance; substance of brain firm and apparently healthy. from the history of this case, it will be found that d. had at no time shown any indication that carbon was infiltrated into the lungs. at an early age he came under the influence of the smoke of coarse linseed oil, and of gunpowder, while labouring in an unhealthy and ill-ventilated pit, which produced a cough common amongst colliers, who may be placed in similar circumstances; and it is evident, that during the last fifteen years of his life, the carbon--having previously taken up a lodgment in the pulmonary tissue--was gradually accumulating, and thereby producing painful dyspnoea, and the other formidable symptoms connected with the circulating organs, which followed as results, till it had almost entirely saturated the cellular structure, and rendered the lungs unfit for the functions of respiration, consequently impeding the necessary change, through the medium of that function upon the blood. there was a marked similarity in the morbid appearances between this case and that of reid, (no. ). they both wrought in the same pit at preston-hall, and were affected in a similar manner. both had enlarged liver, and the left lung principally disorganised. both had extensive anasarcous and other effusions, and both had coagulable urine. neither expectorated black matter, and both died from the bursting of a carbonaceous cyst into the bronchi, producing suffocation. duncan lived longer under the infiltration than reid did; and this was no doubt owing to his being younger, and also his healthy occupation latterly. i have preserved a quantity of the contents of a cyst in the left lung of this patient, for chemical analysis; also a portion of the blood from the vena cava, and a little of the black fluid from the bronchial glands.[ ] case . (the subject of the following case is still alive, .) j. s., aged thirty-six. he was born of collier parents, in the parish of pencaitland, and at as early an age as eight years, went under ground to assist his parents in the transmission of the coal, and when fit for work became a coal-hewer. from his infancy he was rather of a delicate constitution, with flat and contracted chest. when i first saw him, which was about eight years ago, ( ), he was in full employment as a coal-hewer, complaining of shooting pains through his chest, tickling cough in the morning, with scanty tough expectoration, and frequent palpitations. he was repeatedly under treatment for bronchial affection, which was usually relieved by expectorants, blisters, and _continued_ counter-irritants. each attack of bronchitis was the result, as he expressed it, of "breathing bad air in the pit," in which he was obliged to relinquish labouring, as the lamp would not burn, from the state of the atmosphere. he never wrought at the stone-mining nor blasting. in examining the chest with the ear, at this stage of the affection, the mucous râle was distinctly heard, and exceedingly loud throughout the greater part of the chest. the heart's action was strong, but natural; pulse , full and bounding. about four years ago, he removed from huntlaw to blindwell, a coal-work towards the sea-coast, an extension of the same coal formation. at this time, , he had very troublesome cough, particularly in bed, scanty frothy expectoration, annoying dyspnoea, preventing him taking sufficient nourishment, headach, obstinate bowels. he continued under all these ailments to labour with much difficulty, till the summer of .[ ] in reviewing the morbid appearances in the cases now detailed, it will be observed, that in the majority of them, the left lung exhibited the greater amount of diseased structure. this fact is particularly interesting, as in _tubercular_ phthisis, a similar predominance of disease is found on the left side. in almost all the cases, there was found very extensive effusion into the serous cavities, and particularly into those of the pleura and pericardium. both pleuræ were much thickened, and all the marks of a long standing pleuritic and pericardial inflammatory action were seen. the substance of the heart, in all the cases, was soft and attenuated; the right auricle and ventricle were dilated; and there was thickening of several of the valves. the liver and spleen were usually large and congested. in all the cases, as the disease advanced, the pulse came down to a very unfrequent and thready beat. from the great extent of the venous congestion, the disease often assumed the aspect of asphyxia; and in some instances the colour of the patients resembled that of persons labouring under cyanosis. the lividity of countenance, and the other concomitant symptoms, which presented themselves, gave decided indications of the morbid effects of this extraneous body. it requires little explanation to show how such a diseased state of the pulmonary organs, as has been described, should produce such results, by impeding the necessary chemical change of the blood. imperfect oxygenation of the blood, consequent on the altered pulmonary structure, must cause a general depression of all the vital organs. the excess of excrementitious matter in the circulation, must produce effusion of serum into the various cavities, and also into the cellular structure; and the appearances exhibited on the surface of the brain and its membranes, afford a full explanation of the sluggish inanimate condition of all the sufferers towards the close of their existence. from the cases above reported, it must be evident, that black phthisis is the result of foreign matter inhaled and retained within the pulmonary structure. it is a melancholy fact connected with mining occupations in the locality described, that few or none who engage in it, escape this remarkable disease. i have never known one collier in many hundreds, who, even in his usual health, was not, as he expressed it, more or less "touched in his breathing;" and after much experience in auscultation in such pulmonary affections, i am the more convinced that the dyspnoea from which they suffer, arises from impaction of the minute bronchial ramifications induced during their labour below ground, surrounded by an impure atmosphere. the east lothian colliers, of all miners throughout the kingdom, are certainly most subject to this disease; and those at pencaitland are so to a fearful extent. in the late inquiry for the parliamentary report, such has been manifestly brought out, and i am quite able to corroborate the conclusions at which the commissioners have arrived. it has been supposed by many that this carbonaceous affection was caused by inhalation of coal-dust. now, when it can be proved, that there is as much coal-dust at one coal-work as at another, the question comes to be, why should colliers, labouring at one coal-work, be subject to the disease; while those engaged at another, escape? for instance, there is as much coal-dust at penston and huntlaw, where there has never been black spit, as there is at pencaitland, preston-hall, and blindwells. i conclude, therefore, that this cannot be the cause, otherwise they should all be liable to the disease. again, those who labour as coal-bankers at the mouth of the shaft, are obliged to inhale much coal-dust in shovelling and arranging the coal received from the pit, and have the sputum tinged to a certain extent by it--which resumes its natural appearance when the collier leaves the labour producing it. they are not subject to the miners' cough, nor is there carbonaceous infiltration found in the lungs of such labourers after death. the females and boys, when, as formerly, both were allowed to labour, could not fail to inhale much of the coal-dust in which they were generally enveloped in their daily occupation; but no carbonaceous deposit has ever been found in the pulmonary tissue of either the one or the other. there are very interesting facts connected with the history of this disease, showing the length of time which the carbon can be retained, brought out by two cases on record, the one published as formerly mentioned by dr james gregory, in the _edinburgh med. and surg. journal_ for , denominated, "spurious melanosis;" the other, a case published by dr william thomson, (_medico-chirurgical transactions of london_ for ), and which was reported to him by dr simpson, now professor of midwifery in edinburgh. dr gregory's case is that of john hogg, who had been in the army for more than twenty years, had seen much service as a soldier in america and the west indies, and had served in spain during the peninsular war. on his return to his native country, he was engaged for a short time before his death as a collier at dalkeith. i understand, upon inquiry, from those who were connected with hogg, that he wrought in early life as a miner at pencaitland coal-work, and was obliged, though a young man, to relinquish such employment on account of a chest affection, and exchange the pick for the musket. from the history of this case, and from the character of his occupation in early life, i apprehend that the carbonaceous deposit took place when he was first labouring as a miner at pencaitland; and that he carried the foreign body in his lungs, throughout his campaigns. the case reported to dr thomson by dr simpson is that of a george hogg, who lived at collinshiel, near bathgate. in early life, this man laboured at pencaitland coal-work, where the greater number of the cases now under consideration occurred; and it is stated as a certainty, that he contracted the black phthisis while occupied in that district; for i find from those who knew him at an early period, that his breathing was much affected while at pencaitland, and he was long supposed by his fellow-miners to have imbibed the disease,--indeed he removed from pencaitland on account of it. the two hoggs were relatives, and natives of east lothian. it is evident, from several of the cases, that it is no uncommon feature of this affection for the carbon to remain concealed in the pulmonary tissue for very many years; and as both the hoggs were miners at pencaitland, i have not the smallest doubt that it was then and there that the disease had its origin; for i have never known a collier who was a stone-miner who did not ultimately die of the carbonaceous infiltration. apart from colliers and coal-mines, as a proof that carbonaceous particles floating in the atmosphere are inhaled and lodged in the bronchial ramifications, i may state the following circumstance, which came under my own observation several years ago. after a gale of wind, which had continued for more than a week, off the coast of america, in the july of , i was applied to for advice by several of the seamen, on account of a tickling cough, followed by a peculiarly dark blue expectoration, which i was told was almost general amongst the crew. i was certainly at a loss, and put to my shifts, to render a reason; but, upon investigating the matter further, i found that, during the gale, the chimney of the cook's apartment in the _'tween-decks_ was rendered inefficient, whereby the sleeping-berths were constantly filled with smoke. i found almost all the seamen, to the number of nearly a hundred, suffering considerably from cough, and expectorating an inky-coloured phlegm, which continued more or less for about a fortnight. i ordered soothing expectorants, and the dark sputa were profusely voided, and ultimately disappeared; but whether any of the carbon had made a permanent lodgment in the pulmonary tissue, is what i have never been able to ascertain. i am now convinced, in recalling this occurrence, that whatever be the situation, should carbon be floating in the air, it can be conveyed into the air-cells; and had these seamen been longer subjected to this foul atmosphere, a permanent lodgment of the carbon would undoubtedly have been the consequence, and the disease now under our consideration to a certainty produced. i further remember seeing, several years ago, a case of partially carbonized lungs in a person who had lived for a length of time in a smoky and confined room in glasgow. the patient died of dropsy, consequent, no doubt, on the pulmonary affection; and on examining the chest, the upper lobe of both lungs, and the bronchial glands contained black matter, similar in appearance to that found in the colliers. while engaged in committing these remarks to paper, i have been led in my investigations to compare the various kinds of labour carried on in coal-pits with the underground operations of many of the railways now in progress throughout the kingdom; and being convinced of the very injurious effects produced upon miners while prosecuting these operations in confined situations where gunpowder is used, i shall be much surprised if the same results do not follow the hazardous undertakings connected with railway tunnelling, where gunpowder is had recourse to, and in the course of years find in our public hospitals cases of carbonaceous lung arising from this cause.[ ] it is no uncommon occurrence, in examining the pulmonary structure of those who have resided in large and smoky towns, to find both the substance of the lungs and bronchial glands containing black matter; and this is the case especially with persons who, in such situations, have passed the prime of life. but few, though not living in crowded towns, have not, at some period of their life, come in contact with smoke, and been obliged to breathe it, minutely combined with the air. it is not, therefore, to be supposed improbable, that a portion of the infinitely small particles, thus suspended in the atmosphere, should effect a settlement in the more minute air-cells, and in course of time, be conveyed to the interlobular cellular tissue by the process of absorption, and thence to the bronchial glands. there are several cases on record, from amongst iron-moulders,[ ] where the pulmonary structure has been found heavily charged with carbonaceous matter, from the inhalation of the charcoal used in their processes, and where, during life, there was a free black expectoration.[ ] there is, then, little doubt that the bronchial glands, from their appearance in miners, moulders, and others, are the recipients of a portion of impurities which have been carried into the pulmonary structure by inhalation, and also those left after the process of oxygenation of the blood; and when it is fully ascertained, from the character of the atmosphere in the coal mine, that deleterious matter in this form must be conveyed to the air-cells during respiration, there is little difficulty in coming to the conclusion, that the black fluid found to such an extent in these glands in the collier and moulder, is similar to, and a part of, that discovered infiltrated into the substance of the lungs. if we trace the black matter in the lymphatic vessels, (which has been done), from the pulmonary organs to the bronchial, mediastinal, and thoracic glands, and from thence to the thoracic duct, we cannot but admit, that it does find its way into the venous system, and thereby contaminates the vital current.[ ] dr pearson of london, in his very valuable paper, published in the philosophical transactions of , on the coaly matter in the bronchial glands, was convinced beyond a doubt, that it was of foreign origin, and possessed the properties of carbon conveyed into the lungs from without. he, at that period, was not in possession of such facts as have been recently elicited on the subject of deleterious inhalation; but the very interesting materials which he brought to bear on his argument, have, i think, most satisfactorily proved the assertion which he makes, that "the lymphatics of the lungs absorb a variety of substances, especially this coaly matter, which they convey to the bronchial glands, and thus render them of a black or dark-blue colour." "the texture and proportion of the tinging matter of the glands was," he says, "different in different subjects, whether the lungs to which they belonged were in a healthy or diseased condition. in persons, from about to years of age, some of the bronchial glands contained no tinging black matter at all, but were of a reddish colour; others were streaked or partially black." again, he says, "i think the charcoal in the pulmonary organs is introduced with the air in breathing. in the air it is suspended in invisible small particles, derived from the burning of coal, wood, and other inflammable materials in common life. it is admitted that the oxygen of atmospherical air passes through the pulmonary air-vesicles or cells into the system of blood-vessels, and it is not improbable, that through the same channel various matters contained in the air may be introduced. but it is highly reasonable to suppose, that the particles of charcoal should be retained in the minutest ramifications of the air-tubes, or even in the air-vesicles under various circumstances, to produce the coloured appearances on the surface, and in the substance of the lungs, as above described." "when i compare the black lines and black net-like figures, many of them pentagonal, on the surface of the lungs, with the plates of the lymphatic vessels by cruikshank, mascagni, and fyffe, i found an exact resemblance." dr pearson, after various chemical experiments upon the bronchial glands with caustic potash, muriatic and nitric acid, says, "i conceive i am entitled to declare the black matter obtained from the bronchial glands, and from the lungs, to be animal-charcoal in the uncombined state, _i.e._ not existing as a constituent ingredient of organized animal solids or fluids." dr graham of london, in his paper on this subject, recorded in the d vol. of the _edinburgh medical and surgical journal_, gives the following opinion, as the result of a series of investigations, with the view of determining the nature of the disease in question. he says, i have had several opportunities of substantiating the carbonaceous matter in a state of extraordinary accumulation in black lungs supplied by my medical friends. the black powder, as derived from the lungs, (after an analysis,) is unquestionably charcoal, and the gaseous products from heated air, result from a little water and nitric acid being retained persistently by the charcoal, notwithstanding the repeated washing, but which re-acting on the charcoal at a high temperature, coming off in a state of decomposition. in regard to another analysis of a lung, he says, "the carbonaceous matter of the lung cannot therefore be supposed to be coal, altered by the different chemical processes to which it has been submitted in separating it from the animal matter. the carbonaceous matter of this lung, appears rather to be lamp black." from the whole results, i am disposed to draw the following conclusions:-- _ st_, the black matter found in the lungs is not a secretion, but comes from without. the _pigmentum nigrum_ of the ox i find to lose its colour entirely, and to leave only a quantity of white flocks, when rubbed in a mortar with chlorine water. sepia, which is a preparation of the dark-coloured liquor of the cuttle fish, was also bleached by chlorine, but the black matter of the lungs was not destroyed or bleached in the slightest degree by chlorine, it even survived unimpaired the destruction of the lungs by putrefaction in air. _ d_, this foreign matter probably varies in composition in different lungs, but in the cases actually examined, it seems to be little else than lamp black or soot. it does not appear, as far as i can ascertain, that any of the continental physiologists are familiar with the disease now under our consideration. several of them, both ancient and modern, discovered black matter in the pulmonary tissues, but not connected with nor exhibiting the black phthisis. it is therefore unnecessary to refer to them in general. the following foreign authors entertain various opinions in regard to the dark appearances in the pulmonary tissue:-- bichat supposes the black matter in the lungs "to be owing to small bronchial glands extending along the surface of the pleura." breschet believes that it is formed by the blood exhaled into the cellular tissue, stating that its chemical composition leads him to that conclusion. trousseau says that it is produced by a misdirection of the natural pigments of the body, resulting from age, climate, or disease. andral says, that the black appearances are the result of secretion, and that it is more manifest as the individual advances in life. heasinger's opinion is, that it is analogous to pigment, and therefore he agrees with trousseau. lænnec was doubtful as to the real origin of black pulmonary matter. he makes a distinction between melanotic and pulmonary matter. he found that the melanotic matter was composed almost entirely of albumen, while the black pulmonary matter found in the bronchial glands contains a great quantity of carbon and hydrogen, and also that these colouring matters have other distinguishing characters. the melanotic matter is easily effaced by washing, while the other is removed with difficulty. lænnec further says, that he suspected that this pulmonary matter might arise, at least in part, from the smoke of lamps, and other combustible bodies which are used for heat and light; for some old men are to be met with whose lungs contain very little black matter, and whose bronchial glands are but partially tinged with this colour; and it has struck him that he observed this amongst villagers who had never been accustomed to watch.[ ] mons. guillot, physician to the hospital for the aged at paris, has undertaken a series of researches in regard to the black matter found in the lungs of old men of very considerable age. these investigations are published in the january, february, and march numbers of the _archives générales de médecine_.[ ] it is his belief that death in such cases is owing, in all appearance, more or less to a suppression of the circulation of air and blood by the black substance. his impression is, "that the carbon is not procured from without, but naturally deposited, as life advances, in the substance of the respiratory organs; and that this deposit of carbon causes death, by rendering the lungs irrespirable, while, at the same time, it has much influence in modifying the progress of _tubercular_ disease; so that, if the tubercular affection was not cured, its progress was so far checked, that life has been very long preserved." the black matter envelopes completely both the pulmonary tubercles which have undergone a transformation, and the caverns which no longer contain tuberculous matter. he, while regarding these as the results of black matter in the lungs, throws no light on the cause of the deposit of the particles of carbon within the lungs. dr william craig of glasgow, in a letter to mr graham of london, published in the d vol. of the _medical and surgical journal of edinburgh_, states most interesting facts connected with this subject, particularly in regard to black matter found in the pulmonary structure of old people, which deserve considerable attention. he says--"i found that a black discoloration of the lungs was by no means a rare occurrence amongst those old people; and that it was impossible in many instances to decide, whether the black colour was owing to an increase of what is called the healthy black matter,--to a morbid secretion, or to a foreign substance being imbedded with the atmospheric air. after examining a considerable number of lungs, and finding that the division of the black matter into three kinds was not founded upon observation, and that the descriptions of them given by the best authorities were insufficient to enable us to distinguish them from one another, i begin to think, that in every instance in which black matter is found in the lungs, it ought to be considered morbid. if we examine the lungs at different stages of life, we find as a general rule that the quantity of black matter increases with age. in young children we find no traces of it, the lungs being of a reddish colour. at the age of ten years the black matter makes its appearance in the outer surface of the lungs, and in the interlobular spaces. at the age of thirty or forty, the lung presents a greyish or mottled appearance, and the bronchial glands contain more or less black matter. between the age of seventy and a hundred, the lungs are generally infiltrated with fluid black matter, which can be expressed from the cut surfaces, and stain the hands black." "there are many circumstances which favour the accumulation of this black matter in the lungs; for instance, long-continued living in a smoky atmosphere, like that of this city, the inhalation of coal-dust, as in the case of colliers, or of charcoal-powder, as in the case of iron-founders. there can be no doubt that we inhale foreign substances along with the atmospheric air. "we find the mucus which has remained in the nostrils for some time to be of a dark colour, and if we examine it with a microscope, we find, that this is owing to the presence of small particles of dust or other foreign substances, which the air may have accidentally contained. the mucus first coughed up from the lungs in the morning, is of a dark colour from the same cause, and the facts now maintained prove, that foreign substances suspended in minute particles in the atmosphere, may be inhaled into the lungs. i believe in all the extreme cases which have occurred in colliers and moulders, that there must have existed some previous disease of the lungs which prevented the foreign matter from being thrown off." "according to the views which we have taken of the subject, there are only two ways by which black matters may be deposited in the lungs; first, by a morbid secretion; second, by a foreign substance inhaled with the atmosphere. the former is a rare disease, while the latter is very common. i am inclined to think that the true melanosis generally occurs in the form of rounded tumours, which, when cut in two, present a uniform black colour without any trace of air-cells, while in the spurious melanosis the deposition is general, and black matter flows freely out when the cut surfaces are pressed. at first the lung is crepitous, and swims in water; but as the black matter increases, it becomes solid, and, as in the case of colliers who die of this disease, resembles a piece of wet peat in point of consistence. it is only in the cases of colliers, moulders, or others who inhale great quantities of black matter, that the lungs are rendered perfectly solid." there is an exceedingly interesting and valuable paper, written by dr brockmann of clausthal, upon the pulmonary diseases of a certain class of german miners,--supposed to be in the hartz mountains,--in _neumeister's repertorium_ for december , an abridged translation of which is to be found in the september number of the _monthly journal of medical science_. it is very evident that the disease there considered is produced by carbonaceous inhalation, and resembles in all its features the black phthisis so general amongst the colliers in haddingtonshire. the morbid appearances described by dr brockmann are very similar to the first and second division of that disease, presenting a very general carbonaceous infiltration of the pulmonary tissues; but in none of the stages are there to be found the extensive excavations discovered in the lungs of the coal-miner. dr brockmann makes three divisions of the morbid appearances, "the essential (wesentliche), accidental (zufällige), and secondary. the first shows an entirely black (pechschwärze) colour of the lungs through its whole substance, enclosing not only the air, blood, and lymph vessels, but also the connecting cellular tissue, the nervous substance, pleuræ pulmonalis, and bronchial glands." in such a state, it is usual for the lung to remain perfectly normal, and to exhibit the greatest varieties. the accidental (zufällige) is evidently the disease in a more advanced form, corresponding in a great measure with the second stage of the morbid action, found in the pulmonary organ of the collier. it is to be regretted that no accurate description is given either of the character of the mine, or the nature of the employment in which the miners are engaged, whether they be coal, silver, or lead mines, and if they are in the habit of burning coarse lint-seed oil. there is a very striking similarity between what dr brockmann calls the secondary anatomical changes, and many of those exhibited in the collier; first, membranes; second, collections of fluid into the pleuræ and pericardium; third, the softened heart, and very general emaciation; fourth, the extensive venous congestion, with thick black blood. the liver is described by dr brockmann as being small:--in the collier it is usually puffy, and much congested. the symptoms do almost in all points accord with those presented in the collier, as will appear from the following quotation, from the paper. "in the first stage, there is no local, functional, or general feature by which we can ascertain that the disease has commenced; probability is all we can reach. in the second stage, the disease is more obvious. and, first, there is a change in the expression of countenance; to a fine blooming appearance, which perhaps the patient previously had, there has succeeded a dark yellowish cast,--a change which gradually spreads over the whole body. for some time the patient may have remarked a gradual loss of strength, and now he complains of want of appetite and disordered digestion, and more particularly of shooting pains in the back and muscles of the chest. cough likewise supervenes, which may either be quite dry, or at most accompanied with a little pure mucus. there is also a greater or less degree of oppression, accompanied with palpitation of heart, not only after a severe fit of coughing, but after every exertion of the lungs. as yet no local deviation from the normal condition is seen on examination of the chest by percussion or auscultation." "the disease meanwhile passes into the third stage. the features of the patient now become more and more changed and deteriorated, and betray a deep melancholy. the colour of the face, which had been hitherto of an earthly hue, becomes blackish, as also the cornea, whereby the eye loses its lustre. the appearance of the patient becomes still more frightful from the great loss of flesh, and the dark skin hanging loose on his bones. the fat not only seems to have disappeared, but the muscular substance also--the whole frame being shrivelled. the patient complains of increasing weakness, diminished appetite, flying pains often concentrated at the pit of the stomach; and coughs much. the expectoration is for the most part difficult, and consists of masses of mucus, either greyish, or tending to a black colour. a black streak is frequently observed running through the whitish mucus; one half of it may be white, the other black, or occasional black points may be observed throughout the mass, and sometimes, though rarely, blood. dyspnoea is usually connected with the cough. it now begins to tell upon the patient, and is so characteristic, that the disease has been named asthma metallicum. the disturbance of the digestive organs increases the disease,--the appetite is entirely lost,--the tongue is covered with a white fur--there is an oppression at the stomach after a full meal--frequent eructations, and a tendency to constipation. the distress of the patient becomes increased in consequence of the shooting pains in the muscular system." "in the fourth and last stage, all the external appearances indicate the near approach of dissolution,--the face and members become bloated, and the feet greatly swollen." "the dyspnoea meanwhile, from effusion into the chest and pericardium, becomes so severe, that the patient cannot maintain the horizontal position, the expectoration becomes copious, consisting of a black inky (dintenschwarze), or ash-coloured fluid, sometimes of mere masses of mucus streaked with black." "the disease is never accompanied with colliquative sweats or diarrhoea." i am sorry to find that there is no allusion whatever to the state of the pulse. dr brockmann, in his remarks on the essential nature of this pulmonary disease of miners, brought under his notice, seems to entertain the impression that along with the inhaled carbon, resulting from the combustion of gunpowder, there is also an organic pigment-deposit present in the pulmonary tissue, which he supposes must have been formed in the lungs. i have long entertained the belief, which i have stated in another part of this essay, that if the carbon is once conveyed into, and established in the parenchyma of the lungs, that organ commences the formation of carbon; thus increasing the amount originally deposited. dr brockmann sets forth, as grounds for this view, that "if the parenchyma of the lungs were filled with carbonaceous dust, their specific gravity ought to be increased; but this is not the case. a completely melanosed lung swims in water, both as a whole and when cut into parts." it is very evident from these remarks, that the author has not seen the disease as it is exhibited in the third division of morbid action in the collier, otherwise he would have both observed the lungs considerably augmented in weight, and also so densely impacted from the accumulation of carbon, as wholly to sink in water. see for instance case no. , where the lungs weighed about six pounds, and parts of the cellular tissue were so indurated, as to be cut with difficulty. in this case, the patient did not expectorate. dr brockmann, as he advances, puts a question here, which more fully shows that the disease under his consideration was of a mild character compared with that under our notice. "if," says he, "pulmonary melanosis arise entirely from inhalation of carbonaceous dust, why is it not observed in other workmen, who are as much, and even more, exposed to its influence, as for instance, smelters, or moulders, and colliers?" he says, further, "were the carbon inhaled in quantity sufficient to explain the black colour of the lungs, it ought also, from its mechanical irritation, to produce inflammation in the delicate mucous membrane of the organ, but there are no symptoms of this during life, nor any traces of it after death." an answer to these remarks will be most satisfactorily given by a reference to the published cases, where the disease is principally found amongst colliers and moulders, and where the pulmonary organs, particularly in the former, are found to undergo most fearful disorganization from the presence of carbon. it is very remarkable, that the author of these exceedingly interesting observations should never have found excavations of the parenchyma, when it is so general as the result of the same disease in this country, particularly in the locality to which i refer. not knowing the character of the mine, it is impossible to judge; but i am disposed to conclude that there cannot be the same quantity of carbon floating in the atmosphere breathed by the german miner,--the disease resembles very much that milder form found in the iron moulder. with regard to the carbonaceous state of the blood, i am sorry that i have not yet completed my investigations on that subject. it is still my belief that the carbon being once inhaled, there is an affinity found for that in the circulating fluid, and from its not being consumed, owing to a deficiency of oxygen, there is a progressive increase going on. i am very much gratified to find that dr brockmann entertains a somewhat similar opinion in respect to the state of the blood. the effects of such a morbid structure upon the collier population in general is very marked. previous to the late legislative act, the tender youth of both sexes were at an early age consigned to the coal pit, and obliged to labour beyond their feeble strength, in circumstances ill adapted to their years. such early bodily exhaustion soon produced in them a pallid countenance, soft and relaxed muscular fibre, and predisposed much to disease as they advanced in life. the miner on this account was generally from his youth, thin; in fact, you never see a fat and healthy-looking collier, and, according to the advance of pulmonary disease, with them, so is the progress of emaciation. such a state of body may well be looked for in miners, labouring as they do, from ten to twelve hours in the twenty-four under ground, breathing a heated and impure atmosphere, which with difficulty sustains life, and which is demonstrably calculated, from its deleterious qualities, to induce serious disease. the effects manifest in the parent descend, and visible in the youngest children; they are squalid and wretched-looking,--and how can such offspring be otherwise? they are exceedingly subject to all children's diseases, and peculiarly predisposed to pulmonary irritation of one kind or other. with regard to medical treatment, little can be done after the disease has passed its first stage. early removal from the occupation, and proper attention to nutrition, alone seem to hold out the hope of prolonging the life of the patient; but if there be carbon lodged in the pulmonary tissues, there is a certainty of its sooner or later proving fatal. attention to the state of the digestive organs, and using every means to remove the dyspeptic symptoms, which are prominently present throughout the various stages of this disease, are indispensably requisite; and, as to nutrition, the nature of the diet should be as generous as possible. anodynes and expectorants are the only remedies which seem at all efficacious in allaying irritation. with a view to remove urgent symptoms, venesection has repeatedly been had recourse to, but in almost all instances i would say, with decidedly bad effects. blood-letting does harm, producing general debility and rapid sinking.[ ] with regard to the prevention of this disease, ventilation, as has been stated, is very much neglected in the pits now under consideration, where the various cases have occurred; and to that neglect i ascribe the prevalence of the malady. in those pits referred to, the workable apartments are so confined, and become after a time so destitute of oxygen, as, along with the smoke from lamps and gunpowder, to render the air unfit for healthy respiration. the only effectual remedy is a free admission of pure air, so applied as to remove the confined smoke. this remark both applies to coal and stone-mining. the introduction of some other mode of lighting such pits than by oil is required. i know several coal-pits where there is no carbonaceous disease, nor was it ever known; and on examination i find that there is and ever has been in them a free circulation of air. for example, the penston coal-work, which joins pencaitland, has ever been free from this disease; but many of the penston colliers, on coming to work at pencaitland, have been seized with, and died shortly after, of the black spit: for instance, g. case no. , and d. case no. , are such. how this is to be accomplished, is for the scientific man to say. with all due deference, i may be allowed to suggest various modes which might be adopted to free the underground atmosphere of the noxious ingredients. could fresh air not be forced down by the power of the steam-engine, which is at every coal-pit? could extensive fanners not be erected and propelled by the same machinery?[ ] i am much surprised that no attempt has been made to light these pits with portable gas in some way or other. as far as i can understand, such an application of it would not be difficult. a small gasometer could be erected, and the necessary apparatus procured at little expense, and by such means, i would suppose, it could be carried to any part of the mines, which are not extensive. many proprietors may grudge the expense involved in such improvements, and thus prove a barrier to these necessary alterations; but i would ask any candid and generous mind, what is expense when the object in view is the removal of a disease to which many human beings fall a sacrifice?[ ] it must appear to every one that these collier diseases are crying evils, the preventive of which is based, as will be seen, on thorough ventilation; and in order to protect the miner, there should be a vigilant attention paid to the economy of underground works. no one need be surprised at the result of such a noxious atmosphere; and it becomes a duty with the government to protect these poor people by laws, and to adopt those measures which are best calculated to preserve their health; and should there arise difficulties of an insurmountable character in the ventilation of these pits, why continue the mining operation in such situations at such a sacrifice of human life?[ ] * * * * * in the course of my investigations in regard to pulmonary carbonaceous infiltration, i was led to consider the circumstances of those engaged in other occupations than coal-mining. any one who has carefully examined the structure of the human bronchial glands, at different epochs of life, must have been struck with their appearance in those who, from their vocation, are compelled to breathe a sooty atmosphere, or who have lived in ill ventilated dwellings. i am further convinced, from the results of my recent investigations, that the bronchial glands in such persons invariably contain carbonaceous matter which has been inhaled at some period of life. having long entertained the belief that the lungs of chimney sweeps, for example, would, in all probability, be found to contain carbon, within the last few months two cases, of an exceedingly interesting character, connected with the present inquiry, have presented themselves,--the one of pulmonary disease, evidently resulting from the bronchial and lymphatic glands being impacted with inhaled carbon derived from soot,--the other a case of melanosis occurring in a young person. though the two diseases differ materially, they have often been confounded with each other and assigned to the same cause. my object in here reporting a case of stratiform melanosis, in connection with a disease having an external origin, is to afford an illustration of the fact, that all black deposits found in the system are not carbon. there exists a marked chemical distinction between the melanotic and the carbonaceous matter; and the anatomical situation of the two is also different. case.--a chimney sweep, aged , of the name of campbell, residing at stockbridge. the short history of his case i procured from his friends, as i did not see him during his illness. he had been a soldier in early life, and had seen much foreign service. after he relinquished the army, he became a chimney sweep, in which capacity he was constantly engaged for nearly twenty years. he had had, for a considerable time, a troublesome cough with tough expectoration. he experienced a difficulty of breathing in making any exertion, and he had considerable oedema of the limbs. from these symptoms he believed that he was subject to _asthma_. he had only been confined to bed for two days previous to his death. _post-mortem appearances._--the body exhibited extensive anasarca; the thorax was well arched; the cartilages of the ribs were ossified. on removing the anterior part of the chest, the pleuræ were found to adhere strongly, and appeared rough and puckered from extensive exudation of a brown colour, which extended very generally over the serous membranes. both cavities contained nearly three gallons of light brown fluid. the pericardium was considerably distended with a straw-coloured fluid, and several flakes of lymph floated throughout the effusion. both auricles of the heart were enlarged, and distended with exceedingly dark blood. the walls of both ventricles were much thickened. the valvular structure of the auricles was congested and granular. the lungs were removed from the chest with difficulty, owing to the very general pleuritic adhesions. both exhibited extensive emphysema. in dividing the lungs, and tracing the bronchial ramifications, each lobe was found to contain clusters of enlarged and indurated bronchial glands, impacted with thick black matter; and prosecuting the investigations, the minute lymphatic glands were observed clustered in a similar manner, and containing black fluid. in the substance of the upper lobe of both lungs, the bronchial glands were of a bright black colour; they were particularly large, and so numerous as to press considerably upon and obstruct several of the bronchial tubes. in fact the upper lobe of both lungs exhibited the plum-pudding structure. at the bifurcation and back part of the trachea, the bronchial glands were numerous, and of a deep black colour. a considerable mass of the glandular structure was removed for chemical and microscopic examination. the second case was that of a boy aged six years, who was under treatment for an affection of the heart and kidneys, and who died apparently from disease of these organs. he was, during his whole life, of a relaxed and weakly constitution, exceedingly sallow in the complexion, with a very deep blue tint of the sclerotic coat of the eye. in the course of the post-mortem examination, there was discovered, in the lower and lateral part of the right pleura, a cyst containing about an ounce of semi-fluid melanotic matter; and also the morbid secretion presented the stratified appearance described by dr carswell in his article upon melanosis, extending over the inferior half of the costal pleura and the corresponding part of the diaphragm. it formed a distinct layer on the surface of the serous membrane, resembling ink or blacking, and could with difficulty be removed. the black deposit resembled much in appearance the foreign matter found in the pulmonary organs of the coal-miner, and therefore was submitted, as well as the bronchial glands in the other case, to chemical analysis, with the view of ascertaining if there existed any analogy in the component parts of each. dr douglas maclagan submitted both these substances to the action of concentrated nitric acid, and the results were, that the glandular structure of the chimney sweep contained a very large proportion of carbon, while of the contents of the melanotic cyst, the same process did not leave a vestige of colouring matter,--evidently proving the distinction which exists between those two dark deposits, and making it sufficiently obvious, that melanotic matter is composed of the constituent elements of the blood, and has its origin within the body. there cannot remain a doubt as to the nature of the chimney sweeper's case; for, from the knowledge which we have of his occupation, and from the chemical properties manifest after investigation, i think i am entitled to declare the black matter obtained from the bronchial glands to be carbon inhaled with the air during his labour, and not existing as a constituent ingredient of organized solids or fluids. the microscopic examination showed the carbon most distinctly in a molecular form. it is my intention to return to this subject at a future time. northumberland street, edinburgh, january . * * * * * footnotes: [ ] vide an admirable series of papers on this subject in the volume of this journal for , by dr calvert holland. [ ] about ten miles east from edinburgh. [ ] generated from the decay of vegetable and other substances in the _formerly wrought_ pits, which communicate with those at present in use. [ ] it is proved, from the difference in the chemical character possessed by the melanotic matter, as compared with the matter found in the lungs of miners. [ ] it will be observed, that, though the small blood vessels are destroyed, no hemorrhage takes place, owing to the formation of a carbonaceous plug. [ ] the air of the coal-pit is so charged with carbon as to prevent the collier from distinguishing his neighbour when at work. [ ] note from the evidence of a collier examined before the government commissioners in , no. of report. "colliers in this part of the country are subject to many oppressions; first, black spit, which attacks the men as soon as they get the length of years of age;" second, note , "the want of proper ventilation in the pit is the chief cause, and no part requires more looking after than east lothian," the men die off like rotten sheep. note, , the witness, years old, says, "i am unable to labour much now, as i am fashed with bad breathing--the air below is very bad, and till lately no ventilation existed." [ ] the black sputum retains its colour after being submitted for some days to the action of nitric acid. [ ] this is the only case in which i at any time observed colliquative sweats as a symptom of this disease. [ ] to convey an impression of the nature of the labour in which the man was engaged i shall simply extract a few remarks from the evidence of the miners at this coal-work, taken by mr franks for the government's commissioners, note . "at all times the air is foul, and the lamps never burn bright. the seam of coal is inches, and the road only three feet high." note --"experienced colliers do not like the work, and many are touched in the breath." and in such a situation man is doomed to labour! note --"most of the men here are _fashed_ with _that trouble_; foster, miller, blyth, and aitken are all clean gone in the breath together. colliers here drop down very soon." [ ] it is evident in this disease that the bronchial ramifications are destroyed, while the arteries, with the exception of the minute twigs, are preserved. [ ] one of the lungs (the left one) now described, i sent to dr john thomson, late professor of pathology, and will probably be found in his collection, which i understand is in the college of surgeons. [ ] after a free expectoration of black matter, there was an evident mitigation of all the pectoral symptoms, and as the carbon again accumulated in the lungs, the sufferings of the patient were very considerably increased. [ ] this sputum was subjected to the action of nitric acid, which produced no effect upon its colour. [ ] when pulmonary disorganization has proceeded far, from the presence of carbon, there is a languor in the vital action from defective oxygenation of the blood, which produces a gradual reduction in the temperature of the body, requiring double clothing, and even that addition is, with the aid of stimulants, not sufficient to keep the patient warm. [ ] this lung is in the possession of sir james clark, of london. [ ] the above substances were submitted separately to the action of nitric acid and caustic potash, and the result was that a large proportion of carbon was precipitated. [ ] since writing the above the patient has died; and i regret that, owing to neglect in communicating with me, i have been prevented examining the morbid appearances. [ ] several of the pencaitland colliers are at present engaged in the tunnelling operations near to edinburgh, connected with the north british railway. [ ] dr hamilton's of falkirk paper in the edin. med. and surgical journal, vol. xlii. [ ] i have very lately, through the kindness of mr girdwood, surgeon at falkirk, had an opportunity of examining two or three iron-moulders in that district. both from the nature of the employment in those iron works, and the character which the pulmonary affection exhibits, the fact of inhalation is fully established. the moulder is at a certain stage of his labour enveloped in a cloud of finely-ground charcoal, a portion of which cannot fail to find its way to the lungs in breathing. he is subject to tickling cough, and as the disease advances, the respiratory sounds, which indicate considerable bronchial irritation, present themselves, and ultimately become dull, and in some parts obscure. of the several cases which i saw with mr girdwood, one, who has not been labouring for some years as a moulder, occasionally expectorated black matter, and in the other two, there was general dullness of both lungs; and, i doubt not, impaction. [ ] it has not been in my power hitherto to procure so satisfactory a chemical analysis of the blood as i would wish, but through the kind assistance of dr douglas maclagan, who has undertaken to conduct the process, i expect very soon to be able to lay it before the profession. [ ] i found little or no black matter in the lungs of farm servants, who are much in the open air. [ ] _vide_ monthly journal for , p. . [ ] at any time when these colliers required venesection, particularly towards the last stage of the disease, the blood appeared peculiarly dark and treacle-like. [ ] could oxygen not be prepared and forced down? [ ] i am happy to find that the attention of the noble proprietor of the newbattle coal works is now directed to this subject. [ ] i cannot pass from this subject without an observation on the beneficial results which have been the consequence of lord ashley's valuable colliery act. the female labourers, and particularly the unmarried, have improved not only in their appearance, but also in general physical development, since they have abandoned the unhealthy labour of the coal-mine. they are no longer the squalid, filthy, and ill-favoured race they formerly were. there is now exhibited on the face of the collier girl the bloom of health and cheerfulness; and when we descend to their domestic economy, there is observed a comfort in the management of their households, which formerly did not exist. their children are now particularly cared for, both in health and when suffering from disease; and we must regard this early watching as an important step to the removal of that predisposition to pulmonary irritation, so general in the collier community. u. s. department of agriculture, bureau of animal industry. j. r. mohler, chief of bureau. * * * * * special report on diseases of cattle. by drs. atkinson, dickson, eichhorn, hickman, law, lowe, marsh, mohler, murray, pearson, ransom, trumbower, and woodward. * * * * * revised edition, . [illustration: usda seal] washington: government printing office. . * * * * * transcriber's note: minor typos have been corrected, tables have been modified where necessary to fit within the constraints of a text file, and footnotes have been moved to the ends of the sections. inconsistencies in spelling (e.g., d'arboval/d'arborval) and hyphenation (e.g., postmortem/post-mortem) have been resolved in all cases where it was possible to divine the author's intent with a reasonable degree of certainty. the occasional error which could not be resolved was marked [sic]. italicized letters and words are enclosed by _underscores_. subscripts are represented by an underscore and curly braces: _{ } (for example, sio_{ }). ligatures which cannot be reproduced in the latin- character set are enclosed in [brackets] (for example, c[oe]nurus). * * * * * [extract from "an act making appropriations for the department of agriculture for the fiscal year ending june , , and for other purposes," approved february , . public--no. .] for printing, binding, and distribution of the publications entitled "diseases of the horse" and "diseases of cattle," $ , : _provided_, that said publications shall be deposited one-third in the folding room of the senate and two-thirds in the folding room of the house of representatives, and said documents shall be distributed by members of the senate and house of representatives. contents. page. administration of medicines. by leonard pearson diseases of the digestive organs. by a. j. murray poisons and poisoning. by v. t. atkinson diseases of the heart, blood vessels, and lymphatics. by w. h. harbaugh noncontagious diseases of the organs of respiration. by william herbert lowe diseases of the nervous system. by w. h. harbaugh diseases of the urinary organs. by james law diseases of the generative organs. by james law diseases following parturition. by james law diseases of young calves. by james law bones: diseases and accidents. by v. t. atkinson surgical operations. by william dickson and william herbert lowe tumors affecting cattle. by john r. mohler diseases of the skin. by m. r. trumbower diseases of the foot. by m. r. trumbower diseases of the eye and its appendages. by m. r. trumbower diseases of the ear. by m. r. trumbower infectious diseases of cattle. revised by john r. mohler the animal parasites of cattle. by b. h. ransom mycotic stomatitis of cattle. by john r. mohler index illustrations. plates. page. plate i. position of the first stomach (rumen or paunch) ii. stomachs of ruminants iii. instruments used in treating diseases of digestive organs iv. microscopic anatomy of the liver v. ergot in hay vi. ergotism vii. diagram of the circulation of the blood viii. position of the lung ix. kidney and male generative and urinary organs x. microscopic anatomy of the kidney xi. calculi of kidney and bladder xii. fetal calf within its membranes xiii. pregnant uterus with cotyledons xiv. vessels of umbilical cord xv. normal position of calf in utero xvi. abnormal positions of calf in utero xvii. abnormal positions of calf in utero xviii. abnormal positions of calf in utero; surgical instruments and sutures xix. monstrosities xx. instruments used in difficult labor xxi. instruments used in difficult labor xxii. supports for prolapsed uterus xxiii. supports for prolapsed uterus xxiv. instruments used in diseases following parturition xxv. skeleton of the cow xxvi. devices for casting cattle xxvii. surgical instruments and sutures xxviii. various bacteria which produce disease in cattle xxix. upper or dorsal surface of the lungs of the ox xxx. broncho-pneumonia xxxi. contagious pleuro-pneumonia xxxii. contagious pleuro-pneumonia xxxiii. foot-and-mouth disease xxxiv. tuberculosis of the lungs of cattle xxxv. tuberculosis of the liver xxxvi. tuberculosis of lymph gland and of omentum (caul) xxxvii. fig. .--tuberculosis of sirloin and porterhouse cuts of beef. fig. .--tuberculosis of pleura of cow, so-called "pearly disease" xxxviii. tuberculosis of cow's udder xxxix. actinomycosis xl. actinomycosis of the jaw xli. actinomycosis of the lungs xlii. section of muscle from a blackleg swelling xliii. necrotic stomatitis (calf diphtheria) xliv. normal spleen and spleen affected by texas fever xlv. texas fever xlvi. the cattle tick (_margaropus annulatus_), the carrier of texas fever xlvii. the cattle tick (_margaropus annulatus_) xlviii. portion of a steer's hide showing the texas fever tick (_margaropus annulatus_) xlix. fig. .--tick-infested steer. fig. .--dipping cattle to kill ticks l. facsimile of poster comparing ticky and tick-free cattle text figures. fig. . hornfly (_hæmatobia serrata_) in resting position . hornflies (_hæmatobia serrata_) on cow horn . buffalo gnat . screw worm (larva of _chrysomyia macellaria_) . screw-worm fly (_chrysomyia macellaria_) . the warble fly (_hypoderma lineata_) . short-nosed blue louse (_hæmatopinus eurysternus_) of cattle . long-nosed blue louse (_hæmatopinus vituli_) of cattle . red louse (_trichodectes scalaris_) of cattle . egg of short-nosed blue louse (_hæmatopinus eurysternus_) attached to a hair . mite which causes psoroptic scab of sheep . portion of the wall of the first stomach with conical flukes (_paramphistomum cervi_) attached . twisted stomach worms (_hæmonchus contortus_) . twisted stomach worms (_hæmonchus contortus_) enlarged . embryo of twisted stomach worm (_hæmonchus contortus_) coiled on tip of grass blade . a drenching tube made from an ordinary tin funnel, a piece of rubber hose, and a piece of brass pipe . piece of lining of fourth stomach showing cysts of the encysted stomach worm (_ostertatia ostertagi_) . a tapeworm (_moniezia planissima_) which infests cattle . the common liver fluke (_fasciola hepatica_) . the large american fluke (_fasciola magna_) . portion of grass stalk bearing three encysted cercariæ of the common liver fluke (_fasciola hepatica_) . hydatids (_echinococcus granulosus_) in portion of hog's liver . thin-necked bladder worm (_tænia hydatigena_) from abdominal cavity of a steer . lung worms (_dictyocaulus viviparus_) of cattle special report on diseases of cattle administration of medicines. by leonard pearson, b. s., v. m. d. medicines may be administered to cattle in many ways. the channel and method of administration depend on whether a general or local effect is desired, the condition of the animal, and the nature of the medicine that is to be given. the easiest method, and therefore the most common, is to give ordinary remedies by the mouth with the food, with drink, or separately. there, are, however, some conditions in which medicines administered in this way will not act promptly enough, or wherein a desired effect of the medicine on a distant part of the body is wholly lacking unless it is applied in some other way. the various methods of administering medicines to cattle will be considered below. by the mouth.--the simplest way to give medicines by the mouth is to mix them with the food or water. this can be done when the medicine is in the form of a powder or fluid, if but a small quantity is to be given, if it does not have a taste that is disagreeable to the animal and is not so irritant as to injure the lining membranes of the mouth and throat. the usual method of administering bulky or unpalatable doses is to mix them with a fluid vehicle, such as water, milk, molasses, or broth, and give from a bottle. a dose given in this way is known as a "drench." in administering a drench the head of the animal should be elevated a little by an assistant. this is best accomplished when standing on the left side of the cow's head and by grasping the nose with the thumb and fingers of the right hand inserted in the nostrils; with the left hand beneath the chin the head is further raised and supported. if the animal is unruly, it may be tied in a stall or placed in a stanchion. the medicine can now be poured into the mouth by inserting the neck of the bottle between the lips on the right side. care must be taken to avoid getting the bottle between the back teeth. the mouth of the bottle should be inserted as far as the middle of the tongue and the contents poured slowly. if the cow coughs, the head must at once be lowered to permit the fluid to escape from the larynx. if medicine is given during coughing, some of the dose may pass down the windpipe to the lungs and cause a severe or a fatal pneumonia. this is especially to be guarded against when the throat is partly paralyzed or insensitive, as in parturient paresis (milk fever). in this disease it has often happened that drenches have been poured into the lungs, thus killing the cow. the quantity of fluid to be given in a drench depends upon the effect desired and the nature of the medicine. in impactions of the stomach very large quantities of fluid may be given--as much as a gallon or several gallons at a time. usually, however, it is not customary or desirable to give more than from to quarts at a dose, and not more than a pint unless it is necessary on account of the irritant quality of the drug that has to be shielded with a large quantity of the vehicle. soluble medicines should be completely dissolved before they are given; insoluble ones should be finely divided by powdering or by shaking, and should be well agitated and mixed immediately before they are given. in the latter case a menstruum with considerable body, such as molasses or flaxseed tea or milk, will help to hold solids or oils in suspension until swallowed. _balls_ are large pills adapted for the larger animals. powders or gums are sometimes mixed with an adhesive substance and rolled into balls for the purpose of convenience of administration. balls are not used so much and are not so well adapted to the medication of cattle as of horses. the process of solution is slower in the paunch of a cow than in the stomach of a horse; if the cow is so sick as to have stopped ruminating, a ball may get covered up and lost in the mass of material in the paunch and so lie for days, producing no effect whatever. _capsules_ are shells or envelopes made of soluble gelatin in which powders or liquids may be inclosed. capsules and balls are administered by being placed on the tongue well back in the mouth while the tongue is drawn forward and the mouth is held open by a block of wood between the back teeth. the ball should be dropped, the tongue released, and the block removed as nearly simultaneously as possible, so that the backward carriage of the tongue will throw the ball into the throat and lead to its being swallowed. in introducing the ball care must be taken to avoid having the hand cut or crushed. after a little experience it is possible to do away with the block of wood. by the stomach.--medicines are introduced directly into the first stomach by the use of an esophageal tube or through the cannula of a trocar passed into the paunch through the side. this method is used in the treatment of diseases of digestion. by the rectum.--medicines are usually administered by the rectum for the purpose of controlling the bowels and for the treatment of local diseases. sometimes, however, medicines that have a general effect are given in this way when, for any reason, it is not possible or convenient to give them through the mouth. only drugs that are readily absorbed should be given per rectum for a general effect and in somewhat larger dose or more frequently than when given by the mouth. such stimulants as ether, alcohol, or the aromatic spirits of ammonia, diluted with from four to six times their bulk of warm water, may be used in this way. rectal injections, or enemata, are used in the treatment of constipation. if it is the purpose of the injection to soften hardened fecal masses, the water should be comfortably warm and may have a little clean soap in it. if it is the purpose of the injection to stimulate sluggish bowels to contraction, the water may be cold. in giving rectal injections a rectal syringe may be used, or, better, a piece of one-half to three-quarter inch rubber hose feet long with a tin funnel attached to one end. the hose is soaped or oiled and introduced slowly and gently into the rectum or feet. the fluid is then slowly poured into the funnel and allowed to gravitate into the rectum. the same apparatus may be used for feeding by the rectum. by the vagina.--medicines are inserted into the vagina, and through the vagina into the womb, in a manner similar to that of rectal administration. most of the medication made use of in this way is for the local treatment of these organs. following calving, during outbreaks of abortion, and in an infectious disease of the vagina, such injections become necessary. by the udder.--injections into the udder are now regularly made in the treatment of parturient paresis (milk fever). for this purpose a per cent solution of iodid of potassium is commonly employed, although some other solutions and oxygen gas are also used. in making this injection so many precautions are necessary in relation to the sterilization of the apparatus and the teats and skin that this work should be left to a skilled veterinarian. the introduction of even a minute quantity of infectious dirt may cause the loss of the udder. for making this injection one may use one of the prepared sets of apparatus or a milking tube and funnel connected by a piece of small rubber hose. the apparatus should be boiled and kept wrapped in a clean towel until needed. the udder and teats and the hands of the operator must be well disinfected, and the solution must be freshly made with recently boiled water kept in a sterile bottle. the udder should be emptied of milk before the injection is made. after all these precautions have been observed the milking tube may be inserted and through it one-half pint of solution introduced by gravity air pressure or by syringe. there is practically no danger in this mode of treatment if it is properly carried out. injections into the udder are sometimes made in the treatment of garget, but so far with indifferent success. by the nostrils.--an animal may be caused to inhale medicine in the form of gas or vapor or to snuff up a fine powder. sometimes, for the purpose of local treatment, fluids are injected into the nose. a medicine inhaled may have either a local or a general effect. medicated steam, carrying the volatile products of compound cresol solution, carbolic acid, balsam of peru, compound tincture of benzoin, tincture of iodin, etc., may be liberated beneath the nostrils of a cow so that she must inhale these soothing vapors; but such treatment is not so common for cattle as for horses. in producing general anesthesia, or insensibility to pain, the vapor of chloroform or ether is administered by the nostrils. as a preliminary to this it is necessary to cast and confine the animal. great care is necessary to avoid complete stoppage of the heart or breathing. by the trachea.--medicines are injected into the trachea, or windpipe, in the treatment of some forms of diseases of the lungs, and especially in that form of bronchitis or pneumonia that is caused by lungworms. for this injection a large hypodermic syringe, fitted with a very thick, strong needle, is used. the needle is to be inserted about the middle of the neck and between the cartilaginous rings of the trachea. by the skin.--although a number of drugs, notably mercury, are so readily absorbed by the skin of cattle as to render poisoning easy, medicines are not given in this way for their general or constitutional but only for their local effect. diseases of the skin and superficial parasites are treated or destroyed by applications in the forms of washes, ointments, dips, and powders. liniments and lotions are applied to the skin for the relief of some near-lying part, such as a muscle, tendon, or joint. blisters are applied to the skin for the purpose of obtaining the effect of counterirritation upon a neighboring region or organ. cold water may be applied to the skin to reduce the temperature and to diminish congestion or inflammation in a superficial area or to reduce the temperature of the whole body. high fever and heat strokes are treated in this way. by the tissue beneath the skin.--hypodermic or subcutaneous injections are often made for the purpose of introducing a drug, reagent, or vaccine directly into the connecting tissue beneath the skin. introduced in this way, the substance is quickly absorbed, none of it is lost, and its whole effect is obtained, often within a few minutes. there are numerous precautions necessary in making a subcutaneous injection, most of which have to do with cleansing and sterilization. it is also important to select a proper site for the injection, so that blood vessels, joints, and superficial nerves, organs, or cavities may all be avoided. with due regard for the necessary precautions, there is practically no danger in such an injection, but it should be attempted only by those who are able to carry it through in a surgically clean way. only certain drugs can be given subcutaneously, and dosage must be accurately graduated. by the veins.--certain medicines act most promptly and surely when introduced directly into the blood by injecting them into a vein, usually the jugular. some vaccines and antitoxins are administered in this way. intravenous injection should be practiced only by experienced veterinarians. diseases of the digestive organs. by a. j. murray, m. r. c. v. s. [revised by r.w. hickman, v. m. d.] character of feeds and feeding. diseases of the digestive organs are very common among cattle, and may often be traced to defects in feeding. the first three stomachs of the larger ruminants hold the feed for a long time, during which period it is subjected to macerating, mixing, and straining processes in preparation for entrance into the fourth or true stomach. the straining is accomplished through the medium of the manyplies or book, while the paunch, or rumen, with its adjunct, the waterbag, is concerned in the macerating, kneading, and mixing, as well as in regurgitation for rumination or the chewing of the cud. the action of the first three stomachs is merely preparatory to digestion. thus it would seem that as a result of their complex anatomical and functional arrangement the feed of the ox, when of good quality and wholesome, is in the most favorable condition possible for the digestive process when it reaches the fourth stomach, where true digestion first takes place. the location and arrangement of the stomachs are shown in plates i and ii. if the feed is of improper character, or is so given that it can not be cared for by the animal in a normal way, false fermentations arise, causing indigestion, and possibly, later, organic disease. in feeding cattle there are a number of important considerations apart from the economy of the ration, and some of these are noted below. feeds must not be damaged by exposure to the weather, by frost, by molds, or by deleterious fermentations. damaged feeds retard or prevent digestion, and sometimes they contain or cause to be generated substances that irritate the digestive tract, or are distinctly poisonous to the animal. for example, hay that was rained on severely during curing has not only lost a part of its nutritive value through a washing-out process, but what remains is not so readily available as in good hay. roots that have been frozen are likely to irritate and injure the digestive tract. grass eaten with frost on it may cause severe indigestion. all moldy feeds are not injurious, for some molds appear to have no influence on the process of digestion, but those of other species may not only retard digestion and cause local injury to the digestive organs, but may cause general poisoning of a severe and fatal type. the following molds have been shown (dammann) to be dangerous in respect to the production of the morbid conditions enumerated: _tilletia caries_ grows chiefly in wheat and may be found with the grain, thus appearing in the bran or meal. it causes paralysis of the throat and spinal cord and irritation of the digestive tract. the rusts, such as _puccinia graminis_, _p. straminis_, _p. coronata_, and _p. arudinacea_, cause colic and diarrhea, and in some cases partial paralysis of the throat. the rusts that occur on clovers, beans, and peas cause very severe irritation of the lining membrane of the mouth and throat, resulting sometimes in gangrene of this tissue. _polydesmus exitans_ grows on the leaves of rape and turnips, appearing in early summer. this fungus is very irritating to the mouths and feet of cattle, causing severe inflammation and the formation of a false membrane. in some instances this condition has been mistaken for foot-and-mouth disease, but it can be differentiated by the absence of the blister that is characteristic of that disease and by the further fact that it is nontransmissible. _polytrincium trifolii_, which grows on clover, causing it to become black, causes severe irritation of the stomach and intestines of cattle feeding upon it. feeds must not contain too large a proportion of woody fiber or of indigestible substances. if the dry matter ingested or the bulk of the feed is very great on account of the small proportion of digestible matter, it is impossible for the great mass to be moistened properly with and attacked by the digestive juices. in consequence of this, abnormal fermentations arise, causing indigestion and irritation of the digestive organs. on the other hand, a ration too concentrated, and especially too rich in protein, is not suitable, because, after a meal, the animal must have a certain feeling of fullness in order to be comfortable and quiet, and the digestive organs require a relatively large volume of contents to fill them to the point where secretion is properly stimulated and their activity is most efficient. if too much protein is in the ration there is a waste of expensive feed, and the tendency is for the animal to become thin. it is evident that a cow can not thrive on concentrated feeds alone, even though these contain in assimilable form all the nutritive materials needed for perfect support. it is because bulk is necessary that the standard of about pounds of dry matter per cow per day has been reached by experimenters. there is no objection to feeding grain or meal separately to a cow, provided enough bulky feed is fed at another time in the day to keep the digestive tract sufficiently distended. in changing the ration, and especially in making radical changes, as at the beginning and the end of the pasturing season, the change should be made gradually, so that the digestive organs may accommodate themselves to it. after the digestive organs and juices have from long practice become adjusted to the digestion of a certain feed, which is then suddenly withheld and another of quite different character and properties is substituted, the second feed is not well digested; it may even irritate the digestive canal. it is often observed that cattle lose from to pounds when turned on pasture from dry stable feed. this loss can readily be prevented by not shocking the digestive organs by a sudden change of diet. regularity in feeding has much to do with the utilization of the ration, and gross irregularity may cause indigestion and serious disease. water for live stock should be as free from contamination and as nearly pure as that used for household purposes. when practicable it is well to warm the water in the winter to about ° f. and allow cattle to drink often. diseases of the mouth. wounds and contusions of the lips, and snake bite. the lips may become inflamed from contusions, which are sometimes produced by a blow from the horns of another animal, or, in the case of working oxen, by a blow from the driver. while cattle are grazing, more especially when they are in woods, they may be bitten in the lips by insects or serpents. _symptoms._--as a result of a contusion the lips become thick and swollen, and if treatment is neglected the swelling may become hard and indurated, or an abscess may form. this condition renders it difficult for the animal to get food into its mouth, on account of the lips having lost their natural flexibility. in such cases an ox will use his tongue more in the prehension of food to make up for the incapacity of the lips. in cases of snake bite the swelling is soft or puffy and its limits are not well defined. _treatment._--when we have to deal with a bruise, the affected part should be bathed with hot water two or three times daily. in recent cases no other treatment will be required, but if the swelling is not recent and has become hard or indurated, then the swollen part should be treated each day by painting it with tincture of iodin. in snake bite a straight incision penetrating into the flesh or muscle should be made across the center of the swelling and in the direction of the long axis of the face. after this has been done a small wad of cotton batting should be pressed against the wounds until the bleeding has almost stopped. afterwards the following lotion may be applied to the wounds several times a day: permanganate of potassium, half a dram; distilled water, pint. as snake bites are usually attended with considerable depression, which may terminate in stupor, it is advisable to give a stimulant. one ounce of aromatic spirits of ammonia mixed with a pint of water should be given, and the dose should be repeated in half an hour if the animal is sinking into a stupefied and unconscious condition. the repetition of the dose must depend on the symptoms which the animal shows. it must be borne in mind that the object of treatment is to ward off the stupor, which is one of the results of snake bite. the swelling from an insect bite should be bathed with ammonia water as soon as noticed and then treated with frequent applications of hot water. salivation. salivation is a symptom of some general or local disorder. it may be a symptom of a general disease, such as rabies or foot-and-mouth disease, or it may be a purely local trouble, as when copious secretion of the salivary glands is produced by the eating of irritating plants, such as wild mustard. when saliva is observed to dribble from the mouth, that part should be carefully examined by introducing into the mouth an instrument like a balling iron, or, if one is not at hand, by grasping the tongue and partially withdrawing it from the mouth, and by placing a block of wood between the back teeth, while all parts of the mouth are exposed to a good light, so that the presence of any foreign substance may be detected. the cause is sometimes found to be a short piece of wood becoming fixed on the palate, its two ends resting on the upper molar teeth of each side; or it may be a needle, thorn, or splinter of wood embedded in the tongue. sometimes a sharp piece of tin or other metal may become partially embedded in the inner surface of the cheek. hay occasionally possesses some quality, usually dependent upon its having heated in the mow or having become moldy, which produces salivation. second-crop clover and some irritant weeds in the pasture or forage may cause salivation. cattle rubbed with mercurial ointment may swallow enough mercury in licking themselves to bring about the same result. (see "mercury poisoning," p. .) such cases, of course, arise from the constitutional action of mercury, and, on account of the common habit which the animals have of licking themselves, indicate the danger of using such preparation externally. mercury is also readily absorbed through the skin, and as cattle are very susceptible to its action it is thus easy for them to be poisoned by it even without licking it from the surface. cases of mercurial poisoning sometimes follow disinfection of cattle stables with the usual to , solution of mercuric chlorid. _treatment._--if salivation depends on the irritation and inflammation set up by the ingestion of acrid plants, or forage possessing some peculiar stimulating property, the feed must be changed, and a lotion composed of an ounce of powdered alum dissolved in a quart of water may be syringed into the mouth twice a day, using half a pint of the solution each time. if, however, the salivation is due to the presence of a thorn, splinter of wood, or any other foreign substance embedded in the cheek or tongue, the offending object should be removed and the mouth washed occasionally with a weak solution ( per cent) of carbolic acid and tepid water. when salivation is produced by mercurial poisoning or by foot-and-mouth disease, the treatment appropriate to those general conditions of the system, as well as the local treatment should be applied. (for information about foot-and-mouth disease see p. .) irregularities of the teeth. irregularities of the teeth may be occasioned by the unequal wearing of some of the teeth or by some of the incisors being broken, which may happen when cattle are pastured on sandy or gravelly soil. the molar teeth may also show irregular wear from similar causes, or from a disease or malformation of the jaw. their edges may become sharp, or it may happen that a molar tooth has been accidentally fractured. it may also occur that a supernumerary tooth has developed in an unusual position, and that it interferes with the natural and regular mastication of the feed. _treatment._--the mouth may be examined by grasping the animal's tongue with one hand and partially withdrawing it from the mouth, so as to expose the incisor and molar teeth to inspection. when it is desired, however, to examine the molar teeth with the fingers, so as to obtain a better idea of their condition, an instrument like the balling iron which is used for the horse should be introduced into the mouth, so as to separate the jaws and keep them apart while the examination is being made. any sharp edges of the molars must be removed by the tooth rasp, such as is used for horses. any supernumerary tooth which interferes with mastication or any tooth which is fractured or loose should be extracted. in performing such operations it is desirable to throw, or cast, the animal, and to have its head held securely, so as to enable the operator to do what is necessary without difficulty. caries or decay of the teeth. the presence of caries may be suspected if the mouth exhales a bad odor and if the animal during mastication occasionally stops as if it were in pain. the existence of caries in a molar tooth may be ascertained by examining the mouth in the manner already described. if one of the molars is found to be carious, it should be extracted. when the crown of the tooth has been destroyed and only the stump or root is left, extraction is impracticable. in case the animal has special value the root stumps may be removed by a veterinarian by the operation of trephining; otherwise, it is best to sell the animal to the butcher. actinomycosis of the jawbones (big jaw or lumpy jaw). [see actinomycosis, p. .] inflammation of mucous membrane of mouth (stomatitis). the membrane of the mouth may become inflamed by eating some irritating substance or plant, or little vesicles may form in the mouths of calves when they are affected with indigestion, constituting what is termed aphtha. _symptoms._--the saliva dribbles from the mouth, and when the mouth is examined the surface of the tongue and other parts appear red and inflamed. when young animals are affected with the form of disease termed aphtha, small red elevations are observed on the tongue and other parts of the mouth, having little white points on their centers, which consist of the epithelium of the mucous membrane raised into vesicles. these white patches are succeeded by ulcerated surfaces, which are caused by the shedding of the white patches of epithelium. _treatment._--when there is merely a reddened and inflamed condition of the mucous membrane of the mouth, it will suffice to syringe it out several times a day with ounces of the following solution: alum, ounce; water, pints. when the edges of the tongue and other parts of the mouth are studded with ulcers, they should be painted over once a day with the following solution until the affected surface is healed: permanganate of potassium, grains; water, ounce. when indigestion is associated with an ulcerated condition of the mouth, separate treatment is required. ulcerative stomatitis (or ulcers in the mouths of young calves). [see necrotic stomatitis, p. .] mycotic stomatitis (sore mouth). [see p. .] induration of the tongue (actinomycosis). [see actinomycosis, p. .] diseases of the pharynx and gullet. pharyngitis (sore throat). pharyngitis is an inflammation of the mucous membrane lining the pharynx. it is frequently associated with inflammatory diseases of the respiratory tract, such as laryngitis and bronchitis or pleurisy. _symptoms._--the muzzle is dry and the saliva dribbles from the corners of the mouth; the animal swallows with difficulty or not at all, and holds its neck in a stiff, straight position, moving it as little as possible. the eyelids are half closed, the white of the eye is bloodshot, and the animal occasionally grinds its teeth. after masticating the feed the animal drops it out of its mouth as if to avoid the pain of swallowing, and also evinces pain when pressure is applied externally on the pharynx and tries to prevent the pressure from being applied. _causes._--pharyngitis may be produced by a sudden cooling of the surface of the body, as when cattle are exposed to a cold wind or a cold rain; or by swallowing irritant substances. _treatment._--the throat should be syringed three times a day with an ounce of the following solution: nitrate of silver, - / drams; distilled water, pint. bland and soothing drinks, such as linseed tea or oatmeal and water should occasionally be offered. diet should consist of soft food, such as bran mashes with a little linseed meal mixed in them. dry hay and fodder should not be given. fresh, green grass or sound ensilage may be fed in small quantities. the upper part of the throat and the space between the jaws should be well rubbed once a day with the following liniment: liquor ammonia fortior, ounces; oil of turpentine, ounces; olive oil, ounces; mix. when evidence of blistering appears the application of the liniment should be stopped and the skin anointed with vaseline. under the treatment described above the inflammation of the throat will gradually subside and the animal will be able to swallow as usual in five or six days. we need hardly say that during its treatment the sick animal should be kept in a comfortable stable. parotitis. inflammation of the parotid gland may arise from the inflammation extending to it when an ox is affected with pharyngitis or laryngitis, or the inflammation may commence in the salivary ducts and may depend on some influence the nature of which is unknown. parotitis sometimes arises from a blow or contusion severe enough to set up inflammation in the structure of the gland. tuberculosis and actinomycosis may infrequently be characterized by the lodgment of their parasitic causes in the parotid glands, in which case parotitis may be a symptom of either of these diseases. _symptoms._--there is an elongated, painful swelling, beginning at the base of the ear and passing downward along the posterior margin of the lower jaw. the swelling is sometimes limited to one side, and when both are swollen it is generally larger on one side than on the other. the secretion of saliva is increased, the appetite is poor, the neck is stiff, so that it is painful to raise the head, and feed is swallowed with difficulty. in many cases the swelling of the glands, when submitted to proper treatment, disappears in a comparatively short time. in other cases, however, they remain enlarged, even after the animal recovers its appetite. in tuberculosis, lymphatic glands beneath the parotid glands are sometimes enlarged, thus causing the appearance of enlarged parotid glands. _treatment._--a warm bran poultice, made by mixing bran with a hot per cent compound cresol solution in water, should be applied on the swollen gland and kept in place by means of a bandage. whenever the poultice has cooled it should be replaced by a new one. this treatment should be continued until the pain is less and the swelling is reduced or until there is evidence of pus formation, which may be ascertained by examining the surface of the gland with the fingers; and when, on pressing any part of the surface, it is found to fluctuate or "give," then we may conclude that there is a collection of pus at that place. it is well not to open the abscess until the fluctuation is well marked, as at this stage the pus or matter is near the surface and there is less trouble in healing the wound than if the pus is deep seated. the abscess should be opened with a clean, sharp knife. the poulticing should then be continued for two or three days, but the form of the poultice should be changed, by replacing the bran with absorbent cotton and pouring the compound cresol solution on the cotton. at all times the wound should be kept clean and the cavity injected once or twice daily with a solution of dram of carbolic acid in ounces of water. under this treatment the pus may cease and the wound heal without complications. saliva may issue from the orifice and result in the formation of a salivary fistula. this requires operative treatment by a qualified veterinarian. when poulticing fails to reduce the swelling or produce softening, the inflamed area may be rubbed once daily with camphorated oil, compound iodin ointment, or painted twice daily with lugol's solution of iodin. the diet should be as recommended under pharyngitis (p. ). pharyngeal polypi. tumors form not infrequently in the pharynx, and may give rise to a train of symptoms varying according to their size and location. the tumor may be so situated that by shifting its position a little it may partially obstruct the posterior nares (nostrils), when, of course, it will render nasal breathing very noisy and labored. in another situation its partial displacement may impede the entrance of air into the larynx. in almost any part of the pharynx, but especially near the entrance of the gullet, tumors interfere with the act of swallowing. as they are frequently attached to the wall of the pharynx by a pedicel or stalk, it will be seen that they may readily be displaced in different directions so as to produce the symptoms before described. enlarged postpharyngeal lymphatic glands are not rare in tuberculosis, and by pressing upon the wall of the pharynx and restricting the lumen of this organ they cause difficulty in both breathing and swallowing. such enlarged glands may be differentiated from tumors by passing the hand into the cow's throat after the jaws are separated by a suitable speculum or gag. _treatment._--the method of treatment in such cases is to separate the animal's jaws with an instrument termed a gag, and then, after drawing the tongue partially forward, to pass the hand into the pharynx and to twist the tumor gently from its attachment. one veterinarian who has had considerable practice in treating this form of disease scrapes through the attachment of the tumor gradually with his thumb nail. when the attachment is too strong to be severed in this way an instrument like a thimble, but possessing a sharp edge at the end, may be used to effect the same purpose, or the base of the tumor may be severed by the use of a crushing instrument known as an écraseur. choking. choking usually happens from attempting to swallow too large an object, such as a turnip, potato, beet, apple, or pear, though in rare cases it may occur from bran, chaff, or some other finely divided feed lodging in and filling up a portion of the gullet. this latter form of the accident is most likely to occur in animals that are greedy feeders. _symptoms._--the symptoms vary somewhat according to the part of the gullet or throat in which the obstruction is. in most cases there is a discharge of saliva from the mouth; the animal coughs frequently, and when it drinks the water is soon ejected. the cow stops eating and stands back from the trough, the expression is troubled, breathing is accelerated, and oftentimes there is bloating as a result of the retention of gas in the paunch. these symptoms, however, are not always present, for if the obstacle does not completely close the throat or gullet, gas and water may pass, thus ameliorating the discomfort. if the obstruction is in the neck portion of the gullet, it may be felt as a lump in the left jugular gutter. _treatment._--if the object is in the throat, it is advisable to put a gag in the animal's mouth, and, while the head is held in a horizontal direction by two assistants, to pass the hand into the pharynx, grasp the foreign body, and withdraw it gradually and steadily. when the substance is lodged in the upper part of the gullet, pressure should be made by an assistant in an upward direction against the object while the operator passes his hand into the pharynx, and if the assistant can not by pressure dislodge the substance from the gullet, the operator may by passing his middle finger above and partly behind the substance gradually slide it into the pharynx and then withdraw it by the mouth. the presence of an obstructing substance in the cervical (neck) portion of the gullet may be ascertained by passing the hand along the left side of the neck, when a hard and painless swelling will be found to indicate the presence of the foreign body. in such cases we must endeavor by gentle and persevering pressure with the thumb and next two fingers to slide the obstructing substance gradually upward to the pharynx. to facilitate this it is well to give the animal a half pint of raw linseed or olive oil before the manipulations described are commenced. when the substance has been brought into or nearly into the pharynx, then the mouth gag should be used, the tongue drawn partially forward with the left hand, and the right should be passed backward into the pharynx to withdraw the obstruction. when bran or chaff causes the trouble it is best to give a small quantity of oil to lubricate the walls of the gullet, and then by gentle and persevering pressure, to endeavor to separate and divide the mass and to work it downward toward the stomach. this will be assisted by pouring small quantities of oil and water down the animal's throat. it is not advisable to use the probang to push down any soft material, such as oats or chaff, as this generally condenses and renders firmer the obstructing substance by pressing its particles or elements together, so that it forms a solid, resisting mass which can not be moved. in some cases the foreign body, either because it is in the chest portion of the esophagus, and so beyond reach, or because too firmly seated, can not be dislodged from the neck by pressing and manipulating that part externally. in such event we must resort to the use of the probang. (pl. iii, figs. and .) a probang is a flexible instrument and adapts itself to the natural curvature of the gullet, and if used cautiously there is not much risk of injury. before passing the probang, a gag which has an aperture at each end, from which straps pass to be buckled at the back of the head below the horns, is introduced into the mouth. (pl. iii, fig. .) the probang should then be oiled, and, the head and neck being held in a straight line by two assistants, the tongue must be partly drawn out of the mouth, the probang cautiously passed along the roof of the mouth into the pharynx and thence into the gullet, through which it is passed down. if resistance is met, gentle and continuous pressure must be used, under the influence of which the object will generally in a short time pass into the stomach. one must be careful not to pass the probang into the larynx and thence into the windpipe, as an animal may readily be killed in this way. this accident is indicated by efforts to cough and by violently disturbed breathing. if such symptoms arise the probang must be withdrawn at once. to avoid a wrong passage, the end of the tube should be pressed very slowly through the throat until its presence in the esophagus is assured. after it is once in the esophagus care is still necessary, because the walls of this tube may easily be torn. some writers have advised that when the obstruction is lodged in the cervical (neck) portion of the gullet it should be struck with a mallet, to crush it and thus alter its shape, so that it may easily slip down into the stomach. if the obstructing substance is hard, this will be a dangerous operation, but if soft--as in the case of a ripe pear, for example--this procedure may be safely adopted. in all cases, if pressure applied on the neck fails to move the obstruction and the probang also fails to move it, it may be divided by a subcutaneous operation, or the gullet may be opened and the obstructing substance removed through the wound. in such cases the assistance of a veterinarian or a surgeon must be obtained. wounds and injuries of the gullet. sometimes the walls of the gullet may be more or less lacerated or abraded by the rash and too forcible use of the probang, and the animal consequently swallows with pain and difficulty. in such cases dry feed must be withheld for five or six days, so as to allow the injured parts to heal, and the diet must be limited to linseed tea, hay tea, and thin oatmeal gruel and molasses. the same kind of diet must be fed after the operation of cutting into the gullet has been performed. sometimes the gullet is ruptured and lacerated to such an extent that treatment of any kind is hopeless. this has been known to occur when the handle of a pitchfork or buggy whip has been pushed down a cow's throat to remove an obstruction. when such treatment has been applied it is best to slaughter the animal without delay, as the flesh may be utilized so long as there is no fever or general disease, and remedial treatment would be hopeless. in this connection it may be mentioned that whatever substitute may be used for a probang, which sometimes is not at hand, it should be flexible and should possess a smooth surface. a piece of new rope, with the end closely wrapped and waxed and then oiled, or a piece of thin garden hose, or a well-wrapped twisted wire may be used in emergencies. diseases of the stomachs. acute tympanites (hoven, or bloating). tympanites is a distention of the rumen or paunch with gases of fermentation, and is manifested outwardly by swelling in the region of the left flank. _causes._--tympanites may be caused by any kind of feed which produces indigestion. when cattle are first turned into young clover they eat so greedily of it that tympanites frequently results. turnips, potatoes, cabbage, or the discarded pulp from sugar-beet factories may also cause it. middlings and corn meal also frequently give rise to it. care is necessary in turning animals into fields of clover or stubble fields in which there is a strong growth of volunteer grain. it is always better to keep them from such pasturage while it is wet with dew, and they should be taken out when they have eaten a moderate quantity. when cattle are fed upon pulp from sugar beets, germinated malt, etc., they should be fed in moderate amounts until they have become accustomed to it, as any of these feeds may give rise to severe bloating. an excessive quantity of any of the before-mentioned feeds may bring on this disorder, or it may not be caused by excess, but to eating too hastily. sometimes the quality of the feed is at fault. grass or clover when wet by dew or rain frequently disorders digestion and brings on tympanites; frozen roots or pastures covered with hoar frost should also be regarded as dangerous. when feed has been eaten too hastily, or when it is cold and wet, the digestive process is imperfectly performed, and the feed contained in the paunch ferments, during which process large quantities of gas are formed. the same result may follow when a cow is choked, as the obstruction in the gullet prevents the eructation or passing up of gas from the stomach, so that the gas continues to accumulate until tympanites results. _symptoms._--the swelling of the left flank is very characteristic, as in well-marked cases the flank at its upper part rises above the level of the backbone, and when struck with the tips of the fingers emits a drum-like sound. the animal has an anxious expression, moves uneasily, and is evidently distressed. if relief is not obtained in time, it breathes with difficulty, reels in walking or in standing, and in a short time falls and dies from suffocation. the distention of the stomach may become so great as to prevent the animal from breathing, and in some instances the case may be complicated by rupture of the stomach. _treatment._--if the case is not extreme, it may be sufficient to drive the animal at a walk for a quarter or half an hour; or cold water by the bucketful may be thrown against the cow's sides. in some cases the following simple treatment is successful: a rope or a twisted straw band is coated with pine tar, wagon grease, or other unsavory substance and is placed in the cow's mouth as a bit, being secured by tying behind the horns. the efforts of the animal to dislodge this object result in movements of the tongue, jaws, and throat that stimulate the secretion of saliva and swallowing, thus opening the esophagus, which permits the exit of gas and at the same time peristalsis is stimulated reflexly. in urgent cases the gas must be allowed to escape without delay, and this is best accomplished by the use of the trocar. the trocar is a sharp-pointed instrument incased in a cannula or sheath, which leaves the sharp point of the trocar free. (see pl. iii, figs. _ a_ and _ b._) in selecting the point for using the trocar a spot on the left side equally distant from the last rib, the hip bone, and the transverse processes of the lumbar vertebræ must be chosen. here an incision about three-fourths of an inch long should be made with a knife through the skin, and then the sharp point of the trocar, being directed downward, inward, and slightly forward, is thrust into the paunch. (pl. i.) the cannula or sheath of the trocar should be left in the paunch so long as any gas continues to issue from it. if the cannula is removed while gas is still forming in the paunch and the left flank becomes considerably swollen, it may be necessary to insert it again. it is well, accordingly, to observe the cannula closely, and if gas is found to be issuing from it, it should not be removed. when gas issues from it in considerable quantities the sound accompanying its escape renders the exact condition obvious. it is occasionally necessary to keep the cannula in the stomach for several hours. when this is necessary a piece of stout cord should be passed round the neck of the cannula immediately below the projecting rim and then be passed round the animal's body and tied in a secure knot, and a careful attendant must remain with the cow during the entire period that the instrument is in place. the rim surrounding the mouth of the cannula should be in contact with the skin. whenever the person in charge of the cow is convinced that gas has ceased to issue from the cannula the instrument should be removed. the trocar is to be used only in extreme or urgent cases, though everyone who has had experience in treating indigestion in cattle realizes that he has saved the lives of many animals by its prompt application. when the tympanitic animal is not distressed and the swelling of the flank is not great, or when the most distressing condition has been removed by the use of the trocar, it is best to use internal medicine. two ounces of aromatic spirits of ammonia should be given every half hour in a quart of cold water; or half an ounce of chlorid of lime may be dissolved in a pint of tepid water and the dose repeated every half hour until the bloating has subsided; or ounce of creolin in quarts of tepid water may be given at one dose or carefully injected through the cannula directly into the paunch to stop fermentation and the consequent formation of gas. it is generally necessary to give a moderate dose of purgative medicine after bloating has subsided, as animals frequently show symptoms of constipation after attacks of indigestion. for this purpose pound of glauber's salt may be used. the animal should be fed carefully upon easily digested food for several days after the bloating has subsided, so that all fermenting matter may pass out of the stomach. chronic tympanites. cattle, especially those that have been kept in the stable all winter, are liable to suffer from chronic tympanites. in this form they bloat up after feeding, but seldom swell so much as to cause any alarm. the chronic form of indigestion may also follow an acute attack like that previously described. this is also a symptom of tuberculosis when the lymphatic glands lying between the lungs are so enlarged as to press upon and partly occlude the esophagus. it may develop in calves as a result of the formation of hair balls in the stomach. _treatment._--treatment should be preceded by a moderate dose of purgative medicine: pound of sulphate of magnesia (epsom salt) or sulphate of soda (glauber's salt), half an ounce of powdered barbados aloes, ounce of powdered ginger, pint of molasses. the salts and aloes should be dissolved by stirring for a few minutes in quarts of lukewarm water, then the molasses should be added, and after all the ingredients have been stirred together for about minutes the dose should be administered. after the operation of the purgative it is generally necessary to give some tonic and antacid preparation to promote digestion, which is imperfectly performed in such cases. the following may be used: powdered gentian, ounces; powdered bicarbonate of potash, ounces; powdered ginger, ounces; powdered capsicum, ounce. mix and divide into powders, one of which should be given three times a day before feeding, shaken up with a pint and a half of water. it is also advantageous in such cases to give two heaped teaspoonsfuls of wood charcoal, mixed with the animal's feed three times a day. the animal should also go out during the day, as want of exercise favors the continuance of this form of indigestion. if the dung is hard, the constipation should be overcome by feeding a little flaxseed twice daily or by giving a handful of glauber's salt in the feed once or twice daily, as may be necessary. roots, silage, and other succulent feeds are useful in this connection. if tuberculosis is suspected as the cause of chronic bloating, a skilled veterinarian should make a diagnosis, using the tuberculin test if necessary. until it is settled that the cow has not tuberculosis, she should be kept apart from the other members of the herd. distention of rumen or paunch with feed. this form of indigestion is caused by the animal gorging itself with feed, and arises more from the animal's voracious appetite than from any defect in the quality of the feed supplied to it. the condition is, however, more severe if the feed consumed is especially concentrated or difficult of digestion. in cases of this kind there is comparatively no great formation of gas, and the gas which is formed is diffused through the stomach instead of accumulating in a layer in its upper part. on pressing the flank with the closed fist the indent of the hand remains for a short time in the flank, as if the rumen were filled with a soft, doughy mass. this form of indigestion should be treated by stimulants, such as aromatic spirits of ammonia. if the formation of gas is not great and the distention with solid material is somewhat limited, the animal may be drenched through a piece of ordinary garden hose, one end inserted in the mouth, and the other end fitted with a funnel, giving - / pounds of epsom salt or glauber's salt dissolved in gallons of water, at a single dose. immediately after this treatment the left side of the animal, extending below the median line of the abdomen, should be powerfully kneaded with the fist, so that the impacted food mass will be broken, allowing the water to separate it into small portions which can be carried downward for the process of digestion. but if the treatment fails and the impacted or overloaded condition of the rumen continues, it may become necessary to make an incision with a sharp, long-bladed knife in the left flank, commencing at the point where it is usual to puncture the stomach of an ox, and prolong the incision in a downward direction until it is long enough to admit the hand. when the point of the knife is thrust into the flank and the blade cuts downward, the wall of the stomach, the muscle, and the skin should all be cut through at the same time. two assistants should hold the edges of the wound together so as to prevent any food from slipping between the flank and the wall of the stomach, and then the operator should remove two-third [sic] of the contents of the rumen. this having been done, the edges of the wound should be sponged with a little carbolized warm water, and, the lips of the wound in the rumen being turned inward, they should be brought together with catgut stitches. the wound penetrating the muscle and the skin may then be brought together by silk stitches, which should pass through the entire thickness of the muscle and should be about inch apart. the wound should afterwards be dressed once a day with a lotion and the animal covered with a tight linen sheet, to protect the wound from insects and dirt. the lotion to be used in such case is made up as follows: sulphate of zinc, dram; carbolic acid, drams; glycerin, ounces; water, ounces; mix. it is clear that this operation requires special skill and it should be attempted only by those who are competent. imaginary diseases (hollow horn; loss of cud; wolf in the tail). it would appear quite in place here, in connection with the diseases of the stomach and bowels of cattle, to consider the three old fallacies or superstitions known by the above names, since these names, whenever and wherever used, seem to be invariably applied to some form of digestive derangement or disease having its origin in the stomach and bowels. hollow horn.--in the first place it should be noted that the horns of all animals of the ox tribe are hollow. the horn cores are elongations of the frontal bones of the skull, and the frontal sinuses, which are the larger of the air spaces of the head, are prolonged into the horn cores. when a cow is sick, if the horns are hot it is an evidence of fever; if they are cold it indicates impaired circulation of the blood; but these manifestations of sickness are to be regarded as symptoms of some constitutional disorder and do not in themselves require treatment. the treatment should be applied to the disease which causes the abnormal temperature of the horns. the usual treatment for the supposed hollow horn, which consists in boring the horns with a gimlet and pouring turpentine into the openings thus made, is not only useless and cruel, but is liable to set up an acute inflammation and result in an abscess of the sinus. loss of cud.--the so-called loss of cud is simply a cessation of rumination, frequently one of the first indications of some form of disease, since ruminants stop chewing the cud when they feel sick. loss of cud is a symptom of a great many diseases, and when it is detected it should lead the observer to try to discover other symptoms upon which to base a correct opinion as to the nature of the disease from which the animal suffers. no local treatment is required. wolf in the tail.--this term also seems to be vaguely applied to various disturbances of the digestive function, or to some disease which is in reality in the stomach or bowels. vomiting. vomiting is not to be confounded with rumination, though some writers have advanced the opinion that it is merely a disordered and irregular rumination. it is not of common occurrence in cattle. _symptoms._--animals which vomit are frequently in poor condition. after having eaten tranquilly for some time the animal suddenly becomes uneasy, arches the back, stretches the neck and head, and then suddenly ejects to pounds of the contents of the rumen. after having done this the uneasiness subsides and in a short time the animal resumes eating as if nothing had happened. _cause._--the cause of this disordered state of the digestive system in cattle is usually obscure, but has in some cases been traced to a partial closure of the opening into the second stomach or to a distention of the esophagus. it has been found to occur when there was cancerous disease of the fourth stomach, and experimentally it has been shown that a suspension of digestion or great derangement of this stomach produces considerable nervous disorder of the rumen and sometimes vomiting or attempts to vomit. treatment.--easily digested feed and plenty of water should be given. fear and excitement, chasing, or hurrying animals after they have eaten heartily are liable to bring on this result. in order to overcome irritation which may produce vomiting the following draft should be given: hydrate of chloral, half an ounce; water, pint. the dose must be repeated when the condition of the animal seems to require it. as a rule, treatment is not successful. depraved appetite (pica). cattle suffering from this disease have a capricious and variable appetite as regards their ordinary feed but evince a strong desire to lick and eat substances for which healthy cattle show no inclination. alkaline and saline-tasting substances are especially attractive to cattle having a depraved appetite and they frequently lick lime, earth, coal, gravel, and even the dung of other cattle. cows in calf and young cattle are especially liable to develop these symptoms. animals affected in this way lose condition, their coat is staring, gait slow, and small vesicles containing yellow liquid form under the tongue; the milk given by such cows is thin and watery. such animals become restless and uneasy, as is indicated by frequent bellowing. the disease may last for months, the animal ultimately dying emaciated and exhausted. depraved appetite frequently precedes the condition in which the bones of cattle become brittle and fracture easily, which is known as osteomalacia. _cause._--from the fact that this disease is largely one of regions, it is generally believed that some condition of the soil and water and of the local vegetation is responsible for it. it is more prevalent some years than others, and is most common in old countries, where the soil is more or less depleted. cattle pastured on low, swampy land become predisposed to it. it occasionally happens, however, that one individual in a herd suffers though all are fed alike; in such cases the disease must arise from the affected animal's imperfect assimilation of the nutritive elements of the feed which is supplied to it. _treatment._--the aim in such cases must be to improve the process of digestion and to supply the animal with a sufficiency of sound and wholesome feed. the following should be given to the cow three times a day, a heaping tablespoonful constituting a dose: carbonate of iron, ounces; finely ground bone or "bone flour," pound; powdered gentian, ounces; common salt, ounces; powdered fenugreek, ounces; mix. in addition to this, tablespoonfuls of powdered charcoal may be mixed with the feed three times a day, and a piece of rock salt should be placed where the animal can lick it at will. german veterinarians have had brilliant results from the treatment of this disease with subcutaneous injections of apomorphin in doses of - / to grains for three or four days. hair concretions. hair concretions, or hair balls, result from the habit which some cattle have of licking themselves or other animals. as a result the hairs which are swallowed are carried around by the contractions of the stomach and gradually assume the form of a small pellet or ball. this increases in size as fresh quantities of hair are introduced into the stomach and adhere to the surface of the ball. these balls are found most frequently in the reticulum or second stomach (pl. ii, b), though sometimes in the rumen. in calves hair balls are generally found in the fourth stomach. there are no certain symptoms by which we can determine the presence of hair balls in the stomach, and therefore no treatment can be recommended for such cases. in making post-mortem examinations of cattle we have sometimes found the walls of the reticulum transfixed with nails or pieces of wire, and yet the animal had not shown any symptoms of indigestion, but had died from maladies not involving the second stomach. indigestion (dyspepsia, or gastrointestinal catarrh). tympanites, already described, is a form of indigestion in which the chief symptom and most threatening condition is the collection of gas in the paunch. this symptom does not always accompany indigestion, so it is well here to consider other forms under a separate head. if indigestion is long continued, the irritant abnormal products developed cause catarrh of the stomach and intestines--gastrointestinal catarrh. on the other hand, however, irritant substances ingested may cause gastrointestinal catarrh, which, in turn, will cause indigestion; hence, it results that these several conditions are usually found existing together. _causes._--irritant feed, damaged feed, overloading of the stomach, or sudden changes of diet may cause this disease. want of exercise predisposes to it, or feed which is coarse and indigestible may after a time produce it. feed which possesses astringent properties and tends to check secretion may also act as an exciting cause. feed in excessive quantity may lead to disorder of digestion and to this disease. it is very likely to appear toward the end of protracted seasons of drought; therefore a deficiency of water must be regarded as one of the conditions which favor its development. _symptoms._--diminished appetite, rumination irregular, tongue coated, mouth slimy, dung passed apparently not well digested and smelling bad, dullness, and fullness of the flanks. the disease may in some cases assume a chronic character, and in addition to the foregoing symptoms slight bloating or tympanites of the left flank may be observed; the animal breathes with effort and each respiration may be accompanied with a grunt, the ears and horns are alternately hot and cold, rumination ceases, the usual rumbling sound in the stomach is not audible, the passage of dung is almost entirely suspended, and the animal passes only a little mucus occasionally. sometimes there is alternating constipation and diarrhea. there is low fever in many cases. the disease continues a few days or a week in the mild cases, while the severe cases may last several weeks. in the latter form the emaciation and loss of strength may be very great. there is no appetite, no rumination, nor peristalsis. the mouth is hot and sticky, the eyes have receded in their sockets, and milk secretion has ceased. in such cases the outlook for recovery is unfavorable. the patient falls away in flesh and becomes weaker, as is shown by the fact that one frequently finds it lying down. on examining animals which have died of this disease it is found that the lining membrane of the fourth stomach and the intestines, particularly the small intestine, is red, swollen, streaked with deeper red or bluish lines, or spotted. the lining of the first three stomachs is more or less softened, and may easily be peeled off. the third stomach (psalter) contains dry feed in hard masses closely adherent to its walls. in some cases the brain appears to become disordered, probably from the pain and weakness and from the absorption of toxins generated in the digestive canal. in such cases there is weakness and an unsteady gait, the animal does not appear to take notice of and will consequently run against obstacles; after a time it falls and gives up to violent and disordered movements. this delirious condition is succeeded by coma or stupor, and death ensues. _treatment._--small quantities of roots, sweet silage, or selected grass or hay should be offered several times daily. very little feed should be allowed. aromatic and demulcent drafts may be given to produce a soothing effect on the mucous lining of the stomachs and to promote digestion. two ounces of camomile flowers should be boiled for minutes in a quart of water and the infusion on cooling should be given to the affected animal. this may be repeated three or four times a day. when constipation is present the following purgative may be administered: one pound of glauber's salt dissolved in a quart of linseed tea and a pint of molasses. after this purgative has acted, if there is a lack of appetite and the animal does not ruminate regularly, the powder mentioned in remarks on the treatment of chronic tympanites may be given according to directions. the diet must be rather laxative and of an easily digestible character after an attack of this form of indigestion. feed should be given in moderate quantities, as excess by overtaxing the digestive functions may bring on a relapse. ice-cold water should be avoided. indigestion from drinking cold water (colic). this disorder is produced by drinking copiously of cold water, which arrests digestion and produces cramp of the fourth stomach, probably of the other stomachs, and also of the bowels. _causes._---it is not customary for the ox to drink much water at once. in fact, he usually drinks slowly and as if he were merely tasting the water, letting some fall out at the corners of his mouth at every mouthful. it would therefore seem to be contrary to the habits of the ox to drink copiously; but we find that during hot weather, when he has been working and is consequently very thirsty, if he drinks a large quantity of cold water he may be immediately taken with a very severe colic. cows which are fed largely on dry hay drink copiously, like the working ox, and become affected in precisely the same manner. in such cases they are seized with a chill or fit of trembling before the cramps come on. _symptoms._--there is some distension of the abdomen, but no accumulation of gas. as the distension and pain occur immediately after the animal has drunk the water, there can be no doubt as to the exciting cause. _treatment._--walk the animal about for minutes before administering medicine, and this allows time for a portion of the contents of the stomach to pass into the bowel, and renders it safer to give medicine. in many cases the walking exercise and the diarrhea bring about a spontaneous cure of this disorder, but as in some instances the cramps and pains of the stomachs persist, one may give ounce of sulphuric ether and ounce of tincture of opium, shaken up with a pint of warm water, and repeat the dose in half an hour if the animal is not relieved. in an emergency when the medicine is not to be had, a tablespoonful of powdered ginger may be administered in a pint of warm water. indigestion in calves (gastrointestinal catarrh, diarrhea, or scour). calves are subject to a form of diarrhea to which the foregoing designations have been applied. _causes._--calves that suck their dams are not frequently affected with this disease, though it may be occasioned by their sucking at long intervals and thus overloading the stomach and bringing on indigestion, or from improper feeding of the dam on soft, watery, or damaged feeds. suckling the calf at irregular times may also cause it. exposure to damp and cold is a potent predisposing cause. calves separated from their dams and fed considerable quantities of cold milk at long intervals are liable to contract this form of indigestion. calves fed on artificial feed, used as a substitute for milk, frequently contract it. damaged feed, sour or rotten milk, milk from dirty cans, skim milk from a dirty creamery skim-milk vat, skim milk hauled warm, exposed to the sun and fed from unclean buckets may all cause this disease. _symptoms._--the calf is depressed; appetite is poor; sometimes there is fever; the extremities are cold. the dung becomes gradually softer and lighter in color until it is cream colored and little thicker than milk. it has a most offensive odor and may contain clumps of curd. later it contains mucus and gas bubbles. it sticks to the hair of the tail and buttocks, causing the hair to drop off and the skin to become irritated. there may be pain on passing dung and also abdominal or colicky pain. the calf stands about with the back arched and belly contracted. there may be tympanites. great weakness ensues in severe cases, and without prompt and successful treatment death soon follows. _treatment._--remove the cause. give appropriate feed of best quality in small quantities. make sure that the cow furnishing the milk is healthy and is properly fed. clean all milk vessels. clean and disinfect the stalls. for the diarrhea give two raw eggs or a cup of strong coffee. if the case is severe, give ounce of castor oil with a teaspoonful of creolin and grains of subnitrate of bismuth. repeat the bismuth and creolin with flaxseed tea every four hours. tannopin may be used in doses of to grains. calves artificially fed on whole or skim milk should receive only such milk as is sweet and has been handled in a sanitary manner. milk should always be warmed to the temperature of the body before feeding. when calves artificially milk-fed develop diarrhea, the use of the following treatment has given excellent results in many cases: immediately after milking, or the separation of the skim milk from the cream, formalin in the proportion of to , should be added to the milk which is used for feeding; this may be closely approximated by adding four drops of formalin to each quart of milk. this medicated milk should be fed to the calf in the usual quantity. when the diarrhea is not controlled in three or four days by this treatment, the additional use of some of the agents recommended above may assist in a recovery. infectious diarrhea; white scour. [see chapter on diseases of young calves, p. .] gastroenteritis. this consists of an inflammation of the walls of the stomachs and of the bowel. gastroenteritis, or inflammation of the walls of the stomachs and intestines, follows upon irritations more severe or longer continued than those that produce gastrointestinal catarrh. _causes._--severe indigestion may be followed by gastroenteritis, or it may be caused by swallowing irritant poisons, such as arsenic or corrosive sublimate or irritant plants. exposure to cold or inclement weather may produce the disease, especially in debilitated animals or animals fed improperly. it is asserted that if cattle feed on vegetation infested with some kinds of caterpillars this disease may result. _symptoms._--dullness; drooping of the ears; dryness of the muzzle; dry skin; staring coat; loins morbidly sensitive to pressure; fullness of the left flank, which is caused by the distention of the fourth stomach by gas. the pulse is small, the gait is feeble and staggering; each step taken is accompanied with a grunt, and this symptom is especially marked if the animal walks in a downward direction. there is loss of appetite, and rumination is suspended. the passages at first are few in number, hard, and are sometimes coated with mucus or with blood. later a severe diarrhea sets in, when the passages contain mucus and blood and have an offensive odor. there is evidence of colicky pain, and the abdomen is sensitive to pressure. pain may be continuous. there is fever and acceleration of pulse rate and respirations. mental depression and even insensibility occur before death. the disease is always severe and often fatal. _post-mortem appearances._--the mucous membrane of the fourth stomach has a well-marked red color and sometimes presents ulcerations. the wall is thickened and softened, and similar conditions are found in the walls of the intestines. the red discoloration extends in spots or large areas quite through the wall, showing on the outside. _treatment._--very small quantities of carefully selected feed must be given and the appetite must not be forced. protect the animal well from cold and dampness. internally, give linseed tea, boiled milk, boiled oatmeal gruel, or rice water. these protectives may carry the medicine. tannopin in doses of to grains is good. subnitrate of bismuth in doses of to drams may be given. pulverized opium may be used, if the diarrhea is severe, in to dram doses. if the bowel movements are not free, one may give from a pint to a quart of castor or raw linseed oil. traumatic inflammation of the stomach. this disease results from the presence of a foreign body. this condition is not rare in cattle, because these animals have the habit of swallowing their feed without careful chewing, and so nails, screws, hairpins, ends of wire, and other metal objects may be swallowed unconsciously. such objects gravitate to the second stomach, where they may be caught in the folds of the lining mucous membrane, and in some instances the wall of this organ is perforated. from this accident, chronic indigestion results. the symptoms, more or less characteristic, are pain when getting up or lying down; grunting and pain upon sudden motion, especially downhill; coughing; pain on pressure over the second stomach, which lies immediately above the cartilaginous prolongation of the sternum. if the presence of such a foreign body is recognized, it may be removed by a difficult surgical operation, or, as is usually most economical, the animal may be killed for beef, if there is no fever. diseases of the bowels. diarrhea and dysentery. [see also gastrointestinal catarrh, p. .] the word "dysentery," as it is commonly used in relation to the diseases of animals, signifies a severe form of diarrhea. _causes._--diarrhea is a symptom of irritation of the intestines, resulting in increased secretion or increased muscular contractions, or both. the irritation is sometimes the result of chilling from exposure, improper feeding, irritant feeds, indigestion, organic diseases of the intestines, or parasites. _symptoms._--passages from the bowels are frequent, at first consisting of thin dung, but as the disease continues they become watery and offensive smelling, and may be even streaked with blood. at first the animal shows no constitutional disturbance, but later it becomes weak and may exhibit evidence of abdominal pain by looking around to the side, drawing the feet together, lying down, or moving restlessly. sometimes this malady is accompanied with fever, great depression, loss of strength, rapid loss of flesh, and it may terminate in death. _treatment._--when the disease depends on irritating properties of the feed which has been supplied to the animal, it is advisable to give a mild purgative, such as a pint of castor or linseed oil. when the secretions of the bowels are irritating, an ounce of carbonate of magnesia and half an ounce of tincture of opium should be shaken up in a quart of linseed tea and given to the animal three times a day until the passages present a natural appearance. when there is debility, want of appetite, no fever, but a continuance of the watery discharges from the bowels, then an astringent may be given. for such cases the following is serviceable: tannic acid, ounce; powdered gentian, ounces; mix and divide into powders, one powder to be given three times a day until the passages present a natural appearance. each powder may be mixed with a pint and a half of water. tannopin is a new remedy that is most useful in such cases. the dose is from grains to drams. useful household remedies are raw eggs, strong coffee, parched rye flour, or decoction of oak bark. in all cases the food must be given sparingly, and it should be carefully selected to insure good quality. complete rest in a box stall is desirable. when diarrhea is a symptom of a malady characterized by the presence of a blood poison, the treatment appropriate to such disease must be applied. simple enteritis. [see gastroenteritis, p. .] croupous enteritis. under certain conditions, severe irritation of the digestive canal may, in cattle, cause a form of inflammation of the intestines (enteritis) that is characterized by the formation of a false membrane upon the surface of the lining membrane of the intestines, particularly the large ones. _symptoms._--there is fever, depression, loss of appetite, diarrhea, and in the fecal masses shreds of leathery false membrane may be found. these shreds are sometimes mistaken for parasites or for portions of the wall of the intestine. _treatment._--give a pound of glauber's salt, followed by bicarbonate of soda in doses of ounces four times daily. enteritis (obstruction resulting from invagination, or intussusception, twisting, and knotting of the bowels). inflammation may arise from a knot forming on some part of the small intestine from the portion of the bowel becoming twisted on itself, or from one part of the bowel slipping into another, which is termed invagination. this form of enteritis occurs occasionally in animals of the bovine species. _causes._--the small intestine, which in the ox rests on the right side of the rumen, is, from the position which it occupies, predisposed to this accident. it has been ascertained that animals which have shown symptoms of this malady have trotted, galloped, or made other violent exertions in coming from drinking, or that they have been chased by dogs or by animals of their own species while at pasture. the accident is most likely to occur among cattle on very hilly pastures. the danger of jumping or running is greatest when the rumen is distended with food. _symptoms._--this form of enteritis or obstruction is manifested by severe colicky pains; the ox scrapes and strikes the ground with his front and hind feet alternately; keeps lying down and getting up again; he keeps his tail constantly raised and turns his nose frequently to his right flank; he is frequently bloated, or tympanitic, on that side. he refuses feed and does not ruminate, and for some hours suffers severe pains. at first he frequently passes thin dung, and also urinates frequently, but passes only a little urine at a time. on the second day the pains have become less acute; the animal remains lying down; moans occasionally; his pulse is small and quick; he still refuses feed and does not ruminate. at this stage he does not pass any dung, though sometimes a small quantity of bloody mucus may be passed. the animal passes very little urine. this condition may continue for a considerable time, as cattle so affected may live for or even days. _post-mortem appearance._--at death the bowels are found to be misplaced or obstructed, as mentioned above, and inflamed, the inflammation always originating at the point where the intestine has been invaginated, twisted, or knotted. sometimes the part is gangrenous, the compression of the blood vessels preventing circulation, and thus causing the death of the tissues. _treatment._--purgatives, anodynes, and other remedies are of no service in such cases, and bleeding also fails to produce any benefit. indeed, it is usually true that in such cases treatment is useless. some cases are recorded in which an incision has been made in the flank, so as to enable the operator to restore the intestine to its normal position or to remove the kink. constipation. constipation is to be regarded rather as a symptom of disease or of faults in feeding than as a disease in itself. it occurs in almost all general fevers unless the bowels are involved in local disease, in obstructions of all kinds, from feeding on dry, bulky feed, etc. in order to remove the constipation the treatment must be applied to remove the causes which give rise to it. calves sometimes suffer from constipation immediately after birth when the meconium that accumulates in the bowels before birth is not passed. in such cases, give a rectal injection of warm water and an ounce of castor oil shaken up with an ounce of new milk. the mother's milk is the best food to prevent constipation in the new-born calf, as it contains a large amount of fatty matter which renders it laxative in its effects. it is usually better to treat habitual constipation by a change of diet than by medicine. flaxseed is a good feed laxative. if the constipation has lasted long, repeated small doses of purgatives are better than a single large dose. intestinal worms. [see chapter on "the animal parasites of cattle," p. .] ruptures (ventral hernia). ventral hernia, or rupture, is an escape of some one of the abdominal organs through a rupture in the abdominal muscles, the skin remaining intact. the rumen, the small intestine, or part of the large intestine, and the fourth stomach are the parts which usually form a ventral hernia in bovine animals. _causes._--hernia is frequently produced by blows of the horns, kicks, and falls. in old cows hernia may sometimes occur without any direct injury. hernia of the rumen.--hernia of the rumen is generally situated on the left side of the abdomen, on account of the situation of the rumen. in exceptional cases it may take place on the right side, and in such cases it also generally happens that some folds of the intestine pass into the hernial sac. hernias have been classified into simple or complicated, recent or old, traumatic (from mechanical injury) or spontaneous. in recent traumatic hernia there is swelling on the left side of the lower part of the abdomen. the swelling is greatest in the cases of hernia which are situated on the lower part of the abdomen. unless an examination is made immediately after the injury has been inflicted it is difficult, and sometimes impossible, to ascertain the exact extent of the rupture, owing to the swelling which subsequently takes place. frequently there is no loss of appetite, fever, or other general symptoms attending the injury. from the twelfth to the fifteenth day the swelling has generally subsided to such an extent that it is possible by an examination to determine the extent of the rupture. in old cows what is termed spontaneous hernia may sometimes take place without any direct injury. the occurrence of this form of hernia is explained by the increase in the size of the abdomen, which takes place in an advanced stage of pregnancy, causing a thinning and stretching of the muscular fibers, which at last may rupture, or give way. such hernias frequently occur about the end of the period of gestation, and in some instances have contained the right sac of the rumen, the omentum, the small and large intestines, a portion of the liver, and the pregnant uterus. in old hernias the swelling is soft and elastic, and if they have not contracted adhesions to the sides of the laceration, they can be made to disappear by pressure carefully applied. sometimes this accident is complicated by a rupture of the rumen, constituting a complicated hernia. if a portion of the contents of the rumen escape into the abdomen, the case will be aggravated by the occurrence of peritonitis. hernia of the bowel.--when the intestines (pl. iii, fig. ) form the contents of the hernia, it will be situated at the right side of the abdomen. in an intestinal hernia the swelling is usually not painful, of a doughy consistence or elastic, according as the intestine does or does not contain alimentary matter. this swelling can generally be made to disappear by pressure, and when it has been reduced one can easily recognize the direction and extent of the hernial opening. hernias of the bowel which are situated at the upper and right side of the abdomen are usually formed by the small intestine. they are less easily reduced than a hernia in a lower situation, but when reduction has been effected they are less readily reproduced than those occurring lower. in hernias of the small intestine, adhesion of the protruding parts to the walls of the opening, or strangulation, are complications which sometimes take place. if adhesion has taken place the hernia can not be reduced by pressure, and when strangulation has occurred the animal shows symptoms of pain--is restless, turns its nose to the painful part, and shows those symptoms which are usually collectively designated under the term colic. if relief is not afforded, the animal will die. hernia of the rennet, or fourth stomach.--this disease occasionally occurs in calves and is usually caused by a blow from a cow's horn on the right flank of the calf. after such an accident a swelling forms on the right flank near the last rib. this swelling may be neither hot nor painful, even at first, and is soft to the touch. it can be made to disappear by careful pressure, when the sides of the aperture through which it has passed can be felt. the application of pressure so as to cause the disappearance of the hernia is best made immediately after the occurrence of the accident, or when the edema which accompanies the swelling has disappeared. _treatment._--when a hernia is reducible--that is, can be pushed back into the abdomen--then, if it is of recent occurrence, it is advisable to maintain the natural position of the parts by bandaging and to allow the walls of the laceration to grow together. the bowels should be kept reasonably empty by avoiding the use of bulky feed, and the animal must be kept quiet. the following method of bandaging is recommended by bouley: first prepare a bandage (must be of strong material), about yards long and between and inches broad, and a flexible and solid piece of pasteboard adapted in size to the surface of the hernia. the protruding organ must then be replaced in the abdomen and maintained in that position during the application of the bandage. this being done, a layer of melted pitch and turpentine is quickly spread on the skin covering the seat of the hernia, so as to extend somewhat beyond that space. this adhesive layer is then covered with a layer of fine tow, then a new layer of pitch and turpentine is spread on the tow, and the piece of pasteboard is applied on the layer of pitch, its outer surface being covered with the same preparation. lastly, the bandage, adhering to the piece of pasteboard, to the skin, and to the different turns which it makes around the body, is carefully applied so as to form an immovable, rigid, and solid bandage, which will retain the hernia long enough for the wound in the abdominal walls to heal permanently. if the hernia is old and small it may be treated by injecting a strong solution of common salt about the edges of the tear. this causes swelling and inflammation, which, respectively, forces the protruded organ back and closes the opening. there is some risk attached to this method of treatment. in small, old, ventral hernias the method of compressing and sloughing off the skin has been used successfully. if the hernia is large a radical operation will be necessary, and this is also true when the symptoms indicate that a hernia is strangulated. this operation is performed by cutting down on the hernia, restoring the organ to the abdominal cavity, and then closing the wound with two sets of stitches; the inner stitches, in the muscular wall, should be made with catgut and the outer stitches, in the skin, may be made with silk or silver wire. the strictest surgical cleanliness must be observed. bleeding vessels should be tied. then a compress composed of ten or twelve folds of cloth must be placed smoothly over the seat of injury and a bandage applied around the body, the two ends being fastened at the back. in the smaller kinds of hernia, nitric acid may sometimes be applied with success. this treatment should not be applied until the swelling and inflammation attending the appearance of the hernia have subsided; then, the contents of the hernia having been returned, the surface of skin corresponding to it is sponged over with a solution composed of part of nitric acid to of water. this treatment acts by exciting considerable inflammation, which has the effect of causing swelling, and thus frequently closing the hernial opening and preventing the contents of the sac from returning. a second application should not be made until the inflammation excited by the first has subsided. in what is termed spontaneous hernia it is useless to apply any kind of treatment. umbilical hernia.--the umbilicus, or navel, is the aperture through which the blood vessels pass from the mother to the fetus, and naturally the sides of this aperture ought to adhere or unite after birth. in very young animals, and sometimes in newborn calves, this aperture in the abdominal muscles remains open and a part of the bowel or a portion of the mesentery may slip through the opening, constituting what is called umbilical hernia. the wall of the sac is formed by the skin, which is covered on the inner surface by a layer of cellular tissue, and within this there is sometimes, but not always, a layer of peritoneum. the contents of the hernia may be formed by a part of the bowel, by a portion of the peritoneum, or may contain portions of both peritoneum and bowel. when the sac contains only the peritoneum it has a doughy feel, but when it is formed by a portion of the bowel it is more elastic on pressure. _causes._--in the new-born animal the opening of the navel is generally large, and may sometimes give way to the pressure of the bowel on account of the weak and relaxed condition of the abdominal muscles. this defective and abnormal condition of the umbilicus is frequently hereditary. it may be occasioned by roughly pulling away the umbilical cord; through kicks or blows on the belly; through any severe straining by which the sides of the navel are stretched apart. we may mention in this connection that it is best in new-born calves to tie the umbilical cord tightly about inches from the navel, and then to leave it alone, when in most cases it will drop off in a few days, leaving the navel closed. _treatment._--it is well to bear in mind that many, and especially the smaller, umbilical hernias heal spontaneously; that is, nature effects a cure. as the animal gets older the abdominal muscles get stronger and possess more power of resistance to pressure, the bowels become larger and do not pass so readily through a small opening, so that from a combination of causes there is a gradual growing together or adhesion of the sides of the navel. in cases of umbilical hernia in which there are no indications that a spontaneous cure will take place, the calf should be laid on its back; immediately on this being done the hernia will often disappear into the abdomen. if it does not, its reduction may be brought about by gentle handling, endeavoring, if need be, to empty the organs forming the hernia before returning them into the abdomen. after the hernia has been returned, the hair should be clipped from the skin covering it and a compress composed of or folds of linen or cotton should be applied, first smearing the skin with pitch and then a bandage about inches wide should be passed round the body so as to retain the compress in position. the lower part of the compress should be smeared with pitch, and also those portions of the bandage which pass over it, so as to keep it solid and prevent it from shifting. in some cases it will be found that the contents of the sac can not be returned into the abdomen, and this generally arises from the fact that some part of the contents of the sac has grown to or become adherent to the edges of the umbilical opening. in such a case the skin must be carefully laid open in the long direction, the adhesions of the protruding organs carefully separated from the umbilicus, and after the protruding parts have been returned into the abdomen, the sides of the umbilicus must be freshened if necessary by paring, and then the edges of the opening brought together by catgut stitches; the wound in the skin must then also be brought together by stitches. the wound must be carefully dressed every day and a bandage passed round the body so as to cover and protect the part operated on. in small hernias nitric acid has been used successfully in the same manner as has been described in the treatment of ventral hernia. sulphuric acid has also been used for a similar purpose, diluting it to the extent of part of acid to or of water. in thin-skinned animals the weaker preparations ought to be preferred, and caution must be exercised in using such preparations so as not to destroy the tissues on which they are applied. another method of treatment is, after the contents of the sac have been returned into the abdomen, to tie a piece of strong waxed cord round the pendulous portion which formed the outer covering of the hernia. the string is apt to slacken after two or three days, when a new piece of cord should be applied above the first one. the constriction of the skin sets up inflammation, which generally extends to the umbilicus and causes the edges to adhere together, and by the time the portion of skin below the ligature has lost its vitality and dropped off, the umbilicus is closed and there is no danger of the abdominal organs protruding through it. this is what takes place when this method has a favorable result, though if the umbilicus does not become adherent and the skin sloughs, the bowels will protrude through the opening. gut-tie (peritoneal hernia).--in peritoneal hernia of the ox a loop or knuckle of intestine enters from the abdomen into a rent in that part of the peritoneum which is situated at the margin of the hip bone or it passes under the remains of the spermatic cord, the end of which may be grown fast to the inner inguinal ring. the onward pressure of the bowel, as well as the occasional turning of the latter round the spermatic cord, is the cause of the cord exercising considerable pressure on the bowel, which occasions irritation, obstructs the passage of excrement, and excites inflammation, which terminates in gangrene and death. the rent in the peritoneum is situated at the upper and front part of the pelvis, nearer to the sacrum than the pubes. _causes._--among the causes of peritoneal hernia considerable importance is attached to a method of castration which is practiced in certain districts, viz, the tearing or rupturing of the spermatic cord by main force instead of dividing it at a proper distance above the testicle in a surgical manner. after this violent and rough method of operating, the cord retracts into the abdomen and its stump becomes adherent to some part of the peritoneum, or it may wind around the bowel and then the stump becomes adherent, so that strangulation of the bowel results. the rough dragging on the cord may also cause a tear in the peritoneum, the result of which need not be described. the severe exertion of ascending hills and mountains, drawing heavy loads, or the straining which oxen undergo while fighting each other may also give rise to peritoneal hernia. _symptoms._--the ox suddenly becomes very restless, stamps with his feet, moves backward and forward, hurriedly lies down, rises, moves his tail uneasily, and kicks at his belly with the foot of the affected side. the pain evinced may diminish but soon returns again. in the early stage there are frequent passages of dung, but after the lapse of or hours this ceases, the bowel apparently being emptied to the point of strangulation, and the passages now consist only of a little mucus mixed with blood. when injections are given at this time the water passes out of the bowel without even being colored. the animal lies down on the side where the hernia exists and stretches out his hind feet in a backward direction. these two particular symptoms serve to distinguish this affection from enteritis and invagination of the bowel. as time passes the animal becomes quieter, but this cessation of pain may indicate that gangrene of the bowel has set in, and may, therefore, under certain circumstances, be considered a precursor of death. gangrene may take place in from four to six days, when perforation of the bowel may occur and death result in a short time. _treatment._--in the first place the ox should be examined by passing the oiled hand and arm into the rectum; the hand should be passed along the margin of the pelvis, beginning at the sacrum and continuing downward toward the inguinal ring, when a soft, painful swelling will be felt, which may vary from the size of an apple to that of the two fists. this swelling will be felt to be tightly compressed by the spermatic cord. it very rarely happens that there is any similar swelling on the left side, though in such cases it is best to make a thorough examination. the bowel has sometimes been released from its position by driving the ox down a hill; by causing him to jump from a height of feet to the ground; the expedient of trotting him also has been resorted to with the hope that the jolting movement might bring about a release of the bowel. if the simple expedients mentioned have been tried and failed, then the hand being passed into the rectum should be pressed gently on the swelling in an upward and forward direction, so as to endeavor to push the imprisoned portion of the bowel back into the abdomen. while this is being done the ox's hind feet should stand on higher ground than the front, so as to favor the slipping out of the bowel by its own weight, and at the same time an assistant should squeeze the animal's loins, so as to cause it to bend downward and so relax the band formed by the spermatic cord. if the imprisoned portion of gut is freed, which may be ascertained by the disappearance of the swelling, the usual sounds produced by the bowels moving in the abdomen will be heard, and in a few hours the feces and urine will be passed as usual. if the means mentioned fail to release the imprisoned portion of the gut, then an incision about inches long must be made in the right flank in a downward direction, the hand introduced into the abdomen, the situation and condition of swelling exactly ascertained, and then a probe-pointed knife inserted between the imprisoned bowel and band compressing it, and turned outward against the band, the latter being then cautiously divided and the imprisoned gut allowed to escape, or, if necessary, the bowel should be drawn gently from its position into the abdomen. the wound in the flank must be brought together in the same way as in the case of the wound made in operating for impaction of the rumen. wounds of the abdomen. a wound of the abdomen may merely penetrate the skin; but as such cases are not attended with much danger, nor their treatment with much difficulty, we will consider here merely those wounds which penetrate the entire thickness of the abdominal walls and expose to a greater or less extent the organs contained in that cavity. _causes._--such accidents may be occasioned by falling on fragments of broken glass or other sharp objects. a blow from the horn of another animal may penetrate the abdomen. exposure and protrusion of some of the abdominal organs may also be occasioned by the incautious use of caustics in the treatment of umbilical or ventral hernia. the parts which generally escape through an abdominal wound are the small intestine and floating colon. _symptoms._--when the abdominal wound is small, the bowel exposed presents the appearance of a small round tumor, but in a few moments a loop of intestine may emerge from the opening. the animal then shows symptoms of severe pain by pawing with his feet, which has the effect of accelerating the passage of new loops of intestine through the wound, so that the mass which they form may even touch the ground. the pain becomes so great that the ox now not only paws but lies down and rolls, thus tearing and crushing his bowels. in such cases it is best to slaughter the animal at once; but in the case of a valuable animal in which tearing and crushing of the bowels has not taken place the bowels should be washed with freshly boiled water reduced to the temperature of the body and returned and the wounds in the muscle and skin brought together in a manner somewhat similar to that described in speaking of ventral hernia. diseases of the liver and spleen. jaundice (the yellows, or congestion of the liver). when jaundice exists, there is a yellow appearance of the white of the eyes and of the mucous membrane of the mouth. a similar aspect of the skin may also be observed in animals which are either partly or altogether covered with white hair. jaundice is then merely a symptom of disease and ought to direct attention to ascertaining, if possible, the cause or causes which have given rise to it. a swollen condition of the mucous membrane of that part of the bowel called the duodenum may produce jaundice, as that mechanically closes the orifice of the biliary duct. in constipation there is an inactive or torpid condition of the bowel, and the bile which passes into the intestine may be absorbed and cause the yellow staining of jaundice. jaundice is one of the symptoms of texas fever. it may also arise from the presence of parasites or gallstones in the ducts, forming a mechanical obstruction to the onward flow of bile. the conditions under which jaundice most commonly calls for treatment are when cattle have been highly fed and kept in a state of inactivity. at such time there is an excess of nutritive elements carried into the blood, which is associated with increased fullness of the portal vein and hepatic artery. when continued high feeding has produced this congested state of the liver, the functions of that organ become disordered, so that a considerable portion of the bile, instead of being excreted and passing into the intestine, is absorbed by the hepatic veins. the structure of the liver is shown in plate iv. _symptoms._--this disease, although rare, occurs most frequently among stall-fed cattle. pressure along the margin of the short ribs on the right side produces pain; the appetite is poor and the animal shows hardly any inclination to drink; the mucous membranes of the eye and mouth are yellow, the urine has a yellow or brown appearance, the animal lies down much and moves with reluctance, moans occasionally, and has a tottering gait. the ears and horns are alternately hot and cold; in cows the secretion of milk is much diminished, and that which is secreted has a bitter taste; sometimes the animal has a dry, painful cough and presents a dull, stupefied appearance. _treatment._--in such cases it is advisable to produce a free action of the bowels, so as to remove the usually congested condition of the portal vein and liver. for this purpose the administration of the following dose is recommended: sulphate of soda, ounces; molasses, pint; warm water, quart. the sulphate of soda is dissolved by stirring it up in tepid water. following this the animal should have a heaping tablespoonful of artificial carlsbad salt in the feed three times daily. this treatment may be assisted by giving occasional injections of warm water and soap. the diet should be laxative and moderate in quantity and may consist of coarse bran mash, pulped roots, grass in the season, and hay in moderate quantity. hepatitis (inflammation of the liver). hepatitis is an inflammation of the liver and usually occurs as a complication of some infectious disease. it may also occur as a complication of gastrointestinal catarrh or in hot weather from overheating or damaged (putrid or fermented) feeds. _symptoms._--the symptoms are sometimes obscure and their real significance is frequently overlooked. the most prominent symptoms are yellowness of the white of the eye and of the membrane lining the mouth; the appetite is poor, the body presents an emaciated appearance, the feces are light colored, while the urine is likely to be unusually dark; there is thirst, and pain is caused by pressing over the liver. the gait is weak and the animal lies down more than usual, and while doing so frequently rests its head on the side of its chest. _treatment._--give a purge of glauber's salt and after it has operated give artificial carlsbad salts in each feed, as advised under "jaundice." give green feed and plenty of water. oil of turpentine should be rubbed in well once a day over the region of the liver. the skin on which it should be applied extends from the false ribs on the right side to inches in front of the last one, and from the backbone to inches on the right side of it. fluke disease. [see chapter on "the animal parasites of cattle," p. .] splenitis (inflammation of the spleen). this disease occurs almost solely as a result of the existence of some infectious disease, and the symptoms caused by it merge with the symptoms of the accompanying causative disease. the spleen is seriously involved and becomes enlarged and soft in texas fever, anthrax, and blood poisoning. diseases of the peritoneum. peritonitis. peritonitis consists of an inflammation of the peritoneum, which is the thin, delicate membrane that lines the abdomen and covers the abdominal organs. _causes._--wounds are the usual cause in cattle. the wound may be of the abdominal wall or of the intestines, stomach, or uterus; or inflammation may extend from one of the organs of the abdominal cavity to the peritoneum; so this disease may complicate enteritis or inflamed womb. a sharp metal body may perforate the second stomach and allow the gastric contents to escape, irritating the peritoneum. this disease may follow castration or operation for hernia. _symptoms._--a continuous or occasional shivering; the animal lies down, but appears uneasy; it frequently turns its head toward its belly and lows plaintively; pressure on the flanks produces pain; has no appetite; muzzle is dry and no rumination; while standing, its legs are placed well under its body; pulse small and hard. the evacuations from the bowels are dry and hard. if this disease is complicated by the presence of inflammation of the bowels, the pain is more severe and the animal is more restless. the skin is cold and dry in the early stage of this disease, but in a more advanced stage this condition may be succeeded by heat of the skin and quick breathing. the fits of trembling, uneasiness, small and hard pulse, and tension of the left flank are symptoms the presence of which would enable one to reach the conclusion that peritonitis exists. _post-mortem appearance._--the membrane lining the abdomen and covering the surface of the bowels is reddened to a greater or less extent, and there is usually considerable serous, or watery, fluid collected in the abdomen. _treatment._--when we have to do with the form of peritonitis resulting from an injury, as when the horn of another animal has been thrust through the abdominal walls, this lesion must be treated in accordance with directions before given, but the general treatment must be similar to that which follows. peritonitis resulting from castration or from parturient fever must also be treated in connection with the special conditions which give rise to it, as the general treatment of this disease must be modified to some extent by the exciting cause. the aim must be to discover and remove the cause. the cause must be treated according to its nature. harms strongly recommends borax in the treatment of peritonitis. he gives ounces in the first hours, divided into three doses, and afterwards he gives drams three times daily. opium in doses of to drams may be given. to bring on evacuations of the bowels it is better to give rectal injections than to administer purges. the strength may be sustained by coffee or camphor. the body should be warmly clothed, and it is advisable, when practicable, to have a blanket which has been wrung out of hot water placed over the abdomen, then covered by several dry blankets, which are maintained in position by straps or ropes passing round the body. the wet blanket must be changed as it cools--the object of treatment being to warm the surface of the body and to determine as much blood to the skin as possible. the diet should consist of laxative food and drinks, such as linseed tea. if peritonitis assumes chronic form the diet should be nutritious, such as selected clover hay, linseed cake, grass, etc., and iodid of potassium should be given three times a day in gram doses dissolved in a pint of water. dropsy of the abdomen (ascites). in this disease there is a serous, or watery, effusion in the cavity of the abdomen. _causes._--when old animals are fed on innutritious feed or when reduced by disease, they become anemic; in other words, their blood becomes impoverished and dropsy may follow. an innutritious and insufficient diet produces the same effect in young animals. it is one of the results of peritonitis, and may also arise from acute or chronic inflammation of the liver, such as is of common occurrence when flukes are present in the liver in large numbers. heart disease and chronic lung disease may be followed by ascites. it is sometimes, in calves, a symptom of infestation with worms. _symptoms._--a gradual increase in the size of the abdomen at its lower part, while the flanks becomes hollow; pallor of the mucous membrane of the mouth and eye; weak and sluggish gait; want of appetite, and irregularity in ruminating. on percussion or tapping the surface of the abdomen with the fingers, a dull sound is produced. if the hand and arm are oiled and passed into the rectum as far as possible, on moving the hand from one side to the other the fluctuation caused by the presence of fluid in the abdomen may be felt. _treatment._--if possible the cause must be discovered and removed. the diet should be nutritious, and in those cases in which we have merely to deal with anemia (the bloodless state) arising from insufficient diet, the use of tonics and diuretics, at the same time keeping the skin warm, may bring about a gradual absorption of the fluid contained in the abdomen. one of the following powders may be mixed with the animal's feed three times a day; or, if there is any uncertainty as to its being taken in that way, it should be mixed with sirup, so as to form a paste, and smeared well back on the animal's tongue with a flat wooden spoon: carbonate of iron, ounces; powdered gentian, ounces; powdered nitrate of potassium, ounces; mix and divide into powders. the administration of purgatives which promote a watery discharge from the mucous surface of the bowels also tends, by diminishing the serum of the blood, to bring about absorption and a gradual removal of the fluid contained in the abdomen. large doses should not be given, but moderate ones should be administered morning and night, so as to produce a laxative effect on the bowels for several days. to attain this end the following may be used: sulphate of soda, ounces; powdered ginger, half an ounce; to be mixed in quarts of tepid water and given at one dose. * * * * * diseases of the digestive organs. description of plates. plate i. position of the first stomach (rumen or paunch) on the left side. the area inclosed by heavy dotted lines represents the rumen; the elongated, shaded organ is the spleen resting upon it. the skin and muscles have been removed from the ribs to show the position of the lungs and their relation to the paunch. plate ii. stomach of ruminants. fig. . stomach of a full-grown sheep, / natural size (after thanhoffer, from r. meade smith's physiology of domestic animals): _a_, rumen, or first stomach; _b_, reticulum, or second stomach; _c_, omasum, or third stomach; _d_, abomasum, or fourth stomach; _e_, esophagus, or gullet, opening into the first and second stomachs; _f_, opening of fourth stomach into small intestine; _g_, opening of second stomach into third; _h_, opening of third stomach into fourth. the lines indicate the course of the food in the stomachs. the incompletely masticated food passes down the esophagus, or gullet, into the first and second stomachs, in which a churning motion is kept up, carrying the food from side to side and from stomach to stomach. from the first stomach regurgitation takes place; that is, the food is returned through the gullet to the mouth to be more thoroughly chewed, and this constitutes what is known as "chewing the cud." from the second stomach the food passes into the third, and from the third into the fourth, or true, stomach, and from there into the intestines. fig. . stomach of ox (after colin, from r. meade smith's physiology of domestic animals): _a_, rumen; _b_, reticulum; _c_, omasum; _d_, abomasum; _e_, esophagus; _f_, opening of fourth stomach into small intestine. fürstenberg calculated that in an ox of , pounds weight the capacity of the stomach is as follows: per cent. rumen, . quarts, liquid measure . reticulum, . quarts omasum, . quarts abomasum, . quarts . according to colon-- quarts. the capacity of a beef's stomach is . small intestine . cecum . colon and rectum . fig. . clinical thermometer, / natural size. this is used to determine the temperature of the animal body. the thermometer is passed into the rectum after having been moistened with a little saliva from the mouth, or after having had a little oil or lard rubbed upon it to facilitate its passage. there it is allowed to remain two or three minutes, then withdrawn, and the temperature read as in any ordinary thermometer. the clinical thermometer is made self-registering; that is, the mercury in the stem remains at the height to which it was forced by the heat of the body until it is shaken back into the bulb by taking hold of the upper portion of the instrument and giving it a short, sharp swing. the normal temperature of cattle varies from ° to ° f. in young animals it is somewhat higher than in old. the thermometer is a very useful instrument and frequently is the means by which disease is detected before the appearance of any external sign. [illustration: plate i. showing the position of the rumen.] [illustration: plate ii. stomach of ruminants.] [illustration: plate iii. instruments used in treating diseases of digestive organs.] [illustration: plate iv. microscopic anatomy of the liver.] [illustration: plate v. ergot in hay.] [illustration: plate vi. ergotism.] fig. . simple probang, used to dislodge foreign bodies, like apples, potatoes, eggs, etc., which have become fastened or stuck in the esophagus or gullet. fig. . grasping or forceps probang. this instrument, also intended to remove obstructions from the gullet, has a spring forceps at one end in the place of the cup-like arrangement at the end of the simple probang. the forceps are closed while the probang is being introduced; their blades are regulated by a screw in the handle of the instrument. this probang is used to grasp and withdraw an article which may have lodged in the gullet and can not be forced into the stomach by use of the simple probang. fig. . wooden gag, used when the probang is to be passed. the gag is a piece of wood which fits in the animal's mouth; a cord passes over the head to hold it in place. the central opening in the wood is intended for the passage of the probang. figs. _a_ and _b._ trocar and cannula; _a_ shows the trocar covered by the cannula; _b_, the cannula from which the trocar has been withdrawn. this instrument is used when the rumen or first stomach becomes distended with gas. the trocar covered by the cannula is forced into the rumen, the trocar withdrawn, and the cannula allowed to remain until the gas has escaped. fig. . section at right angles through the abdominal wall, showing a hernia or rupture. (taken from d'arboval. dictionnaire de médecine, de chirurgie de hygiene): _a a_, the abdominal muscles cut across; _v_, opening in the abdominal wall permitting the intestines _i i_ to pass through and outward between the abdominal wall and the skin; _p p_, peritoneum, or membrane lining the abdominal cavity, carried through the opening _o_ by the loop of intestine and forming the sac s, the outer walls of which are marked _b f b._ plate iv. microscopic anatomy of the liver. the liver is composed of innumerable small lobules, from / to / inch in diameter. the lobules are held together by a small amount of fibrous tissue, in which the bile ducts and larger blood vessels are lodged. fig. illustrates the structure of a lobule; _v v_, interlobular veins or the veins between the lobules. these are branches of the portal vein, which carries blood from the stomach and intestines to the liver; _c c_, capillaries, or very fine blood vessels, extending as a very fine network between the groups of liver cells from the interlobular vein to the center of the lobule and emptying there into the intralobular vein to the center of the lobule; _v c_, intralobular vein, or the vein within the lobule. this vessel passes out of the lobule and there becomes the sublobular vein; _v s_, sublobular vein. this joins other similar veins and helps to form the hepatic vein, through which the blood leaves the liver; _d d_, the position of the liver cells between the meshes of the capillaries; _a a_, branches of the hepatic artery to the interlobular connective tissue and the walls of the large veins and large bile ducts. these branches are seen at _r r_ and form the vena vascularis; _v v_, vena vascularis; _i i_, branches of the hepatic artery entering the substance of the lobule and connecting with capillaries from the interlobular vein. the use of the hepatic artery is to nourish the liver, while the other vessels carry blood to be modified by the liver cells in certain important directions; _g_, branches of the bile ducts, carrying bile from the various lobules into the gall bladder and into the intestines; _x x_, intralobular bile capillaries between the liver cells. these form a network of very minute tubes surrounding each ultimate cell, which receives the bile as it is formed by the liver cells and carried outward as described. fig. . isolated liver cells: _c_, blood capillary; _a_, fine bile capillary channel. plate v. ergot in hay: , bluegrass; , timothy; , wild rye; , redtop. ergot is a fungus which may affect any member of the grass family. the spore of the fungus, by some means brought in contact with the undeveloped seed of the grass, grows, obliterates the seed, and practically takes its place. when hay affected with ergot is fed to animals it is productive of a characteristic and serious affection or poisoning known as ergotism. plate vi. ergotism, or the effects of ergot. the lower part of the limb of a cow, showing the loss of skin and flesh in a narrow ring around the pastern bone and the exposure of the bone itself. * * * * * poisons and poisoning. by v. t. atkinson, v. s. [revised by c. dwight marsh, ph. d.] definition of a poison. to define clearly the meaning of the word "poison" is somewhat difficult. even in law the word has never been defined, and when a definition is attempted we are apt to include either too much or too little. the following definition given by husemann is perhaps the best: "poisons are those substances, inorganic or organic, existing in the organism or introduced from the outside, produced artificially or formed as natural products, which, through their chemical nature, under definite conditions, so affect some organ of a living organism that the health or well-being of the organism is temporarily or chronically injured." the common conception of a poison is any substance which, in small quantity, will destroy life, except such as act by purely mechanical means, as, for example, powdered glass. some substances that are not usually looked upon as poisons may destroy life if given in large doses, such as common salt. other substances which are perfectly harmless when taken into the body in the usual way are poisons if injected into the circulation, such as distilled water, milk, or glycerin. living organisms are not "chemical substances," and are not considered in this connection. sources of poisoning. poisoning may come from many causes, among the chief of which are the following: ( ) _errors in medication._--by using the wrong substance or too large dose an animal may be poisoned. ( ) _the exposure of poisons used for horticultural, technical, or other legitimate purposes._--poisons used for spraying plants, disinfecting, poisoning vermin, dipping cattle or sheep, painting, smelting, dyeing, or other purposes may be so handled as to come within the reach of animals. ( ) _damaged food._--food that has undergone putrefaction or certain kinds of fermentation or heating, may have become poisonous, producing forage poisoning, meat poisoning, cheese poisoning, etc. ( ) _poisonous plants in the pasture or forage._ ( ) _the bite or sting of a poisonous insect or the bite of an animal._ ( ) _malicious poisoning._ the action of poisons. the action of poisons may be either local, and exerted directly on the tissues with which they come in contact, or remote, acting through the circulation or the nervous system; or both local and remote action may be exerted by the same drug. poisons which act locally generally either destroy by corrosion the tissues with which they come in contact or by inhalation set up acute inflammation. when any corrosive agent is taken into the stomach in poisonous quantities, a group of symptoms is developed which is common to all. the tissues with which the agent comes in contact are destroyed, sloughing and acute inflammation of the surrounding structures take place; intense pain in the abdomen and death ensue. in a like manner, but with less rapidity, the same result is reached if the agent used be not of a sufficiently corrosive nature to destroy the tissues, but sufficiently irritating to set up acute inflammation of the mucous membrane of the digestive tract. if the poison exerts a remote influence alone, the action is quite different, little or no local effect being produced upon the digestive organs. to produce an effect on some part of the body distant from the channel of entrance, a poison must have been absorbed and carried in the blood to the central nervous system or other region involved. the poisonous effect of any substance is modified by the quantity used; by its chemical combinations; by the part of the animal structure with which it comes in contact; by the physical condition of the subject; and also by the rapidity with which the poison is excreted. as an illustration, opium may be given with safety in much larger doses to an animal suffering from acute pain than to one free from pain, and to an adult animal with greater safety than to a young one. the rapidity with which the poison is absorbed, owing to the part of the body with which it is brought in contact, is also an important factor. so marked is this quality that some agents which have the power of destroying life with almost absolute certainty when introduced beneath the skin, may be taken into the stomach without causing inconvenience, as curara, the arrow poisons, or the venomous secretion of snakes. other agents in chemical combination may tend to intensify, lessen, or wholly neutralize the poisonous effect. for example, arsenic in itself has well-marked poisonous properties, but when brought in contact with dialyzed iron it forms an insoluble compound and becomes innocuous. idiosyncrasies are not so noticeable in cattle practice as in practice among human beings, but the uncertainty with which some drugs exert their influence would lead us to believe that well-marked differences in susceptibility exist. even in some cases a tolerance for poison is engendered, so that in a herd of animals equally exposed injurious or fatal effects do not appear with uniformity. for example, among cattle that are compelled to drink water holding in solution a salt of lead the effects of the poisoning will be found varying all the way from fatality to imperceptibility. general symptoms of poisoning. it is not always easy to differentiate between poisoning and some disease. indeed, examination during the life of the animal is sometimes wholly inadequate to the formation of an opinion as to whether the case is one of poisoning or, if it is, as to what the poison may be. a chemical and physical examination after the death of the animal may be necessary to clear up the doubt. on the other hand, the symptoms may be of such a nature as to point unmistakably to poisoning with a certain agent. in general, the following classes of symptoms may be regarded as indicative of poisoning: sudden onset of the disease without visible cause, a number of animals being similarly affected at once, with severe gastrointestinal disorder or derangement of the nervous system, or both; sudden alteration of heart action in relation to frequency, force, or rhythm; local irritation, dyspnea, or change in the urine or urination. after death, lesions of the greatest variety may be found, and it is necessary for one to be skilled in anatomy and pathology in order to determine their significance. oftentimes the stomach and intestines are red, have thick walls, and contain blood. this signifies a severe irritant, such as arsenic or corrosive sublimate. other alterations sometimes found are inflammation of the kidneys or bladder, points of hemorrhage in various organs, changes in the blood, congestion of the lungs, and certain microscopic changes. general treatment. the treatment of animals suffering from poison must vary according to the nature of the toxic agent. there are a few general plans of action, however, which should be followed so far as possible. in man and in some of the smaller animals it is possible to eliminate unabsorbed poison by the use of the stomach pump or by causing vomiting. these proceedings are impracticable in cattle. it is well, therefore, in many cases to endeavor to expel the unabsorbed poison by emptying the digestive tract, so far as may be, with a nonirritating purge. castor oil in doses of pint to quarts is adapted to this purpose. if the poison is known to be nonirritant--as a narcotic plant--from to drops of croton oil may be given with a quart of castor oil. when poisons are somewhat prolonged in their effect, epsom salt in doses of pound can be given advantageously. to protect the mucous membrane from the action of strong irritants, one may give flaxseed tea, barley water, the whites of eggs, milk, butter, olive oil, or fresh lard. chemical antidotes may sometimes be used for special poisons, as advised below. in general, if an acid has been taken it may be neutralized with an alkali, such as chalk, magnesia, bicarbonate of soda (baking soda), ammonia (diluted), or soap. if the poison is an alkali, such as caustic soda or potash (lye), or ammonia, an acid, such as diluted ( per cent) sulphuric acid or vinegar, may be administered. special treatments and antidotes are considered below. a poisonous agent may be so gradually introduced into the system as to slowly develop the power of resistance against its own action. in other cases where the poison is introduced slowly the poisonous action becomes accumulative, and, although there is no increase in the quantity taken, violent symptoms are suddenly developed, as if the whole amount, the consumption of which may have extended over a considerable period, had been given in one dose. other agents, poisonous in their nature, tend to deteriorate some of the important organs, and, interfering with their natural functions, are productive of conditions of ill health which, although not necessarily fatal, are important. such might properly be called chronic poisons. poisons of themselves dangerous when administered in large doses are used medicinally for curative purposes, and a very large percentage of the pharmaceutical preparations used in the practice of medicine if given in excessive quantities may produce serious results. in the administration of medicines, therefore, care should be exercised not only that the animal is not poisoned by the administration of an excessive dose but that injury is not done by continued treatment with medicines the administration of which is not called for. mineral poisons. arsenic poisoning. of the common irritant and corrosive poisons, arsenic, especially one of its compounds (paris green), is likely to be the most dangerous to our class of patients. the common practice of using paris green and other compounds of arsenic as insecticides for the destruction of potato beetle and other insect enemies of the farmer and fruit grower has had the effect of introducing it into almost all farming establishments. white arsenic is also a principal ingredient in some popular dipping preparations, and poisoning from this source occasionally takes place when, after dipping, animals are allowed to run in a yard in which there is loose fodder. the drippings from the animals falling on the fodder render it poisonous and dangerous to animal life if eaten. familiarity with its use has in many instances tended to breed contempt for its potency as a poison. rat poisons often contain arsenic. the excessive use of arsenic as a tonic, or of "condition powders" containing arsenic, has been the means of poisoning many animals. this is the common poison used by malicious persons with criminal intent. the poison may also be absorbed through wounds or through the skin if used as a dip or bath. if a large dose is given, at once acute poisoning is produced; if repeated small doses are given, chronic poisoning may result. the poisonous dose for an ox is from drams to ounce. _symptoms._--the symptoms of acute poisoning first appear as those of colic; the animal is restless, stamping with the feet, lying down and getting up. there is tenderness on pressure over the abdomen. the acute symptoms increase; in a few hours violent diarrhea is developed; in many cases blood and shreds of detached mucous membrane are mixed with the evacuations. there is irregular and feeble pulse and respiration, and death is likely to supervene between the eighteenth hour and the third day. if the latter period is passed, there is a reasonable hope of recovery. in chronic poisoning the symptoms are similar to those of chronic gastrointestinal catarrh, with indigestion, diarrhea, and general weakness and loss of condition. _treatment._--the antidote for arsenic is a solution of hydrated oxid of iron in water. it should be prepared fresh by mixing a solution of sulphate of iron, made by dissolving ounces of sulphate of iron in one-half pint water, with a suspension of ounce of magnesia in one-half pint water. this quantity is sufficient for one dose for a cow and may be repeated in an hour, if much arsenic was taken. a solution of calcined magnesia or powdered iron or iron filings or iron scale from a blacksmith's forge may be given in the absence of other remedies. powdered sulphur is of some value as an antidote. one must also administer protectives, such as linseed tea, barley water, whites of eggs, etc. lead poisoning. lead poisoning of cattle sometimes comes from their having licked freshly painted surfaces and thus swallowed compounds containing white lead. in several instances cattle have been poisoned by silage from a silo painted inside with lead paint shortly before filling. sometimes cattle eat dried paint scrapings with apparent relish and are poisoned. cattle grazing on rifle ranges have been poisoned by lead from the bullets. sugar of lead has been administered by mistake for glauber's salt. lead poisoning may be acute or chronic. the fatal dose of sugar of lead is from to ounces. water drawn from lead pipes or held in a lead-lined tank may cause poisoning. _symptoms._--the symptoms are generally dullness, lying down with the head turned toward the flank, colic, rumbling in the abdomen, loss of control of the limbs when walking, twitching, champing of the jaws, moving in a circle, convulsions, delirium, violent bellowing, followed by stupor and death. the symptoms generally extend over considerable time but may end in death after hours. _chronic lead poisoning_ occasionally occurs in districts where lead mining is the principal industry. the waste products of the mine thrown into streams contaminate the water supply, so that the mineral is taken into the system gradually, and a very small per cent of any of the salts taken into the system in this way is pernicious. water which contains any salt of lead to the extent of more than one-tenth of a grain to the gallon is unfit to drink. such water when used continually is likely to produce colic from the resulting intestinal irritation, and in aggravated cases paralysis more or less severe is likely to be developed. a blue line on the margin of the gums, the last symptom, is regarded as diagnostic and its presence as conclusive evidence of the nature of the disorder. _treatment._--the treatment should first be directed toward removing the cause. a large dose of purgative medicine should be given, and the brain symptoms be relieved by giving bromid of potassium in half-ounce doses every or hours and by the application of cold water to the head. dilute sulphuric acid in half-ounce doses should be given with the purgative medicine. in this case sulphate of magnesia (epsom salt) is the best purgative, and it may be given in doses of from to pounds dissolved in warm water. after the acute symptoms have abated, iodid of potassium may be given, in doses of drams each, three times a day for a week. no treatment is likely to be of avail until the cause is removed. copper poisoning. the soluble salts of copper, though used as a tonic in the medicinal treatment of cattle, are poisonous when taken in large quantities. like lead and arsenic, they have an irritant effect upon the mucous membrane with which they come in contact in a concentrated form. cattle are not very likely to be poisoned from this cause unless through carelessness. sulphate of copper, commonly called blue vitriol, is occasionally used for disinfecting and cleansing stables, where it might inadvertently be mixed with the feed. it is also used largely for making the bordeaux mixture used in spraying fruit trees. the general symptoms produced are those of intestinal irritation, short breathing, stamping, and tender abdomen. _treatment._--give powdered iron, or iron reduced by hydrogen, or calcined magnesia. sulphur may be used. this should be followed by a liberal supply of demulcents, linseed infusion, boiled starch, whites of eggs, etc. zinc poisoning. several of the soluble salts of zinc are irritant poisons. the chlorid and sulphate are those in most common use. in animals which have power to vomit they are emetic in their action. in others, when retained in the stomach, they set up more or less irritation of the mucous membrane and abdominal pain, producing symptoms already described in the action of other poisons which produce the same result. _treatment._--the treatment should be the same as for copper poisoning. phosphorus poisoning. only one of the forms of phosphorus in common use--the ordinary yellow--is poisonous. phosphorus in this form is used for the destruction of rats and mice and other vermin, and has been largely used in the manufacture of matches. _symptoms._--the symptoms are loss of appetite, colic, diarrhea, irritation of the mouth and throat, and paralysis of the throat. there is also weakness, difficult breathing, and rapid pulse. the course of the poisoning is usually rapid, terminating in either recovery or death within three days. the toxic dose for cattle is from to grains. if taken in large quantities the excreta are occasionally noticed to be luminous when examined in the dark. _treatment._--turpentine is given in an emulsion with flaxseed tea in a single dose of from to ounces. permanganate of potassium may be given in a one-fourth of per cent solution. stimulants, such as alcohol and ether, should be administered. oils and milk must not be given. mercury poisoning. mercury poisoning is not rare in cattle from the fact that these animals have a special susceptibility to the action of this substance. antiseptic washes or injections containing the bichlorid of mercury (corrosive sublimate) must be used on cattle with great care. mercurial disinfecting solutions or salves must be used cautiously. calomel can not be given freely to cattle. _symptoms._--the symptoms are salivation, sore mouth, indigestion, diarrhea, skin eruption, paralysis of local groups of muscles, and nephritis. _treatment._--the treatment consists in administering sulphur in large doses ( to ounces) or iron powder. both make insoluble compounds with mercury. follow with the whites of eggs mixed with water and with linseed tea. if the case does not terminate promptly, give iodid of potash in -dram doses twice daily. poisoning by acids. mineral acids.--the mineral acids--nitric, sulphuric, hydrochloric, etc.-- when used in a concentrated form destroy the animal tissues with which they come in contact, and in this respect differ from most of the poisons previously described. when taken into the stomach the mucous membrane of the mouth, pharynx, esophagus, and stomach is apt to be more or less completely destroyed. if taken in large quantities death is likely to result so speedily that nothing can be done to relieve the patient, and even if time is allowed and the action of the acid can be arrested it can not be done until considerable and, perhaps, irreparable damage has been done. the mucous membrane with which the acid has come in contact in the esophagus may be destroyed by its corrosive action and carried away, leaving the muscular tissues exposed. the raw surface heals irregularly, the cicatrice contracting causes stricture, and an animal so injured is likely to die of starvation. in the stomach even greater damage is likely to be done. the peristaltic action of the esophagus carries the irritant along quickly, but here it remains quiet in contact with one surface, destroying it. it is likely to perforate the organ and, coming in contact with the abdominal lining or other organs of digestion, soon sets up a condition that is beyond repair. in a less concentrated form, when this is not sufficiently strong to be corrosive, it exerts an irritant effect. in this form it may not do much harm unless taken in considerable quantity. when thus the mucous membrane of the stomach and intestines becomes inflamed pain and diarrhea are likely to result. _treatment._--any of the alkalies may be used as an antidote. most convenient of these are chalk, baking soda, marble dust, magnesia, lime, soap, or plaster from a wall. mucilaginous drinks should be given in large quantities. vegetable acids.--oxalic acid in particular is corrosive in its action when taken in concentrated solution, losing its corrosive effect and becoming irritant when more dilute. it also exerts a specific effect on the heart, frequently causing death from syncope. taken in the form either of the crystals or solution it is likely to cause death in a very short time. failure of heart action and the attendant small pulse, weakness, staggering, and convulsions are the more noticeable symptoms. acetic acid is irritant to the gastrointestinal tract, and may cause sudden paralysis of the heart. _treatment._--the action of the acid should be counteracted by the use of alkalies, as advised above, by limewater or lime or plaster given promptly, by protectives to the digestive tract, and by stimulants. poisoning by alkalies. the carbonates of potash and soda and the alkalies themselves in concentrated form cause symptoms of intestinal irritation similar to those produced by mineral acids. ammonia, caustic soda, and caustic potash (lye) are those to which animals are most exposed. the degree of their caustic irritant effects depends on their degree of concentration. when they reach the stomach the symptoms are nearly as well marked as in the case of the acids. the irritation is even more noticeable, and purgation is likely to be a more prominent symptom. if death is not caused soon, the irritation of the gastrointestinal tract and malnutrition will last for a long time. _treatment._--treatment consists in neutralizing the alkali by an acid, such as dilute sulphuric acid ( per cent) or strong vinegar. the administration of such an antidote and its action must be carefully watched during administration. in the chemical change which takes place when the acid and alkali are combined, carbonic-acid gas is liberated, which may be to an extent sufficient to cause considerable distention of the abdomen, and even to produce asphyxia from pressure forward on the diaphragm. should this danger present itself, it may be averted by opening the flank, permitting the gas to escape. (see "acute tympanites, or bloating," p. .) flaxseed or slippery-elm decoction must be given to sooth the inflamed mucous surface. opium may be used to allay pain. coal-oil poisoning. coal oil is sometimes administered empirically as a treatment for intestinal parasites. if given in large doses it produces poisonous effects, which are likely to be manifested some time after the administration. it acts as an irritant to the digestive tract, causing dribbling of ropy saliva from the mouth, diarrhea, tenesmus, and loss of appetite, with increased temperature and cold extremities. visible mucous membranes are injected, pupils of the eyes are contracted, and there is a watery discharge from the eyes and nostrils. remotely it exerts a depressing influence on the functions of the brain and slight coma, and occasionally convulsions, from which the animal is easily aroused. the kidneys also suffer. the urine is dark colored and has the characteristic odor of coal oil. death may result from gastroenteritis or convulsions. _treatment._--the patient's strength should be fostered by the frequent administration of mild stimulants, of which aromatic spirits of ammonia is perhaps the best. the animal should be encouraged to eat soft feed and given mucilaginous drinks. crude coal oil is sometimes applied to the skin to kill parasites. if too much is used, especially in hot weather, great weakness and depression may be caused and in some cases death may result. carbolic-acid poisoning. although one of the most valuable antiseptic remedies, carbolic acid in a concentrated form, when taken internally or used over a large surface externally, is likely to produce poisonous effects. it causes whitening, shrinking, and numbness of the structures with which it comes in contact, and, besides its irritant effect, exerts a powerful influence on the nervous system. being readily absorbed, it produces its effect whether swallowed, injected into the rectum, inhaled, or applied to wounds, or even to a large tract of unbroken skin. used extensively as a dressing, it may produce nausea, dizziness, and smoky or blackish colored urine. the last symptom is nearly always noticeable where the poisonous effect is produced. in more concentrated form, or used in larger quantities, convulsions, followed by fatal coma, are likely to take place. even in smaller quantities, dullness, trembling, and disinclination for food often continue for several days. in a tolerably concentrated solution it coagulates albumen and acts as an astringent. _treatment._--as an antidote internally, a solution of sulphate of soda or sulphate of magnesia (glauber's or epsom salt) may be given. the white of egg is also useful. stimulants may be given if needed. when the poisoning occurs through too extensive applications to wounds or the skin, as in treatment of mange, cold water should be freely applied so as to wash off any of the acid that may still remain unabsorbed. as a surgical dressing a per cent solution is strong enough for ordinary purposes. water will not hold more than per cent in permanent solution. no preparation stronger than the saturated solution should be used medicinally under any circumstances. saltpeter poisoning. both nitrate of soda and nitrate of potassium are poisonous to cattle. these substances are used for manure and for preserving meats. they may be administered in a drench by error in place of glauber's salt, or they may be exposed within reach of cattle and thus be eaten. the toxic dose depends upon the condition of fullness of the stomach. if in solution and given on an empty stomach, as little as ounces of saltpeter (nitrate of potassium) may be fatal to a cow. more of the chile saltpeter (nitrate of soda) is required to cause serious trouble. _symptoms._--severe gastroenteritis, colic, tympanites, diarrhea, excessive urination, weakness, trembling, convulsions, collapse. _treatment._--same as for poisoning by common salt. poisoning by common salt. a few pounds ( to ) of common salt will produce well-marked signs of poisoning in cattle. so much salt as this will not be taken by cattle except under unusual conditions. if the feed is poor in salt, and if no salt has been given for a long time, an intense "salt hunger" may occur that may lead an animal to eat a poisonous quantity, or an overdose of salt may be given by error as a drench. in order to prevent overeating of salt, it is doubtless better in salting cattle to use rock salt rather than that in more or less finely divided form. herring and mackerel brine and pork pickle are also poisonous, and are especially dangerous for hogs. in these substances there are, in addition to salt, certain products extracted from the fish or meat which undergo change and add to the toxicity of the solution. sometimes saltpeter is present in such brines. _symptoms._--the symptoms are great thirst, abdominal pain, diarrhea, poor appetite, redness and dryness of the mouth, increased urination, paralysis of the hind legs, weak pulse, general paralysis, coma, and death in from six to eight hours. _treatment._--allow as much warm water as the animal will drink; give protectives, such as linseed tea, etc. linseed or olive oil may be given. to keep up the heart action give ether, alcohol, camphor, digitalis, or coffee. to allay pain, give opium. vegetable poisons. vegetable poisons may be divided into two classes--those that are likely to be administered to the animal as medicine, and such as may be taken in the feed, either in the shape of poisonous plants or as plants or feeds of vegetable origin that have been damaged by fungi or by bacteria which have produced fermentation or putrefaction. vegetable poisons used as medicine. opium (morphin, laudanum) poisoning. opium and its alkaloid, morphia, are so commonly used in the practice of medicine that the poisonous result of an overdose is not uncommon. the common preparations are gum opium, the inspissated juice of the poppy; powdered opium, made from the gum; tincture of opium, commonly called laudanum; and the alkaloid or active principle, morphia. laudanum has about one-eighth the strength of the gum or powder. morphia is present in good opium to the extent of about per cent. in medicine it is a most useful agent in allaying pain. it first produces a stimulating action, which is followed by drowsiness, a disposition to sleep or complete anesthesia, depending on the quantity of the drug used. in poisonous doses a state of exhilaration is well marked at first. this is particularly noticeable in cattle and in horses. the animal becomes much excited, and this stage does not pass into insensibility unless an enormous dose has been given. if the dose is large enough, a second stage sometimes supervenes, in which the symptoms are those of congestion of the brain. the visible membranes have a bluish tint (cyanotic) from interference with the air supply. the breathing is slow, labored, and later stertorous; the pupils of the eyes are very much contracted; the skin dry and warm. gas accumulates in the stomach, so that tympanites is a prominent symptom. the patient may be aroused by great noise or the infliction of sharp pain, when the breathing becomes more natural. a lapse into the comatose condition takes place when the excitement ceases. later, there is perfect coma and the patient can no longer be aroused from the insensible condition. the contraction of the pupil becomes more marked, the breathing intermittent and slower, there is perspiration, the pulse more feeble and rapid, till death takes place. poisoning of cattle with opium or its products rarely goes beyond the stage of excitement, because the quantity of the drug required for the later effects is so great. seventy-five grains of morphia administered subcutaneously has sufficed merely to excite for hours. _treatment._--give strong coffee, to quarts, aromatic spirits of ammonia or carbonate of ammonia. atropia is the physiological antidote. strychnin poisoning. strychnin is a very concentrated poison and produces its effect very quickly, usually only a few minutes being necessary if given in sufficient dose and in such a way that it will be at once absorbed. when employed as a medicine, as a rule, minimum doses should be used, as cattle are quite susceptible to its effects and may be killed by the maximum doses given in the common manuals of veterinary medicine. the first noticeable symptom is evidence of unrest or mental excitement; at the same time the muscles over the shoulder and croup may be seen to quiver or twitch, and later there occurs a more or less well-marked convulsion; the head is jerked back, the back arched and leg extended, the eyes drawn. the spasm continues for only a few minutes, when it relaxes and another occurs in a short time. the return is hastened by excitement and in a short time again disappears, continuing to disappear and reappear until death results. as the poisonous effect advances the intervals between the spasms become shorter and less marked and the spasms more severe until the animal dies in violent struggles. _treatment._--the best method is to put the patient under the influence of chloral, chloroform, or ether, and keep it there continuously until the effect of the poison has passed off. alcohol may be given in large doses. aconite poisoning. in recent years tincture of aconite has become a popular stable remedy. if an animal is ailing, aconite is given whether indicated or not. fortunately the dose used is generally small, and for this reason the damage done is much less than it would otherwise be. aconite is one of the most deadly poisons known. it produces paralysis of motion and sensation, depresses the heart's action, and causes death by paralysis of respiration. in large doses it causes profuse salivation, champing of the jaws, and attempts at swallowing. if not sufficient to cause death, there is impaired appetite with more or less nausea for some time after. in poisonous doses it causes the animal to tremble violently, to lose power to support itself, and brings on slight convulsions, with perspiration. the pulse is depressed, irregular, and afterwards intermittent. _treatment._--the chemical antidote is tannic acid, which forms an insoluble compound with the aconitin. the depressing effect on the heart should be counteracted by the use of ammonia, digitalis, alcohol, camphor, or other diffusible stimulants, which have a physiological effect opposite to aconite. poisonous plants. an important group of poisons may be classed under this head. in most cases it is poison naturally belonging in the plant; in other cases the poisonous principle is developed in what would otherwise be harmless plants as a plant disease, or as a fermentation or putrefaction due to bacterial growth and observed in forage, grain, or meal that has become heated, damaged, or "spoilt." the subject of poisonous plants is an important one and is of especial interest to those using the western stock ranges, for it is probable that there is no other single cause producing so many fatalities. in this article only a few of the more important plants are treated in a brief way, for an extended treatise would be necessary if the subject were to be handled adequately. further information should be sought in the more elaborate publications. many of the american poisonous plants have been treated in bulletins issued by the united states department of agriculture. _treatment for plant poisoning._--remedies given by the mouth in most cases fail to give relief to cattle affected by poisonous plants. the material of the poisonous plants in the first stomach is not very largely affected by a remedy given as a drench. if any beneficial result is effected, it must be on the material which has already passed into the fourth stomach, so that to get any real antidotal result the remedy must be given repeatedly in order to meet the alkaloid poisons as they are passing through the fourth stomach. while certain substances like tannic acid and potassium permanganate are the logical antidotes for plant poisons, in practical application they are very disappointing in the treatment of ruminant animals. reliance must be mainly on prevention and upon such remedies as will increase elimination. a laxative or purgative is always helpful, and for this purpose epsom salt may be given in pound doses, or linseed oil in doses of or pints. in some few cases special remedies can be given as is indicated below. it is well to bear in mind that cattle while grazing freely in good pasture are not likely to eat poisonous plants to any extent. if these same plants are gathered and thrown in a pile, the animals, through a kind of pernicious curiosity, may eat them with disastrous results. this has frequently happened when freshly cut branches of cherry, yew, oleander, and other plants have been thrown where dairy cattle could get at them. oaks. the foliage of oaks is a valuable constituent of the forage on many ranges and pastures. it has been shown, however, that when this is eaten without some admixture of other food, cattle frequently sicken and die. many cases of the poisoning of cattle by acorns have been reported in england and germany, and there have been some complaints in the united states. harmful results from eating acorns do not seem likely to occur except as they are eaten in considerable quantities. _symptoms._--the symptoms of oak poisoning are constipation, mucus and blood in the feces, emaciation, and edema. the symptoms of acorn poisoning are much the same. _treatment._--change of pasture or an addition of other food material. horse chestnut--buckeye. all the species of _Æsculus,_ popularly known as horse chestnut or buckeye, are considered poisonous. the bark, leaves, and fruit are injurious. it is said that if the fruit is boiled or roasted and washed out it becomes harmless and even is a desirable addition to the feed of cattle. the indians in time of scarcity of food have used the fruit after preparing it in this way. the buckeyes are said to have a specific effect in producing abortion in cattle and goats. death camas (species of zygadenus). the death-camas plants, which are commonly known in the pacific states as "lobelia," are especially destructive of sheep, but cattle sometimes eat them and are poisoned. cases of cattle poisoning are not likely to result fatally. _symptoms._--the symptoms are salivation, nausea accompanied by vomiting, great weakness, and lowered temperature. _treatment._--there is no effective treatment for death-camas poisoning. fly poison (chrosperma muscÆtorium). this plant, which is closely related to the death-camas plants, is sometimes known as "stagger grass" and causes a considerable loss in the southern states. it grows earlier than the grasses, and on this account is more likely to be eaten. like death camas, it produces pronounced nausea, resulting in vomiting and weakness, and in cases which recover the effects may continue for several days. apparently the injurious effects are more common in the case of cattle than in other domestic animals. there is no known way of treating these animals, though doubtless purgatives would be beneficial. yew (taxus baccata). the european yew has long been known as a very poisonous plant. it is cultivated in america, and while cases of poisoning have not been common, it is well to recognize its dangerous character. a comparatively small dose is poisonous and ordinarily acts with great rapidity. it causes respiratory paralysis and the animal dies in convulsions. laurel. the laurels, including the broad-leafed laurel, _kalmia latifolia_, the narrow-leafed laurel, _kalmia angustifolia_, the rhododendrons, and other closely related plants are poisonous and cause considerable losses. it is dangerous to let cattle graze where these plants are abundant at times when other forage is scarce. the symptoms are salivation, nausea and vomiting, spasms, dizziness, stupor, and death. fern. the common brake or bracken fern, _pteris aquilina_, has been considered responsible for the poisoning of many horses and cattle. many cases have been reported in england and germany, and some well-authenticated cases in the united states. very little has been learned experimentally of fern poisoning, but there seems to be little question that it has been the cause of many deaths. the symptoms are said to be temperature higher than normal, loss of appetite, bloody discharges from mouth, nose, and bowels, and great depression followed by coma and death. some authors say that the urine is colored by blood. it is thought by some that the disease known as "red water" in the northwestern united states and canada is caused by eating ferns. sorghum poisoning. under certain conditions sorghum contains enough hydrocyanic acid to make it exceedingly dangerous to cattle. these cases of poisoning most commonly occur when cattle are pastured upon the young plant or upon a field where the crop has been cut and is making a second growth. conditions of drought make the sorghum especially dangerous. there is some reason to think that the frosted second growth is particularly rich in hydrocyanic acid. the cases of poisoning occur when animals are grazed upon the plant, but not from the harvested crop or from silage. if cattle are grazed on sorghum or sorghum stubble they should at first be under constant observation and should be removed as soon as any signs of illness appear. similar precautions should be used in grazing kafir. cornstalk disease. considerable losses of cattle have occurred when they were turned upon cornfields in the fall. deaths come very suddenly and there is no opportunity to apply remedies. it has been thought that these fatalities, like those from sorghum, were caused by hydrocyanic acid, but there is good reason to think that this is not true, and at the present time there is no accepted explanation of this disease, although there seems to be no doubt that it is connected in some way with the condition of the corn. whether a given field is poisonous or not can only be determined by experiment, and the wise farmer will keep his cattle under close observation when they are first turned into a cornfield. water hemlock (cicuta). this plant, growing in wet places by ditches and along creeks, is the most poisonous of north american plants. the root is the poisonous part, and cattle generally get it when it is plowed up or washed out by high water. sometimes they pull it up, for the plant occasionally grows out into ditches so that the whole plant will be taken in grazing. the most marked symptoms of cicuta poisoning are the violent convulsions, which remind one of the effect of strychnin. _treatment._--little can be done in the way of treatment. the logical thing is to attempt to control the convulsions by means of morphia, but in view of the fact that the stomach can not be emptied, the prognosis is not good, and most cases die. larkspurs. the larkspurs are a source of heavy loss to cattle owners in the higher ranges of the west. there are a number of species, growing at altitudes from , feet to timber line, and all are poisonous. a few cases of poisoning by larkspurs have been reported in the eastern united states, but most of the losses are confined to the west, both because larkspurs grow there in greater profusion and because cattle are grazed in that region on the open ranges. the losses are confined to cattle, for sheep and horses can graze on larkspur with no resulting harm. most of the larkspur losses occur in the spring and early summer, as the plants lose their toxicity after maturing. _symptoms._--larkspur poisoning is accompanied by a definite line of symptoms. in range animals the first symptom noted is generally the sudden falling of the animal and consequent inability to rise. after a while it may rise, only to fall again. this may happen repeatedly. in severe cases the animal lies prone and exhibits nausea, accompanied by vomiting. it dies of respiratory paralysis, death many times being hastened by the asphyxia following the vomiting. _treatment._--the animal, if found down, should be turned so that its head is uphill in order to relieve the lungs. many cases will recover with no further treatment. nearly all cases will recover if a hypodermic injection is given immediately of physostigmin salicylate grain, pilocarpin hydrochlorid grains, strychnin sulphate / grain. loco. the loco plants have caused especially heavy losses of cattle, horses, and sheep. they grow in the semiarid regions of the west and sometimes in great luxuriance. the best known are the "blue loco," the "woolly loco" or "purple loco," and the "white loco" or "rattle-weed." the blue loco is common in parts of new mexico, arizona, and utah. it affects both horses and cattle. the purple loco, _astragalus mollissimus_, is common in texas and the adjoining states and extends north as far as nebraska and colorado. it is especially destructive to horses. the white loco, _oxytropis lamberti_, is still more widely distributed, being found in the plains region from alaska to mexico and west of the rocky mountains to central utah. the white loco is much more important than the purple loco, for it affects not only horses but cattle and sheep. these plants belong to the pea family, and there are a number of other species of this family that are loco plants and produce the same symptoms. _symptoms._--loco poisoning is a chronic condition and symptoms are shown only after somewhat prolonged feeding. the condition is one of cumulative poisoning, and animals sometimes decline very rapidly after the first symptoms appear. in many cases animals acquire a habit of eating loco and prefer it to any other feed. the poison affects the central nervous system. there is a lack of muscular coordination and the animal performs very erratic movements. in the later stages the animal becomes emaciated and eventually dies of starvation. _treatment._--locoed animals are badly constipated, and it is important that this condition should be remedied at the start. any purgative can be used, but epsom salt has been found especially effective. if locoed animals can be turned into a field of alfalfa, a large proportion of them will recover with no further treatment. recovery may be aided by giving cattle, hypodermically, daily doses of three-twentieths to four-twentieths of a grain of strychnin. by this treatment cattle can be cured and put in condition for market. white snakeroot (eupatorium urticÆfolium). white snakeroot, frequently known as "rich weed," is a plant growing in great abundance in some of the eastern and central regions of the united states. it is particularly abundant in parts of ohio, indiana, and illinois, and in western north carolina. it is responsible for most, if not all, of the cases of a disease which is commonly known as "milk sickness." _symptoms._--the animals are constipated, sometimes have bloody feces, become weak, and exhibit muscular trembling. this trembling is very characteristic, so that the disease is sometimes known as "the trembles." _remedy._--there are no remedies which will work very efficiently. it is desirable to give the animals purgatives like epsom salt and, of course, to remove them from fields where this plant is abundant. rayless goldenrod (isocoma wrightii). the rayless goldenrod is a plant growing in especial abundance in parts of the pecos valley in new mexico and arizona, and there produces a disease so much like that produced in the east by white snakeroot that it is sometimes called milk sickness. more generally this disease goes under the name of "alkali disease." the plant has produced heavy losses in the regions where it grows abundantly. _symptoms._--the symptoms are much like those produced by the white snakeroot. the animals are constipated, sometimes have bloody feces, become weak, and exhibit muscular trembling. there is good reason to think, too, that the milk of cows eating this plant is more or less injurious. _treatment._--a purgative like epsom salt will aid an animal in recovering, but most important is to remove the cattle from pastures where the plant is abundant and give them an abundance of good forage. under such conditions they are almost certain to recover. milkweeds. many of the milkweeds have long been known to have more or less poisonous properties. within the last few years it has been discovered that certain of the milkweeds going under the popular name of whorled milkweeds are especially toxic. there are at least four species of whorled milkweeds, but two of them are particularly important from the standpoint of people handling livestock. one, known scientifically as _asclepias galioides_, is harmful in colorado, utah, arizona, and new mexico, while another, known as _asclepias mexicana_, has produced losses, especially in california and nevada. these whorled milkweeds are distasteful to all animals and are eaten only when the stock is closely confined to pastures where there is little else in the way of forage. _symptoms._--the most prominent symptoms are weakness, producing staggering, and this is followed in acute cases by violent spasms. _treatment._--there is no treatment which will effectively antidote the effect of the poison. in practically all cases, however, poisoning may be avoided if care is taken to prevent animals from being closely confined where this plant is abundant, as they never eat the plant by choice. cherry. in the leaves of the cherries more or less hydrocyanic acid is produced, and when these leaves are eaten in any considerable quantity cases of poisoning are likely to arise. it is popularly supposed that these cases arise from eating wilted cherry leaves, but there is every reason to think that the fresh leaves will produce the same results. these cases are easily prevented, because no harm results from eating a small quantity of the leaves, and if the fact is recognized that poisoning may result from eating a large quantity, it is not difficult to care for the animals so as to prevent poisoning. ergotism. the poisonous effects of ergot (pls. v, vi) appear chiefly in the winter and spring of the year and among cattle. it is developed among grasses grown on rich soil in hot, damp seasons. rye seems more liable to ergot than any of our other crops. of the grasses which enter into the composition of hay, bluegrass is the most likely to become affected. ergot may also affect redtop, oats, grasses, and grains. on the plant the fungus manifests itself on the seeds, where it is easily recognized when the hay is examined in the mow. the ergotized seeds are several times larger than the natural seeds--hard, black, and generally curved in shape. the effect of the protracted use of ergot in the feed is pretty well understood to be that of producing a degeneration and obstruction of the smaller arterial branches. the result is to shut off the blood supply to the distal parts of the body, where the circulation is weakest, and thus to produce a mummification or dry gangrene of the extremities, as the ears, tail, feet, etc. cattle seem to be more susceptible than other animals to the influence of ergot, possibly on account of the slowness of the heart's action. when the effect of the poison has become sufficient to entirely arrest the circulation in any part, the structures soon die. the disorder manifests itself as lameness in one or more limbs; swelling about the ankle which may result in only a small slough or the loss of a toe, but it may circumscribe the limb at any point below the knee or hock by an indented ring below which the tissues become dead. the indentation soon changes to a crack, which extends completely around the limb, forming the line of separation between the dead and living structures. the crack deepens till the parts below drop off without loss of blood, and frequently with very little pus. ergot may cause serious irritation of the digestive tract, or by acting upon the nervous system it may cause lethargy or paralysis. it also operates to cause contraction of the uterus, and may thus cause abortion. _treatment._--regarding the treatment, change of feed and local antiseptics are, of course, indicated. the former may be useful as a preventive, but when the symptoms have appeared the animal is necessarily so completely saturated that recovery is likely to be tedious. tannin may be given internally in doses of one-half dram twice daily for a few days to neutralize the unabsorbed alkaloids of the ergot. at the same time give castor oil. to dilate the blood vessels give chloral hydrate. bathe the affected parts with hot water. if sloughing has gone far, amputation must be resorted to. other poisonous fungi. many other fungi poison herbivora. in some instances, however, where fungi are blamed for causing disease their presence on the feedstuff or herbage is but coincidental with some other and more potent disease-producing factor. for example, if the conditions are favorable to the growth of fungi they are also favorable to the growth of bacteria, and bacteria may produce poisons in feeds. in general it may be said that any feed that is moldy, musty, or putrid is possibly dangerous. silage, properly cured, does not belong to this class, because the curing of silage is not a bacterial process. but spoiled silage and silage matted with mold is dangerous and should not be fed. poisoning by animal products. snake bites. the poison contained in the tooth glands of certain venomous reptiles, particularly some of the snakes, which is injected into or under the skin of an animal bitten by the reptile, is a very powerful agent. it is likely to produce a serious local irritation, and in the case of the more poisonous snakes serious constitutional disturbances, even to causing death, which it may do in either of two ways: first, when very strong, by exerting a narcotic influence similar to that of some of the powerful poisons, checking heart action. second, by diffused inflammation of the areolar tissue, gangrene, and extensive sloughing. _symptoms._--the symptoms of snake bite are a local swelling caused by an intense local inflammation, pricks showing where the fangs penetrated, depression, weakness, feeble pulse, difficult breathing, bluish discoloration of the visible mucous membranes, stupor, or convulsions. if the poison is not powerful or plentiful enough to produce death, it is, at any rate, likely to cause severe local abscesses or sloughs. _treatment._--the treatment may be divided into local and general. locally every effort should be made to prevent absorption of the poison. if discovered at once the bitten part had better be excised. if that is impracticable and a ligature can be applied, as in the case of a bite to one of the limbs, no time should be lost in applying it above the injury. it should be made sufficiently tight to so far as possible arrest circulation in the bitten part. the wound should be freely incised, so that it will bleed freely, and the poison should be extracted by cupping, or pressed out by squeezing with the fingers. permanganate of potassium in per cent solution should be applied to and injected into the wound. the depressing effect of the poison on the general system should be counteracted by hypodermic injections of strychnin, or by liberal drenching with stimulants, such as coffee, digitalis, or the aromatic spirits or carbonate of ammonia. in animal practice the alcoholic stimulants and local treatment above described are likely to meet with best success. a special antitoxin for use in treating snake bite is now prepared and may be had from the leading druggists. it is quite effective if used promptly. wasp and bee stings. wasps and bees secrete a poisonous substance which they are able to insert through the skin of an animal by the aid of their sharp stings. this poison is a severe local irritant and may even cause local gangrene. it also has a depressing effect upon the central nervous system and destroys the red-blood corpuscles. to produce these general effects it must be introduced in very large quantities, as when an animal is stung by a swarm of bees or wasps. _treatment._--the treatment is to wash the parts with diluted ammonia or permanganate of potassium solution and to give stimulants internally. if there is so much swelling about the head and nostrils as to interfere with breathing, tracheotomy may be necessary. poisoning with spanish fly. spanish fly, in the form of powdered cantharides, may be given in an overdose, or when applied as a blister to too large a surface of skin enough may be absorbed to poison. if given by the mouth, it causes severe irritation of the gastrointestinal tract, shown by salivation, sore throat, colic, bloody diarrhea, etc. it also produces, whether given by the mouth or absorbed through the skin, irritation of the urinary tract, as shown by frequent and painful urination. if death results, it is due to respiratory paralysis. _treatment._--give protectives and the white of egg, with opium. do not give oils or alcohol. diseases of the heart, blood vessels, and lymphatics. by w. h. harbaugh, v. s. [revised by leonard pearson, b. s., v. m. d.] the circulatory system. in cattle, as in human beings, the heart, blood vessels, and lymphatics may be described as the circulatory apparatus. the heart is in the thoracic cavity (chest). it is conical in form, with the base or large part uppermost, while the apex, or point, rests just above the sternum (breastbone). it is situated between the right and left lungs, the apex inclining to the left, and owing to this the heart beats are best felt on the left side of the chest, behind the elbow. the heart may be considered as a hollow muscle, containing four compartments, two on each side. the upper compartments are called auricles and the lower ones ventricles. the right auricle and ventricle are completely separated from the left auricle and ventricle by a thick septum or wall, so that there is no communication between the right and left sides of the organ. at the bottom of each auricle is the auriculo-ventricular opening, each provided with a valve to close it when the heart contracts to force the blood into the arteries. in the interval between the contractions these valves hang down into the ventricles. the muscular tissue of the heart belongs to that class known as involuntary, because its action is not controlled by the will. the cavities of the heart are lined by a serous membrane, called the endocardium, which may be considered as a continuation of the veins and the arteries, forming their internal lining. the walls of the ventricles are thicker than those of the auricles, and the walls of the left ventricle are much thicker than those of the right. the heart is enveloped by a fibrous sac (or bag), called the pericardium, which assumes much of the general shape of the outer surface of the heart. the action of the heart is similar to that of a pump and its function is to keep the blood in circulation. the auricles may be considered as the reservoirs or receivers of the blood and the ventricles as the pump chambers. during the interval between contractions, the heart being in momentary repose, the blood pours into the auricles from the veins; the auriculo-ventricular orifices being widely open, the ventricles also receive blood; the auricles contract and the ventricles are filled; contraction of the ventricles follows; the auriculo-ventricular valves are forced up by the pressure of the blood and close the auriculo-ventricular openings and prevent the return of blood into the auricles; the contraction of the ventricles forces the blood from the right ventricle into the lungs through the pulmonary artery and its branches, and from the left ventricle into the aorta, thence through the arteries to all parts of the body. after the contraction of the ventricles the heart is again in momentary repose and is being filled with blood, while the valves in the aorta and pulmonary artery close to prevent the return of blood into the ventricles. (see pl. vii.) the average weight of the heart of an ox is said to be from - / to pounds; but, of course, owing to the many breeds and sizes of cattle, it must vary in different animals. the vessels that convey the blood from the heart to all parts of the body are called arteries; those which return the blood to the heart are called veins. the arteries divide and subdivide (like the branches of a tree), become smaller and smaller, and ultimately ramify into every part of the body. between the ultimate ramifications of the arteries and the beginning of the veins there is an intermediate system of very minute vessels called capillaries, which connect the arterial with the venous system of the circulation. the walls of the arteries are possessed of a certain amount of rigidity, sufficient to keep the tubes open when they are empty. the blood leaves the left ventricle through a single vessel, the common aorta, consisting of the anterior and posterior aortas, which give off the large arteries. the veins take the blood from the capillaries in all parts of the body. they begin in very small tubes, which unite to become larger in size and less in number as they approach the heart. in its course an artery is usually accompanied with a vein and in many situations with a nerve. the more important arteries are placed deep within the body; when they are superficial, however, they are generally found where least exposed to injury, as, for example, on the inner side of the legs. arteries are less numerous than veins, and their total capacity is much less than that of the veins. a great number of veins are in the tissue immediately beneath the skin and do not generally accompany arteries. the blood, throughout its course in the heart, arteries, capillaries, and veins, is inclosed within these vessels. except where the large lymphatics empty into the venous blood, there is no opening into the course of the blood. all the arteries except the pulmonary and its branches carry bright-red blood, and all the veins, except the pulmonary veins, carry dark-red blood. the impure dark-red blood is collected from the capillary vessels and carried to the right auricle by the veins; it passes down into the right ventricle, and thence into the pulmonary artery and through its branches to the capillaries of the lungs, where the carbonic-acid gas and other impurities are given up to the air in the air cells of the lungs (through the thin walls between the capillaries and the air cells), and where it also absorbs from the air the oxygen gas necessary to sustain life. this gas changes it to the bright-red, pure blood. it passes from the capillaries to the branches of the pulmonary veins, which convey it to the left auricle of the heart; it then passes through the auriculo-ventricular opening into the left ventricle, the contraction of which forces it through the common aorta into the posterior and anterior aortas, and through all the arteries of the body into the capillaries, where it parts with its oxygen and nutritive elements and where it absorbs carbonic-acid gas and becomes dark colored. (see theoretical diagram of the circulation, pl. vii.) the branches of certain arteries in different parts unite again after subdividing. this reuniting is called anastomosing, and assures a quota of blood to a part if one of the anastomosing arteries should be tied in case of hemorrhage, or should be destroyed by accident or operation. the blood. the various kinds of food, after being digested in the alimentary canal, are absorbed and carried into the blood by the lymphatics, and by the blood to the places where nutrition is required. the blood takes from all parts of the body all that is no longer required, and carries it to the different organs through which it is eliminated from the body. it contains within itself all the elements which nourish the body. the blood may be considered as a fluid holding in solution certain inorganic elements and having certain bodies suspended in it. to facilitate description, the blood may be considered as made up of the corpuscles and the liquor sanguinis. the corpuscles are of two kinds, the red and the white, the red being the more numerous. the color of the blood is caused by the coloring matter in the red corpuscles, which are the oxygen carriers. both kinds are very minute bodies, which require the aid of the microscope to recognize them. the liquor sanguinis is composed of water containing in solution salts, albumen, and the elements of fibrin. the lymphatics, or absorbents, are the vessels which carry the lymph and chyle in the blood. they begin as capillaries in all parts of the body, gradually uniting to form larger trunks. placed along the course of the lymphatic vessels are glands, in some situations collected into groups; for example, in the groin. these glands are often involved in inflammation arising from the absorption of deleterious matter. absorption is the function of the lymphatics. the liquor sanguinis passes from the blood capillaries to supply nutrition to the tissues. all of the liquor sanguinis that is not required is absorbed by the lymphatic vessels and conveyed back to the blood by the lymphatic ducts. the lymphatics which proceed from the intestines convey the chyle into the blood during digestion. as a rule, the lymphatic vessels follow the course of the veins. all the absorbent vessels convey their contents to the thoracic duct and right great lymphatic vein, which empty into the anterior vena cava, where the lymph and chyle mix with the venous blood, and thus maintain the supply of nutritive elements in the blood. the pulse. as fully explained, the heart pumps the blood throughout the arterial system. the arteries are always full and each contraction of the ventricle pumps more blood into them; this distends their elastic walls and sends along them a wave which gradually becomes less perceptible as it nears the very small arteries. this wave constitutes the pulse, and is lost before the capillaries are reached. the sensation or impression given to the finger when placed upon the artery shows the force exerted by the heart and some important facts concerning the condition of the circulation. in adult cattle the average number of pulsations in a minute is from to . the pulse is faster than normal after exercise, excitement, on hot days, from pain, and as a result of fullness of the stomach. in old animals it is slower than in the young and in males slightly slower than in females. in fevers and inflammations and in local diseases of the heart the pulse rate is increased. if the rate is greater than or to the minute the outlook for recovery is not good. other variations of the pulse are known as infrequent pulse, which means that the number of pulsations in a given time is less than normal. the irregular or the intermittent pulse is when the pulsations do not follow in regular order. the large pulse and the small pulse refer to the volume of the pulse, which may be larger or smaller than usual. the strong pulse and the feeble pulse refer to the strength or weakness of the pulsation. the pulse is said to be hard when the vessel feels hard and incompressible, the soft pulse being the opposite. by dicrotic pulse is meant that kind of pulsation which makes each beat seem double, and therefore it is generally called the double pulse. the venous or "jugular pulse" is the pulsation so frequently observed in the jugular vein of cattle and is particularly noticeable while they are ruminating--"chewing the cud." it is not always associated with disease, but may be a symptom of some disease of the heart; in such cases the jugular pulse is continuous. the place selected for feeling the pulse in cattle is where the submaxillary artery winds around the lower jawbones, just at the lower edge of the flat muscle on the side of the cheek; or, if the cow is lying down, the metacarpal artery on the back part of the fore fetlock is very convenient for the purpose. the examination of the heart. corresponding to the beats of the heart two sounds are emitted which are of a definite type in healthy animals. the first is produced by the contraction of the heart and the flow of blood out of it; the second is caused by the rebound of blood in the aorta and the closure of the valves that prevent it from flowing backward into the heart, whence it came. the first sound is the longer and louder of the two, though of low pitch. the second sound is sharper and shorter, and is not always easy to hear. there is a brief interval between them. to distinguish these sounds, the ear is placed against the left side of the chest, a little above the point where the elbow rests when the animal is standing in a natural position, and about opposite the sixth rib. both heart sounds are reduced in intensity when the animal is weak or when the heart is forced away from the chest wall by collections of fluid or by tubercular or other growths. nonrhythmical heart sound is often caused by pericarditis or by disease of the valves. it may also be attributable to overfilling of the heart upon the right side, as occurs in severe congestion of the lungs and in some febrile diseases. in pericarditis, sounds like scraping, rubbing, or splashing may be heard, entirely apart from the two normal sounds above described. the impulse of the heart, as felt by placing the hand against the chest, is of some consequence in reaching a conclusion in respect to disease of the heart; but it must be remembered that the impulse may be very much increased by diseases other than those of the heart, as, for example, inflammation of various organs, severe pains, etc. the impulse may be increased also (when disease does not exist) by work, exercise, fright, or any cause of excitement, or, in general, by anything that causes acceleration of the pulse. the impulse of the heart may be felt and the sounds may be heard fairly well in lean cattle, but in fat ones it is difficult and often impossible to detect either impulse or sound with any degree of satisfaction. palpitation. when the impulse of the heart is excessive--that is, when it beats more or less tumultuously--the familiar expression "palpitation of the heart" is applied; by many it is called "thumps." the hand or ear placed against the chest easily detects the unnatural beating. in some cases it is so violent that the motion may be seen at a distance. palpitation is but a symptom, and in many instances not connected with disease of the structure of the heart or its membranes. a badly frightened animal may have palpitation. when it comes on suddenly and soon passes away, it depends on some cause other than diseases of the heart; when it is gradually manifested, however, and becomes constant, although more pronounced at one time than another, heart disease may be suspected, especially if other symptoms of heart disease are present. injury to the heart by foreign bodies. cattle are addicted to the habit of chewing and swallowing many objects not intended as articles of food. every veterinarian of experience has met with instances to remind him of this, and it is well known to butchers. among the great variety of things that have thus found their way into the stomachs of cattle the following have been noticed: finger rings, knitting needles, old shoes, table knives, wood, pieces of leather, pieces of wire, buttons, hairpins, brushes, nails, coins, etc. the more sharply pointed objects sometimes penetrate the wall of the stomach, in some cases causing gastric irritation enough to produce indigestion, gradually work their way through the diaphragm toward the heart, pierce the pericardium (bag inclosing the heart), wound the heart, and thus prove fatal to the animal. cases are recorded in which the foreign body has actually worked its way into one of the cavities of the heart. instances are known, however, in which the object took a different course, and finally worked its way toward the surface and was extracted from the wall of the chest. while it is possible that the foreign body may pierce the wall at different parts of the alimentary canal, as it frequently does that of the rumen (paunch), it is thought that in most cases it passes through the wall of the reticulum (smaller honeycombed compartment, or second stomach) and is drawn toward the heart by the suctionlike action of the chest. post-mortem examinations have demonstrated the course it pursued, as adhesions and other results of the inflammation it caused were plainly to be seen. all manner of symptoms may precede those showing involvement of the heart, depending upon the location of the foreign body and the extent of inflammation caused by it. severe indigestion may occur; stiffness and difficulty in moving about owing to the prods of the sharp body following muscular contraction; pain on pressure over the front, lower, or right side of the abdomen; coughing and difficult, quick breathing. in most cases the foreign body does not penetrate to the heart, nor even to the pericardium. _symptoms._--the symptoms are as follows: the animal is disinclined to move actively, the step is restricted and cautious, sudden motion causes grunting, the attitude is constrained, the feet are drawn somewhat together, the back is arched, the face has an anxious expression. if the disease is of several days' standing, there is likely to be soft swelling (edema) beneath the neck, in the dewlap, and under the chest, between the fore legs. breathing is short and difficult; it may clearly be painful. the pulse is rapid, to per minute. the muscles quiver as though the animal were cold. rumination and appetite are depressed or checked. the dung is hard, and to void it appears to cause pain. these symptoms usually develop gradually, and, of course, they vary considerably in different animals, depending upon the size and location of the foreign body and the irritation it causes. as a matter of course, in such cases treatment is useless, but when it is possible to diagnose correctly the animal could be turned over to the butcher before the flesh becomes unfit for use; that is, before there is more than a little suppuration and before there is fever. knowing that cattle are prone to swallow such objects, ordinary care may be taken in keeping their surroundings as free of them as possible. pericarditis. inflammation of the pericardium (heart bag) is often associated with pneumonia and pleurisy, rheumatism, and other constitutional diseases, or with an injury. it also occurs as an independent affection, owing to causes similar to those of other chest affections, as exposure to cold or dampness and changes of the weather. _symptoms._--it may be ushered in with a chill, followed by fever, of more or less severity; the animal stands still and dull, with head hanging low, and anxiety expressed in its countenance. the pulse may be large, perhaps hard; there is also a venous pulse. the hand against the chest will feel the beating of the heart, which is often irregular, sometimes violent, and in other instances weak, depending in part upon the quantity of fluid that has transuded into the pericardial sac. the legs are cold, the breathing quickened and usually abdominal; if the left side of the chest is pressed on or struck, the animal evinces pain. there may be spasms of the muscles in the region of the breast, neck, or hind legs. after a variable time swelling may also appear in the legs and under the chest and brisket. in those animals in which the heart sounds may be heard somewhat distinctly, the ear applied against the chest will detect a to-and-fro friction sound, corresponding to the beats of the heart. this sound is produced by the rubbing of the internal surface of the heart bag against the external surface of the heart. during the first stages of the inflammation these surfaces are dry, and the rubbing of one against the other during the contraction and relaxation of the heart produces this sound. the dry stage is followed by the exudation of fluid into the heart sac, and the friction is not heard until the fluid is absorbed sufficiently to allow the surfaces to come in contact again. but during the time the friction sound is lost a sound which has been called a "churning noise" may take its place. the friction sound of pericarditis can not be mistaken for the friction sound of pleurisy if the examination is a careful one, because in the heart affection the sound is made in connection with the heart beats, while in the pleuritic affection the sound is synchronous with each respiration or breath of air taken in and expelled from the lungs. _treatment._--when pericarditis is complicated with rheumatism or other diseases the latter must be treated as directed in the description of them. the animal must be kept in a quiet, comfortable place, where it will be free from excitement. warm clothing should be applied to the body, and the legs should be hand-rubbed until the circulation in them is reestablished, and then they should be snugly bandaged. the food should be nutritive and in moderate quantity. bleeding should not be performed unless the case is in the hands of an expert. at the beginning give as a purgative epsom salt-- pound to an average-sized cow--dissolved in about a quart of warm water and administered as a drench. when there is much pain ounces of laudanum, diluted with a pint of water, may be given every three hours until the animal is better. do not give the laudanum unless demanded by the severity of the pain, as it tends to constipate. give one-half ounce of nitrate of potassium (saltpeter), dissolved in drinking water, four or five times a day. after the attack has abated mustard mixed with water may be rubbed well over the left side of the chest to stimulate the absorption of the fluid within the pericardium. the other medicines may be discontinued and the following administered: sulphate of iron, ounces; powdered gentian, ounces; mix and make powders. give one powder every day at noon, mixed with feed, if the animal will eat it, or shaken up with water in a bottle as a drench. also the following: iodid of potassium, ounces; nitrate of potassium, ounces; mix and make powders. give one in drinking water or in drench every morning and evening. the last two prescriptions may be continued for several weeks if necessary. in extreme cases tapping the pericardium with a trocar and cannula to draw off the fluid is resorted to, but the operation requires exact anatomical knowledge. after death from pericarditis there is always more or less fluid found in the pericardium; the surfaces are rough and covered with a yellow-colored exudate. there are also in many cases adhesions to a greater or less extent between the heart and pericardium. myocarditis. inflammation of the muscular structure of the heart occurs in limited, circumscribed areas, as evidenced by post-mortem examination, and it is probably always somewhat involved in connection with pericarditis and endocarditis. it may readily be inferred that if the whole organ were inflamed death would ensue immediately. usually myocarditis results from the preexistence of blood poisoning or of some infectious febrile disease. _symptoms._--the chief symptoms are those of heart weakness. the heart beat is fast, weak, and often irregular. respiration is difficult and rapid. there is great general weakness and depression. death comes suddenly. _treatment._--treatment consists in supporting the animal by the use of stimulants, such as ammonia, coffee, digitalis, camphor, etc. complete quiet must be provided, and the general care should be as in pericarditis. endocarditis. when the membrane which lines the cavities of the heart--the endocardium-- suffers inflammation, the disease is called endocarditis. the cause is another disease, during which substances that irritate the lining of the heart are produced and admitted into the circulation. these substances are usually living organisms, or it is possible that in some cases they are chemical irritants. endocarditis occurs as a complication of or sequel to pneumonia, blood poisoning, inflammation of the womb, rheumatism, or severe wounds or abscesses. the symptoms are much the same as those of pericarditis, and it is difficult to discriminate between the two affections. there is a jugular pulse, the legs may become dropsical, and there is a tendency to faint if the head is elevated suddenly. the bellowslike sound is more distinct than it is in pericarditis. it is the most fatal of heart diseases, because of the liability of the formation of clots, which may adhere to the valves, change in the structure of the valves, and often a complication with an abnormal condition of the blood. clots may be formed in the heart, and, being carried to other parts, prove fatal by interrupting the circulation in some vital organ. treatment similar to that advised for myocarditis may be followed in this disease. valves of the heart. the valves are subject to abnormal growths and structural changes in chronic endocarditis or as a result of acute endocarditis. sometimes valves are torn by sudden, extreme muscular effort or a congenital abnormality. cases are also reported in which they have been found ruptured. _symptoms._--the general symptoms are those of heart weakness, accompanied with edema and congestion of the lungs. _treatment._--relief is sometimes afforded, but usually only temporarily, by the use of stimulants, especially digitalis. rupture of the heart. sudden effort, blows, or disease may lead to rupture of the heart of the ox. the first cause does not operate so often in cattle as in horses. tuberculosis or ulceration from other causes, such as a foreign body, is the most common source of this accident. rupture is shown by sudden fainting, followed very shortly by death. hypertrophy and dilatation of the heart. this is an enlargement of the heart, and may consist of the thickening of the walls alone, or at the same time the cavities may be either enlarged or diminished. dilatation of the cavities has been noticed as existing independently of thickened walls. in hypertrophy the sounds of the heart are loud and pronounced, may be heard on both sides of the chest distinctly, and palpitation occurs to a greater or less extent. fortunately both conditions are very rare in cattle. atrophy. atrophy is the technical term for wasting of the muscular tissue. atrophy of the heart is very rare among cattle, and is usually a result of other diseases. fatty degeneration of the heart. this condition of the heart is met with in some very fat cattle, but it must be understood that the accumulation of fat around the heart is not referred to by this designation. in fatty degeneration the elements of the muscular tissue are replaced by fatty or oily granules. the muscle becomes weak, the heart contractions are insufficient, and heart weakness is shown by general weakness, shortness of breath, and weak, rapid pulse. cyanosis. owing to the most prominent symptoms, cyanosis is also called "blue disease," and is seen occasionally in new-born calves. it is recognized by the blue color of the mucous membrane (easily seen by looking within the mouth and nostrils), the coldness of the surface of the body, and rapid, labored breathing. it is caused by non-closure of the foramen ovale, connecting the right with the left side of the heart, and the consequent mixing of the venous with the arterial blood. calves so affected live but a short time. misplacement of the heart. cases are recorded in which the heart has been found out of its natural position, sometimes even outside the chest. this is a congenital condition for which there is no remedy. a heifer calf with the heart entirely outside the thoracic cavity and beneath the skin in the lower part of the neck was kept for two years at the veterinary hospital of the university of pennsylvania, during which time it grew to be a well-developed cow. wounds of arteries and veins. when a blood vessel is opened a glance will tell whether it is an artery or a vein by simply remembering that bright-red blood comes from arteries and dark-red from veins. when a vein or a very small artery is severed the blood flows from the vessel in a continuous and even stream, but when one of the larger arteries is severed the blood comes in intermitting jets or spurts corresponding to the beats of the heart. it is well to call attention to the fact that the dark-red blood which flows or oozes from a wound soon becomes bright red, because it gives up its carbonic-acid gas to the air, and absorbs oxygen gas from the air, which is exactly the change it undergoes in the capillaries of the lungs. the general treatment of wounds will be found in another section; here it is necessary only to refer briefly to some of the most practical methods used to arrest hemorrhages, as instances occur in which an animal may lose much strength from the loss of blood, or even bleed to death unless action is prompt. bleeding (hemorrhage). the severity of a hemorrhage depends upon the size of the vessel from which the blood escapes, though it may be stated that it is more serious when arteries are severed. if the wound in an artery is in the direction of its length, the blood escapes more freely than if the vessel is completely severed, because in the latter instance the severed ends retract, curl in, and may aid very much in arresting the flow. when the blood merely oozes from the wound, and even when it flows in a small stream, the forming of the clot arrests the hemorrhage in a comparatively short time. slight hemorrhages may be checked by the continuous application of cold water, ice, or snow, to the wound, as cold causes contraction of the small vessels. water from a hose may be thrown on a wound, or dashed on it from the hand or a cup, or folds of cotton cloths may be held on it and kept wet. ice or snow may be held against the wound, or they may be put into a bag and conveniently secured in position. hot water of an average temperature of ° to ° f. injected into the vagina or womb is often efficient in arresting hemorrhages from those organs. tow, raw cotton, lint, or sponges may be forced into a wound and held or bound there with bandages. this is an excellent method of checking the flow of blood until the arrival of an expert. if the flow persists, these articles may be saturated with tincture of iron, but it is not advisable to use it unless necessary, as it is a caustic and retards healing by causing a slough. in cases of necessity, the articles may be saturated with vinegar, or tannic acid or alum dissolved in water may be used instead. whatever article is used should be left in the wound sufficiently long to make sure that its removal will not be followed by a renewal of the hemorrhage. sometimes it must remain there one or two days. an iron heated white and then pressed on the bleeding vessel for three or four seconds is occasionally used. it should not be applied longer, or else the charred tissue will come away with the iron and thus defeat the purpose of its application. compression may be applied in different ways, but only the most convenient will be mentioned. to many wounds bandages may easily be applied. the bandages may be made of linen, muslin, etc., sufficiently wide and long, according to the nature of the wound and the region to be bandaged. bed sheets torn in strips the full length make excellent bandages for this purpose. cotton batting, tow, or a piece of sponge may be placed on the wound and firmly bound there with the bandages. many cases require ligating, which is almost entirely confined to arteries. a ligature is a piece of thread or string tied around the vessel. veins are not ligated unless very large (and even then only when other means are not available) on account of the danger of causing phlebitis, or inflammation of a vein. the ligature is tied around the end of the artery, but in some instances this is difficult and it is necessary to include some of the adjacent tissue, although care should be taken not to include a nerve. to apply a ligature, it is necessary to have artery forceps (tweezers or small pincers may suffice) by which to draw out the artery in order to tie the string around it. to grasp the vessel it may be necessary to sponge the blood from the wound so that the end will be exposed. in case the end of the bleeding artery has retracted, a sharp-pointed hook, called a tenaculum, is used to draw it out far enough to tie. the ligature should be drawn tightly, so that the middle and internal coats will be cut through. another method of checking hemorrhage is called torsion. it consists in catching the end of the bleeding vessel, drawing it out a little, and then twisting it around a few times with the forceps, which lacerates the internal coats so that a check is effected. this is very effectual in small vessels, and is to be preferred to ligatures, because it leaves no foreign body in the wound. a needle or pin may be stuck through the edges of the wound and a string passed around between the free ends and the skin (pl. xxvii, fig. ), or it may be passed around in the form of a figure , as is often done in the operation of bleeding from the jugular vein. aneurism. a circumscribed dilatation of an artery, constituting a tumor which pulsates synchronously with the beats of the heart, is called aneurism. it is caused by disease and rupture of one or two of the arterial coats. the true aneurism communicates with the interior of the artery and contains coagulated blood. it is so deeply seated in cattle that treatment is out of the question. such abnormalities are ascribable to severe exertion, to old age, to fatty or calcareous degeneration, or to parasites in the blood vessels. death is sudden when caused by the rupture of an aneurism of a large artery, owing to internal hemorrhage. sometimes spontaneous recovery occurs. as a rule no symptoms are caused in cattle by the presence of deep-seated aneurisms, and their presence is not known until after death. a false aneurism results from blood escaping from a wounded artery into the adjacent tissue, where it clots, and the wound, remaining open in the artery, causes pulsation in the tumor. thrombosis (obstruction) of the arteries. arteries become obstructed as a result of wounds and other injuries to them, as those caused by the formation of an abscess or the extension of inflammation from surrounding structures to the coats of an artery. arteries are also obstructed by the breaking off of particles of a plug or clot, partly obstructing the aorta or other large artery. these small pieces (emboli) are floated to an artery that is too small to permit them to pass and are there securely held, producing obstruction. these obstructions are shown by loss of power in the muscles supplied by the obstructed artery and by excitation of the heart and by respiration after exercise. the loss of power may not come into evidence until after exercise. _symptoms._--while standing still or when walking slowly the animal may appear to be normal, but after more active exercise a group of muscles, a leg, or both hind legs, may be handled with difficulty, causing lameness, and later there is practically a local paralysis. these symptoms disappear with rest. in some cases the collateral circulation develops in time, so that the parts receive sufficient blood and the symptoms disappear. inflammation of veins (phlebitis). when bleeding is performed without proper care or with an unclean lancet, inflammation of the vein may result, or it may be caused by the animal rubbing the wound against some object. when inflammation follows the operation, the coats of the vein become so much enlarged that the vessel may be felt hard and knotted beneath the skin, and pressure produces pain. a thin, watery discharge, tinged with blood, issues from the wound. the blood becomes coagulated in the vessel. in inflammation of the jugular the coagulation extends from the wound upward to the first large branch. abscesses may form along the course of the vein. the inflammation is followed by obliteration of that part in which coagulation exists. this is of small import, as cattle have an accessory jugular vein which gradually enlarges and accommodates itself to the increased quantity of blood it must carry. _treatment._--the treatment for inflammation of the vein is to clip the hair from along the course of the affected vessel and apply a blister, the cerate of cantharides. abscesses should be opened as soon as they form, because there is a possibility of the pus getting into the circulation. in the operation of bleeding the instruments should be clean and free from rust. if the skin is not sufficiently opened, or when closing the wound the skin is drawn out too much, blood may accumulate in the tissue, and if it does it should be removed by pressing absorbent cotton or a sponge on the part. care should also be used in opening the vein, so that the instrument may not pass entirely through both sides of the vein and open the artery beneath it. * * * * * diseases of the heart, blood vessels, and lymphatics. description of plate. plate vii: diagram illustrating the circulation of the blood. the arrows indicate the direction in which the blood flows. the valves of the heart, situated between the right auricle and ventricle, and left auricle and ventricle, and between the ventricles and large arteries, are represented by curved lines. these valves are intended to prevent the flow of blood in a direction contrary to that indicated by the arrows. [illustration: plate vii. diagram of the circulation of the blood.] * * * * * noncontagious diseases of the organs of respiration. by william herbert lowe, d. v. s. diagnosis. in the determination of disease in the human being the physician, in making his diagnosis, is aided by both subjective and objective symptoms, but the veterinary physician, in a very large majority of cases, is obliged to rely almost solely upon objective symptoms, and perhaps in no class of diseases is this more true than in the exploration of those under consideration. this condition of affairs has a strong tendency to develop observation and discernment in the veterinarian, and not infrequently do we find that the successful veterinary practitioner is a very accurate diagnostician. in order to make a differential diagnosis, however, it is not only necessary to know the structure and functions of the organs in health, but to adopt a rigid system of details of examination, without which successful results can not be reached. _history._--the history of a case should always be ascertained so far as possible. the information obtained is sometimes unsatisfactory and not to be depended upon, but even when this is the case it is advisable to weigh the evidence from every point of view. in connection with the history of every case it is always of primary importance to ascertain the cause of illness. a knowledge of the origin and development of a disease is important, both in making a diagnosis and in formulating the treatment. exposure to cold and dampness is frequently the exciting cause of affections of the organs of respiration. the experienced practitioner is always sure to ascertain whether the particular animal he is called on to attend is the only one in the stable or on the premises that is similarly affected. if several animals are similarly affected, the disease may have a common cause, which may or may not be of an infectious nature. another thing that the experienced practitioner ascertains is what previous treatment, if any, the animal has had. medicine given in excessive doses sometimes produces symptoms resembling those of disease. the hygienic and sanitary conditions must always be considered in connection with the cause as well as the treatment of disease. much of the disease which occurs in large dairies and elsewhere could be prevented if owners and those in charge of animals had proper regard for the fundamental laws of animal hygiene and modern sanitation. disregard for these laws is the cause of most of the diseases under consideration in this chapter. _attitude and general condition._--the feeling of pain in animals suffering from serious affections of the organs of respiration is expressed to the close observer in no uncertain language--by their flinching when the painful part is touched; by the care with which they move or lie down; by walking or standing to "favor" the part; by the general attitude and expression of the eye; by the distress and suffering apparent in the face; and by other evidences. the general physical condition and attitude of the sick animal tell the careful observer much that aids him in making a diagnosis and prognosis. cows suffering from affections of the organs of respiration usually assume a position or attitude that is characteristic, well known to experienced stockmen, as well as to veterinarians. when an animal has a fever or is suffering from an inflammation, the skin is one of the first parts to undergo a change that is apparent to the average observer, for it soon loses its elasticity and tone, and the hair becomes dry and staring. from the general condition or state of nutrition one is able to judge the effect that the disease has already had upon the animal and to estimate the strength remaining available for its restoration to health; from the degree of emaciation one can approximate the length of time the animal has been ill. the age and breed of the animal, as well as its constitution and temperament, are among the things that have to be taken into account in making a diagnosis and in overcoming the disease. _the mucous membrane._--the mucous membrane should in all cases be examined. it can be readily seen by everting the eyelids or by an inspection of the lining membrane of the nostrils. paleness of the mucous membrane indicates weak circulation or poor blood and may result from disease, hemorrhage, or from inappropriate feed. in healthy animals increased redness of the mucous membrane occurs from pain, excitement, or severe exertion, and in such instances is always transitory. in certain pathological conditions, such as fevers and inflammation, this condition of the mucous membrane will also be found. the increased redness of the mucous membrane lasts during the duration of the fever or inflammation. a bluish or blue mucous membrane indicates that the blood is imperfectly oxidized and contains an excess of carbon dioxid, and is seen in serious diseases of the respiratory tract, such as pneumonia, and in heart failure. _the secretions._--the secretions may be diminished, increased, or perverted. in the early stage of an inflammation of a secretory organ its secretion is diminished. in the early stage of pleurisy the serous membrane is dry, and as the disease advances the membrane becomes unnaturally moist. the products of secretion are sometimes greatly changed in character from the secretion in health, becoming excessively irritant and yielding evidence of chemical and other alterations in the character of the secretion. _cough._--cough depends upon a reflex nervous action and may be primary when the irritation exists in the lungs or air passages, or secondary when caused by irritation of the stomach, intestines, or other parts having nervous communications with the respiratory apparatus. a cough is said to be dry, moist, harsh, hollow, difficult, paroxysmal, suppressed, sympathetic, etc., according to its character. it is a very important symptom, often being diagnostic in diseases of the respiratory organs, but this is a subject, however, which can be more satisfactorily treated in connection with the special diseases of the organs in question. _respiration._--in making an examination of an animal observe the depth, frequency, quickness, facility, and the nature of the respiratory movements. they may be quick or slow, frequent or infrequent, deep or imperfect, labored, unequal, irregular, etc., each of which indications has its significance to the experienced veterinarian. sleep, rumination, pregnancy in cows, etc., modify the respiratory movements even in health. respiration consists of two acts--inspiration and expiration. the function of respiration is to take in oxygen from the atmospheric air, which is essential for the maintenance of life, and to exhale the deleterious gas known as "carbon dioxid." the frequency of the respiratory movements is determined by observing the motions of the nostrils or of the flanks. the normal rate of respiration for a healthy animal of the bovine species is from to times a minute. the extent of the respiratory system renders it liable to become affected by contiguity to many parts and its nervous connections are very important. rapid, irregular, or difficult breathing is known as dyspnea, and in all such cases the animal has difficulty in obtaining as much oxygen as it requires. among the conditions that give rise to dyspnea may be mentioned restricted area of active lung tissue, owing to the filling of portions of the lungs with inflammatory exudate, as in pneumonia; painful movements of the chest, as in rheumatism or pleurisy; fluid in the chest cavity, as in hydrothorax; adhesions between the lungs and chest walls; compression of the lungs or loss of elasticity; excess of carbon dioxid in the blood; weakness of the respiratory passages; tumors of the nose and paralysis of the throat; swellings of the throat; foreign bodies and constriction of the air passages leading to the lungs; fevers, etc. as already stated, it is only the careful and constant examination of animals in health that will enable one properly to appreciate abnormal conditions. one must become familiar with the frequency and character of the pulse and of the respirations and know the temperature of the animal in health, before changes in abnormal conditions can be properly appreciated. _temperature._--the temperature should be taken in all cases of sickness. experienced practitioners can approximate the patient's temperature with remarkable accuracy, but i strongly recommend the use of the self-registering clinical thermometer, which is a most valuable instrument in diagnosing diseases. (see pl. iii, fig. .) it is advisable to get a tested instrument, as some thermometers in the market are inaccurate and misleading. the proper place to insert the thermometer is in the rectum, where the instrument should be rested against the walls of the cavity for about three minutes. the normal temperature of the bovine is ° to ° f., which is higher than that of the horse. a cow breathes faster, her heart beats faster, and her internal temperature is higher than that of the horse. ordinary physiological influences--such as exercise, digestion, etc.--give rise to slight variations of internal temperature; but if the temperature rises two or three degrees above the normal some diseased condition is indicated. _pulse._--the pulse in a grown animal of the bovine species in a state of good health beats from to times a minute. exercise, fright, fear, excitement, overfeeding, pregnancy, and other conditions aside from disease may affect the frequency and character of the pulse. it assumes various characters according to its rapidity of beat, frequency of occurrence, resistance to pressure, regularity, and perceptibility. thus we have the quick or slow, frequent or infrequent, hard or soft, full or imperceptible, large or small pulse, the character of each of which may be determined from its name; also that known as the intermittent, either regular or irregular. we may have a dicrotic, or double, pulse; a thready pulse, which is extremely small and scarcely perceptible; the venous, or jugular, pulse; the "running down" pulse, and so on. (see p. .) in cattle the pulse is conveniently felt over the submaxillary artery where it winds around the lower jawbone, just at the lower edge of the flat muscle on the side of the cheek. if the cow is lying down the pulse may be taken from the metacarpal artery on the back part of the fore fetlock. the pulsations can be felt from any superficial artery, but in order to ascertain the peculiarities it is necessary to select an artery that may be pressed against a bone. [illustration: plate viii. position of the lung.] there is a marked difference in the normal or physiological pulse of the horse and that of the cow, that of the horse being full and rather tense, while in the cow it is soft and rolling. the pulse is faster in young or old cattle than it is in those of middle age. _auscultation._--auscultation and percussion are the chief methods used to determine the various pathological changes that occur in the respiratory organs. auscultation is the act of listening, and may be either mediate or immediate. mediate auscultation is accomplished by aid of an instrument known as the stethoscope, one extremity of which is applied to the ear and the other to the chest of the animal. in immediate auscultation the ear is applied directly to the part. immediate auscultation will answer in a large majority of cases. auscultation is resorted to in cardiac and certain abdominal diseases, but it is mainly employed for determining the condition of the lungs and air passages. animals can not give the various phases of respiration, as can the patients of the human practitioner. the organs themselves are less accessible than in man, owing to the greater bulk of tissue surrounding them and the pectoral position of the fore extremities, all of which render it more difficult in determining pathological conditions. (see pl. viii.) the air going in and out of the lungs makes a certain soft, rustling sound, known as the vesicular murmur, which can be heard distinctly in a healthy state of the animal, especially upon inspiration. exercise accelerates the rate of respiration and intensifies this sound. the vesicular murmur is heard only where the lung contains air and its function is active. the vesicular murmur is weakened as inflammatory infiltration takes place and when the lungs are compressed by fluids in the thoracic cavity, and disappears when the lung becomes solidified in pneumonia or the chest cavity filled with fluid as in hydrothorax. the bronchial murmur is a harsh, blowing sound, heard in normal conditions by applying the ear over the lower part of the trachea, and may be heard to a limited extent in the anterior portions of the lungs after severe exercise. the bronchial murmur when heard over other portions of the lungs generally signifies that the lung tissue has become more or less solidified or that fluid has collected in the chest cavity. other sounds, known as mucous râles, are heard in the lungs in pneumonia after the solidified parts begin to break down at the end of the disease and in bronchitis where there is an excess of secretion, as well as in other conditions. mucous râles are of a gargling or bubbling nature. they are caused by air rushing through tubes containing secretions or pus. they are said to be large or small as they are distinct or indistinct, depending upon the quantity of fluid that is present and the size of the tubes in which the sound is produced. according to their character they are divided into dry and moist. the friction sound is produced by the rubbing together of roughened surfaces and is characteristic of pleurisy. _percussion._--percussion is that mode of examination by which we elicit sounds by striking or tapping over the part. it may be direct or indirect. if the middle finger of the left hand is placed firmly on the chest and smartly tapped or struck with the ends of the first three fingers of the right hand, the sound will be noticed to be more resonant and clear than when the same procedure is practiced on a solid part of the body. this is because the lungs are not solid, but are always, in health, well expanded with air. in certain pulmonary diseases, however, as in pneumonia, they fill up and become solid, when percussion produces a dull sound, like that on any other solid part of the animal. when fluid has collected in the lower part of the chest cavity the sound will also be dull on percussion. where there is an excess of air in the chest cavity, as in emphysema or in pneumothorax, the percussion sound becomes abnormally loud and clear. by practice on healthy animals the character and boundaries of the sounds can be so well determined that any variation from them will be readily detected, and will sometimes disclose the presence of a diseased condition when nothing else will. percussion is sometimes practiced with the aid of a special percussion hammer and an object known as a pleximeter to strike upon. a percussion hammer is made of rubber or has a rubber tip, so that when the pleximeter, which is placed against the side of the animal, is struck the impact will not be accompanied with a noise. a percussion hammer and pleximeter may be purchased from any veterinary instrument maker. catarrh (cold in the head). nasal catarrh is an inflammation of the mucous membranes of the nostrils and upper air passages. simple catarrh is not a serious disease in itself, but if neglected is liable to be complicated with laryngitis, bronchitis, pneumonia, plurisy, or other serious and sometimes fatal diseases of the respiratory organs. catarrh is a common disease among cattle. it is often caused by sudden exposure to wet and cold after they have been accustomed to shelter. it may arise from inhalation of irritating gases. it is also sometimes produced by certain specific atmospheric conditions, and may assume an enzoötic form. it is very debilitating, and requires prompt and judicious treatment. _symptoms._--redness of the mucous membranes of the nose and redness and watering of the eyes are symptoms of nasal catarrh. the mucous membrane first becomes dry; afterwards a watery discharge appears, and later, in severe cases, the discharge becomes mucopurulent. in mild cases there is little or no fever, but in severe ones it may run high. the animal becomes dull, languid, and is not inclined to move about, and the appetite may become impaired; there is also variable temperature of the horns and ears. if in a cow giving milk the secretion diminishes, the mucus from the eyes and nose becomes thicker and yellower. afterwards, as the symptoms increase in severity, the discharge becomes mucopurulent. _treatment._--the animal should be housed in a well-ventilated place, with good hygienic surroundings. in cold and damp weather it should be kept warm with blanketing, and, in severe cases, hot, medicated inhalations given. if the fever is high, it may be reduced by giving nitrate of potassium, from to ounces, in the drinking water, three times daily. diffusible stimulants are beneficial in most cases. too much importance can not be attached to good nursing. there is no necessity to resort to the old system of bleeding, purging, or the use of powerful sedatives. epistaxis (bleeding from the nose). bleeding from the nostrils is rather rare in cattle. it may arise from any one of a variety of causes, but usually results from disease or injury to the mucous membranes or to violent exertions in coughing and sneezing. it is seldom serious. it generally occurs in drops from one nostril only, accompanied with sneezing, and without frothing. bleeding from the lungs comes from both nostrils, is bright red, frothy, and accompanied with a cough. _treatment._--in many cases the bleeding will cease spontaneously and all that is necessary is to keep the animal quiet and bathe the head and nostrils with cold water. the cause of the bleeding should be learned and governed accordingly in the treatment. in severe and exceptional cases, when the hemorrhage is persistent and long continued, the animal's head should be tied to a high rack or beam and cold water or ice applied, or recourse to styptic injections taken. if the hemorrhage is profuse and persistent, either a drench composed of - / drams of acetate of lead dissolved in a pint of water or - / drams of gallic acid dissolved in a pint of water should be given. laryngitis (sore throat). an inflammation of the mucous membrane lining the larynx is known as laryngitis. it may be either a primary or a secondary disease, complicated or uncomplicated. in the majority of cases it is attributable to some form of exposure, a sudden change from warm to cold surroundings, or exposure to cold storms. it may also result from inhaling irritating gases or from external violence. in an acute attack of laryngitis there is an elevation of temperature, pain on pressure over the region of the larynx, violent paroxysms of coughing, difficult and noisy respiration. the nostrils are dilated, the nose extended, and the animal has a frightened expression. there is marked difficulty in swallowing. _treatment._--treatment consists of fomentations and hot applications over the throat. stimulating liniments, mustard mixed with cold water and well rubbed in with a stiff brush, or other forms of counterirritation may be applied in severe cases. hot inhalations should be frequently resorted to, and often afford much relief to the suffering animal. in this disease medicines should be given so far as possible in the form of electuaries (soft solid) on account of the difficulty of deglutition. large drafts of medicines have a tendency to produce violent spells of coughing, and in this way retard recovery. the subjoined formula for an electuary will be found to answer the purpose in ordinary cases: chlorate of potassium, pulverized, ounces; fluid extract of belladonna, ounces; powdered opium, ounce; powdered licorice root, ounces; sirup, sufficient quantity; mix. place a small tablespoonful of the mixture frequently on the tongue or back teeth. or the following may be used instead: aloes, powdered opium, and gum camphor in equal parts; mix. rub an ounce on the molar teeth every four or five hours. the bowels should be kept open and the diet should be such as the patient can easily swallow. warm, sloppy mashes, boiled oatmeal gruel, linseed tea, and the like are the most suitable substances. if suffocation be threatened during the course of the disease, tracheotomy should be performed without delay. the details of the operation are fully described under the head of "surgical operations." (see p. .) when the disease assumes a chronic form, strong counterirritation is indicated. a cantharides blister may be applied, or the following ointment used: biniodid of mercury part, lard parts; mix. in some cases it will be found necessary to repeat the application. bronchitis. bronchitis is an inflammation of the mucous membrane of the bronchial tubes. when a primary disease, it is generally the result of what is commonly known as "catching cold." it may be secondary to or complicated with many of the diseases of the respiratory system. it may also be caused by breathing irritating gases, or by the introduction of foreign bodies into the bronchial tubes, which sometimes results from injudicious and careless drenching when the larynx is temporarily relaxed. it may be acute or chronic, and is divided, according to the seat of the inflammation, into bronchitis proper when the large tubes are affected, or capillary bronchitis when the trouble is in the smaller ones. _symptoms._--loss of appetite, elevation of temperature, generally ° or ° f. the inspiration is incomplete, short, and painful, and the expiration is prolonged. the pulse is increased in frequency and is hard. a characteristic, painful cough is present, but it is paroxysmal and incomplete. auscultation and percussion greatly aid us in a diagnosis. a normal sound is given on percussion. on auscultation, in the early stages, rhonchus râles are detected if the larger tubes are affected, and sibilant râles if the smaller ones are affected. later mucous râles are noted, and sometimes all sounds in certain parts are absent, owing to the plugging up of the tubes. this plugging, if extensive enough, is sometimes the cause of death, or death may result from extension of the disease to the lungs or pleura. _treatment._--the animal should be placed in a light, well-ventilated box, and the bowels kept in a soft condition by enemas, etc. violent purgatives should not be used. the body should be kept warm by blanketing. in the early stages a draft composed as follows should be given three times daily: extract of belladonna, drams; solution of acetate of ammonium, fluid ounces; water, one-half pint. in the later stage of the disease the following formula may be substituted and given twice daily: carbonate of ammonium, drams; liquor hydrochlorate of strychnin, fluid drams; spirits of nitrous ether, fluid ounce; water, one-half pint. in some cases the following is preferable to either of the above, and may be given in a pint of linseed tea every four hours: spirits of nitrous ether, - / ounces; aromatic spirits of ammonia, ounces; powdered camphor, drams. the feed should be light and nutritious. bronchitis is liable to become chronic if not properly treated in the earliest stage. in this case remedial treatment is of little value. pleurisy. pleurisy is an inflammation of the serous membrane lining the chest cavity and enveloping the lungs. it is somewhat rare as an independent disease, but it often complicates pneumonia; indeed, it is often caused by the same germ that causes pneumonia--pneumococcus. it may arise from exposure to cold or wet or from external violence, and is usually present in some degree in cases in which the ribs have been fractured with or without a penetrated wound. _symptoms._--in the first stage there is great pain aggravated by movement, and the animal is usually stiff as though foundered, the pulse is quick and hard, the breathing abdominal, the chest being fixed so far as possible, the inspiration short and jerky, the expiration longer. the pain is caused by the friction of the dry, inflamed pleural surfaces of the lung and chest on each other. at this stage the ear detects a dry friction murmur, resembling somewhat the sound made by rubbing two pieces of sole leather together. pressure between the ribs gives pain and usually causes the animal to flinch and grunt. the muzzle is hot and dry, the mouth slimy, and the secretions scanty. after a day or two the severity of the symptoms is much lessened, the temperature, which during the first days may have been as high as ° f., falls to ° or °, the pain decreases, the stiffness disappears, and the patient eats a little. the pulse softens, but remains quicker than normal. now, day by day the patient loses a little strength, the friction sound disappears as the exudation moistens the pleural surfaces; percussion now shows a horizontal line of dullness, which day by day rises higher in the chest, the respiration grows more frequent and labored, the countenance is anxious and haggard, the eyes sink somewhat in their sockets, and in unfavorable cases death occurs during the second or third week, from either asphyxia or heart failure. in pleurisy, as in pneumonia, the elbows are usually turned outward. care must be taken to differentiate pleurisy from traumatic pericarditis (which see). in the latter condition the area of dullness of the heart is much increased, and usually a splashing sound is heard at each beat of the heart. another diagnostic symptom of value is that in traumatic pericarditis respiration is painful, not difficult, and the respiratory rate is very much increased on movement. in both conditions a considerable swelling of the dewlap may be noticed in the later stages. _treatment._--give the same general care as recommended in bronchitis or pneumonia. in the early stages give a febrifuge to reduce the fever, as directed for pneumonia. for relief of the cough give electuary formula, which will be found in the treatment of laryngitis. the bowels must be kept relaxed and the kidneys secreting freely. in the stage of effusion the following should be given three times daily: digitalis tincture, ounce; iodid of potassium, to grains; mix. apply strong counterirritant to chest and put seton in dewlap. (see "setoning," p. .) if collapse of the lung is threatened, a surgical operation, termed paracentesis thoracis, is sometimes performed; this consists in puncturing the chest cavity and drawing off a part of the fluid. the instruments used are a small trocar and cannula, which are introduced between the eighth and ninth ribs. the skin should be drawn forward so that the external wound may not correspond to the puncture of the chest, to prevent the entrance of air. only a portion of the fluid should be removed. the animal gets immediate relief, but it is generally only temporary, as the fluid has a tendency to accumulate again. pneumonia. pneumonia is an inflammation of the lung substance, and is divided into three forms, viz, croupous, catarrhal, and interstitial. these various forms, however, can be differentiated only by the expert, and it is therefore deemed necessary for the purpose of the present work to treat the subject under the general head of pneumonia. the causes of pneumonia in general are the same as those of the various other inflammatory diseases of the respiratory tract. the germ is known as a pneumococcus. the disease mostly follows congestion of the lungs, but may in rare cases have a parasitic origin. _symptoms._--in the first stage, that of congestion, the disease is usually ushered in by a chill, although this may not always be observed by the attendant. this is followed by an elevation of temperature, usually ° to ° f., or it may be even higher. the respirations are quick and shallow; the nostrils are dilated; the pulse is full and hard. cough may or may not appear in this stage. the nose is hot and dry; the tongue sometimes protrudes and is slimy; the coat is staring, and the skin dry and harsh. the urine is usually diminished in quantity, high colored, and the bowels constipated. the animal stands with the forelegs wide apart to facilitate respiration. on auscultation crepitation will be observed over the portion of the lung affected. the sounds elicited on percussion are practically normal in this stage. in the second stage the temperature generally drops one or two degrees, and respiration is performed with much difficulty. the cough is frequent and painful. the animal still stands with the forelegs wide apart and the elbows turned outward. if it assumes the recumbent position it rests on the sternum. all secretions are more or less suspended, particularly the milk in cows. the animal has a haggard appearance, and the pulse becomes small and wiry at this period. the extremities are hot and cold alternately; the crepitation which was present in the first stage is now absent, and no sound on auscultation is heard, unless it is a slight wheezing or whistling noise. on percussion dullness over the diseased lung is manifested, indicating consolidation. the lung has now assumed a characteristic liverlike appearance. in the third stage, if the disease is to terminate favorably, the cough becomes loose, the animal improves, the appetite returns, and the symptoms above detailed rapidly subside; if, on the other hand, resolution is not progressing, the lung substance degenerates, becomes clogged up, and ceases to function. in fatal cases the breath has a peculiar, fetid, cadaverous odor, and is taken in short gasps; the horns, ears, and extremities become cold and clammy, and the pulse is imperceptible. on auscultation, when suppuration is taking place and the lung structure is breaking down, a bubbling or gurgling crepitation, caused by the passage of air through pus, is heard. _treatment._--good hygienic surroundings and good nursing are essential in connection with the medical treatment. the probability of recovery depends largely on the extent of the lung tissue involved, as well as on the intensity of the inflammatory process. in the early stage, when the fever is high, febrifuges should be given. if the pulse be strong and full, aconite (fleming's tincture, to drams, every four or five hours) may be given for a short time, but should be discontinued as soon as the fever begins to abate. aconite is a valuable drug in the hands of the intelligent practitioner, but my experience leads me to believe that not infrequently animals are lost by its injudicious use, for in many febrile conditions it is positively contraindicated, owing to its action upon the heart. in a plethoric animal, with a strong, bounding pulse, bleeding may be resorted to instead of administering aconite. if the bowels are constipated, calomel, to drams, which acts as a cathartic and a febrifuge, is advisable. in the second stage diffusible stimulants are required, viz: spirits of nitrous ether, ounces; aromatic spirits of ammonia, ounce; mix, and give in gruel three times daily. in some cases carbonate of ammonia, to drams, has been found beneficial. most practitioners apply counterirritants, such as mustard plasters, turpentine, and ammonia liniment, or cantharides. emphysema (heaves). emphysema is a rupture of the minute air vesicles of the lung substance, and may be either interlobular or vesicular. there is an extreme interference with respiration, inspiration being short and expiration prolonged. it is a nonfebrile condition, in which the appetite is not decreased and the milk secretion is kept up. it may be caused by an attack of asthma or may result from chronic bronchitis. the disease can be diagnosed by the marked interference with respiration. the animal, as a rule, is emaciated, has a staring coat, and is hidebound. if percussion is resorted to, the animal's chest will give a tympanic, drumlike sound. the normal resonant sound is exaggerated. _treatment._--the disease is incurable, and only a palliative form of treatment can be carried out. the destruction of the animal is often advisable, from a humane as well as from a financial point of view. pulmonary congestion. cattle that are overdriven or overworked are liable to pulmonary congestion in an acute form, and sometimes to pulmonary apoplexy. in such cases they should be allowed to rest, and if the weather is hot, they should be put in a shady place. give stimulants internally, unload the venous side of the heart by bleeding, and apply stimulating applications to the legs, and bandage. hemoptysis. hemoptysis is a term used to signify bleeding from the lungs. the trouble may result from a previous congestion of the lungs or from a breaking down of the lung substance, or from specific disorders. bleeding from the lungs comes from both nostrils and from the mouth. the blood is bright red, frothy, and accompanied with a cough, the flow being somewhat profuse and intermingled with mucus. it may cease of its own accord. internally hemostatics are indicated, and locally over the sides cold applications have a tendency to check the hemorrhage. a drench of - / drams of gallic acid dissolved in a pint of water should be given. abscess of the lung. abscesses of the lung sometimes form during the course of or subsequent to tuberculosis or other diseases. an animal affected with abscess of the lung usually has a protracted, feeble cough and a general appearance of emaciation and anemia. the pulse is feeble and the breath foul. an offensive discharge from the lungs frequently occurs. percussion and auscultation aid in making a diagnosis in this condition. the appetite is poor. such animals go from bad to worse, and their prompt destruction would, as a rule, be to the interest of the owner. hydrothorax. hydrothorax, or dropsy of the chest, is not a disease in itself, but is simply a condition in which an effusion takes place in the chest cavity, and is the result or effect of some disease, mostly pleurisy. it can be easily diagnosed by physical signs. a loss of the respiratory murmur will be noticed on auscultation, and on percussion dullness or flatness on a line as high as the effusion has taken place. when a large amount of effusion is present, tapping with the trocar and cannula is generally resorted to. the proper method of performing this operation will be found under the head of "pleurisy." pneumothorax. an accumulation of gas in the pleural sac is known as pneumothorax. the presence of air may result from either an injury of the lung or a wound communicating from the exterior. the indications for treatment are to remove any foreign body that may have penetrated, to exclude the further entrance of the air into the cavity by the closure of the external opening, and to employ antiseptics and adhesive dressings. the air already in the cavity will in most cases be absorbed. verminous bronchitis. this is a disease that sometimes attacks young cattle when pastured in low-lying meadows near rivers subject to flood. it is caused by a small worm, _strongylus micrurus_, which lodges in large numbers in the trachea and bronchial tubes, giving rise to considerable irritation of the air passages and inflammation. sometimes the strongyles lodge in large numbers in the windpipe, forming themselves into a ball, and thus choke the animal to death. _symptoms._--it is liable to attack a number of animals at once, and the weakest are the first to give way. the animal has a remarkably forcible cough, distressing, and of a special hacking and paroxysmal character. a stringy mucus is sometimes expelled during the spells of coughing. this mucus contains the _strongylus micrurus_, which can be detected, or their ova observed, under a low power of the microscope. the attack has a subacute character and is very exhausting. the parasites, by becoming entwined in balls, seriously impede respiration, which is always remarkably labored in this disease. _treatment._--the affected calves should be placed in a dry stable, protected from dampness, and subjected to fumigations of sulphurous anhydrid or chlorin gas. the liberation of chlorin gas is brought about by the action of sulphuric acid, either on a mixture of chlorid of sodium and black oxid of manganese or on bleaching powder. sulphurous anhydrid may be procured by burning sulphur. some practitioners prescribe small doses of spirits of turpentine in linseed oil. the system requires good support, and the diet should therefore be liberal and nutritious. equal parts of sulphate of iron, gentian, and ginger make an excellent tonic. _prevention._--avoid pastures notorious for generating verminous bronchitis. pleurodynia. pleurodynia is a term applied to rheumatism of the intercostal muscles, the apparent symptoms being very similar to those of pleurisy. the animal is stiff, is not inclined to turn around, and the ribs are kept in a fixed state as much as possible. pleurodynia may be distinguished from pleurisy by the coexistence of rheumatism in other parts and by the comparative absence of fever, cough, the friction sound, and the effusion into the chest. the treatment for this affection is the same as that for rheumatism affecting other parts. diseases of the nervous system. by w. h. harbaugh, v. s. [revised by john e. mohler, v. m. d.] the nervous system. the nervous system is the distinguishing feature of animal life. without it there can be no intelligence, no instinct, no sensibility, no perception; in fact, existence would be nothing more than vegetable life. the senses--touch, taste, sight, hearing, smell--all depend on the nervous system. motion depends on it. a muscle can not contract without receiving the stimulus from the nervous system. for example, if a nerve passing from a nerve center to a muscle is severed, the particular muscle that is supplied by the cut nerve is paralyzed. the nervous system is often studied in two divisions--the cerebrospinal division and the sympathetic division. the cerebrospinal division consists of the brain and spinal cord, nerves, and ganglia. the nerves of this division convey the impulses of motion and sensation and supply all parts which are under the control of the will. for example, the voluntary muscular tissue includes all the muscles which act as the will directs. another example: if anything comes in contact with any part of the skin, the impression is immediately perceived. all the special senses belong to this division. the sympathetic division consists of nerves and ganglia. the muscular tissue, which acts independently of the will--as, for example, the stomach, intestines, womb, blood vessels, ducts, etc.--is called involuntary muscular tissue, and receives nervous stimulus from the sympathetic division. the brain, spinal cord, and the ganglia are the central organs of the nervous system. the nerves conduct the nervous influence. the nerves terminate differently according to their function. the terminations are called end organs. the terminal end organs in the skin and other parts endowed with sensation receive the impressions, which are conveyed to the brain, where they are appreciated. they are so sensitive that the most gentle zephyr is perceived. they are so abundant that the point of the finest needle can not pierce the skin without coming in contact with them, and the sensation of pain is instantly conveyed to the brain. the terminal end organs of the nerves that supply the muscles are different, as they give the impulse which is conveyed by the motor nerves to the elements which constitute the muscle, and this impulse is the excitation which causes the muscle to contract. the terminal end organs of the special senses of taste, smell, etc., receive their special impressions, and their respective nerves carry the impressions to the brain. there are two divisions of nerves, the afferent and efferent. the afferent nerves are those which convey the impression to the nerve centers. all the sensory nerves belong to this division. the efferent nerves are those which convey the nervous impulse outward from the nerve centers, and they are further classified according to the function of their respective centers. for example: motor fibers carry the impulse from the nerve center to a muscle to cause contraction. vasomotor fibers carry the impulse to the muscular tissue in the blood vessels, which regulates their caliber. the secretory fibers convey the impulse to the cells of the glands and excite the activity of the gland, and its particular product is secreted or evolved, as, for instance, milk in the mammary gland. inhibitory fibers control or inhibit the action of the organ to which they are distributed, as, for instance, the heart. nerve centers may be considered as a collection or group of nerve cells. both the cerebrospinal and the sympathetic divisions have nerve centers. the centers derive their special names from their functions. the brain is the great center of the nervous system, as it is the center of intelligence and perception. the centers of all the special senses, as well as the centers of various functions, are located in different parts of the brain. nerve centers also exist in the spinal cord and in connection with the sympathetic system. a nerve is a cord consisting of a certain number of fibers of nerve tissue, inclosed in a sheath of connective tissue. nerves divide and subdivide, sending off branches, which ramify in all parts of the body, and, as they near their terminations, they contain but one or two fibers. the brain and spinal cord are contained within a bony canal, which forms a protective covering for them. the spinal cord, or spinal marrow, lodged within the spinal canal, or hollow of the backbone, is continuous with the brain anteriorly, and terminates in a point in the sacrum (that part of the spinal column which immediately precedes the tail). the spinal cord gives off branches at each of the spaces between the segments of the backbone. these branches form nerve trunks which carry both sensory and motor impressions and impulses. the spinal cord is a grand nerve trunk to carry messages to or from the brain and to and from the reflex centers contained within itself. the brain is contained within the cavity of the skull and is continuous with the spinal cord; there is nothing to mark the place where one leaves off and the other begins. the brain is the seat of reason and intelligence. voluntary effort originates from the brain. coordination, or harmony of movement, is controlled by the rear portion of the brain, known as the cerebellum. the meninges are the membranes, three in number, which envelop the brain and spinal cord, and separate them from the bones which form the walls of the cranial cavity and spinal canal. the sympathetic, also called the ganglionic, division of the nervous system consists of two chains of ganglia, reaching from the head to the tail, situated beneath the spinal column, one on either side. the presence of the ganglia or enlargements on the cords give them their chainlike appearance. the sympathetic nerves are closely connected with the cerebrospinal nerves, but are not under the control of the will. inflammation of the brain and its membranes (staggers). inflammation of the brain is technically termed encephalitis and of its membranes cerebral-meningitis, but as both conditions usually occur together, and since it is practically impossible to distinguish one from the other by the symptoms shown by the diseased animal, they may as well be considered together here as varieties of the same disease. staggers, coma, frenzy, etc., are terms that are sometimes applied to this disease in its different forms or stages. _causes._--severe blows on the head with a hard object, or the head coming violently in contact with the ground or other hard substance in a fall, may be followed by encephalitis. irritation caused by tumors in the brain may produce inflammation. feed containing deleterious matters--for example, ergot (see pl. v) and other fungi which contain a narcotic principle--is the most frequent cause of this affection, and hence it is often called "grass staggers" and "stomach staggers." highly nitrogenous feeds are blamed for causing this disease. parasites, mineral and narcotic poisons, hot weather, and severe exertion or excessive excitement may cause this condition. inflammation of the brain may occur as a complication of some infectious disease or may follow some forms of indigestion. in many localities certain plants have the reputation of causing staggers. _symptoms._--the symptoms vary much, but a careful observer will detect a trouble connected with the nervous system without much uncertainty. the first signs may be those of frenzy, but generally at the start the animal is dull and sleepy, with little or no inclination to move about; the head may be pressed against the wall or fence and the legs kept moving, as if the animal were endeavoring to walk through the obstruction; the body, especially the hind part, may be leaned against the side of the stall or stable, as if for support. the bowels are constipated; the urine, when passed, is small in quantity and darker in color than natural. there may be trembling and even spasms of muscles in different parts. in the dull stage the animal may breathe less frequently than is natural, and each breath may be accompanied with a snoring-like sound. the pulse may be large and less frequent than normal. if suddenly aroused from the drowsy state, the animal appears startled and stares wildly. when moving about it may stagger, the hind quarters swaying from side to side. if delirium ensues, the cow is commonly said to be mad. she may bellow, stamp her feet, run about wildly, grate the teeth, froth at the mouth. if she is confined in the stable, she rears and plunges; the convulsions are so violent in many instances that it is really dangerous for one to attempt to render aid. the body may be covered with perspiration. she may fall; the muscles twitch and jerk; often the head is raised and then dashed against the ground until blood issues from the nose and mouth; the eyes may be bloodshot and sightless; the limbs stiff and outstretched, or they may be kicked about recklessly; the head may be drawn back and the tail drawn up; the urine may be squirted out in spurts; often the "washer" (membrane nictitans) is forced over the eye. when the convulsions cease they may be followed by a period of quiet unconsciousness (coma) which is more or less prolonged, when the animal may gradually regain consciousness, get up on its feet, and perhaps quietly partake of food, if there be any within reach, while at other times it arises with much difficulty and staggers blindly about the stall or field. it must be remembered that all the foregoing symptoms are not always seen in the same case. in those cases usually designated "sleepy staggers" the general symptoms of drowsiness are presented, while in other cases the symptoms of frenzy cause the affection to be called "mad staggers." in other cases there are symptoms of paralysis, swaying of the hind quarters, inability to rise, etc., and sometimes these symptoms of paralysis are the most striking manifestations and continue until death. acute cases are accompanied by fever. it is well to remark that when the disease follows injuries to the head the symptoms may not be manifested until two or three days (or longer) after the accident. _treatment._--recoveries are rare in spite of careful attention. to be of any service whatever the treatment must be prompt and begin with the disease. in the early stage, when the pulse is large, most cases will admit of bleeding. eight or quarts of blood should be taken from the jugular vein. this should be followed immediately by a purgative, the following for a cow of average size: epsom salt, ounces; pulverized gamboge, one-half ounce; croton oil, drops; warm water, quarts; mix all together and give at once as a drench. about quarts of warm water or warm soapsuds should be injected with a syringe into the rectum every three or four hours. it is best to keep the animal in a quiet, sheltered place, where it will be free from noise or other cause of excitement. all the cold water the animal will drink should be allowed, but feed must be withheld, except bran slops occasionally in small quantities, or grass, if in season, which may be cut and carried fresh to the patient. the skull must be examined, and if sign of injury is found, appropriate surgical treatment should be given. during the convulsions all possible efforts should be made to prevent the animal injuring itself. the head should be held down on the ground and straw kept under it. cold water may be continuously poured on the head, or bags filled with ice broken in small pieces may be applied to the head. different authors recommend different remedies to allay the convulsions, but for two reasons it will be found extremely difficult to administer medicines during the convulsions: ( ) while the animal is unconscious the power to swallow is lost, and therefore the medicine is more liable to go down the windpipe to the lungs than it is to go to the paunch; ( ) the convulsions are often so violent that it would be utterly useless to attempt to drench the animal; and furthermore it must be borne in mind that during this stage the functions of digestion and absorption are suspended, and as a consequence the medicine (provided it finds its way to the paunch) is likely to remain there unabsorbed and therefore useless. a blistering compound, composed of mustard, ounce; pulverized cantharides, one-half ounce; hot water, ounces, well mixed together, may be rubbed in over the loins, along the spine, and back of the head on each side of the neck. this is occasionally attended with beneficial effect, and especially so in those cases when paralysis is present. if the purgative acts and the animal shows signs of improvement in the course of two or three days, drams of iodid of potassium may be given every night and morning, dissolved in a half bucketful of drinking water, if the animal will drink it, or it may be dissolved in a half pint of water and given as a drench. great care must be observed in regard to the food, which should be nutritive, but not coarse, and at first in small quantities, gradually increased as the patient improves. after some progress is made toward recovery - / drams of pulverized nux vomica may be given twice a day, added to the iodid of potassium drench. this should be administered so long as a staggering gait continues. in those rare cases when recovery takes place it is only partial as a rule, as there is generally a sequel which remains, such as partial paralysis. however, this is but a slight drawback in cattle, because when it is seen to persist the medicine should be stopped and the animal fattened for butchering. post-mortem examinations discover congestion of the brain and its membranes. in those cases which have exhibited much paralysis of the hind legs before death the cord may be congested in the lumbar region (loins). when the disease has been caused by injury to the head, the congestion and extravasated blood may be found inside of the cavity in the location corresponding to the place where the injury was inflicted externally. in some cases pus is also discovered. it remains to be said that in all animals that have died from this affection the lungs are found very much congested. this may lead the superficial observer to suppose that the disease was a lung affection, but in fact it is only a natural consequence when death ensues from brain disease. apoplexy. that form of congestion of the brain known as parturient apoplexy, or parturient paresis, which is so frequently associated with the period of calving is described in another part of this work. (see "milk fever," p. .) cerebral apoplexy, not connected with parturition, is a rare disease among cattle. however, it may be due to degeneration and consequent rupture of a blood vessel in the brain. the attack is sudden, the animal in most cases falling as if it had received a blow on the head. it may stagger and reel some time before going down. after falling, there are convulsive movements of the legs or the animal sinks into insensibility. there may be remissions in the severity of the symptoms, but the pressure from the continued escape of blood soon causes death. rest, quiet, friction to the legs and surface, frequent turning of the animal and cold to the head are to be practiced, if treatment is attempted. congestion of the brain. there is a form of congestive apoplexy affecting cattle which are in a plethoric condition. the congestion, or overfilling with blood, causes pressure on the brain substance and disorganizes its function. it occurs mostly in hot weather. in this disease the symptoms are somewhat similar to those exhibited when the animal has encephalitis, but the onset is more sudden, the duration is shorter, and there is less fever. there may be frenzy or coma, or alternations one with the other. the intelligence is diminished, staring eyes, bracing with the legs, pressing against the stall partition or manger, red mucous membranes. this condition usually terminates in recovery. in such cases bleeding should be resorted to immediately, and when the power of swallowing is not lost purgatives should be administered. cold applications to the head and the general treatment recommended for encephalitis are indicated. concussion of the brain. severe blows on the head, striking the head against some hard object while running, or falling on the head may cause concussion of the brain. the injury may fracture bones of the cranium and produce compression of the brain. _symptoms and treatment._--the symptoms and the treatment that is indicated differ very little from what has been said under congestion of the brain and under encephalitis. in some cases it may be necessary to operate to remove a piece of bone that is pressing on the brain or to remove a clot of blood under the area which received the blow. epilepsy. this affection is characterized by the occurrence of sudden convulsions. the animal may appear to be in a fair state of health usually, but at any time, in the stable or in the field, it may have a convulsion in which it will fall and lose consciousness. epilepsy must not be confounded with vertigo--the fainting which is an effect of heart troubles. the exact cause of epilepsy in the majority of cases is unknown. post-mortem examinations in many instances have failed to discover any lesion in connection with the brain or nervous system, while in other instances disease of the brain has been found in the form of thickening of the membranes, abscesses, and tumors, and in some cases the affection has been manifested in connection with a diseased condition of the blood. the cause has also been traced to reflex irritation, due to teething, worms, and chronic indigestion. _treatment._--when the affection is due to the last-named causes treatment may be successful if the cause is removed. if there are symptoms of worms or of indigestion, follow the general treatment advised for those troubles under their proper heads. if due to irritation caused by teething, the inflamed gums must be lanced. examination of the mouth often develops the fact that one of the temporary teeth causes much irritation by remaining unshed, and thereby interfering with the growth of a permanent tooth. the offending tooth should be extracted. when the cause of epilepsy can not be discovered, it must be confessed that there is no prospect of a cure. however, some benefit may be expected from the occasional administration of a purgative dose of medicine. a pound of epsom salt dissolved in a quart of warm water, for a cow of average size, may be given as a drench once or twice a month. in addition to the purgative, drams of bromid of potassium, dissolved in the drinking water, three times a day, has proved very beneficial in some cases. sunstroke (prostration from heat). owing to the fact that cattle are seldom put to work at which they would have to undergo severe exertion, especially in collars, they are not frequently prostrated by the extreme heat of the summer months. when at pasture they select the coolest places in the shade of trees, in water, etc., when the heat becomes oppressive, and thereby avoid, as much as possible, the effects of it. it does happen, however, that cattle that have been kept up for the purpose of fattening, when driven some distance in very hot weather, are sometimes prostrated, but it must be remembered that it is not really necessary for the animal to be exposed to the rays of the sun, as those confined in hot, close places may suffer. this often happens in shipping, when they are crowded together in cars. _symptoms._--the premonitory signs are those of exhaustion--dullness, panting, frothing at the mouth, tongue hanging out, irregular gait, uneasiness, palpitation--when, if the circumstances which tend to the prostration are not mitigated, the animal staggers or sways from side to side, falls, struggles for a while, and then gradually becomes quiet, or the struggles may continue, with repeated but ineffectual efforts to regain a standing position. in serious cases the attack may be very sudden, unconsciousness occurring without continued or distressing premonitory symptoms. _treatment._--at first, when not very serious, removal to a quiet, sheltered place, with a few days on a reduced diet, is all that need be done. when the animal has fallen, apply cold water or ice to the head; rub the body and limbs with cloths or wisps of straw and continue the rubbing for a considerable time. if the power of swallowing is not lost (which may be ascertained by pouring a little cold water into the mouth), give drams of stronger liquor ammonia, diluted with a quart of cold water. be very careful in drenching the animal when lying down. repeat the drench in a half hour and an hour after the first one has been given. instead of the ammonia, a drench composed of ounces of spirits of nitrous ether in a pint of water may be given, if more convenient, but the ammonia drench is preferable. if unconsciousness continues, so that a drench can not be administered, the same quantity of ammonia and water may be injected with a syringe into the rectum. the popular aqua ammonia, commonly called "hartshorn," will do as well as the stronger liquor ammonia, but as it is weaker than the latter the dose for a cow is about - / ounces, which should be diluted with a quart of water before it is given to the animal, either as a drench or an enema. when ammonia can not be obtained, an ounce of tincture of digitalis may be given. as soon as the animal is able to rise it should be assisted and moved to the nearest shelter. all the cold water it will drink should be allowed. the ammonia or spirits of nitrous ether drench should be administered every three hours so long as there is much failure of strength. the diet should be limited for several days--bran slops and a little grass. when signs of returning strength are presented, ounces of epsom salt dissolved in a quart of warm water may be given in those cases which have been down and unconscious, but do not give it while much weakness remains, which may be for several days after the attack. the flesh of an animal that is suffering from heat stroke should not be prepared for use as food. on account of the fever with which the animal suffers, the flesh contains toxins that may render it poisonous to the consumer. injuries to the spinal cord. the spinal cord is liable to concussion from blows and falls, and paralysis, to a greater or less extent, may be the result. fracture, with displacement of the bones (vertebræ) which form the spinal column, by compressing the spinal cord, produces paralysis, which varies in its effect according to the part of the cord that is compressed. if the fracture is above the middle of the neck, death soon follows, as communication between the brain and diaphragm (the essential muscle of inspiration) is stopped. when the fracture is farther down in the neck, posterior to the origin of the phrenic nerve, the breathing continues, but there is paralysis in all parts posterior to the fracture, including the fore and hind legs. when the fracture is in the region of the loins the hind legs are paralyzed, but the fore legs are not. if the fracture is in the sacrum (the division of the spinal column between the loins and the tail), the tail alone is paralyzed. as a matter of course, when the back is broken there is no remedy; the animal should be killed at once. paralysis. paralysis, or loss of motion in a part, may be due to a lesion of the brain, of the spinal cord, or of a nerve. it may also be caused by reflex irritation. when the paralysis affects both sides of the body, posterior to a point, it is further designated by the name paraplegia. when one side of the body (a lateral half) is paralyzed, the term hemiplegia is applied to the affection. when paralysis is caused by a lesion of a nerve, the paralysis is confined to the particular part supplied by the affected nerve. as already pointed out, paralysis may be due to concussion of the spine, fracture of a bone of the spinal column with consequent compression of the spinal cord, concussion of the brain, or compression of the brain. an injury to one side of the brain may produce paralysis of the same side of the head and of the opposite side of the body (hemiplegia). paralysis may occur in connection with parturient apoplexy, lead poisoning, ergotism, etc. congestion of the spinal cord. paraplegia, or paralysis of the rear part of the body, is the dominant symptom in congestion or inflammation of the spinal cord. the cause is not known, but the disease is probably due to chilling. it is thought by some that some toxic influence (poison) may be responsible for its development. _symptoms._--the symptoms usually appear suddenly and consist in inability to stand. sometimes this is preceded by a period of excitement. the animal usually lies quietly, but sometimes it groans and tosses its head about in a way that indicates pain. cows heavy with calf are sometimes affected with a form of paraplegia, which usually attacks them from about a month to a few days before calving. apparently they are in good health in every respect except the inability to stand up on account of the paralysis of the hind quarters. this form is generally attributed to feeding on feeds containing insufficient protein and ash. it is most likely to occur in cows that are weak and thin. with good care and feed recovery usually occurs. _treatment._--the animal must be given a soft, dry bed under shelter and in a quiet, airy place. it is well to apply mustard along the spine. the action of the mustard may be intensified by rubbing the skin with ammonia or turpentine. internally give a purge of glauber's salt. nux vomica or strychnia ( to grain doses) may be given. turn the cow two to four times daily and rub the legs well each time. there are instances when cows will persist in lying down (in spite of all efforts that are made to compel them to stand up), when it can not really be said that they are paralyzed. they have sensation in all parts; they can move all their feet; they can change their position; and in fact every function seems to be normally performed, but they obstinately refuse to rise or even make an effort to do so. cases of this kind have been killed, as it was an utter impossibility to get the animal on its feet. however, there are instances when a cow, after refusing to rise when all other means had been tried, quickly jumped to her feet and showed fright upon the appearance of a dog or other terrifying object. rabies (hydrophobia). [see discussion of this disease in chapter on "infectious diseases," p. .] lightning stroke (asphyxia electrica). when an animal is struck by lightning the shock is instantaneously expended on the nervous system, and as a rule death occurs immediately; but when the shock is not fatal animation is suspended to a greater or less extent, as evidenced by prostration, unconsciousness, and paralysis. _symptoms._--when not fatal, the symptoms vary much, according to the severity of the shock. the animal usually falls, as from an apoplectic attack, and, as a matter of course, the symptoms are such as are generally manifested in connection with concussion of the brain. the muscular system may be completely relaxed; the legs limber; the muscles flabby and soft to the touch; or there may be convulsions, spasms, and twitching of the muscles. the breathing is generally labored, irregular, or interrupted, and slower than normal. in most instances the electrical fluid leaves its mark by singeing the hair, or by inflicting wounds, burns, or blisters. _treatment._--so long as the beating of the heart is perceptible the endeavor to resuscitate the animal should be continued. dash cold water over the head and body; rub the body and legs; smartly whip the body with wet towels or switches. mustard, mixed with water, should be well rubbed over the legs and back of the head on each side of the neck. inject into the rectum drams of stronger liquor ammonia, or - / ounces of hartshorn diluted with a quart of warm water. cautiously hold an uncorked bottle of hartshorn to the nostrils, so that some of it is inhaled, but care should be taken that too much is not suddenly inhaled. if the animal is unconscious, hypodermic injections of stimulants are indicated, such as drams of camphorated oil in one dose, subcutaneously, or grains of caffein or / grain of strychnin, also subcutaneously. when the animal revives sufficiently to be able to swallow, drams of the stronger liquor ammonia, diluted with a quart of cold water, should be given as a drench, and the dose should be repeated in an hour. one and one-half ounces of ordinary hartshorn may be used instead of the stronger liquor ammonia, but, like the latter, it should be diluted with a quart or more of water, and even then care should be exercised in drenching. in cases where the shock has not caused complete insensibility recovery may be hastened by the ammonia and water drench, or ounces of brandy diluted with a quart of water, or ounces of whisky diluted with a quart of water. these doses may be given every three or four hours if necessary. after recovery from the more serious symptoms drams of sulphate of quinin should be given twice a day until health is restored. if any paralysis remains - / drams of pulverized nux vomica should be given twice a day with the quinin. the foregoing treatment is also applicable when the electrical shock is given by telephone, electric car, or electric-light wires, etc. the wounds, burns, or blisters should be treated according to the antiseptic method of treating wounds. tumors in the brain, etc. tumors of different kinds have been found within the cranial cavity, and in many cases there have been no well-marked symptoms exhibited during the life of the animal to lead one to suspect their existence. cases are recorded where bony tumors have been found in the brain of cattle that died suddenly, but during life no signs of disease were manifested. post-mortem examinations have disclosed tubercles in the membranes of the brain. (see "tuberculosis," p. .) abscesses, usually the result of inflammation of the brain, have been found post-mortem. for the description of hydrocephalus, or dropsy of the brain, of calves the reader is referred to the section on parturition. (see "water in the head," p. .) chorea, constant twitching and irregular spasmodic movements of the muscles, has been noticed in connection with or as a sequel to other affections, as, for example, parturient apoplexy. various diseases, the description of which will be found in other sections of this work, affect the nervous system to a greater or less extent--for example, ergotism, lead poisoning, uremia, parturient apoplexy, colic, and other affections associated with cramps, or spasms, etc. disease of the ovaries or of the spinal cord, by reflex irritation, may cause estromania (see "excess of venereal desire," p. , constant desire for the bull). diseases of the urinary organs. by james law, f. r. c. v. s., _formerly professor of veterinary science, etc., in cornell university._ of the materials that have served their purpose in building up the animal body or in sustaining the body temperature, and that are now to be thrown out as waste, the greater part is expelled from the system through the lungs and the kidneys, but the agents that pass out by either of these two channels differ in the main from those passing by the other. thus from the lungs in the form of dioxid of carbon--the same gas that comes from burning of coal or oil--there escapes most of the waste material resulting from the destruction in the system of fats, sugars, starch, and such other foods as are wanting in the element nitrogen, and do not form fibrous tissues, but go mainly to support animal heat or maintain functional activity. from the kidneys, on the other hand, are thrown out the waste products resulting from the destruction of the foods and tissues containing nitrogen--of, for instance, albumin, fibrin, gluten, casein, gelatin, woody tissue, etc. while much of the waste material containing nitrogen leaves the body by the bowels, this is virtually only such of the albuminoid food as has failed to be fully digested and absorbed; this has never formed a true constituent part of the body itself or of the blood, but is so much waste food, like that which has come to the table and again carried away unused. if the albuminoid food element has entered the blood, whether or not it has been built up into a constituent part of the structure of the body, its waste products, which contain nitrogen, are in the main expelled through the kidneys, so that the latter become the principal channels for the expulsion of all nitrogen-containing waste. it would be an error, however, to infer that all nitrogenous food, when once digested and absorbed into the blood, must necessarily leave the system in the urine. on the contrary, in the young and growing animal, all increase of the fibrous structures of the body is gained through the building up of those flesh-forming constituents into their substance; in the pregnant animal the growth of the offspring and its envelopes has a similar origin, and in the dairy cow the casein or curd of the milk is a means of constant elimination of these nitrogen-containing agents. thus, in the breeding cow and, above all, in the milking cow, the womb or udder carries on a work in one sense equivalent to that otherwise performed by the kidneys. not only are these organs alike channels for the excretion of albuminous products, but they are also related to each other structurally and by nervous sympathy, so that suffering in the one is liable to induce some measure of disorder in the other. as in the case of other mammals, this nitrogenous waste matter is mainly present in the urine of cattle in the form of urea, but also, to some extent, as hippuric acid, a derivative of vegetable food which, in the herbivora, replaces the uric acid found in the urine of man and carnivora. uric acid is, however, found in the urine of sucking calves which have practically an animal diet, and it may also appear in the adult in case of absolute, prolonged starvation, and in diseases attended with complete loss of appetite and rapid wasting of the body. in such cases the animal lives on its own substance, and the product is that of the wasting flesh. the other products containing nitrogen are present in only small quantities and need not be specially referred to. the urine of cattle contains much less of carbonates than that of the horse, and effervesces less on the addition of an acid. as the carbonates form a large proportion of the solid deposits (gravel, stone) from the horse's urine, the ox may thus be held less liable, yet even in the ox the carbonates become abundant or scanty, according to the nature of the feed, and therefore gravel, formed by carbonate of lime, is not infrequent in cattle. when fed on beets, clover hay, or bean straw carbonates are present in large quantities, these aliments being rich in organic acids and alkaline carbonates; whereas upon oat straw, barley straw, and, above all, wheat straw, they are in small amount. in calves fed on milk alone no carbonates are found in the urine. phosphates, usually in combination with lime, are, as a rule, present only in traces in the urine of cattle; however, on a dietary of wheat, bran, or other aliment rich in phosphates, these may be present in large amount, so that they render the liquid cloudy or are deposited in solid crystals. the liquid is rendered transparent by nitric acid. the cow's urine, on a diet of hay and potatoes, contained: parts. urea . potassic hippurate . alkaline lactates . potassium bicarbonate . magnesium carbonate . lime carbonate . potassium sulphate . common salt . silica trace phosphates . water and undetermined substances . _______ total , . the following table after tereg[ ] gives the different conditions of the urine, and especially the amount of urea and hippuric acid under different rations. the subjects were two oxen, weighing, respectively, , pounds and , pounds: --------------+------+-----+-----+-----+-----+-----+------+-----+-----+---- food per day.|water. (pounds) | |urine | |passed. | | |density. | | | |solids | | | |in urine. | | | | |hippuric | | | | |acid. | | | | | |urea. | | | | | | |nitrogen | | | | | | |in hippuric | | | | | | |acid and | | | | | | |urea. | | | | | | | |total | | | | | | | |nitrogen. | | | | | | | | |urea | | | | | | | | |per day. | | | | | | | | | |hip- | | | | | | | | | |puric | | | | | | | | | |acid | | | | | | | | | |per | | | | | | | | | |week --------------+------+-----+-----+-----+-----+-----+-----+-----+-----+----- |_lbs._|_lbs_| |_pct_|_pct_|_pct_|_pct_|_pct_|_ozs_|_ozs_ . wheat | | | | | | | | | | straw, and | . | . | , | . | . | . | . | . | . | . . bean | | | | | | | | | | meal | | | | | | | | | | | | | | | | | | | | . oat | | | | | | | | | | straw, and | . | . | , | . | . | . | . | . | . | . . bean | | | | | | | | | | meal | | | | | | | | | | | | | | | | | | | | . wheat | | | | | | | | | | straw, . | . | . | , | . | . | . | . | . | . | . clover hay, | | | | | | | | | | . bean | | | | | | | | | | meal, and | | | | | | | | | | . starch | | | | | | | | | | | | | | | | | | | | . wheat | | | | | | | | | | straw, . | . | . | , | . | . | . | . | . | . | . clover hay, | | | | | | | | | | . bean | | | | | | | | | | meal, . | | | | | | | | | | starch, and | | | | | | | | | | . sugar | | | | | | | | | | | | | | | | | | | | . wheat | | | | | | | | | | straw, . | . | . | , | . | . | . | . | . | . | . clover hay, | | | | | | | | | | bean meal, | | | | | | | | | | and . sugar | | | | | | | | | | | | | | | | | | | | wheat | | | | | | | | | | straw, | . | . | , | . | . | . | . | . | . | . clover hay, | | | | | | | | | | . bean | | | | | | | | | | meal, . | | | | | | | | | | starch, | | | | | | | | | | sugar, and | | | | | | | | | | . rape oil | | | | | | | | | | | | | | | | | | | | wheat | | | | | | | | | | straw, | . | . | , | . | . | . | . | . | . | . clover hay, | | | | | | | | | | . bean | | | | | | | | | | meal, . | | | | | | | | | | sugar, and | | | | | | | | | | . rape oil | | | | | | | | | | | | | | | | | | | | wheat | | | | | | | | | | straw, | . | . | , | . | . | . | . | . | . | . clover hay, | | | | | | | | | | . bean | | | | | | | | | | meal, . | | | | | | | | | | starch, and | | | | | | | | | | . rape oil | | | | | | | | | | | | | | | | | | | | . bean | | | | | | | | | | straw, and | . | . | , | . | . | . | . | . | . | . . bean meal | | | | | | | | | | | | | | | | | | | | . bean | | | | | | | | | | straw | . | . | , | . | . | . | . | . | . | . | | | | | | | | | | . meadow | | | | | | | | | | hay | . | . | , | . | . | . | . | . | . | . --------------+------+-----+-----+-----+-----+-----+-----+-----+-----+----- the varying quantity of urea (from . to . ounces) is most suggestive as to the action of the more or less nitrogenous feed and the resulting concentration of the urine and blood. hippuric acid, on the other hand, is most abundant when the animal is fed on hay and straw. the specific gravity of the urine of cattle varies from , to , in health, water being , . it is transparent, with a yellowish tinge, and has a characteristic, musky smell. the chemical reaction is alkaline, turning red litmus paper blue. the quantity passed in twenty-four hours varies greatly, increasing not only with the water drunk, but with the albuminoids taken in with the feed and the urea produced. if a solution of urea is injected into the veins the secretion of urine is greatly augmented. similarly the excess of salts like carbonate of potash in the feed, or of sugar, increases the action of the kidneys. only about per cent of the water swallowed escapes in the urine, the remaining per cent passing mostly from the lungs, and to a slight extent by the bowels. the skin of the ox does not perspire so readily nor so freely as that of the horse; hence the kidneys and lungs are called upon for extra work. the influence of an excess of water in the feed is most remarkable in swill-fed distillery cattle, which urinate profusely and frequently, yet thrive and fatten rapidly. among the other conditions that increase the flow of urine is overfilling of (internal pressure in) the blood vessels of the kidneys; hence the contraction of the blood vessels of the skin by cold drives the blood inward, tends to dilate the blood vessels of the kidneys, and to increase the secretion of urine. nervous disorders, such as excitement, fear, congestions, or structural injuries to the back part of the base of the brain, have a similar result, hence, doubtless, the action of certain fungi growing in musty hay or oats in producing profuse flow of urine, whereas other forms of musty fodder cause stupor, delirium, or paralysis. bacteria and their products are mainly expelled by the kidneys, and become sources of local infection, irritation, and disease. the quantity of urine passed daily by an ox on dry feeding averages to pints, but this may be increased enormously on a watery diet. the mutual influence of the kidneys and other important organs tends to explain the way in which disease in one part supervenes on preexisting disorder in another. the introduction of albuminoids in excess into the blood means the formation of an excess of urea, and a more profuse secretion of urine, of a higher specific gravity, and with a greater tendency to deposit its solid constituents, as gravel, in the kidneys or bladder. a torpid action of the liver, leaving the albuminoids in transition forms, less soluble than the urea into which they should have been changed, favors the onset of rheumatism or of nervous disorder, the deposit of such albuminoid products in the kidneys, the formation of a deep-brown or reddish urine, and congestion of the kidneys. any abnormal activity of the liver in the production of sugar--more than can be burned up in the circulation--overstimulates the kidneys and produces increased flow of a heavy urine with a sweetish taste. this increased production of sugar may be primarily due to disease of the brain, which, in its turn, determines the disorder of the liver. disease of the right side of the heart or of the lungs, by obstructing the onward flow of blood from the veins, increases the blood pressure in the kidneys and produces disorder and excessive secretion. inactivity of the kidneys determines an increase in the blood of waste products, which become irritating to different parts, producing skin eruptions, itching, dropsies, and nervous disorders. sprains of the loins produce bleeding from the kidneys and disease of the spinal cord, and sometimes determine albuminous or milky looking urine. the kidney of the ox (pl. ix, fig. ) is a compound organ made up of to separate lobules like so many separate kidneys, but all pouring their secretion into one common pouch (pelvis) situated in an excavation in the center of the lower surface. while the ox is the only domesticated quadruped which maintains this divided condition of the kidney after birth, this condition is common to all while at an early stage of development in the womb. the cluster of lobules making up a single kidney forms an ovoid mass flattened from above downward, and extending from the last rib backward beneath the loins and to one side of the solid chain of the backbone. the right is more firmly attached to the loins and extends farther backward than the left. deeply covered in a mass of suet, each kidney has a strong outer, white, fibrous covering, and inside this two successive layers of kidney substance, of which the outer is that in which the urine is mainly separated from the blood and poured into the fine, microscopic urinary ducts. (pl. x, fig. ) these latter, together with blood vessels, lymph vessels, and nerves, make up the second, or internal, layer. the outer layer is mainly composed of minute globular clusters of microscopic, intercommunicating blood vessels (malpighian bodies), each of which is furnished with a fibrous capsule that is nothing else than the dilated commencement of a urine tube. these practically microscopic tubes follow at first a winding course through the outer layer (ferrein's tubes), then form a long loop (doubling on itself) in the inner layer (henle's loop), and finally pass back through the inner layer (bellini's tubes) to open through a conical process into the common pouch (pelvis) on the lower surface of the organ. (pl. x, figs. , , .) the tube that conveys the urine from the kidney to the bladder is like a white, round cord, about the size of a goose quill, prolonged from the pouch on the lower surface of the kidney backward beneath the loins, then inward, supported by a fold of thin membrane, to open into the bladder just in front of its neck. the canal passes first through the middle (muscular) coat of the bladder, and then advances perceptibly between that and the internal (mucous) coat, through which it finally opens. by this arrangement in overfilling the bladder this opening is closed like a valve by the pressure of the urine, and the return of liquid to the kidney is prevented. the bladder (pl. ix, fig. ) is a dilatable, egg-shaped pouch, closed behind by a strong ring of muscular fibers encircling its neck, and enveloped by looped, muscular fibers extending on all sides around its body and closed anterior end. stimulated by the presence of urine, these last contract and expel contents through the neck into the urethra. this last is the tube leading backward along the floor of the pelvic bones and downward through the penis. in the bull this canal of the urethra is remarkable for its small caliber and for the s-shaped bend which it describes in the space between the thighs and just above the scrotum. this bend is attributable to the fact that the retractor muscles are attached to the penis at this point, and in withdrawing that organ within its sheath they double it upon itself. the small size of the canal and this s-shaped bend are serious obstacles to the passing of a catheter to draw the urine, yet by extending the penis out of its sheath the bend is effaced, and a small, gum-elastic catheter, not more than one-fourth of an inch in diameter, may with care be passed into the bladder. in the cow the urethra is very short, opening in the median line on the floor of the vulva about inches in front of its external orifice. even in her, however, the passing of a catheter is a matter of no little difficulty, the opening of the urethra being very narrow and encircled by the projecting membranous and rigid margins, and on each side of the opening is a blind pouch (canal of gärtner) into which the catheter will almost invariably find its way. in both male and female, therefore, the passing of a catheter is an operation which demands special skill. _general symptoms of urinary disorders._--these are not so prominent in cattle as in horses, yet they are of a similar kind. there is a stiff or straddling gait with the hind legs and some difficulty in turning or in lying down and rising, the act causing a groan. the frequent passage of urine in driblets, its continuous escape in drops, the sudden arrest of the flow when in full stream, the rhythmic contraction of the muscles under the anus without any flow resulting, the swelling of the sheath, the collection of hard, gritty masses on the hair surrounding the orifice of the sheath, the occurrence of dropsies in the limbs under the chest or belly, or in either of these cavities, and finally the appearance of nervous stupor, may indicate serious disorder of the urinary organs. the condition of the urine passed may likewise lead to suspicion. it may be white, from crystallized carbonate of lime; brown, red, or even black, from the presence of blood or blood-coloring matter; yellow, from biliary coloring matter; frothy, from contained albumin; cloudy, from phosphates; glairy, from pus; it may also show gritty masses from gravel. in many cases of urinary disorder in the ox, however, the symptoms are by no means prominent, and unless special examination is made of the loins, the bladder, and the urine the true nature of the malady may be overlooked. diuresis (polyuria, diabetes insipidus, excessive secretion of urine). a secretion of urine in excess of the normal amount may be looked on as disease, even if the result does not lead to immediate loss of condition. cattle fed on distillery swill are striking examples of such excess caused by the enormous consumption of a liquid feed, which nourishes and fattens in spite of the diuresis; the condition is unwholesome, and cattle that have passed four or five months in a swill stable have fatty livers and kidneys, and never again do well on ordinary feed. diuresis may further occur from increase of blood pressure in the kidneys (diseases of the heart or lungs which hinder the onward passage of the blood, the eating of digitalis, english broom, the contraction of the blood vessels on the surface of the body in cold weather, etc.); also from acrid or diuretic plants taken with the feed (dandelion, burdock, colchicum, digitalis, savin, resinous shoots, etc.); from excess of sugar in the feed (beets, turnips, ripe sorghum); also from the use of frozen feed (frosted turnip tops and other vegetables), and from the growths of certain molds in fodder (musty hay, mow-burnt hay, moldy oats, moldy bread, etc.). finally, alkaline waters and alkaline incrustations on the soil may be active causes. in some of these cases the result is beneficial rather than injurious, as when cattle affected with gravel in the kidneys are entirely freed from this condition by a run at grass, or by an exclusive diet of roots or swill. in other cases, however, the health and condition suffer, and even inflammation of the kidneys may occur. _treatment._--the treatment is mainly in the change of diet to a more solid aliment destitute of the special, offensive ingredient. boiled flaxseed is often the best diet or addition to the wholesome dry food, and, by way of medicine, doses of drams each of sulphate of iron and iodid of potassium may be given twice daily. in obstinate cases drams ergot of rye or of catechu may be added. bloody urine (red water, moor ill, wood ill, hematuria, hemaglobinuria). this is a common affection among cattle in certain localities, above all on damp, undrained lands and under a backward agriculture. it is simply bloody urine or hematuria when the blood is found in clots, or when under the microscope the blood globules can be detected as distinctly rounded, flattened disks. it is smoky urine--hemaglobinuria--when neither such distinct clots nor blood disks can be found, but merely a general browning, reddening, or blackening of the urine by the presence of dissolved, blood-coloring matter. the bloody urine is the more direct result of structural disease of the kidneys or urinary passages (inflammation, stone, gravel, tumors, hydatids, kidney worms, sprains of the loins), while the stained urine (hemaglobinuria) is usually the result of some general or more distinct disorder in which the globules are destroyed in the circulating blood and the coloring matter dissolved in and diffused through the whole mass of the blood and of the urine secreted from it. as in the two forms, blood and the elements of blood escape into the urine, albumin is always present, so that there is albuminuria with blood-coloring matter superadded. if from stone or gravel, gritty particles are usually passed, and may be detected in the bottom of a dish in which the liquid is caught. if from fracture or severe sprain of the loins, it is liable to be associated not only with some loss of control of the hind limbs and with staggering behind but also with a more or less perfect paralysis of the tail. the bloodstained urine without red globules results from specific diseases--texas fever (pl. xlvii, fig. ), anthrax, spirillosis, and from eating irritant plants (broom, savin, mercury, hellebore, ranunculus, convolvulus, colchicum, oak shoots, ash privet, hazel, hornbeam, and other astringent, acrid, or resinous plants, etc.). the maybug or spanish fly taken with the feed or spread over a great extent of skin as a blister has a similar action. frosted turnips or other roots will bring on the affection in some subjects. among conditions which act by the direct destruction of the globules in the circulating blood may be named an excess of water in that fluid; the use of water from soils rich in decomposing vegetable matter and containing alkaline salts, particularly nitrites; and the presence in the water and feed of the ptomaines of bacteria growth; hence the prevalence of "red water" in marshy districts and on clayey and other impervious soils, and the occurrence of bloody urine in the advanced stages of several contagious diseases. some mineral poisons--such as iodin, arsenic, and phosphorus taken to excess--may cause hematuria, and finally the symptoms may be merely the result of a constitutional predisposition of the individual or family to bleeding. in some predisposed subjects, exposure of the body to cold or wet will cause the affection. the specific symptom of bloody or smoky water is a very patent one. it may or may not be associated with fever, with the presence or absence of abdominal tenderness on pressure, with a very frothy state of the milk or even a reddish tinge, with or without marked paleness of the mucous membranes, and general weakness. when direct injury to the kidneys is the immediate cause of the disease the urine will be passed often, in small quantity at a time, and with much straining. when there is bloodlessness (a watery blood) from insufficient nourishment, fever is absent and the red water is at first the only symptom. when the active cause has been irritant plants, abdominal tenderness, colics, and other signs of bowel inflammation are marked features. _treatment._--treatment varies according as the cause has been a direct irritant operating on a subject in vigorous health or a microbian poison acting on an animal deficient in blood and vigor. in the first form of red water a smart purgative ( pound to - / pounds glauber's salt) will clear away the irritants from the bowels and allay the coexistent high fever. it will also serve to divert to the bowels much of the irritant products already absorbed into the blood and will thus protect the kidneys. in many such cases a liberal supply of wholesome, easily digestible feed will be all the additional treatment required. in this connection demulcent feed (boiled flaxseed, wheat bran) is especially good. if much blood has been lost, bitters (gentian, one-half ounce) and iron (sulphate of iron, drams) should be given for a week. for cases in which excess of diuretic plants has been taken, it may be well to replace the salts by to pints of olive oil, adding ounce of laudanum and drams of gum camphor; also to apply fomentations or a fresh sheepskin over the loins. buttermilk or vinegar, one-half pint, or sulphuric acid, drops in a pint of water, may also be used frequently as injections. in cases caused by sprained or fractured loins, inflamed kidneys, stone or gravel, the treatment will be as for the particular disease in question. in hematuria from anemia (watery blood), whether from insufficient or badly adjusted rations or from the poisonous products of fermentations in impervious or marshy soils, the treatment must be essentially tonic and stimulating. rich, abundant, and easily digestible feed must be furnished. the different grains (oats, barley, wheat, bran, rye) and seeds (rape, linseed, cotton seed) are especially called for and may be given either ground or boiled. as a bitter, sulphate of quinin, one-half dram, and tincture of chlorid of iron, drams, may be given in a pint of water thrice a day. in some cases or teaspoonfuls of oil of turpentine twice daily in milk will act favorably. in this anemic variety prevention is the great need. the drainage and cultivation of the dangerous soils is the main object. until this can be accomplished young and newly purchased cattle not yet inured to the poisons must be kept from the dangerous fields and turned on only those which are already drained naturally or artificially. further, they should have an abundant ration in which the local product of grass, hay, etc., is supplemented by grain or other seeds. another point to be guarded against is the supply of water that has drained from marshes or impervious soils, rich in organic matter, as such water is charged with nitrites, ptomaines, etc., which directly conduce to the disorder. fence out from all such waters and supply from living springs or deep wells only. albumin in the urine (albuminuria). in bloody urine albumin is always present as an important constituent of the blood, and in congested and inflamed kidneys it is present as a part of the inflammatory exudate. apart from these, albumin in the urine represents in different cases a variety of diseased conditions of the kidneys or of distant organs. among the additional causes of albuminuria may be named: ( ) an excess of albumin in the blood (after easy calving with little loss of blood and before the secretion of milk has been established, or in cases of sudden suppression of the secretion of milk); ( ) under increase of blood pressure (after deep drinking, after doses of digitalis or broom, after transfusion of blood from one animal to another, or in disease of the heart or lungs causing obstruction to the flow of blood from the veins); ( ) after cutting (or disease) of the motor nerves of the vessels going to the kidneys, causing congestion of these organs; ( ) violent exertion, hence long drives; the same happens with violent, muscular spasms, as from strychnia poisoning, lockjaw, epilepsy, and convulsions; ( ) in most fevers and extensive inflammations of important organs, like the lungs or liver, the escape of the albumin being variously attributed to the high temperature of the body and disorder of the nerves, and to resulting congestion and disorder of the secreting cells of the kidneys; ( ) in burns and some other congested states of the skin; ( ) under the action of certain poisons (strong acids, phosphorous, arsenic, spanish flies, carbolic acid, and those inducing bloody urine); ( ) in certain conditions of weakness or congestion of the secreting cells of the kidneys, so that they allow this element of the blood to escape; ( ) when the feed is entirely wanting in common salt, albumin may appear in the urine temporarily after a full meal containing an excess of albumin. it can also be produced experimentally by puncturing the back part of the base of the brain (the floor of the fourth ventricle close to the point the injury to which causes sugary urine). in abscess, tumor, or inflammation of the bladder, ureter, or urethra the urine is albuminous. it follows, therefore, that albumin in the urine does not indicate the existence of any one specific disease, and except when from weakness or loss of function of the kidney cells, it must be looked on as an attendant on another disease, the true nature of which we must try to find out. these affections we must exclude one by one until we are left to assume the noninflammatory disorder of the secreting cells of the kidney. it is especially important to exclude inflammation of the kidney, and to do this may require a microscopic examination of the sediment of the urine and the demonstration of the entire absence of casts of the uriniferous tubes. (see "nephritis," p. .) to detect albumin in the urine, the suspected and frothy liquid must be rendered sour by adding a few drops of nitric acid and then boiled in a test tube. if a solid precipitate forms, then a few more drops of nitric acid should be added, and if the liquid does not clear it up it is albumin. a precipitate thrown down by boiling and redissolved by nitric acid is probably phosphate of lime. _treatment._--treatment is usually directed to the disease on which it is dependent. in the absence of any other recognizable disease, mucilaginous drinks of boiled flaxseed, slippery elm, or gum may be given, tannic acid, one-half dram twice daily, and fomentations or even mustard poultices over the loins. when the disease is chronic and there is no attendant fever (elevation of temperature), tonics (hydrochloric acid, drops in a pint of water; phosphate of iron, drams, or sulphate of quinin, drams, repeated twice daily) may be used. in all cases the patient should be kept carefully from cold and wet, a warm, dry shed, or in warm weather a dry, sunny yard or pasture being especially desirable. sugar in urine (diabetes mellitus). this is a frequent condition of the urine in parturition fever, but as a specific disease, associated with deranged liver or brain, it is practically unknown in cattle. as a mere attendant on another disease it demands no special notice here. inflammation of the kidneys (nephritis). this has been divided according as it affects the different parts of the kidneys, as: ( ) its fibrous covering (perinephritis); ( ) the secreting tissue of its outer portion (parenchymatous); ( ) the connective tissue (interstitial); ( ) the lining membrane of its ducts (catarrhal); and ( ) its pelvis or sac receiving the urine (pyelitis). it has also been distinguished according to the changes that take place in the kidney, especially as seen after death, according to the quantity of albumin in the urine, and according as the affection is acute or chronic. for the purpose of this work it will be convenient to consider these as one inflammatory disease, making a distinction merely between the acute and the chronic or of long standing. the _causes_ are in the main like those causing bloody urine, such as irritant and diuretic plants, spanish flies applied as a blister or otherwise, exposure to cold and wet, the presence of stone or gravel in the kidneys, injuries to the back or loins, as by riding one another, the drinking of alkaline or selenitic water, the use of putrid, stagnant water, of that containing bacteria and their products, the consumption of musty fodder, etc. (see "hematuria," p. .) the length of the loins in cattle predisposes these parts to mechanical injury, and in the lean and especially in the thin, working ox the kidney is very liable to suffer. in the absence of an abundance of loose, connective tissue and of fat, the kidneys lie in close contact with the muscles of the loins, and any injury to them may tend to stretch the kidney and its vessels, or to cause its inflammation by direct extension of the disease from the injured muscle to the adjacent kidney. thus, under unusually heavy draft, under slips or falls on slippery ground, under sudden unexpected drooping or twisting of the loins from missteps or from the feet sinking into holes, under the loading and jarring of the loins when animals ride one another in cases of "heat," the kidneys are subject to injury and inflammation. a hard run, as when chased by a dog, may be the occasion of such an attack. a fodder rich in nitrogenous or flesh-forming elements (beans, peas, vetches (_vicia sativa_), and other leguminous plants) has been charged with irritating the kidneys through the excess of urea, hippuric acid, and allied products eliminated through these organs and the tendency to the formation of gravel. it seems, however, that these feeds are most dangerous when partially ripened and yet not fully matured, a stage of growth at which they are liable to contain ingredients irritating to the stomach and poisonous to the brain, as seen in their inducing so-called "stomach staggers." even in the poisoning by the seeds of ripened but only partially cured rye grass (_lolium perenne_), and darnel (_lolium temulentum_), the kidneys are found violently congested with black blood; also, in the indigestions that result from the eating of partially ripened corn or millet some congestion of the kidneys is an attendant phenomenon. cruzel says that the disease as occurring locally is usually not alone from the acrid and resinous plants charged with inducing hematuria, but also from stinking camomile (_anthemis cotula_) and field poppy when used in the fresh, succulent condition; also from the great prevalence of dead caterpillars on the pasture, or from dead spanish flies in the stagnant pools of water. the fresh plants are believed to be injurious only by reason of a volatile oil which is dissipated in drying. in the case of the stagnant water it may be questioned whether the chemical products of the contained ferments (bacteria) are not more frequently the cause of the evil than the alleged spanish flies, though the latter are hurtful enough when present. inflammation of the kidneys may further be a form or an extension of a specific contagious disease, such as erysipelas, rinderpest, septicemia, or even of poisoning by the spores of fungi. rivolta reports the case of a cow with spots of local congestion and blood staining in the kidney, the affected parts being loaded with bacteria. unfortunately he neither cultivated the bacteria nor inoculated them, and thus the case stands without positive demonstration that they were the cause of disease. in certain cases the _symptoms_ of nephritis are very manifest, and in others so hidden that the existence of the affection can be certainly recognized only by a microscopic examination of the urine. in violent cases there is high fever, increase of the body temperature to ° f. and upward; hurried breathing, with a catching inspiration; accelerated pulse; dry, hot muzzle; burning of the roots of the horns and ears; loss of appetite; suspended rumination; and indications of extreme sensitiveness in the loins. the patient stands with back arched and hind legs extended backward and outward, and passes water frequently, in driblets, of a high color and specific gravity, containing albumin and microscopic casts. (pl. xi, fig. .) when made to move, the patient does so with hesitation and groaning, especially if turned in a narrow circle; when pinched on the flank just beneath the lateral bony processes of the loins, especially on that side on which the disease predominates, it flinches and groans. if the examination is made with oiled hand introduced through the last gut (rectum), the pressure upward on the kidneys gives rise to great pain and to efforts to escape by moving away and by active contractions of the rectum for the expulsion of the hand. sometimes there is a distinct swelling over the loins or quarter on one or both sides. in uncastrated males the testicle on the affected side is drawn up, or is alternately raised and dropped. in all there is a liability to tremors of the thigh on the side affected. in some severe cases colicky pains are as violent as in the worst forms of indigestion and spasms of the bowels. the animal frequently shifts from one hind foot to the other, stamps, kicks at the belly, frequently looks anxiously at its flank, moans plaintively, lies down and quickly gets up again, grinds its teeth, twists its tail, and keeps the back habitually arched and rigid and the hind feet advanced under the belly. the bowels may be costive and the feces glistening with a coat of mucus, or they may be loose and irritable, and the paunch or even the bowels may become distended with gas (bloating) as the result of indigestion and fermentation. in some animals, male and female alike, the rigid, arched condition of the back will give way to such undulating movements as are sometimes seen in the act of coition. the disease does not always appear in its full severity; for a day, or even two, however, there may be merely loss of appetite, impaired rumination, a disposition to remain lying down, yet when the patient is raised it manifests suffering by anxiously looking at the flanks, shifting or stamping of the hind feet, shaking of the tail, and attempts to urinate, which are either fruitless or lead to the discharge of a small quantity of high-colored or perhaps bloody urine. in some recent slight cases, and in many chronic ones, these symptoms may be absent or unobserved, and an examination of the urine is necessary to reach a safe conclusion. the urine may contain blood, or it may be cloudy from contained albumin, which coagulates on heating with nitric acid (see "albuminuria," p. ); it may be slightly glairy from pus, or gritty particles may be detected in it. in seeking for casts of the uriniferous tubes, a drop may be taken with a fine tube from the bottom of the liquid after standing, and examined under a power magnifying diameters. if the fine, cylindroid filaments are seen they may then be examined with a power of or diameters. (pl. xi, fig. .) the appearance of the casts gives some clue to the condition of the kidneys. if made up of large, rounded or slightly columnar cells, with a single nucleus in each cell (epithelial), they imply comparatively slight and recent disease of the kidney tubes, the detachment of the epithelium being like what is seen in any inflamed mucous surface. if made up largely of the small, disk-shaped and nonnucleated red blood globules, they imply escape of blood, and usually a recent injury or congestion of the kidney--it may be from sprains, blows, or the ingestion of acrid or diuretic poisons. if the casts are made of a clear, waxy, homogeneous substance (hyaline), without any admixture of opaque particles, they imply an inflammation of longer standing, in which the inflamed kidney tubules have been already stripped of their cellular (epithelial) lining. if the casts are rendered opaque by the presence of minute, spherical granular cells, like white blood globules, it betokens active suppuration of the kidney tubes. in other cases the casts are rendered opaque by entangled earthy granules (carbonate of lime), or crystals of some other urinary salts. in still other cases the casts entangle clear, refrangent globules of oil or fat, which may imply fatty degeneration of the kidneys or injury to the spinal cord. the presence of free pus giving a glairy, flocculent appearance to the urine is suggestive of inflammation of the urinary pouch at the commencement of the excretory duct (pelvis of kidney) (pl. ix, fig. ), especially if complicated with gritty particles of earthy salts. this condition is known as pyelitis. in the chronic cases swelling of the legs or along the lower surface of chest or abdomen, or within these respective cavities, is a common symptom. so, also, stupor or coma, or even convulsions, may supervene from the poisonous action of urea and other waste or morbid products retained in the blood. _treatment._--in the treatment of acute nephritis the first consideration is the removal of the cause. acrid or diuretic plants in the feed must be removed, and what of this kind is present in the stomach or bowels may be cleared away by a moderate dose of castor or olive oil; extensive surfaces of inflammation that have been blistered by spanish flies must be washed clean with soapsuds; sprains of the back or loins must be treated by soothing fomentations or poultices or by a fresh sheepskin with its fleshy side applied on the loins, and the patient must be kept in a narrow stall in which it can not turn even its head. the patient must be kept in a warm, dry building, so that the skin may be kept active rather than the kidneys. warm blanketing is equally important, or even mustard poultices over the loins will be useful. blisters of spanish flies, turpentine, or other agent which may be absorbed and irritate the kidneys must be avoided. the active fever may be checked by drops tincture of aconite every four hours or by one-third ounce of acetanilid. if pain is very acute, ounce of laudanum or drams of solid extract of belladonna will serve to relieve. when the severity of the disease has passed, a course of tonics (quinin, drams, or gentian powder, drams, daily) may be given. diuretics, too, may be given cautiously at this advanced stage to relieve dropsy and give tone to the kidneys and general system (oil of turpentine, teaspoonfuls; bicarbonate of soda, teaspoonful, repeated twice a day). pure water is essential, and it should not be given chilled; warm drinks are preferable. in the chronic forms of kidney inflammation the same protection against cold and similar general treatment are demanded. tonics, however, are important to improve the general health (phosphate of iron, drams; powdered nux vomica, grains; powdered gentian root, drams, daily). in some instances the mineral acids (nitric acid, drops, or nitrohydrochloric acid, drops, daily) may be used with the bitters. mustard applied to the loins in the form of a thin pulp made with water and covered for an hour with paper or other impervious envelope, or water hotter than the hand can bear, or cupping, may be resorted to as a counterirritant. in cupping, shave the loins, smear them with lard, then take a narrow-mouthed glass, expand the air within by smearing its interior with a few drops of alcohol, setting it on fire and instantly pressing the mouth of the vessel to the oiled portion of the skin. as the air within the vessel cools it contracts, tending to form a partial vacuum, and the skin, charged with blood, is strongly drawn up within it. several of these being applied at once, a strong derivation from the affected kidneys is obtained. in no case of inflamed or irritable kidney should spanish flies or oil of turpentine be used upon the skin. parasites of the kidney. as the kidney is the visual channel by which the bacteria leave the system, this organ is liable to be implicated when microphytes exist in the blood, and congestions and blood extravasions are produced. in anthrax, southern cattle fever (texas fever), and other such affections bloody urine is the consequence. of the larger parasites attacking the kidney may be specially named the cystic form of the echinococcus tapeworm of the dog, the cystic form of the unarmed or beef tapeworm of man, the diving bladderworm--the cystic form of the marginate tapeworm of the dog, and the giant strongyle-- the largest of the roundworms. these give rise to general symptoms of kidney disease, but the true source of the trouble is likely to be detected only if the heads or hooklets of the tapeworm or the eggs of the roundworm are found on microscopical examination of the urine. tumors of the kidney (hypertrophy or atrophy). the kidney may be the seat of cancerous or simple tumors, and it may be unnaturally enlarged or reduced in size, but though there may be signs of urinary disorder the true nature of the disease is seldom manifest until after death. the passing of blood and of large multi-nucleated cells in the urine (to be detected under the microscope) may betray the existence of an ulcerated cancer of the kidney. the presence of cancerous enlargement of (superficial) lymphatic glands may further assist and confirm the decision. retention of urine. inability to pass urine may come from any one of three conditions--first, spasm of the neck of the bladder; second, paralysis of the body of the bladder; third, obstruction of the channel of outlet by a stone (calculus) (see pl. xi) or other obstacle. in _spasm of the neck of the bladder_ the male animal may stand with the tail slightly raised and making rhythmical contractions of the muscle beneath the anus (accelerator urinæ) (see pl. ix, fig. ), but without passing a drop of liquid. in the female the hind legs are extended, widely parted, and the back is arched as if to urinate, but the effort is vain. if the oiled hand is introduced into the rectum or vagina in the early stages of the affection, the bladder may be felt beneath partially filled, but not overdistended with liquid, and its neck or mouth firm and rigid. in the more advanced stages of the affection the organ is felt as a great, tense, elastic bag, extending forward into the abdomen. in this condition the overdistended muscular coat of the bladder has lost its power of contraction, so that true paralysis has set in, the muscle closing the mouth of the sac alone retaining its contractile power. in _paralysis of the body of the bladder_ attention is rarely drawn to the urinary disorder until the bladder has been distended to full repletion and is almost ready to give way by rupture and to allow the escape of the contained liquid into the abdomen. overdistention is the most common cause of the paralysis, yet it may occur from inflammation of the muscular wall of the bladder, or even from injury to the terminal part of the spinal marrow. in this last condition, however, the tail is liable to be powerless, and the neck of the bladder may also be paralyzed, so that the urine dribbles away continuously. _causes._--among the causes of spasm of the neck of the bladder may be named the lodgment of small stones or gravel, the feeding on irritant diuretics (see "bloody urine," p. , or "nephritis," p. ), the enforced retention of urine while at work or during a painful or difficult parturition. the irritation attendant on inflammation of the mucous membrane of the bladder may be a further cause of spasms of the neck, as may also be inflammation of the channel (urethra) back of the neck. extensive applications of spanish flies to the skin, the abuse of diuretics, and the occurrence of indigestion and spasms of the bowels are further causes. so long as spasmodic colic is unrelieved, retention of water from spasm of the neck of the bladder usually persists. _treatment._--treatment depends largely on the cause. in indigestion the irritant contents of the bowels must be got rid of by laxatives and injections of warm water; spanish-fly blisters must be washed from the surface; a prolonged and too active exertion must be intermitted. the spasm may be relaxed by injecting one-half ounce of solid extract of belladonna in water into the rectum or by a solution of tobacco. chloroform or ether may be given by inhalation, or chloral hydrate ( ounce) may be given in water by the mouth. fomentations of warm water may be made over the loins and between the thighs, and the oiled hand inserted into the rectum may press moderately on the anterior part of the bladder, which can be felt as an elastic fluctuating bag of an oval shape just beneath. all other measures failing, the liquid must be drawn off through a tube (catheter). this is, however, exceedingly difficult, alike in male and female, and we can not expect an amateur to succeed in accomplishing it. in the cow the opening into the bladder is found in the median line of the floor of the generative entrance, about inches in front of the external opening, but it is flanked on either side by a blind pouch, into which the catheter will pass, in ninety-nine cases out of a hundred, in the hands of any but the most skilled operator. in the bull or steer the penis, when retracted into its sheath, is bent upon itself like the letter s, just above the scrotum and testicles (see pl. ix, fig. ), and unless this bend is effaced by extending the organ forward out of its sheath it is quite impossible to pass a catheter beyond this point. when, however, by the presentation of a female, the animal can be tempted to protrude the penis, so that it can be seized and extended, or when it can be manipulated forward out of the sheath, it becomes possible to pass a catheter of small caliber (one-third inch or under) onward into the bladder. youatt advised laying open the sheath so as to reach and extend the penis, and others have advocated opening the urethra in the space between the thighs or just beneath the anus, but such formidable operations are beyond the stock owner. the incision of the narrow urethra through the great thickness of muscular and erectile bleeding tissue just beneath the anus is especially an operation of extreme delicacy and difficulty. drawing the liquid through the tube of an aspirator is another possible resort for the professional man. the delicate needle of the aspirator is inserted in such cases through the floor of the vagina and upper wall of the bladder in the female, or through the floor of the rectum (last gut) and roof of the bladder in the male, or finally through the lower and back part of the abdominal wall, just in front of the bones of the pelvis (pubic bones), thence through the lower and anterior part of the bladder near its blind anterior end. after relief has been obtained the administration of belladonna in -dram doses daily for several days will tend to prevent a recurrence of the retention. when the body of the bladder has become benumbed or paralyzed by overdistention, we may seek to restore its tone by doses of one-half a dram of powdered nux vomica repeated daily, and by mustard plaster applied over the loins, on the back part of the belly inferiorly, or between the thighs. small doses ( drams) of balsam of copaiba are sometimes useful in imparting tone to the partly paralyzed organ. incontinence of urine (palsy of the neck of the bladder). this may occur from disease or injury to the posterior part of the spinal cord or from broken back, and in these cases the tail, and perhaps the hind limbs, are liable to be paralyzed. in this case the urine dribbles away constantly, and the oiled hand in the vagina or rectum will feel the half-filled and flaccid bladder beneath and may easily empty it by pressure. _treatment._--treatment is only successful when the cause of the trouble can be remedied. after these (sprains of the back, etc.) have recovered, blisters (mustard) on the loins, the lower part of the abdomen, or between the thighs may be resorted to with success. two drams of copaiba or of solid extract of belladonna or grains spanish flies daily may serve to restore the lost tone. these failing, the use of electric currents may still prove successful. urinary calculi (stone or gravel). stone or gravel consists of hard bodies mainly made up of the solid earthy constituents of the urine which have crystallized out of that liquid at some part of the urinary passage, and have remained as small particles (gravel), or have concreted into large masses (stone, calculus). (see pl. xi, figs. , , .) in cattle it is no uncommon thing to find them distending the practically microscopic tubes in the red substance of the kidney, having been deposited from the urine in the solid form almost as soon as that liquid has been separated from the blood. these stones appear as white objects on the red ground formed by cutting sections of the kidney, and are essentially products of the dry feed of winter, and are most common in working oxen, which are called upon to exhale more water from the lungs and skin than are the slop-fed and inactive cows. little water being introduced into the body with the feed and considerable being expelled with the breath and perspiration in connection with the active life, the urine becomes small in amount, but having to carry out all waste material from the tissues and the tissue-forming feed it becomes so charged with solids that it is ready to deposit them on the slightest disturbance. if, therefore, a little of the water of such concentrated urine is reabsorbed at any point of the urinary passages the remainder is no longer able to hold the solids in solution, and they are at once precipitated in the solid form as gravel or commencing stone. in cattle, on the other hand, which are kept at pasture in summer, or which are fed liberally on roots, potatoes, pumpkins, apples, or ensilage in winter, this concentrated condition of the urine is not induced, and under such circumstances, therefore, the formation of stone is practically unknown. nothing more need be said to show the controlling influence of dry feeding in producing gravel and of a watery ration in preventing it. calculus in cattle is essentially a disease of winter and of such cattle as are denied succulent feed and are confined to dry fodder as their exclusive ration. while there are exceptions, they are so rare that they do not invalidate this general rule. it is true that stone in the kidney or bladder is often found in the summer or in animals feeding at the time on a more or less succulent ration, yet such masses usually date back to a former period when the animals were restricted to a dry ration. in this connection is should be noted that a great drain of water from the system by any other channel than the kidneys predisposes to the production of gravel or stone. in case of profuse diarrhea, for example, or of excessive secretion of milk, there is a corresponding diminution of the water of the blood, and as the whole quantity of the blood is thus decreased and as the urine secreted is largely influenced by the fullness of the blood vessels and the pressure exerted upon their walls from within, it follows that with this decrease of the mass of the blood and the lessening of its pressure outward there will be a corresponding decrease of urine. the waste of the tissues, however, goes on as before, and if the waste matter is passed out through the kidneys it must be in a more concentrated solution, and the more concentrated the urine the greater the danger that the solids will be deposited as small crystals or calculi. again, the concentrated condition of the urine which predisposes to such deposits is favored by the quantity of lime salts that may be present in the water drunk by the animal. water that contains or grains of carbonate or sulphate of lime to the gallon must contribute a large addition of solids to the blood and urine as compared with soft waters from which lime is absent. in this connection it is a remarkable fact that stone and gravel in the domesticated herbivora are notoriously prevalent on many limestone soils, as on the limestone formations of central and western new york, pennsylvania, ohio, and michigan; on the calcareous formations of norfolk, suffolk, derbyshire, shropshire, and gloucestershire, in england; in landes in france, and around munich in bavaria. it does not follow that the abundance of lime in the water and fodder is the main cause of the calculi, as other poisons which are operative in the same districts in causing goiter in both man and animal probably contribute to the trouble, yet the excess of earthy salts in the drinking water can hardly fail to add to the saturation of both blood and urine, and thereby to favor the precipitation of the urinary solids from their state of solution. the known results of feeding cattle a generous or forcing ration in which phosphate of lime is present to excess adds additional force to the view just advanced. in the writer's experience, the second duke of oneida, a magnificent product of his world-famed family, died as the result of a too liberal allowance of wheat bran, fed with the view of still further improving the bone and general form of the duchess strain of shorthorns. lithotomy was performed and a number of stones removed from the bladder and urethra, but the patient succumbed to an inflammation of the bowels, induced by the violent purgatives given before the writer arrived, under the mistaken idea that the straining had been caused by intestinal impaction. in this case not only the second duke of oneida, but the other males of the herd as well, had the tufts of hairs at the outlet of the sheath encased in hard, cylindroid sheaths of urinary salts, precipitated from the liquid as it ran over them. the tufts were in reality resolved into a series of hard, rollerlike bodies, more or less constricted at intervals, as if beaded. when it is stated that the ash of the whole grain of wheat is but per cent, while the ash of wheat bran is . per cent, and that in the case of the former . per cent of the ash is phosphoric acid, and in that of the latter per cent, it can easily be understood how a too liberal use of wheat bran should prove dangerous if fed dry. the following table shows the relative proportion of ash and phosphoric acid in wheat bran and in some common farm seeds: _ash and phosphoric acid in bran and some common farm seeds._ --------------------+----------+-------------+--------------- kind of grain. | ash. | phosphoric | phosphoric | |acid in ash. | acid in the | | | entire feed. --------------------+----------+-------------+--------------- |_per cent_| _per cent_ | _per cent_ wheat bran | . | | . wheat, grain | | . | . oats, grain | . | . | . barley, grain | . | . | . bean, grain | . | . | . peas, grain | . | . | . tare, grain | | . | . indian corn, grain. | . | -- | -- rye, grain | . | . | . --------------------+----------+-------------+--------------- wheat bran, it will be observed, contains three times as much phosphoric acid as is found in any of the other grains, and four times as much as oats, beans, peas, or rye; so that if fed in excess it will readily overcharge the urine with phosphates. there is another point to be considered, however, in estimating this danger. wheat bran contains a far greater quantity of albuminoids and other nitrogen-containing constituents than the common grains (these being made up mainly of starch, which contains no nitrogen); and, all nitrogen-bearing products contained in the blood and tissues being expelled from the body mainly through the kidneys in the form of urea and (in cattle) hippuric acid, it follows that the excess of urea formed when such feed is consumed must load the urine with solids and bring it constantly nearer to the point of saturation, when such solids (or the least soluble of them) must be deposited. the following table will show the relative amounts of the nitrogen-bearing products in wheat bran and some of our common grains: _nitrogenous matter in wheat bran and some common farm grains._ -----------------+---------------+----------------+---------------------- kind of grain. | albuminoids | woody fiber | total nitrogenous- | (nitrogenous).| (nitrogenous.) | bearing constituents. -----------------+---------------+----------------+---------------------- | _per cent_ | _per cent_ | _per cent_ wheat bran. | . | | . wheat, grain | . | . | . barley, grain | . | . | . oats, grain | . | . | . rye, grain | . | . | . indian corn | . | . | . -----------------+---------------+----------------+---------------------- it will be observed that, with the exception of oats, none of the grains contain more than two-thirds of the nitrogenous material present in the wheat bran, while in the case of rye and maize there is practically but one-half. even in the case of oats the albuminoids, which are the more digestible principles, and therefore those that are the most easily and speedily converted into urea, are present only to the amount of two-thirds of that which exists in the wheat bran. with such an excess of ash, of phosphates, and of nitrogenous (urea-forming) constituents in wheat bran, its tendency to favor the formation of calculi is fully explained. it must not, however, be inferred that wheat bran is not a valuable feedstuff. the inference is only that it should be fed with an abundance of water, as a sloppy mash, or in combination with an abundance of roots, potatoes, pumpkins, or other succulent aliment. in this connection the presence of magnesia in the feed or water must be named as favoring calculous formations in the urinary passages. the explanation is that while the phosphate of magnesia thrown out in the urine is soluble in water, the compound phosphate of ammonia and magnesia is insoluble, and, accordingly, if at any time ammonia is introduced into urine containing the phosphate of magnesia there is instantly formed the ammonio-magnesium phosphate, which is as promptly deposited in the solid form. the common source of ammonia in such cases is from decomposition of the urea in fermenting urine. in order to produce this a ferment is necessary, however, and therefore, as an additional prerequisite, the presence of bacteria, or fungi, in the urine is essential. these ferments may make their way from without along the urinary passage (urethra), and their propagation in the bladder is greatly favored by the prolonged retention of urine, as in case of spasm of the neck of the bladder or obstruction by an already existing stone. another mode of entrance of the ferment is an unclean catheter used to draw the urine. still another is the elimination through the kidneys of the bacteria of infectious diseases, or of such as, without producing a general infection, yet determine fermentation in the urine. the precipitation is favored not only by the production of ammonia, but also by the formation of viscid (colloid) products of fermentation. in this sense bacteria are most important factors in causing gritty deposits in the urine. another insoluble salt which enters largely into the composition of many urinary calculi of the ox is carbonate of lime. this is derived mainly from the lime in the feed and water and from the carbon dioxid formed by the oxidation of the organic acids in the fodder. these organic acids, being composed of carbon, hydrogen, and oxygen (without nitrogen), are resolved by the addition of oxygen into carbon dioxid (co_{ }) and water (h_{ }o). the carbon dioxid unites with the lime in the blood to form carbonate of lime, and in this state passes into the urine. now, carbonate of lime is soluble in water containing free or uncombined carbon dioxid, but is precipitated whenever the latter is withdrawn. it is only necessary, therefore, to have in the urine sufficient lime or other available base to unite with all the free carbon dioxid in order to bring about the precipitation of the dissolved carbonate of lime in the solid, crystallized form; hence it is that, of all sediments in the urine of herbivora, this is the most frequent and usually the most abundant. a less common constituent of urinary calculi is the insoluble oxalate of lime. in this case the lime is derived as before from the feed or water, or both, while the oxalic acid is a product of the oxidation of organic acids of the feed, less oxygen having been used than in the formation of carbon dioxid. the final product of the complete oxidation of these acids is carbon dioxid, but when less oxygen is furnished, owing to some disease of the lungs or a disease of the nerve centers, which lessens the activity of the breathing, then oxalic acid may be produced. if this oxalic acid comes into contact with lime, it is instantly precipitated as crystals of oxalate of lime. another inorganic substance at times found in urinary calculi is silica (sio_{ }). this contributes largely to giving stiffness to the stems of growing plants, and in most of our cereals and grasses makes up a large proportion of the ashes of the burned plant. it is found in the soluble form in combination as silicate of potash, but at times is displaced by oxalic or other acid and then appears as gritty, sandy particles in the stem. this gritty, insoluble silica is especially noticeable among the horsetails (_equisetacæceæ_), bamboos, and sedges. the per cent of silica in the ash of several common fodder plants is given below: _silica in ash of various fodder plants._ ash of-- silica. _per cent._ wheat straw . oats and husk . oat straw . barley straw . rye straw . rye-grass hay . wheat chaff . oat chaff . barley awn . it is only soluble silica that is taken up into the system, and it is in this form (usually as silicate of potash or soda) that it enters the urine, but all that is wanted to precipitate it in crystalline form as a gritty sand is the presence of oxalic or other acid having a stronger affinity for its base (potash or soda). other conditions, however, enter largely into the causation of stone, or gravel. a high density of urine resulting from a highly saturated condition is often present for a length of time without any precipitation of solid materials. urea and carbonates may be present in excess, the feed may be given dry, and drinking water may be deficient in quantity without any deposition of stone or gravel. in such cases, the presence of noncrystalline organic matter in the urine becomes an exciting cause. rainey and ord have shown experimentally that colloid (noncrystallizable) bodies like mucus, epithelial cells, albumin, pus, blood, hyaline casts of the kidney tubes, etc., not only determine the precipitation of crystallizable salts from a strong solution, but they determine the precipitation in the form of globular masses, or minute spheres, which, by further similar accessions, become stones, or calculi, of various sizes. the salts that are deposited by mere chemical reaction without the intervention of colloids appear in the form of sharply defined angular crystals, and hence the rough, jagged crystals of oxalate of lime or ammonia-magnesium phosphate. heat intensifies the action of the colloids in causing precipitation of the dissolved salts, so that the temperatures of the kidneys and bladder constitute favorable conditions. colloids that are undergoing decomposition are also specially powerful, so that the presence of bacteria or fungi causing fermentation is an important factor. in looking, therefore, for the immediate causes of urinary calculi we must accord a high place to all those conditions which determine the presence of excess of mucus, albumin, pus, blood, kidney casts, blood-coloring matter, etc., in the urine. a catarrhal inflammation of the pelvis of the kidney, of the ureter, or of the bladder, generating excess of mucus or pus; inflammation of the kidneys, causing the discharge of blood, albumin, or hyaline casts into the urinary passages; inflammation of the liver, lungs, or other distant organ, resulting in the escape of albumin in the urine; disorders of the liver or of the blood-forming functions, resulting in hematuria or hemoglobinuria; sprains or other injuries to the back, or disease of the spinal marrow, which cause the escape of blood with the urine; the presence in the bladder of a bacterial ferment, which determines the decomposition of the mucus and urea, the evolution of ammonia and the consequent destruction of the protecting cellular (epithelia) lining of the bladder, or the irritation caused by the presence of an already formed calculus, may produce the colloid or uncrystallizable body that proves so effective in the precipitation of stone or gravel. it has long been known that calculi almost invariably form around any foreign body introduced into the kidney or bladder, and i have seen a large, calculous mass surrounding a splinter of an arrow that had penetrated and broken off in the body of a deer. the explanation is now satisfactory--the foreign body carries in with it bacteria, which act as ferments upon the urine and mucus in addition to the mechanical injury caused by its presence. if such a body has been introduced through the solid tissues, there is, in addition, the presence of the blood and lymph derived from the wounded structures. classification of urinary calculi. urinary calculi are most conveniently divided according to the locality in which they are found. thus we find first renal calculi, formed in the kidney (pl. xi, fig. ), and which for cattle must be again divided into calculi of the uriniferous tubes and calculi of the pelvis. the second class are named ureteral calculi because they are found in the duct leading from the kidney to the bladder (ureter). the third class are the vesical calculi, from the bladder or vesicle in which they are found. the fourth class are the urethral calculi, and are found in the duct leading outward from the bladder through the penis (urethra). the fifth and last class are the preputial calculi, since they are found within the sheath of the penis (prepuce). calculi may also be classed according to their chemical composition and this has the advantage of suggesting the special cause of each as found in the feed, water, soil, or general conditions of health. this classification affords no guide to their location or symptoms, as calculi of the same chemical composition may be formed at any part of the urinary passages, as those formed in the kidney may pass on through all the various passages outward, unless it is found at any point of their progress that they have grown so large that the passage will not admit them. the following are among the concretions found in the various parts: ( ) _coralline calculi._--these are of a dull-white color and irregular surface, like coral. they are made up of hard and resistant layers evenly deposited around a central nucleus. (pl. xi, fig. .) their specific gravity is , , water being , , and they contain per cent of carbonate of lime with some carbonate of magnesia, organic matter, and a trace of carbonate of iron. yellowish-white, smooth, round calculi of the same chemical composition are met with. ( ) _pearly calculi._--these are more frequent than the first-named variety. they are very hard and smooth on the surface, reflecting a play of various colors after the fashion of a pearl. this peculiarity appears to be caused by the thinness and semitransparency of the supposed layers. they have a specific gravity of , to , , and nearly the same chemical composition as the coralline variety. golding bird found a specimen of this kind formed of carbonate of lime and organic matter only. ( ) _green calculi_ (_metalloid calculi_).--these are usually small and numerous, as they are exceedingly common. they are of a very hard consistency, and have a clear-polished, greenish surface of almost metallic brilliancy. they have a specific gravity of . and a composition almost identical with the second variety. ( ) _white calculi._--pure white, smooth, lustrous calculi are rare. they have a specific gravity of . , and contain as much as per cent of carbonate of lime with carbonate of magnesia and organic matter. ( ) _ammonio-magnesium calculi._--these are of a grayish color and a very rough, crystalline surface, which proves very irritating to the mucous membrane. they have a specific gravity of . to . , and are composed chiefly of ammonio-magnesium phosphate, oxalate of lime, and organic matter, with a little carbonate of lime and magnesia. ( ) _siliceous calculi._--these are clear, smooth, and hard, and usually spherical. they have a specific gravity of . to . , and contain per cent of silica with carbonates of iron and magnesia, organic matter, and traces of iron. in other specimens of siliceous calculi there was a specific gravity of . , and there was to per cent of carbonate of lime together with carbonate of magnesia, and iron, silica, and organic matter. others are almost exclusively made of silica. ( ) _oxalate of lime calculi_ (_mulberry calculi_) (pl. xi, fig. ).-- these are characterized by their extremely rough, angular surface, formed by the octahedral crystals of oxalate of lime. their specific gravity may be . , and they contain oxalate of lime to the extent of per cent, together with carbonates of lime and magnesia and organic matter. ( ) _gravel_ (_pultaceous deposits_).--simple crystals may be met with at any point from the kidneys to the external opening at the end of the prepuce (sheath), and they may appear singly, as crystals, or they may accumulate in masses of fine spherical crystals almost like dirty powdered chalk suspended in water. in the ox this is especially common as a collection in the sheath, distending that into a soft, doughy swelling. forms of calculi in different situations. apart from the rough crystalline surfaces of the calculi of oxalate of lime and ammonio-magnesium phosphate, the general tendency is to a smooth, round outline. at times, however, they show more or less flattening with rounded angular edges, caused by the contact and mutual friction of two calculi. sometimes two or more stones lying together become united into one by a new external deposit, and the resulting mass then shows rounded swellings on opposite sides. the large calculi occupying the pelvis of the kidneys usually show a central part having the outline of the main cavity of the pelvis and two or more projections that have been molded into the corresponding branches or channels which lead to corresponding lobes of the kidney. in winter and spring small concretions in the form of plates are often met with in the branches of the pelvis, having been formed and molded in the confined space between the projecting papilla and the surrounding cuplike branch of the pelvis. finally, the pulplike deposits in the sheath and elsewhere are made up of globular masses, individually so small as to be often practically microscopic. stone in the kidney (renal calculi). [pl. xi, fig. .] in an animal leading the quiet, uneventful life of the ox, stones of large size may be present in the kidney without producing any disorder appreciable to the people about him. in cattle fattened on dry feed in winter, on the magnesian limestone of new york, it is exceptional to find the substance of the kidney free from calculi about the size of a grain of wheat or less, and standing out as white objects in the general red of the cut surface of the organ. similarly around the papillæ in the cuplike arms of the pelvis we find minute, flattened or more or less rounded, yellowish-white concretions. even the large concretions may prove apparently harmless. i have a calculus several ounces in weight which filled the entire pelvis of the kidney, that was found by accident in a fat carcass while being dressed. in work oxen, however, such concretions may give rise to symptoms of kidney disease, such as stiffness of the loins, shown especially in the acts of rising or turning, weakness of the hind parts when set to pull a heavy load, an irritability of the kidneys, shown by the frequent passage of urine in small quantity, tenderness of the loins, shown when they are pinched or lightly struck, and it may be the passage of blood or minute gritty masses with the urine. if the attack is severe, what is called "renal colic" (kidney colic) may be shown by frequent uneasy shifting of the hind limbs, shaking or twisting of the tail, looking around at the flanks, and lying down and rising again at short intervals without apparent cause. the frequent passage of urine, the blood or gritty masses contained in it, and perhaps the hard, stony cylinders around the tufts of hair of the sheath, show that the source of the suffering is the urinary organs. in bad cases active inflammation of the kidneys may set in. (see "nephritis," p. .) ureteral calculi. these are small stones which have passed from the pelvis of the kidney into the canal (ureter) leading from the kidney to the bladder, but, being too large to pass on easily, have blocked that canal and forced the urine back upon the kidney. the result is the production of symptoms more violent than in renal calculi, though not varying, save in intensity, from those of renal colic. in case of complete and unrelieved obstruction, the secretion of the kidney on that side is entirely abolished, and it becomes the seat of passive congestion, and it may even be absorbed in greater part or as a whole, leaving only a fibrous sac containing fluid with a urinous odor. in small cattle, in which the oiled hand introduced into the last gut may reach the affected part, the distended ureter may be felt as a tense, elastic cord, extending forward from the point of obstruction on the lateral wall of the pelvis and beneath the loins toward the kidney. if relief is obtained by the onward passage of the stone a free flow of urine usually follows, in the midst of which may often be found gritty masses. if the outlets from both kidneys are similarly blocked the animal becomes poisoned by the retention in the blood of the elements of the urine, and by their reabsorption after secretion. _treatment of renal and ureteral calculi._--treatment is not very successful, as only the smallest calculi can pass through the ureter and enter the bladder, and even if they should do so they are liable to a progressive increase there, so that later they may cause the symptoms of stone in the bladder. fortunately, ordinary dairy, growing, or fattening cattle rarely show evident symptoms of illness, and even though they do so they can usually be fattened and slaughtered before the health is seriously impaired. in work oxen the case is different, and acute symptoms may develop, but even then the animal may often be fitted for the butcher. when treatment is demanded it is primarily soothing and antispasmodic. fomentations with warm water over the loins should be persisted in without intermission until relief has been secured. the soothing effect on the kidney will often relieve inflammation and irritation, should the stone be in that situation, while if in the ureter the warm fomentations will at once soothe irritation, relax spasm of the muscular coat of the canal, and favor an abundant secretion from the kidney, which, pressing on the obstructing stone, may slowly push it on into the bladder. large doses of laudanum ( ounces) or of solid extract of belladonna ( drams) will not only soothe the pain but relax the spasm and favor the onward passage of the calculus. the animal should be encouraged to drink large quantities of cool water to favor the free secretion of a very watery urine, which will not only serve to obviate irritation and continued deposit caused by a highly concentrated urine, but will press the stone onward toward the bladder, and even in certain cases will tend to disintegrate it by solution of some of its elements, and thus to favor its crumbling and expulsion. this is a principle which must never be lost sight of in the treatment of calculi. the immersion of the stone in a liquid of a lower specific gravity than that in which it has formed and grown tends to dissolve out the more soluble of its component parts, and thus to destroy its density and cohesion at all points, and thereby to favor its complete disintegration and expulsion. this explains why cattle taken from a herd on magnesian limestone in spring, after the long, dry feeding of winter, usually have renal calculi, while cattle from the same herd in the fall, after a summer's run on a succulent pasture, are almost always free from concretions. the abundance of liquid taken in the green feed and expelled through the kidneys and the low density or watery nature of the urine have so opened the texture and destroyed the density of the smaller stones and gravel that they have all been disintegrated and removed. this, too, is the main reason why benefit is derived from a prolonged stay at mineral springs by the human victims of gravel. if they had swallowed the same number of quarts of pure water at home and distributed it at suitable times each day, they would have benefited largely without a visit to the springs. it follows from what has been just said that a succulent diet, including a large quantity of water (gruels, sloppy mashes, turnips, beets, potatoes, apples, pumpkins, ensilage, succulent grasses), is an important factor in the relief of the milder forms of stone and gravel. _prevention._--prevention of calculus especially demands this supply of water and watery rations on all soils and in all conditions in which there is a predisposition to the disease. it must also be sought by attempts to obviate all those conditions mentioned above as causative of the malady. sometimes good rain water can be furnished in limestone districts, but putrid or bad-smelling rain water is to be avoided as probably more injurious than that from the limestone. unsuccessful attempts have been made to dissolve calculi by alkaline salts and mineral acids, respectively, but their failure as a remedy does not necessarily condemn them as preventives. one dram of caustic potash or of hydrochloric acid may be given daily in the drinking water. in diametrically opposite ways these attack and decompose the less soluble salts and form new ones which are more soluble and therefore little disposed to precipitate in the solid form. both are beneficial as increasing the secretion of urine. in cases in which the diet has been too highly charged with phosphates (wheat bran, etc.), these aliments must be restricted and water allowed ad libitum. if the crystals passed with the urine are the sharp angular (octahedral) ones of oxalate of lime, then the breathing should be made more active by exercise, and any disease of the lungs subjected to appropriate treatment. if the crystals are triangular prisms of ammonia-magnesium phosphate or starlike forms with feathery rays, the indications are to withhold the feed or water that abounds in magnesia and check the fermentation in the urine by attempts to destroy its bacteria. in the latter direction plenty of pure-water diuretics, and a daily dose of oil of turpentine in milk, or a dose thrice a day of a solution containing one-tenth grain each of biniodid of mercury and iodid of potassium would be indicated. in considering the subject of prevention, it must never be forgotten that any disease of a distant organ which determines the passage from the blood into the urine of albumin or any other colloid (uncrystallizable) body is strongly provocative of calculus, and should, if possible, be corrected. apart from cases from geological formation, faulty feeding, and other causes, the grand preventive of calculus is a long, summer's pasturage of succulent grasses, or in winter a diet of ensilage or other succulent feed. the calculi formed in part of silica demand special notice. this agent is secreted in the urine in the form of silicate of potash and is thrown down as insoluble silica when a stronger acid displaces it by combining with the potash to its exclusion. in cases of siliceous calculi, accordingly, the appropriate chemical prevention is caustic potash, which being present in the free state would attract to itself any free acid and leave the silica in its soluble condition as silicate of potash. stone in the bladder (vesical calculus, or urethral calculus). stone in the bladder may be of any size, but in the ox does not usually exceed half an inch in diameter. there may, however, be a number of small calculi; indeed, they are sometimes so small and numerous as to form a small, pulpy magma by which the bladder is considerably distended. _symptoms._--the symptoms of stone in the bladder may be absent until one of the masses escapes into the urethra, but when this occurs the escape of urine is prevented, or it is allowed to pass in drops or driblets only, and the effect of such obstruction becomes manifest. the point of obstruction is not always the same, but it is most frequently at the s-shaped curve of the penis, just above the testicles or scrotum. in cows and heifers the urethra is so short and becomes so widely dilated during the urination that the calculi easily escape in the flow of liquid and dangerous symptoms practically never appear. even in the male the signs of illness are at first very slight. a close observer may notice the cylinders of hard, earthy materials encircling the tufts of hair at the opening of the prepuce. it may further be observed that the stall remains dry and that the animal has not been seen to pass water when out of doors. the tail may at times be gently raised and contractions of the muscle (accelerator urinæ) beneath the anus (pl. ix, fig. ) may take place in a rhythmical or pulsating manner. as a rule, however, no symptom is noticed for two days, only the animal is lacking in his usual spirits. by this time the constantly accumulating urine has distended the bladder beyond its power of resistance and a rupture occurs, allowing the urine to escape into the cavity of the abdomen. then dullness increases; the animal lies down most of his time; he becomes stupid and sometimes drowsy, with reddish-brown congestion of the lining membrane of the eyelids; pressure on the abdomen causes pain, flinching, and perhaps groaning, and the lowest part of the belly fluctuates more and more as the escaping urine accumulates in greater and greater amount. if at this stage the oiled hand is introduced into the rectum (last gut), the animal flinches when pressure is made downward on the floor of the pelvis, and no round, distended bladder is felt. if the same examination is made prior to the rupture, the rounded, tense, elastic bladder is felt extending forward into the abdomen, containing one or two gallons of liquid. there may be uneasy shifting of the hind limbs and twisting of the tail, also frequent lying down and rising, but these symptoms are exceptional. when the obstruction is low down between the thighs (at the s-shaped flexure), the line of the pulsating urethra from the anus downward may be felt distended with liquid, and though, by the hard swelling of the urethra, it is seldom easy to distinguish the exact seat of the stone, yet there is usually tenderness at the point of obstruction, and from this it may be accurately located. _treatment._--the treatment of stone in the bladder or urethra consists in the removal of the stone by incision and the use of forceps. (pl. xi, fig. .) when the stone has been arrested at the s-shaped flexure just above the scrotum, the patient being lean, the thickened tender part of the penis may be seized between the fingers and thumb of the left hand, while the calculus is exposed by a free incision with the knife held in the right. if there is no other obstruction between this point and the bladder, and if the latter has not yet ruptured, a flow of urine should take place from the opening. if there is no escape of liquid, a catheter or sound, one-fourth of an inch in diameter, must be passed up through the canal (urethra) until it is arrested by the next stone, on which a similar incision should then be made to effect its extraction. in case the stone has been arrested in the portion of the urethra which is in front of the arch of the hip bone and inside the pelvis, it can be reached only by making an opening into the urethra beneath the anus and over the arch of the hip bone, and from this orifice exploring the urethra with fine forceps to the neck of the bladder or until the stone has been reached and extracted. owing to the small size of the canal (urethra) to be opened and the great thickness of erectile tissue to be cut through, the operation requires a very accurate knowledge of the parts, while the free flow of blood is blinding to the operator. a staff should always be passed up through the urethra from the lower wound, if such has been made, or, in case of its absence, through the whole length of the penis, that organ having been drawn out of its sheath until the s-shaped curve has been effaced and the course of the canal rendered straight. upon the end of this staff the incision can be made with far more confidence and certainty. the operation can be undertaken only by a skilled veterinary anatomist, but the hints given above may be valuable in showing the stock owner when he is being properly served in such a case. in outlying districts, where no skilled operator can be had, a transverse incision may be made with a clean, sharp knife through the root of the penis, just over the arch of the hip bone, when the urine will flow out in a full stream. the attendant bleeding may be ignored, or if profuse it may be checked by packing the wound firmly with cotton wool for several hours. the urine will continue to escape by the wound, and the ox should be fattened for the butcher. the immediate relief is not to be looked upon as a permanent cure, as the calculi in the affected ox are usually numerous, and later attacks are therefore to be looked for. hence it is desirable to fatten and kill such cases after a successful operation. if a breeding animal is too valuable to be killed, he should be subjected to preventive measures, as laid down under "stone in the kidney," page . it should be added that when the bladder is filled with a soft magma a catheter may be introduced through the whole length of the urethra to be used in pumping water into the bladder. this water is extracted through the same channel when it has been charged with the suspended solids by manipulations of the bladder with the oiled hand introduced through the rectum. calculi, or gravel, in the prepuce, or sheath. this is usually a collection of gravel, or a soft, puttylike material which causes distinct swelling of the sheath and gives it a soft, doughy feeling when handled. it may be removed in part by the oiled fingers introduced into the cavity, assisted by manipulation from without, or a tube may be inserted until the end extends behind the collection and water pumped in until the whole mass has been evacuated. should even this fail of success, the sheath may be slit open from its orifice back in the median line below until the offending matter can be reached and removed. in all such cases the interior of the sheath should be finally lubricated with sweet oil or vaseline. it is unnecessary to stitch up the wound made in the sheath. (see "inflammation of the sheath," p. .) [illustration: plate ix. kidney and male generative and urinary organs.] [illustration: plate x. microscopic anatomy of the kidney.] * * * * * diseases of the urinary organs. description of plates. plate ix. kidney and male generative and urinary organs. fig. . kidney of the ox. (from handbuch des vergleichenden anatomie des haus säugethiere, vol. , .) a, renal artery carrying blood into the kidney; v, renal vein carrying blood from the kidney back to the heart; h, ureter, the tube carrying the urine from kidney to bladder. it is formed by the union of a number of branches which begin as cups (calices), each inclosing the tip of a conical mass of tissue from which the urine excludes. fig. . genital and urinary organs of the bull. (from leisering, mueller, and ellenberger, handbuch des verg. anat. des haus säugethiere.) the serous membrane enveloping the testicles; , the right testicle, outer view; ', left testicle, inner view; , epididymis, or the beginning of the excretory canal of the testicle; ', globus major, or the head of the epididymis; '', globus minor, or the tail of the epididymis; , vas deferens, the duct through which the seminal fluid reaches the ejaculatory ducts; ', pelvic dilation of the vas deferens; , vesicula seminalis. the vesiculæ seminalis are two oval pouches, which, in addition to their own secretions, receive the semen conveyed by the seminal ducts and hold it in reserve until copulation; , membranous or intrapelvic portion of the urethral canal covered by wilson's muscle; , part of the prostate gland, covered by wilson's muscle; , cowper's gland. this gland, like the prostate gland, secretes a fluid which is thrown into the urethal canal in abundance immediately before ejaculation; by this means the expulsion of the semen is facilitated; , ejaculator seminis, or accelerator urinæ muscle; , penis; ', cut portion of same; , cut suspensory ligaments of penis; , sheath, or prepuce laid open; , retractor muscles of sheath; , cremaster muscle cut at superior extremity; , duplicature of peritoneum; , ureters carrying urine from the kidneys to the bladder. plate x. microscopic anatomy of the kidney. fig. . in this figure the minute apparatus for the secretion, collection, and discharge of the urine into the pelvis of the kidney (see preceding plate) is shown. the course is as follows: the urine is secreted from the blood vessels in the little round bodies called glomeruli ( ), and by the minute cells in the curved tubes ( , , , ), and passes through the convoluted and straight tubes ( , ) into the larger tube ( ), and then out into the pelvis, thence through the ureters into the bladder. the fluid and salts dissolved in the urine are taken from the blood, and the minute blood vessels are therefore very abundant in the kidneys, as is shown by the branches and network on the left of the figure. the blood passes into the kidney in the artery ( ), which then divides into branches which pass into the glomeruli ( ) and also forms network around the secreting tubules ( , ). the urine and salts pass from these vessels through the cells lining the tubules into the latter, and are discharged as described above. the blood is again collected in veins drawn black in the figure. fig. illustrates the manner in which the blood is distributed in the glomerulus (_f_), and also to the secreting tubules (_e_). fig. shows the relation between the blood vessel in the glomerulus (_e_) the tubule which conducts the urine therein secreted from the blood vessel; (_c_) represents a glomerulus from which the urinary tubule has been removed. plate xi. calculi of kidney and bladder. fig. . calculus, or stone, from the kidney. these are in the pelvis or portion of the ureter receiving the urine. the prolongations are casts of the branches of the pelvis. see the plates of the kidney for further description. fig. . calculus made up of oxalate of lime magnified times. fig. . phosphatic calculus containing a nucleus of uric acid, sawed through to show concentric layers. fig. . straight forceps used in removing stones from the bladder. fig. . casts of the minute tubules of the kidney found in the urine in various kinds of kidney disease. highly magnified. * * * * * [illustration: plate xi. calculi of kidney and bladder.] footnotes: [ ] encyklop. der thierheilk., vol. iv, p. . diseases of the generative organs. by james law, f. r. c. v. s., _formerly professor of veterinary science, etc., in cornell university._ [revised by adolph eichhorn, d. v. s.] general discussion. diseases of the generative organs are practically confined to animals which are kept for reproduction and the dairy. the castration of the bull condemns these organs to inactivity and protects them from the many causes of injury attendant on the engorged blood vessels in the frequent periods of sexual excitement, on the exposure to mechanical violence, and on the exposure to infective inoculation. in three respects the castrated male is especially subject to disease: ( ) to inflammation and tumefaction of the cut end of the cord that supported the testicle and of the loose connective tissue of the scrotum; ( ) to inflammation of the sheath and penis from the accumulation of gravel in the former, from which the penis is not usually protruded in passing water; and ( ) to bruising, abrasion, and inflammation of the sheath and penis during suspension in the stocks for the purpose of shoeing. apart from these the ox is practically almost exempt from the inflammations and injuries of the genital organs. the same applies to the castrated heifer. inflammation may occur in the broad ligament of the womb whence the ovary has been removed or infective inflammation in the abdominal cavity (peritonitis) in case the operation has been performed through the flank, as it usually is in the young heifer. apart from these, the castrated heifer is practically immune from any trouble of the generative apparatus. even the virgin heifer is little subject to such troubles, though she is not exempt from inflammations, and above all, from morbid growths in the ovaries which are well developed and functionally very active after the first year, or in precocious animals after the first few months of life. the breeding cow, on the other hand, is subjected to all the disturbances attendant on the gradual enlargement of the womb, the diversion of a large mass of blood to its walls, the constant drain of nutrient materials of all kinds for the nourishment of the fetus, the risks attendant and consequent on abortion and parturition, the dangers of infection from the bull, the risks of sympathetic disturbance in case of serious diseases of other organs, but preeminently of the urinary organs and the udder, and finally the sudden extreme derangements of the circulation and of the nervous functions which attend on the sudden revulsion of a great mass of blood from the walls of the contracting womb into the body at large immediately after calving. in reviewing this class of diseases, therefore, we have to note, first, that they are almost exclusively restricted to breeding animals, and secondly that in keeping with the absolute difference of the organs in the male and female we find two essentially distinct lists of diseases affecting the two sexes. excess of venereal desire (satyriasis in male, or nymphomania in female). this may occur in the male from too frequent sexual intercourse, or from injury and congestion of the base of the brain (vasodilator center in the medulla), or of the posterior end of the spinal cord, or it may be kept up by congestion or inflammation of the testicles or of the mucous membrane covering the penis. it may be manifested by a constant or frequent erection, by attempts at sexual connection, and sometimes by the discharge of semen without connection. in bad cases the feverishness and restlessness lead to loss of flesh, emaciation, and physical weakness. it is, however, in the female especially that this morbid desire is most noticeable and injurious. it may be excited by the stimulating quality of the blood in cows fed to excess on highly nitrogenous feed, as the seeds of the bean, pea, vetch, and tare, and as wheat bran, middlings, cotton seed, gluten meal, etc., especially in the case of such as have no free exercise in the fields, and are subject to constant association with a vigorous young bull. a more frequent cause is the excitation or congestion of some part of the genital organs. disease of the ovaries is preeminently the cause, and this may be by the formation of cysts (sacs containing liquid) or of solid tumors or degenerations, or, more commonly than all, the formation of tubercle. indeed, in case of tuberculosis attacking the abdominal organs of cows, the ovaries or the serous membranes that support and cover them (the broad ligaments of the womb) are peculiarly subject to attack, and the animal has constant sexual excitement, incessantly riding or being ridden by other cattle, having no leisure to eat or chew the cud, but moving restlessly, wearing the flesh off its bones, and gradually wasting. in some localities these cows are known as "bullers," because they are nearly always disposed to take the bull, but they do not conceive, or, if they do, they are subject to early abortions. they are, therefore, useless alike for the dairy and for the feeder, unless the removal of the ovaries subdues the sexual excitement, when, in the absence of tuberculous disease elsewhere, they may be fattened for the butcher. among the other sources of irritation charged with causing nymphomania are tumors and cancers of the womb, rigid closure of the neck of the womb so that conception can not occur and the frequent services by the male which stimulate the unsatisfied appetite, inflammation, and a purulent discharge from the womb or vagina. _treatment._--the treatment in each case will vary with the cause and is most satisfactory when that cause is a removable one. overfeeding on richly nitrogenous feed can be stopped, exercise in the open field given, diseased ovaries may be removed (see "castration," p. ), catarrhs of the womb and passages overcome by antiseptic, astringent injections (see "leucorrhea," p. ), and tumors of the womb may often be detached and extracted, the mouth of that organ having been first dilated by sponge tents or otherwise. the rubber dilator (impregnator), sometimes helpful in the mare, is rarely available for the cow, owing to the different condition of the mouth of the womb. diminution or loss of venereal desire (anaphrodisia). this occurs in either sex from low condition and ill health. longstanding, chronic diseases of important internal organs, leading to emaciation and weakness, or a prolonged semistarvation in winter may be sufficient cause. it is, however, much more common as the result of degeneration or extensive and destructive disease of the secreting organs (testicles, ovaries) which elaborate the male and female sexual products, respectively. such diseases are, therefore, a common cause of sterility in both sexes. the old bull, fat and lazy, becomes sluggish and unreliable in serving, and finally gets to be useless for breeding purposes. this is not attributable to his weight and clumsiness alone, but largely to the fatty degeneration of his testicles and their excretory ducts, which prevents the due formation and maturation of the semen. if he has been kept in extra high condition for exhibition in the show ring, this disqualification comes upon him sooner and becomes more irremediable. similarly the overfed, inactive cow, and above all the show cow, fails to come in heat at the usual times, shows little disposition to take the bull, and fails to conceive when served. her trouble is the same in kind, namely, fatty degeneration of the ovaries and of their excretory ducts (fallopian tubes), which prevents the formation or maturation of the ovum or, when it has formed, hinders its passage into the womb. another common defect in such old, fat cows is a rigid closure of the mouth of the womb, which prevents conception, even if the ovum reaches the interior of that organ and even if the semen is discharged into the vagina. _preventive._--the true preventive of such conditions is to be found in a sound hygiene. the breeding animal should be of adult age, neither overfed nor underfed, but well fed and moderately exercised; in other words, the most vigorous health should be sought, not only that a strong race may be propagated, but that the whole herd, or nearly so, may breed with certainty. fleming gives per cent as the general average of cows that are found to breed in one year. here more than a fifth of the progeny is sacrificed and a fifth of the product of the dairy. with careful management the proportion of breeders should approach per cent. the various local and general obstacles to conception should be carefully investigated and removed. the vigorous health which comes from a sufficiently liberal diet and abundant exercise should be solicited, and the comparative bloodlessness and weakness which advance with undue fattening should be sedulously avoided. in bull or cow which is becoming unduly fat and showing indications of sexual indifference, the treatment must be active. turning out on a short pasture where it must work hard for a living will often suffice. the bull which can not be turned out to pasture may sometimes be utilized in the yoke or tread power, or he may be kept a part of his time in a field or paddock chained by the ring in his nose to a strong wire extending from one side of the lot to the other and attached securely to two trees or posts. the wire should be higher than the back of the bull, which will move frequently from end to end. if he is indisposed to take sufficient exercise in this way he may be safely driven. an instance of the value of the exercise in these incipient cases of fatty degeneration is often quoted. the cow dodona, condemned as barren at earl spencer's, was sold cheap to jonas webb, who had her driven by a road a distance of miles to his farm at wilbraham, soon after which she became pregnant. in advanced cases, however, in which the fatty degeneration is complete, recovery is impossible. in case of rigid closure of the mouth of the womb the only resort is dilatation. this is far more difficult and uncertain in the cow than in the mare. the neck of the womb is longer, is often tortuous in its course, and its walls so approximated to each other and so rigid that it may be all but impossible to follow it, and there is always danger of perforating its walls and opening into the cavity of the abdomen, or, short of that, of causing inflammation and a new, rigid, fibrous formation which on healing leaves matters worse than before. the opening must be carefully made with the finger, and when that has entered the womb further dilatation may be effected by inserting a sponge tent or by careful stretching with a mechanical dilator. (pl. xx, fig. .) sterility from other causes. the questions as to whether a bull is a sure stock getter and whether a cow is a breeder are so important that it would be wrong to pass over other prominent causes of sterility. breeding at too early an age is a common source of increasing weakness of constitution which has existed in certain breeds. jerseys have especially been made the victims of this mistake, the object being to establish the highest milking powers in the smallest obtainable body which will demand the least material and outlay for its constant repair of waste. with success in this line there has been the counterbalancing disadvantage of impaired vigor, with too often lessened fertility as well as increased predisposition to disease. when the heifers of the race have for generation after generation been bred under a year old, the demand for the nourishment of the fetus is too great a drain on the immature animal, which accordingly remains small and stunted. as it fails to develop in size, so every organ fails to be nourished to perfection. similarly with the immature bull put to too many cows; he fails to develop his full size, vigor, or stamina, and transfers his acquired weakness to his progeny. an increasing number of barren females and an increasing proclivity to abortions are the necessary results of both courses. when this early breeding has occurred accidentally it is well to dry up the dam just after calving, and to avoid having her served again until full grown. some highly fed and plethoric females seem to escape conception by the very intensity of the generative ardor. the frequent passage of urine, accompanied by contractions of the womb and vagina and a profuse secretion from their surfaces, leads to the expulsion of the semen after it has been lodged in the genital passages. this may be remedied somewhat by giving - / pounds of epsom salt a day or two before she comes in heat, and subjecting her at the same time to a spare diet. should the excessive ardor of the cow not be controllable in this way, she may be shut up for a day or two, until the heat is passing off, when under the lessened excitement the semen is more likely to be retained. the various diseases of the ovaries, their tubes, the womb, the testicles and their excretory ducts, as referred to under "excess of venereal desire," are causes of barrenness. in this connection it may be said that the discharges consequent on calving are fatal to the vitality of semen introduced before these have ceased to flow; hence service too soon after calving, or that of a cow which has had the womb or genital passages injured so as to keep up a mucopurulent flow until the animal comes in heat, is liable to fail of conception. any such discharge should be first arrested by repeated injections as for leucorrhea, after which the male may be admitted. feeding on a very saccharine diet, which greatly favors the deposition of fat, seems to have an even more direct effect in preventing conception during such regimen. among other causes of barrenness are all those that favor abortion, ergoted grasses, smutty wheat or corn, laxative or diuretic drinking water, and any improper or musty feed that causes indigestions, colics, and diseases of the urinary organs, notably gravel; also savin, rue, cantharides, and all other irritants of the bowels or kidneys. hermaphrodites are barren, of course, as their sexual organs are not distinctively either male or female. the heifer born as a twin with a bull is usually hermaphrodite and barren, but the animals of either sex in which development of the organs is arrested before they are fully matured remain as in the male or female prior to puberty, and are barren. bulls with both testicles retained within the abdomen may go through the form of serving a cow, but the service is unfruitful; the spermatozoa are not fully elaborated. so i have examined a heifer with a properly formed but very small womb and an extremely narrow vagina and vulva, the walls of which were very muscular, that could never be made to conceive. a post-mortem examination would probably have disclosed an imperfectly formed ovary incapable of bringing ova to maturity. a bull and cow that have been too closely inbred in the same line for generations may prove sexually incompatible and unable to generate together, though both are abundantly prolific when coupled with animals of other strains. finally, a bull may prove unable to get stock, not from any lack of sexual development, but from disease of other organs (back, loins, hind limbs), which renders him unable to mount with the energy requisite to the perfect service. congestion and inflammation of the testicles (orchitis). this visually results from blows or other direct injuries, but may be the result of excessive service or of the formation of some new growth (tumor) in the gland tissue. the bull moves stiffly, with straddling gait, and the right or left half of the scrotum in which the affected testicle lies is swollen, red, and tender, and the gland is drawn up within the sac and dropped again at frequent intervals. it may be treated by rest; by - / pounds epsom salt given in quarts of water; by a restricted diet of some succulent feed; by continued fomentations with warm water by means of sponges or rags sustained by a sling passed around the loins and back between the hind legs. the pain may be allayed by smearing with a solution of opium or of extract of belladonna. should a soft point appear, indicating the formation of matter, it may be opened with a sharp lancet and the wound treated daily with a solution of a teaspoonful of carbolic acid in a half pint of water. usually, however, when the inflammation has proceeded to this extent, the gland will be ruined for purposes of procreation and must be cut out. (see "castration," p. .) inflammation of the sheath. while this may occur in bulls from infection during copulation and from bruises, blows, and other mechanical injuries, the condition is more common in the ox in connection with the comparative inactivity of the parts. the sheath has a very small external opening, the mucous membrane of which is studded with sebaceous glands secreting a thick, unctuous matter of a strong, heavy odor. behind this orifice is a distinct pouch, in which this unctuous matter is liable to accumulate when the penis is habitually drawn back. moreover, the sheath has two muscles (protractors) which lengthen it, passing into it from the region of the navel, and two (retractors) that shorten it, passing into it from the lower surface of the pelvic bones above. (pl. ix, fig. .) the protractors keep the sheath stretched, so that it habitually covers the penis, while the retractors shorten it up in the act of service, so that the penis can project to its full extent. in stud bulls the frequent protrusion of the erect and enlarged penis and the retraction and dilation of the opening of the sheath serve to empty the pouch and prevent any accumulation of sebaceous matter or urine. in the ox, on the other hand, the undeveloped and inactive penis is usually drawn back so as to leave the anterior preputial pouch empty, so that the sebaceous matter has space to accumulate and is never expelled by the active retraction of the sheath and protrusion of the erect penis in service. again, the ox rarely protrudes the tip of the penis in urination, the urine is discharged into the preputial pouch and lodges and decomposes there, so that there is a great liability to the precipitation of its earthy salts in the form of gravel. the decomposing ammoniacal urine, the gritty crystals precipitated from it, and the fetid, rancid, sebaceous matter set up inflammation in the delicate mucous membrane lining the passage. the membrane is thickened, reddened, rendered friable, and ultimately ulcerated, and the now narrowed sheath is blocked by the increasing mass of sebaceous and urinous material and the decomposing mucus and pus. the penis can no longer be protruded, the urine escapes in a small stream through the narrowing sheath, and finally the outlet is completely blocked and the urine distends the back part of the sheath. this will fluctuate on being handled, and soon the unhealthy inflammation extends on each side of it, causing a thick, doughy, tender swelling under the belly and between the thighs. the next step in the morbid course is overdistention of the bladder, with the occurrence of colicky pains, looking at the flanks, uneasy movements of the hind limbs, raising or twisting of the tail, pulsatory contractions of the urethra under the anus, and finally a false appearance of relief, which is caused by rupture of the bladder. before rupture takes place the distended bladder may press on the rectum and obstruct the passage of the bowel dejections. two mistakes are therefore probable--first, that the bowels alone are to be relieved, and, second, that the trouble is obstruction of the urethra by a stone. hence the need of examining the sheath and pushing the finger into its opening to see that there is no obstruction there, in all cases of retention of urine, overdistended bladder, or blocked rectum in the ox. the disease may be acute or chronic--the first by reason of acute, adhesive inflammation blocking the outlet, the second by gradual thickening and ulceration of the sheath and blocking by the sebaceous and calculous accretion. _treatment._--the treatment of this affection depends on the stage. if recent and without instant danger of rupture of the bladder, the narrow opening of the sheath should be freely cut open in the median line below, and the sac emptied out with a finger or spoon, after which it should be thoroughly washed with tepid water. to make the cleansing more thorough a catheter or a small, rubber tube may be inserted well back into the sheath, and water may be forced through it from a syringe or a funnel inserted into the other end of the tube and considerably elevated. a fountain syringe, which should be in every house, answers admirably. the sheath may be daily washed out with tepid water, with a suds made with castile soap, or with a weak solution of sulphate of zinc (one-half dram to a quart of water). if these attentions are impossible, most cases, after cleansing, will do well if merely driven through clean water up to the belly once a day. in case the disease has progressed to absolute obstruction, with the bladder ready to rupture any moment, no time must be lost in opening into the urethra with a sharp knife over the bony arch under the anus, where the pulsations are seen in urinating. this incision is best made in the median line from above downward, but in the absence of a skillful operator a transverse incision with a sharp knife over the bone in the median line until the urine flows with a gush is better than to let the patient die. considerable blood will be lost and the wound will heal tardily, but the ox will be preserved. then the slitting and cleansing of the sheath can be done at leisure, as described above. if the bladder is ruptured, the case is hopeless. inflammation of the sheath and penis from bruising. this also is an affection of work oxen, caused by the pressure and friction of the sling when the animals are held in stocks for shoeing. this crushing of both sheath and penis for half an hour or more leads to the development, some hours later, of a hard, hot, and painful swelling, extending from the scrotum as far as the opening of the sheath. fever sets in, with dry muzzle, red eyes, hard, full, rapid pulse, accelerated breathing, and elevated temperature. the ox stands obstinately with his hind legs drawn apart and urine falling drop by drop from the sheath. appetite and rumination are suspended. in twenty-four hours there may be indications of advancing gangrene (mortification), the swelling becomes cold, soft, and doughy; it may even crack slightly from the presence of gas; a reddish brown, fetid liquid oozes from the swelling, especially around the edges, and if the animal survives it is only with a great loss of substance of the sheath and penis. _prevention._--the prevention of such an injury is easy. it is only necessary to see that the slings do not press upon the posterior part of the abdomen. they must be kept in front of the sheath. _treatment._--treatment, to be effective, must be prompt and judicious. put around the patient a strap with soft pads in contact with the affected parts, constantly soaked in cold water for at least hours. a pound or two of epsom salt in quarts of hot water should also be given. the second day the parts may be washed with quart of witch-hazel (extract), drams sugar of lead, and ounce laudanum, or the cold-water irrigations may be continued if the active inflammation persists. in case the swelling continues hard and resistant, it may be pricked at the most prominent points to the depth of one-third of an inch with a lancet first dipped in dilute carbolic acid, and the whole surface should be washed frequently with some antiseptic solution. when softening occurs in the center of a hard mass and fluctuation can be felt between two fingers pressed on different parts of such softening, it should be freely opened to let out the putrid pus, and the cavity should be syringed often with antiseptic solution. in bad cases extensive sloughs of dead skin, of the whole wall of the sheath, and even of the penis, may take place, which will require careful antiseptic treatment. the soaking of the urine into the inflamed and softened tissue and the setting up of putrefactive action not only endanger great destruction of the tissues from putrid inflammation, but even threaten life itself from a general blood poisoning (septicemia). every case should have skillful treatment to meet its various phases, but in the severe ones this is most urgently demanded. inflammation of the urethra. like other males, the bull sometimes suffers from inflammation of the canal which conveys the urine through the penis, and a whitish mucopurulent discharge forms in consequence. it may have originated in gravel, the excitement of too frequent service, infection from a cow with leucorrhea, or from extension of inflammation from the sheath. besides the oozing of the whitish liquid from the end of the penis and sheath, there is tenderness and pain when handled, and while there is no actual arrest of the urine, its flow is subject to frequent voluntary checks, as the scalding liquid irritates the tender surface. _treatment._--if recognized before the discharge sets in, a dose of - / pounds of epsom salt and local, warm fomentations would be appropriate. after the onset of the whitish discharge a daily injection of a solution of grains of permanganate of potassium in a pint of water into the penis will be beneficial. warts and papillary growths on the penis. these are not frequent in bull or ox. they may interfere with the protrusion of the organ from its sheath or with service, and always give rise to a bad-smelling discharge. _treatment._--they may be twisted off with a pair of small tweezers or cut off with a pair of scissors, and the seat burned with a pencil of lunar caustic. to get hold of the penis in the bull, bring him up to a cow. in the ox it will be necessary to push it out by manipulation through the sheath. in difficult cases the narrow opening of the sheath may be slit open. wounds of the penis. the most common wounds are those sustained by blows of horns, sticks, etc. the blood vessels and sacs are ruptured to a greater or less extent and considerable swellings filled with coagulated blood and inflammatory products occur, leading to distortion of the organ, and it may be to the impossibility of protruding it. _treatment._--a lotion of a dram of alum in a quart of water may be applied (injected into the sheath, if necessary), and a large sponge constantly irrigated by a stream of cold water may be kept applied by means of a surcingle to the outer side of the sheath. incisions are rarely applicable to an organ of this kind, but in case of the existence of an extensive clot which is unlikely to be absorbed the lancet may be resorted to. if the injury leads to paralysis of the penis and hanging out of its sheath, it should be supported in a sling and astringents used freely until inflammation subsides. then the restoration of power may be sought by a blister between the thighs, by the use of electricity, or by the careful use of nerve stimulants, such as strychnin, grain twice daily. ulcers on the penis. sores on the penis of the bull may result from gravel or sebaceous masses in the sheath or from having served a cow having leucorrhea. _treatment._--these may be treated by frequent injections into the sheath of a lotion made with dram sugar of lead, drops carbolic acid, and quart water. polypus of the vagina or uterus. a polypus is a tumor growing from the mucous membrane, and often connected to it by a narrow neck. a definite cause can not always be assigned. if growing in the vagina, a polypus may project as a reddish, rounded tumor from the vulva, especially during the act of passing water. it can be distinguished from descent of the womb by the absence of the orifice of that cavity, which can be felt by the oiled hand beyond the tumor in the depth of the vagina. from a vaginal hernia caused by the protrusion of some abdominal organ enveloped by the relaxed wall of the vagina it may be distinguished by its persistence, its firm substance, and the impossibility of returning it into the abdomen by pressure. a hernia containing a portion of bowel gurgles when handled and can be completely effaced by pressure, the gut passing into the abdomen. a polypus in the womb is less easily recognized. at the time of calving it may be felt through the open mouth of the womb and recognized by the educated touch (it must be carefully distinguished from the mushroom-formed cotyledons (pl. xiii, fig. ), to which in ruminants the fetal membranes are attached). at other times, unless the womb is opened in the effort to expel it, the polypus can be detected only by examining the womb with the oiled hand introduced through the rectum. polypi may cause a mucopurulent discharge or they may only be suspected when they prove an obstacle to parturition. the best way to remove them is to put the chain of an écraseur around the neck, or pedicle, of the tumor and tear it through; or the narrow neck may be torn through by the emasculator, or in an emergency it may be twisted through by rotating the tumor on its axis. the removal of the tumor will allow calving to proceed; after this the sore may be treated by a daily injection of one-half dram sulphate of zinc, dram carbolic acid, and quart milk-warm water. signs of pregnancy. if a cow remains for three or four weeks after service without showing signs of heat (bulling), she is probably pregnant. there are very exceptional cases in which the well-fed cow will accept the bull weeks or months after actual conception, and others equally exceptional in which the well-thriven but unimpregnated female will refuse the male persistently, but these in no way invalidate the general rule. the bull, no matter how vigorous or how ardent his sexual instinct, can not be made to pay any attention to a cow which is not in heat; hence indications of pregnancy can be had from both the male and female side. when she has conceived, the cow usually becomes more quiet and docile, and lays on flesh and fat more rapidly, especially during the first four months of gestation. the stimulus to digestion and nutrition created by the demands of the growing fetus, added to the quieter and more uneventful life, contributes to this result. some feeders avail themselves of this disposition to prepare heifers and cows speedily for the butcher. the enlargement of the abdomen, and its dropping so that it bulges below and to each side, while it falls in at the flank, between the outer angle of the hip bone and the last rib, are significant features which, though they may be caused by abdominal tumor or dropsy, are usually marks of pregnancy. from the same increasing weight of the abdomen the spine in the region of the loins sinks so that the bones of the croup seem to rise, especially back toward the root of the tail. in the early stages of pregnancy the udder develops slowly, and toward its completion quite rapidly. for a long time there is merely a sense of greater fullness when handled; the wrinkles in the skin become shallower and are effaced, and the teats are materially enlarged. beginning a few weeks after conception, this tends to a steady development, though slight alternations in the sense of successive growth and shrinkage are not uncommon. in milking cows this does not hold, as the milk usually tends to a steady diminution and the udder shrinks slowly until near the completion of the period, when it undergoes its sudden, remarkable development, and yields at first a serous liquid and then the yellow colostrum, which coagulates when heated. as pregnancy advances the mucous membrane lining the vulva becomes swollen and of a darker, bluish-red hue; the mucous secretion also increases, becoming very abundant just before calving. when the feeding has not been altered or restricted, a steady diminution of the salts of lime excreted in the urine is an attendant on pregnancy, the lime being demanded for the growing body of the fetus. after the fifth month the movements of the calf may often be observed in the right flank, nearly in front of the stifle, when the cow is drinking cold water. the sensation of cold on the side of the first stomach, which lies to the left and directly below the womb (pl. i), stimulates the calf to active movements, which are detected on the sudden jerking outward of the abdominal wall as if from blows delivered from within. in a loose, pendent abdomen in the latter months of gestation the skin may often be seen pushed out at a sharp angle, irrespective of the period of drinking. another mode of examination through the flank is by touch. the palm of the hand is pressed strongly inward, about inches in front of the stifle and a little below, several times in succession, and is then brought to rest with the pressure maintained. presently there are felt distinct and characteristic movements of the fetus, which has been disturbed and roused to action. another mode is to press the closed fist strongly inward in the same situation and hold it so, forming a deep indentation in the abdominal wall. presently the knuckles are felt to be struck by a solid body, which is no other than the fetus that has been displaced to the left by the push of the hand, and now floats back in its liquid covering (amniotic fluid; see pl. xii) downward and to the right. of all the modes of examination by touch, that done through the rectum gives the earliest satisfactory indications. the hand and arm, well oiled, are introduced, and the excrement having been removed if necessary, the palm of the hand is turned downward and the floor of the pelvis carefully examined. there will be felt in the median line the pear-shaped outline of the bladder, more or less full, rounded or tense, according to the quantity of urine it contains. between this and the hand will be felt a soft, somewhat rounded tubular body, which divides in front into two smaller tubes or branches, extending to the right and left into the abdomen. this is the womb, which in its virgin, or unimpregnated, condition is of nearly uniform size from before backward, the main part or body being from - / to inches across, and the two anterior branches or horns being individually little over an inch wide. immediately after conception the body and one of the horns begin to enlarge, the vacant horn remaining disproportionately small, and the enlargement will be most marked at one point, where a solid, rounded mass indicates the presence of the growing embryo. in case of twins, both horns are enlarged. at a more advanced stage, when the embryo begins to assume the form of the future animal, the rounded form gives place to a more or less irregular nodular mass, while later still the head, limbs, and body of the fetus may be distinctly made out. the chief source of fallacy is found in the very pendent abdomen of certain cows, into which in advanced gestation the fetus has dropped so low that it can not be felt by the hand in the rectum. the absence of the distinct outline of the vacant womb, however, and the clear indications obtained on external examination through the right flank will serve to prevent any mistake. the fetus may still be felt through the rectum if the abdomen is raised by a sheet passed from side to side beneath it. still another sign is the beating of the fetal heart, which may be heard in the latter half of pregnancy when the ear is pressed on the flank in front of the right stifle or from that downward to the udder. the beats, which are best heard in the absence of rumbling, are about a minute and easily distinguished from any bowel sounds by their perfect regularity. duration of pregnancy. from extended statistics it is found that the average duration of pregnancy in the cow is days. a calf born at the two hundred and fortieth day may live, and dietrichs reported a case of a calf born on the three hundred and thirty-fifth day, and another was reported by the american journal of medical science as having been born on the three hundred and thirty-sixth day. it is the general observation that in most cases of prolonged pregnancies the offspring are males. lord spencer found a preponderance of males between the two hundred and ninetieth and the three hundredth days, but strangely enough all born after the three hundredth day under his observation were females. it may be reasonably inferred that while the prevailing tendency is to carry the males overtime, yet that the smaller and comparatively much less developed female sometimes fails to stimulate the womb to contraction until very far beyond the regular date. hygiene of the pregnant cow. among domestic animals considerations of hygiene must be made subservient to profit, and therefore the first consideration is not to obtain the most robust health, but such a measure of vigor and stamina as is compatible with the most profitable utilization of the animal. the breeding cow must carry a calf every year, and this notwithstanding that she is at the same time suckling another large, growing calf. the dairy cow must breed every year, and at the same time must furnish a generous flow of milk from nine to eleven months yearly. if her health is lowered thereby or her life shortened, the question of profit must still hold sway, and, when disqualified, she must yield her place to another. there are exceptions, of course, but this rule generally holds. there are certain points, however, in which the interests of hygiene may be considered. the pregnant cow should have exercise, and as regards both exercise and feed, nothing is better than a run on a smooth pasture. she should be withheld from all violent excitement, hunting with dogs, riding or being ridden by cows in heat, driving in herd rapidly through narrow gateways, causing to jump ditches or fences, subjecting to blows with the horns of pugnacious cattle, driving on icy or otherwise slippery ground, carrying in railroad cars, kicking by vicious attendants, and fastening or throwing down for operations. the diet should be good, not of a kind to fatten, but with a generous quantity of nitrogenous constituents which will favor both the yield of milk and the nourishment of the fetus. aliments like wheat bran, middlings, etc., which are rich in lime and phosphates, can be used to advantage, as there is a constant drain of earthy salts for the building of the body of the calf, and thereby the danger of undue concentration of the urine is lessened. hard, innutritious, and indigestible aliments, musty grain or hay, partially ripened rye grass, millet, hungarian grass, vetches, peas, or maize are objectionable, as they are liable to cause indigestion or even paralysis; and corn or hay affected by smut or ergot, or that has been spoiled by wet, overripened, and rendered fibrous and innutritious, is equally objectionable. in the main the feed should be laxative, as costiveness and straining are liable to cause abortion. roots and green feed that have been frosted are objectionable, as being liable to cause indigestion, though in their fresh condition most wholesome and desirable. ice-cold water should be avoided, as calculated to check the flow of milk, to derange digestion, and to cause abortion. a good temperature for the drink of the dairy cow is ° f. in the case of plethoric and heavy-milking cows of mature age and in the prime of life, the hitherto liberal diet must be changed at the last week for the scantiest possible fare, and the bowels must be kept open by laxatives, if need be, if the owner would avoid milk fever. her stall should not incline downward from shoulder to croup, lest the pressure of the abdominal organs should produce protrusion or abortion. she should be kept aloof from all causes of acute diseases, and all existing diseases should be remedied speedily and with as little excitement of the abdominal organs as possible. strong purgatives and diuretics are to be especially avoided, unless it is in the very last days of gestation in very plethoric cows. protrusion of the vagina (prolapsus vaginÆ). during pregnancy this is common from chronic relaxation of the vaginal walls and from lying in stalls that are lower behind than in front. the protrusion is of a rounded form and smooth, and if it embraces both sides of the canal it is double, with a passage between. it may sometimes be remedied by raising the hind part of the stall higher than the front part. this failing, a truss may be applied as for eversion of the womb, and worn until the period of calving approaches. (pls. xxii, xxiii.) hernia (breach) of the uterus. in advanced pregnancy this occurs usually from a gradual relaxation and distention of the lower wall of the abdomen in the region of the udder, so that the latter is displaced downward, and in the sac above and in front of it may be felt the form and movements of the fetus. in other cases the womb escapes through a great laceration of the abdominal muscles to one side of the udder, and the hernial mass extends down to one side of that organ. however unsightly, this often allows the animal to complete its pregnancy naturally, and a broad, supporting bandage placed around the abdomen is about all that can be recommended. after calving it is best to fatten the cow. cramps of the hind limbs. the compression of the nerves by the womb and fetus passing through the pelvis sometimes causes cramp and inability to move the limb, but it disappears under friction and motion and is never seen after calving. dropsy of the hind limbs and between the thighs. in the latter months of pregnancy the hind legs may swell beneath the hocks, or a soft swelling which pits on pressure with the finger appears from the vulva down between the thighs to the udder and in front. it is mainly ascribable to the pressure of the enlarged womb on the blood vessels, is not dangerous, and disappears after calving. dropsy of the membranes of the fetus (dropsy of the womb). the unimpregnated womb may be filled with a dropsical fluid, but the pregnant womb is more liable to become overdistended by an excess of fluid in the inner water bag in which the fetus floats. (pl. xii.) from an unhealthy state of this membrane or of blood of the fetus (water blood) this liquid may go on accumulating until the cow seems almost as broad as she is long. if the trouble has not originated in the ill health of the cow, the result is still to draw on her system, overtax her strength, and derange her digestion, so that the result may prove fatal to both mother and offspring. on the other hand, i have known extreme cases that came to the natural term without help and produced a living calf, after which the dam did well. the natural resort is to draw off a portion of the fluid through a hollow needle passed through the neck of the womb or through its tense wall adjacent. this may be repeated several times, as demanded, to relieve the cow from the injurious distention. paralysis of the hind parts. in ill-fed, weak, unthrifty cows palsy of the hind limbs and tail may appear in the last weeks of pregnancy. the anus and rectum may participate in the palsy so far as to prevent defecation, and the rectum is more or less completely impacted. exposure to wet and cold are often accessory causes, though the low condition, general weakness, and the pressure on the nerves going to the hind limbs are not to be forgotten. something may be done for these cases by a warm, dry bed, an abundant diet fed warm, frictions with straw wisps or with a liniment of equal parts of oil of turpentine and sweet oil on the loins, croup, and limbs, by the daily use of ginger and gentian, by the cautious administration of strychnia ( grain twice daily), and by sending a current of electricity daily from the loins through the various groups of muscles in the hind limbs. the case becomes increasingly hopeful after calving, though some days may still elapse before the animal can support herself upon her limbs. extrauterine gestation (fetus developing outside the womb). these curious cases are rare and are usually divided into three types: ( ) that in which the fetus is formed in or on the ovary (ovarian gestation); ( ) that in which it is lodged in the fallopian tube, or canal between the ovary and womb (tubal gestation); and ( ) that in which it is lodged in the abdominal cavity and attached to one or more of its contents from which it draws its nourishment (abdominal gestation). undoubted cases of the first and last varieties are recorded as occurring in the cow. the explanation of such cases is to be found in the fact that the actively moving sperm cells (spermatozoa) thrown into the womb have made their way through the fallopian tubes to the ovary. if they met and impregnated an ovum in the tube, and if the consequent growth of that ovum prevented its descent and caused its imprisonment within the tube, it developed there, getting attached to and drawing nourishment from the mucous walls. such product has its development arrested by compression by the undilatable tube, or, bursting through the walls of the tube, it escapes into the abdomen and perishes. if, on the contrary, the spermatozoa only meet and impregnate the ovum on or in the ovary, the development may take place in the substance of the ovary, from which the fetus draws its nourishment, or the impregnated ovum, escaping between the ovary and the open end of the tube, falls into the abdominal cavity and becomes adherent to and draws nourishment from some of the abdominal organs (womb, bowel, liver, stomach, etc.). _symptoms._--the symptoms are those of pregnancy, which may be suddenly complicated by inflammation (peritonitis), owing to rupture of the sac containing the fetus; or at full term signs of calving appear, but no progress is made; an examination with the oiled hand in the vagina or rectum finds the womb empty and its mouth closed. further examination will disclose the fetal sac attached in some part of the abdominal cavity and containing the more or less perfectly developed body of a calf. in the most hopeful cases the fetus perishes at an early stage of gestation, becomes inclosed in a fibrous sac, and is slowly absorbed, its soft parts becoming liquefied and removed and the bones remaining encysted. in some cases the bones have finally sloughed into the rectum or through an artificial opening in the side of the belly. _treatment._--little can be done in such cases except to quiet pain and excitement by anodynes (opium, chloral, etc.) and leave the rest to nature. a fistula discharging bones may be dilated and the bones extracted, the sac being then washed out with a solution of grains bichlorid of mercury in a quart of water. in certain cases with a live calf a skillful operator may be justified in cutting into the abdomen and extracting the calf with its membranes, using the lotion just named as an antiseptic. prolonged retention of the fetus. even when the fetus has developed within the womb it may fail to be delivered at the proper time; labor pains have quickly subsided and the cow resumed her usual health. in such cases the calf dies, and its soft parts are gradually liquefied and absorbed, while its bones remain for years in the womb inclosed in the remains of the fetal membranes. these may be expelled at any time through the natural channels, or they may remain indefinitely in the womb, not interfering with the general health, but preventing conception. if the true condition of things is recognized at the time of the subsidence of the labor pains, the mouth of the womb may be dilated by the fingers, by the insertion of sponge tents, or by a mechanical dilator (pl. xx, fig. ), the fetal membranes may be ruptured and the calf extracted. after the removal of the calf and its membranes the danger of putrid poisoning may be obviated by injecting the antiseptic solution advised in the paragraph above. abortion (slinking the calf). technically, abortion is the term used for the expulsion of the offspring before it can live out of the womb. its expulsion before the normal time, but after it is capable of an independent existence, is premature parturition. in the cow this may be after seven and one-half months of pregnancy. earl spencer failed to raise any calf born before the two hundred and forty-second day. dairymen use the term abortion for the expulsion of the product of conception at any time before the completion of the full period of a normal pregnancy, and in this sense it will be used in this article. abortion in cows is either contagious or noncontagious. it does not follow that the contagium is the sole cause in every case in which it is present. we know that the organized germs (microbes) of contagion vary much in potency at different times, and that the animal system also varies in susceptibility to their attack. the germ may therefore be present in a herd without any manifest injury, its disease-producing power having for the time abated considerably, or the whole herd being in a condition of comparative insusceptibility. at other times the same germ may have become so virulent that almost all pregnant cows succumb to its force, or the herd may have been subjected to other causes of abortion which, though of themselves powerless to actually cause abortion, may yet so predispose the animals that even the weaker germ will operate with destructive effect. in dealing with this disease, therefore, it is the part of wisdom not to rest satisfied with the discovery and removal of one specific cause, but rather to try to find every existent cause and to obtain a remedy by correcting all the harmful conditions. noncontagious abortion. as abortion most frequently occurs at those three-week intervals at which the cow would have been in heat if nonpregnant, we may assume a predisposition at such times owing to a periodicity in the nervous system and functions. poor condition, weakness, and a too watery state of the blood is often a predisposing cause. this in its turn may result from poor or insufficient feed, from the excessive drain upon the udder while bearing the calf, from the use of feed deficient in certain essential elements, like the nitrogenous constituents or albuminoids, from chronic, wasting diseases, from roundworms or tapeworms in the bowels, from flat-worms (flukes, trematodes) in the liver, from worms in the lungs, from dark, damp, unhealthful buildings, etc. in some such cases the nourishment is so deficient that the fetus dies in the womb and is expelled in consequence. excessive loss of blood, attended as it usually is with shock, becomes a direct cause of abortion. acute inflammations of important organs are notorious causes of abortion, and in most contagious fevers (lung plague, rinderpest, foot-and-mouth disease) it is a common result. affections of the chest which prevent due aeration of the blood induce contractions of the womb, as shown experimentally by brown-sequard. pregnant women suffocated in smoke aborted in many cases. (retoul.) ergoted grasses have long been known as a cause of widespread abortion in cows. the ergot is familiar as the dark purple or black, hard, spurlike growths which protrude from the seeds of the grasses at the period of their ripening. (pl. v.) it is especially common, in damp localities and cloudy seasons on meadows shaded by trees and protected against the free sweep of the winds. the same is to a large extent true of smut; hence, wet years have been often remarkable for the great prevalence of abortions. abortions have greatly increased in new zealand among cows since the introduction of rye grass, which is specially subject to ergot. as abortion is more prevalent in old dairying districts, the ergot may not be the sole cause in this instance. the riding of one another by cows is attended by such severe muscular exertion, jars, jolts, mental excitement, and gravitation of the womb and abdominal organs backward that it may easily cause abortion in a predisposed animal. keeping in stalls that slope too much behind (more than inches) acts in the same way, the compression from lying and the gravitation backward proving more than a predisposed cow can safely bear. deep gutters behind the stalls, into which one or both hind limbs slip unexpectedly, strain the loins and jar the body and womb most injuriously. slippery stalls in which the flooring boards are laid longitudinally in place of transversely, and on which there is no device to give a firm foothold, are almost equally dangerous. driving on icy ground, or through a narrow doorway where the abdomen is liable to be jammed, are other common causes. aborting cows often fail to expel the afterbirth, and if this remains hanging in a putrid condition it is most injurious to pregnant cows in the near vicinity. so with retained afterbirth in other cows after calving. that some cows kept in filthy stables or with slaughterhouses near by may become inured to the odors and escape the evil results is no disproof of the injurious effects so often seen in such cases. the excitement, jarring, and jolting of a railroad journey often cause abortion, especially as the cow nears the period of calving, and the terror or injury of railway or other accidents proves incomparably worse. all irritant poisons cause abortions by the disorder and inflammation of the digestive organs, and if such agents act also on the kidneys or womb, the effect is materially enhanced. powerful purgatives or diuretics should never be administered to the pregnant cow. among other causes of abortion must be named the death or the various illnesses of the fetus, which are about as numerous as those of the adult; the slipping of a young fetus through a loop in the navel string so as to tie a knot which will tighten later and interrupt the flow of blood with fatal effect, and the twisting of the navel string by the turning of the fetus until little or no blood can flow through the contorted cord. there is in addition a series of diseases of the mucous membrane of the womb, and of the fetal membranes (inflammation, effusion of blood, detachment of the membranes from the womb, fatty or other degenerations, etc.), which interfere with the supply of blood to the fetus or change its quality so that death is the natural result, followed by abortion. _treatment._--although the first symptoms of abortion have appeared, it does not follow that it will go on to completion. so long as the fetus has not perished, if the waters have not been discharged, nor the water bags presented, attempts should be made to check its progress. every appreciable and removable cause should be done away with, the cow should be placed in a quiet stall alone, and agents given to check the excitement of the labor pains. laudanum in doses of ounce for a small cow or ounces for a large one should be promptly administered, and repeated in three or four hours should the labor pains recur. this may be kept up for days or even weeks if necessary, though that is rarely required, as the trouble either subsides or abortion occurs. if the laudanum seems to lack permanency of action, use bromid of potassium, or, better, extract of _viburnum prunifolium_ (black haw), grains, at intervals of two or three hours until five or six doses have been given. contagious abortion. contagious abortion (also known as epizootic abortion, enzootic abortion, and slinking of calves) is a disease affecting chiefly cattle and to a lesser degree other domestic animals, and characterized by an inflammatory condition of the female reproductive organs, which results in the expulsion of the immature young. _history._--this disease has been known in england and continental europe for many years, and descriptions of it are mentioned in the writings of mascal, lafoose, skellet, lawrence, st. cyr, zündel, and youatt. in the early part of the eighteenth century british veterinarians recognized its contagiousness, but it remained for franck ( ), lehnert ( ), and bräuer ( ) to produce the disease in healthy, pregnant cows by the introduction of exudate and material from aborting animals. nocard ( ) isolated from the exudate between the mucous membrane of the uterus and fetal membranes a micrococcus and a short bacillus which were found continually in contagious abortion, but he failed to reproduce the disease by inoculations of pure cultures of these organisms into healthy, pregnant animals. in bang, assisted by stribolt, published their findings regarding infectious abortion of cattle, in which they incriminated bang's bacillus of abortion as the causative agent. with pure cultures of this bacillus they were able to produce the disease artificially and to recover the same organism from the experimental cases. since that time many noted investigators, both in this country and in europe, have confirmed these findings. _cause._--the _bacterium abortus_ of bang is now generally recognized as the causative agent of the disease of cattle. formerly it was thought that abortion was due to injury, such as blows, horn thrusts, falls, etc., or the eating of spoiled feed and certain plants, and while this may be true in a limited number of cases, careful investigations have demonstrated these claims to be largely unfounded. it is now generally recognized that when abortion occurs in herds from time to time, it is safe to assume that the disorder is of an infectious nature and should be so treated. _natural mode of infection._--this phase of the disease is of greatest importance for a clear understanding of the methods of prevention. many investigators have demonstrated that the infection is transmitted through the digestive tract, through contaminated feed and water. the germs are taken up by the body from the intestines with the liquid nourishment, reach the blood, and are carried to the genital organs, where they find conditions best suited to their development. some assert that calves are infected in this manner by suckling infected mothers, the germs being present in the milk, or the teats having been contaminated by coming in contact with infective discharges. it is claimed that infection contracted in this manner remains dormant in the body of the calf until pregnancy begins, and then the organism, finding conditions suitable for its development, produces the disease. abortion may occasionally be transmitted from cow to cow by direct contact. the discharges from diseased cows, swarming with the germs, soil the external genitals, tail, and hind quarters, and then a susceptible animal, by contact, gets the infective material upon the vulva, the infection traveling up the genital canal and directly infecting the uterus. the belief long entertained that the female acquires the disease at the time of copulation as a result of transference of the infection from affected to healthy females on the genital organs of the bull has failed to receive the support of experimental evidence. the view that the disease is spread to any great degree in this way has been largely discredited. cows of all ages are more or less susceptible, but young ones in first or second pregnancy most frequently abort. a second abortion is not unusual, and a third may occasionally occur, after which the cow usually becomes immune and thereafter carries her calf to maturity. heifers from aborting mothers sometimes seem to be less susceptible than others. _symptoms._--contagious abortion is a very insidious disease, developing very slowly through several months of the gestation period, and resulting finally in the expulsion of the immature young, this act being simply an indication of the presence of the disease and not the disease itself. because of this slow development and the fact that the health of the animal is not noticeably influenced, the presence of the disease may not be suspected until it has gained a firm foothold in the herd. the symptoms of approaching abortion are those preceding normal calving. in addition, there may be observed, a few days previous to abortion, a sticky, sometimes purulent, rusty, and odorless discharge. abortion occurs most frequently from the third to the seventh month, according to the number of abortions, occurring early in first abortion, and later in each succeeding abortion until the calf is carried to full term and the mother has become immune. it happens frequently that calves are carried almost to full term, and are born alive, but are sickly, and soon die. following abortion there is a dirty, yellowish-gray mucopurulent discharge which persists for two or more weeks. if abortion occurs early, the fetus is passed surrounded by its membranes, but if late in the period of pregnancy, the membranes are retained, decomposition sets in and blood poisoning, which may cause the death of the animal, or sterility may result. _lesions._--the most characteristic change is found in the uterus where a dark-brown fluid, purulent or even gluey in consistency, and containing grayish-white flakes separates the material membranes from those of the fetus, preventing that intimate contact between the two which is so necessary for the interchange of fluids and gases by which the fetus is nourished and by which it obtains its oxygen. these being cut off, the fetus must of course die. the germs producing the disease are found in greatest numbers at this point. in addition there may be inflammatory changes, first in the walls of the uterus and then in the tissues of the fetus. these inflammatory changes seem most intense in the cotyledons and result in the destruction of the minute structure of those bodies, and they appear swollen, pale, and soft. the membrane of the uterus between the cotyledons also may show inflamed and necrotic patches. _complications._--serious results sometimes follow abortion, and this is particularly the case when there is retained afterbirth. the retained membranes decompose, the poisonous products of decomposition and the organisms of decomposition themselves are absorbed, blood poisoning results, and the animal dies. sometimes, when the animal is able to resist the effects of this decomposition, the uterus becomes the seat of such severe changes that sterility results. the walls of that organ become thickened and hard, the lining membranes become eroded, and conception can not take place. at other times the ovaries, where the reproductive cells originate, become affected and lose their function. abortion does not invariably follow infection, but the calf is carried to full term. in these cases, however, retained afterbirth is a common occurrence, even to the extent that frequent retention of afterbirth in a herd may be taken as an indication of the presence of the disease. very often suppurative processes persist for a long time, preventing conception, or sterility may result without apparent cause. a sterile cow is valueless, of course, for any purpose except for beef. such animals are a source of infection for the others and should not be allowed to remain in the herd. _diagnosis._--the diagnosis of infectious abortion is made from the changes occurring in the fetal membranes and in the expelled fetus. this, however, is substantiated with certainty only by microscopic demonstration of the germ of abortion. the fact that repeated abortions are observed in a herd is also evidence of the presence of the disease. in consideration, however, of the fact that animals may be affected with the disease and disseminate the germs, even though they carry the fetus to full time, a diagnosis in such instances is only possible by laboratory methods. for this purpose the agglutination and also the complement-fixation tests are being used with splendid results, and by the aid of these biological tests it is possible to determine all infected animals in a herd. the tests are carried out with the serum from animals to be examined, only a teaspoonful of serum being necessary for the execution of both of these tests. it, however, has to be confined to laboratories which are properly equipped for such work. _treatment and prevention._--it may be said in general that treatment is without avail and all efforts should be directed toward prevention. various medicinal agents, such as carbolic acid administered subcutaneously and methylene blue fed in large quantities, have been recommended, but have failed to stand the tests of scientific investigation and practical use. serums and vaccines have also been prepared and sold as cures and preventives, but the work is still considered in the experimental stage. bacterial vaccines are at present extensively used in the control of this disease, and while numerous reports indicate beneficial results from their administration, in other instances total failures have been recorded. it appears that the experiments in this line have not progressed sufficiently to justify definite conclusions. the spread of the disease can be controlled to a great degree by the practice of sanitary measures directed toward the disinfection of premises and the isolation of animals at time of calving and aborting. for methods of disinfection of premises see page . make frequent observations of the animals of affected herds for symptoms of aborting, such as swelling of vulva or udder enlargement, and upon the discovery of an animal showing these symptoms place her immediately in a stall which is somewhat remote from healthy stock as a means of confining the products of abortion as much as possible should the act occur. if an animal aborts unexpectedly she should be removed to separate quarters and given proper attention as promptly as possible. the fetus, afterbirth, provided it has been expelled, and all litter that has been contaminated with them and uterine discharges should be gathered up and destroyed either by burning or burying. clean and thoroughly disinfect the floor, gutters, and manger in the vicinity of the aborting animal. daily irrigations of the uterus with nonirritating antiseptic solutions, such as . per cent solution of cresol or compound solution of cresol, at body temperature have a tendency to prevent the multiplication of microorganisms in the uterus and in this way promote recovery. douching of the uterus should be continued until the discharge ceases. in addition, the external genitals, root of the tail, escutcheon, etc., should be sponged daily with the antiseptic solution. aim to place all pregnant animals in disinfected individual pens or stalls a few days before they are expected to calve, and confine them to these quarters for three or four weeks following the delivery of the calf, or as long thereafter as uterine discharges are observed. avoid carrying infection from the maternity stalls to other portions of stable, on shoes or otherwise. this may be prevented to some degree by the use of disinfectant solutions on shoes after the stalls have been entered or by wearing rubbers while in the maternity stalls, removing them after the isolated animals have been attended to. the isolation of cows at time of calving and the aborting animal is based upon the knowledge that the fetus, afterbirth, and uterine discharges of an affected animal at these times very frequently contain myriads of the abortion bacteria, and that unless these substances are confined and promptly destroyed an abundant opportunity is provided for the contamination of the food substances of the healthy animals and their contraction of the disease. refrain from breeding fresh cows for a period of six weeks to two months following calving. the aborting animal should be isolated for a period of six weeks to two months and under no consideration be permitted to mingle with the rest of the herd as long as uterine discharges are observed. douching of the external genitals of the bull, a practice formerly regarded as highly important for preventing the spread of the disease, is now recognized as being of doubtful value. the bull is protected from abortion infection to a great degree by permitting him to serve only such animals as have calved or aborted from six weeks to two months previously. investigational work has indicated that when the bull is affected with the disease the organs of his generative system commonly involved are not reached by the antiseptic solutions. a more rational method for the prevention of the spread of the disease by the bull consists in keeping him in an inclosure separate from the females and in having all services take place on neutral ground. great care should be used in purchasing cattle, and cows not known to be free from the disease should be kept in separate quarters until this point is determined. granular venereal disease (infectious granular vaginitis). the affection to which the foregoing names have been given is a chronic, mild, and apparently contagious disease of cattle, characterized by an inflammatory condition of the mucous membrane of the vagina and the development of nodules upon its surface. this disease is very widely spread, but from an economic point of view it does not appear to have great significance. williams, who investigated it, asserts that it is difficult to find a single herd in this country which is free of this disease. he considers it of great importance, claiming that granular vaginitis has a vital relation to abortion. this view, however, is not substantiated by other investigators, it being now generally accepted that the disease is only rarely responsible for abortion, and further, that it exerts no apparent ill effects on the health of the animal and that it has no effect on the milk yield. _symptoms._--natural infection may take place either by direct contact of animals or at the time of service. most of the cows in the affected herd contract the disease, but the bulls are rarely or very mildly affected. the inflamed condition of the membranes of the vagina results in a catarrhal exudate, and this discharge, which soils the external genitals and the tail, and the uneasiness and sometimes the straining of the animal, are the first and most prominent symptoms observed. upon examination, small, hard, grayish nodules can be seen and felt upon the inflamed membranes. this acute stage may last for three or four weeks, then it gradually subsides and assumes the chronic form, only to flare up again as the animal comes in heat. these nodules are sometimes found on the membranes of the uterus, and some investigators have argued from this fact that it was responsible for abortion and sterility. others, however, deny this and point out that the bacillus of abortion can be demonstrated in nearly every case. the importance of the disease is therefore in dispute and the decision must be left to future investigation. _treatment._--the exaggerated importance which has been attached to this disease resulted in the exploitation of the most varied kinds of remedies for its treatment. it is true that with a protracted and laborious treatment it is possible to effect cures in from one to three months, but with our present knowledge of this disorder it is advisable to limit the treatment to animals which show an acute inflammatory condition of the vagina and vulva with a discharge as a result of the granular affection. the treatment should be local and confined to the application of antiseptic washes in the form of irrigations. for this purpose a . per cent solution of the compound solution of cresol or of lugol's solution has been found satisfactory. parturition (calving). symptoms of calving. in the cow the premonitions of calving are the enlargement of the udder, which becomes firm and resistant to the touch, with more or less swelling in front, and yields a serous, milky fluid; the enlargement and swelling of the vulva, which discharges an abundant, stringy mucus; the drooping of the belly, and the falling in of the muscles at each side of the root of the tail, so as to leave deep hollows. when this last symptom is seen, calving may be counted on in hours or in or days. when the act is imminent, the cow becomes uneasy, moves restlessly, leaves off eating, in the field leaves the herd, lies down and rises again as if in pain, shifts upon her hind feet, moves the tail, and may bellow or moan. when labor pains come on the back is arched, the croup drooped, the belly is drawn up, and straining is more or less violent and continuous. meanwhile blood may have appeared on the vulva and tail, and soon the clear water bags protrude between the lips of the vulva. they increase rapidly, hanging down toward the hocks, and the fore or hind feet can be detected within them. with the rupture of the bags and escape of the waters the womb contracts on the solid, angular body of the fetus and is at once stimulated to more violent contractions, so that the work proceeds with redoubled energy to the complete expulsion. this is why it is wrong to rupture the water bags if the presentation is normal, as they furnish a soft, uniform pressure for the preliminary dilation of the mouth of the womb and passages, in anticipation of the severe strain put upon them as the solid body of the calf passes. the cow often calves standing, in which case the navel string is broken as the calf falls to the ground. if, however, she is recumbent, this cord is torn through as she rises. the afterpains come on or hours later and expel the membranes, which should never be left longer than hours. natural presentation. when there is but one calf the natural presentation is that of the fore feet with the front of the hoofs and knees turned upward toward the tail of the dam and the nose lying between the knees. (pl. xv.) if there are twins the natural position of the second is that of the hind feet, the heels and hocks turned upward toward the cow's tail. (pl. xviii, fig. .) in both of these natural positions the curvature of the body of the calf--the back arched upward--is the same with the curvature of the passages, which descend anteriorly into the womb, ascend over the brim of the pelvis, and descend again toward the external opening (vulva). any presentation differing from the above is abnormal. obstacles to parturition. with a well-formed cow and calf and a natural presentation as above, calving is usually prompt and easy. obstacles may, however, come from failure of the mouth of the womb to dilate; from twisting of the neck of the womb; from tumors in the vagina; from dropsy in the womb or abdomen; from overdistention of the rectum or bladder; from undue narrowing of the passages; from excess of fat in the walls of the pelvis; from the disturbance of a nervous cow by noises; from stone or urine in the bladder; from wrong presentation of the calf, its back being turned downward or to one side in place of upward toward the spine of the dam; from the bending backward of one or more limbs or of the head into the body of the womb; from presentation of the back, shoulder, or croup, all four limbs being turned back; from presentation of all four feet at once; from obstruction caused by an extra head or extra limbs, or double body on the part of the offspring (pl. xix); from dropsy or other disease of the calf; from excessive or imperfect development of the calf; from the impaction of twins into the passages at the same time; or at times it may be from the mere excessive volume of the fetus. general maxims for the assistant concerning difficult parturition. do not interfere too soon. "meddlesome midwifery is bad" with animals as with women. after labor pains set in, give a reasonable time for the water bags to protrude and burst spontaneously, and only interfere when delay suggests some mechanical obstruction. if there is no mechanical obstruction, let the calf be expelled slowly by the unaided efforts of the cow. bruises and lacerations of the passages and flooding from the uncontracted womb may come from the too speedy extraction of the calf. when assistance is necessary, the operator should dress in a thick flannel shirt from which the sleeves have been cut off clear to the shoulders. this avoids danger of exposure and yet leaves the whole arm free and untrammeled. before inserting the hand it and the arm should be smeared with oil, lard, or vaseline, care being taken that the oil or lard is fresh, neither salted nor rancid, and that it has been purified by boiling or rendered antiseptic by the addition of a teaspoonful of carbolic acid to the pound. this is a valuable precaution against infecting the cow by introducing putrid ferments into the passages and against poisoning of the arm by decomposing discharges in case the calving is unduly protracted. when labor pains have lasted some time without any signs of the water bags, the dropping in at the sides of the rump, and the other preparations for calving being accomplished, the hand should be introduced to examine. when the water bags have burst and neither feet nor head appear for some time, examination should be made. when one fore foot only and the head appear, or both fore feet without the head, or the head without the fore feet, examine. if one hind foot appears without the other, make examination. the presenting limb or head should be secured by a rope with a running noose, so that it may not pass back into the womb and get lost during the subsequent manipulations, but may be retained in the vagina or brought up again easily. in searching for a missing member it is usually better to turn the head of the cow downhill, so that the gravitation of the fetus and abdominal organs forward into the belly of the cow may give more room in which to bring up the missing limb or head. if the cow is lying down, turn her on the side opposite to that on which the limb is missing, so that there may be more room for bringing the latter up. even if a missing limb is reached, it is vain to attempt to bring it up during a labor pain. wait until the pain has ceased and attempt to straighten out the limb before the next pain comes on. if the pains are violent and continuous, they may be checked by pinching the back or by putting a tight surcingle around the body in front of the udder. these failing, ounce or - / ounces of chloral hydrate in a quart of water may be given to check the pains. if the passages have dried up or lost their natural, lubricating liquid, smear the interior of the passages and womb and the surface of the calf, so far as it can be reached, with pure fresh lard; or pure sweet oil may be run into the womb through a rubber tube (fountain syringe). in dragging upon the fetus apply strong traction only while the mother is straining, and drag downward toward the hocks as well as backward. the natural curvature of both fetus and passages is thus followed and the extraction rendered easier. labor pains before relaxation of the passages. any of the various causes of abortion may bring on labor pains before the time. straining comes on days or weeks before the time, and there is not the usual enlargement, swelling, and mucous discharge from the vulva. there is little or no falling in by the sides of the root of the tail; the abdomen has not dropped to the usual extent, and the udder is less developed and yields little or no milk. in spite of the pains no water bags appear, and the oiled hand cautiously introduced into the vagina finds the neck of the womb firmly closed, rigid, and undilatable. if it is known that the cow has not reached her proper time of calving, the examination through the vagina should be omitted and the animal should be placed in a dark, quiet place by herself, and be given to ounces laudanum. _viburnum prunifolium_ (black haw), ounce, may be added, if necessary, and repeated in three hours. the pains will usually subside. in some instances the external parts are relaxed and duly prepared, but the neck of the womb remains rigidly closed. in such case the solid extract of belladonna should be smeared around the constricted opening and the animal left quiet until it relaxes. diseased induration of the mouth of the womb. from previous lacerations or other injuries the neck of the womb may have become the seat of fibrous hardening and constriction, so as to prevent its dilatation, when all other parts are fully prepared for calving. the enlarged, flabby vulva, the sinking at each side of the rump, the full udder, and drooping abdomen indicate the proper time for calving, but the labor pains effect no progress in the dilatation of the mouth of the womb, and the oiled hand introduced detects the rigid, hard, and, in some cases, nodular feeling of the margins of the closed orifice which no application of belladonna or other antispasmodic suffices to relax. sponge tents may be inserted or the mechanical dilator (pl. xx, fig. ) may be used if there is opening enough to admit it, and if not, a narrow-bladed, probe-pointed knife (pl. xxiv, fig. ) may be passed through the orifice and turned upward, downward, and to each side, cutting to a depth not exceeding a quarter of an inch in each case. this done, a finger may be inserted, then two, three, and four, and finally all four fingers and thumb brought together in the form of a cone and made to push in with rotary motion until the whole hand can be introduced. after this the labor pains will induce further dilation, and finally the presenting members of the calf will complete the process. twisting of the neck of the womb. this is not very uncommon in the cow, the length of the body of the womb and the looseness of the broad ligaments that attach it to the walls of the pelvis favoring the twisting. it is as if one were to take a long sack rather loosely filled at the neck and turn over its closed end, so that its twisting should occur in the neck. the twist may be one-quarter round, so that the upper surface would come to look to one side, or it may be half round, so that what was the upper surface becomes the lower. the relation of the womb of the cow to the upper and right side of the paunch favors the twisting. the paunch occupies the whole left side of the abdomen and extends across its floor to the right side. its upper surface thus forms an inclined plane, sloping from the left downward and to the right, and on this sloping surface lies the pregnant womb. it is easy to see how, in the constant movements of the paunch upon its contents and the frequent changes of position of the growing fetus within the womb, to say nothing of the contractions of the adjacent bowels and the more or less active movements of the cow, the womb should roll downward to the right. yet in many cases the twist is toward the left, showing that it is not the result of a simple rolling downward over the paunch, but rather of other disturbances. the condition may be suspected when labor pains have continued for some time without any sign of the water bags, and it is confirmed when the oiled hand, introduced through the vagina, finds the mouth of the womb soft and yielding, but furnished with internal folds running forward in a spiral manner. if the folds on the upper wall of the orifice run toward the right, the womb is twisted to the right; if, on the contrary, they turn toward the left, it indicates that the womb is turned over in that direction. the direction of the twist must be known before treatment can be undertaken. then, if the twist is toward the right, the cow is laid upon her right side with her head downhill, the hand of the operator is introduced through the spirally constricted neck of the womb, and a limb or other portion of the body of the calf is seized and pressed firmly against the wall of the womb. meanwhile two or three assistants roll the cow from her right side over on her back to her left side. the object is to hold the womb and calf still while the body of the cow rolls over. if successful, the twist is undone, its grasp on the wrist is slackened, and the water bags and calf press into the now open passage. if the first attempt does not succeed, it is to be repeated until success has been attained. if the spiral folds on the upper wall of the opening turn toward the left, the cow is laid on her left side and rolled over on her back and on to the right side, the hand being, as before, within the womb and holding the fetus, so that all may not rotate with the cow. in introducing the hand it will usually be found needful to perforate the membranes, so that a limb of the calf may be seized direct and firmly held. among my occasional causes of failure with these cases have been, first, the previous death and decomposition of the fetus, leading to such overdistention of the womb that it could not be made to rotate within the abdomen, and, second, the occurrence of inflammation and an exudate on the twisted neck of the womb, which hindered it from untwisting. in obstinate cases, in which the hand can be made to pass through the neck of the womb easily, additional help may be had from the use of the instrument shown in plate xx, figure . two cords, with running nooses, are successively introduced and made fast on two limbs of the calf; the cords are then passed through the two rings on the end of the instrument, which is passed into the womb and the cords drawn tight and fixed round the handle. then, using the handle as a lever, it is turned in the direction opposite to the twist. the hand should meanwhile be introduced into the womb and the snared limbs seized and pressed against its walls so as to secure the rotation of the uterus along with the body of the fetus. the relaxation of the constriction and the effacement of the spiral folds will show when success has been gained, and the different members at one end of the body should then be brought up so as to secure a natural presentation. narrow pelvis from fracture or disease. in a small cow the pelvis may be too narrow to pass a calf sired by a bull of a large breed, but this is exceptional, as the fetus usually accommodates itself to the size of the dam and makes its extra growth after birth. when the pelvic bones have been fractured repair takes place with the formation of a large permanent callus, which, projecting internally, may be a serious obstacle to calving. worse still, if the edge of the broken bone projects internally as a sharp spike or ridge, the vaginal walls are cut upon it during the passage of the calf, with serious or fatal result. in other cases, where the cow has suffered from fragility of bone (fragilitas ossium) the thickening of the bone causes narrowing of the long passage of the pelvis and the crumbling fractures poorly repaired, with an excess of brittle new material, may form an insuperable obstacle to parturition. cows affected in any of these ways should never again be bred, but if they do get pregnant and reach full time a careful examination will be necessary to determine whether natural parturition can take place or if the calf must be extracted in pieces. (see "embryotomy," p. .) obstruction by masses of fat. this is not unknown in old cows of the beef breeds, the enormous masses of fat upon and within the pelvis being associated with weakness or fatty degeneration of the muscles. if the presentation is natural, little more is wanted than a judicious traction upon the fetus to compress and overcome the soft resisting masses. obstruction by a full bladder or rectum or by stone. in all cases of delayed or tardy parturition the evacuation of rectum and bladder is important, and it is no less so in all difficult parturitions. stone in the bladder is fortunately rare in the cow, but when present it should be removed to obviate crushing and perhaps perforation of the organ during calving. calving retarded by nervousness. in a public fair ground i have seen labor pains begin early in the day and keep up in a weak and insufficient manner for many hours, until the stall was thoroughly closed in and the cow secluded from the constant stream of visitors and the incessant noise, when at once the pains became strong and effective and the calf was soon born. coagulated blood under the vaginal walls. this is common after calving, but sometimes occurs before, as the result of accidental injury. the mass may be recognized by its dark hue and the doughy sensation to the touch. it may be cut into and the mass turned out with the fingers, after which it should be washed frequently with an antiseptic lotion (carbolic acid dram in quart of water). constriction of a member by the navel string. in early fetal life the winding of the navel string around a limb may cause the latter to be slowly cut off by absorption under the constricting cord. so at calving the cord wound round a presenting member may retard progress somewhat, and though the calf may still be born tardily by the unaided efforts of the mother, it is liable to come still-born, because the circulation in the cord is interrupted by compression before the offspring can reach the open air and commence to breathe. if, therefore, it is possible to anticipate and prevent this displacement and compression of the navel string it should be done, but if this is no longer possible, then the extraction of the calf should be effected as rapidly as possible, and if breathing is not at once attempted it should be started by artificial means. water in the head of the calf (hydrocephalus). this is an enormous distention of the cavity holding the brain, by reason of the accumulation of liquid in the internal cavities (ventricles) of the brain substance. the head back of the eyes rises into a great rounded ball (pl. xix, figs. and ), which proves an insuperable obstacle to parturition. the fore feet and nose being the parts presented, no progress can be made, and even if the feet are pulled upon the nose can not by any means be made to appear. the oiled hand introduced into the passages will feel the nose presenting between the fore limbs, and on passing the hand back over the face the hard rounded mass of the cranium is met with. a sharp-pointed knife or a cannula and trocar should be introduced in the palm of the hand and pushed into the center of the rounded mass so as to evacuate the water. the hand is now used to press together the hitherto distended but thin and fragile walls, and the calf may be delivered in the natural way. if the enlarged head is turned backward it must still be reached and punctured, after which it must be brought up into position and the calf delivered. if the hind feet present first, all may go well until the body and shoulders have passed out, when further progress is suddenly arrested by the great bulk of the head. if possible, the hand, armed with a knife or trocar, must be passed along the side of the shoulder or neck so as to reach and puncture the distended head. failing in this, the body may be skinned up from the belly and cut in two at the shoulder or neck, after which the head can easily be reached and punctured. if in such case the fore limbs have been left in the womb, they may now be brought up into the passage, and when dragged upon the collapsed head will follow. if the distention is not sufficient to have rendered the bony walls of the cranium thin and fragile, so that they can be compressed with the hand after puncture, a special method may be necessary. a long incision should be made from behind forward in the median line of the cranium with an embryotomy knife (pl. xxi, fig. ) or with a long embryotome (pl. xx, fig. ). by this means the bones on the one side are completely separated from those on the other and may be made to overlap and perhaps to flatten down. if this fails they may be cut from the head all around the base of the rounded cranial swelling by means of a guarded chisel (pl. xx, fig. ) and mallet, after which there will be no difficulty in causing them to collapse. dropsy of the abdomen of the calf (ascites). this is less frequent than hydrocephalus, but no less difficult to deal with. with an anterior presentation the fore limbs and head may come away easily enough, but no effort will advance the calf beyond the shoulders. the first thought should be dropsy of the belly, and the oiled hand introduced by the side of the chest will detect the soft and fluctuating yet tense sac of the abdomen. if there is space to allow of the introduction of an embryotomy knife, the abdomen may be freely cut with this, when the fluid will escape into the womb and parturition may proceed naturally. if this can not be effected, a long trocar and cannula may be passed between the first two ribs and straight on beneath the spine until it punctures the abdomen. (pl. xviii, fig. .) then the trocar is to be withdrawn and the liquid will flow through the cannula and will be hastened by traction on the fore limbs. in the absence of the trocar and cannula, two or three of the first ribs may be cut from the breastbone, so that the hand may be introduced through the chest to puncture the diaphragm with an embryotomy knife and allow an escape of the water. in some slighter cases a tardy delivery may take place without puncture, the liquid bulging forward into the chest as the abdomen is compressed in the pelvic passages. with a posterior presentation the abdomen may be punctured more easily either in the flank or with a trocar and cannula through the anus. general dropsy of the calf. this occurs from watery blood or disease of some internal organ, like the liver or kidney, and is recognized by the general puffed-up and rounded condition of the body, which pits everywhere on pressure but without crackling. if not too extreme a case, the calf may be extracted after it has been very generally punctured over the body, but usually the only resort is to extract it in pieces. (see "embryotomy," p. .) swelling of the calf with gas. this is usually the result of the death and decomposition of the fetus when extraction has been delayed for a day or more after the escape of the waters. it is impossible to extract it whole, owing to its large size and the dry state of the skin of the calf, the membranes, and the wall of the womb. these dry surfaces stick with such tenacity that no attempt at traction leads to any advance of the calf out of the womb or into the passages. when the fetus is advanced the adherent womb advances with it, and when the strain is relaxed both recede to where they were at first. the condition may be helped somewhat by the free injection of oil into the womb, but it remains impossible to extract the enormously bloated body, and the only resort is to cut it in pieces and extract it by degrees. (see "embryotomy," p. .) rigid contractions of muscles. in the development of the calf, as in after life, the muscles are subject to cramps, and in certain cases given groups of muscles remain unnaturally short, so that even the bones grow in a twisted and distorted way. in one case the head and neck are drawn round to one side and can not be straightened out, even the bones of the face and the nose being curved around to that side. in other cases the flexor muscles of the fore legs are so shortened that the knees are kept constantly bent and can not be extended by force. the bent neck may sometimes be sufficiently straightened for extraction by cutting across the muscles on the side to which it is turned, and the bent knees by cutting the cords on the back of the shank bones just below the knees. if this fails, there remains the resort of cutting off the distorted limbs or head. (see "embryotomy," p. .) tumors of the calf (inclosed ovum). tumors or new growths grow on the unborn calf as on the mature animal, and by increasing the diameter of the body render its progress through the passage of the pelvis impossible. in my experience with large, fleshy tumors of the abdomen, i have cut open the chest, removed the lungs and heart, cut through the diaphragm with the knife, and removed the tumor piecemeal by alternate tearing and cutting until the volume of the body was sufficiently reduced to pass through. where this failed it would remain to cut off the anterior part of the body, removing as much of the chest as possible, and cutting freely through the diaphragm; then, pushing back the remainder of the body, the hind limbs may be seized and brought into the passages and the residue thus extracted. the tumor, unless very large, will get displaced backward so as not to prove an insuperable obstacle. in many cases the apparent tumor is a blighted ovum which has failed to develop, but has grafted itself on its more fortunate twin and from it has drawn its nourishment. these are usually sacs containing hair, skin, muscle, bone, or other natural tissues, and only exceptionally do they show the distinct outline of the animal. monstrosity in the calf. as a monstrous development in the calf may hinder calving, it is well to consider shortly the different directions in which these deviations from the natural form appear. their origin and significance will be rendered clearer if we divide them according to the fault of development in individual cases. monsters are such-- ( ) from absence of parts--absence of head, limb, or other organ--arrested development. ( ) from some organ being unnaturally small, as a dwarfed head, limb, trunk, etc.--arrested development. ( ) from unnatural division of parts--cleft lips, palate, head, trunk, limbs, etc.--abnormal growth. ( ) from the absence of natural divisions--absence of mouth, nose, eye, anus; the cloven foot of ox or pig becomes solid, like that of the horse, etc.--confluence of parts which are rightfully separate. ( ) from the fusion of parts--both eyes replaced by central one, both nostrils merged into one central opening, etc.--confluence of parts. ( ) from unnatural position or form of parts--curved nose, neck, back, limbs, etc.--lack of balance in the growth of muscles during development. ( ) from excessive growth of one or more organs--enormous size of head, double penis, superfluous digits, etc.--redundancy of growth at given points. ( ) from imperfect differentiation of the sexual organs--hermaphrodites (organs intermediate between male and female), male organs with certain feminine characters, female organs with certain well-marked male characters. ( ) from the doubling of parts or of the entire body--double monsters, doubled heads, doubled bodies, extra limbs, etc.--redundant development. (pl. xix, figs. , , .) _causes._--the causes of monstrosities are varied. some, like extra digits, lack of horns, etc., run in families, which produce them with absolute certainty when bred in the direct line, although they were originally acquired peculiarities which have merely been fixed by long habit in successive generations. the earliest horse had five toes, and even the most recent fossil horse had three toes, of which the two lateral ones are still represented in the modern animal by the two splint bones. yet if our horse develops an extra toe it is pronounced a monstrosity. a more genuine monstrosity is the solid-hoofed pig, in which two toes have been merged into one. another of the same kind is the solid shank bone of the ox, which consists of two bones united into one, but which are still found apart in the early fetus. though originally acquired peculiarities, they now breed as invariably as color or form. other monstrosities seem to have begun in too close breeding, by which the powers of symmetrical development are impaired, just as the procreative power weakens under continuous breeding from the closest blood relations. a monstrosity consisting in the absence of an organ often depends on a simple lack of development, the result of disease or injury, as a young bone is permanently shortened by being broken across the soft part between the shaft and the end, the only part where increase in length can take place. as the result of the injury the soft, growing layer becomes prematurely hard and all increase in length at that end of the bone ceases. this will account for some cases of absence of eye, limb, or other organ. sometimes a monstrosity is owing to the inclosure of one ovum in another while the latter is still but a soft mass of cells and can easily close around the first. here each ovum has an independent life; they develop simultaneously, only the outer one having direct connection with the womb and being furnished with abundant nourishment advances most rapidly and perfectly, while the inclosed and starved ovum is dwarfed and imperfect often to the last degree. in many cases of excess of parts the extra part or member is manifestly derived from the same ovum, and even the same part of the ovum, being merely the effect of a redundancy and vagary of growth. such cases include most instances of extra digits or other organs, and even of double monsters, as manifested by the fact that such extra organs grow from the normal identical organs. hence the extra digit is attached to the normal digit, the extra head to the one neck, the extra tail to the croup, extra teeth to the existing teeth, and even two similarly formed bodies are attached by some point common to both, as the navels, breastbones, backs, etc. (pl. xix, figs. , , .) this shows that both have been derived from the same primitive layer of the embryo, which possessed the plastic power of building up a given structure or set of organs. an inclosed ovum, on the other hand, has no such identity or similarity of structure to the part with which it is connected, showing an evident primary independence of both life and the power of building tissues and organs. the power of determining extra growth along a given natural line is very highly developed in the early embryo and is equally manifest in the mature examples of some of the lower forms of animal life. thus a newt will grow a new tail when that member has been cut off, and a starfish will develop as many new starfishes as the pieces made by cutting up the original one. this power of growth in the embryo and in the lower form of animals is comparable to the branching out again of a tree at the places from which branches have been lopped. the presence of this vegetablelike power of growth in the embryo accounts for most double monsters. the influence of disease in modifying growth in the early embryo, increasing, decreasing, distorting, etc., is well illustrated in the experiments of st. hilaire and valentine in varnishing, shaking, or otherwise disturbing the connections of eggs and thereby producing monstrosities. one can easily understand how inflammations and other causes of disturbed circulation in the womb, fetal membranes, or fetus would cause similar distortions and variations in the growing fetus. it is doubtless largely in the same way that certain mental disturbances of a very susceptible dam affect the appearance of the progeny. the monstrosities which seriously interfere with calving are mainly such as consist in extra members or head, which can not be admitted into the passages at the same time, where some organ of the body has attained extra size, where a blighted ovum has been inclosed in the body of a more perfect one, or where the body or limbs are so contracted or twisted that the calf must enter the passages doubled up. _treatment._--extraction is sometimes possible by straightening the distorted members by the force of traction; in other cases the muscles or tendons must be cut across on the side to which the body or limbs are bent to allow of such straightening. thus, the muscles on the concave side of a wry neck or the cords behind the shank bones of a contracted limb may be cut to allow of these parts being brought into the passages, and there will still be wanting the methods demanded for bringing up missing limbs or head, for which see paragraphs below. in most cases of monstrosity by excess of overgrowth it becomes necessary to cut off the supernumerary or overdeveloped parts, and the same general principles must be followed as laid down in "embryotomy" (p. ). wrong presentations of the calf. the following is a list of abnormal presentations of the calf: simultaneous presentation of twins. a { {limbs curved at the knee. flexor tendons shortened. n {fore limbs{limb crossed over the back of the neck. t { {limb bent back at the knee. e { {limb bent back from the shoulder. r { i { {head bent downward on the neck. o p { {head and neck turned downward beneath the breast. r r {head {head turned to one side upon the side of the neck. e { {head and neck turned back on the side of the chest and s { { abdomen. e { {head turned upward and backward on the back. n { t { {hind limbs rotated outward. toes and stifles turned a { { outward. t {hind limbs{hind limbs bent forward, their feet resting in the pelvis. i { o {transverse{back of the calf turned to the right or left side. n { s {inverted {back of the calf turned to the floor of the pelvis and { { udder. p p { o r { {hind limb bent on itself at the hock. hock and buttocks s e {hind limbs{ present. t s { {hind limb bent at the hips. buttocks present. e e { r n {transverse{back of calf turned to the right or left side. i t { o a {inverted {back of calf turned to the floor of the pelvis and udder. r t { i { o { n { {head up toward the spine, croup {position of calf vertical { toward udder. t { { {head down toward udder, croup r {back { { toward spine. u p {and { n r {loins { {head toward the right side, k e {presented.{position of calf transverse{ croup toward the left. s { { e { { {head toward the left side, n { { { croup toward the right. t { { a { { t {breast { {head toward right side, croup i {and {position of calf transverse{ toward left. o {abdomen { {head toward left side, croup n {presented.{ { toward right. s { these include all general presentations, yet other subsidiary ones will at once occur to the attentive reader. thus, in each anterior or posterior presentation, with the back of the calf turned downward or to one side, the case may be complicated by the bending back of one or more members as a whole or at the joint just above the shank bones (knee or hock). so also in such anterior presentation the head may be turned back. _head and fore feet presented--back turned to one side._--the calf has a greater diameter from above down (spine to breastbone) than it has from side to side, and the same is true of the passage of the pelvis of the cow, which measures, on an average, - / inches from above downward and - / inches from side to side. hence the calf passes most easily with its back upward, and when turned with its back to one side calving is always tardy and may be difficult or impossible. the obvious remedy is to rotate the calf on its own axis until its spine turns toward the spine of the cow. the operation is not difficult if the body of the calf is not yet fixed in the passages. the presenting feet are twisted over each other in the direction desired, and this is continued until the head and spine have assumed their proper place. if the body is firmly engaged in the passages the skin of the whole engaged portion should be freely lubricated with lard, and the limbs and head twisted over each other as above. the limbs may be twisted by an assistant when the head is manipulated by the operator, who drags on the rope turned halfway round the limbs and assists in the rotation with his other hand in the passages. _head and fore feet presented--back turned down toward the udder._--this position (pl. xvi, fig. ) is unnatural, and the parturition is difficult for two reasons: first, the natural curvature of the fetus is opposed to the natural curvature of the passages; and, second, the thickest part of the body of the calf (the upper) is engaged in the narrowest part of the passage of the pelvis (the lower). yet unless the calf is especially large and the pelvis of the cow narrow, parturition may usually be accomplished in this way spontaneously or with very little assistance in the way of traction on the limbs. if this can not be accomplished, two courses are open: first, to rotate the calf as when the back is turned to one side; second, to push back the presenting fore limbs and head and search for and bring up the hind limbs, when the presentation will be a natural, posterior one. _presentation of the hind feet with the back turned to one side or downward._--these are the exact counterparts of the two conditions last described, are beset with similar drawbacks, and are to be dealt with on the same general principles. (pl. xvii, fig. .) with the back turned to one side the body should be rotated until the back turns toward the spine of the dam, and with the back turned down it must be extracted in that position (care being taken that the feet do not perforate the roof of the vagina) or it must be rotated on its own axis until the back turns upward, or the hind limbs must be pushed back and the fore limbs and head advanced, when the presentation will be a natural anterior one. _impaction of twins in the passage._--it is very rare to have twins enter the passages together so as to become firmly impacted. as a rule, each of the twins has its own separate membranes, and as the water bags of one will naturally first enter and be the first to burst, so the calf which occupied those membranes will be the first to enter the passage and the other will be thereby excluded. when the membranes of both have burst without either calf having become engaged in the pelvis, it becomes possible for the fore legs of one and the hind legs of the other to enter at one time, and if the straining is very violent they may become firmly impacted. (pl. xviii, fig. .) the condition may be recognized by the fact that two of the presenting feet have their fronts turned forward, while the two others have their fronts turned backward. if the four feet belonged to one natural calf, they would all have the same direction. by means of this difference in direction we can easily select the two feet of one calf, place running nooses upon them just above the hoofs or fetlocks, and have an assistant drag upon the ropes while the feet of the other calf are pushed back. in selecting one of the twins to come first several considerations should have weight. the one that is most advanced in the passage is, of course, the first choice. though the fore feet of one are presented, yet if the head is not in place the calf presenting by its hind feet is to be chosen as being less liable to obstruct. again, if for either calf one limb only is presented and the other missing, the one presenting two feet should be selected to come first. as soon as one calf has been advanced so as to occupy the pelvis the other will be crowded back so that it will not seriously obstruct. _fore limbs curved at the knee--limbs sprawling outward._--in this case not only are the knees somewhat bent in a curve, but the calf has a position as if it rested on its breastbone, while the legs were drawn apart and directed to the right and left. the shoulder blades being drawn outward from the chest and the elbows turned out, the muscles extending from the trunk to the limb are unduly stretched and keep the knees bent and the feet directed outward so as to press on the sides of the passages. they become retarded in their progress as compared with the more rapidly advancing head, and may bruise or even lacerate the walls of the vagina. it would seem easy to rectify this by extending the legs, but the already tense and overstretched muscles operate against extension in the present position, and it is not easy to rotate the limbs so as to apply the shoulder flat against the side of the chest. under these circumstances a repeller (pl. xx, fig. ) may be planted in the breast and the body of the calf pushed backward into the womb, when the limbs will extend easily under traction and the presentation becomes at once natural. _fore limbs curved at knee--flexor tendons shortening._--in this case the feet will press against the floor of the pelvis though the limb has no outward direction, and the shoulder meanwhile presses against the roof of the same passage. unless the knees can be sufficiently straightened by force a knife must be used to cut across the cords behind the knee, when the limbs may be straightened sufficiently. _fore limbs flexed at knee--flexor tendons unshortened._--this is mostly seen in cases in which the body of the calf is in the proper position, its back being turned up toward the back of the dam, and in cows with a drooping abdomen. the feet have been supposed to catch beneath the brim of the pelvis, and being retarded while the head advances into the passages, they get bent at the knee and the nose and knees present. (pl. xvi, fig. .) the calf, however, is not an inanimate body advanced by the mere contraction of the womb, but it moves its limbs freely under the stimulus of the unwonted compression, and in moving the feet as they are advanced they slip down over the pelvic brim and finding no other firm support they bend back until, under the impulsion, they can no longer straighten out again. the knees, therefore, advance with the neck and head, but the feet remain bent back. the result is that the upper part of the limb is also flexed, and the shoulder blade and arm bone with their masses of investing muscles are carried backward and applied on the side of the chest, greatly increasing the bulk of this already bulky part. as the elbow is carried back on the side of the chest, the forearm from elbow to knee further increases the superadded masses of the shoulder and renders it difficult or impossible to drag the mass through the passages. when the fore limbs are fully extended, on the contrary, the shoulder blade is extended forward on the smallest and narrowest part of the chest, the arm bone with its muscles is in great part applied against the side of the back part of the neck, and the forearm is continued forward by the side of the head so that the nose lies between the knees. in this natural presentation the presenting body of the calf forms a long wedge or cone, the increase of which is slow and gradual until it reaches the middle of the chest. the difficulty of extending the fore limbs will be in proportion to the advance of the head through the pelvic cavity. in the early stage all that is necessary may be to introduce the oiled hand, the left one for the right leg or the right one for the left, and passing the hand from the knee on to the foot to seize the foot in the palm, bend it forcibly on the fetlock, and lift it up over the brim of the pelvis, the knee being, of course, pressed upward against the spine. as soon as the foot has been raised above the brim of the pelvis (into the passage) the limb can be straightened out with the greatest ease. when, however, the shoulders are already engaging in the pelvis the feet can not thus be lifted up, and to gain room a repeller (pl. xx, fig. ) must be used to push back the body of the calf. this is an instrument with a long, straight stem, divided at the end into two short branches ( to inches long) united to the stem by hinges so that they can be brought into a line with the stem for introduction into the womb and then spread to be implanted in the breast. in the absence of a repeller a smooth, round, fork handle may be used, the prongs having been removed from the other end. a third device is to have an assistant strip his arm to the shoulder and, standing back to back with the operator, to introduce his right arm into the passages along with the operator's left (or vice versa) and push back the body of the calf while the operator seeks to bring up a limb. the repeller or staff having been planted safely in the breast of the calf, an assistant pushes upon it in a direction either forward or slightly upward, so as not only to follow the natural curve of the body and favor its turning in the line of that curve within the womb, but also to carry the shoulders upward toward the spine and obtain more room for bringing up the missing feet. it is good policy, first, to put a halter (pl. xxi, figs. _a_ and _b_) on the head or a noose (pl. xxi, fig. ) on the lower jaw and a rope round each limb at the knee, so as to provide against the loss of any of these parts when the body is pushed back into the womb. this offers the further advantage that by dragging upon these ropes the body can be advanced in the passage until the foot is reached, when the rope must be slackened and the repeller used to get room for bringing up the foot. if the cow is lying, the operator should first secure the foot on the upper side and then, if necessary, turn the cow on its opposite side so as to bring up the other. in using the instruments some precautions are demanded. they must be invariably warmed before they are introduced, and they should be smeared with lard or oil to make them pass easily and without friction. the assistant who is pushing on the instrument must be warned to stop if at any time resistance gives way. this may mean the turning of the fetus, in which case the object of repulsion has been accomplished, but much more probably it implies the displacement of the instrument from the body of the fetus, and unguarded pressure may drive it through the walls of the womb. when the calf enters the passage with its back turned down toward the belly and udder, the bending back of the fore limbs is rare, probably because the feet can find a straighter and more nearly uniform surface of resistance in the upper wall of the womb and the backbone, and do not slide over a crest into an open cavity, as they do over the brim of the pelvis. the weight of the calf, too, gravitating downward, leaves more room for the straightening of the bent limbs, so that the desired relief is much more easily secured. the manipulation is the same in principle, only one must add the precaution of a steady traction on the feet in extraction, lest, owing to the adverse curvature of the fetus, the hoofs are suddenly forced through the roof of the vagina, and, perhaps, the rectum as well, during a specially powerful labor pain. when the back of the calf is turned to the right side or the left the main difference is that in addition to straightening the limbs the fetus must be rotated to turn its back upward before extraction is attempted. in this case, too, it may be difficult to bring up and straighten the lower of the two limbs until the body has been rotated into its proper position. cord the upper straightened limb and head, then rotate the body and search for the second missing limb. _fore limbs bent back from the shoulders._--this is an exaggeration of the condition just named, and is much more difficult to remedy, owing to the distance and inaccessibility of the missing limb. it usually happens with the proper position of the body, the back of the calf being turned toward the back of the mother. the head presents in the passage and may even protrude from the vulva during an active labor pain, but it starts back like a spring when the straining ceases. examination with the oiled hands in the intervals between the pains fails to detect the missing limbs. (pl. xvi, fig. .) if, however, the hand can be introduced during a pain it may be possible to reach the elbow or upper part of the forearm. in the absence of a pain a halter or noose on the head may be used to advance the whole body until the forearm can be seized just below the elbow. this being firmly held and the head or body pushed back into the womb, room may be obtained for bringing up the knee. the forearm is used as a lever, its upper part being strongly forced back while its lower part is pressed forward. if a pain supervenes the hold must be retained, and whatever gain has been made must be held if possible. then during the next pain, by pushing back the body and continuing to operate the forearm as a lever, a still further advance may be made. as the knee is brought up in this way, the hand is slid down from the elbow toward the knee, which is finally brought up over the brim of the pelvis and into the passage. it is now corded at the knee, and the subsequent procedure is as described in the last article. in a large, roomy cow with a small calf the latter may pass with one or both forelegs bent back, but this is a very exceptional case, and, as early assistance is the most successful, there should never be delay in hope of such a result. _one fore limb crossed over the back of the neck._--this is a rare obstacle to calving, but one that not altogether unknown. the hand introduced into the passage feels the head and one forefoot, and farther back on the same side of the other foot, from which the womb can be traced obliquely across the back of the neck. (pl. xvi, fig. .) this foot, projecting transversely, is liable to bruise or tear the vagina. if still deeply engaged in the vagina, it may be seized and pushed across to the opposite side of the neck, when the presentation will be natural. _head bent down beneath the neck._--in this case, with drooping belly and womb allowing the brim of the pelvis to form a ridge, the advancing calf, having unduly depressed its nose, strikes it on the brim of the pelvis, and the neck advancing, the head is bent back and the poll and ears either enter the pelvis or strike against its brim. the two forefeet present, but they make no progress, and the oiled hand introduced can detect no head until the poll is felt at the entrance of the pelvis, between the forearms. the two forefeet must be fixed with running nooses and dragged on moderately while the oiled hand seeks to bring up the head. the hand is slid down over the forehead and brim of the pelvis until the nose is reached, when it is passed into the mouth, the muzzle resting in the palm of the hand. the legs are now pushed upon, and in the space thus gained the muzzle is drawn up so as to enter it into the pelvis. in doing this the operator must carefully see that the mouth does not drop open so that the sharp, front teeth cut through the floor of the womb. should this danger threaten, the hand should be made to cover the lower jaw as well. the lessened security of the hold is more than compensated by the safety of the procedure. with the nose in the pelvis, it has only to be drawn forward and the parturition is natural. _head bent down beneath the breast._--this is an exaggerated condition of that last named. the head, arrested by the brim of the pelvis and already bent back on the neck, is pressed farther with each successive throe until it has passed between the forelegs and lodges beneath the breast bone. (pl. xvi, fig. .) on examination, the narrow upper border of the neck is felt between the forearms, but as a rule the head is out of reach below. keeping the hand on the neck and dragging on the feet by the aid of ropes, the hand may come to touch and seize the ear, or, still better, one or two fingers may be inserted into the orbit of the eye. then in pushing back upon the limbs, with or without the aid of a repeller applied against the shoulder, space may be obtained to draw the head into a vertical position, and even to slip the hand down so as to seize the nose. should it prove impossible to draw the head up with the unassisted fingers, a blunt hook (pl. xxi, fig. ) may be inserted into the orbit, on which an assistant may drag while another pushes upon the limbs or repeller. meanwhile the operator may secure an opportunity of reaching and seizing the nose or of passing a blunt hook into the angle of the mouth. success will be better assured if two hooks (pl. xxi, fig. ) are inserted in the two orbits, so as to draw up the head more evenly. in other cases a noose may be placed on the upper jaw, or even around both jaws, and traction made upon this and on the hooks in the orbits while the legs are pushed back, and while the operator pushes back on the poll or forehead. in still more difficult cases, in which even the orbits can not be reached, a sharp hook on the end of a straight iron rod (pl. xx, fig. ) may be inserted over the lower jaw as far forward as it can be reached, and by dragging upon this while the body is pushed back the head will be brought up sufficiently to allow the operator to reach the orbit or nose. if even the jaw can not be reached, the hook may be inserted in the neck as near to the head as possible and traction employed so as to bring the head within reach. in all such cases the cow's head should be turned downhill, and in case of special difficulty she should be turned on her back and held there until the head is secured. in old-standing cases, with the womb closely clasping the body of the calf, relaxation may be sought by the use of chloroform or a full dose of chloral hydrate-- ounces; the free injection of warm water into the womb will also be useful. _head turned back on the shoulder._--with a natural, anterior presentation this may happen because of the imperfect dilation of the mouth of the womb. under the throes of the mother the forefeet pass through the narrow opening into the vagina, while the nose, striking against it and unable to enter, is pressed backward into the womb and turns aside on the right or left shoulder. the broad muzzle of the calf forms an especial obstacle to entrance and favors this deviation of the head. the worst form of this deviation is the old-standing one with shortening of the muscles of the neck on that side, and oftentimes distortion of the face and neck bones, as noticed under "monstrosities" (p. ). when the head is bent on the shoulder the feet appear in the natural way, but no progress is made, and examination reveals the absence of the nose from between the knees, and farther back, from above and between the elbows, a smooth rounded mass is felt extending to the right or left, which further examination will identify with the neck. following the upper border of this the hand reaches the crown of the head with the ears, and still further the eyes, or even, in a small calf, the nose. as the bulky head of the calf can not be extracted along with the shoulders, it becomes necessary to push the body of the fetus back and straighten out the head and neck. the cow should be laid with her head downhill and with that side up toward which the head is turned. if the throes are very violent, or the womb strongly contracted on the calf, it may be best to seek relaxation by giving chloroform, or ounces of laudanum, or ounces of chloral hydrate. if the calf or the passages are dry, sweet oil may be injected, or the whole may be liberally smeared with fresh lard. in the absence of these, warm water rendered slightly slippery by castile soap may be injected into the womb in quantity. ropes with running nooses are placed on the presenting feet and the oiled hand introduced to find the head. if, now, the fingers can be passed inside the lower jawbone, and drag the head upward and toward the passage, it unwinds the spiral turn given to the neck in bending back, and greatly improves the chances of bringing forward the nose. if, at first, or if now, the lower jaw can be reached, a noose should be placed around it behind the incisor teeth and traction made upon this, so that the head may continue to be turned, forehead up, toward the spine and jaws down, thereby continuing to undo the screwlike curve of the neck. if, on the contrary, the nose is dragged upon by a cord passing over the upper border of the neck, the screwlike twist is increased and the resistance of the bones and joints of the neck prevents any straightening of the head. as soon as the lower jaw has been seized by the hand or noose, a repeller (pl. xx, fig. ), planted on the inside of the elbow or shoulder most distant from the head, should be used to push back the body and turn it in the womb, so that the head may be brought nearer to the outlet. in this way the head can usually be brought into position and the further course of delivery will be natural. sometimes, however, the lower jaw can not be reached with the hand, and then the orbit or, less desirably, the ear, may be availed of. the ear may be pulled by the hand, and by the aid of the repeller on the other shoulder the calf may be so turned that the lower jaw may be reached and availed of. better still, a clamp (pl. xviii, figs. and ) is firmly fixed on the ear and pulled by a rope, while the repeller is used on the opposite shoulder, and the hand of the operator pulls on the lower border of the neck and lifts it toward the other side. to pull on the upper border of the neck is to increase the spiral twist, while to raise the lower border is to undo it. if the outer orbit can be reached, the fingers may be inserted into it so as to employ traction, or a blunt finger hook (pl. xxi, fig. ) may be used, or a hook with a rope attached, or, finally, a hook on the end of a long staff. then, with the assistance of the repeller, the body may be so turned and the head advanced that the lower jaw may be reached and availed of. in case neither the ears nor the orbit can be reached, a cord should be passed around the neck of the calf as near the head as possible, and traction made upon that while the opposite shoulder is pushed toward the opposite side by the repeller, assisted by the hand dragging on the lower border of the neck. to aid the hand in passing a rope around the neck a cord carrier (pl. xxi, fig. ) is in use. it fails, however, to help us in the most difficult part of the operation--the passing of the cord down on the deep or farthest side of the neck--and to remedy this i have devised a cord carrier, furnished with a ring at the end, a joint or inches from the end, and another ring on the handle, close to this joint. (pl. xx, fig. .) a cord is passed through both rings and a knot tied on its end, just back of the terminal ring. the instrument, straightened out, is inserted until it reaches just beyond the upper border of the neck, when, by dragging on the cord, the movable segment is bent down on the farther side of the neck, and is pushed on until it can be felt at its lower border. the hand now seizes the knotted end of the cord beneath the lower border of the neck and pulls it through while the carrier is withdrawn, the cord sliding through its rings. the cord, pushed up as near to the head as possible, is furnished with a running noose by tying the knotted end round the other, or, better, the two ends are twisted around each other so as to give a firm hold on the neck without dangerously compressing the blood vessels. by pushing on the opposite shoulder with the repeller, and, assisting with the hand on shoulder, breastbone, or lower border of the neck, such a change of position will be secured as will speedily bring the head within reach. afterwards proceed as described above. these cases are always trying, but it is very rarely necessary to resort to embryotomy. when absolutely required, first remove one fore limb, and then, if still unsuccessful, the other, after which the head can easily be secured. (see "embryotomy," p. .) _head turned upward and backward._--in this case the face rests upon the spine; the forefeet appear alone in the passage, but fail to advance, and on examination the rounded, inferior border of the neck can be felt, extending upward and backward beneath the spine of the dam, and if the calf is not too large the hand may reach the lower jaw or even the muzzle. (pl. xvi, fig. .) a repeller is planted in the breast and the body of the calf pushed backward and downward so as to make room and bring the head nearer to the passage; or in some cases the body may be pushed back sufficiently by the use of the fore limbs alone. meanwhile the head is seized by the ear or the eye socket, or, if it can be reached, by the lower jaw, and pulled downward into position as space is obtained for it. if the hand alone is insufficient, the blunt hooks may be inserted in the orbits or in the angle of the mouth, or a noose may be placed on the lower paw, and by traction the head will be easily advanced. in case of a large fetus, the head of which is beyond reach, even when traction is made on the limbs, a rope may be passed around the neck and pulled, while the breastbone is pressed downward and backward by the repeller, and soon the change of position will bring the orbit or lower jaw within reach. with the above-described position the standing position is most favorable for success, but if the calf is placed with its back down toward the udder, and if the head is bent down under the brim of the pelvis, the best position for the cow is on her back, with her head downhill. in neglected cases, with death and putrefaction of the fetus and dryness of the passages, it may be necessary to extract in pieces. (see "embryotomy," p. .) _outward direction of the stifles_--_abduction of hind limbs._--as an obstacle to parturition, this is rare in cows. it is most liable to take place in cows with narrow hip bones, and when the service has been made by a bull having great breadth across the quarter. the calf, taking after the sire, presents an obstacle to calving in the breadth of its quarters, and if at the same time the toes and stifles are turned excessively outward and the hocks inward the combined breadth of the hip bones above and the stifles below may be so great that the pelvis will not easily admit them. after the forefeet, head, and shoulders have all passed out through the vulva, further progress suddenly and unaccountably ceases, and some dragging on the parts already delivered does not serve to bring away the hind parts. the oiled hand introduced along the side of the calf will discover the obstacle in the stifle joints turned directly outward and projecting on each side beyond the bones which circumscribe laterally the front entrance of the pelvis. the evident need is to turn the stifles inward; this may be attempted by the hand introduced by the side of the calf, which is meanwhile rotated gently on its own axis to favor the change of position. to correct the deviation of the hind limb is, however, very difficult, as the limbs themselves are out of reach and can not be used as levers to assist. if nothing can be done by pushing the body of the calf back and rotating it and by pressure by the hand in the passages, the only resort appears to be to skin the calf from the shoulder back, cut it in two as far back as can be reached, then push the buttocks well forward into the womb, bring up the hind feet, and so deliver. _hind limbs excessively bent on the body and engaged in the pelvis._--in this case the presentation is apparently a normal, anterior one; fore limbs and head advanced naturally and the parturition proceeds until half the chest has passed through the external passages, when suddenly progress ceases and no force will effect farther advance. an examination with the oiled hand detects the presence, in the passages, of the hind feet and usually the hind legs up to above the hocks. (pl. xvii, fig. .) the indications for treatment are to return the hind limbs into the body of the womb. if they have not advanced too far into the pelvis, this may be done as follows: a rope with running noose is passed over each hind foot and drawn tight around the lower part of the hock; the ropes are then passed through the two rings in the small end of the rotating instrument (pl. xx, fig. ) which is slid into the passages until it reaches the hocks, when the ropes, drawn tight, are tied around the handle of the instrument. then in the intervals between the pains the hocks are pushed forcibly back into the womb. if by this means flexion can be effected in hocks and stifles, success will follow; the hind feet will pass into the womb and clear of the brim of the pelvis and the body may now be advanced without hindrance, the hind limbs falling into place when the hip joints are extended. at the same time the pressure upon hind limbs must not be relaxed until the buttocks are engaged in the pelvis, as otherwise the feet may again get over the brim and arrest the progress of delivery. when the hind limbs are already so jammed into the pelvis that it is impossible to return them, the calf must be sacrificed to save the mother. cords with running nooses are first put on the two hind feet. the body must be skinned from the shoulders back as far as can be reached, and is to be then cut in two, if possible, back of the last rib. the remainder of the trunk is now pushed back into the body of the womb and by traction upon the cords the hind feet are brought up into the passages and the extraction will be comparatively easy. _hind presentation with one or both legs bent at the hock._--after the bursting of the water bags, though labor pains continue, no part of the fetus appears at the vulva unless it be the end of the tail. on examination the buttocks are felt wedged against the spine at the entrance of the pelvis and beneath them the bent hock joints resting on the brim of the pelvis below. (pl. xvii, fig. .) the calf has been caught by the labor pains while the limb was bent beneath it and has been jammed into or against the rim of the pelvis, so that extension of the limb became impossible. with the thigh bent on the flank, the leg on the thigh, and the shank on the leg, and all at once wedged into the passage, delivery is practically impossible. the obvious remedy is to push the croup upward and forward and extend the hind legs, and in the early stages this can usually be accomplished in the cow. a repeller (pl. xx, fig. ) is planted across the thighs and pointed upward toward the spine of the cow and pushed forcibly in this direction during the intervals between labor pains. meanwhile the oiled hand seizes the shank just below the hock and uses it as a lever, pushing the body back and drawing the foot forward, thus effectually seconding the action of the repeller. soon a distinct gain is manifest, and as soon as the foot can be reached it is bent back strongly at the fetlock, held in the palm of the hand, and pulled up, while the repeller, pressing on the buttocks, assists to make room for it. in this way the foot may be brought safely and easily over the brim of the pelvis without any risk of laceration of the womb of the foot. after the foot has been lifted over the brim, the whole limb can be promptly and easily extended. in cases presenting special difficulty in raising the foot over the brim, help may be had by traction on a rope passed around in front of the hock, and later still by a rope with a noose fastened to the pastern. in the worst cases, with the buttocks and hocks wedged deeply into the passages, it may prove difficult or impossible to push the buttocks back into the abdomen, and in such case the extension of the hind limb is practically impossible without mutilation. in some roomy cows a calf may be dragged through the passages by ropes attached to the bent hocks, but even when this is possible there is great risk of laceration of the floor of the vagina by the feet. the next resort is to cut the hamstring just above the point of the hock and the tendon on the front of the limb (flexor metatarsi) just above the hock, and even the sinews behind the shank bone just below the hock. this allows the stifle and hock to move independently of each other, the one undergoing extension without entailing the extension of the other; it also allows both joints to flex completely, so that the impacted mass can pass through a narrower channel. if now, by dragging on the hocks and operating with the repeller on the buttocks, the latter can be tilted forward sufficiently to allow of the extension of the stifle, the jam will be at once overcome, and the calf may be extracted with the hock bent, but the stifle extended. if even this can not be accomplished, it may now be possible to extract the whole mass with both hocks and stifles fully bent. to attempt this, traction may be made on the rope around the hocks and on a sharp hook (pl. xx, fig. ) passed forward between the thighs and hooked on to the brim of the pelvis. everything else failing, the offending limb or limbs may be cut off at the hip joint and extracted, after which extraction may proceed by dragging on the remaining limb, or by hooks on the hip bones. very little is to be gained by cutting off the limb at the hock, and the stifle is less accessible than the hip, and amputation of the stifle gives much poorer results. _hind limbs bent forward from the hip_--_breech presentation._--this is an exaggeration of the condition last described, only the hocks and stifles are fully extended and the whole limb carried forward beneath the belly. (pl. xvii, fig. .) the water bags appear and burst, but nothing presents unless it may be the tail. examination in this case detects the outline of the buttocks, with the tail and anus at its upper part. the remedy, as in the case last described, consists in pushing the buttock upward and forward with a repeller, the cow being kept standing and headed downhill until the thigh bone can be reached and used as a lever. its upper end is pushed forward and its lower end raised until, the joints becoming fully flexed, the point of the hock can be raised above the brim of the pelvis. if necessary a noose may be passed around the leg as far down toward the hock as possible and pulled on forcibly, while the hand presses forward strongly on the back of the leg above. when both hocks have been lodged above the brim of the pelvis the further procedure is as described under the last heading. if, however, the case is advanced and the buttocks wedged firmly into the passages, it may be impossible safely to push the fetus back into the womb, and the calf must either be dragged through the passage as it is or the limbs or the pelvis must be cut off. to extract successfully with a breech presentation the cow must be large and roomy and the calf not too large. the first step in this case is to separate the pelvic bones on the two sides by cutting from before backward, exactly in the median line below and where the thighs come together above. this may be done with a strong embryotomy knife, but is most easily accomplished with the long embryotome (pl. xx, fig. ). the form which i have designed (pl. xx, fig. ), with a short cutting branch jointed to the main stem, is to be preferred, as the short cutting piece may be folded on the main stem so that its cutting edge will be covered, and it can be introduced and extracted without danger. this is pushed forward beneath the calf's belly, and the cutting arm opened, inserted in front of the brim of the pelvis and pulled forcibly back through the whole length of the pelvic bones. the divided edges are now made to overlap each other and the breadth of the haunch is materially reduced. one end of the cord may then be passed forward by means of a cord carrier (pl. xxi, fig. ) on the inner side of one thigh until it can be seized at the stifle by the hand passed forward on the outer side of that thigh. this end is now pulled back through the vagina, the other end passed through the cord carrier and passed forward on the inner side of the other thigh until it can be seized at the stifle by the hand passed forward outside that thigh. this end is drawn back through the vagina like the first, and is tied around the other so as to form a running noose. the rope is now drawn through the ring until it forms a tight loop, encircling the belly just in front of the hind limbs. on this strong traction can be made without interfering with the full flexion of the limbs on the body, and if the case is a suitable one, and the body of the fetus and the passages are both well lubricated with oil or lard, a successful parturition may be accomplished. a less desirable method is to put a rope around one thigh or a rope around each and drag upon these, but manifestly the strain is not so directly on the spine, and the limbs may be somewhat hampered in flexion. this method being inapplicable, the next resort is to cut off one or both hind limbs at the hip joint. free incisions are made on the side of the haunch so as to expose the hip joint, and the muscles are cut away from the head of the thigh bone down to its narrow neck, around which a rope is passed and firmly fixed with a running noose. the joint is now cut into all around, and while traction is made on the cord the knife is inserted into the inner side of the joint and the round ligament severed. the cord may now be dragged upon forcibly, and the muscles and other parts cut through as they are drawn tense, until finally the whole member has been extracted. traction on the rope round the other thigh will now suffice to extract, in most cases, but if it should fail the other limb may be cut off in the same manner, and then hooks inserted in front of the brim of the pelvis or in the openings in the bones of its floor (obturator foramina) will give sufficient purchase for extraction. another method is to insert a knife between the bone of the rump (sacrum) and the hip bone and sever their connections; then cut through the joint (symphysis) between the two hip bones in the median line of the floor of the pelvis, and then with a hook in the opening on the pelvic bones (obturator foramen) drag upon the limb and cut the tense soft parts until the limb is freed and extracted. _presentation of the back._--in this presentation straining may be active, but after the rupture of the water bags no progress is made, and the hand introduced will recognize the back with its row of spinous processes and the springing ribs at each side pressed against the entrance to the pelvis. (pl. xvii, fig. .) the presence or absence of the ribs will show whether it is the region of the chest or the loins. by feeling along the line of spines until the ribs are met with we shall learn that the head lies in that direction. if, on the contrary, we follow the ribs until they disappear, and a blank space is succeeded by hip bones, it shows that we are approaching the tail. the head may be turned upward, downward, to the right side, or to the left. the object must be to turn the fetus so that one extremity or the other can enter the passage, and the choice of which end to bring forward will depend on various considerations. if one end is much nearer the outlet than the other, that would naturally be selected for extraction, but if they are equidistant the choice would fall on the hind end, as having only the two limbs to deal with without any risk of complication from the head. when the head is turned upward and forward it will usually be preferable to bring up the hind limb, as, owing to the drooping of the womb into the abdomen, rotation of the fetus will usually be easier in that direction, and if successful the resulting position will be a natural posterior presentation, with the back of the calf turned toward the rump of the cow. similarly with the croup turned upward and forward, that should be pushed on forward, and if the forefeet and head can be secured it will be a natural anterior presentation, with the back of the calf turned upward toward the rump of the cow. the womb should be injected with warm water or oil, and the turning of the calf will demand the combined action of the repeller and the hand, but in all such cases the operator has an advantage that the body of the fetus is wholly within the body of the womb, and therefore movable with comparative ease. no part is wedged into the pelvic passages as a complication. the general principles are the same as in faulty presentation fore and hind, and no time should be lost in making the manipulations necessary to bring the feet into the pelvis, lest they get inbent or otherwise displaced and add unnecessary complications. with a transverse direction of the calf, the head being turned to one side, the pressure must be directed laterally, so that the body will glide around on one side of the womb, and the extremities when reached must be promptly seized and brought into the passages. sometimes a fortunate struggle of a live fetus will greatly aid in rectifying the position. _breast and abdomen presented._--all four feet in the passages._--in this form the calf lies across the womb with its roached back turned forward and its belly toward the pelvis. all four feet may be extended and engaged in the passages, or one or more may be bent on themselves so as to lie in front of the pelvis. the head, too, may usually be felt on the right side or the left, and if detected it serves to identify the exact position of the fetus. the position may further be decided upon by examination of the feet and limbs. with the limbs extended the front of the hoofs and the convex aspect of the bent pasterns and fetlocks will look toward that flank in which lie the head and shoulders. on examination still higher the smooth, even outline of the knee and its bend, looking toward the hind parts, characterize the fore limb, while the sharp prominence of the point of the hock and the bend on the opposite side of the joint, looking toward the head, indicate the hind limb. (pl. xvii, fig. .) the remedy of this condition is to be sought in repelling into the womb those limbs that are least eligible for extraction, and bringing into the passages the most eligible extremities. the most eligible will usually be those which project farthest into the passages, indicating the nearer proximity of that end of the calf. an exception may, however, be made in favor of that extremity which will give the most natural presentation. thus if, owing to obliquity in the position of the fetus, the hind extremities promised a presentation with the back of the fetus turned down toward the udder, and the anterior extremities one with the back turned up toward the spine, the latter should be selected. again, if the choice for the two extremities is evenly balanced, the hind may be chosen as offering less risk of complication, there being no head to get displaced. the first step in the treatment is to place a running noose on each of the four feet, marking those of the fore limbs to distinguish them from those of the hind ones. in case it is proposed to bring the anterior extremities into the passage, a noose should also be placed on the lower jaw. then run the ropes attached to the two feet that are to be pushed back through the ring of a cord carrier (pl. xxi, fig. ), passing the rings down to the feet, and by the aid of the carrier push them well back into the womb and hold them there. meanwhile drag upon the ropes attached to the two other feet so as to bring them into the passage (or, in case of the anterior extremity, on the two foot ropes and the head one). the other feet must be pushed back into the womb until the body of the calf is fully engaged in the passages. after this they can no longer find an entrance, but must follow as the body escapes. neglected and aggravated cases. in laying down the foregoing rules for giving assistance in critical cases of calving it is not intimated that all cases and stages can be successfully dealt with. too often assistance is not sought for many hours or even days after labor pains, and the escape of the waters intimate the danger of delay. not seldom the long delay has been filled up with unintelligent and injurious attempts at rendering assistance, violent pulling when resistance is insurmountable without change of position, injuries to the vagina and womb by ill-considered but too forcibly executed attempts to change the position, the repeated and long-continued contact with rough hands and rougher ropes and hooks, the gashes with knives and lacerations with instruments in ignorant hands, the infecting material introduced on filthy hands and instruments, and the septic inflammations started in the now dry and tender passages and womb. not infrequently the death, putrefaction, and bloating of the calf in the womb render the case extremely unpromising and make it impossible to apply successfully many of the measures above recommended. the labor pains of the cow may have practically ceased from exhaustion; the passages of the vagina may be so dry, tender, friable, red, and swollen that it requires considerable effort even to pass the oiled hand through them, and the extraction of the calf or any portion of it through such a channel seems a hopeless task; the womb may be equally dry, inflamed and swollen, so that its lining membrane or even its entire thickness is easily torn; the fetal membranes have lost their natural, unctuous and slippery character, and cling firmly to the dry walls of the womb, to the dry skin of the calf, or to the hands of the operator; the dead and putrefying calf may be so bloated with gases that the womb has been overdistended by its presence, and the two adhere so closely that the motion of the one on the other is practically impossible. in other cases reckless attempts to cut the calf in pieces have left raw surfaces with projecting bones which dangerously scratch and tear the womb and passages. in many cases the extreme resort must be had of cutting the fetus to pieces (embryotomy), or the still more redoubtable one of cæsarean section (extraction through the flank). dissection of the unborn calf (embryotomy). in some cases the dissection of the calf is the only feasible means of delivering it through the natural passages; and while it is especially applicable to the dead calf, it is also on occasion called for in the case of the living. as a rule, the living calf should be preserved, if possible, but if this threatens to entail the death of the cow it is only in the case of offspring of rare value that its preservation is to be preferred. to those acquainted with the toil, fatigue, and discomfort of embryotomy, no discussion is necessary so long as there is a prospect of success from the simple and generally easier method of rectifying the faulty position of the calf. when the correction of the position is manifestly impossible, however, when distortions and monstrosities of the fetus successfully obstruct delivery, when the pelvic passages are seriously contracted by fractures and bony growths, when the passages are virtually almost closed by swelling, or when the calf is dead and excessively swollen, no other resort may be available. in many cases of distortion and displacement the dismemberment of the entire calf is unnecessary, the removal of the offending member being all that is required. it will be convenient, therefore, to describe the various suboperations one by one and in the order in which they are usually demanded. _amputation of the fore limb._--in cutting off a fore limb it is the one presenting that should be selected, since it is much more easily operated on, and its complete removal from the side of the chest affords so much more space for manipulation that it often makes it easy to bring the other missing limb or the head into position. the first consideration is to skin the limb from the fetlock up and leave the skin attached to the body. the reasons for this are: (_a_) that the skin is the most resistant structure of the limb, and when it has been removed the entire limb can be easily detached; (_b_) the tough skin left from the amputated limb may be used as a cord in subsequent traction on the body of the calf; (_c_) the dissection and separation of the limb are far more safely accomplished under the protection of the enveloping skin than if the operator's hands and instruments were in direct contact with the walls of the passages or womb; (_d_) the dissection can be much more easily effected while the skin is stretched by the left hand, so as to form a comparatively firmer resistant point for the knife, than when it is attempted to cut the soft, yielding, and elastic tissues which naturally offer little solid resistance, but constantly recede before the cutting edge of the instrument. the preservation of the skin is therefore a cardinal principle in the amputation of all parts in which it is at all feasible. the presenting foot is inclosed in a noose and drawn well out of the passages. then a circular incision through the skin is made around the limb just above the fetlock. from this the skin is slit up on the inner side of the limb to the breast. then the projecting part of the limb is skinned up to the vulva, traction being made on the foot by an assistant so as to expose as much as possible. the embryotomy knife may now be taken (pl. xxi, fig. ), and a small hole having been cut in the free end of the detached portion of skin, that is seized by the left hand and extended while its firm connections with the deeper structures are cut through. the looser connections can be more quickly torn through with the closed fist or the tips of the four fingers held firmly together in a line or with the spud, of which there are several kinds. much of the upper part of the limb can be skinned more speedily without the knife, but that must be resorted to to cut across tough bands whenever these interrupt the progress. the skinning should be carried upward on the outer side of the shoulder blade to the spine or nearly so. then with the knife the muscles attaching the elbow and shoulder to the breastbone are cut across, together with those on the inner side of the shoulder joint and in front and behind it as far as these can be reached. steady traction is now made upon the foot, the remaining muscles attaching the shoulder blade to the trunk are torn through with a cracking noise, and the whole limb, including the shoulder blade and its investing muscles, comes away. if the shoulder blade is left the bulk of the chest is not diminished, and nothing has been gained. before going further it is well to see whether the great additional space thus secured in the passages will allow of the missing limb or head to be brought into position. if not, the other presenting part, limb or head, is to be amputated and extracted. for the limb the procedure is a repetition of that just described. _amputation of the head._--the head is first seized and drawn well forward, or even outside the vulva, by a rope with a running noose placed around the lower jaw just behind the incisor teeth, by a sharp hook inserted in the arch of the lower jaw behind the union of its two branches and back of the incisor teeth, or by hooks inserted in the orbits, or, finally, in case the whole head protrudes, by a halter. (pl. xxi, figs _a_ and _b._) in case the whole head protrudes, a circular incision through the skin is made just back of the ear, and the cut edge being held firmly by the left hand, the neck is skinned as far as it can be reached. then the great ligamentous cord above the spine is cut across at the farthest available point, together with the muscles above and below the spine. strong traction on the head will then detach it at this point and bring it away, but should there still be too much resistance the knife is inserted between the bodies of two vertebræ just behind one of the prominent points felt in the median line below, and their connecting fibrous cartilage is cut through, after which comparatively moderate pulling will bring it away. the detached neck and body at once slip back into the womb, and if the fore limbs are now brought up and pulled they are advanced so far upon the chest that the transverse diameter of that is greatly diminished and delivery correspondingly facilitated. if the head is still inclosed in the vagina two methods are available: ( ) the removal of the lower jaw and subsequent separation of the head from the neck; ( ) the skinning of the whole head and its separation from the neck. to remove the lower jaw the skin is dissected away from it until the throat is reached. then the muscles of the cheeks and side of the jaw (masseters) are cut through and those connecting the jaw with the neck. when traction is made on the rope around the lower jaw it will usually come away with little trouble. should it resist, its posterior extremity on each side (behind the grinding teeth) may be cut through with bone forceps or with a guarded bone chisel. (pl. xx, fig. .) after the removal of the lower jaw the way will be open to separate the head from the neck, the knife being used to cut into the first or second joint from below, or the bone forceps or chisel being employed to cut through the bones of the neck. then traction is made on the head by means of hooks in the orbits, and the hand, armed with an embryotomy knife, is introduced to cut through the tense resisting ligament, and muscles above the bones. the skin and the strong ligamentous cord attached to the poll are the essential things to cut, as the muscles can easily be torn across. unless there are great difficulties in the way it is well to skin the head from the eyes back, and on reaching the poll to cut through the ligament and then bring the head away by pulling. if it is decided to remove the entire head at once, it may be skinned from the front of the eyes back to behind the lower jaw below and the poll above, then cut through the muscles and ligaments around the first joint and pull the head away, assisting, if need be, in the separation of the head by using the knife on the ligament of the joint. if the calf is a double-headed monster, the skinning of the head must be carried backward until the point has been reached where both heads branch from the single neck, and the separation must be made at that point. the muscles and ligaments are first to be cut through; and if the part can not then be detached by pulling, the bodies of the vertebræ may be separated by passing the knife through the joint. the second head may now be secured by a noose around the lower jaw or hooks in the orbits and brought up into place, the body being pushed back toward the other side by a repeller, so as to make room. it should be added that, except in the case of a double-headed monster, or in case of the head protruding or nearly so, and one or both fore limbs presenting, it is rarely desirable to undertake amputation of the head. the space desirable in the passages can usually be obtained by the much simpler and easier procedure of removing one or both fore limbs. _amputation of the hind limbs._--this is sometimes demanded on the one extended limb when the other can not be brought up and delivery can not be effected; also in case of monsters having extra hind limbs; when the calf is dead, putrid, and bloated with gas; and in some cases of breech presentation, as described under that head. when the limb is extended the guiding principles are as in the case of the fore limbs. the skin is cut through circularly above the fetlock and slit up to beneath the pelvic bones on the inner side of the thigh. it is then dissected from the other parts as high as it has been slit on the inner side and to above the prominence (_trochanter major_) on the upper end of the thigh bone on the outer side of the joint. in this procedure the hands and spud can do much, but owing to the firmer connections the knife will be more frequently required than in the case of the fore limb. the muscles are now cut through all around the hip joint, and strong traction is made by two or three men on the limb. if there is still too much resistance, a knife is inserted into the joint on the inner side and its round ligament cut through, after which extraction will be comparatively easy. this accomplished, it will often be possible to extract the fetus with the other leg turned forward into the womb. if the calf is bloated with gas, it may be necessary to remove the other leg in the same way, and even to cut open the chest and abdomen and remove their contents before extraction can be effected. in the case of extra limbs it may be possible to bring them up into the passages after the presenting hind limbs have been removed. if this is not practicable, they may be detached by cutting them through at the hip joint, as described under "breech presentation," page . another method of removing the hind limb is, after having skinned it over the quarter, to cut through the pelvic bones from before backward, in the median line below, by knife, saw, or long embryotome (pl. xx, fig. ), and then disjoint the bones of the spine (sacrum) and the hip bone (ilium) on that side with embryotome, knife, or saw, and then drag away the entire limb, along with all the hip bones on that side. this has the advantage of securing more room and thereby facilitating subsequent operations. both limbs may be removed in this way, but on the removal of the second the operator is without any solid point to drag upon in bringing away the remainder of the fetus. _division across the middle of the body._--in cases of extra size, monstrosity, or distortion of one end of the body it may be requisite to cut the body in two and return the half from the passages into womb, even after one-half has been born. the presenting members are dragged upon forcibly by assistants to bring as much of the body as possible outside. then cut through the skin around the body at some distance from the vulva, and with hand, knife, and spud detach it from the trunk as far back into the passages as can be reached. next cut across the body at the point reached, beginning at the lower part (breast, belly) and proceeding up toward the spine. this greatly favors the separation of the backbone when reached, and further allows of its being extended so that it can be divided higher up. when the backbone is reached, the knife is passed between the two bones, the prominent ridges across their ends acting as guides, and by dragging and twisting the one is easily detached from the other. with an anterior presentation the separation should, if possible, be made behind the last rib, while with a posterior presentation as many of the ribs should be brought away as can be accomplished. having removed one half of the body, the remaining half is to be pushed back into the womb, the feet sought and secured with nooses, and the second half removed in one piece if possible; and if not, then after the removal of the extra limb or other cause of obstruction. _removed of the contents of chest or abdomen._--if the body of the calf sticks fast in the passages by reason of the mere dryness of its skin and of the passages, the obstacle may be removed by injecting sweet oil past the fetus into the womb through a rubber or other tube, and smearing the passages freely with lard. when the obstruction depends on excess of size of the chest or abdomen or thickening of the body from distorted spine, much advantage may be derived from the removal of the contents of these great cavities of the trunk. we have already seen how the haunches may be narrowed by cutting the bones apart in the median line below and causing their free edges to overlap each other. the abdomen can be cut open by the embryotomy knife or the long embryotome in the median line, or at any point, and the contents pulled out with the hand, the knife being used in any case when especial resistance is encountered. if the abdomen is so firmly impacted that it can not be dealt within this way, one hind limb and the hip bone on the same side may be removed as described under "amputation of the hind limbs," page . this will allow the introduction of the hand into the abdomen from behind, so as to pull out the contents. by introducing an embryotomy knife in the palm of the hand and cutting through the muscle of the diaphragm the interior of the chest can be reached in the same way and the heart and lungs removed. when, in dealing with an anterior presentation, it becomes necessary to remove the contents of the chest, the usual course is to cut through the connections of the ribs with the breastbone (the costal cartilages) close to the breastbone on each side, and from the abdomen forward to the neck. then cut through the muscles connecting the front of the breastbone with the neck and its hinder end with the belly, and pull out the entire breastbone. having torn out the heart and lungs with the hand, make the rib cartilages on the one side overlap those on the other, so as to lessen the thickness of the chest, and proceed to extract the body. if it seems needful to empty the abdomen as well, it is easy to reach it by cutting through the diaphragm, which separates it from the chest. _delivery through the flank_ (_cæsarean section, or laparotomy_).--this is sometimes demanded, when the distortion and narrowing of the hip bones are such as to forbid the passage of the calf, or when inflammation has practically closed the natural passages and the progeny is more valuable and worthy of being saved than the dam; also in cases in which the cow has been fatally injured, or is ill beyond possibility of recovery and yet carries a living calf. it is too often a last resort after long and fruitless efforts to deliver by the natural channels, and in such cases the saving of the calf is all that can be expected, the exhausted cow, already the subject of active inflammation and too often also of putrid poisoning, is virtually beyond hope. the hope of saving the dam is greatest if she is in good health and not fatigued, in cases, for example, in which the operation is resorted to on account of broken hip bones or abnormally narrow passages. the stock owner will not attempt such a serious operation as this. yet, if the mother has just died or is to be immediately sacrificed, no one should hesitate to resort to it in order to save the calf. if alive, it is important to have the cow perfectly still. her left fore leg being bent at the knee by one person, another may seize the left horn and nose and turn the head to the right until the nose rests on the spine just above the shoulder. the cow will sink down gently on her left side without shock or struggle. one may now hold the head firmly to the ground, while a second, carrying the end of the tail from behind forward on the inside of the right thigh, pulls upon it so as to keep the right hind limb well raised from the ground. if time presses she may be operated on in this position, or if the cow is to be sacrificed a blow on the head with an ax will produce quietude. then the prompt cutting into the abdomen and womb and the extraction of the calf requires no skill. if, however, the cow is to be preserved, her two forefeet and the lower hind one should be safely fastened together and the upper hind one drawn back. two ounces chloral hydrate, given by injection, should induce sleep in minutes, and the operation may proceed. in case the cow is to be preserved, wash the right flank and apply a solution of grains of corrosive sublimate in a pint of water. then, with an ordinary scalpel or knife, dipped in the above-mentioned solution, make an incision from inches below and in front of the outer angle of the hip bone in a direction downward and slightly forward to a distance of inches. cut through the muscles, and more carefully through the transparent lining membrane of the abdomen (peritoneum), letting the point of the knife lie in the groove between the first two fingers of the left hand as they are slid down inside the membrane and with their back to the intestines. an assistant, whose hands, like those of the operator, have been dipped in the sublimate solution, may press his hands on the wound behind the knife to prevent the protrusion of the intestines. the operator now feels for and brings up to the wound the gravid womb, allowing it to bulge well through the abdominal wound, so as to keep back the bowels and prevent any escape of water into the abdomen. this is seconded by two assistants, who press the lips of the wound against the womb. then an incision inches long is made into the womb at its most prominent point, deep enough to penetrate its walls, but not so as to cut into the water bags. in cutting, carefully avoid the cotyledons, which may be felt as hard masses inside. by pressure the water bags may be made to bulge out as in natural parturition, and this projecting portion may be torn or cut so as to let the liquid flow down outside of the belly. the operator now plunges his hand into the womb, seizes the fore or hind limbs, and quickly extracts the calf and gives it to an attendant to convey to a safe place. the womb may be drawn out, but not until all the liquid has flowed out, and the fetal membranes must be separated from the natural cotyledons, one by one, and the membranes removed. the womb is now emptied with a sponge, which has been boiled or squeezed out of a sublimate solution, and if any liquid has fallen into the abdomen it may be removed in the same way. a few stitches are now placed in the wound in the womb, using carbolized catgut. they need not be very close together, as the wound will diminish greatly when the womb contracts. should the womb not contract at once it may have applied against it a sponge squeezed out of a cold sublimate solution, or it may be drawn out of the abdominal wound and exposed to the cold air until it contracts. its contraction is necessary to prevent bleeding from its enormous network of veins. when contracted, the womb is returned into the abdomen and the abdominal wound sewed up. one set of stitches, to be placed at intervals of inches, is passed through the entire thickness of skin and muscles and tied around two quills or little rollers resting on the skin. (pl. xxvii, fig. .) these should be of silver, and may be cut at one end and pulled out after the wound has healed. the superficial stitches are put in every half inch and passed through the skin only. they, too, may be of silver, or pins may be inserted through the lips and a fine cord twisted round their ends like a figure . (pl. xxvii, fig. .) the points of the pins may be snipped off with pliers. the edges may be still further held together by the application of venice turpentine, melted so as to become firmly adherent, and covered with a layer of sterilized cotton wool. then the whole should be supported by a bandage fixed around the loins and abdomen. * * * * * diseases of the generative organs. description of plates. plate xii. fetal calf within its membranes (at mid term). the uterus is opened on the left side. in the uterus the fetus is surrounded by several membranes which are known as the amnion or inner layer, the allantois or central layer, and the chorion or outer layer. the amnion is nearest the fetus and forms a closed sac around it filled with a fluid known as liquor amnii, in which the fetus floats. the allantois is composed of two layers, which form a closed sac in connection with the urachus, or the tube which extends from the fetal bladder through the umbilical cord. the one layer of the allantois is spread over the outer surface of the amnion and the other over the inner surface of chorion. the allantois also contains a fluid which is known as the allantoid liquid. the chorion is the outer envelope or membrane of the fetus, completely inclosing the fetus with its other membranes. on the outer surface of this membrane are found the fetal placentulæ, or cotyledons, which, through their attachment to the maternal cotyledons, furnish the fetus with the means of sustaining life. the relation of the fetal and maternal cotyledons to each other is illustrated on the following plate. plate xiii. pregnant uterus with cotyledons. fig. . uterus of the cow during pregnancy, laid open to show the cotyledons (_d_) on the internal surface of uterus (_c_). the ovary (_a_) is shown cut across, and the two halves are laid open to show the position of the discharged ovum at _a_'. fig. illustrates the relation of the fetal and maternal parts of a cotyledon. a portion of the uterus (_a_) is shown with the maternal cotyledon (_bb_) attached to it. the fetal portion (_d_) consists of a mass of very minute hairlike processes on the chorion (_e_), which fit into corresponding depressions or pits of the maternal portion. each portion is abundantly supplied with blood vessels, so that a ready interchange of nutritive fluid may take place between mother and fetus. plate xiv. vessels of umbilical cord. fig. . fetal calf with a portion of the wall of the abdominal cavity of the right side and the stomach and intestines removed to illustrate the nature of the umbilical or navel cord. it consists of a tube ( - ') into which pass the two umbilical arteries ( ) carrying blood to the placenta in the uterus or womb and the umbilical vein ( ) bringing the blood back and carrying it into the liver. the cord also contains the urachus ( ') which carries urine from the bladder ( ) through the cord. these vessels are all obliterated at birth. , liver; ', lobe of same, known as the lobus spigelii; '', gall bladder; , right kidney; ', left kidney; '', ureters, or the tubes conducting the urine from the kidneys to the bladder; , rectum, where it has been severed in removing the intestines; , uterus of the fetus, cut off at the anterior extremity; , aorta; , posterior vena cava. (from _fürstenberg-leisering, anatomie und physiologie des rindes._) fig. . blood vessels passing through the umbilical cord in a human fetus. (from quain's anatomy, vol. .) _l_, liver; _k_, kidney; _i_, intestines; _u c_, umbilical cord; _ua_, umbilical arteries. the posterior aorta coming from the heart passes backward and gives rise to the internal iliac arteries, and of these the umbilical arteries are branches. _uv_, umbilical vein; this joins the portal vein, passes onward to the liver, breaks up into smaller vessels, which reunite in the hepatic vein; this empties into the posterior vena cava, which carries the blood back to the heart. * * * * * [illustration: plate xii. fetal calf within its membranes.] [illustration: plate xiii. pregnant uterus with cotyledons.] [illustration: plate xiv. vessels of umbilical cord.] [illustration: plate xv.] [illustration: plate xvi.] [illustration: plate xv. normal position of calf in utero.] [illustration: plate xvi. abnormal positions of calf in utero.] [illustration: plate xvii. abnormal positions of calf in utero.] * * * * * plate xv. normal position of calf in utero. this is the most favorable position of the calf or fetus in the womb at birth, and the position in which it is most frequently found. this is known as the normal anterior position. the back of the fetus is directly toward that of the mother, the forelegs are extended back toward the vulva of the mother, and the head rests between them. the birth of the calf in this position usually takes place without artificial assistance. plate xvi. abnormal positions of calf in utero. (figs. , , , and from fleming's veterinary obstetrics; fig. after st. cyr, from hill's bovine medicine and surgery; fig. from d'arboval, dictionaire de médecine et de chirurgie.) fig. . anterior presentation; one fore limb completely retained. the retained limb must be reached if possible and brought forward joint by joint and the fetus then extracted. fig. . anterior presentation; fore limbs bent at knee. the limbs must be extended before delivery can be accomplished. fig. . anterior presentation; fore limb crossed over neck. the leg should be grasped a little above the fetlock, raised, drawn to its proper side, and extended in genital canal. fig. . anterior presentation; downward deviation of head. the head must be brought into position seen in plate xv before delivery can take place. fig. . anterior presentation; deviation of the head upward and backward. retropulsion is the first indication, and will often bring the head into its normal position. fig. . anterior presentation; head presented with back down. the fetus should be turned by pushing back the fore parts and bringing up the hind so as to make a posterior presentation. plate xvii. abnormal positions of calf in utero. (figs. and from fleming; figs. , , and from d'arboval.) fig. . anterior presentation, with hind feet engaged in pelvis. a very serious malpresentation, in which it is generally impossible to save the fetus if delivery is far advanced. the indications are to force back the hind feet. fig. . thigh and croup presentation, showing the fetus corded. the cord has a ring or noose at one end. the two ends of the cord are passed between the thighs, brought out at the flanks, and the plain end passed through the noose at the top of the back and brought outside the vulva. the fetus must be pushed back and an attempt made to bring the limbs properly into the genital passage. fig. . croup and hock presentation. the indications in this abnormal presentation are the same as described for fig. . fig. . posterior presentation; the fetus on its back. turn the fetus so as to make a normal anterior presentation. fig. . sterno-abdominal presentation. the fetus is on its side with limbs crossing and presenting. the limbs least eligible for extraction should be forced back into the uterus. fig. . dorso-lumbar presentation; the back presenting. the fetus must be turned so that one or the other extremity can enter the passage. plate xviii. abnormal positions of the calf in utero. surgical instruments and sutures. fig. . twin pregnancy, showing the normal anterior and posterior presentations. (from fleming.) fig. . abdominal dropsy of the fetus; normal presentation; fore limbs corded. (after armatage.) the drawing illustrates the method of puncturing the abdomen through the chest with a long trocar and cannula. the fluid is represented escaping from the cannula after the withdrawal of the trocar. fig. . tallich's short, bent, crotchet forceps. the forceps have bent and toothed jaws, which are intended to take hold of the fetus where neither cords nor hooks can be applied, as the ear, nose, or skin of cheek. fig. . clamp for ear, skin, etc.: - , blades with hooks and corresponding holes; , ring to close the blades; , stem with female screw for handle; , handle, which may be either straight or jointed and flexible. plate xix. monstrosities. this plate illustrates various malformations and diseases of the fetus which act as the cause of difficult parturition. figs. , , . fetuses with portions of their bodies double. fig. (from fleming), double head, neck, and fore limbs. fig. (from encyclop. der gesam. thierheilkunde, ), double head, neck, fore limbs, and body. fig. (from fleming), double faced. fig. . fetus with head very much enlarged. (from fleming.) this affection is known as hydrocephalus, or dropsy of the brain, and is due to a more or less considerable quantity of fluid in the cranial cavity of the fetus. fig. . skull of the calf represented in fig. . the roof of the skull is absent. (from fleming.) plate xx. instruments used in difficult labor. fig. . long embryotome with joint. fig. . long, sharp hook. this instrument is about feet in length, including the handle. hooks of this kind, both blunt and sharp, are applied directly to the fetus to assist in delivery. fig. . günther's long-handled embryotome. this instrument and that represented in fig. are of special value in cutting through muscular tissue and in separating the limbs from the trunk when the fetus can not be removed entire. these embryotomes are usually inches long, but may be made either longer or shorter. fig. . jointed cord-carrier, used in difficult parturition to carry a cord into regions which can not be reached by the arm. fig. . instrument used to rotate or turn the fetus, known as a rotator. fig. . dilator of the neck of the womb, used when conception can not take place owing to a contracted condition of the neck of the womb. fig. . repeller. an instrument from to feet long, used to force the fetus forward into the womb. this operation is generally necessary when the presentation is abnormal and the fetus has advanced too far into the narrow inlet to the uterus to be moved. fig. . cartwright's bone chisel. including the handle, this instrument is about inches in length; the chisel portion is a little more than inches long and to - / broad. only the middle portion is sharp, the projecting corners are blunt, and the sides rounded. this instrument is used for slitting up the skin of a limb and as a bone chisel when it is necessary to mutilate the fetus in order to effect delivery. * * * * * [illustration: plate xviii. abnormal position of calf in utero. surgical instruments and sutures.] [illustration: plate xix. monstrosities.] [illustration: plate xx. instruments used in difficult labor.] [illustration: plate xxi. instruments used in difficult labor.] * * * * * plate xxi. instruments used in difficult labor. fig. . embryotome, an instrument used when it is necessary to reduce the size of the fetus by cutting away certain parts before birth can be effected. this instrument may be long or short, straight or curved. fig. . also an embryotome. the blade can be made to slide out of or into the handle. the instrument can thus be introduced into or withdrawn from the genital passage without risk of injury to the mother. fig. . schaack's traction cord. this is merely a cord with a running noose at one end and a piece of wood at the other, to offer a better hold for the hand. figs. _a_ and _b._ reuff's head collar for securing the head of the fetus. fig. . curved cord-carrier, used in difficult parturition to carry a cord into regions which can not be reached by the arm. fig. . blunt hook, used in difficult parturition. fig. . short hook forceps, used in difficult parturition. fig. . blunt finger hook. * * * * * diseases following parturition. by james law, f. r. c. v. s., _formerly professor of veterinary science, etc., in cornell university._ flooding (bleeding from the womb). though not so common in the cow as in the human female, flooding is sufficiently frequent to demand attention. it may depend on a too rapid calving and a consequent failure of the womb to contract when the calf has been removed. the pregnant womb is extraordinarily rich in blood vessels, especially in large and tortuous veins, which become compressed and almost obliterated under contraction, but remain overfilled and often bleed into the cavity of the womb should no contraction take place. cox records cases in which the labor pains had detached and expelled the fetal membranes, while the calf, owing to large size or wrong presentation, was detained in the womb, and the continued dilatation of the womb in the absence of the fetal membranes led to a flow of blood which accumulated in clots around the calf. other causes are laceration of the cotyledons of the womb, or from an antecedent inflammation of the placenta, and the unnatural adhesion of the membranes to the womb, which bleeds when the two are torn apart. weakness of the womb from overdistention, as in dropsy, twins, etc., is not without its influence. finally, eversion of the womb (casting the withers) is an occasional cause of flooding. the trouble is only too evident when the blood flows from the external passages in drops or in a fine stream. when it is retained in the cavity of the womb, however, it may remain unsuspected until it has rendered the animal almost bloodless. the symptoms in such case are paleness of the eyes, nose, mouth, and of the lips of the vulva, a weak, rapid pulse, violent and perhaps loud beating of the heart (palpitations), sunken, staring eyes, coldness of the skin, ears, horns, and limbs, perspiration, weakness in standing, staggering gait, and, finally, inability to rise, and death in convulsions. if these symptoms are seen, the oiled hand should be introduced into the womb, which will be found open and flaccid and containing large blood clots. _treatment._--treatment consists in the removal of the fetal membranes and blood clots from the womb (which will not contract while they are present), the dashing of cold water on the loins, right flank, and vulva, and if these measures fail, the injection of cold water into the womb through a rubber tube furnished with a funnel. in obstinate cases a good-sized sponge soaked in tincture of muriate of iron should be introduced into the womb and firmly squeezed, so as to bring the iron into contact with the bleeding surface. this is at once an astringent and a coagulant for the blood, besides stimulating the womb to contraction. in the absence of this agent astringents (solution of copperas, alum, tannic acid, or acetate of lead) may be thrown into the womb, and one-half-dram doses of acetate of lead may be given by the mouth, or ounce powdered ergot of rye may be given in gruel. when nothing else is at hand, an injection of oil of turpentine will sometimes promptly check the bleeding. eversion of the womb (casting the withers). like flooding, this is the result of failure of the womb to contract after calving. if that organ contracts naturally, the afterbirth is expelled, the internal cavity of the womb is nearly closed, and the mouth of the organ becomes so narrow that the hand can not be forced through, much less the whole mass of the matrix. when, however, it fails to contract, the closed end of one of the horns may fall into its open internal cavity, and under the compression of the adjacent intestines, and the straining and contraction of the abdominal walls, it is forced farther and farther, until the whole organ is turned outside in, slides back through the vagina, and hangs from the vulva. the womb can be instantly distinguished from the protruding vagina or bladder by the presence, over its whole surface, of to mushroomlike bodies (cotyledons), each to inches in diameter, and attached by a narrow neck. (pls. xii, xiii.) when fully everted, it is further recognizable by a large, undivided body hanging from the vulva, and two horns or divisions which hang down toward the hocks. in the imperfect eversions the body of the womb may be present with two depressions leading into the two horns. in the cases of some standing the organ has become inflamed and gorged with blood until it is as large as a bushel basket, its surface has a dark-red, bloodlike hue, and tears and bleeds on the slightest touch. still later lacerations, raw sores, and even gangrene are shown in the mass. at the moment of protrusion the general health is not altered, but soon the inflammation and fever with the violent and continued straining induce exhaustion, and the cow lies down, making no attempt to rise. _treatment._--treatment varies somewhat, according to the degree of the eversion. in partial eversion, with the womb protruding only slightly from the vulva and the cow standing, let an assistant pinch the back to prevent straining while the operator pushes his closed fist into the center of the mass and carries it back through the vagina, assisting in returning the surrounding parts by the other hand. in more complete eversion, but with the womb as yet of its natural bulk and consistency and the cow standing, straining being checked by pinching the back, a sheet is held by two men so as to sustain the everted womb and raise it to the level of the vulva. it is now sponged clean with cold water, the cold being useful in driving out the blood and reducing the bulk, and finally it may be sponged over with laudanum or with a weak solution of carbolic acid ( dram to quart water). the closed fist may now be planted in the rounded end of the largest horn and pushed on so as to turn it back within itself and carry it on through the vagina, the other hand being used meanwhile to assist in the inversion and in pushing the different masses in succession within the lips of the vulva. in case of failure, resort should be had at once to a plan which i have successfully followed for many years. take a long linen or cotton bandage, or inches wide, and wind it around the protruding womb as tightly as it can be drawn, beginning at the free end and gradually covering the entire mass up to the vulva. by this means the greater part of the blood will be forced out of the organ and its bulk greatly reduced, so that its reduction is much facilitated. an additional advantage is found in the protection given to the womb by its investing bandage while it is being pushed forward into the vagina and abdomen. in manipulating the exposed womb there is always danger of laceration, but when the organ is covered with a sheet it is next to impossible to tear it. the subsequent manipulation is as in the other case, by pushing the blind end forward within itself with the closed fist and carrying this on through the vagina into the abdomen with the constant assistance of the other hand. often it will be found convenient to use the edge of the left hand to push the outer part of the protruding mass inside the lips of the vulva, while the right hand and arm are carrying the central portions forward through the vagina. an intelligent assistant, pushing with the palms of both hands on the outer portion of the mass, will also afford material assistance. as the womb is turned within itself the wrapping bandage will gradually loosen, but once the great mass has entered the passages it is easy to compel the rest to follow, and the compression by the bandage is no longer so important. when the womb is fully replaced the bandage is left in its interior in a series of loose folds, and can be easily withdrawn. it is well to move the hand from side to side to insure that the two horns of the womb are fully extended and on about the same level before withdrawing the arm and applying a truss. when the womb has been long everted and is gorged with blood, inflamed, and friable there is often the additional disadvantage that the animal is unable or unwilling to rise. when lying down the straining can not be controlled so effectually, and, even in the absence of straining, the compression of the belly is so great as to prove a serious obstacle to reduction. the straining may be checked by or ounces of laudanum or ounces of chloral hydrate, or by inhalation of chloroform to insensibility, and then by raising the hind parts on straw bundles the gravitation of the abdominal organs forward may be made to lessen the resistance. if not successful in this way, the cow may be further turned on her back, and if return is still impossible, the hind limbs may be tied together and drawn up to a beam overhead by the aid of a pulley. in this position, in place of the pressure backward of the bowels proving a hindrance, their gravitation forward proves a most material help to reduction. in seeking to return the womb the sponging with ice-cold water, raising on a sheet, and wrapping in a tight bandage should be resorted to. another method which is especially commendable in these inflamed conditions of the womb is to bring a piece of linen sheet, by inches, under the womb, with its anterior border close up to the vulva, then turn the posterior border upward and forward over the organ, and cross the two ends over this and over each other above. the ends of the sheet are steadily drawn, so as to tighten its hold on the womb, which is thus held on the level of the vulva or above, and cold water is constantly poured upon the mass. the reduction is further sought by compression of the mass with the palms applied outside the sheet. fifteen or twenty minutes are usually sufficient to cause the return of the womb, provided straining is prevented by pinching the back, or otherwise. in old and aggravated cases, with the womb torn, bruised, or even gangrenous, the only resort is to amputate the entire mass. this is done by tying a strong, waxed cord around the protruding mass close to the vulva, winding the cord around pieces of wood, so as to draw it as tightly as possible, cutting off the organ below this ligature, tying a thread on any artery that may still bleed, and returning the stump well into the vagina. retention of the returned womb is the next point, and is most easily accomplished by a rope truss. take two ropes, each about feet long and an inch in thickness. double each rope at its middle, and lay the one above the other at the bend, so as to form an ovoid of about inches in its long diameter. twist each end of the one rope twice around the other, so that this ovoid will remain when they are drawn tight. (pls. xxii and xxiii.) tie a strap or rope around the back part of the neck and a surcingle around the body. place the rope truss on the animal so that the ovoid ring will surround the vulva, the two ascending ropes on the right and left of the tail and the two descending ones down inside the thighs on the right and left of the udder. these descending ropes are carried forward on the sides of the body and tied to the surcingle and to the neck collar. the ascending ropes proceed forward on the middle of the back, twisting over each other, and are tied to the surcingle and collar. the upper and lower ropes are drawn so tightly that the rope ring is made to press firmly all around the vulva without risk of displacement. this should be worn for several days, until the womb shall have closed and all risk of further eversion is at an end. variations of this device are found in the use of a narrow triangle of iron applied around the vulva and fixed by a similar arrangement of ropes, surcingle, and collar (pl. xxiii, fig. ), a common crupper similarly held around the vulva (pl. xxii, fig. ), stitches through the vulva, and wire inserted through the skin on the two hips (pl. xxiii, fig. ), so that they will cross behind the vulva; also pessaries of various kinds should be inserted into the vagina. none of these devices, however, present any advantage over the simple and comparatively painless rope truss described above. such additional precautions as keeping the cow in a stall higher behind than in front, and seeing that the diet is slightly laxative and nonstimulating may be named. if straining is persistent, ounce doses of laudanum may be used twice a day, and the same may be injected into the vagina. if the womb has been cut off, injections of a solution of a teaspoonful of carbolic acid in a quart of water should be used daily, or more frequently, until the discharge ceases. eversion of the bladder. a genuine eversion of the bladder is almost unknown in the cow, owing to the extreme narrowness of its mouth. the protrusion of the bladder, however, through a laceration sustained in calving, in the floor of the vagina and its subsequent protrusion through the vulva, is sometimes met with. in this case the protruding bladder contains urine; this can never be the case in a real eversion, in which the inner surface of the bladder and the openings of the ureters are both exposed outside the vulva. the presence of a bag containing water, which is connected with the floor of the vagina, will serve to identify this condition. if the position of the bladder in the vulva renders it impracticable to pass a catheter to draw off the urine, pierce the organ with the nozzle of a hypodermic syringe, or even a very small trocar and cannula, and draw off the water, when it will be found an easy matter to return the bladder to its place. the rent in the vagina can be stitched up, but as there would be risk in any subsequent calving it is best to prepare the cow for the butcher. rupture of the bladder. this has been known to occur in protracted parturition when the fetus finally passed while the bladder was full. the symptoms are those of complete suppression of urine and tenderness of the abdomen, with a steady accumulation of liquid, and fluctuation on handling its lower part. if the hand is introduced into the vagina it is felt to be hot and tender, and perhaps slightly swollen along its floor. as a final test, if the lower, fluctuating part of the abdomen is punctured with a hypodermic needle, a straw-colored liquid of a urinous odor flows out. the condition has been considered as past hope. the only chance for recovery would be in opening the abdomen, evacuating the liquid, and stitching up the rent in the bladder, but at such a season, and with inflammation already started, there would be little to hope for. rupture of the womb. when the womb has been rendered friable by disease rupture may occur in the course of the labor, but much more frequently it occurs from violence sustained in attempting assistance in difficult parturition. it is also liable to occur during eversion of the organ through efforts to replace it. if it happens while the calf is still in the womb, it will usually bleed freely and continuously until the fetus has been extracted, so that the womb can contract on itself and expel its excess of blood. another danger is that in case of a large rent the calf may escape into the cavity of the abdomen and parturition become impossible. still another danger is that of the introduction of septic germs and the setting up of a fatal inflammation of the lining membrane of the belly (peritoneum). still another is the escape of the small intestine through the rent and on through the vagina and vulva, so as to protrude externally and receive perhaps fatal injuries. in case of rupture before calving, that act should be completed as rapidly and carefully as possible, the fetal membranes removed, and the contraction of the womb sought by dashing cold water on the loins, the right flank, or the vulva. if the calf has escaped into the abdomen and can not be brought through the natural channels, it may be permissible to fix the animal and extract it through the side, as in the cæsarian section. if the laceration has happened during eversion of the womb it is usually less redoubtable, because the womb contracts more readily under the stimulus of the cold air so recently applied. in case the abdomen has been laid open it is well to stitch up the rent, but if not, it should be left to nature, and will often heal satisfactorily, the cow even breeding successfully in after years. rupture of the floor of the vagina has been already referred to as allowing the protrusion of the bladder. laceration of the roof of this passage is also met with as the result of deviations of the hind limbs and feet upward when the calf lies on its back. in some such cases the opening passes clear into the rectum, or the foot may even pass out through the anus, so that that opening and the vulva are laid open into one. simple, superficial lacerations of the vaginal walls are not usually serious, and heal readily unless septic inflammation sets in, in which case the cow is liable to perish. they may be treated with soothing and antiseptic injections, such as carbolic acid, dram; water, quart. the more serious injuries depend on the complications. rupture of the anterior part of the canal, close to the mouth of the womb, may lead to the introduction of infecting germs into the cavity of the abdomen, or protrusion of the bowel through the rent and externally, either of which may prove fatal. if both these conditions are escaped the wound may heal spontaneously. rupture into the bladder may lead to nothing worse than a constant dribbling of the urine from the vulva. the cow should be fattened if she survives. rupture into the rectum will entail a constant escape of feces through the vulva, and, of course, the same condition exists when the anus as well has been torn open. i have successfully sewed up an opening of this kind in the mare, but in the case of the cow it is probably better to prepare her for the butcher. clots of blood in the walls of the vagina. during calving the vagina may be bruised so as to cause escape of blood beneath the mucous membrane and its coagulation into large bulging clots. the vulva may appear swollen, and on separating its lips the mucous membrane of the vagina is seen to be raised into irregular rounded swellings of a dark-blue or black color, and which pit on pressure of the finger. if the accumulation of blood is not extensive it may be reabsorbed, but if abundant it may lead to irritation and dangerous inflammation, and should be incised with a lancet and the clots cleared out. the wounds may then be sponged twice a day with a lotion made with dram sulphate of zinc, dram carbolic acid, and quart water. retained afterbirth. the cow, of all our domestic animals, is especially subject to this accident. this may be partly accounted for by the firm connections established through the fifty to one hundred cotyledons (pl. xiii, fig. ) in which the fetal membranes dovetail with the follicles of the womb. it is also most liable to occur after abortion, in which preparation has not been made by fatty degeneration for the severance of these close connections. in the occurrence of inflammation, causing the formation of new tissue between the membranes and the womb, we find the occasion of unnaturally firm adhesions which prevent the spontaneous detachment of the membranes. again, in low conditions of health and an imperfect power of contraction we find a potent cause of retention, the general debility showing particularly in the indisposition of the womb to contract, after calving, with sufficient energy to expel the afterbirth. hence we find the condition common with insufficient or innutritious feed, and in years or localities in which the fodder has suffered from weather. ergoted, smutty, or musty fodder (pl. v), by causing abortion, is a frequent cause of retention. old cows are more subject than young ones, probably because of diminishing vigor. a temporary retention is sometimes owing to a too rapid closure of the neck of the womb after calving, causing strangulation and imprisonment of the membranes. conditions favoring this are the drinking of cold (iced) water, the eating of cold feed (frosted roots), and (through sympathy between udder and womb) a too prompt sucking by the calf or milking by the attendant. _symptoms._--the symptoms of retention of the afterbirth are usually only too evident, as the membranes hang from the vulva and rot away gradually, causing the most offensive odor throughout the building. when retained within the womb by closure of its mouth and similarly in cases in which the protruded part has rotted off, the decomposition continues and the fetid products escaping by the vulva appear in offensively smelling pools on the floor and mat together the hairs near the root of the tail. the septic materials retained in the womb cause inflammation of its lining membrane, and this, together with the absorption into the blood of the products of putrefaction, leads to ill health, emaciation, and drying up of the milk. _treatment._--treatment varies according to the conditions. when the cow is in low condition, or when retention is connected with drinking iced water or eating frozen feed, hot drinks and hot mashes of wheat bran or other aliment may be sufficient. if along with the above conditions, the bowels are somewhat confined, an ounce of ground ginger, or half an ounce of black pepper, given with a quart of sweet oil, or - / pounds of glauber's salt in at least quarts of warm water, will often prove effectual. a bottle or two of flaxseed tea, made by prolonged boiling, should also be given at frequent intervals. other stimulants, like rue, savin, laurel, and carminatives like anise, cumin, and coriander, are preferred by some, but with very questionable reason, the more so that the first three are not without danger. ergot of rye, ounce, or its extract, dram, may be resorted to to induce contraction of the womb. the mechanical extraction of the membranes is, however, often called for; of this there are several methods. the simplest is to hang a weight of or pounds to the hanging portion, and allow this, by its constant dragging and by its jerking effect when the cow moves, to pull the membranes from their attachments and to stimulate the womb to expulsive contractions. it frequently happens that the afterbirth is only loosely adherent to the womb and its removal is effected if but a slight amount of traction on it is exerted. this can be determined by seizing the dependent part of the afterbirth between two sticks and rolling it up on them until they lie against the vulva; then, by careful traction, accompanied with slight jerking movements from side to side, the womb is stimulated to expulsive contractions and the afterbirth is wound up more and more on the sticks until finally its last connections with the womb are severed and the remainder is expelled suddenly en masse. it is quite evident that neglected cases with putrid membranes are poor subjects for this method, as the afterbirth is liable to tear across, leaving a mass in the womb. during the progress of the work any indication of tearing is the signal to stop and proceed with greater caution or altogether abandon the attempt in this way. the following method (that with the skilled hand) is the most promptly and certainly successful. for this the operator had better dress as for a parturition case. again, the operation should be undertaken within twenty-four hours after calving, since later the mouth of the womb may be so closed that it becomes difficult to introduce the hand. the operator should smear his arms with carbolized lard or vaseline to protect them against infection, and particularly in delayed cases with putrid membranes. an assistant holds the tail to one side, the operator seizes the hanging afterbirth with the left hand, while he introduces the other along the right side of the vagina and womb, letting the membranes slide through his palm until he reaches the first cotyledon to which they remain adherent. in case no such connection is within reach, with the left hand gentle traction is made on the membranes until the deeper parts of the womb are brought within reach and the attachments to the cotyledons can be reached. then the soft projection of the membrane, which is attached to the firm fungus-shaped cotyledon on the inner surface of the womb, is seized by the little finger, and the other fingers and thumb are closed on it so as to tear it out from its connections. to explain this, it is necessary only to say that the projection from the membrane is covered by soft, conical processes, which are received into cavities of a corresponding size on the summit of the firm, mushroom-shaped cotyledon growing from the inner surface of the womb. to draw upon the former, therefore, is to extract its soft, villous processes from within the follicles or cavities of the other. (pl. xiii, fig. .) if at times it is difficult to start this extraction it may be necessary to get the finger nail inserted between the two, and once started the finger may be pushed on, lifting all the villi, in turn, out of their cavities. this process of separating the cotyledons must be carefully conducted, one after another, until the last has been detached and the afterbirth comes freely out of the passages. i have never found any evil result from the removal of the whole mass at one operation, but shaack mentions the eversion of the womb as the possible result of the necessary traction, and in cases in which those in the most distant part of the horn of the womb can not be easily reached, he advises to attach a cord to the membranes inside the vulva, letting it hang out behind, and to cut off the membranes below the cord. then, after two or three days' delay, he extracts the remainder, now softened and easily detached. if carefully conducted, so as not to tear the cotyledons of the womb, the operation is eminently successful; the cow suffers little, and the straining roused by the manipulations soon subsides. keeping in a quiet, dark place, or driving a short distance at a walking pace, will serve to quiet these. when the membranes have been withdrawn, the hand, half closed, may be used to draw out of the womb the offensive liquid that has collected. if the case is a neglected one, and the discharge is very offensive, the womb must be injected as for leucorrhea. inflammation of the vagina (vaginitis). this may occur independently of inflammation of the womb, and usually as the result of bruises, lacerations, or other injuries sustained during calving. it will be shown by swelling of the lips of the vulva, which, together with their lining membrane, become of a dark-red or leaden hue, and the mucous discharge increases and becomes whitish or purulent, and it may be fetid. slight cases recover spontaneously, or under warm fomentations or mild astringent injections (a teaspoonful of carbolic acid in a quart of water), but severe cases may go on to the formation of large sores (ulcers), or considerable portions of the mucous membrane may die and slough off. baumeister records two cases of diphtheritic vaginitis, the second case in a cow four weeks calved, contracted from the first in a newly calved cow. both proved fatal, with formation of false membranes as far as the interior of the womb. in all severe cases the antiseptic injections must be applied most assiduously. the carbolic acid may be increased to one-half ounce to a quart, or chlorin water, or peroxid of hydrogen solution may be injected at least three times a day. hyposulphite of soda, ounce to a quart of water, is an excellent application, and the same amount may be given by the mouth. leucorrhea (mucopurulent discharge from the passages). this is from a continued or chronic inflammation of the womb, or the vagina, or both. it usually results from injuries sustained in calving or from irritation by putrid matters in connection with retained afterbirth, or from the use of some object in the vagina (pessary) to prevent eversion of the womb. exposure to cold or other cause of disturbance of the health may affect an organ so susceptible as this at the time of parturition so as to cause inflammation. _symptoms._--the main symptom is the glairy, white discharge flowing constantly or intermittently (when the cow lies down), soiling the tail and matting its hairs and those of the vulva. when the lips of the vulva are drawn apart the mucous membrane is seen to be red, with minute elevations, or pale and smooth. the health may not suffer at first, but if the discharge continues and is putrid the health fails, the milk shrinks, and flesh is lost. if the womb is involved the hand introduced into the vagina may detect the mouth of the womb slightly open and the liquid collected within its cavity. examination with the oiled hand in the rectum may detect the outline of the womb beneath, somewhat enlarged, and fluctuating under the touch from contained fluid. in some cases heat is more frequent or intense than natural, but the animal rarely conceives when served, and, if she does, is liable to abort. _treatment._--treatment with the injections advised for vaginitis is successful in mild or recent cases. in obstinate ones stronger solutions may be used after the womb has been washed out by a stream of tepid water until it comes clear. a rubber tube is inserted into the womb, a funnel placed in its raised end, and the water, and afterwards the solution, poured slowly through it. if the neck of the womb is so close that the liquid can not escape, a second tube may be inserted to drain it off. as injections may be used chlorid of zinc, one-half dram to the quart of water, or sulphate of iron, dram to the quart. three drams of sulphate of iron and one-half ounce ground ginger may also be given in the feed daily. inflammation of the womb (metritis, inflammation of womb and abdomen, or metroperitonitis). inflammation of the womb may be slight or violent, simple or associated with putrefaction of its liquid contents and general poisoning, or it may extend so that the inflammation affects the lining membrane of the whole abdominal cavity. in the last two cases the malady is a very grave one. _causes._--the causes are largely the same as those causing inflammation of the vagina. greater importance must, however, be attached to exposure to cold and wet and to septic infection. _symptoms._--the symptoms appear two or three days after calving, when the cow may be seen to shiver, or the hair stands erect, especially along the spine, and the horns, ears, and limbs are cold. the temperature in the rectum is elevated by one or two degrees, the pulse is small, hard, and rapid ( to ), appetite is lost, rumination ceases, and the milk shrinks in quantity or is entirely arrested, and the breathing is hurried. the hind limbs may shift uneasily, the tail be twisted, the head and eyes turn to the right flank, and the teeth are ground. with the flush of heat to the horns and other extremities, there is redness of the eyes, nose, and mouth, and usually a dark redness about the vulva. pressure on the right flank gives manifest pain, causing moaning or grunting, and the hind limbs are moved stiffly, extremely so if the general lining of the abdomen is involved. in severe cases the cow lies down and can not be made to rise. there is usually marked thirst, the bowels are costive, and dung is passed with pain and effort. the hand inserted into the vagina perceives the increased heat, and when the neck of the womb is touched the cow winces. examination through the rectum detects enlargement and tenderness of the womb. the discharge from the vulva is at first watery, but becomes thick, yellow, and finally red or brown, with a heavy or fetid odor. some cases recover speedily and may be almost well in two days; a large proportion perish within two days of the attack, and some merge into the chronic form, terminating in leucorrhea. in the worst cases there is local septic infection and ulceration, or even gangrene of the parts, or there is general septicemia, or the inflammation involving the veins of the womb causes coagulation of the blood contained in them, and the washing out of the clots to the right heart and lung leads to the blocking of the vessels in the latter and complicating pneumonia. inflammation of the womb and passages after calving are always liable to these complications, and consequently to a fatal issue. franck records three instances of rapidly fatal metritis in cows, all of which had been poisoned from an adjacent cow with retained and putrid afterbirth. others have had similar cases. _treatment._--treatment in the slight cases of simple inflammation does not differ much from that adopted for vaginitis, only care must be taken that the astringent and antiseptic injections are made to penetrate into the womb. after having washed out the womb a solution of chlorid of lime or permanganate of potassium (one-half ounce to quart of water), with an ounce each of glycerin and laudanum to render it more soothing, will often answer every purpose. it is usually desirable to open the bowels with - / pounds of glauber's salt and ounce of ginger in quarts of warm water, and to apply fomentation of warm water or even mustard poultices or turpentine to the right flank. in the violent attacks with high temperature and much prostration, besides the salts agents must be given to lower the temperature and counteract septic poisoning. salicylate of soda one-half ounce, or quinia drams every four hours will help in both ways, or ounce doses of hyposulphite of soda or dram doses of carbolic acid may be given as often until six doses have been taken. tincture of aconite has often been used in -drop doses every six hours. if the temperature rises to ° or ° f., it must be met by the direct application of cold or iced water to the surface. the animal may be covered with wet sheets and cold water poured on them frequently until the temperature in the rectum is lowered to ° f. in summer the cow may be allowed to dry spontaneously, while in winter it should be rubbed dry and blanketed. even in the absence of high temperature much good may be obtained from the soothing influence of a wet sheet covering the loins and flanks and well covered at all points by a dry one. this may be followed next day by a free application of mustard and oil of turpentine. when the animal shows extreme prostration, carbonate of ammonia ( ounce) may be given to tide over the danger, but such cases usually perish. in this disease, even more than in difficult and protracted parturition or retained placenta, the attendants must carefully guard against the infection of their hands and arms from the diseased parts. the hand and arm before entering the passages should always be well smeared with lard impregnated with carbolic acid. milk fever (parturition fever, parturient apoplexy, or parturient collapse). this disease is not only peculiar to the cow, but it may be said to be virtually confined to the improved and plethoric cow. it further occurs only at or near the time of calving. indeed, these two factors, calving and plethora, may be set apart as preeminently the causes of this disease. it is the disease of cows that have been improved in the direction of early maturity, power of rapid fattening, or a heavy yield of milk, and hence it is characteristic of those having great appetites and extraordinary power of digestion. the heavy milking breeds are especially its victims, as in them the demand for the daily yield of to pounds of milk means even more than a daily increase of to pounds of body weight, mainly fat. the victims are not always fat when attacked, but they are cows having enormous powers of digestion, and which have been fed heavily at the time. hence the stall-fed, city-dairy cow, and the farm cow on a rich clover pasture in june or july are especially subject. the condition of the blood globules in the suffering cow attests the extreme richness and density of the blood, yet this peculiarity appears to have entirely escaped the notice of veterinary writers. i have never examined the blood of a victim of this disease without finding the red-blood globules reduced to little more than one-half their usual size. now, these globules expand or contract according to the density of the liquid in which they float. if we dilute the blood with water they will expand until they burst, whereas if solids, such as salt or albumin, are added they shrink to a large extent. their small size, therefore, in parturition fever indicates the extreme richness of the blood, or, in other words, plethora. confinement in the stall is an accessory cause, partly because stabled cattle are highly fed, partly because the air is hotter and fouler, and partly because there is no expenditure by exercise of the rich products of digestion. high temperature is conducive to the malady, though the extreme colds of winter are no protection against it. heat, however, conduces to fever, and fever means lessened secretion, which means a plethoric state of the circulation. the heats of summer are, however, often only a coincidence of the real cause, the mature rich pastures, and especially the clover ones, being the greater. electrical disturbances have an influence of a similar kind, disturbing the functions of the body and favoring sudden variations in the circulation. a succession of cases of the malady often accompany or precede a change of weather from dry to wet, from a low to a high barometric pressure. costiveness, which is the usual concomitant of fever, may in a case of this kind become an accessory cause, the retention in the blood of what should have passed off by the bowels tending to increase the fullness of the blood vessels and the density of the blood. mature age is a very strong accessory cause. the disease never occurs with the first parturition, and rarely with the second. it appears with the third, fourth, fifth, or sixth--after the growth of the cow has ceased and when all her powers are devoted to the production of milk. calving is an essential condition, as the disturbance of the circulation consequent on the contraction of the womb and the expulsion into the general circulation of the enormous mass of blood hitherto circulating in the walls of the womb fills to repletion the vessels of the rest of the body and very greatly intensifies the already existing plethora. if this is not speedily counterbalanced by a free secretion from the udder, kidneys, bowels, and other excretory organs, the most dire results may ensue. calving may thus be held to be an exciting cause, and yet the labor and fatigue of the act are not active factors. it is after the easy calving, when there has been little expenditure of muscular or nervous energy and no loss of blood, that the malady is seen. difficult parturitions may be followed by metritis, but they are rarely connected with parturition fever. all these factors coincide in intensifying the one condition of plethora and point to that as a most essential cause of the affection. it is needless to enter here into the much-debated question as to the mode in which the plethora brings about the characteristic symptoms and results. as the results show disorder or suspension of the nervous functions mainly, it may suffice to say that this condition of the blood and blood vessels is incompatible with the normal functional activity of the nerve centers. how much is due to congestion of the brain and how much to bloodlessness may well be debated, yet in a closed box like the cranium, in which the absolute contents can not be appreciably increased or diminished, it is evident that, apart from dropsical effusion or inflammatory exudation, there can be only a given amount of blood; therefore, if one portion of the brain is congested, another must be proportionately bloodless; and as congestion of the eyes and head generally and great heat of the head are most prominent features of the disease, congestion of the brain must be accepted. this, of course, implies a lack of blood in certain other parts or blood vessels. the latest developments of treatment indicate very clearly that the main cause is the production of poisonous, metabolic products (leucomains and toxins) by secreting cells of the follicles of the udder, acting on the susceptible nerve centers of the plethoric, calving cow. less fatal examples of udder poisons are found in the first milk (colostrum), which is distinctly irritant and purgative, and in the toxic qualities of the first milk drawn from an animal which has been subjected to violent overexertion or excitement. still more conclusive as to the production of such poisons is the fact that the full distention of the milk ducts and follicles, and the consequent driving of the blood out of the udder and arrest of the formation of depraved products, determines a speedy and complete recovery from the disease. this does not exclude the other causes above named, nor the influence of a reflex nervous derangement proceeding from the udder to the brain. _symptoms._--it may be said that there are two extreme types of this disease, with intervening grades. in both forms there is the characteristic plethora and more or less sudden loss of voluntary movement and sensation, indicating a sudden collapse of nervous power; in one, however, there is such prominent evidence of congestion of head and brain that it may be called the congestive form par excellence, without thereby intimating that the torpid form is independent of congestion. in the congestive form there is sudden dullness, languor, hanging back in the stall, or drooping the head, uneasy movements of the hind limbs or tail; if the cow is moved, she steps unsteadily, or even staggers; she no longer notices her calf or her feed; the eyes appear red and their pupils dilated; the weakness increases and the cow lies down or falls and after that is unable to rise. at this time the pulse is usually full, bounding, and the temperature raised, though not invariably so, the head, horns, and ears being especially hot and the veins of the head full, while the visible mucous membranes of nose and eyes are deeply congested. the cow may lie on her breastbone with her feet beneath the body and her head turned sleepily round, with the nose resting on the right flank; or, if worse, she may be stretched full on her side, with even the head extended, though at times it is suddenly raised and again dashed back on the ground. at such times the legs, fore and hind, struggle convulsively, evidently through unconscious nervous spasm. by this time the unconsciousness is usually complete; the eyes are glazed, their pupils widely dilated, and their lids are not moved when the ball of the eye is touched with the finger. pricking the skin with a pin also fails to bring any wincing or other response. the pulse, at first from to a minute, becomes weaker and more accelerated as the disease advances. the breathing is quickened, becoming more and more so with the violence of the symptoms, and at first associated with moaning (in exceptional cases, bellowing), it may, before death, become slow, deep, sighing, or rattling (stertorous). the temperature, at first usually raised, tends to become lower as stupor and utter insensibility and coma supervene. the bowels, which may have moved at the onset of the attack, become torpid or completely paralyzed, and, unless in case of improvement, they are not likely to operate again. yet this is the result of paralysis and not of induration of the feces, as often shown by the semiliquid, pultaceous condition of the contents after death. the bladder, too, is paralyzed and fails to expel its contents. a free action of either bladder or bowels, or of both, is always a favorable symptom. the urine contains sugar, in quantity proportionate to the severity of the attack. in nearly all cases the torpor of the digestive organs results in gastric disorder; the paunch becomes the seat of fermentation, producing gas, which causes it to bloat like a drum. there are frequent eructations of gas and liquid and solid feed, which, reaching the paralyzed throat, pass in part into the windpipe and cause inflammations of the air passages and lungs. in the torpid form of the disease there is much less indication of fever or violence. there may be no special heat about the horns, ears, or forehead, nor any marked redness or congestion of the eyes or nose, nor engorgement of the veins of the head. the attack comes on more slowly, with apparent weakness of the hind limbs, dullness, drowsiness, suspension of rumination and appetite, and a general indifference to surrounding objects. soon the cow lies down, or falls and is unable to rise, but for one or two days she may rest on the breastbone and hold the head in the flank without showing any disorderly movements. meanwhile there is not only loss of muscular power and inability to stand, but also considerable dullness of sensation, pricking the skin producing no quick response, and even touching the edge of the eyelids causing no very prompt winking. unless she gets relief, however, the case develops all the advanced symptoms of the more violent form, and the animal perishes. in advanced and fatal cases of either form the insensibility becomes complete; no irritation of skin or eye meets any response; the eye becomes more dull and glassy; the head rests on the ground or other object; unless prevented the cow lies stretched fully on her side; the pulse is small, rapid, and finally imperceptible; the breathing is slow, deep, stertorous, and the expirations accompanied with puffing is slow, the cheeks, and death comes quietly or with accompanying struggles. _prevention._--for such fatal disease prevention is of far more consequence than treatment. among the most efficient preventives may be named a spare diet (amounting to actual starvation in very plethoric, heavy-milking cows) for a week before calving and at least four days after. a free access to salt and water is most important, as the salt favors drinking and the water serves to dilute the rich and dense blood. iced water, however, is undesirable, as a chill may favor the onset of fever. a dose of epsom salt ( to pounds) should be given to hours before calving is due, so that it may operate at or just before that act. in case calving has occurred unexpectedly in the heavy milker, no time should be lost in giving the purgative thereafter. a most important precaution in the fleshy, plethoric cow, or in one that has been attacked at a previous calving, is to avoid drawing any milk from the bag for or hours after calving. breeders on the island of jersey have found that this alone has almost abolished the mortality from milk fever. if epsom salt is not at hand, saltpeter ( ounce) should be used for several days. daily exercise is also of importance, and, excepting in midsummer, when the heat of the sun may be injurious, the value of open air is unquestionable. even in summer an open shed or shady grove is incomparably better than a close, stuffy stall. a rich pasture (clover especially), in may, june, or july, when at its best, is to be carefully avoided. it is better to keep the cow indoors on dry straw with plenty of salt and water than to have access to such pastures. _treatment._--treatment of milk fever has been completely revolutionized, with the result that a former mortality of to per cent has been practically abolished. formerly the most vigorous treatment was practiced by bleeding, purging, the increase of peristalsis by eserin or pilocarpin, enemas, cold in the head, counterirritants, aconite, tartar emetic, sponging, wet-sheet packing, etc. the gross mortality, however, was not materially reduced, and nearly all that were attacked within the first two days after calving perished. the first step in the modern treatment was made in , when j. schmidt published his successful treatment by the injection of the teats and milk ducts with a solution of iodid of potassium ( - / drams to quart of water). this reduced the mortality to per cent. others followed this lead by the injection of other antiseptics (lysol, creolin, creosol, chinosol, common salt, etherized air, oxygen). these succeeded as well as the iodid solution. with the injection of gases, however, a fuller distention of the udder was usually secured, and virtually every case recovered. this suggested the full distention of the udder with common atmospheric air filtered and sterilized, and this with the most perfect success. with sterile air schmidt-kolding claimed . per cent recoveries in cases. in america the full distention of the udder, whether with oxygen or filtered air, has proved invariably successful in all kinds of cases, including the violent ones that set in within a few hours after calving. in or hours after the injection the cow has got up, had free passages from the bowels and bladder, bright expression of countenance, and some return of appetite. in my cases which had made no response for hours to the iodid injection, the injection of the udder to full repletion with the gas (oxygen or air) has had immediately beneficial results. a similar full distention of the bag with a common-salt solution ( . to ), or even with well-boiled water, is equally effective, but in these cases the weight of the liquid causes dragging upon the udder and a measure of discomfort which is escaped under the treatment with gas. the value of each method depends on the fullness of distention of the udder and the arrest in larger part of the circulation and chemical changes in its tissues. this distention acts like magic, and seems hardly to admit of failure in securing a successful outcome. it can not, however, be recommended as absolutely devoid of dangers and serious complications. to get the best results it should be applied only by one who has been trained in the careful antiseptic methods of the bacteriological laboratory. some readers will recall the case of the injection of the udders of show cows at toronto to impose upon the judges. the cows treated in this way had the udders infected and ruined, and several lost their lives. there is no better culture medium for septic and other germs than the first milk (colostrum) charged with albumin and retained in the warm udder. already in the hands of veterinarians even the schmidt treatment has produced a small proportion of cases of infective mammitis. how many more such cases will develop if this treatment becomes a popular domestic resort, applied by the dairyman himself in all sorts of surroundings and with little or no antiseptic precautions? even then, however, the losses will by no means approach the past mortality of to per cent, so that the economy will be immeasurable under even the worst conditions. a fair test and judgment of this treatment, however, can be obtained only when the administrator is trustworthy and painstaking, well acquainted with bacteriological antisepsis and with the general and special pathology of the bovine animal. the necessary precautions may be summarized as follows: ( ) provide an elastic rubber ball and tubes furnished with valves to direct the current of air, as in a common davidson syringe. ( ) fill the delivery tube for a short distance with cotton sterilized by prolonged heating in a water bath. ( ) in the free end of the delivery tube fit a milking tube to be inserted into the teat. ( ) sterilize the entire apparatus by boiling for minutes, and, without touching the milking tube, wrap it in a towel that has been sterilized in a water bath or in live steam and dried. ( ) avoid drawing any milk from the teats; wash them and the udder thoroughly with warm soapsuds; rinse off with well-boiled and cooled water, and apply to the teats, and especially to their tips, a per cent solution of carbolic acid or lysol, taking care that the teats are not allowed to touch any other body from the time they are cleansed until the teat tube is inserted. it is well to rest the cleansed and disinfected udder on a sterilized pad of cotton or a boiled towel. ( ) the injecting apparatus is unwrapped; the teat tube, seized by its attached end and kept from contact with any other body, is inserted into the teat, while an assistant working the rubber pump fills the quarter as full as it will hold. the tube is now withdrawn and a broad tape is tied around the free end of the teat to prevent escape of the air. ( ) the teat tube, which has been carefully preserved from possible contact with other bodies, is dipped in the carbolic acid solution and inserted in a second teat, and the second quarter is inflated, and so with the third and fourth. ( ) the recumbent cow is kept resting on her breastbone, with the head elevated, even if it should be necessary to pack around her with straw bundles or to suspend the head by a halter. when lying on her side she is liable to develop fatal bloating and to have belching of gas and liquids, which, passing down the windpipe, cause fatal broncho-pneumonia. ( ) if in hours the cow is not on her feet, if there is no brighter or more intelligent expression, if she has passed no manure or urine, and if the air has become absorbed, leaving the udder less tense, the injection of the bag may be repeated, under the same scrupulous and rigid precautions as at first. in all cases, but especially in severe ones, it is well to keep watch of the patient, and to repeat the distention on the first indication of relapse. should there not be a free discharge of feces and urine after rising, indicating a natural resumption of the nervous functions, the case should be all the more carefully watched, so that the treatment may be repeated if necessary. accessory treatment may still be used, but is rarely necessary. a dose of purgative medicine ( - / pounds of epsom salt) in warm water may be given in the early stages, while as yet there is no danger of its passing into the lungs through paralysis of the throat. eserin or pilocarpin ( - / grains) may be given under the skin to stimulate the movements of the bowels. sponging the skin, and especially the udder, with cool water, may be resorted to in hot weather. bloating may demand puncture of the paunch, in the left flank, with a cannula and trocar, the evacuation of the gas, and the introduction through the tube of a tablespoonful of strong liquid ammonia in a quart of cold water or other antiferment. the economic value of the new treatment of milk fever is enormous. the united states has more than , , milk cows. if we could raise their quality by preserving and breeding from the largest producers of both milk and butterfat, in place of losing the best by milk fever, as in the past, and if we could thus obtain an average increase of quarts a day, the proceeds at cents a quart would amount to $ , , a year. palsy after calving (dropping after calving). this consists in a more or less complete loss of control of the hind limbs occurring after calving, and caused by low condition, weakness, and exposure to cold or to injurious compression of the nerves of the hind limbs by a large calf passing through the pelvis. its symptoms do not differ from those of palsy of the hind limbs, occurring at other times, and it may be treated in the same way, except so far as bruises of the vagina may demand special smoothing treatment. congestion of the udder (garget). in heavy milkers, before and just after calving, it is the rule that the mammary gland is enlarged, hot, tense, and tender, and that a slight exudation or pasty swelling extends forward from the gland on the lower surface of the abdomen. this physiological congestion is looked upon as a matter of course, and disappears in two or three days when the secretion of milk has been fully established. this breaking up of the bag may be greatly hastened by the sucking of a hungry calf and the kneading it gives the udder with its nose, by stripping the glands clean thrice daily, and by active rubbing at each milking with the palm of the hand, with or without lard or, better, with camphorated ointment. the congestion may be at times aggravated by standing in a draft of cold air or by neglect to milk for an entire day or more (overstocking, hefting) with the view of making a great show of udder for purposes of sale. in such cases the surface of the bag pits on pressure, and the milk has a reddish tinge or even streaks of blood, or it is partially or fully clotted and is drawn with difficulty, mixed, it may be, with a yellowish serum (whey) which has separated from the casein. this should be treated like the above, though it may sometimes demand fomentations with warm water to ward off inflammation, and it may be a week before the natural condition of the gland is restored. inflammation of the udder (simple mammitis). congestion may merge into active inflammation, or it may arise direct, in connection with exposure to cold or wet, with standing in a cold draft, with blows on the udder with clubs, stones, horns, or feet, with injury from a sharp or cold stone, or the projecting edge of a board or end of a nail in the floor, with sudden and extreme changes of weather, with overfeeding on rich albuminous feed like cotton seed, beans, or peas, with indigestions, with sores on the teats, or with insufficient stripping of the udder in milking. in the period of full milk the organ is so susceptible that any serious disturbance of the general health is liable to fall upon the udder. _symptoms._--the symptoms and mode of onset vary in different cases. when following exposure there is usually a violent shivering fit, with cold horns, ears, tail, and limbs, and general erection of the hair. this is succeeded by a flush of heat (reaction) in which the horns, ears, and limbs become unnaturally warm and the gland swells up and becomes firm and solid in one, two, three, or all four quarters. there is hot dry muzzle, elevated temperature, full, accelerated pulse, and excited breathing, impaired or suspended appetite and rumination, with more or less costiveness, suppression of urine, and a lessened yield of milk, which may be entirely suppressed in the affected quarter. in other cases the shivering escapes notice, the general disorder of the system is little marked or comes on late, and the first observed sign of illness is the firm swelling, heat, and tenderness of the bag. as the inflammation increases and extends, the hot, tender udder causes the animal to straddle with its hind limbs, and, when walking, to halt on the limb on that side. if the cow lies down it is on the unaffected side. with the increase in intensity and the extension of the inflammation the general fever manifests itself more prominently. in some instances the connective tissue beneath the skin and between the lobules of the gland is affected, then the swelling is uniformly rounded and of nearly the same consistency, pitting everywhere on pressure. in other cases it primarily attacks the secreting tissue of the gland, then the swelling is more localized and appears as hard, nodular masses in the interior of the gland. this last is the usual form of inflammation occurring from infection entering by the teats. in all cases, but especially in the last-named form, the milk is suppressed and replaced by a watery fluid colored with blood (sometimes deeply) and mingled with masses of clotted casein. later it becomes white and purulent, and in many cases of an offensive odor. the course of the disease is sometimes so rapid and at others so slow that no definite rule can be laid down. in two or three days, or from that to the end of the week, the bag may soften, lose its heat and tenderness, and subside into the healthy condition, even resuming the secretion of milk. the longer the inflammatory hardness continues the greater the probability that its complete restoration will not be effected. when a portion of the gland fails to be restored in this way, and has its secretion arrested, it usually shrinks to a smaller size. more commonly a greater quantity of the inflammatory product remains in the gland and develops into a solid, fibrous mass, causing permanent hardening (induration). in other cases, in place of the product of inflammation developing into a fibrous mass, it softens and breaks down into white, creamy, liquid pus (abscess). this abscess may make its way to the surface and escape externally, or it may burst into a milk duct and discharge through the teat. it may break into both and establish a channel for the escape of milk (fistula). in the worst types of the disease gangrene may ensue, a quarter or half or even the whole udder, losing its vitality, and sloughing off if the cow can bear up against the depressing influence. these gangrenous cases are probably always the result of infection and sometimes run a very rapidly fatal course. i remember one to which i was called as soon as the owner noticed it, yet i found one-quarter dark blue, cold, and showing a tendency to the formation of blebs containing a bloody secretion. the cow, which had waded through a depth of semiliquid manure to reach her stall, died within hours. _treatment._--treatment varies with the type and the stage of the disease. if the case is seen in the shivering fit, every effort should be made to cut it short, as the inflammation may be thereby greatly moderated, if not checked. copious drinks of warm water thrown in from horn or bottle; equally copious warm injections; the application of heat in some form to the surface of the body (by a rug wrung out of hot water; by hanging over the back and loins bags loosely filled with bran, sand, salt, chaff, or other agent previously heated in a stove; by the use of a flatiron or the warming of the surface by a hot-air bath), or by active friction with straw wisps by two or more persons; the administration of ounce of ground ginger may serve to shorten the attack. after half an hour's sweat the animal should be rubbed and covered with a dry blanket. if, on the other hand, there is little or no fever, and only a slight inflammation, rub well with camphorated ointment or a weak iodin ointment, and milk three, four, or six times a day, rubbing the bag thoroughly each time. milking must be done with great gentleness, squeezing the teat in place of pulling and stripping it, and if this causes too much pain, the teat tube (pl. xxiv, fig. ) or the spring teat dilator (pl. xxiv, fig. ) may be employed. antiseptic injections of the teats and udder are often useful, and iodoform in water has been especially recommended. it may be replaced by one of the injections advised for parturition fever, used with the same careful precautions. in cases in which the fever has set in and the inflammation is more advanced, a dose of laxative medicine is desirable (epsom salt, to pounds; ginger, ounce), which may be followed, after the purging has ceased, by daily doses of saltpeter, ounce. many rely on cooling and astringent applications to the inflamed quarter (vinegar, sugar-of-lead lotion, cold water, ice, etc.), but a safer and better resort is continued fomentation with warm water. a bucket of warm water, replenished as it cools, may be set beneath the udder, and two persons can raise a rug cut of this and hold it against the udder, dipping it anew whenever the temperature is somewhat lowered. a sheet may be passed around the body, with holes cut for the teats, soft rags packed between it and the udder, and kept warm by pouring water on every or minutes, as warm as the hand can bear. when this has been kept up for an hour or two, the bag may be dried, well rubbed with soap, and left thus with a soapy coating. if the pain is great, extract of belladonna may be applied along with the soap, and a dry suspensory bandage with holes for the teats may be applied. strong, mercurial ointment is very useful in relieving pain and softening the bag. this is especially valuable when the disease is protracted and induration threatens. it may be mixed with an equal quantity of soap and half as much extract of belladonna. in cases of threatened induration excellent results are sometimes obtained from a weak-induction current of electricity sent through the gland daily for minutes. if _abscess_ threatens, it may be favored by fomentation and opened as soon as fluctuation from finger to finger shows the formation of matter at a point formerly hard. the wound may bleed freely, and there is a risk of opening a milk duct, yet relief will be obtained; also a dressing twice daily with a lotion of carbolic acid part, water parts, and glycerin part will suffice to keep the wound clean and healthy. _gangrene_ of the affected part is often fatal. it demands antiseptics (chlorid of zinc, dram to quart water) applied frequently to the part, or, if the case can not be attended, smear the affected quarter with venice turpentine, melted, or even wood tar. antiseptic tonics (tincture of chlorid of iron, drams) may also be given four times daily in a quart of water. contagious mammitis (contagious inflammation of the udder). as stated in the last article, that form of inflammation of the udder which attacks the gland ducts and follicles, causing deep-seated, hard, nodular swellings, is often contagious. franck has demonstrated this by injecting into the milk ducts in different cows (milking and dry) the pus from the bags of cows affected with mammitis, or the liquids of putrid flesh, or putrid blood, and in every case he produced acute inflammation of the gland tissue within twenty-four hours. he thinks that in ordinary conditions the septic germ gains access by propagating itself through the milk, filling the milk canal and oozing from the external orifice. he points to this as a reason why dry cows escape the malady, though mingling freely with the sufferers, and why such dry cows do not suffer from inflammation of the gland tissue when attacked with foot-and-mouth disease. in this last case it is evident that it is not simply the inoculation with the milker's hand that is lacking, for the skin of the bag is attacked, but not its secreting, glandular parts. now that in any case of abscess we look for the cause in the chain forms of globular bacteria (_streptococcus pyogenes_), in the cluster form of white, globular bacteria (_staphylococcus pyogenes albus_), and in the golden and citron-yellow forms of clustered globular bacteria (_staphylococcus pyogenes aureus_ and _staphylococcus pyogenes citreus_), the formation of pus gives presumptive evidence of the action of one or more of these germs. so in cases of mortification of the bag; in the very occurrence there is fair circumstantial evidence of the presence of erysipelas micrococcus or other germ which kills the local tissues. again, in tuberculosis affecting the bag (a not uncommon condition), the active local cause is without doubt the tubercle bacillus. it has been found that false membranes have formed in certain cases of mammitis in the cow, and klein, after inoculating the diphtheria of man on the cow, found an ulcerous sore in the seat of inoculation and blisters on the teats and udder, in which he found what he believed to be the bacillus of diphtheria. the results are doubtful, even in the absence of false membranes. löffler, too, in the diphtheria of calves, found that the germ was longer and more delicate than that of man, and that its pathogenesis for rodents was less, guinea pigs having only a nonfatal abscess. the presence of false membranes in one form of mammitis in cows does not necessarily imply its communicability to man. it has been asserted that scarlet fever has been transmitted from the cow to man, and it can not be denied that in many cases the infection has been spread by means of the milk. the facts, however, when brought out fully have shown that in almost every case the milk had first come into contact with a person suffering or recovering from scarlet fever, so that the milk was infected after it left the cow. the alleged exceptional cases at hendon and dover, england, are not conclusive. in the hendon outbreak inoculations were made on calves from the slight eruption on the cow's teats, and they had a slight eruption on the lips and a form of inflammation of the kidneys, which dr. klein thought resembled that of scarlatina. the cows that had brought the disease to the hendon dairies were traced back to wiltshire, where cows were found suffering from a similar malady, but no sign of scarlet fever resulted. in the dover outbreak the dairyman first denied any disease in his cows, and brought a certificate of a veterinarian to prove that they were sound at the time of the investigation; then later he confessed that the cows had had foot-and-mouth disease some time before, and consequent eruption on the teats. so the question remains whether the man who denied sickness in the cows to begin with, and adduced professional evidence of it, did not later acknowledge the foot-and-mouth disease as a blind to hide the real source of the trouble in scarlatina in his own family or in the family of an employee. in america dr. stickler said that he had produced scarlatina in children by inoculation with imported virus of foot-and-mouth disease, but his contention is negatived by the facts that with foot-and-mouth disease constantly present in europe scarlatina does not accompany it, and that in america, with scarlatina constantly prevailing at some point, foot-and-mouth disease is unknown locally except at long intervals and as the result of the importation of infected animals or their products. man is susceptible to foot-and-mouth disease, but it never appears during the frequent epidemics of scarlatina. among other contagious forms of mammitis i may name one which i have encountered in large dairies, starting as a sore and slight swelling at the opening of the teat and extending up along the milk duct to the gland structure in the bag, all of which become indurated, nodular, and painful. the milk is entirely suppressed in that quarter of the bag, and from that it may extend to the others as it does from cow to cow through the milker's hands. another form almost universally prevalent in this district of central new york in broke out on the teats and udders as blisters strongly resembling cowpox, but which were not propagated when inoculated on calves. it was only exceptionally that this extended through the teat to the gland tissue, yet in some instances the bag was lost from this cause. scarlatina in man was very prevalent at the time (many schools were closed in consequence), but no definite connection seemed to exist between this and the cow disease, and on different dairy farms there were families of young children that had never had scarlet fever and who did not at that time contract it. the most common cause of contagious mammitis in cattle is a spherical bacterium in chain form (_streptococcus_) (moore, ward). yet it is clear that contagious mammitis is not a single affection, but a group of diseases which have this in common, that they attack the udder. _prevention._--prevention is to be especially sought in all such cases. in purchasing new cows see that they come from a herd where the teats and udder are sound. if a new cow with unknown antecedents comes from a public market, let her be milked for a week by a person who does not milk any other cows. keep her in a separate stall from others, so that there may be no infection from litter or flooring. wash the udder with soap and water, and wet with a solution of two teaspoonfuls of carbolic acid in a pint of water before letting the regular milker of the other cows take her. if any cow in the herd shows the indurated end of the teat or the inflammation and nodular tender character of the gland, sequestrate her at once and give her a separate milker. if another cow is to be put into the stall she occupied, first clean and scrape it, and wet it with a strong solution of bluestone, ounces in a gallon of water. the milk may be drawn off with a teat tube, or spring teat dilator (pl. xxiv, figs. and ), and the milk ducts injected frequently with a solution of peroxid of hydrogen or iodoform. i have had little success in checking the upward progress of the disease through the teat with carbolic acid or boric-acid solutions. used on the outside of the other teats, however, they may serve to prevent them from becoming infected. in the absence of peroxid of hydrogen the affected teat may be injected with a solution of grain corrosive sublimate in a pint of water, and the same may be used on the other teats, provided it is washed off every time before milking. as additional precautions, no cow with a retained afterbirth or unhealthy discharge from the womb should be left with the other cows. such cows doubtless infect their own udders and those of the cows next them by lashing with the soiled tail. if milkers handle retained afterbirth or vaginal discharge, or unhealthy wounds, or assist in a difficult and protracted parturition, they should wash the hands and arms thoroughly with soap and warm water and then rub them with the corrosive-sublimate solution, or if not, at least with one of carbolic acid. clothes stained with such offensive products should be thoroughly washed. the general treatment of contagious mammitis does not differ from that of the simple form, except that antiseptics should be given by the mouth as well as applied locally (hyposulphite of soda, one-half ounce daily). cowpox. this is another form of contagious inflammation of the udder which does not spread readily from animal to animal except by the hands of the milker. it is held to occur spontaneously in the cow, but this is altogether improbable, and so-called spontaneous cases are rather to be looked on as instances in which the germs have been preserved dry in the buildings or introduced in some unknown manner. it is not uncommon in the horse, attacking the heels, the lips, or some other inoculated part of the body, and is then easily transferred to the cow, if the same man grooms and dresses the horse and milks the cow. it may also appear in the cow by infection, more or less direct, from a person who has been successfully vaccinated. many believe that it is only a form of the smallpox of man modified by passing through the system of cow or horse. it is, however, unreasonable to suppose that this alleged modified smallpox could have been transmitted from child to child (the most susceptible of the human race) for years, under all possible conditions, without once reverting to its original type of smallpox. chauveau's experiments on both cattle and horses with the virus of smallpox and its inoculation back on the human subject go far to show that in the climate of western europe, at least, no such transformation takes place. smallpox remains smallpox and cowpox, cowpox. again, smallpox is communicable to a person who visits the patient in his room but avoids touching him, while cowpox is never thus transferred through the air unless deliberately diffused in the form of spray. the disease in the cow is ushered in by a slight fever, which, however, is usually overlooked, and the first sign is tenderness of the teats. examined, these may be redder and hotter than normal, and at the end of two days there appear little nodules, like small peas, of a pale-red color, and increasing so that by the seventh day they may measure three-fourths of an inch to inch in diameter. the yield of milk diminishes, and when heated it coagulates slightly. from the seventh to the tenth day the eruption forms into a blister, with raised margins and a depression in the center, and from which the whole of the liquid can not be drawn by a single puncture. the blister, in other words, is chambered, and each chamber must be opened to evacuate the whole of the contents. if the pock forms on a surface where there is thick hair it does not rise as a blister, but oozes out a straw-colored fluid which concretes on the hairs in an amber-colored mass. in one or two days after the pock is full it becomes yellow from contained pus and then dries into a brownish-yellow scab, which finally falls, leaving one or more distinct pits in the skin. upon the teats, however, this regular course is rarely seen; the vesicles are burst by the hands of the milker as soon as liquid is formed, and as they continue to suffer at each milking they form raw, angry sores, scabbing more or less at intervals, but are slow to undergo healing. the only treatment required is to heal the sores. as milking is the main cause of their persistence, that must be done as gently as possible, or even with the teat tube or dilator. (pl. xxiv, figs. and .) it is essential to check the propagation of the germ, and for this purpose the sore teats may be washed frequently with a solution of half an ounce hyposulphite of soda in a pint of water. this will usually check the inflammation and cut short the malady. suppression of milk. the absence of milk in the udder may result from ill health, debility, emaciation, chronic disease of the bag, wasting of the gland from previous disease, or insufficient feed, but sometimes it will occur suddenly without any appreciable cause. the treatment consists in removing the cause of the disease, giving rich albuminoid feed made into warm mashes, and administering ounce doses of aromatic carminatives, like anise seed, fennel seed, etc. rubbing and stripping the udder are useful; the application of oil of lavender or of turpentine, or even a blister of spanish flies, will sometimes succeed. bloody milk. blood may escape with the milk when the udder has been injured by blows; also when it is congested or inflamed, when the circulation through it has been suddenly increased by richer and more abundant feed, or when the cow is under the excitement of heat. the milk frothing up and assuming a pink tinge is often the first sign of red water, and it may result from eating acrid or irritant plants, like the ranunculaceæ, resinous plants, etc. deposits of tubercle or tumors in the udder, or induration of the gland, may be efficient causes, the irritation caused by milking contributing to draw the blood. finally, there may be a reddish tinge or sediment when madder or logwood has been eaten. in milk which becomes red after it is drawn it may be from the presence in it of the _bacillus prodigiosus._ this also grows on bread, and is the explanation of the supposed miracle of the "bleeding host." the treatment will vary with the cause. in congested glands give pound of epsom salt, and daily thereafter one-half ounce saltpeter, with a dram of chlorate of potassium; the bag should be bathed with hot or cold water, and rubbed with camphorated lard. if the feed is too rich or abundant it must be reduced. if from acrid plants, they must be removed from pasture or fodder. induration of the udder may be met by rubbing with a combination of iodin ointment part, soft soap parts; mercurial ointment and soap also may be used. careful milking is imperative. blue milk. watery milk is blue, but the presence of a germ (_bacillus cyanogenes_) causes a distinct blue shade even in rich milk and cream. it may reach the milk after it has been drawn, or it may find its way into the opening of the milk ducts and enter the milk as it is drawn. in the latter case frequent milking and the injection of a solution of drams of hyposulphite of soda in a pint of water into the teats will serve to destroy the germs. stringy milk. this may be caused by fungi developing in the liquid, and that the spores are present in the system of the cow may be safely inferred from the fact that in a large herd two or three cows only will yield such milk at a time, and that after a run of days or a fortnight they will recover and others will be attacked. i have found that such affected cows had the temperature raised one or two degrees above the others. like most other fungi this does not grow out into filaments within the body of the cow, but in five or six hours after milking the surface layers are found to be one dense network of filaments. if a needle is dipped in this and lifted the liquid is drawn out into a long thread. in one case which i investigated near ithaca, n. y., the contamination was manifestly from a spring which oozed out of a bank of black-muck soil and stood in pools mixed with the dejections of the animals. inoculation of pure milk with the water as it flowed out of this bank developed in it the fungus and the stringy characters. by fencing the spring in and giving the affected cows each drams bisulphite of soda daily, the trouble was arrested promptly and permanently. chapped teats. these may be caused by anything which irritates them. the powerful sucking of the calf; the sudden chilling of the teat in winter after the calf has just let it go or after the completion of milking with a wet hand; contact with cold water or stagnant, putrid water, or with filth or irritants when lying down; slight congestions of the skin in connection with overstocking; indeed, any source of local irritation may cause chapping. this may be slight or extend into great, gaping sores and induce retention of milk or even mammitis. soothing applications of vaseline or a combination of equal parts of spermaceti and oil of sweet almonds may be applied. if healing is tardy, add grains balsam of peru to the ounce of ointment. if the irritation is very great, wash first with a solution of dram sugar of lead in pint of water and then apply benzoated zinc-oxid ointment. warts on the teats. these are often very troublesome, yet they may be greatly benefited or entirely removed by smearing them thickly with pure olive oil after each milking. if they persist they may be cut off with a pair of sharp scissors and the sore touched with a stick of lunar caustic. they may now be oiled and the caustic repeated as demanded to prevent their renewed growth. _scabby teats_ may be smeared with vaseline containing carbolic acid enough to give it an odor. teat blocked by concretion of casein. under unhealthy conditions of the gland or milk ducts clots of casein form which, pressed clear of most of their liquid and rolled into rounded masses, may block the passage. they can be moved up and down by manipulation of the teat, and if they can not be pressed out they may be extracted by using the spring teat dilator (pl. xxiv, fig. ), being held surrounded by its three limbs. before extraction is attempted an ounce of almond oil, boiled, should be injected into the teat. teat blocked by calculus. when the calcareous matter of the milk has been precipitated in the form of a smooth, rounded stone, a rough, conglomerated concretion, or a fine, sandlike débris, it may cause obstruction and irritation. these bodies are felt to be much harder than those formed by casein, and the milk usually contains gritty particles. extraction may be attempted, in the case of the finely divided gritty matter, by simple milking or with the spring dilator (pl. xxiv, fig. ) in the case of the larger masses. should this fail the teat may be laid open with the knife and sewed up again or closed with collodion, but such an operation is best deferred until the cow is dry. teat blocked by a warty or other growth inside. in this case the obstruction may be near the orifice of the teat or farther up, and the solid mass is not movable up and down with the same freedom as are concretions and calculi. the movement is limited by the elasticity of the inner membrane of the teat from which it grows, and is somewhat freer in certain cases because the growth has become loose and hangs by a narrow neck. in the case of the looser growths they may be snared by a fine, spring wire passed as a loop through a fine tube (like a teat tube open at each end) and introduced into the teat. when this can not be done, the only resort is to cut in and excise it while the cow is dry. thickening of the mucous membrane and closure of the milk duct. as a result of inflammation extending from without inward, a gradual narrowing of the milk duct may occur from thickening and narrowing of its lining membrane. this may be limited to a small area near the lower end, or it may extend through the whole length of the teat. the stream of milk becomes finer and finer until it finally ceases altogether, and a firm cord is felt running through the teat. if the constriction is only at the outlet, the teat may be seized and distended by pressing the milk down into it from above, and an incision may be made with a sharp penknife in two directions at right angles to each other and directly in the original opening. the knife should be first cleansed in boiling water. the opening may be kept from closing by a dumb-bell shaped bougie of gutta-percha (pl. xxiv, fig. ) or by the spring dilator. if the obstruction is more extended it may be perforated by lüthi's perforating sound. (pl. xxiv, fig. a and b.) this is a steel wire with a ring at one end, and at the other is screwed on to the wire a conical cap with sharp cutting edges at the base, which scrapes away the thickened masses of cells as it is drawn back. this may be passed again and again to enlarge the passages sufficiently, and then the passage may be kept open by wearing a long, dumb-bell bougie, a thick piece of carbolized catgut, or a spring dilator. if the passage can not be sufficiently opened with the sound it may be incised by the hidden bistoury. (pl. xxiv, fig. .) this is a knife lying alongside a flattened protector with smooth, rounded edges, but which can be projected to any required distance by a lever on the handle. the incisions are made in four directions, as deep as may be necessary, and the walls then can be held apart by the spring dilator until they heal. in case the constriction and thickening of the canal extend the whole length of the teat, it is practically beyond remedy, as the gland is usually involved so as to render it useless. closure of the milk duct by a membrane. in this form the duct of the teat is closed by the constriction of its lining membrane at one point, usually without thickening. the closure usually takes place while the cow is dry; otherwise its progress is gradual, and for a time the milk may still be pressed through slowly. in such case, if left at rest, the lower part of the teat fills up and the milk flows in a full stream at the first pressure, but after this it will not fill up again without sufficient time for it to filter through. this is to be cut open by the hidden bistoury (pl. xxiv, fig. ), which may be first passed through the opening of the membrane, if such exists. if not it may be bored through, or it may be pressed up against the membrane at one side of the teat and opened toward the center, so as to cut its way through. incisions should be made in at least two opposite directions, and the edges then may be held apart by wearing the spring dilator until healing has been completed. in all cases of operations on the teats the instruments must be thoroughly disinfected with hot water, or by dipping in carbolic acid and then in water that has been boiled. opening in the side of the teat (milk fistula). this may occur from wounds penetrating the milk duct and failing to close, or it may be congenital, and then very often it leads to a distinct milk duct and an independent portion of the gland. in the first form it is necessary only to dissect away the skin leading into the opening for some distance down, to close the orifice with stitches, and to cover the whole with collodion. a teat tube or spring dilator may be worn to drain the milk off and prevent distention and reopening of the orifice. in case of an independent milk duct and gland one of two courses may be selected--to open the one duct into the other by incision and then close the offending opening, or to inject the superfluous gland through its duct with a caustic solution, so as to destroy its secreting power. in both cases it is desirable to wait until the cow goes dry. * * * * * diseases following parturition. description of plates. plates xxii, xxiii. supports for prolapsed uterus. these illustrations show various appliances used in prolapse or inversion of the uterus. the uterus should first be returned to its proper situation and then some apparatus applied to prevent a recurrence of the inversion or protrusion. plate xxii: fig. . crupper, strap truss. (from hill's bovine medicine and surgery.) fig. . renault's rope truss. the rope for this truss should be from to feet long and about the thickness of the little finger. plate xxiii: fig. . cow to which delwart's rope truss has been applied. fig. _a_ shows the loop of delwart's truss. fig. . zundel's labial sutures. these consist of two wires passed through the lips of the vulva in a horizontal direction, and two additional wires passed through the loops at the ends of the horizontal wires in order to hold them in place. fig. . iron truss for holding the vagina or uterus in place after calving. the cords are passed through the eyes at the corners of the triangular iron; the base of the triangle fits under the tail. the truss is from to inches long and about - / inches wide. plate xxiv. instruments used in diseases following parturition. fig. . lüthi's perforating sound, for opening the milk canal through the teat when this has become occluded; a, the sound one-half the natural size; b, section of head of sound, natural size, showing cutting edge. fig. . bistouri caché. a blade hidden in its sheath which by pressure of the finger may be made to protrude a certain distance. this distance is regulated by the screw near the handle. the instrument is used to open the milk canal when closed up. it is introduced into the milk canal with its blade in the sheath and withdrawn with the blade protruding. fig. . spring teat dilator, about one-half natural size, for dilating the milk canal. fig. . ring teat syphon, for withdrawing milk when the teat is sore or injured. fig. . gutta-percha bougie, for dilating the opening of the teat. fig. . truss applied to calf for umbilical or navel hernia. (from fleming's veterinary obstetrics.) fig. . armatage's iron clamp for umbilical or navel hernia. when this clamp is applied care must be taken not to include a portion of the bowel. * * * * * [illustration: plate xxii. supports for prolapsed uterus.] [illustration: plate xxiii. supports for prolapsed uterus.] [illustration: plate xxiv. instruments used in diseases following parturition.] diseases of young calves. by james law, f. r. c. v. s., _formerly professor of veterinary science, etc., in cornell university._ suspended breathing. the moment the circulation through the navel string is stopped the blood of the calf begins to become overcharged with carbon dioxid (co_{ }), and unless breathing is speedily established death promptly follows. fortunately the desire to breathe, roused by the circulation of the venous blood and the reflex action from the wet and chilling skin, usually starts the contractions of the diaphragm at once and life is insured. among the obstacles to breathing may be named suffocation before or during birth from compression of the navel cord and the arrest of its circulation; the detachment of the fetal membranes from the womb before the calf is born; a too free communication between the two auricles (foramen ovale) of the heart by which the nonaerated blood has mixed too abundantly with the aerated and induced debility and profound weakness; a condition of ill health and debility of the calf as a result of semistarvation, overwork, or disease of the cow; fainting in the debilitated calf when calving has been difficult and prolonged; the birth of the calf with its head enveloped in the fetal membranes, so that it has been unable to breathe, and the presence of tenacious phlegm in the mouth and nose, acting in the same manner. besides the importance of proper care and feeding of the cow as a preventive measure, attention should be given at once to relieve the newborn calf of its investing membrane and of any mucus that has collected in mouth or nostrils. wiping out the nose deeply with a finger or feather excites to sneezing, hence to breathing. blowing into the nose has a similar effect. sucking the nostril through a tube applied to it is even more effective. slapping the chest with the palm of the hand or with a towel dipped in cold water, compression and relaxation alternately of the walls of the chest, may start the action, and ammonia or even tobacco smoke blown into the nose may suffice. every second is precious, however, and if possible the lungs should be dilated by forcibly introducing air from a bellows or from the human lungs. as the air is blown in through bellows or a tube the upper end of the windpipe must be pressed back against the gullet, as otherwise the air will go to the stomach. in a large dairy a piece of elastic tubing one-third of an inch in bore should be kept at hand for sucking and blowing in such cases. bleeding from the navel. this may occur in two conditions--when the cord is cut off too close to the navel and left untied and when it tears off at the navel. (pl. xiv.) it may also bleed when torn across naturally, if it is sucked by the dam or another calf. in an animal with little plasticity to its blood it will flow under almost any circumstances. when any cord is left it is always safe to tie it, and it is only when it is swollen and may possibly contain a loop of the bowel that there is danger in doing so. by pressing upward any bulky contents such danger is avoided. if torn or cut too close to be tied the bleeding may be checked by applying alum, copperas, or for a fraction of a second the end of an iron rod at a dull-red heat. if much blood has been lost it may be requisite to transfuse several ounces of blood or of a weak, common-salt solution into the open, umbilical vein. urine discharged through the navel (persistent urachus). before birth the urine passes from the bladder by a special tube through the navel and navel string into the outer water bag (allantois). (pl. xii.) this closes at birth, and the tube shrinks into a fine cord up to the bladder. it is only in the bull calf that it is liable to remain open, doubtless because of the long, narrow channel through which the urine must otherwise escape. the urethra, too, is sometimes abnormally narrow, or even closed, in the male. if part of the cord remains, it should be tied and the whole allowed to wither up naturally. if the cord has been removed and the tube (urachus) protrudes, discharging the urine, that alone must be tied. if there is nothing pendent the urachus must be seized, covered by the skin, and a curved needle being passed through the skin and above the duct, it may be tied along with this skin. a blister of spanish flies, causing swelling of the skin, will often close the orifice--so with the hot iron. if the urethra of the male is impervious it can rarely be remedied. inflammation of the urachus (navel urine duct). this may originate in direct, mechanical injury to the navel in calving, or shortly after, with or without the lodgment of irritant or septic matter on its lacerated or cut end. the mere contact with healthy urine, hitherto harmless, can now be looked on as becoming suddenly irritating. the affection is usually marked by the presence of redness and swelling at the posterior part of the navel and the escape of urine and a few drops of whitish, serous pus from the orifice of the urachus. in those cases in which urine is not discharged a tender swelling, like a thick cord extending upward and backward from the navel into the abdomen, may be identified. the navel enlargement may be considerable, but it is solid, does not gurgle on handling, and can not be done away with by pressing it back into the abdomen, as in a case of hernia. in cases at first closed the pus may burst out later, coming from the back part of the navel and the swelling extending backward. in other cases whitish pus may pass with the urine by the ordinary channel, showing that it has opened back into the bladder. in other cases the umbilical veins become involved, in which case the swelling extends forward as well as backward. thus the disease may result in destructive disorders of the liver, lungs, and, above all, of the joints. the disease may usually be warded off or rendered simple and comparatively harmless by applying antiseptics to the navel string at birth (carbolic acid part, water and glycerin parts each, or wood tar). later, antiseptics may be freely used (hyposulphite of soda drams, water quart) as an application to the surface and as an injection into the urachus, or even into the bladder if the two still communicate. if they no longer communicate, a stronger injection may be used (tincture of chlorid of iron drops, alcohol ounce). several weeks will be required for complete recovery. abscess of the navel. as the result of irritation at calving or by the withered cord, or by licking with the rough tongue of the cow, inflammation may attack the loose connective tissue of the navel to the exclusion of the urachus and veins, and go on to the formation of matter. in this case a firm swelling appears as large as the fist, which softens in the center and may finally burst and discharge. the opening, however, is usually small and may close prematurely, so that abscess after abscess is formed. it is distinguished from hernia by the fact that it can not be returned into the abdomen, and from inflammations of the veins and urachus by the absence of swellings forward and backward along the lines of these canals. treatment consists in an early opening of the abscess by a free incision and the injection twice a day of an astringent antiseptic (chlorid of zinc one-half dram, water pint). inflammation of the navel veins (umbilical phlebitis). in this affection of the navel the inflammation may start directly from mechanical injury, as in either of the two forms just described, but on this are inoculated infective microbes, derived from a retained and putrefying afterbirth, an abortion, a metritis, a fetid discharge from the womb, an unhealthy open sore, a case of erysipelas, from overcrowding, from filthy floor or bedding, or from an offensive accumulation of manure, solid or liquid. as the microbes vary in different cases, given outbreaks will differ materially in their nature. one is erysipelatoid; another purulent infection with the tendency to secondary abscesses in the joints, liver, lungs, etc.; another is from a septic germ and is associated with fetid discharge from the navel and general putrid blood poisoning. in estimating the causes of the disease we must not omit debility of the calf when the mother has been underfed or badly housed or when either she or the fetus has been diseased. _symptoms._--the symptoms vary. with the chain-form germs (streptococci) the navel becomes intensely red, with a very firm, painful swelling, ending abruptly at the edges in sound skin and extending forward along the umbilical veins. the secondary diseases are circumscribed, black engorgements (infarctions) or abscesses of the liver, lungs, kidneys, bowels, or other internal organs, and sometimes disease of the joints. with the ordinary pus-producing germs (_staphylococcus pyogenes aureus_ and _streptococcus pyogenes_) the local inflammation in the navel causes a hot, painful swelling, which rapidly advances to the formation of matter (pus), and the raw, exposed surface, at first bright red, becomes dark red or black, soft, friable, and pultaceous. if the pus is white, creamy, and comparatively inoffensive in odor, the secondary formations in internal organs and joints are mainly of the same purulent character (secondary abscesses). if, on the other hand, the discharge is very offensive and the pus more serous, watery, or bloody, there is reason to suspect the presence of some of the septic bacteria, and the results on the general system are a high fever and softening of the liver and spleen and no tendency to abscesses of the internal organs. diarrhea is a common symptom, and death ensues early, the blood after death being found unclotted. complicated cases are common, and in all alike the umbilical veins usually remain open and can be explored by a probe passed at first upward and then forward toward the liver. prevention is sought by applying a lotion of carbolic acid or iodin solution to the navel string at birth, or it may be smeared with common wood tar, which is at once antiseptic and a protective covering against germs. in the absence of either a strong decoction of oak bark may be used. _local treatment_ consists in the application of antiseptic to the surface and their injection into the vein. as a lotion carbolic acid, ounce in a quart of strong decoction of oak bark, should be used, or salicylic acid or salol may be sprinkled on the surface. the interior of the vein should be swabbed out with a probe wrapped around with cotton wool and dipped in boracic salicylic acid. if complications have extended to the liver or other internal organs, or the joints, other treatment will be demanded. in acute cases of general infection an early fatal result is to be expected. pyemic and septicemic inflammation of joints in calves (joint ill). this occurs in young calves within the first month after birth. it persists in the joints when once attacked, and is usually connected with disease of the navel. rheumatism, on the other hand, rarely occurs in a calf under a month old. it tends to shift from joint to joint, and is independent of any navel disease. again, it affects the fibrous structures of the joints, and rarely results in the formation of white matter, while the affection before named attacks the structures outside as well as inside the joints and, above all, the ends of the bones, and tends to the destruction and crumbling of their tissue, and even to the formation of open sores, through which the fragile bones are exposed. the microbes from the unhealthy and infected wound in the navel pass into the system through the veins, or lymphatics, and form colonies and local inflammations and abscesses in and around the joints. _symptoms._--the symptoms are the swelling of one or more joints, which are very hot and tender. the calf is stiff and lame, lies down constantly, and does not care to suck. there is very high fever, accelerated breathing and pulse, and there is swelling and purulent discharge (often fetid) from the navel. there may be added symptoms of disease of the liver, lungs, heart, or bowels, on which we need not here delay. the important point is to determine the condition of the navel in all such cases of diseased and swollen joints beginning in the first month of life, and in all cases of general stiffness, for besides the diseases of the internal organs there may be abscesses formed among the muscles of the trunk, though the joints appear sound. cases of this kind, if they do not speedily die, tend to become emaciated and perish later in a state of weakness and exhaustion. _prevention._--prevention must begin with the purity of the buildings and the navel, as noted in the last article. _treatment._--treatment is in the main antiseptic. the slighter forms may be painted daily with tincture of iodin, or an ointment of biniodid of mercury ( dram) and lard ( ounces) may be rubbed on the affected joints daily until they are blistered. in case of swellings containing matter, this may be drawn through the nozzle of a hypodermic syringe and the following solution injected: compound tincture of iodin, dram; distilled (or boiled) water, ounces. internally the calf may take grains quinin twice daily and grains hyposulphite of soda, or grains salicylate of soda three times a day. umbilical hernia (breach at the navel). this may exist at birth from imperfect closure of the muscles around the opening; it may even extend backward for a distance, from the two sides failing to come together. apart from this, the trouble rarely appears after the calf has been some time on solid feed, as the paunch then extends down to the right immediately over the navel, and thus forms an internal pad, preventing the protrusion of intestine. _symptoms._--the symptoms of umbilical hernia are a soft swelling at the navel, with contents that usually gurgle on handling, and can be entirely returned into the abdomen by pressure. the diseases of the navel hitherto considered have no gurgling contents and can not be completely returned into the abdomen. the only exception in the case of the hernia is when the walls of the sac have become greatly thickened. these will, of course, remain as a swelling after the bowel has been returned; and when the protruding bowel has contracted permanent adhesion to the sac, it is impossible to return it fully without first severing that connection. _treatment._--treatment is not always necessary. a small hernia, like an egg, in a new-born calf, usually recovers of itself as the animal changes its diet to solid feed and has the paunch fully developed as an internal pad. in other cases apply a leather pad inches square attached around the body by two elastic bands connected with its four corners, and an elastic band passing from its front border to a collar encircling the neck, and two other elastic bands from the neck collar along the two sides of the body to the two bands passing up over the back. (pl. xxiv, fig. .) for small hernias nitric acid may be used to destroy the skin and cause such swelling as to close the orifice before the skin is separated. for a mass like a large goose egg one-half ounce of the acid may be rubbed in for three minutes. no more must be applied for days. for large masses this is inapplicable, and with too much loss of skin the orifice may fail to close and the bowels may escape. the application of a clamp like those used in castration is a most effective method, but great care must be taken to see that all the contents of the sac are returned so that none may be inclosed in the clamp. (pl. xxiv, fig. .) another most effective resort is to make a saturated solution of common salt, filter and boil it, and when cool inject under the skin (not into the sac) on each side of the hernia a dram of the fluid. a bandage may then be put around the body. in hours an enormous swelling will have taken place, pressing back the bowel into the abdomen. when this subsides the wound will have closed. dropsy of the navel. a sac formed at the navel, by contained liquid accumulated by reason of sucking by other calves, is unsightly and sometimes injurious. after making sure that it is simply a dropsical collection it may be deeply punctured at various points with a large-sized lancet or knife, fomented with hot water, and then daily treated with a strong decoction of white-oak bark. blue disease (cyanosis). this appearing in the calf at birth is due to the orifice between the two auricles of the heart (foramen ovale) remaining too open, allowing the nonaerated (venous) blood to mix with the aerated (arterial) blood, and it is beyond the reach of treatment. it is recognized by the blueness of the eyes, nose, mouth, and other mucous membranes, the coldness of the surface, and the extreme sensitiveness to cold. constipation. at birth the bowels of the calf contain the meconium, a tenacious, gluey, brownish-yellow material largely derived from the liver, which must be expelled before they can start their functions normally. the first milk of the cow (colostrum, beestings), rich in albumin and salts, is nature's laxative to expel this now offensive material and should never be withheld from the calf. if, for lack of this, from the dry feeding of the cow, or from any other cause, the calf is costive, straining violently without passage, lying down and rising as in colic, and failing in appetite, no time should be lost in giving relief by an ounce dose of castor oil, assisting its action by injections of soapsuds or oil. whatever meconium is within reach of the finger should be carefully removed. it is also important to give the cow a sloppy, laxative diet. indigestion. this may occur from many different causes, as costiveness; a too liberal supply of milk; milk too rich; the furnishing of the milk of a cow long after calving to a very young calf; allowing a calf to suck the first milk of a cow that has been hunted, driven by road, shipped by rail, or otherwise violently excited; allowing the calf too long time between meals, so that impelled by hunger it quickly overloads and clogs the stomach; feeding from the pail milk that has been held over in unwashed (unscalded) buckets, so that it is fermented and spoiled; feeding the milk of cows kept on unwholesome feed; keeping the calves in cold, damp, dark, filthy, or bad-smelling pens; feeding the calves on artificial mixtures containing too much starchy matter; or overfeeding the calves on artificial feed that may be appropriate enough in smaller quantity. the licking of hair from themselves or others and its formation into balls in the stomach will cause obstinate indigestion in the calf. _symptoms._--the symptoms are dullness, indisposition to move, uneasiness, eructations of gas from the stomach, sour breath, entire loss of appetite, lying down and rising as if in pain, fullness of the abdomen, which gives out a drumlike sound when tapped with the fingers. the costiveness may be marked at first, but soon it gives place to diarrhea, by which the offensive matters may be carried off and health restored. in other cases it becomes aggravated, merges into inflammation of the bowels, fever sets in, and the calf gradually sinks. _prevention._--prevention consists in avoiding the causes enumerated above or any others that may be detected. _treatment._--treatment consists in first clearing away the irritant present in the bowels. for this purpose or ounces of castor oil with drops of laudanum may be given, and if the sour eructations are marked a tablespoonful of limewater or one-fourth ounce calcined magnesia may be given and repeated two or three times a day. if the disorder continues after the removal of the irritant, a large tablespoonful of rennet, or grains of pepsin, may be given at each meal along with a teaspoonful of tincture of gentian. any return of constipation must be treated by injections of warm water and soap, while the persistence of diarrhea must be met as advised under the discussion following this. in case of the formation of loose hair balls inclosing milk undergoing putrid fermentation, temporary benefit may be obtained by giving a tablespoonful of vegetable charcoal three or four times a day, but the only real remedy is to cut the paunch open and extract them. at this early age they may be found in the third or even the fourth stomach; in the adult they are confined to the first two and are comparatively harmless. diarrhea (scouring) in calves (simple and contagious). as stated in the last article, scouring is a common result of indigestion, and at first may be nothing more than an attempt of nature to relieve the stomach and bowels of offensive and irritating contents. as the indigestion persists, however, the fermentations going on in the undigested masses become steadily more complex and active, and what was at first the mere result of irritation or suspended digestion comes to be a genuine contagious disease, in which the organized ferments (bacteria) propagate the affection from animal to animal and from herd to herd. more than once i have seen such epizootic diarrhea start on the headwaters of a creek and, traveling along that stream, follow the watershed and attack the herds supplied with water from the contaminated channel. in the same way the disease, once started in a cow stable, is liable to persist for years, or until the building has been thoroughly cleansed and disinfected. it may be carried into a healthy stable by the introduction of a cow brought from an infected stable when she is closely approaching calving. another method of its introduction is by the purchase of a calf from a herd where the infection exists. in enumerating the other causes of this disease we may refer to those noted above as inducing indigestion. as a primary consideration any condition which lowers the vitality or vigor of the calf must be accorded a prominent place among factors which, apart from contagion, contribute to start the disease de novo. other things being equal, the strong, vigorous races are the least predisposed to the malady, and in this respect the compact form, the healthy coat, the clear eye, and the bold, active carriage are desirable. even the color of the hair is not unimportant, as in the same herd i have found a far greater number of victims among the light colors (light yellow, light brown) than among those of a darker tint. this constitutional predisposition to indigestion and diarrhea is sometimes fostered by too close breeding, without taking due account of the maintenance of a robust constitution; hence animals that are very much inbred need to be especially observed and cared for unless their inherent vigor has been thoroughly attested. the surroundings of the calf are powerful influences. calves kept indoors suffer to a greater extent than those running in the open air and having the invigorating influences of sunshine, pure air, and exercise; close, crowded, filthy, bad-smelling buildings are especially causative of the complaint. the presence in the air of carbon dioxid, the product of breathing, and of the fetid, gaseous products of decomposing dung and urine diminish by about one-fourth of their volume the life-giving oxygen and in the same ratio hinder the aeration of the blood and the maintenance of vigorous health. worse than this, such fetid gases are usually direct poisons to the animal breathing them; for example, sulphureted hydrogen (hydrogen sulphid sh_{ }) and various alkaloids (ptomaines) and toxins (neutral poisonous principles) produced in the filth fermentations. these lower the general health and stamina, impair digestion, and by leading to the accumulation in stomach and bowels of undigested materials they lay the foundation for offensive fermentations within these organs and consequent irritation, poisoning, and diarrhea. they further weaken the system so that it can no longer resist and overcome the trouble. the condition of the nursing cow and her milk is another potent cause of trouble. the feed of the cow is important. the influence of this is shown in the following tables: _influence of feed on milk._ (_from becquerel and vernois._) +--------------------------+--------+----------+--------+--------+--------+ | | | casein | | | |character of feed. | water. | and | milk | | | | |extractive| sugar. | butter.| salts. | | | matter. | | | +--------------------------+--------+----------+--------+--------+--------+ | |_parts |_parts |_parts |_parts |_parts | |in , _ in , _|in , _in , _in , _ |cows on winter feed: | | | | | | trefoil or lucern, - | | | | | | pounds; oat straw, - | | | | | | pounds; beets, pounds;| | | | | | water, buckets | . | . | . | . | . |cows on summer feed: | | | | | | green trefoil, lucern, | | | | | | maize, barley, grass, | | | | | | buckets water | . | . | . | . | . |goat's milk on different | | | | | | feed: | | | | | | on straw and trefoil | . | . | . | . | . | on beets | . | . | . | . | . |normal mean | . | . | . | . | . | | | | | | +--------------------------+--------+----------+--------+--------+--------+ in these examples the deterioration of the milk in casein on the less nutritious winter feeding is very marked, although the relative quantity of butter remains almost unchanged. in the case of the goat the result is even more striking, the beet diet giving a very large decrease of both casein and butter and an increase of milk sugar. the second table following, condensed from the iowa agricultural experiment station bulletin, gives the results in butter and total solids when the same cows were fed on different rations in succession. each cow was fed a daily ration of pounds corn fodder and pounds clover hay, besides the test diet of ( ) - / pounds corn-and-cob meal, and ( ) pounds sugar meal--a product of the glucose manufacture. this special feed was given seven days before the commencement of each test period to obviate the effects of transition. the analyses of the special rations are given below: _analyses of special rations._ ------------------------------+--------------+-----------+ constituents. | corn-and-cob | sugar | | meal. | meal. | ------------------------------+--------------+-----------+ | _per cent._ |_per cent._| moisture | . | . | salts | . | . | fat | . | . | carbohydrates (heat formers). | . | . | woody fiber | . | . | proteids (flesh formers) | . | . | ------------------------------+--------------+-----------+ the great excess of fat and nitrogenous or flesh-forming principles in the sugar meal is very evident. _influence of feed on milk._ (_iowa station._) ------------------------+-------+----+-------+------+-------+------------ | | | | | |ratio of fat animal. | milk. |fat.|solids.| fat. |solids.|to solids | | | | | |not fat. ------------------------+-------+----+-------+------+-------+------------ _pounds__pct_| _pct_ _pounds_pounds_| grade shorthorn cow: | | | | | | first period, days,| | | | | | corn-and-cob meal | . | . | . | . | . | . : , second period, days| | | | | | sugar meal | . | . | . | . | . | . : , third period, days,| | | | | | corn-and-cob meal | . | . | . | . | . | . : , grade shorthorn cow: | | | | | | first period, days,| | | | | | corn-and-cob meal | . | . | . | . | . | . : , second period, days| | | | | | sugar meal | . | . | . | . | . | . : , third period, days,| | | | | | corn-and-cob meal | . | . | . | . | . | . : , grade shorthorn cow: | | | | | | first period, days,| | | | | | sugar meal | . | . | . | . | . | . : , second period, days| | | | | | corn-and-cob meal | . | . | . | . | . | . : , third period, days,| | | | | | sugar meal | . | . | . | . | . | . : , grade holstein cow: | | | | | | first period, days,| | | | | | sugar meal | . | . | . | . | . | . : , second period, days| | | | | | corn-and-cob meal | . | . | . | . | . | . : , third period, days,| | | | | | sugar meal | . | . | . | . | . | . : , ------------------------+-------+----+-------+------+-------+------------ here we see in every instance a marked relative increase of the butter, and to a less extent of the other milk solids whenever the sugar meal--rich in fat and albuminoids--was furnished. the opposite theory having been largely taught, it becomes needful thus to sustain the old and well-founded belief of the dairymen. not only does the richness of the milk vary with the nature of the food, but it varies also according to the time of the day when it is drawn, the morning milk giving - / per cent of cream and the evening milk - / per cent (hassall). boedecker found that the morning milk had per cent of solids, while the evening milk had per cent. again, the milk first drawn at any milking is always poorer than the last drawn. the first may have only one-half, or in extreme cases one-fourth, the cream of the last. once more, when the cow is in heat the milk becomes richer in solids (casein and butter), and contains granular and white blood cells like the colostrum, and often disagrees with the young animal living on it. now, while these various modifications in the amount of solid matters may prove harmless to a strong and vigorous calf, they can easily be the occasion of intestinal disorder in a weaker one, or in one with health already somewhat impaired by sickness, exposure, or unwholesome buildings. the casein of the cow's milk coagulates in one solid mass, and is much less easily penetrated by the digesting fluids than the fine, flaky coagula of woman's or mare's milk. an excess of casein, therefore, thrown on an already overtaxed stomach can all the more readily induce disorder. so it is with butter fat. while a most important element in nutrition, it may be present in the stomach in such quantity as to interfere with the action of the gastric juice on the casein, and with the interruption of the natural stomach digestion the fats themselves undergo decomposition with the production of offensive and irritating fatty acids. the milk of the very young cow is usually more watery than that of the mature animal, and that of the old cow has a greater liability to become acid. it varies much with the breed, the channel island cattle being notorious for the relatively large quantity of cream, while the holsteins, ayrshires, and shorthorns are remarkable rather for the quantity of casein. the milk of cows fed on potatoes and grass is very poor and watery; that from cows fed on cabbage or swedish turnips has a disagreeable taste and odor (from the former an offensive liquid has been distilled). cows fed on overkept, fermented, and soured rations have acid milk, which readily turns and coagulates. thus old, long-kept brewer's grains, swill, the refuse of glucose factories, and ensilage which has been put up too green all act in this way. the same may come from disease in the cow's udder, or any general disease of the cow with attendant fever, and in all such cases the tendency is to rapid change and unwholesomeness. if the milk is drawn and fed from a pail, there is the added danger of all sorts of poisonous ferments getting into it and multiplying; it may be from the imperfect cleansing and scalding of the pail; from rinsing the pails with water that is impure; from the entrance of bacterial ferments floating in the filthy atmosphere of the stable, or from the entrance of the volatile chemical products of fermentation. in addition to the dangers coming through the milk, the calf suffers in its digestive powers from any temporary illness, and among others from the excitement attendant on the cutting of teeth, and impaired digestion means fermentations in the undigested masses and the excessive production of poisonous ptomaines and toxins. whatever may be the starting or predisposing cause of this malady, when once established it is liable to perpetuate itself by contagion and to prove a veritable plague in a herd or a district. _symptoms._--the symptoms of a diarrhea may appear so promptly after birth as to lead to the idea that the cause already existed in the body of the calf, and it usually shows itself before the end of the second week. it may be preceded by constipation, as in retained meconium, or by fetid eructations and colicky pains, as in acute indigestion. the tail is stained by the liquid dejections, which are at first simply soft and mixed with mucus with a sour odor, accompanied with a peculiar and characteristic fetor (suggesting rotten cheese), which continually grows worse. the quantity of water and mucus steadily increases, the normal predominance of fatty matters becoming modified by the presence of considerable undigested casein, which is not present in the normal feces, and in acute cases death may result in one or two days from the combined drain on the system and the poisoning by the absorbed products of the decomposition in the stomach and bowels. when the case is prolonged the passages, at first or a day, increase to or , and pass with more and more straining, so that they are projected from the animal in a liquid stream. the color of the feces, at first yellow, becomes a lighter grayish yellow or a dirty white (hence the name white scour), and the fetor becomes intolerable. at first the calf retains its appetite, but as the severity of the disease increases the animal shows less and less disposition to suck, and has lost all vivacity, lying dull and listless, and, when raised, walking weakly and unsteadily. flesh is lost rapidly, the hair stands erect, the skin gets dry and scurfy, the nose is dry and hot, or this condition alternates with a moist and cool one. by this time the mouth and skin, as well as the breath and dung, exhale the peculiar, penetrating, sour, offensive odor, and the poor calf has become an object of disgust to all that approach it. at first, and unless inflammation of the stomach and bowels supervenes (and unless the affection has started in indigestion and colic), the belly is not bloated or painful on pressure, symptoms of acute colicky pains are absent, and the bowels do not rumble; neither are bubbles of gas mingled with the feces. the irritant products of the intestinal fermentations may, however, irritate and excoriate the skin around the anus, which becomes red, raw, and broken out in sores for some distance. similarly the rectum, exposed by reason of the relaxed condition of the anus, or temporarily in straining to pass the liquid dejection, is of a more or less deep red, and it may be ulcerated. fever, with rapid pulse and increased breathing and temperature, usually comes on with the very fetid character of the feces and is more pronounced as the bowels become inflamed, the abdomen sore to the touch and tucked up, and the feces more watery and even mixed with blood. _prevention._--the prevention of these cases is the prevention of constipation and indigestion, with all their varied causes as above enumerated, the selection of a strong, vigorous stock, and, above all, the combating of contagion, especially in the separation of the sick from the healthy, and in the thorough purification and disinfection of the buildings. the cleansing and sweetening of all drains, the removal of dung heaps, and the washing and scraping of floors and walls, followed by a liberal application of chlorid of lime (bleaching powder), ounces to the gallon, are indicated. great care must be exercised in the feeding of the cow to have sound and wholesome feed and water, so apportioned as to make the milk neither too rich nor too poor, and to her health, so that the calf may be saved from the evil consequences of poisonous principles that may be produced in the body of the cow. the calves should be carefully kept apart from all calving cows and their discharges. similarly each calf must have special attention to see that its nurse gives milk which agrees with it, and that this is furnished at suitable times. if allowed to suck, it should either be left with the cow or be fed three times a day. if it becomes hungry twice a day, it is more liable to overload and derange the stomach, and if left too long hungry it is tempted to take in unsuitable and unwholesome feed, for which its stomach is as yet unprepared. so, if fed from the pail, it is safer to do so three times daily than twice. there should be the utmost cleanliness of feeding dishes, and the feeder must be ever on the alert to prevent the strong and hungry from drinking the milk of the weaker in addition to their own. in case the cow nurse has been subjected to any great excitement by reason of travel, hunting, or carrying, the first milk she yields thereafter should be used for some other purpose and only the second allowed to the calf. indeed, one and all of the conditions indicated above as causes should be judiciously guarded against. _treatment._--treatment varies according to the nature and stage of the disease. when the disease is not widespread, but isolated cases only occur, it may be assumed to be a simple diarrhea and is easily dealt with. the first object is to remove the irritant matter from stomach and bowels, and for this or ounces of castor oil may be given, according to the size of the calf. reduce the milk by one-half or two-thirds. if the stools smell particularly sour, the milk may be replaced by ounce calcined magnesia, and in any case a tablespoonful or two of limewater must be given with each meal. great harm is often done by giving opium and astringents at the outset. these serve merely to bind up the bowels and retain the irritant source of the trouble; literally, "to shut up the wolf in the sheep-fold." when the offending agents have been expelled in this way, carminatives and demulcent agents may be given-- dram of anise water, dram nitrate of bismuth, and dram of gum arabic, three times a day. under such course the consistency of the stools should increase until in a day or two they become natural. if, however, the outbreak is more general and evidently the result of contagion, the first consideration is to remove all sources of such contamination. test the milk of the cow with blue litmus paper; if it reddens, reject the milk until by sound, dry feeding, with perhaps a course of hyposulphite of soda and gentian root, the milk is made alkaline. the castor oil or magnesia will be demanded to clear away the (now infecting) irritants, but they should be combined with antiseptics, and, while the limewater and the carminative mixture may still be used, a most valuable addition will be found in the following: calomel, grains; prepared chalk, ounce; creosote, teaspoonful; mix, divide into parts, and give one four times a day. or the following may be given four times a day: one dram dover's powder, grains powdered ipecacuanha; mix, divide into equal parts. injections of solutions of gum arabic are often useful, and if the anus is red and excoriated, one-half dram of copperas may be added to each pint of the gummy solution. all the milk given must be boiled, and if that does not agree, eggs made into an emulsion with barley water may be substituted. as the feces lose their watery character and become more consistent, tincture of gentian in doses of teaspoonfuls may be given three or four times a day. counter-irritants, such as mustard, ammonia, or oil of turpentine, may be rubbed on the abdomen when it becomes tender to the touch. acute contagious scouring in the newborn. the most violent and deadly form of diarrhea in the newborn calf deserves a special mention. this may appear immediately after birth, and shows itself almost invariably within the first or second day. the most intense symptoms of white scour are complicated by great dullness, weakness, and prostration, sunken eyes, retracted belly, short, hurried breathing, and very low temperature, the calf lying on its side, with the head resting on the ground, lethargic and unconscious or regardless of all around it. the bowel discharges are profuse, yellowish white, and very offensive. as a rule death ensues within to hours. a marked characteristic of this form of illness is that it attacks almost every calf born in the herd, or in the building, rather, and if the calf escapes an attack in the first two or three days of its life it usually survives. those that recover from an attack, however, are liable one or two weeks later to suffer from an infective inflammation of the lungs. the infection clings to a stable for years, in many cases rendering it impossible to preserve and raise the calves. it has frequently coincided with abortions and failures to conceive in the same herd, so that it has been thought that the same infective germ produces one type of abortion. on the other hand, the removal of the calving cow from the herd to calve in a separate building, hitherto unused and therefore uninfected, usually effects the escape and survival of the offspring. the disease has been traced by nocard and lignières to a small bacillus having the general characters of those that produce hemorrhagic septicemia, which is usually combined with a variety of others, but is in some cases alone and in pure culture, especially in the joints. the theory of lignières is that this bacillus is the primary offender, and that once introduced it so depresses the vital powers of the system and tissue cells that the healthy resistance to other bacteria is impaired or suspended, and hence the general and deadly invasion of the latter. inoculations with this bacillus killed guinea pigs or rabbits in to hours, and calves in hours, with symptoms and lesions of hemorrhagic septicemia, including profuse fetid diarrhea. the predominance of the early and deadly lesions in the alimentary tract would seem to imply infection through the feed, and the promptitude of the attack after birth, together with the frequent coincidence of contagious abortion in the herd, suggest the presence of the germ in the cow; yet the escape of the calf when the cow calves in a fresh building is equally suggestive of the infection through germs laid up in the building. this conclusion is further sustained by the observation that the bacillus evidently enters by the raw, unhealed navel, that it is diffused in the blood, and that a very careful preservation of the navel against infection gives immunity from attack. _prevention._--the disease is so certainly and speedily fatal that it is hopeless to expect recovery, and therefore prevention is the rational resort. when a herd is small, the removal of the dam to a clean, unused stable a few days before calving and her retention there for a week usually succeeds. it is in the large herd that the disease is mainly to be dreaded, however, and in this it is impossible to furnish new and pure stables for each successive group of two or three calving cows. the thorough disinfection of the general stable ought to succeed, yet i have seen the cleanest and purest stable repeatedly disinfected with corrosive sublimate without stopping the malady. it would appear as if the germ lodged on the surface or in the bowels of the cow and tided the infection over the period of stable disinfection. though insufficient of themselves, the supply of separate calving boxes and the frequent thorough cleaning and disinfection of both these and the stables should not be neglected. the most important measure, however, is the disinfection of the navel. the cow should be furnished with abundance of dry, clean bedding, sprinkled with a solution of carbolic acid. as soon as calving sets in the tail and hips and anus and vulva should be sponged with a carbolic-acid solution (one-half ounce to the quart), and the vagina injected with a weaker solution ( drams to the quart). fresh carbolized bedding should be constantly supplied, so that the calf may be dropped on that and not on soaked litter nor manure. the navel string should be at once tied with a cord that has been taken from a strong solution of carbolic acid. the stump of the cord and the adjacent skin should then be washed with the following solution: iodin, one-half dram; iodid of potassium, one-half dram; water, quart. when dry it may be covered with a coating of collodion or tar, each containing per cent of iodin. whenever a calf shows any sign of scouring it should be instantly removed to another pen and building, and the vacated one should be thoroughly cleaned and disinfected. different attendants should take care of the sound calves and the infected ones, and all utensils, litter, etc., kept scrupulously apart. after one week the healthy calves may usually be safely herded together, or they may be safely placed in the cow stable. other ailments of the calf. among these may be named several congenital imperfections, such as imperforate anus, vulva, or prepuce, which are to be recognized by the inability to pass dung or urine, in spite of straining, and the formation of swellings in the anus, vulva, or sheath. each must be carefully incised with the knife, taking care not to injure the muscles which circumscribe the respective openings; also tongue-tie, in which the thin, flaccid, mucous membrane passing from the median line of the lower surface of the tongue binds the latter too closely to the floor of the mouth and renders the tongue unfit for gathering in the food in after life. this must be cut with knife or scissors, so as to give the tongue a reasonable degree of liberty. aphtha, or thrush, is another trouble of the sucking calf, showing itself as a white, curdy elevation on the tongue, lips, cheeks, or gums, and when detached leaving a raw, red, angry surface. it is due to the growth of a vegetable parasite long recognized as the _oïdium albicans_ (_saccharomyces albicans_). it is easily removed by rubbing with powdered borax, but inasmuch as other colonies are liable to start either in the mouth or in the pharynx, gullet, or stomach, it is well to give a dose of one-half dram of hyposulphite of soda in water day by day for several days. rickets is not a common disease in calves, and comes on, if at all, later than those we have been considering. it consists in softening and friability of the bones from a deficiency of lime salts, and appears to be mainly connected with an inherited weakness of constitution, unsuitable feeding, cold, close, damp buildings, microbian infection, and other conditions inimical to health. the prevention and treatment of rickets consists essentially in the improvement of the digestion and general health; hence sunshine, open air, exercise, nourishing food, and tonics are indicated. (see p. .) bones: diseases and accidents. by v. t. atkinson, v. s. [revised by john r. mohler, v. m. d.] some knowledge of the skeleton is advisable to facilitate the study of diseases of bones and the accidental injuries to which they are exposed. the skeleton of the adult ox is made up of the following number of bones: spinal column head chest shoulder -- on each side. arm -- on each side. forearm -- on each side. forefoot -- on each side. pelvis -- on each side. thigh -- on each side. leg -- on each side. hind foot -- on each side. ---- total without attempting to burden the reader with the technical names and a scientific classification of each, it appears desirable to describe some of the characteristics of forms in general and of a few classes into which they may be divided, leaving the special study of individual bones to the illustrations of the skeleton (pl. xxv), which will serve better than a great deal of writing to fix in the mind of the reader the location, relation, and function of each one. in early fetal life the place of bone is supplied by temporary cartilage, which gradually changes to bone. for convenience of study, bones may be said to be composed of a form of dense connective tissue impregnated with lime salts and to contain two elementary constituents--the organic or animal and the inorganic or earthy. in young animals the former predominates; with increasing years the relative proportions of the two change, so that when advanced age is reached the proportion of inorganic far exceeds the organic. the gradual change with advancing years from organic to inorganic has the effect of rendering the bone harder and more brittle, and though it is stronger, the reparative process is slower when injury does occur. the bones are nourished in two ways: first, from the outside through their covering, called the periosteum--the thin, strong membrane that covers every part of the bone except the articular surface of the joints; and, second, from within through the minute branches of blood vessels which pass into the bones through holes (foramina) on their surface and are distributed in the soft structure (medulla) of the inside. the structure of the bone is divided into two parts--the compact or hard material of the outside, which gives strength and is more abundant in the shafts of long bones, and the cancellated, softer tissue of the inside, which affords accommodation to the blood vessels necessary for the nourishment of that part of the structure. in shape, bones are divided into three classes--long, flat, and short. the long bones are the ribs and those mostly found in the limbs; the flat bones are found in the head, the shoulder, and the pelvis; the short bones in the spinal column and in the lower portions of the limbs. with this little introduction, which seems almost indispensable, we will proceed at once to the consideration of diseases of bones, for they undergo disease processes like any other living tissue. osteitis. inflammation of the compact structure of bones (osteitis) may be either acute or chronic, and may involve the whole extent of the bone affected or may be confined to only a portion of it. this inflammation results from injury, such as concussion, laceration, or a crushing bruise; also from specific influences, as in actinomycosis (lumpy jaw) or cases of foul foot. the latter affection frequently involves the bones, and for this reason the pastern is the most frequent seat of osteitis. there is dull pain on pressure and a painful swelling of bone when pus is present. suppuration may involve the overlying soft tissues, causing an abscess, which may finally break through the skin. the inflammatory condition sometimes assumes an ulcerated form (caries) or from interrupted nutrition of the part deprived of the blood necessary to its nourishment may cause death of a large section of bone (necrosis); this dead fragment (sequestrum), becoming separated from the main portion of bone, acts as a foreign body. _treatment._--this consists in resting the affected part and in giving vent at the earliest possible moment to whatever pus may be present. free drainage should then be maintained. apply dressings of lactic acid or inject with per cent zinc-chlorid solution and pack with tampons of cotton soaked in antiseptic solutions. a laxative to keep the bowels moving freely is the only internal treatment necessary. periostitis. this disease is an inflammation of the external covering of bone (periosteum) and is usually produced by wounds, pressure, or crushing the part. the periosteum is well supplied with sensitive nerve endings and when inflamed is very sensitive to pressure and may cause lameness. this condition is often difficult to determine, and even an acute observer may fail to locate the point of its existence. there are three forms of periostitis--aseptic, purulent, and fibrous. aseptic periostitis when it becomes chronic causes such a bony enlargement (exostosis) as is seen in the callous formation following the fracture of a bone. the formation of such a tumor or enlargement on the surface of a bone is liable to occur in any part of the bone covered with periosteum, and when found near a joint involving two or more bones it is liable to result in their union (anchylosis). _treatment._--applications of cold water to check the inflammatory processes is indicated for the first few days in aseptic periostitis, followed by hot fomentations to hurry resorption of fluids. massage should then be given with camphor ointment, mercurial ointment, soap liniment, or lugol's solution. in the chronic form point firing or a biniodid-of-mercury blister will be found beneficial. purulent periostitis follows wounds which reach the periosteum and become infected, as observed in compound fractures, or it may result from advancing purulent conditions in neighboring structures, as in foul foot. it may also occur in the course of an infectious disease, when small abscesses are formed under the periosteum (subperiosteal abscess). it may lead to necrosis of the bone or a fistulous tract from the bone to the surface. there is usually much pain and fever, and the odor from the wound is offensive. _treatment._--in this form of periostitis the periosteum should be freely incised, followed either by continuous irrigation or frequent injection of the wound with antiseptic solutions. fibrous periostitis.--this form of the disease consists in the thickening of the outer layer of the periosteum from the inflammation reaching it from neighboring structures. this newly formed fibrous tissue may become ossified or may transmit the inflammation to the deeper bony structures. it is frequently seen in cases in which there has been an intense inflammation of the skin close to an underlying bone. _treatment._--the treatment should be the same as that recommended for aseptic periostitis. osteomyelitis. this term refers to an inflammation of the bone marrow, which is most commonly seen following the bacterial infection of a compound fracture and usually results in pus formation. the bone is melted away and pus escapes from the bone under the periosteum, involving the soft tissues. it is principally confined to the long bones and seldom affects more than one. _treatment._--the bone should be opened for the purpose of curetting out the diseased portion of the marrow cavity and removing all the necrotic pieces of bone. this should be undertaken only by a competent veterinarian. the after-treatment consists in tamponing the wound with pledgets of iodoform gauze or a mixture of iodoform part and glycerin parts. the wound in the soft tissue should be kept open until the cavity in the bone has filled with granulation tissue. rickets. this disease, also called "rachitis," is an inflammatory affection of young, growing bones, and mostly involves the ribs and long bones of the legs. it consists in a failure of the organism to deposit lime salts in bone, and for this reason the bones do not ossify so rapidly as they should. the cartilaginous ends of the bones grow rapidly, but ossification does not keep pace with it. the bones become long and their ends bend at the joints, the legs become crooked, and the joints are large and irregular. all the bones affected with this disease are thicker than normal, and the gait of the animal is stiff and painful. a row of bony enlargements may be found where the ribs articulate with the cartilages connecting them with the breastbone and is called the "beaded line." a catarrhal condition of the digestive tract is usually observed. the disease may result from an inherited weakness of constitution, poor hygienic surroundings, or improper diet. calves and foals are less frequently affected with rickets than dogs and pigs. _treatment._--the affected animal should have nourishing feed containing a proper quantity of lime salts. outdoor exercise and plenty of fresh air are indispensable. limewater should be given once daily for drinking purposes and ground bone meal mixed with the food. phosphorus, one-fortieth of a grain, and calcium phosphate, dram, given twice daily to a -month-old calf, and proportionally increased for older animals, has proved efficacious in this disease. in some cases the long bones of the limbs are too weak at birth to support the weight of the animal, and temporary splints, carefully padded and wrapped on with some soft bandages, become necessary. osteomalacia (creeps). this is a condition of bone brittleness or softening of bone found usually in adult life. it consists in the decalcification of mature bone, with the advancing diminution of the compact portion of bone by absorption. the periosteum strips very easily from the bone. this disease is seen in milch cows during the period of heavy lactation or in the later stages of pregnancy, and the greater the yield of milk the more rapid the progress of the disease. heifers with their first calves are frequently affected, as these animals require a considerable quantity of mineral salts for their own growth and for the nourishment of their offspring. _symptoms._--in marked cases there is a gradual emaciation and symptoms of gastrointestinal catarrh, with depraved appetite, the animal eating manure, decayed wood, dirt, leather, etc. muscular weakness is prominent, together with muscle tremors, which simulate chills, but are not accompanied with any rise of temperature. the animal has a stiff, laborious gait; there is pain and swelling of the joints, and constant shifting of the weight from one leg to another. the restricted movements of the joints are frequently accompanied with a crackling sound, which has caused the name of "creeps" to be applied to the disease. the coat is dull and rough and the skin dry and hidebound. the animal is subject to frequent sprains or fracture of bones without apparent cause, as in lying down or turning around, and when such fractures occur they are difficult to unite. the bones principally involved are the upper bones of the legs, the haunch bone, and the middle bones of the spinal column. the disease in this country is confined to localized areas in the southwest, known as the "alkali districts," and in the old dairy sections of new york state. the cause of this affection is the insufficiency of lime salts in the food, also to feeding hay of low, damp pastures, kitchen slops, and potatoes, or to overstocking lands. it occurs on old, worn-out soil poor in lime salts, and has also been observed to follow a dry season. _treatment._--this should consist in a change of feed and the artificial feeding of lime salts, such as magnesium and sodium phosphate. feed rich in mineral salts may be given, such as beans, cowpeas, oats, cottonseed meal, or wheat bran. cottonseed meal is one of the best feeds for this purpose, but it should be fed carefully, as too large quantities of it are injurious to cows. phosphorus may also be given in one-fourth grain doses twice daily, together with a tablespoonful of powdered bone meal or crude calcium phosphate at each meal. ordinary lime dissolved in drinking water (limewater) will also be found efficacious in combating this disease, and can be provided at slight expense. a change of pasture to a locality where the disease is unknown and a free supply of common salt and bone meal will be the most convenient method of treating range cattle. sprains. the most common accident occurring to bones and joints is a sprain of the ligaments uniting the bones, or the tendons uniting the muscles and bones. a sprain is the result of a sudden forcing of a joint in an unnatural direction, or, if in a natural direction, beyond the power of the ligament or tendon to restrain it properly, so that part of the fibers of either are ruptured. when such an accident occurs pain is immediately inflicted, varying in degree with the extent of the injury, which is soon followed by swelling, with more or less heat and tenderness. if the seat of the injury be in any of the limbs, lameness is likely to result. of the causes of sprain, slipping on ice or a wet floor, playing, and fighting with another animal are the most common. sprain of the shoulder joint.--this is liable to occur from any of the causes mentioned above or from the animal slipping suddenly into a rut or hole. when such an accident occurs, sudden lameness will attract attention. the animal will be noticed to drag the leg when walking and to carry it in a circular direction, outward and forward, at each step. the leg should be carefully examined, pressure over the joint causing the animal to evince pain. if the person making the examination is in doubt, it is well to make a comparison between the shoulders by pressing first on one and then the other. after such an accident the animal should be tied up so as to limit so far as possible the use of the injured joint. soft feed should be given with a view of keeping the bowels acting freely. _treatment._--during the first three days the treatment should consist of cold-water irrigation to check the inflammation and relieve the pain. hot fomentations may then be applied to hasten the absorption of the inflammatory fluids. when the pain has somewhat abated, equal parts of mercurial ointment and green soap may be rubbed into the swollen tissue. should lameness continue after the tenth day, good results will be obtained from the application of a blister. this may be done by carefully clipping off the hair over the joint, including a surface of or inches in circumference, and rubbing in the following preparation: powdered cantharides dram biniodid of mercury do vaseline ounce the animal's head should be carefully tied until the third day, to prevent its licking the blister. the blistered surface should then be smeared with lard or vaseline every other day until the scabs fall off. gentle exercise should be allowed after the fourth or fifth day from the application of the blister. if the lameness still remains the blister may be repeated in three weeks or a month. sprain of the fetlock.--this may occur from misstep when the animal is moving rapidly, and the twisting or wrenching of the foot is sufficient to rupture partially the ligaments which bind the bones together at that part. such an accident also frequently occurs by the foot getting fastened in a hole in the floor; the wrenching is the result of the animal's attempt to liberate it. lameness, followed by swelling of the joint and pain when it is handled, or when the animal moves the joint, and heat, are the more noticeable symptoms. if the sprain is very severe, the animal occasionally does not bear its weight on the limb. _treatment._--the most important consideration in the treatment of this affection is rest, which is best enforced by keeping the animal in the stall and placing strong, muslin bandages about the inflamed joint. as in the sprain of the shoulder, cold water in the form of douches, continuous irrigation with hose or soaking tub, or finely chopped ice poultices are indicated for the first three days. following this apply a priessnitz bandage[ ] moderately tight about the joint, which not only conduces to rest, but also favors absorption. massage with stimulating liniments, such as soap or camphor, may later be applied to the affected parts. if the lameness has not disappeared by the tenth day, the blister advised for the sprain of the shoulder should be applied and the same precautions observed as to tying the animal's head and subsequent smearing with vaseline. when a blister is applied in this locality, the back part of the heel should be first filled with lard or vaseline, and care taken to prevent any of the blistering preparation from coming in contact with the skin of that part. if this precaution is not observed, scratches may ensue and prove troublesome. sprain of the hip.--this is liable to result from the animal's slipping in such way as to spread the hind feet wide apart. the patient goes stiff in the hind legs, or lame in one hind leg, walking with a straddling gait and swinging the leg outward as it is carried forward. tenderness may occasionally be detected on pressure, but owing to the heavy covering of muscles outside the joint this test is not always reliable. in the acute cases give rest and cold local applications. after the fourth or fifth day the blister mentioned for sprain of the shoulder may be applied with advantage, and if this proves insufficient, as a last resort we may fire in points over the joint. sprain of the back.--sprain of the back, particularly in the region of the loins, is not an uncommon accident among cattle. it is liable to occur from the animals slipping with both hind feet sidewise so as to twist the back, or from slipping violently backward so that great stress is thrown on the loins. the patient moves with difficulty, using the hind parts in a guarded manner, as if afraid of causing severe pain. occasionally, if the sprain is severe, the animal will rise with difficulty. pressure on the back in the immediate region of the loins causes pain. such cases may be mistaken for paralysis, and, in fact, in severe cases, during the early stages of the injury, although the nerve supply is not interfered with, the injury to the muscles and resulting pain is so great that the condition is almost equal to paralysis, although liable to be attended with more favorable results. hot applications, such as blankets wrung out of hot water and changed often, will be likely to afford relief during the earlier stages. afterwards the blister mentioned for sprain of the shoulder may be applied with advantage. fractures (broken bones). bones may be accidentally broken in many ways and from different causes. fractures in general are liable to be produced by external force suddenly and violently applied, either directly to the part or at a distance, the force being transmitted through the stronger bones until it expends itself by breaking a weaker one remote from the seat of the injury. occasionally violent contraction of muscles is sufficient to break a bone. certain bones, those of the limbs in particular, owing to their exposed position, are more liable to fracture than others. owing to certain predisposing causes, such as age, habit, or hereditary constitutional weakness, the bones of some animals are more easily fractured than those of others. the bones of an animal advanced in years are more subject to fracture because of the preponderance of inorganic matter rendering them more brittle. they are also occasionally rendered liable to fracture by a previously existing diseased condition. fractures are divided into four classes--partial, simple, compound, and comminuted. partial fractures.--partial fractures are those which are liable to occur in a young animal in which the preponderance of animal matter or the semicartilaginous condition of the bone renders it tough, so that even when considerable force is applied the bone bends, breaking on the side opposite that to which the force was applied, after the manner in which a green stick bends and breaks. simple fractures. simple fracture is one in which the bone is severed in two parts, transversely, longitudinally, or obliquely, without serious injury to the adjoining structures. compound fractures.--compound fracture is one in which there is an open wound permitting the air to communicate with the ends of the broken bones. comminuted fractures.--comminuted fracture is one in which the bone is shattered or divided into a number of fragments. complicated fractures.--complicated fracture is one in which other structures surrounding the bones are injured. general symptoms of fracture.--when a fracture of one or more of the large bones of a limb occurs, symptoms are sure to be well marked. after the accident the animal refuses to touch the foot to the ground and, if compelled to move, does so with great pain and reluctance. there is more or less shortening of the limb, with trembling of the muscles in the vicinity of the injury; deformity, and increased mobility, so that, instead of the natural joints of the limb and the natural, muscular control of their motion, a new joint, over which the animal has no control, is formed where the fracture occurred. as the leg, shortened by the ends of the bones being forced past one another from the muscular contraction which invariably takes place, hangs dependent from the body it swings in an awkward and unnatural manner, permitting the toe and foot to assume positions in their relations to other parts of the body which otherwise would be impossible. if the fractured bone is so situated that the parts may be moved one upon another, a grating sound, known as crepitus, will be heard. general treatment of fractures.--when a fracture occurs, the advisability of attempting treatment must first be determined. if the animal is young, valuable, and of reasonably quiet temperament, and the fracture is not too great in extent, the chances of recovery are fair. on the other hand, if the animal should be of little value, irritable, advanced in years, and the fracture is a serious compound or comminuted one, the wiser course would generally be to put the creature out of its misery. having determined to attempt treatment, no time should be lost in restoring the parts as nearly as possible to their natural position and retaining them there. if the ends of the bones have been drawn one past the other, they should be drawn out by firm and continuous tension, until they again assume the position in which they were before the accident. all this can better be done before the swelling (which is sure to result) takes place. if the swelling has occurred before the injury is noticed, do not attempt to treat it, but proceed at once to treat the fracture as though the swelling were not present, for no step can be taken toward recovery until the ends of the bone have been restored to their proper position. when that is done and proper appliances have been used to prevent them from being again misplaced, the swelling, which is the result of irritation, will be relieved. in selecting the appliances to be used in the treatment of fracture the judgment and ingenuity of the operator are of much importance. splints, made of wood shaped to fit the limb and padded with soft material where they come in contact with bony prominences, and held in position by means of bandages, are the oldest method, and with some are still most popular. the fracture pads used in human surgery, and for sale in surgical depots, are very convenient. after being dipped in water they may be molded to fit the limb and be retained by means of bandages. heavy sole leather is also used after being soaked in warm water and molded to the shape of the limb and holes cut in it to fit over any sharp irregularities in the natural shape of the bones. gutta-percha sheets are also used and answer well. they are prepared and used in the same way as the leather. another and perhaps the simplest of all methods is the application of a plaster-of-paris bandage, which is made as follows: strips of thin cheesecloth inches wide and or feet long are laid flat on a board and on them is spread a layer of plaster of paris about one-eighth of an inch thick; then, starting at one end, roll carefully so as to gather the plaster in between the layers of the bandage. it is of course important that the cloth be thin and the plaster of paris fresh and active. after preparing four or five of such bandages the operator is ready to dress the fracture, which, after the parts have been brought into position, should be done by covering all that part of the limb to which the plaster-of-paris bandage is to be applied with a single layer of the dry bandage, letting it extend both above and below the part to which the plaster bandage is to be applied and including under the folds of the dry bandage at each end a layer of absorbent cotton, which is intended to form a pad to prevent the ends of the plaster bandage from chafing the skin beneath. when this is done one of the plaster bandages should be placed in a vessel of water and allowed to remain till the air bubbles have ceased to rise from it, which will generally indicate that it is soaked through. then, taking it in the hand, wind it carefully around and around the limb, unrolling the bandage as it is wound around the limb, occasionally smoothing down the plaster of paris. should it form roughly or in ridges the hand may be dipped in water to impart increased moisture to it. when about finished with one bandage, place another one in the water, so that the winding operation may be continued without delay. the bandages should be applied till the cast is from one-half to three-quarters of an inch thick, then gently restrain the animal for one-half or three-quarters of an hour till the plaster is hardened. any of the appliances used should be so manipulated as to prevent absolutely any motion of the detached parts. if the fracture is near a joint, it is generally best to include the joint in the appliance. the part of the limb below the bandage should be carefully and firmly wrapped with an ordinary cotton bandage all the way from the plaster bandage down to the hoof. this last bandage will tend to prevent swelling, which is liable to occur, the result of the dependent position in which the animal is forced by nature to keep the injured limb. when plaster-of-paris bandages are applied to a compound fracture the injured part may be previously dressed with a small, thick pad of cotton immediately over the wound. in applying the bandage the operator may with a little care so arrange it as to keep the folds of the bandages off the cotton, or have only a thin layer over it, which may be easily cut out and the cotton removed, leaving a convenient opening through which to dress the wound without removing the bandage. the ends of the bandage or other appliance should be carefully watched to see that the skin does not become chafed, particularly at the lower end. if the bandage should become weak or broken at any part, it may be strengthened without removal by applying other bandages immediately over it. if swelling has taken place before the bandage has been applied, there is liable to be some loosening as it disappears, and even without the swelling there may be a tendency of the bandage to slide downward. this may be overcome by fastening it to a suspender attached to a surcingle or passed over the body and attached to the opposite leg. if the looseness can not be overcome in this way, the space may be filled by pouring in a thin paste of plaster of paris. a better method, however, is to remove the bandage and apply another. owing to the hardness of the bandage it will be removed with some difficulty. a deep groove should be cut down completely through it on the opposite sides. this may be done with a chisel and a small hammer if the bandage is carefully held by an assistant so that the concussion of the blows is not transmitted to the injured bones. the patient should have a roomy stall, and should be tied by the head to prevent any attempts to move around. in some cases slings have been used. ordinarily, however, they are not satisfactory in cattle practice, and if applied should be for only a few days at a time, and with a view to lessen the animal's disposition to lie down, rather than to prevent it. when they are used continuously the pressure on the abdomen may interfere with digestion and the general health of the animal. _modes of union._--the animal should be kept as quiet as possible and given such feed as will have a tendency to keep the bowels slightly relaxed. the success of the operation depends chiefly on the skill of the operator, but not alone in the selection and use of the appliances, for as much attention must be given to subsequent management. the patients are restless, and a single awkward motion may undo the work of weeks so far as the union of the parts of the bone is concerned. union takes place after the same process and, if the conditions are favorable, with greater rapidity than in the human being. the injury that caused the fracture is almost sure to have extended to some of the adjacent tissues, and even though the fracture may be of the simplest type there is almost sure to be considerable hemorrhage around the ends of the broken bone. this, however, is unimportant if the skin remains intact, unless a very large vessel should be injured, or the fracture should open some of the important cavities of the body, in which case a fatal hemorrhage may result. if, on the other hand, the fracture is compound the external opening furnishes a fertile field for the lodgment of disease-producing germs. unless great care is taken in such cases, a suppurative process is liable to be established which will seriously interfere with, if not entirely arrest, the process of union between the bones; or it may become so serious as to endanger the general health of the animal and even be attended with fatal results. this last danger is greater if the injury has occurred to the bones of the arm or thigh. in such cases, owing to the dense covering of fascia which ensheathes the muscular covering pus is liable to be imprisoned, and, burrowing downward, saturate the whole structure, not only endangering the limb, but, by absorption, may set up blood poisoning and seriously interfere with the general health of the patient, even to causing death. in order so far as possible to prevent such an unfortunate complication, the wound should be carefully cleansed with a mild solution of carbolic acid, then dusted over with iodoform before the bandages are applied, and cleansed and dressed daily in the same way. after dressing, always cover with absorbent cotton. in the early process of union an exudation of lymph takes place, which is at first fluid, gradually becoming thicker and firmer till it forms a callus, known as the external or ensheathing callus, in the shape of a ring or ferrule surrounding the detached portions of the bone. it occasionally happens that this callus forms only at the ends of the bones, filling the spaces that exist between them, when it is known as the intermediate callus. the process of union may be divided into five stages. in the first stage, including the first eight days, the detached portions of the bone and the sharp projections that are not sufficiently nourished are absorbed; the blood which escaped into the surrounding tissues, the result of the injury, is gradually absorbed, and the effused lymph, which is ultimately to constitute the temporary cartilage, takes it place. in the second stage, from the tenth to the twentieth day, the tumor or callus is formed and fibrocartilage is developed inside and around the exposed end of the bone. in the third stage, extending from the twentieth to the fortieth or fiftieth day, according to the age and strength of the animal, the fibrocartilaginous structure undergoes a change and is gradually converted into bone, forming a ferrule on the outside and a plug on the inside, which serve to hold the part in position. in the fourth stage, extending to about the sixth month, the whole of the new structure is converted into bone. in the fifth stage, extending to the end of the first year, the callus is absorbed, being no longer necessary, and the connection between the cavities of the two bones is again established. _common complications._--the process of union just described is healthy and normal. diseased conditions may at any time supervene during the treatment and render the operation unsuccessful. in the case of compound fracture, the open wound communicating with the ends of the bones, a septic condition is liable to arise which may become so serious as to endanger the animal's life and bring about conditions which in human surgery would indicate amputation. although that operation is not a general one in veterinary practice, there is no reason why it should not be attempted as a last resort, particularly if the animal is valuable or is one whose existence is necessary in order to perpetuate some valuable strain. even in the simplest form of fracture, if the splints or bandages are improperly applied and the fractured bone left so loosely guarded that the broken ends move one upon another, the formation of the calluses previously described is liable to be interfered with, and in place of a strong, rigid, and healthy union a formation of elastic cartilage is the result. this false structure unites the broken ends of the bones in such way that they move one upon another, depriving the bone of its stability and usefulness. when once the healthy process of union is interrupted in the manner just described, it is again established with great difficulty. it no longer does any good to continue the restraining power; in fact, the change of the temporary cartilage into bone is more liable to be reestablished if the parts move violently upon each other for a short time so as to set up and renew the process of inflammation. then if the restraint is again applied there is some chance of union. in order so far as possible to avoid this danger, care should be taken to see that the bandage fits closely and that it is kept on till there is no longer any danger but that a perfect union has taken place. it is impossible to say at just what time the splints or bandages can safely be removed. in a young and healthy animal of quiet temperament, if the parts have been firmly held in position throughout the whole time, from to days may be regarded as reasonably safe. under more unfavorable conditions as to age, vitality, and restraint, the period would better be extended to days, if the general condition of the animal is such as to permit of so long a continuance. after the appliance has been removed the animal should be allowed to stand quiet for a few days, then be given very gentle exercise, gradually increased for a week or days, by which time the patient will be so far recovered as to be placed in pasture. it should, however, be alone for a time, so as not to take any chance of injury from fighting or other accidents that association with other animals might involve. special fractures. fracture of the horns.--of the special fractures liable to occur, that of the horn is perhaps the most common. it is always the result of violent mechanical means, such as blows, injury occurring while fighting, or from the animal getting its head locked in some manner while feeding from a rack. when it occurs there are two ways in which the injury may affect the animal. first and most common, the horny crust is liable to be stripped from the bony projection which it covers. second, the crust and bone may both be broken or bent down, the fracture occurring in that case at the root of the horn and involving part of the bones of the head in the immediate vicinity. in the first case, if the horny covering is knocked off, little attention is necessary. the animal may be relieved from suffering if the stump is smeared with pine tar and wrapped in cloth. if the core is much lacerated, perhaps it would be better to amputate. the necessity for such operation must be determined by the condition of the injury, influenced to some extent by the owner's ideas on the subject. when the operation is performed, it should be done with a sharp, fine-toothed saw, and by sawing the horn off close enough to include a little of the skin and hair around its base. the practice of dehorning has grown popular in many parts of the country. it is a simple operation, and, although attended with some immediate suffering, does not produce serious constitutional disturbance. the advisability of performing the operation on all cattle is a question of expediency and must be justified by the expectation of benefit on the part of the feeder. if the horn should be broken so that the core and crust are bent out of shape without the detachment of one from the other, it may be restored to its normal position and retained there by means of a splint made to fit across the back of the head, so as to be laced to both horns, the sound horn serving to hold the broken one in position. such a splint may be fastened on by means of either a wire or cord and allowed to remain six weeks or two months. if both the horn and core have been broken off, bleeding is usually severe and should be checked by astringents, such as alum, or by pressure. after the hemorrhage has ceased the exposed portion of the fracture should be covered with pine tar, with or without a bandage. an imperfect growth of horn will in due time cover the exposed bone. fractures of the bones of the face.--these occasionally occur, and when over the cavities of the nose produce depression, disfigurement, and impeded respiration, owing to the lessening of the caliber of the nasal passages. when such accident occurs, the depressed bone should be gently forced back to place by introducing the finger in the nostril, or if the fracture is too far up for this, a probe may be passed and the parts retained by placing immediately over it a plaster of thin leather or strong canvas smeared with tar, extending out to the sound surroundings, taking care to embed the hair over the fractured portion in the tar of the plaster, so that it will be firmly held and prevented from again becoming depressed. if only one nostril is involved, the depressed portion may be held in position by packing that nostril with absorbent cotton. this practice, however, has the objection of giving the animal great discomfort and in some cases a disposition to aggravate the injury. fracture of the skull (cranium).--fractures of the bones forming the cavity in which the brain is situated are, owing to their strength, comparatively rare among cattle. such an accident can only be the result of external violence, and it is hardly possible that it could occur without some fragment of the broken bone pressing upon the brain so as to cause coma or other severe nervous derangement, or even death. if the animal survives the first shock, the efforts should be directed toward relieving the pressure, which may be done by making an opening in the bone (trephining), and with a hook drawing the depressed part outward. interference is not so liable to be attended with good results as to be warranted in all cases. the effects of a very severe shock which may not have produced a fracture, although the symptoms were alarming, will in many cases pass off, leaving the animal in a better condition than if an operation had been performed. fracture of the lower jaw.--this occasionally occurs, and is more liable to result from the kick of a horse than from any other cause. the front part of the jaw may be split or shattered in any direction in which the force may have been applied. bloody discharges from the mouth and failure to eat or ruminate are symptoms most likely to attract attention. the treatment is simple and consists in first removing detached pieces of bone, then drawing the parts together and retaining them by means of pieces of copper wire fastened around the teeth, and feeding the animal on sloppy feed until recovery takes place. the wound should be dressed once or twice a day with a per cent solution of carbolic acid, forced gently in with a syringe, so as to remove any feed which may have become impacted and interfere with the healing process. fracture of the vertebra (spinal column).--this is not so common among cattle as other animals. if the fracture should be through the body of the bone, there may be pressure on or laceration of the spinal cord, causing paralysis of all parts posterior to the seat of injury. fractures of the prominences on a vertebra occasionally occur without interfering with the canal in which the spinal cord is situated. such accidents are liable to pass unnoticed, for, although the animal may suffer considerable pain, it may not be manifested in such way as to attract attention, and the deep covering of muscles serves effectually to conceal the injury. when the fracture occurs in the upper part of the neck, paralysis of the muscles used in respiration must result, and death from asphyxia very shortly ensues. the more common accident is to the loins, and when a fracture of the body of a vertebra occurs in this region so as to produce pressure on the spinal cord, paralysis of the hind legs and quarters is the result. diagnosis of such an accident is more difficult than in the case of any other fracture. the parts can not be moved one upon another so that crepitus is noticeable. the heavy coating of muscles conceals irregularities of shape, which otherwise may attract attention. about the only reliable symptom is paralysis or loss of use and sensation of the parts posterior to the injury. careful examination may reveal the seat of the injury. if it was the result of a blow, there may be some abrasion of the skin. the diagnosis is only important as an aid in determining the proper course to pursue. if paralysis is present and a depression or irregularity of the spinal column is so apparent as to leave no doubt of the existence of a fracture, the only alternative is to destroy the animal, for of recovery there can be no hope. if, on the other hand, the paralysis is incomplete and there is no depression or irregularity of the spinal column or other evidence of fracture, the patient should be made as comfortable as possible by being placed in a well-bedded box stall and a few days permitted to elapse before the case is abandoned. the symptoms last described may possibly be the result of a severe strain of the muscles of the loins, in which case an improvement will soon be noticeable. fractures of the pelvis.--the pelvis, or bony framework which gives shape to the posterior part of the body, is liable to fracture in many ways. a common one is by a separation of the two bones which constitute the whole pelvis along the bottom and center line (symphysis pubis). in early life the two bones are separate and distinct. the union between them, which is at first cartilaginous, undergoes a change and is converted into bone, so that in adult life the whole pelvis is practically one bone. the point on which the two bones are united is weaker than the adjoining parts of the bone. when an animal slips violently, spreading the legs wide apart, the weaker materials give way and the bones are divided. if the accident is noticed when it occurs, it is likely to throw light on the nature of the injury. the animal will immediately go stiff behind, the legs being spread apart. further examination may be made by introducing the hand, previously carefully oiled, into the rectum or vagina and pressing down along the central line, which will cause the patient to evince acute pain. in this case no appliance can be used to advantage. the animal should be tied in a stall until the parts become reunited and the lameness disappears. fracture of the posterior parts of the bone (ischium), which forms the point of the buttocks occasionally occurs. the buttock on the injured side will be less prominent than the other. careful manipulation will generally move the parts so that crepitus may be recognized. if the fracture is through the posterior part of the bone, it is unimportant and deserving of no more attention than placing the animal in such position as to insure it against subsequent injury until the bones are united. some distortion may result, but not sufficient to warrant interference. fracture through the body of the bone on a line with the hip joint (acetabulum) occasionally, though rarely, occurs, and is nearly always associated with dislocation of the hip joint and the forcing of the head of the upper bone of the leg (femur) upward, far out of its place. the violent contraction of the powerful muscles of the hip renders it impossible to reduce the dislocation, and even if it were possible the fractured pelvis could not be held in position, so that the case becomes at once hopeless. it may be recognized by the animal's standing on three legs, the leg on the injured side seeming shorter than its fellow and hanging pendulous, the muscles of the hip violently contracted and hard to the touch. the animal evinces great pain when the limb is moved. there is liable to be some apparent distortion in the relations between the point of the hip and the point of the buttock. this will be more readily noticed by comparing the injured side with the other. the parts may be moved so as to produce crepitus. the examination may be completed by introducing the oiled hand into the vagina or rectum, when the two sides of the pelvis will reveal well-marked differences. fracture of the point of the hip.--the anterior and external part of the pelvis (ilium), commonly known as the point of the hip, is liable to fracture, which stock owners describe as "hipping," or being "hipped," or having the hip "knocked down." this accident may be the result of crowding while passing through a narrow door, of falling violently on the point of the hip, or from a violent blow directed downward and forward against it. the lesion generally extends across the flat surface of the bone from its outer and posterior edge forward and inward. distortion is liable to be the only noticeable symptom. the detached portion varies in size in different cases and with it the resulting deformity. the animal is noticed to be slightly lame, but this symptom soon disappears. the detached portion of the bone is drawn downward and away from the main part by the action of the muscles below, which are so powerful as to render return impossible. the bones therefore remain permanently separated, union taking place by fibrous callus. the animal suffers very little inconvenience, and for practical use may be as serviceable as before the accident, though the distorted appearance depreciates its value. fracture of the ribs.--such an occurrence can take place only as the result of a direct injury, as from blows or crowding. the posterior ribs, being more exposed, are more liable to fracture. pain in moving, slight swelling over the seat of injury, and difficult breathing are obvious symptoms. if the fracture is complete, crepitation may be occasionally noticed by placing the hand flat over the injured part, carefully observing the motion as the chest contracts and expands during respiration. this symptom is more noticeable when the animal coughs. unless the point of the broken bone penetrates the cavity of the chest the fracture is usually unimportant and calls for no treatment other than quiet. if the breathing is very labored and attended with much pain, motion may be limited by applying a wide bandage firmly around the chest. the animal should be restricted in the amount of feed and water for a few days, the stomach being kept as nearly empty as possible. sloppy feed should be given to encourage, as much as possible, free action of the diaphragm in breathing. fracture of bones of the limbs.--on this subject much has been said in the preceding remarks on general fractures. as a rule, fracture through one of the large bones of the shoulder (scapula) or thigh (femur) is very difficult to manage. the powerful contraction of the muscles and the changing shape of the limb resulting from their action renders it impossible to retain the detached parts of the bone in proper position. therefore, though the union should take place, there is almost sure to be considerable deformity and more or less lameness. fracture of the arm (humerus) or leg (tibia) is likely to be attended with better results. the muscular covering is not so thick, the sheath in which they are held is more tense, and the change in the shape of the limb from muscular action not so noticeable, the muscular force not so great, all of which facilitate replacing the dislodged ends and retaining them. fracture of the knee (carpus) and hock (tarsus).--this seldom occurs unless it is the result of a very violent injury, and is generally associated with other injury and serious complications. displacement does not generally occur to any considerable extent. the treatment, of course, consists in holding the limb perfectly quiet in a natural position, which may be done by the application of long, wooden splints retained by bandages, or a plaster-of-paris bandage. fractures below the knee.--fracture of the long bone below the knee (metacarpus) and hock (metatarsus) is more common. in young animals of quiet temperament the treatment of simple fractures here is likely to be attended with good results. on the other hand, a compound fracture in this region becomes a serious matter. the structures which surround the bones are so thin that a very small degree of sloughing will expose parts of the bones and be liable to lead to serious complications and probably fatal results. fractures of bones below the fetlock.--these fractures are comparatively unimportant unless associated with other serious injury. the parts can generally be held in position without much difficulty, and union generally takes place quite rapidly. appliances.--of the appliances used in the treatment of the fracture of limbs above the knee, splints made of wood or iron strips and bandages are likely to serve best. below the knee plaster-of-paris bandages are preferable. the writer is well aware that many of the standard authors deprecate the use of the latter, but an extensive experience leads me to believe that they have many advantages over any of the other appliances when used alone, and in many ways they may be used with advantage in combination with others. dislocations. luxation, or displacement without fracture of the bones forming a joint, is comparatively rare among cattle. it most frequently occurs in the stifle joint, where dislocation of the kneepan (patella) takes place. a glance at the skeleton (pl. xxv) will show the relations better than they can be described. it will be observed that the small, irregularly shaped bone (patella) plays on the anterior rounded part of the lower edge of the thigh bone (femur) and between it and the upper end of the shank bone (tibia). the outer ridge on the lower end of the thigh bone is less prominent than the inner one, so that displacement, when it does take place, is by slipping outward. such an accident may occur from direct injury or external force, as a blow, or from slipping. when it does occur the symptoms produced are somewhat alarming. the animal is unable to draw the leg forward, and either stands with it thrown back with the toe pointing downward, or, if it should succeed in getting its weight upon it, holds it firmly on the ground, fearing to move it. examination of the outside of the joint will disclose the situation of the patella outside its proper place. if the operator is not familiar with the normal appearance of the joint, it is well to make a comparison between the injured and the sound one. if compelled to move, the animal does so with great difficulty, jerking the leg which it is unable to bring forward, hopping with the other, and partially dragging the injured one. [illustration: plate xxv. skeleton of the cow.] _treatment._--the treatment is simple. a rope feet long should be applied around the fetlock of the affected leg, passed forward between the front legs and up over the opposite side of the neck, back over the withers, and wrapped once behind the elbow around that portion of the rope which passes between the front legs. the leg is then drawn away from the body and forcibly pushed forward by an assistant, while another person tightens up the slack in the rope until the affected leg is off the ground in front of the supporting leg. the rope is then drawn taut and the assistant grasps the tail and pulls the cow toward the affected side. the animal makes a lurch to keep from falling, contracts the muscles, and the patella slips into place with a sharp click, and the animal walks off as if nothing had happened. if the animal resists this method of handling, it may suffice to manipulate the dislocated kneepan by shoving it inward and forward with the heel of the hand while the affected leg is drawn well forward. unless some precaution is taken the accident is liable to recur, as the ligaments have been stretched by the dislocation till they no longer hold the bone with that firmness necessary to retain it. the animal should be tied and the foot fastened forward, so that the patient can just stand on it comfortably, by means of a rope or strap around the fetlock carried forward between the front legs, around the neck, and tied on the breast. should this accident occur more than once it is a good practice to apply a blister around the joint, as in the formula recommended for sprain of shoulder, and observe the precautions as to restraint and subsequent treatment there recommended. with this one exception dislocations in the ox occurring independently of other complications are rare. dislocation with fracture may occur in any of the joints, and if one is suspected or discovered, examination should always be made for the other before treatment is applied. when a fracture occurs near a joint the force sufficient to rend the bone is liable to be partly exerted on the immediate tissues, and when the bone gives way the structures of the joints may be seriously injured. it occasionally happens that the injury to the joint becomes the most important complication in the treatment of a fracture. in order clearly to understand the reason for this a few words are necessary in relation to the structure of joints. the different pieces constituting the skeleton of the animal body are united in such manner as to admit of more or less motion one upon another. in some of the more simple joints the bones fitting one into another are held together by the dense structures around them, admitting of very little or no movement at all, as the bones of the head. in other joints the bones are bound together by dense, cartilaginous structures, admitting of only limited motion, such as the union of the small bones at the back part of the knee and hock (metacarpal and metatarsal). in the more nearly perfect form of joint the power of motion becomes complete and the structures are more complex. the substance of the bone on its articular surface is not covered with periosteum, but is sheathed in a dense, thin layer of cartilage, shaped to fit the other surfaces with which it comes in contact (articular). this layer is thickest toward its center when covering bony eminences, and is elastic, of a pearly whiteness, and resisting, though soft enough to be easily cut. the bones forming an articulation are bound together by numerous ligaments attached to bony prominences. the whole joint is sealed in by a band or ribbonlike ligament (capsular ligament) extending around the joint and attached at the outer edge of the articular surface, uniting the bones and hermetically sealing the cavities of the articulation. this structure and the articular surface of the bone is covered by a thin, delicate membrane, known as the "synovial membrane," which secretes the joint oil (synovia). this fluid is viscid and colorless, or slightly yellow, and although it does not possess a large quantity of fat, its character somewhat resembles oil, and it serves the same purpose in lubricating the joints that oil does to the friction surface of an engine. although the tissues of the joint when used in a natural way are able to withstand the effect of great exertion, when unnaturally used, as they are very delicate and complex, they are liable to inflammatory and other changes of a very serious nature. the synovial membrane, and in fact the whole structure of the joint, is susceptible to injury and serious inflammatory derangement, and the capsular ligament is liable to be distended from excessive secretion of synovia. the latter process may be almost noninflammatory, and attended with little inconvenience or importance other than a blemish to the animal, which in cattle is not serious. it may occur on the back part of the leg above the fetlock or on the inner and fore part of the hock, corresponding in its location to windgalls and bog spavin of the horse. continuous support by bandages will generally force reabsorption, and as the limb is not subjected to violent action, as in the case of the horse, the affection is not so liable to recur. spavin. occasionally working oxen that are used in the lumber woods and made to pull heavily, with bad footing, are afflicted with this condition. when it occurs lameness is the first symptom. during the early stages of the disease the lameness is most severe in the morning, and disappears after the animal is exercised; it gradually becomes more severe as the disease advances, so that when the disease is well established the animal is lame continuously. shortly after the lameness appears a bunch (exostosis) will be noticed on the inner and fore part of the affected joint. this bunch differs from bog spavin in that it is hard, while bog spavin is soft. it increases in size as the disease advances till the animal is too lame to be used for labor. as the disease is always attended with considerable pain there is more or less loss of flesh. in the most advanced stage the animal will step with difficulty, frequently holding the foot from the ground, or, if forced to take a few steps, stands with it elevated, twitching with pain. in the earlier stages of the disease only a small portion of the fore part of the lower, or second, articulation is involved, but the inflammatory process gradually extends over the whole surface of the lower joints of the hock. the structures of the joint are broken down and the bones are united (anchylosis). this process may include any or all of the three lower joints of the hock. the joint of motion which is situated on the lower end of the leg bone is seldom involved. _treatment._--treatment of spavin in the ox, as in the horse, is likely to be tedious, and not always resulting in perfect cure. usually it is best to fatten the animal for slaughter. if, however, treatment is decided upon, it should consist of complete rest and counterirritation of the part either by sharp blisters or the firing iron. it is advisable to try the effect of blistering first, and for this purpose the following mixture is recommended: powdered cantharides drams biniodid of mercury do vaseline ounces - / clip the hair off and apply over the inner and fore part of the joint, covering the surface an inch and a half in every direction from the enlargement, or over an area to inches across. fasten the animal's head so that it can not reach the part to lick it; after the third day grease with lard every other day until the scabs come off. this blister may be repeated three or four times at intervals of three weeks. the lameness will generally begin to disappear about the third or fourth month if the above-described treatment proves beneficial. should lameness persist, firing in points by a qualified veterinarian may effect the desired result and should be tried as a last resort. in a case of spavin the cure is not effected by restoring the diseased parts to their natural condition, but by uniting the bones and obliterating the joints. if this union extends over the whole articular surface of the joints affected and is sufficiently strong to prevent any motion of the bones, the animal will again go sound. the joints that are obliterated, not being those of motion, are not important, so that the animal suffers no inconvenience in their loss. rheumatism. rheumatism is a constitutional disease from a specific condition of the blood and characterized by inflammation of the fibrous structures of the body. it is usually accompanied with stiffness, lameness, and fever. the parts affected are usually swollen, but swelling may be lacking. the inflammation may be transitory; that is, it changes from place to place. the parts usually affected are the fibrous structures of the joints, tendons, ligaments, and muscles. the serous membranes and heart may also be affected. according to its location, rheumatism is specified as articular or muscular. according to its course, it is designated as acute or chronic. _cause._--among the factors which are actively causative of rheumatism may be mentioned exposure to dampness and cold, especially while the animal is perspiring or fatigued after severe physical exertion. among other causes often mentioned are acidity of the blood, nervous derangement, microbes, and injuries. it occasionally follows another disease, such as pleurisy. the influence of age and heredity may be considered as secondary or predisposing causes. sometimes the disease appears without any apparent cause. on the whole, it may be said that any of the above-mentioned factors may have more or less influence on the production of rheumatism, but the specific cause is as yet unknown. _symptoms of articular rheumatism._--the symptoms appear suddenly and with varying degrees of severity. the animal presents a downcast appearance, with staring coat, horns and ears cold, and the mouth and muzzle hot and dry. appetite and rumination may be impaired and followed later or be accompanied at the same time by constipation. constipation may be followed by impaction of the stomach or bowels. thirst is increased, but the amount of urine voided is scanty. respiration and pulse are accelerated, and there is usually a fever, rising sometimes as high as ° f. the animal prefers to lie down, and when forced to rise stands with its back arched. the movements are stiff and lame and cause great pain. the disease may attack one or more joints at the same time; in fact, it is often symmetrical. one joint may improve while another becomes affected, thus showing the shifting tendency of the inflammation. the affected joints, including their tendons, ligaments, and synovial membranes, may be swollen, hot, and distended with liquid. they are very tender, and, if treated carelessly or injured, may become infected, thus leading to suppuration. while rheumatism attacks perhaps more frequently the knees and fetlocks, it has no special affinity for any joint and may attack the stifle, hip, shoulder, or elbow joint. in mild cases of articular rheumatism, the animal may fully recover in a few days. in chronic articular rheumatism there is less tendency of the disease to shift about, but there is a greater liability of structural change in the affected joints. this change may consist of induration, exostosis, or even anchylosis. these structural changes about the joints may lead to permanent deformity, such as the bending of the neck. fever is not so constant in the chronic form as in the acute, and the latter may lapse into the former. _symptoms of muscular rheumatism._--this form of rheumatism may appear under the same general conditions as the articular form. the general appearance of the animal is the same in both forms. the cow usually assumes a recumbent position, and all the movements made are stiff and lame. the method of rising or of locomotion indicates pain in certain muscles or groups of muscles, as of the croup, shoulder, or neck. as in the case of articular rheumatism, the tendons, ligaments, and synovial membranes may become involved. the constitutional symptoms in both articular and muscular rheumatism are similar, so that it is often perplexing to differentiate between the two forms. _prevention._--it is somewhat difficult to procure preventive treatment for cattle, especially when there are large numbers with little or no shelter. in general, it is advisable to protect the animals so far as possible from inclement weather conditions, such as cold rains, heavy dews, and frosts. this is more particularly necessary for animals in poor condition, or those which are perspiring or fatigued after long physical exertion. careful feeding is also essential. _treatment._--in attempting to treat cattle for rheumatism the first step is to procure proper shelter and environment. the animal should be quartered in a large, clean, dry stall, with plenty of light and fresh air, but protected from strong drafts. there should be an abundance of clean, dry bedding. the feed should be soft, easily digestible, and slightly laxative, and the animal should have access to clean, pure, cool water. for general or constitutional treatment of acute rheumatism, sodium salicylate is indicated. in order to gain the best results from this drug, it should be administered with the idea of rapidly saturating the system. to cattle it may be given in doses of one-half ounce every two hours for ten hours or until immediate relief is obtained. this drug should not be continued indefinitely, but may be given once a day after immediate relief has been obtained, and this single dose continued daily until permanent relief ensues, when it should be stopped. the use of sodium salicylate in chronic rheumatism is not advisable on account of the danger of depressing the heart, whose action is already somewhat impaired by the lesions which have attacked it. in this case one-half ounce doses of potassium nitrate or bicarbonate may be given three times a day. besides the constitutional treatment, it may be necessary to give special attention to the bowels in order to relieve constipation. cattle may be given saline laxatives at the outset, such as pound of epsom salt for an ordinary-sized cow, and the bowels kept regular by an occasional smaller dose. in chronic rheumatism the best course of treatment is to give tonics and local treatment. local treatment may also be advisable in acute rheumatism in addition to the constitutional treatment already prescribed. external treatment depends solely on the local conditions and should be applied judiciously. among the various remedies may be mentioned hot or cold moist packs, hot air and vapor baths, friction, etc. anodynes are often applied locally with good results. blisters are occasionally indicated. as anodynes may be mentioned liniments and ointments containing salicylic acid or sodium salicylate in combination with laudanum, aconite, or chloral hydrate. camphorated spirit, soap liniment, and essential oils also afford some relief when applied locally. of blisters, those containing cantharides are most effective. footnotes: [ ] a priessnitz bandage is a dressing which combines the three properties of keeping a part warm, moist, and subjecting it to uniform pressure. it consists of three layers of material. the inner layer is composed of absorbent cotton or some other material which is capable of holding moisture. this is soaked in water and wrapped around the part. the second layer consists of a substance which is impervious to moisture, as oiled silk or oiled paper, and is applied about the inner layer to prevent evaporation. the third or outside layer is composed of a flannel or woolen bandage to prevent the radiation of heat and thus keep the moist inner layer at the temperature of the body. surgical operations. by william dickson and william herbert lowe, d. v. s. [revised by b. t. woodward, v. m. d.] surgery is both a science and an art. the success of surgical operations depends on the judgment, skill, and dexterity, as well as upon the knowledge of the operator. the same fundamental principles underlie and govern animal and human surgery, although their applications have a wide range and are very different in many essential particulars. we must not lose sight of the fact that hygiene and sanitation are essential to the best results in veterinary as well as in human surgery. asepsis is an ideal condition which, although not always possible in animal surgery, is highly important in connection with the mechanical details of all surgical operations in proportion to the nature and seriousness of the same. aseptic surgery is considered to be the performance of operations with sterile instruments with the hands of the operator and the site of operation being rendered as nearly sterile as possible, and the wound treated during operation with sterile solutions and protected following the operation with sterile bandage material. in other words, it is the preservation of the highest degree of cleanliness in connection with operations. local or general anesthesia should be resorted to in painful and serious surgical operations, as operations upon all living creatures should be humanely performed and all unnecessary pain and suffering avoided. anesthesia is necessary where absolute immobility of the patient is essential and where entire muscular relaxation is indispensable. the anesthetic condition is also favorable for the adjustment of displaced organs. large animals have to be cast and secured before an anesthetic is administered. for complete anesthesia inhalations of chloroform are generally employed; sometimes of both ether and chloroform. the quantity of chloroform required to produce insensibility to external impressions varies much in different cases and must be regulated, as well as the admixture of air, by a competent assistant. if the probability of the success of an operation is remote and the animal is in healthy physical condition, so that its flesh is good for human food, it is more advisable to butcher the animal than to attempt a surgical operation that offers little encouragement to the owner. the best judgment has to be exercised in determining a matter of this kind, for no animal suffering from inflammation or that is in a feverish condition is fit for human food. all cases of major operative surgery require the skill and dexterity of the experienced veterinary surgeon, and no one else should attempt such an operation, for unnecessary suffering must be prevented. nevertheless, the more knowledge and understanding an owner of animals has of the principles of surgical operations and manipulations, the better for all concerned. in the first place, such an owner will appreciate more fully the skill of the qualified veterinarian, and, in the second place, he will be the better prepared and equipped to render assistance to his suffering dumb dependents where no practitioner is accessible and in cases of emergency. there are, moreover, some minor operations upon cattle, some of which can hardly be classed as surgical, that the stockman and farmer should be able to perform himself. in the performance of any operation upon an animal of the size and strength of the bull or cow, the first consideration is to secure the animal in such a manner as to preclude the possibility of its injuring either itself or those taking any part in the operation. the nature and time likely to be occupied by an operation must, of course, largely determine the method to be adopted. the majority of operations with which the present chapter is concerned are usually performed on the animal in a standing position. a bull should always be held by a staff attached to the ring in his nose. to secure the cow in a standing position, grasp the nose, the finger and thumb being introduced into the nostrils, and press against the cartilage which makes a division between them. if she has horns, grasp one of them with the disengaged hand. if this is insufficient the animal should be secured to a post, along the side of a fence, or put into a stanchion. an excellent method of restraint is to tie a long rope in a slip noose over the horns, pass it around the chest just behind the forelegs, taking a half hitch on itself, taking another half hitch in front of the hind limbs, passing the free end under the tail, bringing it forward and making it fast either to the head or one of the hitches. the head should be raised to the level of the back before the final knot is tied, so as to render it too serious and painful a matter for her to repeat the first attempt she makes to lower it. should the nature or extent of the operation be likely to take up considerable time, it is invariably the best plan to throw the animal. in the case of the ox this is very easily done, either by use of horse hobbles, should they be at hand, or by the application of a simple rope. if the horse hobbles are used, they should be fastened on the leg just above the fetlocks (ankle joints), as in that position they are less liable to come off than if placed around the pastern. of the many ways of applying the rope for this purpose we will describe only two, which we consider the best and simplest: first. take a long, strong rope (one which has been used a few times is more flexible), double it, and at or feet from the doubled end, according to the size of the animal, make a knot and pass the collar thus formed over the animal's head, allowing it to rest on what would be the collar place in a horse. now, pass the ends of the rope between the forelegs, carry one around each hind leg just above the fetlock joint, from outside in, under itself once, and bring the free ends forward, passing each through the collar loop on its own side and bringing the slack back toward and beyond the hind quarters. (pl. xxvi, fig. .) two or three men should then take hold of each rope and at a given signal pull. the animal's hind legs being drawn forward, the balance is lost, and if the animal does not fall or lie down he can be readily pushed over on his side and secured in the desired position. second. the three half hitches. take a rope or more feet long, make a slip noose at the end and pass it over the animal's horns, leaving the knot in the loop between the horns; then pass the rope backward along the neck to the withers, just in front of which take a half hitch on it, passing it along the back, take one half hitch just behind the forelegs and a second in front of the hind limbs round the flank. (pl. xxvi, fig. .) the free end of the rope is taken hold of by one or two assistants while another holds the animal's head. by pulling firmly on the rope, or inducing the animal to make a step or two forward while steady traction is made on the rope, the beast will lie down, when his feet can be secured in the way most convenient for the operator. there are numerous other methods, involving more or less complete restraint, which may be equally efficacious, but one or other of the ways indicated will doubtless be found to meet fully all ordinary cases. ringing the bull. this is usually and ought always to be done before the calf has attained sufficient weight or strength to make his restraint a matter of serious difficulty. an ordinary halter is usually all that is required, the strap being secured to a tree or post. a jointed steel or copper ring is ordinarily used. those made of the latter metal are preferable. the common method of punching a round piece out of the nasal septum for the introduction of the ring is, i think, open to objection, as portions of the fine nervous filaments are destroyed. the sensibility of the parts is thus lessened and the object of ringing to some extent defeated. the insertion of the ring by means of a trocar and cannula is preferable, as the method is not open to this objection. for some years we have used a little instrument, which can be made by any worker in metal, consisting of a steel point riveted into a short cannula made to fit on one end of the ring while open. (pl. xxvii, fig. .) when attached to the ring it is easily and quickly passed through the septum, the half of the ring following as a matter of course. it can then be removed and the ends of the ring brought together and fastened by means of the screw for that purpose. dehorning. in the wild state the utility of the horns of cattle as weapons of offense and defense is apparent, but with domestication of cattle and their confinement the presence of horns constitutes a menace to the safety of their companions. horned cattle frequently inflict with their horns painful and serious injuries to others. deaths as a result of such injuries are not unusual. the operation of dehorning would therefore be indicated as a matter of general safety. on farms where breeding is conducted, the most desirable method is to prevent the horns from growing on the young calves. this action results in a more symmetrical appearance of the poll and eliminates the dangers which would result from the presence of horns on the young cattle prior to their operative removal at a later age. a calf should be treated not later than one week after it is born--preferably when it is from to days old. the agent to be used may be either caustic soda or potash in the form of sticks about the thickness of an ordinary lead pencil. these caustics must be handled with care, as they dissolve the cuticle and may make the hands or fingers sore. the preparation of the calf first consists in clipping the hair from the parts, washing clean with soap or warm water, and thoroughly drying with a cloth or towel. the stick of caustic should be wrapped in a piece of paper to protect the hands and fingers, leaving one end of the stick uncovered. moisten the uncovered end slightly and rub it on the horn buttons or little points which may be felt on the calf's head--first on one, then on the other--two or three times, allowing the caustic to dry after each application. be careful to apply the caustic to the horn button only, for if it is brought in contact with the surrounding skin it will cause pain. too much moisture on the stick of caustic will allow the application to spread to the surrounding skin. after treatment keep the calf protected from rain, as water on the head after application of the caustic will cause it to run down over the face. dehorning of adult animals is usually performed after the age of years, as after that age there is less probability of the horns again growing. the horns should be severed from the head from a quarter to a half-inch below where the skin joins the base of the horn, cutting from the back toward the front if a saw is used. if the horn is not cut close enough to the head, an irregular, gnarly growth of horn is liable to follow. before attempting to dehorn the animal, it should be securely controlled by ropes in a stanchion or by casting. upon the range the cattle are usually controlled by casting or by placing them in a "squeezer" connected with a corral. a clean, sharp meat saw or a miter saw with a rigid back may be used. various types of dehorning shears or clippers are in general use. one type of dehorner has a stationary knife edge with its cutting edge shaped like a very wide v, and opposing this, another knife of similar shape moving in a slide, so that the cutting edges act upon the horn from all four sides at once, all the edges passing the center at the same time. another type has a movable knife, with one oblique or one curved edge, and the cutting is done in one direction only. the power for cutting with these instruments is supplied by pulling together two long handles which, in order to transmit a greater force, are generally so constructed that they act through the medium of a series of cogs. in dehorning with these instruments the cutting edges should be slipped down over the horn and the knives closed, so that their edges set firmly against the horn in such position that the cut will be made in the right place and in the right direction. the handles should then be drawn together with a quick, firm, strong pull so that the horn will be completely severed by the first act and without twisting. dehorning should, when possible, be performed in cool weather when the flies are not plentiful. the loss of blood from the operation is not sufficient, as a rule, to be of consequence, and after care being taken to prevent substances from getting into the openings left after the removal of the horns it is not usual to apply any dressing. pine tar or a mixture of pine tar and tannic acid may be applied, particularly if the weather is warm. setoning. the ordinary use of a seton is to keep up constant drainage from a cavity containing matter or to act as a stimulant or counterirritant. to insert a seton, the place of entrance and exit having been decided on, with the finger and thumb make a small fold of the skin transversely to the direction the seton is to be inserted, and cut it through, either with a sharp knife or a pair of scissors (this should be done at both the entrance and exit); then with a steady pressure and slight lateral movement insert the seton by means of a seton needle. (pl. xxvii, figs. and .) the seton should consist of a piece of strong tape, varying in breadth according to circumstances, and should be kept in place either by a knot on each end or by tying the ends together. setons should be gently moved once a day after suppuration is set up, and they should not be allowed to remain in over three weeks, or a month at the outside. tracheotomy. this operation consists in making an opening in the trachea, or windpipe. it is indicated whenever there is an obstruction from any cause in the upper part of the respiratory tract which threatens the death of the animal by asphyxia (suffocation). the mode of procedure is as follows: have an assistant extend the animal's head as far as possible to make the trachea tense and prominent; make a longitudinal incision about to - / inches long through the skin and deeper tissues and trachea at the most prominent part of the trachea, which is about the middle or upper third, and then insert the tracheotomy tube. the latter should be removed once or twice daily and cleansed, and the wound dressed antiseptically. to ascertain when it is time to discontinue the use of the tube and to allow the wound to close, the hand should be held over the opening, which will require the animal to use its natural passages in breathing. observe whether it is performed in a natural manner, and if so, remove the tube and allow the wound to close. often the operation has to be performed in great haste without the proper instruments and under great disadvantages, the operator having to cut down quickly, open the trachea and spread the parts, using some instrument improvised by him at the time. this operation only gives the animal relief in breathing, and therefore the proper remedial treatment should be adopted at the onset of the attack and continued until the cause (the disease) has been overcome. rumenotomy. the opening of the paunch, or rumen, in cattle and the removal of a part or the whole of the ingesta through said opening is termed rumenotomy. the operation should be performed in severe cases only, where the rumen is excessively overloaded and distended. the animal is placed with its right side against a wall and firmly held in position by strong assistants. the incision is made in the same place that the trocar is inserted for puncturing that organ in cases of hoven. the opening is increased in size until the operator's hand can be inserted into the rumen. before any of the contents are removed from that organ a linen cloth should be placed from the outer wound into the rumen in order to prevent any of the ingesta from getting into the abdominal cavity. some practitioners, after removing a portion of the contents of the rumen, introduce such medicine as may be indicated before closing the wound. clean the wound and close the opening in the rumen with uninterrupted (pl. xxvii, fig. ) carbolized catgut sutures. next close the external wound, consisting of the integument, muscle, and peritoneum, with stout, interrupted (pl. xxvii, fig. ) metallic sutures. no feed should be given for several hours after the operation, and then gruels only. (see "distention of rumen or paunch with feed," p. .) treatment of abscesses. an abscess may be detected, if situated externally, by heat, pain, redness, and swelling in the early stages, and, if further developed, by the fluctuation which is present. when any of these symptoms are absent, the suppuration should be encouraged by the means of hot fomentations and poultices. care must be taken that the abscess is not opened too soon, or to some extent it may cause it to scatter, and the escape of pus will be lessened. the time to open an abscess is just before it is ready to break, and should be done with a sharp lance, a crucial incision sometimes being necessary. the cavity should be syringed out with an antiseptic solution. care should be taken not to allow the wound to close too rapidly, to prevent which a tent of lint or oakum should be introduced. wounds. for the purposes of the present work wounds may be divided into three classes: ( ) incised; ( ) punctured; ( ) lacerated or contused. in any wound all that the most suitable applications can accomplish is, in the first place, to prevent the access of those poisonous germs which exist in the animal's surroundings, such as the soil and the manure, and, in the second place, when the process of repair is for some reason temporarily inactive or altogether arrested, to incite that curative inflammation that is the invariable method by which the cure is effected. incised wound.--this is one with clean-cut edges, and may be either superficial or deep. in wounds of all descriptions there is necessarily more or less bleeding, and this is especially liable to be the case in incised wounds, particularly when they penetrate to a considerable depth, or when inflicted on a part where blood vessels of any considerable size approach the surface. to arrest the hemorrhage must therefore be the first consideration. if slight, a generous use of cold water is all that is necessary, but if one or more vessels of any size have been wounded or entirely severed, they should be taken up and ligated. if the blood flows continuously and is dark in color, it proceeds from a vein, but if bright-colored and jerky in its flow, it is arterial. the taking up of an artery simply means the tying up of the bleeding vessel, which should be accomplished as follows: to discover the bleeding artery take a piece of clean absorbent cotton, dip it in cold water, and by gentle pressure on the wound clear it of the accumulated blood. the jet of fresh blood reveals the end of the vessel, which is readily recognized by its whitish-yellow or buff color. it should be seized with a forceps or pincers and slightly drawn clear of the surrounding tissues. now take the thread and place the middle of it under the artery, take up the ends, tie one simple knot tightly, pressing the thread down with the forefinger so as not to include the forceps, then a second one over it and cut off the ends. the bleeding being arrested, the operator can now carefully clean and inspect the wound, taking care to remove all blood and foreign matters and clip the hair around the edges before proceeding to stitch it up. if the wound is superficial, the lips may be brought together by a series of independent stitches (pl. xxvii, fig. ) about one-half of an inch to three-fourths of an inch apart. the stitches should not be drawn tightly; it is sufficient to bring the edges of the wound in apposition. if the wound is deep, the needle should be introduced perpendicularly at as great a distance from the lip of the wound as the depth it is to be inserted, so as to give the thread sufficient hold. all the stitches should be as nearly as possible at equal distances from the border of the wound, to prevent unequal strain, and the knots should be made at the side, not over the wound. (pl. xxvii, fig. .) when the wound is large and deep, care should be taken to have an opening in the lowest part to allow for the escape of the discharges. in deep wounds which run crosswise of a limb or muscle it is often advisable to use what is technically known as the "quilled suture," which is most readily understood by reference to plate xxvii, figure . to accomplish this method a curved needle with an eye in the point and a strong double thread should be used. the needle thus threaded is introduced perpendicularly at least an inch from the wound on one side, carried across below and brought out the same distance from the border of the cut on the opposite side, the thread being seized and held in position while the needle is withdrawn, leaving a loop of thread protruding on one side and two loose ends on the other side of each stitch. when enough stitches have been made, take a light piece of wood about the size of a lead pencil, corresponding in length to the size of the wound or slightly longer, and insert it through each of the loops, drawing up the free ends of the threads, which should in turn be tied securely on a similar piece of wood on that side. punctured wounds.--owing to the uncertainty of their depth and the structures they may involve, punctured wounds are by far the most dangerous and difficult to treat. not only is the extent of the damage hidden from view, but the very character of the injury, as can be readily understood, implies at least the possibility of deep-seated inflammation and consequent discharge of pus (matter), which, when formed, is kept pent up until it has accumulated to such an extent that it burrows by simple gravity, as no other exit is possible. in this way foreign matters, such as a broken piece of the stake or snag, or whatever caused the wound, may be carried to an indefinite depth, or the cavity of a joint may be invaded and very serious, if not fatal, consequences occur. the danger is especially marked when the injury is inflicted on parts liable to frequent and extensive motion, but all cases of punctured wounds should receive unusual care, as no judgment can be accurately formed from the external appearance of the wound. while a probe can ascertain the depth, it throws but little light on the extent or exact nature of the internal injury. for this reason all punctured wounds should invariably be carefully searched by means of a probe or some substitute devised for the occasion, such as a piece of wire with a smooth blunt end, or a piece of hard wood shaped for the purpose. stitching is not admissible in the case of punctured wounds. after thoroughly cleansing the opening of the wound and its surroundings, tincture of iodin should be injected directly into the wound. if a punctured wound is not very deep, and when the bruising and laceration are slight, it is possible for healing to take place by adhesion, and this should always be encouraged, as the process of repair by this method is far superior to that by granulation, which will be referred to later. with this object in view, the animal should be kept as quiet as possible. a dose of physic, such as a pound of glauber's or epsom salt, should be administered, and warm antiseptic fomentations or poultices, when this is practicable, applied frequently to the surface of the wound. in wounds of this description the process of repair may be complicated by the appearance of exuberant granulations, popularly known as "proud flesh," which is really an overgrowth of new tissue--granulation tissue; but these should not be interfered with unless they continue after the acute stage of inflammation has been subdued. if, after this, they persist, they may be treated with a per cent solution of sulphate of copper (bluestone) or nitrate of silver (lunar caustic) in water. contused or lacerated wounds.--these are usually caused by a blow with some blunt instrument or by falls. the seriousness depends largely on the depth of the injury, and treatment should be directed to allaying the inflammation and preventing the consequent tendency to sloughing. to this end soothing applications, such as antiseptic fomentations and poultices, are plainly indicated. methods of healing.--technically these may be divided into a number of distinct processes, but practically we may speak of them as two only, namely, by primary union, or adhesion, and by granulation. as suppuration is not so liable to occur in cattle as in horses, healing by the former and more speedy process is much more common in the first-named species, more particularly in clean-cut or incised wounds, provided they have been stitched within hours from the time the injury which caused them was inflicted, that they have been kept antiseptically clean, and that the patient by some means has been kept fairly still. this latter stipulation is probably hardest to comply with. quiet is an important factor in the process of repair among the lower animals. the second method of healing, namely, by granulation, which is, however, the manner in which most wounds in animals heal, takes much longer. in punctured wounds of any depth healing necessarily takes place in this way only, and the treatment should be directed largely to alleviating pain and moderating inflammation. after-treatment and dressing of wounds.--the dressing of wounds is one of the most important branches of veterinary surgery, and one of the most constant difficulties that the practicing veterinarian has to contend with lies in the lack of cooperation on the part of owners in the care and attention in the after-treatment of wounds. in summarizing the treatment of wounds, the following recommendations should be observed: wounds must be cleansed and kept clean, using antiseptic solutions which do not produce irritation, and applying the solutions with a syringe or with clean pieces of absorbent cotton. bleeding should be stopped before the closing of the wound by sutures or bandages. an opening at the bottom of all wounds except small superficial wounds should be provided as a drainage outlet for the escape of wound secretions or pus if it should form. the edges of wounds and the muscles involved in the wound should be kept as quiet as possible during the process of healing. every wound should be protected by a sterile or antiseptic dressing whenever it is possible to retain a dressing in place. dressings should be changed when it is apparent that they have become drenched with wound secretions or pus, or have become disarranged or too loose, permitting dirt to enter between them and the skin. if swelling appears beyond the edges of a bandage, it is an indication that it is too tight and it should then be removed and again applied. the hands of the operator and all instruments and dressings coming in contact with a wound at any time should be made as clean as possible by the use of antiseptics. barbed-wire cuts.--we have specified these simply because in some sections of the country there is a fixed idea that there is a specific poison in barbed wire, causing injuries which require treatment differing from that which is applicable to ordinary wounds. barbed-wire cuts differ from ordinary wounds only in the parts being often lacerated and torn, and the treatment already indicated for wounds of that description is applicable to them. castration. castration consists in the removal of the essential organs of generation, and is performed upon both the male and the female. in the male the organs removed are the testicles and in the female the ovaries. castration of the male. castration in the male is performed for several different purposes. it may be necessary, as is the case in certain diseased conditions of the testicles and in strangulated hernia, but the usual object of the operation is to enhance the general value of the animal. for example, if the animal is intended for burden, the operation will better fit him for his work by so modifying his temperament and physical condition that he may easily be controlled by his master. again, if he is merely to be used for beef purposes, the operation will improve the quality of the flesh and cause an added development of the most valuable portions of the dressed carcass. the operation upon the female may be performed on account of diseased conditions, but we may say that the chief object of the operation is to make the animal one of more profit to its owner by lessening the lacteal secretion and also improving the physical condition from the point of view of beef production. when the cow is spayed, it does away with all trouble attending estrum, or heat, gestation, and parturition with its accidents and ailments. the flesh of the spayed cow is more tender and juicy than that of the natural animal. the operation upon the male may be either the uncovered or the covered. in the former the incision is made down to the testicle proper, and in the latter the cut is made through the scrotum or the outside covering and through the dartos, or the next coat, care being taken to cut no deeper tissues or coats. the age at which the operation is performed varies, but usually it is performed between the second and third month. if done in early life, there is less danger of complications, the organs being in a latent condition and not fully developed. there are many different methods of operating, the principal ones of which we shall mention. in the uncovered operation a good free incision should be made, exposing the testicle completely. now it may be removed by simply cutting it off. the only danger of doing this is that hemorrhage is liable to follow. to obviate this, before the division of the spermatic cord it should be twisted several times in the following manner: take hold of the cord with the left hand, having it between the thumb and the index finger. now twist the free portion several times with the right hand, all the time being careful to push with the left hand toward the body of the animal. in this way the danger of injury to the cord during the animal's struggles will be overcome. there will be no hemorrhage, or very little, if it has been done properly. this is the most simple manner of torsion. there are forceps and other instruments made to perform the operation in this manner. the actual cautery is an old method, but we shall not describe it, as we consider that we have better methods now. the next method with the clamps, although extensively used upon the horse, is not practiced to so great an extent upon the bovine at the present time. it is a very old method, and is considered very safe. clamps are used in the covered and uncovered operations. more modern methods are by the use of special instruments known as the emasculator and the écraseur. the operation of "mulling" or crushing the spermatic cord is an unscientific and barbarous procedure, causing unnecessary pain and suffering. the methods described above apply only to the animal in a normal condition. before operating everything should be examined to see that it is as it should be. if otherwise, a special operative procedure will be necessary. whichever mode of operation is adopted from a practical standpoint, the principal precautions to be taken in order to attain success are as follows: first, thorough cleanliness under strict aseptic and antiseptic precautions; second, a free and boldly made incision; third, the avoidance of undue pulling or tension upon the spermatic cord; fourth, free drainage, which can be maintained, provided the original incision has been properly made. the operation of castration of the male is by no means a serious one, and when properly performed there is little danger from complications. although the danger is trifling, the complications which may arise are sometimes of a serious nature. hemorrhage, either primary or secondary, tetanus (or lockjaw), abscesses, hernia (or rupture), gangrene, and peritonitis are the most serious complications that follow castration. whichever complication arises will require its own special treatment, which we will not go into here, as it will be fully dealt with under another heading. we would add, however, that, generally speaking, the animal, after being castrated, should either be regularly exercised or be allowed freedom so that it can exercise itself. sudden changes of the temperature are dangerous. the animal should be fed moderately, but of a diet easily digestible. castration of the female. the operation of ovariotomy (spaying) should be performed when the heifer is in her prime and in moderate condition not too plethoric and not in heat or pregnant. this operation may be performed in one of two ways--namely, by the flank or by the vagina--each operation having its special advantages. in the flank operation the animal may be operated upon either while standing or while in the recumbent position. if standing, she should be placed against a wall or a partition and her head held by a strong assistant. the legs also must be secured to prevent the animal from kicking. a vertical incision should be made in the left flank, about the middle of the upper portion, care being taken not to make the opening too far down, in order to avoid the division of the circumflex artery which traverses that region. the operator should now make an opening through the peritoneum, which is best done with the fingers. next the hand and arm should be introduced into the abdominal cavity and the hand directed backward toward the pelvis, searching for the horns of the uterus; if followed up the ovaries will easily be found. they should then be drawn outward and may be removed either by the écraseur or by torsion. closing and suturing the wound will complete the operation. an adhesive plaster bandage can be beneficially applied. the operation by the vagina is more complicated and requires special and expensive instruments. the mode of procedure in brief is as follows: a speculum is introduced into the vagina, and an incision is made into the superior wall of that passage about inches from the neck of the uterus, cutting from below upward and from before backward. an incision which should not exceed - / inches in length should be made. the next step is to get possession of the ovaries. they are situated in a fold of the broad ligament and should be drawn carefully through the incision into the vagina. now take the long-handled scissors, specially made for this purpose, with which the thick border of the broad ligament is divided. the torsion forceps are introduced and applied to the broad ligament above the ovary. the left hand is then introduced, and the thumb and the index finger grasp hold of the broad ligament above the forceps. with the right hand torsion is applied and the ovary removed. the other ovary may be removed in the same manner. what has been said with regard to complications and aftertreatment in the case of the male also applies to the female. other surgical operations. descriptions of other surgical operations not given in this chapter may be found in other parts of this work by reference to the index. * * * * * surgical operations. description of plates. plate xxvi. devices for casting cattle. (from fleming.) fig. . reuff's method of throwing or casting the ox. fig. . miles's method of throwing or casting the ox. plate xxvii. surgical instruments and sutures. (after reynders and fleming.) figs. and . seton needles. these may be either long or short, straight or curved, according to the locality in which a seton is to be inserted. fig. . various forms of surgical needles. fig. . suture forceps or needle holder, for passing needles through thick and dense tissues. fig. . knot properly tied. figs. , , , , . various forms of sutures. fig. , interrupted suture; , quilled suture; , uninterrupted suture; , twisted suture, made by passing suture pins through the parts to be held together and winding the thread about them so as to represent the figure ; , single-pin suture. fig. . appliance for ringing the bull, one-fourth natural size. fig. . nose clamp, with spring and keeper. [illustration: plate xxvi. devices for casting cattle.] [illustration: plate xxvii. surgical instruments and sutures.] * * * * * tumors affecting cattle. by john r. mohler, v. m. d., _chief, bureau of animal industry._ [_synonyms:_ new growth, neoplasm, neoformation, pseudoplasm, swelling, and hyperplasia.] _definition._--tumors[ ] are abnormal masses of tissue, noninflammatory and independent in character, arising, without obvious cause, from cells of preexistent tissue, possessing no physiologic function, and characteristically unrestrained in growth and structure. tumors are abnormal masses of tissue. the application of the term "tumor" is directly connected with the fact that they produce local enlargement. they are noninflammatory; that is, the process of inflammation is not directly the cause or accompaniment of them. an inflammatory new growth tends to disappear upon the subsidence of the inflammatory process, while spontaneous disappearance of a tumor is comparatively rare. tumors are independent. for instance, their nutrition bears no relation to the nutrition of the body. a lipoma, or fatty tumor, in the subcutaneous tissue, may go on increasing to huge bulk while the body is steadily emaciating. again, the tissues of the aged gradually undergo atrophy, yet cancers arise at this time and grow rapidly. tumors are unrestrained in growth and structure. in the development of an animal we know at what period of its existence the mass of tissue called liver will develop--what its site, structure, and size will be. we know that it will remain only in that locality, and not, as it were, colonize throughout the system. with tumors it is different; there are no laws by which we can forecast the time, place, nature, or size of development of them. there is no cartilage in the kidney or parotid gland, yet a chondroma, or cartilage tumor, may develop in either. even when a new growth of tissue is started by an injury and consequent inflammation--as, for instance, proud flesh--there is a limitation of its size, but the controlling influences which govern the size of an organ or normal mass of tissue and limit the extent of an inflammatory overgrowth are all absent in the case of tumors. they are unrestrained, lawless. metastasis expresses the lawlessness of tumors as regards being limited to the original site of development. small particles of tumors enter the blood vessels or lymph streams and are carried to distant parts of the body, where they lodge and start new tumor formations. expansion by colonization in this manner is a rule with many tumors, and, since they exercise no function of use to the organism, this dissemination of actively growing particles becomes a menace to the system by numerically increasing the body's burden, opening new channels of drain upon the system and adding new centers for the absorption of putrefactive materials when the secondary tumors shall have degenerated. it is this which makes metastasis such an important element in the malignancy of tumors. tumors possess no physiological function. they are absolutely useless. fibrous tumors bind no parts of the organism together; bony tumors add nothing to the supporting framework of the body; the tissue of fatty tumors never serves as a storehouse of feed and energy; the cells of an adenoma, or gland tumor, furnish no secretion; a tumor composed of muscle tissue produces no increase to the strength of the individual--its muscle cells are not contractile. tumors arise from cells of preexistent tissue. tumor tissue is not a new variety. whatever the structure of a tumor, its counterpart is found among the tissues of the body, the lawlessness of the tumor, however, showing itself in more or less departure from the normal type. this departure is usually a reversion to a more elementary or embryonic stage, so that the tumor tissues may be said to be structurally immature. tumors arise without obvious cause. concerning the ultimate cause of tumor formation we are absolutely ignorant. various theories have been advanced from time to time, but none of them have been applicable to more than a limited number of cases. the most important theories may be briefly mentioned. ( ) _the theory of tumor diathesis._--bilroth taught that tumors are caused by a peculiar predisposition consisting of a diseased state of the fluids of the body. this constitutional taint might be acquired, but, having been acquired, is also hereditary. this theory is known also as the heredity hypothesis, but, while it is true that heredity appears to play some role in the causation of certain neoplasms, its application is too limited to make it of value. ( ) _the mechanical or irritant theory._--virchow assumed that tumors arise as the result of previous irritation of the part. this has been noticed particularly in the case of certain cancers. they frequently develop on the edges of old ulcers, thus being dependent apparently on chronic irritation. cancer of the lip in pipe smokers is a case in point. cancerous tumors of the skin often develop on the arms of workers in paraffin, tar, or soot, the chemical irritation of these substances being the cause. on the contrary, the proportion of those thus affected among the exposed is very small and forces the conclusion that if the real cause were in the irritation vastly more cases would occur. ( ) _the theory of nervous influence._--that is based upon (_a_) the observed fact that tumors occur more frequently in man and the higher animals than in those lower in the scale, among which the nervous system is less highly developed; (_b_) that certain formations seem to be directly connected with nerve distribution, while others have been associated with alternations in neighboring nerve trunks. ( ) _the embryonal theory._--this is known also as cohnheim's hypothesis. in early fetal life there occurs a production of cells in excess of those required for the construction of the various parts of the body, so that a certain number of them are left over in the fully developed tissue or become misplaced during the sorting of cells for future development of tissues and organs. these cells lie dormant until favorable conditions arise or until some sufficient stimulus is applied, when, released from their inactivity, they begin to reproduce and grow. not being normally related to their site, they lack the controlling and limiting influences of the part, and, their embryonic character enduing them with a most potent proliferating power, they develop in a lawless and unrestrained manner. there are tumors whose existence can be explained only on these grounds. still, this theory falls far short of answering the question as to the origin of tumors. ( ) _the parasitic theory._--this is not only one of the latest, but, merely as a hypothesis, it is the most attractive and plausible of all. the serious objections to it, however, are the almost uniform failure that has met the attempts to transplant these tumors from one animal to another and the absence of any constant variety of organism in them. several forms of parasites have been found in certain tumors, but nothing definite has been shown with reference to the relation they bear to the causation of the neoplasm. classification of tumors. in senn's work on tumors occurs the following: "a uniform system of classification of tumors is one of the great wants of modern pathology, and all attempts in this direction have proved failures." it would be folly, therefore, to burden the pages of a work of this kind with one or several of the proposed systems which have, admittedly, at some important point, failed of their purpose. since the value of this chapter depends chiefly upon its practical character, which in turn is measured by its aid in diagnosis, prognosis, and treatment, the old but important clinical division is here adopted. tumors are either malignant or benign. the essential difference between the two classes is that while _benign tumors depend for their ill effects entirely upon their situation, malignant neoplasms wherever located inevitably destroy life._ the clinical features of each group are in many cases sufficiently marked to distinguish them. malignant tumors. ( ) these are invariably pernicious, and from the beginning tend to destroy life. ( ) the cellular element predominates; therefore they grow rapidly. ( ) possessing no capsule, they infiltrate surrounding tissues. ( ) they infect adjacent lymph glands. ( ) they recur even after complete removal. ( ) they give metastasis; that is, they become disseminated in different organs. ( ) their presence develops a progressive emaciation. benign tumors. ( ) these in and of themselves do not tend to produce death. ( ) as the cellular element is not liable to predominate, they grow slowly. ( ) they are encapsulated, and when diffuse do not infiltrate surrounding tissues. ( ) they do not infect adjacent lymph glands. ( ) they do not recur after complete removal. ( ) they do not manifest metastasis. benign tumors, though harmless, may, by the accident of their location, indirectly produce death. mere pressure on the brain substance of an otherwise innocent tumor, compression of the blood supply for vital organs, growth in such manner as to cause obstruction in the alimentary tract or pressure upon nerves, may cause death, or, prior to death, so combine the effects of anemia (deficiency of blood), starvation, and pain, with its consequent restlessness, as to produce a veritable cachexia (condition of general ill health). on the other hand, a malignant tumor in its primary growth may so implicate a vital organ as to destroy life before metastasis can occur or even before cachexia can develop. thus, to the untrained observer, environment may so operate as to cause these two classes of new growths to simulate each other. the boundary lines may seem to overlap. it is here that the microscope, as the court of last appeal, adjudicates positively in the diagnosis between these two clearly marked divisions. it may almost be asserted that a true classification of tumors can not be made until we know more about the cause of them. the arrangement here presented is offered to meet the practical needs of the veterinarian, student, and farmer rather than of the pathologist. we may roughly divide the tissues of the body into structural and lining tissues. the structural tissues are composed of the tissues of special function and simple connective tissues. the lining or covering tissues, both internal and external, are known as epithelium. section a of the table below contains the true tumors or proper neoplasms. section b includes the cysts, some of which are true tumors, while others are false ones, but the latter are added because of their gross resemblance to the true and the consequent necessity of considering them at the same time. tumors and cysts. a.--tumors. benign. i.--_tumors composed of tissues resembling those of special function._ . type of muscle tissue myoma. . type of nerve tissue neuroma. . type of vascular tissue angioma. . type of gland tissue adenoma. ii.--_tumors composed of fully developed connective tissue._ . type of fibrous tissue fibroma. . type of adipose, or fat, tissue lipoma. . type of cartilage tissue chondroma. . type of osseous, or bone, tissue osteoma. . type of neuroglia, or nerve, sheath glioma. . type of mucoid, or mucous, tissue myxoma. malignant. iii.--_tumors composed of embryonic or immature connective tissues._ . type of immature connective tissue sarcoma. . type of endothelial tissue endothelioma. iv.--_tumors in which epithelial elements predominate._ . type of various epithelial cells and associated tissues carcinoma. b.--cysts. i.--_cysts which develop in preexisting cavities._ retention cysts. proliferation cysts. ii.--_cysts which are of congenital origin and are true tumors._ dermoid cysts. iii.--_cysts which originate independently as the result of pathological changes and are nontumorous._ . cysts formed by the softening and disintegration of lesions softening cysts. . cysts formed around parasites parasitic cysts. . cysts formed by an outpouring of blood and lymph into the tissue spaces with subsequent encapsulation of the fluid extravasation cysts. terminology.--the principle of naming tumors is quite simple. the greek word "oma" (plural "omata") means tumor. this word "oma" is added to the stem of the word ordinarily used to designate the kind of tissue of which the tumor is composed. thus a tumor formed after the type of fibrous tissue is a fibroma. the only exception to this is in the naming of the two large classes of malignant neoplasms. there the names were formed from the fleshlike appearance of the one and the crablike proliferations of the other--namely, sarcoma (sarks=flesh), carcinoma (karkinos=crab). diagnosis.--in the diagnosis of tumors note is taken of ( ) clinical history and ( ) examination of the tumor. ( ) _clinical history._--circumstances connected with the origin of the tumor and its rapidity of growth may point to an inflammatory swelling rather than a tumor. the location of the tumor at its commencement is important, as, for instance, in diagnosing between lipoma and carcinoma, the former being more or less movable under the skin, while a carcinoma develops in the skin. while tenderness on pressure may be caused by compression of a sensitive nerve by a tumor or by tumors of the nerve or nerve sheaths, as a rule this symptom is indicative of inflammatory swelling rather than of the existence of a tumor. ( ) _direct examination of the tumor._--in the application of this diagnosis the trained observer will note color, size, shape, and surface structure, transmission of light, movableness, consistence, resistance, pulsation, and crepitation. percussion, auscultation, and exploration are also available methods. finally, microscopic examination of the growing portions of the tumor by a pathologist will be found most satisfactory. general treatment of tumors. for benign tumors treatment is required only when it damages the animal's value or when merely for sake of appearance. when it is possible, the removal of the tumor by an operation is indicated. if the tumor has a small, constricted base, remove by torsion, ligation, or with an écraseur. ligation following the incision of the skin with a knife avoids the pain of pressing on the sensitive nerves of the skin and is suitable for tumors of broad base and small bodies. a firing iron, such as is used in line or feather firing, may also be used in removing tumors with small attachments. this not only stops the bleeding but forms a firm scab, under which healing may occur rapidly. those tumors that can not be removed by the above methods may be treated with caustics or acids, such as sulphuric acid, hydrochloric acid, caustic potash, arsenic, silver nitrate, or chromic acid, but it is difficult to limit the action of these drugs. the injection, into the tumor, of such chemicals as anilin dyes, alcohol, acetic acid, citric acid, or ergotin, is of doubtful value, as is also the injection of the germs of erysipelas--thought by some to be a specific. certain specific tumors, such as actinomycosis and botryomycosis, may be successfully treated by the internal administration of potassium iodid, together with the injection into the tumor or the painting of its surface with either lugol's solution or the tincture of iodin. the most reliable means of treating tumors is by extirpation with cutting instruments. dissect the tumor from the surrounding tissue, ligating all the larger blood vessels, and tearing the tissues with the fingers rather than cutting with a knife. the bleeding may be stopped with a hot iron. the after treatment is the same as for any ordinary wound of similar size. description of individual tumors. although a full list of the tumors that may be found in bovines has been given above, there are a number that warrant a detailed description, and the following mention will be made of the most important of them: myoma. these tumors are after the type of muscle. they are sharply circumscribed and, as a rule, are very hard, a condition owing usually to combination with fibroma and are then known as fibromyoma. in fact, the clinical differentiation between myoma and fibroma is almost impossible. myomas are found in the uterus, vagina, stomach, intestines, gullet, and bladder of a bovine animal. they grow very large, but, as a rule, are benign. treatment should consist of their removal. neurofibroma. a true neuroma built up of nerve fibers and nerve cells is infrequent, if it ever occurs, in cattle. false neuromas, or neurofibromas, are knotty, spreading tumors of the size of a large potato, which are developed within the nerve sheaths and composed of nerve fibers and connective tissue bands interlaced. the commingling of these varied fibers is often so intricate that separation is practically impossible. this tumor is most frequently found upon the shoulder of cattle. treatment is surgical. angioma. the angiomas are tumors composed mainly of blood vessels or blood spaces and are observed on the skin of man, where they are called "birthmarks" or "mother marks." cavernous angiomas are seen in cattle, affecting the liver and the mucous membrane of the nasal septum. in the liver they appear as smooth, flat, nonprojecting tumors of a dark-red or purple color and of about the size of a silver -cent piece. they are somewhat softer in consistency than the adjoining liver substance into which they are gradually fused. these tumors are frequently observed by meat inspectors in livers of slaughtered cattle. treatment of angioma is unnecessary. adenoma. the structure of this tumor is after the type of gland tissue. it is rarely seen in cattle except in combination with cancer or sarcoma. a growth which occurs more frequently in bovines, especially calves, and which in some instances bears a striking resemblance to an adenoma is the so-called goiter. goiter (struma). this is a noninflammatory enlargement or a hyperplasia of the thyroid gland. while it can not be definitely classed among tumors, yet, owing to its resemblance to the latter, it will be discussed at this time. the cause of goiter has never been definitely ascertained. among the most probable causes may be mentioned heredity, insufficient and improper diet, close confinement, unhygienic surroundings, and an unknown toxic substance which is supposed to obtain in those localities rich in magnesium and lime salts. certain organisms found in goiter have been suspected of producing this trouble, but their relation to the disease has not been satisfactorily proved. a goiter may consist of ( ) simple enlargement of the follicles which are filled with albuminous matter (follicular goiter); ( ) an increase of connective tissues between the follicles, causing the swelling to be dense and resistant (fibrous goiter); ( ) a great increase in size of one or more follicles, forming a cyst (cystic goiter); ( ) great dilatation of the blood vessels in the gland accompanied with pulsation with each heart beat (vascular goiter). _symptoms._--goiter may be observed at the side of the throat, reaching the size of a fist or even larger, or it may hang down below the windpipe. in cattle the two thyroid glands are close together, and when the disease affects both there may be but one uniform swelling placed in front of the windpipe below the angle of the jaw. this swelling may be hard, soft, or doughy in consistence, and with each beat of the heart it may pulsate like an artery. it may cause labored breathing by pressure on the windpipe, and death may result from pressure on this structure, on the gullet, or on the adjoining large vessels. _treatment._--in young animals the treatment is usually satisfactory, and consists in giving the animal a complete change of feed and plenty of exercise in the open air. if the condition appears enzootic in the district, remove the animal to another location when possible. iodin, either in the form of ointment or the tincture, should be applied to the swelling. injections of iodin solution, grains of iodin in dram of per cent alcohol, may also be made into the substance of the gland. when the swelling which follows this injection has subsided it may be repeated. potassium iodid should be given internally in - / dram doses twice daily for a cow, or in -grain doses twice a day for a calf. extirpation of all but a small section of the swelling may be successfully accomplished by a qualified veterinarian, but if it should be entirely removed, myxedema and death follow. fibroma. fibromas are tumors made up chiefly of connective tissue and are usually confined to the skin and subcutaneous tissue. indurative fibromas of the skin appear as tumors of gelatinous connective tissue or as firm, white vascular connective tissue growths, which are more or less sharply outlined, move readily over the underlying tissues in company with the skin, and owe their origin to mechanical injuries, perforating wounds, repeated abrasions, or the invasion of pus cocci or botryomyces into the tissues. these tumors in cattle are frequently found upon the dewlap as solid lumps, hard as stone to the touch, lying loosely between the layers of skin, and gradually losing themselves in the softer tissues of the neck above, or as smooth, hard tumors of glistening white substance with interlacing lines of softer tissue. they may also be found in the region of the knee or at the elbow. the skin over the growths, in accordance with the originating cause, will be found chafed, covered with scabs, or even ulcerated and accompanied with collateral edema. these connective tissue tumors grow slowly but reach enormous size. they sometimes follow injuries to the region of the throat and form there as hard, firm growth, even reaching the size of a child's head. a fibroma upon the larynx is not an infrequent occurrence in the ox. these tumors are always sharply outlined and have a roughened surface. they may be differentiated from actinomycotic tumors (see chapter on "infectious diseases of cattle," p. ) in the same location by their firm, fibrous structure and by the absence of pus from the interior. a tumor is sometimes seen upon the muzzle of cattle, which assumes a diameter equaling the width of the muzzle. it is a voluminous connective-tissue formation known by the name of "fibroma diffusum." another form is sometimes observed upon the tongue. it grows upon a broad, spreading base, becoming very hard. it is almost lacking in blood vessels, although the few that are present are plainly in view, and in consequence is poorly supplied with fluids. it is of a smooth contour, white or whitish yellow in color, is sharply limited from the normal substance of the tongue, may be covered with mucous membrane, on which prominent papillæ are located, or only by a thin, delicate layer of epithelium, and is usually found in the middle part of the tongue, where it may reach the size of two fists. pedunculate or stemmed fibrous tumors are frequently noticed growing upon or near the extremity of the tails of cows. they are apparently of traumatic origin, such as tying the tail fast while milking or shaving it too closely while trimming for show purposes, and usually contain bloody or gelatinous material within, or, again, they may be strongly edematous throughout. _treatment._--the treatment of large fibromas is surgical and consists of the operative removal of the tumor, followed by suturing of the wound. small external tumors may be painted with zinc chlorid, chromic acid, or a concentrated solution of bichlorid of mercury. papilloma (wart). when fibromas develop from the lining or covering tissues they frequently form papillary growths, more or less thickly covered with epithelium, and are then called papillomas, or warts. papillomas consist of villouslike projections, resulting from a proliferation of the outer layer (epithelium) of the skin or mucous membrane. these growths are also called "angle berries," and may assume a variety of forms. sometimes there is a preponderance of epidermis in the formation, and the tumor then appears as a hard, dense, insensitive, clublike growth, or wart. again the swelling is chiefly in the derm, or true skin, and we have what is known as a flesh wart (verucca carnea). in other cases the growth of papillar bodies projects in great cauliflowerlike tumors with deeply furrowed and lobulated surface, over which a covering of epidermis may or may not be present. these are usually much softer and are well supplied with blood vessels. it is not uncommon for them to be pedunculate or stemmed, and in this case considerable rotary motion or twisting is possible. their color is cloudy gray or grayish red, with white bands of connective tissue radiating from the center. their consistence varies. upon their surfaces and within their clefts and fissures they undergo retrogressive changes, softening, bleeding, or ulcerations. a favorite location for the papilloma in cattle is the udder and teats, where they may develop in such numbers as to cover the entire surface and make the animal troublesome to milk. the sides of the head, neck, and shoulders also afford satisfactory conditions for their growth, and are frequently seen to be affected by them. _treatment._--warts may be removed with the scissors, twisted off with the fingers, or ligatured by means of a rubber band or horsehair. the roots should then be cauterized with tincture of iron, glacial acetic acid, or lunar caustic. acids should never be used in removing warts about the eyes or in the mouth. papillomas of the eyelids sometimes change to cancers and should be removed by taking out a wedge-shaped section of the eyelid. young cattle should be given arsenic internally in the form of fowler's solution, tablespoonful twice a day for a -months-old calf. polyps. polyps are usually fibromas or myxomas, occurring on the mucous membrane of the nasal passages or genital tract. they grow upon a narrow stem, bleed readily when injured, and often contain a center of thin, limpid fluid. a bloody discharge is sometimes seen coming from the affected nostril, but this is not always easy of detection in cattle, owing to the pliancy of their tongues and to their habit of licking an irritated nostril. usually these tumors grow downward and may project from the nostril, causing snoring sounds and uneasy breathing. they may occasionally force themselves backward into the throat, where they interfere seriously with respiration, the patient being obliged to breathe with an effort, and even forced to cough in order to dislodge temporarily the obstruction from the larynx. such tumors, when near the nostril, may easily be removed by the use of forceps or a loop made of bailing wire. serious bleeding is not liable to follow their removal, but an astringent wash, such as a solution of the perchlorid of iron, if applied to the cut surface, will be found very beneficial. in case the tumor is not within easy reach, the services of a qualified veterinarian should be obtained to perform the necessary operation. lipoma. this is a tumor consisting chiefly of fat cells. the growth is irregularly rounded and distinctly lobulated, very soft, and almost fluctuating. it is insensitive, grows slowly, and is always inclosed in a distinct fibrous capsule, from which it can be easily shelled out. it may become very large and often hangs pendulous from a long, elastic pedicle. in cattle this tumor may be found in the subcutaneous tissues, especially of the back and shoulders, uterus, and intestines, and in the latter position it may cause strangulation, or "gut tie," by winding around a loop of the intestine. _treatment._--when found on the skin the tumor may be readily removed with a knife or by a ligature. caustics and the cautery produce wounds that heal slowly and can not be recommended in the treatment of this tumor. chondroma. this tumor formation is composed of cartilage cells. it is a rounded and very often unevenly nodular and sharply described tumor. it is very hard, dense, elastic, and painless and develops principally where we find normal cartilage cells. it is rare in cattle, but has been found in the subcutaneous tissues and nasal cavities. _treatment._--extirpation. osteoma (bony tumor). bones may occasionally grow in such a profuse and irregular manner that the product, or osteophyte, assumes the character of a tumor. the bone tissue may possess either spongy or compact properties and grow either from the periphery of the bone or within its interior. these tumors most frequently appear about the head of the animal, either upon the jawbones, within the nasal passages, or in connection with the horns. they are usually of bony hardness, painless, benign, and sharply outlined. _treatment._--the treatment consists in either removing them with a saw, chisel, or trephine, or preventing their further development by counterirritation with blisters or firing iron. myxoma. characteristic myxomas are mucoid tumors which chiefly originate from the mucous membrane and are especially to be found within the nasal passages and uteri of cattle. they can reach a size of three fists, are smooth or velvetlike, or may be lobulated, broad at the base, and consist of a glassy-looking mass of connective tissue, which usually shows a distinctive yellowish color. being homogeneous and elastic, the moist, jellylike tissue composing the tumor may be easily destroyed or crushed. when cut through, these tumors soon collapse from the loss of their fluids. they sometimes inclose elliptical cavities filled with slimy, gelatinous masses. _treatment._--extirpation. sarcoma. this is a malignant tumor after the type of embryonal tissue, and consists of several varieties, such as the round cell, spindle cell, giant cell, alveolar, and melanosarcoma. they grow by preference in connective tissue and are quite vascular. sarcomas appear either as single or multiple nodules, varying in size from a hempseed to a hazelnut, or else as a moderate number of tumors of the size of hen eggs. their surface, at first smooth, later becomes lumpy and tuberous from internal degeneration. secondary nodules may appear near the primary tumor. the outer skin is not involved so soon as in cancer, nor does ulceration follow so rapidly. sarcoma is about the most frequent and dangerous tumor that is found in cattle. it occurs in young animals, and is found on the serous membranes, in the glandular organs, and on the outer skin, especially of the neck and shoulders--in fact, in nearly every tissue and in almost every part of the body. this tumor is often found in places exposed to traumatisms and at seats of scars, or of irritations from pressure and inflammation. _treatment._--treatment should consist in early and complete removal by the knife, including one-half or three-quarters of an inch of the sound tissue adjoining the tumor. if there is a possibility that sarcomatous tissue still remains, either cauterize the wound with a hot iron or powder the walls of the cavity with arsenious acid. cancer (carcinoma). cancers are tumors of epithelial tissues and are malignant. there are several varieties of cancers, such as hard, soft, and colloid, but only those growing on the surface will be mentioned here. these malignant tumors of the superficial organs develop primarily from the epidermis or from the glands of the skin. they appear secondarily as spreading infections from milk glands, thyroids, anal glands, or as embolisms. in such cases their sole character depends wholly upon the kind of cancer from which they have sprung. the infiltrating cancer begins as an elevation of the skin, which progresses until it becomes rough and nodular. the surface later becomes attacked, and an ulcer results whose edges are outlined by a hard, firm zone. the ulcerations may remain limited by cicatricial tissue, but it is more likely that the infiltration and destruction of tissue will spread out wider and deeper until a rodent ulcer (so called) is formed. one of the most frequent sites of cancer in cattle is in the eye, where they are called fungus hematodes, but they also occur on the skin, on the genitals, in the stomach, and within the organs. _fungus hematodes._--this starts at the inner corner of the eye as a papillary elevation or as small nodules which become fused. they grow larger and become papillomatous, with superficial ulcerations and a tendency toward hemorrhage. in some cases the eye is displaced by the growing tumor or is attacked by the cancer cells and entirely destroyed. cancerous growths upon the external genitals and the anus usually present a rough, irregular surface from which there is a constant sloughing of decomposed tissue accompanied with a penetrating disagreeable odor. the diagnosis of cancer may be made clinically by noting the simultaneous infection of the lymph glands which surround the primary lesion. deeply burrowing and infiltrating forms which appear as lumps and ulcerations cause marked disfiguration of the affected part. the surface becomes a soft, greasy mass; later it cracks open and from the fissures blood-colored pus exudes, being continually formed by the moist degeneration of the tissues beneath. at first the general health of the animal does not appear affected, but later the cancer nodules spread to important organs and give rise to marasmus and progressive emaciation. cancer is not a frequent tumor of cows. fröhner states that of cases of tumors in cattle which came under his observation , or . per cent, were found to be cancers, while , or . per cent, were sarcomas. _treatment._--treatment consists in the early and complete removal of the tumor, taking care to include a wide border of healthy tissue. this has been most successful in such superficial cancers as those of the eye, penis, anus, testicle, vulva, and sheath. if the disease has advanced too far, this treatment may not prove efficacious, owing to the great malignancy of the cancer and its tendency to recur. in such cases the animal may be slaughtered, but the flesh should be used for food only after inspection by a competent veterinarian. cysts. cysts may be true or false tumors and consist of a capsule containing a fluid or semisolid content. among the most important cysts, which have been briefly referred to in a previous table, the following are probably the most noteworthy, owing to the frequency with which they are found in bovines: softening cysts. softening cysts, which result from the degenerative liquefaction of normal or diseased tissues, especially of tumors of different kinds, followed by the encapsulation of the fluid. parasitic cysts. parasitic or foreign-body cysts, from the inflammatory reaction induced by such parasites as the echinococcus (hydatid cyst) or by the presence of various kinds of foreign bodies. extravasation cysts. extravasation cysts, caused by injuries which rupture blood vessels, followed by an increase of fibrous tissue which forms a capsule about the fluid. the hygromata in front of the knee in cattle, so-called tumor of the knee, and serous cysts belong to this variety. hygromata, or tumors of the knee.--these consist in the simplest form of a collection of serous fluid mixed with fibrin within a distended bursa. the walls surrounding the fluid become firm, smooth, and dense. outwardly the tumor appears fluctuating, though tense, while the skin which covers it may be normal, denuded of hair, or covered with hard epidermal scales, possibly half an inch in thickness, forming a hard, horny plate. the cavity which contains the fluid may have the dimensions of a hen's egg, an apple, or a child's head. its walls are formed by the diseased secreting membrane of the bursal sac, and are readily detachable from the subcutis of the skin. their internal surfaces are often uneven or supplied with projections or tufted growths which support a fibrous network within the tumor. tumors of the knee may also assume a granular type, as the result of chronic inflammation or following operative or spontaneous evacuation of pus from the part. they are either firmly connected with the skin or are detachable from it, and when laid open disclose a whitish-red, porklike tissue surrounding a central nucleus of pus, or a fistulous tract leading to the outer surface. they are caused by the chronic inflammation which follows the bruises received by cattle in lying down and in rising, or they may be due to falls on uneven, hard ground. _treatment for hygromata._--when the swelling first appears cold water should be applied, followed later by bandaging with cloths wrung out of warm water. if the swelling is soft, it should be punctured at the lowest point, and afterwards the cavity should be syringed with lugol's solution. if the tumor is hard and nonfluctuating, a mercurial blister may cause absorption and at the same time prevent further injury to the part by making it more painful, thus sparing it. serous cysts.--these swellings are another variety of extravasation cysts, and are caused by such injuries as butting, running against hard objects, and shipping bruises, which are followed by an outpouring of blood and lymph into the tissue spaces. these cysts develop rapidly and may reach the size of a man's head or even larger. they are soft, edematous, and hot at first and contain a serous or blood-tinged fluid. later, partially organized clots and shreds of a fibrinous nature and of a gelatinous consistence are formed within, and the temperature of the swelling is reduced. they appear on the surface of the body, especially on the belly and flank of cattle. _treatment of serous cysts._--treatment consists in opening the cyst at the most dependent point with a sharp knife. the cavity should be washed out twice daily with a per cent solution of carbolic acid, and drainage encouraged by keeping the incision open. dermoid cysts. these cysts have a wall which is almost an exact duplicate of the structure of the skin, and frequently contain epidermal structures, such as hair and teeth, which, in the development of the embryo, have been misplaced. thus we may find in an ovary or testicle a dermoid cyst, containing a tooth or a ball of hair. dental cysts are included in the class above. dental cysts.--it happens occasionally that the teeth of cattle, instead of developing normally within strong supporting alveolæ, remain inclosed within a cystic membrane, which assumes a tumorlike character. one tooth may be included alone in the cyst or a number may be inclosed together. however this may be, the malformation progresses, especially if confined to the incisor teeth, until the remaining teeth that began to develop normally are crowded out of position and rendered useless. the tumor may reach the size of a man's fist. it appears to be fleshy and dents upon pressure, but it may also appear on closer examination as though it contained irregular sections of thin bone. the outer surface is always smooth, and no indication of purulence, softening, or scab formation is ever exhibited. upon being laid open with the knife the tumor is seen to be surrounded by a firm, smooth membrane which limits it completely from the adjoining tissues. it is filled with material which possesses partly edematous, partly fleshy, and partly bony properties. it is supposed that this mass is composed of rudiments of the jawbone or of the alveolar walls which, becoming spongy, lose themselves in the soft, fleshy mass contained within the capsule of the tumor. it occasionally happens that the tumor is hollow and that the cavity extends back into the body of the lower jaw for a considerable distance. tumors of this kind, being of congenital origin, are very naturally observed most frequently in young cattle, but they may continue to expand for a period of several months after the birth of the calf, even until they become troublesome and unsightly. _treatment for dental cysts._--treatment consists in the complete extirpation of the cyst and the destruction of the lining pouch by curetting. retention cysts. retention cysts arise from the retention of normal secretions, owing to obstruction of a duct leading from a gland. the mucous cysts found in the mouth, udder, and vestibule of cows are samples of this form. mucous cysts.--saclike dependent tumors, caused by retention of the secretions from the mucous glands, sometimes develop in the mouth, nose, pharynx, and vulva of cattle. they are called "mucous cysts." these are of sizes varying from peas to pigeon eggs, are roundish and translucent, and surrounded by a delicate, vascular membrane. they contain a siruplike substance more or less thick and transparent and whitish yellow in color. treatment consists in the puncturing of the swelling, if accessible, and the destruction of the cyst walls by the injection of lugol's solution. proliferation cysts. these are found especially in the ovaries of cows, called "cystic ovaries," and may produce nymphomania (chronic bulling). the treatment indicated in this case is the removal of the diseased ovaries. footnotes: [ ] the term "tumor" literally means a swelling, and thus has been applied to the prominence caused by an overdistended bladder, to the enlargement of pregnancy, to the swelling produced by an abscess, to the overgrowth of tissue (hyperplasia) associated with injury and consequent inflammation, and to numerous other phases of tissue enlargement directly connected with recognized disease processes. for this reason it is becoming more common for scientists to apply the word "neoplasm" to the new growths described in this chapter. because of the still popular use of the word "tumor," it is retained in this chapter for the designation of those new growths to which the sevenfold characterization of our descriptive definition applies. diseases of the skin. by m. r. trumbower, d. v. s. [revised by john r. mohler, v. m. d.] general discussion. the skin consists of two parts--a superficial layer, the epidermis, or cuticle, and the deep, or true, skin, the dermis, cutis vera, or corium. the epidermis, cuticle, or scarf skin, is an epithelial structure, forming a protective covering to the corium. it varies in thickness, is quite insensible and nonvascular, and consists of a sheet of cells. the epidermis is divided into a firm and transparent superficial and a deep, soft layer. the latter is the rete mucosum, whose cells contain the pigment which gives color to the skin. the deep surface of the epidermis is accurately molded on the papillary layer of the true skin, and, when removed by maceration, presents depressions which correspond to the elevations on the dermis. from the cuticle tubular prolongations pass into the sebaceous and sudorific glands; thus the entire surface of the body is inclosed by the cuticle. the dermis, or true skin, is vascular and highly sensitive, containing the tactile ends of the nerves of touch. it is covered by epidermis and attached to the underlying parts by a layer of areolar tissue, which usually contains fat. the cutis consists of a fibro-areolar tissue and vessels of supply. it is divided into two layers, the deep, or true, corium and the upper, or papillary. the corium consists of strong interlacing fibrous bands, chiefly white; its meshes are larger and more open toward the attached surface, giving lodgment to the sweat glands and fat. the papillary, or superficial, layer is formed of a series of small conical eminences or papillæ, which are highly sensitive, and consists of a homogenous, transparent tissue. the blood vessels form dense capillary plexuses in the corium, terminating by loops in the papillæ. the papillary nerves run in a waving manner, usually terminating in loops. hair is an appendage of the skin and forms its external covering. it is a special modification of epidermis, having the same essential structure, and consists of a root, shaft, and point. the root has a bulbous extremity, is lighter and softer than the stem, and is lodged in a recess or hair follicle, which may either be in the corium or subcutaneous areolæ. the follicle is dilated at the bottom to correspond to the root bulb, and the ducts of one or more sebaceous glands open into it. at the bottom of each follicle is a conical, vascular papilla, similar in every respect to those on the surface of the dermis; this papilla fits into a corresponding depression in the root of the hair. the shaft consists of a center, or medulla, a surrounding fibrous portion, and an external coating, or cortex. the medulla consists of cells containing pigment or fat, is opaque, and deeply colored. all kinds of hair do not have this medulla. the fibrous portion occupies the bulk of the stem, and the cortex is merely a single layer of thin, flat, imbricated (shinglelike) scales. the sebaceous glands, lodged in the corium, are most abundant in parts exposed to friction. they generally open into the hair follicles, occasionally on the surface of the body. each gland consists of a small duct which terminates in a lobulated recess. these lobules vary, and are, as is the duct, lined with epithelium. they are filled with sebaceous matter which, as it is secreted, is detached into the sacs. they are very plentiful between the claws of cattle. the sudorific glands, or sweat glands, are situated in the subcutaneous areolar tissue, surrounded by a quantity of fat. they are small, round, reddish bodies, each of which consists of one or more fine tubes coiled into a ball, the free end of the tube being continued up through the true skin and cuticle, and opening on the surface. each sweat gland is supplied with a cluster of capillary blood vessels which vary in size, being very large when perspiration is excessive. the contents of the smaller ones are fluid, and of the larger, semifluid. the skin may be regarded as an organ supplementary in its action to the lungs and kidneys, since by its secretion it is capable of removing a considerable quantity of water from the blood; it also removes small quantities of carbon dioxid, salts, and in certain instances during suppression of the renal secretions a small quantity of urea. the skin is also the chief organ for the regulation of animal heat, by or through conduction, radiation, and evaporation of water, permitting of loss of heat, while it also, through other mechanisms, is able to regulate the heat lost. the hair furnishes protection against extreme and sudden variations of temperature by reason of the fact that hairs are poor conductors of heat, and inclose between them a still layer of air, itself a nonconductor. the hairs are also furnished with an apparatus by which the loss of heat may be regulated; thus, in cold weather, through the contraction of unstriped muscular fibers of the skin, the hairs become erect and the external coat becomes thicker. cold, too, acts as a stimulus to the growth of hair, and we find, in consequence, a thicker coat in winter than in summer. the hairs also furnish protection against wet, as they are always more or less oily from the secretion of sebaceous glands, and thus shed water. through their elasticity they furnish mechanical protection, and through the thickness of the coat, to a certain degree, resist the attacks of insects. finally, the hairs assist the sense of touch. the sweat glands are constantly discharging a watery secretion in the form of insensible perspiration, and by their influence act as regulators of the temperature of the body; hence, in warm weather, the secretion of the skin is increased, which tends to prevent overheating. sweating, in addition to regulating heat, is also an active agent in removing effete material from the blood; therefore this secretion can not be checked without danger. if the skin is covered with an impermeable coating of grease or tar, death results from blood poisoning, owing to the retention of materials destined to be excreted by the skin. all secretion poured out by the skin is not only modified by the condition of the atmosphere but also by the character and quantity of the food, by the amount of exercise, and especially by the quantity of fluid taken. the sebaceous secretion is intended to lubricate the skin and hairs. it consists of soft, fatty material suspended in water, and is characterized by an odor peculiar to the animal by which it is secreted. i will not attempt to classify the various diseases of the skin, for in a work of this kind it would serve only to confuse the reader. we shall first consider a class of diseases which are of an inflammatory type; next, those caused by faulty secretion and abnormal growth; then, diseases of parasitic origin; lastly, local injuries of the skin. pruritis (itching). we shall consider pruritis first as a distinct subject. it is not a disease, only a sensation, and therefore a symptom. it is one of the symptoms accompanying the majority of the diseases which we will consider in this chapter. it is, then, a functional affection produced by slight irritation from without or by an internal cause acting upon the sensory nerves of the skin. nothing characteristic is seen except the secondary lesions, produced mechanically by scratching or rubbing. there are various forms of itching, the result of specific skin diseases, where the pruritis is a secondary symptom. in such cases it should not be regarded as an independent affection. _causes._--many causes may induce the condition which we recognize here as pruritis. the most common one is dirt on the skin, resulting from insufficient care. if the ceiling of the stable is open, so that dust and straw may fall, the skin is irritated and pruritis results. it also occurs in some forms of indigestion. the parts of the body most exposed to this condition are the croup, the back, the top of the neck, and the root of the tail. another cause is found in affections of the liver and of the kidneys, when an increase of effete material has to be thrown off by the skin. morbid materials circulating in the blood may produce a tickling or smarting sensation of the skin in their passage from the blood to the free surface of the skin. certain irritating substances when eaten may be excreted by the skin, and coming thus in direct contact with the sensory nerves produce itching, or may go further and cause distinct inflammation of the skin. in another class of cases the pruritis may be ascribable to an atrophy, contraction, or hardening of the skin, when the nerves become irritated by the pressure. these conditions may be so slightly marked in a thick skin like that of the ox that they can not be recognized. it is frequently noticed that cattle rub themselves as soon as they pass from the stable into the open air--changing from a warm to a cold atmosphere. again, we may find one that does all its rubbing in the stall. we may look for lice, but fail to find them. these conditions are generally attributable to high feeding and to too close confinement. they may be associated with inflammatory irritation or not; certainly we fail to discover any morbid changes in the skin. there is to some extent a delightful sensation produced by rubbing, and it may partly become a habit of pleasure. _treatment._--we must place our chief reliance upon a change of food, plenty of exercise, and in most cases the administration of an active cathartic-- to - / pounds of epsom salt, a handful of common salt, a tablespoonful of ginger or pepper, mixed with quarts of water, all of which is to be given at one dose. afterwards half an ounce of hyposulphite of soda mixed with the feed may be given twice a day for a week. for an external application, when the skin is abraded or thickened from rubbing, a solution of borax, ounces to the quart of water, may be used. carbolic acid, / ounce to a quart of water, will give relief in some cases. inflammatory diseases of the skin. erythema. this is the simplest form of inflammation of the skin. it consists of an increased redness, which may occur in patches or involve considerable surface. the red coloration disappears when pressed by the finger, but soon returns after the pressure is removed. there is seldom much swelling of the affected part, though often there is a glutinous discharge which dries and mats the hair or forms a thin scale upon the skin. in simple erythema the epidermis alone is affected; when it becomes chronic, fissures form and extend into the corium, or true skin. _causes._--simple erythema, consisting of an inflammatory irritation, is seen in very young calves, in which the navels leak. the discharge being urine, it causes an irritation of the surrounding skin. chafing, which is another form of erythema, is occasionally seen on the udders of cows from rubbing by the legs; chafing between the legs is not uncommon among fat steers. chronic erythema is found in the form of chapped teats of cows and chapped lips in sucking calves. it frequently occurs in cows when they are turned out in winter directly after milking, and in others from chafing by the sucking calf. some cows are peculiarly subject to sore teats. the fissures when neglected in the early stage of formation become deep, very painful, often bleeding at the slightest touch, and when milked in that condition cause the animal to become a kicker. occasionally the lower portions of the legs become irritated and chapped when cattle are fed in a muddy or wet yard in winter, or if they are compelled to wade through water in frosty weather. another form of erythema occurs in young cattle highly fed and closely stabled for a long winter. the erythema appears in patches, and as it is most common near the end of the winter it is known as the "spring eruption" or "spring itch." _treatment._--in ordinary cases of erythema the removal of the cause and the application of benzoated oxid of zinc ointment, carbolized cosmoline, or ichthyol ointment applied a few times, will restore the skin to a healthy condition. when there are fissures the zinc ointment is the best. if at the teats, a milk siphon (pl. xxiv, fig. ) should be used instead of milking by hand, and the calf, if one is suckled, should be taken away. the calf should be fed by hand if its mouth is affected. when the legs are irritated or chapped, dry stabling for a few days and the application of tar ointment will soon heal them. urticaria (nettle rash, or surfeit). this is a mild, inflammatory affection of the skin, characterized by sudden development of patches of various sizes, from that of a nickel to one as large as the hand. the patches of raised skin are marked by an abrupt border and are irregular in form. all the swelling may disappear in a few hours, or it may go away in one place and reappear on another part of the body. it is always accompanied with a great desire to rub the affected part. in its simplest type, as just described, it is never followed by any serous exudation or eruptions, unless the surface of the skin becomes abraded from scratching or rubbing. _causes._--digestive derangements caused by overloading the stomach when the animal is turned out to graze in the spring, certain feed constituents, high feeding of fattening stock, functional derangement of the kidneys, spinal and other nervous affections, are the most common sources of nettle rash. the disease consists in paralysis of the nerve ends that control the volume of the capillary vessels in certain areas of skin, thus permitting the vessels to expand, their contents in part to exude, and thus produce a soft, circumscribed swelling. _treatment._--administer a full dose of epsom salt. give soft, easily digested feed, and wash the affected parts with a solution of bicarbonate of soda (common baking soda), ounces to the gallon of water twice a day, or diluted glycerin may be applied to the skin. if it assumes a persistent tendency, give a tablespoonful of the following powder in the feed three times a day: cream of tartar, sulphur, and nitrate of potassium, equal parts by weight; mix. eczema. eczema is a noncontagious inflammation of the skin, characterized by any or all of the results of inflammation at once or in succession, such as erythema, vesicles, or pustules, accompanied with more or less infiltration and itching, terminating in a watery discharge, with the formation of crusts or in scaling off. the disease may run an acute course and then disappear, or it may become chronic; therefore two varieties are recognized, vesicular (or pustular) and chronic eczema. _causes._--eczema is not so common among cattle as in horses and in dogs, in which it is the most common of all skin diseases. among cattle it is occasionally observed under systems of bad hygiene, filthiness, lousiness, overcrowding, overfeeding, excessively damp or too warm stables. it is found to develop now and then in cattle that are fed upon sour substances, distillery swill, house or garden garbage, etc. localized eczema may be caused by irritant substances applied to the skin--turpentine, ammonia, the essential oils, mustard, spanish-fly ointment, etc. occasionally an eruption with vesiculation of the skin has been induced by the excessive use of mercurial preparations for the destruction of lice. it is evident that eczema may arise from local irritation to the skin or from an autointoxication. cattle fed on the refuse from potato-starch factories develop a most obstinate and widespread eczema, beginning on the legs. _symptoms._--in accordance with the variety of symptoms during the progress of the disease we may divide it into different stages or periods: ( ) swelling and increased heat of the skin; the formation of vesicles, which are circumscribed, rounded elevations of the epidermis, varying in size from a pinhead to a split pea, containing a clear, watery fluid; ( ) exudation of a watery, glutinous fluid, formation of crusts, and sometimes suppuration, or the formation of vesicles containing pus (pustules); ( ) scaling off (desquamation), with redness, and thickening of the skin. from the very beginning of the disease the animal commences to rub the affected parts; hence the various stages may not always be easily recognized, as the rubbing produces more or less abrasion, thus leaving the skin raw-- sometimes bleeding. neither do these symptoms always occur in regular succession, for in some cases the exudation is most prominent, being very profuse, and serve to spread the disorder over a large surface. in other cases the formation of incrustations, or rawness of the skin, is the most striking feature. the disease may be limited to certain small areas, or it may be diffused over the greater part of the body; the vesicles, or pustules, may be scattered in small clusters, or a large number run together. the chronic form is really only a prolongation of the disease, successive crops of pustules appearing on various portions of the body, frequently invading fresh sections of the skin, while the older surfaces form scabs, or crusts, upon the raw, indurated skin. in old, standing cases the skin breaks, forming fissures, especially on portions of the body that bend--the neck and limbs. thus the disease may be prolonged indefinitely. when eczema reaches its latest period, either acute or chronic, desquamation of the affected parts is the most prominent feature. the formation and shedding of these successive crops of scales constitute the character of the disease frequently denominated psoriasis. _treatment._--the treatment of eczema is often anything but a pleasant task. there is no one method of treatment which always proves successful, no matter how early it is begun or how small an area is involved. we must endeavor to remove the cause by giving attention to the general health of the animal and to its environment. feeding should be moderate in quantity and not too stimulating in character--green feed, bran mashes, ground oats, clean hay, plenty of salt. if the animal has been fed too high, give an active purgative--epsom salt preferred--once a week, if necessary, and half an ounce of acetate or nitrate of potassium may be given in the feed twice a day. if the animal is in poor condition and debilitated, give a tablespoonful of the following mixture in feed twice a day: powdered copperas, gentian, sulphur, and sassafras bark, equal parts by weight. if the animal is lousy, the parasite must be destroyed before the eczema can be cured. the external treatment must vary with the character of the lesions; no irritating application is to be made while the disease is in its acute vesicular, or pustular, stage, and, in the chronic stage, active stimulants must be used. much washing is harmful, yet crusts and scales must be removed in order to obtain satisfactory results from the external applications. both objects, however, can be attained by judiciously combining the curative agents with such substances as will at the same time cleanse the parts. in the vesicular stage, when the skin is feverish and the epidermis peeling off, thus exposing the exuding dermis, an application of boric-acid solution, drams of the acid to ounces of water, often relieves the smarting or itching, and also serves to check the exudation and dry the surface. if this fails to have the desired effect compound cresol, ounce to quarts of water, should be used as a wash. either of these washes may be used several times a day until incrustation is well established. then compound cresol, ounce to quarts of sweet oil, or the benzoated oxid of zinc ointment, giving the affected surfaces a thorough application once a day, will be efficacious. when the eczema is not the result of an external irritant, it takes usually from one to two weeks to heal. in chronic eczema, when there is a succession of scabs or scales, indolent sores or fissures, the white precipitate ointment, nitrate of mercury ointment, or blue ointment, mixed with equal parts of cosmoline or fresh lard, may be applied every second day, taking care to protect the parts so that the animal can not lick it off. the internal administration of arsenic often yields excellent results in chronic eczema. dissolve dram of arsenic and dram of carbonate of potassium in pint of boiling water, and give ounce of this twice a day in water, after feeding. an alkali internally may be of service. as such, one may give ounces of bicarbonate of soda twice daily. sublimed sulphur may also be tried in ounce doses twice daily. pustules (impetigo). impetigo is an inflammatory disease of the skin, characterized by the formation of distinct pustules, about the size of a pea or a bean, without itching. the pustules develop from the papular layer of the skin, and contain a yellowish-white pus. after reaching maturity they remain stationary for a few days, then they disappear by absorption and dry up into crusts, which later drop off, leaving upon the skin a red spot that soon disappears. occasionally the crusts remain firmly adherent for a long time, or they may be raised and loosened by the formation of matter underneath. the dry crusts usually have a brown or black appearance. _causes._--impetigo affects sucking calves, in which the disease appears upon the lips, nostrils, and face. it is attributed to some irritant substance contained in the mother's milk. impetigo is also witnessed among grazing animals, regardless of age, and it especially attacks animals with white hair and skin. the mouth, face, and limbs become covered with pustules, which may rupture in a few hours, followed by rapid and successive incrustations; the scabs frequently coalesce, covering a large surface; pus may form under them, and thus the whole thickness of the skin become involved in the morbid process. this form of the disease is attributed to the local irritant properties of such plants in the pasture as st. john's wort (_hypericum perforatum_), smartweed (_polygonum hydropiper_), vetches, honeydew, etc. buckwheat, at the time the seeds become ripe, is said to have caused it; also bedding with buckwheat straw. _treatment._--sucking calves should be removed from the mother, and a purgative given to the latter to divert the poisonous substance secreted with the milk. when the more formidable disease among grazing cattle appears, the pasturage should be changed and the affected parts of the animal thoroughly anointed once a day with sweet oil containing drams of carbolic acid to the pint. this should be continued until the crusts soften and begin to drop off, then the parts may be cleansed thoroughly with warm water and soap. subsequently the white precipitate ointment or carbolized cosmoline should be applied daily until the parts are healed. pemphigus (water blisters). this is an inflammatory disease of the skin, characterized by successive formations of rounded, irregularly shaped water blisters, varying in size from a pea to a hen's egg. _causes._--obscure. _symptoms._--the formation of a blister is preceded by a congestion or swelling of the skin. yellowish-colored water collects beneath the cuticle, which raises the latter from its bed in the form of a blister. the blisters appear in a succession of crops; as soon as one crop disappears another forms. they usually occur in clusters, each one being distinct, or they may coalesce. each crop usually runs its course in a week. the disease is attended with itching or burning sensations which cause the animal to rub, thereby frequently producing excoriations and formation of crust on the affected region. _treatment._--give a tablespoonful of the following-described mixture in feed twice a day: saltpeter, cream of tartar, and sulphur, equal parts by weight. the blisters should be opened as soon as formed, to allow the escape of the serum, followed by a wash composed of chlorid of zinc, dram to ounces of water. when there is any formation of crusts, carbolized cosmoline should be applied. furunculus (boils). this is an acute affection of the skin, usually involving its whole thickness, characterized by the formation of one or more abscesses, originating generally in a sebaceous gland, sweat gland, or hair follicle. they usually terminate by absorption, or by the formation of a central core, which sloughs out, leaving a deep, round cavity that soon heals. _causes._--impoverished state of blood, the result of kidney diseases or of local friction or contusions, with the entrance of pus cocci through the damaged skin or through a hair follicle or a sebaceous gland. _symptoms._--boils in cattle usually appear singly, not in clusters; they may attain the size of a hen's egg. the abscess begins as a small round nodule, painful on pressure, gradually increases in size until death of the central portion takes place, then the surface of the skin gives way to internal pressure and the core is released and expelled. constitutional symptoms are generally absent, unless the boils occur in considerable numbers, or by their size involve a great deal of tissue. _treatment._--poulticing to ripen the abscess. if this can not be done, apply camphorated oil two or three times a day until the core is formed. as soon as the central or most prominent part becomes soft, the abscess should be opened to release the core. then use carbolized cosmoline once a day until the healing is completed. if the animal is in poor condition, give tonics--copperas, gentian, ginger, and sulphur, equal parts by weight, tablespoonful twice a day. if the animal manifests a feverish condition of the system, give half an ounce of saltpeter twice a day, continuing it several days or a week. faulty secretions and abnormal growths of the skin. pityriasis (seborrhea, dandruff, or scurf). this is a condition characterized by an excessive secretion of sebaceous matter, forming upon the skin in small crusts or scales. _causes._--it is ascribable to a functional derangement of the sebaceous glands, usually accompanied with dryness and loss of pliancy of the skin. the animal is hidebound, as it is commonly termed, thin in flesh, inclined to rub, and very frequently lousy. the condition is observed most often toward the spring of the year. animals that are continually housed, and the skins of which receive no cleaning, generally present a coat filled with fine scales, composed of epithelium from the epidermis and dried sebaceous matter. this, however, is a physiological condition and compatible with perfect health. _symptoms._--pityriasis may affect the greater portion of the body, though usually only certain parts are affected--the ears, neck, rump, etc. the skin becomes scurfy, the hairy coat filled with branlike gray or whitish scales. _treatment._--nutritious feed, such as oil-cake meal, bran, ground oats, and clean hay. in the spring the disease generally disappears after the animal is turned out to pasture. when lice are present they should be destroyed. elephantiasis (scleroderma). this condition consists in a chronic thickening of the skin, which may affect one or more limbs or involve the whole integument. it is characterized by recurrent attacks of swelling of the skin and subcutaneous areolar tissue. after each attack the affected parts remain infiltrated to a larger extent than before, until finally the skin may attain a thickness of an inch, becoming wrinkled and fissured. in cattle this disease is confined to hot climates. the predisposing cause is unknown. edema (anasarca of the skin). this is a dropsical condition of the skin and subcutaneous areolar tissue, characterized by pitting under pressure, the fingers leaving a dent which remains a short time. _causes._--edema generally results from a weakened state of the system arising from previous disease. it may also be dependent upon a functional derangement of the kidneys, upon weak circulation, or obstruction to the flow of blood through the lungs. in debilitated animals and in some animals highly infested with parasites there is swelling of the dewlap or of the fold of the skin between the jaws. _symptoms._--painless swelling of a limb, udder, lower surface of abdomen, or lower jaw becomes apparent. this may increase in dimensions for several days or may attain its maximum in less than hours. unless complicated with some acute disease of a specific character, there is not much, if any, constitutional disturbance. the deep layer of the skin is infiltrated with serum, which gives it the characteristic condition of pitting under pressure. _treatment._--when the cause can be ascertained and removed we may expect to see the edema disappear. when no direct specific cause can be discovered and the animal is debilitated, give general tonic. if, on the contrary, it is in good flesh, give a purgative, followed by half an ounce of acetate of potassium twice a day. external applications are useless. edema may be distinguished from erysipelas or anthrax by the absence of pain and fever. dermoid and sebaceous cysts (wens). a dermoid cyst is formed by an involution of the skin with a growth of hair on the inner wall of the sac. it may become embedded deeply in the subcutaneous tissues or may just penetrate the thickness of the skin, where it is movable and painless. they are generally found within the ear or at its base, although they may form on any part of the body. usually they have a small opening, from which a thick, cheesy matter can be squeezed out. the rational treatment is to dissect them out. sebaceous cysts appear not unlike the former. they are formed by a dilatation of the hair follicle and sebaceous duct within the skin, and contain a gray or yellowish sebaceous mass. the tumor may attain the size of a cherry stone or a walnut. generally they are round, movable, and painless, soft or doughy in consistency, and covered with skin and hair. they develop slowly. the best treatment is to dissect out the sac with contents entire. verruca (warts). cattle are affected with two varieties of warts. one, the verruca vulgaris, is composed of a cluster of enlarged papillæ, covered with a thickened epidermis, the number of papillæ determining the breadth and their length its height. they are generally circular in figure, slightly roughened on the surface, and spring from the skin by a broad base. occasionally large numbers of very thin, long, pedunculated warts grow from the skin of the ear, lips, about the eyes, and vulva. another variety, the verruca acuminata, sometimes erroneously denominated epithelial cancers, are irregularly shaped elevations, tufted or club shaped, occasionally existing as thick, short, fleshy excrescences, giving the growth the appearance of granulation tissue. their color is red or purplish, and oftentimes by friction they become raw and bleeding, emitting then a very offensive odor. they usually grow in clusters and their development is rapid. _causes._--an abnormal nutrition of the skin, determined by increased energy of growth operating upon a healthy skin; at other times, upon a weak or impoverished skin. _treatment._--when they are small and pedunculated, they may be snipped off with shears and the stump touched with nitrate of silver. when they are broad and flattened, they may be dissected out and the wound cauterized if necessary. if they are large and very vascular, they may be ligated, one by one, by taking a strong cord and tying it as firmly around the base as possible. they will then shrivel, die, and drop off. if there is a tendency to grow again, apply a red-hot iron or nitric acid with a glass rod. very often warts quickly disappear if they are kept soft by daily applications of sweet or olive oil. kelis. kelis is an irregularly shaped flat tumor of the skin, resulting from hypertrophy--increased growth of the fibrous tissue of the corium, producing absorption of the papillary layer. _causes._--it may arise spontaneously or follow a scar after an injury. _symptoms._--kelis generally appears below the knee or hock, and may occur singly or in numbers. there are no constitutional symptoms. its growth is very slow and seldom causes any inconvenience. it appears as a flattened, irregular, or spreading growth within the substance of the skin, is hard to the touch, and is especially characterized by divergent branches or roots, resembling the claws of a crab; hence the name. occasionally some part of it may soften and result in an abscess. it may grow several inches in length and encircle the whole limb. _treatment._--so long as it causes the animal no inconvenience it is best not to meddle with it; when it does the animal ought to be fattened for beef, the meat being perfectly harmless to the consumer. parasitic diseases of the skin. ringworm (tinea tonsurans and tinea favosa). ringworm is an affection of the skin, caused by a vegetable parasite. the form known as tinea tonsurans is produced by the presence of a minute or microscopic fungus--the _trichophyton tonsurans_, which affects the hair and the epidermic layer of the skin, and is highly contagious, being readily transmitted from one animal to another. this fungus consists of spores and filaments. the spores, being the most numerous, are round and seldom vary much in size. they are very abundant in the hair follicle. the filaments are articulated, waving, and contain granules. this disease is productive of changes in the root and shaft of the hair, rendering it brittle and easily broken off. this disease becomes manifest by the formation of circular patches on the skin, which soon becomes denuded of hair. the cuticular layer of the skin in slightly inflamed, and vesication with exudation occurs, followed by the formation of scaly, brittle crusts. the patches appear silvery gray when incrusted, and are mostly confined to the head and neck. it is a common disease among young cattle in the winter and spring. very early in the development of the patches the hairs split, twist, and break off close to the skin. this disease is attended with more or less itching. it is communicable to man. tinea favosa comes from another fungus, the _achorion schönleinii._ this enters the hair follicle and involves the cuticle surrounding it, small crusts form which increase in diameter and thickness and then become elevated at their margin, forming a cup-shaped scab, the favus cup, which gives the disease its distinctive character. the number of these cups varies from a few to many hundreds. the hairs involved become brittle and broken, fall off with the crusts, leaving small bald patches. the crusts are of a pale or sulphur-yellow color at first; as they grow older they turn darker, or to a brown color. this form of ringworm has a peculiar odor, resembling that of mice or musty straw. it is occasionally communicated to cattle by man, mice, cats, etc., all being subject to it. _treatment._--remove all crusts by washing with soap and water, then apply acetic acid, sulphur ointment, tincture of iodin or nitrate of mercury ointment once a day. cleanse the stable and whitewash it to destroy the spores scattered by the crusts. other parasites and parasitic diseases of the skin. for discussion of mange, itch, scab, lousiness, warbles (grub in the skin), buffalo gnats, hornfly (_hoematobia serrata_), ticks, flies, etc., see the chapter on "the animal parasites of cattle," page . wounds of the skin. snake bites and venomous stings. [see discussion of these subjects in chapter on "poisons and poisoning."] burns and scalds. this is a rare accident among cattle, yet in cases of fire it may occur. the application of heat, whether dry or moist, unless sufficient instantly to destroy the life of a part, is always followed by the development of vesicles or blisters, which contain a thin, watery fluid. the blisters may be isolated and not very large, or one blister may cover a very large surface. when the burn is very severe the skin may be wholly devitalized, or the injury may extend into the deeper structures of the skin. then sloughs will occur, followed by a contraction of the parts in healing; if on a limb, this may render the animal stiff. when the burn or scald has been a severe one, the resulting pain is great and the constitutional disturbance very marked. _treatment._--for a superficial burn use a mixture of equal parts of limewater and linseed oil, or common white paint--white lead ground in oil--to exclude the atmosphere and protect the inflamed skin. if it is not convenient to get anything else, chimney soot, flour, or starch may be spread on the wound (dry), and covered with cotton batting and light bandage. the blisters should be opened to let the contained fluid escape, but do not pull off the thin cuticle which has been raised by the blister. when the burn is extensive and deep sloughing occurs, the parts should be treated, like other deep wounds, by poulticing, astringent washes, etc. when the system has sustained much shock, the animal may require internal stimulants, such as drams of carbonate of ammonia every hour until it rallies. when the pain is very great, hypodermic injections of grains of morphia may be administered every six hours. _frostbite_ on any portion of the body may be treated as recommended in the article on diseases of the ears. emphysema (air or gas under the skin). emphysema of the skin is not a true disease of the skin, but it is mentioned as a pathological condition. it is characterized by a distention of the skin with air or gas contained in the subcutaneous areolar tissue. it may depend upon a septic condition of the blood, as in anthrax or blackleg, or air may be forced under the skin about the head, neck, and shoulders, as a result of rupture of the windpipe. it occurs in the region of the chest and shoulders from penetrating wounds of the chest and lung, and occasionally follows puncture of the rumen when the escaping gas is retained under the skin. _symptoms._--the skin is enormously distended over a greater or less portion of the body; thus any region of the body may lose its natural contour and appear like a monstrosity. there is a peculiar crackling beneath the skin when the hand is passed over it, and on tapping it with the fingers a resonant, drumlike sound is elicited. _treatment._--puncture the distended skin with a clean, broad-bladed knife and press the air out. further treatment must be directed with a view to the removal of the cause. diseases of the foot. by m. r. trumbower, d. v. s. [revised by leonard pearson, b. s., v. m. d.] laminitis (founder). laminitis denotes an active inflammation of the sensitive structures within the wall of the hoof, which in severe cases may result in suppuration and the loss of one or more claws. owing to the simplicity of the structure of the foot of an ox compared with that of the horse, this disease is rarely seen in an acute form, but a mild form, commonly called "foot soreness," is not of infrequent occurrence. _causes._--laminitis in cattle may be caused by overfeeding, overheating, continued standing without exercise on a stone or cement floor without sufficient bedding, or by driving long distances over rough or stony soil. _symptoms._--an unwillingness to maintain the standing position; the animal persists in lying down. the feet will be found unnaturally hot, and frequently some swelling may be noticed above the hoof. pressure upon the hoof with blacksmith's hoof pincers causes pain and flinching. the general body temperature is increased and the breathing accelerated. ordinarily the animal eats and drinks as usual. when it is made to move excessive tenderness of the feet becomes manifest, as is shown by reluctance to walk and by the very short, hesitating step. founder affects the hind as well as the fore feet, although the front feet are more often exposed. _treatment._--cold packs to the feet, or if the animal can be made to stand in a stream of water, having a soft bottom, the inflammation is often relieved without the necessity of any additional treatment. it may be well, however, to give a full dose of epsom salt, to - / pounds, followed by half-ounce doses of saltpeter two or three times a day. soreness (foot soreness). cattle that have been stabled or pastured on soft ground and are driven over stony roads soon wear down the soles of their feet and become lame from foot soreness. draft oxen, for this reason, require to be shod. when the soreness is excessive it may develop into an active inflammation of all the sensitive structures of the foot--laminitis, or into a local bruise commonly called a "corn." _treatment._--rest, poulticing the feet with moistened clay, followed by astringent washes--strong white-oak bark or alum water. if the pain and heat last several days, it is probable that pus has formed beneath the wall of the hoof. in this case it is necessary to cut through the wall, usually at the most prominent part of the sole, to allow the accumulation to drain out. the animal should then stand for several hours daily in a tub containing a per cent solution of some good milky coal-tar disinfectant. when not in the disinfecting solution the foot should be dressed with pine tar and cotton and bandaged with bagging. loss of hoof. cattle sometimes become fastened between planks or otherwise and pull off the wall of one or both claws in the effort to extricate themselves. the claws of one or more feet may be shed as the result of acute laminitis. _treatment._--wash the bleeding surface with an antiseptic and then with an astringent, such as a weak solution of alum, then apply a thick coating of pine tar; cover this with a layer of oakum or absorbent cotton; apply another coat of tar over this, and then bandage closely and firmly. this may remain without disturbance until the new growing wall becomes sufficiently strong to sustain the pressure and weight of the animal. if, however, at any time oozing or bad smell indicates that pus is forming under this dressing, the bandage should be removed and the suppurating surface freshly cleaned and dressed. this may have to be repeated every few days and should be continued so long as there is any pus formation. if the loss of hoof is owing to suppurative laminitis, the parts denuded of the horny covering must be thoroughly cleansed and disinfected with carbolic acid, lysol, or other antiseptic. then apply a moderately thick layer of absorbent cotton and over this apply the tar and bandage. after this the antiseptic solution may be poured in daily at the top of the dressing. it will thus soak in and saturate the dressing and inflamed tissue. it may become necessary to remove all the dressing at daily or longer intervals to give the parts a fresh cleaning, and then to reapply it. foul in foot (foot rot). a variety of causes may produce inflammation of the foot between the claws or toes. it may be on account of overgrowth of the claws and inward pressure, as in ingrowing nail of man, or it may be caused by the irritation of stable filth by impaction and hardening of soil between the claws, or by other foreign substances becoming wedged in, causing inflammation and softening or ulceration of the skin in the interdigital space. under some conditions several cattle in the same herd become affected, which has led some to think that the disease may be contagious. occurrences have been reported in which foot rot of cattle has appeared within a short time among a large proportion of the cattle in a farming district. this disease is most frequently seen in the hind feet, though all four feet may become affected. _symptoms._--the animal is observed to limp. on examination of the foot we discover heat and swelling above the hoof and of the soft parts between the claws which frequently spreads the claws apart to a considerable extent, or the inflammation may have advanced to softening and sloughing of the interdigital membrane. if the disease is neglected at this stage, deep abscesses may form and the pus burrow under the horny wall, or the joint within the hoof may become inflamed and the articular attachments destroyed, in which case the treatment will be difficult and recovery will be very tedious. _treatment._--in the earlier stages of the disease, before pus burrows beneath the horn, a thorough cleansing and an application of a carbolic-acid solution-- ounce to a pint of water--clean stabling, and laxative food will usually remedy the evil. compound solution of cresol is an excellent remedy at this stage. it should be applied, in its pure or undiluted state, to the suppurating and putrefying tissue between the claws. it is best applied by means of a cotton swab on a thin stick. care must be taken to keep it from contact with the skin about the coronary band or heels. if deep sloughing has taken place the carbolic solution should be used, and a wad of oakum or cotton smeared with pine tar should be secured firmly in the cleft. this can be done by taking a strip of strong cloth, inches wide, passing the middle between the claws, then tying the ends after winding them in opposite directions above the hoof. sometimes warm poulticing with flaxseed meal or bran is necessary to relieve excessive fever and pain. if the pus burrows under the horn, its channel must be followed by paring away the horn until the bottom is reached. the aftertreatment is the same as that already recommended. if the joint becomes diseased an amputation of that toe is the quickest and surest method to relieve the suffering of the animal, and offers the best chance for an early recovery. ulceration of the heel. occasionally we find ulcers at the junction of the hair with the hoof at the heel, which present an elevated, raw, or ragged surface, and cause considerable lameness. this is generally caused by a bruise of the fibrous cushion of the back part of the foot. subsequent sloughing or necrosis may occur, or pus may form deep within the wall and gain an exit at the margin of the heel. sometimes, from no visible cause, large pieces of skin slough from the heel and pastern. this condition is caused by an infection with certain microorganisms (streptococci, necrosis bacilli) and may be contagious. _treatment._--if there is a deep opening, inject carbolic solution once a day until it closes. if the ulcer is only superficial, wash with carbolic solution and apply a mixture of equal parts of blue vitriol and alum in dry powder. fissure of the wall (split hoof). this is rarely seen among cattle. it may occur in weak walls, in heavily bodied cattle, caused by stepping on an uneven surface, especially when the point of the toe is grown out long. one may find the point of the toe broken and the wall split almost up to the hair. _treatment._--the divided sections may be brought into approximation and held in place by drilling a small hole from one side into and through the other, commencing half an inch back of the fissure on each side; then drive a light horseshoe nail through the hole and clinch it. pare the injured claw as short as it will bear. interdigital fibroma. hard, nodular, fibrous tumors sometimes grow in the cleft of the foot, and cause inconvenience, lameness, absorption, or ulceration of the contiguous parts. _treatment._--they should be dissected out and the wound dressed with carbolic-acid lotion and pine tar once a day until healing is completed. deformities. deformities in the feet of cattle usually consist in overgrowth of horn, generally from want of wear in animals which are stabled. the hoof may turn inward, outward, or upward, and may give rise to lameness, inability to walk, foul foot, etc. bulls which are continually stabled and dairy cows very frequently have misshapen feet from want of an occasional trimming, and this deformity may eventually lead to permanent injury. _treatment._--cut the superabundant growth of horn down with saw, knife, or rasp, until the foot assumes its natural form. pricks and wounds. if an animal suffers with a penetrating wound from prick of fork or nail, the orifice of the wound should be enlarged to permit a free discharge of pus; then the foot should be soaked in a cresol compound solution ( per cent) in a tub, or a flaxseed poultice applied, changing it three times a day until the fever has abated. the foot should be kept bandaged and dressed with pine tar and oakum; the animal must also be kept on a clean floor until the wound is closed and all or nearly all lameness has disappeared. if an animal is cut in the foot with barbed wire, piece of glass, or any other substance, the wound, after proper cleansing, should be dressed with carbolic-acid solution, ounce of the acid to of water. if any uneven edges of horn, skin, or lacerated flesh project, trim them off, and in all cases when it can be done a tarred bandage should be applied. this will serve to sustain the cut surfaces in their place, exclude dirt, and protect against flies, maggots, etc. when the wound has extended into a joint, surgical treatment, which will require the services of an educated veterinarian, may be necessary. occasionally an animal gets caught by the foot in a crevice and sustains severe bruising, wrenching, or fracture of some part of the foot. in such cases cold-water packs to the injured member are of service until the fever and swelling disappear. afterwards the animal should rest until the usefulness of the foot is restored. sometimes such an accident, causing fracture, renders necessary plaster bandages or amputation. diseases of the eye and its appendages. by m. r. trumbower, d. v. s. [revised by leonard pearson, b. s., v. m. d.] description. for the sake of gaining a clear comprehension of the diseases of the eye it becomes necessary to review the anatomy of this important organ. the essential organ of vision, or globe of the eye, will be first described, then its receptacle or orbital cavity, the muscles that move it, the protective membranes, or eyelids, the membrana nictitans, or accessory eyelids, and, lastly, the lacrimal apparatus. the globe or ball of the eye is almost spherical in form. on closer inspection, however, it appears to be made up of two combined portions from spheres of different sizes. the posterior portion, forming about five-sixths of the ball, is a sphere of comparatively large size with a small segment cut off it in front, and at this point there is applied to it the anterior portion, which, being a segment of a smaller sphere, projects at the front of the ball with a greater convexity than the posterior portion. the eyeball consists of concentrically arranged coats and of refracting media inclosed in them. the coats are three in number, namely, ( ) an external protective tunic made up of the sclerotic and cornea; ( ) a middle vascular and pigmentary tunic, the choroid; ( ) an internal nervous layer, the retina. the sclerotic is the white, opaque part of the outer tunic, of which it forms about the posterior five-sixths, being coextensive with the larger sphere already mentioned. the cornea forms the remaining one-sixth of the outer tunic, being coextensive with the segment of the smaller sphere. it is distinguished from the sclerotic by being colorless and transparent. the choroid coat will be recognized as the black layer lying subjacent to the sclerotic. it does not line the cornea, but terminates behind the line of junction of that coat with the sclerotic by a thickened edge--the ciliary processes. at the line of junction of the sclerotic and cornea the iris passes across the interior of the eye. this (which may be viewed as a dependency of the choroid) is a muscular curtain perforated by an aperture termed the pupil. the retina will be recognized as a delicate, glassy layer, lining the greater part of the choroid. the refracting media of the eye are three in number, namely ( ) the aqueous humor, a watery fluid inclosed in a chamber behind the cornea; ( ) the crystalline lens and its capsule, a transparent, soft solid of a biconvex form, and placed behind the iris; ( ) the vitreous humor, a transparent material with a consistence like thin jelly, and occupying as much of the interior of the eye as is subjacent to the choroid. the sclerotic is a strong, opaque, fibrous membrane, which, in a great measure, maintains the form of the eyeball and protects the more delicate structures within it. its interior portion, which is covered by the ocular conjunctiva, is commonly known as the "white of the eye." in form it is bell-shaped, and the optic nerve pierces it behind like a handle, the perforation being a little to its inner side. in front, the rim of the bell becomes continuous with the cornea. the outer surface of the membrane receives the insertion of the muscles of the eyeball. the coat is thickest over the posterior part of the eyeball, and is thinnest a little behind its junction with the cornea. the cornea is the anterior transparent portion of the outer coat of the eyeball. it may be viewed as a part of the sclerotic specially modified to permit the passage of light into the interior of the eye. its outline is elliptical, nearly circular, and its greatest diameter is transverse. at its periphery it joins the sclerotic by continuity of tissue, and as the edge of the cornea is slightly beveled and has the fibrous sclerotic carried for a little distance forward on its outward surface, the cornea is generally said to be fitted into the sclerotic like a watch glass into its rim. the venous canal of schlemm runs circularly around the eyeball at the line of junction of the sclerotic and cornea. the anterior surface of the cornea is exquisitely smooth, and is kept moist by the lacrimal secretions. its posterior surface forms the anterior boundary of the chamber in which the aqueous humor is contained. the cornea is of uniform thickness and is of a dense, almost horny, consistence. save a few capillary loops of blood vessels at its margin the cornea is without vessels. its structure is comprised of five distinct layers. the aqueous humor occupies a chamber which is bounded in front by the posterior surface of the cornea and behind by the capsule and suspensory ligament of the lens and by the ends of the ciliary processes. it is across this chamber that the iris extends. the aqueous humor is composed of water, with a small proportion of common salt in solution. the iris is a muscular, pigmented curtain extending across the interior of the eye and having about its center an aperture termed the pupil. by variations in the size of this aperture the amount of light transmitted to the retina is regulated. it varies somewhat in color, but is most frequently of a yellowish-brown tint. its anterior face is bathed by the aqueous humor. the greater part of the posterior surface is in contact with the capsule of the lens and glides on it during the movements of the curtain. the circumferential border is attached within the junction of the sclerotic cornea. the inner border circumscribes the pupil, which varies in outline according to its size. when much contracted the pupil is a very elongated ellipse, the long axis of which is in the line joining the nasal and temporal angles of the eyelids. it contains muscular tissue, which, by contracting or relaxing, lessens or dilates the pupillary opening. the choroid coat is a bell-shaped, dark membrane which lines the sclerotic. its outer surface has a shaggy appearance, caused by the tunica fusca, which unites the two coats. between the two the ciliary vessels and nerves pass forward. behind it is pierced by the optic nerve; in front it is continued as the ciliary processes, which form, as it were, the rim of the bell. the ciliary processes form a fringe around the slightly inverted rim of the choroid. the retina is the most delicate of the coats of the eyeball. it is formed by the expansion of the optic nerve on the inner surface of the choroid, and, like that coat, it is bell-shaped. its inner surface is molded on the vitreous humor. the nervous structures of the retina terminate at a wavy line, the ora serrata, behind the ciliary processes. ten distinct layers are described as composing the thickness of the retina. the lens is situated behind the pupil and is contained within a capsule of its own. the capsule is a close-fitting, firm, transparent membrane. the anterior surface forms the posterior boundary of the cavity containing the aqueous humor, and the iris in its movement glides on it. the posterior surface is in contact with the vitreous humor. the vitreous humor occupies four-fifths of the interior of the eyeball. it is globular in form, with a depression in front for the lodgment of the lens. it is colorless, transparent, and of a consistency like thin jelly. it is enveloped by a delicate capsule--the hyaloid membrane--which is connected in front with the suspensory ligament of the lens, and ends by joining the capsule behind the lens. the orbital cavity, at the side of the head, is circumscribed by a bony margin; posteriorly, however, there are no bony walls, and the cavity is often confounded with the depression above and behind the orbit--the temporal fossa. a fibrous membrane completes this cavity and keeps it distinct from the temporal fossa. this membrane--the ocular sheath or periorbita--is attached posteriorly around the opening in the back part of the orbital cavity (the orbital hiatus) and anteriorly to its inner face; then it becomes prolonged beyond the margin to form the fibrous membrane of the eyelids. when complete the orbital cavity has the form of a regular hollow cone, open at its base and closed at the apex. the opening of this cone is directed forward, downward, and outward. independently of the globe of the eye, this cavity lodges the muscles that move it, the membrana nictitans, and the lacrimal gland. the muscles of the eye are seven in number--one retractor, four straight, and two oblique. the retractor oculi envelops the optic nerve between the brain and the ball of the eye and becomes attached upon the external face of the sclerotic tunic. when this muscle contracts, it draws the globe back into the orbit, away from the light. the superior, inferior, external, and internal recti or straight muscles are attached to the back part of the orbital sheath and spread forward in four bundles over the globe of the eye, where they are inserted by a fibrous expansion into the sclerotic at the margin of the cornea. when they act singly, they turn the globe either upward, downward, inward, or outward. the great oblique, by its action, pivots the eye inward and upward in the orbit. the small oblique turns the eye outward and downward. the eyelids are two movable curtains, superior and inferior, which cover and protect the eye in front. they are attached to the circumference of the orbit and have a convex external face formed by the skin and a concave internal face molded on the anterior surface of the eye and are lined by the conjunctiva, which is reflected above and below on the eyeball. the border of each lid is slightly beveled on the inner side and shows the openings of the meibomian glands. these glands secrete an unctuous fluid, which is thrown out on the border of the lids, the function of which is to facilitate their movements and enable them to retain the tears in the ocular cavity. the eyelid is composed of a fibrous inner membrane ending in a stiff arch near the border, a muscle to close the lid, another to open it, the skin externally, and the conjunctival mucous membrane internally. the border of each lid is covered and protected by long hairs to prevent floating particles of matter in the atmosphere from gaining entrance to the eye. the membrana nictitans, which is also named the third eyelid, winking eyelid, haw, etc., is placed at the inner angle of the eye, whence it extends over the eyeball to relieve it from foreign bodies which may fall upon it. it has for its framework a fibro-cartilage, irregular in shape, thick, nearly prismatic at its base, and thin anteriorly where it is covered by the conjunctiva; behind, it is loosely attached to a fatty cushion. the lacrimal gland is situated between the orbital process and the upper part of the eyeball. it secretes the tears destined to lubricate the anterior surface of the eye. this fluid escapes upon the organ at the outer angle of the lids and is carried between them and the eyeball toward the inner angle. the caruncula lacrimalis is a small round body, frequently entirely or partially black, situated in the inner angle of the eye, and is designed to direct the tears toward the puncta lacrimalia. the puncta lacrimalia are two little openings, situated one in each eyelid, a short distance from the inner corner, which admit the tears into the lacrimal ducts leading to the lacrimal canal, whence they are emptied into the nasal passages. conjunctivitis (simple ophthalmia). this is an inflammation of the conjunctival mucous membrane of the eyeball and lids; in severe cases the deeper coats of the eye are involved, seriously complicating the attack. _causes._--it may result from a bruise of the eyelid; from the introduction of foreign matters into the eye, as chaff, hayseed, dust, gnats, etc.; from exposure to cold; poisonous or irritating vapors arising from filthiness of stable. dust, cinders, or sand blown into the eyes during transportation frequently cause conjunctivitis. _symptoms._--a profuse flow of tears, closure of the eyelids from intolerance of light, retraction of the eyeball and corresponding protrusion of the haw, disinclination to move, diminution of milk secretion, etc. on parting the lids the lining membrane is found injected with an excess of blood, giving it a red and swollen appearance; the sclerotic, or white of the eye, is bloodshot and the cornea may be cloudy. if the disease advances, keratitis results, with its train of unfavorable symptoms. _treatment._--careful examination should be made to discover particles of chaff, etc., which may have lodged in the eye, and upon the discovery of such a cause prompt removal is indicated. this may be accomplished by flushing the eye with warm water by means of a syringe, or, if the foreign substance is adherent to the eyeball or lid, it may be scooped out with the handle of a teaspoon or some other blunt instrument. to relieve the congestion and local irritation, a wash composed of boracic acid in freshly boiled water, grains to the ounce, or acetate of zinc, grains to the ounce of pure soft water, may be used, to which may be added drops of laudanum. a few drops of this should be placed in the eye with a camel's-hair pencil or soft feather three or four times daily. the animal should be placed in a cool, darkened stable; then a cloth folded into several thicknesses should be fastened to the horns in such manner as to reach below the eyes. this should be kept wet with cold water during the day and removed at night. if there is much fever and constitutional disturbance, it becomes advisable to administer pound of epsom salt dissolved in quart of water. infectious catarrhal conjunctivitis (specific ophthalmia). this generally appears in an enzootic or epizootic form and affects a considerable number in the herd. it is distinctly a contagious disease and may be brought into a previously healthy herd by one infected animal. it may continue in a herd for a season or for several years, affecting all newly purchased animals. it is seldom seen in the winter months. it affects old and young animals alike. _symptoms._--this form of catarrh conjunctivitis is characterized chiefly by a mucopurulent discharge from the eyes, an intense degree of inflammation of the mucous membrane, accompanied with swelling of the eyelids and an early opacity of the cornea. the flow of tears is mixed with pus, sometimes streaked with blood, and the skin of the face is kept moist and soiled. the eyes are kept continually closed. the implication of the cornea in the disease frequently blinds the animal for a time, and occasionally suppurative keratitis, ulcers of the cornea, or staphyloma supervene. the attack is marked from the onset by fever, partial loss of appetite, partial loss of milk, suspended rumination, and separation from the herd. _treatment._--the animal should be housed in a cool, dark stable, supplied with plenty of fresh water to drink and soft, succulent feed. administer pound of epsom salt--if a very large animal, use - / pounds--dissolved in or pints of water. for an eyewash, take boracic acid, dram, and pour ounces of boiling water over it. use this as often as is convenient, applying it directly to the eye. in the majority of cases improvement becomes manifest in a few days, and the eye becomes clear and free from inflammation in days or weeks. where the disease develops ulceration of the cornea, or well-marked, deep-seated keratitis, the treatment recommended for those conditions should be adopted. _prevention._--whenever this affection appears in a herd all the unaffected animals should be moved to fields which possess a different character of soil and feed. the water should also be changed, especially if they have been obtaining it from a stagnant pond. keratitis (corneitis). this is an inflammation of the cornea proper, although the sclerotic at the corneal border becomes involved to some extent. it may be divided into diffuse and suppurative. _causes._--the cornea constitutes the most prominent portion of the eyeball, hence it is subject to a variety of injuries--scratches, pricks, contusions, lacerations, etc. inflammation of the cornea may also be due to the extension of catarrhal conjunctivitis or intraocular disease, and it may occasionally occur without any perceptible cause. _symptoms._--diffuse keratitis is characterized by an exudation into and an opacity of the cornea. the swelling of the anterior part of the eyeball may be of an irregular form, in points resembling small bladders, or it may commence at the periphery of the cornea by an abrupt thickening, which gradually diminishes as it approaches the center. if the whole cornea is affected, it has a uniform gray or grayish-white appearance. the flow of tears is not so marked as in conjunctivitis, nor is the suffering so acute, though both conditions often exist together. both eyes usually become affected, unless it is caused by an external injury. in favorable cases the exudate within the cornea begins to disappear within a week or days, the eye becomes clearer and regains its transparency, until it eventually is fully restored. in unfavorable cases blood vessels form and are seen to traverse the affected part from periphery to center, vision becomes entirely lost, and permanent opacity (albugo or leucoma) remains. when it arises from constitutional causes recurrence is frequent, leaving the corneal membrane more cloudy after each attack, until the sight is permanently lost. suppurative keratitis may be a sequel of diffuse keratitis; more commonly, however, it abruptly becomes manifest by a raised swelling on or near the center of the cornea that very soon assumes a yellow, turbid color, while the periphery of the swelling fades into an opaque ring. suppurative keratitis is seldom noticed for the first day or two--not until distinct pus formation has occurred. when it is the result of diffuse keratitis, ulceration and the escape of the contained pus is inevitable; otherwise the pus may be absorbed. when the deeper membranes covering the anterior chamber of the eye become involved, the contents of this chamber may be evacuated and the sight permanently lost. _treatment._--place the animal in a darkened stable, give green or sloppy feed, and administer ounces of glauber's salt (sulphate of soda) dissolved in a quart of water once a day. if the animal is debilitated a tablespoonful of tonic powder should be mixed with the feed three times a day. this may be composed of equal parts by weight of powdered copperas (sulphate of iron), gentian, and ginger. as an application for the eye, nitrate of silver, grains to the ounce of soft water, with the addition of grain sulphate of morphia, may be used several times a day. if ulceration occurs, it is well to dust powdered calomel into the eye twice daily, or apply to the eyelids a salve of yellow oxid of mercury, per cent in lanolin. some of this may go on to the cornea and beneath the lids. apply twice daily. (see "ulcers of the cornea.") to remove opacity, after the inflammation has subsided, apply a few drops of the following solution twice a day: iodid of potassium, grains; tincture sanguinaria, drops; distilled water, ounces; mix. sometimes keratitis exists in a herd as a transmissible disease, spreading like infectious conjunctivitis. calomel, applied to the eye, is especially useful in such cases. ulcers of the cornea. an ulcer comes from erosion or is the consequence of the bursting of a small abscess, which may have formed beneath the delicate layer of the conjunctiva, continued over the cornea; or, in the very substance of the cornea itself, after violent keratitis, or catarrhal conjunctivitis. at other times it is produced by bruises, scratches, or other direct injury of the cornea. _symptoms._--the ulcer is generally at first of a pale gray color, with its edges high and irregular, discharges instead of pus an acrid, watery substance, and has a tendency to spread widely and deeply. if it spreads superficially upon the cornea, the transparency of this membrane is lost; if it proceeds deeply and penetrates the anterior chamber of the aqueous humor, this fluid escapes, the iris may prolapse, and the lens and the vitreous humor become expelled, thus producing destruction of the whole organ. _treatment._--it is of the greatest importance, as soon as an ulcer appears upon the cornea, to prevent its growing larger. the corroding process must be converted into a healthy one. for this purpose nothing is more reliable than the use of solid nitrate of silver. a stick of this medicine should be scraped to a point; the animal's head should be firmly secured; an assistant should part the lids; if necessary, the haw must be secured within the corner of the eye and then all parts of the ulcer should be lightly touched with the silver. after waiting a few minutes the eye should be thoroughly washed out with a very weak solution of common salt. this operation generally has to be repeated at the end of three or four days. if healthy action succeeds, the ulcer assumes a delicate fleshy tint, and the former redness around the ulcer disappears in proportion as the ulcer heals. in superficial abrasions of the cornea, where there is no distinct excavation, this caustic treatment is not needed. the eye should be bathed several times a day with sulphate of zinc, grains to half a pint of soft water, and protected against exposure to cold air and sunlight. excessive ulceration sometimes assumes the form of fungous excrescence upon the cornea, appearing to derive its nourishment from loops of blood vessels of the conjunctiva. under these circumstances the fungoid mass must be cut away and the wound cauterized with the nitrate of silver, or else the eye will soon be destroyed. when ulcers of the cornea appear indolent, with a tendency to slough, in addition to the treatment already prescribed, tonic powders of copperas, gentian, and ginger, equal parts by weight, should be given twice a day, mixed with the feed; dose, one tablespoonful. staphyloma. this is a disease of the eyeball, in which the cornea loses its transparency, rises above the level of the eye, and even projects beyond the eyelids in the form of an elongated, whitish, or pearl-colored tumor, which is sometimes smooth, at other times uneven. _causes._--inflammation is the only known cause, although it may not occur immediately; it frequently follows catarrhal conjunctivitis and keratitis as a sequela. _treatment._--in a few cases restoration of sight may be effected by puncturing the projecting tumor and treating it afterwards with nitrate of silver in the same manner as prescribed for ulceration of the cornea. in some cases spontaneous rupture has occurred, and healing without any treatment at all. cataract. in cataract the crystalline lens becomes opaque and loses its transparency, the power of refraction is lost--the animal can not see. _causes._--cataract generally arises from a diminution (atrophy) or other change in the nutrition of the lens; it may occur as a result of inflammation of the deep structures of the eye. cataract may be simple, or complicated with amaurosis, adhesions, etc. _symptoms._--it is known by the whiteness or loss of transparency of the lens, although the pupil dilates and contracts. sight may be totally lost; however, evidence is usually manifested that the animal distinguishes light when brought out of a darkened stable. for the most part the formation of cataract takes place slowly, the cases in which it originates very quickly being but few. _treatment._--there is only one method for the treatment of cataract--a surgical operation for the removal of the lens; but this is not advisable, for the sight can not be perfectly restored, and objects would be seen imperfectly without the aid of glasses. amaurosis. this is a paralysis of the nerve of sight or the expansion of the retina. _causes._--this is the result of concussion from a blow upon the forehead, fracture of bone over the eye (causing downward pressure), rheumatic inflammation of the optic nerve, or from extension of deep inflammation of the eye involving the retina. it sometimes occurs as the result of excessive loss of blood or of great debility. _symptoms._--in this disease observation is seldom made until the animal in its gait and by its action indicates blindness. generally both eyes are affected. the eyeball remains clear, and the pupil is permanently dilated. no response to light is manifested. _treatment._--if caused by debility, loss of blood, or associated with rheumatism, general blood tonics may be given in the feed, namely, powdered sulphate of iron, dram; gentian, drams; nux vomica, one-half dram; to be given twice a day. in cases of rheumatism, one-half ounce of saltpeter may be added. filaria oculi (worm in the eye). _filaria oculi_ (provisionally taken as the larva of _f. cervina_) is a small white worm, found swimming in the aqueous fluid in the anterior chamber. it may be apparently harmless for a long time, but will eventually induce keratitis with inflammatory exudations. _treatment._--the cornea may be punctured at its upper and outer margin, and the worm squeezed out with the aqueous humor. the latter will be formed again. this operation results disastrously unless the greatest care and skill are employed. corneal dermatoma (hairy tumor on the eyeball). in a few instances this has been seen as a congenital growth. the tumor arises from the cornea or the sclerotic, covered by its respective membrane, with a growth of hair upon its surface. these tumors may be quite prominent or flattened, and are dark in color; the hair may protrude between the eyelids, giving the animal the appearance of having a double eyelid. _treatment._--a surgical operation becomes necessary for their removal-- one requiring a skilled operator. strabismus (squinting). this is a very rare affection among cattle. strabismus may be either single or double--affecting one eye or both. it is caused by a paralysis, or a weakening of one of the straight muscles of the eyeball. generally it is a congenital defect, and the squinting is toward the nose--strabismus convergens. it is best not to attempt to remedy the defect, as the risk in an operation is greater than the chances of success warrant. pterygium. this term is applied to a flesh-colored membrane, triangular in form, which most frequently grows from the inner angle of the eye and extends over the cornea, thus interfering with vision. it may grow from the outer angle, or even from either the superior or inferior hemisphere of the eyeball. the figure is invariably that of a triangle, with its base on the white of the eye and its apex more or less advanced over the cornea toward its center. the distinguishing characteristics are the constancy of the triangular form, and the facility with which the whole of it may be taken hold of with a pair of forceps and raised into a fold on the cornea. every other kind of excrescence attached to this membrane continues firmly adherent to it, and can not be folded and raised from the surface of the cornea in any manner whatever. _treatment._--raise the fold and dissect it away from all points of attachment. trichiasis (inversion of the eyelashes). in the simplest form the eyelashes bend inwardly, touching the eyeball, causing irritation and simple conjunctivitis. it may be also associated with entropion. _treatment._--the offending eyelashes should be cut off or pulled out. in case the natural growth of the eyelashes is directed inward, an operation similar to that for entropion becomes necessary. entropion (inversion of the eyelid). in inversion of the eyelid the eyelashes soon irritate the anterior face of the cornea and produce more or less inflammation and opacity. the inversion may be due to the growth of a tumor within or without the lid, to abscess, laceration, or injury, causing the lid to lose its natural conformity to the eyeball, ulcerations, etc. surgical interference in either case becomes necessary to restore the lid to its natural direction. ectropion (eversion of the eyelid). this serves to injure the eye by permitting dust or other foreign substances to enter the eye and interferes with the natural removal of them. _treatment._--a delicate surgical operation--the removal of an elliptic section of the palpæbral conjunctiva--may remedy the defect. tumors of the eyelids. occasionally tumors form upon or within the substance of the eyelid. they may be of a fibroid nature and arise from the follicles of the hair as sebaceous tumors or may be in the form of an abscess. in debilitating diseases the lids sometimes become swollen and puffy, a condition which may possibly be taken for the growth of a tumor. this generally disappears with the improvement of the health of the animal. warts not uncommonly appear on or about the eyelids of cattle. _treatment._--the removal of a tumor in the vicinity of so delicate an organ as the eye should not be attempted by anyone not qualified to perform the operation. laceration of the eyelid. this accident is not uncommon where cattle are fenced in by barbed wire; an animal may be caught under the eyelid by the horn of another, or the laceration may occur in the stable by means of a projecting nail or splinter of wood. _treatment._--the edges of the wound should be brought together closely and correctly, by means of pins pushed through very nearly the whole thickness of the lid, extending through each lip of the torn part; then a waxed silk or linen thread must be wound over each end of the pin, crossing the torn line in the form of the figure (pl. xxvii, fig. ); the pins should be placed about three-eighths of an inch apart. the projecting ends of the pins should be cut off close to the ligature, and the parts kept anointed with vaseline, to which per cent of compound cresol has been added. in place of a pin suture, silver wire, catgut, or strong linen thread may be used in the way of an ordinary suture. foreign bodies in the eye. splinters of wood, hedge thorns, pieces of cornstalk or leaves, stems of hay or straw, twigs of trees, or weeds may penetrate into the eye, break off, and remain, causing inflammation, blindness, abscess, etc. these substances may penetrate the eyeball, but more frequently they glide off and enter between the eye and the ocular sheath. _treatment._--their removal becomes often a very difficult task, from the fact that the organ is so extremely sensitive, and the retracting power so strong as to necessitate casting the animal, or even the administration of sufficient chloroform to render it completely insensible. the removal, however, is of paramount importance, and the after treatment depends upon the extent and location of the injury--cold water compress over the injured eye, the application of mild astringent and cooling washes, such as acetate or sulphate of zinc, grains to the ounce of water. when there is extreme suffering from pain a solution of atropia or morphia, grains to the ounce of water, may be dropped into the eye, alternating with the cooling wash several times a day. when abscesses form within the orbit a free opening must be maintained for the discharge of pus. in deep penetrating wounds of the eye there is a great tendency to the formation of a fungous growth, which often necessitates the enucleation of the whole eyeball. orbital and periorbital abscess. orbital abscess may form outside the globe and within the orbital sheath, as the result of a previous wound of the parts or from fracture of the bony orbit, etc. periorbital abscess commences outside the ocular sheath, beneath the periosteal membrane covering the bone, and is usually the result of a disease or fractured bone which enters into the formation of the orbital cavity. _symptoms._--orbital abscess is manifested by a pushing forward of the eyeball (exophthalmos), a swelling of the conjunctiva and eyelids. the bulging out of the eye is in proportion to the size of the abscess; the movement of the eye is fixed, due to the painfulness of any voluntary movement of the eyeball. periorbital abscess generally pushes the eye to one side; otherwise the symptoms are similar to the foregoing. the pain generally is very great; paralysis of the nerve of sight may occur, and death may be caused by the abscess extending to the brain. _treatment._--the treatment for either orbital or periorbital abscess is the same as that for abscess occurring in any other part of the body--a free opening for the escape of imprisoned pus. this should be made as soon as the true nature of the disease is recognized. afterwards antiseptic injections may be needed to stimulate healthy granulation and to prevent septic infection of the ocular membranes. for this purpose a saturated solution of boric acid or listerine part to of water may be used. when the fever runs high, glauber's salt (sulphate of soda) may be given in -ounce doses once a day. the animal should be kept in a darkened stable, on soft or green feed. fracture of the orbit. this accident occasionally occurs among belligerent animals, or as the result of blows delivered by brutal attendants. the orbital process above the eye may be entirely crushed in, pressing down upon the eyeball. in such an event the depressed bone should be elevated into its proper place, and if it fails to unite it may have to be removed with saw or chisel. the margin of the orbit may be crushed at any point and cause periorbital abscess, or necrosis may result from the presence of a splinter of bone or the excessive destruction of bone. in all cases of fracture the animal should be kept by itself until the injured part heals. necrosis of the bony orbit. as the result of fracture of the margin of the orbit a part of the injured bone may become necrosed (dead), and periostitis and periorbital abscess will follow as a consequence. the discovery of this disease will at first resemble abscess, but on making an examination with a probe after the abscess is open we find the bone rough and brittle at the point of disease. the discharge has a peculiar fetid odor, and is often mixed with blood. _treatment._--the affected bone must be laid bare and all diseased portions removed by scraping or, if necessary, with saw or chisel, disregarding the extent of the injury or the size of the wound necessary to be inflicted. a large portion of the bony orbit may be removed without serious danger to the eye, provided the eyeball itself has not been previously affected by the disease or involved in the original injury. tumors of the orbit. a fungous tumor of the eyeball or orbit occasionally appears, which is designated fungus hæmatodes. this may arise without any appreciable cause, or as the result of a wound. it frequently commences within the eyeball as a small, red mass, eventually bursts through, and pushes its way outside the orbit as a large, dark-red mass, bleeding at the slightest touch. it has a peculiar, fetid odor, and early in its appearance destroys sight, involving all the contents of the orbit, not infrequently the bony wall itself. unless the tumor is totally removed in its early stage of growth, together with the eyeball, the disease will eventually cause emaciation and death of the animal. the enucleation of the eyeball should not be undertaken by anyone unacquainted with the anatomical structures involved in such an operation. when the operation is performed early enough the result is generally satisfactory. bony tumors of the orbit, the result of bruises, fractures, etc., are occasionally present in cattle. they may encroach upon the contents of the orbit, causing paralysis of the optic nerve--the condition known as amaurosis--or by pressure upon the posterior surface of the eyeball force it forward, or produce atrophy (shrinking). they may displace the eye in any direction, with or without disturbing vision. fibrous tumors growing within the orbit will produce symptoms similar to those of bony tumors. _treatment._--when the outlines of the tumor, whether fungoid, bony, or fibrous, can be detected, an operation for its removal should be undertaken as soon as the sight of the eye is in any manner disturbed. dislocation of the eyeball. the eyeball may be torn out of its socket by the horns of another animal, or it may be crowded out with the blunt end of a club, cane, or probe in the hands of a brutal attendant. _treatment._--when the optic nerve is not lacerated and the retractor muscles at the back of the eye are intact, an attempt at reduction is advisable. this, however, must follow very soon after the injury--before swelling takes place. divide the outer corner of the eyelid to enlarge the orifice, then by pressure with the fingers of both hands placed upon the sides of the eye the ball may be put into its place. apply a firm compress over the injured eye and keep it constantly wet with cold water containing dram of sugar of lead to each quart. if the attempt at reduction proves unsuccessful the artery at the back of the eye should be ligated, and then the whole mass cut off as deep within the orbit as possible. the orbital cavity, after washing it out with a per cent solution of carbolic acid or compound cresol, should be packed daily with fresh absorbent cotton. inflammation and enlargement of the haw. the haw, or membrana nictitans, is subject to inflammation and swelling from the extension of conjunctivitis, or direct injury by foreign substances. it presents a red, swollen appearance, accompanied with considerable pain and a profuse flow of tears. a slight scarification with a sharp knife and the application of a cooling lotion, such as is recommended for conjunctivitis, will soon reduce the swelling and restore it to its normal function. there is, however, a tendency for an inflammation of this membrane to take on a chronic character, which may eventually result in a permanent enlargement, resembling a tumor. when it attains sufficient size to protrude itself permanently over the eye, or project between the lids so as to obstruct the sight, its removal may become necessary. a threaded needle is passed through the body of the enlarged mass, by which the membrane is drawn out as far as possible, then with a blunt pair of scissors it may be dissected away from its attachments. the eye is afterwards treated with simple cooling lotions. diseases of the ear. by m. r. trumbower, d. v. s. [revised by leonard pearson, b. s., v. m. d.] diseases of the ears of cattle are not very common, for the reasons probably that they are not subjected to the brutality of drivers so much as horses and that the horns to a great extent protect them against external violence. otitis (inflammation of the internal ear). inflammation of the deep part of the ear is often difficult to recognize in cattle. it may be caused by disease of bone in that region, from blows inflicted by drivers, or from injury by other cattle. occasionally the ear becomes involved in actinomycosis (lumpy jaw), or the inflammation may be the result of a tuberculous affection. _symptoms._--the animal will hold its head to one side, or shake it, while the ear itself is held immovable. the movement of the jaws in eating usually gives rise to a manifestation of pain; the base of the ear may be feverish and swollen, and very sensitive to the touch. if the inflammation has advanced to a suppurative stage, offensive matter will flow from the ear. _treatment._--at first, hot fomentations to reduce pain and fever, followed by a sharp blister below the ear. laudanum, part to of sweet oil, may be injected into the ear to relieve pain and to soften the secretions. if there is a discharge from the ear, it should be thoroughly washed out by injecting warm soapsuds until all the matter has been washed away; then inject the following mixture twice a day: sulphate of morphia, grains; water, pint; glycerin, ounces. abscess. abscesses, caused by contusions, sometimes form about the base of the ear, either inside or outside. a serous cyst is found occasionally between the cartilage and the skin on the base of the ear, which may be from a similar cause. _treatment._--with the knife make a free incision into the most prominent part of the abscess or cyst, then, with a syringe, wash out the sac with carbolized water. if the abscess recurs, open it again, wash it out, and inject tincture of iodin, or fill it with iodoform. fungoid growths. as a result of laceration or wound of any kind, fungous growths, characterized by a raw, bleeding, granulating surface, with a tendency to become pendulous, may develop on the ear. _treatment._--the whole tumor or diseased structure should be cut away, and the wound treated daily with a dressing of carbolized cosmoline or turpentine and sweet oil, part of the former to of the latter. foreign bodies in the ear. bugs have been known to gain entrance into the ears of animals. i once removed an acorn from the ear of a cow that had been roaming in the woods; also pieces of wood from a stanchion may be lodged accidentally in the ear. _symptoms._--there is usually a continuous uneasiness or frequent shaking of the head, occasionally the manifestation of exceedingly great pain. the animal may rub the head and ear against trees or other objects in an endeavor to dislodge the offending body. _treatment._--a careful examination reveals the cause, which may be removed with a pair of forceps or scraped out with a hairpin or piece of wire bent at one end. if much inflammation exists, the ear may be swollen so that the foreign substance is hidden from sight; then a probe may be inserted to feel for the object, which, when found, should be removed, even if it becomes necessary to split the ear at the base. afterwards treat the ear with frequent warm water fomentations and the injection of soapy water or oil and water. scurfy ears. cattle are subject to scurfy ears, which may be owing to a generally morbid condition of the skin, or may be confined to the ears alone. the affected animal shows an inclination to rub the ear; thick scales, which sometimes have the appearance of hard, dry, horny scales, of scurf collect on it. this condition is chiefly caused by a faulty secretion of the sebaceous glands of the ear. thoroughly clean the ear with a stiff brush, then anoint it, so far as affected, with vaseline parts to part of white precipitate ointment. if the scurfy ears are only a part of a general scurfiness of the skin, the condition of the animal needs attention. (see "pityriasis," p. .) frostbite. it is not uncommon among young cattle which are poorly nourished and exposed outdoors to storms and extreme cold to suffer frostbite of the ear, which may constitute actual freezing of the part. _symptoms._--frostbite presents naturally every degree of severity from the mere chilling of the tip of the ear to positive freezing and death of a portion. in a day or two after the freezing has occurred the ear becomes swollen and very painful; the dead part remains cold and begins to shrivel; a line of separation then forms between the inflamed and the dead or dying portion, and finally the piece destroyed drops off, leaving a raw healing surface. when the ear is only slightly affected by the cold, an excoriation or peeling off of superficial skin takes place, accompanied with some pain and itching. _treatment._--a good liniment for frozen ears is a mixture of turpentine, ammonia, and chloroform, of each part, added to parts of sweet oil. rub this on the ear several times a day. it will relieve pain and stimulate the circulation, thus favoring a recovery of the injured structures. lacerations of the ear. aggressive dogs are the most frequent cause of lacerated ear, generally leaving a torn, ragged edge and bruised cartilage. if the wound is extensive, a trimming of the ragged edges becomes necessary; then the edges should be fastened together with silver wire, catgut, or strong, thick, linen thread, taking a deep hold, and pine tar applied. disease of the cartilage and necrosis. occasionally the cartilages of the ear become affected, usually the result of a deep bruise; pus forms, burrows under the skin, and may find a discharge from any part of the ear more or less distant from the seat of the disease. when the cartilage has been extensively injured, pieces of it may become dead (necrosed) and dissolve, to be carried away with the pus, or it may lead to extensive sloughing and the formation of numerous running sores. in the disease of the cartilage there is seldom much swelling or great pain. the discharge is usually very offensive, and occasionally streaked with blood. whenever there is a long-continued, persistent discharge from one or more openings in the ear, disease of the cartilage may be suspected. _treatment._--the sinus formed by the passage of matter should be probed and searched to the bottom for the presence of a foreign substance or the evidence of decaying cartilage. when the probe touches necrosed cartilage it will feel like a piece of dry leather or partially softened wood. a counter opening must then be made at this place, and all diseased cartilage cut away with the knife. the subsequent treatment consists in keeping the artificial wound open for the discharge of pus, and the injection of chlorid of zinc, grains to the ounce of water, once or twice a day, until the wound is healed. enchondroma of the ear. this is an excessive growth of cartilage, found at the base of the ear in the form of a hard, painless tumor, firmly attached to the movable ear. the only recourse for its removal is the knife in the hands of one acquainted with the anatomy of the part involved in the operation. infectious diseases of cattle. revised by john r. mohler, a. m., v. m. d., _chief, bureau of animal industry._ general introduction. the importance, to the farmer and stock raiser, of a general knowledge of the nature of infectious diseases need not be insisted on, as it must be evident to all who have charge of farm animals. the growing facilities for intercourse between one section of a country and another, and between different countries, cause a wide distribution of the infectious diseases once restricted to a definite locality. not only the animals themselves, but the cars, vessels, or other conveyances in which they are carried may become agents for the dissemination of disease. the growing tendency of specialization in agriculture, which leads to the maintenance of large herds of cattle, sheep, and hogs, makes infectious diseases more common and more dangerous. fresh animals are being continually introduced which may be the carriers of disease from other herds, and when disease is once brought into a large herd the losses become very high, because it is difficult, if not impossible, to check it after it has once obtained a foothold. these considerations make it plain that only by the most careful supervision by intelligent men who understand the nature of infectious diseases and their causes in a general way can these be kept away. we must likewise consider how incomplete our knowledge concerning many diseases is, and probably will be for some time to come. the suggestions and recommendations offered by investigators, therefore, may not always be correct, and may require frequent modification as our information grows more comprehensive and exact. an infectious disease may be defined as any malady caused by the introduction, into the body, of minute organisms of a vegetable or animal nature which have the power of indefinite multiplication and of setting free certain peculiar poisons which are chiefly responsible for the morbid changes. this definition might include diseases caused by certain animal parasites, such as trichinæ, for example, which multiply in the digestive tract, but whose progeny is limited to a single generation. by common consent the term "infectious" is restricted to those diseases caused by the invasion and multiplication of certain very minute unicellular organisms included under the general classes of bacteria and protozoa. nearly all the diseases of cattle for which a definite cause has been traced are from bacteria. among these are tuberculosis, anthrax, blackleg, and tetanus (or lockjaw). some diseases, such as texas fever and nagana, are traceable to protozoa, while others, like actinomycosis and aspergillosis, are caused by fungi. those diseases of which the cause is unknown or imperfectly worked out are pleuropneumonia, rinderpest, foot-and-mouth disease, rabies, cowpox, malignant catarrh, and dysentery. bacteria may be defined as very minute, unicellular organisms of a plantlike character. their form is very simple, as may be seen from an inspection of the various species depicted on plate xxviii. the description of these figures will be found on page . the magnification there given will furnish the reader some idea of their very minute size. they multiply in two ways. the bacterium elongates and then divides in the middle to form daughter cells. these go through the same process at once, and thus cells are produced. the division of these leads to , the division of to , and so on indefinitely. the rapidity with which this multiplication takes place depends upon the nature of the bacterium. the bacillus of tuberculosis multiplies very slowly, while that of anthrax does so with great rapidity, provided both are in the most favorable condition. another mode of reproduction, limited to certain classes of bacteria, consists in the formation of a spore within the body of the bacterium. spore formation usually takes place when the conditions pertaining to the growth of the bacteria become unfavorable. the spores are much more resistant to destructive agents than the bacteria which produced them. the anthrax spore may live several years in a dried state, but the anthrax bacillus perishes in a few days under like conditions. this matter will be referred to again when we come to discuss the subject of disinfection. of the protozoa which cause disease very little is at present known. one which produces texas fever is pictured on plate xlv, in figs. and . these parasites have a more complex life history than bacteria; and as they can not be grown in artificial media, their thorough investigation is at present hampered with great difficulties. the differences in the symptoms and lesions of the various infectious diseases are due to differences in the respective organisms causing them. similarly the great differences observed in the sources from which animals become infected and the manner in which infection takes place are due to differences in the life history of these minute organisms. much discussion has taken place of late years concerning the precise meaning of the words "infection" and "contagion." * * * * * various bacteria which produce disease in cattle. description of plate xxviii. the bacteria on this plate are partly from tissues, partly from cultures, and stained artificially with aniline colors (fuchsin or methylene blue). figs and are copied from fränkel and pfeiffer's atlas. all but fig. are magnified , times; fig. , times. fig. . bacteria from pneumonia in cattle. these are also the cause of hemorrhagic septicemia and are closely related to swine-plague bacteria. these bacteria were drawn from a piece of spleen pulp (rabbit). fig. . micrococci (streptococcus) which produce inflammation of the lining membranes of the abdomen, thorax, heart, brain, and joints. frequently associated with the preceding bacteria in abscesses. fig. . micrococci (staphylococcus) which produce inflammation and suppuration; also pyemia. fig. . bacilli of blackleg. the pale oval bodies as well as the light spots in one end of the bacilli represent spores. fig. . bacilli which produce tetanus or lockjaw. the light spot in the enlarged end of each rod represents a spore. fig. . bacilli of tuberculosis. microscopic sections of a pearly nodule from the lining membrane of the chest cavity. the bacilli are stained red and appear as small straight rods within the cells of the nodule or tubercle. fig. . bacilli of anthrax. bacilli from the spleen of a mouse inoculated with a culture. the bacilli were obtained from the blood of a cow which died of anthrax in mississippi. the bacilli appear as rods stained blue. the round bodies are blood corpuscles, also stained artificially. [illustration: plate xxviii. haines del. zeese-wilkinson co., inc., n.y. various bacteria which produce disease in cattle.] * * * * * these words, however, are now wholly inadequate to express the complex processes of infection, and it may be said that each species of bacterium or protozoon has its own peculiar way of invading the animal body, differing more or less from all the rest. there are, however, a few broad distinctions which may be expressed with the help of these old terms. infection, as laid down above, refers at present in a comprehensive way to all microorganisms capable of setting up disease in the body. some microorganisms are transmitted directly from one animal to another, and the diseases produced may be called contagious. among these are included pleuropneumonia, rinderpest, foot-and-mouth disease, rabies, cowpox, and tuberculosis. again, certain organisms are perhaps never transmitted from one animal to another, but may come from the soil. among these are tetanus, blackleg, anthrax to a large extent, and perhaps actinomycosis in part. these diseases, according to some authorities, may be called miasmatic. there is a third class of infectious diseases, the specific bacteria of which are transmitted from one animal to another, as with the contagious diseases, but the bacteria may, under certain favorable conditions, find food enough in the soil and in the surroundings of animals to multiply to some extent after they have left the sick animal and before they gain entrance into a healthy one. this general classification is subject to change if we take other characteristics into consideration. thus tuberculosis, because of its insidious beginning and slow course, would not by many be considered contagious in the sense that foot-and-mouth disease is; yet, in either case, the bacillus must come from preexisting disease. the disease of rabies, or hydrophobia, is not contagious in the sense that rinderpest is, because the virus of rabies must be inoculated into a wound before it can take effect; yet, in both cases, the virus passes without modification from one animal to another, though in different ways. again, all the diseases under the second group, which seem to come from the soil and from pastures, are in one sense contagious in that the virus may be taken from a sick animal and inoculated directly, with positive results, into a healthy animal. other illustrations may be cited which show that these old terms are not in themselves satisfactory. there are so many conditions which enter into the process of infection that no single classification will give a sufficiently correct or comprehensive idea of it. these statements will be easily understood if the different infectious diseases in the following pages are studied with reference to the way or ways in which each disease may be contracted. enough has been said, therefore, to show that if we wish to make ourselves acquainted with the dangers of any given disease, we must study it and not rely upon any single work to tell the whole story. infectious diseases have, as a general rule, a period of incubation, which comprises the time elapsing between the exposure to the infection and the actual appearance of the disease. this period varies with the malady. the most common symptom of this class of diseases is fever. the severity of the fever is measured by the temperature of the animal; this is readily and accurately ascertainable by the clinical thermometer. (see pl. iii, fig. .) the other symptoms are variable and depend upon the particular organ or organs most implicated. loss of appetite, cessation of rumination and milk secretion, and general dullness are symptoms quite invariably present in most infectious diseases. during the course of infectious diseases secondary diseases or complications may arise which are largely caused by bacteria other than those producing the original malady. these complications are often so severe as to become fatal. in general it may be stated that they are due to filthy surroundings, and hence cleanliness may become an important aid to recovery. the treatment of infectious diseases is given under each malady so far as this is allowable or advisable. these diseases are not, as a rule, amenable to treatment. when the symptoms have once appeared the disease is liable to run its course in spite of treatment, and if it is one from which animals usually recover, all that can be done is to put them into the most favorable surroundings. many infectious diseases lead sooner or later to death, treatment is useless so far as the sick are concerned, and it may be worse than useless for those not yet infected. all animals suffering with infectious diseases are more or less directly a menace to all others. they represent for the time being manufactories of disease germs, and they are giving them off more or less abundantly during the period of disease. they may infect others directly or they may scatter the virus about, and the surroundings may become a future source of infection for healthy animals. this leads us to the subject of prevention as the most important of all which claim our attention. in this place only a few general remarks will suffice to bring the subject before the reader. the most important thing is to keep disease away from a herd or farm. to do this all sick or suspicious animals should be avoided. a grave form of disease may be introduced by apparently mild or trivial cases brought in from without. it is generally conceded that continual change and movement of animals are the most potent means by which infectious diseases are disseminated. with some cattle diseases, such as anthrax, rinderpest, and pleuropneumonia, preventive inoculation is resorted to in some countries. this may be desirable when certain diseases have become established in any locality so that eradication is impossible. it should not be practiced in territories where a given disease may still be extirpated by ordinary precautions. preventive inoculation is applicable to only a few maladies, and therefore its aid in the control of diseases is limited. when an infectious disease has gained foothold in a herd the course to be pursued will depend upon the nature of the malady. a good rule is to kill diseased animals, especially when the disease is liable to run a chronic course, as in tuberculosis. the next important step is to separate the well from the sick by placing the former on fresh ground. this is rarely possible; hence the destruction or removal of the sick, with thorough disinfection of the infected locality, is the next thing to be done. as to the disinfectants to be used, special directions are given under the various diseases, to which the reader is referred. here we will simply call attention briefly to the general subject. disinfection and disinfectants. disinfection consists in the use of certain substances which possess the power to destroy bacteria or their spores, or both. those which are cheapest and most available for animal diseases are ordinary freshly slaked lime or unslaked in powder, chlorid of lime, crude carbolic acid, corrosive sublimate, formaldehyde gas, formalin, and compound cresol solution. ( ) slaked lime is perhaps the most easily procured, but its disinfecting power is limited. while it is capable of destroying all bacteria in their vegetative state, it is unable to destroy such spores as those of anthrax and blackleg. it is probable, however, that in incrusting spores it may destroy their vitality sooner or later. it is regarded as safe practice to use only spore-destroying substances for the virus of those diseases of which we have no definite knowledge. nevertheless, in the absence of other disinfectants, lime is very useful. it may be employed as a whitewash on wood and stone and sprinkled as a dilute wash or in powder over yards, manure heaps, and over carcasses before they are buried, and over the ground on which they have lain to prevent other animals from carrying the infection away. ( ) chlorid of lime is more efficient than simple slaked or unslaked lime, as it destroys spores. it is the ordinary bleaching powder of commerce and is quite unstable, hence old preparations, unless sealed, are of little value. a per cent solution is sufficiently strong for all spore-bearing bacteria ( ounces in quarts of water). it may be efficiently applied to the walls and floor of an infected stable by mixing with limewash in the proportion of ounces of the lime to each gallon of limewash. the ceilings and those portions of the walls which can not be reached should be disinfected by means of chlorin gas liberated from the chlorid of lime by crude carbolic acid. this is accomplished by making a cone of or pounds of chlorid of lime, in the top of which a deep crater is made for the placement of from to pints of crude acid. the edge of the crater is thereupon pushed into the fluid, when a lively reaction follows. the fumes of chlorin are strongly irritating to the respiratory tract and therefore all live stock should be removed before the work is started. owing to the heat generated, it is advisable to place the lime in an iron crucible and to have nothing inflammable within a radius of feet. the number and location of these cones of chlorid of lime depend on the size and structure of the building to be disinfected. as a rule, it may be stated that chlorin gas liberated from the above-sized cone will be sufficient for disinfecting , cubic feet of air space. ( ) crude carbolic acid. the ordinary purified carbolic acid is too expensive to be used on a large scale, and the crude produce is a very good substitute. this is made more powerful by mixing with it an equal volume of commercial sulphuric acid. while the sulphuric acid is being added to the crude carbolic acid much heat is evolved, and if the glass jar in which the two are mixed is placed in cold water the resulting product is said to have a higher disinfecting power. the mixture is added to water enough to make a per cent solution (about ounces to quarts of water). this is strong enough for all purposes. it may be kept in wood or glass, but not in metal, owing to the corroding action of the acid. it should be used freely on woodwork and on infected floors, and a force pump of the kind used by orchardists is very convenient as a means of applying the disinfectant. if the solution is warm when applied, it will penetrate the woodwork better than when cold, especially if the spraying is done during cold weather. the addition of air-slaked lime in any quantity that will dissolve in water to the above solution (say - / pounds of lime to ounces of crude carbolic acid to each gallon of water) is preferred by many, as it makes any neglected places at once visible and leaves cleaner and better air within the buildings. in most cases in which its application becomes desirable--and this rule should apply to all disinfections--the disinfected stables, stalls, etc., should remain vacant as long as possible before cattle are again stabled therein. ( ) mercuric chlorid, or corrosive sublimate, is a powerful disinfectant, but it is likewise very poisonous; hence its uses are limited. cattle are especially susceptible to its action and caution must be used in its application. a solution of one-tenth of per cent is usually sufficient ( ounce to gallons of water). it should not be placed in wooden pails, which would form the tannate of mercury, a weak antiseptic; nor, owing to its corrosive action, should expensive metal pails be used. agate vessels or tin pails are to be preferred. all solutions should be labeled "poison," and to avoid accidents none should be kept on hand. ( ) formalin and formaldehyde gas have been found very efficacious as sanitary agents. formalin is the commercial name for the per cent solution of formaldehyde gas in water, and is one of the most powerful antiseptic and disinfectants that we possess. solutions of this strength are manufactured by different commercial houses and sold by the drug trade under the name of "formalose" and "formal." in this connection it should be mentioned that while the per cent solution of formaldehyde gas and formalin are exactly the same thing, the former can be purchased at - / to per cent less than the latter. formalin, diluted with water in the proportion of pint to parts of water, or ounces to each gallon of water, may be applied, and it may thus be used as a wash or as a spray on all paints, metals, and woodwork, as well as on clothing and other fabrics, without injuring them. it may also be applied to floors, walls, and woodwork in whitewash by mixing part to parts of limewash, or ounces to each gallon of limewash. formalin has the appearance of water and in the strong solution is poisonous, but when diluted as recommended above it is not dangerous. the fumes given off by it, however, are very disagreeable and irritating to the eyes and nasal mucous membranes. one and one-half ounces of formalin added to gallon of water is a valuable agent for the disinfection of the skin or septic wounds, but is somewhat painful and irritating to raw surfaces. formaldehyde is a gas which is soluble in - / parts of water ( parts of formaldehyde gas to parts of water); this solution constitutes the formalin of commerce. the use of formaldehyde gas is in most cases impracticable for stable disinfection. in case the stable is not too large and can be made almost air-tight the generation of formaldehyde gas, after removing all the animals, will be found very serviceable. it penetrates all parts of the stable--the walls, crevices, floors, ceiling--and is probably the best fumigating disinfectant that we have. probably one of the most simple and practical methods of liberating this gas is by means of the chemical reaction which takes place when formalin is poured upon permanganate of potassium. for each , cubic feet of air space, - / ounces of crystallized or powdered permanganate of potassium is placed in a wide-surfaced pan; ounces of formalin is then poured upon it, and the stable immediately closed for a period of hours or longer. this method is efficient only when it is possible to seal tightly the place to be disinfected, and should be used only by experienced persons. ( ) some coal-tar products are cheap, effective, and easily applied disinfectants, their action being due to the carbolic acid and creosote in their composition. they may be used in to per cent solution. as a rule they form a milky solution in water. ( ) compound solution of cresol (liquor cresolis compositus), now recognized as an official preparation, is composed of equal parts of cresol and linseed-oil-potash soap. the mixture is a thick, dark, amber-colored fluid which mixes readily with water in all proportions to form a clear, soap solution. it is an efficient disinfectant in a or per cent solution, and in this strength it may be applied in the same manner as a per cent solution of carbolic acid. when it is desired to apply one of these above-mentioned agents to the stable or barnyard, a preliminary cleaning up of all débris and litter is advisable, together with the scraping of the floor, mangers, and walls of the stable with hoes; also the removal of all dust and filth. this should be followed by the burning of all such accumulations, inasmuch as this material likewise contains the infectious principle and is best destroyed by heat. heat may be applied to the surface of the affected pen, byre, or barnyard by means of a cyclone burner, which consists of a tank, pump, hose, and cyclone nozzle for spraying with paraffin (gas oil). the latter is ejected in the form of spray, which when ignited gives a very hot and effective flame to be applied to the infected ground. where such burning is impracticable the surface soil of the yard and surroundings should be removed to a depth of or inches and then placed in a heap and thoroughly mixed with air-slaked lime. the fresh surface of the soil thus exposed may then be sprinkled with the disinfectant. in addition to these artificial substances there are several natural sanitary agents of great importance as destroyers of virus. these are cleanliness, ventilation, drying, and sunshine. all virus, excepting such as may live in the soil, is killed sooner or later by drying and sunshine, and the importance of these factors in the daily life of animals need not be insisted on here. finally, all sanitary measures which contribute to the healthfulness of animal surroundings are directly or indirectly inimical to disease germs, and all carelessness in the keeping of animals may be regarded as an ally of these destructive organisms. contagious pleuropneumonia. [pls. xxix-xxxii.] _definition and history._--this disease has been eradicated from the united states, and it is not probable that it will ever be seen in this country again. as, however, much interest was manifested in regard to it for a number of years, and as our cattle are still prohibited from some foreign markets on account of its previous existence here, the subject is treated at greater length than would otherwise be necessary. the contagious pleuropneumonia of cattle is a specific, epizootic disease which affects bovine animals, and from which other species are exempt. it is characterized, when the disease results from exposure in the usual manner, by an inflammation of the lungs and pleuræ, which is generally extensive, and which has a tendency to invade portions of these organs not primarily affected and to cause death of the diseased portion of the lung. this disease is frequently called the lung plague, which corresponds to its german name of lungenseuche. in french it is spoken of as the péripneumonie contagieuse. the history of the contagious pleuropneumonia of cattle can not be traced with any certainty to a period earlier than the beginning of the eighteenth century. no doubt it existed and ravaged the herds of europe for many years and perhaps centuries before that time, but veterinary knowledge was so limited that the descriptions of the symptoms and post-mortem appearance are too vague and too limited to admit of the identification of the maladies to which they refer. it has been supposed by some writers that certain passages in the writings of aristotle, livy, and virgil show the existence of pleuropneumonia at the time that their works were composed, but their references are too indefinite to be seriously accepted as indicating this rather than some other disease. it seems quite plain that as early as and pleuropneumonia existed in swabia and several cantons of switzerland. there are even clearer accounts of its prevalence in switzerland in , , and . in a disease called murie was investigated in franche-comté by bourgelat which undoubtedly was identical with the pleuropneumonia of to-day. from that period we have frequent and well-authenticated accounts of its existence in various parts of europe. during the period from to it was spread throughout a large portion of the continent of europe by the cattle driven for the subsistence of the armies, which marched and countermarched in all directions. it was generally prevalent in italy in . it appears to have been unknown, however, in the department of the nord, france, until , but during the years from to it penetrated into most parts of that country. during the same period it was introduced into and allowed to spread over belgium and holland. this contagion is said to have been carried to ireland from holland in , and is reported as existing in england in . the disease was brought to the united states at several different times. probably its first introduction was with a diseased cow sold in brooklyn, n. y., in . it came to new jersey by importing affected animals in . massachusetts was infected in the same way in . south africa was infected by a bull brought from holland in , and australia likewise received the contagion with an english cow in . it is also reported as existing in various parts of the continent of asia, but the time of its first appearance and the extent of its distribution are very uncertain. some countries, such as norway, sweden, and denmark, which had been infected for only a short time, have succeeded in eradicating the disease without much difficulty by slaughtering all affected and exposed animals. other countries long infected and in which the contagion was thoroughly established, like australia, south africa, italy, france, belgium, and parts of germany, have labored long, in some cases making no progress and in others being only partially successful. holland was one of the first of the thoroughly infected countries to free itself from the contagion. in the united states, massachusetts eradicated pleuropneumonia during the period from to . new york and new jersey made an attempt to eradicate it in , but were not successful. late in the contagion was carried to ohio, probably by jersey cattle purchased in the vicinity of baltimore, md., to which place it had extended before . from the herd then infected it was spread by the sale of cattle during to a limited number of herds in illinois, to one herd in missouri, and to two in kentucky. the alarm caused among the stock owners of the united states by this widespread dissemination of a disease so much dreaded led to the adoption of active measures for its control and eradication. by cooperation between the united states department of agriculture and the authorities of the affected states it was found possible to prevent the further spread of the contagion and to eradicate it after a few months' delay. in pleuropneumonia was discovered in some of the large distillery stables of chicago and among cows on neighboring lots. this led to renewed efforts for the complete extirpation of this disease from the country. congress in enlarged the appropriation available for this purpose and gave more extended authority. during the same year the disease was stamped out of chicago, and has not since appeared in any district west of the allegheny mountains. the work of eradication was at the same time commenced in all the infected states. before the end of the year pennsylvania, delaware, maryland, the district of columbia, and virginia had been freed from the disease. more difficulties, however, were encountered in the states of new york and new jersey, on account of the larger territory infected and the density of the population. the long struggle was successful, however, and the last animal in which the disease appeared in the state of new york was slaughtered early in , and the last one affected in new jersey met the same fate early in the spring of . [illustration: plate xxix. haines del. zeese-wilkinson co., inc., n.y. upper or dorsal surface of the lungs of the ox. (one-twelfth natural size.)] [illustration: plate xxx. haines del. zeese-wilkinson co., inc., n.y. bronchopneumonia.] [illustration: plate xxxi. fig. fig. haines del. zeese-wilkinson co., inc., n.y. contagious pleuropneumonia.] [illustration: plate xxxii. haines del. zeese-wilkinson co., inc., n.y. contagious pleuropneumonia.] during these same years a supreme effort had been made to stamp out this lung plague from great britain. from the official reports it appears that the number of infected districts and of diseased animals had rapidly diminished, but it was not until that the infection was finally eradicated. the other infected european countries, though they maintain a veterinary sanitary service, are not making satisfactory progress in eradicating the disease. this is owing partly to delays in carrying out the provisions of the laws and partly to mistaken ideas as to the measures which are necessary to accomplish the object. the united states was the last of the countries having old infected districts which undertook to stamp out this contagion, and, except holland, it was the first to reach success. _the cause (etiology) of pleuropneumonia._--this is a contagious disease, and arises only by contagion from a previously affected animal; consequently it can never be seen here except as the result of importing affected animals from the old world. when thoroughly stamped out it does not reappear; and if imported animals continue to be properly inspected and quarantined, we have every reason to believe that pleuropneumonia will never again be seen in this country. the exact nature of the virus or contagion of lung plague has never been determined. various investigators have from time to time claimed the discovery of the specific organism of the disease, but it was not until that nocard and roux, by an ingenious method of cultivation, succeeded in obtaining a very feeble growth of an exceedingly minute microorganism. with these cultures the disease was produced in cattle. some investigators and writers are of the opinion that the disease can be contracted only by an animal coming near enough to a living diseased one to receive the contagion directly from it. they hold that the contagion is expired with the air from the affected lungs, and that it must be almost immediately inspired by another animal in order to produce the disease. some experimental attempts to infect animals by placing them in stables where diseased animals have been, and by placing the diseased lungs of slaughtered animals in their feeding troughs have failed, and, consequently, apparently confirm this view. * * * * * contagious pleuropneumonia. description of plates. plate xxix. upper or dorsal surface of the lungs of the ox, reduced to one-twelfth of the natural size: _a_, _a'_, the right and left principal lobes. these are the largest and are situated posteriorly, resting upon the diaphragm; _b_, _b'_, the ventral lobes, situated between the principal lobes; and _c_, _c'_, _c''_ the most anterior, or cephalic, lobes. the right anterior is divided into two lobes (_c_, _c'_), the left is single (_c''_); _d_, trachea, or windpipe. in the majority of the lungs examined in the laboratory of the bureau which were affected with contagious pleuropneumonia the principal lobes (_a_, _a'_) were primarily affected. plate xxx. bronchopneumonia. the ventral or middle lobe of the right lung affected with collapse and beginning bronchopneumonia. the light yellowish portions represent healthy lung tissue; the red represents the disease. it will be noticed that the lines between the lobules are quite faint, indicating little or no inflammation of the connective tissue between the lobules. the healthy lung tissue is seen to be raised above the level of the diseased portion. in contagious pleuropneumonia the exact reverse is the case, the diseased portions being very much larger than the healthy. plate xxxi. contagious pleuropneumonia. appearance of a cow's lung affected with contagious pleuropneumonia when sections or slices are made of it and cut surfaces examined. fig. . transverse section through the right principal lobe in a case of acute pleuropneumonia. the area drawn includes the air tubes, veins, and arteries, and illustrates the great thickening of the interlobular connective tissue into broad whitish bands and of the walls of the air tubes, veins, and arteries: _a_, air tube cut obliquely; _a'_, air tube cut directly across; _b_, arteries cut across; _c_, large vein completely occluded by a thrombus or plug formed during life. the great thickening of the walls of the artery and vein in this disease is especially brought out by stating that in the healthy lung they are so thin as to be easily overlooked. fig. . transverse section of the principal lobe in a case of acute pleuropneumonia, illustrating the different kinds of hepatization or consolidation of the lung. these are indicated by the different colors from dark red to reddish yellow. this variation of color is regarded by some as the real marbling characteristic of pleuropneumonia, while the whitish bands penetrating the lung tissue in all directions constitute the true marbling according to other observers. plate xxxii. contagious pleuropneumonia. this illustrates what are called infarctions. the right half of the figure shows nearly normal lung tissue. the left represents a blackish mass, in which the lung tissue is filled with blood and solidified. this is caused by the plugging of the vein carrying away the blood from this portion. the heart forces the blood through the artery into the tissue at considerable pressure, but owing to the fact that its return is prevented, the minute blood vessels rupture and the air vesicles become distended with blood, which coagulates and causes the firmness of the tissue. * * * * * on the other hand, it is known that the serum from affected lungs retains its virulence and may be used successfully for inoculation weeks or months after the death of the animal from which it was taken. this is particularly the case when this liquid is hermetically sealed in glass tubes. other investigators state that they have successfully infected cattle by placing, in the nostrils, sponges or pledgets of cotton saturated with such serum. cattle have also, according to the best evidence obtainable, been infected from the clothing of attendants, from horns used in drenching, and from smelling about wagons which have been used to transport affected carcasses. in the work of eradicating pleuropneumonia from the united states many stables were found in which the disease would appear and reappear after the slaughter of affected herds, and in spite of any precautions which were adopted. these were always old stables, with woodwork in a decaying condition and with floors underlaid with filth which could not be thoroughly removed or disinfected. in every one of these cases the destruction of the stable, the burning of the lumber of which it was constructed, the removal of the accumulations beneath the floors, and thorough disinfection, prevented the recurrence of the plague in new stables built upon the same premises. this experience conclusively shows that under certain conditions, at least, stables may retain the infection for a considerable time, and that when restocked the disease may break out again from such infection. as a rule, however, the disease is acquired by a healthy animal being near an affected one and receiving the contagion direct. affected animals may give off the contagion in the early stages of the disease before the symptoms are apparent to the observer; also, they may retain this infectious character, if they survive the attack, for six months and probably for a year after all symptoms of the disease have disappeared. _incubation._--the time which elapses between exposure to the contagion of pleuropneumonia and the first appearance of the symptoms of this disease varies greatly with different individuals and with different outbreaks of the disease. ordinarily the symptoms of disease make their appearance within three to six weeks after exposure; they may be observed, however, within two weeks or they may not become apparent until nearly or quite three months. it is this long period of incubation and the great length of time that an animal may disseminate the contagion after apparent recovery which give the plague that insidious character so often spoken of, and which greatly increase the difficulties of eradication. _symptoms._--the symptoms are such as would be expected with inflammation of the lungs and pleuræ, but they vary considerably, according to the type which the disease manifests. if the attack is an acute one, as is frequently seen in hot weather, the symptoms appear suddenly; the breathing becomes rapid and difficult, the animal grunts or moans with each expiration, the shoulders stand out from the chest, the head is extended on the neck, the back is arched, the temperature is ° to ° f., the milk secretion is suspended, there is no appetite, rumination is stopped, the animal may bloat and later be affected with a severe diarrhea. such cases are generally fatal in to days. very often the attack comes on slowly and the symptoms are much less clear. in the mildest cases there is a cough for a week or two, but no appreciable loss of appetite or elevation of temperature. the lungs are but slightly affected and recovery soon follows. such animals may disseminate the contagion for a long time without being suspected, and for that reason are the most dangerous of all. a more severe type of the plague is the most frequently seen. in these cases the cough is frequent, more or less painful, the back somewhat arched, and the milk secretion diminished. the prominence of these symptoms increases, the appetite is affected, the animal loses flesh, the breathing becomes more rapid, the cough more painful, pressure of the fingers between the ribs shows tenderness, the hair loses its gloss and stands erect, the skin becomes adherent, little, if any, milk is secreted, and the temperature rises, varying in different animals from ° to ° f. animals thus affected may continue to grow worse and die in from three to eight weeks, or they may after a time begin to improve and make an apparent recovery. the inflammation of the lung does not, as a rule, subside and the organ return to its normal condition, as is the case in ordinary pneumonia, but with this disease the life of the affected portion of the lung is destroyed, the tissue dies, and a fibrous wall is formed around it to shut it away from the living parts. the tissue, thus encysted, gradually softens, becomes disintegrated, and breaks down into pus. the recovery, therefore, is not complete; it is only apparent and partial. to those accustomed to examining the lungs of cattle, other and extremely important symptoms may be apparent during the course of the disease. by applying the ear over the walls of the chest an area of a certain extent may be found in which the natural breathing sound is diminished or entirely lost. this represents the diseased portion of the lungs. in other cases a loud blowing sound may be heard, quite different from any sound produced when the lung is in a healthy condition. in some cases crepitation is heard near the border line of the diseased area and friction sounds produced by the roughened pleura; these can be appreciated, however, only by those whose ears have been trained to distinguish between the different sounds which reach the ear when applied to the chest wall. by percussion--that is, by pressing the fingers of the left hand firmly against the wall of the chest and tapping upon the middle finger with the ends of the fingers of the right hand--an area of dullness may be discovered corresponding to the portion from which the respiratory murmur has disappeared. this loss of respiration detected by auscultation, and the dullness brought out by percussion, are the most important evidences of an inflamed or consolidated lung. seriously affected animals remain standing if they have sufficient strength, but those which lie down always lie on the affected side. the proportion of animals which become affected after being exposed varies according to the virulence of the outbreak, the susceptibility of the animals, and the length of time during which exposure is continued. sometimes not more than , , or per cent will contract the disease when a large herd is exposed; on the other hand, however, or per cent may be affected. the proportion of cases in which the disease proves fatal also varies greatly--it may not exceed and it may reach per cent. in general, it may be said that about per cent of the exposed animals will contract the disease and about one-half of these cases will prove fatal. _post-mortem appearances._--owing to the complexity of the structure of the lung tissue, its ramifications of bronchial tubes and blood vessels, and its abundant supply of lymphatics, the pathological changes in pleuropneumonia are interpreted with great difficulty. furthermore, there are certain kinds of pneumonia which present some resemblances to pleuropneumonia and which may therefore be confused with it in some of its phases. if we kill an animal affected with acute pleuropneumonia and examine the cavity of the chest and lungs, the following appearances will be noted: the thorax may contain more or less serum, which may be clear or clouded. there may be firm adhesions of different parts of the lungs to the chest wall, the extent of which depends on the stage and severity of the disease. the diseased lobes are unusually large and exceedingly firm to the touch. the weight of a single large lobe may reach pounds. usually only one side is affected, often but a single lobe, and this most commonly the large or principal lobe. the pleura may be covered with one or more layers of a firm, elastic, grayish membrane, which varies in thickness and which sometimes may be pulled away entirely. sometimes it is absent. the pleura, however, is opaque and apparently very much thickened. this is owing to the diseased condition of the connective tissue beneath the pleura, as will be explained later. when an affected lobe is cut through at right angles to its long diameter, the cut surface presents a variety of interesting changes. in the first place the spaces between the small subdivisions of the lung (the lobules), which in the healthy lung are barely visible, are distended with a yellowish-white, usually quite firm, substance, which is coagulated fibrin. the cut surface thus appears divided into small fields by yellowish-white bands of varying thickness running in various directions through the lung tissue and beneath the pleura. (pl. xxxi.) these bands may appear honeycombed and the spaces filled with yellowish fluid (serum) or they may be uniformly solid. it will also be noticed that the space immediately outside of and around the artery, vein, and air tube is similarly broadened by fibrinous deposits. some authorities look upon these bands as constituting the so-called "marbling" of pleuropneumonia. in addition to these changes which have taken place in the connective tissue between the lobules, the lung tissue itself may be markedly altered. certain areas of the cut surface may be very firm in texture and of a brownish-red color. the cut surface is granular or roughened, not smooth to the eye. other areas equally firm may be more grayish yellow and still others may be blackish. (pl. xxxii.) besides these areas which represent solidified (hepatized) lung tissue there may be others which approach the normal lung tissue in color, are soft, and float in water. from these a milky, purulent fluid may often be expressed. these different shades are represented in plate xxxi, fig. , within a small compass. some authorities are inclined to consider these variations in color on the same cut surface as the so-called marbling of pleuropneumonia. it matters not whether we regard the bands between the lobules or the varying shades of the lobules themselves as the marbling, provided either or both are peculiar to contagious pleuropneumonia. if we examine the blood vessels appearing on such cut surface they will usually be found plugged within the firmly hepatized regions. the artery contains a dark, soft, removable clot, the vein a grayish-pink, granular, fragile plug (thrombus), which adheres firmly to the wall of the vein, and if this is slit open, indications of a diseased condition of the inner coat will be readily detected. when large regions of the lung tissues are hepatized, the main air tube and its branches are usually filled with grayish, cylindrical branched masses of fibrin that are easily removed, as they do not adhere to the mucous membrane. the views of pathologists differ as to the nature of the earliest changes in pleuropneumonia, and it is not within the scope of this work to present controverted or imperfectly developed theories. in the foregoing description we have taken as a type the acute pleuropneumonia in its fully developed phase, which can scarcely be mistaken for any other disease. we have seen that there is an inflammatory condition of the connective tissue between the lobules, resulting in the exudation of coagulable lymph. this inflammation is equally marked around the blood vessels and air tubes. it leads to inflammatory changes in the inner wall of the veins, and these cause the deposition of thrombi or plugs in the vessels, which prevent the return of the blood. the blood pumped into the lung tissue through the artery, but unable to get out by way of the vein, leaves the mesh-work of capillaries around the air vesicles, enters the latter, and produces the firm, hepatized condition so characteristic of this disease. if we bear in mind that the veins in different parts of the lung tissue are plugged at different times, and that, therefore, the affected regions are in different stages of disease, it will be easily understood how the different shades of color from dark red to grayish or yellowish red are produced. the complete plugging of the veins may lead to the death of circumscribed masses of lung tissue. a line of separation forms between the living and the dead tissue and a thick cyst wall of fibrous tissue forms around the latter. the dead tissue for a time preserves the appearance of lung tissue, then undergoes disintegration and liquefaction. the softened mass is finally absorbed, and the walls of the cyst, or capsule around it, gradually collapse and form a cicatrix. this favorable termination takes place only when the dead mass is not too large. it may, however, involve over half of one of the large lobes. under such circumstances recovery is improbable. a more favorable termination is the abundant growth of fibrous tissue around and into the hepatized masses. the formation of fibrous tissue may extend to the pleura, or lung covering, and cause firm adhesion of the lungs to the chest wall and to the pericardium, or heart case. the same peculiar, inflammatory changes which take place between the lobules of the lung and around the bronchi and vessels may invade the pleural cavity, cause extensive membranous and spongy deposits on the pleura and firm deposits around the heart and large arteries, the gullet, and windpipe. these are the main features of the lung disease caused by contagious pleuropneumonia. in the typical, acute cases there are a sufficient number of peculiarities to enable us to make a positive diagnosis. there are, however, many cases in which the disease is restricted to small areas, or to the interlobular tissue, or in which the changes are still imperfectly developed, or else so far advanced that doubts may arise as to the true nature of the affection. in such cases all obtainable facts, including the history of the case, the symptoms during life, and the pathological changes observed on post-mortem examination must be taken into consideration. only one who has made a careful study of the disease is fitted to decide in such cases. other kinds of lung disease, because of certain features common to most lung diseases of cattle, may be confounded with pleuropneumonia. the inflammation of the connective tissue between the lobules is not infrequently observed in so-called interstitial pneumonia and may lead to the formation of whitish bands intersecting the lung tissues in various directions. on the cut surface these bands may give rise to a decidedly marbled appearance. again, in traumatic pneumonia, caused, as its name implies, by the entrance of foreign bodies into the lung tissue, generally from the paunch, the connective tissue around the place of disease becomes inflamed and thickened, and the disease itself may simulate pleuropneumonia in its retrogressive stages when it is confined to a small portion of lung tissue. the filling up of the interlobular spaces with fibrin and connective tissue of inflammatory origin is not thus limited to pleuropneumonia, but may appear in a marked degree in other lung diseases. it must not be inferred from this statement that these interlobular changes are necessarily the same as those in pleuropneumonia, although to the naked eye they may appear the same. we simply note their presence without discussing their nature. in general, the distinction between pleuropneumonia and bronchopneumonia is not difficult to make. in the latter disease the pneumonia generally invades certain lobes. the disease attacks the smaller lobes in their lowest portions first and gradually extends upward, i. e., toward the root of the lung or the back of the animal and backward into the large principal lobes. again, both lungs in advanced cases are often symmetrically affected. in contagious pleuropneumonia the large principal lobe of one side is most frequently affected, and a symmetrical disease of both lungs is very rare, if, in fact, it has ever been observed. the lung tissue in bronchopneumonia is not enlarged, but rather more contracted than the normal tissue around it. this is well illustrated in plate xxx. normal, air-containing lobules may be scattered among and around the hepatized portion in an irregular manner. in pleuropneumonia the diseased and healthy portions are either sharply divided off, one from the other, or else they shade into each other by intermediate stages. the hepatized lung tissue in bronchopneumonia when the cut surface is examined is visually of a more or less dark flesh color with paler grayish-yellow dots regularly interspersed, giving it a peculiar, mottled appearance. in the more advanced stages it becomes more firm, and may contain nodular and firmer masses disseminated through it. the air tubes usually contain more or less soft, creamy, or cheesy pus or a turbid fluid quite different from the loose, fibrinous casts of acute pleuropneumonia. the interlobular tissue may or may not be affected. it sometimes contains loose, fibrinous plugs, or it may be greatly distended with air, especially in the still normal portions of the lung. the pleura is seldom seriously diseased. if we contrast with these features the firm dark-red hepatizations, the plugging of the veins, the extensive interlobular deposits, and the well-marked pleuritis in pleuropneumonia, there is little chance for confusion between well-developed cases of these two lung diseases. it should not be forgotten, however, that the lesions of the disease known as contagious pleuropneumonia may be confined to the serous membranes of the thorax, or they may be confined to the parenchyma of the lungs; they may affect a whole lobe, or only a small portion of it; they may or may not cause the so-called marbled appearance. in the same way bronchopneumonia may vary as to the parts of the lung affected, the extent of the lesions, the degree and kind of pathological changes in the interlobular tissue, the color of the lung on cross section and the amount of hepatization. in individual cases, therefore, it is often necessary to take into account the history of the animal, the course of the disease, and the communicability of the affection before a diagnosis can be made between the two diseases. _prevention and treatment._--the prevention of pleuropneumonia, as of other contagious diseases, consists in keeping animals so that they will not be exposed to the contagion. as the disease arises only by contagion, there is no possibility of an animal becoming affected with it unless it has been exposed. if, therefore, pleuropneumonia exists in a locality the owner of healthy cattle should make every effort to keep his animals from coming near affected ones or which have been exposed. he should be equally particular not to allow persons who have been on the infected premises to visit his own pastures, stables, or cattle. if pleuropneumonia breaks out in a herd, every animal in it should be slaughtered, the stables thoroughly cleaned and disinfected, and no other cattle allowed on the premises until a period of days has elapsed. medical treatment of affected animals is unavailing and should not be attempted. no matter how valuable the diseased animals may have been before they contracted the disease, they should at once be destroyed and the contagion eradicated. this is the best policy for the individual as well as for the community. the eradication of this disease by local or national governments can be successful only when the same principles are adopted and carried out as here recommended for individual stables. it is then a difficult undertaking, simply because the contagion is generally widely disseminated before any measures are adopted, and because a great majority of cattle owners will never report the existence of the disease. regulations must therefore be enforced which will insure the prompt discovery of every herd in which the disease appears, as well as the destruction of all diseased and exposed animals and the thorough disinfection of the premises. to discover pleuropneumonia sufficiently early for this purpose, the district supposed to be infected should be clearly defined and inspectors should be constantly employed to inspect every herd in it at least once in two weeks, or, better, once a week. no bovine animal should be allowed to go out of the defined district alive, and all which enter it should be carefully inspected to insure their freedom from disease. as an assistance to the discovery of diseased herds, every animal which, from any cause, dies in the infected district and every animal which is slaughtered, even if apparently in good health, should be the subject of a careful post-mortem examination. many affected herds will be found in this way. in addition to these measures it is also necessary to guard against the removal of animals from one stable to another and the mixing of herds upon common pastures or in the public highways. the object must be to isolate every individual's cattle as completely as possible, or otherwise a single affected animal may infect a dozen or more herds. to prevent surreptitious sale or trading of cattle, each animal must in some way be numbered and recorded in the books kept by the official in charge of the district. in the work of the united states department of agriculture a numbered metal tag was fastened to each animal's ear and index books were so arranged that with a number given the owner could be at once ascertained, or from the owner's name the cattle for which he was responsible could be at once learned. in this way, if an animal was missing from a stable, the fact became apparent at once, or if one too many was found in a stable the number in its ear would indicate where it came from. when pleuropneumonia is discovered by these means, the entire herd should be slaughtered as soon as the formalities of appraisement can be arranged. in country districts the carcasses should be buried, as it is generally impracticable to dispose of them in any other way. in city districts the animals may be taken to a slaughterhouse, with such precautions as are possible to prevent dissemination of the contagion. the animals should be slaughtered under the supervision of an inspector. the healthy carcasses may be utilized for food, but the blood, entrails, and all diseased carcasses should be heated to a temperature equal to that of boiling water or above, and then used for the manufacture of fertilizers. the disinfection of premises should be thorough and should be carried out by a trained corps of men employed for the purpose. the floors of stables should be removed, the accumulations removed from beneath them, the contents of haylofts should be destroyed, and the woodwork and soil beneath the stables should be thoroughly drenched with a solution of bichlorid of mercury, part to , of water. after the flooring is replaced the woodwork should be coated with limewash, containing one-fourth pound of chlorid of lime to the gallon of mixture. usually in these cases the owners are dependent upon their herd of cows for a living, and consequently it is difficult or impossible to hold the stables vacant for any considerable period. in a majority of instances cattle may be admitted at once to stables so disinfected, without the reappearance of the disease. occasionally, however, it will reappear without apparent cause. for this reason the inspection and other measures must be maintained in the infected district for six months or a year after the last case of disease has been disposed of. many people have objected to the slaughter of diseased and exposed animals as an unscientific and expensive method of eradicating the disease. to these it may be answered that it is the only method which has ever proved successful, and that in the end it is much more economical than temporizing measures. inoculation has been adopted in many countries, and has undoubtedly lessened the death rate, but where this practice is allowed the disease is kept up and spreads. for this reason it should be prohibited wherever there is a possibility and disposition to eradicate the contagion. rinderpest. rinderpest, also known as cattle plague, is an acute, infectious disease of cattle, in which the digestive organs are mainly involved. though unknown in this country, the importance of having near at hand a few definite facts concerning this disease, should it ever reach our shores, will be at once appreciated. a knowledge of such facts may aid in an early recognition of the disease. it must not be forgotten, on the other hand, that a superficial knowledge of diseases, such as the layman may gain through reading, not infrequently leads to confounding comparatively harmless, noninfectious maladies with such as are truly dangerous (foot-and-mouth disease, rinderpest, etc), and causes temporary panics among stock owners. according to some authorities, rinderpest has its home in the territory around the black sea and the volga river in russia; according to others, in central asia. thence it has been conveyed at various times by cattle to nearly every country of europe and asia, where it has proved to be a veritable bovine scourge. it probably visited europe as early as the beginning of the christian era, and since then the migrations of the people from the far east have from time to time introduced the disease. especially during the eighteenth century it was more or less prevalent in europe, owing to the frequent wars, during which herds of cattle were brought from eastern europe and asia to supply the demands of the armies. it prevailed in europe during the franco-prussian war. at present it exists in eastern europe and in portions of asia and africa. the virus is conveyed from one country to another chiefly by means of infected cattle, although infected hides, wool, and feed may play an important part in its dissemination. the railroad facilities of the present, which furnish the means of such rapid communication, are particularly liable to aid in the spread of the disease. in the past rinderpest has been supposed to be identical with various human diseases, among them smallpox and typhoid fever. these suppositions are unfounded, and the view of authorities to-day is that it is a disease of a peculiar kind, not identical with any other known infectious disease. _the contagion of rinderpest._--the cause of rinderpest must be looked for among microorganisms--most likely bacteria. the investigations made thus far for this causal factor have been fruitless. however, certain recent experiments would indicate that the unseen microbe is of such dimensions that it is withheld by the dense bacterial filters, but passes through the more porous ones. formerly it was supposed by various authorities that rinderpest virus appeared spontaneously under the influence of deteriorated feed and long and exhausting drives; also during unusual meteorological conditions. this view, however, is no longer maintained. it is probable that in its home in asia the disease is perpetuated by continual infection of fresh animals, and some authorities go even so far as to believe that the disease would be entirely stamped out, even in its native haunts, by a destruction of all sick and infected herds. however this may be, the success of such an undertaking would largely depend on the nature of the cause. if a strictly parasitic organism, like the contagion of pleuropneumonia, it might be completely extirpated in this way. if, however, the germs or bacteria may live and multiply outside of the bovine body, in the soil, water, or in some other animal, extirpation would be impossible. the virus may be transmitted in a variety of ways, both direct and indirect, from sick to healthy animals. it is said to be present in the various excreta, such as the discharges from the nose, and the saliva, the urine, and the manure, of the diseased. for months it retains its vitality in a moist state outside the body, and the disease is reported to have developed after feeding hay a year after it had lain in an infected stable; hence manure and the fodder and bedding soiled with discharges may convey it. persons may carry the virus on their shoes, clothing, or implements. even small animals, such as cats and rats, which frequent barns and stables, have been looked upon as carriers of the virus. cattle are very susceptible to the disease, and in its virulent type all those exposed are said to become infected. buffaloes, sheep, and goats are likewise susceptible, but in a less degree. it is also claimed that animals after having passed through one attack successfully resist future attacks. inoculation with virus is said to produce immunity, but in many cases the process of inoculation itself is followed by death. _symptoms._--the symptoms of rinderpest are not very characteristic, and hence the diagnosis of a suspected case in the beginning of an invasion is attended with difficulties. certain appearances which are characteristic of one epizootic may be absent in another. different observers are not quite agreed as to the most constant and important. the period of incubation, i. e., the time between the exposure to infection and the earliest outward symptoms, varies from three to nine days. the first sign is a very high fever, which may reach ° f. the heat of the skin varies in different parts of the body, and may be felt at the base of the ears and horns. repeated chills are frequently observed. the pulse reaches to beats a minute, and in very severe attacks may rise to or . the animal manifests great debility. the head droops and rests on some object of support. one or both ears may droop. the coat is staring and the muzzle dry. the secretion of milk diminishes very rapidly. within twelve to twenty hours the usual quantity may have become reduced one-half or two-thirds. the back is arched, and the four limbs are brought together under the body. as the disease progresses, symptoms with reference to the digestive and respiratory organs become prominent. the mucous membrane of the mouth and the nose, as well as that of the rectum and vagina, becomes reddened, either in patches or diffusely, and assumes a scarlet hue. the discharges, at first firm, become softer, and soon diarrhea sets in. this is said to be one of the most constant symptoms. the rectum may become everted and paralyzed, and the bowels move spontaneously. the discharges become fetid, viscid, and streaked with blood. coughing is a common symptom, and by some is considered characteristic. it is associated with discharges from the nose and vagina and dribbling of saliva from the mouth. the eyes also are affected. there is an increased formation of a viscid secretion which flows down the face. another series of changes prominent in some epizootics and mild or absent in others are the ulcers, or so-called "erosions," in the mouth. these begin as red patches and streaks. the mucous membrane in such localities is converted into a grayish-white slough, which, when shed, leaves a small erosion, or ulcer. at the same time similar changes may go on in the skin of the thighs, the udder, or the scrotum, or about the vagina, which lead to small sloughs. in severe cases, which are the most common in the susceptible cattle of western europe, death ensues four to seven days after the first appearance of the disease, and is preceded by great emaciation and debility, fetid, purulent discharges from the nose and mouth, and the relaxed rectum and vagina. after death, if the animal is opened and the organs carefully examined, the chief changes are found in the digestive organs. the lining membrane of the mouth and pharynx is covered with mucus, is reddened in spots, and shows superficial, yellowish-gray, cheesy patches, which represent dead tissue, and when removed expose ulcerated depressions. the same reddening in spots and the yellowish-gray, cheesy deposits or patches are found in the fourth stomach, the small intestines, and more rarely in the cecum, while the third stomach, or manyplies, is more or less impacted with dry, hard feed. similar changes may be found on the mucous membrane of the nasal cavity, larynx, trachea, the uterus, vagina, and rectum. the lungs may be injected, edematous, or pneumonic. the heart muscle is pale and flabby, and frequently hemorrhages are observed in its internal membrane. the liver may be pale or injected with blood, and at times shows hemorrhages beneath its capsule. the bile is thin and watery in consistence. the kidneys may be inflamed or contain small hemorrhages within their substance or under the capsule. the lymphatic glands may be swollen and injected or even hemorrhagic. _treatment._--on account of the danger of spreading the infection, neither medicinal treatment nor inoculation is permitted in european countries, with the exception of russia, where the disease is more generally diffused. the most effective method of exterminating rinderpest in those districts in which the disease is not indigenous has been found to be the slaughter of all affected and exposed animals. where the disease is general, successful efforts adopted for its control have followed the immunization by inoculation of the exposed animals and a strict application of appropriate sanitary measures. this protective inoculation has been practiced with very gratifying results in russia, south africa, and in the philippine islands. an active immunity is thus induced in susceptible animals which lasts until the danger from exposure to the disease is over. this immunity may be attained ( ) by the inoculation of pure bile from an animal which recently died of rinderpest, ( ) by the inoculation of glycerinated bile, followed by pure bile or virulent blood, or ( ) by the simultaneous inoculation of strong standardized serum and virulent blood. the latter method has been adopted by the united states government in its endeavor to exterminate the disease in the philippines, and to protect the cattle and carabaos against rinderpest after their importation into those islands. owing to the existence of this and other infectious diseases in the philippine islands, an order has been issued by the department of agriculture prohibiting the landing of any live stock or animals of any kind from the philippines at any of the ports of the united states or the dependencies thereof. this prohibition removes the greatest source of danger to which the united states is exposed as the result of its intercourse with the islands. the introduction of rinderpest from those countries from which we import animals is rendered extremely improbable, especially in live animals, owing to its short period of incubation and to the -day quarantine for cattle (counting from date of shipment) and -day (counting from date of landing) quarantine for sheep and other ruminants and swine which are at present enforced in the united states at all ports of entry. foot-and-mouth disease. [pl. xxxiii.] foot-and-mouth disease, also known as aphthous fever, epizootic aphtha, and eczema contagiosa, is an acute, highly communicable disease chiefly confined to cloven-footed animals and characterized by an eruption of vesicles or blisters on the mucous membrane of the mouth and on the skin between the toes and above the hoofs. the vesicles rupture, forming erosions and ulcerations; there are also salivation, tenderness of the affected parts, loss of appetite, lameness, emaciation, and diminution in the quantity of milk secreted. the tremendous ravages of the disease are seen in the number and variety of the species attacked. while it may be regarded as essentially a disease of cattle, hogs would seem to be as easy a prey. almost in the same grade of receptivity are sheep and goats. next in order of susceptibility come the buffalo, american bison, camel, chamois, llama, giraffe, and antelope. horses, dogs, cats, and even poultry may occasionally become infected with the disease, the last three being particularly dangerous as carriers of the contagion. man himself is not immune, and the frequency of his infection by coming in contact with diseased animals is established by numerous observations. as with other communicable diseases, the source and origin of foot-and-mouth disease have given rise to much speculation. the disease had been known in europe for centuries, but it was not until comparatively recent years that the erroneous conceptions of its spontaneous origin as a result of climatic and meteorological conditions, exhausting journeys, etc., were abandoned. it is now conceded that foot-and-mouth disease is propagated by a specific virus and that every outbreak starts from some preexisting outbreak. so far investigators have been unable to identify or isolate the specific organism causing the disease, although numerous attempts have been made to cultivate and stain it by laboratory methods. experiments have shown that the virus will pass through standard germ-proof filters, thus indicating its minute size and the reason it has not been detected by the staining methods. the contagion may be found in the serum of the vesicles on the mouth, feet, and udder; in the saliva, milk, and various secretions and excretions; also in the blood during the rise of temperature. a wide distribution of the virus and a rapid infection of a herd is the result. animals may be infected directly, as by licking, and in calves by sucking, or indirectly by such things as infected manure, hay, utensils, drinking troughs, railway cars, animal markets, barnyards, and pastures. human beings may carry the virus on their shoes and clothing and transmit it on their hands when milking, since the udder is occasionally the seat of the eruption. it may also be carried by dogs, cats, rats, chickens, pigeons, etc. milk in a raw state may also transmit the disease to animals fed with it. the observations made by some veterinarians would lead us to suppose that the virus is quite readily destroyed. it is claimed that stables thoroughly cleaned become safe after drying for a short time; hence, litter of all kinds, such as manure or soiled hay and straw, may remain infective for a longer time because they do not dry out. other authorities maintain that the virus is quite tenacious and may live in stables even so long as a year. they also state that animals which have passed through the disease may be a source of infection for several months after recovery. unlike most other infectious diseases, foot-and-mouth disease may repeatedly attack the same animals. the immunity conferred by an attack is of limited duration. the period of incubation (that is, the time between the exposure of an animal to infection and the development of the disease) is variable, usually from three to six days. the disease may appear in hours, or, in exceptional cases, not for days or even longer. _losses._--the highly contagious character of foot-and-mouth disease and its rapid spread to practically all exposed susceptible animals lead to heavy losses. since the mortality is comparatively low, ranging from only per cent or less in mild forms to or per cent in malignant cases, the havoc caused by the pestilence is sometimes underestimated. but there are other sources of loss which are much more important than the actual mortality. the fever and the difficulty of eating cause a rapid and extreme loss in flesh and a lessening or cessation of the milk secretion. the udders often become inflamed and ruined by the formation of abscesses, and cows affected in this way are sometimes rendered permanently valueless for milk production. the inflammation of the feet may cause the horn to drop from the toes, producing great lameness and lasting injury. abortion is frequent, and typical lesions have been observed in the newly born at birth. altogether these losses may amount to or per cent of the value of the affected animals. in addition there are indirect losses of a commercial nature. dairy farmers are put out of business for a time. necessary quarantine restrictions greatly interfere with the movement of live stock and such commodities as hay, straw, hides, and farm produce. the business of the stockyards and slaughtering centers is greatly interfered with. sometimes it is necessary to close stockyards for disinfection. the whole business of marketing, transporting, feeding, and slaughtering is interrupted and deranged. losses of this character may reach enormous proportions. [illustration: plate xxxiii. foot-and-mouth disease.] _the disease in other countries._--foot-and-mouth disease has prevailed in europe for a great many years and has occasioned tremendous economic losses there. in italy, france, switzerland, germany, and russia the plague has existed so long and has gained such a foothold that it is economically impossible to fight it with the american methods of slaughter and disinfection, for to do so would kill a large percentage of the live stock of those countries. in consequence, little or no progress toward eradication has been made by the authorities, though the severity of the disease in france appears to have abated somewhat in recent months. the outbreak which appeared in germany in increased steadily until , when it diminished gradually for a few years, but the disease again reached great proportions in . thereafter it continued to exist to a greater or less extent until in it attained a virulence unequaled before. in that year , , cattle, , , sheep, , , hogs, and , goats were affected. at that time the total number of cattle, sheep, swine, and goats in germany was only , , , while there were in the united states , , , or between three and four times as many. it can readily be imagined, therefore, what it would mean to the united states if the disease were to gain the foothold here that it had in germany, where, as these figures show, approximately one out of seven of the animals susceptible to the disease was affected. the german government, of course, has not left the disease to itself. it attempted to control some outbreaks by the method of slaughter, but the pestilence had gained too much headway and was too firmly established in too many portions of the country for this method to succeed, and the slaughter of the infected herds had to be abandoned. it now appears that there is no hope of getting rid of it until the virus has worn itself out. as soon as the animals' period of acquired immunity is over and favorable conditions present themselves, the contagion breaks out with renewed virulence. it has been impossible to control it by means of quarantines. one scientist has asserted that unless all the infected farms were absolutely isolated and the movement, not only of live stock but of persons, absolutely prohibited, the disease could not be stamped out. such a quarantine is, of course, utterly impossible to enforce. in portions of germany the farmers, realizing that the disease is inevitable, make haste to be done with it by exposing their stock deliberately to mild cases in the hope that this will result in an immediate, mild attack and immunity for several years thereafter. such immunity, however, is very uncertain. great britain, denmark, norway, and sweden, on account of their comparatively isolated positions, have been more successful in keeping out the disease. the outbreaks in those countries have been more sporadic, and by resorting to immediate slaughter the authorities have been able to stamp them out. great britain has applied both quarantine and slaughter for many years, and in an outbreak near dublin in measures were adopted which were even more stringent than any that have been used in the united states. a british official (cope) asserted in that after his country's experience with this disease it was "more dreaded by the farmers and stock raisers of great britain than cattle plague or pleuropneumonia, and they are now willing and ready to put up with any restrictions, of however drastic a character, considered necessary by the central department to stamp it out." the british authorities have succeeded in suppressing each outbreak, but reinfection often occurs from the neighboring continent. at the present time (april, ) great britain is having a siege of the disease, but is applying vigorous measures for its suppression. in november, , the disease reached belgium from france, where it was quite prevalent, and by the end of the year every province in belgium was affected, and the netherlands as well. efforts to eradicate it from belgium were unavailing. the netherlands apparently succeeded in stamping it out for about six months, but it reappeared there. the disease is also more or less prevalent in central europe, spain, and in the balkan countries. australia and new zealand have remained free from it. we have less accurate information regarding asia and africa, but the disease is known to prevail in japan and china and in the philippine islands, and it is doubtful whether any considerable part of the orient is free from it. in south america it is reported as common in brazil, argentina, and uruguay, and it probably exists in other countries. canada and mexico are fortunately free from the disease. _outbreaks in the united states._--foot-and-mouth disease has appeared in the united states on six different occasions-- , , , , , and . an extensive outbreak in was introduced by way of canada, where the infection was brought by an importation of cattle from scotland. it spread into the new england states and new york and appears to have been arrested within a few months. its failure to spread more extensively and its early disappearance have been ascribed to favorable conditions, such as the movement of live stock from west to east, the limited trading at that period as compared with the present time, the restriction of traffic by winter weather, and the infrequency of travel which obtained at that time among people. about two or three lots of animals affected by this disease were brought to the united states, but there was no extension from the animals originally affected. in , at portland, me., there was a small outbreak caused by imported cattle, and the disease spread to a few herds outside the quarantine station. owing to the small number of animals affected and the limited area of territory covered by the disease, it was easily controlled by the ordinary measures of quarantine and disinfection. it will be observed that in all these early outbreaks the contagion was introduced with imported animals. since the development of a stringent system of inspection and quarantine of imported live stock, no instance of that kind has occurred. on subsequent occasions the infection has evidently been brought in with contaminated products or materials and not by means of live animals. in november, , the disease was discovered in massachusetts and rhode island. the earliest cases were traced to chelsea, mass., near the docks, and it was suspected for a time that the infection was brought in with foreign shipping, by some such means as hay, straw, halters, ropes, hides, hair, wool, etc. later developments, however, and especially investigations into the cause of the outbreak, led to the belief that a more probable source of the infection was cowpox vaccine virus imported from a country (probably japan) where foot-and-mouth disease existed, the vaccine virus being contaminated with the virus of foot-and-mouth disease. a federal quarantine was declared by the secretary of agriculture on november , , as soon as the nature of the disease was established, and steps for eradication were at once taken by the bureau of animal industry of the united states department of agriculture in cooperation with authorities of the affected states. the methods followed consisted of inspection to trace and detect the disease, quarantine of infected premises and territory, slaughter and burial or burning of diseased and exposed animals, and disinfection of premises. this outbreak involved massachusetts, new hampshire, vermont, and rhode island, and was eradicated in about six months. two hundred and forty-four herds, including , cattle, were found infected. of these, herds with , cattle, as well as hogs and sheep and goats, were slaughtered. the cattle infected but not slaughtered were those that either died or completely recovered before slaughtering could be carried out. the animals slaughtered were valued at $ , . , and the federal government reimbursed owners to the extent of per cent, or $ , . . it is understood that the states paid the remainder. the total cost to the department of agriculture of stamping out the disease was about $ , . the next appearance of the foot-and-mouth disease was early in november, , when it was observed in cattle near danville, pa. a federal quarantine was issued november . the infection was traced back to the stockyards at east buffalo, n. y., and to detroit, mich. the disease appeared in the states of michigan, new york, pennsylvania, and maryland. a careful and thorough investigation made by mohler of the bureau of animal industry and rosenau of the public health service demonstrated that the outbreak started from calves used to propagate vaccine virus at an establishment near detroit, and that the source of the infection was contaminated japanese vaccine virus. vigorous measures of eradication similar to those employed in - were at once put into effect and the disease was stamped out in about five months at an expense of about $ , to the department of agriculture, and of about $ , to the states. the inspectors made , visits to farms, stockyards, etc., and inspected more than , , animals (including reinspections). one hundred and fifty-seven premises were found infected, and , animals ( , cattle, , hogs, and sheep and goats), valued at $ , . , were slaughtered. owners were reimbursed for the value of their animals and property destroyed, one-third being paid by the states and two-thirds by the federal government. the latest invasion was discovered in the vicinity of niles, mich., in october, , after it had evidently been under way since august of the same year. this is the most serious and extensive outbreak ever known in this country. the disease extended to states and the district of columbia, at places ranging from the atlantic to the pacific coasts. the work of eradication was not completed for more than a year. the affected states were connecticut, delaware, illinois, indiana, iowa, kansas, kentucky, maryland, massachusetts, michigan, minnesota, montana, new hampshire, new jersey, new york, ohio, pennsylvania, rhode island, virginia, washington, west virginia, and wisconsin. illinois had the largest infected area and the largest number of animals affected. the union stock yards at chicago became infected and were a source of dissemination of the contagion north, east, south, and west. these and other yards found infected were closed temporarily and disinfected. the first federal quarantine was issued october , . a campaign to check the spread of the disease and to stamp it out was immediately begun by the united states department of agriculture in cooperation with the state authorities. quarantines against the movement of animals and certain materials from the infected areas were declared, shipments were traced, rumors investigated, and thorough inspections made in an effort to discover all infected stock. as measures of eradication, diseased herds were slaughtered and buried and the premises disinfected. the owners of live stock and other property destroyed on account of the disease were reimbursed to the extent of the appraised value, half of which is paid by the federal government and half by the state. there were slaughtered , animals ( , cattle, , swine, , sheep, goats, and deer), in , herds. the total appraised value of these animals was more than $ , , . the expense to the federal government of eradicating this outbreak was about $ , , . _symptoms._--in three to six days, or even longer, after the exposure of the animal to the infection the disease makes its appearance. it is usually first indicated by the animal suffering from a chill, quickly followed by an invasion of fever, which may cause the temperature to rise as high as ° f. these symptoms are not always present, or may be in so slight a form as to escape notice. following this in one or two days it will be noticed that small vesicles or blisters about the size of hempseeds or peas are making their appearance upon the mucous membranes of the mouth at the border and upper surface of the tongue near the tip, the inside of the cheeks, on the gums and the inner surface of the lips, or on the margin of the dental pad. these little blisters contain a yellowish, watery fluid and gradually become more extensive as the disease advances. soon after the eruptions have appeared in the mouth of the animal considerable swelling, redness, and tenderness will be noticed about the feet, at the coronet, and between the digits of each foot. a day or two later eruptions similar to those within the mouth make their appearance upon these swollen regions of the foot, and at this stage it is usual to find that like lesions have made their appearance upon the perineum of the victim. in the case of milk cows the udder, and more particularly the teats, show the same vesicular eruption, but the latter as the result of milking soon become covered with reddened spots deprived of the superficial layer of skin and may develop deep, obstinate fissures. as soon as the disease has become well established the patient evinces pain when attempting to eat; in fact, the appetite is often so seriously affected that all feed is refused, and the animal uneasily opens and shuts its mouth with a characteristic smacking sound, while strings of cohesive, ropy saliva hang suspended from the lips. with the advance of the disease the vesicles widen and extend until they may reach a diameter ranging from that of a dime to that of a silver dollar. these rupture soon after their appearance, sometimes on the first day, more rarely on the second or third day. after they have ruptured, the grayish-white membrane forming the blister may remain attached for a day or more, or disappear speedily and leave deeply reddened, sensitive spots or erosions, both within the mouth and upon the coronet and between the claws of the feet. similar erosions, which quickly form scabs, as a rule, may be noticed in cases in which the teats of milk cows have become affected, and instances are reported in which sloughing of the tegument immediately around the lesions upon the udder has occurred. owing to the tough, fibrous nature of the bovine skin, it is exceedingly rare for sloughing to occur upon any part of the body other than those mentioned. the attack upon the feet of an animal is frequently manifested in all four feet at once, but one or more of the feet may entirely escape and remain unaffected throughout the course of the disease. the ulceration of the interdigital tissue may extend to the ligaments of the fetlock or produce disease of the joint or bone. as the feet become sensitive and sore the animal persistently lies down, and it has been found that bedsores develop with amazing rapidity in all such cases and wholly baffle all attempts at treatment until after the patient has regained its feet. the disease may attack some of the internal organs before it appears upon any of the external tissues. these cases are very liable to prove quickly fatal. the animal dies from paralysis of the heart, due to the formation of poisonous principles within the system; it may suffocate by reason of the action of these same poisons upon the tissues of the lungs, or it may choke to death as a result of paralysis of the throat. in cases of serious affection of the udder the erosions will often be found within the passages of the teats, resulting in a "caked" udder, and the same toxic poisoning which is the cause of death in the apoplectiform types just mentioned may arise from this source. in any event the milk from such cases is dangerous for use, causing fatal diarrhea in sucking calves or young pigs and serious illness in human consumers. the milk obtained from cows suffering with foot-and-mouth disease is not readily converted into either butter or cheese, but remains thick, slimy, and inert in spite of churning and attempts at curdling. pregnant animals may abort. in pigs, sheep, and goats the lesions in the foot are most common, but both forms may be observed or only the mouth lesions. when the disease has become fully established it will be found that the duration of the attack will vary greatly with different animals. from to days are usually required for the recovery of the normal appetite and spirits in mild outbreaks, while the return to a full flow of milk, in the case of milk cows, seldom occurs before the arrival of the following season. in the malignant type of the disease it requires from three months to a year for an animal to recover. the mortality, as already stated, is usually low. the disease is more fatal in young animals that have been fed on infected milk, and produces death in from to per cent of these cases as a result of gastroenteritis. in the outbreak numerous new centers of infection started among hogs and calves which were fed on unpasteurized, infected milk from creameries. _diagnosis._--the recognition of this affection should not, as a rule, be difficult, especially when the disease is known to be in the vicinity; in fact, the group of symptoms form a clinical picture too decided to be doubted. the combination of high fever, vesicular inflammation of the mouth, and hot, painful, swollen condition of the feet, followed to hours later by the appearance of numerous blisters varying in size from that of a pea to that of a walnut on the udder and feet and in the mouth should prevent any serious or long-continued error in the diagnosis; however, in the inoculation of calves we have a certain and final test. in to hours after inoculation the calves present the characteristic blisters. such inoculation should be practiced, however, only by officials properly authorized to deal with contagious diseases. _differential diagnosis._--the lesions of no other disease of cattle closely simulate the vesicular eruption of foot-and-mouth disease on the lining membrane of the mouth. when the blisters have ruptured, however, and the resulting lesions have become contaminated by numerous secondary forms of microorganisms, the correct recognition of the disease may be involved in considerable difficulty. cowpox or horsepox may be accidentally transmitted by inoculation. but the eruption of the "pox" goes on to the development of a pustule, while in foot-and-mouth disease the eruption is never more than a vesicle, even though the contained fluid may become turbid. the inoculation test in the case of cowpox does not respond with fever and eruption for at least days, and often longer. necrotic stomatitis (sore mouth due to a germ) may be distinguished from foot-and-mouth disease by the fact that in the latter there is a rapid infection of the entire herd, including the adult cattle, as well as the infection of hogs and sheep. the characteristic lesion of foot-and-mouth disease is the appearance of blisters containing a serous fluid upon the mucous membrane of the mouth and upon the udder, teats, and feet of the affected animals. in necrotic stomatitis blisters are never formed, destruction of the tissues occurring from the beginning and being followed by the formation of yellowish, cheesy patches, principally found involving the lining membrane of the mouth, especially the tongue and cheeks. in mycotic stomatitis (sore mouth due to a fungus or mold), portions of the lining membrane become inflamed and in a few days it changes to a croupous membrane which peels off, leaving a raw surface, while the thin skin between the toes may also be inflamed. the previous history of the case; the failure of the blisters, if any appear, to spread extensively; the absence of vesicular eruptions on other portions of the body, notably the udder and teats, and, characteristically, the hoof, together with the absence of rapid spread to practically all cattle in the herd and the complete negative character of inoculation of calves, distinguish between the local disease named and foot-and-mouth disease. mycotic stomatitis occurs in only from to per cent of the animals in a herd, usually in the late summer or early fall after a dry spell, and it does not run a regular course. the lesion, resulting from ergotism may be distinguished from those of foot-and-mouth disease by the lack of eruptions in the mouth and by the location of the disease at the tips of the ears, end of the tail, or upon the lower part of the legs, usually below the knees or hocks. the lesion of ergotism does not take the form of pustules or blisters, but manifests itself first as a swelling about the ankle, which later may slough and circumscribe the limb, forming a deep crack, extending entirely around the limb and forming a distinct line of demarcation between the healthy skin above and the diseased below. the absence of ulcerous sores on the coronet and between the claws, together with the healthy condition of the membranes of the mouth and the knowledge that the lesion upon the limb in question extends uninterruptedly around it, should point conclusively to a diagnosis of ergotism and to the exclusion of all fears of foot-and-mouth disease. in foul foot or ground itch of cattle, the inflammation of the skin and toes is general and not in certain spots, as in foot-and-mouth disease. the mouth remains unaffected, and the presence of the disease may be traced to filth and poor drainage. the severer forms of the disease might be confounded with certain general diseases. if gastrointestinal symptoms predominate, acute gastric catarrh or inflammation of the intestines might be thought of. involvement of the lungs may lead to a diagnosis of acute congestion of the lungs or pneumonia. the distinction is apparent in these diseases by the lack of vesicular eruption on the mucous membrane or skin, and also by lack of evidences of infection in the herd or neighboring animals. _prevention and eradication._--the measures to be adopted to prevent the spread of the affection must take into consideration the highly infectious nature of the disease, its ease of dissemination, and the liability of the virus to live for long periods outside the body of an animal. great care should therefore be observed in keeping healthy animals unexposed to the contagion. when an outbreak occurs in a community the owner should make every effort to keep other animals from coming in contact with his diseased cattle. this especially applies to dogs, cats, goats, and poultry, which usually have access to the stables and barnyards and in this way furnish excellent means for disseminating the infectious principle. he should be equally particular in prohibiting any person from coming onto his premises, especially an attendant or owner or other person in any way connected with cattle. such a herd may be placed under quarantine, with an inspector appointed to keep the premises under constant surveillance. this method of quarantine alone, while very satisfactory in many instances, is rather tardy in obtaining the desired result. the experience of european governments already mentioned shows that eradication by this method alone, when the disease has obtained a foothold, is practically impossible. for this reason, when the disease breaks out in a country like the united states, where the contagion is likely to spread rapidly by means of infected cars, manure, hay, and other feed, and where the results of its obtaining a firm foothold would be so disastrous, it seems that this method of temporizing is rather tedious, and more radical steps are required in order to suppress and eradicate completely the infection in the quickest and most thorough manner possible. it would therefore appear better, after judicious appraisement, to concentrate the expense incident to the extermination of foot-and-mouth disease by purchasing and slaughtering all affected and exposed cattle. the carcasses of these animals should be totally destroyed, preferably by cremation, or otherwise by burying them in a hole feet deep and covering them with air-slaked lime. the infected stable should be disinfected by thoroughly cleaning it, scrubbing the floor with hot water, brushing down all loose dust from the walls, and tearing off all woodwork which is partly decayed. then the whole interior of the stable should be disinfected with one of the following substances: a per cent solution of pure carbolic acid. chlorid of lime, u. s. p. strength ( per cent available chlorin), pound to gallons of water. formaldehyde, quart per cent solution to gallons of water. a per cent solution of cresol compound, u. s. p., or accepted substitute therefor, containing at least per cent cresylic acid. all stable utensils should be thoroughly cleaned and disinfected by the application of a solution of one of the above-named disinfectants. the manure should be burned or disinfected and spread over ground (other than meadow land) that is to be turned under. no other cattle should be purchased for at least sixty days after the complete disinfection of the premises. the success in eradicating the disease by combined quarantine, slaughter, and disinfection, as practiced in the united states, denmark, great britain, and a few other countries, demonstrates in a striking manner the efficacy of slaughtering and the futility of relying upon quarantine alone to stamp out the disease. inoculation has been adopted in some countries in order to have the disease spread quickly through the herds, and while this practice has undoubted value where the disease is indigenous, it is not desirable in this country and should not be adopted. as a rule medicinal treatment with a view of curing affected animals is not to be recommended under conditions prevailing in the united states, where the disease has not become established, and the first object is to stamp it out as quickly as possible. even though most animals would recover, with or without treatment, it would be practically impossible, while they were being held for recovery, to prevent the spread of the infection to others. the disease would be liable to spread faster than it could be cured. as already pointed out, it has been found impossible to prevent absolutely the spread of the contagion by the strictest quarantine alone, under the usual farm conditions. in addition, the affected animals that have passed through the disease may become a source of further infection as virus carriers for weeks and months after they have apparently recovered, and are susceptible of reinfection, as one attack does not confer permanent immunity. _foot-and-mouth disease in man._--foot-and-mouth disease is primarily and principally a disease of cattle; secondarily and casually, a disease of man. it is transmissible to man through the eating or drinking of raw milk, buttermilk, butter, cheese, and whey from animals suffering from foot-and-mouth disease. it is also transmitted directly, though more rarely, from the salivary secretions or other infected material which may gain entrance through the mucous membrane of the mouth. it is doubtful whether the disease can be transmitted to man by cutaneous or subcutaneous inoculation, though it is probable that the infection may be communicated if the virus directly enters the blood through wounds of any kind. children are not infrequently infected by drinking unboiled milk during the periods in which the disease is prevalent in the neighborhood, while persons in charge of diseased animals may become infected through contact with the diseased parts or by milking, slaughtering, or caring for the animals. the symptoms in man resemble those observed in animals. there is fever, sometimes vomiting, painful swallowing, heat and dryness of the mouth, followed by an eruption of vesicles on the mucous membrane of the mouth, and very rarely by similar ones on the fingers. the vesicles appear on the lips, gums, cheek, and edge of the tongue, and are about the size of a pea. the vesicles soon rupture, leaving a small erosion which is soon covered by a thin crust under which the new formation of epithelium proceeds rapidly. the skin eruption mostly appears on the hands, tips of the fingers, base of the nails, and more seldom on the toes and other parts of the body. besides these local changes, during the course of the disease headache, pain in the limbs, vertigo, abdominal cramps, vomiting, diarrhea, and weakness are occasionally observed. the disease is seldom fatal, usually appearing in a very mild form except in weakened children, in whom an accompanying intestinal catarrh may lead to a fatal termination. veterinarians who have had considerable experience with the disease among animals regard the human affection as by no means uncommon in countries where foot-and-mouth disease prevails, but the disturbance of health is usually too slight to come to the notice of the family physician. but few outbreaks of the disease in man have occurred in the united states, and therefore cases of its transmission to man in this country are rather rare. dr. james law reports having observed the disease in man from drinking infected milk during the epizootic of in the eastern states, but the outbreaks of and affected such a small number of animals and were so quickly suppressed that no instance of its transmission to man was recorded. a few cases have been reported by brush accompanying the new england outbreak of . similar reports have been likewise received concerning the appearance of vesicular eruptions in the mouths of children during the and outbreaks, and the history of these cases incriminates the milk supply. experiments by loeffler and froesch, as well as recent experiments which have been made in denmark and germany, indicate that the infection is comparatively easy to destroy by heat or the usual antiseptics. milk pasteurized at a temperature of ° c. for minutes is safe so far as infection by foot-and-mouth disease is concerned. septicemia and pyemia. these two names are applied to diseased conditions which are so nearly alike in their symptoms that it is sometimes difficult to distinguish the one from the other. indeed, the name pyosepticemia, or septicopyemia, is often applied when it is impossible to make a distinction between septicemia and pyemia or where each is equally responsible for the diseased condition. the name septicemia is derived from two greek words meaning "poison" and "blood," and signifies that the germ lives in the blood, hence the use of the term "blood poisoning" for this disease. pyemia is likewise derived from two greek words, meaning "pus" and "blood," and is that form of septicemia caused by pus-producing organisms and characterized by secondary abscesses. _causes._--neither of these diseases is brought about, strictly speaking, by any specific organism; hence neither can be looked upon as a specific disease. the organisms most frequently found in cases of septicemia are, on the whole, the same as those of pyemia, and may be pus cocci, the bacillus coli, or other pus-producing organisms. these organisms are often found as secondary invaders in other diseases, such as advanced cases of tuberculosis, in which cases they are responsible for the formation of pus. aside from the causative organism, or, in other words, the active cause, there are many secondary causes. the most important of these in pyemia is a break in continuity of the protective covering, as a wound, which affords an entrance into the tissues for the organisms. among the different varieties of wounds may be mentioned cuts, bruises, punctures, burns, chemical or frozen wounds, and compound fractures of bones. injuries received during parturition, stoppage of the milk ducts, and infection of the umbilicus in the newly born are also frequent causes of pyemia. septicemia usually follows surgical wounds, local suppuration, enteritis, bronchitis--in fact, wherever there is a local lesion of any kind permitting germs to enter the blood. septicemia was formerly applied to designate the condition in which the organisms were localized, but in which their toxins were diffused in the blood. pyemia was made to represent that condition when the organisms were localized, but in which the pus was transported by the blood. these terms now are applied to conditions in which both the organisms and their toxins, or the pus, are present in the blood. the term septicemia is indicated when intoxication is the more pronounced symptom and pyemia if pus formation and metastatic or secondary abscess formation are observed. _symptoms._--the symptoms of both diseases include primarily a high fever ( ° to ° f.). coupled with this there is disinclination to move, the animal is depressed and not cognizant of its surroundings. the pulse is rapid, small, and feeble, respiration increased, mucous membrane injected, swollen, and of a yellowish tinge. appetite is lost and death follows in the case of septicemia in from two to four days. in pyemia the symptoms come on more slowly and are not so intense as in septicemia, while the course of the disease is longer, lasting from six days to four weeks. the mortality is not so great as in septicemia, but the period of convalescence is always long. _lesions._--septicemia is characterized by the destructive changes in the blood, which is chocolate colored, noncoagulable, and swarms with bacteria. the lining membranes of the heart are studded with red spots, often running together to form a large hemorrhagic area. the lungs, liver, and kidneys may also show these hemorrhages. the spleen is enlarged and full of black blood. the cadaver decomposes very rapidly and in some cases forms great quantities of fetid gas. in pyemia, in addition to these lesions, abscesses are formed in the various organs throughout the body. if the disease develops slowly a post-mortem examination shows the abscesses to be the chief alterations. the pus content is usually greenish, stained with blood, and contains strings of fibrous tissue and necrosed matter. _treatment._--treatment is almost futile in advanced cases of either disease. septicemia is usually fatal and pyemia frequently so. prevention and the immediate treatment of local infections are the surest means of combating them. for local treatment of wounds the usual antiseptics are indicated, such as per cent compound cresol or carbolic acid, or one one-thousandth bichlorid-of-mercury solution. for pyemia, where the abscesses are near the skin, they should be opened and treated antiseptically by injecting any of the previously mentioned germicides. general and heart stimulants are indicated, such as a drench containing digitalis drams and alcohol ounces. quinin and calomel in repeated small doses of one-half dram each three times a day are sometimes beneficial. camphor in the form of oil of camphor (camphor dissolved in parts of sweet oil) is a good stimulant and has some antiseptic properties, which make it a valuable drug in combating these diseases when it is given in doses of drams three times daily. hemorrhagic septicemia. hemorrhagic septicemia is a name applied to a highly fatal, infectious disease existing in various species of domestic and wild animals, from a microorganism having definite biological characters and possessing the properties of producing clearly defined and characteristic lesions. this causal agent, _bacterium bovisepticum_, belongs to the same group of cocco-bacilli as those causing chicken cholera, swine plague, and rabbit septicemia, and may be described as an ovoid, nonmotile, polar-staining bacterium with rounded ends, / of an inch wide by / of an inch long, sometimes seen in pairs and sometimes in chains. various names have been applied to this disease, and though the causative agent and the distinctive lesions are well known, it is more than likely that the affection is seldom recognized. it was described by bollinger in , and named wild und rinderseuche, from its having affected deer, wild boars, cattle, and horses in an epizootic which swept over germany at that time. before this, however, several epizootics of what was evidently the same disease had been well described, notably that which occurred in england in . since then it has occurred in epizootic and enzootic forms in many sections of europe, asia, africa, and america. in this country the disease has been observed in texas, tennessee, new york, minnesota, pennsylvania, district of columbia, south dakota, and wisconsin. other names given to it are game and cattle disease, buffalo disease, barbone, pasteurellosis bovina, ghotwa, and infectious pneumoenteritis. in earlier times it was evidently confounded with gloss anthrax, and even now it is probably mistaken in a great many instances for anthrax, blackleg, cornstalk disease, and cerebrospinal meningitis. the disease is essentially a septicemia, or blood poisoning, and the microbic invasion occurs from inoculation probably either through abrasions of the skin or by injury to the mucous membranes from coarse fodder, etc. moore and smith have found in the mouths and nasal cavities of healthy animals, including cattle, bacteria belonging to this group; but these organisms proved to be nonpathogenic. as is well known, however, many pathogenic germs at times exist in a saprophytic state, and it is not hard to conceive how a microbe may cease such existence and assume parasitic or pathogenic properties when the surroundings are eminently favorable. this may be a connecting link in the etiology of sporadic outbreaks of the disease in which all other hypotheses as to its genesis seem untenable. the disease seems to occur most frequently in swampy or mucky localities or in pastures receiving the overflow from infected fields. it is said to occur usually in the spring of the year, when the melting snows and rains bring to the surface the subterranean waters from rich soils containing nitrogenous materials in which the bacteria have been existing. in a great many instances there does not seem to be any plausible explanation for an outbreak of the disease and one can only surmise as to its origin. _symptoms._--three forms of the disease are recognized, based upon the distribution of the lesions--the superficial, or cutaneous, the pectoral, or thoracic, and the intestinal form. the last is a usual accompaniment of the other two and may be mild or severe. naturally the symptoms vary according to the violence of the attack and to the particular form of disease with which the animal is affected. in the superficial, or cutaneous, form the presence of a swollen tongue, throat, and dewlap, or even of the lower portion of the legs, gives us a clew to the trouble. an entire loss of appetite occurs, and in milk cows there is a diminution of the milk secretion. the temperature may be only slightly elevated, but it is usually very high. salivation is set up by the inflammation of the mouth and pharynx. unsuccessful efforts at eating and swallowing are made. there may be difficulty in breathing, depending on the amount of involvement of the larynx, trachea, bronchi, or lungs. there may be a blood-stained discharge from the nostrils, and the mucous membrane thereof will often show punctiform hemorrhages. the pulmonary form shows the same symptoms as croupous pneumonia, with a frequent suffocative cough and oppressed breathing, or dyspnea. when the intestines are involved the patient strains to defecate, and passes shreds of intestinal mucus along with blood-stained feces. the urine also may be tinged with blood. finally a severe diarrhea takes place, the animal becomes correspondingly weak, and death takes place in to hours. cases may die in as short a period as six to eight hours, while in the pectoral form of the disease the animal may linger six or eight days. cases have been reported which became chronic and in which death did not take place for a month or more. in some of the cases running an acute course, symptoms of toxemia are present; there is a lack of sensation of the skin, staggering gait, trembling, eyes fixed, neck at times bent to one side, and the eyes showing a wild expression. at times the animals appear as if in pain and look around at the flanks. in the pectoral form they may stand with the forelegs wide apart in evident effort to breathe more freely. sometimes there is a champing of the jaws and a very free flow of glairy saliva dropping from the mouth. the prognosis is decidedly unfavorable and to per cent of the cases result fatally. _lesions._--the characteristic lesions of hemorrhagic septicemia consist of hemorrhagic areas in the subcutaneous, subserous, and muscular tissues, the lymph glands, and the viscera; in fact, they are distributed more or less widely throughout the body and vary in size from a mere speck to the diameter of a half dollar or even larger. the superficial form presents itself first as a doughy tumefaction of the skin about the region of the throat, neck, dewlap, or legs, which pits on pressure. this tumefaction consists essentially of a cerogelatinous exudate into the subcutaneous and intermuscular tissues. bloody extravasations may take place in subcutaneous tissues in various places, but they are usually seen about the lower portion of the neck. the mucous membranes and submucous tissues of the mouth, tongue, pharynx, and larynx become involved in the process and are greatly thickened, inflamed, and infiltrated with serum. the mucous membrane becomes reddish purple, and that of the nostrils may in addition show hemorrhagic spots on its surface. the lymphatic glands in this region are also swollen and infiltrated with bloody serum. the salivary glands are pale and dry. the pectoral type, though at times existing alone, may coexist with the cutaneous form. the inflammatory edema of the mouth extends to the mucous membrane of the trachea and bronchi, producing an extensive thickening and a yellowish infiltration. the lung shows interstitial thickening from the outpouring of serum into its meshes. it may become pneumonic. the diaphragm, heart sac, and heart walls show numerous hemorrhagic points and larger bloody extravasations. sometimes there is a serous pleurisy, with more or less fibrinous exudate. in the intestinal form the submucous and subperitoneal tissues show alterations from a few hemorrhagic spots to large bloody suffusions, or even gelatinous infiltrations. this latter is seen about the region of the pancreas and in the folds of the mesentery. there is a severe hemorrhagic inflammation of the intestines and a staining of the intestinal contents with blood. the muscular system throughout shows hemorrhagic areas. the abdominal viscera, liver, spleen, and kidneys often present hemorrhagic lesions. _differential diagnosis._--anthrax, which presents superficial swellings, like hemorrhagic septicemia, may be distinguished from that affection on post-mortem examination by the enlargement and engorgement of the spleen, the contents of which are soft and tarry. the blood of anthrax animals is very dark, and does not become light red on exposure to air, nor does it coagulate, while in hemorrhagic septicemia the blood is normal in appearance and coagulates. the detection of the anthrax bacillus in the blood would be final. in blackleg the animals affected are usually under years of age. the swellings are quite evident, and usually occur on the legs, above the knees or hocks, and are distended with gas, which crackles, or crepitates, when pressed upon. if one of these tumors is opened, a bloody serum will exude, and the gas gives off the odor of rancid butter. the internal hemorrhages are not general, although they may occur. a microscopic examination of the juices from the tumefaction will show the blackleg bacillus. in cerebrospinal meningitis the causative agent is unknown, but probably exists in the feed. it may occur in any locality and at any season of the year. there are no local swellings, and cattle are not frequently affected. cornstalk disease may be differentiated from this affection from the fact that it always occurs after the cattle are turned into a cornstalk field, by its sudden onset, the absence of any characteristic symptoms or post-mortem lesions, and the failure to find the causative agent in the blood. in making a post-mortem examination of animals affected with hemorrhagic septicemia, it would be well to examine the articular surfaces of the long bones, as it has been reported that they are frequently ulcerated. this should apply especially to those cases that have shown lameness. _treatment._--treatment is absolutely useless, so far as we know at present, and for all practical purposes prophylaxis alone should be relied upon. the same sanitary precautions, such as isolation, disinfection, and burial or burning of all dead carcasses, should be observed as for anthrax and other highly infectious diseases. all the premises, barns, stalls, litter, and stable utensils should be thoroughly disinfected. separate the apparently well animals from the sick by placing them in a separate lot. experiments by the bureau of animal industry toward protective inoculation of the exposed cattle on infected premises have been made and the results have been so satisfactory that several commercial houses handling biological products are manufacturing a vaccine for hemorrhagic septicemia in accordance with the government's experiments on this subject. the method of preparing the vaccine is similar to that recommended by lignières. it consists in growing the cultures of the organism of the disease at to ° c. and preparing from them growing at this temperature two different strengths of vaccine. the weaker vaccine, which is used for the first injection, is grown for five days at this temperature, whereas the stronger vaccine, for the second injection, is grown for only two days. these vaccines are used with an interval of days between the injections, the dose being cubic centimeter at each injection. the effect of this vaccine in abating outbreaks already in progress has been highly satisfactory and it is plain that the general introduction of preventive vaccination for hemorrhagic septicemia must be of material benefit to the cattle raisers in the infected districts. vesicular eruption of the genital organs. this contagious disease is called coital exanthema or vesicular exanthema, and is more or less prevalent on the continent. it has also been observed in the breeding districts of the united states. it is the subject of legislation in germany, and governmental statistics are published annually concerning its distribution in the empire. according to the reports from hungary head of cattle were attacked during , in , and in . a similar or perhaps identical disease of horses has the same distribution and is transmissible from horses to cattle and vice versa. the disease may be defined as a highly contagious eruption situated upon the external genital organs of both sexes and accompanied with little or no general disturbance of health. the contagion, the nature of which remains still unknown, is transmitted mainly during copulation. the bull may have the disease and convey it to all the cows with which he comes in contact, or he may become infected by one cow, and, although not showing the disease, he may, during copulation, transmit it for several days after to all other cows. simple contact between one cow and another may convey the disease, or the sponges used in cleaning the diseased may carry the virus to the healthy. it has also been conveyed to healthy cows by these animals lying with their hind quarters against infected wooden troughs. _symptoms._--the period between the infection and the appearance of symptoms is somewhat variable. it is usually given as three to six days. it may be briefer or much longer. in cows the mucous membrane of the vagina and the vulva become swollen, inflamed, very tender, and covered with dark-red spots. the secretion is very abundant and consists at first largely of serum and mucus resembling the white of an egg. small vesicles then appear, which rapidly burst and are converted into excoriations or deeper ulcerations. the secretion becomes more purulent and is apt to dry in crusts about the root of the tail. the eruption is accompanied with much itching and difficulty in urinating. the walk may be stiff and awkward. in bulls the eruption is situated on the prepuce and the end of the penis, and consists of pimples, vesicles, and ulcers, as in cows. it is accompanied with a little purulent discharge from the prepuce, itching, and difficulty in urinating. in severe cases the inflammation and swelling may extend backward to the scrotum and forward upon the abdomen. the disease lasts from one to four weeks and always terminates in recovery. the acute stage lasts only four or five days, while the complete healing of the inflammation is slow. the eruption is usually accompanied with very little general disturbance. if the pain and irritation are severe, there may be some light loss of appetite and diminished milk secretion in cows. the disease rarely causes abortion. chronic catarrh of the vagina and permanent sterility frequently follow as sequelæ. _treatment_ need not be resorted to excepting in severe cases. the secretion and exudation should be washed off and a mild antiseptic applied, such as a per cent solution of carbolic acid ( ounce to quarts of water) or per cent solution of cresol compound in water. care must be taken not to carry the disease from the sick to the well by sponges, etc., which have come in contact with the affected organs. these should be destroyed. to prevent the spread of the disease the infected animals should be kept isolated until they have recovered. rabies of cattle. rabies is a disease preeminently affecting the canine race, although all warm-blooded animals, including man, are susceptible to the malady, which is always communicated through bites from a preceding case. it has required many years of patient, scientific research to lead the ablest investigators to a clear comprehension of the cause, nature, and characteristics of this affection. it was known and described several centuries prior to the beginning of the christian era, and from the earliest dawn of history it has been feared and dreaded. its terrible manifestations have always been surrounded with an atmosphere of awe and mystery, and it is not surprising that myths, fallacies, and misconceptions in regard to it have been common and widely accepted. as the investigations by which we have come to a tolerably clear understanding of the facts concerning rabies have been comparatively recent, and for the most part, have appeared in scientific periodicals, fallacies in regard to the disease continue to have a strong hold upon the public mind. for instance, it is still a widely prevalent belief that if persons or animals are bitten by a dog they are liable to become rabid if the dog should contract the disease at any future time. there is no foundation for this impression, and it would be a great comfort to many people who are now and then bitten by animals if the fallacy of this idea were known. all experience, both scientific and practical, goes to show that rabies is transmitted only by animals that are actually diseased at the time the bite is inflicted. rabies is an infectious disease involving the nervous system and characterized by extreme excitability and other nervous disorders and always terminating in death. the contagion of this disease has never been isolated, but the fact that it is caused by a specific organism principally found in the nervous system is indisputable. for instance, if an emulsion of the brain of a rabid animal is filtered through a germ-proof filter, the filtrate will be harmless. this fact indicates that the infectious principle is not in solution, but is an organism withheld from the filtrate by the filter. this contagion can be propagated only in the body of an animal. it is transmitted naturally from one animal to another solely by bites, and the old idea of spontaneous appearance of the disease is absolutely fallacious. it may be produced artificially by inoculating susceptible animals with an emulsion of the brain or spinal cord, as well as the saliva, milk, and other secretions of the affected animal. the blood, on the contrary, seems to be free from the infectious principle. the saliva contains the virus, which, under natural conditions, is introduced into or under the skin on the tooth of the rabid animal. the disease is widespread, being found in many countries of europe, asia, and africa, and in certain sections of the united states. owing to the rigid quarantine regulations enforced against dogs imported into australia, that country remains absolutely free from the disease. following the canine race, cattle seem to be the most frequently affected, probably because rabid dogs, next to their morbid desire to attack other members of their own race, have a better opportunity to bite grazing cattle than any other species of animal. the relative frequency of rabies in these two species of animals is indicated by the carefully compiled statistics of the german empire, which shows that dogs and cows died of rabies in , while in there were cases in dogs and in cattle. the latter receive bites most frequently on the hind legs and in the hips and about the lower jaw. these places are most accessible to dogs, owing to the habit of cattle to drive their tormentors away by lowering their heads and using their horns. every animal bitten does not necessarily develop the disease, but the per cent of fatalities has been variously estimated, and averages from to . this, however, depends on the location and size of the wound as well as the amount of hemorrhage produced, and various other conditions. in general, the nearer the bite is located to the central nervous system and the deeper the wound inflicted, the greater the danger of a fatal result. in cases in which the hemorrhage resulting from the bite is profuse, there is a possibility that the virus will be washed out of the wound and thus obviate the danger of subsequent appearance of the disease. the virus after being deposited in the wound remains latent for an extremely variable period of time, which also depends on the size and depth of the wound as well as its location and the amount of the virulent saliva introduced. experiments have proved that the virus follows the course of the nerves to the spinal cord and along the latter to the brain before the symptoms appear. gerlach, having collected the statistics from cases, has found this time, known as the period of incubation, to vary from to days. the great majority of cases, however, contract the disease in one to three months after the bite has been inflicted. _symptoms._--as in dogs, both furious and dumb rabies are met with, the former being more common in cattle. a sharp line of distinction, however, can not be drawn between these two forms of the disease, as the furious form usually merges into the dumb, from the paralysis which appears prior to death. the typical cases of dumb rabies are those in which the paralysis appears at the beginning of the attack and remains until death. the disease first manifests itself by a loss of appetite and rumination, stopping of the secretion of milk, great restlessness, anxiety, manifestation of fear, and change in the disposition of the animal. this preliminary stage is followed in a day or two by the stage of excitation, or madness, which is indicated by increasing restlessness, loud roaring at times with a peculiar change in the sound of the voice, violent butting with the horns and pawing the ground with the feet, with an insane tendency to attack other animals, although the desire to bite is not so marked in cattle as in the canine race. a constant symptom is the increased secretion of saliva with a consequent frothing at the mouth, or the secretion may hang from the lips in long strings. constipation is marked, and there is manifested a continual, although unsuccessful, desire to defecate. spasms of the muscles in different parts of the body are also seen at intervals. about the fourth day the animal usually becomes quieter and the walk is stiff, unsteady, and swaying, showing that the final paralysis is coming on. this is called the paralytic stage. the loss of flesh is extremely rapid, and even during the short course of the disease the animal becomes exceedingly emaciated. the temperature is never elevated, it usually remaining about normal or even subnormal. finally, there is complete paralysis of the hind quarters, the animal being unable to rise, and but for irregular convulsive movements lies in a comatose condition and dies usually from the fourth to the sixth day after the appearance of the first symptom. _anatomy._--if animals which have succumbed to rabies are examined post mortem, very slight evidence of disease will be found in any of the organs, and, indeed, the absence of any specific lesions may be considered as characteristic. the blood is dark and imperfectly coagulated. the throat is frequently reddened, and there may be small spots of extravasated blood in the intestines. the stomachs are usually empty. in the spleen there may be hemorrhagic enlargements (infarcts). the cadavers rapidly undergo decomposition. _differential diagnosis._--it is not an easy matter to decide definitely that a given animal has rabies, since the symptoms given above belong in part to a variety of other diseases, among which may be mentioned the excitement seen in young animals following close confinement, certain vegetable and mineral poisons, acute enteritis, and alterations of the central nervous system in cattle, the most common of which is tuberculosis of the brain and its covering membranes. the post-mortem lesions, however, should assist in making a correct diagnosis. tetanus may readily be differentiated from rabies by the persistence of muscular cramps, especially of the face and abdomen, which cause these muscles to become set and as hard as wood. in tetanus there is also an absence of a depraved appetite or of a willful propensity to hurt other animals or to damage the surroundings. the cow remains quiet and the general muscular contraction gives her a rigid appearance. there is an absence of paralysis which marks the advanced stage of rabies. the form of dumb rabies in dogs is characterized by the paralysis and pendency of the lower jaw, while in tetanus the jaws are locked. this locking of the jaws in cattle renders the animal incapable of bellowing, as in rabies. finally, tetanus may be distinguished from rabies by the fact that the central nervous system does not contain the infectious principle, while in rabies the inoculation of test rabbits with the brain or cord of a rabid animal will produce the disease with characteristic symptoms after an interval of to days. this period of incubation is much longer than in tetanus, since the inoculation of rabbits with tetanus cultures invariably results in death after a short period and usually within three days. the positive evidence that a rabid dog has been near cattle would greatly assist in making a decision in doubtful cases. the disease in dogs is pretty well recognized by most people, but in case a suspected dog is killed it is desirable to open the animal and examine the contents of the stomach. while feed is absent, a variety of odd things may be present which the abnormally changed appetite of the rabid dog has induced it to swallow. among such things may be straws, sticks, glass, rags, earth, pieces of leather, and whatever the animal may have encountered small enough to be swallowed. this miscellaneous collection in the stomach of dogs, together with absence of feed, is regarded by authorities as a very valuable sign, and in case of doubt may be made use of by laymen. in important cases, however, the head of the dog, cow, or other suspected animal should be removed and sent to the nearest biological laboratory, where a positive diagnosis can be made within hours by the histological examination of the plexiform nerve ganglia, and within two or three weeks by the intracerebral inoculation of rabbits with an emulsion of the brain of the suspected animal. _treatment._--this is useless after the first appearance of symptoms. when, however, a wound inflicted by a rabid animal can be discovered, it should be immediately cauterized or even completely extirpated, care being taken to cut entirely around the wound in the healthy tissues. for cauterizing the wound, fuming nitric acid, the hot iron, and per cent solution of zinc chlorid are the most efficacious. to afford an absolute protection, this should be done within a few moments after the bite has been inflicted, although even as late as a few hours it has been known to thwart the development of the disease. pasteur originated and perfected a system of preventive inoculation against this disease which has greatly reduced the mortality in human subjects. its application to animals, however, is difficult and requires considerable time and expense. a method of vaccination applicable to animals, consisting of a single injection of a suspension of "fixed" rabies virus, is now being quite extensively employed by veterinarians. sanitary regulations which seek to control effectively the disease by exterminating it among dogs are most likely to prove successful. the measures which are adopted to this end can not be discussed in this place, but it is a striking fact that where the muzzling of all dogs has been rigidly enforced, as in england and in certain german districts, the disease has been practically stamped out. tuberculosis. [pls. xxxiv-xxxviii.] tuberculosis is an infectious and communicable disease characterized in its early stages by the formation, in various organs of the body, of minute nodules or tubercles, which contain _mycobacterium tuberculosis_, the cause of the disease. the disease, in its various manifestations, has been known for many centuries, and legislative enactments having reference to the destruction of affected animals and forbidding the use of the flesh date far back into the middle ages. the opinions entertained regarding the nature and the cause of the malady varied much in different periods and very markedly influenced the laws and regulations in vogue. thus, in the sixteenth century, the disease was considered identical with syphilis in man. in consequence of this belief very stringent laws were enacted, which made the destruction of tuberculous cattle compulsory. in the eighteenth century this erroneous conception of the nature of the disease was abandoned and all restrictions against the use of meat were removed. since that time, however, its communicable nature has been established by many investigators, and the tide of opinion has again turned in favor of repressing the disease and prohibiting the sale of contaminated products. _occurrence._--the statistics concerning tuberculosis show that it is a disease prevalent in all civilized countries. in some countries, such as the northern part of norway and sweden, on the steppes of eastern europe and russia, in sicily and iceland, and in algiers, it is said to be quite rare. the returns from testing british cattle with tuberculin, supplied by the royal veterinary college, as stated in march, , showed that among , animals tested , , or per cent, reacted. during the slaughter of cattle for pleuropneumonia careful examinations of the carcasses were made for tuberculosis. of head killed near edinburgh , or per cent, were tuberculous. of , killed in england per cent were tuberculous. of one of these lots of cattle ( animals) the president of the lancashire farmers' association testified that they were fairly representative cattle--cows, heifers, and growing stock--a thoroughly mixed lot; per cent of them had tuberculosis. of bovine animals taken haphazard in the city of manchester, , or per cent, were tuberculous. among them were cows, , or per cent, being tuberculous, and having diseased udders. the result of testing the queen's herd at windsor was that out of , or per cent, were found tuberculous. the investigations made by the british dairy farmers' association deserve particular attention, coming as they do directly from a cattle owners' organization. the council of this association "resolved to submit the general consideration of the question to a committee, with a view to some more definite understanding as to the possible extent to which tuberculosis exists in dairy cattle." the secretary was instructed to write to a number of dairy farmers being members of the association, asking their cooperation and the use of their herds for the application of the tests. of the herds offered, were selected, containing cows and bulls, and of these animals reacted, being . per cent. there were among these cattle shorthorns, of which , or per cent, reacted; crossbreds, of which , or per cent, reacted; ayrshires, of which , or per cent, reacted. another experiment of much interest is that of the cheshire county council. the technical instruction committee set aside £ to be used by a joint committee from the agricultural and horticultural schools and worleson dairy institute for applying the tuberculin test to their herds. the tests were made february , . the results were: worleson herd of animals, diseased, or . per cent; agricultural school herd of animals, diseased, or . per cent. the worleson herd consisted of shorthorn cows. in each herd the purebred shorthorn bull was tuberculous. the results of the tuberculin test were confirmed by the slaughter of the animals and examination of the carcasses. sir t. d. g. carmichael, member of parliament for midlothian, gave evidence before the royal commission that his polled angus herd was tested in the spring of . "the results of the test were fearfully unexpected and alarming." of tested showed decided reaction-- per cent. again, he speaks of having animals tested the same spring and reacted-- . per cent. of shorthorn cattle intended for export which were tested reacted, or per cent. of a herd of british shorthorns recently tested in quarantine per cent were found tuberculous. the addition of these animals above referred to gives , head examined and , , or per cent, pronounced tuberculous. and these herds were not selected because they were supposed to be tuberculous, but represent the general cattle stock of the country. these animals included at least head of shorthorns, of which , or per cent, were tuberculous. to these facts may be added the evidence of prof. bang that in the first half of the nineteenth century tuberculosis was brought to denmark by cattle from switzerland, schleswig, and england, and that the same thing is now going on in sweden and norway, particularly through english cattle. also the evidence of m. sivori, chief of section at the ministry of agriculture, argentina, who has investigated tuberculosis in that country and who says that " or years ago tuberculosis was unknown in argentine cattle, and it is still unknown among the native (criollo) cattle. its appearance dates from the introduction of pure breeding animals. statistics prove that tuberculosis is observed among the grades--above all among those of the durham and less among the hereford." moreover, the reports of the royal commission of victoria, australia, and of the new zealand department of agriculture show a large proportion of tuberculous cattle in those colonies, where the disease was almost certainly carried by british cattle. in the same manner that tuberculosis has been carried from great britain to denmark, sweden, norway, argentina, and australia, it has also been taken to canada. in one herd of imported cattle slaughtered in the canadian quarantine station, of the animals were found tuberculous. one of the largest shorthorn herds in canada was some time ago tested because an animal from it was condemned when offered for shipment to the united states. this herd was found to be very badly affected, and an effort is being made to eradicate the disease by the bang method. a canadian official publication says of another shorthorn herd, which at one time had a very high reputation, that when an investigation in regard to tuberculosis was recently made the disease was found among ordinary cattle wherever animals from this herd had been introduced, and that this herd, which had been looked upon as one of the greatest benefits to the farming community, was really a danger, because it disseminated tuberculosis among the farmers' herds. still another well-known herd recently attracted attention because four animals from it offered for export to the united states were all tuberculous. from december , , to february , , the period that the department inspector tested all canadian cattle intended for shipment to the united states, purebred shorthorns and shorthorn grades were tested, and of the total number , or per cent, reacted. during the first month that this inspection was enforced, and when it may be assumed that the condition of the cattle most nearly represented what it had previously been, cattle were offered for importation, and , or . per cent, were found tuberculous. in justice to shorthorn cattle it should be said in this connection that they are probably no more susceptible to tuberculosis than are other breeds, but the disease has been allowed to spread in certain herds and families to such an extent as to give a wrong impression concerning the breed as a whole. the slaughterhouse statistics of prussia show . per cent of the cattle and . per cent of the hogs to be tuberculous. in saxony the percentage is . with cattle and . with hogs. in the city of leipzig the figures are . for cattle and . for hogs. (siedamgrotzky.) of , animals in belgium tested with tuberculin in , . per cent reacted. (stubbe.) of , tested in denmark from to , . per cent reacted; and of , tested from to , . per cent reacted. (bang.) figures available in the united states allow us to make a reliable estimate of the extent of tuberculosis of cattle. the following summary is presented: _statistics of tests for tuberculosis in the united states, to march , ._ -----------------------+---------+------------+------------- state. | number | number | per cent | tested. |tuberculous.|tuberculous. -----------------------+---------+------------+------------- alabama | , | , | . arkansas | , | | . colorado | , | | . connecticut | , | , | . delaware | , | , | . florida | , | , | . georgia | , | | . idaho | , | , | . illinois | , | , | . indiana | , | , | . iowa | , | , | . kansas | , | , | . kentucky | , | , | . louisiana | , | | . maine | , | , | . maryland | , | , | . massachusetts | , | , | . michigan | , | , | . minnesota | , | , | . mississippi | , | | . missouri | , | , | . montana | , | , | . nebraska | , | , | . nevada | , | , | . new hampshire | , | , | . new jersey | , | , | . new mexico | , | | . new york | , | , | . north carolina | , | , | . north dakota | , | , | . ohio | , | , | . oklahoma | , | , | . oregon | , | , | . pennsylvania | , | , | . rhode island | , | | . south carolina | , | | . south dakota | , | , | . tennessee | , | | . texas | , | , | . utah | , | | . vermont | , | , | . virginia | , | , | . washington | , | , | . west virginia | , | | . wisconsin | , | , | . wyoming | , | | . -----------------------+---------+------------+------------- reports of tuberculin tests made on , cattle in the united states during the years to by federal, state, and other officers with tuberculin prepared by the bureau of animal industry show , reactions, or . per cent. these were mostly dairy cattle, and in some cases herds were suspected of being diseased. later reports of tuberculin tests made in the united states from july , , to march , , on , , cattle by state, county, and federal officers engaged in cooperative tuberculosis eradication work showed , reactions, or . per cent. all cattle in the district of columbia, numbering , , were tested with tuberculin in - , and . per cent reacted. in - herds in maryland and virginia supplying milk to the district of columbia were tested, with . and . per cent of reactions, respectively, among , cattle. all cattle in the district of columbia were tuberculin tested in - , numbering , , and animals reacted, or . per cent, demonstrating that tuberculosis may be eradicated from all the herds in a circumscribed area. the beef cattle of the united states show a much smaller proportion of the disease than dairy cattle, though the percentage of cattle found tuberculous in the government meat-inspection service has increased considerably in recent years. this increase is due partly, but not wholly, to more stringent inspection. of , , adult cattle slaughtered under federal inspection during the fiscal year ended june , , , were found tuberculous, a percentage of . . from the statistics above referred to, and other data, it appears that in the more densely populated areas of europe and america from to per cent of the dairy cattle are more or less affected with tuberculosis, while the proportion of beef cattle affected is distinctly less, ranging from . to per cent. this difference is due to a number of causes. beef cattle average younger when slaughtered. they are not so frequently stabled, and are for that reason less liable to infection, and as the males constitute a large proportion of this class of animals the effect of milk secretion in lowering the vital forces is not so apparent. in the united states it has been estimated that about per cent of the dairy cattle are tuberculous, while only about per cent of the beef cattle are so infected. _cause and nature of the disease._--the cause of tuberculosis is the tubercle bacillus, which gains entrance to the body, lodges somewhere in the tissues, and begins to grow and multiply at that point. as this bacillus vegetates and increases in numbers it excretes substances which act as irritants and poisons and which lead to the formation of a small nodule, called a tubercle, at the point of irritation. as the bacilli are disseminated through the animal body they affect many parts and cause the formation of an enormous number of tubercles. by the union of such tubercles, masses of tubercular material are formed, which in some cases are of great size. the disease is called tuberculosis because it is characterized by the formation of these peculiar nodules, and the bacillus which causes the disease is for the same reason known technically as the _mycobacterium tuberculosis._ there are undoubtedly predisposing conditions which contribute toward the development of the disease; some of these are found in the animal body and others in the environment. an enfeebled condition caused by insufficient feed, exposure to great extremes of atmospheric temperature and insanitary surroundings, or the drain occasioned by heavy production of milk, appear to aid the development of the bacillus, and there is also a special individual susceptibility in some cases which may be otherwise described as an inability of the animal tissues to resist and destroy the bacilli when they have penetrated to the inner recesses of the body. among the conditions of environment which aid the development of tuberculosis may be mentioned stabling with lack of ventilation, damp buildings, the keeping of many animals together, drafts of air which cause colds and catarrhs, and, in general, everything which prevents the animals from developing and maintaining the highest condition of health. none of these conditions of body or environment are sufficient to cause the disease, however, unless the animals are exposed to the _mycobacterium tuberculosis_ and it penetrates the tissues of their bodies. the ways in which the tubercle bacilli find their way into the body may be considered under four heads: ( ) by inhalation into the lungs; ( ) by taking into the digestive tract in the milk of tuberculous cows or with other contaminated feed; ( ) during coition when the sexual organs are tuberculous; ( ) from the tuberculous mother to the fetus in the uterus. the bacilli can reach the lungs by inhalation only when the bacilli are thoroughly dried and pulverized and in condition to be carried by currents of air. it is well known that the bacilli withstand drying for months before they lose their power of producing disease. they leave the bodies of diseased animals in several ways. there may be a little discharge occasionally coughed up as a spray from the diseased lungs, or this material may be swallowed and the bacilli carried off with the excrement, or milk may be spilt, or there may be a discharge from the vagina when the genital organs are tuberculous. there may also be ulcers of the intestines, from which many bacilli escape with the feces. the bacilli from these sources may become dried and pulverized and carried in the air of the stable and into the lungs of still healthy cattle, where the disease then develops. the disease of the stomach, intestines, and mesenteric glands is very probably the result of feed infection. tubercle bacilli may have been scattered upon the feed by diseased animals, but the most common source of such infection is the milk of tuberculous cows. calves may become infected in this way. the disease may remain latent until the animal becomes older. the not-infrequent occurrence of tuberculosis of the uterus and ovaries makes it probable that the disease may be transmitted by a diseased bull or carried by a healthy one from a diseased cow to a number of healthy cows. the source of infection is always some previous case of the disease, for the disease can never rise spontaneously; hence, in those stables in which there is frequent change of cattle the introduction of tuberculosis by cattle coming from other infected stables is the most frequent source of infection. since the bacilli when dried can be carried by the air, it is not necessary that healthy animals come in direct contact with cases of disease to become infected. in general, the greatest number of cases occur in the immediate environment of cities, where there are not only abundant opportunities for infection, owing to the frequent introduction of new animals into herds, but where the sanitary conditions may be regarded as the poorest. the bacillus of tuberculosis was discovered by robert koch in . it is a slender, rodlike body (see pl. xxviii, fig. ) from one-third to two-thirds the diameter of a red blood corpuscle in length. as already explained, when the bacillus has become lodged in any organ or tissue it begins to multiply, and thereby causes an irritation in the tissue around it, which leads to the formation of the so-called tubercle. the tubercle, when it has reached its full growth, is a little nodule about the size of a millet seed. it is composed of several kinds of tissue cells. soon a change takes place within the tubercle. disintegration begins, and a soft, cheesy substance is formed in the center, which may contain particles of lime salts. when these tubercles continue to form in large numbers they run together, forming masses of various sizes. the disintegration which attacks them leads to the formation of large cheesy masses of a yellowish color, containing more or less of lime salts in the form of gritty particles. these large tuberculous masses are surrounded by or embedded in layers of fibrous tissue which in some cases becomes very dense and thick. the disease is thus a development of these tubercles in one or more organs of the body. the distribution and number of the tubercles determine the course of the disease. in a large number of cases the changes are limited to the lungs and the serous membranes[ ] of the thorax and abdomen. pathologists have been in the habit of calling the lung disease tuberculosis and the disease of the serous membranes "pearly disease." statistics have shown that in about one-half of the cases both lungs and serous membranes are diseased, in one-third only the lungs, and in one-fifth only the serous membranes. at the same time the lymphatic glands near the diseased organs are usually involved. other organs, such as the liver, not infrequently contain tubercles. though the disease may remain restricted to a single organ, it now and then is found generalized, affecting all organs of the body. in the lungs (pl. xxxiv) the changes observed vary according to the age and intensity of the disease process. they usually begin with the appearance of very minute tubercles. these may appear in large numbers on the surface of the lungs or within the lung tissue. later the contents become cheesy and partly calcified. when these tubercles are sufficiently numerous to become confluent, large masses may be formed, which undergo the same retrogressive changes of caseation and calcification. in addition to the formation of tubercles in the lung tissue, certain other changes take place. there is usually bronchitis with abundant catarrhal secretion; this plugs up the smaller air tubes, and the lung tissue supplied with air by the tubes collapses. subsequently it becomes filled with yellowish, cheesy matter, which greatly distends the small air tubes and air vesicles (bronchopneumonia). the connective tissue between the lung lobules, around the tubercles, and around the air tubes becomes thickened and indurated. in the larynx and the bronchi tubercles may vegetate upon the mucous membrane, and ulcers may result from their breaking down. the inflammatory irritation which the growth of the tubercles on the surface of the lungs arouses gives rise to adhesion of the lungs to the ribs and diaphragm. this adhesion is sometimes so firm and extensive that the lungs appear grown to the chest wall. when, therefore, the lungs in advanced stages of the disease are cut open we observe large yellowish masses, from one-quarter to three-quarters of an inch in diameter, of a cheesy texture, in which calcified, gritty particles are embedded and which are surrounded by very firm connective tissue. the neighboring lung tissue, when collapsed and involved in bronchopneumonia, has the color and consistency of pale-red flesh. the air tubes, large and small, stand out prominently on the cut surface. they are distended with a pasty, yellowish, cheesy mass, surrounded and enveloped in thick mucus, and their walls greatly thickened. the larger bronchi may be sacculated, owing to the distention produced by the cheesy contents. the disease usually attacks the bronchial glands, which are situated on the trachea and bronchial tubes at the bifurcation. the changes in the glands are the same as those going on in the lung tissue, and they frequently reach an enormous size. the tubercle formation on the serous membranes covering the lungs and chest wall (pl. xxxvii, fig. ), which may go on at the same time with the lung disease or independent of it, has been called "pearly disease," on account of the peculiar appearance of the tubercles. these begin as very minute, grayish nodules, which give the originally smooth, lustrous membrane a roughened appearance. these minute tubercles enlarge, become confluent, and project above the surface of the membrane as wartlike masses, attaining the size of peas. in this stage their attachment to the membrane is by means of delicate fibers. the attachment is loose, so that the tubercle hangs by a short pedicle or neck and may be moved slightly to and fro. large masses are frequently formed by a coalescence of many tubercles and the secondary formation of the same. these may be found on the lungs, the ribs, and the diaphragm. these tubercles likewise undergo degenerative changes. the center partly softens and partly calcifies into a grayish mortarlike mass, and is gritty. associated with the formation of tubercles on the pleura, those glands situated back of the center of the lungs between the two main lobes (posterior mediastinal) become greatly enlarged and the center cheesy. (pl. xxxvi, fig. .) they may compress the esophagus and interfere with swallowing. the size attained by these tumors and new growths is well illustrated by the fact that, taken together, they not infrequently weigh from to pounds. the bronchial glands, which in the healthy state are not so large as horse-chestnuts, have been found to attain a weight of more than pounds. in the abdominal cavity tubercles may be found, both in the organs and on the serous membranes covering them. they are situated usually on the omentum, or caul (see pl. xxxvi, fig. ), the diaphragm, and the walls of the abdomen. in the liver large and small tubercular masses are occasionally encountered. (see pl. xxxv.) the mesenteric glands are occasionally enlarged and tuberculous; likewise the glands near the liver. tubercles may also develop in the spleen, the kidneys, the uterus and ovaries, and the testicles. tubercular affection of the intestines seems to be quite rare, although ulcers of the large intestines have been observed. nodules may also form under the serous covering of the intestines. the brain and spinal cord are occasionally found tuberculous. of cases, semmer found tuberculosis of the brain in . it is not improbable that, owing to the infrequency of exposing the brain and spinal cord, tuberculosis may have escaped the attention of pathologists, and it may be that it is not so uncommon as is generally supposed. the tubercles occur on the membranes of the brain as well as in the substance of the brain itself. they project into the ventricles as masses, varying in size from a pinhead to a hen's egg. they finally lead to various inflammatory changes. jöhne has observed numerous small tubercles on the membranes of the spinal cord. very rarely tuberculous lesions have been observed in the bones and muscles of the body. not so rare, however, is the affection of the lymphatic glands embedded in the muscular tissue, and those which can be felt beneath the skin. these are situated at the joints, under the jaw, and along the neck. of late tubercular disease of the udder in cows (pl. xxxviii) has received considerable attention from sanitarians, owing to the infection of the milk with the virus of tuberculosis. according to those who have given this subject special attention, the udder becomes swollen uniformly and quite firm. this swelling, which is painless, frequently attacks but one quarter, more rarely two, these being usually the hind quarters. the larger milk ducts contain yellowish, cheesy particles, in which are many tubercle bacilli. later larger nodules can be felt within the udder, which undergo the various changes to which tubercles are subject. the udder may grow very hard to the touch and become very large, weighing in some cases up to pounds. the milk, at first normal, becomes thin and watery after a month or so, and is mixed with flakes and tubercle bacilli. as regards the frequency of the tuberculous processes in the different organs, the following carefully compiled statistics of the disease in bavaria and baden may serve as a guide: bavaria: per cent. tuberculosis of lungs and serous membranes tuberculosis of lungs alone tuberculosis of serous membranes alone (pearly disease) tuberculosis of other organs baden: tuberculosis of lungs alone tuberculosis of serous membranes alone both combined generalized tuberculosis tuberculosis of the sexual organs alone _symptoms._--the beginning of the disease usually passes unnoticed, inasmuch as it is very slow and insidious and rarely accompanied with fever. when the lungs are involved a dull, short cough is noticed, which may later on become prolonged, convulsive, and very troublesome to the animal. the cough is more frequent in the morning after movement and drinking. the breathing varies. only when much of the lung tissue is diseased is it labored and accompanied with active movements of the chest and nostrils. discharge from the nose is rare or absent. at times, however, when the tubercles have broken down and cavities containing cheesy masses have formed in the lung tissue, or when the air tubes have become filled with cheesy and mucous masses, coughing will dislodge them and cause their discharge. in advanced stages the breath may have a disagreeable odor. pressure on the chest wall may give rise to pain. the general effect on the body is at first slight. in fact, animals may remain in good flesh for a considerable time. invariably as the disease progresses loss of flesh and appetite and paleness of the mucous membranes become manifest. these symptoms are accompanied with a gradual diminution of the milk secretion. the debilitated condition of the animal is also manifested by a staring coat and a tough, dry, harsh skin (hidebound). digestive disturbances are indicated by tympanites, or distention of the rumen by gas, colic, and diarrhea, alternating with constipation. the animal generally dies from exhaustion after a period of sickness which may last months or even years. [illustration: plate xxxiv. tuberculosis of the lungs of cattle.] [illustration: plate xxxv. tuberculosis of the liver.] [illustration: plate xxxvi. tuberculosis of lymph gland and of omentum (caul).] [illustration: plate xxxvii. fig. .--tuberculosis of sirloin and porterhouse cuts of beef. fig. .--tuberculosis of pleura of a cow, so-called "pearly disease."] [illustration: plate xxxviii. tuberculosis of cow's udder.] * * * * * tuberculosis. description of plates. plate xxxiv. tuberculosis of the lungs of cattle. the upper figure represents a large cheesy mass, surrounded by a capsule of connective tissue, the whole embedded in healthy lung tissue. the lower figure illustrates in section a mass of tubercles which have undergone cheesy degeneration, and some of which are surrounded by dense connective tissue. plate xxxv. tuberculosis of the liver. a large portion of the lobe represented in the plate has undergone tuberculous changes. numerous nodules are shown in various stages of the disease, the majority of which, however, contain the yellowish, partly cheesy, partly gritty areas characteristic of advanced tuberculous degeneration. this large mass involves the surface of the liver, and also extends into the liver substance. plate xxxvi. tuberculosis of lymph gland and of omentum (caul). fig. . a lymph gland from the region of the thorax behind or above the esophagus, or gullet (posterior, or dorsal, mediastinum). the gland is shown cut through and laid open. it is very much enlarged, and the yellowish cheesy masses which represent tissue undergoing tuberculous changes are well shown on the cut surface. fig. . omentum, or caul, resting upon the paunch. the reddish nodules with which the membrane is beset are tubercles, the product of the disease. plate xxxvii. fig. . tuberculosis of the sirloin and porterhouse cuts of beef. the grapelike tuberculous growths are mainly restricted to the lining membrane of the abdomen. fig. . tuberculosis of the pleura of a cow, so-called "pearly disease." notice the grapelike clusters of tubercular nodules scattered over the lining membrane of the chest (pleura). plate xxxviii. tuberculosis of cow's udder. the udder was uniformly swollen and quite firm. small cheesy foci and yellowish lines of tuberculous material follow the course of the milk ducts. the mucous membrane of the milk cistern (_a_) is ulcerated and covered with yellowish cheesy particles. the supramammary lymphatic gland (_b_) is greatly enlarged and contains many miliary tubercular foci. * * * * * tuberculosis in the abdominal organs is often signalized by abortion and by abnormal sexual manifestations. when the brain is involved, the disease may cause convulsions, unconsciousness, paralysis, as well as peculiar movements in a circle, oblique position of the head, etc. lydtin quotes the following description of the disease as taken from a swiss sanitary order: a dry, short, interrupted, hoarse cough, which the sick animals manifest, especially in the morning at feeding time, still more after somewhat violent exertion. at first these animals may be full blooded and lay on a considerable amount of fat when well fed. as the disease progresses they grow thin and show more and more those appearances which indicate diseased nutrition, such as a staring, lusterless, disheveled coat; dirty, tense skin, which appears very pale in those regions free from hair. the temperature of the skin is below normal. the loss of fat causes sinking of the eyes in their sockets. they appear swimming in water, and their expression is weak. the cough is more frequent, but never or very rarely accompanied with discharge. the body continues to emaciate, even with plenty of food and a good appetite, so that the quantity of milk is small. at times in the early stages of the disease, still more in the later stages, the diseased animals manifest considerable tenderness when pressure is applied to the front or the sides of the chest by coughing, moaning, etc. often symptoms are wanting in spite of the existence of the disease. lydtin also quotes at length a description of the abnormal sexual desire occasionally observed among cows when affected with this disease. _diagnosis._--a disease so varied in its attack upon the different organs of the body and in the extent of the disease process must necessarily lead to mistakes when diagnosis is attempted by ordinary means of examination. it has been confounded with the later stages of pleuropneumonia, with parasitic diseases of the brain, the lungs, the intestines, and with actinomycosis. a careful examination of the lungs by auscultation and percussion enables the expert to locate large tuberculous masses, owing to dullness, loss of respiratory murmur, and abnormal sounds, such as blowing, whistling, and creaking. the majority of cases of tuberculosis in cattle, however, including many in which the lungs are quite seriously involved, can not be detected in this manner. the tuberculin test. the tuberculin test, which is marvelously accurate in its indications, has been almost universally adopted for the detection of tuberculosis. tuberculin is a drug prepared by sterilizing, filtering, and concentrating the liquids in which the tubercle bacillus has been allowed to vegetate. it contains the cooked products of the growth of these bacilli, but no living bacilli; consequently, when this substance is injected under the skin of an animal it is absolutely unable to produce the disease, cause abortion, or otherwise injure the animal. in case the injected animal is normal there is no more effect upon the system than would be expected from the injection of sterile water; however, if the animal is tuberculous, a decided rise of temperature will follow the use of tuberculin by the subcutaneous method. this substance, discovered by koch, has the effect, when injected into the tissues of a tuberculous animal, of causing a decided rise of temperature or other manifestations while it has no such effect upon animals free from the disease. the value of tuberculin for this purpose was tested during the years and by guttman, roeckl and schütz, bang and salomonsen, lydtin, jöhne and siedamgrotzky, nocard, and many others. it was at once recognized as a most remarkable and accurate method of detecting tuberculosis even in the early stages and when the disease had yet made but little progress. it is now quite generally employed. the tuberculin test came into existence through the most careful and thorough scientific experimentation. as a result of its use an accurate diagnosis may be established in more than per cent of the cases tested. the relatively few failures in diagnoses are included among two classes of cattle. the first class contains those that are tuberculous, but which do not react either because of the slight effect of an ordinary-sized dose of tuberculin on an advanced case of the disease with so much natural tuberculin already in the system, or on account of a recent previous test with tuberculin which produces a tolerance to this material, lasting for about six weeks. the second class includes those that are not tuberculous, but which show indications of a reaction as a result of (_a_) advanced pregnancy, (_b_) the excitement of [oe]strum, (_c_) concurrent diseases, as inflammation of the lungs, intestines, uterus, udder, or other parts, abortion, retention of afterbirth, indigestion, etc., (_d_) inclosure in a hot, stuffy stable, especially in summer, or exposure to cold drafts or rains, (_e_) any change in the method of feeding, watering, or stabling of the animal during the test. notwithstanding all these possibilities of error, the results of thousands of tests show that in less than per cent of the cases tested do these failures actually occur. in the first class the chances of error are decidedly reduced by the skilled veterinarian by making careful physical examination and diagnosing clinically these advanced cases, and by the injection of double or triple doses into all recently tested cattle, with the taking of the after-temperature, beginning two hours following the injection and continuing hourly for hours. it is therefore apparent that tuberculin should be applied only by or under the direction of a competent veterinarian, capable not only of injecting the tuberculin but also of interpreting the results, and particularly of picking out all clinical cases by physical examination. the latter observation is extremely important and should always be made on every animal tested. in the second class, where the temperature test is used, errors are avoided by eliminating from the test those cases that are nearing parturition or are in heat or show evidence of the previously mentioned diseases or exhibit temperatures sufficiently high to make them unreliable for use as normal. where other methods of test are used these conditions do not have an important bearing on the results. in addition, a satisfactory tuberculin must be used; also an accurate thermometer and a reliable syringe, in order that a sufficient dose of tuberculin may be given. finally, the number of apparent errors of the tuberculin test will be greatly diminished if a careful post-mortem examination is made, giving especial attention to the lymph glands. this low percentage of failures being the case, cattle owners should welcome the tuberculin test, not only for their own interest but for the welfare of the public as well. where this method of diagnosing the disease has been adopted tuberculosis is gradually being eradicated. without its use the disease can not be controlled and the owner is confronted with serious and continuous losses; with its use the disease can be eradicated from the herd, a clean herd established in a few years without very serious loss or hardship, and the danger of its spread to man removed. tuberculin may therefore be considered a most beneficial discovery for the stock raiser. law has clearly stated the question when he says-- many stock owners still entertain an ignorant and unwarranted dread of the tuberculin test. it is true that when recklessly used by ignorant and careless people it may be made a root of evil, yet as employed by the intelligent and careful expert it is not only perfectly safe, but it is the only known means of ascertaining approximately the actual number affected in a given herd. in most infected herds living under what are in other respects good hygienic conditions two-thirds or three-fourths are not to be detected without its aid, so that in clearing a herd from tuberculosis and placing both herd and products above suspicion the test becomes essential. * * * in skilled hands the tuberculin test will show at least nine-tenths of all cases of tuberculosis when other methods of diagnosis will not detect one-tenth. probably the most popular objection to tuberculin is that it is too searching, since it discovers cases in which the lesions are small and obscure. while this fact is admitted, it should also be remembered that such a small lesion to-day may break down and become widely disseminated in a relatively short period. therefore any cow affected with tuberculosis, even to a slight degree, must be considered as dangerous not only to the other animals in the herd but also to the consumer of her products. in bang, of copenhagen, one of the highest european authorities, in his paper presented to the congress for the study of human and animal tuberculosis, at paris, said: numerous tests made in almost every civilized country have demonstrated that in the majority of cases tuberculin is an excellent means for diagnosing the existence or nonexistence of the disease, but giving us no positive information as to the extent to which the disease has progressed. when tuberculin produces a typical reaction we may be almost sure that there exists in the body of the animal a tubercular process. the cases in which a careful examiner has not succeeded in finding it are very rare, and i am led to believe that when, notwithstanding all the pains taken, it has escaped discovery, the reason is that it is located in a portion of the body that is particularly inaccessible. nevertheless, it is not to be denied that a fever, entirely accidental and of short duration, may in some rare cases have simulated a reaction. however this may be, the error committed in wrongly condemning an occasional animal for tuberculosis is of no practical consequence. a worse aspect of the case is that there are some diseased animals in which tuberculin fails to discover the existence of tuberculosis. in most of these, no doubt, the deposits are old, insignificant, and generally calcified, or they are cases where the disease is arrested and perhaps in process of recovery, and which are possibly incapable of disseminating the contagion. but it is known that there are cases, not altogether rare, where tuberculin fails to cause a reaction in a highly tuberculous animal, and consequently one in which the disease exists in an extremely contagious form. for this reason a clinical examination should always be made of an animal which does not give a reaction but which shows symptoms indicating that, notwithstanding the test, it may suffer from tuberculosis. nocard, of paris, wrote also in as follows: the degree of certainty of the indications furnished may be stated in precise terms. _the observation of a clear reaction to tuberculin is unequivocal; the animal is tuberculous._ the pretended errors imputed to the method are explained by the extreme sensitiveness of the reagent, which is capable of detecting the smallest lesion. it often requires prolonged and minute researches in the depths of all the tissues to discover the few miliary centers, the presence of which has been revealed. the reaction is absolutely specific. in those cases where it is observed with animals which show lesions of another disease (actinomycosis, hydatid disease, verminous bronchitis, distomatosis), it may be affirmed that there exists, in addition to these conspicuous changes, a tuberculous center which alone has provoked the reaction. _the failure to react does not necessarily imply absence of tuberculosis._ such failures of tuberculin are very exceptional. they are seen most frequently with animals affected with tuberculosis in a very advanced stage and made evident by plain external signs. sometimes, also, there are found at the post-mortem examination of animals which have not reacted small fibrous or calcified lesions in such a condition that one is tempted to believe them cured. whether sterile or not, these lesions have no tendency to increase, and they are not very dangerous from the point of view of contagion. these opinions of two eminent authorities, living in different countries, after long experience of their own and after studying the results of the many tests made in different parts of the world, should have great weight. they are essentially the same throughout. in voges compiled statistics of tuberculin tests, the accuracy of which had been determined by post-mortem examination. of , animals tested, it appeared that errors had been made with , or . per cent. in the work of the pennsylvania live stock sanitary board post-mortem examinations were made on about , reacting cattle and the disease was found in all but of those which had given characteristic reactions. the results of a much larger number of tests might be compiled at this time, but they would not materially change the average of those already mentioned. it is plain that tuberculin is a remarkably accurate test of tuberculosis, that the animals which react may be safely considered as tuberculous, and that when a careful clinical examination is practiced in addition to the test there are few animals in a dangerous condition which escape detection. the first questions asked by those who oppose the adoption of the tuberculin tests are: is this test infallible? and, if it is not infallible, why should it be forced upon the cattle owners of the country? in answer to these questions it may be said that tuberculin is not absolutely infallible, and yet it is by far the best method of diagnosing tuberculosis that has been discovered. it is much better than any test known for pleuropneumonia when that disease was eradicated. practically all the animals that react are affected with tuberculosis and should be separated from the herd, not only in the interest of the public, but in the interest of the owner of the herd. the best authorities admit, after studying many thousands of tests, that there are few, if any, mistakes made in condemning cattle which show a typical tuberculin reaction. the errors are principally in the other direction--that is, some tuberculous animals are not discovered by the tuberculin test, but as the most dangerous of these may be picked out by ordinary clinical examination this fault of tuberculin is not so serious as it at first sight appears. this being the case, it should not be necessary to force the tuberculin test upon owners. they should be anxious to adopt it in their own interests and for the protection of their patrons. there is to-day no greater danger to the cattle and hog industries than that which confronts them in the form of tuberculosis, a disease already widespread and rapidly extending. furthermore, in view of the results revealed by numerous tests covering vast numbers of animals, tuberculin must be considered as harmless for healthy animals. it has also been clearly demonstrated that tuberculin interferes in no way with the milking function in healthy cattle; neither in the quantity of milk nor in butter-fat value has any variation been detected. the conclusions of some of the best authorities on the subject of its harmlessness to healthy animals are given below. nocard and leclainche state: direct experiments and observations collected by thousands show that the tuberculin injections have no unfavorable effect. with healthy animals the system is indifferent to the inoculation; with tuberculous animals it causes slight changes which are not at all serious. bang has written as follows on this question: we will now consider the following question, a very important one, in the application of tuberculin, viz: can the reaction produce a worse condition in tuberculous animals than before existed? hess emphatically states that it can, and on this account he earnestly warns against its application. my attention has been directed to this question from the beginning. in my first publication on tuberculin injection i reported two cases in which acute miliary tuberculosis was proved in two high-grade tuberculous cows several weeks after the tuberculin injection. i then stated my suspicion that perhaps the tuberculin injection had some connection with this, just as is often supposed to be the case in human practice. with my present very large amount of material for observation at hand i may express the following opinion: such an acute development of tuberculosis as a result of tuberculin injection is to be feared only exceptionally, and then in cases of advanced tuberculosis. _it must not be forgotten that acute miliary tuberculosis by no means rarely accompanies an advanced tuberculosis of long standing._ it is therefore impossible to offer strict proof of the causal connection with the injection, and only oft-repeated observation could make this probable. in support of my view i offer the following: in the course of the last three years i have made careful post-mortem examinations of tuberculous animals, which have been removed from my experiment farm, thurebylille. among these were (or, strictly speaking, ) high-grade tuberculous animals. i have been able to prove miliary tuberculosis in only of these. among the others, which showed less developed tuberculosis, i have never found miliary tuberculosis, and with very many i have never found any sign of a more rapid development of the process. on the contrary, it has been proved that the disease was restricted locally, often for years, in spite of yearly repeated injections. dissections were made at very different periods after the injections--in cases from to days after the last test. in all of these cases earlier tests had been made months or years before. in cases the injection took place from days to months before the butchering; in of these cases earlier injections had been made. in cases from two and one-half months to one year intervened between the last injection and the dissection. dissection gives the best explanation of this question, but a clinical observation, continued for years, of a herd tested with tuberculin can render very essential aid. if hess's opinion is correct, it is to be assumed that tuberculosis must take an unusually vicious course in such herds, but this i have been unable to prove. at thurebylille there has existed for three years a reacting division, consisting originally of head and now . although these animals are yearly tested, and although most of them react every year, the division certainly appears to be made up of healthy animals, and the farm inspector has expressed the decided opinion that the tuberculosis in this division is no more developed than at the beginning of the experiment. the testimony of many owners of large herds of cattle which have long ago been injected is to the same effect. i will adduce statements from several. a farm tenant whose cattle were injected months previously, when per cent of the grown animals reacted, wrote me recently as follows: "only cows from the division of head had been sold as decidedly tuberculous. the majority appeared afterwards, just as before, entirely healthy. the fat animals which had been slaughtered had been pronounced healthy by the butchers." another farm tenant with a herd injected in had not been obliged to remove a single animal from the tuberculosis division, numbering head. a large farm owner in jutland stated in september that he had traced no undesirable result from the injection. his herd of had been injected in february and about per cent reacted. similar answers have been given by other owners and veterinarians. a veterinarian who had injected animals, among them a herd of a large farm, months previously, expressed the belief that the injection had produced in no single case an unusually rapid or vicious course of tuberculosis. in spite of a demand made months ago, i have received thus far no report from any veterinarian of an undesirable result. on a large farm, on which before the injection tuberculosis had appeared in a vicious form, the owner had the impression that the severe cases had afterwards become more numerous. he had, however, not suffered severe losses, and months later the large reacting division by no means made a bad impression. finally, it is to be noticed that tuberculin has been employed on a large scale in denmark for years, and still the demand from farmers constantly increases. this could certainly not be the case if the injections were generally followed by bad results. paige said, after the tests of the herd of the massachusetts agricultural college, that "its use is not followed by any ill effects of a serious or permanent nature." lamson, of the new hampshire college agricultural experiment station, said: "there is abundant testimony that its use is not in any way injurious to a healthy animal." conn, who made a special study of the present attitude of european science toward tuberculosis in cattle, reached the following conclusions: it has been, from the first, thought by some that the use of tuberculin produces a direct injury upon the inoculated animals. this, however, is undoubtedly a mistake, and there is no longer any belief anywhere on the part of scientists that the injury thus produced is worthy of note. in the first place, the idea that it may produce the disease in a perfectly healthy animal by the inoculation is absolutely fallacious. the tuberculin does not contain the tubercle bacillus, and it is absolutely certain that it is impossible to produce a case of tuberculosis in an animal unless the tubercle bacilli are present. the use of tuberculin, therefore, certainly can never produce the disease in the inoculated animal. it has been more widely believed, however, that the inoculation of an animal with this material has a tendency to stimulate an incipient case of tuberculosis. it has been thought that an animal with a very slight case of the disease may, after inoculation, show a very rapid extension of this disease and be speedily brought to a condition where it is beyond any use. the reasons given for this have been the apparent activity of the tuberculosis infection in animals that have been slaughtered shortly after inoculation. this has been claimed, not only by agriculturists who have not understood the subject well, but also by veterinarians and bacteriologists. but here, too, we must recognize that the claim has been disproved, and that there is now a practical unanimity of opinion on the part of all who are best calculated to judge that such an injurious effect does not occur. even those who have been most pronounced in the claim that there is injury thus resulting from tuberculin have, little by little, modified their claim, until at the present time they say either that the injury which they formerly claimed does not occur or that the stimulus of the disease is so slight that it should be absolutely neglected in view of the great value which may arise from the use of tuberculin. apart from two or three who hold this very moderate opinion, all bacteriologists and veterinarians unite in agreeing that there is no evidence for believing that any injury results. in denmark, especially, many hundreds of thousands of animals have been inoculated, and the veterinarians say there is absolutely no reason in all their experience for believing that the tuberculin inoculation is followed by any injurious results. in tuberculosis was found in the large shorthorn herd belonging to w. c. edwards, of canada, who with commendable promptness and public spirit had his animals tested, and at once proceeded to separate the diseased from the healthy animals. they were all finely bred animals, and of the very class which we have been told are most susceptible to the injurious effects of tuberculin. after using this test regularly for two years, mr. edwards wrote as follows: i have seen nothing to lead me to believe that the tuberculin test had any injurious influence on the course of the disease. it is by no means our opinion that the disease has been stimulated or aggravated by the application of the tuberculin test. all animals that we have tested two or three times continue as hale and hearty as they were previously, and not one animal in our herds has broken down or failed in any way since we began testing. mr. edwards, in december, , verbally stated that his views as to the harmlessness of tuberculin remained unchanged, and that he had not seen the least ill effect in any of his cattle from its use. those who have had most experience with tuberculin have failed to observe any injurious effects following its use upon healthy cattle. with tuberculous cattle it produces a fever of short duration, and in the great majority of cases all derangement of the system which it causes disappears within hours after the tuberculin is administered. there appear to have been a very few cases in which the disease was aggravated, and a greater number in which it was benefited by the injection of tuberculin. the cases of abortion following the tuberculin test have not been numerous, even when cows were tested within a few weeks of the normal time of calving. the few cases of this kind which have occurred may be explained by the fact that abortion in cattle is a very common occurrence, and that it would inevitably happen sometimes after the tuberculin test as a mere coincidence and without any relation between the test and the loss of the calf. the cases of abortion which have been cited appear to be no more numerous than might be expected to have occurred among the same number of cattle within the same period if the test had not been applied. at the present time there is ample evidence to show that tuberculin is the most reliable means of detecting tuberculosis in the living animal and that its use is not attended by any harmful aftereffects. an act of congress was approved july , , for the purpose of controlling and eradicating tuberculosis of animals. the official means of detecting tuberculosis in the living animal is the tuberculin test, which may be applied by three different methods--the subcutaneous, the intradermic, and the ophthalmic. it is not necessary to discuss here the details of these three methods, which are made use of in the work of eradication of tuberculosis. the plan adopted by the state and federal authorities in eradication of the disease is known as "the accredited-herd plan." under this plan herds are tested under state and federal supervision, the diseased animals are appraised, removed, and slaughtered under federal inspection. retests are then made after definite periods of time until two successive tests show all the animals to be free from the disease. at this time the herd owner is given a certificate of an accredited herd. details concerning the accredited-herd plan may be obtained by applying to the chief of the bureau of animal industry, washington, d. c. the tuberculin tests. testing animals with tuberculin is the process of introducing tuberculin into the animal and interpreting results according to well-known standards. from the investigations and observations that have been mentioned, it may be safely concluded-- . that the tuberculin test is a wonderfully accurate method of determining whether an animal is affected with tuberculosis. . that by its use the animals diseased with tuberculosis may be detected and removed from the herd, thereby eradicating the disease. . that it has no injurious effect upon healthy cattle. . that the comparatively small number of cattle which have aborted, suffered in health, or fallen off in condition after the test were either diseased before it was made or were affected by some cause other than the tuberculin. the subcutaneous test (under the skin). the most frequently used method of testing is the subcutaneous test, which consists in injecting the proper quantity of tuberculin underneath the skin into the subcutaneous tissue. if an animal is tuberculous, the action of the tuberculin causes a fever, which is indicated by a rise in temperature. this rise, under ordinary conditions, may occur any time between the eighth and twentieth hours after the tuberculin is injected, but in some cases it is desirable to measure the temperature before the eighth hour and continue to the twenty-fourth hour or longer. the temperatures are measured at least times in advance of the injection, at -hour intervals, to learn whether the animal is in proper condition to receive the test. the temperatures after injection are taken every hours until the test is completed. the proper interpretation of the temperatures is made by the person applying the test, and a careful observance of any clinical changes is always important in determining the result. it can not be set forth too strongly that the test, including the two following methods, should be attempted only by those who are properly qualified to do the work. the intradermic test (into the skin). the intradermic test for detecting tuberculosis is used to a considerable extent, especially in area work and on range cattle not easily controlled. when made by those who have become skilled in its application, it is very accurate. in this test the tuberculin is injected between the layers of the skin, only a few drops being used, and it is usually applied in the region at the base of the tail, where the skin is soft and nearly hairless. the intradermic test is satisfactory also for the diagnosis of tuberculosis in swine and, when so used, the tuberculin is applied into the skin of the ear near its base. the reaction from the intradermic test consists of a swelling at the point of injection and is observed from to hours after the injection. the character of the swelling varies, and a proper diagnosis of tuberculosis by this test can be made only by an experienced person. the ophthalmic test (into the eye). still another method, known as the ophthalmic test, is used quite frequently and has been found to be of considerable value in what is known as "check" testing; that is, it is used in connection with either of the previously described methods. sometimes a tuberculous animal that fails to react to those tests shows evidence of the disease upon the application of the ophthalmic test. the ophthalmic tuberculin is placed in one eye and the other eye is used as a check. a reaction is indicated by a characteristic discharge from the eye receiving the treatment, which may occur in from to hours after the application or even later. some swelling and inflammation of the eye and lids are often noted. treatment of tuberculosis. treatment of the disease is not seriously considered by any authorities at the present time. the measures to be adopted to prevent the spreading of the disease must take into consideration not only the tubercle bacillus, but likewise all those circumstances that make cattle more susceptible to the disease, and which have already been dwelt upon. it would be useless to repeat here all that has been said above on the transmission of tubercle bacilli from one animal to another, and on the dangers of certain debilitating influences. a careful study of these influences will show how tuberculosis may, at least in some cases, be prevented. great care should be bestowed upon the breeding, the surroundings, and the feed of the animal, so that the latter may be put into a condition to resist infection even when exposed to it. a tuberculin test should be applied to all strange cattle before they are introduced into the herd, and those which show a reaction should be refused. a rigid exclusion of tuberculous animals is all that is necessary to prevent the appearance of the disease, provided cattle are not infected by consumptive persons and animals. the transmission of the disease from man to cattle is probably not frequent, but is regarded as a possible source of infection. tuberculosis in cattle must also be considered as bearing upon tuberculosis of other domesticated animals, particularly hogs. in europe and the united states this disease is not uncommon among hogs, and appears to be on the increase. the reason for its existence may be looked for in the feeding of pigs with skim milk, buttermilk, and whey from creameries, with the offal of the abattoirs, with the household refuse generally, and behind tuberculous cattle. if tuberculosis is common among cattle, it is likely to be transmitted to hogs kept in this way. the carcasses of animals which have died of tuberculosis should be buried deeply so that they can not be eaten by other animals. this is likewise true of all organs or tissues of slaughtered animals containing tubercles. these should never be fed to other animals, such as hogs, dogs, and cats, and should either be destroyed by fire or deeply buried. when any of the animals in a herd of cattle show evident symptoms of tuberculosis, or when the tuberculin test proves that they are affected with this disease, the best method of procedure in most cases is to have the affected animals slaughtered and the stables disinfected. a large proportion of the animals which are slightly affected yield carcasses which are perfectly wholesome and fit for human food, but in all such cases there should be an inspection by an expert at the time of slaughter to determine which carcasses may be used and which should be destroyed. the disinfection of stables may be accomplished by thoroughly cleaning them, scrubbing the floors with hot water, brushing down all loose dust from the walls, and tearing off all woodwork which is partly decayed. then the whole interior of the stable should be covered with a good coat of limewash containing part of formalin (which is a per cent watery solution of formaldehyde) to parts of the lime wash, or ounces of formalin to each gallon of lime wash. similar precautions should be observed in removing the manure of the infected herd from the barnyard and other places accessible to cattle, since it is known that tuberculous cattle frequently eliminate large numbers of tubercle bacilli through the feces. the ground under the manure pile should then be disinfected, either by the above-mentioned formalin solution or by unslaked lime thickly sprinkled over the soil. if all the animals which react are destroyed and the stables disinfected in this manner, the herd should remain free from the disease unless other affected animals are added to it. the introduction of the disease in this manner may be avoided by requiring a tuberculin test of all new animals admitted on the premises. unfortunately it is a fact that tuberculous animals which have been tested several times may become so accustomed to tuberculin that they will no longer react; consequently it is always advisable to purchase cattle from some one who is known to be reliable, as otherwise animals of this kind may be treated with tuberculin for the purpose of hiding the disease. in the case of very valuable purebred animals and under exceptional circumstances it may be more advantageous to retain the reacting animals which are in good condition in order to breed from them and in that manner avoid the excessive loss which would follow from their immediate slaughter. this may be done if proper precautions are adopted. the disposal of reactors depends upon the state laws and live-stock regulations of the state in which the herd belongs. if this policy is followed it should be attempted only after careful study of the plan known as the bang method of controlling tuberculosis. the live-stock officials of the state should be frequently consulted and their advice followed; otherwise failure will surely ensue. the plan necessitates considerable trouble and is not recommended except under the circumstances mentioned. bovine tuberculosis and the public health. the increasing amount of evidence pointing to the identity of human and animal tuberculosis, combined with the extraordinary mortality of human beings from this disease, often amounting to to per cent, has raised the question in all civilized countries as to how far animal, and especially bovine, tuberculosis is to blame for this high mortality. the medical and veterinary professions have approached this problem with equal zeal, and much has come to light within recent years which enables us to come to some conclusion. if this disease is transmitted from animals to man, how does the transmission take place? as comparatively few people come in direct contact with tuberculous cattle, it must be either through the meat, the milk, the butter, the cheese, or through all these products that the virus enters the human body. the question has thus narrowed itself down to the food products furnished by cattle. it has become a very urgent question, especially in the poorer countries of europe, whether all flesh from tuberculous animals is unfit for human food. it is argued there that if it can be shown that in the majority of cases of tuberculosis the bones and the muscular system are free from infection, there is no reason why the meat should not be put on sale under certain restrictions. the question may be resolved into two divisions: ( ) how frequently does the disease invade those parts of the body which are used as food? ( ) when the disease process is manifestly restricted to the internal organs, do tubercle bacilli circulate in the blood and lymph and can they be detected in the muscular tissue? ( ) disease of the bones is not unknown, although very rare. according to walley, it appears chiefly in the spongy bones of the head and backbone and in the long bones of the limbs. occasionally the ends of the bones, where they are covered by the synovial membrane of the joints, are dotted with tubercles. the muscular system itself is very rarely the seat of tuberculous deposits, although the lymphatic glands lying near and among the muscles may be not infrequently diseased. ( ) whether tubercle bacilli are found in muscle juice independent of any tuberculous deposits is a question which must be approached experimentally. there is on record a great variety of opinions on this matter, some authorities considering all flesh from tuberculous animals unfit for food, while others hold a contrary view. experiments have shown that in rare cases the flesh of tuberculous cattle contains a small number of tubercle bacilli. in germany the flesh of animals in which the disease is just beginning, or in which it is restricted to one or more related organs, is not rejected. when, however, the disease has affected the muscles or bones, or lymphatic glands situated on or between them, the flesh is condemned as unfit and dangerous. animals are also rejected in which it is evident, from the general distribution of tubercles throughout the various organs, that the bacilli have been distributed by the blood and may have been carried into the muscular system (generalized tuberculosis). concerning the infectious nature of milk secreted by tuberculous cows, authorities have universally agreed that when the udder itself is in the slightest degree involved the milk possesses infectious properties, and is therefore dangerous. tubercle bacilli in large numbers have been found in the milk and the udder under such circumstances. unlike other affections of the udder, tuberculosis of this organ does not at once change the appearance and the quality of the milk secreted. bang states that for at least a month after the disease has appeared the milk is normal in appearance and may be consumed and sold without arousing the suspicion of the owner. considerable danger is, therefore, involved in this disease, and the necessity for the careful inspection of dairy cows seems more urgent than ever. authorities are, however, not fully agreed as to whether the milk from tuberculous cows in which the udder is apparently not invaded by the disease should be considered dangerous or not. some incline to the belief that the milk secreted by healthy udders is never infectious, even when the lungs or other organs are affected; that, in other words, the tubercle bacilli are rarely, if ever, separated from the lesions which they produce, and that the udder itself must be diseased before tubercle bacilli can appear in the milk. experiments made with the milk of tuberculous cows in which there were no indications of udder disease do not bear out this theory, since tubercle bacilli have been found in their milk. some authorities still believe that the udder is diseased when the milk is infected, but that the disease escapes observation. however this may be, the fact that the udder may be diseased and the disease not recognizable simply casts suspicion upon all milk from tuberculous animals. we know that the milk of tuberculous cattle may or may not contain tubercle bacilli when the udder is apparently free from disease, but we have no rapid method of determining whether in any given case the milk contains tubercle bacilli or not. moreover, the bacilli may be absent at one time and present at another in milk from the same cow. when we consider, therefore, the extent of tuberculosis and the hidden character of the disease, a certain degree of suspicion rests upon all milk from untested cattle. fortunately, tubercle bacilli are readily destroyed by the temperature of boiling water, and hence both meat and milk are made safe, the former by the various processes of cooking, the latter by boiling for a few moments. it is incumbent upon all communities to have dairy cows examined and tested with tuberculin. if disease is detected, the affected animal should be killed at once or else all opportunity for the sale of such milk removed by appropriate measures. where milk or cream is sold to the trade in large towns or cities pasteurization should be required as an additional safeguard. recently there has been much discussion of the question as to whether human and animal tuberculosis are identical diseases and as to the possibility of the tuberculosis of animals being transmitted to man or that of man being transmitted to animals. the fact that tuberculous material from human subjects often failed to produce serious disease in cattle was observed by a number of the earlier investigators who experimented with such virus. it was the experiments and comparative studies of theobald smith, however, which attracted special attention to the difference in virulence shown by tubercle bacilli from human and bovine sources when inoculated upon cattle. smith mentioned also certain morphological and cultural differences in bacilli from these two sources, and in the location and histology of the lesions in cattle produced by such bacilli. he did not conclude, however, that bovine bacilli could not produce disease in the human subject, but said: it seems to me that, accepting the clinical evidence on hand, bovine tuberculosis may be transmitted to children when the body is overpowered by large numbers of bacilli, as in udder tuberculosis, or when certain unknown favorable conditions exist. koch, however, in his address at the british congress on tuberculosis, went far beyond this and maintained that "human tuberculosis differs from bovine and can not be transmitted to cattle." as to the susceptibility of man to bovine tuberculosis, he said it was not yet absolutely decided, but one was "nevertheless already at liberty to say that, if such a susceptibility really exists, the infection of human beings is but a very rare occurrence." he emphasizes this view in the following language: i should estimate the extent of infection by the milk and flesh of tubercular cattle and the butter made of their milk as hardly greater than that of hereditary transmission, and i therefore do not deem it advisable to take any measures against it. this conclusion was so radically different from the views of most experimenters and so out of harmony with facts which had apparently been demonstrated by others that it at once aroused opposition in the congress, followed by the adoption of dissenting resolutions, and led to numerous investigations in various countries. koch's conclusions were based upon his failure to produce tuberculosis in cattle and other animals by inoculating them with tuberculous material of human origin and his success in causing progressive and fatal tuberculosis in the same kinds of animals when inoculated with tuberculous material of bovine origin. with such positiveness did he hold to the constant and specific difference between the human and bovine bacillus that he promulgated an experimental method of discriminating between them. speaking of the etiology of intestinal tuberculosis in man, he said: hitherto nobody could decide with certainty in such a case whether the tuberculosis of the intestine was of human or of animal origin. now we can diagnose them. all that is necessary is to cultivate in pure culture the tubercle bacilli found in the tubercular material, and to ascertain whether they belong to bovine tuberculosis by inoculating cattle with them. for this purpose i recommend subcutaneous injection, which yields quite specially characteristic and convincing results. these important and comprehensive conclusions followed from a comparatively few experiments upon animals, and apparently no effort had been made to learn to what extent human tubercle bacilli may differ in their virulence for cattle or what grades of virulence there might be among bacilli of bovine origin. vagedes had already shown that bacilli were sometimes present in human lesions which were as virulent as bovine bacilli, but his work was wholly ignored by koch. a considerable number of investigators, including chauveau, vagedes, ravenel, de schweinitz, mohler, de jong, delépine, orth, stenström, fibiger and jensen, max wolff, nocard, arloing, behring, dean and todd, hamilton and young, the german tuberculosis commission, and theobald smith, have found tubercle bacilli in the bodies of human beings who died of tuberculosis which proved to have about the same virulence for cattle as had the bacilli from bovine animals affected by the disease. kossel, in a preliminary report, stated that the german commission had tested cultures of tuberculosis from cattle and hogs-- from cattle and from hogs. two proved acutely fatal in cattle after eight to nine weeks; likewise produced a generalized tuberculosis, but which certainly had a more chronic course, while of the cultures caused only an infiltration at the point of inoculation, with some caseous foci in the adjoining prescapular gland and in one of the mediastinal glands, and there was lacking the spreading of the tuberculosis over the entire body which they were accustomed to see after the injection of cultures of bovine tuberculosis. "hence," says kossel, "among bovine tuberculosis bacilli there can also occur differences with regard to the virulence." the german commission also tested different freshly made cultures from tuberculous disease in man. nineteen did not produce the slightest symptoms in cattle; with others the cattle exhibited after four months very minute foci in the prescapular glands, which were mostly encapsuled and showed no inclination to progress; with other cases there was somewhat more marked disease of the prescapular glands, but it did not go so far as a material spreading of the process to the adjoining glands. there were cultures, however, which were more virulent and caused generalized tuberculosis in the cattle inoculated with them. it would appear, therefore, that hereafter everyone must admit that it is impossible always to tell the source of a culture of the tubercle bacillus by its effect when it is inoculated upon cattle. one of the bovine cultures failed to produce generalized tuberculosis in cattle, and some of the human cultures did produce it in such animals. moreover, while some of the human cultures caused no disease at all, others led to the development of minute foci in the prescapular glands, and still others to somewhat more marked disease of the glands. there were, consequently, four degrees of virulence noted in these cultures of bacilli from human sources and three degrees of virulence in the cultures from animal. now, if we accept the views of koch as to the specific difference between human and bovine tubercle bacilli, and that the human bacilli produce only localized lesions in cattle, while bovine bacilli produce generalized lesions in them, must we not conclude that the one non-virulent bovine culture was in reality of human origin, and that the animal from which it was obtained had been infected from man? this is a logical deduction, but reverses the dictum laid down at london that human tuberculosis is not transmissible to cattle. again, how are we to explain the human cultures of medium virulence? are they human bacilli which, for some unknown reason, are increasing in virulence and approaching the activity of the bovine bacillus, or are they really bovine bacilli which have multiplied in the human body until their virulence has become attenuated? in whatever manner these questions are decided it would seem that the findings of the german commission, instead of supporting koch's views that we can decide with certainty by the inoculation of cattle as to the source of any given bacillus, really show that this method of diagnosis is extremely uncertain in the present condition of our knowledge. it is definitely admitted that of the human cultures caused generalized tuberculosis in cattle; kossel suggest, however, that it may be possible that the bacilli in cases of human tuberculosis under certain circumstances can likewise attain a very high pathogenic activity for cattle without being for that reason bovine bacilli. undoubtedly the german commission is confronting the two horns of a dilemma, either one of which is fatal to the views of koch as stated with such positiveness at london. if we accept this suggestion thrown out by kossel, we must conclude that koch was wrong in his claim that human tuberculosis can not be transmitted to cattle, and thus with one blow we destroy the entire experimental support which he had for his argument before the british congress on tuberculosis. if, on the other hand, we accept the conclusion which follows from the principle laid down by koch for the discrimination between human and bovine bacilli, and which appears to be favored by kossel, we must admit that bovine tuberculosis is an extremely important factor in the etiology of human tuberculosis. of the cases of human tuberculosis tested, , or more than per cent, were virulent for cattle and would be classified as of bovine origin; however, these cases, were all found among the cases of tuberculosis in children which the commission investigated; hence it is plain that per cent of the cases tested of tuberculosis in children would by koch's method be classified as of bovine origin. in the bureau of animal industry two distinct lines of experiments have been carried on, in order that one might serve as a check against the other. there has been, however, no discrepancy in the results. de schweinitz, in the biochemic division, bureau of animal industry, isolated cultures from human tuberculosis. two were derived from human sputum, from cases of generalized tuberculosis in adults, and from cases of generalized tuberculosis in children. by comparing these cultures with a newly isolated virulent culture of bovine tuberculosis, there were found among them cultures from children which were identical in their cultural and morphological characters with the bovine bacillus. these cultures also killed rabbits and guinea pigs in as short a time as did the bovine bacillus. hogs which were inoculated subcutaneously with these cultures from children died of generalized tuberculosis. two calves weighing more than pounds each were inoculated subcutaneously with these virulent human cultures, and as a result developed generalized tuberculosis. a yearling heifer inoculated with of the cultures showed generalized tuberculosis when killed three months after inoculation. both the cattle and the hogs had been tested with tuberculin and found to be free from tuberculosis before the inoculations were made. it is important to observe in this connection that out of , or per cent, of the cultures obtained from cases of generalized tuberculosis in children proved virulent for cattle. mohler, working in the pathological division, bureau of animal industry, obtained very virulent cultures of tubercle bacilli from the human subject. a goat inoculated subcutaneously with of these cultures died in days with miliary tuberculosis of the lungs involving the axillary and prescapular glands. this bacillus was obtained from the mesenteric gland of a boy. of still greater interest is a bacillus isolated by mohler from human sputum. a goat inoculated subcutaneously with a culture of this germ died in days of pulmonary tuberculosis. a cat inoculated in the same manner died in days of generalized tuberculosis. a rabbit similarly inoculated died in days of pulmonary tuberculosis. another rabbit inoculated with a bovine culture for comparison lived days longer than the one inoculated with this sputum germ. mohler also inoculated subcutaneously a -year-old heifer with a culture derived from the tuberculosis mesenteric gland of a boy years of age. this culture was always refractory in its growth under artificial conditions, and the bacilli were short, stubby rods, corresponding in appearance to the bovine type. at the autopsy, held days after the inoculation, the general condition was seen to be poor and unthrifty, and large, hard tumors were found at the points of inoculation. on the right side the swelling measured - / by inches, and the corresponding lymph gland was - / inches long by - / inches in diameter. this gland contained numerous calcareous foci; one at the apex was an inch in diameter. the lesions on the left shoulder of the animal were very similar to those found on the right side, but the dimensions of the tumor were slightly less. the lungs presented an irregular mass of tuberculous nodules, and or grapelike nodules were seen on the parietal pleura. bronchial and mediastinal lymph glands contained numerous tuberculous foci, and the pericardium, peritoneum, spleen, and liver also were affected. in order to throw some light, if possible, upon the morphological constancy of the different types of tubercle bacilli, mohler made comparative studies of bacilli from various sources, and which had been passed through various species of animals, by making the cultures upon dog serum after the method described by theobald smith. some important results have been obtained. one culture of human bacilli which had morphological and cultural peculiarities similar to those of the bovine bacillus, and which produced only local lesions in cattle, was passed through a series of five cats. it was then found to be completely changed in its morphological characters, the rods being elongated, slender, more or less beaded, and entirely of the human type. far from decreasing in virulence, however, as might be expected from its morphological appearance, this bacillus had so increased in its pathogenic activity that it produced generalized tuberculosis in a cow. this cow was inoculated subcutaneously in front of each shoulder with cubic centimeters of a salt-solution emulsion of the tuberculous omentum of the last cat of the series. the cow rapidly lost flesh, had a temperature of ° f., with the point of inoculation and adjacent glands greatly swollen. the autopsy revealed generalized tuberculosis, involving the lungs, mediastinal glands, spleen, liver, and kidneys. tubercle bacilli of the bovine type obtained from the mesenteric glands of a sheep, hog, and cow were similarly transformed in their morphological appearance after being passed through a series of cats and recovered on dog serum. these bacilli also increased in virulence, as the last cat in the series invariably succumbed in a shorter time than the first of the series. these experiments and observations indicate that the types of tubercle bacilli are very inconstant, and that under suitable conditions they readily change both in morphology and in virulence. a similar conclusion was reached by other investigators in working with the avian and porcine types of tubercle bacilli several years ago, and was reasonably to have been expected with the human and bovine types. later investigations made by park and krumweide, of the research laboratory of new york city, novick, richard m. smith, ravenel, rosenau, chung yik wang, and others tend to show the incidence of bovine infection in the human family. chung yik wang stated in that studies of cases of various clinical forms of tuberculosis in edinburgh, scotland, resulted in the isolation of the bovine tubercle bacilli in . per cent of cases under the age of years, in . per cent between the ages of and , and in . per cent over the age of . this investigator states that from the prophylactic point of view any measure resorted to in combating the disease should be directed not only against the human spread of infection, but also, more particularly in children's cases, against the bovine source of infection. ravenel, in summarizing the work of drs. park and krumweide, as well as others throughout the world, gives the following results: of children dying of tuberculosis at the babies' hospital cases proved to be human infection and bovine, a percentage of - / . of children dying of tuberculosis at the foundling hospital proved to have derived their infection from human sources and from bovine, a percentage of . of a total of children under years of age who died of tuberculosis proved to have derived their infection from human sources and from bovine, a percentage of - / . combining the cases studied in new york with those of other observers in different parts of this country and europe, the following results are obtained: adults, cases-- human and bovine infection. children, to years, cases-- human and bovine infection. children under years, cases-- human and bovine infection. the figures of the foundling hospital show the real danger of unprotected cows' milk. the conclusion from these studies is inevitable, namely, that in children, in addition to the large number of deaths which occur from bovine infection, there are many cases of infection resulting in deformities, necessitating operations more or less severe in character and which frequently leave the patient disfigured permanently. it must be plain to all, from these recent developments, that too much has been made of the slight differences in cultural characteristics, in morphology, and in virulence which have been observed in some cases in comparing the human and the bovine bacilli. the observations were interesting, and it was important that they be followed up until their significance was made entirely clear, but it was an almost unpardonable error, from a sanitary point of view, to promulgate sweeping generalizations calculated to arrest and abolish important measures for preventing human tuberculosis before the soundness of these generalizations had been established by a thorough course of experimentation. when koch said in the british congress on tuberculosis that he should estimate the extent of infection by the milk and flesh of tuberculous cattle and the butter made of their milk as hardly greater than that of hereditary transmission, and that he therefore did not deem it advisable to take any measures against it, he went far beyond what was justified by any experiments or observations which he reported, and he did a great deal of harm, which will be manifested for years to come, to those who endeavor to guard the human race from the dangers of animal tuberculosis. the researches which have been alluded to make these dangers more definite and certain than they have appeared before, and sanitarians should therefore most earnestly endeavor to counteract the erroneous and harmful impression which was made by koch's address at london and his subsequent address at the international conference on tuberculosis at berlin. vaccinia or cowpox. variola of cattle, more correctly vaccinia, is a contagious disease of cattle which manifests its presence through an elevation of temperature, a shrinkage in milk production, and by the appearance of characteristic, pustular eruptions, especially upon the teats and udders of dairy cows. although this is a contagious disease, strictly speaking, it is so universally harmless and benign in its course that it is robbed of the terrors which usually accompany all spreading diseases, and is allowed to enter a herd of cattle, run its course, and disappear without exciting any particular notice. the contagion of cowpox does not travel through the air from animal to animal, but is transfused only by actual contact of the contagious principle with the skin of some susceptible animal. it may be carried in this manner, not alone from cattle to cattle, but horses, sheep, goats, and man may readily contract the disease whenever suitable conditions attend their inoculation. an identical disease frequently appears upon horses, attacking their heels, and thence extending upward along the leg, producing, as it progresses, inflammation and swelling of the skin, followed later by pustules, which soon rupture, discharging a sticky, disagreeable secretion. other parts of the body are frequently affected in like manner, especially in the region of the head, where the eruptions may appear upon lips and nostrils, or upon the mucous surfaces of the nasal cavities, mouth, or eyes. variola of the horse is readily transmitted to cattle, if both are cared for by the same attendant, and, conversely, variola of cattle may be carried from the cow to the horse on the hands of a person who has been milking a cow affected with the disease. the method of vaccination with material derived from the eruptions of cowpox as a safeguard against the ravages of smallpox in members of the human family is well known. the immunity which such vaccination confers upon the human subject has led many writers to assert that cowpox is simply a modified form of smallpox, whose harmless attack upon the human system is owing to a certain attenuation derived during its passages through the system of the cow or horse. the results of numerous experiments which have been carried out for the purpose of determining the relationship existing between variola of the human and bovine families seem to show, however, that although possessing many similar characteristics, they are nevertheless distinct, and that in spite of repeated inoculations from cattle to man, and vice versa, no transformation in the real character of the disease ever takes place. _symptoms._--the disease appears in four to seven days after natural infection, or may evince itself in two or three days as the result of artificial inoculation. young milch cows are most susceptible to an attack, but older cows, bulls, or young cattle are by no means immune. the attack causes a slight rise in temperature, which is soon followed by the appearance of reddened, inflamed areas, principally upon the teats and udder, and at times on the abdominal skin or the skin of the inner surface of the thighs. in a few cases the skin of the throat and jaws has been found similarly involved. if the affected parts are examined on the second day after the establishment of the inflammation numerous pale-red nodules will be found, which gradually expand until, within a few days, they reach a diameter of one-half inch or even larger. at this period the tops of the nodules become transformed into vesicles which are depressed in the center and contain a pale, serous fluid. they usually reach their maturity by the tenth day of the course of the disease and are then the size of a bean. from this time the contents of the vesicles become purulent, which requires about three days, when the typical pox pustule is present, consisting of a swelling with broad, reddened base, within which is an elevated, conical abscess varying from the size of a pea to that of a hazelnut. the course of the disease after the full maturity of the pustule is rapid if outside interference has not caused a premature rupture of the small abscess at the apex of the swelling. the pustules gradually become darker colored and drier until nothing remains but a thick scab, which at last falls off, leaving only a slight, whitish scar behind. the total duration of the disease covers some days in each animal, and owing to the slow spread of the infection from animal to animal, many weeks may elapse before a stable can be fully freed from it. the fallen scabs and crusts may retain their contagious properties for several days when mixed with litter and bedding upon the floor of the stable, and at any time during this period they are capable of producing new outbreaks should fresh cattle be brought into the stalls and thus come into actual contact with them. again, the pustules may appear, one after another, on a single animal, in which case the duration of the disease is materially lengthened. _treatment._--in herds of cattle that regularly receive careful handling, no special treatment will be found necessary beyond the application of softening and disinfecting agents to such vesicles upon the teats as may have become ruptured by the hands of the milker. carbolized vaseline or iodoform ointment will be found well suited to this work. in more persistent cases it may be found desirable to use a milking tube in order to prevent the repeated opening of the pustules during the operation of milking. washing the sores twice daily with a weak solution of zinc chlorid ( - / per cent solution) has been found to assist in checking the inflammation and to cleanse and heal the parts by its germicidal action. when the udder is hard, swollen, and painful, support it by a bandage and foment frequently with hot water. if calves are allowed to suckle the cows the pustules become confluent, and the ulcerations may extend up into the teat, causing garget and ruining the whole quarter of the udder. as young cows are most susceptible to variola, the milker must exercise constant patience with these affected animals so long as their teats or udders are sore and tender, else the patient may contract vicious habits while resisting painful handling. the flow of milk is usually lessened as soon as the fever becomes established, but is again normal with the return of perfect health. the practice of thorough cleanliness in handling or milking affected cattle may, in many instances, prevent the dissemination of the trouble among the healthy portion of the herd, but even the greatest care may prove insufficient to check the spread until it has attacked each animal of the herd in turn. actinomycosis (lumpy jaw) [pls. xxxix-xli.] actinomycosis, also known as lumpy jaw, big jaw, wooden tongue, etc., is a chronic infectious disease characterized by the formation of peculiar tumors in various regions of the body, more particularly the head, and is due to the specific action of a certain fungus-like germ (actinomyces). this fungus is an organism which occurs in the tissues in the form of rosettes, and it has therefore been termed the "ray fungus." the disease is not directly transmitted from one animal to another, but it seems apparent that the fungus is conveyed into the tissues by various feedstuffs through slight wounds of the mucous membrane of the mouth, decayed teeth, or during the shedding of milk teeth. the ray fungus is found in nature vegetated on grasses, on the awns of barley, the spears of oats, and on other grains. quantities of the fungi have been found between the vegetable fibers of barley which had penetrated the gums of cattle and on the awns of grain embedded in the tongues of cows. although actinomycotic tumors on cattle had been the object of study for many years, it was not until that the constant presence of actinomyces was pointed out by bollinger, of munich, and since that time considered the cause. this fungus was observed in these tumors as early as by rivolta, and by others subsequently, without having been suspected as causing them. since bollinger's publication much work has been done, many observations made, and many hitherto obscure disease processes brought into relation with this fungus. furthermore, a similar disease in man was first definitely shown to be associated with the same fungus in by israel, and in the following year ponfick pointed out that the disease described by bollinger in animals and that found by israel in man were due to the same cause; that is, that the fungi described by these observers were one and the same. the tumors and abscesses wherever they may be are all found to be the same in origin by the presence of the actinomyces fungus. when they are incised, a very close scrutiny with the naked eye, or, at most, a hand lens, will reveal the presence of minute grains which vary from a pale-yellow to a sulphur-yellow color. they may be very abundant or so few as to be overlooked. they are embedded in the soft tissue composing the tumor or in the pus of the abscess. with a needle they are easily lifted out from the tissue, and then they appear as roundish masses about one-half millimeter ( / inch) in diameter. to anyone familiar with the use of a microscope the recognition of these grains or particles without any previous preparation is a comparatively easy task. when examined in the fresh condition under a microscope magnifying up to diameters the general structure is made out without much difficulty. these grains consist of collections of minute, roundish masses. their outer surface is made up of club-shaped bodies all radiating from the center of the mass (see pl. xxxix, fig. ), somewhat like a rosette. if the fungus is crushed, the interior is found made up of bundles of very fine filaments, which are probably continuous into the club-shaped bodies. the addition of a dilute solution of caustic soda or potash greatly aids the examination, as it removes the layer of cells adhering to the fungus, which obscures the structure. now and then these grains are found to be in a calcified condition. the exterior is incrusted in lime salts, which are dissolved by adding some weak dilute acid, like acetic acid. only by this procedure can the fungus be definitely recognized when in a mummified condition. these are the bodies whose presence causes sufficient irritation in the tissues into which they find their way to set up inflammatory growths. these growths increase as the fungus continues to multiply until they reach enormous dimensions, if the affected animal is permitted to live long enough. the true nature of this parasite is not yet definitely settled, although many excellent observers have occupied themselves with it. according to earlier observers, it is a true fungus. later ones are inclined to place it among the higher bacteria. present knowledge concerning the actinomyces growth indicates that it should be classified with the higher bacteria or trichomycetes. whatever the situation of the disease caused by actinomyces may be, its nature is fundamentally the same and peculiar to the fungus. the pathological details which make this statement clear can not be entered upon in this place, nor would they be of any practical value to the farmer. we will simply dwell upon a few obvious characters. the consistency of the tumor varies in different situations according to the quantity of fibrous or connective tissue present. when very little of this is present the tumor is of a very soft consistency. as the quantity of connective tissue is increased the tumor is firmer and of a more honeycombed appearance. the individual actinomyces colonies are lodged in the spaces or interstices formed by the meshwork of the connective tissue. there they are surrounded by a mantle of cellular elements which fill up the spaces. by scraping the cut surface of such a tumor these cell masses inclosing the fungi come away, and the latter may be seen as pale-yellow or sulphur-yellow specks, as described above. _location of the disease._--in cattle the disease process may be located both externally, where it is readily detected, and in internal organs. its preferred seat is on the bones of the lower and upper jaws, in the parotid salivary gland in the angle of the jaw, and in the region of the throat. it may also appear under the skin in different parts of the body. internally it may attack the tongue and appear in the form of a tumor in the mouth, pharynx, or larynx. it may cause extensive disease of the lungs, more rarely of the digestive tract. it appears, furthermore, that in certain districts or countries the disease seems by preference to attack certain parts. thus in england actinomycosis of the tongue is most prevalent. in denmark the soft parts of the head are most prone to disease, while in russia the lips are the usual seat. in certain parts of germany actinomycotic tumors are most frequently encountered in the throat region and in the jawbones. a description of actinomycosis of the jaw (lumpy jaw) and of the tongue has already been given in a previous chapter, and hence they will be dealt with here only very briefly. when the disease attacks the soft parts of the head a rather firm swelling appears, in which are formed one or more smaller projecting tumors, varying from the size of a nut to that of an egg. these push their way outward and finally break through the skin as small, reddish, funguslike bodies covered with thin sloughs. or the original swelling, in place of enlarging in the manner described, may become transformed into an abscess which finally bursts to discharge creamy pus. the abscess cavity, however, does not disappear, but is soon filled with fungus-like growths, which force their way outward through the opening. when the tumors are situated within the cavity of the pharynx they have broken through from some gland, perhaps beneath the mucous membrane, where the disease first appeared, and hang or project into the cavity of the pharynx, either as pendulous masses with slender stems or as tumors with broad bases. their position may be such as to interfere with swallowing and with breathing. in either case serious symptoms will soon appear. the invasion of the bones of the jaws by actinomycosis must be regarded as one of the most serious forms of the disease. (pls. xxxix, xl.) it may start in the marrow of the bone and by a slow extension gradually undermine the entire thickness of the bone itself. the growth may continue outward, and after working its way through muscle and skin finally break through and appear externally as stinking fungoid growths. the growth may at the same time work its way inward and appear in the mouth. the disease may also begin in the periosteum, or covering of the bone, and destroy the bone from without inward. actinomycosis of the lungs is occasionally observed, and it is not improbable that at times it has been mistaken for tuberculosis. the actinomyces grains are, however, easily observed if the diseased tissue is carefully examined. the changes in the lungs as they appear to the naked eye vary considerably from case to case. thus in one animal the lungs were affected as in ordinary bronchopneumonia as to the location, extent, and appearance of the disease process. the affected lobes had a dark-red flesh appearance, with yellowish areas sprinkled in here and there. (see pl. xli, figs. , .) these latter areas were the seat of multiplication of the actinomyces fungus. in another case, of which only a small portion of the lungs was sent to the laboratory, they were completely transformed into a uniformly grayish mass, very soft and pulpy to the touch, and appearing like very soft and moist dough. (pl. xli, fig. .) the actinomyces grains were exceedingly abundant in this tissue, and appeared when the tissue was incised as minute sulphur-yellow grains, densely sprinkled through the tissue, which readily came away and adhered to the knife blade. in still another case a portion of the lung tissue was converted into large, soft masses from to inches in diameter, each partly inclosed in very dense connective tissue. these soft, grayish-yellow masses likewise resembled moist dough in their consistency, and the actinomyces grains, though neither very distinct nor at all abundant, were easily fished out and identified as such. a portion of this growth, which was as large as a child's head, was converted into an abscess filled with creamy semiliquid pus. this case differed from the preceding in that all appearance of lung tissue had disappeared from the diseased mass. only on the exterior the lung tissue could be recognized, although even there it had been largely converted into very dense, whitish connective tissue inclosing the fungoid growth. in the other case the external form of the lung and the shape and outline of the lobules were preserved, but the lung tissue itself was not recognizable as such. in the case first mentioned the changes were still less marked, and actinomycosis would not have been suspected by a simple inspection. these few illustrations suffice to show that actinomycosis of the lungs may appear under quite different forms, and that the nature of the disease can be accurately determined only by finding the fungus itself. rarely actinomycosis attacks the body externally in places other than the head and neck. crookshank describes the case of a bull in which the flank was attacked and subsequently the scrotum became diseased. a large portion of the skin of the flank was destroyed and covered with a leathery crust. when this was pulled away the pus beneath it showed the actinomyces grains to the naked eye. actinomycosis may also involve the udder, the spermatic cord of castrated animals, the vagina, and, when it becomes generalized, the brain, liver, spleen, and muscular tissue. actinomycosis may in some cases be confounded with tuberculosis. the diagnosis does not offer any difficulties, since the presence of the actinomyces fungus at once removes any existing doubts. as has already been intimated, these grains, simulating sulphur balls, are visible to the naked eye, and their nature is readily determined with the aid of a microscope. the course of the disease is quite slow. as the tumors grow they may interfere with the natural functions of the body. according to their situation, mastication, rumination, or breathing may be interfered with, and in this way the animal may become emaciated. actinomycosis of the jawbones leads to destruction of the teeth and impedes the movements necessary to chewing the feed. similarly, when the disease attacks the soft parts of the head obstructions may arise in the mouth by an inward growth of the tumor. if tumors exist in the pharynx they may partially obstruct the movements necessary to breathing, or close the air passages and cause partial suffocation. actinomycosis of the tongue, in interfering with the many and varied movements of this important organ, is also a serious matter. there is no reason to suppose that the localized disease interferes with the general health in any other way than indirectly until internal organs, such as the lungs, become involved. a very small proportion of the cases may recover spontaneously, the tumors being encysted or undergoing calcification. in most cases the disease yields readily to proper treatment, and about per cent of the affected animals may be cured. _prevention._--the question as to how and where animals take this disease is one concerning which we are still in the stage of conjecture, because so far we possess very little information concerning the life history of the actinomyces itself. the quite unanimous view of all observers is that animals become infected from the feed. the fungus is lodged upon the plants and in some way enters the tissues of the head, the lungs, and the digestive tract, where it sets up its peculiar activity. it is likewise generally believed that the fungus is, as it were, inoculated into the affected part. this inoculation is performed by the sharp and pointed parts of plants which penetrate the mucous membrane and carry the fungus with them. the disease is therefore inoculable rather than contagious. the mere presence of the diseased animal will not give rise to disease in healthy animals unless the actinomyces grains pass directly from the diseased into some wound or abrasion of the healthy or else drop upon the feed which is consumed by the healthy. not only are these views deducible from clinical observation, but they have been proved by the positive inoculation of calves and smaller animals with actinomyces. the danger therefore of the presence of actinomyces for healthy animals is a limited one. nevertheless an animal affected with this disease should not be allowed to go at large or run with other animals. if the fungus is being scattered by discharging growths we certainly can not state at this stage of our knowledge that other animals may not be infected by such distribution, and we must assume, until more positive information is at hand, that this actually occurs. it is, however, the opinion of the majority of authorities that when actinomycosis appears among a large number of animals they all contract it in the same way from the feed. much speculation has therefore arisen whether any particular plant or group of plants is the source of the infection and whether any special condition of the soil favors it. very little positive information is at hand on these questions. it would be very desirable for those who live in localities where this disease is prevalent to make statistical and other observations on the occurrence of the disease with reference to the season of the year, the kind of feed, the nature of the soil (whether swampy or dry, recently reclaimed, or cultivated for a long time) upon which the animals are pastured or upon which the feed is grown. it is highly probable that such investigations will lead to an understanding of the source of the fungus and the means for checking the spread of the disease itself. veterinarian jensen, of denmark, made some observations upon an extensive outbreak of actinomycosis a number of years ago which led him to infer that the animals were inoculated by eating barley straw harvested from pieces of ground just reclaimed from the sea. while the animals remained unaffected so long as they pastured on this ground or ate the hay obtained from it, they became diseased after eating the straw of cereals from the same territory. others have found that cattle grazing upon low pastures along the banks of streams and subject to inundations are more prone to the disease. it has also been observed that feed gathered from such grounds, even after prolonged drying, may give rise to the disease. actinomycosis is not infrequent in cattle in the southwest and is generally supposed to be the result of eating the prickly fruit of the cactus plant, causing wounds of the mucous membrane and subsequent infection with the parasite. much additional information of a similar kind must be forthcoming before the source and manner of infection in this disease and its dependence upon external conditions will be known. it is not at all improbable that they may vary considerably from place to place. _treatment._--until recently this has been almost entirely surgical. when the tumors are external and attached to soft parts only, an early removal may lead to recovery. this, of course, can be undertaken only by a trained veterinarian, especially as the various parts of the head and neck contain important vessels, nerves, and ducts which should be injured as little as possible in any operation. unless the tumor is completely removed it will reappear. disease of the jawbones is at best a very serious matter and treatment is liable to be of no avail. in march, , an important contribution to our knowledge of this subject was made by nocard, of the alfort veterinary school, in a communication to the french central society of veterinary medicine. he showed clearly that the actinomycosis of the tongue, a disease which appears to be quite common in germany, and is there known as "wooden tongue," could be quickly and permanently cured by the administration of iodid of potassium. nocard calls attention to the success of thomassen, of utrecht, who recommended this treatment so long ago as , and who has since treated more than cases, all of which have been cured. a french veterinarian, godbille, has used the same remedy in a number of cases of actinomycosis in the tongue, all of which have been cured. nocard also gives details of a case which was cured by himself. all the cases referred to were of actinomycosis of the tongue, and no one appears to have attempted the cure of actinomycosis of the jaw until it was undertaken by nörgaard, of the bureau of animal industry. in april, , he selected a young steer in fair condition which had a tumor on the jaw measuring - / inches in circumference and from which a discharge had already been established. this animal was treated with iodid of potassium, and the result was a complete cure. the iodid of potassium is given in doses of - / and - / drams once a day, dissolved in water, and administered as a drench. the dose should vary somewhat with the size of the animal and with the effects that are produced. if the dose is sufficiently large signs of iodism appear in the course of a week or days. the skin becomes scurfy, there is weeping from the eyes, catarrh of the nose, and loss of appetite. when these symptoms appear the medicine may be suspended for a few days and afterward resumed in the same dose. the cure requires from three to six weeks' treatment. some animals, generally the ones which show no signs of iodism, do not improve under treatment with iodid of potassium. if there is no sign of improvement after the animals have been treated four or five weeks, and the medicine has been given in as large doses as appear desirable, it is an indication that the particular animal is not susceptible to the curative effects of the drug, and the treatment may therefore be abandoned. it is not, however, advisable to administer iodid of potassium to milch cows, as it will considerably reduce the milk secretion or stop it altogether. furthermore, a great part of the drug is excreted through the milk, making the milk unfit for use. it should not be given to animals in advanced pregnancy, as there is danger of producing abortion. the best results are obtained by pushing the drug until its effect is seen. the many tests to which this treatment has been subjected have proved, with few exceptions, its specific curative value. in addition to this the tumor should be painted externally with either the tincture of iodin or lugol's solution, or the drug should be injected subcutaneously into the tumor. godbille has given as much as drams of potassium iodid in one day to a steer, decreasing the dose one-fourth dram each day until the dose was - / drams, which was maintained until the twelfth day of treatment, when the animal appeared to be entirely cured. nocard gave the first day - / drams in one dose to a cow; the second and succeeding days a dose of dram in the morning and evening, in each case before feeding. this treatment was continued for days, when the animal was cured. _actinomycosis and the public health._--the interest which is shown concerning this cattle disease is largely due to the fact that the same disease attacks human beings. its slow progress, its tendency to remain restricted to certain localities, and the absence of any directly contagious properties have thus far not aroused any anxiety in other countries as to its influence on the cattle industry, not even to the point of placing it among the infectious diseases of which statistics are annually published. its possible bearing on public health has, however, given the disease a place in the public mind which it hardly deserves. it has already been stated that the actinomyces fungus found in human disease is considered by authorities the same as that occurring in bovine affections. it is therefore of interest to conclude this article with a brief discussion of the disease in man and its relation to actinomycosis in cattle. in man the location of the disease process corresponds fairly well to that in cattle. the majority of cases which have been reported in different parts of the world--and they are now rather numerous--indicate disease of the face. the skin, tongue, or the jawbones may become affected, and by a very slow process it may extend downward upon the neck and even into the cavity of the chest. in many cases the teeth have been found in a state of more or less advanced decay and ulceration. in a few cases disease of the lungs was observed without coexisting disease of the bones or soft parts of the head. in such cases the fungus must have been inhaled. the disease of the lungs after a time extends upon the chest wall, where it may corrode the ribs and work its way through the muscles and the skin. an abscess is thus formed discharging pus containing actinomyces grains. disease of the digestive organs caused by this fungus has also been observed in a few instances. granting the identity of the disease in man and cattle, the question has been raised whether cattle are responsible for its occurrence in man. any transmission of the infectious agent may be conceived of as taking place during the life of the animal and from the meat after slaughter. that human beings have contracted actinomycosis by coming in contact with diseased cattle is not shown by the cases that have been reported, for the occupations of most of the patients did not bring them into any relation whatever with cattle. while the possibility of such direct transmission is not denied, nevertheless it must be considered as extremely remote. practically the same position is maintained at present by most authorities as regards the transmission of the disease to man by eating meat. israel, who has studied this question carefully, found the disease in jews who never ate pork,[ ] and who likewise were protected from bovine actinomycosis by the rigorous meat inspection practiced by that race. furthermore, it must be borne in mind that actinomycosis is a local disease, causing great destruction of tissue where the fungus multiplies, but which very rarely becomes generally disseminated over the body from the original disease focus. the fungus is found only in places where the disease process is manifest to the eye or becomes so in a very short time after the lodgment of the fungus. only the greatest negligence would allow the actually diseased parts to be sold and consumed. finally, this parasite, like all others, would be destroyed in the process of cooking. most authorities thus do not believe that actinomycosis in man is directly traceable to the disease in animals, but are of the opinion that both man and animals are infected from a third source, which has already been discussed above. how far these views may be modified by further and more telling investigations of the parasite fungus itself no one can predict. there are still wide gaps in our knowledge, and the presentation above simply summarizes the prevailing views, from which there are dissenters, of course. an attempt to give the views of both sides on this question would necessitate the summarizing and impartial discussion of all the experiments thus far made--a task entirely beyond the scope of the present work. whether an animal affected with actinomycosis should be used for human food after all diseased organs and tissues have been thoroughly removed is a question the answer to which depends on a variety of circumstances. among these may be mentioned the thoroughness of the meat inspection itself, the extent of the disease, and the general condition of the animal affected. the federal meat-inspection regulations require that carcasses of animals showing generalized actinomycosis shall be condemned. if carcasses are in a well-nourished condition, showing uncomplicated localized lesions of actinomycosis, they may be passed after the infected organs or parts have been removed and condemned. when the disease of the jaw is slight, strictly localized, and without pus formation, fistulous tracts, or lymph-gland involvement, the tongue, if free from disease, may be passed. the heads affected with actinomycosis (lumpy jaw), including the tongue, shall be condemned, except that when the lesions in the jaw are strictly localized and slight in extent, the tongue may be passed, if free from disease. anthrax. anthrax or charbon may be defined as an infectious disease which is caused by specific bacteria, known as anthrax bacilli, and which is more or less restricted by conditions of soil and moisture to definite geographical localities. while it is chiefly limited to cattle and sheep, it may be transmitted to goats, horses, cats, and certain kinds of game. smaller animals, such as mice, rabbits, and guinea pigs, speedily succumb to inoculation. dogs and hogs are slightly susceptible, while fowls are practically immune. the variety of domesticated animals which it may attack renders it one of the most dreaded scourges of animal life. it may even attack man. of this more will be stated further on. * * * * * actinomycosis (lumpy jaw). description of plates. plate xxxix. actinomycosis. (from jöhne's encyklopädie d. gesammt. thierheilkunde.) fig. . actinomycosis of the jaw. the lower jawbone has been extensively eaten away by the disease. fig. . actinomyces fungus from a tumor of the jawbone in cattle, magnified times. plate xl. actinomycosis of the jaw. (reduced one-half. from jöhne's encyklopädie d. gesammt. thierheilkunde.) the lower jaw is sawed through transversely, i.e., from right to left, and shows the disease within the jawbone itself; _a_, within the mouth, showing the papillæ on the mucous membrane of the cheek; _b_, front view of a molar tooth; _c_, the skin covering the lower surface of the jawbone; _d_, the jawbone hollowed out and enlarged by the formation of cavities within it, which are filled with the soft growth of the actinomycotic tumor. the section makes it appear as if the bone were broken into fragments and these forced apart; _e_, a portion of the tumor which has broken through the bone and the skin and appears as a tumor on the cheek. the little roundish masses represent the granulomata (minute tumors) in which the fungus vegetates. plate xli. actinomycosis of the lungs. fig. . transverse section of the ventral lobe of the right lung, from a case studied in the laboratory. the yellowish dots represent the places where the actinomyces fungus is lodged. the larger yellowish patches are produced by the confluence of a number of isolated centers. the entire lobe is of a dark flesh-red color, due to collapse and bronchopneumonia. fig. . the cut surface of a portion of the principal lobe of the same lung, showing the recent invasion of antinomycosis from the other lobe: _a_, large air tube; _b_, artery; _c_, a pneumatic lobule; _d_, lobule containing minute yellowish dots. in these the actinomyces fungus is lodged. fig. . cut surface of a small portion of another lung, showing a few lobules, _a._ the fungus is sprinkled throughout the lung tissue in the form of yellowish grains, as shown in the illustration. the pleural covering of the lung tissue is shown in profile above. [illustration: plate xxxix. fig. fig. actinomycosis.] [illustration: plate xl. actinomycosis of the jaw.] [illustration: plate xli. fig. fig. fig. actinomycosis of the lungs.] * * * * * _cause._--the cause of anthrax is a microscopic organism known as the anthrax bacillus. (see pl. xxviii, fig. .) in form it is cylindrical or rodlike, measuring / to / inch in length and / inch in diameter. like all bacteria, these rodlike bodies have the power of indefinite multiplication, and in the bodies of infected animals they produce death by rapidly increasing in numbers and producing substances which poison the body. in the blood they multiply in number by becoming elongated and then dividing into two, each new organism continuing the same process indefinitely. outside the body, however, they multiply in a different way when under conditions unfavorable to growth. oval bodies, which are called spores, appear within the rods, and remain alive and capable of germination after years of drying. they also resist heat to a remarkable degree, so that boiling water is necessary to destroy them. the bacilli themselves, on the other hand, show only very little resistance to heat and drying. it has long been known that the anthrax virus thrives best under certain conditions of the soil and on territories subject to floods and inundations. the particular kinds of soil upon which the disease is observed are black, loose, warm, humous soils; also those containing lime, marl, and clay, finally peaty, swampy soils resting upon strata which hold the water, or, in other words, are impervious. hence fields containing stagnant pools may be the source of infection. the infection may be limited to certain farms, or even to restricted areas on such farms. even in the alps, more than , feet above sea level, where such conditions prevail in secluded valleys, anthrax persists among herds. aside from these limitations to specific conditions of the soil, anthrax is a disease of world-wide distribution. it exists in most countries of europe, in asia, africa, australia, and in our own country in the lower mississippi valley, the gulf states, and in some of the eastern and western states. it seems to be gradually spreading in this country and every year occurs in new districts. meteorological conditions also have an important share in determining the severity of the disease. on those tracts subject to inundations in spring a very hot, dry summer is liable to cause a severe outbreak. the relation which the bacillus bears to these conditions is not positively known. it may be that during and immediately after inundations or in stagnant water the bacilli find nourishment enough in the water here and there to multiply and produce an abundant crop of spores, which are subsequently carried, in a dry condition, by the winds during the period of drought and disseminated over the vegetation. animals feeding upon this vegetation may contract the disease if the spores germinate in the body. another source of the virus, and one regarded by many authorities as perhaps the most important, is the body of an animal which has died of anthrax. it will be remembered that in such bodies the anthrax bacilli are present in great numbers, and wherever blood or other body fluids are exposed to the air on the surface of the carcass there the formation of spores will go on with great rapidity in the warm season of the year. it will thus be readily understood how this disease may become stationary in a given locality and appear year after year and even grow in severity if the carcasses of animals which have succumbed to it are not properly disposed of. these carcasses should be buried deeply, so that spore formation may be prevented and no animal have access to them. by exercising this precaution the disease will not be disseminated by flies and other insect pests. we have thus two agents at work in maintaining the disease in any locality--the soil and meteorological conditions, and the carcasses of animals that have died of the disease. besides these dangers, which are of immediate consequence to cattle on pastures, the virus may be carried from place to place in hides, hair, wool, hoofs, and horns, and it may be stored in the hay or other fodder from the infected fields and cause an outbreak among stabled animals feeding upon it in winter. in this manner the affection has been introduced into far-distant localities. _how cattle are infected._--we have seen above that the spores of the anthrax bacilli, which in their functions correspond to the seeds of higher plants and which are the elements that longest resist the unfavorable conditions in the soil, air, and water, are the chief agents of infection. they may be taken into the body with the feed and produce disease which begins in the intestinal tract, or they may come in contact with scratches, bites, or other wounds of the skin, mouth, and tongue, and produce in these situations swellings or carbuncles. from such swellings the bacilli penetrate into the blood and produce a general disease. it has likewise been asserted that the disease may be transmitted by various kinds of insects which carry the bacilli from the sick and inoculate the healthy as they pierce the skin. when infection of the blood takes place from the intestines the carbuncles may be absent. it has already been stated that since anthrax spores live for several years, the disease may be contracted in winter from feed gathered on permanently infected fields. the disease may appear sporadically, i. e., only one or several animals may be infected while the rest of the herd remain well, or it may appear as an epizootic attacking a large number at about the same time. _symptoms._--the symptoms in cattle vary considerably, according as the disease begins in the skin, in the lungs, or in the intestines. they depend also on the severity of the attack. thus we may have what is called anthrax peracutus or apoplectiform, when the animal dies very suddenly as if from apoplexy. such cases usually occur in the beginning of an outbreak. the animal, without having shown any signs of disease, suddenly drops in the pasture and dies in convulsions, or one apparently well at night is found dead in the morning. the second type (anthrax acutis), without any external swellings, is the one most commonly observed in cattle. the disease begins with a high fever. the temperature may reach ° to ° f. the pulse beats from to a minute. feeding and rumination are suspended. chills and muscular tremors may appear and the skin show uneven temperature. the ears and base of the horns are cold, the coat staring. the animals are dull and stupid and manifest great weakness. to these symptoms others are added in the course of the disease. the dullness may give way to great uneasiness, champing of the jaws, spasms of the limbs, kicking and pawing the ground. the breathing may become labored. the nostrils then dilate, the mouth is open, the head raised, and all muscles of the chest are strained during breathing, while the visible mucous membranes (nose, mouth, rectum, and vagina) become bluish. if the disease has started in the bowels, there is much pain, as shown by the moaning of the animal; the discharges, at first firm, become softer and covered with serum, mucus, and blood. as the disease approaches the fatal termination the weakness of the animal increases. it leans against supports or lies down. blood vessels may rupture and give rise to spots of blood on the various mucous membranes and bloody discharges from nose, mouth, rectum, and vagina. the urine not infrequently contains blood (red water), and death ensues within one or two days. a third type of the disease (anthrax subacutus), which is rarely observed, includes those cases in which the disease is more prolonged. it may last from three to seven days and terminate fatally or end in recovery. in this type, the symptoms are practically as described in the acute form, only less marked. in connection with these types of intestinal anthrax, swellings may appear in different parts of the body under the skin, or the disease may start from such a swelling, caused by the inoculation of anthrax spores in one of the several different ways already described. if the disease begins in the skin, it agrees in general with the subacute form in prolonged duration, and it may occasionally terminate in recovery if the swellings are thoroughly incised and treated. _lesions._--these swellings appear as edemas and carbuncles. the former are doughy tumors of a more or less flattish form passing gradually into the surrounding healthy tissue. as a rule, they are situated beneath the skin in the fatty layer, and the skin itself is at first of healthy appearance, so that they are often overlooked, especially when covered with a good coat of hair. when they are cut open they are found to consist of a peculiar, jellylike mass of a yellowish color and more or less stained with blood. the carbuncles are firm, hot, tender swellings, which later become cool and painless and undergo mortification. the edemas and carbuncles may also appear in the mouth, pharynx, larynx, in the tongue, and in the rectum. the bodies of cattle which have died of anthrax soon lose their rigidity and become bloated, because decomposition sets in very rapidly. from the mouth, nose, and anus bloodstained fluid flows in small quantities. when such carcasses are opened and examined it is found that nearly all organs are sprinkled with spots of blood or extravasations of various sizes. the spleen is enlarged from two to five times, the pulp blackish and soft and occasionally disintegrated. the blood is of tarry consistency, not firmly coagulated, and blackish in color. in the abdomen, the thoracic cavity, and in the pericardium, or bag surrounding the heart, more or less blood-stained fluid is present. in addition to these characteristic signs, the carbuncles and swellings under the skin, already described, will aid in determining the true nature of the disease. the most reliable method of diagnosis is the examination of the blood and tissues for anthrax bacilli, which requires a trained bacteriologist. the cases of fatal anthrax number from to per cent, and are usually more numerous at the first outbreak of the disease. _differential diagnosis._--the diagnosis from blackleg may be made by noting the subcutaneous swellings which appear upon the patient. those of blackleg are found to crackle under pressure with the finger, owing to the presence of gas within the tissues, while the tumors of anthrax, being caused by the pressure of serum, are entirely free from this quality and have a somewhat doughy consistence. the tumors of blackleg are usually on the shoulder or thigh and are not found so frequently about the neck and side of the body as are the swellings of anthrax. the blood of animals dead of blackleg is normal, and the spleen does not appear swollen or darkened, as in those affected with anthrax. the chief differences between anthrax and texas fever are that the course of the former is more acute and the blood of the animal is dark and of a tarlike consistence, while in the latter it is thinner than normal. the presence of texas-fever ticks on the cattle would also lead one to suspect that disease in regions where cattle are not immune from it. _treatment._--in cases which originate from external wounds, the swellings should be opened freely by long incisions with a sharp knife and washed several times daily with carbolic-acid solution ( ounce to a quart of water). care should be taken to disinfect thoroughly any fluid discharge that may follow the incision. when suppuration has set in the treatment recommended in the chapter on wounds should be carried out. in the treatment of animals showing symptoms of anthrax, the serum recommended under the next heading of "prevention" should be administered in large doses. animals showing only a high temperature with no other symptoms of the disease should be given from to cubic centimeters of the serum, but if the gravity of the disease is pronounced cubic centimeters should be administered. in most instances a drop in temperature may be observed and a diminishing of the severity of the symptoms. at times, however, a relapse occurs about the second or third day following the serum injection, when it becomes necessary to administer another dose of serum. it has been proved that animals affected with anthrax may recover after injections of potent serum. _prevention._--in this disease prevention is the most important subject demanding consideration. the various means to be suggested may be brought under two heads: ( ) the surroundings of the animal, and ( ) preventive inoculation. ( ) surroundings.--what has already been stated of those conditions of the pastures which are favorable to anthrax, after a little thought, will suggest to most minds some of the preventive measures which may be of service in reducing losses in anthrax localities. all that conduces to a better state of the soil should be attempted. the state or nation, by appropriate engineering, should do its share in preventing frequent inundations. if pools of stagnant water exist in the pastures, or if any particular portions are known by experience to give rise to anthrax, they should be fenced off. efforts should likewise be made toward the proper draining of swamp lands frequented by cattle. sometimes it has been found desirable to abandon for a season any infected or dangerous pastures. this remedy can not be carried out by most farmers, and it is liable to extend the infected territory. in some instances withdrawal of cattle from pastures entirely and feeding them in stables is said to have reduced the losses. it is of the utmost importance that carcasses of animals which have died of anthrax be properly disposed of, as every portion of such animal contains the bacilli, ready to form spores when exposed to the air. perhaps the simplest means is to bury the carcasses deep, where they can not be exposed by dogs or wild animals. it may be necessary to bury them on the pasture, but it is better to remove them to places not frequented by susceptible animals and to a point where drainage from the graves can not infect any water supply. if they are moved some distance it must be borne in mind that the ground and all objects which have come in contact with the carcass should be disinfected. this is best accomplished with chlorid of lime. for washing utensils, etc., a per cent solution may be prepared by adding ounces to quarts of water. this should be prepared fresh from the powder, and it is but little trouble to have a small tin measure of known capacity to dip out the powder, to be added to the water whenever necessary. the carcass and the ground should be sprinkled with powdered chlorid, or, if this is not at hand, an abundance of ordinary, unslaked lime should be used in its place. the removal of carcasses to rendering establishments is always fraught with danger, unless those who handle them are thoroughly aware of the danger of scattering the virus by careless handling in wagons that are not tight. as a rule, the persons in charge of such transfer have no training for this important work, so that deep burial is to be preferred. burning large carcasses is not always feasible; it is, however, the most certain means of destroying infectious material of any kind, and should be resorted to whenever practicable and economical. all carcasses, whether buried, rendered, or burned, should be disposed of unopened. when stables have become infected they should be thoroughly cleaned out, and the solution of chlorid of lime freely applied on floors and woodwork. the feed should be carefully protected from contamination with the manure or other discharges from the sick. ( ) preventive inoculation.--one of the most important discoveries in connection with the disease was made by louis pasteur in , and consisted in the new principle of producing immunity by the inoculation of weakened cultures of the bacillus causing the disease. this method has been quite extensively adopted in france, and to some extent in other european countries, and in the united states. the fluid used for inoculation consists of bouillon in which modified anthrax bacilli have multiplied and are present in large numbers. the bacilli have been modified by heat so that to a certain degree they have lost their original virulence. two vaccines are prepared. the first or weaker, for the first inoculation, is obtained by subjecting the bacilli to the attenuating effects of heat for a longer period of time than in the case of the second, or stronger vaccine, for a second inoculation some days later. there are several difficulties inherent in the practical application of pasteur's vaccine. among them may be mentioned the variable degree of attenuation of different tubes of the vaccine and the varying susceptibility of the animals to be inoculated. the use of this vaccine is increasing, nevertheless, and has reduced the mortality in the affected districts from an average of per cent in the case of sheep, to less than per cent, and from per cent with cattle, to less than one-half of per cent. it is very important to call attention to the possibility of distributing anthrax by this method of protective inoculation, as the bacilli themselves are present in the culture liquid. it is true that they have been modified and weakened by the process adopted by pasteur, but it is not impossible for such modified virus to regain its original virulence after it has been scattered broadcast by the inoculation of large herds. it is obviously unsafe to have such vaccine injected by a layman; instead, it should be handled only by a competent veterinarian. there are other disadvantages in this method of vaccination, and they all must be given due consideration. the unstable keeping quality of the pasteur vaccine is a very important factor to be considered. experience in this line has proved that pasteur vaccine may deteriorate within a very short time after its preparation, and in repeated instances it has proved inert within three months of its preparation. when exposed to warm temperature and light, it deteriorates very rapidly; and when it is considered that the products of manufacturers may be stored under unfavorable conditions in branch houses and on the shelves of rural drug stores, the loss of potency can be readily explained. these deficiencies have been recognized by many investigators, and because of the superior keeping qualities particular attention has been directed toward the preparation of a spore vaccine by zenkowsky of russia, detre of hungary, and nitta of japan. for the purpose of producing a spore vaccine it is desirable to use a peptone-free agar medium, and after inoculation with an attenuated culture of the anthrax bacillus, it is allowed to grow at a temperature of ° c. for to days. by this time an abundance of spores will have formed. the growth is then collected in sterile flasks and heated to a temperature of ° c. for one-half hour to destroy the vegetative forms of the organism. if it is desired to use for vaccination one million spores, it is advisable to dilute the vaccine to a quantity of which cubic centimeter would contain this number. of such a vaccine cubic centimeter would constitute the dose for cattle and horses. in all forms of vaccination against anthrax in sheep the greatest care must be exercised, as these animals are very susceptible to the disease, and at times vaccines which have no ill effects on cattle will prove fatal to sheep. therefore the dose of the spore vaccine for sheep should not be more than one-fourth of that given to cattle. sclavo, sobernheim, and others have established that injections of increasing quantities of virulent cultures into immune animals produced a serum which has great protective value against anthrax. such protective serum may be produced in the various susceptible animals. for immunization purposes it is advisable to use the simultaneous method; that is, both the spore vaccine and the anthrax serum should be injected. it is desirable to divide the herd to be treated into groups of ten or twelve and inject, first, each animal of the group with the serum, following this with the injection of the spore vaccine. the serum should be injected on one side, either on the neck or back of the shoulder, and the spore vaccine on the other side, injections being made subcutaneously. in herds in which the disease has already made its appearance it is necessary to take the temperatures of all the animals and to subject to the simultaneous vaccination only those that show no rise in temperature. all others should be given the serum-alone treatment in doses varying in accordance with the severity of the symptoms manifested by the individual animals. if the examination reveals a considerable number of infections, it is advisable to use the serum alone for all the animals, and in three or four weeks to revaccinate by the simultaneous method. the dosage should depend on the potency of the serum, serum of a high potency naturally being most desirable. thus serum in cubic centimeter doses for large animals, and to cubic centimeter doses for smaller ones, has been found to be effective in producing a temporary immunity. as anthrax is entirely different from blackleg, vaccine for the latter does not act as a preventive against the former. anthrax in man (malignant pustule, or carbuncle). anthrax may be transmitted to man in handling the carcasses and hides of animals which have succumbed to the disease. the infection usually takes place through some abrasion or slight wound of the skin into which the anthrax spores, or bacilli, find their way. the point of inoculation appears at first as a dark point or patch, compared by some writers to the sting of a flea. after a few hours this is changed into a reddened pimple, which bears on its summit, usually around a hair, a yellowish blister, or vesicle, which later on becomes red or bluish in color. the burning sensation in this stage is very great. later this pimple enlarges, its center becomes dry, gangrenous, and is surrounded by an elevated, discolored swelling. the center becomes drier and more leatherlike, and sinks in as the whole increases in size. the skin around this swelling or carbuncle is stained yellow or bluish, and is not infrequently swollen and doughy to the touch. the carbuncle itself rarely grows larger than a pea or a small nut, and is but slightly painful. anthrax swellings or edemas, already described as occurring in cattle, may also be found in man, and they are at times so extensive as to produce distortion in the appearance of the part of the body on which they are found. the color of the skin over these swellings varies according to the situation and thickness of the skin and the stage of the disease, and may be white, red, bluish, or blackish. as sooner or later these carbuncles and swellings may lead to an infection of the entire body, and thus be fatal, surgical assistance should at once be called if there is well-grounded suspicion that any swellings resembling those described above have been caused by inoculation with anthrax virus. inasmuch as physicians differ as to medicinal treatment of such accidents in man, it would be out of place to make any suggestions in this connection. extensive data are available, however, on the effectiveness of anthrax serum for the treatment of the disease in man. it is recommended that from to cubic centimeters of serum be injected in three or four different places. should no improvement follow in hours additional injections of to cubic centimeters should be administered. in most instances the results are favorable, and this treatment is acknowledged to be superior to any other mode of treatment known for the disease. to show that the transmission of anthrax to man is not so very uncommon, we take the following figures from the report of the german government: the attention of the authorities was brought to cases, of which terminated fatally. the largest number of inoculations were caused by the slaughtering, opening, and skinning of animals affected with anthrax; hence, the butchers suffered most extensively. of the thus affected, belonged to this craft. infected shaving brushes also are very dangerous. in addition to anthrax of the skin (known as malignant pustule), human beings are subject, though very rarely, to the disease of the lungs and the digestive organs. in the former case the spores are inhaled by workmen in establishments in which wool, hides, and rags are worked over, and it is therefore known as woolsorter's disease. in the latter case the disease is contracted by eating the flesh of diseased animals which has not been thoroughly cooked. these forms of the disease are more fatal than those in which the disease starts from the skin. blackleg. [pl. xlii.] blackleg, black quarter, quarter ill, symptomatic anthrax, charbon symptomatique of the french, rauschbrand of the germans, is a rapidly fatal, infectious disease of young cattle, associated with external swellings which emit a crackling sound when handled. this disease was formerly regarded identical with anthrax, but investigations by various scientists in recent times have definitely proved the entire dissimilarity of the two affections, both from a clinical and a causal standpoint. the disease is produced by a specific bacillus, readily distinguishable from that causing anthrax. (pl. xxviii, fig. .) cattle between months and years of age are the most susceptible. sucking calves under months are rarely attacked, nor are they so susceptible to inoculation as older animals. cattle more than years of age may become affected, but such cases are infrequent. sheep and goats may also contract the disease, but man, horses, hogs, dogs, cats, and fowls appear to be immune. like anthrax, blackleg is more or less restricted to definite localities. there are certain pastures upon which the disease regularly appears in the summer and fall of the year. as to any peculiarities of the soil nothing is definitely known. some authors are inclined to regard moist, undrained, and swampy pastures favorable to this disease, but these theories will hardly hold, as it is found in all kinds of soil, in all altitudes, at all seasons of the year, and under various climatic conditions. it occurs in this country from the atlantic to the pacific and from mexico to canada, but it is more prevalent in the western and southwestern states. in europe it exists in france, various parts of germany, in belgium, norway, denmark, italy, and in the alps of switzerland. in africa it occurs in algeria and to some extent in natal and bordering countries. in south america it prevails quite extensively throughout argentina. cattle in cuba and australia also suffer. _cause._--the cause of the disease is a bacillus resembling in some minor respects the anthrax bacillus and differing but little from it in size. it also possesses the power of forming within itself a spore. in plate xxviii, figure , this is represented as an uncolored spot located in one end of the rod, which is enlarged so that the rod itself appears more or less club-shaped. what has already been stated concerning the significance of the spore of the anthrax bacillus applies equally well to these bodies. they resist destructive agents for a considerable time, and may still produce disease when inoculated after several years of drying. this fact may account for the occasional appearance of blackleg in stables. in order to meet the requirements for the development of the spores, which takes place only in the absence of the atmosphere, it is necessary that the wound be very small and deep enough to penetrate the subcutaneous tissue. several observers have found this organism in the mud of swamps. by placing a little of the mud under the skin, the disease has been produced. since the disease may be produced by placing under the skin material containing the specific bacilli and spores, it has been assumed that cattle contract the disease through wounds, principally of the skin, or very rarely of the mouth, tongue, and throat. slight wounds into which the virus may find access may be caused by barbed wire, stubbles, thorns, briers, grass burs, and sharp or pointed parts of feed. infection by way of digestive tract is also probable. _symptoms and lesions._--the symptoms of blackleg may be either of a general or of a local nature, though more frequently of the latter. the general symptoms are very much like those belonging to other acute infectious or bacterial diseases. they begin, from one to three days after the infection has taken place, with loss of appetite and of rumination, with dullness and debility, and a high fever. the temperature may rise to ° f. to these may be added lameness or stiffness of one or more limbs, due to the tumor or swelling quite invariably accompanying the disease. after a period of disease lasting from one to three days the affected animal almost always succumbs. death is preceded by increasing weakness, difficult breathing, and occasional attacks of violent convulsions. the most important characteristic of this disease is the appearance of a tumor or swelling under the skin a few hours after the setting in of the constitutional symptoms described above. in some cases it may appear first. this tumor may be on the thighs (hence "blackleg," "black quarter"), the neck, the shoulder, the breast, the flanks, or the rump; never below the carpal (or knee) and the hock joint. it more rarely appears in the throat and at the base of the tongue. the tumor, at first small and painful, spreads very rapidly both in depth and extent. when it is stroked or handled a peculiar crackling sound is heard under the skin; this is due to a collection of gas formed by the bacilli as they multiply. at this stage the skin becomes dry, parchment-like, and cool to the touch in the center of the tumor. if the swelling is cut into, a frothy, dark-red, rather disagreeable-smelling fluid is discharged. the animal manifests little or no pain during the operation. as it is frequently desirable to know whether the disease is anthrax or blackleg, a few of the most obvious post-mortem changes may here be cited. the characteristic tumor with its crackling sound when stroked has already been described. if after the death of the animal it is more thoroughly examined, it will be noted that the tissues under the skin are infiltrated with blood and yellowish, jellylike material and gas bubbles. the muscular tissue beneath the swelling may be brownish or black, shading into dark red. (pl. xlii.) it is soft, easily torn and broken up. the muscle tissue is distended with numerous smaller or larger gas-filled cavities, often to such extent as to produce a resemblance to lung tissue. upon incision it does not collapse perceptibly, as the gas cavities are not connected with one another. in the abdomen and the thorax bloodstained fluid is not infrequently found, together with bloodstaining of the lining membrane of these cavities. blood spots (or ecchymoses) are also found on the heart and lungs. the liver is congested, but the spleen is always normal in appearance. _differential diagnosis._--among the features of this disease which distinguish it from anthrax may be mentioned the unchanged spleen and the ready clotting of the blood. it will be remembered that in anthrax the spleen (milt) is very much enlarged, the blood tarry, coagulating feebly. the anthrax carbuncles and swellings differ from the blackleg swellings in not containing gas, in being hard and solid, and in causing death less rapidly. it is difficult to distinguish between the swellings of blackleg and malignant edema, as they resemble each other very closely and both are distended with gas. malignant edema, however, generally starts from a wound of considerable size; it usually follows surgical operations, and seldom results from the small abrasions and pricks to which animals are subjected in pastures. inoculation experiments on guinea pigs, rabbits, and chickens will generally disclose the differences between the three diseases above, as all these species are killed by the germ of malignant edema, only the first two species by the anthrax bacillus, while the guinea pigs alone will succumb to the blackleg infection. hemorrhagic septicemia may be differentiated from blackleg by its affecting cattle of all ages, by the location of the swelling usually about the region of the throat, neck, and dewlap, by the soft, doughy character of the swellings without the presence of gas bubbles, and finally by the characteristic hemorrhages widely distributed throughout the body. other means of diagnosis, which have reference to the specific bacilli, to the inoculable character of the virus upon small animals, and which are of decisive and final importance, can be utilized only by the trained bacteriologist and veterinarian. _treatment._--in this disease remedies have thus far proved unavailing. some writers recommend the use of certain drugs, which seem to have been beneficial in a few cases, but a thorough trial has shown them to be valueless. others advise that the swelling be opened by deep and long incisions and a strong disinfectant, such as a per cent solution of carbolic acid, applied to the exposed parts; but this procedure can not be too strongly condemned. as nearly all those attacked die, in spite of every kind of treatment, and in view of the fact that when these tumors are opened the germs of the disease are scattered over the stables or pastures, thus becoming a source of danger to other cattle, it is obvious that such measures do more harm than good and should be put aside as dangerous. bleeding, nerving, roweling, or setoning have likewise some adherents, but the evidence indicates that they have neither curative nor preventive value and therefore should be discarded for the method of vaccination which has been thoroughly tried and proved to be efficacious. _prevention._--the various means suggested under "anthrax" to prevent the spread or recurrence of this disease are equally applicable to blackleg, and hence do not need to be repeated here in full. they consist in the removal of well animals from the infected pasture to a noninfected field, the draining of the swampy ground, the burial or burning of the carcasses to prevent the dissemination of the germs over vast areas through the agency of dogs, wolves, buzzards, or crows, the disinfection of the stables and the ground where the animals lay at the time of death, and, if possible, the destruction of the germs on the infected pastures. one of the most effective methods for freeing an infected pasture from blackleg is to allow the grass to grow high, and when sufficiently dry to burn it off. one burning off is not sufficient to redeem an infected pasture, but the process should be repeated several years in succession. this method, however, is in many instances impracticable, as few cattle owners can afford to do it, and the only means left for the protection of the animals is vaccination. _immunization by vaccination._--three french veterinarians, arloing, cornevin, and thomas, were the first to discover that cattle may be protected against blackleg by inoculation with virulent material obtained from animals which have died of this disease. later they devised a method of inoculation with the attenuated or weakened blackleg spores which produced immunity from natural or artificial inoculation of virulent blackleg germs. their method has undergone various modifications both in regard to the manufacture of the vaccine and in the mode of its application. kitt, a german scientist, modified the method so that but one inoculation of the vaccine was required instead of two, as was the case with that made by the french investigators. the vaccine formerly prepared and distributed by the bureau of animal industry combined the principle of arloing, cornevin, and thomas, and the modification of kitt. by vaccination we understand the injection of a minute amount of attenuated--that is, artificially weakened--blackleg virus into the system. this virus is obtained from animals which have died from blackleg, by securing the affected muscles, cutting them into strips, and drying them in the air. when they are perfectly dry they are pulverized and mixed with water to form a paste, smeared in a thin layer on flat dishes, placed in an oven, and heated for six hours at a temperature close to that of boiling water. the paste is then transformed into a hard crust, which is pulverized and sifted and distributed in packages containing either or doses. this constitutes the vaccine, the strength of which is thoroughly tested on experiment animals before it is distributed among the cattle owners. this vaccine, which is in the form of a brownish, dry powder, is mixed with definite quantities of sterile water, filtered, and by means of a hypodermic syringe the filtrate injected under the skin in front of the shoulder of the animal. the inoculation is usually followed by insignificant symptoms. in a few cases there is a slight rise of temperature, and by close observation a minute swelling may be noted at the point of inoculation. the immunity conferred in this way may last for months, but animals vaccinated before they are months old and those in badly infected districts should be revaccinated before the following blackleg season. the effect of the vaccine prepared by this bureau in preventing outbreaks of the disease and in immediately abating outbreaks already in progress was highly satisfactory, and it is not to be doubted that thousands of young cattle were saved to the stock owners during the years in which the vaccine was distributed.[ ] more than , , doses were sent out during this period, and from reports received it is safe to conclude that more than , , were actually injected, whereby the percentage of loss from blackleg has been reduced from per cent, which annually occurred before using, to less than one-half of per cent per annum. with these figures before us it is plain that the general introduction of preventive vaccination must be of material benefit to the cattle raisers in the infected districts. moreover, there is every reason to believe that with the continued use of blackleg vaccine in all districts where the disease is known to occur, and an earnest effort on the part of the stock owners to prevent the reinfection of their pastures by following the directions given, blackleg may be kept in check and gradually eradicated. immunization against blackleg is now frequently accomplished by the use of the so-called blackleg aggressin and blackleg filtrates. necrotic stomatitis (calf diphtheria). [pl. xliii.] necrotic stomatitis is an acute, specific, highly contagious inflammation of the mouth occurring in young cattle, and characterized locally by the formation of ulcers and caseo-necrotic patches and by constitutional symptoms, chiefly toxic. this disease has also been termed calf diphtheria, gangrenous stomatitis, ulcerative stomatitis, malignant stomatitis, tubercular stomatitis, and diphtheritic patches of the oral mucous membrane. _history._--during the last few years farmers and cattlemen in this country, especially in colorado, texas, and south dakota, have increasingly noted the occurrence of enzootics of "sore mouth" among the young animals of their herds. instead of healing, like the usual forms, of themselves, these cases, if untreated, die. careful study of some of them has resulted in their identification with cases reported in by dammann, from the shore of the baltic; in by blazekowic, in slavonia; in by vollers, in holstein; in by lenglen, in france; in by macgillivray, in england; and in by löffler, who isolated and described the microorganism which produces the disease. bang obtained this organism from the diphtheritic lesions of calves in , and kitt likewise recovered the bacillus from similar lesions of the larynx and pharynx of calves and pigs in . [illustration: plate xlii. section of muscle from a blackleg swelling. a. gas bubbles. b. cavities due to gas formation.] [illustration: plate xliii. necrotic stomatitis (calf diptheria).] _etiology._--the cause of necrotic stomatitis, as demonstrated by löffler and since confirmed by other investigators, is _bacillus necrophorus_, often spoken of as the bacillus of necrosis. this organism varies in form from a coccoid rod to long, wavy filaments, which may reach a length of µ; the width varies from . µ to µ. hence it is described as polymorphic. it does not stain by gram, but takes the ordinary anilin dyes, often presenting, especially the longer forms, a beaded appearance. a characteristic of the organism, of great moment when we come to treatment, is that it grows only in the absence of oxygen, from which fact it is described as an obligate anærobe. very few organisms exhibit a wider range of pathogenesis. according to clinical observation to the present time, _bacillus necrophorus_ is pathogenic for cattle, horses, hogs, sheep, reindeer, kangaroos, antelope, and rabbits. experimentally it has been proved pathogenic for rabbits and white mice. the dog, cat, guinea pig, pigeon, and chicken appear to be absolutely immune. it is not pathogenic for man. the importance of this bacillus is far beyond even its relation to necrotic stomatitis. besides this disease it has been demonstrated as the causative factor in foot rot, multiple liver abscesses, disseminated liver necrosis, embolic necrosis of the lungs, necrosis of the heart, in cattle; gangrenous pox of the teats, diphtheria of the uterus and vagina, in cows; diphtheritic inflammation of the small intestine of calves. among horses it is the agent in the production of necrotic malanders, quittor, and diphtheritic inflammation of the large intestine. in hogs it has caused necrotic or diphtheritic processes in the mucous membrane of the mouth, necrosis of the anterior wall of the nasal septum, and pulmonary and intestinal necrosis, accompanying hog cholera. abscesses of the liver, gangrenous processes of the lips and nose, and gangrenous affections of the hoof have all been caused in sheep by this organism. _pathology._--the principal lesions in necrotic stomatitis occur in the mucous membrane of the mouth and pharynx. the alterations may extend to the nasal cavities, the larynx, the trachea, the lung, the esophagus, the intestines, and to the hoof. the oral surfaces affected are, in the order of frequency, tongue, cheeks, hard palate, gums, lips, and pharynx. in the majority of cases the primary infection seems to occur in the tongue. (pl. xliii.) infection takes place by inoculation. some abrasion or break in the continuity of the mucous membrane of the mouth occurs. very likely the origin may be connected with the eruption of the first teeth after birth, or, in animals somewhat older, the entrance of a sharp-pointed particle of feed. gaining an entrance at this point, the bacilli begin to multiply. during their development they elaborate a toxin, or poisonous substance, which causes the death, or necrosis, of the epithelial, or superficial, layer of the mucous membrane and also of the white blood cells which have sallied forth through the vessel walls to the defense of the tissues against the bacillary attack. this destruction of the surface epithelium seems to be the essential factor in the production of the caseous patch, often called the false membrane. from the connective-tissue framework below is poured forth an inflammatory exudate highly albuminous or rich in fibrin-forming elements. when this exudate and the necrosed cellular elements come in contact, the latter furnish a fibrin ferment which transforms the exduate into a fibrinous mass. this process is known as coagulation necrosis, and the resulting fibroid mass, containing in its meshes the necrosed and degenerated epithelium and leucocytes, constitutes the diphtheritic or false membrane. did the process cease at this point it would be properly called a diphtheritic inflammation, but it does not. a caseating ferment is supplied by the bacilli, and this, acting upon the fibroid patch, transforms it into a dry, finely granular, yellowish mass of tissue detritus resembling cheese. frequently this caseous inflammation results in the formation of one or more ulcers with thickened, slightly reddened borders, surmounted by several layers of this necrosed tissue. the floor of the ulcer is formed by a grayish-yellow, corroded surface, under which the tissue is transformed into a dry, friable, or firm cheesy mass. in the tongue this may progress to two fingers' thickness into the muscular portion; in the cheek it may form an external opening, permitting fluids to escape from the mouth; upon the palate it frequently reaches and includes the bone in its destructive course; upon the gums it has produced necrosis of the tooth sockets, causing loss of the teeth. in the advanced forms, caseous foci may be seen in the lung and in the liver and necrotic patches observed on the mucous membrane of the gastrointestinal tract. _symptoms._--necrotic stomatitis is both a local and a systemic affection. primarily it is local. the local lesion is the caseo-necrotic patch or ulcer developed as a result of the multiplication of the bacilli at the point of inoculation. the general affection is an intoxication, or poisoning, of the whole system produced by a soluble toxin elaborated by the bacilli. the stage of incubation is from three to five days. the first symptoms noted are a disinclination to take nourishment, some drooling from the mouth, and an examination of the mouth will show on some portion of its mucous membrane a circumscribed area of infiltration and redness, possibly an erosion. the latter gradually extends in size and depth, forming a sharply circumscribed area of necrotic inflammation. it may measure anywhere from the size of a -cent piece to that of a silver dollar or even larger. it has the appearance of a corroded surface, under which the mucous membrane or muscular tissue seems transformed into a dry, friable, or firm cheesy mass. it is grayish yellow in color and is bordered by a zone of thickened tissue slightly reddened and somewhat granulated. the necrotic tissue is very adherent and can be only partially peeled off. it is homogeneous, cheesy, and may extend two fingers' depth into the tissues beneath. the general symptoms are languor, weakness, and slight fever. in spite of plenty of good feed the calf is seen to be failing. it stops sucking, or, if older, altogether refuses to eat. the temperature at this time may be from ° to ° f. the slobber becomes profuse, swallowing very difficult, opening of the mouth quite painful, and a most offensive odor is exhaled. the tongue is swollen and its motion greatly impaired. sometimes the mouth is kept open, permitting the tumefied tongue to protrude. one or more of the above symptoms direct the attention to the mouth as the seat of disease; or, having noticed the debility and disinclination to eat, an examination of the animal may show a lump under the neck or swelling of the throat or head. the following extract from a letter is characteristic: i noticed my calves beginning to fail about the first week in december, but could not account for it, as they were getting plenty of grain and hay. my attention was first attracted by a swelling under the neck of one of the calves. i cast the animal and found that it was feed that had collected and the animal couldn't swallow it. i removed it, and in so doing noticed a large ulcer on the tongue and a very offensive odor. this was the first knowledge i had of anything being wrong with the calves' mouths. they may have been sick for some time before this. out of a herd of belonging to this man, were affected, and the letter emphasizes the insidious character of the onset. the general affection at this time manifests itself by dejectedness, extreme weakness, and emaciation, constant lying down, with stiffness and marked difficulty in standing. the disease frequently extends to the nasal cavities, producing a thin, yellowish, or greenish-yellow, sticky discharge which adheres closely to the borders of the nostrils. their edges also show caseous patches similar to those in the mouth. sometimes the nasal passage is obstructed by great masses of the necrosed exudate, thus causing extreme difficulty in breathing. when the caseous process involves the larynx and trachea there result cough, wheezing, and dyspnea, together with a yellowish mucopurulent expectoration. when life is prolonged three or four weeks, caseous foci may be established in the lung, giving rise to all the signs of a bronchopneumonia. many of these cases are associated with a fibrinous pleurisy. the invasion of the gastrointestinal tract is announced by diarrheal symptoms. this disease principally attacks sucklings not more than weeks of age, but calves and months old are frequently affected, and several cases in adult cattle have been reported to this office. in its very acute form many of the cases run their course in from five to eight days. in these the local lesions are not strongly marked, and death seems due to acute intoxication. in other enzootics the majority of the affected animals live from three to five weeks. these are cases that occasionally present the pulmonary and intestinal symptoms, and sometimes develop also caseo-necrotic lesions in the liver. ordinarily cases show no tendency to spontaneous cure. left to themselves they die. on the contrary, if taken in hand early, the disease is readily amenable to treatment. in the latter event the prospects of recovery are excellent. _differential diagnosis._--necrotic stomatitis may be differentiated from foot-and-mouth disease by the fact that in the latter there is a rapid infection of the entire herd, including the adult cattle, as well as the infection of hogs and sheep. the characteristic lesion of foot-and-mouth disease is the appearance of vesicles containing a serous fluid upon the mucous membrane of the mouth and upon the udder, teats, and feet of the affected animals. in necrotic stomatitis vesicles are never formed, necrosis occurring from the beginning and followed by the formation of yellowish, cheesy patches, principally found in the mouth. mycotic stomatitis occurs in only a few animals of the herd, chiefly the adult cattle, and the lesions produced consist of an inflammation of the mouth and lips and of the skin between the toes, followed in a few days by small irregular ulcers in the mouth. this disease appears sporadically, usually in the early fall after a dry summer, does not run a regular course, and can not be inoculated. _prevention._--prophylaxis should be carried out along three lines: ( ) separation of the sick from the healthy animals. ( ) close scrutiny and thorough disinfection once or twice daily for five days of the mouths and nasal passages of those animals that have been exposed. ( ) complete disinfection of all stalls and sheds. the disease appears to break out in winter and hold over to spring. it is conceivable that exposure to cold might so disturb the normal circulation of the oral tissues as to make the mucous membrane an excellent location for the causative factor of the disease. there is another possibility, however, which bears on the third line of prophylaxis. the so-called diphtheritic inflammations of the vagina and uterus in cows are caused by the same organism that induces necrotic stomatitis. a european writer has recently pointed out the almost constant relation of such attacks to previous occurrences of foul foot or foot rot in the same or other cattle on the place. in all likelihood, in such cases, the stalls and sheds are the harborers of this germ. it is possible that many of these outbreaks have some relation to preceding cases of the above-mentioned diseases and the greater use in winter of the stalls and sheds, thus harboring the _bacillus necrophorus._ _treatment._--the treatment consists almost solely in careful and extensive cleansing and disinfection of the mouth and other affected surfaces. the mucous membrane of the mouth should be copiously irrigated with a per cent solution of boracic acid in warm water at least twice daily. as exposure to oxygen kills the bacilli, one need have no fear about disturbing or tearing off the caseous patches or necrotic tissue during irrigation. the irrigation of the sores should then be followed by the application with a brush or rag on a stick of a paste made with part of salicylic acid and parts of water, or the affected areas may be painted with lugol's solution of iodin (iodin, ; potassium iodid, ; water, ). frequent injections of per cent carbolic-acid solution into the mouth make an excellent treatment. the internal administration of grams of salicylic acid and grams of chlorate of potassium three times a day has also proved to be very beneficial when accompanied with local antiseptic treatment. malignant catarrh. malignant catarrh, or infectious catarrhal fever, is an acute infectious disease of cattle preeminently involving the respiratory and digestive tracts, although the sinuses of the head, the eyes, and the urinary and sexual organs are very frequently affected. it is relatively rare in this country, being more common on the continent of europe. outbreaks have occurred, however, in minnesota, new york, and new jersey. so far the causal agent of the disease has never been isolated, and inoculation experiments with the view of artificially reproducing the disease have proved negative in every case. in spite of the foregoing statements the consensus of opinion of eminent investigators points to malignant catarrh as being of specific origin; that is, due to some form of microorganism the contagious character of which is poorly developed. this accounts for the slow transmissibility of the disease from one animal to another. in fact, malignant catarrh is a type of that class of affections scientifically known as miasmatic diseases; that is, they remain stationary in stables with damp floors, low ceilings, poor ventilation, and bad sanitary conditions in general. such places furnish a favorable seat of propagation for the infective material, and it will remain active for a long time, causing the loss of a few animals each year. one european veterinarian reports an instance in which the disease remained for years on the same farm, attacking in all animals, with a mortality of about per cent. the disease is most common in late winter and early spring, at all altitudes, and has a special preference for young, well-nourished cattle, although older animals are not immune. the time between the entrance of the infective principle into the body of the animal and the appearance of the first symptoms is relatively very long, averaging, according to german investigators, from to days. fortunately, it is not a disease which spreads to any great extent or which causes severe losses, and hence legislative enactments do not seem to be necessary for its restriction. _symptoms._--these are extremely variable according to the point of localization of the lesions. it is usually ushered in with a chill, followed by a marked rise of temperature ( ° to ° f.). the head droops, the skin is hot and dry, and the coat staring. quivering of the muscles in various parts of the body is frequently observed. marked dullness of the animal, passing, according to some observers, into an almost stupefied condition later on, is quite common. the secretion of milk stops in the beginning of the disease, and loss of flesh, invariably associated with the disease, is extremely marked and rapid. the lesions of the eyes may best be likened to moon blindness (periodic ophthalmia) in horses. there is first an abundant secretion of tears, which run down the face. the lids are swollen and inflamed, and indeed this may be so marked as to cause involuntary eversion, exposing the reddened conjunctiva to view. sunlight is painful, as is shown by the fact that the animal keeps the eyes continuously closed. this inflammation may extend to the cornea, causing it to assume a slightly clouded appearance in mild cases or a chalky whiteness in more severe affection. cases of ulceration of the cornea followed by perforation and subsequent escape of the aqueous humor, leading to shrinking of the eyeball and permanent loss of sight, have been recorded, but these are relatively rare, although slight inflammation of the deeper structures of the eye (iris) are more frequent. in mild cases this inflammation may undergo complete resolution, but more frequently permanent cloudliness of the cornea, either diffuse or in spots (leucoma), is the result. the mucous membrane of the mouth, nose, sinuses of the head, throat, and lower respiratory passages are also involved. it is first catarrhal in character, but soon a false or diphtheritic membrane is formed, with the production of shallow ulcers. there is dribbling of saliva from the mouth and discharge from the nose, at first watery, becoming thicker and mixed with blood and small masses of cast-off croupous membrane, causing a very fetid odor. these croupous areas when they form in the throat, larynx, or windpipe, may lead to narrowing of the passages, with consequent difficult breathing and even suffocation. various respiratory murmurs may also be heard, caused by the to-and-fro movement of mucus and inflammatory deposits along the air passages. there is also inflammation of the horn core with consequent loosening of the horn shell, and the horns are thus readily knocked off by the uneasy, blind sufferer. the animal may refuse all feed from the time of the initial rise of temperature, or in less severe cases, and especially when the lesions of the digestive tract are not so marked, the appetite may remain until the disease is well advanced. constipation is quite common at the commencement of the attack, followed by diarrhea and severe straining, the evacuations becoming very soft, fetid, and streaked with blood. cases of the evacuation of desquamated patches of diphtheritic membrane from the intestinal mucosa to feet in length have been reported. the kidneys and bladder are usually inflamed, the urine being voided with difficulty and the animal evincing signs of pain. inflammatory elements, as albumen, casts, etc., may be seen on examination of the urine. in cows the mucous membrane of the vestibule is congested, swollen, and may contain ulcers and an excessive quantity of mucus. abortion during advanced pregnancy is not infrequent, following a severe attack. in connection with these various symptoms there may be much uneasiness on the part of the animal, leading in some cases to madness and furious delirium, in others to spasms and convulsions or paralysis. a vesicular eruption of the skin may occur, seen principally between the toes and on the inside of the flank and in the armpits, with subsequent loss of hair and epidermis. like other infectious diseases, malignant catarrh pursues a longer or shorter course in accordance with the severity of the attack. in acute cases death is said to take place three to seven days after the appearance of symptoms. recovery, if it occurs, may take three or four weeks. according to statistics, from to per cent of the affected animals die. if animals which have died of this disease are examined, in addition to the changes of the mucous membrane of mouth and nasal cavities referred to above, shallow ulcers in these situations will be found occasionally. these necrotic processes may pass beneath the mucous membrane and even involve the underlying bony structure. in severe cases membranous (croupous) deposits are found in the throat. similar deposits have been found upon the mucous membrane of the fourth stomach and intestine, which is always inflamed. there is more or less inflammation of the membranes of the brain, kidneys, and liver, and some fatty degeneration of the voluntary muscles. in countries where rinderpest occasionally appears it may be difficult to distinguish between it and malignant catarrh, owing to a general similarity of the symptoms. the principal points to be observed in differentiating between the two are the very slight transmissibility of the latter as compared with the intense contagiousness of the former, and the tendency of malignant catarrh to run a more chronic course than rinderpest, which usually results fatally in a very few days. only a trained veterinarian who takes into consideration all the different symptoms and lesions of both diseases should decide in such cases. _treatment._--there is no specific treatment for this affection. copious blood letting in the earliest stages has been highly recommended, however, as this has a tendency to deplete the system and lessen the exudation of inflammatory products. antiseptic washes, such as per cent boric-acid solution to the eyes and dobell's solution applied to the nose and mouth with ice poultices over the crest of the head and frontal region, have also proved efficacious. calomel should also be given in -dram doses twice a day for three days, and in severe cases, involving the respiratory tract, a powder containing ferrous sulphate, quinin, and subnitrate of bismuth, given twice a day, will be found beneficial. at the same time it must be remembered that much greater success is to be looked for in the preventive treatment. this consists in the removal of the healthy from the infected animals (not vice versa) and thorough cleaning and disinfecting of the contaminated stables. if the floors are low and damp, they should be raised and made dry. if this can not be done, place a layer of cement under the stable floor to prevent water from entering from below. the stable should be well ventilated and the soil in the pastures thoroughly drained. if this is carefully carried out, the contagion should be destroyed and the danger of the reappearance of the disease in a great measure lessened. malignant edema. malignant edema, also termed gangrenous septicemia, is an acute, inflammatory disease of domestic and wild animals, resulting from the introduction of a specific organism into the deep connective tissues of a susceptible animal and proving fatal in many instances within to hours. the disease may be inoculated from one animal to another, but only by inserting the virus deeply below the skin. it is infrequently met with in cattle, but may follow operating wounds, as roweling, castration, and phlebotomy, which have become infected with septic matter, soil, or unclean instruments. in the pathological laboratory of the bureau of animal industry the organism has also been obtained from the infected muscles of a calf that was supposed to have died of blackleg, and, as a result, all blackleg virus is thoroughly tested before it is made into blackleg vaccine in order to exclude the malignant-edema organism. the essential cause of malignant edema is a long, slender, motile, spore-bearing bacillus, resembling the bacillus of blackleg, and which can develop only in the absence of the atmosphere. unlike the bacilli of anthrax and blackleg, which are confined to certain districts, this organism is widely distributed and found in ordinary garden soil, foul water, and in the normal intestinal tract of the herbivora. it may be brought to the surface of the soil by growing plants, rains, winds, or burrowing insects and rodents. in animals that have succumbed to the disease the germ is confined to the seat of infection, but a few hours after death it may migrate through the blood channels to other parts of the body. the bacillus may attack man, horses, asses, goats, sheep, pigs, cats, dogs, and poultry. adult cattle, although refractory to experimental inoculation, suffer from natural infection, while calves are susceptible to both these methods of exposure. (kitt.) the introduction of the bacillus into abrasions of the skin and superficial sores rarely does any harm, because the germ is quickly destroyed by contact with air. if, however, the organisms are inserted deeply into the subcutaneous tissues of susceptible animals, they quickly develop, producing a soluble poison, which is the fatal agent. in lamb-shearing season, or after docking or castration, the mortality is higher among these animals because of wounds inflicted at such times. the application of antiseptics to wounds thus made will reduce the percentage of deaths to a minimum. _symptoms._--usually the first symptoms are overlooked. in the early stages the animal appears listless, disinclined to move about, and lies down in shady and quiet places. if forced to move about, the hind legs are drawn forward with a peculiar, stiff, dragging movement, and there may be slight muscular trembling over all the body, which becomes more intense as the disease progresses. when driven, the animal shows signs of fatigue, ultimately dropping to the ground completely exhausted. breathing becomes fast and painful, with frequent spasmodic jerks. the pulse is quick and weak and the temperature is ° to ° f. an edematous, doughy, and painful swelling appears at the point of infection. this tumefaction spreads more and more, and crackles on pressure. in case of an open wound, a fetid liquid and frothy discharge is observed. the center of the swelling may appear soft and jellylike, while the margin is tense, hot, and painful. the symptoms increase rapidly, resulting in coma and death. _lesions._--after death the fat and subcutaneous tissues surrounding the infected area are infiltrated with a yellow gelatinous material containing an orange-colored foam, due to the presence of gas bubbles. the muscles at this point are friable, spongy, and of a uniform brownish tint, dissociated by gas and with a blood-tinged exudate. this gangrenous tissue, when present before death, can be removed without pain to the animal. the intestines are generally normal, but, together with the peritoneum, they may be inflamed, and the lungs are usually the seat of an edema. the spleen, liver, and kidneys retain their normal appearance, in marked contrast with anthrax. _differential diagnosis._--unlike blackleg, this disease never appears as an epizootic but in isolated cases. it may also be differentiated from the former by the history of a recent parturition or surgical operation, by the presence of an external injury at the site of the swelling accompanied with a fetid liquid discharge, and the gangrenous appearance of the tumefaction. man is susceptible to malignant edema, but not to blackleg. malignant edema may also be easily differentiated from anthrax in that the blood and spleen are normal in appearance, while in the latter disease the blood is dark and of a tarlike consistency, and the spleen appears swollen, injected, and softened. the local tumor in malignant edema contains gas bubbles, which are absent in anthrax swellings. inoculation experiments of guinea pigs, rabbits, and chickens will also disclose the differences among the above-mentioned three diseases, since all these species are killed by the germ of malignant edema, only the first two species by the anthrax bacillus, while the guinea pig alone will succumb to the blackleg infection. _treatment._--treatment is chiefly surgical and consists in laying the infected areas wide open by free incision, followed by a liberal application of a per cent solution of hydrogen dioxid and subsequently a per cent solution of carbolic acid. usually the disease when observed has advanced to such an extent that medicinal interference is without avail. preventive treatment is by far the most desirable, and consists, essentially, in a thorough disinfection of all accidental and surgical wounds, the cleansing of the skin, and the exclusion of soil, filth, and bacteria during surgical operations of any nature. sheds, barns, and stables should receive a thorough application of quicklime or crude carbolic acid wash after all rubbish has been removed and burned. all dead animals should be burned or deeply buried and covered well with quicklime. southern cattle fever (texas fever, tick fever). [pls. xliv-xlix.] this disease, which is more commonly known as texas fever, and sometimes as splenetic fever, is a specific fever communicated by cattle which have recently been moved northward from the infected district; it is also contracted by cattle taken into the infected district from other parts of the world. it is characterized by the peculiarity among animal diseases that the animals which disseminate the infection are apparently in good health, while those which sicken and die from it do not, as a rule, infect others. it is accompanied with high fever, greatly enlarged spleen, destruction of the red blood corpuscles, escape of the coloring matter of the blood through the kidneys, giving the urine a deep-red color, with a yellowness of the mucous membranes and fat, which is seen more especially in fat cattle, by a rapid loss of strength, and with fatal results in a large proportion of cases. this disease has various names in different sections of the country where it frequently appears. it is often called spanish fever, acclimation fever, red water, black water, distemper, murrain, dry murrain, yellow murrain, bloody murrain, australian tick fever, and tristeza of south america. the earliest accounts we have of this disease date back to , when it was stated by dr. james mease, before the philadelphia society for promoting agriculture, that the cattle from a certain district in south carolina so certainly disease all others with which they mix in their progress to the north that they are prohibited by the people of virginia from passing through the state; that these cattle infect others while they themselves are in perfect health, and that cattle from europe or the interior taken to the vicinity of the sea are attacked by a disease that generally proves fatal. similar observations have been made in regard to a district in the southern part of the united states. the northern limits of this area are changed yearly as a result of the dissemination or eradication of the cattle tick along the border, but the infected area has gradually decreased, owing to the successful endeavors pushed forward to eliminate the ticks. it was the frequent and severe losses following the driving of cattle from the infected district in texas into and across the western states and territories which led to the disease being denominated texas fever. it is now known, however, that the infection is not peculiar to texas or even to the united states, but that it also exists in southern europe, central and south america, australia, south africa, and the west indies. when cattle from other sections of the country are taken into the infected district they contract this disease usually during the first summer, and if they are adult animals, particularly milch cows or fat cattle, nearly all die. calves are much more likely to survive. the disease is one from which immunity is acquired, and therefore calves which recover are not again attacked, as a rule, even after they become adult. when the infection is disseminated beyond the permanently infected district, the roads, pastures, pens, and other inclosures are dangerous for susceptible animals until freezing weather. the infection then disappears, and cattle may be driven over the grounds or kept in the inclosures the succeeding summer and the disease will not reappear. there are some exceptions to this rule in the section just north of the boundary line of the infected district. in this locality the infection sometimes resists the winters, especially if they are mild. in regard to the manner in which the disease is communicated, experience shows that this does not occur by animals coming near or in contact with one another. it is an indirect infection. the cattle from the infected district first infect the pastures, roads, pens, cars, etc., whence the susceptible cattle obtain the virus secondhand. usually animals do not contract the disease when separated from infected pastures by a fence. if, however, there is any drainage or washing by rains across the line of fence this rule does not hold good. the investigations made by the bureau of animal industry demonstrate that the ticks which adhere to cattle from the infected district are the only known means of conveying the infection to susceptible cattle. the infection is not spread by the saliva, the urine, or the manure of cattle from the infected district. in studying the causation and prevention of this disease, attention must therefore be largely given to the tick, and it now seems apparent that if cattle could be freed from this parasite when leaving the infected district they would not be able to spread the malady. the discovery of the connection of the ticks with the production of the disease has played a very important part in determining the methods that should be adopted in preventing its spread. it established an essential point and indicated many lines of investigation which have yielded and are still likely to yield very important results. _nature of the disease._--texas fever is caused by an organism which lives within the red blood corpuscles and breaks them up. it is therefore simply a blood disease. the organism does not belong to the bacteria but to the protozoa. it is not, in other words, a microscopic plant, but it belongs to the lowest forms of the animal kingdom. this very minute organism multiplies very rapidly in the body of the infected animal, and in acute cases causes an enormous destruction of red corpuscles in a few days. how it gets into the red corpuscle it is not possible to state, but it appears that it enters as an exceedingly minute body, probably endowed with motion, and only after it has succeeded in entering the corpuscle does it begin to enlarge. plate xlv, figure , illustrates an early stage of this blood parasite. the red corpuscle contains a very minute, roundish body which is stained blue to bring it into view. the body is, as a rule, situated near the edge of the corpuscle. figure illustrates an older stage in the growth of the parasite, in fact the largest which has thus far been detected. it will be noticed that there are usually two bodies in a corpuscle. these bodies are in general pear-shaped. the narrow ends are always toward each other when two are present in the same corpuscle. if we bear in mind that the average diameter of the red blood corpuscles of cattle is from / to / inch, the size of the contained parasite may be at once appreciated by a glance at the figures referred to. the various disease processes which go on in texas fever, and which we may observe by examining the organs after death, all result from the destruction of the red corpuscles; this destruction may be extremely rapid or slow. when it is rapid we have the acute, usually fatal, type of texas fever, which is always witnessed in the height of the texas-fever season, that is, during the latter weeks of august and the early weeks of september. when the destruction of corpuscles is slower, a mild, usually nonfatal, type of the disease is called forth, which is only witnessed late in autumn or more rarely in july and the early part of august. cases of the mild type occurring thus early usually become acute later and terminate fatally. the acute disease is fatal in most cases, and the fatality is due not so much to the loss of blood corpuscles as to the difficulty which the organs have in getting rid of the waste products arising from this wholesale destruction. how great this may be a simple calculation will serve to illustrate. in a steer weighing , pounds, the blood in its body weighs about pounds, if we assume that the blood represents one-twentieth of the weight of the body, which is a rather low estimate. according to experimental determination at the bureau station, which consists in counting the number of blood corpuscles in a given quantity of blood from day to day in such an animal, the corpuscles contained in from to pounds of blood may be destroyed within hours. the remains of these corpuscles and the coloring matter in them must be either converted into bile or excreted unchanged. the result of this effort on the part of the liver causes extensive disease of this organ. the bile secreted by the liver cells contains so much solid material that it stagnates in the finest bile canals and chokes these up completely. this in turn interferes with the nutrition of the liver cells and they undergo fatty degeneration and perish. the functions of the liver are thereby completely suspended and death is the result. this enormous destruction of corpuscles takes place to a large extent in the kidneys, where a great number of corpuscles containing the parasites are always found in acute cases. this accounts largely for the blood-colored urine, or red water, which is such a characteristic feature of texas fever. the corpuscles themselves are not found in the urine; it is the red coloring matter, or hemoglobin, which leaves them when they break up and pass into the urine. _symptoms._--after a period of exposure to infected soil, which may vary from to days, and which will be more fully discussed under the subject of cattle ticks as bearers of the texas-fever parasite, the disease first shows itself in dullness, loss of appetite, and a tendency to leave the herd and stand or lie down alone. a few days before these symptoms appear the presence of a high fever may be detected by the clinical thermometer. the temperature rises from a normal of ° to ° f. to ° and ° f. there seems to be little or no change in temperature until recovery or death ensues. the period of high temperature or fever varies considerably. as it indicates the intensity of the disease process going on within, the higher it is the more rapid the fatal end. when it does not rise above ° f. the disease is milder and more prolonged. the bowels are mostly constipated during the fever; toward the end the feces may become softer and rather deeply tinged with bile. the urine shows nothing abnormal during the course of the disease until near the fatal termination, when it may be deeply stained with the coloring matter of the blood. (hemoglobinuria; see pl. xlv, fig. .) although this symptom is occasionally observed in animals which recover, yet it may generally be regarded as an indication of approaching death. the pulse and respiration are usually much more rapid than during health. other symptoms in addition to those mentioned have been described by observers, but they do not seem to be constant, and only those described above are nearly always present. as the end approaches emaciation becomes very marked, the blood is very thin and watery, and the closing of any wound of the skin by clots is retarded. the animal manifests increasing stupor and may lie down much of the time. signs of delirium have been observed in some cases. death occurs most frequently in the night. the duration of the disease is very variable. death may ensue in from three days to several weeks after the beginning of the fever. those that recover ultimately do so very slowly, owing to the great poverty of the blood in red corpuscles. the flesh is regained but very gradually, and the animal may be subjected to a second, though mild, attack later on in the autumn, which pushes the full recovery onward to the beginning of winter. in the mild type of the disease, which occurs in october and november, symptoms of disease are well-nigh absent. there is little if any fever, and if it were not for loss of flesh and more or less dullness the disease may pass unnoticed, as it undoubtedly does in a majority of cases. if, however, the blood corpuscles are counted from time to time a gradually diminishing number will be found, and after several weeks only about one-fifth or one-sixth of the normal number are present. it is indeed surprising how little impression upon the animal this very impoverished condition of the blood appears to make. it is probable, however, that if two animals kept under the same conditions, one healthy and the other at the end of one of these mild attacks, are weighed, the difference would be plainly shown. _pathological changes observable after death._--in the preceding pages some of these have already been referred to in describing the nature of the disease. it is very important at times to determine whether a certain disease is texas fever or some other disease, like anthrax, for example. this fact can, as a rule, be determined at once by a thorough microscopic examination of the blood. the necessary apparatus and the requisite qualifications for this task leave this method entirely in the hands of experts. there are, however, a considerable number of changes caused by this disease which may be detected by the naked eye when the body has been opened. put together they make a mistake quite impossible. the presence of small ticks on the skin of the escutcheon, the thighs, and the udder is a very important sign in herds north of the texas-fever line, as it indicates that they have been brought in some manner from the south and have carried the disease with them, as will be explained later. another very important sign is the thin, watery condition of the blood, either just before death or when the fever has been present for four or five days. a little incision into the skin will enable any one to determine this point. frequently the skin is so poor in blood that it may require several incisions to draw a drop or more. the changes in the internal organs, as found on post-mortem examinations, are briefly as follows: the spleen, or milt, is much larger than in healthy animals. it may weigh three or four times as much. when it is incised the contents or pulp is blackish (see pl. xliv, fig. ), and may even well out as a disintegrated mass. the markings of the healthy spleen (fig. ) are all effaced by the enormous number of blood corpuscles which have collected in it, and to which the enlargement is attributable. next to the spleen the liver will arouse our attention. (see pl. xlv, fig. .) it is larger than in the healthy state, has lost its natural brownish color (fig. ), and now has on the surface a paler, yellowish hue. when it is incised this yellowish tinge, or mahogany color, as it has been called by some, is still more prominent. this is owing to the large quantity of bile in the finest bile capillaries, and as these are not uniformly filled with it the cut surface has a more or less mottled appearance. this bile injection causes in many cases a fatty degeneration of the liver cells, which makes the organ appear still lighter in color. in all cases the gall bladder should be examined. this is distended with bile, which holds in suspension a large number of yellow flakes, so that when it is poured into a tall bottle to settle fully one-half or more of the column of fluid will be occupied by a layer of flakes. if mucus is present at the same time, the bile may become so viscid that when it is poured from one glass to another it forms long bands. the bile in health is a limpid fluid, containing no solid particles. if the animal during life has not been observed to pass urine colored with blood or red water, the bladder should be opened. this quite invariably, in acute cases, contains urine which varies in color from a deep port wine to a light claret. in many cases the color is so dense that light will not pass through even a thin layer. (pl. xlv, fig. .) the kidneys are always found congested in the acute attack. the disease exerts but little effect on the stomach and intestines beyond more or less reddening of the mucous membrane; hence an examination of them may be safely omitted. the lungs are, as a rule, not diseased. the heart usually shows patches of blood extravasation on the inside (left ventricle) and less markedly on the outer surface. we have observed jaundice of the various tissues but very rarely. it has been observed by some quite regularly, however. during the hot season about per cent of the susceptible mature animals from a noninfected district die, but later, in the cool weather, the disease assumes a milder type, with a consequent decrease in the number of deaths. _the cattle tick, margaropus annulatus, as the carrier of texas fever._ (pls. xlvi, xlvii, and xlviii.)--the cattle tick is, as its name indicates, a parasite of cattle in the southern part of the united states. it belongs to the group of arthropoda and to the genus _margaropus_ (or _boophilus_), which is included in the order acarina. its life history is quite simple and easily traced from one generation to another. it is essentially a parasite, attaching itself to the skin (pl. xlviii) and drawing the blood of its host. it is unable to come to maturity and reproduce its kind unless it becomes attached to the skin of cattle, whence it may obtain its food. the eggs laid on the ground after the female has dropped from the host begin to develop at once. when the embryo is fully formed within the shell it ruptures this and gains its freedom. the time required from the laying of the eggs to their hatching varies considerably, according to the temperature. in the laboratory in the heat of midsummer this was accomplished in about days. in the late fall, under the same conditions, it required from four to six weeks. the larva after emerging from the egg is very minute, six-legged, and is just visible to the naked eye. (pl. xlvi, fig. .) if these larvæ are kept on a layer of moist sand or earth in a covered dish, they may remain alive for months, but there is no appreciable increase in size. so soon, however, as they are placed upon cattle growth begins. on pastures these little creatures soon find their way on to cattle. they attach themselves by preference to the tender skin on the escutcheon, the inside of the thighs, and on the base of the udder. yet when they are very numerous they may be found in small numbers on various parts of the body, such as the neck, the chest, and the ears. (pl. xlviii and pl. xlix, fig. .) the changes which they undergo during their parasitic existence were first studied by dr. cooper curtice, of the bureau of animal industry, in . the young tick molts within a week, and the second or nymphal stage of the parasite's life is thus ushered in. after this change it has four pairs of legs. within another week another molt takes place by which the tick passes from the nymphal to the sexual, or adult, stage. impregnation now takes place, and, with the development of the ova in the body, the tick takes an increased quantity of blood, so that in a few days it becomes very much larger. that the rapid growth is due to the blood taken in may be easily proved by crushing one. the intestine is distended with a thick, tarry mass composed of partly digested blood. when the female has reached a certain stage of maturity she drops to the ground and begins to lay a large number of eggs, which hatch in the time given above. the life of the cattle tick is thus spent largely on cattle, and although the young, or larvæ may live for a long time on the ground in the summer season, they can not mature except as parasites on cattle and horses. we have purposely omitted various details of the life history, including that of the male, as they are not necessary to an understanding of our present subject--texas fever. how this is transmitted we will proceed to consider. before the enforcement of the federal quarantine southern cattle sent north during the spring and summer months carried on their bodies large numbers of the cattle ticks, which, when matured, would drop off and lay their eggs in the northern pastures. after hatching, the young ticks would soon get upon any northern cattle which happened to be on the pasture. so soon as they attached themselves to the skin they inoculated the cattle, and texas fever would break out a week or more thereafter. for many years there had been a growing suspicion that the cattle tick was in some way concerned in the spread of texas fever, and the facts which supported this supposition finally became so numerous and convincing that a series of experiments was inaugurated by the bureau of animal industry which served to show that the tick is abundantly able to carry the disease to a herd of healthy cattle, and, in fact, is probably the only agent concerned in the transmission of the disease from southern cattle to susceptible northern animals. _injurious effects of cattle ticks._--unfortunately many cattle owners who have always been accustomed to see both ticks and ticky cattle on their farms are not inclined to attach much importance to these parasites, and, as a rule, through lack of appreciation of their damaging effects, placidly consider them as of little consequence. that ticks may be detrimental to their hosts in several ways has probably not suggested itself to these stockmen, who are most vitally affected, and it therefore seems necessary to emphasize the fact that, in addition to their relation to texas fever, they may also be injurious to cattle as external parasites. while the power of transmitting texas fever is undoubtedly the most dangerous property possessed by the cattle tick and is the principal cause for adopting stringent measures looking to its complete eradication, nevertheless there still remain other good reasons for the accomplishment of this achievement. these secondary objections to the presence of ticks on cattle consists in the physical harm they do to the host aside from the production of the specific disease of texas fever. true, a few parasites may remain on cattle indefinitely without causing any noticeable effect, but it is not uncommon to notice bovine animals on pastures with their hides heavily infested with these pests. in such cases it can readily be seen that the continuous sucking of blood causes more or less impoverishment of the circulation. the animal must therefore be fed more in order to meet the demands of the parasites in addition to the ordinary needs of the host. if the ticks are removed from the body, the bites inflicted are often distinguished by small, inflamed or reddened areas somewhat swollen, with perforations of the skin which may allow the entrance of various kinds of disease germs, and showing that more or less irritation of the hide is produced by these parasites. this condition, together with the loss of blood, frequently induces an irritable state and evidence of uneasiness commonly known as "tick worry," which results in the loss of energy and other derangements of the animal's health. it may in some cases, especially in hot weather, become so pronounced that the animal will lose flesh in spite of good pasturing, thereby reducing the vitality and rendering it more susceptible to the inroads of disease. moreover, if the infestation of ticks is not controlled, the cattle may be so reduced in condition that growth is retarded, and, in the case of young animals, they may never become fully developed, but remain thin, weak, and stunted--a condition that has been termed "tick poverty"--and easily succumb to other diseases as a result of lowered vitality. in milch cows this debilitating influence of the numerous ticks is shown in a greatly reduced milk supply. this should not appear strange when it is considered that some animals harbor several thousand of the bloodsucking parasites. if these parasites are crushed, it will be found that their intestines are completely filled with a dark, thick mass of blood abstracted from the animal host and containing nutriment that should go to the formation of milk, flesh, and the laying on of fat. in some rare cases the large number of bites on a limited area of skin may be followed by infection with pus-producing organisms, giving rise to small abscesses which may terminate in ulcers. the discharge from these sores, or in some cases the mere oozing of blood serum through the incision made by the mouth parts of the ticks, keeps the hair moist and matted together, and the laying and hatching of fly eggs in these areas give rise to infestation with destructive maggots, causing ulcers and other complications that require medical treatment. these statements regarding the secondary injurious effects of cattle ticks also apply to those ticks which have been previously spoken of as harmless so far as texas fever is concerned, and, in fact, to all external parasites. therefore, it is just as important to eradicate the cattle ticks for reasons other than those associated with texas fever as it is to exterminate lice, fleas, and other vermin. furthermore, cattle ticks, aside from the losses sustained by their purely parasitic effects, are the greatest menace to the profitable raising and feeding of cattle in the south, because they are an obstacle to cattle traffic between the infected and noninfected districts. _loss occasioned by cattle ticks._--the economic aspect of the tick problem is unquestionably of the greatest practical interest, since the fundamental importance of all the other questions which surround it depends upon the actual money value involved. a careful and conservative estimate made in placed the annual loss caused by the ticks in the united states at $ , , , and indicated that the ticks also lowered the assets of the south by an additional $ , , . the principal items in these losses are set forth below. it is well known that those animals coming from an infected district and sold in the "southern pens" of northern stockyards bring about one-half a cent less per pound than the quoted market price. the handicap that is placed on the southern cattle raiser as a result of this decrease in value of his stock will average at this figure $ per head, allowing an individual weight of pounds for all classes of animals. this decreased value reacts and fixes the valuation of all cattle which remain in the infected territory, thereby reducing the assets of the cattle industry of that section. in addition there is a very great loss from the decrease in flesh and lack of development of southern cattle occasioned by the parasitic life of the ticks from without and by the blood-destroying and enervating properties of the protozoan parasites from within. the presence of the tick among the cattle of the south not only lessens the value of the cattle on the hoof but causes the gradings of hides that have been infested with ticks as no. quality. the same hide, if free from tick marks, would grade no. . the difference in price between these two grades of hides is cents a pound. as the hide of a southern steer weighs about pounds, the presence of the tick in the hide causes a loss in the hide alone of more than $ . a hide. it has been shown that the cost of tick eradication is only about cents a head, so that if the counties make a systematic campaign to eradicate the tick, the increase in value of the hide alone would pay for the cost of tick eradication and leave the farmer a net profit of about cents a hide. the shrinkage in the milk production of cattle harboring many ticks will average quart a day, which in the aggregate is a heavy loss. the damage resulting to the southern purchaser of northern purebred or high-grade cattle is another item of no small moment. about per cent of all such cattle taken into the south die of texas fever, even after they are immunized by blood inoculations, and about per cent of them succumb to texas fever when not so treated. as they are usually very expensive animals and of a highly valued strain of blood, the loss in certain cases is excessive and in others almost irreparable, owing to the possible extinction of some particular type especially selected for the improvement of the herd. another instance in which it is difficult to figure the injury done by the ticks is in the case of death of nonimmune cattle in the tick-free pastures of the south. such animals are as susceptible to texas fever as nonimmune northern cattle, and inasmuch as there is in many states only one out of every four farms infested with ticks, the cattle on the remaining farms will in many cases contract texas fever when exposed to the fever tick. these losses can scarcely be computed, as the death rate depends so much on the season of the year when exposure occurs and on the age of the animal affected. however, the deaths among such cattle are considerable, although this fact is little appreciated or understood by many outside the infected area. on rare occasions a small outbreak of texas fever occurs north of the quarantine line as a result of improperly disinfected cars, of unscrupulous dealers breaking the quarantine regulations, or of some accidental condition. such damage, however, is slight, but should be considered in summing up the loss occasioned by the fever tick. the advertisement which a breeder obtains and the sales which are made by having his stock in the show ring are usually lost to the cattle raiser in the infected area who aspires to display his animals in the north, as they are barred from most of these exhibitions. on the other hand, the southern farmer is not given an opportunity to see and be stimulated by the fine specimens of northern cattle which might be shown at southern stock exhibits, for the reason that the danger of contracting texas fever is too patent to warrant such exposure. a heavy expense is incurred by the government and the states in enforcing the regulations that apply to the quarantine line. another loss which is indirectly sustained by the southern cattle industry through increased freight rates is the cost, to the railroad companies, of cleaning and disinfecting the cars that carry cattle and in providing separate pens for them at various places. these statements are sufficient to indicate that the loss to the quarantined section from the cattle tick is something enormous. such a series of encumbrances as those recorded could be carried by the cattle industry of no other section of the country than the south, whose excellent pastures, rich soil, and salubrious climate are the only reasons for its ability to overcome such obstacles in meeting the competition of the west; and it is the inherent capacity of the south for greatly increasing its herds and enlarging its pasture lands that makes the actual loss even secondary to the potential loss from restrictions necessitated by the presence of the cattle tick. this potential loss may be described as the difference between the value of the cattle industry of the south to-day and the extent to which this industry would be increased if farmers and ranchmen were assured that their lands and cattle would not become infested with fever ticks. could this assurance be given, the beneficial effects would extend over the entire country, because the market of the northern breeder would thereby become greatly extended. these appalling losses and annual sacrifices of the cattle raisers of the infected district can be entirely effaced, and this at a small proportionate cost; for, with enthusiastic stockmen, satisfactory state legislation, sufficient money, and a corps of trained inspectors, the cattle tick may be exterminated, and every dollar expended in this work will be returned many times during each succeeding year. _the so-called period of incubation._--after the young ticks have attached themselves to cattle the fever appears about days thereafter in midsummer. when the weather is cool, as in autumn, this period may be a little longer. the actual period of incubation may be shorter, for if blood from a case of texas fever is injected into the blood vessels of healthy cattle the fever may appear within five days. when cattle graze upon pastures over which southern cattle have passed, the time when the disease appears varies within wide limits. when the animals have been put upon pastures immediately after southern cattle have infected them with ticks, it may take from to days, or even longer, before the disease appears. this will be readily understood when we recall the life history of ticks. the southern cattle leave only matured ticks which have dropped from them. these must lay their eggs and the latter must be hatched before any ticks can get upon native cattle. the shortest period is thus not less than days if we include days for the period of incubation after the young ticks have attached themselves to native cattle. when the infection of pastures with ticks has taken place early in the season, or when it is cold, the period is much longer, because it takes longer for the eggs to hatch. if native cattle are placed upon pastures which have been infected with ticks some time before, the disease will appear so much sooner, because the young ticks may be already hatched and attack the cattle at once. it will be evident, therefore, that the length of time between the exposure of native cattle on infected fields and the appearance of the disease depends on the date of original infection, and on the weather, whether cold or hot. when native cattle are placed upon fields on which young ticks are already present, they will show the fever in to days if the season is hot. the fever appears before the ticks have matured. in fact, they are still small enough to be overlooked. in any case very careful search should be made for them in those places which they prefer--the thighs, escutcheon, and udder. after the acute stage of the fever has passed the ticks begin to swell up and show very plainly. (pl. xlvi, figs. and .) _prevention._--it is generally accepted that if southern cattle are entirely free from that species of tick known as _margaropus annulatus_ they can be allowed to mingle with the most susceptible animals without danger. furthermore, it has been learned from the study of the life history of the cattle tick and by observation that this tick infests pastures only transiently, never permanently, and will not mature except upon cattle or equines, that its extermination is possible, and that the disease it causes may be prevented. therefore the various methods with these results in view should be directed toward the destruction of ticks on cattle as well as their eradication from the pastures. methods of eradicating the ticks.[ ] in undertaking measures for eradicating the tick it is evident that the pest may be attacked in two locations, namely, on the pasture and on the cattle. in freeing pastures the method followed may be either a direct or an indirect one. the former consists in excluding all cattle, horses, and mules from pastures until all the ticks have died from starvation. the latter consists in permitting the cattle and other animals to continue on the infested pasture and treating them at regular intervals with agents destructive to ticks and thus preventing engorged females from dropping and reinfesting the pasture. the larvæ on the pasture, or those which hatch from eggs laid by females already there, will all eventually meet death. such of these as get upon the cattle from time to time will be destroyed by the treatment, while those which fail to find a host will starve in the pasture. animals may be freed of ticks in two ways. they may be treated with an agent that will destroy all the ticks present, or they may be rotated at proper intervals on tick-free fields until all the ticks have dropped. the method most generally used is dipping the cattle in a solution of arsenic. the pasture-rotation method is not only more complicated, but the necessary tick-free fields are seldom available. dipping. the dipping vat is the best and cheapest means of applying the tick-destroying solution. the great advantage of dipping over spraying and applying remedies by hand lies in the fact that thoroughness of the treatment is practically assured. when eradication is undertaken, all the cattle, and also the horses and mules if they harbor ticks, are treated regularly every two weeks during the part of the year that the temperature is favorable to treatment, until the ticks have disappeared. the purpose of the treatment is to destroy all ticks that get on the animals before they have had a chance to mature and drop, thus preventing them from reinfesting the pasture, farm, or range. if the treatment used were absolutely effective in destroying each and every tick on the animals treated there would be no renewal of the infestation after the treatment is begun. the cattle would act simply as collectors of ticks which would be destroyed regularly by the treatment applied every two weeks. it is probable, however, that in most instances, either because of the lack of efficiency of the dip or imperfect application, or because of failure to dip all cattle systematically, some ticks escape treatment and reproduce, thus prolonging the time that otherwise would be required for eradication. if ticks apparently disappear from the cattle after they have been under treatment for some time, the dipping should not be discontinued until a number of careful inspections show that the cattle are free of ticks. if ticks continue on cattle until cold weather and then finally disappear it should be borne in mind that in all probability eradication has not been accomplished and that there may be engorged females, unhatched eggs, and inactive seed ticks on the farm or range, and that even if the cattle should remain free of ticks during the winter they may become reinfested the following spring. in any case in which ticks disappear from the cattle and treatment is discontinued, the cattle should be watched very carefully for ticks until ample time has elapsed to leave no doubt that eradication has been accomplished. as a general rule it has been found that if dipping is begun in march and systematically and thoroughly done, all cattle being dipped every days until november, complete eradication will be secured. in dipping, each animal should be completely covered by the dip. to prevent any animals from going through the vat without becoming wet all over, a man, provided with a forked stick, should be stationed at the middle of the vat to shove under those that have not been completely submerged. dipping is the only really satisfactory method of treating animals for ticks. in cases of emergency, however, or where there are not cattle enough within a radius of several miles to warrant the construction of a vat in which all the cattle of the community may be dipped, spraying may be advisable. in spraying animals the work should be done with great thoroughness and every portion of the body treated. an animal can not be sprayed properly unless it is tied or otherwise held, nor can good results be obtained unless the hair and skin are thoroughly wetted. _preparation and use of arsenical dips._[ ]--after experimenting for many years to discover a practical method for dipping cattle to destroy ticks without injury to the cattle, the bureau of animal industry has developed a very satisfactory arsenical dip. two formulas are given for homemade dips, one known as the "s-b" (self-boiled) and the other as the boiled dip. the former is the one usually employed. _the s-b dip._--the formula calls for two stock solutions, arsenic stock and tar stock, which must not be mixed except in the diluted dipping bath. arsenic stock requires the following materials ready to hand before starting: pounds. caustic soda white arsenic sal-soda crystals there should be also some means for heating the solution in case, as sometimes happens because of impure materials, lack of skill, or some unforeseen circumstance, the heat created by mixing the materials should be insufficient to dissolve all the arsenic. in a -gallon kettle or metal[ ] pail place the pounds of caustic soda, add gallon of cold water, and stir with a stick until the caustic soda is practically all dissolved. without delay begin adding the white arsenic, in portions of a pound or two at a time, as fast as it can be dissolved without causing the solution to boil, stirring all the time. if the liquid begins to boil, stop stirring and let it cool slightly before adding more arsenic. the secret of success is to work the arsenic in fast enough to keep the solution very hot--nearly but not quite at the boiling point. the result should be a clear solution, except for dirt. if the liquid persistently remains muddy or milky, it may be because the operation has been conducted so fast that much water has been boiled out and sodium arsenite is beginning to crystallize, so add another gallon of water and stir. if the solution does not then clear up, the caustic soda must have been very low grade, and the undissolved substance must be arsenic. in that case, put the kettle over the fire, heat nearly, but not quite, to boiling, and stir. as soon as the solution of arsenic is complete, dilute to about gallons, add the sodium carbonate, and stir until dissolved. _cautions._--it is necessary to avoid splashing. hence never work hurriedly; stir deliberately and regularly; do not dump in the arsenic and sal soda, but carefully slide them in from a grocer's scoop held close to the side of the pail and to the surface of the liquid. perform the whole operation in a well-ventilated place and avoid inhaling steam. after the solution has become cold add water to make it to exactly gallons,[ ] mix well, let settle, and draw off into containers which can be tightly corked or otherwise closed. jugs or demijohns are best, but tin cans will serve if occasionally inspected for leaks which may occur after a time through the action of the solution upon the solder of the can. tar stock is prepared thus: in a large metal pail dissolve three-fourths of a pound of caustic soda in quart of water, add gallon of pine tar, and stir thoroughly with a wooden paddle until the mixture, which at first looks streaked and muddy, brightens to a uniform, thick fluid somewhat resembling molasses. test it by letting about a teaspoonful drip from the paddle into a glass of water (a glass fruit jar or a wide-mouth bottle will do) and stirring thoroughly with a sliver of wood. it should mix perfectly with the water. globules of tar which can be seen by looking at the glass from underneath and which can not be blended with the water by repeated stirring indicate that more caustic-soda solution is needed. in that case make up more caustic-soda solution of the same strength and add it, not more than a pint at a time, with thorough stirring, until the desired effect is produced. if an appropriate glass vessel for making the test is not at hand, take a little of the mixture between the fingers, then dip the fingers under water and try to rub off the tar. it should leave the fingers perfectly clean after a little rubbing with water. if an oily coating remains, more caustic-soda solution is needed. such an extra addition of caustic soda will be required only in case of a very low-grade chemical or a very highly acid tar. the tar stock should be kept in closed containers, such as a pail with a friction top. the quantity of s-b arsenic stock or of tar stock made in one operation can be varied as desired, provided the above-given proportions of the ingredients are adhered to. but one should attempt to work the s-b formula on a larger scale only after skill and experience have been acquired. _the boiled dip_ is less convenient than the s-b dip, but the final composition and effect of dipping baths prepared from the two are the same. to make a -gallon bath provide: sal-soda crystals pounds. white arsenic pounds. pine tar gallon. put gallons of water into a kettle or tank of from to gallons' capacity, heat to boiling, and add the sal soda. when this has dissolved add the white arsenic, then boil and stir for minutes or longer, until the white arsenic has entirely disappeared. if intended for immediate use cool to ° f. (by addition of cold water if desired), then pour in the pine tar in a thin stream while constantly and vigorously stirring the solution. immediately empty the liquid into the dipping vat, which has already been three-fourths filled with water, and stir thoroughly. all the utensils must be free from greasy or oily matter which would coat the arsenic and hinder its solution. the operation of boiling requires constant attention to avoid loss by foaming. hard water may be used, but in that case considerable undissolved material, which, however, does not contain any arsenic, may be left after boiling. for a stock solution to be kept on hand and used when needed add no tar, but after the solution has become cold make it up to gallons, stir well, let settle, and draw off into containers which can be well closed. in this case the tar stock previously described is also required. _diluting the dip._--first run water into the vat about three-fourths up to the dipping line, at which its capacity must be known. if tar stock is to be used the necessary amount will be one-third of a gallon for every gallons of vat capacity. measure it out, mix it with or times its volume of water and pour it along the surface of the water in the vat, stirring a little. every gallons of standard-strength bath calls for - / pounds white arsenic, which quantity is contained in four-fifths of a gallon of s-b stock or in gallons of boiled stock. from these figures the quantity of arsenic or stock needed to charge the vat may be calculated. or one may base the calculation on the following facts: one pound of white arsenic will make - / gallons of bath. one gallon of s-b stock will make gallons of bath. one gallon of boiled arsenic stock will make gallons of bath. all solutions of arsenic are considerably heavier than water and if carelessly put into the vat they may plunge to the bottom and be difficult to mix. therefore always pour the arsenic stock or a proprietary dip in a thin stream evenly along the vat except at the shallow exit end. another precaution to be taken in handling proprietary dips is never to mix them first with small quantities of water, which may "break" them. pour them directly into the water in the vat. finally, add water up to the dipping line and stir well. an excellent way to stir is by a pail tied to a rope. sink it at the entrance end of the vat and haul it along the bottom to the exit. then raise it, throw it back to the entrance end, and haul through again, repeating as many times as necessary but always hauling through in the same direction. the standard-strength bath prepared as above contains practically . per cent arsenious oxid when fresh. after use oxidation may set in and weaken it, but it will not need to be strengthened so long as it tests not less than . per cent arsenious oxid. to make up small quantities for spraying, to each gallons of water measured out add first fluid ounces ( tablespoonfuls) of tar stock, and then - / fluid ounces of s-b stock or - / pints of boiled arsenic stock. the standard strength of bath should be adhered to so far as possible because its effectiveness against ticks will effect eradication in the least time and with fewest dippings. but if time is not pressing it is sometimes best to begin with a lower strength, say . or . per cent, and gradually work up to full strength as the cattle become accustomed to the treatment. this is certainly a wise method for the individual cattle owner who is outside the area of cooperative work and who lacks aid and advice from experts. weather conditions also need to be considered. hot or moist weather is more trying to the cattle than cool or dry weather. the longer the time needed for the cattle to dry off after dipping, which of course primarily depends on the proportion of moisture in the air, the more liable they are to show blistering or other injury through the continued absorption of arsenic by the skin. the combination of heat and moisture is particularly bad, and under such conditions it may be desirable, unless other conditions prohibit, to use the bath somewhat weaker than standard strength. the following table shows the quantities of arsenic and stock solutions contained in gallons of bath of different strengths, so that the quantities necessary to charge a vat of any size at any strength can be found by simple multiplication. _composition of dipping baths._ +-----------+------------------------------+ | actual | per gallons of bath. | | arsenious +------------------------------+ | oxid. | white | s-b | boiled | | | arsenic. | stock. | stock. | +-----------+----------+---------+---------+ | per cent. | pounds. | gallons.| gallons.| | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | . | | . | . | . | ... | | . | . | . | ... | | . | . | . | ... | | . | . | . | ... | | . | . | . | ... | +-----------+----------+---------+---------+ as dipping goes on the bath naturally needs replenishing, and its strength probably needs correction from time to time. full directions on these points may be found in farmers' bulletin . _prepared dips._--proprietary arsenical cattle dips appear now to have passed the experimental stage and to have become established as reliable and useful products. at any rate this can be said of the brands which have received permission for use in official dipping in place of the homemade dip. the formulas and standard samples of all such brands are in possession of the bureau of animal industry and the manufacturers are required to guarantee that their products as placed on the market will be kept up to standard and that all requirements of the bureau will be observed. like the homemade dip they all contain sodium arsenite as the active tick-killing agent. they do not all contain pine tar, because that substance is difficult to blend into a highly concentrated product, but they all contain some other substance or mixture of substances of such character and in such quantity as field trials have proved will produce the same effects. they are not regarded as any more effective or any milder on the cattle than properly prepared homemade dips. none the less they are undoubtedly safer for general use because they offer decidedly fewer opportunities for making mistakes in the quantities used or in the operations gone through and also fewer chances for accidental poisoning or other injury from the handling of powerful chemicals. whether their higher cost is sufficiently outweighed by these considerations is necessarily a matter for individual decision. _precautions in the use of arsenic and arsenical dips._--the fact that arsenic is a violent poison is what renders it valuable, for the fever tick is hard to kill. but, like a keen-edged tool, it may be decidedly dangerous if ignorantly or carelessly handled. three possibilities of danger must be kept constantly in mind; danger to oneself, danger to other persons, danger to animals. the dry, powdered white arsenic should be kept in a tightly covered pail, plainly labeled. paper bags are unsafe because they easily burst, and arsenic so scattered about looks harmless enough. in weighing or otherwise handling the arsenic avoid raising dust or breathing it in, if raised, and keep it off the skin and clothing. in mixing or boiling stock solutions work only in a well-ventilated place, and on the windward side of the kettle so that steam arising from it will not be inhaled. the stock solutions are in some respects more dangerous than the original substance because the arsenic in them is already in solution and can act very quickly. if any gets on the skin or clothing it must be washed off without delay. cattle must be kept away from such solutions or from anything that has been in contact with them, for cattle craving salt have been poisoned by licking the outside of leaky barrels and by licking the earth around dipping vats where a little concentrate had been carelessly spilled in charging the vat. all such poisoned earth must be removed, buried, and replaced by fresh. the diluted bath is naturally much less dangerous, but no chances can be taken with it. no puddles from which animals may drink should be allowed to accumulate. the persons who do the dipping should not allow the skin or clothing to be wet by the dip any more or any longer than absolutely necessary. when spraying, the operator should see to it that neither he nor the animals inhale any of the spray. when a vat is to be emptied the approved practice is to run the waste bath into a pit properly guarded by a fence, where it will gradually seep away under the surface and do no harm, provided only that seepage can not be carried to a well, stream, or spring from which any person or domestic animal may drink. the symptoms of arsenical poisoning are rather variable and also depend on the size of the dose and the method of administration. if an animal sickens or dies shortly after dipping it by no means follows that arsenical poisoning or any other effect of the dipping is the cause. very few cattle relative to the total number dipped have suffered undoubted arsenical poisoning and in most of the cases the cause could be traced to somebody's error or carelessness. in regard to arsenical poisoning of human beings there is a standard antidote, which may be obtained at any drug store with directions for use. it should be kept on hand for emergencies. if the antidote is not at hand the poison must be removed from the stomach by encouraging repeated vomiting, and soothing drinks such as milk, white of eggs and water, or flour and water must be freely given meanwhile. a suspected case of arsenical poisoning must have the attention of a physician at the earliest possible moment, as sometimes the poison works very quickly. _crude petroleum._--various kinds of crude petroleum and emulsions of it have been used with more or less success in destroying ticks, but on account of the difficulty of obtaining suitable grades of oil and the liability of injury to cattle, their use has been practically abandoned. _method of dipping._--the method usually adopted in dipping cattle is to construct a narrow swimming tank with a chute at one end for the entrance of the cattle, and a sloping exit at the other end when the cattle emerge after passing through the vat. (see pl. xlix, fig. .) a drip chute, or floor, is connected with the exit, where the excess of dip is allowed to drip off the animals and to drain into the vat. plans and specifications for installing dipping plants may be obtained from the bureau of animal industry, department of agriculture, washington, d. c. treatment. when texas fever has broken out, all animals, the sick as well as the healthy, should at once be removed to a noninfected pasture. while this may not cut short the disease, it may save the lives of some by removing them from the possibility of attack by more young ticks. removal from infected pastures likewise prevents a second attack, in october or early in november, which is caused by another generation of ticks. sick native cattle infect with a new generation of ticks the pasture to which they are removed, but these usually appear so late that they have but little opportunity to do any damage; hence, sick natives do not, as a rule, cause visible disease in other natives. it is of importance to remove all ticks, so far as this is possible, from sick animals, since they abstract a considerable quantity of blood and thereby retard the final recovery. medical treatment of the sick has generally been unsatisfactory, although in chronic cases and those occurring late in the fall beneficial results have followed. if the animal is constipated, a drench containing pound of epsom salt dissolved in quart of water should be administered, followed by sulphate of quinin in doses of to grains, according to the size of the animal, four times a day until the system is well saturated with it. tincture of digitalis one-half ounce and alcohol ounces may be combined with the quinin, according to indications of individual cases. an iron tonic containing reduced iron ounces, powdered gentian ounces, powdered nux vomica ounces, powdered rhubarb ounces, and potassium nitrate ounces will be found beneficial in the convalescent stage when the fever has run its course. this tonic should be given in heaping teaspoonful doses three times a day in the feed. good nursing is essential in treating these cases, and the animal should be given a nutritious, laxative diet with plenty of clean and cool drinking water and allowed to rest in a quiet place. if the stable or pasture is infested with ticks, the animal should be placed in a tick-free inclosure to prevent additional infestation with these parasites and the introduction of fresh infection into the blood. furthermore, all ticks that can be seen should be removed from the sick cattle, as they keep weakening the animal by withdrawing a considerable quantity of blood, and thereby retard recovery. quarantine regulations. the sanitary regulations issued by the department of agriculture for the control of cattle shipments from the infected districts have for their initial purpose the prevention of the transportation of ticks from infected regions to those that are not infected, either upon cattle or in stock cars or other conveyer. they are based upon the fact that texas fever is carried north only by the cattle tick, and the exclusion of this parasite from the noninfected territory has in every instance been found a certain method of excluding texas fever. the regulations governing the movement of cattle from below the quarantine line are made yearly by the secretary of agriculture, and they define the boundary of infected districts. the infected area as now determined is shown in maps issued periodically. in consequence of the enforcement of these quarantine regulations, texas fever has been practically prevented in the noninfected districts for several years, and little or no hardship has been caused to stockmen handling cattle from the infected areas. prior to the adoption of these regulations the tick-infested district was rapidly extending northward, but since the quarantine line was established and rational regulations enforced it has gradually been moved farther south. this problem of still further reducing the infested area is of the greatest importance to the cattlemen of the south--in fact, to those on both sides of the line--and one which is receiving special consideration by this department as well as by many of the interested states. tick eradication. systematic cooperative work by the federal government and the affected states for the eradication of the cattle ticks which transmit texas fever was begun in the summer of under authority given by congress in the appropriation act for the department of agriculture. the first federal appropriation for the fiscal year ended june , , was $ , , and for the fiscal year an appropriation of $ , was made, then for several years $ , , and this has been increased to $ , for . funds have also been provided by states and counties. the original infected area amounted to , square miles. of this territory there has been released from quarantine as a result of the work above mentioned , square miles (up to july , ). in other words, per cent of the area has been freed from ticks in years. great improvement has resulted from this work in the released territory. more cattle are being raised, and a better grade of breeding stock is being introduced; calves grow faster, and cattle put on flesh more rapidly during the grazing season and go into the winter in better condition because of the absence of the ticks; they can be marketed without quarantine restrictions, and higher prices are being obtained; dairy cows give a larger yield of milk; and values of farm lands are enhanced. the difference between the prices realized for cattle from the tick-infested region and the prices of cattle of similar grades from above the quarantine line has ranged from $ . to $ a head at the principal northern live-stock markets, without taking into account the improvement in quality and weight of cattle because of the eradication of the ticks. it can easily be seen that the extermination of the ticks means a large total annual increase in the prices obtained for southern cattle sold in northern markets. in addition to this, the increase in prices of cattle sold locally in the south would represent a large sum. this local increase has been found to amount to from $ to $ a head in territory freed from ticks. an agricultural official of one of the southern states has reported that calves in the tick-free area bring double the prices that can be obtained for similar calves in the tick-infested region. heretofore it has been impracticable to improve the quality of southern cattle by introducing fine breeding animals from other sections, because such animals were liable to contract texas fever and die unless protected by inoculation. furthermore, it is impossible for animals to attain good growth and to thrive when they are heavily infested with ticks. with the eradication of the ticks, however, the southern farmers are enabled to introduce good breeding animals and to improve the grade of their stock. there is no longer any doubt that it is entirely practicable to exterminate the ticks throughout the entire region, and the accomplishment of this result will be of tremendous economic advantage not only to the south but to the whole country. the rate of progress depends mainly on two factors-- the amounts appropriated by the federal and state governments, and the cooperation of the people. * * * * * southern cattle fever (texas fever, tick fever). description of plates. plate xliv. normal spleen and spleen affected by texas fever. fig. . spleen of an acute, fatal case of texas fever. the narrow end of the spleen is here represented. fig. . spleen of healthy steer. though the latter animal weighed one-half more than the former, the weight of the diseased spleen ( - / pounds) was nearly three times that of the healthy spleen ( - / pounds). plate xlv. texas fever. fig. . the cut surface of a healthy liver taken from a steer slaughtered for beef. fig. . the cut surface of the liver in texas fever. fig. . appearance of the urine in an acute, fatal case of texas fever. fig. . red corpuscles, magnified , diameters, containing the parasite of texas fever. this appears as a blue point _a_ near the edge of the corpuscle. the blood was taken from a skin incision. the case was nonfatal and occurred late in the fall. fig. . red corpuscles from the blood of an acute, fatal case, hours before death. the texas-fever microbes _a_ are shown as pear-shaped bodies, stained with methylene blue, within the red corpuscles. the larger body on the right _b_ is a white blood corpuscle, also stained with methylene blue. (magnified , diameters.) plate xlvi. the cattle tick (_margaropus annulatus_), the carrier of texas fever. fig. . a series of ticks, natural size, from the smallest, just hatched from the egg, to the mature female, ready to drop off and lay eggs. fig. . eggs, magnified times. fig. . the young tick just hatched (magnified times). fig. . the male after the last molt (magnified times). fig. . the female after the last molt (magnified times). fig. . a portion of the skin of the udder, showing the small ticks. from a fatal case of texas fever produced by placing young ticks on the animal. (natural size.) fig. . a portion of the ear of the same animal, showing same full-grown ticks ready to drop off. (natural size.) plate xlvii. the cattle tick (_margaropus annulatus_). fig. . dorsal view of male. (greatly enlarged. original.) fig. . ventral view of male. (greatly enlarged. original.) fig. . dorsal view of replete female. (greatly enlarged. original.) fig. . ventral view of same. plate xlviii. portion of a steer's hide, showing the texas-fever tick (_margaropus annulatus_). (natural size. original.) plate xlix. fig. . tick-infested steer. fig. . dipping cattle to kill ticks. plate l. facsimile of poster used to show the difference between cattle of similar breeding raised on a tick-free farm in one case and on a ticky farm in the other. * * * * * chronic bacterial dysentery. chronic bacterial dysentery is a chronic infectious disease of bovines caused by an acid-fast bacillus simulating the tubercle bacillus and characterized by marked diarrhea, anemia, and emaciation, terminating in death. this disease was observed in the united states for the first time by pearson in pennsylvania cattle, and later by mohler in virginia cattle, and in an imported heifer from the island of jersey at the athenia quarantine station of the bureau of animal industry. pearson proposed the name chronic bacterial dysentery for this affection, and it has also been termed johne's disease, chronic bacterial enteritis, chronic hypertrophic enteritis, and chronic bovine pseudotuberculous enteritis by various european investigators. the disease was first studied in by johne and frothingham in dresden, but they were inclined to attribute to the avian tubercle bacillus the cause of the peculiar lesions of enteritis which they observed. in markus reported this disease in holland, and subsequently it was observed in belgium, switzerland, denmark, and great britain. _cause._--the bacillus, which has been invariably demonstrated in the intestinal lesions and mesenteric lymph glands in this disease, is a rod about to microns long and . micron wide. it stains more or less irregularly, like the tubercle bacillus, and moreover the similarity goes further, in that the organism is also strongly acid-fast, which facts led johne and frothingham to surmise that the disease was caused by avian tubercle bacilli. however, it has now been plainly demonstrated that the bacillus of chronic bacterial dysentery is readily distinguished from the latter organisms, for while it resembles the tubercle bacillus in form and staining qualities, no one has succeeded in growing it in culture media or in reproducing the disease by injecting experiment animals. _symptoms._--probably the first symptom noticed is that the animal is losing condition despite the fact that its appetite is good and the food nourishing. this is soon followed by a diarrhea which, while moderate at first, soon becomes excessive and may be either irregular or persistent, the feces being of the consistency of molasses and passed frequently. in the meantime the hair becomes dry and harsh and the animal falls off considerably in weight. the temperature, however, remains about normal. the appetite does not seem to be greatly impaired until the last few weeks of life, but nevertheless emaciation continues, the animal becomes more and more anemic, great muscular weakness and exhaustion are manifested, and death follows, apparently as the result of the persistent diarrhea and great emaciation. the disease may continue for four or five weeks or may last for a year, or even longer, before death intervenes. _lesions._--the lesions observed on post-mortem are remarkably slight and are out of all proportion to the severity of the symptoms manifested. the disease appears to start in the small intestines, especially in the lower portion, where the lesions are usually the most marked, but it also involves the large intestines, including the rectum. the mucous membrane may alone be affected, although usually in the long-standing cases the submucosa is also invaded and the entire intestinal wall is then much thicker than normal and the tissue infiltrated with an inflammatory exudate. the mucous membrane or inside lining membrane is markedly wrinkled or corrugated, showing large, coarse folds with more or less reddening or hemorrhagic patches or spots on the summits of the ridges, especially noticeable in the large intestines. the mesenteric lymph glands are usually somewhat enlarged and appear watery on section. the other organs do not appear to be affected except from the anemia present in the later stages of the disease. _differential diagnosis._--the principal disease with which bacterial dysentery may be confused is tuberculosis, but the application of the tuberculin test will readily diagnose the latter disease, while no reaction will be noted in case the injected animal is suffering with the former affection. the disease may also be mistaken for the parasitic affections resulting from stomach worms (verminous gastritis) and intestinal parasites, especially uncinariasis, but a microscopic examination of the feces is necessary in order to establish definitely the diagnosis. _treatment._--as with all other forms of infectious disease, it is advisable to separate immediately the diseased and suspected cattle from the healthy animals. the feces passed by the former animals should be placed on cultivated soil where healthy cattle will not be exposed to them, as the bacilli producing the disease are readily found in such manure. the stalls, stables, and barnyards should also be thoroughly disinfected, as has been described under "tuberculosis," in this chapter, special attention being given to those places which have been soiled by feces. the administration of medicines has thus far been quite unsatisfactory, although treatment should be directed toward disinfecting the intestines with intestinal antiseptics, such as tannopin in dram doses twice daily, and strengthening the animal by the use of stimulants such as strychnin in half-grain doses given twice daily hypodermically. salol, turpentine, or subnitrate of bismuth in a starch or wheat-flour gruel may also give temporary relief, but the diarrhea is likely to reappear and cause the death of the animal. in all cases the feed must be carefully selected to assure good quality, and should consist preferably of nutritious dry feed. nagana. nagana, also called tsetse-fly disease, is an infectious fever occurring chiefly in horses and cattle, characterized by alternating paroxysms and intermissions and produced by a specific flagellate protozoan (_trypanosoma brucei_) in the blood. it is probably transmitted from animal to animal solely by the bites of the tsetse fly. this insect is something like a large house fly, and when it settles on a diseased animal, sucks the blood and infects its proboscis, it is enabled on biting a second animal to infect the latter by direct inoculation. this disease is found throughout a large portion of central and southern africa, along the low-lying and swampy valleys. it has never occurred in the united states, nor is it known to be present in the philippines, but its relation to surra and the possibility of its appearance in one of our island dependencies are the reasons for including a few remarks at this time. _symptoms._--the chief symptoms in addition to the fever, which is usually about ° to ° f., are the muscular wasting, progressive anemia, and loss of power, together with the edema most marked about the head, legs, abdomen, and genital organs. the urine is yellow and turbid, and occasionally contains albumin and blood. there is paralysis of one or both of the hind legs, difficult urination and defecation, labored breathing, discharge from the eyes and nose, extreme thirst, and gradual extension of paralysis to other parts of the body. the disease runs a chronic course, lasting from three to six weeks in horses, and from one to six months in cattle. besides these animals, the mule, ass, buffalo, antelope, hyena, camel, and dog contract the disease naturally, and sheep, goats, cats, and small laboratory animals succumb to artificial inoculation. _lesions._--the spleen and lymphatic glands are enlarged. there are sero-fibrinous exudates in the body cavities, the liver is enlarged and engorged, heart flabby, and a catarrhal condition is present in the respiratory passages. pathological changes occur in the spinal cord. the finding of the trypanosoma by microscopic examination of the blood will be conclusive evidence for diagnosis. _treatment._--treatment has not proved satisfactory. quinin, arsenic, methylene blue, and other drugs have been used, but without success. endeavors thus far made to produce immunity from this disease have likewise been unavailing. cattle farcy. this is a chronic disease of cattle occurring in france and the island of guadeloupe, west indies. it is characterized by caseating nodular swellings, first of the skin and afterwards of the superficial lymphatic vessels and glands, finally proving fatal within a year by extension to the viscera. the swellings rupture and discharge a purulent yellowish fluid, which contains the causative organism. this affection, called farcin du boeuf by the french, resembles cutaneous glanders or farcy of horses, but is caused by an entirely different organism, the streptothrix of nocard. moreover, cattle are immune from glanders, and for this reason the name, unfortunately applied to this disease, should not lead to any confusion with the cutaneous glanders or farcy of horses. although the disease has been described as occurring only in guadeloupe and france, the possibility of its occurrence in american possessions warrants its mention in this chapter. _treatment._--treatment consists in making incisions into the swellings and syringing them out with per cent compound cresol solution. the cavities may then be packed with cotton, soaked in per cent zinc-chlorid solution. the swollen lymphatics may also be bathed or covered with cloths wrung out in this solution. other infectious diseases. the following are also infectious diseases of cattle, a discussion of which will be found in previous chapters: page. contagious abortion white scour of calves infectious ophthalmia (pink eye) footnotes: [ ] these membranes comprise the smooth, very delicate, glistening lining of the large body cavities. in the thorax the serous membrane (pleura) covers the ribs and diaphragm as well as the whole lung surface. in the abdomen a similar membrane (peritoneum) lines the interior of the cavity and covers the bowels, liver, spleen, etc. [ ] hogs are subject to actinomycosis. [ ] the distribution of government blackleg vaccine was discontinued july , . [ ] only a general outline of methods of eradication will be given here. for detailed information, including directions for the construction of dipping vats and for the preparation of dips, the reader is referred to farmers' bulletin , which may be obtained free upon application to the department of agriculture, washington, d. c. [ ] for fuller information see farmers' bulletin , from which the directions here given are mainly derived. [ ] the chemicals employed have no effect upon iron. they will, however, actively corrode zinc, tin, or solder; hence a soldered pail must be watched for leaks and is far inferior to a seamless pail, stamped from a single sheet of iron. a tinned pail is preferred to a galvanized one, but a plain iron seamless pail or an iron kettle should be obtained if possible. [ ] best done by previously determining by measurement the depth of gallons of water in the kettle. set the kettle exactly level and mark the depth on a stick held vertically on the center of the bottom. animal parasites of cattle. by b. h. ransom, ph. d., _chief of zoological division, bureau of animal industry._ the animal parasites of cattle comprise more than a hundred different species, belonging to various groups of the animal kingdom. fortunately not all these parasites occur in this country--many are uncommon, and many are comparatively harmless. some forms, however, occur frequently, and some are of distinct importance to the american stockman on account of the damage for which they are responsible. it is these parasites particularly which will be referred to in the present article, and although some forms are discussed which are rare or apparently of little economic importance, most of the minor and unusual parasites and species not found in this country have been omitted from consideration. flies.[ ] of the various species of flies which infest cattle some are injurious on account of the annoyance, pain, and loss of blood due to their bites, and sometimes also on account of diseases or parasites which are thus transmitted from the blood of diseased animals to that of healthy cattle, while others, which in the winged adult state do not bite, are injurious because they live parasitic on cattle during their larval stages. _remedies for flies._[ ]--most remedies used for protecting cattle from the attacks of flies have to be applied frequently, and few, if any, will keep flies away for more than a day or two following their application. the numerous proprietary fly repellents to be found on the market are usually more expensive, and often less efficacious than homemade mixtures. at the minnesota experiment station rancid lard pound and kerosene one-half pint, mixed thoroughly until a creamy mass forms, was found to give excellent results as a fly repellent, lasting for two or three days, when rubbed not too thickly with a cloth or with the bare hand over the backs of cows. mixtures of cottonseed oil and pine tar containing from to per cent of the latter substance were found by investigations in the bureau of animal industry to have a marked repellent action against flies when applied lightly every day. a too free application of tar mixtures and other preparations containing phenols is liable to cause poisoning; hence care should be observed in this regard. jensen ( ) recommends the following formula, which is said to protect cows for a week: common laundry soap pound. water gallons. crude petroleum gallon. powdered naphthalin ounces. cut the soap into thin shavings and dissolve in water by the aid of heat; dissolve the naphthalin in the crude oil, mix the two solutions, put them into an old dasher churn, and mix thoroughly for minutes. the mixture should be applied once or twice a week with a brush. it must be stirred well before being used. the stable fly (stomoxys calcitrans).[ ] this fly very closely resembles the house fly, but, unlike the latter, it is a biting fly. it is common about stables and often enters dwellings, especially in cloudy weather. according to noé, it is the agent of transmission of a parasitic roundworm of cattle (_setaria labiato-papillosa_, see p. ). this fly has been shown capable of transmitting anthrax from diseased to healthy animals, and under some conditions it may transmit surra, a disease caused by a blood parasite which affects horses, cattle, and other livestock. the annoyance suffered by cattle and horses from stable flies is much lessened if the stables are darkened. the screening of doors and windows, however, is preferable, as ventilation is not interfered with as it is in darkening stables. for milk cows coverings made from burlap (double thickness), including trouserlike coverings for the legs, may be used when the flies are very numerous and troublesome. one of the fly repellents mentioned above may be applied to cattle to protect them from stable flies. the hodge flytrap fitted to the windows of dairy barns is a useful means of destroying stable flies. the united states bureau of entomology has found that a mixture of fish oil ( gallon), oil of pine tar ( ounces), oil of pennyroyal ( ounces), and kerosene ( / pint) is fairly effective for a short time when applied lightly, but thoroughly, to the portions of animals not covered with blankets. the risk of poisoning with tar mixtures as already mentioned should be borne in mind in using this remedy. care should be taken to apply it lightly. the stable fly breeds in moist accumulations of straw, chaff, cow or horse manure, and various fermenting vegetable substances. the débris collecting in and under outdoor feed troughs, and the remains of straw stacks are favorable breeding places for the stable fly. under the most favorable conditions about three weeks are required for development from the egg to the adult stage. the proper care of straw and the proper disposal of stable manure are very necessary in the control of stable flies. straw stacks should be carefully built so as to shed rain, and loose straw or chaff should be scattered or burned. straw not required for winter feed should be promptly disposed of by burning or scattering and plowing it under. stable manure should be hauled out and scattered at regular intervals, preferably every three days, and the vicinity of stables should be kept free from accumulations of straw and hay that may become wet and serve as breeding places for the stable fly. the hornfly (lyperosia irritans).[ ] this fly, now found nearly everywhere in the united states, was introduced into this country from europe about the year . hornflies have the habit of clustering about the base of the horn (fig. ), whence the name by which they are popularly known. they do not damage the horn, and congregate there only to rest. in view of the general practice of dehorning cattle, the name hornfly is less distinctive than it once was. moreover, hornflies rest on other parts of the body as well as the horns. when resting, their wings are held down close to the body (fig. ); when feeding, their wings are held out nearly at right angles, ready for flight. they puncture the skin and suck blood, usually attacking the upper parts of the body, particularly those which are out of reach of the animal's head or tail. unlike most flies, they remain on the animal more or less constantly, day and night. owing probably to the irritation and annoyance caused by these flies, cattle often do not thrive as they should during seasons when the flies are numerous. the hornfly has also been charged with transmitting diseases, such as anthrax. [illustration: plate xliv. normal spleen and spleen affected by texas fever. fig. . spleen of an acute, fatal case of texas fever. fig. . spleen of healthy steer.] [illustration: plate xlv. texas fever.] [illustration: plate xlvi. the cattle tick (margaropus annulatus), the carrier of texas fever.] [illustration: plate xlvii. the cattle tick (margaropus annulatus). figs. and dorsal and ventral views of male. figs. and dorsal and ventral views of replete female. (greatly enlarged.)] [illustration: plate xlviii. portion of a steer's hide, showing the texas-fever tick (margaropus annulatus) of the united states. natural size. original.] [illustration: plate xlix. fig. .--tick-infested steer.] fig. .--dipping cattle to kill ticks.] [illustration: plate l. facsimile of poster used in tick eradication work.] the fly lays its eggs in freshly dropped cow manure. they hatch in about hours, and the larvæ or maggots in four or five days develop to the pupal stage, which lasts a week or days. from the pupal stage the mature fly emerges. the entire process of development from the deposition of the egg to the appearance of the mature fly therefore may be completed in two weeks, or even in a shorter time. to protect cattle from attacks of the hornfly they may be treated with one of the remedies mentioned above (p. ). dipping cattle in a vat provided with splashboards set at the proper angle destroys most of the hornflies present on the animals. unless the splashboards are used all but a few of the flies succeed in escaping as the cattle plunge into the bath and later return to them. scattering the droppings of cattle with a shovel, or with brush dragged over pastures, in order to insure the rapid drying of the manure and consequent destruction of the larvæ, is, when practicable, an efficient means of reducing the number of these flies. [illustration: fig. .--hornfly (_lyperosia irritans_) in resting position. enlarged. (from bureau of entomology.)] [illustration: fig. .--hornflies (_lyperosia irritans_) on cow horn. (from bureau of entomology.)] buffalo gnats. these small flies, also known as black flies, are about one-eighth of an inch long and have a characteristic "humped" back (fig. ). they breed in running water and appear in swarms during spring and summer, often in enormous numbers, causing great annoyance to stock and human beings, on account of their bites and their entrance into the eyes, nose, mouth, and other openings of the body. their bites appear to be poisonous, and in seasons especially favorable to the gnats heavy losses of horses and cattle often occur. buffalo gnats are more troublesome in bright, sunny weather than when it is cloudy, and animals which have not shed their winter coats suffer more from their attacks than those with smooth coats. cattle kept in darkened stables are not molested. the application of one of the fly repellents already mentioned (p. ) may help to protect animals from buffalo gnats. the burning of smudges is also a useful means of protecting stock from the attacks of these flies. [illustration: fig. .--buffalo gnat. enlarged. (from bureau of entomology.)] screw worms.[ ] screw worms (fig. ) are the maggots of a fly (_chrysomyia macellaria_), so called from their fancied resemblance to a screw. the adult fly (fig. ) is about one-third of an inch long, with a bluish-green body, red eyes, and with three dark longitudinal stripes on the back (thorax). attracted by odors of decay, it deposits its eggs, to at a time, in cuts, sores, castration wounds, etc. the crushing of a tick on the skin commonly results in screw-worm infection at that point. the eggs hatch in a few hours and the larvæ or maggots, or so-called screw worms, begin to burrow into the flesh and continue burrowing and feeding from three to six days, after which they leave the wound and crawl into the earth, there transforming into the quiescent pupal stage. this stage is completed in three to fourteen days. the mature flies then emerge from the pupal envelope and are soon ready for egg laying. from two to three weeks are therefore required for the entire life cycle, although under certain conditions it is possible for the fly to undergo its full development in as short a time as seven days, and on the other hand as long as a month is often required. besides cattle, the screw-worm fly attacks sheep, horses, dogs, and man. in the case of hogs it is generally the ears which are affected. the fly also breeds in dead animals, and all carcasses should therefore be buried deeply or burned. the complete destruction of all dead animals by burning has been found by the bureau of entomology to be by far the best method of controlling screw worms. _treatment for screw worms._--for proper treatment an animal suffering from screw worms should be caught and thrown. chloroform is then poured into the wound, taking care that it penetrates thoroughly into all the burrows of the screw worm, if necessary using a slender stick or a small bunch of twisted hay as a probe. the animal should be held for several minutes in order to insure the continued action of chloroform. instead of chloroform, gasoline may be used, and carbon tetrachlorid is said by some authorities to give good results. finally, the dead or dying maggots may be removed with forceps, the wound washed with a weak carbolic or cresylic acid solution, and painted with pine tar to reduce the chances of further attack by flies. finally the wound should be dressed with a carbolic or cresylic ointment to promote healing and thus prevent further infection, or the wound may be painted with pine tar. dipping in the arsenical dips used for destroying cattle ticks is a convenient method of treatment if many animals are involved. [illustration: fig. .--screw worm (larva of _chrysomyia macellaria_). enlarged. (from bureau of entomology.)] [illustration: fig. .--screw-worm fly (_chrysomyia macellaria_). enlarged. (from bureau of entomology.)] grubs, warbles, bots. ox warbles are whitish or, when full grown, dark-colored grubs or maggots that develop from the eggs deposited on the hairs of cattle by certain flies known as warble flies. in the united states there are two species of ox-warble flies, technically known as _hypoderma lineatum_ and _hypoderma bovis._ these flies somewhat resemble bees in their general appearance, but like all flies have only two wings. the first named, _h. lineatum_, is commonly called the heel fly and is more generally distributed over the united states than the other species. the tail has a distinctive reddish-orange color and the legs are rough and hairy. this fly commonly deposits its eggs about the coronet, whence the name of heel fly, and on the fetlocks, knees, and hocks. when cattle are resting, eggs are deposited along the line of contact of the body with the soil. cattle are frequently indifferent to the activity of this fly in depositing its eggs. commonly to eggs, sometimes as many as , are attached to a single hair. in the united states the other warble fly, _h. bovis_, has been found only in the north (new england, new york, pennsylvania, maryland, michigan, iowa, missouri, and washington) and has not yet been found in the southern states. the tail is orange-yellow, lighter in color than that of the other species, and the legs have but few hairs. this fly commonly deposits its eggs on the outside of the hind quarters and above the fetlocks when the animals are moving, or lower down if they are quiet. cattle are usually much disturbed by the activity of this fly and not infrequently appear terror stricken. the eggs are attached singly, one egg to a hair near its base. the eggs of the warble flies hatch as a rule in about a week, the time varying with local conditions. the young warble is about mm. ( / inch) long. it crawls to the base of the hair and burrows into the hair follicle. the entrance of the larvæ frequently causes sudden appearance of swellings. the larvæ of _h. bovis_ in entering the skin rarely cause a flow of serum or pus formation, but those of _h. lineatum_ commonly cause a considerable flow of serum with pus formation resulting in a matting of the hair on affected areas of the skin. the warbles after penetrating the skin migrate through the body and ultimately reach the backs of the cattle, _h. lineatum_ usually appearing there in northern latitudes about the middle of december and _h. bovis_ about a month later. during their migrations, before they reach the back, the young warbles spend a considerable period in the walls of the esophagus, or gullet, and may be found in this location as early as august . during the fall and winter a large proportion of the gullets of cattle that are slaughtered are found to be infested with warbles, and are known as grubby gullets or weasands in the packing houses. when the warbles first appear in the back they are about / inch long. they cause swellings about the size of pigeons' eggs, each swelling having a small hole in the center, which has been punctured in the skin by the warble to enable it to breathe. through this hole the warble leaves the back of the cow when it has completed its parasitic stage of development, at which time it measures nearly an inch in length. the full-grown larvæ begin to leave the backs of the cattle early in the year, and in northern latitudes the last leave before the middle of july. after leaving the backs of the cattle they burrow into the ground, lie quiescent for about a month, and become transformed into mature flies. in northern latitudes the mature flies of the species _h. lineatum_ may be observed during april and may, and those of the other species during june and july. the damage caused by warbles includes injury to stampeding cattle frightened by the fly, decreased milk flow and diminished growth in infested animals, and injury to hides, the last item being especially serious. _treatment._--the best method of control known at present is to extract the warbles from the backs of cattle and kill them. if they are almost ready to leave the cattle, they may be squeezed from the backs with the fingers. forceps are useful in removing the warbles, but it is important to be careful in extracting warbles not to crush them, as the body juices of these parasites are sometimes poisonous to cattle if absorbed into their circulation. in the south herds may be examined in november or early in december and once a month during the next two or three months. in the north the first examination may be made six weeks to two months later, with two or, better, three following examinations at intervals of a month. if this procedure is carefully carried out there will be a noticeable diminution of warbles the following year, and if persisted in the warble can be almost if not completely eradicated. where an entire community follows up the practice of removing and destroying warbles, the results are highly beneficial. as a result of recent studies by various investigators it appears that the tiny grubs, newly hatched from the eggs, may gain entrance to the body by penetrating directly through the skin. many observers, however, have held that the eggs or newly hatched larvæ are taken into the mouth by the cattle licking themselves. it is possible, as in the case of several other parasites, that both modes of infection may occur and that the larvæ may gain entrance to the body either by penetrating the skin or by being swallowed. from the evidence at present available it seems likely that the usual mode of entrance is through the skin. irrespective of the mode of infection, the larvæ evidently wander extensively through the tissues of the body, developmental stages being found in considerable numbers in the wall of the esophagus during the fall of the year. they have also been found in the spinal canal and in various other locations. finally, about january they appear beneath the skin of the back, forming the well-known swellings. the posterior end of the grub is near the small opening in the hide, through which the grub breathes and discharges its excrement, and through which, when its development is complete, it finally escapes. the anterior end of the grub is at the bottom of the tumor, where the mucus collects upon which it feeds. by spring or early summer the grub is full grown and forces its way out of the skin, falling to the ground, into which it burrows for a short distance and transforms into the pupal stage. in about a month the mature fly emerges. it has lately been discovered that a second species of warble fly (_hypoderma bovis_) common in europe is of not uncommon occurrence in canada and the northern part of the united states, whereas it was formerly supposed that the ox warbles of this country were all of the one kind. the general appearance, life history, and effects of the european species are much the same as those of the american form. grubs weaken cattle, cause them to fall off in flesh and milk, and decrease the value of the hide. the beef in the immediate vicinity of a grub becomes slimy and of a greenish color, and is known to the butchers as "licked beef." the total loss to this country on account of the warble fly is estimated at $ , , to $ , , a year, at the least, and may amount to considerably more. _treatment for warbles._--during the winter and spring examine the cattle for the presence of warbles. by passing the hand over the backs of the animals the swellings marking the location of the grubs may be readily found. pressure properly applied to the swellings will cause the grubs to "pop out" if they have reached a late stage of development. they may be more easily removed by means of slender forceps inserted into the opening of the warbles, and a still more certain method of removing them, particularly if the lumps are still very small, is to cut into the swellings with a sharp knife or bistoury, after which they may be pressed out. care should be taken to crush all grubs removed, so as to prevent the possibility of their further development and transformation into flies. in order that none may escape it is advisable to examine the cattle every two weeks during the late winter and spring, at each examination removing the grubs which have developed sufficiently to cause perceptible swellings. another method of treatment is to force grease or oil into the openings of the warbles, which kills the grubs. this method is less certain than that of removing the grubs, and has the further objection that the dead grubs remain beneath the skin. cattle may be treated during the summer with fly repellents (p. ) to keep off the warble flies. the efficacy of repellents against these flies is probably, however, not very great. in localities where the character of the cattle industry is such as to render practicable the systematic examination of cattle and the removal of the grubs--that is, where the herds are comparatively small and subject to the close supervision of the owners--it is possible, by the exercise of a little care and with very little effort on the part of the cattle owners, provided they work together, each doing his share by seeing to the removal of grubs from his own cattle, so that as few as possible survive to transform into flies, to reduce the number of grubs within one or two seasons almost, if not entirely, to the point of extinction. investigations not yet completed indicate that grub eradication may sometimes be accomplished by the use of arsenical dips, which are extensively used at the present time for destroying cattle ticks. (see p. .) it is possible that the destructive action of arsenical dips upon warbles is more or less dependent upon the fact that arsenic is stored up in small quantities in and upon the skin of cattle that are repeatedly dipped in arsenical dips. the arsenical dip appears to act, not upon the well-developed grub beneath the skin, but upon the eggs or the newly hatched larvæ, probably the latter. accordingly the dipping of cattle to destroy grubs should be carried out during the fly season and repeated treatments should be given every two or three weeks, as in dipping cattle to eradicate ticks. [illustration: fig. .--the warble fly (_hypoderma lineatum_): _a_, adult female; _b_, eggs attached to a hair, × ; _c_, larva as seen in egg; _d_, larva from esophagus of an ox; _e_, later stage of larva from beneath the skin of the back; _f_, larva at the stage when it leaves the back of cattle and falls to the ground--all enlarged (after riley).] lice.[ ] cattle in the united states are commonly infested with three species of lice, two of them sucking lice (_hæmatopinus eurysternus_, the short-nosed cattle louse, and _linognathus vituli_, the long-nosed cattle louse), commonly known as blue lice, and one biting louse (_trichodectes scalaris_), commonly known as the red louse. the blue lice (figs. and ) suck the blood of cattle and are more injurious than the red lice (fig. ). unless very abundant the latter cause little injury. if numerous they irritate and worry their host probably more by their sharp claws than by their bites, as their food seems to consist entirely of particles of hair and dead skin. cattle lice reproduce by means of eggs or nits (fig. ) which they fasten to the hair. the blue lice infest chiefly the neck and shoulders; red lice, when present, may be found almost anywhere on the body, but are usually most numerous on neck, shoulders, and at the root of the tail. on account of the itching caused by the lice, infested cattle rub against posts, trees, etc., and lick themselves, the hair sometimes coming out and the skin becoming thickened so that mange may be suspected. _treatment for lice._--cattle may be treated for lice by means of hand applications, spraying, or dipping. dusting powders sold under various trade names are of value in helping to hold lice in check when the weather is too cold for dipping or spraying. the application of greases and insecticidal liquids by hand is fairly effective and practicable in cases in which there are only a few animals to be treated. the following remedies have proved effective when applied by hand, the treatment being repeated if necessary in about days: ( ) cottonseed oil and kerosene, equal parts; ( ) kerosene, / pint, mixed with lard, pound; ( ) crude petroleum; ( ) any of the dips recommended for use in dipping, and diluted in the same proportions as for dipping. oils or greases should not be used in very warm or very cold weather. the remedies mentioned may be applied with a brush or a cloth. they should be distributed in a thin, even coating over the surface of the body, taking care that there is no excess quantity at any point. in spraying, any of the dips recommended for lice, properly diluted, are applied by means of a spray pump over the entire body. thorough wetting of the skin and hair is important, and a second treatment should be given or days later. when a considerable number of animals are to be treated the most satisfactory method of destroying lice is by the use of a dipping vat. two dippings should be given or days apart. dipping in the fall is good insurance against risk of loss from lice during the winter. all animals in the herd should be treated regardless of the number showing infestation. either coal-tar-creosote or nicotin dips may be used. these are sold under various trade names. the directions for dilution given by the manufacturer should be carefully followed. as coal-tar-creosote dips do not mix well with all kinds of water, they should be tested with the water to be used for making the solution by mixing some of the dip in the proper proportions with the water in a clean and clear-glass bottle or jar. if an oily layer or mass of globules collects either at the top or the bottom of the mixture after standing an hour, the dip is not suitable for use with that kind of water. imperfectly mixed coal-tar-creosote dips are liable to poison animals even when not used in stronger solutions than that recommended by the manufacturers, and are also likely to be inefficacious. the lime-sulphur dip, which is highly efficacious as a mange remedy, is of little value for destroying lice, especially blue lice. the arsenical dip used in tick eradication is a good louse remedy, but its use is not advisable on account of its poisonous nature, except under the supervision of capable persons who know how to use it and what precautions to take. [illustration: fig. .--short-nosed blue louse (_hæmatopinus eurysternus_) of cattle. enlarged. (from bureau of entomology.)] [illustration: fig. .--long-nosed bluelouse (_linognathus vituli_) of cattle. enlarged. (from bureau of entomology.)] [illustration: fig. .--red louse (_trichodectes scalaris_) of cattle. enlarged. (from bureau of entomology.)] [illustration: fig. .--egg of short-nosed blue louse (_hæmatopinus eurysternus_) attached to a hair. enlarged. (from bureau of entomology.)] mange, itch, scab.[ ] cattle are subject to four kinds of mange, of which common mange or psoroptic mange is the most important. psoroptic mange. psoroptic mange of cattle is caused by small mites (fig. ) which multiply rapidly and are spread from diseased to healthy cattle by bodily contact, or by pens, stables, railroad cars, etc., recently occupied by mangy cattle. the mites attack the skin and cause it to become thickened and covered with crusts and scabs, with a consequent loss of hair. intense itching accompanies the disease, and affected cattle are more or less constantly rubbing and licking themselves. psoroptic mange commences at the root of the tail, or on the neck, or withers, and gradually extends over the back up to the head, over the sides, and may finally affect nearly the entire body except the legs. in serious cases the skin may become ulcerated; the animals are greatly weakened and emaciated, and finally die. by taking scrapings from the edges of scabby patches and placing them on a piece of black paper in a warm place the mites may be seen as tiny white objects crawling over the paper, more distinctly if a magnifying glass is used. mange may be confused with lousiness, ringworm, or with any condition in which there is itching or loss of hair, but if mites are found there is no question of the diagnosis. the disease is worse during cold, wet weather. mangy cattle when on good pasture during the summer often seem to recover, but in the fall the disease again appears in a severe form. _treatment._--the most generally used and most satisfactory method of treating cattle mange consists in dipping the animals in a vat filled with a liquid of such nature that it will kill the parasites without injuring the cattle. vats for dipping cattle are built of wood, stone, or concrete, and vary in length from to feet or more. they vary in width from to feet at the top and - / to feet at the bottom, and the depth may be from to feet. a narrow chute through which the cattle are driven leads to one end of the vat, where a steep slide pitches the cattle into the dipping fluid, through which they swim, and climb out of the vat at the other end, which is built sloping and provided with cross cleats to give the animals a foothold. a draining pen with floor sloping back toward the vat is generally provided. the dip should be used warm, ° to ° f., and the cattle should be held in the vat for two minutes to insure thorough action of the dip. the head of each animal should be ducked at least once. care should be taken that the vat contains a sufficient depth of fluid to swim the animals to be dipped. the dipping fluid may be heated from a steam boiler by pipes or hose, or water heated in large iron cauldrons or tanks may be used for charging the vat, and hot water with a proper quantity of dip added from time to time as the dipping fluid becomes cool. if crude-petroleum dips are used, one dipping is usually sufficient, and the dip is used cold. crude-petroleum dips are rarely used for common mange, but are of special value for sarcoptic mange, which is cured with difficulty by the ordinary dips. in the treatment of ordinary mange with lime-sulphur or nicotin dips two dippings are necessary, the second dipping being given to days after the first. the second treatment is necessary to kill the few parasites which sometimes escape at the first treatment, either in the egg stage or as fecundated females. [illustration: fig. .--mite which causes psoroptic scab of sheep. enlarged about times. the mite of psoroptic cattle mange is almost identical in appearance.] lime-sulphur dip. the lime-sulphur dip is made in the proportion of pounds of unslaked lime (or pounds of commercial hydrated lime--not air-slaked lime), pounds of flowers of sulphur, and gallons of water. _directions for preparing gallons of dip._--weigh out the lime, pounds (or hydrated lime, pounds), and sulphur, pounds. place the unslaked lime in a shallow, water-tight box similar to a mortar box, or some other suitable vessel, and add water enough to slake the lime and form a lime paste or lime putty. sift into this paste the flowers of sulphur and stir well; then place the lime-sulphur paste in a kettle, boiler, or tank containing gallons of water, the water being first heated nearly to the boiling point. boil the mixture for two hours at least, stirring frequently; add water occasionally to maintain the original quantity. allow the mixture to settle in the tank or draw the entire contents of the kettle or boiling tank into a large tub or barrel placed near the dipping vat and provided with a bunghole about inches from the bottom, and then allow ample time to settle--from two to three hours or more if necessary. when fully settled, draw off the clear liquid into the dipping vat, taking care not to allow any of the sediment to accompany it, as the sediment is liable to render the dip unnecessarily caustic. the clear liquid thus obtained requires only the addition of sufficient clear warm water to bring the total up to gallons. flowers of sulphur must be used and the lime must be of good quality. the dipping bath should be used at a temperature of ° to ° f., and for official dippings must be maintained at all times at a strength of not less than per cent of "sulphid sulphur" as indicated by the bureau of animal industry field test for lime-sulphur baths. nicotin dip. the nicotin dip is made with sufficient extract of tobacco, or nicotin solution, to give a mixture containing not less than five one-hundredths of per cent nicotin and per cent flowers of sulphur. sufficient nicotin would therefore be furnished for gallons (about pounds) of dip by pound of a per cent solution of nicotin. the formula for this dip would be: nicotin, four-tenths of a pound; flowers of sulphur, pounds; water, gallons. to calculate how much nicotin solution or extract of tobacco should be used for gallons of water, divide the quantity of nicotin required in the dip by the proportion of nicotin in the extract. for example, suppose the nicotin solution contains per cent nicotin, we have . ÷ . = . . therefore in this case it would require . pounds of nicotin solution for the gallons of dip. or, if a tobacco extract is used, having, for example, . per cent of nicotin, the formula would be as follows: . ÷ . = . , and therefore . pounds would be required for gallons of dip. do not use any preparation the strength of which is not given on the outside of the package. in preparing these dips the nicotin solution and sulphur should be mixed together with water before adding them to the water in the dipping vat. on no account should the dip be heated above ° f. after the nicotin solution is added, as heat is liable to evaporate the nicotin and weaken the dip. for official dippings the dipping bath should be used at a temperature of ° to ° f. and at all times must be maintained at a strength of not less than five one-hundredths of per cent nicotin as indicated by a field test approved by the bureau of animal industry. a homemade nicotin dip may be prepared as follows: for each gallons of dip desired, take pounds of good, prepared tobacco leaves; soak the leaves in cold or lukewarm water for hours in a covered pot or kettle; then bring the water to near the boiling point for a moment, and, if in the morning, allow the infusion to draw for an hour; if in the evening, allow it to draw overnight; the liquid is next strained (pressure being used to extract as much nicotin as possible from the wet leaves) and diluted to gallons per pounds of tobacco. this dip should be used as fresh as possible, as it contains a large amount of organic material which will soon decompose. crude-petroleum dips. crude-petroleum dips, which are valuable for the treatment of sarcoptic mange, are not often used for the treatment of psoroptic mange or of chorioptic mange, oily dips being liable to injure animals, especially if they are moved rapidly soon after treatment, if they are exposed to bright sunshine, or if they become chilled. besides unprocessed crude petroleum, processed petroleum from which the gasoline and other light hydrocarbons have been removed may be utilized in the treatment of cattle for mange, particularly sarcoptic mange. there are a number of proprietary brands of crude-petroleum dips on the market, consisting of processed crude petroleum with other substances added, mainly lighter oils to give the dip a suitable consistency. in dipping cattle in crude-petroleum dips fill the vat with water to within foot or inches of the dip line and then add the oil until the surface is flush with the dip line. the oil floats on the water, and as the animals pass through the vat their bodies become coated with oil. chorioptic mange. chorioptic mange, due to a species of mite different from that causing common cattle mange, is confined almost entirely to the region at the root of the tail and if not treated may persist for years. the treatment is the same as for psoroptic mange. sarcoptic mange. sarcoptic mange, frequently called "barn itch," is caused by a mite very similar to that which causes itch in human beings. it commonly affects the head and neck, but may also occur on various other parts of the body. bulls are particularly liable to be affected with this form of mange. cattle may become infected not only from other cattle, but also from horses, goats, dogs, sheep, and hogs. as a rule sarcoptic mange in any species of animal, if acquired from an animal of another species, is likely to run a short course and tend toward a spontaneous recovery. the treatment likely to be most efficacious is that of dipping in a crude-petroleum dip, one treatment as a rule being sufficient. if lime-sulphur dip is used, four or five successive treatments, or even more, at weekly intervals, may be necessary before a cure is effected. demodectic mange. demodectic mange, which is caused by a small parasite that lives in the hair follicles, causing pustules, especially on the neck and shoulders, occurs occasionally among cattle in this country and is of importance on account of the injury to the hide. when tanned, hides infested by this parasite are pitted, the pits, in some cases, being so deep that they form holes. no practicable treatment is known for this disease. ticks.[ ] about species of ticks have been reported as parasites of cattle in the united states. the most common and most important is the species known as _margaropus annulatus_, which transmits texas fever. information concerning this tick and texas fever has been given elsewhere in this volume (p. ). the spinose ear tick (_ornithodoros megnini_) is frequently found in the ears of cattle in the western part of the united states, and is of common occurrence also in the ears of horses, dogs, cats, etc. when its parasitic stage of development is completed the ear tick leaves its host. mating between the sexes occurs after the ticks have cast their skins following the abandonment of their host. they usually crawl up some distance from the ground and secrete themselves in cracks and crevices in trees, walls of buildings, etc., where the females deposit their eggs. after the eggs hatch, the larval ticks, which emerge from them, when they succeed in finding a host, enter the ears and gradually develop to the stage at which they are ready to leave the host animal. the females may live several months, or even years, if they do not find mates. after mating they may deposit their eggs intermittently. hatching of the eggs may occur as early as days after deposition. the larvæ may live for days without a host. the parasitic period has been observed to vary from about two to about seven months. _treatment._--on account of their habits and great vitality and their occurrence in various kinds of animals besides cattle, complete eradication is a difficult problem. the only effective treatment known is to introduce directly into the ear passages a remedy that will kill the ticks. later, of course, the cattle may become reinfested from exposure to infested ranges or inclosures. the following mixture, however, in addition to killing the ticks in the ears, will protect against reinfestation for about days: ordinary commercial pine tar, two parts; cottonseed oil, one part--in each case by volume. animals to be treated are confined in a chute, and the mixture is injected into the ears with a syringe, after the wax and other débris in the ears have been cleaned out with a wire probe that has an eyelet at one end. further information concerning ear ticks and the details of their treatment is given in farmers' bulletin . bloodsuckers or leeches. these worms are sometimes taken up by cattle when drinking from ponds. they may attach themselves to the inner surface of the mouth or nose, and sometimes reach the upper part of the windpipe or of the gullet. bleeding at the mouth or nose may be noticed, the membranes where the leech is attached are liable to be swollen and congested, and as a result of the loss of blood a condition of anemia may result. _treatment._--if the worm can be reached it may be destroyed by cutting it in two with a pair of scissors, or it may be removed with forceps or with the fingers after wrapping a towel around the hand so that the worm can be held without slipping. fumigation with tobacco or tar may cause the worm to release its hold if it can not be removed by other means. ponds may be rid of infestation with bloodsuckers by the introduction of eels. parasites of the stomach. the stomach of cattle consists of four compartments, of which the first and fourth are most likely to be the seat of parasitic infestation. the first stomach, or paunch, contains large numbers of minute parasites known as protozoa, which are too small to be seen with the naked eye. these small organisms apparently are in no way injurious. a species of fluke (_paramphistomum cervi_ or a closely related species) is occasionally found in north american cattle, especially grass-fed cattle, attached to the inner surface of the first stomach (fig. ). this worm is about one-half inch long, and somewhat conical in shape; hence the name, conical fluke, by which it is sometimes known. although this parasite has been accused of producing serious effects, it is generally considered harmless. several species of roundworms may occur in the fourth stomach. two of these are of special importance. [illustration: fig. .--portion of the wall of the first stomach with conical flukes attached.] the twisted stomach worm (hÆmonchus contortus). the twisted stomach worm (_hæmonchus contortus_, figs. , , ) is sometimes found in enormous numbers in the fourth stomach of cattle. sheep, goats, and other ruminants may also be infested with it. among the symptoms caused by this parasite may be mentioned anemia, loss of flesh, general weakness, dullness, capricious appetite, excessive thirst, and diarrhea. the anemic condition is seen in the paleness of the skin and mucous membranes of the mouth and eye, and in the watery swellings which often develop under the lower jaw ("poverty jaw"). if the fourth stomach of a dead animal is cut open and the contents carefully examined, the parasites, which are from / inch to - / inches in length and about as thick as an ordinary pin, may be seen, if present in any considerable number, actively wriggling about like little snakes. cattle become infected with these parasites by grazing on pastures on which infested cattle, sheep, or goats have grazed and scattered their droppings. the worms in the stomach produce a multitude of eggs (fig. _c_) of microscopic size, which pass out of the body in the feces. in warm weather these eggs hatch in a few hours. if the temperature is below ° f., they remain dormant, and if below freezing, they soon die. the eggs are also killed by dryness; moisture, on the other hand, favoring their development. the larvæ which hatch from the eggs are microscopic in size, and, like the eggs, are, at first and until they have developed to a certain stage, very susceptible to freezing and drying. in very warm weather the larvæ complete their development, so far as they are able to develop outside the body, in two or three days. in cooler weather the time required for this development is longer, and at temperatures below ° f. days to several weeks may be necessary. the larvæ are then ready to be taken into the body. the eggs and early stages of the larvæ apparently do not develop if swallowed, and only the completed larval stage seems to be infectious. in this stage the larvæ migrate up grass stalks (fig. ) or other objects, showing activity whenever the air is saturated with moisture; that is, during rains, fogs, and dews. when the air becomes dry and the moisture evaporates from the grass the young worms cease their activity, resuming their migrations when the air again becomes overladen with moisture. larvæ which have developed to the infectious stage, unlike the eggs and early larval stages, are able to survive long periods of freezing and dryness. in two weeks to a month after the embryos are swallowed they reach maturity and begin producing eggs. _preventive treatment._--preventive measures are important. as moisture favors the development of the embryos, high sloping ground is preferable for pastures. if low ground is used, it should be properly drained. the pasture should not be overstocked. burning over the pasture will destroy most of the young worms on the grass and on the ground, and this means of disinfection under certain circumstances may be very advantageously used. the herd should be changed to fresh pasture as often as possible. cattle should be supplied with water from wells, springs, or flowing streams, preferably in tanks or troughs raised above the ground. to a slight degree salt serves to protect cattle against infection with internal parasites, and plenty of it should therefore be kept accessible. affected animals should be isolated from the rest of the herd in hospital pens or pastures. a plentiful supply of nourishing feed is an important factor in enabling cattle to withstand the attacks of stomach worms and other intestinal parasites. the stabling of cattle, with the maintenance of clean and sanitary surroundings and liberal feeding, will often stop losses from internal parasites, even though no medicinal treatment is given. _medicinal treatment._--in dosing animals for stomach worms it is advisable to treat not only the animals which are seriously affected, but the rest of the herd as well, since the parasites with which they are infested will remain as a source of reinfection to the others. the cattle should be removed to fresh pasture after treatment, if possible. the animals to be treated should be deprived of feed for to , or even , hours before they are dosed, and if the bluestone treatment is used should receive no water on the day they are dosed until several hours after dosing. in drenching, a long-necked bottle or a drenching tube may be used. in case the former is used the dose to be given may be first measured off, poured into the bottle, and the point marked on the outside with a file, so that subsequent doses may be measured in the bottle itself. a simple form of drenching tube (fig. ) consists of a piece of rubber tubing about feet long and one-half inch in diameter, with an ordinary tin funnel inserted in one end and a piece of brass or iron tubing to inches long, of suitable diameter, inserted in the other end. in use the metal tube is placed in the animal's mouth between the back teeth, and the dose is poured into the funnel, which is either held by an assistant or fastened to a post. the flow of liquid through the tube is controlled by pinching the rubber tubing near the point of union with the metal tube. it is important not to raise the animal's head too high on account of the danger of the dose entering the lungs. the nose should not be raised higher than the level of the eyes. the animal may be dosed either standing on all fours or lying on the side. the position on all fours is preferred by some authorities, who believe that more of the remedy is likely to reach the fourth stomach when the animal is dosed standing than when dosed in other positions. great care should be used in dosing to prevent the entrance of the liquid into the lungs, and in the preparation and administration of the remedy to avoid getting the solution too strong or the dose too large. bluestone, or copper sulphate, has been extensively used in south africa in the treatment of sheep and cattle for stomach worms and is recommended by the colonial veterinary surgeon of the cape colony as the best and safest remedy. to prepare the solution take pound (avoirdupois) of pure bluestone, powder it fine, and dissolve in - / gallons of warm water. it is better first to dissolve the bluestone in or quarts of boiling water, then add the remaining quantity of cold water, and mix thoroughly. this solution may be given to cattle in the following-sized doses: calves - / to fluid ounces. yearlings fluid ounces. two-year-olds and over to fluid ounces. in making up the solution only clear blue crystals of bluestone should be used. bluestone with white patches or crusts should be rejected. it is especially important that the bluestone and water be accurately weighed and measured, and that the size of the dose be graduated according to the age of the animal. the special value of medicated salts advertised under various trade names as preventives against worms is problematical. commonly they contain little else than ordinary salt, the other substances being in such small quantity that their therapeutic effect is practically negligible. definite evidence that they are more efficacious than plain salt is not yet available and their use is not recommended. [illustration: fig. .--twisted stomach worms (_hæmonchus contortus_). outlines showing natural size of male (above) and female.] [illustration: fig. .--twisted stomach worms (_hæmonchus contortus_). male (_a_), female (_b_), and egg (_c_). enlarged.] [illustration: fig. .--larva of twisted stomach worm (_hæmonchus contortus_) coiled on tip of grass blade. enlarged.] [illustration: fig. .--a drenching tube made from an ordinary tin funnel, a piece of rubber hose, and a piece of brass pipe.] the encysted stomach worm (ostertagia ostertagi). this parasite is as thick as a fine hair and less than half an inch in length. it lives in small cysts in the wall of the fourth stomach (fig. ) and is also found free in the cavity of the stomach. when numerous, these parasites cause a thickening of the stomach wall and disturb its digestive functions. the symptoms caused by this parasite are very similar to those produced by the twisted stomach worm. the life history of the encysted stomach worm is not known in detail, but it is undoubtedly very much the same as that of the twisted stomach worm. the same measures as recommended above for preventing infection with the twisted stomach worm should be used. medicinal treatment would seem to be of little use, owing to the protected position in which the parasite occurs. [illustration: fig. .--piece of lining of fourth stomach, showing cysts of the encysted stomach worm (_ostertagia ostertagi_).] intestinal parasites. tapeworms. two species of tapeworms (fig. ) are known to occur in the small intestine of american cattle. they sometimes grow to a length of several yards and to a breadth of three-fourths of an inch. small portions of tapeworms, consisting of one or more segments, are occasionally seen in the droppings of infested cattle. the life history is not known, but the infectious stage is undoubtedly taken in with the feed or water, infection being spread by the eggs of the parasite contained in the feces of infested animals. the eggs are perhaps swallowed by some small creature (an insect, worm, or snail) which acts as an intermediate host, and which when accidentally swallowed by a cow while grazing or drinking carries with it into her stomach the infectious stage of the tapeworm. adult cattle do not seem to suffer much from infestation with tapeworms, but in calves these parasites may cause scouring and emaciation. _treatment._--medicinal treatment for tapeworms in cattle is usually unsatisfactory, but the bluestone treatment used for stomach worms and mentioned above (p. ) sometimes expels tapeworms. arsenic in doses of - / to grains has been claimed to give good results in the treatment of calves for tapeworms. from results obtained at the oklahoma experiment station in the treatment of tapeworms of sheep it would appear that the efficacy of the bluestone treatment against these parasites may be increased by the addition of tobacco. for use on cattle the bluestone and tobacco mixture may be prepared as follows: ounces of snuff or powdered tobacco is soaked over night in about gallons of water. to this decoction is added pound of copper sulphate which has been dissolved in or quarts of boiling water. sufficient water is then added to the mixture to make a total of - / gallons. the doses of this solution are the same as for the simple copper sulphate solution, described on page , namely: calves - / to fluid ounces. yearlings fluid ounces. two-year-olds and over to fluid ounces. [illustration: fig. .--a tapeworm (_moniezia planissima_) which infests cattle.] roundworms. a large roundworm (_ascaris vitulorum_) measuring to inches in length, sometimes found in the intestines of cattle, especially calves, may cause inflammation and occasionally rupture of the intestine. infection occurs through the swallowing of the eggs of the parasite in feed or water which has been contaminated with the feces of infested cattle. a number of species of small roundworms, varying in size from an eighth of an inch to an inch or more in length, occur in the intestines. of these may be mentioned the hookworm (_bunostomum phlebotomum_) and the nodular worm (_[oe]sophagostomum radiatum_). the former is about an inch long and is found in the small intestine. the latter is somewhat smaller and is found in the cecum and large intestine. hookworms, when numerous, may cause anemia and other symptoms similar to those caused by stomach worms (see p. ). the injury to the mucous lining of the intestine from the bites of hookworms may cause severe inflammation, and affords an avenue of infection with the germs of various diseases. the adult nodular worms apparently do not attack the wall of the intestine, but derive their nourishment from the intestinal contents. several species of small, very slender roundworms (_trichostrongylus_), less than a quarter of an inch in length, sometimes occur in the small intestine and fourth stomach, and a severe gastroenteritis, or inflammation of the stomach and intestines, has been attributed to them. one species of small roundworm (_cooperia punctata_) burrows in the wall of the small intestine and causes caseous nodules in the mucous lining. this parasite sometimes occurs in very large numbers in the intestines of cattle in certain sections of the country, and apparently does considerable damage. _nodular disease_ of the intestine, due to young nodular worms which burrow in the intestinal wall during a certain stage in their life history, sometimes apparently produces serious effects, particularly in young cattle, but commonly has little or no perceptible influence on the general health. it, however, often renders the intestine unfit for use as sausage casings, and as it is widely prevalent among cattle the loss from this source is considerable. the greenish or yellowish nodules with cheesy contents are frequently mistaken by the inexperienced for lesions of tuberculosis. the life histories of the various small roundworms occurring in the intestines of cattle, so far as they have been worked out, are very similar to that of the twisted stomach worm as described on page . _treatment for intestinal roundworms._--the preventive measures are similar to those recommended in the case of the twisted stomach worm (p. ). medical treatment is generally not very satisfactory. according to the oklahoma experiment station, the addition of per cent of tobacco to the bluestone solution used in the treatment of stomach worms in sheep is effective in the removal of hookworms. the bluestone and tobacco mixture described on page may be of value in the treatment of hookworms in cattle. it is asserted by one author that or drams of rectified empyreumatic oil in a mucilaginous emulsion, followed the next morning with a purgative of to - / pounds of sulphate of soda, will expel the large roundworms (_ascaris vitulorum_). protozoa. a number of species of protozoa have been reported as parasites of the intestines of cattle. to one species has been attributed a serious disease of cattle in switzerland known as red dysentery, but so far comparatively few cases of this disease have been recorded in america. it is probably more common than is generally supposed. calves particularly seem most likely to be affected. flukes in liver and lungs. two species of flukes occurring in the liver and lungs are known to affect cattle in the united states. these parasites are flat, leaf-like worms; one of them, the common liver fluke (_fasciola hepatica_, fig. ), is less than an inch in length, while the other, the large american fluke (_fasciola magna_, fig. ), is considerably larger when full grown. in their life history these flukes depend on snails as intermediate hosts. at a certain stage of development the young flukes leave the snails, become encysted on stalks of grass (fig. ), or fall into drinking water, and finally may be swallowed by cattle. stiles writes as follows: flukes may produce a serious, often fatal, disease, more especially in younger animals. the symptoms are somewhat similar to those produced by worms in the stomach. the first symptoms are generally overlooked, the disease not attracting attention until the appetite is diminished; rumination becomes irregular, the animals become hidebound, and the coat dull and staring. the staring coat is due to the contraction of the muscles of the hair follicles. the visible mucous membranes become pale, eyes become dull, there is running at the eyes, and the animal gradually becomes emaciated. as the disease advances the milk supply is lessened, fever appears, there is generally great thirst, but the appetite almost ceases; edematous swellings appear on the belly, breast, etc.; diarrhea at first alternates with constipation, but finally becomes continuous. the disease lasts from two to five months, when the most extreme cases succumb. most of the german cattle are said to be infested with liver flukes, but even when a large number are present the nourishment of the cattle is not disturbed. thickening of the gall ducts, so that a so-called "medusa's head" forms on the surface of the liver toward the stomach, appears in even well-nourished animals; even in cases of a cirrhosis of the liver it is seldom that any effect upon the cattle's health can be noticed, and so long as a portion of the liver tissue about twice the size of the fist remains intact, the nourishment of the animal may be comparatively good. it is rare that one sees a generalized edema in slaughtered cattle as a result of fluke invasion, and even in the heaviest infections of young cattle only emaciation is noticed. _treatment._--medicinal treatment is unsatisfactory. the disease may be prevented to a considerable extent by giving animals plenty of salt, and by introducing carp, frogs, and toads into infected districts; these animals destroy the young stages of the parasite and feed upon the snails which serve as intermediate hosts. the drainage of wet pastures and the avoidance of swampy lands for grazing purposes are important measures in the prevention of fluke diseases. railliet and others have recently recommended the application of lime to fluky pastures, having discovered that very weak solutions are destructive not only to fluke embryos but to snails. this application is to be made during the summer months at the rate of about to , pounds of lime per acre. the same authors also recommend extract of male fern for the treatment of fluke disease. moussu states that the average dose for cattle is gram of the extract for each kilograms of live weight; that is, grams for a young animal weighing kilograms (about pounds) up to grams as a maximum for large animals weighing kilograms (about , pounds) or more. the extract is mixed with about times as much non-purgative oil and the dose is administered each morning for five consecutive days two hours before the animal is allowed to feed after having been fasted over night. the extract of male fern used should have a guaranteed strength of to per cent of filicine and . per cent of filicic acid. [illustration: fig. .--the common liver fluke (_fasciola hepatica_).] [illustration: fig. .--the large american fluke (_fasciola magna_).] [illustration: fig. .--portion of grass stalk bearing three encysted cercariæ of the common liver fluke (_fasciola hepatica_). enlarged.] tapeworm cysts of liver and other viscera. three kinds of tapeworm cysts are found in the viscera of cattle. one of these (_multiceps multiceps_, or _c[oe]nurus cerebralis_) will be further referred to in the discussion of gid (p. ). all these are the intermediate stages of tapeworms, which live when mature in the intestines of dogs, wolves, and other canines. the eggs of the tapeworms are scattered over the fields in the droppings of infested dogs or wolves, and when swallowed in food or water by cattle hatch out and the embryos migrate to the liver, mesentery, lungs, brain, or other organs, where they develop into cysts, variously known as hydatids, bladder worms, water balls, etc. when organs of cattle thus infested are eaten by dogs or wolves the cystic worms are also liable to be swallowed and then develop into mature tapeworms. to prevent cattle from infection with these parasites stray dogs, wolves, and coyotes should be killed wherever found, and dogs too valuable to kill should be kept free from tapeworms. as a precaution against infection with tapeworms, the viscera of cattle, sheep, or hogs should not be fed to dogs unless cooked. hydatids (_echinococcus granulosus_) form tumors (fig. ) of varying size (sometimes as large as inches in diameter) in the liver, lungs, and other organs. their contents are liquid, resembling water. the presence of these parasites can not be detected in the living animal and there is no medicinal treatment for them. organs containing hydatids should be destroyed by burning in order to prevent their being eaten by dogs. this is especially important, as dogs infested with the tapeworm stage of this parasite are a menace to human beings on account of the danger of infecting them with hydatids, which develop in man if the eggs of the hydatid tapeworm are swallowed. thin-necked bladder worms (_tænia hydatigena_, fig. ) are most commonly found attached to the mesentery and omentum. there is no medicinal treatment. gid.--bladder worms (_multiceps multiceps_, or _c[oe]nurus cerebralis_), which are occasionally found in the brain of cattle and cause gid, "turnsick," or "staggers," deserve mention, as they are rather common among sheep in the northwest. as already alluded to, these worms are the intermediate stage of a tapeworm found in dogs, and their life history and the means of preventing infection have been briefly discussed above (see p. ). cattle harboring this parasite show symptoms indicating an affection of the brain, walking or turning in circles, dizziness, uneven gait, impaired vision, etc. treatment consists in trephining the skull and removing the parasite, an operation which requires a skillful operator and is frequently unsuccessful. unless the parasite is removed affected cattle almost invariably die. [illustration: fig. .--hydatids (_echinococcus granulosus_) in portion of hog's liver.] [illustration: fig. .--thin-necked bladder worm (tænia hydatigena) from abdominal cavity of a steer.] tapeworm cysts in the muscles, beef measles.[ ] small tapeworm cysts (_tænia saginatæ_), about the size of a pea, found in the muscles of cattle are the larvæ of the common tapeworm of man. cattle become infected from feed or water which has been contaminated by the feces of persons harboring the adult tapeworms, and human beings in turn become infected by eating raw or rare beef infested with the larval stage (measly beef). to prevent cattle from becoming infested with this parasite care should be taken that human feces are not placed where they will contaminate the feed or drinking water. this parasite is very common in cattle in the united states, at least per cent being infested. as a result considerable loss is entailed through condemnations of beef carcasses by meat inspectors, because of the presence of tapeworm cysts. all this loss could be avoided and the danger of tapeworm infestation in human beings from this source could be removed by the observance of proper precautions in disposing of human excreta. at the same time much sickness and many deaths from diseases (hookworm, typhoid fever, etc.) caused by soil pollution would be prevented, and farm life would be rendered much safer than under the poor sanitary conditions which are responsible for the high percentage of tapeworm cysts among cattle in the united states. thread worms in the abdominal cavity. thread worms (_setaria labiato-papillosa_) to inches long are frequently found in the abdominal cavity. they seem to cause little or no trouble. the embryos produced by these worms enter the blood vessels. according to noé, they are spread from one animal to another by stable flies (see p. ), but this has not been definitely proved. the roundworms found occasionally in the anterior chamber of the eye (see p. ) are perhaps immature forms of this species which have reached this location during their migration. lung worms. lung worms (_dictyocaulus viviparus_, fig. ) in cattle are thread-like worms to inches long, found in the bronchial tubes and producing a condition known as verminous bronchitis. the life history of the parasite is not fully known, but infection is evidently derived through the medium of pastures where infested cattle have grazed. in the later stages of the disease the cattle cough, especially at night. young cattle are more seriously affected than old animals. _treatment for lung worms._--various treatments have been advocated for lung worms, including fumigating with different substances and injections of remedies into the trachea by means of a large hypodermic syringe or by a special spraying apparatus, but none have been very successful from a practical standpoint. about all that can be done is to feed affected animals well and protect them from exposure, removing them from the pasture and keeping them in dry yards or stables maintained in a cleanly, sanitary condition. the methods of prevention in general are similar to those described under the discussion of the twisted stomach worm (p. ). [illustration: fig. .--lung worm (_dictyocaulus viviparus_) of cattle. outlines showing natural size of male (above) and female.] parasites of the blood. certain flukes (_schistosoma bovis_ and related species) which live in the blood vessels (the large veins) of cattle in tropical and sub-tropical countries cause bloody urine and diarrhea, the feces being mixed with blood. these parasites have not yet been discovered in the united states, although the natural conditions are such in some parts of the country that they are liable to become established if introduced. the embryos of _setaria labiato-papillosa_ (p. ) which occur in the blood may be found by microscopical examination. they apparently cause no trouble. the organism which causes texas fever is a protozoan parasite (_piroplasma bigeminum_) of microscopic size, which lives in the blood and attacks the red blood corpuscles. for a discussion of this parasite and the disease which it produces see page of this volume. other parasites which live in the blood cause serious diseases known as surra and nagana (p. ), but as yet neither of these diseases has gained a foothold in the united states. parasites of the eye. small roundworms, one-third to four-fifths of an inch in length, may occur in the ducts of the lacrimal glands. several species all belonging to the same genus (_thelazia_) are known. they sometimes escape from their usual location and may be found on the surface of the eyeball beneath the lids, or even in the eyeball. it has been supposed by some writers that the worms seen in the interior of the eyeball ("snakes in the eye") are immature stages of _setaria labiato-papilosa_ (see p. ) which have gone astray from the normal course of their migration, but the correctness of this supposition is uncertain. worms in the eyes and lacrimal ducts may cause inflammation, in which case the eyes may be syringed with an antiseptic, such as a weak solution of coal-tar stock dip, and iodoform ointment applied if the condition is severe. when worms are present in the eyeball itself, their removal depends upon surgical treatment, usually not advisable, as the worms in that location either cause but little trouble or disappear without treatment. footnotes: [ ] further information may be found in a very full report on "insects affecting domestic animals," issued as bulletin , new series, of the bureau of entomology of this department. [ ] further information on fly repellents may be found in bulletin of the department of agriculture. [ ] for further information consult farmers' bulletin . [ ] for further information consult circular of the bureau of entomology. [ ] for further information consult farmers' bulletin . [ ] for further information see farmers' bulletin . [ ] for a fuller discussion see farmers' bulletin , issued by the u.s. department of agriculture. [ ] for a more complete discussion consult farmers' bulletin , bulletins and of the bureau of animal industry, and bulletins (technical series), , and of the bureau of entomology, all issued by the united states department of agriculture. [ ] for further information consult bureau of animal industry circular . mycotic stomatitis of cattle. by john r. mohler, v. m. d., _chief, bureau of animal industry._ introduction. numerous letters have been received by this bureau in recent years relative to the existence of a disease affecting the mouths and feet of cattle in certain eastern and central western states. later reports indicate that the malady has made its appearance in the southwest, where it has caused much alarm among the stockmen owing to its similarity to the foot-and-mouth disease of europe. the disease, which is to be discussed under the name of mycotic stomatitis, has been carefully investigated by this department on various occasions, and it is with the view of giving the results of these clinical investigations as well as to assert its noninfectiousness and to differentiate it from the virulent foot-and-mouth disease, which it so closely simulates, that this article is prepared. name and synonyms. the name stomatitis signifies that there is present in the affected animals an inflammation of the mucous membrane of the mouth. this inflammation, which quickly develops into ulcers, is one of the principal and most frequently observed lesions. mycotic stomatitis refers to that form of stomatitis which results from eating food containing irritant fungi. thus the name not only suggests the cause of the disease, but also indicates the location of the earliest and most prominent symptoms. other names which have been applied to this disease by different writers are sporadic aphthæ; aphthous stomatitis; sore mouth of cattle; sore tongue; benign, simple, or noninfectious foot-and-mouth disease; mycotic aphthous stomatitis; and sporadic stomatitis aphthosa. character of the disease. mycotic stomatitis is a sporadic, or noninfectious, disease which affects cattle of all ages that are on pasture, but more especially milch cows. it is characterized by inflammation and ulceration of the mucous membrane of the mouth, producing salivation and inappetence, and secondarily affecting the feet, which become sore and swollen. superficial erosions of the skin, particularly of the muzzle and of the teats and udders of cows, may also be present, with some elevation of temperature and emaciation. cause. this disease, as its name indicates, results from the eating of forage containing fungi or molds. it is probable that more than one fungus is involved in the production of this disease, but no particular species has been definitely proved to be the causative factor. several attempts have been made by the writer to determine the exact cause and also to transmit the disease to other animals by direct inoculation, but with negative results. suspicion, however, has been directed by various observers to the uromyces and the red and black rusts that occur on clovers. these fungi cause very severe irritation of the lining membrane of the mouth, producing sometimes a catarrhal, at other times an aphthous, and occasionally an ulcerous stomatitis. the fungus of rape, etc. (_polydesmus excitiosus_), is very irritating to the mouths and feet of cattle, causing severe inflammation and in some instances producing symptoms that have been mistaken for foot-and-mouth disease. the fungi (penicillium and puccinia) found on grasses have also been credited with the production of stomatitis. the fact that this disease disappears from a locality at a certain time and reappears at irregular intervals would suggest the probability that certain climatic conditions were essential for the propagation of the causative fungi, since it is well known that the malady becomes prevalent after a hot, dry period has been followed by rain, thus furnishing the requirements necessary for the luxuriant development of molds and fungi. owing to this fact the disease is observed in one locality during one season and in an entirely different section another year, but reappears in the former center when favorable conditions prevail. in this way the affection has occurred at irregular intervals in certain sections of both the united states and canada. symptoms and lesions. among the first symptoms observed in mycotic stomatitis are inability to eat, suspension of rumination, frequent movements of the lips with the formation of froth on their margins, and in some cases a dribbling of saliva from the mouth. there is a desire to eat, and frequent attempts to take food are made, but prehension is very difficult. if, however, feed is placed on the back of the tongue, it is readily masticated and swallowed. if the mouth is examined at this time, it will be found red and hot, and exceptionally small blisters will be seen, which, however, quickly become eroded and develop into active ulcers varying in size from one-eighth to inch in diameter. where several ulcers have coalesced a large and irregularly indented patch is formed. these erosions are most frequently found on the gums around the incisor teeth, on the dental pad, inside the lips, and on the tip of the tongue, but they also occur on the cheeks, interdental space, and dorsum of the tongue. the ulcers have a hemorrhagic border, a depressed suppurating surface, and contain a brownish or yellowish colored débris, which is soon replaced by granulation tissue. as a result of this sloughing of the tissues and the retention of food in the mouth, a very offensive odor is exhaled. the muzzle becomes dry and parched in appearance, which condition is shortly followed by erosions and exfoliations of the superficial layer of the skin. adherent brownish crusts and scabs form over the parts, and similar lesions are seen around the nostrils and external surface of the lips. in some cases there are associated with these alterations a slight swelling and painfulness in the region of the pasterns, at times affecting the forefeet, at other times the hind feet, and occasionally all four feet. in a few cases the swelling may extend above the fetlock, but it has never been observed above the knee or hock. the skin around the coronet may occasionally become fissured and the thin skin in the cleft of the foot eroded and suppurated, but without the formation of vesicles. as a result of these feet lesions, the affected animal may assume a position with its back arched and the limbs propped under the body as in a case of founder, and will manifest much pain and lameness in walking. if it lies down, the animal shows reluctance in getting up, and although manifesting no inclination to move about, when forced to do so there is more or less stiffness and a tendency to kick or shake the foot as if to dislodge a foreign body from between the claws. in some outbreaks the milch cows have slight superficial erosions on the teats which at times extend to the udder. the cracks in the skin are filled with serum and form brownish-colored scabs. the teats become tender and the milk secretion diminishes; in some cases it disappears. a similar tendency toward the formation of fissures and scabs on the skin of the neck and shoulders has manifested itself in a recent outbreak in texas, and this feature was likewise noticeable in the disease when it occurred in maryland and virginia in . in mild cases only the mouth lesions may be observed, or these alterations may be associated with one or more of the other above-described symptoms, but in severe cases, where there is a generalized mycotic intoxication, one animal may show all these alterations. when the disease is well developed the general appearance of the animal is one of great lassitude, and it either stands off by itself with hind feet drawn under the body and its forefeet extended, or it assumes a recumbent position. owing to the inability to eat and to the general systemic disturbance present, the animal loses flesh very rapidly and becomes greatly emaciated in the latter stages of the disease. the temperature and pulse are somewhat increased, the former or degrees, the latter to from to beats per minute. the fever is not lasting, and these symptoms are soon modified. the animal has an anxious look, and in a few cases there is a gastrointestinal irritation, the feces being thin, of a dark color, and of an offensive odor. prognosis and mortality. mycotic stomatitis is not a serious disease, and in uncomplicated cases recoveries soon follow the removal of the cause and the application of the indicated remedies. in such cases complete restoration may take place within one week. in mild outbreaks a large percentage of the animals will recover without treatment, but that the disease is fatal is shown by the fact that animals which develop an aggravated form of the affection succumb if not treated. in such animals death occurs in or days, but the mortality in the serious outbreaks thus far investigated has been less than . per cent. the course of this disease is irregular and runs from to days, the average case covering a period of about days. differential diagnosis. foot-and-mouth disease. in examining a case of mycotic stomatitis it is important not to mistake it for foot-and-mouth disease, which has appeared in this country on six occasions only. this may be easily accomplished by taking into consideration the fact that in the contagious foot-and-mouth disease there is a rapid infection of the entire herd, as well as of any hogs and sheep that may be on the premises. it is also readily transmitted to neighboring herds by the spread of the infection from diseased animals, but it never occurs spontaneously. the characteristic lesion of foot-and-mouth disease is the appearance of vesicles containing serous fluid in the mouth and upon the udder, teats, heels, and coronary bands of the affected animals. drooling is profuse, and there is a peculiar smacking sound made by sucking the affected lips. mycotic stomatitis occurs sporadically on widely separated farms, affecting only a few animals in each herd, and the lesions produced consist of erosions without the typical vesicular formations of foot-and-mouth disease. the failure of the vesicles, if any appear, to spread extensively in the mouth, the absence of these blisters on other portions of the body-- notably the teats and udder, and characteristically the feet--together with the absence of infection in the herd, and the inability to transmit the disease to calves by inoculation, distinguish between this affection and foot-and-mouth disease. the erosions of the mouth are not so extensive and they heal more rapidly in mycotic stomatitis. the swelling of the feet and stiffness of the animal are also more marked in mycotic stomatitis. ergotism. the lesions resulting from ergotism may be differentiated from those of mycotic stomatitis by the lack of ulcerative eruptions in the mouth and by the location of the lesions at the tips of the ears, end of the tail, or upon the lower part of the legs, usually below the knees or hocks. the lesions of ergotism do not take the form of ulcers or festers, but the end of the limb affected is diseased "in toto" and the eruption extends entirely around the limbs, followed soon afterwards by a distinct line of demarcation between the healthy skin above and the diseased below. the absence of suppurating sores between the claws and on the mucous membrane of the mouth, the knowledge that the lesion upon the limb in question extends uninterruptedly around it, and the presence of ergotized seeds in the hay or grain fed the animals should point conclusively to a diagnosis of ergotism. foul foot. in foul foot, or ground itch, of cattle, the inflammation of the skin and toes usually affects but one foot. it begins as a superficial inflammation followed by sloughing, ulceration, and the formation of fistulous tracts which may involve the tendons, bones, and joints. the mouth remains unaffected, and the presence of the disease may be traced to filth and poor drainage. necrotic stomatitis. in necrotic stomatitis (calf diphtheria) there is a formation of yellowish cheesy patches in the mouth without any lesions of the feet or udder. it affects sucking calves chiefly, and is caused by the _bacillus necrophorus._ treatment. the treatment of mycotic stomatitis should consist in first removing the herd of cattle from the pasture in which they have been running. the affected animals should, if it is possible, be brought to the barn or corral and fed on soft, nutritious food, such as bran mashes, ground feed, and gruels. a bucket of clear, cool water should be kept constantly in the manger, so that the animal may drink or rinse the mouth at its pleasure; and it will be found beneficial to dissolve heaping tablespoonfuls of borax or tablespoonful of potassium chlorate in each of the first two buckets of water taken during the day. if the animals are gentle enough to be handled, the mouth should be swabbed out daily with antiseptic washes, such as a per cent solution of carbolic acid or a per cent solution of compound solution of cresol or of permanganate of potassium, or part of hydrogen peroxid to parts of water. this should be followed by astringents, such as one-half tablespoonful of alum, borax, or chlorate of potassium placed on the tongue. probably a more satisfactory method of administering the antiseptic treatment to a large number of animals would be to mix thoroughly teaspoonfuls of pure carbolic acid every morning in a quart of bran mash and give to each affected animal for a period of five days. range cattle may be more readily treated by the use of medicated salt placed in troughs accessible to the animals. this salt may be prepared by pouring ounces of crude carbolic acid upon quarts of ordinary barrel salt, after which they are thoroughly mixed. the lesions of the feet should be treated with a per cent solution of carbolic acid, while the fissures and other lesions of the skin will be benefited by the application of carbolized vaseline or zinc ointment. if the animals are treated in this manner and carefully fed, the disease will rapidly disappear. index. abdomen-- dropsy affecting, causes, symptoms, and treatment, inflammation, causes, symptoms, and treatment, of calf, dropsy, description, and treatment, wounds, causes, symptoms, and treatment, abdominal cavity, kinds of parasites affecting, abortion-- contagious-- description and causes, treatment and prevention, noncontagious-- causes, treatment, abscess-- bacteria causing, ear treatment, lung, description, navel, cause and treatment, orbital and periorbital, symptoms and treatment, abscesses-- danger in castration of cattle, treatment, absorbents, description, _achorion schonleinii_, fungus causing _tinea favosa_, acids-- mineral, poisoning, description and treatment, poisoning, description and treatment, vegetable, poisonous, description and treatment, aconite poisoning, description and treatment, actinomycosis-- description and symptoms, - jawbone, description and treatment, lungs, prevention and treatment, - relation to public health, adenoma, description, administration of medicines, chapter by leonard pearson, - afterbirth, retention, causes, symptoms, and treatment, air tubes, lung, parasites affecting, description and treatment, air under the skin, description, symptoms, and treatment, albumin, urine, description and treatment, albuminuria, description and treatment, alkalies, poisoning, description and treatment, amaurosis, causes, symptoms, and treatment, anaphrodisia, cause, prevention, and treatment, anasarca of the skin, causes, symptoms, and treatment, anesthesia, uses in operations, aneurism, description, angioma tumor, description, animal industry bureau, experiments against hemorrhagic septicemia, animal parasites of cattle, chapter by b. h. ranson, - animal products, poisonous, description and treatment, anthrax-- cause, symptoms, treatment, etc., - human, description, serum, relation to blackleg, symptomatic, description, cause, treatment, etc., - treatment by use of serum, aphtha, calf, description and treatment, aphtha parasite (_saccharomyces albicans_), cause, aphthous fever. _see_ foot-and-mouth disease. aphthous stomatitis, reference, apoplexy-- cerebral, description and treatment, parturient, description, symptoms, and treatment, appetite-- depraved, description, causes and treatment, loss, symptom of foot-and-mouth disease, aqueous humor of eye, description, argentina, foot-and-mouth disease, arsenic poisoning, description, symptoms, and treatment, arsenical dips-- for destroying cattle ticks, use against screw worms, arsenical vapor, danger of inhalation in making cattle dip, arteries-- and veins, wounds, description and treatment, obstruction, description and treatment, _ascaris vitulorum_, intestinal roundworm, description and treatment, ascites-- causes, symptoms, and treatment, description and treatment, asepsis in surgical operations, aseptic periostitis, description and treatment, asphyxia electrica, symptoms and treatment, atkinson, v. t.-- chapter on "bones: diseases and accidents", - chapter on "poison and poisoning", - atrophy, description, auscultation, definition, austria-hungary, foot-and-mouth disease, _bacillus_-- _cyanogenes_, causing blue milk, _tuberculosis_, (_mycobacterium tuberculosis_, new terminology) causing tuberculosis, back, sprain, causes and treatment, bacteria-- causing abscess, definition, _bacterium bovisepticum_, causing hemorrhagic septicemia, balkan countries, foot-and-mouth disease, ball-- eye, description, hair, in stomach, description, balls, use in administering medicines, bee stings, description and treatment, beef measles, discussion and management, belgium, foot-and-mouth disease, benign tumors, description, big jaw. _see_ actinomycosis. black quarter. _see_ blackleg. blackleg-- description, cause and treatment, , serum, relation to anthrax, vaccine, note on distribution by animal industry bureau, bladder-- eversion, description, and treatment, or rectum, full, as obstruction to parturition, palsy of neck, cause and treatment, paralysis, causes and treatment, rupture, symptoms, spasms, description and treatment, stone, symptoms and treatment, bladder worms-- affecting brain, description and treatment, thin-necked, description and treatment, bleeding-- description and treatment, lungs, description and treatment, navel, cause and treatment, nose, cause and treatment, womb, description, symptoms, and treatment, blisters, water, symptoms and treatment, bloating, causes, symptoms, and treatment, blood-- clots on walls of vagina, description and treatment, coagulated, under vaginal walls after calving, treatment, description and influence of food on, flukes (_schistosoma bovis_), note, parasites affecting, different kinds, protozoa affecting, - vessels-- functions, heart, lymphatics, diseases, chapter by w. h. harbaugh, - bloodsuckers affecting cattle, description and treatment, bloody milk, cause and treatment, bloody urine-- caused by blood flukes, description, symptoms, and treatment, blue disease, cause, blue lice (_hæmatopinus eurysternus_ and _h. vitali_), description, blue milk, cause and treatment, boils, causes, symptoms, and treatment, bones-- broken, description of kinds and treatment, - diseases and accidents, chapter by v. t. atkinson, - dislocations, description and treatment, face, fracture, description, and treatment, luxations, description and treatment, manner of nourishment, number and description, shape, classes, bony tumor, description and treatment, _boophilus annulatus_, texas fever tick. _see margaropus annulatus._ bots affecting cattle, description and treatment, bovine tuberculosis and the public health, bowel hernia, description and treatment, bowels-- diseases affecting, causes, symptoms, and treatment, - obstruction resulting from invagination, symptoms and treatment, twisting and knotting, symptoms, post-mortem appearance, and treatment, brain-- and its membranes, inflammation, causes, symptoms, and treatment, bladder worms affecting, treatment, _c[oe]nurus cerebralis_ _(multiceps multiceps)_ affecting, treatment, concussion, cause, symptoms, and treatment, congestion, description and treatment, description, tumors, description, brazil, foot-and-mouth disease, breach-- navel, symptoms and treatment, uterus, cause and treatment, breathing, suspended in young calves, discussion, bronchial tubes, parasites affecting, bronchitis-- description, symptoms, and treatment, verminous-- description, symptoms, treatment, and prevention, parasite (_strongylus micrurus_), cause, brush, report of foot-and-mouth disease in man, buffalo gnats, description and remedy, bull, ringing, method, bulls, susceptibility to sarcoptic mange, burns and scalds, causes and treatment, calculi-- classification, forms in different situations, in prepuce or sheath, treatment, renal, description and treatment, urethral, description and treatment, urinary-- classification, description and causes, effect of different feeds, calculus-- blocking teats, treatment, prevention, vesical or urethral, symptoms and treatment, calf-- attention necessary at birth, diphtheria, description, symptoms, and treatment, - dropsy-- general, cause and treatment, of abdomen, description and treatment, monstrosities, descriptions, causes, and treatment, - muscles, rigid contraction, cause and treatment, slinking, description, swelling, caused by gas, treatment, tumors affecting, description and treatment, calves-- congenital imperfections, kinds, indigestion affecting, causes, symptoms, and treatment, newborn, acute scouring, description, prevention and treatment, pyemic and septicemic inflammation, symptoms and treatment, young-- aphtha, or thrush, affecting, description and treatment, constipation affecting, cause and treatment, diseases affecting, chapter by james law, - rickets affecting, description and treatment, ulcers in mouth, causes, symptoms, and treatment, calving-- dropping and palsy following, description and treatment, retarded by nervousness, symptoms, canada, source of foot-and-mouth infection, cancer, description and treatment, capsule, eye, description, capsules, use in administering medicines, carbolic-acid poisoning, description and treatment, carbon dioxid, formation in preparing cattle dip, carbuncle, description, carcinoma, description and treatment, caries, teeth, description, carpus, fracture, description and treatment, cartilage, ear, necrosis affecting, caruncula lacrimalis of eye, description, casein concretions blocking teats, cause and treatment, casting the withers, cause and treatment, castration-- dangers and care, - of female, description of operation, of male, description of operation, cataract, causes, symptoms, and treatment, catarrh-- description, symptoms, and treatment, , gastrointestinal, causes, symptoms, and treatment, , malignant, description, symptoms, and treatment, - nasal, description, symptoms, and treatment, catarrhal fever, infectious, description, symptoms, and treatment, - cats, ear ticks on, note, cattle-- animal parasites affecting, chapter by b. h. ransom, - dip, preparation and use, - dose of vaccine against anthrax, drenching, care of lungs, farcy, description and treatment, infected with anthrax, description, infection with sarcoptic mange, infectious diseases, chapter by john r. mohler, - infestation with tapeworm, injury by use of petroleum against ticks, loss of blood by inoculations, limits of safety, northern, immunization against texas fever, manner, parasitic diseases, prevention, plague. _see_ rinderpest. protection from flies, formulas for mixtures, - rabies affecting, description, symptoms, etc, - southern, injury by ticks, tick, _margaropus annulatus_, as carrier of texas fever, ticks-- injurious effects of and losses caused by, - methods of ridding cattle of, - tumors affecting, chapter by john r. mohler, - cerebral apoplexy, description and treatment, cerebrospinal division, description, chapped teats, cause and treatment, charbon. _see_ anthrax. chest, dropsy affecting, description and treatment, children, infection with foot-and-mouth disease, china, foot-and-mouth disease, choking, symptoms and treatment, chorioptic mange, location and treatment, choroid coat of the eye, description, chrondroma tumor, description and treatment, chronic tympanites, cause and treatment, coal-oil poisoning, description and treatment, _c[oe]nurus cerebralis_ (_multiceps multiceps_) affecting brain, treatment, coital exanthema, description, symptoms, and treatment, cold in the head, description, symptoms, and treatment, colic, causes, symptoms, and treatment, concussion of the brain, cause, symptoms, and treatment, congenital imperfections in calves, kinds, congestion-- and inflammation of testicles, description and treatment, brain, description and treatment, liver, description, symptoms, and treatment, spinal cord, description, symptoms, and treatment, bladder, description and treatment, conjunctivitis-- causes, symptoms, and treatment, infectious catarrhal, symptoms, treatment and prevention, connecticut, foot-and-mouth disease, constipation-- cause and treatment, young calves, cause and treatment, contagious-- abortion-- causes, - prevention and treatment, diseases, disinfection of premises, inflammation of the udder, description, prevention, and treatment, mammitis, description, prevention, and treatment, pleuropneumonia-- cause, incubation, and symptoms, definition and history, post-mortem appearance, prevention and treatment, scouring, acute, in newborn calves, description, prevention, and treatment, contused or lacerated wounds, description and treatment, contusion of lips, wounds, and snake bites of mouth, symptoms and treatment, copper poisoning, description and treatment, cornea-- eye, description, ulcers, cause, symptoms, and treatment, corneal dermatoma, description and treatment, corneitis, causes, symptoms, and treatment, cough, examination, cow, pregnant, hygiene, cowpox, description, symptoms, and treatment, , cows, milk, protection from flies, cramps of hind limbs during pregnancy, cause, cranium, fracture, description and treatment, creeps, description, symptoms, and treatment, cresol-- compound solution, composition and use, use in foot-and-mouth disease, croupous enteritis, description, symptoms, and treatment, crude petroleum-- danger to cattle in use against ticks, dip for destroying cattle ticks, cud, loss, description, cuts, barbed-wire, description and treatment, cyanosis, cause, , cysts-- dental, description and treatment, dermoid-- and sebaceous, description and treatment, description and treatment, description, extravasation, description, mucous, description and treatment, parasitic, description, proliferation, description and treatment, serous, description and treatment, dairy business, injury by foot-and-mouth disease, dandruff, causes, symptoms, and treatment, deformities, hoof, causes and treatment, dehorning, description, delaware, foot-and-mouth disease, demodectic mange, description and treatment, denmark, foot-and-mouth disease, dental cysts, description and treatment, dermis, description, dermoid cysts, description and treatment, , diabetes-- insipidus, cause and treatment, mellitus, description, diarrhea-- and dysentery, causes, symptoms, and treatment, calf, causes, symptoms, and treatment, causes, symptoms, prevention, and treatment, - _see also_ gastrointestinal catarrh. dickson, william, and william h. lowe, chapter on "surgical operations", - digestive organs, diseases affecting, chapter by a. j. murray, - dilatation and hypertrophy of heart, description, diphtheria, calf, description, cause, treatment, etc, - dipping-- bath, cattle, temperature, remedy for screw worms, dips-- arsenical, protection of hands in use, cattle, for ticks, - mange and scab, , disinfection, house, methods, dislocation, eyeball, treatment, dislocations, bones, description and treatment, diuresis, causes and treatment, dogs, ear tick, drainage, usefulness in prevention of fluke diseases, drenching tube, use in eradicating worms, dropping, following calving, description and treatment, dropsy-- abdomen, causes, symptoms, and treatment, abdomen of calf, description and treatment, chest, description and treatment, general, of calf, cause and treatment, hind limbs and between thighs, during pregnancy, cause, membranes of fetus, description and treatment navel, description and treatment, womb, description and treatment, dysentery-- and diarrhea, causes, symptoms, and treatment, chronic bacterial, description, treatment, etc, red, note, _see also_ gastrointestinal catarrh. dyspepsia, causes, symptoms, and treatment, ear tick, spinose, presence in cattle, horses, dogs, etc, ears-- abscess affecting, treatment, cartilage, necrosis affecting, diseases affecting, chapter by m. r. trumbower, - enchondroma, description and treatment, foreign bodies lodging in, symptoms and treatment, frostbite, symptoms and treatment, fungoid growths, cause and treatment, internal inflammation, symptoms and treatment, lacerations, cause and treatment, scurvy, cause and treatment, ticks affecting, treatment, _echinococcus granulosus_, hydatid, description, ectropion of the eyelid, description and treatment, eczema-- description, causes, symptoms, and treatment, epizootic, reference, edema-- causes, symptoms, and treatment, malignant, description, symptoms, and treatment, - elephantiasis, description, emaciation, symptom of foot-and-mouth disease, emphysema, description and treatment, , enchondroma, ear, description and treatment, encysted stomach worm, description and treatment, endocarditis, description and treatment, enemata, uses and methods, enteritis-- causes, symptoms, post-mortem appearance, and treatment, croupous, description, symptoms, and treatment, simple. _see_ gastroenteritis. entropion, eyelid, description and treatment, epidermis, description, epilepsy, description, cause, and treatment, epistaxis, cause and treatment, epizootic aphtha, reference, ergotism-- and mycotic stomatitis, differentiation, description and treatment, eruption, vesicular, of genital organs, description, symptoms, and treatment, erythema, description, causes, and treatment, eversion-- bladder, description and treatment, eyelid, description and treatment, womb, cause and treatment, extra-uterine gestation, description and treatment, extravasation cysts, description, eye-- and its appendages, diseases affecting, chapter by m. r. trumbower, - aqueous humor, description, capsule, description, caruncula, lacrimalis affecting, choroid coat, description, cornea-- description, ulcers affecting, cause, symptoms, and treatment, description, foreign bodies penetrating, treatment, lens, description, muscles, description, parasites affecting, treatment, , puncta lacrimalia, description, retina, description, roundworms affecting, treatment, sclerotic membrane, description, vitreous humor, description, eyeball-- description, dislocation, cause and treatment, hairy tumor affecting, description and treatment, eyelashes, inversion, treatment, eyelids-- description, ectropion affecting, description and treatment, entropion, description and treatment, eversion, description and treatment, inversion, description and treatment, laceration, cause and treatment, tumors affecting, description and treatment, face bones, fracture, description and treatment, farcy, cattle, description and treatment, _fasciola hepatica_, description, _fasciola magna_, description, fatty degeneration, heart, description, feed, character, analyses, effect on milk, - feeding-- character, effect on digestive organs, value as remedy for stomach worms, - "feeding-lot" method of freeing cattle and pastures from ticks, - fetlock-- fracture below, treatment, sprain, causes and treatment, fetus-- developing outside womb, description and treatment, membranes, dropsy affecting, description and treatment, prolonged retention, description and treatment, fever-- milk, description, symptoms, and treatment, - parturition, description, symptoms, and treatment, southern, splenetic, or texas. _see_ texas fever. fibroma-- interdigital, description and treatment, tumor, description and treatment, fibrous periostitis, description and treatment, _filaria cervina_, worm found in the eye, _filaria lablato-papillosa_, parasitic roundworm of cattle, _filaria oculi_, description and treatment, fissure of the wall of hoof, description and treatment, fistula, milk, description and treatment, flies-- injurious to cattle, - larval, note, flooding from womb, description and treatment, fluke disease, control by use of lime, flukes, prevention by drainage, fly-- spanish, poison, description and treatment, stable, breeding places, fly preventives, injury to cattle by poisoning, flytrap, use against stable flies, fluke, disease of cattle, flukes, liver and lungs, description, foods, character, effect on digestive organs, foot-- diseases affecting, chapter by m. r. trumbower, - foul, causes, symptoms, and treatment, soreness, description and treatment, foot rot, causes, symptoms, and treatment, foot-and-mouth disease-- benign, simple, or noninfectious, danger to man, - description, cause, symptoms, etc., - diagnosis, - eradication by slaughter, efficacy, incubation period, losses other than by death of animal, mortality, , occurrence in various countries of world, - prevention and eradication, - similarity to mycotic stomatitis, symptoms, , - symptoms in man, united states, outbreaks, - forage, insects on, description of poisonous effect, formaldehyde gas, liberation by use of permanganate, foul in foot, causes, symptoms, and treatment, founder, description, causes, symptoms, and treatment, fractures-- below hock and fetlock, description and treatment, compound, comminuted, and complicated, description of different kinds, and treatment, - face bones, description and treatment, general symptoms and treatment, , hip point, causes and treatment, horns, description and treatment, limbs, description and appliances for treatment, - lower jaw, cause and treatment, metacarpus and metatarsus, description and treatment, pelvis, description and treatment, , ribs, cause and treatment, special, descriptions and treatment, spinal column, description and treatment, vertebra, description and treatment, france, foot-and-mouth disease, froesch, note on destruction of foot-and-mouth infection, frostbites-- ears, symptoms and treatment, treatment, fungi, poisonous, description of poisoning, fungoid growth of the ear, cause and treatment, fungus hematodes-- cause and treatment, description, furunculus, causes, symptoms, and treatment, ganglionic division of the nervous system, gangrene, danger in castration of cattle, gangrenous septicemia, symptoms and treatment, garget, description and treatment, gas-- cause of swelling in calf, treatment, under the skin, symptoms and treatment, gastroenteritis, causes, symptoms, and treatment, gastrointestinal catarrh, causes, symptoms, and treatment, , generative organs-- diseases, chapter by james law, - discussion, genital organs, vesicular eruption affecting, description, symptoms, and treatment, germany, foot-and-mouth disease, - gestation, extra-uterine, description and treatment, gid, parasite of sheep and cattle, glands, skin, location and use, gnats, buffalo, description and remedy, goiter, cause, description, symptoms, and treatment, gonorrhea, description and treatment, gravel-- description and cause, effect of different feeds, in prepuce or sheath, treatment, great britain, foot-and-mouth disease, grubs, cattle, description, gullet-- diseases affecting, description, symptoms, and treatment, - wounds and injuries, cause and treatment, gut tie, description, causes, symptoms, and treatment, _hæmatopinus eurysternus_ and _h. vituli_, description and treatment, _hæmonchus contortus_, description and treatment, hair balls, cause, hair, description, harbaugh, w. h.-- chapter on "diseases of the heart, blood vessels, and lymphatics", - chapter on "diseases of the nervous system", - haw, inflammation and enlargement, description and treatment, health, public, relation of actinomycosis, heart-- blood vessels and lymphatics, chapter by w. h. harbaugh, - description, dilation and hypertrophy, description, examination of, fatty degeneration, description, injury by foreign bodies, description, symptoms, and treatment, misplacement, description, palpitation, description, rupture, description, valves, diseases affecting, symptoms and treatment, heat prostration, symptoms and treatment, heaves, description and treatment, heel, ulcerations, causes and treatment, hemaglobinuria or hematuria, description, symptoms, and treatment, hematodes, fungus, description, hemoptysis, description and treatment, hemorrhage-- danger in castration of cattle, treatment, hemorrhagic septicemia, causes, symptoms, etc, - hepatitis, symptoms and treatment, hernia-- bowel, description and treatment, danger in castration of cattle, peritoneal, description, causes, symptoms, and treatment, rennet, description and treatment, rumen, description and cause, stomach, description and treatment, umbilical, description, causes, and treatment, , uterus, cause and treatment, ventral, description and causes, hides, injury by cattle ticks, hip point, fracture, causes and treatment, hip sprain, cause and treatment, hock-- fracture below, description and treatment, fracture, treatment, hollow horn, imaginary disease, hoof-- deformities, causes and treatment, loss, causes and treatment, split, description and treatment, wall, fissure affecting, description and treatment, wounds and pricks, treatment, horns, fracture, description and treatment, horses-- dose of vaccine against anthrax, ear tick, note, hoven, causes, symptoms, and treatment, hydatids-- and flukes affecting the lungs of animals, description and treatment, hydrocephalus, description and treatment, hydrophobia. _see_ rabies. hydrothorax, description and treatment, hygiene, pregnant cow, hygromata, description and treatment, hyperplasia, reference, hypertrophy-- description, heart, with dilation, description, _hypoderma bovis_, new warble fly, _hypoderma lineata_, warble fly, description, illinois, foot-and-mouth disease, immunization, northern cattle against texas fever, manner, impetigo, description, causes, and treatment, incised wounds, description and treatment, incontinence, urine, cause and treatment, incubation period of infectious diseases, indiana, foot-and-mouth disease, indigestion-- calves, causes, symptoms, and treatment, , causes, symptoms, and treatment, , , induration-- tongue. _see_ actinomycosis. womb mouth, description and treatment, infectious aphtha. _see_ foot-and-mouth disease. infectious catarrhal conjunctivitis, symptoms, treatment, and prevention, infectious catarrhal fever, description, symptoms, and treatment, - infectious diseases-- cattle, chapter by john r. mohler, - classification of symptoms and lesions, general discussion, incubation periods, treatment, discussion, infectious ophthalmia, or infectious catarrhal conjunctivitis, inflammation-- brain and its membranes, causes, symptoms, and treatment, contagious, of the udder, description, prevention, and treatment, ear, symptoms and treatment, haw, description and treatment, kidneys, description, causes, symptoms, and treatment, liver, symptoms and treatment, mucous membrane of mouth, symptoms and treatment, navel veins, description, symptoms, and treatment, parotid gland, symptoms and treatment, pyemic and septicemic, of joints of calves, symptoms and treatment, sheath and penis from bruising, prevention and treatment, sheath, causes and treatment, spleen, description, testicles, description and treatment, traumatic, of the stomach, cause, symptoms, and treatment, udder, description, symptoms, and treatment, urachus, causes and treatment, urethra, description and treatment, vagina, causes and treatment, veins, description and treatment, womb, causes, symptoms, and treatment, inflammatory diseases, skin, description, symptoms, and treatment, - inhalation of medicines, manner, inoculation, use against hemorrhagic septicemia, intercostal muscles, rheumatism affecting, description and treatment, interdigital fibroma, description and treatment, intestinal parasites, description and treatment, intestines, roundworms affecting, kind and treatment, intussusception, causes, symptoms, post-mortem appearance, and treatment, invagination, cause of obstruction of bowels, symptoms, and treatment, inversion-- eyelashes, treatment, eyelid, description and treatment, iodin, tincture, use in punctured wounds, iowa, foot-and-mouth disease, iris, description, italy, foot-and-mouth disease, itch, scab, mites, and mange, description and treatment, itching, cause and treatment, japan, foot-and-mouth disease, jaundice, description, symptoms and treatment, jaw-- big, lump, or lumpy, _see_ actinomycosis. lower, fracture, cause and treatment, poverty, caused by twisted wireworms, jawbones, actinomycosis affecting, description and treatment, - jensen, formula for protection of cattle from flies, joint-ill, description, symptoms, and treatment, kansas, foot-and-mouth disease, kelis, causes, symptoms, and treatment, kentucky, foot-and-mouth disease, keratitis, causes, symptoms, and treatment, kidney-- ox, description, parasites affecting, discussion, stone in, description and treatment, kidneys-- inflammation, description, causes, symptoms, and treatment, tumors affecting, description, knee-- fracture below, description and treatment, fracture, description and treatment, tumors, description and treatment, knotting and twisting of bowels, causes, symptoms, and treatment, labor pains before relaxation of passages, lacerated wounds, description and treatment, laceration, eyelid, cause and treatment, lacerations-- and ruptures of the vagina, description and treatment, ear, cause and treatment, lacrimal gland of the eye, description, lameness, symptom of foot-and-mouth disease, laminitis, description, causes, symptoms, and treatment, laryngitis, cause and treatment, laurel poisoning, description and treatment, law, james-- chapter on "diseases following parturition", - chapter on "diseases of the generative organs", - chapter on "diseases of the urinary organs", - chapter on "diseases of young calves", - observation of foot-and-mouth disease in man, lead poisoning, description, symptoms, and treatment, leeches in cattle, description and treatment, lens of the eye, description, leucorrhea, symptoms and treatment, lice-- blue (_hæmatopinus eurysternus_ and _h. vituli_), description and treatment, red, description and treatment, lightning stroke, symptoms and treatment, limbs, fracture of bones, description, lime, use in fluke control, lipoma tumor, description and treatment, lips, contusions, wounds, and snake bites, symptoms and treatment, livestock, immunization against anthrax, - liver-- congestion, description, symptoms, and treatment, diseases affecting, causes, symptoms, and treatment, - flukes, description and treatment, inflammation affecting, symptoms and treatment, lockjaw-- danger in castration of cattle, reference, loco weed poisoning, description and treatment, loeffler, note on description of foot-and-mouth infection, louse, red (_trichodectes scalaris_), description and treatment, lowe, william h.-- and william dickson, chapter on "surgical operations", - chapter on "noncontagious diseases of organs of respiration", - lump, or lumpy jaw. _see_ actinomycosis. lung-- abscess, description, tissue, parasites affecting, lungs-- actinomycosis affecting, bleeding from, description and treatment, bronchial tubes, parasites affecting, description and treatment, parasites affecting, note, worms of cattle, description and treatment, luxations of bones, description and treatment, lymphatics-- description, heart, and blood vessels, diseases, chapter by w. h. harbaugh, - malignant-- catarrh, description, symptoms, and treatment, - edema, description, symptoms, and treatment, - pustule, description, tumors, description, mammitis-- contagious, description, prevention, and treatment, simple, description, symptoms, and treatment, man-- relation to beef measles in cattle, symptoms of foot-and-mouth disease, treatment with anthrax serum, mange-- common, description and treatment, itch, scab, mites, description and treatment, psoroptic, description and treatment, sarcoptic, cause and treatment, manure, breeding place for flies, _margaropus annulatus_, texas fever tick, maryland, foot-and-mouth disease, massachusetts, foot-and-mouth disease, , measles, beef, discussion and management, measly beef, description and prevention, medicines, methods of administration, chapter by leonard pearson, - membrana nictitans of eye, description, meninges, number and functions, mercury poisoning, symptoms and treatment, metacarpus, fracture, description and treatment, metatarsus, fracture, description, treatment, metritis, causes, symptoms, and treatment, metroperitonitis, causes, symptoms, and treatment, michigan, foot-and-mouth disease, _micrococcus prodigiosus_, cause of bloody milk, microorganisms, transmission, milk-- absence, cause and treatment, bloody and blue, cause and treatment, , , - diminution, symptom of foot-and-mouth disease, duct-- closure and thickening of mucous membrane, cause and treatment, closure by membrane, description and treatment, effect of different feeds, analyses, - fever, description, symptoms, and treatment, - fistula, description and treatment, pasteurization as guard against foot-and-mouth infection, source of foot-and-mouth disease infection, stringy, cause and treatment, mineral-- acid poisoning, description and treatment, poisons, description and kinds, minnesota, foot-and-mouth disease, misplacement, heart, description, mites-- description, mange, itch, scab, description and treatment, mohler, john r.-- chapter on "infectious diseases of cattle", - chapter on "mycotic stomatitis of cattle", - chapter on "tumors affecting cattle", - monstrosities, calf, descriptions, causes, and treatment, - montana, foot-and-mouth disease, moor-ill, description, symptoms, and treatment, morphia, poisoning, description and treatment, mouth-- diseases affecting, symptoms and treatment, - inflammation of the mucous membrane, cause, symptoms, and treatment, sore, characteristic differences from foot-and-mouth disease, - ulcers affecting, in young calves. _see_ necrotic stomatitis. mucopurulent discharge from passages, symptoms and treatment, mucous cysts, description and treatment, mucous membrane-- of mouth, inflammation, cause, symptoms, and treatment, thickening and closure of milk duct, cause and treatment, _multiceps multiceps_ (bladderworm), parasite of brain, murray, a. j., chapter on "diseases of digestive organs", - muscles-- calf, rigid contraction, cause, and treatment, eye, description, intercostal, rheumatism affecting, description and treatment, mycotic stomatitis-- cattle, chapter by john r. mohler, - character, cause, symptoms, lesions, etc., characteristic differences from foot-and-mouth disease, - differential diagnosis and treatment, prevalence, synonyms, myocarditis, description, symptoms, and treatment, myoma tumor, description and treatment, myxoma tumor, description and treatment, nagana, description, symptoms, and treatment, nasal catarrh, description, symptoms, and treatment, navel-- abscess affecting, causes and treatment, bleeding, cause, and treatment, breach, symptoms, and treatment, dropsy, description and treatment, string, constricting member of fetus, description, urine discharged through, description and treatment, urine duct, inflammation, cause, and treatment, veins, inflammation, description, causes, and treatment, necrosis-- and diseases of cartilage of the ear, cause and treatment, bony orbit, cause and treatment, necrotic stomatitis-- characteristic differences from foot-and-mouth disease, description, symptoms, and treatment, - differentiation from foot-and-mouth disease, neoformation and neoplasm. _see_ tumors. nephritis, description, causes, symptoms, and treatment, nerves, description, - nervous system, diseases, chapter by w. h. harbaugh, - nervousness, cause of retarding calving, netherlands, foot-and-mouth disease, nettle rash, description, causes, and treatment, neurofibroma tumor, description and treatment, new hampshire, foot-and-mouth disease, - new jersey, foot-and-mouth disease, new york, foot-and-mouth disease, nicotin dip, directions for making, nodular disease of intestines due to hookworms, note, noncontagious-- abortion-- causes, treatment, diseases of organs of respiration, chapter by william h. lowe, - foot-and-mouth disease, reference, norway, foot-and-mouth disease, nose bleeding, cause and treatment, nymphomania in female, cause and treatment, obstruction-- arteries, description and treatment, bowels, resulting from invagination, causes, symptoms, etc, parturition by full bladder or rectum, parturition by masses of fat, cause, _[oe]sophagostomum radiatum_, parasite causing nodular disease, treatment, ohio, foot-and-mouth disease, _oidirum albicans_, parasite causing aphtha, or thrush, operations-- asepsis, importance of, surgical-- chapter by william dickson, william h. lowe, - manner of securing the animals, uses of anesthesia, ophthalmia-- simple, causes, symptoms, and treatment, specific, symptoms, treatment, and prevention, opium poisoning, description and treatment, orbit-- bony, necrosis affecting, cause and treatment, fracture, cause and treatment, tumors, cause and treatment, orbital-- and periorbital abscess, symptoms and treatment, cavity of the eye, description, orchitis, description and treatment, _ornithodoros megnini_, ear tick of cattle, osteitis, description and treatment, osteoma, description and treatment, osteomalacia, description, symptoms, and treatment, osteomyelitis, description and treatment, _ostertagia ostertagi_, encysted stomach worm of cattle, otitis, symptoms and treatment, _otobius magnini_, ear tick, ovariotomy, description of the operation, ovum, inclosed, description and treatment, ox warbles and grubs, treatment, pains, labor, before relaxation of passages, palpitation of heart, description, palsy-- following calving, description and treatment, of neck of bladder, cause and treatment, papillary growths and warts on the penis, treatment, papilloma, description and treatment, paralysis-- bladder, causes and treatment, description, hind parts during pregnancy, cause and treatment, rear parts of body, cause, _paramphistonum cervi_, parasite affecting cattle, paraplegia, symptoms and treatment, parasites-- animal, of cattle, chapter by b. h. ransom, - blood, kinds, bronchial tubes, description and treatment, ear, kinds and treatment, eye, kinds and treatment, intestinal tract, kinds and treatment, kidney, discussion, lung, kinds, stomach, kinds and treatment, parasitic-- cysts, description, diseases of the skin, description and treatment, parotid gland, inflammation, cause, symptoms, and treatment, parotitis, causes, symptoms, and treatment, parturient-- apoplexy, description, symptoms, and treatment, collapse, description, symptoms, and treatment, fever, description, symptoms, and treatment, parturition-- difficult, suggestions for assisting, diseases following, chapter by james law, - obstacles, causes, pasteurization, value in check of foot-and-mouth infection, pastures, how to free from ticks, paunch, distention with food, description and treatment, pearson, leonard, chapter on "administration of medicines", - pelvis-- fracture, description and treatment, narrow, fracture, cause of difficult parturition, pemphigus, symptoms and treatment, penis-- inflammation from bruising, prevention and treatment, ulcers affecting, cause and treatment, warts and papillary growths, treatment, wounds, cause and treatment, pennsylvania, foot-and-mouth disease, percussion method of examination, pericarditis, symptoms and treatment, periorbital and orbital abscess, symptoms and treatment, periostitis, aseptic, purulent, and fibrous, description and treatment, peritoneal hernia, description, causes, symptoms, and treatment, peritoneum, diseases affecting, causes, symptoms, and treatment, - peritonitis-- causes, symptoms, and treatment, , danger in castration of cattle, permanganate, use in production of formaldehyde gas, persistent urachus, description and treatment, pharyngeal polypi, description and treatment, pharyngitis, symptoms, causes, and treatment, pharynx-- diseases, description, symptoms, and treatment, - tumors affecting, description and treatment, philippine islands, foot-and-mouth disease, phlebitis-- description and treatment, umbilical, description, symptoms, and treatment, phosphorus poisoning, symptoms and treatment, pica, description, causes, and treatment, pink eye. _see_ ophthalmia. _piroplasma bigeminum_, _protozoan_ causing texas fever, pityriasis, causes, symptoms, and treatment, plants, poisonous, description of poisoning, - pleurisy, description, symptoms, and treatment, pleurodynia, description and treatment, pleuropneumonia-- cause, incubation, and symptoms, definition and history, post-mortem appearance, prevention and treatment, pneumonia, description, symptoms, and treatment, pneumothorax, description and treatment, poison, definition, poisoning-- acid, description and treatment, aconite, description and treatment, alkali, description and treatment, animal products, description and treatment, arsenic, description, symptoms, and treatment, carbolic acid, description and treatment, chapter by v. t. atkinson, - coal oil, description and treatment, copper, description and treatment, fungi, description, laurel, description and treatment, lead, description, symptoms, and treatment, loco weed, description and treatment, mercury, description, symptoms, and treatment, phosphorus, symptoms and treatment, plant, description, salt and saltpeter, description, symptoms, and treatment, - sources, strychnin, description and treatment, symptoms and treatment, poisonous-- fungi, description, plants, description, - poisons-- chapter by v. t. atkinson, - description of action, mineral, descriptions, - vegetables, uses as medicine, - _polydesmus excitans_, effect on cattle, polypi-- description and treatment, pharyngeal, description and treatment, vagina or uterus, description and treatment, polyuria, causes and treatment, pork measles, note, potash, permanganate, use in production of formaldehyde gas, poverty jaw and scours, caused by twisted wireworm, treatment, pregnancy-- cramps of hind limbs during, cause, duration, signs, pregnant cow, hygiene, prepuce, calculi affecting, treatment, presentation of fetus, natural, pricks, hoof, treatment, probang, use in prevention of choking, prolapsus vaginæ, description and treatment, proliferation cysts, description and treatment, prostration, heat, symptoms and treatment, protozoa-- as intestinal parasites, note, definition, protrusion, vagina, description and treatment, pruritis, causes and treatment, pseudoplasm. _see_ tumors. psoroptic mange, description and treatment, _pucinia arundinacea_, _p. coronata_, _p. graminis_, _p. straminis_, effect on cattle, pulmonary congestion, treatment, pulse-- description, examination, puncta lacrimalia of the eye, description, purulent periostitis, description and treatment, pustule-- description, causes, and treatment, malignant, in man, description, pterygium, description and treatment, pyemia, causes, symptoms, and treatment, pyemic inflammation of joints in calves, description, symptoms, and treatment, quarter-ill. _see_ blackleg. rabies, cattle, description, symptoms, etc., - rachitis. _see_ rickets. ransom, b. h., chapter on "animal parasites of cattle", - rauschbrand. _see_ blackleg. rectal injections, uses and methods, rectum-- full, obstruction to parturition, method of administering medicines, red dysentery, note, red water, description, symptoms, and treatment, regulations, sanitary, for controlling texas fever, renal calculi, description and treatment, rennet, hernia affecting, description and treatment, respiration-- examination, organs, methods of diagnosis, organs, noncontagious diseases affecting, chapter by william h. lowe, - retina, eye, description, rheumatism-- articular and muscular, symptoms, prevention, and treatment, , intercostal muscles, description and treatment, rhode island, foot-and-mouth disease, , ribs, fracture, cause and treatment, rickets-- description and treatment, in young calves, description and treatment, rinderpest, description, cause, symptoms, etc., - ringing, bull, method, ringworm, description, symptoms, and treatment, roundworms-- description, eye, treatment, intestine, kinds and treatment, stomach, description, rumen-- distention with food, description and treatment, hernia, description and cause, rumenotomy, description, rupture-- bladder, symptoms, danger in castration of cattle, heart, description, womb, cause and treatment, ruptures-- and lacerations of the vagina, description and treatment, - description and cause, russia, foot-and-mouth disease, _saccharomyces albicans_, parasite of aphtha, or thrush, salivation-- cause, symptoms, and treatment, symptoms of foot-and-mouth disease, salt, common, poisoning, description, symptoms, and treatment, saltpeter poisoning, description, symptoms, and treatment, salts, medicated, doubtful value against worms, sarcoma tumor, description and treatment, satyriasis in male, cause and treatment, scab, mange, itch, description of kinds and treatment, scabby teats, treatment, scalds, causes and treatment, _schistosoma bovis_, cause of bloody urine, scleroderma, description, sclerotic membrane of eye, description, scouring-- acute contagious, in newborn calves, description, prevention, and treatment, causes, symptoms, prevention, and treatment, - scours-- and poverty jaw, caused by twisted wireworm, treatment, causes, symptoms, and treatment, screens, use against flies, remarks, screwworms-- affecting animals, description and remedy, control by dipping, scurf, causes, symptoms, and treatment, scurfy ears, cause and treatment, sebaceous cysts, description and treatment, sebaceous glands, location, seborrhea, causes, symptoms, and treatment, septicemia-- causes, symptoms, and treatment, gangrenous, description, symptoms, and treatment, hemorrhagic, causes, symptoms, etc, - hemorrhagic, control by vaccination, etc, septicemic inflammation of joints in calves, description, symptoms, and treatment, serous cysts, description and treatment, serum, use against anthrax, _setaria labiato-papillosa_, embryo in blood, note, setoning, description and use, sheath-- calculi affecting, treatment, inflammation, causes and treatment, penis, inflammation from bruising, prevention and treatment, sheep, dose of vaccine against anthrax, shoulder joint, sprain, causes and treatment, skeleton, number of bones, skin-- description, diseases, chapter by m. r. trumbower, - gas or air under, symptoms and treatment, glands, location and use, inflammatory diseases, causes and treatment, parasites affecting, description and treatment, - secretions and growths, descriptions, causes, and treatment, - wounds, kinds, description and treatment, - skull, fracture, description and treatment, slinking, calf, description, snake bites, description, symptoms, and treatment, , sore mouth-- characteristic differences from foot-and-mouth disease, - reference, sore throat, cause and treatment, , sore tongue, reference, soreness, foot, description and treatment, southern cattle fever. _see_ texas fever. spanish-fly poisoning, description and treatment, spasm of the neck of the bladder, description and treatment, spavin, description and treatment, spaying, description of operation, spinal column, fracture, description and treatment, spinal cord-- congestion, description, symptom, and treatment, description, injuries, description, spleen-- diseases, causes, symptoms, and treatment, - inflammation, description, splenetic fever. _see_ texas fever. splenitis, description, split hoof, description and treatment, sporadic-- aphthae, reference, stomatitis aphthosa, reference, sprain-- fetlock, causes and treatment, hip, cause and treatment, shoulder joint, causes and treatment, sprains, description and treatment, squinting, description, stable flies (_stomoxys calcitrans_), affecting cattle, stabling, value against stomach worms, - staggers, causes, symptoms, and treatment, , _staphylococcus pyogenes aureus_ and _s. pyogenes citreus_, bacteria of abscess, staphyloma, description, symptoms, and treatment, sterility, causes, stings-- venomous. _see_ snake bites. wasps and bees, description and treatment, stomach-- diseases affecting, causes, symptoms, and treatment, - fourth, affected with hernia, description and treatment, hair balls in, parasites affecting, treatment, , , roundworms affecting, traumatic inflammation, cause, symptoms, and treatment, worm-- encysted, description and treatment, sanitary measures for suppression, - worms, different kinds affecting cattle, stomatitis-- cause, symptoms, and treatment, characteristic differences from foot-and-mouth disease, - mycotic. _see_ mycotic stomatitis. necrotic, description, symptoms, treatment, etc., - _stomoxys calcitrans_ affecting cattle, stone-- bladder, obstruction to parturition, bladder, symptoms and treatment, description and causes, effect of different feeds, - kidney, description and treatment, strabismus, description, straw, breeding place of stable fly, _streptococcus pyogenes_, bacteria of abscess, string, navel, constricting member of fetus, description, stringy milk, cause and treatment, _strongylus micrurus_, parasite of verminous bronchitis, struma, cause, description, symptoms, and treatment, strychnin poisoning, description and treatment, sudorific glands, location and use, sugar in urine, description, sunstroke, symptoms and treatment, suppression, milk, cause and treatment, surfeit, description, causes, and treatment, surgery, discussion, surgical operations-- asepsis, importance, chapter by william dickson and william h. lowe, - manner of securing the animals during, uses of anesthesia, swamp lands, drainage as measure against fluke disease, sweat glands, location and use, sweden, foot-and-mouth disease, swelling of calf with gas, cause and treatment, switzerland, foot-and-mouth disease, symptomatic anthrax. _see_ blackleg. _tænia saginatæ_, tapeworm cysts, presence in cattle, tail, wolf in, imaginary disease, tapeworm cysts, source of injury to cattle, tapeworms-- adult, of small intestine, species and remedy, cysts in muscles of cattle, cysts of liver, tarsus, fracture, description and treatment, teats-- blocked by calculus, treatment, blocked by concretion of casein, cause and treatment, blocked by warty and other growth inside, description and treatment, chapped, cause and treatment, opening in the side, description and treatment, scabby, treatment, warts affecting, treatment, teeth-- caries, description, irregularities, cause and treatment, temperature-- how to examine, limits for dipping bath, test, tuberculin. _see_ tuberculin test. testicles, congestion and inflammation, description and treatment, tetanus-- danger in castration of cattle, reference, texas fever-- description, symptoms, prevention, etc, - immunization of northern cattle, infection carried by the cattle tick (_margaropus annulatus_), injurious effect of ticks, loss occasioned by cattle ticks, methods of eradication, - nature of the disease, period of incubation of ticks, prevention, quarantine regulations, symptoms and pathological changes after death, - tick eradication, plan of work, threadworms in abdominal cavity of cattle, throat, sore, symptoms, causes, and treatment, thrombosis, description and symptoms, thrush-- calf, description and treatment, parasite (_saccharomyces albicans_), cause, ticks-- cattle, time required to kill, ear, injury to cattle hides, parasites of cattle, note, _see also_ cattle tick; texas fever. _tilletia caries_ in wheat, effect on cattle, _tinea favosa_, description, symptoms, and treatment, _tinea tonsurans_, description, symptoms, and treatment, tracheotomy, description, traumatic inflammation of the stomach, cause, symptoms, and treatment, trichiasis, treatment, _trichodectes scalaris_ (red louse), description and treatment, _trichophyton tonsurans_, fungus causing _tinea tonsurans_, trumbower, m. r.-- chapter on "diseases of the ear", - chapter on "diseases of the eye and its appendages", - chapter on "diseases of the foot", - chapter on "diseases of the skin", - _trypanosoma brucei_, cause of nagana, or tsetse-fly disease, tsetse-fly disease, description, symptoms, and treatment, tuberculin test-- description and history, harmless to healthy animals, summary of directions for making, _tuberculosis_-- bovine, and public health, cause and nature of disease, occurrence, statistics of tests in united states, symptoms and diagnosis, - transmissibility of human and bovine, treatment, tumor-- bony, description and treatment, chrondroma, description and treatment, fibroma, description and treatment, hairy, on eyeball, description and treatment, lipoma, description and treatment, sarcoma, description and treatment, tumors-- brain, description, calf, description and treatment, cattle, chapter by john r. mohler, - definition and description, description, , , description of kinds, diagnosis, eyelid, description and treatment, general treatment, kidney, description, malignant and benign, description, orbit, cause and treatment, pharynx, description and treatment, twisted stomach worms, description and treatment, - twisting-- and knotting of the bowels, causes, symptoms, post-mortem appearance, and treatment, of the neck of the womb, description and treatment, tympanites-- acute, causes, symptoms, and treatment, chronic, causes and treatment, udder-- congestion, description and treatment, contagious inflammation affecting, description, prevention, and treatment, inflammation, description, symptoms, and treatment, ulceration, heel, causes and treatment, ulcerative stomatitis. _see_ necrotic stomatitis. ulcers-- calves. _see_ necrotic stomatitis. cornea, cause, symptoms, and treatment, penis, cause and treatment, umbilical hernia-- description, causes, and treatment, symptoms and treatment, umbilical phlebitis, description, causes, and treatment, urachus-- inflammation, causes and treatment, persistent, description and treatment, ureteral calculi, description and treatment, urethra, inflammation affecting, description and treatment, urethral calculus, symptoms and treatment, urinary calculi-- classification, description and causes, , effect of different feeds, urinary disorders, symptoms, urinary organs-- diseases, chapter by james law, - functions, urine-- albumin in, description and treatment, amount passed daily, analyses under different rations, bloody, caused by blood flukes, bloody, description, symptoms, and treatment, cow, analysis, discharged through navel, description and treatment, excessive secretion, cause and treatment, incontinence, cause and treatment, ox, analysis, retention, effect, cause, and treatment, sugar in, description, urticaria, description, causes and treatment, uruguay, foot-and-mouth disease, uterus-- hernia affecting, cause and treatment, polypus affecting, description and treatment, vaccination, disadvantages in use against anthrax, vaccine-- anthrax, care and use, blackleg, free distribution, note, preparation and use against hemorrhagic septicemia, vagina-- clots of blood on walls, description and treatment, inflammation, causes and treatment, lacerations and rupture, description and treatment, polypus affecting, description and treatment, _vaginæ prolapsus_, description and treatment, vaginal walls, affected with coagulated blood after calving, treatment, vaginitis, causes and treatment, valves, heart, diseases affecting, symptoms and treatment, variola, description, symptoms, and treatment, vegetable-- acids, poisonous, description and treatment, poisons-- note, uses as medicine, description, symptoms, and treatment, - veins-- inflammation, description and treatment, wounds, description and treatment, venereal desire, diminution or loss, cause, prevention, and treatment, venereal excess, cause and treatment, venomous stings. _see_ snake bites. ventral hernia, description and causes, verminous bronchitis-- description, symptoms, and prevention, _parasites_ causing, vermont, foot-and-mouth disease, verruca, description, cause, and treatment, vertebra, fracture, description, and treatment, vesical calculus, symptoms and treatment, vesicular eruption of genital organs, description, symptoms, and treatment, vesicular exanthema, symptoms and treatment, veterinarians, views on foot-and-mouth disease in man, virginia, foot-and-mouth disease, vitreous humor of the eye, description, vomiting, symptoms, cause, and treatment, wall, hoof, fissure, description and treatment, warble fly-- damages, estimate, european species, appearance in united states, warbles-- description and treatment, penetration of skins of cattle, reference, warts-- description, causes, and treatment, , penis, treatment, teats, treatment, washington, foot-and-mouth disease, wasp stings, description and treatment, water-- blisters, symptoms and treatment, cold, drinking, a cause of indigestion, symptoms and treatment, head of calf, description and treatment, weather, relation to occurrence of mycotic stomatitis, wens, description and treatment, west virginia, foot-and-mouth disease, wisconsin, foot-and-mouth disease, withers, casting, cause and treatment, wolf in the tail, imaginary disease, womb-- bleeding from, description, symptoms, and treatment, dropsy, description and treatment, eversion, cause and treatment, fetus developing outside, description and treatment, inflammation, causes, symptoms, and treatment, mouth, induration, description and treatment, rupture, cause and treatment, twisting of neck, description and treatment, wooden tongue. _see_ actinomycosis. wood-ill, description, symptoms, and treatment, worm-- encysted stomach, description and treatment, eye, description and treatment, worms-- bladder, description, lung, of cattle, description and treatment, screw, description and remedies, thread, in abdominal cavity of cattle, twisted stomach, description and treatment, - wounds-- abdomen, causes, symptoms, and treatment, arteries and veins, description and treatment, contused and lacerated, description and treatment, contusions of the lips and snake bites of mouth, description and treatment, danger of infection from foot-and-mouth disease, drainage, necessity, gullet, description and treatment, healing, treatment and dressing, description, hoof, treatment, incised-- description and treatment, punctured, and lacerated, description and treatment, - mouth, snake bites and contusions of lips, treatment, penis, cause and treatment, skin, kinds, description, and treatment, - treatment, summary of care after dressing, yellows, description, symptoms, and treatment, zinc poisoning, description and treatment, additional copies of this publication may be procured from the superintendent of documents government printing office washington, d. c. at $ . per copy none intestinal ills chronic constipation indigestion autogenetic poisons diarrhea, piles, etc. also auto-infection, auto-intoxication, anemia, emaciation, etc. due to proctitis and colitis published by chas. a. tyrrell, m.d. west th street, new york city copyright, by alcinous b. jamison, m.d. w. th street, new york u. s. a. to the unfortunate sufferer from ills described in this volume and to those whom i have had the pleasure of curing this book is respectfully dedicated beauty's fall. it was an image good to see, with spirits high and full of glee, and robust health endowed; its face was loveliness untold, its lines were cast in beauty's mold; at its own shrine it bowed. with perfect form in each respect, it proudly stood with head erect and skin surpassing fair; surveyed itself from foot to head, and then complacently it said: "naught can with me compare." when lo the face began to pale, the body looked too thin and frail, the cheek had lost its glow; the tongue a tale of woe did tell, with nerves impaired its spirits fell; the fire of life burned low. in the intestinal canal waste matter lay, and sad to tell, was left from day to day; and while it was neglected there it undermined that structure fair, and caused it to decay. the doctor's words i would recall who said: "neglect precedes a fall," and verily 'tis true; for ye who disregard your health, and value not that precious wealth, will surely live to rue. preface. the following chapters were contributions to _health_--a monthly magazine published in new york city. certain peculiarities of form and considerable repetition of statement--both of which the reader cannot fail to notice--are owing to the fact that about two-thirds of the chapters were written under the caption "auto-genetic poisons in the intestinal canal and their auto-infection." in revising these contributions for book form i have given to each chapter a caption of its leading thought; but i am convinced that repetition of some of the matters treated, especially if the repetition be in a somewhat different connection, is not such a very bad thing. i have used my blue pencil sparingly, and as a consequence the consecutive reader will find that constipation, diarrhea, biliousness, indigestion, auto-infection and proctitis are treated in nearly all the chapters--but with varying applications. therefore anyone suffering from one of these complaints would better read the whole book instead of only the chapter with the corresponding title. these pages were written for intelligent laymen by a specialist, during a busy, assiduous practice. i take such radical ground, however, going to the very root of the matter, that the general practitioner will do well to give my thesis his careful consideration; he should at least glance at the following introduction for the gist of my claim. contents. chapter i. page man, composed almost wholly of water, is constipated. why? chapter ii. the physics of digestion and egestion chapter iii. the interdependence of anus, rectum, sigmoid flexure and colon chapter iv. indigestion, intestinal gas and other matters chapter v. key to auto-infection chapter vi. how auto-infection affects the gastric digestion, and vice versa chapter vii. how auto-infection affects intestinal digestion, and vice versa chapter viii. the cause of constipation and how we ignorantly treat it chapter ix. cures for constipation: "fearfully and wonderfully made" chapter x. biliousness and bilious attacks chapter xi. king liver and bile-bouncers chapter xii. semi-constipation and its dangers chapter xiii. the etiology of the most common form of diarrhea, i.e., excessive intestinal peristalsis chapter xiv. ballooning of the rectum chapter xv. ballooning of the rectum--_continued_ chapter xvi. the usual diagnosis and treatment of bowel troubles wrong chapter xvii. costiveness chapter xviii. inflammation chapter xix. proctitis and piles chapter xx. pruritus or itching of the anus chapter xxi. abscess and fistula chapter xxii. the origin and use of the enema chapter xxiii. how often should an enema be taken? chapter xxiv. man's best friend chapter xxv. physiological irrigation chapter xxvi. proper treatment for diseases of anus and rectum essential chapter xxvii. the body's book-keeping chapter xxviii. selection and preparation of food chapter xxix. diet for indigestion chapter xxx. diet for constipation and obstipation chapter xxxi. costiveness, diet, etc. chapter xxxii. diet for diarrhea a final word no. . chronic constipation and the use of the enema no. . objections to the use of enema answered introduction. the keynote of this book is proctitis, inflammation of the anal and rectal canals. hardly a civilized man escapes proctitis from the day of the diaper to that of death. the diaper is in truth chiefly responsible for proctitis, and proctitis is in turn chiefly responsible for chronic constipation, chronic diarrhea, auto-infection; and hence for mal-assimilation, mal-nutrition, anemia; and for a thousand and one reflex functional derangements of the system as well. the inflamed surface of the intestinal canal (proctitis) inhibits the passage of feces. absorbent glands begin to act on the retained sewage, and the whole system becomes more or less infected with poisonous bacteria. various organs (especially the feeblest) endeavor to perform vicarious defecation, and the patient, the friends, and even the physician are deceived by such vicarious performance into thinking and treating it as a local ailment. i cannot, accordingly, insist too emphatically that proctitis, the exciting cause, must be treated primarily if we would cure chronic constipation. millions of human beings are sent to untimely graves by these ailments. indeed, the body of nearly every human being is a pest-house of absorbed poison instead of being the worthy temple of a wondrous soul. all due to proctitis! intestinal ills chapter i. man, composed almost wholly of water, is constipated. why? naturally the mind of man was first educated to observe external objects and forces in their effects upon himself, and the external still continues to engross his attention as if he were a child in a kindergarten. fascinated by the without, he ignores the within. but, marvel of marvels, disease (which when looked at with discerning eyes is seen to be an angel in disguise) comes to enlighten him concerning the world within. disease gradually acquaints him with the fact that there are within him organs and functions corresponding to the objects and forces in the world without,--servitors in fact which must not be ignored under penalty of transforming them into foes to his well-being. disease makes him aware that by ignoring the claims of his inner relations he has been converting his very food, juices and gases into insidious and formidable poisons, which perforce he absorbs into his blood and tissues and circulates throughout his entire system. thus does the disguised angel admonish the ignorant that the rights of the inner world must not be ignored--that one's duties thereto cannot be neglected without disastrous consequences. thus does pathology, which is really physiology reversed, become the self-revealer _par excellence_. through digestion and assimilation the physiological process takes up the food, juices and gases, to support and augment the life of man. the pathological process, on the contrary, because the conditions for nutrition are ignored, reverses the upbuilding processes; and the organs of life wither, waste and weaken, until life goes out like fire unfed. man has been slowly learning to take sanitary measures in reference to everything that contributes to comfort in his surroundings, and hygienic measures in reference to everything conducive to stability in his health. through ages he has learned, by experience and experiment, of the changes that inevitably occur in such perishable nutritive substances as water, milk, meats, vegetables, fruits, etc., if they be left uncared for; and he has been led thus to the inference of the law of decomposition--or putrefactive and fermentative changes. idle substances, like idle minds, have decomposition and the devil for companions. substances confined in containers open to the air--ponds, cesspools, etc.--are every-day object lessons to man of the fact that the chemical changes they undergo furnish the conditions for breeding bacterial poisons, and that these poisons are a dread menace to animal life. if the reader will observe the analogy between the decomposition of substances in vessels or pools, and the decomposition of food in the reservoir called the stomach; and its further decomposition in a long canal (the small intestine), connecting the stomach with other receptacles called the colon and sigmoid flexure; and then the decomposition of _their_ contents; he will readily comprehend the chemical putrefactive or fermentative changes or bacterial action that take place in the organism, if for any reason the contents be confined. of the four chief elements that enter into the composition of living bodies three are gaseous, or convertible into gas. in the physical man water constitutes three-fourths of the weight of the body. this being so we realize why, notwithstanding our sense of solidity and weight, chemical changes occur quite as readily in our organism as in the substances we see about us. there are no waterproof walls in the body of man to impede the percolation of liquids freighted with promiscuous passengers from the alimentary canal; passengers designed to nourish the organs for which they have an affinity. but there are those that have no organic affinity, and these are tramps, vagabonds, and even murderers, disturbing and destroying the normal functions of the system. through extravasation, that is, through fluid infiltration of tissues, these passengers come to be one with us, and we make them part of our tissue; but some of the passengers are the demolishers of the living temple. water is universally present in all the tissues of the body, and it is indispensable for introducing new substances into the system and for eliminating the worn-out tissues and foreign substances. it is indeed important to emphasize the fact that properly to eliminate the foreign and waste products from the system requires, in a healthy person, at least five pints of water during twenty-four hours. the amount of gastric juice secreted in twenty-four hours is from six to fourteen pints; of pancreatic juice, one pint; of bile there are two to three pints, and of saliva one to three pints. it is estimated that the juices secreted during digestion in a man weighing pounds amount to twenty-three pounds in twenty-four hours. these fluids are poured back and forth in the process of transforming food into flesh and eliminating waste material. in the alimentary canal there are vessels for holding fluid, semi-fluid and moist masses of substance, in all of which decomposition occurs if the substances be retained beyond the normal length of time. these vessels or reservoirs are the stomach, duodenum, small intestines, colon, sigmoid flexure, and too often the rectum. through the harmonious action of this intestinal retinue of servitors man is well equipped and qualified for health, and he in whom this harmonious subservience prevails is among the blessed and elect of mankind. but alas! the great majority of human beings are sufferers from the inharmonious and insubordinate action of these servitors. how many a human being suffers from _chronic constipation and indigestion_, the exciting causes of which are insidious, and the consequences a protean enemy to his happiness! medical writers on the subject of chronic constipation have assigned numerous causes, and likewise prescribed multitudinous remedies to the patient; but as a general rule this patient, after suffering various woes, if still surviving the many years of medication, rebels against taking further remedies and resigns himself to the chronic enemy on the best terms he can make with diet. for this large class of chronic sufferers we have good news; and for the class that have suffered five or ten years we have better news; and for the class of infants and children that have started on the road of ill-health we have real glad tidings. to know that there is only one chief cause for chronic constipation and its train of disorders, and that that cause overshadows all other causes combined, and is easily diagnosed and treated, is news long hoped and prayed for by a multitude of sufferers the world over. twenty years as a specialist in diseases of the lower bowels have demonstrated to the writer that chronic inflammation, and often ulceration, of the rectum and sigmoid flexure, in ninety-nine cases out of a hundred, is the cause of chronic constipation and the long army of ills resulting from it. and yet, as the reader is well aware, constipation has had many "causes," since the days of hippocrates, especially the abnormal condition of the liver. the etiology, that is, the exciting cause, of the inflammation of the anus, rectum, colon, etc., may date from the time a diaper was placed on the new-born infant. excoriations of the integument about the anus by the excretions of bowels and bladder indicate that the mucous membrane of anus and rectum demands local remedies, as well as the integument of the buttocks, and that it is not the liver which is at fault. the many applications of the diaper during the period of its use, and the frequently delayed removal at night or during long rides in baby wagons, railway trains or carriages, and during long social visits of the nurse; constipating foods, lack of drinking water, constipating medicines, followed by all sorts of purgatives, etc., are among a few of the direct causes of diseases of the rectum. a child at the age of eighteen months with a healthy rectum is most rare. the ten thousand and one chances for contracting disease of the anus and rectum do not cease with the period of infancy. the child is left pretty much to shift for itself as to regularity of eating and the evacuation of the contents of its bowels, wherein disease has already obtained a foothold. all kinds of foodstuffs, at all hours, with seeds, stones, etc., are poked into its stomach, followed by constipating remedies to quiet inevitable troubles, or brisk purgatives given with the hope of expelling the arrested contents of the bowels. is it any wonder that ninety-eight persons of adult age out of every hundred suffer more or less from chronic inflammation and ulceration of anus, rectum, sigmoid flexure, colon, or appendix? traumatic (externally produced) injuries to the mucous membrane of the rectum frequently cause inflammation, and hard pieces of bone, wood, seeds, imbedded in the feces, scratch, cut and bruise the tissues before and during the act of defecation. cold boards, stones, earth and other substances used as seats may produce inflammation of the rectum. there are many and various causes which may be the means of exciting inflammation of the anus and rectum later in life; but it is the writer's opinion that the cause can be traced back to infancy or early childhood, and that accidents or imprudence in after years merely excite an already-existing chronic inflammation. piles, fissure, itching pockets, tabs, prolapse, abscesses, fistulæ, etc., are only the outcome and symptoms of a chronic disease which has incubated for fifteen, twenty or more years. none of this list of troubles produces constipation. it is the inflammation located at the middle portion of the rectum and extending into the sigmoid flexure that causes constipation; that protean monster which deranges more lives with nervousness than any other pathological condition to which the flesh of man is heir! chapter ii. the physics of digestion and egestion. a tree is simply an extension from its roots; and, in an analogous manner, man's body may be said to be an extension from the alimentary canal. does it not follow, consequently, that the digestive apparatus, from a physiological point of view, is the most important organ of the human body? it must be prime and paramount because all other organs depend upon it: it provides them with nourishment for preservation and improvement, and it punishes them--if they do not mind the laws of normality--by withholding its gifts, or by presenting these gifts in the form of poisons that impoverish, hinder and degenerate the system of organs. uncleanliness is surely one of the chief ways in which physiological thoughtlessness is exhibited, and due punishment will inevitably follow disobedience. foodstuffs are prepared for assimilation in the alimentary laboratory through the process of normal fermentation. is it not essential, therefore, that the connecting canals and receptacles be cleansed of the fermented debris that may remain unused and unexpelled, before more food be taken by the digestive apparatus? the all-important question is:--how soon and how well have the residuary part of the food (for some part will always be undigested or unassimilated), and the waste resulting from worn-out tissues of the various organs, been eliminated from the system? wisdom declares that it is not so much what we eat, but what and how well we eliminate, that decides the issues of health and disease. do the egesta pass out in the form of normal feces? three times in twenty-four hours foodstuffs are taken, and as many times the bowels should be freed of accumulated excrement and gases. does nature have her way, or do neglect and bad habits rule the assimilative and eliminative functions of the bowels? the habit of storing feces for twenty-four hours ought to concur and keep pace with a habit of eating one meal in the same period. household and laboratory receptacles in which fermentation has occurred are emptied and cleaned before fresh material is put into them. is not the same precaution more essential with the receptacles for digestion and egestion? they constitute our chief physiological economy; they are precious household and laboratory utensils; exceedingly precious, as we can purchase no other set when these are worn and wasted beyond repair. what marvelous possessions, and how reckless most of us are with them! neither love nor money will bring another "body"-house to us when this decays; when poisons or parasites infest it as the result of a pernicious diathesis, of debasing, destructive tendencies; in short, of unmindfulness! too often criminal negligence or the lack of proper convenience has brought on the habit of using the intestinal canal as a storehouse for dried feces, and the glands and blood-vessels as reservoirs for the absorbed fluid poisons from the feces that have been stored and thus dried. this baneful habit is general throughout civilized communities. it is this habit that has made the words "constipation," "indigestion," "diarrhea," etc., familiar and household subjects of complaint. medical writers agree that "constipation" is the most common malady that afflicts mankind; but they are also unanimous in preposterously attributing the cause to the abnormal action of the liver and the secondary symptoms of constipation. chronic constipation is the result of proctitis and colitis. proctitis, the inflammation of the rectal and anal canals, is the most common disease that afflicts the human creature from infancy to old age; and colitis is only the extension of proctitis to the colon. the scientific diagnosis of constipation predicates proctitis and sometimes colitis. it is declared that constipation is its primary symptom; and that diarrhea is one of its secondary symptoms, resulting from constipation. there is a legion of secondary symptoms of proctitis, all of which medical empiricism considers and denominates causes. as constipation is such an every-day complaint of almost everybody one meets, it will not tax our imagination unduly to conceive how it may be a frequent cause of diarrhea, which is only nature's effort to get rid of its useless and excessive burden of retained feces and gases. constipation, semi-constipation, and irregular action of the bowels, excessive fermentation, putrefaction, self-generated or auto-infection, are the factors to be considered. it is to be noted that in many cases diarrhea is simply an increased peristalsis of the bowels, often due to local and diffused irritation and often to inflammation of the mucous membrane (not infrequently with ulceration); all of these may be the outcome of fecal impaction. to make intelligible the physics of the digestive and egestive processes, we must understand the apparatus. one would naturally think that were the bends or curves of the large intestine undone, it would be found to be a long, straight, smooth canal or bore like a rubber tube. but such is not the case. the outer muscular longitudinal bands are much shorter than the musculo-areolo-mucous tube, an arrangement which brings about a transverse puckering of the gut and mucous membrane, thus forming valves, folds, sacs or pouches at short intervals along the canal. these transverse folds or valves inhibit the too hasty passage of the feces along the bowels by checking and retaining the egested product in the large recesses or pools between the folds; they thus serve as so many dams in the passage of feces toward elimination. this wise provision of nature to moderate the steady motion of the feces as they proceed toward the sigmoid flexure or receptacle, to wait there till there is a proper stimulus for expulsion, is wofully abused by man. he is quite willing to take foodstuffs three or four times a day, to fill the long row of intestinal pools between the dams with feces and gases in all stages of decomposition, not dreaming of the danger from developing bacteria and their absorption into the system. really he is inclined to eat at all times, yet begrudges a few minutes spent in a hurried effort to perform the act of defecation once in twenty-four hours. some of us even have our minds absorbed in reading while awaiting an "automatic action" of the bowels. what a contrast between the gusto and time spent in taking foodstuffs and the indifference and indolence regarding the action of the bowels, unless indeed severe biliousness or diarrhea reminds us strongly of our sewer of waste products. an attack of acute or chronic diarrhea is the penalty some pay for long inattention to the demands nature makes for intestinal cleanliness three times in twenty-four hours. constipated people, semi-constipated people, irregular people and twenty-four-hour people, are not healthy. they are constantly being poisoned by the abnormal products of indigestion and putrefaction resulting from fecal stagnation, which products enter the blood and circulate through every tissue of the body. all cases of proctitis are more or less accompanied by constipation and diarrhea. in all cases of chronic constipation i have found proctitis, and often colitis, and am forced to believe it is the most common and proximate cause of chronic constipation of the bowels. constipation being a primary symptom, there must of necessity follow numerous secondary symptoms, of which diarrhea well marks the progress of septic infection. some of the symptoms of infection are headache, megrim, vertigo, dyspepsia, foul tongue and mouth, back-aches, stiff neck, gnawing pain or numb feeling at the lower end of the spine, biliousness, bad odor from breath and skin, muddy complexion, cold hands and feet, jaundice, neurasthenia, loss of memory, drowsy feeling, pernicious anemia, emaciation, flabby obesity with pallor, capricious appetite, fits of great mental depression, palpitation of the heart, bloating of the stomach and bowels, disturbance of the kidneys, liver, lungs and mucous membrane in general, and especially chronic rhinitis and pharyngitis, which latter are among the first symptoms of imperfect alimentary excretion. as auto-intoxication (that condition of the system when it is continually poisoned, usually by one's own excretions) gains the mastery of the vital forces at any period of life, the mucous membranes are likely to be first affected by inflammation of catarrhal character; then the serous membranes of the body. mal-assimilation, mal-nutrition, cell-atrophy, are symptoms of the giving way of the vital energies to the invasion of the filth and bacterial poisons absorbed from the intestinal canal. on the inner surface of the alimentary canal, from the stomach to the colon, there are, it is estimated, over , , rootlets (called glands, lacteals, follicles, villi), which take up intestinal juices as roots of a plant take sap from the soil. these millions of rootlets give a velvety appearance to the alimentary canal, like a nap or downy surface. intestinal rootlets of the small intestines, like vegetal rootlets, demand a certain amount of normal fluid and solid substance, free from noxious gas. it is the down or nap of fabrics, and not their body, that shows damage first. so it is with the frail structure of vegetal and animal life if not properly supplied with nourishment from day to day. there is probably in the vegetal bodies a continuous circulation of sap corresponding to the digestive circulating fluids of the alimentary canal. this circulation from the alimentary canal to the blood-vessels, and from the blood-vessels to the alimentary canal, involves a wonderful mechanism, facilitating the flow of several gallons daily from each to the other during the process of metamorphosis of food into flesh. you can thus see how inevitable it is that the functions of these millions of secreting and excreting rootlets will be disturbed by the clogging of the system with filth and bacterial poisons as a consequence of chronic constipation, biliousness and general foulness of the alimentary canal. through such disturbance nutrition is diminished, cell-atrophy progresses, and emaciation becomes more marked. the progressive destruction of these rootlets, involving the pathological change indicated, will be manifest in one of its results, either costiveness or diarrhea. often the power of properly digesting and absorbing the foodstuffs is so greatly diminished that the alimentary canal is about as useless as a soft rubber tube. millions on millions of these glands, lacteals and follicles in the stomach and small intestines, are destroyed like the rootlets of a plant or tree in unwholesome soil. the active circulation of the digestive fluids ceases, and the sufferer is said to be costive or to have chronic diarrhea. both symptoms are the outgrowth of many years of intestinal foulness, and indicate the degree and character of intestinal irritability and semi-starvation of the body, as a consequence of either the absorption of poisons or the excessive elimination of the vital substance of the body through diarrhea. chapter iii. the inter-dependence of anus, rectum, sigmoid flexure, and colon. physiologically, or in a normal state, the rectum is not a receptacle for liquids and feces but a conduit during the act of defecation. should, therefore, the feces have passed into the rectum and the desire to stool be not responded to--though the desire continue urgent--the feces will be returned to the sigmoid cavity by physiological action. when, however, the functions of the anus and rectum are disturbed by chronic inflammation, etc., the lower portion of the rectum becomes a more or less roomy pouch, a receptacle for feces and liquids; and instead of being physiologically empty it becomes pathologically distended, the result of spasmodic action or of more or less permanent stricture of the sphincter ani. see illustration in my book entitled _how to become strong_ (page ). the putrid fecal mass of solid and liquid contents accumulated in the artificial reservoir at the end of the intestinal sewer, is one of the most common and serious pathogenic (disease-producing) and pyogenic (pus-producing) sources, which, by auto-infection, afflict man from infancy to old age. here--in the dilated and obstructed sewer--the ptomain and leucomain class of poisons, and many of the poisonous germs, led by the king of morbid disturbers, the bacillus coli communis, find another and last chance to be taken up by the absorbing cells of the mucous membrane and returned to the blood; with which they are carried to all parts of the body, clogging the glands, choking up the pores and obstructing the circulation, thereby causing congestion and inflammation of the various organs. the action of cathartics, laxatives, etc., fills the ano-rectal cavity with a watery solution of foul substances; this solution is readily absorbed into the circulation, aggravating the auto-intoxication (the established self-poisoned condition) already existing. danger does not end with the absorption of bacterial poisons, as we have to reckon with the deleterious effects of the various intestinal gases, resulting, with rapid augmentation of volume, from the putrefactive changes in the imprisoned feculent matter. a sphincter ani permanently constricted or irritable owing to disease results in an _abnormal_ receptacle just above the anal orifice (as shown in the illustration referred to); and a constricted and irritable rectum results in the impaction and dilatation of the sigmoid cavity, which is normally a receptacle, closed at its lower end by circular fibres separating it (the cavity) from the rectum and performing the function of a sphincter muscle. the rectal muscular fibres perform the office of a sphincter for the sigmoid cavity. the pathological changes that result in rectal impaction of feces usually extend to the sigmoid cavity. this cavity is - / inches in length, shaped in a double curve like an italic _s_. civilized man should consider the disturbance to the functional action of body and brain, and the danger to health and longevity involved in the storage of effete and fetid matter. the disturbance and danger are enhanced when the tissues of the sigmoid flexure and the rectum are invaded by inflammation. a healthy action of the sigmoid receptacle depends on the rectum (a conduit six to eight inches in length); and as it is the universal verdict that disease of the rectum is one of the most common maladies that afflict the human race, it must inevitably follow that the feces will be abnormally stored in the sigmoid cavity, occasioning thereby habitual constipation which in turn brings on a host of functional disturbances throughout the system. the colon is a receptacle and a conduit some three feet in length (see ib. p. ) and its action depends upon the ability of the sigmoid flexure to perform its function as a final normal receptacle; and this in turn upon the rectum, which depends on the sphincter ani. the colon does not appear to possess any digestive powers, though it is capable of absorbing substances. its function is not only to receive and forward the trifling residue of food which escapes digestion and absorption, but chiefly to excrete, through its own minute glands, the waste of the system coming from the blood. the excretion from these glands of the colon into the colon, plus the effete portion of the food received by the colon from the small intestine, approximate in weight from four to six ounces in an adult person in twenty-four hours; and of this amount passed per cent is water; so that were the excreta dried the solid matter thus evacuated would not be found to weigh more than one ounce, or one and a half ounces. chapter iv. indigestion, intestinal gas, and other matters. we noted the fact that the "digestive secretions" in a man weighing pounds amount to twenty-three pounds in twenty-four hours; now add to these the food and liquids taken in that period, and you will form some estimate of the work done in the human chemical laboratory in its normal and abnormal states. we noted further that substances confined too long in receptacles decompose and generate pathogenic poisons, that is, poisons productive of disease; and that the intestinal reservoirs are no exception to this law of putrefactive changes. how could we avoid drawing the inference, therefore, that disease-breeding germs, (generated in the organism and hence called "autogenetic"), and their auto-infection, _i.e._, absorption by the system, are an inevitable consequence of the undue retention and fermentation of the contents of these reservoirs: a consequence, in other words, of that intestinal uncleanliness commonly called biliousness, constipation, indigestion. by far the most common and immediate source of autogenetic (self-produced) poisons and their auto-infection, is some degree of chronic constipation and the deadening, smothering effects of constipation on digestion; an effect analogous to what takes place when we allow waste material or ashes to bank up against a fire, shutting off its draft. does the fire then continue to digest the coal? clog up the receptacle for ashes and the coal grows cold. dam up the colon or sigmoid and digestion is disturbed, diminished and debased, as evidenced by the local and general discomfort, and later by the train of inevitable disorders. indigestion is a household word. it has the widest range of all the diseases, because it forms a part of almost every other; and some diseases, such as chronic catarrh and pulmonary consumption, are in many cases produced by indigestion; which in turn had its source in chronic constipation caused by injury or inflammation of the lower bowel, as explained in our first chapter. diminished nutrition, impoverished blood, and loss of weight of from ten to twenty-five pounds, are the signs that indicate the coming disaster to the sufferer from auto-intoxication: the thoroughly poisoned state of the system resulting from auto-infection. vessels used by the dairyman and by those who furnish us with food products and liquids are kept scrupulously clean. why? because it is a question of loss of trade--of money. should these vessels be used when foul from fermentation or putrefaction of their contents, wealth would flee from the coffers of our purveyors, and the boards of health would, or rather should, take a hand in the matter. and these same purveyors, by the way, why do they care more for wealth than for health, their own and ours? but why are we all of us so neglectful of inner cleanliness and so careful of outer? the receptacles of the inner man reek with augean filth, and we cleanse them not. the immortal fountains of health and happiness are dammed, blasted and degraded by just this neglect of our imperative duty; the duty of furnishing full opportunity for the functions of replenishment and life, _by keeping the sewer passages clear_. are a sour stomach and foul intestinal canal fit receptacles for food and liquids? when our receptacles are in this condition, why do we add more material for the generation of poisons of the ptomain and leucomain classes, and morbid gaseous elements? it has been demonstrated that during fermentation an apple will evolve a volume of gas six hundred times its own size. what folly then to add to the fermenting mass! food taken under such conditions will produce results not hard to imagine. the gases that are commonly found in the stomach and small intestines are carbonic acid, nitrogen, oxygen and hydrogen; while, besides all these, sulphureted and carbureted hydrogen are found in the large intestine, causing in a normal state the necessary and useful distention of the alimentary canal. the writer has long regarded the abnormal production of gaseous substances in the intestinal canal from putrefactive changes as of itself not only a grave menace to health, but as a condition productive of morbific results of which we have still much to learn. the more or less constant and excessive distention of the whole or even of a part of the intestinal canal by gases is a serious condition, affecting as it does the various organs of the body, not only through the absorption of these gases into the general circulation but also through the reflex nervous reaction of these organs. it is astonishing what amount of mechanical force is exerted by the gases in the intestinal canal. they distend not only the muscular walls of the intestines and stomach but the strong abdominal walls as well, until the clothing worn has to be loosened for ease and comfort. this more or less extreme mechanical pressure may account for many cases of hernia, prolapse of the uterus, dislocation of various organs, disturbance of the circulation of the blood, and interference with the function of the nervous system, as indicated by its many protests in the way of aches and pains. naval-constructor hobson has lately demonstrated the dynamic power of gas confined in bags or receptacles in raising battleships; and it still remains for some physiologist or pathologist to demonstrate the morbid dynamic results of gases confined in the alimentary apparatus. the deleterious effect of the abnormal quantity of gases on all the organs of the body is imperfectly understood at present, but will be better apprehended when we are able to study more minutely the pathogenic poisons of the human system. it is known, however, that a stream of carbonic acid gas, or even of hydrogen, will paralyze a muscle against which it is directed. chapter v. key to auto-infection. in a previous chapter we stated that the average quantity of fecal discharge daily, by an adult, is from four to six ounces, and that of this weight per cent is water. we referred of course to the daily passage from the bowels alone, not including that from the bladder. our studies have thus furnished us with the key wherewith to unlock the secret chambers of auto-infection. what is that key? it is the discovery that the system may possibly absorb as high as three-fourths of this feculent substance in the colon; that this absorption is made possible by an obstructed or sluggish intestinal canal where disease germs are propagated and lodged; that these germs, along with a certain amount of excrement, invade the tissues by absorption; and that we thus have the system constantly saturated with poisonous germs and filth, re-excreted, re-absorbed and re-secreted--no one knows how many times--by the various organs of the body. that the importance of intestinal cleanliness may be better appreciated, i will quote from the following authors on the subjects of excretion, absorption and circulation of the intestinal fluids. dr. murchison states that: "from what is now known of the diffusibility of fluids through animal membranes, it is impossible to conceive bile long in contact with the lining membrane of the gall-bladder, bile-ducts, and intestine, without a portion of it (including the dissolved pigment) passing into the blood. a circulation is constantly taking place between the fluid contents of the bowel and the blood, the existence of which, till within the last few years, was quite unknown, and which even now is too little heeded. it is now known, says dr. parker, that in varying degrees there is a constant transit of fluid from the blood into the alimentary canal, and as rapid absorption. the amount thus poured out and absorbed in twenty-four hours is almost incredible, and of itself constitutes a secondary or intermediate circulation never dreamt of by harvey. the amount of gastric juice alone passing into the stomach in a day, and then re-absorbed, amounted in the case lately examined by grunewald to nearly imperial pints. if we put it at pints we shall certainly be within the mark. the pancreas, according to kröger, furnishes - / pints in twenty-four hours, while the salivary glands pour out at least pints in the same time. the amount of the bile is probably over pints. the amount given out by the intestinal mucous membrane cannot be guessed at, but must be enormous. altogether the amount of fluid effused into the alimentary canal in twenty-four hours amounts to much more than the whole amount of blood in the body (which is pounds in a man weighing pounds); in other words, _every portion of the blood may, and possibly does, pass several times into the alimentary canal in twenty-four hours_. the effect of this continual out-pouring is supposed to be to aid metamorphosis; the same substance more or less changed seems to be thrown out and re-absorbed until it be adapted for the repair of tissues, or become effete." the reader will readily perceive how the system may become so charged that other organs of the body will vicariously attempt to play the part of a receptacle and conduit for the bowel, in order to excrete and eliminate ancient and offensive filth and bacterial poisons. the phenomenon of vicarious excretion may occur through the kidneys, lungs, skin, throat, nose, vagina, or uterus, thus keeping up chronic diseases and discharges that would not exist but for the chronic constipation or even for _incomplete action of the bowels each day_. over-distention of the rectum, sigmoid and colon, due to the pressure of gases and the impaction of feces, results in inflammation, ulceration, stricture, appendicitis, abscess, strangulation, intussusception, and abnormal ballooning or roominess in certain portions of these intestines or conduits. this roominess, though it becomes filled with feces, and often with liquids, permits of sufficient space for even the daily passage of feces without dislodging the stored contents. the fact that there is a passage daily deceives both sufferer and medical adviser as to the source of the poisonous condition of the system, and masks the origin of such disorders as chronic inflammation and ulceration of the nose, throat, lungs, stomach, duodenum, colon, appendix vermiformis, uterus, bladder, kidneys and edema of the legs. but these evidences of auto-infection are generally preceded and accompanied by a general loss of vitality and weight, by anemia, by a lowering of the resisting power of the organism--all of which produce a fit soil for the various diseases to which flesh is heir. as soon as the system becomes saturated with bacteria and effete matter, auto-intoxication results, in which condition there is but little or no store of vitality for resistance, reaction and recuperation. dr. bright has recorded several instances of fecal accumulation in the colon mistaken for enlargement of the liver and for malignant tumors. in one of the cases there was jaundice which disappeared after free evacuation of the bowels. frerichs also relates a case where enlargement from fecal accumulation was at first ascribed to a pregnant uterus, and subsequently, on the supervention of deep jaundice, to an enlarged liver, but in which purgatives dispelled the patient's anxiety about a diseased liver and at the same time her hopes for a child. dr. n. chapman, in his _clinical lectures_ (p. ), says: "the feces sometimes accumulate in distinct indurated scybala or in enormous masses, solid and compact. taunton, a surgeon of london, has a preparation of the colon and rectum of more than twenty inches in circumference containing three gallons of feces, taken from a woman, whose abdomen was as much distended as in the maturity of pregnancy. by lemazurier, another case is reported of a pregnant woman, who was constipated for two months, from whom, after death, thirteen and one-half pounds of solid feces were taken away, though a short time before between two and three pounds had been scraped out of the rectum. cases are reported by dr. graves of dublin, which he saw in women, where from the great distentions in certain directions of the abdomen, the one was considered to be owing to a prodigious hypertrophy of the liver, and the other of the ovary; in the latter of which he removed a bucket-full of feces in two days. mr. wilmot of london has recently given a case where a gallon of matter was lodged in the cæcum, and the intestines perforated by ulceration." dr. pavy, in his treatise on _the functions of digestion_ (p. ), writes: "the morbid conditions that constipation may occasion are of various kinds. under an undue retention of fecal matters within the colon noxious products may be formed there, and act as irritants upon the mucous coat, setting up inflammation, followed by ulceration. it is to be here remarked that fecal matters are sometimes retained in the sacculi or pouches of the colon, and may give rise to the circumstances referred to, whilst a passage exists along the centre of the canal that shall permit a daily evacuation to occur. the dejections, even, may be loose in character, and still the same sequence of events ensue. from the irritating influence of preternaturally retained feces, colicky pains are, as a rule, induced, and the ultimate effects may be such as to lead to the production of fatal inflammation. "the effect of constipation upon the muscular coat of the bowel is, through distention to which it is subjected, to weaken or deteriorate its evacuating power. as the result of a great amount of distention, like as happens in the case of the urinary bladder, more or less complete paralysis is induced. from the prolonged retention of fecal matter accompanying constipation, excrementitious products that ought to be eliminated become absorbed and thereby contaminate the contents of the circulatory system. as the result of this contamination, the secretions become vitiated, and a general disturbance of the conditions of life is produced. the action of the liver becoming deranged, its eliminative office is imperfectly discharged, and thus sallowness of the face and a bilious-tinged conjunctiva are produced. a coated tongue, foul mouth, loss of appetite, and other dyspeptic manifestations, accompany the general disorder of the digestive organs that prevails. the accumulation existing in the colon leads to a sense of distention and uneasiness in the abdomen. the kidneys vicariously discharge products that ought to have been eliminated by the alimentary canal. in this manner the urine becomes preternaturally loaded. from the contaminated state of the blood the functions of animal life also become disturbed; and hence the lassitude, debility, headache, giddiness and dejected spirits, that form such frequent accompaniments of constipation.... a distended cæcum, colon, and rectum may also, by the pressure exerted upon the nerves and vessels of the lower extremities, be the cause of numbness, cramps, pains and edema of the legs. the edema occasioned by constipation, if not exclusively confined to one side, will in all probability be decidedly greater in one leg than in the other." case (from _gaz. méd. de paris_, july , ): a woman of fifty was troubled with habitual diarrhea and frequent calls to urinate, in which urine could be discharged only by drops. after six years of suffering and unsuccessful use of remedies, she was examined for the first time per anum, and an accumulation of fecal matter discovered, forming a mass the size of an infant's head. this was removed and found to weigh four pounds. she then got well. chapter vi. how auto-infection affects the gastric digestion, and vice versa. frederick the great said that all culture comes through the stomach. this saying emphasizes pithily the dependence of psychology upon physiology. the stomach with the intestines is certainly the source from which every portion of the body receives its nourishment and most of its diseases. the physiological _plus_ and _minus_ processes leave their reflex on the mind. prof. ch. bouchard, in his lectures on auto-intoxication (oliver's trans., p. ), says: "the organism in its normal, as in its pathological state, is a receptacle and a laboratory of poisons. amongst these some are formed by the organism itself, others by microbes, which either are the guests, the normal inhabitants of the intestinal tube, or are parasites at second-hand, and disease producing." in the preceding chapters we have mentioned some of the most common cases of retention of excreta in the rectum, sigmoid cavity, colon, cecum, duodenum and stomach, and how the consequent foul conditions often resulted in diarrhea. auto-infection impairs the functions of every organ in the body, by clogging the pores with poisons and filth. by the transfer of disease germs from one infected, that is, tainted, contaminated part of the body to parts that were free from infection, the kidneys, mucous membrane and skin receive these unnatural products, and their functions are disturbed thereby. the disturbance of the various organs throughout the system sets up such a multiplicity of symptoms that one gets the impression of a pandemonium--a veritable council-hall of evil spirits. the visitation is omnipresent. infliction, misery, are everywhere. the taint of auto-generated intestinal morbific products, carried and communicated to the remotest parts, manifests itself now here now there as if it were a local trouble, and it is difficult therefore, nay, impossible, to classify scientifically the symptoms of auto-infection. a classification, though necessarily imperfect, will aid in the diagnosis and treatment of the various abnormal conditions of the stomach and intestines, that is, of mal-digestion. the sympathy, good understanding and responsiveness between the brain and the digestive apparatus are so close and intimate that the physician must take into consideration the inter-relationship of these organs before deciding which one is reporting reflex nervous symptoms, and which direct symptoms. plutarch says in one of his essays: "should the body sue the mind before a court judicature for damages, it would be found that the mind had been a ruinous tenant to its landlord." the digestive apparatus is, or should be, a farm for the mind, but unfortunately it usually has to wait twenty or more years before the tenant understands how to cultivate it for the uses of his intellectual and esthetical life. i have referred to the fact that the most common causes of constipation, indigestion and other foul conditions of the alimentary canal favorable to the production of autogenetic poisons and their auto-infection, are such common and every-day matters, so familiar to almost every one that the victim, the parents and the physician feel no alarm of the coming danger for years. during these ignorant and innocent years the poison and filth were being absorbed, infecting the system with their morbific taint and lowering the quality of the blood and lessening its quantity, producing the state known as anemia. associated with progressive anemia is mal-assimilation, improper nutrition, ebbing of the nervous and vital forces and the lessening of the secretory, excretory and digestive powers. by the time the poor victim is weighing fifteen to twenty-five pounds less than he ought to the symptoms of ill-health are sufficiently alarming to compel the sufferer to seek medical aid for disease of the stomach, bowels, liver, kidneys, lungs, etc. _slow digestion_ is perhaps the most common form of functional disturbance of the stomach, due to an insidious auto-infection for years. the eyes and the skin begin to show the effect of the poisonous infection. the skin becomes dry, pale and muddy in color; has more or less annoying eruptions, and exhibits a jaundiced appearance. the body is ill nourished, the nervous system depressed, the blood impoverished, the memory failing, the general appearance languid, irritable, anxious. what a household picture this is to every one of the human family! but let us fill it out somewhat more fully. note how the undue delay of food in the stomach occasions a sense of weight and oppression, the feeling beginning about an hour after a meal and continuing for hours, sometimes attended with fermentation and sometimes without it. at times there is a feeling of drowsiness due to the absorption of an excessive amount of the gases which distend the stomach and bowels, and this absorption is accompanied by pains in the stomach, head, between the shoulders and in the region of the heart. sleep is disturbed by dreams, or one is awakened with a feeling of numbness and palpitation of the heart. at times the urine is scanty, strongly acid or high-colored. the tongue is more or less foul, with white or creamy coating. now and then tasteless or saltish eructations occur. the appetite may be too good, or there is no appetite at all. note the careworn expression, the wondering what to eat, what to drink or what remedy to take. so between much worse and some better, the trouble continues--both of body and mind. _indigestion_, however, with undue formation of acids proper, or acids unnatural, to the stomach, is a much more annoying affliction than slow digestion. the sufferer from indigestion may be debilitated, anemic, may have a general want of tone; or he may be a more or less vigorous and plethoric person. in some cases flatulence is very troublesome. but the most usual symptoms are heartburn, acid eructations that produce burning sensations, sour taste at intervals or constantly in the mouth, setting the teeth on edge. in the more vigorous or plethoric sufferers a gouty diathesis may exist, which may result in a tendency to inflammation, bringing on neuralgia, rheumatism, gout, etc. tongue more or less foul; uric acid in the system; confusion in the mind; headaches; pains in the loins, legs and feet; in fact, more or less shifting pains everywhere: these are the common exhibits of indigestion. on the whole, the sufferer is a victim to an irritable body and a fretful mind, necessitating the cultivation by him of patience and the effort to be agreeable. besides the symptoms mentioned, indigestion may also be accompanied by gastric pain or by uneasiness at the pit of the stomach. it may be a sense of fulness or tightness, or a feeling of distention or weight, or again, a feeling of emptiness, goneness or sinking. now and then there are burning, tearing, gnawing, dragging sensations under the breast-bone; and there is a general complaint of a capricious appetite, heartburn, vomiting, nervous headache, neuralgia and cold extremities. other symptoms are pain from lack of food at the proper hour, or from food taken at the improper time; both of which practices may be followed by flatulency, occasioning a swollen, drum-like condition of the stomach and abdomen; the body of the tongue will be coated white, while the edges will present a redder appearance than in health. _impaired digestion_ with nervous symptoms--in which the morbid sensibility of the mind is apparently the greatest--is called _hypochondria_. this class of sufferers, whose bodily and mental ills and morbid fears are so chaotically interwoven, are deserving of much consideration. so numerous are their fears and so fertile are their reasons for the many changes they arbitrarily make in their efforts to get well or keep from getting worse, so obstinately sure are they of being always right--that we can but give them our sincerest pity. in some cases the functional troubles of the stomach and mind are aggravated by disease of the pelvic organs, which adds to the depression of the mind through nervous sympathy with the abdominal organs. dr. cullen says on this point:-- "in certain persons there is a state of mind distinguished by a concurrence of the following circumstances: a languor, a listlessness, or want of resolution and activity with respect to all undertakings; a disposition to seriousness, sadness and timidity as to all future events; an apprehension of the worst or most unhappy state of them; and therefore, often upon slight grounds, an apprehension of great evil. such persons are particularly attentive to the state of their own health, to every smallest change of feeling in their bodies; and from any unusual feeling, perhaps of the slightest kind, they apprehend great danger and even death itself. in respect to all these feelings and apprehensions, there is commonly the most obstinate belief and persuasion." (quoted in leared, _on imperfect digestion_, p. .) chapter vii. how auto-infection affects intestinal digestion, and vice versa. intestinal indigestion is a more common form of functional disturbance than is gastric indigestion. it is a well established fact that the greater portion of the digestive work is done beyond the stomach, in the duodenum, by the hepatic and pancreatic fluids. the duodenum--very properly called the _second stomach_--has none of the peculiar characteristics of a receptacle that receives crude substances--the office of the stomach. much greater sensitiveness characterizes the digestive canal than the stomach; which is accounted for by the fact that a network of nerves, forming the sympathetic system, surrounds the bowels. the symptoms of intestinal indigestion are not always clearly defined and distinguishable from gastric indigestion, especially as the two are frequently associated. the cecum, more than any other portion of the digestive canal, resembles the stomach, and it secretes an acid, albuminous fluid having considerable solvent properties. it is to be observed that as the cecum is only three inches in length and two and a half in diameter, and as its contents are necessarily propelled in opposition to gravity, a slight casualty will hinder or obstruct the upward movement of the pultaceous mass of the effete ingesta. the turning point in the ascending colon affords another ready hindrance to the upward and onward movement of this mass; and the gases and ancient feces beyond the turn conduce to further sluggish peristalsis, bringing about more or less obstruction and reflex irritation of the remaining length of intestinal canal. undue retention of the contents of the cecum, and the disturbance and obstruction of the duodenum by the pressure incident to the distention of the colon with feces and gases, lead to congestion, inflammation and occasionally to ulceration of the mucous membrane in various parts of the intestinal tube. this condition of affairs increases the occlusion (closing) of the bowels, but makes very easy indeed the entrance and propagation of micro-organisms in the sub-mucous coat of the intestine. the conditions are now ripe and rife for auto-infection. which of the following microbes are the most active agents of progressive auto-infection: the streptococcus lanceolatus, the bacterium pyogenes, the bacillus subtilis, the staphylococci, the bacterium coli commune? they all play a part in the game, reducing the body in time to a charnel-house. or are such substances as putrescein, cadaverin, skatol or indol--which are derived through chemical change in the putrescent mass--contributors to the spread of the poisonous taint throughout the system? any single one or a group of the fifty or more bacterial poisons may be the responsible agents in the ensuing auto-infection. chemical analysis of the gases resulting from decomposition reveals oxygen, nitrogen, hydrogen, carbonic acid, protocarbonated hydrogen and sulphureted hydrogen, ammonia, and sulphate of ammonia. leucin, tyrosin, lithic acid, lithates, xanthin, cystin, keratin, sulphureted hydrogen, etc., are deposits in the urine and are signs of the derangement of the intestinal canal and liver. the external symptoms observed are the following: the tongue is large, pale, flabby and indented by the teeth at the edge of the anterior third, while its surface is white and the papillæ often enlarged; the appetite may be excellent, though there is great functional derangement of the liver with lithemia, so that the sufferer is tempted to eat what he knows from experience will disagree with him; a bitter coppery taste in the mouth, due to taurocholic acid--a common symptom of lithemia or of imperfect oxidation of albumen; emaciation, fatigue, depression, headache, buzzing in the ears and deafness, disturbance of sight, loss of memory, faintness and vertigo, very marked in some cases; sometimes tenderness and pain under the cartilages of the right ribs; the fretting of the sensitive surface of the bowels by imperfectly digested, semi-putrescent food, resulting sometimes in convulsions, coma, paralysis, or in fetid diarrhea of an acid character producing a burning sensation or pain of the anus when the discharges are being passed; rumbling and twisting sensations in the region of the navel occurring with flatulency, and occasionally colicky pains which at times are so severe as to simulate poisoning. in some people certain articles of food, without being either toxic or putrid, induce indigestion and the production of microbes in quantity amounting to one third of fecal dejections. prof. ch. bouchard says: "the consequence of this development of acid in the whole length of the digestive tube is an inflammatory condition. we notice catarrh of the stomach, ulcerative gastritis, to which patients often succumb after twenty-five years of _bad stomach_; these are the _false cancers_, as they are called, or malignant gastritis without tumor. the large intestine is inflamed; around the fecal matter are seen glairy secretions and sometimes blood (membranous enteritis)." (op. cit., p. .) in chronic inflammation of the rectum and colon there is more or less discharge of mucous, and in some cases of membranous, desquamation, with yellow or bloody mucus. the shreds, cords or complete tubular casts are discharged constantly or at varying intervals. the quantity and character often alarm the sufferer. the discharge is nothing less than a thick, tenacious mucus that had formed a thin coating on the inflamed mucous membrane, and become exfoliated in casts or thin shreds--the result of many years of morbid intestinal exaggerated action. microscopical examination of the desquamated intestinal membrane and mucus from a man forty years of age, revealed the following products: crystals, mostly complete; incomplete phosphates, very numerous; mucous shreds in abundance; fat globules and granules, numerous; anal epithelia; red blood globules, few; connective tissue, scanty; pus corpuscles, very few; margaric acid and detritus (substances resulting from the destruction or wearing away of the part); undigested material, mostly cellulose; leptothrix threads, micrococci; and the bacillus coli communis. diagnosis: foul, undigested material, due to a chronic inflammation of the lower intestinal tract. the microscopical examination of mucus and desquamated membrane from a woman sixty-five years of age, disclosed that she was suffering from proctitis and colitis. she wrote: "please tell me how long this mucous discharge must continue. i am alarmed at the quantity of membrane, cords, casts, etc., in my excreta, and i think that if this process goes on much longer there will soon be no bowels left to purify." this letter was written some weeks after contracting a severe cold, which accounts for the unusual amount of exfoliation and mucus. the sample she sent contained a large quantity of mucus, both threads and corpuscles; with a moderate number of epithelial scales, partly anal and partly intestinal. pus corpuscles were present in small numbers; also vegetable fibres, fat, starch, muscle fibres and cellulose--the remains of undigested material. in the membranes themselves no micro-organisms were found; in the pieces containing undigested material the bacillus coli communis was found as well as micrococci, and the bacilli of putrefaction (secondary formation) were seen. chapter viii. the cause of constipation and how we ignorantly treat it. one of the best preparations for active life is a first-class intestinal canal. "an old scotch physician," says sir astley cooper, "for whom i had a great respect and whom i frequently met in consultation, used to say to me as we were about to enter our patient's room together, 'weel, misther cooper, we ha' only twa things to keep in meend, and they'll serve us for here and herea'ter; one is au'ways to hae the fear o' the laird before our e'es, that'll do for herea'ter; and th' t'other is to keep our boo'els au'ways open, and that'll do for here.'" a person whose mind is devoted to the realization of ideals, and whose body has a set of bowels that perform the act of defecation twice every twenty-four hours is doubly prepared for a useful life. "if thou well observe in what thou eat'st and drink'st, seek from thence due nourishment, not gluttonous delight, till many years over thy head return: so may'st thou live, till like ripe fruit thou drop into thy mother's lap, or be with ease gathered, not harshly plucked, for death mature." milton's advice in poetic lines is all very well for those who have escaped chronic inflammation of the lower bowels, an ailment common and troublesome even under the very best dietetic regulations. inflammation having once penetrated the circular and longitudinal muscular fibres or bands of a section of the intestine, all hope of a comfortable existence is at an end, for such inflammation will bring on constipation and constipation nervous misery. it is inevitable that inflammation should determine this outcome since it induces spasmodic contraction of the muscular walls of the tube, lessening the bore or closing the portion of the canal invaded. plastic infiltration takes place in the walls of the gut, thickening and binding them together; or, if the inflammation be of a simple catarrhal or atrophic nature, the plastic infiltration will more or less bind the circular muscular bands of the gut together in their abnormally contracted state! the presence of feces and gases above the zone of the disease will increase the irritation and contraction of the affected portion of the intestine. consequent upon these changes wrought by inflammation, gases and excrementitious material are perforce imprisoned in the intestine, inducing constipation, foul fermentation, flatulency, diarrhea, indigestion, nausea, loss of appetite, sick headache and, in fine, autogenetic poisons, the source of auto-infection, ending in auto-intoxication, the chronic poisoned condition of the system. since the most common cause of chronic constipation, internal sluggishness and uncleanliness, is known, too much cannot be said in condemnation of the wide-spread abuse of "liver and atony persuaders" and the use of irritating suppositories and dilating bougies, candles, etc. the numerous and various drastic purgative nostrums--which literally fill our medical literature--and the universal demand for them, are evidence of this very common disease, which disease is rendered worse by the drugs taken for the relief of a foul intestinal alveus. an abnormal amount of watery secretion is forced by the drug into the foul canal, to mix there with its contents, of which the major portion is retained and re-absorbed into the system. and to make the bad condition and treatment worse, all such sufferers, as a rule, drink very little water, some scarcely any. the demand for an irritating stimulus to "open the bowels" (the exciters contribute to close them) is largely due to the popular error in thinking, "i can treat my own bowels quite as well as the doctor, if not better." no intelligent person would think of stimulating and irritating daily an inflamed region of tissue on the outer portion of the body; yet this is precisely what intelligent persons do when they habitually use liver and peristaltic persuaders. the primary disease in the lower bowels and the consequent symptoms are gradually aggravated as the "physic" habit is formed. as in the case of opium fiends and drunkards, so with habitual cathartic drug-users, should they be suddenly deprived of the accustomed artificial stimulus and irritant they become absolutely miserable, mentally and physically. it is a well-known physiological fact that every artificial stimulation of the intestines is followed by a corresponding loss of vitality and reaction. now that the almost universal cause of undue retention of foul, effete matter has been ascertained, it is important to communicate to the world at large the best means of cleansing the bowels without increasing the local primary disease and its annoying symptoms. that external physical cleanliness is next to godliness is an apt proverb. that internal physical cleanliness is nearer to godliness no one will deny. water is a universal solvent and therapeutic agent and is therefore indispensable in the cleansing and purifying of the integument and mucous membrane of the body. a large quantity of water is necessary to carry on the functions of the animal economy. water enters every cell and fibre of the living organism, aiding in nutrition and in the elimination of worn-out tissues which if retained turn into poisons. it is really not an intelligent but rather a barbarous practice to prescribe liver and intestinal exciters for the purpose of throwing into the alimentary tract a sufficient quantity of watery excretions to "cleanse itself"; to succeed they must first soften and liquefy the dry, hardened feces and scybalous masses (little ancient, bullet-like formations) imprisoned above an inflamed and fevered lower bowel, even colon. normal feces consist of per cent water; and when unduly retained in the colon much of this fetid percentage is absorbed into the system. then drugs are prescribed to liquefy the hardened putrid remnant and absorption begins again: a fact very shocking to a sensitive, even sensible, person. chapter ix. cures for constipation: "fearfully and wonderfully made." diseases of the anus and rectum are very common, very numerous and of very critical consequences. this is especially true of the disease of chronic inflammation, one of whose symptoms is piles or hemorrhoids. in the writings of the early greek and roman physicians will be found minute descriptions of the latter disorder. but on the whole, the most important symptom of chronic inflammation of the lower bowel, and the most far-reaching in its morbific results, is that protean monster, chronic constipation. it deranges more lives, from infancy to old age, than any other pathological condition that can be named. for the cause and cure of that mere symptom of a disease, constipation, the so-called scientific physicians, from the early history of medication to the present time, have had one immutable theory as to the leading cause, and one grand motto as to the "safe and sure" cure. they have always prescribed remedies for this malady on the theory of portal congestion and hepatic derangement, and hence their supreme motto: "_physic! physic!! physic!!!_" the layman naturally adopted the theory and the motto of his medical advisers; hence in his self-medication and also under advice he consumes such vast quantities of purgative nostrums. i have just received some medical literature beginning with the usual salutation--"dear doctor"--setting forth a new and remarkable theory of the cause, and an original motto for the cure, of constipation. its authors have discovered that the "rectal nerve-tissues" are hungry, torpid, anemic, and to overcome the "atony" they must be "_fed! fed!! fed!!!_" "the greatest of physical ills in america," we are informed, "is digestive torpor or semi-paralysis, originally induced by a kind of starvation of the intestinal nerve-tissues. one of its most prevalent forms is constipation," caused by "local torpor or semi-paralysis, dependent upon an anemic condition of the nerve-tissues of the rectal region." by "feeding directly" the limpid, bedraggled rectum and colon, they receive their "appropriate nutriment, by which comes added vigor,"--the nutriment the stomach and the rest of the system had failed to furnish on account of constipation, excessive fermentation, indigestion and auto-infection. to overcome this "atony" of two or more feet of the lower bowel, a little "nutritious" suppository, weighing twenty grains, is a "specific." it is claimed to cure chronic auto-infection and the spasmodic occlusion of the lower bowel! the excessive activity of all the region invaded by the chronic inflammation and the local irritation are perpetuated by such "feeding" instead of allayed! does it not stand to reason that there is already too much activity, and that when the irritability reaches a certain stage diarrhea or looseness of the bowels must result? twenty grains prescribed once a day to nourish an organ (the rectum) six to eight inches in length, and from one and a half to two and a half inches in diameter! when for two to three feet the lower bowel requires nourishment, a suppository night and morning is prescribed! however, the new treatment has the merit of some consistency between the diagnosis and the treatment, notwithstanding both are wrong. chronic inflammation of the lower bowel causes, as i have pointed out, excessive activity and thereby excessive nutrition of the tissues involved in the morbid process. but sphincter ani gymnastics have been suggested by some one who thinks chronic constipation is owing to a lack of muscular activity of the lower bowels; and the following reason is given: "physiological experiments have shown that rapid voluntary movements of the external sphincter ani and the levator ani produce very active peristaltic movements of the large intestine. this effect is produced by the mechanical excitement of the plexus myentericus of auerbach. this curious automatic center lies between the two muscular coats of the intestine and controls the peristaltic movements. a person suffering from constipation should make powerful movements of the sphincter ani, and of the levator ani, in as rapid succession as possible, continuing the exercise for three or four minutes or until the muscles are fatigued. the time chosen for this exercise should be either before breakfast or an hour after breakfast, according to the natural habit of the individual in respect to the evacuation of the large intestines." there are surgeons who recommend stretching and paralyzing the external sphincter muscle; and if they are correct in their diagnosis and treatment, those who prescribe _bile-bouncers_, and those who prescribe "_nutrient suppositories_," and those who prescribe the use of _rubber bougies_ and _candles_, should call a convention (to meet in, say, new york city) to discuss the subject and see if they cannot agree to inform the people that constipation is a sign of, or a factor in, the evolution of the human race. those who believe in the gymnastics of man's ears and of his sphincter ani and the therapeutic merits of this and of that could readily assent to the same glorious conclusion. strange to say, there are in new york physicians who are in the habit of inserting a rubber bougie up their patients' rectums two or three times a week for the cure of constipation. some, more bold, intrust the bougie performance to the patient in order that a daily dilatation and stimulation may be kept up until "recovery from the disease is effected." others, more original, order the patient to insert a candle some six inches in length up the rectum and allow it to remain ten minutes, with the hope of a "rapid cure." a mrs. p----, who had used the candle treatment for a great length of time by order of her distinguished physician, once consulted me. on examination, i found her afflicted with atrophic catarrh, chronic constipation and anal ulceration, from which she had suffered for seven years, with but little intermission from pain during each day of that entire period. chapter x. biliousness and bilious attacks. commonly the source of chronic gastro-intestinal uncleanliness, of dyspepsia, of autogenetic poisons and auto-infection is inflammatory occlusion--more or less permanent or spasmodic--of some part of the lower bowel. many years of auto-infection will exhibit such diseased symptoms as poor appetite, bad digestion, impoverished blood, emaciation, etc., accompanied by increased virulence of the catarrhal discharge of mucus, shreds, etc., and a mind and body sinking down to the morbid plane of hysteria, hypochondriasis (fear of illness) and neurasthenia (debility of the nervous system). biliousness and bilious attacks are evidence that there is a more or less constipated condition, that there has been an occasional imprudence in diet, and that the dreadful sense of fulness up to the end of the tongue is a faithful report of the state of affairs. what is it but a full foul condition of the digestive canal, a complete blockade of the canal from the rectum or colon to the stomach, making the victim feel that there must be something done in the way of cleaning out? he fears that the condition will be followed by fever--not infrequently this is the case. biliousness is usually supposed to be occasioned by hindrance to the flow of bile, and the conclusion is drawn that the liver requires stimulating. this supposition is erroneous and very far from pathological veritude, as the liver, like the other organs, is merely _a secondary sufferer from the over-eating and the closed sewer_. "the _bowels_ with sullen vapours cloud the brain, and bind the spirits in _their_ heavy chain; howe'er the cause fantastick may appear, the effect is real, and the pain severe." the bilious attack is usually noticed in the morning before food has been taken. the tongue is heavily coated and often so foul that it is necessary to scrape it and cleanse the mouth of disagreeable taste. eructations, nausea followed by vomiting of undigested foul-smelling food, and if the vomiting be long-continued, mucus from the stomach and bile that had accumulated in the duodenum, are sufficient evidence that there was no torpidity of the liver. there is likewise more or less headache, neuralgia, giddiness, hebetude (state of mild stupidity), dejection, confusion of the senses, skin disease, acne rosacea (scarlet redness of the nose and cheeks), eczema, etc. the headache may be seated in the centre of the brain and extend to one or both eyeballs and be increased by stooping. should diarrhea occur many of the annoying symptoms are likely not to be present. in this form of indigestion the bowels are often much constipated, which is usually only a more marked symptom of chronic constipation. the system now and then vigorously rebels against this chronic condition and an acute bilious attack is the evidence of such rebellion. the whole digestive canal is involved in the rebellion, resulting in the symptoms described and also in a morose, petulant and querulous temper, accompanied by a peculiar, despairing expression,--partly due, perhaps, to regrets of having only _one_ digestive apparatus,--or in some cases, perhaps, of having _any_. that the character and disposition may be materially influenced by such a state of the bowels is well established. plato believed that "an infirm constitution is an obstacle to virtue, because such persons think of nothing but their own wretched carcasses"; for which reason he contended that Ã�sculapius should not undertake to patch up persons habitually complaining, lest they beget children as useless as themselves, being persuaded that it was an injury both to the community and to the infirm person himself that he continue in the world, even though he were richer than midas. acting on this well-known fact, the celebrated voltaire, in one of the articles in his _philosophical dictionary_, has very humorously ascribed half the evils of europe to the intestinal irritations of the public men of the age. "let the person," he adds, "who may wish to ask a favor of a minister, or a minister's secretary, or kept mistress, endeavor previously, by all means, to ascertain whether they go to stool regularly; and, if possible, to approach them after a comfortable evacuation, that being a most propitious moment, one of the _mollia tempora fandi_, when the individual is good-humored and pleased with all around him." chapter xi. king liver and bile-bouncers. the "house not made with hands"--the human body--has, like the house made with hands, _its_ sewer system, which is over twenty-five feet in length. to cleanse (?) this wonderfully delicate, tortuous and extended passage-way of waste material, civilized man knows no better than to put in at the top of the house, purgatives, cathartics, bile-bouncers, etc., with one hope and purpose in view, namely, that these policemen go searching, scouring and hustling the intestines in the greatest possible haste, in order to remove an obstruction about three hundred inches distant from where these "forcers" had entered the intestinal sewer. with mercury as a scavenger the work is pretty thoroughly done, though extra care has to be taken that some of the teeth may remain after the victim survives the additional intestinal inflammation occasioned by its drastic measures. traits acquired by the father are inherited by the children; present-day doctors follow early practitioners; they still pour in many and various decoctions at the top of the obstructed sewer of the human house to dislodge accumulated gases and feces at the bottom. the plumber treats the sewer of the house of brick and stone more wisely. our fathers partook of laxatives, cathartics, purgatives, and in consequence we start in life with teeth, intestines, appendices, out of gear and nervous systems on edge. with unconscious stupidity we continue the fatuous practice. the monarch selected to preside over the functions of human life was the liver; and it is only with bated breath that any doctor dares question the legitimacy of that monarch's claim. the loyal subjects of king liver are ever ready to call out "quack," "charlatan," etc., to those who dare repudiate the sovereignty of the liver. so much attention and flirtation does the liver receive from the _liver-persuaders_ that the pancreas ought to be very jealous. the pancreas excretes quite as much fluid into the duodenum as its larger neighbor, and is, therefore, no mean organ. and we need not wonder should we find the intestinal glands piqued at our over-attention to the liver, as they, in their work at the metamorphosis of digested food into blood, excrete two or three gallons of fluid in a day to the liver's two or three pints; yet witness our medieval solicitude for the liver, for one among many organs. the liver is located near the upper portion of the intestinal canal and connected by a tube (the bile duct) to the rest of the excursion route. the following liver-persuading knights-errant are prescribed and ordered by disciples of hippocrates, galen, herodicus, and iccus, to treat with that digestive and eliminative monarch, the liver--usually at night-time, that the family may not be disturbed. after making as good terms as possible they journey on, riotously churning and swashing the long, tortuous canal and its contents in search of ancient toxic gases and feces lodged in the lower bowel. it is believed by the prescribers that the length of the journey adds dignity to the drastic, dredging knights-errant. the reader needs no introduction to the podophyllins, the aloes, the jalaps, the rhubarbs, the mercurys, the croton oils, the sennas, the salines, the seltzers, the carters, the beechams, the websters, the pierces, the ayers, the ripans, the warners, and others belonging to "the four hundred" fashionable grenadiers, with their credentials and stamp! after these knights-errant have paid their respects to king liver, and ended their long, tortuous and eventful journey, they depart and leave behind them burning and painful abdominal and anal regrets, and then some soothing, stimulating and tonic remedies are in order, so that the dredged though chronically constipated sufferer and his friends may still hope that life will be spared to repeat the same nauseating and often painful process in a few days or weeks, taking, in the meanwhile, milder bile-bouncers daily as a reminder to king liver that the time for the knights-errant is coming again. sufferers from chronic constipation receive assurances that by the use of these "remedies" the anemia will be corrected, nutrition and digestion restored, atony of the liver and intestines overcome, yellow complexion and morbid feeling disappear. in short, remove the numerous symptoms and "causes" of toxicity of the body and of chronic constipation, and proclaim the victory of powder and pill! all of us would believe medicus, the son who so abjectly follows in the footsteps of his father, if we could really feel the possibility of such a victory; but the protests of our bowels are living witnesses against the validity of the medieval practice as here described; and we ask for a modern scientific solution of the fulness and foulness within and the fatuity without. i must now apologize to the large class of sufferers from chronic constipation for hurting their feelings. i know very well how seriously they have been compelled to regard their trouble, and out of respect for their protracted suffering and efforts to get relief i should instead have sympathized and condoled with them in their dire misfortune. but we all know and realize that there are occasions when we get into awful and painful predicaments, and, when the whole situation is taken in, it becomes comical and ridiculous, so that for a time we cannot treat it seriously, even when old chronic biliousness and the mighty knights-errant are having a deadly combat at our internal and external (and possibly infernal) expense. chapter xii. semi-constipation and its dangers. "at least six times in every fleeting day some tribute to the renal functions pay, and twice or thrice all alvine calls obey." what has been said thus far has been based on chronic constipation mainly, and the accompanying intestinal foulness, which condition was shown to be so annoying that it compelled the sufferer to resort frequently to some more or less direct and artificial means for the relief of the bowels and the incidental indigestion. it has been further shown that many of the chronic cases fail to take on the normal amount of flesh or lose what flesh they have because of self-poisoning (auto-infection), which in turn is the outcome of mal-assimilation and mal-nutrition, and that this consequence must occur wherever there is an absorption of waste through a checking or disturbance of systemic functions. emaciation and anemia are inevitable in such cases. on the other hand, there are cases that have such great powers of assimilation and elimination that they are able to stand the invasion of destructive material, may maintain the normal amount of flesh, or even take on an abnormal amount, but with the invariable accompaniment of more or less impoverishment of blood, disturbed circulation, indigestion, and the usual nervous derangements. the harmful practice of the lean and the fleshy sufferers of resorting to daily medicines--cathartics, digestives and tonics--has been commented upon. willingly do they squander their money to get relief from an ever-present ailment. cases are these of hope deferred that maketh the heart sick. the primary cause of chronic constipation, namely, proctitis, has been explained, and its many symptoms, as indicated by the functional disturbances of many or all of the organs of the body, enumerated. but beside the cases of chronic constipation--both lean and fat--there are many sufferers from auto-infection who have only semi-constipation, or partial evacuation of the feces daily. though they suffer from the effects of self-poisoning, yet they have no such well-defined symptoms of local disease and functional disturbance as are always found in those who have chronic constipation. nevertheless, they have disturbances of practically all the functions of the system. believing as they do that the evacuation of their bowels is complete, they are at a loss to find a cause for the toxemia (blood-poisoning), mal-nutrition, debility and general atony. the symptoms of auto-infection with the semi-constipated are as complex as with the severer cases, but not so well defined. the most prominent symptoms are those connected with the process of katabolism, that is, of degeneration of the tissues, as indicated by their color and texture. the liver, however, is usually held responsible for the bad complexion, impaired nutrition, constipation and diminished vitality, when really the liver is only indirectly concerned, as made manifest in the previous articles. the seat and source are found to be the diseased colon and rectum. dr. treves says: "the colon being the part of the bowel involved in obstruction due to fecal accumulation, it may be further assumed that the blocking of the gut will most usually concern its lower or terminal parts. accumulation of feces is most common in the rectum and sigmoid flexure, and then in the cecum. masses of feces may block the colon at any point, and more particularly at the flexures of the bowel. still, the three common sites of the accumulation are those just named. the accumulation in the colon may assume the form of a more or less isolated nodule or mass. thus a considerable lump may be found in the cecum or sigmoid flexure and the rest of the colon be comparatively clear of any gross accumulation. an isolated lump may even persist after free purgation. on the other hand, the accumulation may assume the form of several isolated fecal masses. one of them may occupy the cecum, another the transverse colon, and possibly a third the sigmoid flexure. the bowel between these masses may appear to be fairly clear." a number of the exciting causes of inflammation of the lower or terminal portion of the large intestine have been mentioned. it cannot, however, be too strongly emphasized that chronic inflammation of the colon and rectum results in hyperkinesis (excessive muscular irritability) and contraction of the diseased portion invaded, thereby retarding or preventing the passage of feces and gases. a portion of the daily accumulation of feces in the sigmoid may pass through the diseased rectum every day, but not without increasing the inflammation and the spasmodic contraction; this in time inhibits the elimination of the accumulating feces, which by undue retention become condensed and hardened. each day will then be a repetition of the abnormal and partial effort of the organ to accomplish the act of defecation, and there will be no thought of the cumulative and chronic intoxication (poisoning) of the system from the imprisoned feces and gases. it may be stated without reservation that the rectal canal cannot be involved in chronic inflammation without involving the anal canal, and _vice versa_. one half of civilized people are suffering from chronic constipation, and very nearly the remainder from semi-constipation. the semi-constipated are now under consideration. the chronic cases are those that have a _complete_ impaction of feces in the terminal portion of the sigmoid and rectum; the semi-constipated have the usual daily _partial_ impaction, that is, an incomplete or partially successful evacuation of the contents of the bowels: the incompleteness is due to disease of the anal and rectal canals. the anal and rectal canals are made up of circular and longitudinal muscular bands, which, when invaded by disease, lose their proper or normal sensibility and coöperative voluntary action. the excessive contraction of the circular muscles closes the calibre or bore of the gut, and the excessive contraction of the longitudinal muscles shortens the length of the gut, thus throwing the mucous membrane into abnormal folds which increase the depth of the sacculi, or cavities, between the fibrous folds. in the normal gut the sacculi and bands act as valves to control the descent of the feces. this valvular arrangement and the curvatures of the lower bowels conserve the energy of the involuntary and voluntary nerve force until there is a sufficient accumulation of feces to excite a normal desire for stool; otherwise the feces would rush upon the anus at once and occasion much inconvenience. catarrhal inflammation of the mucous membrane of the anal canal will sooner or later penetrate the muscular structure of that canal, causing an abnormal irritability and contraction of the sphincter ani and the other tissues composing its structure. the contraction of the anal tissues becomes more permanent as the muscular tissues of the structure become cohered or bound together by the process of inflammation. the normal stimulus and sensation that should precede the act of defecation are perverted or destroyed by the excessively irritable contraction of the sphincter ani, which contraction is occasioned by the presence of feces and gases just above the seat of inflammation, that is, above the anal canal or at the lower end of the rectum. as the bulk of feces and gases lodged at this point increases, the anal contraction becomes firmer in grip, and as a consequence permits no hint of the imprisoned contents until the accumulating bulk is beyond the power of toleration by the organ. daily a portion of the lodged feces, or some new addition to the mass, passes the anal canal, but the attending irritation or contraction of the muscles prevents any further exit of the imprisoned rectal contents. chapter xiii. the etiology of the most common form of diarrhea, i.e., excessive intestinal peristalsis. if you are interested to know why a certain plant does not flourish in the temperature and light to which it has been accustomed, you investigate the soil--the source of nourishment--and thus determine why the downy or velvety appearance has left the flower; why the leaves are yellow, dry or falling; why the stems are withering. even the most ignorant person knows that the symptoms the plant presents did not bring about the unsuitableness of the soil; that, on the contrary, the condition of the soil is responsible for the plant's present state. would it not be unwisdom, therefore, to treat directly the symptoms of decay, instead of treating the soil, or changing it? just so misguided is the judgment of the physician who prescribes physic or tonics in the case of a person having a foul intestinal canal, a condition destructive of the absorbent and the excretory glands. but members of county medical societies do just such foolish things. notwithstanding their prescriptions, a point will be reached by the patient where the restoration of his millions of small rootlets, or organic feeders, will be impossible, and like a decaying plant in unfavorable soil he gradually decays or withers, here and there, until finally he topples over before he knows it, probably long before maturity has been reached. it is not generally known among laymen, nor sufficiently appreciated among physicians, that the mass of fecal matter normally evacuated from the bowels comes mainly from the blood; and that this mass is not, as it is usually supposed to be, the residue of the food that has been left unassimilated. embedded in the mucous membrane of the colon are tubular glands under the control of the nervous system. when these glands become unduly excited through local inflammation and irritation, the normal flow from them is increased to such an extent that a rapid waste of precious tissue occurs throughout the system, and the vital force--which had taken perhaps years to store--is depleted to the point of exhaustion, sometimes even in a few hours. almost every one has had some experience of exhaustion following diarrhea. the increased flow of blood to the mucous membrane of the colon furthers this extraordinary secretion by the glands. as has been pointed out, inflammation, septic poisoning, intestinal foulness, or retained feces, act as irritants on the mucous membranes, thereby drawing the blood to the colon where it is excreted and exhaustion follows. the great danger in diarrhea, therefore, is the rapid depletion of the vital force. but when the small intestines are affected the consequences may be still more deplorable. then the unassimilated food is hurried along too quickly for absorption and the body receives but little nourishment to restore its powers. thus another draught is made upon the sufferer's reservoir of vitality, and hence additional exhaustion. but this waste of tissue, loss of vital force, non-assimilation and non-supply, are not so grave as the positive danger of the permanent destruction of the millions of small absorbing vessels (villi) of the small intestine by a continuance of this abnormal irritation. of course the secretory and excretory glands of the colon also suffer, and we then have costiveness resulting from lack of absorption and excretion. abnormal irritability of the bowels is necessarily involved in the inflammatory process known as proctitis and colitis. increase this irritability to a certain point and diarrhea takes the place of constipation--a much more alarming symptom. diarrhea is more alarming because the intensified local activity of the excretory glands of the bowels brings on, as has been said, a general exhaustion of the vital powers. the severity of diarrheal symptoms is much increased by the character and abundance of bacterial poisons. bacteria find a ready medium in fetid feces, and are absorbed by the excited glands to the degree in which these glands have time and power for absorption. of course the extent and character of the intestinal irritation have a good deal to do with the severity of the diarrheal symptoms. this irritation is not infrequently intensified by a catarrhal process, or by a lesion of an ulcerative nature. all these forms of irritation bring on "excessive intestinal peristalsis"--which, accordingly, is our definition of diarrhea. the normal peristaltic action of the intestines propels the nutritive as well as the effete material through the canal at a rate that allows of both proper absorption and timely elimination. but when excessive peristalsis occurs, neither absorption nor elimination will be normal or suited to the requirements of the system. undigested foodstuffs may become an irritant, or increase, as is usually the case, the established irritation, and thus bring on an acute attack of diarrhea. the immediate consequence of the acute attack may indeed be, and often is, comparatively beneficial, inasmuch as the diarrhea removes the undigested material that occasioned the irritation. when this removal is accomplished, the diarrhea usually subsides without treatment. this is the case, however, only when the patient has committed an infrequent error in diet. when such errors are habitual the burden on the glands of the intestinal mucous membrane becomes intolerable, and the chronic inflammation once established has a tendency to proceed from bad to worse. it will then be observed that digestion becomes more and more impaired. in such a case diarrhea will no longer serve a good end, but will on the contrary debilitate the system. a change to better dietetic habits will then aid, but will not suffice for cure. only treatment and time will restore the inflamed parts to a healthy tone. when, however, the digestive tract is invaded by any of the many forms of bacteria, treatment will avail little and serious consequences follow rapidly. too much cannot be said or done to secure intestinal cleanliness in infancy, childhood and maturity. mothers and nurses cannot give this subject too much thought and care, since the welfare of future generations depends largely upon intestinal cleanliness, in view of the rich and racy life of our hothouse civilization. we are a people poisoned through constipation and diarrhea: two affections that derange more lives than all other pathological conditions together. banish alimentary uncleanliness and you take most of the poisons from the human race--poisons that stunt the body and blunt the mind. the soul of man should dwell in a palace, not in a pest-house; in a human temple, velvety, lined with down, inside and out; in which there are hundreds of millions of lilliputian trappings, fittings and articles of furniture, to carry on the minute and finer functions and chemistry of the soul. the very multitude of the fine equipments that decorate the temple give it that beautiful blending of color and form which its coating has when in normal condition. they adorn this body-house with health, and supply it with the rich red wine of joy. the blood is dependent for its richness not only on the digestive fluids, but also on the proper eliminating powers of the system. if you would avoid premature decay you must not neglect the reservoir of vitality, the alimentary canal, but see to it that it be kept clean and pure. then will the elixir of life spring from an almost inexhaustible fountain. to recur to our plant analogy. keep the soil in your own vegetable garden sweet, for intestinal cleanliness corresponds to soil fitness. purity of the stomach and bowels is more important than quantity or quality of food. that defecation should occur normally two or three times in twenty-four hours is more important than that three meals should be eaten within that time. the conveniences for eating and drinking are on every hand, but oh, how few, inaccessible, miserably constructed, and poorly cared for, are the toilet cabinets for the accommodation of the gourmand! suspenders and silk hats mark the progress of our outer refinement; toilet cabinets and flushing appliances, of our inner. when the _inner_ refinement comes we shall live longer and be healthier. chapter xiv. ballooning of the rectum. to make plainer what has been said of the rectal and anal tubes or canals, consider the sleeve of an infant's gown. this sleeve well represents the rectal tube, the wrist-band the anal orifice and tube--an inch or more long. think of the sleeve or rectal tube as being made up of four layers of material or membranes; and counting from the inside of the sleeve or rectum there are ( ) the mucous layer; ( ) the areolar layer; ( ) the muscular layer; ( ) the serous layer. the muscular membrane is itself composed of two layers, and may be said to form the framework of the rectum. one layer is composed of circular muscular fibres, and the other of longitudinal muscular fibres. in a similar manner you could make a sleeve out of fine circular rubber bands; then bind them together by rubber strings extending lengthwise of the sleeve. with the circular bands the bore of the sleeve may be contracted or widened; and with the longitudinal bands the length may be shortened or extended. just so with the corresponding muscular membranes of the rectum, in their normal and abnormal conditions. outside of the longitudinal muscular bands are the serous and areolar layers, the latter covering the lower half of the rectum. as you look inside the incomplete model of the rectum, or rather sleeve, you observe circular muscular bands or fibres which it is necessary to cover with soft spongy or fatty substance in whose meshes are nerves, blood-vessels, etc. this is called the areolar layer or coat. one more layer or coat upon this--the mucous coat--completes the structure. this latter possesses the power of accommodating itself to the distention and contraction of the muscular tube. the mucous membrane is thrown into folds and columns which serve as valves to inhibit the undue descent of the feces, thus assisting the mucous membrane in performing its office. the length of the rectum varies in different persons, six inches is the average length. it is divided into two parts. the upper part is a little more than three inches long; beginning in front of the third sacral vertebra and extending down to the end or tip of the coccyx. in shape this part conforms to the curve of the sacrum and the coccyx, to which it is attached behind. the lower part of the rectum is a little shorter than the upper part, and begins at the tip of the coccyx and extends down with the same curve as the upper part, terminating at the upper portion of the anal canal. returning to the sleeve again; the portion of it from the shoulder to the elbow illustrates the upper part of the rectum when partially covered with a serous coat on the side opposite the bore (the outside). from the elbow to the wrist-band illustrates the lower part of the rectum, when covered on the outside with an areolar coat. the wrist-band of the sleeve will represent the anal tube if drawn into a pucker and turned slightly backward from the direction of the sleeve of which it is a continuation. the muscular fibres described above likewise enter into the formation of the anal canal or orifice. this orifice is closed by two strong muscles that lie close together and are called internal and external sphincters, which are abundantly supplied with nerves and blood-vessels whose branches extend to the neighboring organs. nine persons in every ten have more or less chronic inflammation of the mucous membrane of the anus and rectum. in time the areolar and muscular coats become invaded by the morbid process, and this increases the irritability of the tissues of the organ. the change from the normal functions of the anal membranes is slow, and the symptoms are not well marked and are consequently ignored for years owing to inexpertness in detecting an invading serious disease, until the time comes when the suffering can no longer be tolerated by the victim of the neglect. the result of disease to muscular tissue is contraction of its fibres, and the contractions become more painful as the disease increases. accompanying the inflammation, there is a more or less inflammatory product secreted between muscular fibres that "glues" them together in their contracted state. and as the anal and rectal tubes are made up of round muscular fibres, it is not hard to see how the bore of the canal can be lessened by the slow binding together of its fibres in the contracted state. the fact is that when the anal structure is invaded by inflammation, there is more or less stricture of the canal and of the orifice. recalling the sleeve illustration, and how the wrist-band was puckered and bent back a trifle so that the contents of the sleeve would not pass out so easily, suppose you now pucker the wrist-band rather tightly, and suppose there is a forcible descent of sand in the sleeve, the natural result would be a bulging out of the lower portion of the sleeve just above the wrist-band, or place of undue constriction. if the abnormally constricted condition of the anal orifice has been growing from bad to worse for years, the locality immediately above the anal canal will become dilated or cavernous (caused by retained feces or gases), which cavity is called ballooning of the rectum. when a speculum is introduced into the rectum (as shown on page of pamphlet _how to become strong_), and through it a bent probe is inserted to determine the depth of the dilatation or abnormal cavity, it is as if one were poking inside of an inflated balloon: hence the name. anatomists describe the rectum as terminating in a forward pouch, which is close to the prostate gland in the male and the lower part of the vagina in the female. in some cases there may be such a slight pouch, due to the anal canal not following the direction of the rectum, and slightly turning backward; but in most cases such a normal pouch is not perceptible or observed through the speculum. the small pouch sometimes found on the anterior wall of the rectum i have thought due to a very acute inflammation on the verge of forming abscess, which often occurs in the triangular space. (see in diagram in pamphlet cited above.) immediately above the sphincter muscles on the posterior wall of the rectum the greatest dilatation is found (as shown by the bent probe), and extends on each side with less depth about the anterior wall of the rectum. the greater portion of the lower part of the rectum, which part is about three inches long, is usually involved in the dilatation or ballooning. often the upper half or more of the anal canal is also dilated with the rectum, leaving the sphincter muscles quite bare of fatty tissue, with anal length of a quarter of an inch or less. your attention was called to a sleeve containing sand, and the bulging or dilatation above the puckered wrist-band that was an inch or more broad. now suppose there were two strong rubber rings at the lower end of the wrist-band, whose power of resistance to pressure is much greater than the tissues above them forming the wrist-band. naturally, the tissues which form the upper part of the wrist-band would dilate the same as the terminal portion of the sleeve just above the wrist-band. similar changes in structure or formation take place in diseases of the anal and rectal canals which result in ballooning of the rectum; and two frail constricted sphincter muscles are left to guard this balloon, filled, as it so often is, with feces and gas. chronic inflammation, that results in contraction of the circular muscular fibres, will sooner or later constrict the gut so that it will lose its normal power to expand without causing pain. the anal canal may be said to be strictured to the degree in which it is unable to dilate normally, and this strictured condition usually grows from bad to worse. the first symptom of rectal disease is usually an affection of the anus, which affection occasions an inhibition, that is, a reluctant permission for the passage of the feces; and this inhibition results, consequently, in some degree of constipation. and this constipation reacts more or less on the peristaltic action of the bowels and in time defeats the function of peristalsis. all this will react on the inflammatory processes at the anus, which originally engendered the constipation. the narrow and contracted strait or canal through which the feces must pass, gives a tape-like shape to the stools. the anal and rectal mucous membrane is of a firm and tough structure, similar to the integument at the bottom of a boy's heel. after many years' observation of diseases of the anus and rectum i am forced to conclude that as a rule inflammation exists in the tissues twenty or more years before the severe symptoms, such as piles, fissure, anal pockets, pruritus, hypertrophy, atrophy, tabs, abscesses, and fistula, are sufficiently annoying to compel the sufferer to seek medical aid. i believe it to be of as much importance to give early attention to disease of the anus and rectum as to teeth and eyes, or even more. chapter xv. ballooning of the rectum--continued. in the last chapter a description was given of the anatomy of the anus and rectum; and it was shown how a chronic inflammatory process involving these organs develops stricture in the parts invaded; and it was shown how a partial stricture of the anal canal results in ballooning or dilatation of the lower part of the rectum. the primary cause of all the symptoms of rectal disease is chronic inflammation (proctitis) involving the whole structure of the anal tubes and in a few cases the sigmoid flexure as well. perhaps the first marked symptom of disease of the rectum is constipation, semi-constipation or of chronic character. the function of the anus and rectum being disturbed by the inflammation, the fecal mass is unduly retained and its moisture is absorbed by the system. this accounts for the condensed and hardened fecal mass in isolated lumps of various proportions. a hard-formed stool is abnormal, and is evidence of auto-infection. when three-fourths of the normal fecal mass has been re-absorbed by the system, does it not stand to reason that the blood and tissues have been poisoned by their own waste products (auto-intoxication) and that anemia, emaciation and local disturbances of other organs of the body are symptoms of such intoxication? the loading and blocking of the sigmoid flexure come from _too much activity or irritability, due to inflammation, of the upper half of the rectal tube_. a consequence of this excessive sensitiveness is a diminished or perverted normal stimulus, notice or desire, that the act of defecation should take place. the victim of proctitis simply forms a habit of daily soliciting an evacuation, though the normal invitation or desire to stool may be entirely absent, and the evacuation in such cases is attended with more or less delay and straining effort to accomplish partially or wholly the expulsion of the more or less inspissated feces. as the extreme sensitiveness of the inflamed upper half of the rectum offers resistance to the passage of the fecal contents of the sigmoid flexure; so, in a somewhat similar manner, the inflamed anal tube, in its more or less constricted state, prevents the passage of feces and gases as they approach the terminal part of the rectum. as a consequence, the feces and gas deposit and lodge at this latter location, producing in so doing the abnormal cavity called ballooning of the rectum, so often found just above the anal tube. the greatest depth of the dilated pouch is on the posterior wall of the rectum, or just in front of the tip of the coccyx. in some cases the pouch measures two and a half inches in depth at the back and gradually diminishes in depth on each side as you near the anterior wall of the rectum. often the upper end of the anal canal is higher than the depressed circumference of the spacious cavity that almost surrounds it. the irritable orifice of the cavity will invariably compel a quantity of liquids and feces to lodge in the cavity as a permanent cesspool, allowing the absorbent vessels to absorb as much as they can by incessant work. the height or length of this abnormal cone-shaped rectal cavity is from two to three inches, involving usually the lower half of the rectum. the anal canal frequently becomes shortened by the dilating process to a quarter of an inch, leaving two frail, irritable muscles at the vent, to guard the rectal cavity. and fortunate are these two thin, sore, contracted muscles, and the possessor of them, if they escape the surgeon's barbarous notion of operating on them. if the medical butcher has operated on them, you will find an anal canal open to such an extent that two fingers can be inserted without distending the tissues in the least. and when the victim of ballooning of the rectum and ignorant operation makes further complaint to the surgeon of the aches and pains, he is consoled by being informed that the end of the spine will have to be removed. irreparable damage done and no aid at all received! it is a pity such ignorance on the subject should exist in the medical profession in this city. the abnormal cavity, so difficult to empty properly owing to its depth and diseased outlet, is seldom free from gases, feces and liquids. daily evacuations will not empty this cavity, nor will cathartics or diarrhea. a permanent cesspool of poisons is this, where all forms of poisonous germs are propagated, and infect the system by absorption. no use to take medicines for your _poor blood, bad complexion and horrid feelings_, as they will not cleanse the augean stable so long neglected. no use to journey to other localities for health so long as you carry so formidable a foe to health with you. the mucous membrane in the chronic state of the disease presents a rather dry, indolent and bluish appearance, except that here and there the tissues show more activity of the disease, more especially so over the anal region, due to harsher disturbance during the act of stooling. in the subacute or acute stage of the inflammatory process there is more general redness and puffiness of the mucous membrane, or a swollen condition with increased discharge of mucus and perhaps some blood. there is a heavy, uncomfortable feeling, with more or less soreness and pain, especially after evacuation of the feces. if a fissure or anal ulcer is present the pain is in proportion to its size and the general aggravation of all the diseased parts. itching or pruritus about the anus may accompany the trouble to a very annoying extent, being an evidence that the anal pockets are becoming much diseased. the partially constricted and irritable sphincter muscles become excited during the act of stooling and react on the anal grip or contraction, making it more intense. this latter condition may shut off the flow of blood in a local vein; and the blood becoming coagulated forms a painful bluish grape-like tumor at the external opening of the anus. abscesses may form at some portion of the diseased gut and result in an external fistula. piles may co-exist in some cases of ballooning, but are usually not annoying. it is the local anal or external annoyances that compel the sufferer to seek medical advice and aid, and he learns that the troubles complained of are only symptoms of a chronic disease, therefore easily removed without harsh treatment while the cause is being properly cured. it is very fortunate for the sufferer from ballooning of the rectum to have in or near the anal canal those painful hints or symptoms of a very grave and long existing disease whose constitutional symptoms were well marked but attributed to other causes, especially to disease of the liver--an organ of _so much solicitude_ that the poor liver-worshipping patient ought to receive more gracious response from it. in every case of chronic proctitis, or inflammation of the anus and rectum, the sigmoid flexure must be more or less dilated, as the upper part of the rectum is very irritable and contracted and inhibits the feces from passing beyond the sigmoid; but this irritability and contraction of the rectum, as a rule, is not nearly so severe as that of the anal canal, whose orifice is closed by very strong sphincter muscles. such being the pathological change in the sigmoid flexure and especially in the lower portion of the rectum, as described in these two chapters, who, with ordinary intelligence and an idea of cleanliness, would take or prescribe remedies to move the bowels, if it were possible to cleanse the foul capacious cavities with water? we know that they can be thus cleansed, and that it can be easily accomplished with benefit to the diseased canals. after the system has absorbed per cent of the fecal mass, a "remedy" is taken to excite a flow of watery excretions into the bowels, of which a portion will be retained in the colon, and especially the ballooned cavities, and reabsorbed; and every day the objectionable practice is repeated without any thought of the harm being done. the flushing of the rectum, sigmoid flexure and colon with water is not a _cure-all_, but it is one of the means of treating a grave chronic disease, a disease insidious and far-reaching in its poisonous effects on the human organism. chapter xvi. the usual diagnosis and treatment of bowel troubles wrong. herodotus tells us that among certain tribes when a man fell sick his next-door neighbor did not wait for him to become thin but killed him at once, lest by the loss of his adipose his flesh might be rendered less appetizing. but alas! in this age of constipation and piles, of self-generated poisons and self-infection, how changed is the custom! our next-door neighbor, the doctor, waits till we are really thin, and then begins to feed and grow fat on our ills! in our day, through the continuous process of self-poisoning we take on no flesh from puny, peaked childhood, or we insidiously lose what little flesh we had, and when our bones are well exposed, become alarmed, realize that we are sick, rush for the doctor, and dispossess ourselves of our spare cash. very frequently, as stated in the first chapter, auto-infection begins in infancy and slowly but steadily progresses, but it may not be before adult age is reached and one or more organs are seriously diseased that it becomes apparent to all. the vital round of the alternate building-up and breaking-down of the system has been going on unceasingly during these years of increasing infection, but prematurely the balance between up and down is lost in favor of down; the building-up process becoming feebler, slower, and the breaking-down process quicker, easier. what can the inevitable outcome be but _emaciation_ and _anemia_, and all their attendant suffering and consequences? it is the superabundance of vitality in the growing child that retards (inhibits) the morbid changes going on in the blood and tissues of the system; but the process is all the more insidious by being thus restrained, and its very subtlety and stealth beguile us all into fancied security: parents, friends, physicians--all are deceived. as stated in a previous chapter, the first unwelcome visitor, in infancy, is inflammation of the integument and mucous membrane of the anal orifice, invited by the uncleanliness involved in the use of diapers; and this visitor takes up its residence slowly along several inches of the lower bowel. its first symptoms are likely to be constipation, flatulency, colic, indigestion, bacterial and other poisons, occasionally diarrhea, and the usual general disturbance of the system as above detailed. it is admitted by all authors that inflammation of the anus, rectum, etc., is by far the most common disease that afflicts mankind at all ages; and i maintain that the natural result of such inflammation is a more or less extensive occlusion of the lower bowel, which in turn involves an undue retention of the feces, and thus we have the foul intestinal canal and stomach called gastric and intestinal indigestion. the wrong treatment of constipation, diarrhea, indigestion and auto-intoxication up to the present time has been due to improper diagnosis. writers on these subjects speak of them as causes when they are merely symptoms. and the remedies for these "causes" are even more numerous. _mistaken diagnosis on the one hand, measured doses on the other, and there you have the scientific doctor!_ the primary cause, inflammation, like the original spark applied to dry shavings, sets up morbid changes in the various parts of the digestive canal and the other organs of the body, and these "set up" or established changes are properly secondary or derivative causes accompanied by their own symptoms. the primary disease and symptoms may exist for five, ten, twenty or more years before any pronounced secondary or derivative diseases and their symptoms occur or are noticeable to a sufficiently marked degree. the chronic character of the malady, and the complication of primary with secondary diseases and their symptoms, have thoroughly disconcerted the doctors. hence the many "causes" assigned for indigestion, constipation, etc., and the many kinds of remedies prescribed with the one sure result, failure; and hence, also, not a few of the self- and drug-intoxicated ones dubbed, or actually developed into, hypochondriacs. diagnosis wrong, treatment wrong, failure certain, and the foulness of the intestinal canal continued! this is the experience and testimony of the many, many sufferers from the most common malady that afflicts humanity from infancy to old age, and which will continue to afflict the great majority until it is properly understood and treated. when a sewer of a town is obstructed, the most sensible plan is to begin the investigation at the outlet and then proceed up, section after section, to trace the obstacle that had occasioned the accumulation of debris. when the waste-pipes of a house are clogged, we do not expect the plumber to go to the top of the building and poke substances down the pipe to dislodge the unduly retained material some twenty-five feet or more away. nor would we believe him if he informed us that the sewer-gas and overflow of waste in the house were the _cause_ of the constipated condition of the drain. but just this is what the doctor declares concerning our sewer; just this is what he does when he doses it with laxatives, cathartics, purgatives. such is the treatment we receive when we rush to the doctor, or such the treatment we give ourselves. the poor, sensitive, inflamed canal is desecrated on all hands, though part of a house not made with hands--a house that should be a home for the soul of man. chapter xvii. costiveness. the words constipation, obstipation and costiveness are often employed as if of exactly similar meaning, but it is well to let each stand for a particular condition. obstipation implies that the canal of the intestine is stopped up or closed. constipation carries the idea that the canal is completely filled up with refuse matter. in the normal condition the intestine is divided by transverse bulges or valves or dams into a number of separate segments, the entire arrangement having the effect of preventing too rapid descent of the feces. these folds within the canal may become too much narrowed by disease and thus prevent the movement of the matters inside; this is obstipation. constipation, stuffing of the gut, may be the result of neglecting the call of nature, and after a time the ability to recognize and answer it is lost; or it may result from inflammation which itself comes from the bad habit mentioned. the author prefers to use the term costiveness for the general debased condition of the system from auto-intoxication depending upon proctitis and similar conditions of the intestinal tract. and it must be remembered that the same patient may have two or more of these conditions at the same time. constipation, obstipation and diarrhea may alternate through the progress of the case. we would expect people suffering from constipation or obstipation to pass as fairly well people for a time, but the same is not true of patients having the other condition, costiveness. as we may speak of the stages of a disease like consumption, so we may speak of these three conditions as different stages of one affliction, the worst being costiveness with its progressive self-poisoning by the products of intestinal decomposition. early in the case the system may pass these poisons out of the body with comparative ease, by way of the lungs, skin and kidneys. in time the second stage begins to make itself apparent, vitality becomes less and less, calling for a greater variety of medicines to correct the condition, as in the second stage of consumption, and also to arrest the progress of emaciation and anemia or anemic obesity. the third stage of auto-intoxication is a most unhappy one. the impoverished tissues offer a most favorable soil for the development of diseased conditions. these three stages which are clear to the experienced eye of the physician may to the patient seem to be indistinguishable, the one from the other; and it must not be forgotten that the three conditions do not mean simply that a smaller or larger part of the intestine is clogged by its contents, but that the whole system is involved as well. it cannot indeed be otherwise with the rapid circulation of the blood, nor need it excite wonder that such patients are thin and debilitated by the deadening of the powers of absorption, assimilation and elimination. as a rule the many thin and puny infants and children of either sex, with bony points well exposed under a tightly drawn skin, which latter is clay-colored and pimply; children with headache and languor, without healthy interest in either studies or play;--these are the victims of intestinal poisoning as described. if they have inherited a spare habit of body from their parents such bodily ills will manifest themselves the more quickly. they ought to be fat and hearty as are the young of animals, but alas many are not! when the young animal is spare, a few days of rest with good diet will put flesh on it, demonstrating that the state of the bowels and the powers of assimilation are intact. why does not man take on flesh in a similar way? if the intelligent animals could talk, they would undoubtedly make all manner of fun of the intestinal canals which they see walking about, with a little flesh here and there seemingly by accident, and a skin which is clay-colored or jaundiced, anemic or flabby, the owner of it all poisoning himself by decomposition in his intestines! chapter xviii. inflammation. if we desire to get a general idea of the changes that occur in an organ when it becomes inflamed, we must first have a knowledge of the normal structure of that organ, even though that knowledge be but superficial. taking the intestines, for example, we see under the microscope that they are composed of layers of different tissues, called connective, epithelial, muscle, and nerve tissue; the first two forming a large part of the structure. in the connective (and fatty) tissues a great many blood-vessels are found (varying in different parts of the organ), the existence of which is necessary for the production of inflammation, since at the very outset of the process, a discharge (or exudation) takes place from these blood-vessels, accompanied by changes or degenerations in the other kinds of tissue. the process of inflammation is commonly associated with symptoms of heat, redness, swelling and pain, in greater or less degree, combined with which a change in the function of the organ is soon noticed. micro-organisms are considered the primary cause of inflammation in many or even in most cases in which mechanical or chemical influences may undoubtedly be responsible primarily; and then again, each of these causes may be either external--that is, may originate from the outside world--or internal, that is, may be produced in and by the body itself. the first pronounced change occurring in an organ under inflammation is an increase in the rapidity with which the blood circulates through the vessels--a so-called hyperemia--which soon gives place to a diminution (stasis) in the current together with an exudation from the blood-vessels; the latter is due to changes in the structure of their walls. this exudation soon occasions a cloudiness of the connective tissues and at the same time a desquamation (shedding in scales) of the epithelia (cells of the thin mucous surface). an irritation of the nerves also takes place. the varieties of inflammation can be best apprehended by considering the different characters of the exudation. the exudation may be watery (called serous) or dense, the latter either fibrinous or albuminous. with a serous exudation there is swelling of the connective tissue and a desquamation of epithelia--the latter usually slight in character--which constitutes what is known as a catarrh; while with a fibrinous or albuminous exudation there is usually more or less destruction of the tissue itself, when, for example, we have "croup" or "diphtheria." when the changes in the epithelia are only slight and secondary, it is spoken of as an interstitial (lying between) inflammation, which strictly speaking denotes confined to connective tissue, and is therefore a term not entirely correct. when the inflammation of the epithelia is severe and may lead to their partial destruction, it is called a parenchymatous inflammation; that is, one involving the soft cellular substance. there is still another variety, the suppurative, which is the most intense of all, and indicates the production of an abscess and the entire destruction of the tissue implicated. beside these general grades of inflammation there are special sorts produced by specific micro-organisms. in all general inflammation we may expect to find such organisms, which in most cases belong to the class of micrococci, such as staphylococci and streptococci. in gonorrhea we have a special organism called the "gonococcus"; while in tuberculosis--a variety of inflammation in which the blood-vessels are completely destroyed and a change or degeneration called "cheesy" is produced, leading to the production of a tubercle--a rod-like bacillus is invariably found, the well-known and unfortunately too common tubercle bacillus. in syphilis--another special variety of inflammation--a specific micro-organism is also surely present, but of this microbe science has not as yet discovered the exact nature. the question of the origin of tumors or new growths is also an extremely important one; and it is undoubtedly true that many tumors arise where there was a previous inflammation, this being especially the case in tumors of the rectum. why such a growth should arise in some cases and not in others is as yet unknown, though microbes are held by many to play an important rôle. when an inflammation has lasted for such a length of time that it has become chronic, a new tissue will sooner or later be produced in varying amount; and this newly formed fibrous connective tissue may entirely replace previous normal structures. through the exudation and consequent changes in the normal tissue a large amount of mucus is at first secreted, but this secretion becomes less and less marked the more the inflammation causes a desquamation of the epithelia. pronounced desquamation with new formation of connective tissue and no fresh exudation will, sooner or later, occasion dryness--this dryness being sometimes very pronounced. the longer the inflammation lasts, the severer it will be; and the greater the amount of tissue it attacks, the more will the normal tissue be destroyed and replaced by a new connective tissue. a partial destruction will cause shrinkage of the organ (so-called "cirrhosis"); while a complete destruction of certain parts will result in what is known as "atrophy" (a wasting away of normal tissue). in atrophy the blood-vessels as well as the original connective and epithelial tissue are destroyed; while the newly formed tissue leads to hypertrophy (excessive over-growth) of other portions of the organ. such a hypertrophy must not be confounded with an induration that may be present later, or even at the very commencement of an inflammation, due to modification of the blood-vessels and surrounding tissues. chronic inflammation, sooner or later, leads to secondary degenerations, that is, new products of the protoplasm, the most common of which is fatty degeneration. in this form fat granules and globules arise, which are at first minute, later on larger; these in certain organs, such as the liver, may become so pronounced as to entirely replace the original tissue. another degeneration--which, however, is found only in chronic systemic disturbances, such as tuberculosis or syphilis--is the waxy or amyloid degeneration, a peculiar chemical change the exact nature of which is unknown. various chemical changes are by no means uncommon. an important question is the decision as to the length of time an inflammation has lasted; and this at best can be determined only approximately and after long experience. the older the inflammation, the more the connective tissue has developed; this connective tissue is at first soft, but soon becomes more and more dense; the result being a varying degree of hardness of the organs. again, secondary degenerations are more pronounced in long-standing processes. in comparatively fresh cases blood-vessels are still more or less numerous and the tissue appears red, while in older cases these vessels become completely obliterated, and the tissues take on a white, glistening color, becoming harder and denser as the years advance. if a process has lasted twenty or thirty years, the changes to the eye and touch are practically the same as after forty or sixty years. the changes, as here described, will be the same upon any mucous membrane; and in the large intestine can be easily studied and are perfectly characteristic. rarely does an infant escape repeated attacks of inflammation of the integument of the anus and the mucous membrane of the anal canal. the inflamed integument is treated and healed, but no attention is given to the inflamed mucous membrane so that the inflammation in time becomes chronic, involving the rectum also. should the infant be so fortunate as to escape inflammation (proctitis) of these organs during the wearing of the diaper, there are numerous other exciting causes of inflammation which it will not be likely to escape, hence the almost universal symptom of constipation among civilized people; and hence later in life you hear the familiar expression, "i have a touch of the piles," and many other complaints of bowel ailments that are usually the outcome of that deplorable inflammation. i have endeavored to make clear the fact that inflammation destroys normal tissues and blood-vessels, and that the newly formed tissue is cicatricial in character, that is poor in cells and vessels, with a tendency to contraction which of course lessens the bore of the gut. when the hypertrophy or thickening is extensive the appearance of the mucous membrane suggests the addition of one or more thicknesses of a chamois skin added to the inner surface of the anal and rectal canals. the hypertrophied or newly formed tissue may be limited to the rectum, leaving the anal tissues comparatively exempt from the superabundant cicatricial formation; or the hypertrophy may involve, to quite a degree, only the anal tissues and the integument around the anal orifice. the added connective tissue about the anus forms the skin into tabs, or into a circle of elongated integument around the orifice, with a mucous lining. these hypertrophied tabs or folds, like pruritus ani, are symptoms of proctitis. proctitis (the inflammation of the anal and rectal canals) is the most common and serious disease that afflicts man. the system is not only poisoned by bacteria and filth through proctitis, but proctitis is also the cause of the many annoying and painful local symptoms, such as hypertrophy, piles, abscess, fistula, cancer, polypus, fissure, pruritus, etc. when the subject of proctitis is better understood by laymen they will see to it that the rectums of children receive an examination before the children are six years old, and thus obviate the necessity of dosing them with all sorts of medicine that follow improper diagnosis. chapter xix. proctitis and piles. piles (hemorrhoids) are not the result of either the normal or abnormal growth of the tissues of the anal and rectal mucous membrane. they are developed by the combination of pathological and physiological conditions: ( ) chronic inflammation or proctitis; ( ) stricture of the anal canal and lower portion of the rectum, which may be spasmodic, or more or less permanent, which stricture pinches or constricts the canal, thereby inhibiting the circulation of the blood; ( ) the pressure or straining effort during the act of defecation, occasioned by the constricted canal, which effort brings on greater local congestion and constriction of the tissues. pile formations are a symptom of chronic proctitis of fifteen, twenty or more years duration. proctitis (inflammation of the anus or rectum) and periproctitis (inflammation of the connective tissue about the rectum) are by no means uncommon inflammatory processes. the mucous membrane like the skin is liable to injury or poisons and especially so at the orifices of the body. let inflammation set in: if it be not cured at once, it will invade the canal, especially a canal like the rectum; in which case it will establish itself throughout from six to ten inches of its length, sometimes taking in the sigmoid flexure and even the colon. just how long chronic inflammation confines itself to the mucous membrane before invading the areolar or lace-like connective tissue and the muscular tissue of the organ, i am unable to state. the first symptom or indication that all the tissues are involved in the inflammatory process will most naturally be constipation. you have observed that inflammation of a portion of the skin on the arm, trunk or leg does not disturb the muscular movements of the region involved, except when the muscles underneath the skin are affected also, as in the case of deep burns where the movements are very much disturbed by the irritability, soreness and contraction of the diseased muscles. there is also an adhesive product excreted from the inflamed tissue that binds the muscular fibres of an organ together, and you have contraction of the organ and its usefulness impaired. now, as this is precisely the pathological or diseased condition which chronic cases of proctitis and periproctitis present, you will readily understand how spasmodic and partial stricture or contraction occurs in the sore muscles (circular and longitudinal) of the anus and rectum. the length and the bore of the canal are diminished, and thus the circulation of the blood arrested by the pressure or gripping of the contracted muscles. this congestion of the blood brings about an anatomical change in the structure of the mucous membrane, which we call piles: a mere symptom of inflammation. medical authors have defined inflammation as follows: "( ) a series of changes constituting the local reaction to injury; ( ) a series of changes that constitute the local attempt at repair of actual or referred injury of a part; ( ) a series of local phenomena that are developed in consequence of primary lesion of the tissues and that tend to heal these lesions; ( ) the method by which an organism attempts to render inert the noxious elements introduced from without or arising within it; ( ) a disturbance of the mechanism of nutrition of an organ or tissue, affecting the structures concerned in its function." these effects or changes give rise to the five cardinal symptoms of inflammation: pain, heat, redness, swelling and impaired function (dolor, calor, rubor, tumor, functio læsa). proctitis may exist many years before the pain and heat become noticeable or are complained of by the victim of this insidious disease, the bodily symptoms of which are well expressed before the local trouble demands attention and treatment. the sufferer from proctitis is unable to detect the change from a normal color of the mucous membrane (a light, muddy gray) to an extremely abnormal one (a fiery redness). the swelling or puffiness of the mucous membrane becomes more marked as repeated attacks of subacute and acute inflammation occur, from year to year, over a period of twenty or more years. during all this time impairment of the function and structure of the anal and rectal canals is incessantly going on. the nervous and muscular spasmodic contraction of the diseased anus and rectum, which in time become more or less permanently constricted, steadily increases the stagnation and engorgement of blood in the dilated arteries, veins, arterioles, venous rootlets and capillaries. all of the circulatory vessels, especially the smaller ones, become enlarged, varicose; and an aggregation of varicosed vessels forms a tumor called a pile or hemorrhoid. inflammation interferes with nutrition of the anal and rectal tissues, rendering them friable or weak and easily broken; whence the bleeding and painful fissure or the anal ulcer, which so often are the outcome of proctitis and an accompaniment of piles. as already stated, piles are one of the symptoms of proctitis, and all cases of piles involve more or less irritability and contraction of the anal canal and the terminal portion of the rectum through which the fecal matter is forced. all the muscular ability of the rectum, assisted by straining effort of the abdominal muscles, is concentrated upon the feces to force it through the constricted portion of the lower bowel. the force exerted not only develops pile tumors, but carries out with the feces those tumors that had reached considerable proportions; thus the frail diseased mucous membrane is torn, and another symptom added to a chronic disease. observation for over twenty years has convinced me that chronic proctitis usually exists fifteen, twenty or more years before piles are developed (if developed at all), from daily pressure on the inflamed, congested, dilated, varicose, friable blood-vessels and surrounding tissue. piles are easily and quickly cured without any annoyance to the sufferer. chronic proctitis may be cured, but not quickly, as time is required to undo damage to tissues so long invaded by inflammatory process. any one that allows a continuance of "a touch of the piles," as the expression is, and omits to take proper treatment as soon as this "touch" is felt, simply invites or takes chances of some form of cancer of the lower bowel later in life. all other forms of disease of the lower bowel will yield to treatment satisfactory to physician and patient, but i am sorry to say cancer cases are numerous, and up to the present time we have no cure for this dreadful disease. if you value health, if you desire to avoid future suffering and disease, be sure that the lower bowel is free from inflammation, for with such freedom you will escape the many symptoms of proctitis described in my treatise on diseases of the anus and rectum. chapter xx. pruritus or itching of the anus. one of the many symptoms of proctitis is the existence of anal channels from which an inflammatory product exudes through the skin, causing painful itching of the skin around the anal margin and not infrequently around the buttocks to the distance of three, six or even more inches from the anal orifice. an aggravated form of pruritus ani is much more trying to physical endurance than severe pain. sometimes the torture is so great that a portion of the body will be covered with cold perspiration. the natural color of the integument about the anus slowly changes to a dull whitish appearance. as the pathological process goes on, the skin becomes thickened and parchment-like. in exceptional cases the mucous membrane of the anal canal becomes toughened and hardened like cardboard. as a consequence there is a degree of inertia in the muscular action of the parts affected. the inflamed, thickened and indurated integument near the anus takes on the form of folds, wrinkles or rugæ, of more or less prominence; but as these extend out over the buttocks they become more and more obliterated, leaving no clue to the direction of the channel which leads from the site of inflammation; which latter, however, may be learned from the itching, or from the burning sensation with some soreness, over portions of their length. during a practice extending over twenty years, i have found only two cases in which one of these channels was the seat of a slight abscess. it is not usual that pus formations occur in these inflammatory channels. at the margin of the opening from the rectum to the anal tube are five or six small crescent-shaped loops, semi-lunar valves, separated by vertical ridges (the anal columns). naturally in chronic proctitis the zone of tissue just above the sphincter muscles and slightly within their grasp at the upper portion of the anal tube, would suffer greatly from the morbid process, owing to the abnormal constriction of the tissues and to the incidental pressure and injury, from time to time, as the stool passes the diseased region. just under the mucous membrane covering the anal columns and semilunar valves is the fatty tissue forming a bed upon which the mucous membrane rests. it is sufficiently lax to permit considerable movement of the mucous membrane on the muscular coat beneath it. the frail, fatty, loose connective tissue in the grasp of the sphincter muscles would be the first to become impaired by inflammatory process, the product of which finds its way down and out under the mucous membrane of the anal canal and integument of the buttocks for quite a distance, occasioning itching, pain, soreness or burning in the integument covering the course of the channel. here we have the pathological reason why local remedies to the outer surface of the skin will not cure pruritus ani. also the reason why dieting is useless, and why internal remedies are worthless for the cure of anal itching; for the itching, as shown, is the result of an inflammatory product in the channels under the skin of the victim, numbering from five to twenty. over fifteen years ago i discovered the cause of the great suffering from painful itching at the anus and contiguous tissues and have been able to give instant relief, and in a little time permanent cure, in every case treated since then. it is well for those who have an occasional attack of pruritus ani to take treatment at once for proctitis proper, as well as for this symptom, itching resulting from these channels. the proctitis, if neglected, will only be the means of increasing the size, length and number of these channels. in chronic, sub-acute and acute stages of proctitis there is more or less secretion of inflammatory product; and often the sufferer is able to discover, in dejections from the bowels, a yellow syrup-like fluid, of the consistency of glycerine or white of egg, at times streaked with blood and purulent matter indicating ulceration. should the proctitis be cured and these channels remain, there may be sufficient inflammatory product in the channels to ooze through the skin to the outer surface, and excite itching; or if a portion of the channel escapes treatment, the same symptom may be expected at any time. the size and length of these channels are best determined by making a small opening into them through the integument, then inserting a silver probe in both directions, determining the distance under the mucous membrane of the anal tube and the distance under the skin of the buttocks. in some cases a few of these channels open into the rectum just above the internal sphincter muscles and become filled with water during the use of the enema taken to move and cleanse the bowels. as a rule, one end of the channel is under the mucous membrane of the terminal portion of the rectum, and the other somewhere under the skin of the anus or of the buttocks. i presume that no disease of the human body has been assigned more reasons for its existence, with the exception of constipation, than that mere symptom of a disease, anal pruritus; a symptom which "regulars" call a "disease," but "irregulars" know to be only a symptom. it is very amusing to observe how they fill pages in their text-books, guessing, wondering and paying their respects to the imaginary quack doctors, "who are reaping a harvest of ill-gotten gain." the usual medical writer is a compound of ignorance, egoism and garrulity, and this may account for the great crop of reasons for "diseases." however, the writers in question are not so much to blame after all, even though they do belong to county medical societies; for how can they well resist the literary itch with which most of them are afflicted? let them keep on writing while victims of pruritus ani wear out their weary lives scratching through weary nights--nights that extend into years, until permanent invalidism seems to be their destiny and end. who, verily, are the medical quacks? i will leave it to a jury composed of those who have been cured of pruritus ani. i have yet to meet the first case of pruritus ani that is without the presence of the channels above described. there may be cases of itching at the anus and these channels entirely absent, but i have yet to discover such a case and i very much doubt if it exists. i am happy to inform the reader that all cases of pruritus ani are cured with ease and without any restrictions as to diet, and without internal remedies for the blood, nervous system, etc., given by doctors that guess. the causes are easily discovered; the symptoms are easily found and removed; the victim of pruritus ani may therefore escape from the labyrinth of error of the medical authors and practitioners who ought to be educators instead of "obstacators"--obstacles and stumbling-blocks in medical progress. chapter xxi. abscess and fistula. in our daily affairs we take thought for the future and reason from cause to effect. we observe, anticipate, expect and suspect. this is a commendable practice, for it is the one that is most likely to lead to success. can we not acquire a similar attitude and habit in regard to our health? habit is sub-conscious attention. can we not give sub-conscious attention to the little details of such bodily functions as are liable to get out of order? can we not by a settled habit, that is, by the formation of a second nature, assure our vital success, on which the continuance of the enjoyment of life so much depends? if some part of a complicated machine gets out of order it must be repaired at once or damage may result to other parts of it. again, if our business accounts will not balance, the error must be found and corrected at once, or the evidence of it will annoy us sooner or later. why should not such prompt care and attention be given to the human mechanism, to the economy of vital functions? it is not often that we neglect disease of the hands, head, face or neck because the exposure of such disease to public gaze might embarrass us; but alas for the portion of the body out of sight, especially for the internal organs, when they fail to perform their functions normally. most of us allow the mechanism of the human body to shift as best it can and as long as it can, should it happen to become ungeared, ignoring the frequent warnings which the ever increasing morbid changes and wreckage give us. and then we surrender and succumb. what else can we do? our vital creditors file their claims in the high court of vital bankruptcy. what poor business policy, and what a wretched tenant! for fifteen or more years we may have had warning "touches of the piles," sometimes accompanied with indigestion, constipation, diarrhea and insidious auto-infection and occasionally with local symptoms in and around the anal canal and its external orifice; these to an intelligent tenant should have been evidence of proctitis, or worse, of periproctitis--inflammation of the connective tissue of the rectal tube. what have we done? we have disregarded the warnings of our ungeared, disordered machine, or else we have merely tinkered with it. the human factory receives less attention than does the commercial. soon, all too soon, the silver cord is loosed and the golden bowl broken, and just before that event, frightened, but too late, we do a little more tinkering under a doctor's direction, and spill the contents--of the golden bowl with which we were so careless--spill it into another world, to begin our folly over again! do you know that this occasional "touch of the piles" over a period of many years, and all that it involves, is a precursor and an invitation to the development of that deadly enemy, cancer--a worse disaster than financial ruin? it is my duty to utter a warning here. only one making a specialty of the diseases of the alimentary canal is aware of the frequency of the occurrence of cancer in the lower bowel resulting from chronic inflammatory process, induration, etc. i have been, again and again, shocked and alarmed at the reckless neglect that has brought on this as yet incurable disease--cancer. these remarks apply well to what i have to say on abscess and fistula at the terminal portion of the intestinal canal. it is the old, old story of being "touched by the piles for many years," and neglect, ending in dread and despair at the necessity of being bored full of holes by pus seeking an outlet. the victim wonders at the spread of the local trouble, and that an opening for the pus canals has frequently to be made three to sixteen inches away from the seat of the abscess. in a former chapter the subject of proctitis and piles was gone into, and some idea given of the invasion of inflammation in the rectal and anal tissues. in exceptional cases the exciting cause of anal and rectal abscess and fistula, or of abscess and fistula of the buttocks, may be a traumatic injury or accident, produced, say, by a blow or a fall bruising the tissues, or by sharp, hard substances--such as pieces of bone or nutshell--from within the canal, lacerating it. but wounds of this character are very infrequent compared with chronic inflammation (proctitis) as the exciting cause. there are several varieties of proctitis recognized as the exciting cause of abscess and fistula, namely, traumatic, dysenteric, diphtheritic, gonorrheal, catarrhal, etc. the reader should not only pardon me, but should be grateful if by adding another name to the list i point out the most common cause, namely, _diaper-itic proctitis_. as pointed out in the first chapter or two, the improper use of the diaper will evidence its deplorable result when the period of manhood or womanhood is reached, by some of the many symptoms of proctitis. proctitis may be considered as acute, subacute or chronic according to the duration of the process; or as atrophic or hypertrophic from the structural changes induced. but no matter about the cause and character of the proctitis, the question is, have you inflamed anal and rectal canals? if you have, then the very annoying symptom, abscess or fistula, is liable to occur any day. can you afford to take the chances? just under the mucous membrane of the anus and rectum there is a layer of loose, fatty, connective tissue, called areolar tissue. when it is invaded by inflammation, abscess and fistula may occur. on the outside of the rectal wall, at the terminal portion, there is also much loose, fatty (areolar) tissue filling the ischio-rectal fossa, which is very prone to suppuration, and inflammation here is called periproctitis. this is the most common and serious seat and source of the septic process, which process is usually the proximate cause of death after capital surgical operations upon the rectum. beside the abundance of fatty tissue--whose function is to serve as a cushion to the rectum at its terminal portion and at the back and sides of the wall--there is a triangular space in front of the rectum containing fatty areolar tissue, which space is often the location of a pus cavity. pus, like all fluids, follows the path of least resistance. the progress of imprisoned pus may take weeks, months and years before an abnormal communication between the abscess and the external portion of the body is completed. the imprisoned contents of the abscess cavity and the pus canal or fistula often give rise to much annoyance before finding an outlet. there will be pain in the muscles of the buttocks, called myalgia; and pain at the end of the spine, called coccygodynia. for this latter pain do not, i pray you, as is so often done, have your spine removed by the too ready surgeon. no need of it at all. you might just as sensibly have the muscles cut out for myalgia. pus in fistulous channels may burrow for several years through the muscular and connective tissue structures before finally forming an external opening through the integument; although its nearness to the surface is frequently marked by a localized puffiness and inflammation, which, however, may disappear for a time without forming an external opening. this condition of affairs results in periodical attacks of coccygodynia, myalgia and neuralgia of the buttocks and lower extremities. the important question with the victim of abscess and fistula is, "how did i get it? i don't care for the various and numerous names you give to these fistulas: what i should like to know is, how does it come about that i, an apparently healthy person, have such a nasty disease?" simply years of neglect, is my answer. neglect is due sometimes, and perhaps generally, to ignorance of the thing neglected. the laity can in large measure blame the medical profession for it, and especially those surgeons who have long made a specialty of the treatment of anal and rectal diseases. chapter xxii. the origin and use of the enema. pliny recorded the fact that "the use of clysters or enemata was first taught by the stork, which may be observed to inject water into its bowels by means of its long beak." the _british medical journal_, reviewing the newly published _storia della farmacia_, says that frederigo kernot describes in it the invention of the enema apparatus, which he looks upon as an epoch in pharmacy as important as the discovery of america in the history of human civilization. the glory of the invention of this instrument, so beneficial to suffering mankind, belongs to an italian, gatenaria, whose name ought to find a modest place together with columbus, galileo, gioja and other eminent and illustrious italians. he was a compatriot of columbus and professor at pavia, where he died in , after having spent several years in perfecting his instrument. the enema apparatus may be justly named the queen of the world, as it has reigned without a rival for three hundred years over the whole continent, besides brazil and america. the enema came into use soon after the invention of the apparatus itself. bouvard, physician to louis xiii, applied two hundred and twenty enemata to this monarch in the course of six months. in the first years of louis xiv it became the fashion of the day. ladies took three or four a day to keep a fresh complexion, and the dandies used as many for a white skin. enemata were perfumed with orange, angelica, bergamot and roses, and mr. kernot exclaims enthusiastically, "_o se tornasse questa moda!_" (oh, that this fashion would return!). the medical profession at first hailed the invention with delight, but soon found the application _infra dig._, and handed it over to the pharmacist; but shameful invectives, sarcasms and epigrams, hurled at those who exercised the humble duty of applying the apparatus, made them at last resign it to barbers and hospital attendants. (_year book of therapeutics_, wood, .) "the history of the warm bath," says dr. paris, "presents another curious instance of the vicissitudes to which the reputation of our valuable resources is so universally exposed. that which for so many ages was esteemed the greatest luxury in health, and the most efficacious remedy in disease, fell into total disrepute in the reign of augustus, for no other reason than because antonius musa had cured the emperor of a dangerous malady by the use of the cold bath. the most frigid water that could be procured was in consequence recommended on every occasion.... this practice, however, was doomed but to an ephemeral popularity, for, although it restored the emperor to health, it shortly afterward killed his nephew and son-in-law marcellus, an event which at once deprived the remedy of its credit and the physician of his popularity. "that the _warm_ and not the _cold_ bath was esteemed by the ancient greeks for its invigorating properties may be inferred from a dialogue of aristophanes, in which one of the characters says, 'i think none of the sons of the gods ever exceeded hercules in bodily and mental force.' upon which the other asks, 'where didst thou ever see a cold bath dedicated to hercules?' "thus there exists a fashion in medicine, as in the other affairs of life, regulated by the caprice and supported by the authority of a few leading practitioners, which has been frequently the occasion of dismissing from practice valuable medicines and of substituting others less certain in their effects and more questionable in their nature. as years and fashion revolve, so have these neglected remedies, each in its turn, risen again into favor and notice, whilst old receipts, like old almanacs, are abandoned until the period may arrive that will once more adjust them to the spirit and fashion of the times." (j. a. paris, _pharmacologia_, p. , new york, .) "a story told of voltaire," says dr. arthur leared, "well illustrates both the evil effects of constipation and the advantage of using the enema. the great philosopher was one day so miserable and dejected that he told a friend he had resolved to hang himself. his friend called the next morning to ascertain whether the resolve had been or was intended to be carried out. but voltaire only replied, with a smile, 'i have been well washed out this morning.'" (op. cit., p. .) for those suffering from chronic intestinal uncleanliness or constipation, an occasional intestinal wash-out, or bath, is quite as satisfactory as an "occasional" external bath or the "occasional" use of a cathartic medicine. if there is a necessity for cleansing and purifying the bowels at all, why not do it properly and systematically until the condition that made the artificial cleansing necessary is removed? who would tolerate the cleaning of dining-room, kitchen, dairy and other utensils in domestic use only when they became so foul that they could not be endured any longer without great annoyance? away with the "occasional" cleansing habit for either external or internal bodily cleanliness! there are persistent causes for internal uncleanliness, for the tardy action of the bowels, which require regular periods for cleansing until cure is effected. it is estimated that food taken into the stomach will reach the colon in five hours. for nineteen hours the sewage waste of the body is gradually becoming a fetid pool before an outlet is furnished it by the one-movement-a-day people; and o ye gods of health! how many of us there are that haven't even one movement a day! for a few hours the absorbent cells of the colon will try to extract as much of the nutritious residue as the system calls for, but along with it a lot of poisonous filth will be absorbed. the call of the system for nourishment should be fully answered by the small intestines. savages have four or five movements a day, and we certainly should not have less than three. people of refined sentiments will, at such a disclosure, bestir themselves to better things. water, when properly applied, is the only remedy that meets the physiological and pathological requirements of the chronically constipated. by its use the diseased, spasmodically contracted muscular tube is simply dilated, and the imprisoned feces and gases above are permitted to pass down and through the temporarily occluded section of the diseased bowels, the patient will have the consciousness of neatly accomplishing an imperative requirement, and the satisfaction which cleanliness entails. chapter xxiii. how often should an enema be taken? the following lines will show you how advertising is done in medical journals. "dear doctor: the spring being the time for cathartics, i beg to call your attention to r. l. (yellow label),..." why is spring a special time for cathartics? has the intestinal canal been obstructed like the erie canal during the winter months? with as much propriety they might advertise: "dear doctor: the spring being the time for bathing, i beg to call your attention to antiseptic bath soap,..." i suppose that a sort of annual cleansing of the alimentary canal is suggested so that the summer heat may be less objectionable, as it warms up foul bodies. however, attention once a year is better than none at all, as said of the augean stables. not long ago i had a conversation with the proprietor of a bath cabinet company, who had given some thought to hygienic measures, and he considered it essential to flush the bowels with water once a month to secure "proper cleanliness." this opinion is quite in advance of the annual cathartic cleansing. some people may have acquired the habit of a monthly cathartic "cleansing"; others wash out once a week, and a few once a day: all of them act from their idea of cleanliness, as they would perform the ablution of their hands, face and body. there are some hygienic students who have adopted the idea of "cleansing" the bowels with warm water once or twice a week, which practice is quite in advance of the annual or monthly attention. all have reasons for the manner and time they adopt to "cleanse" the bowels; and yet they find that they are not cleansed properly, as they still have spells of biliousness and misery. they wonder at themselves for being so rash and bold as to take an enema twice a week, and begin to feel that they have reached a point of positive danger. one anxiety is that they will weaken the bowels by the use of a pint or a quart of water once a month, or once or twice a week. another is that they will wash away the mucus, leaving the membrane of the bowels as dry as an oven. another is that they will form the dreadful habit of using the enemata. what a pity to form such a cleanly habit! sorry for them! another stubborn objection is, that flushing of the bowels is not natural. these foolish objections and fears can be attributed to medical authors who belong to medical societies. it is very strange how these authors adopt so many wrong notions about the physiology and pathology of the bowels. what an erroneous and absurd idea that the enema should weaken the bowels! why should it? exercise ought to strengthen muscular tissue; and what could give the bowels more gentle muscular exercise than the proper use of them? has the reader any idea of the amount of water requisite for the distention of an elastic muscular tube, about five feet in length and two and a half inches in diameter in the widest part? the large intestine is capable of great distention, as is frequently demonstrated in fecal impaction described in previous chapters. the quantity is named in gallons. the amount of water usually injected at one time--from one pint to two quarts--can hardly be said to distend the bowels at all. i wish the enemata did have power to weaken that part of the bowel involved in disease. i am very sorry it does not weaken it. for twenty years it has been demonstrated to my mind that almost every case of chronic constipation, biliousness, intestinal foulness, diarrhea, indigestion, self-poisoning (auto-infection or auto-intoxication) was due to too much activity and vigor of the lower bowels, this excessive activity and vigor being the result of chronic proctitis, colitis, etc. to lessen this muscular irritability, and to devise means to relieve and cure quickly, has cost me more studious hours than the aggregate of all the other diseases and symptoms of the lower bowels. if liquids washed away the mucus from the mucous membrane, the throats of many individuals ought to be very harsh and dry, inasmuch as six to eight glasses of liquids pass through their mouths and throats during every day of twenty-four hours. even after the "dry feeling in the throat and stomach" has been bountifully attended to by the owner, the conversation usually becomes more loquacious and hilarious, and there is no suggestion that the intemperate person had spent many hours in a hot desert without water. the frequent flushings they give their throats and stomachs really do not seem to wash the mucus away. when a person consults an oculist about an affection of the eyes and glasses are prescribed, good sense will inform him that the glasses must be worn while the imperfect functioning of the eyes requires them. if a limb be fractured and splints be applied, would you worry lest you form the habit of wearing them? certainly not; you expect in due time to recover the proper use of the limb. so if you are compelled to use crutches you do not worry about forming the crutch habit, for you will use them as long as needed and discard them at the proper time. as to its being unnatural to flush the bowels with water, i would say that it is very unnatural to suffer from proctitis accompanied with its annoying symptoms, such as constipation, indigestion, diarrhea, auto-intoxication, emaciation, anemia, muddy complexion, foul breath, blotches and pimples on the face, each and all of which indicate a physical debasement. it is unnatural to wear glasses, crutches, splints, wigs, artificial teeth, artificial eyes, but many people do such unnatural things. many of our habits are not exactly "natural," but they are rational, none the less; such, for example, as bathing the body night and morning; cleansing the mouth and teeth after each meal; and the nostrils and ears several times a day. the frequency of these practices may, with some people, be unnecessary and useless, but no real harm is done by their scrupulous cleanliness--physical and mental. proctitis is usually worse than it seems to be. this is because of the insidious progress of the inflammation during the fifteen, twenty or more years before the local symptoms at the anus or in the anal canal are sufficiently annoying to compel the sufferer to seek treatment. such sufferers are, as a rule, born with the idea that the liver regulates the whole alimentary canal; and if the sufferer has not this hereditary notion, his physician will soon impart it to him with his diagnosis and treatment. the disciple of cathartics, whether the cathartics be in the form of pills, powders, or solutions, or contain belladonna and opium to overcome the cramping pain the dose would otherwise occasion, has no legitimate reason to indulge in the hope of a cure or of even moderate relief of the real source of trouble--the proctitis. it is proceeding on the liver theory, when the key is, as has been shown in these articles, _proctitis_, inflammation of the anus and rectum. physicians ignorant of the key to all bowel troubles even prescribe strychnine in order to stimulate bowels which have already an excessive amount of stimulation due to the presence of the proctitis, which, as has been said, over-stimulates the lower bowels because of the inflammation. the chronic character of proctitis of many years' duration, improperly diagnosed and treated, must necessarily compel a rather long and continued use of the enema, especially so if not accompanied by proper local treatment of all the inflamed surface. i should not care to treat patients suffering from proctitis, constipation, etc., unless they used the enema twice a day. the feces and gases should escape the bowels at least twice in twenty-four hours. any less than two stools a days is abnormal and will result in infection and disease. you may not always succeed in having two stools when first treating the local disease, but what you properly start out to accomplish will be attained in due time. free evacuation of the contents of the bowels should occur at least twice in twenty-four hours. this can be accomplished by injecting into the colon from one to four quarts of warm water. before taking the large injection, relieve the bowels of any gas seeking liberation, and of course, also, of whatever feces may come readily. then take a small injection, using very little water: just enough to bring on a relief of as much feces and gas as possible. it is not well to drive the gas back and up into the colon; hence the precaution to suggest a further passage with a small quantity of water before taking the large injection. enemata, and also the use of the recurrent douche, can in no way be harmful--if the water be of a proper temperature--to a normal or even to a diseased bowel; therefore the fear of habit is absurd and should not receive a moment's consideration. the length of time during which the enemata and the douche are to be used, whether months or years, will depend on the character of the disease that made its use necessary. chapter xxiv. man's best friend. travel the world from end to end you ne'er will find a better friend than sparkling water, pure and free, most precious boon to you and me. it cheers the faint, it crowns the feast, makes food to grow for man and beast; in sickness soothes the fevered frame, there's healing in its very name. and what can more life-giving be than cooling breezes from the sea, whose bosom bears upon their way the stately ships from day to day? a treasure trove of priceless worth; a jewelled belt for mother earth, encircling with its silvery bands, she binds together many lands. to cure disease dame nature brings her remedy in mineral springs; water without, water within, equally good for stout or thin; and more than man can e'er devise invigorates and purifies. travel the world from end to end, you ne'er will find a better friend. chapter xxv. physiological irrigation. the scientific irrigation of land is pretty well understood by those who have financial interest in soil requiring it. the wonderful beauty and freshness of flower and fruit give evidence of what scientific irrigation can do. so from a commercial and esthetic point of view the proper amount of daily moisture for land, tree or vine, is of such importance that it receives the consideration of those interested. how many persons, however, in the course of a lifetime have given ten minutes to serious consideration of the question: _how much water should be imbibed daily under the varying conditions of the body's garden?_ those who give no consideration to the problem of how to attain and maintain a healthy and vigorous physical basis are persons who usually drift into habits for which they will, sooner or later, have to pay the penalty. for the first twenty or more years the body is, as a rule, unfortunate in not having an intelligent tenant. for man misuses his physiological estate, and lets things go to rack and ruin ere he wakes to realize how it might have been as to length of days and strength of body and mind. enlighten him, after he has reached adult years, on the values and needs of physiological and psychological functions; you will find that however eager he may be to follow the light he is handicapped by vicious habits and by confirmed, destructive changes which had seized on him when he was quite too young and incompetent to care for his body. what a topsy-turvy world this is, to be sure! it is astonishing what a number of people there are who drink little or nothing, and especially amazing is it to find this lack of sense in people suffering from constipation. one would suppose that they above all others would see the wisdom of irrigating their bowels. but it is seldom that there is one who thinks of such a thing. a cup of coffee or tea at meal-time, in addition to the liquid contained in the food, is the extent of water consumption by ever so many teetotalers and other "totalers," especially women, until they reach, say, thirty years of age. such persons as a rule are not long-lived, inasmuch as their power of resistance is small, owing to their lack of blood, a lack in quality as well as in quantity. the blood pressure in their arteries and veins is light, as evidenced by their pale, sallow complexion, and the dry, scaly, feverish skin, which seldom or never perspires. the body garden has not been properly irrigated and is slowly drying up as age advances. did you ever notice how like death such persons appear when they are asleep? their dull, pasty complexions alarm us then. when i see them a desire to soak these dried specimens of humanity possesses me. is it not unfortunate that we were not born with an automatic irrigator? we even lack a tube on our boiler to indicate the danger point! deficient by nature in these little conveniences, and unaided by science, man is compelled to give some attention to the irrigation of his physiological soil, however indifferent or careless he may be. planters and gardeners have treatises on irrigation. have mothers or nurses any similar guides? such books are unknown to modern civilization. infants, boys and girls, and adults are brought up haphazard, and their garden of life becomes choked with weeds. the drought soon makes itself felt, and a little graveyard mound is their usual fate. before some of us wither and fade, to what a pest-weed is our adipose changed for want of life-giving water. man's most serious physiological fault is the toleration of constipation; or even of semi-constipation induced by the twenty-four-hour habit of stooling. in other words, his fault is the toleration of intestinal uncleanliness. and next to this foolhardiness is his negligence in the matter of drinking daily a quantity of pure soft water sufficient to aid in the proper stimulation and circulation of the blood, in the proper elimination of the waste material from the body, and in the proper assimilation of nutriment by the system. if parents would encourage their children to become bibbers of pure spring water daily it would not be easy to make them bibbers of intoxicants in after years. i would give a child all the liquid it desires, i would even encourage it to take more rather than less, and the best liquid of all for this purpose is pure soft water. man's body is per cent water. it is therefore a good-sized water cask with a ramification of countless canals or pipes imbedded in soft connective tissues, nerves and muscles, all of which are supported by a bony framework; through the centre of this runs the alimentary canal, down which waters may flow and disappear like unto a stream lost in the sand, to reappear and ooze from skin, lungs, kidneys and intestinal canal. every organ and tissue luxuriates in water; they lave and live in and by it. with all kinds of food it is introduced into the body. water acts as a solvent for the nutritious elements and as a sponsor for the elimination of foreign substances and worn-out tissues of the system. it also serves to maintain a proper degree of tension in the tissues, which tension is essential to the proper circulation of the lymphatic fluids. the tonic reaction of externally applied water is well known. but the advantages of the internal use of water are hardly known at all because the reactions of the circulation, temperature, respiration, digestion and secretions are less noticed. two or three pints of cold water at a temperature of forty to forty-five degrees drunk at intervals of half an hour will reduce the pulse from eight to thirty beats. the copious drinking of cold water will act as a diuretic, removing stagnated secretions, and will at the same time improve the quality of the pulse and the arterial tone. the drinking of warm water will increase the pulse from five to fifteen beats, and at the same time will relax the vessel walls and also increase the cutaneous secretions to a marked degree. the drinking of a large quantity of water not only increases the secretions of the kidneys--assisting them in the work of carrying off solid constituents, especially urea--it also increases the secretions of the skin, saliva, bile, etc. under proper conditions the internal use of water acts as a stimulant to the nerves that control the blood-vessels, a stimulant similar to that produced by its external application. i advise the drinking of a copious quantity of water daily. there need be no fear that this practice will thin the blood too much, as the ready elimination of the water will not permit such a result to ensue. i would further advise the generous use of water (temperature °) at meal-times. i pray you do not drink to wash down food: a bad habit of most of us. drink all you desire; and if you are like many who have no desire for water, cultivate it, even if it takes years. the imbibed water will be in the tissues in about an hour; and the entire quantity will escape in about three and one-half hours. the demand on the part of the system for water is subject to great variation and is somewhat regulated by the quantity discharged from the organism. physiologists declare that water is formed in the body by a direct union of oxygen and hydrogen, but those who have cultivated the drink-little habit need not hope to find an excuse for themselves in this fact: chronic ill-health betrays them. water in organic relations with the body never exists uncombined with inorganic salts (especially sodium chloride) in any of the fluids, semi-solids, or solids of the body. it enters into the constitution of the tissues, not as pure water, but always in connection with inorganic salts. in case of great loss of blood by hemorrhage, a saline solution of six parts of sodium chloride with one thousand parts of sterilized water injected into the system will wash free the stranded corpuscles and give the heart something to contract upon. when water is taken into the stomach, its temperature, its bulk, and its slight absorption react upon the system; but the major part of it is thrown into the intestinal canal. when it is of the temperature of about ° it gives no very decided sensation either of heat or cold; between ° and ° it creates a cool sensation, and below ° a decidedly cold one. water at a temperature of about ° is a generator of appetite. a sufficient quantity should be taken for that end; say, one or two tumblers an hour or so before each meal, followed by some exercise. those who have acquired the waterless habit, and the many ills resulting from it, will hardly relish cool water as an appetizer; but if they would become robust they must adopt the water habit--a habit that will refresh and rejuvenate nature. water of a temperature between ° and ° relaxes the muscles of the stomach and is apt to produce nausea, especially if the effect of bulk be added to that of temperature. lukewarm water seems to excite an upward peristalsis of the intestines and thus produces sickness. hot water acts as a stimulant and antiseptic, as a sedative and as a food. water at a temperature of ° to °, or more, will nearly always relieve a foul stomach and intestines. it should be slowly sipped, so that the stomach may not be uncomfortably distended. after imbibing a pint or a pint and a half, wait for fifteen or thirty minutes to give it time to pass into the bowels, then drink more if thought advisable. drink it an hour before meal-time. it will excite downward peristalsis, will dilute the foul contents of the stomach, and will thus aid the escape of these contents into the intestines, which latter require the washing process as well. sometimes it is a good thing to omit one, two or three meals while the washing process is being continued. commence treatment with pure hot water. to make it appetizing, add a pinch of salt or of bicarbonate of soda; with children add sugar. it will pay you to follow this treatment for the cleansing of the alimentary canal. the vitality of the body may be sustained for days and weeks on water alone; there is therefore no hurry about food. if human beings would only keep their bowels and stomachs clean they would avoid all the ills that flesh is heir to, except, of course, those due to accident. my remarks have been confined to irrigation _per orem_ (that is, by way of the mouth), and nothing has been said of irrigation _per anum_ (by injection), since i have treated the latter subject fully in several previous chapters, to which the reader is referred. be sure to follow the counsel there given, and use the enema two or three times a day in moderate quantities as indicated. chapter xxvi. proper treatment for diseases of the anus and rectum very essential. no doubt the readers of the preceding chapters on proctitis and its numerous symptoms--noted under separate headings--would like to know something about the home treatment for such an insidious and grave disease. every sufferer wants to be a self-doctor. this commendable desire it is usually impossible to put into practice. if physicians so often fail to cure the ailments i have described, what can be expected of those who have no knowledge at all of diagnosis and treatment? a skilful physician is the choicest gem of civilization, and an intelligent patient its worthy setting. surely it is a moral crime, an inexcusable folly to tolerate a disease with its inevitable train of dire consequences, up to the point when the discomfort compels one to seek treatment. there are patients, of course, who have good and sufficient excuses for their painful predicament; they have, for example, tried persistently for relief and cure, but have failed to find a physician competent to treat their particular case. how many unskilled prescribers there are, and how glaring their shortcomings! some hold out taking inducements to sufferers; their one object being to transfer their patients' cash to their own pocket. 'twere charitable to consider these ignorant; but alas! many of them are poisoned by the "fakir" germ. stuff is sold by the conscienceless, claiming to cure "piles," to "give instant relief," and promising "a complete cure in a few days"; and as to itching piles, why! "only a few applications are necessary for a cure; six boxes for five dollars"! etc. no remedy that sufferers apply themselves can be more than a temporary relief: it cannot really cure piles, polypus, fistula, tabs, pruritus (itching)--all of them consequences of proctitis. of course one should be thankful for the little relief to be got temporarily from advertised and drug-store drugs; nothing more than relief can be expected of them. there are indeed times when a palliative treatment will serve to tide the sufferer over a few days until he is able to consult a competent physician. but how strange it is that so many sufferers regard their anatomy and physiology so lightly as to think of using remedies, even for relief, without first undergoing a thorough examination by a competent physician. in troubles of a rectal character it is exceedingly foolhardy to allow any one to prescribe without insisting upon a thorough examination to ascertain whether there be any disease of a cancerous nature present, or what the trouble actually is, and its progress. to expect one remedy or prescription to meet all the requirements for the cure of a chronic disease of the anus and rectum and of the many complications accompanying it is hardly sensible, but that is just what a great many do expect. no one remedy in the market, or any number of them combined can effect a cure, for the simple reason that proper local treatment by a physician is of paramount importance. unless of a traumatic (externally produced wound) origin, diseases of the anal and rectal canals are usually of fifteen, twenty or more years' incubation before the annoying symptoms become apparent. this accounts for the slight attention to the maturing trouble and for the fact that such attention can afford nothing more than a palliation or postponement. a real cure requires a combination of means, all working harmoniously for the proper length of time. proper treatment and the proper time are the two prime requisites; and the third and final requisite is, of course, a sensible patient. before home treatment is to be thought of it is accordingly advisable to have an examination and a prescription for the specific local treatment necessary for a trouble like piles, fissure, polypus, tabs, itching, fistula, varicose veins, abscess, ulcer, granulation, hypertrophy, or atrophy as the case may be. the local treatment can best be aided by a combination of remedies with suitable instruments for their use between the periods of local attention by the physician. the writer of this has no cure-all to send the sufferers, although it might be to his financial advantage to have one; he is, however, always ready to advise and relieve those who cannot visit him immediately. the relief afforded often facilitates the cure by permitting a more extensive local treatment at the first visit. _the use of instruments for injecting water._ to do something at home for one's self for relief from soreness and pain due to anal and rectal diseases, a few suitable instruments are required with which specific remedies may be used, especially that excellent remedy--water. it is unfortunate that the anal and rectal canals cannot be given rest when invaded by disease. daily elimination of feces is a very important factor to health and to treatment. to accomplish this the very best means is water in various quantities as the case demands. it does not irritate the diseased canals--as cathartics do--but aids in the escape of imprisoned feces and gases which lodge above the region of the morbid process. evacuation should be accomplished twice a day, by the injection at first of three or four quarts of water--thus obtaining a good daily flushing of one's sewer--and then, if advisable, gradually lessening the quantity at subsequent injections to one or two pints at a time. the temperature should be ° to ° or more. some people have an idea that water at the temperature named has a remedial effect on an inflamed anus and rectum. it has none whatever; all it does is to wash away the deposits which might irritate the inflamed surface. water at a temperature of ° to ° is not an especially good antiseptic; and its intestinal use should not be continued longer than to bring away the effete and fetid material which may be lodged in the colon, sigmoid flexure and rectum. in the majority of cases its use should be limited to aiding the feces to escape from their normal receptacle--the sigmoid flexure--whenever proctitis does not extend beyond the rectum. but many persons are deceived by the conduct of proctitis and are thus likely to omit the regular irrigation twice a day. they believe themselves to be in pretty good condition and do not realize that their old, implacable enemy may be excited into riot any day; in which case the insurrection may last for months and then slowly settle down to semi-quiet again, reaching finally the point of its best behavior for a short period or until again provoked. _the use of the recurrent douche._ water at a temperature of ° to ° properly applied is a good therapeutic agent in the treatment of proctitis. at that temperature it is an excellent antiseptic and astringent. its continuous use for half to one hour applied with a recurrent douche brings about a contraction of the engorged and dilated blood-vessels; and accompanied by local treatment and by other remedies is the best means known for restoring the nerves to their normal function of controlling the proper circulation of blood in the diseased organ. treatment with the recurrent douche is of course to follow, not to precede, the evacuation of the bowels; but at any time when there is a tendency toward additional evacuation on the admission of the hot water, the new douche is easily adjustable to the contingency without removal from the anal canal; it will facilitate the escape of the feces with the return flow of the water. the new recurrent douche has therefore the great advantage of promoting simultaneously both the thorough evacuation of the bowels, and the therapeutic effect of hot water. _sitz-bath._ there are patients who, because of years of neglect of their local ailments, are taken with severe attacks of inflammation of the anus and rectum, involving considerable prolapse, much swelling around the anus, and general local soreness and pain; all of which is often accompanied by a general disrelish of life. for this condition nothing is so good as a very hot sitz-bath, if properly adjusted to the parts and continued for about an hour at a sitting. the alleviation afforded is so decided and the local and prolonged application of hot water so restorative that it may be left to the sufferer to determine how often this bath is to be repeated. it may be taken as often as there is an inclination to do so. the sitz-bath apparatus should be scientifically adapted to the parts so that the bather will not sit lower than ten or twelve inches, thereby avoiding a straining position. during the bath there should be more or less pressure against the anal tissues, which assists the hot water in expelling the blood from the inflamed parts. from the beginning to the end of the bath the water must be as hot as the tissues will tolerate. only a small portion of the buttocks need be immersed in the hot water. _spring water the ideal beverage._ those who suffer from disease of the rectum, with rare exceptions, are constipated or semi-constipated, which condition in turn aggravates or disturbs the inflamed parts. to overcome this constipated condition all sorts of laxatives are taken, which will in the end do grave harm not only to the whole system, but especially to the inflamed parts, irritating them still more. there is a valuable therapeutic agent seldom taken by the constipated; in fact, it is never thought of; unfortunately the remedy is not easily to be had in its pure state by most of us, boxed as we are in cities. sold under various names as mineral water, it is too often adulterated. 'tis a simple remedy, and yet it has a wider range of healing power than any other; a universal solvent, applicable to all diseases and all states of health. i would write it at the head of all remedial agents: pure spring water! we do not drink enough water. if we were to imbibe at least two quarts of pure water daily we would be healthier and have better movements of our bowels. water may be taken freely during mealtime; not, however, for the purpose of washing down half-masticated food. alcoholic drinks, coffee and tea would better be dispensed with, also tobacco. the nervous system has enough to bear without the use of avoidable irritants. _other hygienic agencies._ too much cannot be urged as to the advisability of a proper amount of exercise, sleep, rest, food, breathing, cleanliness (internal and external), as well as and above all, pure, high-minded thoughts and serene temper--the outcome of the habit of viewing life philosophically. care should be taken to protect the feet and body from sudden climatic changes, thus avoiding catarrhal troubles, especially of the lower bowels. as to the wise and proper use of nature's pharmacopoeia, nothing need be said here. however, i may be within my limits when i advise patients to use a little sense and not neglect disease of the lower bowel any more than they would neglect that of the eye, ear and throat. in the latter case they submit at once to an examination. why not in the former? let them bear in mind that the cure of chronic proctitis is no holiday job; that it is, on the contrary, a task which requires constant attention. to merely relieve the annoying symptoms that accompany it cannot be called a cure. but on the other hand relief may be the commencement of a cure. of course the true way of looking at the subject of this disease is to regard the cure of proctitis as necessarily leading to the disappearance in time of all the other troubles that were the outcome of that ailment. through the harmonious efforts of patient and physician, marvellous results are often obtainable. chapter xxvii. the body's book-keeping. man's food is as varied as his work, more varied than the climate, with one food for the luxurious and one for the poor. the majority of us take what we can get, making no complaints; even when we have a cook and a good one the same is true. the ideal diet prepared by the ideal cook no one has as yet made fashionable, but one thing is within the reach of all--cleanliness of the sewers of the body. keep the contents of the bowels moving down and out steadily and regularly and you may eat almost any food and in almost any preparation and still be healthy. just as a steam-engine, running at a given rate of speed, must be supplied with fuel sufficient to maintain that speed, so the human body must have the requisite food to maintain the speed of civilized society and business, and replace the waste of the tissues; otherwise decline sets in and the reserve store of strength is exhausted. how shall we determine the proper amount and kind of food for the various ages, sexes, and conditions of life? a leading authority says that the character and amount of the daily excreta furnish suggestions as to the required food supply. (kirk's _physiology_, p. .) these excreta are found to be carbon, nitrogen, hydrogen, oxygen in great part, with some sulphur, phosphorus, chlorine, sodium, etc. a summary is given (_ibid._, p. ) of the expenditure for twenty-four hours: . from the lungs: carbonic acid about , grains water " , " . from the skin: water " , " solid and gaseous matters " " . from the kidneys: water " , " organic matter " " saline bodies " " . from the intestines: water " , " organic and mineral substances " " total daily expenditure: solid matters " , " water " , " altogether about eight and a half pounds. the credit side of the sheet is about as follows: solids (chemically dry foods) " , grains water, combined or otherwise , to , " oxygen, absorbed by the lungs " , " altogether about eight and a half pounds. with the proper balance between the intake and the outgo, the functions of the body will be carried on normally, but the balance must be a proper one; that is, not only must the entire waste be repaired but the correct proportions of one kind of food and another must be observed. if all the elements needed are not furnished there can be no true counterpoise. how do we expend the energy? by the common wear-and-tear incident upon all voluntary motion, all work and recreation, carrying on the internal movements of digestion and respiration, by thinking, by loss of temperature, by indulgence of any of our functions, and by any wrong indulgence especially. excessive use, voluntary or otherwise, will of course diminish our total capital and cut short our lives. could we always maintain the right balance we need never die. the importance of what has been said must now be clearly apparent. we ought to be wisely interested in choosing the proper foods for our daily needs and in having them properly prepared; we ought to know how much carbohydrates we need, how much proteids, and regulate our diet accordingly. the foods which contain nitrogen are chiefly the following: flesh of all animals, milk, eggs, leguminous fruits (peas, beans, lentils); those which contain carbohydrates chiefly are bread, starch, vegetables and especially potatoes, rice, etc.; foods supplying fat are butter, lard, fat of meat, etc. salts are furnished in almost all other substances, but especially in green vegetables and fruits. liquid food is obtained by water, too often neglected, and tea, coffee, beer, cider, etc. alcohol has no power to form tissue or to repair waste and cannot be regarded as a true food. tea and coffee are almost entirely stimulant, not nutritious, and should be taken sparingly or not at all. the common mistakes in diet are over-feeding or taking too much of one kind of food, and of the latter class perhaps an excess of starchy food is the most mischievous. if taken in excess, especially by the young, the starchy foods are not digested and what does not digest must putrefy: the result is a bowel distended with harmful gases. many people eat too much nitrogenous food, with resulting plethora or gout. a great deal of vigorous exercise in the open air is required to use up such a diet. chapter xxviii. selection and preparation of food. the requirements for normal digestion, assimilation and elimination are: ( ) an intestinal canal clean and sound from mouth to anus; ( ) nutritious food properly prepared; ( ) regularity and moderation in eating; ( ) free use of pure water, sufficient to forward the emulsification and assimilation of the food and the elimination of waste--whether that waste be of the residual portion of the food or of detritus of tissue; ( ) a seasonably clad body, free from fatigue or loss of sleep; ( ) a cheerful mind. every sensible person will grant that a good digestion of vegetable or animal food furnishes sufficient steam and stimulus for the physical man; that a good digestion of intellectual food (ideas) furnishes the corresponding requisites for the mental man; and that exalted sentiments are the pabulum of the spiritual. why over-stimulate the physical, and reflexively degrade the mental and spiritual, by indulgence in tea, coffee, beer, wine, liquors, opium, tobacco, etc.? over-stimulation will bring on indigestion; and prostration will follow that. remember that nature does not carry long credit accounts. a suggestion for the selection and preparation of physical foods is here given; this book being hardly the place for a corresponding list of mental and spiritual foods. foods easy of digestion. articles of food how prepared time of digestion venison steak broiled hour minutes pig's feet soused boiled " " brains boiled " " salmon, tripe or trout (fresh) boiled or fried " " eggs, fresh whipped " " rice boiled " " sago or barley boiled " " apples, sweet and mellow raw " " tomatoes or lettuce raw " " melons or watercress raw " " peaches, plums or pears raw or stewed " " oranges or bananas raw " " asparagus or dandelion boiled " " onions or apricots stewed " " mushrooms boiled " " cereal coffee boiled " " blackberries " " grape-nuts " " lemons " " watermelons " " doxsee's clam juice and little neck clams " " milkine, horlick's and mellin's food " " cereal milk " " armour & co.'s vigoral. " " valentine's or wyeth's beef juice or wiel's beef jelly " " foods not so easy of digestion. articles of food how prepared time of digestion beef boiled hours minutes pig, sucking roasted " " liver, beef (fresh) broiled " " lamb, fresh broiled " " turkey, domestic roasted or boiled " " " wild roasted " " goose " roasted " " chicken fricasseed " " codfish, cured and dry boiled " " oysters, fresh raw " " hash (chopped meat and vegetables) warmed " " eggs, fresh roasted " " " " raw " " milk boiled " " " uncooked " " gelatine boiled " " custard baked " " tapioca or barley boiled " " beans, green boiled " " sponge cake baked " " apples, sour and mellow raw " " " " " hard raw " " parsnips or green corn boiled " " potatoes and yams roasted or baked " " cabbage, head raw " " " " with vinegar raw " " cauliflower boiled " " peas (green) or squash boiled " " cranberries or cherries stewed " " rhubarb or figs stewed " " turnips boiled " " sprouts boiled " " raspberries raw " " dates raw " " buttermilk raw " " pumpkin cooked " " foods somewhat difficult of digestion. articles of food how prepared time of digestion beef, fresh, lean broiled hours minutes " " " roasted " " beef, dry roasted " " " with salt only boiled " " " " mustard, etc. boiled " " pork, steak broiled " " " recently salted broiled " " " " " raw " " " " " stewed " " mutton, fresh broiled " " " " roasted " " " " boiled " " flounder, fresh boiled " " oysters, fresh roasted " " " " stewed " " codfish (salted) or whitefish boiled " " sausages, fresh broiled " " rabbits broiled " " butter or cream " " eggs, fresh hard-boiled or fried " " " " soft-boiled " " potatoes, turnips or carrots boiled " " radishes or lentils boiled " " bread (white) fresh baked " " " whole wheat baked " " " rye baked " " " graham baked " " " corn baked " " corn cake baked " " apple dumpling boiled " " soup, mutton or oyster boiled " " " bean boiled " " " chicken boiled " " chocolate or cocoa boiled " " currants or filberts " " raisins " " hazelnuts " " peanuts roasted " " potatoes (sweet) roasted " " walnuts " " chestnuts roasted " " beans, lima boiled " " zwieback " " turkey boiled or roasted to hours eels fried " " oleomargarine " " cabbage boiled " " buckwheat cakes " " mutton, lean roasted " " herring broiled - / " - / " cheese - / " " foods very difficult of digestion. articles of food how prepared time of digestion beef, fresh, lean fried hours minutes " old, hard, salted boiled " " " recently salted boiled " " " " " fried " " " fat or lean roasted " " " suet (fresh) boiled " " " soup with vegetables and bread boiled " " beef, soup from marrow bones boiled " " pork, fat and lean roasted " " " recently salted boiled " " pork recently salted fried " " " ham cured " " veal broiled " " " fried " " mutton, suet boiled " " fowls boiled or roasted " " heart, animal fried " " salmon, salted, or mackerel boiled " " cabbage, with vinegar boiled " " cheese, old, strong raw - / to - / hours duck roasted hours " chapter xxix. diet for indigestion. indigestion is a symptom of a functional disturbance or is due to a local disease in some portion of the digestive apparatus. therefore diet must be adapted to the sensibility of the stomach and bowels, to gastric and intestinal secretions, mobility, absorption and elimination, to the abnormal increased feeling of hunger or to the absence of the sensation of hunger. the food should be of easy solubility and offer slight resistance to the digestive juices. it should not mechanically or chemically irritate or impede intestinal peristalsis. it should not increase fermentation or putrefaction and the greater portion of it should be absorbed. the object of diet is not to eat less food than usual but to secure more nourishment until the proper quantity is consumed each day. the restriction of foods does not mean limitation. regular hours for meals should be religiously observed by sufferers from indigestion. the food should be thoroughly masticated. good judgment should be used by each individual in selecting and preparing the foodstuffs; also in the amount taken at each meal, and the proper length of time to continue the diet. you may take: _soup_--in moderate quantity: doxsee's clam juice, and little neck clams; cream of peas, etc.; vermicelli; tapioca; tomato; clear soups of chicken, beef, mutton. _fish_: trout; bass; perch; shad; weakfish; whitefish; smelts; raw oysters. _meat_: roasted or boiled beef; mutton; venison; calf s head; tongue; sweetbread; lamb chops; squab; roasted partridge; pigeon; calf's-foot jelly; armour & co.'s vigoral; valentine's or wyeth's beef juice, or wiel's beef jelly. _eggs_: raw; soft-boiled; poached; omelette; eggs on toast. _bread_--all over a day old: brown; graham; gluten; rye; zwieback; crackers; cracked wheat; corn meal; hominy; wheaten and graham grits; rolled rye and oats; granose; cerealin; macaroni with toasted bread-crumbs; farina, boiled with milk; milkine; horlick's or mellin's food. _vegetables_: spinach; green peas; greens; lettuce; watercress; sweet corn; asparagus; celery; artichokes; baked tomatoes; cauliflower. _dessert_: baked, roasted or stewed apples; stewed pears or peaches; baked bananas; grapes; oranges; and most ripe fruits, if fresh. _beverages_: hot, cool or cold water an hour before meals. drink freely of the same during meal-time, but not to wash down food. drink also: cereal coffee; buttermilk; koumiss; fresh cider; bouillon. _avoid_: coffee; tea; milk; ice-water; cocoa; chocolate; malt liquors; spirituous liquors; sweet and effervescent wines; sugar; candies; foods containing much starch; rich soups; sauces and chowders; all fried foods; hot or fresh bread; griddle-cakes; doughnuts; veal; pork; liver; kidney; hashes; stews; pickled, canned, preserved and potted meats; turkey; goose; duck; sausage; salmon; salt mackerel; cabbage; radishes; cucumbers; cole-slaw; turnips: potatoes; beets; pastry; jellies; jams; nuts. chapter xxx. diet for constipation and obstipation. diet is too often a makeshift for ignorance, or it may be an aid until the cause of indigestion is removed; or if not curable, a compromise effected on the best possible terms for continued existence. we have found out the almost universal cause for constipation, obstipation and costiveness; therefore until you can have the proper local treatment we suggest the following foodstuffs, trusting to the sufferer's judgment how much and how often to take the nourishment. coarse foods, stimulants and laxatives unduly excite the bowels. avoid them if possible. be regular in your habits as to meal-times; eat three times daily, and about an equal amount at each meal. you may take: _soup_: all kinds of meat and vegetable soup; broth; bouillon. reliable preparations of beef juice, jelly, etc. _fish_: all kinds, broiled or baked; raw oysters; doxsee's clam preparations. _meat_: boiled or roasted; poultry; game, etc. _bread_: graham; brown; whole wheat; corn; rye; ginger; shredded-wheat biscuit. _cereals_: wheaten grits; wheatena; granose; oatmeal porridge; milkine; horlick's and mellin's food. _vegetables_: cauliflower; spinach; beans; asparagus; carrots; onions; brussels sprouts; tomatoes; peas; celery; cabbage. vegetables should be especially well cooked to render them soft and easy of digestion. _salads_: may be eaten if dressed with a generous supply of olive oil. _dessert_: oranges; melons; prunes; tamarinds; figs; apples (raw or baked); pears; plums; peaches; cherries; raisins; stewed fruit; honey; blackberries; strawberries; huckleberries; bananas. some may find it advantageous to eat fruit before or between meals. _beverages_: water--pure spring water preferably; if this cannot be had, get, if possible, distilled water that has been aërated; buttermilk; fresh cider; beer; ale. mineral waters like hunyadi, etc., irritate the cause of constipation (proctitis) in a way similar to cathartic remedies. drink a tumbler or more of hot or cold water an hour before meals--preferably hot water. if the hot water be distasteful add a little salt. drink freely of water about the temperature of ° during the meals, but not for the purpose of emptying the mouth of food. on retiring at night and rising in the morning sip slowly from a quarter to half pint of water (hot or cold). in the morning be sure to rinse the mouth free of the accumulated mucus before drinking the water. the use of tea, chocolate, coffee and alcoholic drinks is so abused by those even who consider themselves temperate in their habits, that i recommend these beverages as remedies only in certain conditions of the system. about four pints of pure water (_i.e._, free from all salts or other foreign ingredients) should be imbibed in twenty-four hours. _avoid_: sweets; pastry of all kinds; puddings; rice; milk; cheese; new bread; nuts; fried foods; rich gravies; farina and sago puddings; salt meats; salt fish; veal; goose; liver; hard-boiled eggs; pork; tea; tobacco; spirituous liquors; uncooked strawberries and huckleberries. avoid also tomatoes and peaches when not fresh, as the acid generated by keeping them a few days is very irritating to an already inflamed bowel. avoid substances that would inflame the tissues or cause congestion of any organ of the body. if the tongue be coated avoid sugar, starchy foods and fresh milk. chapter xxxi. costiveness, diet, etc. take anything in the way of food which the unconsciously starved person can eat without the stomach and intestines protesting too much; any of the foods recommended for constipation, indigestion, diarrhea; and take yet more food if by so doing there is a gain in flesh, after exercising much patience as to time. irrigate the system by imbibing freely of hot and cold water at various periods of the day. good red wine mixed with the water drunk at meal-time may serve a good purpose in helping to enrich the blood. keep the pores of the skin open by bathing; and all the functions of the body active by exercise, massage, pure air, sunlight, rest, sleep and seasonable clothing. the large intestines should be kept clean by proper amounts of water injected into them. the local cause of all the trouble should be treated by a competent physician. and with all the efforts, continue the treatment long enough to accomplish some good and then a much longer time to get well. do not give up treatment under which you have improved if it requires one, two or three years to accomplish what you have so well started out to do. chapter xxxii. diet for diarrhea. a period marked by constipation, biliousness or poisons generated within or taken into the intestinal canal is often followed by diarrhea. mental excitement will induce it in some persons. more often man's early and most common malady, proctitis, is the direct or indirect cause. some forms of ulceration of the lower bowel induce diarrhea. chronic cases of diarrhea usually follow the decline of vitality marked by the symptom of costiveness, which means the interruption of all the functions of nutrition. the intestinal canal is then like a rubber tube with the contents hurried through it. the whole system is irritable as the result of an accumulation of secondary symptoms expressed by the word auto-intoxication. the food should be nutritious and non-irritating to the intestinal canal. reliance must be placed, in severe cases, on liquid foods and beverages. the more solid foods may be taken in limited quantity as the recovery progresses. in more acute cases it is well to stop all food for twelve or twenty-four hours. you may take: _liquid food and beverages_: drink, if possible, pure spring water. if this cannot be obtained, sterilize the water, or distil and aërate it; it must be pure and soft. better still: drink toast- or rice-water; kefyr, four days old; koumiss; lactic-acid water; zoolak; egg lemonade; sterilized milk with one third lime-water; whortleberry wine; acorn cocoa; unfermented grape-juice. _soup_: chicken; mutton; clam; oyster broth; doxsee's clam-juice; bouillon; milkine; horlick's and mellin's food. _meat_: minced chicken; scraped beef; roast fowl; beef steak; fillet of beef; raw beef; sweetbread; raw oysters. _eggs_: lightly boiled, poached. _cereals and fruit_: grapes at all hours, eaten without seeds or skin; arrowroot; tapioca; sago; barley mush; macaroni; rice boiled with milk; milk toast; dry toast; crackers; junket; bread pudding; egg pudding, not sweetened; hasty pudding, with flour and milk; mashed potatoes. _avoid_: pork; veal; nuts; salt meats; fish; fried foods; sugary foods; fruits, cooked or raw; oatmeal; brown and graham bread; new bread; vegetables; and most soups. a final word to those to whom i have dedicated this book. it is very evident from the perusal of this work that the symptoms of proctitis, both general and local, proceed from no trifling disease; and also that the disease may have existed for a very long time, perhaps as much as twenty, forty or more years. during the greater part of its existence all sorts of medication have been tried to allay this or that annoying prominent symptom with a hope of a cure. at the congress of physicians that met in paris in , one of the subjects discussed was chronic constipation and their "wise" conclusion was that man needed more grease, therefore they mourned the loss of the frying-pan. symptoms induced by proctitis in various parts of the body are often accompanied by painful local symptoms, called piles or a "touch of the piles." then local medication is added to the general treatment, and as usual matters go from bad to worse. physicians consulted have been honest and kind, but with all their advice the increasing troubles continue. your demands grow more pressing on your doctor and as a last resort he mentions a surgical operation for the removal of one or more painful local symptoms. the fright is sufficient in most cases to make the sufferer endure the ills he has rather than flee to others he knows not, even risking life itself. others more bold submit to an examination by the surgeon, which proves so painful at the time and causes so much subsequent suffering that they are now really content not to importune any more for help. a few in desperation make up their minds to have the local anal symptom removed regardless of the final result. thus millions of human beings have suffered and died and countless numbers are enduring the ills they have, not knowing of a rational and humane system of treatment; a treatment that not only removes the numerous annoying symptoms, but _the cause as well_; a system that will stand the test of time, _of common-sense_, _of constant investigation_ to know the _why_ and _wherefore_ of both disease and treatment. for over twenty years i have concerned myself with this and allied ailments, and have treated--without the use of the knife--all cases of piles, polypus, fissure, stricture, ulcerations, etc. at the present time physicians are writing me in this wise: "i want to take a course of instruction from you. i have performed some successful surgical operations on the rectum, but it is not profitable; the people will not submit to it." another writes: "your treatment of hemorrhoids has been brought to my notice by my friend and patient, mr. ----. the method you practise is certainly an ideal one and seems to have been most successful in your hands, and i would like to adopt it." to physicians and laymen interested, i will send, for twenty-five cents, my treatise on diseases of the anus and rectum (entitled _how to become strong_). it contains over anatomical illustrations, and testimonials, and forms, therefore, a valuable adjunct to this volume. all whose testimonials appear in the -page book suffered from proctitis to a greater or less extent and with the exception of a few all suffered from chronic constipation, indigestion, etc. surgeons usually desire strong and vigorous patients. the author asks merely for an intelligent patient, or for some one to direct the home attention necessary between treatments. this book, as well as the one entitled _how to become strong_, and the author's other printed instructions, are the result of his desire to make his patients intelligent on the subject of the disease and symptoms for which they seek his assistance. they truly cannot know too much for their own good in this regard; an ignorant patient can not do justice either to himself or to his physician. those who have tried all the fads and so-called cures in order to relieve their troubles will certainly appreciate what i have here presented for their study. with enlightenment comes the desire to set things right. so i have no appeal to make to the lazy: i shall leave them to their ills and their pills. and for those who appreciate the beauty of cleanliness, both external and internal, i shall write another book on that subject, including a prophecy for coming generations. eternal vigilance is the price we must pay if we would enjoy the highest physical, mental and spiritual expression of our personalities. thanking the indulgent reader who has read my description of intestinal ills, i advise him to rewrite it in his own organism, if not in printer's ink: the world will be better for it! intestinal ills. no. . chronic constipation and the use of the enema. "civilized" man is the victim, by inheritance from distant ancestors, of undesirable characteristics, traits, and tendencies. while, during the long process of evolution, some of the cruder features of the physical and mental traits have been refined or eliminated, the modern man still clings to certain habits inherited from his wholly animalistic days. even as the man of that day, so the man of to-day eats far too much and far too frequently. to the scientific eye, your capacious digestive apparatus is a psycho-physical exhibit of the racial proclivity to overeat. here, in this exhibit, the race's inordinate craving for food and drink, its gluttonous thought, have embodied themselves; and this exhibit, this apparatus, is accordingly not merely physical, but also psychical, for its sub-conscious outreach for "more and always more" is only too apparent. man's stomach and bowels are too much like those of a mere animal, and are the source of nine-tenths of his ills. all great consumers of foodstuffs, nature declares, should walk on all fours; if you will persist in walking on your hind legs, you will have to pay the penalty. you will, moreover, contract other habits not conducive to real animal health. and, as nature predicted, man's social customs to-day are out of all accord with gluttonous feeding; he, as well as his capacious bowels, suffers the consequences of his excessive feeding, and this suffering leads him to adopt artificial means for relief or escape. up-to-date civilization has constrained man to adopt a cooped-up existence, one that shuts out, to a great extent, sunshine and air; an existence, moreover, that involves but a limited amount of exercise. how, then, can it be otherwise than--gormand that he is--that he should fare ill with this gluttonous, mammoth digestive canal? man is not as yet more than half human, and he will not become truly human until he makes more use of the upper lobes of his brain, nor until the spiritual part of his nature becomes dominant. when that day dawns he will have a corresponding evolution of the physical body, especially of the gastro-intestinal canal. some one has sagely said that man's brain is a mere extension of his intestinal canal. well, possibly by and by the intestinal canal may become an extension of a spiritually awakened mind, with all its dominating influence over the physical body. surely the evolutional trend from animal to complete manhood may be aided by intelligent foresight as to bodily care and hygiene. cooped up like a canary bird, or penned up and fattening like a hog, with his enormous eating capacity and vast intestinal storage space, poor man has matters made worse by having his several orifices liable to inflammatory invasions. he does not seem able to escape from his enemies anywhere. the mucous membrane lining the orifices of the body is nothing more than the skin turned in to line canals for air, gases, liquids, and solids to pass in and out in order to keep up the physio-logical functions of the body. very rarely, indeed, do we find, from childhood to old age, the orifice of the intestinal sewer otherwise than chronically inflamed, the invasion extending, moreover, the whole length of the rectum for some distance into the sigmoid colon. it is no trifling matter to have the function of some thirty feet of the gastro-intestinal tract disturbed, especially of the large intestine--some five feet in length, two and a half inches in diameter in not a few sections. almost without exception, we find the lower portion of the intestinal sewer the seat of chronic inflammation that extends into the sigmoid colon; and, as an inevitable result of the inflammation, contraction more or less permanent has taken place in the circular and longitudinal muscular bands that form its structure. the constriction is especially severe at the junction of the rectum with the sigmoid colon, where it flexes upon itself in the region where the bore of the rectum is less. the comparative shutting up of the caliber of the upper end of the rectum and lower portion of the sigmoid colon occasions undue retention of the feces and gases which accumulate, and in accumulating dislocate various portions of the large intestine, thus forming pouches, sacks, reservoirs, prolapse, etc., which hold the products of putrefaction as well as the irritating, poisonous mucus thrown out from the inflamed tissue. i regard the occlusion of the upper portion of the rectum, and especially of the region involved in the flexure of the bowel, as the most usual seat and source of constipation. not so very long ago it was the custom to stretch the sphincter muscles for the "cure" of constipation; at the present time the "cure" is found in the valves of the middle lower portion of the rectum. the folly of these "cures" becomes apparent when we understand that the parts treated were neither the seat nor the source of constipation. i have always regarded great retention of feces in the rectum as _impaction_ in a delivery canal, due to contraction of the anal muscles, not as constipation, which can only take place in the temporary storage-place--the sigmoid flexure. the lower two-thirds of the rectum plays no part in constipation of the bowels. form a manikin, made out of very thin, soft rubber tubing, to represent the stomach and small and large intestine, holding the various parts in place with elastic bands, and cotton to represent fat. when all portions are properly and anatomically placed close the lower eight or ten inches of the manikin, representing the lower portion of the sigmoid colon, rectum, and anus, just as tightly as we should find it closed in sufferers from chronically acute proctitis and colitis. now insert at the stomach portion of the manikin a generous amount of man's usual mixture of foodstuffs and liquids, and repeat the supply three or four times during the day (without any previous attempts at cleansing), and then note the fermentative and putrefactive changes that take place; the ensuing bacterial poisons and the great volume of poisonous gases--all of which occasion squirming, twisting movements of the manikin as dislocations here and there occur, as pouches and reservoirs develop, as the walls become distended with gas and putrid substance; and then, time elapsing, the usual foodstuffs are added to the foul mass within! now, if there is any pity in your soul, you medical man, for the enfouled and deformed human manikin, you will want to wash it out with cleansing water before its structure comes to an untimely end. we medical men all know the numerous and grave symptoms exhibited by one or more organs of the body, or by all of them, from the persistent work of the deleterious gases and bacterial poisons on the system--a work going on for years, finally placing the victim beyond medical aid. all of us are agreed that the capacious gastro-intestinal canal should be clean. what, i submit, is the best means of keeping clean this long, large, tortuous, spacious, valved and flexed canal--a canal that disease has here and there pouched, dislocated, bagged, reservoired; a canal at whose lower end a great cesspool exists; that, like other portions of the gut, is never empty and clean--what is the best means but a flushing with copious amount of water? proctitis or colitis is a very serious disease; like a railroad injury, it is found, on examination, to be much worse than appearances at first indicated. a physician who prescribes for a case of chronic constipation or diarrhea without first examining the sufferer for proctitis and colitis, is either ignorant or does wilful harm to his patient and injury to his practice. the abominable, aboriginal and almost universal custom at the present time of giving some physic to "cleanse" the gastro-intestinal canal is in every respect a deplorable mistake for a conscientious doctor to make. many persons suffering from chronic constipation drink very little or no water. as a consequence, they are a sort of dirty, dried-up plant, with but little juice of life in them. others, again, equally unclean, or more so, take a moderate amount of fluid every day, and present a more or less roly-poly appearance, with considerable abdominal distention, due to malnutrition and gases. of course, their eyes, skin, tongue, breath, and lack of vim and vigor tell the story of a long process of self-poisoning, with every now and then the eventuation of a storm of foulness, called a bilious attack--meaning an overflow of filth. death often brings about a radical change in such poisoned bodies. now, what can a prescriber of a gastro-intestinal ejector expect to accomplish by disturbing the maleconomy of this apparatus? usually he expects that considerable trouble will ensue; consequently, he will add belladonna or some other soothing drug to mitigate the act of expulsion. the ejector (called laxative, purgative, cathartic) occasions irritation, which sets up twisting, writhing, rumbling of the bowels, accompanied with a shower of liquid into the canal (as tears fill the eyes from the effects of sand or a blow), which liquid mingles again with the putrid refuse materials, from which it had been recently absorbed, and, mingling, proceeds to fill up the normal and abnormal spaces just described, _to be again reabsorbed into the system_. oh, the foulness of it all! the spirits of the departed, as well as the still incarnate patients, demand of the healing art safe and sane hygienic methods of cure. _the enema, regularly and properly used, is the remedy par excellence._ those that suffer from chronic constipation are usually deficient in the quantity and quality of intestinal secretions. physic increases the depletion of the intestinal juices. of the watery secretion forced into the bowels, four-fifths are reabsorbed into the system, plus poisons and filth. the system soon becomes accustomed to the irritation of drugs, and requires an ever-increasing amount. these irritate and increase the chronic inflammation of the lower bowel, often to the extent of a discharge of blood. straining effort to induce defecation is injurious. the use of massage, of vibratory exercises, of electricity; the spraying of cold water on the abdomen, etc.,--none of them are calculated to remove or even to relieve the proctitis and colitis. the temperature of the water used for an enema should be about one hundred degrees. it should be taken at least twice daily, preferably on retiring at night and soon after breakfast, at regular times, if possible. such practice obviates the need of large injections. in beginning the use of the enema it is well to inject from a half to a pint of water, and expel it. this constitutes a preliminary injection. frequently it is desirable to take another preliminary injection before taking the large one, which latter is variously called "flushing the colon," "taking an enema," "taking an internal bath" or "a washout," etc. it is essential first to get rid of the feces and gases in the rectum, so that they be not sent back when you proceed to flush the colon. no. . objections to the use of enema answered. the privilege of raising objections belongs to the ignorant as well as to the intelligent. but the objector is under as great obligations to state his reasons as the advocate. the _first_ plausible objection to the use of the enema is that it is not natural. admitting this charge, i should say that, inasmuch as proctitis, colitis, and constipation are unnatural, the use of a preternatural or, in other words, a rational means to overcome the consequences of these diseases is imperative. the enema is such a means. can any one that suffers from proctitis, etc., have a natural stool? unnatural conditions require preternatural aids, as we all know. the injected water dilates the constricted portion of the gut and arouses a revulsive impulse to expel the invading water. in obeying this impulse the imprisoned feces, gases, etc., are ejected with the water. it may be unnatural to put water into the rectum, etc., but once there its expulsion from healthy bowels would be quite natural. no natural action can be expected from unhealthy bowels; they do the best they can under the circumstances. eye-glasses, false teeth, crutches, etc., are unnatural but invaluable aids, but no more so than is the enema as a means of relief from overloaded bowels. the enema, moreover, be it noted, not only aids the system by relieving it of its loads; it cleanses and soothes an organ that must be kept at work and perform its functions even when invaded by disease. surely it is unhygienic and irrational to ignore the valuable service of the enema in cases in which the bowels are in an unnatural condition. the _second_ objection is that the water will wash away the mucus from the mucous membrane of the bowels and leave them dry and parched, and thus apt to crack and break in two. i would remind the objector that, since about per cent. of the normal feces is water, it seems strange that so great a quantity of water in contact with the mucous surface of the bowels should not also cause dryness. the integument of the body and that of the mucous membrane are similar in structure, yet whoever had a fear of producing dryness of the skin by much application of water? the mucous membrane is simply the skin turned inward; and since it is much more vascular it is less apt to become dry--if, indeed, its dryness were at all possible. the objector should also remember that the body is composed of over per cent. of water--an organism not to be made dry or parched by the application of water to the skin or to the mucous membrane two or three times a day. the mucous membrane of the lower bowel is not unlike that of the mouth, throat, or stomach. do you realize how often the upper end of the intestinal canal is washed or bathed daily with liquids, soft and hard drinks, hot and cold, especially by those who have formed the drink habit instead of the enema habit? they have no fear of drying the mucous membrane thereby; but if you can instil this fear they will increase the quantity with pleasure. this second objection, being the result of too vivid an imagination and too little reflection, is a very nonsensical objection indeed. a _third_ objection is that if you begin the use of the enema you will have to continue its use; you can't stop, and, lo and behold! the enema habit is formed--a new habit in addition to the many habits civilized man is already carrying; the constipated habit, the physic habit, the sand, bran, sawdust-food habit, the muscular peristaltic habit, etc.--and with all these habits the poor victim of proctitis and intestinal foulness wonders that he is alive. usually the first symptom of proctitis is constipation, and for relief the enema habit should be formed and continued while the constipation remains. when the proper means are found to remove the intestinal inflammation--proctitis and colitis--then the constipation will disappear, and with its disappearance the enema habit can be discontinued. but let it be well noted that the enema is itself an aid in curing the cause, an aid superior to any other at our command. a cleanly habit ought not to be an objectionable one, especially in cases in which it is most needed to prevent toxic substances from entering the system. a _fourth_ objection is that after taking the first enema the constipation is worse. with many persons a certain amount of undue accumulation of feces will excite a sufficient muscular effort of the gut to force the dried mass through the proctitis- and colitis-strictured bowels. this unnatural effort may occur once a day or once in two or three days, and has doubtless been a habit of many years' duration. to introduce a new order of conduct on the part of the bowels requires time. if the bowels have been in the habit of expelling feces in the morning, and an enema were taken the night before, there might be no desire to stool the next morning because of the fact that the bulk or accumulated mass of excrement was no longer there to create a vigorous call or impulse for defecation. but we have found the extent of local damage and reflex to the organs, and more especially the constant absorption of poisons into the system, due to the presence of feces. it is for this reason that the elimination of feces twice or thrice in twenty-four hours is advised. the condition for which an enema is used is one of disturbance and poison to the system. it is, therefore, a most unnatural condition. what is more rational, consequently, than to employ an "unnatural" yet not harmful means to bring about a more normal condition, one free from poisoning and irritating consequences? a _fifth_ objection is made by those who have as a symptom of proctitis a large development of pile tumors or hemorrhoids (distended mucous membrane). the objection is that at times these tumors or sacs prolapse very freely during the act of expelling the injected water. but this prolapse occurs in many cases whether water is used or not. a certain amount of anal irritation caused by the passage of feces occurs, causing contraction of the circular muscular tissue that forms the anal and rectal canal, also of the longitudinal muscular bands and the levator muscles of the organs. the enema lessens or entirely diminishes the irritation of passing feces, and the natural result is that the serum-filled sacs, called piles, and the tissue loosened by the inflammatory product will more readily prolapse during the act of defecating. it is simply a choice between irritation of the stool keeping the tissue up and no irritation permitting a prolapse. of course, if there be no expulsion of feces and water the stretched or dilated sacs may keep their places in the rectum. and then again, the enema may be used for quite a period, when all at once a large prolapse of sacculated mucous membrane occurs, and the enema is thought to be the cause of it. that this is not the cause, let it be remembered that in all cases of proctitis the chronic inflammation is apt to become subacute or acute, and that this intense engorgement and enlargement of the tissue with blood and the increased fever in the parts often result in prolapse at any time, especially at times of convulsive effort at evacuation. whatever follows the proper use of an enema, even though what follows be annoying, should not be blamed on the enema, for its action is most kindly, lessening as it does the irritation that otherwise would be more severe when the feces pass through a disease-constricted canal. the _sixth_ objection is that the use of the enema will weaken the bowels, which are already too "weak" to expel their contents. "atony, paralysis, fatty degeneration of the gut, are bad enough," say these objectors, "without having an enema increase their uselessness." diagnosis wrong and objection groundless. distend and contract an organ for a short time two or three times a day, and it will gain in strength from the exercise. every one knows that this is the case. what more gentle means of exercising the large intestines than by the enema? but the truth of the matter is that in all cases of proctitis and constipation the diseased portion of the gut is too active in its muscular movements, contracting spasmodically, as it does, at even the suggestion or suspicion of feces near it. every impulse of the bowels above the constricted section to force the feces down through the closed bore only intensifies the spasmodic action and increases the muscular obstruction, compelling the victim to resort to some one of the many drastic means of relief. the enema does no more than kindly to dilate the constricted region, which, when dilated, evokes a harmonious concerted action of all the nerves and muscles to pass along and down the burden of feces, which, without the aid of a flood of water, they had been incapable of moving, and would have had to leave to poison the system. the _seventh_ objection is quite naive: "inasmuch as the indians of this country had no use for the enema, why should we resort to it?" the all-sufficient answer to this objection is that the indians lived a natural life, while ours is artificial. much can be said on this point, but the reader is surely rational enough to follow out the distinction suggested. our lives are much more important than were the lives of the aborigines of this country, and our "demands of nature" are more exigent. if your life is of no greater value than theirs, for leisure's sake don't use the enema! you will be taking too much trouble. it really should seem that the cleanliness of the skin and mucous membrane, the care we take of our bodies, is an indication and measure of our sense of refinement. an ancient scripture hath it: "let those that are filthy, be filthy still." it all depends upon how you wish to be classed--with the filthy or the cleanly. the _eighth_ objection to be noted is the fear of "poking things" (points of instruments) "into the rectum." this looks like a real objection. no healthy nor even unhealthy organ, for that matter, should be "abused." and what seems more likely to cause it trouble than to poke a hard or soft rubber point or tube through its vent in opposition to its bent or inclination? still, the muscles of the vent are strong, and they soon accommodate themselves to the practice. their slight disinclination is not to be considered alongside of the relief and cure you effect by the use of the enema. have no fear that the point will occasion disease when intelligently used. always see to it that the point is scrupulously clean. those made of hard rubber or metal can be kept so without effort. soft rubber points are always foul and dangerous, especially after they are used a few times. a good rule is never to put a point higher in the bowel than is absolutely necessary. the _ninth_ objection seems serious. it is that in taking an enema the water escaping from the syringe point will injure the mucous membrane where the jet strikes. but on examination this objection falls to the ground, for it stands to reason the jet cannot directly hit the surface for more than a moment. immediately thereafter the accumulation of water will force the jet to spend its energy on the increasing volume, to lift it out of the way so that the continuous inflow may find room. but even were it possible for the jet to strike a definite section of the mucous membrane during the taking of the enema, it could do no harm provided the water be at the proper temperature. and this is true even if a hydrant pressure be used. not a few persons use the hydrant pressure of their houses in taking an enema. for a really successful flushing of the colon a considerable pressure is requisite to force the volume up and along a distance of five feet, especially when sitting upright. but it is folly to use a long syringe point, since it is like introducing one canal into another for the purpose of cleansing it. therefore, have no fear from the use of proper syringe points; the jet of water will not hurt the mucous membrane. my professional brethren at least ought to know that the idea of such harm is sheer nonsense. the _tenth_ objection to using an enema is in being obliged to use it from the fact of having such a disease as chronic inflammation of the rectum and colon. every victim hates to be compelled to do a thing, and the victim of proctitis and colitis is no exception to the rule. in fact, he is beginning to realize that unless he uses it his system will be poisoned by the absorption of the sewage waste. let the victim object to the disease that necessitates the use of the enema and he will shortly be well. then this objection to the use of the enema will indeed be the most important of all. the _eleventh_ objection, and the most ridiculous of all, is that it requires too much time to take the enema twice or thrice daily. i lose all patience with persons urging this objection. those that have little or no system with their daily duties seldom have time to do anything of importance. they suffer from "haphazarditis," a very difficult disease to cure, and they are in many cases hopeless. usually they are an uncleanly lot of people, full of good intentions, but their intentions though taken often, seldom operate as an antidote to foulness. their one sigh the livelong day is: "oh, could we be like birds that can stool while on the wing or on foot!" this feat of time-saving being hardly possible in the present incarnation and order of society, they content themselves with making a storehouse out of the intestinal canal for an indefinite length of time as they concern themselves with external affairs of work or sport. a sorry lot they are indeed when they are laid up for repairs. many doctors, i am sorry to say, encourage with a chuckle this foolish practice. "any time to stool you can manage to get, so that you stool at least once a day, or once in every two or three days; stool when it is normal for you to do so." this criminal advice just suits the sleepy, the lazy, or the "awfully busy." the american habit of doing things en masse, of handling things in large quantities or in bulk, has something to do with their don't care constipated habit. small evacuations two or three times a day seem too much like small business, which, of course, is a waste of precious time. wholesaling, laziness, lack of system, hurry, are the cause of good-for-nothingness of body and mind. _it should never be too much trouble to restore the lost impulse for stooling twice or thrice daily._ is it a small matter to have the main sewer of a city partly or entirely closed, or the main sewer pipe of a dwelling stopped up? think of the dire results, notwithstanding that the windows and doors remain wide open! the board of health would soon deal with the negligent official or landlord. with very few exceptions, "civilized" men, women, and children are negligent and niggardly caretakers of the human dwelling place--the marvellous body of man. "lack of time," "haven't the time," or "no time," is the excuse they give themselves and others. notwithstanding the numberless victims around them, none of these negligent and niggardly ones seem to get alarmed until the secondary symptoms, such as indigestion, gout, rheumatism, or disease of some vital organ, are sufficiently annoying to demand attention. but i have full faith in humanity. man does the best he knows how, as a general rule. but often he doesn't know how; he needs enlightening. the hints i have given will, i am confident, be considered and acted upon by all to whose attention they are brought, for by acting upon them, normal bodies and minds will result, and blessings attained heretofore considered impossible. normal health depends on right doing and being. eternal vigilance is the price to be paid for the attainment and maintenance of the goal of normal life and progress. eliminate all waste material from the body and all shifty vermin from the mind, and the millennium for all things in the universe will soon dawn. fourteen reasons why we should bathe internally as well as externally . because very few persons are free from chronic inflammation of the anus, rectum, and sigmoid flexure, which causes contraction of the caliber of the organs. . none escape self-poisoning from the gastro-intestinal canal. many are constantly being poisoned from the entrance of bacterial and other toxic substances into the system. . nine-tenths of the ills that afflict mankind have their origin in a foul digestive apparatus and a consequently poisoned body. . disease of the anus, rectum, and sigmoid flexure results in from two-thirds to three-fourths of the feces being daily absorbed into the system. . feces unduly retained become very foul or malodorous. if the feces of birds and domestic fowls and animals were as obnoxious as that usually ejected by man their discharges would require immediate removal from human neighborhoods. . man is the only creature that has formed the habit of making a fecal cesspool of his large intestine; hence his diseases of many varieties. there is nothing wholesome about him and he is quite destitute of vim, vigor, and push. the fecal poisoning of his parents is stamped upon him, and the unhygienic condition of his bowels makes matters worse. . man needs to form the habit of stooling as frequently as birds, fowls, and quadrupeds--at least as many times in twenty-four hours as he partakes of food. . making a reservoir of the lower bowels is not a time-saving habit, but, on the contrary, a breeder of many poisons, causing all sorts of acute and chronic diseases, which demand much time and attention, as countless numbers know to their sorrow. . you are a factor in the social and business world; then why not look, feel, and be your best by simply adopting internal hygienic measures? . by the use of the internal j.b.l. cascade bath you can secure two or three stools a day, as desired; and while you are preventing self-poisoning you are regaining a normal habit and natural health, which for so many years and generations have been denied you. do not longer perpetuate the dire results of a foul alimentary canal and consequently diseased body. . all desire to be strong and healthy, and many would add beauty of form and complexion, which is also commendable. this can be attained by preventing disease through hygienic attention and the proper use of water. . the gastro-intestinal canal is a physiological, moving food supply for the body, and, like any other vessel that has contained fermenting substances, it should be emptied and cleaned before a fresh supply is put into it. this is only a sensible, reasonable, and cleanly duty to one's self. . who can fear being made sick by adopting cleanly habits? you have perhaps tried all other means to keep well, and have failed; now try intestinal cleanliness--a method you should have thought of long ago. . every one desires to avoid surgery, the taking of numerous medicines, and the spending of money in that way--and they _can_ be avoided if you keep _clean_, both internally and externally. * * * * * you're not healthy unless you're clean inside and the one way to real internal cleanliness--by which you are protected against ninety per cent of all human ailments--is through _proper_ internal bathing, with plain antiseptic warm water. there is nothing unusual about this treatment--no drugs, no dieting--nothing but the correct application of nature's own cleanser. but only since the invention of the j.b.l. cascade has a means for _proper_ internal bathing existed. only one treatment is known for actually cleansing the colon without the aid of elaborate surgical apparatus. this is the internal bath by means of the j.b.l. cascade prof. metchnikoff, europe's leading authority on intestinal conditions, is quoted as saying that, if the colon and its poisonous contents were removable, people would live in good health to twice the present average of human life. dr. a. wilfred hall, ph.d., l.l.d., and w. e. forest, b.d., m.d., two world-famous authorities on internal bathing, are among the thousands of physicians who have given their hearty and active endorsement and support to the j.b.l. cascade treatment. fully half a million men and women and children now use this real boon to humanity--most of them in accordance with their doctor's orders. let dr. tyrrell advise you dr. tyrrell is always very glad of an opportunity to consult freely with anyone who writes him--and at no expense or obligation whatever. describe your case to him and he gives you his promise that you will learn facts about yourself which you will realize are of vital importance. you will also receive his book, "the what, the why, the way," which is a most interesting treatise on internal bathing. consultation with dr. tyrrell involves no obligation. charles a. tyrrell, m.d. w. th street, new york if you suffer from rough, scaly, cracked skin if you value a good complexion dr. tyrrell's health soap effectually disposes of troubles. it is refreshing, purifying, invigorating among the necessities of life there is one to which few people pay the attention they ought, and that is soap. yet it is undoubtedly a most important matter, for the skin is a very delicate and sensitive organ, and the constant application of impure or inferior soaps injures its texture, and gives rise to numerous cutaneous troubles. most people are content, so long as it appeals to the eye and the sense of smell, without stopping to consider that perfumes may be employed to hide defects. dr. tyrrell has given this matter long and profound consideration and now offers to the public a soap that leaves nothing to be desired. it is not only absolutely free from any deleterious substance, but is a perfect antiseptic and healing soap. its use thoroughly cleanses and invigorates the skin, keeps it soft, flexible and healthy, and effectually prevents rough, cracked and scaly conditions. it is invaluable for tan, freckles, sunburn, etc., and is a perfect hygienic safeguard against cutaneous disorders. it is a positive pleasure to use it for the toilet or bath, as it leaves such a grateful, refreshing after-effect. as a shaving soap it is unequalled, absolutely preventing those disagreeable results that frequently follow the use of impure soap. cents per cake manufactured solely by charles a. tyrrell, m.d. formerly president of tyrrell hygienic institute w. th street, new york city sufferers from catarrh there is glorious news for you. no matter how much you may suffer from that most distressing and inconvenient complaint, a speedy and effective release from your sufferings is now offered to you. the j. b. l. catarrh remedy is one of those sterling specifics whose curative effects are quickly realized on the first trial. it is intended to be used in connection with the flushing treatment, and the two used in conjunction rarely fail to effect a cure. catarrh is first caused by inflammation of the membrane of the nasal cavities and air passages, which is followed by ulceration, when nature, in order to shelter this delicate tissue, and protect the olfactory nerves, throws a tough membrane over the ulcerated condition. flushing the colon lays the foundation for recovery, but the membrane must be removed, and for that purpose the j.b.l. catarrh remedy is without an equal. it is composed of several kinds of oils, and gently, but effectually, removes the membrane that nature has built over the inflamed parts, while its emollient character soothes and allays the inflammation. these drugs are not absorbed into the system, but act only locally. the most obstinate case will readily yield to this treatment. the price is one dollar per bottle, which, in view of its marvellous curative power, is a veritable gift, and with each bottle we furnish an inhaler specially manufactured for the purpose. two bottles will usually effect a cure--though one has been frequently known to do so in mild cases--but in the event of any one taking six bottles without being cured, we will forfeit one hundred dollars, now deposited in the lincoln trust co. of new york, if they can honestly make oath that they have faithfully used the remedy according to the directions, and have received no benefit from it. you cannot afford to neglect this opportunity of ridding yourself of this most distressing complaint, which, if neglected too often leads to consumption. _delays are dangerous._ charles a. tyrrell, m.d. formerly president of tyrrell's hygienic institute, west th street new york the j.b.l. antiseptic tonic should always be used when introducing water into the intestines. the use of this preparation renders the water completely sterile unless it be notoriously impure. such water should never be used. but the antiseptic tonic possesses another important property which is most valuable in cases of constipation, for it acts as an admirable tonic on the muscular coat of the colon, strengthening it and restoring it to normal. for these reasons it is invaluable. owing to the importance of using the tonic, i have arranged to make it as inexpensive as possible and am prepared to furnish it (to users of the cascade only) in one pound air-proof cans at the price of $ . ; by mail twenty cents extra. you can buy this at your druggist and save mail charges. charles a. tyrrell, m.d. west th street, new york city none none [illustration: the southern hound.] the dog, by william youatt. with illustrations [illustration: head of bloodhound] edited, with additions, by e. j. lewis, m.d. member of the academy of natural science of philadelphia; of the philadelphia medical society; of the parisian medical society, &c. &c. . entered, according to the act of congress, in the year , by lea and blanchard, in the clerk's office of the district court of the united states for the eastern district of pennsylvania. * * * * * list of illustrations. the southern hound head of bloodhound ancient sculpture of greyhounds the thibet dog the dingo, or new holland dog the hare indian dog the danish, or dalmatian dog the greyhound the grecian greyhound blenheims and cockers the water spaniel the poodle the alpine spaniel, or bernardine dog the newfoundland dog the esquimaux dog the english sheep dog the scotch sheep dog the beagle the harrier the fox hound plan of goodwood kennel the setter the pointer the bull-dog the mastiff the scotch terrier skeleton of the dog dog's head confined for an operation dog's eye prepared for an operation teeth of the dog at seven different ages * * * * * preface of the editor. the editor, having been called upon by the american publishers of the present volume to see it through the press, and add such matter as he deemed likely to increase its value to the sportsman and the lover of dogs in this country, the more readily consented to undertake the task, as he had previously, during the intervals of leisure left by professional avocations, paid much attention to the diseases, breeding, rearing, and peculiarities of the canine race, with a view to the preparation of a volume on the subject. his design, however, being in a great measure superseded by the enlarged and valuable treatise of mr. youatt, whose name is a full guarantee as to the value of whatever he may give to the world, he found that not much remained to be added. such points, however, as he thought might be improved, and such matter as appeared necessary to adapt the volume more especially to the wants of this country, he has introduced in the course of its pages. these additions, amounting to about sixty pages, will be found between brackets, with the initial of the editor appended. he trusts they will not detract from the interest of the volume, while he hopes that its usefulness may be thereby somewhat increased. with this explanation of his connexion with the work, he leaves it in the hope that it may prove of value to the sportsman from its immediate relation to his stirring pursuits; to the general reader, from the large amount of curious information collected in its pages, which is almost inaccessible in any other form; and to the medical student, from the light it sheds on the pathology and diseases of the dog, by which he will be surprised to learn how many ills that animal shares in common with the human race. the editor will be satisfied with his agency in the publication of this volume, if it should be productive of a more extended love for this brave, devoted, and sagacious animal, and be the means of improving his lot of faithful servitude. it is with these views that the editor has occasionally turned from more immediate engagements to investigate his character, and seek the means of ameliorating his condition. philadelphia, october, . * * * * * table of contents. chapter i. the early history and zoological classification of the dog ii. the varieties of the dog.--first division iii. the varieties of the dog.--second division iv. the varieties of the dog.--third division v. the good qualities of the dog; the sense of smell; intelligence; moral qualities; dog-carts; cropping; tailing; breaking-in; dog-pits; dog-stealing vi. description of the skeleton. diseases of the nervous system: fits; turnside; epilepsy; chorea; rheumatism and palsy vii. rabies viii. the eye and its diseases ix. the ear and its diseases x. anatomy of the nose and mouth; and diseases of the nose and other parts of the face. the sense of smell; the tongue; the lips; the teeth; the larynx; bronchocele; phlegmonous tumour xi. anatomy and diseases of the chest: the diaphragm; the pericardium; the heart; pleurisy; pneumonia; spasmodic cough xii. anatomy of the gullet, stomach, and intestines: tetanus; enteritis; peritonitis; colic; calculus in the intestines; intussusception; diarrhoea; dysentery; costiveness; dropsy; the liver; jaundice; the spleen and pancreas; inflammation of the kidney; calculus; inflammation of the bladder; rupture of the bladder; worms; fistula in the anus xiii. bleeding; torsion; castration; parturition; and some diseases connected with the organs of generation xiv. the distemper xv. small-pox; mange; warts; cancer; fungus hæmotodes; sore feet xvi. fractures xvii. medicines used in the treatment of the diseases of the dog appendix. new laws of coursing index. * * * * * the dog. chapter i. the early history and zoological classification of the dog. the dog, next to the human being, ranks highest in the scale of intelligence, and was evidently designed to be the companion and the friend of man. we exact the services of other animals, and, the task being performed, we dismiss them to their accustomed food and rest; but several of the varieties of the dog follow us to our home; they are connected with many of our pleasures and wants, and guard our sleeping hours. the first animal of the domestication of which we have any account, was the sheep. "abel was a keeper of sheep." [ ] it is difficult to believe that any long time would pass before the dog--who now, in every country of the world, is the companion of the shepherd, and the director or guardian of the sheep--would be enlisted in the service of man. from the earliest known history he was the protector of the habitation of the human being. at the feet of the 'lares', those household deities who were supposed to protect the abodes of men, the figure of a barking dog was often placed. in every age, and almost in every part of the globe, he has played a principal part in the labours, the dangers, and the pleasures of the chase. in process of time, man began to surround himself with many servants from among the lower animals, but among them all he had only one friend--the dog; one animal only whose service was voluntary, and who was susceptible of disinterested affection and gratitude. in every country, and in every time, there has existed between man and the dog a connection different from that which is observed between him and any other animal. the ox and the sheep submit to our control, but their affections are principally, if not solely, confined to themselves. they submit to us, but they can rarely be said to love, or even to recognise us, except as connected with the supply of their wants. the horse will share some of our pleasures. he enjoys the chase as much as does his rider; and, when contending for victory on the course, he feels the full influence of emulation. remembering the pleasure he has experienced with his master, or the daily supply of food from the hand of the groom, he often exhibits evident tokens of recognition; but that is founded on a selfish principle--he neighs that he may be fed, and his affections are easily transferred. the dog is the only animal that is capable of disinterested affection. he is the only one that regards the human being as his companion, and follows him as his friend; the only one that seems to possess a natural desire to be useful to him, or from a spontaneous impulse attaches himself to man. we take the bridle from the mouth of the horse, and turn him free into the pasture, and he testifies his joy in his partially recovered liberty. we exact from the dog the service that is required of him, and he still follows us. he solicits to be continued as our companion and our friend. many an expressive action tells us how much he is pleased and thankful. he shares in our abundance, and he is content with the scantiest and most humble fare. he loves us while living, and has been known to pine away on the grave of his master. [it is stated that the favourite lap-dog of mary, queen of scots, that accompanied her to the scaffold, continued to caress the body after the head was cut off, and refused to relinquish his post till forcibly withdrawn, and afterwards died with grief in the course of a day or two. the following account is also an authentic instance of the inconsolable grief displayed by a small cur-dog at the death of his master:--a poor tailor in the parish of st. olave, having died, was attended to the grave by his dog, who had expressed every token of sorrow from the instant of his master's death, and seemed unwilling to quit the corpse even for a moment. after the funeral had dispersed, the faithful animal took his station upon the grave, and was with great difficulty driven by the sexton from the church ground; on the following day he was again observed lying on the grave of his master, and was a second time expelled from the premises. notwithstanding the harsh treatment received on several succeeding days by the hands of the sexton, this little creature would persist in occupying this position, and overcame every difficulty to gain access to the spot where all he held most dear was deposited. the minister of the parish, learning the circumstances of the case, ordered the dog to be carried to his house, where he was confined and fed for several days, in hopes of weaning him by kind treatment to forget his sorrow occasioned by the loss of his master. but all his benevolent efforts were of no utility, as the dog availed himself of the first opportunity to escape, and immediately repaired to his chosen spot over the grave. this worthy clergyman now allowed him to follow the bent of his own inclinations; and, as a recompense for true friendship and unfeigned sorrow, had a house built for him over this hallowed spot, and daily supplied him with food and water for the space of two years, during which time he never wandered from his post, but, as a faithful guardian, kept his lonely watch day and night, till death at last put an end to his sufferings, and laid him by the side of his long-expected master.--l.] as an animal of draught the dog is highly useful in some countries. what would become of the inhabitants of the northern regions, if the dog were not harnessed to the sledge, and the laplander, and the greenlander, and the kamtschatkan drawn, and not unfrequently at the rate of nearly a hundred miles a day, over the snowy wastes? in newfoundland, the timber, one of the most important articles of commerce, is drawn to the water-side by the docile but ill-used dog; and we need only to cross the british channel in order to see how useful, and, generally speaking, how happy a beast of draught the dog can be. [large mongrel dogs are very extensively used on the continent in pulling small vehicles adapted to various purposes. in fact, most of the carts and wagons that enter paris, or are employed in the city, have one of these animals attached to them by a short strap hanging from the axle-tree. this arrangement answers the double purpose of keeping off all intruders in the temporary absence of the master, and, by pushing himself forward in his collar, materially assists the horse in propelling a heavy load up-hill, or of carrying one speedily over a plain surface. it is quite astonishing to see how well broken to this work these dogs are, and at the same time to witness with what vigour and perseverance they labour in pushing before them, in that way, enormous weights.--l.] though, in our country, and to its great disgrace, this employment of the dog has been accompanied by such wanton and shameful cruelty, that the legislature--somewhat hastily confounding the abuse of a thing with its legitimate purpose--forbade the appearance of the dog-cart in the metropolitan districts, and were inclined to extend this prohibition through the whole kingdom, it is much to be desired that a kindlier and better feeling may gradually prevail, and that this animal, humanely treated, may return to the discharge of the services of which nature has rendered him capable, and which prove the greatest source of happiness to him while discharging them to the best of his power. in another and very important particular,--as the preserver of human life,--the history of the dog will be most interesting. the writer of this work has seen a newfoundland dog who, on five distinct occasions, preserved the life of a human being; and it is said of the noble quadruped whose remains constitute one of the most interesting specimens in the museum of berne, that forty persons were rescued by him from impending destruction. when this friend and servant of man dies, he does not or may not cease to be useful; for in many countries, and to a far greater extent than is generally imagined, his skin is useful for gloves, or leggings, or mats, or hammercloths; and, while even the romans occasionally fattened him for the table, and esteemed his flesh a dainty, many thousands of people in asia, africa, and america, now breed him expressly for food. if the publication of the present work should throw some additional light on the good qualities of this noble animal; if it should enable us to derive more advantage from the services that he can render--to train him more expeditiously and fully for the discharge of those services--to protect him from the abuses to which he is exposed, and to mitigate or remove some of the diseases which his connection with man has entailed upon him; if any of these purposes be accomplished, we shall derive considerable "useful knowledge" as well as pleasure from the perusal of the present volume. some controversy has arisen with regard to the origin of the dog. professor thomas bell, to whom we are indebted for a truly valuable history of the british quadrupeds, traces him to the wolf. he says, and it is perfectly true, that the osteology of the wolf does not differ materially from that of the dog more than that of the different kinds of dogs differs; that the cranium is similar, and they agree in nearly all the other essential points; that the dog and wolf will readily breed with each other, and that their progeny, thus obtained, will again mingle with the dog. [the relative length of the intestines is a strong distinctive mark both as to the habits and species of animals; those of a purely carnivorous nature are much shorter than others who resort entirely to an herbaceous diet, or combine the two modes of sustenance according to circumstances. the dog and wolf have the intestines of the same length. (see sir everard home on comparative anatomy.)--l.] there is one circumstance, however, which seems to mark a decided difference between the two animals; the eye of the dog of every country and species has a circular pupil, but the position or form of the pupil is oblique in the wolf. professor bell gives an ingenious but not admissible reason for this. he attributes the forward direction of the eyes in the dog to the constant habit, "for many successive generations, of looking towards their master, and obeying his voice:" but no habit of this kind could by possibility produce any such effect. it should also be remembered that, in every part of the globe in which the wolf is found this form of the pupil, and a peculiar setting on of the curve of the tail, and a singularity in the voice, cannot fail of being observed; to which may be added, that the dog exists in every latitude and in every climate, while the habitation of the wolf is confined to certain parts of the globe. there is also a marked difference in the temper and habits of the two. the dog is, generally speaking, easily manageable, but nothing will, in the majority of cases, render the wolf moderately tractable. there are, however, exceptions to this. the author remembers a bitch wolf at the zoological gardens that would always come to the front bars of her den to be caressed as soon as any one that she knew approached. she had puppies while there, and she brought her little ones in her mouth to be noticed by the spectators; so eager, indeed, was she that they should share with her in the notice of her friends, that she killed them all in succession against the bars of her den as she brought them forcibly forward to be fondled. m.f. cuvier gives an account of a young wolf who followed his master everywhere, and showed a degree of affection and submission scarcely inferior to the domesticated dog. his master being unavoidably absent, he was sent to the menagerie, where he pined for his loss, and would scarcely take any food for a considerable time. at length, however, he attached himself to his keepers, and appeared to have forgotten his former associate. at the expiration of eighteen months his master returned, and, the moment his voice was heard, the wolf recognised him, and lavished on his old friend the most affectionate caresses. a second separation followed, which lasted three years, and again the long-remembered voice was recognised, and replied to with impatient cries; after which, rushing on his master, he licked his face with every mark of joy, menacing his keepers, towards whom he had just before been exhibiting fondness. a third separation occurred, and he became gloomy and melancholy. he suffered the caresses of none but his keepers, and towards them he often manifested the original ferocity of his species. these stories, however, go only a little way to prove that the dog and the wolf have one common origin. [there are some naturalists that even go so far as to state that the different varieties of dogs are sprung from, or compounded of, various animals, as the hyaena, jackal, wolf, and fox. the philosophic john hunter commenced a series of experiments upon this interesting subject, and was forced to acknowledge that "the dog may be the wolf tamed, and the jackal may probably be the dog returned to his wild state." the ancient cynegetical writers were not only acquainted with the cross between the wolf and dog, but also boasted the possession of breeds of animals, supposed to have been derived from a connection with the lion and tiger. the hyrcanian dog, although savage and powerful beast, was rendered much more formidable in battle, or in conflict with other animals, by his fabled cross with the tiger. in corroboration of this singular, but not less fabulous belief, pliny states that the inhabitants of india take pleasure in having dog bitches lined by the wild tigers, and to facilitate this union, they are in the habit of tieing them when in heat out in the woods, so that the male tigers may visit them. (see l. , c. xl.) there is, however, but little doubt that the wolf and dog are varieties of the same family, as they can he bred together, and their offspring continuing the cross thus formed, will produce a race quite distinct from the original. french writers do not hesitate at all upon this point, but even assert that it is very difficult to take a she-wolf with male dogs during the period of oestrum, parceque la veulent saillir et covrir comme une chienne. baudrillart, in the "dictionaire des chasses," further remarks that the mongrels produced by this connection are very viciously disposed and inclined to bite. the period of utero-gestation, and the particular mode of copulation in the wolf, is the same as that of the canine family, which two circumstances are certainly very strong presumptive evidences of the similarity of the species. the dogs used by our northern indians resemble very much, in their general appearance, the wolves of that region, and do not seem very far removed from that race of animals, notwithstanding they have been in a state of captivity, or domestication, beyond the traditionary chronicles of this rude people. another strong circumstance in favour of the common origin of these two quadrupeds, is the existence in our own country of the canis latrans, or prairie wolf, who whines and barks in a manner so similar to the smaller varieties of dogs, that it is almost impossible to distinguish his notes from those of the terrier. major long remarks that "this animal which does not seem to be known to naturalists, unless it should prove to be the mexicanus, is most probably the original of the domestic dog, so common in the villages of the indians of this region, some of the varieties of which still remain much of the habit and manners of this species." (vol. i, page .) if further proof be necessary to establish the identity of the dog and wolf, the circumstances related by captain parry in his first voyage of discovery, ought to be sufficient to convince every mind that the wolf, even in its wild state, will seek to form an alliance or connection with one of our domestic dogs. "about this time it had been remarked that a white setter dog, belonging to mr. beverly, had left the griper for several nights past at the same time, and had regularly returned after some hours absence. as the daylight increased we had frequent opportunities of seeing him in company with a she-wolf, with whom he kept up an almost daily intercourse for several weeks, till at length he returned no more to the ships; having either lost his way by rambling to too great a distance, or what is more likely, perhaps, been destroyed by the male wolves. some time after a large dog of mine, which was also getting into the habit of occasionally remaining absent for some time, returned on board a good deal lacerated and covered with blood, having, no doubt, maintained a severe encounter with a male wolf, whom we traced to a considerable distance by the tracks on the snow. an old dog, of the newfoundland breed, that we had on board the hecla, was also in the habit of remaining out with the wolves for a day or two together, and we frequently watched them keeping company on the most friendly terms." (page , st voyage.) [in volume st, page , of the menageries, it is stated that mr. wombwell exhibited in october, , two animals from a cross between the wolf and the domestic dog, which had been bred in that country. they were confined in the same den with a female setter, and were likely again to multiply the species. mr. daniel remarks that mr. brook, famous for his menagerie, turned a wolf to a pomeranian bitch at heat; the congress was immediate, and, as usual between the dog and bitch, ten puppies were the produce. these animals strongly resembled their sire both in appearance and disposition, and one of them being let loose at a deer, instantly caught at the animal's throat and killed it. (see daniel's rural sports, vol. i, page .)--l.] it may appear singular that in both the old testament and the new the dog was spoken of almost with abhorrence. he ranked among the unclean beasts. the traffic in him and the price of him were considered as an abomination, and were forbidden to be offered in the sanctuary in the discharge of any vow. [ ] one grand object in the institution of the jewish ritual was to preserve the israelites from the idolatry which at that time prevailed among every other people. dogs were held in considerable veneration by the egyptians, from whose tyranny the israelites had just escaped. figures of them appeared on the friezes of most of the temples, [ ] and they were regarded as emblems of the divine being. herodotus, speaking of the sanctity in which some animals were held by the egyptians, says that the people of every family in which a dog died, shaved themselves--their expression of mourning--and he adds, that "this was a custom existing in his own time." [ ] the cause of this attachment to and veneration for the dog is, however, explained in a far more probable and pleasing way than many of the fables of ancient mythology. the prosperity of lower egypt, and almost the very subsistence of its inhabitants, depended on the annual overflowing of the nile; and they looked for it with the utmost anxiety. its approach was announced by the appearance of a certain star--sirius. as soon as that star was seen above the horizon, they hastened to remove their flocks to the higher ground, and abandoned the lower pastures to the fertilizing influence of the stream. they hailed it as their guard and protector; and, associating with its apparent watchfulness the well-known fidelity of the dog, they called it the "dog-star," and they worshipped it. it was in far later periods and in other countries that the appearance of the dog-star was regarded as the signal of insufferable heat or prevalent disease. one of the egyptian deities--anubis--is described as having the form and body of a man, but with a dog's head. these were types of sagacity and fidelity. ["who knows not that infatuate egypt finds gods to adore in brutes of basest kinds? this at the crocodile's resentment quakes, while that adores the ibis, gorged with snakes! and where the radiant beam of morning rings on shattered memnon's still harmonious strings; and thebes to ruin all her gates resigns, of huge baboon the golden image shines! to _mongrel curs_ infatuate cities bow, and cats and fishes share the frequent vow!" juvenal, 'sat. xv'.--badham's trans.--l.] in ethiopia, not only was great veneration paid to the dog, but the inhabitants used to elect a dog as their king. he was kept in great state, and surrounded by a numerous train of officers and guards. when he fawned upon them, he was supposed to be pleased with their proceedings: when he growled, he disapproved of the manner in which their government was conducted. these indications of his will were implicitly obeyed, or rather, perhaps, dictated. [among the many strange and wonderful things mentioned by pliny as being discovered in africa, is a people called ptoembati or ptremphanae, whose principal city is aruspi, where they elect a dog for their king and obey him most religiously, being governed entirely by the different motions of his body, which they interpret according to certain signs. (see pliny, lib. vi, c. xxx.)--l.] even a thousand years after this period the dog was highly esteemed in egypt for its sagacity and other excellent qualities; for, when pythagoras, after his return from egypt, founded a new sect in greece, and at croton, in southern italy, he taught, with the egyptian philosophers, that, at the death of the body, the soul entered into that of different animals. he used, after the decease of any of his favourite disciples, to cause a dog to be held to the mouth of the dying man, in order to receive his departing spirit; saying, that there was no animal that could perpetuate his virtues better than that quadruped. it was in order to present the israelites from errors and follies like these, and to prevent the possibility of this species of idolatry being established, that the dog was afterward regarded with utter abhorrence among the jews. [ ] this feeling prevailed during the continuance of the israelites in palestine. even in the new testament the apostle warns those to whom he wrote to "beware of dogs and evil-workers;" [ ] and it is said in the revelations that "without are dogs and sorcerers," &c. [ ] dogs were, however, employed even by the jews. job says, "now they that are younger than i have me in derision, whose fathers i would have disdained to have set with the dogs of my flock." [ ] dogs were employed either to guide the sheep or to protect them from wild beasts; and some prowled about the streets at night, contending with each other for the offal that was thrown away. to a certain degree this dislike of the dog continues to the present day; for, with few exceptions, the dog is seldom the chosen companion of the jew, or even the inmate of his house. nor was it originally confined to palestine. wherever a knowledge of the jewish religion spread, or any of its traditions were believed, there arose an abhorrence of the dog. the mohammedans have always regarded him as an unclean animal, that should never be cherished in any human habitation--belonging to no particular owner, but protecting the street [ ] and the district rather than the house of a master. the hindoos regard him likewise as unclean, and submit to various purifications if they accidentally come in contact with him, believing that every dog was animated by a wicked and malignant spirit, condemned to do penance in that form for crimes committed in a previous state of existence. if by chance a dog passed between a teacher and his pupil during the period of instruction, it was supposed that the best lesson would be completely poisoned, and it was deemed prudent to suspend the tuition for at least a day and a night. even in egypt, dogs are now as much avoided as they were venerated. in every mohammedan and hindoo country, the most scurrilous epithet bestowed on a european or a christian is--"a dog!" [ ] this accounts for the singular fact that in the whole of the jewish history there is not a single allusion to hunting with dogs. mention is made of nets and snares, but the dog seems to have been never used in the pursuit of game. in the early periods of the history of other countries this seems to have been the case even where the dog was esteemed and valued, and had become the companion, the friend, and the defender of man and his home. so late as the second century of the christian era, the fair hunting of the present day needed the eloquent defence of arrian, who says that "there is as much difference between a fair trial of speed in a good run, and ensnaring a poor animal without an effort, as between the secret piratical assaults of robbers at sea, and the victorious naval engagements of the athenians at artemisium and at salamis." [ ] the first hint of the employment of the dog in the pursuit of other animals is given by oppian in his cynegeticus, who attributes it to pollux, about years after the promulgation of the levitical law. of the precise species of dog that prevailed or was cultivated in greece at this early period, little can with certainty be affirmed. one beautiful piece of sculpture has been preserved, and is now in the possession of lord feversham at duncombe hall. it is said to represent the favourite dog of alcibiades, and to have been the production of myson, one of the most skillful artists of ancient times. it differs but little from the newfoundland dog of the present day. he is represented as sitting on his haunches, and earnestly looking at his master. any one would vouch for the sagacity and fidelity of that animal. the british museum contains a group of greyhound puppies of more recent date, from the ruins of the villa of antoninus, near rome. one is fondling the other; and the attitude of both, and the characteristic puppy-clumsiness of their limbs, which indicate, nevertheless, the beautiful proportions that will soon be developed, are an admirable specimen of ancient art. [illustration of ancient sculpture of greyhounds] the greeks, in the earlier periods of their history, depended too much on their nets; and it was not until later times that they pursued their prey with dogs, and then not with dogs that ran by sight, or succeeded by their swiftness of foot, but by beagles very little superior to those of modern days [ ]. of the stronger and more ferocious dogs there is, however, occasional mention. the bull-dog of modern date does not excel the one (possibly of nearly the same race) that was presented to alexander the great, and that boldly seized a ferocious lion, or another that would not quit his hold, although one leg and then another was cut off. it would be difficult and foreign to the object of this work fully to trace the early history of the dog. both in greece and in rome he was highly estimated. alexander built a city in honour of a dog; and the emperor hadrian decreed the most solemn rites of sepulture to another on account of his sagacity and fidelity. the translator of arrian imagines that the use of the 'pugnaces' (fighting) and the 'sagaces' (intelligent)--the more ferocious dogs, and those who artfully circumvented and caught their prey--was known in the earlier periods of greek and roman history, but that the 'celeres', the dogs of speed, the greyhounds of every kind, were peculiar to the british islands, or to the western and northern continents of europe, the interior and the produce of which were in those days unknown to the greeks and romans. by most authors who have inquired into the origin of these varieties of the dog, the 'sagaces' have been generally assigned to greece--the 'pugnaces' to asia--and the 'celeres' to the celtic nations. [the vertragi, 'canes celeres', or dogs that hunted by sight alone, were not known to the ancients previous to the time of the younger xenophon, who then describes them as novelties just introduced into greece: "but the swift-footed celtic hounds are called in the celtic tongue [greek: ouéztragoi]; not deriving their name from any particular nation, like the cretan, carian, or spartan dogs, but, as some of the cretans are named [greek: diaponoi] from working hard, [greek: itamai] from their keenness, and mongrels from their being compounded of both, so these celts are named from their swiftness. in figure, the most high-bred are a prodigy of beauty; their eyes, their hair, their colour, and bodily shape throughout. such brilliancy of gloss is there about the spottiness of the parti-coloured, and in those of uniform colour, such glistening over the sameness of tint, as to afford a most delightful spectacle to an amateur of coursing." it is probable these dogs were carried, about this time, into the southern parts of europe by the various tribes of celts who over-ran the continent, and also occupied ireland, britain, and the other western islands, and ultimately took possession of gaul.--l.] of the aboriginal country of the latter there can be little doubt; but the accounts that are given of the english mastiff at the invasion of britain by the romans, and the early history of the english hound, which was once peculiar to this country, and at the present day degenerates in every other, would go far to prove that these breeds also are indigenous to our island. oppian thus describes the hunting dog as he finds him in britain: "there is, besides, an excellent kind of scenting dogs, though small, yet worthy of estimation. they are fed by the fierce nation of painted britons, who call them 'agasoei'. in size they resemble worthless greedy house-dogs that gape under tables. they are crooked, lean, coarse-haired, and heavy-eyed, but armed with powerful claws and deadly teeth. the 'agasoeus' is of good nose and most excellent in following scent [ ]." among the savage dogs of ancient times were the hyrcanian, said, on account of their extreme ferocity, to have been crossed with the tiger [ ],--the locrian, chiefly employed in hunting the boar,--the pannonian, used in war as well as in the chase, and by whom the first charge on the enemy was always made,--and the molossian, of epirus, likewise trained to war as well as to the honours of the amphitheatre and the dangers of the chase. this last breed had one redeeming quality--an inviolable attachment to their owners. this attachment was reciprocal; for it is said that the molossi used to weep over their faithful quadruped companions slain in war. [of all the dogs of the ancients, those bred on the continent of epirus were the most esteemed, and more particularly those from a southern district called molossia, from which they received their name. these animals are described as being of enormous size, great courage and powerful make, and were considered worthy not only to encounter the wolf, bear, and boar, but often overcame the panther, tiger, and lion, both in the chase and amphitheatre. they also, being trained to war, proved themselves most useful auxiliaries to this martial people. the learned translator of arrian states that "the fabled origin of this breed is consistent with its high repute; for, on the authority of nicander, we are told by julius pollux, that the epirote was descended from the brazen dog which vulcan wrought for jupiter, and animated with all the functions of canine life." these were not the only dogs fashioned by the skilful hands of the olympic artist, as we find alcinous, king of the phaeacians, possessing golden dogs also wrought at the celestial forge. pliny states that a dog of enormous magnitude was sent as a present by the king of albania to alexander the great when on his march to india; and "that this monarch being delighted at the sight of so huge and fair a dog, let loose unto him first bears, then wild boars, and lastly fallow deer, all of which animals he took no notice of, but remained perfectly unconcerned. this great warrior being a man of high spirit and wonderful courage, was greatly displeased at the apparent cowardice and want of energy in so powerful an animal, and ordered him to be slain. this news was speedily carried to the king of albania, who thereupon sent unto him a second dog, stating that he should not make trial of his courage with such insignificant animals, but rather with a lion or elephant, and if he destroyed this one also, he need not expect to obtain any other of this breed, as these two were all he possessed. tanta: suis petiere ultra fera semina sylvis, dat venus accessus, et blando foedere jungit. tunc et mansuetis tuto ferus erat adulter in stabulis, ultroque gravis succedere tigrim ausa canis, majore tulit de sanguine foetum. 'gratii falisci cyneget.,' liv. . v. . alexander being much surprised, made immediate preparations for a trial, and soon saw the lion prostrate, with his back broken, and his body torn in pieces by the noble dog. then he ordered an elephant to be produced; and in no fight did he take more pleasure than in this. for the dog, with his long, rough, shaggy hair, that covered his whole body, rushed with open mouth, barking terribly, and thundering, as it were, upon the elephant. soon after he leaps and flies upon him, advancing and retreating, now on one side, now on the other, maintaining an ingenious combat; at one time assailing him with all vigour, at another shunning him. so actively did he continue this artificial warfare, causing the huge beast to turn around so frequently on every side to avoid his attacks, that he ultimately came down with a crash that "made the earth tremble with his fall". book viii. chap. . the molossian dogs were at a later period much esteemed by the romans as watch dogs, not only of their dwellings, but also to guard their flocks against the incursions of wild animals. horace, in the following lines, passes a just tribute to the worth of this animal, when referring to his watchfulness, and the ardour with which he pursues those wild animals, even 'per altas nives,' that threaten the flocks entrusted to his care. "quid immerentes, hospites vexas canis, ignarus adversum lupos? quin huc inanes, si potes, vertis minas, et me remorsurum petis? nam, qualis aut molossus, aut fulvus lacon, amica vis pastoribus, agam per altas aure sublatâ nives, quaecunpue praecedet fera." 'epode' vi.--l.] Ælian relates that one of them, and his owner, so much distinguished themselves at the battle of marathon, that the effigy of the dog was placed on the same tablet with that of his master. soon after britain was discovered, the 'pugnaces' of epirus were pitted against those of our island, and, according to the testimony of gratius, completely beaten. a variety of this class, but as large and as ferocious, was employed to guard the sheep and cattle, or to watch at the door of the house, or to follow the owner on any excursion of business or of pleasure. gratius says of these dogs, that they have no pretensions to the deceitful commendation of form; but, at the time of need, when courage is required of them, most excellent mastiffs are not to be preferred to them. the account of the british 'pugnaces' of former times, and also of the 'sagaces' and 'celeres', will be best given when treating of their present state and comparative value. in describing the different breeds of dogs, some anecdotes will be related of their sagacity and fidelity; a few previous remarks, however, may be admissible. a young man lost his life by falling from one of the precipices of the helvellyn mountains. three months afterwards his remains were discovered at the bottom of a ravine, and his faithful dog, almost a skeleton, still guarding them. sir walter scott beautifully describes the scene: dark-green was the spot, 'mid the brown mountain heather, where the pilgrim of nature lay stretched in decay; like the corpse of an outcast, abandoned to weather, till the mountain winds wasted the tenantless clay; nor yet quite deserted, though lonely extended, for, faithful in death, his mute favourite attended, the much loved remains of her master defended, and chased the hill-fox and the raven away. how long didst thou think that his silence was slumber? when the wind waved his garments, how oft didst thou start? how many long days and long weeks didst thou number ere he faded before thee, the friend of thy heart? burchell, in his travels in africa, places the connexion between man and the dog, and the good qualities of this animal, in an interesting point of view. a pack of dogs of various descriptions formed a necessary part of his caravan, occasionally to provide him with food, but oftener to defend him from wild beasts or robbers. "while almost every other quadruped fears man as his most formidable enemy," says this interesting traveller, "there is one who regards him as his companion, and follows him as his friend. we must not mistake the nature of the case. it is not because we train him to our use, and have made choice of him in preference to other animals, but because this particular species of animal feels a natural desire to be useful to man, and, from spontaneous impulse, attaches himself to him. were it not so, we should see in various countries an equal familiarity with other quadrupeds, according to their habits, and the taste or caprices of different nations; but, everywhere, it is the dog only that takes delight in associating with us, and in sharing our abode. it is he who knows us personally, watches over us, and warns us of danger. it is impossible for the naturalist not to feel a conviction that this friendship between creatures so different from each other must be the result of the laws of nature; nor can the humane and feeling mind avoid the belief that kindness to those animals, from which he derives continued and essential assistance, is part of the moral duty of man. "often in the silence of the night, when all my people have been fast asleep around the fire, have i stood to contemplate these faithful animals watching by their side, and have learned to esteem them for their social inclination towards mankind. when, wandering over pathless deserts, oppressed with vexation and distress at the conduct of my own men, i have turned to these as my only friends, and felt how much inferior to them was man when actuated only by selfish views." of the stanchness and incorruptible fidelity of the dog, and his disregard of personal inconvenience and want, when employed in our service, it is impossible to entertain a doubt. we have sometimes thought that the attachment of the dog to its master was increased, or, at least, the exhibition of it, by the penury of the owner. at all events one fact is plain enough, that, while poverty drives away from us many a companion of our happier hours, it was never known to diminish the love of our quadruped friend. the early history of the dog has been described, and the abomination in which he was held by the israelites. at no great distance of time, however, we find him, almost in the neighbourhood of palestine, in one of the islands of the ionian sea, the companion and the friend of princes, and deserving their regard. the reader will forgive a somewhat abbreviated account of the last meeting of ulysses and his dog. twenty years had passed since argus, the favourite dog of ulysses, had been parted from his master. the monarch at length wended his way homewards, and, disguised as a beggar, for his life would have been sacrificed had he been known, stood at the entrance of his palace-door. there he met with an old dependant, who had formerly served him with fidelity and who was yet faithful to his memory; but age and hardship and care, and the disguise which he now wore, had so altered the wanderer that the good eumaeus had not the most distant suspicion with whom he was conversing; but: near to the gates, conferring as they drew, argus the dog his ancient master knew, and, not unconscious of the voice and tread lifts to the sound his ears, and rears his head. he knew the lord, he knew, and strove to meet; in vain he strove to crawl and kiss his feet; yet, all he could, his tail, his ears, his eyes salute his master, and confess his joys. [ ] [lord byron, who had much experience and acquaintance with the canine family, was rather sceptical as regards the memory of this animal, having been, on one occasion, entirely forgotten by a favourite dog from whom he was separated some considerable time, and in fact was most savagely assailed by him, when on his return he attempted to caress him as he was wont to do in former times. this unkind reception at newstead abbey, on the part of his pampered pet, may have given rise to the poet's feelings as embodied in the following misanthropic lines:-- "and now i'm in the world alone, upon the wide, wide sea: but why should i for others groan, when none will sigh for me? perchance my dog will whine in vain, till fed by stranger hands; but long ere i come back again, he'd tear me where he stands."--l.] in daniel's rural sports, the account of a nobleman and his dog is given. the nobleman had been absent two years on foreign service. on his return this faithful creature was the first to recognise him, as he came through the court-yard, and he flew to welcome his old master and friend. he sprung upon him; his agitation and his joy knew not any bounds; and at length, in the fulness of his transport, he fell at his master's feet and expired. [an interesting circumstance, strongly exhibiting canine fidelity and attachment in a large mastiff, came under the editor's own eye during his childhood, and which, from its striking character, deserves to be recorded on the page of history as another testimony to the high moral worth of these useful animals. a gentleman of baltimore, with his family, lived during a portion of the year a short distance in the country, and was in the habit of returning to the city late in the fall to pass the winter. on his estate there was a fine young mastiff, who though extremely cross to strangers, exhibited at all times a great degree of tenderness and affection for the younger branches of the family;--more particularly for the younger son, his most constant companion, and who would often steal secretly away to share his daily meal with this affectionate participator in his childish sports: or, when fatigued with romping together, would retire to the well-kept kennel, and recruit his limbs in a refreshing sleep, while reclining upon the body of the faithful dog. if the little truant should now be missed by those having him in charge, the most natural question to ask was, "where is rolla?" knowing full well that wherever this honest brute was, there might his young master be found also. on such occasions, however, this trusty guardian would refuse all solicitations to abandon his post, and express great dissatisfaction at any attempt to arouse or carry off his young charge, whom he continued to watch over till he awoke, refreshed from his slumber and eager again to resume their frolics. the period of returning to the city at last arrived, and the dog exhibited marked signs of uneasiness, while the bustling preparations for this end were going on, as if conscious of the separation that was about to take place between his young master and himself, as also the other children, who had been his constant companions for so many joyful months. everything being completed, the childish group bid an affectionate adieu to the downcast rolla, whom they left standing on the hill-top, watching the carriage as it disappeared in the wood. a few days after their departure, and when this poor animal was forgotten in the new scenes around them, a communication was received from the overseer of the farm, in which he stated that the favourite dog appeared much grieved since the family had left for the city, and was fearful that he might die if he continued in the same condition. little attention, however, was given to these remarks, all imagining that the dog's melancholy was only the result of temporary distress, owing to his secluded life, so different from that which he had led when surrounded by the various members of a large family. little did any one suppose that this poor neglected brute was suffering the acutest pangs of mental distress, even sufficient to produce death. two weeks had now elapsed since the separation from rolla, when another message came from the overseer, stating that the dog would surely die with grief, if not removed to the city, as he had refused all sustenance for several days, and did nothing but wander about from place to place, formerly frequented by the children, howling and moaning in the most piteous manner. orders were now given, much to the children's delight, for the conveyance of the favourite to the city; but, alas! this arrangement came too late, as the poor creature sank from exhaustion, while in the wagon on his way to join those beloved companions whose short absence had broken his heart and grieved him even unto death.--l.] we will not further pursue this part of our subject at present. we shall have other opportunities of speaking of the disinterested and devoted affection which this noble animal is capable of displaying when he occupies his proper situation, and discharges those offices for which nature designed him. it may, however, be added that this power of tracing back the dog to the very earliest periods of history, and the fact that he then seemed to be as sagacious, as faithful, and as valuable as at the present day, strongly favour the opinion that he descended from no inferior and comparatively worthless animal,--that he was not the progeny of the wolf, the jackal, or the fox, but he was originally created, somewhat as we now find him, the associate and the friend of man. if, within the first thousand years after the deluge, we observe that divine honours were paid to him, we can scarcely be brought to believe his wolfish genealogy. the must savage animals are capable of affection for those to whom they have been accustomed, and by whom they have been well treated, and therefore we give full credit to several accounts of this sort related of the wolf, the lion, and even the cat and the reptile: but in no other animal--in no other, even in the genus 'canis'--do we find the qualities of the domestic dog, or the slightest approach to them. "to his master he flies with alacrity," says the eloquent buffon, "and submissively lays at his feet all his courage, strength, and talent. a glance of the eye is sufficient; for he understands the smallest indications of his will. he has all the ardour of friendship, and fidelity and constancy in his affections, which man can have. neither interest nor desire of revenge can corrupt him, and he has no fear but that of displeasing. he is all zeal and obedience. he speedily forgets ill-usage, or only recollects it to make returning attachment the stronger. he licks the hand which causes him pain, and subdues his anger by submission. the training of the dog seems to have been the first art invented by man, and the fruit of that art was the conquest and peaceable possession of the earth." "man," says burns, "is the god of the dog; he knows no other; and see how he worships him. with what reverence he crouches at his feet--with what reverence he looks up to him--with what delight he fawns upon him, and with what cheerful alacrity he obeys him!" if any of the lower animals bear about them the impress of the divine hand, it is found in the dog: many others are plainly and decidedly more or less connected with the welfare of the human being; but this connexion and its effects are limited to a few points, or often to one alone. the dog, different, yet the same, in every region, seems to be formed expressly to administer to our comforts and to our pleasure. he displays a versatility, and yet a perfect unity of power and character, which mark him as our destined servant, and, still more, as our companion and friend. other animals may be brought to a certain degree of familiarity, and may display much affection and gratitude. there was scarcely an animal in the menagerie of the zoological society that did not acknowledge the superintendent as his friend; but it was only a casual intercourse, and might be dissolved by a word or look. at the hour of feeding, the brute principle reigned supreme, and the companion of other hours would be sacrificed if he dared to interfere; but the connexion between man and the dog, no lapse of time, no change of circumstances, no infliction of evil can dissolve. we must, therefore, look far beyond the wolf for the prototype of the dog. cuvier eloquently states that the dog exhibits the most complete and the most useful conquest that man has made. each individual is entirely devoted to his master, adopts his manners, distinguishes and defends his property, and remains attached to him even unto death; and all this springing not from mere necessity, or from constrain, but simply from gratitude and true friendship. the swiftness, the strength, and the highly developed power of smelling of the dog, have made him a powerful ally of man against the other animals; and, perhaps, these qualities in the dog were necessary to the establishment of society. it is the only animal that has followed the human being all over the earth. there is occasionally a friendship existing between dogs resembling that which is found in the human being. the author pledges himself as to the accuracy of the following little anecdote. two dogs, the property of a gentleman at shrewsbury, had been companions for many years, until one of them died of old age. the survivor immediately began to manifest an extraordinary degree of restless anxiety, searching for his old associate in all his former haunts, and refusing every kind of food. he gradually wasted away, and, at the expiration of the tenth day, he died, the victim of an attachment that would have done honour to man. the dog, belongs to the division of animals termed vertebrated, (see 'the horse', d edition, page ), because it has a cranium or skull, and a spine or range of vertebrae proceeding from it. it ranks under the 'class' mammalia, because it has teats, by which the female suckles her young; the 'tribe' unguiculata, because its extremities are armed with nails; the 'order' digitigrades, because it walks principally on its toes. the 'genus' canis has two tubercular teeth behind the large carnivorous tooth in upper jaw; and the 'sub-genus familiaris', the dog, has the pupils of the eye circular, while those of the wolf are oblique, and those of the fox upright and long. there has been some dispute whether the various species of dogs are of different origin, or sprung from one common source. when we consider the change that climate and breeding effect in the same species of dog, and contrast the rough irish or highland greyhound with the smoother one of the southern parts of britain, or the more delicate one of greece, or the diminutive but beautifully formed one of italy, or the hairless one of africa or brazil--or the small blenheim spaniel with the magnificent newfoundland; if also we observe many of them varied by accident, and that accidental variety diligently cultivated into a new species, altogether different in form or use, we shall find no difficulty in believing that they might be derived from one common origin. one of the most striking proofs of the influence of climate on the form and character of this animal, occurs in the bull-dog. when transported to india he becomes, in a few years, greatly altered in form, loses all his former courage and ferocity, and becomes a perfect coward. it is probable that all dogs sprang from one common source, but climate, food, and cross-breeding caused variations of form, which suggested particular uses; and these being either designedly or accidentally perpetuated, the various breeds of dogs thus arose, and they have become numerous in proportion to the progress of civilization. among the ruder, or savage tribes, they possess but one form; but the ingenuity of man has devised many inventions to increase his comforts: he has varied and multiplied the characters and kinds of domestic animals for the same purpose, and hence the various breeds of horses, and cattle, and dogs. the parent stock it is now impossible to trace; but the wild dog, wherever found on the continent of asia, or northern europe, has nearly the same character, and bears no inconsiderable resemblance to the british fox-dog, while many of those from the southern ocean can scarcely be distinguished from the english lurcher. there is, however, no more difficulty in this respect with regard to the dog, than any other of our domesticated animals. climate, or chance, produced a change in certain individuals, and the sagacity of man, or, perhaps, mere chance, founded on these accidental varieties numerous breeds possessed of certain distinct characteristic properties. the degeneracy of the dog, also, in different countries, cannot for a moment be disputed. the most natural arrangement of all the varieties of the dog is according to the development of the frontal sinus and the cerebral cavity, or, in other words, the power of scent, and the degree of intelligence. this classification originated with m.f. cuvier, and has been adopted by most naturalists. he reckoned three divisions of the dog: i. those having the head more or less elongated, and the parietal bones of the skull widest at the base, and gradually approaching towards each other as they ascend, the condyls of the lower jaw being on the same line with the upper molar teeth. the _greyhound_ and all its varieties belong to this class. ii. the head moderately elongated, and the parietals diverging from each other for a certain space as they rise upon the side of the head, enlarging the cerebral cavity and the frontal sinus. to this class belong our most valuable dogs,--the _spaniel_, _setter_, _pointer_, _hound_, and the _sheep-dog_. iii. the muzzle more or less shortened, the frontal sinus enlarged, and the cranium elevated, and diminished in capacity. to this class belong some of the _terriers_, and a great many dogs that might very well be spared. this division of the different species of the dog is adopted here as being the most simple, intelligible, and satisfactory. [footnote : gen. iv. .] [footnote : deut. xxiii. .] [footnote : in some of belzoni's beautiful sketches of the frieze-work of the old egyptian temples, the dog appears, with his long ears and broad muzzle, not unlike the old talbot hound.] [footnote : herodotus, lib. ii. c. .] [footnote : no dog was suffered to come within the precincts of the temple at jerusalem. [greek: ex_o kunes] was a prevalent expression among the jews. byrant's 'mythology', vol. ii. p. .] [footnote : phil. iii. .] [footnote : rev. xxii. .] [footnote : job xxx. . see also isaiah lvi, , .] [footnote : psalm lix. .] [footnote : carpenter's 'scripture natural history', p. . it is a remarkable fact that from this faithful animal, the companion of man, and the guardian of his person and property, should originate as many terms of reproach as "dog," "cur," "hound," "puppy," "dog-cheap," "a dog's trick," "dog sick," "dog-weary," "to lead the life of a dog," "to use like a dog." all this probably originated in the east, where the dog was held in abhorrence as the common scavenger of the streets.] [footnote : arrian's 'cynegeticus', cap .] [footnote : ''new sporting magazine, vol. xiv. p. .] [footnote : oppian's 'cynegeticus', lib. i. v. - .] [footnote : ["at contrà faciles, magnique lycaones armis. sed non hyrcanæ satis est vehementia genti."]] [footnote : pope's 'odyssey', xvii.] * * * * * chapter ii. the varieties of the dog. first division. the head more or less elongated, the parietal bones widest at the base and gradually approaching to each other as they ascend, and the condyls of the lover jaw being on the same line with the upper molar teeth. to this division belong the greater number of the wild dogs. the wild dog, as existing in considerable numbers or communities, seems to be nearly extirpated in the southern parts of europe; but there are several cases on record, of dogs having assumed native independence. a black greyhound bitch, belonging to a gentleman in scarisbrick, in lancashire, though she had apparently been well broken in, and always well used, ran away from the habitation of her master, and betook herself to the woods. she killed a great number of hares and made free with the sheep, and became an intolerable nuisance to the neighbourhood. she was occasionally seen, and the depredations that were committed were brought home to her. many were the attempts made to entrap or destroy her, but in vain: for more than six months she eluded the vigilance of her pursuers. at length she was observed to creep into a hole in an old barn. she was caught as she came out, and the barn being searched three whelps were found, which, very foolishly, were destroyed. the bitch evinced the utmost ferocity, and, although well secured, attempted to seize every one who approached her. she was, however, dragged home and treated with kindness. by degrees her ferocity abated. in the course of two months, she became perfectly reconciled to her original abode, and, a twelve-month afterwards ( ), she ran successfully several courses. there was still a degree of wildness in her appearance; but, although at perfect liberty, she seemed to be altogether reconciled to a domestic life. in a dog was left by a smuggling vessel on the coast of northumberland. he soon began to worry the sheep for his subsistence, and did so much mischief that he caused very considerable alarm. he was frequently pursued by hounds and greyhounds; but when the dogs came up he lay upon his back as if supplicating for mercy, and in that position they would never hurt him. he therefore lay quietly until the hunters approached, when he made off without being followed by the hounds until they were again excited to the pursuit. he one day led them miles in this way. it was more than three months before he was caught and was then shot [ ]. a dog with every character of the wild one has occasionally been seen in some of the forests of germany, and among the pyrenean mountains; but he has rarely been found gregarious there. in the country on the eastern side of the gulf of venice wild dogs are more frequent. they increase in the austrian and turkish dominions, and are found on almost every part of the coast of the black sea, but even there they rarely gather in flocks: they do not howl in concert, as the wolf; nor are they the precursors of other and larger beasts, like the jackal. most of these dogs have the muzzle and head elongated, the ears erect, triangular, and small, the body and neck large and muscular, and the tail short, but with a brush of crisped hair. in many parts of arabia the wild dog--or 'dakhun'--is occasionally found. in persia, they are most decidedly congregated together, and still more so in almost every part of india [ ]. mr. hodgson has favoured the zoological society with an account of the wild dog of nepal, the 'búánsú', and, finding it more or less prevailing through the whole of northern india, and even southward of the coast of coromandel, he thought that he had discovered the primitive race of the dog. this is a point that can never be decided. "these dogs hunt their prey by night, as well as by day, in packs of from six to ten individuals, maintaining the chase more by the scent than by the eye, and generally succeeding by dint of strength and perseverance. while hunting, they bark like the hound, yet the bark is peculiar, and equally unlike that of the cultivated breeds of dogs, and the cries of the jackal and the fox." bishop heber gives the following account of them. "they are larger and stronger than a fox, which in the circumstances of form and fur they much resemble. they hunt, however, in packs, give tongue like dogs, and possess an exquisite scent. they make of course tremendous havoc among the game in these hills; but that mischief they are said amply to repay by destroying wild beasts, and even tigers." [ ] wild dogs are susceptible of certain social combinations. in egypt, constantinople, and throughout the whole of the east, there are in every village troops of wandering dogs who belong to no particular person. each troop has its own quarter of the place; and if any wander into a quarter which does not belong to him, its inhabitants unite together and chase him out. at the cape of good hope there are many dogs half-starved. on going from home the natives induce two or more of these animals to accompany them, warn them of the approach of any ferocious animal, and if any of the jackals approach the walls during the night, they utter the most piercing cries, and at this signal every dog sallies out, and, uniting together, put the jackals to speedy flight. [ ] the wild nepal dogs caught when at an adult age make no approach towards domestification; but a young one, which mr. hodgson obtained when it was not more than a month old, became sensible to caresses, and manifested as much intelligence as any sporting dog of the same age. [ ] captain t. williamson gives an interesting account of the ferocious character of some of these wild dogs. "they have considerable resemblance to the jackal in form. they are remarkably savage, and frequently will approach none but their 'doonahs' or keepers, not allowing their own masters to come near them. some of them are very fleet; but they are not to be depended upon in coursing; for they are apt suddenly to give up the chase when it is a severe one, and, indeed, they will too often prefer a sheep or a goat to a hare. in hog-hunting they are more valuable. it seems to suit their temper, and they appear to enjoy the snapping and the snarling, incident to that species of sports." he says that many persons affect to treat the idea of degeneration in quadrupeds with ridicule; but all who have been any considerable time resident in india must be satisfied that dogs of european breed become, after every successive generation, more and more similar to the pariah, or indigenous dog of that country. the hounds are the most rapid in their decline, and, except in the form of their ears, they are very much like many of the village curs. greyhounds and pointers also rapidly decline, although with occasional exceptions. spaniels and terriers deteriorate less, and spaniels of eight or nine generations, and without a cross from europe, are not only as good as, but far more beautiful than, their ancestors. the climate is too severe for mastiffs, and they do not possess sufficient stamina; but, crossed by the east indian greyhound, they are invaluable in hunting the hog [ ]. colonel sykes, at one of the meetings of the zoological society, produced a specimen of the wild dog of dakhun or deccan, a part of india far to the south of nepâl, and gave the following description of this supposed primitive dog: "its head is compressed and elongated, but its muzzle not very sharp. the eyes are oblique, the pupils round, and the 'irides' light-brown. the expression of the countenance is that of a coarse ill-natured persian greyhound, without any resemblance to the jackal, the fox, or the wolf. the ears are long, erect, and somewhat rounded at the top. the limbs remarkably large and strong in relation to the bulk of the animal. the size is intermediate between the wolf and the jackal. the neck long, the body elongated, and the entire dog of a red-brown colour. none of the domesticated dogs of dakhun are common in europe, but those of dakhun and nepâl are very similar in all their characters. there is also a dog in dakhun with hair so short as to make him appear naked. it is called the 'polugar' dog." the wild dog of the mahrattas possesses a similar conformation; and the fact is, that the east indian wild dog is essentially the same in every part of that immense extent of country. there is no more reason, however, for concluding that it was the primitive dog, than for conferring on the indian cattle the same honour among the ruminants. the truth of the matter is that we have no guide what was the original breed in any country. the lapse of years would effect strange alterations in the breeds. the common name of this dog, in the track lying between south bahar and the mahratta frontier towards maghore, is dhole, the 'chryseus scylex' of hamilton smith. captain williamson, in his oriental field sports, gives the following account of the dholes: "they are to be found chiefly, or only, in the country from midnapore to chamu, and even there are not often to be met with. they are of the size of a small greyhound. their countenance is enlivened by unusually brilliant eyes. their body, which is slender and deep-chested, is thinly covered by a coat of hair of a reddish-brown or bay colour. the tail is dark towards its extremity. the limbs are light, compact, and strong, and equally calculated for speed and power. they resemble many of the common pariah dogs in form, but the singularity of their colour and marks at once demonstrates an evident distinction. "these dogs are said to be perfectly harmless if unmolested. they do not willingly approach persons; but, if they chance to meet any in their course, they do not show any particular anxiety to escape. they view the human race rather objects of curiosity, than either of apprehension or enmity. the natives who reside near the ranochitty and katcunsandy passes, in which vicinity the 'dholes' may frequently be seen, describe them as confining their attacks entirely to wild animals, and assert that they will not prey on sheep, goats, &c.; but others, in the country extending southward from jelinah and mechungunge, maintain that cattle are frequently lost by their depredations. i am inclined to believe that the 'dhole' is not particularly ceremonious, but will, when opportunity offers, and a meal is wanting, obtain it at the expense of the neighbouring village. "the peasants likewise state that the 'dhole' is eager in proportion to the size and powers of the animal he hunts, preferring the elk to every other kind of deer, and particularly seeking the royal tiger. it is probable that the 'dhole' is the principal check on the multiplication of the tiger; and, although incapable individually, or perhaps in small numbers, to effect the destruction of so large and ferocious an animal, may, from their custom of hunting in packs, easily overcome any smaller beast found in the wilds of india. "they run mute, except that they sometimes utter a whimpering kind of note, similar to that sometimes expressed by dogs when approaching their prey. this may be expressive of their own gratification, or anxiety, or may serve as a guide to other 'dholes' to join in the chase. the speed of the 'dhole' is so strongly marked in his form as to render it probable no animal in the catalogue of game could escape him for any distance. many of the 'dholes' are destroyed in these contests; for the tiger, the elk, and the boar, and even many of the smaller classes of game are capable of making a most obstinate defence. hence the breed of the 'dholes' is much circumscribed." the thibet dog. mr. bennett, in his scientific and amusing description of the zoological gardens, gave the best account we have of this noble dog, and our portrait is a most faithful likeness of him. he is bred in the table-land of the himalaya mountains bordering on thibet. the bhoteas, by whom many of them are carefully reared, come down to the low countries at certain seasons of the year to sell their borax and musk. the women remain at home, and they and the flocks are most sedulously guarded by these dogs. they are the defenders of almost every considerable mansion in thibet. in an account of an embassy to the court of the teshoo llama in thibet, the author says, that he had to pass by a row of wooden cages containing a number of large dogs, fierce, strong, and noisy. they were natives of thibet, and, whether savage by nature or soured by confinement, they were so impetuously furious that it was unsafe even to approach their dens. every writer who describes these dogs, speaks of their noble size, and their ferocity, and antipathy to strangers. it is said, however, that the thibet dog rapidly degenerates when removed from its native country, and certainly the specimens which have reached the zoological gardens exhibited nothing of ferocity. the one that was in that menagerie had a noble and commanding appearance; but he never attempted to do any injury. the colour of the thibet dog is of a deep black, slightly clouded on the sides, his feet alone and a spot over each eye being of a full tawny or bright brown hue. he has the broad short truncated muzzle of the mastiff, and the lips are still more deeply pendulous. there is also a singular general looseness of the skin on every part of him. the pariah. there are several varieties of this dog. there is a wild breed very numerous in the jungles and in some of the lower ranges of the himalaya mountains. they usually hunt in packs, and it is not often that their prey escapes them. they generally are very thin, and of a reddish-brown colour, with sharp-pointed ears, deep chest, and tucked-up flanks. many persons hunt with these dogs singly, and they are very useful. they bring the hog to bay, or indicate the course that he has taken, or distract his attention when the sportsman is at hand. there is also in every inhabited part of the country the poor desolate pariah,--unowned by any one,--daring to enter into no house, but wandering about, and picking up a living in any way that he can. he is, however, of a superior race to the wild dog, and belongs to the second class of the dog, although mentioned here in order that we may altogether quit the dog of india. they are neglected by the hindoos; but the mohammedans of india, and other strangers, consider it an act of charity to throw out occasionally a morsel of food to them. they are most of them mongrels; but the benevolent bishop heber does them no more than justice when he says that he "was forcibly struck at finding the same dog-like and amiable qualities in these neglected animals as in their more fortunate brethren in europe." colonel sykes says of these outcasts that among the pariahs is frequently found the turnspit-dog. there is also a small petted variety of the pariah, usually of a white colour, and with long silky hair. this animal is taught to carry flambeaux and lanterns. according to captain williamson, in some of the ditches of the carnatic forts, alligators are purposely kept, and all the pariah dogs found in the forts are thrown into the ditches as provision for these monsters. some persons who have kept tigers in cages have adopted the same means of supply for their royal captives, putting the poor pariah through an aperture made for the purpose in the cage; and they justify themselves by asserting that they thus get rid of a troublesome breed of curs, most of which are unappropriated, and which being numerous are very troublesome to passengers, often wantonly biting them, and raising a yelling noise at night, that sets all attempts to rest at defiance. it did not always happen that the tiger killed the pariah put into his cage. "i knew an instance," says captain williamson, "of one that was destined for the tiger's daily meal, standing on the defensive in a manner that completely astonished both the tiger and the spectator. he crept into a corner, and whenever the tiger approached seized him by the lip or the neck, making him roar most piteously. the tiger, however, impelled by hunger,--for all supply of food was purposely withheld,--would renew the attack. the result was ever the same. at length the tiger began to treat the dog with more deference, and not only allowed him to partake of the mess of rice and milk furnished daily for his subsistence, but even refrained from any attempt lo disturb him. the two animals at length became reconciled to each other, and a strong attachment was formed between them. the dog was then allowed ingress and egress through the aperture; and, considering the cage as his own, he left it and returned to it just as he thought proper. when the tiger died he moaned the loss of his companion for a considerable period." a wild variety exists in sumatra. it is described by cuvier as "possessing the countenance of a fox, the eyes oblique, the ears rounded and hairy, the muzzle of a foxy-brown colour, the tail bushy and pendulous, very lively, running with the head lifted high, and the ears straight." this animal can scarcely be rendered tractable, and even when he is apparently tamed can rarely be depended upon. as we proceed through the indian archipelago, towards australasia, we skirt the coast of java. every javanese of rank has large packs of dogs with which he hunts the muntjak, the deer of that country. the dogs are led in strings by the attendants until they scent the prey: they are then unloosed, while the sportsmen follow, but not at the speed which would distinguish the british sportsman. the animal is generally found at bay. the male muntjak usually exhibits considerable courage, and probably several of the dogs have been wounded by his tusks. as soon as they come up every gun is discharged, and the animal almost immediately drops. at other times the mounted sportsmen attack them with a spear or sword. generally, the muntjak does not go off like the stag in any direct track, but takes a circular course, and soon returns to the spot whence it was started. it perhaps makes several of these circles, and at length entangles itself in a thicket, where it is secured. these dogs are the indigenous breed of the island, the body lank, the ears erect, ferocious in their disposition, and with very little attachment to their masters. such is the account given of them by dr. horsfield. the dingo, australasian, or new holland dog. the newly discovered southern continent was, and some of it still continues to be, overrun by the native wild dogs. dampier describes them, at the close of the last century, as "beasts like the hungry wolves, lean like so many skeletons, and being nothing but skin and bone." it was not until the publication of governor phillip's voyage to botany bay, that any accurate description or figure of this dog could be obtained. he approaches in appearance to the largest kind of shepherd's dog. the head is elongated, the forehead flat, and the ears short and erect, or with a slight direction forwards. the body is thickly covered with hair of two kinds--the one woolly and gray, the other silky and of a deep yellow or fawn colour. the limbs are muscular, and, were it not for the suspicious yet ferocious glare of the eye, he might pass for a handsome dog. the australasian dog, according to m. desmarest, resembles in form and in the proportion of his limbs the common shepherd's dog. he is very active and courageous, covered in some parts with thick hair woolly and gray, in other parts becoming of a yellowish-red colour, and under the belly having a whitish hue. when he is running, the head is lifted more than usual in dogs, and the tail is carried horizontally. he seldom barks. mr. bennett observes that "dogs in a state of nature never bark. they simply whine, howl, or growl. the explosive noise of the bark is only found among those that are domesticated." sonini speaks of the shepherds' dogs in the wilds of egypt as not having this faculty; and columbus found the dogs which he had previously carried to america, almost to have lost their propensity to bark. he does, however, occasionally bark, and has the same kind of snarling voice which the larger dogs generally have. the australasian dogs that have been brought to europe have usually been of a savage and untractable disposition. there are several of the australasian dogs in the gardens of the zoological society of london. one of them has been an inmate of that establishment nine years, others more than five years; but not an individual has acquired the bark of the other dogs by which they are surrounded. when a stranger makes his appearance, or when the hour of feeding arrives, the howl of the australasian is the first sound that is heard, and it is louder than all the rest. if some of them have thrown off a portion of their native ferocity, others retain it undiminished. a bitch and two of her whelps, nearly half grown--a male and female--had inhabited the same cage from the time that the young ones were born. some cause of quarrel occurred on a certain night, and the two bitches fell upon the dog and perfectly destroyed him. there was not a limb left whole. a stronger instance of the innate ferocity of this breed could scarcely be given. even in their native country all attempts perfectly to domesticate them have failed; for they never lose an opportunity to devour the poultry or attack the sheep. every domesticated dog coming within their reach was immediately destroyed. one that was brought to england broke his chain--scoured the surrounding country--and, before dawn, had destroyed several sheep; and another attacked, and would have destroyed, an ass, if he had not been prevented. mr. oxley, surveyor-general of new south wales, however, gives an interesting account of the mutual attachment between two of the native and wild new holland dingos. "about a week ago we killed a native dog, and threw his body on a small bush. on returning past the same spot to-day, we found the body removed three or four yards from the bush, and the female in a dying-state lying close beside it: she had apparently been there from the day the dog was killed. being now so weakened and emaciated as to be unable to move on our approach, it was deemed a mercy to despatch her." when van diemen land began to be colonized by europeans, the losses sustained by the settlers by the ravages of the wild dogs were almost incredible. the districts infested by these animals were principally those appropriated to sheep, and there was scarcely a flock that did not suffer. it was in vain to double the number of shepherds, to watch by night and by day, or to have fires at every quarter of the fold; for these animals would accomplish their object by stratagem or by force. one colony lost no fewer than sheep and lambs in three months; another colony lost . the ravagers were either the native wild dogs of the island, or those that had escaped from their owners. they seemed to have apportioned the country into different districts, each troop having its allotted range. at length the evil became so great that a general meeting of the colonists was convened. the concluding sentences of the speech of lieutenant hill forcibly express the extent of the evil. "the country is free from bush-rangers: we are no longer surrounded and threatened by the natives. we have only one enemy left in the field; but that enemy strikes at the very root of our welfare, and through him the stream of our prosperity is tainted at its very source." the colonists were then few, but they cordially united in the endeavour to extirpate this formidable enemy; and, although the wild dog is still found in the interior of the island, he is comparatively seldom seen, and his ravages have nearly ceased. the canis australis--karÁrahÉ, new zealand dog. a tradition exists in new zealand of this dog having been given to the natives two or three centuries ago by a number of divinities who made their descent on these shores, probably juan fernandez and his companions. the sagacious animal has, however, dwindled down to the lowest rank of his family, but ill usage has not altogether destroyed his worth. in new zealand he is the safeguard of every village. should the slightest alarm exist, he is the first to ascertain the cause of it, and many families have saved themselves by flight, or have taken arms in self-defence against the incursions of predatory bands. the new zealanders are therefore kind in their treatment of the dog, except that they occasionally destroy him for his hide. the name formerly given to the new zealand dog was 'pero', which in some measure substantiates the supposition of juan fernandez having visited the country--'perro', in the spanish language, being the name of a dog. we will now turn to the northern parts of america. the races of wild dogs are there considerably limited, both in number and the districts which they occupy. in the elevated sandy country north of the source of the missouri, inhabited by the "stone" and the "black foot" indians, is a doubtful species of dogs--wolves they used to be called--who hunt in large packs and are exceedingly swift; whose bark is similar to that of the domestic dog, but who burrow in the ground, and eagerly run to their holes, when the gun of the hunter is heard. [our author evidently, in the above remarks, confounds the louisiana marmot, arctomys ludovicianus or prairie dog, with the canis latrans of say, as he certainly would not make us believe that such harmless animals as the marmot should associate themselves in packs to hunt the deer or other quadrupeds; neither would he tell us that so different an animal as the canis latrans could burrow in the ground and retreat to their holes when surprised by the hunter. the louisiana marmot, improperly called prairie dog, is about sixteen inches long, and lives in extended villages or excavations surmounted by mounds. these communities often comprise several thousand inhabitants, whose sole food consists in the scanty herbage surrounding the settlement, as they seldom extend their excursions beyond a half-mile from their burrows for fear of the wolves, and many other enemies. the canis latrans, on the other hand, is quite a large and savage animal, and frequently unites in bands to run down deer or buffalo calves, but as for living under ground in burrows, it is quite out of reason to suppose such a thing possible with this quadruped, who secretes himself in the depths of the forest, and appears on the open plain only when in pursuit of game.--l.] the habit of selecting large, open, sandy plains, and burrowing there, extends to the greater part of the american wild dogs. [we have been credibly informed by several gentlemen, familiar with the country of mexico, that there is a diminutive species of dog running wild, and burrowing in the ground as rabbits, in the neighbourhood of santa fe and chihuahua. a gentleman who has seen these animals, states that there is no doubt as to their identity, having met with them in a state of domestication, when they exhibited all the actions and manners of a french lap dog, such as come from cuba or other west india islands. they are of every variety of hue, and resort to their burrows whenever disturbed in their natural haunts. what they subsist on it is difficult to say, as they are too harmless and insignificant to attack any other animal beyond a mouse or a snail. they are represented as being very difficult to tame, but when domesticated show no disposition to return to their former mode of life. the lady of the mexican minister, when in this city, had one of these dogs as a boudoir pet; it was lively and barked quite fiercely. we have not been able to ascertain whether they bark in their natural state. the breed of dog cultivated in china for food alone, are fed entirely upon rice meal and other farinaceous articles, having no relish whatever for flesh or other strong aliment.--l.] in some parts of north america whole troops of horses are guarded and kept together by dogs. if any of the troop attempt to steal away, the dog will immediately fly after the horse, head him, and bring him back to his companions. [to show the necessity of having dogs for this purpose, as well as to guard the flocks of sheep, we need only mention that it is no uncommon thing for a mexican to own several thousand horses, besides an immense number of cattle. mr. kendall, in his santa fé expedition, states that the proprietress of one hacienda, a widow, and comparatively poor when the wonderful wealth of her ancestors is considered, now owns fifty thousand horses and mules, beside herds of cattle and sheep, and that the pasture ground extended for fifty miles on either side of the road. one of the former owners of this immense estate, a short time previous to the revolution, sent as a present to a spanish colonel, just arrived with his regiment of dragoons, a thousand white horses, nearly all of the same age, and every one raised on this prolific hacienda.--l.] the wild dogs abound in many parts of south america. in some of the forests on the banks of the oronoko they multiply to an annoying degree. the cayotte of mexico, described by some as a wolf, and bearing no slight resemblance to that animal, belongs to the south american wild dogs, as do also the aguara dogs of every kind. these wanderers of the woods are, however, diminished in numbers in every part of that continent, and are replaced by other kinds, many of which have been imported from europe and domesticated. [there is no country in the world more cursed with worthless curs than that of mexico and the other southern republics; the cities and villages actually swarm with these animals, and produce no little vexation to travellers, who speak of their eternal yelping and barking in the most indignant terms. mr. kendall, on entering san antonio, says, "from every house some half dozen mexican curs would jump forth and greet us with a chorus of yelps and barks, and before we had fairly entered the town the canine hue and cry was general. those who have for the first time entered a mexican town or city must have been struck with the unusual number of dogs, and annoyed by their incessant barking; but the stranger soon learns that they spend all their courage in barks--they seldom bite."--l.] many of the indian tribes have succeeded in reclaiming the dog of the woods, and have made him a useful although not a perfectly attached servant. the dogs of the falkland islands, and the indian north american dogs generally, are brown or gray-coloured varieties of the wild dog; but as they are nearly exterminated, will occupy little space. it has already been stated that in egypt and in nubia we have the first records of the dog. many superstitious notions were connected with him, and divine honours were paid to him. those times are passed away, and he is regarded with aversion by the moslem of the present day. he is an outcast. he obtains a scanty living by the offal which he gathers in the towns, or he is become a perfect wild dog, and scours the country for his prey. his modern name is the 'deab'. he is of considerable size, with a round muzzle, large head, small erect ears, and long and hairy tail, spotted with black, white, and yellow, and having a fierce wolfish aspect. these dogs are not, however, numerous; but the mischief which they do is often great, whether in pairs they burrow in the earth, or associate with others and hunt in troops. [ ] in nubia is a smaller dog of the same kind, which never burrows. it lives on small animals and birds, and rarely enters any of the towns. a similar dog, according to colonel hamilton smith, inhabits the neighbourhood of the cape, and particularly the karroo or wilderness. it is smaller than either of the others, and lives among bushes or under prominent rocks. others, although not identified with the jackal, yet associating with him, inhabit the uplands of gambia and senegal. on the gold coast, the dog is used and prized as an article of food. he is fattened and driven to market as the european drives his sheep and hogs. the dog is even more valued than the sheep for human subsistence, and is deemed the greatest luxury that can be placed even on the royal table. in loango, or lower guinea, is a town from which the african wild dogs derive their name--the 'dingo'. they hunt in large packs. they fearlessly attack even the elephant, and generally destroy him. in the neighbourhood of the cape, the country is nearly cleared of wild beasts; but in cape town there are a great number of lean and miserable dogs, who howl about the streets at night, quitting their dens and lurking-places, in quest of offal. no great while ago, the wolves and hyaenas used to descend and dispute the spoil with the dogs, while the town resounded with their hideous howlings all the night long. this will be a proper place to refer to the numerous accounts that are given both in ancient and modern times of the immolation of dogs, and of their being used for food. they were sacrificed at certain periods by the greeks and romans to almost all their deities, and particularly to mars, pluto, and pan, to minerva, proserpine, and lucina, and also to the moon, because the dog by his barking disturbed all charms and spells, and frightened away all spectres and apparitions. the greeks immolated many dogs in honour of hecate, because by their baying the phantoms of the lower world were disturbed. a great number of dogs were also destroyed in samothrace in honour of the same goddess. dogs were periodically sacrificed in february, and also in april and in may; also to the goddess rubigo, who presided over the corn, and the bona dea, whose mysterious rites were performed on mount aventine. the dog cerberus was supposed to be watching at the feet of pluto, and a dog and a youth were periodically sacrificed to that deity. the night when the capitol had nearly been destroyed was annually celebrated by the cruel scourging of a dog in the principal public places, even to the death of the animal. [as on a certain occasion, the dogs who had the capitol in custody, did not bark and give warning when the gauls attempted to scale the wails, there is a custom annually observed at rome, to transfix certain dogs to forks, and thus crucified, hang them on an elder tree as examples of justice. (book , chap. iv. pliny.)-l.] many of the greek and roman epicures were strangely fond of the flesh of the dog, and those who ought to have known much better encouraged the use of this food. galen speaks of it in the strongest terms of praise. hippocrates says that the meat of old dogs is of a warm and dry quality, giving strength to the eater. ananias, the poet, speaks of dog's flesh served up with that of the hare and fox. virgil recommends that the fatted dog should be served up with whey or butter; and dioscorides, the physician, says that they should be fed on the whey that remains after the making of cheese. [independent of the many useful and interesting qualities that necessarily endeared this animal to the ancients, he had yet stronger claims upon them, in the prophylactic properties of different portions of his body. pliny, hippocrates, aristotle and others, speak of various preparations made of his flesh, for the cure of many distempers. the first-mentioned writer observes, that the ashes of burnt dogs, made into a liniment, with oil, will make an excellent application to the eye-brows, to turn them black. we doubt not that an analogous compound, if proved to be really efficacious, might he introduced to the notice of the belles of our own time, or meet with extensive sale for dyeing the pagoties and mustachios of the modern dandy. this quaint philosopher also recommends the same substance as a healing salve, for malignant wounds, and the internal use of the same article as a preventive or cure of hydrophobia and other distempers. (book , chap, xi. and x.)--l.] before christianity was established among the danes, on every ninth year at the winter solstice, a monstrous sacrifice of dogs was effected. in sweden the sacrifice was still worse. on each of successive days, dogs were destroyed. this sacrifice of the dog, however, gave way to one as numerous and as horrible. on every th year, human victims were immolated, and the sons of the reigning tyrant among the rest, in order that the life of the monarch might be prolonged. [ ] on the other hand, the dog was frequently the executioner; and, from an early period, whether in the course of war or the mock administration of justice, thousands of poor wretches were torn to pieces by animals trained to that horrible purpose. many of the indians of north america, and almost of the present day, are fond of the flesh of the dog. captain carver, in his travels in north america in , , and , describes the admission of an indian into one of the horrible societies of that country. "the dishes being brought near to me," says he, "i perceived that they consisted of dog's flesh, and i was informed that at all their grand feasts they never made use of any other food. the new candidate provides fat dogs for the festival, if they can be procured at any price. they ate the flesh; but the head and the tongue were left sticking on a pole with the front towards the east. when any noxious disease appeared among them, a dog was killed, the intestines were wound between two poles, and every man was compelled to pass between them." the nandowepia indians also eat dog's flesh as an article of luxury, and not from any want or scarcity of other animal food; for they have the bear, buffalo, elk, deer, beaver, and racoon. professor keating, in his interesting work on the expedition to peter's river, states that he and a party of american officers were regaled in a large pavilion on buffalo meat, and 'tepsia', a vegetable boiled in buffalo grease, and the flesh of three dogs kept for the occasion, and without any salt. they partook of the flesh of the dogs with a mixture of curiosity and reluctance, and found it to be remarkably fat, sweet, and palatable, divested of any strong taste, and resembling the finest welsh mutton, but of a darker colour. so strongly rooted, however, are the prejudices of education, that few of them could be induced to eat much of it. the feast being over, great care was taken to replace the bones in their proper places in the dish, after which they were carefully washed and buried, as a token of respect to the animals generally, and because there was the belief among them that at some future time they would return again to life. well-fattened puppies are frequently sold; and an invitation to a feast of dog's meat is the greatest distinction that can be offered to a stranger by any of the indian nations east of the rocky mountains. [notwithstanding the indians occasionally eat their dogs either through necessity or when they wish to pay a marked tribute of respect to their gods, or prepare a feast of friendship with strangers, they value them very highly, and do not by any means consider their flesh superior to that of the buffaloes or other animals of the chase. mr. catlin remarks, that "the dog, amongst all indian tribes, is more esteemed and more valued than amongst any part of the civilized world: the indian, who has more time to devote to his company, and whose untutored mind more nearly assimilates to that of his faithful domestic, keeps him closer company and draws him nearer his heart: they hunt together and are equal sharers in the chase--their bed is one; and on the rocks and on their coats of arms they carve his image as the symbol of fidelity." (vol. i., p. .) on visiting the sioux, they prepared for this gentleman as a token of regard a dog feast, previous to partaking of which they addressed him in a manner that plainly exhibits the veneration in which they held these faithful animals, at the same time forcibly demonstrating the peculiar circumstances under which they alone are willing to destroy them: "my father, i hope you will have pity upon us; we are very poor. we offer you to-day not the best we have got; for we have a plenty of good buffalo hump and marrow; but we give you our hearts in this feast, we have killed our faithful dogs to feed you, and the great spirit will seal our friendship. i have no more to say." (vol. i., p. .)--l.] as a counterpart to much of this, the ancient hyrcanians may be mentioned, who lived near the caspian sea, and who deemed it one of the strongest expressions of respect to leave the corpse of their deceased friends to be torn and devoured by dogs. every man was provided with a certain number of these animals, as a living tomb for himself at some future period, and these dogs were remarkable for their fierceness. [not only the hyrcanians but most of the people dwelling on or near the caspian sea, preserved this race or a similarly formidable one, more particularly to devour their dead; it being considered more propitiatory to the gods, and more flattering to the spirits of the deceased, to make this disposition of the corpse, than consigning it to the gloomy grave or funeral pile. this custom is noticed by theodoret as being pursued by the inhabitants of those parts, and was not abolished till after their adherence to christianity.--l.] domesticated dogs of the first division some of the readers of this work may possibly recollect three beautiful dogs of this species in the gardens of the zoological society of london, which afforded a perfect illustration of the elongated head of the dogs belonging to cuvier's first section. mr. bennett, the secretary of the society, gave an interesting account of them in , derived from the observation of sir john franklin and dr. richardson. the elongation and sharpness of the muzzle, and the small capacity of the skull, first attract attention. the dog was doubtless fitted for its situation, where its duty is to hunt by sight after the moose or rein-deer, but would have been comparatively worthless if he was to be guided by the scent. its erect ears, widened at the base and pointed at the top, gave it an appearance of vivacity and spirit. its depth of chest, and tucked-up flank, and muscular quarters, marked it as a dog of speed, while its light frame, and the length of the toes, and wideness of web between them, seem to depict the kind of surface over which it was to bound. it is not designed to seize and to hold any animal of considerable bulk; it bounds over the snow without sinking, if the slightest crust is formed upon it, and eagerly overtakes and keeps at bay the moose or the rein-deer until the hunters arrive. this animal furnishes a beautiful illustration of adaptation for a particular purpose. the hair of these dogs is white, with patches of grayish-black and brown. they are known only in the neighbourhood of the mackenzie river and of the great bear lake in north america they appear to be good-tempered and easily manageable, and soon become familiar even with strangers. they are most valuable to the indians, who live almost entirely on the produce of the chase. in their native country they never bark, but utter a whine and howl resembling that of the esquimaux dog; yet one of the three, who was born a few days after its parents arrived at the gardens, while it whined and howled occasionally with its parents, at other times uttered the perfect bark of its companions of various breeds around it. [it is the general belief among the indians and others who are familiar with this dog, that his origin is connected, in some way, with the arctic fox, canis lagopus, as he so much resembles this animal in his general appearance and habits. this fox when taken is easily tamed, a few days of captivity being often sufficient to render him quite docile, and ample opportunities have thus been afforded for studying his peculiarities. although the cross between the wolf and dog may be considered established beyond controversy, the testimony is not so very conclusive as regards the fox. the most authentic instances on record are perhaps those mentioned by mr. daniel, who states that mr. tattersall had a terrier bitch, who bred by a fox, and the produce again had whelps by dogs, also that the woodman of mongewell manor had a bitch, the offspring of a tame dog-fox, by a shepherd's cur, and she again had puppies by a dog; he does not state, however, that he knew these facts personally; but concludes from these two instances, that the fox species may be fairly added to the other supposed original stocks of dogs. (daniel's rural sports, vol. . p. .) mr. collinson also states, that it is certain that the siberian dog not only copulates with the wolf, but with the fox also. notwithstanding this assertion, he is not able to cite a single instance, but on the other hand is forced to acknowledge, that he never met with any person who had seen the coupling of these two animals. the peasants of that country have a small dog, which, from their foxy appearance, they term fox-dogs. our indian dogs, also, resemble somewhat the wolves and foxes, the original inhabitants of this continent, while the canine family throughout the east is strongly marked with the jackal, the wild aborigines of that portion of the world. these dogs, when fighting, do not shake their antagonists, like the perfectly domesticated dog; their teeth are extremely sharp, and when snarling, the skin is drawn from the mouth; their bite is more severe, and they show but little disposition to attack the wolves, although quite eager in the pursuit of all other game. the indians had no dogs previous to the coming of the whites, but depended in a great measure, when hunting, upon the presence of the wolves, who, by their howlings, indicated the position of the herds of buffalo or deer, knowing full well that after the general carnage, they would come in for a full share of the garbage of these animals. harlan, in his fauna americana, says, "we have very little doubt that the various species of domestic dogs are mere varieties of prolific hybrids, produced by the union of the wolf with the fox or jackal. a prolific hybrid of this kind once produced, the progeny would more readily unite with the congeners of either parent, and with each other, and in this manner give rise to the innumerable varieties which at the present day are found scattered over the face of the earth." (page .) it is somewhat strange, that no naturalist has, as yet, succeeded in causing a union between the fox and dog, if the thing be possible. we ourselves are cognizant of an instance, where every effort was made to produce an offspring from such a connexion, but to no purpose, although the terrier bitch was thrice in heat while confined with the fox, and lived on the most amicable terms with him. we agree with doct. godman, that if a litter has ever been generated by these two animals, they were hybrids, as nothing to the contrary of an authentic character has been brought forward, whereas it is well known that the fox always exhibits a great antipathy and instinctive repugnance to such an union. it is also reasonable to suppose that if prolific hybrids had at any time been produced, the breed, from its singular character, would have been propagated by the fortunate possessor, either from curiosity or utility. the intestines of the fox are shorter than those of the dog or wolf--l.] the albanian dog can be traced to a very remote period of history. some of the old authors speak of it as the dog which in the times of ancient mythology diana presented to procris. pliny describes in enthusiastic terms the combat of one of them with a lion, and afterwards with an elephant. a dog very much resembling the ancient stories is yet found in albania, and most of the districts of greece. he is almost as large as a mastiff, with long and silky hair, the legs being shorter and stronger than those of the greyhound. he is gentle and tractable with those whom he knows, and when there is no point of duty at stake; but no bribe can seduce him from his post when any trust is committed to him. [this dog, it is very probable, was highly impregnated with molossian blood, and like that animal, was trained both for war and the chase. it is rather doubtful, whether the dogs presented to alexander the great by the king of albania, were those of his own country or some that he had obtained from other parts. we are inclined to believe that they were imported dogs, for pliny distinctly states, that these two were all that the generous monarch possessed, and if destroyed could not be replaced. from this circumstance it is natural to suppose that, if these dogs had been native albanians, the king would have been able to supply any reasonable quantity of them, and, therefore, not necessitated to send this message to alexander. on the other hand, if these dogs had been of the pure molossian type, such as were raised in epirus, it is probable that their huge dimensions would not have surprised this monarch so much, as it is reasonable to believe that alexander would certainly have seen, if not heard, of dogs so remarkable, belonging to a kingdom in immediate contiguity with his own. we are, therefore, forced to look to some other source, from whence came these proud dogs, who alone deigned to contend with the lion and elephant, and must yield to strabo, who states that these animals were of the indian breed.--l. .] the great danish dog, called also the dalmatian or spotted dog. the difference between these two breeds consists principally in the size, the dalmatian being much smaller than the danish. the body is generally white, marked with numerous small round black or reddish-brown spots. the dalmatian is said to be used in his native country for the chase, to be easily broken, and stanch to his work. he has never been thus employed in england, but is chiefly distinguished by his fondness for horses, and as being the frequent attendant on the carriages of the wealthy. to that its office seems to be confined; for it rarely develops sufficient sense or sagacity to be useful in any of the ordinary offices of the dog. [this dog is, perhaps, the tallest of the canine species in existence; the smaller dane, or "le braque de bengal," of the french writers, is perhaps a cross of this animal with the pointer or hound, or the original dog degenerated by removal from his native soil. although these dogs generally display little or no intelligence, and are, in fact, denounced by many writers as being incapable of acquiring sufficient knowledge to make them in any way serviceable for hunting, still we are led to believe that these latent qualities might be developed in this breed as well as any other of his particular physical construction. we had a little dane in our possession, whom we instructed, with little trouble, in a variety of tricks; although at first surly and stupid, he soon exhibited great aptness and pleasure in repeating the various lessons which we taught him. if he had been younger we might have given him an opportunity of displaying himself in the field, as we are confident, from his tractable disposition, that he might have been tutored, with perseverance, even sufficiently well to stand upon game. the dogs of epirus were supposed to have been spotted like the dalmatian, if not of the same breed. these dogs may also be the "spotted hounds" given by pan to diana. let the little dane's intellectual abilities be what they may, long habit and association have so intimately connected him with the stable and its occupants that he seems no longer fit for any other purpose than that of following in the wake of the carriages of the wealthy. this he does with peculiar fondness and singular ingenuity; for, although constantly by the side or at the heels of the horses, or under the tongue of the vehicle, his sure retreat when attacked by other dogs, who seem to have an antipathy for these pampered and fancy attendants on the affluent, he seldom or never is trod upon, or otherwise injured. the little dane is often a good ratter; and a gentleman of this city informs me that his dogs not only exhibit an attachment to horses in general, but that one of them has a particular partiality for an old carriage-horse, with whom he has been intimately associated for many years, and always greets his return to the stable with every demonstration of delight, by jumping up and kissing him, &c.--l.] the french matin. ('canis laniarius'). there is considerable difficulty in describing this variety. the french consider it as the progenitor of all the breeds of dogs that resemble and yet cannot be perfectly classed with the greyhound. it should rather be considered as a species in which are included a variety of dogs,--the albanian, the danish, the irish greyhound, and almost the pure british greyhound. the head is elongated and the forehead flat, the ears pendulous towards the tips, and the colour of a yellowish fawn. this is the usual sheep-dog in france, in which country he is also employed as a house-dog. he discharges his duty most faithfully; and, notwithstanding his flat forehead, shows himself to possess a very high degree of intelligence. [the french matin we have seen of every variety of colour, being mostly patched with brown, yellow, grey, black, or white. he is employed both in france and germany in hunting the boar and wolf; which savage animals he fearlessly attacks with courage equal to any dog they possess.--l.] the greyhound. we find no mention of this dog in the early grecian records. the 'pugnaces' and the 'sagaces' are mentioned; but the 'celeres'--the swift-footed--are not spoken of as a peculiar breed. the celtic nations, the inhabitants of the northern continent of europe and the western islands, were then scarcely known, and the swift-footed dogs were peculiar to those tribes. they were not, however, introduced into the more southern parts of europe until after the dissolution of the roman commonwealth. the dog is, however, mentioned by ovid; and his description of coursing the hare is so accurate that we cannot refrain from inserting it. we select a translation of it from golding. "i gat me to the knap of this same hill, and there behelde of this strange course the hap, in which the beaste seemes one while caught, and ere a man would thinke doth quickly give the grewnd [ ] the slip, and from his biting shrinke; and, like a wilie fox, he runs not forth directly out, nor makes a winlas over all the champion fields about, but, doubling and indenting, still avoydes his enemie's lips, an turning short, as swift about as spinning-wheele he wips, to disappoint the snatch. the grewnd, pursuing at an inch, doth cote [ ] him, never loosing. continually he snatches in vaine, but nothing in his mouth, save only hair, he catches." there is another sketch by the same poet: "as when th' impatient greyhound, slipped from far, bounds o'er the glade to course the fearful hare, she in her speed does all her safety lay, and he with double speed pursues the prey; o'erruns her at the sitting turn, but licks his chaps in vain, yet blows upon the flix; she seeks the shelter, which the neighbouring covert gives, and, gaining it, she doubts if yet she lives." [ ] the english, scotch, and irish greyhounds were all of celtic derivation, and their cultivation and character correspond with the civilization of the different celtic tribes. the dogs that were exported from britain to rome were probably of this kind. mr. blaine gives an account of the progress of these dogs, which seems to be evidently founded on truth. "scotland, a northern locality, has long been celebrated for its greyhounds, which are known to be large and wiry-coated. they are probably types of the early celtic greyhounds, which, yielding to the influences of a colder climate than that they came from, became coated with a thick and wiry hair. in ireland, as being milder in its climate, the frame expanded in bulk, and the coat, although not altogether, was yet less crisped and wiry. in both localities, there being at that time boars, wolves, and even bears, powerful dogs were required. in england these wild beasts were more early exterminated, and consequently the same kind of dog was not retained, but, on the contrary, was by culture made finer in coat, and of greater beauty in form." [the canis leporarius, or greyhound of the present day, is quite an inferior animal in point of size, when compared with his forefathers, who alone were occupied in the chase of the boar, wolf, bear, deer, and other animals both powerful and savage. as these wild animals gradually disappeared under the hand of civilization, these hardy dogs were less wanted; and thus, by slow degrees, have degenerated into the less powerful, but more beautiful and symmetrical proportions that we now see. this change, however, has better adapted him for speed, and the coursing of such quadrupeds as depend upon nimbleness and activity of motion, to secure their escape. owing, in some measure, to the climate, but more particularly to the inactive life that they lead in this country, so much at variance with that of england, we can lay claim to but few dogs that would be considered above mediocrity among british sportsmen. we have seen several of these dogs which, living in a state of idle luxury, have degenerated considerably even in the third generation; and we cannot now recall but one dog, in the possession of a young lady in philadelphia, that would at all come up to the english standard of perfection; and this one is a descendant from a fine imported stock in the second generation. the ancient greeks were much devoted to coursing, but previous to the time of arrian, their hounds were not a sufficient match, in point of speed, for the hare, and it was seldom that their sports were attended with success in the actual capture of this fleet animal by the dogs alone. if taken at all, it was generally by running them down in a long chase, or driving them into nets, toils, and other similar contrivances, as forcibly described in the following lines of the ancient poet, when extolling the pleasures of a country life. "aut trudit acres hinc et hinc multâ cane apros in obstante plagas, aut amite levi rara leiidit retia, turdis edacibus dolos; pavidumve leporem, et advenam laqueo gruem, jucunda captat præmia." (horace, 'epode ii.', v. .) even after the introduction of the celtic hound, who, as before stated, was far inferior as regards speed to the present race, it was no easy matter to take the hare, it being necessary to carry several couples of dogs into the field, and let them slip at certain intervals in the chase, so that the fresh dogs might, in this way, overtake the little animal, already frightened and fatigued by previous exertion. in reference to this mode of coursing, the younger xenophon particularly enjoins that to prevent confusion in the field, naturally arising from the hunters letting their dogs loose at improper intervals, from eagerness to see them run, "that a steward should be appointed over the sport, should match the dogs, and give orders to the field:--if the hare start on this side, you and you are to slip, and nobody else; but if on that side, you and you: and let strict attention be paid to the orders given." (arrian, chap. xx.) alciphron, in his familiar epistles descriptive of the domestic manners of the greeks, gives a lively description of a course not very different from those of the present day, as will be seen in the following extract: "in trying whether the young dogs were fit for the chase, i started a hare from a little bush; my sons loosed the dogs from the slips. they frightened her confoundedly, and were very near taking the game. the hare, in her flight, climbed a steep place, and found a retreat in some burrow. one of the more spirited of the dogs, pressing close upon her, gasping, and expecting to take her in his gripe, went down with her into the hole. in endeavouring to pull out the hare, he broke one of his fore-legs. i lifted up my good dog, with his lame leg, and found the hare half devoured: thus, when i hoped to get something, i encountered a serious loss." (letter ix.) we will close our remarks upon this subject by introducing a few descriptive lines, selected from one of the very rare english authors who have attempted a versification of this exciting sport. "yet if for silvan sport thy bosom glow, let thy fleet greyhound urge his flying foe. with what delight the rapid course i view! how does my eye the circling race pursue! he snaps deceitful air with empty jaws; the suttle hare darts swift beneath his paws; she flys, he stretches, now with nimble bound eager he presses on, but overshoots his ground: then tears with goary mouth the screaming prey." ('gay's poems', vol i.--'rural sports', v. ),--l.] mr. richardson, in his history of the greyhound, gives a different derivation of the name of this dog. he says that the 'greyhound' was of grecian origin--'cannis græcus',--that 'græcus' was not unfrequently written 'græius', and thence was derived the term 'greyhound'. this derivation, however, is somewhat too far-fetched. mention occurs of the greyhound in a very early period of the british history. he was an inmate of the anglo-saxon kennels in the time of elfric, king of mercia. there are paintings of him that can be satisfactorily traced to the ninth century. in the time of canute he was reckoned first in degree of rank among the canine species, and no one under the degree of a gentleman, 'liberalis', or more properly, perhaps a 'freeholder', was allowed by the forest laws to keep them. even he could not keep them within two miles of a royal forest, unless two of the toes were cut off and for every mile that an uncut dog was found within this distance a fine of a shilling was levied on the owner. the nobleman was rarely seen abroad without his hawk upon his fist, and his greyhound at his side. henry ii was passionately fond of them. john spared no expense to procure good horses and swift hounds, and appears frequently to have received greyhounds in lieu of money on the issue or removal of grants. for the renewal of a grant in the year he received five hundred marks, ten horses, and ten leashes of greyhounds, and for another, in , one swift running horse and six greyhounds. the isle of dogs, now devoted to purposes of commerce, received its name from its having been, at this period, the receptacle of the greyhounds and spaniels of this monarch. it was selected on account of its contiguity to waltham and the other royal forests where coursing was a frequent amusement. for the same purpose he often took up his abode at greenwich. [ ] blount's ancient tenures abound with instances of the high repute in which this dog has ever been held in great britain. the holders of land in the manor of setene in kent were compelled, as the condition of their tenure to edward i and ii, to lend their greyhounds, when this king went into gascony, "so long as a pair of shoes of d price would last." edward iii was partial to greyhounds; for when he was engaged in war with france he took with him sixty couples of them, besides other large hunting dogs. charles i was as fond of the greyhound as his son charles ii was of the spaniel. sir philip warwick thus writes of that unfortunate monarch; "methinks, because it shows his dislike of a common court vice, it is not unworthy the relating of him, that one evening, his dog scratching at his door, he commanded me to let in gipsy; whereupon i took, the boldness to say, sir, i perceive you love a greyhound better than you do a spaniel. yes, says he, for they equally love their masters, and yet do not flatter them so much." on most of the old tombs in the sculpture of which the dog is introduced, the greyhound is represented lying at the feet of his master; and an old welsh proverb says that a gentleman may be known by his hawk, his horse, and his greyhound. the following poetical record of the fidelity, prowess, and ill-fate of gêlert, the favourite greyhound of llewellyn prince of wales, and son-in-law to king john, will he read with interest: the spearman heard the bugle sound and cheerly smiled the morn, and many a brach and many a hound obeyed llewellyn's horn. and still as blew a lowder blast, and gave a louder cheer, "come, gêlert! why art thou the last llewellyn's horn to hear?" "oh, where does faithful gêlert roam? the flower of all his race! so true, so brave; a lamb at home, a lion in the chase?" 'twas only at lewellyn's board the faithful gêlert fed, he watched, he served, he cheered his lord, and sentinel'd his bed. in sooth he was a peerless hound, the gift of royal john; but now no gêlert could be found, and all the chase rode on. and now as over rocks and dells the gallant chidings rise, all snowdon's craggy chaos yells with many mingled cries. that day llewellyn little loved the chase of hart or hare; and scan and small the booty proved, for gêlert was not there. unpleased llewellyn homeward hied, when near the portal seat his truant gêlert he espied, bounding his lord to greet. but when he gained the castle-door, aghast the chieftan stood; the hound was smeared with gouts of gore-- his lips and fangs ran blood. llewellyn gazed with wild surprise: unused such looks to meet, his favourite check'd his joyful guise and crouched and licked his feet. onward in haste llewellyn pass'd, and on went gélert too; and still where'er his eyes he cast, fresh blood-gouts shocked his view. o'erturned his infant's bed he found, the blood-stained covert rent; and all around the walls and ground, with recent blood besprent. he called his child--no voice replied-- he searched with terror wild: blood! blood! he found on every side, but nowhere found the child. 'hellhound! by thee my child's devoured!' the frantic father cried; and to the hilt his vengeful sword he plunged in gélert's side. his suppliant, as to earth he fell, no pity could impart; but still his gélert's dying yell passed heavy o'er his heart. aroused by gélert's dying yell, some slumberer wakened nigh: what words the parent's joy can tell to hear his infant cry! concealed beneath a mangled heap his hurried search had missed, all glowing from his rosy sleep, his cherub boy he kissed. nor scratch had he, nor harm, nor dread, but the same couch beneath, lay a great wolf, all torn and dead, tremendous still in death. ah, what was then llewellyn's pain! for now the truth was clear: the gallant hound the wolf had slain, to save llewellyn's heir. vain, vain was all llewellyn's wo: "best of thy kind, adieu! the frantic deed which laid thee low, this heart shall ever rue." and now a gallant tomb they raise, with costly sculpture decked; and marbles, storied with his praise, poor gélert's bones protect. here never could the spearman pass, or forester, unmoved; here oft the tear-besprinkled grass llewellyn's sorrow proved. and here he hung his horn and spear; and oft, as evening fell, in fancy's piercing sounds would hear poor gêlert's dying yell! it will be evident, however, from the story of the noble hound whose history is just related, that the greyhounds of the time were very different from those which are used at the present day. there are no gêlerts now to combat successfully with the wolf, if these ferocious animals were yet to be met with in our forests. the greyhound of this early period must have resembled the irish wolf-dog of the present day, a larger, stronger, fiercer dog than we are accustomed to see. the owner of gêlert lived in the time of john, in the early part of the thirteenth century; but, at the latter part of the fifteenth century, the following singular description is given of the greyhound of that period. it is extracted from a very curious work entitled "the treatise perteynynge to hawkynge, huntynge, &c., emprynted at westmestre, by wynkyn de werde, ." a greyhounde should be headed lyke a snake, and neckyd lyke a drake, fotyd lyke a cat tayled lyke a ratte, syded like a teme and chyned like a bream. the fyrste yere he must lerne to fede, the seconde yere to feld him lede. the thyrde yere he is felow lyke. the fourth yere there is non syke. the fifth yere he is good ynough. the syxth yere he shall hold the plough, the seventh yere he will avaylle grete bytches for assayle. but when he is come to the ninth yere have him then to the tannere; for the best hounde that ever bytch had at the ninth yere is full bad. as to the destiny of the poor animal in his ninth year, we differ from the author; but it cannot be denied that few dogs retain their speed beyond the eighth or ninth year. there can scarcely be a better description of the greyhound of the present day; but it would not do for the antagonist of the wolf. the breed had probably begun to degenerate, and that process would seem to have slowly progressed. towards the close of the last century, lord orford, a nobleman enthusiastically devoted to coursing, imagined, and rightly, that the greyhound of his day was deficient in courage and perseverance. he bethought himself how this could best be rectified, and he adopted a plan which brought upon him much ridicule at the time, but ultimately redounded to his credit. he selected a bull-dog, one of the smooth rat-tailed species, and he crossed one of his greyhound bitches with him. he kept the female whelps and crossed them with some of his fleetest dogs, and the consequence was, that, after the sixth or seventh generation, there was not a vestige left of the form of the bulldog; but his courage and his indomitable perseverance remained, and, having once started after his game, he did not relinquish chase until he fell exhausted or perhaps died. this cross is now almost universally adopted. it is one of the secrets in the breeding of the greyhound. of the stanchness of the well-bred greyhound, the following is a satisfactory example. a hare was started before a brace of greyhounds, and ran by them for several miles. when they were found, both the dogs and the hare lay dead within a few yards of each other. a labouring man had seen them turn her several times; but it did not appear that either of them had caught her, for there was no wound upon her. a favourite bitch of this breed was czarina, bred by lord orford, and purchased at his decease by colonel thornton: she won every match for which she started, and they were no fewer than forty-seven. lord orford had matched her for a stake of considerable magnitude; but, before the appointed day arrived, he became seriously ill and was confined to his chamber. on the morning of the course he eluded the watchfulness of his attendant, saddled his favourite piebald pony, and, at the moment of starting, appeared on the course. no one had power to restrain him, and all entreaties were in vain. he peremptorily insisted on the dogs being started, and he would ride after them. his favourite bitch displayed her superiority at every stroke; she won the stakes: but at the moment of highest exultation he fell from his pony, and, pitching on his head, almost immediately expired. with all his eccentricities, he was a kind, benevolent, and honourable man. in the thirteenth year of her age, and in defiance of the strange verses just now quoted, czarina began to breed, and two of her progeny, claret and young czarina, challenged the whole kingdom and won their matches. major, and snowball, without a white spot about him, inherited all the excellence of their dam. the former was rather the fleeter of the two, but the stanchness of snowball nothing could exceed. a scotch greyhound, who had beaten every opponent in his own country, was at this time brought to england, and challenged every dog in the kingdom. the challenge was accepted by snowball, who beat him in a two-mile course. snowball won the mailton cup on four successive years, was never beaten, and some of his blood is now to be traced in almost every good dog in every part of the kingdom, at least in all those that are accustomed to hunt in an open country. the last match run by snowball was against mr. plumber's celebrated greyhound speed; and, so severely contested was it, that speed died soon afterwards. a son of the old dog, called young snowball, who almost equalled his father, was sold for one hundred guineas. the speed of the greyhound has been said to be equal to that of the fleetest horse. a singular circumstance, which occurred at doncaster, proved that it was not much inferior. a mare cantering over the doncaster course, her competitor having been withdrawn, was joined by a greyhound bitch when she had proceeded about a mile. she seemed determined to race with the mare, which the jockey humoured, and gradually increased his pace, until at the distance they put themselves at their full speed. the mare beat her antagonist only by a head. the race-horse is, perhaps, generally superior to the greyhound on level ground, but the greyhound would have the advantage in a hilly country. lord rivers succeeded to major topham and colonel thornton, the owners of major and snowball, as the leading man on the course. his kennels at strathfieldsaye were the pride of the neighbouring country. at first he bore away almost every prize, but breeding too much in and in, and for speed more than for stoutness, the reputation of his kennel considerably declined before his death. in a brace of greyhounds coursed a hare over the edge of a chalk-pit at offham, in sussex. the hare and both the dogs were found dead at the bottom of the pit. on another occasion a hare was chased by a brace of greyhounds: she was killed at the distance of seven miles from the place at which they started. both of the dogs were so exhausted, that every possible assistance being given, they were with difficulty recovered. the english greyhound hunts by sight alone; not because he is altogether devoid of scent, but because he has been taught to depend upon his speed, and that degree of speed which is utterly incompatible with the searching out of the scent. it is like a pack of hounds, running breast high, with the game in view. they are then running by sight, and not by scent, almost doubling their usual pace, and sometimes, from an unexpected turning of the fox or hare, thrown out for a little while. the hound soon recovers the track by his exquisite sense of smell. the english greyhound is never taught to scent his game, but, on the contrary, is called off the moment he has lost sight of the hare, the re-starting of which is left to the spaniel. the english greyhound is distinguished by its peculiarly long and attenuated head and face, terminating in a singular sharpness of the nose, and length of the muzzle or month. there are two results from this: the length of the mouth gives a longer grasp and secures the prey, but, as the nasal cavities and the cavity of the skull are proportionately diminished, there is not so much room for the expansion of the membrane of the nose, there is less power of scent, and less space for the development of the brain. there is little want of extraordinary acute hearing, and the ears of the greyhound are small compared with his bulk. markham recommends the ears to be close, sharp, and drooping, neither protruding by their bulk, nor tiring by their weight. the power of the eye is but of little consequence, for the game is rarely distant from the dog, and therefore, easily seen. the neck is an important portion of the frame. it should be long, in order to correspond with the length of the legs, and thus enable the dog to seize and lift the game, as he rapidly pursues his course, without throwing any undue or dangerous weight on the fore extremities. in the act of seizing the hare the short-necked dog may lose the centre of gravity and fall. the chest is a very important part of the greyhound, as well as of every other animal of speed. it must be capacious: this capacity must be obtained by depth rather than by width, in order that the shoulders may not be thrown so far apart as to impede progression. the form and situation of the shoulders are of material consequence; for on them depends the extent of the action which the animal is capable of exerting. the shoulders should be broad and deep, and obliquely placed. they are so in the horse, and the action of the dog depends entirely on this conformation. the fore legs should be set on square at the shoulder: bulging out at the elbow not only gives a clumsy appearance, but makes the dog slow. the legs should have plenty of bone, and be straight, and well set on the feet, and the toes neither turned out nor in. the fore arm, or that portion of the leg which is between the elbow and the knee, should be long, straight and muscular. these are circumstances that cannot be dispensed with. the length of the fore arm, and the low placing of the pastern, are of essential importance. with regard to the form of the back and sides of the greyhound, mr. thacker says, with much truth, that "it is the strength of the back which is brought into requisition, in particular, in running over hilly ground. here may be said to rest the distinction between long and short backs, supposing both to be good and strong. the more lengthy the back, and proportionately strong, the more the greyhound is calculated to beat the shorter-backed dog on the flat; but on hilly ground one with a shorter back will have the advantage." [ ] the ribs should also be well arched. we would perhaps avoid him with sides too decidedly outswelling, but still more would we avoid the direct flat-sided dog. without really good haunches and muscular thighs, it has been well remarked that the odds are against any dog, be his other points whatever they may. it is by the propulsatory efforts of the muscles of the loins and thighs that the race is won. the thighs should be large, and muscularly indented; the hocks broad, and, like the knee, low placed. these are very important points; for, as mr. blaine has properly remarked, "on the extent of the angles formed between these several portions of the hinder limbs, depends the extent of the space passed over at each bound." the colour of the greyhound varies exceedingly. some are perfectly black and glossy. in strength and endurance, the brindled dog, or the brown or fawn-coloured one, is the best. the white greyhound, although a beautiful animal and swift, is not, perhaps, quite so much to be depended on. the greyhound is said to be deficient in attachment to his master and in general intelligence. there is some truth in the imputation; but, in fact, the greyhound has, far less than even the hound, the opportunity of forming individual attachments, and no other exercise of the mind is required of him than to follow the game which starts up before him, and to catch it if he can. if, however, he is closely watched he will be found to have all the intellect that his situation requires. [ ] as to the individual attachment which the greyhound may form, he has not always or often the opportunity to acquire or to exhibit it. the keeper exercises over him a tyrannical power, and the owner seldom notices him in the manner which excites affection, or scarcely recognition; but, as a plea for the seeming want of fondness, which, compared with other breeds, he exhibits, it will be sufficient to quote the testimony of the younger xenophon, who had made the greyhound his companion and his friend. "i have myself bred up," says he, "a swift, hard-working, courageous, sound-footed dog. he is most gentle and kindly affectioned, and never before had i any such a dog for myself, or my friend, or my fellow-sportsman. when he is not actually engaged in coursing, he is never away from me. on his return he runs before me, often looking back to see whether i had turned out of the road, and as soon as he again catches sight of me, showing symptoms of joy, and once more trotting away before me. if a short time only has passed since he has seen me or my friend, he jumps up repeatedly by way of salutation, and barks with joy as a greeting to us. he has also many different tones of speech, and such as i never heard from any other dog. now really i do not think that i ought to be ashamed to chronicle the name of this dog, or to let posterity know that xenophon the athenian had a greyhound, called hormé, possessed of the greatest speed, and intelligence, and fidelity, and excellent in every point." [the greek sportsmen held their dogs in peculiar estimation; they were not only their attendants in the field, but their constant companions in their houses, were fed from their tables, and even shared their beds. it is with some degree of pleasure that the patrons of this noble animal will witness, in the following remarks, the tender solicitude with which this people watched over their dogs. "there is nothing like a soft and warm bed for greyhounds, but it is best for them to sleep with men, as they become thereby affectionately attached, pleased with the contact of the human body, and as fond of their bed-fellow as of their feeder. if any ailing affect the dog the man will perceive it, and will relieve him in the night, when thirsty, or urged by any call of nature. he will also know how the dog has rested. for if he has passed a sleepless night, or groaned frequently in his sleep, or thrown up any of his food, it will not be safe to take him out coursing. all these things the dog's bed-fellow will be acquainted with." (arrian, chap. ix. trans.) it was also not an unusual circumstance for the most polished greeks, when sending notes of invitation to their friends, requesting their presence in celebration of some festive occasion, to extend the same civilities to their favourite dogs, by desiring them to be brought along, as will be seen by the following paragraph selected from a letter of this kind addressed by one friend to another. "i am about to celebrate the birth-day of my son, and i invite you, my pithacion, to the feast. but come not alone; bring with you your wife, children, and your brother. if you will bring also your bitch, who is a good guard, and by the loudness of her voice drives away the enemies of your flocks, she will not, i warrant, disdain to be partaker of our feast, &c." (letter xviii., alciphron's epistles.)--l.] the greyhound has within the last fifty years assumed a somewhat different character from that which he once possessed. he is distinguished by a beautiful symmetry of form, of which he once could not boast, and he has even superior speed to that which he formerly exhibited. he is no longer used to struggle with the deer, but he contends with his fellow over a shorter and speedier course. the rules for breeding and breaking-in of greyhounds are very simple. the utmost attention should be paid to the qualities of the parents; for it is as certain in these dogs as in the horse that all depends upon the breeding. the bitch should be healthy and of good size; the dog muscular, stanch, and speedy, and somewhat larger than the bitch. both should have arrived at their full vigour, and with none of their powers beginning to fail. those as much as possible should be selected whose peculiar appearance bids fair to increase the good qualities and diminish the bad ones on either side. the best blood and the best form should be diligently sought. breeding from young dogs on either side should, generally speaking, be avoided. with regard to older dogs, whether male or female, there may be less care. many greyhounds, both male and female, eight, nine, and ten years of age, have been the progenitors of dogs possessing every stanch and good quality. on no consideration, however, should the bitch be put to the dog before she is two years old. little can be done to regulate the period of oestrum; but the most valuable breed will be almost invariably that which is produced during the spring, because at that time there will often be opportunity for that systematic exercise on which the growth and powers of the dog so materially depend. a litter of puppies in the beginning or even the middle of winter will often be scarcely worth the trouble or expense of rearing. the age of the greyhound is now taken from the first day in the year; but the conditions of entry are fixed at different periods. it seems, however, to be agreed that no dog or bitch can qualify for a puppy cup after two years of ago. one principle to be ever kept in mind is a warm and comfortable situation, and a plentiful supply of nourishment for the mother and for the puppies from the moment of their birth. the dog that is stinted in his early growth will never do its owner credit. the bitch should be abundantly supplied with milk, and the young ones with milk and bread, and oatmeal, and small portions of flesh as soon as they are disposed to eat it; great care, however, being taken that they are not over-gorged. regular and proper feeding, with occasional exercise, will constitute the best preparation for the actual training. if a foster-mother be required for the puppies, it should, if possible, be a greyhound; for it is not at all impossible that the bad qualities of the nurse may to a greater or less degree be communicated to the whelps. bringing up by hand is far preferable to the introduction of any foster-mother. a glass or indian-rubber bottle may be used for a little while, if not until the weaning. milk at first, and afterwards milk and sop alternately, may be used. there is a difference of opinion whether the whelp should be kept in the kennel and subjected to its regular discipline, or placed at walk in some farm-house. in consequence of the liberty he will enjoy at the latter, his growth will probably be more rapid; but, running with the farmers' dogs, and probably coursing many hares, he will acquire, to a certain degree, a habit of wildness. it is useless to deny this; but, on the other hand, nothing will contribute so much to the development of every power as a state of almost unlimited freedom when the dogs are young. the wildness that will be exhibited can soon be afterwards restrained so far as is necessary, and the dog who has been permitted to exert his powers when young will manifest his superiority in more advanced age, and in nothing more than his dexterity at the turn. when the training actually commences, it should be preceded by a couple of doses of physic, with an interval of five or six days, and, probably, a moderate bleeding between them; for, if the dog begins to work overloaded with flesh and fat, he will suffer so severely from it that possibly he will never afterwards prove a game dog. in the course of his training he should be allowed every advantage and experience every encouragement. his courses should be twice or thrice a-week, according to their severity, and as often as it can be effected be should be rewarded with some mark of kindness. in the 'sportsman' for april, , is an interesting account of the chase of the hare. it is said that, in general, a good greyhound will reach a hare if she runs straight. he pursues her eagerly, and the moment he is about to strike at her she turns short, and the dog, unable to stop himself, is thrown from ten to twenty yards from her. these jerking turns soon begin to tell upon a dog, and an old well-practised hare will seldom fail to make her escape. when, however, pursued by a couple of dogs, the hare has a more difficult game to play, as it frequently happens that when she is turned by the leading dog she has great difficulty in avoiding the stroke of the second. it is highly interesting to witness the game of an old hare. she has generally some brake or thicket in view, under the cover of which she means to escape from her pursuers. on moving from her seat she makes directly for the hiding-place, but, unable to reach it, has recourse to turning, and, 'wrenched' by one or the other of her pursuers, she seems every moment almost in the jaws of one of them, and yet in a most dexterous manner she accomplishes her object. a greyhound, when he perceives a hare about to enter a thicket, is sure to strike at her if within any reasonable distance. the hare shortens her stride as she approaches the thicket, and at the critical moment she makes so sudden, dexterous, and effectual a spring, that the dogs are flung to a considerable distance, and she has reached the cover and escaped. the isle of cyprus has for many years been celebrated for its breed of the greyhound. on grand days, or when the governor is present, the sport is conducted in a curious manner. when the hare is ready to become the prey of its enemies, the governor rushes forwards, and, throwing before the greyhounds a stick which he carries, they all instantaneously stop. the hare now runs a little distance; but one of the swiftest greyhounds is then let loose. he pursues the hare, and, having come up with it, carries it back, and, springing on the neck of the governor's horse, places it before him. the governor delivers it to one of his officers, who sends it to the park, where he maintains many prisoners of the same kind; for he will not destroy the animal that has contributed to his amusement. [ ] the following, according to mr. blaine, an ardent courser in his youth, is the best mode of feeding greyhounds at regular work: "the dogs had a full flesh meal every afternoon or evening, as more nutriment is derived from night-feeding than by day, and when sleeping than when waking. in the morning they were let out, and either followed the keeper about the paddock, or the groom in his horse exercise, and then had a trifling meat of mixed food, as a quieting portion, until the evening full meal. such was our practice on the days when no coursing was contemplated, and, with the exception of lowering the quantity and quality of the evening meal, the same plan was pursued throughout the year. on the day previous to coursing, if we intended anything like an exhibition of our dogs before company engaged to meet us on the marshes, we gave a plentiful meal early the previous day, some exercise also in the afternoon, and a light supper at night, of meal with either broth or milk, with a man on horseback going a gentle trot of six or seven miles an hour." [ ] mr. thacker orders the greyhounds out on the fore part of every day; but, instead of being loose and at liberty, they would be much better two and two; then, when he meets with a proper field to loose them in, to give them a good gallop. this will be a greater novelty than if they had been loose on the road, and they will gallop with more eagerness. four days in a week will be enough for this exercise. on one day there should he a gallop of one or two miles, or even a course for each brace of dogs. the young dog has usually an older and more experienced one to start with him. that which is of most importance is, that his leader should be a thoroughly stout and high-mettled dog. if he shrinks or shies at any impediment, however formidable, the young one will be sure to imitate him, and to become an uncertain dog, if not a rank coward. early in november is the time when these initiatory trials are to be made. it is of consequence that the young one should witness a death as soon as possible. some imagine that two old dogs should accompany the young one at its first commencement. after the death of the leveret, the young dog must be coaxed and fondled, but never suffered to taste the blood. in kennels in which the training is regularly conducted, the dog should be brushed all over twice every day. few things contribute so much to health as general cleanliness, and friction applied to the skin. warmth is as necessary for greyhounds as for horses, and should not be forgotten in cold weather. body-clothing is a custom of considerable antiquity, and should not be abandoned. the breeder of greyhounds for the purpose of coursing must reckon upon incurring considerable expense; but, if he loves the sport, ho will be amply remunerated by the speed and stoutness of his dogs. a question has arisen whether, on the morning of the coursing, any stimulant should be given to the dog. the author of this work would unhesitatingly approve of this practice. he has had abundant experience of the good effect of it; but the stimulus must be that which, while it produces the desired effect, leaves no exhaustion behind. [ ] the scotch greyhound has the same sharpness of muzzle, length of head, lightness of ear, and depth of chest, as the english dog; but the general frame is stronger and more muscular, the hind quarters more prominent, there is evident increase of size and roughness of coat, and there is also some diminution of speed. if it were not for these points, these dogs might occasionally be taken for each other. in coursing the hare, no north-country dog will stand against the lighter southern, although the southern would be unequal to the labour often required from the highlander. the scotch greyhound is said--perhaps wrongly--to be oftenest used by those who look more to the quantity of game than to the fairness and openness of the sport, and in some parts of the country this dog is not permitted to be entered for a sweepstakes, because, instead of depending on his speed alone, as does the english greyhound, he has recourse to occasional artifices in order to intercept the hare. in sporting language he runs sly, and, therefore, is sometimes excluded. the highland greyhound, or deer-hound is a larger, stronger, and fiercer dog, and may be readily distinguished from the lowland scotch greyhound by its pendulous, and, generally, darker ears, and by the length of hair which almost covers his face. many accounts have been given of the perfection of its scent, and it is said to have followed a wounded deer during two successive days. he is usually two inches taller than the scotch greyhound. the head is carried particularly high, and gives to the animal a noble appearance. his limbs are exceedingly muscular, his back beautifully arched. the tail is long and curved, but assumes the form of an almost straight line when he is much excited. the only fault which these dogs have is their occasional ill-temper, or even ferocity; but this does not extend to the owner and his family. it appears singular that the english greyhound exhibits so little power of scent; but this is simply because he has never been taught to use it, or has been cruelly corrected when he has attempted to exercise it. holinshed relates the mischief that followed the stealing of one of these dogs: "divers of the young pictesh nobilitye repaired unto craithlint, king of the scots, for to hunt and make merie with him; but, when they should depart homewards, perceiving that the scotish dogs did far excel theirs, both in fairnesse, swiftnesse, and hardinesse, and also in long standing up and holding out, they got diverse both dogs and bitches of the best kind for breed, to be given them by the scotish lords: and yet not so contented, they stole one belonging to the king from his keeper, being more esteemed of him than all the others which he had about him. the maister of the leash, being informed hereof pursued after them that had stolen the dog, thinking, indeed, to have taken him from them: but they not being to part with him fell at altercation, and at the end chanced to strike the maister of the leash through with their horse spears, so that he did die presently. whereupon noise and crie being raised in the country by his servantes, divers of the scots, as they were going home from hunting, returned, and falling upon the picts to revenge the death of their fellow, there ensued a shrewed bickering betwixt them; so that of the scots there died three score gentlemen, besides a great number of the commons, not one of them understanding what the matter meant. of the picts there were about slaine." mr. h.d. richardson describes a cross between the greyhound and british bloodhound: "it is a tall muscular raw-boned dog, the ears far larger, and more pendulous, than those of the greyhound or deer-hound. the colour is generally black, or black and tan; his muzzle and the tips of the ears usually dark. he is exceedingly swift and fierce; can pull down a stag single-handed; runs chiefly by sight, but will also occasionally take up the scent. in point of scent, however, he is inferior to the true deer-hound. this dog cannot take a turn readily, but often fails at the double." [ ] the irish greyhound. this dog differs from the scotch, in having shorter and finer hair, of a pale fawn colour, and pendent ears. it is, compared with the scotch dog, gentle and harmless, perhaps indolent, until roused. it is a larger dog than the scottish dog, some of them being full four feet in length, and proportionately muscular. on this account, and also on account of their determined spirit when roused, they were carefully preserved by some irish gentlemen. they were formerly used in hunting the wolf when that animal infested the forests of ireland. mr. bell says that the last person who kept the pure breed was lord altamont, who in "had eight of them." [ ] the gasehound, the 'agasaeus' of former times, was probably allied to, or connected with, the irish greyhound. it hunted entirely by sight, and, if its prey was lost for a time, it could recover it by a singular distinguishing faculty. should the deer rejoin the herd, the dog would unerringly select him again from all his companions: "seest thou the gasehound how with glance severe from the close herd he marks the destined deer?" [ ] there is no dog possessed of this quality at present known in europe; but the translator of arrian thinks that it might be produced between the irish greyhound and the bloodhound. the irish wolf-dog this animal is nearly extinct, or only to be met with at the mansions of one or two persons by whom he is kept more for show than use, the wild animals which he seemed powerful enough to conquer having long disappeared from the kingdom. the beauty of his appearance and the antiquity of his race are his only claims, as he disdains the chase of stag, fox, or hare, although he is ever ready to protect the person and the property of his master. his size is various, some having attained the height of four feet, and dr. goldsmith stales that he saw one as large as a yearling calf. he is shaped like a greyhound, but stouter; and the only dog which the writer from whom this account is taken ever saw approaching to his graceful figure, combining beauty with strength, is the large spanish wolf-dog: concerning which he adds, that, showing one of these spanish dogs to some friends, he leaped through a window into a cow-house, where a valuable calf was lying, and seizing the terrified animal, killed it in an instant; some sheep having in the same way disappeared, he was given away. the same writer says that his grandfather had an irish wolf-dog which saved his mother's life from a wolf as she was paying a visit attended by this faithful follower. he rushed on his foe just when he was about to make his spring, and after a fierce struggle laid him dead at his mistress's feet. his name was bran. [ ] the russian greyhound is principally distinguished by its dark-brown or iron-grey colour--its short semi-erect ears--its thin lanky body--long but muscular legs--soft thick hair, and the hair of its tail forming a spiral twist, or fan, (thence called the fan-tailed dog,) and as he runs having a very pleasing appearance. he hunts by scent as well as by sight, and, therefore, small packs of this kind are sometimes kept, against which the wolf, or even the bear, would stand little chance. he is principally used for the chase of the deer or the wolf, but occasionally follows the hare. the deer is the principal object of pursuit, and for this he is far better adapted than to contend with the ferocious wolf. his principal faults are want of activity and dexterity. he is met with in most parts of russia, where his breed is carefully preserved by the nobility, with whom coursing is a favourite diversion. some dogs of this breed were not long ago introduced into ireland. the grecian greyhound the author is glad that he is enabled to present his readers with the portrait of one now in the menagerie of the zoological society of london. it is the dog whose image is occasionally sculptured on the friezes of some of the ancient grecian temples, and was doubtless a faithful portrait of one of the dogs which xenophon the athenian valued, and was the companion of the heroes of greece in her ancient glory. the principal difference between the grecian and the english greyhound is, that the former is not so large, the muzzle is not so pointed, and the limbs are not so finely framed. the turkish greyhound is a small-sized hairless dog, or with only a few hairs on his tail. he is never used in the field, and bred only as a spoiled pet, yet not always spoiled, for anecdotes are related of his inviolable attachment to his owner. one of them belonged to a turkish pacha who was destroyed by the bowstring. he would not forsake the corpse, but laid himself down by the body of his murdered master, and presently expired. the persian greyhound is a beautiful animal. he is more delicately framed than the english breed; the ears are also more pendulous, and feathered almost as much as those of a king charles's spaniel. notwithstanding, however, his apparent slenderness and delicacy, he yields not in courage, and scarcely in strength, to the british dog. there are few kennels in which he is found in which he is not the master. in his native country, he is not only used for hunting the hare, but the antelope, the wild ass, and even the boar. the antelope is speedier than the greyhound: therefore the hawk is given to him as an ally. the antelope is no sooner started than the hawk is cast off, who, fluttering before the head of the deer, and sometimes darting his talons into his head, disconcerts him, and enables the greyhound speedily to overtake and master him. the chase, however, in which the persians chiefly delight, and for which these greyhounds are mostly valued, is that of the 'ghoo-khan', or wild ass. this animal inhabits the mountainous districts of persia. he is swift, ferocious, and of great endurance, which, together with the nature of the ground, renders this sport exceedingly dangerous. the hunter scarcely gives the animal a fair chance, for relays of greyhounds are placed at various distances in the surrounding country; so that, when those by which the animal is first started are tired, there are others to continue the chase. such, however, is the speed and endurance of the ghoo-khan, that it is seldom fairly run down by the greyhounds, its death being usually achieved by the rifle of some horseman. the persians evince great skill and courage in this dangerous sport, galloping at full speed, rifle in hand, up and down the most precipitous hills, and across ravines and mountain streams, that might well daunt the boldest rider. [ ] the persian greyhound, carried to hindoostan, is not always to be depended upon; but, it is said, is apt to console itself by hunting its own master, or any one else, when the game proves too fleet or escapes into the cover. the italian greyhound possesses all the symmetry of the english or persian one, on a small scale. so far as beauty can recommend it, and, generally speaking, good nature, it is deservedly a favourite in the drawingroom; but, like the large greyhound, it is inferior in intelligence. it has no strong individual attachment, but changes it with singular facility. it is not, however, seen to advantage in its petted and degraded state, but has occasionally proved a not unsuccessful courser of the rabbit and the hare, and exhibited no small share of speed and perseverance. in a country, however, the greater part of which is infested with wolves, it cannot be of much service, but exposed to unnecessary danger. it is bred along the coasts of italy, principally for the purpose of sale to foreigners. in order to acquire more perfect beauty of form, and more activity also, the english greyhound has received one cross from the italian, and with decided advantage. the speed and the beauty have been evidently increased, and the courage and stoutness have not been diminished. it has been said that frederick the great of prussia was very fond of a small italian greyhound, and used to carry it about with him under his cloak. during the seven years' war, he was pursued by a party of austrian dragoons, and compelled to take shelter, with his favourite, under the dry arch of a bridge. had the little animal, that was naturally ill-tempered and noisy, once barked, the monarch would have been taken prisoner, and the fate of the campaign and of prussia decided; but it lay perfectly still, and clung close to its master, as if conscious of their mutual danger. when it died, it was buried in the gardens of the palace at berlin, and a suitable inscription placed over its grave. [footnote : 'annals of sporting', vol. vi. p. .] [footnote : the superstition of the arabians and turks with regard to dogs is somewhat singular: neither have they much affection for these animals, or suffer them to be in or near the camp, except to guard it in the night. they have, however, some charity for the females that have whelps. as for other dogs, they feed them well, and give them good words, but never touch them nor go near them, because dogs are regarded as unclean animals. they particularly drive them away in wet weather; for, if one drop of water from a dog should fall on their raiment, their devotion would be interrupted and useless. they who are fond of hunting make their religion subservient to their pleasure, and say that greyhounds and setters are excepted from the general rule, because when not running these dogs are tied up where nothing unclean can reach them, and they are never suffered to eat any thing unclean. their opinion is the same with regard to small dogs, which are kept with great care, and no one willingly injures a dog, or, if he should injure purposely, or destroy one of them, the law would punish him. chevalier darvieux's 'travels in arabia deserta', , p. .] [footnote : 'heber's narrative', p. .] [footnote : 'histoire du chien', par elzear blaze, p. .] [footnote : 'proceedings of the zoological society', part i. .] [footnote : williamson's 'oriental field sports'] [footnote : poiret, in his 'travels in barbary' asserts that "the dog loses in the east a great part of those good qualities that make him the friend of man. he is no longer a faithful domesticated animal, faithfully attached to his master, and ever ready to defend him even at the expense of his own life. he is cruel and blood-thirsty, his look is savage, and his appearance revolting; carrion, filth, anything is good enough for him if he can but appease his hunger. they seldom bite one another, but they unite against a stranger who approaches the arab tents, and would tear him to pieces if he did not seek his safety in flight." vol. i. p. . denon, when in the city of alexandria, in egypt, says, "i have no longer recognised the dog, that friend of man, the attached and faithful companion--the lively and honest courtier. he is here a gloomy egotist, and cut off from all human intercourse without being the less a slave. he does not know him whose house he protects, and devours his corpse without repugnance." travels in lower egypt, p. .] [footnote : 'histoire du chien', p. . the voyage of dumont d'urville, vol. ii. p. .] [footnote : greyhound.] [footnote : overcast, or overrun.] [footnote : ovid, 'metamorph.', lib. i. v. .] [footnote : a singular story is told of richard ii, and one of these dogs. it is given in the language of froissart. "a grayhounde called mithe, who always wayted upon the kynge, and would knowe no man els. for when so ever the kynge did ryde, he that kept the grayhounde dyd lette him lose, and he wolde streyght runne to the kynge and faune uppon hym, and leape with his fore fete uppon the kynge's shoulders. and, as the kynge and the erle of derby talked togyder in the courte, the grayhounde who was wonte to leape uppon the kynge, left the kynge and came to the erle of derby, duke of lancastre; and made to him the same friendly continuance and chere as he was wonte to do to the kynge. the duke, who knewe not the grayhounde, demanded of the kynge what the grayhounde wolde do? 'cousin,' qoud the kynge, 'it is a greate goode token to you, and an evyl signe to me.' 'how knowe you that?' quod the duke. 'i knowe it well,' quod the kynge. 'the grayhounde acknowledgeth you here this daye as kynge of england, as ye shall be, and i shal be deposed; the grayhounde hath this knowledge naturally: therefore take hyme to you, he wyll followe you and forsake me.' the duke understood well those words, and cheryshed the grayhounde, who would never after followe kynge richarde, but followed the duke of lancastre."] [footnote : 'thacker on sporting'.] [footnote : the writer of this work had a brace of greyhounds as arrant thieves as ever lived. they would now and then steal into the cooking-room belonging to the kennel, lift the lid from the boiler, and, if any portion of the joint or piece of meat projected above the water, suddenly seize it, and before there was time for them to feel much of its heat, contrive to whirl it on the floor, and eat it at their leisure as it got cold. in order to prevent this, the top of the boiler was secured by an iron rod passing under its handle of the boiler on each side; but not many days passed ere they discovered that they could gnaw the cords asunder, and displace the rod, and fish out the meat as before. small chains were then substituted for the cords, and the meat was cooked in safety for nearly a week, when they found that, by rearing themselves on their hind legs, and applying their united strength towards the top of the boiler they could lift it out of its bed and roll it along the floor, and so get at the broth, although the meat was out of their reach. the man who looked after them expressed himself heartily glad when they were gone; for, he said, he was often afraid to go into the kennel, and was sure they were devils, and not dogs.] [footnote : scott's 'sportsman's repository', p. .] [footnote : blaine's 'encyclopedia of sporting'.] [footnote : for a set of laws for coursing matches. see appendix.] [footnote : 'sportsman', vol. xi. p. ] [footnote : bell's 'british quadrupeds', p. .] [footnote : tickell's 'miscellanies'] [footnote : 'sporting mag.' , p. .] [footnote : 'new sports. mag.' xiii. .] * * * * * chapter iii. the varieties of the dog. second division. the head moderately elongated, the parietals not approaching from their insertion, but rather diverging, so as to enlarge the cerebral cavities and the frontal sinuses; consequently giving to these dogs greater power of scent and intelligence. they constitute the most pleasing and valuable division of the dog. the spaniel is evidently the parent of the newfoundland dog and the setter; while the retriever, the poodle, the bernardine, the esquimaux, the siberian, and the greenland dogs, the shepherd and drover's dog, and every variety distinguished for intelligence and fidelity, have more or less of his blood in them. the spaniel is probably of spanish origin, and thence his name. the ears are large and pendent, the tail elevated, the fur of a different length in different parts of the body, but longest about the ears, under the neck, behind the thighs and on the tail, varying in colour, but most commonly white with brown or black patches. there are many varieties of the spaniel. the smallest of the 'land' spaniels is the cocker. it is chiefly used in flushing woodcocks and pheasants in thickets and copses into which the setter, and even the springer, can scarcely enter. "but, if the shady woods my cares employ, in quest of feathered game my spaniels beat, puzzling the entangled copse, and from the brake push forth the whirring pheasant." the cocker is here very useful, although he is occasionally an exceedingly impatient animal. he is apt to whimper and babble as soon as he comes upon the scent of game, and often raises the bird before the sportsman is within reach: but when he is sufficiently broken in not to give tongue until the game rises, he is exceedingly valuable. there can scarcely be a prettier object than this little creature, full of activity, and bustling in every direction, with his tail erect; and, the moment he scents the bird, expressing his delight by the quivering of every limb, and the low eager whimpering which the best breaking cannot always subdue. presently the bird springs, and then he shrieks out his ecstasy, startling even the sportsman with his sharp, shrill, and strangely expressive bark. the most serious objection to the use of the cocker is the difficulty of teaching him to distinguish his game, and confine himself within bounds; for he will too often flush everything that comes within his reach. it is often the practice to attach bells to his collar, that the sportsman may know where he is; but there is an inconvenience connected with this, that the noise of the bells will often disturb and spring the game before the dog comes fairly upon it. patience and perseverance, with a due mixture of kindness and correction, will, however, accomplish a great deal in the tuition of the well-bred spaniel. he may at first hunt about after every bird that presents itself, or chase the interdicted game; but, if he is immediately called in and rated, or perhaps corrected, but not too severely, he will learn his proper lesson, and will recognise the game, to which alone his attention must be directed. the grand secret in breaking in these dogs is mildness, mingled with perseverance, the lessons being enforced, and practically illustrated by the example of an old and steady dog. these spaniels will sometimes vie with almost every other species of dog in intelligence, and will not yield to one of them in fidelity. a gentleman in sussex had an old cocker, that was his constant companion, both in the house and the field. if the morning was rainy, the dog was perfectly quiet; if it was fine, he became restless, and, at the usual time for his master to go out, he would take him by the flap of his coat, and gently pull at it. if the door was opened, he ran immediately to the keeper's lodge, which was at a considerable distance from the house. this was a signal for the other dogs to be brought up, and then he trotted back to announce their approach. [this beautiful and interesting dog, so called from his peculiar suitableness for woodcock shooting, is but little known among us except as a boudoir companion for our ladies. he is, nevertheless, extensively used in england by sportsmen for finding and flushing this bird, as also the pheasant; and no doubt, if introduced into our country, would prove equally, if not more serviceable, in putting up game concealed in the thickets and marshy hollows of our uncleared grounds. having extremely fine scenting powers, they are also employed in greyhound coursing, to give warning of the proximity of a hare, which they seldom fail to accomplish. this active little animal hunts with great spirit, and soon becomes attached to the sport; in fact the only difficulty to be overcome in breaking him, is the effort it requires to make him suppress his natural ardour and withhold his exclamations of delight till the bird is actually on the wing. the tutelage of the cocker intended for the field should commence as early as possible, and is not, as many suppose, attended with great difficulty. his first lessons should be confined to the art of bringing and carrying, which he soon, in common with all the other members of the spaniel tribe, learns. the next thing to be inculcated is implicit obedience to our wishes; then, at the age of four months or so, he may be carried to the field, where his natural fondness for hunting will soon be developed by his chasing every bird within his reach. when this impulse is fully exhibited, and the dog expresses gratification in the amusement, he should be then instructed to give chase, or not, at his master's pleasure. when this desirable end has been accomplished, he may be introduced to the particular kinds of game which it is proposed to hunt him on, and by slow degrees teach him to confine his attentions to those varieties alone. it is absolutely necessary that the dog be forced to hunt as near to the sportsman as possible, otherwise the game will be flushed at such a distance that it will be impossible to get at it. the cocker spaniel is much smaller than the springer; his ears are long, pendulous, and silky; his body round and compact; his legs short and tufted; his coat variable; his nose black; tail bushy and feathered, and, when hunting, is kept in constant motion. some are black and white, others liver colour and yellow; the latter variety we have most usually seen in this country, and some of them have been represented to us as well-broken and serviceable dogs.--l.] the king charles's spaniel, so called from the fondness of charles ii for it--who usually had some of them following him, wherever he went--belongs likewise to the cockers. its form and character are well preserved in one of the paintings of the unfortunate parent of that monarch and his family. the ears deeply fringed and sweeping the ground, the rounder form of the forehead, the larger and moister eye, the longer and silken coat, and the clearness of the tan, and white and black colour, sufficiently distinguish this variety. his beauty and diminutive size have consigned him to the drawing-room or parlour. charles the first had a breed of spaniels, very small, with the hair black and curly. the spaniel of the second charles was of the black and tan breed. the king charles's breed of the present day is materially altered for the worse. the muzzle is almost as short, and the forehead as ugly and prominent, as the veriest bull-dog. the eye is increased to double its former size, and has an expression of stupidity with which the character of the dog too accurately corresponds. still there is the long ear, and the silky coat, and the beautiful colour of the hair, and for these the dealers do not scruple to ask twenty, thirty, and even fifty guineas. [this breed of dog was cultivated with such jealous care by the late duke of norfolk, that no solicitation or entreaty could induce this nobleman to part with one of these favourites, except under certain peculiar stipulations and injunctions, as detailed in the following interview of mr. blain with the late duchess of york. "on one occasion, when we were accompanying her royal highness to her menagerie, with almost a kennel of canine favourites behind her, after drawing our attention to a jet black pug pup she had just received from germany, she remarked that she was going to show me what she considered a present of much greater rarity, which was a true king charles's breed sent to her by the duke of norfolk. 'but,' she observed, 'would you believe he could be so ungallant as to write word that he must have a positive promise not from myself, but from the duke of york, that i should not breed from it in the direct line?'" notwithstanding these selfish restrictions on the part of this noble patron of the spaniel, this breed of dog has become quite common in england, and not a few have found their way to this country.--l.] the springer this dog is slower and steadier in its range than the cocker; but it is a much safer dog for the shooter, and can better stand a hard day's work. the largest and best breed of springers is said to be in sussex, and is much esteemed in the wealds of that county. from a cross with the terrier a black and tan variety was procured, which was cultivated by the late duke of norfolk, and thence called the norfolk spaniel. it is larger than the common springer, and stancher, and stouter. it often forms a strong individual attachment, and is unhappy and pines away when separated from its master. it is more ill-tempered than the common springer, and, if not well broken in, is often exceedingly obstinate. [mr. skinner informs us that this breed, in its greatest purity, may be found in the carrollton family, as also in the possession of mr. keyworth of washington city.--l.] the black and tan spaniel, the cross of the terrier being nearly or quite got rid of, is often a beautiful animal, and is much valued, although it is frequently considered a somewhat stupid animal. the cocker and the springer are sometimes used as finders in coursing. the blenheim spaniel, a breed cultivated by one of the dukes of marlborough, belongs to this division. from its beauty, and occasional gaiety, it is oftener an inhabitant of the drawing-room than the field; but it occasionally breaks out, and shows what nature designed it for. some of these carpeted pets acquit themselves nobly in the covert. there they ought oftener to be; for they have not much individuality of attachment to recommend them, and, like other spoiled animals, both quadruped and biped, misbehave. the breed has degenerated of late, and is not always to be had pure, even in the neighbourhood of blenheim. this spaniel may he distinguished by the length and silkiness of the coat, the deep fringe about the ear, the arch and deep-feathering of the tail, the full and moist eye, and the blackness of the palate. the water-spaniel. of this breed there are two varieties, a larger and smaller, both useful according to the degree of range or the work required; the smaller, however, being ordinarily preferable. whatever be his general size, strength and compactness of form are requisite. his head is long, his face smooth, and his limbs, more developed than those of the springer, should be muscular, his carcase round, and his hair long and closely curled. good breaking is more necessary here than even with the land-spaniel, and, fortunately, it is more easily accomplished; for, the water-spaniel, although a stouter, is a more docile animal than the land one. docility and affection are stamped on his countenance, and he rivals every other breed in his attachment to his master. his work is double; first to find, when ordered so to do, and to back behind the sportsman when the game will be more advantageously trodden up. in both he must be taught to be perfectly obedient to the voice, that he may be kept within range, and not unnecessarily disturb the birds. a more important part of his duty, however, is to find and bring the game that has dropped. to teach him to find is easy enough, for a young water-spaniel will as readily take to the water as a pointer puppy will stop; but to bring his game without tearing is a more difficult lesson, and the most difficult of all is to make him suspend the pursuit of the wounded game while the sportsman re-loads. the water-spaniel was originally from spain; but the pure breed has been lost, and the present dog is probably descended from the large water-dog and the english setter. the water and land spaniels differ materially from each other. the water-spaniel, although when at his work being all that his master can desire, is, when unemployed, comparatively a slow and inactive dog; but under this sobriety of demeanor is concealed a strength and fidelity of attachment to which the more lively land-spaniel cannot always lay just claim. the writer of this work once saved a young water-spaniel from the persecution of a crowd of people who had driven it into a passage, and were pelting it with stones. the animal had the character of being, contrary to what his species usually are, exceedingly savage; and he suffered himself to be taken up by me and carried from his foes with a kind of sullenness; but when, being out of the reach of danger, he was put down, he gazed on his deliverer, and then crouched at his feet. from that moment he attached himself to his new master with an intensity of affection scarcely conceivable--never expressed by any boisterous caresses, but by endeavouring to be in some manner in contact with him; resting his head upon his foot; lying upon some portion of his apparel, his eye intently fixed upon him; endeavouring to understand every expression of his countenance. he would follow one gentleman, and one only, to the river-side, and behave gallantly and nobly there; but the moment he was dismissed he would scamper home, gaze upon his master, and lay himself down at his feet. in one of these excursions he was shot. he crawled home, reached his master's feet, and expired in the act of licking his hand. perhaps the author may be permitted to relate one story more of the water-spaniel: he pledges himself for its perfect truth. the owner of the dog is telling this tale. "i was once on the sea-coast, when a small, badly-formed, and leaky fishing-boat was cast on shore, on a fearful reef of rocks. three men and a boy of ten years old constituted the crew. the men swam on shore, but they were so bruised against the rocks, that they could not render any assistance to the poor boy, and no person could be found to venture out in any way. i heard the noise and went to the spot with my dog. i spoke to him, and in he went, more like a seal than a dog, and after several fruitless attempts to mount the wreck he succeeded, and laid hold of the boy, who clung to the ropes, screaming in the most fearful way at being thus dragged into the water. the waves dashed frightfully on the rocks. in the anxiety and responsibility of the moment i thought that the dog had missed him, and i stripped off my clothes, resolved to render what assistance i could. i was just in the act of springing from the shore, having selected the moment when the receding waves gave me the best chance of rendering any assistance, when i saw old 'bagsman,' for that was the name of my dog, with the struggling boy in his mouth, and the head uppermost. i rushed to the place where he must land, and the waves bore the boy and the dog into my arms. "some time after that i was shooting wild-fowl. i and my dog had been working hard, and i left him behind me while i went to a neighbouring town to purchase gunpowder. a man, in a drunken frolic, had pushed off in a boat with a girl in it; the tide going out carried the boat quickly away, and the man becoming frightened, and unable to swim, jumped overboard. bagsman, who was on the spot, hearing the splash, jumped in, swam out to the man, caught hold of him, and brought him twenty yards towards the shore, when the drunken fellow clasped the dog tight round the body, and they both went down together. the girl was saved by a boat going to her assistance. the body of the man was recovered about an hour afterwards, with that of the dog clasped tight in his arms, thus dragging him to the bottom. 'poor bagsman! thy worth deserves to be thus chronicled.'" the poodle. the particular cross from which this dog descended is unknown, but the variety produced has been carefully preserved. it is, probably, of continental origin, and is known by its thick curly hair concealing almost every part of the face, and giving it the appearance of a short, thick, unintelligent head. when, however, that hair is removed, there is still the large head; but there is also the cerebral cavity more capacious than in any other dog, and the frontal sinuses fully developed, and exhibiting every indication of the intellectual class to which it belongs. it was originally a water-dog, as its long and curly hair, and its propensities in its domesticated state, prove; but, from its peculiar sagacity, it is capable of being trained to almost any useful purpose, and its strong individual attachment renders it more the companion of man than a mere sporting dog: indeed, its qualities as a sporting dog are seldom recognised by its owner. these dogs have far more courage than the water-spaniel, all the sagacity of the newfoundland, more general talent, if the expression may be used, and more individual attachment than either of them, and without the fawning of the one, or the submissiveness of the other. the poodle seems conscious of his worth, and there is often a quiet dignity accompanying his demonstrations of friendship. this dog, however, possesses a very peculiar kind of intelligence. it will almost perform the common offices of a servant: it will ring the bell and open the door. mr. wilkie, of ladythorn in northumberland, had a poodle which he had instructed to go through all the apparent agonies of dying. he would fall on one side, stretch himself out, and move his hind legs as if he were in great pain; he would next simulate the convulsive throbs of departing life, and then stretch out his limbs and thus seem as if he had expired. in this situation he would remain motionless, until he had his master's command to rise. the portrait of sancho, a poodle, that was with difficulty forced from the grave of his master, after the battle of salamanca, is familiar to many of our readers. enticed from his post he could not be, nor was he at length taken away until weakened by grief and starvation. he by degrees attached himself to his new master, the marquis of worcester, but not with the natural ardour of a poodle. he was attentive to every command, and could perform many little domestic offices. sometimes he would exhibit considerable buoyancy of spirit; but there oftener seemed to be about him the recollection of older and closer friendship. another poodle occupies an interesting place in the history of the peninsular war. he too belonged to a french officer, who was killed at the battle of castella. the french were compelled to retreat before they could bury their dead, and the soldiers wished to carry with them their regimental favourite; but he would not be forced from the corpse of his master. some soldiers afterwards traversing the field of battle, one of them discovered the cross of the legion of honour on the breast of the fallen officer, and stooped to take it away, when the dog flew savagely at him, and would not quit his hold, until the bayonet of another soldier laid him lifeless. a veterinary surgeon, who, before any other animal than the horse was acknowledged to be the legitimate object of medical care, did not disdain to attend to the diseases of the dog, used to say that there were two breeds which he never wished to see in his infirmary, namely, the poodle and the norfolk spaniel; for, although not always difficult to manage, he could never attach them to him, but they annoyed him by their pitiful and imploring gaze during the day, and their mournful howling at night. custom has determined that the natural coat of this animal shall be taken from him. it may be a relief to the poodle for a part of his coat to be stripped off in hot weather, and the curly hair which is left on his chest, contrasted with his smooth and well-rounded loins and quarters, may make it look pretty enough; but it should he remembered that he was not designed by nature to be thus exposed to the cold of winter, and that there are no dogs so liable to rheumatism, and that rheumatism degenerating into palsy, as the well-trimmed poodle. the barbet is a small poodle, the production of some unknown and disadvantageous cross with the true poodle. it has all the sagacity of the poodle, and will perform even more than his tricks. it is always in action; always fidgety; generally incapable of much affection, but inheriting much self-love and occasional ill temper; unmanageable by any one but its owner; eaten up with red mange; and frequently a nuisance to its master and a torment to every one else. we must not, however, do it injustice; it is very intelligent, and truly attached to its owner. the barbet possesses more sagacity than most other dogs, but it is sagacity of a particular kind, and frequently connected with various amusing tricks. mr. jesse, in his gleanings in natural history, gives a singular illustration of this. a friend of his had a barbet that was not always under proper command. in order to keep him in better order, he purchased a small whip, with which he corrected him once or twice during a walk. on his return the whip was put on a table in the hall, but on the next morning it was missing. it was soon afterwards found concealed in an out-building, and again made use of in correcting the dog. once more it would have been lost, but, on watching the dog, who was suspected of having stolen it, he was seen to take it from the hall table in order to hide it once more. the maltese dog can be traced back to an early period. strabo says that "there is a town in sicily called melita, whence are exported many beautiful dogs called 'canes melitæi'. they were the peculiar favourites of the women; but now (a.d. ) there is less account made of these animals, which are not bigger than common ferrets or weasels, yet they are not small in understanding nor unstable in their love." they are also found in malta and in other islands of the mediterranean, and they maintain the same character of being devotedly affectionate to their owners, while, it is added,--and they are not loved the less for that,--they are ill-tempered to strangers. the lion dog is a diminutive likeness of the noble animal whose name it bears. its head, neck, shoulders, and fore-legs down to the very feet, are covered with long, wavy, silky hairs. on the other parts of the dog it is so short as scarcely to be grasped, except that on the tail there is a small bush of hair. the origin of this breed is not known; it is, perhaps, an intermediate one between the maltese and the turkish dog. the turkish dog, as it is improperly called, is a native of hot climates. the supposition of buffon is not an improbable one, that, being taken from some temperate country to one considerable hotter, the european dog probably acquired some cutaneous disease. this is no uncommon occurrence in guinea, the east indies, and south america. some of these animals afterwards found their way into europe, and, from their singularity, care was taken to multiply the breed. aldrovandus states that the first two of them made their appearance in europe in his time, but the breed was not continued, on account, as it was supposed, of the climate being too cold for them. the few that are occasionally seen in england bear about them every mark of a degenerated race. they have no activity, and they show little intelligence or affection. one singular circumstance appertains to all that the author of this work has had the opportunity of seeing,--their teeth become very early diseased, and drop from the gums. that eminent zoologist, mr. yarrell, examining, with the author of this work, one that had died, certainly not more than five years old, found that it had neither incisors nor canine teeth, and that the molars were reduced to one on each side, the large tubercular tooth being the only one that was remaining. at the scientific meeting of the zoological society, the same gentleman stated, that he had examined the mouths of two individuals of the same variety, then alive at the gardens, in both of which the teeth were remarkably deficient. in neither of them were there any false molars, and the incisors in both were deficient in number. before the age of four years the tongue is usually disgustingly hanging from the mouths of these animals. the alpine spaniel, or bernardine dog, is a breed almost peculiar to the alps, and to the district between switzerland and savoy. the passes over these mountains are exceedingly dangerous from their steepness and narrowness. a precipice of many hundred feet is often found on one side, and perpendicular rocks on the other, while the path is glazed with frozen snow or ice. in many places the path is overhung with huge masses of frozen snow, which occasionally loosen and fall, when the dreadful storms peculiar to these regions suddenly come on, and form an insurmountable barrier, or sweep away or bury the unfortunate traveller. should he escape these dangers, the path is now become trackless, and he wanders amid the dreary solitudes until night overtakes him; and then, when he pauses from fatigue or uncertainty with regard to the path he should pursue, his limbs are speedily benumbed. fatal slumbers, which he cannot shake off, steal upon him, and he crouches under some ledge and sleeps, to wake no more. the snow drifts on. it is almost continually falling, and he is soon concealed from all human help. on the top of mount st. bernard, and near one of the most dangerous of these passes, is a convent, in which is preserved a breed of large dogs trained to search for the benighted and frozen wanderer. every night, and particularly when the wind blows tempestuously, some of these dogs are sent out. they traverse every path about the mountains, and their scent is so exquisite that they can discover the traveller, although he may lie many feet deep in the snow. having found him, they set to work and endeavour to scrape away the snow, uttering a deep bark that reverberates from rock to rock, and tells those who are watching in the convent that some poor wretch is in peril. generally, a little flask of spirits is tied round the neck of the animal, by drinking which the benighted traveller may recruit his strength, until more effectual rescue arrive. the monks hasten in the direction of the sound, and often succeed in rekindling the vital spark before it is quite extinguished. very many travellers have been thus rescued from death by these benevolent men and their intelligent and interesting quadruped servants. one of these bernardine dogs, named barry, had a medal tied round his neck as a badge of honourable distinction, for he had saved the lives of forty persons. he at length died nobly in his vocation. a piedmontese courier arrived at st. bernard on a very stormy day, labouring to make his way to the little village of st. pierre, in the valley beneath the mountain, where his wife and children lived. it was in vain that the monks attempted to check his resolution to reach his family. they at last gave him two guides, each of whom was accompanied by a dog, one of which was the remarkable creature whose service had been so valuable. descending from the convent, they were overwhelmed by two avalanches or heaps of falling snow, and the same destruction awaited the family of the poor courier, who were travelling up the mountain in the hope of obtaining some news of the husband and father. a beautiful engraving has been made of this noble dog. it represents him as saving a child which he had found in the glacier of balsore, and cherished, and warmed, and induced to climb on his shoulders, and thus preserved from, otherwise, certain destruction. the newfoundland dog. the newfoundland is a spaniel of large size. he is a native of the island of which he bears the name; but his history is disgraceful to the owners of so valuable an animal. the employment of the lower classes of the inhabitants of st. john, in newfoundland, is divided between the cutting of wood, and the drawing of it and other merchandise in the winter, and fishing in the summer. the carts used in the winter work are drawn by these dogs, who are almost invariably urged and goaded on beyond their strength, fed only with putrid salt-fish, and an inadequate quantity even of that. a great many of them are worn out and die before the winter is over; and, when the summer approaches, and the fishing season commences, many of them are quite abandoned, and, uniting with their companions, prowl about preying on the neighbouring flocks, or absolutely starving. mr. macgregor, however, states that "in almost every other part of british america they are valuable and useful. they are remarkably docile and obedient to their masters, serviceable in all the fishing countries, and yoked in pairs to draw the winter's fuel home. they are faithful, good-natured, and ever friendly to man. they will defend their master and their master's property, and suffer no person to injure either the one or the other; and, however extreme may be the danger, they will not leave them for a minute. they seem only to want the faculty of speech, in order to make their good wishes and feelings understood, and they are capable of being trained for all the purposes for which every other variety of the canine species is used".[ ] that which most recommends the newfoundland dog is his fearlessness of water, and particularly as connected with the preservation of human life. the writer of the present work knows one of these animals that has preserved from drowning four human beings. [this breed of dog, though much esteemed both in england and other portions of the world, as well for his majestic appearance as for many useful and winning traits of character, has but few sportsmen as patrons with us. he is not only used in england as a water-dog for the pursuit of wild fowl, but has been trained by many sportsmen to hunt on partridges, woodcocks, and pheasants, and is represented by captain hawker and others as surpassing all others of the canine race, in finding wounded game of every description. mr. blain remarks that, "as a retriever, the newfoundland dog is easily brought to do almost anything that is required of him, and he is so tractable, likewise, that, with the least possible trouble, he may be safely taken among pointers to the field, with whose province he will not interfere, but will be overjoyed to be allowed to look up the wounded game, which he will do with a perseverance that no speed and no distance can slacken, nor any hedge-row baulk. in cover he is very useful; some, indeed, shoot woodcocks to a newfoundland, and he never shines more than when he is returning with a woodcock, pheasant, or hare, in his mouth, which he yields up, or even puts into your hand unmutilated." notwithstanding the high commendations of these gentlemen, we cannot look upon the newfoundland in any other light than that of a dog, whose powers of sagacity are destined for display in the water. in contending with this element, either in the preservation of human life, or in search of wounded fowl, he has no equal, and volumes might be filled with accounts of his various daring achievements in this particular branch, not only in england, but on the rivers of our own country. mr. blain mentions two varieties of these dogs as being common in england, the labrador and st. john. the former is very large, rough-haired, and carries his tail very high; the latter is smaller, more docile, and sagacious in the extreme, and withal much more manageable. we were not aware of these varieties, and more particularly as regards the difference in docility and sagacity, but are convinced, from subsequent observations, that such is the case even in our own country, for we have often noticed a great dissimilarity in the size and appearance of these dogs and attributed it to the effects of the climate and cross breeding with inferior animals. we are indebted to mr. skinner for bringing before the public a faithful and minute account of two of these animals imported into this country by mr. law, of baltimore, and may be pardoned for giving again publicity to this gentleman's letter in relation to these two sagacious brutes. baltimore, maryland, january th, . "my dear sir:--in the fall of i was on board of the ship canton, belonging to my uncle, the late hugh thompson, of baltimore, when we fell in, at sea, near the termination of a very heavy equinoctial gale, with an english brig in a sinking condition, and took off the crew. the brig was loaded with codfish, and was bound to poole, in england, from newfoundland. i boarded her, in command of a boat from the canton, which was sent to take off the english crew, the brig's own boats having been all swept away, and her crew in a state of intoxication. i found on board of her two newfoundland pups, male and female, which i saved, and, subsequently, on our landing the english crew at norfolk, our own destination being baltimore, i purchased these two pups of the english captain for a guinea a-piece. being bound again to sea, i gave the dog-pup, which was called sailor, to mr. john mercer, of west river; and the slut-pup, which was called canton, to doctor james stewart, of sparrow's point. the history which the english captain gave me of these pups was, that the owner of his brig was extensively engaged in the newfoundland trade, and had directed his correspondent to select and send him a pair of pups of the most approved newfoundland breed, but of different families, and that the pair i purchased of him were selected under this order. the dog was of a dingy red colour, and the slut black. they were not large; their hair was short, but very thick coated; they had dew claws. both attained great reputation as water-dogs. they were most sagacious in everything, particularly so in all duties connected with duck-shooting. governor lloyd exchanged a mexican ram for the dog at the time of the merino fever, when such rams were selling for many hundred dollars, and took him over to his estate on the eastern shore of maryland, where his progeny were well known for many years after, and may still he known there, and on the western shore, as the sailor breed. the slut remained at sparrow's point till her death, and her progeny were, and are still, well known through patapsco neck, on the gunpowder, and up the bay, amongst the duck-shooters, as unsurpassed for their purposes. i have heard both doctor stewart and mr. mercer relate most extraordinary instances of the sagacity and performances of both dog and slut, and would refer you to their friends for such particulars as i am unable, at this distance of time, to recollect with sufficient accuracy to repeat. yours, in haste, george law." these dogs are represented as being of fine carriage, broad-chested, compact figure, and in every respect built for strength and activity. their patience and endurance were very great when pursuing wounded ducks through the floating ice, and when fatigued from extraordinary exertions were known to rest themselves upon broken portions of ice till sufficiently recovered again to commence the chase. we have seen some of the descendants of these sagacious animals on the chesapeake, engaged, not only in bringing the ducks from the water when shot, but also toling them into shore within range of the murderous batteries concealed behind the blind. this may not be an inappropriate place to speak of this wonderful mode of decoying ducks, termed toling, so extensively practised upon the chesapeake bay and its tributaries, where the canvass-back and red-heads resort in such numerous quantities every fall. a species of mongrel water-dog, or often any common cur, is taught to run backwards and forwards after stones, sticks, or other missiles thrown from one side to the other. in his activity and industry in this simple branch of education, within the comprehension of any dog, consists the almost incredible art of toling the canvass-back. with a dog of this character, the shooting party, consisting of several persons all prepared with heavy double-barrelled duck-guns, ensconce themselves at break of day behind some one of the numerous blinds temporarily erected along the shore contiguous to the feeding-grounds of these ducks. everything being arranged, and the morning mists cleared off, the ducks will be seen securely feeding on the shallows not less than several hundreds of yards from the shore. the dog is now put in motion by throwing stones from one side of the blind to the other. this will soon be perceived by the ducks, who, stimulated by an extreme degree of curiosity, and feeling anxious to inform themselves as to this sudden and singular phenomenon, raise their heads high in the water and commence swimming for the shore. the dog being kept in motion, the ducks will not arrest their progress until within a few feet of the water's edge, and oftentimes will stand on the shore staring, as it were, in mute and silly astonishment at the playful motions of the dog. if well trained the dog takes no notice whatever of the duck, but continues his fascination until the quick report of the battery announces to him that his services are now wanted in another quarter, and he immediately rushes into the water to arrest the flight of the maimed and wounded, who, struggling on every side, dye the water with their rich blood. the discovery of this mode of decoying ducks was quite an accident, being attributed to a circumstance noticed by a sportsman, who, concealed behind a blind patiently awaiting the near approach of the canvass-back, observed that they suddenly lifted up their heads and moved towards the shore. wondering at this singular and unusual procedure on the part of this wray bird, he naturally looked round to discover the cause, and observed a young fox sporting upon the river bank, and the ducks, all eagerness to gaze upon him, were steering their course directly for the shore. these ducks will not only be decoyed by the dog, but will often come in by waving a fancy coloured handkerchief attached to the ramrod. we have seen a dog fail to attract their attention till bound around the loins with a white handkerchief, and then succeed perfectly well. the toling season continues about three weeks from the first appearance of the ducks, often a much shorter time, as these birds become more cautious, and are no longer deceived in this way. the canvass-back toles better than any other duck; in fact, it is asserted by many sportsmen, that this particular variety alone can be decoyed in this mode. there are always numbers of other ducks feeding with the canvass-back, particularly the red-heads and black-necks, who partake of the top of the grass that the canvas-back discards after eating off the root, which is a kind of celery. these ducks, though they come in with the canvass-back when toled, do not seem to take any notice whatever of the dog, but continue to swim along, carelessly feeding, as if entrusting themselves entirely to the guidance of the other ducks. as far as we have been able to judge, we are inclined to this opinion also, and do not recollect ever having succeeded in toling any other species of duck, unaccompanied by the canvass-back, although we have made the effort many times. these ducks are a very singular bird, and although very cunning under ordinary circumstances, seem perfectly bewildered upon this subject, as we were one of a party several years since, who actually succeeded in decoying the same batch of ducks three successive times in the course of an hour, and slaying at each fire a large number, as we counted out over forty at the conclusion of the sport. although the toling of ducks is so simple in its process, there are few dogs that have sufficient industry and perseverance to arrive at any degree of perfection in the art. the dog, if not possessed of some sagacity and considerable training, is very apt to tire and stop running when the ducks have got near to the shore, but too far to be reached by the guns, which spoils all, as the birds are very apt to swim or fly off if the motion of the animal is arrested for a few moments.--l.] a native of germany was travelling one evening on foot through holland, accompanied by a large dog. walking on a high bank which formed one side of a dyke, his foot slipped, and he was precipitated into the water; and, being unable to swim, soon became senseless. when he recovered his recollection, he found himself in a cottage on the contrary side of the dyke, surrounded by peasants, who had been using the means for the recovery of drowned persons. the account given by one of them was, that, returning home from his labour, he observed at a considerable distance a large dog in the water, swimming and dragging, and sometimes pushing along something that he seemed to have great difficulty in supporting, but which he at length succeeded in getting into a small creek on the opposite side. when the animal had pulled what he had hitherto supported as far out of the water as he was able, the peasant discovered that it was the body of a man, whose face and hands the dog was industriously licking. the peasant hastened to a bridge across the dyke, and, having obtained assistance, the body was conveyed to a neighbouring house, where proper means soon restored the drowned man to life. two very considerable bruises, with the marks of teeth, appeared, one on his shoulder and the other on his poll; hence it was presumed that the faithful beast had first seized his master by the shoulder, and swam with him in this manner for some time, but that his sagacity had prompted him to quit this hold, and to shift it to the nape of the neck, by which he had been enabled to support the head out of water; and in this way he had conveyed him nearly a quarter of a mile before he had brought him to the creek, where the banks were low and accessible. dr. beattie relates an instance of a gentleman attempting to cross the river dee, then frozen over, near aberdeen. the ice gave way about the middle of the river; but, having a gun in his hand, he supported himself by placing it across the opening. his dog then ran to a neighbouring village, where, with the most significant gestures, he pulled a man by the coat, and prevailed on him to follow him. they arrived at the spot just in time to save the drowning man's life. of the noble disposition of the newfoundland dog, dr. abel, in one of his lectures on phrenology, relates a singular instance. "when this dog left his master's house, he was often assailed by a number of little noisy dogs in the street. he usually passed them with apparent unconcern, as if they were beneath his notice; but one little cur was particularly troublesome, and at length carried his impudence so far as to bite the newfoundland dog in the leg. this was a degree of wanton insult beyond what he could patiently endure; and he instantly turned round, ran after the offender, and seized him by the skin of the back. in this way he carried him in his mouth to the quay, and, holding him some time over the water, at length dropped him into it. he did not, however, seem to design that the culprit should be punished capitally. he waited a little while, until the poor animal, who was unused to that element, was not only well ducked, but nearly sinking, and then plunged in, and brought him safe to land." "it would be difficult," says dr. hancock, in his essay on instinct, "to conceive any punishment more aptly contrived or more completely in character. indeed, if it were fully analyzed, an ample commentary might be written in order to show what a variety of comparisons and motives and generous feelings entered into the composition of this act." no one ever drew more legitimate consequence from certain existing premises. one other story should not be omitted of this noble breed of water-dogs. a vessel was driven on the beach of lydd, in kent. the surf was rolling furiously. eight poor fellows were crying for help, but not a boat could be got off to their assistance. at length a gentleman came on the beach accompanied by his newfoundland dog: he directed the attention of the animal to the vessel, and put a short stick into his mouth. the intelligent and courageous fellow at once understood his meaning, sprung into the sea, and fought his way through the waves. he could not, however, get close enough to the vessel to deliver that with which he was charged; but the crew understood what was meant, and they made fast a rope to another piece of wood, and threw it towards him. the noble beast dropped his own piece of wood and immediately seized that which had been cast to him, and then, with a degree of strength and determination scarcely credible,--for he was again and again lost under the waves,--he dragged it through the surge and delivered it to his master. a line of communication was thus formed, and every man on board was rescued. there is, however, a more remarkable fact recorded in the penny magazine. "during a heavy gale a ship had struck on a rock near the land. the only chance of escape for the shipwrecked was to get a rope ashore; for it was impossible for any boat to live in the sea as it was then running. there were two newfoundland dogs and a bull-dog on board. one of the newfoundland dogs was thrown overboard, with a rope thrown round him, and perished in the waves. the second shared a similar fate: but the bull-dog fought his way through that terrible sea, and, arriving safe onshore, rope and all, became the saviour of the crew." some of the true newfoundland dogs have been brought to europe and have been used as retrievers. they are principally valuable for the fearless manner in which they will penetrate the thickest cover. they are comparatively small, but muscular, strong, and generally black. a larger variety has been bred, and is now perfectly established. he is seldom used as a sporting dog, or for draught, but is admired on account of his stature and beauty, and the different colours with which he is often marked. perhaps he is not quite so good-natured and manageable as the smaller variety, and yet it is not often that much fault can be found with him on this account. a noble animal of this kind was presented to the zoological society by his royal highness prince albert. he is a great ornament to the gardens; but he had been somewhat unmanageable, and had done some mischief before he was sent thither. a portion of lord byron's beautiful epitaph on the death of his newfoundland dog will properly close our account of this animal: "the poor dog! in life the firmest friend, the first to welcome, foremost to defend; whose honest heart is still his master's own; who labours, fights, lives, breathes for him alone." [notwithstanding the many excellent qualities so conspicuous in this noble breed of dog, he is said to possess one most ungenerous trait of character, "a peculiar antipathy to sheep," and if not early trained to endure their presence, will take every opportunity to destroy these innocent animals.] the esquimaux dog is a beast of burden and of draught, usefully employed by the inhabitants of the extreme parts of north america and the neighbouring islands. when the esquimaux indian goes in pursuit of the seal, the rein-deer, or the bear, his dogs carry the materials of his temporary hut, and the few necessaries of his simple life; or, yoked to the sledge, often draw him and his family full sixty miles a-day over the frozen plains of these inhospitable regions. at other times they assist in the chase, and run down and destroy the bear and the rein-deer on land, and the seal on the coast. these dogs are very early trained to the work which they are destined to follow, and even at the tender age of four or five months are harnessed together or in company with older animals, and are compelled, either by persuasion or brutal chastisement, to draw heavy weights, and thus soon become accustomed to the trammels of the rude gearing, and familiar with the service that they afterwards perform with so much sagacity and alacrity. capt. lyon states that they are very similar in appearance to the shepherd dog of england, but more muscular and broad chested, owing to severe work; ears pointed, of a savage appearance; the finer dogs are equal to the newfoundland breed in point of height and general symmetry. it is also somewhat curious to be informed that these dogs have no particular season of oestrum, but bear young indiscriminately at all times of the year, cold or warm, having very little or no effect upon their reproductive powers, being often seen in heat during the month of december when the thermometer was forty degrees below zero. their journeys are often without any certain object; but, if the dogs scent the deer or the bear, they gallop away in that direction until their prey is within reach of the driver, or they are enabled to assist in destroying their foe. captain parry, in his journal of a 'second voyage for the discovery of a north-west passage', gives an amusing account of these expeditions. "a number of dogs, varying from six to twelve, are attached to each sledge by means of a single trace, but with no reins. an old and tried dog is placed as the leader, who, in their simple journeys, and when the chase is the object, steadily obeys the voice of the driver sitting in front of the sledge, with a whip long enough to reach the leader. this whip, however, is used as seldom as possible; for these dogs, although tractable, are ferocious, and will endure little correction. when the whip is applied with severity on one, he falls upon and worries his neighbour, and he, in his turn, attacks a third, and there is a scene of universal confusion, or the dogs double from side to side to avoid the whip, and the traces become entangled, and the safety of the sledge endangered. the carriage must then be stopped, each dog put into his proper place, and the traces re-adjusted. this frequently happens several times in the course of the day. the driver therefore depends principally on the docility of the leader, who, with admirable precision, quickens or slackens his pace, and starts off or stops, or turns to the right or left, at the summons of his master. when they are journeying homeward, or travelling to some spot to which the leader has been accustomed to go, he is generally suffered to pursue his own course; for, although every trace of the road is lost in the drifting snow, he scents it out, and follows it with undeviating accuracy. even the leader, however, is not always under the control of his master. if the journey lies homeward, he will go his own pace, and that is usually at the top of his speed; or, if any game starts, or he scents it at a distance, no command of his driver will restrain him. neither the dog nor his master is half civilized or subdued." each of these dogs will draw a weight of lb. over the snow, at the rate of seven or eight miles an hour. [it is extraordinary to consider the powers and wonderful speed of these animals, almost equalling that of many horses. captain lyon informs us that three dogs drew a sledge weighing lbs. and himself, one mile in six minutes; his leader dog, which is generally more powerful than the others, drew lb. the same distance in eight minutes; seven dogs ran one mile in four minutes and thirty seconds, with a heavy sledge full of men attached to them; ten dogs ran one mile in five minutes; nine dogs drew lb. the same distance in nine minutes.--'lyon's journal', p. .--l.] in summer, many of these dogs are used as beasts of burden, and each carries from thirty to fifty pounds. they are then much better kept than in the winter; for they have the remains of the whale and sea-calf, which their masters disdain to eat. the majority, however, are sent adrift in the summer, and they live on the produce of the chase or of their constant thievery. the exactness with which, the summer being past, each returns to his master, is an admirable proof of sagacity, and frequently of attachment. in some parts of siberia, on the borders of the oby, there are established relays of dogs, like the post-horses in other countries. four of these are attached to a very light vehicle; but, when much haste is required, or any very heavy goods are to be conveyed, more than treble or quadruple that number are harnessed to the vehicle. m. de lesseps [ ] gives an almost incredible account of this. he is speaking of the voracity of these poor beasts, in the midst of the snowy desert, with little or no food. "we had unharnessed our dogs, in order to bring them closer together, in the ordinary way; but, the moment they were brought up to the pole, they seized their harness, constructed of the thickest and toughest leather, and tore it to pieces, and devoured it. it was in vain that we attempted every means of restraint. a great number of them escaped into the wilds around, others wandered here and there, and seized everything that came within their reach, and which their teeth could destroy. almost every minute some one of them fell exhausted, and immediately became the prey of the others. every one that could get within reach struggled for his share. every limb was disputed, and torn away by a troop of rivals, who attacked all within their reach. as soon as one fell by exhaustion or accident, he was seized by a dozen others, and destroyed in the space of a few minutes. in order to defend ourselves from this crowd of famished beasts, we were compelled to have recourse to our bludgeons and our swords. to this horrible scene of mutual destruction succeeded, on the following day, the sad appearance of those that surrounded the sledge, to which we had retreated for safety and for warmth. they were thin, and starved, and miserable; they could scarcely move; their plaintive and continual howlings seemed to claim our succour; but there was no possibility of relieving them in the slightest degree, except that some of them crept to the opening in our carriage through which the smoke escapes; and the more they felt the warmth closer they crept, and then, through mere feebleness, losing their equilibrium, they rolled into the fire before our eyes." these dogs are not so high as the common pointer, but much larger and stouter, although their thick hair, three or four inches long in the winter, gives them an appearance of more stoutness than they possess. under this hair is a coating of fine close soft wool, which begins to grow in the early part of winter, and drops off in the spring. their muzzles are sharp and generally black, and their ears erect. the greenland, and siberian, and kamtschatdale are varieties of the esquimaux or arctic dogs, but enlarged in form, and better subdued. the docility of some of these is equal to that of any european breed. a person of the name of chabert, who was afterwards better known by the title of "fire king," had a beautiful siberian dog, who would draw him in a light carriage miles a day. he asked £ for him, and sold him for a considerable portion of that sum; for he was a most beautiful animal of his kind, and as docile as he was beautiful. between the sale and the delivery, the dog fell and broke his leg. chabert, to whom the price agreed on was of immense consequence, was in despair. he took the dog at night to a veterinary surgeon. he formally introduced them to each other. he talked to the dog, pointed to his leg, limped around the room, then requested the surgeon to apply some bandages around the leg, and he seemed to walk sound and well. he patted the dog on the head, who was looking alternately at him and the surgeon, desired the surgeon to pat him, and to offer him his hand to lick, and then, holding up his finger to the dog, and gently shaking his head, quitted the room and the house. the dog immediately laid himself down, and submitted to a reduction of the fracture, and the bandaging of the limb, without a motion, except once or twice licking the hand of the operator. he was quite submissive, and in a manner motionless, day after day, until, at the expiration of a month, the limb was sound. not a trace of the fracture was to be detected, and the purchaser, who is now living, knew nothing about it. the employment of the esquimaux dogs is nearly the same as those from newfoundland, and most valuable they are to the traveller who has to find his way over the wild and trackless regions of the north. the manner, however, in which they are generally treated seems ill calculated to cause any strong or lasting attachment. during their period of labour, they, like their brethren in newfoundland, are fed sparingly on putrid fish, and in summer they are turned loose to shift for themselves until the return of the severe season renders it necessary to their masters' interest that they should again be sought for, and once more reduced to their state of toil and slavery. they have been known for several successive days to travel more than miles. they seldom miss their road, although they may be driven over one untrodden snowy plain, where they are occasionally unable to reach any place of shelter. when, however, night comes, they partake with their master of the scanty fare which the sledge will afford, and, crowding round, keep him warm and defend him from danger. if any of them fall victims to the hardships to which they are exposed, their master or their companions frequently feed on their remains, and their skins are converted into warm and comfortable dresses. the lapland dog. captain clarke thus describes the lapland dog: "we had a valuable companion in a dog belonging to one of the boatmen. it was of the true lapland breed, and in all respects similar to a wolf, excepting the tail, which was bushy and curled like those of the pomeranian race. this dog, swimming after the boat, if his master merely waved his hand, would cross the lake as often as he pleased, carrying half his body and the whole of his head and tail out of the water. wherever he landed, he scoured all the long grass by the side of the lake in search of wild-fowl, and came back to us, bringing wild-ducks in his mouth to the boat, and then, having delivered his prey to his master, he would instantly set off again in search of more." [ ] but we pass on to another and more valuable species of the dog: the sheep-dog. the origin of the sheep-dog is somewhat various; but the predominant breed is that of the intelligent and docile spaniel. although it is now found in every civilized country in which the sheep is cultivated, ii is not coeval with the domestication of that animal. when the pastures were in a manner open to the first occupant, and every shepherd had a common property in them, it was not so necessary to restrain the wandering of the sheep, and the voice of the shepherd was usually sufficient to collect and to guide them. he preceded the flock, and they "followed him whithersoever he went." in process of time, however, man availed himself of the sagacity of the dog to diminish his own labour and fatigue, and this useful servitor became the guide and defender of the flock. the sheep-dog possesses much of the same form and character in every country. the muzzle is sharp, the ears are short and erect, and the animal is covered, particularly about the neck, with thick and shaggy hair. he has usually two dew claws on each of the hind legs; not, however, as in the one claw of other dogs, having a jointed attachment to the limb, but merely connected by the skin and some slight cellular substance. these excrescences should be cut off when the dog is young. the tail is slightly turned upwards and long, and almost as bushy as that of a fox, even in that variety whose coat is almost smooth. he is of a black colour or black prevails, mixed with gray or brown. professor grognier gives the following account of this dog as he is found in france: "the shepherd's dog, the least removed from the natural type of the dog, is of a middle size; his ears short and straight; the hair long, principally on the tail, and of a dark colour; the tail is carried horizontally or a little elevated. he is very indifferent to caresses. possessed of much intelligence and activity to discharge the duties for which he was designed. in one or other of its varieties it is found in every part of france. sometimes there is but a single breed, in others there are several varieties. it lives and maintains its proper characteristics, while other races often degenerate. everywhere it preserves its proper distinguishing type. it is the servant of man, while other breeds vary with a thousand circumstances. it has one appropriate mission, and that it discharges in the most admirable way: there is evidently a kind and wise design in this." this account of the french sheep-dog, or of the sheep-dog everywhere, is as true as it is beautiful. one age succeeds to another, we pass from one climate to another, and everything varies and changes, but the shepherd's dog is what he ever was--the guardian of our flocks. there are, however, two or more species of this dog; the one which professor grognier has described, and which guards and guides the sheep in the open and level country, where wolves seldom intrude; another crossed with the mastiff, or little removed from that dog, used in the woody and mountainous countries, their guard more than their guide. [ ] in great britain, where he has principally to guide and not to guard the flock, he is comparatively a small dog. he is so in the northern and open parts of the country, where activity is principally wanted; but, in the more enclosed districts, and where strength is often needed to turn an obstinate sheep, he is crossed with some larger dog, as the rough terrier, or sometimes the pointer, or now and then the bull-dog: in fact, almost any variety that has strength and stoutness may be employed. thus we obtain the larger sheep-dog and the drover's dog. the sagacity, forbearance, and kindness of the sheep-dog are generally retained, but from these crosses there is occasionally a degree of ferocity from which the sheep often suffer. in other countries, where the flock is exposed to the attack of the wolf, the sheep-dog is larger than the british drover's dog, and not far inferior in size to the mastiff. the strength and ferocity which qualify him to combat with the wolf, would occasionally be injurious or fatal to those who somewhat obstinately opposed his direction; therefore, in denmark and in spain, the dog is rarely employed to drive the flock. it is the office of the shepherd, to know every individual under his charge, to, as in olden times, "call them all by their names," and have always some docile and tamed wether who will take the lead, almost as subservient to his voice as is the dog himself, and whom the flock will immediately follow. in whatever country the dog is used, partly or principally to protect the flock from the ravages of the wolf, he is as gentle as a lamb, except when opposed to his natural enemy; and it is only in england that the guardian of the sheep occasionally injures and worries them, and that many can be found bearing the mark of the tooth. this may he somewhat excusable (although it is often carried to a barbarous extent) in the drover's dog; but it will admit of no apology in the shepherd's dog. it is the result of the idleness of the boy, or the mingled brutality and idleness of the shepherd, who is attempting to make the dog do his own work and that of his master too. we have admired the prussian sheep-dog in the discharge of his duty, and have seen him pick out the marked sheep, or stop and turn the flock, as cleverly as any highland colley, but he never bit them. he is a shorter, stronger, and more compact dog than ours. he pushes against them and forces them along. if they rebel against this mild treatment, the shepherd is at hand to enforce obedience; and the flock is as easily and perfectly managed as any english or highland one, and a great deal more so than the majority that we have seen. mr. trimmer, in his work on the merinos, speaking of the spanish flocks, says: "there is no driving of the flock; that is a practice entirely unknown; but the shepherd, when he wishes to remove his sheep, calls to him a tame wether accustomed to feed from his hands. the favourite, however distant, obeys his call, and the rest follow. one or more of the dogs, with large collars armed with spikes, in order to protect them from the wolves, precede the flock, others skirt it on each side, and some bring up the rear. if a sheep be ill or lame, or lag behind unobserved by the shepherds, they stay with it and defend it until some one return in search of it. with us, dogs are too often used for other and worse purposes. in open, unenclosed districts, they are indispensable; but in others i wish them, i confess, either managed, or encouraged less. if a sheep commits a fault in the sight of an intemperate shepherd, or accidentally offends him, it is 'dogged' into obedience: the signal is given, the dog obeys the mandate, and the poor sheep flies round the field to escape from the fangs of him who should be his protector, until it becomes half dead with fright and exhaustion, while the trembling flock crowd together dreading the same fate, and the churl exults in this cowardly victory over a weak and defenceless animal." [ ] if the farmer will seriously calculate the number of ewes that have yeaned before their time, and of the lambs that he has lost, and the accidents that have occurred from the sheep pressing upon one another in order to escape from the dog, and if he will also take into account the continual disturbance of the sheep while grazing, by the approach of the dog, and the consequent interference with the cropping and the digestion of the food, he will attach more importance to the good temper of the dog and of the shepherd than he has been accustomed to do. there would be no injustice, or rather a great deal of propriety, in inflicting a fine for every tooth-mark that could be detected. when the sheep, instead of collecting round the dog, and placing themselves under his protection on any sudden alarm, uniformly fly from him with terror, the farmer may he assured there is something radically wrong in the management of the flock. instinct and education combine to fit this dog for our service. the pointer will act without any great degree of instruction, and the setter will crouch; and most certainly the sheep-dog, and especially if he has the example of an older and expert one, will, almost without the teaching of the master, become everything that can be wished, obedient to every order, even to the slightest motion of the hand. there is a natural predisposition for the office he has to discharge, which it requires little trouble or skill to develop and perfect. it is no unpleasing employment to study the degree in which the several breeds of dogs are not only highly intelligent, but fitted by nature for the particular duty they have to perform. the pointer, the setter, the hound, the greyhound, the terrier, the spaniel, and even the bull-dog, were made, and almost perfected, by nature chiefly for one office alone, although they maybe useful in many other ways. this is well illustrated in the sheep-dog. if he be but with his master, he lies content, indifferent to every surrounding object, seemingly half asleep and half awake, rarely mingling with his kind, rarely courting, and generally shrinking from, the notice of a stranger; but the moment duty calls, his sleepy, listless eye, becomes brightened; he eagerly gazes on his master, inquires and comprehends all he is to do, and, springing up, gives himself to the discharge of his duty with a sagacity, and fidelity, and devotion, too rarely equalled even by man himself. mr. james hogg, the ettrick shepherd, living in his early days among the sheep and their quadruped attendants, and an accurate observer of nature, as well an exquisite poet, gives some anecdotes of the colley, (the highland term for sheep-dog), with which the reader will not be displeased. "my dog sirrah," says he, in a letter to the editor of 'blackwood's edinburgh magazine', "was, beyond all comparison, the best dog i ever saw. he had a somewhat surly and unsocial temper, disdaining all flattery, and refusing to be caressed, but his attention to my commands and interest will never again be equalled by any of the canine race. when i first saw him, a drover was leading him with a rope. he was both lean and hungry, and far from being a beautiful animal; for he was almost black, and had a grim face, striped with dark brown. i thought i perceived a sort of sullen intelligence in his countenance, notwithstanding his dejected and forlorn appearance, and i bought him. he was scarcely a year old, and knew so little of herding that he had never turned a sheep in his life; but, as soon as he discovered that it was his duty to do so, and that it obliged me, i can never forget with what anxiety and eagerness he learned his different evolutions; and when i once made him understand a direction, he never forgot or mistook it." on one night, a large flock of lambs that were under the ettrick shepherd's care, frightened by something, scampered away in three different directions across the hills, in spite of all that he could do to keep them together. "sirrah," said the shepherd, "they're a' awa!" it was too dark for the dog and his master to see each other at any considerable distance, but sirrah understood him, and set off after the fugitives. the night passed on, and hogg and his assistant traversed every neighbouring hill in anxious but fruitless search for the lambs; but he could hear nothing of them nor of the dog, and he was returning to his master with the doleful intelligence that he had lost all his lambs. "on our way home, however," says he, "we discovered a lot of lambs at the bottom of a deep ravine called the flesh cleuch, and the indefatigable sirrah standing in front of them, looking round for some relief, but still true to his charge. we concluded that it was one of the divisions which sirrah had been unable to manage, until he came to that commanding situation. but what was our astonishment when we discovered that not one lamb of the flock was missing! how he had got all the divisions collected in the dark, is beyond my comprehension. the charge was left entirely to himself from midnight until the rising sun; and, if all the shepherds in the forest had been there to have assisted him, they could not have effected it with greater promptitude. all that i can say is, that i never felt so grateful to any creature under the sun us i did to my honest sirrah that morning." a shepherd, in one of his excursions over the grampian hills to collect his scattered flock, took with him (as is a frequent practice, to initiate them in their future business) one of his children about four years old. after traversing his pastures for a while, attended by his dog, he was compelled to ascend a summit at some distance. as the ascent was too great for the child, he left him at the bottom, with strict injunctions not to move from the place. scarcely, however, had he gained the height, when one of the scotch mists, of frequent occurrence, suddenly came on, and almost changed the day to night. he returned to seek his child, but was unable to find him, and concluded a long and fruitless search by coming distracted to his cottage. his poor dog also was missing in the general confusion. on the next morning by daylight he renewed his search, but again he came back without his child. he found, however, that during his absence his dog had been home, and, on receiving his allowance of food, instantly departed. for four successive days the shepherd continued his search with the same bad fortune, the dog as readily coming for his meal and departing. struck by this singular circumstance, he determined to follow the dog, who departed as usual with his piece of cake. the animal led the way to a cataract at some distance from the spot where the child had been left. it was a rugged and almost perpendicular descent which the dog took, and he disappeared in a cave, the mouth of which was almost on a level with the torrent. the shepherd with difficulty followed; but, on entering the cavern, what were his emotions when he beheld the infant eating the cake which the dog had just brought to him, while the faithful animal stood by, eyeing his young charge with the utmost complacency! from the situation in which the child was found, it appeared that he had wandered to the brink of the precipice, and then either fallen or scrambled down, the torrent preventing his re-ascent. the dog by means of his scent had traced him to the spot, and afterwards prevented him from starving by giving up a part, or, perhaps, the whole of his own daily allowance. he appears never to have quitted the child night or day, except for food, as he was seen running at full speed to and from the cottage. [ ] mr. hogg says, and very truly, that a single shepherd and his dog will accomplish more in gathering a flock of sheep from a highland farm than twenty shepherds could do without dogs; in fact, that without this docile animal, the pastoral life would be a mere blank. it would require more hands to manage a flock of sheep, gather them from the hills, force them into houses and folds, and drive them to markets, than the profits of the whole flock would be capable of maintaining. well may the shepherd feel an interest in his dog; he it is indeed that earns the family bread, of which he is himself content with the smallest morsel: always grateful, and always ready to exert his utmost abilities in his master's interests. neither hunger, fatigue, nor the worst treatment will drive him from his side, and he will follow him through every hardship without murmur or repining. if one of them is obliged to change masters, it is sometimes long before he will acknowledge the new owner, or condescend to work for him with the willingness that he did for his former lord; but, if he once acknowledges him, he continues attached to him until death. [ ] we will add another story of the colley, and proceed. it illustrates the memory of the dog. a shepherd was employed in bringing up some mountain sheep from westmoreland, and took with him a young sheep-dog who had never made the journey before. from his assistant being ignorant of the ground, he experienced great difficulty in having the flock stopped at the various roads and lanes he passed in their way to the neighbourhood of london. in the next year the same shepherd, accompanied by the same dog, brought up another flock for the gentlemen who had had the former one. on being questioned how he had got on, he said much better than the year before, as his dog now knew the road, and had kept the sheep from going up any of the lanes or turnings that had given the shepherd so much trouble on his former journey. the distance could not have been less than miles. [ ] buffon gives an eloquent and faithful account of the sheep-dog: "this animal, faithful to man, will always preserve a portion of his empire and a degree of superiority over other beings. he reigns at the head of his flock, and makes himself better understood than the voice of the shepherd. safety, order, and discipline are the fruits of his vigilance and activity. they are a people submitted to his management, whom he conducts and protects, and against whom he never employs force but for the preservation of good order." "if we consider that this animal, notwithstanding his ugliness and his wild and melancholy look, is superior in instinct to all others; that he has a decided character in which education has comparatively little share; that he is the only animal born perfectly trained for the service of others; that, guided by natural powers alone, he applies himself to the care of our flocks, a duty which he executes with singular assiduity, vigilance, and fidelity; that he conducts them with an admirable intelligence which is a part and portion of himself; that his sagacity astonishes at the same time that it gives repose to his master, while it requires great time and trouble to instruct other dogs for the purposes to which they are destined: if we reflect on these facts we shall be confirmed in the opinion that the shepherd's dog is the true dog of nature, the stock and model of the whole species." [ ] [after reading the above history of this truly valuable dog, it is almost superfluous for us to attempt to add anything more on this head; however, we must pause for a few moments, to call the attention of our agriculturists and others engaged in raising sheep, to the immense advantages to be derived from the introduction of this sagacious animal throughout our own country. the increased vigour that is now given for the cultivation of sheep, to supply the necessary demands of the numerous woollen factories springing up in every quarter, renders the services of this faithful creature absolutely indispensable, not only as a guardian of the flocks, but as a mere expedient of economy. many portions of our country, now lying idle, particularly the mountainous ranges, are peculiarly adapted for the grazing of sheep, and we are destined not only to supply the world with cotton, but may hope ere long to add to our national wealth the other equally valuable staple commodity, that of wool. in the care of sheep, each dog not only supplies the place of two or three men, but, as is seen in the foregoing pages, renders such assistance as cannot be obtained from any other source. the shepherds of mexico lead a life not unlike the patriarchs of old, shifting about from day to day, watching their immense flocks, attended only by a few dogs, who have the entire control of the sheep, keeping them from straying away, and not only defending them from the blood-thirsty wolf, but even attacking, if necessary, the skulking savage. these dogs of mexico are represented as being much larger than the english variety, and no doubt are the descendants of the spanish shepherd dog, so highly prized in protecting the merino flocks from the wolves that infest the mountainous parts of spain, most frequented by the herds during the summer season. these dogs are the same breed as those engaged by the philanthropic monks of st. bernard in hunting up the benumbed traveller when sinking from exhaustion, or already overwhelmed by the sudden rushing of an avalanche into some one of the mountain passes. the original spanish shepherd dog is a very powerful animal, and even those of mexico, when armed with spiked collars, are a sufficient match for the largest wolves. mr. kendall mentions having met on the grand prairie with a flock of sheep numbering seventeen thousand, which immense herd was guarded by a very few men, assisted by a large number of noble dogs, which appeared gifted with the faculty of keeping them together. "there was no running about, no barking or biting in their system of tactics; on the contrary, they were continually walking up and down, like faithful sentinels, on the outer side of the flock, and should any sheep chance to stray from his fellows, the dog on duty at that particular post would walk gently up, take him carefully by the ear, and lead him back to the fold. not the least fear did the sheep manifest at the approach of these dogs, and there was no occasion for it." vol. i. p. . this account coincides with the remarks of mr. trinner upon this dog in old spain; and mr. skinner very justly remarks, that the mexican sheep-dog has not his equal in any part of the world, except, perhaps, in his native country, and that the scotch or english dog sinks into insignificance when compared with him. a flock of a thousand sheep in spain requires the attendance of two men and an equal number of dogs, who never for a moment quit their charge, watching them without intermission day and night. the great inferiority of the english dogs, may be attributed, perhaps, to their want of care in training and bringing up, which is considered the most essential, and actually the foundation of all their future usefulness with the mexicans. the pups when first born, are taken from the bitch, and put to a sucking ewe, already deprived of her own lamb. for several days the ewe is confined with the pups in the shepherd's hut, and either from force, or an instinctive desire to be relieved of the contents of the udder, she soon allows the little strangers to suck, and in the course of a few days more, becomes quite reconciled to the change, and exhibits a great degree of affection for her foster children, who, knowing no other parentage, becomes thus early engrafted into the general community, and returns their early kindness by every mark of affection and fidelity hereafter; never being willing for a moment to quit their society, but remains with them night and day, expressing a peculiar attachment to this particular flock, and seeming able to distinguish each member of it from all other intruders. in the third volume of the 'american agriculturist' will be found an interesting article connected with this subject, and from which we might extract much useful information, if our limits would allow of its insertion in the present volume. mr. skinner states, that in he had two of these dogs, a male and female, both trained, but unfortunately lost the latter before obtaining any pups from her; he also remarks, that they can be imported via havana and santander, at an expense of not less than $ or $ . we see no reason why the same dogs might not be obtained at a much less cost by the santa fé traders, who, no doubt, would be glad to bring them into the country as companions de voyages, provided there was any demand for them.--l.] the drover's dog bears considerable resemblance to the sheep-dog, and has usually the same prevailing black or brown colour. he possesses all the docility of the sheep-dog, with more courage, and sometimes a degree of ferocity, exercised without just cause upon his charge, while he is in his turn cruelly used by a brutal master. there is a valuable cross between the colley and the drover's dog in westmoreland, and a larger and stronger breed is cultivated in lincolnshire; indeed it is necessary there, where oxen as well as sheep are usually consigned to the dog's care. a good drover's dog is worth a considerable sum; but the breed is too frequently and injudiciously crossed at the fancy of the owner. some drovers' dogs are as much like setters, lurchers, and hounds, as they are to the original breed. stories are told of the docility and sagacity of the drover's dog even more surprising than any that are related of the sheep-dog. the ettrick shepherd says, that a mr. steel, butcher in peebles, had such implicit dependence on the attention of his dog to his orders, that whenever he put a lot of sheep before her, he took a pride in leaving them entirely to her, and either remained to take a glass with the farmer of whom he had made the purchase, or travelled another road to look after bargains or business. at one time, however, he chanced to commit a drove to her charge, at a place called willenslee, without attending to her condition, which he certainly ought to have done. this farm is about five miles from peebles, over wild hills, and there is no regularly defined path to it. whether mr. steel chose another road is uncertain; but, on coming home late in the evening, he was surprised to hear that his faithful animal had not made her appearance with her flock. he and his son instantly prepared to set out by different paths in search of her; but, on going into the street, there was she with the flock, and not one of the sheep missing; she, however, was carrying a young pup in her mouth. she had been taken in travail on those hills; and how the poor beast had contrived to manage the sheep in her state of suffering is beyond human calculation, for her road lay through sheep-pastures the whole way. her master's heart smote him when he saw what she had suffered and effected; but she was nothing daunted; and, having deposited her young one in a place of safety, she again set out at full speed to the hills, and brought another and another little one, until she had removed her whole litter one by one; the last, however, was dead. mr. blaine relates as extraordinary an instance of intelligence, but not mingled, like the former, with natural affection. a butcher and cattle-dealer, who resided about nine miles from alston, in cumberland, bought a dog of a drover. the butcher was accustomed to purchase sheep and kine in the vicinity, which, when fattened, he drove to alston market and sold. in these excursions he was frequently astonished at the peculiar sagacity of his dog, and at the more than common readiness and dexterity with which he managed the cattle; until at length he troubled himself very little about the matter, but, riding carelessly along, used to amuse himself with observing how adroitly the dog acquitted himself of his charge. at length, so convinced was he of his sagacity, as well as fidelity, that he laid a wager that he would intrust the dog with a number of sheep and oxen, and let him drive them alone and unattended to alston market. it was stipulated that no one should be within sight or hearing who had the least control over the dog, nor was any spectator to interfere. this extraordinary animal, however, proceeded with his business in the most steady and dexterous manner; and, although he had frequently to drive his charge through other herds that were grazing, he did not lose one; but, conducting them to the very yard to which he was used to drive them when with his master, he significantly delivered them up to the person appointed to receive them by barking at his door. when the path which he travelled lay through grounds in which others were grazing, he would run forward, stop his own drove, and then, chasing the others away, collect his scattered charge, and proceed. the italian or pomeranian wolf-dog. the wolf-dog is no longer a native of great britain, because his services are not required there, but he is useful in various parts of the continent, in the protection of the sheep from the attacks of the wolf. a pair of these dogs was brought to the zoological society of london in , and there long remained, an ornament to the gardens. they appeared to possess a considerable degree of strength, but to be too gentle to contend with so powerful and ferocious an animal as the wolf. they were mostly covered with white or gray, or occasionally black hair, short on the head, ears and feet, but long and silky on the body and tail. the forehead is elevated, and the muzzle lengthened and clothed with short hair. the attachment of this dog to his master and the flock is very great, and he has not lost a particle of his sagacity, but, where wolves are common, is still used as a sheep-dog. the cur is the sheep-dog crossed with the terrier. he has long and somewhat deservedly obtained a very bad name, as a bully and a coward; and certainly his habit of barking at everything that passes, and flying at the heels of the horse, renders him often a very dangerous nuisance: he is, however, in a manner necessary to the cottager; he is a faithful defender of his humble dwelling; no bribe can seduce him from his duty; and he is likewise a useful and an effectual guard over the clothes and scanty provisions of the labourer, who may be working in some distant part of the field. all day long he will lie upon his master's clothes seemingly asleep, but giving immediate warning of the approach of a supposed marauder. he has a propensity, when at home, to fly at every horse and every strange dog; and of young game of every kind there is not a more ruthless destroyer than the village cur. mr. hogg draws the following curious parallel between the sheep-dog and the cur: "an exceedingly good sheep-dog attends to nothing but the particular branch of business to which he is bred. his whole capacity is exerted and exhausted in it; and he is of little avail in miscellaneous matters; whereas a very indifferent cur bred about the house, and accustomed to assist in everything will often put the more noble breed to disgrace in these little services. if some one calls out that the cows are in the corn or the hens in the garden, the house colley needs no other hint, but runs and turns them out. the shepherd's dog knows not what is astir, and, if he is called out in a hurry for such work, all that he will do is to run to the hill, or rear himself on his haunches to see that no sheep are running away. a well-bred sheep-dog, if coming hungry from the hills, and getting into a milk-house, would likely think of nothing else than filling his belly with the cream. not so his initiated brother: he is bred at home to far higher principles of honour. i have known such lie night and day among from ten to twenty pails full of milk, and never once break the cream of one of them with the tip of his tongue, nor would he suffer cat, rat, or any other creature to touch it. while, therefore, the cur is a nuisance, he is very useful in his way, and we would further plead for him, that he possesses a great deal of the sagacity and all the fidelity of the choicest breed of dogs." the dog who, according to the well-known and authentic story, watched the remains of his master for two years in the churchyard of st. olave's, in southwark, was a cur. the following story is strictly authentic: "not long ago a young man, an acquaintance of the coachman, was walking, as he had often done, in lord fife's stables at banff. taking an opportunity, when the servants were not regarding him, he put a bridle into his pocket. a highland cur that was generally about the stables saw him, and immediately began to bark at him, and when he got to the stable-door would not let him pass, but bit him by the leg in order to prevent him. as the servants had never seen the dog act thus before, and the same young man had been often with them, they could not imagine what could be the reason of the dog's conduct. however, when they saw the end of a valuable bridle peeping out of the young man's pocket, they were able to account for it, and, on his giving it up, the dog left the stable-door, where he had stood, and allowed him to pass." [ ] the lurcher. this dog was originally a cross between the greyhound and the shepherd's dog, retaining all the speed and fondness for the chase belonging to the one, and the superior intelligence and readiness for any kind of work which the latter possessed. this breed has been crossed again with the spaniel, combining the disposition to quest for game which distinguishes the spaniel with the muteness and swiftness of the greyhound. sometimes the greyhound is crossed with the hound. whatever be the cross, the greyhound must predominate; but his form, although still to be traced, has lost all its beauty. the lurcher is a dog seldom found in the possession of the honourable sportsman. the farmer may breed him for his general usefulness, for driving his cattle, and guarding his premises, and occasionally coursing the hare; but other dogs will answer the former purposes much better, while the latter qualification may render him suspected by his landlord, and sometimes be productive of serious injury. in a rabbit-warren this dog is peculiarly destructive. his scent enables him to follow them silently and swiftly. he darts unexpectedly upon them, and, being trained to bring his prey to his master, one of these dogs will often in one night supply the poacher with rabbits and other game worth more money than he could earn by two days' hard labour. mr. h. faull, of helstone, in cornwall, lost no fewer than fifteen fine sheep, and some of them store sheep, killed by lurchers in january, . [ ] we now proceed to the different species of dog belonging to the second division of cuvier, which are classed under the name of hound; and, first we take the beagle. the origin of this diminutive hound is somewhat obscure. there is evidently much of the harrier and of the old southern, connected with a considerable decrease of size and speed, the possession of an exceedingly musical voice, and very great power of scent. beagles are rarely more than ten or twelve inches in height, and were generally so nearly of the same size and power of speed, that it was commonly said they might be covered with a sheet. this close running is, however, considered as a mark of excellence in hounds of every kind. there are many pleasurable recollections of the period when "the good old english gentleman" used to keep his pack of beagles or little harriers, slow but sure, occasionally carried to the field in a pair of panniers on a horse's back; often an object of ridicule at an early period of the chase, but rarely failing to accomplish their object ere the day closed, "the puzzling pack unravelling wile by wile, maze within maze." it was often the work of two or three hours to accomplish this; but is was seldom, in spite of her speed, her shifts, and her doublings, that the hare did not fall a victim to her pursuers. the slowness of their pace gradually caused them to be almost totally discontinued, until very lately, and especially in the royal park at windsor, they have been again introduced. generally speaking, they have all the strength and endurance which is necessary to ensure their killing their game, and are much fleeter than their diminutive size would indicate. formerly, considerable fancy and even judgment used to be exercised in the breeding of these dogs. they were curiously distinguished by the names of "deep-flewed," or "shallow-flewed," in proportion as they had the depending upper lip of the southern, or the sharper muzzle and more contracted lip of the northern dogs. the shallow-flewed were the swiftest, and the deep-flewed the stoutest and the surest, and their music the most pleasant. the wire-haired beagle was considered as the stouter and better dog. the form of the head in beagles has been much misunderstood. they have, or should have, large heads, decidedly round, and thick rather than long; there will then be room for the expansion of the nasal membrane, that of smell, and for the reverberation of the sound, so peculiarly pleasant in this dog. the beagle runs very low to the ground, and therefore has a stronger impression of the scent than taller dogs. this is especially the case when the scent is more than usually low. among the advocates for beagles, several years ago, was colonel hardy. he used to send his dogs in panniers, and they had a little barn for their kennel. the door was one night broken open, and every hound, panniers and all, stolen. the thief was never discovered, not even suspected. the use of beagles was soon afterwards nearly abandoned by the introduction of the harrier, and by his yielding in his turn to the fox-hound; but the beagles of colonel thornton and colonel molyneux will not be soon forgotten. [ ] there is, however, a practice which fair sportsmen will never resort to--the use of a beagle to start a hare in order to be run down by a brace of greyhounds, or perhaps by a lurcher. the hare is not fairly matched in this way of proceeding. the harrier occupies an intermediate station between the beagle and the fox-hound. it is the fox-hound bred down to a diminished size, and suited to the animal he is to pursue. he retains, or did for a while retain, the long body, deep chest, large bones, somewhat heavy head, sweeping ears, and mellow voice, which the sportsman of old so enthusiastically described, with the certainty of killing, and the pleasing prolongation of the chase. with this the farmer used to be content: it did not require expensive cattle, was not attended with much hazard of neck, and did not take him far from home. almost every country squire used in former days to keep his little pack of harriers or beagles. he was mounted on his stout cob-horse, that served him alike for the road and the chase; and his huntsman probably had a still smaller and rougher beast, or sometimes ran afoot. he could then follow the sport, almost without going off his own land, and the farmer's boys, knowing the country and the usual doublings of the hare, could see the greater part of the chase, and were almost able to keep up with the hounds, so that they were rarely absent at the death: indeed, they saw and enjoyed far more of it than the fox-hunter or the stag-hunter now does, mounted on his fleetest horse. the harrier was not more than or inches high. he was crossed with the fox-hound if he was getting too diminutive, or with the beagle if he was becoming too tall. the principal objects the sportsman endeavoured to accomplish were to preserve stoutness, scent, and musical voice, with speed to follow the hare sufficiently close, yet not enough to run her down too quickly, or without some of those perplexities, and faults, and uncertainties which give the principal zest to the chase. the character and speed of the hound much depend on the nature of the country. the smaller harrier will best suit a deeply enclosed country; but where there is little cover, and less doubling greater size and fleetness are requisite. the harrier, nevertheless, let him be as tall and as speedy as he may, should never he used for the fox; but every dog should be strictly confined to his own game. mr. beckford, in his 'thoughts upon hunting', gives an account, unrivalled, of the chase of the hare and fox. many sporting writers have endeavoured to tread in his steps; but they have failed in giving that graphic account of the pleasures of the field which mr. beckford's essay contains. he says that the sportsman should never have more than couple in the field, because it would he exceedingly difficult to get a greater number to run together, and a pack of harriers cannot be complete if they do not. a hound that runs too fast for the rest, or that lags behind them, should be immediately discarded. his hounds were between the large slow-hunting harrier and the fox-beagle. he endeavoured to get as much bone and strength in as little compass as possible. he acknowledges that this was a difficult undertaking; but he had, at last, the pleasure to see them handsome, small, yet bony, running well together, and fast enough, with all the alacrity that could be desired, and hunting the coldest scent. he anticipates the present improvement of the chase when he lays it down as a rule never to be departed from, that hounds of every kind should be kept to their own game. they should have one scent, and one style of hunting. harriers will run a fox in so different a style from the pursuit of a hare, that they will not readily, and often will not at all, return to their proper work. the difference in the scent, and the eagerness of pursuit, and the noise that accompanies fox-hunting, all contribute to spoil a harrier. mr. beckford pleasingly expresses a sportsman's consideration for the poor animal which he is hunting to death. "a hare," he says, "is a timorous little animal that we cannot help feeling some compassion for at the time that we are pursuing her destruction. we should give scope to all her little tricks, nor kill her foully nor overmatched. instinct instructs her to make a good defence when not unfairly treated, and i will venture to say that, as far as her own safety is concerned, she has more cunning than the fox, and makes shifts to save her life far beyond all his artifice." [ ] the fox hound is of a middle size, between the harrier and the stag-hound; it is the old english hound, sufficiently crossed with the greyhound to give him lightness and speed without impairing his scent; and he has now been bred to a degree of speed sufficient to satisfy the man who holds his neck at the least possible price, and with which few, except thorough-bred horses, and not all of them, can live to the end of the chase. the fox-hound is lighter, or as it is now called, more highly bred, or he retains a greater portion of his original size and heaviness, according to the nature of the country and the fancy of the master of the pack: therefore it is difficult to give an accurate description of the best variety of this dog; but there are guiding points which can never be forgotten without serious injury. he derives from the greyhound a head somewhat smaller and longer in proportion to his size than either the stag-hound or the harrier. but considerable caution is requisite here. the beauty of the head and face, although usually accompanied by speed, must never be sacrificed to stoutness and power of scent. the object of the sportsman is to amalgamate them, or rather to possess them all in the greatest possible degree. this will generally be brought to a great degree of perfection if the sportsman regards the general excellence of the dog rather than the perfection of any particular point. the ears should not, comparatively speaking, be so large as those of the stag-hound or the harrier; but the neck should be longer and lighter, the chest deep and capacious, the fore legs straight as arrows, and the hind ones well bent at the hock. some extraordinary accounts have been given of the speed of the fox-hound. a match that was run over the beacon course at newmarket is the best illustration of his fleetness. the distance is miles furlong and yards. the winning dog performed it in minutes and a few seconds; but of the sixty horses that started with the hounds, only twelve were able to run in with them. flying childers had run the same course in minutes and seconds. "the size, or, as we should rather say, the height of a fox-hound, is a point on which there has been much difference of opinion. mr. chule's pack was three inches below the standard of mr. villebois', and four inches below that of mr. warde's. the advocates of the former assert, that they get better across a deep and strongly fenced country, while the admirers of the latter insist on their being better climbers of hills and more active in cover. as to uniformity in size, it is by no means essential to the well-doing of hounds in the field, and has been disregarded by some of our best sportsmen: mr. meynell never drafted a good hound on account of his being over or under sized. the proper standard of height in fox-hounds is from to inches for bitches, and from to for dog-hounds. mr. warde's bitches, the best of the kind that our country contained, were rather more than inches. a few of his dogs were inches high. the amount of hounds annually bred will depend upon the strength of the kennel. from sixty to eighty couples is the complement for a four days a-week pack, which will require the breeding of a hundred couples of puppies every year, allowing for accidents and distemper." [ ] nimrod very properly observes, that "mr. beckford has omitted a point much thought of by the modern sportsmen, namely, 'the back-ribs', which should also be deep, as in a strong-bodied horse, of which we say, when so formed, that he has a good 'spur place;' a point highly esteemed in him. nor is he sufficiently descriptive of the hinder legs of the hound; for there is a length of thigh discernible in first-rate hounds which, like the well-let-down hock of the horse, gives them much superiority of speed, and is also a great security against their laming themselves in leaping fences, which they are more apt to do when they become blown and consequently weak. the fore legs, 'straight as arrows,' is an admirable illustration of perfection in those parts by beckford; for, as in a bow or bandy legged man, nothing is so disfiguring to a hound as having his elbows projecting, and which is likewise a great check to speed." [ ] mr. daniel gives a curious account of the prejudices of sportsmen on the subject of colour. the white dogs were curious hunters, and had a capital scent; the black, with some white spots, were obedient, good hunters, and with good constitutions; the gray-coloured had no very acute scent, but were obstinate, and indefatigable in their quest; the yellow dogs were impatient and obstinate, and taught with difficulty. [ ] the dog exhibits no criteria of age after the first two years. that period having elapsed, the whiteness and evenness of the teeth soon pass away, and the 'old' dog can scarcely be mistaken. nimrod scarcely speaks too positively when he says that an old hound cannot be mistaken, if only looked in the face. at all events, few are found in a kennel after the eighth year, and very few after the ninth. mr. beckford advises the sportsman carefully to consider the size, shape, colour, constitution, and natural disposition of the dog from which he breeds, and also the fineness of the nose, the evident strength of the limb, and the good temper and devotion to his master which he displays. the faults or imperfections in one breed may be rectified in another; and, if this is properly attended to, there is no reason why improvements may not continually be made. the separation of the sexes in the kennel and in the field is one of the latest innovations in the hunting world, and generally considered to be a good one. the eye is pleased to see a pack of hounds, nearly or quite of a size. the character of the animal is more uniformly displayed when confined to one sex. in consequence of the separation of the two, the dogs are less inclined to quarrel; and the bitches are more at their ease than when undergoing the importunate solicitations of the male. as to their performances in the field, opinions vary, and each sex has its advocates. the bitch, with a good fox before her, is decidedly more off-hand at her work; but she is less patient, and sometimes overruns the scent. sir bellingharn graham has been frequently heard to say, that if his kennels would have afforded it, he would never have taken a dog-hound into the field. that in the canine race the female has more of elegance and symmetry of form, consequently more of speed, than the male, is evident to a common observer; but there is nothing to lead to the conclusion that, in the natural endowments of the senses, any superiority exists. [ ] the bitch should not be allowed to engage in any long and severe chase after she has been lined. she should be kept as quiet as may be practicable, and well but not too abundantly fed; each having a kennel or place of retreat for herself. she should be carefully watched, and especially when the ninth week approaches. the huntsman and the keeper without any apparent or unnecessary intrusion, should be on the alert. the time of pupping having arrived, as little noise or disturbance should be made as possible; but a keeper should be always at hand in case of abortion or difficult parturition. should there be a probability of either of these occurring, he should not be in a hurry; for, as much should be left to nature as can, without evident danger, be done, and the keeper should rarely intrude unless his assistance is indispensable. the pupping being accomplished, the mother should be carefully attended to. she should be liberally fed, and particularly should have her share of animal food, and an increased quantity of milk. the bitch should not have whelps until she has hunted two seasons; for, before that time it will be scarcely possible to ascertain her excellences or defects. if there are any considerable faults, she should be immediately rejected. when the time approaches for her to produce her puppies, she should be allowed a certain degree of liberty, and should choose her couch and run about a little more than usual; but, when the young ones are born, the less they are handled the better. the constitution and appearance of the mother will indicate how many should be kept. if two litters are born at or about the same time, or within two or three days of each other, we may interchange one or two of the whelps of each of them, and perhaps increase the value of both. when the whelps are able to crawl to a certain distance, it will be time to mark them, according to their respective litters, some on the ear and others on the lip. the dew-claws should be removed, and, usually, a small tip from the tail. their names also should be recorded. the whelps will begin to lap very soon after they can look about them, and should remain with the mother until they are fully able to take care of themselves. they may then be prepared to go to quarters. two or three doses of physic should be given to the mother, with intervals of four or five days between each: this will prepare her to return to the kennel. there is often considerable difficulty in disposing of the whelps until they get old and stout enough to be brought into the kennel. they are mostly sent to some of the neighbouring cottages, in order to be taken care of; but they are often neglected and half starved there. in consequence of this, distemper soon appears, and many of them are lost. whelps 'walked', or taken care of at butchers' houses, soon grow to a considerable size; but they are apt to be heavy-shouldered and throaty, and perhaps otherwise deformed. there is some doubt whether it might not be better for the sportsman to take the management of them himself, and to have a kennel built purposely for them. it may, perhaps, be feared that the distemper will get among them: they would, however, be well fed, and far more comfortable than they now are; and, as to the distemper, it is a disease that they must have some time or other. from twenty to thirty couples are quite as many as can be easily managed; and the principal consideration is, whether they are steady, and as nearly as possible equal of speed. when the packs are very large, the hounds are seldom sufficiently hunted to be good. few persons choose to hunt every day, or, if they did, it is not likely that the weather would permit them. the sportsman would, therefore, be compelled to take an inconvenient number into the field, and too many must be left behind. in the first place, too many hounds in the field would frequently spoil the sport; and, on the other hand, the hounds that remained would get out of wind, or become riotous, or both. hounds, to be useful and good, should be constantly hunted; but a great fault in many packs is their having too many old dogs among them. young hounds, when first taken to the kennel, should be kept separate from the rest of the pack, otherwise there will be frequent and dangerous quarrels. when these do occur, the feeder hears, and sometimes, but not so frequently as he ought, endeavours to discover the cause of the disturbance, and visits the culprits with deserved punishment; too often, however, he does not give himself time for this, but rushes among them, and flogs every hound that he can get at, guilty or not guilty. this is a shameful method of procedure. it is the cause of much undeserved punishment: it spoils the temper of the dog, and makes him careless and indifferent as long as he lives. mr. beckford very properly remarks, that "young hounds are, and must be awkward at first, and should be taken out, a few at a time, with couples not too loose. they are thus accustomed to the usual occurrences of the road, and this is most easily accomplished when a young and an old dog are coupled together." a sheep-field is the next object, and the young hound, properly watched, soon becomes reconciled, and goes quietly along with the companion of the preceding day. a few days afterwards the dogs are uncoupled in the field, and perhaps, at first, are not a little disposed to attack the sheep; but the cry of "ware sheep!" in a stern tone of voice, arrests them, and often, without the aid of the whip; it being taken as a principle that this instrument should be used as seldom as possible. if, indeed, the dog is self-willed, the whip must be had recourse to, and perhaps with some severity; for, if he is once suffered to taste the blood of the sheep, it may be difficult to restrain him afterwards. a nobleman was told that it was possible to break his dogs of the habit of attacking his sheep, by introducing a large and fearless ram among them; one was accordingly procured and turned into the kennel. the men with their whips and voices, and the ram with his horns, soon threw the whole kennel into confusion. the hounds and the ram were left together. meeting a friend soon afterwards, "come," said he, "to the kennel, and see what rare sport the ram is making among the hounds." his friend asked whether he was not afraid that some of them might be spoiled. "no," said he; "they deserve it, and let them suffer." they proceeded to the kennel; all was quiet. the kennel-door was thrown open, and the remains of the ram were found scattered about: the hounds, having filled their bellies, had retired to rest. the time of entering young hounds must vary in different countries. in a corn country, it should not be until the wheat is carried; in grass countries, somewhat sooner; and, in woodlands, as soon as we please. frequent hallooing may be of use with young hounds; it makes them more eager; but, generally speaking, there is a time when it may be of use, a time when it does harm, and a time when it is perfectly indifferent. the following remarks of mr. beckford are worthy of their author: "hounds at their first entering cannot be encouraged too much. when they begin to know what is right, it will be soon enough to chastise them for doing wrong, and, in such case, one rather severe beating will save a great deal of trouble. the voice should be used as well as the whip; and the smack of the whip will often be of as much avail as the lash to him who has felt it." flogging hounds in the kennel, the frequent practice of too many huntsmen, should be held in utter abhorrence, and, if carried to a considerable excess, is a disgrace to humanity. generally speaking, none but the sportsman can form an adequate conception of the perfect obedience of the hound both in the kennel and the field. at feeding-time, each dog, although hungry enough, will go through the gate in the precise order in which he is called by the feeder; and, in a well-broken pack, to chop at, or to follow a hare, or to give tongue on a false scent, or even to break cover alone, although the fox is in view, are faults that are rarely witnessed. let not this obedience, however, be purchased by the infliction of a degree of cruelty that disgraces both the master and the menial. a young fox-hound may, possibly, mistake the scent of a hare for that of a fox, and give tongue. in too many hunts he will be unmercifully flogged for this, and some have almost died under the lash. mercy is a word totally unknown to a great proportion of whippers-in, and even to many who call themselves gentlemen. there can be no occasion or excuse for barbarity: a little trouble, and moderate punishment, and the example of his fellows, will gradually teach the wildest hound his duty. that the huntsman, and not the hound, may occasionally be in fault, the following anecdote will furnish sufficient proof. in drawing a strong cover, a young bitch gave tongue very freely, while none of the other hounds challenged. the whipper-in railed to no purpose; the huntsman insisted that she was wrong, and the whip was applied with great severity. in doing this, the lash accidentally struck one of her eyes out of its socket. notwithstanding the dreadful pain that must have ensued, she again took up the scent, and proved herself right; for the fox had stolen away, and she had broken cover after him, unheeded and alone. after much delay and cold hunting, the pack hit off the same scent. at some distance a farmer informed the sportsmen, that they were a long way behind the fox, for he had seen a single hound, very bloody about the head, running breast-high, so that there was but little chance of their getting up with her. the pack, from her coming to a check, did at last overtake her. the same bitch once more hit off the scent, and the fox was killed, after a long and severe run. the eye of the poor animal, that had hung pendent through the chase, was then taken off with a pair of scissors. the commencement of the season. during the beginning of autumn, the hounds should be daily exercised when the weather will permit. they should often be called over in the kennel to habituate them to their names, and walked out among the sheep and deer, in order that they may he accustomed perfectly to disregard them. a few stout hounds being added to the young ones, some young foxes may occasionally be turned out. if they hunt improper game, they must be sternly checked. implicit obedience is required until they have been sufficiently taught as to the game which they are to pursue. no obstinate deviation from it must ever be pardoned. the hounds should be, as much as possible, taken out into the country which they are afterwards to hunt, and some young foxes are probably turned out for them to pursue. at length they are suffered to hunt their game in thorough earnest, and to taste of its blood. after this they are sent to more distant covers, and more old hounds are added, and so they continue until they are taken into the pack, which usually happens in september. the young hounds continue to be added, two or three couple at a time, until all have hunted. they are then divided into two packs, to be taken out alternate days. properly speaking, the sport cannot be said to begin until october, but the two preceding months are important and busy ones. [ ] "it would appear, then," says nimrod, "that the breeding of a pack of fox-hounds, bordering on perfection, is a task of no ordinary difficulty. the best proof of it is to be found in the few sportsmen that have succeeded in it. not only is every good quality obtained if possible, but every imperfection or fault is avoided. the highest virtue in a fox-hound is his being true to the line his game has gone, and a stout runner at the end of the chase. he must also be a patient hunter when there is a cold scent and the pack is at fault." while there is no country in the world that can produce a breed of horses to equal the english thorough-bred in his present improved state, there are no dogs like the english fox-hound for speed, scent, and continuance. it would seem as if there were something in the climate favourable and necessary to the perfection of the hound. packs of them have been sent to other countries, neighbouring and remote; but they have usually become more or less valueless. as regards the employment of the voice and the horn when out with hounds, too much caution cannot be used. a hound should never be cheered unless we are perfectly convinced that he is right, nor rated unless we are sure that he is wrong. when we are not sure of what is going on we should sit still and be silent. a few moments will possibly put us in possession of all that we wish to know. [ ] the horn should only be used on particular occasions, and a huntsman should speak by his horn as much as by his voice. particular notes should mean certain things, and the hounds and the field should understand the language. we have heard some persons blowing the horn all the day long, and the hounds have become so careless as to render it of no use. when a hound first speaks in cover to a fox, you may, if you think it necessary, use 'one single' and prolonged note to get the pack together. the same note will do at any time to call up a lost or loitering hound; but, when the fox breaks cover, then let your horn be marked in its notes: let it sound as if you said through it, "gone away! gone away! gone away! away! away! away!" dwelling with full emphasis on the last syllable. every hound will fly from the cover the moment he hears this, and the sportsmen and the field will know that the fox is away. it is the perfection of the horse, and the perfection of the hound, and the disregard of trifling expense, that has given to englishmen a partiality for field-sports, unequalled in any other country. mr. ware's pack of fox-hounds cost guineas, and the late lord middleton gave the same to mr. osbaldeston for ten couples of his hounds. hunting-kennels. it is time, however, to speak of the kennel, whether we regard the sporting architecture of mr.g. tattersall, or the scientific inquiries of mr. vyner, or a sketch of the noble buildings at goodwood. the lodging-rooms should be ceiled, but not plastered, with ventilators above and a large airy window on either side. the floors should be laid with flags or paved with bricks. cement may be used instead of mortar, and the kennels will then be found wholesome and dry. the doorways of the lodging-houses will generally be four feet and a half wide, in the clear. the posts are rounded, to prevent the hounds from being injured when they rush out. the benches may be made of cast-iron or wood; those composed of iron being most durable, but the hounds are more frequently lamed in getting to them. the wooden benches must be bound with iron, or the hounds will gnaw or destroy them. a question has arisen, whether the benches should be placed round the kennel, or be in the centre of it, allowing a free passage by the side. there is least danger of the latter being affected by the damp. the walls should be wainscoted to the height of three feet at least. this will tend very considerably to their comfort. the floors of all the courts should be arranged in nearly the same way; the partition walls being closed at the bottom, but with some iron work above. the doorways should also be so contrived, that the huntsman may be able to enter whenever he pleases. the boiling-house should be at as great a distance from the hunting-kennel as can be managed, continuing to give warmth to the infirmary for distempered puppies, and at the same time being out of the way of the other courts. mr. vyner gives an interesting account of the young hounds' kennel: "this building," he says, "should be as far from the other lodging-rooms as the arrangements of the structure will allow. there is also an additional court, or grass-yard, an indispensable requisite in the puppies' kennel. the size must be regulated according to the waste land at the end of the building; but the longer it is, the better. at the farther end of the grass-court is a hospital for such young hounds as are distempered, so contrived as to be remote from the other kennels, and, at the same time, within an easy distance of the boiling-house, whence it is apparently approached by an outside door, through which the feeder can constantly pass to attend to the sick hounds without disturbing the healthy lots. although this lodging room is warmed by the chimney of the boiling-house, it must be well ventilated by two windows, to which shutters must be attached; ventilation and good air being quite as necessary to the cure of distemper as warmth." kennel lameness. we now proceed to a most important and ill-understood subject--the nature and treatment of 'kennel lameness'. it is a subject that nearly concerns the sportsman, and on which there are several and the most contrary opinions. this is a kind of lameness connected with, or attributable to, the kennel. according to the early opinion of mr. asheton smith, who is a good authority, it was referable to some peculiarity in the breed or management of the hounds; but, agreeably to a later opinion, it is dependent on situation and subsoil, and may be aggravated or increased by circumstances over which we have no control. some kennels are in low and damp situations, yet the hounds are free from all complaint: and others, with the stanchest dogs and under the best management, are continually sinking under kennel lameness. mr. r. t. vyner was one of the first who scientifically treated on this point, and taught us that 'clay is not by any means an objectionable soil to build a kennel upon', although so many pseudo-sportsmen are frightened by the very name of it. he enters at once into his subject. "i am thoroughly convinced," says he, "from my own experience, and, i may add, my own suffering, that the disease of kennel lameness arises only from one cause, and that is an injudicious and unfortunate selection of the spot for building. the kennel is generally built on a sand-bed, or on a sandstone rock, while the healthiest grounds in england are on a stiff clay, and they are the healthiest because they are the least porous. although this may be contrary to the opinion and prejudice of the majority of sportsmen, it is a fact that cannot be contradicted. "through a light and friable soil, such as sand and sandstone, a vapour, more or less dense, is continually exhaling and causing a perpetual damp, which produces that fearful rheumatism which goes by the name of kennel lameness, while the kennels that are built on a clay soil, a soil of an impervious nature, are invariably healthy. "i could," he adds, "enumerate twenty kennels to prove the effect--the invariable effect--of the existence of the disease on the one part, and of the healthiness of the situation on the other. i turn particularly to her majesty's kennel at ascot, the arches of which were laid under the very foundation strain, and yet little at no amendment has ever taken place in the healthiness and comfort of the dogs. it is necessary to select a sound and healthy situation when about to erect a kennel, and that sound and healthy situation can be met with alone on a strong impervious clay soil. we must have no fluid oozing through the walls or the floor of the kennel, and producing damp and unhealthy vapours, such as we find in the sandbed." with regard to this there can be no error. nimrod, in his excellent treatise on 'kennel lameness', asks, whether it does not appear that this disease is on the increase. he asks, "how is it that neither beckford nor somerville says one word that clearly applies to the disease; and no one, however learned he might be in canine pathology, has been able clearly to define the disease, much less to discover a remedy for it?" all that mr. blaine says on the matter amounts only to this: "the healthiness of the situation on which any kennel is to be built, is an important consideration. it is essential that it should be both dry and airy, and it should also be warm. a damp kennel produces rheumatism in dogs, which shows itself sometimes by weakness in the loins, but more frequently by lameness in the shoulders, known under the name of kennel lameness." mr. blaine illustrates this by reference to his own experience. "there is no disease, with the exception of distemper and mange, to which dogs are so liable as to a rheumatic affection of some part of the body. it presents almost as many varieties in the dog as it does in man; and it has some peculiarities observable in the dog only. rheumatism never exists in a dog without affecting the bowels. there will be inflammation or painful torpor through the whole of the intestinal canal. it is only in some peculiar districts that this occurs; it pervades certain kennels only; and but until lately there has been little or almost no explanation of the cause of the evil." [ ] nimrod took a most important view of the matter, and to him the sporting world is much indebted. "how is it," he asks, "that, in our younger days, we never heard of kennel lameness, or, indeed, of hounds being lame at all, unless from accident, or becoming shaken and infirm from not having been composed of that iron-bound material which the labours of a greyhound or a hound require? how is it, that, in our younger days, masters of hounds began the season with or couples, and, bating the casualties, left off at the end of it equally strong in their kennels, and able, perhaps, to make a valuable draft; whereas we now hear of one-half of the dogs in certain localities being disabled by disease, and some masters of hounds compelled to be stopped in their work until their kennels are replenished." washing hounds when they come home after work must be injurious to them, although it has almost become the fashion of modern times. if they are not washed at all, and we believe it to be unnecessary, yet the kennels in which lameness has appeared should be strictly avoided. it should be on the day following and not in the evening of a hunting-day that washing should take place. mr. hodgson told nimrod, that the quorn pack never had a case of kennel lameness until his late huntsman took to washing his hounds after hunting, and then he often had four or five couples ill from this cause. he deprecated even their access to water in the evening after hunting, and we believe that he was quite right in so doing. the tongue of the dog, with the aid of clean straw, is his best and safest instrument in cleansing his person; and, if he can be brought to his kennel with tolerably clean feet, as mr. foljambe enables him to be brought, he will never be long before he is comfortable in his bed, after his belly is filled. there is another mode, as a preventive of kennel lameness, which we have the best authority for saying deserves particular attention, and that is, the frequently turning hounds off their benches during the day, even if it were to the extent of every two hours throughout the entire day. we do not mean to deny the existence of a disease, which, being produced in the kennel, is properly termed kennel lameness. some kennels are, no doubt, more unhealthy and prone to engender rheumatic affections than others; but, by proper management, and avoiding as much as possible all exciting causes, their effects may, at least, be very much lessened, if not entirely obviated. lord fitzhardinge's management. lord fitzhardinge's opinion of the situation of the kennel and the management of the hounds, as given in the 'new sporting magazine', is somewhat different from that which has been just given. the following is the substance of it: [ ] he states that the kennel should be built on a dry and warm situation. of this there can be no doubt: the comfort and almost the existence of the dog depend upon it. to this he adds that it must not be placed on a gravelly or porous soil, over which vapours more or less dense are frequently or continually travelling, and thus causing a destructive exhalation over the whole of the building. there must be no fluid oozing through the walls or the floor of the kennel, and producing damp and unhealthy vapours. when we have not a deep supersoil of clay, one or two layers of bricks or of stone may line the floor, and then, not even the most subtile vapour can penetrate through the floor. a clean bed of straw should be allowed every second day, or oftener when the weather is wet. the lodging-houses should be ceiled, and there should be shutters to the windows. a thatched roof is preferable to tiles, being warmer in winter and cooler in summer. stoves in the kennels are not necessary: probably they are best avoided; for, if dogs are accustomed to any considerable degree of artificial heat, they are more easily chilled by a long exposure to cold. their teeth and the setting-up of their backs will confirm this. hounds, when they feel cold, naturally seek each other for warmth, and they may be seen lying upon the straw and licking each other; and that is by far the most wholesome way of procuring comfort and warmth. on returning from hunting, their feet should be washed with some warm fluid, and especially the eyes should be examined, and their food got ready for them as soon as possible. the feeding in the morning should be an hour, or an hour and a half, before they start for the field. it is truly observed by the noble writer to whom we have referred, that there is no part of an establishment of this kind that merits more attention than the boiling and feeding house. the hounds cannot perform their work well unless judiciously fed. each hound requires particular and constitutional care. no more than five of them should be let in to feed together, and often not more than one or two. the feeder should have each hound under his immediate observation, or they may get too much or too little of the food. some hounds cannot run if they carry much flesh; others are all the better for having plenty about them. the boilers should be of iron, two in number,--one for meal and the smaller one for flesh. the large boiler should render it necessary to be used not more than once in four days or a week. the food should be stirred for two hours, then transferred to flat coolers, until sufficiently gelatinous to be cut with a kind of spade. by the admixture of some portion of soups it may be brought to any thickness requisite. the flesh to be mixed with it should be cut very small, that the greedy hounds may not be able to obtain more than their share. four bushels and a half of genuine old oatmeal should be boiled with a hundred gallons of water. the flesh should he boiled every second or third day. too great a proportion of soup would render the mixture of a heating nature. mr. delmé radcliffe very truly observes that the feeding of hounds, as regards their condition, is one of the most essential proofs of a huntsman's skill in the management of the kennel. to preserve that even state of condition throughout the pack which is so desirable, he must be well acquainted with the appetite of every hound; for some will feed with a voracity scarcely credible, and others will require every kind of enticement to induce them to feed. mr. meynell found that the use of dry unboiled oatmeal succeeded better than any other thing he had tried with delicate hounds. when once induced to take it, they would eat it greedily, and it seemed to be far more heartening than most kinds of aliment. other hounds of delicate constitution might be tempted with a little additional flesh, and with the thickest and best of the trough, but they required to be watched, and often to be coaxed to eat. the dog possesses the power of struggling against want of food for an almost incredible period. one of these animals, six years old, was missing three-and-twenty days; at length some children wandering in a distant wood thought that they frequently heard the baying of a dog. the master was told of it, and at the bottom of an old quarry, sixty feet deep, and the mouth of which he had almost closed by his vain attempts to escape, the voice of the poor fellow was recognised. with much difficulty he was extricated, and found in a state of emaciation; his body cold as ice and his thirst inextinguishable, and he scarcely able to move. they gave him at intervals small portions of bread soaked in milk and water. two days afterwards he was able to follow his master a short distance. this occurrence is mentioned by m. pinguin as a proof that neither hunger nor thirst could produce rabies. messrs. majendie and f. cousins have carried their observations to the extent of forty days--a disgraceful period. [ ] management of the pack. sixty-five couple of hounds in full work will consume the carcases of three horses in one week, or five in a fortnight. the annual consumption of meal will be somewhat more than two tons per month. in feeding, the light eaters should be let in first, and a little extra flesh distributed on the surface of the food, in order to coax those that are most shy. some hounds cannot be kept to their work unless fed two or three times a day; while others must not be allowed more than six or seven laps, or they would get too much. in summer an extra cow or two will be of advantage in the dairy; for the milk, after it has been skimmed, may be used instead of flesh. there must always be a little flesh in hand for the sick, for bitches with their whelps, and for the entry of young hounds.[ ] about christmas is the time to arrange the breeding establishment. the number of puppies produced is usually from five to eight or nine; but, in one strange case, eighteen of them made their appearance. the constitution and other appearances in the dam, will decide the number to be preserved. when the whelps are sufficiently grown to run about, they should be placed in a warm situation, with plenty of fresh grass, and a sufficient quantity of clean, but not too stimulating, food. they should then be marked according to their respective letters, that they may be always recognised. when the time comes, the ears of the dog should be rounded; the size of the ear and of the head guiding the rounding-iron. this being passed, the master of the pack takes care that his treatment shall be joyous and playful; encouragement is always with him the word. the dog should be taught the nature of the fault before he is corrected: no animal is more grateful for kindness than a hound; the peculiarities of his temper will soon be learned, and when he begins to love his master, he will mind, from his natural and acquired affection, a word or a frown from him more than the blows of all the whips that were ever put into the hands of the keepers. the distemper having passed, and the young hounds being in good health, they should be walked out every day, and taught to follow the horse, with a keeper who is selected as a kind and quiet person, and will bear their occasionally entangling themselves in their couples. they are then taken to the public roads, and there exercised, and checked from riot, but with as little severity as possible; a frequent and free use of the whip never being allowed. no animals take their character from their master so much as the hounds do from theirs. if he is wild, or noisy, or nervous, so will his hounds be; if he is steady and quick, the pack will be the same. the whip should never be applied but for some immediate and decided fault. a rate given at an improper time does more harm than good: it disgusts the honest hound, it shies and prevents from hunting the timid one, and it is treated with contempt by those of another character who may at some future time deserve it. it formerly was the custom, and still is too much so, when a hound 'has hung on a hare', to catch him when he comes up, and flog him. the consequence of this is, that he takes good care the next time he indulges in a fault not to come out of cover at all. we will conclude this part of our subject by a short account of the splendid kennel at goodwood, for which we are indebted to lord w. lennox, with the kind permission of the duke of richmond. it is described as one of the most complete establishments of the kind in england. the original establishment of this building, although a little faulty, possesses considerable interest from its errors being corrected by the third duke of richmond, a man who is acknowledged to have been one of the most popular public characters of the day, and who in more private life extended his patronage to all that was truly honourable. it was to the duke's support of native talent that we may trace the origin of the present royal academy. in , the duke of richmond displayed, at his residence in whitehall, a large collection of original plaster casts, taken from the finest statues and busts of the ancient sculptors. every artist was freely admitted to this exhibition and, for the further encouragement of talent, he bestowed two medals annually on such as had exhibited the best models. we have thus digressed in order to give a slight sketch of the nobleman by whom this kennel was built, and we do not think that we can do better than lay before our readers the original account of it. early in life the duke built what was not then common, a tennis-court, and what was more uncommon, a dog-kennel, which cost him above £ . the duke was his own architect, assisted by, and under the guidance of, mr. wyatt; he dug his own flints, burnt his own lime, and conducted the wood-work in his own shops. the result of his labours was the noble building of which a plan is here given. the dog-kennel is a grand object when viewed from goodwood. the front is handsome, the ground well raised about it, and the general effect good; the open court in the centre adds materially to the noble appearance of the building. the entrance to the kennel is delineated in the centre with a flight of stairs leading above. the huntsman's rooms, four in number first present themselves, and are marked in the plan before us by the letter c; each of them is fifteen feet four inches, by fourteen feet six inches. at each end of the side towards the court is one of the feeding-rooms, twenty-nine feet by fourteen feet four inches, and nobly constructed rooms they are; they are designated by the letters b. at the back of the feeding-rooms, are one set of the lodging-rooms, from thirty-five feet six inches, to fourteen feet four inches, and marked by the letters a, and at either extremity is another lodging-room, thirty-two feet six inches in length, and fourteen feet six inches in width: this is also marked by the letter a. coming into the court we find the store-room twenty-four feet by fourteen and a half, marked by the letter d, and the stable, of the same dimensions, by the letter e. at the top of the buildings are openings for the admission of cold air, and stoves to warm the air when too cold. there are plentiful supplies of water from tanks holding , gallons; so that there is no inconvenience from the smell, and the whole can at any time be drained, and not be rendered altogether useless. round the whole building is a pavement five feet wide; airy yards and places for breeding, &c., making part of each wing. for the huntsman and whipper-in there are sleeping-rooms, and a neat parlour or kitchen. soon after the kennel was erected, it would contain two packs of hounds. the stag-hound. the largest of the english hounds that has been lately used, is devoted, as his name implies, to the chase of the deer. he is taller than the fox-hound, and with far more delicate scent, but he is not so speedy. he answers better than any other to the description given of the old english hound, so much valued when the country, less enclosed, and the forests, numerous and extensive, were the harbours of the wild deer. the deer-hound and the harrier were for many centuries the only hunting-dogs. the fox-hound has been much more recently bred. the most tyrannic and cruel laws were enforced for the preservation of this species of game, and the life of the deer, except when sacrificed in the chase, and by those who were privileged to join in it, was guarded with even more strictness than the life of the human being. when, however, the country became more generally cultivated, and the stag was confined to enclosed parks, and was seldom sought in his lair, but brought into the field, and turned out before the dogs, so much interest was taken from the affair, that this species of hunting grew out of fashion, and was confined to the neighbourhood of the scattered forests that remained, and enjoyed only by royalty and a few noblemen, of whose establishment a kennel of deer-hounds had, from time immemorial, formed a part. since the death of george iii, who was much attached to this sport, stag-hunting has rapidly declined, and the principal pleasure seems now to consist in the concourse of people brought together to an appointed place and hour, to witness the turning out of the deer. there is still maintained a royal establishment for the continuance of this noble sport, but, unless better supported than it has of late years been, it will gradually decline. the stag-hounds are now a part of the regular crown establishment. the royal kennel is situated upon ascot heath, about six miles from windsor. at the distance of a mile from the kennel is swinley lodge, the official residence of the master of the stag-hounds. the stag-hound is a beautiful animal. he is distinguished from the fox-hound by the apparent broadness and shortness of his head, his longer cheek, his straighter hock, his wider thigh and deeper chest, and better feathered and more beautifully arched tail. his appearance indicates strength and stoutness, in which indeed he is unequalled, and he has sufficient speed to render it difficult for the best horses long to keep pace with him; while, as is necessary, when the distance between the footmarks of the deer is considered, his scent is most exquisite. he is far seldomer at fault than any other hound except the blood-hound, and rarely fails of running down his game. of the stoutness of this dog, the following anecdotes will be a sufficient illustration. a deer, in the spring of , was turned out before the earl of derby's hounds in hayes common. the chase was continued nearly four hours without a check, when, being almost run down, the animal took refuge in some outhouses near speldhurst in kent, more than forty miles across the country, and having actually run more than fifty miles. nearly twenty horses died in the field, or in consequence of the severity of the chase. a stag was turned out at wingfield park, in northumberland. the whole pack, with the exception of two hounds, was, after a long run, thrown out. the stag returned to his accustomed haunt, and, as his last effort, leaped the wall of the park, and lay down and died. one of the hounds, unable to clear the wall, fell and expired, and the other was found dead at a little distance. they had run about forty miles. "when the stag first hears the cry of the hounds, he runs with the swiftness of the wind, and continues to run as long as any sound of his pursuers can be distinguished. that having ceased, he pauses and looks carefully around him; but before he can determine what course to pursue, the cry of the pack again forces itself upon his attention. once more he darts away, and after a while again pauses. his strength perhaps begins to fail, and he has recourse to stratagem in order to escape. he practises the doubling and the crossing of the fox or the hare. this being useless, he attempts to escape by plunging into some lake or river that happens to lie in his way, and when, at last, every attempt to escape proves abortive, he boldly faces his pursuers, and attacks the first dog or man who approaches him." [ ] southern hound. there used to be in the south of devon a pack or cry of the genuine old english or southern hounds. there is some reason to believe that this was the original stock of the island, or of this part of the island, and that this hound was used by the ancient britons in the chase of the larger kinds of game with which the country formerly abounded. its distinguishing characters are its size and general heavy appearance; its great length of body, deep chest, and ears remarkably large and pendulous. the tones of its voice were peculiarly deep. it answered the description of shakspeare: "so flewed, so sanded; and their heads are hung with ears that sweep away the morning dew; crook-knee'd, and dew-lapp'd, like thessalian bulls; slow in pursuit, but match'd in mouth like bells, each under each." it was the slowness of the breed which occasioned its disuse. several of them, however, remained not long ago at a village called aveton gifford, in devonshire, in the neighbourhood of which some of the most opulent of the farmers used to keep two or three dogs each. when fox-hunting had assumed somewhat of its modern form, the chase was followed by a slow heavy hound, whose excellent olfactory organs enabled him to carry on the scent a considerable time after the fox-hound passed, and also over grassy fallows, and hard roads, and other places, where the modern high-bred fox-hound would not be able to recognise it. hence the chase continued for double the duration which it does at present, and hence may be seen the reason why the old english hunter, so celebrated in former days and so great a favourite among sportsmen of the old school, was enabled to perform those feats which were exultingly bruited in his praise. the fact is, that the hounds and the horse were well matched. if the latter possessed not the speed of the meltonian hunter, the hounds were equally slow and stanch. the blood-hound. this dog does not materially differ in appearance from the old deer-hound of a larger size, trained to hunt the human being instead of the quadruped. if once put on the track of a supposed robber, he would unerringly follow him to his retreat, although at the distance of many a mile. such a breed was necessary when neither the private individual nor the government had other means to detect the offender. generally speaking, however, the blood-hound of former days would not injure the culprit that did not attempt to escape, but would lie down quietly and give notice by a loud and peculiar howl what kind of prey he had found. some, however, of a savage disposition, or trained to unnatural ferocity, would tear to pieces the hunted wretch, if timely rescue did not arrive. hounds of every kind, both great and small, may be broken in to follow any particular scent, and especially when they are feelingly convinced that they are not to hunt any other. this is the case with the blood-hound. he is destined to one particular object of pursuit, and a total stranger with regard to every other. in the border country between england and scotland, and until the union of the two kingdoms, these dogs were absolutely necessary for the preservation of property, and the detection of robbery and murder. a tax was levied on the inhabitants for the maintenance of a certain number of blood-hounds. when, however, the civic government had sufficient power to detect and punish crime, this dangerous breed of hounds fell into disuse and was systematically discouraged. it, nevertheless, at the present day, is often bred by the rangers in large forests or parks to track the deer-stealer, but oftener to find the wounded deer. the blood-hound is taller and better formed than the deer-hound. it has large and deep ears, the forehead broad and the muzzle narrow. the expression of the countenance is mild and pleasing, when the dog is not excited; but, when he is following the robber, his ferocity becomes truly alarming. the thrapstone association lately trained a blood-hound for the detection of sheepstealers. in order to prove the utility of this dog, a person whom he had not seen was ordered to run as far and as fast as his strength would permit. an hour afterwards the hound was brought out. he was placed on the spot whence the man had started. he almost immediately detected the scent and broke away, and, after a chase of an hour and a half, found him concealed in a tree, fifteen miles distant. mr. john lawrence says, that a servant, discharged by a sporting country gentleman, broke into his stables by night, and cut off the ears and tail of a favourite hunter. as soon as it was discovered, a blood-hound was brought into the stable, who at once detected the scent of the miscreant, and traced it more than twenty miles. he then stopped at a door, whence no power could move him. being at length admitted, he ran to the top of the house, and, bursting open the door of a garret, found the object that he sought in bed, and would have torn him to pieces, had not the huntsman, who had followed him on a fleet horse, rushed up after him. somerville thus describes the use to which he was generally put, in pursuit of the robber: "soon the sagacious brute, his curling tail flourished in air, low bending, plies around his busy nose, the steaming vapour snuffs inquisitive, nor leaves one turf untried, till, conscious of the recent stains, his heart beats quick. his snuffing nose, his active tail, attest his joy. then, with deep opening mouth, that makes the welkin tremble, he proclaims th' audacious felon. foot by foot he marks his winding way. over the watery ford, dry sandy heaths, and stony barren hills, unerring he pursues, till at the cot arrived, and seizing by his guilty throat the caitiff vile, redeems the captive prey." the setter is evidently the large spaniel improved to his peculiar size and beauty, and taught another way of marking his game, viz., by 'setting' or crouching. if the form of the dog were not sufficiently satisfactory on this point, we might have recourse to history for information on it. mr. daniel, in his 'rural sports', has preserved a document, dated in the year , in which a yeoman binds himself for the sum of ten shillings, fully and effectually to teach a spaniel to 'sit' partridges and pheasants. [as this old document may prove interesting to the curious, we take the liberty of inserting it, knowing full well, that mr. daniel's work is quite rare in this country, and copies of it are not easily obtained even in england. ribbesford, oct. , , "i, john harris, of willdon, in the parish of hastlebury, in the county of worcester, yeoman, for and in consideration of ten shillings of lawful english money this day received of henry herbert of ribbesford, in the said county, esqr., and of thirty shillings more of like money by him promised to be hereafter pay'd me, do hereby covenant and promise to and with the said henry herbert, his exôrs and admôrs, that i will, from the day of the date hereof, untill the first day of march next, well and sufficiently mayntayne and keepe a spanile bitch named quand, this day delivered into my custody by the said henry herbert, and will, before the first day of march next, fully and effectually traine up and teach the said bitch to sitt partridges, pheasants, and other game, as well and exactly as the best sitting doggers usually sett the same. and the said bitch, so trayned and taught, shall and will delivere to the said henry herbert, or whom he shall appoint to receive her, att his house in ribbesford aforesaid, on the first day of march next. and if at anytime after the said bitch shall, for want of use or practice, or orwise, forgett to sett game as aforesaid, i will, at my costes and charges, maynetayne her for a month, or longer, as often as need shall require, to trayne up and teach her to sett game as aforesaid, and shall and will, fully and effectually, teach her to sett game as well and exactly as is above mentyon'd. witness my hand and seal the day and year first above written, john harris, his x mark. sealed and delivered in presence of h. payne, his x mark." l.] the first person, however, who systematically broke-in setting dogs is supposed to have been dudley duke of northumberland in . a singular dog-cause was tried in westminster, in july, . at a previous trial it was determined that the mere possession of a dog, generally used for destroying game, was sufficient proof of its being actually so used. mr. justice best, however, determined that a man might be a breeder of such dogs without using them as game-dogs; and mr. justice bailey thought that if a game-dog was kept in a yard, chained up by day, and let loose at night, and, being so trained as to guard the preimises, he was to be considered as a yard-dog, and not as a game-dog. the setter is used for the same purpose as the pointer, and there is great difference of opinion with regard to their relative value as sporting-dogs. setters are not so numerous; and they are dearer, and with great difficulty obtained pure. it was long the fashion to cross and mix them with the pointer, by which no benefit was obtained, but the beauty of the dog materially impaired; many irish sportsmen, however, were exceedingly careful to preserve the breed pure. nothing of the pointer can be traced in them, and they are useful and beautiful dogs, altogether different in appearance from either the english or scotch setter. the irish sportsmen are, perhaps, a little too much prejudiced with regard to particular colours. their dogs ate either very red, or red and white, or lemon-coloured, or white, patched with deep chestnut; and it was necessary for them to have a black nose, and a black roof to the mouth. this peculiar dye is supposed to be as necessary to a good and genuine irish setter as is the palate of a blenheim spaniel to the purity of his breed. a true irish setter will obtain a higher price than either an english or scotch one. fifty guineas constituted no unusual price for a brace of them, and even two hundred guineas have been given. it is nevertheless, doubtful whether they do in reality so much exceed the other breeds, and whether, although stout and hard-working dogs, and with excellent scent, they are not somewhat too headstrong and unruly. the setter is more active than the pointer. he has greater spirit and strength. he will better stand continued hard work. he will generally take the water when necessary, and, retaining the character of the breed, is more companionable and attached. he loves his master for himself, and not, like the pointer, merely for the pleasure he shares with him. his somewhat inferior scent, however, makes him a little too apt to run into his game, and he occasionally has a will of his own. he requires good breaking, and plenty of work; but that breaking must be of a peculiar character: it must not partake of the severity which too often accompanies, and unnecessarily so, the tuition of the pointer. he has more animal spirit than the pointer, but he has not so much patient courage; and the chastisement, sometimes unnecessary and cruel, but leaving the pointer perfect in his work, and eager for it too, would make the setter disgusted with it, and leave him a mere 'blinker'. it is difficult, however, always to decide the claim of superiority between these dogs. he that has a good one of either breed may be content, but the lineage of that dog must be pure. the setter, with much of the pointer in him, loses something in activity and endurance; and the pointer, crossed with the setter, may have a degree of wildness and obstinacy, not a little annoying to his owner. the setter may be preferable when the ground is hard and rough; for he does not soon become foot-sore. he may even answer the purpose of a springer for pheasants and woodcocks, and may be valuable in recovering a wounded bird. his scent may frequently be superior to that of the pointer, and sufficiently accurate to distinguish, better than the pointer, when the game is sprung; but the steadiness and obedience of the pointer will generally give him the preference, especially in a fair and tolerably smooth country. at the beginning of a season, and until the weather is hot, the pointer will have a decided advantage. [we beg leave to finish this history of the setter by referring to our essay on this dog, published in vol. xv, no. , of the "new york spirit of the times", or as lately transferred to the pages of an interesting and valuable sporting work, about being published by our esteemed friend, wm. a. porter, and from which we now abstract our remarks upon the merits of the setter compared with those of the pointer. it cannot for a moment be doubted that the setter has superior advantages to the pointer, for hunting over our uncleared country, although the pointer has many qualities that recommend him to the sportsman, that the setter does not possess. in the first place, the extreme hardiness and swiftness of foot, natural to the setter, enables him to get over much more ground than the pointer, in the same space of time. their feet also, being more hard and firm, are not so liable to become sore from contact with our frozen ground. the ball pads being well protected by the spaniel toe-tufts, are less likely to be wounded by the thorns and burs with which our woods are crowded during the winter season. his natural enthusiasm for hunting, coupled with his superior physical powers, enables him to stand much more work than the pointer, and oftentimes he appears quite fresh upon a long continued hunt, when the other will be found drooping and inattentive. the long, thick fur of the setter, enables him to wend his way through briary thickets without injury to himself, when a similar attempt on the part of a pointer, would result in his ears, tail, and body being lacerated and streaming with blood. on the other hand, the pointer is superior to the setter in retaining his acquired powers for hunting, and not being naturally enthusiastic in pursuit of game, he is more easily broken and kept in proper subjection. the setter frequently requires a partial rebreaking at the commencement of each season, in his younger days, owing to the natural eagerness with which he resumes the sport. the necessity of this, however, diminishes with age, as the character and habits of the dog become more settled, and then we may take them into the field, with a perfect assurance of their behaving quite as well on the first hunt of the season, as the stanchest pointer would. the extreme caution, and mechanical powers of the pointer in the field, is a barrier to his flushing the birds, as is often witnessed in the precipitate running of the setter, who winds the game and frequently overruns it in his great anxiety to come up with it. but this occasional fault on the part of the setter, may be counterbalanced by the larger quantity of game that he usually finds in a day's hunt, owing to his enthusiasm and swiftness of foot. setters require much more water while hunting than the pointer, owing to their thick covering of fur, encouraging a greater amount of insensible perspiration to fly off than the thin and short dress of the pointer. consequently they are better calculated to hunt in the coldest seasons than early in our falls, which are frequently quite dry and warm. a striking instance of this fact came under our own immediate observation this fall, when shooting in a range of country thinly settled and uncommonly dry. the day being warm and the birds scarce, the dogs suffered greatly from thirst, in so much that a very fine setter of uncommon bottom, was forced to give up entirely, completely prostrated, foaming at the mouth in the most alarming manner, breathing heavily, and vomiting from time to time a thick frothy mucus. his prostration of both muscular and nervous powers was so great, that he could neither smell nor take the slightest notice of a bird, although placed at his nose. he could barely manage to drag one leg after the other, stopping to rest every few moments, and we were fearful that we should be obliged to shoulder and carry him to a farm-house, a considerable distance off. however, he succeeded, with much difficulty, in reaching the well, where he greedily drank several pints of water administered to him with caution. he recovered almost immediately, gave me a look of thanks, and was off to the fields in a few moments, where he soon found a fine covey of birds. the pointer, his associate in the day's work, and a much less hardy dog, stood the hunt remarkably well, and seemed to suffer little or no inconvenience from the want of water. the setter has natural claims upon the sportsman and man generally, in his affectionate disposition and attachment to his master, and the many winning manners he exhibits towards those by whom he is caressed. the pointer displays but little fondness for those by whom he is surrounded, and hunts equally as well for a stranger as his master.--l.] of the difference between the old english setter and the setters of the present day, we confess that we are ignorant, except that the first was the pure spaniel improved, and the latter the spaniel crossed too frequently with the pointer. it must be acknowledged, that of companionableness, and disinterested attachment and gratitude, the pointer knows comparatively little. if he is a docile and obedient servant in the field, it is all we want. the setter is unquestionably his superior in every amiable quality. mr. blaine says, that a large setter, ill with the distemper, had been nursed by a lady more than three weeks. at length he became so ill as to be placed in a bed, where he remained a couple of days in a dying state. after a short absence, the lady, re-entering the room, observed him to fix his eyes attentively on her, and make an effort to crawl across the bed towards her. this he accomplished, evidently for the sole purpose of licking her hand, after which he immediately expired. [daniel lambert celebrated for his enormous magnitude, weighing seven hundred and thirty-nine pounds, had a very superior breed of sellers, which were publicly sold, at the following prices; after his death, which forcibly illustrates the immense value placed on this dog in england; whereas, many american sportsmen considers it a great hardship to be obliged to give thirty or forty dollars for a well-bred setter in this country. guineas peg, a black setter bitch.......................... punch, a setter dog.................................. brush, do .......................................... bob, do............................................ bell, do........................................... bounce, do............................................ sam, do............................................ charlotte, a pointer bitch............................... lucy, do............................................ ------ --l.] the pointer is evidently descended from the hound. [we beg leave to make the following extracts from our essay on this subject, published in no. , vol. xvi, of the "spirit of the times": the origin of the pointer, like that of the setter, is involved in much obscurity; he is of mixed blood, and no doubt largely indebted to both hound and spaniel for his distinct existence. many sportsmen are under the erroneous idea that the pointer is contemporary with, if not older than, the setter. such, however, is not the case; and we are led to believe that the pointer is of quite modern origin; at all events, the production of a much later date than the spaniel. strut, in his "sports and pastimes", chap. , sects. xv. and xvi., mentions a ms. in the cotton library, originally written by william twici, or twety, grand huntsman to edward ii, who ascended the throne in . this manuscript contains the earliest treatise on hunting that the english possess, and enumerates the various kinds of game and different species of dogs then in existence, as also the modes of taking the former and using the latter. after describing, in the usual minute manner, the specific employment of each dog, he finishes by stating: "the spaniel was for use in hawking, hys crafte is for the perdrich or partridge, and the quail; and when taught to couch, he is very serviceable to the fowler, who takes these birds with nets." no mention is made in this treatise of the pointer, and we naturally infer that he did not exist, or he would have been noticed in connexion with the spaniel, who, it appears, even at this early period, was taught to 'couch' on and point out game to those employed in netting it. in the early portion of the sixteenth century, we have another enumeration of dogs, 'then' in use, in a book entitled--"a jewel for gentrie;" which, besides the dogs already descanted upon by twici, we find added to the list, "bastards and mongrels, lemors, kenets, terrours, butchers' hounds, dung-hill dogs, trindel-tailed dogs, prychercard curs, and ladies' puppies." (chap. st., sec. xvi.--strut.) the pointer being the offspring of the fox-hound and spaniel, is consequently sprung from the two ancient races known as 'sagaces' and 'pugnaces' or 'bellicosi'. he certainly evinces a larger share of the 'bellicosi' blood than the setter, being ever ready for fight when assailed, while the latter generally exhibits a conciliatory disposition under the most trying circumstances.--l.] it is the fox-hound searching for game by the scent, but more perfectly under the control of the sportsman, repressing his cry of joy when he finds his game, and his momentary pause, and gathering himself up in order to spring upon it artificially, converted into a steady and deliberate point. there still remains a strong resemblance, in countenance and in form, between the pointer and the fox-hound, except that the muzzle is shorter, and the ears smaller, and partly pendulous. seventy or eighty years ago, the breed of pointers was nearly white, or varied with liver-coloured spots; some, however, belonging to the duke of kingston, were perfectly black. this peculiarity of colour was supposed to be connected with exquisite perfection of scent. that is not the case with the present black pointers, who are not superior to any others. mr. daniel relates an anecdote of one of his pointers. he had a dog that would always go round close to the hedges of a field before he would quarter his ground. he seemed to have observed that he most frequently found his game in the course of this circuit. [ ] mr. johnson gives the following characteristic sketches of the different breeds of pointer: the spanish pointer, originally a native of spain, was once considered to be a valuable dog. he stood higher on his legs, but was too large and heavy in his limbs, and had widely spread, ugly feet, exposing him to frequent lameness. his muzzle and head were large, corresponding with the acuteness of his smell. his ears were large and pendent, and his body ill-formed. he was naturally an ill-tempered dog, growling at the hand that would caress him, even although it were his master's. he stood steadily to his birds; but it was difficult to break him of chasing the hare. he was deficient in speed. his redeeming quality was his excellent scent, unequalled in any other kind of dog. [to convince our readers of the value of this particular breed, we may mention the very singular sale of colonel thornton's dog dash, who was purchased by sir richard symons for one hundred and sixty pounds worth of champagne and burgundy, a hogshead of of claret, and an elegant gun and another pointer, with a stipulation that if any accident befell the dog, he was to be returned to his former owner for fifty guineas. dash unfortunately broke his leg, and in accordance with the agreement of sale was returned to the colonel, who considered him a fortunate acquisition as a stallion to breed from. (see blain or daniel).--l.] the portugese pointer, although with a slighter form than the spanish one, is defective in the feet, often crooked in the legs, and of a quarrelsome disposition. he soon tires, and is much inclined to chase the hare. the tail is larger than that of the spaniel, and fully fringed. the french pointer is distinguished by a furrow between his nostrils, which materially interferes with the acuteness of smell. he is better formed and more active than either the spanish or portugese dog, and capable of longer continued exertion; but he is apt to be quarrelsome, and is too fond of chasing the hare. [we will close this account of the pointer by transferring from the pages of the "spirit of the times" our remarks upon this particular breed. the french variety, as described by english authors, is much smaller than either of the above breeds; and although possessed of great beauty, acute scent, and other qualifications that would render him valuable in their eyes, still is considered much inferior, not being able to cope with their dogs in hunting, owing to a want of physical power of endurance. youatt states, that he is distinguished by a furrow in his nose, which materially interferes with his acuteness of smell. these accounts do not agree with the french writers, to whom, it is very true, the english should not look for any particular information respecting hunting or shooting. nevertheless, all must admit that they are quite as capable of describing their particular breeds of animals as other nations; and, in fact, we might go farther, and say that they are much more competent to the task than english writers, judging from their extensive knowledge in comparative anatomy, and their long array of celebrated writers on natural history--the cuviers, buffon, &c. 'baudrillart', in his 'dictionnaire des chases', describes the french pointer as having endurance and great industry, and of their being used oftentimes solely for 'la grande chasse'. in the atlas of plates accompanying this interesting work, will be found two distinct and extremely correct drawings of the english pointer, and also an engraving of the french variety, which latter, certainly, is represented as being equally, if not more muscular and and hardy, than the english. as for the furrow in the nose, as mentioned by youatt, no reference is made to it in connection with this species, and in the engraving the nose is square. but in describing another variety, known in france as coming from spain, 'baudrillart' states, that they are vulgarly called "à deux nez, parceque ce chien a les narines separées par une gouttiere." as for mr. youatt's declaration in reference to the furrow in the nose "materially interfering with the acuteness of smell," i cannot understand how, or on what principle of reasoning, this slight deviation from nature should affect the properties of the olfactory apparatus. that these furrow-nosed dogs are inferior to the english in scenting powers, as stated by mr. youatt, we do not question; but that their deficiency depends upon this furrow, remains to be proved. this furrow in the nose is merely a deformity, and like many others in various breeds of animals, was solely the result of accident in the first place; and as we often see, even in the human species, the deformities and infirmities of our ancestors entailed upon their progeny, so has this 'cut in the nose' been so extensively inherited by succeeding generations, that it has now become a distinctive mark of a whole class of dogs. the french pointer, as known in this country, is a beautiful, well-shaped, compact, square-nosed dog; not so long or high as the english, but extremely well built, full-chested, large head, pendent ears, projecting eyes, large feet, and thickish tail. his colour, seldom white, but generally intermingled with small spots of brown or chocolate over the body, and more particularly over the head and ears. such a dog is in the possession of the writer, who knows nothing of his ancestry; but is convinced from those he saw in france, that they must have been imported from that country. the english pointer will now claim more particularly our attention. it is quite useless to go into a general description of an animal of whom we have already said much, and with whom we are all familiar; but we will endeavour to mention the most striking points of the species, which marks can be referred to as guides in the purchase of a dog. it is a difficult matter to put on paper, in a manner satisfactory either to the reader or writer, the peculiarities of any animal, whereby he may be judged pure or mixed. however, there are, generally, some few points in each species, that can be selected as proofs of their genuineness and ability to perform certain actions peculiar to the race. but, after all, more reliance must be placed upon the good faith of the seller, or the previous knowledge of the strain from which the purchaser selects--and what is better than either, from actual observation in the field; all of which precautions may, nevertheless, prove abortive, and our dog be worthless. as regards the size of the english pointer, we may say, that he averages in length about feet from the tip of the muzzle to the base of the tail, and from to inches high. his head not bulky nor too narrow, the frontal sinuses largely developed. the muzzle long and rather tapering, the nostrils large and well open, the ear slightly erect, not over long, and the tip triangular; if too pendent, large and rounded at the tip, there is too much of the hound present. the eyes lively, but not too prominent; the neck rather long and not over thick, the chest broad, the limbs large and muscular; the paws strong, hard and wide. the body and loins thin, rather than bulky, the hind quarters broad, and the limbs in the same proportion with the fore members; the tail long and tapering.--l.] the russian pointer is a rough, ill-tempered animal, with too much tendency to stupidity, and often annoyed by vermin. he runs awkwardly, with his nose near the ground, and frequently springs his game. he also has the cloven or divided nose. the early training of the dog. the education of these dogs should commence at an early period, whether conducted by the breeder or the sportsman; and the first lesson--that on which the value of the animal, and the pleasure of its owner, will much depend--is a habit of subjection on the part of the dog, and kindness on the part of the master. this is a 'sine quâ non'. the dog must recognise in his owner a friend and a benefactor. this will soon establish in the mind of the quadruped a feeling of gratitude, and a desire to please. all this is natural to the dog, if he is encouraged by the master, and then the process of breaking-in may commence in good earnest. no long time probably passes ere the dog commits some little fault. he is careless, or obstinate, or cross. the owner puts on a serious countenance, he holds up his finger, or shakes his head, or produces the whip, and threatens to use it. perhaps the infliction of a blow, that breaks no bones, occasionally follows. in the majority of cases nothing more is required. the dog succumbs; he asks to be forgiven; or, if he has been self-willed, he may be speedily corrected without any serious punishment. a writer, under the signature of "soho," in the new sporting magazine for , gives an interesting account of the schooling of the pointer or setter, thus commenced. a short abstract from it may not be unacceptable: "the first lesson inculcated is that of passive obedience, and this enforced by the infliction of severity as little as the case will admit. we will suppose the dog to be a setter. he is taken into the garden or into a field, and a strong cord, about eighteen or twenty yards long, is tied to his collar. the sportsman calls the dog to him, looks earnestly at him, gently presses him to the ground, and several times, with a loud, but not an angry voice, says, 'down!' or 'down charge!' the dog knows not the meaning of this, and struggles to get up; but, as often as he struggles, the cry of 'down charge!' is repeated, and the pressure is continued or increased. "this is repeated a longer or shorter time, until the dog, finding that no harm is meant, quietly submits. he is then permitted to rise; he is patted and caressed, and some food is given to him. the command to rise is also introduced by the terms 'hie up!' a little afterwards the same process is repeated, and he struggles less, or perhaps ceases altogether to struggle. "the person whose circumstances permit him occasionally to shoot over his little demesne, may very readily educate his dog without having recourse to keepers or professional breakers, among whom he would often be subject to imposition. generally speaking, no dog is half so well broken as the one whose owner has taken the trouble of training him. the first and grand thing is to obtain the attachment of the dog, by frequently feeding and caressing him, and giving him little hours of liberty under his own inspection; but, every now and then, inculcating a lesson of obedience, teaching him that every gambol must be under the control of his master; frequently checking him in the midst of his riot with the order of 'down charge!' patting him when he is instantly obedient; and rating, or castigating him, but not too severely, when there is any reluctance to obey. 'passive obedience is the first principle, and from which no deviation should be allowed.' [ ] "much kindness and gentleness are certainly requisite when breaking-in the puppy, whether it be a pointer or a setter. there is heedlessness in the young dog which is not readily got rid of until age has given him experience. he must not, however, be too severely corrected, or he may be spoiled for life. if considerable correction is sometimes necessary, it should be followed, at a little distance of time, by some kind usage. the memory of the suffering will remain; but the feeling of attachment to the master will also remain, or rather be increased. the temper of a young dog must be almost as carefully studied as that of a human being. timidity may be encouraged, and eagerness may be restrained, but affection must be the tie that binds him to his master, and renders him subservient to his will. "the next portion of the lesson is more difficult to learn. he is no longer held by his master, but suffered to run over the field, seemingly at his pleasure, when, suddenly, comes the warning 'down!' he perhaps pays no attention to it, but gambols along until seized by his master, forced on the ground, and the order of 'down!' somewhat sternly uttered. "after a while he is suffered again to get up. he soon forgets what has occurred, and gallops away with as much glee as ever. again the 'down!' is heard, and again little or no attention is paid to it. his master once more lays hold of him and forces him on the ground, and perhaps inflicts a slight blow or two, and this process continues until the dog finds that he must obey the command of 'down charge!' "the owner will now probably walk from him a little way backward with his hand lifted up. if the dog makes the slightest motion, he must be sharply spoken to, and the order peremptorily enforced. "he must then be taught to 'back,' that is, to come behind his master when called. when he seems to understand all this, he is called by his master in a kindly tone, and patted and caressed. it is almost incredible how soon he will afterwards understand what he is ordered to do, and perform it. "it will be seen by this that no one should attempt to break-in a dog who is not possessed of patience and perseverance. the sportsman must not expect to see a great deal of improvement from the early lessons. the dog will often forget that which was inculcated upon him a few hours before; but perseverance and kindness will effect much: the first lessons over, the dog, beginning to perceive a little what is meant, will cheerfully and joyfully do his duty. "when there is much difficulty in teaching the dog his lesson, the fault lies as often with the master as with him; or they are, generally speaking, both in fault. some dogs cannot be mastered but by means of frequent correction. the less the sportsman has to do with them the better. others will not endure the least correction, but become either ferocious or sulky. they should be disposed of as soon as possible. the majority of dogs are exceedingly sagacious. they possess strong reasoning powers; they understand, by intuition, almost every want and wish of their master, and they deserve the kindest and best usage. "the scholar being thus prepared, should be taken into the field, either alone, or, what is considerably better, with a well-trained, steady dog. when the old dog makes a point, the master calls out, 'down!' or 'soho!' and holds up his hand, and approaches steadily to the birds; and, if the young one runs in or prepares to do so, as probably he will at first, he again raises his hand and calls out, 'soho!' if the youngster pays no attention to this, the whip must be used, and in a short time he will be steady enough at the first intimation of game. "if he springs any birds without taking notice of them, he should be dragged to the spot from which they rose, and, 'soho!' being cried, one or two sharp strokes with the whip should be inflicted. if he is too eager, he should be warned to 'take heed.' if he 'rakes' or runs with his nose near the ground, he should be admonished to 'hold up', and, if he still persists, the 'muzzle-peg' may be resorted to. some persons fire over the dog for running at hares: but this is wrong; for, besides the danger of wounding or even killing the animal, he will for some time afterwards he frightened at the sound, or even at the very sight of a gun. the best plan to accustom dogs to the gun, is occasionally to fire one off when they are being fed. "some persons let their dog fetch the dead birds. this is very wrong. except the sportsman has a double-barrelled gun, the dog should not be suffered to move until the piece is again charged. the young one, until he is thoroughly broken of it, is too apt to run in whether the bird is killed or not, and which may create much mischief by disturbing the game. "although excessive punishment should not be administered, yet no fault, however small, should pass without reproof: on the other hand, he should be rewarded, but not too lavishly, for every instance of good conduct. "when the dog is grown tolerably steady, and taught to come at the call, he should also learn to range and quarter his ground. let some clear morning, and some place where the sportsman is likely to meet with game, be selected. station him where the wind will blow in his face; wave your hand and cry, 'heigh on, good dog!' then let him go off to the right, about seventy or eighty yards. after this, call him in by another wave of the hand, and let him go the same distance to the left. walk straight forward with your eye always upon him; then, let him continue to cross from right to left, calling him in at the limit of each range. "this is at first a somewhat difficult lesson, and requires careful teaching. the same ground is never to be twice passed over. the sportsman watches every motion, and the dog is never trusted out of sight, or allowed to break fence. when this lesson is tolerably learned, and on some good scenting morning early in the season, he may take the field, and perhaps find. probably he will be too eager, and spring his game. make him 'down' immediately, and take him to the place where the birds rose. chide him with 'steady!' 'how dare you!' use no whip; but scold him well, and be assured that he will be more cautious. if possible, kill on the next chance. the moment the bird is down, he will probably rush in and seize it. he must be met with the same rebuff, 'down charge!' if he does not obey, he deserves to have, and will have, a stroke with the whip. the gun being again charged, the bird is sought for, and the dog is suffered to see it and play with it for a minute before it is put into the bag. "he will now become thoroughly fond of the sport, and his fondness will increase with each bird that is killed. at every time, however, whether he kills or misses, the sportsman should make the dog 'down charge.' and never allow him to rise until he has loaded. "if a hare should be wounded, there will, occasionally, be considerable difficulty in preventing him from chasing her. the best broken and steadiest dog cannot always be restrained from running hares. he must be checked with 'ware chase,' and, if he does not attend, the sportsman must wait patiently. he will by-and-by come slinking along with his tail between his legs, conscious of his fault. it is one, however, that admits of no pardon. he must be secured, and, while the field echoes with the cry of 'ware chase,' he must be punished to a certain but not too great extent. the castigation must be repeated as often as he offends; or, if there is much difficulty in breaking him of the habit, he must be got rid of." the breaking-in or subjugation of pointers and setters is a very important, and occasionally a difficult affair; the pleasure of the sportsman, however, depends on it. the owner of any considerable property will naturally look to his keeper to furnish him with dogs on which he may depend, and he ought not to be disappointed; for those which belong to other persons, or are brought at the beginning of the season, whatever account the breaker or the keeper of them may give, will too often be found deficient. the otter hound used to be of a mingled breed, between the southern hound and the rough terrier, and in size between the harrier and the fox-hound. the head should be large and broad, the shoulders and quarters thick, and the hair strong, wiry, and rough. they used to be kept in small packs, for the express purpose of hunting the otter. two hundred and fifty years ago, otter-hunting was a favourite amusement in several parts of great britain. many of our streams then abounded with this destructive animal; but, since the population are more numerous, and many contrivances are adopted to ensnare and destroy otters, few are now to be found. the turnspit this dog was once a valuable auxiliary in the kitchen, by turning the spit before jacks were invented. it had a peculiar length of body, with short crooked legs, the tail curled, its ears long and pendent, and the head large in proportion to the body. it is still used in the kitchen on various parts of the continent. there are some curious stories of the artfulness with which he often attempted to avoid the task imposed upon him. there is a variety of this dog; the crooked-legged turnspit. [footnote : 'historical and descriptive sketches of british america', by j. macgregor] [footnote : 'journal historique du voyage de m. de lesseps', paris, . vols.--tome .] [footnote : clarke's 'scandinavia', vol. i. p. .] [footnote : the migratory sheep, in some parts of the south of france almost as numerous as in spain, are attended by a goat, as a guide; and the intelligence and apparent pride which he displays are remarkable.] [footnote : 'trimmer on the merinos', p. . see also the society's work on sheep.] [footnote : 'annals of sporting', vol. viii. p. .] [footnote : "the ettrick shepherd has probably spoken somewhat too enthusiastically of his dog; but accounts of the sagacity and almost superhuman fidelity of this dog crowd so rapidly upon us that we are compelled to admire and to love him." 'hogg's shepherd's calendar', vol. ii. p. .] [footnote : 'jesse's gleanings', vol. i. p. ]. [footnote : 'buffon's natural history', vol. v. p. .] [footnote : 'travels in scotland', by the rev. j. hall, vol. ii. p. .] [footnote : 'annals of sporting', vol. v. p. .] [footnote : mr beckford at one time determined to try how he should like the use of beagles, and, having heard of a small pack of them, he sent his coachman, the person he could best spare, to fetch them. it was a long journey, and, although he had some assistance, yet not being used to hounds, he had some trouble in getting them along, especially as they had not been out of the kennel for several weeks before. they were consequently so riotous that they ran after everything they saw, sheep, cur dogs, birds of all sorts, as well as hares and deer. however, he lost but one hound; and, when mr. beckford asked him what he thought of them, he said that they could not fail of being good hounds, for they would hunt everything.] [footnote : 'beckford on hunting', p. .] [footnote : 'the horse and the hound', by nimrod, p. .] [footnote : 'the horse and the hound', by nimrod, p, .] [footnote : 'daniel's foxhound', p. .] [footnote : 'the horse and the hound', by nimrod, p. .] [footnote : 'beckford's thoughts on hunting', p. .] [footnote : mr. beckford gives the following excellent account of what a huntsman should be: "a huntsman should be attached to the sport, and indefatigable, young, strong, active, bold, and enterprising in the pursuit of it. he should be sensible, good-tempered, sober, exact, and cleanly--a good groom and an excellent horseman. his voice should be strong and clear, with an eye so quick as to perceive which of his hounds carries the scent when all are running, and an ear so excellent as to distinguish the leading hounds when he does not see them. he should be quiet, patient, and without conceit. such are the qualities which constitute perfection in a huntsman. he should not, however, be too fond of displaying them until called forth by necessity; it being a peculiar and distinguishing trait in his character to let his hounds alone while they thus hunt, and have genius to assist them when they cannot." 'beckford on hunting', letter ix.] [footnote : 'blaine on the diseases of the dog', p. .] [footnote : see 'hints to young masters of fox-hounds'--'new sport. mag.', vol. viii. p. - .] [footnote : 'traité de la folie dex animaux', tom. ii. .] [footnote : mr. d. radcliffe.] [footnote : the late lord oxford reduced four stags to so perfect a degree of submission that, in his short excursions, he used to drive them in a phaeton made for the purpose. he was one day exercising his singular and beautiful steeds in the neighbourhood of newmarket, when their ears were saluted with the unwelcome cry of a pack of hounds, which, crossing the road in their rear, had caught the scent, and leaving their original object of pursuit, were now in rapid chase of the frightened stags. in vain his grooms exerted themselves to the utmost, the terrified animals bounded away with the swiftness of lightning, and entered newmarket at full speed. they made immediately for the ram inn, to which his lordship was in the habit of driving, and, having fortunately entered the yard without any accident, the stable-keepers huddled his lordship, the phaeton, and the deer into a large barn, just in time to save them from the hounds, who came into the yard in full cry a few seconds afterwards. ('annals of sporting', vol. iii. .)] [footnote : the author of the 'field book' says that he saw an extremely small pointer, whose length, from the tip of the nose to the point of the tail, was only two feet and half an inch, the length of the head being six inches, and round the chest one foot and three inches. he was an exquisite miniature of the english pointer, being in all respects similar to him, except in his size. his colour was white, with dark liver-coloured patches on each side of the head, extending half down the neck. the ears, with some patches on the back, were also of the same colour, and numerous small dark-brown spots appeared over his whole body and legs. this beautiful little animal had an exquisite sense of smell. some of the same breed, and being the property of the earl of lauderdale, were broken-in and made excellent pointers, although, from their minute size, it could not be expected that they would be able to do much work. when intent upon any object, the dog assumed the same attitude as other pointers, holding up one of his feet. ('the field book', p. .)] [footnote : another writer in the same volume gives also an interesting account of the management of the setter.] * * * * * chapter iv. the varieties of the dog. third division. 'the muzzle more or less shortened, the frontal sinus enlarged, and the cranium elevated and diminished in capacity.' at the head of this inferior or brutal division of dogs stands the bull-dog. the round, thick head, turned-up nose, and thick and pendulous lips of this dog are familiar to all, while his ferocity makes him in the highest degree dangerous. in general he makes a silent although ferocious attack, and the persisting powers of his teeth and jaws enable him to keep his hold against any but the greatest efforts, so that the utmost mischief is likely to ensue as well to the innocent visitor of his domicile as the ferocious intruder. the bull-dog is scarcely capable of any education, and is fitted for nothing but ferocity and combat. the name of this dog is derived from his being too often employed, until a few years ago, in baiting the bull. it was practised by the low and dissolute in many parts of the country. dogs were bred and trained for the purpose; and, while many of them were injured or destroyed, the head of the bull was lacerated in the most barbarous manner. nothing can exceed the fury with which the bull-dog rushed on his foe, and the obstinacy with which he maintained his hold. he fastened upon the lip, the muzzle, or the eye, and there he hung in spite of every effort of the bull to free himself from his antagonist. bull-dogs are not so numerous as they were a few years ago; and every kind-hearted person will rejoice to hear that bull-baiting is now put down by legal authority in every part of the kingdom. the bull terrier. this dog is a cross between the bull-dog and the terrier, and is generally superior, both in appearance and value, to either of its progenitors. a second cross considerably lessens the underhanging of the lower jaw, and a third entirely removes it, retaining the spirit and determination of the animal. it forms a steadier friendship than either of them, and the principal objection to it is its love of wanton mischief, and the dangerous irascibility which it occasionally exhibits. sir walter scott, a warm friend of dogs, and whose veracity cannot be impeached, gives an interesting account of a favourite one belonging to him. "the cleverest dog i ever had was what is called a bull-dog terrier. i taught him to understand a great many words, insomuch that i am positive the communication between the canine species and ourselves might be greatly enlarged. camp, the name of my dog, once bit the baker when bringing bread to the family. i beat him, and explained the enormity of the offence; after which, to the last moment of his life, he never heard the least allusion to the story without creeping into the darkest corner of the room. towards the end of his life when he was unable to attend me while i was on horseback, he generally watched for my return, and, when the servant used to tell him, his master was coming down the hill, or through the moor, although he did not use any gesture to explain his meaning, camp was never known to mistake him, but either went out at the front to go up the hill, or at the back to get down to the moor-side." the mastiff the head considerably resembles that of the bull-dog, but with the ears dependent. the upper lip falls over the lower jaw. the end of the tail is turned up, and frequently the fifth toe of the hind feet is more or less developed. the nostrils are separated one from another by a deep furrow. he has a grave and somewhat sullen countenance, and his deep-toned bark is often heard during the night. the mastiff is taller than the bull-dog, but not so deep in the chest, and his head is large compared with his general form. it is probable that the mastiff is an original breed peculiar to the british islands. he seems to be fully aware of the impression which his large size makes on every stranger; and, in the night especially, he watches the abode of his master with the completest vigilance; in fact, nothing would tempt him to betray the confidence which is reposed in him. captain brown states that, "notwithstanding his commanding appearance and the strictness with which he guards the property of his master, he is possessed of the greatest mildness of conduct, and is as grateful for any favours bestowed upon him as is the most diminutive of the canine tribe. there is a remarkable and peculiar warmth in his attachments. he is aware of all the duties required of him, and he punctually discharges them. in the course of the night he several times examines every thing with which he is intrusted with the most scrupulous care, and, by repeated barkings, warns the household or the depredator that he is at the post of duty." [ ] the mastiff from cuba requires some mention, and will call up some of the most painful recollections in the history of the human race. he was not a native of cuba, but imported into the country. the spaniards had possessed themselves of several of the south american islands. they found them peopled with indians, and those of a sensual, brutish, and barbarous class--continually making war with their neighbours, indulging in an irreconcilable hatred of the spaniards, and determined to expel and destroy them. in self-defence, they were driven to some means of averting the destruction with which they were threatened. they procured some of these mastiffs, by whose assistance they penetrated into every part of the country, and destroyed the greater portion of the former inhabitants. las casas, a catholic priest, and whose life was employed in endeavouring to mitigate the sufferings of the original inhabitants, says that "it was resolved to march against the indians, who had fled to the mountains, and they were chased like wild beasts, with the assistance of bloodhounds, who had been trained to a thirst for human blood, so that before i had left the island it had become almost entirely a desert." the iceland dog. the head is rounder than that of the northern dogs; the ears partly erect and partly pendent; and the fur soft and long, especially behind the fore legs and on the tail. it much resembles the turkish dog removed to a colder climate. this dog is exceedingly useful to the icelanders while travelling over the snowy deserts of the north. by a kind of intuition he rarely fails in choosing the shortest and the safest course. he also is more aware than his master of the approach of the snow storms; and is a most valuable ally against the attack of the polar bear, who, drifted on masses of ice from the neighbouring continent, often commits depredations among the cattle, and even attacks human beings. when the dog is first aware of the neighbourhood of the bear, he sets up a fearful howl, and men and dogs hasten to hunt down and destroy the depredator. the travelling in iceland is sometimes exceedingly dangerous at the beginning of the winter. a thin layer of snow covers and conceals some of the chasms with which that region abounds. should the traveller fall into one of them, the dog proves a most useful animal; for he runs immediately across the snowy waste, and, by his howling, induces the traveller's friends to hasten to his rescue. the terrier the forehead is convex; the eye prominent; the muzzle pointed; the tail thin and arched; the fur short; the ears of moderate size, half erect, and usually of a deep-black colour, with a yellow spot over the eyes. it is an exceedingly useful animal; but not so indispensable an accompaniment to a pack of fox-hounds as it used to be accounted. foxes are not so often unearthed as they formerly were, yet many a day's sport would be lost without the terrier. some sportsmen used to have two terriers accompanying in the pack, one being smaller than the other. this was a very proper provision; a large terrier might be incapable of penetrating into the earth, and a small one might permit the escape of the prey. many terriers have lost their lives by scratching up the earth behind them, and thus depriving themselves of all means of retreat. the coat of the terrier may be either smooth or rough; the smooth-haired ones are more delicate in appearance, and are somewhat more exposed to injury or accident; but in courage, sagacity, and strength, there is very little difference if the dogs are equally well bred. the rough terrier possibly obtained his shaggy coat from the cur, and the smooth terrier may derive his from the hound. the terrier is seldom of much service until he is twelve months old; and then, incited by natural propensity, or the example of the older ones, or urged on by the huntsman, he begins to discharge his supposed duty. an old terrier is brought to the mouth of the earth in which a vixen fox--a fox with her young ones--has taken up her abode, and is sent in to worry and drive her out. some young terriers are brought to the mouth of the hover, to listen to the process that is going forward within, and to be excited to the utmost extent of which they are capable. the vixen is at length driven out, and caught at the mouth of the hole; and the young ones are suffered to rush in, and worry or destroy their first prey. they want no after-tuition to prepare them for the discharge of their duty. this may be pardoned. it is the most ready way of training the young dog to his future business; but it is hoped that no reader of this work will be guilty of the atrocities that are often practised. an old fox, or badger, is caught, his under jaw is sawn off, and the lower teeth are forcibly extracted, or broken. a hole is then dug in the earth, or a barrel is placed large and deep enough to permit a terrier, or perhaps two of them, to enter. into this cavity the fox or badger is thrust, and a terrier rushes after him, and drags him out again. the question to be ascertained is, how many times in a given period the dog will draw this poor tortured animal out of the barrel--an exhibition of cruelly which no one should be able to lay to the charge of any human being. it is a principle not to be departed from, that wanton and useless barbarity should never be permitted. the government, to a certain extent, has interfered, and a noble society has been established to limit, or, if possible, to prevent the infliction of useless pain. the terrier is, however, a valuable dog, in the house and the farm. the stoat, the pole-cat, and the weazel, commit great depredations in the fields, the barn, and granary; and to a certain extent, the terrier is employed in chasing them; but it is not often that he has a fair chance to attack them. he is more frequently used in combating the rat. the mischief effected by rats is almost incredible. it has been said that, in some cases, in the article of corn, these animals consume a quantity of food equal in value to the rent of the farm. here the dog is usefully employed, and in his very element, especially if there is a cross of the bull-dog about him. there are some extraordinary accounts of the dexterity, as well as courage, of the terrier in destroying rats. the feats of a dog called "billy" will he long remembered. he was matched to destroy one hundred large rats in eight and a half minutes. the rats were brought into the ring in bags, and, as soon as the number was complete, he was put over the railing. in six minutes and thirty-five seconds they were all destroyed. in another match he destroyed the same number in six minutes and thirteen seconds. at length, when he was getting old, and had but two teeth and one eye left, a wager was laid of thirty sovereigns, by the owner of a berkshire bitch, that she would kill fifty rats in less time than billy. the old dog killed his fifty in five minutes and six seconds. the pit was then cleared, and the bitch let in. when she had killed thirty rats, she was completely exhausted, fell into a fit, and lay barking and yelping, utterly incapable of completing her task. the speed of the terrier is very great. one has been known to run six miles in thirty-two minutes. he needs to be a fleet dog if, with his comparatively little bulk, he can keep up with the foxhound. a small breed of 'wry-legged' terriers was once in repute, and, to a certain degree, is retained for the purpose of hunting rabbits. it probably originated in some rickety specimens, remarkable for the slow development of their frame, except in the head, the belly, and the joints, which enlarge at the expense of the other parts. the scotch terrier there is reason to believe that this dog is far older than the english terrier. there are three varieties: first the common scotch terrier, twelve or thirteen inches high; his body muscular and compact-- considerable breadth across the loins--the legs shorter and stouter than those of the english terriers. the head large in proportion to the size of the body--the muzzle small and pointed--strong marks of intelligence in the countenance--warm attachment to his master, and the evident devotion of every power to the fulfilment of his wishes. the hair is long and tough, and extending over the whole of the frame. in colour, they are black or fawn: the white, yellow, or pied are always deficient in purity of blood. another species has nearly the same conformation, but is covered with longer, more curly, and stouter hair; the legs being apparently, but not actually, shorter. this kind of dog prevails in the greater part of the western islands of scotland, and some of them, where the hair has obtained its full development, are much admired. her majesty had one from islay, a faithful and affectionate creature, yet with all the spirit and determination that belongs to his breed. the writer of this account had occasion to operate on this poor fellow, who had been bitten under somewhat suspicious circumstances. he submitted without a cry or a struggle, and seemed to be perfectly aware that we should not put him to pain without having some good purpose in view. a third species of terrier is of a considerably larger bulk, and three or four inches taller than either of the others. its hair is shorter than that of the other breeds, and is hard and wiry. the shock-dog is traced by buffon, but somewhat erroneously, to a mixture of the small danish dog and the pug. the head is round, the eyes large, but somewhat concealed by its long and curly hair, the tail curved and bent forward. the muzzle resembles that of the pug. it is of small size, and is used in this country and on the continent as a lap-dog. it is very properly described by the author of "the field book" as a useless little animal, seeming to possess no other quality than that of a faithful attachment to his mistress. the artois dog with his short, flat muzzle, is a produce of the shock-dog and the pug. he has nothing peculiar to recommend him. the andalusian, or alicant dog, has the short muzzle of the pug with the long hair of the spaniel. the egyptian and barbary dog, according to cuvier, has a very thick and round head, the ears erect at the base, large and movable, and carried horizontally, the skin nearly naked, and black or dark flesh-colour, with large patches of brown. a sub-variety has a kind of mane behind the head, formed of long stiff hairs. buffon imagines that the shepherd's dog--transported to different climates, and acquiring different habits--was the ancestor of the various species with which almost every country abounds; but whence they originally came it is impossible to say. they vary in their size, their colour, their attitude, their usual exterior, and their strangely different interior construction. transported into various climates, they are necessarily submitted to the influence of heat and cold, and of food more or less abundant and more or less suitable to their natural organization; but the reason or the derivation of these differences of structure it is not always easy to explain. [footnote : brown's 'biographical sketches', p. .] * * * * * chapter v. the good qualities of the dog; the sense of smell; intelligence; moral qualities; dog-carts; cropping; tailing; breaking-in; dog-pits; dog-stealing. in our history of the different breeds of the dog we have seen enough to induce us to admire and love him. his courage, his fidelity, and the degree in which he often devotes every power that he possesses to our service, are circumstances that we can never forget nor overlook. his very foibles occasionally attach him to us. we may select a pointer for the pureness of his blood and the perfection of his education. he transgresses in the field. we call him to us; we scold him well; perchance, we chastise him. he lies motionless and dumb at our feet. the punishment being over, he gets up, and, by some significant gesture, acknowledges his consciousness of deserving what he has suffered. the writer operated on a pointer bitch for an enlarged cancerous tumour, accompanied by much inflammation and pain in the surrounding parts. a word or two of kindness and of caution were all that were necessary, although, in order to prevent accidents, she had been bound securely. the flesh quivered as the knife pursued its course--a moan or two escaped her, but yet she did not struggle; and her first act, after all was over, was to lick the operator's hand. from the combination of various causes, the history of no animal is more interesting than that of the dog. first, his intimate association with man, not only as a valuable protector, but as a constant and faithful companion throughout all the vicissitudes of life. secondly, from his natural endowments, not consisting in the exquisite delicacy of one individual sense--not merely combining memory with reflection--but possessing qualities of the mind that stagger us in the contemplation of them, and which we can alone account for in the gradation existing in that wonderful system which, by different links of one vast chain, extends from the first to the last of all things, until it forms a perfect whole on the wonderful confines of the spiritual and material world. we here quote the beautiful account of sir walter scott and his dogs, as described by henry hallam: "but looking towards the grassy mound where calm the douglass chieftains lie, who, living, quiet never found, i straightway learnt a lesson high; for there an old man sat serene, and well i knew that thoughtful mien of him whose early lyre had thrown o'er mouldering walls the magic of its tone. it was a comfort, too, to see those dogs that from him ne'er would rove, and always eyed him reverently, with glances of depending love. they know not of the eminence which marks him to my reasoning sense, they know but that he is a man, and still to them is kind, and glads them all he can and hence their quiet looks confiding; hence grateful instincts seated deep by whose strong bond, were ill betiding, they'd lose their own, his life to keep. what joy to watch in lower creature such dawning of a moral nature, and how (the rule all things obey) they look to a higher mind to be their law and stay!" the subject of the intellectual and moral qualities of the inferior animals is one highly interesting and somewhat misunderstood--urged perhaps to a ridiculous extent by some persons, yet altogether neglected by others who have no feeling for any but themselves. anatomists have compared the relative bulk of the brain in different animals, and the result is not a little interesting. in man the weight of the brain amounts on the average to - th part of the body. in the newfoundland dog it does not amount to - th part, or to - th part in the poodle and barbet, and not to more than - th part in the ferocious and stupid bull-dog. when the brain is cut, it is found to be composed of two substances, essentially different in construction and function--the cortical and the medullary. the first is small in quantity, and principally concerned in the food and reproduction of the animal, and the cineritious in a great measure the register of the mind. brute strength seems to be the character of the former, and superior intelligence of the latter. there is, comparing bulk with bulk, less of the medullary substance in the horse than in the ox--and in the dog than in the horse--and they are characterized as the sluggish ox, the intelligent horse, and the intellectual and companionable dog. from the medullary substance proceed certain cords or prolongations, termed 'nerves', by which the animal is enabled to receive impressions from surrounding objects and to connect himself with them, and also to possess many pleasurable or painful sensations. one of them is spread over the membrane of the nose, and gives the sense of smell; another expands on the back of the eye, and the faculty of sight is gained; a third goes to the internal structure of the ear and the animal is conscious of sound. other nerves, proceeding to different parts, give the faculty of motion, while an equally important one bestows the power of feeling. one division, springing from a prolongation of the brain, and yet within the skull, wanders to different parts of the frame, for important purposes connected with respiration or breathing. the act of breathing is essential to life, and were it to cease, the animal would die. there are other nerves--the sympathetic--so called from their union and sympathy with all the others, and identified with life itself. they proceed from a small ganglion or enlargement in the upper part of the neck, or from a collection of minute ganglia within the abdomen. they go to the heart, and it beats; and to the stomach, and it digests. they form a net-work round each vessel, and the frame is nourished and built up. they are destitute of sensation, and they are perfectly beyond the control of the will. we have been accustomed, and properly, to regard the nervous system, or that portion of it which is connected with animal life--that which renders us conscious of surrounding objects and susceptible of pleasure and of pain--as the source of intellectual power and moral feeling. it is so with ourselves. all our knowledge is derived from our perception of things around as. a certain impression is made on the outward fibres of a sensitive nerve. that impression, in some mysterious way, is conveyed to the brain; and there it is received--registered--stored--and compared; there its connections are traced and its consequences appreciated; and thence a variety of interesting impressions are conveyed, and due use is made of them. the sense of smell our subject--the intellectual and moral feelings of brutes, and the mechanism on which they depend--may be divided into two parts, the portion that receives and conveys, and that which stores up and compares and uses the impression. the portion that receives and conveys is far more developed in the brute than in the human being. whatever sense we take, we clearly perceive the triumph of animal power. the olfactory nerve in the horse, the dog, the ox, and the swine, is the largest of all the cerebral nerves, and has much greater comparative bulk in the quadruped than in the human being. the sense of smell, bearing proportion to the nerve on which it depends, is yet more acute. in man it is connected with pleasure--in the inferior animals with life. the relative size of the nerve bears an invariable proportion to the necessity of an acute sense of smell in the various animals--large in the horse compared with the olfactory nerve in the human being--larger in the ox, who is often sent into the fields to shift for himself--larger still in the swine, whose food is buried under the soil, or deeply immersed in the filth or refuse,--and still larger in the dog, the acuteness of whose scent is so connected with our pleasure. [the disposition to hunt by scent is not peculiar to the setter or pointer, but in fact is common to all animals; developing itself in different proportions according to their various physical constructions and modes of life. the method of finding and pointing at game, now peculiar to these dogs, and engendered in their progeny through successive generations, is not the result of any special instinct, that usually governs the actions of the brute creation--but rather the effect of individual education and force of habit upon their several ancestors. this habit of life, engrafted through progressive generations into these breeds, has become a second nature, and so entirely the property of the species, that all its members, with but little care on the part of man, will perform these same actions in the same way, and will ever continue to exhibit these propensities for hunting, provided opportunities be offered for indulging them. nevertheless, as these peculiar predilections for "'setting or pointing'," as before said, are the effect of education and habit, the artificial impulse would very soon be entirely obliterated, if not encouraged in the young dogs of each generation. this circumstance alone, proves to us the importance of getting dogs from a well-known good strain, whose ancestors have been remarkable for their exploits in the field. this necessary precaution will insure a favourable issue to our troubles, and lessen materially our labours. in fact young puppies have been frequently known to exhibit this propensity the first time they have been taken to the field. some of these dogs have come under the notice of the writer, who at a few months old exhibited all the peculiarities of their race; in fact were "self-broke." these dogs were the progeny of a well-known imported stock, in the possession of a gentleman who selected them in england. although other dogs, and other animals even, have been with great difficulty and perseverance taught to find and point game, still these two breeds seem especially adapted by nature, both in their physical and intellectual construction, for the performance of this particular duty to man. the sense of smell is differently developed in different animals; the olfactory nerve of the dog is larger than any other in the cerebrum, which peculiarity will at once account for their wonderful powers of scent. 'swine', also, have these nerves largely developed; and necessarily so, as both in a state of nature or half-civilization, the greater portion of their food is buried under the earth or mingled with the filth and mire of their sties, and would pass unheeded, if not for the acuteness of their nasal organs. in daniels' "rural sports," will be found an interesting account of a sow having been taught to find and point game of various kinds, and often having been known to stand on partridges at a distance of forty yards, which is more than can reasonably be expected of every first-rate dog. she was not only broke to find and stand game, but hunted with the dogs, and backed successfully when on a point. this extraordinary animal evinced great aptness for learning, and afterwards great enthusiasm in the sport; showing symptoms of pleasure at the sight of a gun, or when called upon to accompany a party to the field. her hunting was not confined to any particular game, but stood equally well on partridges, pheasants, snipes, rabbits, &c. (see blaine, part vii, chap, iii, page .) most of animals instinctively employ the organ of scent to seek out food, or avert personal danger, in preference to that of sight; but some depend more upon the latter than the former, either from instinct or the force of education. for instance, the greyhound, though equally gifted with the sense of smell, as that of sight, has been taught to depend upon the one organ to the entire exclusion of the other, which is quite the reverse of the setter and pointer; but the wonderful speed of these dogs renders it quite unnecessary that he should employ the olfactory nerves, as no animal, however swift, can hope to escape from him in a fair race, when once near enough to be seen; though there are some that may elude his grasp by a "'ruse de guerre'" when too hardly pressed. ('extracted from our essay in no. , vol. xvi, of the "spirit of the times.'")--l.] intelligence we find little mention of insanity in the domesticated animals in any of our modern authors, whether treating on agriculture, horsemanship, or veterinary medicine, and yet there are some singular and very interesting cases of aberration of intellect. the inferior animals are, to a certain extent, endowed with the same faculties as ourselves. they are even susceptible of the same moral qualities. hatred, love, fear, hope, joy, distress, courage, timidity, jealousy, and many varied passions influence and agitate them, as they do the human being. the dog is an illustration of this---the most susceptible to every impression--approaching the nearest to man in his instincts, and in many actions that surprise the philosopher, who justly appreciates it. what eagerness to bite is often displayed by the dog when labouring under enteritis, and especially by him who has imbibed the poison of rabies! how singular is the less dangerous malady which induces the horse and the dog to press unconsciously forward under the influence of vertigo!--the eagerness with which, when labouring under phrenitis, he strikes at everything with his foot, or rushes upon it to seize it with his teeth! a kind of nostalgia is often recognised in that depression which nothing can dissipate, and the invincible aversion to food, by means of which many animals perish, who are prevented from returning to the place where they once lived, and the localities to which they had been accustomed. these are circumstances proving that the dog is endowed with intelligence and with affections like ours; and, if they do not equal ours, they are of the same character. with regard to the foundation of intellectual power, viz.: attention, memory, association, and imagination, the difference between man and animals is in degree, and not in kind. thus stands the account,--with the quadruped as well as the biped,--the impression is made on the mind; attention fixes it there; memory recurs to it; imagination combines it, rightly or erroneously, with many other impressions; judgment determines the value of it, and the conclusions that are to be drawn from it, if not with logical precision, yet with sufficient accuracy for every practical purpose. a bitch, naturally ill-tempered, and that would not suffer a stranger to touch her, had scirrhous enlargement on one of her teats. as she lay in the lap of her mistress, an attempt was repeatedly made to examine the tumour, in spite of many desperate attempts on her part to bite. all at once, however, something seemed to strike her mind. she whined, wagged her tail, and sprung from the lap of her mistress to the ground. it was to crouch at the feet of the surgeon, and to lay herself down and expose the tumour to his inspection. she submitted to a somewhat painful examination of it, and to a far more serious operation afterwards. some years passed away, and whenever she saw the operator, she testified her joy and her gratitude in the most expressive and endearing manner. a short time since, the following scene took place in a street adjoining hanover-square. it was an exhibition of a highly interesting character, and worthy to be placed upon record. the editor of the lancet having heard that a french gentleman (m. léonard), who had for some time been engaged in instructing two dogs in various performances that required the exercise, not merely of the natural instincts of the animal and the power of imitation, but of a higher intellect, and a degree of reflection and judgment far greater than is commonly developed in the dog; was residing in london, obtained an introduction, and was obligingly favoured by m. leonard with permission to hold a 'conversazione' with his extraordinary pupils. he thus describes the interview: two fine dogs, of the spanish breed, were introduced by m. leonard, with the customary french politesse, the largest by the name of m. philax, the other as m. brac (or spot); the former had been in training three, the latter two, years. they were in vigorous health, and, having bowed very gracefully, seated themselves on the hearth-rug side by side. m. léonard then gave a lively description of the means he had employed to develop the cerebral system in these animals--how, from having been fond of the chase, and ambitious of possessing the best-trained dogs, he had employed the usual course of training--how the conviction had been impressed on his mind, that by gentle usage, and steady perseverance in inducing the animal to repeat again and again what was required, not only would the dog be capable of performing that specific act, but that part of the brain which was brought into activity by the mental effort would become more largely developed, and hence a permanent increase of mental power be obtained. this reasoning is in accordance with the known laws of the physiology of the nervous system, and is fraught with the most important results. we may refer the reader interested in the subject to the masterly little work of dr. verity, "changes produced in the nervous system by civilization." after this introduction, m. léonard spoke to his dogs in french, in his usual tone, and ordered one of them to walk, the other to lie down, to run, to gallop, halt, crouch, &c., which they performed as promptly and correctly as the most docile children. then he directed them to go through the usual exercises of the 'manége', which they performed as well as the best-trained ponies at astley's. he next placed six cards of different colours on the floor, and, sitting with his back to the dogs, directed one to pick up the blue card, and the other the white, &c., varying his orders rapidly, and speaking in such a manner that it was impossible the dogs could have executed his commands if they had not had a perfect knowledge of the words. for instance, m. léonard said, "philax, take the red card and give it to brac; and, brac, take the white card and give it to philax;" the dags instantly did this, and exchanged cards with each other. he then said, "philax, put your card on the green, and brac, put yours on the blue;" and this was instantly performed. pieces of bread and meat were placed on the floor, with figured cards, and a variety of directions were given to the dogs, so as to put their intelligence and obedience to a severe test. they brought the meat, bread, or cards, as commanded, but did not attempt to eat or to touch unless ordered. philax was then ordered to bring a piece of meat and give it to brac, and then brac was told to give it back to philax, who was to return it to its place. philax was next told he might bring a piece of bread and eat it; but, before he had time to swallow it, his master forbade him, and directed him to show that he had not disobeyed, and the dog instantly protruded the crust between his lips. while many of these feats were being performed, m. léonard snapped a whip violently, to prove that the animals were so completely under discipline, that they would not heed any interruption. after many other performances, m. léonard invited a gentleman to play a game of dominos with one of them. the younger and slighter dog then seated himself on a chair at the table, and the writer and m. léonard seated themselves opposite. six dominos were placed on their edges in the usual manner before the dog, and a like number before the writer. the dog having a double number, took one up in his mouth, and put it in the middle of the table; the writer placed a corresponding piece on one side; the dog immediately played another correctly, and so on until all the pieces were engaged. other six dominos were then given to each, and the writer intentionally placed a wrong number. the dog looked surprised, stared very earnestly at the writer, growled, and finally barked angrily. finding that no notice was taken of his remonstrances, he pushed away the wrong domino with his nose, and took up a suitable one from his own pieces, and placed it in its stead. the writer then played correctly; the dog followed, and won the game. not the slightest intimation could have been given by m. léonard to the dog. this mode of play must have been entirely the result of his own observation and judgment. it should be added that the performances were strictly private. the owner of the dogs was a gentleman of independent fortune, and the instruction of his dogs had been taken up merely as a curious and amusing investigation. [ ] another strange attainment of the dog is the learning to speak. the french academicians mention one of these animals that could call in an intelligible manner for tea, coffee, chocolate, &c. the account is given by the celebrated leibnitz, who communicated it to the royal academy of france. this dog was of a middling size, and was the property of a peasant in saxony. a little boy, a peasant's son, imagined that he perceived in the dog's voice an indistinct resemblance to certain words, and therefore took it into his head to teach him to speak. for this purpose he spared neither time nor pains with his pupil, who was about three years old when his learned education commenced, and in process of time he was able to articulate no fewer than thirty distinct words. he was, however, somewhat of a truant, and did not very willingly exert his talent, and was rather pressed than otherwise into the service of literature. it was necessary that the words should be pronounced to him each time, and then he repeated them after his preceptor. leibnitz attests that he heard the animal talk in this way, and the french academicians add, that unless they had received the testimony of so celebrated a person they would scarcely have dared to report the circumstance. it took place in misnia, in saxony. the moral qualities of the dog. we pass on to another division of our subject, 'the moral qualities of the dog', strongly developed and beautifully displayed, and often putting the biped to shame. it is truly said of the dog that he possesses "many a good and useful quality, and virtue too, attachment never to be weaned or changed by any change of fortune; proof alike against unkindness, absence, and neglect; fidelity, that neither bribe nor threat can move or warp; and gratitude, for small and trivial favours, lasting as the life, and glistening even in the dying eye." it may here be noticed that, among the inferior animals with large nerves and more medullary substance, there are acuter senses; but man, excelling them in the general bulk of his brain, and more particularly in the cortical portion of it, has far superior powers of mind. these are circumstances that deserve the deepest consideration. in their wild state the brutes have no concern--no idea beyond their food and their reproduction. in their domesticated state, they are doomed to be the servants of man. their power of mind is sufficient to qualify them for this service: but were proportionate intellectual capacity added to this--were they made conscious of their strength, and of the objects that could be effected by it--they would burst their bonds, and man would in his turn be the victim and the slave. there is an important faculty, termed 'attention'. it is that which distinguishes the promising pupil from him of whom no good hope could be formed, and the scientific man from the superficial and ignorant one. the power of keeping the mind steadily bent upon one purpose, is the great secret of individual and moral improvement. we see the habit of attention carried in the dog to a very considerable extent. the terrier eagerly watching for vermin--the sporting dog standing staunch to his point, however he may be annoyed by the blunders of his companion or the unskilfulness of his master--the foxhound, insensible to a thousand scents, and deaf to every other sound, while he anxiously and perseveringly searches out the track of his prey--these are striking illustrations of the power of attention. then, the impression having been received, and the mind having been employed in its examination, it is treasured up in the storehouse of the mind for future use. this is the faculty of memory; and a most important one it is. of the 'memory' of the 'dog', and the recollection of kindness received, there are a thousand stories, from the return of ulysses to the present day, and we have seen enough of that faithful animal to believe most of them. an officer was abroad with his regiment, during the american war. he had a fine newfoundland dog, his constant companion, whom he left with his family. after the lapse of several years he returned. his dog met him at the door, leaped upon his neck, licked his face, and died. of the accuracy and retentiveness of memory in the dog, as respects the instruction he has received from his master, we have abundant proof in the pointer and the hound, and it may perhaps be with some of them, as with men, that the lesson must sometimes be repeated, and even impressed on the memory in a way not altogether pleasant. [we know an imported irish setter, formerly in possession of a gentleman of this city, who on many occasions, while hunting, displayed an extraordinary instinct, even sufficiently remarkable to make us believe that he possessed not only the most acute powers of observation, but that he also enjoyed the faculty of "inductive reasoning," independent of any mechanical training, many of his performances being entirely voluntary, and the result of causes dependent upon accidental circumstances alone: for instance, when lost from observation, he would noiselessly withdraw from his point, hunt up his master, and induce him, by peculiar signs, to follow him to the spot where he had previously observed the birds. in his old days, "smoke" was much opposed to hunting with an indifferent shot, and would leave the field perfectly disgusted, after a succession of bad shooting; seeming to argue that he no longer sought after game for amusement, but that he expected his efforts to be repaid by the death of the birds. this dog was of a morose and dignified disposition, surly with strangers, and inclined to quarrel with any one who carried a stick or whip in their hands; never forgetting an injury, and growling whenever any person who had offended him made their appearance. he was also particularly irritable and tenacious of his rights when hunting, shunning all puppies or heedless dogs, and exhibiting a very irascible disposition if superseded in a point by another dog; and on one occasion attacked a young pointer in the field, who, in opposition to all his growling and show of irony, would persist in crawling before him, when on a point.--l] dog-carts. these were, and still are, in the country, connected with many an act of atrocious cruelty. we do not object to the dog as a beast of draught. he is so in the northern regions, and he is as happy as any other animal in those cold and inhospitable countries. he is so in holland, and he is as comfortable there as any other beast that wears the collar. he is not so in newfoundland: there he is shamefully treated. it is to the abuse of the thing, the poor and half-starved condition of the animal, the scandalous weight that he is made to draw, and the infamous usage to which he is exposed, that we object. we would put him precisely on the same footing with the horse, and then we should be able, perhaps, to afford him, not all the protection we could wish, but nearly as much as we have obtained for the horse. we would have every cart licensed, not for the sake of adding to the revenue, but of getting at the owner; and therefore the taxing need not be any great sum. we would have the cart licensed for the carrying of goods only; or a separate license taken out if it carried or drew a human being. it is here that the cruelty principally exists. before the dog-carts were put down in the metropolis, we then saw a man and a woman in one of these carts, drawn by a single dog, and going at full trot. every passenger execrated them, and the trot was increased to a gallop, in order more speedily to escape the just reproaches that proceeded from every mouth. we would have the name and address of the owner, and the number of the cart, painted on some conspicuous part of the vehicle, and in letters and figures as large as on the common carts. every passenger who witnessed any flagrant act of cruelty would then be enabled to take the number of the cart, and summon the owner; and the police should have the same power of interference which they have with regard to other vehicles. after a plan like this had been working a little while, the nuisance would be materially abated; and, indeed, the consciousness of the ease with which the offender might be summoned, would go far to get rid of it. cropping. this is an infliction of too much torture for the gratification of a nonsensical fancy; and, after all, in the opinion of many, and of those, too, who are fondest of dogs, the animal looks far better in his natural state than when we have exercised all our cruel art upon him. besides, the effects of this absurd amputation do not cease with the healing of the ear. the intense inflammation that we have set up, materially injures the internal structure of this organ. deafness is occasionally produced by it in some dogs, and constantly in others. the frequent deafness of the pug is solely attributable to the outrageous as well as absurd rounding of his ears. the almost invariable deafness of the white wire-haired terrier is to be traced to this cause. [among the many tastes and fancies that the americans have inherited from their ancestors, the english, may be enumerated the absurd practice of fashioning the ears of different breeds of dogs to a certain standard of beauty. mr. blain very justly remarks that it must be a false taste which has taught us to prefer a curtailed organ to a perfect one, without gaining any convenience by the operation. the dogs upon which this species of barbecuing are more particularly practised in this country, are the bull-dogs and terriers. we imagine that many of our readers will be surprised when they learn that this operation, although so simple in itself, and performed by every reckless stable-boy, is attended with great suffering to the puppy, and not unfrequently with total deafness. severe inflammation, extending to the interior of the ear, often follows this operation, more especially when awkwardly performed, as is frequently the case, by the aid of the miserable instruments within the reach of our hostlers; to say nothing of the savage fashion of using the teeth for this purpose, as is often done by ignorant fellows, who even take credit to themselves for the clever style in which they perform this outlandish operation. mr. blain states, that it is a barbarous custom to twist the ears off, by swinging the dog around; and we are satisfied that every sensible person will respond to this humane sentiment. we have never had the misfortune to see this latter method put into practice, and trust that such an operation is unknown among us, although, from the manner in which this gentleman condemns it, we are led to suppose that this mode is not uncommon in the old country. as custom has sanctioned the cropping of dogs, in spite of all that can be said upon the subject, it should be done in such a manner as to cause the least possible pain to the animal. the fourth or fifth week is the proper age for this operation; if done sooner, the flap is apt to sprout and become deformed: if later, the cartilage has grown more thick and sensitive. the imaginary beauty of a terrier crop consists in the foxy appearance of the ears, which is easily produced by the clean cut of a sharp, strong pair of scissors. the first cut should commence at the posterior base of the ear, near to the head, and be carried to the extremity of the flap, taking off about the eighth of an inch or more in width. the second cut should extend from the base of the ear in front, somewhat obliquely, to intersect the other cut within a few lines of the point of the flap. these two cuts will shape the ear in such a style as to please the most fastidious eye, and will require no further trimming. the pieces taken from the first ear will answer as guides in cutting the other. the mother should not be allowed to lick the ears of the puppies, as is generally done, under the supposition that she assists in the healing process, when, in fact, she irritates them, and occasions increased inflammation. if the wounds are tardy at healing, or become mangy, they may be bathed gently with a weak solution of alum. we regret to find that mr. skinner, so well known to the sporting world as the able extoller and defender of the rights of our canine friends, should recommend the cropping of terriers. we are convinced that he would change his feelings upon this subject, if he placed any confidence in the opinions of blain, youatt, scott, or daniel, all of whom condemn the practice as barbarous, and as often occasioning great suffering, and even total deafness, throughout the progeny of successive generations, as witnessed in the white wire-haired terrier and pug above mentioned. wo have had the good fortune to persuade some of our friends to desist from thus mutilating their terrier pups, all of whom, consequently, grew up with beautiful full ears and long tails, which were much admired; and to the eyes of many, the dogs seemed more sprightly and knowing with their long flaps, than when deprived of those natural appendages.--l.] tailing. then 'the tail' of the dog does not suit the fancy of the owner. it must be shortened in some of these animals, and taken off altogether in others. if the sharp, strong scissors, with a ligature, were used, the operation, although still indefensible, would not be a very cruel one, for the tail may be removed almost in a moment, and the wound soon heals; but for the beastly gnawing off of the part, and the drawing out of the tendons and nerves--these are the acts of a cannibal; and he who orders or perpetrates a barbarity so nearly approaching to cannibalism, deserves to be scouted from all society. [as a matter of necessity, we cannot sanction the too frequent and cruel practice of cutting or otherwise barbecuing different portions of the bodies of our domestic animals, and more particularly the often absurd fancy or cropping and sterning dogs. nevertheless, we must admit the propriety of, and, in fact, recommend, the taking off a small portion of the pointer's tail, not to increase his beauty, but to save him some after suffering. a long tail is frequently lacerated in close thickets, and thus rendered sore and mangy: this is prevented by the operation, as it becomes better protected by the body, as also more thickly covered by the feather which generally forms over it. when the pups are a month or six weeks old, this operation can be performed with little pain to the animal, by means of sharp scissors or a knife; but never allow any one to bite the tail off, as is often done by some dirty and unfeeling stable-men. although a long tail is inconvenient, a too short one is more unsightly; care should therefore be taken not to remove too much. the quantity should be regulated by the size of the breed: for a medium breed, an inch is sufficient to be cut off at this age. some sportsmen in england, mr. blain also informs us, draw out the lower tendons of the tail, which present themselves after amputation, with a pair of forceps, with a view of causing the tail to be carried higher, which adds to the style and appearance of the dog, when in the field. this practice, we agree with mr. youatt, is cannibal-like, and very painful; and, to say the least of it, of very doubtful propriety, as it is but seldom we find a good breed of dog carrying, while hunting, a slovenly tail. if there should be any appearance of hemorrhage after this operation, a small piece of tape or twine may be tied around the tail, which will immediately arrest the bleeding. this ligature should not remain on longer than a few hours, as the parts included in it will be apt to slough and make a mangy ulcer, difficult to heal.--l.] dew-claws next comes the depriving the dog of his 'dew-claws'--the supplementary toes a little above the foot. they are supposed to interfere with hunting by becoming entangled with the grass or underwood. this rarely happens. the truth of the matter is, they are simply illustrations of the uniformity of structure which prevails in all animals, so far as is consistent with their destiny. the 'dew-claws' only make up the number of toes in other animals. if they are attached, as they are in some dogs, simply by a portion of skin, they may be removed without any very great pain, yet the man of good feeling would not meddle with them. he would not unnecessarily inflict any pain that he can avoid; and here, in several of the breeds, the toe is united by an actual joint; and if they are dissected because they are a little in the way, it is a barbarous operation, and nothing can justify it. [notwithstanding our author's condemnation of this practice, there are many sportsmen who think it very necessary to remove this supernumerary toe, fearing that it may interfere with the dog while hunting, as above stated. mr. blain, both a practical sportsman and scientific gentleman, to whose opinions we must at all times show a due regard, considers the removal of these false appendages very necessary, stating that they often become troublesome, not only in the field, but that they frequently turn in and wound the flesh with their nails. we have never seen any particular inconvenience arising from the presence of these dew-claws, and are not in the habit of taking them off; but, as the operation is a trifling one, and attended with little or no pain, we are disposed to recommend its general adoption, as it improves the appearance of the legs; and their presence may sometimes prove inconvenient to the animal, as stated by mr. blain. these claws most commonly have a ligamentous attachment only to the leg, which may be divided, a few days after birth, by a pair of sharp scissors or a knife; and if a bony union exists, it is generally of such a trifling nature that it can be severed in the same way.--l.] the cruelties that are perpetrated on puppies during the course of their education or 'breaking-in', are sometimes infamous. young dogs, like young people, must be to a certain degree coerced; but these animals receive from nature so great an aptitude for learning, and practising that which we require of them, and their own pleasure is so much connected with what they learn, that there is no occasion for one-tenth part of the correction that is occasionally inflicted; and the frequent consequence of the cruelty to which they are subjected, is cowardice or ferocity during life. not many years ago, as the author was going over one of the commons in the neighbourhood of the metropolis, now enclosed, he heard the loud sounds of the lash and the screams of a dog. he hurried on, and found two men, one holding a greyhound while another was unmercifully flogging him. he had inflicted many lashes, and was continuing the correction. the author indignantly interfered, and the dog was liberated, but with a great deal of abuse from the men; and a gentleman galloping up, and who was the owner of the dog, and a middlesex magistrate to boot, seemed disposed to support his people in no very measured terms on being addressed, however, by name, and recognising the speaker, and his attention being directed to the 'whaled' and even bloody state of the dog, he offered the best excuse that he could. we met again some months afterwards. "that hiding," said he, "that offended you so much did carlo good, for he has not been touched since." "no," was the reply; "you were a little ashamed of your fellows, and have altered your system, and find that your dogs do not want this unmerciful negro-whipping." stories are told of the 'kennel-hare'--a hare kept on purpose, and which is sometimes shown to the fox or stag-hounds. the moment that any of them open, they are tied up to the whipping-post, and flogged, while the keepers at every stroke call out "ware hare!" a sheep has also been shown to them, or still is, after which another unmerciful flogging is administered, amidst cries of "ware sheep!" if this is not sufficient, some of the wool is dipped in train oil, and put into the dog's mouth, which is sewed up for many hours in order to cure him of sheep-biting. there was an almost similar punishment for killing poultry; and there was the 'puzzle' and the 'check-collar', cruelly employed, for killing other dogs. there is a great deal of truth, and there may occasionally be some exaggeration, in these accounts; but the sportsman who is indebted for the pleasures of the field to the intelligence and exertions of his horses and his dogs, is bound, by every principle that can influence an honourable mind, to defend them from all wanton and useless cruelty. there is a dog, and a faithful and valuable one, that powerfully demands the assistance of the humane--the yard or watch-dog. he is not only for the most part deprived of his liberty, but too often neglected and made unnecessarily to suffer. how seldom do we see him in the enjoyment of a good bed of straw, or, rather, how frequently is everything about his kennel in a most filthy and disgusting state! the following hint not only relates to him, but to every dog that is tied up out of doors. "their cribs or their kennels, as they are called, should be constructed so as to turn, in order to prevent their inmates from being exposed to the cutting blasts of winter. where they have no other refuge, all animals seek shelter from the weather by turning their backs to the wind; but, as the dog thus confined cannot do so, his kennel should be capable of turning, or at least should be placed so as not to face the weather more than is necessary. the premises would be in quite as great security, for the dog depends as much upon his ear and sense of smell as upon his eye, and would equally detect a stranger's presence if he were deprived of sight." in the zoological gardens, an old blind dog used to be placed at the door of the dissecting-house. few had any business there, and every one of them he, after a while, used to recognise and welcome full ton yards off, by wagging his tail; at the same distance, he would begin to growl at a stranger unless accompanied by a friend. from the author's long habit of noticing him, he used to recognise his step before it would seem possible for its sound to be heard. he followed him with his sightless eyes in whatever direction he moved, and was not satisfied until he had patted and fondled him. dog-pits. of the demoniacal use of the dog in the 'fighting-pits', and the atrocities that were committed there, i will not now speak. these places were frequented by few others than the lowest of the low. cruelties were there inflicted that seemed to be a libel on human nature; and such was the baneful influence of the scene, that it appeared to be scarcely possible for any one to enter these pits without experiencing a greater or less degree of moral degradation. the public dog-pits have now been put down; but the system of dog-fighting, with most of its attendant atrocities, still continues. there are many more low public-houses than there used to be pits, that have roomy places behind, and out of sight, where there are regular meetings for this purpose. those among the neighbours who cannot fail of being annoyed and disgusted by the frequent uproar, might give a clue to these dens of infamy; and the depriving of a few of the landlords of their license would go a great way towards the effectual suppression of the practice. would it be thought possible that certain of our young aristocracy keep fighting-dogs at the repositories of various dealers in the outskirts of the metropolis; and that these animals remain there, as it were, at livery, the owners coming at their pleasure, and making and devising what matches they think proper? however disgraceful it may be, it is actually the fact. here is a field for "the suppression of cruelty!" dog-stealing. the practice of stealing dogs is both directly and indirectly connected with a great deal of cruelty. there are more than twenty miscreants who are well known to subsist by picking up dogs in the street. there are generally two of them together with aprons rolled round their waists. the dog is caught up at the corner of one of the streets, concealed in a moment in the apron, and the thieves are far away before the owner suspects the loss. these dogs, that have been used to every kind of luxury, are crowded into dark and filthy cellars, where they become infected by various diseases. the young ones have distemper, and the old ones mange, and all become filled with vermin. there they remain until a sufficient reward is offered for their recovery, or they are sent far into the country, or shipped for france or some other foreign market. little or nothing is done by punishing the inferior rogues in this traffic. the blow must be struck at those of a superior class. i will not assert that every dog-dealer is in league with, and profits by, the lower thieves; but it is true of a great many of them, and it is the principal and most lucrative part of their trade. they are likewise intimately connected with the dog-fights, and encourage them, for the sake of their trade as dealers. an attempt should be made to bring the matter home to these scoundrels. [ ] [dog-stealing, we are more particularly informed by col. hawker, is reduced to a perfect system in london, and carried on by a set of fellows who, by their cunning and peculiar knack, are enabled to avoid all detection in their nefarious traffic, and thus, by extortion of rewards or sales of stolen dogs, reap a rich harvest for the whole fraternity from the well-stored pockets of the numerous dog-fanciers of the english capital. the villains engaged in this business are known among themselves under the too often abused sobriquet of "the fancy," and assuming the garb of different mechanics, prowl about the streets, oftentimes with the proper tools in their hands, carelessly watching the movements of every dog that passes by, ready to grab him up the first fitting opportunity. the dog is then concealed till a suitable reward is offered for him, when, through the intervention of a third person, a trusty agent of the society, he is delivered over to his rightful owner, the actual rogue never appearing in the whole transaction. if no reward, or an insufficient one, is offered for the recovery of the dog, he is either sent off to the country, or, perhaps, cautiously exposed for sale in some distant quarter of the city, or perhaps killed for his skin alone. these gentry, however, prefer returning dogs to their owners for a moderate compensation, as they thus know at what rate the animal is valued, and cherish the hope of soon being able to steal him again, and thus obtaining another reward. there have been instances of a lady paying, in successive rewards, a sum not less than fifteen guineas for a miserable little lap-dog not worth as many shillings. if anything is said about the law, or threats of prosecution held out in the notice offering a reward for a "lost or stolen dog," the death of the kidnapped animal is inevitable, as the "fancy" prefer sacrificing an occasional prize rather than run the risk of detection by some enthusiastic or stubborn dog owner. these fellows, as well as thieves generally, are said to have a method of quieting the fiercest watch-dogs by throwing them a narcotic ball, which they call "puddening the animal." the following account, extracted from hawker's work, will give the american reader a 'perfect' insight into the maneuvering of these sharpers. "in the month of may, , mr. lang lost a favourite setter. he posted handbills offering two guineas reward; on hearing of which a man came and told him the reward was not enough, but that if he would make it four guineas he could find his dog, and the amount must be deposited in the hands of a landlord who would procure him a ticket-card. he should then be met to his appointment in some private field, where he would receive his dog on condition that no questions should be asked. mr. lang sent his shopman, about half-past ten at night, to white conduit fields to meet the parties, who, on receiving the ticket, delivered up the dog. but there was great hesitation in transacting this affair, in consequence of the dog having on a lock to a steel chain collar with mr. lang's name, and which, therefore, induced them to proceed with extreme caution, through fear, as they supposed, of detection for felony. the whole amount paid for recovering this setter was £ s., £ s. of which went to the men who had him. the rest was divided among others of the "fancy". the same person who gave mr. lang the information, said that if ever he lost a dog, and applied to him, he could undertake to get him back again within thirty-six hours, provided he would make it worth his while to do so; because all dogs taken by the "fancy" are brought to their office and regularly booked by the secretary." ('hawker on shooting', p. .)--l.] [footnote : plutarch relates that, at the theatre of marcellus, a dog was exhibited before the emperor vespasian, so well instructed as to exercise in every kind of dance. he afterwards feigned illness in a most singular manner, so as to strike the spectators with astonishment. he first exhibited various symptoms of pain; he then fell down as if dead, and, afterwards seeming to revive, as if waking from a profound sleep, and then sported about and showed various demonstrations of joy.] [footnote : mr. bishop, of bond-street, has assured the public, that he is able to prove that money has recently been extorted from the owners of dogs by dog-stealers and their confederates, to the amount of more than a thousand pounds. surely this calls for the decided interposition of the legislature. a strange case of atrocity and cruelty was related by a gentleman to mr. bishop. "a young dog of mine," says he, "was lost in london, and, being aware that if a noise was made about it, a great price would be asked for it, i gave out that i wanted to purchase one: i was shown my own dog. i seized it; but there were several scoundrels present who professed to belong to it, and threatened to kill the dog if i did not pay for it. i proceeded to describe it as my own, stating that it had 'bad back or double teeth'. judge of my surprise when, after great difficulty, and the dog crying greatly, its mouth was opened, and all the back teeth had been taken out! i paid two pounds for it before they would let me take it away; but, in consequence of the injuries it had received, it died a few days afterward."] * * * * * introduction to canine pathology. by the editor. predisposition to, and causes of, diseases in dogs.--the claims of dogs upon us. "unnumbered accidents and various ills attend thy pack, hang hovering o'er their heads, and point the way that leads to death's dark cave. short is their span, few at the date arrive of ancient argus, in old homer's song so highly honour'd." the dog from early youth, in fact oftentimes at the very period of birth, is exposed to many dangerous and troublesome affections, the result of causes not less complex and multifarious than those that exert an influence over the human organization. many diseases are the consequence of their domesticity and the hereditary defects of their progenitors, others are dependent upon accidental circumstances, bad treatment, and improper nourishment. not a few, however, of their most mortal maladies are the production of contagion, infection, and other like causes, all exercising a general tendency to disease difficult to define and impossible to avoid. although every species of dog is more or less subject to certain diseases peculiar to their race, those breeds of most value and more particularly subservient to the will of man are liable to a greater number of ills and casualties than other dogs, for the reason that they are more frequently exposed to unnatural fatigue, extremes of heat and cold, as also to the various dangers dependent upon the chase of wild animals. those diseases resulting from specific causes, either natural to the race or artificially produced by the animal itself in a state of morbid derangement, are most frequent and fatal, as witnessed in distemper, rabies, mange, &c. the intimate connexion existing between the diseases of our canine friends and those of the human race, as also the strong similarity in the action of many drugs over the two systems, render the study of one branch almost synonymous with that of the other. a little attention, therefore, on the part of the physician will render him quite familiar with and competent to relieve the many sufferings of these our most faithful and grateful of companions, and at the same time create an interest in a study that cannot fail to be productive of pleasure as well as information. this subject, though claiming the attention of many skilful and intelligent persons in england and other countries, has scarce been thought of among us, and the mere mention of an infirmary or hospital for the accommodation of invalid dogs, would involuntarily create a smile of incredulity or contempt upon the face of most of our countrymen. notwithstanding this display of ignorance and positive want of humane feeling for animal suffering, or a just appreciation of canine worth, we must beg leave to inform these unbelievers that such institutions are quite numerous in many large cities of the old world; and they must also learn that these institutions are conducted by gentlemen of science upon a system not less regular and useful in this particular branch, than similar establishments appropriated for the relief of suffering humanity. to these hospitals hundreds of valuable sick dogs are annually sent, where they receive every attention, and are often snatched from the very jaws of death, or prevented, when attacked by rabies or other frightful affections, from doing mischief or propagating infection. medicines the most potent are administered to these interesting patients with the utmost care, either as assuagers of temporary pain, or as remedial agents in the cure of disease. operations the most complex are performed with the greatest skill, and every attention is bestowed upon these invalids in their different wards, and no trouble is considered too great to save the life and secure the services of a valuable and faithful dog. as we have no such establishments in this country, and but a few persons upon whom we can rely for assistance in case of need, it behooves every lover of the dog to make himself familiar with, and the mode of treating the most prominent affections of these companions of our sports, and at the same time acquire a knowledge of the operations of certain medicines upon the system in a state of health or disease, so that our trusty followers may not be left to the tender mercies and physicking propensities of ignorant stablemen, or the officious intermeddling of the "pill-directing horse doctor." the necessity of resorting to the assistance of either one or the other of these worthies is equally unfortunate, as the former will most generally kill the patient by slow degrees in forcibly and largely administering the two modern specifics for all canine affections, viz.: "soap pills and flowers of sulphur." while the latter, more bold but not less ignorant than the former, and his practice is perhaps the preferable of the two evils, will murder the dog out-right by the free exhibition of calomel, nux vomica and other deleterious substances, of the operation of which he has but little knowledge or conception. this latter system, as before said, is the most preferable, as its adoption secures for our favourite a speedy termination of his sufferings, and also relieves our own minds from a state of suspense that illustrates too forcibly the remark, "hope deferred maketh the heart sick." remedial means for the cure of diseases. there are but few remedies useful for the cure of diseases in the human race that might not he employed by a skilful practitioner in overcoming the same or different ailments in the dog. there are, however, several drugs that cannot be used in the same proportions for the one as for the other, without danger of producing fatal consequences, as instanced in calomel, a medicine so often abused by those who pretend to a knowledge of its administration in the maladies of dogs. this article, though given with impunity to mankind in doses varying from five grains to twenty grains, as also oftentimes administered to horses in quantities three or four times as great, without any appreciable effect, will not unfrequently, in minute doses of three grains to four grains, produce the most violent symptoms in the strongest dogs. we have seen severe vomiting and purging occasioned by these small doses, and we once salivated a large mastiff by the administration of two blue pills. it is thus that both the regular physician, and even the veterinary surgeon, unacquainted with this remarkable peculiarity, will make fatal mistakes; and how much oftener must such blunders take place when we intrust our canine friends to the care of stable-boys, or a "routine horse-doctor!" nux vomica, another medicine much used, and most important in the treatment of all nervous affections, is particularly noxious to dogs even in small quantities; a dose sufficient for a human subject under some circumstances, would almost inevitably destroy the animal under the same or analogous conditions. a drachm of the powdered nux vomica is sufficient to destroy the largest and most powerful dog, while a few grains will sometimes produce death in a few minutes if administered to smaller animals. we prescribed forty grains in a roll of butter for a worthless cur a short time since, which, as expected, produced great anxiety, difficulty of respiration, severe vomiting, tremors, spasmodic twitchings of the muscles, convulsions, and ultimate death in the course of half an hour. this powerful drug acts by causing a spasmodic stricture of the muscles engaged in respiration, as no signs of inflammation are observable in the stomach and other organs after death. spirits of turpentine, another remedy both simple and innocent in its operations upon the human economy, and so frequently prescribed for the expulsion of worms from the bowels, is a dangerous medicine for a dog, and will often in very small quantities prove fatal. aloes, a medicine more extensively used in canine pathology than any other in the materia medica, is also very peculiar in its operations upon these animals, they being able to bear immense doses of it, in fact quite sufficient to produce death if given to a hearty man. thus we might continue to enumerate other drugs which we have ascertained, from practical observation as well as the experiments of other, to exercise a peculiar action on the vital functions of the whole canine race, quite at variance with that common to both man and the other domestic animals. in combating with the diseases of animals, the veterinary surgeon has more to contend with than the regular physician, and, in fact, should possess a knowledge and habit of observation even superior to the former; although the responsibility of his calling, in a moral sense, is much inferior to that of the other, as the importance of animal existence, under no circumstances, can be placed in comparison with that of human life: still acuteness of observation alone can direct him to the main cause of suffering in the brute creation, as the animal, though groaning under the most severe pains, cannot by any word of explanation point out to us the seat, the probable cause, or peculiar characteristics of such pain. we see that our dog is ill, he refuses his food, retires gloomily to his house, looks sullen, breathes heavy, is no longer delighted at our call. we cannot question him as to his feelings, or ask him to point out the particular region of his sufferings; we watch his motions, study his actions, and rely for our diagnosis upon general symptoms deduced from close observation. besides these external ocular evidences of morbid action, we have, as in the human subject, guides to direct us in forming a just opinion as to the nature of a dog's indisposition. the state of the circulation is the first thing that should command our particular attention. the pulse of dogs in health varies from one hundred to one hundred and twenty strokes per minute, according to the size and peculiar temperament of the animal, being more frequent in the small breeds. the standard of the setter, pointer, hound, &c., may be stated at one hundred and five. the action of the heart may be felt by placing the hand immediately over that organ, or applying the fingers to several points in the body and limbs where the large arteries are somewhat superficial, as on the inside of the fore-knee and the thigh of the hind-leg. if the pulse in a state of rest exceeds the average standard in frequency, regularity, and softness, and a general feeling of uneasiness be present, together with reddened eyes, warm nose, and coated tongue, we know at once that there is an unnatural derangement of the vital functions, and that fever in some form is present. the next question to determine is, upon what does this fever depend? whether it be idiopathic, arising from morbific causes difficult to define, or whether it be sympathetic, with some organic affection yet to be discovered. the appearance of the tongue in canine diseases will often materially assist us in forming a correct diagnosis; this organ in simple fever loses its rose-colour and becomes pale and coated, the gums and fæces also participate in this change. if, however, the tongue be much furred, with a bright inflammatory appearance around the edges, with high arterial excitement, and disgust of food, with general anxiety and craving for water in small but frequent quantities, inflammation of the stomach or bowels may be suspected. if, on the other hand, the tongue remains brown and streaked, with less action of the pulse, variable appetite and diminution of pain, derangement of the liver may be apprehended. if, in connection with some or all of the above symptoms, the breathing be laboured and painful, with a disposition to remain in the erect or sitting position, with great anxiety and general distress, we must look to the pulmonic viscera as the seat of the disease. thus, by examining each and every individual symptom of disease, the intelligent sportsman will soon be able to arrive at the proximate cause of all this unnatural state of things, and then he will be competent to administer such remedies as may seem most likely to afford relief. without these precautions, however, he would often be groping in the dark, and, consequently, not unfrequently, apply those remedies more calculated to aggravate than cure the malady. * * * * * chapter vi. description of the skeleton. diseases of the nervous system:--fits; turnside, or giddiness, epilepsy; chorea; rheumatism and palsy. [as with all the illustrations in this text, the canine skeleton and legend to the diagram are displayed fully in the html version.] diseases of the nervous system. fits th feb. .--a pug was accustomed to howl frequently when his young master played on the flute. if the higher notes were sounded, he would leap on his master's lap, look in his face, and howl vehemently. to-day the young man purposely blew the shrillest sound that he could. the dog, after howling three or four times, began to run round the room, and over the tables and chairs, barking incessantly. this he continued more than an hour. when i saw him all consciousness of surrounding objects was gone. he was still running feebly, but barking might and main. i dashed a basin of cold water in his face, and he dropped as if he had been shot. he lay motionless nearly a minute, and then began to struggle and to bark; another cup of water was dashed in his face, and he lay quite motionless during two minutes or more. in the mean time i had got a grain each of calomel and tartar emetic, which i put on his tongue, and washed it down with a little water. he began to recover, and again began to yelp, although much softer; but, in about a quarter of an hour, sickness commenced, and he ceased his noise. he vomited three or four times, and lay frightened and quiet. a physic-ball was given him in the evening, and on the following morning. on the next day the young man put open the door, and sat himself down, and began to prepare the flute; the dog was out in a moment, and did not return during a couple of hours. on the following day he made his escape again, and so the matter went on; but before the expiration of the week, his master might play the flute if he pleased. turnside, or giddiness. this is a singular disease prevalent among cattle, but only occasionally seen in the dog. he becomes listless, dull, off his food, and scarcely recognises any surrounding object. he has no fit, but he wanders about the room fur several hours at a time, generally or almost invariably in the same direction, and with his head on one side. at first he carefully avoids the objects that are in his way; but by degrees his mental faculties become impaired; his sense of vision is confused or lost, and he blunders against everything: in fact, if uninterrupted, he would continue his strange perambulation incessantly, until he was fairly worn out and died in convulsions. i used to consider the complaint to be uniformly fatal. i have resorted to every remedial measure that the case could suggest. i have bled, and physicked and setoned, and blistered, and used the moxa; but all without avail, for not in a single case did i save my patient. no opportunity of 'post-mortem' examination was lost. in some cases i have found spicula projecting from the inner plate of the skull, and pressing upon or even penetrating the dura mater. i know not why the dog should be more subject to these irregularities of cranial surface than any of our other patients; but decidedly he is so, and where they have pressed upon the brain, there has been injection of the membranes, and sometimes effusion between them. in some cases i have found effusion without this external pressure, and, in some cases, but comparatively few, there has not been any perceptible lesion. hydatids have been found in the different passages leading to the cranium, but they have not penetrated. i used to recommend that the dog should be destroyed; but i met with two or three favourable cases, and, after that, i determined to try every measure that could possibly be serviceable. i bled, and physicked, and inserted setons, and tried to prevent the utter exhaustion of the animal. when he was unable longer to perform his circumvolutions, and found that he was foiled, he laid himself down, and by degrees resumed his former habits. he was sadly impatient and noisy; but in a few cases he was cured. [we have seen but two or three cases of this disease in dogs, are led to believe that it is quite uncommon with our domestic animals. one case in a valuable setter came on suddenly, and without any apparent cause (except perhaps over-feeding), and terminated fatally in the course of a few days.--l.] epilepsy in the dog assumes a most fatal character. it is an accompaniment, or a consequence, of almost every other disease. when the puppy is undergoing the process of dentition, the irritation produced by the pressure of the tooth, as it penetrates the gum, leads on to epilepsy. when he is going through the stages of distemper, with a very little bad treatment, or in spite of the best, fits occur. the degree of intestinal irritation which is caused by worms, is marked by an attack of epilepsy. if the usual exercise be neglected for a few days, and the dog is taken out, and suffered to range as he likes, the accumulation of excitability is expended in a fit. the dog is, without doubt, the most intellectual animal. he is the companion and the friend of man: he exhibits, and is debased by some of his vices; but, to a greater degree than many will allow, he exhibits all the intelligence and the virtues of the biped. in proportion to his bulk, the weight of his brain far exceeds that of any other quadruped--the very smallest animals alone being excepted, in whom there must be a certain accumulation of medullary matter in order to give origin to the nerves of every system, as numerous in the minutest as in him of greatest bulk. as it has been said of the human being that great power and exertion of the mental faculties are sometimes connected with a tendency to epilepsy, and, as violent emotions of joy or of grief have been known to be followed by it, i can readily account for its occurrence in the young dog, when frightened at the chiding of his master, or by the dread of a punishment which he was conscious that he had deserved. then, too, i can understand that, when breaking loose from long confinement, he ranges in all the exuberance of joy; and especially when he flushes almost his first covey, and the game falls dead before him, his mental powers are quite overcome, and he falls into an epileptic fit. the treatment of epilepsy in the dog is simple, yet often misunderstood. it is connected with distemper in its early stage. it is the produce of inflammation of the mucous passages generally, which an emetic and a purgative will probably, by their direct medicinal effect, relieve, and free the digestive passages from some source of irritation, and by their mechanical action unburthen the respiratory ones. when it is symptomatic of a weak state of the constitution, or connected with the after stages of distemper, the emeto-purgative must be succeeded by an anodyne, or, at least, by that which will strengthen, but not irritate the patient. a seton is an admirable auxiliary in epilepsy connected with distemper; it is a counter-irritant and a derivative, and its effects are a salutary discharge, under the influence of which inflammation elsewhere will gradually abate. i should, however, be cautious of bleeding in distemper fits. i should be fearful of it even in an early stage, because i well know that the acute form of that general mucous inflammation soon passes over, and is succeeded by a debility, from the depression of which i cannot always rouse my patient. when the fits proceed from dentition, i lance the jaws, and give an emetic, and follow it up with cooling purgative medicine. when they are caused by irregular and excessive exercise, i open the bowels and make my exercise more regular and equable. when they arise from excitation, i expose my patient more cautiously to the influence of those things which make so much impression on his little but susceptible mind. if the fit has resisted other means, bleeding should be resorted to. a fit in other animals is generally connected with dangerous determination of blood to the head, and bleeding is imperative. a fit in the dog may be the consequence of sudden surprise and irritation. if i had the means i should see whether i could not break the charm; whether i could not get rid of the disturbance, by suddenly affecting the nervous system, and the system generally, in another way. i would seize him by the nape of the neck, and, with all my force, dash a little cold water in his face. the shock of this has often dispersed the epileptic agency, as it were by magic. i would give an emeto-purgative; a grain or a grain and a half of calomel and the same quantity of tartar emetic: i would soothe and coax the poor animal. then,--and if i saw it at the beginning, i would do it early,--if the fit was more dependent upon, or was beginning to be connected with, determination of blood to the head, and not on any temporary cause of excitation or irritation, i would bleed freely from the jugular. the following singular case of epilepsy is narrated by m.w. leblanc: a dog of small size, three years old, was very subject to those epileptic fits that are so frequent among dogs. after a considerable period, the fits would cease, and the animal recover the appearance of perfect health; but the more he advanced in age the more frequent were the fits, which is contrary to that which usually happens. the last fit was a very strong one, and was followed by peculiar symptoms. the animal became dispirited. the eyes lost their usual lively appearance, and the eyelids were often closed. the dog was very drowsy, and, during sleep, there were observed, from time to time, spasmodic movements, principally of the head and chest. 'he always lay down on the left side'. when he walked, he had a marked propensity to turn to the left. m. leblanc employed purgatives, a seton to the back part of the neck, and the application of the cautery to the left side of the forehead; but nothing would stop the progress of the disease, and he died in the course of two months after the last fit. the nearer he approached his end the smaller were the circles that he took; and, in the latter part of his existence, he did little more than turn as if he were on a pivot, and, when the time arrived that he could walk no more, he used to lay himself down on the right side. on the 'post-mortem' examination, a remarkable thickness of the meninges was found on almost the whole of the left lobe of the brain. the dura mater, the two leaves of the arachnoid membrane, and the pia mater did not constitute more than one membrane of the usual thickness, and presented a somewhat yellow colouring. the cerebral substance of the left lobe appeared to be a little firmer than that of the right lobe. the fissures of the cerebral devolutions were much less deep than those of the other side the red vessels which ran in the fissures were of smaller size, and in some places could scarcely be discovered. [confinement, over-feeding, blows on the head or spine, drying up of old ulcers, repelling of cutaneous affections, or, in fact, anything that is liable to derange the general health of the animal, will produce epileptic fits. we formerly had a beagle hound of very active temperament, which we were necessarily obliged to keep much confined while in the city; and to restrain her from running too wildly when taken into the streets, we were in the habit of coupling her with a greyhound of much milder disposition. not being willing to submit lamely to this unpleasant check upon her liberty, she was ever making fruitless attempts to escape, either by thrusting herself forwards, or obstinately pulling backwards. these efforts resulted on several occasions in fits, produced by congestion of the brain, owing to the pressure of the collar on the neck, thereby interrupting the circulation, and inducing an influx of blood to those parts. we were ultimately obliged to abandon this method of restraint, which nearly proved fatal to our much-admired beagle: she being suddenly seized with one of these fits on a hot summer's day in one of our principal thoroughfares, the crowd of ignorant bystanders concluded it to be a case of rabies, and nothing but my taking her up in my arms, and carrying her from the scene of action, saved her from falling a victim to their ignorance. if the disease appears dependent upon plethora the result of confinement and gross living, the animal must be reduced by bleeding and purging, low diet, and exercise. if, however, the malady proceeds from weakness, as is sometimes the case in bitches while suckling a large litter, it will be necessary to relieve her of some of the pups, and supply her with the most nutritious diet, as also administer tonic balls; the following will answer. [symbol: rx]: extract of gentian, quassia, ââ (each) grs. v, made into two pills, and one or two given morning and evening; or, [symbol: rx]: powdered columbo. carbonate of iron, ââ, grs. v, made into two pills, and one given morning and evening, or more frequently if desirable. a seton placed in the poll will often prevent these attacks, particularly when depending upon slight cerebral irritation, accompanying distemper and mange. blisters and frictions to the spine are also serviceable.--l.] chorea. this is an irregular reception or distribution of nervous power--a convulsive involuntary twitching of some muscle or set of muscles. it is an occasional consequence of distemper that has been unusually severe or imperfectly treated, and sometimes it is seen even after that disease has existed in its mildest form. [this nervous affection, more commonly known as st. vitus' dance, is not a rare disease, and we doubt not that examples of it have been seen by most of our readers, more particularly in young dogs affected with distemper. this malady is characterized by sudden involuntary twitchings of the different muscles of the body, the disease being sometimes confined to one limb, sometimes to two, and frequently pervades the whole system, giving the dog a distressing and painful appearance. these involuntary motions, it is very true, are generally restricted during sleep, although in old chronic cases of long standing they often continue in full activity without any remission whatever. the disease is not attended with fever, and all the functions generally remain for a considerable time unimpaired.--l.] it first appears in one leg or shoulder, and is long, or perhaps entirely, confined to that limb. there is a singular spasmodic jerking action of the limb. it looks like a series of pulsations, and averages from forty to sixty in a minute. oftener, perhaps, than otherwise, both legs are similarly affected. when the animal is lying down, the legs are convulsed in the way that i have described, and when he stands there is a pulsating depressing or sinking of the head and neck. in some cases, the muscles of the neck are the principal seat of the disease, or some muscle of the face; the temporal muscle beating like an artery; the masseter opening and closing the mouth, the muscles of the eyelid, and, in a few cases, those of the eye itself being affected. these convulsive movements generally, yet not uniformly, cease during sleep, but that sleep is often very much disturbed. if the case is neglected, and the dog is in a debilitated state, this spasmodic action steals over the whole frame, and he lies extended with every limb in constant and spasmodic action. in the majority of cases, such an expenditure of nervous and muscular power slowly destroys the strength of the animal, and he dies a mere skeleton; or the disease assumes the character of epilepsy, or it quiets down into true palsy. in the most favourable cases, no curative means having been used, the dog regains his flesh and general strength; but the chorea continues, the spasmodic action, however, being much lessened. at other times, it seems to have disappeared; but it is ready to return when the animal is excited or attacked by other disease. in a variety of instances, there is the irritable temper which accompanies chorea in the human being, and most certainly when the disease has been extensive and confirmed. chorea, neglected or improperly treated, or too frequently pursuing its natural course, degenerates into paralysis agitans. there is a tremulous or violent motion of almost every limb. the spasms are not relaxed, but are even increased during sleep, and when the animal awakes, he rises with agitation and alarm. there is not a limb under the perfect control of the will; there is not a moment's respite; the constitution soon sinks, and the animal dies. no person should be induced to undertake the cure of such a case: the owner should be persuaded to permit a speedy termination to a life which no skill can render comfortable. chorea is oftenest observed in young dogs, and especially after distemper; and it seems to depend on a certain degree of primary or sympathetic inflammatory affection of the brain. chorea is often very plainly a consequence of debility: either the distribution of nervous power is irregular, or the muscles have lost their power of being readily acted upon, or have acquired a state of morbid irritability. the latter is the most frequent state. their action is irregular and spasmodic, and it resembles the struggles of expiring nature far more than the great and uniform action of health. it is not the chorea that used to be described, in which there was an irresistible impulse to excessive action, and which was best combated by complete muscular exhaustion; but the foundation of this disease is palpable debility. [rickets, bad feeding, cold and damp housing, worms in the alimentary canal, mange, and other chronic affections, are all forerunners of this malady.--l.] in the treatment of chorea there must be no bleeding, no excessive purgation, but aperients or alteratives, merely sufficient to keep the fæces in a pultaceous state, so as to carry off any source of irritation to the intestinal canal, and particularly some species of worms, too frequent sources of irritation there. to these should be added nutritious food, gentle exercise, tonic medicines, and general comforts. counter-irritants may be applied--such as blisters over the head, and setons, extending from poll to poll--the application of turpentine, or the tincture of cantharides; but all of these will frequently be of no effect, and occasionally a rapid and fearful increase of irritability will ensue: antispasmodics are in this case of no use, and narcotics are altogether powerless. as for tonics, iron and gentian have been serviceable to a certain extent, but they have never cured the complaint. the nitrate of silver will be the sheet-anchor of the practitioner, and if early used will seldom deceive him. it should be combined with ginger, and given morning and night, in doses varying from one-sixth to one-third of a grain, according to the size of the dog. the condition and strength of the dog, and the season of the year, will be our best guides. if the patient has not lost much flesh, and is not losing it at the time that we have to do with him, and has few symptoms of general debility, and spring or summer are approaching we may with tolerable confidence predict a cure; but, if he has been rapidly losing ground, and is doing so still, and staggers about and falls, there is no medicine that will restore him. th october, .--a pointer, eighteen months old, had had the distemper, but not severely, and was apparently recovering when he suddenly lost all voluntary power over his limbs. he was unable to get up, and his legs were in constant, rapid, and violent motion. this continued three days, during which he had refused all food, when, the dog being in the country, my advice was asked. i ordered a strong emetic to be given to him, and after that a dose of epsom salts, the insertion of a seton, and, in addition to this, our usual tonic was to be given twice every day. his food to consist chiefly of good strong soup, which was to be forced upon him in a sufficient quantity. in two days he was able to get up and stagger about, although frequently falling. his appetite returned. he continued to improve, and most rapidly gained strength and especially flesh. a very peculiar, high-lifting, clambering, and uncertain motion of the legs remained, with an apparent defect of sight, for he ran against almost everything. in six weeks the seton was removed, and the dog remained in the same state until the th of december. the uncertain clambering motion was now increasing, and likewise the defect of sight. he ran against almost every person and every thing. the cornea was transparent, the iris contracted, there was no opacity of the lens, or pink tint of the retina, but a peculiar glassy appearance, as unconscious of everything around it. an emetic was given, and, after that, an ounce of sulphate of magnesia. th. he was dreadfully ill after taking the salts; perhaps they were not genuine. for two days he panted sadly, refused his food, and vomited that which was forced upon him. his muzzle was hot; he could scarcely stand; he lost flesh very rapidly. an emetic was given immediately, and a distemper-ball daily. th. he soon began rapidly to recover, until he was in nearly the same state as before, except that the sight was apparently more deficient. the sulphate of magnesia was given every fourth day, and another seton inserted. st. he continued the medicine, and evidently improved, the sight returning, and the spasms being considerably less. the distemper-ball was continued. th january, .--the spasms were better; but the vision did not improve. in the afternoon he fell into a momentary fit. he almost immediately rose again, and proceeded as if nothing had happened. an ounce of epson salts was given, and then the tonic balls as before. d. the spasms were lessened, the clambering gait nearly ceased, but the vision was not improved. the seton was removed, and only an additional dose of salts given. th. the spasms suddenly and very considerably increased. the left side appeared now to be particularly affected. the left leg before and behind were most spasmed, the right scarcely at all so. the vision of the left eye was quite gone. the dog had been taken to mr. alexander's, the oculist, who attributed the affection of the eye and the general spasmodic disease to some pressure on the brain, and recommended the trial of copious and repeated bleeding. th. the dog was dull; the spasms appeared to have somewhat increased and decidedly to affect the left side. fever-balls were ordered to be given. th. considerable change took place. at three o'clock this morning i was disturbed by a noise in the hospital. the poor fellow was in a violent fit. water was dashed in his face, and a strong emetic given; but it was not until seven o'clock that the fit had ceased; he lay until eleven o'clock, when the involuntary spasms were almost suspended. when he was placed on his feet, he immediately fell; he then gradually revived and staggered about. his master brought a physician to see him, who adopted mr. alexander's idea and urged bleeding. ten ounces of blood were immediately taken; the dog refused to eat. st february.--the strength of the animal was not impaired, but the spasms were more violent, and he lay or wandered about stupid and almost unconscious. i subtracted eight ounces more of blood. d. the spasms were fully as violent, and no amendment in the vision. eight ounces more of blood were subtracted without benefit. a fever-ball was ordered to be given. d. no amendment; but the bleeding having been carried to its full extent, i again resorted to the tonic balls, which were given morning and night. the dog was well fed and the seton replaced. th. a very considerable amendment is evident. th. the spasms rapidly subsided and almost disappeared. vision was not perfectly restored; but the dog evidently saw with his left eye. he was taken away, and tonic balls sent with him and ordered to be continued. th march.--the dog had improved in strength and no spasmodic affection remained; he likewise evidently saw with his left eye. the tonic-balls had been discontinued for a week, and his master hoped that all would turn out well, when suddenly, while at home, he was seized with a fit that lasted ten minutes. a strong emetic was given, which brought up a vast quantity of undigested food. a strong purging-ball was given to him in the evening. th. the dog had lain slightly spasmed for two or three days, when they all at once ceased, and the animal appeared as well as before. suddenly he was taken with another fit, and again a vast quantity of food was vomited. these spasms remained two days, but on the st the fit returned with the same discharge of food. courses of purgatives were then determined on. a strong dose of sulphate of magnesia was given every third day. after four doses had been given, it was impossible to force any more upon him. the syrup of buckthorn was tried, but the fourth dose of that it was impossible to give. the dog was then sent into the country; no fit occurred, but there were occasional spasms. d september.--he was brought back to town, and i saw him. during the last month he had had many fits. his owner at length consented that the actual cautery should be applied to his head. the searing-iron for doctoring was used, and applied red-hot to the centre of the head. it was exceedingly difficult so to confine the dog as to make the application effectual, without destroying the skin. under the influence of the sudden violent pain, he wandered about for more than two hours, and then the spasms returned with greater force than usual. he refused all food. we determined to try the cautery to its full extent. we chained him up in the morning, and penetrated through the skin with the budding-iron. the spasms were dreadfully violent, and he was scarcely able to walk or to stand. this gradually subsided, and then he began to run round and round, and that increased to an extraordinary velocity: he would then lie for a while with every limb in action. the owner then yielded to all our wishes, and he was destroyed with prussic acid. no morbid appearance presented itself in the brain; but, on the inner plate of the right parietal bone, near the sagittal suture, were two projections, one-sixth of an inch in length, and armed with numerous minute spicula. there was no peculiar inflammation or vascularity of any other part of the brain. [we once cured a case quite accidentally, by throwing a pup into a cold stream of water, and making him swim ashore; we do not recommend the plan, although we should be willing to try it again with one of our own dogs. the animal should be forced to swim till nearly exhausted, and wrapped up in blankets on coming out of the water. the intense alarm created in the pup, together with the violent struggle and coldness of the water, all act as revulsives to the disease, which, if purely nervous, may be overcome by these powerful agents. if the dog be weak, and the stomach deranged, the following tonic balls will answer a good purpose: [symbol: rx]: carbonate of iron. ground ginger, ââ, grs. x, made into two pills, one given morning and evening, or more frequently according to the age or size of the animal.--l.] rheumatism and palsy. i do not know any animal so subject to 'rheumatism' as the dog, nor any one in which, if it is early and properly treated, it is so manageable. [we agree with our author, that the canine family are exceedingly liable to inflammation of the fibrous and muscular structures of the body, and there is no disease from which they suffer more, both in their youth and old age, than rheumatism. no particular species of dogs are more subject to its attacks than others, all being alike victims to its ravages. mr. blaine remarks, that the bowels always sympathize with other parts of the body suffering under this disease, and that inflammation will always be found existing in the abdominal viscera, if rheumatism be present, and the lower bowels will be attended with a painful torpor, which he designates as rheumatic colic. we ourselves noticed, that old setters particularly, when suffering from this disease, are frequently attacked with an acute diarrhoea, or suffer from obstinate constipation attended by griping pains, but did not know that this state of things was so uniform an accompaniment to the other affection. there are two varieties of rheumatism, the 'acute' and 'chronic', both of which are attended with either general fever or local inflammation. the attacks usually come on rather suddenly, the joints swell, the pulse becomes full and tense, the parts tender, and the eyes blood-shot, the stomach deranged, and the bowels costive. severe lancinating pain runs through the articulation, and along the course of the larger muscles, the tongue is coated, the muzzle hot and dry, and the poor animal howls with agony. the breathing becomes laboured, all food is rejected, and if you attempt to move the sufferer he sends forth piteous cries of distress. 'the causes' of this serious affection are very numerous; among the most usual and active agents may be enumerated, exposure to atmospherical vicissitudes, remaining wet and idle after coming from the water, damp kennels, suppressed perspiration, metastasis of eruptive diseases, luxurious living, laziness and over-feeding. these and many other causes are all busy in the production of this disease. duck dogs on the chesapeake, we have noticed as often suffering from this affection, owing no doubt to the great exposure they are obliged to endure; but few of them arrive at old age without being martyrs to the chronic form. 'chronic rheumatism', generally the result of the other form of disease, is most usually met with in old dogs: it is attended with little fever, although the local inflammation and swelling is sometimes considerable. the pain is often stationary in one shoulder or loin, at other times shifts about suddenly to other portions of the body. the muscles are tender and the joints stiff, the animal seems lame till he becomes healed, and limber when all appearance of the disease vanishes. in old cases the limbs become so much enlarged, and the joints so swollen, that the dog is rendered perfectly useless, and consequently increases his sufferings by idleness. 'this form of the disease is known as gout.' treatment of 'acute rheumatism'--bleeding largely is very important in this affection, and if followed up with two or three purges of aloes, gamboge, colocynth and calomel will arrest the progress of this disease. rx. extract of colocynth [symbol: scruple] i. calomel grs. x. powdered gamboge grs. ii. socet. aloes grs. x. made into four pills, two to be given at night, and the other the following morning. if these medicines should not be handy, give a large purging ball of aloes, to be followed by a full dose of salts. when the inflammatory action is not sufficiently high to demand depletion, warm bathing, friction and keeping the dog wrapped up in blankets before a fire will generally afford relief. if the pain appear very severe, it will be necessary to repeat the baths at short intervals: great attention must be paid to the state of the bowels: if a diarrhoea supervenes, it must not he checked too suddenly, by the use of astringent medicines, but rather corrected by small doses of oil and magnesia. if constipation attended with colic be the character of the affection, small quantities of oil and turpentine in connexion with warm enemata will be the proper remedies. if paralysis should occur, it will be found very difficult to overcome, but must be treated, after the reduction of inflammation, upon principles laid down under the head of this latter affection. blisters to the spine, setons, electricity, acupuncturation, &c. 'treatment of chronic rheumatism'--warm baths are useful, and warm housing absolutely necessary, attention to diet, and an occasional purge of blue mass and aloes, together with electricity, acupuncture, rubefacient applications to the spine, &c.--l.] a warm bath--perchance a bleeding--a dose or two of the castor-oil mixture, and an embrocation composed of spirit of turpentine, hartshorn, camphorated spirit, and laudanum, will usually remove it in two or three days, unless it is complicated with muscular sprains, or other lesions, such as the 'chest-founder' of kennels. this chest-founder is a singular complaint, and often a pest in kennels that are built in low situations, and where bad management prevails. where the huntsman or whippers-in are too often in a hurry to get home, and turn their dogs into the kennel panting and hot; where the beds are not far enough from the floor, or the building, if it should be in a sufficiently elevated situation, has yet a northern aspect and is unsheltered from the blast, chest-founder prevails; and i have known half the pack affected by it after a severe run, the scent breast-high, and the morning unusually cold. it even occasionally passes on into palsy. the veterinary surgeon will be sometimes consulted respecting this provoking muscular affection. his advice will comprise--dryness, attention to the bowels, attention to the exercise-ground, and perhaps, occasionally, setons--not where the huntsman generally places them, on the withers above, but on the brisket below, and defended from the teeth of the dog by a roller of a very simple construction, passing round the chest between the fore legs and over the front of the shoulders on either side. the pointer, somewhat too heavy before, and hardly worked, becomes what is called chest-foundered. from his very make it is evident that, in long-continued and considerable exertion, the subscapular muscles will be liable to sprain and inflammation. there will be inflammation of the fasciæ, induration, loss of power, loss of nervous influence and palsy. cattle, driven far and fast to the market, suffer from the same causes. [by palsy, we mean a partial or complete loss of the powers of motion or sensation in some portion of the muscular system: this affection is very common to the canine race, and very few of them reach an advanced age without having at some time in their life experienced an attack of this malady. the loins and hind legs suffer oftener than other parts, in fact we do not recollect ever meeting with paralysis of the fore limbs alone. although the limbs become perfectly powerless, and are only dragged after the animal by the combined efforts of the fore legs and back, it is seldom that they lose their sensibility.--l.] palsy is frequent, as in the dog. however easy it may be to subdue a rheumatic affection, in its early stage, by prompt attention, yet if it is neglected, it very soon simulates, or becomes essentially connected with, or converted into, palsy. no animal presents a more striking illustration of the connexion between intestinal irritation and palsy than the dog. he rarely or never has enteritis, even in its mildest form, without some loss of power over the hinder extremities. this may at first arise from the participation of the lumbar muscles with the intestinal irritation; but, if the disease of the bowels continues long, it will be evident enough that it is not pain alone that produces the constrained and incomplete action of the muscles of the hind extremities, but that there is an actual loss of nervous power. a dog is often brought to the veterinary surgeon, with no apparent disease about him except a staggering walk from weakness of the hind limbs. he eats well and is cheerful, and his muzzle is moist and cool; but his belly is tucked up, and there are two longitudinal cords, running parallel to each other, which will scarcely yield to pressure. the surgeon orders the castor-oil mixture twice or thrice daily, until the bowels are well acted upon, and, as soon as that is accomplished, the dog is as strong and as well as ever. perhaps his hind limbs are dragged behind him; a warm bath is ordered, he is dosed well with the castor-oil mixture, and, if it is a recent case, the animal is well in a few days. in more confirmed palsy, the charge, or plaster on the loins, is added to the action of the aperient on the bowels. the process may be somewhat slow, but it is seldom that the dog does not ultimately and perfectly recover. it is easy to explain this connexion, although we should have scarcely supposed that it would have been so intimate, had not frequent experience forced it on our observation. the rectum passes through the pelvis. whatever may be said of that intestine, considering its vertical position in the human being, it is always charged with fæces in the quadruped. it therefore shares more in the effect, whatever that may be, which is produced by the retention of fæces in the intestinal canal, and it shares also in the inflammatory affection of other parts of the canal. almost in contact with this viscus, or at least passing through the pelvis, are the crural nerves from the lumbar vertebræ, the obtusator running round the rim of the pelvis, the glutal nerve occupying its back, and the sciatic hastening to escape from it. it is not difficult to imagine that these, to a certain degree, will sympathize with the healthy and also the morbid state of the rectum; and that, when it is inert, or asleep, or diseased, they also may be powerless too. here is something like fact to establish a very important theory, and which should be deeply considered by the sportsman and the surgeon. [loss of the contractile power of the sphincters of the bladder and rectum, sometimes attends this disease, and involuntary evacuations are constantly taking place, or costiveness and retention are the consequences.--l.] mr. dupuy has given a valuable account of the knowledge we possess of the diseases of the spinal marrow in our domestic quadrupeds. he has proved: . that in our domestic animals the spinal marrow is scarcely ever affected through the whole of its course. . that the dorsal and lumbar regions are the parts oftenest affected. . that inflammation of the spinal marrow of these regions always produces palsy, more or less complete, of the abdominal members. . that, in some cases, this inflammation is limited to the inferior or superior parts of the spinal marrow, and that there is loss only of feeling or of motion. . that sometimes animals die of palsy without any organic lesion. [blows on the head, producing effusion on the brain, poisoning by lead, inflammation of the spinal marrow, affections of the nerves, caries of the spine, costiveness and affections of the bowels, are all productive of palsy. if the disease proceeds from rheumatism, or other inflammatory affections, independent of any organic lesion, the disease, if taken early, is not difficult to overcome in the young subject. warm baths, bleeding, purging, and stimulating applications to the parts and along the spine, will answer. castor oil and turpentine is a good purge: where the malady depends upon costiveness, purges of aloes should be administered in connexion with warm enemata, stimulating frictions along the spine, and hot baths. croton oil dropped on the tongue will also be of great benefit: if there should be effusion or compression from fracture of the bones of the cranium, nothing but trephining will be of any service, as we can hardly hope for the absorption of the matter, and the removal of the spicula of bone can alone afford relief to the patient. paralysis arising from poisoning should be treated as described under the head of mineral poisons. chronic cases of paralysis arising from want of tone of the nerves and spinal marrow, repeated blistering, introduction of the seton along the spine, electricity, &c., have all been tried with some success. strychnia, from its peculiar effects upon the animal economy, and its almost exclusive direction to the nerves of motion, makes it a medicine particularly applicable to the treatment of this disease. it may be given in all stages of the malady, but is most serviceable after the reduction of inflammatory action, and when we are convinced that the disease depends upon want of tone in the motor muscles. great care should be had in its administration, as it is a powerful poison in too large doses, to a large dog; commence with a quarter of a grain in pill, three times daily, and gradually increase to a half grain or more if the animal seems to bear it well. but it should be discontinued immediately on the appearance of any constitutional symptoms, such as spasmodic twitchings of the eyelids or muzzle.--l.] palsy--mange th february, .--a persian bitch, at the zoological gardens, who was well yesterday, now staggers as she walks, and has nearly lost the use of her hind legs. gave a good dose of the castor-oil mixture. th. she is materially worse and drags her hind legs after her. i would fain put on a charge, but the keeper does not like that her beautiful coat should be spoiled, and wishes to try what gentle exercise will do. she certainly, after she has been coaxed a great deal, will get on her legs and stagger on fifty yards or more. gave the castor-oil mixture daily. th. she is a little stronger, and walks a little better. continue the mixture. embrocate well with the rheumatic mixture--sp. tereb., sp. camph., liq. ammon., et tinct. opii--and give gentle exercise. d march.--she does improve, although slowly; the charge is therefore postponed. continue treatment. th. she is considerably better. continue the mixture, and use the embrocation every second day. th april--she has mange in the bend of her arm, and on her chest. use the sulphur ointment and alterative balls, and omit the embrocation and mixture. in less than a week she nearly recovered from her lameness, and ran about almost as well as ever. th. she runs about very fairly, but the mange has assumed that character of scurvy which i do not know how to grapple with. continue the alterative balls, and the ointment. th may.--the mange has disappeared, but the palsy is returning; she staggers slightly, and droops behind. give the castor-oil mixture and use the embrocation. th june.--mange quite gone, but palsy continues to a very considerable degree. i want to use the plaster; but the keeper pleads for a little delay. continue the treatment. st july.--i have at length determined to have recourse to the charge. a piece of thick sheep's leather was fitted lo her loins and haunches. th. she appears to be improving, but it is very slowly. st. very little change. the plaster keeps on well: she has no power over her hind limbs; but she eats and drinks as well as ever. d august.--no change. give her half a grain of strychnia, morning and night. th that singular secretion of milk, to which the bitch is subject nine weeks after oestrum, is now appearing. her mammæ are enlarged, and i can squeeze a considerable quantity of milk out of the teats. give an aloetic pill, and continue the strychnia. st. the secretion of milk continues. there is slight enlargement and some heat of the mammæ; but she feeds as well as ever. increase the dose of strychnia to three-quarters of a grain. on the following day she was found dead. in making the usual longitudinal incision through the integuments of the abdomen a considerable quantity of milky fluid, mingled with blood, followed the knife. there was very slight enlargement of the teats, but intense inflammation of the whole of the mammary substance. the omentum, and particularly the portion opposite to the external disease, was also inflamed. besides this there was not a vestige of disease. this is an interesting case and deserves record. i fear that justice was not done to the animal at the commencement of the paralytic affection. in nineteen cases out of twenty in the dog, the constant but mild stimulus of a charge over the lumbar and sacral regions removes the deeper-seated inflammation of the spinal cord or its membranes, when the palsy is confined to the hind extremities, and has not been sufficiently long established to produce serious change of structure. the charge should have been applied at first. the almost total disappearance of the palsy during the cutaneous disease, which was attended with more than usual inflammation of the integument, is an instructive illustration of the power of counter-irritation, and of what might possibly have been effected in the first case; for much time was lost before the application of the charge, and when at length it was applied, it and the strychnia were powerless. i consider the following case as exceedingly valuable, at least with reference to the power of strychnia in removing palsy:-- th august, .--a fine alpine dog was suddenly attacked with a strange nervous affection. he was continually staggering about and falling. his head was forcibly bent backward and a little on one side, almost to his shoulder. a pound of blood was abstracted, a seton inserted from ear to ear, and eight grains of calomel administered. st. he has perfectly lost the use of every limb. he has also amaurosis. perfect blindness, which had not appeared the day before. he hears perfectly, and he eats, and with appetite, when the food is put into his mouth. gave him two large spoonfuls of the castor-oil mixture daily; this consists of three parts of castor-oil, two of syrup of buck-thorn, and one of syrup of white poppies. d. a little better; can lift his head and throw it upon his side, and will still eat when fed. continue the mixture, and give half a grain of strychnia daily. th. little change. th. no change, except that he is rapidly losing flesh. continue the treatment. th. the strychnia increased to three-fourths of a grain morning and night. the castor-oil mixture continued in its full quantity. he was fed well, but there was a sunken, vacant expression of countenance. d september.--he can move his head a little, and has some slight motion in his limbs. th. he can almost get up. he recognises me for the first time. his appetite, which was never much impaired, has returned: this is to be attributed to strychnia, or the seton, or the daily aperient mixture. they have all, perhaps, been serviceable, but i attribute most to the strychnia; for i have rarely, indeed, seen any dog recover from such an attack. continue the treatment. th. fast recovering. medicine as before. th. improving, but not so fast as before. still continue the treatment. th. going on slowly, but satisfactorily. remove the seton, but continue the other treatment. th october.--quite well. * * * * * chapter vii. rabies. we are now arrived at one of the most important subjects in veterinary pathology. in other cases the comfort and the existence of our quadruped patients are alone or chiefly involved, but here the lives of our employers, and our own too, are at stake, and may be easily, and too often are, compromised. here also, however other portions of the chain may be overlooked or denied, we have the link which most of all connects the veterinary surgeon with the practitioner of human medicine; or, rather, here is the circumscribed but valued spot where the veterinary surgeon has the vantage-ground. in describing the nature, and cause and treatment of rabies, it will be most natural to take the animal in which it oftenest appears, by which it is most frequently propagated; the time at which the danger commences, and the usual period before the death of the patient. some years ago a dog, naturally ferocious, bit a child at lisson grove. the child, to all appearance previously well, died on the third day, and an inquest was to be held on the body in the evening. the coroner ordered the dog to be sent to me for examination the animal was, contrary to his usual habit, perfectly tractable. this will appear to be of some importance hereafter. i examined him carefully. no suspicious circumstance could be found about him. there was no appearance of rabies. in the mean time the inquest took place, and the corpse of the child was carefully examined. one medical gentleman thought that there were some suspicious appearances about the stomach, and another believed that there was congestion of the brain. the owner of the dog begged that the animal might not be taken from him, but might accompany him home. he took him home and destroyed him that no experiments might be made. with great difficulty we procured the carcass, and from some inflammatory appearances about the tongue and the stomach, and the presence of a small portion of indigestible matter in the stomach, we were unanimously of opinion that the dog was rabid. i do not mean to say that the child died hydrophobous, or that its death was accelerated by the nascent disease existing in the dog. there was probably some nervous affection that hastened the death of the infant, and the dog bit the child at the very period when the malady first began to develop itself. on the following day there were morbid lesions enough to prove beyond doubt that he was rabid. this case is introduced because i used afterwards to accompany every examination of supposed or doubtful rabies with greater caution than i probably had previously used. it is occasionally very difficult to detect the existence of rabies in its nascent state. in the year , a child attempted to rob a dog of its morning food, and the animal resisting the theft, the child was slightly scratched by its teeth. no one dreamed of danger. eight days afterwards symptoms of rabies appeared in the dog, the malady ran its course, and the animal died. a few days afterwards the child sickened--undoubted characteristics of rabies were observed--they ran their course and the infant was lost. there are other cases--fortunately not numerous--in the records of human surgery, resembling this. a person has been bitten by a dog, he has paid little or no attention to it, and no application of the caustic has been made. some weeks, or even months, have passed, he has nearly or quite forgotten the affair, when he becomes languid and feverish, and full of fearful apprehensions, and this appearing perhaps during several days, or more than a week. the empoisonment has then ceased to be a local affair, the virus has entered into the circulation, and its impression is made on the constitution generally. fortunately the disposition to bite rarely develops itself until the full establishment of the disease, otherwise we might sometimes inquire whether it were not our duty to exterminate the whole race of dogs. the following case deserves to be recorded. on the st of october, , a dog was brought to me for examination. he had vomited a considerable quantity of coagulated blood. i happened to be particularly busy at the moment, and not observing anything peculiar in his countenance or manner, i ordered some astringent sedative medicine, and said that i would see him again in the afternoon. in the course of the afternoon he was again brought. the vomiting had quite ceased. his mouth seemed to be swollen, and, on examining him, i found that some of his incisor teeth, both in the upper and lower jaw, had been torn out. this somewhat alarmed me; and, on inquiring of the servant, i was told that he suspected that they had had thieves about the house on the preceding night, for the dog had torn away the side of his kennel in attempting to get at them. i scolded him for not having told me of this in the morning; and then, talking of various things, in order to prolong the time and to be able closely to watch my patient, i saw, or thought i saw, but in a very slight degree, that the animal was tracing the fancied path of some imaginary object. i was then truly alarmed, and more especially since i had discovered that in the giving of the physic in the morning the man's hand had been scratched; a youth had suffered the dog to lick his sore finger, and the animal had also been observed to lick the sore ear of an infant. he was a remarkably affectionate dog, and was accustomed to this abominable and inexcusable nonsense. i insisted on detaining the dog, and gave the man a letter to the surgeon, telling him all my fears. he promptly acted on the hint, and before evening, the proper means were taken with regard to all three. i watched this dog day after day. he would not eat, but he drank a great deal more water than i liked. the surgeon was evidently beginning to doubt whether i was not wrong, but he could not dispute the occasional wandering of the eye, and the frequent spume upon the water. on the th of october, however, the sixth day after his arrival, we both of us heard the rabid howl burst from him: he did not, however, die until the th. i mention this as another instance of the great difficulty there is to determine the real nature of the case in an early stage of the disease. m. perquin relates an interesting case. a lady had a greyhound, nine years old, that was accustomed to lie upon her bed at night, and cover himself with the bed-clothes. she remarked, one morning, that he had torn the covering of his bed, and, although he ate but little, drank oftener, and in larger quantity, than he was accustomed to do. she led him to a veterinary surgeon, who assured her that there was nothing serious the matter. on the following day, he bit her fore-finger near the nail, as she was giving him something to eat. she led him again to the veterinary surgeon, who assured her that she needed not to be under the least alarm, and as for the little wound on her finger, it was of no consequence. on the following day, the th of december, the dog died. he had not ceased to drink most abundantly to the very last. on the th of february, as the lady was dining with her husband, she found some difficulty in deglutition. she wished to take some wine, but was unable to swallow it. on the th, she consulted a surgeon. he wished her to swallow a little soup in his presence. she attempted to do it, but could not accomplish her object after many an effort. she then fell into a state of violent agitation, with constriction of the pharynx, and the discharge of a viscid fluid from the mouth. on the th, she died, four days after the first attack of the disease, and in a state of excessive loss of flesh. there can be no doubt that both the dog and his mistress died rabid, the former having communicated the disease to the latter; but there is no satisfactory account of the manner in which the dog became diseased. [ ] joseph delmaire, of looberghe, twenty-nine years old, was, on the th of october, , bitten in the hand by a dog that he met with in the forest, and that was evidently rabid. on the following morning, he went to a medical man of some repute in the country, who washed the wound, and scarified it, and terminated the operation by tracing a bloody cross on the forehead of the patient. he returned home, but he was far from being satisfied. the image of the dog that had attacked him was always before him, and his sleep was troubled with the most frightful dreams. so passed four-and-twenty days, when delmaire, rising from his bed, felt the most dreadful trepidation; he panted violently; it seemed as if an enormous weight oppressed his chest, and from time to time there was profound sighing and sobbing. he complained every moment that he was smothered. he attempted to drink, but it was with great difficulty that a few drops of barley-water were swallowed. his mouth was dry, his throat burning, his thirst excessive, and all that he attempted to swallow was rejected with horror. at nine o'clock at night he was largely bled. his respiration was more free, but the dread of every fluid remained. after an hour's repose, he started and felt the most fearful pain in every limb--his whole body was agitated with violent convulsions. the former place of bleeding was reopened, and a great quantity of blood escaped. the pulse became small and accelerated. the countenance was dreadful--the eyes were starting from their sockets--he continually sprung from his seat and uttered the most fearful howling. a quantity of foam filled his mouth, and compelled a continued expectoration. in his violent fits, the strength of six men was not sufficient to keep him on his bed. in the midst of a sudden recess of fury he would disengage himself from all that were attempting to hold him, and dash himself on the floor; there, freed from all control, he rolled about, beat himself, and tore everything that he could reach. in the short intervals that separated these crises, he regained possession of his reasoning powers: he begged his old father to pardon him, he talked to him and to those around with the most intense affection, and it was only when he felt that a new attack was at hand, that he prayed them to leave him. at length his mental excitation began to subside; his strength was worn out, and he suffered himself to be placed on his bed. the horrible convulsions from time to time returned, but the dread of liquors had ceased. he demanded something to drink. they gave him a little white wine, but he was unable to swallow it; it was returned through his nostrils. the poor fellow then endeavoured to sleep; but it was soon perceived that he had ceased to live. the early symptoms of rabies in the dog are occasionally very obscure. in the greater number of cases, these are sullenness, fidgetiness, and continual shifting of posture. where i have had opportunity, i have generally found these circumstances in regular succession. for several consecutive hours perhaps he retreats to his basket or his bed. he shows no disposition to bite, and he answers the call upon him laggardly. he is curled up and his face is buried between his paws and his breast. at length he begins to be fidgety. he searches out new resting-places; but he very soon changes them for others. he takes again to his own bed; but he is continually shifting his posture. he begins to gaze strangely about him as he lies on his bed. his countenance is clouded and suspicious. he comes to one and another of the family and he fixes on them a steadfast gaze as if he would read their very thoughts. "i feel strangely ill," he seems to say: "have you anything to do with it? or you? or you?" has not a dog mind enough for this? if we have observed a rabid dog at the commencement of the disease, we have seen this to the very life. there is a species of dog--the small french poodle--the essence of whose character and constitution is fidgetiness or perpetual motion. if this dog has been bitten, and rabies is about to establish itself, he is the most irritative restless being that can be conceived of; starting convulsively at the slightest sound; disposing of his bed in every direction, seeking out one retreat after another in order to rest his wearied frame, but quiet only for a moment in any one, and the motion of his limbs frequently stimulating chorea and even epilepsy. a peculiar delirium is an early symptom, and one that will never deceive. a young man had been bitten by one of his dogs; i was requested to meet a medical gentleman on the subject: i was a little behind my time; as i entered the room i found the dog eagerly devouring a pan of sopped bread. "there is no madness here," said the gentleman. he had scarcely spoken, when in a moment the dog quitted the sop, and, with a furious bark sprung against the wall as if he would seize some imaginary object that he fancied was there. "did you see that?" was my reply. "what do you think of it?" "i see nothing in it," was his retort: "the dog heard some noise on the other side of the wall." at my serious urging, however, he consented to excise the part. i procured a poor worthless cur, and got him bitten by this dog, and carried the disease from this dog to the third victim: they all became rabid one after the other, and there my experiment ended. the serious matter under consideration, perhaps, justified me in going so far as i did. this kind of delirium is of frequent occurrence in the human patient. the account given by dr. bardsley of one of his patients is very appropriate to on profit purpose: "i observed that he frequently fixed his eyes with horror and affright on some ideal object, and then, with a sudden and violent emotion, buried his head beneath the bed-clothes. the next time i saw him repeat this action, i was induced to inquire into the cause of his terror. he asked whether i had not heard howlings and scratchings. on being answered in the negative, he suddenly threw himself on his knees, extending his arms in a defensive posture, and forcibly threw back his head and body. the muscles of the face were agitated by various spasmodic contractions; his eye-balls glazed, and seemed ready to start from their sockets; and, at the moment, when crying out in an agonizing tone, 'do you not see that black dog?' his countenance and attitude exhibited the most dreadful picture of complicated horror, distress, and rage that words can describe or imagination paint." i have again and again seen the rabid dog start up after a momentary quietude, with unmingled ferocity depicted on his countenance, and plunge with a savage howl to the end of his chain. at other times he would stop and watch the nails in the partition of the stable in which he was confined, and fancying them to move he would dart at them, and occasionally sadly bruise and injure himself from being no longer able to measure the distance of the object. in one of his sudden fits of violence a rabid dog strangled the cardinal crescence, the legate of the pope, at the council of trent in . m. magendie has often injected into the veins of an hydrophobous dog as much as five grains of opium without producing any effect; while a single grain given to the healthy dog would suffice to send him almost to sleep. one of mr. babington's patients thought that there was a cloud of flies about him. "why do you not kill those flies!" he would cry; and then he would strike at them with his hand, and shrink under the bed-clothes, in the most dreadful fear. there is also in the human being a peculiarity in this delirium which seems to distinguish it from every other kind of mental aberration. "the patient," in mr. lawrence's language, "is pursued by a thousand phantoms that intrude themselves upon his mind; he holds conversation with imaginary persons; he fancies himself surrounded with difficulties, and in the greatest distress. these thoughts seem to pass through his mind with wonderful rapidity, and to keep him in a state of the greatest distress, unless he is quickly spoken to or addressed by his name, and, then, in a moment the charm is broken; every phantom of imagination disappears, and at once he begins to talk as calmly and as connectedly as in perfect health." so it is with the dog, whether he is watching the motes that are floating in the air, or the insects that are annoying him on the walls, or the foes that he fancies are threatening him on every side--one word recalls him in a moment. dispersed by the magic influence of his master's voice, every object of terror disappears, and he crawls towards him with the same peculiar expression of attachment that used to characterize him. then comes a moment's pause--a moment of actual vacuity--the eye slowly closes, the head droops, and he seems as if his fore feet were giving way, and he would fall: but he springs up again, every object of terror once more surrounds him--he gazes wildly around--he snaps--he barks, and he rushes to the extent of his chain, prepared to meet his imaginary foe. the expression of the countenance of the dog undergoes a considerable change, principally dependent on the previous disposition of the animal. if he was naturally of an affectionate disposition, there will be an anxious, inquiring countenance, eloquent, beyond the power of resisting its influence. it is made up of strange suppositions as to the nature of the depression of mind under which he labours, mingled with some passing doubts, and they are but passing, as to the concern which the master has in the affair; but, most of all, there is an affectionate and confiding appeal for relief. at the same time we observe some strange fancy, evidently passing through his mind, unalloyed, however, by the slightest portion of ferocity. in the countenance of the naturally savage brute, or him that has been trained to be savage, there is indeed a fearful change; sometimes the conjunctiva is highly injected; at other times it is scarcely affected, hut the eyes have an unusually bright and dazzling appearance. they are like two balls of fire, and there is a peculiar transparency of the hyaloid membrane, or injection of that of the retina. a very early symptom of rabies in the dog, is an extreme degree of restlessness. frequently, he is almost invariably wandering about, shifting from corner to corner, or continually rising up and lying down, changing his posture in every possible way, disposing of his bed with his paws, shaking it with his mouth, bringing it to a heap, on which he carefully lays his chest, or rather the pit of his stomach, and then rising up and bundling every portion of it out of the kennel. if he is put into a closed basket, he will not be still for an instant, but turn round and round without ceasing. if he is at liberty, he will seem to imagine that something is lost, and he will eagerly search round the room, and particularly every corner of it, with strange violence and indecision. in a very great portion of cases of hydrophobia in the human being, there is, as a precursory symptom, uneasiness, pain, or itching of the bitten part. a red line may also be traced up the limb, in the direction of the lymphatics. in a few cases the wound opens afresh. the poison is now beginning fatally to act on the tissue, on which it had previously lain harmless. when the conversation has turned on this subject, long after the bitten part has been excised, pain has darted along the limb. i have been bitten much oftener than i liked, by dogs decidedly rabid, but, proper means being taken, i have escaped; and yet often, when i have been over-fatigued, or a little out of temper, some of the old sores have itched and throbbed, and actually become red and swollen. the dog appears to suffer a great deal of pain in the ear in common canker. he will be almost incessantly scratching it, crying piteously while thus employed. the ear is, oftener than any other part, bitten by the rabid dog, and, when a wound in the ear, inflicted by a rabid dog, begins to become painful, the agony appears to be of the intensest kind. the dog rubs his ear against every projecting body, he scratches it might and main, and tumbles over and over while he is thus employed. the young practitioner should be on his guard there. is this dreadful itching a thing of yesterday, or, has the dog been subject to canker, increasing for a considerable period. canker both internal and external is a disease of slow growth, and must have been long neglected before it will torment the patient in the manner that i have described. the question as to the length of time that an animal has thus suffered will usually be a sufficient guide. the mode in which he expresses his torture will serve as another direction. he will often scratch violently enough when he has canker, but he will not roll over and over like a football except he is rabid. if there is very considerable inflammation of the lining membrane of the ear, and engorgement and ulceration of it, this is the effect of canker; but if there is only a slight redness of the membrane, or no redness at all, and yet the dog is incessantly and violently scratching himself, it is too likely that rabies is at hand. in the early stage of rabies, the attachment of the dog towards his owner seems to be rapidly increased, and the expression of that feeling. he is employed, almost without ceasing, licking the hands, or face, or any part he can get at. females, and men too, are occasionally apt to permit the dog, when in health, to indulge this filthy and very dangerous habit with regard to them. the virus, generated under the influence of rabies, is occasionally deposited on a wounded or abraded surface, and in process of time produces a similar disease in the person that has been so inoculated by it. therefore it is that the surgeon so anxiously inquires of the person that has been bitten, and of all those to whom the dog has had access, "has he been accustomed to lick you? have you any sore places about you that can by possibility have been licked by him?" if there are, the person is in fully as much danger as if he had been bitten, and it is quite as necessary to destroy the part with which the virus may have come in contact. a lady once lost her life by suffering her dog to lick a pimple on her chin. there is a beautiful species of dog, often the inhabitant of the gentleman's stable--the dalmatian or coach dog. he has, perhaps, less affection for the human species than any other dog, except the greyhound and the bull-dog; he has less sagacity than most others, and certainly less courage. he is attached to the stable; he is the friend of the horse; they live under the same roof; they share the same bed; and, when the horse is summoned to his work, the dog accompanies every step. they are certainly beautiful dogs, and it is pleasing to see the thousand expressions of friendship between them and the horse; but, in their continual excursions through the streets, they are exposed to some danger, and particularly to that of being bitten by rabid dogs. it is a fearful business when this takes place. the coachman probably did not see the affray; no suspicion has been excited. the horse rubs his muzzle to the dog, and the dog licks the face of the horse, and in a great number of cases the disease is communicated from the one to the other. the dog in process of time dies, the horse does not long survive, and, frequently too, the coachman shares their fate. i have known at least twenty horses destroyed in this way. a depraved appetite is a frequent attendant on rabies in the dog. he refuses his usual food; he frequently turns from it with an evident expression of disgust; at other times, he seizes it with greater or less avidity, and then drops it, sometimes from disgust, at other times because he is unable to complete the mastication of it. this palsy of the organs of mastication, and dropping of the food, after it has been partly chewed, is a symptom on which implicit confidence may be placed. some dogs vomit once or twice in the early period of the disease: when this happens, they never return to the natural food of the dog, but are eager for everything that is filthy and horrible. the natural appetite generally fails entirely, and to it succeeds a strangely depraved one. the dog usually occupies himself with gathering every little bit of thread, and it is curious to observe with what eagerness and method he sets to work, and how completely he effects his object. he then attacks every kind of dirt and filth, horse-dung, his own dung, and human excrement. some breeds of spaniels are very filthy feeders without its being connected with disease, but the rabid dog eagerly selects the excrement of the horse, and his own. some considerable care, however, must be exercised here. at the period of dentition, and likewise at the commencement of the sexual affection, the stomach of the dog, and particularly that of the bitch, sympathises with, or shares in, the irritability of the gums, and of the constitution generally, and there is a considerably perverted appetite. the dog also feels the same propensity that influences the child, that of taking hard substances into the mouth, and seemingly trying to masticate them. their pressure on the gums facilitates the passage of the new teeth. a young dog will, therefore, be observed gathering up hard substances, and, if he should chance to die, a not inconsiderable collection of them is sometimes found in the stomach. they are, however, of a peculiar character; they consist of small pieces of bone, slick, and coal. the contents of the stomach of the rabid dog, are often, or generally, of a most filthy description. some hair or straw is usually found, but the greater part is composed of horse-dung, or of his own dung, and it may be received as a certainly, that if he is found deliberately devouring it, he is rabid. some very important conclusions may be drawn from the appearance and character of the urine. the dog, and at particular times when he is more than usually salacious, may, and does diligently search the urining places; he may even, at those periods, be seen to lick the spot which another has just wetted; but, if a peculiar eagerness accompanies this strange employment, if, in the parlour, which is rarely disgraced by this evacuation, every corner is perseveringly examined, and licked with unwearied and unceasing industry, that dog cannot be too carefully watched, there is great danger about him; he may, without any other symptom, be pronounced to be decidedly rabid. i never knew a single mistake about this. much has been said of the profuse discharge of saliva from the mouth of the rabid dog. it is an undoubted fact that, in this disease, all the glands concerned in the secretion of saliva, become increased in bulk and vascularity. the sublingual glands wear an evident character of inflammation; but it never equals the increased discharge that accompanies epilepsy, or nausea. the frothy spume at the corners of the mouth, is not for a moment to be compared with that which is evident enough in both of these affections. it is a symptom of short duration, and seldom lasts longer than twelve hours. the stories that are told of the mad dog covered with froth, are altogether fabulous. the dog recovering from, or attacked by a fit, may be seen in this state; but not the rabid dog. fits are often mistaken for rabies, and hence the delusion. the increased secretion of saliva soon passes away. it lessens in quantity; it becomes thicker, viscid, adhesive, and glutinous. it clings to the corners of the mouth, and probably more annoyingly so to the membrane of the fauces. the human being is sadly distressed by it, he forces it out with the greatest violence, or utters the falsely supposed bark of a dog, in his attempts to force it from his mouth. this symptom occurs in the human being, when the disease is fully established, or at a late period of it. the dog furiously attempts to detach it with his paws. it is an early symptom in the dog, and it can scarcely be mistaken in him. when he is fighting with his paws at the corners of his mouth, let no one suppose that a bone is sticking between the poor fellow's teeth; nor should any useless and dangerous effort be made to relieve him. if all this uneasiness arose from a bone in the mouth, the mouth would continue permanently open instead of closing when the animal for a moment discontinues his efforts. if after a while he loses his balance and tumbles over, there can be no longer any mistake. it is the saliva becoming more and more glutinous, irritating the fauces and threatening suffocation. to this naturally and rapidly succeeds an insatiable thirst. the dog that still has full power over the muscles of his jaws continues lo lap. he knows not when to cease, while the poor fellow labouring under the dumb madness, presently to be described, and whose jaw and tongue are paralysed, plunges his muzzle into the water-dish to his very eyes, in order that he may get one drop of water into the back part of his mouth to moisten and to cool his dry and parched fauces. hence, instead of this disease being always characterised by the dread of water in the dog, it is marked by a thirst often perfectly unquenchable. twenty years ago, this assertion would have been peremptorily denied. even at the present day we occasionally meet with those who ought to know better, and who will not believe that the dog which fairly, or perhaps eagerly, drinks, can be rabid. january d, .--a newfoundland dog belonging to a gentleman in piccadilly was supposed to have swallowed a penny-piece on the th. on the evening of that day he was dull, refused his food, and would not follow his master. st. he became restless and pouting, and continually shifting his position. he would not eat nor would he drink water, but followed his mistress into her bed-room, which he had never done before, and eagerly lapped the urine from her chamber-pot. he was afterwards seen lapping his own urine. his restlessness and panting increased, he would neither eat nor drink, and made two or three attempts to vomit. d. he was brought to me this evening. his eyes were wild, the conjunctiva considerably inflamed, and he panted quickly and violently. there was a considerable flow of saliva from the corners of his mouth. he was extremely restless and did not remain in one position half a minute. there was an occasional convulsive nodding motion of the head. the eyes were wandering, and evidently following some imaginary object; but he was quickly recalled from his delirium by my voice or that of his master. in a few moments, however, he was wandering again. he had previously been under my care, and immediately recognised me and offered me his paw. his bark was changed and had a slight mixture of the howl, and there was a husky choking noise in the throat. i immediately declared that he was rabid, and with some reluctance on the part of his master, he was left with me. d, a. m. the breathing was less quick and laborious. the spasm of the head was no longer visible. the flow of saliva had stopped and there was less delirium. the jaw began to be dependent: the rattling, choking noise in his throat louder. he carried straw about in his mouth. he picked up some pieces of old leather that lay within his reach and carefully concealed them under his bed. two minutes afterwards he would take them out again, and look at them, and once more hide them. he frequently voided his urine in small quantities, but no longer lapped it. a little dog was lowered into the den, but he took no notice of it. p. m. every symptom of fever returned with increased violence. he panted very much, and did not remain in the same posture two seconds. he was continually running to the end of his chain and attempting to bite. he was eagerly and wildly watching some imaginary object. his voice was hoarser--more of the howl mixing with it. the lips were distorted, and the tongue very black. he was evidently getting weaker. after two or three attempts to escape, he would sit down for a second, and then rise and plunge to the end of his chain. he drank frequently, yet but little at a time, and that without difficulty or spasm. p. m. the thirst strangely increased. he had drunk or spilled full three quarts of water. there was a peculiar eagerness in his manner. he plunged his nose to the very bottom of his pan, and then snapped at the bubbles which he raised. no spasm followed the drinking. he took two or three pieces from my hand, but immediately dropped them from want of power to hold them. yet he was able for a moment suddenly to close his jaws. when not drinking he was barking with a harsh sound, and frequently started suddenly, watching, and catching at some imaginary object. th, a. m. he was more furious, yet weaker. the thirst was insatiable. he was otherwise diligently employed in shattering and tearing everything within his reach. he died about three o'clock. it is impossible to say what was the origin of this disease in him. it is not connected with any degree or variation of temperature, or any particular state of the atmosphere. it is certainly more frequent in the summer or the beginning of autumn than in the winter or spring, because it is a highly nervous and febrile disease, and the degree of fever, and irritability, and ferocity, and consequent mischief are augmented by increase of temperature. in the great majority of cases, the inoculation can be distinctly proved. in very few can the possibility be denied. the injury is inflicted in an instant. there is no contest, and before the injured party can prepare to retaliate, the rabid dog is far away. it can easily be believed that when a favourite dog has, but for a moment, lagged behind, he may be bitten without the owner's knowledge or suspicion. a spaniel belonging to a lady became rabid. the dog was her companion in her grounds at her country residence, and it was rarely out of her sight except for a few minutes in the morning, when the servant took it out. she was not conscious of its having been bitten, and the servant stoutly denied it. the animal died. a few weeks afterwards the footman was taken ill. he was hydrophobous. in one of his intervals of comparative quietude he confessed that, one morning, his charge had been attacked and rolled over by another dog; that there was no appearance of its having been bitten, but that it had been made sadly dirty, and he had washed it before he suffered it again to go into the drawing-room. the dog that attacked it must have been rabid, and some of his saliva must have remained about the coat of the spaniel, by which the servant was fatally inoculated. another case of this fearful disease must not be passed over. a dog that had been docile and attached to his master and mistress, was missing one morning, and came home in the evening almost covered with dirt. he slunk to his basket, and would pay no attention to any one. his owners thought it rather strange, and i was sent for in the morning. he was lying on the lap of his mistress, but was frequently shifting his posture, and every now and then he started, as if he heard some strange sound. i immediately told them what was the matter, and besought them to place him in another and secure room. he had been licking both their hands. i was compelled to tell them at once what was the nature of the case, and besought them to send at once for their surgeon. they were perfectly angry at my nonsense, as they called it, and i took my leave, but went immediately to their medical man, and told him what was the real state of the case. he called, as it were accidentally, a little while afterwards, and i was not far behind him. the surgeon did his duty, and they escaped. in may, , i attended on a bitch at pimlico. she had snapped at the owner, bitten the man-servant and several dogs, was eagerly watching imaginary objects, and had the peculiar rabid howl. i offered her water. she started back with a strange expression of horror, and fell into violent convulsions that lasted about a minute. this was repeated a little while afterwards, and with the same result. she was destroyed. the horrible spasms of the human being at the sight of, or the attempt to swallow, fluids occur sufficiently often to prove the identity of the disease in the biped and the quadruped; but not in one in fifty cases is there, in the dog, the slightest reluctance to liquids, or difficulty in swallowing them. in almost every case in which the dog utters any sound during the disease, there is a manifest change of voice. in the dog labouring under ferocious madness, it is perfectly characteristic. there is no other sound that it resembles. the animal is generally standing, or occasionally sitting, when the singular sound is heard. the muzzle is always elevated. the commencement is that of a perfect bark, ending abruptly and very singularly, in a howl, a fifth, sixth, or eighth higher than at the commencement. dogs are often enough heard howling, but in this case it is the perfect bark, and the perfect howl rapidly succeeding to the bark. every sound uttered by the rabid dog is more or less changed. the huntsman, who knows the voice of every dog in his pack, occasionally hears a strange challenge. he immediately finds out that dog, and puts him, as quickly as possible, under confinement. two or three days may pass over, and there is not another suspicious circumstance about the animal; still he keeps him under quarantine, for long experience has taught him to listen to that warning. at length the disease is manifest in its most fearful form. there is another partial change of voice, to which the ear of the practitioner will, by degrees, become habituated, and which will indicate a change in the state of the animal quite as dangerous as the dismal howl; i mean when there is a hoarse inward bark, with a slight but characteristic elevation of the tone. in other cases, after two or three distinct barks, will come the peculiar one mingled with the howl. both of them will terminate fatally, and in both of them the rabid howl cannot possibly be mistaken. there is a singular brightness in the eye of the rabid dog, but it does not last more than two or three days. it then becomes dull and wasted; a cloudiness steals over the conjunctiva, which changes to a yellow tinge, and then to a dark green, indicative of ulceration deeply seated within the eye. in eight and forty hours from the first clouding of the eye, it becomes one disorganised mass. there is in the rabid dog a strange embarrassment of general sensibility--a seemingly total loss of feeling. absence of pain in the bitten part is an almost invariable accompaniment of rabies. i have known a dog set to work, and gnaw and tear the flesh completely away from his legs and feet. at other times the penis is perfectly demolished from the very base. ellis in his "shepherd's sure guide," asserts, that, however severely a mad dog is beaten, a cry is never forced from him. i am certain of the truth of this, for i have again and again failed in extracting that cry. ellis tells that at the kennel at goddesden, some of the grooms heated a poker red hot, and holding it near the mad hound's mouth, he most greedily seized it, and kept it until the mouth was most dreadfully burned. in the great majority of cases of furious madness, and in almost every case of dumb madness, there is evident affection of the lumbar portion of the spinal cord. there is a staggering gait, not indicative of general weakness, but referable to the hind quarters alone, and indicating an affection of the lumbar motor nerve. in a few cases it approaches more to a general paralytic affection. in the very earliest period of rabies, the person accustomed to dogs will detect the existence of the disease. the animal follows the flight, as has been already stated, of various imaginary objects. i have often watched the changing countenance of the rabid dog when he has been lost to every surrounding object. i have seen the brightening countenance and the wagging tail as some pleasing vision has passed before him; but, oftener has the countenance indicated the mingled dislike and fear with which the intruder was regarded. as soon as the phantom came within the proper distance he darted on it with true rabid violence. a spaniel, seemingly at play, snapped, in the morning, at the feet of several persons. in the evening he bit his master, his master's friend, and another dog. the old habits of obedience and affection then returned. his master, most strangely, did not suspect the truth, and brought the animal to me to be examined. the animal was, as i had often seen him, perfectly docile and eager to be caressed. at my suggestion, or rather entreaty, he was left with me. on the following morning the disease was plain enough, and on the following day he died. a post-mortem examination took place, and proved that he was unequivocally rabid. a lady would nurse her dog, after i had declared it to be rabid, and when he was dangerous to every one but herself, and even to her from the saliva which he plentifully scattered about. at length he darted at every one that entered the room, until a footman keeping the animal at bay with the poker, the husband of the lady dragged her from the room. the noise that the dog made was then terrific, and he almost gnawed his way through the door. at midnight his violence nearly ceased, and the door was partially opened. he was staggering and falling about, with every limb violently agitated. at the entreaty of the lady, a servant ventured in to make a kind of bed for him. the dog suddenly darted at him, and dropped and died. a terrier, ten years old, had been ill, and refused all food for three days. on the fourth day he bit a cat of which he had been unusually fond, and he likewise bit three dogs. i was requested to see him. i found him loose in the kitchen, and at first refused to go in, but, after observing him for a minute or two, i thought that i might venture. he had a peculiarly wild and eager look, and turned sharply round at the least noise. he often watched the flight of some imaginary object, and pursued with the utmost fury every fly that he saw. he searchingly sniffed about the room, and examined my legs with an eagerness that made me absolutely tremble. his quarrel with the cat had been made up, and when he was not otherwise employed he was eagerly licking her and her kittens. in the excess or derangement of his fondness, he fairly rolled them from one end of the kitchen to another. with difficulty i induced his master to permit me to destroy him. it is not every dog, that in the most aggravated state of the disease shows a disposition to bite. the finest newfoundland dog that i ever saw became rabid. he had been bitten by a cur, and was supposed to have been thoroughly examined in the country. no wound, however, was found: the circumstance was almost forgotten, and he came up to the metropolis with his master. he became dull, disinclined to play, and refused all food. he was continually watching imaginary objects, but he did not snap at them. there was no howl, nor any disposition to bite. he offered himself to be caressed, and he was not satisfied except he was shaken by the paw. on the second day i saw him. he watched every passing object with peculiar anxiety, and followed with deep attention the motions of a horse, his old acquaintance; but he made no effort to escape, nor evinced any disposition to do mischief. i went to him, and patted and coaxed him, and he told me as plainly as looks and actions, and a somewhat deepened whine could express it, how much he was gratified. i saw him on the third day. he was evidently dying. he could not crawl even to the door of his temporary kennel; but he pushed forward his paw a little way, and, as i shook it, i felt the tetanic muscular action which accompanies the departure of life. on the other hand there are rabid dogs whose ferocity knows no bounds. if they are threatened with a stick, they fly at, and seize it, and furiously shake it. they are incessantly employed in darting to the end of their chain, and attempting to crush it with their teeth, and tearing to pieces their kennel, or the wood work that is within their reach. they are regardless of pain. the canine teeth, the incisor teeth are torn away; yet, unwearied and insensible to suffering, they continue their efforts to escape. a dog was chained near a kitchen fire. he was incessant in his endeavours to escape, and, when he found that he could not effect it, he seized, in his impotent rage, the burning coals as they fell, and crushed them with his teeth. if by chance a dog in this state effects his escape, he wanders over the country bent on destruction. he attacks both the quadruped and the biped. he seeks the village street, or the more crowded one of the town, and he suffers no dog to escape him. the horse is his frequent prey, and the human being is not always safe from his attack. a rabid dog running down park-lane, in , bit no fewer than five horses, and fully as many dogs. he was seen to steal treacherously upon some of his victims, and inflict the fatal wound. sometimes he seeks the more distant pasturage. he gets among the sheep, and more than forty have been fatally inoculated in one night. a rabid dog attacked a herd of cows, and five-and-twenty of them fell victims. in july, , a mad dog broke into the menagerie of the duchess of york, at oatlands, and although the palisades that divided the different compartments of the menagerie were full six feet in height, and difficult, or apparently almost impossible to climb, he was found asleep in one of them, and it was clearly ascertained that he had bitten at least ten of the dogs. at length the rabid dog becomes completely exhausted, and slowly reels along the road with his tail depressed, seemingly half unconscious of surrounding objects. his open mouth, and protruding and blackened tongue, and rolling gait sufficiently characterise him. he creeps into some sheltered place and then he sleeps twelve hours or more. it is dangerous to disturb his slumbers, for his desire to do mischief immediately returns, and the slightest touch, or attempt to caress him, is repaid by a fatal wound. this should be a caution never to meddle with a sleeping dog in a way-side house, and, indeed, never to disturb him anywhere. in an early period of the disease in some dogs, and in others when the strength of the animal is nearly worn away, a peculiar paralysis of the muscles of the tongue and jaws is seen. the mouth is partially open, and the tongue protruding. in some cases the dog is able to close his mouth by a sudden and violent effort, and is as ferocious and as dangerous as one the muscles of whose face are unaffected. at other times the palsy is complete, and the animal is unable to close his mouth or retract his tongue. these latter cases, however, are rare. a dog must not be immediately condemned because he has this open mouth and fixed jaw. bones constitute a frequent and a considerable portion of the food of dogs. in the eagerness with which these bones are crushed, spicula or large pieces of them become wedged between the molar teeth, and form an inseparable obstacle to the closing of the teeth. the tongue partially protrudes. there is a constant discharge of saliva from the mouth, far greater than when the true paralysis exists. the dog is continually fighting at the corners of his mouth, and the countenance is expressive of intense anxiety, although not of the same irritable character as in rabies. i was once requested to meet a medical gentleman in consultation respecting a supposed case of rabies. there was protrusion and discoloration of the tongue, and fighting at the corners of the mouth, and intense anxiety of countenance. he had been in this state for four-and-twenty hours. this was a case in which i should possibly have been deceived had it been the first dog that i had seen with dumb madness. after having tested a little the ferocity or manageableness of the animal, i passed my hand along the outside of the jaws, and felt a bone wedged between two of the grinders. the forceps soon set all right with him. it is time to inquire more strictly into the post-mortem appearances of rabies in the dog. in dumb madness the unfailing accompaniment is, to a greater or less degree, paralysis of the muscles of the lower jaw, and the tongue is discoloured and swollen, and hanging from the mouth; more blood than usual also is deposited in the anterior and inferior portion of it. its colour varies from a dark red to a dingy purple, or almost black. in ferocious madness it is usually torn and bruised, or it is discoloured by the dirt and filth with which it has been brought into contact, and, not unfrequently, its anterior portion is coated with some disgusting matter. the papillae, or small projections on the back of the tongue, are elongated and widened, and their mucous covering evidently reddened. the orifices of the glands of the tongue are frequently enlarged, particularly as they run their course along the froenum of the tongue. the fauces, situated at the posterior part of the mouth, generally exhibit traces of inflammation. they appear in the majority of cases of ferocious madness, and they are never deficient after dumb madness. they are usually most intense either towards the palatine arch or the larynx. sometimes an inflammatory character is diffused through its whole extent, but occasionally it is more or less intense towards one or both of the terminations of the fauces, while the intermediate portion retains nearly its healthy hue. there is one circumstance of not unfrequent occurrence, which will at once decide the case--the presence of indigestible matter, probably small in quantity, in the back part of the mouth. this speaks volumes as to the depraved appetite of the patient, and the loss of power in the muscles of the pharynx. little will depend on the tonsils of the throat. they occasionally enlarge to more than double their usual size; but this is more in quiet than in ferocious madness. the insatiable thirst of the rabid dog is perhaps connected with this condition of them. the epiglottis should be very carefully observed. it is more or less injected in every case of rabies. numerous vessels increase in size and multiply round its edge, and there is considerable injection and thickening. inflammation of the edges of the glottis, and particularly of the membrane which covers its margin, is often seen, and accounts for the harsh guttural breathing which frequently accompanies dumb madness. the inflammatory blush of the larynx, though often existing in a very slight degree, deserves considerable attention. the appearances in the trachea are very uncertain. there is occasionally the greatest intensity of inflammation through the whole of it; at other times there is not the slightest appearance of it. there is the same uncertainty with regard to the bronchial tubes and the lungs; but there is no characteristic symptom or lesion in the lungs. great stress has been laid on the appearance of the heart; but, generally speaking, in nine cases out of ten, the heart of the rabid dog will exhibit no other symptoms of disease than an increased yet variable deepness of colour in the lining membrane of the ventricles. no dependence can be placed on any of the appearances of the oesophagus; and, when they are at the worst, the inflammation occupies only a portion of that tube. with regard to the interior of the stomach, if the dog has been dead only a few hours the true inflammatory blush will remain. if four-and-twenty hours have elapsed, the bright red colour will have changed to a darker red, or a violet or a brownish hue. in a few hours after this, a process of corrosion will generally commence, and the mucous membrane will be softened and rendered thinner, and, to a certain extent, eaten through. the examiner, however, must not attribute that to disease which is the natural process of the cession of life. much attention should be paid to the appearance of the stomach and its contents. if it contains a strange mingled mass of hair, and hay, and straw, and horse-dung, and earth, or portions of the bed on which the dog had lain, we should seldom err if we affirmed that he died rabid; for it is only under the influence of the depraved appetite of rabies that such substances are devoured. it is not the presence of every kind of extraneous substance that will be satisfactory: pieces of coal, or wood, or even the filthiest matter, will not justify us in pronouncing the animal to be rabid; it is that peculiarly mingled mass of straw, and hair, and filth of various kinds, that must indicate the existence of rabies. when there are no solid indigesta, but a fluid composed principally of vitiated bile or extravasated blood, there will be a strong indication of the presence of rabies. when, also, there are in the duodenum and jejunum small portions of indigesta, the detection of the least quantity will be decisive. the remainder has been ejected by vomit; and inquiry should be made of the nature of the matter that has been discharged. the inflammation of rabies is of a peculiar character in the stomach. it is generally confined to the summits of the folds of the stomach, or it is most intense there. on the summits of the rugae there are effusions of bloody matter, or spots of ecchymosis, presenting an appearance almost like crushed black currants. there may be only a few of them; but they are indications of the evil that has been effected. from appearances that present themselves in the intestines, the bladder, the blood-vessels, or the brain, no conclusion can be drawn; they are simply indications of inflammation. we now rapidly, and for a little while, retrace our steps. what is the cause of this fatal disease, that has so long occupied our attention? it is the saliva of a rabid animal received into a wound, or on an abraded surface. in horses, cattle, sheep, swine, and the human being, it is caused by inoculation alone; but, according to some persons, it is produced spontaneously in other animals. i will suppose that a wound by a rabid dog is inflicted. the virus is deposited on or near its surface, and there it remains for a certain indefinite period of time. the wound generally heals up kindly; in fact, it differs in no respect from a similar wound inflicted by the teeth of an animal in perfect health. weeks and months, in some cases, pass on, and there is nothing to indicate danger, until a degree of itching in the cicatrix of the wound is felt. from its long-continued presence as a foreign body, it may have rendered the tissue, or nervous fibre connected with it, irritable and susceptible of impression, or it may have attracted and assimilated to itself certain elements, and rabies is produced. the virus does not appear to have the same effect on every animal. of four dogs bitten by, or inoculated from, one that is rabid, three, perhaps, would display every symptom of the disease. of four human beings, not more than one would become rabid. john hunter used to say not more than one in twenty; but that is probably erroneous. cattle appear to have a greater chance of escape, and sheep a still greater chance. the time of incubation is different in different animals. with regard to the human being, there are various strange and contradictory stories. some have asserted that it has appeared on the very day on which the bite was inflicted, or within two or three days of that time. dr. bardsley, on the other hand, relates a case in which twelve years elapsed between the bite and the disease. if the virus may lurk so long as this in the constitution, it is a most lamentable affair. according to one account, more than thirty years intervened. the usual time extends from three weeks to six or seven months. in the dog i have never seen a case in which plain and palpable rabies occurred in less than fourteen days after the bite. the average time i should calculate at five or six weeks. in three months i should consider the animal as tolerably safe. i am, however, relating my own experience, and have known but two instances in which the period much exceeded three months. in one of these five months elapsed, and the other did not become affected until after the expiration of the seventh month. the quality and the quantity of the virus may have something to do with this, and so may the predisposition in the bitten animal to be affected by the poison. if it is connected with oestrum, the bitch will probably become a disgusting, as well as dangerous animal; if with parturition, there is a strange perversion of maternal affection--she is incessantly and violently licking her young, continually shifting them from place to place; and, in less than four-and-twenty hours, they will be destroyed by the reckless manner in which they are treated. in both cases the development of the disease seems to wait on the completion of her time of pregnancy. it appears in the space of two months after the bite, if her parturition is near at hand, or it is delayed for double that time, if the period of labour is so far distant. the duration of the disease is different in different animals. in man it has run its course in twenty-four hours, and rarely exceeds seventy-two. in the horse from three to four days; in the sheep and ox from five to seven; and in the dog from four to six. of the real nature of the rabid virus, we know but little. it has never been analysed, and it would be a difficult process to analyse it. it is not diffused by the air, nor communicated by the breath, nor even by actual contact, if the skin is sound. it must be received into a wound. it must come in contact with some tissue or nervous fibre, and lie dormant there for a considerable, but uncertain period. the absorbents remove everything around; whatever else is useless, or would he injurious, is taken away, but this strange substance is unchanged. it does not enter into the circulation, for there it would undergo some modification and change, or would be rejected. it lies for a time absolutely dormant, and far longer than any other known poison; but, at length, the tissue on which it has lain begins to render it somewhat sensible, and assimilates to itself certain elements. the cicatrix begins to be painful, and inflammation spreads around. the absorbents are called into more powerful action; they begin to attack the virus itself, and a portion of it is taken up, and carried into the circulation, and acquires the property of assimilating other secretions to its own nature, or it is determined to one of the secretions only; it alters the character of that secretion, envenoms it, and gives it the power of propagating the disease. something like this is the history of many animal poisons. in variola and the vaccine disease the poison is determined to the skin, in glanders to the schneiderian membrane, and in farcy to the superficial absorbents. each in its turn becomes the depot of the poison. so it is with the salivary glands of the rabid animal; in them it is formed, or to them it is determined, and from them, and them alone, it is communicated to other animals. professor dick, in his valuable manual of veterinary science, states some peculiar views, and those highly interesting, respecting the disease of rabies. he holds it to be essentially an inflammatory affection, attacking peculiarly the mucous membrane of the nose, and extending thence through the cribriform plate of the ethmoid bones to the interior part of the brain, and so giving rise to a derangement of the nervous system as a necessary consequence. this train of symptoms constitutes mainly, if not wholly, the essence of an occasional epidemic not unlike some forms of influenza or epizootic disease, and the bite of a rabid animal is not always, to an animal so bitten, the exciting cause of the disease, but merely an accidental concomitant in the prevailing disorder. also the disease hydrophobia, produced in man, is not always the result of any poison introduced into his system, but merely the melancholy, and often fatal result of panic fear, and of the disordered slate of the imagination. those who are acquainted with the effects of sympathy, and imitation, and panic, in the production of nervous disorders, will readily apprehend the meaning of the professor. some of these diseases speedily run their course and exhaust themselves. cowpox and farcy, in many instances, have this character. perhaps, to a certain degree, this may be affirmed of all of them. i have seen cases, which i could not mistake, in which the symptoms of rabies were one after another developed. the dog was plainly and undeniably rabid, and i had given him up as lost; but, after a certain period, the symptoms began to be less distinct; they gradually disappeared, and the animal returned to perfect health. this may have formed one ground of belief in the power of certain medicines, and most assuredly it gives encouragement to perseverance in the use of remedial measures. it has then been proved, and i hope demonstratively, that rabies is propagated by inoculation. it has also been established that although every animal labouring under this disease is capable of communicating it, yet, with very few exceptions, it can be traced to the bite of the dog. it has still further been shown that the malady, generally appears at some period between the third and seventh month from the time of inoculation. at the expiration of the eighth month, the animal may be considered to be safe; for there is only one acknowledged case on record, in which the disease appeared in the dog after the seventh month from the bite had passed. then it would appear that if a species of quarantine could be established, and every dog confined separately for eight months, the disease would be annihilated in our country, or could only reappear in consequence of the importation of some infected animal. such a course of proceeding, however, could never be enforced either in the sporting world or among the peasantry. other measures, however, might be resorted to in order to lessen the devastations of this malady; and that which first presents itself to the mind as a powerful cause of rabies is the number of useless and dangerous dogs that are kept in the country for the most nefarious and, in the neighbourhood of considerable towns, the most brutal purposes; without the slightest hesitation, i will affirm that rabies is propagated, nineteen times out of twenty, by the cur and the lurcher in the country, and the fighting-dog in towns. a tax should be laid on every useless dog, and doubly or trebly heavier than on the sporting-dog. no dog except the shepherd's should be exempt from this tax, unless, perhaps, it is the truck-dog, and his owner should be compelled to take out a license; to have his name in large letters on his cart; and he should be heavily fined if the animal is found loose in the streets, or if he is used for fighting. the disease is rarely propagated by petted and house-dogs they are little exposed to the danger of inoculation; yet, we pity, or almost detest, the folly of those by whom their favourites are indulged, and spoiled even more than their children. we will now suppose that a person has had the misfortune to be bitten by a rabid dog: what course is he to pursue? what preventive means are to be adopted? some persons, and of no mean standing in the medical world, have recommended a ligature. the reply would be, that this ligature must be worn during a very inconvenient and dangerous period of time. the virus lies in the wound inert during many successive weeks and months. dr. haygarth first suggested that a long-continued stream of warm water should be poured upon the wound from the mouth of a kettle. he says that the poison exists in a fluid form, and therefore we should suppose that water would be its natural solvent. dr. massey adds to this, that if the wound is small, it should be dilated, in order that the stream may descend on the part on which the poison is deposited. we are far, however, from being certain that this falling of water on the part, may not by possibility force a portion of the virus farther into the texture, or cause it to be entangled with other parts of the wound. [ ] there is a similar or stronger objection to the cupping-glass of dr. barry. the virus, forced from the texture with which it lies in contact by the rush of blood from the substance beneath, is too likely to inoculate, or become entangled with, other parts of the wound. there is great objection to suction of the wound; for, in addition to this possible entanglement, the lips, or the mouth, may have been abraded, and thus the danger considerably aggravated. there also remains the undecided question as to the absorption of the virus through the medium of a mucous surface. excision of the part is the mode of prevention usually adopted by the human surgeon, and to a certain extent it is a judicious practice. if the virus is not received into the circulation, but lies dormant in the wound for a considerable time, the disease cannot supervene if the inoculated part is destroyed. this operation, however, demands greater skill and tact than is generally supposed. it requires a determination fully to accomplish the desired object; for every portion of the wound with which the tooth could possibly have come into contact, must be removed. this is often exceedingly difficult to accomplish, on account of the situation and direction of the wound. the knife must not enter the wound, or it will be likely to be itself empoisoned, and then the mischief and the danger will be increased instead of removed. dr. massey was convinced of the impropriety of this when he advised that, "should the knife by chance enter the wound that had been made by the dog's tooth, the operation should be recommenced with a clean knife, otherwise the sound parts will become inoculated." if the incision is made freely and properly round the wound, and does not penetrate into it, yet the blood will follow the knife, and a portion of it will enter into the wound caused by the dog, and will come in contact with the virus, and will probably be contaminated, and will then overflow the original wound, and will be received into the new incision, and will carry with it the seeds of disease and death: therefore it is, that scarcely a year passes without some lamentable instances of the failure of incisions. it has occurred in the practice of the most eminent surgeons, and seems scarcely or not all to impeach the skill of the operator. aware of this, there are very few human practitioners who do not use the caustic after the knife. every portion of the new wound is submitted to its influence. they do not consider the patient to be safe without this second operation. but has the question never occurred to them, that if the caustic is necessary to give security to the operation by incision, the knife might have been spared, and the caustic alone used? the veterinary surgeon, when operating on the horse, or cattle, or the dog, frequently has recourse to the actual cautery. i could, perhaps, excuse this practice, although i would not adopt it, in superficial wounds; but i do not know the instrument that could be safely used in deeper ones. if it were sufficiently small to adapt itself to the tortuous course of little wounds, it would be cooled and inert before it could have destroyed the lower portions of them. if it were of sufficient substance long to retain the heat, it would make a large and fearful chasm, and probably interfere with the future usefulness of the animal. the result of the cases in which the cautery has been used proves that in too many instances it is an inefficient protection. the rabid dog in park lane has already been mentioned. he bit several horses before he could be destroyed. caustic was applied to one of them, and the hot iron to the others. the first was saved, almost all the others were lost. a similar case occurred last spring; the caustic was an efficacious preventive; the cautery was perfectly useless. what caustic then should be applied? certainly not that to which the surgeon usually has recourse--a liquid one. certainly not one that speedily deliquesces; for they are both unmanageable, and, what is a more important consideration, they may hold in solution, and not decompose the poison, and thus inoculate the whole of the wound. the application which promises to be successful, is that of the 'lunar caustic'. it is perfectly manageable, and, being sharpened to a point, may be applied with certainty to every recess and sinuosity of the wound. potash and nitric acid form a caustic which will destroy the substances with which they come in contact, but the combination of this caustic and the animal fibre will be a soft or semi-fluid mass. in this the virus is suspended, and with this it lies or may be precipitated upon the living fibre beneath. then there is danger of re-inoculation; and it would seem that this fatal process is often accomplished. the eschar formed by the lunar caustic is dry, hard, and insoluble. if the whole of the wound has been fairly exposed to its action, an insoluble compound of animal fibre and the metallic salt is produced, in which the virus is wrapped up, and from which it cannot be separated. in a short time the dead matter sloughs away, and the virus is thrown off with it. previous to applying the caustic it will sometimes be necessary to enlarge the wound, in order that every part may be fairly got at; and the eschar having sloughed off, it will always be prudent to apply the caustic a second time, but more slightly, in order to destroy any part that may not have received the full influence of the first operation, or that, by possibility, might have been inoculated during the operation. mr. smerdon, in the medical and physical journal, march , thus reasons: "all the morbid poisons that require to lie dormant a certain time before their effects are manifested, pass into the system through the medium of the absorbents," (we somewhat differ from mr. smerdon here, but his reasoning is equally applicable to the nervous system,) "and if the absorbents are excited, their action is increased. i am satisfied that even in a venereal sore the application of a caustic, instead of destroying the disease, causes its rapid extension. then," asks he, "if the virus on a small venereal sore is rendered more active by the caustic, is it not highly probable that the same law holds good with respect to the poison of rabies?" the sooner the caustic is applied the better; but i should not hesitate to have recourse to it even after the constitution has become affected. it is related in the medico-chirurgical annals of altenburg (sept. ), that two men were bitten by a rabid dog. one became hydrophobous and died; the other had evident symptoms of hydrophobia a few days afterwards. a surgeon excised the bitten part, and the disease disappeared. after a period of six days the symptoms returned. the wound was examined; considerable fungus was found sprouting from its bottom. this was extirpated. the hydrophobia symptoms were again removed, and the man did well. this is a most instructive case. in the journal pratique de médecine vétérinaire, m. damalix gives an interesting account of the effect of a bite of a rabid dog on a horse. on the th of july, , a fowl-merchant, proceeding to the market of colmar, was attacked by a dog, who, after some fruitless efforts to get into the cart, bit the horse on the left side of the face, and fled precipitately. a veterinary surgeon was sent for, who applied the cautery to the horse, gave him some populeum ointment, and bled him. everything appeared to go on well, and on the th the wounds were healed. on the th a great alteration took place. the horse was careless and slow; he sometimes refused to go at all, and would not attend in the least to the whip, which had never occurred before. in the evening the wounds opened spontaneously, an ichorous and infectious pus run from them; there was salivation and utter loss of appetite: strange fancies seemed to possess him; he showed a desire to bite his master. the veterinary surgeon might approach him with safety; but the moment his owner or the children appeared, he darted at them, and would have torn them in pieces. the disease now took on the appearance of acute glanders; livid and fungous wounds broke out; the stable was saturated with an infectious smell, the horse refused his food, or was unable to eat. the mayor at last interfered, and the animal was destroyed. in the treatises on the horse, cattle, and sheep, in former volumes, accounts are fully given of this dreadful malady in these animals. it may not be uninteresting to give a hasty sketch of it in some of the inferior classes. 'rabies in the rabbit.'--i very much regret that i never instituted a course of experiments on the production and treatment of rabies in this animal. it would have been attended with little expense or danger, and some important discoveries might have been made. mr. earle, in a case in which he was much interested, inoculated two rabbits with the saliva of a dog that had died rabid. they were punctured at the root of the ears. one of the rabbits speedily became inflamed about the ears, and the ears were paralysed in both rabbits. the head swelled very much, and extensive inflammation took place around the part where the virus was inserted. one of them died without exhibiting any of the usual symptoms of the disease; the other, after a long convalescence, survived, and eventually recovered the use of his ears. mr. earle very properly doubted whether this was a case of rabies. dr. capello describes, but in not so satisfactory a manner as could be wished, a case of supposed rabies in one of these animals. a rabbit and a dog lived together in a family. they were strange associates; but such friendships are not unfrequent among animals. the dog became rabid, and died. a man bitten by that dog became hydrophobous, and died. no one dreamed of the rabbit being in danger, and he ran about the house as usual; but, one day, he found his way to the chamber of the mistress of the house, with a great deal of viscid saliva running from his mouth, furiously attacked her, and left the marks of his violence on her leg. he then ran into a neighbouring stable, and bit the hind-legs of a horse several times. finally, he retreated to a corner of the stable, and was there found dead. neither the lady nor the horse eventually suffered. 'rabies in the guinea-pig'.--a man suspected of being hydrophobous was taken to the middlesex hospital. he was examined before several of the medical students; one of whom, in order to make more sure of the affair, inoculated a guinea-pig with the saliva taken from the man's mouth. the guinea-pig had been usually very playful, and fond of being noticed; but, on the eleventh day after this inoculation, he began to be dull and sullen, retiring into his house, and hiding himself as much as he could in a corner. on the following day he became out of temper, and even ferocious in his way; he bit at everything that was presented to him, gnawed his cage, and made the most determined efforts to escape. once or twice his violence induced convulsions of his whole frame; and they might be produced at pleasure by dashing a little water at him. in the course of the night following he died. 'rabies in the cat'.--fortunately for us, this does not often occur; for a mad cat is a truly ferocious animal. i have seen two cases, one of them to my cost; yet, i am unable to give any satisfactory account of the progress of the disease. the first stage seems to be one of sullenness, and which would probably last to death; but from that sullenness it is dangerous to rouse the animal. it probably would not, except in the paroxysm of rage, attack any one; but during that paroxysm it knows no fear, nor has its ferocity any bounds. a cat, that had been the inhabitant of a nursery, and the playmate of the children, had all at once become sullen and ill-tempered. it had taken refuge in an upper room, and could not be coaxed from the corner in which it had crouched. it was nearly dark when i went. i saw the horrible glare of her eyes, but i could not see so much of her as i wished, and i said that i would call again in the morning. i found the patient, on the following day, precisely in the same situation and the same attitude, crouched up in a corner, and ready to spring. i was very much interested in the case; and as i wanted to study the countenance of this demon, for she looked like one, i was foolishly, inexcusably imprudent. i went on my hands and knees, and brought my face nearly on a level with hers, and gazed on those glaring eyes, and that horrible countenance, until i seemed to feel the deathly influence of a spell stealing over me. i was not afraid, but every mental and bodily power was in a manner suspended. my countenance, perhaps, alarmed her, for she sprang on me, fastened herself on my face, and bit through both my lips. she then darted down stairs, and, i believe, was never seen again. i always have nitrate of silver in my pocket, even now i am never without it; i washed myself, and applied the caustic with some severity to the wound; and my medical adviser and valued friend, mr. millington, punished me still more after i got home. my object was attained, although at somewhat too much cost, for the expression of that brute's countenance will never be forgotten. the later symptoms of rabies in this animal, no one, perhaps, has had the opportunity of observing: we witness only the sullenness and the ferocity. 'rabies in the fowl'.--dr. ashburner and mr. king inoculated a hen with the saliva from a rabid cow. they made two incisions through the integument, under the wings, and then well rubbed into these cuts the foam taken from the cow's mouth. she was after this let loose among other fowls in the poultry-yard. the incisions soon healed, and their places could with difficulty be discovered. ten weeks passed over, when she was observed to refuse her food, and to run at the other fowls. she had a strange wild appearance, and her eyes were blood-shot. early on the following morning her legs became contracted, so that she very soon lost the power of standing upright. she remained sitting a long time, with the legs rigid, refusing food and water, and appearing very irritable when touched. she died in the evening, immediately after drinking a large quantity of water which had been offered to her. 'rabies in the badger'.--hufeland, in his valuable journal of practical medicine, relates a case of a rabid female badger attacking two boys. she bit them both, but she fastened on the thigh of one of them, and was destroyed in the act of sucking his blood. the poor fellow died hydrophobous, but the other escaped. this fact, certainly, gives us no idea of the general character of the disease in this animal; but it speaks volumes as to its ferocity. 'rabies in the wolf'.--rabies is ushered in by nearly the same symptoms, and pursues the same course in the wolf us in the dog, with this difference, which would be readily expected, that his ferocity and the mischief which he accomplishes are much greater. the dog hunts out his own species, and his fury is principally directed against them; although, if he meets with a flock of sheep, or a herd of cattle, he readily attacks them, and, perhaps, bites the greater part of them. the dog, however, frequently turns out of his way to avoid the human being, and seldom attacks him without provocation. the wolf, on the contrary, although he commits fearful ravages among the sheep and cattle, searches out the human being as his favorite prey. he conceals himself near the entrance to the village, and steals upon and wounds every passenger that he can get at. there are several accounts of more than twenty persons having been bitten by one wolf; and there is a fearful history of sixteen persons perishing from the bite of one of these animals. this is in perfect agreement with the account which i have given of the connexion between the previous temper and habits of the rabid dog, and the mischief that he effects under the influence of this malady. the wolf, as he wanders in the forest, regards the human being as his persecutor and foe; and, in the paroxysm of rabid fury, he is most eager to avenge himself on his natural enemy. strange stories are told of the arts to which he has recourse in order to accomplish his purpose. in the great majority of cases he steals unawares upon his victim, and the mischief is effected before the wood-cutter or the villager is conscious of his danger. the following observations and experiments respecting rabies, by dr. hertwich, professor at the veterinary school at berlin, are well worthy of attention. . out of fifty dogs that had been inoculated with virus taken from a rabid animal of the same species, fourteen only were infected. . in the cases where inoculation had been practised without effect, no reason could be assigned why the disease should not have taken place. this consequently proves that the malady is similar to others of a contagious nature, and that there must exist a predisposition in the individual to receive the disease before it can occur. in one experiment, a mastiff dog, aged four years, was inoculated without exhibiting any symptoms of the malady, while seven others, who had been inoculated at the same time and place, soon became rabid. several of these animals had been inoculated several times before any symptoms showed themselves, while in others, on the contrary, once was sufficient. . it appears that in a state of doubtful rabies, one or two accidental or artificial inoculations are not sufficient to create a negative proof of its existence. . this disease has never ben communicated to an individual from one infected by means of the perspirable matter; this, therefore, is a proof that the contagious part of the disease is not of a volatile nature. . it does not only exist in the saliva and the mucus of the mouth, but likewise in the blood and the parenchyma of the salivary glands; but not in the pulpy substance of the nerves. . the power of communicating infection is found to exist in all stages of the confirmed disease, even twenty-four hours after the decease of the rabid animal. . the morbid virus, when administered internally, appears to be incapable of communicating this disease; inasmuch as of twenty dogs to whom was given a certain quantity, not one exhibited the least symptom of rabies. . the application of the saliva upon recent wounds appears to have been as often succeeded by confirmed rabies as when the dog had been bitten by a rabid animal. . it cannot now be doubled that the disease is produced by the wound itself, as was supposed by m. girard of lyons, not by the fright of the individual, according to the opinion of others, but only from the absorption of the morbid virus from its surface. . several experiments have proved to me the little reliance there is to be placed on the opinions of baden and capello, who believe that, in those dogs who become rabid after the bite of an animal previously attacked with this disease, the contagious properties of the saliva is not continued, but only exists in those primarily bitten. . during the period of incubation of the virus there are no morbid, local, or general alterations of structure or function to be seen in the infected animal; neither are there any vesicles to be perceived on the inferior surface of the tongue, nor any previous symptoms which are found in other contagious diseases. . this disease is generally at its height at the end of fifty days after either artificial or accidental inoculation; and the author has never known it to manifest itself at a later period. . it is quite an erroneous idea to suppose that dogs in a state of health are enabled to distinguish, at first sight, a rabid animal, inasmuch as they never refuse their food when mixed with the secretions of those infected. [ ] the following singular trial respecting the death of a child by hydrophobia is worth quoting: 'jones v. parry.'--the plaintiff is a labourer, who gets only fourteen shillings a week to support himself and his family. the defendant is his neighbour, and keeps a public-house. this was an action brought by the plaintiff to recover damages against the defendant for the loss of his son, who was bitten by the defendant's dog, and afterwards became affected with rabies, of which disease he died. it appeared in the evidence that the defendant's dog had, some time ago, been bitten by another dog; in consequence of which this dog was tied in the cellar, but the length of the rope which was allowed him enabled him to go to a considerable distance. the plaintiff's child knew the dog, having often played with him when he was at large. some time ago the child crossed the street, near to the place where the dog was fastened, who rushed out of the place in which he was confined to where the child stood, sprung upon him, and bit him sadly in the face, and afterwards violently shook him. the child being thus wounded, a surgeon was sent for, who, after having dressed him, and attended him for a certain time, gave directions that he should be taken to the sea-side, and bathed in the salt water. this having been continued for some time, the child was brought home, and, at the expiration of a month from the day on which he was bitten, became evidently and strangely ill. the surgeon proved beyond all shadow of doubt thai the child laboured under rabies; that he had the never-failing symptoms of that dreadful affliction; and that a little while before he expired, he even barked like a dog. the surgeon's charge to the father for his attendance was'£ . s. d.', which, together with the charge of the undertaker for the funeral of the child, amounted to between six and seven pounds. application was made to the defendant to defray this expense, which at first he expressed a willingness to comply with, but afterwards refused; upon which this action was brought. after some time the defendant offered to pay the plaintiff the sum of '£ . s. d.', and the expense of the funeral and the surgeon, provided the plaintiff would bear the expenses of the lawsuit, which he was not in a condition to do, as probably it would amount to more than that money. on this account, therefore, the action was now brought into court. there was no proof that the defendant knew or suspected his dog to be mad, previously to his attacking the boy; but an animal known to have been bitten by a mad dog, ought either to have been at once destroyed, or so secured that it was impossible for him to do mischief. lord kenyon observed to the jury, that this was one of those causes which came home to the feelings of all, yet must not be carried farther than justice demanded. a cause like this never, perhaps, before occurred in a court of justice; but there had been many resembling it in point of principle. if a dog, known to be ill-tempered and vicious, did any person an injury without provocation, there could be no question that the owner of the dog was answerable, in a court of justice, for the injury inflicted. here was a worse case. the dog by whom the child was bitten had been attacked by another that was undeniably rabid. his master was aware of this, and placed him in a state of partial confinement--a confinement so lax, and so inefficient, that this poor child had broken through it, and was bitten and died. what other people would have done in such a situation he could not tell; but, if he were asked what he would do, he answered, he certainly would kill the dog, however much of a favourite he had been, because no atonement was within the reach of his fortune to make to the injured party for such a dreadful visitation of providence as this. it was not enough for the owner of such a dog to say, he took precaution to prevent mischief: he ought to have made it impossible that mischief could happen; and, therefore, as soon as there was any reasonable suspicion that the dog was rabid, he ought to have destroyed him. but, if the owner wished to save the animal, until he was satisfied of the actual state of the case, he ought to have secured him, so that every individual might be safe. whether the defendant thought he had done all that was necessary, his lordship did not know; but this he knew, that the dog was not perfectly secured, otherwise this misfortune could not have happened. the care which the defendant took in this case was not enough, and, therefore, he had no doubt that this action was maintainable. the jury would judge what damages they ought to give. he would refer this to their feelings. they could not avoid commiserating the distress of the family of this poor man. he should, however, observe to the jury, that they must not give vindictive damages; but still he did not think that damages merely to the amount of '£ '. or '£ '., which was stated to be the expense of the funeral, &c., would at all meet the justice of the case. he was inclined to advise them to go beyond that, although he did not plead vindictive damages. there would be costs to be defrayed by the plaintiff, well known in the profession under the head of "extra costs," even although he had a verdict. if the verdict had been at his disposal, he would have taken care that these costs should have been borne by the party that had been the cause of the injury. that appeared to him to be the justice of the case. he trusted that none who heard him would doubt his sincerity, when he said, he lamented the misfortune which had given birth to this action; and, with that qualification of the case, he must say that he was not sorry that this action had been brought. he thanked the plaintiff for bringing it; for it might be of public benefit. it would teach a lesson that would not soon be forgotten, "that a person, who knowingly keeps a vicious, dangerous animal, should be considered to be answerable for all the acts of that animal." there were instances in which very large damages had been given to repair such injuries. he did not say that the present case called for large damages; but, if other cases of the same kind should be brought into court after this had been made public, he hoped the jury would go beyond the ordinary limits, and give verdicts which might operate 'in terrorem' on the offending parties. verdict for the plaintiff--damages £ . [ ] a child was bitten by a rabid dog at york, and became hydrophobous. all possibility of relief having vanished, the parents, desirous of putting an end to the agony of their child, or fearful of its doing mischief, smothered it between two pillows. they were tried for murder, and found guilty. they were afterwards pardoned; but the intention of the prosecutor was that of deterring others from a similar practice, in a like unfortunate situation [ ]. in , a physician, at poissy, was sentenced to pay francs (£ ) to a poor widow whose husband died of hydrophobia, in consequence of a bite from the physician's dog, he knowing that the dog had been bitten, yet not confining him. [our author having written so extensively upon the subject of rabies, it would seem superfluous in us to attempt to add anything more upon a subject so ably and practically handled by one having so great opportunities to make personal observations. however, to allay the feelings of many of our dogkilling citizens, we will not hesitate to assert that we do not place as much credence in the frequency of rabies as is generally done; but, on the other hand, are strongly led to believe that the accounts of this much-dreaded malady are greatly exaggerated both in this country and in england. that there may be a few cases of rabies in our country in the course of a year, we do not doubt; but, at the same time, we are satisfied that the affection in its genuine form is quite rare, and that the great hue and cry made every season about mad dogs, is more the result of ignorance and fright than of reality. our limits in this publication would not allow us sufficient space to enlarge upon the many pathological questions naturally arising from a minute examination of this subject, more particularly as our views are somewhat at variance with the generally received opinion, and which, of course, we would be forced to express with considerable diffidence, owing to the impossibility of collecting such evidence as might seem necessary to substantiate any peculiar doctrine. that tetanus, hysteria, and other spasmodic affections have often been mistaken for rabies, there is no doubt, and we can easily imagine the mental effect produced upon an individual of a highly nervous temperament, by the knowledge of his being bitten by an animal known to be hydrophobic; and we can, without difficulty, reconcile with our best judgment the belief 'that the workings of such an individual's imagination, occasioned by the never-ceasing dread of the horrid malady to which he is now exposed, might be sufficient to produce a train of symptoms somewhat resembling the actual state of rabies.' for the benefit of these nervous unfortunates, we might say to them, that the statistics of this affection show a very considerable ratio in favour of escape from inoculation when bitten, or of entire recovery even after the development of the disease, and that there are many other ills in the catalogue of medicine that they should take equal pains to provide against as lyssa canina. we doubt not that the minds of many will be relieved, when informed that john hunter mentions an instance, in which, out of twenty persons bitten by a rabid dog, only one suffered from the malady; and that of fifty-nine dogs inoculated by professor hertwick at the veterinary school of berlin, only fourteen were affected; and of eleven patients entrusted to the care of m. blaise of cluny, seven recovered after exhibiting greater or less degrees of spasmodic symptoms. it may prove interesting to our readers, to insert in these pages an account of the first two cases of rabies known in philadelphia, and as related to us by a venerable and much-esteemed citizen, who is well known in the scientific world as a gentleman of deep research, and we agree with him in opinion, that this much-dreaded disease is most frequently the result of like causes, or rather that like symptoms often induce the belief of the presence of this malady, when, in fact, no such disease does exist. towards the close of the last century, there lived a tailor in front street, near market, in the midst of the most respectable people of that period; among the number was our esteemed friend mr. hembel, as also judge tilghman. this tailor possessed an ill-tempered little spaniel, who, lounging about the street-door, attacked every one that passed by, snapping and snarling in the most worrisome manner, more particularly at every little urchin that invaded his "right of pavement," and not unfrequently biting them or tearing their clothes from their back. the owner of the dog was appealed to on many occasions by the neighbours, begging that the quarrelsome brute should either be disposed of or kept within doors. to all these solicitations and warnings the little tailor paid no heed, but continued stitching his breeches and cribbing his customers' goods, while the ugly little spaniel, without interruption, amused himself by snapping at and biting the heels of the passers-by. the nuisance at last became insufferable, and judge tilghman applied to mr. hembel to assist him in getting rid of this troublesome brute; the latter gentleman advised the administration of a small quantity of strychnia, concealed in a portion of meat, which proposition was agreed upon and immediately carried into execution. a short time after the administering of this dose the spaniel sickened, and retired from his post to the kitchen, which was in the basement, and where an irish domestic was engaged in washing; the dog appeared uneasy for a time, and suddenly, being taken with the involuntary muscular convulsions that so frequently follow the administration of this powerful drug, ran around the kitchen yelping and howling at a most terrible rate, and ultimately, to the no small discomfiture and amazement of the maid, sprang up into the wash-tub, at which unceremonious caper, on the part of the dog, the woman became greatly alarmed and ran out into the street, followed by the whole household, crying mad dog, which soon produced an uproar in the neighbourhood, no one daring to satisfy himself as to the correctness of the report, and all, perhaps, too ignorant of the subject to discern the real cause of the animal's singular behaviour. the tailor, still bearing a strong attachment to his unfortunate favourite, and being somewhat more daring than his neighbours, ventured, at length, to peep into the kitchen to see the state of affairs, and seeing the dog still convulsed and foaming at the mouth, was more than ever confirmed in the belief of hydrophobia, and knowing full well the biting propensities of the animal, independent of rabies, concluded, much to the relief of every one, to shoot him. the next step in the programme was the dragging out and consigning of the patient to a watery grave, which was accomplished by placing, with a pair of tongs, a noose over the head of the animal, and thus hauling him out of the basement window amid the cheers of the assembled populace who soon cast him into the delaware. the second case of rabies as related to us by mr. hembel was as follows:--in the barbers of the city were in the habit of going around to the various boarding-houses for the purpose of shaving the visitors in their apartments, instead of accommodating them, as at the present time, in their own establishments. one of these knights of the razor, living also in front street, when going to and from a fashionable boarding-house in the vicinity, was not unfrequently assailed by a small cur who often took him by the heels when hurrying along. to get rid of this annoying little animal as speedily and secretly as possible, he had recourse to the powers of strychnia, which produced in a very short time similar effects upon the poor victim, and the result was another great hue and cry about mad dogs. these authentic and remarkable cases of hydrophobia were heralded in all the papers of the day, which, from that time forward, were filled with notes of caution to all dog-owners. of the 'treatment' of rabies we will make but a few remarks, as of the immense number of specifics proposed for this disease, amounting in all to several hundred, few or none can be relied on to the exclusion of the others; but those medicines, perhaps, known as opiates or anti-spasmodics, claim a larger share of attention than any others in combating the disease after its development. in looking over the very original works of jacques du fouilloux, a worthy cynegetical writer of the sixteenth century, we find a prescription that was supposed by many to be an infallible specific for this disease, and as it appears to us quite as certain in its effects on the animal economy as many others of the inert substances that have been lauded to the skies both in our country and in other parts of the world as antidotes, we take the liberty of transcribing it, as also of adding a translation of his quaint french. 'autre recepte par mots preservants la rage.' 'ay appris vne recepte d'vn gentil-homme, en bretaigne, lequel faisoit de petits escriteaux, où n'y auoit seulement que deux lignes, lesquels il mettoit en vne omellette d'oeufs, puis les faisoit aualer aux chiens qui auorient esté mords de chiens enragez, et auoit dedans l'escriteau, 'y ran quiran cafram cafratrem, cafratrosque'. lesquels mots disoit estre singuliers pour empescher les chiens de la rage, mais quant à moi ie n'y adiouste pas foy. i have learned a recipe from a nobleman of brittany, which is composed of a written charm, in which there are only two lines; these he put in an omelet of eggs, he then made the dogs that had been bitten by a rabid animal swallow them. there was on the paper "'y ran quiran cafram cafratrem, cafratrosque'". these words were said to be singularly efficacious in preventing madness in dogs, but for my part i do not credit it. although our quaint author considered the above charm even too marvellous for his belief, we give below his own prescription in which he placed implicit confidence, but, no doubt, on trial it would prove '"as singularly efficacious" as the other'. baing pour lauer, les chiens, quand ils ont esté mords des chiens enragez, de peur qu'ils enragent. quand les chiens sont mords ou desbrayez de chiens enragez, il faut incontinent emplir vne pippe d'eau, puis prendre quatre boisseaux de sel et les ietter dedans, en meslaut fort le sel auec vn baston pour le faire fondre soudainement: et quand il sera fondu, faut mettre le chien dedans, et le plonger tout, sans qu'il paroisse rien, par neuf fois: puis quand il sera bien laué, faut le laisser aller, celà l'empeschera d'enrager. when a dog has been bitten or scratched by another affected with madness, we must immediately take a tub of water and throw into it four bushels of salt, stirring it briskly with a stick to make it dissolve quickly. when the salt shall be dissolved, put the dog into the bath, and plunge him well nine times, so that the bath shall cover him each time; now that he is well washed you may let him go, as this will prevent his becoming rabid. having given publicity to the two preceding valuable receipts, we must be pardoned for adding our own views upon this point, as a caution to those who may not feel sufficient faith in the remedies above mentioned. the wound should be thoroughly washed and cleansed as soon as possible after the bite is inflicted: no sucking of the parts, as is advised by many, for the purpose of extracting the poison, as the presence of a small abrasion of the lips or interior of the mouth would most assuredly subject the parts to inoculation. if the wound be ragged, the edges may be taken off with a pair of sharp scissors; the wound must then be thoroughly cauterized with nitrate of silver (lunar caustic), being sure to introduce the caustic into the very depths of the wound, so that it will reach every particle of poison that may have insinuated itself into the flesh. if the wound is too small to admit of the stick of caustic, it may be enlarged by the knife, taking care, however, not to carry the poison into the fresh cut, which can be avoided by wiping the knife at each incision. should the wound be made on any of the limbs, a bandage may be placed around it during the application of these remedies, the more effectually to prevent the absorption of the virus. nitrate of silver is a most powerful neutralizer of specific poisons, and the affected parts will soon come away with the slough, no dressings being necessary, except perhaps olive oil, if there should be much inflammation of the parts. if the above plan be pursued, the patient need be under no apprehension as to the result, but make his mind perfectly easy on the point. this is the course generally pursued by the veterinary surgeons of europe, and there are but few of them who have not, some time in their practice, been bitten and often severely lacerated by rabid animals; nevertheless, we never hear of their having suffered any bad effects from such accidents. if caustic be not at hand, the wound may be seared over with red-hot iron, which will answer as good a purpose, although much more painful in its operation. mr. blaine, in closing his able and scientific article on this subject, very justly remarks, "would i could instil into such minds the 'uncertainty' of the disease appearing at all; that is, even when no means have been used; and the 'perfect security' they may feel who have submitted to the preventive treatment detailed. i have been bitten several times, mr. youatt several also; yet in neither of us was any dread occasioned: our experience taught us the 'absolute certainty' of the 'preventive' means; and such i take on me to pronounce they always prove, when performed with dexterity and judgment." we acknowledge ourselves a convert to this gentleman's doctrine; and feel satisfied that if the above course be adopted, there need be no fear whatever of the development of this frightful affection.--l.] [footnote : 'la folie des animaux', by m. perquin.] [footnote : the physician apollonius, having been bitten by a rabid dog, induced another dog to lick the wound, "ut idem medicus esset qui vulneris auctor fuit."] [footnote : 'journal pratique de méd. vét.'] [footnote : 'sporting magazine', vol. xviii. p. .] [footnote : daniel's 'rural sports', vol. i. p. .] * * * * * chapter viii. the eye and its diseases. the diseases that attack the same organ are essentially different, in different animals, in their symptoms, intensity, progress, and mode of treatment. in periodic ophthalmia--that pest of the equine race and opprobrium of the veterinary profession--the cornea becomes suddenly opaque, the iris pale, the aqueous humour turbid, the capsule of the lens cloudy, and blindness is the result. after a time, however, the cornea clears up, and becomes as bright as ever; but the lens continues impervious to light, and vision is lost. ophthalmia in the dog presents us with symptoms altogether different. the conjunctiva is red; that portion of it which spreads over the sclerotica is highly injected, and the cornea is opaque. as the disease proceeds, and even at a very early period of its progress, an ulcer appears on the centre; at first superficial, but enlarging and deepening until it has penetrated the cornea, and the aqueous humour has escaped. granulations then spring from the edges of the ulcer, rapidly enlarge, and protrude through the lids. under proper treatment, however, or by a process of nature, these granulations cease to sprout; they begin to disappear; the ulcer diminishes; it heals; scarcely a trace of it can be seen; the cornea recovers its perfect transparency, and vision is not in the slightest degree impaired. there is a state of the orbit which requires some consideration. it is connected with the muscles employed in mastication. generally speaking, the food of the dog requires no extraordinary degree of mastication, nor is there usually any great time employed in this operation. that muscle which is most employed in the comminution of the food, namely, the temporal muscle, has its action very much limited by the position of the bony socket of the eye; yet sufficient room is left for all the force that can be required. in some dogs, either for purposes of offence or defence, or the more effectual grasping of the prey, a sudden violent exertion of muscular power, and a consequent contraction of the temporal muscle, are requisite, but for which the imperfect socket of the orbit does not seem to afford sufficient scope and room. there is an admirable provision for this in the removal of a certain portion of the orbital process of the frontal bone on the outer and upper part of the external ridge, and the substitution of an elastic cartilage. this cartilage momentarily yields to the swelling of the muscles; and then, by its inherent elasticity, the external ridge of the orbit resumes its pristine form. the orbit of the dog, the pig, and the cat, exhibits this singular mechanism. the horse is, to a certain extent, also an illustration of this. he requires an extended field of vision to warn him of the approach of his enemies in his wild state, and a direction of the orbits somewhat forward to enable him to pursue with safety the headlong course to which we sometimes urge him; and for this purpose his eyes are placed more forward than those of cattle, sheep, or swine. that which mr. percivall states of the horse is true of our other domesticated animals: "the eyeball is placed within the anterior or more capacious part of the orbit, nearer to the frontal than to the temporal side, with a degree of prominence peculiar to the individual, and, within certain limits, variable at his will." in many of the carnivorous animals the orbit encroaches on the bones of the face. a singular effect is also produced on the countenance, both when the animal is growling over his prey and when he is devouring it. the temporal muscle is violently acted upon; it presses upon the cartilage that forms part of the external ridge; that again forces itself upon and protrudes the eye, and hence the peculiar ferocity of expression which is observed at that time. the victims of these carnivorous animals are also somewhat provided against danger by the acuteness of sight with which they are gifted. adipose matter also exists in a considerable quantity in the orbit of the eye, which enables it to revolve by the slightest contraction of the muscles. we should scarcely expect to meet with cases of fracture of the orbital arch in the dog, because, in that animal, cartilage, or a cartilago-ligamentous substance, occupies a very considerable part of that arch; but i have again and again, among the cruelties that are practised on the inferior creation, seen the cartilage partly, or even entirely, torn asunder. i have never been able satisfactorily to ascertain the existence of this during life; but i have found it on those whom i have recommended to be destroyed on account of the brutal usage which they had experienced. blows somewhat higher, or on the thick temporal muscle of this animal, will very rarely produce a fracture. a few cases of disease in the eye may be interesting and useful. 'case' i.--the eyes of a favourite spaniel were found inflamed and impatient of light. nothing wrong had been perceived on the preceding day. no ulceration could be observed on the cornea, and there was but a slight mucous discharge. an infusion of digitalis, with twenty times the quantity of tepid water, was employed as a collyrium, and an aloetic ball administered. on the following day the eyes were more inflamed, the collyrium and the aloes were employed as before, and a seton inserted in the poll. three or four days afterwards the redness was much diminished, the discharge from the eye considerably lessened, and the dog was sent home. the seton, however, was continued, with an aloetic ball on every third or fourth day. two or three days after this the eyes were perfectly cured and the seton removed. 'case' ii.--the eye is much inflamed and the brow considerably protruded. this was supposed to be caused by a bite. i vainly endeavoured to bring the lid over the swelling. i scarified the lid freely, and ordered the bleeding to be encouraged by the constant application of warm water, and physic-ball to be given. on the following day the brow was found to be scarcely or at all reduced, and the eye could not be closed. i drew out the haw with a crooked needle, and cut it off closely with sharp scissors. the excised portion was as large as a small-kidney-bean. the fomentation was continued five days afterwards, and the patient then dismissed cured. 'case' iii.--a pointer was brought in a sad state of mange. redness, scurf, and eruptions were on almost every part. apply the mange ointment and the alterative and physic balls. on the following day there was an ulcer on the centre of the cornea, with much appearance of pain and impatience of light. apply an infusion of digitalis, with the liquor plumbi diacetatis. he was taken away on the twelfth day, the mange apparently cured, and the inflammation of the eye considerably lessened. a fortnight afterwards this also appeared to be cured. 'case' iv.--a spaniel had been bitten by a large dog. there was no wound of the lids, but the eye was protruded from the socket. i first tried whether it could be reduced by gentle pressure, but i could not accomplish it. i then introduced the blunt end of a curved needle between the eye and the lid; and thus drawing up the lid with the right hand, while i pressed gently on the eye with the left hand, i accomplished my object. i then subtracted three ounces of blood and gave a physic-ball. on the following day the eye was hot and red, with some tumefaction. the pupil was moderately contracted, but was scarcely affected by any change of light. the dog was sent home, with some extract of goulard, and a fortnight afterwards was quite well. 'case' v.--a dog received a violent blow on the right eye. immediate blindness occurred, or the dog could apparently just discern the difference between light and darkness, but could not distinguish particular objects. the pupil was expanded and immovable. a pink-coloured hue could be perceived on looking earnestly into the eye. a seton was introduced into the poll, kept there nearly a month, and often stimulated rather sharply. general remedies of almost every kind were tried: depletion was carried to its full extent, the electric fluid was had recourse to; but at the expiration of nine weeks the case was abandoned and the dog destroyed. permission to examine him was refused. i have, in two or three instances, witnessed decided cases of dropsy of the eye, accumulation of fluid taking place in both the anterior and posterior chambers of the eye; there was also effusion of blood in the chambers, but in one case only was there the slightest benefit produced by the treatment adopted, and in that there was gradual absorption of the effused fluid. about the same time there was another similar case. a pointer had suddenly considerable opacity of one eye, without any known cause: the other eye was not in the least degree affected. the dog had not been out of the garden for more than a week. the eye was ordered to be fomented with warm water. on the following day the inflammation had increased, and the adipose matter was protruded at both the inner and outer canthus. the eye was bathed frequently with a goulard lotion. on the fourth day the eyeball was still more inflamed, and the projections at both canthi were increased. a curved needle was passed through both eyes, and there was considerable bleeding. on the following day the inflammation began to subside. at the expiration of a week scarcely any disease remained, and the eye became as transparent as ever. a curious ease of congenital blindness was brought to my infirmary. a female pointer puppy, eight weeks old, had both her eyes of their natural size and formation, but the inner edge of the iris was strangely diseased. the pupil was curiously four-cornered, and very small. there hung out of the pupil a grayish-white fibrous matter, which appeared to be the remainder of the pupillary membrane. six months afterwards we examined her again, and found that the pupil was considerably enlarged, and properly shaped, and the white skin had vanished. in the back-ground of the eye there was a faint yellow-green light, and the dog not only showed sensibility to light, but some perception of external objects. at this period we lost sight of her. a very considerable improvement has taken place with regard to the treatment of the enlarged or protruded ball of the eye. a dog may get into a skirmish, and have his eye forced from the socket. if there is little or no bleeding, the case will probably be easily and successfully treated. the eye must, first, be thoroughly washed, and not a particle of grit must be left. a little oil, a crooked needle, and a small piece of soft rag should be procured. the blunt end of the needle should he dipped into the oil, and run round the inside of the lid, first above and then below. the operator will next--his fingers being oiled--press upon the protruded eye gently, yet somewhat firmly, changing the pressure from one part of the eye to the other, in order to force it back into the socket. if, after a couple of minutes' trial, he does not succeed, let him again oil the eye on the inside and the out, and once more introduce the blunt end of the needle, attempting to carry it upwards under the lid with two or three fingers pressing on the eye, and the points of pressure being frequently changed. in by far the greater number of cases, the eye will be saved. if it is impracticable to cause the eye to retract, a needle with a thread attached must be passed through it, the eye being then drawn as forward as possible and cut off close to the lids. the bleeding will soon cease and the lids perfectly close. 'ophthalmia' is a disease to which the dog is often liable. it is the result of exposure either to heat or to cold, or violent exertion; it is remedied by bleeding, purging, and the application of sedative medicine, as the acetate of lead or the tincture of opium. when the eye is considerably inflamed, in addition to the application of tepid or cold water, either the inside of the lids or the white of the eye may be lightly touched with the lancet. from exposure to cold, or accident or violence, inflammation often spreads on the eye to a considerable degree, the pupil is clouded, and small streaks of blood spread over the opaque cornea. the mode of treatment just described must be pursued. the crystalline lens occasionally becomes opaque. there is cataract. it may be the result of external injury or of internal predisposition. old dogs are particularly subject to cataract. that which arises from accident, or occasionally disease, may, although seldom, be reinstated, especially in the young dog, and both eyes may become sound; but, in the old, the slow-growing opacity will, almost to a certainty, terminate in cataract. there is occasionally an enlargement of the eye, or rather an accumulation of fluid within the eye, to a very considerable extent. no external application seems to have the slightest effect in reducing the bulk of the eye. if it is punctured, much inflammation ensues, and the eye gradually wastes away. in 'amaurosis', the eye is beautifully clear, and, for a little while, this clearness imposes upon the casual observer; but there is a peculiar pellucid appearance about the eye--a preternatural and unchanging brightness. in the horse, the sight occasionally returns, but i have never seen this in the dog. the occasional glittering of the eyes of the dog has been often observed. the cat, the wolf, some carnivora, and also sheep, cows, and horses, occasionally exhibit the same glittering. pallas imagined that the light of these animals emanated from the nervous membrane of the eye, and considered it to be an electrical phenomenon. it is found, however, in every animal that possesses a 'tapetum lucidum'. the shining, however, never takes place in complete darkness. it is neither produced voluntarily, nor in consequence of any moral emotion, but solely from the reflection that falls on the eye. [the eye and its diseases being so concisely treated by mr. youatt, we are emboldened to add a more full and particular treatise on this interesting subject, couched in language the most simple, and we trust sufficiently plain to be understood by the most unscientific patron of the canine race. the eye and its diseases. the nictitating membrane. it is somewhat astonishing that an organ, so delicate and so much exposed as the eye of the hunting dog necessarily is, should not more frequently be attacked with disease, or suffer from the thorns, poisonous briars, and bushes that so constantly oppose their progress while in search of game. nature, ever wise in her undertakings, while endowing this organ with extreme sensibility, also furnished it with the means of protecting itself in some measure against the many evils that so constantly threaten its destruction. the plica semilunaris, haw or nictitating membrane, though not as largely developed in the dog as in some other animals, is, nevertheless, of sufficient size to afford considerable protection to the ball of the eye, and assists materially in preventing the accumulation of seeds and other minute particles within the conjunctiva. this delicate membrane is found at the inner canthus of the eye, and can be drawn at pleasure over a portion of the globe, so as to free its surface from any foreign substances that might be upon it. although the eye of the dog is attacked by many diseases, almost as numerous as those of the human being, still they are much less frequent and far more tractable. opthamalia--simple inflammation of the eye. in its mild form this disease is frequently met with, and easily yields to the administration of the proper remedies, but when it appears as an epidemic, in a kennel, it proves more stubborn. the discharge in epidemic ophthalmia, when carried from one dog to the eyes of another, no doubt is contagious, and, therefore, it is necessary to separate dogs as much from each other as possible during any prevalent epidemic of this nature. the disease announces itself by slight redness of the conjunctiva, tenderness to light, and increased flow of the secretions. the eyeball appears retracted in its socket, and more moist and transparent than usual. the infected vessels of the conjunctiva form a species of net-work, and can be moved about with this membrane, showing that the inflammation is entirely superficial, and not penetrating the other coverings of the eye. extravasation of blood within the conjunctiva, (bloodshot,) is also not an uncommon appearance, but is frequently the first symptom that draws our attention to the malady. as the disease progresses, the conjunctiva becomes more vascular, the photophobia intolerable, the cornea itself becomes opaque, and sometimes exhibits a vascular appearance. there is considerable itching of the ball, as evinced by the disposition of the dog to close the eye. if the disease progresses in its course, unchecked by any remediate means, the cornea may lose its vitality, ulceration commence, and the sight be for ever destroyed by the bursting and discharge of the contents of the eye. 'causes.'--simple canine opthalmia proceeds from many causes, distinct in their character, but all requiring pretty much the same treatment. bad feeding, bad lodging, want of exercise, extremes of heat, and cold, are the most active agents in producing this affection. 'treatment.'--the disease in its mild form is very tractable, and requires but little attention; soothing applications, in connexion with confinement to an obscure apartment and low diet, will generally correct the affection in its forming stage. in all inflammations of the eye, tepid applications we consider preferable to cold, the latter producing a temporary reaction, but no permanent good, while the former exerts a soothing and relaxing influence over the tissues and parts to which they are applied. weak vinegar and water, with a small proportion of laudanum, we have frequently seen used with advantage as a wash in this complaint. when there is fever, it will be necessary to bleed, and purge. scarifying the conjunctiva with the point of a lancet, has been resorted to by some veterinary surgeons with success. chronic ophthalmia. when the disease assumes this form, the discharge from the eyes is lessened, and becomes more thick, the conjunctiva is not of such a bright arterial red, but more of a brick-dust colour, and the inner side of the lids when exposed will present small prominences and ulcerations. 'treatment.'--more stimulating collyria will now be necessary, as solutions of sulphate of zinc, copper, acetate of lead, &c. see no. , , , of the collyria. the direct application of sulphate of copper, or nitrate of silver, will often be of great benefit in changing the action of the parts. the lids should be turned down and brushed over two or three times with the above articles in substance, and the dog restrained for a few moments to prevent him from scratching during the temporary pain inflicted upon him by the application. laudanum dropped in the eye will also prove very beneficial, allaying the itching and pain, at the same time stimulating the organs to renewed action. if the disease does not succumb under this treatment, a seton placed in the pole will generally conquer it. traumatic ophthalmia is produced by wounds of poisoned briars, stings of insects, bites of other dogs, the scratching of cats, or the actual presence of foreign bodies in the eye itself, which latter cause frequently occurs, and is often overlooked by the sportsman. 'treatment'.--this species of ophthalmia is best subdued by the application of emollient poultices, depletion, purgation and cooling washes. if a seed, small briar, or other substance has got in under the lids, or inserted itself in the globe of the eye, the dog keeps the eye closed, it waters freely, and in a short time becomes red and inflamed. the removal of the article alone, will generally produce a cure; sometimes it is necessary to use a cooling wash and administer a purge or two. great care should he had for the extraction of extraneous substances from the eyes of dogs, as their presence often causes great suffering to the animal even while diligently employed in the field. the writer has seen dogs more than once rendered useless while hunting, by grass, cloverseeds, or other small particles burying themselves under the lids. 'ophthalmia of distemper'.--this species of inflammation will be spoken of when treating of this latter affection. sympathetic ophthalmia arises from the presence of some other disease located in another portion of the body, as derangement of the stomach, mange, surfeit, &c. the presence of one of these affections will indicate the cause of the other. 'treatment'.--soothing applications to the organ itself, and remedies for the removal of the primary affection. hydrophthalmia though not a common affection in the canine race, is occasionally met with; several cases have come under the observation of the writer, and no doubt there are but few dog-fanciers who have not seen the eyeballs of some dog suffering with this malady, ready to start from their sockets. this affection depends upon a superabundance of the humours of the eye, occasioned by over-secretion, or a want of power in the absorbent vessels to carry off the natural secretions of the parts. old dogs are more apt to suffer from this disease than young dogs: nevertheless, the latter are not by any means exempt; we once saw a pup, a few days old, with the globe of the eye greatly extended by this affection. as the disease progresses, the eye becomes more hard and tender, the sight is greatly impaired, and ultimately, if not arrested, the eye bursts, discharges its contents, and total blindness ensues, greatly to the relief of the poor animal. 'treatment'.--this disease is very intractable, and is to be combated by saline purges, bleeding, and stimulating application to the organ itself. mercurial ointment, rubbed over the eyebrow, will assist in stimulating the absorbents. when the disease has progressed for a long time, and the pain, as is often the case, seems intense, it will save the animal great suffering, by opening the ball and allowing the humours to escape. this may be done by puncturing the cornea or the sclerotic coat with a needle. setons introduced along the spine would have a good effect. congenital blindness occasionally occurs throughout a whole litter, no doubt being entailed upon the progeny of those dogs who have defective vision, or who are old and infirm at the time of copulation. the best and only remedy is speedy drowning. cataract consists in the partial or complete opacity of the crystalline lens; it results from numerous causes, and is more frequent in the old than the young subject. in old dogs both eyes are usually attacked, producing absolute blindness, while in young animals one eye alone is generally attacked. 'causes.'--old age, hard work, and bad feeding, are the agents most active in the production of this affection; it generally comes on slowly, but sometimes very quickly. when the disease occurs in young dogs, it is generally the result of wounds or blows over the head, convulsions and falls. 'treatment.'--little can be accomplished towards curing this disease either in the old or young dog, as the disease, in spite of all our efforts, will run its course, and terminate in total opacity of the lens. mild purging, blistering on the neck, introduction of the seton, and blowing slightly stimulating powders into the eye, will sometimes arrest the progress of the disease in the young dog. ulcerations on the cornea are sometimes very troublesome, and if not put a stop to, will often cause opacity and blindness, if not total destruction of the eye. slightly stimulating washes and purges are useful; the careful application of nitrate of silver will often induce the ulcer to heal; it must be put on very nicely and gently. spots on the cornea are the result of ulcers and inflammation. if they do not materially interfere with vision, they had better be left alone. powdered sugar and a small quantity of alum blown into the eye daily through a quill, we have seen used with much success. amaurosis--gutta serena or glass eye, a partial or complete paralysis of the optic nerves of either side is not a frequent disease. it usually comes on gradually, but sometimes may appear in the course of a few hours from the effects of wounds or convulsions. when the paralysis is complete, total blindness of course ensues. the intimate connection, or sympathy, existing between the nerves of either eye, is so peculiar that disease of one is quickly followed by a corresponding disease in the other. amaurosis, therefore, ordinarily ends in total blindness. the disease is characterized by a dilated stage of the pupil, which seldom contracts under the effect of any degree of light thrown upon it. the coats and humours of the eye are perfectly transparent, in fact appear to be more pellucid than natural. 'causes.'--this affection is produced in many different ways; among the most common causes may be mentioned wounds on the head, or of the parts surrounding the nerve, strains, falls, disease of the bone, convulsions, and epileptic fits. we have seen a case produced by a tumour, which occupied the posterior portion of the orbit, and caused the organ to be somewhat protruded from its proper position, giving the eye the appearance of hydrophthalmia, for which it was taken, the existence of the tumour never for a moment being suspected. in this case there was partial amaurosis in both sides, although nothing of disease could be discovered in the left eye. amaurosis is a very deceptive disease, the nerves alone being affected; the humours and coverings of the eye remaining perfectly transparent and natural, imposes upon the inexperienced observer, but is easily detected by those who have witnessed the disease in others. there is a singular watery appearance and vacant stare about the eye of the dog that cannot be mistaken. this peculiarity is owing, no doubt, to the enlargement of the pupil, as before observed. 'treatment'.--when proceeding from blows, convulsions, or inflammation of the nerve itself, bleeding will be serviceable, as also purging and blistering. if the disease should appear without any symptom, or other cause, to lead us to believe that there is any local affection, the antiphlogistic course should be laid aside, and resort be had to local and constitutional tonic applications, and revulsive frictions to the nape of the neck and spine. a seton may also be applied; and electricity has been recommended in such cases, no doubt arising from want of tone in the general system. this affection, in spite of every effort, is very unmanageable, and but seldom yields to any course of treatment. strychnia has been used lately, both internally and externally, in the cure of this complaint; it may be sprinkled over a blistered surface immediately above the eye, in the proportion of a grain morning and evening; it may also be administered inwardly at the same time, in doses from the half a grain to a grain twice a day. extirpation of the eye. it sometimes becomes necessary, from the diseased state of this organ, that it should be taken completely from its socket. this operation, though frightful, perhaps, to consider, is very simple in its application, and may be performed without difficulty by any one accustomed to the use of the knife. the animal is to be held firmly, as before directed, and an assistant to keep the lids widely extended. if the lids cannot be drawn well over the eye, owing to enlargement of the ball caused by disease, they may be separated by an incision at the external angle. a curved needle armed with a thread is now to be passed entirely through the eye, being careful to include sufficient of the sound parts within its grasp to prevent its tearing out. this finished, the needle may be detached, and the ends of the thread being united, the movements of the eye can be governed by means of this ligature: then proceed as follows: st. the assistant keeping the lids well separated, the operator draws the eye upward and outward, and then inserting the scalpel at the inner and lower angle of the eye, with a gentle sweep separates the ball from the lids, extending the incisions through to the external canthus. d. the ball is now to be drawn inwardly and downward, while the scalpel, continuing the circular movement as far as the internal canthus, separates the upper lid. d. the muscles and optic nerves still bind this organ to the orbit, which attachments can easily be destroyed by the scalpel, by pulling the eye forward sufficiently to reach them. if the eye has been extirpated on account of any malignant disease, it is necessary to remove every particle of muscle from the orbit; and when the disease has extended itself to the lids, it will also be proper to remove that portion of them included in the affection. the hemorrhage from the operation is trifling, and may generally be arrested by the pressure of the fingers, or the insertion of a conical ball of lint within the socket, which may be allowed to remain two or three days if necessary. if there is nothing to apprehend from hemorrhage, it is only necessary to draw the lids together, and unite that portion which has been separated by a suture, and place a hood over the whole. we do not recommend the stuffing of the orbit with lint, except in case of hemorrhage, as its presence will sometimes produce violent inflammation, which may extend to the brain. the cavity of the eye will, in a measure, be filled up by newly formed matter. the dog must be restricted to a low cooling diet, and have administered two or three saline purges. ulcerations of the eyelids are often met with in old mangy, ill-fed animals, and are difficult to overcome, except by curing the the primary affection, which is often no easy task. the lids become enlarged, puffy, and tender, the lashes fall out, and the edges present an angry reddish appearance. 'treatment'--must be directed, in the first place, to the curing of the old affection, by which, in connection with blisters, purging, stimulating washes, &c., a cure may be effected. when the swelling of the lids is considerable, scarifying them with the point of a lancet will often be of much service. ointment of nitrate of silver may also be smeared on the edges. warts on the eyelids sometimes make their appearance; they may be lifted up with the forceps, and excised with a knife or scissors, and the wound touched with nitrate of silver. the same treatment will answer for those warts, or little excrescences, that sometimes come on the inside of the lids. entropium--inversion of the eyelids. this disease we do not find mentioned by any of the writers on canine pathology: nevertheless, we are led to believe that it is not an uncommon form of ophthalmia; and we must express our surprise that it should have escaped the attention of such close observers as blain and youatt. the acute form of the disease resulting from, or attending, simple ophthalmia, we have often witnessed, but the chronic form, of which we more particularly speak, is more rare. we have seen three cases of the latter, and, no doubt, might have found many more if our opportunities of studying canine pathology were equal to those of the english writers. the inversion of the eyelids upon the globe is accompanied with pain and irritation, swelling and inflammation, both of the lids and eye, which ultimately renders the dog almost useless, if not entirely blind. 'causes'.--neglected chronic ophthalmia was, no doubt, the cause of the disease in two cases, a setter and a pointer, while the other, in a hound, was the result of an acute attack of ophthalmia brought on by scalding with hot pitch thrown upon the animal. some of this substance entered the eye, while a large portion adhered to the muzzle and lids. the eye, as well as the lids, became inflamed; the latter, being puffed up and contracted on their edges, were necessarily drawn inwards from the tension of the parts, and double entropium was thus produced. the inflammation and tumefaction of the parts continued for a considerable time, and when ultimately reduced by the application of tepid fomentations, the skin appeared greatly relaxed; and the muscular fibres having lost their power of support or contractility, owing to their long quiescence, seemed no longer able to keep their lids in their proper situation; the edges therefore remained in the abnormous position previously assumed. by this strange condition of the parts, the eyeball continued greatly irritated by the constant friction of the lashes; water was continually flowing over the lids, and from its irritating character produced considerable excoriation of the face and muzzle. the conjunctiva remained inflamed, the cornea in due course became ulcerous, and the eye was ultimately destroyed by the discharge of its contents. this was the course and final termination of the disease in the case of the hound above referred to, all of which disastrous results might have been prevented by proper management. 'treatment.'--when in england, we sent to the united states a fine bred pointer dog, designed as a present for one of our sporting friends. this animal travelled from leeds to liverpool, chained on top of the railroad cars; the journey occupied several hours, daring which the weather was cold and boisterous, and we noticed on his arrival at the latter place that his eyes were watering and somewhat inflamed. on examining them more particularly, we were enabled to extract several pieces of cinder from under the lids, which seemed to relieve him somewhat. he went to sea, in the care of the steward, on the following day; and remained on deck exposed to the inclemency of the weather during a long voyage. when he arrived in philadelphia, the inflammation, we were informed, was very considerable, occasioned by the presence of some other small particles of cinder that may have escaped our attention before shipping him. the presence of these foreign substances in the eye, in connection with the salt spray and irritating atmosphere, greatly aggravated the ophthalmia, and resolved it into a chronic affection, which ultimately resulted in entropium. "fop" was hunted during the same autumn, which no doubt increased the malady to a considerable extent; and before the hunting season was over, the dog was rendered almost useless: the lids becoming so much swollen and the irritation so considerable, that it was deemed cruel to allow him to go into the field. when we saw him some time in the course of the same winter, the lower lids of both eyes were completely inverted on their globes, and the conjunctival inflammation and flow of tears considerable. the eyes seemed contracted within their sockets, and at times were nearly hidden from view, the corneas were somewhat opaque, the photophobia intolerable, and the animal showed evident signs of extreme pain, by his restless anxiety and constant efforts at scratching and rubbing the eyes. under the judicious application of cooling astringent collyria, and other remediate means, the irritation and pain of the parts were relieved, and the lids somewhat retracted. "fop" remained in this condition till the following autumn, suffering at times considerably from the increased inflammation and tumefaction of the lids, which continued obstinately to persist, insomuch that when turned out by the pressure of the fingers on them, they immediately contracted, and were forced inwards on the ball when freed from the fingers. finding that no external application was of any permanent benefit, we resolved to have resort to the same operation we saw practised in the parisian hospitals for the cure of a similar malformation in the human subject. to insure quiet we enclosed the body of the dog in a case, made stationary and sufficiently small to prevent struggling, with the head firmly fixed by a sliding door, as represented in the accompanying drawing. the mouth was kept closed by a small strap passed around the muzzle. this method of fixing a strong dog, we consider the best ever adopted for all nice operations on the face. the first step in the operation was to pinch up a portion of the lax skin of the diseased lid and pass three needles, armed with silk ligatures, successively through the base of the upraised integuments. one needle approximating the external canthus, another the internal, and a third midway between these two points, as represented in the annexed drawing. the next step was lo raise up the integuments included in the ligature, and, by means of a pair of sharp scissors, cut off the super-abundant skin as near to the ligatures as possible; having care however to leave sufficient substance included in the ligatures, to prevent their sloughing out before adhesion has taken place. the next and last step of the operation was, to draw the edges of the wound together by tying each ligature, which procedure immediately secured the lid and held it firmly in its natural position. the ligatures were now cut short, and a large wire muzzle, covered over with some dark substance on the operated eye, being put on him, and his legs hobbled with a piece of strong twine, more effectually to prevent his scratching the head, "fop" was then set at liberty, and soon became reconciled to this eye-shade. the hemorrhage was trifling, the wound healed up by the first intention and the ligatures were drawn away in a few days, when a perfect cure was effected--the conjunctiva having lost its inflammatory appearance, and the cornea having again become quite transparent. the other eye was operated on in the same way and with like success. in the first operation we cut away the loose flaccid integuments only; whereas, in the second, we snipped small longitudinal fibres from the cartilage itself, and the operation consequently was more perfect, if possible, than in the first instance. the eyes were now perfectly restored, and remained well during the whole of the shooting season, after which we lost sight of our patient, he having accompanied one of our friends as a "compagnon de voyage" on a commercial expedition to santa fe, and, when on his return, had the misfortune to lose "fop," who was carried off into captivity by some prowling camanches, who no doubt have long since sacrificed him to the great spirit in celebrating the buffalo or wolf dance. protrusion of the eye the eye may be forced from its orbit by wounds or the bites of other animals. if not materially injured, the ball should be cleaned with a little tepid water, or by wiping off with a fine silk or cambric handkerchief, and immediately replaced within its socket; otherwise the inflammation and swelling of the lids will soon prevent its easy admission. when handling the protruded eye, the fingers should be dipped in olive oil or warm water. when sufficient time has elapsed from the occurrence of the accident to prevent the ball being replaced, owing to the swelling and contraction of the lids, an incision may be made at the external angle of the eye, so as to divide the lids, which will then admit the eye into its natural position. if not, the lid itself can be raised up and slit far enough to allow its being drawn over the globe. as considerable inflammation generally follows this accident, it will be prudent to bleed the animal and confine him. we have seen eyes replaced, that have been out of their sockets for several hours, perfectly recover their strength and brilliancy. weak eyes. some dogs, particularly several breeds of spaniels, have naturally weak eyes, attended by an over-secretion and constant flow of tears, more particularly when exposed to the sun. when there is no disease of the lachrymal duct, the secretion may be diminished and the eyes strengthened by the daily application of some slightly tonic wash, as no. , , , &c. fistula lachrymalis. the lachrymal duct is a small canal, leading from the internal angle of the eye to the nostrils, and is the passage through which the tears escape from the eye. this duct may become closed by inflammation of the lining membrane of the nose, caries of the bone, ulcers, fungous growths, or by the presence of some extraneous substance impacted in it. the tears, no longer having a natural outlet, are necessarily forced over the lids, accompanied, not unfrequently, by a good deal of purulent matter. this canal, when thus obstructed from some one of the above causes, often forms an ulcerous opening at its upper extremity, just below the internal canthus, for the escape of the pus that usually collects in a sac at that point. this perforation is called "fistula lachrymalis." the tears, entering the canal at its punctum, are carried along till they pass out at the fistulous opening. treatment'.--this is a very troublesome affection, and has been pronounced incurable by some writers. however, we would not hesitate making an attempt at relieving a favourite or valuable dog of this disagreeable deformity. we should first endeavour to clear out the nasal canal, either by means of a minute flexible probe, or by directing a stream of water from a suitable syringe through its course. a small silver or copper style may then be placed in the canal to keep it open, as also to direct the tears through the natural route. this being done, and the dog confined in such a way as not to be able to scratch or rub the eye, the fistulous opening might close up in a short time. however, it might be necessary to wear the style for many months. in such a case, we see no reason why a wire muzzle, such as used by us after the operation for entropium, might not be worn for an indefinite period, without any inconvenience to the animal. caruncula lachrymalis and plica semilunaris, or haw. the caruncula lachrymalis is a small glandular body situated at the internal commissure of each eye. this little gland often becomes greatly enlarged from inflammation or fungous growths--old dogs are much more subject to the disease than young ones. 'treatment'.--the application of cooling collyria and a weak solution of nitrate of silver, will generally suppress the further growth of this gland. if, however, it continues much swollen and runs on to suppuration, it may be punctured with a lancet and poultices applied. if the affection be of a malignant character, the gland may be drawn out by passing a ligature through its base, and then excised. the haw is most frequently concerned in the disease, and may also be removed. collyria: no. i. [symbol: rx] vinegar [symbol: ounce] i. laudanum [symbol: scruple] i. water [symbol: ounce] vii. mix.--the eyes to be frequently bathed with the mixture. no. . [symbol: rx] sulphate of zinc (white vitriol) [symbol: scruple] i. water [symbol: ounce] vi. m.--to be used as above. no. . [symbol: rx] sulphate of copper (blue vitriol) [symbol: scruple] i. water [symbol: ounce] vi. m.--to be used as above. no. . [symbol: rx] acetate of lead (sugar of lead) [symbol: scruple] ii. water [symbol: ounce] vi. m.--to be used as above. no. . [symbol: rx] argenti nitrat. (nitrate of silver) [symbol: scruple] i. water [symbol: ounce] vi. m.--to be dropped in the eye or times daily. no. . [symbol: rx] sub-muriate of mercury (corrosive sublimate) grs. x. water [symbol: ounce] vi. m.--to be used as the preceding. no. . [symbol: rx] argenti nitrat (nitrate of silver) grs. v. fresh butter or lard [symbol: ounce] i. no. . [symbol: rx] powdered alum grs. xv. calomel grs. vii. m.--blown in the eye, will often have a most excellent effect, more particularly in old chronic ophthalmia. no. . infusions of slippery elm bark, sassafras or elder pith, infusions of green tea, flaxseed, &c., are all excellent emollient applications--l.] * * * * * chapter ix. the ear and its diseases. 'canker in the ear.' all water-dogs, and some others, are subject to a disease designated by this name, and which, in fact, is inflammation of the integumental lining of the inside of the ear. when the whole of the body, except the head and ears, is surrounded by cold water, there will be an unusual determination of blood to those parts, and consequent distension of the vessels and a predisposition to inflammation. a newfoundland dog, or setter, or poodle, that has been subject to canker, is often freed from a return of the disease by being kept from the water. the earliest symptom of the approach of canker is frequent shaking of the head, or holding of the head on one side, or violent scratching of one or both ears. redness of the integument may then be observed, and particularly of that portion of it which lines the annular cartilage. this is usually accompanied by some enlargement of the folds of the skin. as soon as any of these symptoms are observed, the ear should be gently but well washed, two or three times in the day, with lukewarm water, and after that a weak solution of the extract of lead should be applied, and a dose or two of physic administered. if the case is neglected, the pain will rapidly increase; the ear will become of an intenser red; the folds of the integument will enlarge, and there will be a deposition of red or black matter in the hollow of the ear. the case is now more serious, and should be immediately attended to. this black or bloody deposit should be gently but carefully washed away with warm water and soap; and the extract of lead, in the proportion of a scruple to an ounce of water, should be frequently applied, until the redness and heat are abated. a solution of alum, in about the same quantity of alum and water as the foregoing lotion, should then be used. some attention should be paid to the method of applying these lotions. two persons will be required in order to accomplish the operation. the surgeon must hold the muzzle of the dog with one hand, and have the root of the ear in the hollow of the other, and between the first finger and the thumb. the assistant must then pour the liquid into the ear; half a tea-spoonful will usually be sufficient. the surgeon, without quitting the dog, will then close the ear, and mould it gently until the liquid has insinuated itself as deeply as possible into the passages of the ear. should not the inflammation abate in the course of a few days, a seton should be inserted in the poll, between the integument and the muscles of the occiput, reaching from ear to ear. the excitement of a new inflammation, so near to the part previously diseased, will materially abate the original affection. physic is now indispensable. from half a drachm to a drachm of aloes, with from one to two grains of calomel, should be given every third day. should the complaint have been much neglected, or the inflammation so great as to bid defiance to these means, ulceration will too often speedily follow. it will be found lodged deep in the passage, and can only be detected by moulding the ear; the effused pus will occasionally occupy the inside of the ear to its very tip. however extensive and annoying the inflammation may be, and occasionally causing so much thickening of the integument as perfectly to close the ear, it is always superficial. it will generally yield to proper treatment, and the cartilage of the ear may not be in the slightest degree affected. still, however, the animal may suffer extreme pain; the discharge from the ulcer may produce extensive excoriation of the cheek; and, in a few cases, the system may sympathise with the excessive local application, and the animal may be lost. the treatment must vary with circumstances. if the ulceration is deep in the ear, and there is not a very great degree of apparent inflammation, recourse may be had at once to a stimulating and astringent application, such as alum or the sulphate of zinc, and in the proportion of six grains of either to an ounce of water. if, however, the ulceration occupies the greater part of the hollow of the ear, and is accompanied by much thickening of the integument, and apparent filling up of the entrance to the ear, some portion of the inflammation must be first subdued. the only chance of getting rid of the disease is to confine the ear. a piece of strong calico must be procured, six or eight inches in width, and sufficiently long to reach round the head and meet under the jaw. along each side of it must be a running piece of tape, and a shorter piece sewed at the centre of each of the ends. by means of these the cap may be drawn tightly over the head, above the eyes, and likewise round the neck behind the ears, so as perfectly to confine them. after all, no mild ointment will dispose such an ulcer to heal, and recourse must be had at once to a caustic application. a scruple of the nitrate of silver must be rubbed down with an ounce of lard, and a little of it applied twice every day, and rubbed tolerably hard into the sore until it assumes a healthy appearance; it may then be dressed with the common calamine ointment. if the discharge should return, the practitioner must again have recourse to the caustic ointment. the cartilage will never close, but the integument will gradually cover the exposed edges, and the wound will be healed. the ear will, however, long continue tender, and, if it should be much beaten, by the shaking of the head, the ulcer will reappear. this must be obviated by occasionally confining the ears, and not overfeeding the dog. some sportsmen are accustomed to 'round' the ears, that is to cut off the diseased part. in very few instances, however, will a permanent cure be effected, while the dog is often sadly disfigured. a fresh ulcer frequently appears on the new edge, and is more difficult to heal than the original one. nine times out of ten the disease reappears. the newfoundland dog is very subject to this disease, to remedy which recourse must be had to the nitrate of silver. spaniels have often a mangy inflammation of the edges of the ear. it seldom runs on to canker; but the hair comes off round the edges of the ear, accompanied by much heat and scurfiness of the skin. the common sulphur ointment, with an eighth part of mercurial ointment, will usually remove the disease. from the irritation produced by canker in or on the ear, and the constant flapping and beating of the ear, there is sometimes a considerable effusion of fluid between the integument and the cartilage occupying the whole of the inside of the flap of the ear. the only remedy is to open the enlarged part from end to end, carefully to take out the gossamer lining of the cyst, and then to insert some bits of lint on each side of the incision, in order to prevent its closing too soon. in a few days, the parietes of the cyst will begin to adhere, and a perfect cure will be accomplished if the tumour is simply punctured, the incision will speedily close, and the cyst will fill again in the space of four-and-twenty hours. a seton may be used, but it is more painful to the dog, and slower in its operation. the ear should be frequently fomented with a decoction of white poppies, and to this should follow the goulard lotion; and, after that, if necessary, a solution of alum should be applied. to the soreness or scabby eruption, which extends higher up the ear, olive oil or spermaceti ointment may be applied. in some cases, portions of the thickened skin, projecting and excoriated, and pressing on each other, unite, and the opening into the ear is then mechanically filled. i know not of any remedy for this. it is useless to perforate the adventitious substance, for the orifice will soon close; and, more than once, when i have made a crucial incision, and cut out the unnatural mass that closed the passage, i have found it impossible to keep down the fungous granulations or to prevent total deafness. the following is a singular case of this disease:-- st july, a dog was sent with a tumour, evidently containing a fluid, in the flap of the ear. a seton had been introduced, but had been sadly neglected. the hair had become matted round the seton, and the discharge had thus been stopped. inflammation and considerable pain had evidently followed, and the dog had nearly torn the seton out. i removed it, washed the ear well, and applied the tincture of myrrh and aloes. the wound soon healed. on the th the ear began again to fill. on the th the tumour was ripe for the seton, which was again introduced, and worn until the th of august, when the sides of the abscess appeared again to have adhered, and it was withdrawn. canker had continued in the ear during the whole time; and, in defiance of a cold lotion daily applied, the ear was perceived again to be disposed to fill. the seton was once more inserted, and the cyst apparently closed. the seton was continued a fortnight after the sinus was obliterated, and then removed. six weeks afterwards the swelling had disappeared, and the canker was quite removed. this anecdote is an encouragement to persevere under the most disheartening circumstances. all dogs that are foolishly suffered to become gross and fat are subject to canker. it seems to be a natural outlet for excess of nutriment or gross humour; and, when a dog has once laboured under the disease, he is very subject to a return of it. the fatal power of habit is in few cases more evident than in this disease. when a dog has symptoms of mange, the redness or eruption of the skin, generally, will not unfrequently disappear, and bad canker speedily follow. the habit, however, may be subdued, or at least may be kept at bay, by physic and the use of goulard lotion or alum. sportsmen are often annoyed by another species of canker pointers and hounds are particularly subject to it. this species of canker commences with a scurfy eruption and thickening of the edges of the ear, apparently attended by considerable itching or pain. the dog is continually flapping his ear, and beating it violently against his head. the inflammation is thus increased, and the tip of the ear becomes exceedingly sore. this causes him to shake his head still more violently, and the ulcer spreads and is indisposed to heal, and at length a fissure or crack appears on the tip of the cartilage, and extends to a greater or less distance down the ear. the narration of one or two cases may be useful, as showing the inveteracy of the disease. th feb. .--a newfoundland dog, very fat, had dreadful canker in both ears, and considerable discharge of purulent matter. he was continually shaking his ears, lying and moaning. apply the canker lotion, and give the alterative balls. th. the discharge considerably lessened from one ear, but that from the other has increased. continue the lotion and apply a seton. d. the dog, probably neglected at home, was sent to me. both ears were as bad as ever. th. the dog is perfectly unmanageable when the lotion is poured into the ear, but submits when an ointment is applied. use ung. sambuci, [symbol: ounce] j. cerus, acet. [symbol: ounce] j., mix well together. continue the alteratives. th. slowly amending; the whining has ceased, and the animal seldom scratches. continue the lotion, alteratives, and purgatives. th oct.--slowly improving. continue the treatment. th. one ear well, the other nearly so. th. both ears were apparently well. omit the lotion. th. one ear was again ulcerated. applied the aerugo aeris. st. this has been too stimulating, and the ulceration is almost as great as at first. return to the ung. sambuci and cerusa acetata. from this time to the th february, , we continued occasionally taking out the seton, but returning to it every two or three days; applying the canker lotion until we were driven from it, mixing with it variable quantities of tinctura opii, having recourse to mercurial ointment, and trying a solution of the sulphate of copper. with two or three applications we could keep the disease at bay; but with none could we fairly remove the evil. the sulphate of zinc, the acetate of lead, decoctions of oak bark, a very mild injection of the nitrate of silver,--all would do good at times; but at other times we were set at complete defiance. another gentleman brought his dog about the same time. this was also a newfoundland dog. he had always been subject to mangy eruptions, and had now mange in the feet, the inside of the ear covered with scaly eruptions, the skin red underneath, considerable thickening of the ear, and a slight discharge from its base. a seton was inserted and a physic-ball given every second day. the canker lotion had little good effect. some calamine ointment, with a small portion of calomel, was then had recourse to. in ten days the dog had ceased to scratch himself or shake his head, and the ear was clean and cool. the seton was removed; but the animal being confined, a little redness again appeared in the ear, which the lotion soon removed. at the expiration of a month he was dismissed apparently cured; but he afterwards had a return of his old mangy complaints, which bade defiance to every mode of treatment. herr maassen, v. s., wümemburg, has lately introduced, and with much success, the use of creosote for the cure of canker in the ear. the first experiment was on a setter with canker in his ear. the owner of the dog had ordered it to be hanged, as all remedies had failed in producing a cure. herr maassen prescribed creosoti ss. et spirit, vini rectificat. ij. this mixture was applied once in every day to the diseased part. in a few weeks the dog was completely cured, and has since had no return of the complaint. in a terrier, and also in three spaniels, the effect of this application was equally satisfactory. in some cases, where the disease showed itself in a less degree, the creosote was dissolved in water, instead of spirit of wine. it is always necessary to take away the collar while the dog is under treatment, in order that the flap of the ear may not be injured by striking against it. vegetating excrescences in the ear. (by f. j. j. rigot.) productions of this kind, which he had the opportunity of observing only once, are sometimes united in masses, and completely close the auditive canal. the surface is granulated and black, and there escapes from it an unctuous fetid discharge. on both sides the animal is exceedingly susceptible of pain, and the excrescences bleed if the slightest pressure is brought to bear upon them. he thought it right to cut away these excrescences bodily, which he found to be composed of a strong dense tissue, permitting much blood to escape through an innumerable quantity of vascular openings. they were reproduced with extreme promptitude after they had been cut off or cauterized. some of them appeared no more after being destroyed by the nitrate of mercury. sometimes, however, twenty-four hours after a simple incision, not followed by cauterization, these productions acquire an almost incredible size. it seemed, in m. rigot's case, to be impossible to conquer the evil, and the patient was destroyed. eruptions in the ear. a newfoundland dog had long been subject to mangy eruptions on the back and in the feet. they had suddenly disappeared, and the whole of the inside of the ear became covered with scaly eruptions. the skin was red; there was considerable thickening of the ear, and a discharge from the base of it. the canker-lotion was used, a physic-ball given every second day, and a seton inserted in the poll reaching from ear to ear. no apparent benefit resulted. a little calamine ointment, to which was added one-eighth part of mercurial ointment, was then tried, and considerable benefit immediately experienced. the dog no longer continued to scratch himself or to shake his head, and the ear became clean and cool. the seton was removed, and nothing remained but a little occasional redness, which the lotion very soon dispersed. the owner, however, became ultimately tired of all this doctoring, and the animal was destroyed. a poodle had had exceedingly bad ears during several months. there was considerable discharge, apparently giving much pain. the dog was continually shaking his head and crying. a seton was introduced, the canker-lotion was resorted to, and alterative and purgative medicines exhibited. on the th of december the discharge from the ear ceased; but, owing to the neglect of the servant, it soon broke out again, and there was not only much excoriation under the ear, but, from the matting of the hair, deep ulcers formed on either side, the edges of the wound were ragged, and the skin was detached from the muscular parts beneath. probes were introduced on each side, which passed down the neck and nearly met. the smell was intolerably offensive, and the dog was reduced almost to a skeleton. i was, for the second time, sent for to see the case. i immediately recommended that the animal should be destroyed; but this was not permitted. i then ordered that it should daily be carefully washed, and diluted tincture of myrrh be applied to the wounds. they showed no disposition to heal, and the dog gradually sunk under the continued discharge and died. violent affection of the ear. th may, .--a spaniel screamed violently, even when it was not touched, and held its head permanently on one side, as if the muscles were contracted. the glands beneath the ear were enlarged, but the bowels were regular; the nose was not hot; there was no cough. a warm bath was ordered, with aperient medicine. on the d she was no better. i examined the case more carefully. the left ear was exceedingly hot and tender: she would scarcely bear me to touch it. i continued the aperient medicine, and ordered a warm lotion to be applied, consisting of the liquor plumbi acetatis and infusion of digitalis. she improved from the first application of it, and in a few days was quite well. a fortnight afterwards the pain returned. the lotion was employed, but not with the same success. a seton was then applied. she wore it only four days, when the pain completely disappeared. i have an account in my records of the conduct of a coward, who, coming from such a breed, was not worthy of the trouble we took with him. he was a newfoundland dog, two years old, with considerable enlargement, redness, and some discharge from both ears. he was sent to our hospital for treatment. when no one was near him, he shook his head and scratched his ears, and howled dreadfully. many times in the course of the day he cried as if we were murdering him. we sent him home thoroughly well, and glad we were to get rid of him. cropping of the ears. i had some doubt, whether i ought not to omit the mention of this cruel practice. mr. blaine very properly says, that "it is one that does not honour the inventor, for nature gives nothing in vain. beauty and utility appear in all when properly examined, but in unequal degrees. in some, beauty is pre-eminent; while, in others, utility appears to have been the principal consideration. that must, therefore, be a false taste, that has taught us to prefer a 'curtailed' organ to a perfect one, without gaining any convenience by the operation." he adds, and it is my only excuse saying one word about the matter, that "custom being now fixed, directions are proper for its performance." the owner of the dog commences with maiming him while a puppy. he finds fault with the ears that nature has given him, and they are rounded or cut into various shapes, according to his whim or caprice. it is a cruel operation. a great deal of pain is inflicted by it, and it is often a long time before the edge of the wound will heal: a fortnight or three weeks at least will elapse ere the animal is free from pain. it has been pleaded, and i would be one of the last to oppose the plea, that the ears of many dogs are rounded on account of the ulcers which attack and rend the conch; because animals with short ears defend themselves most readily from the attacks of others: because, in their combats with each other, they generally endeavour to lay hold of the neck or the ears; and, therefore, when their ears are shortened, they have considerable advantage over their adversary. there is some truth in this plea; but, otherwise, the operation of cropping is dependent on caprice or fashion. if the ears of dogs must be cropped, it should not be done too early. four, five, or six weeks should first pass; otherwise, they will grow again, and the second cropping will not produce a good appearance. the scissors are the proper instruments for accomplishing the removal of the ear; the tearing of the cartilages out by main force is an act of cruelty that none but a brute in human shape would practise; and, if he attempts it, it is ten to one that he does not obtain a good crop. if the conch is torn out, there is nothing remaining to retain the skin round the auricular opening: it may be torn within the auditory canal, and as that is otherwise very extensible in the dog, it is prolonged above the opening, which may then probably be closed by a cicatrix. the animal will in this case always remain deaf, at least in one ear. in the mean time, the mucous membrane that lines the 'meatus auditorias' subsists, the secretion of the wax continues; it accumulates and acquires an irritating quality; the irritation which it causes produces an augmentation of the secretion, and soon the whole of the subcutaneous passage becomes filled, and seems to assume the form of a cord; and it finishes by the dog continuing to worry himself, shaking his head, and becoming subject to fits. mr. blaine very naturally observes, that, "it is not a little surprising that this cruel custom is so frequently, or almost invariably, practised on pug-dogs, whose ears, if left alone to nature, are particularly handsome and hang very gracefully. it is hardly to be conceived how the pug's head--which is not naturally beautiful except in the eye of perverted taste--is improved by suffering his ears to remain." if the cropping is to be practised, the mother should have been previously removed. it is quite erroneous, that her licking the wounded edges will be serviceable. on the contrary, it only increases their pain, and deprives the young ones of the best balsam that can be applied--the blood that flows from their wounds. polypi in the ears. dr. mercer, in the veterinarian, of july, , gives an interesting account of the production of polypi in the meatus of the ear. he considers that there are two kinds of polypi--first, the soft, vascular and bleeding polypus, usually produced from the fibro-cartilaginous structure of the outer half of the tube; and, secondly, the hard and cartilaginous polypus or excrescence produced from the lining membrane of its inner half. the first is termed the hæmatoid polypus, and the other the chondromatous. the dog suffering under either generally has a dull, heavy, and rather watery eye. he moans or whines at intervals. if his master is present he feels a relief in pressing and rubbing his aching ear against him. at other times he presses and rubs his ear against the ground, in order to obtain a slight relief, flapping his ears and shaking his head; the mouth being opened and the tongue protruded, and the affected ear pointing to the ground. then comes a sudden, and often a profuse, discharge of fetid pus. the local discharge of pus and blood becomes daily more and more fetid, and the poor animal becomes an object of disgust. in the first variety of polypus, where it is practicable, the soft and vascular excrescence should be excised with a pair of scissors or a small knife, or it may be noosed by a ligature of silk or of silver wire, or twisted off with a pair of forceps. immediately after its removal, the base of the tumour should be carefully destroyed by the nitrate of silver, and this should be repeated as long as there is any appearance of renewed growth. any ulcer or carious condition of the meatus should be immediately removed. in order to protect the diseased parts, a soft cap should be used, and within the ear a little cotton wadding may defend the ear from injury. dr. mercer very properly remarks that, in the second or chondromatous variety of polypus of the meatus, the treatment must depend upon the concomitant circumstances. if the tumour is seated close to the membrana tympani, and has a broad and sessile base, then it cannot be excised or noosed with any degree of success. it must therefore be treated by the daily application of the solid nitrate of silver, applied exactly to its surface; and, in the intervals of application, the use of any collyria may be had recourse to. if the substance of the growth be firm and solid, and possess little sensibility, then a very speedy mode of getting rid of it is to divide its substance with a small knife; and afterwards, by applying the solid nitrate of silver, the tumour will soon be sloughed away. the dog is liable to polypi in the nasal cavity, in the anus, and in the vagina, which it will not be out of place to mention here. the polypi of the nasal and of the anal cavities often show themselves under the form of rounded bodies, projecting from the nose or anus. their size and consistence are variable--sometimes soft, tearing with the greatest facility, and bleeding at the slightest touch; at other times, solid and covered with pituitary membrane. they are generally the result of ulcerations, wounds, fractures, perforations of the turbinated bones, sinuses,&c. these polypous productions obstruct the passage of the air, and more or less impede the breathing. they are best extirpated by means of a ligature, or circular compression, on the pedicle of the polypus, and tightened every second day. we may discover the presence of a tumour of this nature in one of the nasal passages, when, on putting our hand to the orifice of the nostril, there issues little or no air; or when we sound the nostril with the finger or a probe, or examine it on a bright day. the methods of destroying polypi in the nasal cavity vary with the texture, size, form, and position of these excrescences. excision with the bistoury, or with scissors, may be tried when the polypus is near the orifice of the nostril, and particularly when it is not large at the base. excision should be followed by cauterization with the red-hot iron, by which a portion of the base of the tumour is destroyed, and which could not be reached by a sharp instrument. to succeed in these operations, it is frequently necessary to cut through the false nostril. the edges of the wound may afterwards be united by a suture. the ligature, or circular compression, excised immediately on the pedicle of the polypus, by means of a wire or waxed string, and directed into the nasal cavity by means of a proper instrument, may he tried when the polypus is deeply situated, and particularly when its base is narrow. but, for this operation, which is difficult to perform, and which may be followed by a new polypous production, when the base is not perfectly destroyed, we may substitute the forcible detachment, especially when we have to act on vascular and soft excrescences. the italian greyhound is strangely subject to these polypi in the matrix or vagina. the reason for it is difficult to explain. a bitch, ten years old, was brought to the author on the th december, , with an oval substance, as large as a thrush's egg, occasionally protruding from the vagina. i advised that it should be removed by means of a ligature; but the owner was afraid, and a fortnight was suffered to pass before she was brought again. the tumour had rapidly increased; it was as large as a pigeon's egg, considerably excoriated, and the pedicle being almost as large as the tumour itself. the operation was now consented to. i passed a ligature as firmly round the pedicle and as high up as i could. the bitch scarcely seemed to suffer any pain. d jan.--the circulation is evidently cut off, and the tumour is assuming a thoroughly black hue, but it appears to cause no inconvenience to the dog. i tightened the ligature. th. the tumour is now completely black, considerably protruded, and apparently destitute of feeling. i again tightened the ligature. th. the tumour not appearing disposed to separate, and the uterus seeming to be drawn back by its weight, i cut off the tumour close to the ligature. not the slightest pain seemed to be given, and the tumour was hard and black. there was, however, a very little oozing of bloody fluid, which continuing to the th, i injected a slight solution of alum into the vagina, and three days afterwards the discharge was perfectly stopped. [although our author has given us several interesting and practical pages upon the diseases of the ear and its appendages, it seems to us that the arrangement of the matter is rather objectionable, and not sufficiently explicit to be easily comprehended by sportsmen, not before familiar with the subject; we therefore add a concise resumé or epitome of these troublesome affections, which we trust will be found of practical utility to the reader. simple otorrhÆa, or running from the ear, produced by inflammation of the mucous membrane of the external auditory canal, is of frequent occurrence. the dog should be purged with salts, and the ear washed with castile soap and tepid water. the following solution may be introduced several times a day: [symbol: rx] sulphate of zinc [symbol: scruple] i. water [symbol: ounce] i. mix. or, [symbol: rx] sugar of lead [symbol: scruple] i. water [symbol: ounce] i. if the discharge be fetid, the following may be applied often: [symbol: rx] chloride of lime [symbol: drachm] i. water pint. this affection in old dogs is very troublesome, and in most cases impossible to cure. alum, zinc, copper, lead, and other astringent applications may be used in powder, as a local application in these cases. a seton and blisters will also be serviceable. tumors of the flap. a tumour, particularly in old dogs, is often seen extending from the tip of the flap even to the base of the ear. it progresses slowly but surely, if not interfered with in its career, and will become eventually enormously large and very painful. these tumours are most common in old setters, newfoundlands, and hounds. treatment'.--the tumour, at its commencement, may be discussed by the application of astringent washes, as warm vinegar, water, and laudanum, or sugar of lead. when, however, it has become more extensive, the only remedy is opening it through its whole extent, and pressing out its purulent content. a poultice may then be applied, and tepid fomentations used for several days. it is often extremely difficult to heal up the abscess, or arrest the fetid discharge that is constantly collecting: a seton placed in the poll, in connexion with washes of a stimulating character, will, however, effect a cure, if patiently persevered in. either of the following will answer this purpose: [symbol: rx] chloride of lime [symbol: drachm] i. water [symbol: ounce] vi. mix. or, [symbol: rx] sulphate of zinc [symbol: scruple] i. water [symbol: ounce] jii. mix. we used on one occasion tincture of iodine with perfect success in an old and obstinate case. canker in the ear. this is a rather indefinite term, as applied to the diseased ear of a dog; in fact, any malignant corroding sore may be called a canker, no matter where situated. some writers describe, under the head of canker, a violent chronic otitis, attended by a purulent sanguinoid discharge. others understand by canker a species of erysipelatous inflammation, that makes its appearance on the inside of the flap, and extends itself to the interior of the ear. what we understand by canker, is an acute inflammation of the lining membrane of the ear, destroying the tympanum or drum, and producing total deafness. the secretion is often considerable, and if not removed, will soon fill up the cavity of the ear with a dark reddish deposit, which greatly increases the irritation and inflammation of the parts. mr. blaine states that he has seen this disease take a very malignant character, and extend its ravages over the face, destroying the soft parts, and even penetrating through the bone into the interior of the head. 'causes'.--this disease may he excited by any of those causes that produce a general or local inflammatory action; exposure to cold, the presence of malignant diseases on other portions of the body, high living, heat, confinement, or extraneous substances lodged in the organ itself. water-dogs are most subject to this affection, owing, no doubt, to the frequent afflux of blood to these parts, while the remainder of the body is immersed in the water. a tendency to this peculiar inflammation may also be produced in these animals by the action of the water upon the delicate membranes of the ear, which occasions a violent shaking of the head and beating of the flaps, which not unfrequently bruises them considerably. dogs that seldom or never go into the water are not, however, by any means exempt from the disease; as we have often seen it developed in terriers, mastiffs, and every species of mongrel. 'treatment'.--when the disease appears in its acute form, and without any apparent cause beyond luxurious living and confinement, bleeding, purging, low diet, and regular exercise, together with tepid and soothing washes, will generally relieve the inflammatory action of the parts. the ear should be carefully and tenderly washed out with castile soap, and a small quantity of the following solution poured into it two or three times daily, and the ear worked about gently in the hand to secure the percolation of the fluid through its structure. [symbol: rx] goulard's extract [symbol: ounce] sj. water pint. mix. or, [symbol: rx] sugar of lead [symbol: scruple] i. water [symbol: ounce] i. mix. or, [symbol: rx] powdered alum [symbol: scruple] i. water [symbol: ounce] i. mix. the above mixtures should be warmed before using, otherwise the dog may resist their introduction. when the disease from bad treatment or neglect has subsided into the chronic form, and ulceration and suppuration have commenced, it will be necessary to pursue a somewhat different treatment, and remain more patient, awaiting the result. at this time the auditory passage is filled with a dark purulent secretion, which forms a thick and irritating crust. this deposit should first be removed by washing with castile soap and tepid water, and the daily application of a hop poultice. if there be much inflammatory action of the parts, the dog may be bled, and alterative or purgative balls administered. the following wash must be used two or three times daily. [symbol: rx] sugar of lead [symbol: scruple] i. laudanum gtt.-- (drops.) water [symbol: ounce] i. mix. as the discharge is usually very offensive, the following solution will correct its fetor, and should be injected or poured in the ear. [symbol: rx] chloride of lime [symbol: drachm] i. water [symbol: ounce] vi. mix. if granulations have sprung up, touch them with a camel's hair brush, dipped in the following mixture: [symbol: rx] sulphate of copper [symbol: scruple] i. water [symbol: ounce] i. mix. if, however, the excrescences continue to sprout from the cartilage, and the discharge continues unabated and offensive, they may be excised and the parts brushed over with nitrate of silver in substance. after this operation the flap often becomes extremely tender and much swollen; poultices of poppy-heads or hops will often afford much relief. setons are of much value in the treatment of obstinate cases, and should be placed in the poll, and kept open till a cure is effected, or the case abandoned. all greasy applications to the parts should be discarded; the only one we consider allowable would be a very nice preparation of fresh butter, alum, and laudanum, smeared over the surface of the ulcers when very indolent and painful. the following wash will be found very soothing in the same case: [symbol: rx] opium gtt. . gum arabic iss-- lime water [symbol: ounce] iv. if the disease has progressed far enough to destroy a considerable portion of the cartilages, and perforate the tympanum, more care is necessary in using the above washes, as the fluid will enter the internal ear through this opening, and cause much uneasiness to the animal, if not fatal consequences. wounds of the ear. wounds of the flap are often occasioned by the tearing of poisonous briars, while hunting in close cover, or in conflict with other dogs. the former will generally heal up without much trouble, but the latter, when extensive, sometimes two or three inches in length, by requiring uniting by one or more sutures, to prevent deformity. warts. when these little excrescences appear on the external or internal portions of the flap, they may be taken off with the knife, and caustic applied to the wound, to induce them to heal, and keep down further granulations. canker of the edge of the flap. when a corroding sore of this nature attacks the edges of the ear, and refuses to yield to the application of a few stimulating washes, such as sulphate of copper, alum, borax, nitrate of silver, &c., the diseased edges may be paired off, and the actual cautery applied to the parts. this will frequently arrest its further progress. polypus of the ear polypi often spring up from the interior of the ear; they may be cut off with the scissors, or by the application of a fine wire, or horse-hair ligature. the wound should be touched with caustic, tincture of iodine, or the actual cautery. diseases of the ear--mangy edges this affection generally accompanies the same disease in other portions of the body, but may occasionally make its appearance independent of this cause. the edges of the flap become rough, thickened, and furrowed, the itching intolerable; and the dog perpetually shaking and scratching the head, occasions a constant oozing of blood from the wound. smooth-baited dogs are most subject to this disease, such as pointers, hounds, and terriers. 'treatment'--slightly stimulating washes, such as castile soap, alum-water, or infusion of oak-bark, will, in the majority of cases, induce these sores to heal up. if these do not answer, it will be necessary to use the mange ointment, keeping the animal hobbled to prevent him from scratching. old inveterate cases are best cured by trimming off the affected parts.--l.] chapter x--anatomy and diseases of the nose and mouth etc. the ethmoid bones. there is some difficulty in describing the ethmoid bones; but we shall not, however, deviate far from the truth if we give the following account: a great number of small hollow pedicles proceed from and form around the cribriform plate; as they move downwards, they project into distinct vesicles or cavities, smaller and more numerous behind, fewer in number and larger in front; and each of them not a simple cavity, but more or less convoluted, while the long walls of those cells are of gossamer thinness, and as porous as gauze. they even communicate, and are lined, and externally wrapped together, by the same membrane; the whole assuming a pear-like form, attached by its base or greater extremity, and decreasing in size as it proceeds downwards; the cells becoming fewer, and terminating at length in a kind of apex, which passes under the superior turbinated bone, and forms a valve between the nasal cavity and the maxillary sinuses. if to this is added, that the olfactory or first pair of nerves abut on these cribriform plates, and pass through their minute openings, and spread themselves over every one of these cells, we have a tolerably correct picture of this portion of the ethmoid bones. this nerve has different degrees of development in different animals, in proportion to their acuteness of smell. there is comparatively but little necessity for acuteness in the horse. the ox has occasion for somewhat more, especially in the early part of the spring, when the plants are young, and have not acquired their peculiar scent. in the sheep it is larger, and fills the superior portion of the nasal cavity; but in the dog it seems to occupy that cavity almost to the exclusion of the turbinated bones. it is also much more fragile in the dog than in the ox, and the plates have a considerably thinner structure. the ethmoid bone of the horse or the ox may be removed from its situation with little injury; but that of the dog can scarcely be meddled with without fracture. below it are the two turbinated bones; but they are reduced to insignificance by the bulk of the ethmoid bone. the inferior turbinated bone in the dog is very small, but it is curiously complicated. the 'meatus' contains three distinct channels; and the air, loitering, as it were, in it, and being longer in contact with the sensitive membrane by which it is lined, contributes to the acuter sense of smell. the larger cavity is along the floor of the nasal duct. it is the proper air-passage; and because it has this important function to discharge, it is out of the way of violence or injury. the 'lachrymal duct' is the channel through which the superfluous tears are conveyed to the lower parts of the nostril. a long canal here commences, and runs down and along the maxillary bone. it is very small, and terminates in the cuticle, in order that the highly sensitive membrane of the nose may not be excoriated by the tears occasionally rendered acrimonious in inflammation of the eye. the oval termination of this duct is easily brought into view by lifting the nostril. from some occasional acrimony of the tears, the lining of this duct may be inflamed and thickened, or some foreign body, or some unctuous matter from the ciliary glands, may insinuate itself into the duct, and the fluid accumulates in the sac and distends it, and it bursts; or the ulcer eats through the integument, and there is a small fistulous opening beneath the inner canthus of the eye, or there is a constant discharge from it. it is this constant discharge that prevents the wound from healing. in some cases the lachrymal bone is involved in the ulcerative process and becomes carious. in the dog, and particularly in the smaller spaniel, the watery eye, 'fistula lachrymalis', is of no unusual occurrence. the fistula will be recognised by a constant, although perhaps slight, discharge of pus. the structure and office of the 'velum palati', or veil of the palate, is in the horse a perfect interposed section between the cavity of the mouth and the nose, and cutting off all communication between them. in the dog, who breathes almost entirely through the mouth, the velum palati is smaller; the tensor muscle, so beautifully described by mr. percivall, is weak, but the circumflex one is stronger and more developed. when 'coryza' in the dog runs on to catarrh, and the membrane of the pharynx partakes of the inflammation, the velum palati becomes inflamed and thickened, but will not act as a perfect communication between the mouth and the nose. when there is a defluxion from the nose, tinged by the colour of the food, and particles of food mingle with it, we have one of the worst symptoms that can present itself, because it proves the extent and violence of the inflammation. in inflammatory affections of the membrane of the nose in the dog, we often observe him snorting in a very peculiar way, with his head protruding, and the inspiration as forcible as the expiration. an emetic will usually afford relief, or grain doses of the sulphate of copper. the nasal bones. the nasal bones of the dog (see fig. , in the head of the dog, page ) are very small, as they are in all carnivorous animals. instead of constituting the roof, and part of the outer wall of the cavity, as in other animals, the nasal bones form only a portion, and a small one, of the roof. the 'superior maxillaries' here swell into importance, and constitute the whole of the outer wall, and, sometimes, a part of the roof. the jaws are the weapons of offence and defence; and as much space as possible is devoted to the insertion of those muscles that will enable the animal to seize and to hold his prey. one of the most powerful of them, the 'masseter', rises from the superior maxillary bone, and spreads over its whole extent: therefore, that bone is developed, while the nasal bone is compressed into a very small space. the substitution of a portion of cartilage, instead of bone, at the posterior part of the orbital ring, in order to give more play for the coracoid process of the posterior maxillary, round which the temporal bone is wrapped, is a contrivance of the same nature. the scent of the dog is not sacrificed or impaired by the apparent diminution of the nasals; for the cavity enlarges considerably upward, and is occupied chiefly by the 'ethmoid bone', which, having the greater portion of nervous pulp spread on it, seems to have most to do with the sense of smell. the nasal bones of the dog are essentially different from those of the horse, cattle, and sheep. they commence, indeed, as high up in the face as those of the horse, their superior extremities being opposite to the lachrymal gland; but that commencement is an apex or point varying materially in different breeds. they form, altogether, one sharp projection, and are received within breeds these processes extend nearly one-third of the length of the nasals. the superior maxillary ( . .) takes the situation of the nasal ( .), pushes the lachrymal bone ( .) out of its place, and almost annihilates it, reaches the frontal bone ( .) and expands upon it, and forms with it the same denticulated suture which is to be seen in the nasal. the action of the muscle between these bones, and for the development of which all this sacrifice is made, is exceedingly powerful. the strength of this muscle in a large dog is almost incredible: the sutures between these bones must possess corresponding strength; and so strong is the union between them, that, in many old dogs, the suture between the superior maxillary and frontal bones is nearly obliterated, and that between the nasal and frontal maxillary quite effaced. as the nasal bones proceed downward they become somewhat wider. they unite with a long process of the anterior maxillary for the purpose of strength, and then terminate in a singular way. they have their apexes or points on the outer edge of the bone; and these apexes or points are so contrived, that, lying upon, and seemingly losing themselves, on the processes of the anterior maxillary, they complete, superiorly and posteriorly, that elliptical bony opening into the nose which was commenced by the maxillary anteriorly and inferiorly. the nasal cavity of the dog, therefore, and of all carnivorous animals, terminates by a somewhat circular opening, more or less in the form of an ellipse. this bony aperture varies in size in different dogs, and, as we should expect from what we have seen of the adaptation of structure to the situation and wants of the animal, it is largest in those on whom we are most dependent for speed and stoutness. the 'olfactory', or first pair of nerves, have a double origin, namely, from the 'corpus striatum' and the base of the 'corpus callosum'. they are prolongations of the medullary substance of the central portion of the brain. they are the largest of the cerebral nerves. their course is exceedingly short; and they have not a single anastomosis, in order that the impression made on them may be conveyed undisturbed and perfect to the brain. the olfactory nerve is a prolongation of the substance of the brain, and it abuts upon the cribriform bone, of which mention has been made. i will not speak of the singular cavities which it contains, nor of their function; this belongs to the sensorial system: but its pulpy matter has already been traced to the base of the ethmoid bone, and the under part of the septum, and the superior turbinated bone. although we soon lose it in the mucous membrane of the nose, there is little doubt that in a more filmy form it is spread over the whole of the cavity, and probably over all the sinuses of the face and head. it is, however, so mingled with the mucous membrane, that no power of the lens has enabled us to follow it so far. it is like the 'portio mollis of the seventh pair, eluding the eye, but existing in sufficient substances for the performance of its important functions. we have frequent cases of 'ozæna' in old dogs, and sometimes in those that are younger. the discharge from the nostril is abundant and constant, and sometimes fetid. the schneiderian membrane, of more than usual sensibility in this animal, is exposed to many causes of irritation, and debilitated and worn out before its time. pugs are particularly subject to ozæna. i scarcely ever knew a very old pug that had it not to a greater or less degree. the peculiar depression between the nasal and frontal bones in this breed of dogs, while it almost totally obliterates the frontal sinuses, may narrow the air-passage at that spot, and cause greater irritation there from the unusual rush of the air, and especially if the membrane becomes inflamed or any foreign body insinuates itself. little can be done in these cases, except to encourage cleanliness about the face and nostrils. it is, in the majority of these cases, a disease of old age, and must take its course. a terrier uttered a continual loud stertorous sound in breathing, which could be plainly heard in our parlour when the dog was in the hospital. the animal was evidently much oppressed and in considerable pain. he made continual, and generally ineffectual, efforts to sneeze. when he did succeed, a very small quantity of pus-like fluid was discharged; the dog was then considerably relieved, but a quarter of an hour afterwards he was as bad as ever. i ordered a slight emetic every third day. there was some relief for seven or eight hours, and then he was as bad as ever. i could neither feel nor see any cause of obstruction. the owner became tired, and the dog was taken away; but we could not learn what became of it. another terrier was occasionally brought for consultation. the dog breathed with considerable difficulty, and occasionally snorted with the greatest violence, and bloody purulent matter was discharged; after which he was somewhat relieved; but, in the course of a few days, the obstruction was as great as ever. i am not aware of a single instances of this affection of the pug being completely removed. the discharge from the nostrils of the bull-dog is often considerable, and, once being thoroughly established, is almost as obstinate as in the pug. ozÆna. ozæna, or fetid discharge from the nose, is, perhaps, the most troublesome and frequent affection that this organ is subject to; it is attended, at first, with slight fever, swelling of the parts, and a fetid discharge from the nostrils, which, if not corrected in the early stage of the disease, subsides into a chronic purulent secretion, that not only weakens the dog, but renders him peculiarly offensive. caries and destruction of the bones of the nose will ultimately take place. 'causes'.--inflammation of the lining membrane of the nose, either idiopathic, or arising from distemper, or other morbid disturbance of the system. it may also be a symptom, or the produce, of polypi in this organ. 'treatment'.--in commencing the treatment of this disease, it will be necessary first to prescribe some alterative medicines, as balls of aloes and rhubarb, and protect the animal from all severe atmospherical vicissitudes. this precaution, in connexion with mild astringent injections into the seat of the disorder, will generally effect a cure. 'injections for ozæna'. no. . [symbol: rx] sulphate of zinc.........................grs. v to x. water..............................[symbol: ounce] i. mix. no. . [symbol: rx] alum.............................[symbol: scruple] ii. water..............................[symbol: ounce] i. mix no. . [symbol: rx] chloride of soda........................grs. v. to x. water..............................[symbol: ounce] i. mix. no. . [symbol: rx] teneriffe, madeira or sherry wine..[symbol: ounce] i. extract of tannin.............................grs. iv. mix. [any of the above injections will answer a good purpose. no. is particularly useful to correct the fetidness of the discharge. when the disease is an old chronic affection, it should not be arrested too suddenly by astringent injections; in such cases it will be better to insert a seton in the poll, and thus keep up a drain from the system after the suppression of the other.--l.] the sense of smell. in the dog we trace the triumph of 'olfactory power'. how indistinct must be that scent which is communicated to, and lingers on, the ground by the momentary contact of the foot of the hare, the fox, or the deer; yet the hound, of various breeds, recognises it for hours, and some sportsmen have said for more than a day. he also can not only distinguish the scent of one species of animal from another, but that of different animals of the same species. the fox-hound, well broken-in, will rarely challenge at the scent of the hare, nor will he be imposed upon when the crafty animal that he pursues has taken refuge in the earth, and thrusts out a new victim before the pack. the sense of smelling is, to a certain degree, acute in all dogs. it is a provision wisely and kindly made, in order to guide them to their proper food, or to fit them for our service. it may possibly be the medium through which much evil is communicated. certain particles of a deleterious nature may be, and doubtless are, arrested by the mucous membrane of the nose, and there absorbed, and the constitution, to a considerable degree, becomes affected. hence appears the necessity for attention to ventilation, and especially to prevent the membrane of the nose from being habitually stimulated and debilitated by the effluvia generated in a close and hot kennel. m. majendie instituted some curious experiments on the sense of smelling, and he was led to believe that it depended more on the fifth pair of nerves than on the olfactory nerve. he divided the fifth pair, and from that moment no odour, no puncture, produced the slightest apparent impression on the membrane of the nose. in another dog he destroyed the two olfactory nerves, and placed some strong odours beneath the nostrils of the animal. the dog conducted himself as he would have done in his ordinary state. hence he concluded it probable that the olfactory nerve was not that of smelling. the simple fact, however, is, that there are two species of nerves here concerned--those of common and of peculiar sensation. the olfactory nerve is the nerve of smelling, the fifth pair is that of common sensation. they are to a certain degree necessary to each other. 'scent'.--this leads us to the consideration of the term "scent." it expresses the odour or effluvium which is constantly issuing from every animal, and especially when that animal is in more than usual exercise. in a state of heat or excitement, the pores of the skin appear relaxed, and a fluid or aqueous vapour is secreted, which escapes in small or large quantities, adheres to the persona or substances on which it falls, and is, particularly, received on the olfactory organs. the hound, at almost the earliest period, begins to comprehend the work which he has to perform. the peculiar scent which his nostrils imbibe urges him eagerly to pursue but the moment he ceases to be conscious of the presence of the effluvium, he is at a perfect loss. mr. daniel, in his work on the chase, very properly observes, that "the scent most favourable to the hound is when the effluvium, constantly perspired from the game as it runs, is kept by the gravity of the air at the height of his breast. it is then neither above his reach nor does he need to stoop for it. this is what is meant when the scent is said to be breast-high." when the leaves begin to fall, the scent does not lie well in the cover. it frequently alters materially in the same day. this depends principally on the condition of the ground and the temperature of the air, which should be moist but not wet. when the ground is hard and the air dry, there will seldom be much scent. the scent rarely lies with a north or east wind. a southerly wind without rain is the best. sudden storms are sure to destroy the scent. a fine sunshiny day is not good; but a warm day without sun is always a good one. if, as the morning advances, the drops begin to hang on the bushes, the scent will not lie. during a white frost the scent lies high, and also when the frost is quite gone; but at the time of its going off the scent never lies. in a hard rain, if the air is mild, the scent will sometimes be very good. a wet night often produces the best chases. in heathy countries, where the game brushes the grass or the boughs as it goes along, the scent seldom fails. it lies best on the richest soils; but the countries that are favourable to horses are not always so to hounds. the morning usually affords the best scent, and the game is then least able to escape. the want of rest, added perhaps to a full belly, gives the hounds a decided superiority over an early-found fox; and the condition of the ground and the temperature of the air are circumstances of much importance. such are the results of the best observations on scent; but, after all, we have much to learn concerning it. many a day that predicated to be a good one for scent has turned out a very bad one, and 'vice versa'. an old or experienced sportsman, knowing this, will never presume to make sure of his scent. we shall be forgiven if we pursue this subject a little at length. there is not only a constant appropriation of new matter to repair the losses that animals are continually sustaining, but there is a constant elaboration of gaseous or fluid matter maintaining the balance of the different systems, and essential to the continuance of life. this effluvium, as the animal moves from place to place, is attracted and detained for a while by the substances with which it comes into contact, or it remains floating in the atmosphere. there is a peculiar smell or scent belonging to each individual, either generally or under peculiar circumstances. the sportsman takes advantage of this; and, as most species of dogs possess great acuteness of olfactory power, they can distinguish, or are readily taught to distinguish, not only the scent of the hare from that of the fox, but that of the hare or fox which they are pursuing from that of half a dozen others that may be started during the chase. the dogs that are selected for this purpose are those the conformation of whose face and head gives ample room for the development of the olfactory apparatus, and these are the different species of hounds; but a systematic education, and too often a great deal of unnecessary cruelty, is resorted to, in order to make them perfect in their work. the distinction between the scent of the fox and that of the hare is soon learned by the respective packs; and, when it is considered that the hunted hare is perspiring at every pore, and her strength being almost exhausted, she is straining every limb to escape from her pursuers, the increasing quantity of vapour which exudes from her will prevent every other newly started animal from being mistaken for her. it has been well observed that when the atmosphere is loaded with moisture, and rain is at hand, the gas is speedily dissolved and mingles with the surrounding air. a storm dissipates it at once, while the cessation of the rain is preceded by the return and increased power of scent. a cold, dry easterly wind condenses and absorbs it, and this is even more speedily and irretrievably done by superabundant moisture. on fallows and beaten roads the scent rarely lies well, for there is nothing to detain it, and it is swept away in a moment; while over a luxuriant pasture, or by the hedge-row, or on the coppice, it lingers, clinging to the grass or the bushes. in a sunshiny day the scent is seldom strong; for too much of it is evaporated by the heat. the most favourable period is a soft southerly wind without rain, the scent being of the same temperature and gravity with the atmosphere. although it spreads over the level, it rises not far above the ground, and, being 'breast high', enables the hound, keeping his muzzle in the midst of it, to run at his greatest speed. the different manners or attitudes in which the dog runs afford pleasing and satisfactory illustrations of the nature of the scent. sometimes they will be seen galloping with their noses in the air, as if their game had flown away, and, an hour or two afterwards, every one of them will have his muzzle on the ground. the specific gravity of the atmosphere has changed, and the scent has risen of fallen in proportion. a westerly wind stands next to a southerly one, for a hunting morning. this is all simple enough, and needs not the mystification with which it has been surrounded. a valuable account of this may be found in johnson's shooting companion, a work that is justly and highly approved. mr. delmé radcliffe has also, in his splendid work on "the noble science," some interesting remarks on the scent of hounds. he says that there is an idiosyncracy, a peculiarity, in their several dispositions. some young hounds seem to enter on their work instinctively. from their first to their last appearance in the field they do no wrong. others, equally good, will take no notice of anything; they will not stoop to any scent during the first season, and are still slack at entering even at the second; but are ultimately distinguished at the head of the pack; and such usually last some seasons longer than the more precocious of the same litter. the tongue. the manner of drinking is different in the different animals. the horse, the ox, and the sheep do not plunge their muzzles into the water, but bring their lips into contact with it and sip it gradually. the dog, whose tongue is longer, plunges it a little way into the fluid, and, curving its tip and its edges, laps, in the language of johnson, with a "quick reciprocation of the tongue." the horse sucks the water that is placed before him, the dog laps it; and both of them are subject to inflammation of the tongue, to enlargement of that organ, and to a considerable or constant flow of saliva over it. extending from the base to the tip of the tongue there is on either side a succession of tendons, which help to retain the tongue in the mouth, and to curve the edge of it, so as to convey the food or the water to the posterior part of the mouth. these all spring from one central cord, and ramify over the membrane of the tongue. on opening the mouth, and keeping it open by means of two pieces of tape, one behind the upper canine teeth, and the other behind the lower ones, and drawing the tongue from the mouth and exposing its under surface, a cuticular fold or ridge will present itself, occupying a middle line from the base of the tongue to its very point. if this is opened with a lancet, a minute fibrous cord will be exposed through its whole extent. it is the cord which governs the motions of the tongue. this cord is, sometimes, foolishly and uselessly detached from its adhesions, so far as we can effect it, and drawn forward with a tenaculum and divided. there is one abominable course pursued in effecting this. the violence used in stripping down the tendon is so great, and the lacerated fibrous substance is put so much on the stress, and its natural elasticity is so considerable, that it recoils and assumes the appearance of a dying worm, and the dog is said to have been wormed. for the sake of humanity, as well as to avoid the charge of ignorance, it is to be hoped that this practice will speedily cease. the blain. the blain is a vesicular enlargement on the lateral and under part of the tongue in horses, oxen, and dogs, which, although not of unfrequent occurrence, or peculiarly fatal result, has not been sufficiently noticed by veterinary authors. in the horse and the dog it is often unaccompanied by any previous indisposition, or by other disease; but suddenly there is a copious discharge of saliva, at first limpid and without smell, but soon becoming purulent, bloody, and exceedingly fetid. on examination, the tongue is found apparently enlarged. it is elevated from its base between the maxillary bones, and on the side and towards the base of it are seen large vesicles, pellucid, red, livid, or purple; and, if the discharge is fetid, having near their bases ulcers, irregular, unhealthy, and gangrenous. in the horse and the dog the progress of the disease is slow, and seldom extends beyond the sides of the tongue. the vesicles are not of such magnitude as to interfere with respiration, and the ulcers are neither many nor foul. in cattle it is sadly different. the vesicles attain an enormous size. they quickly break and form deep ulcerations, which are immediately succeeded by other vesicles still larger. the whole membrane of the mouth becomes affected; the inflammation and swelling extend to the cellular substance of the neighbouring parts, and the head and neck are considerably, and sometimes enormously, enlarged; the respiratory passages are obstructed; the animal breathes with the greatest difficulty, and is, in some cases, literally suffocated. the primary seat of blain, is the cellular substance beneath the integument of the part. as the sublingual glands stretch along the under part of the tongue, and their ducts open on the side of the frænum, it is possible that this disease may proceed from, or be connected with, obstruction or inflammation of these ducts. dissection, however, has not proved this; and the seat of the disease, when the swellings are first discovered, is chiefly the cellular tissue between the integument and the lateral parts of the tongue, and also that between the membrane of the mouth and the sublingual glands. 'post-mortem' examination shows intense disease: the small intestines are highly inflamed with red and black patches, which are also found in the c¾cum, colon, and rectum. the blain is more frequent in spring and summer than at other seasons of the year. these are the times when the animal is debilitated by the process of moulting, and is then more than usually disposed to inflammatory complaints. it is usually an epidemic disease. many cases of it occur about the same time in certain districts, and over a great extent of country. when it appears in towns, the country is rarely exempt from it. i am not prepared lo say that it is contagious either in the horse or the dog. i have not seen any instance of it. at all events, it is not so virulent in these animals as it is in cattle. the vesicles should be freely lanced from end to end. there will not, perhaps, be much immediate discharge; for the vesicle will be distended by a substance imperfectly organised, or of such a glassy or inspissated nature as not readily to escape. it will, however, soon disappear; and in four-and-twenty hours, in the majority of cases, the only vestige of the disease will be an incision, not, perhaps, looking very healthy, but that will soon become so and heal. if there have been any previous ulcerations, or the slightest fetor, the mouth should he frequently washed with a diluted solution of the chloride of lime; one part of the saturated solution, and eleven of water. this will act as a powerful and useful stimulus to the foul and indolent ulcer. when all unpleasant smell is removed, the mouth should be bathed with a lotion composed of equal parts of tincture of myrrh and water, or half an ounce of alum dissolved in a quart of water, and two ounces of the tincture of catechu added to the solution. i do not recollect a case in the horse or dog, in which these medicines were not employed with advantage. in cattle, before there has been fetor attending the discharge, or the constitution has been materially affected, these simple means will perfectly succeed. if the practitioner is consulted somewhat too late, when the constitution has become affected, and typhoid fever has ensued, he should still lance the tumours, and apply the chloride of lime and the tincture of myrrh, and give a gentle aperient. he should endeavour to rouse and support the system by tonic medicines, as gentian and colomba with ginger, adding to two drachms of the first two, and one drachm of the last, half an ounce of nitre; but he should place most dependence on nourishing food. until the mouth is tolerably sound, it is probable that the animal will not be induced to eat; but it will occasionally sip a little fluid, and, therefore, gruel should be always within its reach. more should occasionally be given, as thick as it will flow, with a spoon or small horn. [inflammation of the tongue. glossitis or inflammation of the tongue is not an unfrequent disease, but is occasionally met with in its simple form or in connexion with inflammatory affections of the throat. under all and any circumstances this affection must be considered a dangerous malady, as it not unfrequently proves fatal in the course of a few hours from suffocation, occasioned by the swelling of the organ itself and other portions of the throat. the disease comes on suddenly with fever, heat, swelling and redness of the tongue. the tongue protrudes from the mouth and exhibits a dry, hot, inflammatory appearance, the respiration is hurried, and the animal expresses great uneasiness, and constant desire to lap water, which he can with difficulty accomplish. if not arrested, the inflammation may terminate in suppuration, by which process the swelling is relieved, and a cure often effected. 'causes'.--independent of the natural agents before referred to in the production of inflammatory affections, there are some few causes to which we can especially attribute this disease. direct injuries done to the member itself, either by wounds or stings of insects, the taking of poisonous or irritating substances into the mouth, want of water while hunting in hot weather, &c. several years ago we witnessed the death of a very valuable pointer, suffering from this disease produced by poison maliciously administered. he was affected so suddenly and violently with inflammation of the throat and tongue that his owner, mr. f--, was lead to believe that a bone had lodged in the throat, which was the occasion of all the trouble. after proper examination and considerable delay, he was forced to abandon this erroneous idea, but not in time to save the poor animal, who soon died from strangulation or congestion of the lungs. this valuable dog might have been saved if promptly and energetically treated. the stings of wasps or bees may also produce this affection. 'treatment'.--nothing can be done with this malady without the use of the lancet, by which six or eight ounces of blood should be drawn at the commencement of the disease. if the tongue is much swollen and very tender, longitudinal incisions should be made in it, extending as far back as possible, and their bleeding assisted by sponging the mouth out with tepid water. astringent applications may then be used as washes, such as alum water, strong vinegar, infusions of oak bark or solutions of nitrate of silver, four or six grains to the ounce, to be applied once or twice a day. a large blister may also be placed under the throat, and when the inflammation is sufficiently reduced to allow the introduction of articles into the stomach, a powerful purge of aloes should be given. nothing, however, can be done without copious bleeding.--l.] the lips of the dog discharge, with somewhat less efficiency, the same office as in the horse, cattle, and sheep; and are usefully employed in gathering together the food, and conveying it to the mouth. the lips also secrete the saliva, a fluid that is indispensably necessary for the proper comminution of the food. swellings on the inside of the cheek or upper lip, and extending nearly to the angle of the lip, are of frequent occurrence. a superficial sore spreads over it, slightly covered by a yellowish, mattery pellicle; and on the teeth, and extending down the gums, there is a deposition of hardened tartarous matter, which is scaled off with a greater or less degree of difficulty. it must be removed, or the sore will rapidly spread over the cheek. a lotion of equal parts of tincture of myrrh and water, with a few drops of the tincture of cantharides, will be usually sufficient to cause the swelling to subside, and the pellicle to be detached. the lip, however, will generally remain slightly thickened. a little soreness will sometimes return, but be easily reduced. the teeth next claim attention. according to the dentition of the dog by m. girard and linnæus, the following is the acknowledged formula: incisors, / ; canines, ( - )/( - ); molars, ( - )/( - ),= . the following cuts exhibit the front teeth of the dog in various stages of growth and decay: [seven illustrations, shown in full in the html version of this text.] the full-grown dog has usually teeth in the upper, and in the lower jaw, with two small supernumerary molars. all of them, with the exception of the tushes, are provided with a bony neck covered by the gums, and separating the body of the tooth from the root. the projecting portion of the teeth is more or less pointed, and disposed so as to tear and crush the food on which the dog lives. they are of a moderate size when compared with those of other animals, and are subject to little loss of substance compared with the teeth of the horse. in most of them, however, there is some alteration of form and substance, both in the incisors and the tushes; but this depends so much on the kind of food on which the animal lives, and the consequent use of the teeth, that the indication of the age, by the altered appearance of the mouth, is not to be depended upon after the animal is four or five years old. the incisor teeth are six in number in each jaw, and are placed opposite to each other. in the lower jaw, the pincers, or central teeth, are the largest and the strongest; the middle teeth are somewhat less; and the corner teeth the smallest and the weakest. in the upper jaw, however, the corner teeth are much larger than the middle ones; they are farther apart from their neighbours, and they terminate in a conical point curved somewhat inwards and backwards. as long as the teeth of the full-grown dog are whole, and not injured by use, they have a healthy appearance, and their colour is beautifully white. the surface of the incisors presents, as in the ruminants, an interior and cutting edge, and a hollow or depression within. this edge or border is divided into three lobes, the largest and most projecting forming the summit or point of the tooth. the two lateral lobes have the appearance of notches cut on either side of the principal lobe; and the union of the three resembles the 'fleur de lis', which, however, is in the process of time effaced by the wearing out of the teeth. (figs. and .) while the incisor teeth are young, they are flattened on their sides, and bent somewhat backwards, and there is a decided cavity, in which a pulpy substance is enclosed. this, however, is gradually contracted as the age of the dog increases. m. f. cuvier speaks of certain supernumerary teeth occasionally developed in each of the jaws. there is much irregularity accompanying them; and they have even been supposed to have extended to seven or eight in number. the indications of age. the dog displays natural indications of age. the hair turns gray to a certain extent as in the human being. this commences about the eyes, and extends over the face, and weakens the sight; and, at ten years old, or earlier, in the majority of dogs, this can scarcely be mistaken. at fifteen or sixteen years the animal is becoming a nuisance, yet he has been known to linger on until he has reached his two-and-twentieth year. among the diseases from which the dog suffers, there are few of more frequent occurrence than decayed teeth, especially in towns, or in the habitations of the higher classes of society: the carious teeth, in almost every case, becoming insufferably fetid, or so loose as to prevent mastication; or an immense accumulation of tartar growing round them. the course which the veterinary surgeon pursues is an exceedingly simple one. if any of the teeth are considerably loose, they must be removed. if there is any deposit of tartaric acid, it must be got rid of by means of the proper instruments, not very different from those which the human surgeon employs. the teeth must be perfectly cleaned, and every loose one taken away. without this the dog will be an almost insufferable nuisance. the decayed and loose teeth being removed, chlorinated lime diluted with or times its bulk of water should be applied to the gums. by the use of this the ulcers will quickly heal; the fetor will be removed, and the deposition of the tartar prevented. mr. blaine first introduced the chlorinated lime for the accomplishment of these purposes. two little histories out of a great number will sufficiently illustrate these cases. a terrier had scarcely eaten during more than a week. he dropped his meat after attempting to chew it, and the breath was very offensive. several of the teeth were loose, and the rest were thickly encrusted with tartar. the gums had receded from the teeth, and were red, sore, and ulcerated. i removed all the loose teeth; for experience had taught me that they rarely or never became again fixed. i next, with the forceps and knife, cleaned the others, and ordered the diluted chlorinated lime to be alternated with tincture of myrrh and water. the extraction of the loose teeth, and the removal of the tartar from those that were sound, occupied a full hour; for the dog resisted with all his might. he, however, soon began to eat; the lotions were continued; and five months afterwards, the mouth of the dog was not in the slightest degree offensive. an old dog should not be quite abandoned. a pug had only four teeth remaining beside the canines. they were all thickly covered with tartar, and two of them were very loose. the gums and lips were in a dreadfully cankerous state, and the dog was unable to eat. all that he could do was to lap a little milk or broth. i extracted the two loose teeth, cleaned the others, and ordered a lotion of equal parts of tincture of myrrh and water to be applied. ' th august', .--a very considerable discharge of pus was observed, with blood from the mouth, apparently proceeding from the cavity whence one of the teeth had been extracted. the dog is exceedingly thirsty, and walks round and round the water-dish, but is afraid to lap. he has not eaten for two days. use the lotion as before, and force him with strong soup. ' th.' the dog has not voluntarily eaten, but is still forced with soup. he is very costive. give two grains of calomel and an equal quantity of antimonial powder. ' th.' he has eaten a very little, but gets thinner and weaker. continue the lotion. ' th.' the ulcers are nearly healed, and the discharge of pus has ceased. ' st.' the mouth is clean, the gums are healed, and there is no longer anything offensive about the dog. the larynx is placed at the top of the windpipe, the exit from the lungs, and is also connected with the schneiderian membrane. at its upper part is the epiglottis, the main guard against the passage of the food into the respiratory tubes, and, at the same time, of the instrument of the voice. it consists of five cartilages united together by a ligamentous substance, and, by distinct and perfect articulations, adapting itself to every change of the respiratory process and the production of the voice. at the base is the 'cricoid cartilage,' the support and bond of union of the rest. above are the 'arytenoid cartilages,' resting on the 'chorda vocales' and influencing their action. the 'epiglottis' is placed at the extremity of the opening into the windpipe, with its back opposed to the pharynx, so that when a pellet of food passes from the pharynx in its way to the oesophagus, the epiglottis is applied over the glottis, and by this means closes the aperture of the larynx, and prevents any portion of the food from passing into it. the food having passed over the epiglottis, that cartilage, from its elastic power, again rises and resumes its former situation. the 'thyroid cartilage' envelopes and protects all the rest, and particularly the lining membrane of the larynx, which vibrates from the impulse of the air that passes. the vibrations spread in every direction until they reach the delicate membrane of the tympanum of the ear. that membrane responds to the motion without, and the vibration is carried on to the pulp of the auditory nerve, deep in the recesses of the ear. the loudness of the tone--its acuteness or graveness--depends on the force of the expired air and the shortening or lengthening of the chord. hence it is, that the tone of the bark of the dog, or the neighing of the horse, depends so much on the age or size of the animal. thus we compare the shrill bark of the puppy with the hoarse one of the adult dog; the high-toned but sweet music of the beagle with the fuller and lower cry of the fox-hound, and the deep but melodious baying of the mastiff. i may, perhaps, be permitted to add to these, the whinnying of the colt and the neighing of the horse. each animal has his peculiar and intelligible language. he who has long lived among them will recognise the tone of delight at meeting, rising into and terminating in a sharper sound; the strong and elevated tone when they are calling to or challenging each other at a distance; the short expression of anger--the longer, deeper, hoarser tone of fear; the murmur almost as deep, but softer, of habitual attachment, and the elevated yet melodious token of sudden recognition. i could carry on a conversation with a dog that i once possessed for several minutes, and one perfectly intelligible to both. inflammation of the larynx is a frequent and dangerous complaint. it usually commences with, and can scarcely be distinguished from, catarrh, except that it is attended by cough more violent and painful, and the dog expectorates considerably. acute laryngitis is not so frequent an occurrence; but there is much danger attending it. blood must be abstracted to as great an extent as the pulse will bear, or until it becomes evidently affected. to this must follow digitalis, nitre, tartar emetic, and aloes, and to these must be added a powerful blister. a considerable quantity is effused and organized, the membrane is thickened, perhaps permanently so, and the whole of the submucous cellular tissue becomes oedematous. the dog is subject to sudden attacks of 'angina'. it has been imagined, from the appearances that are manifested, that some strange body is arrested in the windpipe or the throat. there is no dread of water or of the usual fluids; the dog will lap once or twice from that fluid which is placed before him, and turns slowly away from it; and this circumstance gives rise to what is called dumb madness. the dog barks in a particular manner, or rather howls like a rabid dog: he is out of spirits, has a strange, anxious, altered countenance, and is alternately cold and hot. frequently added to this is redness of the buccal and nasal membranes. he refuses all solid food, and either will not drink or finds it difficult to swallow anything. his mouth is generally open, and contains a spumy matter exhaling an offensive smell. his tongue, charged with a great quantity of saliva, protrudes from his mouth, and the submaxillary glands are enlarged. to these appearances are added a yellow tint of the eyes, constipation, and a small quantity of urine, surcharged with a deep yellow colour. at this period the disease has generally reached a considerable degree of virulence. often the inflammation extends to the back part of the mouth and larynx; and in this last case the respiration is attended by a hoarse, hissing kind of sound. the progress of the disease is rapid, and, in a few days, it reaches its highest degree of intensity. it is always fatal when it is intense; and, when its influence is widely spread, it is a very dangerous complaint. somewhat rarely the subjects of it recover. after death we find great redness and injection in all the affected nervous surfaces, and indications of abscesses in which suppuration was not fully established. foreign articles in the throat when a substance, such as a bone, has become impacted in the throat, the better plan is to attempt to push it downwards into the stomach, as there is but little hope of extracting it. [a portion of sponge may be securely tied on the end of a piece of ratan, whalebone, or other flexible material, and inserted in the mouth, may be carried over the tongue down the throat against the foreign article, which may then be gently pushed before it. if this should not succeed, and the substance appears firmly imbedded in the throat, an incision may be made in the oesophagus and the bone extracted.--l.] bronchocele or goitre in the dog is almost daily forced upon our notice. if a spaniel or pug-puppy is mangy, pot-bellied, rickety, or deformed, he seldom fails to have some enlargement of the thyroid gland. the spaniel and the pug are most subject to this disease. the jugular vein passes over the thyroid gland; and, as that substance increases, the vein is sometimes brought into sight, and appears between the gland and the integuement, fearfully enlarged, varicose, and almost appearing as if it were bursting. the trachea is pressed upon on either side, and the oesophagus by the left gland, and there is difficulty of swallowing. the poor animal pants distressingly after the least exertion, and i have known absolute suffocation ensue. in a few cases ulceration has followed, and the sloughing has been dreadful, yet the gland has still preserved its characteristic structure. although numerous abscesses have been formed in the lower part of it, and there has been considerable discharge, viscid or purulent, the upper part has remained as hard and almost as scirrhous as before. 'cause of goitre'.--in many cases, this enlargement of the thyroid glands is plainly connected with a debilitated state of the constitution generally, and more particularly with a disposition to rickets. i have rarely seen a puppy that had had mange badly, and especially if mange was closely followed by distemper, that did not soon exhibit goitre. puppies half-starved, and especially if dirtily kept, are thus affected; and it is generally found connected with a loose skin, flabby muscles, enlarged belly, and great stupidity. on the other hand, i have seen hundreds of dogs, to all appearance otherwise healthy, in whom the glands of the neck have suddenly and frightfully enlarged. i have never been able to trace this disease to any particular food, whether solid or liquid; although it is certainly the frequent result of want of nutriment. some friends, of whom i particularly inquired, assured me, that it is not to any great extent prevalent in those parts of derbyshire where goitre is oftenest seen in the human being. it is periodical in the dog. i have seen it under medical treatment, and without medical treatment, perfectly disappear for a while, and soon afterwards, without any assignable cause, return. there is a breed of the blenheim spaniel, in which this periodical goitre is very remarkable; the slightest cold is accompanied by enlargement of the thyroid gland, but the swelling altogether disappears in the course of a fortnight. i am quite assured that it is hereditary; no one that is accustomed to dogs can doubt this for a moment. 'treatment'.--i am almost ashamed to confess how many inefficient and cruel methods of treatment i many years ago adopted. i used mercurial friction, external stimulants, and blisters; i have been absurd enough to pass setons through the tumours, and even to extirpate them with the knife. the mercury salivated without any advantage, the stimulants and the blisters aggravated the evil; the setons did so in a tenfold degree, so that many dogs were lost in the irritative fever tint was produced; and, although the gland, when directed out, could not be reproduced, yet i have been puzzled with the complication of vessels around it, and in one case lost my patient by hemorrhage, which i could not arrest. when the power of iodine in the dispersion of glandular tumours was first spoken of, i eagerly tried it for this disease, and was soon satisfied that it was almost a specific. i scarcely recollect a case in which the glands have not very materially diminished; and, in the decided majority of cases, they have been gradually reduced to their natural size. i first tried an ointment composed of the iodine of potassium and lard, with some, but not a satisfactory result. next i used the tincture of iodine, in doses of from five to ten drops, and with or without any external local application; but i found, at length, that the simple iodine, made into pills with powdered gum and syrup, effected almost all that i could wish. it is best to commence with the eighth of a grain for a small dog, and rapidly increase it to half a grain, morning and night. a larger dog may take from a quarter of a grain to a grain. in a few instances, loss of appetite and slight emaciation have been produced; but then, the medicine being suspended for a few days, no permanent ill effect has ever followed the exhibition of iodine. phlegmonous tumour. a phlegmonous tumour under the throat, and accompanied by constitutional disturbance, with the exception of there being little or no cough, often appears in the dog. comparing the size of the animals, these tumours are much larger than in either the horse or ox; but they are situated higher up the face, and do not press so much upon the windpipe, nor is there any apparent danger of suffocation from them. the whole head, however, is sometimes enlarged to a frightful degree, and the eyes are completely closed. more than a pint of fluid has sometimes escaped from a middle-sized dog at the first puncture of the tumour. the mode of treatment is, to stimulate the part, in order to expedite the suppuration of the tumour, and to lance it freely and deeply, as soon as matter is evidently formed. the wound should be dressed with tincture of aloes, and a thick bandage placed round the neck, to prevent the dog from scratching the part, which often causes dreadful laceration. these tumours in the throat of the dog are not always of a phlegmonous character. they are cysts, sometimes rapidly formed, and of considerable size, and filled with a serous or gelatinous fluid. * * * * * chapter xi. anatomy and diseases of the chest; the diaphragm; the pericardium; the heart; pleurisy; pneumonia; spasmodic cough the chest is the superior, or in quadrupeds the anterior, cavity of the trunk of the body: it is divided into two cavities by a membranous partition, termed 'mediastinum;' and separated from the abdomen, or cavity which contains the liver, spleen, pancreas, and other abdominal viscera, by the 'diaphragm,' which is of a musculo-membranous nature. this membrane may be described, as it is divided, into the main circular muscle, with its central tendinous expansion forming the lower part, and two appendices, or 'crura,' as they are termed from their peculiar shape, constituting its superior portion. we trace the fleshy origin of the grand muscle, laterally and inferiorly, commencing from the cartilage of the eighth rib anteriorly, and following somewhat closely, as we proceed backward, the union of the posterior ribs with their cartilages, excepting, however, the two last. the attachment is peculiarly strong. it is denticulated: it encloses the whole of the latter and inferior part of the chest as far as the sternum, where it is connected with the ensiform cartilage. the diaphragm is the main agent, both in ordinary and extraordinary respiration. in its quiescent state it presents its convex surface towards the thorax, and its concave one towards the abdomen. the anterior convexity abuts upon the lungs; the posterior concavity is occupied by some of the abdominal viscera. thus far we have described the diaphragm as found in the horse, ox, and sheep. there is some difference with regard to the dog. the muscular part of the diaphragm is thick and strong in every species of dog, while the aponeurotic expansion is comparatively smaller. from the smaller expanse of the thorax of the dog, and the consequent little expansion of the diaphragm, the action, although occasionally rapid and violent--for he is an animal of speed--is not so extensive, and more muscle and less tendon may be given to him, not only without detriment, but with evident advantage. therefore, although we have occasional rupture of the heart of the dog, oftener perhaps than in the horse, there is no case of rupture of the diaphragm on record. the cavity of the thorax is lined by a membrane, termed pleura, which covers the surface of the lungs. the lungs on either side are enclosed in a separate and perfect bag, anil each lung has a distinct pleura. the heart lies under the left lung; and, more perfectly to cut off all injurious connexion or communication of disease between the lungs and the heart, the heart is enclosed in a distinct pleura or bag, termed the 'pericardium'. this membrane closely invests the heart, supports it in its situation, prevents too great dilatation when it is gorged with blood, and too violent action when it is sometimes unduly stimulated. notwithstanding the confinement of the pericardium, the heart, when under circumstances of unusual excitation, beats violently against the ribs, and, were it not thus tied down, would often bruise and injure itself, and cause inflammation in the neighbouring parts. the 'heart' is composed of four cavities; two above, called 'auricles', from their shape, and two below, termed 'ventricles', occupying the bulk of the heart. in point of fact, there are two hearts--the one on the left side propelling the blood through the frame, and the other on the right side conveying it through the pulmonary system; but, united in the manner in which they are, their junction contributes to their mutual strength, and both circulations are carried on at the same time. the beating of the heart in the dog is best examined behind the elbow on the left side. the hand, applied flat against the ribs, will give the number and character of the pulsations. the pericardium, or outer investing membrane of the heart, is frequently liable to inflammation, milked by a quickened and irregular respiration, and an action of the heart, bounding at an early period of the disease, but becoming scarcely recognisable as the fluid increases. the patient is then beginning gradually to sink. a thickening of the substance of the heart is occasionally suspected, and, on the other hand, an increased capacity of the cavities of the heart; the parietes being considerably thinner, and the frame of the animal emaciated. the pulse of the greater part of our domestic animals has been calculated by mr. vatel, in his excellent work on veterinary pathology, to be nearly as follows: in the horse, from to pulsations in a minute. " ox or cow, " " " " ass, " " " " sheep, " " " " goat, from to pulsations in a minute. " dog, " " " " cat, " " " " rabbit, . . " " guinea-pig, . . " " crow, . . " " duck, . . " " hen, . . " " heron, . . " the pulse of the dog may be easily ascertained by feeling at the heart or the inside of the knee, and it varies materially, according to the breed, as well as the size of the animal. this is very strikingly the case with some of the sporting dogs, with whom the force as well as the rapidity of the pulse vary materially according to the character and breed of the dog. there is, occasionally, in the dog as in the human being, an alteration of the quantity, as well as of the quality, of the blood. 'anæmia' is the term used to designate a deficiency in quantity; 'plethora' is the opposite state of it. m. d'arbor relates a very curious account of the former: two dogs were sent into the hospital of the veterinary school at lyons. they did not appear to suffer any considerable pain. their skin and mucous membranes that were visible had a peculiar appearance. they had also comparatively little power over their limbs; so little, indeed, that they rested continually on one side, without the ability to shift their posture. when they were placed on their feet, their limbs gave way, and they fell the moment they were quitted. in despite of the care that was taken of them, they died on the second day. incisions were made through the skin, but in opening them no blood flowed. the venæ cavæ themselves did not contain any--there were only two clots of blood in the cavities of their hearts. one of them, of the size of a small nutmeg, occupied the left ventricle; the other, which was still smaller, was found at the base of the right ventricle. the chest of one of them enclosed a small quantity of serosity; a similar fluid was between the dura mater and the arachnoid membrane, and the same was the case in the larger ventricles of the encephalon. the other viscera did not offer anything remarkable, except the paleness and flaccidity of their tissue. the great fatigues of the chase, and the immersion of these animals in water at the time that they were very much heated, appeared to have been the causes of this singular disease. in the report of the labours of the school of alfort, in the year , the same anæmia was remarked in two dogs that died there; one of them had lately undergone a considerable hemorrhage, and in the other anæmia had developed itself spontaneously. it is in fact among dogs that this extreme anæmia has been principally observed, and is ordinarily fatal. it has been remarked by m. crusal in a bullock attacked with gastro-enteritis. this disease, according to m. vatel, is generally the symptom of a chronic malady, or the instantaneous effect of an excessive hemorrhage. it is rarely primary. the extreme discoloration of the tissues, and of the mucous membrane more particularly, the disappearance of the subcutaneous blood-vessels, and the extreme feebleness of the animal, are the principal symptoms. there also often exists considerable swelling of the limbs. the following singular case of a wound penetrating into the chest and pericardium of a dog, is recorded by professor delafond: a mastiff dog fighting with another was stabbed in the chest by the master of his antagonist. five hours after the accident, the professor was sent for. on the exterior of the sternum was a laceration an inch and a half in length, covered by a spumy fluid, from the centre of which was heard a gurgling noise, showing that a wound had penetrated into the sac of the pleura. the respiration was quick, and evidently painful; the beating of the heart was also strong and precipitate. the finger being introduced into the wound, penetrated between the fourth and fifth rib on the left side. "having arrived at the pleuritic sac," says the professor, "i gently tapped the surface of the lung, in order to assure myself that it was not injured; my finger penetrated into the pericardium, and the point of the heart beat against it." he bathed the wound with a little diluted wine, and brought the edges of it as near together as he could, and confined them with a suture, administering a mild aperient. on the following day, the animal walked slowly about, seeking for something to eat; he gave him some milk. on changing the dressing, he tried whether he could again introduce any sound into the wound; but it would only penetrate a very little way; indeed, re-union by adhesion had already taken place. on the fifth day, the animal was in good spirits; the wound had a healthy red appearance, and all tended to a speedy cure. on the eighth day he was sent home to his master, a distance of two leagues from his house. he saw the dog eighteen months afterwards, and he was as eager as ever after his game. the following is a case of rupture of the heart:--a black pointer, of the scotch breed, had every appearance of good health, except that she frequently fell into a fit after having run a little way, and sometimes even after playing in the yard. she was several times bled during and after these fits. when i examined her, i could plainly perceive considerable and violent spasmodic motion of the heart, and the sounds of the beating of the heart were irregular and convulsive. she was sent to the infirmary, in order to be cured of an attack of mange; but during her stay in the hospital she had these fits several times: the attack almost always followed after she had been playing with other dogs. she appeared as if struck by lightning, and remained motionless for several minutes, her gums losing their natural appearance and assuming a bluish hue. after the lapse of a few minutes, she again arose as if nothing had been the matter. she was bled twice in eight days, and several doses of foxglove were administered to her. the fits appeared to become less frequent; but, playing one day with another dog, she fell and expired immediately. the 'post mortem' examination was made two hours after death. the cavity of the pericardium contained a red clot of blood, which enveloped the whole of the heart; it was thicker in the parts that corresponded with the valve of the heart; and on the left ventricle, and near the base of the left valve of the heart, and on the external part of that viscus, was an irregular rent two inches long. it crossed the wall of the valve of the heart, which was very thin in this place. the size of the heart was very small, considering the height and bulk of the dog. the walls of the ventricles, and particularly of the left ventricle, were very thick. the cavity of the left ventricle was very small; there was evidently a concentric hypertrophy of these ventricles; the left valve of the heart was of great size. the immediate cause of the rupture of the valve of the heart had evidently been an increase of circulation, brought on by an increase of exercise; but the remote cause consisted in the remarkable thinness of the walls of the valve of the heart. this case is remarkable in more than one respect; first, because examples of rupture of the valve of the heart are very rare; and, secondly, because this rupture had its seat in the left valve of the heart, while, usually, in both the human being and the quadruped, it takes place in the right; and this, without doubt, because the walls and the valves of the right side are thinner. diseases of the investing membrane of the lungs, and the pleura of the thoracic cavity, and of the substance of the lungs, are more frequent than those of the heart. pleurisy, or inflammation of the membrane of the chest and the lungs of the dog, is not unfrequent. there are few instances of inflammation of the lungs, or pneumonia, that do not ultimately become connected with or terminate in pleurisy. the tenderness of the sides, the curious twitching that is observed, the obstinate sitting up, and the presence of a short, suppressed, painful cough, which the dog bears with strange impatience, are the symptoms that principally distinguish it from pneumonia. the exploration of the chest by auscultation gives a true picture of it in pleurisy; and, by placing the dog alternately on his chest, his back, or his side, we can readily ascertain the extent to which effusion exists in the thoracic cavity; and, if we think proper, we can get rid of the fluid. it is not a dangerous thing to attempt, although it is very problematical whether much advantage would accrue from the operation. with a favourite dog it may, however, be tried; and, to prevent all accidents, a veterinary surgeon should be entrusted with the case. pneumonia, or inflammation of the substance of the lungs, is a complaint of frequent occurrence in the dog, and is singularly marked. the extended head, the protruded tongue, the anxious, bloodshot eye, the painful heaving of the hot breath, the obstinacy with which the animal sits up hour after hour until his feet slip from under him, and the eye closes, and the head droops, through extreme fatigue, yet in a moment being roused again by the feeling of instant suffocation, are symptoms that cannot be mistaken. here, from the comparative thinness of the integument and the parietes, we have the progress of the disease brought completely under our view. the exploration of the chest of the dog by auscultation is a beautiful as well as wonderful thing. it at least exhibits to us the actual state of the lungs, if it does not always enable us to arrest the impending evil. mr. blaine and myself used cordially to agree with regard to the treatment of pneumonia, materially different from the opinions of the majority of sportsmen. epidemic pneumonia was generally fatal, if it was not speedily arrested in its course. the cure was commenced by bleeding, and that to a considerable extent, when not more than four-and-twenty or six-and thirty hours had passed; for, after that, the progress of the disease could seldom be arrested. blistering the chest was sometimes resorted to with advantage; and the cantharides ointment and the oil of turpentine formed one of the most convenient as well as one of the most efficacious blisters. a purgative was administered, composed of mutton broth with epsom salts or castor oil; to which followed the administration of the best sedatives that we have in those cases, namely, nitre, powdered foxglove, and antimonial powder, in the proportion of a scruple of the first, four grains of the second, and two grains of the third. congestion of the lungs is a frequent termination of pneumonia; and in that congestion the air-cells are easily ruptured and filled with blood. that blood assumes a black pulpy appearance, commonly indicated by the term of 'rottenness', an indication or consequence of the violence of the disease, and the hopelessness of the case. a different consequence of inflammation of the lungs is the formation of tubercles, and, after that, of suppuration and abscess, when, generally speaking, the case is hopeless. a full account of this is given in the work on the horse. two cases of pneumonia will be useful: oct. d, . a black pointer bitch that had been used lo a warm kennel, was made to sleep on flat stones without straw. a violent cough followed, under which she had been getting worse and worse for a fortnight. yesterday i saw her. the breathing was laborious. the bitch was constantly shifting her position, and, whether she lay down or sat up, was endeavouring to elevate her head. her usual posture was sitting, and she only lay down for a minute. the eyes were surrounded, and the nose nearly stopped with mucus. v. s. [symbol: ounce] viij. emet. fever-ball twice in the day. d. breathing not quite so laborious. will not eat. medicine as before. apply a blister on the chest. th. nearly the same. v. s. [symbol: ounce] vj. bol. utheri. th. decided amendment. she breathes with much less difficulty. less discharge both from eyes and nose. bol. utheri. nov. th. sent home well. a singular and not uninstructive case came before me. a lady in the country wrote to me to say, that her terrier was thin, dull, husking, and perpetually trying to get something from the throat; that her coat stared, and she frequently panted, i replied, that i apprehended she had caught cold; and recommended bleeding to the extent of four ounces, a grain each of calomel and emetic tartar to be given every fourth morning, and a fever-ball, composed of digitalis, nitre, and tartrate of antimony, on each intermediate day. a few days after this i received another letter from her, saying, that the dog was bled as ordered, and died on the following thursday. that another veterinary surgeon had been called in, who said that the first one had punctured the 'vena cava' in the operation, and that the dog had bled to death internally; and she wished to know my opinion. i replied, that the charge proceeded from ignorance or malice, or both. that in one sense he was right--the jugular, which the other had probably opened, runs into the vena cava, and may, with some latitude, be considered a superior branch of it; therefore, thus far the first man had punctured the vena cava, which i had done many hundred times; but that the point of union of the four principal veins that form the vena cava was too securely seated in the upper part of the thorax for any lancet to reach it. that the rupture of some small arterial vessel might have caused this lingering death, but that the puncture of a vein would either have been speedily fatal, or of no consequence; and that, probably, the animal died of the disease which she had described. spasmodic cough is a troublesome disease to manage. dogs, and especially those considerably petted, are subject to frequent cough, requiring a material difference in the treatment. sometimes there is a husky cough, not to so great a degree as in distemper, but followed by the same apparent effort to get something from the throat, the same attempt to vomit, and the ejection of mucus, frothy or adhesive, and occasionally discoloured with bile. it proceeds from irritability or obstruction in some of the air-passages, and oftenest of the superior ones. an emetic will clear the fauces, or at least force out a portion of the adhesive matter which is clogging the bronchial tubes. a cough of this kind, and attended in its early stages by little fever, seldom requires anything more for its cure than the exhibition of a few gentle emetics, consisting of equal portions of calomel and emetic tartar, given in doses varying from half a grain to one grain and a half of each. a harsh hollow cough is attended by more inflammatory action. the depletive system must be adopted here. a loud and harsh cough will yield only to the lancet and to purgatives, assisted by sedative medicines composed of nitre, antimonial powder, and digitalis, or small doses of syrup of poppies, or more minute doses of the hydrocyanic acid; this last medicine, however, should be carefully watched, and only given under surgical advice. th october, . a spaniel was apparently well yesterday, but towards evening a violent cough suddenly came on. it was harsh and hollow, and terminated in retching. there was a discharge of water from the eyes; but the nose was cool and moist. give an emetic, and then two grains of the james's powder. th the animal coughed almost the whole of the night. there was more watery discharge from the eyes, which appeared to be red and impatient of light; the nose continued cool, and the dog did not refuse his food. an aperient ball was given; and twice afterwards in the day, the nitre, antimonial powder, and digitalis. th. the cough is as frequent, but not very loud. give a mixture of syrup of poppies and prussic acid morning and night, and the ball as yesterday. st. nearly in the same state as yesterday, except that he is not so thirsty, and does not eat so well. give the mixture three times daily. nov. st. he had an emetic in the morning, which produced a large quantity of phlegm, but the cough is no better. no evacuation during the two last days. give an aperient ball, and the mixture as before in the evening. the prussic acid has been fairly tried; it has not in the least mitigated the cough, but begins to make the dog sick, and altogether to destroy his appetite. give three times in the day a mixture consisting of two-thirds of a drachm of syrup of poppies, and one-third of syrup of buckthorn. the sickness ceased, and the cough remained as before, i then gave twice in the day half a grain of calomel, the same of opium, two each of pulvis antimonialis and digitalis, and four grains of nitre, morning and noon, with six grains of the dover's powder at night. this was continued on the d, th and th of november, when there were longer intervals of rest, and the dog did not cough so harshly when the fit was on him. on the th, however, no medicine was given; but towards evening the dog coughed as much as ever, and a decided mucous discharge commenced from the nose and the eyes, with considerable snorting. an emetic was given, and the balls resorted to as before. ' th.' he appeared to be much relieved by the emetic. the cough was better, the dog ate well, and had regained his usual spirits. the ball as before. ' th'. slight tenesmus now appeared. it quickly became frequent and violent. the dog strained very much; but the discharge was small in quantity, and consisted of adhesive mucus. give two drachms of castor oil, and the fever ball with opium. the cough is worse, and the dog still continues to strain, no blood, however, appearing. ' th'. the opium and oil have had their desired effect, and the cough is better. ' th', except the animal is kept under the influence of opium, the cough is dreadfully troublesome. i have, however, obtained one point. i have been permitted to subtract four ounces of blood; but blood had been mingling with the expectorated mucus before i was permitted to have recourse to the lancet. ' th'. the dog is better, and we again have recourse to the fever mixture, to which, on the ' th', i added a very small portion of the carbonate of iron, for the dog was evidently getting weak. the sickness has returned, and the cough is decidedly worse. ' th'. rub a small quantity of rheumatic embrocation, and tincture of cantharides. ' th.' the first application of the blister had not much effect; but this morning it began to act. the dog ran about the house as cross as he could be for more than an hour; there was considerable redness on the throat and chest. the cough, however, was decidedly better. ' th'. the cough is better. again apply the embrocation. ' th.' the cough and huskiness have returned. employ an emetic, and continue the embrocation. ' th'. the cough is decidedly worse. continue the embrocation, and give the fever mixture. ' d'. the embrocation and medicine have been daily used; but the cough is as bad as ever. balls of assafoetida, squills, and opium were had recourse to. th. the second ball produced the most distressing sickness, but the cough was evidently relieved. the assafoetida was discontinued. ' th'. the cough, during the last two days, has been gradually getting worse. it is more laborious and longer, and the intervals between it are shorter. give another emetic and continue the other medicine. th'. the effect of the emetic was temporary, and the cough is again worse. 'dec'. d'. very little change. th'. the cough appears to be stationary. again have recourse to the antimony, digitalis, and nitre. th'. the cough is certainly better. try once more the assafoetida. it again produced sickness, but of a very mild character. th'. the assafoetida was again used used morning and night. the cough continues evidently to abate. th'. the dog coughs very little, not more than half-a-dozen times in the day. notwithstanding the quantity of medicine that has been taken, the appetite is excellent, and the spirits good. th'. the cough is still less frequent, but when it occurs it is attended with retching. th'. the cough is daily getting better, and is not heard more than three or four times in the four-and-twenty hours, and then very slight. th'. at length i can say that the cough has ceased. it is seldom that so much trouble would have been taken with a dog. it is the neglect of the medical attendance which is often the cause of death. professor delafond, of alfort, gives a most interesting and complete table of the usual diagnostic symptoms of pleurisy and pneumonia. pleurisy. 'commencement of the inflammation'. shivering, usually accompanied by slight colicky pains, and followed by general or partial sweating. inspiration always short, unequal, and interrupted; expiration full; air expired of the natural temperature. cough unfrequent, faint, short, and without expectoration. artery full. pulse quick, small, and wiry. 'auscultation'. a respiratory murmur, feeble, or accompanied by a slight rubbing through the whole extent of the chest, or in some parts only. 'percussion'. slight, dead, grating sound. distinct resonance through the whole of the chest, and pain expressed when the sides are tapped or compressed. 'terminations' delitescence. cessation of pain; moderate temperature of the skin; sometimes profuse general perspiration. respiration less accelerated; inspiration easier and deeper. pulse fuller and softer. breath of the natural temperature. return of the natural respiratory murmur and resonance. the walls of the chest cease to exhibit increased sensibility. 'effusion, false membranes'. inspiration more and more full. 'auscultation and percussion. complete absence of the respiratory murmur, with the crepitating wheezing always at the bottom of the chest; sometimes a gurgling noise. vesicular respiration very strong in the upper region of the chest, or in the sac opposite to the effusion. 'continuance of the effusion'. absence of the respiratory murmur gains the middle region of the chest, following the level of the fluid. these symptoms may be found on only one side; a circumstance of frequent occurrence in the dog, but rare in other animals. the respiratory murmur increases in the superior region of the chest, or on the side opposite to the effusion. inspiration becomes more and more prolonged. breath always cold. cough not existing, or rarely, and always suppressed and interrupted. exercise producing much difficulty of respiration. 'resolution or re-absorption of the effused fluid, and organization of false membrane, the consequence of pleurisy'. slow but progressive reappearance of the respiratory murmur, and disappearance of the sounds produced by the fluid. diminution of the force of the respiratory murmur in the superior part of the chest, or of the lung opposite to the sac in which the effusion exists. gradual return of the respiratory murmur to the inferior part of the chest. inspiration less deep, and returning to its natural state. 'chronic pleurisy, with hydrothorax'. inspiration short. cough dry, sometimes with expectoration; frequent or capricious; always absence of complete respiratory murmur in the inferior portion of the chest. sometimes the gurgling noise during inspiration and expiration. strong respiratory murmur in the superior portion. in dogs these symptoms sometimes have existence only on one side of the chest. the mucous membranes are infiltrated; serous infiltration on the lower part of the chest and belly; sometimes of the scrotum or the inferior extremities; generally of the fore legs. the animal lies down frequently, and dies of suffocation. pneumonia. 'commencement of the inflammation'. general shivering, rarely accompanied by colicky pains, followed by partial sweats at the flanks and the inside of the thighs. inspiration full, expiration short. air expired hot. cough frequently followed by slight discharge of red-coloured mucus. artery full. pulse accelerated, strong, full, and soft. 'auscultation'. absence of respiratory murmur in places where the lung is congested; feebleness of that sound in the inflamed parts, with humid crepitating wheezing. the respiratory murmur increased in the sound parts. 'percussion'. the dead grating sound confined to the inflamed parts. distinct resonance at the sound parts; increased sensibility of the walls of the chest slight, or not existing at all. 'terminations'. resolution. temperature of the skin moderate. sometimes profuse partial sweats. laborious respiration subsiding; inspiration less deep. artery less full. pulse yielding. breath less hot. gradual and progressive disappearance of the crepitating 'râle'. slow return of the resonance. 'red hepatization'. respiration irregular and interrupted. 'auscultation and percussion. circumscribed absence of the respiratory murmur, in one point, or in many distinct parts of the lung. the respiratory murmur increased in one or more of the sound parts of the lung, or in the sound lung if one is inflamed. 'passage to a state of gray induration'. the absence of respiratory murmur indicates extensive hepatization of one lung; a circumstance, however, of rare occurrence. when the induration is of both lungs, and equally so, the respiratory murmur and the inspiration remain the same, except that they become irregular. the cough dry or humid, frequent, and sometimes varying. exercise accompanied by difficulty of respiration, without dyspnoea. 'resolution or re-absorption of the products of inflammation of the parenchymatous substance of the lungs'. diminution of the force of the respiratory murmur in the sound parts. cessation of the crepitating wheezing. slow return of the respiratory murmur where it had ceased. respiration ceases to be irregular or interrupted, and returns slowly to its natural state, or it remains interrupted. this indicates the passage from red to gray induration. 'chronic pneumonia--(gray induration.)' inspiration or expiration interrupted, cough unfrequent; suppressed; rarely with expectoration; always interrupted. complete absence of respiratory murmur. 'softening of the induration, ulcerations, vomicæ, &c.' mucous and wheezing; mucous râle in the bronchia; discharge from the nostrils of purulent matter, white, gray, or black, and sometimes fetid. paleness of the mucous membranes. the animal seldom lies down, and never long at a time. death by suffocation, when the matter proceeding from the vomicæ, or abscesses, obstructs the bronchial passages, or by the development of an acute inflammation engrafted upon the chronic one. chapter xii. anatomy of the gullet, stomach, and intestines: tetanus; enteritis; peritonitis; colic; calculus in the intestines: intussusception; diarrhoea; dysentery; costiveness; dropsy; the liver; jaundice; the spleen and pancreas; inflammation of the kidney; calculus; inflammation of the bladder; rupture of the bladder; worms: fistula in the anus. the 'oesophagus', or gullet, of the dog, is constructed in nearly the same manner as that of the horse. it consists of a similar muscular tube passing down the neck and through the chest, and terminating in the stomach, in which the process of digestion is commenced. the orifice by which the gullet enters the stomach is termed the 'cardia', probably on account of its neighbourhood to the heart or its sympathy with it. it is constantly closed, except when the food is passing through it into the stomach. the 'stomach' has three coats: the outermost, which is the common covering of all the intestines, called the peritoneum; the second or muscular coat, consisting of two layers of fibres, by which a constant motion is communicated to the stomach, mingling the food, and preparing it for digestion; and the mucous or villous, where the work of digestion properly commences, the mouths of numerous little vessels opening upon it, which exude the gastric juice, to mix with the food already softened, and to convert it into a fluid called the chyme. it is a simpler apparatus than in the horse or in cattle. it is occasionally the primary seat of inflammation: and it almost invariably sympathises with the affections of the other intestines. the successive contractions of each portion of the stomach, expose by turns every portion of the alimentary mass to the influence of the gastric juice, and each is gradually discharged into the alimentary canal. as the chyme is formed, it passes out of the other orifice of the stomach, and enters the first intestine or 'duodenum'. it may be naturally supposed that this process will occasionally be interrupted by a variety of circumstances. inflammation of the stomach of the dog is very difficult to deal with. it is produced by numerous different causes. there is great and long-continued sickness; even the most harmless medicine is not retained on the stomach. the thirst is excessive; there are evident indications of excessive pain, expressed by the countenance and by groans: there is a singular disposition in the animal to hide himself from all observation; an indication that should never be neglected, nor the frequent change from heat to cold, and from cold to heat. the mode of treatment is simple, although too often inefficient. the lancet must be immediately resorted to, and the bleeding continued until the animal seems about to fall; and to this should quickly succeed repeated injections. two or three drops of the croton oil should be injected twice or thrice in the day, until the bowels are thoroughly opened. the animal will be considerably better, or the disease cured, in the course of a couple of days. there is a singular aptitude in the stomach of the dog to eject a portion of its contents; but, almost immediately afterwards, the food, or a portion if not the whole of it, is swallowed again. this is a matter of daily occurrence. there is a coarse rough grass, the 'cynosurus cristatus', or crested dog's-tail. it is inferior for the purposes of hay, but is admirably suited for permanent pastures. it remains green after most other grasses are burnt by a continuance of dry weather. the dog, if it be in his power, has frequent recourse to it, especially if he lives mostly in a town. the dry and stimulating food, which generally falls to his share, produces an irritation of his stomach, from which lie is glad to free himself; and for this purpose he has recourse to the sharp leaves of the cynosurus. they irritate the lining membrane of the stomach and intestines, and cause a portion of the food to be occasionally evacuated; acting either as an emetic or a purgative, or both. they seem to be designed by nature to be substituted for the calomel and tartar emetic, and other drugs, which are far too often introduced. an interesting case of the retention of a sharp instrument in the stomach is related by mr. kent of bristol. on the d of february, mr. harford, residing in bristol, when feeding a pointer-dog, happened to let the fork tumble with the flesh, and the dog swallowed them both. on the following morning, mr. kent was desired to see the animal; and, although he could feel the projection of the fork outwardly, which convinced him that the dog had in reality swallowed it, yet, as he appeared well, and exhibited no particular symptoms of pain or fever, mr. kent gave it as his opinion that there was a possibility that he might survive the danger, and the animal was sent to him, in order to be more immediately under his care. the treatment he adopted was, to feed him on cow's liver, with a view to keep the stomach distended and the bowels open; and he gave him three times a day half a pint of water, with sufficient sulphuric acid to make it rather strongly sour to the human tongue, with the intention of assisting the stomach in dissolving the iron. on the following sunday, the skin, at the projecting point, began to exhibit some indication of ulceration; and on monday a prong of the fork might be touched with the point of the finger, when pressed on the ulcer. mr. kent then determined on making an effort to extract the fork on the following morning, which he accordingly did, and with but little difficulty, assisted by a medical friend of the owner. the dog was still fed on cow's liver; his appetite remained good, and with very little medical treatment the external wound healed. the animal improved rapidly in flesh during the whole time. he left the infirmary in perfect health, and remained so, with one inconvenience only, a very bad cough, and his being obliged to lie at length, being unable to coil himself up in his usual way. the fork was a three-pronged one, six and a half inches long. the handle, which was of ivory, was digested: it was quite gone; and either the gastric fluid or the acid, or both conjointly, had made a very apparent impression on the iron. dogs occasionally swallow various strange and unnatural substances. considerable quantities of hair are sometimes accumulated in the stomach. half-masticated pieces of straw are ejected. straw mingled with dung is a too convincing proof of rabies. dog-grass is found irritating the stomach, or in too great quantities to be ejected, while collections of earth and dung sometimes threaten suffocation. pieces of money are occasionally found, and lead, and sponge. various species of polypus irritate the coats of the stomach. portions of chalk, or stone, or condensed matters, adhere to each other, and masses of strange consistence and form are collected. the size which they assume increases more and more. m. galy relates an extraordinary account of a dog. it was about three years old when a tumour began to be perceived in the flank. some sharp-pointed substance was felt; the veterinary surgeon cut down upon it, and a piece of iron, six inches in length, was drawn out. the following fact was more extraordinary: it is related by m. noiret. a hound swallowed a bone, which rested in the superior part of the oesophagus, behind the pharynx, and caused the most violent efforts to get rid of it. the only means by which it could be made to descend into the stomach was by pushing it with the handle of a fork, which, escaping from the hand of the operator, followed the bone into the stomach. two months afterwards, on examining the stomach, the fork was plainly felt lying in a longitudinal direction, parallel with the position of the body; the owner of the dog wishing mechanically to accelerate the expulsion of this body, endeavoured to push it backwards with his hands. when it was drawn as far back as possible, he inserted two fingers into the anus, and succeeded in getting hold of the handle, which he drew out nearly an inch; but, in order to be enabled fully to effect his object, it was necessary to make an incision into the rectum, and free the substance from every obstacle that could retain it. this he did not venture to do, and he was therefore compelled to allow the fork to pass back into its former position. about three months after the accident, m. noiret made an incision, three inches from above to below, and the same from the front backwards. he also made an incision through the muscular tissue. having arrived at the peritoneum, he made another incision, through which he drew from the abdomen a part of the floating portion of the large intestines, and introduced his fingers into the abdominal cavity. he seized the handle of the fork, which was among the viscera, and free about half-way down, and drew it carefully towards the opening made in the flank. the other half of the fork was found to be closely enveloped by the origin of the mesocolon, which was red, hard, and inflamed. the operator freed it by cutting through the tissues which held the fork, and then drew it easily out. the animal was submitted to a proper course of treatment, and in three weeks afterwards was perfectly cured. the food, having been converted into chyme by the digestive power of the stomach, soon undergoes another and very important change. it, or a portion of it, is converted into chyle. it is mixed with the bile and a secretion from the pancreas in the duodenum. the white thick liquid is separated, and contains the nutritive part of the food, and a yellow pulpy substance is gradually changed into excrement. as these substances pass on, the separation between them becomes more and more complete. the chyle is gradually taken up by the lacteals, and the excrement alone remains. the next of the small intestines is the 'jejunum', so called from its being generally empty. it is smaller in bulk than the duodenum, and the chyme passes rapidly through it. next in the list is the 'ileum'; but it is difficult to say where the jejunum terminates and the ileum commences, except that the latter is usually one-fifth longer than the former. at the termination of the ileum the 'cæcum' makes its appearance, with a kind of valvular opening into it, of such a nature that everything that passes along it having reached the blind or closed end, must return in order to escape; or rather the office of the cæcum is to permit certain alimentary matters and all fluids to pass from the ileum, but to oppose their return. the 'colon' is an intestine of very large size, being one of the most capacious, as well as one of the longest, of the large intestines. it commences at the cæsum caput coli, and soon expands into a cavity of greater dimensions than even that of the stomach itself. having attained this singular bulk, it begins to contract, and continues to do so during its course round the cæcum, until it has completed its second flexure, where it grows so small as scarcely to exceed in calibre one of the small intestines; and though, from about the middle of this turn, it again swells out by degrees, it never afterwards acquires its former capaciousness; indeed, previously to its junction with the rectum, it once more materially differs in size. at the upper part of the margin of the pelvis the colon terminates in the 'rectum', which differs from the cæcum and colon by possessing only a partial peritoneal covering, and being destitute of bands and cells. it enlarges towards its posterior extremity, and is furnished with a circular muscle, the sphincter ani, adapted to preserve the anus closed, and to retain the fæculent matter until so much of it is accumulated in the rectum as to excite a desire to discharge it. tetanus, a disease of great fatality, often depends upon the condition of the stomach; but it is not frequent in dogs. why the dog is so little subject to 'tetanus', or lock-jaw, i am unable to explain. sportsmen say that it sometimes attacks him when, being heated in the chase, he plunges into the water after the stag. the french give it the name of 'mal de cerf', from stags being supposed to be attacked in a similar way, and from the same cause. in the course of nearly forty years' practice, i have seen but four cases of it. the first arose from a wound in the foot. the cause of the second i could not learn. in both the spasmodic action was dreadful as well as universal. the dogs lay on their sides, the neck and legs stretched out, and the upper legs kept some inches from the ground by the intensity of the spasm. they might be taken up by either leg, and not a portion of the frame change its direction. at the same time, in their countenances, and by their hoarse cries, they indicated the torture which they endured. in the third case, which occurred th june, , the head was drawn permanently on one side, and the whole body formed a kind of bow, the dog walking curiously sideways, often falling as it walked, and frequently screaming violently. i ordered him to be well rubbed with an ammoniacal liniment, and balls of tonic and purging medicine to be given twice in the day. the dog gradually recovered, and was dismissed cured on the th. on the th november, in the same year, a bull-terrier had a similar complaint. he had been tried in the pit a fortnight before, and severely injured, and the pain and stiffness of his joints were increasing. the head was now permanently drawn on one side. the dog was unable to stand even for a moment, and the eyes were in a state of spasmodic motion. he was a most savage brute; but i attempted to manage him, and, by the assistance of the owner, contrived lo bleed him, and to give him a physic-ball. at the same time i advised that he should be destroyed. his master would not consent to this; and, as the dog occasionally ate a little, we contrived to give a grain each of calomel and opium every sixth hour. in the course of three days he was materially recovered. he could stand, but was exceedingly weak, i ordered the calomel lo be omitted, but the opium to be continued. three days afterwards he was sent into the country, and, as i heard, perfectly recovered. the following is a very interesting case of tetanus, detailed by m. debeaux, of the royal french chasseurs: a favourite dog was missing. four days had passed, and no intelligence could be obtained with regard to him until he returned home, fatigued and half-starved. he had probably been stolen. in the excess of their joy, the owners crammed him with meat until he became strangely ill. his throat was filled with froth, the pupils of his eyes were dilated, the conjunctiva was strongly injected, his neck was spasmodically contracted, and the spine of the back was bowed, and most highly sensible to the touch. m. debeaux was sent for; it was an hour before he could attend. the dog was lying on his belly; the four limbs were extended and stiff. he uttered the most dreadful and prolonged howling every two or three minutes. the surgeon ordered the application of a dozen leeches to the chest and belly; laxative medicines were given, and embrocations applied to the spine and back. three days passed, and the symptoms evidently augmented. the excrement was dark and fetid, and the conjunctiva had a strong yellow tint. leeches were again employed; emollient lotions and aperient medicines were resorted to. the sensibility of the spine and back was worse than ever; the animal lay on his belly, stretching out his four limbs, his neck fixed, his jaws immovable, his voice hoarse, and he was utterly unable to move. the bathings, lotions, and aperients were continued, with very few intermissions, until the th day, when the muscles began to be a little relaxed; but he cried whenever he was touched. on the th, for the first time, he began to eat a little, and his natural voice returned; still, however, the spasms occasionally appeared, but very much mitigated, and on the th the pain had entirely ceased. on the th of the next month he travelled two leagues with his master. it was cold, and the snow fell. on his reaching home, all the horrible spasms returned, and it was eleven days before he was completely cured. [ ] mr. blaine gives the following account of his experience of this disease: "it is remarkable, that although dogs are subject to various spasmodic affections, yet they are so little subject to lock-jaw that i never met with more than three cases of it among many thousands of diseased dogs. two of these cases were 'idiopathic'; one being apparently occasioned by exposure to cold air all night; the other the cause was obscure. the third was of that kind called 'sympathetic', and arose from extreme injury done to one of the feet. in each of these cases the convulsive spasm was extreme, and the rigidity universal but not intense. in one case the jaw was only partially locked. both warm and cold bathings were tried. large doses of opium and camphor were given by the mouth, and also thrown up in clysters. the spine of one was blistered. stimulating frictions were applied to all, but in neither case with any salutary effect." [ ] enteritis. 'enteritis', or inflammation of the intestine, is a disease to which dogs are very liable. it may be produced by the action of several causes. the intestines of the dog are peculiarly irritable, and subject to take on inflammatory action, and this tendency is often much increased by the artificial life which they lead. it is a very frequent complaint among those dogs that are much petted. a cold temperature is also a common cause of disease in these dogs. i was consulted with regard to a dog who was hiding himself in a cold, dark corner, paved with stone. every now and then he lifted his head and uttered a howl closely resembling that of a rabid dog. he fixed his gaze intently upon me, with a peculiarity of expression which many would have mistaken for rabid. they, however, who have had the opportunity of seeing many of these cases, will readily perceive the difference. the conjunctiva is not so red, the pupil is not so dilated, and the dog appears to implore pity and not to menace evil. in this state, if the dog is approached, he will not permit himself to be touched until he he convinced that no harm is intended. a peculiar slowness attends each motion; his cries are frequent and piteous; his belly hot and tender; two cords, in many cases, seem to run longitudinally from the chest to the pubis, and on these he cannot bear the slightest pressure. he abhors all food; but his thirst for water, and particularly cold water, is extreme; he frequently looks round at his flanks, and the lingering gaze is terminated by a cry or groan. in the majority of cases there is considerable costiveness; but, in others, the bowels are freely opened from the beginning. the peritoneal inflammation is sometimes pure, but oftener involves the muscular coat of the intestines. its prevailing cause is exposure to cold, especially after fatigue, of lying on the wet stones or grass. now and then it is the result of neglected rheumatism, especially in old and petted dogs. the treatment is simple. bleed until the pulse falters, put the animal in a warm bath, and let the belly be gently rubbed while the dog is in the water, and well fomented afterwards; the drink should consist of warm broth, or warm milk and water. the bleeding should be repeated, if little or unsatisfactory relief is obtained; and the examination of the rectum with the finger, and the removal of any hardened fæces that may have accumulated there, and the cautious use of enemata, neither too stimulating nor too forcibly injected, should be resorted to. no medicine should be employed until the most urgent symptoms are abated. castor oil, the mildest of our purgatives--syrup of buckthorn assisting the purgative property of the oil, and containing in its composition as much stimulating power as is safe--and the spirit of while poppies--the most convenient anodyne to mingle with the other medicines--will generally be successful in allaying the irritation already existing, and preventing the development of more. even this must not be given in too large quantities, and the effect must be assisted by a repetition of the enemata every fifth or sixth hour. on examination after death the nature of the disease is sufficiently evident: the peritoneum, or portions of it, is highly injected with blood, the veins are turgid, the muscular membrane corrugated and hardened, while often the mucous membrane displays not a trace of disease. in violent cases, however, the whole of the intestines exhibit evidence of inflammation. i was much gratified a few years ago in witnessing the decided manner in which professor spooner expressed himself with regard to the treatment of enteritis in the dog. "i should deem it advisable," said he, "to administer a purgative; but of what would that consist? calomel? certainly not. i was surprised to hear one gentleman assert that he should administer it to the extent of from five to ten grains, and another to say that he should not hesitate to exhibit a scruple of calomel to a dog, and to all carnivorous animals. i should never think of exhibiting it as a cathartic. i should only administer it in small doses, and for the purpose of producing its specific effect on the liver, which is the peculiar property of this drug. given in larger doses it would not be retained, and if it got into the intestines it would act as a powerful drastic purgative." [ ] in our treatment of the horse we have got rid of a great proportion of the destructive urine-balls and drastic purgatives of the farrier. the cow is no longer drenched with half-a-dozen deleterious stimulants. a most desirable change has been effected in the medical treatment of these animals. let us not, with regard to the dog, continue to pursue the destructive course of the keeper or the huntsman. the following case of enteritis, with rupture of the colon, may be useful: on march , , i was requested to attend a large dog of the bull breed, three years old, who had not appeared to be well during the last four or five days. i had scarcely arrived ere i recognised it to be a case of enteritis. he had a dreadful shivering fit, to which succeeded heat of the skin and restlessness. the muzzle was dry and hot, as also was the tongue. the eyes were sunken and redder than usual; the breathing was accelerated, but not very laborious; the extremities were cold, while the surface of the body was hot and painful to the touch. the bowels were constipated, and had been so during the last week; some dung however was evacuated, but it was hard and dry, and in small quantities. the pulse was quick, but full; and there was a slight pain and considerable irritation in the rectum. i took from him [symbol: ounce] x. of blood before the desired effect was produced, and then gave him tinct. opii gr. xiv., et spt. ether, nit. gutt. viij., cum ol. ricini [symbol: ounce] iij., and an opiate enema to allay the irritation of the rectum. this was about o'clock, a.m. a.m.--the bowels have not been moved, and the pain is more intense; his countenance expresses great anxiety; he frequently lies on his stomach, and the pulse is small but quick. i gave him a little broth, and ordered the abdomen to be fomented with hot flannels. p.m.--he has had distressing sickness, and is extremely anxious for water. i introduced my finger into the rectum, but could not discover any hardened fæces. enemata, composed of mag. sulphas and warm water, were frequently thrown into the intestines; as soon as one came away another was thrown up. p.m.--no better: gave him pulv. aloes [symbol: ounce] j.; calomel, gr. vj. et pulv. opii gr. viij. the fomentations to be continued, and the abdomen rubbed with a lin. terebinthinæ. p.m.--a great change has taken place within the last hour; the hind extremities are paralysed; the mouth and ears are cold; the pulse is more hurried and irregular, and almost imperceptible; the respiration is laborious and irregular, as is the pulse; and the dog is frequently sick. to be kept quiet. p.m.--another change: he lies panting and groaning piteously; his limbs are bathed in sweat, with convulsive struggles. at twenty minutes past six he died. a post-mortem examination presented general marks of inflammation; the small intestines were extremely red, while the large ones were in a gangrenous state and most offensive, with a rupture of the colon. i did not expect to meet with the rupture, and am at a loss to account for it. the liver was of a pale ashen colour, and very light. i put a piece of it into some water, and it floated on the surface. the other contents of the abdomen did not show the slightest appearance of disease. september d, .--a black pug-bitch, months old, was yesterday taken violently sick; the vomiting continued at intervals the greater part of the day, and she had not eaten during the last hours. i could not possibly get at her, on account of her ferocity: as she had not had the distemper, and as i was misled by her age and the watery discharge from her eyes, and as she had had several motions yesterday, i imagined that the attack might be the beginning of that disease. learning that she was fond of sweet things, i prepared an emetic containing a grain of calomel and a grain of tartar emetic: she took it readily, and i promised to call on the following day. sept. .--the weakness at the eyes had disappeared, but there had been no motion. on getting at her by main force i found her belly very tense and rather hot: she had again been sick, was very eager for water, and still refused to eat. the disease was now evident. as she appeared too unmanageable for anything else, i produced a physic-ball, in giving which i was bitten. six hours afterwards i again went: no fæces had passed: i administered two enemas, the second of which was returned with a small quantity of hardened fæces and an intolerable smell. i ordered the water to be removed, and broth to be substituted. sept. .--the dog is in good spirits, has eaten heartily, and had no motion, probably because it was habitually cleanly, and had not been taken out of doors. her owner considered her as quite well, and dismissed me. three days afterwards a servant came to say that all was going on very well. peritonitis. chronic inflammation of the 'peritoneal membrane' is a frequent disease among dogs. the animal loses his appetite and spirits; he sometimes eats a little and sometimes not; he becomes thin, his belly is tucked up, and when we closely examine him we find it contracted and hard, and those longitudinal columns of which i have already spoken are peculiarly dense and almost unyielding. he now and then utters a half-suppressed whine, and he occasionally seeks to hide himself. in the greater number of cases he after a while recovers; but he too often pines away and dies. on examination after death the case is plain enough. there is inflammation of the peritoneal membrane, more indicated by undue congestion of the bowels than by the general blush of the membrane. the inflammation has now spread to the muscular coat, and the whole of the intestine is corrugated and thickened. there is another peritoneal affection, aggravated by combination with a rheumatic tendency, to which the dog is more disposed than any other domesticated animal. it has its most frequent origin in cold, or being too much fed on stimulating and acrid food, and probably from other causes which have not yet been sufficiently developed. here also no drastic purgative is to be admitted; it would be adding fuel to fire: not a grain of calomel should be used, if the life of the animal is valued. the castor oil mixture will afford the most certain relief, a drop or two of the oil of peppermint being added to it. colic. the dog is also subject to fits of 'colic', principally to be traced to improper food, or a sudden change of food, or exposure to cold. this is particularly the case with puppies. there is no redness of the eye, no heat of the mouth, no quickened respiration; but the animal labours under fits of pain. he is not quiet for a minute. he gets into one corner and another, curling himself closely up, but he does not lie there more than a minute or two; another fit of pain comes on; he utters his peculiar yelp, and seeks some new place in which he may possibly find rest. it is with considerable diffidence that i offer an opinion on this subject contrary to that of mr. blaine. he states that the treatment of this species of colic is seldom successful, and that which has seemed the most efficacious has been mercurial purgatives; namely, calomel one grain, aloes a scruple, and opium a quarter of a grain, until the bowels are opened. i have seldom found much difficulty in relieving the patient suffering under this affection; and i gave no aloes nor calomel, but the oleaginous mixture to which i have so often referred. i should not so much object to the aloes, for they constitute an excellent purgative for the dog; nor to a dog that i was preparing for work, or that was suffering from worms, should i object to two or three grains of calomel intimately mixed with the aloes: from the combined effect of the two, some good might be obtained. calculus in the intestines many persons have a very foolish custom of throwing stones, that their dogs may dive or run after them, and bring them to their owner's feet: the consequence is, that their teeth are soon worn down, and there are too many cases on record in which the stone has been swallowed. it has been impeded in its progress through the intestinal canal, inflammation has ensued, and the animal has been lost, after having suffered the most dreadful torture. professor simonds relates a case in which a dog was thus destroyed. the animal for some days previous to his admission into the hospital had refused his food, and there was obstinate constipation of the bowels, to remove which aperient medicine had been given. the pulse was accelerated, there was distension of the abdomen with evident tenderness on pressure, the extremities were cold, no fæces were voided, and he occasionally vomited. some aperient medicine was given, which was retained on the stomach, and enemas and external stimulants were resorted to, but two days afterwards he died. the intestines were examined, and the offending body was found to be a common pebble. the dog had long been accustomed to fetch stones out of the water. one of these stones had passed through the stomach into the intestines, and, after proceeding some distance along them, had been impacted there. the inflammation was most intense so far as the stone had gone; but in the part of the intestine to which it had not reached there was not any. this was an interesting and instructive case, and should make its due impression. another account of the strange contents of the intestines of a bitch may be here introduced. a valuable pointer-bitch was sent to the infirmary of mr. godwin of litchfield. she presented a very emaciated appearance, and had done so for four or five months. her evacuations for a day or two were very thin and copious, and afterwards for several days nothing was passed. when pressing the abdomen with both hands, a hard substance was distinctly felt in the inferior part of the umbilical region. she was destroyed, and, upon 'post-mortem' examination, a calculus was discovered in the ileum about the size and shape of a hen's egg, the nucleus of which was a portion of hair. the coats of the intestines were considerably thickened and enlarged, so as to form a kind of sac for its retention. anterior to this was another substance, consisting of a ball of hair, covered with a layer of earthy matter about the eighth of an inch thick, and next to this another ball of hair of less dimensions, intermixed with a gritty substance. the stomach contained a large quantity of hair, and a portion of the omentum, about the size of n crown piece, was thickly studded with small white calculi, the largest about the size of a pea, and exceedingly hard. intussusception. if 'peritonitis'--inflammation--is neglected, or drastic purgatives are too often and too plentifully administered, a peculiar contraction of the muscular membrane of the intestine takes place, and one portion of the bowel is received within another--there is 'intussusception'. in most cases, a portion of the anterior intestine is received into that which is posterior to it. few of us have opened a dog that had been labouring under this peculiar affection without being struck with the collapsed state of the canal in various parts, and in some much more than in others. immediately posterior to this collapsed portion, it is widened to a considerable extent. the peristaltic motion of the intestine goes on, and the consequence is, that the constricted portion is received into that which is widened, the anterior portion is invaginated in the posterior: obstruction of the intestinal passage is the necessary consequence, and the animal dies, either from the general disturbance of the system which ensues, or the inflammation which is set up in the invaginated part. i will say nothing of medical treatment in this case; for i do not know the symptoms of intussusception, or how it is to be distinguished from acute inflammation of the bowels. acute inflammation will not long exist without producing it; and, if its existence should be strongly suspected, the treatment would be the same as for inflammation. the domesticated dog, from the nature of his food, more than from any constitutional tendency, is liable to constipation. this should never be neglected. if two or three days should pass without an evacuation, the case should be taken in hand; otherwise inflammation will be very soon established. in order to procure an evacuation, the aloetic ball, with one or two grains of calomel, should be given. beyond that, however, i should not dare to go; but, if the constipation continued, i should have recourse to the castor-oil mixture. i should previously examine and empty the rectum, and have frequent recourse to the enema-syringe; and i should continue both. it would be my object to evacuate the intestinal canal with as little increased action as possible. diarrhoea is the discharge of fæces more frequently than usual, and thinner than their natural consistence, but otherwise not materially altered in quality; and the mucous coat of the intestines being somewhat congested, if not inflamed. it is the consequence of over-feeding, or the use of improper food. sometimes it is of very short continuance, and disappears without any bad consequence; the health being unaffected, and the character of the fæces not otherwise altered than by assuming a fluid character. it may not be bad practice to wait a day, or possibly two, as it is desirable for the action of the intestines to be restored without the aid of art. i should by no means give a physic-ball, or a grain of calomel, in simple diarrhoea. i should fear the establishment of that species of purging which is next to be described. the castor-oil mixture usually affords the best hope of success. habitual diarrhoea is not an unfrequent disease in petted dogs: in some it is constitutional, in others it is the effect of neglected constipation. a state of chronic inflammation is induced, which has become part of the constitution of the dog; and, if repressed in the intestines, it will appear under a more dangerous form in some other place. dysentery is a far more serious complaint. in most cases a considerable degree of inflammation of the mucous coat exists, and the mucus is separated from the membrane beneath, and discharged per anum. the mucus thus separated from the intestinal membrane assumes an acrid character. it not only produces inflammation of the membrane, dangerous and difficult to treat, but it excoriates the anus and neighbouring parts, and produces pain and tenesmus. this disease has sometimes been fatally misunderstood. a great deal of irritation exists in the intestinal membrane generally, and in the lower part of the rectum particularly. the fæces passing over this denuded surface cause a considerable degree of pain, and there is much straining, and a very small bit or portion of faces is evacuated. this has often been seen by the careless observer; and, as he has taken it as an indication of costiveness, some drastic purgative has been administered, and the animal quickly killed. no one that had ascertained the real nature of the disease would administer calomel in any form or combination; but the anodyne mixture as an enema, and also administered by the mouth, is the only medicine from which benefit can be expected. costiveness is a disease when it becomes habitual. it is connected with disease of the intestinal canal. many dogs have a dry constipated habit, often greatly increased by the bones on which they are too frequently fed. this favours the disposition to mange and to many diseases depending on morbid secretions. it produces indigestion, encourages worms, blackens the teeth, and causes fetid breath. the food often accumulates in the intestines, and the consequence is inflammation of these organs. a dog should never be suffered to remain costive more than a couple of days. an aloetic ball or some epsom salts should then be administered; and this failing to produce the desired effect, the castor-oil mixture, with spirits of buckthorn and white poppies, should be administered, and the use of the clyster-pipe resorted to. it may be necessary to introduce the finger or the handle of a spoon when the fæcal matter is more than usually hard, and it is with difficulty broken down; small doses of castor-oil should be afterwards resorted to, and recourse occasionally be had to boiled liver, which the dog will rarely refuse. the best means, however, of preventing costiveness in dogs, as well as in men, is regular exercise. a dog who is kept chained up in a kennel should be taken out and have a certain quantity of exercise once in the twenty-four hours. when this cannot be done, the food should consist chiefly of well-boiled farinaceous matter. dropsy another disease, which is not confined to the abdominal cavity, is dropsy: but, as in the dog it most commonly assumes that form which is termed ascites, or dropsy of the abdomen, it may be noticed in this place. it is seldom an idiopathic or primary affection, but is generally the consequence of some other disease, most commonly of an inflammatory kind. dropsy is a collection of fluid in some part of the frame, either from increased exhalation, or from diminished absorption, the consequence of inflammation. the divisions of dropsy are into active and passive, or acute and chronic. the causes are also very properly arranged as predisposing and exciting. the diseases on which dropsy most frequently supervenes are fevers and visceral inflammations and obstructions. the dog is peculiarly subject to 'ascites' or 'dropsy of the belly', and the quantity of fluid contained in the abdomen is sometimes almost incredible. it is usually accompanied or characterised by a weak, unequal, small, and frequent pulse--paleness of the lips, tongue, and gums--flaccidity of the muscles, hurried breathing on the least exertion, feebleness of the joints, swellings of the lower limbs, effusion of fluid into the integuments or among the muscles, before there is any considerable effusion into the thorax or the abdomen, and an unhealthy appearance of the cutaneous surface. the urine seldom coagulates. this form of dropsy is usually seated in the abdomen or cellular tissue. the treatment of ascites is seldom perfectly successful. the great extent of the peritoneum, the number and importance of the viscera with which it is connected, and of the absorbent glands which it encloses, the number and weakness of the veins which transmit their blood to the portal vessels, and the absence of valves, in some measure account for the frequent accumulation of fluid in this cavity. it appears in both sexes from the usual causes of inflammatory disease. unwholesome diet, the drastic operation of purgatives, external injuries, the suppression of accustomed secretions and discharges, all are exciting causes of dropsy. the animal has suffered materially from mange, which has been apparently cured: the itchiness and eruption altogether disappear, but many weeks do not elapse ere ascites begins to be seen, and the abdomen is gradually distended with fluid. when this appears in young and healthy animals, it may be conquered; but when there has been previous disease of almost any kind, comparatively few patients permanently recover. irritability of the stomach, and a small and accelerated pulse, are unfavourable. if the operation of tapping has taken place, at all times there is danger; but, if there is a thick, brown, albuminous or fetid discharge, it is very unlikely that any permanent advantage will result from the operation. we will introduce a few cases as they occur in our clinical records. 'november th, '.--a spaniel, nine years old, had been, during four months, alternately asthmatic or mangy, or both. within the last few days she had apparently increased in size. i was sent for. the first touch of the abdomen betrayed considerable fluctuation. she likewise had piles, sore and swelled. i ordered an alterative ball to be given morning and night. ' th'. one of the balls has been given, and two doses of castor oil; but no effect has been produced. an injection was administered. ' th'. a small evacuation of water has been produced, and the bowels have been slightly opened. give a dose of the castor-oil mixture. ' th'. the obstruction has been removed; the enlargement is somewhat diminished; much water has passed. give an alterative ball every morning. ' th'. the alteratives have been continued, and there is a slow but evident decrease of the abdomen. ' th'. i cannot detect any effusion in the abdomen. give a pill every alternate day for a fortnight. at the expiration of this period the dog was apparently well. 'april d', .--a terrier, ten years old, had cough and mange, which ceased. the belly for the first time began to enlarge, and on feeling the dog considerable fluctuation was evident. he would not eat, but he drank immoderately. give daily a ball consisting of tonic and physic mist., with powdered digitalis and tartrate of iron. 'may th'.--he is in better spirits, feeds tolerably well, but is rather increased in size. give daily a ball of tartrate of iron, digitalis, ginger, and a grain of calomel. 'd'. much thinner, the belly very considerably diminished: a slight fluctuation is still to be perceived. continue medicine, with a half-grain only of calomel. 'july th'.--the medicine has been regularly given, and the water of the abdomen has rapidly disappeared, until a fortnight ago: since that time it has been once more filling. the medicine was ordered to be repeated. 'august th'.--the medicine has once more produced its proper effect, and the fluid has disappeared. on the ' th', however, the fluctuation was again too plainly felt, and the owner determined to have nothing more to do with the case. the animal was never brought again, nor could i trace it. the dog might have been saved if the owner had done it justice. as soon as dropsy appears to be established, proper medicines must be resorted to. foxglove, nitre, and ginger should be first tried in the proportional doses of one, ten, and eight grains, given morning and night. if this does not succeed, iodine from half-a-grain to a grain may be given morning and night, and a weak solution of iodine rubbed on the belly. this being ineffectual, recourse may be had to tapping, taking care that the trocar is not plunged sufficiently deep to wound the intestines. the place for the operation is directly on the 'linea alba', or middle line of the belly, and about midway between the pubis and the navel. the whole of the intestinal fluid may be suffered to escape. a bandage should then be applied round the belly, and retained there a week or more. mr. blaine very properly states, that the difference between fatness and dropsy is, that the belly hangs pendulous in dropsy, while the back bone stands up, and the hips are protruded through the skin; while the hair is rough, and the feeling of the coat is peculiarly harsh. it may be distinguished from pregnancy by the teats enlarging, in the latter case, as gestation advances, and the young ones may occasionally be felt to move. in addition to this it may be stated, that the presence of water is readily and unerringly detected. if the right hand is laid on one side of the belly, and the other side is gently struck with the left hand, an undulating motion will be readily perceived. in old dogs, dropsy, under the title of "anasarca," is an unfrequent but occasional accompaniment of ascites. if pressure is made on any particular parts, they yield and continue depressed for a longer or shorter period of time, and slowly and by degrees regain their natural form. the skin is dry and distended, and with no natural action; the circulation is languid and small, the muscular powers are diminished, the animal is unquiet, the thirst is great, the tongue is pale, the appetite diminished, and the limbs are swelled. the best mode, of treatment is the infliction of some very small punctures in the distended skin, and the application of gentle friction. the majority of cases of this kind are usually fatal, and so is almost every case of encysted dropsy. a dog had cough in february, . various medicines were administered, and at length the cough almost suddenly ceased, and evident ascites appeared. the thirst was insatiable, the dog would not touch food, and he was unable to lie down more than two minutes at a time. digitalis, cream of tartar, and hydrarg. submur. were given on the th april. on the th he was much worse, and apparently dying. he had been unable to rise for the last twelve hours, and lay panting. i punctured the abdomen, and four quarts of fluid were evacuated. ' th'. the panting continues. the dog will not eat, but he can lie down in any posture. ' th'. the panting is diminished, the appetite is returning, and water continues to ooze from the wound, ' th'. the wound healed on the night of the th, and already the fluid begins to collect. the medicine still continued. ' th'. the spirits good, and strength improving; but the belly is evidently filling, and matter is discharged from both the nose and eyes. ' th'. the swelling a little diminished, respiration easy, and the dog walking comfortably about, and feeding well. 'may th'.--the swelling, which for some days past diminished, is now again increasing; but the dog is strong and breathes easily. medicine as before. ' th.'. the dog is thinner, weaker, filling fast, and the thirst excessive. [symbol: rx]: crem. tart., ferri tart. [symbol: ounce] ij., pulv. flor. anthemid. [symbol: ounce] iiij., conser. ros. q. s.: divide in bol. xii.: cap. in dies. ' th'. during two days he has been unable to lie down more than a minute at a time. again tapped: fully as much fluid was evacuated as before; but there is now blood mingling with it. th. much relieved by the tapping, and breathes with perfect ease; but, now that the enormous belly is reduced, the dog is very thin. bol. continued. june th. within the last three days the animal has filled again with extraordinary rapidity. [symbol: rx;]: ferr. tart. [symbol: scruple] j., opii. gr. / , pulv. gentianæ [symbol: scruple] j., cons. ros. q. s.: f. bol. capiend. in dies. th. is again strangely distended; i advised, or rather solicited, that it might be destroyed; but this not being granted, i once more tapped him. at least a gallon of dark-coloured fluid was evacuated. d. again rapidly filling, but not losing either flesh or strength. july th.--once more punctured, and a gallon of dark-coloured fluid evacuated. th. again filling and rapidly losing flesh and strength. th. once more tapped: immediately after which he appeared to be revived, but almost immediately began again to fill. aug. d.--he had eaten tolerably; appeared to have nothing more than usual the matter with him, when, being missed for an hour, he was found dead. no examination was permitted. in a spaniel, six years old, was brought to the infirmary. it had had an asthmatic cough, which had left it. it was now hollow in the flanks, the belly pendulous, and an evident fluctuation of water. the owner would not consent to any operation. an aloetic physic-ball, however, was given every fifth day, and a ball, composed of tartrate of iron, digitalis, nitre, and antimonial powder, on every intermediate morning and night. the water evidently accumulated; the dog was sent for, and died in the course of a week. there are a few medicines that may be useful in arresting the effusion of the fluid; but they too often fail in producing any considerable benefit. the fox-glove is, perhaps, possessed of the greatest power, combined with nitre, squills, and bitartrate of potash. at other times chamomile, squills, and spirit of nitrous ether, may be tried. the following case, treated by the administration of iodine, by professor dick, is important:-- a black and tan coloured retriever was sent to me labouring under ascites. he was tapped, and two quarts of fluid abstracted. tonics, combined with diuretics were given, but the fluid continued to accumulate, and in three weeks he was again tapped, and another two quarts drawn away. the disease still went on, and a fortnight afterwards a similar quantity was withdrawn. various remedies were tried in order to check the power of the disease, but without effect, and the abdomen again became as much distended with the effused serum as before. he was then put under a course of iodine, which soon began to show its beneficial influence by speedily allaying his excessive thirst; and in about a month the whole of the effused fluid was absorbed, although from the size of the abdomen it must have amounted to a similar quantity to that drawn off on the previous occasions. the dog's appetite soon returned; he gained flesh rapidly, and has continued quite well, and, from being a perfect skeleton, soon became overloaded with fat. induced by the great benefit derived in this case from the iodine, i took the opportunity of trying it on a newfoundland dog similarly affected. he was put on a course of iodine, and the quantity of the drug was gradually increased. as absorption rapidly commenced, the fluid was completely taken up; but, partly in consequence of pushing the medicine too far, and partly from extensive disease in the liver, unfavourable symptoms took place, and he sunk rather unexpectedly. still, however, from the obvious and decided advantage derived from the medicine, i have no doubt that iodine will be found one of the most efficient remedies in dropsy in dogs. iodine is a truly valuable drug. when first introduced into veterinary practice it was observed that it readily accomplished the reduction of the enlarged glands that frequently remain after catarrh; but it was presently evident that it reduced almost every kind of tumour, even the growth of tubercles in the lungs. professor morton, in his manual of pharmacy, has admirably described the different combinations of iodine. the liver of the dog seems to follow a law of comparative anatomy, that its bulk shall be in an inverse proportion of that of the lungs. the latter are necessarily capacious; for they need a large supply of arterial blood, in order to answer to their rapid expenditure when the utmost exertion of strength and speed is required. the liver is, therefore, restricted in its size and growth. nevertheless, it has an important duty to fulfil, namely, to receive the blood that is returned from the intestines, to separate from the blood, or to secrete, by means of it, the bile; and then to transmit the remaining portion of it to the lungs, where it undergoes the usual process of purification, and is changed to arterial blood. in the performance of this office, the liver often undergoes a state of inflammation, and disease ensues, inveterate, and setting at defiance every means of cure. both the skin and the urine become tinged with a yellow effusion. the animal is dull, and gradually wastes away. in a few days the yellow hue becomes more intense, and particularly on the cuticle, the conjunctiva, the iris, the gums, and the lips. a state of fever becomes more and more perceptible, and there are alternations of cold and heat. the pulse varies from to ; the dry tongue hangs from the mouth; the appetite ceases, but the animal is peculiarly desirous of cold water. the dog becomes restless; he seeks to hide himself; and he groans, if the parts in the neighbourhood of the liver are pressed upon. frequent vomitings now appear, slimy, and evidently containing gall. the animal becomes visibly thinner, obstinately refuses all solid food, and only manifests thirst. he begins to stagger as he walks; he withdraws himself from observation; he anxiously seeks some dark place where he may lay himself with his chest and belly resting on the cold ground, his fore legs stretched out before him, and his hind legs almost as far behind him. the fever increases, the skin becomes of a dark yellow colour, the mucous membrane of the mouth and conjunctiva is of a dirty red, the expired air is evidently hot, the gaze is anxious, the urine is of a saffron yellow, or even darker: in short, there now appears every symptom of inflammation of the liver, with jaundice. as the disease proceeds the animal begins to vomit masses of a yellowish green substance, occasionally mixed with blood. he wastes away to a skeleton, he totters in his walk, he is half unconscious, the pulse becomes weak and interrupted, the temperature sinks, and death ensues. the duration and course of the disease are deceptive. it occasionally proceeds so insidiously that several days are suffered to pass before the owner perceives any marks of disease, or seeks any aid. the duration of the disease is usually from ten to twelve days. it terminates in congestion of blood in the liver, or a gradual restoration to health. the latter can only take place in cases where the inflammation has proceeded very slowly; where the commencement and progress of the disease could be discovered by debility and slight yellowness of the skin, and especially where speedy recourse has been had to medical aid. the predisposing causes of this disease are often difficult to discover. the dog, in warm climates, seems to have a natural disposition to it. as exciting causes, atmospheric influence may be reckoned, sultry days, cold nights, and damp weather. other occasional causes may be found in violent falls, bruises, and overfeeding. fat petted dogs that are easily overheated by exertion are often attacked by this disease. the result of the disease depends on its duration, course, and complication. if it is attended to early, it can generally be cured. if it has existed for several days, and the fever has taken on a typhoid character--if the yellow hue is perceptible--the appetite failing, and vomiting ensuing, the cure is doubtful; and, if inflammation of the stomach has taken place, with high fever, vomiting of blood, wasting away, and fits occurring, there is no chance of cure. when simple jaundice alone is visible, a moderate laxative of sulphate of magnesia and tartaric acid, in conjunction with some aromatic and mucilaginous fluid, or, quite in the beginning of the disease, an emetic, will be found of considerable service; but, when the yellow colour has become more intense, and the animal will no longer eat, and the fever and weakness are increased, it is necessary to give calomel, tartar-emetic, camphor, and opium, in the form of pills, and to rub some strong liniment on the region of the liver: the doses of calomel, however, must be very small. if inflammation of the stomach appears, mucilaginous fluids only must be given. bleeding may be of service in the commencement of the disease, but afterward it is hurtful. this is an account of hepatitis as it occasionally appears, and particularly on the continent; but it does not often assume so virulent a character in our country. there is often restlessness, thirst, and sickness, accompanied by much prostration of strength; or general heat and tenderness. occasionally there is purging; but much oftener constipation, that bids defiance to almost every medicine. the principal or almost only hope of cure consists in bleeding, physicking, and blistering on the right side. of bilious disease, assuming the character of inflammation, we have too many cases. it may be spontaneous or brought on by the agency of other affections. long-continued and inveterate mange will produce it. it is often connected with, or produced by, distemper, or a dull inflammatory disease of the liver, and it is generally accompanied by pustular eruption on the belly. the skin is usually tinged of a yellow hue, and the urine is almost invariably impregnated with bile. the suffusion which takes place is recognised among sportsmen by the term "yellows." the remedy should be some mercurial, with gentian and aloes given twice in the day, and mercurial ointment well rubbed in once in the day. if this treatment is steadily pursued, and a slight soreness induced in the mouth, the treatment will usually be successful. mr. blaine observes, "a moderate soreness of the mouth is to be encouraged and kept up. i have never succeeded in removing the complaint without it." jaundice. m. w. leblanc, of paris, has given an interesting account of the causes and treatment of 'jaundice' in the dog. the prevailing symptom of this disease in the dog is a yellow discoloration of the skin and the mucous membranes of greater or less intensity. it generally announces the existence of very serious disease, as inflammation of the liver and its excretory ducts, or of the gall-bladder, or the stomach, or small intestines, or contraction or 'obliteration' of the excretory ducts of the liver, in consequence of inflammation of these vessels, or the presence of concrete substances formed from the bile. the dogs in which he found the most decided traces of this disease laboured under diarrhea, with stools of a reddish brown or black colour for one, two or three days. the causes of jaundice are chiefly over-fatigue (thus, greyhounds are more subject to it than pointers), immersions in water, fighting, emetics or purgatives administered in over-doses, the repeated use of poisonous substances not sufficiently strong at once to destroy the animal, the swallowing of great quantities of indigestible food, and contusions of the abdominal viscera, especially about the region of the liver. the most serious, if not the most common cause, is cold after violent and long-continued exercise; and especially when the owners of dogs, seeing them refuse their food after a long chase, give them powerful purgatives or emetics. the treatment should have strict relation to the real or supposed cause of jaundice, and its most evident concomitant circumstances. some of these symptoms are constant and others variable. among the first, whatever be the cause of the disease, we reckon acceleration of the pulse; fever, with paroxysms of occasional intensity; and a yellow or reddish-yellow discoloration of the urine. among the second are constipation, diarrhoea, the absence or increase of colour in the faecal matter, whether solid or fluid. when they are solid, they are usually void of much colour; when, on the contrary, there is diarrhea, the fæces are generally mingled with blood more or less changed. sometimes the dejections are nearly black, mixed with mucus. it is not unusual for a chest affection to be complicated with the lesions of the digestive organs, which are the cause of jaundice. with these leading symptoms there are often others connected that are common to many diseases; such as dryness and heat of the mouth, a fetid smell, a staggering gait, roughness of the hair, and particularly of that of the back; an insatiable thirst, accompanied by the refusal of all food; loss of flesh, which occasionally proceeds with astonishing rapidity; a tucked-up flank, with hardness and tenderness of the anterior part of the belly. the jaundice which is not accompanied with fever, nor indeed with any morbid change but the colour of the skin, will require very little treatment. it will usually disappear in a reasonable time, and m. leblanc has not found that any kind of treatment would hasten that disappearance. when any new symptom becomes superadded to jaundice, it must be immediately combated. fever, injection of the vessels of the conjunctiva, constipation, diarrhoea, or the discoloration of the urine, require one bleeding at least, with some mucilaginous drinks. purgatives are always injurious at the commencement of the disease. "i consider," says m. leblanc, "this fact to be of the utmost importance. almost the whole of the dogs that have been brought to me seriously ill with jaundice, have been purged once or more; and either kitchen salt, or tobacco, or jalap, or syrup of buckthorn, or emetic tartar, or some unknown purgative powders, have been administered. "bleeding should be resorted to, and repeated if the fever continues, or the animal coughs, or the respiration be accelerated. when the pulse is subdued, and the number of pulsations are below the natural standard--if the excrements are still void of their natural colour--if the constipation continues, or the animal refuses to feed--an ounce of manna dissolved in warm water should be given, and the dog often drenched with linseed tea. if watery diarrhoea should supervene, and the belly is not hot nor tender, a drachm or more, according to the size of the dog, of the sulphate of magnesia or soda should be administered, and this medicine should be repeated if the purging continues; more especially should this aperient be had recourse to when the fæces are more or less bloody, there being no fever nor peculiar tenderness of the belly. "when the liquid excrement contains much blood, and that blood is of a deep colour, all medicines given by the mouth should be suspended, and frequent injections should be thrown up, consisting of thin starch, with a few drops of laudanum. too much cold water should not be allowed in this stage of the disease. injections, and drinks composed of starch and opium, are the means most likely to succeed in the black diarrhoea, which is so frequent and so fatal, and which almost always precedes the fatal termination of all the diseases connected with jaundice. "in simple cases of jaundice the neutral salts have seldom produced much good effect; but i have obtained considerable success from the diascordium, in doses of half a drachm to a drachm. "great care should be taken with regard to the diet of the dog that has had jaundice, with bloody or black diarrhoea; for the cases of relapse are frequent and serious and almost always caused by improper or too abundant food. a panada of bread, with a little butter, will constitute the best nourishment when the dog begins to recover his appetite. from this he may be gradually permitted to return to his former food. most especially should the animal not be suffered to take cold, or to be left in a low or damp situation. this attention to the food of the convalescent dog may be thought to be pushed a little too far; but experience has taught me to consider it of the utmost importance, and it is neither expensive nor troublesome." the spleen and pancreas. the spleen is generally regarded as an appendage to the absorbent system. tiedemann and gmelin consider that its specific function is to secrete from the blood a fluid which possesses the property of coagulation, and which is carried to the thoracic duct, and then, being united with the chyle, converts it into blood, and causes an actual communication between the arterial and absorbent systems. according, however, to dr. bostock, there is a fatal objection to this, namely, that animals have been known to live an indefinite length of time after the removal of the spleen, without any obvious injury to their functions, which could not have been the case if the spleen had been essentially necessary for so important a process. a knowledge of the diseases of the spleen in the dog appears to be less advanced than in any other animal. in the cases that i have seen, the earliest indications were frequent vomiting, and the discharge of a yellow, frothy mucus. the animal appeared uneasy, shivering, the ears cold, the eyes unnaturally protuberant, the nostrils dilated, the flanks agitated, the respiration accelerated, and the mucous membranes pale. the best treatment i know is the administration, twice in the day, of a ball composed of a grain of calomel and the same quantity of aloes, and five grains of ginger. the dog frequently cries out, both when he is moved and when he lies on his bed. in the course of three days the yellow mucus is generally disappearing, and the expression of pain is materially diminished. if the bowels are much constipated after two days have passed, two scruples of aloes may be given, and a grain of calomel; frequent injections may also be administered. we are almost totally ignorant of the functions of the 'pancreas'. it probably is concerned in assimilating the food, and converting the chyme of the stomach into chyle. inflammation of the kidney is a serious and dangerous malady. this organ is essentially vascular in its texture; and although it is small in volume, yet, on account of the quantity of blood which it contains, and the rapidity with which its secretions are performed, it is disposed to frequent and dangerous inflammation. the immediate causes of inflammatory action in this viscus are blows and contusions in the lumbar region; hard work long continued, and the imprudent use of stimulating substances employed as aphrodisiacs; the presence of calculi in the kidney, and the arrest of the urine in the bladder. the whole of the kidney may be affected with anæmia or defect of blood, or this may be confined to the cortical substance, or even to the tubular. the kidneys are occasionally much larger than usual, without any other change of structure; or simple hypertrophy may affect but one of them. they are subject to atrophy, which may be either general or partial; or one of the kidneys may be completely wanting, and this evidently the consequence of violence or disease. hydatids, though seldom met with in the human kidney, are not unfrequently found in that of the dog. all these are circumstances that have not received sufficient attention. calculous concretions are of more frequent occurrence than is generally imagined, but they are not confined to the kidneys; there is scarcely a portion of the frame in which they have not been found, particularly in the brain, the glandular substance, and the coats of the intestines. i cannot say with mr. blaine that i have seen not less than or calculi in my museum; but i have seen too many fearful examples of the complaint. there has been usually great difficulty in the urinary evacuation; and at length one of the calculi enters the urethra, and so blocks up the flow of the urine that mortification ensues. m. lautour relates a case of renal calculus in a dog. he had occasionally voided his urine with some difficulty, and had walked slowly and with evident pain. august , , a sudden exacerbation came on, and the dog was dreadfully agitated. he barked and rolled himself on the ground almost every minute; be made frequent attempts to void his urine, which came from him drop by drop. when compelled to walk, his hind and fore legs seemed to mingle together, and his loins were bent into a perfect curve; his flanks were drawn in; he could scarcely be induced to eat; and he evidently suffered much in voiding his fæces. mild and demulcent liquids were his only food. warm baths and injections were applied almost unceasingly, and in eight days he seemed to have perfectly gained his health. in march, in the following year, the symptoms returned with greater intensity. his hind limbs were dragged after him; he rapidly lost flesh, and his howlings were fearful and continuous. the same mode of treatment was adopted without any good effect, and, his cries continuing, he was destroyed. the stomach and intestines were healthy. the bladder was enlarged from the thickness and induration of its parietes; the mucous membrane of it was covered with ecchymoses; the kidneys were three or four times their natural size; and the pelvis contained a calculus weighing grains, composed of grains of uric acid and of ammonia, with grains of phosphate of lime. of the nature and causes of urinary calculi in the bladder we know very little. we only know that some solid body finds its way or is formed there, gradually increases in size, and at length partially or entirely occupies the bladder. boerhaave has given a singular and undeniable proof of this. he introduced a small round pebble into the bladder of a dog. the wound perfectly healed. a few months afterwards the animal was killed, and there was found a calculus of considerable size, of which the pebble was the nucleus. occasionally the pressure of the bladder on the calculus which it contains is exceedingly great, so much so, indeed, as to crush the calculus. a small calculus may sometimes be forcibly extracted, or cut down upon and removed; but when the calculus is large, a catheter or bougie must be passed up the penis as far as the curve in the urethra, and then somewhat firmly held with the left hand, and pressing against the urethra. a scalpel should be taken, and an incision made into the urethra. the catheter being now withdrawn, and the finger or a pair of forceps introduced into the bladder, the calculus may be grasped and extracted. there are some instances in which as many as or small calculi have been taken from the bladder of a dog. twice i have seen calculi absolutely crushed in the bladder of a dog; and mr. blaine says that he found no fewer than or in the bladder of a newfoundland dog. one of them had passed out into the urethra, and had so blocked up the passage that the flow of urine was prevented, and the animal died of mortification. with much pleasure i refer to the details of mr. blaine with regard to the management of 'vesical calculi'. "when a small calculus," says he, "obstructs the urethra, and can be felt, it may be attempted to be forced forward through the urethra to the point of the penis, whence it may be extracted by a pair of forceps. if it cannot be so moved, it may be cut down upon and removed with safety; but when one or more stones are within the bladder, we must attempt lithotomy, after having fully satisfied ourselves of their existence there by the introduction of the sound; to do which it must be remembered that the urethra of the dog in passing the bladder proceeds nearly in a direct line backwards, and then, making an acute angle, it passes again forwards to the bladder. it must be therefore evident, that when it becomes necessary to introduce a catheter, sound, or bougie, it must first be passed up the penis to the extremity of this angle; the point of the instrument must then be cut down upon, and from this opening the instrument may be readily passed forward into the bladder. the examination made, and a stone detected, it may, if a very small one, be attempted to be pushed forward by means of a finger passed up the anus into the urethra; but, as this could be practicable only where the dog happened to be a large one, it is most probable that nothing short of the operation of lithotomy would succeed. to this end, the sound being introduced, pass a very small gorget, or otherwise a bistoury, along its groove into the bladder, to effect an opening sufficient to admit of the introduction of a fine pair of forceps, by which the stone may be laid up and extracted." 'blaine's canine pathology', p. . inflammation of the bladder is of frequent occurrence in the dog; it is also occasionally observed in the horse and the ox. it sometimes appears as an epizootic. it is generally announced by anxiety, agitation, trembling of the hinder limbs, frequent attempts to urine, vain efforts to accomplish it, the evacuation small in quantity, sometimes clear and aqueous, and at other times mucous, laden with sediment, thick and bloody, escaping by jets, painfully and with great difficulty, and then suddenly rushing out in great quantity. to this list of symptoms colic may often be added. the animal drinks with avidity, but seldom eats much, unless at the commencement of the complaint. the skin is hard and dry, he looks at his flanks, and his back and flanks are tender when pressed upon. during the latter portion of my connexion with mr. blaine, this disease assumed an epidemic character. there was a great drought through almost every part of the country. the disease was characterised by general uneasiness; continual shifting of the posture; a tucked-up appearance; an anxious countenance; a quick and noisy pulse; continued panting; the urine voided in small quantities, sometimes discharged drop by drop, or complete stoppage of it. the belly hot, swelled, and tender to the touch; the dog becoming strangely irritable, and ready to bite even his master. ' st may', .--two dogs had been making ineffectual attempts to void their urine for nearly two days. the first was a terrier, and the other a newfoundland. the terrier was bled, placed in a warm bath, and an aloetic ball, with calomel, administered. he was bled a second time in the evening, and a few drops of water were discharged. on the following day, the urine slowly passed involuntarily from him; but when he attempted to void any, his efforts were totally ineffectual. balls composed of camphor, pulv. uva ursi, tinct. ferri mur., mass purg., and pulv. lini. et gum. arab., were administered morning, noon, and night. on the th the urine still passed involuntarily. cold lotions were employed, and tonic and astringent medicines administered, with castor oil. he gradually got well, and no trace of the disease remained until june the th, when he again became thin and weak, and discharged much bloody urine, but apparently without pain. the uva ursi, oak bark, and powdered gum-arabic were employed. on the th he had become much better, and so continued until the st of july, when he again exhibited the same complaint more violently than before. he was exceedingly tender on the loins, and screamed when he was touched. he was bled, returned to his uva ursi and powdered gum, and recovered. i saw him two years afterwards apparently well. the newfoundland dog exhibited a similar complaint, with nearly the same accompaniments. 'may' .--he was disinclined to move; his belly was hard and hot, and he was supposed to be costive. gave an aloetic ball with iron. d. he has endeavoured, in vain, several times to void his urine. he walks stiffly with his back bound. subtract eight ounces of blood; give another physic-ball, and apply cold affusion to the loins. d. he frequently attempts to stale, and passes a little urine at each time; he still walks and stands with his back bound. syr. papav. et rhamni, with tinct. ferr. mur., a large spoonful being given morning and night. th. he again tries, ineffectually, to void his urine. mist. et pulv. th. unable to void a drop of urine; nose hot; tongue hangs down; pants considerably; will not eat; the countenance has an anxious character. bleed to twelve ounces; apply cold affusion. medicine as before, with cold affusion. th. appears to be in very great pain; not a drop of water has passed from him. medicine and other treatment as before. in the evening he lay down quietly. on the next morning he was found dead. all the viscera were sound except the bladder, which was ruptured; the abdomen contained two quarts of bloody fluid. the mucous membrane of the bladder appeared to be in the highest state of inflammation. it was almost black with extravasated blood. on the neck of the bladder was an enlargement of the size of a goose's egg, and almost filling the cavity of the pelvis. on cutting into it, more than two ounces of pus escaped. on june , , a poodle was brought to me. he had not been observed to pass any urine for two days. he made frequent attempts to void it, and cried dreadfully. the bladder could be felt distended in the abdomen. i put him into a warm bath, and took from him a pound of blood. he seemed to be a little relieved. i did not leave him until after midnight, but was soon roused by his loud screams, and the dog was also retching violently. the cries and retching gradually abated, and he died. the bladder had burst, and the parietes were in a dreadful state of inflammation. a dog had laboured under incontinence of urine more than two months. the water was continually dropping from him. the servant told me that, three months before, he had been shut into a room two days, and, being a cleanly animal, would not stale until he was liberated. soon after that the incontinence of urine was observed. i gave the usual tonic balls, with a small portion of opium, night and morning, and ordered cold water to be frequently dashed on the perinæum. a month afterwards he was quite well. comparatively speaking, 'profuse staling' is not a common disease, except when it is the consequence of bad food, or strong diuretics, or actual inflammation. the cause and the result of the treatment are often obscure. bleeding, purging, and counter irritation, would be indicated to a certain extent, but the lowering system must not be carried too far. the medicine would probably be catechu, uva ursi, and opium. at times blood mingles with the urine, with or without coagulation. the cause and the source of it may or may not be determined. generally speaking it is the result of some strain or blow. a terrier bitch, in january, , had incontinence of urine. no swelling or injury could be detected. i used with her the simple tonic balls. th january'.--she is now considerably better, and only a few drops are observed. d february'.--the disease which had seemingly been conquered began again to reappear; the medicine had been neglected. again have recourse to it. 'th march'.--the disease now appears to be quite checked by the cold lotion and the balls. a case of rupture of the bladder this is a singular account, and stands almost alone. the patient was a valuable spaniel belonging to that breed known as "the duke of norfolk's," and now possessed in its full perfection by the earl of albemarle. professor simonds shall give his own account: i was informed that almost from a puppy to the time when he was two years old, the dog had always been delicate in his appearance, and was observed to void his urine with difficulty; but there were not sufficient indications of disease for the owner to suppose that medical attendance was necessary until within a few days of his death, and then, finding that the act of staling was effected with increased difficulty, and accompanied with extreme pain; that the dog refused his food, was feverish; that at length there were frequent or ineffective efforts to expel the urine, the dog crying out from extremity of pain, and it was sufficiently evident that great mischief was going on, he was placed under my care; and even then he was walked a mile and a half to my infirmary. my attention was immediately directed to him; the man who brought him informing me that he seemed much easier since he left home. on examination, i at once pronounced that he could not recover; in fact, that he was rapidly sinking; but, from his then state, i could give no opinion with regard to the precise nature or extent of his disease. he was placed upon a bed in an appropriate apartment, with directions not to be disturbed, and in a few hours he died. the 'post-mortem' appearances were the abdomen containing from four to five pints of fluid, having much the character of, but more bloody than, that found in cases of ascites. the peritoneum seemed to be dyed from its immersion in this fluid, as it showed a general red hue, not apparently deeper in some parts than in others. there was an absence, to a great extent, of that beautiful appearance and well-marked course of the minute blood-vessels which accompany many cases of original peritonitis. extending the examination, i found the bladder to be ruptured, and that the fluid of which i have spoken was to a large extent composed of urine, mingled with some other secretion from the peritoneal investure of the abdomen and its viscera, probably produced from the presence of an irritant, the urine being brought into direct contact with the membrane. farther research showed that this rupture of the bladder was caused in the manner which i have stated. the 'post-mortem' examination displayed a chronic enlargement of the prostate gland of a considerable size, causing by its pressure a mechanical obstruction to the passage of the urine. death in this instance was not immediately brought about by the abnormal state of the original organ affected; but the prostate gland, having early in the life of the animal become diseased, and, being gradually increased in size, became a cause of still more serious disease, attacking more important organs. worms. there are various kinds of worms to which the dog is subject; they have occasionally been confounded with each other; but they are essentially different in the situations which they occupy, and the effects which they produce. the 'ascarides' are small thread-like worms, generally not more than six or ten lines in length, of a white colour, the head obtuse, and the tail terminating in a transparent prolongation. they are principally found in the rectum. they seem to possess considerable agility; and the itching which they set up is sometimes absolutely intolerable. to relieve this, the dog often drags the fundament along the ground. all the domesticated animals are subject to the annoyance which these worms occasion. they roll themselves into balls as large as a nut, and become entangled so much with each other that it is difficult to separate them. sometimes they appear in the stomach, and in such large masses that it is almost impossible to remove them by the act of vomiting. it has been said that packets of ascarides have been collected in the stomach containing more than one hundred worms. these collections are rarely or never got entirely rid of. enormous doses of medicine may be given, and the worms may not be seen again for several weeks; but, at length, they reappear as numerous as ever. young dogs are exceedingly subject to them, and are with great difficulty perfectly freed from their attacks. another species of worm is the 'teres'. it would resemble the earth-worm in its appearance, were it not white instead of a red colour. they are very common among dogs, especially young dogs, in whom they are often attended by fits. occasionally they crawl into the stomach, and there produce a great deal of irritation. another, and the most injurious of the intestinal worms, is the 'taenia', or 'tape-worm'. it is many inches in length, almost flat in the greater part of its extent, and its two extremities are nearly or quite equal. tape-worms associate in groups like the others, but they are not so numerous; they chiefly frequent the small intestines. they are sometimes apt to coil themselves, and form a mechanical obstruction which is fatal to the dog. the presence of all these worms is readily detected. there is generally a dry, short cough, a staring coat, a hot and fetid breath, a voracious appetite, and a peculiar state of the bowels; alternately constipated to a great degree, or peculiarly loose and griping. in young dogs the emaciated appearance, stinted growth, fetid breath, and frequent fits, are indications not to be mistaken. at other times, however, the dog is filled with worms with scarcely any indication of their presence. mr. blaine very properly remarks that it docs not follow, because no worms are seen to pass away, that there are none: neither when they are not seen does it follow even that none pass; for, if they remain long in the intestines after they are dead, they become digested like other animal matter. the means of expelling or destroying worms in the intestines of the dog are twofold: the first and apparently the most natural mode of proceeding, is the administration of purgatives, and usually of drastic ones; but there is much danger connected with this; not merely the fæces will be expelled, but a greater or less portion of the mucus that lines the intestinal canal. the consequence of this will be griping and inflammation to a very dangerous extent. frequent doses of epsom salts have been given; but not always with success, and frequently with griping. mercurial medicines have been tried; but they have not always succeeded, and have often produced salivation. one method of expelling the worm has been adopted which has rarely failed, without the slightest mischief--the administration of glass finely powdered. not a particle of it penetrates through the mucus that lines the bowels, while it destroys every intestinal worm. the powdered glass is made into a ball with lard and ginger. the following account of the symptoms caused by taenia may be interesting. a dog used to be cheerful, and particularly fond of his master; but gradually his countenance became haggard, his eyes were red, his throat was continually filled with a frothy spume, and he stalked about with an expression of constant inquietude and suffering. these circumstances naturally excited considerable fear with regard to the nature of his disease, and he was shut up in a court, with the intention of his being destroyed. thus shut up, he furiously threw himself upon every surrounding object, and tore them with his teeth whenever he could seize them. he retired into one of the corners of the court, and there he was continually rubbing his nose, as it were to extract some foreign body; sometimes he bit and tore up the earth, barking and howling violently; his hair stood on end, and his flanks were hollow. during the whole of his disease he continued to recognise his master. he ran to him at the slightest word. he refused nothing to drink; but he would not eat. he was killed on account of the fear excited among the neighbours. the veterinary surgeon who attended him suspected that there was some affection of the head, on account of the strange manner in which he had rubbed and beaten it. the superior part of the nose was opened, and two tæniæ; lanceolatæ were found: it was plain enough that they were the cause of all the mischief. the proprietor of the dog nevertheless believed that it was a case of rabies; he had the caustic applied to his hands, and could not persuade himself that he was safe until he had been at the baths of bourbonne. [ ] there is a worm inhabiting the stomach of young dogs, the 'ascaris marginata', a frequent source of sickness and occasionally of spasmodic colic, by rolling itself into knots. it seems occasionally to take a dislike to its assigned residence, and wanders into the oesophagus, but rarely into the larger intestines. a dog had a severe cough, which could not be subdued by bleeding or physic, or sedative or opiate medicines. he was destroyed, and one of these ascarides was found in the trachea. others find their way into the nasal cavity; and a dreadful source of irritation they are when they are endeavouring to escape, in order to undergo one of the changes of form to which they are destined, or when they have been forced into the nostril in the act of vomiting. i once had a dog as a patient, whose case, i confess, i did not understand. he would sneeze and snort, and rub his head and nose along the carpet. i happened to say that the symptoms in some respects resembled those of rabies, and yet, that i could not satisfy myself that the dog was rabid. the mention of rabies was sufficient, and in defiance of my remonstrances the animal was destroyed. the previous symptoms led me to examine the nasal cavity, and i found two of these ascarides, one concealed in the middle and the other in the upper meatus, through neither of which could any strong current of air be forced, and from which the ascarides could not be dislodged. worms may be the cause of sudden death in a dog. the following case, communicated by professor dick, illustrates this fact: i lately had the body of a dog sent to me: his owner sent the following letter by the same conveyance. "my keeper went out shooting yesterday morning with the dog which i now send to you. he was quite lively, and apparently well, during the former part of the day; but towards evening he was seized with violent vomiting. when he came home he refused to eat, and this morning about eight o'clock he died. as i have lost all my best dogs rather suddenly, i will thank you to have him examined, and the contents of his stomach analyzed; and have the kindness to inform me whether he has been poisoned, or what was the cause of his death." on opening the abdomen, the viscera appeared quite healthy: the stomach was removed, and the contents were found to be more decidedly acid than usual. the acids were the muriatic and acetic: the finding of an increased quantity of these is far from being unusual. there was not a trace of arsenical, mercurial, nor any other metallic poison present. of the vegetable poisons, i can only say there was not the slightest trace of the morbid effects of any of them. the pericardium and the left side of the thorax contained a small quantity of bloody serous fluid, and the heart was full of black blood. the left lung was a little inflamed. the trachea contained some frothy yellow mucous matter, similar to the contents of the stomach. in the larynx was found one of those worms occasionally inhabiting the cavities of the nose, and which had probably escaped from the nose while the dog had been hunting; and, lodging in the larynx, had destroyed the animal by producing spasms of the larynx. the worm was about one inch and a half in length, and had partly penetrated through the rima glottidis. another worm about the same size was found in the left bronchia, and a still smaller one among the mucus of the trachea: there were also four others in the nose. some years ago i found some worms of the filacia species in the right ventricle of the heart of a dog, which had produced sudden death by interrupting the action of the valves. the following is a curious case of tape-worm, by mr. reynold: on an estate where a great quantity of rabbits are annually destroyed in the month of november, we have observed that several dogs that were previously in good health and condition soon became weak, listless, and excessively emaciated, frequently passing large portions of the tape-worm. this induced us to examine the intestines of several hares and rabbits; and, with, very few exceptions, we found each to contain a perfect tape-worm three to four feet in length. we then caused two of the dogs whose cases appeared the worst to be separated from the others, feeding them on potatoes, &c.; and, in eight or ten days, after voiding several feet of the worms, they were perfectly restored to their former strength and appearance. the worm disease, hitherto so formidable to the spaniel and pointer, may in a great measure be fairly attributed to the custom of giving them the intestines of their game, under the technical appellation of "the paunch." the facts above stated, in explaining the cause of the disease, at the same time suggest the remedy. 'a worm in the urethra of a dog'. m. séon, veterinary surgeon of the lancers of the body guard, was requested to examine a dog who strained in vain to void his urine, often uttering dreadful cries, and then eagerly licking his penis. m. séon, after having tried in vain to abate the irritation, endeavoured to pass an elastic bougie. he perceived a conical body half an inch long protruding from the urethra with each effort of the dog to void his urine, and immediately afterwards returning into the urethra. he crushed it with a pair of forceps, and drew it out. it proved to be a worm resembling a strongylus, four and a half inches long. it was living, and moving about. m. séon could not ascertain its species. the worm being extracted, the urine flowed, and the dog soon recovered. [ ] fistula in the anus. this is a too frequent consequence of piles. it is often the result of the stagnation of hardened fæces in the rectum, which produces inflammation and ulceration, and frequently leaves a fistulous opening. if we may judge what the quadruped suffers by the sufferings of human beings, it is a sadly painful affair, whether the fistula is external or internal. whether it may be cured by a mild stimulant daily inserted to the bottom of the abscess, or whether there is a communication with the opening of the rectum which buries itself in the cellular tissues around it, and requires an operation for its cure, it will require the assistance of a skilful surgeon to effect a cure in this case. [footnote : tetanus observed on a dog, by m. debeaux.--'pract. med. vet.' , p. ] [footnote : 'blaine's canine pathology', p. .] [footnote : 'proceedings of the veterinary medical association', - ] [footnote : 'prat. méd. vét.' , p. .] [footnote : 'prat. méd. vét.', fév. .] * * * * * chapter xiii. bleeding; torsion; castration, parturition; and some diseases connected with the organs of generation. bleeding. this operation is exceedingly useful in many accidents and diseases. it is, in fact, as in the horse, the sheet-anchor of the practitioner in the majority of cases of an inflammatory character. there is some difference, however, in the instrument to be used. the lancet is the preferable instrument in the performance of this operation. the fleam should be banished from among the instruments of the veterinary surgeon. a ligature being passed round the lower part of the neck, and the head being held up a little on one side, the vein will protrude on either side of the windpipe. it will usually be advisable to cut away a little of the hair over the spot designed to be punctured. when a sufficient quantity of blood is abstracted, it will generally be necessary, and especially if the dog is large, to pass a pin through both edges of the orifice, and secure it with a little tow. when no lancet is at hand, the inside of the flap of the ear may be punctured with a pen-knife, the course of a vein being selected for this purpose. in somewhat desperate cases a small portion of the tail may be amputated. the 'superficial brachial vein', the 'cephalic' vein of the human subject, and the 'plat' vein of the farrier, may be resorted to in all lamenesses of the fore limb, and especially in all shoulder-wrenches, strains of the loins, and of the thigh and the leg, and muscular and ligamentous extensions of any part of the hind limbs; the 'vena saphena major', and the 'anterior tibial' vein may be punctured in such cases. the quantity of blood to be abstracted must be regulated according to the size and strength of the dog and the degree of inflammation. one or two ounces may be sufficient for a very small dog, and seven or eight for a large one. torsion to m. amusat, of paris, we are indebted for the introduction of the artery-forceps for the arresting of hemorrhage. i shall do but justice to him by describing his mode of proceeding. he seizes the divided vessel with a pair of torsion-forceps in such a manner as to hold and close the mouth of the vessel in its teeth. the slide of the forceps then shuts its blade, and the artery is held fast. the artery is then drawn from out of the tissues surrounding it, to the extent of a few lines, and freed, with another forceps, from its cellular envelope, so as to lay bare its external coat. the index and thumb of the left hand are then applied above the forceps, in order to press back the blood in the vessel. he then begins to twist the artery. one of the methods consists in continuing the torsion until the part held in the forceps is detached. when, however, the operator does not intend to produce that effect, he ceases, after from four to six revolutions of the vessel on its axis for the small arteries, and from eight to twelve for the large ones. the hemorrhage instantly stops. the vessel which had been drawn out is then replaced, as the surrounding parts give support to the knot which has been formed at its extremities. the knot becomes further concealed by the retraction of the artery, and this retraction will be proportionate to the shortening which takes place by the effect of the twisting, so that it will be scarcely visible on the surface of the stump. it is of the utmost importance to seize the artery perfectly, and to make the stated number of twists, as otherwise the security against the danger of consecutive hemorrhage will not be perfect. mr. w. b. costello, of london, was present when the operation was performed at paris. he brought back a full account of it as performed there, and availed himself of an early opportunity of putting it to the test before some of our metropolitan surgeons. a dog was placed on the table, the forceps were applied, and the operation perfectly succeeded. a few days afterwards a pointer bitch was brought to my infirmary, with a large scirrhous tumour near the anterior teat on the left side. it had been gradually increasing during the last five months. it was becoming more irregular in its form, and on one of its tuberculous prominences was a reddish spot, soft and somewhat tender, indicating that the process of suppuration was about to commence. i had often, or almost uniformly, experienced the power of iodine in dispersing glandular enlargements in the neck of the dog, and also those indurated tumours of various kinds which form about the joints of some domesticated animals, particularly of cattle; but frequent disappointment had convinced me that it was, if not inert, yet very uncertain in its effect in causing absorption of tumours about the mammæ of the bitch. having also been taught that the ultimate success of the excision of these enlargements depended on their removal before suppuration had taken place, and the neighbouring parts had been inoculated by the virus which so plentifully flowed from the ulcer, i determined on an immediate operation; and, as the tumour was large, and she was in high condition, i thought it a good case for 'the first trial of torsion'. she was well physicked, and on the third day was produced before my class and properly secured. i had not provided myself with the 'torsion forceps', but relied on the hold i should have on the vessel by means of a pair of common artery forceps; and the effect of imperfect instruments beautifully established the power of torsion in arresting hemorrhage. two elliptical incisions were made on the face of the tumour, and prolonged anteriorly and posteriorly about an inch from it. the portion of integument that could be spared was thus enclosed, while the opposed edges of the wound could be neatly and effectually brought together after the operation. the dissection of the integument from the remaining part of the face of the tumour was somewhat slow and difficult, for it was in a manner identified with the hardened mass beneath; but the operation soon proceeded more quickly, and we very soon had the scirrhus exposed, and adhering to the thorax by its base. about two ounces of venous blood had now been lost. i was convinced that i should find the principal artery, by which the excrescence was fed, at its anterior extremity, and not far from the spot where the suppuration seemed to be preparing: therefore, beginning posteriorly, i very rapidly cut through the cellular texture, elevating the tumour and turning it back, until i arrived at the inner and anterior point, and there was the only source of supply; the artery was plainly to be seen. in order to give the experiment a fair chance, i would not enclose it in the forceps, but i cut through it. a jet of blood spirted out. i then seized the vessel as quickly as i could, and began to turn the forceps, but before i could effect more than a turn and a half i lost my hold on the artery. i was vexed, and paused, waiting for the renewed gush of blood that i might seize the vessel again; but to my surprise not a drop more blood came from the arterial trunk. that turn and a half, considerable pressure having been used, had completely arrested the hemorrhage. i can safely say that not more than four drachms of arterial blood were lost. the wound was sponged clean: there remained only a very slight oozing from two or three points; the flaps were brought together, secured by the ordinary sutures, and the proper bandages applied. the weight of the tumour was twenty-two ounces; there was no after-bleeding, no unpleasant occurrences; but the wound, which had been nearly six inches in length, was closed in little more than three weeks. he will essentially promote the cause of science, and the cause of humanity, who will avail himself of the opportunity which country practice affords of putting the effect of torsion to the test: and few things will be more gratifying than the consciousness of rescuing our patients from the unnecessary infliction of torture. in docking, it will be found perfectly practicable: our patients will escape much torture, and tetanus will often be avoided. the principal danger from castration has arisen from the severity with which the iron has been employed. the colt, the sheep, and the dog will be fair subjects for experiment. the cautery, as it regards the first, and the brutal violence too frequently resorted to in operating upon the others, have destroyed thousands of animals. castration. this operation is performed on a great portion of our domestic animals. it renders them more docile, and gives them a disposition to fatten. it is followed by fewest serious accidents when it is performed on young animals. the autumn or spring should, if possible, be chosen for the operation, for the temperature of the atmosphere is then generally uniform and moderate. it should be previously ascertained that the animal is in perfect health; and he should be prepared by a mash diet and bleeding, if he is in a plethoric state, or possessed of considerable determination. if it is a young animal that is to be operated upon, an incision may be made into the scrotum, the testicle may be protruded, and the cord cut without much precaution, for the blood will soon be stayed; but for older animals it will be advisable to use a ligature, applied moderately tightly round the spermatic cord a little more than an inch beyond its insertion into the testicle; the scalpel is then used, and a separation effected between the ligature and the testis. the vas derens needs not to be included; a great deal of pain will then be spared to the animal. the ordinary consequences of castration are pain, inflammation, engorgement, and suppuration. the pain and suppuration are inevitable, but generally yield to emollient applications. the engorgement is often considerable at first, but soon subsides, and the suppuration usually abates in the course of a few days. it has been said that the castrated dog is more attached and faithful to his master than he who has not been deprived of his genital powers: this, however, is to be much doubted. he has, generally speaking, lost a considerable portion of his courage, his energy, and his strength. he is apt to become idle, and is disposed to accumulate fat more rapidly. his power of scent is also very considerably diminished and he is less qualified for the sports of the field. of this there can be no doubt. it has been said that he is more submissive: i very much doubt the accuracy of that opinion. he may not be so savage as in his perfect state; he may not be so eager in his feeding; but there is not the devotion to his master, and the quickness of comprehension which belongs to the perfect dog. the removal of the ovaries, or spaying of the female, used to be often practised, and packs of spayed bitches were, and still are, occasionally kept. in performing this operation, an opening is made into the flank on one side, and the finger introduced--one of the ovaries is laid hold of and drawn a little out of the belly; a ligature is then applied round it, just above the bifurcation of the womb, and it is cut through, the end of the ligature being left hanging out of the wound. the other ovary is then felt for and drawn out, and excised and secured by a ligature. the wound is then sewed up, and a bandage is placed over the incision. some farriers do not apply any ligature, but simply sew up the wound, and in the majority of cases the edges adhere, and no harm comes of the operation, except that the general character of the animal is essentially changed. she accumulates a vast quantity of fat, becomes listless and idle, and is almost invariably short-lived. the female dog, therefore, should always be allowed to breed. breeding is a necessary process; and the female prevented from it is sure to be affected with disease sooner or later; enormous collections and indurations will form, that will inevitably terminate in scirrhus or ulceration. a troublesome process often occurs when the female is not permitted to have young ones; namely, the accumulation of milk in the teats, especially if at any previous time, however distant, she may have had puppies once. the foundation is laid for many unpleasant and unmanageable complaints. if she is suffered to bring up one litter after another, she will have better health than those that are debarred from intercourse with the male. the temporary union which takes placed between the male and female at the period at which they are brought together is a very singular one. the corpora cavernosa of the male and the clitoris of the female being suddenly distended with blood, it is impossible to withdraw either of them until the turgescence of the parts has entirely ceased. parturition the pupping usually takes place from the sixty-second to the sixty-fourth day; and the process having commenced, from a quarter to three quarters of an hour generally takes place between the production of each puppy. great numbers of bitches are lost every year in the act of parturition: there seems to be a propensity in the females to associate with dogs larger than themselves, and they pay for it with their lives. the most neglected circumstance during the period of pregnancy is the little exercise which the mother is permitted to take, while, in point of fact, nothing tends more to safe and easy parturition than her being permitted or compelled to take a fair quantity of exercise. when the time of parturition has arrived, and there is evident difficulty in producing the foetus, recourse should be had to the ergot of rye, which should be given every hour or half hour, according to circumstances. if after a certain time some, although little, progress has been made, the ergot must be continued in smaller doses, or perhaps suspended for a while; but, if all progress is evidently suspended, recourse must be had to the hook or the forceps. by gentle but continued manipulation much may be done, especially when the muzzle of the puppy can be brought into the passage. as little force as possible must be used, and especially the foetus little broken. many a valuable animal is destroyed by the undue application of force. if the animal seems to be losing strength, a small quantity of laudanum and ether may be administered. "the patience of bitches in labour is extreme," says mr. blaine; "and their distress, if not removed, is most striking and affecting. their look is at such time particularly expressive and apparently imploring." when the pupping is protracted, and the young ones are evidently dead, the mother may be saved, if none of the puppies have been broken. in process of time the different puppies may, one after another, be extracted; but when violence has been used at the commencement, or almost at any part of the process, death will assuredly follow. 'june' , .--a spaniel bitch was brought to my infirmary to-day, who has been in great and constant pain since yesterday, making repeated but fruitless efforts to expel her puppies. she is in a very plethoric habit of body; her bowels are much confined, and she exhibits some general symptoms of febrile derangement, arising, doubtless, from her protracted labour. this is her first litter. upon examination, no young could be distinctly felt. place her in a warm bath, and give her a dose of castor oil, morning and evening. 'june' .--the bitch appears in the same state as yesterday, except that the medicine has operated freely upon the bowels, and the febrile symptoms have somewhat decreased. her strainings are as frequent and distressing as ever. take two scruples of the ergot of rye, and divide into six doses, of which let one be given every half hour. in about ten minutes after the exhibition of the last dose of this medicine, she brought forth, with great difficulty, one dead puppy, upon taking which away from her, she became so uneasy that i was induced to return it to her. in about a quarter of an hour after this i paid her another visit: the puppy could not now be found; but a suspicious appearance in the mother's eye betrayed at once that she had devoured it. i immediately administered an emetic; and in a very short time the whole foetus was returned in five distinct parts, viz., the four quarters and the head. after this, the bitch began to amend very fast; she produced no other puppy; and as her supply of milk was small, she was soon convalescent. twelve months afterwards she was again taken in labour, about eleven o'clock in the morning, and after very great difficulty, one puppy was produced. after this the bitch appeared in great pain, but did not succeed in expelling another foetus, in consequence of which i was sent for about three o'clock, p.m. i found her very uneasy breathing laboriously; the mouth hot, and the bowels costive; but i could not discover any trace of another foetus. she was put into a warm bath, and a dose of opening medicine was administered. about five o'clock she got rid of one dead and two living puppies. ' d'. she is still very ill; she evinces great pain when pressed upon the abdomen; and it is manifest that she has another foetus within her. i ordered a dose of the ergot, and in about twenty minutes a large puppy was produced, nearly dying. she survived with due care. i cannot refrain from inserting the following case at considerable length. 'sept.' , .--a very diminutive terrier, weighing not lbs. was sent to my hospital in order to lie in. she was already restless and panting. about eight o'clock at night the labour pains commenced; but until eleven scarcely any progress was made. the 'os uteri' would not admit my finger, although i frequently attempted it. at half-past eleven, the membranes began to protrude; at one the head had descended into the pelvis and the puppy was dead. in a previous labour she had been unable to produce her young, although the ergot of rye had been freely used. i was obliged to use considerable force, and she fought terribly with me throughout the whole process. at half-past one, and after applying considerable force, i brought away a large foetus, compared with her own size. on passing my finger as high as possible, i felt another foetus living, but the night passed and the whole of the following day, and she ate and drank, and did not appear to be much injured. several times in the day i gave her some strong soup and the ergot. some slight pains now returned, and by pressing on the belly the nose of the foetus was brought to the superior edge of the pelvis. the pains again ceased, the pudenda began to swell from frequent examination, the bitch began to stagger, and made frequent attempts to void her urine, with extreme difficulty in accomplishing it. i now resorted to the crotchet; and after many unsuccessful attempts, in which the superior part of the vagina must have been considerably bruised, i fixed it sufficiently firmly to draw the head into the cavity of the pelvis. here for a while the shoulder resisted every attempt which i could make without the danger of detruncating the foetus. at length by working at the side of the head until my nails were soft and my fingers sore, i extracted one fore leg. the other was soon brought down; another large puppy was produced, but destroyed by the means necessary for its production. this was the fruit of two hours' hard work. she was completely exhausted, and scarcely able to stand. when placed on the ground she staggered and fell at almost every step. her efforts to void her urine were frequent and ineffectual. at four o'clock i again examined her; the external pudenda were sore and swelled, and beginning to assume a black hue. it was with considerable difficulty that i could introduce my finger. a third foetus irregularly presented was detected. i could just feel one of the hind legs. no time was to be lost. i introduced a small pair of forceps by the side of my finger, and succeeded in laying hold of the leg without much difficulty, and, with two or three weak efforts from the mother,--i could scarcely call them pains,--i brought the leg down until it was in the cavity of the pelvis. i solicited it forward with my finger, and, by forcibly pressing back the 'labia pudendi', i could just grasp it with the finger and thumb of the right hand. holding it there, i introduced the finger of the right hand, and continued to get down the other leg, and then found little difficulty until the head was brought to the superior edge of the pelvis. after a long interval, and with considerable force, this was brought into the pelvis, and another puppy extracted. this fully occupied two hours. the bitch now appeared almost lifeless. as she was unable to stand, and seemed unconscious of every thing around her, i concluded that she was lost: i gave her one or two drops of warm brandy and water, covered her up closely, and put her to bed. to my surprise, on the following morning, she was curled round in her basket; she licked my hands, and ate a bit of bread and butter; but when put on her legs staggered and fell. the pudendum was dreadfully swollen, and literally black. in the afternoon she again took a little food: she came voluntarily from her basket, wagged her tail when spoken to, and on the following day she was taken in her basket a journey of miles, and afterwards did well; no one could be more rejoiced than was her master, who was present at, and superintended the greater part of the proceedings. 'the beneficial effect of ergot of rye in difficult parturition'.--the following case is from the pen of professor dick: on the th instant, a pointer bitch produced two puppies; and it was thought by the person having her in charge that she had no more. she was put into a comfortable box, and with a little care was expected to do well. on the next morning, however, she was sick and breathed heavily, and continued rather uneasy all the day. on the forenoon of the following day i was requested to see her. i found her with her nose dry, breath hot, respiration frequent, mouth hot and parched, coat staring, back roached, pulse , and a black fetid discharge from the vagina. pressure on the abdomen gave pain. a pup could be obscurely felt; the secretion of milk was suppressed, and the skin had lost its natural elasticity. tepid water with a little soap dissolved in it was immediately injected into the uterus, which in a considerable degree excited its action; and this injection was repeated two or three times with the same effect. after waiting for half an hour, the foetus was not discharged nor brought forward; therefore a scruple of the ergot of rye was then made into an infusion with two ounces of water, and one-third of it given as a dose; in half an hour, another one-third of it; the injections of warm water and soap being also continued. soon after the second dose of the infusion, a dead puppy was expelled; the bitch rapidly recovered, and, with the exception of deficiency of milk, is now quite well. this case would seem to prove the great power of the ergot of rye over the uterus; but, until more experiments are made, it is necessary to be cautious in ascribing powers to medicines which have not been much tried in our practice. it is not improbable that the warm water and soap might have roused the uterus into action without the aid of the ergot; and it is therefore necessary that those who repeat this experiment should try the effects of the medicine unaided by the auxiliary. the professor adds, that the great power which this drug is said to have on the human being, and the apparent effect in the case just given, suggest the propriety of instituting a further trial of it, and of our extending our observations to cattle, amongst which difficult cases of calving so frequently occur. mr. simpson thus concludes some remarks on ergot in difficult parturition. this medicine possesses a very great power over the uterus, rousing its dormant or debilitated contractility, and stimulating it to an extra performance of this necessary function after its natural energy has been in some measure destroyed by forcible but useless action. the direct utility of the ergot was manifested in cases where the uterus appeared quite exhausted by its repeated efforts; and certainly it is but fair to ascribe the decidedly augmented power of the organ to the stimulus of the ergot, for no other means were resorted to in order to procure the desired effect. its action, too, is prompt. within ten minutes of the administration of a second or third dose, when nature has been nearly exhausted, the parturition has been safely effected. 'puerperal fits'. nature, proportions the power and resources of the mother to the wants of her offspring. in her wild undomesticated state she is able to suckle her progeny to the full time; but, in the artificial state in which we have placed her, we shorten the interval between each period of parturition, we increase the number of her young ones at each birth, we diminish her natural powers of affording them nutriment, and we give her a degree of irritability which renders her whole system liable to be excited and deranged by causes that would otherwise be harmless: therefore it happens that, when the petted bitch is permitted to suckle the whole of her litter, her supply of nutriment soon becomes exhausted, and the continued drain upon her produces a great degree of irritability. she gets rapidly thin; she staggers, is half unconscious, neglects her puppies, and suddenly falls into a fit of a very peculiar character. it begins with, and is sometimes confined to, the respiratory apparatus: she lies on her side and pants violently, and the sound of her laboured breathing may be heard at the distance of twenty yards. sometimes spasms steal over her limbs; at other times the diaphragm and respiratory muscles alone are convulsed. in a few hours she is certainly lost; or, if there are moments of remission, they are speedily succeeded by increased heavings. the practitioner unaccustomed to this fearful state of excitation, and forgetful or unaware of its cause, proceeds to bleed her, and he seals her fate. although one system is thus convulsively labouring, it is because others are suddenly and perfectly exhausted; and by abstraction of the vital current he reduces this last hold of life to the helpless condition of the rest. there is not a more common or fatal error than this. the veterinary practitioner is unable to apply the tepid bath to his larger patients, in order to quiet the erythism of certain parts of the system, and produce an equable diffusion of nervous influence and action; and he often forgets it when he has it in his power to save the smaller ones. let the bitch in a fit be put into a bath, temperature ° fahrenheit, and covered with the water, her head excepted. it will he surprising to see how soon the simple application of this equable temperament will quiet down the erythism of the excited system. in ten minutes, or a quarter of an hour, she may be taken out of the bath evidently relieved, and then, a hasty and not very accurate drying having taken place, she is wrapped in a blanket and placed in some warm situation, a good dose of physic having been previously administered. she soon breaks out in a profuse perspiration. everything becomes gradually quiet, and she falls into a deep and long sleep, and at length awakes somewhat weak, but to a certain degree restored. if, then, all her puppies except one or two are taken from her, and her food is, for a day or two, somewhat restricted, and after that given again of its usual quantity and kind, she will live and do well; but a bleeding at the time of her fit, or suffering all her puppies to return to her, will inevitably destroy her. a bitch that was often brought to my house was suckling a litter of puppies. she was foolishly taken up and thrown into the serpentine in the month of april. the suppression of milk was immediate and complete. there was also a determination to the head, and attacks resembling epilepsy. the puppies that were suffered to remain with the mother, were very soon as epileptic as she was, and were destroyed. a seton was inserted on each side of her neck. ipecacuanha was administered; and that having sufficiently worked, a small quantity of diluted sulphuric acid was given. a fortnight afterwards she was perfectly well. 'inversion of the uterus in a bull bitch after pupping. extirpation and cure.' by m. cross, m. v., milan.--in july, , i was desired to attend a small bull bitch six years old, and who had had puppies four times. the uterus was completely inverted, and rested all its weight on the vaginal orifice of the urethra, preventing the discharge of the urine, and thus being the cause of great pain when the animal endeavoured to void it, or the faecal matter. the uterus was become of almost a black colour, swelled, softened, and exhaling an insupportable odour. judging from this that the preservation of the uterus was impossible, and reckoning much on the good constitution of the patient, i warned the proprietor of the danger of its reduction, even supposing that it was practicable, and proposed to him the complete extirpation of the uterus as the only means that remained of saving the bitch. armed with his consent, i passed a ligature round the neck of the uterus, at the bottom of the vagina, and drew it as tight as i possibly could. on the following day i again tightened the ligature, in order to complete the mortification of the part, and the separation of the womb. on the third day i extirpated the womb entirely, close to the haunch. there was very slight loss of blood, but there ran from the walls of the vagina a small quantity of ichorous fluid, with a strong fetid smell. the operation was scarcely completed ere she voided a considerable quantity of urine, and then searched about for something to eat and to drink. the portion of the uterus that was removed weighed fourteen ounces. the mucous membrane by which it was lined was in a highly disorganized state. from time to time injections of a slight infusion of aromatic plants were introduced into the vagina, and the animal was nourished with liquid food of easy digestion. the first day passed without the animal being in the slightest degree affected; but, on the following day, in despite of all our care, an ichorous fluid was discharged, which the dog would lick notwithstanding all our efforts to prevent it. the general health of the animal did not seem to be in the slightest degree affected. on the fourth day after the operation, the cords that had served as a ligature fell off, and all suppuration from the part gradually ceased. 'october th'.--three months have passed since the operation, and she is perfectly well. * * * * * chapter xiv. the distemper. by this singular name is distinguished a prevalent disease now about to come under our consideration, which was first observed on the continent. the rapidity with which it spread, the strange protean appearances which it assumed, and its too frequent fatal termination, surprised and puzzled the veterinary surgeons; and they called it "la maladie des chiens," the disease or distemper in dogs. it is comparatively a new disease. it was imported from france about one hundred years since, although some french authors have strangely affirmed that it is of british origin. having once gained footing among us, it has established itself in our country, to the vexation and loss of the sportsman, and the annoyance of the veterinary surgeon. however keepers, or even men of education, may boast of their specifics, it is a sadly fatal disease, and destroys fully one-third of the canine race. dogs of all ages are subject to its attack. many, nine and ten years old, have died of pure distemper; and i have seen puppies of only three weeks fall victims to it; but it oftenest appears between the sixth and twelfth month of the animal's life. if it occurs at an early period, it proves fatal in the great majority of cases; and, if the dog is more than four years old, it generally goes hard with him. it is undeniably highly contagious, yet it is frequently generated. in this it bears an analogy to mange, and to farcy and glanders in the horse. one attack of the disease, and even a severe one, is no absolute security against its return; although the dog that has once laboured under distemper possesses a certain degree of immunity; or, if he is attacked a second time, the malady usually assumes a milder type. i have, however, known it occur three times in the same animal, and at last destroy him. violent catarrh will often terminate in distemper; and low and insufficient feeding will produce it. it frequently follows mange, and especially if mercury has been used in the cure of the malady. when we see a puppy with mange, and that peculiar disease in which the skin becomes corrugated, and more especially if it is a spaniel, and pot-bellied or rickety, we generally say that we can cure the mange, but it will not be long before the animal dies of distemper; and so it happens in three cases out of four. whatever debilitates the constitution predisposes it for the reception or the generation of distemper. it, however, frequently occurs without any apparent exciting cause. that it is highly contagious cannot admit of doubt. a healthy dog can seldom, for many days, be kept with another that labours under distemper without becoming affected; and the disease is communicated by the slightest momentary contact. there is, however, a great deal of caprice about this. i have more than once kept a dog in the foul-yard of my hospital for several successive weeks, and he has not become diseased. inoculation with the matter that flows from the nose, either limpid or purulent, and in an early or advanced stage of the distemper, will, with few exceptions, produce the disease; yet i have failed to communicate it even by this method. inoculation used to be recommended as producing a milder and less fatal disease. so far as my experience goes, the contrary has been the result. distemper is also epidemic. it occurs more frequently in the spring and autumn than in the winter and summer. if one or two dogs in a certain district are affected, we may be assured that it will soon extensively prevail there; and where the disease could not possibly be communicated by contagion. sometimes it rages all over the country. at other times it is endemic, and confined to some particular district. not only is the disease epidemic or endemic, but the form which it assumes is so. in one season, almost every dog with distemper has violent fits; at another, in the majority of cases, there will be considerable chest affection, running on to pneumonia; a few months afterwards, a great proportion of the distempered dogs will be worn down by diarrhoea, which no medicine will arrest; and presently it will be scarcely distinguishable from mild catarrh. it varies much with different breeds. the shepherd's dog, generally speaking, cares little about it; he is scarcely ill a day. the cur is not often seriously affected. the terrier has it more severely, especially the white terrier. the hound comes next in the order of severity; and after him the setter. with the small spaniel it is more dangerous; and still more so with the pointer, especially if he has the disease early. next in the order of fatality comes the pug; and it is most fatal of all with the newfoundland dog. should a foreign dog be affected, he almost certainly dies. the greater part of the northern dogs brought by captain parry did not survive a twelvemonth; and the delicate italian greyhound has little chance, when imported from abroad. not only does it thus differ in different species of dogs, but in different breeds of the same species. i have known several gentlemen who have laboured in vain for many years, to rear particular and valuable breeds of pointers and greyhounds. the distemper would uniformly carry off five out of six. other sportsmen laugh at the supposed danger of distemper, and declare that they seldom lose a dog. this hereditary predisposition to certain kinds of disease cannot be denied, and is not sufficiently attended to. when a peculiar fatality has often followed a certain breed, the owner should cross it from another kennel, and especially from the kennel of one who boasts of his success in the treatment of distemper. this has occasionally succeeded far beyond expectation. it is time to proceed to the symptoms of this disease; but here there is very considerable difficulty, for it is a truly protean malady, and it is impossible to fix on any symptom that will invariably characterise it. an early and frequent symptom is a gradual loss of appetite, spirits, and condition: the dog is less obedient to his master, and takes less notice of him. the eyes appear weak and watery; and there will be a very slight limpid discharge from the nose. in the morning there will, perhaps, be a little indurated mucus at the inner corner of the eye. this may continue two or three weeks without serious or scarcely recognizable illness. then a peculiar husky cough is heard, altogether different from the sonorous cough of catarrh, or the wheezing of asthma. it is an apparent attempt to get something from the fauces or throat. by degrees the discharge from the eyes and nose, and particularly the former, will increase. more mucus will collect in the corners of the eye; and the eye will sometimes be closed in the morning. the conjunctiva and particularly that portion which covers the sclerotica, will be considerably injected, but there will not be the usual intense redness of inflammation. the vessels will be large and turgid rather than numerous, and frequently of a darkish hue. occasionally, however, the inflammation of the conjunctiva will be exceedingly intense, the membrane vividly red, and the eye impatient of light. an opacity spreads over the cornea, and this is quickly succeeded by ulceration. the first spot of ulceration is generally found precisely in the centre of the cornea, and is perfectly circular; this will distinguish it from a scratch or other injury. the ulcer widens and deepens, and sometimes eats through the cornea, and the aqueous humour escapes. fungous granulations spring from it, protrude through the lids, and the animal evidently suffers extreme torture. a remarkable peculiarity attends this affection of the eye. however violent may be the inflammation, and by whatever disorganization it may be accompanied, if we can cure the distemper, the granulations will disappear, the ulcer will heal, the opacity will clear away, and the eye will not eventually suffer in the slightest degree. one-fourth part of the mischief in other cases, unconnected with distemper, would inevitably terminate in blindness; but permanent blindness is rarely the consequence of distemper. it may not be improper here shortly to revert to the different appearance of the eye in rabies. in the early stage of this malady there is an unnatural and often terrific brightness of the eye; but the cornea in distemper is from the first rather clouded. in rabies there is frequent strabismus, with the axis of the eye distorted outwards. the apparent squinting of the eye in distemper is caused by the probably unequal protrusion of the membrana nictitans over a portion of the eye at the inner canthus, in order to protect it from the light. in rabies, the white cloudiness which i have described, and the occasional ulceration with very little cloudiness, and the ulceration, are confined to the cornea; but a dense green opacity comes on, speedily followed by ulceration and disorganization of every part of the eye. the dog will, at this stage of distemper, be evidently feverish, and will shiver and creep to the fire. he will more evidently and rapidly lose flesh. the huskiness will be more frequent and troublesome, and the discharge from the nose will have greater consistence. it will be often and violently sneezed out, and will gradually become more or less purulent. it will stick about the nostrils and plug them up, and thus afford a considerable mechanical obstruction to the breathing. the progress of the disease is now uncertain. sometimes fits come on, speedily following intense inflammation of the eye; or the inflammation of the nasal cavity appears to be communicated, by proximity, to the membrane of the brain. one fit is a serious thing. if it is followed by a second within a day or two, the chances of cure are diminished; and if they rapidly succeed each other, the dog is almost always lost. these fits seldom appear without warning; and, if their approach is carefully watched, they may possibly be prevented. however indisposed to eat the dog may previously have been, the appetite returns when the fits are at hand, and the animal becomes absolutely voracious. nature seems to be providing for the great expenditure of power which epilepsy will soon occasion. the mucus almost entirely disappears from the eyes, although the discharge from the nose may continue unabated; and for an hour or more before the fit there will be a champing of the lower jaw, frothing at the mouth, and discharge of saliva. the champing of the lower jaw will be seen at least twelve hours before the first fit, and will a little while precede every other. there will also be twitchings of some part of the frame, and usually of the mouth, cheek, or eyelid. it is of some consequence to attend to these, as enabling us to distinguish between fits of distemper and those of teething, worms, or unusual excitement. the latter come on suddenly. the dog is apparently well, and racing about full of spirits, and without a moment's warning he falls into violent convulsions. we may here, likewise, be enabled to distinguish between rabies and distemper. when a person, unacquainted with dogs, sees a dog struggling in a fit, or running along unconscious of every surrounding object, or snapping at everything in his way, whether it be a human being or a stone, he raises the cry of "mad dog," and the poor brute is often sacrificed. the very existence of a fit is proof positive that the dog is not mad. no epilepsy accompanies rabies in any stage of that disease. the inflammation of the membrane of the nose and fauces is sometimes propagated along that of the windpipe, and the dog exhibits unequivocal proofs of chest affection, or decided pneumonia. at other times the bowels become affected, and a violent purging comes on. the fæces vary from white with a slight tinge of gray, to a dark slate or olive colour. by degrees mucus begins to mingle with the fæcal discharge, and then streaks of blood. the fæcal matter rapidly lessens, and the whole seems to consist of mingled mucus and blood; and, from first to last, the stools are insufferably offensive. when the mingled blood and mucus appear, so much inflammation exists in the intestinal canal that the case is almost hopeless. the discharge from the nose becomes decidedly purulent. while it is white and without smell, and the dog is not too much emaciated, the termination may be favourable; but when it becomes of a darker colour, and mingled with blood, and offensive, the ethmoid or turbinated bones are becoming carious, and death supervenes. this will particularly be the case if the mouth and lips swell, and ulcers begin to appear on them, and the gums ulcerate, and a sanious and highly offensive discharge proceeds from the mouth. a singular, half-fetid smell arising from the dog, is the almost invariable precursor of death. when the disease first visited the continent, it was regarded as a humoral disease. duhamel, who was one of the earliest to study the character of the malady, contended that the biliary sac contained the cause of the complaint; the bile assumed a concrete form, and its superabundance was the cause of disease. barrier, one of the earliest writers on the subject, described it as a violent irregular bilious fever. others regarded it as a mucous discharge, or a depurative; and others, as a salutary crisis, removing from the constitution that which oppressed the different organs. others had recourse to inoculation, in order to give it a more benign character; and others, and among them chabert, considered that it possessed a character of peculiar malignity, and he gave it a name expressive of its nature and situation--'nasal catarrh'. it exhibited the ordinary symptoms of coryza: it was a catarrhal affection in its early stage; but it afterwards degenerated into a species of palsy. the causes were unknown. by some, they were attributed to the natural voracity of the dog; by others, to his occasional lasciviousness; by others, to his frequent feeding on carrion, or the refuse of fat and soups. there is no doubt that nasal catarrh is, to a very considerable degree, contagious on the continent. it often spreads over a wide extent of country, and includes numerous animals of various descriptions. it is complicated with various diseases; and particularly, at an early stage, with ophthalmia. it may be interesting to the reader to trace the progress of the disease among our continental neighbours. it commences with a certain depression of spirits; a diminution of appetite; a heaviness of the head; a heat of the mouth; an attempt to get something from the throat; an insatiable thirst; an elevated temperature of the body; a dry and painful suffocating cough; and all these circumstances continue twenty to thirty days, until at length the dog droops and dies. the duration of distemper is uncertain. it sometimes runs its course in five or six days; or it may linger on two or three months. in some cases the emaciation is rapid and extreme: danger is then to be apprehended. when the muscles of the loins are much attenuated, or almost wasted, there is little hope; and, although other symptoms may remit, and the dog may be apparently recovering, yet, if he continues to lose flesh, we may be perfectly assured that he will not live. on the other hand, let the discharge from the nose be copious, and the purging violent, and every other symptom threatening, yet if the animal gains a little flesh, we may confidently predict his recovery. when the dog is much reduced in strength and flesh, a spasmodic affection or twitching of the muscles will sometimes be observed. it is usually confined at first to one limb; but the most decisive treatment is required, or these spasms will spread until the animal is altogether unable to stand; and while he lies every limb will be in motion, travelling, as it were, at the rate of twenty miles an hour, until the animal is worn out, and dies of absolute exhaustion. when these spasms become universal and violent, they are accompanied by constant and dreadful moans and cries. in the pointer and the hound, and particularly when there is little discharge from the eyes or nose, an intense yellowness often suddenly appears all over the dog. he falls away more in twenty-four hours than it would be thought possible; his bowels are obstinately constipated; he will neither eat nor move; and in two or three days he is dead. in the pointer, hound, and greyhound, there sometimes appears on the whole of the chest and belly a pustular eruption, which peels off in large scales. the result is usually unfavourable. a more general eruption, however, either wearing the usual form of mange, or accompanied by minute pustules, may be regarded as a favourable symptom. the disease is leaving the vital parts, and expending its last energy on the integument. the 'post-mortem' appearances are exceedingly unsatisfactory: they do not correspond with the original character of the disease, but with its strangely varying symptoms. if the dog has died in fits, we have inflammation of the brain or its membranes, and particularly at the base of the brain, with considerable effusion of a serous or bloody fluid. if the prevailing symptoms have led our attention to the lungs, we find inflammation of the bronchial passages, or, in a few instances, of the substance of the lungs, or the submucous tissue of the cells. we rarely have inflammation of the pulmonary pleura, and never to any extent of the intercostal pleura. in a few lingering cases, tubercles and vomicæ of the lungs have been found. if the bowels have been chiefly attacked, we have intense inflammation of the mucous membrane, and, generally speaking, the small intestines are almost filled with worms. if the dog has gradually wasted away, which is often the case when purging to any considerable extent has been encouraged or produced, we have contraction of the whole canal, including even the stomach, and sometimes considerable enlargement of the mesenteric glands [ ]. the membrane of the nose will always exhibit marks of inflammation, and particularly in the frontal sinuses and ethmoidal cells; and i have observed the portion of membrane on the septum, or cartilaginous division of the nostrils, between the frontal sinuses and ethmoidal cells, to be studded with small miliary tubercles. in advanced stages of the disease, attended with much defluxion from the nose, the cells of the ethmoidal bone and the frontal sinuses are filled with pus. ulceration is sometimes found on the membrane of the nose, oftenest on the spot to which i have referred--occasionally confined to that; and now and then spreading over the whole of the septum, and even corroding and eating through it; generally equal on both sides of the septum; in a few instances extending into the fauces; seldom found in the larynx, but occasionally seen in the bronchial passages. the other viscera rarely present any remarkable morbid appearance. the distemper is clearly a disease of the mucous membranes, usually commencing in the membrane of the nose, and resembling nasal catarrh. in the early stage it is 'coryza', or nasal catarrh; but the affection rapidly extends, and seems to attack the mucous membranes generally, determined to some particular one, either by atmospheric influence or accidental causes, or constitutional predisposition. the fits arise from general disturbance of the system, or from the proximity of the brain to the early seat of inflammation. this account of the nature and treatment of distemper will, perhaps, be unsatisfactory to some readers. one thing, however, is clear, that for a disease which assumes such a variety of forms, there can be no specific; yet there is not a keeper who is not in possession of some supposed infallible nostrum. nothing can be more absurd. a disease attacking so many organs, and presenting so many and such different symptoms, must require a mode of treatment varying with the organ attacked and the symptom prevailing. the faith in these boasted specifics is principally founded on two circumstances--atmospheric influence and peculiarity of breed. there are some seasons when we can scarcely save a dog; there are others when we must almost wilfully destroy him in order to lose him. there are some breeds in which, generation after generation, five out of six die of distemper, while there are others in which not one out of a dozen dies. when the season is favourable, and the animal, by hereditary influence, is not disposed to assume the virulent type of the disease, these two important agents are overlooked, and the immunity from any fatal result is attributed to medicine. the circumstances most conducive to success will be the recollection that it is a disease of the mucous surfaces, and that we must not carry the depleting and lowering system too far. keeping this in view, we must accommodate ourselves to the symptoms as they arise. the natural medicine of the dog seems to be an emetic. the act of vomiting is very easily excited in him, and, feeling the slightest ailment, he flies to the dog-grass, unloads his stomach, and is at once well. in distemper, whatever be the form which it assumes, an emetic is the first thing to be given. common salt will do when nothing else is at hand; but the best emetic, and particularly in distemper, consists of equal parts of calomel and tartar emetic. from half a grain to a grain and a half of each will constitute the dose. this will act first as an emetic, and afterwards as a gentle purgative. then, if the cough is urgent, and there is heaving at the flanks, and the nose is hot, a moderate quantity of blood may be taken--from three to twelve ounces--and this, if there has been previous constipation, may be followed by a dose of sulphate of magnesia, from two to six drachms. in slight cases this will often be sufficient to effect a cure: but, if the dog still droops, and particularly if there is much huskiness, the antimonial or james's powder, nitre and digitalis, in the proportion of from half a grain to a grain of digitalis, from two to five grains of the james's powder, and from a scruple to a drachm of nitre, should be administered twice or thrice in a day. if on the third or fourth day the huskiness is not quite removed, the emetic should be repeated. in these affections of the mucous membranes, it is absolutely necessary to avoid or to get rid of every source of irritation, and worms will generally be found a very considerable one in young dogs. if we can speedily get rid of them, distemper will often rapidly disappear; but, if they are suffered to remain, diarrhoea or fits are apt to supervene: therefore some worm medicine should be administered. i have said that vomiting is very easily excited in the dog; and that for this reason we are precluded from the use of a great many medicines in our treatment of him. calomel, aloes, jalap, scammony, and gamboge will generally produce sickness. we are, therefore, driven to some mechanical vermifuge; and a very effectual one, and that will rarely fail of expelling even the tape-worm, is tin filings or powdered glass. from half a drachm to a drachm of either may be advantageously given twice in the day. there may generally be added to them digitalis, james's powder, and nitre, made into balls with palm oil and a little linseed meal. this course should be pursued in usual cases until two or three emetics have been given, and a ball morning and night on the intermediate days. should the huskiness not diminish after the first two or three days, if the dog has not rapidly lost flesh, i should be disposed to take a little more blood, and to put a seton in the poll. it should be inserted between the ears, and reaching from ear to ear. when there is fever and huskiness, and the dog is not much emaciated, a seton is an excellent remedy; but, if it is used indiscriminately, and when the animal is already losing ground, and is violently purging, we shall only hasten his doom, or rather make it more sure. it is now, if ever, that pneumonia will be perceived. the symptoms of inflammation in the lungs of the dog can scarcely be mistaken. the quick and laborious breathing, the disinclination or inability to lie down, the elevated position of the head, and the projection of the muzzle, will clearly mark it. more blood must be subtracted, a seton inserted, the bowels opened with epsom salts, and the digitalis, nitre, and james's powder given more frequently and in larger doses than before. little aid is to be derived from observation of the pulse of the dog; it differs materially in the breed, and size, and age of the animal. many years' practice have failed in enabling me to draw any certain conclusion from it. the best place to feel the pulse of the dog is at the side. we may possibly learn from it whether digitalis is producing an intermittent pulse, which it frequently will do, and which we wish that it should do: it should then be given a little more cautiously, and in smaller quantities. if the pneumonia is evidently conquered, or we have proceeded thus far without any considerable inflammatory affection of the chest, we must begin to change our plan of treatment. if the huskiness continues, and the discharge from the nose is increased and thicker, and the animal is losing flesh and becoming weak, we must give only half the quantity of the sedative and diuretic medicine, and add some mild tonic, as gentian, chamomile, and ginger, with occasional emetics, taking care to keep the bowels in a laxative but not purging state. the dog should likewise be urged to eat; and, if he obstinately refuses ail food, he should be forced with strong beef jelly, for a very great degree of debility will now ensue we have thus far considered the treatment of distemper from its commencement; but it may have existed several days before we were consulted, and the dog may be thin and husky, and refusing to eat. in such case we should give an emetic, and then a dose of salts, and after that proceed to the tonic and fever balls. should the strength of the animal continue to decline, and the discharge from the nose become purulent and offensive, the fever medicine must be omitted, and the tonic balls, with carbonate of iron, administered. some veterinary surgeons are very fond of gum resins and balsams. mr. blaine, in his excellent treatise on the distemper in his canine pathology, recommends myrrh and benjamin, and balsam of peru and camphor. i much doubt the efficacy of these drugs. they are beginning to get into disrepute in the practice of human medicine; and i believe that if they were all banished from the veterinary materia medica we should experience no loss. when the dog begins to recover, although not so rapidly as we could wish, the tonic balls, without the iron, may be advantageously given, with now and then an emetic, if huskiness should threaten to return; but mild and wholesome food, and country or good air, will be the best tonics. if the discharge from the nose become very offensive, the lips swelled and ulcerated, and the breath fetid, half an ounce of yeast may be administered every noon, and the tonics morning and night; and the mouth should be frequently washed with a solution of chloride of lime. at this period of the disease the sub-maxillary glands are sometimes very much enlarged, and a tumour or abscess is formed, which, if not timely opened, breaks, and a ragged, ill-conditioned ulcer is formed, very liable to spread, and very difficult to heal. it is prudent to puncture this tumour as soon as it begins to point, for it will never disperse. after the opening, a poultice should be applied to cleanse the ulcer; after which it should be daily washed with the compound tincture of benjamin, and dressed with calamine ointment. some balls should be given, and the animal liberally fed. should the fits appear in an early stage, give a strong emetic; then bleed, and open the bowels with five or six grains of calomel and a quarter grain of opium: after this insert a seton, and then commence the tonic balls. the progress of fits in the early stages of the disease may thus be arrested. the occurrence of two or three should not make us despair; but, if they occur at a later period, and when the dog is much reduced, there is little hope. this additional expenditure of animal power will probably soon carry him off. all that is to be done, is to administer a strong emetic, obviate costiveness by castor oil, and give the tonic balls with opium. of the treatment of the yellow disease little can be said; we shall not succeed in one case in twenty. when good effect has been produced, it has been by one large bleeding, opening the bowels well with epsom salts, and then giving grain doses of calomel twice a day in a tonic ball. while it is prudent to obviate costiveness, we should recollect that there is nothing more to be dreaded, in every stage of distemper, than diarrhoea. the purging of distemper will often bid defiance to the most powerful astringents. this shows the folly of giving violent cathartics in distemper; and, when i have heard of the ten, and twenty, and thirty grains of calomel that are sometimes given, i have thought it fortunate that the stomach of the dog is so irritable. the greater part of these kill-or-cure doses is ejected, otherwise the patient would soon be carried off by super-purgation. there is an irritability about the whole of the mucous membrane that may be easily excited, but cannot be so readily allayed; and, therefore, except in the earliest stage of distemper, or in fits, or limiting ourselves to the small portion of calomel which enters into our emetic, i would never give a stronger purgative than castor-oil or epsom salts. it is of the utmost consequence that the purging of distemper should be checked as soon as possible. in some diseases a sudden purging, and even one of considerable violence, constitutes what is called the crisis. it is hailed as a favourable symptom, and from that moment the animal begins to recover; but this is never the case in distemper: it is a morbid action which is then going on, and which produces a dangerous degree of debility. the proper treatment of purging in cases of distemper, is first to give a good dose of epsom salts, in order to carry away anything that may offend, and then to ply the animal with mingled absorbents and astringents. a scruple of powdered chalk, ten grains of catechu, and five of ginger, with a quarter of a grain of opium, made into a ball with palm oil, may be given to a middle-sized dog twice or thrice every day. to this may be added injections of gruel, with the compound chalk mixture and opium. when the twitchings which i have described begin to appear, a seton is necessary, whatever may be the degree to which the animal is reduced. some stimulating embrocation, such as tincture of cantharides, may be rubbed along the whole course of the spine; and the medicine which has oftenest, but not always, succeeded, is castor-oil, syrup of buckthorn, and syrup of white poppies, given morning and night, and a tonic ball at noon. if the dog will not now feed, he should be forced with strong soup. as soon, however, as the spasms spread over him, accompanied by a moaning that increases to a cry, humanity demands that we put an end to that which we cannot cure. until this happens i would not despair; for many dogs have been saved that have lain several days perfectly helpless. as to the chorea which i have mentioned as an occasional sequel of distemper, if the dog is in tolerable condition, and especially if he is gaining flesh, and the spring or summer is approaching, there is a chance of his doing well. a seton is the first thing; the bowels should be preserved from constipation; and the nitrate of silver, in doses of one-eighth of a grain, made into a pill with linseed meal, and increased to a quarter of a grain, should be given morning and night. we should never make too sure of the recovery of a distempered dog, nor commit ourselves by too early a prognosis. it is a treacherous disease; the medicines should be continued until every symptom has fairly disappeared; and for a month at least. it may be interesting to add the following account of the distemper in dogs, by dr. jenner. several of our modern writers have copied very closely from him. "that disease among dogs which has familiarly been called the 'distemper,' has not hitherto, i believe, been, much noticed by medical men. my situation in the country favouring my wishes to make some observations on this singular malady, i availed myself of it, during several successive years, among a large number of foxhounds belonging to the earl of berkeley; and, from observing how frequently it has been confounded with hydrophobia, i am induced to lay the result of my inquiries before the medical and chirurgical society. it may be difficult, perhaps, precisely to ascertain the period of its first appearance in britain. in this and the neighbouring counties, i have not been able to trace it back beyond the middle of the last century; but it has since spread universally. i knew a gentleman who, about forty-five years ago, destroyed the greater part of his hounds, from supposing them mad, when the distemper first broke out among them; so little was it then known by those most conversant with dogs. on the continent i find it has been known for a much longer period; it is as contagious among dogs as the small-pox, measles, or scarlet fever among the human species; and the contagious miasmata, like those arising from the diseases just mentioned, retain their infectious properties a long time after separation from the distempered animal. young hounds, for example, brought in a state of health into a kennel, where others have gone through the distemper, seldom escape it. i have endeavoured to destroy the contagion by ordering every part of a kennel to be carefully washed with water, then whitewashed, and finally to be repeatedly fumigated with the vapour of marine acid, but without any good result. "the dogs generally sicken early in the second week after exposure to the contagion; it is more commonly a violent disease than otherwise, and cuts off at least one in three that are attacked by it. it commences with inflammation of the substance of the lungs, and generally of the mucous membrane of the bronchi. the inflammation at the same time seizes on the membranes of the nostrils, and those lining the bones of the nose, particularly the nasal portion of the ethmoid bone. these membranes are often inflamed to such a degree as to occasion extravasation of blood, which i have observed coagulated on their surface. the breathing is short and quick, and the breath is often fetid; the teeth are covered with a dark mucus. there is frequently a vomiting of a glairy fluid. the dog commonly refuses food, but his thirst seems insatiable, and nothing cheers him like the sight of water. the bowels, although generally constipated as the disease advances, are frequently affected with diarrhoea at its commencement. the eyes are inflamed, and the sight is often obscured by mucus secreted from the eyelids, or by opacity of the cornea. the brain is often affected as early as the second day after the attack; the animal becomes stupid, and his general habits are changed. in this state, if not prevented by loss of strength, he sometimes wanders from his home. he is frequently endeavouring to expel by forcible expirations the mucus from the trachea and fauces, with a peculiar rattling noise. his jaws are generally smeared with it, and it sometimes flows out in a frothy state, from his frequent champing. "during the progress of the disease, especially in its advanced stages, he is disposed to bite and gnaw anything within his reach; he has sometimes epileptic fits, and a quick succession of general though slight convulsive spasms of the muscles. if the dog survive, this affection of the muscles continues through life. he is often attacked with fits of a different description; he first staggers, then tumbles, rolls, cries as if whipped, and tears up the ground with his teeth and fore feet: he then lies down senseless and exhausted. on recovering, he gets up, moves his tail, looks placid, comes to a whistle, and appears in every respect much better than before the attack. the eyes, during this paroxysm, look bright, and, unless previously rendered dim by mucus, or opacity of the cornea, seem as if they were starting from their sockets. he becomes emaciated, and totters from feebleness in attempting to walk, or from a partial paralysis of the hind legs. in this state he sometimes lingers on till the third or fourth week, and then either begins to show signs of returning health (which seldom happens when the symptoms have continued with this degree of violence), or expires. during convalescence, he has sometimes, though rarely, profuse hæmorrhage from the nose. "when the inflammation of the lungs is very severe, he frequently dies on the third day. i know one instance of a dog dying within twenty-four hours after the seizure; and in that short space of time the greater portion of the lungs was, from exudation, converted into a substance nearly as solid as the liver of a sound animal. in this case the liver itself was considerably inflamed, and the eyes and flesh universally were tinged with yellow, though i did not observe anything obstructing the biliary ducts. in other instances i have also observed the eyes looking yellow. "the above is a description of the disease in its several forms; but in this, as in the diseases of the human body, there is every gradation in its violence. "there is also another affinity to some human diseases, viz., that the animal which has once gone through it very rarely meets with a second attack. fortunately this distemper is not communicable to man. neither the effluvia from the diseased dog nor the bite have proved in any instance infectious; but, as it has often been confounded with canine madness, as i have before observed, it is to be wished that it were more generally understood; for those who are bitten by a dog in this state are sometimes thrown into such perturbation that hydrophobia symptoms have actually arisen from the workings of the imagination. mr. john hunter used to speak of a case somewhat of this description in his lectures. "a gentleman who received a severe bite from a dog, soon after fancied the animal was mad. he felt a horror at the sight of liquids, and was actually convulsed on attempting to swallow them. so uncontrollable were his prepossessions, that mr. hunter conceived he would have died had not the dog which inflicted the wound been found and brought into his room in perfect health. this soon restored his mind to a state of tranquillity. the sight of water no longer afflicted him, and he quickly recovered." [ ] palsy, more or less complete, is sometimes the termination of the distemper in dogs. it is usually accompanied by chorea, and it is then, in the majority of cases, hopeless. setons should be inserted in the poll, being then, as nearly as possible, at the commencement of the spinal cord. they should be well stimulated and worn a considerable time. if they fail, a plaster composed of common pitch, with a very small quantity of yellow wax and some powdered cantharides, spread on sheep's-skin, should be placed over the whole of the lumbar and sacral regions, extending half-way down the thigh on either side. the bowels should be kept open by mild aperients, in order that every source of irritation may be removed from the intestinal canal. some mild and general tonic will likewise be useful, such as gentian and ginger. [footnote : the following is a very frequent and unexaggerated history of distemper, when calomel has been given in too powerful doses: 'august , '.--a spaniel, six months old, has been ailing a fortnight, and three doses of calomel have been given by the owner. he has violent purging, with tenesmus and blood. half an ounce of caster-oil administered. ' st.' astringents, morning, noon, and night. 'sept. .' the astringents have little effect, or, if the purging is restrained one day, it returns with increased violence on the following day. getting rapidly thin. begins to husk. astringents continued. ' th'. the purging is at last overcome, but the huskiness has rapidly increased, accompanied by laborious and hurried respiration.--bleed to the extent of three ounces. ' th'. the breathing relieved, but he obstinately refuses to eat, and is forced several times in the day with arrow-root or strong soup. ' th'. he had become much thinner and weaker, and died in the evening. no appearance of inflammation on the thoracic viscera, nor in any part of the alimentary canal. the intestines are contracted through the whole extent. 'veterinarian', ii. .] [footnote : 'medico-chirurgical transitions', st march, .] * * * * * chapter xv. small-pox; mange; warts; cancer; fungus hÆmatodes; sore feet. small-pox. in , there was observed, at the royal veterinary school at lyons, an eruptive malady among the dogs, to which they gave the name of 'small-pox'. it appeared to be propagated from dog to dog by contagion. it was not difficult of cure; and it quickly disappeared when no other remedies were employed than mild aperients and diaphoretics. a sheep was inoculated from one of these dogs. there was a slight eruption of pustules formed on the place of inoculation, but nowhere else; nor was there the least fever. at another time, also, at the school at lyons, a sheep died of the regular sheep-pox. a part of the skin was fastened, during four-and-twenty hours, on a healthy sheep, and the other part of it on a dog, both of them being in apparent good health. no effect was produced on the dog, but the sheep died of confluent sheep-pox. the essential symptoms of small-pox in dogs succeed each other in the following order: the skin of the belly, the groin, and the inside of the fore arm, becomes of a redder colour than in its natural state, and sprinkled with small red spots irregularly rounded. they are sometimes isolated, sometimes clustered together. the near approach of this eruption is announced by an increase of fever. on the second day the spots are larger, and the integument is slightly tumefied at the centre of each. on the third day the spots are generally enlarged, and the skin is still more prominent at the centre. on the fourth day the summit of the tumour is yet more prominent. towards the end of that day, the redness of the centre begins to assume a somewhat gray colour. on the following days, the pustules take on their peculiar characteristic appearance, and cannot be confounded with any other eruption, on the summit is a white circular point, corresponding with a certain quantity of nearly transparent fluid which it contains, and covered by a thin and transparent pellicle. this fluid becomes less and less transparent, until it acquires the colour and consistence of pus. the pustule, during its serous state, is of a rounded form. it is flattened when the fluid acquires a purulent character, and even slightly depressed towards the close of the period of suppuration, and when that of desiccation is about to commence, which ordinarily happens towards the ninth or tenth day of the eruption. the desiccation and the desquamation occupy an exceedingly variable length of time; and so, indeed, do all the different periods of the disease. what is the least inconstant, is the duration of the serous eruption, which is about four days, if it has been distinctly produced and guarded from all friction. if the general character of the pustules is considered, it will be observed, that, while some of them are in a state of serous secretion, others will only have begun to appear. the eruption terminates when desiccation commences in the first pustules; and, if some red spots show themselves at that period of the malady, they disappear without being followed by the development of pustules. they are a species of abortive pustules. after the desiccation, the skin remains covered by brown spots, which, by degrees, die away. there remains no trace of the disease, except a few superficial cicatrices on which the hair does not grow. the causes which produce the greatest variation in the periods of the eruption are, the age of the dog, and the temperature of the situation and of the season. the eruption runs through its different stages with much more rapidity in dogs from one to five months old than in those of greater age. i have never seen it in dogs more than eighteen months old. an elevated temperature singularly favours the eruption, and also renders it confluent and of a serous character. a cold atmosphere is unfavourable to the eruption, or even prevents it altogether. death is almost constantly the result of the exposure of dogs having small-pox to any considerable degree of cold. a moderate temperature is most favourable to the recovery of the animal. a frequent renewal or change of air, the temperature remaining nearly the same, is highly favourable to the patient; consequently close boxes or kennels should be altogether avoided. i have often observed, that the perspiration or breath of dogs labouring under variola emits a very unpleasant odour. this smell is particularly observed at the commencement of the desiccation of the pustules, and when the animals are lying upon dry straw; for the friction of the bed against the pustules destroys their pellicles, and permits the purulent matter to escape; and the influence of this purulent matter is most pernicious. the fever is increased, and also the unpleasant smell from the mouth, and that of the fæces. in this state there is a disposition which is rapidly developed in the lungs to assume the character of pneumonia. this last complication is a most serious one, and almost always terminates fatally. it has a peculiar character. it shows itself suddenly, and with all its alarming symptoms. it is almost immediately accompanied by a purulent secretion from the bronchi, and the second day does not pass without the characters of pneumonia being completely developed. the respiration is accompanied by a mucous 'râle' which often becomes sibilant. the nasal cavities are filled with a purulent fluid. the dog that coughs violently at the commencement of the disease, employs himself, probably, on the following day, in ejecting, by a forcible expulsion from the nostrils, the purulent secretion which is soon and plentifully developed. when he is lying quiet, and even when he seems to be asleep, there is a loud, stertorous, guttural breathing. mange. the existence of certain insects found burrowing under the skin of the human being, and of various tribes of animals, has been acknowledged from the th century. in the th century, correct engravings of these insects were produced. on the other hand many doubted their existence, because it had not been their lot to see them. in , galés, a pupil in the hospital of st. louis, pretended to have found some of them. they were put into the hands of m. raspail, of paris, who proved that they were nothing more than the common cheese-mites; and substituted by galés for those seen by bonomo. professor hertwig, of berlin, has given a graphic sketch of these insects (veterinarian, vol. xi. pp. , ). mr. holthouse states that, "placed on the skin of a healthy individual, they excite a disease in the part to which they were confined, having all the characters of scabies; that insects taken from mangy sheep, horses, and dogs, and transplanted to healthy individuals of the same species, produce in them a disease analogous to that in the animals from which they were taken; and that there are too many well-attested cases on record to permit us to doubt of scabies having been communicated from animals to man." mange may in some degree be considered as an hereditary disease. a mangy dog is liable to produce mangy puppies, and the progeny of a mangy bitch will certainly become affected sooner or later. in many cases a propensity to the disease will be speedily produced. if the puppies are numerous, and confined in close situations, the effluvia of their transpiration and fæcal discharges will often be productive of mange very difficult to be removed. close confinement, salted food, and little exercise, are frequent causes of mange. 'the scabby mange' is a frequent form which this disease assumes. it assumes a pustular and scabby form in the red mange, particularly in white-haired dogs, when there is much and painful inflammation. a peculiar eruption, termed surfeit, which resembles mange, is sometimes the consequence of exposure to cold after a hot sultry day. large blotches appear, from which the hair falls and leaves the skin bare and rough. acute mange sometimes takes on the character of erysipelas; at other times there is considerable inflammation. the animal exhibits heat and restlessness, and ulcerations of different kinds appear in various parts, superficial but extensive. bleeding, aperient and cooling medicines are indicated, and also applications of the subacetate of lead, or spermaceti ointment. a weak infusion of tobacco may be resorted to when other things fail, but it must be used with much caution. the same may be said of all mercurial preparations. the tanner's pit has little efficacy, except in slight cases. slight bleedings may be serviceable, and especially in full habits; setons may be resorted to in obstinate cases. a change in the mode of feeding will often be useful. mild purgatives, and especially epsom salts, are often beneficial, and also mercurial alternatives, as Æthiop's mineral with cream of tartar and nitre. the external applications require considerable caution. if mercury is used, care must be taken that the dog does not lick it. the diarrhoea produced by mercury often has a fatal effect. unguents are useful, but considerable care must be taken in their application. they must be applied to the actual skin, not over the hair. in old and bad cases much time and patience will be requisite. mr. blaine had a favourite setter who had virulent mange five years. he was ordered to be dressed every day, or every second day, before the disease was complete conquered. cutaneous affections have lately been prevalent to an extent altogether unprecedented on this and on the other side of the channel. in the latter part of the disease assumed a character which had not been known among us for many years. the common mange, which we used to think we could easily grapple with, was now little seen: even the usual red mange with the fox-coloured stain was not of more frequent occurrence than usual, but an intolerable itchiness with comparatively little redness of skin, and rarely sufficient to account for the torture which the animal seemed to endure, and often with not the slightest discoloration of the integument, came before us almost every day, and under its influence the dog became ill-tempered, dispirited, and emaciated, until he sunk under its influence. all unguents were thrown away here. lotions of corrosive sublimate, decoction of bark, infusion of digitalis or tobacco, effected some little good; but the persevering use of the iodine of potassium, purgatives, and the abstraction of blood very generally succeeded. the sudden appearance of redness of the skin, and exudation from it, and actual sores attending the falling off of the hair, and itching, that seemed to be intolerable, have also been prevalent to an unprecedented extent. this mange, however, is to a certain degree manageable. a dose or two of physic should he given, with an application of a calamine powder, and the administration of the iodide of potassium. mr. blaine gives a most valuable account of mange in the dog, part of which i shall quote somewhat at length. mange exerts a morbid constitutional action on the skin; it is infectious from various miasmata, and it is contagious from personal communication. in some animals it may be produced by momentary contact; it descends to other animals of various descriptions; there is no doubt that it is occasionally hereditary: it is generated by effluvia of many various kinds; almost every kind of rancid or stimulating food is the parent of it. high living with little exercise is a frequent cause of it, and the near approach of starvation is not unfavorable to it. the scabby mange is the common form under which it generally appears. in red mange the whole integument is in a state of acute inflammation; surfeit, or blotches, a kind of cuticular eruption breaks out on particular parts of the body without the slightest notice, and, worse than all, a direct febrile attack, with swelling and ulceration, occurs, under which the dog evidently suffers peculiar heat and pain. last of all comes local mange. almost every eruptive disease, whether arising from the eye, the ear, the scrotum, or the feet, is injurious to the quality as well as the health of every sporting dog: the scent invariably becomes diseased, and the general powers are impaired. there are several accounts of persons who, having handled mangy dogs, have been affected with an eruption very similar to the mange. a gentleman and his wife who had been in the habit of fondling a mangy pug dog, were almost covered with an eruption resembling mange. several of my servants in the dog-hospital have experienced a similar attack; and the disease was once communicated to a horse by a cat that was accustomed to lie on his back as he stood in the stall. warts. these are often unpleasant things to have to do with. a newfoundland dog had the whole of the inside of his mouth lined with warts. i applied the following caustic:--hyd. suc-corrosivi [symbol: ounce] j., acidi mur. [symbol: ounce], alcoholis [symbol: ounce] iiij., aquæ [symbol: ounce] ij. the warts were touched twice every day, and in less than a fortnight they had all disappeared. another dog had its mouth filled with warts, and the above solution was applied. in four days considerable salivation came on, and lasted a week, but at the expiration of that time the warts had vanished. the owner of the dog had applied the solution with the tip of her finger; she experienced some salivation, which she attributed to this cause. the skin of the dog, from the feebleness of its perspiratory functions, is little sensible to the influence of diaphoretics: therefore we trust so much to external applications for the cure of diseases of the skin of that animal. cancer this is a disease too frequent among females of the dog tribe, and occasionally seen in the male. its symptoms, local and general, are various. they are usually very obscure in their commencement; they increase without any limit; they are exasperated by irritants of any kind; and in the majority of cases their reproduction is almost constant, and perfectly incurable. with regard to the female, it is mostly connected with the secretion of milk. two or three years may pass, and at almost every return of the period of oestrum, there will be some degree of enlargement or inflammation of the teats. some degree of fever also appears; but, after a few weeks have passed away, and one or two physic balls have been administered, everything goes on well. in process of time, however, the period of oestrum is attended by a greater degree of fever and enlargement of the teats, and at length some diminutive hardened nuclei, not exceeding in size the tip of a finger, are felt within one of the teats. by degrees they increase in size; they become hard, hot, and tender. a considerable degree of redness begins to appear. some small enlargements are visible. the animal evidently exhibits considerable pain when these enlargements are pressed upon. they rapidly increase, they become more hot and red, various shining protuberances appear about the projection, and at length the tumour ulcerates. a considerable degree of sanious matter flows from the aperture. the tumours, however, after a while diminish in size; the heat and redness diminish; the ulcer partly or entirely closes, but, after a while, and especially when the next period of oestrum arrives, the tumour again increases, and with far greater rapidity than before, and then comes the necessity of the removal of the tumour, or if not, the destruction of the animal. in the great majority of cases, the removal of the cancer does not destroy the dog, but lessens its torture. the knife and the forceps must usually be resorted to, and in the hands of a skilful surgeon the life of the animal will be saved. when the cancer is attached to the neighbouring parts by cellular substance alone, no difficulty will be experienced in detaching the whole of it. the operation will be speedily performed, and there will be an end of the matter; but, if the tumour has been neglected, and the muscular, the cellular, or even the superficial parts have been attacked, the utmost caution is requisite that every diseased portion shall be removed. mr. blaine adds to this that "it must also be taken into the account, that, although in the canine cancer ulceration does not often reappear in the intermediate part, when the operation has been judiciously performed, yet, when the constitution has been long affected with this ulcerative action, it is very apt to show itself in some neighbouring part soon after." fungus hÆmatodes. in the month of march, , a valuable pointer dog was sent to mr. adam of beaufort, quite emaciated, with total loss of appetite and with a large fungus hæmatodes about the middle of the right side of his neck. it had begun to appear about five months before, and was not at first larger than a pea. mr. adam gave him a purgative of barbadoes aloes, which caused the discharge of much fetid matter from the intestines. at the expiration of three days he removed the tumour with the knife. there was a full discharge of healthy matter from the wound. during the period of its healing the animal was well fed, and ferruginous tonics were given. in a little more than three weeks the wound had completely filled up with healthy granulations, and the dog was sent home to all appearance quite well. at the expiration of three months another tumour made its appearance near the situation of the former one, growing fast; it had attained nearly the size of the other. mr. adam removed it immediately, ordering a system of nutritive feeding and tonics. it appeared at first to go on favourable; but, five days after the removal of the second one, a third made its appearance. this was removed at the expiration of another five days; but the animal was totally unable to walk, with very laborious breathing and cold extremities. a cathartic was given and the legs bandaged; but the wounds made no progress towards healing, and at the end of three days he died. on exposing the cavity of the thorax it was almost covered with variously formed tumours, from the size of a pigeon's egg to that of a small pea. the intercostal muscles had many of these adhering to them, and a few small ones were developed on the heart. there were three on the diaphragm, in the centre of which matter was formed. the blood-vessels, kidneys, &c., were free from disease. these tumours were white, or nearly so, rather hard, and of a glandular substance. the external ones were soft, red, and almost destitute of blood-vessels, except the first, which bled considerably. there was dropsy of the abdomen. sore feet sore feet constitute a frequent and troublesome complaint. it consists of inflammation of the vascular substance, between the epidermis and the parts beneath. it is the result of numerous slight contusions, produced by long travelling in dry weather, or hunting over a hard and rough country, or one covered with frost and snow. the irritation with which it commences continues to increase and a certain portion of fluid is determined to the feet, and tubercles are formed, hard, hot, and tender, until the whole foot is in a diseased state, considerably enlarged. the animal sadly suffers, and is scarcely able to stand up for a minute. sometimes the ardour of the chase will make him for a while forget all this; but on his return, and when he endeavours to repose himself, it is with difficulty that he can be got up again. the toes become enlarged, the skin red and tender, and the horny sole becomes detached and drops. local fever, and that to a considerable extent, becomes established; it reacts on the general economy of the animal, who scarcely moves from his bed, and at length refuses all food. at other times a separation takes place between the dermis and the epidermis, which is a perfect mass of serosity. still, however, it is only when all this has much increased, or has been neglected, that any permanently dangerous consequences take place. when violent inflammation has set in, the feet must be carefully attended to, or the dog may be lamed for life. one or two physic-balls may be given; all salted meat should be removed, and the animal supplied with food without being compelled to move from his bed. the feet should be bathed with warm water, and a poultice of linseed meal applied to them twice in the day. if, as is too often the case, he should tear this off, the feet should be often fomented. it is bad practice in any master of dogs to suffer them to be at all neglected when there are any tokens of inflammation of the feet. the neglect of even a few days may render a dog a cripple for life. if there are evident appearances of pus collecting about the claws, or any part of the feet, the abscess should be opened, well bathed with warm water, and friar's balsam applied to the feet. when the feet have been neglected, the nail is apt to grow very rapidly, and curve round and penetrate into the foot. the forceps should he applied, and the claws reduced to their proper size. if there are any indications of fever, or if the dog should be continually lying down, or he should hold up his feet, and keep them apart as much as he can, scarifications or poultices, or both, should be resorted to. when the feet of a dog become sore in travelling, the foolish habit of washing them with brine should never be permitted, although it is very commonly resorted to. warm fomentations, or warm pot-liquor, or poultices of linseed meal should be applied, or, if matter is apparently forming, the lancet may be resorted to. dogs are frequently sent to the hospital with considerable redness between the toes, and ichorous discharge, and the toes thickened round the base of the nails, as if they were inclined to drop off. the common alterative medicine should be given, and a lotion composed of hydrarg. oxym. gr. vi., alcohol [symbol: ounce] j., et aq. calcis [symbol: ounce] iiij., should he applied to the feet three times every day. leathern gloves should be sewn on them. these cases are often very obstinate. generally speaking, the dog has five toes on the fore feet, and four on the hind feet, with a mere rudiment of a fifth metatarsal bone in some feet; but, in others, the fifth bone is long and well proportioned, and advances as far as the origin of the first phalanx of the neighbouring toe. [the editor begs leave to add a more detailed and systematic treatise of the affections generally attacking the feet and limbs of our dogs. diseases of the feet. sore feet. inflammation of the feet, a disease somewhat analogous to founder in horses, and often attended with equally bad results, particularly in the english kennels, is comparatively rare with us, although there are few sportsmen but have met with some cases among their dogs. the feet become tender, swollen, and hot, violent inflammatory action sets in, the toes become sore, the claws diseased, and the balls very painful, and often suppurate. the animal is thus speedily rendered useless; not being able to support his body, owing to the intense pain, he remains in his house, and employs the most of his time in temporarily assuaging his sufferings by constantly licking the diseased members. 'causes'.--running long distances over frozen or stony grounds, hunting over a rough and ill-cleaned country, over-feeding, confinement, and lazy habits, are all conducive in some measure to this affection. this form of disease is not uncommon among those dogs used in toling ducks on the chesapeake bay, these animals being obliged to run incessantly to and fro over the gravel shores, in their efforts to attract the canvass-back. we have seen many dogs that have been made cripples by this arduous work, and rendered prematurely old while yet in their prime. it would certainly be wise and humane on the part of those who pursue this sport either for pleasure or gain, to provide suitable boots for these sagacious animals, who in return would repay such kindness by increased ardour and length of service. these articles might be made of leather, or some other durable substance, in such a manner that they could be laced on every morning before commencing their labours. the claws should be allowed to project through openings in the boot, as this arrangement will give much more freedom to the feet, and the boot itself will not be destroyed so soon by the penetration of the toes through its substance. boots thus neatly made will neither interfere with his locomotive nor swimming powers, but add greatly to the comfort of the animal, and secure his services for many years. 'treatment'.--no stimulating applications to the feet are to be used, such as salt water, ley, fish brine, or urine, but rather emollient poultices and cooling washes. these last-mentioned remedies should be carefully applied, and the dog confined to his house as much as possible: in fact, there is little difficulty in restraining him in this respect, as he has but little inclination or ability to move about. purging balls should be administered every night, and blood abstracted if there be much fever, as indicated in the heat, swelling, and pain of the limbs. if the balls continue to swell, and there is a collection of pus within them, they may be opened by the lancet, and the contents evacuated, after which apply a linseed poultice. when the inflammation has subsided, simple dressings of melted butter or fresh lard will generally effect a cure. pustular affection of the feet. dogs frequently have a pustular eruption between the toes, either accompanying mange or some other skin disease, or entirely independent of any other affection. 'causes'.--want of cleanliness, bad housing, improper food, vermin, and depraved constitution. 'treatment'.--frequent washing with castile soap and water will correct this disease; the feet and legs after washing should be rubbed dry, particularly between the toes. when the pustules are large, they may be opened with the lancet and a poultice applied. if the disease appears complicated with mange, or dependent upon other general causes, the primary affection must be removed by the proper remedies, which generally carries off with the secondary disease. sprains it is not an uncommon occurrence for dogs, while running, climbing fences, or jumping ditches, to sprain themselves very severely in the knee, or more frequently in the shoulder-joint; and if not properly attended to, will remain cripples for life, owing to enlargement of the tendon and deposition of matter. we once had a fine, large, powerful bull-dog, that sprained himself in the shoulder while running very violently in the street after another dog, and in some way, owing to the great eagerness to overtake the other, tripped up when at the top of his speed, fell on his chest, and when he arose commenced limping, and evidently suffered from considerable pain. on taking him home, we examined his feet, limbs, and chest very particularly, expecting to find a luxation or fracture of some of the bones of the leg or feet, or perhaps the presence of a piece of glass or other article deeply imbedded in the ball. none of the above accidents, however, being brought to light by our examination, or that of a medical friend who expressed a wish to see our patient, we concluded that a simple sprain of some of the tendons had taken place. on the following day there was slight swelling and tenderness of the shoulder-joint, accompanied by great unwillingness to put the foot to the ground, owing to the pain that seemed to be produced by the extension of the leg. the limb was fomented, and the dog confined for several days, till the swelling and tenderness disappeared; but, greatly to our astonishment and that of others, he still remained lame as before. this lameness continued for several months, when we parted with him, sending him to a relative in the country, who informed us that he never recovered the use of his limb, but that it became shrivelled and deformed for want of use. the cause of lameness in this dog is as unaccountable as some cases of lameness we see in horses. we are convinced that there was neither fracture nor luxation, nor any other unnatural displacement of the parts, and can attribute it to nothing but enlargement of one of the tendons of the shoulder-joint resulting from inflammation. if it had been in our power, we should have liked to have examined this animal after death. 'treatment'.--hot fomentations to the part affected, together with purging balls and bleeding, if there be great tenderness and swelling of the limb. when the inflammation and tumefaction have disappeared, rub the parts with opodeldoc, or other stimulating mixtures. wounds of the feet. dogs are apt to cut their feet by stepping upon sharp tools, bits of oyster-shell, old iron, &c., or by the introduction of thorns, burrs, nails, bits of glass, and other articles, into their balls. 'treatment'.--if the cut be very deep, or divides the ball, the foot must be washed in tepid water, and the edges of the wound drawn together and retained in their position by a couple of sutures or a strap or two of adhesive plaster, and the animal confined. where thorns or sand-burrs have pierced the foot, diligent search should be made to extract them, or the wound will suppurate, and the dog continue lame for a long time. this caution is particularly necessary when minute particles of glass have entered the foot. a poultice in such cases should be applied, after removing every particle within our reach, and the, foot be wrapped up, or, what is better, enclosed in a boot of some kind, sufficiently strong to protect it from the dirt or other small particles which otherwise would enter the wound and prevent its healing. in a case of great emergency, one of our friends hunted a setter dog three successive days in a leather boot, which we instructed a country cobbler to put on him to protect his foot from a recent and deep cut, that he had received from treading upon some farming utensils. the boot was taken off every night, the foot nicely cleaned, the leather oiled and replaced ready for the following day. the wound afterwards healed up, and no trace of the incision now remains. the boot should be made of stout, flexible leather, and extend beyond the first joint; the seam must be in front, so as not to interfere with the dog's tread. there should be openings for the claws, and the sole large enough to allow the expansion of the ball pads when in motion: a small layer of tow had better be laid on the bottom of the foot before putting on the boot. it is often very difficult to tell the exact spot where a briar or thorn has entered the foot, owing to its penetrating so far into the substance of the ball as to be entirely concealed under the skin, or by the swelling of the parts surrounding it. in all such cases the bottom of the foot should he gently pressed by the thumb, and the point where the dog exhibits symptoms of must pain should be, particularly examined, and, if necessary, cut down upon to extract the extraneous substance, no matter what it may be. long nails or claws. the nails of some dogs require occasional cutting, otherwise they grow so long and fast that they turn in and penetrate the ball of the foot. if we cut them, a strong, sharp knife is necessary for the purpose; filing them off we consider far preferable. lameness dogs, as well as horses, become lame from stiff joints, splints, and sprains. stiff joints are occasioned by anchylosis, or the deposit of calcareous or osseous matter within the ligament or around the head of the bone, which latter defect is known as ring-bone in the horse. 'treatment'.--stimulating friction to the parts, such as spirits of camphor, or camphorated liniment, mercurial ointment, tincture of iodine, opodeldoc, blistering, c.--l.] * * * * * chapter xvi. fractures these are of not unfrequent occurrence in the dog; and i once had five cases in my hospital at the same time. in the human subject, fractures are more frequent in adults, and, perhaps, in old men, than in infants; but this is not the case with the smaller animals generally, and particularly with dogs. five-sixths of the fractures occur between the time of weaning and the animal being six months old; not, perhaps, because of their chemical composition, that the bones are more fragile at this age; but because young dogs are more exposed to fall from the hands of the persons who carry them, and from the places to which they climb; and the extremities of the bones, then being in the state of epiphysis, are easily separated from the body of the bone. when the fracture takes place in the body of the bone, it is transverse or somewhat oblique, but there is scarcely any displacement. a simple bandage will be sufficient for the reduction of these fractures, which may be removed in ten or twelve days, when the preparatory callus has acquired some consistence. one only out of twenty dogs that were brought to me with fractures of the extremities, in the year , died. two dogs had their jaws fractured by kicks from horses, and lost several of their teeth. in one of them the anterior part of the jaw was fractured perpendicularly; in the other, both branches were fractured. plenty of good soup was injected into their mouths. ten or twelve days afterwards, they were suffered to lap it; and in a little while they were dismissed cured. it will be desirable, perhaps, to describe our usual method of reducing the greater part of the fractures which come under our notice. i.--the 'humerus' was fractured just above the elbow and close to the joint. the limb was enclosed in adhesive plaster, and supported by a firm bandage. the bones were beginning to unite, when, by some means concerning which i could never satisfy myself, the 'tibia' was broken a little above the hock. nothing could well be done with this second fracture; but great care was taken with regard to the former. the lower head of the humerus remained somewhat enlarged; but the lameness became very slight, and in three weeks had nearly or quite disappeared. nothing was done to the second fracture; in fact, nothing more than a slight, annular enlargement, surrounding the part, remained--a proof of the renovating power of nature. ii.--a spaniel was run over by a light carriage. it was unable to put the left hind leg to the ground, and at the upper tuberosity of the ileum some crepitus could be distinguished. i subtracted six ounces of blood, administered a physic-ball, and ordered the patient to be well fomented with warm water several times during the night. on the following day no wound could be discovered, but there was great tenderness. i continued the fomentation. two or three days afterwards she was evidently easier. i then had the hair cut close, and covered the loins and back with a pitch-plaster. at the expiration of six days the plaster was getting somewhat loose, and was replaced by another with which a very small quantity of powdered cantharides was mingled. at the expiration of the fifth week she was quite well. iii.--the 'thigh-bone' had been broken a fortnight. it was a compound fracture: the divided edges of the bone protruded through the integuments, and there was no disposition to unite. it is not in one case in a hundred that an animal thus situated can be saved. we failed in our efforts, and the dog was ultimately destroyed. iv.--the 'femur' was broken near the hip. i saw it on the third day, when much heat and swelling had taken place. i ordered the parts to be frequently bathed with warm water. the heat and tenderness to a considerable degree subsided, and the pitch-plaster was carefully applied. at the expiration of a week the plaster began to be loosened. a second one was applied, and when a fortnight longer had passed, a slight degree of tenderness alone remained. v.--the following account is characteristic of the bull terrier. the 'radius' had been broken, and was set, and the bones were decidedly united, when the dog, in a moment of frantic rage, seized his own leg and crushed some of the bones. they were once more united, but his wrist bent under him in the form of a concave semicircle, as if some of the ligaments of the joint had been ruptured in the moment of rage. it was evident on the following day that it was impossible to control him, and he was destroyed. vi.--a spaniel, three months old, became fractured half-way between the wrist and the 'elbow'. a surgeon bound it up, and it became swollen to an enormous size, from the adhesive plaster that had been applied and the manner of placing the splints. i removed the splints. on the following morning i had the arm frequently fomented: a very indistinct crepitus could be perceived at the point of the humerus: i applied another plaster higher up, and including the elbow. the hair not having been cut sufficiently close, the plaster was removed, applied much more neatly and closely, and the original fracture was firmly bound together. no crepitus was now to be perceived. i saw no more of our patient for four days, when i found that he had fallen, and that the elbow on the other side was fractured within the capsular ligament. a very distinct crepitus could be felt, and the dog cried sadly when the joint was moved. i would have destroyed him, but he was a favourite with his master, and we tried what a few days more would produce. i enclosed the whole of the limb in a plaster of pitch, and bound it up without splints. both the bandages remained on nearly a fortnight, when the fractures were found to be perfectly united, and the lameness in both legs gradually disappeared. vii.--july , . a spaniel was frightened with something on the bed, and fell from it, and cried very much. the instep, or wrist, of the right leg, before was evidently bowed, and there was considerable heat and tenderness. it was well fomented on the two following days, and then set, and adhesive plaster was tightly applied, and a splint bound over that. th. the foot began to swell, and was evidently painful. the outer bandage was loosened a little, but the inner bandage was not touched. aug. . the bandage, that had not been meddled with for eleven days, now appeared to give him some pain. for the last two days he has been gently licking and gnawing it. the splints were removed; but the adhesive plaster appearing even and firm, was suffered to remain. th. everything appeared to be going on well, when he again leaped from his bed. the wrist was much more bowed, and was tender and hot. simple lint and a firm calico bandage were had recourse to. th. he is unable to put his foot to the ground, and the joint is certainly enlarging. an adhesive plaster, made by a frenchman, was applied at the owners request, over which was placed a splint. the dog soon began to gnaw the plaster, which formed a sticky but not very adhesive mass. before night the pain appeared to be very great, and the dog cried excessively. i was sent for. we well fomented the leg, and then returned to our former treatment. there was evidently a great deal of pain, but it gradually passed over, and a slight degree of lameness alone remained. i have great pleasure in adding the following accounts of the successful treatment of fractures in dogs by mr. percivall: "hopeless as cases of fracture in horses generally are, from the difficulty experienced in managing the patient, they are by no means to be so regarded in dogs. i have in several instances seen dogs recover, and with very good use of the parts, if not perfect restoration of them, when the accidents have been considered, at the time they took place, of a nature so irremediable as to render it advisable to destroy the animals. "may , . a valuable irish spaniel fell from a high wall, and fractured his 'off shoulder'. on examination, i found the 'os humeri' fractured about an inch above its radial extremity, causing the limb to drop pendulously from the side, and depriving the animal of all use of it. the arm, by which i mean the fore arm, was movable in any direction upon the shoulder, and there was distinct crepitus: in a word, the nature of the accident was too plain to admit of doubt; nor was there any splinter or loose piece of bone discoverable. i directed that the animal might be laid flat upon his sound side in a hamper, or covered basket or box, of sufficient dimensions, but not large enough to admit of his moving about; to have his hind legs fettered, his mouth muzzled, and his injured parts covered with a linen cloth wetted with a spirit lotion. 'may' . the parts are tumefied, but not more, nor even so much as one night have expected. continue the lotion. ' th'. at my request, mr. youatt was called in to give his opinion as to the probability of effecting a cure. he thought from the inconvenient situation of the fracture, that the chances of success were doubtful; and recommended that a plaster, composed of thick sheep-skin and pitch, cut to the shape of the parts, should be applied, extending from the upper part of the shoulder down upon the arm, and reaching to the knee; and that the whole should be enveloped in well-applied bandages, one of them being carried over the shoulders and brought round between the fore legs, to support the limb, and aid in retaining the fractured ends in apposition. prior to the application of the pitch plaster the hair was closely shorn off. thus bound up, the dog was replaced in his hamper, and had some aperient medicine given to him. ' th'. the medicine has operated; and he appears going on well, his appetite continuing unimpaired. ' th'. he growls when i open the basket to look at him. on examining him (while his keeper had hold of him), i found the plaster loosening from its adhesion; i took it off altogether, and applied a fresh one, composed of the stopping composition i use for horses' feet. june . up to this time everything appears to have been going on properly. the fracture feels as if it were completely united, and, as the plaster continues to adhere firmly, i thought the bandages enveloping it, as they were often getting loose, might now he dispensed with, and that the dog might with benefit be chained to a kennel, instead of being so closely confined as he has been. in moving, he does not attempt to use the fractured limb, but hops along upon the three other legs. july. he has acquired pretty good use of the limb. being now at liberty, he runs about a good deal; halting, from there being some shortness of the limb, but not so much as to prevent him being serviceable, as a 'slow' hunter, in the sporting-field. "about a twelvemonth ago," continues mr. percivall, "i was consulted concerning a blood-hound of great size and beauty, and of the cost of £ , that had been a cripple in one of his hind limbs for some considerable time past, owing, it was said or thought, to having received some injury. after a very careful handling, and examination of the parts about the hips, the places where he expressed pain, i came to the conclusion that there had been, and still existed, some fracture of 'the ischial portion of the pelvis', but precisely where, or of what nature, i could not determine; and all the treatment i could recommend was, that the animal should be shut up within a basket or box of some, sort, of dimensions only sufficient to enable him to lie at ease, and that he be kept there for at least six months, without being taken out, save for the purpose of having his bed cleansed or renewed. his owner had previously made up his mind to have him destroyed; understanding, however, from me, that there still remained a chance of his recovery, he ordered his groom to procure a proper basket, and see that the dog's confinement was such as i had prescribed. the man asked me to allow him to have his kennel, which, being no larger than was requisite for him, i did not object to; and to this he had an iron lattice-door made, converting it into a sort of wild beast cage. after two months' confinement, i had him let out for a short run, and perceived evident amendment. i believe altogether that he was imprisoned five months, and then was found so much improved that i had him chained to his kennel for the remaining month, and this, i believe, was continued for another month. the issue was the complete recovery of the animal, very much to the gratification and joy of his master, by whom he is regarded as a kind of unique or unobtainable production. "the fractures of dogs and other animals must, of course, be treated in accordance with all the circumstances of their cases; but i have always considered it a most essential part of their treatment that such portable patients as dogs and cats, &c., should be placed and kept in a state of confinement, where they either could not, or were not likely to, use or move the fractured parts; and, moreover, i have thought that failure, where it has resulted after such treatment, has arisen from its not having been sufficiently long persisted in." in the opinion of professor simonds, when there is fracture of the bones of the extremities, a starch bandage is the best that can be employed. if applied wet, it adapts itself to the irregularities of the limbs; and if allowed to remain on twelve hours undisturbed, it forms a complete case for the part, and affords more equal support than anything else that can possibly be used. the following case was one of considerable interest. it came under the care of professor simonds. two gentlemen were playing at quoits, and the dog of one of them was struck on the head by a quoit, and supposed to be killed. his owner took him up, and found that he was not dead, although dreadfully injured. it being near the thames, his owner took him to the edge of the river, and dashed some water over him, and he rallied a little. professor simonds detected a fracture of the skull, with pressure on the brain, arising from a portion of depressed bone. the dog was perfectly unconscious, frequently moaning, quite incapable of standing, and continually turning round upon his belly, his straw, or his bed. it was a case of coma; he took no food, and the pulsation at the heart was very indistinct. "i told the proprietor that there was no chance of recovery except by an operation; and, even then, i thought it exceedingly doubtful. i was desired to operate, and i took him home. "the head was now almost twice as large as when the accident occurred, proceeding from a quantity of coagulated blood that had been effused under the skin covering the skull. i gave him a dose of aperient medicine, and on the following morning commenced my operation. "the hair was clipped from the head, and an incision carried immediately from between the eye-brows to the back part of the skull, in the direction of the sagittal suture. another incision was made from this towards the root of the ear. this triangular flap was then turned back, in order to remove the coagulated blood and make a thorough exposure of the skull. i was provided with a trephine, thinking that only a portion of the bone had been depressed on the brain, and it would be necessary, with that instrument, to separate it from its attachment, and then with an elevator remove it; but i found that the greater part of the parietal bone was depressed, and that the fracture extended along the sagittal suture from the coronal and lamdoidal sutures. at three-fourths of the width of the bone, the fracture ran parallel with the sagittal suture, and this large portion was depressed upon the tunics of the brain, the dura mater being considerably lacerated. the depressed bone was raised with an elevator, and i found, from its lacerated edges and the extent of the mischief done, that it was far wiser to remove it entirely, than to allow it to remain and take the chance of its uniting. "in a few days, the dog began to experience relief from the operation, and to be somewhat conscious of what was taking place around him. he still requires care and attention, and proper medicinal agents to be administered from time to time; but with the exception of occasionally turning round when on the floor, he takes his food well, and obeys his master's call."[ ] [footnote : trans. vet. med. assoc., i. .] * * * * * chapter xvii. medicines used in the treatment of the diseases of the dog. these are far more numerous and complicated than would, on the first consideration of them, be imagined. the veterinary surgeon has a long list of them, suited to the wants and dangers, imaginary or real, of his patients; and he who is not scientifically acquainted with them, will occasionally blunder in the choice of remedies, or the application of the means of cure which he adopts. little attention may, perhaps, be paid to the medical treatment of the dog; yet it requires not a little study and experience. i will endeavour to give a short account of the drugs, and mode of using them, generally employed. the administering of medicines to dogs is, generally speaking, simple and safe, if a little care is taken about the matter, and especially if two persons are employed in the operation. the one should be sitting with the dog between his knees, and the hinder part of the animal resting on the floor. the mouth is forced open by the pressure of the fore-finger and thumb upon the lips of the upper jaw, and the medicine can be conveniently introduced with the other hand, and passed sufficiently far into the throat to insure its not being returned. the mouth should be closed and kept so, until the bolus has been seen to pass down. mr. blaine thus describes the difference between the administration of liquid and solid medicines: "a little attention will prevent all danger. a ball or bolus should be passed completely over the root of the tongue, and pushed some way backward and forward. when a liquid is given, if the quantity is more than can be swallowed at one effort, it should be removed from the mouth at each deglutition, or the dog may be strangled. balls of a soft consistence, and those composed of nauseous ingredients, should be wrapped in thin paper, or they may disgust the dog and produce sickness." dogs labouring under disease should be carefully nursed: more depends on this than many persons seem to be aware. a warm and comfortable bed is of a great deal more consequence than many persons who are fond of their dogs imagine. cleanliness is also an essential point. harshness of manner and unkind treatment will evidently aggravate many of their complaints. i have sometimes witnessed an angry word spoken to a healthy dog produce instant convulsions in a distempered one that happened to be near; and the fits that come on spontaneously in distemper, almost instantly leave the dog by soothing notice of him. 'acidum acetum (vinegar)'.--this is useful for sprains, bruises, and fomentations. 'acidum nitricum (nitric acid; aqua fortis)'.--this may be used with advantage to destroy warts or fungous excrescences. a little of the acid should be dropped on the part and bound tightly down. the protuberance will slough off and healthy granulations will spring up. a surer application, however, is the nitrate of silver. 'acidum hydrocyanicum (prussic acid)'.--this is an excellent application for the purpose of allaying irritation of the skin in dogs; but it must be very carefully watched. i have seen a drachm of it diluted with a pint of distilled water, rapidly allay cuticular inflammation. the dreadful degree of itching which had been observed during the last two or three years yielded to this application alone; and to that it has almost invariably yielded, a little patience being used. 'acupuncturation' is a practice lately introduced into veterinary surgery. it denotes the insertion of a needle into the skin or flesh of a person or animal suffering severely from some neuralgic affection. the needle is small and sharp: it is introduced by a slight pressure and semi-rotating motion between the thumb and forefinger, and afterwards withdrawn with the same motion. this should always employ a quarter of an hour at least, and in cases of very great pain it should continue two hours; but when the object is to afford an exit to the fluid collected, mere puncture is sufficient. it is attended with very little pain; and therefore it may be employed at least with safety if not with advantage. the operation was known and practised in japan, many years ago; but it was only in the seventeenth century that its singular value was ascertained. in some trials of it were made in paris, and m. chenel look the lead. he had a young dog that he had cured of distemper, except that a spasmodic affection of the left hind leg remained. he applied a needle, and with fair success. he failed with another dog; but m. prevost, of geneva, relieved two mares from rheumatism, and an entire horse that had been lame sixteen months. in the veterinary school at lyons acupuncturation was tried on two dogs. one had chorea, and the other chronic paralysis of the muscles of the neck. the operation had no effect on the first; the other came out of the hospital completely cured. in the following year acupuncturation was tried without success in the same school. four horses and two dogs were operated upon in vain. 'adeps (hog's lard)' forms the basis of all our ointments. it is tasteless, inodorous and free from every stimulating quality. 'alcohol (rectified spirit)'.--this is principally used in tinctures, and seldom or never administered to the dog in a pure state. 'aloes, barbadoes'.--from these are formed the safest and best aperients for the dog--consisting of powdered aloes, eight parts; antimonial powder, one part; ginger, one part; and palm oil, five parts; beaten well together, and the size of the ball varying from half a drachm to two drachms, and a ball administered every fourth or fifth hour. mr. blaine considers it to be the safest general purgative. he says that such is the peculiarity of the bowels of the dog, that while a man can take with impunity as much calomel as would kill two large dogs, a moderate-sized dog will take a quantity of aloes sufficient to destroy two stout men. the smallest dog can take or grains; half a drachm is seldom too much; but the smaller dose had better be tried first, for hundreds of dogs are every year destroyed by temerity in this particular. medium-sized dogs usually require a drachm; and some large dogs have taken two or even three drachms. 'alteratives' are medicines that effect some slow change in the diseased action of certain parts, without interfering with the food or work. the most useful consist of five parts of sublimed sulphur, one of nitre, one of linseed meal, and two of lard or palm oil. 'alum' is a powerful astringent, whether employed externally or internally. it is occasionally administered in doses of from to grains in obstinate diarrhoea. in some obstinate cases, alum whey has been employed in the form of a clyster. 'oxide of antimony', in the form of a compound powder, and under the name of james's powder, is employed as a sudorific, or to cause a determination to the skin. the 'antimonii potassio tartras (tartar emetic)', besides its effect on the skin, is a useful nauseant, and invaluable in inflammation of the lungs and catarrhal affections of every kind. the 'black sesquisulphuret of antimony' is a compound of sulphur and antimony, and an excellent alterative. 'argenti nitras--nitrate of silver (lunar caustic)'.--i have already strongly advocated the employment of this caustic for empoisoned wounds and bites of rabid animals. in my opinion it supersedes the use of every other caustic, and generally of the knife. i have also given it internally as a tonic to the dog, in cases of chorea, in doses from an eighth to a quarter of a grain. a dilute solution may be employed as an excitant to wounds, in which the healing process has become sluggish. for this purpose, ten grains or more may be dissolved in a fluid ounce of distilled water. a few fibres of tow dipped in this solution, being drawn through the channel which is left on the removal of a seton, quickly excite the healing action. occasionally one or two drops of this solution may be introduced into the eye for the purpose of removing opalescence of the cornea. in cases of fungoid matter being thrown out on the cornea, the fungus may be touched with a rod of nitrate of silver, and little pain will follow. the 'peruvian bark', or its active principle the disulphate of quina, is a valuable tonic in distemper, especially when combined with the iodide of iron; the iron increasing with the general tone of the system, and the iodine acting as a stimulant to the absorbents. 'blisters' are occasionally useful or indispensable in some of the casualties and diseases to which the dog is liable. they are mostly of the same description, and act upon the same principles as in the horse, whether in the form of plaster, or ointment, or stimulating fluid. blisters can be kept on the dog with difficulty: nothing short of a wire muzzle will suffice; mr. blaine says, that for very large dogs, he used to be compelled to make use of a perforated tin one. the judgment of the practitioner will determine in these cases, as well as with regard to the horse, whether the desired effect should be produced by severe measures or by those of a milder character, by active blisters or by milder stimulants; the difficulty of the measures to be adopted, and the degree of punishment that may be inflicted, being never forgotten by the operator. we have stated in our work on the horse, that "the art of blistering consists in cutting or rather shaving the hair perfectly close; then well rubbing in the ointment, and afterwards, and, what is the greatest consequence of all, plastering a little more of the ointment lightly over the part, and leaving it. as soon as the vesicles have perfectly risen, which will be in twenty or twenty-four hours, the torture of the animal may be somewhat relieved by the application of olive or neat's-foot oil, or any emollient ointment. "an infusion of two ounces of the cantharides in a pint of oil of turpentine, for several days, is occasionally used as a languid blister; and when sufficiently lowered with common oil, it is called a 'sweating' oil, for it maintains a certain degree of irritation and inflammation on the skin, yet not sufficient to blister; and thus gradually abates or removes some old or deep inflammation, or cause of lameness." [ ] iodine in various cases is now rapidly superseding the cantharides and the turpentine. 'calomel'--sufficient has been said of this dangerous medicine in the course of the present work. i should rarely think of exhibiting it, except in small doses for the purpose of producing that specific influence on the liver, which we know to be the peculiar property of this drug. in large doses it will to a certain extent produce vomiting; and, if it finds its way into the intestines, it acts as a powerful drastic purgative. 'castor oil (oleum ricini)'.--this is a most valuable medicine. it is usually combined with the syrup of buckthorn and white poppies, in the proportions of three parts of the oil to two of the buckthorn and one of the poppy-syrup; which form a combination of ingredients in which the oleaginous, stimulant, and narcotic ingredients happily blend. 'catechu.'--this is an extract from the wood of an acacia-tree '(acacia catechu)', and possesses a powerful astringent property. it is given in cases of superpurgation, united with opium, chalk, and powdered gum. a tincture of it is very useful for the purpose of hastening the healing principle of wounds. professor morton says, that he considers it as the most valuable of the vegetable astringents. 'clysters.'--professor morton gives an account of the use of clysters. the objects, he says, for which they are administered, are-- . to empty the bowels of fæces: thus they act as an aperient. also, to induce a cathartic to commence its operations, when, from want of exercise or due preparation, it is tardy in producing the desired effect. clysters operate in a twofold way: first, by softening the contents of the intestines; and, secondly, by exciting an irritation in one portion of the canal which is communicated throughout the whole; hence they become valuable when the nature and progress of the disease require a quick evacuation of the bowels. the usual enema is warm water, but this may be rendered more stimulating by the addition of salt, oil, or aloes. . for the purpose of killing worms that are found in the rectum and large intestines: in this case it is usually of an oleaginous nature. . for restraining diarrhoea: sedatives and astringents being then employed. . for nourishing the body when food cannot be received by the mouth. gruel is generally the aliment thus given. . for allaying spasms in the stomach and bowels. 'copper'--both the verdigris, or subacetate, and the blue vitriol of sulphate of copper, are now comparatively rarely used. they are employed either in the form of a fine powder, or mixed with an equal quantity of the acetate of lead in order to destroy proud flesh or stimulate old ulcers. they also form a part of the ægyptiacum of the farrier. there are many better drugs to accomplish the same purpose. 'creosote' is seldom used for the dog. we have applications quite as good and less dangerous. it may be employed as a very gentle excitant and antiseptic. 'creta preparata (chalk)', in combination with ginger, catechu, and opium, is exceedingly useful; indeed, it is our most valuable medicine in all cases of purging, and particularly the purging of distemper. 'digitalis' is an exceedingly valuable drug. it is a direct and powerful sedative, a mild diuretic, and useful in every inflammatory and febrile complaint. 'gentian' and 'ginger' are both valuable; the first as a stomachic and tonic, and the last as a cordial and tonic. it is occasionally necessary, or at least desirable, to draw this distinction between them. 'chloride of lime' is a useful application for ill-conditioned wounds and for the frequent cleansing of the kennel. 'epsom salts', or 'sulphate of magnesia', are mild yet effective in their action: with regard to cattle and sheep, they supersede every other aperient; for the dog, however, they must yield to the castor-oil mixture. 'mercury'--the common mercurial ointment is now comparatively little used. it has given way to the different preparations of iodine. in direct and virulent mange, it is yet, however, employed under the form of calomel, and combined with aloes, but in very small doses, never exceeding three grains. it is also useful in farcy and jaundice. the corrosive sublimate is occasionally used for mange in the dog, and to destroy vermin; but it is a very uncertain and dangerous medicine. 'palm oil' would be an excellent emollient, if it were not so frequently adulterated with turmeric root in powder. it is far milder than the common lard. 'nitrate of potash' is a valuable cooling and mild diuretic, in doses of eight or ten grains. 'sulphur' is the basis of the most effectual applications for mange. it is a good alterative, combined usually with antimonials and nitre, and particularly useful in mange, surfeit, grease, hide-bound, and want of condition. 'turpentine' is an excellent diuretic and antispasmodic; it is also a most effectual sweating blister and highly useful in strains. 'the sulphate of zinc' is valuable as an excitant to wounds, and promotes adhesion between divided surfaces and the 'radix'. [footnote : the horse, p. .] * * * * * appendix. the new laws of coursing, 'as revised and enlarged at a meeting of noblemen and gentlemen, held at the thatched house tavern, st. james's street, june , '. i. two stewards shall be appointed by the members at dinner each day, to act in the field the following day, and to preside at dinner. they shall regulate the plan of beating the ground, under the sanction of the owner or occupier of the soil. ii. three or five members, including the secretary for the time being, shall form a committee of management, and shall name a person, for the approbation of the members, to judge all courses--all doubtful cases shall be referred to them. iii. all courses shall be from slips, by a brace of greyhounds only. iv. the time of putting the first brace of dogs in the slips shall be declared at dinner on the day preceding. if a prize is to be run for, and only one dog is ready, he shall run a by, and his owner shall receive forfeit: should neither be ready, the course shall be run when the committee shall think fit. in a match, if only one dog be ready, his owner shall receive forfeit; if neither be present, the match shall be placed the last in the list. v. if any person shall enter a greyhound by a name different from that in which he last appeared in public, without giving notice of such alteration, he shall be disqualified from winning, and shall forfeit his match. vi. no greyhounds shall be entered as puppies unless born on or after the st of january of the year preceding the day of running. vii. any member, or other person, running a greyhound at the meeting, having a dog at large which shall join in the course then running, shall forfeit one sovereign; and, if belonging to either of the parties running, the course shall be decided against him. viii. the judge ought to be in a position where he can see the dogs leave the slips, and to decide by the colour of the dogs to a person appointed for that purpose: his decision shall be final. ix. if, in running for prizes, the judge shall be of opinion that the course has not been of sufficient length to enable him to decide as to the merits of the dogs, he shall inquire of the committee whether he is to decide the course or not; if in the negative, the dogs shall be immediately put again into the slips. x. the judge shall not answer any questions put to him regarding a course, unless such questions are asked by the committee. xi. if any member make any observation in the hearing of the judge respecting a course, during the time of running, or before he shall have delivered his judgment, he shall forfeit one sovereign to the fund; and, if either dog be his own, he shall lose the course. if he impugn the decision of the judge, he shall forfeit two sovereigns. xii. when a course of an average length is so equally divided that the judge shall be unable to decide it, the owners of the dogs may toss for it; but, if either refuse, the dogs shall be again put in the slips, at such time as the committee may think fit; but, if either dog be drawn, the winning dog shall not be obliged to run again. xiii. in running a match the judge may declare the course to be undecided. xiv. if a member shall enter more than one greyhound, 'bonâ fide' his own property, for a prize, his dogs shall not run together, if it be possible to avoid it; and, if two greyhounds, the property of the same member, remain to the last tie, he may run it out or draw either, as he shall think fit. xv. when dogs engaged are of the same colour, the last drawn shall wear a collar. xvi. if a greyhound stand still in a course when a hare is in his or her sight, the owner shall lose the course; but, if a greyhound drops from exhaustion, and it shall be the opinion of the judge that the merit up to the time of falling was greatly in his or her favour, then the judge shall have power to award the course to the greyhound so falling, if he think fit. xvii. should two hares be on foot, and the dogs separate before reaching the hare slipped at, the course shall be undecided, and shall be run over again at such time as the committee shall think fit, unless the owners of the dogs agree to toss for it, or to draw one dog; and if the dogs separate after running some time, it shall be at the discretion of the committee whether the course shall be decided up to the point of separation. xviii. a course shall end if either dog be so unsighted as to cause an impediment in the course. xix. if any member or his servant ride over his opponent's dog when running, so as to injure him in the course, the dog so ridden over shall be deemed to win the course. xx. it is recommended to all union meetings to appoint a committee of five, consisting of members of different clubs, to determine all difficulties and cases of doubt. 'the following general rules are recommended to judges for their guidance:' the features of merit are: the race from slips, and the first turn or wrench of the hare (provided it be a fair slip), and a straight run-up. where one dog gives the other a go-by when both are in their full speed, and turns or wrenches the hare. (n. b. if one dog be in the stretch, and the other only turning at the time he passes, it is not a fair go-by.) where one dog turns the hare when she is leading homewards, and keeps the lead so as to serve himself, and makes a second turn of the hare without losing the lead. a catch or kill of the hare, when she is running straight and leading homewards, is fully equal to a turn of the hare when running in the same direction, or perhaps more, if he show the speed over the other dog in doing it. if a dog draws the fleck from the hare, and causes her to wrench or rick only, it is equal to a turn of the hare when leading homewards. when a dog wrenches or ricks a hare twice following, without losing the lead, it is equal to a turn. n. b. it often happens when a hare has been turned, and she is running from home, that she turns of her own accord to gain ground homeward, when both dogs are on the stretch after her; in such a case the judge should not give the leading dog a turn. there are often other minor advantages in a course, such as one dog showing occasional superiority of speed, turning on less ground, and running the whole course with more fire than his opponent, which must be led to the discretion of the judge, who is to decide on the merits. local rules. i. the number of members shall be regulated by the letters in the alphabet, and the two junior members shall take the letters x and z, if required. ii. the members shall be elected by ballot, seven to constitute a ballot, and two black balls to exclude. iii. the name of every person proposed to be balloted for as a member, shall be placed over the chimney-piece one day before the ballot can take place. iv. no proposition shall be balloted for unless put up over the chimney-piece, with the names of the proposer and seconder, at or before dinner preceding the day of the ballot, and read to the members at such dinner. v. every member shall, at each meeting, run a greyhound his own property, or forfeit a sovereign to the club. vi. no member shall be allowed to match more than two greyhounds in the first class, under a penalty of two sovereigns to the fund, unless such member has been drawn or run out for the prizes, in which case he shall be allowed to run three dogs in the first class. vii. if any member shall absent himself two seasons without sending his subscription, he shall be deemed out of the society, and another chosen in his place. viii. no greyhound shall be allowed to start if any arrears are due to this society from the owner. ix. any member lending another a greyhound for the purpose of saving his forfeit (excepting by consent of the members present) shall forfeit five sovereigns. x. any member running the dog of a stranger in a match shall cause the name of the owner to be inserted after his own name in the list, under a penalty of one sovereign. xi. no stranger shall be admitted into the society's room, unless introduced by a member, who shall place the name of his friend over the chimney-piece, with his own attached to it; and no member shall introduce more than one friend. xii. the members of the [erased] clubs shall be honorary members of this society, and when present shall be allowed to run their greyhounds on payment of the annual subscription. xiii. this society to meet on the [erased] in [erased], and course on the [erased] following days. * * * * * index. acupuncturation, used in neuralgic affections mode of performing adam, mr., on fungus hæmatodes adeps, the basis of all ointments african wild dog, description of the agasæi, british hunting dogs, description of age, the indications of albanian dog, description of the alcohol, only used in tinctures alicant dog, description of the aloes, barbadoes, the best purgative alpine spaniel, description of alteratives, the most useful alum, a powerful astringent amaurosis, symptoms of american wild dogs, description of the anæmia, description of causes of 'post-mortem' appearances anasarca, nature of andalusian dog, description of the angina, nature of antimony, the oxide of, a sudorific the black sesquisulphuret of, an alterative anubis, an egyptian deity with the head of a dog anus, polypus in the fistula in the aquafortis, a caustic argus, the dog of ulysses arrian on hunting artois dog, description of the ascarides, a species of worms ascites, 'see' dropsy attention, an important faculty auscultation, use of australasian dog, description of the barbary dog, description of the barbet, description of the bark, peruvian, a valuable tonic barry, a celebrated bernardine dog, anecdote of bath, use of in puerperal fits beagle, description of the bell, professor, opinion on the origin of the dog bernardine dog, description of the billy, a celebrated terrier bladder, inflammation of the rupture of the blain, nature, causes, treatment, and 'post-mortem' appearances of blaine, mr., opinion on kennel lameness on tetanus on dropsy on calculus on distemper on mange bleeding, best place for directions for useful in epilepsy useful in distemper blenheim spaniel, description of the blisters, uses of composition mode of applying and guarding bloodhound, description of the brain, comparative bulk of in different animals description of the breaking-in of hounds cruelty disadvantageous breeding of greyhounds should always be permitted british hunting-dogs, agasæi, description of bronchocele, nature of causes and treatment of búánsú, or nepâl dog, description of buffon, opinion as to the origin of the dog bull-dog, description of the crossed with the greyhound bull terrier, description of the cæcum, description of the calculus, nature, causes, and treatment of, in the intestines, causes of, cases, calomel, a dangerous medicine should not be used in enteritis cancer, symptoms of treatment of canis, genus canker in the ear, causes, symptoms and treatment of cases of canute, laws concerning greyhounds by cardia, description of the castor oil, a valuable purgative castration, proper time for mode of performing not recommended catechu, an astringent caustic, lunar, the best cayotte, description of the chabert, anecdote of the dog of chalk, an astringent charles i, anecdote of the dog of charles ii's spaniel, description of chest, anatomy and diseases of the proper form of, in the greyhound in the fox-hound chest-founder, nature, causes, and treatment of chloride of lime, uses of chorea, nature of, causes, treatment cases in distemper chryseus scylex, or dhole, description of the claret, a celebrated greyhound classification, zoological climate, effect of clysters, uses of coach-dog, description of the cocker, description of the colic, causes, symptoms, and treatment of colon, the rupture of the colour of the greyhound of the pointer constipation, causes and treatment of copper, preparations of, and their uses coryza, the early stage of distemper costiveness, causes and treatment of means of preventing cough, spasmodic, nature and treatment of coursing, ovid's description of anecdotes of laws of general rules for the guidance of judges local rules creosote, a dangerous medicine useful in canker creta, an astringent cropping of the ears deafness frequently caused by disapproved of proper method of cross-breeding, effect of cuba, mastiff of cur, description of the cyprus, greyhounds of, described cynosaurus cristatus, an useful emetic czarina, a celebrated greyhound dakhun wild dog, description of the dalmatian dog, description of the danish sacrifices of dogs, description of dog, description of the deab, description of the deafness frequently caused by cropping deer-hound, description of the delafond, professor, his table of the diagnostic symptoms of pleurisy and pneumonia dentition, formula of dew-claws their removal unnecessary dhole, description of the diaphragm, description of the diarrhoea, causes, nature, and treatment of habitual dick, professor, on rabies on the use of ergot of rye digestion, the process of digitalis, the uses of digitigrade, an order of animals dingo, description of the distemper, origin of the name is a new disease causes of is contagious is epidemic effects on different breeds symptoms nature of duration 'post-mortem' appearances treatment a cause of epilepsy sometimes terminates in palsy dog, early history of the used as a beast of draught for food uses of the skin of the origin of mention of, in the old and new testaments anecdotes of the sagacity and fidelity of changes produced in, by breeding and climate zoological description of natural divisions of sacrificed by the greeks and romans by the danes and swedes african wild albanian alicant alpine spaniel american wild andalusian artois australasian barbary barbet beagle black and tan spaniel blenheim spaniel blood-hound british bull bull terrier coach cocker cur dakhun dalmatian danish drover's egyptian esquimaux fox-hound french matin french pointer gasehound grecian grecian greyhound greyhound hare indian harrier highland greyhound hyrcanian iceland irish greyhound italian greyhound italian wolf javanese king charles's spaniel lapland lion locrian lurcher mahratta maltese mastiff molossian nepal newfoundland new zealand otter pannonian pariah persian greyhound pointer polugar poodle portuguese pointer russian greyhound russian pointer scotch greyhound scotch terrier setter sheep shock southern hound spaniel spanish pointer springer stag-hound sumatran wild terrier thibet turkish turkish greyhound water-spaniel wild wolf dog-carts, prohibition of, disapproved should be licensed dog-pits dog-stealing dog's-tail grass, the use of dogs, isle of, origin of the name dropsy, causes of cases of treatment of drover's dog, description of the duodenum, the dupuy, m., on diseases of the spinal marrow dysentery, nature of treatment of ear, diseases of the vegetating excrescences in the eruptions in the cropping of the polypi in the, nature and treatment of pain of, an early symptom of rabies egyptian worship of the dog dog, description of the elfric, king of mercia, possessed greyhounds emetic tartar, uses of enteritis, causes, symptoms, and treatment of epiglottis, description of the epilepsy, causes of treatment of cases puerperal in distemper epsom salts, a purgative ergot of rye, use of, in parturition esquimaux dog, description of the ethiopia, a dog elected king of ethmoid bones, description of the extremities, bones of the eye, distinctive form of the diseases of the construction of the cases of disease of the congenital blindness ophthalmia cataract amaurosis appearance of in rabies appearance of in distemper familiaris, sub-genus feet, sore femur, fracture of the fighting-pits first division of varieties fistula in the anus, causes and treatment of fits, symptoms of treatment of distemper puerperal fitzhardinge, lord, his management of hounds flogging hounds, disapproved of food, the dog used for of the greyhound of the foxhound insufficient, a cause of distemper fore-arm, fracture of the foxhound, description of the size and proper conformation of pupping treatment of whelps breaking in management in the field general management and food of lord fitzhardinge's management fractures, most frequent in young dogs of the humerus of the thigh of the femur of the radius of the fore-arm of the shoulder of the pelvis of the skull french pointer, description of the fungus hæmatodes, a case of 'post-mortem' appearances gasehound, description of gêlert, the dog of llewellyn, poem on the death of gentian, a stomachic and tonic ghoo-khan, or wild ass, hunted by persian greyhounds giddiness, nature and treatment of ginger, a cordial and tonic glass, powdered, the best vermifuge goître, nature of cause and treatment of good qualities of the dog goodwood kennel, description of plan of grecian dogs, description of sacrifices of dogs greyhound, description of the greyhound, description of the puppies, out of origin of known in england in the anglo-saxon period old verses describing the cross with the bull-dog proper conformation of colour of breeding rules for age food training laws for coursing with english grecian highland irish italian persian russian scotch turkish grognier, professor, description of the french sheep-dog gullet, description of the hare indian dog, description of the harrier, description of the head, bones of the form of in the foxhound heart, description of the action of the rupture of the hecate, dogs sacrificed to hepatitis, causes, symptoms, and treatment of hertwich, professor, on rabies highland greyhound, description of the hindoos regard the dog unclean hogg, james, anecdotes of his dog hog's lard, the basis of all ointments hound, the various kinds of blood fox otter southern stag humerus, fracture of the hunting with dogs first mentioned by oppian hunting-kennels huntsman, the requisites of a hydatids in the kidney hydrocyanic acid, useful in cases of irritation of the skin hydrophobia, 'see' rabies hyrcanian dog, description of the iceland dog, description of the ileum, description of the incontinence of urine india, degeneration of dogs in inflammation of the lungs of the stomach of the intestines of the peritoneal membrane of the liver of the kidney of the bladder of the feet intelligence of the dog anecdotes illustrative of the intestines, description of the inflammation of the intussusception, nature and causes of treatment iodine, a valuable medicine in goître in dropsy irish greyhound, description of the wolf-dog setter italian greyhound, description of the wolf-dog james's powder, a sudorific jaundice, causes, symptoms, and treatment of javanese dog, description of the jejunum, description of the jenner, dr., on distemper jews regard the dog with abhorrence john, kept many dogs received greyhounds in lieu of fines kamtschatka, uses of the dog as a beast of draught in karáráhé or new zealand dog, description of the kennel, description of goodwood plan of goodwood for watch-dog construction of hare, use of lameness, nature of causes of means of prevention kidney, inflammation of the hydatids in the king charles's spaniel, description of lachrymal duct, description of the lapland dog, description of the lard, the basis of all ointments larynx, description of the inflammation of the laws of coursing leblanc, m., on jaundice léonard, m., his exhibition of dogs lime, chloride of, the uses of lion dog, description of the lips, functions of the swellings of the liver, description of the functions of the inflammation of the llewellyn, poem on the dog of locrian dog, description of the lunar caustic, the best recommended for bites of rabid dogs lungs, inflammation of the congestion of the lurcher, description of the madness, canine, 'see' rabies magnesia, sulphate of, a purgative mahratta dog description of the majendie, his experiments on the olfactory nerves major, a celebrated greyhound maltese dog, description of the mammalia, a class of animals management of the pack mange, nature of is hereditary the scabby treatment causes of frequently causes goître mastiff, description of the used in cuba to hunt the indians mâtin, description of the maxillary bones, description of the meatus, description of the medicines, a list of the most useful mode of administering medullary substance of the brain memory of the dog mercury, preparations of uses of milk, accumulation of, in the teats secretion of, connected with cancer mohammedan abhorrence of dogs molossian dog, description of the moral qualities of the dog nasal bones, description of the catarrh, nature of cavity, polypus in the neck, should be long in the greyhound nepal dog, description of the nerves, description of the nervous system, diseases of newfoundland dog, description of the new holland dog, description of the new zealand dog, description of the nimrod, opinion on kennel lameness nitrate of potash, a useful diuretic nitrate of silver, a caustic recommended for the bites of rabid dogs useful in chorea in canker nitric acid, a caustic norfolk spaniel, description of the nose, anatomy of the diseases of the discharge from the, in distemper olfactory nerves, size of, in different animals development of the description of the ophthalmia, symptoms of causes of treatment of oppian, the first who mentions hunting with dogs description of british dogs by orbit of the eye, form of the orford, lord, first crossed greyhounds with the bull-dog death of otter-hound, description of the ovaries, removal of the ovid, description of coursing by ozæna, nature and treatment of palate, veil of the inflammation of the palsy, causes of treatment of a consequence of chorea consequence of distemper palm oil, an emollient pancreas, functions of the pannonian dog, description of the pariah, description of the parry, captain, description of the esquimaux dog parturition, time of management during use of the ergot of of rye inversion of the uterus after pelvis, fracture of the percival, mr., on fractures pericardium, description of the case of a wound in the peritonitis, symptoms and treatment of persian greyhound, description of the peruvian bark, a valuable tonic phlegmonous tumour, nature and treatment of pleurisy, nature of diagnostic symptoms of pneumonia, nature and treatment of diagnostic symptoms of in distemper a consequence of small-pox pointer, compared with the setter, ; early training of, ; breaking-in, ; english, ; french, ; spanish, pollux, the introduction of hunting with dogs attributed to polugar dog, description of the polypus in the ear in the nasal and anal cavities in the vagina pomeranian wolf-dog, description of poodle, description of the portuguese pointer, description of the potash, the nitrate of, a useful diuretic prussic acid, useful in cases of irritation of the skin puerperal fits, causes, nature, and treatment of pulse of various animals pupping, 'see' parturition purging in distemper should be avoided pythagoras, his high opinion of the virtues of the dog rabies, cases early symptoms progress 'post-mortem' appearances causes period of incubation duration nature of the virus nature of the disease treatment of persons bitten in the horse in the rabbit in the guinea-pig in the cat in the fowl in the badger in the wolf trials concerning the death of persons by radius, fracture of the radcliffe, d., on scent rectum, the retriever, newfoundland dog used as rheumatism, nature, causes, and treatment of richard ii, anecdote of the dog of richmond, the third duke of, built goodwood kennel roman sacrifices of dogs, description of rottenness of the lungs rupture of the heart, case of 'post-mortem' appearances of the colon of the bladder russian greyhound, description of the pointer, description of the saliva, state of in rabies salts, a purgative scabby mange, nature and treatment of scent, the term description of influence of the atmosphere upon scotch greyhound, description of the terrier, description of the scott, sir walter, anecdote of the dog of verses on the dogs of second division of varieties seton, useful in epilepsy setter, description of the early training of compared with the pointer sheep-dog, description of the anecdotes of the supposed by buffon to be the original type french, description of the shock-dog, description of the shoulder, fracture of the proper form of the, in the greyhound siberian dog, description of the simonds, professor, on fractures simpson, mr., on the use of the ergot of rye skeleton, description of the skin, uses of the skull, form of, adopted as the arrangement of the varieties of the dog fracture of the small-pox, symptoms of causes of treatment smell, the sense of snowball, a celebrated greyhound sore feet, causes of treatment southern hound, description of the spaniel, origin of the description of the blenheim king charles's norfolk water spanish pointer, description of the spasmodic cough, nature and treatment of spaying, mode of performing spleen, functions of the diseases of the springer, description of the staghound, description of the anecdotes of the staling, profuse starch, bandage, useful in fractures stealing of dogs stomach, anatomy and diseases of the case of the retention of a sharp instrument in the strychnia, a valuable medicine in palsy sulphur, the basis of applications for mange a good alterative sumatra, description of the wild dog of surfeit, an eruption resembling mange swedish sacrifices of dogs, description of sympathetic nerves tænia, a species of worm tailing tape-worm, the tapping in cases of dropsy tartar emetic, a useful medicine teeth, distinctive arrangement of the description of the cuts showing various signs of growth and decay supernumerary diseases of the very early lost by the turkish dog teres, a species of worm terrier, description of the training of the anecdotes of the scotch, description of the tetanus, causes of symptoms and treatment of thibet dog, description of the thigh, fracture of the third division of varieties thyroid cartilage, description of the toes, sore number of tongue, description of the mode of drinking worming blain torsion, mode of performing forceps training of the greyhound of the foxhound of the pointer or setter trimmer. mr., description of the spanish sheep-dog trunk, bones of the tumour, phlegmonous, nature and treatment of turkish dog, description of the greyhound, description of the turnside, nature and treatment of turnspit, description of the turpentine, uses of unguents, use of, in mange unguiculata, a tribe of animals uterus, case of inversion of the extirpation and cure vagina, polyps in the van diemen land, ravages of wild dogs in varieties, three divisions of first division of second division of third division of vatel, his observations on the pulse of different animals vegetating excrescences in the ear, nature and treatment of vermifuge, glass the most effectual vertebrated animals, what vinegar, useful for fomentations voice, change of in rabies vyner. mr., opinion on kennel lameness warts, treatment of washing of hounds disapproved of watch-dog, frequent ill-usage of the water-spaniel, description of the anecdotes of the wild dog, description of the of africa of australia of van diemen land williamson, captain, account of the wild dogs of nepâl on the degeneration of dogs in india description of the dhole wolf, supposed to be the origin of the dog anecdotes of the wolf-dog, irish italian worms, varieties of symptoms of means of expelling cases of a cause of sudden death causes of a cause of epilepsy a cause of distemper yellow distemper, nature of treatment of yellows, the zinc, sulphate of, a valuable excitant zoological classification of the dog * * * * * appendix index to the editor's additions. affection of dogs age of the pointer alexander the great, dog sent to aloes, effects of amaurosis, causes and treatment of american greyhound anecdotes of rabid dogs arctic fox bengal, le braque de blindness, congenital brazen dog of jupiter byron, lord, his opinion of the dog's memory canes ceteres canine fidelity, anecdote of canine pathology, introduction to canis lagopus canis latrans canker of the ear of the flap captain lyon's account of the esquimaux dog catlin's remarks on the indian dog chesapeake bay, ducks of the chorea, accidental cure of chronic opthalmia, causes and treatment of circulation, state of the claims of dogs upon us cocker, method of breaking the his style of hunting colonel hawker's account of dog-stealing colonel thornton's spanish pointer collyria congenital blindness cornea, ulceration of the spots on the coursing, ancient mode of gay's poems descriptive of cropping, a barbarous fancy recommended by mr. skinner cross of dog with fox between the wolf and, opinions of the cynegetical writers respecting opinions of the moderns cure of diseases, remedial means for of chorea, accidental daniel lambert's dogs, their price &c. dead bodies, dogs kept to devour dew-claws, removal of, mr. blaine's opinion in reference to diana, spotted dogs given by pan to disease, symptoms of of the eye of the ear of the tongue of the feet disposition of the dog to hunt by scent dog, considered as an animal of draught length of intestines in the molossian fidelity of the of santa fé and the chihuahuas of the mexicans, worthless prophylactic properties of the crossed with the fox with the wolf indian social invitations extended to self-broken claim of, upon man hospitals for rabid, anecdotes of, ; esquimaux, duck of the chesapeake bay, manner of toling the discovery of this method duke of norfolk's breed of king charles' spaniel ear, canker of the, causes and treatment of wounds of the warts on the polypus of the mangy edges in the editor's remarks on rabies his preventive treatment for english pointer, size and appearance of entropium epilepsy, treatment of mistaken for rabies esquimaux dog, captain lyons' account of extirpation of the eye eye and its diseases simple inflammation of extirpation of the protrusion of the weak washes for the eyelids, ulceration of the inversion of the, operation for eye-washes, various feet, diseases of the fidelity of the dog fistula lachrymalis flap, tumours of the fouilloux, jacques du, his recipes for rabies fox, arctic cross of dog with the glossitis, causes and treatment of gay's poems descriptive of coursing greeks, ancient, domestic manners of the, respecting their dogs greyhound of greek sportsman's care of his dogs greyhound of america, ; of ancient greece, gutta serena hawker, colonel, his account of dog-stealing hembel, mr., his anecdotes of rabid dogs herds of the mexicans, immense, hippocrates, prophylactic properties of the dog recommended by horse doctors hospitals for dogs hydrophthalmia, treatment of indian dog introduction to canine pathology irish setter, inductive reasoning in an jacques du fouilloux, his recipes for rabies keyworth, mr., springer belonging to lambert, daniel, the price of his dogs lord byron's opinion of the dog's memory louisiana marmot lyon, captain, his account of the esquimaux dog, mangy edges, treatment of marmot, the louisiana mexicans, immense herds of the, mexico, shepherd dogs of their introduction into this country molossian dogs, newfoundland dog, as a retriever two varieties of account of two imported into this country nictitating membrane of the eye norfolk, duke of, his breed of king charles' spaniels nux vomica, effects of ophthalmia chronic treatment of traumatic sympathetic otorrhoea, simple, treatment of ozæna, injection for pathology, canine, introduction to pointer, english, his size and appearance; merits of, compared with those of the setter; age of; origin of; his disposition to hunt by scent; tailing of the polypus in the ear predisposition to disease in dogs preventative treatment for rabies prophylactic properties of the dog, as recommended by pliny, hippocrates, aristotle, and others protrusion of the eye pustular affection of the feet rabid dogs, anecdotes of rabies, epilepsy taken for; remarks on; recipes for the cure of; preventive treatment for remedial means for the cure of diseases rheumatism, causes and varieties of scent, disposition of the dog to hunt by self-broken dogs setter, old document respecting the training of; merits of, compared with those of the pointer; irish, inductive reasoning in shepherd's dog, importance of the, to our agriculturists; of mexico; their introduction into this country shepherds of mexico skinner. mr., cropping recommended by social invitations extended to dogs sow, account of one finding and standing game spaniel, king charles', breed of spanish pointer, colonel thornton's spirits of turpentine, effects of sportsman, greek, his care of his dogs spots on the cornea spotted dogs given by pan to diana sprains springer stealing dogs, colonel hawke's account of symptoms of disease tailing, objections to of pointers thornton, colonel, his spanish pointer throat, foreign articles in the toling ducks tongue, appearance of the, in disease traumatic ophthalmia, treatment of turnside, uncommon in the country ulceration of the cornea; of the eyelids youatt, mr., his opinion approved warts of the ear weak eyes wounds of the ear * * * * * diseases of the horse's foot by h. caulton reeks fellow of the royal college of veterinary surgeons author of 'the common colics of the horse' to j. macqueen, f.r.c.v.s., professor of surgery at the royal veterinary college, london, as a slight acknowledgment of his ability as a teacher, and in return for many kindly services, this volume is gratefully inscribed by the author. preface stimulated by the reception accorded my 'common colics of the horse,' both in this country and in america, and assured by my publishers that a work on diseases of the foot was needed, i have been led to give to the veterinary profession the present volume. while keeping the size of the book within reasonable limits, no effort has been spared to render it as complete as possible. this has only been achieved by adding to my own experience a great deal of the work of others. to mention individually those who have given me permission to use their writings would be too long a matter here. in every case, however, where the quotation is of any length, the source of my information is given, either in the text or in an accompanying footnote. a few there are who will, perhaps, find themselves quoted without my having first obtained their permission to do so. they, with the others, will, i am sure, accept my hearty thanks. the publishers have been generous in the matter of illustrations and diagrams, and although to the older practitioner some of these may appear superfluous, it is hoped they will serve to render the work an acceptable textbook for the student. h. caulton reeks. spalding, _january, _. contents chapter i introduction chapter ii regional anatomy a. the bones b. the ligaments c. the tendons d. the arteries e. the veins f. the nerves g. the complementary apparatus of the os pedis h. the keratogenous membrane i. the hoof chapter iii general physiological and anatomical observations a. development of the hoof b. chemical properties and histology of horn c. expansion and contraction of the hoof d. the functions of the lateral cartilages e. growth of the hoof chapter iv method of examining the foot chapter v general remarks on operations on the foot a. methods of restraint b. instruments required c. the application of dressings d. plantar neurectomy history of the operation preparation of the subject the operation after-treatment e. median neurectomy f. length of rest after neurectomy g. sequelæ of neurectomy liability of pricked foot going undetected loss of tone in the non-sensitive area gelatinous degeneration chronic oedema of the leg persistent pruritus fracture of the bones neuroma reunion of the divided nerve the existence of an adventitious nerve-supply stumbling h. advantages of the operation i. the use of the horse that has undergone neurectomy chapter vi faulty conformation a. weak heels b. contracted foot (_a_) contracted heels (_b_) local or coronary contraction c. flat-foot d. pumiced-foot, dropped sole, or convex sole e. 'ringed' or 'ribbed' hoof f. the hoof with bad horn (_a_) the brittle hoof (_b_) the spongy hoof g. club-foot h. the crooked foot (_a_) the foot with unequal sides (_b_) the curved hoof chapter vii diseases arising from faulty conformation a. sand-crack definition classification causes complications treatment surgical shoeing for sand-crack b. corns definition classification causes pathological anatomy and histology treatment surgical shoeing for corn c. chronic bruised sole chapter viii wounds of the keratogenous membrane a. nail-bound definition causes symptoms treatment b. punctured foot definition causes common situations of the wound classification symptoms and diagnosis complications prognosis treatment c. coronitis (simple) . acute definition causes symptoms complications prognosis treatment . chronic definition causes symptoms treatment d. false quarter definition causes treatment e. accidental tearing off of the entire hoof chapter ix inflammatory affections of the keratogenous apparatus a. acute acute laminitis definition causes symptoms pathological anatomy complications diagnosis and prognosis treatment broad's treatment for laminitis smith's operation for laminitis b. chronic . chronic laminitis definition causes symptoms pathological anatomy treatment . seedy-toe definition causes symptoms treatment . keraphyllocele definition causes symptoms treatment . keratoma . thrush definition causes symptoms treatment . canker definition causes, predisposing and exciting symptoms and pathological anatomy differential diagnosis and prognosis treatment malcolm's, lieutenant rose's, bermbach's, hoffmann's and imminger's treatment for canker . specific coronitis definition causes symptoms treatment chapter x diseases of the lateral cartilages a. wounds of the cartilages b. quittor definition classification . simple or cutaneous quittor definition causes symptoms pathological anatomy prognosis complications treatment, preventive and curative . sub-horny quittor definition causes symptoms and diagnosis complications necrosis of the lateral cartilage pathological anatomy of the diseased cartilage necrosis of tendon and of ligament ossification of the cartilage treatment operations for extirpation of the cartilage c. ossification of the lateral cartilages (side-bones) definition symptoms and diagnosis causes treatment smith's operation for ossification of the lateral cartilages chapter xi diseases of the bones a. periostitis and ostitis . periostitis (_a_) simple acute periostitis (_b_) suppurative periostitis (_c_) osteoplastic periostitis . ostitis (_a_) rarefying ostitis (_b_) osteoplastic ostitis (_c_) caries and necrosis treatment of periostitis recorded cases of periostitis b. pyramidal disease, buttress foot, or low ringbone definition symptoms and diagnosis pathological anatomy treatment recorded cases of buttress foot c. fractures of the bones . fractures of the os coronæ recorded cases of fractures of the os coronæ . fractures of the os pedis recorded cases of fractures of the os pedis . fractures of the navicular bone recorded case of fracture of the navicular bone treatment of fractures of the bones of the foot chapter xii diseases of the joints a. synovitis (_a_) simple ( ) acute ( ) chronic (_b_) purulent or suppurative b. arthritis (_a_) simple or serous (_b_) acute (_c_) purulent or suppurative (_d_) anchylosis c. navicular disease definition history pathology changes in the bursa changes in the cartilage changes in the tendon changes in the bone causes heredity compression concussion a weak navicular bone an irregular blood-supply to the bone senile decay symptoms and diagnosis differential diagnosis prognosis treatment d. dislocations list of illustrations . the bones of the phalanx . the os coronæ (anterior view) . the os coronæ (posterior view) . the os pedis (postero-lateral view) . the os pedis (viewed from below) . the navicular bone (viewed from below) . the navicular bone (viewed from above) . ligaments of the first and second interphalangeal articulations (lateral view). (_after dollar and wheatley_) . ligaments of the first and second interphalangeal articulations (viewed from behind). (_after dollar and wheatley_) . the flexor tendons and the extensor pedis. (_after haübner_) . the flexor perforans and perforatus . the flexor perforans and perforatus (the perforans cut through and deflected) . median section of normal foot . the arteries of the foot . the veins and nerves of the foot . the lateral cartilage . the keratogenous membrane (viewed from the side) . the keratogenous membrane (viewed from below) . the wall of the hoof . internal features of the hoof . inferior aspect of the hoof . hoof with the sensitive structures removed . section of epidermis . section of skin with hair follicle and hair . section of human nail and nail-bed . section of foot of equine foetus. (_mettam_) . section from foot of sheep embryo. (_mettam_) . section from foot of calf embryo. (_mettam_) . section from foot of equine foetus. (_mettam_) . section through hoof and soft tissues of a foal at term. (_mettam_) . perpendicular section of horn of wall . horizontal section of horn of wall . horizontal section through the junction of the wall with the sole . section of frog. (_mettam_) . professor lungwitz's apparatus for examining the foot movements . professor lungwitz's apparatus for examining the foot movements . the movements of the solar and coronary edges of the hoof illustrated. (_lungwitz_) . the blind . the side-line . method of securing the hind-foot with the side-line . the hind-foot secured with the side-line . the casting hobbles . method of securing the hind-leg upon the fore . the hind-leg secured upon the fore . the drawing-knife (ordinary pattern) . modern forms of drawing-knives . symes's knife - . illustrating colonel nunn's method of applying a poultice to the foot . poultice-boot of canvas and steel . poultice-boot of cocoa-fibre . foot-swab . the shoe with plates . quittor syringe . the esmarch bandage and tourniquet . tourniquet with wooden block . neurectomy bistoury . neurectomy needle . double neurectomy tenaculum . adventitious nerve-supply to foot. (_sessions_) . tip shoe . the tip shoe 'let in' to the foot . the thinned tip . drawing-knife for charlier shoeing . the foot prepared for the charlier shoe . bar shoe . rubber bar pad on leather . the bar pad applied with a half-shoe . frog pad . frog pad applied . smith's expansion shoe for contracted feet . a contracted foot treated with smith's shoe . de fay's vice . hartmann's expanding shoe . broué's slipper shoe. (_gutenacker_) . einsiedel's slipper and bar-clip shoe. (_gutenacker_) . hoof showing coronary contraction. (_gutenacker_) . flat-foot (solar surface). (_gutenacker_) . hoof showing laminitis rings on the wall. _(gutenacker)_ . hoof showing 'grass' rings on the wall. (_gutenacker_) . club-foot. (_gutenacker_) . shoe with extended toe-piece. (_gutenacker_) . a crooked foot in cross-section. (_gutenacker_) . sand-crack firing-iron . sand-crack forceps and clamp. (_vachette's_) . mcgill's sand-crack clamp . koster's sand-crack clamp . sand-crack belt . method of 'easing' the bearing of the wall on the shoe in the treatment of sand-crack . method of 'easing' the bearing of the wall on the shoe in the treatment of sand-crack . method of 'easing' the bearing of the wall on the shoe in the treatment of sand-crack . grooving the wall in the treatment of sand-crack . removing the wall in the treatment of sand-crack . removing the wall in the treatment of sand-crack . horizontal section of corn. (_gutenacker_) . inner surface of the wall, showing changes in chronic corn. (_gutenacker_) . perpendicular section of the wall in a case of chronic corn. (_gutenacker_) . three-quarter shoe . three-quarter bar shoe . shoe with a 'dropped' heel . shoe with a 'set' heel . curette, or volkmann's spoon . resection of the terminal portion of the perforans tendon (_gutenacker_) . shoe with extended toe-piece. (_colonel nunn_) . mesian section of foot with lesions following coronitis. (_gutenacker_) . toe of ordinary hind-shoe . toe of hind-shoe bevelled for the prevention of overreach . hoof showing lesion in the wall following coronitis. (_gutenacker_) . foot with lesions of chronic coronitis. (_gutenacker_) . hoof accidentally tom from foot. (_cartledge_) . hoof accidentally tom from foot. (_rogerson_) . section of foot with laminitis of eight days' duration. (_gutenacker_) . section of foot with laminitis of fourteen days' duration. (_gutenacker_) . chronic ostitis of the os pedis in laminitis. . broad's rocker bar shoe for laminitis. . the foot showing grooves made in the wall for treatment of laminitis (anterior surface). . the foot showing grooves made for the treatment of laminitis (solar surface). . foot with chronic laminitis. (_gutenacker_) . inferior aspect of foot with chronic laminitis. (_gutenacker_) . section of foot with laminitis of three weeks' duration. (_gutenacker_) . section of foot with laminitis of several years' duration. (_gutenacker_) . diagram showing position of the abnormal growth of horn in chronic laminitis. . diagram showing the same abnormal growth of horn removed prior to shoeing. . shoe with heel-clip. . internal seedy-toe. . external seedy-toe. (_colonel nunn_) . external seedy-toe. (_colonel nunn_) . a keraphyllocele on the inner surface of the horn of the wall at the toe. (_gutenacker_) . os pedis showing absorption of bone caused by the pressure of a keraphyllocele. (_gutenacker_) . foot with canker of the frog and heels. (_gutenacker_) . foot with canker extending to the wall. (_malcolm_) . foot with advanced canker. (_gutenacker_) . feet affected with specific coronitis. (_taylor_) . fore-foot with specific coronitis. (_taylor_) . excision of the lateral cartilage (old method). (_gutenacker_) . excision of the lateral cartilage. (_after moller and frick_). (_gutenacker_) . excision of the lateral cartilage. (_after bayer_.) (_gutenacker_) . partial excision of the lateral cartilage . ossified lateral cartilages, or side-bones. . smith's side-bone saw (old pattern). . smith's side-bone saw (improved pattern). . smith's hoof plane. . hodder's hoof chisel. . foot showing the grooves made in smith's operation for side-bones (viewed from the side). . foot showing the grooves made in smith's operation for side-bones (viewed from below). . periostitis involving the pedal and navicular bones. (_litt_) . periostitis involving the pedal and navicular bones. (_litt_) . effects of periostitis on the os pedis. (_smith_) . effects of periostitis on the os pedis. (_smith_) . effects of periostitis on the os pedis. (_jones_) . effects of periostitis on the os pedis. (_jones_) . case of buttress foot. (_routledge_) . foot showing fracture of the pyramidal process in a case of buttress foot. (_routledge_) . fracture of the os coronæ. (_crawford_) . fracture of the os coronæ. (_crawford_) . fractured os pedis. (_freeman_) . navicular bone showing lesions of navicular disease. (_gutenacker_) . foot with the seat of navicular disease exposed (showing lesions). (_gutenacker_) . navicular bone showing lesions of navicular disease (a case of long-standing). (_gutenacker_) . frog seton needle. . diagram showing course of the needle in setoning the frog. diseases of the horse's foot chapter i introduction the importance of that branch of veterinary surgery dealing with diseases of the horse's foot can hardly be overestimated. that the animal's usefulness is dependent upon his possession of four good feet is a fact that has long been recognised. who, indeed, is there to be found entirely unacquainted with one or other of such well-known aphorisms as: 'whoever hath charge of a horse's foot has the care of his whole body'; 'as well a horse with no head as a horse with no foot'; or the perhaps better known, and certainly more epigrammatic, 'no foot, no horse.' without taking these sayings literally, it will be admitted by almost everyone that they contain a vast amount of actual truth. this allowed, it at once becomes clear that a ready understanding of the diseases to which the foot is liable, the means of holding them in check, and the correct methods of treating them should figure largely in the knowledge at the command of the veterinary surgeon. in the very great majority of instances the horse's ability to perform labour is the one thing that justifies his existence, and to that end the presence of four good, sound feet is an almost indispensable qualification. and yet how many circumstances do we see tending to militate against that one essential. even in colthood the foot, if neglected, may become a source of trouble. unless periodically examined and properly trimmed, its shape is liable to serious alteration. from that in which it is best calculated to withstand the effects of the wear it will be called upon to endure in after life, it may become so changed for the worse as to seriously affect the animal's value. in the matter of feeding, too, trouble is likely to ensue. particularly is this the case where the colt shows points of exceptional merit. he is 'got up' for show, and the feet are likely to fall victims to the mismanagement that frequent exhibition so often carries with it. an extra allowance of peas, beans, wheat, or other equally injurious food is given. the result is a severe attack of laminitis, and an otherwise valuable and promising colt is permanently ruined. exposed as it is, too, to injury, the foot of a young horse, even at grass, is frequently the seat of injuries from picked up nails, stakes, or other agents which, unless detected and carefully treated, may terminate in a troublesome case of quittor and incurable lameness. with the passing of colthood, and the coming into effect of the evils of further domestication, the troubles to which the foot is open become more numerous. foremost among them will come those having their starting-point in errors of practice originating in the forge; for, in spite of attempts at their education, smiths, as a class, are as yet grievously unversed in even the elementary knowledge of the delicate construction of the member that is entrusted to their care. this fact has been dilated on in books devoted to shoeing, and in the prefatory note to the last edition of fleming's manual on this subject we find the following statement: 'the records of all humane societies show that, of prosecutions for cruelty to animals, an overwhelming majority refer to the horse; and of these, a large proportion are for working horses while suffering from lameness in one form or other. 'so frequent are such cases that observers have concluded that their prevalence must result from some specific cause, and, not unnaturally, attention has thus been directed to the various modes of management practised in relation to the horse's foot, to the manner of shoeing, and, in particular, to the way in which the foot is prepared for the shoe.' it must be remembered, however, that although harm in the forge may frequently arise from culpable roughness or carelessness, such is not necessarily always the case, and that quite as much injury may result from careful and conscientious workmanship when it is unfortunate enough to be based upon principles wrong in themselves to commence with. it so happens, too, that shoeing, in itself a necessary evil, may be responsible for injuries in the causation of which the smith can have played no part. take, for example, the ill effects following upon the animal's attendant allowing him to carry his shoes for too long a time. in this case the natural growth of the horn carries the heel of the shoe further beneath the foot than is safe for a correct bearing; in fact, anterior to the point of inflection of the wall. the shoe, at the same time, is greatly thinned from excessive wear. result, a sharp and easily-bended piece of iron situate immediately under the seat of corn. pressure or actual cutting of the sole is bound to occur, and the animal is lamed. again, apart from the question of negligence or otherwise on the part of the smith or the animal's attendant, it must be remembered that the nailing on to the foot of a plate of iron is not giving to the animal an easier means of progression. the reverse is the case. in place of the sucker-like face of the natural horn is substituted a smooth, and, with wear, highly-polished surface. slipping and sliding attempts to gain a foothold become frequent, and strains of the tendons and ligaments follow in their wake. as, however, this treatise is not intended to deal with the art of shoeing, the reader must be referred to other works for further information. in addition to fleming's, there may be mentioned, among others, hunting's 'art of horse shoeing,' and the very excellent volume of messrs. dollar and wheatley on the same subject. leaving the forge, we may next look to the nature of the animal's work, and the conditions under which he is kept, for active causes in the production of disorders of the foot. from the yielding softness of the pasture he is called to spend the bulk of his time upon the hard macadamized tracks of our country roads, or the still more hard and more dangerous asphalt pavings or granite sets of our towns. the former, with the bruises they will give the sole and frog from loose and scattered stones, and the latter, with the increased concussion they will entail on the limb, are active factors in the troubles with which we are about to deal. upon these unyielding surfaces the horse is called to carry slowly or rapidly, as the case may be, not only his own weight, but, in addition, is asked to labour at the hauling of heavy loads. the effects of concussion and heavy traction combined are bound primarily to find the feet, and such diseases as side-bones, ringbones, corns, and sand-cracks commence to make their appearance. again, as opposed to the comparative healthiness of the surroundings when at grass, consideration must be given to the chemical changes the foot is frequently subjected to when the animal is housed. only too often the bedding the animal has to stand upon for several hours of the twenty-four can only be fitly described as 'filthy in the extreme.' the ammoniacal exhalations from these collected body-discharges must, and do, have a prejudicial effect upon the nature of the horn, and, though slow in its progress, mischief is bound sooner or later to occur in the shape of a weakened and discharging frog, with its concomitant of contracted heels. lucky it is in such a case if canker does not follow on. observers, too, have chronicled the occurrence in horse's feet of disease resulting from the use of moss litter. tenderness in the foot is first noticeable, which tenderness is afterwards followed by a peculiar softening of the horn of the sole and the frog. what should be a dense, fairly resilient substance is transformed into a material affording a yielding sensation to the fingers not unlike that imparted by a soft indiarubber, and as easily sliced as cheese-rind. lastly, though the foot is extremely liable to suffer from the effects of extreme dryness or excessive humidity, especially with regard to the changes thus brought about in the nature of the horn, it is perforce exposed at all times to the varying condition of the roads upon which it must travel. the intense dryness of summer and the constant damp of winter, each in their turn take part in the deteriorating influences at work upon it. though this subject might be indefinitely prolonged, this brief résumé of the adverse circumstances to which the foot of the horse is exposed is sufficient to point out the extreme importance of its study to the veterinary surgeon. so long as the horse is used as a beast of burden so long will this branch of veterinary surgery offer a wide and remunerative field of labour. chapter ii regional anatomy considered from a zoological standpoint, the foot of the horse will include all those parts from the knee and hock downwards. for the purposes of this treatise, however, the word foot will be used in its more popular sense, and will refer solely to those portions of the digit contained within the hoof. when, in this chapter on regional anatomy, or elsewhere, the descriptive matter or the illustrations exceed that limit, it will be with the object of observing the relationship between the parts we are concerned with and adjoining structures. taking the limit we have set, and enumerating the parts within the hoof from within outwards, we find them as follows: a. the bones.--the lower portion of the second phalanx or os coronæ; the third phalanx, os pedis, or coffin bone; and the navicular or shuttle bone. b. the ligaments.--the ligaments binding the articulation. c. the tendons.--the terminal portions of the extensor pedis and the flexor perforans. d. the arteries. e. the veins. f. the nerves. g. the complementary apparatus of the os pedis. h. the keratogenous membrane. i. the hoof. a. the bones. the second phalanx, os coronÆ, or small pastern bone.--this belongs to the class of small bones, in that it possesses no medullary canal. it is situated obliquely in the digit, running from above downwards and from behind to before, and articulating superiorly with the first phalanx or os suffraginis, and inferiorly with the third phalanx and the navicular bone. [illustration: fig. .--the bones of the phalanx. , the os suffraginis; , the os coronæ; , the os pedis; , the navicular bone, hidden by the wing of the os pedis, is in articulation in the position indicated by the barbed line.] [illustration: fig. .--second phalanx or os coronÆ (anterior view). , anterior surface; , superior articulatory surface; , inferior articulatory surface; , pits for ligamentous attachment.] [illustration: fig. .--second phalanx or os coronÆ (posterior view). , posterior surface; , gliding surface for passage of flexor perforans; , lower articulatory surface.] cubical in shape, it is flattened from before to behind, and may be described as possessing six surfaces: _an anterior surface_, covered with slight imprints; _a posterior surface_, provided above with a transversely elongated gliding surface for the passage of the flexor perforans; _two lateral surfaces_, each rough and perforated by foraminæ, and each bearing on its lower portion a thumb-like imprint for ligamentous attachment, and for the insertion of the bifid extremity of the perforatus tendon; _a superior surface_, bearing two shallow articular cavities, separated by an antero-posterior ridge, for the accommodation of the lower articulating surface of the first phalanx; _an inferior surface_, also articulatory, which in shape is obverse to the superior, bearing two unequal condyles, separated by an ill-defined antero-posterior groove, which surface articulates with the os pedis and the navicular bone. _development_.--the bone usually ossifies from one centre, but often there is a complementary nucleus for the upper surface. the third phalanx, os pedis, or coffin bone.--this also belongs to the class of short bones. it forms the termination of the digit, and, with the navicular bone, is included entirely within the hoof. for our examination it offers _three surfaces_, _two lateral angles_, and _three edges_. _the anterior or laminal surface_, following closely in contour the wall of the hoof, is markedly convex from side to side, nearly straight from above to below, and closely dotted with foraminæ of varying sizes. on each side of this surface is to be seen a distinct groove, the _preplantar groove_, or _preplantar fissure_, which, commencing behind, between the basilar and retrossal processes, runs horizontally forwards from the angles or wings of the bone, and terminates anteriorly in one of the larger foraminæ. as the name 'laminal' indicates, it is this surface which in the fresh state is covered by the sensitive laminæ. _the inferior or plantar surface_, hollowed in the form of a low arch, presents for our inspection two regions, an anterior and a posterior, divided by a well-marked line, the _semilunar crest_, which extends forward in the shape of a semicircle. the anterior region, as is the laminal surface, is covered with foraminæ; in this case more minute. in the recent state it is covered by the sensitive sole. the posterior region, lying immediately behind the semilunar crest, shows on each side of a median process a large foramen, the _plantar foramen_. from this foramen runs the _plantar groove_, a channel, bounded above by the superior edge, and below by the semilunar crest of the bone, which conducts the plantar arteries into the _semilunar sinus_, a well-marked cavity in the interior of the bone. _the superior or articular surface_ consists of two shallow depressions, divided by a slight median ridge. its posterior part shows a transversely elongated facet for articulation with the navicular bone. _the superior edge_, outlining the superior margin of the laminal surface, describes a curve, with the convexity of the curve forward. in the centre of the curve is a triangular process, the _pyramidal process_, which serves as the point of attachment of the extensor pedis. _the inferior edge_, the most extensive of the three, separates the laminal from the solar surface. it is semicircular in shape, sharp, and finely dentated, and is perforated by eight to ten large foraminæ. _the posterior edge_, very slightly concave, divides the small, transversely elongated facet of the superior surface from the posterior region of the inferior surface. _the lateral angles_ of the bone, also termed the _wings_, are two projections directed backwards. each is divided by a cleft into an upper, the _basilar process_, and a lower, the _retrossal process_. in old animals the posterior portion of the cleft separating the two processes gradually becomes filled in with bony deposit, thus transforming the cleft into a foramen, which gives passage to the preplantar artery. we may mention in passing that the lateral angles give attachment to the lateral fibro-cartilages, and that the lateral angles themselves in old horses become increased in size owing to ossification of portions of the adjacent lateral cartilages. _development_.--the os pedis ossifies from two centres, one of which is for the articular surface; but this epiphysis fuses with the rest of the bone before birth. [illustration: fig. .--third phalanx or os pedis (postero-lateral view). , anterior or laminal surface; , preplantar foramen; , preplantar groove; , basilar process of the wing; , retrossal process of the wing; , foramen caused by the ossifying together posteriorly of the basilar and retrossal processes.] [illustration: fig. .--third phalanx or os pedis (viewed from below). , plantar surface; , plantar foramen and plantar groove; , semilunar crest; , tendinous surface; , retrossal processes of the wings.] the navicular bone, shuttle bone, or small sesamoid.--placed behind the articulating point of the second and third phalanges, this small shuttle-shaped bone assists in the formation of the pedal articulation. it is elongated transversely, flattened from above to below, and narrow at its extremities. in it we see two surfaces, and two borders. _the superior or articular surface_ of the bone, which may easily be recognised by its smoothness, is moulded upon the lower articular surface of the second phalanx, being convex in its middle, and concave on either side. _the inferior or tendinous surface_ resembles the preceding in form, but is broader and less smooth. in the recent state it is covered with fibro-cartilage for the passage of the flexor perforans. _the anterior border_ possesses above a small transversely elongated facet for articulation with the os pedis, and below a more extensive grooved portion, perforated by numerous foraminæ, affording attachment to the interosseous ligaments of the articulation. _the posterior border_, thick in the middle, but thinner towards the extremities, is roughened for ligamentous attachment. _development_.--the bone ossifies from a single centre. b. the ligaments. the articulation of the first with the second phalanx, or the pastern joint.--adhering to the limit we have set, this articulation should not receive our attention. as, however, we shall in a later page be concerned with fractures of the os coronæ, which fractures may affect the articulation above mentioned, a brief note of its formation will not be out of place. it is an imperfect hinge-joint, permitting of extension and flexion, allowing the first phalanx to pivot on the second, and admitting of the performance of slight lateral movements. it is formed by the opposing of the inferior surface of the os suffraginis with the superior surface of the os coronæ. the articulating surface of the os coronæ is supplemented by the addition behind of a thick piece of _fibro-cartilage (the glenoid_) attached inferiorly to the posterior edge of the upper articulatory surface of the os coronæ, and superiorly by means of three fibrous slips on each side to the os suffraginis. the innermost of these three slips becomes attached to about the middle of the lateral edge of the suffraginis, and the remaining two, beneath the first, attach themselves to nearer the lower end of that bone. the posterior surface of the complementary cartilage forms a gliding surface for the passage of the perforans. [illustration: fig. .--the navicular bone (viewed from below). , inferior surface (smooth for the passage of the flexor perforans); , anterior edge of inferior surface; , posterior edge of inferior surface.] [illustration: fig. .--the navicular bone (viewed from above, the bone tilted posteriorly to show its anterior border). , superior articulatory surface; , anterior border (grooved portion of); , anterior border (articulatory portion of).] [illustration: fig. .--ligaments of the first and second interphalangeal articulations (viewed from the side). (after dollar and wheatley.) , outermost slip from the glenoidal fibro-cartilage; , lateral ligament of the first interphalangeal articulation; , prolongations of the lateral ligament of the first interphalangeal articulation attached to the end of the navicular bone to form the postero-lateral ligament of the pedal joint; , end of the navicular bone; , antero-lateral ligament of the pedal joint.] _the lateral ligaments_.--these are large and thick, an outer and an inner, running obliquely from above downwards and backwards. each is inserted superiorly into the lateral tubercle of the lower end of the first phalanx, and inferiorly to the side of the second phalanx, their most inferior fibres becoming finally fixed to the extremities of the navicular bone, where they form the postero-lateral ligaments of the pedal articulation. in front of the joint the extensor pedis plays the part of an additional ligament. _the synovial membrane_.--this is limited in front by the tendon of the extensor pedis, on each side by the lateral ligaments of the joint, and behind by the glenoid fibro-cartilage. at this point it is prolonged upwards as a pouch behind the lower extremity of the first phalanx. the articulation of the second phalanx with the third, the pedal, or the coffin joint.--this also is an imperfect hinge-joint, permitting only of flexion and extension, which movements are more restricted than in the previous articulation. three bones enter into its formation: the second phalanx, the third phalanx, and the navicular bone. the lower articulatory surface is formed by the third phalanx and the navicular bone combined. to effect this the navicular is closely and firmly attached to the third phalanx by an interosseous ligament. the two bones, as one, are then connected to the second phalanx by four lateral ligaments, an anterior and a posterior on each side. _the interosseous ligament_ consists of extremely short fibres running from the extensively grooved portion of the anterior surface of the navicular bone to become attached to the os pedis immediately behind its articular surface. _the antero-lateral ligaments_ are attached by their superior extremities to the lateral surfaces of the second phalanx, and by their inferior extremities into the depressions on either side of the pyramidal process of the os pedis. _the postero-lateral ligaments_.--as mentioned when describing the first interphalangeal articulation, these are in reality continuations of the lateral ligaments of that joint. running obliquely downwards and backwards from their point of attachment to the first phalanx they curve round the lower part of the side of the second phalanx and end on the extremities and posterior surface of the navicular bone. having reached that position, they send short attachments to the retrossal process of the os pedis and to the inner face of the lateral cartilage. [illustration: fig. .--ligaments of the first and second interphalangeal articulations (viewed from behind). (after dollar and wheatley.) , suspensory ligament; , innermost slip from complementary cartilage of pastern joint; , middle slip from complementary cartilage of pastern joint; , outermost slip from complementary cartilage of pastern joint; , glenoid or complementary cartilage of pastern joint; , postero-lateral ligaments of the pedal joint; , the navicular bone; , interosseous ligaments of the pedal joint; , semilunar crest of os pedis; , plantar surface of os pedis.] _synovial membrane_.--this extends below the facets uniting the navicular to the pedal bone, and offers for consideration two sacs. a large one posteriorly running up behind the second phalanx to nearly adjoin the sesamoidean bursæ, and a small one, a prolongation of the synovial membrane between the antero-lateral and postero-lateral ligaments of the same side. this latter is often distended, and on account of its close proximity to the seat of operation, is liable to be accidentally opened in excision of the lateral cartilage for quittor. c. the tendons in order to convey an intelligent understanding of the tendons it will be wise to briefly describe the course of their parent muscles from their commencement. the extensor pedis.--the extensor pedis arises from the lower extremity of the humerus in two distinct portions of unequal size, a muscular and a tendinous. these are succeeded by two tendons passing in common through a vertical groove at the lower end of the radius. lower in the limb these tendons separate, the outer and smaller joining the tendon of the extensor suffraginis, and the inner and main tendon continuing its course downwards. with the exception of the navicular, it is attached to all the bones of the foot, and is covered internally by the capsular ligaments of the joints over which it passes, those with which we are concerned being the pastern joint and the pedal joint. before its attachment to the os pedis it receives on each side of the middle of the first phalanx reinforcement in the shape of a strong band descending obliquely over the fetlock from the suspensory ligament. widening out in fanlike fashion, it is inserted into the pyramidal process of the os pedis. _action_.--the action of this muscle is to extend the third phalanx on the second, the second on the first, and the first on the metacarpus. it also assists in the extension of the foot on the forearm. [illustration: fig. .--the flexor tendons and extensor pedis. (after haÜbner.) , tendon of flexor perforans; , its supporting check-band from the posterior ligament of the carpus; , tendon of the flexor perforatus; , ring and sheath of the flexor perforatus; , widening out of the flexor perforatus to form the plantar aponeurosis; , suspensory ligament; , reinforcing band from the suspensory ligament to the extensor pedis; , the extensor pedis.] the flexor pedis perforatus, or the superficial flexor of the phalanges.--in common with the perforans, this muscle arises from the inner condyloid ridge of the humerus. it is reinforced at the lower end of the radius by the superior carpal ligament, passes through the carpal and metacarpo-phalangeal sheaths, and, arriving behind the fetlock, forms a ring for the passage of the flexor perforans. its termination is bifid, and it is inserted on either side to the lateral surface of the second phalanx. [illustration: fig. .--the flexor perforans and flexor perforatus tendons. the metacarpo-phalangeal sheath and the ring of the perforatus laid open posteriorly, and the cut edges reflected to show the passage of the perforans. , reflected cut edges of the perforatus ring and the metacarpo-phalangeal sheath; , the perforans tendon; , point of insertion of the perforans tendon into the semilunar crest of the os pedis (this widened and thickened extremity of the perforans is known as the plantar aponeurosis).] [illustration: fig. .--the flexor perforatus and flexor perforans tendons. the metacarpo-phalangeal sheath and the ring of the perforatus laid open posteriorly, and the cut edges reflected; the flexor perforans cut through at about the region of the sesamoids, and its inferior portion deflected. , superior end of severed perforans tendon; , inferior end of severed perforans tendon; , insertion of flexor perforans into semilunar crest of os pedis; , the cut and reflected edges of the metacarpo-phalangeal sheath and perforatus ring; , the bifid insertion of the flexor perforatus into the lateral surfaces of the os corona; , the capsular ligament of the pedal joint; , the navicular bone; , the posterior surface and glenoid fibro-cartilage of the os coronæ.] _action_.--this muscle flexes the second phalanx on the first, the first on the metacarpus, and the entire foot on the forearm. mechanically, it acts as a stay when the animal is standing by maintaining the metacarpo-phalangeal angle. [illustration: fig. .--median section of foot. _a_, os suffraginis; _b_, os coronæ; _c_, os pedis; _d_, navicular bone; _e_, tendon of the extensor pedis; _f_, insertion of the extensor pedis into the pyramidal process of the os pedis; _g_, the tendon of the flexor perforatus; _h_, insertion of perforatus into the os coronæ; _i_, tendon of the flexor perforans; _j_, its passing attachment to the os coronæ; _k_, its final insertion into the semilunar crest of os pedis; _a_, section of coronary cushion; _b_, section of plantar cushion; _c_, semilunar sinus of os pedis.] the flexor pedis perforans, or the deep flexor of the phalanges.--this muscle consists of three easily-divided portions: an ulnar, a humeral, and a radial, and has for points of origin the olecranon process of the ulna, the inner condyloid ridge of the humerus, and the posterior surface of the radius. these portions are continued by a common tendon which enters the carpal sheath with the tendon of the perforatus, and continues with it through the synovial sheath of the metacarpo-phalangeal region. like the last-named tendon, it receives a supporting check-band, in this case from the posterior ligament of the carpus. passing down between the suspensory ligament in front, and the perforatus tendon behind, it glides over the sesamoid pulley and passes through the ring formed by the perforatus. continuing its course, it passes between the bifurcating portions of the extremity of the perforatus, glides over the smooth posterior surface of the supplementary glenoid cartilage of the articulation of the first and second phalanges, plays over the inferior surface of the navicular bone, and finally becomes inserted into the semilunar crest of the os pedis. on reaching the posterior border of the navicular bone it widens out to form the plantar aponeurosis. in connection with the lower portion of this tendon must be noticed the navicular sheath. this is a synovial sheath lining the deep face of the tendon, and reflected on to the navicular bone and the interosseous ligament of the pedal joint. this will be of particular interest when we come to deal with cases of pricked foot from picked up nails. above, it is in connection with the synovial membrane of the pedal articulation and that of the metacarpo-phalangeal sheath. _action_.--the action of the perforans is to flex the third on the second, and the second on the first phalanx. the latter it flexes in turn on the metacarpus. it also assists in the flexion of the entire foot on the forearm, and in supporting the angle of the metacarpo-phalangeal articulation when the animal is standing. d. the arteries. so far as the arteries supplying the foot are concerned, we shall be interested in following up the distribution of the two digitals, which are the terminal branches of the large metacarpal. the large metacarpal, or collateral artery of the cannon.--this, the larger terminal branch of the posterior radial artery, needs brief mention, for the reason that we shall be afterwards concerned with it in the operation of neurectomy. its point of origin is the inside of the inferior extremity of the radius. descending in company with the flexor tendons, and passing behind the carpus and beneath the carpal sheath, it continues its descent, in company with the internal plantar nerve and the internal metacarpal vein, on the inner side of the flexor tendons until just above the fetlock. at this point it bifurcates into the digital arteries. from the carpus downwards the large metacarpal artery, the internal metacarpal vein, and the internal plantar nerve are in close relation with each other. the vein holds the anterior position. the artery is between the two, and has the nerve in close contact with it behind. the digital arteries, or collateral arteries of the digit.--these are of large volume, and carry the blood to the keratogenous apparatus of the foot. they separate from each other at an acute angle, and pass over the side of the fetlock, one to the inside, the other to the outside, to reach the internal face of the basilar process of the os pedis, where they bifurcate to form the _plantar_ and _preplantar_ arteries. in the whole of their course the digital arteries follow the flexor tendons, and are related in front to the digital vein, and behind to the posterior branch of the plantar nerve. this is the nerve implicated in the lower operation of neurectomy, and its relation to adjoining structures will be detailed under section f. of this chapter. during its course the digital artery gives off branches in the following positions: . _at the fetlock_ numerous branches to the metacarpo-phalangeal articulation, the sesamoid sheath, and the tendons. . _at the upper extremity of the first phalanx_ branches for the supply of the surrounding tissues, and for the tissues of the ergot. . _towards the middle of the third phalanx_, the _perpendicular_ artery of percival. this arises at a right angle from the main vessel, and immediately divides into two series of ramifications--an ascending and a descending. the ramifications of these series freely anastomose with corresponding vessels of the opposite side. . _at the superior border of the lateral cartilage_, the _artery of the plantar cushion_. this is directed obliquely downwards and backwards, under cover of the cartilage, and is distributed to the middle portion of the complementary apparatus of the os pedis, as well as to the villous tissue and the coronet. a branch of it is turned forwards to join with the coronary circle in forming the _circumflex artery of the coronet_. [illustration: fig. .--the arteries of the foot. the digital; , the perpendicular--(_a_) its ascending branch, (_b_) its descending branch; , circumflex artery of coronary cushion; , the preplantar (ungual) artery--this is seen issuing from the preplantar foramen, and distributing numerous ascending (_c_) and descending (_d_) branches (the latter concur in forming the circumflex artery of the toe); , the circumflex artery of the toe; , at the point marked (*) the terminal branch of the digital--namely, the plantar ungual--is hidden behind the lateral cartilage; , the lateral cartilage.] . _under the lateral cartilage_ two transverse branches, an anterior and a posterior, to form the _coronary circle_. the numerous ramifications of these branches anastomose both anteriorly and posteriorly with their corresponding branches of the artery of the opposite side. this circle closely embraces the os coronæ. among the larger branches given off from its anterior portion are two descending, one on each side of the extensor pedis, to assist in the formation of the _circumflex artery of the coronary cushion_. the formation of this last-named artery is completed posteriorly by the before-mentioned branch from the artery of the plantar cushion. the preplantar (ungual[a]) artery.--this, the smaller of the two terminal branches of the digital, is situated inside the basilar process of the os pedis. it turns round this to gain the fissure between the basilar and retrossal processes, and becomes lodged in the preplantar fissure. here it terminates in several divisions which bury themselves in the os pedis. before leaving the inner aspect of the pedal wing it supplies a deep branch to the heel and the villous tissue. gaining the outer aspect of the wing, it distributes a further backward branch, which passes behind the circumflex artery of the pedal bone, and, during its passage in the preplantar fissure, gives off ascending and descending branches, which ramify in the laminal tissue. the plantar (ungual[a]) artery.--this, the larger of the two terminals of the digital, may be looked upon as a continuation of the main vessel. running along the plantar groove, it gains the plantar foramen. here it enters the interior of the bone (the semilunar sinus) and anastomoses with the corresponding artery of the opposite side. the circle of vessels so formed is called the _plantar arch_ or the _semilunar anastomosis_. [footnote a: the epithet 'ungual' is added by chauveau to distinguish these arteries from the properly so-called plantar arteries--the terminal divisions of the posterior tibial artery.] from the semilunar anastomosis radiate two main groups of arterial branches, an ascending group and a descending one. the _ascending_ branches penetrate the substance of the os pedis, and emerge by the numerous foraminæ on its laminal surface. the _descending_ branches, larger in size, also penetrate the substance of the pedal bone, and emerge in turn from the foraminæ cribbling its outer surface--in this case the set of larger foraminæ opening on its inferior edge. having gained exit from the bone, their frequent anastomosis, right and left, with their fellows forms a large vessel following the contour of the inferior edge of the os pedis. this constitutes the _circumflex artery of the toe_. e. the veins. these commence at the foot with a series of plexuses, which may be described as forming ( ) an internal or intra-osseous venous system, and ( ) an external or extra-osseous venous system. . the intra-osseous venous system.--this is a venous system within the structure of, and occupying the semilunar sinus of the os pedis. it follows in every respect the arrangement of the arteries as before described in the same region. efferent vessels emerge from the plantar foraminæ, follow the plantar fissures, and ascend within the basilar processes of the os pedis. here they lie under shelter of the lateral cartilages, and assist in the formation of the deep layer of the coronary plexus of the extra-osseous system. . the extra-osseous venous system.--this may be regarded as a close-meshed network enveloping the whole of the foot. although a continuous system, it is best described by recognising in it three distinct parts: _(a) the solar plexus_. _(b) the podophyllous plexus_. _(c) the coronary plexus_. _(a) the solar plexus_.--the veins of this plexus discharge themselves in two directions: ( ) _by a central canal_ or canals running along the bottom of the lateral lacunæ of the plantar cushion to gain the deep layer of the coronary plexus. ( ) _by the circumflex or peripheral vein of the toe_, a canal formed by ramifications from the solar and the podophyllous plexuses, and following the direction of the artery of the same name. the circumflex vein terminates by forwarding branches to concur in the formation of the superficial coronary plexus. _(b) the podophyllous or laminal plexus_.--the podophyllous veins anastomose below with the circumflex vein of the solar plexus, and above with the veins of the coronary plexus. _(c) the coronary plexus_.--this proceeds from the podophyllous, the intra-osseous, and the solar networks, and consists of a _central_ and _two lateral parts_. the _central_ portion lies between the lateral cartilages and immediately under the coronary cushion. the _lateral portions_ are ramifications on both surfaces of the lateral cartilages. the ramifications on the lateral cartilages may be again distinguished as _superficial_ and _deep_. the superficial layer is distributed over the external face of the cartilage, forming thereon a dense network, and finally converges towards the superior limit of the plexus to form ten or twelve principal branches, which again unite to form two large vessels. these vessels, by their final fusion at the lower end of the first phalanx, constitute the digital vein. the deep layer is formed, as before described, by ascending branches from the posterior parts of the podophyllous and solar plexuses, and by branches from the intra-osseous system of the pedal bone. the veins of this deep layer finally drain into the two vessels proceeding from the superficial layer, which go to the formation of the digital vein. the digital veins--these arise from the network formed on the surfaces of the lateral cartilages, and ascend in front of the digital arteries to unite above the fetlock, where they form an arch between the deep flexor and the suspensory ligament. from this arch (named the _sesamoidean)_ proceed the metacarpal veins. the metacarpal veins.--three in number, they are distinguished as an _internal_ and an _external metacarpal_, and a _deep_ or _interosseous metacarpal_. as we shall be concerned with these in the higher operation of neurectomy, we may give them brief mention. the internal metacarpal vein, the largest of the three, has relations with the internal metacarpal artery and the internal plantar nerve. these relations were shortly discussed under the section devoted to the arteries, to which the reader may refer. the external metacarpal vein.--this ascends on the external side of the flexor tendons in company with the external plantar nerve. _the interosseous vein_.--this is an irregular vessel running up between the suspensory ligament and the posterior face of the large metacarpal bone. f. the nerves. the plantar nerves.--these are two in number, and are distinguished as internal and external. the internal plantar nerve lies behind and in close contact with the great metacarpal artery during that vessel's course down the region of the cannon. a point of interest is that it gives off at about the middle of the cannon a branch which bends obliquely downwards and behind the flexor tendons to join its fellow of the opposite side--namely, the external plantar. this it joins an inch or more above the bottom of the splint bone. measured in a straight line, this is about - / inches below its point of origin. near the fetlock, at the level of the sesamoids, the internal plantar nerve ends in several digital branches. the external plantar nerve.--this holds a position to the outside of the metacarpal region, analogous to that of the internal plantar nerve on the inside of the limb, running down on the external edge of the flexor tendons. unlike the internal nerve, it is accompanied by a single vessel only, the external metacarpal vein, behind which it lies. at the level of the sesamoid bones it divides, as does the _internal_ nerve, into three main branches--the digital nerves. [illustration: fig. .--the veins and nerves of the foot. , the digital vein; , its main tributaries, draining the podophyllous plexus, and concurring to form the digital; . the digital artery (the main trunk only of this is shown, in order to show its relationship with the vein and nerve); , the plantar nerve, with its three branches--(_a_) the anterior digital, (_b_) the middle digital, (_c_) the posterior digital; , the podophyllous plexus; , superficial portion of the coronary plexus; , the peripheral or circumflex vein of the toe.] the digital nerves.--these are distinguished as anterior, middle, and posterior. _the anterior branch_ descends in front of the vein, distributing cutaneous branches to the front of the digit, and terminating in the coronary cushion. _the middle branch_ descends between the artery and the vein, and freely anastomoses with the two other branches. it terminates in the coronary cushion and the sensitive laminæ. _the posterior branch_.--this is the largest of the three, and may be regarded as the direct continuation of the plantar. at the fetlock it is placed immediately above the digital artery, but afterwards takes up a position directly behind that vessel. together with the digital artery it descends to near the basilar process of the os pedis. here it passes with the plantar artery into the interior of the os pedis, and continues its main branch, with the preplantar artery, in the fissure of the same name, to finally furnish supply to the os pedis and the sensitive laminæ. it is this nerve which is divided in the low operation of neurectomy. beyond the fact of this branch descending, in the region of the pastern, inch behind the digital artery, a further point of interest presents itself to the surgeon, and one to which attention must be paid. this is the presence in close proximity to the nerve of the ligament of the pad (percival), or the ligament of the ergot (mcfadyean). this is a subcutaneous glistening cord originating in the ergot of the fetlock, passing in an oblique direction downwards and forwards, and crossing over on its way both the digital artery and the posterior branch of the digital nerve. in the foregoing description of the anatomy, we have taken the fore-limb as our guide. in the hind-limb, where they reach the foot, the counterparts of the tendons, arteries, veins, and nerves differ in no great essential from their fellows in the fore. they will therefore need no special mention. g. the complementary apparatus of the os pedis. this consists of two lateral pieces, the lateral cartilages or _fibro-cartilages_ of the pedal bone, united behind and below by the _plantar cushion_. . the lateral cartilages.--each is a flattened plate of cartilage, possessing two faces and four borders separated by four angles. the external face is convex, covered by a plexus of veins, and slightly overhangs the pedal bone. the internal face is concave, and covers in front the pedal articulation and the synovial sac, already mentioned as protruding between the antero- and postero-lateral ligaments of that joint. we have already remarked that this is a point of interest to be remembered in connection with the operation for quittor. below and behind, the internal face of the cartilage is united to the plantar cushion. [illustration: fig. .--external face of the outer lateral cartilage. , external face of cartilage--(_a_) its upper border, (_b_) its posterior border, (_c_) its anterior border, (_d_) its inferior border; , the os pedis; , wing of os pedis.] the upper border, sometimes convex, sometimes straight, is thin and bevelled, and may easily be felt in the living animal. it is this border that the digital vessels cross to gain the foot, and the border is often broken by a deep notch to accommodate them. the inferior border is attached in front to the basilar and retrossal processes, behind which it blends with the plantar cushion. the posterior border is oblique from before to behind, and above to below, and joins the preceding two. the anterior border is oblique in the same direction, and is intimately attached to the antero-lateral ligament of the pedal articulation. the cartilages of the fore-feet are thicker and more extensive than those of the hind. . the plantar cushion on fibro-fatty frog.--composed of a fibrous meshwork, in the interstices of which are lodged fine elastic and connective fibres and fat cells, this wedge-shaped body occupies the space between the two lateral cartilages, the extremity of the perforans tendon, and the horny frog. it offers for consideration an antero-superior and an infero-posterior face, a base, an apex, and two borders. the antero-superior face is in contact with the terminal expansion of the perforans tendon. the infero-posterior face is covered by the keratogenous membrane, and follows closely the shape of the horny frog, on whose inner surface it is moulded. it presents, therefore, at its centre a single conical prolongation, the _pyramidal body_, which is continued behind, as is the horny frog, in the shape of two lateral ridges divided by a median cleft. the _base_ of the cushion lies behind, and consists of two lateral masses, _the bulbs of the plantar cushion_. in front these are continuous with the ridges of the pyramidal body, while behind they become confounded with the lateral cartilages and the coronary cushion. the _apex_ is fixed into the plantar surface of the os pedis, in front of its semilunar ridge. the _borders_, right and left, are wider behind than before, and are in relation with the inner faces of the lateral cartilages. h. the keratogenous membrane. the keratogenous, or horn-producing membrane, is in reality an extension of the dermis of the digit. it covers the extremity of the digit as a sock covers the foot, spreading over the insertion of the extensor pedis, the lower half of the external face of the lateral cartilages, the bulbs of the plantar cushion, the pyramidal body, the anterior portion of the plantar surface of the os pedis, and over the anterior face of the same bone. in turn, as the human foot with its sock is covered by the boot, this is encased by the hoof, the formation of which we shall study later. to expose the membrane for study the hoof must be removed. this may be done in two ways. by roasting in a fire, and afterwards dragging off the horny structures with a pair of pincers, a knife having first been passed round the superior edge of the horny box. or by maceration in water for several days, when the hoof will become loosened by the process of decomposition, and may be easily removed by the hands. the latter method is less likely to injure the sensitive structures, and will expose them with a fresh appearance for observation. for purposes of description the keratogenous membrane is divided into three regions: . the coronary cushion. . the velvety tissue. . the podophyllous tissue, or the sensitive laminæ. . the coronary cushion. in the foot stripped of the hoof the coronary cushion is seen as a rounded structure overhanging the sensitive laminæ after the manner of a cornice. it extends from the inner to the outer bulbs of the plantar cushion, and is bounded above by the perioplic ring, and below by the laminæ. when _in situ_ it is accommodated by the _cutigeral groove_, a cavity produced by the bevelling out of the superior portion of the inner face of the wall of the hoof. its superior surface is covered by numerous elongated papillæ, set so closely as to give the appearance of the 'pile' of velvet. this is observed to the best advantage with the foot immersed in water. _the superior border_ of the cushion is bounded by the _perioplic ring_, the cells of which have as their function the secreting of the _periople_, a layer of thin horn to be noted afterwards as covering the external face of the wall. from the perioplic ring the cushion is separated by a narrow and shallow, though well-marked, groove. the inferior border is bounded by the sensitive laminæ. [illustration: fig. .--the keratogenous membrane (viewed from the side). (the hoof removed by maceration.) . the sensitive laminæ, or podophyllous tissue; , the coronary cushion; , the perioplic ring; , portion of plantar cushion; , groove separating perioplic ring from coronary cushion; . the sensitive sole.] the upper portions of the laminæ, those in contact with the cushion, are pale in contrast with the portions immediately below, and thus there is given the appearance of a white zone adjoining the inferior border of the cushion. widest at its centre, the cushion narrows towards its extremities, which, arriving at the bulbs of the plantar cushion, bend downwards into the lateral lacunæ of the pyramidal body, where they merge into the velvety tissue of the sole and frog. the papillæ of the coronary cushion secrete the horn tubules forming the wall, and the papillæ of the perioplic ring secrete the varnish-like veneer of thin horn covering the outside surface of the hoof. [illustration: fig. .--the keratogenous membrane (viewed from below). (the hoof removed by maceration.) , the sensitive sole; , the sensitive frog[a]--(a) its median lacuna, ( ) its lateral lacuna; . v-shaped depression accommodating the toe-stay; , the sensitive laminæ which interleave with the horny laminæ of the bar.] [footnote a: the sensitive frog thinly invests the plantar cushion or fibre-fatty frog, the outline of which is here indicated.] . the velvety tissue.--this is the portion of the keratogenous membrane covering the plantar surface of the os pedis and the plantar cushion. to the irregularities of the latter body--its bulbs, pyramidal body, and its lacunæ--it is closely adapted. its surface may, therefore, be divided into _(a) the sensitive frog_, and _(b) the sensitive sole_. _(a) the sensitive frog_ is that part of the velvety tissue moulded on the lower surface of the plantar cushion. the shape of the plantar cushion has already been described as identical with that of the horny frog. it only remains to state that, like the coronary cushion, the surface of the sensitive frog is closely studded with papillæ. the cells clothing the papillæ are instrumental in forming the horny frog. _(b) the sensitive sole_.--as its name indicates, this is the portion of the keratogenous membrane that covers the plantar surface of the os pedis. it also is clothed with papillæ, which again give rise to the formation of that part of the horny box to which they are adapted--namely, the sole. . the podophyllous tissue, or sensitive laminÆ.--this portion of the keratogenous membrane is spread over the anterior face and sides of the os pedis, limited above by the coronary cushion, and below by the inferior edge of the bone. it presents the appearance of fine longitudinal streaks, which, when closely examined with a needle, are found to consist of numerous fine leaves. these extend downwards from the lower border of the coronary cushion to the inferior margin of the os pedis. at this point each terminates in several large villous prolongations, which extend into the horny tubes at the circumference of the sole. at the point of the toe this membrane sometimes shows a v-shaped depression, into which fits a inverted v-shaped prominence on the inner surface of the wall at this point. the sensitive laminæ increase in width from above to below. their free margin is finely denticulated, while their sides are traversed from top to bottom by several folds (about sixty), which, examined microscopically, are seen to consist of secondary leaves, or _laminellæ_. examined on the foot, deprived of its horny covering, the sensitive laminæ are, the majority of them, in close contact with each other. in the normal state this is not so. the interstices between the leaves are then occupied by the horny leaves, to be afterwards described as existing on the inner surface of the wall. reaching and rounding the heels, the sensitive laminæ extend forward for a short distance, where they interleave with the horny laminæ of the bars. much discussion has centred round the point as to whether or no the cells of the sensitive laminæ take any share in the formation of the horn of the wall. this will be alluded to in a future chapter. i. the hoof. removed from the foot by maceration a well-shaped hoof is cylindro-conical in form, and appears to the ordinary observer to consist of a box or case cast in one single piece of horn. prolonged maceration, however, will show that the apparently single piece is divisible into three. these are known as ( ) the wall, ( ) the sole, and ( ) the frog. in addition to these, we have also an appendage or circular continuation of the frog named ( ) the periople, or coronary frog band. these various divisions we will study separately. . the wall is that portion of the hoof seen in front and laterally when the horse's foot is on the ground. posteriorly, instead of being continued round the heels to complete the circle, its extremities become suddenly inflected downwards, forwards, and inwards. these inflections can only be seen with the foot lifted from the floor, and form the so-called _bars_. it will be noticed, too, with the foot lifted, that the wall projects beyond the level of the other structures of the plantar surface, taking upon itself the bearing of the greatest part of the animal's weight. the horn of the wall, viewed immediately from the front, is known as the _toe_, which again is distinguished as _outside toe_ or _inside toe_, according as the horn to its inner or outer aspect is indicated. the remainder of the external face of the wall, that running back to the heels, is designated the _quarters_. in the middle region of the toe, the wall following the angle of the bones is greatly oblique. this obliquity decreases as the quarters are reached, until on reaching the heels the wall is nearly upright. [illustration: fig. .--the wall of the hoof. , the toe; , inner toe; , outside toe; , the quarter; , entigeral groove; , horny laminæ.] for observation the wall offers two faces, two borders, and two extremities. _the external face_ is convex from side to side, but straight from the upper to the lower border. examined closely, it is seen to be made up of closely-arranged parallel fibres running in a straight line from the upper to the lower border, and giving the surface of the foot a finely striated appearance. in addition to these lines, which are really the horn tubules, the external face is marked by a series of rings which run horizontally from heel to heel. these are due to varying influences of food, climate, and slight or severe disease. this will be noted again in a later page. in a young and healthy horse the whole of the external face of the wall is smooth and shining. this appearance is due to a thin layer of horn, secreted independently of the wall proper, termed the periople. [illustration: fig. .--internal features of the wall, frog, and sole (mesian section of hoof). , horny laminæ covering internal face of wall; , superior border of wall; , junction of wall with horny sole; , the cutigeral groove; , the horny sole; , the horny frog (that portion of it known as the 'frog-stay'); , inverted v-shaped ridge on wall and sole (known as the 'toe-stay'); , anterior face of wall; , inferior border of wall.] _the internal face_ of the wall, that adapted to the sensitive laminæ, is closely covered over its entire surface with white parallel leaves _(keraphyllæ_, or horn leaves, to distinguish them from the _podophyllæ_, or sensitive leaves). these keraphyllæ dovetail intimately with the sensitive laminæ, covering the os pedis. running along the superior portion of the inner face is the _cutigeral groove_. this cavity has been mentioned before as accommodating the coronary cushion, whose shape and general contour it closely follows, being widest and deepest in front, and gradually decreasing as it proceeds backwards. it is hollowed out at the expense of the wall, and shows on its surface numberless minute openings which receive the papillæ of the coronary cushion. at the bottom of the internal face, at the point where the toe joins the sole, will be noted the before-mentioned inverted v-shaped prominence. its position will be clearly understood when we say that it gives the appearance of having been forced there by the pressure of the toe-clip of the shoe. this will be noted again when dealing with the sole. _the inferior border_ of the wall offers little to note. it is that portion in contact with the ground, and subject to wear. a point of interest is its union with the sole. this will be noticed in a foot which has just been pared as a narrow white or faint yellow line on the inner or concave face of the wall at its lower portion. it marks the point where the horny leaves of the wall terminate and become locked with corresponding leaves of the circumference of the sole. _the superior border_ follows closely the line marked by the perioplic ring and the groove separating the latter from the coronary cushion. _the extremities_ of the wall are formed by the abruptly reflected portions of the wall at the heels. termed by some the 'inflexural nodes,' they are better known to us as the '_points of the heels_.' . the sole.--the sole is a thick plate of horn which, in conjunction with the bars and the frog, forms the floor of the foot. in shape it is irregularly crescentic, its posterior portion, that between the horns of the crescent, being deeply indented in a v-shaped manner to receive the frog. its upper surface is convex, its lower concave. it may be recognised as possessing two faces and two borders. _the superior or internal face_ is adapted to the sole of the os pedis. its highest point, therefore, is at the point of its v-shaped indentation. from this point it slopes in every direction downwards and outwards until near the circumference. here it curves up to form a kind of a groove in which is lodged the inferior edge of the os pedis. in the centre of its anterior portion--that is to say, at the toe--will be seen a small inverted v-shaped ridge, which is a direct continuation of the same shaped prominence before mentioned on the internal face of the wall. this fleming has termed the toe-stay, from a notion that it serves to maintain the position of the os pedis. the whole of the superior face of the sole is covered with numerous fine punctures which receive the papillæ of the sensitive sole. _the inferior face_ is more or less concave according to circumstances, its deepest part being at the point of the frog. sloping from this point to its circumference, it becomes suddenly flat just before joining the wall. its horn in appearance is flaky. [illustration: fig. .--inferior aspect of hoof. _a_ the inferior face of horny sole; _b_, inferior border of the wall; _c_, body or cushion of the frog; _d_, median lacuna of the frog; _e_, lateral lacuna of the frog; _f_, the bar; _g_, the quarter; _h_, the point of the frog; _i_ the heel.] _the external border_ or circumference is intimately dovetailed with the horny laminæ of the wall. at its circumference the sole, if unpared, is ordinarily as thick as the wall. this thickness is maintained for a short distance towards its centre, after which it becomes gradually more thin. _the internal border_ has the shape of an elongated v with the apex pointing forwards. it is much thinner than the external border, and, like it, is dovetailed into the horny laminæ of the inflections of the wall--namely, the bars. in front of the termination of the bars it is dovetailed into the sides and point of the frog. where unworn by contact with the ground, the horn of the sole is shed by a process of exfoliation. . the frog.--triangular or pyramidal in shape, the frog bears a close resemblance to the form of the plantar cushion, upon the lower surface of which body it is moulded. it offers for consideration two faces, two sides, a base, and a point or summit. [illustration: fig. .--hoof with the sensitive structures removed. , superior face of horny frog; , the frog-stay; , the lateral ridges of the frog's superior surface; , the horny laminæ at the inflections of the wall.] _the superior face_ is an exact cast of the lower surface of the plantar cushion. it shows in the centre, therefore, a triangular depression, with the base of the triangle directed backwards. posteriorly, the depression is continued as two lateral channels divided by a median ridge. the median ridge widens out as it passes backwards, forming the larger part of the posterior portion of the frog. this median ridge fits into the cleft of the plantar cushion. it serves to prevent displacement of the sensitive from the horny frog, and has been rather aptly termed the '_frog-stay_.' _the inferior surface_ is an exact reverse of the superior. the triangular depression of the superior surface is represented in the inferior surface by a triangular projection, and the ridge-like frog-stay of the upper surface is represented below by a median cleft, the _median lacuna_ of the frog. the triangular projection in front of the median lacuna is the body or cushion of the frog. it is continued backwards as two ridge-like branches, which, at the points of the heels, form acute angles with the bars. on the outer side of each lateral ridge is a fissure. these are known as the lateral lacunæ. _the sides_ of the frog are flat and slightly oblique. they are closely united to the bars and to the triangular indentation in the posterior border of the sole. _the base_ of the frog is formed by the extremities of its branches, which, becoming wider and more convex as they pass backwards, form two rounded, flexible, and elastic masses separated from each other by the median lacuna. these constitute the 'glomes' of the frog. they are continuous with the periople. _the point of the frog_ is situated, wedge-like, within the triangular notch in the posterior border of the sole. . the periople, or coronary frog band.--this is a continuation of the substance of the frog around the extreme upper surface of the hoof. it is widest at the heels over the bulbs or glomes of the frog, and gradually narrows as it reaches the front of the hoof. it is, in reality, a thin pellicle of semi-transparent horn secreted by the cells of the perioplic ring. when left untouched by the farrier's rasp it serves the purpose, by acting as a natural varnish, of protecting the horn of the wall from the effects of undue heat or moisture. chapter iii general physiological and anatomical observations the matter embraced by the heading of this chapter will offer for discussion many subjects of great interest to the veterinary surgeon. around some of them debate has for many years waxed more than keen. of the points in dispute, some of them may be regarded as satisfactorily settled, while others offer still further room for investigation. in this volume we can only hope to deal with them in brief, and must select such as appear to have the greatest bearing on the veterinarian's everyday practice. always prolific of heated discussion has been one question: 'are the horny laminæ secreted by the sensitive?' to answer this satisfactorily, it will be best to give a short account of the mode of production of the hoof in general. a. development of the hoof. starting with the statement that it is epidermal in origin, we will first consider the structure of the skin, and follow that with a brief description of the structure and mode of growth of the human nail, a short study of which will greatly assist us when we come to investigate the manner of growth of the horse's hoof. the skin is composed of two portions, the epidermis and the corium. the epidermis is a stratified epithelium. the superficial layers of the cells composing it are hard and horny, while the deeper layers are soft and protoplasmic. these latter form the so-called _retae mucosum_ of malpighi. [illustration: fig. .--vertical section of epidermis (human). (after ranvier) _a_, the horny layer of the epidermis; _b_, the rete mucosum; _a_, the columnar pigment-containing cells of the rete; _b_, the polyhedral cells; _c_, the stratum granulosum; _d_, the stratum lucidum; _e_, swollen horny cells; _f_ the stratum squamosum.] commencing from below and proceeding upwards, we find that the lowermost cells of the rete mucosum, those that are set immediately on the corium, are columnar in shape. in animals that have a coloured skin these cells contain pigment granules. directly superposed to these we find cells which in shape are polyhedral. above them, and forming the most superficial layer of the rete mucosum, is a series of flattened, granular-looking cells known as the _stratum granulosum_. immediately above the stratum granulosum the horny portion of the epidermis commences. in the human skin this is formed of three distinct layers. undermost a layer of clear compressed cells, the _stratum lucidum_. next above it a layer of swollen cells, the nuclei of which are indistinguishable. finally, a surface layer of thin, horny scales, the _stratum squamosum_, which become detached and thrown off in the form of scurf or dandruff. in the skin of the horse, except where it is thickest, these layers are not clearly defined. it is the malpighian layer of the epidermis that is most active in cell division. as they are formed the new cells push upwards those already there, and the latter in their progress to the surface undergo a chemical change in which their protoplasm is converted into horny material. this change, as we have already indicated, takes place above the stratum granulosum. in addition to its constant formation of cells to replace those cast off from the surface, the active proliferation of the elements of the malpighian layer is responsible for the development of the various appendages of the skin, the hairs with their sebaceous glands, the sweat glands, horny growths and the hoof, and, in the human subject, the nail. these occur as thickenings and down-growths of the epithelium into the corium. the epidermis is devoid of bloodvessels, but is provided with fine nerve fibrils which ramify between the cells of the rete mucosum. the corium is composed of dense connective tissue, the superficial layer of which bears minute papillæ. these project into the epidermis, which is moulded on them. for the most part the papillæ contain looped capillary vessels, rendering the superficial layer of the corium extremely vascular. why this must be a moment's reflection will show. the epidermis, as we have already said, is devoid of bloodvessels. it therefore depends entirely for its nourishment upon the indirect supply it receives from the vessels of the corium. the need for extreme vascularity of the corium is further explained when we call to mind the constant proliferation and casting off of the cells of the epidermis, the growth of the hairs, the production of the horn of the hoof, and the work performed by the numerous sweat and other glands. others of the papillæ contain nerves, ending here in tactile corpuscles, or continuing, as we have mentioned before, to ramify as fine fibrils in the rete mucosum of the epidermis. the hairs are growths of the epidermis extending downwards into the deeper part of the corium. each is developed in a small pit, the _hair follicle_, from the bottom of which it grows, the part lying within the follicle being known as the _root_. it is important to note their structure, as it will be seen later that they bear an extremely close relation to the horn of the hoof. under a high power of the microscope, and in optical section, the central portion of a hair is tube-like. in some cases the cavity of the tube is occupied by a dark looking substance formed of angular cells, and known as the _medulla_. the walls of the tube, or the main substance of the hair, is made up of a pigmented, _horny, fibrous material_. this fibrous structure is covered by a delicate layer of finely imbricated scales, and is termed the _hair cuticle_. the root of the hair, that portion within the follicle, has exactly the same formation save at its extreme end. here it becomes enlarged into a knob-like formation composed of soft, growing cells, which knob-like formation fits over a vascular papilla projecting up in the bottom of the follicle. we have already stated that the hairs are down-growths of the epidermis. it follows, therefore, that the hair follicles, really depressions or cul-de-sacs of the skin itself, are lined by epithelial cells and connective tissue. so closely does the epidermal portion of the follicle invest the hair root that it is often dragged out with it, and is known as the _root sheath_. this is made up of an outer layer of columnar cells (_the outer root sheath_) corresponding to the malpighian layer of the epidermis, and of an inner horny layer, next to the hair, corresponding to the more superficial layer of the epidermis, and known as the _inner root sheath_. the hair grows from the bottom of the follicle by a multiplication of the cells covering the papilla upon which its root is moulded. when a hair is cast off a new one is produced from the cells covering the papilla, or, in case of the death or degeneration of the original papilla, the new hair is produced from a second papilla formed in place of the first at the bottom of the follicle. [illustration: fig. .--section of skin with hair follicle and hair. _a_, the hair follicle; _b_, the hair root; _c_, the medulla; _d_, the hair cuticle; _e_, the outer root sheath; _f_, the inner root sheath; _g_, the papilla from which the hair is growing; _h_, a sebaceous gland; _i_, a sudoriferous gland.] the sebaceous glands are small saccular glands with their ducts opening into the mouths of the hair follicles. they furnish a natural lubricant to the hairs and the skin. the sudoriferous or sweat glands are composed of coiled tubes which lie in the deeper portion of the skin, and send up a corkscrew-like duct to open on the surface of the epidermis. they are numerous over the whole of the body. [illustration: fig. .--longitudinal section through nail and nail-bed of a human foetal finger.[a] _a_, the nail; _b_, the rete mucosum; _c_, the longitudinal ridges of the corium.] [footnote a: seeing that the section is a longitudinal one, it would appear from the way the ridges cut that they are running transversely beneath the nail. their extreme delicacy, however, prevents a single one showing itself along the length of the section, and their constant accidental cutting makes them _appear_ to run transversely (h.c.r.).] the human nails are thickenings of the lowermost layer of the horny portion of the epidermis, the stratum lucidum. they are developed over a modified portion of the corium known as the nail-bed. the horny substance of the nail is composed of clear horny cells, and rests immediately upon a malpighian layer similar to that found in the epidermis generally. instead of the papillæ present elsewhere in the skin, the corium of the nail-bed is marked by longitudinal ridges, a similar, though less distinct, arrangement to that found in the laminæ of the horse's foot. having thus paved the way, we are now in a better position to discuss our original question (are the horny laminæ secreted by the sensitive?), and better able to appreciate the work that has been done towards the elucidation of the problem. a most valuable contribution to this study is an article published in by professor mettam.[a] here the question is dealt with in a manner that must effectually silence all other views save such as are based upon similar methods of investigation--namely, histological examination of sections of equine hoofs in various stages of foetal development. [footnote a: the _veterinarian_, vol. lxix., p. .] professor mettam commences by drawing attention to the error that has been made in this connection by studying the soft structures of the foot separated by ordinary putrefactive changes from the horny covering. "in this way," the writer points out, "a wholly erroneous idea has crept in as to the relation of the one to the other, and the two parts have been treated as two anatomical items, when, indeed, they are portions of one and the same thing. as an illustration, and one very much to the point at issue, the soft structures of the foot are to the horny covering what the corium of the skin and the rete malpighii are to the superficial portions of the epidermis. indeed, the point where solution of continuity occurs in macerating is along the line of the soft protoplasmic cells of the rete." in the foregoing description of the skin we have seen that the corium is not a _plane_ surface, but that it is studded by numerous papillary projections, and that these projections, with the depressions between them, are covered by the cells of the epidermis. the corium of the horse's foot, however, although possessed of papillæ in certain positions (as, for example, the papillæ of the coronary cushion, and those of the sensitive frog and sole), has also most pronounced ridges (laminæ) which run down the whole depth of the os pedis. each lamina again carries ridges (laminellæ) on its lateral aspects, giving a section of a lamina the appearance of being studded with papillæ. we have already pointed out the ridge-like formation of the human nail-bed, and noted that, with the exception that the secondary ridges are not so pronounced, it is an exact prototype of the laminal formation of the corium of the horse's foot. the distribution of the laminæ over the foot we have discussed in the chapter devoted to the grosser anatomy. in a macerated foot the sensitive laminæ of the corium interdigitate with the horny laminæ of the hoof; that is to say, there is no union between the two, for the simple reason that it has been destroyed; they simply interlock like the _unglued_ junction of a finely dovetailed piece of joinery. but no further, however, than the irregularities of the underneath surface of the epidermis of the skin can be said to interlock with the papillæ of the corium does interlocking of the horny and sensitive laminæ occur. it is only apparent. the horny laminæ are simply beautifully regular epidermal ingrowths cutting up the corium into minute leaf-like projections. in a macerated specimen, then, the exposed sensitive structures of the foot exhibit the corium as ( ) the _coronary cushion_, fitting into the cutigeral groove; ( ) the _sensitive laminæ_, clothing the outer surface of the terminal phalanx, and extending to the bars; ( ) the _plantar cushion_, or sensitive frog; and ( ) the _sensitive sole_. the main portion of the wall is developed from the numerous papillæ covering the corium of the coronary cushion. we have in this way numberless down-growing tubes of horn. professor mettam describes their formation in a singularly happy fashion: "let the human fingers represent the coronary papillæ, the tips of the fingers the summits of the papillæ, and the folds of skin passing from finger to finger in the metacarpo-phalangeal region the depressions between the papillæ. imagine that all have a continuous covering of a proliferating epithelium. then we shall have a more or less continuous column of cells growing from the tip of the finger or papilla (a hollow tube of cells gradually moving from off the surface of the finger or papilla like a cast), and similar casts are passing from off all the fingers or papillæ." from this description it will be noticed that each down-growing tube of horn bears a striking resemblance to the growth of a hair, described on p. . in fact, the horn tube may be regarded as what it really is, a modified hair. we next continue professor mettam's illustration, and note how the modified hairs or horn tubes become as it were matted together to form the hoof wall. the cells lining the depressions are also proliferating, and their progeny serve to cement together the hollow casts of the papillæ, thus giving the _inter_-tubular substance. we have thus produced hollow tubes, united together by cells, all arising from the rete malpighii of the coronary corium. section of the lower part of the horn tubes shows them to contain a cellular debris. thus, in all, in the horn of the wall we find a tubular, an intertubular, and intratubular substance. in fact, hairs matted together by intertubular material, and only differing from ordinary hairs in their development in that they arise, not from papillæ sunk in the corium, but from papillæ projecting from its surface. although this disposes of the wall proper, there still confronts us the question of the development of the horny laminæ. to accurately determine this point it is absolutely essential to examine, histologically, the feet from embryos. in the foot of any young ungulate in the early stages of intra-uterine life horizontal sections will show a covering of epidermis of varying thickness.[a] this may be only two or three cells thick, or may consist of several layers. lowermost we find the cells of the rete malpighii. as some criterion of the activity with which these are acting, it may be noted that with the ordinary stains their nuclei take the dye intensely. the cells of this layer rest upon a basement membrane separating the epidermis from the corium. at this stage _the corium has a perfectly plane surface_. [footnote a: equine foetus, seventy-seven days old.] [illustration: fig. .--section of foot of equine foetus, seventy-seven days old. the rete malpighii rests on a plane corium; the rent in the section is along the line of the cells of the rete (mettam).] [illustration: fig. .--section from foot of sheep embryo. it shows a pronounced epithelial ingrowth into the corium (mettam).] the next stage will demonstrate the first step in the formation of the sensitive laminæ.[a] the plain surface of the corium has now become broken up, and what is noticed is that the broken-up appearance is due to the epithelial cells irrupting and advancing _en échelon_ into its connective tissue. each point of the ingrowing lines of the _échelon_ has usually one cell further advanced into the corium than its neighbours, and may be termed the _apical cell_. the fine basement membrane separating epithelium from corium is still clearly evident. this epidermal irruption of the corium takes place at definite points right round the foot. it is extremely probable, however, that it commences first at the toe and spreads laterally. [footnote a: sheep embryo, exact age unknown.] as yet, these cellular ingrowths (which are destined to be the _horny_ laminæ, and cut up the corium into _sensitive_ laminæ) are free from irregularities or secondary laminæ. before these are to be observed other changes in connection with the ingrowths are to be noticed. [illustration: fig. .--section from calf embryo. the epithelial ingrowths hang down from the epidermis into the corium like the teeth of a comb (mettam).] the first is merely that of elongation of the epithelial processes into the connective tissue, until the rete malpighii gives one the impression that it has hanging to its underneath surface and into the corium a number of thorn-like processes. these extend all round the front of the foot, and even in great part behind. accompanying this elongation of the processes is a condensation of the epithelial cells immediately above the rete malpighii, with a partial or total loss of their nuclei. this is the first appearance of true horn, and its commencement is almost coincident with the first stages of ossification of the os pedis. [illustration: fig. .--section of an epithelial ingrowth from an equine foetus. it shows commencing secondary laminar ridges. in the centre are epithelial cells which are undergoing change into horny elements to form the horn core, or 'horny laminæ' (mettam).] with the appearance of horn comes difficulty of sectioning. the last specimen that professor mettam was able to satisfactorily cut upon the microtome was from a foetus between three and four months old. in this the secondary laminar ridges were clearly indicated, and the active layer of the rete malpighii could be traced without a break from one ingrowing epithelial process to the next, and around this, following all the irregularities of its outline, and covering the branches of the nascent laminæ. the laminæ mostly show this branching as if a number of different growing points had arisen, each to take on a function similar to the epithelial process as it at first appeared. in the centre of the processes a few nuclei may be observed, but they are scarce, and stain only faintly; they have arisen from the cells of the rete malpighii which have grown into the corium. in fact, the active cells are passing their daughters into the middle of the process, and these pass through similar stages as those derived from the ensheathing epidermis. in other words, the daughter cells of the constituents of the rete malpighii which have grown into the corium pass through a degeneration precisely similar to that undergone by cells shed at desquamation, or those which eventually give rise by their agglutination to a hair. this is the real origin of the horny laminæ, and the thickness of these is increased merely by an increase in the area covered by the cells of the rete malpighii--i.e., by the development of secondary laminar ridges. if a section from a foal at term be examined, the processes will be found far advanced into the corium, and, occupying the axis of each process, will be seen a horny plate, continuous with the horn of the wall. no line of demarcation can be observed between the horn so formed and the intertubular material of the wall. they merge into and blend with each other, with no indication of their different origins. the cells that have invaded the corium have thus _not lost their horn-forming function_. there has merely been an increase in the area for horn-producing cells. the horny processes are continuous with the hoof proper at the point where the epithelial ingrowth first commenced to invade the corium, and fuses here with the horn derived from the cells of the rete malpighii which have _not_ grown inwards, and which are found between the processes in the intact foot. from this it is clear that some considerable portion of the horn of the wall is derived from the cells of the rete malpighii covering the corium of the foot. it becomes even more clear when we remember the prompt appearance of horn in cases where a portion, or the whole, of the wall has been removed by operation or by accident (see reported cases in chapter vii.). the activity of the cells of the rete malpighii of the corium covering the remainder of the foot will be quite as necessary as the activity of the cells of the coronary papillæ which form the horn tubes themselves. 'for,' in professor mettam's own words, 'i am inclined to believe that much of the "white line" which is found uniting the wall of the hoof to the sole has been derived from the horn formed from the rete of the foot corium. this origin will explain the absence of pigment from this thin uniting "line," as it does from the horn lining the interior of the wall. the cells of the rete are free of colouring matter.' [illustration: fig. .--section through hoof and soft tissues of a foal at term. the horn of the wall is shown, and the horn-core ('horny laminæ') of the epithelial ingrowth. the latter has advanced far into the corium, and is now provided with abundant secondary laminar ridges (mettam).] from the matter here given us it is easy to understand how, in a macerated foot, the appearance is given of interlocking of the sensitive and horny laminæ. we see that the horny laminæ are ingrowths of the rete malpighii, ploughing into and excavating the corium into the shape of leaves--the sensitive laminæ. putrefactive changes simply break into two separate portions what originally was one whole, by destroying the cells along its weakest part. this part is the line of soft protoplasmic cells of the rete malpighii. thus the more resistant parts (the horn on the one hand, and the corium covering the foot on the other) are easily torn asunder. as a result of the evidence we have quoted, we are able to answer our original question in the affirmative. seeing that the horny and the sensitive laminæ are both portions of the same thing--namely, a modified skin, in which the epidermis is represented by the horny laminæ, and the corium by the sensitive--it is clear to see that the cells covering the inspreading horny laminæ are dependent for their growth and reproduction upon the cells with which they are in immediate contact--namely, those of the sensitive laminæ--and that therefore the sensitive laminæ are responsible for the growth of the horny. b. chemical properties and histology of horn. horn is a solid, tenacious, fibrous material, and its density in the hoof varies in different situations. it is softened by alkalies, such as caustic potash or soda and ammonia, the parts first attacked being the commissures, then the frog, and afterwards the sole and wall. strong acids, such as sulphuric acid and nitric acid, also dissolve it. the chemical composition of the hoof shows it to be a modification of albumin, its analysis yielding water, a large percentage of animal matter, and materials soluble and insoluble in water. the proportions of these, as existing in the various parts of the hoof, have been given by professor clement as follows: wall. sole. frog. water . . . fatty matter . . . matters soluble in water . . . insoluble salts . . . animal matter . . . horn appears to be identical with epidermis, hair, wool, feathers, and whalebone, in yielding 'keratin,' a substance intermediate between albumin and gelatine, and containing from to per cent. of sulphur. that horn is combustible everyone who has watched the fitting of a hot shoe knows. that it is a bad conductor of heat, the absence of bad after-effects on the foot testifies. [illustration: fig. .--perpendicular section of horn of wall.] in a previous page we have described the manner of growth of the horn tubules, and noted the direction they took in the wall; also, we have noticed the existence between them of an intertubular horn or cement. those who wish to give this subject further study will find an excellent series of articles by fleming in the _veterinarian_ for . we shall content ourselves here with introducing one or two diagrams and photo-micrographs, and dealing with the histology very briefly. under the microscope the longitudinal striation of the wall is found to be due to the direction taken by the horn tubules. fig. is a magnified perpendicular section of the wall. in it the parallel dark striæ are the horn tubules in longitudinal section. the lighter striæ represent the intertubular material. fig. gives us the wall in horizontal section. to the left of this picture we find the horn tubules cut across, and standing out as so many concentrically ringed circles. in the centre of the figure are seen the horny laminæ, with their laminellæ, and the sensitive laminæ. the right portion of the figure pictures the corium. [illustration: fig. .--horizontal section of horn of wall.] fig. is, again, a horizontal section, cut this time at the junction of the wall with the sole. to the left are seen, again, the horn tubules of the wall, and to the centre the horny laminæ. in this position, however, the structures interdigitating with the horny laminæ are not sensitive, but are themselves horny. as the diagram shows, they contain regularly arranged horn tubules cut across obliquely. it is this horn which forms the 'white line.' to the extreme right of the figure are seen the horn tubules of the sole. there remains now but to notice the arrangement of the horn tubules in the frog. the peculiar, indiarubber-like toughness of this organ is well known. histological examination gives a reason for this. [illustration: fig. .--horizontal section of horn through the junction of the wall with the sole. _a_, horn tubule of the wall; _b_, horn tubule of the sole; _c, d_, horny laminæ.] [illustration: fig. .--section of frog through corium and horn. the long finger-like projections of corium into epidermis are sections of the long papillæ from which the horn-tubes of the sole grow. in the stainable portion of the epidermis are to be clearly seen light and dark streaks pointing out the alternate strata-like arrangement of cells mentioned in the text (mettam).] the horn tubules of the frog are sinuous in their course. this is accounted for by the fact that in the horn of the frog there is a large amount of intertubular material, this having the effect of frequently turning the horn tubules from the straight. in addition to this, the intertubular material has a peculiar arrangement of the cells composing it. these are laid down in alternating striæ ( ) of cells with their long axes longitudinal, and ( ) of cells with their long axes horizontal. this is seen in fig. , between the long papillæ of the corium, where the lines of longitudinally arranged cells in horizontal section stand out darker than the adjoining strata in which their arrangement is horizontal. the tortuous direction of the horn tubules, and the almost interlocking nature of the alternating strata of the intertubular material, together combine to give the frog its characteristic toughness and resiliency. c. expansion and contraction of the hoof. among other questions productive of heated argument come those relating to expansion of the horse's hoof. in the past many observers have strenuously insisted on the fact that expansion and contraction regularly occur during progression. opposed to them have been others equally firm in the belief that neither took place. quite within recent times this question also has been settled once and for all by the experiments of a. lungwitz, of dresden. his conclusions were published in an article entitled 'changes in form of the hoof under the action of the body-weight.'[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. iv., p. . the whole of the matter in this article, from which we have borrowed figs. and , is too long for reproduction here. it forms, however, most instructive reading, and its careful perusal will well repay everyone interested in this most important question (h.c.r.).] in connection with this it is interesting to note how, all unconsciously, two separate observers were simultaneously arriving by almost identical means at an equally satisfactory answer to the question. prior to the publication of lungwitz's article on the subject, colonel f. smith, a.v.d., had arrived at similar conclusions by working on the same methods. [illustration: fig. . i. electric bell with dry element. a, under part, with box, for the dry element; , roller for winding up the conducting-wires; c, dry element, with screw-clamp for attachment of the conducting-wires; c', conducting-wire leading to the screw-clamp, with contact-spring in c', fig. , or to the wall in fig. ; d, upper part, with bell; d', conducting-wire to the shoe d' in figs. and ; e, strap for slinging the apparatus around the body of the assistant or rider; f, connecting-wire between bell and dry element.] [illustration: fig. . ii. hoof shod with shoe provided with toe-piece and calkins; wall of the hoof covered with tinfoil. a, heel angle, with b, the contact-screws; c, screw-clamp, with contact-spring (isolated from the shoe); c' conducting-wire from the same; d, screw-clamp, with conducting-wire (d') screwed into the edge of the shoe; e, nails isolated by cutting a small window in the tinfoil.] [illustration: fig. . iii. hoof shod with plain shoe; horny wall covered with tinfoil. a, toe and heel angle, with b, the contact-screws; c, conducting-wire passing from the tinfoil on the wall; d, conducting-wire passing from the shoe; c', d', ends of the conducting-wires, which must be imagined connected with the ends c', d', passing from the apparatus.] it is unnecessary for our purpose here to minutely describe the exact _modus operandi_ of these two experimenters. briefly, the method of inquiry adopted in each case was the 'push and contact principle' of the ordinary electric bell, and the close attention which was paid to detail will be sufficiently gathered from figs. and . [illustration: fig. . i. left fore-foot shod and mounted to recognise the sinking of the sole. _a_, iron plate covering the inner half of the horny sole; _b_, openings in the same, with screw-holes for the reception of the contact-screw _c_ (the part of the sole under the plate is covered with tinfoil, which at _d_ passes out under the outer branch of the shoe, and becomes connected with the tinfoil of the wall; in order to give the freshly applied tinfoil a better hold, copying-tacks are at _e_ passed through it into the horn, and one is similarly used to protect the tinfoil at the place where the contact-screw touches the latter); _f_, holes with screw thread for the fastening of the angle required to measure the movement of the wall, and also for the fastening of the conducting-wire, _g; h_, conducting-wire passing from the tinfoil; _i_, isolated nails.] [illustration: fig. . ii. bar-shoe with openings. _a_, near the inner margin and in the longitudinal bar; _b_, for the reception of the contact-screw _c; d_, openings for fastening the angle and the conducting-wires.] after numerous experiments with the depicted contact-screws, moved to the various positions indicated in the drawings, the following conclusions were arrived at: . behaviour of the coronary edge.--during uniform weighting of all four hoofs the coronary edge shows a tendency to contraction in the anterior and lateral regions of the hoof, and a tendency to expansion posteriorly. with heavy weighting of the hoof, which is shown by a backward inclination of the fetlock, contraction in the anterior and lateral regions is slight, but the expansion behind, in the region of the heels, is distinct, commencing gradually in front, becoming stronger, and diminishing again posteriorly. the coronary edge of the heels becomes slightly bulged outwards. the bulbs of the heels swell up and incline a little backwards and downwards. when the fetlock is raised the expansion of the coronary edge of the heels disappears from behind forwards, passing forwards like a fluid wave. in the lateral and anterior regions of the coronary edge the contraction disappears; and when the weight is thrown off the foot it passes into a gentle expansion of the coronary edge of the toe. during the opposite movement of the fetlock, that of sinking backwards, this change of form is executed in the converse manner. in short, the coronary edge resembles a closed elastic ring, which yields to pressure, even the most gentle, of the body-weight, in such a way that a bulging out of any one part is manifested by an inward movement of another part. in fig. , _b_, the dotted line represents the changes of form in comparatively well-formed and sound hoofs at the moment of strongest over-extension[a] of the fetlock-joint. [footnote a: the term 'over-extension,' as employed by lungwitz, is intended to indicate that position assumed by the fetlock-joint when the opposite foot is raised from the ground.] . behaviour of the solar edge.--under the action of the body-weight this is somewhat different from that of the coronary edge. anteriorly, and at the sides, as far as the wall forms an acute angle with the ground, the tendency to expansion exists, but the change of form first becomes measurable in the region where the lateral cartilages begin. quite posteriorly the expansion again diminishes. fig. , _a_, by the dotted line represents the expansion at the moment of over-extension of the fetlock-joint. this expansion is itself rather less than at the coronary edge, and it shows itself distinctly _only when the weighted hoof is exposed to a counter-pressure on the sole and frog_, no matter whether the counter-pressure is produced naturally or artificially. thus anything tending to the removal of the pressure from below, such as a decayed condition of the frog or excessive paring in the forge, will diminish the extent of expansion of the solar edge. contraction of the solar edge of the heels occurs at the moment of greatest over-extension of the fetlock-joint--that is, in a foot with pressure from below absent. on the face of it, this appears impossible. lungwitz, however, has perfectly demonstrated it; and, when dealing with the functions of the lateral cartilages in a later paragraph, we shall show reason for why it is but a simple and natural result of the foot dynamics. . behaviour of the sole.--the horny sole becomes flattened under the action of the body-weight. this is most distinct at the solar branches, and gradually shades off anteriorly and towards the circumference. as might be supposed, width of hoof and thickness of the solar horn exert an influence on the extent of this movement. the sinking of the horny sole is most marked in flat hoofs. d. the functions of the lateral cartilages.[a] [footnote a: extracted from a paper by j.a. gilruth, m.r.c.v.s., in the _veterinary record_, vol. v., p. .] we have just referred to contraction of the heels as taking the place of a normal expansion in those cases where ground frog-pressure was absent. we shall readily understand this when we bear in mind the anatomy of the parts concerned, especially that of the plantar cushion. this wedge-shaped structure we have already described as occupying the irregular space between the two lateral cartilages, the extremity of the perforans tendon, and the horny frog. now, when weight or pressure is exerted from above on to this organ, and the _frog is in contact with the ground below_, it is clear from the position the cushion occupies that, whatever change of form pressure from above will cause it to take, it must certainly be limited in various directions. [illustration: fig. . _a_, the dotted lines in this diagram represent the expansion of the solar edge of the hoof at the moment of over-extension of the fetlock-joint; _b_, the dotted line represents the change in form of the coronary edge under similar circumstances.] because of the shape of the cushion its change of form cannot be forwards (simultaneous pressure from above and below on to this wedge with its apex forwards must tend to give it a backward change of form). because of the pastern being horizontal, and aiding in the downward pressure, its change of form cannot be upwards. and because of the ground it cannot be downwards. it follows, therefore, that the movement must be backwards and outwards, being especially directed outwards because of its shape and the median lacuna in its posterior half--this latter, the lacuna, accommodating as it does the frog-stay, preventing the tendency to backward movement becoming excessive, and directing the change of form to the sides. where the greatest pressure is transmitted, then, is to the inner aspects of the flexible lateral cartilages. the coronary cushion being continuous with the plantar, the backward and outward movements of the latter will tend to pull upon and tighten the former, especially _in front_. this will account for the contraction noted by lungwitz in the _anterior half_ of the coronary edge of the hoof. remove the body-weight, and naturally the elastic nature of the lateral cartilages and the coronary and plantar cushions, with, in a less degree, that of the hoof, cause things to assume their normal position. repeat the weighting of the hoof, in this second case _without frog-pressure_, and we shall see at once that we have done away with one of the greatest factors in determining the outward and backward movements of the plantar cushion--namely, the pressure from below on its wedge-shaped mass. the movement of the plantar cushion will now be _downwards_ as well as backwards; and, seeing that it is attached to the inner aspect of each lateral cartilage, we shall expect these latter, by the downward movement of the plantar cushion, to be drawn _inwards_. this lungwitz has shown to occur. the chief function of the lateral cartilages, therefore, is to _receive the concussion engendered by locomotion_, which concussion is directed backwards and outwards by the pad-like plantar cushion. in addition to this, the lateral cartilages, together with the plantar and coronary cushions, _play the part of a valve to the whole of the veins of the foot_. it is in this way: we have only to refer to the chapter on anatomy to see that the whole of the foot is covered with a tissue of extreme vascularity. thus we find papillæ--the over the coronary cushion; enlarged and modified papillæ sensitive laminæ--covering the anterior face of the os pedis; and numberless papillæ again covering the sole. there can be no doubt that the quantity of fluid brought by the bloodvessels of these papillæ to the foot acts largely as a means of hydraulic protection to the soft structures.[a] in like manner as that delicate organ, the brain, is best protected by being floated upon the cerebro-spinal fluid and bloodvessels (which fluids transmit waves of concussion or pressure _through_ the organ without injury to the delicate cells forming it), so, in like manner, does the extreme vascularity of the foot protect the cells of its softer structures from the effects of pressure and concussion. [footnote a: the _veterinary record_, vol. iii., p. .] that this law of hydraulics may operate in the horse's foot to the best advantage, the veins must be provided with valves, and valves of no mean strength. these we know to be absent. it is here that the lateral cartilages and the elastic substances of the coronary and plantar cushions step in to supply the deficiency. at the time when weight is placed upon the foot (with, of course, a tendency to drive the blood upwards in the limb), and, therefore, the time when a valvular apparatus is needed to retain the fluid in the foot, we find the wanting conditions supplied by the pressure outwards of the plantar cushion compressing the large plexuses of veins on each side of the lateral cartilages, to which plexuses, it will be remembered, the bulk of the venous blood from the foot was directed. a more perfect valvular apparatus, automatic and powerful, it would be difficult to imagine. e. growth of the hoof. we will conclude this chapter with a few brief remarks on the growth of the hoof. that the rate of growth is slow is a well-known fact to every veterinarian, and it will serve for all practical purposes when we state that, roughly, the growth of the wall is about / inch per month. this rate is regular all round the coronet, from which it follows that the time taken for horn to grow from the coronary edge to the inferior margin will vary according as the toe, the quarters, or the heels are under consideration. as might naturally be expected, the rate of growth will depend on various influences. any stimulus to the secreting structures of the coronet, such as a blister, the application of the hot iron, or any other irritant, results in an increased growth. growth is favoured by moisture and by the animal going unshod, as witness the effects of turning out to grass. exercise, a state of good health, stimulating diets--in fact, anything tending to an increased circulation of healthy blood--all lead to increased production of horn. with the effects of bodily disease and of ill-formed legs and feet on the wear of the hoof, and the growth of horn, we shall be concerned in a future chapter. chapter iv method of examining the foot as a general rule, it may be taken that most diseases of the foot are comparatively easy of diagnosis. when, however, the condition is one which commences simply with an initial lameness, the greatest care will have to be exercised by the practitioner. what remarks follow here should rightly be confined to a treatise on lameness. this much, however, we may state: as compared with lameness arising from abnormal conditions in other parts of the limb, that emanating from abnormalities of the foot is easy of detection. with a case of lameness before him, concerning which he is in doubt, the practitioner remembers that a very large percentage may safely be referred to the foot, and, if wise, subjects the foot to a rigorous examination. much may be gathered by first putting the animal through his paces. when at a trot, notice the peculiarity of the 'drop,' whether any alteration in going on hard or soft ground, and watch for any special characteristic in gait. at the same time inquiry should be made as to the history of the case; its duration; whether pain, as evidenced by lameness, is constant or periodic; the effect of exercise on the lameness; and the length of time elapsed since the last shoeing. this failing to reveal adequate cause for the lameness in any higher part of the limb, one is led, by a process of negative deduction, to suspect the foot. if 'pointing' is a symptom, its manner is noticed. the foot is compared with the other for any deviation from the normal. in some cases the two fore or the two hind feet may differ in size. though this may not necessarily indicate disease, it may, nevertheless, be taken into account if the lameness is not easily referable to any other member. measurement with calipers will then be of help, and a pronounced increase in size, especially if marked in one position only, given due consideration. the hand is used upon each foot alternately to look for change of temperature, to detect the presence of growths small enough to escape the eye, and to discover evidence of painful spots along the coronet. at this stage the method of percussion recommends itself, and in many cases no more useful diagnostic agent is to be found than the ordinary hammer. as a preliminary, the foot of the sound limb should be always tapped first. this precaution will serve to bring to light what is frequently met with--the aversion nervous animals sometimes exhibit to this manner of manipulation of the hoof. unless this is done, the ordinary objection to interference is apt to be read as evidence of pain. no aversion to the method being shown, the suspected foot is gently tapped in various places round the wall, a keen look-out being kept for any manifestation of tenderness. this may vary from a slight resentment to each tap, indicated by a sudden lifting and setting down again of the foot, to a complete removal of the foot from the ground, and a characteristic pawing of the air that points out clearly enough the seat of pain. evidence of pain once given, the tapping is persisted in until, in some cases, the exact position of the tender spot is definitely located. failing evidence obtained from percussion, attention should next be given to the shoeing. we may add here that, even when difficulties have to be encountered in doing it, it is always a wise plan to have the shoe removed. the nails should be removed one by one, the course they have taken, their point of emergence on the wall, and the condition of their broken ends all being carefully noted as they are withdrawn. the removed shoe should next be examined as to the coarseness or fineness of its punching and the 'pitch' of its nail-holes, and close attention given to the shape of its bearing surface. from that we may pass to a consideration of the underneath surface of the foot. the drawing-knife should be run lightly over the whole of its surface, the first thing to be noticed being the point of entrance of the nails as compared with the coarseness or fineness of the punching, and the staining or otherwise of the horn immediately around. we may thus be guided towards mischief arising from tight nailing apart from actual prick of the foot. this done, more than usual care should be taken in following up any other small prick or dark spot that may show itself upon the white surface of the cleaned sole. in any case, a suspicious-looking speck should be followed up with the searcher until it is either cut out or is traced to the sensitive structures. while this is done, we should also have noticed the condition of the horn at the seat of corn; should have noticed the shape of the heels, contracted or otherwise; and the appearance of the frog, clean or discharging. a point to be remembered in making this exploratory paring of the foot is the peculiar consistency of the horn of the frog, and its tendency to hide the existence of punctures. in like manner, as a pin pierces a piece of indiarubber, and leaves no clearly visible trace of the hole it has made, so does a nail or other sharp object penetrate the frog, leaving but little to show for the mischief that has been done. after all, even though we may have fully decided the foot is at fault, our case of lameness may remain obscure so far as a cause is concerned. nothing remains, then, but to acknowledge the inability to discover it, to advocate poulticing, or some other expectant palliative measure, and to bring the case up for further examination at no distant date. where, though we may have suspected the foot, we have not been able to definitely assure ourselves that there the mischief is to be found, a further method of examination presents itself--namely, subcutaneous injections of cocaine along the course of the plantar nerves. the salt of cocaine used is the hydrochlorate, - / grains for a pony, grains for a medium-sized animal, and grains for a large horse. a solution of this is made in boiled water (about drams), and injected at the seat of the lower operation of neurectomy. it is advisable to first render aseptic the seat of operation, and to sterilize both the needle and the syringe by boiling. a suitable point to choose for the injection is exactly over the upper border of the lateral faces of the two sesamoids, the needle being introduced behind the cord formed by the nerve and accompanying vessels, and parallel with it. it is possible that the vein or the artery may be wounded, but such accident is of little importance. all that is necessary in that case is to partly withdraw the needle and again insert it. it is advisable to use a twitch. when the needle is in position, the injection should be made slowly, and at the same time the point of the needle should be made to describe a semicircular sweep, so as to spread the solution over as wide an area as is possible. anæsthesia ensues in from six to twenty minutes, and if the cause of the lameness is below the point of injection the animal moves sound. regarding this method of diagnosis, professor udriski of bucharest, after a series of trials, sums up as follows: . for the diagnosis of lameness cocaine injections are of very considerable value. . these injections should be made along the course of the nerves. . solutions heated to ° or ° c. produced quicker, deeper, and longer anæsthesia than equally strong cold solutions. . in the sale of horses cocaine injections conceal fraud. cocaine being an irritant, it must be remembered that after the anæsthesia the lameness is somewhat more marked than before. to the cocaine other practitioners add morphia in the following proportions: cocaine hydrochlorate - / grains. morphia - / " aqua destil - / drams. as a diagnostic this mixture of the two is said to be far superior to either cocaine or morphia alone. in connection with this subject, professor hobday has published, among others, the following cases illustrating the practical value of this method of diagnosis:[a] [footnote a: the _journal of comparative pathology and therapeutics_ vol. viii., pp. , .] case i.--cab gelding. seat of lameness somewhat obscure; navicular disease suspected. injected grains of cocaine in aqueous solution on either side of the limb, immediately over the metacarpal nerves. _five minutes_.--lameness perceptibly diminished. _ten minutes_.--lameness scarcely perceptible. case ii.--mare. obscure lameness; foot suspected. injected minims of a per cent. solution on either side of the leg just above the fetlock. _ten minutes_.--no lameness, thus proving that the seat of lameness was below the point of injection. case iii.--cab gelding, aged, free clinique; messrs. elme's and moffat's case. obscure lameness; foot suspected of navicular disease; very lame. injected minims of a per cent. solution of cocaine on either side of the leg over the metacarpal nerves. _six minutes_.--lameness perceptibly less; there was no response whatever on the inside of the leg to the prick of a pin. on the outside, which had not been injected so thoroughly, there was sensation, although not so much as in a healthy foot. _ten minutes_.--lameness had almost disappeared; so much so, that the opinion as to navicular disease was confirmed, and neurectomy was performed. immediately after this operation there was no lameness whatever. the same author also reports numerous cases among horses and cattle, dogs and cats, pointing out the toxic properties of the drug. the symptoms following an overdose are interesting enough to relate here, and i select the following case of professor hobday's as being fairly typical:[a] [footnote a: _loc. cit_.] case iv.--cart gelding. free clinique; navicular disease. injected subcutaneously over the metacarpal nerves on each side grains of cocaine in aqueous solution. during the operation the animal manifested no signs of pain whatever, not even when the nerve was cut. this animal received altogether grains of cocaine ( grains were given on either side first, then fifteen minutes afterwards the same dose repeated). the effect was manifested on the system in ten minutes after the second injection by clonic spasms of the muscles of the limbs (the legs being involuntarily jerked backwards and forwards at intervals of about twenty seconds), which materially interfered with the performance of the operation. the animal was also continually moving the jaws, and was very sensitive to sounds, moving the ears backwards and forwards. this hyperæsthesia, as evinced by the movement of the ears, lasted for some considerable time after the animal had been allowed to get up. cocaine hydrochlorate solutions, if intended to be kept for any length of time, should have added to them when freshly made / part of boric acid in order to preserve them. even then they are liable to spoil, and should, for subcutaneous injection, be made up just before needed for use. chapter v general remarks on operations on the foot a. methods of restraint. many of the simple operations on the foot, such as the probing of a sinus, the paring out of corns, or the searching of pricks, may most suitably be performed with the animal's leg held by the operator as a smith holds it for shoeing. according to the temperament of the animal, even the operation for the removal of a portion of the sole, or the injection of sinuses with caustics, may be carried out with the animal simply twitched. when the operation is still a simple one, casting inconvenient or impossible, and the animal restive, the twitch must be supplemented by some other method. the most simple and one of the most effective is the blind, cap, or bluff (fig. ). with it the most vicious animal or the most nervous is in many instances either cowed into submission or soothed into quietness. at the same time, more forcible means than the operator's own strength must be taken to hold the animal's foot from the ground. if the foot is a fore-foot, and the point desired to be operated on is to the outside, the pastern should be firmly lashed to the forearm by means of a thin, short cord, or a leather strap and buckle. much may then be done in the way of paring and probing that would otherwise be impossible. [illustration: fig. --the blind.] [illustration: fig. --the side-line.] if the foot is a hind one, one of the many methods of using what is termed by liautard, in his 'manual of operative veterinary surgery,' the plate-longe, must be adopted. this, in its most useful form, is a length of closely-woven cotton webbing, from about to - / inches wide, and from to yards long, provided with a small loop formed on one of its ends, and perhaps better known to english readers as a 'side-line.' if webbing be not available, a length of soft cotton rope, or a rope plaited and sold for the purpose, as fig. , will serve equally well. one of the most convenient methods of using the side-line for securing the hind-foot is depicted in figs. and . [illustration: fig. .--the side-line adjusted preparatory to securing the near hind-foot.] [illustration: fig. .--the near hind-foot secured with the side-line.] here the side-line has formed upon it a loop sufficiently large to form a collar. this is placed round the animal's neck, the free end of the line run round the pastern of the desired foot, and the foot drawn forward, as in fig. . the loose end of the line is then twisted once or twice round the tight portion, and finally given to an assistant to hold (see fig. ). the foot is thus held from the ground, and violent kicking movements prevented. where the operation is a major one, restraint of a distinctly more forcible nature becomes imperative. many of the more serious operations can most advantageously be performed with the patient secured in some form or other of stock or trevis, and the foot suitably fixed. it is not the good fortune of every veterinary surgeon, however, to be the lucky possessor of one of these useful aids to successful operating. perforce, he must fall back on casting with the hobbles (fig. ). [illustration: fig. .--casting hobbles.] with the use of these we will assume our readers to be conversant, and will imagine the animal to be already cast. it remains, then, but to detail the most suitable means for firmly fixing the foot to be operated on. here the side-line is again brought into use. care should previously have been taken when casting to throw the animal so that the portion of the foot to be operated on, whether inside or outside, falls uppermost, and that the buckle of the hobble on that particular foot is placed so that it also is within easy reach when the animal is down. in the case we are illustrating the point of operation was the outside of the near hind coronet. we will, therefore, describe the mode of fixing the near hind-foot upon the cannon of the near fore-limb. [illustration: fig. .--photograph illustrating method of adjusting the side-line preparatory to fixing the hind-leg upon the fore.] the side-line is first adjusted as follows: it is fixed upon the cannon of the near hind-leg (a) by means of its small loop. from there it is passed under the forearm of the same limb, over the forearm, under the rope running from a to b; from there over and under the thigh, to be finally brought in front of the thigh, and below the portion of rope running from arm to thigh. the loose end of the side-line is then given to an assistant standing behind the animal's back, the buckle of the hobble restraining the foot unloosed, and strong but steady traction brought to bear from behind upon the line. the operator should now stand in front of the fore-limbs, and, by placing a hand on the rope passing round the arm, prevent the line from slipping below the knee. by this means the hind-limb is pulled forward until the foot projects beyond the cannon of the front-limb. when that position is reached, the operator grasps the hock firmly with one hand, and, directing the side-line to be slackened, gently slides downward the coils of rope round the arm and thigh until they encircle the cannons of both limbs. the cannon of the hind-limb is firmly lashed to the cannon of the fore, and the foot firmly and securely fixed in the best position for operating (see fig. ). [illustration: fig. .--photograph showing the near hind-foot secured upon the cannon of the near fore-limb.] similarly, with the horse still on his off side, the off hind-limb may be fixed to the near fore, and the near fore and the off fore to the near hind. with the animal on his near side, we may fix the near hind and the off hind to the off fore, and the off fore and near fore to the near hind. the points to be remembered in fixing the limbs thus are: ( ) the side-line should always commence upon the cannon of the limb to be operated on; ( ) it should next pass under and over (or over and under, it is immaterial which) first the arm and then the thigh, or the thigh and the arm, as the case may be; ( ) in every case, whether rounding the thigh and the arm from above or below, the piece of rope completing the round should always finish below that portion preceding it, so that traction upon it from behind the animal's back should tend to keep all portions of it from slipping below the knee and the hock. with the uppermost fore-limb secured to the hind-limb in the manner we have described, we have the underneath fore-limb suitably exposed for both the higher and lower operations of neurectomy. the position for this operation will be made better still if the lowermost limb (the one to be operated on) is removed from the hobbles and drawn forward by an assistant by means of a piece of rope fastened to the pastern. taking what we have described as a general guide, other modifications of thus securing the foot will suggest themselves to the operator to meet the special requirements of the case with which he is dealing. regarding the administration of chloroform, no description of the method is needed here, as it will be found fully detailed in most good works on general surgery. where great immobility is needed, it is one of the most valuable means of restraint we have. apart from that, its use in any serious operation is always to be advocated, if only on the score of humane consideration for the dumb animal helpless under our hands. b. instruments required. in addition to those required for operations on the softer structures--such as scalpels, forceps, artery forceps, directors, scissors, etc.--the surgery of the foot demands instruments specially adapted for dealing with the horn. a great deal will depend upon the operator as to whether these are few or many. the average man of resource will deem a smith's rasp and one or two strong drawing-knives amply sufficient, and on no account should they be omitted from the list of those ready to hand. [illustration: fig. .--the ordinary drawing-knife.] the ordinary smith's drawing-knife (fig. ) is well known to almost everyone, and is well suited for much of the rougher part of the work. the careful following up of pricks, however, and some of the more special operations demanding removal of portions of the lateral cartilages call for instruments of a more delicate character and peculiar construction. these are to be found in the so-called sage-knife, and the modern (french) pattern of drawing-knife. [illustration: fig. . _a, b_, modern forms of drawing-knife; _c, d, e_, sage-knives.] the modern drawing-knife differs from the smith's instrument in being attached to a straight, instead of a curved, handle, and in usually being sharp on both edges instead of only on one. these are made in various sizes (fig. , _a, b_), and the blades flat, curved on the flat, or curved at an angle with the edges of the haft. the sage-knife, as its name indicates, is a knife with a lanceolate-shaped blade. these also may be obtained in varying forms and sizes (fig. , _c, d, e_). fig. , _c_, is a single-edged, right-handed sage-knife. fig. , _d_, is a left-handed instrument of the same type. the double-edged sage-knife is represented in fig. , _e_. [illustration: fig. .--symes's abscess-knife.] it may be mentioned too, in passing, that the ordinary symes's abscess-knife (fig. ) is a most useful instrument when performing the operation of partial excision of the lateral cartilages, its peculiar shape lending itself admirably to the niceties of the operation. one or two good-shaped firing-irons will also be found useful. they will lighten the labour of tediously excavating grooves with the knife, where that procedure is necessary; and, used in certain positions to be afterwards described, will afford just that necessary degree of stimulus to the horn-secreting structures of the foot, which the use of the knife alone will not. the man in country practice will also be well advised in carrying to every foot case a compact outfit, such as that carried by the smith. this will consist of hammer and pincers, drawing-knife and buffer. much valuable time is then often saved which would otherwise be wasted in driving round for the nearest smith. there are other special operations requiring the use of specially-devised instruments for their successful carrying out. these we shall mention when we come to a consideration of the operations in which they are necessary. c. the application of dressings. one of the most common methods of applying a dressing to the foot is poulticing. usually resorted to on account of its warmth-retaining properties, the poultice may also be medicated. in fact, a poultice, strongly impregnated with perchloride of mercury or other powerful antiseptic, is a useful dressing in a case of a punctured foot, or a wise preliminary to an operation involving the wounding of the deeper structures. the poultice may consist of any material that serves to retain heat for the longest time. meal of any kind that contains a fair percentage of oil is suitable. crushed linseed, linseed and bran, or linseed-cake dust are among the best. to prepare it, all that is necessary is to partly fill a bucket with the material and pour upon it boiling water. the hot mass is emptied into a suitable bag, at the bottom of which it is wise to first place a thin layer of straw, in order to prevent the bag wearing through, and then secured round the foot. this is generally done by means of a piece of stout cord, or by straps and buckles fastened round the pastern and above the fetlock. an improved method of fastening has been devised by lieutenant-colonel nunn: 'a thin rope or stout piece of cord about feet long is doubled in two, and a knot tied at the double end so as to form a loop about or inches long, this length depending on the size of the foot (as at a, fig. ). the poultice or other dressing is applied to the foot, and the cloth wrapped round in the ordinary way, the loop of the cord being placed at the back of the pastern (as in a, fig. ); the ends of the cord are passed round, one on the inside and the other on the outside, towards the front (as in b, fig. ). these ends are then twined together down as far as the toe (see c in fig. ). the foot is now lifted up, and the ends of the cord (cc, fig. ), are passed through the loop a (as at d, fig. ), and then drawn tight. the ends of the cord are now separated, and carried up to the coronet (as at ee, fig. ), one on the outside, the other on the inside of the foot. they are then again twisted round each other once or twice (as at f, fig. ), and are passed round the pastern once or twice on each side. they are now passed under the cord (e, fig. ), and then reversed, so as to tighten up e, and are finally tied round the pastern in the usual manner. the arrangement of the cords on the sole is shown in fig. , which is a view from the posterior part. [illustration: figs. , , , .--illustrating lieutenant-colonel nunn's method of applying a poultice to the foot.] 'the advantages of this method of fastening have been found to be: ( ) it does not chafe the skin; ( ) if properly applied it has never been known to come undone; ( ) it is the only way we know that a poultice can be satisfactorily applied to a mule's hind-foot; ( ) horses can be exercised when the poultice is on the foot, which is almost impossible with the ordinary leather boot; ( ) the sacking or canvas does not cut through so quickly.' [illustration: figs. , .--two forms of poultice-boot.] a further method of applying the poultice is by using one of the poultice-boots made for that purpose (see figs. and ). these have an objection. they are apt to be allowed to get extremely dirty, and so, by carrying infective matter from the foot of one animal to that of another, undo the good that the warmth of the poultice is bringing about. the advantage of the ordinary sacking or canvas is that it may be cast aside after the application of each poultice. where the boot is kept clean, however, it will save a great deal of time and trouble to the attendant. while on the subject of poulticing, it is well to remark that in many cases it may be more advantageous to supply the necessary warmth and moisture to the foot by keeping it immersed in a narrow tub of water maintained at the required temperature. by this means the warmth is carried further up the limb (sometimes an important point), and the water can more conveniently be medicated with whatever is required than can the poultice. in fact, it is the author's general practice, where the attendants can be induced to take the necessary pains, to always advise this latter method. [illustration: fig. .--swab for applying moisture to the foot.] where a dressing is relied upon by some practitioners on account of the warmth it gives, others, even in identical cases, will depend upon the effects of cold. this may be applied by means of what are called 'swabs.' in their simplest form swabs may consist only of hay-bands or several layers of thick bandage bound round the foot and coronet, and kept cool by having water constantly poured upon them. in many cases the form of swab depicted in fig. will be found more convenient. when only one foot is required to be dressed, and a water-supply is available, by far the preferable method is to attach one end of a length of rubber tubing to the water-tap, and fasten the other just above the coronet, allowing the water to trickle slowly over the foot. in cases where a forced water-supply is unobtainable, and the case warrants the extra trouble, much may be done with a medium-sized cask of water placed somewhere over the animal, and the rubber tubing connected with that. where the dressing is desired to be kept applied to the sole and frog only, there is no method more satisfactory than the shoe with plates. [illustration: fig. .--the shoe with plates. _a_, the plates in position; _b_, the plates separated from the shoe.] [illustration: fig. .--the quittor syringe.] the plates are of metal, preferably of thin sheet iron or zinc, and are slipped between the upper surface of the shoe and the foot after the manner shown in fig. . the plates themselves are shaped as depicted in fig. , _a, b, c, a_ and _b_ curved to meet the outlines of the shoe, and _c_ shaped so as to wedge tightly over the posterior ends of the side plates, and between them and the shoe. a distinct advantage of the plate method of dressing is that a certain amount of pressure may be maintained on the sole and frog, a very important consideration in connection with some of the diseases with which we shall later deal. when dealing with sinuous wounds of the foot, another favourite mode of applying dressings is by means of the syringe, and no better instrument for all cases can be found than that known as a quittor syringe (fig. ). a further mode of applying dressing, and one frequently practised in connection with the foot, is known as 'plugging.' this is almost sufficiently indicated by its name. it consists in rolling portions of the dressing into little cylinders, wrapped round with thin paper, and introduced into a sinus or other position where considered necessary. d. plantar neurectomy. as a last resort in the treatment of many diseases of the foot the operation of neurectomy is often advised. it will be wise, therefore, to insert a description of the operation here. _derivation of the word_.--for many years the operation was known simply as 'nerving' or 'unnerving,' and it was not until , at the suggestion of dr. george pearson, that percival introduced the word _neurotomy_ to signify the operation with which we are now about to deal. the word neurotomy, however, used strictly, means the act or practice of dissection of nerves, and, when applied to the operation as practised to-day, describes only a step in the procedure. as the operation really consists in cutting down upon, and afterwards excising a portion of the nerve, the modern appellation of _neurectomy_--from the greek _neuron_, a nerve; and _tome_, a cutting, signifying the cutting out of a nerve or the portion of a nerve--is far more suitable. according as the nerve operated on is the plantar or the median, the operation is known as plantar or median neurectomy. _history of the operation_.--it is to two english veterinarians that we owe the introduction of the operation to the veterinary world. in professor sewell announced himself as the originator of neurotomy. this claim was disputed by moorcraft, who appears to have successfully shown himself to be the real person entitled to that honour, he having satisfactorily performed the operation on numerous animals for fully eighteen years prior to professor sewell's announcement. it appears that moorcraft left this country for india in , having practised the operation in more or less obscurity for some six or seven years previous to that. after his departure neurectomy, as introduced by him, either died away in repute, or was not made by him sufficiently public to become a matter of general knowledge. to professor sewell, therefore, although not the actual originator of the operation, belongs the honour of making it public to the veterinary profession. in , five years after sewell's introduction, we find it practised on the continent by girard. we gather, however, from the writings of percival and liautard, that both in this country and on the continent the operation was for several years largely in the stage of experiment. unsuitable subjects were operated on; the work afterwards given to the animal improperly adjusted to his altered condition; and the bad after-results of the operation almost ignored by some, and greatly exaggerated by others. in fact, some long time elapsed before veterinary surgeons allotted to the operation that measure of credit which the results following it warranted. _the object of the operation_ is to render the foot insensitive to pain, and to give to an otherwise incurably lame animal a further period of usefulness. after the operation, as time goes on, this object may become defeated by the reunion of the divided ends of the nerve. in that case, neurectomy must necessarily be performed again. _the operation_.--two forms of neurectomy are recognised--the high operation and the low. the low operation deals with the posterior digital branch of the plantar nerve, and the high operation with the plantar itself. it is the latter operation with which we shall deal first. in our opinion it is that most likely to be followed by satisfactory results. the area supplied by the posterior digital is mainly the posterior portion of the digit. thus, unless the cause of the lameness is diagnosed with certainty to be situated somewhere in the posterior region of the foot, section of the posterior digital alone will not give total insensibility to pain. added to that, we may remember this: below the point at which the digitals branch off from the plantar there is always more likelihood of the part we are attempting to render insensible being supplied by another and adventitious branch, or a branch that, as regards its direction, is abnormally distributed. as a last consideration, we may say that the higher operation is the easier to perform. percival, in his works on lameness, has some very sage remarks to make by way of a preliminary, and we cannot do better than quote them here. he says: 'to command success in neurectomy three considerations demand attention: ' . the subject must be fit and proper; in particular, the disease for which neurectomy is performed should be suitable in kind, seat, stage, etc. ' . the operation must be skilfully and effectually performed. ' . the use that is made of the patient afterwards should not exceed what his altered condition appears to have fitted him for. 'the veterinarian who is guided by considerations such as those will find that he has restored to work horses who would otherwise have been utterly useless. a plain and safe argument wherewith to meet the objections to neurectomy is simply to ask the question what the animal is worth, or to what useful purpose he can be put, that happens to be the subject of such an operation. 'if the horse can be shown to be still serviceable and valuable, then he is not a legitimate subject for the operation. the rule of procedure i have laid down is to operate on no other but the _incurably lame horse_; and whenever this has been attended to, not only has success been the more brilliant, but indemnification from blame or reproach has been assured.' _preparation of the subject_.--but little in the way of medicinal preparation is necessary. when the animal is a gross, heavy feeder, and carries a more than ordinary amount of cupboard, all that is needed is to withhold his usual allowance of food for some time prior to the operation, simply to avoid risk of rupture when casting. if considered advisable, a dose of physic may also be administered. to the seat of operation, however, careful attention should be given. on the day previous to the operation the hair should be closely removed with the clipping machines, and the skin thoroughly cleansed with warm water and soap. after this, a bandage soaked in a per cent, watery solution of carbolic acid should be wrapped lightly round the limb, and allowed to remain in position until the animal is cast and ready for the operation the following morning. on removing the bandage prior to operating, the part should again be bathed with a cold per cent. solution of carbolic acid and swabbed dry. attention to these details will serve to leave the wound in that favourable condition in which it heals nicely, and with the minimum amount of trouble. _preliminary steps_.--by some practitioners the operation is performed with the animal standing, local anæsthesia having been first obtained by the use of cocaine, or an ethyl chloride spray. there is no gainsaying the fact, however, that the operation of neurectomy is a painful one, and that, with most operators, success will be more fully guaranteed with the animal cast and the limb held in a suitable position by an assistant. the animal is thrown by the hobbles upon the side of the leg which is to be operated on. the cannon of the upper fore-limb is then fixed to the cannon of the upper hind, as described under the section of this chapter devoted to the methods of restraint, and the lower limb freed from the hobbles and drawn forward by an assistant by means of a stout piece of cord round the pastern. an alternative method of holding the limb is to bind both fore-legs together above the knee by means of the side-line run round a few times in the form of the figure , and then fastened off. as in the former method, the lower foot is then removed from the hobble, and again held forward by an assistant. by either method the inside of the limb is operated on first. [illustration: fig. .--the esmarch rubber bandage and tourniquet.] although it is not absolutely necessary, it is an advantage, especially to the inexperienced operator, to apply before operating an esmarch's bandage and tourniquet (fig. ). this expels the greater part of the blood from the limb, and renders the operation comparatively bloodless. [illustration: fig. .--rubber tourniquet with wooden block.] the esmarch bandage is composed of solid rubber, and with it the limb is bandaged tightly from below upwards. on reaching the knee the tourniquet is stretched round the limb, fastened by means of its buckle and strap, and the bandage removed. those who feel they can dispense with the bandage use the tourniquet alone. for this purpose the form depicted in fig. , and the one in general use at the royal veterinary college, is more suitable, on account of its wooden block, which may be placed so as to press on the main artery of supply. [illustration: fig. . neurectomy bistoury.] _instruments required_.--these should be at hand in an earthenware or enamelled iron tray containing just sufficient of a per cent. solution of carbolic acid to keep them covered. those that are necessary will be a sharp scalpel, or, if preferred, one of the many forms of bistoury devised for the purpose (see fig. ), a pair of artery forceps, a needle ready threaded with silk or gut, one of the patterns of neurectomy needle (see fig. ), and a pair of blunt-pointed scissors curved on the flat. it is also an advantage, when once the incision through the skin is made, to employ one of the forms of elastic, self-adjusting tenacula (see fig. ) for keeping the edges of the wound apart while searching for the nerve. [illustration: fig. . neurectomy needle.] _incision through the skin_.--we remember that the plantar nerve of the inner side is in close relation with the internal metacarpal artery, and that both, in company with the internal metacarpal vein, run down the limb in close proximity with the inner border of the flexor tendons. also, we remember that the external plantar nerve has no attendant artery, although, like its fellow, it is to be found in close touch with the edge of the flexor tendons. bearing these landmarks in mind, we feel for the nerve in the hollow just above the fetlock-joint by noting the pulsations of the artery, and determining the edge of the flexor tendons. this done, a clean incision is made with the bistoury or the scalpel in the direction of the vessels. the incision should be made firmly and decisively, so that the skin may be cleanly penetrated with one clear cut. if judiciously made, little else in the shape of dissection will be needed. [illustration: fig. .--double tenaculum.] it is now that the double tenaculum (fig. ) is applied. one clip is fixed to the anterior edge of the wound, and the other carried beneath the limb and made to grasp the posterior edge. if found desirable to keep the edges of the wound apart, and no tenaculum to hand, the same end may be accomplished by means of a needle and silk. in like manner as is the tenaculum, the silk is attached to one edge of the wound, carried under the limb, and firmly secured to the other. having made the incision, the wound should be wiped free from blood by means of a pledget of cotton-wool previously soaked in a carbolic acid solution and squeezed dry. at the bottom of the wound will now be seen the glistening white sheath, containing the vein, artery, and nerve. this should be picked up with the forceps, and a further incision made with the bistoury. care should be exercised in making this second incision, or the artery may accidentally be opened. if an ordinary scalpel is used, the lower end of the sheath should be picked up and the point of the scalpel inserted through it. with the cutting edge of the scalpel turned towards the opening of the wound, the sheath is then slit from below upwards. the second incision satisfactorily made, the wound is again wiped dry, and the nerve seen as a piece of white, curled string in the posterior portion of the wound. at this stage it is advisable to accurately ascertain whether what we have taken to be the nerve actually is it. this is done by taking it up with the forceps and giving it a sharp tweeze. a sudden struggle on the part of the patient will then leave no doubt in the operator's mind that it is the nerve he has interfered with. _section of the nerve_.--the neurectomy needle (fig. ) is now taken, and, excluding the other structures, passed under the nerve. a piece of stout silk or ordinary string is then threaded through the eye of the needle, the needle withdrawn, and the silk left in position under the nerve. the silk is now tied in a loop, and the nerve by this means gently lifted from its bed. with the curved scissors or the scalpel it is severed as high up as is possible. the lower end of the severed nerve is then grasped firmly with the forceps, pulled downwards as far as possible, and then cut off. at least an inch of the nerve should be excised. the animal is then turned over, and the opposite side of the limb operated on in the same manner. the tourniquet is now removed, and the wound is examined for bleeding vessels. if the hæmorrhage is only slight, the wound should be merely dabbed gently with the antiseptic wool until it has stayed. a larger vessel may be taken up with the artery forceps and ligatured, or the hæmorrhage stopped by torsion. on no account, unless it it done to stay hæmorrhage that is otherwise uncontrollable, should the wound be sutured with blood in it. with the wound once dry and clean, it is well to insert three or four silk sutures, but care must be taken not to draw them too tightly. this done, the patient may be allowed to get up. _after-treatment_.--this is simple. over each wound is placed a pledget of antiseptic cotton-wool or tow, and the whole lightly covered with a bandage soaked in an antiseptic solution. for the first night the animal should be tied up short to the rack, and the following morning the bandages removed. a little boracic acid or iodoform, or a mixture of the two combined with starch (starch and boracic acid equal parts, iodoform drachm to each ounce) should now be dusted over the wounds, the antiseptic pledgets renewed, and the bandage readjusted over all. at the end of three or four days the bandages may be dispensed with. all that is necessary now is an occasional dusting with an antiseptic powder, and, as far as possible, the restriction of movement. at the end of a week the sutures may be removed, and the animal turned into a loose box or out to pasture. e. median neurectomy. as a palliative for lameness when confined to the foot, one would imagine that the plantar operation would be all sufficient. there are operators, however, who state that the results following section of the median nerve have been such as to cause them to entirely abandon the lower operation in its favour. if only for that reason a brief mention of the operation must be made here. the operation was first performed in this country in october, , the subject being one of the out-patients at the royal veterinary college free clinique. for five or six years following this date professor hobday performed the operation some several hundred times, and was certainly instrumental in bringing the operation into prominence. though so recently introduced here, it appears to have been practised for several years on the continent, originating in germany as early as . in that country a first public account of it was published in by professor peters of berlin, while in france it was introduced by pellerin in . in this operation a portion of the median nerve is excised on the inside of the elbow-joint just below the internal condyle of the humerus. here the nerve runs behind the artery, then crosses it, and descends in a slightly forward direction behind the ridge formed by the radius. the position of the limb most suitable for the operation is exactly that we have described as most convenient for the plantar excision. the animal is cast, preferably anæsthetized, and the limb removed from the hobbles, and held as far forward as is possible by an assistant with the side-line. professor hobday's description of the operation is as follows: 'a bold incision is made through the skin and aponcurotic portion of the pectoralis transversus and panniculus muscles, about to inches (depending on the size of the horse) below the internal condyle of the humerus, and immediately behind the ridge formed by the radius. this latter, and the nerve which can be felt passing over the elbow-joint, form the chief landmarks. the hæmorrhage which ensues is principally venous, and is easily controlled by the artery forceps. in some cases i have found it of advantage to put on a tourniquet below the seat of operation, but this is not always advisable, as it distends the radial artery. we now have exposed to view the glistening white fascia of the arm, which must be incised cautiously for about an inch. this will reveal the median nerve itself situated upon the red fibres of the flexor metacarpi internus muscle. if not fortunate enough to have cut immediately over the nerve, it can be readily felt with the finger between the belly of the flexor muscle and the radius.'[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. ix., p. .] the nerve exposed, the remainder of the operation is exactly as that described in removing the portion of the nerve in the plantar operation. the wound is sutured and suitably dressed, and a fair amount of exercise afterwards allowed the patient. f. length of rest after neurectomy. this is placed by the majority of surgeons at about three weeks to a month. within that period no excessive exertion should be undergone by the patient. a certain amount of quiet exercise, however, is beneficial, facilitating the healing of the wounds, and accustoming the animal to the altered condition of his limb. g. sequelÆ of neurectomy. these we shall relate collectively, making no distinction between those following excision of the plantar nerve and those succeeding section of the median. it must be remembered by the surgeon, however, that the unfortunate sequelæ we are now about to describe are likely to be far more grave when following section of the larger nerve. _liability of pricked foot going undetected_.--on account of the warning they convey to the surgeon, first place among the sequelæ of neurectomy must be given to accidents following loss of sensation. take, for example, punctured foot. in any case, in the sense of being unforeseen, it is accidental. in the neurectomized foot it becomes doubly accidental, in that not only is it unforeseen, but that it is for some time indiscoverable. with the foot deprived of sensation, a nail may be picked up, or a prick sustained at the forge, and no intimation given to the attendant until pus has underrun the horn, and broken out at the coronet. what follows, then, is that the hoof as a whole, or the greater part of it, sloughs off. no neurectomy should be undertaken unless this contingency has been allowed for. the owner should be advised of it by the surgeon, who should at the same time enjoin on his client the absolute necessity of giving to the neurectomized foot daily and careful attention. _loss of tone in the non-sensitive area_.--in addition to the mischief resulting from a wound going undetected, it must be remembered that the loss of tone resulting from the operation gives to every wound (however slight), in the region supplied by the removed nerve, a sluggish and troublesome character. difficult to deal with as wounds about the foot ordinarily are, they are rendered more so by a previous neurectomy. _gelatinous degeneration_. this is a condition liable to occur in cases where the operation has been too long deferred, and when considerable structural alteration has already taken place in the shape of diseased bone or tendon, more especially in navicular disease. it consists in a peculiar softening of the structures of the limb, accompanied with enlargement, due to swelling of the connective tissues, the enlargement and softening generally making itself first apparent by a soft, pulpy swelling in the hollow of the heel. from this onwards the enlargement increases, and lameness becomes excessive, the animal going more and more on his heels, until, finally, no portion of the solar surface of the foot comes to the ground at all. the case is hopeless, and destruction should be advised. _reported case_.--'the patient, a brown carriage gelding, was brought to the royal veterinary college infirmary in a cart on december , the only previous history obtainable being that it had suddenly fallen lame a month before. 'the symptoms presented were excessive lameness of the near fore-limb. on being trotted, the toe was elevated each time the foot reached the ground, progression being entirely on the heels. separation of the hoof for about inches at the hinder part of the coronet; oedematous swelling from foot to knee, extending during the next three days to the elbow. great tenderness between the knee and the fetlock; below this no sensation whatever, as a pin was inserted in several places round the coronet without causing any symptoms of pain. on further examination, two unnerving scars were found. no treatment was adopted, and the horse was destroyed on january . 'on dissecting the leg, the following appearances presented themselves: 'the limb was very much enlarged, due to thickening of the connective tissue, the skin being removed only with difficulty. the tendons were soft and much thickened. a rupture of the skin at the coronet, just where the skin meets the wall of the foot. large extravasations of blood at the back of the tendons, situated in the lower half. _external_ nerve trunk had become reunited, at the point of junction there being a hard lump about the size of a walnut. _internal_ nerve trunk also had become reunited, and presented a thickened portion at the point of junction, but not so large as that of the outer side, and situated in the lower half of the tendon, about inches higher than that on the external nerve. this nerve trunk was atrophied below the thickening, and had undergone gelatinous degeneration. judging from the scars on the skin, this side had evidently been unnerved a week or ten days previously to that on the outer side. the band stretching across the back of the perforatus, between the external and internal nerves, appeared on the inside to have become firmly fixed into the tendon. 'on removing the hoof, under the sole there appeared a large quantity of very foetid pus; the laminæ were very much inflamed in patches. there was an enormous thickening of connective tissues in the heel. on cutting longitudinally through the perforatus tendon, there was exposed a large blood-coloured mass, of a gelatinous appearance, situated on the perforatus tendon, the latter being very much thickened, and growing to the navicular bone. the underneath surface of the superior suspensory ligament was much thickened, and firmly adherent to the bone; at the posterior surface of the metacarpus there was a quantity of gelatinous substance. the anterior ligament of the fetlock-joint was thickened; the navicular bone was entire, but showed lesions of navicular disease, being ulcerated. section through the bone did not reveal anything further. it may be here remarked that the ulcerations were on either side of the central ridge, and not at all on the ridge itself. 'microscopic examination of the tissue joining the two ends of the nerve together revealed a few nerve fibres; the general appearance was that of granulation tissue, containing capillary vessels, which were fairly plentiful, and comparatively large in size.'[a] [footnote a: _veterinary record_, vol. iv., p. (hobday)] _chronic oedema of the leg_.--in some cases there is a distinct swelling of the leg some time after the operation. this exposes the limb to the infliction of sores from striking with the opposite foot, with, of course, the difficulty in healing we have just described. _persistent pruritus_.--this annoying sequel occurs in the neurectomized limb, with or without gelatinous degeneration, and appears to be without a remedy. the itching in some cases is so intense as to lead the animal to constantly gnaw at the top of the foot. as one observer has remarked, the animal may begin literally biting pieces out of his limb. the result of the irritation and gnawing is fatal. great sloughing of the parts takes place, and the animal has eventually to be slaughtered. _fracture of the bones_.--the sudden loss of sensation in a foot may cause the animal to use violently the limb he has for months past been carefully nursing. it may be that the lameness for which the operation has been performed has been due to disease existing in the navicular bone, and extending, perhaps, to the os pedis. by the disease the bone has already been made brittle, its substance and ligamentous attachments perchance weakened and broken up by a slow-spreading caries, and rarefaction of the remaining bone substance rendered almost certain. in this instance, the free use of the foot, and the application to the diseased structures of an unwonted pressure immediately after the operation results in fracture. with the rupture of the structures we get the elevated toe and soft swelling in the heel, as described in gelatinous degeneration. treatment, of course, is out of the question. _neuroma_.--a further sequel is the appearance at the seat of the operation of what is termed an 'amputational neuroma.' this is a tumour-like growth occurring on the end of the divided nerve. it is composed of connective-tissue elements permeated by nerve fibres which have grown out from the axis-cylinders of the nerve stump. it may vary in size from a pea to a hazel-nut, and is frequently the cause of much pain. this must be cut down upon and cleanly removed, taking away at the same time as much of the nerve as is possible. _reunion of the divided nerve_.--we may say at once that 'reunion' in the popular sense of the word does not take place. at a varying period after section, however, we do get a return of sensation. this is brought about in the following manner: the axis-cylinder of the nerve, still in connection with the spinal cord, swells somewhat, and hypertrophies. the cells of this hypertrophied portion show a great tendency to proliferate and produce new nerve structure. this growing point splits, and gives rise to several fibrils, which are new axis-cylinders. these commence to grow towards the periphery, and, in so doing, grow through the cicatricial tissue that has formed at the seat of the operation. after passing through the cicatricial tissue (the amount of which tissue, of course, controls the length of time that insensibility remains), the growing axis-cylinders reach the degenerated portions of the nerve below the point of section. it is along the track of the old nerve that the new growths from the stump reproduce themselves. the fact of the new growths having to pass through the fibrous tissue of the cicatrix before they can gain the course of the old nerve, along which latter their progress of growth is comparatively easy, affords ample illustration that as large a portion as is possible of the nerve should be removed when operating, in order to convey insensibility for the longest time. after reunion, of course, nothing remains but to repeat the operation. _the existence of an adventitious nerve-supply_.--while not exactly a sequel of the operation, the fact that it is not discovered until after the operation has been performed warrants us in mentioning it here. it is not an uncommon thing in the lower operation to find that sensation and symptoms of lameness still persist after section of the nerve. in many cases this has been traced to the existence of an abnormal nerve branch. in the higher operation this is not so likely to be met with. that it may occur, however, is shown by the following interesting case related by harold sessions, f.r.c.v.s.:[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. xii., p. .] 'in june of i saw a hunter suffering from navicular disease. after carefully examining the leg, i advised the owner to have the operation of neurectomy performed upon him. this he decided to do, and the horse was sent to me about the beginning of july. [illustration: fig. .--dissected external metacarpal nerve and branches. _a_, metacarpal; _b_, anterior plantar; _c_, extra branch (probably from the internal metacarpal), conveying sensation after division of the external metacarpal.] 'the operation was performed in the ordinary way, without any difficulty whatever. the wounds healed nicely, but the horse still continued to go lame. careful examination showed that there was still sensation on the outside of the foot. thinking that possibly there might be two external metacarpal nerves, the horse was again cast, the operation being performed slightly lower down. only the main branch of the external metacarpal nerve could be found. a piece of this was taken out, and the horse let up. on examination, sensation was still found in the posterior part of the outside of the foot. it was very evident that there was some abnormal distribution of the nerve, as sensation was still being conveyed to that part of the foot. 'as the horse was absolutely useless, and would have to be shot unless this piece of nerve could be found, he was again thrown, and after he had been anæsthetized i determined to follow the course of the nerve down, until i found where the accessory branch came from. this i found a little below the fetlock, about / inch below the point where the anterior plantar nerve is given off from the metacarpal nerve. it was about / inch below the spot where the anterior plantar nerve passes between the artery and vein of the foot, and it was somewhat difficult to get at it. 'fig. shows the exact size and distribution of the nerves. after the separation of the accessory branch, sensation was taken from the foot, and the horse went perfectly sound.' _stumbling_.--in addition to the sequelæ we have mentioned, it is urged against the operation of neurectomy that one of the first effects of depriving the foot of the sense of touch is a tendency on the part of the animal to stumble. from the cases we have seen we cannot regard this objection as a serious one. nevertheless, as veterinarians, with a knowledge of the physiology of the structures with which we are dealing, we must treat the objection with respect, for, after all, we are bound to allow that stumbling, and a bad form of it, would be but a natural sequence of the operation we have just performed. the real fact remains, however, that cases of stumbling, even immediately after the operation, are rare; and that even when they do occur, the animal seems easily able to accommodate himself to the altered condition, and as readily uses the comparatively inert mass at the end of his limb as he did previously the intact foot. h. advantages of the operation. from the prominence we have given to the unfortunate sequelæ of the operation it might possibly be inferred that, while not giving it our absolute condemnation, we regard neurectomy with a certain amount of distrust. that we may contradict any such false impression, we state here that in many cases the operation is the only measure which will offer relief from pain, and restore to work an otherwise useless animal. in support of that we will now quote the recognised advantages of the operation. that in many cases, when all other methods--surgical and medicinal--have failed, there is an immediate and total freedom from pain and lameness no one will deny. this, if it restores to active work an animal that would otherwise have had to have been cast aside, is ample justification for giving the operation, in spite of its many unfortunate terminations, a real place among the more highly favoured remedial measures to our hand. 'for _contracted hoofs_, viewing them in the light of idiopathic disease, or as being the immediate cause of the existing lameness in the uninflamed condition of the foot, and when consequential changes of its organism have taken place which bid defiance to therapeutic measures, _neurotomy_ is a _warrantable resource_' (percival). 'for _ringbone_ neurotomy has been practised with perfect success, after blistering and firing had both failed, notwithstanding the work the animal had to perform afterwards was of the most trying nature' (_ibid_.). for _navicular disease_, when that malady is diagnosed, the earlier neurectomy is performed the better. the greater work given to the diseased bursa and bone, and the return of the contracted heels to the normal, brought about by the greater freedom with which the foot is used, are claimed by many to effect a cure. writing of navicular disease, and mentioning his belief in the possibility of the diseased bone effecting its own repair after the operation, harold leeney, m.r.c.v.s., says: 'the expansion of the heel, and rapid development of the frog (in this and many other cases) immediately after the operation, has not, i venture to think, attracted so much attention as it deserves, and may have something to do with those cases which appear to be actually _cured_, not merely made to go sound by absence of pain.'[a] [footnote a: _veterinary record_, vol. xi., p. .] speaking of the median operation before a meeting of the central veterinary medical society, professor hobday says:[a] [footnote a: _veterinary record_, vol. xiii., p. .] 'for old-standing lamenesses, when due to splints, exostoses, chronically sprained, thickened, and painful perforans and perforatus tendons, or cases of that kind which cause pain by pressing on the adjacent nerve structures, after all other known methods have failed, median neurectomy is the operation which will be most likely to give the animal a new lease of life and usefulness.' 'of the _humanity and utility of neurectomy_ there can be no question whatever, and provided the cases are well selected, and the operation is efficiently performed, the advantages to be derived from it are most striking as well as enduring. but the disadvantages attending the loss of sensation in the foot have been brought forward on many occasions as an argument against neurectomy, and no one can deny that the foot with sensation is better than one without that faculty. but in a long experience of the operation i have never found these disadvantages outweigh the great advantages which have immediately followed it.'[a] [footnote a: _veterinary journal_, vol. ix., p. (fleming).] beyond these, the direct advantages of neurectomy, are other and more indirect advantages which claim attention. the most astonishing among them is the fact noted by many writers of repute that exostoses (ringbones, side-bones, splints, etc.) rapidly diminish in size. this is vouched for by such well-known authorities as zundel and nocard. percival, too, mentions at some length the effect of the removal of pain on the oestral and generative functions, quoting a case of a brood cart-mare by reason of bony deposits being stayed from breeding for some years. two months after the operation she went to work, and moved sound, her altered condition leading her to breed several healthy foals. i. the use of the horse that has undergone neurectomy. no operation is of any considerable value to the veterinary surgeon unless he is able to show that after it he has left his patient workable. the alleviation of pain alone, commendable as it is from a humanitarian standpoint, is of no interest to the average owner of horse-flesh, unless with it he sees his animal capable of justifying his existence by the amount of labour performed. criticised in this way, is the operation of neurectomy justifiable? upon that point the opinions of many practitioners, even at the present day, differ. we have already partly answered the objections likely to be raised on this score by stating that the work afterwards allotted the animal should be fixed to suit his altered condition. it may be taken as a general rule that in all cases where the animal's usefulness depends upon his delicacy of touch, as, for example, animals used solely for hacking or hunting, his future usefulness in that special sphere of work will be done away with. percival himself, always a strong advocate for the operation, fully recognises this. 'does the neurotomized horse maintain the same step as before?' he asks. 'to this important question,' he replies, 'i unhesitatingly answer no; he does not. there can be no doubt but that the horse _feels_ the ground upon which he is treading, and that he regulates his action in consonance with such feeling, so as to render his step the least jarring and fatiguing to himself, and therefore the easiest and pleasantest to his rider.... such impressions'--those of touch--'being in the neurotomized subject, so far as regards the feeling of the foot, altogether wanting, a bold, fearless projection of the limb in action will be the consequence, followed by a putting down of the hoof flat upon the ground, as though it were a block, creating a sensation alike unpleasant both to horse and rider.' emphatic as percival is upon this point, there are, nevertheless, others who maintain with equal stoutness that the unnerved animal is positively as safe, if not safer, than the animal who has not been so treated. 'that the tactile sense in the horse's foot is useful, it would be idle to deny; but that it is absolutely essential, even to safe progression, no one who has paid attention to the results of plantar neurectomy will maintain. on several occasions for years i have hunted, hacked, and driven horses which have been deprived of sensation in their fore-feet, and never had an accident with them. their action has not been impaired by the operation; on the contrary, it has been vastly improved compared with what it had been previous to it. and my opinion has not been single in this respect, as many competent horsemen can give like evidence after long and severe trials of neurotomized horses. the opponents of neurotomy were, probably, not aware that there is in progression a _muscular_ as well as a _tactile sense_.' this latter contention is supported by numerous cases, reported at the time when the operation of neurectomy was at the heyday of its popularity. two i select from writings of a later period: _recorded cases_.-- . 'two of the finest among the many fine horses in the second life guards were so lame from navicular disease, when i joined the regiment, that they were unsafe and unsightly to ride, and were therefore entered on the list to be cast off and sold. one was so crippled that it could scarcely be moved out of its stable. peeling sorry at having to get rid of such good horses, and anxious to give another blow to the mistaken theory that unnerved animals were unsafe, i obtained the consent of my commanding officer, who patronizes practical conclusions, to perform neurotomy. this was carried out on both horses about eighteen months ago. within a fortnight they were at their duty, absolutely free from lameness, and with first-rate action, and one of them, from being troublesome and unsteady in the ranks--probably from the pain in its feet--had become quite steady and tractable. instead of being lame, blundering, and unsafe, both were sound, free in movement, and secure, and, the pain being abolished, they looked improved in condition. 'during the month of july the regiment attended the summer drills at aldershot, and five days every week for a month these horses carried a weight of about stones each over the roughest and most dangerous ground, nearly always at a fast pace, and for four, five, or six hours each day; and yet they never fell or blundered, and the troopers who rode them had unbounded confidence in their sure-footedness. they returned to windsor, at the end of the month's severe test, as sound in their paces as when they left, and certainly now offer no indication whatever that they are less safe to ride than any other horse in the regiment. the effects of the relief from pain are also most marked, not only in the altered gait out of doors, but also in the stable.'[a] [footnote a: _veterinary journal, vol_. ix., p. (george fleming, f.b.c.v.s.).] . 'some years ago i operated upon a valuable hunter, the property of a gentleman in kildare, the animal having shown unmistakable symptoms of navicular disease for some months previously, and which had been unsuccessfully combated by the milder forms of treatment for the disease without any benefit. although the horse went sound, the owner feared to ride him, and sent him to be sold in dublin, where he was disposed of for a small price, and i then lost sight of him. the following punchestown races, to my surprise, amongst a group of horses walking round the paddock previous to saddling for an important race, i recognised my old patient, bandaged, clothed, and trained, ready to take his part in the cross-country contest, and surrounded by a host of admirers willing to back him at any price. 'having satisfied myself that it was no other than the same animal, my first impulse was at once to find out the jockey who was to ride him, and warn him of his danger by telling him his mount was devoid of feeling in both fore-feet; but the saddling-bell had already rung, and in a few moments more the jockey emerged from the weighing-room and the next view of the horse was his tearing up the course in the preliminary, and "pulling double." i was sorry for the jockey if he felt as i did at that moment, for if he did i fear he and his horse would have parted company at the first fence, as i was certain there would be a smash before the end of the long and difficult three miles of the kildare hunt cup course. it was not until i saw him again in the front rank passing the stand, in the first round, that i breathed freely, and even then i felt very guilty, and, had he come to grief badly, i don't think i should ever have operated on another horse except in such a way as would have left unmistakable traces after it. '"the old horse wins!" screamed a thousand voices as the competitors safely cleared the last bank (now taken away for a gorse fence) the last time round, and from that moment the operation went up in my estimation a hundredfold, and i almost lost all interest in the finish (and it was a close one, with my patient a good third), resolving i would operate for the future on every animal, young and old, which showed symptoms of navicular disease. 'neither owner nor jockey knew the horse had been operated on, and he was soon after, on the strength of his performance, sold for a good price to come to england. it is idle to think that all cases are as successful as this was, as experience soon told me; but i consider that, in careful hands, the advantages well outweigh the disadvantages of the operation, and i have selected this instance merely as a practical example.'[a] [footnote a: _veterinary journal_, vol. iii., p. (w. pallin, m.b.c.v.s.).] it is solely with the object of ventilating both sides of the question that we quote the last two cases. in our opinion, the colours in which the results of the operation are there painted are far too rosy. the practitioner who has before him the task of satisfying a client as to what will or what will not be the results of an operation he has suggested will do well to weigh each side of the argument carefully, and endeavour in his explanation to strike the happy mean. we hold, further, that the animal who has previously been accustomed to fast work, and to work entailing a large call upon the sense of touch when passing over rough and uneven ground, will be far more likely, in his neurectomized condition, to give satisfaction to his owner if put to a slower and a more suitable means of earning his living. chapter vi faulty conformation under this heading we shall deal with such formations of the feet as depart sufficiently from the normal to render them serious. faulty conformation may be either congenital or acquired, and acquired gradually as the result of slowly operating causes, or suddenly as the sequel to previous acute disease. whether congenital or acquired, serious in its nature or comparatively of no account, the veterinary surgeon will often find that the matter of conformation is one which will have a direct bearing on many of his 'foot' cases, and, furthermore, that it is one upon which he will often be called to give advice. a. weak heels. _definition_.--that condition of the wall in which, owing to the softness of the horn and the oblique direction of the horn fibres, the heels are unable properly to bear the body-weight, and, as a consequence, curve in beneath the sole. we give the condition first mention, not because of its greater importance, but for the reason that it is frequently the forerunner of the condition to be next described--namely, contracted feet. _symptoms_.--the extreme point of the heel is not affected unless the foot has been greatly neglected, and the condition allowed to develop. where, however, the foot has been uncared for, curving in of the wall takes place to an alarming degree, and the heels curl underneath the foot to such an extent as to grow over the sole and the bars. by the pressure they exert on the sole corns result, and the animal is lamed. _causes_.--in the main this defect is hereditary. it is seen commonly in connection with flat-foot, and where the horn of the wall is thin and shelly. _treatment_.--in the case of weak or 'turned in' heels no suitable bearing is offered for the shoe in the posterior half of the foot. any attempt to induce the heels to bear weight is immediately followed by their bending in. it follows from this that the best shoe to be used here is one in which the bearing is confined to the anterior half of the wall, the heels being relieved by being sufficiently pared. as might be expected, this bearing on the anterior half only of the foot is insufficient; pressure must be given the frog. this latter end is best gained by a bar shoe (fig. ). with it the anterior portions of the wall, the whole of the bars, and the whole of the frog may be in contact, and the heels only so pared as to take no bearing at all. a few such shoeings sees the defect remedied. in every instance paring of the sole should be discouraged, as it serves but to increase the deformity. b. contracted foot. _(a)_ general contraction--contracted heels. _definition_. by the term contracted foot, otherwise known as hoof-bound, is indicated a condition in which the foot, more especially the posterior half of it, is, or becomes, narrower from side to side than is normal. it must be borne in mind, however, that certain breeds of horses have normally a foot which nearer approaches the oval than the circular in form, and that a narrow foot is not necessarily a contracted foot. the contraction may be bilateral when affecting both heels of the same foot and extending to the quarters, or unilateral when the inside or outside heel only is affected. in some cases contraction is confined to one foot, while in others it may be noticed equally bad in both. it is a matter of common knowledge that contraction is usually seen in the fore-feet, while the hind seldom or never suffer from it, a fact which, to our minds, seems difficult of adequate explanation. zundel explains this by stating that contraction is principally _observed_ in the fore-feet, by reason of the fact that when lameness arises from it alteration in action will more readily be detected in front than behind. percival, on the other hand, suggests that the greater expansive powers of the hind-foot, by reason of the impetus of its action, is able to overcome any influence operating towards contraction. it may be, however, that given a cause for contraction, such as the removal of the frog's counter-pressure with the ground by faulty shoeing or excessive paring, the fore-feet, by reason of their being called upon to bear the greater part of the body-weight, are the first to suffer. flat feet with weak heels are those most frequently affected, and, as we have already intimated, the condition may exist with or without other disease of the foot. depending upon its degree, contracted foot may vary from a simple abnormality, non-inflammatory and painless, to a condition in which it becomes a veritable disease, giving rise to a bad form of lameness, and bringing about a withered and sometimes discharging and cankerous affection of the frog. _symptoms_.--in its early stages contraction is difficult of detection, and where both feet are affected may for some time go unsuspected. with only one foot undergoing change, the early stages may the more readily be marked, for in this case comparison with the other and sound foot will at once reveal the alteration in shape. if lameness in the suspected foot is present, then any lingering doubt will be quickly dispelled. when far advanced, contraction offers signs that cannot well be missed. the converging of the heels narrows the v-shaped indentation in the sole for the reception of the frog. as a consequence of this, the frog itself becomes atrophied by reason of the _continual_ pressure exerted upon it by the ingrowing horn of the wall and the bars. the median and lateral lacunæ of this organ, from being fairly broad and open channels, become pressed into mere crack-like openings (see the commencing of this condition in fig. , and a badly wasted frog in fig. a). as the case goes on, the lateral branches of the frog entirely disappear, and all that is left of the organ is a remnant of its body or cushion, now wedged in tightly between the bars. following upon the disappearance of the frog, we find that the bars are in contact, or, in some cases, actually overlapping each other at their posterior extremities. at this stage, perhaps, the whole condition has become aggravated by a foul discharge from the place originally occupied by the frog, and the foot, especially in the region of the heels, has become hot and tender--really a form of local and subacute laminitis. the long-continued inflammation, although only of a low type, renders the horn of the hoof hard and dry, and only with difficulty will the ordinary foot instruments cut it. this in its turn leads to cracks and fissures in various places, but more especially in the bars and what is left of the frog. often, too, cracks will appear in the horn of the quarters, and a troublesome and incurable form of sand-crack results. an animal with contraction advanced as far as this, especially if confined to one foot, goes unmistakably lame. with both feet affected, he ordinarily starts out from the stable in a manner that is commonly called 'groggy.' in other words, the gait is uncertain, and feeling; and stumbling is frequent. anyone who has had the misfortune to drive an animal with feet in this condition knows full well that every little irregularity in the road at once makes itself felt to the feet, and that the animal, as time goes on, learns to carefully avoid any suspicious-looking group of stones he may see. to drive an animal like this is to keep one's self continually on tenter-hooks, for, sooner or later, the inevitable happens, and the animal comes down. up to now we have described the changes of form in the hoof as seen when the contracted foot is viewed from the solar surface. with those changes as evident as we have depicted them, there will be no difficulty in detecting the alterations in the form of the wall. in addition to a narrowing from side to side there will be noticed an abnormal straightness of the quarters, with a turning in, more or less sudden, of the heels. this effect is given in these cases by the smith maintaining the shoe of a length and width that should normally fit a foot of that particular animal's size and substance. this is probably done with the idea of deceiving anyone examining the solar surface. viewed from this position, the width of the shoe at the heels gives the impression that it is attached to a foot of normal breadth. this deception is heightened if at the same time has been practised the process of 'opening up the heels.' that expression indicates that the bars have been removed, and the lateral lacunæ of the frog made to continue the concavity of the sole. the arch of the latter is thus made to appear of much greater extent than it really is, and the heels, by reason of their being abruptly cut off when removing the bars, also convey the false impression of being wide apart. the practitioner unversed in the tricks of the forge will best guard against this by viewing the foot, while on the ground, from behind. from that position he will be able to detect the lowness of the quarters, and the projecting portion of the shoe, that the hoof, by reason of its sudden bending inwards, does not touch. the 'feeling' manner of the gait before alluded to, together with the disinclination to put the foot firmly and squarely forward, will sometimes lead the examiner to over-look the contraction, and diagnose his case as one of shoulder lameness. in many cases, too, such consequent conditions as 'thrushy frogs' and 'suppurating corns' are often treated with utter disregard of the contraction that has really brought them about. but above all, the disease most likely to be confounded with simple contraction is navicular disease. more than probable it is that many cases of so-called 'navicular' have in reality been nothing more than contraction brought about by one or other of the causes we shall afterwards enumerate--cases where a due attention to the prime cause of the mischief would, in all likelihood, have remedied the lameness. _changes in the internal structures_.--it follows as a matter of course that the changes we have described in the form of the hoof itself carry with them alterations in the bones and sensitive structures beneath it. the tissues, as a whole, become atrophied. the os pedis becomes deformed, loses its circular shape, and gradually becomes more or less oval in contour. at the same time, its structure becomes more compact, the cribriform appearance of its anterior and lateral faces more or less destroyed, and the few remaining openings apparently increased in size. this atrophy of the os pedis is best noted at the wings. in the plantar cushion the effects of the atrophy are noted in the smallness of the organ, in its becoming whiter in colour than normal, and more resistant to pressure. the coronary cushion is also affected in the same way, where the changes are noted most in its posterior portions. a further effect of the narrowing of the heels, and their consequent tendency to drop downwards, is the exertion of a continual pressure on the sensitive sole. in course of time, and especially in flat feet, this leads to the appearance of corns. the navicular bone and bursa and the tendon of the perforans also suffer from the effects of compression. the movement of the tendon is restricted, and arterial supply to the adjacent structures rendered deficient. the tissues of the bone and bursa are insufficiently nourished, and the secretion of synovia lessened. in this way it is conceivable that navicular disease may follow the condition of simple contracted heels. in common with the other structures, the lateral cartilages also suffer from the continual pressure. their blood-supply is lessened, their functions interfered with, and side-bones result. _causes_.--upon the causation of contraction a very great deal has been written, both by early veterinarians and by those of the present day. many and widely differing opinions have been advanced, but a careful résumé of only a few will lead one to certain fixed conclusions. we may consider the causes of contraction under two headings--predisposing and exciting. _predisposing causes of contraction_.--among these we will first mention heredity, although it is possible it should not be deemed of so great account as it is by some. that the shape of certain feet, especially those with low heels and abnormally sloping walls, predisposes to contraction no one will deny. so long, however, as the animal goes unshod, so long does the foot maintain a normal condition of the heels. in other words, it is not until the tendency to contraction already there is aggravated by careless shoeing and the effects of work that it operates to any noticeable extent. the degree of contraction will also be very largely governed by the amount of the development of the frog. with a frog of good size, low down, and taking part in the pressure of the foot on the ground, contraction will be prevented. on the other hand, an ill-developed frog, one wasted by long-continued and spreading thrush, or one robbed of its normal function by excessive paring in the forge, is a common starting-point of the condition we are considering. we have already referred to this in chapter iii., when considering the experiments of lungwitz in this connection. what we have to bear in mind in these experiments is that the application of a pad to the frog, in such a manner that effective ground-pressure is obtained, results always in a marked expansion of the heels, and that, with counter-pressure with the ground absent, expansion occurs to little or no extent. this is proof positive of the enormous part the frog plays in maintaining an open and elastic condition of the heels--a fact so insisted on by coleman. it is worthy of mention, however, that loss of the frog's function does not operate to nearly so serious an extent in horses with high, upright heels as in those with the heels low and excessively sloping. in illustrating this, mr. dollar, in his work on shoeing, mentions the case of a pair of trotting horses of similar age, size, and weight, each having weak fore-heels. in one case the hoofs were flat, in the other upright. the horse with the flat hoofs suffered from contraction, while the other did not. the reason appears to be that in the animal with upright hoofs the proportion of body-weight borne by the heels is considerably less than in those with the hoofs flat and sloping. certain conditions of the horn-producing membranes also predispose to contraction. for example, in horses reared on marshy soils, and afterwards transferred to standing in town stables, we find that a dry and brittle condition of the horn supervenes. this we may regard as a low form of laminitis, brought about by the heat of the material upon which the animal is standing, and the congestion of the feet engendered by his enforced standing for long periods in one position, as opposed to the more or less continuous exercise when at pasture. with the hoof in this condition it loses by evaporation the moisture that normally it should contain, and, as we might expect, a certain degree of contraction of its structure is the inevitable result. we thus see that contraction brought about in this way is not so much caused by the heat of the stable, as it is by the decreased ability of the horn to retain its own moisture. on the other hand, it cannot be denied that excessive warmth and dryness combined tend also to an undue abstraction of moisture, even from the horn of the healthy foot; and this explains in great measure how it is that lameness, as a rule, and especially that proceeding from contracted heels, is far more frequent and of greater intensity in the hot, dry months of summer, than in the cooler and more humid atmosphere of winter. it is interesting to note, too, that an alternation of humidity and dryness is far more liable to injure the quality of the horn and tend to its contraction than the long-continued effects of dryness alone. a common illustration of this is to be found in the effects of the ordinary poultice. everyone knows that when, after a few days' application, they are discontinued, we get as a result an abnormally dry and brittle state of the horn. this is doubtless due to the poultice removing the thin, varnish-like, and protective pellicle known as the periople, and thereby allowing the process of evaporation to act on the water normally contained in the hoof. _exciting causes of contraction_.--among these, first place must undoubtedly be given to shoeing. this does not necessarily imply shoeing more than ordinarily faulty, nor a faulty preparation of the foot, but shoeing as it is generally practised. no ordinary shoe, except a few devised for the purpose, such as the charlier or the tip, allows the frog to come in contact with the ground. this we take to be the main factor in the causation of contracted heels, especially with a predisposition already present in the foot itself. in the words of lungwitz: 'regarded from this point of view, there is no greater evil than shoeing. it abolishes the necessary counter-pressure, and thus interferes with expansion. bars, sole, and frog cannot perform the functions that naturally belong to them as they would do without the shoe.' in addition to the evil of the shoe itself, errors of practice in the forge contribute to the causation of contraction. taking first the preparation of the foot, we find that often the heels are lowered far too much, and the toe allowed to remain too long. this can have but one effect--that of throwing a greater proportion of the animal's weight upon the heels than properly they should bear, with, what we now know to be the consequence of that, a corresponding pushing inwards and downwards of the horn; in other words, contraction. excessive paring of the bars, to which we have already partly alluded, is also an active agent in bringing about an inward growth of the horn of the heels and quarters. the bar, or inflexion of the wall at the heel, by means of its close contact with the frog, communicates the outward movements of that organ to the wall of the hoof. with the bar removed, the outward movements of the frog under pressure are naturally rendered of no account, and a proper and intermittent expansion of the wall denied it. the same evil follows, though to a less extent, excessive paring of the sole. the shape of the bearing surface of the shoe is often to be blamed. where this is concave--'seated'--and the 'seating' is carried back to the heels, it is easy to see that, when weight is on the foot, there is an ever-present tendency for the bearing edge of the wall to slide down towards the inner edge of the shoe. this tendency, operating on both the inner and outer wall simultaneously, must strongly favour contraction. a further wrong practice is that of continuing the nailing too far towards the heels. in our opinion this is not now often met with. when it occurs its effect is, of course, to prevent those movements of expansion of the wall which we now know to be normal and most marked at the heels. it may be remarked of the build of the shoe, or of errors in the preparation of the foot, that neither are of much moment. neither are they. but when one stays to consider that errors of this description are practised not only once, but each time the horse goes to the forge, and that with some of them--those relating to the build of the shoe--the injury thereby brought about is inflicted not only once, but every day that particular shoe is worn, then it is not to be wondered at that, sooner or later, ill consequences more or less grave result. _prognosis_.--this will depend to a very large extent upon the conformation of the limb, and upon the previous duration of the contraction. contraction of long standing, where atrophy of the sub-lying, soft structures and the pedal bone may be expected, will prove obstinate to treatment. especially will this be so if the lateral cartilages have become ossified. neither may we look for much benefit from treatment if the contraction has occurred in animals with an oblique foot axis and flat hoofs. on the other hand, if the case is comparatively recent, if the limb is straight and the form of the hoof is upright, and if matters are uncomplicated by side-bones, or other serious alteration in the internal structures, then treatment may be rewarded with some measure of success. [illustration: fig. .--tip shoe. the dotted portions represent the length of the branches removed.] _treatment_.--the greater part of the treatment of contracted foot will almost suggest itself as a corollary of the causes we have enumerated. the normal width of the heels may be renewed, and development of the wasted frog brought about by one of three methods: . by restoring the pressure from below to the frog. . by the use of an expansion shoe. . by operative measures upon the horn of the wall. . _by restoring the pressure from below to the frog_. this may be accomplished as follows: _(a) by shoeing with tips_.--this method is advocated by percival, by a.a. holcombe, d.v.s., inspector. bureau of animal industry, u.s.a., by dollar in his work on horseshoeing, and by many others. though requiring more care than in fitting the ordinary shoe, the application of a tip is simple. in reality, the tip is just an ordinary shoe shortened by truncating the heels. before applying the tip, the horn of the wall at the toe should be shortened sufficiently to prevent any undue obliquity of the hoof, and the foot should be so prepared as to allow the heels of the tip to sink flush with the bearing edge of the wall behind it. when the foot does not allow of the removal of much horn at the toe, what is termed a 'thinned' tip is to be preferred. its shape is sufficiently shown by the accompanying figure (fig. ). with the tip the posterior half of the foot is allowed to come into contact with the ground, and the object we are striving for--namely, frog pressure, and greater facilities for alternate expansion and contraction of the heels--is thus brought about. [illustration: fig. .--the tip shoe 'let in the foot.] [illustration: fig. .--the thinned tip.] _(b) by shoeing with the charlier_.--the results brought about by the use of a tip may be arrived at by the application of a charlier or preplantar shoe, or by a modified charlier or charlier tip. briefly described, a charlier is a shoe that allows the sole and the frog to come to the ground exactly as in the unshod foot. this is accomplished by running a groove round the inferior edge of the hoof by removing a portion of the bearing edge of the wall with a specially devised drawing-knife. into this groove is fitted a narrow and somewhat deep shoe, made, preferably, of a mixture of iron and steel, and forged in such a manner that its front or outer surface follows the outer slope of the wall. the charlier should have the inner edge of its upper surface very slightly bevelled, in order to prevent any pressure on the sensitive sole, and should be provided with from four to six nail-holes. these latter should be small in size and conical in shape. the nails themselves should be small, and have a conical head and neck, to fit into the nail-hole of the shoe. [illustration: fig. .--the special drawing-knife (fleming's) for preparing the foot for the charlier shoe.] the modified charlier, or charlier tip, perhaps the better of the two for the purpose we are describing, is really a shortened charlier, and bears the same relation to the charlier proper as the tip does to the ordinary shoe. it is let into the solar surface of the foot in exactly the same manner as its larger fellow, but it does not extend backwards beyond the commencement of the quarters. by its use greater opportunity for expansion is given to the heels than is done by the charlier with heels of full length. [illustration: fig. .--foot prepared for the charlier shoe.] we do not here intend to deal at any length with the arguments for and against the charlier as regards its adoption for general use. these will be found fully set out in any good work on shoeing. the point that it is correct in theory it would be idle to attempt to evade; but that it is generally practicable, or that it offers any very pronounced advantages, as compared with the disadvantages urged against it, over the shoes in ordinary use, the limited favour it has drawn to itself, since its introduction in , seems sufficiently to deny. _(c) by the use of a bar shoe_.--where the frog is not excessively wasted benefit will be derived from the use of a bar shoe. [illustration: fig. .--bar shoe.] the transverse portion at the back, termed the 'bar,' and which gives the shoe its name, is instrumental in bringing about from below that counter-pressure on the frog that we now know to be so necessary a factor in remedying contraction. when the frog, by wasting or disease, is so deficient as to be unable to reach the 'bar,' this shoe must be supplemented by a leather or rubber sole. in the event of corn or sand-crack existing with the contraction, the shoe known as a 'three-quarter bar' is preferable (see fig. ). the break here made in the contour of the shoe allows of dressing the corn, and, in the case of sand-crack, removes the bearing from that portion of the wall. _(d) by the use of a bar pad and a heelless or 'half' shoe_.--the bar pad consists of a shape of rubber composition firmly fixed to a leather foundation, which shape of rubber takes the place of the 'bar' of the bar shoe. [illustration: fig. .--rubber bar pad on leather.] [illustration: fig. .--the bar, pad applied with a half-shoe.] for habitual use in such cases as prove obstinate to treatment, or where a complete cure was never from the commencement expected, the bar pad is undoubtedly one of the most useful inventions to our hand. the animal's 'going' is improved, the tender frog is protected from injury by loose stones, and greater comfort given to both the horse and the driver. [illustration: fig. .--frog pad.] [illustration: fig. .--frog pad applied.] _(e) by the use of a frog pad and a shoe of ordinary shape_.--the shape of rubber on this pad is designed to cover the frog only. its shape and mode of application is sufficiently shown in the accompanying illustrations. _(f) by turning out to grass_.--where the expense of keep is no object, a return of contracted feet to the normal may be brought about by removing the shoes and turning the animal out to pasture, thus giving the feet the advantages to be derived from a more or less continuous operation of the normal movements of expansion and contraction. in this case the treatment must extend from three to four, or possibly six months. . _by the use of some form of expansion shoe_. [illustration: fig. .--smith's expansion shoe seen from its ground surface and from the side. _a_, the screw, with a fine-cut thread; _b_, nut which travels along it; _c_, a hollow thimble into which the screw passes at one end, the other being cut out v-shaped to catch into a slot (_d_) on the shoe; _e, e_, the grip[a] for the bars, the length and direction of which depend upon the shape of the foot; _f, f_, the counter-sunk rivets forming the hinge (_f_'); _g_, the counter-sunk rivet of the expanding piece.] [footnote a: the inventor of this shoe uses the word 'grip' to denote what, in describing other expansion shoes, we term the 'clip' (h.c.r.).] _(a) smith's_.--for many years past continental writers have been practising this method. so far as we know, however, lieutenant-colonel fred smith was the first english veterinarian to use a shoe of his own devising, and to report on its effects. this shoe we will, therefore, give first mention. the above figure, with its accompanying letterpress, sufficiently explains the nature of the shoe. in fitting the shoe, care must be taken to have the hinges (_f, f_) far enough back, or the shoe will have a tendency to spring at the heels, and the grips _(e, e)_, which catch on the bars, will have a difficulty in biting. this trouble will be avoided by having the hinges about - / to inches from the heels. after the shoe has been firmly nailed to the foot, the travelling nut _b_ is driven forward on the screw _a_ so as to cause the grips to just catch on the inside of the bars of the foot. according to the inventor, the amount of pressure to be exerted must be learned by experience, and he says: 'i screw up very gradually until i see the cleft of the frog just beginning to open. i now trot the horse up, and if he goes sound it is certain that the pressure i have exercised will not give rise to trouble. the animal is sent to work to assist in the expansion of the foot. on examining the shoe next day, the grip is found to be quite loose, the foot has enlarged, and the nut is turned once more until the grip on the bars is tightened, the horse being again trotted to ascertain that no injurious pressure is exerted. 'every day or two i repeat this process, making measurements in all cases before widening the heels. the increase in width of the foot which results is astonishing, / to / inch during the first week may be safely predicted, and in a month to six weeks it is impossible to recognise in the large healthy frog and wide heels, the shrivelled-up organ of a short time before.'[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. v., p. .] it is pointed out by the writer of the above (and his observations, doubtless, apply to the use of all other expansion shoes in which the bars are gripped and forcibly expanded) that the whole secret of success lies in avoiding injurious pressure by exerting too great an expansion at one operation. after each manipulation of the expanding apparatus the horse should trot sound and the frog remain cool. should the foot become hot, and lameness supervene, then tension should at once be relaxed. _recorded cases of the use of the shoe_.--the inventor of the shoe relates two cases of contracted foot treated by these means in which the heels of one, after thirty-nine days' treatment, had increased in width to the extent of inch, and the heels of the other, after twenty-four days', had enlarged / inch. of the first case he gives the drawings in fig. . a represents the foot before treatment; b the same foot after nine days' treatment, when the heels had widened / inch; and c the same foot at the end of the thirty-nine days' treatment, at which date the frog was an excellent-looking one, and the foot had increased an inch in width.[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. v., p. ] [illustration: fig. .--the changes in form of a contracted foot treated with smith's expansion shoe] in , at a meeting of the midland counties veterinary medical association, the late mr. olver said he had applied this shoe to a valuable hunter that had gone so lame that he could scarcely put his foot to the ground. after a fortnight's application, and by the assistance of the double screw in the shoe, the heel was forced out. then the horse was put to work with the shoe on, and he had hunted the whole of the last season in a perfectly sound condition.[a] [footnote a: _veterinary record_, vol. vi., p. ] f.d. mclaren, m.r.c.v.s., writes:[a] 'i resolved to try one of captain smith's shoes in a case where the hoof was badly contracted, and where the frog had entirely disappeared, there being also slight lameness. the roof rapidly expanded, and every other day the nut was moved on a bit to keep the cross-piece tight. i then had the cross-piece bent downwards a little _to prevent the nut pressing on the rapidly-growing frog_.[b] after another fortnight or so, i had a shoe made with clips resting against the inside of the bars,[c] and the next time he was shod these were also dispensed with. it is now a year ago since the animal recovered his frog, and he still has the largest frog in the stable, and the hoof shows no sign of contraction.' [footnote a: _ibid_., vol. vi., p. ] [footnote b: the italics are mine (h.c.r.).] [footnote c: the expanding shoe itself was here evidently dispensed with, and an ordinary shoe with bar-clips used in its stead (h.c.r.).] _(b) de fay's_.--among other shoes of the expansion class may be mentioned that of de fay. like the preceding, it is a shoe with a flat bearing surface, and provided with bar-clips. it is, however, _un_ hinged. the requisite degree of periodic expansion is in this case arrived at by a forcible widening of the heels of the shoe, accomplished by bending the substance of which it is made, and for this purpose the instrument illustrated in fig. is employed. the foot is first properly trimmed by levelling the heels and thinning the sole on each side of the frog. the shoe is then fixed by nails in the ordinary manner, taking care that the last nails come not too far back, and that the clips rest evenly and firmly on the inside of the bars. the dilator, hoof-spreader, or vice, as it is variously called, is then applied, its two jaws (_a_ and _b_) fitting against the inner edge of the shoe at the heels. careful note is taken of the width of the hoof as measured on the graduated scale (_e_, _e_), and the double screw (_g_, _h_) revolved by means of the wrench (k), until the opening of the jaws thus obtained registers an expansion of / to / inch. the dilatation is repeated at intervals of from eight to ten days, until, at the expiration of a month or six weeks, the amount of total expansion of the heels registers nearly an inch. that the method requires the greatest care may be gathered from the reports of continental writers. they state that frequently the pain and consequent lameness keep the patient confined to the stable for several days. numerous and but slightly differing forms of the dilator are on the market. as in principle they are all essentially the same, and are to be found illustrated in any reliable instrument catalogue, they need no description here. [illustration: fig. .--de fay's vice.] _(c) hartmann's_.--a further useful expansion shoe is that of hartmann's (fig. ), in that it may be adapted for either unilateral or bilateral contraction. this shoe is also provided with bar-clips, and forcibly expanded at the heels by means of a dilator. the expansion is governed by saw-cuts through the inner margin of the shoe directed towards its outer margin, and running only partially through the inner half of the web (see fig. ). according as the contraction is confined to the inner or outer heel, the saw-cuts, one or two in number, are placed to the inner or outer side of the toe-clip. when the contraction is bilateral, the saw-cuts, one or more in number, are placed on each side of the toe-clip. _(d) broué's_.--this is one of the forms of so-called 'slipper' shoes (see fig. ). we have already indicated that the shape of the bearing surface of the ordinary shoe--by its 'seating' or sloping from outside to inside--is sometimes a cause of contraction. in the 'slipper' of broué this bearing is reversed, and the slope is from inside to outside. in the original form of this shoe the slope to the outside was continued completely round the shoe. experience taught that the strain this enforced upon the junction of the wall with the sole was injurious, and that the 'reversed seating,' if we may so term it, was best confined to the hinder portions of the shoe's branches. [illustration: fig. . this figure illustrates the principle of the hartmann expanding shoe. _a, a_, the clips to catch the inside of the bars; _b, c_, saw-cuts.] the amount of slope should not be excessive. if it is, too rapid and too forcible an expansion takes place, and pain and severe lameness results. dollar gives the requisite degree of incline by saying that the outer margin of the bearing surface of the shoe should be from / to / inch lower than the inner. in the case of the broué slipper, it is the animal's own weight that brings about the widening of the heels, the slope or outward incline of the slipper simply causing the inferior edge of the wall at the heels to spread itself outwards instead of sliding inwards on the bearing surface of the shoe. [illustration: fig. .--the slipper shoe of brouÉ.] _(e) einsiedel's_.--like the 'slipper' of broué, the einsiedel shoe depends for its effects upon the slope of the bearing surface. it differs from the broué in being provided with a 'bar-clip.' this, in addition to gripping the bars like the bar-clips of other expanding shoes, also assists, under the body-weight, in expanding the heels by the pronounced slope given to its upper surface. the expanding force exerted by the body-weight falls thus, through the medium of the bar-clip, clip, _partly_ upon the bars, instead of, as in the broué, solely upon the wall. we say _partly_ advisedly, for, in addition to the slope upon the outer side of the bar-clips, the bearing surface of the heels of the shoe is _slightly_ sloped outwards also. the good office served by the bar-clip is the lessening of any tendency to strain upon the white line. [illustration: fig. .--the slipper and bar-clip shoe of einsiedel.] those we have described by no means exhaust the number of expansion shoes that have been devised. there are numerous others, many of which are composed of three-hinged portions, the two hindermost of which are gradually separated by a toothed arrangement of their inner margins and a travelling bar, the disadvantage of which is that it is liable to work loose. in the majority of this class of shoe the hinges are placed far forward, one on each side of the toe. they there become exposed to excessive wear. in fact, against the bulk of this form of shoe it may be urged that they cannot be worn by the animal at work, that they are expensive, difficult to make, and easily put out of order. . _by operations on the horn of the wall_. _(a) thinning the wall in the region of the quarters_.--this is best done by means of an ordinary farrier's rasp. the thinning should lessen gradually from the heel for - / to inches in a forward direction. that portion of the wall next to the coronary border, about / inch in breadth, should not be touched. at this point the thinning should commence, should be at its greatest, and lessen gradually downwards until at the inferior margin of the wall the normal thickness of horn is left. the animal is then shod with a bar shoe and the hoof bound with a bandage soaked in a mixture of tar and grease, in order to keep the thinned portion of the wall from cracking. in this condition the animal may remain at light labour. when possible, however, it is better to combine the thinning process thus described with turning out to grass. in this case the ordinary shoe is first removed, and the foot poulticed for twenty-four hours to render the horn soft. the foot is then prepared by slightly lowering the heels--leaving the frog untouched--and thinning the quarters in exactly the manner described above. after this is done, the animal is shod with an ordinary tip, a sharp cantharides blister applied to the coronet, and then turned out in a damp pasture. in this case the object of the tip is to throw the weight on to the heels and quarters. the thinned horn yields to the pressure thus applied, and a hoof with heels of a wider pattern commences to grow down from the coronet. two to three months' rest is necessary before the animal can again he put to work.[a] [footnote a: this is the treatment strongly advocated by a.a. holcombe, d.v.s., inspector, bureau of animal industry, u.s.a.] _(b) thinning the wall in the region of the toe_.--this is done with the idea that the tendency of the heels to expand under pressure of the body-weight is helped by the thinned portion at the toe allowing the heels to more readily open behind. seeing that in the case of toe sand-crack the converse is argued--that contraction of the heels readily takes place and forces the sand-crack wider open--it is doubtful whether this method is of any utility in treating contracted heels. _(c) grooving the wall vertically or horizontally, and shoeing with a bar shoe_.--marking the wall with a series of grooves, each running in a more or less vertical direction, was suggested to english veterinarians by smith's operation for side-bones. the manner of making the grooves, and the instruments necessary, will be found fully described in section c of chapter x. that the method is followed by satisfactory results the undermentioned case will show: 'a mare, which i have had in my possession since she was a foal, has always had contracted feet, which were also unnaturally small.... lately the mare has been going very "short," and at length her action was quite crippled. at times she was decidedly lame on the off fore-foot. at no time have i been able to detect any sign of structural disease. i thereupon concluded that the lameness was due to mechanical pressure on the sensitive structures, and i determined to try the effects of the above treatment. as this was my first experience of the process, i was careful to carry it out in all its details, as described by professor smith. after the bar shoes had been put on, the mare was very lame. i allowed her two days' rest, then commenced regular walking exercise, and she daily improved. after fourteen days there was no lameness, but still short action. i thereupon gave the mare another week's walking exercise, at the expiration of which i drove her a short turn of five miles, which she did quite well, and free from lameness. for three months i kept the saw-cuts open to the coronet, and continued the bar shoes, keeping the mare at exercise, and giving her occasionally a drive. she never liked the bar shoes, and i was glad when i could discontinue them, which i did in the fourth month. when shod with the usual shoes the complete success of the treatment was shown. i have now had her going with the ordinary shoes for the past two or three months, and the improvement in the shape of the feet is very marked; there is no lameness; the mare is free in movement, fast, and spirited, whereas previously she was quite the reverse, and almost unfit to drive.'[a] [footnote a: w.s. adams, m.r.c.v.s., _veterinary journal_, vol. xxx., p. .] this method, though but recently introduced to the english veterinary surgeon, is by no means new. according to zundel, it was recently made known on the continent by weber, but was previously known and mentioned by lagueriniere, brognier, and hurtrel d'arboval. when the grooving is in a horizontal direction, a single incision is sufficient. this is made / inch below the coronary margin of the wall, and parallel with it, extending from the point of the heel for or inches in a forward direction. as in the previous method, a bar shoe is applied, and the animal daily exercised. thus separated from the fixed and contracted portion of the wall below, the more elastic coronet under pressure of the body-weight commences to bulge. the bulging is of such an extent as to cause the new growing hoof from the top to considerably overhang the contracted portion below, and cure of the condition results from the newly-expanded wall above growing down in a normal direction. this consideration of contracted heels may be concluded by drawing attention to the advisability of always maintaining the horn of the wall in as soft and supple a condition as is natural by the application of suitable hoof dressings. a useful one for the purpose is that made with lard, to which has been added a small quantity of wax or turpentine. especially should a dressing like this be used when the hoof is inclined to be hard and brittle, and where tendency to contraction has already been noticed. the application of a hoof ointment is also particularly indicated where the foot is much exposed to dampness, where the animal is compelled to stand for long periods upon a dry bedding, or where the bedding is of a substance calculated to have a deleterious effect upon the horn. this, in conjunction with correct shoeing, will probably serve to avoid the necessity for more drastic measures at a later time. _(b)_ local or coronary contraction. _definition_.--contraction at the heels, confined to the horn immediately succeeding that occupied by the coronary cushion. really, the condition is but a somewhat arbitrary subdivision of contracted hoof, as we have just described it in general. for that reason we shall give it but very brief mention. _symptoms_.--in this case the horn of the heels, instead of running down in a straight line from the coronary margin to the bearing surface of the wall, presents a more or less distinct concavity (see fig. , _a_, _a_). as is the case with contraction considered as a whole, this deformity may affect one or both heels; and during its first appearance, which is after the first few shoeings, the animal may go distinctly lame. _causes_.--coronary contraction may occur in hoofs of normal shape immediately shoeing is commenced, and frog pressure with the ground removed. it is far more likely to ensue, however, if the hoof is flat, with the heels low, and the wall sloping. and with those predisposing circumstances it is that the horse goes lame, and not with the hoof of normal shape. seeing, then, that this condition is largely dependent upon the shape of the foot, we may, to some extent, regard it as hereditary. seeing further, however, that it only appears when shoeing is commenced, we may in a greater degree also regard it as acquired. the lesson, therefore, that this and other forms of contraction should teach us is the carefulness with which the shoeing should be superintended in a large stud, or in any case where the animal is of more than ordinary value. [illustration: fig. .--hoof with local or coronary contraction (as indicated at the points _a, a_).] the explanation of the restricted nature of this form of contraction is simple enough. we have only to refer to the lessons taught by the experiments of lungwitz, described in chapter iii., and the condition almost explains itself. we remember that, briefly, the coronary margin of the wall resembles a closed elastic ring, which yields and expands to local pressure, no matter how slight. we remember also that removal of the counter-pressure of the frog with the ground tended to contraction of the wall's solar edge when weight was applied. connect these two facts with the experience that this form of contraction more often than not occurs in hoofs with sloping heels, and we arrive at the following: . the excessive slope of the heels tends to throw a more than usual part of the body-weight upon the posterior portion of the coronary margin of the wall, with a consequent expansion of that part of the coronary margin implicated. . that the shoeing, in removing the counter-pressure of the frog with the ground, is at the same time tending to bring about contraction of the lower portions of the wall at the heels and quarters. . that this tendency to contraction will at first appear in the thinner portion of the area of wall named--namely, in that immediately below the bulging coronary margin. we thus get the appearance depicted in fig. --a contraction _(a, a)_ of the heels in the horn below the coronary margin, with the coronary margin itself bulging above, and a hoof of apparently normal width below. we say 'apparently' with a purpose, for, as actual measurements will show, the wall near the solar edge is really contracting, for reasons which we have just described connected with shoeing. its 'appearance' of normal width is accounted for thus: the contraction at _a, a_ is caused by the dragging inwards of the coronary cushion brought about by the sinking downwards of the plantar cushion, with which body it will be remembered the coronary cushion is continuous. with the constant dragging in and down of the coronary cushion there is given, to the horn-secreting papillæ, studding both the lower third of its outer face and its lowermost surface, a distinct 'cant' outwards. below the lowermost limit of the coronary cushion, then, by reason of the cant outwards of the coronary papillæ in the situations mentioned, the horn of the wall takes a more outward direction than normal, a fact which lessens in effect the contraction as a whole really going on. it is interesting, too, to note that by this outward cant of the wall below, and the bulging of the coronary margin above it, the contraction (_a, a_) is heightened in effect, and caused to appear greater than really it is. from what we have said it follows that contraction of the heels, excepting the extreme coronary margin, is existent generally, and not confined solely to _a, a_. we have, then, in this condition, as we indicated at the commencement, but a phase in the evolution of ordinary contracted heels, for, with the progress of the contraction already existing at _a, a_, and below those points, it is only fair to assume that with it falling in of the at present bulging coronary margin must sooner or later occur, that, though expanded when compared with the wall below it, it will be really contracted as compared with what it was once in that same foot. we may therefore conclude this section by remarking that factors tending to contraction of the heels in general are equally potent in the causation of contracted coronet alone. _treatment_.--exactly that described for contracted heels. bearing in mind that contracted coronary margin is but the onset of contracted heels, and that its first exciting cause is that of removal of the ground-pressure upon the frog, the most careful attention must be paid to the shoeing. the use of bar shoes, ordinary frog pads, or heelless shoes and bar pads, are especially indicated, together with abundant exercise. by these means the normal movements of expansion will be brought into play, and the condition quickly remedied. c. flat-foot. _definition_.--by this term is indicated a condition of the foot where the natural concavity of the sole is absent. _symptoms_.--in the flat-foot the inferior edge of the wall, the sole, and the frog, all lie more or less in the same plane. it is a condition observed far more frequently in fore than in hind limbs, and is seen in connection with low heels, more or less obliquity of the wall, and a tendency to contraction. the action of the animal with flat feet is heavy, a result partly of the build of the foot, and partly of the tenderness that soon comes on through the liability of the sole to constant bruising. [illustration: fig. . this figure represents the lower surface of a typical flat-foot. it illustrates, too, the commencement of a condition we referred to in section b of this chapter--namely, the compression of the frog by the ingrowing heels (b) and bars (a).] _causes_.--flat-foot is undoubtedly a congenital defect, and is seen commonly in horses of a heavy, lymphatic type, and especially in those bred and reared on low, marshy lands. it is thus a common condition of the fore-feet of the lincolnshire shire. as might be expected, a foot of this description is far more prone to suffer from the effects of shoeing than is the foot of normal shape, and regarded in this light shoeing may be looked upon as, if not an actual cause, certainly a means of aggravating the condition. directly the shoe--or at any rate the ordinary shoe--is applied, mischief commences. the frog is raised from the ground, and the whole of the weight thrown on to the wall. the heels, already weak and inclined to turn in, are unable to bear the strain. they _turn in_, and contraction commences. this 'turning in' of the heels is favoured by the undue obliquity of the wall. at the same time, the sole being archless, a certain amount of elasticity is lost. the weight is thrown more on to the heels, and the os pedis slightly descends, rendering the flatness of the sole even more marked than before. with the loss of elasticity of the sole concussion makes itself more felt. the animal is easily lamed, bruised sole becomes frequent, and corns sooner or later make their appearance. _treatment_.--flat-foot is incurable. all that can be done is to pay careful attention to the shoeing, and so prevent the condition from being aggravated. in trimming the foot the sole should not be touched; the frog, too, should be left alone, and the wall pared only so far as regards broken and jagged pieces. the most suitable shoe is one _moderately_ seated. if the seating is excessive, and bearing allowed only on the wall, there is a tendency for the wall to be pushed outwards, and for the sole to drop still further. on the other hand, if the seating is insufficient, or the web of the shoe too wide, and too great a bearing thus given to the sole, then we get, first, an undue pressure upon the last-named portion of the foot a bruise, and, finally, lameness. the correct bearing should take in the whole of the wall and the whole of the white line, and should _just impinge_ upon the sole. above all, the heels of the shoe should be of full length, otherwise, if the shoe is worn just a little too long, its heels are carried under the sole of the foot, and by pressure there produce a corn. if, with these precautions in shoeing flat-foot, tenderness still persists, a sole of leather or gutta-percha must be used with the shoe. d. pumiced-foot, dropped sole, or convex sole. _definition_.--this term is applied to the foot when the shape of the sole is comparable to the bottom of a saucer. when least marked it is really an aggravated form of flat-foot. _symptoms_.--in pumiced-foot the sole projects beyond the level of the wall. the obliquity of the latter is more marked than in the previous condition, and progression, to a large extent, takes place upon the heels. in addition to its deformity, the horn is greatly altered in quality, and, as the name 'pumice' indicates, is more or less porous in appearance, bulging, and brittle. _causes_.--as a general rule, it may be taken that pumiced-foot is a sequel of previous disease, although in its least pronounced form it may occur as the result of accidental or other causes, such as those described in the causation of flat-foot. occurring in its most marked form, there is no gainsaying the fact that pumiced-foot is a sequel of either acute or subacute laminitis. as we shall see when we come to study that disease, the dropping of the sole is brought about by distinct and easily-understood morbid processes affecting the sensitive structures. briefly, these morbid processes in laminitis may be described thus: the accumulated inflammatory exudate, and in some cases pus, weakens and destroys the union between the sensitive and insensitive laminæ. this separation, for reasons afterwards to be explained, is greatest in the region of the toe. the os pedis, loosened from its intimate attachment with the horny box, is dropped upon the sole, and the sole, unable to bear the weight, commences to bulge below. the altered character of the horn is accounted for by the inflammatory changes in the sensitive laminæ and the papillæ of the keratogenous membrane generally, for it follows as a matter of course that these tissues, themselves in a diseased condition, must naturally produce a horn of a greatly altered and inferior quality. when following the _subacute_ form of laminitis, the changes characterizing pumiced-foot are slow in making their appearance. the animal at first goes short, and the lameness thus indicated gradually becomes more severe, until the animal is no longer able to work. the feet become hot and dry, the hoof loses its circular form, and the growth of horn at the heels becomes excessive. at this stage the appearance of bulging at the sole begins to make itself seen. later, the outer surface of the wall becomes 'ringed' or 'ribbed,' the rings being somewhat closely approximated in the region of the toe, and the distance between them gradually widening towards the heels. the wall too, especially in the region of the toe, instead of running in a straight line from the coronary margin to the shoe, becomes concave. it is this change, together with the appearance of the rings, that indicates the loosening of the attachment of the os pedis to the wall, and its afterwards backward and downward direction (see fig. ). [illustration: fig. .--hoof with the ribs or rings caused by chronic laminitis.] as a sequel of _acute_ laminitis, these changes make their appearance with more or less suddenness, and are generally complicated in that they owe their occurrence to the formation of pus within the horny box. _treatment_.--pumiced-foot is always a serious condition. the animal is useless for work upon hard roads or town pavings, and is of only limited utility for slow work upon soft lands. the more serious form, that following acute laminitis, and complicated by the presence of pus, we may regard as beyond hope of treatment. with the more simple form of the condition, we may do much to render greater the animal's usefulness. the same principles as were applied to the shoeing of flat feet will have to be observed here. trimming or paring of any kind, save 'straightening up' of the wall, must be severely discountenanced. a broad-webbed shoe, one that will give a certain amount of cover to the sole, is indicated. as in the treatment of flat-foot, however, direct pressure upon the sole must be avoided, and the shoe 'seated.' the 'seating,' however, should not commence from the absolute outer margin of the shoe's upper surface. a _flat_ bearing should be given to the wall and the white line, and the seating commenced at the sole. we have already remarked on the increased growth of horn at the heels. it is in this position, then, that will be found the greatest bearing surface for the shoe, and it is wise, in this case, to have the heels of the shoe kept flat. in other words, the 'seating' is not to be continued to the hindermost portion of the branches of the shoe. by this means there may be obtained at each heel a good solid bearing of from to inches, which would otherwise be lost. where the accompanying condition of the horn is bad enough to indicate it, a leather sole should be used, beneath which has been packed a compress of tow and grease, rendered more or less antiseptic by being mixed with tar. where the sole is exceedingly thin, and inclined to be easily wounded, and where the hoof, by its brittleness, has become chipped and ragged at the lower margin of the wall, it may perhaps be more advantageous to use, in place of the compress of tow, the _huflederkitt_ of rotten. this is a leather-like, dark brown paste. when warmed in hot water, or by itself, it becomes soft and plastic, and may readily be pressed to the lower surface of the foot, so as to fill in all little cracks and irregularities, and furnish a complete covering to the sole and frog, and to the bearing surface of the wall. when cold it hardens, without losing the shape given to it, into a hard, leather-like substance. treated in this way, the animal with pumiced feet may yet be capable of earning his living at light labour or upon a farm. e. 'ringed' or 'ribbed' hoof. _definition_.--a condition of the hoof in which the wall is marked by a series of well-defined ridges in the horn, each ridge running parallel with the coronary margin. they are known commonly as 'grass rings,' and may be easily distinguished from the more grave condition we have alluded to as following laminitis, by the mere fact that they do not, as do the laminitic rings, approximate each other in the region of the toe, but that they run round the foot, as we have already said, _parallel with each other_. [illustration: fig. .--hoof showing the rings in the horn brought about by physiological causes.] _causes_.--this condition is purely a physiological, and not a pathological one, and the words of its more common name, 'grass rings,' sufficiently indicate one of the most common causes. anything tending to an alternate increase and decrease in the secretion of horn from the coronet will bring it about. thus, in an animal at grass, with, according to the weather conditions, an alternate moistness and dryness of the pasture, with its consequent influence on the horn secretion, these rings nearly always appear. the effects of repeated blisters to the coronet make themselves apparent in the same way, and testify to the efficacy of blisters in this region in any case where an increased growth of horn is deemed necessary. from this it is clear that the condition depends primarily upon the amount and condition of the blood supplied to the coronary cushion. thus, fluctuations in temperature during a long-continued fever, or the effects of alternate heat and cold, or of healthy exercise alternated with comparative idleness, will each rib the foot in much the same manner. _treatment_.--the condition is so simple that we may almost regard it as normal. consequently, treatment of any kind is superfluous. where constitutional disturbance is exerting an influence upon either the quality or quantity of the blood directed to the part, then, of course, attention must be paid to the disease from which it is arising. f. the hoof with bad horn. (_a_) the brittle hoof. _definition_.--as the name indicates, we have in this condition an abnormally dry state of the horn. _symptoms_.--these are obvious. the horn is hard, and when cut by the farrier's tools gives the impression of being baked hard and stony, the natural polish of the external layer is wanting, and there is present, usually, a tendency to contracted heels. with the dryness is a liability to fracture, especially at points where the shoe is attached by the nails. as a consequence, the shoes are easily cast, leading to splits in the direction of the horn fibres. these run dangerously near the sensitive structures, giving rise in many cases to lameness. even where pronounced lameness is absent the action becomes short and 'groggy,' and the utmost care is required in the shoeing to keep the animal at work. _causes_.--to a very great extent the condition is hereditary, and is observed frequently in animals of the short, 'cobby' type. in ponies bred in the welsh and new forest droves the condition is not uncommon, especially in the smaller animals. animals who have had their feet much in water--as, for instance, those bred and reared on marshy soils--and afterwards transferred to the constant dryness of stable bedding, are also particularly liable to this condition. it is noticed, too, following the excessive use of unsuitable hoof-dressings, more especially in cases where coat after coat of the dressing is applied without occasionally removing the previous applications. _treatment_.--as a prophylactic, a good hoof-dressing is indicated. it should not consist solely of grease, but should have mixed with it either wax, turpentine, or tar. above all, careful shoeing should be insisted on, and the owner of an animal with feet such as these will be well advised if he is recommended to have the shoeing superintended by one well competent to direct it rightly. the foot should be trimmed but lightly, always remembering that in a foot of this description the horn, in addition to being brittle, is generally abnormally thin. jagged or partly broken pieces should be removed, and the bearing surface rendered as level as possible. the foot should be carefully examined before punching the nail-holes in the shoe, and the nail-holes afterwards placed so as to come opposite the soundest portions of horn. the nails themselves should be as thin as is consistent with durability, and should be driven as high up as possible. on the least sign of undue wear the shoes should be removed, never, as is too often done, allowing them to remain on so long that a portion breaks away. if, with the laudable idea of not interfering with the horn more than is possible, this is practised, the portion of the shoe breaking off is bound to tear away with it more or less of the brittle horn to which it is attached. where the breaks in the horn are so large as to prevent a level bearing for the shoe being obtained, the interstices should be filled up with one or other of the preparations made for this purpose. one of the most suitable is that discovered by m. defay. by its means sand-cracks or other fractures of the horn may be durably cemented up. 'even pieces of iron may be securely joined together by its means. the only precaution for its successful application is the careful removal of all grease by spirits of sal-ammoniac, sulphide of carbon, or ether. m. defay makes no secret of its composition, which is as follows: take part of coarsely-powdered gum-ammoniac, and parts of gutta-percha, in pieces the size of a hazel-nut. put them in a tin-lined vessel over a slow fire, and stir constantly until thoroughly mixed. before the thick, resinous mass gets cold mould it into sticks like sealing-wax. the cement will keep for years, and when required for use it is only necessary to cut off a sufficient quantity, and remelt it immediately before application. we have frequently used this cement for the repair of seriously broken hoofs. it is so tenacious that it will retain the nails by which the shoe is attached without tearing away from the hoof.'[a] [footnote a: _veterinary journal_, vol. iii., p. .] failing this, the bearing surface may be made level, and fractures repaired by using the _huflederkitt_ described in the treatment of pumiced sole. (_b_) the spongy hoof. _definition_.--this is the opposite condition to the one we have just described, and is characterized by the soft and non-resistant qualities of the horn. _symptoms_.--spongy hoof is quite common in animals that have large, flat, and spreading feet--in fact, the two appear to run very much together. it is a common defect in animals reared in marshy districts, and of a heavy, lymphatic type. the lincolnshire shire, for instance, has often feet of this description, and, the causative factors being in this case long-continued, render the feet extremely predisposed to canker. the horn is distinctly soft to the knife, and has an appearance more or less greasy. animals with spongy feet are unfit for long journeys on hard roads. when compelled to travel thus, the feet become hot and tender, and lameness results. a mild form of laminitis, extending over a period of three or four days, often follows on this enforced travelling on a hard road, more especially in cases where the animal is 'heavy topped,' and the usual food of a highly stimulating nature. in fact, it has been the author's experience to meet with this condition several times in the case of shire stallions doing a long walk daily upon hard roads, with the weather hot and dry. _treatment_.--when a horse with spongy feet is shod for the first time, care must be taken to avoid excessive paring of the sole, for already the natural wear of the foot has been sufficient to keep the soft horn in a state of thinness. for the same reason hot fitting of the shoe must not be indulged in for too long a time. that common malpractice of the forge, 'opening up the heels,' must, in this case, be especially guarded against, or the excessive paring of the frog and partial removal of the bars that this operation consists in will lay the foot open to risk of contraction. to begin with, the heels are naturally weak, and, once the bars are removed, there is nothing to prevent them rapidly caving in towards the frog. even when carefully shod, a foot of this class is readily prone to contract directly the animal is brought into the stable, and the horn commences to dry to excess. an ordinary light shoe should be used, and the nails should be light and thin. they should be driven carefully home, and the 'clinching' made as tight and secure as possible. g. club-foot. _definition_.--under this name we indicate all cases in which the horn of the wall become straightened from above to below. it will, therefore, include all conformations varying from the so-called 'upright hoof,' in which the toe forms an angle of more than degrees with the ground, to the badly 'clubbed' foot, in which the horn at the toe forms a right angle with the ground, or is even directed obliquely backwards and downwards, so that the coronary margin overhangs the solar edge of the wall. [illustration: fig. .--the club-foot.] _symptoms_.--even in its least pronounced form the condition is apparent at a glance, the alteration in the angle formed by the hoof with the ground striking the eye at once, and the heels, as compared with the toe, appearing much too high. when the condition is slight, the wall of the toe is about twice as high as that of the heels, while in the most marked form the toe and the heels may in height be nearly equal (see fig. ). when congenital, but little interference with the action is noticed. such animals, by reason of their 'stiltiness,' are unfit for the saddle, but at ordinary work will perform their duties equally well with the animal of normal-shaped feet. when acquired as the result of overwork, of contracted tendons, or other causes, however, the gait becomes stumbling and uncertain. the body-weight is transferred from the heels to the anterior parts of the foot, and the shoe shows undue signs of wear at the toe. _causes_.--upright hoof is undoubtedly hereditary, and is even seen as a natural conformation in the feet of asses and mules. when hereditary in the horse, however, it is certainly a defect, and is associated commonly with an upright limb, and a short, upright pastern (see fig. ). among other causes, we may enumerate sprains or wounds of the flexor tendons, or any disease of the limbs for a long time preventing extension of the fetlock-joint, such as sprains or injuries of the posterior ligaments of the limb, splints or ringbones so placed as to interfere with the movements of the flexor tendons, or, in the hind-limb, spavin, keeping for some months the fetlock in a state of flexion. in the very young animal the condition may be induced by an improper paring of the foot--cutting away too much at the toe, and allowing the heels to remain. _treatment_.--when the condition is congenital, no treatment at all is indicated. it might, in fact, be said that interference would tend rather to minimize than enhance the animal's usefulness; for, in this case, the club-shaped feet are in all probability due to faulty conformation above. in other words, the upright hoof is in this instance but a natural result of the animal's build, with which useful interference is impossible. where the upright hoof is a consequence of excessive paring of the toe, or insufficient removal of the heels, the condition may be remedied by directing attention to those particulars, and preventing their continuance. at the same time, a greater obliquity of the limb axis may be given by the use of a suitable shoe. the shoe indicated is a short one, with thin heels and a thick toe. in some cases the abnormality may be remedied by the use of a tip. whatever method is adopted, care must be taken not to attempt too positive a change in the direction of the limb at one operation. the process must be gradual. in cases where the abnormality has been brought about by wounds to the flexor tendons, the alteration in the direction of the limb is often so great as to produce 'knuckling over' of the fetlock. this, to a very great extent, may be remedied by the use of a shoe with calkins and an extended toe-piece (see fig. ). [illustration: fig. .--the shoe with extended toe-piece and high calkins.] with this shoe a certain amount of forced exercise is advisable, and at intervals of about two weeks the calkins should be somewhat lowered, until the heels are brought as close to the ground as is possible. in giving directions for this shoe to be made the veterinary surgeon must, when referring to the length of the toe-piece, be guided entirely by the condition of the case. ordinarily, a suitable length is from to inches. it is necessary also to warn the owner that, by reason of the length projecting, the shoe is liable to be torn off. should the 'knuckling over' have become complicated by bony deposits round the seat of the original injury, then a favourable modification of the condition is not so likely to result. the benefit to be derived from the shoe with an extended toe-piece in a case of excessive knuckling is admirably shown in a brief report of a case, under the title of 'hooked foot,' in vol. xiv. of the _veterinary record_, p. : 'an eighteen months' old filly showed a deformity of the third phalanx, resulting in her walking with the front face of the hoof on the ground. the flexors were apparently all right, and the bending back seemed to be due to contraction of the ligaments of the joint and the sheath of the perforans. 'on the ground of absence of contraction of the flexors, or atrophy and paralysis of the extensors, the surgeon considered the lesion curable by simple orthopædic measures. by means of an elongated toe-piece to the shoe and calkins, which were shortened every fifteen days, the filly was completely cured in seventy days.' h. the crooked foot. (_a_) the foot with unequal sides. _definition_.--the foot thus affected has one side of the wall higher than the other. _symptoms_.--this deformity is the better recognised when the foot on the floor is viewed from behind. in addition to the difference between the height of the inner and outer heel is seen at once a deviation in the normal direction of the horn. that of the higher side is distinctly more upright than that of the lower, and runs from above downwards and inwards towards the axis of the foot, while the horn of the lower side maintains its normal direction of downwards and outwards. from what we have said before on contracted foot, this bending in of the wall of the upright side will at once be recognised as a form of contraction. it is, in fact, contraction confined to one-half of the foot only, and, as a result, the upright side of the crooked foot is prone to the troubles arising from that condition. corns are frequent, and atrophy of that half of the frog on the affected side supervenes. with the inflammatory changes accompanying these conditions we find the horn of the affected side deteriorating in quality. it becomes dry and brittle, and extremely liable to sand-crack. at the same time, thrush of the contracted frog begins to make its appearance. _causes_.--more often than not this condition is a result of the conformation of the limb. according as the build above inclines the animal to 'turned in' or 'turned out' toes, so shall we have feet with a wall crooked inwards or crooked outwards; and it may be mentioned here that the evil results inflicted on the foot by ill-shaped limbs above will make themselves the more readily noticed when the animal comes to be shod for any length of time. so long as a natural wear of the foot is allowed, so long does it accommodate itself to the form of limb above. so soon, however, as the shoe is applied, and a more or less equal (and in this case harmful) wear by that means insisted on, so soon does this abnormal change in the height and direction of the horn fibres begin to make itself seen. while arising in the majority of instances from faulty conformation of the limb, crooked feet may also be brought about by bad shoeing, or by unequal paring of the foot, and, in a few cases, from unequal wear of the foot in a state of nature. _treatment_.--although it may be taken as a rule that lowering of the higher wall, even if persisted in at every shoeing, will do nothing towards remedying the primary cause (viz., the evil conformation of the limb), yet it will serve to keep the condition within reasonable limits. in this case, while removing so much of the wall as is deemed necessary, care must be taken to leave uncut the sole and the bar. leaving these intact gives us two natural and very potent protections against the contraction already mentioned as impending. where, by reason of the thinness of the horn or other causes, sufficient paring to equalize the tread cannot be practised, then the same end may be arrived at by the use of special shoes. that branch of the shoe applied to the half of the foot with the lower wall should be thickened from above downwards. or, on the same branch, may be turned up a calkin of sufficient height for the purpose. of the two methods the first is preferable. in any case, whether depending upon paring, or upon the use of a special shoe, the animal should be sent to the forge quite often, for it is only by a well-directed, and therefore constant, application of the principles here laid down that improvement may be brought about. when marked contraction of one-half of the foot is present, it will be best treated with the expanding shoe of hartmann, already described in the section of this chapter dealing with contracted heels (see fig. ). (_b_) the curved hoof. _definition_.--the hoof with the wall of one side convex, and that of the opposite side concave. fig. , showing the foot in section from side to side, gives an exact idea of this malformation. _causes_.--as was the case with the condition previously described, this abnormality finds its primary cause in an unequal distribution of weight due to vice of conformation in the limb above, causing one side of the hoof to be higher than the other. as a result of this, the wall that is inordinately increasing in height commences to bulge outwardly (fig. , _a_), while the opposite (fig. , _b_) becomes concave. the same state of affairs may be occasioned in the forge by leaving one side of the foot too high, and subjecting the other to excessive paring for several consecutive shoeings. _treatment_.--in the main this condition may be regarded as a long-standing and aggravated form of the foot with unequal sides. we may say at once, therefore, that it is not so easily remedied as that simpler defect; that, although identical principles will be followed in its treatment, cure must be a matter of some considerable time. [illustration: fig. .--section through a crooked foot. _a_, the higher and convex side of the wall; _b_, the lower and concave side of the wall] again, we must look to successive parings of the wall of the higher side to bring about a gradual return to the normal. at the same time, the tendency to contraction of that side is counteracted by shoeing wide, and, if necessary, giving to the upper surface of that branch of the shoe what we have termed elsewhere a 'reversed seating'--viz., an incline of its upper surface from within outwards. chapter vii diseases arising from faulty conformation a. sand-crack. _definition_.--a solution of continuity of the horn of the foot, occurring usually in the wall, and following the direction of the horn fibres. _classification_.--it is usual to classify sand-cracks according to-- _(a) their position_.--_toe-crack_ when occurring in the middle line of the horn of the toe, and _quarter-crack_ when occurring in the horn of the quarters. sand-crack of the frog and sand-crack of the sole may also each be met with. they are, however, of rare occurrence, and are seldom serious enough to merit special attention. the toe-crack is met with more often in the hind-foot than in the fore, while the quarter-crack more often than not makes its appearance in the fore-foot, and is there, as a rule, confined to the inner side. the reasons for these positions being so affected we shall deal with when treating of the causes of sand-crack in general. it is interesting to note that the portions of wall known as inside and outside toe are seldom affected. _(b) their length_.--_complete_ when they extend from the coronary margin of the wall to its wearing edge; _incomplete_ when not so extensive. _(c) their severity_.--_simple_ when they occur in the horn only, and do not implicate the sensitive structures beneath; _complicated_ when deep enough to allow of laceration and subsequent inflammation of the keratogenous membrane. such complications may vary from a simple inflammation set up by laceration and irritation of the sensitive structures by particles of dirt and grit that have gained entrance through the crack, to other and more serious changes in the shape of the formation of pus, hæmorrhage from the laminal vessels, caries of the os pedis, or the development of a tumour-like growth of horn on the inner surface of the wall known as a keraphyllocele. _(d) their duration_.--_recent_ when newly formed; _old_ when of long standing. _(e) their starting-point_.--this last distinction we make ourselves, and, referring to cracks of the wall, term them _high_ when commencing from the coronary margin, _low_ when starting from the bearing surface. _causes_.--we have already classified sand-crack as a disease arising from faulty conformation. thus, in just so far as a predisposing build of body may be handed down from parent to offspring, we may regard sand-crack as hereditary. if we do so, however, we must afterwards make up our minds to sharply distinguish between the sand-crack plainly brought about by accidental cause, and that occurring as a result of hereditary evil conformation. with regard to the latter, we need hardly say that feet with abnormally brittle horn are extremely liable. but with this, as with many other affections of the feet, we shall find it necessary to consider several causes acting in cooperation. in this case, for instance, given the brittle horn, it becomes necessary to further look for exciting causes of its fracture. we will take conformation first. in the animal with turned-out toes a more than fair share of the body-weight is imposed on the horn of the inner quarter. here, then, three causes exert their influence together: the horn is brittle; the wall of the inner quarter is thinner than that of the outer; additional weight is imposed upon it. fracture results. take, again, the vice of contracted heels. here, in the first place, we have a variety of causes tending to bring about the contraction. with the contraction, and its consequent pressure upon the sensitive structures in the region of the quarters and the frog, has arisen a low type of inflammation. the horn of the part has become dry and brittle. the exciting cause of its fracture is found in an excessive day's work upon a hard, dry road, with, perhaps, a suddenly-imposed improper distribution of weight, due to treading upon a loose stone, or a succession of such evil transfers of weight due to travelling upon a road that is rough in its whole extent. in their turn, too, such defects of the feet as we have mentioned in the last chapter--as, for example, the foot with the pumiced horn, the foot with abnormally upright heels, or that which is upright on one side only, or crooked--each offers a condition which is predisposing to the formation of a sand-crack. in each case it wants but the uneven distribution of the body-weight, which, as a matter of fact, some of these conditions themselves give, to bring about a fracture. apart from the predisposition conferred by conformation, must be remembered the simpler predisposing causes leading to brittleness of the hoof. we refer to the after-effects of poulticing, the moving from pasture to stable, the emigration from a damp to a dry climate, or the alternate changes from damp to dry in a temperate region. each may have a deteriorating influence upon the horn, rendering it liable to the condition we are describing. excessive dampness alone, especially when the animal is called upon to labour at the drawing of heavy loads upon a rough road, is not infrequently a cause. in this case the wet, together with the constant friction of the sharp materials of which the road is made, serves to destroy the varnish-like periople. the wet gains access to the inner structures of the wall, the agglutination of the horn fibres is weakened, and fissures begin to appear. other causes of sand-crack are purely accidental. an animal at fast work over-reaches. the secretion of horn at the injured coronet is interfered with, a diminished supply at an isolated spot being the result. from this point grows down a fissure in the wall. an injury of the same character may also be sustained in various other ways--treads from other animals when working in pairs, accidental wounding with the stable-fork, blows of any kind, or a self-inflicted tread with the calkin of an opposite foot--each with the same result. so far as causation is concerned, toe-crack stands in a class almost by itself. it is met with nearly always in a heavy animal in the hind-foot, and is directly attributable to the force exerted in starting a heavy load. unskilful shoeing also plays a part in the causation of sand-crack. removal of the periople by excessive rasping of the wall is most certainly a predisposing cause. cracks, or their starting-points, may also be caused by using too wide a shoe, or by the use of nails too large in the shank. also, they may arise from unskilful fitting of the toe-clip, especially in the hind-foot of a heavy animal. it must be admitted, however, that the part shoeing plays in the causation of sand-crack is not a large one; far more depends upon the state of the horn and the animal's conformation than upon the exciting cause. so far, our observations on the causes of sand-crack have referred to that form occurring in the wall. sand-crack of the sole or frog we have already said is but seldom met with, and then it is always in connection with some exceptionally deteriorated quality of the horn, as in the case of badly pumiced feet, or occurs as a result of direct injury. extensive slit-like cuts in this region, when deep enough to lacerate the keratogenous membrane, are sometimes followed by the growth of a fissure in the horn, and what might almost be termed a permanent sand-crack results. such cuts may be occasioned by sharp flints, broken glass, or other sharp objects picked up on the road, or may result from the animal treading on the toe-clip of a partially cast shoe. _symptoms_.--in every case the fissure, or evidence of its commencement, is a diagnostic symptom. it is well to remember, however, that this may be easily overlooked, especially when the crack is one commencing at the coronary margin. the reason is this: sand-cracks in this position often commence in the wall proper, and not in the periople. they may, in fact, be first observed as a fine separation of the horn fibres immediately beneath the perioplic covering. a crack of this description may even show hæmorrhage, and have been in existence for some time, without the periople itself showing any lesion whatever. thus, unless lameness is present, or a more than specially keen search is directed to the parts in question, the sand-crack goes undiscovered, until of greater dimensions. further, the fissure may be hidden, either accidentally or of set purpose. it may be covered by the hair, filled in and covered over with mud, or intentionally concealed by being 'stopped' with an artificial horn, with wax, or with gutta-percha, or, as is more common, be hidden by the lavish application of a greasy hoof-dressing. in this latter connection it is well to warn the veterinary surgeon, especially the beginner, when examining for soundness, to be keenly critical before passing an animal who is presented with feet smothered with tar and grease or any other dressing. more especially should this warning be heeded when examining any of the heavier breeds of animal with an abundance of hair about the coronet. referring again to the search for the crack, it is well to know that with toe-crack the fissure is the more readily seen when the foot is lifted from the ground. with quarter-crack, on the other hand, the fissure is wider, and consequently the easier detected with the foot bearing weight. although commencing in the insidious manner we have described, the lesion is not thus often seen by the veterinary surgeon. usually, the animal with sand-crack is brought for his inspection when lameness has arisen from it. in this case the cause for the lameness will reveal itself in the crack, which is now too large to escape observation. the coronet is hot and tender to the touch, and a sensation of warmth is sometimes conveyed to the hand by the horn of the surrounding parts of the wall. it is hardly necessary to say that, with accompanying conditions such as these, the sand-crack is a _deep_ one. where the lameness is but slight, we may attribute it almost solely to the pain occasioned by the mere wounding of the keratogenous membrane, and to no very extensive inflammatory changes therein. by some authorities this is said to be due to the pinching of the sensitive structures between the edges of the fissure in the horny covering. in our opinion, however, pinching does not occur unless inflammatory exudation into the sensitive structures adjoining the crack has led to sufficient swelling to cause them to protrude. in other words, the movements of the horny box, communicating themselves to the structures beneath, and so occasioning movement in the wounded keratogenous membrane, are quite sufficient to give rise to the lameness without actual pinching of the structures implicated. the severity of the lameness will vary with the rapidity of the gait, and with the character of the road upon which the animal is made to travel. for instance, many animals in which the lameness is imperceptible at a walk become 'dead' lame at a fast trot. it is sufficiently explained when one remembers the greater movements of expansion and contraction of the posterior parts of the wall brought about by the increase in the rate of progression. the same animal, too, will go distinctly more lame upon a hard than upon a soft surface. in like manner the lameness from toe-crack also varies in degree with the rate of progression and the character of the travelling, though not to such a noticeable extent as in the lameness from quarter-crack. a greater variation may in this case be brought about by moving the animal on ascending and descending ground. descending an incline, with a more than ordinary share of the body-weight thus thrown upon the heels, the lameness is most marked. the reason would appear to be that the greater expansion of the wall of the heels thus brought about leads to a proportionate contraction of the wall at the toe, especially at the edges of the crack, thus causing undue pressure upon the exact spot of the wound in the sensitive structures. ascending--the weight in this case transferred from the posterior to the anterior portion of the foot--the expansion of the heels becomes a contraction, with a corresponding lessening of the contraction at the toe and a distinct decrease in the lameness. in the case of a deep but recent crack there is always more or less hæmorrhage. this favours risk of infection of the lesion with pus-forming organisms, and so leads to a more or less pronounced lameness, a degree of swelling, heat and tenderness in the coronet above, and a certain amount of surgical fever. the acute symptoms subdued, but the fissure still remaining, gives us the crack we have classified as 'old.' this may in every case be distinguished from a more recent lesion by the amount of thickening of the overhanging coronet, and the presence of an increased quantity of sub-coronary horn in the region immediately about the crack. the previous inflammatory changes in the adjoining sensitive structures have here led to an increased secretion of horn, and a greater or less deposition of inflammatory connective tissue in the wounded coronary cushion. sand-crack of the toe always follows the direction of the horn fibres. that of the quarter, however, may on occasion run a course that is somewhat zigzag, first following the direction of the horn fibres for a short distance, then travelling in a horizontal direction, and finally continuing its course again in a line with the horn fibres, commonly at a point posterior to that at which it commenced. in a quarter-crack that is old, and when contraction of the heels exists (which in this case it usually does), then will often be found overlapping of the edges of the crack. the expansion of the wall brought about when the body-weight is on the heels, cannot, by reason of the break in it, continue itself anterior to the crack. as a consequence, repeated expansion of the wall posterior to the crack, with the portions anterior to it in a state of enforced quiescence, leads in time to the posterior edge of the crack coming to lie over that of the anterior. _complications_.--the first complication likely to arise in a case of sand-crack is that attending simple laceration of the sensitive structures in a _deep_ lesion. with the laceration all the phenomena of a repairing inflammation make their appearance. as a result, there is more or less heat according to the degree of inflammatory hyperæmia, swelling according to the amount of inflammatory exudate, and pain according to the amount of pressure the two foregoing bring to bear on the nerves in the inflamed area. a second and more serious complication is the greater inflammation set up by the introduction into the crack of foreign substances. small portions of gravel and flint, both by the irritation set up by their friction and by the infection they carry in with the dirt surrounding them, are responsible for the mischief. when, from direct communication with the blood-stream, due to extensive hæmorrhage, bacteria from the outside gain entrance, this simple inflammation is further complicated by the formation of pus, or a limited gangrene of the keratogenous membrane. in cases of great severity the gangrene of the keratogenous membrane spreads until the deeper structures are involved. we then get a necrosis (in the case of toe-crack) of the extensor pedis, and sometimes caries of the os pedis. in like manner the necrotic changes occurring under these circumstances may invade the deeper structures in the region of quarter-crack. as a result of this, we may have the starting-point of suppurating corn, or necrosis of the lateral cartilage--in other words, cartilaginous quittor. commonly accompanying quarter-crack is the condition of contracted heels and atrophied frog. sometimes described as a complication of sand-crack, it appears to us more rational to rather regard the sand-crack as a result or complication of the vice of contraction. the overlapping of the edges of the crack before referred to occasionally gives rise to the condition known as false quittor. a probe or a director passed beneath the overhanging ledge of horn reveals sometimes a fissure of inch or considerably more in depth, and quittor is diagnosed. a careful paring away of the overhanging horn, however, reveals the true state of affairs, and exposes to view the original cause of the mischief--a simple fissure in the wall. a serious complication--one fortunately met with but rarely--is that of keraphyllocele. this is a tumour-like growth of horn, varying in size from the thickness of an ordinary quill pen to that of one's middle finger, growing down from the coronary cushion, and attached to the inner side of the wall of the hoof. with this lameness is always present, and more or less deformity of the hoof results. this condition will be found described at greater length in chapter ix. _prognosis_.--in the case of sand-crack this should always be guarded. it may be taken as a general rule that cracks commencing from the coronary margin are more troublesome to deal with than those originating below. the reason is not far to seek. they here affect the wall just where the bevel in it for the accommodation of the coronary cushion has rendered it weakest. not only is it weakest, but being more resilient than the portions below it, it suffers more from the alternate movements of expansion and contraction of the foot than does the horn below. although in many cases a cure of the existing crack may be easily accomplished, regard should be paid to the possibility of its recurrence, either in the same position or elsewhere. really, in offering an opinion as to the future usefulness of an animal so affected, a greater attention should be directed to the animal's conformation than to the crack itself. where the vice of conformation giving rise to it (as, for example, contracted heels or upright hoof) gives hope of being remedied, then naturally it may be safely said that the liability to sand-crack goes with it. a like favourable prognosis may be given in the case of cracks occasioned by purely accidental causes. ordinarily, however, cracks once commenced tend rather to increase than decrease in size and severity. from being superficial and incomplete, they become complete and deep, with every unfavourable circumstance that an increase in size and depth brings with it. this much, however, may be promised to the owner. a simple crack, even though originating from the coronary margin, is, in the vast majority of cases, curable. under a rational treatment its increase in size may be prevented, and a sound wall caused to grow down from the coronet. _treatment_.--the principles governing the treatment of sand-crack are simple enough in themselves, if not always followed by success. . _preventive_. this, as a rule, does not suggest itself until a crack of greater or less extent has made its appearance. then, simultaneously with the treatment proper of the lesion, preventive measures should be adopted, to aid both in the healing of the fissure already present, and to ward off the occurrence of others that might be likely to form. the hoof, if abnormally brittle, should be regularly dressed with a suitable ointment (one containing glycerine for preference), and its horn kept as nearly as possible in a normal condition. when the condition of the horn predisposing to its fracture is brought about by excessive wet, then the appropriate preventive measures to be adopted suggest themselves. with regard to the lesion itself, we may term 'preventive treatment' all those measures having for their object the prevention of increase in the size of the crack. they are as follows: _(a) blistering the coronet_.--in a simple case, where the crack is superficial and close under the coronary margin of the wall, a sharp cantharides blister to the coronet immediately above it will have the desired effect. an increased secretion of horn is brought about, and by this simple means the crack prevented from becoming longer. very often this is all that is necessary. in fact, we may say here that, no matter what other treatment is adopted, the simultaneous application of a blister to the coronet is always beneficial. to derive full advantages therefrom, the blistering should be repeated several times at intervals of about a fortnight. _(b) clamping the crack_.--when the services of a skilled smith are at hand, one of the readiest methods of performing this is to draw the edges of the crack together with an ordinary horse-nail. on each side of the crack a small horizontal furrow is burned or cut into the wall, leaving the horn for about / inch on each side of the crack intact. this provides a groove for the ends of the clamping-nail to rest in, and brings them flush with the outer surface of the wall. the nail is then driven carefully home through the crack, and the pointed end grasped by the farrier's pincers. the edges of the crack are then drawn tightly together, and the nail firmly clenched. [illustration: fig. .--the sand-crack firing-iron.] 'the horse-nails are prepared in the ordinary way as for driving, with the exception that each is pointed on the reverse side, to prevent puncturing the sensitive structures. before being used the nails are put in a vice, and the head hammered to form a shoulder, to prevent their being driven too far into the wall, and breaking out the hold.'[a] [footnote a: _veterinarian_, vol. xlviii., p. .] before driving the nail some operators burn or bore a hole for it. opinion seems to differ as to whether this is at all necessary. a method of clamping which, on account of its simplicity, has become greatly popular, is that of vachette. for this operation is needed the outfit depicted in figs. and . [illustration: fig. .--the sand-crack forceps and clamp.] with the special firing-iron (fig. ) an indentation, sufficiently large to admit the points of the clamp (fig. ), is made on each side of the crack. the clamp is then adjusted, and pressed home tight by means of the sand-crack forceps (fig. ). according to the length of the crack, one, two, or three clamps may be necessary. another useful clamp, though far more complicated in its structure, is that of professor mcgill (fig. ). [illustration: fig. .--mcgill's sand-crack clamp.] 'the object of this invention is to arrange on a spindle, which is screw-threaded at one end with a right-hand thread and at the other with a left-hand thread, two clips or clamps, free to travel on the thread, there being a nut between the two which can be turned by a spanner. the clips are placed on the hoof, one on each side of the sand-crack, the hoof being prepared to receive the instrument by filing a groove or notch for the clamps to fit into, and by turning the nut on the screw the clamps are brought towards each other, and the crack thus prevented from spreading.'[a] [footnote a: _veterinarian_, vol. lxi., p. .] still a further useful clamp is that of koster. this is considerably broader than the clamp of vachette, and its gripping edges are provided with teeth (see fig. ). as with the clamp of vachette so with this, a groove is burned into the wall on each side of the crack for the accommodation of the jaws of the instrument, and the clamp itself pressed home by means of a special pair of forceps. this form of clamp holds well, and has the advantage of securing a wider area of horn than that of vachette or mcgill. [illustration: fig. .--koster's sand-crack clamp.] clamping by any method should be advised or undertaken only under certain conditions. the horn should be moderately strong, and the wall should be thick. this practically restricts the use of the clamp to cracks of the toe, and it is there, as a fact, they are found of most benefit. while burning the grooves for the clamp, and while tightening the clamp itself, the animal's foot should be on the ground and bearing weight at the heels, thus insuring the greatest possible approximation of the edges of the crack. with all methods of clamping an untoward result is sometimes the formation of a fresh crack at the point of insertion of the clamps. (c) _by the use of thin metal plates_.--these are of use when the horn of the wall is too thin to allow of clamping, and are therefore of especial use in cracks of the quarters. the plates are made so as to cover the greater part of the length of the lesion, and are fastened to the wall by two or more screws on either side of the crack. it is an advantage to slightly let the plate into the wall by means of fitting it hot. in a complicated crack the plate serves the further useful purpose of holding in position antiseptic pledgets, and so keeping the lesion free from dirt and grit. _(d) by various methods of bandaging the whole circumference of the wall_.--in our opinion this method of attempting to secure immobility of the crack, and so prevent its extension, is not often followed by success. the main objection to the method is that it subjects the whole of the wall to the same pressure, and does not restrict the operation to the point at which it is required. as in the case of the metal plate, however, this method has the advantage that antiseptic dressings may be kept in position in the case of a complicated crack. [illustration: fig. .--sand-crack belt.] the binding of the wall may be accomplished in two ways. the simpler of the two is to merely apply the sand-crack belt depicted in fig. . beneath this should be applied a compress of tar and tow or other material, and the whole tightened up and kept in position by means of the buckle and strap. this method of binding admits of after-tightening should it unfortunately work loose. the older method of binding the wall, and one now often practised by the smith, is to use a quantity of so-called 'tar-band' or other stout cord. with this the foot is neatly bound after the manner of a cricket-bat handle, and all movement of the crack apparently restricted. there is always a tendency, however, for such a dressing to work loose, and in the case of a complicated crack it has the disadvantage of permanently hiding from view the changes taking place in the discharge from the fissure. _(e) by wedging the crack_.--this is the exact opposite of clamping. whereas in clamping we obtain immobility of the crack by keeping it fixed in the position of greatest approximation of its edges, in wedging, the crack is rendered free from movement by maintaining it in that position where its edges are most widely separated. in this case the edges of the crack are pared smooth, the cavity thoroughly cleansed, and a wedge of hard wood firmly driven in so as to fit exactly the fissure. on the face of it it appears that this procedure would really tend to force open and so lengthen the crack, especially at its coronary extremity. what one should really remember, however, is that the crack _is not made wider_ than before, but that it is simply maintained in a position occurring with every contraction of the heels of the foot, when it is normally at its widest. movement of the edges is thereby stopped, the immediately surrounding structures are rested, and a new growth of horn, free from crack, induced to grow down from the coronet. this method of treatment only serves to emphasize the fact that, with a sand-crack once formed, it is the constant movement of the parts that tends most to keep it in existence, and not any particularly marked exertion of force. some practitioners, with the wedge, apply also a clamp, thus assuring additional firmness and solidity to that portion of the wall under treatment. the method of wedging is undoubtedly successful, if neatly performed. _(f) by surgical shoeing_.--a partial rest is given to the affected parts by easing the bearing of the shoe at the point required. this may be done either by removal of part of the wall at the spot indicated, or by thinning the web of the shoe in the same position. the former is the method usually practised. cessation of movement given in this way is, as we have already said, only partial; for, while the effects of pressure and concussion from below are minimized, the crack is still able to suffer from the movements of expansion and contraction of the foot. still, as an auxiliary to other treatments, 'easing' of the wall under the affected part should always be practised. [illustration: fig. .---the bearing 'eased' by removal of the wall.] [illustration: fig. .--the bearing 'eased' by thinning the web of the shoe.] figs. and show respectively the manner of 'easing' by removal of the wall, and by thinning the web of the shoe. in this connection it is necessary to point out that on no account should 'springing' of the heels of the shoe be allowed. fig. illustrates the ill-practice. in this case, when the entire weight is thrown on to the heels, the portion of wall posterior to the crack is bound to participate unduly in the downward movement, and so tend to widening of the crack at its highest point. [illustration: fig. .--the bearing 'eased' by 'springing' the heel of the shoe.] we have already referred to the matter of 'clips.' in no case, whether the crack be at the toe or in the quarters, should a clip be placed immediately below it. if the crack is at the toe, the usual clip should be dispensed with, and a clip at each side made to take its place. at the same time care should be taken to avoid throwing the weight far forward. for that reason a shoe with calkins or with very high heels should be removed, and a shoe with an ordinary flat web substituted. in the case of quarter-crack, where the constant movement of the parts under expansion and contraction of the foot makes itself most felt, it is wise to apply a shoe with clips fitting moderately tight against the inside of the bars. by this means movement will to a very large extent be curtailed. where a marked tendency to contraction is found, as is often the case with quarter-crack, then the shoe with the clips may be rendered more marked in its operation by giving to the outer face of each clip--that face applied to the bar--a slope from above downwards and outwards. in other words, a slipper shoe should be applied and the contraction given equally as much attention as the sand-crack itself. where the crack is situated far back in the quarter, and easing of the bearing cannot be accomplished without tending to spring the heels, then the most suitable shoe is a bar shoe. with it the bearing may, of course, be eased in exactly the position required, and the heels still allowed to take their fair share in bearing the body-weight, and thus assist in closing the crack. the bar shoe, if properly fitted, gives us also a bearing on the frog, and aids greatly in counteracting contraction. . _curative_. _(a) the application of dressings to the lesion_.--in the case of a recent crack, deep, and attended with hæmorrhage, the foot should be thoroughly cleansed. where possible, a constant flow of cold water from a hose-pipe should be allowed to run over the foot. by this means the inflammatory symptoms will be held in check and pain prevented. later the shoe may be eased at the required place, and a blister applied to the coronet. this, with rest, will sometimes prove all that is needed. should a crack be of old standing, and complicated by the presence of pus, a course of hot poulticing will often prove of benefit. the poultice should be medicated with any reliable disinfectant, and should be renewed, or at any rate reheated, two or three times daily. the crack itself should be thoroughly cleaned after the removal of each poultice, and a concentrated antiseptic solution--such as tuson's spts. hydrarg. perchlor., carbolic acid, and water, ( in ) or liquor zinci chlor.--poured into it. on discontinuing the poulticing, the strength of the antiseptic solutions may be decreased, the parts rested by correct shoeing, and a blister applied to the coronet as before. if these measures alone should prove insufficient, then the surgeon will either fall back on those we have just related, or proceed to methods next to be described. _(b) immobilizing the crack by means of grooving the wall_.--to our minds, this is as ready and withal as successful a method of dealing with sand-crack as has yet been devised. it may be done in a variety of ways: ( ) by two grooves arranged about the crack in the form of a v, as fig. ; ( ) by a perpendicular groove on either side of the crack, about inch in distance from it, and parallel with the horn fibres, as fig. ; ( ) by a single horizontal groove at the extreme upper limit of the crack; ( ) by drawing two horizontal grooves, one at its upper and one at its lower end (see fig. ). [illustration: fig. , fig. , fig. . in figs. , , and the thick black lines illustrate the positions of the various grooves made with the firing-iron for the purpose of immobilizing a quarter sand-crack.] the points to be observed in carrying out this line of treatment are simple enough. in all cases see that the crack is rendered as clean as possible by the use of suitable dressings, and if an excess of horn is present immediately around it, as in the case of a long-standing and complicated lesion, have it thinned down by rasping. all that is then needed is one or two moderately sharp, flat firing-irons. the groove is then burned into the horn in the positions indicated, and that portion of the wall containing the sand-crack thus prevented from participating in the movements of the foot. for our own part, we consider the v-shaped incision, or either of the horizontal methods of grooving, preferable to lines running in the direction of the horn fibres. with the latter there is certainly a greater tendency to the formation of new cracks than with either of those we advocate. the v-shaped incision we consider most suitable of all, for the reason that by its means a greater degree of immobility is conferred upon the necessary portion of the wall. whichever method is adopted, care should be taken to carry the grooves deep enough into the horn, taking them down as near as possible to the sensitive structures. at the same time, especial care should be exercised in not carrying them too deep at their extreme upper limit, or in that case the liability to the formation of fresh cracks in those positions will be greatly increased. after grooving, a sharp blister should be applied to the coronet every three or four weeks, and the animal, if free from lameness, put to work. _(c) by stripping away a v-shaped portion of the wall around the crack_.--this method is only indicated when the crack is greatly complicated by the presence of pus, or by the growth of adventitious horn on the inner surface of the wall. a radical cure is thus obtained, but the animal for a longer time incapacitated from work. the operation is best performed by first grooving a line to connect the points _a_ and _c_ (fig. ). this should run immediately under the coronary margin of the wall, and should stop short of injuring the coronary cushion beneath. grooves forming the sides _ab_ and _bc_ of the triangular piece of horn are next made, and the horn contained within the lines _ab, bc_, and _ca_, carefully removed. the grooves are the easiest made by a cautious use of the firing-iron. the greater thickness of the horn may thus be penetrated, and the grooves afterwards carried to their full and requisite depth by the use of the drawing-knife. with the removal of the horn the diseased structures are exposed to view. all such should be removed by a free use of the scalpel, and a suitable dressing afterwards applied. a necessary factor in the treatment is the employment of pledgets of antiseptic tow. with these the exposed tissues are covered, and the successive turns of a bandage run tightly over them, so as to exert a moderate degree of pressure. when hæmorrhage has accompanied the operation, this dressing should be removed on the following day, the wound dressed, and the pledgets of tow and the bandage renewed. any after-dressing need only then be practised at intervals of a week. repair after this operation is rapid, and takes place both from the exposed podophyllus membrane and from the coronary cushion. [illustration: fig. . the dotted lines outline the v-shaped portion of wall to be removed in the treatment of complicated toe-crack.] [illustration: fig. . the dotted lines indicate the portion of wall to be removed in the complete operation for complicated toe-crack.] _(d) by stripping the wall from the coronary margin to its wearing edge on either side of the crack_.--this is merely a more extensive application of the method just described, and is only indicated in a _complete_ and _complicated_ crack that has refused to yield to other modes of treatment (see fig. ). as in the previous case, a groove is run from _a_ to _c_. the grooves _ab_ and _de_ are then continued to the lowermost edge of the wall, and the whole of the wall within these points removed. to facilitate removal, the white line should be grooved between the points _b_ and _d_. after-treatment is exactly the same as that just referred to. b. corns. _definition_.--in veterinary surgery the term 'corn' is used to indicate the changes following upon a bruise to that portion of the sensitive sole between the wall and the bar. usually they occur in the fore-feet, and are there found more often in the inner than in the outer heel. the changes are those depending upon the amount of hæmorrhage and the accompanying inflammatory phenomena occasioned by the injury. thus, with the hæmorrhage we get ecchymosis, and consequent red staining of the surrounding structures. as is the case with extravasations of blood elsewhere, the hæmoglobin of the escaped corpuscles later undergoes a series of changes, giving rise to a succession of brown, blue, greenish and yellowish coloration. with the inflammation thereby set up we get swelling of the surrounding bloodvessels, pain from the compression of the swollen structures within the non-yielding hoof, and moistness as a result of the inflammatory exudate. in a severe case the inflammation is complicated by the presence of pus. _classification_.--putting on one side the classification of lafosse _(natural_ and _accidental_), as perhaps wanting in correctness, seeing that all are accidental, and disregarding the suggested divisions of zundel _(corn_ of the _sole_ and _corn_ of the _wall_) as serving no practical use, we believe, with girard, that it is better to classify corns according to the changes just described. following his system, we shall recognise three forms: ( ) _dry_, ( ) _moist_, ( ) _suppurating_. the _dry_ corn is one in which the injury has fortunately been unattended with excessive inflammatory changes, and where nothing but the coloration imparted to the horn by the extravasated blood remains to indicate what has happened. the _moist_ corn is that in which a great amount of inflammatory exudate is the most prominent symptom. it indicates an injury of comparatively recent infliction. the _suppurating_ corn, as the name indicates, is a corn in which the inflammatory changes are complicated by the presence of pus. _causes_.--the causes of corns we may consider under two headings--namely, _predisposing_ and _exciting_. _predisposing causes_.--by the heading of this chapter we have already intimated that corns are due to faulty conformation of the foot. it is, therefore, merely a description of such shapes of foot as favour their formation that will need mention here. the wide, flat foot, with low heels, may be first considered. here the posterior portions of the sole, those portions between the wall and the bars, fall very largely in the same plane as the wearing surface of the bars and the wall. as a consequence, these portions of the sole are more prone to receive injury from stones and rough roads and from the pressure of the shoe. the low heels, too, favour a more than due proportion of the body-weight being thrown on to the posterior parts of the foot. two evils, both inclining to the production of corn, result from this. in the first place, the sensitive structures of the posterior portions of the foot are subjected to undue pressure from above; secondly, the posterior half of the foot, by reason of the extra weight thrown upon it, is exposed also to greater effects of concussion than normally it should meet. added to this we find that the abnormally flat condition of the sole has resulted in a great loss of resiliency. with undue pressure above, and a loss of resiliency and added effects of concussion below, the sensitive structures included between the opposing pedal-bone and the horny sole are bound to suffer more or less bruising each time the foot comes to the ground, especially if the animal is moved at a rapid pace. writing here of the effects of pressure and concussion affords a fitting occasion to mention the fact that corns occurring in feet affected with side-bones are always worse than in feet with normal elastic cartilages. the explanation of this is simple, for there can be no doubt that the loss of resiliency in the diseased cartilage is only another aid to undue pressure and concussion. the sensitive structures are pinched between unyielding bone above and practically unyielding horn below. feet with high and contracted heels are also predisposed to corn. the contraction in this case interferes with the downward movements of the os pedis during progression, while in a state of rest there is a more or less constant pressure upon the sensitive structures, due to the correct downward displacement of the pedal-bone being opposed by the amount of contraction present. in the contracted foot, too, the nutrition of the vessels supplying the secretory apparatus of the horn is largely interfered with. the horn loses its natural elasticity, fails to respond to the normal movements of the parts within, and aids in the compression and laceration of the sensitive structures. weak feet, with horn too thin to withstand the expansive movements continually going on--in other words, feet with weak, spreading heels--are also prone to suffer from corns. in this case the flatness induced by the spreading, and the insufficient protection afforded by the thin horn, both combine to lay the sole open to the effects of concussion and direct injury. brittle feet--feet with horn of undue dryness, by reason of the contraction thus brought about--are, again, particularly subject to corn. so also with long feet. whether occurring as a natural deformity, or as the result of insufficient paring, bruises of the sole in feet thus shaped are common. the reason for this will be better understood when we come to deal with the shoeing. other and minor predisposing causes are those mainly referring to an unnatural dryness of the hoof when animals reared in the country are put to work in large towns. we here really get several predisposing causes combining. a sudden change is made from a more or less moist condition underfoot to one excessively dry. the character of the travelling is wholly altered from occasional work upon soft lands to continual labour upon hard-paved roads. the horn is often exposed to the vicious influences of unsuitable litter, the application of unsuitable dressings, and the deleterious effects of the street mud of our cities. all these play their part in determining a condition of the horn, rendering it open to receive the effects of the more exciting causes which we shall next consider. _exciting causes_.--than the shoeing, no more frequent and exciting cause of corn exists. whatever the predisposing influences may be, it is the shoeing that in nearly every case completes the list, and finally inflicts the injury. the evils in this connection we shall consider under two headings--viz., ( ) the manner in which the foot is pared; ( ) the make and fitting of the shoe. first among the faulty preparations of the foot comes that of excessive thinning of the sole, especially in the regions subject to corn. the farrier addicted to this is not as a rule content to confine his operations to the sole alone. in addition, the frog and the bars also suffer from the too lavish use of his knife. his main object is doubtless that of giving a broad and open appearance to the foot. it follows from this that his operations are confined more to the posterior than the anterior parts of the foot, and that the toe is therefore left too long. this gives us a combination of causes leading to pressure and bruises upon the sensitive structures at the seat of corn. by this unequal paring of the toe and the heels greater weight is thrown upon the posterior half of the foot. what then happens to the structures thinned as we have described is this: the pared frog, lessened in volume, does not meet the ground. it therefore fails to expand laterally with weight, and cannot assist, as normally it should, in aiding the heels generally in their movements of expansion. the weakened bars and the thinned sole, meeting with no opposition from the frog, give downwards and inwards with the body-weight at the precise moment these movements should be directed mainly outwards. as a further result of non-resistance on the part of the frog, this time in a lateral direction, the bars, the sole, and the wall at the heels all contract at the exact time they should expand. the end result must mean abnormal pressure and bruising of the sensitive structures in that particular region. naturally, also, the excessive thinning of the horn renders direct injury to the sole from stones or other objects in the road far more probable. for this one reason alone--the manner in which it favours the production of corn--too great a condemnation cannot be placed upon excessive paring of the sole, the bars, and the frog. when corns are already present, as they may be from other causes, the same remarks will again apply to excessive paring. it is the custom with many smiths to carefully pare down the discoloured horn in every case of corn they meet with, and at the same time to again weaken the bars and even part of the wall at the heels, with the laudable idea of relieving pressure on the part diseased. after what has gone before, we need hardly say that their well-meant efforts have a precisely opposite effect to the one they intend. the fitting of the shoe is, perhaps, to a greater extent responsible for the causation of corn than is the paring we have just described. a few of the evils connected with the shoe may, however, be justly described as unavoidable. we _must_ shoe; we cannot shoe and leave a normal foot! a shoe excessively seated, especially from the last nail-hole backwards, may be regarded as dangerous. in this case, with every application of the body-weight, there is given to the foot a tendency to contract, especially at its lower margin. result: undue pressure upon the tissues around and the production of corn. on the other hand, varying with the form of foot, the seating may be insufficient. in the case of flat-foot, or dropped sole, for instance, insufficient seating will lead to undue pressure of the web of the shoe upon the sole, and in that way bring about bruising of the sensitive sole beneath. shoes with heels or calks too high, by destroying the counter-pressure of the frog with the ground, serve to bring about a series of changes we have described under contraction, and again result in pinching and bruising of the sensitive structures. the opposite excess--a shoe thick at the toe and thin at the heels--is blamed by zundel for causing a like injury. in our opinion, the reason this author gives--namely, that the throwing of greater weight upon the heels leads to bruising of the sensitive structures--can only correctly apply to a _wrongly-applied_ shoe of this type, and not to the shoe itself. true, a shoe with a thick toe and thinned heels will throw an undue proportion of the body-weight upon the heels if the foot is not properly prepared for it. a wise man, however, will most certainly so cut down the toe for the reception of this shoe that, with the shoe in position, there will still be maintained a tread that is normal. to our minds harm is far more likely to arise from a shoe of this class through the thinned iron heels of the shoe becoming attenuated under wear to the point of bending, and so inflicting an injury upon the adjoining sole. similarly, this last remark with regard to the thinning of the heels of the shoe will apply to a shoe with too broad a web. as the thinning of the shoe proceeds with wear, the inner portion of the thinned branch is bent up on to the sole, and again inflicts the injury. the matter of bearing is also of importance when considering the causation of corn. in a previous chapter we have already described the correct bearing as that which includes the whole of the lower margin of the wall and the white line, and just impinges on the sole. any marked deviation from that will, if long continued, be followed by injury to the foot. with the bearing surface of the shoe too narrow--in contact with the wall solely, or perhaps only a portion of it--it is evident that a large proportion of the foot that should properly bear weight is thrown out of action. a heavy strain is imposed on the white line, and undue descent of the sole and contraction of the heels brought about. again the result of this is compression and bruising of the tissues around the seat of corn. with its bearing surface too wide, the shoe immediately exerts direct pressure upon the sole with every movement of the animal. the sole normally is not made to receive this, and harm is bound to result. among other ill-fitting shoes we may mention the one with branches too short, and the one with the extremities of the branches too pointed. in the first case, as wear of the shoe proceeds, the thinned end is far more likely to turn in under the seat of corn than is a shoe with branches of ordinarily correct length. it is evident in the second case that the pointed branch, when thinned, is a more dangerous agent than the branch which is nearer the square at its end. the matter contained in the first half of the foregoing paragraph explains in a large measure the rarity of corns in the hind-feet. here there is nothing to prevent a shoe with branches of full length being used. the correct bearing is thus maintained, even with a shoe excessively thinned with wear, and the liability to injury from it decreased. an exception is to be found in the case of a feather-edged shoe, such as is used to prevent cutting or brushing. the thinning by wear from above to below of the branch already purposely thinned from side to side leads to the formation of a thin and narrow piece of iron admirably calculated to bend over and injure the sole. even with a shoe of correct length, with a flat-bearing surface at the heels, and other conditions favourable to correct application, evil may still result from the shoe itself being made too narrow. as a result of this, the branch of _each_ side is set too far under the foot, with consequent injury to the sole. this is, of course, sheer carelessness on the part of the smith. when practised, however, it is not easy of detection, as in all cases the foot is rasped down to cover what has been done. in other words, the foot is made to fit the shoe and not the shoe the foot. recognising this close fitting of the shoe as a cause, we are able to explain in some measure how it is that corns should occur with greater frequency in the inner than in the outer heel. there is no doubt that the inner branch of the shoe is nearly always fitted closer than is the outer. in the fore-foot it is also often shorter. take these two evils and add to them the fact that the inner heel is called upon to bear more of the body-weight than is the outer, and the frequency of corns in the inner heel will no longer be wondered at. indirectly, the shoe may still be a cause of corn by reason of the irritation set up by gravel and small pieces of flint becoming firmly fixed between the sole and the web of the shoe. in nearly every case of this description the part to be injured is the white line. corns may also result from the animal picking up a stone. the stone becomes firmly wedged in between the inner border of the branch of the shoe and the bar or the frog. with every step the animal takes it becomes wedged more tightly into position. projecting below the level of the lower surface of the shoe, it imparts the concussion it thus obtains directly to the sole. a bruise--and a bad bruise--is the result. finally, it cannot be denied that the work the horse is put to is largely responsible for the causation of corn. in country animals corns are comparatively rare, while in animals in town, almost constantly upon hard paving, they are common. this seems to point strongly to the fact that concussion through constant work upon unyielding roads is a great factor in their production. _symptoms_.--unless the discoloration of the horn is accidentally discovered by the smith, the simple, dry corn may go undetected. the disturbance excited by it is so small, and the pain occasioned so slight, that the patient may offer no indication of its existence. ordinarily, however, the first symptom is that of pain. the animal goes feelingly with one or both feet, in some cases even showing decided lameness. the lameness, however, is in no way diagnostic, and the lesion itself must be discovered before an exact opinion can be pronounced. as an aside, it is well to observe in this connection that a negative opinion as to the existence of corn should never be given unless the superficial layers of horn have first been removed with the knife. when standing at rest the animal exhibits signs more or less common to all foot lamenesses. he 'points' the foot--in other words, the limb is slightly advanced, the fetlock partly flexed, and the heels from off the ground. when both feet are affected they are pointed alternately, and the animal often manifests his uneasiness by repeated pawing movements, and by scraping his bedding behind him. should the injury run on to suppuration, the lameness becomes most acute. the pawing movements become more pronounced, and there is evident disinclination on the part of the animal to place the foot squarely on the ground. one is then led to manipulate the foot. the hoof is hot to the touch. percussion causes the animal to flinch, and to flinch particularly when that portion of the wall adjoining the corn is struck. finally, exploration with the knife reveals the serious extent to which the injury has developed. in a neglected case of this description it is even possible to detect the presence of pus by the amount of swelling and fluctuating condition of the coronet. the suppurative process has advanced in the direction of least resistance, and is on the point of breaking through the tissues immediately above the horn. lameness due to corn is oftentimes intermittent. with a simple corn, dry or moist, this intermission is largely dependent on the degree of dryness of the hoof or the road, and also on the character of the road surface. with a neglected, suppurating corn, on the other hand, variation in the degree of lameness, in addition to depending on circumstances such as these, is dependent to a larger extent upon the changes occurring with the suppuration. in this case the time of greatest lameness is immediately before the pus gains outlet. immediately after its exit at the coronet the animal will go almost sound. soundness continues so long as the opening at the coronet remains clear. the tendency, however, is for the opening thus made to quickly close again. pus again accumulates, lameness arises as before, and disappears again with the second discharge of the contents of the sinus now formed. _pathological anatomy_.--when dealing with their classification we gave in outline the main pathological changes to be met with in corns. it now only remains to give the same matter in slightly greater detail. _in dry corn_ the changes we meet with are those accompanying blood extravasation. from excessive compression of the parts, or from the effects of direct injury, a portion of the sensitive sole has become lacerated. the escaping blood stains the surrounding soft tissues after the manner of blood extravasation elsewhere. if the escape of blood is sufficiently large, the horn fibres in the immediate vicinity also are stained. it is this stain in the horn that is the direct evidence of the injury, and is itself popularly known as the corn. it may vary in size from quite a small spot to a broad patch as large as half a crown, while its colour may be a uniform red, or a mottled red and white. the microscopic changes in this connection are illustrated in fig. . [illustration: fig. .--horizontal section of a corn. the section cut at about the base of the papillæ of the sensitive sole. _a_, papillæ, with horn-cells surrounding them; _b_, interpapillary or intertubular horn; _c_, hollow spaces in the intertubular material filled with blood; _d_, a papilla and its surrounding horn-cells filled with blood.] ordinarily, this ecchymosis of the horny sole is due to injury of the sensitive sole _immediately beneath_ it. it may, however, proceed from injury to the vessels of the laminæ either of the bars or of the wall. in this case the ecchymosis of the horny sole may be explained by the fact that the escaped blood tends to _gravitate_ to that position. when the corn is of long standing, or is due to _repeated_ injuries on the same spot, the horn adjacent to the lesion becomes hard and dry, and often abnormally brittle, simply on account of the inflammatory changes thus kept in continuation. this is often seen when attempts are made to _pare out_ the corn with the knife. should the injury be seated in the sensitive laminæ, then the brittle nature of the horn secreted by the injured tissues makes itself apparent by the appearance of cracks in the wall of the quarter. why this should occur will be readily understood by a reference to fig. . [illustration: fig. .--inner surface of the wall of the quarter, showing changes in the horny laminÆ brought about by chronic corn.] it will here be seen that the injury to the keratogenous membrane has led to great interference with the secretion of horn from the sensitive laminæ. as a result, the regularly leaf-like arrangement of the horny laminæ has been largely broken up. certain of the laminæ are altogether wanting, while others are broken in their length and rendered incomplete. with this condition there is always more or less contraction of the quarter. microscopic examination of the structures involved in such a case reveals the fact that with the contraction is an alteration in the normal direction of the horny and sensitive laminæ. they become bent backward, and, instead of the regular and normal arrangement depicted in fig. , show the distorted appearance given in fig. . from the appearances and characters of the blood-stain in the horny sole we are able to deduce evidence relative to the duration and nature of the injury. [illustration: fig. .--perpendicular section of the wall of a contracted quarter in a case of chronic corn. both the sensitive and horny laminæ are bent backwards, and hæmorrhages have taken place at the base of the sensitive laminæ.] when, for instance, the stain is not to be found in the superficial layers of the sole, but is only discoverable by deep paring, then the injury is a recent one. where the stain _is_ met with in the superficial layers of horn, and is quickly pared out, then the injury has been inflicted some time before, and has not been repeated. when, as is sometimes the case, layers of horn that are stained are found alternated with layers that are healthy, then we have evidence that the cause of the corn, whatever it may be, is not in constant operation. similar indication of the age of the injury is also afforded by the colour of the lesion. a stain that is deep red is proof that the injury is comparatively recent. a distinct yellow or greenish tinge, on the other hand, is evidence that the injury is an old one. _in the moist corn_ we have, in addition to the blood extravasation, the outpouring of the inflammatory exudate. in the most superficial layer of the horn this may not be noticeable. as one cuts deeper into the sole with the knife, however, it will be found that the lower layers of horn are more or less infiltrated with the discharge. this gives to the horn a soft consistence, a yellow appearance, and a touch that is moist to the fingers. with the accompanying inflammation the cells in the neighbourhood of the injury are enfeebled and their normal functions interfered with. we may thus expect a corresponding interference with the growth of horn. this is exactly what happens, and as one cuts deeper still into the horn a point is finally reached when a well-marked cavity is encountered. a pale yellow and usually watery exudate fills it. this cavity points out the exact spot where the force of the injury has been greatest, where death of certain cells of the keratogenous membrane has resulted, and where the natural formation of horn has for a time been suspended. _in the suppurating corn_, as in moist corn, we have pathological changes due to the tissue reaction to the injury, _plus_ the addition of pus organisms. confined within the horny box we have a discharge that, by reason of the living and constantly multiplying elements it contains--the pus organisms--is always increasing in bulk. this must be at the expense of the softer structures of the foot. accordingly, as the formation of pus increases, we get pressure upon and final gangrene of the sensitive sole and of the sensitive laminæ of the bars and the wall. with no outlet below, the pus formation increases until finally it finds its way out of the hoof by emerging at the coronet. this in some instances it may do by confining its necrotic influences solely to the sensitive laminæ of the wall, in which case, if a dependent orifice is quickly made at the sole, the injury to the laminæ is soon repaired by the healthy tissue remaining. in other cases, however, the necrosis has spread deeper. caries of the os pedis, of the lateral ligaments of the pedal-joint, or of the lateral cartilages, is a result. when this occurs the exuding discharge from the coronet becomes thinner and more putrescent, and its feel, when rubbed between the fingers, sometimes gritty with minute fragments of broken-up bone. here, unless operative measures prevent it, necrosis soon spreads deeper still. the deeper portions of the os pedis become affected. the capsular ligament of the joint is penetrated by the suppurative process, and a condition of septic arthritis results. the cavity of the joint becomes more or less tensely distended, according to the amount of drainage present, which in this case is almost nil, with matter in a state of putrescence. as a consequence, the surrounding ligaments become softened and yield, and the articular surfaces displaced. the articular cartilages also suffer, become necrotic in patches, and frequently wholly destroyed. the end result is one of anchylosis of the joint and permanent lameness. _prognosis_.--with the ordinary dry corn a return to the normal may nearly always be looked for. similarly, with moist corn, and even with careful treatment of the suppurating variety, the same favourable termination may be looked for and promised. what cannot so safely be assured is that a relapse will not occur. in other words, the extent of the injury, no matter how serious, does not often offer anything that cannot be overcome by nature and careful surgery; but the conformation of the animal does. a vicious predisposing conformation once there is there always, and although the injury resulting from it may easily give way to correct treatment, the same injury is bound to re-occur when the animal is again put to work. although with care suppurating corn, like other cases of suppuration within the hoof, may yield to treatment, the owner of the animal should, nevertheless, be warned that the condition is a serious one, especially should the joint become affected. it may so happen, as sometimes in fact it does, that the animal may die as a result of the infective fever so set up. from no surface in the body can absorption take place quicker than from the synovial membrane of a joint. so soon, therefore, as this membrane comes in contact with septic material, so soon does a severe septic fever make its appearance. the septic matter has gained the blood-stream, and the patient succumbs to septic poisoning. apart from death occurring naturally, the changes taking place in the joint in the shape of bony growths or of actual anchylosis may be so severe as to render the animal useless, and slaughter may have to be advised. _treatment_.--we have already said that by far the most active cause in the production of corn is the shoe. it follows from this that it is to the shoeing we must largely look for a successful means of their prevention, and that the treatment of corn in its most simple form is really a matter for the smith, and not for the veterinary surgeon. the faults in connection with the shoeing we have mentioned fully when treating of the _causes_ of corn. from those we learn that a shoe with a flat-bearing surface, or one moderately seated but flat at the heels, is the correct shoe for nearly all feet. the heels of the shoe should not be too high, should not be too short, and should be wide enough apart from each other to insure the wall of the foot obtaining a fair share of the bearing. finally, even with the present method of shoeing, whenever it is possible to allow the frog to come to the ground, it should be encouraged to do so, and excessive paring either of the latter organ or of the bars or the sole should be strictly discountenanced. where the sole is thin, or the frog wasted, use a leather sole or a rubber pad. with these precautions, corns may be prevented from occuring even in a foot with a predisposing conformation. when corn is present, the first treatment usually adopted is that of 'paring it out.' this is advocated by percival and by many other writers. we cannot say, however, that we agree with it--at any rate, not in the case of simple dry corn. 'paring it out,' and by that we mean thinning down the sole until close on the sensitive structures, can only be advised in the case of suppurating corn, or in cases where doubt exists as to whether pus is present or not. in the latter case paring becomes necessary as an exploratory means to diagnosis. when it appears fairly certain, even in the case of a moist corn, that pus does not exist, then paring is to be discountenanced, for the reason that it only tends to weakening of the parts and to assist largely in the corn's recurrence. those who advocate it do so for the reason that it relieves pressure on the injured parts. that it does so directly from below cannot be denied; but that it also favours contraction and compression from side to side is equally certain. a moderate paring may, however, be indulged in, say, to about one-half the estimated thickness of the sole. softening of the horn and consequent lessening of pressure may then be brought about by the use of oil, oil and glycerine, tincture of creasote, or by poulticing. in the case of a moist corn the paring should be stopped immediately the true nature of the injury has made itself apparent. warm poultices or hot baths should then be used in order to soften the surrounding parts, lessen the pressure, and ease the pain. after a day or two day's poulticing, should pain still continue with any symptom of severity, the formation of pus may be expected, and it is then time for the paring to be carried further, until the question 'pus or no pus?' is definitely settled. should the moisture be due simply to the presence of the inflammatory exudate, then poulticing alone will have the desired effect, and the pain will be lessened. with the decrease in pain the poulticing may be discontinued, and the horn over the seat of the injury dressed with some antiseptic and hardening solution. sulphate of zinc, a mixture of sulphate of zinc and lead acetate, sulphate of copper, or the mixture known as villate's solution,[a] may either of them be used. suitably shod, and with a leather sole for preference, the animal may then again be put to work. [footnote a: the composition of the escharotic liquid bearing his name was published by m. villate in as under: subacetate of lead liquid ... ... ... grammes. sulphate of zinc [=a=a] ... ... ... grammes. sulphate of copper, [=a=a] ... ... ... grammes. acetic acid ... ... ... ... / litre. dissolve the salts in the acid, add little by little the subacetate of lead, and well shake the mixture.] when dealing with suppurating corn, then, a considerable paring away of the horn of the sole becomes a matter of necessity. the freest possible exit should be given to the pus, and this even when an opening has already occurred at the coronet. unless this is done, and done promptly, the putrescent matter still contained within the hoof will make further inroads upon the soft structures therein, and later upon the ligaments, and even bone itself. having given drainage to the lesion by the dependent orifice in the sole, poulticing should again be resorted to and maintained for at least three or four days. the poulticing may then be discontinued, and the openings in the sole injected with a weak solution of tuson's spts. hydrarg. perchlor., a in solution of carbolic acid, a solution of copper sulphate, with villate's solution, or with any other combined antiseptic and astringent. the success of the treatment is soon seen in the cessation of pain and in the decreased amount of discharge from the opening in the sole. should pain unfortunately continue, the discharge remain, and a state of fever reveal itself, then it may be understood that the suppurative process has not been checked, that a portion of necrosed ligament, cartilage, or bone still remains, which, surrounded as it is by pus organisms and putrefactive germs, is sufficient to excite a constant irritation and maintain the internal structures in a state of infection. in other words, we have what is known as a quittor. this will call for deeper operation. the horn of the wall must be removed, and the diseased structures, whether gangrenous keratogenous membrane, necrosed ligament, or carious bone, carefully excised or curetted. this will be better understood by a reference to the chapter on quittor, where the means for carrying out the necessary operative measures will be found described in detail. _surgical shoeing for corn_.--in the case of an ordinary dry corn, where the injury has been definitely ascertained to be accidental, no alteration in the shoeing will be necessary. where, however, the corn is attended with a more than ordinary degree of inflammation, or where for some reason or other excessive paring has been practised, then it will become needful to shoe with a special shoe. the object to be attained is the removal of pressure from that portion of the wall next to the seat of corn. the most simple shoe for effecting this is the ordinary three-quarter shoe. the only way in which this differs from the ordinary shoe is that about an inch and a half of that branch of the shoe adjoining the corn is cut off (fig. ). if at the same time contraction of the heels exists, then, perhaps, a better shoe is that known as the three-quarter bar (fig. ). or, if preferred, a complete bar shoe such as that described for sand-crack may be used, and the upper portion of the web in contact with the foot at the seat of corn thinned out so as to avoid pressure on the wall at this point. with this shoe we shall at the same time supply a certain amount of pressure to the frog, and aid in the healthy development of the part indirectly involved in the disease. the same pressure may also be given to the frog, and protection afforded the sole, by the use of a leather sole, or rubber pad on leather, as described when dealing with contracted feet. a further method of relieving pressure on this portion of the wall, without removing the wall itself (a practice which should never be advised) is to make certain alterations in the web of the shoe. this may be done in one of two ways. [illustration: fig. .--three-quarter shoe.] [illustration: fig. .--three-quarter bar shoe.] in the first, that portion of the bearing surface of the heel of the shoe is 'dropped' about / inch from the plane of the remainder, so that the shoe at this position does not come into contact with the foot at all (see fig. ). in the second case the shoe is what is termed 'set' at the heel. here it is the plane of the _wearing_ surface of the shoe that is altered. the hinder portion of the required heel is thinned so that its lower surface does not come into contact with the ground. by this means the wall is freed from concussion and pressure. at the same time the upper surface of the shoe is in contact with the wall of the foot (see fig. ). this 'setting' of the shoe is preferable to the method first described. it affords a greater protection to the foot, and does not allow of fragments of stone and flint getting in between the foot and the shoe, and so giving rise to further mischief. the 'set' portion should be fitted full and long. it is obvious, too, that the animal should not be allowed to carry the shoe too long; otherwise, as the other portion of the shoe wears down to the level of the 'set' heel, pressure on the tender part of the foot will again result. [illustration: fig. .--shoe with a 'dropped' heel.] [illustration: fig. .--shoe with a 'set' heel.] in applying surgical shoes for corn of long standing, it must be remembered that the protection so afforded must be continued for some time. it is not sufficient to see the lesion itself disappear. in addition to that there is also, in the majority of cases, a certain amount of contraction to be overcome. this can only be done by continuing the use of a leather sole or some form of frog or bar-pad as recommended for the relief of that condition. c. chronic bruised sole. a similar condition to that of corn may be met with in other positions on the sole. it is described by rogerson as sand-crack of the sole[a], and is invariably met with around that portion of the sole in contact with the shoe. [footnote a: _veterinarian_, vol. lxiii., p. .] the animal is lame, and the shoe is removed in order to ascertain the cause. nothing at first is noticeable except that the animal flinches when pressure is applied to the spot with the pincers, or the sole is tapped with the hammer. on removing the sole with the knife, however, a distinct black mark is discovered, which, when followed up by careful paring, is often found to have pus at the bottom. in this case the injury has resulted, as we have already intimated elsewhere, from causing the animal to wear for too long a time a shoe with too broad a web or insufficiently seated. or it may have originated with the irritation set up by foreign and hard substances between the web of the shoe and the foot. in his description of this condition mr. rogerson draws attention to the fact that the pus found should not be wrongly attributed to accidental pricking of the foot. he says: 'considering that the cracks or splits are always found in the immediate vicinity of the nail-holes, a certain amount of discretionary skill is required in order that the lameness may be attributed to its proper cause. this is an instance in which the presence of the veterinary surgeon is imperative, in order to prevent undue blame being attached to the shoeing-smith. misconception in these cases might very easily arise when parties concerned are disposed to accept an unskilled opinion, sometimes resulting in danger to the proprietor of the forge, not only of losing a shoeing contract, but also of being involved in other ways which would probably prove even more disastrous. 'horses that stand on sawdust or moss litter are sometimes found with extensive discoloration of the horny sole in front of the frog. their bedding material collects in the shoe as snow does, and forms a mass, which keeps a continued and uneven pressure upon the sole. a sound foot is not injuriously affected, but a very thin sole is, and so also is a sole which has been bruised by a picked up stone. even a slight bruise becomes serious if pressure is allowed to remain active over the injured part. lameness increases, serous fluid is effused between the horn and sensitive part, or even hæmorrhage may take place.'[a] [footnote a: hunting, _veterinary record_, vol. xiv., p. .] _the treatment of chronic bruised sole_ offers no special difficulty. removal of the cause (in nearly every case incorrect bearing of the shoe) is the first consideration. that done, the lesion may be searched for and treated in the ordinary manner as described for corn. when pus is present it must, of course, be given exit, and an antiseptic solution applied to the wound. should the sensitive structures be laid bare when allowing the pus to escape, then the wound so made should afterwards be protected with a leather sole and antiseptic stopping. chapter viii wounds of the keratogenous membrane a. nail-bound--bind or tight-nailing. _definition_.--by the term 'nail-bound' is indicated that accident occurring in the forge in which the nail of the shoe is driven too near the sensitive structures. although involving no actual wound, it is important to consider the condition under the heading of this chapter, in order that it may be distinguished from the graver accident of a 'prick.' _causes_.--very largely the whole matter of causation turns on the correct fitting of the shoe. the points especially to be noticed in this connection are ( ) the position of the nail-holes in the web of the shoe, ( ) the 'pitch' of the nail-holes. regarding the position of the nails, it goes without saying that the first consideration when 'holing' the shoe should be to punch the holes opposite to sound horn. this remark applies especially to shelly and brittle feet, the type of feet in which tight-nailing most often occurs. the next consideration in this connection is that of punching the holes so that the nail emerges from the upper surface of the web at exactly its correct point of entrance on the bearing surface of the foot. this should be on the white line immediately where it joins the wall. from this position any marked deviation inwards ('fine-nailing,' as it is termed) is bound to give to the nail a direction dangerously near the sensitive structures. the 'pitch' of the nail-holes should be such that the nail is guided more or less nearly to follow the line of inclination of the wall. accordingly, the nail-holes at the toe should be 'pitched' distinctly inwards, the inward pitch lessening as the quarters are reached, until the hindermost nail-hole or two is pitched in a direction that is almost perpendicular. too great an inward inclination of the nail will, however, give rise to a bind. it is probable that 'tight-nailing' results more often from fine punching of the shoe than from any fault in the pitch of the hole. inattention to either detail, however, is apt to bring the mischief about. even with a correctly fitted shoe, and with a normal foot, tight-nailing may occur as a result of sheer carelessness on the part of the smith. _symptoms_.--possibly the animal returns from the forge sound. it is on the following day, as a rule, that evidence of the injury is given by the animal coming out from the stable lame. in a well-marked case the foot is warmer to the hand than its fellow, and percussion over the wall will sometimes reveal the particular nail that is the cause of the trouble. should the shoe be removed, then the fact that the hole the nail has made is far too close to the sole often points out at once the seat of the mischief. _treatment_. as to whether or not the shoe should be removed is very much a matter for careful discretion on the part of the veterinary surgeon. where the foot is shelly and brittle even a good smith sometimes finds himself unable to firmly attach the shoe without verging closely on causing the condition we are now describing. the author has known cases where animals with feet of this description have almost invariably returned from the forge, or rather been found the next day, with a suspicion of tenderness. after the lapse of a day or two this has quite often disappeared, and nothing in the meantime been done with the foot. seeing, therefore, that removal and refitting of the shoe is in this case attended with risk of breaking away portions of the brittle horn, and so rendering the foot in an even worse condition than it was before, it is policy to decline to have the shoes removed unless worse symptoms make their appearance. in coming to this decision the veterinary surgeon must be guided by noting in the wall the points of exit of the nails. should the nail adjoining the position already pronounced to be tender have come out at a higher point than the others, it may be assumed that at a lower position in its course through the horn it has gone near the sensitive structures without actually penetrating the horny box, and that in the course of a day or two the sensitive structures involved will accommodate themselves to the pressure thus inflicted. if, on the other hand, symptoms of tight-nailing show themselves in an animal with good sound feet, then there is no objection to be raised against having the shoe at once removed. should the offending nail be definitely detected, then the shoe may again be put on, and that particular nail omitted from the set. b. punctured foot. (_pricked foot_--_nail-tread_--_gathered nail_.) _definition_.--under this heading we propose describing wounds of the foot occurring in the sole or in the frog, and penetrating the sensitive structures beneath. _causes_.--these we shall consider under two headings: . wounds resulting from the animal himself 'picking-up' or 'treading' on the offending object. . cases of pricking in the forge. those occurring under the first heading are, of course, purely accidental. in the majority of cases, the object picked up is a nail; but similar injury may result from the animal treading on sharp pieces of wood or iron, on pieces of umbrella wire, on pointed pieces of bones, broken-off stable-fork points, sharp pieces of flint, etc. the same accident may also occur in the forge as a result of the animal treading on the stumps of nails, from treading on an upturned shoe with the stumps of nails _in situ_, or from treading on an upturned toe-clip. it may also occur from an accidental prick with the stable-fork when 'bedding up,' or from casting part of a shoe when on the road and treading on the nails, in this case left sometimes partly in and partly out of the horn. 'serious wounds of this description are also met with in animals engaged in carting timber from plantations in which brushwood has recently been cut down. this is, of course, from treading on the stake-like points that are left close to the ground. hunters also meet with the same class of injury when passing through plantations or over hedge banks, where the hedge has just been laid low or cut down. 'agricultural horses also meet with severe wounds of this class from treading on an upturned harrow.'[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. iv., p. .] it has been remarked how strange it is that nails should so readily penetrate the comparatively hard covering of the foot. the matter, however, admits of explanation. one knows from common observation how easy it is to tilt a nail with its point upwards by exerting a pressure in a more or less slanting direction upon its head. this is exactly the form of pressure that is no doubt put upon the nail if the animal treads upon it when moving at any pace out of a walk. the foot in its movement forward tilts the nail up, and almost simultaneously puts weight upon it. the great weight of the animal is then quite sufficient to account for its ready penetration. in purely country districts cases of punctured foot are of far less frequent occurrence than in large towns. in the latter, animals labouring in yards where a quantity of packing is done, or engaged in carting refuse containing such objects as we have mentioned, or broken pieces of earthenware or glass bottles, meet with it constantly. for the manner of causation of those wounds to the foot occurring in the forge the reader may be referred to the matter under the heading of 'nail-bound.' as in that case so in this the nail may be wrongly directed by improper fitting of the shoe, by the 'pitch' of the hole, or by the position of the hole. the nails may also be wrongly directed as a result of faulty pointing, or by meeting with the stump of a nail that has carelessly been allowed to remain in the substance of the horn. often pricking is a result of carelessness engendered by a rush of work. often it is almost unavoidable on account of the character of the foot that is brought to be shod. feet with thin horn, especially a thin sole, feet with horn shelly and brittle, each in their way are difficult to shoe. sometimes pricking is purely accidental, as in the case of a 'split' nail. the nail as it is driven splits at its point, and continues to split down its centre, one half emerging at the correct spot on the wall, the other half bending inwards, and penetrating the sensitive structures. _common situations of the wound_.--in a case of picked-up nail the common seat of puncture is about the point of the frog, either in one of the lateral lacunæ, in the median lacuna, or the apex of the frog itself. in comparison with this puncture of the sole is rare. prick sustained at the hands of the smith may, of course, run in either of the following directions: ( ) directly into the position where the horny and sensitive laminæ interleave; ( ) between the sensitive laminæ and the os pedis; ( ) into the os pedis itself; ( ) the nail may bend excessively immediately after entering the horn, and so pass either between the horny and sensitive sole; or ( ) between the sensitive sole and the bone. _classification_.--punctured wounds of the foot may be classified as follows: _simple or superficial_ when penetrating no structure of great importance. for instance, a prick that penetrates to the sensitive sole and is not driven with sufficient force to seriously injure the os pedis we may regard as simple. in the same manner a prick to the frog that, although deep, is mainly concerned with penetrating the plantar cushion may also be classed as simple. _deep or penetrating_ when driven with sufficient force or in such a direction as to injure structures whose penetration is calculated to give rise either to serious constitutional disturbance or to permanent lameness. in this category we may place injuries to the terminal portion of the perforans, puncture of the navicular bursa, fracture of the navicular bone and penetration of the pedal articulation, and splintering of the os pedis. _symptoms and diagnosis_.--while discussing the symptoms and diagnosis, we will still continue to consider our subject under the two headings of ( ) accidental 'gathering' of some foreign body, and ( ) pricks inflicted in the forge. in a few cases belonging to the former class the veterinary surgeon is fortunate in obtaining a direct history of the injury. the driver has seen the animal go suddenly lame, and has examined the foot for the cause. either the nail has been found embedded in the horn, or the puncture it has made detected, and the matter has been reported. the foot is then explored and the full extent of the injury ascertained. in many cases, however, it so happens that no evidence of the infliction of the injury is forthcoming. the momentary lameness occurring at the time of the prick is unreported at the time by the attendant, and the horse for a time goes sound. it is not until the changes set up by the subsequent inflammatory phenomena make their appearance, and lameness results, that attention is called to the foot. when this happens there has, as a rule, been time for pus to form around the seat of puncture--a matter of about forty-eight hours. the horse is now brought out for the veterinary surgeon's examination, going distinctly lame. if the case is well marked there may then be noted by the man of experience many little signs pointing to the foot as the seat of the lameness. these, though well enough known to the practitioner, are nevertheless difficult to describe. it is, in fact, hard to say exactly in what they really consist, appearing to be as much a matter of intuition as of actual observation. there is a peculiar 'feeling' characteristic in the gait. the affected foot is put forward fearlessly enough, but is not nearly so rapidly put to the ground. when at rest the foot is almost immediately pointed, and the pain at intervals manifested by pawing movements. it is this extreme liberty of the rest of the limb, as evinced during the pawing movements, that really strikes one. shoulder, elbow, knee, and fetlock are all easily and painlessly flexed and extended. there is nothing wrong with them; it must be the foot. the short manipulation necessary to test the lameness--viz., the walk and slow trot--is sufficient to raise the animal's pulse and quicken the breathing. all this is enough, and more than enough, to lead the veterinary surgeon to examine the foot. it is hot to the touch, and at the coronet tender to pressure, possibly in a neglected case fluctuating at the heel. pain is evinced by the animal withdrawing his foot when percussion takes place over the affected spot. in a bad case one gentle tap is all that is needed. the animal at once snatches away his foot, holds it high from the ground, and makes pawing movements in the air. at that moment, too, his countenance is highly expressive of the pain he is suffering. again the foot is explored, the injury found, and the pus liberated. regarding the manner of exploration of the foot we will take first that case in which the veterinary surgeon is called in early, and in which pus has not yet had time to form. sometimes the merest cleaning up of the inferior surface of the foot then reveals a distinct stab either in the sole or the frog. if the accident be recent only a little blood will be found, either liquid, or coagulated about the wound. later there exudes from the stab a flow of yellow, serous fluid. the opening thus found should be carefully probed, and its depth and situation noted. at other times the prick is not so readily apparent. the nail or other object has penetrated and afterwards withdrawn itself. the natural elasticity of the horn, especially that of the frog, causes it to contract upon the puncture, and to largely obliterate the hole made. what, therefore, may look to be but a simple injury to the horn alone may in reality be the only evidence of a stab complicating the sensitive structures. it thus behoves the veterinary surgeon to follow up and carefully cut out any unnatural-looking mark in the horn, more especially if the horn is discoloured, or if blood is extravasated into its fibres, or there is moisture exuding from the part. in some cases of this description the knife in the act of paring comes into contact with the cause of the trouble. sometimes this is a nail, sometimes a sharp and small piece of flint, so deeply penetrated as to have become quite buried. when met with in this manner, however, the foreign body is more often than not a splinter of wood deeply embedded in the cleft of the frog or in the frog itself. the fact that multiple punctures may occur should here be remembered, and the remainder of the inferior surface of the foot thinly pared. on withdrawal of the foreign object blood may immediately follow. should the former have been fixed in position for some time, however, pus is nearly always found at the bottom of the wound. as a rule, its removal is comparatively easy, but one case recalls itself to the author's mind in which the extraction was a matter of considerable difficulty. the offending object was a large, flat-headed nail, some inches long. this was driven fast into the os pedis, and necessitated the employment of a pair of pincers and the exertion of some amount of force to move it from its position. in this connection it must be remembered that the penetrating object sometimes breaks off after entering the foot. the fact that this occasionally happens only serves to give point to the advice we have previously rendered--that every stab should be carefully probed, and its exact condition and depth ascertained. in those cases where percussion has led to the positive opinion that pus really exists, then the exploration must be most searching. there may, or may not, be a suspicious-looking mark to work on. in the latter case, the veterinary surgeon must not be content with confining his paring operations to one spot. the sole should be carefully thinned all round, and the thinning cautiously proceeded with until either small, pin-point hæmorrhages denote that healthy sensitive structures have been reached, or a sudden flow of pus indicates that the injury has been definitely located. while the symptoms remain much about the same, the diagnosis of pricks received in the forge, as compared with those occurring in the natural manner, is easy. the animal starts to the forge quite sound, and returns, perhaps, with a slight limp. the slight limp in two days' time becomes a decided lameness, and no doubt remains as to what has occurred. the mere fact of the lameness arising immediately after a visit to the forge should be sufficient in the majority of cases to lead one to a correct diagnosis. where the opinion has been formed that a prick has been received, then the shoe should be removed. this operation should always be superintended by the veterinary surgeon himself. after the removal of the clinches, the nails should be drawn one at a time with the pincers, and carefully examined. often the offending nail may thus be picked out by observing upon it blood-stains, or the moisture from inflammatory exudate or from pus. further inflammation will also be gathered by occasionally meeting with a nail that has split. at this stage, too, the veterinary surgeon should have noticed whether or not the smith has previously sent the animal home with what is known as a 'draw back.' he has discovered, immediately after he has done it, that he has pricked the animal. he has then withdrawn the nail, and either sent the animal back with that nail altogether missing from the set in the shoe, or with the hole filled up with a stump. the shoe once off, the holes made by the nails in the horn should be minutely examined for the presence of hæmorrhage, inflammatory fluid, or pus exuding from them, and also for evidence of their correct placing in the foot. should fluid matter issue from any one of them, or should it be deemed that one has approached too near the inner margin of the white line, more especially if tenderness exists around it, that hole should be followed up with a 'searcher' or small drawing-knife until diagnosis is certain. _complications_.--before proceeding to discuss the complications that may arise in the case of pricked foot, we may call to mind that the anatomy of the parts teaches us that the most serious position in which a punctured wound can occur is at the centre of the foot. here the plantar aponeurosis, the navicular bursa, the navicular bone itself, or the pedal articulation may be injured. anterior to this position the most serious mischief that can ordinarily result is stabbing of the os pedis. posterior to the position we have named, the only structure to be injured is the plantar cushion. anatomically, then, the inferior surface of the foot may be divided into three zones, as follows: _a. anterior_, extending from the toe to the point of the frog. _b. middle_, extending from the point of the frog to the commencement of its median lacuna. _c. posterior_, including everything posterior to the middle zone. this division of the inferior surface of the foot into zones will be somewhat of a guide also when describing the complications next to follow: _(a) suppuration_.--this is the common complication of most wounds of the foot. when detected, it calls for immediate surgical interference in the shape of removal of the horn of the sole or the frog, as the case may be. this we shall consider further under the treatment. _(b) separation of the horny frog_.--this is a sequel to pus formation in the sensitive structures immediately beneath it, and the condition makes itself apparent by a line of separation between the horn and the skin of the heel of the injured side. _(c) wounding of the plantar aponeurosis_.--this occurs when a moderately-deep penetration of the horn of the middle zone has taken place. it is always most painful, especially when complicated by necrosis. the heel is then persistently elevated, and lameness is extreme, in some cases so severe as to cause the leg to be carried altogether. in favourable cases the necrosed piece of tendon is sloughed off by the process of suppuration, and escapes with the discharges from the wound. there is then an abatement in the symptoms, and recovery is rapid. commonly, however, on account of the non-vascularity of the structure of the tendon, the necrotic spot in it tends to spread. the wound is thus led to become fistulous in character, and the pus forming within it prevented from escaping from the original opening. as a result, lameness and fever persist. there is a gradual increase in the severity of the symptoms, and later fistulous openings appear in the hollow of the heel. _(d) puncture of the navicular bursa_.--this results from a prick in exactly the same position as that last described, and means that the penetrating object has gone deeper, it may be distinguished from puncture of the plantar aponeurosis alone by the fact that there is an excessive discharge of synovia from the wound. this, as it escapes, is at first clear and straw-coloured. later it becomes cloudy and flaked with pus, and shows a tendency to coagulate in yellowish clots. pain and accompanying fever is most marked, much more so than when the plantar aponeurosis alone is injured. should the original wound be insufficiently enlarged, or should its opening become occluded by the solid matters of the discharge, then this condition, like the last, ends in the formation of fistulous openings in the heel. these make their appearance as hot, painful, and fluctuating swellings in that position. later they break, discharge their contents, and leave a fistulous track behind. _(e) fracture of the navicular bone_.--penetration of the substance of the navicular bone, _without_ its fracture, adds nothing to the symptoms we have described under puncture of the bursa. that the bone has been reached by the penetrating object may be detected by probing. this, however, must be performed with care, especially if a flow of synovia is absent. otherwise, the wound, as yet, perhaps, superficial enough to avoid penetrating even the bursa, is made a penetrating one by the probe itself. fracture of the navicular bone is fortunately rare. _(f) penetration of the pedal articulation and arthritis_.--this we shall consider in greater detail in chapter xii. it is sufficient here to state that the condition may be suspected when a hot and painful swelling of the whole coronet makes its appearance. there is at the same time a diffused oedema of the fetlock and the region of the cannon, sometimes extending upwards to the whole of the limb. of all the complications to be met with in punctured foot this is the one most to be dreaded. the intense pain and the high fever render the animal weak and thin in the extreme. the appetite becomes impaired, sometimes altogether lost, and the patient in many cases appears to die from sheer exhaustion. added to this is always the extreme probability of the wound becoming purulent, and later the dread of general septic infection of the blood-stream ensuing, and death resulting from that. even with the happier ending of resolution, anchylosis of the joint and incurable lameness is more often than not left behind. (see suppurative or purulent arthritis, chapter xii.) _(g) ostitis and caries of the os pedis_.--injuries to the os pedis are met with in the anterior zone of the foot. evidence that the bone has been injured is not usually forthcoming until after the lapse of some days. one is led to suspect it by the fact that there is no indication of the suppurative process extending further upwards, coupled with the facts that great pain, high fever, and extreme lameness persist, and that there is a continuous discharge from the wound of a copious blood-stained and foetid pus. used now, the probe reveals the fact that the bone is bared, and conveys to the hand that is holding it a sensation of crumbling fragility. _(h) wounding of the lateral cartilage and quittor_.--this occurs as the result of a deep stab in the posterior zone. ordinarily, wounds in this position are unattended with serious consequences, and the prick has to be a deep and a severe one before the cartilage is reached. what then happens is that a spot of necrosis is formed round the seat of puncture in the cartilage. this, unless met with surgical interference, is sufficient to maintain the wound in a septic condition; it takes on a fistulous character, and a quittor is formed. (see chapter x.) _(i) septic infection of the limb_.--this we have already once or twice referred to. it simply means that the septic matters from the wound have gained the lymphatics, and finally the blood-vessels of the limb, and set up local lesions elsewhere than in the foot. although dismissed here with these few words, the condition is a most serious one. usually, it has resulted from penetration of the pedal articulation and septic infection of the joint. in the vast majority of these cases slaughter is both humane and economical. _prognosis_.--the first consideration in giving a prognosis in punctured foot should be the position of the wound. when occurring in the middle zone, the surgeon's statements should be most guarded, and the dangers attending a wound in that particular position fully explained to the owner. a wound in the anterior position is, as we have said, far less serious, and one in the posterior region of the foot even less serious still. whenever possible, the nail or other object causing the prick should be examined. much of the prognosis may be based upon the estimated depth of the wound, and this, in many cases, it is far safer to calculate from the length of the offending body than from the use of the probe. we need hardly say that in the middle zone the deeper the prick, the more serious the case, and the less favourable the prognosis. as in succession the sensitive sole, the plantar aponeurosis, the navicular bursa, the navicular bone, or the pedal articulation is injured, so with each step deeper of the prick is the severity of the case increased. the shape of the penetrating object may also be considered. one excessively blunt, and calculated to bruise and crush the tissues, will inflict a more serious wound than one of equal length that is pointed and sharp. the conformation of the foot should also be regarded. wounds in well-shaped feet are less serious than in feet with soles that are flat or convex, or in which the horn is pumiced or otherwise deteriorated in quality. although unaffecting the prognosis so far as the actual termination of the case is concerned, it may be mentioned that punctured foot is far more serious in a nag than in a heavy draught animal. with an equal degree of lameness resulting in each case, the former will be well-nigh useless, but the latter still capable of performing much of his usual labour. the temperament and condition of the patient will also in many cases largely influence the prognosis. an animal of excitable and nervous disposition is far more likely to succumb to the effects of pain and exhaustion than the horse of a more lymphatic type. in the case of a patient suffering from a prick to a hind-foot while heavily pregnant, the attempted forecast of the termination should be cautious. more especially does this apply to the case of a heavy cart-mare. ordinarily, the heavier the breed, the greater the tendency to lymphatic swelling of the hind-limbs. with pregnancy this tendency is enormously increased, and it is no uncommon thing to find a cart-mare in this condition, with legs, as the owner terms it, 'as thick as gate-posts.' a prick to the foot, with the lymphatics of the limb in this state, is extremely likely to end in septic infection of the leg, for there appears to be no doubt but that invasion of the lymphatics with septic matter is favoured by a sluggish stream. also, in the case of a patient in the advanced stages of pregnancy, it must be remembered that, no matter how great may be the need, one is debarred, for obvious reasons, from using the slings. _treatment_.--_in a simple_ case--and by 'simple' here we mean the case in which the injury is discovered early, and pus has not yet commenced to form--our first duties are to give the wound free drainage, and to maintain it in an aseptic condition. the first of these objects is to be arrived at by paring down the horn in a funnel-shaped fashion over the seat of the prick. it is, perhaps, even better to thin the horn down to the sensitive structures for some little distance round the injury. by this latter method pressure from inflammatory exudate is lessened, and the after-formation of pus, if unfortunate enough to occur, the more readily detected, and the less likely to spread upwards. the matter of asepsis may then be attended to. when the puncture is sufficiently large to admit of it, the antiseptic dressing is best applied by means of the probe. this instrument is thinly wrapped with tow, or other absorbent material, so as to form a small swab. dipped in a suitable solution (as, for example, zinc chloride, spts. hydrarg. perchlor., carbolic acid, or any other that suggests itself), the swab is inserted into the prick, and the wound conveniently mopped clean. a further portion of the medicated tow is then pushed partially into the wound, and allowed to remain in position. the foot is subsequently wrapped in a clean bag, and kept free from dirt. this dressing should be repeated twice daily. if the prick is in a dangerous position, and deep enough to occasion alarm, our precautions to prevent the formation of septic matters within it may be more elaborate. the thinning of the horn and the swabbing of the wound may, as before, be proceeded with. in addition, the whole foot may then be immersed for some hours daily in a cold bath, which bath should be strongly impregnated with one or other of the following salts: iron sulphate, zinc sulphate, copper sulphate, aluminium sulphate, lead acetate, or sodium chloride--better still, a mixture of the various sulphates here mentioned. if preferred, one of the more commonly accepted antiseptics--such as carbolic acid, lysol, boracic acid, or perchloride of mercury--may be substituted. by the cold of the bath inflammatory phenomena are held in check, while its added antiseptic prevents the formation of septic discharges. the lameness gradually diminishes, and resolution is rapid. in this way deep and serious, wounds are sometimes easily and successfully treated. _when suppuration has occurred_--and this, by-the-by, is by far the most frequent condition in which we find punctured foot--treatment must be prompt and decided. careful search must at once be made by thinning down the sole, and carefully trimming the frog. on no account should the veterinary attendant rest content with 'digging' in one place, and upon that basing a negative opinion as to the existence of pus. the paring should be carried on, until either pus or hæmorrhage shows itself, in at least three positions--namely, at the most anterior portion of the sole, and in the sole at each side of the frog. in addition to this, the frog itself should be minutely examined for evidence of puncture, or for leaking of pus at the spot where the horn of the heels joins the skin. in many of our cases, however, this careful search is not so necessary. the accompanying symptoms are so decided as to leave no doubt as to the condition of the case. in such instances paring may often be commenced over the exact position of suppuration as previously ascertained by percussion. when met with, the track formed by the suppurative process should be followed up in whichever direction it has spread. this will often necessitate the removal of the greater part, if not the whole, of the horny sole. having given vent to the pus, and opened up the cavity made by its formation, the foot should be placed in a hot poultice or, preferably, in a hot antiseptic bath.[a] [footnote a: at the time of writing this, a certain amount of discussion is going on in our veterinary journals as to whether a hot or a cold bath is the one indicated. it is urged against the application of heat that it favours organismal growth and reproduction, and tends rather to induce the spread of the suppurative process than to overcome it. those who hold this opinion urge in support of it that cold applications are inimical to the life of the pus organism. at the same time, it must be remembered that in just so far as cold inhibits the growth of the invading germ, so in just the same degree does it adversely influence the functions of the tissues that are to fight against it. to our minds the question thus set up must always remain more or less a moot-point, and while we fully agree that cold undoubtedly checks the growth of septic material, we just as fully believe that warmth serves to place the healthy surrounding structures in a far better condition to maintain a vigorous phagocytosis against it. we thus continue to advise a hot antiseptic poultice, or, better still, a bath.--the author.] at the end of the third or fourth day the poultice or the bath may be discontinued, and the opening in the sole dressed with any suitable astringent and antiseptic. the most serious complication arising from this method of treatment is one of excessive granulation of the sensitive sole. this we find to be successfully held in check by a daily application of undiluted spts. hydrarg. perchlor. (tuson). should the granulations become very exuberant, then the knife must be called to our aid, and the wound so made afterwards dressed with an astringent. when the suppuration has under-run the horny frog there should be no hesitation in at once removing all the horn that is visibly separated from the sensitive structures beneath. _when the os pedis is splintered and carious_, a portion of the sole round the wound is removed, and the bone exposed. the diseased portion is scraped away either with a curette or with the point of the drawing-knife. in this case the only after-treatment called for is the application of suitable antiseptic dressings. _when necrosis of the plantar aponeurosis has occurred_. we have already pointed out the tendency there is in this case for the wound to maintain a fistulous character, and lead to the formation of abscesses in the hollow of the heel. with a wound in this position, as with a wound in any other, the only method of avoiding this termination consists in removing all that is visibly diseased, whether it be soft structures, bone, ligament, or tendon, and giving the wound free drainage. this can only be done by removing the horny sole and frog, and cutting boldly down upon the structures beneath. the operation is known as resection of the plantar aponeurosis, or the complete operation for gathered nail. practised for some years on the continent, this operation, on account of its gravity, has been avoided by english veterinarians. from reported cases, however, it appears often to be followed by success. that there is a large element of risk in the operation is quite evident, if only from the two facts mentioned beneath: . that the close attachment of the plantar aponeurosis to the navicular bursa, and the nearness of both to the pedal articulation, render penetration of a synovial sac or a joint cavity extremely likely. . that there is always great difficulty in maintaining strict asepsis of the foot, more especially if it is a hind one. on the other hand, it may be argued that equal risk to the patient is run in allowing him to remain with a disease (and that disease a progressive one) of the structures so closely antiguous to the navicular bursa and the pedal articulation. if only for that reason we give the operation brief mention here. the animal is prepared in the usual way for the operating bed; the foot soaked for a day or two previously in a strong antiseptic solution, the patient cast and chloroformed, and the operation proceeded with. [illustration: fig. .--'curette,' or volkmann's spoon.] an esmarch's bandage should be first applied, and a tourniquet afterwards placed higher up on the limb. the foot is then secured as described in an earlier chapter, and the whole of the horny structures of the lower surface of the foot (the sole, the frog, and the bars) pared until quite near the sensitive structures, or, if under-run with pus, stripped off entirely. an incision is then made in each lateral lacuna of the frog, the two meeting at the frog's point. each incision thus made should be carried deep enough to cut through the substance of the plantar cushion. a tape is then passed through the point of the frog, tied in a loop, and given to an assistant to draw backwards. the plantar cushion itself is then incised in a direction from before backwards, and pulled on by the assistant, so as to expose the plantar aponeurosis. should this be found at all necrotic, it may be taken that purulent inflammation of the navicular bursa and of the navicular bone itself exists. the operator must then proceed to resection of the tendon in order to treat the deeper structures thus affected. at its point of insertion into the semilunar crest the tendon is severed and afterwards reflected. this exposes the inferior face of the navicular bone. instead of the glistening and clear appearance it ordinarily presents, its glenoid cartilage is found to be showing hæmorrhagic or even purulent spots of necrosis. the terminal portion of the tendon must then be excised. to effect this a clean transverse incision is made at the extreme upper border of the navicular bone. here we are in close contact with the pedal articulation, and great care is necessary in making this last incision, in order that the synovial sac may not be penetrated. all structures showing spots of necrosis should now be carefully removed, either with the knife or with the curette. the knives most suitable for the last stages of this operation are those depicted in fig. (_c_, _d_, and _e_). the curette, or volkmann's spoon, we show in fig. . [illustration: fig. .--resection of terminal portion of the perforans. the horny sole and the horny frog stripped from off the sensitive structures. _a_, the plantar cushion; _b, b_, the plantar aponeurosis, or terminal portion of perforans; _c_, the navicular bone; _d_, interosseous ligaments of the pedal articulation; _e, e_, semilunar crest of the os pedis; _f_, inferior surface of os pedis; _g, g_, the sensitive laminæ of the bars; _h, h_, bearing surface of the wall; _i, i_, the sensitive sole; _k_, the sensitive frog.] when at all diseased the glenoidal surface of the navicular bone should be curetted, even to the extent of the removal of the whole of the cartilage. a healthy, granulating surface is thus insured. the above figure from gutenacker's 'hufkrankheiten' explains shortly the position of the operation wound and the structures involved, rendering further description unnecessary here. the operation ended, the dressing follows. upon this depends very largely the ultimate recovery of the patient, for it is only by careful attention and suitable dressings that effectual repair of the injured structures may be brought about. a light shoe is first tacked on to the foot, and those portions of the horny sole that have been allowed to remain dressed with venice turpentine, tar, or other thickly-adherent antiseptic. the exposed soft tissues are then dressed with pledgets of tow[a] soaked in alcohol and carbolic acid. this dressing must be allowed to remain in position, and is kept there by means of a bandage, or the shoe with plates (fig. ) and a bandage over it. no pressure is needed; consequently, the pledgets of tow must not be too thick. [footnote a: when using tow in the form of a pad, it is well to remember that many small balls of the material rolled lightly in the palm of the hand and afterwards massed together are far better than one large pad of the tow taken without this preparation. the irregularities of the wound are better fitted, and the whole dressing easier remains _in situ_ (h.c.r.).] in the after-dressing of the wound careful attention must be paid to the granulating surface. where tending to become too vigorous in growth it should be held in check by suitable caustic dressings. at the same time it must be remembered that the granulating process of repair is always more rapid upon the plantar cushion and fleshy sole than upon the bone, or upon tendinous or cartilaginous structures. as a result of this we have a wound showing various aspects of cicatrization. healthy granulation may be profuse in one spot, while in another it may be checked either by a flow of synovia from the still open bursa, or by fragments of bone or of tendon still acting as foreign bodies in the wound. these latter may be readily detected by their standing out as dark and uncovered spots in the healthy granulation around, and should be at once removed. the time that an operation wound of this description takes to heal--and that without complication--is from one to two or three months. continuation of pain and intensity of lameness are not to be taken as indications of failure. the reparative inflammation in the synovial membrane is quite sufficient to induce pain severe enough to prevent the animal from placing his foot to the ground for some weeks, even though the progress of the case, all unknown, may be all that is desired. so long as a great amount of pain is absent, and so long as appetite remains and swellings in the hollow of the heel fail to make their appearance, so long may the progress of the case be deemed satisfactory. _recorded case of the treatment_.--a cart-horse, aged six years, was sent to the alfort school by a veterinary surgeon for having picked up a nail in the hind-foot. professor cadiot, judging the necessity for the complete operation, performed it on january , and spared the plantar cushion as much as possible. in consequence of the plantar aponeurosis being extensively necrosed, it was advisable to scrape the navicular bone and a part of the semilunar crest. the wound having been washed with a per cent. solution of perchloride of mercury, it was dusted with iodoform and packed with gauze, and covered with a cotton-wool dressing, kept in position by means of a suitable shoe. on january there was no snatching up of the limb when the horse was made to put weight upon it; he ate his food well, and his condition improved every day. on january the dressing was removed; the wound appeared pinky and granular, and there was no suppuration. the clot remaining from the hæmorrhage after the operation was removed, the wound was irrigated with a hot solution of sublimate, and then dusted with iodoform and covered with a dressing of iodoform gauze and absorbent wool. at this date the horse could stand on the injured limb. on january a second dressing was made, and the animal almost walked sound. on february the wound had almost closed up, save in its central part, where there was a small cavity, and the lameness had disappeared. on february the wound had completely healed, and its borders were covered by a layer of thin horn. as the animal was sound it was sent to work. the author directs attention to the rapidity with which a large and complete wound cicatrizes after the operation for gathered nail.[a] [footnote a: _veterinary record_, vol. xv., p. (jourdan).] _in the case of penetrated navicular bursa_, unaccompanied by the formation of any large quantity of pus, and uncomplicated by necrosis of the aponeurosis, our aim must be to maintain the wound in that happy condition. this is doubtless best done by keeping the foot continually in a cold bath, rendered strongly antiseptic by the addition of sulphate of copper and perchloride of mercury. should there be intervals when the bath must be neglected, the foot in the meantime must be kept clean by antiseptic packing and bandaging, and a clean bag over all. this treatment should be continued so long as the character of the discharge denotes that synovia is running. if, in spite of our precautions, the discharge becomes purulent, then the track made by the penetrating object should be syringed twice daily with a in , solution of perchloride of mercury. during the treatment it will be wise to shoe the animal with a high-heeled shoe. we do not know as yet the full extent of the injury. the navicular bone may be tending to caries; or necrosis of the plantar aponeurosis, all unknown, gradually becoming pronounced. this calls for a relief of tension on the perforans, and is only to be brought about by the high-heeled shoe. the result of the inflammatory changes in the tendon, aided possibly by the use of the high-heeled shoe, is to afterwards bring about contraction. where this has occurred, and the animal walks continuously on his toe, the shoe with the projecting toe-piece (fig. ) must be applied. when the continual use of the toe-piece appears inadvisable, the shoe devised by colonel nunn may be used in its stead (see fig. ). the toe-piece is screwed into the toe of the shoe when the horse is about to be exercised, and forms a powerful point of leverage with which to stretch the contracted tendon, and the shoe, being thin at the heels, admits of this. the advantage of this form of toe-piece over the ordinary form of fixed toe-lever is that it can be removed when the horse is in the stable; while the curved point diminishes the danger of the horse hurting itself--a danger always present if it is on a hind-foot. (see also treatment of purulent arthritis in chapter xii.) [illustration: fig. .--colonel nunn's shoe with detachable toe extension.] _should a sinuous wound remain in the region of the lateral cartilage_, it should be explored, and its depth and likely number of branches ascertained. should this exploration denote that the cartilage itself is diseased, or that the wound is not able to be sufficiently drained from the sole, then we know that we have on our hands a case of quittor. the treatment necessary in such a case will be found described in chapter x. _when the complication of purulent arthritis has arisen_, the surgeon has to admit to himself, reluctantly no doubt, that the case is often beyond hope of aid from him. nothing can be done save to order continuous antiseptic baths and antiseptic irrigation of the wounds with a quittor syringe, and to attend to the general health and condition of the patient. at the best it is but a sorry look-out both for the veterinary attendant and the owner of the animal. even with resolution incurable lameness results, and the animal is afterwards more or less a walking exhibition of the limitations of surgery, while the owner, unless the animal is valuable for the purpose of breeding, finds himself encumbered with a life that is practically useless. (see treatment of purulent arthritis, chapter xii.) _in the case of lameness persisting after the healing of all appreciable lesions_, then neurectomy is followed by good results. the animal, apparently recovered, is for a long time useless. lameness persists for several months, as if the nail had at the moment of its penetration caused lesions, which doubtless it sometimes does, similar to those of navicular disease. examination of the foot in this case reveals no lesion, and the pain has evidently a deep origin. the lameness caused by it is subject to variation. frequently it becomes lessened during rest, and increased by hard work, while sometimes it is very much more pronounced at starting than after exercise. it is here that neurectomy is called for. the operation does nothing to impede the work of healing going on, and allows free movement of the foot and pastern to take place. at the same time suffering and emaciation cease, and the animal is rendered workable.[a] [footnote a: _veterinary record_, vol. ii., p. .] c. coronitis (simple). tread, overreach, etc. . _acute_. _definition_.--under the heading of simple coronitis in its acute form we intend to describe those inflammatory conditions of the skin and underlying structures of the coronet occurring without specific cause. specific coronitis will be found described in chapter ix. _causes_.--this condition is almost invariably set up by an injury--either a bruise or an actual wound--to the coronet. by far the most common among such injuries are those inflicted by the animal himself by means of the shoes. that known as 'tread' is caused by the shoe on the opposite foot, and may happen in a variety of ways. more often than not it is met with in the feet of heavy draught animals, and is there caused by the calkin, either when being violently backed or suddenly turned round. it may also occur in horses with itchy legs, as a result of the animal rubbing the leg with the shoe of the opposite limb. the irritation in this case is nearly always due to parasitic infection (_symbiotes equi_), and becomes sometimes so unbearable as to render the animal unmindful of the injury he may be inflicting so long as he experiences the relief obtained by the rubbing. self-inflicted tread is also sometimes met with when horses are worked abreast at plough. the animal in the furrow, with one foot sometimes in and sometimes out of the hollow, is caused to make a false step, and so brings the injury about. animals worked in pairs are further liable to receive a tread from the foot of their companion. this is commonly seen in heavy animals at agricultural labour in fields, where the walking is uneven, and abrupt turning constant. it is not uncommon either in animals at work in vans in town, and is occasionally met with in the feet of carriage-horses. 'overreach' is the term used to indicate the injury inflicted on the coronary portion of the heel of the fore-foot by the shoe of the hind. ordinarily, overreach occurs when the animal is at a gallop, and is thus met with in its severest form in hunters and steeplechasers. it can only occur when the fore-foot is raised from the ground and the hind-foot of the same side reached right forward. when the feet separate the injury takes place. in its movement backwards the inner border of the shoe of the hind-foot catches the coronet of the fore, and tears it backwards with it. quite frequently a portion of the skin is removed entirely, but often it hangs as a triangular flap. the flap in such a case is always attached by its hindermost edge, and indicates plainly enough that the direction of the blow that cut it must have been from before backwards. although ordinarily inflicted at the gallop, the same injury may, nevertheless, be caused by allowing a fast trotter, and one with extreme freedom of action behind, to push forward at the utmost limit of his pace. the outside heel is the one most subject to the injury. while the common form of injury to the coronet is, as we have described, that occasioned by the animal's own shoe, or that of a companion, it is evident that the foot is also open to similar injuries from quite outside sources. falls of the shafts when unyoking animals from a heavy cart, blows or wounds from the stable fork, wounds resulting from the foot becoming fixed in a gate or a fence, either may equally well set up the mischief. apart from severe injury, a particularly troublesome form of coronitis may arise from the condition of the roads. we refer to the conditions attendant on a thaw after snow. the animal is called upon to labour in, or perhaps stand for long periods in, a mixture of snow and water, or snow and mud. that this must have a prejudicial effect upon the structure of the coronet is plain. the circulation of the part, already predisposed to sluggishness by reason of its distance from the heart, is farther impeded by the action of the cold. small abrasions of the skin, so small as to scarce be noticeable, are in this case freely open to infection with the septic matter the mud contains. necrosis and consequent sloughing of the skin is bound to follow, and an extensive ulcerous wound, or a spreading suppuration of the coronary cushion is the result. _symptoms_.--we will take first the case in which no actual wound is observable. here the first indication of the trouble is the appearance of an inflammatory swelling, confined usually to one side, but extending sometimes to the whole of the coronet. always the part is hot and tender, and with it the patient is lame--so much so, in many cases, as to be unable to put the foot to the ground, the toe alone being used. in a mild case, uncomplicated by septic infection, these symptoms rapidly subside, and resolution occurs. always, however, the presence of septic infection must be suspected and looked for. when this has occurred, the inflammatory swelling becomes larger and more diffuse, and the animal fevered. this is then followed by a slough of the injured part. a portion of the skin first becomes gray, or even black, in appearance, and around it oozes an inflammatory exudate, or even pus. the skin immediately adjoining the spot of necrosis is swollen and hyperaæmic, and extremely painful and sensitive. later, the necrosed portion becomes cast off, and an open wound remains. this as a rule marks the turning-point in the case. the pain and other symptoms rapidly abate, and the wound, with proper attention, is not more than ordinarily difficult to treat. in the case of an actual wound the symptoms are probably less severe. the injury is, in this instance, the sooner detected, and remedial measures put into operation. in this manner the formation of septic material is often checked, and nothing but the treatment of a simple wound demands attention. there are, however, complications. _complications--(a) diffuse purulent inflammation of the sub-coronary tissue_.--this condition is brought about by the spread into the loose tissue of the coronary cushion of the septic material introduced by the tread. the whole coronet in this instance becomes excessively swollen, hot, and painful, and the dangerous nature of the complication is evident enough when the structure and situation of the parts involved is considered. the amount of tendinous and ligamentous material in the neighbourhood offers a strong predisposition to necrosis, and the necrosis, with its attendant formation of pus, offers a further danger when the close proximity of the pedal articulation and the unyielding character of the horny box is considered with it. the pus formed in this condition may remain confined to the coronet and break through the skin as an ordinary abscess, or it may, before so doing, burrow beneath the wall, and invade the sensitive laminæ. in this case, whenever portions of the secreting layer of the keratogenous membrane are destroyed, or perhaps only temporarily prevented from fulfilling their horn-producing functions, then corresponding cavities in the horn are the result (see fig. ). _(b) purulent arthritis_.--only too readily the pus so formed tends to penetration of the articulation and the causation of an incurable arthritis (see chapter xii.). [illustration: fig. .--mesial section of a hoof illustrating the conditions following upon coronitis. _a_, cavity in the horn of the wall; _b_, enlargement of the coronet and the horn of the wall following subcoronary suppuration; _c_, cavity in the wall following purulent inflammation of the sensitive laminæ; _d_, hollow in the horn of the sole consequent upon suppuration of the sensitive sole.] _(c) necrosis of the extensor pedis_.--this may arise either as a result of spreading purulent infection of the coronary cushion, or as a result of direct injury immediately over it. the close relation of the terminal portion of this tendon with the pedal articulation, and the incomplete protection from outside injuries here afforded to the joint by the horny box, sufficiently points out the gravity of the condition. _(d) penetration of the articulation_.--this also may be a result either of the inroads made by pus, or of an actual wound. when occurring from the latter, it is seen more often than not in the hind-foot, being there caused by the calkin of the opposite foot. where a wound in this position is characterized by an excessive flow of synovia, the condition should be suspected, and, if the wound be large enough, the little finger should be introduced in order to ascertain. needless to say, the injury is a grave one. _(e) sand-crack_.--sand-crack is likely to result from tread when an injury is inflicted in the region of the quarter by a severe overreach. treads, too, especially with the calkin of the hind-shoe, are especially apt to end in this way. in this latter instance the sand-crack usually has its origin in a nasty jagged tear at the top of the wall of the toe. _(f) quittor_.--in one respect any suppurating wound at the coronet may be deemed a quittor. by indicating quittor as a complication of coronitis, however, we denote the more serious form of this disease, in which the wound has taken on a sinuous character, and conducted pus to invasion of the lateral cartilage. it is one of the worst complications we are likely to meet with in this condition, and will be found fully described in chapter x. _(g) false quarter_.--this complication of coronitis occurs when the injury or after-effect of the formation of pus has been severe enough to destroy outright a comparatively large portion of the papillary layer of the coronary cushion. to this condition we devote section d of this chapter. _prognosis_.--in giving a prognosis in a case of coronitis, attention should be paid to the manner in which the condition originated, and the extent, when present, of the wound. when the inflammatory swelling has arisen from bruising alone, without actual division of the skin, when the weather is that of winter, and the swelling showing a marked tendency to spread, then the prognosis must be guarded. as we have seen, this state of affairs is probably ushering in a condition of spreading suppuration of the coronary cushion, and considerable gangrene and sloughing of the skin. we have here no intimation as yet of how far the suppurative process may run, nor what important structures it may involve. consequently, the guarded prognosis we have mentioned is imperative. where an actual wound is to be seen, and where advice is sought early, then a more favourable opinion may be advanced. in this case antiseptic measures, commenced early and persisted in, may prevent the rise of further mischief. it goes without saying that, should there arise any other of the complications we have mentioned (viz., arthritis, necrosis of the extensor pedis, sand-crack, quittor, and false quarter), the fact should be pointed out to the owner, and the prognosis regulated thereby. _treatment--preventive_.--seeing that at any rate the majority of cases of coronitis result from injuries inflicted by the shoes, we may look at once to that particular for a means of prevention. take first the case of 'treads'. there is no doubt that they are most common in animals shod with heavy shoes and with high and sharp calkins. this suggests at once that a preventive is to be found in substituting a calkin that is low and square. where the injury is an overreach, and where, on account of the animal's pace and manner of gait it is in risk of being constantly inflicted, the shoeing should be seen to at once. we have already pointed out that it is the inner border of the lower surface of the toe of the hind-shoe which, in the act of being drawn backwards, inflicts the injury. (see fig. ). in this case prevention may be brought about either by shoeing with a shoe whose ground surface is wholly concave, or by bevelling off the sharp border (see fig. , _a_, p. ). when the tendency to overreach is not excessive, prevention may in many cases be effected by simply placing the shoe of the hind-foot a trifle further backwards than would ordinarily be correct, thus allowing the horn of the toe to project beyond the shoe. this at the same time does away with the annoyance of 'forging' or 'clacking,' which, as a rule, accompanies this condition. while recognising the value of shoeing in these cases, we must not forget that a great deal may be brought about by careful horsemanship. the animal should be held together and kept well up to the bit, but should _not_ be allowed to push forward at the top of his pace. with many animals of fast pace and free action overreach is more an indiscretion of youth than any defect in action or conformation, and his powers should therefore be husbanded by the driver until the animal has settled down into a convenient and steady manner of going. [illustration: fig. .--under surface of the toe of a hind-shoe. _a_, marks the portion of the inner margin that inflicts overreach.] [illustration: fig. .--the inner margin of the inferior surface of the hind-shoe bevelled to prevent overreach.] _curative_.--although in some cases it is so small as to go undetected, we may take it that in all cases of coronitis there is a wound, with consequent danger of septic infection of the surrounding parts. therefore, after attention to the shoeing and removal of the cause, the first indication in the treatment will be to render the parts aseptic. this is best done by removing the hair from the coronet and soaking the whole foot in a cold antiseptic solution. after removal from the bath, the coronet may be dressed with a moderately strong solution of carbolic acid or perchloride of mercury. when the injury is slight and recent, such is sufficient to effect resolution. when marked swelling persists, however, and the increase in heat and tenderness denotes the formation of pus, recovery is not so easily obtained. in this case the application of hot poultices or hot baths is called for. by these means suppuration is promoted and induced to early break through in the most favourable position--namely, the softened skin of the coronet. the pus so escaping is always more or less blood-stained, and contains both large and small pieces of broken down and decomposed tissue. after discharge of the pus, the cavity remaining should be mopped out with an antiseptic solution, and a pledget of antiseptic tow or other material left in position. all that is then needed is constant dressing in a suitable manner. we prefer in this instance washing some three or four times a day with hot water until a perfectly clean wound is obtained, and, after the washing, painting the raw surface with a strong solution ( in , or in ) of perchloride of mercury. when the abscess we have described as forming is extremely large, or where it is more than ordinarily slow in 'pointing,' the likelihood of its having burrowed for some distance below the upper margin of the wall must be suspected. here it is sometimes wise to thin the wall with the rasp immediately below the point of greatest swelling of the coronet. this will serve to lessen pressure on the sensitive structures beneath. immediately the abscess contents have found exit at the coronet, the cavity formerly occupied by the pus should be explored. if to any extent it is found then to have 'pocketed' beneath the upper border of the wall, a counter-opening should be made where the horn of the wall has been thinned with the rasp. when it so happens, either from extensive bruising or from the action of excessive cold, that we have or suspect the condition of sloughing, then the first indication is to aid the live tissues to throw off the necrosed portion. in spite of what is sometimes urged to the contrary, a hot poultice is, perhaps, the best means of bringing this about. directly the necrosed piece is shed, a wound remains which, so far as treatment is concerned, may be regarded exactly as that left by the formation of pus. hot water applications, some three or four times daily, will serve both to cleanse the wound and also to maintain vitality in the tissues immediately surrounding it. after each washing, the use of a strong antiseptic solution to the wound is again beneficial. in the case of an actual wound, whether, as in overreach, affecting the coronet alone or involving destruction of part of the wall, or, as in the case of toe-tread, penetrating the pedal articulation, the treatment to be followed is simple enough, in theory, if not always easy to carry out. it consists solely in maintaining a rigid asepsis of the parts until healing is well advanced or complete. the whole foot, including the coronet, should first be thoroughly washed in warm water. at the same time there should be used some agent that will tend to remove the natural grease of the parts. in this manner cleansing will be rendered more thorough, and penetration of the antiseptic solution to be afterwards applied made the more certain. the most ready way of effecting this is to use the ordinary stable 'water'-brush, and plenty of a freely-lathering soap. this done, the foot should be rinsed in cold water, and afterwards constantly soaked in a cold antiseptic bath. where it is inconvenient or impossible to have the constant bathing carried out, a dry antiseptic dressing may be tried in its stead. in this case the foot should first be thoroughly washed and dressed as before. afterwards an antiseptic powder in the shape of a mixture of iodoform part, boracic acid parts, should be freely dusted on the wound, a pledget of carbolized tow or cotton-wool placed over it, and the whole maintained in position with a bandage previously soaked in a in solution of perchloride of mercury. once on, this dressing should be allowed to remain until healing is complete. should the animal manifest pain, however, by constantly pawing, or should swelling and heat of the parts be suspected, the bandage should be removed, and the condition of the wound ascertained. an excellent example of the value of this method of treatment is that given below: 'i call to mind a valuable hunter in my practice a few seasons since, who, whilst hunting, we suppose, struck himself in the way we suggest. he not only removed the superior portion of the inner heel, but tore about inches of the hoof from the top nearly to the bottom. this was clapped back by the owner, tied with a handkerchief, and the horse removed home. when the handkerchief was removed, i confess i did not think the horse looked at all like hunting again. the heel was fairly pulled down, the portion of the hoof that was hanging to it i could easily have wrenched off. the parts were fomented, however, with warm water which was slightly carbolized. i then removed a great portion of the heel and the lateral cartilage, which was split; placed the portion of hoof again on the laminæ, smothered the wound with iodoform pulv., covered it with cotton-wool packing, and all the boracic acid i could get it to hold. a piece of linen bandage was then tightly wrapped a few times round, and the lot enclosed in a plaster-of-paris bandage. i did not undo it for a fortnight, when, to my great pleasure, the heel and hoof presented a highly satisfactory appearance. i did it up in much the same way for another ten days, then put the sand-crack clamps into the hoof and fixed it to the sound part. the hoof remained in position while the new horn grew from the top, and the horse hunted again the same season.'[a] [footnote a: _veterinary record_, vol. ix., p. (bower).] _sequels_.--either of the complications we have mentioned--as, for instance, arthritis, sand-crack, or quittor--may persist and remain as sequels to the case. in addition to these, there may be left behind a cavity in the horn of the wall (see fig. ), or a loss of the horn-substance of the wall proper, as that depicted in fig. , or described under the heading of false quarter. [illustration: fig. .--hoof with a cavity in the substance of the wall following upon 'tread' to the coronet.] the treatment of arthritis, sand-crack, quittor, false quarter, and seedy-toe, will be found in the chapters devoted to their consideration. . _chronic_. _definition_.--coronitis in which, owing to the persistence of the cause, inflammatory phenomena continue, resulting in the growth of large fibrous tumours about the coronet. _causes_.--in many cases it is possible, of course, that abnormal large growths in this position may have an origin similar to that of neoplasms elsewhere--that is to say, an origin as yet undiscovered. there is no doubt, however, that the majority of the huge enlargements about the coronet have their starting-point in one or other of the diseases to which the foot is liable, in which the cause remains, and a low type of inflammation persists. in chronic and neglected suppurating corn, in untreated quittor, and in long-standing complicated sand-crack, for instance, we have conditions in which pus and other septic matters find ready entrance into the subcoronary tissues. should either of these be neglected, or should the pus formation from the onset take on a slow but gradually spreading form (in other words, should either of these cases run a chronic rather than an acute course) then, with the persistence of the inflammatory phenomena so caused, is bound to result a steady and increasing growth of inflammatory fibrous connective tissue. this, as it grows, becomes in its turn penetrated by the ever-invading pus, and, under the stimulus thus caused, itself throws out new tissue. and so, constantly excited, the tumour-like mass tends to steady increase in size, until enlargements are formed which one may sometimes truly term enormous. _symptoms_.--the appearance of the growth is, of course, immediately evident. usually these swellings are slow in forming, so that the size of the enlargement depends entirely upon its age. we may thus meet with growths of this description, varying in weight from or pounds to the almost incredible size of - / pounds. in the majority of cases a discharging sore is to be found upon it--in some cases several. explored, these sores reveal their true nature. their lip-like openings, and the ready manner in which they may be searched by the probe, show them to be sinuses. in a few cases, however, the outer surface of these tumours is intact. when this is the case, it is possible that the growth is a true fibroma--that is to say, a non-inflammatory new growth of fibrous connective tissue. on the other hand, it may have resulted from one or other of the causes we have enumerated, and its exact diagnosis have been impossible until operative measures had been proceeded with. in this case, small and encysted foci of inspissated pus scattered more or less throughout the growth indicate its true nature. pain as a rule is absent, and, unless the growth, on account of its size, interferes with progress, the animal walks perfectly sound. here the patient may, without offending the dictates of humanity, be put to slow work. _treatment_.--in very many cases, possibly on account of the decreased circulation and vitality of the parts, these growths occur in aged animals. here treatment is not economic, and may for that reason be put out of the question. further, the growths are more common in heavy cart animals of a lymphatic type than in those of a lighter breed. couple this with the fact that the tumour is often unattended with pain, and we see that the animal is still able to perform his accustomed labour. here, again, treatment is contra-indicated. for still another reason surgical treatment, which is the only treatment likely to be of benefit, must not be undertaken rashly. a large and open wound is bound to be left behind. so large is it in many cases that the complete covering of the exposed surface with epidermal growths from the circumference cannot possibly be looked for. there is then left a large and horny-looking scar, which is an even worse eyesore than was the original enlargement. when the patient is a young and otherwise valuable animal, however, and when the case, judged either by the size of the swelling or its outside appearance, promises a fair measure of success, operative measures may be determined on. in this case the author's practice has been, after casting the animal, to apply a tourniquet to the limb and proceed to excision. a lozenge-shaped incision, extending to near but not quite the circumference of the swelling, should be made with a large knife right through the skin and deeply into the growth. the whole is then removed, proceeding in an excavating manner under the thickened skin at the margin. hæmorrhage, though proceeding from several apparently large vessels in the structure of the tumour, and oozing generally over the whole of the outer surface, is rarely profuse enough to interfere with the operation, and is easily controlled by cold water douches and the application of the artery forceps to one or more of the larger vessels. the operation completed, the larger bleeding-points should be secured by exerting torsion with the artery forceps, and the surface oozing stayed by frequent dashing with cold water. when the hæmorrhage has sufficiently ceased, an ordinary flat firing-iron should be passed over the whole of the cut surface, and an effectual eschar formed. following this, and _before removing the tourniquet_, the wound should be filled with pledgets of carbolized tow, and the whole tightly secured by a stout and broad linen bandage of not less than yards in length. _reported case_.--'the patient, a middle-aged cart mare, had a pair of fore-feet the like of which i never saw. as the result of long-standing and imperfectly-treated quittor all over the seat of side-bone on the outer side of each fore-foot, beginning pretty far forward, and extending to the heel on the inner side, filling up the hollow and reaching nearly to the fetlock, was a big, bulging, hard, calloused enlargement or tumour standing out or inches all round, covered with thick horny skin and stubby hair, and having on its surface the small openings of several sinuses leading deeply down to the ossified and diseased cartilage underneath. and yet with all this diseased undergrowth the mare, strangely enough, walked and trotted sound. i was told that this mare had been troubled with suppurating corns and quittor, that many unsuccessful attempts had been made at cure, but that, getting worse instead of better, these tumours had formed. 'after casting and anæsthetizing, a strong rubber tourniquet was placed above the knee and the operation commenced. with a surgeon's amputating knife all the big fibrous mass which i could safely remove was cut and sliced off, and the coronet and pastern reduced as nearly as possible to its natural dimensions. the diseased cartilage, or side-bone, gave some trouble, a considerable portion having to be cut and scraped, and the sinus in it gouged out; but its complete removal did not appear to be called for. 'there was little if any hæmorrhage until release of the tourniquet, when the whole broad surface became deluged with blood, three or four small arteries spurting and veins flowing in all directions, so much so that i was glad to reafix the clasp, and with the firing-iron seal up the vessels, searing gently all over the surface. [illustration: fig. .--chronic coronitis following 'tread.'] 'a good dusting with antiseptic powder, a thick pad of carbolized wool, and two long calico bandages wound tightly round, completed the work. 'the other, the near-leg, was then dealt with in the same way. 'the mass removed weighed a little over - / pounds-- pounds from the off-foot and - / pounds from the near. its structure was fibrous tissue, almost as firm and hard as cartilage, and with no appearance of malignancy. 'the after-treatment consisted simply of fresh dry dressings--copper, sulphate, zinc sulphate, and calamine, equal parts--applied every third or fourth day, after first bathing the feet in a shallow tub of warm antiseptic water. 'at the end of eight or ten weeks a fairly presentable appearance existed. the greater part of what had been raw surface was covered with healthy skin, and the remainder had become dry and horny.'[a] [footnote a: _veterinary record_, vol. xiv., p. (c. cunningham, m.r.c.v.s.).] a further form of chronic coronitis is that shown in fig. . this condition is commonly the result of a severe and jagged tread with the calkin, and takes the form of an ulcerous and excessively granulating wound. as time goes on the granulations become hard and horny-looking, and their fibrous tissue as hard and unyielding as tendon or cartilage. these if treated in the early stages with repeated dressings of caustic, or, if very exuberant, the use of the knife, usually yield to treatment. if neglected until the condition depicted in the figure is arrived at, then treatment, as a rule, is of no avail. neither is treatment of any use if any great loss of the coronary cushion has occurred. d. false quarter. _definition_.--false quarter is the term applied to that condition of the horn of the quarter in which, owing to disease or injury of the coronet, the wall is grown in a manner that is incomplete. _symptoms_.--this condition of the foot appears as a gap or shallow indentation, narrow or wide, in the thickness of the wall, with its length in the direction of the horn fibres. by this we do not mean that the sensitive laminæ are bared and exposed. horn of a sort there is, and with this the sensitive structures are covered. running down the centre of the incomplete horn is usually a narrow fissure marking the line of separation in the papillary layer of the coronary cushion, which, as we shall later see, is responsible for the malformation. on either side of the indentation, as if wishing to aid further than ordinarily it should in bearing the body-weight, the horn takes on an increased growth, and stands above the level of the horn surrounding it. it may, as perhaps it really is, be regarded as a form of hypertrophy, brought about by the increased work that the loss of substance in the region of the false quarter puts upon it. so long as the sensitive structures are protected the animal remains sound. sometimes, however, from the effects of concussion or of the body-weight, a fissure appears in the narrow veneer of horn that covers them. into this, which, of course, is but a form of sand-crack, gravel and dirt penetrate, and so set up inflammatory changes in the keratogenous membrane. as a result suppuration ensues, and the animal is lame. _causes_.--false quarter may result from any disease of the foot that involves destruction of a portion of the coronary cushion. as we may see from a reference to chapter iii., it is from the papillæ of this body that the horn tubules of the wall are secreted. destruction of any portion of it necessarily results in a corresponding loss of horn in that position. the disease occasioning this more often than any other is perhaps quittor. it may also result from suppurating corn, from a severe tread or overreach, or from the effects of a slowly progressing suppurating coronitis. _treatment_.--a radical treatment of false quarter is not to be found. once destruction of the secreting layer of the coronary cushion has occurred, the appearance of the fissure in the wall will always have to be reckoned with. a false quarter, therefore, not only renders the horse liable to occasional lameness, but also renders weaker that side of the hoof in which it occurs. the only method of treatment that can be practised, therefore, is that of palliation. seeing that the trouble the veterinary attendant will have to deal with is loss of a portion of the weight-bearing surface, his attention is immediately directed to the shoeing. as with sand-crack, so with false quarter, the frog and the bars must be called upon to take more of the body-weight than commonly they do with the ordinary shoe. the indication, then, is a bar shoe. at the same time, the bearing of the wall on the shoe on either side of the fissure should be eased by slightly paring it, and the hypertrophied horn on the outer surface of the wall removed with the rasp. in cases where penetration of the sensitive structures has occurred, complicated with the formation of pus, the same treatment as for complicated crack is to be followed. the foot should be poulticed for several days with hot antiseptic dressings, and thorough cleansing of the infected parted brought about. afterwards strong solutions of suitable antiseptics should be applied daily until such time as the horny covering has renewed itself. this done and the bar shoe applied, the fissure may be plugged with any effectual stopping. either a mixture, such as percival's, of pitch parts, tar part, and resin part, melted and mixed together, or one of the artificial hoof-horns may either be used with advantage. e. accidental tearing off of the entire hoof. _causes_.--seeing that this accident to, and consequent severe wounding of, the keratogenous membrane nearly always occurs in but one way, it is worthy of special mention. so far as we are able to ascertain, it is an accident peculiar to horses continually engaged in shunting operations either in pits or station-yards. at the moment the animal is released from the waggon he has been pulling, and should turn to the right or the left in order to allow it to pass him, the shoe either becomes wedged in between two converging rails, or is trapped by the wheel of the waggon. either the approaching waggon with the added weight its impetus gives it then pushes the animal suddenly away, leaving a part of his foot still fixed to the rails, or the animal himself, feeling securely held, makes a sudden effort to release himself, and draws his foot cleanly out of the imprisoned horny box. the author calls to mind a case in which entire removal of the horn of the foot of an ox occurred through the passing over it of the wheel of a heavily-laden cart. it is therefore quite conceivable that the same accident might occur to the horse. as a matter of fact, we find one case on record where one-half of the horny box was thus removed.[a] [footnote a: _veterinary record_, vol. xiii., p. .] so far as we are able to gather, it is more a result of imprisonment of the shoe than of the foot. it appears, further, to be always a result of the animal being newly shod, and the clinches firmly secured; so much so that it would be probable, with imperfectly secured clinches, that the animal would draw the hoof from the clinches and the shoe rather than the foot from its horny covering. therefore, as the author of one of the cases we shall afterwards relate suggests, it should be proposed as a preventive that the shoe-nails of animals regularly engaged in work on the metals should not be clinched in the regulation manner, but should have their points merely screwed off, and the nails afterwards rasped level with the wall. these cases are particularly interesting as illustrating the rapid manner in which a new hoof is afterwards formed, and the way in which the exposed sensitive laminæ take their share in adding to, though not forming the bulk of, the horn of the wall. from the cases we are able to record it will be seen that this accident need not be looked upon as fatal, nor the injury itself beyond hope of repair. dependent largely upon the temperament of the animal, the amount of pain that is caused, and the way in which the animal bears it, recovery may be looked for. even from the very commencement of the accident, however, the pain may be so acute and the animal so violent with it that slaughter becomes necessary. _treatment_.--this consists in applying an antiseptic and sedative dressing to the injured parts (for example, carbolized oil and tincture of opium, equal parts) and afterwards bandaging. from the only data we are able to work on, it appears that this dressing should be repeated daily, the bandage being removed, each time, the foot well bathed in warm water, and the dressing and bandage afterwards replaced. on first sight, it would appear that once cleansed and bandaged the dressings might be left _in situ_ for several days. seeing, however, that suppuration, if once set up, would add further to the intense pain the animal is already suffering, and considering the always constant exposure of the foot to infection, it is perhaps wise to persist in daily changing of the dressings. at the same time, the general health of the animal should be attended to. suitable febrifuges should be administered, either in the shape of a dose of physic, or salines and liq. ammonia. acetatis; and the pain, if appearing unbearable, allayed by doses of choral and hypodermic injections of morphia. _recorded cases_.-- . 'a short time ago i was called to see a horse which had had his hoof torn off in a railway "point." when i arrived at the stable the injury had been done two hours, and the horse had been led from the railway to a loose-box nearly half-a-mile off. on going to this box i was surprised and horrified to find the poor animal mad with pain, rolling and dashing himself about. when on his back he would struggle and kick the walls with the injured foot, as though unconscious of pain. not one moment was he still, and as i could see that the sensitive structures were much damaged by his violence, i obtained a gun and put him out of his pain. 'the accident happened in this way. the horse was employed in shunting coal-waggons, and had just drawn four loaded trucks up to a point at which they diverged to the left, and the horse, being unhooked, ought to have turned to the right. here, unfortunately, the near fore-foot became wedged in between two converging railway plates, one of which formed a part of the waggon-way, on which the trucks were running. the horse was a big animal, and freshly shod with heavy shoes, on which a toe-piece and calkins were used. the shoe was roughly but strongly nailed on with eight nails, the clinches of which were all firm. this shoe was fitted wide at the heels, and when the foot was fixed in the points (toe downwards) it protruded over the face of the rail. when the trucks reached it they pressed it down, and, the horse leaning forward, the hoof was drawn off like a glove. the hoof was almost as clean inside as if taken off by maceration--only towards the toe was a small portion of the coffin-bone and some torn laminæ left inside the hoof. 'as soon as possible after the accident, so i was told, the foot was bound up with tow and a bandage; then a sack was cut up and placed over all, and the horse slowly led to his loose-box. he "carried" the leg all the way, limping along on the three sound ones. almost immediately after reaching the box he lay down, but only for a short time. the standing position was not long maintained--profuse perspiration set in, and the alternations of position became more rapid and violent, till plunging and rolling were added to the other signs of excruciating pain. i was also told that the groaning of the poor animal was almost constant, and at times so loud and prolonged as to amount to a shriek. 'i have no experience of a similar case, and i should not have supposed that this accident would have caused such acute suffering and violent symptoms. i think i have heard of such cases making a complete recovery; but i feel sure that, in this case, i only anticipated death by, at most, a few hours.'[a] [footnote a: _veterinary record_, vol. iv., p. .] . 'the case i am about to give you an account of, being one of rare occurrence, i thought would not prove uninteresting to the members of the veterinary medical association. it is an instance of complete removal of the hoof by mechanical force. 'our patient was a brown mare, five years old, the property of messrs. crawshaw and co., railway contractors on the sheffield and manchester line. 'on june the mare was, as usual, working on the line, drawing one of the waggons for the removal of soil from one place to another, and, as was the custom, the pace is generally increased at about the distance of from sixty to eighty yards from where the unloading takes place, in order to add to the velocity, so that the contents of the waggons might roll down so great a precipice. it was at this increased action, when the mare was being removed from the waggon, that she stepped between the ends of two iron rails, sufficiently apart to admit the foot only, when one end of the rail inserted itself between the sole and toe of the shoe, the other at the top and in front of the crust. 'the mare, finding herself fixed, endeavoured to disengage herself, and, in doing so, got in front of the waggon, which, coming at a great pace, forced her down into the pit, leaving behind the off fore-hoof, which was only removed from its situation between the two rails by a large hammer, it being so firmly wedged in. the shoe and hoof were bent in a very peculiar manner, as the accompanying cuts will show, the inside heel being completely raised from above the level of the frog, not one of the nails being unclenched, or in the slightest degree having given way to so large an amount of force imposed upon them, although the toe of the shoe was raised from the sole by the rail being immediately under it (see fig. ). the mare had been shod the day before, and, having a good sound foot, the shoe was firmly put on. 'being a mile from home, she was with some difficulty made to travel that distance. on her arrival, my preceptor, mr. taylor, was immediately sent for, who found her, as i have before stated, with the off fore-foot hoofless. 'proceeding to examine the foot, he ascertained that it had bled considerably, which, however, was stopped by bandages to the foot and a ligature round the coronet. the laminæ on one side and a small portion of the sensitive sole, though not to any great extent, were lacerated. the coffin-bone was not at all injured. the bleeding having nearly ceased, she was put into slings, the foot carefully washed with warm water, and immediately bound up with pledgets of tow saturated with the simple tincture of myrrh and tincture of opium, of each equal parts. [illustration: fig. .--hoof torn from the foot by accident.] 'the dressing was ordered to be allowed to remain on all night, and on the following morning to be removed. the foot was then bathed, as before, in warm water, and the application of the tinctures repeated night and morning. the medicine internally given was castor oil, with tinct. opium, and this, in a diminished dose, was ordered the next morning. blood was also abstracted from the jugular vein, to the amount of quarts, so as to allay the inflammatory fever set up. the food consisted of bran and linseed, with small portions of hay and water. the mare being in a highly excited state, and suffering such severe pain, the opinion mr. taylor gave was that, should she get over the first four days (which appeared quite uncertain), he had no doubt of her ultimately getting well, and also that she would have a perfect hoof formed. it was now left for the owners' consideration, whether they thought the mare worth her keep till such took place, the time mentioned by mr. taylor being four or five months. she was seen again the fourth day after the accident, and was then found to be perfectly tranquil and feeding well; her pulse, which at the first visit could not be counted, was now not more than beats in the minute. on removing the dressings, the foot presented a very favourable appearance, the treatment therefore varied only in the application of a linseed-meal poultice over the former dressings of tinctures of opium and myrrh, confining the whole in a soft leather boot. diet as before, in addition to which give a few oats. should the bowels become constipated, repeat the castor oil without the opium. '_june_ .--the animal was again seen, and appeared to be going on very favourably. the poultices were directed to be discontinued, and the parts dressed every other day with sol. sulph. cupri, as the granulations were getting rather luxuriant. '_july_ .--to-day she was found to have gone on so well, having two days before been removed from the slings, that it was thought justifiable to turn her out, protecting the foot with a boot, and ordering the dressings to be repeated. '_july_ .--she was seen by me in the field, where i had the boot removed, and so much had she improved, that not less than inches of crust, proceeding from the coronary ring, had been formed, and the foot looked remarkably healthy. 'it will be seen that the accident occurred on june , a fortnight after which time i observed the horny crust to be forming from the coronet, and the insensitive laminæ at the same time, in which on every visit an increase of growth was perceptible, and it soon attained a thickness exceeding that of the other hoof, but which at the same time presented a more upright appearance. it was not until three weeks after our first visit that any formation of new sole or frog was to be seen. of the two the sole was the first, being secreted by the sensitive sole, the growth proceeding from the heels. in like manner the insensitive frog was being produced by the sensitive. [illustration: fig. .--hoof torn from the foot by accident.] 'during the last week in october the mare, having her foot protected with a bar shoe plated at the bottom, and so formed as to open without necessity of removing the shoe, in order to facilitate the applications of the tinctures, was put to light work, which has since been gradually increased, and she now performs her usual labour equal to any other horse. 'the growth of the wall or crust and insensitive laminæ is not yet quite complete, nor is the sole, there being wanting about an inch of the horny substance of it, the entire completion of which i should rather doubt, as i mentioned in my former communication that the sensitive laminæ and a small portion of the sole were lacerated, and it is in these parts that the imperfections exist. 'the yet imperfectly-formed wall not admitting of the insertion of nails all around it, the shoe is held on partly by nails and partly by a strap attached to it bound round the coronet.'[a] [footnote a: _veterinary record_, vol. iv., p. (b. cartledge).] . 'this case is related by mr. a. rogerson, f.r.c.v.s. it occurred to an animal regularly engaged in shunting, and happened through the corner of the shoe becoming "trapped" between a line of metal and the wheel of a truck. it is particularly interesting on account of the photograph accompanying it, and which we here reproduce in fig. . 'the photograph shows plainly the manner in which the holding of the "clinches" on the left side of the hoof has resulted in drawing it off from the foot. had these clinches, as mr. rogerson suggests, been left unfastened, then the accident in all probability would not have occurred. the animal was destroyed.'[a] [footnote a: _ibid_., vol. xiii., p. .] chapter ix inflammatory affections of the keratogenous apparatus a. acute. acute laminitis. _definition_.--the term 'laminitis' is used to indicate a spontaneous and diffuse inflammation of the whole of the sensitive structures of the foot, more particularly the sensitive laminæ. usually it occurs in the two front feet, often in all four, and occasionally in the hind alone. _causes_.--in dealing with the causes of laminitis, we will first dispose of those coming under the heading of _traumatic_. correctly speaking, however, lesions of the laminæ thus occurring do not present the same symptoms, nor run an identical course with the disease we now purpose describing, and for which we would prefer to entirely reserve the term 'laminitis.' the fact, however, that traumatic causes are detailed in other works on the same subject compels us to give them mention here. strictly traumatic causes giving rise to a limited inflammation of the sensitive laminæ are violent blows upon the foot, either purely accidental, or self-inflicted by violent kicking. a similar limited laminitis is to be found in the conditions we have described under 'nail-bound and punctured foot.' it is met with also in the injuries resulting from tread and overreach, and in the tissue-changes accompanying corn. the tenderness following upon excessive hammering in the forge, or of too long an application of the shoe in hot-fitting has also been described as laminitis. with either of the conditions we have mentioned, it goes without saying that there is either a simple congestion or an actual inflammation, localized or general, of the laminæ of the injured foot. in neither case, however, can the resulting mischief be closely compared with the lesions attending an attack of laminitis proper, a disease which appears to have an almost specific cause, and to run a course peculiarly its own. the specific cause we have indicated as existing can, in the present state of our knowledge, be only vaguely described as a poisoned state of the blood-stream. this, as clinical evidence teaches us, may result from a variety of causes. among these, by far the most common is that state of the circulation induced by excessive feeding with too stimulating or too irritating a diet. in any case, where the use of old oats as a staple diet is departed from, and where the quantity and manner of using the substitute is left to the discretion of careless or unskilled attendants, trouble is likely to ensue. the food more prone, perhaps, than any other to bring about an attack is wheat improperly prepared--that is, uncooked or unground. so much so is this the case that one full meal of this provender to an animal unused to it is sufficient to lead to a train of symptoms often ending fatally. beans, peas, barley, rye, new maize, or even new oats, are all liable, if carelessly used, to have the same effect. it is the laminitis following feeding on new oats that has caused us to apply to the food the adjective 'irritating.' here, more often than not, the peristaltic action of the bowels is found to be abnormally in evidence, and the excessive use of the diet is always accompanied by a more or less fluid discharge of the intestinal contents. in addition to the foods we have mentioned, many others might be enumerated, more especially the numerous 'made-up' feeding materials now on the market. many are composed of substances that may be regarded as absolutely opposed to the correct feeding of a horse, and their use can only be followed by this and other evil results. another most fruitful cause of laminitis is a severe and continued inflammatory condition of the system elsewhere. it is the laminitis known to veterinary surgeons as 'metastatic,' and perhaps the two most notable examples of it are the laminitis following a prolonged attack of pneumonia, and the 'parturient laminitis' occurring as a concomitant of septic metritis. parturient laminitis it is that offers us the most striking illustration of the truth that a poisoned state of the blood-stream is a sure factor in the causation of an attack. from the direct evidence of our senses (namely, manual exploration of the infected womb, and the stench of the exuding discharge) we know that we have in the interior of the womb matter in a state of putrescence. from the experience of previous post-mortems we know, further, that the putrescent matter thus originating often gains the blood-stream, and forms foci of septic lesions elsewhere--liver or lung. when, therefore, during an attack of septic metritis a condition of laminitis supervenes, we are justified in attributing it to the escape of septic matter from the already infected uterus. in the same category of laminitis from metastasis may also be placed the laminitis occurring as a result of an overdose of aloes. the enteritis thus set up is often followed by laminitis, and that of a serious type. prolonged and excessive work upon a hard road is also apt to induce an attack. when this occurs it in many cases resolves itself into a case of cruelty. (see reported case, no. , p. .) laminitis from this cause was frequent among coach and carriage horses in the pre-railroad period, and resulted from attempting to obtain from the animal a faster pace and a greater number of miles than he was physically capable of giving. in our day, however, it is more often a result of gross feeding, combined with only that amount of work which the horse, if ordinarily fed, would be easily able to perform. an excellent example of this is the laminitis occurring in the shire stallion when commencing his rounds of service in the spring and early summer. at this season these animals are constantly supplied with a more than sufficient supply of a highly stimulating and nutritious diet. in this case the blood is already in that state in which it is predisposed to the disease. add to this the unwonted exercise--for during all the winter the animals are idle--and congestion of the venous apparatus of the extremities is not to be wondered at. passing from these, the more common, we may consider other and less frequent causes of the disease. congestion of the laminal blood-vessels and consequent laminitis occurs when animals are made to maintain a standing position for prolonged periods, as, for instance, when making sea voyages. a long and painful disease of one foot, necessitating the whole of the weight being borne by the other, ends often in laminitis of the second member. it may thus occur as a sequel to quittor, complicated sand-crack, suppurating corn, and punctured wounds of the feet. laminitis has also been known to occur as a result of septic infection of the blood-stream consequent on the operation of castration. (see recorded case, no. , p. .) a sudden lowering of the surface circulation at a time when the animal is excessively perspiring is also said to favour an attack, as also is the giving to drink of cold water to an animal just in from a long and tiring journey. also, according to zundel, 'the influence of the season cannot be denied, and it is during the summer months that laminitis is more frequent, while it is rare in winter, as well as in the spring and autumn.' further, laminitis has been described as occurring when the animal is at grass, and when all causes--at any rate, active ones--have appeared to be absent. (see reported case, no. , p. .) regarding heredity, we may safely say that, as a cause of laminitis, it may be almost totally disregarded. that a bad form of foot, either a flat-foot or a foot with heels contracted, and already thus affected with a mild type of inflammation, did not offer a certain predisposition, we should not like to assert. there must, however, be an exciting cause--namely, a poisoned condition of the blood-stream. this latter cannot, of course, be in any way regarded as hereditary. in short, the dietetic cause is by far the most common, and, in prosecuting inquiries as to the starting-point of an attack, the veterinarian's attention should be directed in the main to that particular. _symptoms_.--laminitis is always ushered in by a set of symptoms indicative of a high state of fever. the pulse is raised from the normal to as many as or a minute, muscular tremors are in evidence, the respirations are short and hurried, and the temperature rises to °, °, or ° f. the visible mucous membranes are injected, that of the eye, in addition to the hyperæmia, often tinged a dirty yellow. the mouth is dry and hot, the urine scanty, and the bowels frequently torpid. as yet, however, the walk is sound. called in during this early stage, the veterinarian is often puzzled as to the exact significance of the symptoms. enteritis, lymphangitis, or pneumonia he knows to be often heralded in the same manner. in this connection, zundel says: 'laminitis, in most instances, is preceded by certain general symptoms, such as are premonitory of the invasions of ordinary inflammatory diseases, but of an uncertain significance.' so far we agree with him, but to what we have already said we would add that, even in this early stage, there is an additional symptom, unmentioned by zundel, which often leads one to an exact diagnosis. the feet are in turn lifted a short distance from the ground, and almost immediately replaced. this movement ('paddling,' we may term it) is constant, the animal appearing to obtain ease in no one position for more than a few moments at a time. seen but a few hours later, when the swelling caused by the hyperæmia and outpouring of the inflammatory exudate has led to compression of the sensitive structures within the horny box, the symptoms presented admit of no misreading, save by the most casual and careless observer. the patient now stands as though fixed to the ground. the pulse is hard and frequent, the respirations tremendously increased in number, the body wet with a patchy perspiration, and the countenance indicative of the most acute suffering. only with difficulty, and often only at the instigation of the whip, can the animal be induced to move. this he does by throwing his weight, so far as he is able, on to the heels of the feet affected, and putting the feet slowly forward in a shuffling and feeling manner. the feet themselves give to the hand a sensation of abnormal heat, percussion upon them with the hammer is followed by painful attempts at withdrawal, while any effort we may make to remove one foot from the ground is useless, so great an aversion does the animal show to placing a greater weight upon the opposite foot. according as the front-feet alone, the hind-feet alone, or all four feet are affected, the symptoms will vary. with all four feet diseased, the animal stands with the two front-feet extended in front of him, while the hind-limbs are at the same time propped as far beneath him as is possible. the horse is, in fact, standing upon the extreme hindermost portions of the feet. why the animal should thus distribute his weight is easily explained. standing in the normal position, the body-weight is borne by the sensitive laminæ, the sole, of course, sharing in the burden, but the laminæ taking by far the greater part of the pressure thus exerted. with the vessels of the laminæ gorged with blood, and the laminal connective tissue infiltrated with a profuse inflammatory exudate, the most excruciating pain is bound to result by reason of the compression of the diseased tissues within the non-yielding structures. in some little measure the suffering animal may afford himself relief by partly removing pressure from the fore-parts of the hoof. when placing the body-weight behind, the pressure, instead of falling upon the highly sensitive laminæ, is directed to the follicular and fatty tissues of the plantar cushion: from there, with only a small portion of the sensitive sole intervening, to the horny frog, and from thence to the ground. the same distribution of weight also places the foot in a position of greatest expansion, thus, by giving greater room to the diseased parts, again affording relief of pressure on the inflamed lamina, while it at the same time relieves of weight the foremost portions of the sensitive sole. with the fore-feet alone attacked, the animal affects exactly the same position of standing as that just described. the fore-feet are again extended, and the hind propped far beneath him. the fore extended, in order to obtain the relief occasioned by standing on the heels; the hind in this case carried forward in order to take a greater share of the body-weight, and thus relieve the congested members in front. with the hind only attacked, then the fore and the hind feet are more closely approximated than in the normal position. the reason, of course, is that the hind-feet are carried forward in order to be placed upon the heels, while the fore are taken backwards to relieve the hind of the body-weight. in like manner the movements of the animal will vary with the feet affected. with only the front-feet diseased the animal is, comparatively speaking, comfortable. the hind-feet take the weight, and the animal stands for long periods together, resting alternately first one fore-foot and then the other, moving often in a circle of which his body is the radius, and his hind-limbs the centre. if urged to move forward, then immediately his countenance and movements manifest the pain to which he is put. only with reluctance does he cause the fore-feet to take weight. they are shuffled forward quickly one after the other, so that weight may not be placed upon them for one instant longer than is necessary, and the hind-limbs immediately brought again with two short, awkward movements beneath the body. progress thus takes place in a succession of movements 'half hobble,' 'half jump.' painful though this may appear, progress is still more difficult when the hind-feet alone are diseased. afraid that, in placing his fore-members freely forward, he will add to the pain in his hind, the walk takes place in a series of extremely short steps, with the feet more or less closely approximated. the gait is thus rendered extremely awkward, and zundel, by saying that 'the animal appears as if treading on sharp needles,' most fitly describes it. movement with all four feet affected, though less awkward in appearance, is doubtless more painful than in either of the other conditions. here the animal can hardly be induced to shift his position at all. only by flogging, and that severe, can he be made to go forward. when so induced to move, the agonizing pain to which the patient is subjected may be gathered by noting his countenance and manner of progression. with each movement forward, muscular tremors affect the limbs; each step is short, jerky, and convulsive; the respirations and pulse are almost immediately greatly quickened, and the lower lip is hung pendulous, and moved almost unconsciously up and down with a flapping noise against the upper. a patchy perspiration breaks out about the body and quarters, and the tail is outstretched and quivering. at the same time the lines of the face become drawn, the commissures of the lips pulled upwards, the eyes staring and haggard, the eyelids puckered, the nostrils extended, and the whole expression indicative of the intense and agonizing pain of the disease. one can perhaps better give one's client some vague idea of the patient's suffering by likening the pain to the throbbing sensation of a festered finger-nail. tell him that each hoof of the horse is similarly, or, if anything, more delicately, constructed, that in each foot the same process of 'festering' is going on, and that upon them the animal has perforce to stand. as one might expect, the position of greatest ease is the decumbent. strange to say, though, in many cases of laminitis the animal persists in maintaining a standing posture. once down, however, one has sometimes the greatest difficulty in persuading him again to rise. the lying position is so long maintained that bedsores begin to make their appearance, and the animal rapidly loses flesh, not only by reason of the fever and the pain, but by giving to rest the time he should normally give to feeding. difficulty in rising is greatest when all four feet are affected; is _nearly_ as great when the hind-limbs only are in trouble, but is least when the disease exists alone in the two fore-feet. the course of the disease and its pathological anatomy.--as with most inflammations of any severity, so with this we may consider the pathological changes taking place in the foot under three headings: (a) the period of congestion; (b) the period of exudation; (c) the period of suppuration. (a) _congestion_.--in the early stages of laminitis there is a state of engorgement of the vessels of the keratogenous apparatus generally, but more particularly the laminal portion of it. with the hoof removed at this stage the sensitive laminæ are found to be swollen, dark red in colour, and affording a distinct feeling of increased thickness when pressed between the fingers, incised, there escapes from the cut surface a large flow of dark venous-looking blood. at this stage hæmorrhages of the laminal vessels occur. the escaping blood infiltrates the surrounding connective tissue, and in many cases destroys the union between the horny and sensitive laminæ. this change is most noticeable in the region of the toe and the commencement of the quarters, the os pedis appearing as though pushed backwards by the escaping fluid collected between the wall and the bone. in severe cases, fortunately but rarely seen, the blood so escaping continues to infiltrate, and separate the tissues until it is seen to be freely oozing at the region of the coronet. (see reported case, no. , p. .) (b) _exudation_.--the period of exudation marks the outpouring of the inflammatory fluid. this, even more than the hæmorrhages attending the stage of congestion, tends to destroy the intimacy between the sensitive and the horny laminæ, leading finally to their complete separation at the region of the toe. fig. illustrates this state of affairs after laminitis has existed for a week. the sensitive and horny laminæ are here shown to be distinctly separated from each other, a well-marked cavity existing between them, which cavity is greatest in extent at the toe of the os pedis. with the sensitive structures thus detached from the wall, it is evident that very much that formerly held the os pedis in normal position has been destroyed. what then happens is that the whole of the body-weight is placed upon the sole. never intended to bear the strain thus imposed, it naturally sinks. with the sinking is a corresponding 'dropping' of the pedal bone--in fact, of the whole of the bony column. seeing that the structures _above_ the hoof are still normally adherent to the bones, it follows that they must, as the os pedis sinks, be carried with it. as a consequence we get a marked depression at the coronet (see fig. , _a_), which depression may be often noticed after the second or third week of a severe attack of the disease. [illustration: fig. .--longitudinal section of a foot with laminitis of eight days' standing. the separation between the sensitive structures and the hoof is indicated by a dark line. the cavity is filled with exudate. it will be noted that as yet there is little change in the position of the os pedis.] here, again, though to a greater extent than that caused by the hæmorrhage alone, the os pedis appears to be pushed backwards, the space at the toe between the bone and the horny box being closely filled with the yellow, slightly blood-stained exudate. this condition is well depicted in fig. . [illustration: fig. .--longitudinal section of a foot with laminitis of fourteen days' standing. _a_, the depression at the coronet caused by the dropping of the bony column within the horny-box: _b_, a portion of the sensitive sole pushed downwards and forwards by the descending os pedis.] with the descent of the os pedis we get in many cases a penetration of the horny sole (see fig. ), leading always to serious displacement of the sensitive sole (see fig. , _b_), and often to caries of the exposed bone. the backward displacement of the os pedis may be accounted for in two ways. firstly, the greater vascularity of the membrane covering its front leads to a greater outpouring of inflammatory fluid in that particular position. here, therefore, loss of adhesion with the wall is greatest, while into the cavity so formed is poured a large quantity of a fluid that is practically incompressible. the os pedis _must_ be pushed backwards. secondly, the manner in which the animal distributes his weight--namely, upon the heels--is calculated to aid in the bone's backward movement, for with his feet in this position tension upon the extensor pedis is relaxed, while that upon the flexor perforans is greatly increased. (c) _suppuration_.--should the animal survive the pain and exhausting calls made upon his system by the accompanying fever of the foregoing conditions, the case ends either in resolution or suppuration. when suppuration occurs it is found, as a rule, at the sole, leading to almost entire separation of the sensitive and horny structures. the pain, if possible, is even worse than in either of the foregoing stages, and relief for the suffering patient is only obtainable by the natural exit of the pus at the coronet, or by giving it escape with the knife at the sole. as a rule, suppuration in laminitis is rare, and then only occurs when the disease has been of some several days' duration. it has been the author's experience, however, to meet with it in a case but three days' old. this particular animal had laminitis restricted to the hind-feet. the condition was diagnosed and pus liberated at the sole of one foot during the third day of the lameness. the animal was cast on the fourth day, and pus obtained from the sole of the opposite foot. _complications_.--in a moderate case, carefully treated, laminitis terminates at the end of three or four days in resolution. the general symptoms of fever gradually subside, the appetite returns, and the walk becomes easier. cases thus terminating fortunately leave behind them no change of serious importance, either in the sensitive tissues or in the horny envelope. should resolution, however, be longer delayed, then the case, although eventually terminating successfully so far as soundness in gait is concerned, leaves more or less evidence behind in the shape of rings about the wall and alterations in the build of the sole. when the happy ending of rapid resolution is denied us, then, in addition to the condition we have described as suppuration, we may meet with one or other of the following complications: _(a) metastatic pneumonia_.--this complication is not uncommon, and, when occurring, more often than not ends fatally. it may be accounted for indirectly by the greater work the lungs are called upon to perform in carrying out the increased number of respirations occasioned by the general fever and pain, and directly by the poisonous materials circulating in the blood-stream. _(b) metastatic colic_.--this may be either a subacute obstruction of the bowel or an enteritis accompanied by an offensive purge. a striking case of the former is related in the _veterinary journal_ (vol. xvi., p. ) by h. thompson, of aspatria. here no evacuation of the bowels occurred for three days, and the pains of laminitis were added to by the usual pains of intestinal obstruction. the colic of enteritis is in some cases caused by the nature of the food, giving rise to laminitis. in our opinion, however, it is more often occasioned by the drastic action of the aloes nearly always resorted to in the treatment of the disorder. as does the pneumonia, the enteritis thus brought about nearly always has a fatal termination. _(c) gangrene of the structures within the hoof_.--this complication is the one most to be dreaded. it occurs as a result of the great pressure exerted by an excessive exudation, and doubtless affects first the laminæ and softer structures. once commenced, however, it rapidly extends to death of the other structures (ligament, tendon, and even bone), and gives a fatal ending to the case. that gangrene of the tissues ("mortification" as our older writers called it) has occurred is soon made evident to the veterinarian by the symptoms shown by the patient. the agonizingly acute pains suddenly subside, the feet are placed firmly and squarely to the ground, and the animal walks with ease. perhaps but the night before the patient is seen racked with excruciating pain; the morning sees the astounding change of apparent absolute recovery. too well, however, the eye of the experienced veterinary surgeon sees that such is not the case. even before proceeding to take a record of the other symptoms, he knows that it is but the commencement of the end. methodically, however, he notes the other conditions. the pulse he finds small and imperceptible, save at the radial. the thermometer registers a subnormal temperature, the extremities are cold, and cold sweats bedew the body. to the same experienced eye the countenance of the animal is almost suggestive of what has occurred. the drawn and haggard expression, to which we have previously referred, becomes more marked, and the angles of the lips are drawn back in what has been described by some writers as a 'sardonic' grin. we can best express what the whole look of the animal's countenance indicates to us by saying that it gives us the impression that the animal himself knows that some serious change, and a change fatally inimical to his chances of life, has taken place in his feet. it may be that in some odd cases, although it has not yet been our lot to meet with them, gangrene may terminate in the casting off of one or more hoofs. needless to say, there can still be but one termination to the case. _(d) periostitis and ostitis_.--this complication is referred to by other writers under the term of 'peditis.' it signifies, of course, that the periosteum and the bone have become invaded by the inflammatory process. it is our opinion that these two conditions, even including an actual arthritis, always exist, even in an attack of laminitis that ends favourably. we do not claim, however, to be able to relate any means, save that of post-mortem examination, by which it may be singled out from the other changes occurring in the foot. the high fever and pain occasioned by the inroads of the inflammation into the other sensitive structures serves to effectually mask whatever evidence of it we might otherwise obtain. it may be sometimes only small in degree, but we feel confident that inflammation, at any rate of the _outer_ layer of the periosteum, is in laminitis constant even, we repeat, in a mild case. [illustration: fig. .--showing changes in the os pedis with laminitis of long standing, (_a_, viewed from the front; _b_, viewed from the side.) the porous condition of the bone, which is here shown, is a result of a rarefying or rarefactive ostitis. this specimen also illustrated (what the photograph cannot show) an accompanying condition of condensation of bone, or osteoplastic ostitis. (for a fuller description of the changes occurring in these forms of ostitis, see chapter xi.)] when the case is a serious one we have ample evidence to show that ostitis exists, and exists in a severe form. the bones become vastly altered in shape, a process of absorption leads to the formation of large, irregular cavities within their substance, and what of the bone is left is rendered hard and ivory-like (condensed) near what was the original centre, while the edges and other portions show often a tendency to become brittle and porous. fig. illustrates the effects of a severe ostitis in pedal bones removed from hoofs with laminitis of several weeks' standing. _(e) chronic laminitis_.--the most common complication--or, perhaps, rather we should term it 'sequel'--to acute laminitis is the chronic form of the disease. for this condition we have reserved a separate section of our work. it will be found described in section b of this chapter. _diagnosis and prognosis_.--one is almost tempted to state that the diagnosis of laminitis offers no difficulty. in the very early stages, however, it may, as we have already indicated, be mistaken for the oncoming of enteritis, lymphangitis, or even pneumonia. the paddling of the feet may help us. if this is absent, however, nothing but a most careful examination, or, if necessary, the withholding of our opinion until the following visit will prevent a blunder being made. even when well established, laminitis has been mistaken for paralysis, for tetanus, for rheumatic affections of the loins, or even for some undiscovered affection of the muscles of the arms and chest. this latter is no doubt suggested to the uninitiated by the reluctance the animal shows to move the muscles _apparently_ of that region, and led the older writers to give to the disease its name of 'chest-founder.' it is only fair to add, however, that these blunders in diagnosis are nearly always committed by persons without a veterinary training. thus warned, the veterinary surgeon of average ability should have no difficulty in establishing a distinction between the diseases we have enumerated as likely to be confounded with it, and the one this chapter is describing. the prognosis in laminitis should, in our opinion, always be guarded. no advice given in a work of this description can be of any real use, for every case must be judged entirely on its merits. the severity of the symptoms, the cause of the attack, the complications, and the idiosyncrasies of the patient, have all to be taken into account. these the veterinarian must be left to judge for himself. _treatment_.--the treatment of acute laminitis in its early stage must be based upon the fact that we have to deal with a congested state of the circulatory apparatus of the whole of the keratogenous membrane. this fact was well enough known to the older veterinarians. it is not surprising, therefore, to learn that jugular phlebotomy was at once resorted to as the readiest means of relieving the overcharged vessels of their blood. as a matter of fact, bleeding from the jugular is still advocated by modern authorities. we cannot say, however, that we unhesitatingly recommend it. mechanically, of course, the removal of a large quantity of blood is bound to result in a lowering of the pressure in the vessels. the effect, however, is but transient. blood removed in this way is again quickly returned to the vessels so far as its fluid matter is concerned, and the pressure, removed for a time, is again as great as before. with the other and more vital constituents of the blood-stream--namely, the corpuscles--restoration is not so rapid. we have, in fact, a weakened state of the system, in which it is probable it will not so successfully combat the adverse conditions the disease may induce. with these prefatory remarks, we may advise bleeding under certain conditions. the quantity removed must be moderate ( to pints), and the pulse and other conditions must show no signs of weakness or collapse. local bleeding, either from the toe or the coronet, is also advised. in the former situation the sole is thinned down until a sufficient flow is obtained, while at the coronet scarification is the method adopted. bleeding locally, however, is far less effectual than the jugular operation. neither must it be forgotten that wounds in these situations, more particularly at the toe, are extremely liable, especially with the existing poisoned state of the blood-current, to take on a septic character. what might possibly have remained a comparatively simple inflammation is induced by the operation itself to terminate in the more complicated and serious condition of suppuration. other means of combating the congested state of the membrane are principally those of local applications. with many veterinary surgeons warm poulticing is still largely advocated and practised. we do not believe in it. warmth, as a means of removing local congestion, can only be successful when applied _widely_ round the congested area, and so dilating surrounding bloodvessels and lymphatics. applied to the congested area itself, and to that alone, it is almost worse than useless. with the foot, both around and below it, a surrounding area is denied us. the only vessels we are able to dilate with the warmth, and so enable them to carry off the fluid from the congested foot, are those in the limb above. that poulticing cannot be successfully there applied is self-evident. apart from that, it is an open question whether poultices may not do actual harm in inducing suppuration in cases where, probably, it would not otherwise occur. for these reasons we hold to the opinion that when a local application is determined on it should be a cold one. various methods of applying cold are in vogue. cold swabs are perhaps most in favour. they must, however, be _kept_ cold. when a suitable water-course, pond, or other expanse of shallow water is at hand, then the animal may be kept standing therein, or preferably walked about in it. when suitable apparatus is obtainable, a constant stream over each foot from a rubber hosepipe is most beneficial. astringent baths, containing solutions of alum, of copper sulphate, of iron sulphate, or of common salt, or composed of a mixture of two or more of the salts mentioned, may also be used with advantage. in addition to the fact that such solutions are for a time below the temperature of simple water, we have the advantage that they have also a more or less antiseptic property. while on the subject of the relief of the congestion, we must not forget to mention a treatment which we ourselves have practised with considerable success--namely, that of forced exercise. it appears to have been first brought into prominence by mr. broad, of bath, and the two terms 'forced exercise and rocker shoes' and 'broad's treatment' have come to be synonymous. the broad shoe is a shoe with a web of quite twice the thickness of the animal's ordinary shoe, and has this web gradually thinned from the toe backwards until at the heels the shoe is at its thinnest (see fig. ). the excessive thickness of the shoe serves two purposes. it allows of the requisite amount of slope being given to the web, and so enables the animal readily to throw himself back on to his heels, a position in which, as we have already indicated, he obtains the greatest ease. it also minimizes to some extent the effects of concussion. [illustration: fig. .--seated rocker bar shoe (broad's) for treatment of laminitis.] with forced exercise, as practised by mr. broad, this shoe is first applied, and the animal afterwards made to walk upon soft ground, or even upon the roadway, for a half an hour to an hour and a half three times a day. for our own part, we consider the shoe to be almost if not quite superfluous, so far as its influence upon the progress of the disease is concerned. we therefore dispense with it, and have the animal exercised in his ordinary shoes. to do this, the patient has sometimes to be severely flogged into taking the first few steps. after that progress gradually becomes easier. it has been said to be cruel. in so far as we knowingly, and of set purpose, occasion the animal pain, cruel it undoubtedly is; but it is cruelty with an aim that is truly benevolent, and the object of our benevolence is the animal upon whom the cruelty is practised. one word of advice is needed. the forced exercise must be commenced early. in the later stages, when the stage of congestion has passed from that to the acuter stages of the inflammation and the outpouring of the inflammatory exudate, then forced exercise cannot be safely commenced. the loss of adhesion between the pedal bone and the horny box, which we know to be then existent, negatives its advisability. by many it is advised to always remove the shoes. from what we have already said, it will be seen that this is not our practice. but one argument in favour of so doing appears to us to carry weight, and that is that 'dropping' of the sole is probably prevented from becoming so marked. that condition, however, is entirely dependent upon the changes occurring within the horny box. it is bound to occur with the animal shod or unshod, and to reach a stage when only contact with the ground prevents its further descent. the complication then sometimes following--namely, penetration of the sole by the bone, is not prevented by having the shoes removed. it may, in fact, be thus rendered more likely. internal treatment consists in the exhibition of suitable febrifuges and the administration of a dose of aloes. with regard to the wisdom of the latter proceeding, opinion seems to be divided. personally, we hold an open mind concerning it. this much is certain: in many cases of laminitis--those cases which have their origin in overfeeding with an irritating food--there is already a strong predisposition to enteritis. the administration of aloes in this case is extremely apt to induce a fatal super-purgation. aloes is, again, contra-indicated when the laminitis is a result of excessively long journeys, and the patient is already greatly exhausted. neither can it be advocated in the laminitis occurring as a sequel to septic metritis or to pneumonia. on the other hand, when the disease has occurred as a result of long standing in the stable and an overloaded condition of the bowels, or where one full meal of some constipating food, such as whole wheat, pea or bean meal, wheat or barley meal, has occasioned the attack, then a dose of aloes at the commencement of the treatment is productive of good. suitable febrifuges are found in potassium nitrate, potassium chlorate, sodium sulphate, or magnesium sulphate, either of which or a mixture of two or more of them, the animal will readily take in his drinking-water. the administration of sedatives is also indicated. in this connection aconite will be found most useful. more especially in the early stages of the disease, when pain is excessive and the temperature high, will its good effects be noticed. this also the animal will often take in his drinking-water. we have been in the habit of so prescribing the b.p. tincture in / -dram doses three times daily. by its use the temperature is rapidly lowered, the pulse reduced in number and in fulness, and the pain in some instances perceptibly diminished. with others hypodermic injections of morphia and atropine have given equally satisfactory results. needless to say, good nursing is a _sine quâ non_. during the first stages of the fever a light and easily digested diet should be allowed--bran-mashes, roots and grass when obtainable, and a carefully regulated supply of water. the animal should be warmly clothed and the box well ventilated, even to the opening of the doors and windows. only in this way is pneumonia as a sequel sometimes prevented. the patient's comfort should be attended to in providing him with a suitable bed. anything in the shape of long litter should be avoided. when nothing else is at hand, litter that has already been broken and shortened by previous use is best. with this the box floor should be thickly covered, and matting of the material prevented by constant turning. a good bed for the horse with laminitis is peat-moss mixed with short straw. this, without being dragged into irregular heaps, remains springy and elastic with but little attention. better than all, however, especially with good weather, is an open crewyard. here the animal has an abundance of fresh air, has a bed that is always soft, and has plenty of room in which to get up and down with some degree of ease. leaving the dietetic and medicinal, we may consider other treatments of laminitis that come more particularly under the heading of operative. the first matter that here demands our attention is that of allowing the exudate to escape at the sole. if after the expiration of three or four days pain and other symptoms of distress continue, then it may be judged that the inflammatory exudate has made its appearance. operative measures allowing of its escape, though not giving absolute ease, do undoubtedly relieve the more marked expressions of suffering, and should be at once determined on. to do this completely it is necessary to cast the animal. the sole is then thinned at the toe with the drawing-knife until the sensitive structures are reached. a flow of yellow and sometimes blood-stained discharge is immediately obtained, and the sole itself found to be underrun to a considerable extent. an opening sufficiently large to admit of free drainage (about the size of a half a crown-piece) is made, the wounds antiseptically dressed, and the hobbles removed. if showing an inclination to do so, the animal should then be allowed to remain and rest. in one instance in which we so operated (a case of laminitis in the hind-feet alone), the relief given was at once manifested. for three days previously the animal had remained standing in agonizing pain. on the fourth he was cast, and the discharge--partly inflammatory exudate, and partly a sanious foetid pus--liberated. the hobbles were removed, and the animal allowed to remain down while our attention was drawn to another case. this attended to, we walked back to the field where, our first patient was lying. his breathing, but a short time before distressedly short and catching, was now so slow and deeply regular that for one brief moment the thought flashed across our mind that he was dead. he was in a _profound_ sleep. other operators sometimes give the exudate escape while making the grooves in what is now known as 'smith's operation.' in this operation the hoof is so grooved as to allow of its expansion, so relieving the pressure on the sensitive structures within it. incidentally, the inflammatory exudate is given exit. [illustration: fig. .--diagram of hoof showing the position of the three grooves made in the treatment of laminitis.] the animal is cast, the shoes removed, and three vertical grooves made in the wall. the first is cut down the centre of toe, extending from the coronet to the ground surface. the second is made to the right of this, and the third to the left, each following the direction of the horn fibres, and each distant about inches from the first (see , , and , fig. ). each of the grooves must run completely from the coronary margin to the ground surface, and each should be carried through the substance of the horn until the horny laminæ are reached. this done, the underneath surface of the foot is grooved at the white line (see curved groove , fig. ) in such a manner as to entirely isolate the two pieces of horn _a_ and _b_ from the remainder of the hoof. expansion of the horny box is thus brought about, while at the same time the semicircular groove at the toe is made deep enough to allow of the escape of the exudate. if thought wise by the operator, the two pieces of horn _a_ and _b_ may be isolated, and the exudate given exit by making the fourth groove in the position of the dotted lines in fig. --that is to say, at the lowermost portion of the sensitive structures. by this means the sole will be left intact. [illustration: fig. .--lower surface of foot showing position of the grooves made in the treatment of laminitis.] fuller instruction for making the grooves and the instruments required will be found described in section c of chapter x. the animal should be afterwards shod, and the bearing on the portions _a_ and _b_ of the wall removed. almost immediate relief is afforded the patient. _recorded cases_.-- . 'on the evening of september last, i was called rather hurriedly to attend a posting-horse which had just arrived from a twenty-one miles' journey, and was said to be "very ill." i lost no time in proceeding to the spot, and found my patient "very ill" indeed. no need for long consideration as to diagnosis; the symptoms showed at once that i had an uncommonly severe case of acute founder before me. on examination i found the pulse was , the respirations , and the thermometer ° f. the poor brute could not move, the fore-legs were well out before, and the hind-legs thrown back behind; in fact, he was, as one might say, propping himself up with his four legs! 'on examining his feet, i discovered what i had never either seen or heard of before--namely, _blood freely oozing out_ at the coronet of all four feet; if anything, the hind-feet were the worst, and, showing that this bloody discharge at coronets had commenced during progression and before he was stabled, the inside of the thighs were all shotted over with blood, which had been thrown up by his feet while he was trotting or walking. he was completely soaked all over with perspiration. 'my prognosis could not well be otherwise than unsatisfactory. i resolved, however, to do all i could to relieve the poor suffering brute. as a matter of course, jugular phlebotomy was utterly impracticable; so, to relieve the pressure in the feet, i had him (after, with extreme difficulty, removing the shoes) bled, or rather opened, at all four toes, and hot poultices applied. on opening the off-side toe, in both hind and fore feet, i found an escape of very dark-coloured blood, with a great many bubbles of gas, thus showing that the destructive process was fairly established in the two bony extremities mentioned. the near fore and near hind feet showed no signs of gas-bubbles on being opened at the toe. 'i gave a laxative in combination with a diffusible stimulant, and ordered doses of aconite and potassium iodide; i also applied strong sinapisms to each side, immediately behind the shoulders. after three hours i found my patient rather easier; respiration about , and temperature °; willing to take a little water, and even attempted to take some hay. ordered continued applications of hot water to the poultices at feet, and clothed him up for the night. next morning there was little improvement; respirations over , and temperature . °. continue same treatment. second morning, horse apparently easier; temperature . °, but very difficult respiration; laxative had operated during the night; ordered diffusible stimulants. about two hours and a half after my last visit, the horse turned round in his stall and dropped down dead! '_history of the horse_.--he belonged to an extensive horse-hiring establishment; was purchased a short time before for £ --a long price for a post-horse--had recently suffered and been off work from some "severe cold"; was taken out, and did forty-seven miles of a journey the day _before_ i saw him; on forenoon of the day on which he was attacked he did two or three short turns, and then twenty-one miles of a journey in the afternoon, during which he became so ill as scarcely to be able to conclude the twenty-one miles; this was the last turn he was to do. he was a grand stepper, and no doubt was pushed a little during this final journey, as the driver intended, after a short rest, to finish off with the twenty-six miles between this and home. with the short turns on the second forenoon, this would have been over miles in less than two days, with a horse just out of a _severe cold_.'[a] [footnote a: _veterinary journal_, vol. xvii., p. (a.e. macgillivray).] . 'whilst attending a patient on a farm on september last my attention was called to a cart-horse, five years of age, that had been castrated in the standing position by a travelling castrator about ten days previously. 'i found the animal presenting the following symptoms: head down, blowing hard, very dull, and disinclined to move, temperature ° f., hard, rapid, slightly irregular pulse, membranes injected, appetite lost; scrotum, sheath, and penis tremendously swollen, castration wounds unhealthy, and exuding a thin, reddish-brown discharge of a most foetid odour. 'the next day well-marked symptoms of laminitis were present. i finally ceased attending him about the middle of october, and at the end of that month he was turned out for the winter.'[a] [footnote a: _veterinary record_, vol. xiv., p. (charles a. powell).] . 'on july an interesting case of laminitis came under my notice. the subject was a mare, eight years old, which had been running on the common here for some months, and was taken up on the night of july by a boy, who did not observe anything amiss with her. the following morning, on the owner going to the stable, he found the animal in great pain, and at once sent for me. i discovered her to be suffering from laminitis, and saw her again in the evening, when she was much worse. the attack proved to be a most severe one. 'the owner informed me that she had not been allowed any corn for two months, and that she had no distance to travel on the road from the common. 'though on such a poor pasture, the mare was very fat; she had never been unwell before this attack. 'this is the first case i have seen of laminitis occurring when the animal was on grass.'[a] [footnote a: _veterinary journal_, vol. ix., p. (w. stanley carless).] b. chronic. . chronic laminitis. _definition_.--a low and persisting type of inflammation of the sensitive structures of the foot, characterized by changes in the form of the hoof, and incurable pathological alterations within it. _causes_.--chronic laminitis more often than not is a sequel to the acute form we have just described. with an attack of acute laminitis that defies treatment, and does not end in resolution in from ten days to a fortnight, then the chronic form may be expected. the brittle horn, convex sole, and other changes we have described under pumiced foot may, however, be regarded as a chronic laminitis, and this condition, as we have already indicated in chapter vi., may run a course slow and insidious from the onset. _symptoms_.--when the disease arises without previous acute symptoms, the first thing noticeable is an alteration in the gait. the animal begins to go feelingly, especially when first moved out from the stable. our opinion is asked as to the cause of the lameness, and an inspection is made. with the changes in the form of the hoof as yet wanting, we have nothing to guide us, and other causes for the lameness suggest themselves, probably corns. evidence of these is not forthcoming, and we in all probability withhold our opinion until a later visit. on the second or a subsequent call we are perhaps lucky enough to find our patient down. diagnosis is then rendered easier. made to rise, the animal stands in the attitude we have described as indicative of laminitis. we have him walked and trotted out. the symptoms of tenderness disappear, and the animal soon goes fairly sound. he is, in fact, workable--that is, by anyone who is careless as to the comfort of his beast. when following an acute attack, we have the most marked symptoms of pain and distress, somewhat abating after the second or third week. the walk, however, is still painful, and, for a short time after rising from the ground, even difficult. in short, in both cases we have the horse going on his heels, with a walk that is painful, and with symptoms of pain that are most apparent when moved on after a rest. later, the changes in the form of the hoof begin to appear. it seems to have lost its elasticity, and is seen to be dry and chippy, and to have become denuded of its varnish-like outer covering. in addition, it is of largely altered shape. the toe, by reason of the animal walking on his heels, and by reason of an increased growth of horn, becomes elevated, so that the front of the wall, instead of forming an obtuse angle with the ground, comes to run very nearly horizontal with it. the horn of the heels, as compared with that of the toe, takes on an increased growth. the same thing we have already indicated as happening at the toe, though in lesser degree. taken together, this increased growth of horn at the toe and at the heels has the result of lengthening the diameter of the foot from before backwards, the transverse diameter remaining more or less normal. the hoof thus loses its circular build, and comes to approach nearer an elongated oval. [fig. .--foot badly deformed as a result of chronic laminitis.] at this stage, too, the pathological 'ribbing' of the hoof is observable. the outer surface of the wall becomes marked with a series of ridges encircling the hoof from heel to heel (see fig. , which illustrates a moderate deformity of the hoof occurring after laminitis). in the badly laminitic hoof, however, this deformity is largely increased, until in some cases the shapeless mass can hardly be likened to a foot at all (see fig. ). the inferior or solar surface of the foot also offers certain changes for our consideration. the first thing that strikes one is the convexity of the sole. this, as we have already pointed out, is due to descent of the os pedis, and the highest point of the convex portion is that immediately in front of the apex of the frog. here the horn is sometimes found to be quite yielding to the finger, is excessively thin, and is more or less granular and inclined to break up under manipulation. as a consequence, any rough use of the drawing-knife, or an accidental wounding with sharp flints or stones, leads to exposure of the sensitive structures and local gangrene. with the horn of the sole thus deteriorated by reason of excessive and continued pressure upon the parts secreting it, it is not surprising to find that, in many cases, actual penetration of it with the os pedis occurs. it is the anterior portion of the inferior margin of the bone that makes its appearance, and shows itself as a small semicircular white or dark gray line on the sole. [illustration: fig. .--solar aspect of foot with chronic laminitis, showing its abnormal oval shape from before backwards, and the excess of horn growing from the white line in the region of the toe.] exposure of the bone is soon followed by its necrosis, in which case the wound takes on an ulcerating character. from it there is a discharge of pus, black in colour and offensive in smell, and, protruding from the opening, are excessive granulations of the remains of the sensitive sole. the 'white line,' so apparent when a normal foot is cleaned with the knife, can no longer be sharply distinguished from the surrounding horn, while in some cases the horn composing it takes on an abnormal growth at the toe (see fig. ). this adds still further to the abnormal lengthening of the antero-posterior diameter of the foot already mentioned. in other cases horn in this position is altogether wanting, and in its place is a well-defined cavity, into which the blade of a knife can be readily passed. this cavity is bounded in front by the original wall of the hoof, and is here lined by a degenerated and hypertrophied growth of the horny laminæ. posteriorly the cavity is bounded by the front of the os pedis, and is lined by a thin growth of horn secreted by the keratogenous membrane covering the bone. superiorly the cavity is quite narrow, and extends to near the lower surface of the coronary cushion, while inferiorly, at its open portion, it is often / inch to inch wide. laterally it extends on each side of the toe to the commencement of the quarters. [illustration: fig. .--longitudinal section of a foot with laminitis of three weeks' standing. on the anterior face of the cavity, in front of the os pedis, are thickened horny laminæ. due to the sinking of the bony column, the os pedis has perforated the horny sole.] exploration with a director, or with the blade of a scalpel, removes from the opening a dry detritus. this is composed of the solid constituents of the escaped blood, the dried remains of the inflammatory exudate, and broken-down fragments of cheesy-looking horn. the size to which the cavity may sometimes extend is illustrated in fig. . the thickened horny laminæ forming the anterior boundary of the cavity are here depicted, together with commencing perforation of the horny sole by the os pedis. it is this cavity which, when opened at the bottom and discharging its mealy-looking contents, is known as seedy-toe, for a further description of which see p. . the lameness occurring with chronic laminitis does not always persist. as time goes on the sensitive structures accommodate themselves to the altered form and conditions of the horny box. in certain situations--namely, where pressure is greatest--the softer structures become atrophied, and sometimes even wholly destroyed; while in other positions the changes in form of the hoof tend to increase in size of its interior, with a consequent diminution of pressure upon, and increased growth of the structures within it. _pathological anatomy_.--in detailing the changes to be observed in chronic laminitis, we take up the description where we left it when dealing with the pathological anatomy of the acute form. the alterations to be met with are best observed by taking a foot so diseased and making of it two sections--one longitudinal, from before backwards; the other horizontal, and in such a position as to cut the os pedis through at its centre. these sections will expose to view the cavity formed by the pouring out of the exudate, and its full extent may be noticed by examining the sections alternately. taking the horizontal section first, it will be seen that the hollow space extends wholly round the toe, and as far back as the commencement of the quarters. in the latter position one is able to observe laminæ still in their normal positions and condition. at the toe, however, the horny and secretive laminæ are widely separated, and the space between them filled with a yellow, semi-solid material, the remains of the inflammatory exudate and new horn secreted by the keratogenous membrane. the laminæ, both horny and sensitive, are greatly enlarged. this is a hypertrophy, resulting from the continued effects of the inflammation, and leads in time to the formation of laminæ quite three or four times their normal size. it is this hypertrophy of the laminæ and the pressure of the exudate that causes the bulging and increased growth of the horn at the toe (see fig. ), and contributes towards the oval formation of the foot we have mentioned before. [illustration: fig. .--longitudinal section of a foot with laminitis of several years' duration.] in the longitudinal section the first thing noticeable is the change in position of the bones, more especially in that of the os pedis. the circumstances we have mentioned before--pressure of the exudate upon it in front and tension of the perforans on it behind--have caused it to assume a more upright position than is normal, so much so that in a bad case the front of the bone becomes quite vertical. this vicious direction the other bones of the digit follow (see fig. ). consequent upon the displacement of the bone, the plantar cushion, by reason of the continued pressure thus put upon it, becomes atrophied, while its hinder half is, as it were, squeezed into taking up a position more posterior and higher in the digit than normally it should. the horn-secreting papillæ covering its inferior face thus become directed backwards sooner than downwards, in which way we account in some measure for the noticeable increase of horn at the heels. _treatment_.--chronic laminitis is incurable. treatment must therefore be directed towards the palliation of such conditions as are present, with the object of rendering the the animal better able to perform work. when perforation of the sole has occurred, with the attendant formation of pus and necrosis of the os pedis, it is doubtful whether treatment of any kind is advisable. there are on record cases of this description, where careful curetting of the exposed and necrotic portions and the after application of antiseptic dressings, held in position by a plate shoe or a leather sole, has been followed by good results, and the animal restored for a time to labour. in our opinion, however, early slaughter is the most economical course to adopt, and certainly the wisest advice to give to the ordinary client. when perforation of the sole is absent, and when serious alteration in the shape of the horny box has not occurred, then the most simple treatment is to put the animal straight away to slow work, with the feet protected by suitable shoes. here, again, the most useful shoe is the rocker bar (fig. ). the broad web and deep seating gives ample protection to the convex sole, and with the ease in distributing his weight that this shoe affords the animal is able to perform slow work on soft lands with some degree of comfort. should the growth of the horn at the toe and at the heels be unduly excessive, then our attention may be directed towards reducing it to some approach to the normal. this is accomplished by removing with the rasp and the knife those portions indicated by the dotted lines in fig. . here it will be seen that the bulk of the horn removed is that protruding at the toe. after this the animal should again be suitably shod. in this connection it should be noted that the fact of the animal walking largely on the heels tends to a forward displacement of the shoe. this must be prevented by providing each heel of the shoe with a clip, after the manner shown in fig. ; or, in the case of a bar shoe, supplying it with a clip at the centre of the bar. [illustration: fig. .--diagram illustrating the abnormal growth of horn at the toe and heels of the foot with chronic laminitis.] [illustration: fig. .--the same foot as in fig. . the dotted lines show the excess of horn removed preparatory to shoeing.] among other treatments to be noted we may mention one or two to be found chiefly in continental works on this subject. the method of gross consists in thinning down with a rasp about - / inches of the horn of the wall immediately below the coronet, the thinned portion extending from heel to heel. the groove made is filled with basilicon ointment,[a] and the coronet stimulated with a cantharides ointment, in this way there is induced to grow from the coronet a new wall of nearly normal dimensions. [footnote a: basilicon ointment is made by heating together resin parts, beeswax parts, olive oil parts, and lard parts. allow to cool without stirring.] by other operators (bayer, imminger, meyer, and gunther) this treatment has been modified by enlarging upon it and removing the whole of the adventitious horn. [illustration: fig. .--the shoe with heel-clip.] this is done by means of the drawing-knife and the rasp, the ugly-looking pumiced foot being carefully cut and trimmed until, so far as outward appearances are concerned, it is perfectly normal. this done, the whole foot is treated with a suitable hoof ointment, and a shoe applied that affords protection to the sole without imposing pressure upon it. the shoe indicated is either an ordinary shoe with an unusually broad and well-seated web, or the seated rocker bar of broad. with either it is well to additionally protect the sole by means of a leather or rubber pad and tar stopping, or by using the huflederkitt described on p. . in every case the nails must be kept well back in order to avoid the weakened and degenerated horn at the toe, and to take advantage of the greater growth of horn at the heels. the wisdom of thus removing the whole of the adventitious horn may be questioned. although a foot of a nearly normal shape is obtained, it must be remembered that the grave alterations within it are unchanged, and that in certain positions the operation must have carried us nearer the sensitive structures than is advisable. all other treatments failing, the operation of neurectomy has been advised. this we do not think wise. one would imagine that, with degenerative processes already going on in the foot, the tendency to gelatinous degeneration, always to be looked for in neurectomy, would be increased. this, as a matter of fact, is the case, and is borne out by the statements of those who have tried this method of treatment. in many cases the lameness even is not got rid of. even where it is, the operation is afterwards followed by a great tendency to stumble, by sloughing of the hoof, or by a marked increase in the adventitious horn, and a consequent greater deformity of the foot. sooner than risk neurectomy, it seems to us wiser to give a trial to the operation advocated by m.g. joly, namely, that of ligaturing one of the digital arteries on each affected foot. this operation is performed in the same position as is the higher operation of plantar neurectomy, and may be either internal or external. the vessel is exposed, and a double ligature, preferably of silk, placed on it. the artery is then divided between the two ligatures. the immediate effect of the operation is to cause a considerable diminution in the arterial pressure, and so lessen the intensity of the ostitis in the os pedis. its consequences are not so serious as those of neurectomy, and it decongests tissues which neurectomy congests. in cases related by m. joly this operation, practised both in conjunction with removal of the excess of horn and without it, has resulted in a marked improvement in the gait, the animal going to work one month after the treatment, and remaining sound for some time afterwards. . seedy-toe. _definition_.--a defect in the horn of the wall, usually at the toe, but occurring elsewhere, resulting in loss of its substance in either its internal or external layers (see figs. , , and ). _causes_.--the most common factor in the causation of this defect is undoubtedly disease of the sensitive laminæ. we have, in fact, just given an excellent example of the formation of a seedy-toe in the sections of this chapter devoted to laminitis (see pp. and ). the cavity here formed by the outpouring of the inflammatory exudate and the separation of the sensitive and horny laminæ persists. it becomes filled with the dried remains of the exudate and perverted secretions from the horny and sensitive laminæ (see p. ). as yet, however, the cavity is closed below, and its existence only surmised. later, with successive visits to the forge, the layer of solar horn forming its floor is cut away, and the cavity exposed to view. its mealy-looking contents are removed, and the case reported by the smith. although occurring in this way with an acute attack of laminitis, it must be remembered that seedy-toe may arise without previous noticeable cause. the first intimation the owner has is a report from the forge that seedy-toe is in existence. to refer to cases so arising a probable cause is far from easy. at one time it was believed to be due to parasitic infection of the horn. others have blamed the pressure of the toe-clip, excessive hammering of the wall, or pressure from nails too large or driven too close. others, again, say that seedy-toe may result from a prick in the forge, from hot-fitting of the shoe, from standing on a dry and sandy soil, or from the use of high calkins on the front shoes. in these cases--cases with an insidious onset--we are inclined to the opinion that the disease of the horn commences from below, and that the sensitive laminæ become implicated later. holding this view, one must account for the commencing disease of the horn by giving, as causes, firstly, those factors (as, for instance, alternate excessive dampness and dryness) leading to disintegration of the horn tubules; secondly, the penetrating into and between the degenerated tubules of parasitic matter from the ground; and, thirdly, the final breaking up of the horn, and spread of the lesion under the invasion thus started. [illustration: fig. .--diagram illustrating position of seedy-toe (internal). , the horn of the wall; , the horn of the sole; , the cavity of the seedy-toe; , the os pedis; , the keratogenous membrane.] _symptoms_.--lameness sometimes attends seedy-toe, and sometimes does not. this is an important point to be carried in mind by the veterinary surgeon who is accustomed in his practice to have many animals pass through his hands for examination as to soundness. an animal with advanced seedy-toe--a condition constituting serious unsoundness--may walk and trot absolutely sound, and may give no indication, either in the shape of the wall or the condition of the sole, that anything abnormal is in existence. later, however, after the veterinary surgeon has passed him, the purchaser lodges the complaint that the horse has a bad seedy-toe, which, so he is told, must have been there for some time. in this case, culpable though he may appear, there is every excuse for the veterinary surgeon. once the cavity is opened at the toe in the neighbourhood of the white line, then diagnosis is easy. a blunt piece of wood, the farrier's knife, or a director may be easily passed into it, sometimes as far up as the coronary cushion (see fig. ). issuing from the opening is seen occasionally a little inspissated pus; more often, however, the dry, mealy-looking detritus to which we have before referred. this form of the disease we may term 'internal seedy-toe.' for, plainly enough, it has had its origin in chronic inflammatory changes in the keratogenous membrane. [illustration: fig. .--external seedy-toe commencing at the plantar border of the wall.] [illustration: fig. .--external seedy-toe commencing on the anterior face of the wall.] disease of the horn and loss of its substance may, however, also commence from without. a report on this condition, under the title of 'external seedy-toe,' is to be found in vol. xxix. of the _veterinary journal_, from which we borrow figs. and . in fig. it will be seen that the disease commences at the plantar surface of the toe, and extends upwards and inwards. the same condition may also appear anywhere between the coronet and the ground, gradually extending into the substance of the wall, as shown in fig. . according to the writer, colonel nunn, the progress of the disease in this latter case appears to be faster in a downward than in an upward direction. this, however, is more apparent than real, as the rate of growth of the horn downwards detracts from the progress of the disease upwards, although it spreads over the horn at the same rate. before concluding the symptoms, we may again allude to the fact that, although usually occurring at the toe, the same condition may be met with in other positions--namely, at either of the quarters. in appearance and in other respects it is identical with that occurring at the toe. when the animal is lame and the existence of seedy-toe is surmised, or when the cause of the lameness is altogether obscure, a little information may perhaps be gathered from noting the wear of the shoe. if the animal has been going lame for any length of time as a result of disease in the sensitive laminæ, then the shoe will be greatly thinned at the heels, and the toe but little worn. _treatment_.--as with diseased structures elsewhere, the most rational treatment, when possible, is that of excision. the entire portion of the wall forming the anterior boundary of the cavity is thinned down with the rasp and afterwards removed with the knife, wholly exposing the hypertrophied, but usually soft layer of horn covering the sensitive structures. these hypertrophied portions are also removed, and every particle of the dust-like detritus cleaned away. after-treatment consists in dressing the parts with a good hoof ointment, protecting them, if necessary, with a pad of tow and a stout bandage. it may be that the removal of a large portion of the wall may for some time throw the animal out of work. acting on colonel fred smith's suggestion, this may be avoided by having made a thin plate of sheet-iron, slightly larger in circumference than the portion of horn removed, and shaped to follow the contour of the foot. this made, it is sunk flush with the wall by hot-fitting it, and kept in position by several small steel screws fixed into the sound horn, just as in the treatment for sand-crack (see p. ). this will serve the useful purpose of maintaining in position any dressing that may be thought necessary, of acting as a support to the horn left on each side of the portion removed, and of keeping the exposed structures free from dirt and grit. practical points to be remembered in fitting plates of this description to the feet are: the plate must never quite reach the shoe, or it will participate in the concussion of progression, and so loosen the screws that hold it in place. for the same reason, that portion of the sole adjoining the piece of horn removed must have its bearing on the shoe relieved. the screws holding the plate should be oiled to prevent rusting, and should take an oblique direction in order to obtain as great a hold as possible on the wall. when excision is deemed unwise or unnecessary, treatment should be directed towards maintaining the cavity in a state of asepsis. to this end it should be thoroughly cleaned of its contents, and afterwards dressed with medicated tow. the ordinary tar and grease stopping is as suitable as any. this, together with the tow, is tightly plugged into the opening and kept in position by a wide-webbed shoe. instead of the tar stopping and the tow, there may be used with advantage the artificial hoof-horn of defay (see p. ). before using this the cavity should again be thoroughly cleaned out, and should in addition be mopped out with ether. the latter injunction is important, as unless the grease is thus first removed, the composition will fail to adhere to the horn. with the cavity thus cleaned and prepared, the artificial horn, melted ready to hand, is poured into it and allowed to set. in every case, no matter what else the treatment, the bearing of the horn adjacent to the lesion should be removed from the shoe. whether practising the method of plugging the cavity or that of excision of the wall external to it, attempts to quickly obtain a new growth of horn from the coronet should be made. to further that, frequent stimulant applications should be used. ointment of biniodide of mercury in , of cantharides in , or the ordinary oil of cantharides, either will serve. . keraphyllocele. _definition_.--by this term is indicated an enlargement forming on the inner surface of the wall. in shape and extent these enlargements vary. usually they are rounded and extend from the coronary cushion to the sole, sometimes only as thick as an ordinary goose-quill, at other times reaching the size of one's finger. often they are irregular in formation and flattened from side to side. [illustration: fig. .--a portion of the horn of the wall at the toe removed in order to show a keraphyllocele on its inner surface.] _causes_.--keraphyllocele is very often a sequel to the changes occurring at the toe in laminitis. probably, however, the most common cause is an injury upon, or a crack through, the wall. it may thus occur from excessive hammering of the foot, from violent kicking against a wall or the stable fittings, and from the injury to the coronet known as 'tread.' it may also occur as a sequel to complicated sand-crack, and to chronic corn. that fissures in the wall are undoubtedly a cause has been placed on record by the late professor walley, who noticed the appearance of these horny growths following upon the operation of grooving the wall.[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. iii, p. .] this gentleman had a large clydesdale horse under his care for a bad sand-crack in front of the near hind-foot, and, as the lameness was extreme, he adopted his usual method of treatment--viz., rest, fomentations, poulticing, and the making of the v-shaped section through the wall, and subsequently the application of an appropriate bar shoe to the foot, and repeated blisters to the coronet. in a short time the lameness passed off, and the horse was put to work. a few days later the animal met with an accident, and was killed. on examining a section of the hoof it was found that a vertical horny ridge corresponding to the external fissure had been formed on the internal surface of the wall, and that a well-marked cicatrix extended upwards through the structure of the hoof at the part forming the cutigeral groove; furthermore, _a similar ingrowth had been taking place in the line of the oblique incisions made for the relief of the sand-crack_. this case has an important bearing on the operation of grooving the wall, which operation we have several times in this work advocated for the relief of other diseases. it teaches us that the incisions should not be carried so completely through the horn as to interfere with and irritate the sensitive laminæ, and so set up the chronic inflammatory condition leading to hypertrophy of the horn. from the position on the os pedis of the indentation made in it by the keraphyllocele (see fig. ) it has been argued that pressure of the toe-clip is a cause of the new growth. this, we should say, cannot be a very strong factor in the causation, for, while we admit that the continual pressure of the clip, and the heavy hammering that sometimes fits it into position, is likely to set up a chronic inflammatory condition of the sensitive laminæ in that region, we must still point out that the rarity of keraphyllocele, as compared with the fact that clips are on every shoe, does not allow of the argument carrying any great weight. _symptoms_.--except under certain conditions this defect is difficult of detection. as a rule, lameness is not produced by it. in making that statement we are led largely by the conclusion arrived at by professor walley. this observer noted the fact that ingrowths of horn such as we are describing nearly always take place in false quarter, or after a sand-crack has been repaired, and that they commonly occur after the operation of grooving the wall in the manner we have just shown. now, we know that quite often under these circumstances the horse goes perfectly sound. thus, while we know that in all probability keraphyllocele is in existence, we have ocular demonstration that the animal is quite unaffected by it. in some cases, however, lameness is present. during the early stages of the growth's formation it is but slight, increasing as the keraphyllocele enlarges. should this be the case, other symptoms present themselves. the coronet is hot, and tender to the touch, sometimes even perceptibly swollen, and percussion over the wail is met with flinching on the part of the animal. in other cases one is led to suspect the condition by the prominence of the horn of the wall of the toe. this is distinctly ridge-like from the coronet to the ground, while on either side of it the quarters appear to have sunk to less than their normal dimensions. we believe this to be an illusion, as a ridge of any size at the toe readily gives one the impression of atrophy behind it, without this latter condition being actually present. should this ridge-like formation and the accompanying symptoms of pain and lameness occur after repair of a sand-crack, then keraphyllocele may, with tolerable certainty, be diagnosed. when these outward signs are wanting, however, and the true nature of our case is a matter of mere conjecture, a positive diagnosis may still be made at a later stage--that is, when the abnormal growth of horn reaches the sole. in this case either there is met with when paring the sole a small portion of horn, circular in form, distinctly harder than normal, and indenting in a semicircular fashion the front of the white line at the toe, or solution of continuity between the tumour and the edge of the sole and the os pedis takes place, and the lameness resulting from the ingress of dirt and grit thus allowed draws attention to the case. _pathological anatomy_.--with the sensitive structures removed from the hoof by maceration or other means, these growths are at once apparent. they may occur in any position, but are usually seen at the toe, and they may extend from the coronary cushion to the sole, or they may occupy only the lower or the upper half of the wall. in places the tumour (or 'horny pillar' as the germans term it) is roughened by offshoots from it, and does not always exhibit the smooth surface depicted in fig. . commonly, the horn composing the new growth is hard and dense. sometimes, however, it is soft to the knife, and is then found to be itself fistulous in character, a distinct cavity running up its centre, from which issues a black and offensive pus. in a few cases the sensitive laminæ in the immediate neighbourhood are found to be enlarged, but in the majority of cases atrophy is the condition to be observed. not only are the sensitive structures found to be shrunken and absorbed, but the atrophy and absorption extends even to the bone itself (see fig. ). this latter is a result of the continued pressure of the horny growth, in a well-marked case ending in a sharply-defined groove in the os pedis in which the keraphyllocele rests. the fact that the softer structures, and even the bone, thus accommodate themselves to the altered conditions is, no doubt, the reason that lameness in many of these cases is absent. _treatment_.--it is doubtful whether anything satisfactory can be recommended. when we have suspected this condition ourselves, it has been our practice to groove the hoof on either side of the toe, after the manner illustrated in fig. , and, at the same time, point-firing the coronet and applying a smart cantharides blister. certainly, after this operation, lameness has often disappeared--whether, however, as a result of the treatment adopted or by reason of the structures within accommodating themselves to the condition, we would not care to say. [illustration: fig. .--os pedis showing the groove in it caused by atrophy and absorption induced by pressure of a keraphyllocele.] other writers advocate the removal of that portion of the wall to which the tumour is attached, after the manner described on p. , and illustrated in fig. . this, however, should be a last resource, and should be adopted only when weighty reasons, such as excessive and otherwise incurable lameness, appear to demand it. . keratoma. in our nomenclature the terms 'keratoma' and 'keraphyllocele' are both used to indicate the condition we have just described. there are some, however, who reserve the term 'keratoma' for horny tumours occurring only on the sole, and for that reason we draw special attention to the word here. keratoma may thus be used to describe what we have called keraphyllocele directly that growth makes its appearance at the sole, and is there able to be cut with the knife. similar hard and condensed growths may, however, make their appearance on the sole in other positions quite removed from the white line, plainly being secreted by the villous tissue of the sensitive sole, and having no connection whatever with the sensitive laminæ. they appear as circular patches, varying in size from a shilling to a two-shilling piece. compared with the surrounding horn, they stand out white and glistening, while in structure they are dense and hard, and offer a certain amount of resistance to the knife. they are of quite minor importance, and, beyond keeping them well pared down, need no attention. keratoma probably offers us the best analogy we have to corn of the human subject. . thrush. _definition_.--a disease of the frog characterized by a discharge from it of a black and offensive pus, and accompanied by more or less wasting of the organ. _causes_.--the primary cause of this affection is doubtless the infection of the horn, and later the sensitive structures, with matter from the ground. those factors, therefore, leading to deterioration of the horn, and so exposing it to infection, may be considered here. such will be changes from excessive dampness to dryness, or _vice versâ_; work upon hard and stony roads; prolonged standing in the accumulated wet and filth of insanitary stables, or long standing upon a bedding which, although dry, is of unsuitable material. in this latter connection may be mentioned the harm resulting from the use of certain varieties of moss litter. this we find pointed out by j. roalfe cox, f.r.c.v.s.[a] tenderness in the foot was first noticed, and, on examination, the horn of the sole and of the frog was found to be peculiarly softened. it afforded a yielding sensation to the finger, not unlike that which is imparted by indiarubber, and on cutting the altered horn it was almost as easily sliced as cheese-rind. the outer surface being in this way slightly pared off, the deeper substance of the horn was discoloured by a pinkish stain. the horn of the frog was in many instances found detaching from the vascular surface, which was very disposed to take on a diseased action, somewhat allied to canker, and became extremely difficult to treat. [footnote a: _veterinary journal_, vol. xvi., p. .] conditions such as these, although not constituting the disease itself, certainly lay the frog open to infection, especially if afterwards the animal is called upon to work in the mud of the streets of a large town, or to stand in a badly drained and damp stable. a further cause of thrush is to be found in the condition of the frog, brought about by contraction of the heels (see p. ). we have already seen that one of the most prominent factors in the causation of contraction is the removal of the frog from the ground by shoeing, with its consequent diminution in size and deterioration in quality of horn. this leads to fissures in the horny covering, and favours infection of the sensitive structures beneath. thrush is, in fact, nearly always present in the later stages of contracted foot. by some thrush is believed to be but the commencement of canker. with this, however, we do not hold. we believe both to be due to specific causes as yet undiscovered, but that the cause of thrush is not the one operating in canker. in arriving at this conclusion we are guided by clinical evidence. the two conditions are quite dissimilar, even in appearance, and, while one is readily amenable to treatment, the other is just as obstinately resistant. _symptoms_.--the symptoms of thrush are always very evident. probably the first thing that draws one's attention to it is the stench of the puriform discharge. the foot is then picked up and the characteristic putrescent matter found to be accumulated in the median, and often in the lateral, lacunæ. the organ is wasted and fissured, the horn in the depths of the lacunæ softened and easily detachable, and portions of the sensitive frog often laid bare. with a bad thrush lameness is present, the frog itself is tender to pressure, and often there is considerable heat and tenderness of the heels and the coronet immediately above. more especially is this noticeable after a journey. it is, perhaps, more common in the hind-feet than in the fore, and more often met with in heavy draught animals than in nags. the hind-feet are, of course, more open to infection by reason of their being constantly called upon to stand in the animal discharges in the rear of stable standings, while it is a well-known fact that heavy animals have their stables kept far less clean, and their feet less assiduously cared for, than do animals of a lighter type. in a nag-horse with thrush of both fore-feet lameness becomes sometimes very great. the gait when first moved out from the stable is feeling and suggestive of corns, while progress on a road with loose stones is sometimes positively dangerous to the driver. _treatment_.--when this condition has arisen, as it often does, from want of counter-pressure of the frog with the ground, this pressure must be restored after the manner described when dealing with the treatment of contracted foot (see p. ) either by the use of tip or bar shoes, or by suitable pads and stopping. so far as direct treatment of the lesion itself is concerned, the first step is to carefully trim away all diseased horn and freely open up the lacunæ in which the discharge has accumulated. good results are then often arrived at by poulticing, afterwards followed up by suitable antiseptic dressings. with us a favourite one is the sol. hydrarg. perchlor. of tuson, used without dilution. others use a dry dressing, and dust with calomel, with a mixture of sulphate of copper, sulphate of zinc and alum, or with subacetate of copper and tannin. with restoration, so far as is possible, of the frog functions, and with careful dressing, a cure is nearly always obtained. . canker. _definition_.--under this unscientific, yet expressive term, is indicated a chronic diseased condition of the keratogenous membrane, commencing always at the frog, and slowly extending to the sole and wall, characterized by a loss of normal function of the horn secreting cells, and the discharge of a serous exudate in the place of normal horn. _causes_.--the exact cause of canker has still to be discovered. therefore, before expressing an opinion as to what the _probable_ cause may be, we may state here that such opinion can only be based upon clinical observation. such being the case, we are almost duty bound to give the views of older authors before those of more modern writers. from the mass of material ready to hand we may select the following as serving our purpose. the earliest opinion appears to have been that canker, as the name indicates, was of a cancerous or cancroid nature. this was also believed by hurtrel d'arboval, who looked upon canker as carcinoma of the recticular structure of the foot. the same theory we find enunciated in the _veterinary journal_ so late as . although the word 'cancer' or 'carcinoma' is not there used, the author employs the terms 'papilloma' and 'epithelioma' with the evident intention of expressing his belief in the malignant nature of the disease. another early opinion was that the disease was a _spreading ulcer_, gradually extending and changing the tissues which it invaded. a further early theory, and one which if not still believed in, has died a hard death, is the constitutional theory. this was believed in by nearly all the older writers, and is mentioned so late as by the late professor williams. in his 'principles and practice of veterinary surgery,' he says: 'canker is a constitutional disease due to a cachexia or habit of body, grossness of constitution, and lymphatic temperament.' this, we believe, is credited to-day by some, and yet, quite years before the date of the edition of williams's work--in , to be exact--we find a veterinary writer when talking of grease (a disease, by-the-by, very closely allied to canker) exclaiming against this habit of referring everything which we do not rightly understand to some ill-humour of the body. the wisdom his words contain justifies us in giving them mention here. 'it is a very foolish and absurd notion,' he says, 'to imagine a horse full of humours when he happens to be troubled with the grease. but such shallow reasoning will always abound while peoples' judgments are always superficial. therefore, to convince such unthinking folks, let them take a thick stick and beat a horse soundly upon his legs so that they bruise them in several places, after which they will swell, i dare say, and yet be in no danger of greasing. now, pray, what were these offending humours doing before the bruises given by the stick?' at the present day it is safe to assert that neither the ulcerative, the cancerous, nor the constitutional theory is believed in widely, and, among the mass of contrary opinions as to the cause of this disease, we may find that even quite early many of the older writers had discarded them. quoting from zundel, we may say that dupuy in considered canker as a hypertrophy of the fibres of the hoof, admitting at the same time that these fibres were softened by an altered secretion; while mercier in stated that canker was nothing more than a chronic inflammation of the reticular tissue of the foot, characterized by diseased secretions of this apparatus. saving that they make no mention of a likely specific cause, these last two statements express all that we believe to-day. as early as , however, the existence of a specific cause was hinted at by blaine in his 'veterinary art.' we find him here describing canker as a _fungoid_ excrescence, exuding a thin and offensive discharge, which _inoculates_ the soft parts within its reach, particularly the sensitive frog and sole, and destroys their connections with the horny covering. the use of the word 'fungoid,' and particularly that of 'inoculate,' is suggestive enough, and is evidence sufficient that either blaine or his editor recognised, simply through clinical observation, the working of a special cause. four years later, bouley is found holding the opinion that canker was closely allied to tetter, thus recognising for it a local specific cause. the same observer also pointed out that the secretion of the keratogenous membrane instead of being suspended was greatly increased, taking care to explain, as did dupuy, that the products of the secretion were perverted and had lost their normal ability to become transformed into compact horn. in this slowly growing recognition of a specific cause received further impetus from the statements of megnier. this observer claimed to have discovered in the cankerous secretions the existence of a vegetable parasite (namely, a cryptogam, as in favus), which he termed the keraphyton, or parasitic plant of the horn. modern research, though failing to substitute anything more definite, has not confirmed this. the exact and exciting cause of canker is therefore still an open question, and a matter for research. we may, however, sum the matter up by briefly discussing the causes, so far as clinical observation teaches us. this we shall do under two headings--namely, _predisposing_ and _exciting_. _predisposing causes_.--starting with the assumption that the disease is due to local infection, we may relate as predisposing causes anything having a prejudicial effect upon the horn, disintegrating it, and so laying the tissues beneath open to attack. the most prominent in this connection is certainly a continued dampness of the material on which the animal has to stand. particularly is this the case when the material is also excessively foul and dirty, contaminated with the animal discharges, and presumably swarming with the lower forms of animal and plant life. we shall therefore find bad cases of canker in stables where the "sets" are irregular, or where no paving at all is attempted, where the drainage is defective, and where darkness and want of proper ventilation favours organismal growth. the fact that with modern drainage and a general hygienic improvement in stabling, canker has to a large extent died out, supports this contention. again, as with thrush, anything removing the counter-pressure of the frog with the ground and throwing that organ out of play, may be looked upon as a predisposing cause. the atrophy of the frog thus occurring, the deterioration in the quality of its horn and the fissures in its surface lay it specially open to infection. that one of the principal factors in the treatment of canker is a restoration of ground-pressure to the frog and the sole is sufficient proof of this. further, it is well to note that, although playing no part in the actual causation, certain constitutional conditions may in some measure predispose the foot to attack. clinical observation teaches us that animals of a lymphatic nature, with thick skins and an abundance of hair, with flat feet and thick, fleshy frogs, are far more liable to attack than are animals with reverse points. _exciting causes_. those who give this subject careful consideration cannot fail to arrive at the conclusion that canker is most certainly due to local infection with a specific poison, and that poison a germicidal one from the ground. the symptoms arising may be due to the action of a single germ, or to two or more germs acting in conjunction. as to whether the parasitic invasion is single or multiple we cannot feel certain, but that it _is_ parasitic we feel absolutely assured. it is simply the light that bacteriological advance has made during the last two decades that enables us to make the statement with such feelings of assurance. we arrive at our conclusions by reasoning from analogy. here we have a disease always exhibiting the same symptoms, more or less peculiar to one class of animal, always with a similar characteristic appearance and smell, always obstinately refractory to treatment, showing always a tendency to spread to the other feet of the same animal, and often to the feet of other animals _near enough to become_ infected, and always cured--when cured it is--by a treatment which may be summed up in two words as 'rigid antisepsis.' other diseases, with points in common with this, have been directly proved to be due to a specific cause. common regard for logic compels us to admit the same for canker. [illustration: fig. .--a foot, the subject of canker, showing destruction of the horny frog, and a fungoid-looking hypertrophy of the tissues beneath.] _symptoms and pathological anatomy_.--the symptoms of canker are seldom noticeable at the commencement of an attack. the disease is slow in its progress; for some time confines its ravages to the sub-horny tissues unseen, and is quite unattended with pain. it is not observed, therefore, until considerable damage has been done, and the disease is far advanced. what is usually first seen is a peculiar softening and raising of the horn of the frog. the infective material has set up a chronic inflammation of the keratogenous membrane, leading to abnormal secretion, and, in place of the horny cells it should normally secrete, is thrown out an abundance of a serous fluid. this upraised and softened horn once thrown off is not again renewed, and the whole of the sensitive frog and perhaps a portion of the sensitive sole is left uncovered. in place of the normal horn, however, is often found a hypertrophy of the elements of the keratogenous membrane leading to huge fungoid-looking growths with a papillomatous aspect, damp in appearance and offensive in smell, and readily bleeding when injured (see fig. ). the horn immediately surrounding the lesion is loose and non-adherent to the sensitive structures. this indicates, of course, that the disease has spread further beneath the horny covering than is at first sight apparent. portions of this loose horn removed reveal beneath it a caseous foetid matter, easily removed by scraping (the perverted secretion of the keratogenous membrane). when this is carefully scraped away, the sensitive structures appear to be covered with a thin, smooth membrane, gray in colour and almost transparent, while beneath it may be seen the red appearance of normal sensitive structures. if the horn surrounding the lesion is not touched with the knife, but little is seen of the extent of the disease, for that removed by natural means is often very small in quantity. to all intents and purposes the disease appears to be confined to the frog. this appearance is misleading, especially if the disease has been in existence for some time, for it may have easily spread to the whole of the sole, and even to the greater portions of the laminæ secreting the wall. it is, in fact, not until the pressure exerted by the normal horn is removed by its breaking away that the vascular structures of the keratogenous membrane begin to swell, and the perverted secretions to enlarge in size. once the pressure is removed, however, this quickly comes about, and the characteristic fungoid growths rapidly make their appearance. this tendency to spread is highly indicative of canker. the serous matter exuding from the diseased keratogenous membrane appears, in fact, to be highly infective. once its flow is commenced, it slowly, but surely, invades the sensitive structures near it, appearing, as elaine has put it, to 'inoculate' them. what is really the case, of course, is not that the discharge itself is infective, but that it is contaminated with infective material. the fungoid-looking growths to which we have before referred are, in reality, nothing more than the villi of the sensitive frog and sole greatly hypertrophied and irregular in shape. at times the hypertrophy is as a huge and compact enlargement occupying the position of the frog. sometimes, however, it occurs as numerous elongated and twisted fibrous bundles, separated from each other by deep clefts, and the clefts filled with the offensive cankerous discharge (see fig. ). [illustration: fig. .--lower aspect of cankered foot, showing destruction of wall.] at a very advanced stage canker leads to destruction of much of the horny sole and frog; or even parts of the wall may become separated from the tissues beneath, and break away from the foot (see fig. ). at other times the disease brings about a deformity of the whole of the foot. its longitudinal and transverse diameters become enormously increased, and the whole foot apparently flattened from above to below (see fig. ). this indicates that not only has the horny sole been entirely destroyed, but that the destructive process has also extended to the greater part of the lower half of the wall, with a consequent hypertrophy of exposed soft structures, and a sinking of the bony column, similar to that which occurs in laminitis, but not so pronounced. [illustration: fig. .--foot with advanced canker.] a further aspect of the badly-cankered foot is to be found in an apparently enormous increase in the length of the wall. this we have seen protruding for quite inches beyond the plane of the sole. it simply indicates that, in order to keep the animal at work, the smith has at every shoeing spared the wall, so that the diseased structures might be kept from contact with the ground. as we have said before, pain and other symptoms of distress are quite absent. animals affected with canker for a long time maintain their condition, feed well, and are quite capable of performing work under ordinary conditions. _differential diagnosis and prognosis_.--perhaps the only disease with which canker may be confounded is thrush. they should, however, be easily distinguishable. the discharge from thrush is not so profuse, and is thicker and darker in colour, while the loosening of the horn is almost entirely absent. furthermore, thrush shows no tendency to spread, and, even when left untreated, may remain confined to the frog for months, and even years. canker, on the other hand, is slowly progressive, and soon shows the characteristic fungoid excresences, which growths are in thrush never seen. a further point of difference is discovered when treatment is commenced. canker is found to be refractory to a point that is absolutely disheartening, while thrush, with careful attention, is soon got under hand, and a permanent cure effected. the prognosis must be guarded. by many canker has been said to be incurable. this, however, has been clearly shown to be wrong. when the animal is young, and treatment may reasonably be judged to be economical, then a favourable prognosis may be indulged in, provided the veterinary surgeon intends to put into that treatment a more than ordinary amount of individual care and attendance. even then, however, he will have to be very largely guided by the condition of his case. he should see that it is not too far advanced, and that a great deformity of the hoof, or actual exploration, does not indicate disease of the greater part of the wall. _treatment_.--from what has gone before, it will be seen that the eradication of canker is no easy task, that it is, in fact, a most difficult matter, and one not to be lightly undertaken. at the risk of recapitulating what we have said before, we may mention here the two points which the veterinarian must bear in mind. ( ) that there is no actual disease or alteration in structure of the deep layers of the keratogenous apparatus. it is only the superficial, or horn-secreting, layer that concerns us. ( ) that the disease of this superficial layer is infection with a material that may reasonably be presumed to be infective. put thus, treatment of canker would at first sight appear to be easy. one would imagine that a simple and long-continued soaking of the entire foot in a strong enough antiseptic would be all that was needed. clinical observation, however, shows that this is not so, and for this there must be reasons. the reasons are these: ( ) between us and the diseased layer upon which our attention must be directed is often a layer of normal horn, effectually protecting the tissues beneath from any dressing which we might consider beneficial. ( ) anything applied with the object of destroying septic material, but strong enough, or caustic enough, to injure the membrane upon which we are working, only makes the case worse. the superficial layer of the keratogenous membrane in which we have judged the disease to exist is, after all, but a delicate structure. when attacked by the application of too potent a drug its horn-secreting layer is easily destroyed, and thus, although we may succeed in establishing asepsis, we cannot expect at the point of injury a growth of horn. in its place we are confronted with large outgrowths of inflammatory fibrous tissue. ( ) shedding of the diseased horn and removal of the pressure exerted by the hoof faces us with hypertrophy of the exposed villi. the difficulty of meeting this with an adequate and evenly-distributed pressure is well enough known, and we find in that a further reason that the treatment of canker is superlatively difficult. ( ) the material on which the animal has to stand is a distinct bar to the maintaining of a strict asepsis. when we have said this, it is easy to understand that canker is not to be successfully met with any so-called specific--that it makes but little difference what the application may be so long as it is antiseptic, and is used by a man thoroughly conversant with the difficulties he has to contend with, and with his mind firmly set upon surmounting them. with this point established, we will not devote more of our space to a consideration of the various dressings that have at different times been highly advocated in the treatment of the disease. it is interesting, however, to note that intensely irritating and caustic applications have been greatly in favour. nitric acid, sulphuric acid (either alone or its action reduced by the addition of alcohol, oil, or turpentine), arsenic, butter of antimony, creasote, chromic acid, carbolic acid, arsenite of soda, and the actual cautery, have all been used. without dwelling further on that, we may say at once that a correct treatment consists in ( ) the removal of all horn overlying infected portions of the keratogenous membrane, ( ) the application of an antiseptic not too powerfully caustic in its action, ( ) frequent changes of the dressings in order to insure a maintenance of antisepsis, and ( ) the application of an adequate pressure to the exposed soft structures. thus combated, canker is curable. the man who, at the expense of much time and trouble, has demonstrated the truth of these axioms is mr. malcolm, of birmingham. the determination with which he clung to his point that canker was, with correct treatment, in every case curable, was some years ago provocative of much discussion in veterinary circles. that he was successful in proving his contention is more to our point here. it is his method of treatment, therefore, that we shall give, and this we shall do by liberal extracts from mr. malcolm's own writings. 'on the first occasion of operating upon and dressing the cankered foot, it is usually necessary to cast the horse, and this may have to be done at intervals for a second or even third time; but in most cases once is sufficient, subsequent dressing being usually accomplished without much difficulty, frequently even without the aid of a twitch. after the horse has been secured, the drawing-knife is first employed; and if the frog alone is affected, it is unnecessary even to pare the sole, the removal of all frog horn not intimately adherent to its secreting surface being all that is required. but if both sole and frog be involved, the whole of the sound horn should be first thinned until it springs under the thumb, and then, using a sharp knife, every particle of diseased horn must be carefully removed from both sole and frog, a process much more easily, and with far greater certainty, secured by the previous thinning of the horn. 'the removal of diseased horn should always commence at the most dependent part of the foot, so that any hæmorrhage produced may be below the parts still to be operated on, a matter of considerable moment for effective treatment. but with due care there will be little hæmorrhage, as, except in the initial stage, there is no real union between the diseased horn and the diseased vascular secreting surface. 'after all apparently diseased horn has been removed by the knife, any still remaining should be at once destroyed by the actual cautery, by which it can be identified. all the diseased secreting surface should be _carefully scraped with a thin hot iron_,[a] fungoid growths excised and cauterized, and, indeed, every particle of cankered tissue should, if possible, be eradicated. in securing this more reliance can be placed on the actual cautery than on any other, whether liquid or solid: it is more under control in application, more decisive in effect, and its results can be anticipated with a far greater certainty. moreover, its aid in diagnosis is of immense value; applied to the thinned horn or secreting surface it unmistakably demonstrates the presence or absence of canker. healthy tissue chars black; cankered tissue, on the contrary, bubbles up white under the hot iron, and presents an appearance not unlike roasted cheese. 'although this test is certain for horn thinned to the quick, it is not to be relied upon with thick horn, the outside of which may be practically healthy and char black, while its underlying surface may be cankered. with this exception the test is an infallible one, as by it the demarcation between cankered and healthy tissue can be clearly traced, and as a result we can with equal confidence radically _remove_[a] all cankered tissue, and conserve all healthy. as the object of that abominably cruel and barbarous operation of stripping the sole is the exposure of all canker, and as this can be done with equal certainty with the aid of the hot iron, there can be no necessity for performing it. the pain of cauterizing cankered tissue, which is a necessary operation, is infinitesimal (canker largely destroying sensation), compared with the pain produced in the totally unnecessary process of tearing healthy horn from a highly sensitive tissue. [footnote a: the words in italics are alterations in the original article made by mr. malcolm in a private letter to the author (h.c.k.).] 'having by means of the knife and cautery removed every known particle of disease, the next procedure is to pack the surface of the sole and frog thus exposed with a _mild dressing, such as vaseline; but if the cankered surface has not been efficiently, scraped, than there is required a more_ [a] powerful astringent or caustic dressing, which may vary considerably according to the individual fancy. a great favourite of mine consists of equal parts of sulphates of copper, iron, and zinc, mixed with strong carbolic acid, a very little vaseline being added to give the mass cohesion. the dressing, covered by a pledget of tow, is held in position by a shoe with an iron or leather sole, and the dressing and tow together should be of sufficient bulk to produce slight pressure on the sole when the nails of the shoe are drawn up. this insures contact between the dressing and the exposed surface, as well as any benefit derivable from pressure. [footnote a: the words in italics are alterations in the original article made by mr. malcolm in a private letter to the author (h.c.e.).] 'the dressing of the foot and nailing of the shoe can usually be more expeditiously performed when the horse is on his feet than when prone. if only the frog, or the frog and a small part of the sole, be involved, the horse should be kept at work, but if a large part or the whole of the sole a few days' rest may be necessary; but as soon as the condition of the foot will allow, work should be resumed, and it is simply marvellous how sound a horse will walk while minus the greater part of his sole from canker. 'on the second day following the shoe should be removed, and the foot redressed. to effect this it is necessary to recast the horse. commencing at the edge of the sound horn, at the most dependent part of the foot, all new horn, no matter what its condition, must be pared to the quick, especial care being taken to effectually remove any lingering disease. want of success is frequently attributable to neglect of this precaution. a small particle of canker remains undetected, forms a new centre of infection, and just when success is anticipated, much to your chagrin you have to deal with a fresh outbreak of canker, instead of a rapidly-healing foot. parenthetically, i may here remark that the amount of more or less imperfect new horn produced by a cankered surface after an effective but not too destructive cauterization is almost incredible, and one cannot fail to be struck with the very active proliferation here compared with the meagre production of new horn by the healthy surface. 'after all disease has been excised, carefully clean the foot with waste, thoroughly protect any raw surface resulting from overcauterization by some mild agent, such as a saturated calomel ointment, reapply an astringent dressing over the whole affected surface, and nail on the shoe. this method of procedure should now be thoroughly carried out daily for a time, and as it is proceeded with a successful issue soon becomes assured in nearly every case. where, in spite of these efforts, the disease still persists, depend upon it the fault is with the operator, who has failed to eradicate some centre of infection. under these circumstances it may be necessary to recast the patient, repare the foot, and by the aid of eye, knife, and cautery, endeavour to find the cause, and having found it, which can invariably be done, remove it. the usual treatment will then speedily become successful. as the case proceeds dressing every other day will soon be sufficient, then twice a week, and finally, once a week until sufficiently cured. 'during this healing process, and after the complete eradication of canker it may be again repeated, no agent seems to have a more beneficial effect than calomel, and for this purpose it is best used as a dry powder. under this dressing any remaining spot of canker is readily detected by the wet condition of the calomel when the shoe is removed the next day. in dealing with such a spot, a very good plan, after all apparently diseased tissue has been excised, is to touch the cankered part with solid nitrate of silver, or a feather dipped in one of the strong mineral acids, and then reapply calomel over the surface. the result of this treatment is frequently very gratifying. 'in successful treatment the shoe must be removed each time--an adjustable plate will not do, as no man can thoroughly pare and examine a foot with the shoe on, and imperfect dressings are worse than useless. indeed, it is better not to pare or thin the horn at all, than to imperfectly pare, since canker, if undestroyed, develops far more rapidly under thin horn than under thick. 'in conclusion, i would again urge the necessity, at the very first operation, when the horse is down, of removing _every single particle_ of the diseased tissue, either by excision or effectual cauterization, but at the same time taking very great care to guard against the latter being too destructive. the cautery should be laid aside as soon as the tissue cauterized ceases to _burn white_. the moment at which the canker has thus been eradicated without destroying sound tissue is indicated by the appearance of healthy horn, by the intimate union of that with the secreting surface, and by the healthy aspect of the exuded blood when paring has been carried to the quick. 'should subjacent healthy structures be destroyed during the process, that is shown by the production of a raw sore, or of a sore to which a "sit-fast," coextensive to the injury, is firmly attached. this seriously retards recovery. the secreting surface having been destroyed, no new horn can be produced directly from the part, and a new secreting surface and new horn have now to grow inwards from the surrounding undestroyed tissue, and that is a slow process. at the same time, on the principle of choosing the least of two evils, practical experience teaches that it is better to produce a small sore or a "sit-fast" than to leave a part of the canker undetected; but, on the other hand, it is better to leave a small part of canker undetected, which can be recognised and removed at the next examination, than to cause a large slough. the object of the skilful surgeon is, naturally, to avoid both extremes; and if trouble be taken to carry out the procedure described, there need be no fear of the result.'[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. iv., p. .] treated in this way, the horse with cankered feet may be usually kept at work during the whole time that treatment is carried out, and a cure is obtainable in periods varying from six weeks to six or even twelve months. the same essentials in treatment--namely, removal of diseased horn, antiseptic dressings, and pressure--are insisted on by other writers. bermbach,[a] in , treats canker as follows: the horse having been cast, the undermined hoof-horn is removed with the knife, and the hypertrophied sensitive structures, if necessary, reduced in the same manner. the chief difficulty in removing the latter is experienced in the lateral lacunæ of the frog, where it is most conveniently scraped away with a spoon or sharp curette. professors hoffmann and imminger also operate in the same way, applying an esmarch's hæmostatic bandage, and using the knife and curette freely.[b] [footnote a: _ibid_., vol. ii., p. .] [footnote b: _veterinary journal_, vol. xxxv., p. .] hæmorrhage is afterwards arrested, and a dressing of perchloride of mercury (a solution, / per cent., in equal parts of alcohol and water) applied. the after-dressings succeeding best are those of _slightly_ caustic and astringent agents, preferably in the form of a powder, and held in position by carbol-jute pads and linen bandages applied with a certain amount of pressure. the same author draws attention to the fact that caustic agents such as nitrate of lead, chloride of zinc, etc., act too powerfully if the bleeding has been arrested and the wound disinfected. they then form a thick crust, under which profuse suppuration takes place. the same agents are likewise contra-indicated when hæmorrhage is still present. in this latter case they combine with the blood to form metallic albuminates, which lie as an impenetrable layer on the surface of the wound, and so hinder the action of drugs on the tissue below. during his after-treatment, bermbach advocates removal of the dressings every second day, all cheesy material to be scraped away with the knife, and the sublimate lotion to be used again. he also insists on the animal being kept standing in a _dry stable_,--nothing but a stone pavement kept clean--and put to regular work in a plate shoe after the first or second week. cure of advanced cases is said to be obtainable in from four to six weeks. as illustrative of the value of pressure in the treatment of canker, we may also draw attention to a treatment advocated by lieutenant rose.[a] this observer holds that adequate pressure is unobtainable by packing the foot, and, to obtain it, removes the wall from heel to heel, much after the manner of preparing the foot for the charlier shoe, so that the _whole_ of the weight is taken by the sole and the frog. tar and tow is then lightly applied, the foot placed in a boot, and the patient turned into a loose-box. the dressing is repeated at intervals of four or five days until the animal is cured. [footnote a: _veterinary record_, vol. xi., p. .] those who have followed this method of treatment have modified it by actually shoeing the animal charlier fashion, and keeping him at work, attention, of course, being at the same time given to a proper antiseptic dressing. _reported cases_.-- . (malcolm's treatment[a]). the subject was a five-year old horse belonging to a client of mr. giver's, of tamworth. the case was an exceptionally bad one, for not only was the whole of the frog and sole of the near hind-foot cankered, but the disease on the outside quarter extended to within / inch of the coronet, and on the inside quarter to within inches of it. as the owner, a farmer, had not proper convenience for mr. olver to treat the case, the latter asked me, while visiting him, if i would care to undertake the treatment, saying at the time it would be a very good test-case, as the disease was so far advanced. i readily agreed, and, after the necessary arrangements, had the horse removed to birmingham on july . in this case it was found necessary to cast the animal and cauterize the foot a second time before a healthy granulating surface was secured; but after this the progress towards recovery was uninterrupted, although necessarily slow, on account of the large amount of new secreting surface which had to be formed. [footnote a: _journal of comparative pathology and therapeutics_, vol. v., p. .] the horse was finally discharged, after inspection by mr. olver, absolutely cured and free from canker, on january . the illustration (fig. , p. ) is from a photograph, and it gives a somewhat imperfect representation of the state of the foot two months after it came under my care. . (rose's treatment.[a]) this was a bad case of canker, which had been for two or three months treated in the ordinary manner, with but little sign of ultimate success. commenced in june and carried on until the end of september, the ordinary treatment consisted in burning down the fungus growth with the hot iron, and dressing with copper sulphate, zinc sulphate, and boracic acid. the cauterization was repeated every five days. [footnote a: _veterinary record_, vol. xi., p. .] the treatment of lieutenant rose was commenced at about the end of september, at which date the disease extended from the toe on one side of the foot right back to the heel, involving the sole, half of the frog, and the bulb of the heel. one week after treatment the diseased surface was drier, and granulations were more healthy. at the expiration of a fortnight the new horn had commenced to grow from the wall, and also from the frog, right round the diseased surface, the diseased part of the bulb of the heel being divided from the sole by new horn. three to four weeks later the diseased surface was gradually getting smaller, while in about six weeks it was quite healed up, the last place to heal being a strip outside the bar, between it and the wall, and a smaller spot on the bulb of the heel. these healed up simultaneously, and left the animal sound. . (treatment by pressure, h. leeney [a]). i was consulted in the early part of last summer, before the dry weather had begun, as to a farm-horse with canker in three feet. her shoes were in the 'disgruntle' condition we so often find on farms, that, to give her a level bearing until i should call another day with a farrier to help me to pack the foot up in the old-fashioned way, i had the remaining shoes pulled off. the case somehow dropped out of my list, and i neglected to call, until asked one day to see something else. [footnote a: _veterinary records_, vol. xi., p. ] i then found that, under a pressure of work, the animal had been used in the shafts of a farm-cart on tolerably level ground, and when the dry weather had already set in. there was a distinct improvement in all the diseased feet, and as she was badly wanted i contented myself with rasping off some broken crust, and supplied some caustic dressing for use at night. without shoes she worked continuously on the dry and hard meadow-land for several weeks, and was practically cured in something less than three months. my astringent or caustic lotion may have had something to do with the cure of the deep-seated parts, but the bare recital of the case should be sufficient to show that it is all a question of bearing, or nearly so. . specific coronitis. _definition_.--in describing this condition under the above heading, we are following the lead of mr. malcolm. we may define it as a chronic inflammatory condition of the keratogenous membrane, usually confined to that of the coronary cushion, the ergots and the chestnuts, but sometimes extending to that of the frog and the sole, characterized by a malsecretion of the affected membrane similar to that observed in canker. _causes_.--the cause which we have indicated for canker--namely, a local specific one, is in all probability the one operating here. apparently there is a variance of opinion as to whether the condition is actually canker or not. we think, however, that the character of the secretion of the affected membranes, the appearance of the growths, the manner in which they react to the hot iron, the comparative absence of pain, and other points of similarity, point to the fact that the two conditions are actually identical. in other words, the cause is precisely the same, and the only point of difference is the alteration in the point of attack. _symptoms_.--like canker, the disease is insidious in onset. in precisely similar manner the horn, and in this case the skin of the coronet, is underrun. later there is the partial shedding and fissuring of the undermined horn and the exuding of the characteristic discharge--in this case not so watery as that of canker. the caseous material of canker is also present, as is a disposition to hypertrophy of the exposed sensitive structures. what horn is left becomes rough and irregularly fissured, and has been likened by some observers to deeply-wrinkled bark of an old tree. a peculiar characteristic of this condition is the state of the ergots and chestnuts. here the keratogenous membrane participates in the diseased process, and their horn becomes dry and brittle, and readily splits into small fibrous bundles very similar to the fibroid growth described in canker. these excrescences are easily separated from the sensitive structures beneath, and the exposed surface is seen to be more or less moist, or even exhibiting a slight oozing of blood. again, as in canker, the deeper layers of the sensitive structures appear to be normal, the horn-secreting layers being the only ones affected. according to malcolm, the disease is in its nature equally as inveterate as canker, but it is easier to treat, on account of its more exposed position. _treatment_.--this is exactly that as described for canker. [illustration: fig. .--specific coronitis of all four feet.] [illustration: fig. .--off fore-foot affected with specific coronitis.] _recorded case_.--the subject of this case was a young black cart gelding. the disease is reported as having begun as thrush, and then extended to the coronet. when i saw him he had been in a similar condition to that depicted in fig. for, it was said, two or three months, the driver of the horse meanwhile endeavouring to effect a cure by some potent drug of his own. the animal was in good condition, but walked with difficulty owing to the pain. the coronary bands were swollen to two or three times their natural size, and this caused the hair immediately above to curl upwards. just below the coronary bands there was a line of separation between them and the wall. they themselves were covered with the cheesy substance typical of canker, and they bled on friction. down the wall of the off fore-foot some blood had trickled, which may be seen in fig. . the frogs of all four feet bulged backwards, and were badly affected. the soles were covered with normal horn, but i did not resort to paring to see if they were affected. one very curious feature about the case was the fact that all the callosities (ergots and chestnuts) seemed to participate in the morbid process, and they, too, were covered with a thin layer of soft cheesy horn. the animal used to bite at his coronets and also the callosities above the knees and hocks until they bled, which they did quite easily. the owner would not go to the expense of having him treated, so he was destroyed.[a] [footnote a: henry taylor, _veterinary record_, vol. xvii., p. .] chapter x diseases of the lateral cartilages a. wounds of the cartilages. to a consideration of this we shall devote but little space. it is sufficient to say that any wound in the region of the coronet should always be given the most careful attention. more particularly should this be so when it is ascertained that the wound has involved one of the lateral cartilages. wounds of non-vascular bodies such as these are always slow to heal, and, by reason of their slowness, invite septic infection. in many cases, in fact, it happens that they do not heal at all. instead, the injured part becomes necrotic, is unable to cast itself off, and remains as a centre of infection in the depths of the wound, thus constituting what is known as a quittor. apart from this, it will be remembered that the internal face of the cartilage is in intimate contact with the pedal articulation, especially anteriorly. wounds in this situation are, therefore, likely to penetrate the joint, giving us as a complication of the injury the conditions of synovitis and arthritis. immediately a wound is inflicted in this position, attempts should be made to insure thorough asepsis of the part. when possible, by far the better way of accomplishing this will be to wholly immerse the foot in a tub of cold antiseptic solution, and keep it there for an hour three times daily. during the time the foot is out of the solution the wound should be protected with a pad of carbolized tow or other suitable dressing, and wrapped in a linen bandage or clean bag. if unable to use the bath, then antiseptic solutions of more than moderate strength should be freely applied to the wound and the adjacent parts, a carbolized or other antiseptic pad placed over it, and the bandage adjusted as before. repeated injuries to the cartilages, even if not attended with an actual wound, are apt to bring about their ossification and end in the formation of side-bones. b. quittor. _definition_.--a fistulous wound of the foot, usually opening at the coronet, and variously complicated according to the structures invaded by its contained pus. for the reason that quittor is in every-day veterinary nomenclature _usually_ associated with necrosis or other abnormal condition of the lateral cartilage, we include its description in this chapter. _classification_.--it has been customary with continental authors to classify quittor according to the extent and position of the diseased process. there were thus distinguished: _(a)_ the _simple_ or _cutaneous quittor_, in which had occurred nothing more than necrosis of a portion of the coronary skin and the structures immediately underlying it--that is, the superficial portion of the coronary cushion. _(b)_ the _tendinous quittor_, in which not only the immediately subcutaneous tissues were attacked, but also portions of tendon and of ligament. _(c)_ the _sub-horny quittor_, in which the diseased process had invaded the deeper portions of the coronary cushion, and continued a downward course until the laminal tissue below the upper margin of the wall was involved, or any other case, no matter what the starting-point, in which pus existed within the horny box and was discharging itself by a fistulous opening. _(d)_ the _cartilaginous quittor_, in which a portion of the lateral cartilage had become attacked and rendered necrotic. we believe that--in this country, at any rate--the word 'quittor' is usually held to indicate one or other of the two latter conditions, and probably the last of these; and that the two first are held of small account, or hardly of sufficient gravity to allow of the word 'quittor' being applied to them. in fact, by defining quittor as a 'fistula,' or little pipe, we have ourselves already indirectly restricted the use of the word to the two latter conditions, for in those varieties known as simple or cutaneous and tendinous, the wound is generally broad and open, or, at any rate, superficial, and can scarcely be strictly described as 'fistulous.' in the two latter, however, a true fistula exists. these, however, have only one essential difference, and that consists simply in the position of the lesion and the structures it has attacked. in the main the symptoms will be the same, the disease in each case about equally serious, and in each the same essentials of treatment will have to be regarded. in our opinion, therefore, a lengthy classification serves no useful end, and we think matters will be simplified by considering quittor under two headings only--namely, 'simple or cutaneous' and 'sub-horny,' and discussing the other varieties as simply complications of either of these two. . simple or cutaneous quittor. _definition_.--this condition is simply a sloughing of a portion of the skin of the coronet, together with a portion of the immediately underlying soft structures. _causes_.--this form of quittor has its origin more often than not in contusions, punctures, or wounds of the region severe enough to cause death of a small portion of the tissues. in this case the low vitality of the parts does not allow of the dead portion being removed piecemeal by a process of phagacytosis, as is usually the case with similar injuries elsewhere. instead, the tissues around, aided by a process of suppuration, cast the offending portion off as a slough. it is the wound remaining after the slough which we may really regard as a quittor. in this connection may be considered as causes blows from falling shafts, self-inflicted treads, or treads from other horses, overreach, etc. on the other hand, simple or cutaneous quittor may occur without ascertainable cause. in this case we can only explain its appearance, as we did that of simple coronitis (see p. ), by attributing it to septic infection through a wound or a blow that is able to inoculate the skin, yet which is insufficient to cause pain, or in any other way attract the attendant's notice. meanwhile, the spot of infection thus started spreads, and the end result is an abscess in the coronary region, again accompanied with necrosis and sloughing of more or less skin and other tissue, which terminates by discharging its contents and leaving behind a wound which again constitutes a cutaneous quittor. thus, as with simple coronitis, anything lowering the vitality of the parts, and so favouring infection of the skin, may bring about a quittor. walking through much water in the winter months, through the dirt and mud of our streets, through melting ice and snow, or through anything in the nature of a chemical irritant, may be looked upon as a cause. _symptoms_.--whether commencing from an ascertainable injury, or beginning at first unnoticed, cutaneous quittor is characterized sooner or later by the appearance of an inflammatory swelling, usually confined to the seat of injury. heat and tenderness are present, and the animal is lame. later the inflammatory swelling becomes more profuse, the animal is fevered, and the symptoms of lameness increased. poulticing is at this stage perhaps resorted to. by its means the process of suppuration is aided, and the swelling (at first tense and hard) either becomes gradually softened, its contents discharged, and a simple abscess cavity left behind, or the suppuration runs immediately round the necrosed structures, and casts them off bodily as a slough. this latter condition is always manifested, where the hair does not hide it, by the colour of the skin. at first this is only red in colour--the angry red of an inflamed spot. as its intention to slough away becomes evident, the red gradually gives way to a gray, or even blue-black appearance, while from around it oozes a slight discharge of pus, yellow in colour and non-offensive, or blood-stained and dark in appearance, and foetid to the smell. almost invariably these symptoms are added to by a more or less diffuse and oedematous swelling of the lower portion of the limb, extending in some cases to as high as the fetlock or the upper third of the cannon. with the casting off of the slough the phenomena of inflammation to a great extent subside, the pain ceases, and the case under ordinary conditions commences to mend. _pathological anatomy_.--in its early stages the condition of simple or cutaneous quittor is really a condition of acute coronitis (see p. ), and consists in an inflammation of the subcutaneous tissue, and the more superficial portions of the coronary cushion. the tissues implicated are destroyed outright, become infiltrated with the inflammatory exudate and escaped blood, and act as a source of irritation to the still living tissues around. under the irritation the latter, as we have said before, cast the necrosed portion away by a process of sloughing. always, however, it is found that the portion to be sloughed off, while easily separated from the tissues adjacent to its sides, is closely connected on its lowermost or deeper face with the structures below, and cannot be torn away without hæmorrhage and the causing of acute pain. _prognosis_.--with wounds about the feet our forecast should always be guarded. even with this, the most simple form of quittor, no decided opinion should be given until the progress of the case warrants one in reasonably assuming that complications are absent. once this point is decided, a favourable prognosis may be given. _complications_.--with cutaneous quittor various complications may arise, according to the extent of the invasion of the septic matter. necrosis of tendon, of ligament, or of cartilage, caries of the bone, or a condition of synovitis and arthritis may be met with. as these complications are equally common to sub-horny quittor, we shall reserve their description until dealing with that condition. _treatment (preventive)_.--immediately after the infliction of an injury in this position, more especially if it is such as to lead one to judge that necrosis will follow to any large extent, the patient should be rested. ill effects may then be probably warded off by having the foot immersed in a cold antiseptic solution, and afterwards bound with an antiseptic pad and bandage. _curative_.--when the condition has gone undiscovered until commencing necrosis and suppuration are plainly discernible, then the wisest course we can follow is to do all we can to hasten removal of the necrosed portion. this is best done by promoting the suppurative process by means of warmth or stimulant applications. to this end hot poultices, or, better still, hot baths, should be resorted to. under their influence a greater supply of blood is directed to the still healthy tissues enabling them to actively continue the inflammatory processes necessary to the detaching of the portion necrosed, while, at the same time, the pus organisms, stimulated by the heat, are stirred into greater activity, and the readier accomplish their purpose of destroying the adhesion still existing between the necrotic portion and the surrounding living tissues. when prolonged poulticing or bathing cannot be practised, then the swelling should be stimulated with a sharp cantharides blister, repeated, if the case demands it, at intervals of a few days. should the swelling show distinct signs of pointing, and an abscess is plainly the condition to be dealt with, its contents should be liberated by a free use of the knife. in this connection it is important to insist on the fact that the opening should be made large enough. one bold incision from the uppermost limit of the swelling down to the coronary margin of the wall is usually sufficient. even when pointing is not very evident, and suppuration is plainly more or less diffuse, benefit may still be derived from the use of the knife. in this case a deep scarification of the part is indicated. three, four, or more vertical incisions are made in the swelling, and from them obtained a flow of blood mingled with a small quantity of pus from several different centres. by this means sloughing of the diseased portion is quickly obtained, and nothing but an ordinary open wound left for treatment. it should be mentioned, however, that when sloughing can be in any way induced to take place naturally it is better to allow this to take place. even when the necrosed portion is freely movable, and only adherent by its base, it should not be forcibly removed, but left to the slower but more effectual action of the tissue reactions. if torn forcibly away, we in all probability leave in the bottom of the wound remnants of the dead tissue, which, being small and consequently less productive of inflammatory phenomena, are not so readily sloughed as the larger portion. these remain as centres of infection, and prolong the case. once a suitable slough has occurred, the after-treatment is simple. it consists in dressing the wound with reliable antiseptics, and maintaining the parts in a healthy condition until nature completes the cure by repairing the breach. solutions of carbolic acid, of perchloride of mercury, of zinc chloride, or of moderately strong solutions of copper sulphate, are all of them useful (see also treatment of coronitis on p. ). it is sometimes found that even with careful attention the wound left by the removal of the slough shows a marked disinclination to heal. the greater portion of the cavity becomes filled with granulation tissue, and the epidermis gradually closes round until all is covered except a spot of perhaps the size of half a crown or a crown piece. here the regenerative process stops, and the wound obstinately refuses to effectually close. in such cases we have derived excellent results with the actual cautery. the animal is cast, the foot firmly secured by fastening it upon the cannon of another limb, and the animal chloroformed. a practical point to be remembered in this connection is that all necessary fixing of the limb is easier performed if the chloroform is administered first. with the patient thus secured we first of all ascertain by means of the probe whether or no the non-healing of the wound is due to the presence of a fistula. decided in the negative, we take an ordinary flat firing-iron, and with it cut away a portion of the skin immediately around the still open wound, carrying our incisions deep enough to 'scoop' out a large portion of the new inflammatory tissue beneath. with the loss of pressure from beneath, occasioned by the removal of so much of the cicatricial tissue, the epidermis the more readily closes over the wound. to a large extent also this new growth of epidermis is helped by the renewal of the inflammatory phenomena brought into being with the cauterization. . sub-horny quittor. _definition_.--a fistulous wound of the foot in which the lower and blind end of the fistula is situated below the level of the coronary margin of the wall. _causes_.--these, again, will be practically the same as those mentioned in the cause of cutaneous quittor--namely, bruises, punctures, wounds--in fact, any injury upon the coronet severe enough to cause death of tissue and a suppurating wound. we may thus expect sub-horny quittor to follow upon treads, overreach, accidental injuries with the stable-fork, and kicks from other animals. sub-horny quittor may also arise without original injury at all to the coronet. either from a violent blow upon the hoof, or from the animal himself kicking violently against a wall, death of a portion of the sensitive structures takes place within the hoof, suppuration ensues, and the formation of quittor commences. with the escape of the pus at the coronet the quittor is fully formed. any other diseased condition of the foot in which suppuration is present may in like manner terminate in quittor. in complicated sand-crack, suppurating corn, or in ordinary pricked foot quittor may be a sequel. in these conditions the pus formation either goes unnoticed or is neglected, and after seriously invading the sensitive structures within the hoof, breaks out at the coronet. again, too, as with the simpler form of quittor, and as with coronitis, we may always regard as a predisposing cause the action of excessive cold in promoting septic infection of the wound when occurring at the coronet. _symptoms and diagnosis_.--where the fistulous wound has had its starting-point in an injury to the coronet diagnosis is, of course, easy. the history of the case explains it. nothing in this instance remains but to probe the opening, and ascertain its direction, depth, and extent. an animal with the wound thus open at the coronet, and freely discharging its contents, may, if no serious complications exist, walk tolerably sound. it is only when put to the trot that symptoms of lameness are apparent. it may so happen, however, that we first see the case when the symptoms are wholly those arising from a painful suppuration within the horny box. this occurs when the original injury has taken place at a more dependent position than the coronet. either from violent blows upon the hoof, puncture from below, from corn or from sand-crack, or any other causes we have enumerated, suppuration is occurring deeply within the hoof, with as yet no opening upon the coronet. even when an opening has already occurred on the coronet, the same condition of sub-horny suppuration may be met with in cases when the opening of the fistula has by some means or other become occluded. granulation tissue, for instance, may have temporarily closed the mouth of the fistula. the pus, instead of continuing its discharge thereat, is made to burrow in other directions. in either of these cases pain is excessive, the animal walks on three legs, the foot is painful to percussion, and grave constitutional disturbance is noticeable. the presence of pus is immediately suspected, and, in the absence of any indication of an opening having existed at the coronet, searched for at the sole. it may or may not be found. if found it is given exit, and the case ends as one of ordinary pricked foot, of suppurating corn, or some other condition equally simple when compared with quittor. in those cases where the pus is not discovered at the sole, one adopts the expectant treatment of poulticing. this, if pus is present, is followed by a painful swelling of the coronet. at one point there forms a hot and tender enlargement, with the hairs on it standing straight up from the skin, which latter is seen below red and inflamed in appearance. later, the abscess--for abscess it is--discharges its contents, the opening is explored, and we find that in extent it is not confined to the coronary region, but that it is deep enough to constitute a true sub-horny quittor. this discharge of the abscess contents may take place at a well-defined spot on the coronet, or it may ooze out at the junction of the wall with the skin. in appearance the discharged pus varies. when the softer structures only are attacked it is thick, and yellow or white in colour; when bone is involved it is ichorous; and when attacking the horn itself black or gray. it may or may not be extremely foetid, and often it is mingled with blood. when evidence of a previous opening upon the coronet is plain, then it is not considered wise to attempt a paring of the sole. instead, poulticing is at once resorted to, to induce the discharge of the pus through its original channel. once this has occurred a fistulous wound remains, which is open for treatment upon one or other of the lines we shall afterwards indicate. complications--_(a) necrosis of the lateral cartilage_.--this is the so-called 'cartilaginous quittor' of other writers. in all probability it is the condition generally understood when the word 'quittor' is used by one practitioner to the other. its tendency to keep the disease existing in a chronic form renders it of grave importance, and for that reason we give it first mention among the complications. it may occur as a sequel either of cutaneous or of sub-horny quittor, and may result either from actual wounding and infection of the cartilage, or from an attack on it of septic matter originating elsewhere. unless there has been discovered a fistula, which on probing is seen to lead direct to the position in which we know the cartilage to be, we know of no precise means by which the existence of this condition may be diagnosed. when free from other complications, the horse with his foot in this state may travel fairly sound. this is so when the necrosis is situate in the posterior half of the cartilage, in which case the irritation set up by the disease is confined to the comparatively non-sensitive tissues of the cartilage itself and the fibrous mass of the plantar cushion. when attacking the anterior half of the cartilage, the close contiguity of the joint renders the disease of a more serious nature. it is then that we have acute pain, and with it extreme lameness, for in this position it is more than likely that we have involved either the synovial membrane of the articulation or the tops of the sensitive laminæ. it will be remembered that here the synovial membrane protrudes as a small sac between the antero- and postero-lateral ligaments of the joint. more or less easily then it is bound to come into intimate contact with the septic matter attending the necrosis of the cartilage, and so share in the inflammatory processes, afterwards communicating them to the interior of the articulation. with necrosis of the lateral cartilage is always swelling and thickening of the skin and subcutaneous structures of the coronet. this is the greater the longer the disease has been in existence. upon the swelling is seen the mouth of the fistula, or it may be the mouths of several, and from them all a discharge of pus. the mouth of each fistula is generally filled with a mulberry-like granulation tissue, standing above the level of the skin, and bleeding easily if touched. the exuding pus is thin and pale gray in appearance, gritty to the touch, and generally free from pronounced smell. at other times its colour is reddened with contained blood, and floating in it are tiny particles of a pale-green substance, which when picked up and rubbed between the fingers are seen to be small fragments of the diseased cartilage. should the mouth of a fistula become occluded with the granulations filling it, and the discharge prevented from escaping, it soon happens that we have close to the fistula that has closed a tender fluctuating swelling. this points and breaks, and pus is again discharged from another opening. in this manner is accounted for the multiplicity of scars and fistulas seen on the swelling of an old-standing quittor. the continued, inflammation thus kept in existence has the effect of rendering the skin and subcutaneous tissues in the neighbourhood greatly thickened and indurated. this in time leads to a tumour-like enlargement, and causes the structures of the coronet to greatly overhang the hoof. at the same time the constant inflammation has made its stimulant effects noted in a great increase in the growth of the horn of the wall. although more abundant, however, the quality of the horn is deteriorated. the perioplic ring has become obliterated, and the varnish-like appearance of the healthy wall destroyed. cracks and fissures in its surface are numerous, and sometimes deep enough to lead to exposure of the sensitive structures beneath, complicating the quittor with a sand-crack of a peculiarly objectionable type. _pathological anatomy of the diseased cartilage_.--the bulk of observers appear to agree in the statement that in quittor the necrotic cartilage is pea-green in colour, and recognise it by that characteristic. in size the necrotic portion thus recognisable varies from the tiniest speck to a portion the size of a horse-bean. commonly, however, it is about as large only as a pea. it is seen to be more or less detached from the rest of the cartilage, to which it is adherent by one of its extremities only. in general appearance we can best liken it to the split half of a green pea, whilst others have compared it with the green sprouting of a seed. the portions of cartilage nearest the necrotic piece are also slightly green in colour, thus indicating that here also the diseased process has commenced. this peculiar change of colour in the affected cartilage is of great importance to the surgeon. it enables him when operating to distinguish with some degree of certainty those portions of the cartilage which are healthy and those which are not. _(b) necrosis of tendon and of ligament_.--this complication of quittor is, as we have said before, treated by other writers as a distinct form of the disease, and described by them under the heading of tendinous quittor. this simply means, of course, that the diseased process has extended to either of the flexor tendons, to the tendon of the extensor pedis, or, perhaps, to the ligaments of the pedal articulation. of the flexor tendons, the perforans is the one commonly attacked, by reason, of course, of its more superficial position. at times, however, especially when its aponeurotic expansion is diseased, the necrosis of the perforans spreads until the aponeurosis is eaten through and the phalangeal sheath penetrated. septic materials gain entrance thereto, and commence to multiply. in this way the flexor perforatus is invaded, and comes to share in the diseased process. the extensor pedis is usually attacked by extension of the disease from a necrotic cartilage, or results from the infliction of a severe tread in a hind-foot. in this case the diseased structure has nothing between it and the articulation, the synovial membrane in one position actually lining its inner face. the result is that a condition of synovitis is easily set up, and the case aggravated by that and by arthritis. with the flexor tendons attacked pain is always very great, and lameness is excessive. this, however, is not sufficiently characteristic to enable us to determine the precise seat of the necrotic changes. later, however, a tender but hard enlargement made its appearance in the hollow of the heel, which enlargement, later still, became soft and fluctuating. at this stage there is also considerable swelling along the whole course of the tendons, as high up as the knee or the hock. the foot is carried forward with all the phalangeal articulations flexed, and in many cases the limb is unable to take weight at all. manipulated after the manner of examining the tendons for sprain, this swelling is found to be extremely painful. the animal flinches from the hand, and shows every sign of acute suffering. this condition may, in fact, be mistaken for sprain, and is only to be distinguished from it by carefully noting the history of the case--first, the appearance of the swelling in the hollow of the heel, and, secondly, the _after_-swelling of the upper portions of the tendons. the formation of the abscess, the after-discharge of its contents, and the final establishing of a fistula, are processes greatly prolonged in this form of quittor. it will readily be understood why this should be so when one remembers the depth at which the suppurative process is going on, the thickness of the metacarpo-phalangeal sheath, and the resistant nature of the material of which this latter is made, and which must be penetrated before the condition becomes observable. after the opening of the abscess, which usually takes place in the hollow of the heel, there is left the fistulous wound which obstinately refuses to heal. or it may be, again, that there are several of these fistulas, each opening in the heel, and the mouth of each marked by a small, ulcer-like projection. the discharge continually oozing from these keeps the heel constantly wet with a thick purulent discharge, which is nearly always blood-stained, and very often foetid. this constitutes what is known as tendinous quittor in its worst form, for more often than not there is associated with it inflammation of the navicular bursa, caries of the bones, or arthritis of the pedal articulation. with the extensor pedis attacked matters are not quite so grave, in spite of the fact that the articulation is closely situated thereto, for in this case the more superficial position of the diseased structure allows both of readier exit of the discharges and of easier removal of the necrosed portion and after-treatment of the wound. _(c) caries of the bones_.--portions of the os pedis, more especially of its wings, and therefore usually occurring in conjunction with necrosed cartilage, become carious in quittor. in many cases it is impossible to say with certainty when this has occurred. in a few instances, however, the exuding discharge gives evidence of what has happened. it is thin, but extremely offensive, with the characteristic odour of decayed bone or tooth, and with a feel that is gritty with contained particles of broken-up bone. if, with a discharge of this nature present, the probe also conveys to the fingers the sensation that bone is reached, then diagnosis may be sure. _(d) ossification of the cartilage_.--this may take place in part or in whole. it, of course, constitutes side-bone, a fuller description of which will be found in a later portion of this chapter. _(e) penetration of the articulation_.--this may occur either as a result of the suppurative changes or as an accident in excision of the diseased cartilage. unless it is followed by a severe purulent arthritis, it is not so grave a complication as at first sight it would appear. _(f) synovitis and arthritis (purulent)_.--should this complication arise, the case is a most serious one. beyond here mentioning the fact that it may occur, we shall not dwell on it. fuller consideration is given to it in chapter xii. _treatment_.--the various treatments adopted for the cure of sub-horny quittor offer the veterinary surgeon a large number to select from. we will describe them in the order in which they are, perhaps, most commonly practised. _poultices and hot baths_.--as in cutaneous quittor, and as in coronitis, when the pus formation is only suspected, and has not yet broken out at the coronet or elsewhere, then the first indication in treatment is the use of warm poultices or of hot baths. their application is in most cases productive of pointing at the coronet. directly this appears it is a wise plan to thin the wall down with the rasp immediately below the swelling. to some extent it relieves the pressure of the inflammatory products within, and at the same time paves the way for operative measures which may be necessary later on. with the breaking of the abscess and the discharging of its contents, we may in some measure ascertain the condition we have to deal with. the probe is used, and the abscess cavity explored. the size of the wound, its depth below the upper margin of the wall, the structures involved, and other information, may be thus obtained. at first, however, the nature of the wound, and the character of the discharges, must largely guide us as to the treatment we adopt. in many cases, even where the abscess cavity is far below the upper margin of the wall, and is presumably in an unfit position to drain and heal, a a regular application of an astringent and antiseptic dressing is sufficient to bring about resolution. if, however, the discharge from the wound continues to be liquid, and the wound itself at one spot refuses to heal, it may be judged that a portion of necrotic tissue is situated under the wall, and affecting the laminæ, the cartilage, or ligament, as the case may be. if this is so, then operative measures must be determined on (see removal of the wall, p. ). _blisters_.--instead of the poultice and hot baths, the pointing of the abscess and the casting off of the slough may be brought about by the application of a sharp cantharides blister. we have, in fact, seen many cases where this treatment was adopted prior to the formation of a fistula, and also in cases where one or more fistulous openings already existed, where repeated blisters to the coronet have alone been sufficient to effect a cure. we are bound to admit, however, that the treatments of poulticing and blistering are only expectant--we might almost say empirical. at any rate, we admit to ourselves that what we have advised and carried out is not in itself curative, but only a means of assisting nature to satisfactorily work her own ends. empirical or not, however, we believe that in every case of quittor it is wise in practice to at first adopt some such simple measure, for in nearly every instance where operative measures are practised, the patient must be laid aside for at least several weeks, whereas in this way he may be kept at work and a cure effected at the same time. _the actual cautery_.--largely of the same empirical nature, yet doing something a little more calculated to destroy necrotic tissue and bring about its sloughing is the use of the cautery, both actual and potential. the actual cautery may be beneficially employed for the relief of sub-horny quittor in at least two ways. in the first place, it is often used--a blunt 'point-firing' iron being the instrument--instead of the knife as a means of evacuating the contents of the coronary abscess. those who use it for this purpose are able to say this in its favour: it brings about the opening of the abscess without the unsightly hæmorrhage attending the use of the knife, and at the same time just as effectually empties it. the opening made is not nearly so likely to close prematurely--that is, before a proper course of treatment of the wound has been carried out--and so leave necrotic tissue at its bottom. the intense tissue reaction it sets up is productive of a large slough, cast off by highly active inflammatory phenomena, which means that the remaining wound is one in which no dead tissue is left, and which is more amenable to treatment. we have also seen the actual cautery used in sub-horny quittor, where that disease has reached a chronic fistulous stage, as a means of cauterizing the whole length of the lining of each fistulous passage. at the present day this method is regarded as barbarous, and savouring too largely of the methods and practice of the old empirics. there is no denying the fact, however, that it is at times followed by a speedy and complete cure of what has for months been an intractable and apparently incurable quittor; and, honestly speaking, we ourselves can see nothing very greatly against the operation in certain cases save its appearance. in that it is certainly rough, and is not calculated to favourably impress the more critical of our clientele. with the animal chloroformed, however, much of what can really be urged against it disappears, and on farms and other places where a skilled and competent dressing of an operation wound cannot be looked for, it is sometimes wise to advise this method of treatment in preference to more advanced methods of operating. so far as we can judge, the after-effects are very little worse than those following other operative measures, more especially when a suitable case has been chosen. this method of treatment is particularly applicable to cases of chronic sub-horny quittor in the more posterior parts of the foot. here, if one or more fistulas exist, their openings are probed and the direction of the sinuses determined. in all probability they are burrowing down along-side the wall to the sole, where, for want of outlet, they are invading the substance of the plantar cushion or the plantar aponeurosis. should this preliminary probing demonstrate that neither of the fistulas run dangerously near the joint, then the operation may be decided on. the animal is cast and chloroformed, the foot firmly fixed, and the horn of the quarter rasped away quite thin. the sole of the same side is also pared with the knife until the horn of both the quarter and the sole yields easily to pressure of the thumb. all that is then needed is three or four long, round, and pointed irons (about / to / inch in diameter) heated to redness. these are inserted into the fistulas, and the false mucous coat of these passages thus destroyed. when the iron, on being directed into the fistulous opening at the coronet, is found to travel alongside the wall, and to easily reach the sole, it should be made to go further still. the sole is penetrated, and a dependent opening thus made for the escape of the discharge that afterwards accumulates. what happens now, of course, is that an intense and acute inflammation is set up along the whole track of the fistula, in which position the inflammatory changes were heretofore chronic. the whole lining of the fistula, and with it, we hope, all necrotic tissue, is cast as a slough, leaving nothing but healthy tissue behind. this, with a suitable dressing, heals and gives no further trouble. the after-treatment consists in the application of hot poultices. these tend to greatly ease the pain, and at the same time to facilitate the removal of the slough. the poulticing should be continued, therefore, until the sloughing comes about, which happens, as a rule, at about the fifth or seventh day. immediately the slough is cast off, the poultices may be discontinued and dressing of the wound carried out. this consists of injections of solutions of zinc chloride in , perchloride of mercury in , , carbolic acid in , of villate's solution, or of such other antiseptic as the surgeon may think fit. the dependent orifice at the sole should be kept open for as long as possible, being occasionally trimmed round with the drawing-knife, and scooped out with a sharp-edged director. directly a healthy and pink-looking granulation is observed along the track of the iron, and the discharge therefrom takes on a thick and yellow appearance, the strength of the antiseptic solutions should be gradually diminished. this point, in fact, is of great importance in treating all wounds of the foot. there is a great temptation, on account of the known excessive liability of the parts to septic infection, to use an antiseptic solution unduly strong. what must be remembered is that used _too_ strong they themselves give rise to dead tissue, or to impermeable layers consisting of compounds of the discharges with themselves, and so create substances that prove a source of irritation and subsequent trouble. _the potential cautery_.--this is employed in the treatment of sub-horny quittor, either in the solid form (in sticks, in lumps, or in the powder), or in the liquid form, when it is injected with a quittor syringe. in the former method such drugs as perchloride of mercury in the lump, or nitrate of silver, chloride of zinc, and caustic potash or soda in the stick, are introduced into each of the sinuses present. this is done by means of a director or a probe. a better method, however, when the dressing lends itself to the purpose, is to use it in the form of a powder, wrapped in the form of small cubes in extremely thin paper, such, for instance, as is used for rolling cigarettes. it is then conveniently inserted into each fistula. introduced in this more finely divided form the drug is, perhaps, a little more active in bringing about the desired result. this method of 'plugging,' although practised by many, we cannot recommend in preference to the use of the hot iron or of liquid injections. our reasons are these: the action of the drug is a protracted one. almost immediately after its introduction into the fistula there is formed about it an almost impermeable layer of a metallic albuminate, which effectively prevents further rapid action of the caustic. in addition to thus preventing further action of the dressing, this combination of the tissue albumin with the metal of the salt, together with much necrotic tissue that it has caused, is extremely hard to remove from the healthy tissues. this we explain by pointing out that the action of the caustic, prolonged as it is, sets up a tissue reaction which partakes largely of the type of a chronic rather than an acute inflammation. with a chronic inflammation there is sooner a tendency to the production of fibrous tissue (and thus the firmer attachment of the necrosed portions) rather than an active phagocytosis and the casting-off of a slough. again, careful though we may be with the probe, it is extremely difficult to be certain that we have discovered the whole extent of any fistula. an equal difficulty, therefore, exists in being certain that we have placed the caustic in the position in which it is most wanted--namely, at the furthermost end of the fistula where the necrotic tissue is to be found. when a caustic is used at all, it is far better to employ it in the liquid form, when either of the drugs we have just mentioned may again be used. in the first place, the liquid is far more likely to be brought into contact with the diseased structures than is the solid salt. also, its action may be regulated by altering the strength of the solution, and the liability to form impermeable albuminates thus diminished. probably the best solution for use in this way is the old-fashioned villate's solution (see p. ). this liquid should be injected at least every day, and, in a bad case, even two or three times daily. practical hints to be borne in mind when attempting to cure quittor by means of injections are these: if the fistulas are numerous, the fluid should be injected into their various orifices. in order to force the fluid to the bottom of each diseased track, it is necessary, when injecting one opening, to firmly close all others. several injections should be made at each time of injection. in other words, we must not be content with just forcing fluid in. it must be forced in, and again forced out by a further syringeful. the fistulous tracks must, in fact, be washed in the liquid. the effect of the injection during the first eight or ten days is to render suppuration more abundant and whiter. after two weeks of the treatment sloughing of the inside of the sinuses occurs, and healing of the wound commences. signs that this is occurring are--slight hæmorrhage at the end of each injection, and a gradually increasing difficulty in forcing in the fluid. _the making of counter-openings to the fistulas_.--although villate's solution or any other caustic used in the manner we have described often effects a cure, many practitioners insist on the fact that a counter-opening to the fistula must also be made. the probe is used and the direction and depth of the fistula ascertained. through the wall is then made an opening at exactly opposite the lowest point found by the probe, or through the sole if the probe should there lead us. this opening is best made with a sharp-pointed iron, and may afterwards be kept large enough by an occasional trimming with the knife. many of the older authors, and with them writers of the present day, declare that unless this is done the ordinary injection is likely to fail in a great many instances where it would otherwise have been successful. where a counter-opening is thus made it is found that it very readily closes with granulation tissue, and the purpose for which it was made defeated. this may be avoided by the use of a seton. in preference to the seton, however, we ourselves would advise that the opening be kept free by the occasional use of a sharp-edged director or a fine scalpel. an interesting modification of the practice of making a counter-opening is that related by veterinary-captain s.m. smith.[a] in point of severity it runs a middle course between the making of a simple counter-opening and the removal of a wedge-shaped portion of the coronary band and the wall, a method which we shall later describe. [footnote a: _veterinary record_, vol ii., p. .] to perform this operation, the animal is cast and chloroformed. the foot is fixed and the parts thoroughly cleansed. the horn of the wall is then sawed through in a direct line from the coronary margin to the solar edge, the saw-line running exactly over the seat of the sinus. a strong scalpel is now introduced at the coronary opening, with its cutting-edge outwards, and is gradually passed down the opening made by the saw. in this way the sinus is completely destroyed, and from end to end converted into an open wound. the parts are then washed in a perchloride of mercury solution, covered with a mixture of powdered iodoform and boracic acid, over which a pledget of carbolized tow is placed, and then a bandage over the whole. this dressing should be left on three or four days, after which the injury should be treated as an ordinary wound. in conclusion, the author says: 'i can safely recommend this line of treatment to any practitioner having an obstinate case under treatment.' _removal of the wall and excision of the necrotic tissue_.--this we may term the radical operation for sub-horny quittor, for it is often productive of a successful issue when all other means have failed. no matter in what position the sinus is, whether at the extreme anterior portion of the coronet, or whether in the region of the heels, it is to be thoroughly opened up. to do this, the fistula is carefully explored with the probe and a knowledge of its exact dimensions arrived at. this is carefully noted, and the horn of the wall for some little distance around it then rasped down quite thin. immediately over the sinus, and for a short distance on either side of it, the horn is stripped away to the sensitive structures. the cavity of the fistula is then opened up with a scalpel, and every particle of diseased tissue removed with this instrument and a pair of forceps. after-dressing consists simply in the application of suitable antiseptics. _when the complication of necrosed tendon or ligament exists_.--we may take it as an axiom that wherever this exists, whether it is in the extensor pedis, in the lateral ligaments of the joint, or in portions of the flexors, all diseased structures should, where possible, be removed. this is done either with a scalpel or with a curette. when septic matter has gained the sheath of the perforans, and the formation of pus therein is indicated by inflammatory swellings in the hollow of the heel, it is sometimes advisable to lay the sheath open for to inches along the course of the tendons. this, if a fistula is present, may be best done with a blunt-pointed bistoury, or with a cannulated director and a scalpel. with the pus thus given exit, and an antiseptic dressing regularly applied, the case sometimes ends in rapid resolution. more often than not, however, it is found that the pus has been liberated too late, and that it has gravitated in the sheath to the extent of affecting the plantar aponeurosis. or it may be, of course, that it was in the plantar aponeurosis the disease commenced. whichever may have been the case, we have in the hollow of the heel one or more fistulous openings, or an opening we have made ourselves, leading down to a necrosed portion of the terminal expansion of the perforans. in such cases we ourselves have derived benefit from a regular flushing of the sinuses with a in , solution of perchloride of mercury, introduced by means of a glass syringe, followed later by flushing in the same manner with a in solution of carbolic acid, the hollow of the heel meanwhile being kept clean with an antiseptic pad and bandage, or by liberal applications of an antiseptic powder. the septic materials are in this way destroyed, and the wound heals without further complication. we must admit, however, that the cure of the lesion is generally at the expense of slight lameness, due, in all probability, to inflammatory tissue adhesions between the flexor perforans and the perforatus, and to a partial destruction of the synovial membrane of the sheath. if, in spite of the antiseptic irrigations, the fistula persists, then nothing remains but to resort to excision of the aponeurosis, as described on p. . _when necrosis of the lateral cartilage is present_.--in this case we may at first try the ordinary treatments of poulticing; and blistering, of antiseptic caustic injections, and of plugging. in some cases a cure is effected. should these fail, however, and we intend to see the finish of our case, then operative measures must be determined on. this means cutting down upon the diseased cartilage, and either removing the necrosed portion, or excising the cartilage in its entirety. the latter method is seldom practised in this country. as it is the most radical of the two, however, we shall describe it here first. _extirpation of the lateral cartilage_.--the operation of extirpating the lateral cartilage is by no means a new one, being introduced, according to zundel, by the senior lafosse in . it consisted in removing a portion of the wall by grooving and stripping it, and of excising the exposed cartilage by means of a sage-knife. as to what portion of, and how much of the horn of, the quarter should first be removed, and as to what particular direction each groove should take, opinion among the older writers varied considerably. this we know now is not an important matter, and it is sufficient to say that the first preliminary is a thinning down of the horn of the quarter with the rasp over the position occupied by the cartilage. at the present time there are two or three modifications of the operation as originally introduced. in all, however, the preliminary steps are the same. we shall therefore describe them collectively, as applying correctly to either of the three methods of operating we are about to show. _preparation of the subject and preliminary steps in the operation_.--on the day previous to the operation the horn of the wall immediately over the cartilage must be so thinned with a rasp as to yield readily to pressure of the thumb in any position. it should be so thin as to only just avoid wounding the sensitive structures below. the whole of the foot must then be thoroughly cleansed, and rendered as nearly aseptic as possible. the use of warm water, soap, and a stiff brush is the readiest means of removing the surface dirt. afterwards the foot should be soaked for some time in a reliable antiseptic solution, a in , solution of perchloride of mercury being the most suitable. when removed from the solution the foot must be packed round with wool or tow impregnated with corrosive sublimate, and then bandaged, the whole afterwards wrapped in a thick cloth, or protected with a boot. on the following day the animal is brought out and cast, and the foot desired to be operated on firmly secured, after the manner described on p. . the bandages and sublimate pads are then removed, and the skin of the coronet over the seat of operation shaved of hair. an esmarch rubber bandage is next run up the limb, and the tourniquet applied, thus rendering the operation a nearly bloodless one. this done, the animal is chloroformed, and an antiseptic douche played over the foot. so far, the steps in the operation are common to all methods. there are now, however, three slightly differing modes of extirpating the cartilage, which modes vary simply according to the structures severed by the knife. _first method_.--this is the oldest method of the three, and consists in making ( ) a horizontal incision through the sensitive laminæ along the lower border of the cartilage, and ( ) a vertical incision through the skin of the coronet, the coronary cushion, and a portion of the sensitive laminæ (see fig. ). the flaps (fig. , _a, a_) are now held back by tenaculæ, and the whole of the cartilage, or only the necrosed portion, carefully excised by means of right- and left-handed sage-knives. fistulous openings in either of the flaps _a, a_ must now be carefully curetted and dressed, and the flaps allowed to fall into position. they are then sutured with carbolized gut, and the wound finally dressed as to be described later (p. ). [illustration: fig. .--excision of the lateral cartilage (old method). the wall covering the lateral cartilage first thinned and stripped off; the two flaps (_a, a_) of skin and the coronary cushion made by the vertical incision turned back. _a_, the operation flaps; _b_, the exposed cartilage; _c_, the sensitive laminæ; _d_, the coronary cushion.] _second method (after holler and frick_[a]).--these operators deem it wise to leave untouched the skin of the coronet and the coronary cushion. they therefore make their first incision along the lower border of the coronary cushion (see fig. ), afterwards exposing the lower half of the cartilage by removing a half-moon-shaped portion of the thinned horn and underlying sensitive laminæ (see fig. , _b_). [footnote a: two cases of quittor successfully treated by this method are reported by r. paine, m.r.c.v.s., in the _journal of comparative pathology and therapeutics_, vol. xv., p. .] [illustration: fig. .--excision of the lateral cartilage. (after moller and frick.) _a_, the thinned horny wall covering the coronary cushion; _b_, the lateral cartilage exposed by stripping off the thinned wall; _c_, the sensitive laminæ.] this done, the external face of the cartilage is separated from the skin of the coronet. to do this a double sage-knife is run flatwise between the coronary cushion and the cartilage, with the convex surface of the blade towards the skin. the knife is then passed backwards and forwards until the necessary separation is accomplished. during these movements of the knife a finger of the unoccupied hand should follow the knife, and guard the coronary cushion against injury. following this, the inner surface of the cartilage must be also separated from the structures lying beneath it. to this end a sage-knife (right- or left-handed, according as to whether the anterior or posterior portion of the cartilage is to be first removed) is again passed into the incision. with the cutting-edge of the knife forward, it is gradually reached round and under the hindermost end of the cartilage, and theposterior half of the cartilage separated from underlying structures, and at the same time excised by one clean cut forwards. using the second sage-knife in a similar manner, the cutting-edge this time backwards, it is reached in front of the cartilage, whose anterior half is then excised by a careful cut backwards. any small portions of cartilage remaining after this are sought for with the finger, and carefully removed by means of a scalpel and a tenaculum. the fistulous opening or openings in the skin of the coronet should now be thoroughly curetted, and the whole of the wound dressed as to be described later. in removing the anterior half of the cartilage it is highly important to remember the close contiguity to it of the synovial membrane of the pedal articulation. this projects as a small sac between the antero- and postero-lateral ligaments of the joint. risks of injury to it may be diminished by having the foot secured with a line, and pulled forward by an assistant while the cut is being made. _third method (after bayer)_.--this operator recommends that, after stripping a half-moon-shaped piece of horn from the seat of operation, instead of raising the skin of the coronet and the attached coronary cushion in two flaps (as fig. , a, a), that the cartilage be exposed by raising up one flap only (fig. , a), consisting of a portion of the sensitive laminæ, the coronary cushion, and the skin and underlying structures of the coronet. with the horse cast and the preliminary steps over, the thinned horn of the quarter is incised in a semicircular fashion, and the half-moon-shaped piece thus separated from its surroundings stripped off. at about / inch from the incision in the horn, a second incision of similar shape is made through the sensitive structures, which incision is also carried up into the skin and structures of the coronet. this incision severs, from bottom to the top, ( ) the sensitive laminæ covering a portion of the pedal bone and a portion of the lateral cartilage, ( ) the coronary cushion, and ( ) the skin of the coronet and such structures as lie between it and the cartilage. [illustration: fig. .--excision of the lateral cartilage. (after bayer.) the horny wall is stripped off over the seat of operation. _a_, semicircular flap of sensitive laminæ, coronary cushion, and skin; _b_, the lateral cartilage; _c_, the sensitive laminæ; _d_, the coronary cushion.] that this incision of the sensitive structures should be kept at / inch from the one in the horn has a reason. it is that when this flap is again placed into position (as later it will have to be) we have round its circumference a rim of soft structures into which to place the sutures. and in this connection it is well to advise the operator that the thinness of the keratogenous membrane (the laminal portion of it) should warn him that the portion of it to be turned up--namely, that forming the tip of the flap--should be _scraped_ away quite close to the os pedis. unless this is done, there will not be a sufficient thickness left to afterwards bring into position and suture. the half-moon-shaped piece of tissue incised is now carefully dissected away from the external face of the cartilage, until it may be turned up as a flap (see fig. , _a_), and held from off the cartilage by a tenaculum. the exposed cartilage is now carefully removed by the aid of a sage-knife and a stout pair of forceps, the same precaution of holding the foot well forward being again taken in order to avoid wounding of the articular capsule. at this stage in the operation considerable care is required. the operator must remember that close beneath him, and more particularly in front, is the pedal articulation. it is better, therefore, to excise the cartilage piecemeal, and to do it carefully, than to attempt, at the risk of injury to the joint, to make the operation 'showy.' during removal of the cartilage, the terminal branches of the digital arteries are wounded, as also are the veins of the coronary plexus. should either of these stand out with extra prominence from the others, it should be picked up with a pair of forceps, and ligatured with either carbolized gut or silk. attention should then be given to the flap of skin and coronary cushion. wherever a sinus has existed in it, it is to be carefully scraped, and all dead portions of tissue removed. this done, the flap is allowed to fall into position, and is there carefully sutured, not only at the skin of the coronet, but along the whole circumference of the incision. _dressing of the wound and after-treatment_.--the whole secret of the success of this operation is in afterwards maintaining a strict asepsis of the wound. unless there is reasonable room for belief that this may be done, the operation had far better not be advised, for if the wound is afterwards suffered to get into a suppurating and dirty condition, the last stage of the case may be worse than the first synovitis and arthritis, with certain anchylosis of the joint, and a probable loss of our patient, is almost bound to follow. we cannot, therefore, too strongly insist upon the advice that the whole of the preliminary antisepticising of the foot that we have described, and the after maintaining of asepsis that we are now about to relate, _must_ be methodically and thoroughly carried out. it is of even _more_ importance than little details in the operation itself. in the first and second methods of operating, directly the actual operation is over, the surface of the wound and both surfaces of the skin-flaps should first be thoroughly douched with a in , solution of perchloride of mercury. bayer prefers a in solution of iodoform in ether. next, either iodoform or chinosol in the powder should be dusted over the whole surface, including again both inner and outer faces of the reverted skin-flaps. this done the flaps are allowed to fall into position and sutured there with carbolized silk or gut. another liberal application of an antiseptic dressing follows this. iodoform, iodoform and boracic acid, or chinosol, is freely dusted over the wound and for some distance around it. bayer, however, again prefers a dressing of the wound, and especially the moistening of the line of sutures with the in solution of iodoform in ether. over the wound is then placed a protective layer of gauze, impregnated either with boric acid, with a mercuric salt, or with iodoform. finally, numerous small and lightly-rolled balls of dry carbolized tow are packed regularly over the whole of the operation wound, and the foot bandaged. practical points to be remembered in this after-dressing are: ( ) the balls[a] of tow should be numerous enough to exercise pressure upon the sutured flap when the foot is finally bandaged. ( ) the bandage should be run on from the coronet downwards, in order to insure pressure being exerted in the exact position over the sutured flap. ( ) bandages should be used in abundance, commencing always from the coronet, and carefully applied so as to exert an even and uniform pressure. ( ) the bandages should be of clean, unused linen. [footnote a: bayer recommends that the tow be rolled into cylindrical tampons, each long enough to cross the wound. these are placed on the wound in alternate horizontal and vertical layers, so that when rolled round by a bandage they are pressed into an even and compact pad.] once the bandages are adjusted, the hobbles may be removed, and the tourniquet loosened. directly the tourniquet is removed there is a steady oozing of blood through the bandages, no matter how many we have put on. this should occasion no alarm, as experience has taught that the careful attention to antiseptic measures observed throughout the operation has the effect of maintaining the lowermost dressings, those next to the wound, in a state of asepsis. the bandaged foot should now be wrapped in a piece of thick clean cloth or placed in a boot. if our antiseptic precautions have been thorough, the dressings and bandages so adjusted may be allowed to remain without disturbance for from eight to fourteen days. in this, however, the veterinary surgeon must be largely guided by the symptoms of his patient. if, at the end of the first three or four days, the animal maintains a vigorous appetite, if he commences to place a little weight on the foot, and if the thermometer gives no indication of a rise beyond the one or two degrees of ordinary surgical fever, then the surgeon may know that things are proceeding satisfactorily. pawing movements with the foot, inability to place weight upon it, loss of appetite, an increase in the number of respirations, and a serious rise of temperature, denote the opposite state of affairs. the wound is in all probability suppurating. the bandages and dressings should therefore be removed, and the wound either redressed and bandaged, or treated as an ordinary open wound. ordinarily, however, if the operation has been properly performed, healing takes place by first intention, and the wound when the bandages are removed at the end of the first or second week appears clean and _dry_. having assured ourselves that such is the case, we dress the foot in exactly the same manner as before, save that so many bandages are not put on. a similar dressing is repeated weekly until such time as the wound shows sufficient growth of horn--quite a thin pellicle--to act as a protective. it may then be left undressed, except for some simple hoof dressing and a bandage. complete healing of the wound takes from about four to eight weeks, at the end of which time the animal can be again gradually put into work. the labour, however, should be light, and quite three or four months should be allowed to elapse before any attempt is made to put him to heavy work. should the second method of operating have been the one adopted, then there is one slight difference in the after-dressing that needs attention calling to it. in this case we have more or less of a _hidden_ cavity left to deal with rather than the broad and _open_ wound left in either of the other methods. this cavity, left by the extirpation of the cartilage, must be thoroughly dressed with iodoform or chinosol, or with bayer's iodoform in ether. the packing with carbolized tow and the bandaging may then be proceeded with as before. in conclusion, we may say that the operation is one of some delicacy, and needs a good surgeon for its successful performance. furthermore, no one of the antiseptic precautions we have advised can be omitted. it is, perhaps, these two considerations (and in justice to the english surgeon we should say most probably the latter of them) that have prevented this operation from being generally adopted. that it is successful there is no gainsaying. professor bayer, of the vienna school, with whose name is associated the last of the three methods of operating we have described, is enthusiastic in praise of the operation, and says: 'the favourable results that i have got by this operation have caused me wholly to abandon the medicinal treatment, and to prefer in all cases the surgical operation as being the best means to the end.' _partial excision of the lateral cartilage_.--discarding the somewhat elaborate methods we have just described, there are english operators who removed the necrosed portion only of the cartilage, and do so in what appears at first sight a comparatively rough-and-ready manner. the apparent roughness is that they do not concern themselves with conserving the coronary cushion, and hesitate but little in cutting portions of it bodily away. one would imagine that in this case the quarter of the side operated on would be always more or less bare of horn. such, however, is not the case. to perform this operation the animal is again cast and chloroformed. some operators, however, use the stocks and dispense with the anæsthetic. the foot is first well cleaned with soap and water and a stiff brush, and the hair of the coronet over the seat of operation shaved. again, too, the horn of the affected quarter is rasped until it yields easily to pressure of the thumb, and the whole of the foot washed in an antiseptic solution. a probe is now inserted into the opening at the coronet, and the direction of the fistula noted, after which the foot is firmly secured, and an esmarch bandage and tourniquet applied to the limb. this done, a triangular or wedge-shaped portion of skin, coronary cushion, and thinned horn is removed with a strong sage-knife or scalpel. the base of the wedge-shaped portion removed contains the opening of the fistula, and the apex of the wedge should reach to the bottom of the sinus (see fig. ). after the horn is removed and the fistula followed up, it is sometimes found that what we at first thought was its end, it may now be continued in an altogether different direction. it is again followed up with the probe, and the horn and sensitive structures excised until we are quite certain we have reached its furthest extent. attention should next be paid to the cartilage. wherever spots of necrosis are found, as indicated by the pea-green colour of the affected parts, they must be _carefully_ excised. care should be taken in so doing to carry the line of excision some little distance around the visibly affected parts. this is done that we may be quite certain nothing at all remains calculated to give rise to further trouble. it goes without saying that, in addition to the necrosed cartilage, all other diseased and necrotic tissues should also be removed. the os pedis is occasionally found necrotic just where the cartilage joins it, or it may be that a small portion of the sensitive laminæ, by reason of its _liver-red_ or even gray coloration, gives evidence of death of the part. the former must be well curetted, and the latter cleaned carefully with a scalpel and forceps. [illustration: fig. .--partial excision of the lateral cartilage by removing a portion of the coronary cushion. the dotted lines show the outline of the wedge-shaped portion of structures to be removed, including skin, coronary cushion, horn, and sensitive laminæ. _a_, the opening of the fistula.] the operation finished, the foot is again douched in an antiseptic solution, the wound mopped dry with carbolized tow, dressed with either of the dressings described on page , and finally bandaged. the dressing should be changed every three days only, unless in the meanwhile pawing movements and other symptoms of distress indicate their removal. the length of coronary cushion removed in this operation is from / to / inch (we ourselves, however, have seen it more), and yet its loss seems to occasion no serious after-trouble beyond a slight deformity of the parts beneath. the sensitive structures become sufficiently covered with horn, and the animal in nearly every case is returned to work, while in a great many instances he may also trot perfectly sound. simple though the operation may appear, and apparently rough in its method, it is nevertheless successful in effecting a cure in cases where blisters, plugging, injections, and other means have failed. mr. w. dacre, m.r.c.v.s.,[a] after reading an article on the operation before the members of the lancashire veterinary medical association, says: 'my observations have not been based on a single case, and having had nine of them, and all of them successful, i felt it to be my duty to bring this subject before the society.' [footnote a: _veterinary record_, vol. v., p. .] mr. t.w. thompson, m.r.c.v.s.,[a] says: 'in a great number of cases i have removed a / inch of the coronary band.... i have performed the operation a great number of times, and have never seen a foot that has been damaged by it.' [footnote a: _ibid_.] professor macqueen[a] says: 'i do not spare the coronary band or sensitive laminæ when i find those parts diseased. i do not unnecessarily damage those structures. at the same time, i am confident that excision of a piece of the coronary band or removal of a few sensitive laminæ has not the untoward consequences so much dreaded in former days.' [footnote a: _ibid_., p. .] mr. john davidson, m.e.c.v.s.,[a] says: 'the treatment described, if carefully carried out and details attended to, will be found a success in dealing with the majority of cases of quittor. if i may be permitted to say so, without being considered boastful, i have yet to see the first case that has resisted the treatment.' [footnote a: _ibid_., vol. xiv., p. .] should our case of quittor be complicated by caries of the bone, this must, where possible, be scraped or curetted until the whole of the diseased portion is removed, and a healthy surface is left. after-dressing must then be carried out as in other cases. the treatment of ossified cartilage will be found under treatment of side-bones, and the methods of dealing with penetrated articulation and purulent arthritis are treated of in chapter xii. _surgical shoeing in quittor_.--in the case of simple or cutaneous quittor, no alteration in the shoeing is necessary. when the condition becomes sub-horny, however, and particularly when it is situated in the region of the quarters, ease is afforded to the diseased parts by removing the bearing of the shoe in that position. should there be no dependent opening at the sole, then the best shoe for the purpose is an ordinary bar shoe (fig. ), with the bearing eased under the affected quarter. if, however, there is a dependent orifice, or one is expected, then it will be necessary either to leave the animal unshod or to provide him with a shoe that admits of dressing the lesion. in the latter case the most suitable shoe will be found to be either a three-quarter shoe (fig. ) or a three-quarter bar shoe (fig. ). many operators, however, keep the animal unshod. we must say ourselves that we consider a shoe useful after either of the operations for removal of the cartilage, if only to assist in maintaining the bandages and dressings in position. in this case a very useful shoe will be the three-quarter bar shoe. with a little manipulation the bandages are easily run under the bar portion of the shoe, and a few of their turns every now and again wrapped round the bar in order to keep the whole firmly in position. in connection with tendinous quittor, when septic matter has gained the sheath of the flexor tendons, there is, for a long time after healing of the fistula, a marked tendency for the animal to go on his toe. to a large extent we judge this to be due to slight adhesions between the two tendons brought about by the growth of inflammatory fibrous tissue. in such cases benefit is sometimes derived from the application of a shoe with an extended toe-piece (see figs. and ). c. ossification of the lateral cartilages, or side-bones. _definition_.--an abnormal condition of the lateral cartilages, in which the substance of the cartilage becomes gradually removed and bone formed in its place. [illustration: fig. .--ossified lateral cartilages (side-bones).] _symptoms and diagnosis_.--side-bones are nearly always met with in heavy draught animals, and are rarely seen in the feet of nags. they are, moreover, nearly always confined to the fore-feet. in the ordinary way little need be said concerning their characteristics, and the way in which they may be detected. neither need any concern be ordinarily manifested with regard to the effect they may have on the animal's gait and future usefulness. seeing, however, that side-bone constitutes one of the recognised hereditary diseases, and that at the various agricultural and horse shows its existence or otherwise in a certain animal is a matter of great importance, some little attention must be given to these two points. with a side-bone anywhere approaching full development, diagnosis is easy. the thumb is pressed into the coronet over the seat of the cartilage, when, in place of the elasticity we should normally meet with, we have the solid resistance offered by bone. in some instances diagnosis is even easier still. we refer to those cases in which the side-bone stands above the level of the coronet with such prominence as to be readily _seen_ and recognised without manipulation, and where its growth has caused distinct enlargement and bulging of the wall of the affected quarter. it seems that in such cases the bone-forming process does not end with simply depositing bone in place of the removed cartilage, but that, after that is accomplished, the bone still continues to be produced, as in the case of an exostosis elsewhere. although diagnosis in cases such as these is easy, it becomes a very different matter when we are called upon to give an opinion in cases where ossification of the cartilage is only just commencing. whether the result of our examination is to decide the sale or purchase of an animal, to determine his fitness or otherwise to enter the show-ring, or to merely advise a client as to whether or no a side-bone is in course of formation, our position is equally difficult, and in either case our examination must be searching. perhaps the best advice we can give is to say that the whole of the cartilage must be manipulated both with the foot _on_ and _off_ the ground. what the reason may be we do not pretend to say, but it is a well-known fact that in many instances the cartilage, with the foot bearing weight, is so rigid as to at once convey the impression that ossification has commenced or is even far advanced. and yet that same cartilage, with the foot removed from the ground, is as pleasantly yielding to pressure of the thumb as the most exacting of us could wish for. in any case, then, where doubt exists, the foot should be lifted to the knee, and the cartilage carefully examined with the foot in that position. if, then, at any spot above the normal contour of the os pedis we meet with hardness or rigidity, we are to look upon that foot with suspicion. nevertheless, providing our conscience is sufficiently elastic, the animal may be passed _sound_ so far as the _existence_ of a side-bone is concerned. we know, however, that with commencing rigidity we may ere long expect one, and if our opinion is asked with regard to that particular, it must be admitted that with rigidity of the cartilage once commenced it is usually not long afterwards before a fully-developed side-bone makes its appearance. as is only to be expected, the first noticeable hardening of the cartilage is to be found near the normal bone. we may thus look for it more particularly in the lower portions of the cartilage. we think we may say, too, that in the vast majority of cases the ossification of the cartilage commences in its anterior half. it is thus brought about that often we are called upon to examine and report on the condition when we have _anteriorly_ a side-bone in course of formation, and _posteriorly_ a perfectly normal cartilage. it is to the latter half of the cartilage that dealers and others mainly, if not wholly, devote their attention. a horse with the cartilage in this transition state will therefore pass muster, and a nice little point of ethics has again to be decided by the veterinary surgeon before giving his signature to a certificate of examination of an animal in this condition. with regard to alteration in gait, we may say at once that side-bones in heavy animals are not often the cause of lameness. in fact, where the foot is well developed, when neither the foot as a whole nor the phalangeal bones give evidence of disease, and where the pasterns are fairly oblique and well formed, this alteration of the cartilages may be looked upon as of no serious import at all. neither is the side-bone due to blows or other injuries likely to be productive of lameness--that is, always supposing, of course, that the foot in other respects is of good shape. if lameness is met with at all, then it is where we have a foot that is in other respects unsound, with badly contracted heels and upright 'stumpy' hoof, or where side-bones have occurred in a young animal, and have already reached a large size before the horse is put to labour. in this latter case, the added effects of concussion and the evil influences of shoeing are sufficient to turn the scale. directly the animal, previously sound, is asked to work, lameness is the result. it follows, therefore, that side-bone in the feet of young animals is of far more serious import than when occurring in older horses. in a nag animal they constitute a positive unsoundness, and lameness in this case is more often than not an accompanying symptom. _causes_.--to commence with, we may remark that, although met with sometimes in very early life, side-bones are seldom, if ever, congenital, and that more often than not they may be looked for in animals of three years old, or older, seldom earlier. they appear, in fact, only when the animal is shod and commences work. this at once suggests two of the principal factors in their causation--namely, concussion and loss of normal function. directly the horse is put to work he has for a great part of his time to travel upon roadways--either macadamized roads or town sets--where everything is calculated to bring concussion about. in addition to that he has the lateral cartilage itself thrown largely out of action by shoeing. we explained in chapter iii. (p. ) that the chief function of the cartilage was to take concussion received by the plantar cushion and direct the greater part of it outwards and backwards. now, with the animal shod, the plantar cushion does not itself, as normally it should, receive concussion. by the shoeing the frog is lifted from the ground, and the plantar cushion, together with the cartilage, taken largely out of active work. in other words, the normal outward and inward movements of the cartilage are enormously reduced. it is fair, we think, to take it that the mere fact of the lateral cartilage persisting _as_ cartilage is due in large measure to its constant movement. directly, therefore, it is placed in a state of comparative idleness, then it commences to ossify, more particularly if there should at the same time be a tendency to a low type of inflammation of the parts. does this latter exist? we may safely say that it does. it is in this way: the secondary effect of loss of ground-pressure upon the frog and plantar cushion is to bring about contraction of the heels. with this we get compression of the parts within, with a certain amount of irritation and the exact low type of inflammatory phenomena calculated to assist in the bone-forming process. the fact that concussion acts as a cause explains in great measure how it is that side-bones are more frequent in cart animals than in nags, and also why they should be more common in the fore-feet than in the hind. taking, in both animals, a rough calculation as to the weight of body carried by feet of a certain size, we notice at once that the cart animal has proportionately more weight to carry than has the nag. concussion to the foot is therefore greater. the greater part of the body-weight is borne by the fore-limbs. concussion is therefore greater to the fore-feet than to the hind. this, however, does not explain altogether the comparative immunity of the nag animal from this defect. he, too, must also be subject to the effects of concussion, especially when his higher and faster action is taken into account. to our minds there is only one explanation to be offered here. we point at once to the years of constant and judicious breeding of the nag. compare that with the relatively few minutes that have been devoted to a more careful selection of the cart animal, and we at once see a possible explanation. that the explanation holds some amount of truth is borne out by the fact that, since a greater attention has been paid to the selection of our cart animals, side-bone has grown a great deal less common. is side-bone hereditary? we can best answer that by saying that, some several years ago, the council of the royal college of veterinary surgeons, at the request of the royal commission on horse breeding, drew up a list of those diseases 'which by heredity rendered stallions so affected unfit as breeding sires,' and that in that list was included side-bone. side-bones, therefore, are hereditary. we think, however, the statement needs qualifying. it is in this way: side-bones occur only at a certain, usually well-defined, time after birth, and we might say are _never_ congenital. they occur only after the animal has been put to work, and are more or less plainly due to mechanical causes--namely, the ill effects of shoeing and concussion. the cause of their appearance, in short, is more plainly extrinsic than intrinsic, and side-bone in the horse is, as professor mccall puts it, about as much due to heredity as is corn on the human foot. between these two opinions--that they are plainly hereditary, and that they just as plainly are not--it is well to strike a middle course. they are, we will say, hereditary in this way: so long as a cart animal is bred, to put it vulgarly, 'top-heavy' (that is, with a body out of reasonable proportion to the feet that have it to support), so long will the foot be subjected to a greater concussion, and so long will side-bones in such animals commence to make their appearance at about middle life. in addition to the causes we have now mentioned, side-bones are often the result of other diseases of the foot. they thus occur as a sequel to sub-horny quittor, to suppurating corn, to complicated quarter sand-crack, or to the inflammation of the parts occasioned by a prick. they also arise in many instances from the effect of a prick or injury to the coronet. among the latter we may mention treads from other animals, and treads inflicted by the animal himself with the calkin of an opposite shoe, or the repeated injury occasioned by the shafts being carelessly allowed to drop on to the foot. in severe cases of laminitis, too, the cartilages are nearly always affected. in this instance the inflammatory phenomena in the os pedis no doubt give rise to an abnormal activity of bone-forming cells. the cartilage is invaded, and the side-bone formed (see fig. ). _treatment_.--in the ordinary way the 'treatment' of side-bone is a thing but rarely mentioned. the explanation lies, of course, in the fact that side-bones are so rarely the cause of lameness. when lameness does occur with a side-bone, and we have reason to believe that the said side-bone is the cause of the lameness, it is well before talking of treatment to question ourselves thus: 'in what way does the side-bone cause lameness?' the now generally-accepted answer to that query is the explanation put forward several years ago by colonel fred smith--namely, that the pain, and therefore the lameness, was due to the compression of the sensitive laminæ between the ossified and enlarged cartilage and the non-yielding and often contracted wall of the quarters. that, in fact, constitutes the basis upon which smith's operation for side-bone (that of grooving the wall of the quarters) is founded. before describing the operation, however, we may say that we are now able to understand that older operators who claimed success for other methods of treatment, were to a very great extent justified in so doing. for instance, take the combined treatments of firing and blistering, and the use of a bar shoe. here the beneficial action of the cautery and the blister may be largely problematical. the bar shoe, however, would be almost certain to give good results. frog-pressure with the ground would be again restored, and the contraction of the heels removed. pinching of the sensitive structures would be diminished, and the lameness cured. take, again, the treatment of 'unsoling.' it was barbarous, we know barbarous, because unnecessary and easily avoidable. it was practised, however, certainly very little more than two decades ago, and practised by men of standing in the profession. without dragging the case to light again by mentioning the names of those concerned, we may mention that not many years ago a highly respected member of the profession was, at the instigation of the royal society for the prevention of cruelty to animals, prosecuted for practising unsoling for the relief of side-bone. practically only one other member of the profession was able to come forward and defend the operation on the score of its utility. we see now, however, that--as does smith's operation--unsoling does permit of the greater expansion of the heels. the contraction is done away with, the pressure on the sensitive laminæ again diminished, and the lameness relieved. not that we are attempting to defend the operation--far from it. we simply mention it as interesting, and quote this and the use of the bar shoe (with both of which methods older operators have claimed success) merely as evidence that the operation of smith is based on a logical foundation. when treatment is decided on, therefore, we may first advise blistering and the use of a bar shoe. after that, should the lameness continue, and should we still judge the side-bone to be the cause of it, the operation may be advised. as we have said before, the operation consists in so grooving the wall as to allow of the quarters widening sufficiently to relieve pressure on the parts within. in one or two previous portions of this work we have considered operations involving this procedure. before detailing the operation here, therefore, we will first describe the instruments necessary, and the most satisfactory methods of incising the horn. to begin with, it must be remembered that all methods of hoof section have for their object the after-expansion of the horny box, and that this can only be brought about by making each groove complete from coronary margin to solar edge of the wall, and carrying it, throughout its length, _deep enough to reach the commencement of the sensitive structures_. to this end, therefore, the operator must bear in mind the comparative thickness of the various parts of the wall, and must, in particular, remember the relative thinness of that portion of horn forming the outer boundary of the cutigeral groove, and accommodating the coronary cushion. for the making of the incisions there is the special saw devised for this operation by colonel f. smith, a.v.d., and which we illustrate in fig. . with this the wall is sawn through _until the depth arrived at is equal to what is indicated by a previous examination of the thickness of the crust as viewed from the solar surface_. here colonel smith says: 'i strongly advise everyone to use a metal gauge (a thin piece of material) to introduce into the incision made by the saw, and run it up and down to ascertain whether the wall is properly divided throughout. the depth to which this should be done we know from the previous measurements of our gauge on the crust.' [illustration: fig. .--smith's side-bone saw (early pattern).] should the saw be of a pattern in which the set of its teeth makes only a narrow incision,[a] it should, while operating, be kept well oiled, and should be withdrawn every few seconds in order that the horn-dust lying in its teeth may be examined. if this is getting slightly blood-stained, we know, of course, that the sensitive structures are reached, and the incision has been carried far enough. in so judging the depth of the incision, however, care must be taken to see that the top of the coronary cushion is not injured with the saw, for if this is done the blood trickling into the depth of the incision will tinge the horn-dust, and give the false impression that the incision is sufficiently deep. [footnote a: that is smith's older pattern. the newer pattern (fig. ) has the teeth so set as to make an incision wide enough to be looked into. in this case the depth arrived at is to be judged by the appearance of the bottom of the incision.] if the operator has had no previous experience of the use of the saw in this operation, he must also be careful to avoid placing too great a pressure on the teeth of its lower third. this is done by keeping the hand too greatly depressed. again, this leads to wounding of the sensitive structures (this time at the lower end of the incision), and again the operator is confused by the blood thus allowed to run into the groove. the only portion of horn difficult to operate on is that immediately under the coronet. this is best severed with a succession of downward movements, and is easier performed with smith's later pattern of side-bone saw (fig. ) in which the set of the foremost teeth is reversed. [illustration: fig. .--smith's side-bone saw (improved pattern).] in making these grooves we must say that we think the use of the special saw may be dispensed with, and the incisions just as easily, or, at any rate, just as successfully, made with the knife. those who select to use this instrument should choose a narrow-topped and sharp searcher, or a modern shaped drawing-knife of suitable size, such as those depicted in fig. , _a_ and _b_, and they will find their work much easier if they will make the first steps in the incisions with an ordinary flat firing-iron. by the use of the latter instrument the grooves are made conveniently open along their tops, and room left for nicely finishing the more delicate manner of removing with the knife the softer horn near the sensitive structures. those whose leaning is towards the use of special instruments, but who, at the same time, do not care to use the saw, will find their wants supplied in the hoof plane (smith's), fig. , or the hoof chisel (hodder's), fig. . with the hoof plane the groove in the wall is made by a succession of downward scraping movements, while with the chisel the cut in the wall is made either from below upwards, or from above downwards, according as the foot is held forward or backward--whichever, in fact, comes most convenient. [illustration: fig. .--hoof plane (smith's).] when using the knife or the hoof plane it is not often that the sensitive structures are injured. in all cases, however, no matter what the instrument used, the metal gauge should be employed when the sensitive structures have been touched, and the operation obscured by blood. [illustration: fig. .--hoof chisel (hodder's).] our instruments at hand, the operation may be proceeded with. the first step is to ascertain the extent of the side-bone, and to determine the position of the incisions. to do this the coronet is felt with the thumb, and the anterior extremity of the side-bone noted. this is marked on the horn with a piece of chalk, and a vertical line dropped from this position to the inferior margin of the wall (fig. , ). the line crosses the horn fibres obliquely, and is purposely made in that direction in order that its inferior end may be far enough back to avoid the last nail-hole. should the side-bone reach very far forwards, it may be wise to cause this line to slant from before backwards (see dotted line _a_, fig. ). unless this is done, it is found that in some feet so much of the wall is isolated at the bottom that insufficient is left to nail the shoe to. the next line to be made is the rear one. its correct position is ascertained by first noting the junction off the wall with the bar (see groove , fig. ); and its inferior end must be just anterior to the inflexion of the wall. this is done that we may avoid cutting the bar. the position of the lower end of the rear line thus ascertained, it is run upwards with the chalk in the direction of the horn fibres. [illustration: fig. .--diagram illustrating the position of the grooves in the wall in colonel smith's operation for side-bone. , , and , mark the grooves in the order in which they are made; the dotted line _a_ marks the position taken by the anterior line when the side-bone, is one reaching far forward, while the dotted lines _b_ and _c_ mark the position of the additional grooves to be made if thought necessary.] the third line is made in such a position as to divide into two equal portions the wall between lines and . here, however, some operators prefer to make two, or even three, lines, adding those as at _b_ and _c_, fig. ; and smith himself says that a multiplicity of lines is an advantage rather than not. in any case, having once determined the position of the lines, they should be plainly marked out with chalk, and then viewed from a distance with the foot on the ground, in order to judge of their regularity. if we are satisfied with them, we then lightly mark them with the saw, with the hot iron, or with the knife, whichever instrument we may be intending to use. unless the details are methodically carried out as here described, it is probable that more of the foot will be isolated than is necessary, and that as a consequence very little is left to which to nail the shoe. [illustration: fig. .--diagram illustrating the position of the grooves made in the hoof in colonel smith's operation for side-bones. , , and , show the grooves in the wall in the order in which they are made; shows the groove made at the junction of the sole with the wall.] the incisions are then made with the saw or the knife, with the foot held in a convenient position by an assistant. that usually found most comfortable for the first incision is with the foot held forwards and placed on an assistant's thigh in the position adopted for 'clenching up' when shoeing, while that for the rear incision is with the animal's knee flexed, and the foot held well up to the elbow. in this, however, each operator will suit himself. should the preliminary steps in making the incisions be performed with the iron, it will be easiest done with the foot on the ground. when the incisions through the wall are complete, our attention must be given to the sole. a drawing-knife is here used, and a further incision made over the white line so as to destroy the union of the sole with the wall between incisions and , and so completely isolate the portions of wall included within the four grooves (see groove , fig. ). when this is done it should be found that the portions of the isolated wall spring readily to pressure of the thumb. the inferior or wearing margin of the isolated wall must now be so trimmed that it takes no bearing on the ground when the opposite limb is held up by an assistant and full weight placed upon the foot. for a day or two after the operation lameness is intense. this is to be treated with hot poultices or hot baths, and and soon disappears. three to four days later a bar shoe is nailed on (taking care that the bearing of the quarters is still eased), and the hot poultices still continued. four days later still walking exercise may be commenced, to be followed shortly afterwards by trotting. at about the twelfth day some animals may conveniently be put to work, while in other cases a fortnight, or even a month, must elapse before this can be done. when put to work early, it is wise to fill in the fissures made in the wall with hard soap, with wax, or with a suitable hoof dressing, in order that irritation of the sensitive structures with outside matter may be prevented. this operation is soon followed by remarkable changes in the shape of the foot. at about the third week the coronet shows signs of bulging, and the upper part of the wall operated on is often so protruding as to render the foot wider here than at the ground surface. this is a sign that the case is doing well. should no improvement be noticed at the end of three weeks or a month, or should the grooves become filled from the bottom (which they do remarkably fast), then the incisions must be deepened, the exercise reduced, and the fomentations or poulticing repeated. so treated, many cases of side-bone lameness will be relieved, if not entirely cured, and, should the worst happen, and no alteration in the lameness is noticeable, no harm will have been done to the foot. in this connection, the originator of the treatment says: 'i may assure those induced to doubt either their diagnosis or the value of hoof section that no harm is done to the foot, even should the operation be of no value. it may do much good; it cannot do harm. the operation will never succeed until the inherent timidity of sawing or cutting into the wall is overcome. the _incisions must be deep, and of the same depth from the coronet to the ground_.'[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. iii., p. .] it is well to remark here that the operation of hoof section cannot be expected to succeed in every case. the last man in the world to claim that for it would be its originator. failure to relieve the lameness may be accounted for in a variety of ways. first, of course, will come errors in diagnosis. no one of us is infallible, and the lameness we have judged as resulting from side-bone may arise from another cause. there are, too, complications to be reckoned with, the existence or absence of which cannot always be definitely ascertained. such are: ringbone, especially that form of ringbone known as 'low'; bony deposits on the pedal bone, either on its laminal or plantar surface, or even changes in the navicular bursa. chapter xi diseases of the bones a. periostitis and ostitis. we head this section, periostitis _and_ ostitis, for the reason that in actual practice it is rare for one of these affections to occur without the other. the periosteum and the bone are so intimately connected that it is difficult to conceive of disease of the one failing to communicate itself in some degree to the other. pathologically, however, and for purposes of description, it is more convenient to describe separately the abnormal changes occurring in these two tissues. with the main phenomena of inflammation occurring elsewhere we presume our readers are aware. briefly we may put it, that under the action of an irritant, either actual injury, chemical action, or septic infection, the healthy tissues around react in order to effect repair of the parts destroyed. also that this reaction involves the distribution of a greater blood-supply to the part, with an abundant migration of leucocytes, and the outpouring of an inflammatory exudate, together with symptoms of heat, pain, redness, and swelling of the affected area. and that in chronic inflammations, owing to persistence of the cause, the process of repair thus instituted does not stop at mere restoration of lost tissue, but continues to the extent of forming an abnormal quantity of such tissue as normally exists in the parts implicated. the process of inflammation in bone is essentially the same. it takes place along the course of the bloodvessels, and is only modified in its attendant phenomena by the structure of the parts involved. swelling, for instance, cannot take place in the centre of compact bone tissue. otherwise, other changes occur exactly as in inflammations of other structures. when the causal irritant has been excessively severe and the migration of leucocytes abundant, actual formation of pus may occur, the bony tissue being broken down and mingled with it, and an abscess cavity formed. in milder cases, affected and necrotic tissue is removed by a process of phagocytosis, and new tissue (this time osseous) formed in its place. in the periosteum we may take it roughly that inflammation runs a course similar to that occurring in soft tissues elsewhere. there is but one exception, and that, as we shall mention shortly, is connected with its deeper layer. as we know, the periosteum consists of two layers, an outer fibrous and an inner yellow elastic, and is extremely vascular. numerous bloodvessels ramify in it, and, with their attendant nerves, break up to enter the numberless canals of the haversian system. this extreme vascularity, of course, favours abundant exudation. the exudate, however, is, as it were, shut in by the dense fibrous layer of the membrane, and the result is that in periostitis it collects between the membrane and the bone, causing swelling and raising of the membrane, and giving rise to excruciating pain from pressure upon the nerves. should the periostitis be complicated by the formation of pus, then the vessels entering and supplying the bone are, in the suppurative area, destroyed. with their destruction it may happen that we get also death of a portion of the osseous tissue. this, however, when the suppuration is abundant, cannot commonly occur, as the bloodvessels within the bone--those of the medulla--commence to supply blood to the affected part. in cases of trouble with the bones of the foot, these last few remarks have a special significance. here we have three bones whose medullary cavity is extremely small--almost nil, in fact--which explains in some measure how easy it is when suppuration exists to get necrosis and exfoliation of, say, portions of the os pedis. necrosis and sloughing of the periosteum itself may also happen, but as the extreme vascularity of the membrane is a fairly strong safeguard against that it is of only rare occurrence. in connection with the deep layer of the periosteum, and forming part of it, are found numerous bone-forming cells (_osteoblasts_). these, under ordinary conditions, are relatively quiescent. under the slightest irritation or stimulation, however, their bone-forming functions are stirred into abnormal activity, thus explaining how easy it is (especially with bones so open to receive slight injuries as are those of the foot) to get ossific deposits, the starting-point of which we are quite unable to account for. with this brief introduction we will now describe such pathological changes as occur in the separate structures, and which we are likely to encounter in the various diseases of the foot. while so doing, we shall draw attention to such diseases as we have previously described in which the pathological conditions we are considering may be met with. . periostitis. this we shall consider under _(a)_ simple acute periostitis, _(b)_ suppurative periostitis, _(c)_ osteoplastic periostitis. _(a) simple acute periostitis_.--this is the periostitis that follows on the infliction of a slight injury to the membrane--an injury without an actual wound and free from infective material. it is one, therefore, which we always judge as existing in those cases where we have distinct evidence or history of injury, but in which the injury has not been severe enough to lead to fracture or to the infliction of an actual wound. such cases may be those of lamenesses persisting after violent blows upon the foot--cases where the animal has been kicking against the stable fittings, or where the foot has been partially passed over by the wheel of a waggon. it may be, too, that in a case of 'nail-bound' a great deal of the pain and lameness is due to a simple periostitis caused by pressure of the bulged inner-layer of horn upon the sensitive structures. simple acute periostitis may also occur in cases where an actual wound is in existence, but where such wound, fortunately, remains aseptic. we may thus have this condition accompanying ordinary cases of pricked foot, of treads in the anterior region of the coronet, and of accidental injuries of other kinds. in simple acute periostitis the membrane is thicker and redder than normal, and is easily stripped from the bone. as it is pulled off it is noticed that there are numerous fibril-like processes hanging to its inner surface, and which draw out from the substance of the bone. these are simply the vessels (bloodvessels and nerves) which, loosened by the inflammatory exudate, are readily detached and drawn from the haversian canals into which they normally run. in addition to its increased redness, the membrane has a swollen and gelatinous appearance owing to its infiltration with the inflammatory discharges. simple acute periostitis may and often does end in resolution. on the other hand, it may end in suppuration or may become chronic. if the latter, then the osteoblasts of the innermost layer become active, and abnormal deposits of bone are the result. _(b) suppurative periostitis_.--this condition simply indicates that the inflammation is complicated by the presence of pus organisms. it is, therefore, a common termination of the simple acute form attending the infliction of a wound. the wound becomes contaminated, and the case of simple periostitis is soon changed into the suppurative form. once having gained entrance to the wound, the pus increases in quantity, and slowly runs between the membrane and the bone. this, however, it does not do to any large extent, showing rather a tendency to penetrate the outer fibrous layer and gain the outside of the membrane. suppurative periostitis is met with in foot cases, commonly in connection with punctured foot. it occurs, too, as a complication in suppurating corn, in severe tread, in complicated sand-crack, as a result of the spread of suppurative matter in acute coronitis, and in sub-horny quittor. in ordinary cases of suppurative periostitis the pus formed is yellow in colour, creamy thick, and free from pronounced odour--the so-called 'laudable' pus of the older writers. it so happens in many cases of foot trouble, however, that putrefactive organisms gain entrance side by side with those of pus. in this case the characters of the discharge are very different. it is distinctly more fluid, is of a pink or even light chocolate colour, and extremely offensive. in these instances the pus shows a marked tendency to spread, strips the periosteum from the bone, perforates the outer layer of the membrane, and finally infiltrates the surrounding tissues. this forms a near approach to what is known in human surgery as an _infective_ periostitis, and in our subjects is nearly always met with in cases of severe prick. its rapidly spreading character makes it always a dangerous condition, and a punctured foot exuding a discharge of this nature should always be regarded as serious. the close contiguity of the joint (it can never be _far_ distant in foot cases), the spreading character of the disease, and the rapidity with which the horse succumbs to arthritis, are all factors to be taken into consideration, and to lead to a warning-note being struck when attending a case of such kind. a further instance of infective periostitis is that met with in acute laminitis. the discharge obtained from the sole in these cases very often bears the character we have just described, and when one considers the thinness of the keratogenous membrane, one is bound to admit that changes so grave occurring in it cannot fail to spread and infect the periosteum. _(c) osteoplastic periostitis_.--this is more particularly a chronic process, and is, as the suffix '_plastic_' indicates, associated with bone-forming changes in the membrane. it may occur as a consequence of slight but continued irritation, often without ascertainable origin (see case , p. ), or it may be the sequel of acute disease. in this form of periostitis the membrane is again swollen and more vascular than in health, and is also easily separable from the bone. the exposed bone is generally rough, in some cases even spicular, and the inner layer of the removed membrane is rough and gritty to the touch--characters imparted to it by numerous minute fragments of bone that have been torn away with it from the more compact osseous tissue beneath. the results of an osteoplastic periostitis are frequently met with in the bones of the foot, and are described by veterinary writers under such headings as 'pedal exostoses,' 'ossifying ostitis,' and 'pedal ossification' (see figs. , , , and ). in many of these cases the disease is purely chronic, and the original cause nearly always wanting. when the foot has been subjected to laminitis of some weeks' duration, the same condition is also met with, being at the same time associated with rarefactive osteoplastic ostitis, conditions which we shall shortly describe. cases we have examined have undoubtedly shown this condition of osteoplastic periostitis, the rarefactive and osteoplastic changes in the bone itself, met with in older cases, occurring no doubt as a result of non-expansion of the horny box. so far as we are able to ascertain, there is every reason to believe that in chronic laminitis the accompanying periostitis leads to the formation of bone, and would, if it were possible, lead to increase in the size of the os pedis. if proof were wanted of this, it is only necessary to point out the increased growth at points where resistance is nil--namely, along the upper margin of the bone (see fig. ). however, increase in size elsewhere is prevented by the resistance of the hoof, so that, as the bone-forming process progresses, as it inevitably _must_ under the inflammatory changes going on, it is, as it were, compensated for by rarefaction or bone-absorption changes occurring simultaneously with it. . ostitis. we shall next deal with the inflammatory changes occurring in the bones themselves, and shall consider them under (_a_): rarefying or rarefactive ostitis, (_b_): osteoplastic ostitis, and (_c_): caries and necrosis. inflammatory changes occurring in the medulla we may pass without consideration, for in the bones of the foot the medullary cavity is so small, and the changes taking place in it of such minor importance, that we may do this without in any way seriously prejudicing our work. _(a) rarefying or rarefactive ostitis_.--by this term is indicated an inflammation of the bone attended by its absorption, the absorption being due to the action of certain cells, termed _osteoclasts_. this condition may be due to the pressure of tumours, may occur as the result of injury when a piece of bone is stripped of periosteum, or may be the result of an inflammation occurring in the periosteum elsewhere. a piece of bone undergoing rarefactive ostitis is redder than normal, and the openings of the haversian canals are distinctly increased in size. as a result a greater number of them become visible. their increase in size is due to the inflammatory absorption of the bony tissue forming them, and in the larger of them may be seen inflammatory granulation tissue surrounding the bloodvessels. this enlargement of the haversian canals is well seen when the bone is macerated, the whole then giving the appearance of a piece of very rough pumice-stone. this process of rarefaction or absorption of bone tissue may be confined to quite a small portion, or it may be spread over the whole of the bone, rendering it more porous than is normal, but stopping short of complete destruction of the bone tissue (a condition which is sometimes known as inflammatory osteoporosis (see fig. )). in this latter case the condition is a chronic one, and the bone tissue remaining often appears to be strengthened by a compensatory process of condensation. for an example of rarefactive ostitis as met with in cases of disease of the feet, we refer the reader to laminitis (see fig. ). the osteoplastic or condensing process that appears to exist simultaneously with it explains, no doubt, how it is that bones so affected do not more commonly fracture. a further example of this process is illustrated in fig. . the pressure of a tumour (in this case a keraphyllocele) has led to rarefactive changes in the bone, forming a neat indentation in the normal contour of the bone which serves to accommodate the tumour. _(b) osteoplastic ostitis, osteosclerosis, or condensation of bone_.--this, too, is essentially a chronic process. it may occur as a result of, or, as we have just shown, exist simultaneously with the condition of, diffuse rarefactive ostitis. in this case there is a formation of new bone in the connective tissue surrounding the vessels in the haversian canals. as a consequence the bone affected is greatly increased in density, and many of the haversian canals by this means obliterated. the end result is an increase in size of the bones in such positions as the horny box admits of it, and a peculiar ivory-like change in their consistence. for an example of this, we again refer the reader to the changes occurring in chronic laminitis. _(c) caries and necrosis_.--_caries_ is a word which appears to be used with a considerable amount of looseness. in addition to the meaning implied by necrosis (namely, 'death' of the part), caries is generally used to indicate that there is also a condition of rottenness, decay, and stench. it is particularly applied, in fact, when the death of the bone is slowly progressive, and is due to the inroads made upon it by putrefactive or septic matter. _necrosis_ of bone may be the result of any injury, such as severe blows, or pricks and stabs. in such cases it would appear that it is loss of a portion of periosteum that is the starting-point. with death of a portion of this membrane the vascular supply to a portion of the bone is cut off, and necrosis ensues. it may also result from the extension of inflammatory affections of the structures adjoining it, as, for instance, the spread of the infective material in severe tread, or the encroaches made by pus in cases of quittor, suppurating corn, or complicated sand-crack. when the necrosed portion of bone is small, and is free from infective properties, it is quite possible that it may, as is the case with small spots of necrosis in softer tissues, be removed by a process of absorption. it must be remembered, however, that where the necrosis has occurred as a result of septic invasion this cannot be looked for, for in every case such reparative changes are worked solely by healthy tissue. if the tissues around the necrosis are engaged in dealing with organismal invasion and the poisonous products thus poured into their working area, their state of health is so weakened that they are unable to successfully combat with the two conditions simultaneously. as a consequence, the necrotic piece of bone persists, and acts as a permanent source of irritation. it must be remembered, too, that if the dead portion of bone--even though it be free from septic matter--is very large, that it may itself act as a continual irritant, in which case it again persists, and cannot by natural means be removed. in our cases necrosis of bone may be met with in punctured foot, in severe cases of tread, in cases of complicated crack, and in suppurating corn. it is met with, too, in navicular disease, in the extension of irritating discharges in cases of quittor, and in cases of chronic laminitis where the solar margin of the os pedis has penetrated the sole. in this latter case the protruding portion of bone is quickly denuded of its periosteum. its blood-supply is destroyed, and necrosis follows. _treatment_.--in simple cases of periostitis, those caused by a blow but free from an actual wound, the most beneficial treatment is the continued application of cold by means of a hose-pipe or by swabs. if by these means we are successful in holding the inflammatory phenomena in check, any large formation of new bone is prevented, and the case does well. when the case is complicated by a wound, then antiseptic measures, such as those described in the treatment of punctured foot, will at the same time have to be practised. it must be admitted, however, that in all but the most simple cases ordinary treatment such as this is of very little use; for with only a slight exostosis in almost any position in the foot, excessive lameness presents itself and remains. in such cases nothing is left to us but the operation of neurectomy. when the periostitis and ostitis is the result of a wound, and is complicated by caries or necrosis of the bone, the diseased portion of bone must in every case be laid bare and removed. it so happens that the majority of cases of this kind occur in positions where the diseased bone is easily got at. the lower margin of the os pedis or portions of the wings are commonly the seat of such changes. we meet with the former in cases of pricked foot, and with the latter in severe cases of tread, or as a complication in suppurating corn or in quittor. in such cases the animal must be cast and the foot secured. the wound is then followed up, the horn if necessary removed, and the bone curetted with a volkmann's spoon; or, if showing itself as a sequestrum, removed with a scalpel and a strong pair of forceps. care must be taken that every particle of the diseased bone is removed, and that no part of it is left to act as an after-source of irritation. with removal of the diseased portion and a strict attention to antisepsis healing soon takes place. _reported cases of periostitis and ostitis_.-- . 'figs. and represent the phalangeal bones of the off fore-leg of a thoroughbred horse named osman, who was well known as a hunt steeplechaser of considerable merit in the midland counties some twenty years ago. i may say that this horse was under my observation pretty regularly during the whole of his career, and up to the time of his death, from ruptured aorta, when eight years old. my attention was called to him as a yearling by his owner, who told me that he sometimes fancied the colt was lame. i went over to see him, and found that he was unmistakably lame on the off fore-leg. careful examination showed no heat or enlargement anywhere. i advised rest and the colt became pretty sound, though not quite so--in fact, he never did become quite sound, and sometimes he was very lame indeed. [illustration: fig. .--effects of periostitis on the pedal and navicular bones.] 'every imaginable sort of treatment was tried short of neurectomy, without avail. the curious part of the case was that there never was much heat or any apparent change of structure, nor was "pointing" a very noticeable feature. the foot always remained a good-looking one. as the horse won a good number of races he was of some value, and was seen by a good many members of the profession, who were by no means unanimous as to the cause of lameness. the favourite theory was that it was a sequence of "split pastern." a post-mortem examination showed that there was no fracture. there was no adherence of the tendon to the navicular bone nor any ulceration. the morbid changes consisted entirely of osseous deposit as shown in the photographs. the under surface of the navicular bone was much enlarged and roughened by this bony deposit, which extended on to the os pedis, causing complete anchylosis at each extremity of the navicular. the lateral cartilages were healthy. the interesting points in connection with the case are the insidious commencement of osseous disease, its extensive development, and the entire absence of any external manifestation, through its being confined entirely within the limits of the hoof. [illustration: fig. .--effects of periostitis on the pedal and navicular bones.] 'it should also be noted that the animal was able to undergo a severe course of training for some years, and to gallop successfully over some of the most trying courses in england. during the whole of this time he walked and galloped apparently sound, but trotted always lame, and generally dead lame.'[a] [footnote a: w. e litt, m.r.c.v.s., _veterinary record_, vol. viii., p. .] [illustration: fig. .--effects of periostitis on the os pedis.] . 'i herewith send you photographs of three cases of the above disease, occurring in the internal surfaces of the wings of the os pedis. the photos were kindly done for me by dr. a. lingard, imperial bacteriologist to government of india. it is a cause of many cases of obscure foot lameness in india, and frequently accounts for the numerous entries on veterinary medical history sheets under the heading "contused foot." 'the course of the disease is as follows: the disease makes its appearance very soon after arrival in india, the animal being admitted to hospital suffering with undoubted foot lameness, generally slight. one is soon led to suspect this disease by negative symptoms of other disease being in existence. no coronary enlargement or flinching on pressure to the coronet, no shrinkage or wiring in of the heels, neither is the characteristic pointing of navicular present. in the early stages one has false hopes of recovery by finding gradual improvement for a time by fomentation and poultices, followed by irrigation and stimulants to the coronet, and perhaps the animal is discharged from hospital, to be returned after a few days worse than ever. the disease then becomes insidious and more pronounced, the nodding of the head, even at a walk, more exaggerated, and, in fact, the animal seems afraid to put his foot to the ground, and much resembles a horse with an abscess in his foot, either from prick or picked up nail. he absolutely nurses his foot. there is a certain amount of heat always present. the disease being now well developed, pressure is caused by the ends of the navicular bone, and they become involved at their points by bony deposits. the causes of this disease i attribute, firstly, to hereditary predisposition; and, secondly the exciting cause, standing confined on board ship, where no doubt pedal congestion takes place. and perhaps some subjects start it in their marches in mobs down country in australia. concussion may be the cause among older horses, but the specimens photographed were taken from remounts, that had either done no work or only very gentle work, in a deeply littered riding school. [illustration: fig. .--effects of periostitis on the os pedis.] '_treatment_.--it is obvious from the position of this disease that treatment will be of no avail in producing a cure. as already stated, the disease is insidious and progressive, and it is hopeless to expect to arrest the growths once they are started. unnerving would no doubt remove the symptom (lameness) of the disease, but an unnerved horse is not of much good for army purposes. i therefore consider that once the disease becomes firmly established it is an unfortunate and incurable one. [illustration: fig. , --effects of periostitis on the os pedis.] 'post-mortem reveals the small nodular growths on the inner surfaces of the wings of the pedal bone, and if long established the ends of the navicular bone are also involved. exudation and gradual growth of false material around the nodules takes place, which also serves to increase pressure.'[a] [footnote a: captain l.m.smith, a.v.d., _veterinary record_, vol. xi., p. .] . 'this case was brought for my opinion. the horse was lame, and walked similar to one that had had laminitis, putting the heel down first upon the ground. i ordered the patient to be destroyed. you will note the ossification of the flexor pedis at its attachment to the pedal bone. i enclose photos of the ground, also of the articular, surfaces of the bone.'[a] [footnote a: f.b.jones, m.r.c.v.s., _veterinary record_, vol. xi., p. .] b. pyramidal disease, buttress foot, or low ringbone. _definition_.--a condition of periostitis and ostitis in the region of the pyramidal process of the os pedis, usually preceded, but sometimes followed, by fracture of the process, and characterized by deformity of the hoof and an alteration in the normal angle of the joint. _causes_.--in the majority of cases buttress foot is brought about by fracture of the pyramidal process. thus, although distinct evidence of such is nearly always wanting, we may assume that the original cause is violent injury to the part in question. properly, therefore, one would say that this condition should be described under fractures of the os pedis. it appears, however, that other cases of the kind arise in which fracture is altogether absent, or in which it is plainly seen to be subsequent to the diseased processes in the bone. for that reason, and also for the reason that the condition has come to be known by the name we have given, we give it special mention. _symptoms and diagnosis_.--even when the condition arises as the result of fracture, the ordinary manifestations of such a lesion are absent. by reason of the situation of the parts within the hoof we are unable to detect crepitation, and the resulting lameness is perhaps--in fact, nearly always is--neglected until such time as any heat or swelling caused by the injury has disappeared, in which case we are denied what evidence we might have obtained from that. all that is presented is lameness, and lameness that is at times excessive. but with the lameness there is nothing distinctive. the foot is tender on percussion, and the gait suggestive of foot lameness, that is all. we are unable, therefore, to make an exact diagnosis, and the condition goes for some time undetected. later, however, changes in the form of the hoof and the coronet begin to appear. the skin of the coronet, especially in the region of the toe, becomes more or less thickened and indurated, and the same remark applies to the subcutaneous tissues. the most marked change, however, is the alteration in the shape of the hoof. the wall protrudes at the toe in a manner that has been termed 'buttress-like,' and has given to the condition one of its names. this, of course, entirely alters the contour of the horny box. from being more or less u-shaped, it approaches nearer the formation of the letter v, the point of the v being at the toe. in the later stages the coronary enlargement is plainly seen to be due to an extensive formation of bone. it is, in fact, a reparative callus, and the reason it reaches so large a size is probably to be accounted for by the pull of the extensor pedis upon the detached pyramidal process. as might be expected, this displacement of the fractured portion, with its effect of giving greater length to the extensor pedis, leads to a backward displacement of the os coronæ upon the pedal bone. as a result there is a marked depression at the coronet, the depression being heightened in effect by the exostosis in front. pyramidal disease is, as a rule, met with in the hind-feet, but occurs also in the fore. _pathological anatomy_.--when occurring without fracture, the first observable change is a thinning of the articular cartilage of the pyramidal process, through which the bone beneath appears abnormally white. later the thinning of the cartilage progresses until at last it becomes entirely obliterated. this destruction of the cartilage commences first at the highest point of the articular surface of the pyramid, and gradually reaches further backward into the joint. while this is taking place the new bone is being formed on the front of the os pedis, below and around the process, until, as we have already seen, an exostosis is formed, large enough to be noticeable at the coronet. this, of course, partly implicates the joint and the points of the insertion of the extensor tendon. finally, fracture may, or may not, take place. when it does, the exostosis is larger, and the general deformity of the hoof greater. _treatment_.--ordinary treatment, such as point or line firing, repeated blisters, or hoof section, each of which we have tried, appears to be utterly useless. so far as we have been able to gather from the writings of other practitioners, however, neurectomy returns the animal for a time to usefulness. if the fore-limb is the seat of trouble, either plantar or median neurectomy may be practised; if the hind, then the best results are obtained by section of the posterior tibial. _reported cases_.-- . this animal, a mare, had been rested for lameness behind for two or three weeks, and then sent out to work, going sound. this was repeated several times, and each time the coachman reported, "goes very lame behind after she has been at work about fifteen to twenty minutes." she always pulled out sound when i saw her in a halter on the following day, so i had her ridden, and after about seven or eight minutes she began to go lame in a hind-limb. her lameness got rapidly worse as she was being ridden, and within a quarter of mile of her first showing lameness, she dropped and carried the lame foot in a way that suggested a badly fractured pastern. there was no recognisable disease in the limb to account for this lameness. 'i divided the posterior tibial nerve, and she went back to work moving sound, and continued to work sound up to her death from one of the regularly fatal bowel lesions twist or rupture. 'she worked nearly two years after unnerving, and developed the usual thickening at the coronet.'[a] [footnote a: w. willis, m.k.c.v.s., _journal of comparative pathology and therapeutics_, vol. xv., p. .] . 'the subject of this note was a chestnut mare, nine years old, and used for omnibus work. '_history_.--for about two months the mare was lame on the off fore-leg, and in spite of treatment the condition became steadily worse. the off fore-foot was rather long and narrow, and the fetlock-joint was inclined to be bowed outwards, but the degree of lameness was out of proportion to these defects, and the diagnosis was obscure. 'median neurectomy was performed on may , , and reduced the lameness to about half of what it was before. on june ulnar neurectomy was performed, with the result that the mare became sound, and went to work three weeks later. she continued to work soundly and well, being inspected from time to time. 'during february of the coronet began to enlarge in front and slightly to the outer side, and gradually a ridge of bone grew down from the coronet to the toe. the case, in fact, became a typical one of so-called "buttress foot," which my friend mr. willis has described as diagnostic of disease of the pyramidal process of the pedal bone. meanwhile the swelling of the coronet, which appeared to be mainly composed of fibrous tissue, increased in size, until the whole of the front and sides became involved, assuming the appearance shown in fig. . 'in spite of the coronary enlargement the mare worked well, and remained free from lameness till june , , on which day the limb became swollen up to the site of the median operation. the appearance of the limb closely simulated an attack of lymphangitis. the mare was kept under observation till the th of the same month, during which time the swelling increased, as did also the lameness to a slight degree. during progression she brought the heel to the ground and "rocked the toe," as in a case of rupture of the perforans tendon. the mare was killed on june . [illustration: fig. .--a case of buttress foot.] [illustration: fig. .--fracture of the pyramidal process in buttress foot.] '_post-mortem_.--in trying to pull away the hoof from the sensitive structures with a pair of farrier's pincers, the tendons and ligaments of the corono-pedal articulation gave way, leaving the pedal bone _in situ_. the flexor perforans tendon showed inflammatory softening, and was very nearly ruptured through at the level of the navicular bone. there was slight evidence of navicular disease. the articular cartilage of the corono-pedal joint had been almost completely removed, and there was sclerosis of the opposed bony surfaces, which by unequal wear had brought about deformity of the os coronæ and os pedis. there was very old-standing fracture of the pyramidal process (see fig. ), with the formation of a false joint between the process and the pedal bone. there was also a recent fracture of the part of the pedal bone which carries the articulation for the navicular bone, and this and the tendon lesions probably accounted for the final symptoms of 'break-down.' neurectomy enabled us to get a year's useful work out of what would otherwise have been a hopeless cripple.[a] [footnote a: a.r. routledge, m.r.c.v.s., _journal of comparative pathology and therapeutics_, vol. xvi., p. .] c. fractures of the bones. more or less by reason of the protection afforded them by the hoof fractures of the bones of the foot are rare. when occurring they are more often than not the result of direct injury, as, for example, violent blows, the trapping of the foot in railway points, the running over of the foot with a heavily-laden waggon, or violent kicking against a gate or a wall. they occur also as a result of an uneven step upon a loose stone when going at a fast pace, and as a result of sudden slips and turns, in which latter case they are met with when animals have been galloping unrestrained in a field, or when an animal, ridden or driven at a fast pace, is suddenly pulled up, or just as suddenly turned. at other times fractures in this region take place without ascertainable cause, and cases are on record where animals turned overnight into a loose box in their usual sound condition have been found in the morning excessively lame, and fracture afterwards diagnosed. . fractures of the os coronÆ. fractures of the os coronæ result from such causes as we have just enumerated, and are nearly always seen in conjunction with fractured os suffraginis. when this latter bone is also fractured diagnosis is comparatively easy, a certain amount of crepitus, even when the suffraginis is only split, being obtainable. when the os corona alone is fractured then diagnosis is extremely difficult, the smallness of the bone and the comparative rigidity of the parts rendering manipulation almost useless, and effectually preventing the obtaining of crepitus. it is, in fact, only when the bone is broken into many pieces that crepitus may be detected, and even then it is slight. _reported cases_.-- . 'the subject was a four-year old hunter. while at exercise in the morning of august he bolted, got rid of his rider, and ran about in a mad fashion, came into contact with a wheelbarrow in a narrow passage, and finally came into violent contact with a wall, which had the effect of throwing him down. the rider stated that the animal suddenly put down his head and managed to get off the bridle; he then bolted, and the only chance for the rider was to throw himself off. 'on examination i found the horse unable to place any weight on the off fore-leg, the pastern was swollen and painful, the hollow of the heel was also swollen, and there was marked constitutional disturbance. 'after a short time he would place the heel on the ground and elevate the toe to a slight degree. on manipulating the pastern slight crepitation could be discovered, and there was abnormal mobility in the corono-pedal articulation. on the near fore-leg there were extensive wounds in the region of the knee, and great laceration of the tissues. the animal was destroyed. 'on examining the leg i found the subcutaneous tissues infiltrated from below the knee to the foot, large masses of gelatinous blood-stained material being present along the flexor tendons and in the hollow of the heel. the inferior articular surface of the os suffraginis was denuded of cartilage anteriorly; the os coronæ was fractured into eight moderate sized, irregular fragments, and ten minute pieces. the surface of the perforans tendon as it glides over the smooth surface at the back of the os coronæ was lacerated, and minute portions of the bone were found embedded therein.'[a] [footnote a: e. wallis hoare, f.r.c.v.s., _veterinary record_, vol. xiv., p. .] . 'here, again, fracture was the result of the animal bolting with his rider. trying to avoid collision with a conveyance coming towards him, the animal slipped on a wooden pavement, sliding along until his near fore-leg came in contact with the wheel of a standing cab. there was considerable swelling from the knee downwards, great pain, and evidence of fracture in the region of the pastern. 'post-mortem revealed the os suffraginis broken into about thirty pieces, and the os coronæ with a piece broken off the inside of its proximal end.[a] [footnote a: a.f. appleton, m.r.c.v.s., _veterinary journal_, vol. xiii., p. .] . 'the patient was a brown mare used for heavy van work in london. about january she was lame, and as she had a cracked heel, was treated by poulticing for a day, and then by antiseptic lotions. in a week she was sent to work, but the following day lameness returned, and continued till about february . no special symptom was detected which indicated the exact position of any cause of lameness. then the lameness increased in severity, and some swelling around the coronet began to show itself. 'in consultation with another veterinary surgeon, two possible causes of this intense lameness were discussed: one, that we had septic infection of the coronet, and that probably the swelling of this part would soften, and sloughs occur; the other, that a fracture of the os pedis or os coronæ existed. the enlargement of the coronet was hard and firm, not particularly sensitive. it was decided to do nothing for a few days. in a week the pain abated, and the mare would put her foot on the ground, and ceased to "nurse" the limb as she had done. when moved over in the box she put a little weight on the foot, but limped very decidedly. 'another week passed, and the pain and lameness further abated, but the swelling around the coronet continued. perhaps it was a little less in front, but it had not decreased on the inside. it remained firm, and was not painful on pressure. it showed no soft places, and the upper part of the leg remained free from oedema. [illustration: fig. .--fracture in situ (os coronÆ).] 'the diagnosis was now that a fracture existed, and it was proposed to send the mare to grass for a few months. the consulting veterinary surgeon suggested that before doing so a blister might be applied to the coronet. this was done. the mare was found next day again on three legs. she had apparently been down during the night. in a few days the coronet increased again in size, and within a week "broke out" in two places. 'the opinion now formed was that, with a fracture and this additional cause of inflammation around the joint, it would be most economical for the owner to have her killed. this was done, and a post-mortem examination was made by mr. hunting and mr. willis. [illustration: fig. .--with broken portion removed.] '_post-mortem_.--the foot, cut off at the fetlock-joint, showed extensive swelling all round the coronet. there were two wounds on the skin--one on the front of the coronet, the other on the inner side. from both pus and blood had escaped. they both communicated under the skin with a large abscess cavity. the abscess did not communicate with the joint. the pastern bone was sound. on separating the pastern from the coronet bone the articular surfaces were of a healthy colour, but the soft tissues immediately surrounding them were inflamed. on the centre of the articular surface of the coronary bone a thin red ring was noticed, and the portion of cartilage within it seemed raised. with the point of a scalpel this portion was lifted, and was found to be not only cartilage, but a layer of bone completely detached from the os coronæ. on removing the bones from the hoof the rest of the bone was quite normal, as was the pedal bone. 'fig. shows the articular surface of the coronet with the fracture _in situ_; and fig. the surface from which the broken portion is removed and laid to the side of the foot. 'some interesting questions arise. how was the fracture caused? when did it occur? between the broken portion and the main bone there was a layer of granulation tissue, so that it is certain the injury existed before the blister was applied, and it may possibly have existed from the commencement of the lameness.'[a] [footnote a: r. crawford, m.r.c.v.s., _veterinary record_, vol. viii., p. .] . fractures of the os pedis. these also are a result of the causes we have before given. the os pedis is also liable to fractures from pricks, from treads in the region of the wings, and from the malnutrition and careless use of the foot sometimes following neurectomy. it is interesting to note that, with fracture of this bone, lameness is nearly always excessive, but that at times it may be entirely absent. crepitus is, of course, denied us, and in nearly every instance the case is only diagnosed when the lameness persists and pus commences to form, or when grave changes in the normal shape of the foot compel our attention to the parts. when it is the continued formation of pus that draws our notice to something more than ordinarily grave, it is in giving exit to the pus that the fracture is nearly always discovered. _reported cases_.--two interesting cases of fractured os pedis are reported by mr. gladstone mayall, m.r.c.v.s., in the _veterinary record_, vol. xiv., p. : . 'the horse was brought in markedly lame on the off hind-foot, knuckling at the fetlock, and taking a long stride with the injured limb. there was a punctured wound at the toe. the horn was pared, and antiseptic poultices applied. notwithstanding the antiseptic treatment pus continued to form. at the end of a week sufficient horn was removed to ascertain the cause of the constant suppuration. a movable object was found at the bottom of the wound, and a piece of bone as large as a sixpence finally removed. recovery was uneventful.' [illustration: fig. .--fractured os pedis.] . 'a filly was attended for a discharging fistula at the coronet. externally it had all the appearances of a quittor. at first no history was given. the filly went scarcely lame at all, and had never been shod. treatment with poultices and caustic injections was useless. finally the filly was cast and the foot examined. a piece of bone, apparently part of the wing of the os pedis, was removed, and the case made a good recovery. subsequent inquiries elicited the fact that the animal had kicked at and hit a gate-post, and it was judged that then the injury had occurred.' . 'the subject was a bay horse, nine years old, used for railway shunting. on august he was found to be intensely lame of the near hind-limb, and, after inquiries, there was no evidence bearing on the cause, as is often the case, and at times this comes to light when least expected. 'i was called in consultation on september , and found him suffering acute pain, with great swelling around the coronet. the foot was examined thoroughly, and the diagnosis was fracture of the pedal bone, and immediate slaughter was recommended. however, that was not carried out, and he died on september . 'the post-mortem inspection revealed a complete fracture of nearly the whole of the articulating surface and the left wing of the pedal bone (as shown in fig. ).'[a] [footnote a: j. freeman, m.r.c.v.s., _veterinary journal_, vol. xxxi., p. .] . a further interesting case is reported by mr. william hurrell.[a] here the cause was presumably galloping in the field, for the subject, a cart mare running out at grass with her foal, was suddenly found to be lame. [footnote a: _ibid_., vol. v., p. .] as the lameness continued to increase in severity, mr. hurrell was called in on august , and diagnosed the case as one of foot lameness. on this date the foot was pared out, and a large accumulation of pus discovered, poulticing and antiseptic dressings were continued until august , when a movable piece of the os pedis was found at the toe. on august this detached portion of the bone was removed, and turned out to be the whole of the anterior margin of the os pedis, measuring - / inches long, and varying in width from / inch to - / inches. on september the mare was working without lameness. . fractures of the navicular bone. hidden within the wings of the os pedis, and protected as it is by its tendinous covering and the yielding substance of the plantar cushion, the navicular bone is even less liable to fracture than either of the other bones of the foot. the most common cause of fracture of the navicular is that of stabs or deep pricks in the region of the point of the frog (see p. ). following that, the next most common cause is violent injury. we thus find the navicular bone fractured, together with one or both of the other bones of the foot, when the foot is run over by a heavy vehicle. one such case is reported by mr. j.h. carter, f.r.c.v.s., where the horse's foot was run over by a tram-engine, in which the os pedis and the navicular were fractured in several places.[a] a further case is on record where a sharp blow on the front of the hoof was the cause. in this case the os pedis and other structures were uninjured, but the navicular bone was fractured into three large, and about half a dozen small, pieces.[b] [footnote a: _veterinary journal_, vol. xxxi., p. .] [footnote b: _veterinarian_ for , p. .] fractures of the navicular may occur, however, in which history of a prick or of a violent injury is absent. see reported case below. as with fractures of the os pedis and the os coronæ, so with this exact diagnosis is difficult--we may say almost impossible. with a history of violent injury, however, some little regard may be paid to a continued heat and tenderness of the foot, and a distinct inclination on the part of the animal to go on the toe. even when the fracture is the result of a prick, and the bone is plainly felt with the probe, we still cannot be positive as to fracture. _reported case_.--'the animal was a hungarian, a troop-horse in the rd hussars (g. ). on november , , on the march from norwich to aldershot, the horse suddenly made a violent stumble, very nearly coming on to his knees. the rider declared that he put his foot on a stone. the accident caused great lameness in the near fore-leg, and the horse had to be led the remainder of that day's march. on the following day he was also led; but, after going some sixteen or eighteen miles, he was so lame that he was left at the nearest billet (in edmonton). he was here attended by mr. stanley, m.r.c.v.s., of edmonton, who pronounced it a case of navicular disease. i first saw the animal on december , , and quite agreed with mr. stanley that it was a case of foot lameness, though, from the horse's former history, i could not think it a case of ordinary navicular disease. i diagnosed it a case of fracture, without displacement, either of the os coronæ or the navicular bone, but was more inclined to the former than the latter. this was after a full hour's examination. i failed to find any heat in, or any flinching by manipulation of, any part of the limb; but, in walking, the horse was excessively lame, going on the toe, and, indeed, trying if possible to keep the foot entirely off the ground. 'on december the horse was sent on to aldershot by rail. he was then walking better, though still very lame. my only treatment for a short time was to apply cold water constantly to the coronet and foot. for two hours daily this was done by a hose, the remainder of the time by a cold swab. on december i applied a strong blister over the coronet, reaching up to the fetlock. this was washed off about the end of december. the horse was then not nearly so lame. i then resumed the cold-water treatment, and he got gradually better, and was sent to light duty on february , . he, however, only attended one field-day, and was taken into the horse infirmary again on march , very lame. again, there was an entire absence of heat or pain on pressure, but the same action, viz., going on the toe. i forgot to remark that he always pointed the toe of the affected leg when standing in the stable, and this symptom continued. i put him under the cold-water treatment for a short time, and about the middle of march again applied a strong blister over the coronet up to the fetlock. this was washed off about the end of the month, and was succeeded by the cold water again. towards the end of april there was no improvement at all, and i applied for permission to destroy the horse. this was carried out on april , at the recommendation of mr. gudgin, i.v.s., aldershot, and a board of veterinary surgeons. 'on making the post-mortem examination i first thought the bone was only partly fractured or cracked, but on manipulating it, after its being in hot water a short time, i saw the fracture was complete.'[a] [footnote a: s.w. wilson, m.r.c.v.s., a.v.d., _veterinary journal_, vol. xv., p. .] _treatment of fractures of the bones of the foot_.--it will be seen at once that in most cases anything in the way of bandaging is well-nigh useless. when the os coronæ is fractured, however, a little more may be added to the natural rigidity of the parts by enclosing the region of the pastern and the foot in a plaster-of-paris bandage. the main treatment, however, in every case, will be a continual use of the slings for at least seven to eight weeks, by that means compelling the animal to give to the injured parts the necessary amount of rest. with fracture of the os pedis, when such is caused by pricks and complicated by a flow of pus, then attention must be given to removal of the displaced piece of bone. the pus track is to be followed up with the searcher, sufficient horn removed with the knife, and the broken piece of bone removed with a scalpel and a pair of strong forceps, the operation to be afterwards followed up by antiseptic dressings to the opening. until this is done the wound refuses to heal. fracture of the navicular bone, if in any way diagnosed with certainty, offers us an almost hopeless case, for it appears to be a commonly reported fact that attempts at reunion are rare. this, in all probability, is due to the pressure put upon it every now and again, when the animal's weight presses the bone between the os coronæ and the os pedis above and the perforans tendon below. even should reunion take place, the resulting callus, interfering as it does with the movements of the perforans, leaves us a case of incurable lameness. when the fracture is complicated by the formation of pus, as in the case of prick, then the case, with the attendant purulent synovitis and arthritis, is even more hopeless still. diagnosis of fracture of either of the bones of the foot is, as we have said before, extremely difficult. it so happens, therefore, in those cases caused by violent blows, that anything approaching an accurate opinion cannot be given until some months after the injury. after some time we are met with unmistakable changes in the form of the foot, and are able to assume that the persisting lameness is due to pressure of a reparative callus within the hoof. in such cases the only treatment of any use is that of neurectomy. chapter xii diseases of the joints[a] [footnote a: properly speaking, we have in the foot of the horse but _one_ joint--namely, the corono-pedal articulation. although not a joint in the strict sense of the word, we, nevertheless, intend here to consider the navicular bursa as such. in this apparatus, although we have no articular cartilage proper, and no apposition of bone to bone, we still have a large synovial cavity, and in close proximity to it bone. we may, in fact, and do get in it exactly similar changes to those termed 'synovitis' and 'arthritis' elsewhere. therefore, we include the changes occurring in it in this chapter, and hence the plural use of the word to which this note refers.] a. synovitis. _definition_.--by the term 'synovitis' is indicated an inflammation of the synovial membrane. it may be either (_a_) _simple_ or _acute_, or it may be (_b_) _purulent_ or _suppurative_. in the simple form there is little or no tendency for the affection to implicate the other structures of the joint, whereas in the suppurative form the joint capsule, the ligaments, and the bones soon come to participate in the diseased processes, giving us a condition which we shall afterwards describe as acute arthritis. (_a_) simple synovitis. . _acute--(causes)_.--simple or acute synovitis is nearly always brought about by injury to the joint--by blows or bruises, or by sprains of the ligaments. at other times it occurs without ascertainable cause, and is then put down to the influence of cold, or to poisonous materials (as, for example, that of rheumatism) circulating in the blood-stream. _pathology_.--uncomplicated acute synovitis never causes death. the pathological changes in connection with it have therefore been studied in cases purposely induced, and the animal afterwards slaughtered. it is then found that, as in inflammation elsewhere, the synovial membrane is showing the usual inflammatory phenomena--that it is thick and swollen as a result of the inflammatory hyperæmia and commencing exudation. later, the synovial fluid becomes increased in quantity, is thin and serous, and after a time is seen to be mixed with the inflammatory exudation poured into it. we then find that it has lost its clear appearance, has become thick and muddy, and has floating in it flakes of fibrin. if the case progresses favourably these materials are soon absorbed and resolution occurs. in rarer cases the thickening and congestion of the membrane increases, and the articular capsule becomes so distended with the increased synovia and accumulated inflammatory discharges that a kind of chemosis occurs. in other words, there oozes through, without actual rupture of the membrane, a thin, blood-stained, and purulent-looking discharge. it is an important point to note that in cases of synovitis the fringes of the synovial membrane become swollen and blood-injected, forming noticeable red elevations at the margins of the cartilages. it is then that the diseased condition soon spreads and runs into arthritis. further, it is important, especially with regard to the question of the degree of pain and lameness likely to be caused, to note that often granulations are thrown out upon the looser folds of the membrane. as these increase in size they come to form fringed and villous membranous projections inserting themselves between the bones forming the articulation. in such cases there is no doubt that the intense pain sometimes observed in these cases is due to pinching of these prolongations of the synovial membrane by the opposing bones of the joint. _symptoms and diagnosis_.--acute synovitis of a joint leads to heat of the parts, pain, distension of the capsule, and, where the joint may be easily felt, fluctuation. in the articulation with which we are dealing, however, these last two symptoms are not easily detected, for the surrounding structures--namely, the lateral and other ligaments of the joint, the extensor pedis tendon in front, and the perforans behind, together with the dense and comparatively unyielding nature of the skin of the parts--are such as to prevent distension and fluctuation becoming marked to a visible extent. we are able to diagnose the case as one of foot lameness, and, with a history of a severe blow or other injury, are able to assume that this condition, perhaps attended with periostitis, is in existence. when other symptoms present themselves diagnosis may be more certain. the animal becomes slightly fevered, throbbing pains in the joint manifest themselves by irregular pawing movements on the part of the patient. the animal comes out from the stable stiff, even dead-lame, and the limb is carried with the lower joints semiflexed. the breathing is hurried and the pulse firm and frequent, while in a bad case patchy perspiration breaks out at intervals on various parts of the body. if with this we get a puffy and tender swelling in the hollow of the heel, our diagnosis may be certain at any rate as to the existence of joint trouble, although, from reasons we have given, we may not be able to mark its exact nature. . _chronic_.--simple synovitis may in many instances become chronic. in this case we have simply a pouring into the synovial capsule of serous fluid, and with it an increased quantity of synovia--this time with an absence of the usual inflammatory phenomena. beyond the swelling of the capsule there is little to be noticed. the joint becomes perhaps a little weaker, but pain or tenderness and heat are entirely absent. such a condition, by reason of the natural rigidity of the parts, is not to be observed in the foot, although at times it must most certainly occur. examples of such a condition are to be found in bog-spavin, in hygroma of the stifle, and sometimes in the fetlock. from a study of these, we know that they may be induced by frequent attacks of acute synovitis, from repeated slight injuries or bruises, or from strains to the ligaments of the joint; or that they may be chronic from the outset. we know, too, that in such cases the synovial membrane becomes thickened, and that in places it may have extended somewhat over the edges of the articular cartilages. it is only fair to suppose that such changes occur also in the pedal articulation. in that case we may take it for certain that the natural rigidity of the surrounding structures has the effect of pushing the thickened membrane further between the bones of the joint than occurs in a like condition elsewhere, leading, of course, to a lameness that is marked in degree but occult as to cause. in our minds there is no doubt that many of the occult and chronic forms of foot-lameness we meet with in practice are in this way to be accounted for. we may, in fact, explain them by suggesting either a chronic synovitis alone, or a synovitis complicated with periostitis. _treatment of synovitis_.--if a joint has been injured, as we have suggested, by slight blows or other causes--in other words, if the injury is subcutaneous, and no wound is in existence--then there is no treatment which offers better results than does the continued application of cold. at the same time, the animal should be slung, or, if non-excitable and inclined to rest, allowed at intervals to lie on a thick and comfortable straw bed, the cold fomentations during such intervals being discontinued. when the case is a marked one and the animal valuable, benefit will be derived from the application of crushed ice. the animal's condition must be watched, and the case helped as far as is possible by the administration of a mild dose of physic, by saline drinks, and, when necessary, by the giving of small but repeated doses of fleming's tincture of aconite in order to relieve the pain. in a chronic case the repeated application of a blister is indicated. (b) purulent or suppurative synovitis. in this condition we have synovitis complicated by the presence of pus. unlike the simple form, it shows a marked disposition to spread, and quickly involves the surrounding structures. very soon the ligaments of the joint, the periosteum, the articular cartilages, and the bones are implicated. this, of course, constitutes a condition of acute purulent arthritis. under that heading, therefore, the condition will be later discussed. b. arthritis. (a) simple or serous arthritis. with an attack of simple synovitis it may be always assumed that the changes commenced in the synovial membrane, communicate themselves more or less readily to the surrounding tissues, and are not confined to the synovial membrane alone. we may thus have the inflammatory phenomena asserting themselves in the surrounding ligaments, in the periosteum, in the bone, and in the articular cartilages. it depends, in fact, upon the severity of our case whether we call it synovitis or arthritis. the two conditions merge so the one into the other that no hard-and-fast rule may be laid down whereby they may with certainty be differentiated. such symptoms, therefore, as we have given for synovitis may be also read as indicating a condition of simple arthritis. the course of the case will be very similar, and the treatment to be followed identical with that just given. (b) acute arthritis. _causes_.--an attack of acute arthritis may commence with the affection of the synovial membrane, and spread from that to the other structures. in other cases the disease of the synovial membrane, and after it the disease of the joint, may be secondary to diseases commencing in the structures around the joint. this affection may therefore follow on a case of acute coronitis, a case of suppurating corn, a case of quittor, a severe case of tread, or may attend a case of laminitis. _symptoms_.--in our cases we get very little beyond a magnification of such symptoms as we have described under acute synovitis. the heat and the pain is perhaps greater, and the lameness more marked. it is rather to the constitutional disturbance we must look, however, for a confirmation of our opinion that arthritis is in existence. this is always severe, and of an acute febrile nature. the pulse is fast, thin, and thready, the respirations enormously increased, and the temperature high. the appetite is in abeyance, the animal quickly becomes what is termed 'tucked-up,' or greyhound-like, in the body, and patchy perspirations break out about him. the limb is held with the joints all semiflexed, and severe and intense throbbing pains are indicated by the frequent pawing movements the animal makes in the air. manipulation of the foot is resented, and the agonizing intensity of the pain so caused is shown by the drawn and haggard appearance of the eyes. in a favourable case the symptoms from now onwards may gradually subside. the appetite returns, the breathing and other signs of disturbance show a return to the normal, weight is placed on the limb, and resolution slowly but surely takes place. in many of these, our favourable cases, however, resolution is incomplete, and recovery only takes place at the expense of anchylosis of the joint, a condition we shall refer to later. in unfavourable cases, and these unfortunately are only too common, the condition terminates in suppuration. (c) purulent or suppurative arthritis. _definition_.--by this term we indicate an arthritis complicated by the formation of pus within the joint. _causes_.--the organisms of pus may infect the joint by extension of a suppurating process from without. for example, in the case of a suppurating corn, in quittor, in tread, or in the case of a suppurating wound caused by a prick, the pus formed may in many instances be very near the capsular ligament of the articulation. under such circumstances, unless there is a free and unhindered flow of the pus from an outside opening, inroads will be made by it upon the thin capsule. the latter is quickly penetrated, and pus is admitted to the interior of the joint. in other cases infection of the joint may proceed from within, from a poisoned state of the blood-stream. the condition occurs, for instance, in bad attacks of laminitis. we ourselves, too, have seen two cases where suppuration of the pedal articulation occurred in the septic pyæmia of foals, a disease known commonly as 'joint-ill,' and characterized by an infected state of the circulation. cases have also come under our notice where this condition has resulted from slight injuries in the region of the insertion of the extensor pedis inflicted by the animal himself when galloping away. perhaps, however, the most common cause of suppurative arthritis in the foot is direct penetration of the articulation in the case of pricks. the penetrating object is nearly always dirty--bacterially dirty, at any rate--and suppuration only too readily commences. even should such a wound be inflicted by an aseptic body, infection would quickly ensue as a result of the wound gathering dirt from the ground, or even from admission to the joint of impure and bacilli-laden air. _symptoms and diagnosis_.--this is one of the most serious conditions we are called upon to face when dealing with diseases of the foot, for in many cases it quickly ends in exhaustion and death of the patient, while in even the most favourable cases nothing better than a condition of complete and bony anchylosis is to be expected. the owner, therefore, should be warned accordingly. as in the other joint affections, so here, we get all the symptoms of acute febrile constitutional disturbance. the pulse, the temperature, the respirations, and the general haggard, 'tucked-up,' and distressed appearances of the animal all tell too plain a tale. our patient is in constant pain, and the seat of the trouble is clearly enough shown by the constant pawing movements of the affected foot. if he has room to get up and down in comfort the animal adopts for long periods at a stretch the recumbent position, and is not upon his legs long enough to take the necessary amount of food to keep him going. even when down, it is plain to see that the animal is not at rest. the pawing movement is still maintained with the foot, and every now and again the eyes are opened and the headed lifted to give a troubled look round. the appetite, too, is capricious, and in many cases almost entirely lost. in some slight degree the condition is less to be feared in a fore than in a hind foot--that is, so far as absolutely fatal results are concerned. with the condition confined to one fore-foot, the animal is able to get up and down with a moderate degree of comfort. at intervals, therefore, he rises to take nourishment, and as soon as his wants are satisfied again lies down. with the disease in a hind-foot matters are not taken so comfortably. the patient finds that with each day's increasing weakness the difficulty that at first he had to raise himself with only one sound hind-foot becomes enormously increased. the consequence is that he fears to go down, and the standing position is maintained until sheer weakness overcomes him, and he goes down, not to rise again without assistance. if judiciously attended he is, of course, put in slings before this stage is reached; but there are instances, as in the case of a cart-mare heavy with foal, where the use of slings is most decidedly contra-indicated. if doubt before existed as to the nature of the case, it is at a later stage dispelled by the appearance, generally in the hollow of the heel, of a hot and painful swelling. this at first is hard, but later fluctuates. finally it breaks at one or more spots, and there exudes from the opening or openings a purulent and oftentimes sanious discharge, which coagulates about each fistula after the manner of ordinary synovia. with the discharge of the abscess contents there is some slight improvement in the symptoms. here, with a suitable treatment, and with a patient of a particularly robust constitution, the case appears to turn, and slowly but surely progresses towards the only end we can hope for--namely, a more or less painless anchylosis of the articulation. in less favourable cases the purulent discharge continues, and (always a bad sign) becomes more or less chocolate-like in colour, distinctly thin, and stinking. the diseased process spreads until the ligaments of the joint, both by reason of their infiltration with the inflammatory discharges, and also on account of the ravages made on them by the invading pus, either greatly stretch or altogether rupture. the joint, after its ligaments have been destroyed in this manner, is loosened, and the bones are now freely movable. their manipulation gives to the touch a sickening, grating sound--in other words, we have crepitus. this, of course, indicates that the articular cartilages have become greatly eroded by the inflammatory process, and so left what we may term 'raw' surfaces of bone to rub together. when the animal is put to the walk the toe of the foot is elevated, and the extreme mobility of the foot gives one the idea of fracture. with every step there is a peculiar sucking noise, comparable to that of a foot moving in a boot of water, and putrescent matter is squeezed from every opening each time the foot is put to the ground. although we have seen cases even advanced thus far recover, it is questionable whether it is now wise to attempt to prolong life. slaughter is far more humane, and, in our opinion, except with a valuable brood animal, more economical. if the animal is allowed to linger, other symptoms will nearly always present themselves before death occurs. whether in slings or not, a careful watch should be kept upon the sound limb. for some time the patient stands upon it incessantly, but sooner or later it happens that a farther visit show us the animal standing with full weight on the diseased foot, and making painful pawing movements with what before was the sound. we immediately jump to the conclusion 'laminitis.' and so it is, but it is a laminitis brought about by pyæmia. this is indicated by the swollen and oedematous nature of the lymphatics of the limb. plainly enough they indicate the road by which the poison has travelled. it is in this way: pus and putrefactive organisms have gained entrance to the lymphatics of the original diseased limb. from these they have rapidly gained the blood-stream and set up infection elsewhere. in this particular instance it is demonstrated by the laminitis and lymphangitis of the previously sound limb. with the poison thus circulating in the blood-stream, we often also get spots of infection commenced in one or other of the more vital organs--notably the lungs or the kidneys. the end of our case is then either a gangrenous pneumonia or complications induced by a condition of widespread pyæmia. with the animal in slings there are one or two other symptoms that call for attention. in many cases, especially with animals of a lymphatic and indolent nature, the use made of them is inordinate. the patient rests so continually in them that alarming swellings commence to make their appearance about the rectum, or in the case of a mare about the vulva. the animal must then be let down at regular intervals and again raised when rest is obtained. a more alarming symptom still is when the animal, instead of resting in the slings by his buttocks, casts his weight bodily into the belly-rest and hangs with a heavy head into the head-stall. this indicates complete exhaustion and a wish for death. matters should therefore be explained to the owner, and his consent obtained for immediate destruction. _pathology_.--the pathological changes occurring in suppurative arthritis we shall pass over briefly. it is almost sufficient, in fact, to say that the whole of the joint becomes completely disorganized. the synovial membrane becomes so tremendously thickened and injected as to be scarcely recognisable as such, the thickening in the later stages being due to large growths of granulation tissue which entirely alter the appearance of the membrane as we know it normally. in the early stages the contents of the joint are composed of thin pus and synovia. later, as destruction of the synovial membrane proceeds, the flow of synovia is stopped, while the pus formation goes on until finally nothing but pus and dead tissue products fill the cavity. if the suppurative process has commenced from within, the pus that is formed is, as a rule, thick and creamy, comparatively unstained, and free from marked odour. if, on the other hand, air has gained access to the joint, or the suppurative process has started from the materials introduced by a foreign body, the joint contents are thin, blood-stained, and stinking. the inflammatory changes in the joint soon spread to the ligaments, and to the soft structures in contact with them. this means that the ligaments become infiltrated with inflammatory exudate, that the fibrous bundles composing them become separated, and that the ligaments are weakened and easily stretched. as a consequence, a certain amount of displacement or dislocation of the bones is allowed. in like manner the inflammatory changes keep spreading until we have the periosteum next the ends of the bones affected. the periostitis thus set up invariably takes the osteoplastic form, and as a result of this we have growths of new bone in the near neighbourhood of the joint. it is in the later stages of the disease--that is, when the pus has been evacuated and reparative changes commenced--that this osteoplastic periostitis is most marked, and it plays a large part in bringing about the condition of anchylosis, which we shall afterwards describe. grave changes also occur in the articular cartilages. they quickly lose their peculiar glistening polish, their semitransparency is lost, and the natural tint of a pearl-like blue gives way to a dirty yellow. later this is followed by erosion of the cartilages at such points as they happen to be in greatest contact. the ends of the bones are thus exposed, and their medullary cavities exposed to infection. as a result we get in them the changes we have already described under ostitis. _treatment_--_(a) preventive_.--seeing that many of these cases have their starting-point in stabs or penetrating wounds of the sole, we shall be concerned first with a consideration of the correct treatment to be adopted when we know the wound to have reached the articulation. only too frequently the treatment practised is that of poulticing. in other portions of this work we have pointed out the advantages that a continued antiseptic bathing has over the application of a poultice, the greater readiness with which the solution comes into contact with the deeper parts of the wound, and the far greater chance there is of maintaining water in an antiseptic condition than there is of keeping a poultice in the same state. there is no doubt, that in this case also, the cold or warm antiseptic bath is to be preferred to the poultice. it is questionable, however, whether even the bath is sufficient for our purpose here. we have in this case a deep punctured wound, and a wound that in every probability is infected with the organisms of pus or of putrefaction. it is a wound, moreover, which is likely to impede the thorough access to it of the solution in which the foot is fomented, on account of the flakes of coagulated fibrin which fill it. the most rational treatment, therefore, if we get to the case early enough, is to irrigate the wound freely with a solution of carbolic acid in water ( in ), or with a solution of perchloride of mercury ( in , ), injected by means of a glass syringe, or the pattern of syringe devised for quittor. this injecting should be done thoroughly, and by that we mean that several syringefuls of the solution should be injected, the joint after each injection being manipulated so as to distribute the solution as far as possible over it. when this is done the opening in the sole may be plugged with a little perchloride of mercury, or, better still, with a little piece of tow saturated with a concentrated solution of perchloride of mercury or a solution of iodoform in alcohol and an antiseptic pad of tow or lint placed over all. the foot should then be bandaged and encased in a boot or sacking protective. the bandage should be removed daily and the antiseptic pad changed. at each visit the animal's condition must be carefully noted. so long as constitutional disturbance is slight, the foot appears comfortable, is free from marked heat and tenderness, and pawing movements are absent, and so long as the discharge on the pad appears non-purulent, free from marked odour, and small in quantity, then this dressing may be persisted in. this treatment of open joint, preventive as it is of arthritis, is also indicated in the case of open navicular bursa. in several instances we have practised this treatment for the dressing of wounds implicating the bursæ of tendons and the capsules of joints. it is also spoken of favourably by mr. c.h. flynn in the _american veterinary review_ for june, , whose treatment is as follows: 'place the patient in a clean, well-ventilated, and drained stable. have all the litter removed, and insist on the stall being kept clean. either place the animal in slings, or tie the head so as to prevent lying down. clip the hair and cleanse the parts well. he prefers the corrosive sublimate solution ( in , ). should the wound be of two or more days' standing, inject the joint with the corrosive sublimate solution. now dry the parts with a clean towel and sprinkle the wound with iodoform. over this place a thick layer of absorbent cotton-wool, filled with iodoform, bandage securely, and keep the patient on a moderate diet, preserving the utmost quietude possible. should the bandage remain in position and the animal free from pain, leave the bandage and dressing in place from five days to a week. then change it, and should the discharge be little, do not disturb it, but renew the iodoform and cotton dressing, leaving it on for another week.' other treatments for the same condition are practised, in which the wound is dusted with powdered iodoform, with potassium permanganate, or with corrosive sublimate, or where the wound, instead of being dusted, has the corrosive sublimate applied in the form of a plug. in each case the preliminary irrigation with the corrosive sublimate solution is dispensed with. this, however, should on no account be omitted. in our opinion it constitutes the very essence of the rationality of the treatment. _(b) curative_.--it may happen, however, and often does, that this first injection of an antiseptic is unsuccessful in preventing organismal infection of the wound. in this case grave constitutional disturbance and other untoward symptoms such as we have already described quickly make their appearance. the animal should now be placed in slings and preparations made for actively treating the wound with antiseptics. whether we fail or not, we have the satisfaction of knowing that we have given to the patient the best and the only chance of recovery. it should be remembered, however, and should be pointed out to the owner, that with purulent arthritis fully developed, with the grave constitutional changes it occasions, and with the ever-present danger of a general septic invasion of the blood-stream, that the human surgeon under such circumstances offers to his patient the alternatives of amputation or probable death. with us no such alternative is possible. it is either return the joint to some semblance of its former usefulness, or destroy the patient. in this case we advise the injection of the original wound, and also such fistulous openings as may have formed, with the in , sublimate solution. also, in order to avoid the sometimes abortive attempts of the antiseptic pad, to maintain a condition of asepsis around the wound, we advise the continual soaking of the whole foot in a cold antiseptic bath. this may be either carbolic acid in , or--what is less volatile, perhaps more effectual, and certainly more economical--perchloride of mercury in , . it has been our good fortune, even when we have seen the foot almost detached from the limb by the devastating inroads of the pus, to see the suppurative process by this means gradually overcome, a reparative anchylosis set in, and the animal restored to good health and usefulness, if not to soundness. once the suppurative process is checked and anchylosis commences, it is good treatment to smartly blister the whole of the region of the coronet, the pastern, and the wound itself with a mixed blister of cantharides and biniodide of mercury, repeated at intervals of a fortnight. this prevents to some extent further infection of the wound, and assists also in promoting the changes that tend to anchylosis. _(d)_ anchylosis. the word anchylosis signifies the stiffening of a joint. when one has read the serious changes occurring within the joint in the more serious forms of arthritis, it is easy to understand how it comes about. in suppurative arthritis, for instance, we have the synovial membrane destroyed, the articular cartilages partly or wholly obliterated, and the former boundaries of the joint entirely lost. if the animal lives, nature is bound to make repair of a sort. the synovial membrane and the articular cartilages utterly destroyed, as we have described, cannot again be replaced. nature can only build again from such materials as are left to her. in this case the material is bone. it must be remembered, however, that often the bone has been so diseased that spots of necrosis or caries within it are bound to remain unless moved by operative interference. such diseased portions, when dealing with the foot, are beyond reach of the surgeon's knife, and we have no alternative but to allow them to remain. we get, therefore, in many cases, a condition of rarefactive ostitis occurring side by side with a slowly progressive caries within the bone, while outside is occurring an osteoplastic periostitis. the concurrence of these conditions leads in time to great increase in size of the parts, together with increasing anchylosis and deformity. c. navicular disease. _definition_.--chronic inflammatory changes occurring in connection with the navicular bursa, affecting variously the bursa itself, the perforans tendon, or the navicular bone, and characterized by changes in the form of the hoof and persisting lameness. the disease is commonly noticed in thoroughbreds or in horses of the lighter breeds, and is but seldom observed in heavy cart animals. usually it is met with in one or both fore-feet. although of extremely rare occurrence, it has been noticed in the hind. _history_.--to english veterinarians appears to belong the credit of discovering navicular disease. as early as we find one, jeremiah bridges, in 'no foot, no horse,' drawing attention to 'coffin-joint lameness,' and advocating for its treatment setoning of the frog. it appears, too, that moorcroft, prior to his departure for india in , was acquainted with what was then known as coffin-joint[a] lameness, having drawn attention to it in in a letter to sir edward codrington.[b] in moorcroft made it even plainer still that he was fully acquainted with what we now know as navicular disease. this we learn from a letter written by him to sewell, in which he laid claim to being the originator of neurectomy. in this letter he says: [footnote a: the coffin-joint at this time included the navicular bursa.] [footnote b: percival's 'hippopathology,' vol. iv., p. .] 'on dissecting feet affected with these lamenesses, the flexor tendon was now and then observed to have been broken, partially or entirely, but more commonly to have been bruised and inflamed in its course under the navicular or shuttle bone, or at its insertion into the bone of the foot. sometimes, although seldom, the navicular bone itself has been found to have been fractured; at others its surface has been deprived of its usual coating, and studded with projecting points or ridges of new growth, or exhibiting superficial excavations more or less extensive.'[a] [footnote a: _ibid_.] _pathology and point of commencement of the disease_.--the exact position in which the diseased process starts has for a long time been a subject of discussion, and even now it is doubtful whether the point has been definitely settled. to mention but a few among many: we find mr. broad, of bath, strenuously insisting on the fact that the disease commences in the interior of the navicular bone. just as strenuously we find the editor of the journal in which the matter is being discussed, the late mr. fleming, asserting that the disease commences in the bursa.[a] others, too, hold that the disease commences primarily in the tendon. wedded to this view was the discoverer, mr. turner, of croydon; while percival commits himself to the statement that it is either the central ridge or the postero-inferior surface of the navicular bone, or the opposed concavity in the perforans tendon, that shows the earliest signs of the disease. the observations made by dr. brauell, the first continental writer to fully describe the disease, led him to the statement that neither the bone nor the bursa was the _invariable_ starting-point of the trouble, but that usually it commenced in inflammation of the bursa itself. [footnote a: percival's 'hippopathology,' vol. iv., p. .] without, therefore, committing ourselves to an expression of opinion as to the precise starting-point of the affection, we shall describe the pathological changes occurring in navicular disease as noted in ( ) the bursa, ( ) the cartilage, ( ) the tendon, and ( ) the bone. . _changes in the bursa_.--upon the internal surface of the bursal membrane is first noticed a slight inflammatory hyperæmia, accompanied by more or less swelling and tumefaction, owing to its infiltration with inflammatory exudate. the portion covering the hyaline cartilage of the navicular bone has lost its peculiar pearl-blue shimmer, and become a dirty yellow. remembering that the bursal membrane is a synovia-secreting one, and bearing in mind what happens in ordinary synovitis and arthritis (with which, of course, this may be very closely compared), we shall first expect changes in the bursal contents. it is highly probable, though difficult of proof, that in the very early stages the chronic inflammatory stimulus has the effect of increasing the flow of synovia. in every case, however, where it can with any certainty be said that navicular disease exists, it is too late to meet with this condition. the disease has then progressed until destruction of the secreting layer of the bursal membrane has been seriously interfered with, and in this case we find a distinct deficiency in the quantity of synovia in the bursa. in advanced cases it is even found that the bursa is _absolutely dry_. . _changes in the cartilage_.--directly that portion of the bursal membrane covering the cartilage is the subject of inflammatory change, the cartilage itself, by reason of its low vitality, soon suffers. under a process, which we may term 'dry ulcerative,' the cartilage covering the ridge on the lower surface of the bone commences to become eroded, and in appearance has been likened, both by english and continental writers, to a piece of wood that has been worm-eaten (see fig. ). [illustration: fig. .--navicular bone (postero-inferior surface) showing the 'worm-eaten' appearance caused by erosion of the hyaline cartilage, and commencing rarefactive arthritis.] 'at this stage, or much earlier'--we are quoting colonel smith, a.v.d.--'may be found calcareous deposits in the fibro-cartilage and the bone. they are scattered like fine sand here and there, generally across the inferior half of the face of the bone; they are sometimes numerous, frequently scanty, occasionally entirely absent. the amount of calcareous degeneration depends upon the lesions present. if much destruction of bone exists, there will be but few calcareous deposits; whilst if there are many calcareous deposits, there may be but slight ulceration of bone tissue, and perhaps none at all. in fact, i have held the opinion, and see no reason to modify it, that calcareous deposits are safeguards against caries.'[a] [footnote a: _journal of comparative pathology and therapeutics_, vol. vi., p. .] . _changes in the tendon_.--the effect of these calcareous deposits on the under surface of the bone is to produce a certain amount of roughness. seeing that with every movement of the foot the perforans tendon is called upon to glide over this surface, it is clear that a secondary effect must be that of inducing erosion and destruction of the tendon. the point at which this usually commences is at the bottom of the depression that accommodates the ridge on the bone. with erosion of the cartilage and of the tendon at points exactly opposite each other, we have two surfaces come together that are prone to readily unite, and fibrous tissue adhesions often take place between the bone and the tendon. in some measure this accounts for the torn and ragged appearance of the tendon. adhesions take place, and, under some small strain, are broken down. this may happen more than once or twice, and with each breaking of the adhesion between the bone and tendon, fibres from the latter are lacerated and torn from their place (see fig. ). . _changes in the bone_.--the changes occurring in the bone are essentially those of a rarefactive ostitis. these changes are described by many writers, and, whether originating primarily in the bone or not, it seems certain that extensive changes may have occurred within the bone, with but little or nothing to be noted on its outer surface. it would seem that the first change is one of congestion of the vessels of the bone's cancellous tissue. with the cause, whatever it may be, in constant operation, the congestion persists until a low type of inflammation is set up, interfering, not only with the flow of synovia in the adjoining bursa, but with the nutrition of the bone itself. as the disease progresses, there is softening and enlarging of the cancellated tissue towards the centre of the bone. the cells break up, and absorption takes place. this goes on until a large portion of the interior of the bone is in a state of dry necrosis, with, in many cases, but slight signs of mischief on the exterior of the bone. in other cases, however, the changes in the interior of the bone are accompanied by well-marked lesions on its gliding or postero-inferior surface, and by evidences of an osteoplastic periostitis along its edges. that an osteoplastic periostitis has been in existence is witnessed by the appearance along the edges of the bone of numerous outgrowths of bone, termed osteophytes (see fig. ). [illustration: fig. .--a foot with the seat of navicular disease exposed. on the anterior surface of the perforans fibres of the tendon are seen to be torn away from their abnormal adhesion with the navicular bone, while others are seen to be still attached thereto. the surface of the navicular bone itself exhibits small defects in the bony substance, which have been brought about by a rarefactive ostitis. _a_, the perforans tendon cut through and reflected; _b_, the sole.] the interosseous and postero-lateral ligaments of the articulation often participate in the inflammatory changes, and in many cases become completely ossified. the true articulatory surface of the bone, that articulating with the os pedis and with the os coronæ, is never affected. _causes_.--in enumerating the causes of navicular disease, we shall follow the example of colonel smith and classify them under certain headings--namely, ( ) _hereditary predisposition_; ( ) _compression_; ( ) _concussion_; ( ) _a weak navicular bone_; ( ) _a defective or irregular blood-supply to the bone_; and ( ) _senile decay_. [illustration: fig. .--the navicular bone from a case of long-standing navicular disease. the erosion of the cartilage on its central ridge is most marked, and the porous appearance of the bone thus uncovered points to the existence within it of a rarefactive ostitis. along its edges large osteophytic outgrowths speak of the effects of an osteoplastic periostitis.] . _hereditary predisposition_.--that navicular disease is hereditary is a fact that has for a long time been insisted on, and has come to be so generally admitted that we do not intend to dwell on it here. as we have said before, it is found in the lighter breeds of horses (and, according to zundel, especially in the english breeds), and is there seen to be frequently transmitted from parent to offspring. . _compression_.--by this is meant the compression of the navicular bone between the os pedis and the os coronæ in front, and the perforans tendon behind. in order to appreciate this explanation of the causation of navicular disease at its true value, it will be well to consider briefly the physiology of the parts in question. the navicular bone is what we may term a complement of the os pedis. it exists, in fact, simply in order that the os coronæ may have a sufficiently large articulatory surface to play upon. one wonders at first that nature did not arrive at this by originally placing a larger bone below. colonel smith explains this by suggesting that this would in all probability have meant its fracture. in progression the hind part of the foot comes to the ground first, and upon the hinder portion of the articulation would fall the first effects of concussion, together with the greater part of the body-weight. a yielding joint was in this position necessary, and that formed by the navicular bone fills all requirements. in this connection one next considers the part played by the front limbs during progression. as zundel expresses it, they are columns of support rather than of impulsion, and, as the body-weight is thrown forward by the hind-limbs, it is the duty of the fore-limbs to receive it. the shock or concussion of the body-weight thus thrown forwards is first received by the muscles uniting the limb to the trunk, and a great part of it there minimized by their sling-like attachment. it is further absorbed by the shoulder-joint, and from there passed on to the almost vertical bony column represented by the radius and ulna, the knee, and the metacarpus. on reaching the first phalanx, a portion of the remaining force is passed on to the front of the phalanges and loses itself in front of the hoof, while the other portion is transmitted to the flexor tendons, finally to the perforans, and to the posterior parts of the foot. during progression, therefore, the navicular bone is constantly pushed downwards and backwards by the bony column, and is just as constantly pushed forwards and upwards by the resistance of the perforans tendon. this means, of course, that the navicular bone is more or less constantly subject to compression, and constant pressure, as we know full well, is a pretty sure factor in bringing about malnutrition of the parts, with atrophy or chronic inflammatory changes as an end result. even with the limb at rest the pressure on both sides of the navicular bone is still constant. the only circumstances under which we can conceive of it being entirely absent, in fact, are when the tension on the tendon is relaxed, and the body-weight altogether removed by the animal adopting the recumbent position. the compression theory as to the causation of navicular disease was, we believe, first originated by colonel smith. he, at any rate, has laid much stress on it in his writings. if we accept it, and we see every reason that we should, then we must, with the author, admit the possibility of navicular disease arising from long standing in one position. . _concussion_.--this we are bound to admit as a cause, and in so doing partly explain the comparative, almost total, immunity of the hind-feet from the disease. the fore-limbs, as we have already pointed out, are little more than props of support, and the force of the propelled body-weight is transmitted largely down their almost vertical lines, to end largely in concussion in the foot. with the hind-limbs matters are different. 'these,' as percival explains it, 'have their bones obliquely placed, so as to constitute, one with the other, so many obtuse angles, to the end, that by forming powerful levers, and affording every advantage for action to the muscles attached to them, they may be fitted for the purpose of propulsion of the body onward.' the effect of these several obtuse-angled joints in the limb is to absorb the greater part of the force exerted by the body-weight before it reaches the foot. when with this we take the facts that the fore-limbs have to carry the head and neck, and that they have to bear this added weight, plus a propelling force from behind, we see why it is that they should be so subject to the disease, and the hind-limbs so exempt. as pointing out the part that concussion plays in its causation, we may mention that navicular disease is a disease of the middle-aged and the worked animal. it is interesting to note, too, that it occurs in animals with well developed frogs--in feet in which frog-pressure with the ground is most marked. this at first sight appears to flatly contradict what we have said with regard to frog-pressure in other portions of this work. with this, however, must be reckoned other predisposing causes. in this case it is not to frog-pressure alone we must look, but to the condition of the frog itself, and that of the neighbouring parts. it is when we have a frog which, though well developed and apparently satisfying all demands as to size and build, is at the same time composed of a hard, dry, and non-yielding horn that we must look for trouble. the foot predisposed to navicular disease is the strong, round, short-toed or clubby foot, open at the heels, with a sound frog jutting prominently out between them. here is a frog exposed to all the pressure that might be desired for it, bounded at its sides by heels thick and strong, and indisposed to yield, and itself liable, from its very exposure, to become, in the warm stable, hard and dry, and incompressible' (percival). here, instead of acting, as normally it should, as a resilient body, and an aid to the absorption of concussion, it seems rather to play the part of a foreign body, and to bring concussion about. seeing, then, that the navicular bursa is in very near contact with it, it is conceivable that this joint-like apparatus should suffer, and the pedal articulation be left unaffected, the more so when we take into consideration the compression theory just described. . _a weak navicular bone_.--when the disease commences first in the bone--and there is no denying the fact that sometimes, although not invariably, it does--it may be explained by attributing to the structure of the bone an abnormal weakness in build. the navicular bone consists normally of compact and cancellated tissue arranged in certain proportions, the compact tissue without, and the cancellated within. these proportions can only be judged of by the examinations of sections of the bone, and when it is found in any case that the cancellated tissue bulks more largely in the formation of the bone than normally it should, we have what we may term a weak navicular bone. in this connection colonel smith says: 'though it is far from present in every case of the disease, still i consider it a factor of great importance.' . _a defective or irregular blood-supply to the bone_.--this, colonel smith considers, is brought about by excessive and irregular work, and by the opposite condition--rest. the author points out that the bloodvessels passing to and from the navicular bone run in the substance of the interosseous ligaments, or in such proximity to them that it is conceivable that under certain circumstances mechanical interference may occur to the navicular circulation. he further points out a fact that is, of course, well known to every veterinarian, that in periods of work the circulation of the foot is hurried, and that in rest there is always a tendency to congestion; and he says in conclusion: 'i cannot help thinking that irregularities in the blood-supply in a naturally weak bone must be a factor of some importance, especially when the kind of work the horse is performing is a series of vigorous efforts followed by rest.' . _senile decay_.--with approaching age the various tissues lose their vigour, and are prone to disease. the navicular bone and surrounding structures are not exempt. with the other and more active causes we have described acting at the same time it is not surprising that navicular disease is seen as a result. in conclusion, it is well, perhaps, to say that, no matter to which particular theory of causation we may lean, we should make up our minds to consider them as a whole. while one cause may be exciting, the other may be predisposing, and the two must act together before evil results are noticed. it may be that even more than two are concerned in bringing on the disease, and to each the careful veterinarian will give due consideration. _symptoms and diagnosis_.--in the early stages of navicular disease the symptoms are obscure. pointing of the affected limb is the first evidence the animal gives. this, however, more often than not, goes unnoticed, and the first symptom usually observed by the owner or attendant is the lameness. even this is such as to at first occasion no alarm, being intermittent and slight, and only very gradually becoming marked. in a few cases, however, lameness will come on suddenly, and is excessive from the commencement. it is the lameness, slow in its onset, intermittent in its character, and gradual in its progress, however, that is ordinarily characteristic of navicular disease. the animal is taken out from the stable sound, with just a vague suspicion, perhaps, that he moved a bit stiffly. while out he is thought by his driver or rider to be going feelingly with one foot or with both. even this is not marked, and the driver has some difficulty in assuring himself whether or no he really observed it, or whether it was but imagination. on the return home the limb is examined, and nothing abnormal is to be found. the leg is of its normal appearance, and neither heat nor tenderness is to be observed in it or in the foot. on the following day the animal again is sound, and the lameness of the previous day is put down to a slight strain or something equally simple. the patient is then, perhaps, rested for a day or two. when next he is worked he again moves out from the stable sound, but again during the going gives the driver the unpleasant impression that something is amiss; and so the case goes on. one day the owner fears the animal is becoming seriously enough affected to warrant him in calling in his veterinary surgeon; the next he is confidently assuring himself that nothing is wrong. perhaps the animal is now rested for a week or two, or even for a month or two, hoping that this will put him sound. immediately on commencing work, however, the same symptoms as before assert themselves, and the veterinary surgeon is called in. with a history such as we have given the veterinarian's suspicions are aroused. he has the animal trotted, and may notice at this stage that there is an inclination to go on the toes, that the lame limb or limbs are not put forward freely, and that progression is stilty and uncertain; it is such, in fact, as to at once suggest the possibility of corns being present. in some cases there is just the suspicion of a limp with one limb, and this only at intervals during the trot. at one moment the veterinarian is positive that he sees the animal going lame; at another he is just as confident he sees him coming towards him sound. nothing is found in the limb--neither heat, tenderness, nor swelling. there is nothing in the gait (either a limited movement of the radius, or a circular sweep with the leg) to indicate shoulder or other lameness, and the veterinary surgeon, by eliminative evidence, is bound to conclude that the trouble is in the foot. the foot is then examined--pared, percussed, pinched, and in other ways manipulated--but nothing further is forthcoming. in such a case the veterinary surgeon is wise to declare the abortive result of his examination, to hint darkly of his suspicions, and to suggest a second examination at some future date. it may be that two, three, four, or even more, such examinations are necessary before he can justly pronounce a positive verdict. later he is enabled to do this by an increase in the severity of the symptoms, and by the changes that take place in the form of the foot. the lameness is now more marked, and the 'pointing' in the stable more frequent. with regard to the latter symptom, it has been seriously discussed whether the horse with navicular disease points with the heel elevated or with it pressed to the ground. in either case, of course, the limb is advanced; but while some hold that the phalangeal articulations are flexed and the heel slightly raised, in order to relieve the pressure of the perforans tendon on the affected area, and so obtain ease, there are others who hold that the heel is pressed firmly to the ground in order to deaden the pain. it may be, and most probably is, that both are right; but, in our opinion, there is no doubt whatever that pointing with the heel elevated is by far the most common. the lameness is now excessive, and is especially noticeable when the animal is put to work on a rough or on a hard ground. even now, however, heat of the foot or tenderness is so slight as to be out of all proportion to the alteration in gait. with the case thus far advanced, evidence of pain may be obtained by pressing with the thumb in the hollow of the heel. evidence of pain may also be obtained by using the farrier's pincers on the frog. these methods, however, are never wholly satisfactory, as a horse with the soundest of feet will sometimes flinch under these manipulations. extreme and forcible flexion of the corono-pedal articulation also sometimes gives evidence of tenderness. in this case the foot is held up, the animal's metacarpus resting on the operator's knee, and the toe of the hoof pushed downwards with some degree of force. the same movement of the joint is given by causing the animal to put full weight upon the diseased limb, a small wedge of wood being first placed under the toe. in this manner the pressure of the perforans tendon upon the bursa is greatly increased, and the animal is caused to show symptoms of distress. the lameness may also be increased, and diagnosis helped, by paring the heels, so as to leave the frog prominent and take the whole of the body-weight. the same end is also obtained by applying a bar shoe. this was originally pointed out by brauell, and is quoted by zundel and by möller. the changes in the form of the hoof may now be noticed. these are largely dependent on the fact that more or less constantly the patient saves the heel. the horn of the walls in this region, and the horn of the frog, is thereby put out of action and induced to atrophy. the hoof gradually assumes a more upright shape, and the heels contract. we thus get a hoof which is visibly narrowed from side to side, with a frog that is atrophied and often thrushy, and with a sole that is abnormally concave, hard, and affected with corns. when occurring in the hind-feet--a condition that is rare, but which has been noticed by loiset, and quoted by zundel--the animal is stiff behind, walks on his toes, and gives one the impression that he is suffering from some affection in the region of the loins. one such case is reported by an english veterinary surgeon, and we quote it here: 'a gray gelding, and a capital hunter, the property of a gentleman in this neighbourhood, became lame in the near fore-foot after the hunting season of . the lameness was believed to be due to navicular disease. the operation of neurectomy was ultimately had recourse to. the horse subsequently did his work as well as ever, and was ridden to hounds regularly till the end of the year , when he went lame of the off fore-foot. from this date he also showed very peculiar action behind, and was at times lame of both hind-limbs without any apparent cause. 'in the year , from the groom's indiscreet use of physic, superpurgation was brought on which caused the animal's death. on a post-mortem examination being made, the horse was found to have _navicular disease of all four feet_. it is worthy of note that this horse had always "extravagant" action behind, but was a remarkably quick and good jumper.'[a] [footnote a: f. blakeway, m.r.c.v.s., _veterinarian_, vol. ii., p. .] _differential diagnosis_.--navicular disease may be mistaken for ordinary contracted foot. it will be remembered, however, that in the early stages of navicular disease contraction is absent, and that it is only when the disease in the bursa is of long standing that contraction comes on. with ordinary contracted foot, too, careful paring and suitable shoeing soon sees a diminution in the degree of lameness, and a return to the normal in shape (see treatment of contracted foot, p. ). with navicular disease, however, such shoeing as is beneficial in the treatment of contracted foot (notably the various methods of giving to the frog counter-pressure with ground) soon brings on an aggravation of the lameness. it is, perhaps, even more likely to be confounded with contraction when we have with the contraction a state of atrophy and thrush of the frog. with a frog in this condition pressure will give rise to pain, and navicular disease be erroneously judged to be present. in such a case we must rely wholly upon either extreme flexion or extreme extension of the joint to guide us, when, if contraction _only_ is the offending condition, no symptom of pain will be shown. navicular disease may also be confused with rheumatic affections, with sprain of the posterior ligaments of the first interphalangeal articulation, and with sesamoid lameness. mistakes are sometimes made, too, especially with a hasty observer, in confounding it with shoulder lameness. in rheumatism the constant changing of the seat of pain, the sometimes elevated temperature, and the appearance of symptoms of heat, tenderness, and swelling in the affected area should guide one to a right conclusion. in sprain of the posterior ligaments of the coronet and in sesamoid lameness, nothing but a careful examination and manipulation of the parts will ward off error, for in each of these cases there is 'pointing' and resting of the limb, and considerable disinclination to put weight firmly upon it. if at the same time manipulation gives distinct evidence of pain, all doubt may be set at rest. roughly speaking, sesamoid lameness is a condition of the gliding surface of the sesamoids, and the face of the tendon playing over them, similar to that found in navicular disease. all symptoms of pointing, the constant maintaining of the limb in a state of flexion, and a feeling manner of progression are again all present. it is plain from this that in all cases where an animal with a gait at all suggestive of navicular disease is brought for our examination, the manipulation of the limb should be thorough. the character of the lameness is almost sure to deceive us; and it is not until we are able to obtain local symptoms pointing to the one or the other of the conditions we have enumerated that a decisive opinion may be given. in sesamoid lameness the local symptoms are those of heat and pain in the fetlock on palpation, and a swelling of the affected parts, such swelling being at first slight, yielding, and barely distinguishable, and afterwards larger, bony and hard, and more marked. later still there is distinct evidence of 'knuckling' over at the fetlock and inability to fully flex it. in cases of shoulder lameness the gait alone should be sufficient to render liability of error small, for with nearly every case there is a manifest inability to 'get the limb forward', and this is best seen at a side view when the animal is trotting past the observer. when trotting towards one, there is a further and unmistakable symptom common to most shoulder lamenesses that serves to distinguish it at once, and that is the peculiar 'sweeping' outwards with the affected limb. lastly, with either of the conditions we have just mentioned, it is the exception to get contracted foot follow on. with navicular disease it sooner or later makes its appearance. _prognosis_.--the prognosis of navicular disease (once diagnosed with certainty) must almost of necessity be unfavourable. the facts that the disease has made serious progress before it is really noticeable, that the situation of the parts prohibits operative interference, and that the disease is one of a chronic and slowly progressive type, all point to an unfavourable termination. _treatment_.--we have seen from the pathology of this disease that it may commence either as a rarefactive ostitis, or as a synovitis and tenositis in connection with the bursa. with the former condition in existence, or when this and the synovitis has led to erosion of the cartilage, treatment is probably of no avail, on account of the more chronic nature of these two conditions. when, however, the condition is simply that of synovitis or tenositis, a more or less acute condition, we may assume that suitable treatment and a long rest will bring about resolution. the first indications in treatment are those of what we may term 'nursing' the foot. it should have sufficient rest, should be placed so as to minimize as far as possible compression of the parts, and should have its posterior half treated so as to render it softer and less liable to concussion. the period of rest required cannot be satisfactorily advised, and the practitioner is wise who makes it a long one. best should be advised, in fact, long after symptoms of lameness have disappeared and recovery is judged to have taken place. compression of the parts may be somewhat minimized, if the animal be kept in the stable, by allowing the floor upon which the front-feet are to stand to be slightly sloping from behind forwards. the same effect, though not so marked, is obtained by removing the shoes, and considerably lowering the wall at the toe, while allowing that of the heels to remain. it may here be remarked that it is a good practice to allow the shoes to remain on, and this even when the animal is at grass. they should, however, be frequently removed, and the foot trimmed as we have directed. with the foot thus trimmed so as to most suitably adjust the angles of the articulations, it should next be thoroughly pared and rasped in its posterior half, so as to render the horn of the sole and the frog and the horn of the quarters as thin as possible. the heels, however, should not be excessively lowered, _if at all_. we now have the foot in a soft condition, and easily expanded. it should, if possible, be kept so; and this may be done either by the use of poultices, by tepid baths, or by standing the animal upon a bedding that may easily be kept constantly damp. such materials as tan, peat moss, or sawdust, are either of them suitable. all this, of course, calls for keeping the animal in the stable. it is far better, however, more especially if a piece of marshy land is at hand, to turn him out in that. a moderate amount of exercise is beneficial rather than not, and the feet are thus constantly kept damp without trouble to the attendants. the second indication in the treatment is that of applying a counter-irritant as near to the diseased parts as possible. regarding its efficacy we must confess to being somewhat sceptical. the treatment has been constantly practised and advised, however, and we feel bound to give it mention here. a smart blister may, therefore, be applied to the whole of the coronet, and need not be prevented from running into the hollow of the heel. instead of blistering the coronet (or in conjunction with that treatment), the counter-irritant may be applied by passing a seton through the plantar cushion or fibro-fatty frog. setoning the frog appears to have been introduced by sewell. in many cases great benefit is claimed to have been derived from it, especially by english veterinarians of sewell's time, and by others on the continent. percival, however, was not an advocate for it, and, at the present day, it is a practice which appears to have dropped out of use altogether. [illustration: fig. .--frog seton needle.] to perform this operation a seton needle of a curved pattern is needed (see fig. ). this is threaded with a piece of stout tape dressed with a cantharides, hellebore, or other blistering ointment, and then passed in at the hollow of the heel, emerging at the point of the frog. the course the needle should take will be understood from a reference to fig. . the seton may be passed with the horse in the standing position. previously the point of the frog should be thinned, and the animal should be twitched. after-treatment consists simply in moving the seton daily, and dressing it occasionally with any stimulating ointment, or with turpentine. if, in spite of these treatments, the disease persists, then nothing remains but neurectomy. d. dislocations. the firm and rigid manner in which the bones of the pedal articulation are held together renders dislocation of this joint an exceedingly rare occurrence, and then it is only liable to happen under the operation of great force. in the literature to our hand we have only been successful in discovering one reported instance, and, strange to say, in this, a well-marked case, the cause was altogether obscure. we quote the case at the end of this section. [illustration: fig. .--diagram showing the course taken by the needle when setoning the frog. this is shown by the dotted curved line _a, b_. , the navicular bone; , the plantar cushion; , the os pedis; , the perforans tendon.] a partial dislocation of this articulation is the condition met with in 'buttress foot.' in this case the fracture of the pyramidal process, and the consequent lengthening of the tendon of the extensor pedis, allows the os coronæ to occupy upon the articulatory surface of the os pedis a more backward position than normally it should. it is quite probable, too, that slight lesions of the other restraining ligaments and tendons of the articulation may bring about a similar though less marked condition. we may be quite sure of this--that whenever such lesions (as, for example, sprain and partial rupture of the lateral ligaments) do occur, and the normal position of the opposing bones is changed, if only slightly, that great pain and excessive lameness must be the result, and this with but little to show in the foot. many of our cases of obscure foot lameness might, if capable of demonstration, turn out to be cases of sprain and partial dislocation of the pedal articulation. _recorded case_.--'the animal, a trooper of the th hussars, was found on the morning of april unable to bear any weight on the limb (the near hind). cause not known--the heel-rope i thought at first; but on investigation i found the heel-rope had been on the other leg. _diagnosis_.--dislocation of the left os coronæ from the articulating surface of the os pedis in a backward direction. 'every devisable means were unsuccessful in reducing the limb to its natural position. the horse was thrown, and a strong rope, with four men pulling at it, was fastened round the hoof, whilst i put my knee to the back of the pastern, using all possible force, with one hand to the foot and the other to the fetlock, but all to no purpose. next day other means were tried. first by throwing the horse and placing him on his belly, with the fore-legs stretched out forwards, and the hind-legs backwards. this i did so as to get the injured limb placed as nearly flat on the ground as possible, with its anterior aspect downwards. then a very heavy man, with his boots off, was made to jump on the back of the pastern, where the prominence showed most; and afterwards, when these means failed, a strong piece of wood, well covered with leather, was placed (where the hollow of the heel ought to have been) on the most prominent part, and hit several times with a heavy hammer; but all efforts were futile. '_prognosis_.--unfavourable. during the latter operations i had a very strong pressure applied to the hoof, and the horse firmly fastened in every way, and it appeared as though no amount of force would ever reduce the dislocation. '_tautological_.--the case was destroyed on april , being of no further use to the service. '_post-mortem_.--the os coronæ was found to have slipped out of the articulating cavity of the os pedis, backwards and past the lateral ligaments. these last-named structures prevented the bone being forced forward into its proper position, being firmly locked over the lateral prominences. the capsular ligament was considerably lacerated and inflamed, causing slight effusion and swelling about the region of the coronet.'[a] [footnote a: t. flintoff, a.v.d., _veterinary journal_, vol. xix., p. .] _treatment_.--after the forcible means of reduction related by mr. flintoff, we may add that when they are successful, they should be followed by suitable bandaging of the parts, and rest. the first is effected by applying plaster of paris and linen, and the second by having the animal put in slings. index accidental tearing off of the entire hoof acute arthritis causes of symptoms of treatment of acute laminitis causes of complications in congestion in course of definition of diagnosis in exudation in pathological anatomy of prognosis in suppuration in symptoms of treatment of acute periostitis simple acute simple coronitis causes of definition of symptoms of prognosis of treatment of acute simple synovitis advantages of neurectomy amputational neuroma after neurectomy anatomy, pathological, of corn applying poultices, method of arteries of the foot arthritis, acute causes of symptoms of treatment of arthritis, simple or serous arthritis, suppurative causes of definition of diagnosis of pathology of symptoms of treatment of articulation, the first interphalangeal articulation, the second interphalangeal bar pad and a half-shoe in the treatment of contracted feet bar shoes in the treatment of contraction bayer's treatment for chronic laminitis bermbach's treatment for canker bind bone, caries of bones, fracture of the, after neurectomy bones, fracture of the bones, necrosis of bones, the brittle hoof causes of definition of symptoms of treatment of broad's treatment of laminitis broué's expansion shoe bruised sole, chronic buttress foot canker bermbach's treatment of causes of definition of differential diagnosis in history of hoffmann's treatment of imminger's treatment of malcolm's treatment of pathological anatomy of prognosis in rose's treatment of symptoms of treatment of caries of bone caries of the os pedis in pricked foot cartilage, the lateral cartilaginous quittor causes of acute laminitis of acute simple coronitis of brittle hoof of canker of chronic coronitis of chronic laminitis of club-foot of corn of contracted feet of coronary contraction of the foot of crooked foot of curved hoof of false quarter of flat-foot of keraphyllocele of nail-bound of navicular disease of pumiced foot of punctured foot of ringed hoof of sand-crack of seedy-toe of side-bone of simple chronic coronitis of simple cutaneous quittor of specific coronitis of sub-horny quittor of thrush of weak heels caustic solution, villate's changes in the bone in navicular disease in the bursa in navicular disease in the cartilage in navicular disease in the internal structures of the foot in contraction in the tendon in navicular disease charlier shoe, the charlier shoeing for contracted foot chemical properties of horn chronic coronitis, simple causes of definition of symptoms of treatment of chronic bruised sole treatment of chronic laminitis bayer's treatment of causes of definition of gross's treatment of gunther's treatment of imminger's treatment of joly's treatment of meyer's treatment of pathological anatomy of surgical shoeing for symptoms of treatment of treatment of, by ligaturing the digital arteries chronic oedema of the leg after neurectomy chronic synovitis clamp, sand-crack, koster's mcgill's vachette's clamping sand-cracks, methods of classification of corns of punctured foot according to the situation of the wound of sand-crack of quittor club-foot causes of definition of symptoms of treatment of cocaine injections as an aid to diagnosis in foot lamenesses colic, metastatic, in laminitis commencement, point of, in navicular disease common situations of the wound in punctured foot. complicated sand-crack, operations for complications in coronitis in laminitis in pricked foot in sand-crack in simple or cutaneous quittor in sub-horny quittor compression as a cause of navicular disease concussion as a cause of navicular disease conformation, faulty congestion in laminitis contracted foot causes of changes in the internal structures of definition of local or coronary prognosis of surgical shoeing for symptoms of treatment of contraction of the foot, a bar pad and a half-shoe in the treatment of bar shoes in the treatment of expansion shoes in the treatment of corn causes of classification of definition of pathological anatomy of prognosis in surgical shoeing in symptoms of the dry the moist the suppurating treatment of coronary contraction of the foot causes of definition of symptoms of treatment of coronary cushion, the coronary edge of the wall, expansion and contraction of the coronitis acute simple causes of complications in definition of prognosis of symptoms of treatment of coronitis, simple chronic causes of definition of symptoms of treatment of coronitis, specific causes of definition of symptoms of treatment of course of acute laminitis crooked foot causes of definition of symptoms of treatment of curved hoof causes of definition of treatment of cushion the coronary the plantar cutaneous or simple quittor de fay's expansion shoe. defective or irregular blood-supply to the bone a cause of navicular disease definition of acute laminitis of acute simple coronitis of brittle hoof of canker of chronic coronitis of chronic laminitis of club-foot of contracted foot of corn of coronary contraction of the foot of crooked foot of curved hoof of false quarter of flat-foot of keraphyllocele of nail-bound of navicular disease of pumiced foot of punctured foot of pyramidal disease of quittor of ringed hoof of sand-crack of seedy-toe of side-bone of simple chronic coronitis of specific coronitis of spongy hoof of sub-horny quittor of thrush of weak heels development of the hoof diagnosis of acute laminitis of canker of foot lameness by injections of cocaine of navicular disease of punctured foot of pyramidal disease of side-bone of sub-horny quittor differential diagnosis in canker in navicular disease diseases arising from faulty conformation dislocation of the os coronæ recorded case of dislocations dry corn einsiedel's expansion shoe examining the foot method of exercise, forced, in the treatment of laminitis expansion and contraction of the coronary edge of the wall of the hoof under the body-weight of the solar edge of the wall of the sole expansion shoe broué's de fay's einsiedel's hartmann's smith's expansion shoes in the treatment of contraction extensor pedis tendon, the extirpation of the lateral cartilage in quittor of the lateral cartilage, after moller and frick of the lateral cartilage, after bayer exudation in laminitis false quarter causes of definition of symptoms of treatment of faulty conformation diseases arising from feeding a cause of laminitis flat-foot causes of definition of symptoms of treatment of flexor pedis perforans tendon, the flexor pedis perforatus tendon, the foot, buttress foot, changes in the internal structures in contraction of the foot, contracted causes of definition of prognosis of symptoms of treatment of forced exercise in laminitis fractures fractures of the bones after neurectomy of the navicular bone of the os coronæ of the os pedis frog, the functions of the lateral cartilages gangrene of the sensitive structures in laminitis gathered nail gelatinous degeneration after neurectomy grooving the wall in laminitis (smith's operation) in treatment of sand-crack in treatment of side-bone (smith's operation) gross's treatment of chronic laminitis growth of hoof, rate of gunther's treatment of chronic laminitis hartmann's expansion shoe heels, weak causes of definition of symptoms of treatment of heredity as a cause of navicular disease as a cause of side-bone histology of horn history of canker of navicular disease of neurectomy hind-feet, navicular disease in the hind-limb with the side-line, method of securing hoffmann's treatment of canker hoof, the accidental tearing off of expansion and contraction of development of rate of growth of horn chemical properties of histology of hutlederkitt imminger's treatment for chronic laminitis for canker immobilizing a sand-crack by grooving the wall, methods of infection of the limb, septic injections of cocaine as an aid to diagnosis in foot lameness interphalangeal articulation the first the second instruments required in plantar neurectomy in operations on the foot irregular blood-supply to the bone as a cause of navicular disease joly's treatment of chronic laminitis koster's sand-crack clamp keraphyllocele causes of definition of pathological anatomy of symptoms of treatment of keratoma lameness, cocaine injections as an aid to diagnosis in laminæ, the sensitive laminitis acute broad's treatment of causes of complications in congestion in course of definition of diagnosis in exudation in feeding, a cause of forced exercise in the treatment of gangrene of the sensitive structures in grooving the wall in the treatment of local applications in the treatment of local bleeding in the treatment of metastatic colic in metastatic pneumonia in neurectomy in opening the sole in the treatment of parturient pathological anatomy of periostitis and ostitis in phlebotomy in the treatment of prognosis in rocker bar shoes in the treatment of smith's operation in suppuration in symptoms of symptoms of, in the four feet symptoms of, in the fore-feet alone symptoms of, in the hind-feet alone treatment of laminitis chronic bayer's treatment of causes of definition of gross's treatment of gunther's treatment of imminger's treatment of joly's treatment of meyer's treatment of pathological anatomy of surgical shoeing for symptoms of treatment of laminitis, parturient lateral cartilage, the extirpation of, in quittor, after holier and frick extirpation of, in quittor, after bayer functions of necrosed, pathological anatomy of necrosis of ossification of wounds of leg, chronic oedema of the, after neurectomy length of rest required after neurectomy ligaments, the ligaturing the digital arteries, in chronic laminitis limb, septic infection of local applications in laminitis local bleeding in laminitis local or coronary contraction of the foot low ringbone malcolm's treatment of canker mcgill's sand-crack clamp median neurectomy metal plates in the treatment of sand-crack metastatic colic in laminitis metastatic pneumonia in laminitis methods of applying poultices of examining the foot of immobilizing sand-crack by grooving the wall methods of restraint of securing a hind-limb with the side-line of securing the foot to the cannon of another limb meyer's treatment of chronic laminitis moist corn nail-bound causes of definition of symptoms of treatment of nail-tread navicular bone, the fracture of navicular bursa, puncture of the, in pricked foot navicular bursa punctured, treatment of navicular disease causes of changes in the bone in changes in the bursa in changes in the cartilage in changes in the tendon in definition of diagnosis of differential diagnosis of history of in the hind-feet point of commencement of prognosis of symptoms of treatment of necrosed lateral cartilage pathological anatomy of necrosis of bone of tendon and ligament in sub-horny quittor of the lateral cartilage (cartilaginous quittor) necrotic plantar aponeurosis, treatment of nerve, reunion of, after neurectomy nerves, the neurectomy advantages of amputational neuroma in fracture of the bones after gelatinous degeneration after history of instruments required in in laminitis length of rest required after persistent pruritus after pricked foot after reunion of divided nerve after sequelæ of stumbling after use of the horse after neurectomy median plantar neuroma, amputational, after neurectomy oedema of the leg after neurectomy opening the sole in the treatment of laminitis operation for complicated sand-crack for laminitis for necrosed lateral cartilage in quittor for necrosed plantar aponeurosis for side-bone operations on the foot, instruments required in operations on the horn, treatment of contracted foot by os coronæ, the dislocation of fracture of os pedis, the caries of, in pricked foot fracture of osteoplastic ostitis osteoplastic periostitis ostitis in laminitis ostitis, rarefying osteoplastic ossification of the lateral cartilages (side-bone) overreach shoeing for treatment of parturient laminitis pathological anatomy of acute laminitis of canker of chronic laminitis of corn of keraphyllocele of necrosed lateral cartilage of pyramidal disease of simple cutaneous quittor of navicular disease pedal articulation, puncture of the perforans tendon, the flexor pedis perforates tendon, the flexor pedis periople, the periostitis and ostitis in laminitis periostitis, osteoplastic periostitis, recorded cases of periostitis, simple acute suppurative periostitis, treatment of persistent pruritus after neurectomy phlebotomy in laminitis plantar aponeurosis, wounds of the treatment of necrosed plantar cushion plantar neurectomy history of instruments required in operation of pneumonia in laminitis metastatic point of commencement of navicular disease poultices, methods of applying preventive treatment of cutaneous quittor pricked foot after neurectomy complications of prognosis in acute simple coronitis in canker in contracted foot in corn in laminitis in navicular disease in punctured foot in sand-crack in simple cutaneous quittor properties of horn, chemical protection of sand-crack by metal plates pruritus after neurectomy pumiced foot causes of definition of symptoms of treatment of punctured foot causes of classification of common situation of the wound in complications in definition of diagnosis of prognosis of symptoms of treatment of puncture of the navicular bursa treatment of puncture of the pedal articulation purulent synovitis pyramidal disease quittor classification of definition of quittor, simple or cutaneous causes of complications in curative treatment of definition of pathological anatomy of preventive treatment of prognosis of symptoms of treatment of sub-horny causes of complications in definition of diagnosis of extirpation of the lateral cartilage in, after moller and frick extirpation of the lateral cartilage in, after bayer necrosis of the lateral cartilage in (cartilaginous quittor) necrosis _of_ tendon and ligament in (tendinous quittor) surgical shoeing in symptoms of treatment of rarefying ostitis recorded case of dislocation of the os coronæ of navicular disease in both hind-feet of periostitis of pyramidal disease rest required after neurectomy, length of restraint, methods of reunion of the divided nerve after neurectomy ringbone, low ringed hoof causes of definition of treatment of rocker bar shoes in laminitis rose's treatment of canker sand-crack causes of clamp koster's mcgill's vachette's clamping, methods of classification of complications in definition of operations for complicated prognosis in surgical shoeing for symptoms of treatment of treatment of, by grooving the wall treatment of, by wedging the fissure second interphalangeal articulation, the securing a hind-limb with the side-line, method of securing the foot to the cannon of another limb, method of seedy-toe causes of definition of symptoms of treatment of senile decay as a cause of navicular disease sensitive laminæ, the sensitive structures, gangrene of, in laminitis septic infection of the limb sequelæ of neurectomy serous arthritis shoe, bar charlier's charlier's tip expansion broué's de fay's einsiedel's hartmann's smith's for overreach plate rocker bar slipper, broué's slipper and bar-clip, einsiedel's three-quarter three-quarter bar thinned tip tip with 'dropped' heel with extended toe-piece with extended toe-piece (nunn's) with heel-clip with 'set' heel side-bone causes of definition of diagnosis of heredity a cause of smith's operation for symptoms of treatment of side-line, the simple acute coronitis simple acute periostitis simple coronitis acute chronic simple or cutaneous quittor causes of complications in curative treatment of definition of pathological anatomy of preventive treatment of prognosis of symptoms of treatment of simple serous arthritis simple synovitis, acute smith's expansion shoe operation for laminitis operation for side-bone solar edge of the wall, expansion and contraction of the sole, chronic bruised sole, expansion and contraction of the sole, the specific coronitis causes of definition of symptoms of treatment of spongy hoof definition of symptoms of treatment of stumbling after neurectomy sub-horny quittor causes of complications in definition of diagnosis of necrosis of the lateral cartilage in (cartilaginous quittor) necrosis of tendon and ligament in (tendinous quittor) symptoms of treatment of surgical shoeing for suppurating corn suppuration in laminitis suppurative arthritis causes of definition of diagnosis of pathology of symptoms of treatment of suppurative periostitis suppurative synovitis surgical shoeing for corn for chronic laminitis for laminitis, acute for sand-crack for quittor symptoms of acute simple coronitis of brittle hoof of canker of chronic coronitis of chronic laminitis of club-foot of contracted foot of corn of coronary contraction of the foot of crooked foot of false quarter of flat-foot of keraphyllocele of laminitis of laminitis in all four feet of laminitis in the fore-feet alone of laminitis in the hind-feet alone of nail-bound of navicular disease of pumiced foot of punctured foot of pyramidal disease of sand-crack of seedy-toe of side-bone of simple chronic coronitis of simple cutaneous quittor of specific coronitis of spongy hoof of sub-horny quittor of synovitis, chronic of synovitis, purulent or suppurative of synovitis, simple acute of thrush of weak heels synovitis, acute simple causes of treatment of tearing off of the entire hoof, accidental tendon the extensor pedis the flexor pedis perforans the flexor pedis perforatus tendons, the thrush causes of definition of symptoms of treatment of tight-nailing tip-shoes tissue, the velvety tread, see overreach treatment of acute laminitis of acute simple coronitis of brittle hoof of canker of canker bermbach's hoffmann's imminger's malcolm's rose's of chronic bruised sole of chronic coronitis of chronic laminitis of chronic laminitis by ligaturing the digital arteries of club-foot of contracted feet of contracted feet by expansion shoes of contracted feet by operations on the horn of corns of coronary contraction of the foot of crooked foot of curved hoof of cutaneous quittor of false quarter of keraphyllocele of nail-bound of navicular disease of necrotic plantar aponeurosis of periostitis of pumiced foot of punctured foot of punctured navicular bursa of pyramidal disease of ringed hoof of sand-crack of sand-crack by clamping the fissure of sand-crack by grooving the wall of sand-crack by wedging the fissure of seedy-toe of side-bone of simple chronic coronitis of specific coronitis of spongy hoof of sub-horny quittor of synovitis of thrush of weak heels use of the horse that has undergone neurectomy vachette's sand-crack clamp veins, the velvety tissue, the villate's caustic solution wall, the weak heels causes of definition of symptoms of treatment of wedging the fissure in the treatment of sand-crack wound in punctured foot, common situations of the wounds of the lateral cartilages wounds of the plantar aponeurosis the end transcriber's notes: passages in italics are indicated by _underscores_. passages in bold are surrounded by =. small caps have been replaced by all caps. erratum page , figure shown is not the brown sphygmomanometer described in the text, but the baumanometer manufactured by w. a. baum co., inc., new york. it is claimed that the baumanometer is made with particular care and hence the readings are said to be more accurate than other mercury instruments. it is apparently a good instrument. the author has had no personal experience with it. arteriosclerosis and hypertension with chapters on blood pressure by louis m. warfield, a.b., m.d., (johns hopkins), f.a.c.p. formerly professor of clinical medicine, marquette university medical school; chief physician to milwaukee county hospital; associate member association american physicians; member american association pathologists and bacteriologists; american medical association, etc., fellow american college of physicians _third edition_ st. louis c. v. mosby company copyright, , , by c. v. mosby company _press of c. v. mosby company st. louis_ to my mother this volume is affectionately dedicated preface to third edition several years have elapsed since the appearance of the second edition of this book. during this time there has been considerable experimentation and much writing on arteriosclerosis. the total of all work has not been to add very much to our knowledge of the etiology of arterial degeneration. points of view and opinions change from time to time. it is so with arteriosclerosis. in this edition arteriosclerosis is not regarded as a disease with a definite etiologic factor. rather it is looked upon as a degenerative process affecting the arteries following a variety of causes more or less ill defined. it is not considered a true disease. possibly syphilitic arteritis may be viewed as an entity, the cause is known and the lesions are characteristic. much new material and many new figures have been added to this edition. some rearranging has been done. the chapter on blood pressure has been much expanded and some original observations have been included. the literature has been selected rather than indiscriminately quoted. much that is written on the subject is of little value. it has always seemed to the author that there is not enough of the personal element in medical writings. at the risk of being severely criticized, he has attempted to make this book represent largely his own ideas, only here and there quoting from the literature. new chapters on cardiac irregularities associated with arteriosclerosis, and blood pressure in its clinical application have been added. the fact that the book has passed through two editions is very gratifying and seems to show that it has met with favor. the author takes this opportunity of thanking those who have loaned him illustrations. wherever figures are borrowed due credit is given. it is hoped that the kind of reception accorded to the first and second editions will also not be withheld from this present edition. louis m. warfield. milwaukee, wisc. preface to the second edition in this second edition so many changes and additions have been made that the book is practically a new one. all the chapters which were in the previous edition have been carefully revised. two chapters, "pathology" and "physiology," have been completely rewritten and brought up to date. it was thought best to add some references for those who had interest enough to pursue the subject further. these references have been selected on account of the readiness with which they may be procured in any library, public or private. two new chapters have been added--one on "the physical examination of the heart and arteries," the other on "arteriosclerosis in its relation to life insurance," and it is hoped that these will add to the practical value of the book. arteriosclerosis can scarcely be considered apart from blood pressure, and in the view expressed within, with which some may not concur, high tension is considered to be a large factor in the production of arteriosclerosis. as the data on blood pressure have increased, the importance of it has become more evident. the chapter on "blood pressure" has been wholly rewritten, expanded so as to give a comprehensive grasp of the essential features, and several illustrations have been added in order to elucidate the text more fully. the chief objects in view were to make clear to the physician the technique and the necessity for estimating both systolic and diastolic pressures. the author is grateful for the kindly reception accorded the first edition. no one is more keenly aware of the imperfections than he. the necessity for a second edition is taken to mean that the book has found a place for itself and has been of use to some. the author hopes that this new edition will fulfill adequately the purpose for which he prepared the book--namely, as a practical guide to the knowledge and appreciation of a most important and exceedingly common disease. louis m. warfield. milwaukee, may, . preface to the first edition it is hoped that this small volume may fill a want in the already crowded field of medical monographs. the author has endeavored to give to the general practitioner a readable, authoritative essay on a disease which is especially an outcome of modern civilization. to that end all the available literature has been freely consulted, and the newest results of experimental research and the recent ideas of leading clinicians have been summarized. the author has supplemented these with results from his own experience, but has thought it best not to burden the contents with case histories. the stress and strain of our daily life has, as one of its consequences, early arterial degeneration. there can be no doubt that arterial disease in the comparatively young is more frequent than it was twenty-five years ago, and that the mortality from diseases directly dependent on arteriosclerotic changes is increasing. fortunately, the almost universal habit of getting out of doors whenever possible, and the revival of interest in athletics for persons of all ages, have to some extent counteracted the tendency to early decay. nevertheless, the actual average prolongation of life is more probably due to the very great reduction in infant mortality and in deaths from infectious and communicable diseases. the wear and tear on the human organism in our modern way of living is excessive. hard work, worry, and high living all predispose to degenerative changes in the arteries, and so bring on premature old age. the author has tried to emphasize this by laying stress on the prevention of arteriosclerosis rather than on the treatment of the fully developed disease. no bibliography is given, as this is not intended as a reference book, but rather as a guide to a better appreciation and understanding of a most important subject. it has been difficult to keep from wandering off into full discussions of conditions incident to and accompanied by arteriosclerosis, but, in order to be clear in his statements and complete in his descriptions, the author has to invade the fields of heart disease, kidney disease, brain disease, etc. it is hoped, however, that these excursions will serve to show how intimately disease of the arteries is bound up with diseases of all the organs and tissues of the body. some authors have been named when their opinions have been given. thanks are extended also to many others to whom the writer is indebted, but of whom no individual mention has been made. the author also takes this opportunity of expressing his appreciation of the kindness of dr. d. l. harris, who took the microphotographs, and to the publishers for their unfailing courtesy and consideration. louis m. warfield. st. louis, august, . contents page chapter i anatomy introduction, ; definition, ; general structure of the arteries, ; arteries, ; veins, ; capillaries, . chapter ii pathology syphilitic aortitis, ; experimental arteriosclerosis, ; arteriosclerosis of the pulmonary arteries, ; sclerosis of the veins, . chapter iii physiology of the circulation blood pressure, ; blood pressure instruments, ; technic, ; arterial pressure, ; normal pressure variations, ; the auscultatory blood pressure phenomenon, ; the maximum and minimum pressures, ; relative importance of the systolic and diastolic pressures, ; pulse pressure, ; blood pressure variations, ; hypertension, ; hypotension, ; the pulse, ; the venous pulse, ; the electrocardiogram, . chapter iv important cardiac irregularities associated with arteriosclerosis auricular flutter, ; auricular fibrillation, ; ventricular fibrillation, ; extrasystole, ; heart block, . chapter v blood pressure in its clinical applications blood pressure in surgery, ; head injuries, ; shock and hemorrhage, ; blood pressure in obstetrics, ; infectious diseases, ; valvular heart disease, ; kidney disease, ; other diseases, liver, spleen, abdomen, etc., . chapter vi etiology congenital form, ; acquired form, ; hypertension, ; age, sex, race, ; occupation, ; food poisons, ; infectious diseases, ; syphilis, ; chronic drug intoxications, ; overeating, ; mental strain, ; muscular overwork, ; renal disease, ; ductless glands, . chapter vii the physical examination of the heart and arteries heart boundaries, ; percussion, ; auscultation, ; the examination of the arteries, ; estimation of blood pressure, ; palpation, ; precautions when estimating blood pressure, ; the value of blood pressure, . chapter viii symptoms and physical signs general, ; hypertension, ; the heart, ; palpable arteries, ; ocular signs and symptoms, ; nervous symptoms, . chapter ix symptoms and physical signs special, ; cardiac, ; renal, ; abdominal or visceral, ; cerebral, ; spinal, ; local or peripheral, ; pulmonary artery, . chapter x diagnosis early diagnosis, ; differential diagnosis, ; diseases in which arteriosclerosis is commonly found, . chapter xi prognosis chapter xii prophylaxis chapter xiii treatment hygienic treatment, ; balneotherapy, ; personal habits, ; dietetic treatment, ; medicinal, ; symptomatic treatment, . chapter xiv arteriosclerosis in its relation to life insurance chapter xv practical suggestions illustrations fig. page . cross section of a large artery . cross section of a coronary artery . arteriosclerosis of the thoracic and abdominal aorta . arteriosclerosis of the arch of the aorta . normal aorta . radiogram showing calcification of both radial and ulnar arteries . syphilitic aortitis of long standing . diagrammatic representation of strain hypertrophy . strain hypertrophy . cross section of small artery in the mesentery . enormous hypertrophy of left ventricle . aortic incompetence with hypertrophy and dilatation of left ventricle . cook's modification of riva-rocci's blood pressure instrument . stanton's sphygmomanometer . the erlanger sphygmomanometer with the hirschfelder attachments . desk model baumanometer . faught blood pressure instrument . rogers' "tycos" dial sphygmomanometer . detail of the dial in the "tycos" instrument . faught dial instrument . detail of the dial of the faught instrument . the sanborn instrument . method of taking blood pressure with a patient in sitting position . method of taking blood pressure with patient lying down . observation by the auscultatory method and a mercury instrument . observation by the auscultatory method and a dial instrument . schema to illustrate decrease in pressure . chart showing the normal limits of variation in systolic blood pressure . tracing of auscultatory phenomena . tracing of auscultatory phenomena . clinical determination of diastolic pressure, fast drum . clinical determination of diastolic pressure, slow drum . venous blood pressure instrument . new venous pressure instrument . events in the cardiac cycle . simultaneous tracings of the jugular and carotid pulses . jugular and carotid tracings . right side of the heart showing distribution of the two vagus nerves . normal electrocardiogram . auricular flutter . auricular fibrillation . auricular fibrillation . pulse deficit . ventricular fibrillation . auricular extrasystoles . ventricular extrasystole . delayed conduction . partial heart block . complete heart block . alternating periods of sinus rhythm and auriculoventricular rhythm . auriculoventricular or "nodal" rhythm . influence of mechanical pressure on the right vagus nerve . schematic distribution of right and left vagus . blood pressure record from a normal reaction to ether . chart showing the method of recording blood pressure during an operation . method of using blood pressure instrument during operation . finger-tip palpation of the radial artery . finger-tip palpation of the radial artery . aneurysm of the heart wall . large aneurysm of the aorta eroding the sternum arteriosclerosis and hypertension chapter i anatomy with the increased complexity of our modern life comes increased wear and tear on the human organism. "a man is as old as his arteries" is an old dictum, and, like many proverbs, the application to mankind today is, if anything, more pertinent than it was when the saying was first uttered. notwithstanding the fact that the average age of mankind at death has been materially lengthened--the increase in years amounting to fourteen in the past one hundred years of history--clinicians and pathologists are agreed that the arterial degeneration known as arteriosclerosis is present to an alarming extent in persons over forty years of age. figures in all vital statistics have shown us that all affections of the circulatory and renal systems are definitely on the increase. "arterial diseases of various kinds, atheroma, aneurysm, etc., caused , deaths in , or . per , . this rate, although somewhat lower than the corresponding ones for and , is higher than that for , and is very much higher than that for , which was . ." the great group of cases of which cardiac incompetence, aneurysm, cerebral apoplexy, chronic nephritis, emphysema, and chronic bronchitis are the most frequent and important appear as terminal events in which arteriosclerosis has probably played an important part. thus, in the sense in which we speak of tuberculosis or pneumonia as a distinct disease, we can not so designate the diseased condition of the arteries. arteriosclerosis is not a disease =sui generis=. it is best viewed as a degeneration of the coats of the arteries, both large and small resulting in several different more or less distinct types. these types blend one into the other and in the same patient all types may be found. thus the sclerosis of the arteries is the result of a variety of causes, none of which is definitely known in the sense of a bacterial disease. as we shall see later, one type of arteriosclerosis has a special pathology and etiology, the syphilitic arterial changes. bearing in mind that arteriosclerosis (called by some "arteriocapillary fibrosis," by others "atherosclerosis") is not a true disease, it may, for convenience be defined as a chronic disease of the arteries and arterioles, characterized anatomically by increase or decrease of the thickness of the walls of the blood vessels, the initial lesion being a weakening of the middle layer caused by various toxic or mechanical agencies. this weakness of the media leads to secondary effects, which include hypertrophy or atrophy of the inner layer--and not infrequently hypertrophy of the outer layer--connective tissue formation and calcification in the vessels, and the formation of minute aneurysms along them. the term arteriocapillary fibrosis has a broader meaning, but is a cumbersome phrase, and conveys the idea that the capillary changes are an essential feature of the process, whereas these are for the most part secondary to the changes in the arteries. the veins do not always escape in the general morbid process, and when these are affected the whole condition is sometimes called vascular sclerosis or angiosclerosis. upon the anatomical structure of the arteries depends, as a rule, the character and extent of the arteriosclerotic lesions. for the clear comprehension of the process, it is necessary to keep in mind the essential histological differences between the aorta and the larger and smaller branches of the arterial tree. the vascular system is often likened to a central pump, from which emanates a closed system of tubes, beginning with one large distributing pipe, which gives rise to a series of tubes, whose number is constantly increasing at the same time that their caliber is decreasing in size. from the smallest of these tubes, larger and larger vessels collect the flowing blood, until, at the pump, two large trunks of approximately the same area as the one large distributing trunk empty the blood into the heart, thus completing the circle. this is but a rough illustration, and, while possibly useful, takes into account none of the vital forces which are constantly controlling every part of the distributing system. general structure of the arteries the aorta and its branches are highly elastic tubes, having a smooth, glistening inner surface. when the arteries are cut open, they present a yellowish appearance, due to the large quantity of elastic tissue contained in the walls. the elasticity is practically perfect, being both longitudinal and transverse. the essential portion of any blood vessel is the endothelial tube, composed of flat cells cemented together by intercellular substance and having no stomata between the cells. this tube is reinforced in different ways by connective tissue, smooth muscle fibers, and fibroelastic tissue. although the gradations from the larger to the smaller arteries and from these to the capillaries and veins are almost insensible, yet particular arteries present structural characters sufficiently marked to admit of histological differentiation. the whole vascular system, including the heart, has an endothelial lining, which may constitute a distinct inner coat, the tunica intima, or may be without coverings, as in the case of the capillaries. the intima (fig. ) consists typically of endothelium, reinforced by a variable amount of fibroelastic tissue, in which the elastic fibers predominate. the tunica media is composed of intermingled bundles of elastic tissue, smooth muscle fibers, and some fibrous tissue. the adventitia or outer coat is exceedingly tough. it is usually thinner than the media, and is composed of fibroelastic tissue. this division into three coats is, however, somewhat arbitrary, as in the larger arteries particularly it is difficult to discover any distinct separation into layers. [illustration: fig. .--cross section of a large artery showing the division into the three coats; intima, media, adventitia. the intima is a thin line composed of endothelial cells. the wavy elastic lamina is well seen. the thick middle coat is composed of muscle fibers and fibroelastic tissue. the loose tissue on the outer (lower portion of cut) side of the media is the adventitia. (microphotograph, highly magnified.)] the muscular layer varies from single scattered cells, in the arterioles, to bands of fibers making up the body of the vessel in the medium-sized arteries and veins. there is elastic tissue in all but the smallest arteries, and it is also found in some veins. it varies in amount from a loose network to dense membranes. in the intima of the larger arteries the elastic tissue occurs as sheets, which under the microscope appear perforated and pitted, the so-called fenestrated membrane of henle. the nutrient vessels of the arteries and veins, the vasa vasorum, are present in all the vessels except those less than one millimeter in diameter. the vasa vasorum course in the external coat and send capillaries into the media, supplying the outer portion of the coat and the externa with nutritive material. the nutrition of the intima and inner portion of the media is obtained from the blood circulating through the vessel. lymphatics and nerves are also present in the middle and outer layers of the vessels. arteries the structure of the arteries varies notably, depending upon the size of the vessel. a cross section of the thoracic aorta reveals a dense network of elastic fibers, occupying practically all of the space between the single layer of endothelial cells and the loose elastic and connective tissue network of the outer layer. smooth muscle fibers are seen in the middle coat, but, in comparison with the mass of elastic tissue, they appear to have only a limited function. in a cross section of the radial artery one sees a wavy outline of intima, caused by the endothelium following the corrugations of the elastica. the endothelium is seen as a delicate line, in which a few nuclei are visible. the media is comparatively thick, and is composed of muscle cells, arranged in flat bundles, and plates of elastic tissue. between the media and the externa the elastic tissue is somewhat condensed to form the external elastic membrane. the adventitia varies much in thickness, being better developed in the medium-sized than in the large arteries. it is composed of fibrous tissue mixed with elastic fibers. "followed toward the capillaries, the coats of the artery gradually diminish in thickness, the endothelium resting directly upon the internal elastic membrane so long as the latter persists, and afterward on the rapidly attenuating media. the elastica becomes progressively reduced until it entirely disappears from the middle coat, which then becomes a purely muscular tunic, and, before the capillary is reached, is reduced to a single layer of muscle cells. in the precapillary arterioles the muscle no longer forms a continuous layer, but is represented by groups of fiber cells that partially wrap around the vessel, and at last are replaced by isolated elements. after the disappearance of the muscle cells the blood vessel has become a true capillary. the adventitia shares in the general reduction, and gradually diminishes in thickness until, in the smallest arteries, it consists of only a few fibroelastic strands outside the muscle cells." (piersol's anatomy.) the large arteries differ from those of medium size mainly in the fact that there is no sharp line of demarcation between the intima and the media. there is also much more elastic tissue distributed in firm bundles throughout the media, and there are fewer muscle fibers, giving a more compact appearance to the artery as seen in cross section. the predominance of elastic tissue permits of great distention by the blood forced into the artery at every heartbeat, the caliber of the tube being less markedly under the control of the vasomotor nerves than is the case in the small arteries, where the muscle tissue is relatively more developed. the adventitia of the large arteries is strong and firm, and is made up of interlacing fibroelastic tissue, of which some of the bundles are arranged longitudinally. veins the walls of the veins are thinner than those of the arteries; they contain much less elastic and muscular tissue, and are, therefore, more flaccid and less contractile. many veins, particularly those of the extremities, are provided with cup-like valves opening toward the heart. these valves, when closed, prevent the return of the blood to the periphery and distribute the static pressure of the blood column. the bulgings caused by the valves may be seen in the superficial veins of the arm and leg. there are no valves in the veins of the neck, where there is no necessity for such a protective mechanism, gravity sufficing to drain the venous blood from the cranial cavity. capillaries these are endothelial tubes in the substance of the organs, the tissue of the organ giving them the necessary support. they are the final subdivisions of the blood vessels, and the vast capillary area offers the greatest amount of resistance to the blood flow, thus serving to slow the blood stream and allowing time for nutritive substances or waste products to pass from and to the blood. usually the capillaries are arranged in the form of a network, the channels in any one tissue being of nearly uniform size, and the closeness of the mesh depending upon the organ. as far back as , stricker observed contraction of the capillaries. this observation was apparently forgotten until revived again by krogh recently. the latter finds that the capillaries are formed of cells which are arranged in strands encircling the vessel. the capillaries are rarely longer than mm., and, according to krogh, are capable of enormous dilatation. the rate of flow through any capillary area is very inconstant, and the usual explanation has been that the capillaries were endothelial tubes the blood flow of which was dependent upon the contraction or dilatation of the terminal arterioles. the actual fact that in an observed capillary area some capillaries are empty renders the above explanation untenable. the color of a tissue depends upon the state of filling of the capillaries with blood. it would seem that all the evidence now leads us to believe that the capillaries themselves are contractile and it is even possible that they may be under vasomotor control. if the anatomic structure as stated above, is correct, it would take but a slight contraction of the encircling cell to shut off completely the capillary. when the enormous capillary bed is considered, it is not inconceivable that circulating poisons may act on large areas and produce a true capillary resistance to the onflow of blood which might express itself, if long continued, in actual hypertrophy of the heart. chapter ii pathology the whole subject of the pathology of arteriosclerosis has been much enriched by the study of the experimental lesions produced by various drugs and microorganisms upon the aortas of rabbits. simple atheroma must not be confused with the lesions of arteriosclerosis. the small whitish or yellowish plaques so frequently seen on the aorta and its main branches, may occur at any age, and have seemingly no great significance. such plaques may grow to the size of a dime or larger, and even become eroded. they represent fatty degeneration of the intima which, at times, has no demonstrable cause; at times follows in the course of various diseases, and undoubtedly is due to disturbances of nutrition in the intima. except for the remote danger of clot formation on the uneven or eroded spot, these places are of no special significance, and are not to be confused with the atheroma of nodular sclerosis. the lesions of arteriosclerosis are of a different character. it has been customary to differentiate three types: ( ) nodular; ( ) diffuse; ( ) senile. it must be understood that this is not a classification of distinct types. as a rule in advanced arteriosclerosis, lesions representing all types and all grades are found. the nodular type, however, may occur in the aorta alone, the branches remaining free. this is most often found in syphilitic sclerosis where the lesion is confined to the ascending portion of the arch of the aorta. the retrogressive changes of advancing years can not be rightly termed disease, yet it becomes necessary to regard them as such, for the senile changes, as we shall see, may be but the advanced stages of true arteriosclerosis. much depends on the nature of the arterial tissue and much on the factors at work tending to injure the tissue. a man of forty years may therefore have the calcified, pipe stem arteries of a man of eighty. our parents determine, to great extent, the kind of tissue with which we start life. the arteries are elastic tubes capable of much stretching and abuse. in the aorta and large branches there is much elastic tissue and relatively little muscle. when the vessels have reached the organs, they are found to be structurally changed in that there is in them a relatively small amount of elastic tissue but a great deal of smooth muscle. this is a provision of nature to increase or decrease the supply of blood at any point or points. the aorta and the large branches are distributing tubes only. it is after all in the arterioles and smaller arteries that the lesions of arteriosclerosis do the most damage. a point to be emphasized is that the whole arterial system is rarely, if ever, attacked uniformly. that is, there may be a marked degree of sclerosis in the aorta and coronary arteries with very little, if any, change in the radials. on the contrary, a few peripheral arteries only may be the seat of disease. a case in point was seen at autopsy in which the aorta in its entirety and all the large peripheral branches were absolutely smooth. in the brain, however, the arteries were tortuous, hard, and were studded with miliary aneurysms. it is not possible to judge accurately the state of the whole arterial system by the stage of the lesion in any one artery; but on the whole one may say that an undue thickening of the radial artery indicates analogous changes in the mesenteric arteries and in the aorta. so far as the anatomical lesions in the aorta and branches are concerned, there is much uniformity even though the etiologic factors have been diverse. the only difference is one of extent. to thoma we owe the first careful work on arteriosclerosis. he regarded the lesion in arteriosclerosis as one situated primarily in the media; there is a lack of resistance in this coat. his views are now chiefly of historical interest. as the author understands him, he considered a rupture in the media to be the cause of a local widening and consequently the blood could not be distributed evenly to the organ which was supplied by the diseased artery or arteries. moreover, there was danger of a rupture at the weak spot unless this were strengthened. it was essential for the even distribution of blood that the lumen be restored to its former size. nature's method of repair was a hypertrophy of the subintimal connective tissue and the formation of a nodule at that point. the thickening was compensatory, resulting in the establishment of the normal caliber of the vessel. thoma showed that by injecting an aorta in the subject of such changes, with paraffin at a pressure of mm. of mercury, these projections disappeared and the muscle bulged externally. he recognized the fact that the character of the artery changed as the years passed, and to this form he gave the name, primary arteriosclerosis. to the group of cases caused by various poisonous agents, or following high peripheral resistance and consequent high pressure, he gave the name, secondary arteriosclerosis. this is a useful but not essential division, as the changes which age and high tension produce may not be different from those produced in much younger persons by some circulating poison. and most important to bear in mind, octogenarians may have soft, elastic arteries. as the body ages, certain changes usually take place in the arteries leading to thickening and inelasticity of their walls. this is a normal change, and in estimating the palpable thickening of an artery, such as the radial, the age of the individual must always be considered. thayer and fabyan, in an examination of the radial artery from birth to old age, found that, in general, the artery strengthens itself, as more strain is thrown upon it, by new elastica in the intima and connective tissue in the media and adventitia. up to the third decade there is only a strengthening of the media and adventitia. during the third and fourth decades there is also distinct connective tissue thickening in the intima. "in other words, the strain has begun to tell upon the vessel wall, and the yielding tube fortifies itself by the connective tissue thickening of the intima and to a lesser extent of the media." by the fifth decade the connective tissue deposits in the intima are marked, there is an increase of fibrous tissue upon the medial side of the intima and, in lesser degree, throughout the media. "finally, in these sclerotic vessels degenerative changes set in, which are somewhat different from those seen in the larger arteries, consisting, as they do, of local areas of coagulation necrosis with calcification, especially marked in the deep layers of the connective tissue thickenings of the intima, and in the muscle fibers of the media, particularly opposite these points. these changes may ... go on to actual bone formation." the mesenteric artery differs in some respects from the radial, but in the main, the changes brought about by age are the same. thayer and fabyan note two striking points of difference: "( ) calcification is apparently much less frequent than in the radials; ( ) in several cases plaques were seen with fatty softening of the deeper layers of the intima and superficial proliferation--a picture which we have never seen in the radial." (see fig. .) [illustration: fig. .--cross-section of a coronary artery, x , showing nodular sclerosis. note the heaping up of cells in the intima, the fracture of the elastica, and the destruction of the media beneath the nodule. the primary lesion evidently was in the media. the thickened intima is the effort on the part of nature to heal the breach. at such places as shown here aneurysms may form. (microphotograph.)] aschoff's studies of the aorta show that, "in infancy the elastic laminæ of the media stand out sharply defined, well separated from each other by the muscle layers, which are well developed.... from childhood there is to be observed a slowly progressive increase in the elastic elements of the media. not only do the individual lamellæ seen in cross-sections become thicker, but also they afford an increasing number of fine secondary filaments feathering off from these and crossing the muscle layer, so that now they are no longer sharply defined, but more ragged upon cross-section. this progressive increase attains its maximum at or about the age of thirty-five, and from now on for the next fifteen years the condition is relatively stationary. after fifty there is to be observed a slowly progressive atrophy of the elastica. the media becomes obviously thinner and presumably weaker." (adami.) it has also been found (klotz) that after the age of thirty-five, the muscle of the media begins to exhibit fatty degeneration which after fifty years is well marked. the fatty degeneration may then give place to a calcareous infiltration or the fibers may undergo complete absorption. it would appear that the thinning of the aortic media is due not so much to the atrophy of the elastic tissue as to that of the muscle tissue. the elastic tissue does lose its specific property and the artery thus becomes practically a connective tissue tube. scheel has made very careful measurements of the ascending, the thoracic, and the abdominal aorta, and the pulmonary artery. he found that from birth to sixty years, the aorta became progressively wider and lost its elasticity. the pulmonary changed little, if at all, after thirty to forty years, and where before it was wider than the aorta, it now was found to be smaller. in chronic nephritis both were widened. the continuous increase of width and length of the aorta stands in reverse relationship to the elasticity of its walls. although the division of the lesions into nodular, diffuse, and senile has been the usual one, it is better to separate three groups into ( ) nodular, ( ) diffuse or senile, and ( ) syphilitic. there is more known about the histology of the syphilitic form and the lesions which consist of puckerings and scars seen on opening an aorta just above the valves, and on the ascending portion of the arch are characteristic. a macroscopic examination suffices in most cases for a definite diagnosis. in the nodular form the lesions are found on the aorta and large branches particularly at or near the orifices of branching vessels. these nodules may increase in size, forming rather large, slightly raised plaques of yellowish-white color. they are, as a rule, irregularly scattered throughout the aorta and branches and tend to be more numerous and larger in the abdominal aorta. the initial lesion is in the media, consisting of an actual dissolution of this coat with rupture of the elastic fibers and infiltration with small round cells. there is thus a weak spot in the artery. hypertrophy of the intimal cells takes place, layer upon layer being added in an attempt to strengthen the vessel at the injured place. coincidently with this, there is thickening by a connective tissue growth in the adventitia. the process begins, at least in syphilis, around the terminals of the vasa vasorum. it will be recalled that the blood supply of the inner portion of the media comes from within the vessel itself. as the intimal growth increases, the blood supply is cut off. the inevitable result is softening of the portion farthest from the lumen of the vessel. as a rule there has been a sufficient growth of connective tissue in the media and adventitia to repair the damage done to the media. this softening and dissolution gives rise to a granular debris composed of degenerated cells and fat. this is the so-called atheromatous abscess. there are no leucocytes as in ordinary pus. these "abscesses" are frequent and in rupturing leave open ulcers with smooth bases, the atheromatous ulcer. a further change which often takes place is calcification of the bases of the ulcers and calcification of the softened spots before rupture takes place. this only occurs in advanced cases. (see fig. .) [illustration: fig. .--arteriosclerosis of the thoracic and abdominal aorta, showing irregular nodules, atheromatous plaques, denudation of the intima, thin plates of bone scattered throughout with spicules extending into the lumen of the vessel. note the contraction of the openings of the large branches, the rough appearance of the aorta and the greater degree of sclerosis of the upper two-thirds, i. e., of the aorta above the diaphragm. this aorta in the recent state was much thickened and almost inelastic.] [illustration: fig. .--arteriosclerosis of the arch of the aorta. numerous calcified plaques, thickening and curling of the aortic valves, giving rise to insufficiency of the aortic valves. the aortic ring is rigid and not much dilated. (milwaukee county hospital.)] [illustration: fig. .--normal aorta. compare with fig. . note the perfectly smooth, glossy appearance of the intima. the openings of all the intercostal arteries are distinctly seen. in the recent state this artery was highly elastic, capable of much stretching both transversely and longitudinally.] rather contrary to what one would expect, there are no new capillaries advancing from the media to the intima in the nodular form of arteriosclerosis, consequently there is no granulation tissue to heal and leave scars. it must be borne in mind that these changes rarely, if ever, are the only ones found throughout the arterial system. nevertheless, the manifold changes, as will be shown within, appear to be but stages of one primary process. the character of the changes which are known as diffuse arteriosclerosis seems to have, at first sight, little in common with those of the nodular sclerosis. the aorta may or may not have plaques of nodular sclerosis, while the arteries, such as the radial or temporal, may be beaded or pipe stem in hardness. in spite of these far advanced peripheral lesions the aorta may appear smooth but it is markedly dilated, particularly the thoracic portion, it is noticeably thinned even on macroscopic examination, it has elongated as evidenced by its slight tortuosity, and it has lost the greater part of its elasticity. the abdominal aorta is not so extensively affected, although this, too, shows some elongation and slight thinning. this is considered by some pathologists to be the uncomplicated form of the so-called senile arteriosclerosis. it is more of the nature of a degenerative change, it is true, but, as will be shown later, it has its beginnings, at times, in comparatively young persons and its etiology is not simple. this type has been studied most carefully by moenckeberg, who showed that on the large branches of the aorta there were depressions due to a degeneration of the middle coat. these depressions encircled the vessel to a greater or lesser extent, causing small bulgings at such places and giving to the vessel a beaded appearance. on viewing such an artery held to the light, the sacculated spots are seen to be much thinner than the contiguous normal artery. associated with such changes in the aorta and large branches is marked sclerosis of the smaller arteries. intimal fibrosis is common, together with hypertrophy and fibrosis of the middle coat. not infrequently periarterial thickening is also seen. calcification of the media is found and is said to be preceded by hypertrophy of the middle coat. pure cases of this, the so-called moenckeberg type, are seen but seldom. most commonly there are nodules and plaques in the aorta and large branches together with thinning and sacculation of other portions of the vessels' walls. while the two processes appear at a glance to be so different from each other, it is possible for them to have a common origin. the initial lesion is in the media but the resulting sclerotic changes depend upon the kind of vessel, the strength of the coats, the pressure in the vessel, and other causes. thus the sclerosis of the radials of such an extent that these arteries are easily palpable, appears to be a different process from that of the sclerosis in the aorta, yet fundamentally it is the same. the difference lies in the anatomic structure of the two vessels, and possibly also in the degree of stretching and strain to which the vessels are subjected at every heart beat. in the radial artery the media as usual is affected first. the muscle cells undergo degeneration and either marked thickening takes place or sacculation results, depending upon the severity of the exciting cause. calcification of the media is common. this occasionally takes the form of rings encircling the vessel, and gives to the examining finger the sensation of feeling a string of fine beads. there may be calcification of the subintimal tissue without deposits of lime salts in the media, but this is more commonly found in the larger arteries. when the calcification occurs in plates through the media, the well known pipe stem vessel is produced. (fig. .) [illustration: fig. .--radiogram of a man aged seventy-five, showing calcification of both radial and ulnar arteries.] the senile sclerosis found in old people is usually a combination of the moenckeberg type in the large and medium-sized arteries, and the nodular type in the aorta, leading eventually to calcareous intimal deposits, and widened, elongated, inelastic aorta. =syphilitic aortitis= [illustration: fig. .--syphilitic aortitis of long standing. the aortic valves are curled and thickened, the heart is enlarged and the cavity of the left ventricle is dilated. (milwaukee county hospital.)] the seat of election of the syphilitic poison is in the aorta just above the aortic valves, fig. , and in the ascending portion of the arch. there are semitranslucent, hyaline-like plaques which have a tendency to form into groups and, instead of undergoing an atheromatous change as in the ordinary nodular form of arteriosclerosis, they are prone to scar formation with puckering, so that macroscopically the nature of the process may, as a rule, be readily diagnosed. microscopically the process is found to be a subacute inflammation of the media, which has been called a mesaortitis. there is marked small celled infiltration around some of the branches of the vasa vasorum and there appears to be actual absorption of the tissue elements of the middle coat. this is accompanied by hypertrophy of the intimal tissue. there follows degeneration in the deeper portions of this new tissue and new capillaries are formed which have their origin in the inflammatory area in the media. as is everywhere the case throughout the body, granulation tissue in the process of healing contracts and forms scars. this explains the scar formation in the aorta. when the process is more acute, instead of there being a reparative attempt on the part of the intima, there is actual stretching of the wall at the weakened spot and there results an aneurysmal dilatation. =spirochetæ pallidæ= have been found in the degenerated media and in small gummata which were situated beneath the intima. within the past years it has been found that a large percentage of patients with cardiovascular disease give the wassermann reaction. in cases of aortic insufficiency, the reaction is present in almost every case. this is in marked contrast to the cases of diffuse endocarditis where the reaction is rarely present. according to adami the effects of syphilis upon the aorta are the following: ( ) the primary disturbance is a granulomatous, inflammatory degeneration of the media; ( ) this leads to a local giving way of the aorta; ( ) if this be moderate it results in a strain hypertrophy of the intima and of the adventitia, with the development of a nodose intimal sclerosis; ( ) if it be extreme, there results, on the contrary, an overstrain atrophy of the intima and aneurysm formation; ( ) the intimal nodosities are here not of an inflammatory type and are nonvascular, although, with the progressive laying down of layer upon layer of connective tissue on the more intimal aspect of the intima, the earlier and deeper-placed layers of new tissue gain less and less nourishment, and so are liable to exhibit fatty degeneration and necrosis; ( ) these products of necrosis exert a chemotactic influence upon the nearby vessels of the medial granulation tissue, with, as a result, (a) a secondary and late entrance of new vessels into the early and deeply-placed atheromatous area, (b) absorption of the necrotic products, (c) replacement by granulation tissue, (d) contraction of the granulation tissue, and (e) depression and scarring of the sclerotic nodules so characteristic of syphilitic sclerosis. in the smaller arteries and arterioles the arteriosclerotic process appears on superficial examination to be a different process from that in the aorta and large arteries, but the difference is only apparent. it will be recalled that there is relatively much more muscle tissue in the arterioles than in the large arteries. the size, of course, is much less. large nodular plaques are not possible. the atheromatous degeneration is not marked. in the smaller muscular arteries is seen the intimal proliferation, the stretching of the moenckeberg type, and the calcification of the media rather than the intima. the media is thinned beneath the marked intimal proliferation so that the artery exhibits translucent areas when held to the light. again, there is seen degeneration of the muscle and replacement by connective tissue with or without hypertrophy of the intima. in the arterioles three kinds of changes occur: a muscular hypertrophy; a fibrosis of all the coats; or a marked proliferation of the intimal endothelium. the last two are probably the same process, the connective tissue having its origin in the proliferated endothelial cells. such a deposition of layer upon layer of cells in an arteriole and the resulting fibrosis leads to the condition of disappearance of the lumen of the vessel, endarteritis obliterans. this obliterating endarteritis is not, of course, due alone to syphilis. syphilis is only a type of poison which produces such changes as have been described above. it is in the organs such as the kidney, liver, spleen, and intestines that one sees the most perfect examples of this obliterating endarteritis. endarteritis deformans is a term applied to the condition of the arteries as a result of irregular thickenings and deposits of lime salts in the walls. these changes give rise to marked tortuosity of the vessels. occasionally such an obliterating process takes place in a larger artery. a thrombus forms and by a process of central softening, new channels permeate the thrombus, thus restoring to some extent the function of the vessel. that the same process leads at one time to thinning and at another time to thickening of the arterial walls has been noted above. prof. adami holds that the regular development of layer upon layer of new connective tissue is non-inflammatory. he calls it a "strain hypertrophy." it is analogous to the localized hypertrophy of bone where the muscle tendons are attached, as is so frequently seen in athletes. the increased tension on connective tissue, provided that it is not overstrained, leads to its overgrowth, but only when there is sufficient nourishment. such conditions are adequately fulfilled in the arteries. when a local giving way under pressure occurs in the media, the intima is put on the stretch (see fig. ), and there results a hypertrophy of the intima until the volume of the new tissue and the resistance which this affords to the mean distending force, balances the loss sustained by the weakened media. when the balance is struck, the hypertrophy is arrested. the youngest tissue is thus found directly beneath the endothelium. now should this local weakening of the media have an acute origin, instead of a stimulus to growth there is overstrain, and there is, in consequence, not hypertrophy but atrophy. the beginning process is here a mesaortitis, but the acuteness of the poison, and the pressure from within the artery so stretches the artery that there is no compensatory hypertrophy, but a thinning, and the ground is prepared for aneurysmal dilatation or pouching. [illustration: fig. .--i, media weakened at m' with overgrowth of intima filling in the depression. ii, with postmortem rigor and contraction of the muscles of the media and removal of the blood pressure from within, the stretched media at m'' contracts; the intimal thickening thus projects into the arterial lumen. (after adami.)] again, one not infrequently encounters intimal nodosities when the underlying media appears of normal thickness. the explanation of this apparent exception is that the media in the living aorta is actually thinned, but the layers of subintimal tissue deposited over the weak spot due to strain hypertrophy become bulged inward when the pressure is relieved, as at postmortem. the media has not lost all of its elasticity (see fig. ), hence it contracts and there is the appearance of a nodule on the intima beneath which is a media equal in thickness to that of the healthy surrounding media. [illustration: fig. .--schematic representation of the increased strain brought to bear upon the cells of the intima, int., when the media, med., undergoes a localized expansion through relative weakness. (after adami.)] the essential lesion in arteriosclerosis of the aorta and large arteries is a degeneration in the middle coat. this may be brought about by a variety of poisons circulating in the body. in syphilis, for example, the initial lesion has been shown to be a mesaortitis. the media seems to be dissolved, the artery is consequently thinned, there is actual depression along the level of the vessel. the elastic fibers disappear and small-celled infiltration takes its place. the intima hypertrophies, layer upon layer being added in an attempt to restore the strength of the vessel. there is also, as a rule, rather pronounced hypertrophy of the adventitia. =experimental arteriosclerosis= within the past few years many workers have attempted by various means, to produce arterial lesions in animals, chiefly rabbits and dogs. the present status is somewhat chaotic, some affirming and some denying that arterial changes follow the various methods employed. following the injection of small, repeated doses of adrenalin over a certain period of time, changes occur in the arteries of rabbits which are arteriosclerotic in type, the essential lesion being a degeneration of the muscular and elastic tissue of the media with the consequent production of aneurysm in the vessel. this is said by some to be quite like the type of arteriosclerosis in man which has been so well described by moenckeberg. the degenerations in the arteries following the experimental lesions are of the nature of a fatty metamorphosis, and later proceed to calcification. barium chloride, digitalin, physostigmin, nicotin and other substances, as well as adrenalin, have been found to exert a selective toxic action on the muscle cells of the middle coat of the aorta. the infundibular portion of the pituitary body, the portion which is developed from the infundibulum of the brain, possesses an internal secretion, which, injected intravenously, causes a marked rise of blood pressure and slowing of the heart beat. so far as i know, this active principle of the gland has not been used in an attempt to produce experimentally the lesions of arteriosclerosis. wacker and hueck succeeded in producing aortic disease in rabbits which they considered to be in many points quite like human arteriosclerosis. they injected the rabbits intravenously with cholesterin. they feel that this is of great importance in view of the fact that exercise (muscle metabolism) dyspnea, certain poisons, as well as adrenalin, and even adrenal extirpation occasion a high cholesterin content of the blood. anitschow's experiments are confirmatory. he fed rabbits on large amounts of cholesterin-containing substances (yolk of egg, brain tissue) and pure cholesterin and found changes in the intima and inner portion of the media consisting of fatty infiltration between the muscle and elastic fibres, advent of small round cells and large phagocytic cells containing fat droplets of cholesterin esters. the elastic fibres were dissolved, broken up into fibrillæ and these seemed to be absorbed. the internal elastic lamina as such disappeared and the inner layer of the aorta fused with the middle coat. he considers these changes to be quite analogous to those found in human aortas. oswald loeb produced changes in the arteries of rabbits by feeding them sodium lactate (lactic acid). his controls fed on other acids became cachectic, but showed no arterial changes. he further found that in gm. of human blood there was normally from to mg. of lactic acid. after heavy work, he found as much as gm. he considers that after adrenalin or nicotin injections, the function of the liver is so disturbed that lactic acid is not bound. the arteriosclerosis is actually due to the presence of free lactic acid in the circulation. he succeeded, also, in producing lesions of the intima in a dog fed for a long time on protein poor diet, plus lactic acid and sodium lactate. another investigator, steinbiss, fed rabbits on animal proteins only, a diet totally foreign to their natural habits. he succeeded, however, in keeping some alive for three months. he also tried various substances and in the general conclusions says that no aortic changes could be produced in animals kept in natural living conditions by any mechanical means, increase of blood pressure, digital compression, hanging by hind legs, etc. in infectious diseases, especially septic, widespread sclerotic changes occurred in the aorta. a most suggestive conclusion in this "the most important result of feeding rabbits with animal proteins is, along with a constant glycosuria, disease of the aorta and peripheral arteries which is identical with changes in the aorta produced by injections of adrenalin. the degree of disease of the circulatory system increases with the duration of the experiment." by a small addition of vegetable to the protein diet, the lives of the animals were prolonged at will. with this modification of the experiment, the findings in the vessel walls were noticeably altered. the changes affected chiefly the intima, to less degree the media, and histologically were very much like human intimal disease. i have been unable to produce the slightest arterial lesions in rabbits by intravenous injections of lead. frothingham had no success feeding animals with lead. in a study of autopsy material from persons up to years, who died of infectious disease, he found changes in the arteries of those who had succumbed to infection with the pus cocci or to very severe infectious disease. these changes were, however, localized, and were not like those of the general diffuse arteriosclerosis. adler has recently reported experiments on dogs, to which he fed or injected intravenously various substances supposed to induce arteriosclerotic changes. he was unable to find any arterial lesions comparable to human arteriosclerosis. the difficulty experienced by experimenters is not surprising when the character of the changes is considered. arteriosclerosis is not an acute process. in its very nature, it is of months' or years' standing, the specific changes are of slow growth, and more in the nature of degeneration. it would seem that a very careful study of the histories of those with arteriosclerosis and a final examination upon the actual tissue might eventually give us data for the etiology. the most frequent site of disease in these experimental lesions is the thoracic aorta, and it is there also that the most severe changes are seen. while the toxic action is felt in the vessels all over the body, the lesions are, as a rule, scattered and small. the thoracic aorta stands the brunt of the high pressure, and this combined with the poisonous action of the drug or drugs, results in the formation of a fusiform aneurysmal dilatation which stops at the diaphragmatic opening. the aortic opening in the diaphragm seems to act as a flood gate, allowing only a certain amount of blood to flow through, and thus the abdominal aorta is protected to a great extent from the deleterious effects of increased pressure. focal degenerative lesions are, however, found in the abdominal aorta. changes somewhat analogous to those found in the human aorta as the result of intimal proliferations, are produced in animals by the toxins of the typhoid bacillus and the streptococcus pyogenes. clinically, thayer and brush have found that the arteries of those who have recovered from an attack of typhoid fever are more palpable than the arteries of average individuals of equal age who have never had the disease. experimentally, the changes caused by the toxins above noted are proliferations of cells in the intima and subintimal tissues, and a breaking up of the internal elastic laminæ into several parallel layers which stretch themselves among the proliferating cells. the diphtheria toxin, on the contrary, produces a lesion more like that caused by adrenalin. all pathologists are not agreed as to whether the experimental lesions produced by blood pressure raising drugs are similar to the arteriosclerotic changes in the arteries of man. some of the work on rabbits has been discredited for the reason that arteriosclerosis appears spontaneously in about fifteen per cent of all laboratory rabbits. furthermore, comparatively young rabbits have been found with arteriosclerosis. o. loeb, however, denies this. he has examined in the course of eight years healthy rabbits and never found arterial changes. the spontaneous lesions can not be distinguished histologically from those due to adrenalin. they differ macroscopically in that the lesion is usually limited to a few foci near the origin of the aorta. lesions produced by the drugs enumerated above represent one type of experimental arteriosclerosis. more interesting and important are the experiments which seem to show that high tension alone is capable of producing lesions in arteries which in all respects correspond to adami's strain hypertrophy and overstrain theory. it has been shown that when a portion of vein is placed under conditions of high arterial pressure, as in a transplantation of a portion of vein into a carotid artery, the vein undergoes marked connective tissue hypertrophy which includes all the coats. this is evidently strain hypertrophy. again, it has been demonstrated that by suspending a previously healthy rabbit by the hind legs for three minutes daily over a period of three to four months, there results hypertrophy of the heart with thinning and dilatation of the arch and the upper part of the thoracic aorta. no change was found in the abdominal aorta. the carotids, however, were larger than normal and they showed typical intimal sclerosis with connective tissue thickening. neither i nor others have been able to confirm this experiment, so it is very doubtful whether mechanical pressure alone can produce true arteriosclerosis. some evidence is adduced to bear on this point, however, in the fact that sclerosis of the pulmonary artery follows often upon mitral stenosis. yet we do not know but that factors other than pressure alone produce the arteriosclerotic change in such cases, so we are forced back on our conclusion expressed above; viz., that experiments on animals fail to sustain the purely mechanical origin of arteriosclerosis. the changes in the intima constitute the effort on the part of nature to repair a defect in the vessel wall which is to compensate for the weakened media and the widened lumen. this applies only to true arteriosclerosis, not to the condition produced experimentally by the toxin of the typhoid bacillus, for example. when an artery loses its elasticity and begins to have connective tissue deposited in its walls, the pressure of the blood stretches the vessel which is now no longer capable of retracting when the pulse wave has passed, and, in consequence, the artery is actually lengthened. this necessarily causes a tortuosity of the vessel which can be easily seen in such arteries as the temporals, brachials, radials, and other arteries near the surface of the skin. the exact mechanism of increase of blood pressure is not satisfactorily explained. the smaller arteries all over the body are supplied with vasoconstrictor and vasodilator nerve fibers from the sympathetic nervous system. normally when an organ is actively functionating the vessels are widely dilated and the flow of blood is rapid. among the many factors which influence blood pressure and blood supply must be reckoned the psychic. we know that normally there is a certain resistance offered to the propulsion of blood through the arteries by the contraction of the heart. this tonus is essential to the maintenance of an equalized circulation. the muscular arterioles throughout the body by their tonus serve to keep up the normal blood pressure and to distribute the blood evenly to the various organs. contraction of a large area of arterioles increases the blood pressure and, strangely enough, the arteries respond to increased arterial pressure, not by dilatation, but by contraction. it would appear that rise of blood pressure tends to throw increased work upon the musculature of the arterioles. this may be sufficient only to cause them to hypertrophy, but further strain may easily lead to exhaustion and to dilatation. "as a result strain hypertrophy of the intima shows itself with thickening, and it may also be of the adventitia, resulting in chronic periarteritis. and now with continued degeneration of the medial muscle in those muscular arteries, fibrosis of the media may also show itself. i would thus regard muscular hypertrophy of the arteries and fibrosis of the different coats as different stages in one and the same process. whether these peripheral changes are the more marked, or the central, depends upon the relative resisting power of the elastic and muscular arteries of the individual respectively." (adami.) [illustration: fig. .--cross-section of a small artery in the mesentery. note that the vessel appears capable of being much widened. the internal elastic lamina is thrown into folds somewhat resembling the convolutions of the brain. note also that the middle coat of the artery is composed almost entirely of muscle. the enormous number of such vessels in the mesentery and intestines explains the ability of the splanchnic area to accommodate the greater part of the blood in the body. universal constriction of these vessels would naturally render the intestines anemic. the vasomotor control of these vessels plays an important rôle in the distribution of the blood. small arteries in the skin and in other organs, possibly the brain, have a similar function. (microphotograph, highly magnified.)] it is conceivable that in one section of the body the vessels may be markedly contracted, but if there is dilatation in some other part there will be no increased work on the part of the heart, and theoretically, there should be no rise of blood pressure. the vascular system, however, while likened to a system of rubber tubes, must be regarded as a very live system, every subsystem having the property of separate control. for blood tension to be raised all over the body, conditions must favor the generalized contraction of a large area of arterioles. some authors consider that the so-called viscosity of the blood also is a factor in the causation of increased tension. the usual cause for the high tension is probably the presence in the blood of some poisonous substance. it is held by some authors that the great splanchnic area is capable of holding all the blood in the body and in respect of its liability to arteriosclerosis, it is second only to the aorta and coronary arteries. the enormous area of the skin vessels could probably contain most of the blood. the tone of the vasoconstrictor center controls the distribution of blood throughout the body. the fact that the vessels in the splanchnic area are frequently attacked by sclerotic changes means, as a rule, increase of work for the heart.[ ] the resistance offered to the passage of the blood must be great and signifies that, for blood to travel at the same rate that it did before the resistance set in, more power must be expended in its propulsion. in other words, the heart must gradually become accustomed to the changed conditions, and, as a result of increased work, the muscle hypertrophies. (see fig. .) [ ] longcope and mcclintock, however, conclude that permanent constriction of the superior mesenteric artery and celiac axis, as well as gradual occlusion of one or both of these vessels, may be present in dogs for at least five months without giving rise to definite and constant elevation of blood pressure or to hypertrophy of the heart. further, they have been unable to find at autopsy on man a definite association between sclerosis of the abdominal aorta and great splanchnic vessels and cardiac hypertrophy. [illustration: fig. .--enormous hypertrophy of left ventricle probably due to prolonged increased peripheral resistance. note that the whole anterior surface of the heart is occupied by the left ventricle. the right ventricle does not appear to be much affected. x / .] in diffuse arteriosclerosis accompanied by chronic nephritis the heart is always hypertrophied. this is a result, not a cause of the condition. in the pure type, there is hypertrophy only of the left ventricle without dilatation of the chamber. the muscle fibers are increased in number and in size, and there are frequently areas of fibrous myocarditis due to necrosis caused by insufficient nutrition of parts of the muscle. in these cases the coronary arteries share in the generalized arteriosclerotic process. the openings of the arteries behind the semilunar valves may be very small. there is often thickening and puckering of the aortic valves and of the anterior leaflet of the mitral valve leading, at times, to actual insufficiency of the orifice. later, when the heart begins to weaken, there is dilatation of the chambers and loud murmurs result, caused by the inability of the nondistensible valves to close the dilated orifices. until the compensation is established, it is impossible to say whether or not true insufficiency is present. in senile arteriosclerosis there is the physiologic atrophy of the media to be reckoned with. this change has already been referred to. when such degeneration has taken place, the normal blood pressure may be sufficient to cause stretching of the already weakened media with or without hypertrophy of the intima. the arteries may be so lined with deposits of calcareous matter that they appear as pipe stems. more frequently there are rings of calcified material placed closely together or irregular beading, giving to the palpating finger the impression of feeling a string of very fine beads. the arteries are often tortuous, hard, and are absolutely nondistensible. at times no pulse wave can be felt. the larger arteries such as the brachials and femorals are most affected. the walls become thinned and show cracks, and areas apparently, but not actually denuded of intima. yellowish-white, irregular, raised plaques are scattered here and there. interspersed among these areas are irregularly shaped clean-cut ulcers having as a rule a smooth base, and frequently on the base is a thin plate of calcified matter. the color of these denuded areas is usually brownish red or reddish brown. white thrombi may be deposited on these areas. the danger of an embolus plugging one of the smaller arteries is great and probably happens more often than we think. the collateral circulation is able to supply the thrombosed area. should the thrombus be on the carotid arteries, hemiplegia may result from cerebral embolism. on microscopic examination of the arteries there is seen extreme degeneration of all the coats, the degeneration of the media leading almost to an obliteration of that coat. on seeing such arteries as these one wonders how the circulation could have been maintained and the organs nourished. senile atrophy of the internal organs naturally goes hand in hand with such arterial changes. there is, as a rule, no increase in arterial tension; on the contrary, the pressure is apt to be low. this is readily understood when the heart is seen. this organ is small, the muscle is much thinned, it is flabby and of a brownish tint, the so-called "brown atrophy." microscopically, there is seen to be much fragmentation of the fibers with a marked increase of the brown pigment granules which surround the cell nuclei. cases are seen, however, in which blood pressure increases as the patient grows older. the hearts in such cases are more or less hypertrophied and show extensive areas of fibroid myocarditis. from what has been said, it follows that hypertension alone may be the cause of arteriosclerosis; that certain poisons in the blood which attack the media and cause it to degenerate and weaken cause arteriosclerosis without increased blood pressure; that the normal blood pressure may be, for the artery which is physiologically weakened in an individual over fifty, really hypertension, and arteriosclerosis may result. our observations lead us to believe that the process is at bottom one and the same. the different types noted clinically depend upon the nature of the etiologic factors and the kind of arterial tissue with which the individual is endowed. this view at least brings some order out of previous chaos, and corresponds well with our present knowledge of the disease. there are many cases of arteriosclerosis which lead to definite interference with the closure of the valves of the heart, particularly the aortic and the mitral. it has been said that puckerings of the valves frequently occur (fig. ). this arteriosclerotic endocarditis at times leads to very definite heart lesions, chiefly aortic or mitral insufficiency, or both with, at times, murmurs of a stenotic character at the base. there is rarely true aortic stenosis, however. the murmur is caused by the passage of the blood over the roughened valves and into the dilated aorta. aortic stenosis is one of the rarest of the valvular lesions affecting the valves of the left heart, and should be diagnosed only when all factors, including the typical pulse tracings, are taken into consideration. [illustration: fig. .--aortic incompetence with hypertrophy and dilatation of left ventricle, the result of arteriosclerosis affecting the aortic valves. note how the valves have been curled, thickened, and shortened, the edges of valves being a half inch below the upper points of attachment. the anterior coronary artery is shown, the lumen narrowed. (reduced one-half.)] the kidneys, as a rule, show extensive sclerosis. they are small, firm, and contracted and not always to be differentiated from the contracted kidneys of chronic inflammation. the lesions of the arteriosclerotic kidney are due to narrowing and eventual obstruction of the afferent vessels. the organs are usually bright red or grayish red in color. at times there is marked fatty degeneration of cortex and medulla, giving to them a yellowish streaking. the capsule is here and there adherent, the cortex is much thinned and irregular. the surface presents a roughly granular appearance. the glomeruli stand out as whitish dots and the sclerosed arteries are easily recognized, as their walls are much thickened. the process does not, as a rule, affect the whole kidney equally, but rather affects those portions corresponding to the interlobular arteries. the replacement of the normal kidney tissue by connective tissue and the resulting contraction of this latter tissue leads to the formation of scars. as the process is not regular, the scarring is deeper in some places than in others, with the result that localized rather sharply depressed areas appear on the surface. the pelvis is relatively large and is filled with fat. the renal artery is often markedly sclerosed and the whole process may be due to localized thickening of the artery, or as part of a general arteriosclerosis. the latter is the more frequent. microscopically, it is seen that the tubules are atrophied, the bowman's capsules are, as a rule, thickened, and the glomeruli are shrunken or have been replaced by fibrous tissue. in places they have fallen out of the section. there is marked proliferation of connective tissue in cortex and medulla. the arterioles are thickened, the sclerosis being either of the intima or media or of both. there is even occlusion of many arterioles. changes in other organs as the result of arteriosclerosis of their afferent vessels occur, but are not so characteristic as in the kidney. in the brain the result of gradual thickening of the arterioles is a diminished blood supply, softening of the portion supplied by the artery, and later a connective tissue deposit. the occurrence of thrombi is favored and, now and again, a thrombus plugs an artery which supplies an important and even vital part of the brain. the arteries of the brain are end arteries, hence there is no chance for collateral circulation. it is therefore evident how serious a result may follow the disturbance in or actual deprivation of blood supply to any of the brain centers or to the internal capsule. =arteriosclerosis of the pulmonary arteries= there have been a number of cases of sclerosis of the pulmonary arteries, either alone, or associated with general systemic arteriosclerosis. a primary and a secondary form are recognized, the former in conjunction with congenital malformations of the heart, the latter as the result of severe infection or of mitral stenosis. these two causes seem to be the most important in the production of the arterial changes. the cases thus far described have revealed widespread thickening of the pulmonary arteries. if one may judge by the description of the pathologic changes, the condition is quite similar to that produced in a vein by transplantation along the course of an artery. the diffuse form with connective tissue thickening of all coats has been generally described. there is also obliterating endarteritis of the smaller vessels. in the etiology of the condition severe infection seems to play a prominent rôle. the constant presence of right ventricular hypertrophy is interesting, the heart dullness extends, as a rule, far to the right of the sternum. in some of the cases no demonstrable changes were observed in the bronchial arteries or in the pulmonary veins. sanders has described a case of primary pulmonary arteriosclerosis with hypertrophy of the right ventricle. recently warthin[ ] has reported a case of syphilitic sclerosis of the pulmonary artery which places the lesion in exactly the same category as that of syphilis in the systemic arteries. there was also aneurysm of the left upper division present and, to settle the etiologic nature of the process, spirochete pallida were found in the wall of the aneurysm sac and in that of the pulmonary artery. the microscopic picture in the pulmonary artery could not be told from that in a syphilitic aorta. [ ] warthin, a. s.: am. jour. syph., , i, . =sclerosis of the veins= phlebosclerosis not infrequently occurs with arteriosclerosis. it is seen in those cases characterized by high blood pressure. such increased pressure in the veins is due, for example, to cirrhosis of the liver which affects the portal circulation, or to mitral stenosis which affects the pulmonary veins. the affected vessels are usually dilated. the intima shows compensatory thickening especially where the media is thinned. as a rule all the coats are involved in the connective tissue thickening. occasionally hyaline degeneration or calcification of the new-formed tissue is seen. "without existing arteriosclerosis the peripheral veins may be sclerotic usually in conditions of debility, but not infrequently in young persons." (osler.) in many cases of arteriosclerosis, the pathologic changes are not confined to the arteries, but are found in the veins as well as in the capillaries. such cases could be called angiosclerosis. chapter iii physiology of the circulation no attempt will be made to cover the entire subject of the physiology of the circulation. only in so far as it relates to arteriosclerosis and blood pressure and has a bearing on the probable explanation of blood pressure phenomena will it be discussed. "the heart and the blood vessels form a closed vascular system, containing a certain amount of blood. this blood is kept in endless circulation mainly by the force of the muscular contractions of the heart; but the bed through which it flows varies greatly in width at different parts of the circuit, and the resistance offered to the moving blood is very much greater in the capillaries than in the large vessels. it follows, from the irregularities in size of the channels through which it flows, that the blood stream is not uniform in character throughout the entire circuit--indeed, just the opposite is true. from point to point in the branching system of vessels the blood varies in regard to its velocity, its head of pressure, etc. these variations are connected in part with the fixed structure of the system and in part are dependent upon the changing properties of the living matter of which the system is composed." (w. h. howell.) if the vascular system were composed of a central pump, projecting at every stroke a given amount of liquid into a series of rigid tubes, the aggregate cross sections of which were equal to the cross section of the main pipe, then the velocity at the openings would be the same as at the source (making allowances for friction). the problem would then be a simple one. in the circulation of the blood no such simple condition obtains. the capillary beds is an enormous area through which the blood flows slowly. from the time the blood is thrown into the aorta the velocity begins to diminish until it reaches its minimum in the capillaries. in no two persons is the initial velocity at the heart the same, nor in the same person is it the same at all times of day. the size of the heart, the actual strength of the muscle, the amount of blood ejected at every beat, and the size and elasticity of the aorta are some of the factors which determine the velocity of blood at the aortic orifice. when to these factors are added the differences in arterial tissue, the activity or resting stage of the various organs, etc., the question becomes exceedingly complicated. in spite of these many disturbing elements, attempts more or less successful have been made to estimate the velocity of the blood in animals. thus, in the carotid of the horse the velocity was found to be mm. per second (volkman) and mm. (chauveau); in the carotid of the dog, mm. (vierordt). in the jugular vein of the dog vierordt found the velocity to be mm. per second. these figures do not represent the actual velocity of the blood in all horses or all dogs, but they do give us some general idea of the rate of flow of the blood. for man it has been calculated that the velocity in the aorta is about mm. per second. the velocity is not uniform in the large arteries, where at every heart beat there is a sudden increase followed by a decrease as the heart goes into diastole. the farther away from the heart the measurements are made the more even is the flow. observations by w. h. luedde with the zeiss binocular corneal microscope on the rate of flow in the conjunctival capillaries must modify somewhat our former conceptions. he finds that "the rate varies in the different arteries, capillaries, and veins from a barely perceptible motion to a little more than mm. per second. further, some parts of the capillary network are ordinarily supplied with blood elements only occasionally. this is shown by the passage of a column of corpuscles along a certain line, followed after an interval of seconds, during which no corpuscles pass, by another column in the same line as before." the vessels of the conjunctiva probably are quite like superficial vessels in the skin and mucous membranes. therefore, we must be free to admit that the circulation in them is not absolutely steady. luedde found further that in syphilitics there were tortuosities, irregularities, minute aneurysmal dilatations and even obliterations of capillaries. some of the changes occurred as early as one month after infection. the rate in the capillaries of man is estimated to be between . mm. and . mm. per second. as the blood is collected into the veins and the bed becomes smaller, the velocity increases until at the heart it is almost the same as in the aorta. that the velocity could not be exactly the same is evident from the fact that the cross section of the veins, which return the blood to the right auricle, is greater than is the cross section of the aorta. the volume of the bed is subject to rapid and wide fluctuations, which are dependent on many causes, both physiologic and pathologic. the call of an actively functionating organ or group of organs causes a widening of a more or less extensive area, and the velocity necessarily varies. in states of great relaxation of the vessels there may be a capillary pulse. in order to force blood at the same rate through dilated vessels as through normal vessels, there must be more blood or there must be a more rapid contraction of the central pump. what actually happens, as a rule, is an increase in the rate of the heart beat. there are conditions--such, for example, as aortic insufficiency--where actually more blood is thrown into the circulation at every beat, so that the rate is not changed. it has been calculated that the average amount of blood thrown into the aorta at every systole of the heart is from to c.c. this is forcibly ejected into a vessel already filled (apparently) with blood. in order to accommodate this sudden accession of fluid, the aorta must expand. the aortic valves close, and during diastole the blood is forced through the vascular system by the forcible, steady contraction of the highly elastic aorta. other large vessels which branch from the aorta also have a part in this steady propulsion of blood. from seventy to eighty times a minute the aorta is normally forcibly expanded to accommodate the charge of the ventricle. it is not difficult to understand the great frequency of patches of sclerosis in the arch when these facts are borne in mind. what relationship the viscosity of the blood has to the rate and volume of flow is not fully understood. as yet there is not much known about the subject, and no one has devised a satisfactory means of measuring the viscosity. it is thought by some that an increased viscosity assists in producing an increased amount of work for the heart. =blood pressure= blood pressure is the expression used for a series of phenomena resulting from the action of the heart. as every heart beat is actual work done by the heart in overcoming resistance to the outflow of blood, this force is approximately measurable in a large artery such as the brachial. it has been determined that the pressure in the brachial artery is almost equal to the intraventricular pressure in the left ventricle. in animals it is easy to attach manometers to the carotid artery and to measure the blood pressure accurately. formerly the method consisted in attaching a tube and allowing the blood to rise in the tube. the height to which the blood rose measured the maximum pressure. this is a crude method and has been replaced by the u-tube of mercury with connection made to the artery by saline or ringer's solution. this apparatus is familiar to all physiologists. in man the measurement is most conveniently made from the brachial artery. there is some difference in the pressure in the femoral and the brachial and some use both arteries. however, the difficulty of adjusting instruments to the upper leg, the great force which must be used to compress the femoral artery and the relative inaccessibility of the leg as compared to the arm, make the leg an inconvenient part for use in blood pressure determinations. it is not to be recommended. blood pressure is a valuable aid in diagnosis and of material help in many cases in prognosis, but it is not infallible neither can it be used alone to diagnose a case. blood pressure is only one of many links in a chain of evidence leading to diagnosis. it has been badly used and much abused. it has been condemned unjustly when it did not furnish _all_ the evidence. it has been made a fetish and worshipped by both doctors and patients. a sane conception of blood pressure must be widely disseminated lest we find it being discarded altogether. blood pressure consists of more than the estimation of the systolic pressure. the blood pressure picture consists of ( ) the systolic pressure, ( ) the diastolic pressure, ( ) the pulse pressure which is the difference between the systolic and diastolic pressure, ( ) the pulse rate. expressed in the literature it should read thus: - - ; . that tells the whole story in a brief, accurate form. this is recommended in history reporting. it must be ever kept in mind that a blood pressure reading represents the work of the heart at the _moment when it was taken_. within a few minutes the pressure may vary up or down. there is no normal pressure as such, but an average pressure for any group of people of the same age living under similar conditions. the habit of speaking of any systolic figure as normal should be broken. a pressure picture may be normal but a systolic reading, whatever it may be, is not accurately designated as normal. this distinction is worth insisting upon. =blood pressure instruments= there are several instruments which are in common use for the purpose of recording blood pressure in man. historically, the determination of blood pressure for man began with the attempt of k. vierordt in to measure the blood pressure by placing weights on the radial pulse until this was obliterated. the first useful instrument, however, was devised by marcy in . he placed the hand in a closed vessel containing water connected by tubing with a bottle for raising the pressure and by another tube with a tambour and lever for recording the size of the pulse waves. he maintained that when pressure on the hand was made, the point where oscillations of the lever ceased was the maximal pressure, the point where the oscillations of the recording lever was largest, was the minimal pressure. this pioneer work was practically forgotten for twenty-five years. it was not until that v. basch devised an instrument which was used to some extent. this instrument recorded only maximum pressure. it consisted of a small rubber bulb filled with water communicating with a mercury manometer. the bulb was pressed on the radial artery until the pulse below it was obliterated and the pressure then read off on the column of mercury. v. basch later substituted a spring manometer for the mercury column. potain modified the apparatus by using air in the bulb with an aneroid barometer for recording the pressure. these instruments are necessarily grossly inaccurate. moreover, they do not record the diastolic pressure. in and further attempts were made to record blood pressure by the introduction of a flat rubber bag encased in some nonyielding material, which was placed around the upper arm. riva-rocci used silk, while hill and barnard used leather. the latter used a bulb or davidson syringe to force air into the cuff around the arm and palpated the radial artery at the wrist, noting the point of return of the pulse after compression of the upper arm, and reading the pressure on a column of mercury in a tube. except that the width of the cuff has been increased from cm. to cm., this is the general principle upon which all the blood pressure instruments now in use are based. most of the apparatuses make use of a column of mercury in a u-tube to record the millimeters of pressure. as the mercury is depressed in one arm to the same extent as it is raised in the other arm the scale where readings are made is . cm. and the divisions represent mm. of mercury but are actually mm. apart. the cuff was made cm. in diameter because it was shown (v. recklinghausen) that with narrow cuffs much pressure was dissipated in squeezing the tissues. janeway has shown that with the use of the cm. cuff accurate values are obtained independently of the amount of muscle and fat around the brachial artery. in other words if an actual systolic blood pressure of mm. is present in two individuals, the one with a thin arm, the other with a thick arm, the instrument will record these pressures the same where a cm. arm band is used. we need have no fear of obtaining too high a reading when we are taking pressure in a stout or very muscular individual. janeway also was the first to call attention to the fact that the diastolic or minimal pressure was at the point where the greatest oscillation of the mercury took place. this is difficult to estimate in many cases as the eye can not follow slight changes in the oscillation when the pressure in the cuff is gradually reduced. practically this is the case in small pulses. the riva-rocci instrument was modified by cook. (see fig. .) he used a glass bulb containing mercury into which a glass tube projected. the bulb was connected by outlet and tubing to the cuff and syringe. the glass tube was marked off in centimeters and millimeters and for convenience was jointed half way in its length. the instrument could be carried in a box of convenient size. this instrument is fragile and more cumbersome, although lighter in weight, than others and is very little used at present. [illustration: fig. .--cook's modification of riva-rocci's blood pressure instrument.] stanton's instrument (fig. ) is practically cook's made more rigid in every way but without the jointed tube. the cuff has a leather casing, the pressure bulb is of heavy rubber, the glass tube in which the mercury rises is fixed against a piece of flat metal and there are stopcocks in a metal chamber introduced between the bulb and mercury with which to regulate the in- and out-flow of air. the pressure can be gradually lowered conveniently without removing the pressure bulb. [illustration: fig. .--stanton's sphygmomanometer.] the most accurate mercury manometer is that of erlanger. (fig. .) the instrument is bulky and is not practicable for the physician in practice. the principle is that used by riva-rocci. there is an extra t-tube introduced between the manometer and air bulb connecting with a rubber bulb in a glass chamber. the oscillations of this are communicated to a marey tambour and recorded on smoked paper revolving on a drum. there is a complicated valve which enables the operator to reduce the pressure with varying degrees of slowness. the mercury is placed in a u-tube with a scale alongside it. the instrument is expensive and not as easy to manipulate as its advocates would have us believe. hirschfelder has added to the usefulness (as well as to the complexity) of the erlanger instrument, by placing two recording tambours for the simultaneous registering of the carotid and venous pulses. in spite of its complexity and necessary bulkiness, very valuable data are obtained concerning the auricular contractions. [illustration: fig. .--the erlanger sphygmomanometer with the hirschfelder attachments by means of which simultaneous tracings can be obtained from the brachial, carotid, and venous pulses.] one of the best of the mercury instruments is the brown sphygmomanometer. in this (fig. ) the mercury is in a closed, all-glass tube so that it can not spill under any sort of manipulation. it is in this sense "fool-proof." the cuff, however, is poorly constructed. it is too short and there are strings to tie it around the arm. i have found that this causes undue pressure in a narrow circle and renders the reading inaccurate. in the clinic we use this mercury instrument with a long cuff like that provided by the tycos instrument. [illustration: fig. .--desk model baumanometer.] the faught instrument (fig. ) is larger than the brown, but is less easily broken and is not too cumbersome to carry around. the substitution of a metal air pump for the rubber makes the apparatus more durable. [illustration: fig. .--the faught blood pressure instrument. an excellent instrument which is quite easily carried about and is not easily broken.] the v. recklinghausen instrument is not employed to any extent in this country. it is both expensive and cumbersome, and has no advantages over the other instruments. several other instruments have been devised and new ones are constantly being added to the already large list. with those employing mercury the principle is the same. the aim is to make an instrument which is easily carried, durable, and accurate. in all the mercury instruments the diameter of the tube is mm. one would suppose that there would be noticeable differences in the readings of the different mercury instruments depending upon the amount of mercury used in the tube. by actual weight there is from to gms. of mercury in the several instruments. after many trials, no noticeable differences in blood pressure readings can be made out between a column weighing gm. and one weighing gm. there is, however, the inertia of the mercury to be overcome, friction between the tube and the mercury, and vapor tension. the mercury is therefore not as sensitive to rapid changes of pressure in the cuff as a lighter fluid would be. the mercury must be clean and the tube dry so that there is no more friction than what is inherent between the mercury and glass. in making readings on a rapid pulse the oscillations of the mercury column are apt to be irregular or to cease now and then, due to the fact that the downward oscillation coincides with a pulse wave, or an upward oscillation receives the impact of two pulse waves transmitted through the cuff. instruments have been devised to obviate this difficulty, but they have not come into favor. they are usually too complicated and at present can not be recommended. [illustration: fig. .--rogers' "tycos" dial sphygmomanometer.] an instrument devised by dr. rogers (the "tycos") has met with considerable popularity. (fig. .) this is not an instrument which operates with a spring and lever. the instrument is composed essentially of two metal discs carefully ground and attached at their circumferences to the metal casing below the dial. there is an air chamber between these discs through the center of which air is forced by the syringe bulb. when air is forced into the space between these two discs, they are forced apart to a very slight extent, with the highest pressures only - mm. of bulging occurs. from data gathered after extensive use for five years these discs were not found to have sprung. a lever attached to a cog which in turn is attached to the dial needle magnifies to an enormous extent the slightest expansion of the discs. every dial is handmade and every division is actually determined by using a u. s. government mercury manometer of standard type. no two dials therefore are alike in the spacing of the divisions of the scale but every one is calibrated as an individual instrument. there is no doubt in the author's mind that for the general practitioner the instrument has some advantages over the mercury instruments. it reveals the slightest irregularity in force of the heart beat. the oscillation of the dial needle is more accurately followed by the eye than is that of the column of mercury. the needle passes directly over the divisions of the scale, while with usual mercury instruments the scale is an appreciable distance (sometimes . cm.) from the column of mercury at the side. (fig. .) the diastolic pressure is more easily read on the "tycos." it is where the maximum oscillation of the needle occurs as the pressure is slowly released from the cuff. although it does not appear that this instrument, if properly made and standardized, could become inaccurate, nevertheless it is advisable to check it every few months against a known accurate mercury manometer instrument. [illustration: fig. .--detail of the dial in the "tycos" instrument.] [illustration: fig. .--faught dial instrument.] [illustration: fig. .--detail of the dial of the faught instrument.] another perfectly satisfactory dial instrument is the faught (figs. and ). the general plan of this differs in some minor points from the "tycos." i have compared the two and have found no difference in the readings. both can be recommended. [illustration: fig. .--the sanborn instrument.] one or two other cheaper dial instruments are on the market. the sanborn seems to be quite satisfactory. (fig. .) it is cheaper than the other dial instruments. there is this much to be said, no instrument using a spring as resistance to measure pressure can be recommended. =technic= the same technic applies to all the mercury instruments. the patient sits or lies down comfortably. the right or left arm is bared to the shoulder, the cuff is then slipped over the hand to the upper arm. (see fig. .) at least an inch of bare arm should show between the lower end of the cuff and the bend of the elbow. the rubber is adjusted so that the actual pressure from the bag is against the inner side of the arm. the straps are tightened, care being taken not to compress the veins. the upper part of the cuff should fit more snugly than the lower part. the part of the instrument carrying the mercury column is now placed on a level surface; the two arms of the mercury in the tube must be even, and at _ _ on the scale. with the fingers of one hand on the radial pulse, the bag is compressed until the pulse is no longer felt. (see fig. .) one should raise the pressure from - mm. above this, and close the stopcock between the bulb and the mercury tube. in a good instrument the column should not fall. if it does there is a leak of air in the system of tubing and arm bag. now with the finger on the pulse, or where the pulse was last felt, gradually allow air to escape by turning the stopcock so that the column of mercury falls about mm. (one division on the scale) for every heart beat or two. one must not allow the column of mercury to descend too slowly as it is uncomfortable for the patient and introduces a psychic element of annoyance which affects the blood pressure. on the other hand, the pressure must not be released too rapidly, else one runs over the points of systolic and diastolic pressure and the readings are grossly inaccurate. it is impossible to say how rapidly the mercury must fall. every operator must find that out for himself by practice. the first perceptible pulse wave felt beneath the palpating finger at the wrist, represents on the scale the systolic pressure. this can be seen to correspond to a sudden increase in the magnitude of the oscillation of the mercury column. the systolic pressure, thus obtained, is from - mm. lower than the real systolic pressure. the more sensitive the palpating finger, the more nearly does the systolic pressure reading approach that found by using such an instrument as erlanger's, where the first pulse wave is magnified by the lever of the tambour. [illustration: fig. .--method of taking blood pressure with a patient in sitting position.] [illustration: fig. .--method of taking blood pressure with patient lying down.] the pressure is now allowed to fall, until the palpating finger feels the largest possible pulse wave, which is coincident with the greatest oscillation of the mercury. this is the diastolic pressure. beyond this point there is no oscillation of the mercury column. the difference between the two is the pulse pressure. thus the pulse is felt after compression at on the scale, and the maximum oscillation occurs at . the systolic pressure is mm., the diastolic is mm., and the pulse pressure is mm. with the "tycos" or faught the arm band is snugly wound around the arm, the bag next to the skin and the end tucked in, so that the whole band will not loosen when air is forced into the bag. the cuff is blown up until the pulse is no longer felt. one should raise the pressure not more than mm. above the point of obliteration of the pulse. the valve is then carefully opened so that the needle gradually turns toward zero. at the first return of the pulse wave felt at the wrist, the needle is sure to give a sudden jump. this is the systolic pressure and is read off on the scale. the needle is now carefully watched until it shows the maximum oscillation. this is the diastolic pressure. the difference between the two is, as above, the pulse pressure. in taking pressure one should take the average of several, three or four. moreover, one must not take consecutive readings too quickly and one must be sure that between every two readings all the air is out of the cuff and that the mercury or dial is at zero. _it has been repeatedly shown that in a cyanosed arm the systolic pressure is raised so that even slight cyanosis between readings must be carefully avoided._ the only accurate method of determining both the systolic and diastolic pressure, but especially the diastolic, is by the so-called auscultatory method. (see fig. .) the cuff is adjusted in the usual way and one places the bell of a binaural stethoscope over the brachial artery from one to two centimeters below the lower edge of the cuff.[ ] care must be taken that the bell is not pressed too firmly against the arm and that the edge of the bell nearest the cuff is not pressed more firmly than the opposite end. for this purpose, one can not use the ordinary bowles stethoscope or any of the other much lauded stethoscopes, because the surface of the bell is too large. the diameter of the bell must not be more than twenty-five millimeters, twenty is still better. it is advisable before beginning the observation to locate with the finger the pulse in the brachial artery just above the elbow, so that the stethoscope may be placed over the course of the artery. (fig. .) the first wave which comes through is heard as a click, and occurs at a point on the manometer or dial scale from - mm. higher than can usually be palpated at the radial artery. this is the true systolic pressure. by keeping the bell of the stethoscope over the brachial artery while the pressure is falling, one comes to a point when all sound suddenly ceases. this is said to be the diastolic pressure. this is incorrect as will be shown later. [ ] a firm makes a stethoscope so that the bell is clamped on the arm leaving both the operator's hands free. [illustration: fig. .--observation by the auscultatory method and a mercury instrument. one hand regulates the stop cock which releases air gradually.] [illustration: fig. .--observation by the auscultatory method and a dial instrument. the right hand holds the bulb and regulates the air valve.] =arterial pressure= the arterial pressure in the large arteries undergoes extensive fluctuations with every heart beat. the maximum pressure produced by the systole of the left ventricle of the heart is known as the =maximum= or =systolic pressure=. it practically equals the intraventricular pressure. the minimum pressure in the artery, the pressure at the end of diastole, is called the =diastolic pressure=. the difference between the systolic and diastolic pressures is known as the =pulse pressure=. there is yet another term known as the =mean pressure=. for convenience, this may be said to be the arithmetical mean of the systolic and diastolic pressures. actually, however, this can not be the case, owing to the form of the pulse wave, which is not a uniform rise and fall--the upstroke being a straight line, but the downstroke being broken usually by two notches. we do not make use of the mean pressure in recording results. it is of experimental interest and needs only to be mentioned here. [illustration: fig. .--schema to illustrate the gradual decrease in pressure from the heart to the vena cava: (a), arteries; (c), capillaries; (v), veins; (a), aorta, pressure mm.; (b), brachial artery, pressure mm.; (f), femoral vein, mm.; (ivc), inferior vena cava, mm. (modified from howell.)] it has been shown that the mean pressure is quite constant throughout the whole arterial system. the maximum pressure necessarily falls as the periphery of the vascular system is approached. in general it may be said that the minimal pressure is quite constant. too little attention is paid to minimal and pulse pressure. the minimal pressure is important, for it gives us valuable data as to the actual propulsive force driving the blood forward to the periphery at the end of diastole. it is readily understood how the maximum pressure falls as the periphery is approached, until in the arterioles the maximum and minimum pressures are about equal. the pressure then in these arterioles is practically the same as the diastolic pressure. actually it is a few millimeters less. the diastolic blood pressure would, therefore, measure the peripheral resistance and, as the maximum for systolic pressure represents approximately the intraventricular pressure, the difference between the two, the pulse pressure, actually represents the force which is driving the blood onward from the heart to the periphery. it is hence very evident that the mere estimation of the systolic pressure gives us but a portion of the information we are seeking. the pulse pressure is subject to wide fluctuations but as a rule for any one normal heart it remains fairly constant as the rate varies. in a rapidly beating heart the diastole is short and the diastolic pressure rises. if the systolic pressure does not also rise, as in a normal heart following exercise, we will say, the pulse pressure falls. we know that when the pulse rate is constant, vasodilatation causes a fall in diastolic pressure and a rise in pulse pressure. on the contrary, vasoconstriction causes a rise in diastolic pressure and a fall in pulse pressure. it is very probably the case that with two individuals of equal age and equal pulse rate, and equal systolic pressure of mm., the one with a diastolic pressure of mm. and, therefore, a pulse pressure of mm. is much worse off than the other with a diastolic pressure of mm. and a pulse pressure of mm. the latter may be normal for the age of the person especially when certain forms of fibrous arteriosclerosis accompanied by enlarged heart are present. the former is not normal for any age. low pulse pressure usually means a weak vasomotor control and is only found in failing circulation or in markedly run down states, such as after serious illness or in tuberculosis. therefore, it is most important to estimate accurately the diastolic pressure as well as the systolic pressure, for only in this way can we obtain any data of value regarding the driving power of the heart and the condition of the vasomotor system. a high systolic pressure does not necessarily mean that a great deal of blood is forced into the capillaries. actually it may mean that very little blood enters the periphery. the heart wastes its strength in dilating constricted vessels without actually carrying on the circulation adequately. =normal pressure variations= the systolic pressure varies considerably under conditions which are by no means abnormal. thus, the average for men at all ages is about mm. hg. (all measurements are taken from the brachial artery, with the individuals in the sitting posture.) for women the average is somewhat lower, mm. hg. the pressure is lowest in children. in children from - years the average systolic pressure is mm. normally, there is a gradual increase as age comes on, due, as will be shown in the succeeding chapter, to physiologic changes which take place in the arteries from birth to old age. in the chart here appended is graphically shown the normal variations in the blood pressure at different ages compiled from observations made on one thousand presumably normal persons. (fig. .) [illustration: fig. .--chart showing the normal limits of variation in systolic blood pressure. (after woley.)] the diastolic pressure has been estimated to be about to mm. hg lower than the systolic pressure, and consequently these figures represent the pulse pressure in the brachial artery of man. this is equivalent to saying that every systole of the left ventricle distends this artery by a sudden increase in pressure equal to the weight of a column of mercury mm. in diameter and to mm. high. naturally, at the heart the pressure is highest. as the blood goes toward the capillary area the pressure gradually decreases until, at the openings of the great veins into the heart, the pressure is least. at the aorta (a) the pressure (systolic) is approximately mm. hg, at the brachial artery (b) it is mm., in the capillary system (c) it is mm., in the femoral vein (f) it is mm., at the opening of the inferior vena cava (i) it is mm. attention has been called to the normal systolic pressure at different ages. this is not the only cause for variations in the blood pressure. normally, it is greater when in the erect position than when seated, and greater when seated than when lying down. during the day there are well-recognized changes. the pressure is lowest during the early morning hours, when the person is asleep. in women there are variations due to menstruation. muscular exercise raises the blood pressure markedly. the effect of a full meal is to raise the blood pressure. the explanation is that during and following a meal there is dilatation of the abdominal vessels. this takes blood from other parts of the body, provided that the other factors in the circulation remain constant. a fall of pressure would necessarily occur in the aorta. to compensate for this, there is increased work on the part of the heart, which reveals itself as increased pressure and pulse pressure. it is well known that the interest in the process taken by an individual upon whom the blood pressure is estimated for the first time tends to increase the rate of the heart and to raise the blood pressure. for this reason the first few readings on the instrument must be discarded, and not until the patient looks upon the procedure calmly can the true blood pressure be obtained. as a corollary to this statement, mental excitement, of whatever kind, has a marked influence on the pressure. the patient must remain absolutely quiet. raising the head or the free arm causes the pressure to rise. another important physiologic variation is produced by concentrated mental activity. this tends to hurry the heart and increase the force of the beat. in short, it may be stated as a general rule that any active functioning of a part of the body which naturally requires a great excess of blood tends to elevate the blood pressure. at rest the pressure is constant. variations caused by the factors mentioned act only transitorily, and the pressure shortly returns to normal. =the auscultatory blood pressure phenomenon= since the first description of the auscultatory blood pressure sounds by korotkov in , this method has been more and more employed until today it is the standard, recognized method of determining the points in the blood pressure reading. when one applies the cm. arm band over the brachial artery and listens with the bell of the stethoscope about one cm. below the cuff directly over the brachial artery near the bend of the elbow, one hears an interesting series of sounds when the air in the cuff is gradually reduced. the cuff is blown up above the maximum pressure. as the air pressure around the arm gradually is lowered, the series of sounds begins with a rather low-pitched, clear, clicking sound. this is the first phase. this only lasts through a few millimeters fall when a murmur is added and the tone becomes louder. this click and murmur phase is the second phase. a few millimeters more of drop in pressure and a clear, sharp, loud tone is audible. usually this tone lasts through a greater drop than any of the other tones. this is the third phase. rather suddenly the loud, clear tone gives place to a dull muffled tone. in general the transition is quite sharp and distinct. this is the fourth phase. the tone gradually or quickly ceases until no tone is heard. this is the fifth phase (ettinger.) the first phase is due to the sudden expansion of the collapsed portion of the artery below the cuff and to the rapidity of the blood flow. this causes the first sharp clicking sound which measures the systolic pressure. the second, or murmur and sound phase, is due to the whorls in the blood stream as the pressure is further released and the part of the artery below the cuff begins to fill with blood. the third tone phase is due to the greater expansion of the artery and to the lowered velocity in the artery. a loud tone may be produced by a stiff artery and a slow stream or by an elastic artery and a rapid stream. this tone is clear cut and in general is louder than the first phase. the fourth phase is a transition from the third and becomes duller in sound as the artery approaches the normal size. the fifth phase, no sound phase, occurs when the pressure in the cuff exerts no compression on the artery and the vessel is full throughout its length. it is generally conceded that the sounds heard are produced in the artery itself and not at the heart. the tones vary greatly in different hearts. a very strong third tone phase or prolongation of this phase usually means that the heart which produces the tone is a strongly acting one, although allowances must be made for a sclerosed artery in which there is a tendency to the production of a sharp third phase. weakness of the third phase, as a rule, indicates weakness of the heart and this dulling of the third phase may be so excessive that no sound is produced. goodman and howell have carried this method further by measuring the individual phases and calculating the percentage of each phase to the pulse pressure. thus, if in a normal individual the systolic pressure is mm., the diastolic mm., and the pulse pressure mm., the first phase lasts from to or mm., the second from to , or mm., the third from to or mm., the fourth from to , or mm. the first phase would then be . per cent of the total pulse pressure, the second phase . per cent, the third phase . per cent, and the fourth phase . per cent. they consider that the second and third phases represent cardiac strength (c. s.) and the first and fourth represent cardiac weakness (c. w.). they believe that c. s. should normally be greater than c. w. in the example above c. s.:c. w. = . : . . in weak hearts, especially in uncompensated hearts, the conditions are reversed and c. w. > c. s. this is often the case. as a heart improves c. s. again tends to become greater than c. w. they think that the phases should be studied in respect to the sounds and also to the encroachment of one sound upon another. these observations are interesting but we have not found the division into phases as helpful as it was thought to be. we spent a great deal of time on this question. all that can be said, in my opinion, is that a loud, long third phase is usually evidence of cardiac strength. a further interesting feature which can be heard in all irregular hearts is a great difference in intensity of the individual sounds. goodman and howell call this phenomenon tonal arrhythmia. irregularities can be made out by the auscultatory method which can not be heard at the heart. in anemia the sounds are very loud and clear and do not seem to represent the actual strength of the heart. the general lack of vasomotor tone in the blood vessels together with some atrophy and flabbiness of the coats probably explains the loud sounds. in polycythemia the sounds have a curious, dull, sticky character and can not be differentiated accurately into phases, a condition which was predicted from the knowledge of the sharp sounds in anemia. in not all cases can all phases be made out. it is usually the fourth phase which fails to be heard. in such cases the loud third tone almost immediately passes to the fifth phase or no sound phase. the importance of this will later be taken up. "in arteriosclerosis, with hardening and loss of elasticity of the vessel walls, the auscultatory phenomena, according to krylow, are apt to be more pronounced, since the back pressure at the cuff probably causes some dilatation of the vessel above it, while the lumen of the vessel is smaller than normal. both of these factors cause an increased rapidity in the transmission of the blood wave when pressure in the cuff is released, which in time favors the vibration of the vessel walls. "in high grade thickening of the arterial walls, however, especially where calcification had occurred, fischer found that the sounds were distinctly less loud than normal, the more so in the arm, which showed the greater degree of hardening. according to ettinger's experience, the rapidity of the flow distinctly increases the auscultatory phenomenon." (gittings.) the sounds depend upon the resonating character of the cuff, upon the size and accessibility of the vessel, upon the force of the heart beat, and upon the velocity of the blood. =the maximum and minimum pressures= the maximum (systolic) pressure is read at the point where the first audible click is heard after the cuff is blown up and the pressure gradually reduced by means of the needle valve in the hand bulb or on the upright of the glass containing the mercury. all are agreed upon this point. there has been some dispute as to the place where the diastolic pressure should be read. korotkov considered that the diastolic pressure should be read at the fourth phase when the loud tone suddenly becomes dulled. others held that the diastolic pressure should be read at the fifth phase, the absence of all sound. experiments carried out to determine this point were made by me with the assistance of prof. eyster and dr. meek at the physiological laboratory of the university of wisconsin. we arranged apparatus making it possible to hold the pressure in the carotid artery of dogs at maximum or minimum. a femoral artery was then dissected and an instrument devised to compress the artery with a water jacket. the whole was connected up with a kymograph. a time marker was put in so as to record the place where changes in sound were heard while listening below the cuff around the femoral artery. two sets of records were taken. one with pressure greater than minimum pressure and a falling pressure over the femoral artery (fig. ), the other with pressure at zero and gradually raised to minimum pressure (fig. ). both sets of records showed the same result; viz., that at a point corresponding to the sudden change of tone the pressure on the artery corresponded to the minimum pressure. it was therefore concluded that experimentally in dogs the point where diastolic pressure should be read is at the tone change from clear to dull, not at the point where all sound disappears. [illustration: fig. .--tracing of auscultatory phenomena. (see explanation in legend of fig. .)] [illustration: fig. .--figures are to be read from left to right. the top line records the points where sounds were heard, the figures above the short vertical lines refer to tones (see text). mx. b. p., maximum blood-pressure. m. b. p., minimum blood-pressure. p. b., pressure bulb recorder. it was impossible to lower and raise this bulb by hand without obtaining the great irregular oscillations of the attached lever above the mercury manometer. b. l., base line.] erlanger showed some years ago, that with his instrument, the point at which diastolic pressure should be read was at the instant when the maximum oscillation of the lever suddenly became smaller. while checking up the graphic with the auscultatory method using erlanger's instrument, it was noticed that the disappearance of all sound did not correspond with the sudden diminution of the oscillation of the lever connected with the brachial artery. a series of records were carefully made on patients. it was seen that during the period of the third tone phase the oscillations of the lever on the drum reached a maximum (fig. ) and remained at approximately the same height for some millimeters while the pressure was gradually falling. at a point at which the third tone, clear and distinct, became dull, there was an appreciable decrease in the height of the pulse wave. from this point to the disappearance of all sound there was a gradual diminution of the size of the pulse waves. [illustration: fig. .--fast drum. sudden decrease in size of pulse wave at , marking the change from clear sharp tone to dull tone.] [illustration: fig. .--slow drum. sudden decrease in amplitude at .] for normal pressures the difference between the fourth (dull) tone and the fifth (disappearance of all tone) phase, amounted to to mm. occasionally the difference was so little, the change from sharp third tone through fourth dull tone to disappearance of all sound was so abrupt, that one could take the disappearance of all sound as the diastolic pressure, with an error of not more than to mm. this is within the limits of normal error and practically may be used by those who have difficulty in noting the change from third to fourth phase. for high pressures, however, the difference between fourth and fifth phases was never less than mm., and was found as much as mm. the diastolic, therefore, should always be taken at the fourth phase if possible. it was found that with the dial instrument the greatest fling of the lever corresponded to the third phase and the sudden lessened amplitude of the oscillation was at the fourth phase and was coincident with the change of tone from sharp to dull. thus the diastolic pressure may be read off on the dial scale by watching the fling of the hand and with some practice one might acquire considerable accuracy. it is better, simpler, and, for most observers, more accurate to use the stethoscope and hear the change of sound. =the relative importance of the systolic and diastolic pressures= the systolic pressure represents the maximum force of the heart. it is measured by noting the first sound audible over the brachial artery using the auscultatory method. it is the summation of two factors largely; the force expended in opening the aortic valves (potential) and the force expended from that point to the end of systole, the force which is actually driving the blood to the periphery (kinetic). to start the blood in motion, the heart must overcome a dead weight equal to the sum of all the forces holding the aortic valves closed. this sum of factors, called the peripheral resistance, must be reached and passed by the force of the ventricular beat before one drop of blood is set in motion along the aorta. this factor of resistance assumes a great importance. the systolic pressure is always fluctuating as it depends upon so many conditions, and the calls of the body except during sleep are many and various. in a study of diurnal variations in arterial blood pressure it has been found that--( ) a rise of maximum pressure averaging mm. of hg. occurs immediately on the ingestion of food. a gradual fall then takes place until the beginning of the next meal. there is also a slight general rise of the maximum pressure during the day. ( ) the range of maximum pressure varies considerably in different individuals, but the highest and lowest maximum pressures are practically equidistant from the average pressure of any one individual.[ ] [ ] weyse, a. w., and lutz, b. r.: diurnal variations in arterial blood pressure, am. jour. physiol., , xxxvii, . the pressure is lowest during sleep and gradually rises near the end of sleep, so that on awakening the pressure was the same as before sleep. physiologically there are many conditions which modify the systolic pressure. sleep, position, meals, exercise, emotional states cause often wide fluctuations which may be very sudden. it should be constantly borne in mind, that the systolic pressure reading which is made, is the maximum effort of the heart at that moment only. the diastolic pressure measures the peripheral resistance. it measures the work of the heart, the potential energy, up to the moment of the opening of the aortic valves. it is the actual pressure in the aorta. the diastolic pressure is not very variable; it is not subject to the same influences which disturb the systolic pressure. it fluctuates as a rule, within a small range. it is not affected by diet, by mental excitement, by subconscious psychic influences, to anything like the extent to which the systolic pressure is affected by the action of these factors. the diastolic pressure is determined by the tone in the arterioles and is under the control of the vasomotor sympathetic system. any agent which causes chronic irritation of the whole vasomotor system produces increase in the peripheral resistance with consequent rise in the diastolic pressure. any agent which acts to produce thickening of the walls of the arterioles, narrowing their lumina, produces the same effect. such states naturally result in increased work on the part of the heart, which as a result, hypertrophies in the left ventricle. the increase in size and strength is a compensatory process in order to keep the tissues supplied with their requisite quota of blood. conversely, paralysis of the vasomotor system produces fall of diastolic pressure which, if long continued, results in death. the diastolic pressure then is of importance for the following reasons: . it measures peripheral resistance. . it is the measure of the tonus of the vasomotor system. . it is one of the points to determine pulse pressure. . pulse pressure measures the actual driving force, the kinetic energy of the heart. . it enables us to judge of the volume output, for pulse pressure which is only determined by measuring both systolic and diastolic pressure, is such an index. . it is more stable than the systolic pressure, subject to fewer more or less unknown influences. . it is increased by exercise. . it is increased by conditions which increase peripheral resistance. . the gradual increase of diastolic pressure means harder work for the heart to supply the parts of the body with blood. . increased diastolic pressure is always accompanied by increased pulse pressure, and increased size of the left ventricle, temporarily (exercise) or permanently. . decreased diastolic pressure goes hand in hand with vasomotor relaxation, as in fevers, etc. . low diastolic pressure is frequently pathognomonic of aortic insufficiency. . when the systolic and diastolic pressures approach, heart failure is imminent either when pressure picture is high or low. when all these factors are taken into consideration, it becomes apparent that the diastolic pressure is most important, if not the most important part of the pressure picture. up to within a very brief time all the statistical evidence of blood pressure was based on systolic readings alone. this data is most valuable and much has been learned as to diagnosis and prognosis, but it is a mass of data based on a one-sided picture and can not be as valuable as the statistics which will undoubtedly be published later when all the pressure picture figures can be analyzed. =pulse pressure= the pulse pressure is the actual head of pressure which is forcing the blood to the periphery. at every systole a certain amount of blood - c.c. (howell) is thrown violently into an already comfortably filled aorta. the sudden ejection of this blood instigates a wave which rapidly passes down the arteries as the pulse wave. the elastic recoil of the aorta and large arteries near the heart contract upon the blood and keep it moving during diastole. normally the blood-vessels are highly elastic tubes with an almost perfect coefficient of elasticity. the pulse pressure varies under normal conditions from to mm. hg. there is a very definite relationship between the velocity of blood and the pulse pressure which is expressed thus; velocity = pulse rate x pulse pressure.[ ] further it has been demonstrated that under normal conditions and during various procedures--the pulse pressure is a reliable index of the systolic output.[ ] [ ] erlanger and hooker: an experimental study of blood pressure and of pulse pressure in man, johns hopkins hosp. rep., , xii, . [ ] dawson and gorham: the pulse pressure as an index of systolic output, jour. exper. med., , x, . increased pulse pressure therefore goes hand in hand with greater systolic output. physiologically this is most ideally seen during exercise. following exercise the pulse rate increases, the systolic pressure rises greatly, the diastolic slightly or not at all. the pulse pressure therefore is increased. the velocity also is much increased. the call comes for more blood and the heart responds. in the chronic high pulse pressures there are four correlated conditions which, so far as i have studied them, are always present. these are: ( ) an increase in size of the cavity of the left ventricle. the ventricle actually by measurement contains more blood than normal, and therefore throws out more blood at every systole. the volume output is greater per unit of time. ( ) there is actual permanent increase in diameter of the arch of the aorta. this is a compensating process to accommodate the increased charge from the left ventricle. ( ) there are on careful auscultation over the manubrium, particularly the lower half, breath sounds which vary from bronchial to intensely tubular, depending upon the anatomic placing of the aorta, the shape of the chest, and the degree of dilatation. often there is very slight impairment of the percussion note as well. ( ) there is increase in size of all the large distributing arteries, carotids, brachials, femorals, renals, celiac axis, etc., with fibrous changes in the media, loss of some elasticity, and increase in size of the pulse wave. increased pulse pressure means increased volume output, but does not always mean increased velocity. the proper distribution of blood to the various organs of the body is regulated by the vasomotor system acting upon the small arteries which contain considerable unstriated muscle. when fibrous arteriosclerosis is present there is loss of elasticity in the distributing arteries and a greater volume of blood must be thrown out by the ventricle at every systole in order that every organ shall have its full quota of blood. a force which is sufficient to send blood through elastic normal distributing tubes becomes totally insufficient to send the same amount of blood through tortuous and more or less inelastic tubes. it is evident then that pulse pressure is exceedingly important. it can only be determined by measuring both the _systolic_ and _diastolic_ pressure. the pulse rate must also be known in order to compute the velocity. it is essential to have the whole pressure picture for all cases if correct conclusions are to be drawn. in an irregular heart, especially in the cases due to myocardial disease, it is quite impossible to determine the true diastolic pressure. one can only approximate it and say that the pulse pressure is low or high. as a matter of fact the real systolic pressure can not be determined. for this figure the place on the scale where most of the beats are heard may be taken for the average systolic pressure. no one can seriously maintain that he can measure the diastolic pressure under all circumstances. by means of the auscultatory method of measuring blood pressure we are able to determine irregularities of force in the heart beats more easily than by listening to the heart sounds. a pulsus alternans is readily made out. the irregular tones heard over the brachial artery in cases of irregular heart action have been called "tonal arrhythmias." =blood pressure variations= a recent study of diurnal variations in blood pressure has shown that while the maximum pressure rises after the ingestion of food and steadily rises slightly throughout the day, the minimum blood pressure is very uniform throughout the day, and is little affected by the ingestion and digestion of meals. when it is affected, a rise or a fall may take place. throughout the day, it tends to become slightly lower. the pulse pressure then is greater towards evening. weysse and lutz in a study of this question draw the following conclusions: . a rise of maximum pressure averaging mm. of hg occurs immediately on the ingestion of food. a gradual fall then takes place until the beginning of the next meal. there is also a slight general rise of the maximum pressure during the day. . the average maximum blood pressure for healthy young men in the neighborhood of years of age is mm. of hg. this pressure obtains commonly one hour after meals. the higher maximum pressures occur immediately after meals, and the lower, as a rule, immediately before meals. . the range of maximum pressure varies considerably in different individuals, but the highest and lowest maximum pressures are practically equidistant from the average pressure of any one individual. . the minimum blood pressure is very uniform throughout the day, and is little affected by the ingestion and digestion of meals. when it is affected a rise or fall may take place. there is a tendency for a slight general lowering of the minimum pressure throughout the day. . the average minimum blood pressure for healthy young men in the neighborhood of years of age is mm. of hg. thus we get an average pulse pressure of mm. of hg. . pulse pressure, pulse rate, and the relative velocity of the blood flow are increased immediately upon the ingestion of meals. they attain the maximum, as a rule, in half an hour, and then decline slowly until the next meal. there is a general increase in each throughout the day. these measurements were made upon persons at rest. almost any form of exercise would have made the variations much greater. no account is taken of the psychic variations which for the physician are the most important to bear in mind. neglect to take this variation into account will inevitably lead to false conclusions. the average diurnal blood pressure record of the ten subjects ==========+=======+=======+=======+=======+========+=======+=============== time |maximum|minimum| mean | pulse | pulse |pp x pr| notes | | | | |pressure| rate | ----------+-------+-------+-------+-------+--------+-------+--------------- |_mm._hg|_mm._hg|_mm._hg|_mm._hg| | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | |before dinner : p.m. | . | . | . | . | . | |after dinner : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : a.m. | . | . | . | . | . | | : a.m. | . | . | . | . | . | before breakfast : a.m. | . | . | . | . | . | |after breakfast : a.m. | . | . | . | . | . | | : a.m.| . | . | . | . | . | | : a.m.| . | . | . | . | . | | : m | . | . | . | . | . | |before luncheon : p.m.| . | . | . | . | . | |after luncheon : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | |before dinner : p.m. | . | . | . | . | . | |after dinner : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | : p.m. | . | . | . | . | . | | +-------+-------+-------+-------+--------+-------+ average | . | . | . | . | . | | ----------+-------+-------+-------+-------+--------+-------+--------------- (taken from weysse and lutz.) in some experiments to determine the changes upon the blood pressure induced by hot and cold applications on and within the abdomen, hammett, tice and larson found that heat applied to the outside of the abdomen raises the blood pressure. the application of cold produces no change. either hot or cold saline introduced within the abdomen causes a fall in blood pressure. experimentally, certain drugs such as adrenalin, barium chloride, nicotine, digitalis, strophanthus and the infundibular portion of the pituitary body known as pituitrin raise the maximum pressure. in the clinic it is difficult to conclude always whether the drug alone is responsible for rise in maximum pressure. adrenalin given intravenously will raise the pressure. so will digitalis and strophanthus. i have watched the maximum pressure rise within three minutes following an intravenous injection of gr. / ( . gm.) strophanthin mm. of hg: i have seen the subcutaneous injection of minims of adrenalin repeated several times daily for six months fail to have the least effect on the blood pressure picture. elevation of the foot of the bed about nine inches proved so efficacious in steadying failing hearts in acute infectious diseases, particularly typhoid, that a study was made of the effect upon blood pressure. many observations were made, but no instrumental proof of rise in blood pressure could be adduced. exercise always raises blood pressure, the maximum much more than the minimum. in athletes the minimum pressure may actually fall, the maximum rise so that a greater volume output results from the greater pulse pressure. shock and hemorrhage lower it. hemorrhage lowers also the pulse pressure, and it may be possible to prognosticate internal hemorrhage by frequent estimations of the systolic and diastolic pressures (wiggers). compression of the superior mesenteric artery or the celiac axis in dogs raises the blood pressure measured in the carotid artery for a period of at least an hour. this seems to be dependent on purely mechanical causes, and is not a reflex vasomotor phenomenon. (longcope and mcclintock.) experimentally blood pressure can be increased by direct compression of the brain as cushing has shown. it was thought at one time that in man the same effect would result from tumor of the brain or especially from subdural or extradural hemorrhage following head injuries. this, however, is not the case. no information of great value can be obtained by the measurement of blood pressure in these states. we do know that too high and too prolonged compression of the medulla brings about exhaustion of the cardiac center accompanied with rapid pulse, low pressure and eventual death. =hypertension= all the conflict during the past few years over the subject of blood pressure has revolved around this much overworked word. hypertension means high pressure, and yet it carries with it a suggestion of high pressure which is harmful to the individual. as a matter of fact hypertension is a compensatory process, it is often a saving process in spite of the fact that it carries possibilities of harm in its possessor. it has been made a fetish, a god to fall down before and worship and it has been the means of holding a torch of fear over a patient which has not been lost on the charlatans. popularization of blood pressure has brought its crop of evils, no one of which has been as fruitful in dollars to unprincipled quacks as hypertension. hypertension is the expression on the part of the circulation to meet new conditions in the tissues so that all tissues will be nourished and all will be enabled to function. looked at from that point of view it is a conservative process and in many cases it is. it is not an average normal state, but it is normal state for the man who has it in chronic form. hypertension should be viewed rationally and its proper place in the whole make-up of the patient determined. hypertension is a relative term. what might be high pressure in a man of sedentary habits who reaches the age of fifty, might not be high pressure in a full blooded formerly athletic man of the same age. temporary hypertension due to excitement, exercise, etc., must be kept in mind. it is not intended to convey the impression that hypertension is of no moment. it is a matter for investigation, but not a matter to worship as the all-in-all. hypertension is, after all, a physiologic response on the part of the organism in order to maintain the circulation in equilibrium in the face of conditions which tend to produce vasoconstriction in large areas and, therefore tend to deprive these areas of blood. that there must be some substance in the blood stream which causes this constriction seems certain. what it is, is not at present known. recently, voegtlin and macht[ ] have isolated a crystalline substance from the blood of man and other mammals which they regard as a lipoid and closely related to cholesterin. this substance was recovered by them from the cortex of the adrenal gland. this becomes of added interest in the light of observations made by gubar (quoted by voegtlin and macht). he noted "that the vasoconstricting properties of blood serum vary in different pathologic conditions, being increased in nephritis, for instance, and diminished in others." in some experiments made in the summer of , we found there was no marked difference in the anaphylactic shock produced in half-grown rabbits by the injection of normal and uremic blood serum. as lipoids do not cause anaphylaxis, there should be no difference in the reaction of normal and uremic sera unless in one there was some form of protein not in the other. this does not seem to be the case. the presence of something in the circulation, therefore, produces constriction of vessels. this calls for more force in contraction on the part of the heart. this substance may be of lipoid nature. the continued presence of this hypothetical substance naturally would lead to hypertrophy of the heart. [ ] isolation of a new vasoconstrictor substance from the blood and the adrenal cortex, jour. am. med. assn., , lxi, . what makes hypertension of significance is not the hypertension itself, but the fact that it is the expression of processes going on in the body which demand exhaustive investigation. to attach a blood pressure cuff to the arm, find the pressure, and diagnose hypertension is like putting a thermometer under the tongue, noting a rise in the mercury, and diagnosing fever. what causes the hypertension? can the causes be removed? those are the really vital questions after the symptom hypertension has been discovered. all states of hypertension are accompanied by more or less increase of pulse pressure. in other words the systolic pressure is always increased to greater degree than the diastolic pressure. in studies carried out in the wards and pathological laboratory of the milwaukee county hospital, milwaukee, we found that in all of the cases of chronic high blood pressure with resulting high pulse pressure four correlated factors were found. if any one of these factors is present, the other three are found. . in all high pulse pressure cases there is increase in the size of the cavity of the left ventricle. the ventricle actually contains more blood when it is full, and throws out, therefore, more blood at each systole. the actual volume output is greater per unit of time. such hearts always show increase in thickness of the ventricular wall. i quite agree with stone,[ ] who says, "it is merely to be emphasized that when the pulse pressure persistently equals the diastolic pressure (high pressure pulse, in other words) with a resulting per cent, _overload_, which means the expenditure of double the normal amount of kinetic energy on the part of the heart muscle, cardiac hypertrophy has occurred." they are found in aortic insufficiency, in chronic nephritis, in the diffuse fibrous type of arteriosclerosis, and in some cases of exophthalmic goiter. such a condition occurs temporarily after exercise. [ ] stone, w. j.: the differentiation of cerebral and cardiac types of hyperarterial tension in vascular diseases, arch. int. med., november, , p. . . in all high pulse pressure cases there is actual permanent increase in diameter of the arch of the aorta. this is a compensating process to accommodate the increased charge from the left ventricle. smith and kilgore[ ] have shown this to be true in cases of chronic nephritis with hypertension. their research confirms my own observations. they found dilatation of the arch in ( ) syphilis (that is, aortitis); ( ) age over (that is, probable factor of arteriosclerosis); ( ) other serious cardiac enlargement, and ( ) hypertension (with more or less hypertrophy, as in chronic nephritis). [ ] smith, w. h., and kilgore, a. r.: dilatation of the arch of the aorta in chronic nephritis with hypertension, am. jour. med. sc., , cxlix, . in ten cases showing arches at the upper limit of normal (that is, cm. in diameter) and hypertrophy of the heart, three were chronic mitral endocarditis; one was chronic aortic endocarditis; three were chronic mitral and aortic endocarditis, and there was one each of hyperthyroidism, pericarditis and adherent pericardium. in fourteen cases of hypertension (highest systolic mm., average systolic, mm.), all showed cardiac hypertrophy. "all but three of these cases had great vessels whose transverse diameters measured over the normal limit of cm., and in one of those measuring cm. the roentgen-ray diagnosis was 'slight dilatation' of the arch." smith and kilgore are at a loss to explain the three exceptions. they did not give diastolic pressures, so pulse pressures are not known. possibly the three exceptions were cases of high diastolic pressure in which the pulse pressure possible was not over mm. such cases might show "slight dilatation of the arch," but not marked dilatation, such as was found in the other, evidently high pulse pressure cases. we have found that only the high pulse pressure cases show dilatation of the arch. certain high tension cases which have had a very high diastolic pressure do not reveal any accurately measurable dilatation of the aortic arch. an empty aorta after death is quite different from a functionating aorta during life. hence the dilatation which is found postmortem must have been considerable during life. and conversely, a dilatation which was present during life might not be looked on as such after death. . in all high pulse pressure cases one will find on careful auscultation over the manubrium, particularly its lower half, breath sounds which vary from bronchial to intensely tubular. at times the percussion note will be slightly impaired, as mccrae[ ] has shown in dilatation of the arch of the aorta. this auscultatory sign is evidence of some more or less solid body in the anterior mediastinum which is lying on the trachea and permits the normal tubular breathing in the trachea to be audible over the upper part of the sternum. it is found in cases of dilated aortic arch. fluoroscopic examination has confirmed the findings on auscultation. [ ] mccrae, thomas: dilatation of the arch of the aorta, am. jour. med. sc., , cxl, . . in all high pulse pressure cases, in which the pulse pressure is over mm. of mercury, there is increase in the size of all large distributing arteries, carotids, brachials, femorals, renals, celiac axis, etc., with fibrous changes in the media, loss of some of the elasticity, and in the palpable superficial arteries, increase in size of the pulse wave. increased pulse pressure means increased volume output, but does not always mean increased velocity. the proper distribution of blood to the various organs of the body is regulated by the vasomotor system acting on the small arteries which contain considerable unstriated muscle. in order that there may be enough blood at all times and under varying conditions of rest and function, there must be a proper supply coming through the distributing vessels, the large arteries, those containing much elastic tissue, and only a very small amount of unstriated muscle tissue or none whatever. fibrous sclerosis of these vessels causes them to become enlarged and tortuous and to lose much of their elasticity, which is essential for the even distribution of blood. a greater blood volume is therefore necessary in order that the organs may receive their quota of blood. a force which is sufficient to send blood through elastic normal distributing tubes becomes totally insufficient to send the same amount of blood through tortuous and more or less inelastic tubes. as a compensatory process the pulse pressure increases. for this to increase, the left ventricular cavity dilates, the arch dilates, and as a greater force must be exerted to keep the increased mass in motion, the heart responds by hypertrophy of its left ventricle and becomes itself the subject of fibrous changes in the myocardium. the mass movement of blood is therefore greater in high pulse pressure cases than in cases of normal pulse pressure. in cases of chronic interstitial nephritis--contracted granular kidney--it may well be that the sclerosis of the arteries is a secondary process caused, as adami thinks, by the hypertension itself. in aortic insufficiency the situation is somewhat different. the high pulse pressure is due to a very low diastolic pressure, for in my experience with uncomplicated aortic insufficiency the systolic pressure is, as a rule, not much increased above the normal for the individual's age. here peripheral resistance is so low that a capillary pulse is common. the volume output per unit of time is greatly increased, the arch of the aorta is dilated, and the pulse is large. the fact that a large part of the blood regurgitates during diastole back into the ventricle, and the fact that the diastolic pressure is low means that there is no increased resistance to overcome, and the systolic pressure is not raised. stone[ ] has divided the cases of hypertension into the cerebral and cardiac types. he finds that there is a difference in prognosis and in the mode of death in the two groups. he has further attempted to judge of the work placed upon the heart by calculating what he calls the heart load or pressure-ratio. for example, he takes a normal pressure at - - . the relation between and is / or per cent. that he considers normal. when the heart load increases so that the pulse pressure equals or exceeds the diastolic pressure, the heart load is per cent or more, he considers the danger of myocardial exhaustion graver than when the heart load is normal or less than per cent. [ ] stone, w. j.: arch. int. med., , xvl, . it is his opinion, in which i heartily concur, "that an individual with a systolic pressure of and a diastolic pressure of , is in greater danger of cerebral death than an individual with a systolic pressure of and a diastolic pressure of ." he is "likewise certain that the individual with a systolic pressure of and a diastolic of to is in greater danger of a cardiac death. it is apparently the constant high diastolic pressure rather than the intermittently high systolic pressure which predisposes to cerebral accident." i have not been able to confirm all of stone's conclusions. his contention holds good for some cases, but not, in my experience, for the great majority of the hypertension cases. i feel that in the classification of the chronic high pressure case we can go one step farther and split his first group into two usually differentiable groups. syphilis is not an etiological factor in any of these groups. it is not considered that these groups are absolutely distinct and can always be rigidly separated. there are variations and combinations which render an exact separation impossible. but bearing this in mind the following classification is proposed as a working classification. group a. chronic nephritis. group b. essential hypertension. group c. arteriosclerotic hypertension. group a. _chronic nephritis._ these are the cases with a high-pressure picture, that is to say, high systolic ( +) and high diastolic ( - +). the pulse pressure is much increased. the palpable arteries are hard and fibrous. there is puffiness of the under eyelids, which is more pronounced in the morning on arising. polyuria with low specific gravity and nycturia are present. there are almost constant traces of albumin in the urine, with hyaline and finely granular casts. functionally these kidneys are much under normal. the functional capacity determined by mosenthal's modification of the schlayer-hedinger method shows a marked inability to concentrate salts and nitrogen. the phthalein output is below normal. as the case advances the phthalein output becomes less and less, until a period is reached when there are only traces or complete suppression at the end of a two-hour period. such patients may live for ten weeks (one of our cases) or longer, all the time showing mild uremic symptoms, and suddenly pass into coma and die. the natural end of patients in this group is either uremia or cardiac decompensation (so-called cardiorenal disease). cerebral accidents may happen to a small number. it is only to this group, in my opinion, that the term cardiorenal disease should be applied. formerly i believed that all high systolic pressure cases were cases of chronic nephritis of some definite degree. from the purely pathologic standpoint that is true, but from the important, functional standpoint it is far from being the true state of the cases. in this group there is marked hypertrophy and moderate dilatation of the left ventricle with dilatation and nodular sclerosis of the aorta. the kidneys are firm, red, small, coarsely granular, the cortex much reduced, the capsule adherent. cysts are common. it is the familiar primary contracted kidney. mallory calls this capsular-glomerulonephritis. the etiology is obscure. often no cause can be found. again, there is a history of some kidney involvement following one of the acute infectious diseases, or it may follow the nephritis of pregnancy. usually, however, these cases fall into the group of secondary contracted kidneys, chronic parenchymatous nephritis. illustrative case.--r. z., a woman, aged thirty-six years, was seen july , , in coma. there was a history of typhoid fever at nineteen years, but no other disease. she had had nine full-term pregnancies, the last one thirteen months previously. for a week before the onset of the present illness she had complained of severe headaches and dizziness. there were no heart symptoms. for the past year she has had nycturia. physical examination revealed tubular breathing beneath the manubrium, a few rales in the chest, an enlarged heart (left side), with a systolic murmur over the aortic area. blood pressure was - - , the pulse rate , leucocytes , . venesection of c.c. of blood and intravenous injections of c.c. of per cent nahco_ in normal saline were employed. lumbar puncture withdrew c.c. of clear fluid under pressure with cells per cubic millimeter. the eye grounds showed distinct haziness of the disks and dilatation of the veins. blood pressure after venesection was - - , pulse , but in a few days rose to - - , pulse . a second venesection of c.c. and proctoclysis of c.c. saline solution was tried. the blood-pressure now was - - . the ph of the blood was . , the alkaline reserve was volume per cent (van slyke), and the co_ tension of the alveolar air (marriott) was mm. the phthalein on the day following the second venesection was per cent in two hours. the urine at first showed c.c. in twenty-four hours, specific gravity , albumin and casts. later she passed to c.c. with specific gravity around . the blood-pressure fluctuated considerably, reaching as low as - - , pulse . she was discharged improved september , . she had constant headache but managed to keep up. in june, , she suddenly died in an uremic coma. group b. this one might designate as the hereditary type, although there is not always a history in the antecedent. this group includes the robust, florid, exuberantly healthy people. they often are heard to boast that they have never had a doctor in their lives. they are usually thick-set or very large, fleshy people. the pressure picture is exceedingly high. the pulse pressure is moderately increased. the arteries are rather large, fibrous, and often quite tortuous, although this is not always the case. some persons have hard, small, fibrous arteries. there is no puffiness beneath the eyes, no polyuria, and no nycturia as a rule. the urine is of normal amount, color, and specific gravity. albumin is only rarely found and then in traces, but careful search of a centrifuged specimen invariably reveals a few hyaline casts. the phthalein excretion is normal or only slightly reduced. the kidneys excrete salt and nitrogen normally. it is in this group that apoplexy is found most frequently. the rupture of the vessel occurs when the victim is in perfect health, often without any warning. occasionally when such a case recovers sufficiently to be around, cardiac decompensation sets in later and he dies then of the cardiac complications. pathologically the hearts of such persons are found to have the most enormous hypertrophy of the wall of the left ventricle. the cavity is somewhat enlarged, as is always the case when the pulse-pressure is increased, but the size of the cavity is not the striking feature. the aorta is fibrous, thick walled, and the arch is slightly dilated. there are patches of arteriosclerosis. one such case seen only at autopsy had a rupture of the aorta just above the sinus of valsalva and died of hemopericardium. the kidneys are of normal size, dark red, firm, the capsule strips readily, the surface is smooth or finely granular, the cortex is not decreased. the pyramids are congested and red streaks extend into the cortex. microscopically the capsules of the glomeruli are a trifle thickened; a few show hyaline changes. there is rather diffuse, mild, round-cell infiltration between the tubules. the tubular epithelium shows little or no demonstrable changes. the arterioles are generally the seat of a moderate thickening of the intima and media, but it is not usual to find obliterating endarteritis. there is evidently a diffuse fibrous change which has not affected either the tubules or glomeruli to any great extent. illustrative case.--l. c., a man, aged fifty-six years, stonemason by trade, is a stocky, thick-necked individual. he had never been ill in his life until a year ago, when he fell from his chair unconscious. he had a right-sided hemiplegia which has cleared up so completely that except for a very slight drag to his foot he walks perfectly well. he came in complaining of shortness of breath and cough. there was no swelling of the feet. here evidently was left-heart decompensation. examination showed the blood pressure to be - - , pulse irregular, to the minute. there were cyanosis and rales throughout both chests. the urine was normal in color, specific gravity , small amount of albumin, few casts, hyaline and granular. the phthalein elimination was per cent in two hours. under rest, purgatives, and digitalis he was much improved. he has since had two other apoplectic strokes, the last of which was fatal. when these patients are seen with acute cardiac decompensation, there are, of course, much albumin and many casts in the urine, and the phthalein output is, for the time being, decreased. group c. this might be called the arteriosclerotic high-tension group (stone's cardiac group). the cases are usually over fifty years old. they are men and women who have lived high and thought hard. often they have had periods of great mental strain. many men in this group were athletes in their young manhood. many have been fairly heavy drinkers, although never drinking to excess. they are usually well nourished and inclined to stoutness. the pressure picture is high systolic with normal or only slightly increased diastolic and large pulse pressure. the arteries are large, full, fibrous, usually tortuous. the heart is very large, the apex far down and out. there is no polyuria; nycturia is uncommon, quite the exception. the urine is normal in color, amount, and specific gravity. albumin is only rarely found and hyaline casts are not invariably present. the phthalein excretion is quite normal and the excretions of salt and nitrogen are also normal. the terminal condition in most of the patients in this group is cardiac decompensation. they may have several attacks from which they recover, but after every attack the succeeding one is produced by less exertion than the preceding one, and it becomes more and more difficult to control attacks. eventually the patients become bed- or chair-ridden, and finally die of acute dilatation of the heart. occasionally patients in this group may have a cerebral attack, but in my experience this is uncommon. pathologically the heart is large, at times true _cor bovinum_, dilated and hypertrophied. the cavity of the left ventricle is much dilated. the aorta is dilated and sclerosed. the kidneys are increased in size, are firm, dark red in color, with fatty streaks in the cortex. the capsule strips readily and the cortex is normal in thickness or only slightly increased. the organ offers some resistance to the knife. the microscope shows small areas scattered throughout where the glomeruli are hyalinized, the stroma full of small round cells, the tubules dilated, and the cells are almost bare of protoplasm. naturally the tubules are full of granular cast material. also the arterioles show extensive intimal thickening, fibrous in character, with occasional obliterating endarteritis. one gets the impression that the small sclerotic lesions are the result of anemia and gradual replacement of scattered glomeruli by fibrous tissue. for the most part the kidney, except for the chronic passive congestion, appears quite normal. one can readily understand that in such a kidney function could not have been much interfered with. illustrative case.--c. k., an active, stout, business man, aged fifty-six years, consulted me on account of shortness of breath and swelling of the feet in may, . he had just returned from a hospital in another city, where he had gone with what was apparently cardiac decompensation. in his early manhood he had been a gymnast and a prize winner. he has worked hard, often given way to violent paroxysms of temper, has eaten heavily but drunk very moderately. the heart was greatly enlarged, the arch of the aorta dilated, a mitral murmur was audible at the apex. the radials and temporals were large, tortuous, and fibrous. the blood pressure picture ranged around - - . he was easily made dyspneic and had a tendency to swelling of the lower legs. the urine was acid, of normal specific gravity, normal in amount, normal phthalein, normal concentration of salt and nitrogen, contained albumin only when he was suffering from decompensation of the heart. casts were always found. he finally died, after sixteen months, with all the symptoms of chronic myocardial insufficiency. the heart was enormous, a true _cor bovinum_. the kidneys were typical of this condition, possibly somewhat larger than usual. =hypotension= when the pressure is constantly below the normal, it is called hypotension. this may be transient--as in fainting--it may be a normal state of the individual, it occurs in most fevers and in a great variety of diseases, including anemias. in arteriosclerosis, especially the diffuse (senile) type, the blood pressure is invariably low, and may be spoken of as hypotension. the heart in such a case is small, the muscle is flabby, there is brown atrophy of the fibers, and some replacement of the muscle cells by connective tissue. the same causes which have produced general arteriosclerosis have also produced sclerosis of the coronary arteries, and probably the lessened blood supply accounts for much of the atrophy of the heart muscle. in typhoid fever the maximum blood pressure during beginning convalescence may be as low as mm. hg. i have frequently seen hypotension of mm. this is common. meningitis is the only acute infectious disease in which the blood pressure is more often high than low. this is accounted for by the increased intracranial tension. following large hemorrhages the blood pressure is reduced. in venesection the withdrawal of blood may not affect the blood pressure. the procedure is done to relieve overdistension of the heart. in pleurisy with effusion and in pericarditis with effusion there is hypotension. collapse, whether from poisoning by drugs or as the result of dysentery, cholera, or profuse vomiting from whatever cause, reduces the blood pressure. in cachectic states, such as cancer, the blood pressure is low. general wasting of the whole musculature includes that of the heart and the heart muscle shows the condition known as "brown atrophy." a most interesting and important condition in which hypotension occurs is pulmonary tuberculosis. haven emerson has recently gone over the whole subject in a careful piece of work and his summary is as follows: "hypotension or subnormal blood pressure is universally found in advanced pulmonary tuberculosis, in which condition emaciation may play a part in its causation. hypotension is found in almost all cases of moderately advanced tuberculosis, or in early cases in which the toxemia is marked except when arteriosclerosis, the so-called arthritic or gouty diathesis, chronic nephritis, or diabetes complicate the tuberculosis and bring about a normal pressure or a hypertension. occasionally the period just preceding a hemoptysis or during a hemoptysis may show hypertension in a patient whose usual condition is that of hypotension. "hypotension has been found by so many observers in early, doubtful or suspected cases with or before physical signs of the disease in the lungs, and is considered by competent clinicians so useful a differential sign between various conditions and tuberculosis, that it should be sought for as carefully as it is the custom at present to search for pulmonary signs. "hypotension when found persistently in individuals or families or classes living under certain unhygienic conditions should put us on our guard against at least a predisposition to tuberculosis. most unhygienic conditions, overwork, undernourishment and insufficient air, are of themselves causes of a diminished resistance, and it seems likely that a failure of normal cardiovascular response to exercise or change of position may be found to indicate this stage of susceptibility, especially to tuberculous infection. "... hypotension, when it is present in tuberculosis, increases with an extension of the process. recovery from hypotension accompanies arrest or improvement. return to normal pressure is commonly found in those who are cured. continuation of hypotension seems never to accompany improvement. prognosis can as safely be based on the alteration in the blood pressure as on changes in the pulse or temperature...." there are a few drugs which lower the blood pressure, but, as a rule, their effects are more or less transitory. we know of no drug, unless it be iodide of potassium, which has the property of causing changes in the blood (decrease in viscosity?), which tends to reduce the blood pressure when it is excessive. this drug fails us many times. some drugs which influence the blood pressure =pressure raisers= adrenalin, when injected directly into a vein or deep into the muscles. the action is transitory. caffeine, preferably in the form of caffeine-sodium-benzoate. a good drug. strychnine, which does not act directly but seemingly through the higher centers. ergot, somewhat uncertain. nicotine, not used therapeutically. camphor, used in sterile olive oil and injected deeply into the muscles. digitalis, when the cardiac tone is low and decompensation is present. its action is prolonged but slow. injections of the infundibular portion of the pituitary body. not in use clinically. =pressure depressors= nitroglycerine and amyl nitrite, action transitory but rapid. sodium nitrite and erythrol tetranitrate. action somewhat more prolonged. aconite, veratrum viride, chloral, etc. these depress the heart. purgatives, drastic and hydragogue. potassium and sodium iodide may lower blood pressure. when they do, the action is prolonged. diuretin and theocin-sodium-acetate. =venous pressure= comparatively little work has been done upon the determination of the pressure in the veins in man. it is conceivable that this procedure may, at times, be of great value. a number of attempts have been made to measure the venous pressure by compressing the arm veins and noting on a manometer the force necessary to obliterate the vein. as the pressure is so slight, water is used instead of mercury, and readings have been given in centimeters of water. [illustration: fig. .--apparatus for estimating the venous blood pressure in man, devised by drs. hooker and eyster. the small figure is the detail of the box b. see explanation in text.] in the apparatus shown in the figure (fig. ), drs. hooker and eyster succeeded in making estimations of the venous pressure. the box _b_ is held in position by the tapes _a_, so that the vein is visible through the rectangular opening in the thin rubber covering the bottom. the box is connected with the water manometer _g_, by a rubber tube, from which a t-tube enters the rubber bulb _e_. when the bulb _e_ is compressed between the plates _d_, by the coarse thumbscrew _c_, air is forced into the box _b_, exerting a pressure on the vein lying exposed beneath. this pressure is transmitted directly to the manometer =g=, and may be read off in centimeters of water on the accompanying scale. the veins of the back of the hand are used and there must be no obstruction between them and the heart. the rubber-covered box is accurately and lightly fitted over a vein and pressure made until it is obliterated. by measuring the distance above or below the heart level that the hand was when the observation was made, and subtracting or adding these figures to the manometer reading, we obtain the venous pressure at the heart level. eyster has modified this instrument so that it is now much simpler to operate. he uses a small glass cup with a flaring edge and a diameter of about cm. this is sealed to the skin directly over a vein on the back of the hand by means of collodion. the stem of the cup has a rubber tube leading to a small hand bulb and to the manometer tube which contains colored water. slight compression of the hand bulb obliterates the vein which can be seen through the glass cup. the pressure in centimeters of water is then read off. (fig. .) the principle is the same as in the earlier instrument, but the application is easier. [illustration: fig. .--new venous pressure instrument. (after eyster.)] practically hooker and eyster found that the normal variation in healthy subjects was from to cm. of water. the pressure rose in cases of decompensated hearts with dyspnea and venous stasis, and returned to normal with improvement in the condition of the patient. it might be possible with this instrument to foretell an oncoming decompensation by the rise in venous pressure. the venous pressure may also be estimated roughly by slowly elevating the arm and noting the instant at which a particular vein collapses. by measuring the height of the vein above the heart some idea may be obtained of the pressure within the right auricle. =the pulse= there is nothing characteristic about the pulse of a person suffering from arteriosclerosis, except it be the difference in the pulse of high tension and of low tension. the pulse of high tension has a gradual rise, a more or less rounded apex, and the dicrotic wave is slightly marked and occurs about half-way down on the descending limb. in arteriosclerosis with low tension the radial artery is usually so rigid that very little pulse wave can be obtained. the general form of a low tension pulse is a sharp upstroke, a pointed summit, and a secondary wave on the base line, which corresponds to the dicrotic wave. such a pulse can be easily palpated, and is known as a dicrotic pulse. however, such a pulse can occur only when the artery still retains all or a large part of its elasticity; hence in arteriosclerotic low tension we would never see such a pulse as the typical dicrotic. =the venous pulse= it would carry us too far to discuss fully the character of the venous pulse, but a brief summary of the essential features of the normal venous pulse is presented. the venous pulse is a term used to express the tracing obtained from the internal or external jugular vein at the root of the neck. normally a very characteristic curve is produced, which can be readily analyzed into a series of waves corresponding to the fluctuations in the cardiac cycle. to understand these waves and their values, the accompanying figure is helpful. (fig. .) [illustration: fig. .--semidiagrammatic representation of the events in the cardiac cycle: jug., pulse in the jugular vein; aur., contraction of auricle; v. pr., intraventricular pressure; pap. m., contraction of the papillary muscles; car., carotid pulse. below are given the times of occurrence of the heart sounds and of the opening and closing of the heart valves. (after hirschfelder.)] bachmann summarizes the normal waves in the venous pulse tracing as follows: "the physiological or so-called venous pulse consists of three positive and three negative waves, bearing a more or less definite relation to the events of the cardiac cycle, and having their origin in the various movements of the chambers and structures of the right heart. the first positive wave (_a_) is presystolic in time, and is due to the contraction of the auricle, causing a slowing of the venous current and producing a centrifugal wave through a sudden arrest of the inflowing blood. the second positive wave (_s_) is presystolic in time, and originates in the sudden projection of the tricuspid valve into the cavity of the auricle during the quick, incipient rise in the intraventricular pressure occurring in the protosystolic period. the third positive wave (_v_) occurs toward the end of ventricular systole. it consists of two lesser waves separated by a shallow notch. the factors entering into its formation are the relaxation of the papillary muscle at a time when the intraventricular is still higher than the intraauricular pressure, resulting in an upward movement of the tricuspid leaflets and a return of the auriculoventricular septum to its position of rest. "the first negative wave (between positive wave _a_ and _s_) is due to the relaxing auricle. the second negative wave (_af_) occurs during the diastole of the auricle. it is due to the dilatation of its walls, to the displacement of the auriculoventricular septum toward the apex occurring at the time of ventricular systole, and to the pull of the papillary muscles on the tricuspid valve leaflets. the third negative wave (_vf_) appears during ventricular diastole and in the common pause of the heart chambers. its cause is found in the passage of the blood from the auricle into the ventricle. it is somewhat modified possibly by the continual ascent of the auriculoventricular septum and by a wave of stasis due to the accumulation of blood coming from the periphery." (fig. .) [illustration: fig. .--simultaneous tracings of the jugular and carotid pulses showing normal waves in the venous pulse and relation to carotid pulse. (after bachmann.)] hirschfelder has described another wave which he calls the "h" wave, which is due to the floating up of the tricuspid valve by the blood in the ventricle before the complete filling of the ventricle following the auricular systole. (fig. .) [illustration: fig. .--jugular and carotid tracing from a normal individual with a well-marked third heart sound showing a large "h" and a smaller pre-auricular wave "w." ? indicates a small wave in mid-diastole following the "h" wave, occasionally found though perhaps an artefact. (after hirschfelder.)] =the electrocardiogram= in the past few years an immense amount of work has been done by numerous observers on the changes in the electrical potential of the various portions of the heart during contraction. the very elaborate and delicate electrocardiograph with the string galvanometer devised by einthoven is used. it has been definitely determined that the impulse to cardiac contraction originates in the sinus node, a collection of differentiated nerve cells situated at the junction of the superior vena cava with the right auricle. from there the impulse travels in certain fibers in the interauricular wall, passes through another node, the auriculoventricular or tawara node, situated in the auricular wall just above the auriculoventricular ring, thence via the y-bundle, or bundle of his to the ventricles. this sequence is orderly, regular, and normally invariable. (fig. .) [illustration: fig. .--right side of the heart showing diagrammatically the distribution of the two vagus nerves to different parts of the viscus. the impulse to contraction originates at the sino-auricular node and passes over the wall of the auricle to tawara's node, and thence over his' bundle across the auriculoventricular septum to be distributed throughout the ventricular wall. if the upper, sino-auricular, node is damaged, or if its impulses fail to get across the wall of the auricle, tawara's node acts in its place to start off the ventricle. if a lesion at the base of the mesial segment of the tricuspid valve damages his' bundle, so that tawara's node is cut off from the ventricle, then the ventricle may originate its own impulses to contraction. (hare's practice of medicine.)] the sino-auricular (s-a) node is the most irritable portion of the heart, it is endowed with the greatest amount of rhythmicity as well. it is under the control of the vagus nerve. its inherent rate of rhythmicity is probably more rapid than the usual numbers of impulses per minute, but it is inhibited by the vagus. paralysis of the vagus endings increases the rate of impulse formation and therefore the rate of the heart. the electrocardiogram is a graphic representation on a photographic film or sensitive bromide paper of the changes of electrical potential during muscular activity. the lines are made by the highly magnified string of the galvanometer as it moves across the slit in the photographic apparatus in response to the induction currents set up in the heart magnified by the special galvanometer. the record is made in three so-called leads. lead i the electrodes are attached to right arm and left arm. lead ii the electrodes are attached to right arm and left leg. lead iii the electrodes are attached to left arm and left leg. a series of regular figures is normally obtained in which are depressions and elevations and regular spacing of these elevations and depressions. the waves so-called have been arbitrarily designated _p_, _q_, _r_, _s_, _t_. there is some difference in the three leads. "the wave _p_ is positive in _all leads_. _p_ to _r_ interval varies slightly in the _three leads_. all the waves of _lead ii_ are greater than those of _leads i_ and _iii_. the wave _r_ is positive in _all leads_. _t_ is usually positive in _all leads_, but is occasionally negative in lead iii. even in normal individuals there is a considerable range of variation in the electrocardiogram which is within the limits of the normal." (hart.) (fig. .) [illustration: fig. .--normal electrocardiogram. (after hart.)] the _p_ wave is admitted to be the wave of auricular contraction. _q_, _r_, _s_, is the ventricular complex caused, it is thought, by the current passing over the ventricles. _t_ wave is not yet definitely settled. it has been thought by some that it represented actual ventricular contraction and its height and shape had some meaning in heart force. this is denied by others. hart defines it as "the final activity of the ventricle." the _t_ wave is usually increased in size during exercise. the _p-r_ interval is almost the most important feature of the tracing. it is the actual conduction time in fractions of a second of the impulse from s-a node to the ventricles. normally this is about . second or slightly less. much that was hoped for from the electrocardiograph in the clinic has not been forthcoming. its greatest value is in states of abnormal conductivity, such as various grades of heart block, extrasystoles, whether originating in auricles or in either ventricle, abnormalities of rhythm, as flutter and fibrillation. it has, however, aided materially in the intelligent interpretation of many phenomena heretofore not well understood, and has enormously increased our knowledge of the physiology and pathologic physiology of the heart. it is not possible to enter farther into the subject here. this brief discussion must suffice. the reader is referred to works on this subject in connection with diseases of the heart. chapter iv important cardiac irregularities associated with arteriosclerosis arteriosclerosis of the aorta, of the coronary arteries, or of both, is practically always found in cases dying of various cardiac irregularities other than those the result of rheumatic cardiac lesions. it is not that arteriosclerosis causes the cardiac lesions (although the thickening of the walls of the coronary arteries does interfere mechanically with the nutrition of the heart muscle), but the arteriosclerosis is a part of the tissue reaction in the arteries to some set of causes affecting the whole body. it is true when one boils down the question to its last analysis, general arteriosclerosis may mechanically so interfere with the blood supply to tissues that the tissue is thrown out of function either in the reduction or even loss of function. so it may be that occasionally the arteriosclerosis in the arteries supplying the heart is really responsible for the cardiac irregularity. the past few years have been fruitful ones in increasing our knowledge of the various irregularities of the heart. we can do no more than sketch briefly some of them in relation to arteriosclerosis. the chief irregularities are ( ) auricular flutter, ( ) auricular fibrillation, ( ) ventricular fibrillation, ( ) auricular extrasystole, ( ) ventricular extrasystole, ( ) heart block, partial or complete. =auricular flutter= auricular flutter is an abnormal rhythm characterized by very rapid, but rhythmic auricular contractions usually to per minute. the auricular contractions are so rapid that the ventricle can not respond, so that an electrocardiagram of a heart in such a state (fig. ) shows the ventricle beating regularly but at a much slower rate than the auricle. [illustration: fig. .--(after hart.)] the majority of cases exhibiting this peculiar rhythm are over years of age. in many cases sclerosis of the coronary arteries as a part of general arteriosclerosis has been found. auricular flutter can be suspected when the pulse is regular or not particularly irregular and a fluttering, rapid pulsation is seen in the jugular vein on the right side. one can only be sure of the condition by making graphic records of the heart. attacks usually come on suddenly and may disappear as suddenly, suggesting paroxysmal tachycardia. the patient feels a commotion in his chest, dyspnea, precordial distress, etc. the attack may last for weeks or months, in which case the patient may carry on his usual work but be conscious of palpitation in his chest. one may safely assume that the flutter is a sign of a failing myocardium and sooner or later the heart will pass to the graver stage of auricular fibrillation. =auricular fibrillation= in this condition the auricle is widely dilated and over its surface are countless twitchings of individual muscles giving to the auricle the appearance of a squirming bunch of worms. such a condition may be readily produced in a dog's exposed heart by direct faradization of the auricle. it should be seen by every physician in order fully to appreciate the passive, dilated sac part which the auricle plays when in such a state. there is no auricular wave on the electrocardiogram (figs. and ) only a series of fine tremulous lines, and the ventricles beat irregularly with many dropped beats and variations in the size and force of individual beats. extrasystoles are also frequent. the heart is absolutely irregular. such a condition is readily recognizable as the state of broken compensation. graphic records are not essential as in auricular flutter to establish the condition. inspection of the root of the neck for jugular pulsations and examination of the pulse with the patient's evident dyspneic, cyanotic, edematous condition settles the diagnosis. [illustration: fig. .--electrocardiogram showing auricular fibrillation in leads i (upper) and ii (middle and lower). (courtesy of dr. g. c. robinson.)] [illustration: fig. .--auricular fibrillation. (after hart.)] in no case of auricular fibrillation is the heart muscle free from extensive fibrous changes. these may be the result of general arteriosclerotic changes or may result from toxic changes. it is the general consensus of opinion that auricular fibrillation may persist for months or even years. some hold that the state of perpetual irregular pulse is associated with auricular fibrillation. if that is true, then auricular fibrillation may last for many years. patients may go about their work but always live with the imminent danger of a sudden dilatation of the ventricle and symptoms of acute cardiac decompensation. in these cases the blood pressure is of particular interest. it is often stated that the blood pressure is lowered as compensation returns and digitalis has exhibited its full action. as a matter of fact this statement needs some modification. if one takes the highest pressure at the strongest beat, which may be only one in a dozen or more, that may be true, but that does not represent the action of the much embarrassed heart. we know that the circulation is much interfered with, that there is hypostatic congestion, that the mass action is slow. the pulse pressure is greatly disturbed and the head of pressure which should force the blood to the periphery is so little that the circulation almost ceases. a count of the cardiac contractions heard with the stethoscope and a count of the pulse shows a great discrepancy in number. this has been called the "pulse deficit" (hart). in order to arrive at the true average systolic pressure the following procedure is done. "the apex and radial are counted for one minute, at the same time by two observers, (if possible) then a blood pressure cuff is applied to the arm, and the pressure raised until the radial pulse is completely obliterated; the pressure is then lowered mm., and a second radial count is made; this count is repeated at intervals of mm. lowered pressure until the cuff-pressure is insufficient to cut off any of the radial waves (between each estimation the pressure on the arm should be lowered to zero). from the figures thus obtained the average systolic blood pressure is calculated by multiplying the number of radial beats by the pressures under which they came through, adding together these products and dividing their sum by the number of apex-beats per minute, the resulting figure is what we have called the 'average systolic blood pressure.'" (fig. .) [illustration: fig. .--the shaded area represents the pulse deficit; the upper edge is the apex rate, the lower edge the radial rate. the broken line indicates the "average systolic blood pressure." (compare these values with the figures at the bottom of the chart, which show the systolic blood pressure determined by the usual method.) (after hart.)] for example: "b. s., april , , apex ; radial, ; deficit, . brachial pressure radial count mm. hg. mm. x = mm. - = x = mm. - = x = mm. - = x = mm. - = x = ---- apex = ) ---- average systolic blood-pressure plus b. s., may , , apex ; radial, ; deficit . brachial pressure radial count mm. hg. mm. x = mm. - = x = mm. - = x = ---- apex = ) ---- average systolic blood-pressure plus" the diastolic pressure in these cases can not be determined except approximately. this may be done by using an instrument with a dial and noting the pressure where the oscillations of the dial hand show the maximum excursion. the diastolic pressure is not at all important under such conditions of acute cardiac breakdown. it would make no difference in treatment whether the case was one of pure cardiac disease or one of the hypertension groups. after the heart has rallied and the circulation is reestablished, then a careful determination of the diastolic pressure can be made and the prognosis will rest on what is found at the compensated stage. =ventricular fibrillation= ventricular fibrillation as its name implies, is fibrillation of the ventricle analogous to that of the auricle, but the condition is rarely observed as it is incompatible with life. it has been shown that hearts at the time of death at times enter a state of fibrillation of the ventricles and that cases of sudden death may be due to this condition. recently g. canby robinson[ ] has seen and made electrocardiograms of a case of ventricular fibrillation. (fig. .) the case was that of a woman forty-five years old, "who had a series of attacks of prolonged cardiac syncope, closely resembling stokes-adams syndrome, from which she recovered." during an attack of unconsciousness in which there was no apex beat for about four minutes, the electrocardiogram was taken. following this the tracings showed an almost regular heart beating at the rate of to per minute. the patient had three convulsions and died with edema of lungs about hours after the attack of ventricular fibrillation. [ ] robinson, g. c., and bredeck, j. f.: arch. int. med., , xx, . [illustration: fig. .--upper curve. record obtained during period of cardiac syncopy at : p.m., lead ii. lower curve from dog. ventricular fibrillation observed in the exposed heart. lead from right foreleg and left hind leg. (courtesy of dr. g. c. robinson.)] autopsy revealed chronic fibrous endocarditis of aortic and mitral valves, arteriosclerosis, bilateral carcinoma of the ovaries, and signs of general chronic passive congestion. it is possible that the syncopal attacks in this case were the result of sclerosis of the vessels supplying the heart muscle although careful microscopical examination did not throw much light on the ultimate cause. =extrasystole= whenever there is a dropped beat or an intermittent pulse one may be sure that it is the result of an extrasystole. such extrasystoles are produced in the ventricle at some point other than the regular path of conduction of impulses. the extrasystole may have its origin in either the auricle or the ventricle. if there is auricular extrasystole it can not usually be recognized except by graphic methods. (fig. .) the ventricular extrasystole on the contrary is commonly seen and readily recognized. most of those seen in the clinic have their origin in some part of the ventricular wall. their two characteristics are that they occur too early and that they are followed by a pause longer than the normal diastolic pause. (fig. .) [illustration: fig. .--electrocardiogram showing auricular extrasystoles (p). (courtesy of dr. g. c. robinson.)] [illustration: fig. .--electrocardiogram showing ventricular extrasystole. heart rate - beats per minute. note that diastolic pause in which extrasystole occurs is practically equal to two normal diastolic pauses. (courtesy of dr. g. c. robinson.)] when one listens over the chest to a heart when extrasystoles are occurring, one suddenly hears a weak beat which has taken place rather too early after the previous systole to be strong enough to effect the opening of the aortic valves. consequently there is no pulse, the blood does not move, and that beat is lost to the circulation. moreover, when the next regular stimulus comes from the s-a node it finds the ventricle in a refractory condition, having just ceased a contraction, and it is not until the next sinus impulse that the ventricle responds normally. (fig. .) patients who have occasional extrasystoles will say that all of a sudden the heart turns upside down in the chest. sometimes there is slight sharp twinge of pain. patients are at times quite alarmed about their condition. provided there is no evidence of gross myocardial lesion, the extrasystole itself is of no great significance. while many cases showing pathologic causes for extrasystoles have more or less marked arteriosclerosis, there are other states in which no arteriosclerosis is found where the extrasystole is present. =heart block= as heart block occurs frequently in cases characterized by extensive arteriosclerosis, a brief discussion of the essential features will be given. it is, however, probable that arteriosclerosis is not the cause of any of the cases of heart block directly, but it is only a result of the same etiological conditions which produce the lesion or lesions which result in heart block. we may define heart block as the condition in which the auricles and ventricles beat independently of each other. there may be delayed conduction (fig. ), partial (fig. ), or complete heart block (fig. ). in the former there are ventricular silences, during which the auricles beat two, three, four, five, even up to nine times, with only one ventricular contraction. it is believed by most physiologists that the essential factor in the production of heart block is an interference in the conduction of impulses from the auricles to the ventricles through the band of tissue known as the auriculoventricular bundle. [illustration: fig. .--electrocardiogram showing delayed conduction (lengthening of p-r interval). these p-r intervals are quite regular. when irregular there is apt to be extrasystole of ventricle or occasional blocking of impulse going to ventricle. (courtesy of dr. g. c. robinson.)] [illustration: fig. .--electrocardiogram showing partial heart-block in the three leads. note the variability of p-r interval calculated in seconds in lead ii. (courtesy of dr. g. c. robinson.)] [illustration: fig. .--complete heart block. (courtesy of dr. g. c. robinson.)] the bundle of muscles described by his in , connecting the auricles and ventricles, has been definitely shown to be the path through which impulses having their origin in the orifices of the great veins pass to the ventricles. the situation and size of this bundle has been thus described in man by retzer: "when viewed from the left side, the bundle lies just above the muscular septum of the ventricles and below the membranous septum. in some hearts the muscular septum is so well developed that it envelops the bundle. it is then difficult to find, but occasionally it can be seen directly by means of transmitted light. from the left side the bundle can be followed no farther posteriorly than the right fibrous trigone, for here the connective tissue becomes so dense that it is difficult to dissect it away. the impression is, therefore, received that this mass of connective tissue forms the insertion of the bundle. the bundle may be followed anteriorly until it becomes intimately mixed with the musculature of the ventricles. "when viewed from the right side of the heart, the bundle can not be seen, because it is covered by the mesial leaflet of the tricuspid valve, whose line of attachment passes obliquely over the membranous septum. then, if the endocardium is removed from the posterior part of the septum of the auricle up to the membranous septum, the posterior part of the auriculoventricular bundle will be exposed. if, in addition, the membranous septum be removed, the bundle may be traced from the point to which it could be followed when viewed from the left side as it passes posteriorly over the muscular septum. in the region of the auriculoventricular junction it loses its compactness, the fibers divide, and the bundle seems to fork. one branch passes into the superficial part of the valve musculature which descends from the auricles, and the other branch passes directly into the musculature of the auricle. "briefly, the auriculoventricular bundle runs posteriorly in the septum of the ventricles about mm. below the posterior leaflet of the aortic semilunar valves; with a gentle curve it passes posteriorly just over the upper edge of the muscular septum and sends its fibers into the musculature of the right auricle and of the auricular valves. in the heart of the adult the bundle is mm. long, . mm. wide, and . mm. thick." (erlanger.) all normal impulses have their origin in the sino-auricular node at the junction of the superior vena cava with the right auricle (fig. ). from there the impulse travels in the wall of the auricle in the interauricular septum to the node of tawara or a-v node (fig. ), thence through the bundle of his to be distributed to the fibers of the right and left ventricles. this sequence is orderly and perfectly regular. [illustration: fig. .--showing alternating periods of sinus rhythm and auriculoventricular rhythm. (after eyster and evans.)] [illustration: fig. .--period of auriculoventricular or "nodal" rhythm following exercise in sitting posture. (after eyster and evans.)] it has also been shown that the independent auricular and ventricular rates vary somewhat, that of the auricle being in general faster than that of the ventricle. a strip of mammalian ventricle placed outside of the body in proper surroundings will begin to beat automatically at the rate of about beats a minute. experimentally various grades of heart block have been produced in the dog's heart by more or less compression of the bundle at the a-v ring. the block may be partial, when two to nine auricular beats occur to every one of the ventricle, up to absolute complete block when the auricles and ventricles beat independently of one another. in any stage of partial block, pressure on the vagus nerve in the neck produces certain specific changes. (fig. .) robinson and draper[ ] have found qualitative differences in the two vagi. the right vagus sends most of its fibers to the s-a node (fig. ) and has a more evident influence on the rate and force of the cardiac contractions. the majority of fibers from the left vagus are distributed to the a-v node so that its most evident action is upon the conductivity of the impulse. pressure then on the right vagus will have a tendency to slow the whole heart. pressure on the left vagus will have a tendency to prolong the p-r interval until even complete block occurs. even when the heart block is complete, stimulation of the accelerator nerve, as a rule, increases the rate of both auricles and ventricles. [illustration: fig. .--influence of mechanical pressure on the right vagus nerve. (after eyster and evans.)] [illustration: fig. .--schematic distribution of right and left vagus. (after hart.)] [ ] jour. exper. med., , xiv, . if the block is functional, depending upon some temporary overstimulation of the vagus nerve, atropin, which paralyzes the endings of the vagus, will naturally lift the block. if the block is due to some actual lesion of the bundle of his, such as fibrosis, gumma, or other lesion, then atropin will have no influence to terminate the block. in this manner we are able to distinguish between functional and organic heart block. chapter v blood pressure in its clinical applications it is well to bear constantly in mind the point made over and over in this work, that blood pressure is only one of many methods of acquiring information. he who worships his sphygmomanometer as a thing apart and infallible will sooner or later come to grief. judgment must be used in interpreting changes in blood pressure just as judgment is essential in properly evaluating any instrumental help in diagnosis. one must not forget the personal equation which enters into even accurate instrumental recording in medicine and surgery. in this chapter there will be no attempt to quote largely from what others have said or thought. every one has his own opinion as to the value of certain methods after he has worked with them for a long time. the ideas here expressed, except in cases where no opportunity has offered to make personal studies, are those gathered from personal experience. =blood pressure in surgery= careful estimation of the blood pressure in surgical cases has, at times, great value. in all surgical diseases the most important fact to know is not the systolic pressure, but the pulse pressure. if the pulse pressure keeps within the range of normal, does not drop much below mm. in an adult, then so far as we can tell the circulation is being carried on. when the systolic pressure is gradually falling and the diastolic remains the same, the circulation is failing and unless the pulse pressure can be established again the patient will die. again we see the value of the pulse pressure. all prolonged febrile diseases tend to produce a lowering of the blood pressure picture. the diastolic does not fall to the same extent as the systolic so that there is a pulse pressure smaller than normal. this is to be expected from what we know of the general depression of the circulation in fevers. the blood pressure reading is only a graphic record of what we have long known, and enables us from day to day accurately to measure the general circulation. =head injuries= it was claimed that in fracture of the skull or in concussion much could be gained by frequent estimations of the blood pressure. this seemed probable in the light of experiments on compressing the brains of dogs by the use of bags inserted through trephine openings (cushing). in the clinic, however, it has not been found of any material value. it has a value in differentiating a simple fracture, let us say, from a case of uremia which is picked up on the street with a bump on the head. there the high pressure usually found would at once direct attention to the kidneys and the newer methods of blood examination would at once settle the question. naturally uremics may also have skull fracture. there the diagnosis would be complicated. a decompression done at once would be indicated. if the skull fracture happened in a uremic, the decompression would probably do no harm. in fact, there are some who advise decompression for uremia. =shock and hemorrhage= in shock the blood pressure picture is low but the pulse pressure drops to abnormally low figures. it seems to me that the blood pressure instrument has its greatest value in surgery in the warning it gives to the operating surgeon in cases of impending shock. it is well known that the first effect of ether, the commonly used anesthetic, is to raise the blood pressure and quicken the pulse rate. the whole blood pressure picture is at first elevated (fig. ). soon the whole pressure falls slightly but continues at a higher level than normal. the diastolic pressure drops back nearly to normal and the increased pulse pressure is due almost entirely to the slight rise in the systolic pressure. now the whole duty of the anesthetist is to administer the ether so that this ratio of systolic and diastolic is maintained throughout the operation. warning comes to him of impending shock before it comes to any one in the neighborhood (fig. ). any sudden change in the pressure is a signal for increased watchfulness. should the pressure all at once drop he can immediately notify the surgeon and institute measures to resuscitate the patient. [illustration: fig. .--blood pressure record from a normal reaction to ether. note that the systolic and diastolic rise and fall together. at the end of the anesthetization the pulse pressure is practically the same as at the beginning. compare this with the record in fig. , where the operation had to be discontinued on account of the onset of shock.] [illustration: fig. .--beginning of operative shock. chart showing the method of recording blood pressure during operation. note that the pulse and respiration show no remarkable changes, but the blood pressure steadily fell, the systolic more than the diastolic so that the pulse pressure was gradually reaching the danger point. further work on this case was stopped following the warning given by the blood pressure. the patient was returned to the ward and a week later anesthesia was again given, the operation was completed, and the patient had a satisfactory convalescence.] a method which is widely used is as follows: the anesthetist wraps the cuff of one of the dial instruments around the patient's arm, and arranges the dial so that it can easily be seen by him at all times. this does not in any way interfere with the work of the surgeon. over the brachial artery below the cuff is the bell of a binaural stethoscope held in place by the strap attachment now on the market. the tubes of the stethoscope are long enough to reach conveniently to the ear pieces. a watch is pinned to the sheet of the table. he has a chart, as illustrated (fig. ) on a board and makes a dot in every space for five minute intervals. by joining the lines a curve is obtained which tells at a glance what the circulation is doing. i feel sure that more attention and care exercised on the part of the anesthetist would be the means of conserving many lives lost from shock following operation. [illustration: fig. .--showing method of using blood pressure instrument during operation without interfering with the operator or assistants. sheet thrown back to show cuff on arm of patient. anesthetist has chart on table beside him, dial pinned to pad in full view, bulb near hand. extra tubing must be put on the blood pressure instrument.] a sudden drop in the pressure picture may mean a large hemorrhage. the gradual return of the pressure picture means that the vasomotor mechanism has acted to keep up the pulse pressure. should the diastolic pressure continually fall, it may mean that the hemorrhage is still taking place (wiggers). =blood pressure in obstetrics= one might affirm almost without fear of contradiction that the constant determination of blood pressure during pregnancy is more important than the examination of the urine. within recent years a number of observers having access to a large material, have given the results of their findings. there is a striking unanimity of opinion, although now and then a difference in minor details. the blood pressure should be taken frequently during pregnancy. the usual and highly essential precautions in taking pressure in general apply most particularly in these cases. towards the end of pregnancy the pressure should if possible be taken daily and oftener if necessary. pressure in women is usually below mm. many patients have a temporary rise in blood pressure during pregnancy, due oftenest to constipation, without developing other symptoms. this is common to all conditions and has no significance. some think that an abnormally low pressure, that is, a systolic below mm., suggests that the patient is likely to react unduly to the strain of labor. this is denied by others. among cases (irving) the pressure was below in only one case. a gradually rising pressure precedes albuminuria, as a rule. if there is albumin without change in pressure the albumin may usually be disregarded. some think that a pressure over mm. systolic should be carefully watched. the danger limit is set by some at mm. if the blood pressure from the very first is high, it may mean only that that was the patient's normal pressure. this calls for increased watchfulness. it is held by some that high blood pressure favors hemorrhage and probably explains the hemorrhagic lesions in the placenta and some viscera in eclampsia and albuminuria. all are agreed that the most significant change is the gradual but sure rise from a low pressure. when this is combined with albuminuria the danger of toxemia is imminent. the high blood pressure in those under thirty years of age seems to be a more certain sign of approaching toxemia than the same pressure in those older. the pressure falls within a few days to its normal after delivery in the toxic cases. although the emesis gravidarum is held to be a sign of a toxemia of some unknown nature, the blood pressure is never raised even in the pernicious form. =infectious diseases= in all infectious diseases the blood pressure tends to be lower than normal. during chills the systolic may rise to great height due to the violent muscular contractions. we found the blood pressure of great value in giving information concerning the circulation. again we repeat that it is not the systolic alone or the diastolic alone but the pulse pressure which we wish to keep informed about. in pneumonia we have tried out gibson's law only to discard it. this so-called law is that in pneumonia the systolic pressure in millimeters should remain above the figure for the pulse rate. when the figure in mm. of pressure is equalled by or exceeded by the pulse rate the prognosis is grave. in typhoid fever we have made many estimations at various stages of the disease. we can only say that the pressure picture tends to fall during the course. the systolic falls more than the diastolic so that it is not uncommon to see pulse pressures of mm. at the beginning of convalescence in spite of the high caloric feeding practiced. at the time of perforation the systolic pressure may be raised. this is only the reflex from the initial pain. soon the pressure falls and if peritonitis sets in, the pressure is exceedingly low and the pulse pressure gradually falls until the circulation can no longer be carried on. in large hemorrhage the pressure suddenly falls. if only one hemorrhage has occurred a gradual rise takes place, but the general pressure picture remains at a lower level for days, gradually returning where it was before the hemorrhage. in beginning failure of the circulation we found elevation of the foot of the bed about nine inches to be of such value that we felt there must be some increase in blood pressure. numerous readings were made covering a period of several months. although we felt certain that the circulation was improved, we rarely needed cardiac stimulation, we never could prove any increase of blood pressure with the sphygmomanometer. in all infectious diseases there is no help offered by blood pressure estimations in diagnosis. the sole and important use is that of keeping track of the circulation. =valvular heart disease= no rules can be laid down for blood pressure in valvular heart disease. aortic stenosis, the rarest of the valvular lesions, is practically always accompanied by high pressure picture. mitral stenosis on the contrary usually shows a low pressure picture. mitral insufficiency may show an exceedingly low picture or an exceedingly high picture. aortic insufficiency also may be accompanied by a high systolic or by a normal systolic pressure. it depends on the etiology. practically all the rheumatic cases have low pressure, the syphilitic cases have a high pressure. it is characteristic of all cases of aortic insufficiency that the diastolic pressure is low, even as low as mm. the pulse pressure is invariably high. usually there is no difficulty in determining the diastolic pressure. the intense third tone suddenly becomes dull at the point of diastolic pressure and frequently the dull sound can be distinctly heard over the artery down to the zero of the scale. if difficulty is found in reading the diastolic as the pressure is reduced, the estimation may be reversed and the pressure gradually increased from zero to the point where the dull tone suddenly becomes loud and clear. these points always coincide. =kidney diseases= this has already been discussed somewhat fully in chapter iii and will receive more consideration later. it might be remarked in passing that in a case of seeming coma where albumin is found in the urine but where the blood pressure is low or normal, i have found at autopsy in several cases pyonephrosis and not chronic nephritis. the blood pressure may be useful in differentiating uremic coma from the coma of pyonephrosis. also in the cases of coma with anasarca, either the acute, subacute or chronic form the blood pressure is not raised as a rule. other diseases of the kidney, as tuberculosis, cancer, infection with pyogenic organisms, are not accompanied with any notable changes in blood pressure. =other diseases, liver, spleen, abdomen, etc.= blood pressure is only of value in the above diseases in affording information concerning the state of the circulation. there is nothing characteristic about the pressure in any of these diseases. chapter vi etiology the causes of arteriosclerosis are many and varied. no two persons have the same resisting power toward poisons that circulate in the blood. some go through life exposed to all the infectious diseases without ever becoming infected, while others fall easy victims to every disease that comes, no matter how careful they may be, and it is quite the same in regard to the resistance of the arterial tissues. if the tubing is of first class quality and the individual does not place too much strain on it, he may live to the biblical three-score years and ten, and possess arteries which have undergone such slight changes that they are not palpable. such a person is, however, the exception. on the other hand, if the tissue is of poor quality, even the ordinary wear and tear of life causes early changes in the vessels, and a person of forty may have hard arteries. we have described in a previous chapter the changes which normally occur in the arteries as age advances. an artery that is normal for a man of fifty years would be distinctly abnormal for a boy of fifteen. two broad divisions of arteriosclerosis may be made: ( ) congenital, or the result of inherited tendency; ( ) acquired. =congenital form= when dr. o. w. holmes was asked how to live to the age of seventy, he replied that a man should begin to pick his ancestors one hundred years before he was born. our parents determine the character of the tissues with which we start in life, and this determines our general resistance. we might properly speak of congenital arteriosclerosis where the affected individual had poor arterial tissue with which to begin life, for that, in a sense, is a congenital defect, and arterial tissue that is poor in quality is prone to disease. the author is more and more impressed with the part that heredity plays in the determination of arterial degeneration. especially does syphilis in the parents or grandparents leave its stigma in the succeeding generations in the shape of poor arterial tissue which is prone to early degeneration. recently w. w. graves has called attention to a malformation of the vertebral border of the scapula which consists in a concavity instead of the normal convexity of the bone. to this malformation he has given the name, scaphoid scapula. he considers this to be but one manifestation of a general lack of development in the individual. he speaks of this maldevelopment as a blight and considers that syphilis in the ancestors is responsible for the condition in the offspring. he finds that even in children, the subjects of the scaphoid scapula, the arteries are very definitely thickened. while confirmation of his observations is lacking, there is no doubt that we must lay the blame for much of the arteriosclerosis in our patients to the poor quality of arterial tissue transmitted by ancestors who have acquired some constitutional disease. it may have been syphilis, it may have been the degeneration produced by alcohol or other drug. we can not ignore the part which heredity plays. the various factors to be considered in the production of the acquired form of arteriosclerosis appear to me to be but contributory factors to a very great extent, the essential and fundamental factor being the quality of arterial tissue with which the individual is endowed. arteriosclerosis may occur in infants. cases have been reported of calcification of the arteries in infants and children. the arteriosclerosis may occur without nephritis or rise of blood pressure. cerebral hemorrhage in a child of two years has been seen. heredity in these cases plays a most important rôle. in many of the reported cases there was no question of congenital syphilis. aneurysms, single or multiple, have been found in the arteries of children, and even the pulmonary artery may show sclerotic changes. =acquired form= as a rule the cases usually seen belong in this group because it seems as if a connection could be established almost always between one or more of the etiologic factors to be described and the disease. while this apparently is the case, we must never lose sight of the part which the quality of the tissue plays. when we leave this out of our calculations we undoubtedly make many false deductions. when two men of the same age who have been exposed to the same conditions as far as we can learn, are found to have quite different arteries, the one normal, the other thickened, we must postulate congenitally poor tissue on the part of the latter. such tissue readily becomes diseased following conditions which would very likely have produced no noticeable effect on perfectly normal, healthy tissue. =hypertension= hypertension must still be reckoned with in the etiology of arteriosclerosis although the rôle that it was thought to play does not seem so important. changes of blood pressure alone are not considered by many to be sufficient for the production of arteriosclerosis. this may play some part, but there are many other factors mostly unknown which determine in any case the production of arterial lesions. with every systole of the heart, blood is forced out into the arterial system against a certain amount of resistance represented by the tonicity of the capillary area, and the amount of cohesion between the viscous blood and the walls of arterioles. when a dilatation of the capillaries over any large area takes place, the blood pressure falls, provided there is no compensatory contraction in other areas to make up for the decreased resistance in the dilated vessels. the viscosity of the blood, as such, probably has very little effect on the resistance to the flow. with the systole of the heart there is a sudden dilatation of the arch of the aorta, and a wave of expansion follows, which is transmitted to the periphery and is lost only in the capillaries. the blood pressure is constantly changing. physiologically there are relatively wide variations in the pressure in a perfectly normal individual. there are some persons who have hypotension, a blood pressure much below the normal. such persons have usually small hearts, small aortas, and they seem to have but little resistance to disease. many diseases, especially the prolonged fevers, diminish markedly the blood pressure. whether the hypertension is the cause of the structural changes that are found in the walls of the vessels, or is the result of the diminished area of the arterial tree through which the same amount of blood has to be driven as before the vessel walls became narrowed, is still disputed. as has been stated, experimental evidence would tend to place the initial blame upon the poisons circulating in the blood, which first damage the vessel walls. the subsequent changes then produce thickening and inelasticity. some think (allbutt) that the hypertension is primary. there are cases seen clinically that lend support to this view and there is experimental evidence also (v. chap. ii). not infrequently individuals in middle life begin to show increase of arterial blood pressure without discoverable cause. in such case it may be that there is slowly progressing chronic nephritis. the urine if examined only superficially in single specimens may not reveal any abnormalities. careful functional examination by means of the newer tests may reveal functional deficiency. it must not be supposed that all cases of increasing hypertension are cases of chronic nephritis. the opinion has already been expressed (chap. iii) concerning this point. experience has convinced me that the opinion expressed in former editions is not altogether correct. =age= no age is exempt from the lesions of arteriosclerosis if we consider the two groups. however, the disease is seen for the most part in persons past middle life. the relative frequency with which it is found in the different decades depends on so many factors that it is of no value to tabulate them. as has been stated, arteriosclerosis of all types is an involution process that advances with age. longevity is a question of the integrity of the arterial tissue, and no one can tell what sort of "vital rubber" (osler) any one of us has. however, many with poor tubing may make such use of it that it will outlast good tubing that is badly treated. unfortunately we have no way of telling early enough with just what sort of arterial tissue we are starting life. =sex= there is no doubt that men are far more prone to arterial disease than women are; all statistics are in accord on this point. this is explained by the greater exposure of men to those conditions of life which tend to produce circulatory strain, and so to produce arteriosclerosis, or vice versa. arteriosclerosis in women is not often seen until after the fiftieth year. cases of the most extreme grade of pipe stem arteries are, however, seen in old women, and calcified arteries are not hard to find among the inmates of an old woman's home. =race= some of the most beautiful examples of arteriosclerosis in this country are seen in the negro. not only is this disease more frequent in the black race, but the age of onset is much earlier than in the caucasian. the accidents of arteriosclerosis, viz., aneurysm, cerebral hemorrhage, etc., are more common among the negro males. the etiologic factors that are most often found in the history are the prevalence of syphilis and hard physical labor. =occupation= certain occupations have a distinct causal relationship to arteriosclerosis; among such are particularly those entailing prolonged muscular exercise, especially if much lifting is necessary. every one is familiar with the phenomena accompanying the exertion of lifting. the breath is drawn in, the glottis is closed, and the muscles of the chest wall are held rigidly while the exertion lasts. this causes a great increase in blood pressure, and constant repetition of this will produce permanent high tension. in hospitals, the stevedores as a class have marked arteriosclerosis, and, almost without exception, they are comparatively young men. occupations that are accompanied with prolonged mental strain, such as now occur to the heads of large manufacturing and financial institutions, also predispose to early arterial changes. psychic activity, especially when it is accompanied by worry, is a potent factor in the production of the increased blood pressure which is the chief factor in producing arterial disease. it has been suggested that sexual continence in high-strung men produces changes in the nervous system which can conceivably lead to the production of high tension and further to arteriosclerosis. this, however, i can not think has any foundation in fact except in so far as such men are prone to live at high speed and wear themselves out sooner than the normal person. the sexual continence _per se_ is not harmful. there are, however, men who seem not to be harmed by the constant wear and tear of our modern life. these are the exceptions. workers in factories where paint is made and the ingredients hand-mixed, are prone to develop arteriosclerosis early in life. it has been found that the laborers most apt to be victims of lead intoxication are those who are careless in their habits of cleanliness, particularly in regard to the fingernails. the continuous absorption of lead into the system, brings about a condition of hypertension that has its inevitable results. the fact is that any occupation which entails either the absorption of toxic substances, or prolonged muscular labor, will hasten markedly the onset of arterial disease. =food poisons= the opinion that arteriosclerosis is due in large part to poisoning by end products or by-products of protein digestion is now receiving much support. experiments on dogs and rabbits have lent some confirmation to chemical observations. it has been shown that dogs fed for a long time on putrefied meat developed inflammation and degeneration of the adventitia and media, with hyperplasia and calcification of the intima of many arteries. in the pulmonary and carotid arteries, in the vena cavas and myocardium, there were extensive necroses and hyaline degeneration. moreover, injections of sodium urate and ergot caused necroses in the muscularis and elastica of the aorta, pulmonary artery, vena cavas inferior and heart muscle, but there was no calcification. guinea pigs which were fed indol in small doses by the mouth over a long period showed atheromatous degeneration of the aorta. =infectious diseases= as more study has been given to the arteries in persons who have died of the acute infectious diseases, more has come to light concerning the effects of the toxins of these diseases on the vessel walls. in the arteries of children who have died of measles, scarlet fever, diphtheria, cerebrospinal meningitis, etc., degenerative changes in the arteries occur, modified only by the length of time that the toxins have acted. thayer has shown that the arteries of those who have passed through an attack of moderately severe or severe typhoid fever are as a rule more readily palpable than are the vessels of persons of corresponding years who have never had the disease. clinically the typhoid toxin appears to cause the early production of arteriosclerosis. the changes in the arteries occur for the most part, and always earlier, in the peripheral arteries, and the media is chiefly affected. minute yellowish patches are found on the aorta, carotids, and coronaries. in persons who have passed through an attack of one of the fevers, and have later died from some other cause, regenerative changes are sometimes found to have taken place in the arteries, consisting of an ingrowth of elastic fibers from the intact adventitia to the diseased media. that there are some other factors than the infectious disease which are concerned in the production of arterial changes seems evident from a study[ ] made recently among a group of almshouse inmates ranging in age from to years. the study included persons of both sexes. careful histories were taken to determine the presence of antecedent infectious disease. the radial artery was palpated to determine the presence of sclerosis. among the cases giving a history of one infectious disease the following table gives the results: ------------------------------------------------------------- disease no. + ++ +++ positive negative ------------------------------------------------------------- measles infectious arthritis pneumonia typhoid scarlet fever smallpox miscellaneous ------------------------------------------------------------- ------------------------------------------------------------- [ ] warfield, l. m.: jour. lab. and clin. med., november, . a summary of the cases showed: cases without sclerosis; with sclerosis; cases with infections but no sclerosis; cases with infections and sclerosis. this study failed to throw any positive light on the question. infectious diseases undoubtedly play a certain rôle, particularly those continuing a long time and certain particular infectious diseases, as measles. =syphilis= syphilis is one of the most important of the etiologic factors in the production of arteriosclerosis. it has been shown that in per cent of cases of aortic insufficiency in persons, usually males, over forty-five years, who did not have chronic infective endocarditis, the wassermann reaction was positive. acute aortitis affecting the ascending and transverse portions of the arch of the aorta is very commonly seen, and the irregular, scattered, slightly raised, yellowish-white patches of sclerosis in the arch which are found years after the syphilitic lesion, are considered by some to be very characteristic of syphilis. mesaortitis is the primary lesion and acts as a _locus minoris resistentiæ_ where an aneurysm forms. hypertensive cardiovascular cases have been serologically studied, and a positive wassermann reaction found in a large percentage of one series. in fifty cases, per cent either gave a positive wassermann reaction or luetin test, were known to have syphilis, or had children with hereditary syphilis. this suggests what might be called "familial cardiovascular syphilis." hypertensive disease is possibly one of the common so-called "late" manifestations of syphilis. that syphilis is responsible for the arterial disease in the vessels of the brain, resulting in apoplexy or sudden cardiac death in middle life, has long been known. in fact, it is claimed (osler) that all aneurysms occurring in persons under thirty years of age are due to syphilitic aortitis. in the late stages of syphilis the arterial lesions may be of a diffuse character. =chronic drug intoxications= lead, tobacco, and according to some, tea and coffee, are to be classed as causal factors in the production of arteriosclerosis. certain it is that all these substances have a tendency to raise the arterial pressure, but whether the drug itself causes first a degeneration, and later a hypertension results, or vice versa, is not yet positively known. we have just mentioned that lead particularly has a marked effect in producing arterial lesions. other drugs as adrenalin, barium chloride, physostigmin, etc., while producing experimental arteriosclerosis, hardly could produce the disease in man. =alcohol= has been blamed for much, and as an etiologic factor in the production of arteriosclerosis formerly was accorded a first place. more recently much doubt has been thrown on this supposition by the work of cabot, who showed that the mere drinking of even large quantities of spirits had no effect in producing arterial disease. this observation has been recently substantiated by hultgen, who carefully studied clinically cases of chronic alcoholism. he says, "there are no cardiovascular symptoms which might be termed characteristic of chronic alcoholism, unless it be the peculiar fetal qualities of the heart sounds which we know as embryocardia. i find this very frequent among drinkers, but i can offer only a tentative explanation for it, namely the following: embryocardia can only occur with low tension blood pressure, and in the absence of renal insufficiency. hence it might be considered as a useful condition of no pathologic significance at all. that alcohol is a sclerogenic pharmakon and productive of arteriosclerosis with its usual train of symptoms may be a fact, but its demonstration would be difficult and is really not shown by my tabulations. there were cardiovascular changes, such as myocarditis, aortitis, valvular heart disease and arteriosclerosis in chronic alcoholics in . per cent of cases, but this by no means constitutes a proof of the causal relationship between these lesions and the abuse of liquors. i believe it, nevertheless, to be good reasoning to ascribe the bulk of cardiovascular symptoms to the sclerogenic action of alcohol, while abstaining from an interpretation of its pathogenesis." just what rôle =tobacco= plays is difficult to say. my own opinion is, that of itself when used in moderation, it has no ill effects. however, as tobacco is a drug that may raise the blood pressure, excessive use must be held responsible for the production of arteriosclerosis. it is difficult to separate its effects from those produced by eating and drinking. =overeating= there can be no doubt but that the constant overloading of the stomach with rich or difficultly digestible food is responsible for a large number of cases of arteriosclerosis. every one must have noted the increase in force and volume of the heart beat after the ingestion of a large meal. the constant repetition of such processes conceivably can lead to damage to the vessel walls through hypertension. in the metabolism of food in the intestines there are substances produced which are poisonous when absorbed directly into the circulation. ordinarily these substances are rendered harmless either before absorption or are detoxicated in the liver to harmless substances. it is conceivable that a constant overproduction of such poisons would eventually damage the defensive mechanism of the body to such an extent that some of the poisons would circulate in the blood. an expression of a surplus of one, at least, of these decomposition products is the appearance of indican in the urine. it is not believed that indicanuria has the importance attached to it which some authors would have us believe. it is found too often and in too many varying conditions, nevertheless it undoubtedly does reveal the presence of perverted metabolism. in how far the toxins absorbed from the intestinal tract are responsible for the production of arterial disease, it is not possible to say. some observers lay great stress on this factor as a cause of arteriosclerosis. the author believes that the rôle played by the absorption of products of perverted intestinal metabolism is an important one. the primary change is an increased tension in the arterioles which later leads to thickening of the coats of the vessels and to the other consequences of arterial disease. a vicious circle is thus established which has a tendency to become progressively worse. =mental strain= more and more does one become impressed with the fact that patients with arteriosclerosis are very often those who take life too seriously and either from ambition or from an exalted sense of duty lead especially strenuous lives. not always are these persons addicted to drug or liquor habit. many are rather abstemious in their habits. it is not so often that we see as a victim of arteriosclerosis, the carefree person who laughs his way through life without worrying about the morrow. he is not so prone to arteriosclerosis. worry is a far more potent cause of breakdown than actual manual work. it is the rule to find thickened arteries among neurasthenics. this may be only part of a generalized degeneration of all tissue in the body. the blood pressure in such persons is usually low. so many men of our better class live under a continuous mental strain in the business world. the increase in arteriosclerosis cases is real, not apparent. the intense mental strain seems to cause a marked increase in blood pressure (for short periods of mental effort this has been proved) over a period of time sufficient to cause permanent changes in the vessel walls. the same sequence of events repeats itself; high tension, arterial strain, compensatory thickening, hypertrophied heart, etc. certainly the character of the arterial tissue has much to do with the determination of degenerative changes which may result from the action of one or more of the etiologic factors. =muscular overwork= muscular overwork is to be reckoned with as an etiologic factor. one sees it especially among the laboring class in both whites and negroes. possibly other factors, as alcohol and coarse heavy food, contribute to the early arterial degeneration. hypertrophy of the heart occurs in athletes, and statistics gathered among the oarsmen especially, show a relatively high mortality at the different decades traceable to the high tension produced while in training. this question deserves more consideration than has been accorded it. =renal disease= chronic disease of the kidneys (contracted red kidney) is one of the most certain producers of hypertension; in fact, some maintain that high tension, even without demonstrable kidney lesions, as revealed by careful urine examinations, is a valuable sign pointing to chronic nephritis. this is doubted by others, myself among them. just what causes the increase in blood pressure sometimes to over mm. of hg, is not definitely known. it seems most probable that it is some poison elaborated by the diseased kidneys and absorbed into the general circulation. there it acts primarily on the musculature of the arterioles causing tonic contraction and an increase of work on the part of the heart to force the blood through narrowed channels. one fact is certain. we see patients in coma due to renal disease with blood pressure much over mm of hg. as these cases clear up, the pressure may fall, and should they seemingly recover, the recovery is accompanied with a marked decrease in blood pressure, finally reaching the normal for the individual. moreover, in the course of a severe acute or subacute nephritis, hypertension is associated with headache, partial or total blindness, and drowsiness. when the pressure is reduced, all these symptoms disappear. there is also the chronically shrunken and scarred kidney known pathologically as the arteriosclerotic kidney. it is probable that there are two groups of cases which we may designate: ( ) primary; ( ) secondary. in the primary group the kidney disease antedates the sclerosis of the arteries, and the sclerosis is most probably dependent on the constant high tension. we know that prolonged hypertension will produce severe forms of arteriosclerosis. the arterial disease in this group is caused by the renal disease. in the second group the kidney changes are apparently due to the general arteriosclerosis which, affecting the kidney vessels, causes changes leading to atrophy and subsequent fibrous tissue ingrowth of scattered areas. these cases are not necessarily associated with hypertension; on the contrary there is more apt to be hypotension. where the first group occurs for the most part in young and active middle-aged people, the second group is the result of involutionary processes which accompany advanced age. however careful a urinalysis may be, there is no assurance that one can predict the pathologic state of the kidney. often so-called normal urine will be secreted by a badly diseased kidney, whereas a urine which contains considerable albumin and many casts may be secreted by a kidney which is only temporarily the seat of inflammation. what matters after all is not the state of the kidney which the pathologist describes, but the actual functional response of the kidney in the body to the various tests now well known. =ductless glands= at the present time the tendency among some writers is to make the ductless glands the responsible agents in almost all diseases. arteriosclerosis is no exception to this tendency. sajous, for example, divides the morbid process producing arteriosclerosis into three types; ( ) autolytic, ( ) adrenal, ( ) denutrition. in the first type he finds the pancreas to be the most important gland. it supplies an internal secretion which "takes a direct part in the protein metabolism of the tissue cells, and also in the defensive reactions within these cells, as well as in the phagocytes and in the blood stream." this being the case exaggeration of this digestive process has tissue destruction as its result, arteriosclerosis among them. in the adrenal type sajous argues that adrenalin produces lesions experimentally, therefore the adrenal gland has a profound influence by its internal secretion in connection with the sympathetic system in producing degenerations leading to arteriosclerosis. the denutrition type has as its particular gland the thyroid. the sclerotic process in the arteries is due to the lack of thyroid as in cases of myxedema. after a long résumé of his ideas he concludes "that arteriosclerosis is the result of excessive or deficient activity of certain ductless glands, the thyroid and adrenal in particular." no one can dogmatically deny the part which the ductless glands may play in the production of arteriosclerosis, but it hardly seems that there is enough actual experimental evidence to show that they take such an important part as sajous believes. until further and more convincing evidence is offered by competent investigators, i prefer to look with some skepticism upon the ductless gland theory of the causation of arteriosclerosis. the field lends itself too easily to speculation and imagery. some are already allowing themselves the mental debauch of this nature. chapter vii the physical examination of the heart and arteries =heart boundaries= in order to be able to estimate the departures from normal in the boundaries of the heart, it is essential that there be a definite appreciation of the boundaries of the normal heart in relation to the chest wall. it is frequently stated that the right limit of cardiac dullness is normally, in the adult, just at the right border of the sternum. this is not strictly accurate. careful dissections at the autopsy table and x-ray plates of the chest made at a distance of two meters from the tube show that the border of the right auricle is from one to one and a half and even two centimeters from the edge of the sternum at the level of the fourth rib, and on the living subject this can be also demonstrated. the right border of the heart usually is from to cm. from the midsternal line at the level of the fourth rib. again there is a term used in defining the apex, known as the point of maximum impulse. as this does not always coincide with the apex beat and with the outer lower left border of the heart, it would be better to use the term apex beat. normally, then, the cardiac dullness, the so-called relative cardiac dullness, begins above at the upper border of the third costal cartilage, as a rule, and taking a somewhat curved line with the concavity inward, descends to the fifth interspace or beneath the fifth rib from to cm. from a line drawn through the center of the sternum parallel to its length, the midsternal line. this seems to me to be a better method of recording the size of the heart than by the lines commonly used; viz., the nipple, or midclavicular, or parasternal line. below, the cardiac dullness is merged into the tympany from the stomach and the dullness from the liver. at the sixth right costosternal articulation there is a sharp turn upwards forming at that point with the liver the cardiohepatic angle. at the fourth right cartilage or the third interspace, the dullness is from one to two centimeters from the edge of the sternum. we have then a somewhat pear-shaped area or triangular area with the apex at the apex of the heart. the so-called absolute cardiac dullness does not appear to me to be of any great significance. in reality it is the limit of lung resonance and may be greater or less, not so much on account of variations in the size of the heart, as of variations in size of the lungs and shape of the chest wall. the really crucial question which should always be asked is, is the heart enlarged or decreased in size? the position of the apex beat alone can not determine this, neither can the limit to the right of the sternum. the distance between these two points and the depth of the dullness at a distance of cm. from the midsternal line on the left side, will give the size of the heart as nearly as can be obtained in the living subject. a series of measurements in normal adults average to cm. and to cm. respectively. for women they are about cm. less in each direction. the elaborate mechanism known as the orthodiagraph is probably the best means of determining the actual limits of the heart, but few men have such an expensive instrument, and, moreover, at the bedside such an instrument could not be used. from comparative measurements i concur in the belief of those who affirm that careful percussion will furnish equally as accurate limits. the first step in making an examination of the heart is to expose the patient's chest in a good light, and, sitting at his right side, carefully inspect the chest. the position of the apex beat, heaving, bulging, retraction of interspaces, etc., can easily be seen if visible. after careful inspection has given all the data which it is possible to obtain, one next lays the palm of the hand over the heart and attempts to palpate the apex beat. the thrust of the apex in a hypertrophied heart can readily be felt, and one can feel whether the heart is regular, irregular, intermittent, or has other change in rhythm. the shock of the closing valves, particularly the aortic, can be felt, and that and the forcible apical impulse are very suggestive signs of hypertrophy and hypertension. thrills may also be felt and can be timed in relation to the heart cycle. =percussion= it is to percussion that we next proceed, and for the data in regard to the size of the heart, it is, for our purpose, the most valuable of all the physical methods of heart examination. first and foremost we wish by percussion to learn the actual size of the heart, in other words what is ordinarily called the relative cardiac dullness. with the absolute dullness we are not concerned. that irregular area represents, as has been said, actually the =limits of lung resonance=. the heart may or may not be covered with lung; there may or may not be the incisura cardiaca. what i wish to insist upon is that the size of the area of absolute dullness can give us no data in regard to the size of the heart. what we must endeavor to learn is the actual size of the heart as nearly as our crude means will permit. light, very light, almost inaudible percussion, what goldscheider called "schwellungsperkussion," must be practiced. use the middle finger of the right (left) hand as the hammer and the last joint of the middle finger of the left (right) hand pressed firmly against the chest, as pleximeter. i believe it is better to place the pleximeter finger parallel to the boundary to be limited although some place the finger perpendicularly, that is, pointing toward the boundary. now and then it helps to bend the pleximeter finger at the second joint, hold it perpendicularly to the chest wall, and strike the joint directly in line of the finger. this in my hands has been of great assistance in percussing the limits of the heart dullness. pottenger's "light touch palpation" is a modification of the light palpation and, to my mind, has no very special advantages. auscultatory percussion is of great value at times. the bell of the stethoscope is placed over the portion of heart uncovered by lung (should such be the case), and with this point as a center the chest is lightly and quickly tapped along radii converging toward the stethoscope. one soon learns to recognize the change of pitch as the tapping reaches the border of the heart. it is well to use all methods, especially in difficult cases, and to compare the results. personally i have found that by light percussion i can limit with much accuracy the upper, right, and left borders of the heart. there is much to be gained by using light percussion. strong blows set in vibration not only the underlying structures, but also more or less of the chest wall. we wish to avoid this source of error, we do not wish to differentiate by pitch alone. finally one's pleximeter finger becomes, after long practice, so sensitive to changes in the resonance of structures lying below it, that there is actual feeling of impairment to the slightest degree. this delicate touch is what we should endeavor to cultivate. it is at times of advantage to use immediate percussion. this is done by bending the fingers of the striking hand, bringing the tips in a line and striking the chest lightly with the four fingers as one finger. some find it easier to percuss the dullness due to the heart in this way than by mediate percussion. the little hammer and hard rubber, celluloid, bone, or ivory pleximeter does not seem to me to be nearly as good as the fingers. moreover, one always has his hands, but may forget his hammer and pleximeter. =auscultation= in auscultating the heart i prefer the binaural stethoscope of the ford pattern. the recent substitution of an aluminum bell for the hard rubber bell is an improvement. personally i do not favor the phonendoscope or any of the new patent non-roaring instruments now for sale by urgent instrument makers. the phonendoscope has its uses, for example in auscultating the back when a patient is lying in bed or in listening to the heart sounds when a patient is under an anesthetic; but for differentiating the murmurs and for heart diagnosis, i much prefer the regular bell stethoscope. in arteriosclerosis the two places over which it is important to listen are the apex and the second right cartilage, the aortic area. over the former, one gains data in regard to the strength of the heart as indicated by the first sound, over the latter point, one learns of the tension in the aorta by the character of the sound produced when the aortic valves close. the hypertrophy of the heart in arteriosclerosis is invariably due to the enlargement and thickening of the left ventricle. from the nature of the position which the heart assumes in the thorax, this enlargement is downward and to the left. the apex beat will therefore be found in the fifth or sixth interspace, and definitely at an increased distance from the midsternal line. as stated above, it is most important that this distance be accurately measured and put down in the notes of the case for future reference. no satisfactory prognosis can be given unless this is done, for the gradual increase or the decrease under treatment in the size of the heart can thus be definitely known, and, knowing the other factors, a prognosis may be given which will be of some value to the patient. =the examination of the arteries= it is exceedingly difficult at times to affirm definitely that an artery, the radial for example, is actually sclerosed. much depends on the sensitiveness of the fingers of him who palpates, and much upon the relation of the palpated artery to the surrounding, chiefly underlying, structures. in the examination of arteries it is well to inspect the body for the pulsations caused by them. frequently an exceedingly tortuous artery, such as the brachial, may be seen throughout its whole extent and yet the radial appear little, if any, thickened by palpation. again the artery of a pulse of high tension which is small in size but full between the beats, may not be as sclerosed as one which collapses and feels much softer. it is difficult to obtain accurate data in regard to the tension in an artery by feeling it with the fingers of one hand. one should use both hands. with the middle finger of the right (left) hand the artery is compressed peripherally, that is, nearest the wrist. the blood is then pressed out of the artery with the middle finger of the left (right) hand, so as to obliterate completely the pulse wave and the two or three inches between the middle fingers are felt with the index fingers. by holding the finger firmly on the artery near the wrist so as to block any wave that may come through the palmar arch by anastomosis with the ulnar artery and by releasing pressure on the proximal middle finger, some idea may be had of the degree of pulse tension. however, no amount of practice can more than approximate the tension and when one is surest that he can tell how many millimeters of pressure there are, he is apt to be farthest wrong when he checks his guess with the sphygmomanometer. much may be learned from carefully palpating the peripheral arteries, and, as a rule, the sclerosis of these arteries means general arteriosclerosis, although there are many exceptions to this. a more recent method, and one which in the author's hands has been found to be valuable, is that proposed by wertheim-salomonson who palpates the artery not with the ball of the finger but with the fingernail. the finger is held so that the nail is perpendicular to the surface of the skin and the artery is felt with the end of the nail. the sensation is perceived at the root and makes use of all the sensitive nerve endings there. in this way it is possible to feel the arterial wall distinctly, and a little practice will enable one to determine whether or not the vessel wall is thickened. it is also possible to determine with a considerable degree of accuracy the diameter of the artery and the size of the wall when the current is cut off by pressure on the proximal side of the artery. it is best to have a firm background when this "fingernail" palpation is used. this may be obtained by palpating the radial artery against the lower end of the radius. probably the best method of palpating the arteries, especially the radial, to determine the degree of sclerosis and thickening, is to use the tip of the finger and roll it carefully over the artery. the tip of the finger is exceedingly sensitive and, moreover, it is a firmer palpating surface than the ball, thus enabling one to appreciate degrees of sclerosis which could not be differentiated by palpation with the soft yielding ball. this finger tip palpation is well illustrated in the figures here shown. (figs. and .) [illustration: fig. .--a method of finger-tip palpation of the radial artery. (graves.)] [illustration: fig. .--another method of finger-tip palpation of the radial artery. (graves.)] =estimation of blood pressure= it must be borne in mind at the outset that arteriosclerosis and high blood pressure are not always associated. as a matter of fact in the severest grades of senile arteriosclerosis the blood pressure is usually below the normal for the individual's years. however, as high tension is a frequent factor in the production of arterial thickening, blood pressure readings are of importance. the instrument which one uses is of minor importance provided it is properly standardized. the most important feature of the instrument is the cuff. this must be cm. wide and be long enough to wrap around the arm several times so that the pressure is evenly distributed over the whole arm and not over a small portion. one mercury instrument we had in the hospital was reported to be at great variance with a dial instrument. this mercury instrument was provided with a cuff which was short and was tied around the arm by means of a piece of tape. this caused a tight constriction over a small area and rendered the estimation too high. a new, long tailed cuff easily remedied the apparent defect in the instrument. in taking blood pressures the difference from day to day of or even mm. of systolic pressure has no great significance. fluctuations of the systolic pressure alone, it is insisted upon, have very little meaning. one must take the whole pressure picture into consideration and determine how the picture changes in order to draw any conclusion in regard to the state of the blood pressure. failure to pay attention to this evident point has caused much futile work to be written and published. it is well to emphasize again the point that the blood pressure picture consists of the systolic, the diastolic, the pulse pressure and the pulse rate. =palpation= hoover has called attention to the direct palpation of the femoral artery just below poupart's ligament as a more accurate index of the pressure in the aorta than the palpation of the radial artery. possibly one can obtain a more accurate estimate of the blood pressure in this way. this, however, is open to dispute. to estimate the blood pressure by palpating the radial artery is most deceptive. in about per cent of cases one can tell fairly well whether the pressure is abnormally high or abnormally low. small variations are impossible to determine. unquestionably it is most advantageous to get into the habit of palpating the femoral artery and checking the result with the sphygmomanometer so that the fingers may be trained to appreciate as accurately as possible changes of pressure. it may be that one day when the instrument is needed it is not at hand. a well-trained touch then becomes a great asset. =precautions when estimating blood pressure= there are certain precautions which must be strictly observed when deductions are drawn from the manometer readings. the psychic factor must be reckoned with. any emotion may cause marked variations in the pressure. excitement and anger are especial sources of error. even the slight excitement arising from taking the first blood pressure on a nervous patient especially is apt to give false values. usually the readings must be taken many times at the first sitting and the first few may have to be set aside. worry is a potent factor in raising the pressure. a walk to the physician's office, especially if rapid, has its effect. the position of the patient when the blood pressure is taken is important. usually in the office the pressure is taken when the patient sits in a chair. he should assume a relaxed, comfortable attitude. the readings should be made at the same time of day and at the same interval between meals. the pressure in both arms should be measured and comparisons should be made only between readings on the same arm. these precautions may seem useless and even somewhat trivial, and the conditions difficult to control. but unless they are carefully observed the readings will be false, no comparisons can be drawn between the readings on different days, and the instrument will most probably be blamed. i have known this to happen so often that i can not emphasize too strongly the importance of controlling all the essential conditions which go to make accurate work. =the value of blood pressure= in the past few years there has been a veritable avalanche of blood pressure instrument salesmen who have covered the country, sold instruments, and have made many startling claims for the instrument. they have emphasized its value out of proportion to what the instrument can do even in the hands of one familiar will all the defects. consequently it is not necessary to emphasize the value of blood pressure. it seems best to utter a few words of caution in regard to its interpretation. the value lies not in the occasional estimation compared with some other one reading, but in the frequent estimation and in the visualization of the blood pressure picture. for the great majority of diseases the blood pressure has no particular value except to show that the circulation is not materially disturbed. the limits of normal are rather wide, so that consideration of the patient's age, sex, build, etc., will give us some idea of a base line, so to speak, for any one person. wide departures from relatively normal figures are important, but are not diagnostic or, rather, pathognomonic. i can not help but feel that the diastolic pressure is _the_ most important part of the blood pressure picture. persistent high diastolic pressure means increased work for the heart, which, if acting for a long time against the high peripheral resistance, must eventually hypertrophy. the arteries become thickened, lose their wonderful elasticity, fibrous tissue is deposited in their walls, and the vicious circle is established which leads to pathologic hypertension. blood pressure readings must be intimately mixed with brains in order to be of any great value in diagnosis or prognosis. chapter viii symptoms and physical signs =general= well developed arteriosclerosis shows four pathognomonic signs: ( ) hypertrophy of the heart; ( ) accentuation of the aortic second sound; ( ) palpable thickening of the arteries; and ( ) heightened blood pressure. however, it must not be inferred that these signs must be present in order to diagnose arteriosclerosis. it has already been said that a very marked degree of thickening, with even calcification of the palpable arteries, may occur with absolutely no increase of blood pressure, and at autopsy a small flabby heart may be found. while arteriosclerosis is usually a disease which is of slow maturation, nevertheless cases are occasionally seen which develop rather rapidly. the peripheral arteries have been noticed to become stiff and hard in as relatively brief a time as two years from the recognized onset of the disease. since involution processes are physiologic, as has been described (vide infra), arteriosclerosis may assume an advanced grade and run its course devoid of symptoms referable to diseased arteries. it is doubtful whether the sclerosis itself could produce symptoms, except in cases later to be described, were it not that the organs supplied by the diseased arteries suffer from an insufficient blood supply and the symptoms then become a part of the symptom-complex of any or all the affected organs. there are cases, however, in comparatively young persons where a combination of certain ill-defined symptoms gives a clue to the underlying pathologic processes. these symptoms of early arteriosclerosis are the result of slight and variable disturbances in the circulation of the various organs. normally there are frequent changes in the blood pressure in the organs, but the vasomotor control of normal elastic vessels is so perfect that no symptoms are noted by the individual. when the arteries are sclerosed, they are less elastic and the blood supply is, therefore, less easily regulated. at times symptoms occur only after effort. the patient may tire more readily than he should for a given amount of mental or bodily exercise; he is weary and depressed, and occasionally there is noted an unusual intolerance of alcohol or tobacco. vertigo is common, especially on rising in the morning or in suddenly changing from a sitting to a standing position. some complain of constant roaring or ringing in the ears. there may be dull headache that the accurate fitting of glasses does not alleviate. unusual irritability or somnolency with a disinclination to commence a new task may be present. sometimes the effort of concentrating the attention is sufficient to increase the headache. this has been called "the sign of the painful thought." numbness and tingling in the hands, feet, arms, or legs are also complained of, and neuralgias, not following the course of the nerves but of the arteries, also occur. it is important to remember that the train of symptoms resembling neurasthenia in a person over forty-five years old may be due to incipient arteriosclerosis. this tardy neurasthenia frequently accompanies cancer, tuberculosis, diabetes, and incipient general paralysis, as well as incipient arteriosclerosis. bleeding from the nose, epistaxis, taking place frequently in a middle-aged person, sometimes is an early symptom. the bleeding may be profuse, but is rarely so large as to be positively harmful. in fact, it may do much good in relieving tension. slight edema of the ankles and legs is seen. dyspnea on slight exertion is not uncommon. dyspeptic symptoms are not infrequent, pyrosis (heartburn), a feeling of fullness after meals with belching or a feeling of weight in the epigastrium. the dyspeptic symptoms may be so marked that one might almost speak of a variety of arteriosclerosis, the dyspeptic type. for quite a while before any symptoms that would definitely fix the case as one of undoubted arteriosclerosis, the patient complains that foods which previously were digested with no difficulty now give him gastric distress. the examination of the stomach contents of a patient presenting gastric symptoms reveals usually a subacidity. the total acidity measured after the ewald test meal may be only and the free hcl may be absent. attention has been called to an unnatural pallor of the face in early arteriosclerosis. progressive emaciation is sometimes seen in cases of arteriosclerosis and may be the only symptom of which the patient complains. =hypertension= not all cases of arteriosclerosis are accompanied by increased arterial tension. as has been stated in a previous chapter, the blood pressure in the arterial system depends chiefly on two factors; viz., the degree of peripheral (capillary) resistance, and the force of the ventricular contraction. the highest arterial pressures recorded with the sphygmomanometer occur not in pure arteriosclerosis but in cases where there is concomitant chronic interstitial disease of the kidneys. when this is found there is always arteriosclerosis more or less marked. in cases where the arteries are so sclerosed that they feel like pipe stems there may be an actual decrease in the blood pressure. hence the clinical measuring of the pressure in the brachial artery alone is not sufficient for a diagnosis of arteriosclerosis. a persistent high blood pressure even with normal urinary findings is not a sign of arteriosclerosis. the high tension later may lead to the production of sclerosis of the arteries, but in these cases the kidney may be primarily at fault. the impression must not be gained that hypertension in itself always constitutes a disease or even a symptom of disease. hypertension itself is practically always a compensatory process. that is to say, it is the attempt on the part of the body to equalize the distribution of blood in the body when there is some poison causing constriction of the small arteries. in this sense hypertension is not only essential, but actually life-saving. a heart which is so diseased that it can not respond to the call for increased action by hypertrophy of its fibers, would shortly wear out. the very fact that the heart becomes enlarged and the tension in the arteries becomes high, indicates that in such a heart there was great reserve power. but while hypertension is largely an effort at adjustment among the various parts of the circulation, it nevertheless tends to increase, provided the cause or causes which produced it act continuously. moreover, as has been said (chap. ii), the arterioles do not respond to increased work on the part of the heart by expanding, but by contracting. a vicious circle is thus maintained which eventually must lead to serious consequences. hypertension is then, if anything, only a symptom which may or may not demand treatment. that hypertension leads to the production of sclerosis of the arteries has been repeatedly affirmed here. in certain cases it is good and should not be experimented with. in other cases it is bad and some treatment to reduce the tension must be tried. the main point is to regard hypertension as one regards a compensated heart lesion. prof. t. clifford allbutt divides the causes of arteriosclerosis clinically into three classes: ( ) the toxic class--the results of poisons of the most part of extrinsic origin, chiefly those of certain infections. in some of these diseases, the blood pressures, as for example, in syphilis, are ordinarily unaffected; in others, as in lead poisoning, they are raised. ( ) the class he calls hyperpietic,[ ] in which an arteriosclerosis is the consequence of tensile strength, of excessive arterial blood pressure persisting for some years. a considerable example of this class is the arteriosclerosis of granular kidney, but in many cases kidney disease is, clinically speaking, absent. ( ) the involutionary class, in which the change depends upon a senile, or quasisenile degradation. this may be no more than wear and tear, a disposition of all or of certain tissues to premature failure--partly atrophic, partly mechanical--under ordinary stresses; or it also may be toxic, a slow poisoning by the "faltering rheums of age." in ordinary cases of this class the blood pressures for the age of the patient are not excessive. although the toxins of the specific fevers, notably typhoid, as stated above, and influenza, have been shown to produce arteriosclerosis, this, under favorable circumstances he believes tends to disappear. this has been shown by wiesel. [ ] from piesô to squeeze, oppress or distress. hyperpiesis, therefore, signifies excessive pressure. as the blood pressure is dependent on the resistance offered by the capillaries and arterioles, there are only two ways in which increased pressure can be brought about; either by rendering the blood more viscous, or by the generation of some poison from the food taken into the body which, acting on the vasomotor center or directly on the finer vessels, arteriolar or capillary, sets up a constriction over any large area, and mainly in the splanchnic area. in regard to the liability to arteriosclerosis, this area stands second only to the aortic and coronary areas. he believes that arteriosclerosis itself has little effect in raising arterial pressure. many cases are seen in which with extreme arteriosclerosis there was no rise in blood pressure, and some in which pressures have been rising even long before the appearance of arterial disease. prof. allbutt also believes that in the hyperpietic cases the arteries undergo a transient thickening, which can be removed if the causes can be reached and overcome. clinically speaking, then, hyperpietic arteriosclerosis is not a disease, but a mechanical result of disease. if the narrowing of the arterioles is brought about by thickening due to arteriosclerosis, then it would seem _a priori_ that such obliteration should cause a rise in pressure. were the vascular system a mere mechanical set of tubes and a pump, this would happen, but other factors of great importance must be taken into consideration besides the mechanical factors; viz., chemical and biological factors. thus, whole parts may be closed and with compensatory dilatation in other parts there would be little or no change in pressure, unless there were hyperpiesis. in established hyperpiesis, we note two conditions in the radial artery: first, a comparatively straight vessel with a small diameter; secondly, a larger, more tortuous vessel, "the large leathery artery." in the cases of the first group, hyperpiesis is often more marked, although not appearing so to the examining finger, than in the second class. in view of the difficulty of estimating by touch alone the amount of hyperpiesis in a contracted hard artery, it is often overlooked until a ruptured vessel in the brain startles us to a realization of our mistake. the "narrow" artery is more dangerous than the tortuous one, for with every change in pressure the passive vessels of the brain must receive blood that under normal conditions would go to other parts of the circulation. in involutionary sclerosis there is a gradual thickening and tortuosity of the vessel, which although it may be greater than in the hyperpietic cases, yet is never so dangerous to life. the heart in hyperpiesis hypertrophies and dilates, but such a heart is the result, not an integral part, of the arterial disease. =the heart= when the arterial tree becomes narrowed and the resistance offered to the flow of blood thereby is increased, more muscular work is required of the left ventricle and according to the general laws which govern muscles the ventricle hypertrophies. there is an actual increase in number of fibers as well as an increase in the size of the individual fibers. some of the best examples of simple hypertrophy of the left ventricle are found under such circumstances. the chambers as a rule do not dilate until the resistance becomes greater than the contraction can overcome, when symptoms of broken compensation of the heart take place. the hypertrophy of the left ventricle brings more of this portion of the heart toward the anterior chest wall. the enlargement is toward the left, also, consequently the apex-beat is found below and to the left of its usual site, even an inch or more beyond the nipple line. the impulse is heaving, pushing the palpating hand forcibly up from the chest wall. the visible area of pulsation may occupy three interspaces and the precordium is seen to heave with every systole. on auscultation the second sound at the aortic cartilage is ringing, clear, and accentuated. not infrequently, too, the first sound is loud and booming, but has a curious muffled sound that may even be of a murmurish quality. the leaflets of the mitral valve may be the seat of sclerosis, the edges are slightly thickened and do not quite approximate, thus causing a definite murmur with every systole. this murmur may be transmitted out into the axilla and be heard at the inferior angle of the left scapula. =palpable arteries= not every artery that can be felt is the subject of arteriosclerosis, and, as has been stated, palpable arteries being more or less a condition of advancing years, judgment as to whether the artery is pathologically or physiologically thickened may be a matter of individual opinion. a radial artery that lies close to the lower end of the radius and can actually be seen to pulsate when the hand is held slightly extended on the back of the wrist, is easily felt, but must not, therefore, be considered a sclerosed artery. the radial may be so deeply situated in the wrist of a fat subject that it is difficultly palpable. yet the two cases just described may have arteries of identical structure, there being no more retrogressive changes in the one than in the other. "experience is fallacious and judgment difficult." the small, contracted, wiry artery of a chronic nephritic may feel like a pipe stem, but if properly felt the mistake will not be made of considering such an artery an unusually sclerosed one. when the wave is pressed out of such a high tension artery, it is found that what seemed to be a firm sclerosed vessel, was in reality an artery tightly stretched over the column of blood. =ocular signs and symptoms= it would not exaggerate too much to say that the examination of the eye grounds with the ophthalmoscope is the most important aid in the early diagnosis of arteriosclerosis. long before there are any subjective symptoms, changes can be seen in the blood vessels of the retina which, while not always diagnostic, at least call attention to a beginning chronic disease. as i become more proficient in the use of the ophthalmoscope, i am impressed with the importance of the ocular signs of arterial disease. i would urge practitioners to familiarize themselves with this instrument. the electrically lighted instruments on the market now have so simplified the technic that any physician should be able to see the grosser changes which take place in the arteries and veins of the retina and in the disc. frequently the ophthalmologist is the first to recognize early arteriosclerosis. in the fundus are seen increased tortuosity of the retinal vessels and their terminal twigs with more or less bending of the vessels at their crossings. the arteries are terminal ones, and small patches of retinitis are therefore found. the changes have been divided into ( ) suggestive, ( ) pathognomonic. under ( ) are: (a) uneven caliber of the vessels, (b) undue tortuosity, (c) increased distinctness of the central light streak, (d) an unusually light color of the breadth of the artery. under ( ) are: (a) changes in size and breadth of the retinal arteries so that they look beaded, (b) distinct loss of translucency, (c) alternate contractions and dilatations in the veins, (d) most important of all, the indentation of the veins by the stiffened arteries. there is yet another sign which appears to be pathognomonic. the arteries are pale, appear rigid and through the center, parallel to the course, is a rather bright, fine threadlike line. the appearance is known as the "silverwire" artery. it is particularly constant in hypertension where the most beautiful examples are seen. moreover, there is the arcus senilis, the fine translucent to opaque circle surrounding the outer portion of the iris. practically every one with a well-marked arcus senilis has arteriosclerosis, but vice versa not every one with even marked arteriosclerosis has an arcus senilis. in general, the symptoms are gradual loss of acute vision, and attacks of transient loss of vision. the explanation which has been offered for these phenomena is the contraction in a diseased central artery. =nervous symptoms= the onset of arteriosclerosis is, in the majority of cases, so insidious that certain nervous manifestations, due in all probability to disturbances in blood pressure, are present long before the actual sclerosis of the arteries can be felt. these nervous symptoms are at times the sign posts to show us the way to accurate diagnosis. there may be gradual increase in irritability of temper, inability to sleep, vertigo even extending to transient attacks of unconsciousness. loss of memory for details frequently is an early symptom of sclerosis of the cerebral arteries. nervous indigestion may be present. various paresthesias as numbness, tingling, a sense of coldness or of heat or burning, a sense of stiffness or even actual stiffness or weakness may occur in the arms and legs, more frequently in the legs. the pain complained of may be due to occlusion of an artery, although evidence for this is lacking. it has been thought by some that the pain in angina pectoris might be due to this cause. several curious and interesting diseases which have been thought by some to have arteriosclerosis as a basis are accompanied by pain. such are erythromelalgia, raynaud's disease, "dead fingers," and intermittent claudication. erb has reported a large series of intermittent limp (claudication) from his private practice. he finds that the large majority of the cases occur in men. the abuse of tobacco was evidently the main etiologic factor in about half of the cases. repeated exposure to cold and the abuse of alcohol were responsible for most of the other cases. curiously enough he finds that a history of syphilis was present in only a small proportion of his cases. it is his firm conviction that intermittent limping--which he thinks should be called angiosclerotic dysbasia--is frequently incorrectly diagnosed. it is mistaken for other troubles and treated wrongly. as gangrene may develop this is particularly dangerous. the affection generally develops gradually, although he has seen cases where the onset was rather acute. the partial or complete lack of the pulse in the foot is the one striking sign, together with the varying behavior of the pulse, its disappearance when the feet are cold and its return after a warm foot bath or under other treatment. signs of general arteriosclerosis were present in nearly every case. when there is a tendency to the development of intermittent limp he finds that a valuable sign is the manner in which the leg blanches when it is lifted repeatedly while the patient is recumbent and becomes hyperemic later when placed horizontally. in health this change occurs more rapidly. chapter ix symptoms and physical signs =special= our conception of arteriosclerosis as a degenerative process affecting the vascular tree rather than a disease, removes the possibility of discussing special symptoms. as a matter of fact, we know of very few organs where even profound pathologic changes in the vascular system produced during life any symptoms which could be laid to these arterial changes. kind nature has given to us such an excess of organs of every kind that the destruction of large portions of any organ seems to affect the function but little. so only particular groups of organs, which show symptomatic changes as the result of arteriosclerotic processes, will be discussed. it is realized that this may not give teutonic completeness to the discussion, but it certainly saves paper and has a distinct practical value to the long suffering reader. although arteriosclerosis is a disease which affects the whole arterial system, it nevertheless never reaches the same grade all over the body. the difference in the structure and functions of the various organs determines to great extent the eventual symptomatology. endarteritis obliterans of a small sized artery in the liver or leg would lead to no marked symptoms, as the circulation is so rich that the anastomoses of the blood vessels would soon establish a collateral circulation that would be perfectly competent to sustain the function of the part. quite different would it be should one of the small arteries of the brain, the lenticulo-striate, for example, which supplies the corpus striatum, become the seat of a thrombosis or embolism caused by arteriosclerosis. the arteries of the brain are terminal arteries and the blood supply would be cut off entirely with a resulting anemic necrosis of the part supplied by the artery and a loss of function of the part. what would be of no moment in the leg or arm might prove even fatal in the brain. the further symptomatology, therefore, of arteriosclerosis depends entirely on the organ or organs most affected by the interference with the blood supply. the following groups may be recognized: . cardiac. . renal. . abdominal. . cerebral. . spinal. . local vasomotor effects. . pulmonary. =cardiac= most cases of arteriosclerosis sooner or later present symptoms referable to the heart. when the organ is hypertrophied and is already working against an enormous peripheral resistance, a slight excess of work put upon it may cause a dilatation of the chambers with the resulting broken compensation. there is dyspnea on slight exertion, possibly some precordial distress, slight edema of the ankles and lower legs and possibly scanty urine. with proper care, a patient with such symptoms may recover, but the danger of another break in compensation is enhanced. the next attack is more severe. the edema is greater, there may be signs of edema of the lungs, effusions into the serous cavities may occur. the heart shows marked dilatation. there is gallop or canter rhythm and there are loud murmurs at the apex. when a patient is first seen in this stage, it may be quite impossible to state whether or not there is true valvular disease of the heart. the muscle is usually diseased in that there is fibroid degeneration of more or less extensive character. this factor causes the heart to lose much of its elasticity and increases the tendency to permanent dilatation. such cases must be watched before one can say that true valvular insufficiency is not present. the fatal termination of such a case is quite like that of true valvular disease. there is increasing dyspnea, increasing anasarca, and the patient usually succumbs to edema of the lungs, drowned in his own secretions. [illustration: fig. .--aneurysm of the heart wall. (milwaukee county hospital.)] a very rare complication of the fibroid degeneration of the heart muscle is aneurysm of the heart wall. (fig. .) the apex of the left ventricle is most commonly the site of the aneurysm and rupture occasionally occurs. such an accident is rapidly fatal. in the arteriosclerotic process which occurs at the root of the aorta, the coronary arteries become involved both at the openings and along the courses of the vessels. a branch or branches or even one artery may become blocked as a result of obliterating endarteritis. the arteries of the heart are not terminal vessels but as a rule blocking of a large branch leads to anemic infarct. these areas become replaced by fibrous tissue which in the gross specimen appears as streaks of whitish or yellowish color in the musculature. anemic infarcts may not occur. in such cases the anastomosis between branches of the coronary arteries is unusually free. through arteriosclerosis of the coronary vessels extensive fibrous changes may occur that lead to a myocardial insufficiency with its attending symptoms--dyspnea, irregular and intermittent heart, gallop rhythm, edema, etc. one of the most distressing and dangerous results of sclerosis of the coronary arteries and of the root of the aorta is angina pectoris. while in almost every case of angina pectoris there is disease of the coronary arteries, the contrary does not hold true, for most extensive disease, even embolism, of the arteries is frequently found in persons who never suffered any attacks of pain. this symptom group is more common in males than in females and as a rule occurs only in adult life. "in men under thirty-five syphilitic aortitis is an important factor." (osler.) since the valuable experiments of erlanger on heart block, considerable attention has been paid to lesions of the y-shaped bundle of fibers, a bundle arising at the auriculoventricular node and extending to the two ventricles, known also as the auriculoventricular bundle of his. interference with the transmission of impulses through this bundle gives rise to the symptom group known as the stokes-adams syndrome, which is characterized by: (a) slow pulse, (b) cerebral attacks--vertigo, syncope, transient apoplectiform and epileptiform seizures, (c) visible auricular impulses in the veins of the neck. many of the cases which occur are in elderly people the subjects of arteriosclerosis. [illustration: fig. .--large aneurysm of the aorta eroding the sternum. death from rupture through the skin preceded by frequent small hemorrhages. (milwaukee county hospital.)] so far as we now know all cases of the stokes-adams syndrome are caused by heart block which is only another name for disease in the auriculoventricular bundle. of interest here is the fact that besides gummata, ulcers, and other lesions of the bundle, definite arteriosclerotic changes have been found. "the investigation of a typical case of stokes-adams disease has shown that the symptoms of this case are caused by some lesion in the heart which gives rise to the condition now generally termed heart block. practically all degrees of heart block have been observed, namely, complete heart block and partial block with : , : , and : rhythm, and occasionally ventricular silences. these stages occurred during recovery. "experiments testing the reaction of the heart to various extrinsic influences demonstrate that when the block is complete the ventricles do not respond to influences presumably of vagus origin, although the auricles still respond normally to such influences, that effects exerted upon the heart presumably through the accelerators still influence the rate of the ventricles as well as that of the auricles. "when the block is partial the rate of the ventricular contraction varies proportionally with the rate of the auricular contractions but only within certain limits. when these limits are exceeded the block becomes more complete, i. e., a : rhythm may be changed into a : rhythm, this into a : rhythm, and this into complete block, and vice versa. "the syncopal attacks are, in all probability, directly dependent upon a marked reduction of the ventricular rate. such reductions of the ventricular rate are always associated with an increase of the auricular rate, and it is believed that the latter is the cause of the former." (erlanger.) the epileptiform seizures of the syndrome may be caused by the anemia of the brain resulting from failure of the heart to supply a sufficient quantity of blood. the apoplectiform attacks are most probably caused by venous congestion when the slowing of the ventricular contractions is not sufficient to cause convulsions, but will just cause complete unconsciousness. =renal= chronic nephritis, hypertension, arteriosclerosis form a most important trinity. some stoutly affirm that in all cases of high tension there is chronic renal disease. certainly the very highest blood pressures which we see occur in the chronic interstitial forms of kidney disease. the cause is most probably to be sought in some poison which is elaborated in the kidney, is absorbed into the circulation and acts powerfully either on the vasoconstrictor center as a stimulus, or directly on the musculature of the small arteries all over the body. usually hypertension is progressive but it may be temporary. a man, years old, entered the milwaukee county hospital in uremic coma. the systolic blood pressure was - mm. hg, the diastolic pressure mm. (janeway instrument). under treatment his blood pressure gradually became lower, at the same period the albumin and casts gradually disappeared from the urine. in two weeks from admission he seemed perfectly well, there were no albumin or casts found in the urine, and the systolic blood pressure was mm., not a high figure for a muscular man of the laboring class. it must be admitted, however, that such cases are the exception, not the rule. patients suffering from the association of chronic nephritis with hypertension die slowly, usually. there is gradual development of anasarca. headache is frequent and severe. pains all over the body may occur. the sight may suddenly become dim or may even be lost. dizziness may be complained of and dyspnea is usually marked. cyanosis comes on, the pulse becomes weak, irregular or intermittent, heart failure sets in, and the patient dies with edema of the lungs. another class of renal arteriosclerosis is characterized by a small granular kidney in which fibrous changes of a patchy character have taken place. these scattered areas are the result of obliterating endarteritis of renal arteries here and there with consequent anemia, death of cells, and replacement by fibrous tissue. it occurs as part of a generalized arteriosclerosis in which the whole arterial system is the seat of diffuse (senile) sclerosis. the palpable arteries are usually beaded or even encircled with calcareous deposits and the aorta is the seat of an extensive nodular and ulcerating sclerosis. the heart is usually small, shows extensive fibrous and fatty changes and possibly the condition known as "brown atrophy;" the blood pressure is low. such cases do not show any special symptoms. they are anemic, short of breath on exertion, have the appearance and show the signs of senility. in the first group it is, at times, difficult to say whether the kidney disease or the arterial disease is the most important. from a clinical standpoint the decision is not essential as the end results are much the same in both. however, when actual uremic symptoms dominate the picture, it becomes evident that the disease of the kidney is the chief feature in the causation of the symptoms. =abdominal or visceral= there is an important group of cases to which but little attention has been paid until quite recently. this is the abdominal or visceral type of arteriosclerosis. it has been stated that arteriosclerosis of the splanchnic vessels almost invariably causes high tension. among others, janeway has shown that general arteriosclerosis without marked disease of the splanchnic vessels does not cause as a rule increase of blood pressure. there are cases in which the brunt of the lesion falls upon the abdominal vessels. such cases have been called "angina abdominalis." it has been suggested (harlow brooks) that this type of arteriosclerosis may be determined by constant overloading of the stomach with food, especially rich and spiced food. this causes overwork of the special arteries connected with digestion and so leads to sclerosis of the vessels of the stomach, pancreas, and intestines. personal habits probably influence to great extent the production of this more or less =localized= condition. the organs supplied by the diseased arteries suffer from changes analogous to those occurring in general or local malnutrition, such as starvation, old age, or local anemias. these changes are atrophy with hemachromatosis (brown atrophy) or fatty infiltration and degeneration. following the degenerative changes there result connective tissue growth and further limitation of the functionating power of the affected organs. pain is a more or less constant symptom of visceral sclerosis. in the early stages there may be only a sense of oppression, of weight, or of actual pressure in the abdomen or pit of the stomach. there may be only recurring attacks of violent abdominal pain accompanied by vomiting. in some cases symptoms of tenderness in the epigastrium, pains in the stomach after eating, vomiting and backache may suggest gastric ulcer. there may be dyspnea and a sense of anguish accompanied with a rapid and feeble pulse. hematemesis may make the symptom group even more like ulcer of the stomach, and only the course of the disease with the failure of rigid ulcer treatment and the substitution of treatment directed toward relief of the arterial spasm with resulting betterment, enables one to make a diagnosis. the condition may be present for years and the symptoms only epigastric tenderness with dizziness and sweating on lying down after dinner, as in one of perutz's patients. the attacks are probably due to spasmodic contraction of the sclerosed intestinal vessels with a resulting local rise in blood pressure. the pains are most probably due to the spasm of the intestinal muscles, and some think they are located in the sympathetic and mesenteric plexuses. this result of arteriosclerosis is not so uncommon, and by keeping this cause of obscure abdominal pain in mind we are now and then enabled to save a patient from operation. an autopsy on a case which for many years had attacks of abdominal pain and cramp-like attacks, with high blood pressure and heart hypertrophy, showed extensive sclerosis of the abdominal aorta, superior mesenteric and iliacs. these vessels were calcified. hypertrophy of the left ventricle was found. the kidneys were microscopically normal. there were no changes in the ascending aorta but in the descending portion there were scattered nodules and small calcified plaques. the attacks of pain from which this patient suffered for many years, the hypertrophy of the left ventricle and the increased blood pressure were thought to be directly due to the sclerosis of the abdominal vessels. =cerebral= it has been stated that arteriosclerosis is a general disease, yet certain systems of vessels may be affected far more than others, and indeed there may be marked sclerosis at one part of the body and none demonstrable at another part. in advanced sclerosis there may be one or more of a series of accidents due to embolism, thrombosis, or rupture of the vessels. such conditions as transient hemiplegia, monoplegia or aphasia may occur. the attacks may come on suddenly and be over in a few minutes; what allbutt calls "larval apoplexies." they may last from a few hours up to a day, and are very characteristic. a patient aged years with pipe stem radials and tortuous hard temporals would be lying quietly in bed when suddenly he would stiffen, the eyes would become fixed and the breathing cease. in a few seconds consciousness returned, the patient would shake himself, pass his hand over his brow and ask, "where am i? oh, yes, that's all right." he had as many as thirty of these attacks in twenty-four hours, none of them lasting over one minute. to just what such attacks are due, it is hard to say. some have attributed them to spasm of the smaller blood vessels of the brain, but there have never been demonstrated in the vessels any constrictor fibers. there is a well recognized form of dementia caused by arteriosclerosis. in general paralysis of the insane and in senile dementia the blood vessels are always diseased. milder grades of psychic disturbances are accompanied by such symptoms as mental fatigue, persistent headaches, vertigo, memory weakness and fainting. aphasia, periods of excitement and mental confusion occur in some. later stages are at times accompanied by inclination to fabulate, loss of judgment, disorientation, narrowing of the external interests, episodes of confusion and hallucinatory delirium. the hemiplegias, monoplegias and paraplegias may occur again and again and last for one or two days. unless there has been rupture of the vessels, there is complete recovery as a rule. in persons who have arteriosclerosis with high tension attacks of melancholia are seen. there are at the same time fits of depression, insomnia, irritability, fretfulness, and a generally marked change in disposition. when the tension is reduced by appropriate treatment these symptoms disappear, to recur when the tension again becomes high. on the contrary, attacks of mania are accompanied by low blood pressure. the dizziness and vertigo in cerebral arteriosclerosis are probably due to the stiffness of the vessels which prevents them from following closely the variations of pressure produced by position, and thus, at times, the brain is deprived of blood and a transient anemia occurs. arteriosclerosis of the cerebral vessels is always a serious condition. the greatest danger is from rupture of a blood vessel. another of the dangers is gradual occlusion of the arteries bringing about necrosis with softening of the brain substance. the latter is more apt to be associated with psychic changes, dementia, etc.; the former, with hemiplegia. it is curious that a small branch of the sylvian artery, the lenticulo-striate, which supplies the corpus striatum, should be the one which most frequently ruptures. where the motor fibers from the whole cortex are gathered together in one compact bundle, a very small hemorrhage may and does cause very serious effects. a comparatively large hemorrhage in the silent area of the brain may cause few or no symptoms. =spinal= it is conceivable that arteriosclerosis of the vessels of the spinal cord might cause symptoms which would be referred to the areas of the cord where the process was most advanced. the lesions would be scattered and consequently the symptoms might be protean in character. true epileptic convulsions dependent on arteriosclerotic changes are also seen and are not so uncommon. this is on the whole a rare condition, much less common than arteriosclerosis of the cerebral vessels. collins and zabriskie report the following typical case: "h., a fireman, fifty-one years old, was in ordinary good health until toward the end of . at that time he noticed that his legs were growing weak and that they tired easily. later he complained of a jerking sensation in different parts of the lower extremities and at times of sharp pain, which might last from several minutes to two or three hours. the legs were the seat of a heavy, unwieldy sensation, but there was no numbness or other paresthesia. about the same time he began to have difficulty in holding the urine, a symptom which steadily increased in severity. these symptoms continued until march, , i. e., for three months, then he awakened one morning to find that he was unable to stand or walk, and the sphincters of the bowels and bladder relaxed. there was no complaint of pain in the back or legs, no difficulty in moving the arms, in swallowing or in speaking. he says he was able to tell when his lower extremities were touched and he could feel the bed and clothes. he was admitted to the city hospital three weeks later and the following record was made on april , . "the patient was a frail, emaciated man of medium height, who had the appearance of being - years of age. he was unable to stand or walk. when he was lying, he could flex the thigh and the legs slowly and feebly. there was slight atrophy of the anterior and inner muscles, more of the left than of the right side. the knee jerks and ankle jerks were absent. irritation of the soles caused quite a typical babinski phenomenon. the patient had fair strength in the upper extremities, but the arms tired very soon, he said. the grip was moderate and alike in each hand. the motility of the face, head, and neck was not noticeably impaired. there was no difficulty in swallowing, and articulation was not defective. tactile sensibility was slightly disordered in the lower extremities, although he could feel contact of the finger, the point of a pin, and the like. sensibility was not so acute as normal; there was a quantitative diminution. sensory perception was not delayed. there was a distinct zone of slight hyperesthesia about as wide as the hand above the femoral trochanters. above that, sensibility was normal. there was no discernible impairment of thermal sensibility. no part of the body was particularly tender on pressure. a bedsore existed over the sacrum, and there was excoriation of the genitals from constant dribbling of urine. "examination of the chest showed shallow respiratory movements. the heart was regular, weak, there were no murmurs, the second sound was accentuated. examination of the abdomen showed that the liver and spleen were palpable, but were not enlarged. the abdominal reflexes, both upper and lower, were sluggish. the patient was slow of speech, likewise apparently of thought. he did not seem to show an adequate interest in his condition, still he was fully oriented and seemed to have a fair memory. his mental reflex was slow. there were indications in the peripheral blood vessels and heart of a moderate degree of general arteriosclerosis. the peripheral vessels such as the radial, were palpable, the walls thickened, the blood pressure increased. "the patient did not complain of pain while he was in the hospital, a period of four weeks, nor was there any particular change in the patient's symptoms, subjective and objective, during this time. his mental state remained clear until forty-eight hours before death, when he became sleepy, stuporous, and comatose, dying apparently of cardiac weakness, which had set in simultaneously with the clouding of consciousness." at autopsy, except for a few small hemorrhages in the posterior horns of the lower dorsal segments on the right side and a similar condition of the left anterior horns, there was nothing noticed. on microscopic examination, there was found widespread sclerosis of the vessels of the cord to a marked degree with only slight thickening of the vessels of the brain. there were secondary degenerations of ascending and descending type particularly marked at the ninth dorsal segment. they included portions of all the tracts, the pyramidal tract as well. the symptoms in brief were: ( ) weakness and easily induced fatigue of the legs; ( ) peculiar sensations in the lower extremities, described as jerky, numbness, heaviness, and occasionally sharp pain; ( ) progressive incontinence of urine; ( ) progressive paraplegia. since one of the chief manifestations of syphilis is sclerosis of the arteries, neurologic cases characterized by irregular symptoms and signs which can not be placed in any of the definite system disease groups, are possibly due to irregularly scattered areas of sclerosis throughout the spinal cord caused by obliterating arteritis. such cases are not so very uncommon. several have come under my observation. further studies of the spinal cords of these cases at autopsy are necessary before a final opinion can be given as to their dependence on arteriosclerosis of the spinal vessels. =local or peripheral= when the arteriosclerosis in the peripheral arteries reaches a stage where endarteritis obliterans supervenes, there is usually no chance for a compensatory or collateral circulation to be established. the area supplied by the vessel undergoes dry gangrene. a portion of a toe or finger or a whole foot or hand may shrivel up. it is more common to see the spontaneous amputation take place in the lower extremities. the same effect may be produced by the plugging of a vessel with a thrombus. there may be much pain connected with the sudden blocking, whereas the gradual obliteration of the blood supply of a toe or foot is not as a rule at all painful. the condition is at times revealed more or less accidentally when a patient injures his toe or foot and discovers that there is no sensation in the part and that the wound instead of healing is inclined to grow larger. other interesting vasomotor phenomena are frequently connected with arteriosclerosis. such a one is the curious condition known as raynaud's disease, a vascular disorder which is divided into three grades of intensity: ( ) local syncope, ( ) local asphyxia, ( ) local or symmetrical gangrene. this is not the place to describe this condition except to say that the condition called "dead fingers" is the most characteristic feature of the first stage. chilblains represent the mildest grade of the second stage. the parts are intensely congested and there may be excruciating pain. any one who has ever had chilblains knows how painful they can be. the general health is not impaired as a rule, although the attacks are apt to come on when the person is run down. the third stage may vary from a very mild grade, with only small necrotic areas at the tips of the fingers, to extensive multiple gangrene. another and very rare condition in which chronic endarteritis was the only constant finding is the disease described by s. weir mitchell and called by him erythromelalgia (red neuralgia). this is "a chronic disease in which a part or parts--usually one or more extremities--suffer with pain, flushing, and local fever, made far worse if the parts hang down." (weir mitchell.) probably the most frequently seen result of arteriosclerosis in the leg arteries is the remarkable condition, first described by charcot, known as intermittent claudication. persons the subject of this disease are able to walk if they go slowly. if, however, any attempt be made to hurry the step, there results total disability accompanied at times by considerable cramp-like pain. the condition is much more prone to occur in men than in women, and hebrews seem more frequently affected. the cause is most probably to be sought in the anemia which results from the narrowing of the channels through which the blood reaches the part. the stiff, much narrowed arteries allow sufficient blood to pass along for the nutrition of the part at rest or in quiet motion. just as soon as more violent exercise is taken, calling for more blood, an ischemia of the part supervenes, for the stiff vessels can not accommodate themselves to changes in the necessary vascularity of the part. a rest brings about a gradual return of blood and the function of the part is restored. pulsation may be totally absent in the dorsal arteries of the feet and when the legs are allowed to hang down there is apt to be deep congestion. in this connection a curious case reported by parkes weber will not be out of place. the patient, a male, aged years, complained of cramp-like pains in the sole of the left foot and calf of the leg occurring after walking for a few minutes and obliging him to rest frequently. when the legs were allowed to hang over the side of the bed, the distal portion of the left foot became red and congested looking. no pulsation could be felt in the dorsal artery of the left foot or in the posterior tibial artery. there was no evidence of cardiovascular or other disease. an ulcer on the little toe had slowly healed, but cramp-like muscular pains still occurred on walking. the disease had lasted about five years without the appearance of gangrene. weber calls this case one of arteritis obliterans with intermittent claudication. =pulmonary artery= in the symptomatology of sclerosis of the pulmonary artery the clinical signs and symptoms are mostly referable to the obliterating endarteritis of the smaller vessels, while the physical signs are more apt to reveal the involvement of the main trunk. a history of severe infection in the past is frequent, especially smallpox, and accompanying aortic sclerosis with insufficiency of the mitral valve or stenosis of this valve is the rule. striking cyanosis is an early symptom, while there is little if any dyspnea and edema. intermittent dyspragia is common. there seems to be no tendency to clubbed fingers. repeated hemorrhages from the lungs without the formation of infarcts may occur. there is usually an area of dullness at the upper left margin of the sternum and nearby parts, sensitive to pressure and to percussion, and the heart dullness extends unusually far towards the right. the diagnosis of the right ventricular hypertrophy may be substantiated by a fluoroscopic examination. chapter x diagnosis =early diagnosis= arteriosclerosis is essentially a disease of middle life and old age. it is not unusual, however, to find evidences of the disease in persons in the third decade and even in the second decade. hereditary influences play a most important rôle, syphilis and the abuse of alcohol in the family history are particularly momentous. the recognition of the early changes in the arteries among young persons depends largely upon how carefully these changes are looked for. the difference in the point of view of one man who finds many cases in the comparatively young, and another man who rarely finds such changes early in life, at times, depends upon the acuity of perception and observation and not upon the fact that one man has had a series of unusually young arteriosclerotic subjects. the diagnosis of arteriosclerosis may be so easily made that the tyro could not fail to make it. it is, however, the purpose of this volume to lay stress on the earliest possible diagnosis and, if possible, to point out how the diagnosis may be arrived at. it is obviously much to the advantage of the patient to know that certain changes are beginning in his arteries, which, if allowed to go on, will inevitably lead to one or more of the symptom groups described in the preceding chapters. the combination of ( ) hypertrophied heart, ( ) increased blood pressure, ( ) palpable arteries, and ( ) ringing, accentuated second sound at the aortic cartilage is, in reality, the picture of advanced arteriosclerosis. if the individual is in good condition much may be done by judicious advice and treatment to ward off complications and prolong life with a considerable degree of comfort. but we should not wait until such signs are found before making a diagnosis and instituting treatment. as in all forms of chronic disease the early diagnosis is all important. the history of the case is the first essential. often a careful inquiry into the personal habits of a patient, with the record of all the preceding infectious diseases will give us valuable information and may be the means of directing the attention at once to the possible true condition. particularly must we inquire into the family history of gout and rheumatism. an individual who comes of gouty stock is certainly more prone to arterial degeneration than one who can show a healthy heredity. alcoholism in the family also is of importance because of the fact that the children of alcoholics start in life with a poor quality of tissue, and conditions that would not affect a man from healthy stock might cause early degeneration of arterial tissue in one of bad ancestry. what infectious diseases has the patient had? even the exanthemata may cause degenerations in the arteries, but, as has been shown, such lesions probably heal completely with no resulting damage to the vessel. should the patient have passed through a long siege of typhoid fever the problem is quite different. here (vide supra) (thayer), the palpable arteries do appear to be sclerosed permanently. probably the length of time that the toxin has had a chance to act determines the permanent damage to the vessel wall. more potent than all other diseases to cause early arteriosclerosis is syphilis, and hence very careful inquiry should be made in regard to the possibility of infection with this virus. not only the fact of actual infection but the duration and thoroughness of treatment are important matters for the physician to know. what is the patient's occupation? has he been an athlete, particularly an oarsman? has he been under any severe, prolonged, mental strain? is he a laborer? if so, in what form of manual labor is he engaged? such questions as these should never be overlooked, as they form the foundation stones of an accurate diagnosis, and early, accurate diagnosis, we repeat, is essential to successful therapy. we have called attention to the factor of sustained high pressure in the production of arteriosclerosis. constant overstretching of the vessels leads to efforts of the body to increase the strength of the part or parts. the material which is used to strengthen the weakened walls has a higher elastic resistance than muscle and elastic tissue, but a lower limit of elasticity, and is none other than the familiar connective tissue. in athletes, laborers, brain workers who are under constant mental strain, and in those whose calling brings them into contact with such poisons as lead, there is every factor necessary for the production of high tension and consequently of arteriosclerosis. another question in regard to personal habits is how much tobacco does the patient use and in what form does he use it? our experience is that the cigar smoker is more prone to present the symptoms of arteriosclerosis than the cigarette smoker, the pipe smoker, or the one who chews the tobacco. a very irritable heart results not infrequently from cigarette smoking but such is almost always found in young men in whom the lesions of arteriosclerosis are exceedingly rare. the probabilities are that the arteriosclerosis in cigar smoking results from the slowly acting poison which causes a rapid heart rate with an increase of pressure. last but not least, and perhaps the most important question is, has the patient been a heavy eater? this i believe to be a potent cause of splanchnic arteriosclerosis with the resulting indigestion, cramp-like attacks, high blood pressure, etc. in a joking manner we are accustomed to remark, "overeating is the curse of the american people." there is, however, much truth in that sentence. osler, than whom there is no keener observer, states that he is more and more impressed with the fact that overloading the stomach with rich or heavy or spiced foods is today one of the first causes of arterial degeneration. it stands to reason that this is true. we know that organs exposed constantly to hard work undergo hypertrophy, and that the blood tension in those organs is high. blood tension is, after all, dependent on capillary resistance, and if the capillaries are distended with blood, the resistance is great. the digestive organs can be no exception to this rule. increased work means an increase of blood. this inevitably causes distension of the capillaries with stretching of the arteries and consequent damage to the walls. once arteriosclerosis is present a vicious circle is established. a man about forty-five consults us and says that he has noticed recently that he gets out of breath easily; in tying his shoes he experiences some dizziness. he finds that he has palpitation of the heart and possibly pain over the precordial region now and then. he notices also that he is irritable, that is, his family tell him he is, and he notices that things that formerly did not annoy him, now are almost hateful to him. on examination, one finds a palpable radial, a somewhat hypertrophied heart and slightly accentuated second aortic sound. the blood pressure may be high. the urine may or may not reveal any abnormalities. not infrequently, although no albumin may be found, there are hyaline casts. such a case of arteriosclerosis is evidently not to be regarded as early. then the question arises, how are we to recognize early arteriosclerosis? i do not believe that the solution of this problem lies entirely in the hands of the physician. some men are fortunate enough to come up for an examination for life insurance before an observant doctor who recognizes the palpable artery, makes out the beginning heart hypertrophy and the slightly accentuated second aortic sound. the patient will tell you that he never felt better in his life. he gets up at seven, works all day, plays golf, drinks his three to six whiskies, and is proud of his physical development. but the great mass of people are not fortunate from this standpoint. they do not seek the advice of the physician until they are stretched out in bed. they boast of the fact that for twenty years they have never had a doctor. one may well say that it is a problem how to reach such persons. it seems to me that there can be but one way to do this. the people must be taught that the duty of a physician is just as much to keep them in health as it is to bring them back to health when they are ill. to that end people should be taught that at least twice a year they should be carefully examined. i do not mean that the patient should present himself to the doctor and, after a few questions the doctor say cheerfully, "you are all right." the patient should be systematically examined. that means a removal of the clothing and examination on the bare skin. such cooperation on the part of patient and doctor would save the patient years of active life and make of the doctor, what his position entitles him to be, the benefactor to the community. too often careless work on the physician's part lulls the patient into a false sense of security and he wakes up too late to find that he has wasted months or years of life. early diagnosis of arteriosclerosis is only possible in exceptional cases unless people present themselves to the physician with the thought in mind that he is the guardian of health as well as the healer. there are patients who go to the ophthalmologist for failing vision. physically they feel quite well. they have been heavy eaters, hard workers, men and women who have been under great mental strain. on examination of the fundus of the eye there is found slight tortuosity of the vessels with possibly areas of degeneration in the retina. a careful physical examination will usually reveal the signs of arteriosclerosis elsewhere. we have mentioned frequently high tension as an early sign. this must be taken with somewhat of a reservation, for this reason: not infrequently a persistent high tension is the earliest sign of chronic nephritis. the arteries may be pipe stem in character and the heart small and flabby. however, if one watches for the palpably thickened superficial arteries (always bearing in mind the normal palpability as age advances) and the high tension, he can not go far wrong in his treatment whether the case is one of chronic nephritis or of arteriosclerosis. there is also this to bear in mind. arteriosclerosis may be marked in some vessels and so slight in the peripheral vessels that it can not with certainty be made out. but when the radials are sclerosed, it is usually the case that similar changes exist in other parts. then too, there may be marked changes at the root of the aorta leading to sclerosis of the coronary vessels alone, and the first intimation that the patient or any one else has that there is disease, may be an attack of angina pectoris. except for symptoms on the part of the heart there is no way to make the diagnosis of sclerosis of the coronary arteries. =differential diagnosis= in arriving at a diagnosis, when the question is whether or not arteriosclerosis is the main etiologic factor, the most important fact to know is the age of the patient. other points that have been dwelt on fully must of necessity also be borne in mind. possibly the chief conditions that may be confused with some of the results of arteriosclerosis are pseudo angina pectoris which may be mistaken for true angina pectoris, and ulcer of the stomach, appendicitis (?) or other inflammatory abdominal condition which may be mistaken for angina abdominalis. differential tables are sometimes of value in fixing the chief points of difference graphically. =pseudo angina pectoris=. etiology rather certain; hysteria, neurasthenia, toxic agents, and reflex irritations. no age is exempt. usually in young people, chiefly females. paroxysms of pain occur spontaneously, are periodic and often nocturnal. pain, while severe, is diffuse and sensation is of distension of heart. no sense of real anguish. duration may be an hour or more. restlessness and emotional symptoms of causative conditions are prominent. usually no increase in arterial tension. prognosis favorable. =true angina pectoris=. etiology not certain but almost always associated with arteriosclerosis of the coronary arteries and also aortic regurgitation. age is important factor. rare before forty, and males usually affected. paroxysms brought on by overexertions or excessive mental emotion. rarely periodic. intense pain, radiating down arm; heart felt as in a vise. sense of anguish and impending dissolution. duration from few seconds to several minutes. silent and fixed attitude, rigidity rather than restlessness. arterial tension is as a rule increased. prognosis most unfavorable. in differentiating between ulcer of the stomach and angina abdominalis the following points may be of service: =ulcer=. occurs as a rule in young persons, more often females. pain of boring character increased by food and by certain positions with food in stomach. felt through to left of spine. occult blood found in stools. considerable anemia apt to be present. arterial tension usually low. =angina abdominalis=. only occurs in adults over forty who have been heavy eaters and drinkers, mostly males. pain cramp-like, diffuse, although more localized in epigastrium. not necessarily any connection with food. no occult blood in stools. anemia more often absent. arterial tension high. (splanchnic sclerosis.) =diseases in which arteriosclerosis is commonly found= there are certain more or less chronic diseases in which arteriosclerosis is found either as a separate disease or as a result of the chronic disease itself, or the sclerosis may be the cause of the disease. as examples of the first class are diabetes mellitus and cirrhosis of the liver. as examples of the second class are chronic nephritis, gout, syphilis, and lead poisoning. examples of the third class have already been fully described. then certain rare diseases that have been briefly described in this chapter, viz.: raynaud's disease and erythromelalgia are frequently associated with demonstrable arteriosclerosis. chapter xi prognosis in a disease that presents as many vagaries as arteriosclerosis, it is not possible to give a certain prognosis. unfortunately we do not as a rule see the arteriosclerotic until the disease is well advanced, or even after some of the more serious complications have taken place. by that time the condition is progressive, and while the prognosis is grave the individual may live a number of years. it is fortunate for the arteriosclerotic that mild grades of the disease are compatible with a fairly active life. the disease in this stage may become arrested and the patient may live many years. not only in the mild grades is this possible. even patients with advanced sclerosis may enjoy good health provided the organs have not been so damaged as to render them unfit to perform their functions. the frequency with which we see advanced arteriosclerosis at the postmortem table as an accidental discovery, attests the truth of the foregoing statement. yet how often does it happen that individuals, apparently in the best of health, suddenly succumb to an asthmatic or uremic attack, an apoplexy, cessation of the heart beat, or a rupture of the heart due to arteriosclerosis! in order to arrive at an intelligent opinion in regard to prognosis certain factors must be taken into consideration, chief of which are: the seat of the sclerosis; the probable stage; the existing complications; and, last and most important, the patient himself. the whole man must be studied and even then our prognosis must be most guarded. it is much more dangerous for the patient when the process is in the ascending portion of the arch of the aorta than when it has attacked the peripheral arteries. here, at the root of the aorta, are the openings of the coronary arteries and the arteries supplying the brain are close by. the coronary arteries here control the situation. when loud murmurs are heard at the aortic orifice and the heart is evidently diseased, it is useful to divide the endocarditis into two types, the arteriosclerotic and the endocarditic. the etiology of the former is sclerosis and the prognosis is grave because of the liability, nay the probability, that the orifices of the coronary arteries will become narrowed. the etiology of the second type is in most cases rheumatic fever or some other infectious disease, and the prognosis is far better than in the first type. true, the two may be combined. in such a case, the prognosis is entirely dependent upon the course of the arteriosclerosis. the involvement of the arteries in the kidneys is of considerable importance, for it is usually bilateral and widespread. as a rule, the disease makes but slow progress provided that the general condition of the patient is good, but at any time from a slight indiscretion or for no assignable cause, symptoms of renal insufficiency may appear and may rapidly prove fatal. it must not be thought that because the localization of the arteriosclerosis in the peripheral arteries is usually the most favorable condition that it is therefore devoid of ill effects. on the contrary, very serious, even fatal, results may be brought about by interference with the circulation with resultant extensive gangrene of the part supplied by the diseased arteries. the amputation of a portion of a leg, for instance, may relieve, to some extent, an overburdened heart and prove life-saving to the patient, but the neuritic pains are not necessarily relieved. the torture from these pains may be excruciating. no stage of the disease is exempt from its particular danger. in the early stages of the disease before the artery or arteries have had time to become strengthened by proliferation of the connective tissue, there is the danger of aneurysm. later, the very same protective mechanism leads to stiffening and narrowing of the arteries and hence to increased work on the part of the heart with all of its consequences. thrombosis is favored, and where atheromatous ulcers are formed, embolism is to be feared. as the complications and results of arteriosclerosis come to the front every one must be considered by itself and as if it were the true disease. there may be a slight apoplectic attack from which the patient fully recovers, but the prognosis is now of a grave character, as the chances are that another attack may supervene and carry off the subject. yet, after an apoplectic attack, patients have lived for many years. probably the most noted illustration of this is the life of pasteur. he had at forty-six hemiplegia with gradual onset. he recovered with a resulting slight limp, did some of his best work after the stroke, and lived to be seventy-three years old. yet the exception but proves the rule and the prognosis after one apoplectic stroke should always be guarded. the first attack of cardiac asthma is to be looked upon as the beginning of the end. the end may be postponed for some time, but it comes nearer with every subsequent attack. one may recover from what appears to be a fatal attack of cardiac asthma accompanied by edema of the lungs and irregular, intermittent, laboring heart, but the recovery is slow and the chances that the next attack will be the fatal one are increased. the significance of albuminuria is difficult to determine. the kidneys secrete albumin under so many conditions that the mere presence of albumin in the urine may have but little prognostic value. many cases are seen where there is no demonstrable albumin, and yet the patient may suddenly have a cerebral hemorrhage. as a general rule the urine should be carefully examined, but not too much stress should be laid on the discovery of albumin and casts. it is not always possible to determine the extent of the kidney lesion by the urinary examination, yet at any time a uremic attack may appear and prove fatal. after all the most important fact for the patient is not what the pathologist finds in his kidneys after he is dead, but what the living functional capacity of the kidneys is. this can now be determined in a variety of ways as the result of extensive work carried out in quite recent years. the simplest method of determining the functional capacity of the kidneys is by the injection into the muscles of the back of a solution containing mg. of the drug phenolsulphonephthalein in one c.c. of fluid. this comes already prepared in ampules, with full directions for its employment.[ ] some clinicians use indigo-carmine in place of phthalein. the general consensus of opinion is in favor of phthalein. [ ] i have found the small colorimeter made by hynson, westcott and dunning, baltimore, mo., costing $ . , a very practical instrument. the nephritic test meal carefully worked out by mosenthal[ ] gives much valuable information. the determination of the nonprotein nitrogen or the creatinin in the blood also reveals the functional capacity of the kidneys.[ ] [ ] mosenthal, h. o.: arch. int. med., , xvi, . [ ] myers and lough: arch. int. med., , xvi, . one might say that the appearance of albumin in the urine of an arteriosclerotic where it had not been before, is a bad sign, and in making a prognosis this must be taken into consideration. bleeding from the nose is not infrequently seen in those who have arteriosclerosis. it can hardly be called a dangerous symptom as it can always be controlled by tampons. there are times when epistaxis is decidedly beneficial as it relieves headache, dizziness, and may avert the danger of a hemorrhage into the brain substance. it is rare to have nose bleed except in cases of high tension in plethoric individuals. my experience has been that it has saved me the trouble of bleeding the patient. it is always of serious import in that it indicates a high degree of tension, but there is scarcely ever any immediate danger from the nose bleed itself. intestinal hemorrhage is always a grave sign. as has been shown, arteriosclerosis of the splanchnic vessels not infrequently occurs, and an embolus or thrombus may completely occlude the superior mesenteric artery. the chances of the establishment of a collateral circulation are small, as the arteries of the intestines are end arteries. necrosis of the part follows, blood is found in the stools, and perforation or gangrene, or both, are apt to follow. there may be blocking of small branches only, leading to ulceration of the intestine. under all conditions the prognosis is serious. the general condition of the patient, his build, physical strength, powers of recuperation, etc., must be taken into account in giving a prognosis. the more powerful the individual, the more favorable, as a rule, is the prognosis, with this reservation always in mind, that the greater the body development, the greater is the heart hypertrophy, and the accidents from high tension must not be overlooked. many puny individuals with stiff, calcified arteries go about with more ease than a robust man with thickened arteries only. the differentiation as pointed out by allbutt (page ), is well to keep in mind in giving a prognosis. it can not be too strongly emphasized that it is the whole patient that we must consider and not any one system that at the time happens to be the seat of greatest trouble, and by its group of symptoms dominates the picture. it is evident from what has been said that an accurate prognosis in arteriosclerosis is no easy matter. were arteriosclerosis a simple disease of an acute character there might be grounds for giving a more or less definite prognosis. the most that can be said is that arteriosclerosis is always a serious disease from the time that symptoms begin to make themselves known. the gravity depends altogether on the seat of the greatest arterial changes, and is necessarily greater when the seat is in the brain than when it is in the legs or arms. the attitude of the patient himself also determines to a great extent the prognosis. some men, especially those who have always enjoyed good health, turn a deaf ear to warnings and instead of ordering their lives according to the advice of the physician, persist in going their own way in the hope that the luck that has always been with them will continue to stand at their elbows. neither firmness nor pleadings avail with some men. the only salve for the conscience of the physician is that he has done his best to steer the patient away from the shoals and breakers. in others who realize their condition and take advantage of the advice given as to the regulation of their lives, the prognosis is generally favorable. to sum up the chapter in a few words, i should say: always remember that the patient is a human being; study his habits and character and mode of life; look at him as a whole; take everything into consideration, and give always a guarded prognosis. chapter xii prophylaxis arteriosclerosis comes to almost every one who lives out his allotted time of life. as has been noted within, many diseases and many habits of life are conducive to the early appearance of arterial degeneration. decay and degeneration of the tissues are necessary concomitants of advancing years and none of us can escape growing old. from the period of adolescence certain of the tissues are commencing a retrograde metamorphosis, and hand in hand with this goes the deposit of fibrous tissue which later may become calcified. the arterial tissue is no exception to this rule, and we have already shown that certain changes normally take place as the individual grows older, changes which are arteriosclerotic in type and are quite like those caused in younger people by many of the etiologic factors of the disease. we are absolutely dependent upon the integrity of our hearts and blood vessels for the maintenance of activity and span of life. respiration may cease and be carried on artificially for many hours while the heart continues to beat. even the heart has been massaged and the individual has been brought back to life after its pulsations have ceased, but such cases are few in number. we can not live without the heart beat and the prophylaxis of arteriosclerosis consists in the adjustment of our lives to our environment, so that we may get the maximum amount of work accomplished with the minimum amount of wear and tear on the blood vessels. the struggle for existence is keen. competition in every profession or trade is exceedingly acute, so much so that to rise to the head in any branch of human activity requires exceptional powers of mind. among those who are entered in this keen competition, the fittest only can survive for any period of time. the weaklings are bound to succumb. a scion of healthy stock will stand the wear and tear far better than will the progeny of diseased parentage. it is only necessary to call attention to the part that alcohol, syphilis and insanity play in heredity. these have been discussed fully in the earlier part of this book. we live rapidly, burning the candle at both ends. it is not strange that so many comparatively young men and women grow old prematurely. while heredity is a factor as far as the prophylaxis of arteriosclerosis is concerned, of far more importance is the mode of life of the individual. scarcely any of us lead strictly temperate lives. if we do not abuse our bodies by excessive eating and drinking and so wear out our splanchnic vessels and cause general sclerosis by the high tension thereby induced, we abuse our bodies by excessive brain work and worry with all their multitudinous evils. the prophylaxis of arteriosclerosis might well be labeled, "the plea for a more rational mode of life." moderation in all things is the keynote to health, and to grow old gracefully is an art that admits of cultivation. excesses of any kind, be they mental, moral, or physical, tend to wear out the organism. people habitually eat too much; many drink too much. they throw into the vascular system excessive fluid combined frequently with toxic products that cause eventually a condition of high arterial tension. it has been shown how poisonous substances absorbed from the intestines have some influence on the blood pressure. anything that causes constant increase of pressure should be studiously avoided. mild exercise is an essential feature of prophylaxis. one may, by judicious exercise and diet, make of himself a powerful muscular man without, at the same time, raising his average blood pressure. the man who goes to excess and continually overburdens his heart, will suffer the consequences, for the bill with compound interest will be charged against him. it is a great mistake for any one to work incessantly with no physical relaxation of any kind, and yet, after all, it is not so much physical relaxation that is necessary, as the pursuit of something entirely different, so that the mind may be carried into channels other than the accustomed routes. diversification of interests is as a rule restful. that is what every man who reaches adult life should aim at. hobbies are sometimes the salvation of men. they may be ridden hard, but even then they are helpful in bearing one completely away from daily cares and worries. the man who can keep the balance between his mental and physical work is the man who will, other things being equal, live the longest and enjoy the best health. nowadays the trend of medicine is toward prophylaxis. we give the state authority to control epidemics so far as it is possible by modern measures to control them. we urge over and over again the value of early diagnosis in all chronic diseases, for we know that many of them, and this applies particularly to arteriosclerosis, could be prevented from advancing by the recognition of the condition and the institution of proper hygienic and medicinal treatment. _it is the patent duty of every physician to instruct the members of his clientele in the fundamental rules of health._ recently the president of the american medical association, in his address before the meeting, urged the dissemination of accurate knowledge concerning diseases among the laity. while this may be done by city and state boards of health, it seems far better for the modern trained physician to work among his own people. with concise information concerning the modes of infection and the dangers of waiting until a disease has a firm hold before consulting the health mender, people should be able to protect themselves from infections and be able to nip chronic processes in the bud. but it is difficult to turn the average individual away from the habit of having a drug-clerk prescribe a dose of medicine for the ailment that troubles him. it is really unfortunate that most of the pains and aches and morbid sensations that one has speedily pass away with little or no treatment. herein lies the strength of charlatanism and quackery. unfortunate, yes, for a man can not tell whether the trivial complaint from which he suffers is any different from the one that was so easily conquered six months ago. but instead of recovering, he grows worse. hope that springs eternal in the human breast, leads him to dilly-dally until he at last seeks medical advice, only to find that the disease has made such progress that little can be done. _instruct the public to consult the doctors twice a year._ the dentists have their patients return to them at stated intervals only to see if all is well. _how much more rational it would be if men and women past the age of forty had a physical examination made twice a year to find out if all is well._ the prophylaxis of arteriosclerosis is moderation in all the duties and pleasures of life. this in no sense means that a man has to nurse himself into neurasthenia for fear that something will happen to him. as one grows in years exercise should not be as violent as it was when younger, and food should be taken in smaller quantities. many forms of exercise suggest themselves, particularly walking and golf. walking is a much neglected form of exercise which, in these modern days with our thousand and one means of locomotion, is becoming almost extinct. there is no better form of exercise than graded walking. to strengthen the heart selected hill climbing is one of the best therapeutic methods that we have. the patient is made to exercise his heart just as he is made to exercise his legs, and as with exercise of voluntary muscles comes increase in strength, so by fitting exercise may the heart muscle be increased in power. a warning should be sounded, however, against over exercise. this leads naturally to hypertrophy with all its disastrous possibilities. men who have been athletes when young should guard against overeating and lack of exercise as they grow older. many of the factors which favor the development of arteriosclerosis are already there, and a sedentary, ordinary life, such as office all day, club in afternoon, a few drinks and much rich food, will inevitably lead to well-advanced arterial disease. karl marx in his famous socialistic platform said: "no rights without duties; no duties without rights." so we may paraphrase this and say: "no brain work without moderate physical exercise in the open air; no physical exercise without moderate brain work." there is yet one other point that is important, the combination of concentrated brain work and constant whiskey drinking. this is most often seen in men of forty-five to fifty-five, heads of large business concerns who habitually take from six to twelve drinks of whiskey daily, and with possibly a bottle of wine for dinner. such men appear ruddy and in prime health but, almost invariably, careful examination will reveal unmistakable signs of arterial disease. there is usually the enlarged heart and pulse of high tension with or without the trace of albumin in the urine. the lurking danger of this group of manifestations has so impressed the medical directors of several of the large insurance companies that a blood pressure reading must be made on all applicants over forty years of age. should high blood pressure be found, the premium is increased, as the expectation of life is proportionately shorter in such men than in normal persons. therefore, let every physician act his part as guardian of health. only in this way is the prophylaxis of arteriosclerosis possible. chapter xiii treatment although it has been rather dogmatically stated (vide supra) that every one who reaches old age has arteriosclerosis, it must not be inferred that absolutely no exceptions to this rule are found. cases are known where persons of ninety years even had soft arteries, and we have seen persons of eighty whose arteries could not be palpated. when infants and children are seen with considerable sclerosis, it proves that, after all, it is the quality of the tissue even more than the wear and tear, that is the determining factor in the production of arteriosclerosis. it would be well if those who can not bring healthy progeny into the world were to leave this duty to those who can. in general the treatment of arteriosclerosis is prophylactic and symptomatic. in the preceding chapter i had something to say about prophylaxis in general; i must again refer to it in detail. arteriosclerosis is essentially a chronic progressive disease, and the secret of success in the management of it is not to treat the disease or the stage of the disease, but to treat the patient who has the disease. to infer the stage of the disease from the feeling of the sclerosed artery, may lead to serious mistakes. persons with calcified arteries may be perfectly comfortable, while those with only moderate thickening may have many severe symptoms. the keynote is individualization. it is manifestly absurd to treat the laboring man with his arteriosclerosis as one would treat the successful financier. the habits, mode of life, every detail, should be studied in every patient if we expect to gain the greatest measure of success in the treatment. one may treat fifty patients who have typhoid fever by a routine method and all may recover. individualizing, while of great value in the treatment of acute diseases, yet is not absolutely essential in order that good results may be obtained. far different is it when treating a disease like arteriosclerosis. one who relies on textbook knowledge will find himself at a loss to know what to do. textbooks can only outline, in the briefest manner, the average case, and no one ever sees the average book case. at the bedside with the patients is the place to learn therapeutics as well as diagnosis. all that can be hoped for in outlining the treatment of arteriosclerosis is to lay down a few principles. the tact, the intuition, the subtle something that makes the successful therapeutist, can not be learned from books. so the man who treats cases by rule of thumb is a failure from the beginning. there are certain general principles that will be our sheet anchors at all times and for all cases. the art of varying the application of these fundamentals to suit the individual case, is not to be culled from printed words. =hygienic treatment= every man is more or less the arbiter of his own fate. granted that he has good tissue to begin life, his own habits and actions determine his span of comfortable existence. no one cares to live after his brain begins to fail, and the failing brain is often due to disease of the cranial arteries. the hygienic treatment resolves itself into advice in regard to prophylaxis. first and foremost is exercise. it has seemed to us that the revival of out-of-door sports is one of the best signs of promise of the preservation of a virile, hardy race. that women, as well as men, indulge in the lighter forms of out-of-door exercise should bring it about that the coming generation will start in life under the most advantageous conditions of bodily resistance. among all the forms of exercise, golf probably is the best. it is not too violent for the middle-aged man, yet it gives the young athlete quite enough exercise to tire him. it is played in the open. one is compelled to walk up and down in pleasant company, for golf is essentially a companionable game, while he reaps the full benefit of the invigorating exercise. the blood courses through the muscles and lungs more rapidly; the contraction of the skeletal muscles serves to compress the veins and so to aid the return of blood to the heart: the lungs are rendered hyperemic, deeper and fuller breaths must be taken; oxidation is necessarily more rapid, and effete products, which if not completely oxidized would possibly act as vasoconstrictors, are oxidized to harmless products and eliminated without irritating the excretory organs. other forms of out-door exercise that can be recommended are tennis, canoeing, rowing, fishing, horseback riding, swimming, etc. tennis is the most violent of all the sports mentioned and might readily be overdone. rowing as practiced by the eights at college is undoubtedly too violent a form of exercise, and may be productive in later life of very grave results. canoeing is a delightful and invigorating exercise. the muscles of the arms, shoulders, and trunk are especially used, the leg muscles scarcely at all. nevertheless, the deep breathing that necessarily comes with all chest exercises aerates every portion of the lungs, and is of great benefit to the whole body. swimming as an exercise has much to recommend it. in this sport all the muscles take part and at the same time the chest is broadened and deepened. all these methods of using the muscles to keep oneself in trim, so to speak, are part and parcel of the general hygienic mode of life that is conducive to a healthy old age. exercise can be overdone, as eating can be overdone. both are essential and yet both can be the means of hastening an individual to a premature grave. when the arteriosclerosis has advanced so far that it is easily recognizable, certain forms of exercise should be absolutely prohibited. such are tennis, rowing and swimming. horseback riding to be allowed must be strictly supervised. at times this may be an exceedingly violent exercise. as an out-of-door sport, there is nothing that equals golf. the physician, knowing the character of the course, and the length of it, can say to his patient that he may play six, nine, twelve, or eighteen holes, depending on the patient's condition. for those who are not able to get out, exercise in the room with the windows open must take the place of out-of-door sports. here the use of chest weights is a most excellent means of keeping up the tone of the muscles. by adjusting the weights, the exercise may be made light, medium, or heavy. every physician should be familiar with the chest weight exercises. they are not as good as open air exercise but they undoubtedly have been the means of saving years of life to many patients with arterial disease. there comes a time when all forms of exercise must be prohibited on account of the dyspnea, edema, dizziness, etc. it seems unwise to keep such a patient in bed, even though the edema be considerable. once on his back in bed he becomes weak, and the danger of edema of the lungs or hypostatic congestion of the bases, with subsequent bronchopneumonia, is very great. such patients may be allowed to sit up in a comfortable chair with the legs supported straight out on a stool or other chair. the half reclining position is not easy to assume in bed. considerable ingenuity must often be exercised by the physician in making the patient comfortable without increasing the symptoms from which the patient suffers following the least amount of exercise. although such persons can not exercise actively, they should have passive exercise in the form of massage, carefully given, so that no injury is done to the rigid vessels. it is possible to rupture a vessel, the walls of which are encrusted with lime salts, and full of small aneurysmal dilatations. every patient must be watched carefully and measures instituted for the individual. =balneotherapy= as a tonic and invigorator, the cold or cool bath (shower or tub), in the morning on arising can be highly recommended. it promotes skin activity, is a stimulant to the bowels and kidneys and to the general circulation, besides being cleansing. we find today that the morning bath has become such a necessity to the average american that all new hotels are fitted with private baths, and old hotels, in order to get patronage, are arranging as many baths connected with sleeping rooms as is possible. our generation assuredly is a ruddy, clean-bodied one. what the actual results of this out-door life and frequent bathing will be for the race remains to be seen, but one can not but feel that it must build up a stronger, more resistant race of people, who not only enjoy better health than did their forefathers, but enjoy it longer. not every one can stand a cold bath. it is folly to urge it on one to whom it is distasteful, or on one who does not feel the comfortable glow that should naturally result. for the well, or those with a tendency to arteriosclerosis, or those in whose families there have been several members who had early arteriosclerosis, such proceedings as recommended could not be improved upon. however, for the person who has well recognized sclerosis, only warm baths should be advised, and these not daily. the water should be at a temperature of - ° f. care should be taken that persons sent to spas be cautioned against hot baths. it is not inconceivable that the increased force of the heart beat that accompanies a hot bath might be sufficient to rupture a small cranial vessel. hence, turkish and russian baths should be most unqualifiedly condemned. as a matter of fact, persons vary so in their habits with regard to bathing that what might suit one person would do another much harm. =personal habits= the personal habits of the individual, more than any other factor, determine whether or not arteriosclerosis sets in early in his life. the man or woman who is moderate in eating and drinking, sees that the kidneys are kept in good condition, and attends strictly to regularity of the bowels, lays a good basis for the measure of health which is so essential for happiness. it has been shown that sclerosis of the splanchnic vessels may be due to constant irritation of toxic products elaborated in digesting constantly enormous meals. in obstinate constipation, many poisons, the nature of which we do not know, are absorbed and circulate in the blood. we have not sufficient data to prove that constipation favors the production of arteriosclerosis, but our impression has been that it does favor it. constipation can often be relieved by a glass of water before breakfast, a regular time to go to stool, and abdominal massage or exercises. some maintain that it is a bad habit only, and can be readily overcome. whatever is done, avoid leading the patient into the drug habit, for the last state of the patient will be worse than the first. habits of sleep are not of such great importance. most persons get enough sleep except when under severe mental strain. most adults need from seven to eight hours' sleep, although some can do all their work and keep in prime health on five or six hours' sleep. tobacco has been accused of causing many ills and has been thereby much maligned. we can not see that the use of tobacco in any form in moderation is harmful to most men. undoubtedly the blood pressure is raised when mild tobacco poisoning occurs, and individual peculiarities of reaction to the weed are multitudinous. but to condemn offhand its use is the height of folly. there is no reason why the arteriosclerotic who has always used tobacco in moderation, should not continue to use it, whether he smoke cigarettes, cigars, or pipe. his supply should be decreased, but there is no sense in depriving a man of one of the solaces of life, unless, as is sometimes the case, abstinence is easier for the patient than moderation. as for alcohol, opinions differ widely.[ ] some see in alcohol one of the most frequent causes of arteriosclerosis; others do not believe that the part played by alcohol is a serious one, only in conjunction with other poisonous substances is it dangerous. probably unreasoning fanaticism has had much to do with the wholesale condemnation of alcoholic beverages. the general effect of alcohol is to lower the blood pressure by causing marked dilatation of all the vessels of the skin. true, the alcohol circulates in the blood, and is broken up in the liver, and this organ would seem to bear the brunt of the harm done. alcoholic drinks in moderation, i do not believe have any deleterious effect on health. on the contrary, i believe that they may in some cases assist digestion and assimilation. indiscriminate indulgence is to be condemned, as is overindulgence in exercise or eating. what may be moderate for a, might be excessive for b. every man is then the arbiter of his own fortune and within his own limits can indulge moderately (a relative term after all) without fear of doing himself harm. in advanced arteriosclerosis it is necessary to decrease the supply of alcohol just as it is necessary to cut down the food supply. this must rest entirely on the judgment of the physician, who must not act arbitrarily, but must have his reasons for every one of his orders. [ ] discussion of alcohol at present has value only as it relates to the past. the present is dry. the future is in the lap of the gods. =dietetic treatment= most persons eat too much. we not only satisfy our hunger, but we satisfy our palates, and, instead of putting substantial foodstuffs into our stomachs, we frequently take unto ourselves concoctions that defy description. foodstuffs are composed of one or all of three classes: ( ) proteins, ( ) fats, ( ) carbohydrates. as examples of the first are beef and white of egg; of the second, the oils, butter, lard; of the third, sugar, potato, beet, corn, etc. the physiologists and chemists have shown us that both endogenous and exogenous uric acid in excess will cause a rise of blood pressure, but the bodies most concerned in the production of elevated blood pressure are the purin bodies, those organic compounds which are formed from proteins and represent chemically a step in the oxidation of part of the protein molecule to uric acid. red meat contains more of the substances producing purin bodies than any other one common foodstuff, and for this reason the excessive meat eater is, _ceteris paribus_, more apt to develop arteriosclerosis comparatively early in life. the fats and carbohydrates contain practically no substances that react on the body of the ordinary individual in a deleterious manner during their digestion. the extra work that is put on the heart by the formation of many new blood vessels in adipose tissue is the only harmful effect of overindulgence in these foodstuffs. it has been found that nitrogen equilibrium can be maintained at a wide range of levels. formerly - gms. of protein daily were considered necessary for a man doing light work. now it is known that half that amount is sufficient to keep one in nitrogenous equilibrium, and to enable one to keep his weight. a person at rest requires even less than that. one who is engaged in hard physical labor burns up more fuel in the muscles, and so must have a larger fuel supply. although we habitually eat too much we drink too little water. for those who have any form of arterial disease an excess of fluid is harmful, as the vessels become filled up and a condition of plethora results, which necessarily reacts injuriously on the heart and circulation. the drinking of a glass of water during meals is, in the author's opinion, good practice. the water must be taken mouthful at a time, and not gulped down. if this is done, there results sufficient dilution of the solid food to enable the gastric juices successfully and rapidly to reach all parts of the meal. some are in favor of a rigid milk diet for those who have arteriosclerosis. some men have lived on nothing but milk for several years and have not only kept in good health, but have actually gained weight and led at the same time active lives. it has been held by others that rigid milk diet is positively harmful on account of the relatively large quantity of calcium salts that are ingested. this was thought to favor the deposition of calcareous material in the walls of the already diseased arteries. while possibly there may be some danger of increased calcification, the majority of clinicians are in favor of a milk cure given at intervals. thus the patient is made to take three to four quarts daily for a period of a month. there is then a gradual return to a general diet, exclusive of meat, for several weeks, then another rigid milk diet period. if we are bold enough to follow metschnikoff in his theories of longevity, we might advise resection of the large intestine, on the ground that it is an enormous culture tube that produces prodigious amounts of poisonous substances which are thrown into the general circulation. to combat such a grave (?) condition as the carrying of several feet of large intestine, we are recommended to take buttermilk or milk soured by means of the _b. acidus lacticus_. clinical experience has taught that in arteriosclerosis buttermilk is of great value, whether it be the natural product, or made directly from sweet milk by the addition of the bacilli. the latter is a smoother product and has, to my mind, a delightful flavor. it may be diluted with vichy or plain soda water. cases that can not take milk or any other food will often take buttermilk, and do well on this restricted diet. from two to four quarts daily should be taken. it should be drunk slowly as should milk. =medicinal= it has long been thought that the iodides have some specific effect on the advancing arteriosclerosis, checking its spread, if not really aiding nature to a limited restoration of the diseased arteries. it is possible that the eulogies upon the iodides owe their origin to the successful treatment of syphilitic arteriosclerosis, in which condition these drugs have a specific action. however that may be, there is no doubt that the administration of sodium or potassium iodide is good therapeutics in cases of arteriosclerosis. unfortunately many persons have such irritable stomachs that they can not take the iodides, even though they be diluted many times. they may be made less irritating by giving them with essence of pepsin. unless the case is syphilitic, it is doubtful whether it is of value to increase the dose gradually until a dram or even more is taken three times daily after meals. usually a maximum dose of ten grains seems to be quite sufficient. this may be taken three times a day, well diluted, for three months. there follows a month's rest, then the treatment is resumed for another period of three months, and so on. either sodium or potassium iodide in saturated solution may be given. the sodium salt is possibly less irritating, and contains more free iodine than the potassium salt, although the latter is more generally used. the strontium iodide may also be used. one sees a patient now and then who can not take the iodides, however they may be combined. for such patients one may obtain good results with iodopin, sajodin, or other of the preparations put up by reputable firms. personally i have never yet seen a patient who could not take the ordinary iodides in some form or other, and i am opposed to ready made drugging. the action of the iodides is to lower the blood pressure, and they are of greatest value when the blood pressure is high, and when headache and precordial pain are present. when the case is moderately advanced, very mild doses, gr. / , morning and evening, of the thyroid extract may be given. it is generally believed that the internal secretion of the thyroid and the adrenal are antagonistic. that the thyroid secretion lowers blood pressure in certain forms of hypertension is certain, possibly on account of its iodine content. some combinations of iodine and thyroid such as the iodothyroidin have been used and have had some measure of success attributed to them. hypertension does not always demand active measures for its reduction. viewed from the physiologic standpoint, hypertension is but the expression of a compensating mechanism which is designed to keep the blood moving through narrowed channels. heart hypertrophy then is absolutely essential to the maintenance of life. it has been said that the highest blood pressures occur in chronic disease of the kidneys. the poisonous substances produced in the kidneys must exert their action through absorption into the general blood stream. this toxin may be completely eliminated, if we accept as our criterion the reduction of tension to normal together with the complete return of the affected individual to health. a concrete example is as follows: a man aged years was brought to the milwaukee county hospital in coma. his systolic blood pressure was over mm. hg, diastolic mm., his urine contained considerable albumin and many casts. he had general anasarca. venesection was done at once and c.c. blood obtained. immediately following this operation the pressure was - , but within twelve hours it was again above - . he was given no medication to reduce pressure except that he was freely purged. he was given a steam sweat bath daily. frequent blood pressure readings were taken. within seven days the pressure was - . he had, in the meantime, completely recovered from his symptoms. he was kept in the hospital for two weeks longer assisting in the work on the ward, and he was discharged with a pressure (systolic) between and diastolic - . the treatment was rest in bed, free purging, venesection, and sweat baths, simple but exceedingly effective. should there be actual indications for reducing the blood pressure, i must admit that it can not always be done. the majority of cases will do well on the sodium nitrite or erythrol tetranitrate. however, these do not always lower blood pressure and keep it within normal limits. when a man has very high tension we do not wish to reduce it to what it should normally be for the age of the patient, as symptoms of collapse might set in at any time under such conditions. observations made with the sphygmomanometer[ ] show that the effect of nitroglycerin is transient or of no effect except in doses which are relatively enormous (one drop of the one per cent solution given every hour). sodium nitrite may lower the blood pressure but the effects will have worn off in two hours. it is the same with erythrol tetranitrate. sodium sulphocyanate in doses of from one to three grains three times a day is highly recommended by some. my own experience with it does not lead me to believe that it is of any great value in hypertension. it, however, may be tried. benzyl benzoate has been used recently to reduce the high blood pressure of hypertension. macht has reported some success. in the author's hands it has been efficacious in a few cases. as long as the patient takes the drug the pressure may be slightly reduced, but upon the withdrawal of the drug the pressure returns to its former level. it is well worth a trial and further experimentation may reveal better methods of administration. the dose is from to c.c. mixed with water at intervals. [ ] miller, jos. l.: hypertension and the value of the various methods for its reduction. jour. am. med. assn., , liv, p. . in the hypertension of the menopause some have had success with large doses of corpus luteum extract. as a matter of fact the drug treatment of hypertension, when it becomes necessary to treat this condition with drugs, has suffered a notable set-back since more careful control has been made with the blood pressure instruments. in giving any of the depressor drugs their action should be controlled by blood pressure measurements, for only in this way can we be sure that the drug is exerting its physiological effect and we may expect results. the individual reaction to these drugs varies greatly and no rule for dosage can be dogmatically laid down. the only successful therapy is rigid individualization. this is the keystone to treatment in cases of arteriosclerosis and high tension. it must not be inferred from what has been said that the nitrites are of no value. they are of decided value but they have their limitations. the most evanescent of these drugs is amyl nitrite. this is put up in the form of capsules, or pearls, containing from one to three minims. when it is desired to dilate the peripheral vessels suddenly, one or two of these capsules are broken in a cloth held to the nose. the effect is almost instantaneous. there is flushing of the face and other peripheral vessels, particularly near the head, denoting a relaxation and widening of the bed of the blood stream, and a consequent decrease in pressure in the arteries. these effects are over in a short while. it is only used in attacks of cardiac spasm, as in angina pectoris. nitroglycerin, the spiritus glonoini of the u. s. p., acts in about the same manner as amyl nitrite but the effects last usually a trifle longer. one drop of the one per cent solution may be given every hour until physiologic effects are produced. it may be given hypodermically. this may be a means of reducing pronounced high tension. this drug has been found of benefit especially in cases where arteriosclerosis combined with chronic nephritis causes cardiac asthma. the other drug which may be of service in these conditions, one whose sphere of action is somewhat broader, because its effects are more lasting, is sodium nitrite. this is given in water in doses of one to three or five grains every four hours. some have objected to the use of this drug, but my experience has made me place considerable confidence in its harmlessness, provided that the patient is carefully watched. this, however, applies to all of the nitrite compounds. my experience with erythrol tetranitrate is not large. it may be used in place of sodium nitrite. for a mild case, one often finds that sweet spirits of niter is sufficient to control the pressure and relieve the distressing symptoms, and it is undoubtedly the least harmful of all the nitrites. drugs that are of great value, but of which little is noted in textbooks, are aconite and veratrum viride. both of these drugs are well known to be marked circulatory depressors. veratrum viride in my experience should be very cautiously used, and never used unless a trained attendant is constantly at hand. with regard to aconite i have no such feeling, and a mixture of tincture of aconite and spiritus etheris nitrosi may be given for several weeks with no fear of doing any harm. personally, of all the drugs mentioned, i prefer the nitrite of sodium or the combination just given. they may be advantageously alternated. my own feeling is that the most successful means of treatment of acute high tension is without the use of drugs. the most important measure is absolute rest in bed. this often suffices to lower the blood pressure and to arrest the symptoms produced by high tension. venesection i believe is also of value. true the arterioles appear to contract almost immediately upon the lessened quantity of blood, or there is immediate interchange of serum from the tissues which brings the blood volume back to the original amount. whatever happens the pressure is not greatly reduced, at times not reduced at all, but often the symptoms are relieved. hot packs or sweat baths assuredly do reduce the pressure in many cases. this seems to me to be an exceedingly valuable measure. finally the diet should be nourishing, but very light, not too much fluid should be ingested, and the bowels should be freely opened. with the fibrolysin of merck, i have had no experience. some men assert that they have had good results from its use, but on the whole the evidence is not highly favorable. morphine is invaluable. no drug is of such value in the nocturnal dyspneic attacks that occur in the late stages of arteriosclerosis when the heart or the kidneys are failing. morphine not only relaxes spasm and quiets the cerebral centers, but is an actual heart stimulant under such conditions, and should never be withheld, as the danger of the patient's becoming addicted to its use is more fanciful than real. however, morphine, at times, suppresses the secretion of urine. so that if after trial the urine becomes scanty and the edema increases, recourse must be had to other drugs. the various hypnotics may be used with caution. one which seems to be very useful is adalin. as heart stimulants, one may use strychnine, spartein, caffein, or camphor. in desperate cases, where a rapidly diffusible stimulant is needed, a hypodermic syringeful of ether may be given, and repeated in a short while. several years ago a so-called serum was brought out by trunecek which was said to have a favorable effect on the metabolism of the vessel walls. it was given at first hypodermatically or intravenously but the former method was painful. it was later stated that given by mouth it acted just as well. the results with the trunecek serum have not come up to the expectations that the early favorable reports promised. the original serum was composed as follows: nacl, . gm.; na_ so_ , . gm.; na_ co_ , . gm.; k_ so_ , . gm.; aqua destil. q. s. ad. . c.c. later this was modified for internal use to the following prescription: r_{x} natrii chlor. . gm. natrii sulphat. . gm. natrii carbonat. . gm. natrii phosphat. . gm. calcii phosphat. magnesii phosphat. aa. . gm. m. ft. cachets no. xiii. the contents of every cachet corresponds to c.c. of the fluid serum or to c.c. of blood serum. the preparation called antisclerosin consists of the salts contained in the serum. as to its efficacy, i can not judge, as i have never felt that it was worth while to use it. reports of cases in which it has been tried do not speak very highly of it. in the general treatment of arteriosclerosis, there is no one factor of more importance than the regular daily bowel movement. attention to this may save the patient much discomfort and even acute attacks of cardiac embarrassment. the choice of the purgative is immaterial, with this reservation only, that the mild ones, such as cascara, rhubarb, licorice powder and the mineral waters, should be thoroughly tried before we resort to the more drastic purgatives. plenolphthalein in to grain doses acts remarkably well in some people as a pleasant laxative. agar-agar with or without cascara may be useful. liquid paraffin under a variety of names is a most useful and efficacious laxative. as its action is purely mechanical it may be taken indefinitely without doing harm to the intestinal musculature. the old lady webster dinner pill is an excellent tonic aperient. when the heart is embarrassed and edema of the legs and effusion into the serous cavities have taken place, then it becomes necessary to use the drastic purgatives that cause a number of watery movements. epsom salts given in concentrated form, elaterin gr. - , the compound cathartic pill, blue mass and scammony, or even croton oil may be used. since the observation of a greatly congested intestine from a patient who had been given croton oil, i have ceased to use this purgative, and i doubt much whether its use is ever justifiable in these cases. the management of the ordinary case of arteriosclerosis resolves itself into a careful hygienic and dietetic regime with the addition of the iodides, aconite, or the nitrites. a diet consisting of very little meat, alcohol in moderation or even absolutely prohibited, and not too much fluid should be prescribed. condiments and spices should also be used sparingly. cold baths, shower baths, cold and hot sheets alternating, are of great benefit in assisting the heart to do its best work by making the large capillary area of the skin more permeable. it is not true that such baths raise the blood pressure so markedly. certain acts, as sneezing, violent coughing, etc., increase the blood pressure much more than judicious bathing. =symptomatic treatment= the fact that arteriosclerosis really loses much of its own identity and, in later stages, becomes merged with the symptomatology of the diseases of various organs, as the kidney, brain, heart, compels us, for completeness' sake, to say a few words about the treatment of these complications. one of the results of arteriosclerosis of the coronary arteries, angina pectoris, demands prompt treatment. in the acute attack, the chief object is to relieve the spasm and pain. pearls of amyl nitrite should be inhaled, and morphine sulphate with atropine sulphate given hypodermatically at the very earliest moment. it is senseless to withhold morphine. the only possible reason for withholding it would be uncertainty as to the diagnosis. it is probably better to err on the safe side, and should the case prove to be one of pseudo angina, in the next attack sterile water can be given instead of the morphine and atropine. when a patient is seen in the condition of broken compensation with the much dilated heart, anasarca, dyspnea and suppression of urine, there is no better practice than venesection. especially is this valuable when the tension is still fairly high and the individual is robust. following the abstraction of six to eight ounces of blood ( - c.c.)[ ] the whole picture changes, so that a man who a short while before was apparently at death's door, notices his surroundings and takes an interest again in life. this should be followed up with thorough purgation, and cardiac stimulants should be ordered. in such cases digitalis is useful, but its action is never so striking as in cases of this general character due to uncompensated valvular disease. it must be remembered that in arteriosclerosis the changes in the myocardium must be of a considerable grade for the heart to give away. therefore, digitalis can not be expected to act on a diseased muscle as it acts on a comparatively healthy muscle. it is only in such cases of broken compensation that digitalis should ever be used. [ ] i have taken as much as c.c. from a large man. he recovered and went back to work. digitalis is not a general vasoconstrictor as used to be taught. its action on the kidney is actually a vasodilator one. and in its action on the heart the digitonin dilates the coronary arteries, according to macht, while the digitoxin acts on the heart muscle. overdosing with digitalis has produced partial heart block in many cases. it is absolutely contraindicated in stokes-adams syndrome. there are, however, some cases, especially those with transudations, when digitalis may be carefully tried even though high tension be present. it is sometimes of advantage to combine digitalis with the nitrites although they are said to be physiologically incompatible. still another drug, that is of great value in conditions such as have been described, is diuretin. this may be given in capsule or tablets, grs. x. three times daily. there is only one caution to express in the use of this drug. it should not be given when the kidneys are the seat of chronic inflammatory changes; in fact, actual harm may be done by administering the drug under such conditions. the same is true even to a greater extent with theocin. this is a powerful diuretic. if given by mouth it should be well diluted as it is most irritating to the stomach. it is best given intravenously in doses of two and a half to three grains dissolved in five to six cubic centimeters of distilled water. one must be reasonably sure that the kidneys are not the subject of chronic disease and are functionally, therefore, below par. the intravenous dose should not be given oftener than once in four days. for the pain in aneurysm, nothing (except, of course, morphine) is so valuable as iodide of potassium. patients who are suffering agony, when put to bed and given ki grs. x. three times a day, soon lose all the distressing symptoms. this applies particularly to aneurysms of the arch of the aorta. when the sclerosis has affected the cerebral arteries to such an extent that symptoms result, the case is, as a rule, exceedingly grave. not much can be done except to relieve the headaches and keep down the blood pressure, if this is high, by means of rest in bed, the iodides, aconite, or the nitrites. the cases of transient monoplegias or hemiplegias can be much relieved by careful hygienic measures and judicious administration of drugs. much ingenuity is sometimes required to overcome the idiosyncrasies of patients, but care and patience will succeed in surmounting all such difficulties. the treatment of intermittent claudication is the treatment of arteriosclerosis in general. sometimes the circulation in the affected leg or legs is much helped by daily warm foot baths. light massage might be tried and the galvanic current may be used once or twice daily. there are a few distressing symptoms that occur usually late in the disease, when complications have already occurred, which frequently baffle the therapeutic skill of the physician. the chief of these--insomnia, dyspnea, and headache--may not be late manifestations, but insomnia and headache are frequently associated with the moderately advanced stages of arteriosclerosis. at times all the symptoms seem to be due to the high tension, the relief of which causes them to disappear. there are, unfortunately, times when high tension is not responsible for the headache and insomnia. under these circumstances such drugs as trional, veronal, amylene hydrate, ammonol, etc., may be tried until one is found which produces sleep. for the headaches, phenacetin, alone or in combination with caffein and bromide of sodium, may be tried. acetanilid, cautiously used, is at times of value. there have been cases of arteriosclerosis with low blood pressure, accompanied by severe headaches, that have been relieved by ergot. codeine should be used with care, and morphine only as a very last resource. great care must always be exercised in giving drugs that depress the circulation, for it is easily conceivable that more harm than good can come from injudicious drugging. chapter xiv arteriosclerosis in its relation to life insurance the value of the early recognition of cases of arteriosclerosis and hypertension has been spoken of within, but it needs to be further emphasized. there is perhaps no class among physicians to whom is afforded a better opportunity of seeing early cases than the medical examiners of life insurance companies. the relationship between a patient and the physician whom he consults, and the applicant for life insurance and the examiner are diametrically opposite. in the former the patient desires to conceal nothing and the physician is called upon to diagnose and treat disease. in the latter the applicant, a presumably healthy person, may have much to conceal and the examiner is there to pass upon the state of health. the question is this--"is the applicant now in good health?" it becomes then of vital importance for the examiner to be able to detect among other abnormal conditions the incipient signs of arteriosclerosis and of hypertension. parenthetically it may be stated that arteriosclerosis and hypertension are not one and the same disease as has been so frequently insisted upon within; the former may occur without the latter but the latter can not from its very nature be present for long without arterial thickening supervening. it is necessary in discussing the question here to group the two conditions together in order to prevent needless repetition. such a case as the following is common. a successful business man of forty-four years was brought to me by an agent in for examination. the man was six feet tall, weighed pounds, had a ruddy color and looked to be the picture of health. he was not strictly intemperate, he never became intoxicated, but every day he drank three or four whiskies and often he had a bottle of wine for dinner in the evening. when he was examined his pulse was of good quality and owing to the fleshiness of the wrist it was difficult to say positively whether the radial artery was sclerosed or not. in the heart no murmurs were heard, and it was difficult to be sure that the left ventricle was enlarged. there was, however, a slight but definite accentuation of the second sound at the aortic cartilage which might readily have been overlooked had the patient not been stripped and a careful examination made with the stethoscope. upon taking the blood pressure it was found to be from - mm. of hg. the urine specimen examined at the visit was normal, no casts were found. the applicant was seen at his home and the blood pressure measured. it was again the same. he was seen a third time and practically the same systolic blood pressure was found. under protests from all the agency staff the man was declined. two years later he died of apoplexy. the man was angry at being refused. instead of looking the matter squarely in the face he thrust aside the idea that there was anything the matter with him. he had never had one ill day in his life, his forebears had lived to ripe old age, and he was sure that he knew more about himself than the examiner. had this applicant showed a sense of reasonableness he should have been grateful to the doctor for calling his attention to a condition which surely would sooner or later prove either fatal itself or lead to some fatal lesion. it was learned that this man had gone directly to his family physician who laughed at such nonsense as had been told the (now) patient by the examiner. another illustration of a slightly different type of case is afforded in the following history. a man of fifty years of age, five feet ten in height and lbs. in weight, was brought for examination. in his youth there was a history of a mild attack of scarlet fever. he was almost a total abstainer, rarely taking liquor in any form. physically he appeared to be an excellent risk. however, on examining the heart it was found that there was slight hypertrophy with an accentuated second aortic sound at the base, and the blood pressure was mm. of hg. some sclerosis of the radial arteries was found. one company had refused him on account of albumin in the urine. there was none in the first specimen which was passed while in the office. the specific gravity was . a morning specimen was obtained and contained a trace of albumin. several specimens were then examined. some contained albumin, some had no albumin content. the man was declined; no protests from the agent as albumin had been found. there was something tangible in that. had the applicant been refused on account of his high tension, sclerosis of the radials, and slightly enlarged heart there would undoubtedly have been protests. and yet an applicant revealing such a state of the cardiovascular system without albumin in the urine should unhesitatingly be declined. attention has been called to hypertension as an early, and some think an invariable, sign of chronic nephritis. my own experience has confirmed me in the belief that in hypertension the kidneys are often the seat of chronic interstitial changes. careful palpation of the radial and brachial arteries will in every case reveal more or less thickening. there is yet another group of cases which the examiner sees as healthy subjects, namely those cases of sclerosis of the peripheral arteries without sclerosis of the aorta and without high tension. in such cases the radials, brachials, temporals and other superficial arteries are readily palpable, sometimes even revealing irregularities along the course of a vessel. such cases are not subjects for insurance. the recognition of such a condition is of great importance to the one who has it and he should be urged to go to his regular physician for thorough examination. should the physician ridicule the idea, as has happened to me more than once when i was actively engaged in insurance work, the examiner has done his full duty to the company, the applicant, and himself. a life insurance examiner has a difficult position to fill. he has four people to satisfy; the applicant, the agent, the medical director and himself. the straight and narrow path of strict honesty is his only salvation. by being honest with himself he necessarily gives a square deal to the other three parties. no applicant who has palpable arteries or hypertension can be considered a first class risk. it can not be denied that men with arteriosclerosis live to an advanced age and may even outlive those who have apparently normal arteries, but the average life expectancy at any age for an arteriosclerotic is less than that for a normal person. the apparently healthy applicant who learns for the first time when examined for life insurance that he has the early or moderately advanced signs of arterial disease, should thank the agent and examiner for showing him the danger signals ahead. the sensible man then orders his life so that he puts as little strain on his heart, arteries, and kidneys as possible and may add many years to his life. it is on account of this very insidiousness of onset that i have elsewhere urged as a prophylactic measure the examination every six months of all persons over forty years of age. i am more and more convinced that it is of vital importance to the health of the public. as i have remarked, the average man consults his dentist at least once a year so that no tooth may be so far diseased that it can not be saved. it is purely a means of preserving the teeth. why not do the same with the whole body? of what use is it to save the teeth and lose the body? it seems to me that the great army of life insurance examiners are in an enviable position in their ability to add years of life to many men and women. i doubt whether they realize their importance in the campaign for health. i should urge life insurance companies not to employ recent graduates unless they have had at least a year's hospital experience. for the company as well as for the individuals i believe that there is a prognostic sense which the examiner should have and this can only be acquired by experience. i believe that arteriosclerosis and hypertension are increasing for the reasons which have been given in another chapter. there can be no doubt that when these conditions are recognized long before symptoms would naturally supervene, men and women would not only live longer but also die more comfortably and many very likely would be carried off by some disease having no relationship whatever to arteriosclerosis. slight enlargement of the heart downward and to the left, accentuation of the second aortic sound at the base, a full pulse, arteries which are palpably thickened, increased blood pressure are signs to which attention must be paid. when the peripheral arteries are palpable they are not always sclerosed. the radial artery, the one usually palpated, may lie very close to the bone in a thin person. under these conditions the artery can be easily felt. it is better then to palpate for the brachial as it lies beneath the inner edge of the biceps muscle. should this artery be felt then very probably sclerosis is present. opinion as to whether or not sclerosis is present, when it is slight, may differ. it is difficult at times to say definitely. should such be the case the applicant should be most carefully questioned as to his family and past history, the heart should be carefully outlined by percussion and the blood pressure should be taken, both the systolic and diastolic pressures. the urine should be examined with particular care. i am aware that the average examination for life insurance is not made with the care which is bestowed upon a patient. yet i see no reason why the same attention to detail should not be given in one as in the other. the examination of the great majority of applicants can he made in a short time, as there is no question of latent chronic disease. when the exception turns up he should be given a searching examination and a full report should be sent to the medical director. only in this way will it be possible to weed out the undesirable risks. on the surface it does not seem to require any great diagnostic acumen to be a life insurance examiner. in the old days of many of the companies there were no examiners. the applicant was brought before the president or other appointed official and he was passed or rejected on his general appearance. this has changed, and now the medical department with its scores of examiners in the field is a well organized department. it seems to me that the examiner should be an exceedingly able diagnostician and prognosticator. there is no telling when he may be called upon to pass judgment on a borderline case. from personal experience i know how difficult it is to make a decision in some cases. these suspicious cases after a careful examination had better be passed by the examiner and a supplementary report sent to the medical director containing unbiased details. but no applicant with readily palpable arteries, even though the blood pressure be normal, should be considered a first class insurance risk. the question of the value of the diastolic pressure reading in examinations for life insurance is not yet settled to the satisfaction of all medical directors. certain medical directors with clinical experience behind them, lay great stress on the increased diastolic pressure and consider a persistent diastolic of mm. really more significant as an indication of hypertension than a systolic pressure of mm. other directors pay little or no attention to the diastolic reading. should an applicant show a systolic above the average normal on several successive readings, he is declined. when one takes into consideration the psychic effect of knowing that he is being examined for high blood pressure, it seems unfair to refuse insurance on such grounds as is constantly done. up to the present there are no extensive series of life-expectancy tables in which hundreds of thousands of cases are analyzed from the diastolic pressure values. there are many such tables for the systolic pressures alone. in the tabulation of such statistics one must not lose sight of the important fact that the figures are taken by thousands of men of varying capacity and different degrees of intelligence. such studies to be of any real value must be taken from records made at the home offices by capable men. we shall await these tables with interest. in the meantime we must be permitted to have the impression that the diastolic pressure has been much neglected. this has no doubt been due to the difficulty of measuring it with any degree of accuracy. now with the auscultatory method and the correct place to read the diastolic pressure the results of blood pressure estimations should begin to have some value for statistical data. clinically the diastolic is probably more important than the systolic. until proof is brought to the contrary we shall believe that in life insurance examinations it has the same importance. chapter xv practical suggestions the time spent in obtaining a careful history of a case is time well spent. often the diagnosis can be made from the history alone, the physical examination merely adding confirmation to the data already obtained. the younger the patient who has arteriosclerosis, the more probable is it that syphilis is the etiologic factor. a denial of infection should have little weight if the history of possible exposure is present. miscarriages in a woman should arouse the suspicion of lues in her husband. the complement-fixation reaction will often clear up an apparently obscure diagnosis. there are various ways of examining a patient but there is only one right way; the examination should be made on the bare skin. however skillful one may be in the art of physical diagnosis, he can gather few accurate data by examining over the clothes even if he use a phonendoscope. the immoderate eater is laying up for himself a wealth of trouble at the time when he can least afford to bear it. the ounce of advice in time is worth more to him than the pounds of medicine later. it is a wise maxim never to drive a horse too far. apply that to the human being and the rule holds equally well. there may be no symptoms in a case of advanced arteriosclerosis. do not on that account neglect to advise a patient in whom the disease is accidentally discovered. many a man owes a debt of gratitude to the life insurance examiner. he rarely feels grateful. when a competent ophthalmologist refers a case to a general practitioner with the statement that he believes from the appearance of the fundus of the eye that arteriosclerotic changes are present over the body, the case should be most carefully examined. the earliest diagnoses are not infrequently made by the ophthalmologist. it is the part of wisdom never to have such a firmly preconceived idea of the diagnosis that facts observed are perverted in order to fit into the diagnosis. let the facts speak for themselves. beware of the snap diagnosis. even in a case of well-marked arteriosclerosis when the diagnosis seems to be written in large letters all over the patient, go through the routine. nine times out of ten this may seem needless. the tenth time it saves your conscience and reputation. always consider that you are examining a tenth case. gradual loss of weight in a person over fifty years old should arouse the suspicion of arteriosclerosis. do not call the nervous symptoms displayed by a middle-aged man or woman neurasthenia until you have ruled out all organic causes, particularly arteriosclerosis. when palpating the radial artery, always use both hands according to the method already described. pay attention to the superficial or deep situation of the artery. the examination of one specimen of urine does not give much information, especially if it should be found to contain no abnormal elements. fairly accurate data may be gathered from the mixed night and morning urine; most accurate data from the twenty-four hour specimen. to be of any real value there should be frequent examinations of the day's excretion. in measuring the day's output a good rule is as follows: begin to collect urine after the first morning's micturition and collect all including the first quantity passed the next morning. it is best to examine the centrifugated urine for casts even though no albumin be present. it is useless to look for casts in an alkaline urine. casts are not infrequently found in chemically normal urine from a middle-aged patient. other things being normal, the finding has no significance. the kidneys must be carefully tested functionally. blood pressure readings should always be taken with the patient in the same posture at every estimation. at the first examination it is advisable to take readings from both brachial arteries. let the patient sit comfortably and relax all muscles. differentiate as soon as possible between the uncompensated heart caused by valvular disease and that caused by arteriosclerosis. there is a difference in prognosis. both give the same symptoms, and are treated similarly until compensation returns; thereafter the management of the two forms is different. aortic incompetence that comes on late in life is generally the result of curling of the free margins of the valves caused by syphilitic arteriosclerosis. prognosis is grave because of the fact that the heart muscle also is the seat of degenerative changes and compensatory hypertrophy is established with difficulty. when laying down a regime for a patient, consider his disposition, and individualize the treatment. remember that exercise is an essential feature of the hygiene of the patient's life but do not forget to be explicit about the amount and character of the permissible exercise. in the prophylaxis of arteriosclerosis, a rational mode of living is the all-important factor. as a rule, the less meat one eats, the less is the liability of arterial degeneration as age advances. the exceptions to this rule are many, and probably depend upon the character of the "vital rubber" with which the individual begins life. the diet in well-marked cases of arteriosclerosis should be carefully selected with regard to its nutritive and non-irritating character. animal proteins should be sparingly used. milk should have an important place in the dietary. no drug relieves the pain of uncomplicated aneurysm as surely as iodide of potassium. iodides frequently upset the stomach. be cautious in the use of them. the irritable stomach may turn the scales against your patient. use cardiac stimulants with care and judgment. if all the valuable ammunition is used up at first, the fight will be lost. use digitalis with especial care. its chief usefulness is in steadying the decompensated heart, improving the conduction of impulses, and increasing the tone of the cardiac muscle. _it should never be given to patients with very slow pulses, the subjects of stokes-adams syndrome._ digitalis has been found to produce partial to complete heart block when therapeutically administered. remember that in the uncompensated heart morphine not only eases the oppressive dyspnea, but also steadies and stimulates the heart. see to it that the patient has a daily movement of the bowels. in the early stage try the effect of liquid paraffin or of the mineral waters such as pluto, or hunyadi janos, or artificial carlsbad salts (sprudel salts). these last can be made as follows: sodium chloride, ounce i; sodium bicarbonate, ounce ii; sodium sulphate, ounce iv. take two tablespoonsful of this in a glass of hot water before breakfast. should these not succeed, assist the action of the drugs by the use of enemata. the pill of aloin, strychnine sulphate, and extract of cascara, with the addition of a small quantity of hyoscyamus, is a mild tonic purgative. in cases of constipation with high tension, there is no drug as valuable as calomel or one of the other mercurials given occasionally. never give epsom salts unless copious watery stools are desired to deplete effusion into the serous cavities or into the subcutaneous tissue. chronic constipation increases the gravity of the prognosis. in case of suppression of urine and anasarca, hot air packs may be of value. the patient may be wrapped in a hot wet sheet and covered with blankets. i do not believe in administering pilocarpine to assist the sweating. remember to treat the patient and not the disease. the careful hygienic and dietetic treatment, combined with the least amount of drugging, is the best and most rational method of treatment. index a abdominal symptoms, aconite in treatment, acquired arteriosclerosis, adami, effect of syphilis in aorta, adventitia, age in arteriosclerosis, albuminuria, albutt's classification of arteriosclerosis, alcohol, , , anatomy, angina abdominalis, , pectoris, , pseudo, angiosclerosis, , aorta, anatomical lesions in, aschoff on, normal, syphilis in, thoracic, thoracic and abdominal, arteriosclerosis of, velocity of blood in, aortic incompetence, , stenosis, aortitis, acute, arcus senilis, arrhythmia, tonal, , arterial pressure, symptoms, arteries, examination of, , general structure of, large, adventitia of, palpable, pulmonary, arteriosclerosis of, arteriocapillary fibrosis, arteriosclerotic endocarditis, , artery, coronary, cross-section of, pulmonary, radial, aschoff on aorta, atheroma, simple, atheromatous abscess, auricular fibrillation, flutter, auscultation, auscultatory blood pressure phenomenon, method of taking blood pressure, percussion, b balneotherapy, basch's blood pressure instrument, blood, circulation of, velocity of, in animals, in aorta, in capillaries, viscosity of, blood pressure, auscultatory method of taking, clinical applications of, diurnal variations of, drugs influencing, estimation of, in cancer, in collapse, in exercise, in head injuries, in hemorrhages, , , in infectious diseases, in kidney diseases, in meningitis, in obstetrics, in pulmonary tuberculosis, in shock, , in surgery, in typhoid fever, , in valvular heart disease, increase of, instruments, brown's, cook's, erlanger's, faught's, , hill and barnard's, hirschfelder's, k. vierordt's, marcy's, potain's, riva rocci's, roger's, sanborn's, stanton's, technique of, "tycos," v. basch's, v. recklinghausen's, mechanism of, normal variations of, phenomenon, auscultatory, precautions when estimating, value of, bowman's capsules, sclerosis of, brain, changes in, brown atrophy, , , c calcification of media, , cancer, blood pressure in, capillaries, anatomy of, , capillary pulse, cardiac dullness, irregularities in arteriosclerosis, symptoms, cerebral symptoms, circulation of blood, physiology of, cirrhosis of liver, , classification of arteriosclerosis, , allbutt's, collapse, blood pressure in, congenital arteriosclerosis, cook's blood pressure instrument, cor bovinum, coronary artery, cross section of, corpus luteum, d definition of arteriosclerosis, diabetes mellitus, diagnosis, differential, early, ophthalmic examination in, diastolic pressure, , , , importance of, dicrotic pulse, dietetic treatment, differential diagnosis, , diffuse arteriosclerosis, , , , digitalis in treatment, , diuretin in treatment, drug intoxications, drugs influencing blood pressure, , ductless glands, dullness, cardiac, dyspeptic symptoms, dyspnea, treatment of, e electrocardiogram, embolism, endarteritis deformans, obliterans, endocarditis, arteriosclerotic, , endothelial lining, tubes, epistaxis, , erlanger's blood pressure instrument, erythromelalgia, , estimation of blood pressure, etiology, examination of arteries, , of heart, of urine, exercise, blood pressure in, in prophylaxis, in treatment, experimental arteriosclerosis, extrasystole, f faught's blood pressure instrument, , fibrillation, auricular, ventricular, fibrolysin in treatment, fingernail palpation, finger tip palpation, flutter, auricular, food poisons in arteriosclerosis, g gibson's law, h "h" wave, habits, personal, head injuries, blood pressure in, headache, treatment of, heart block, boundaries, examination of, hypertrophy of, physical examination of, stimulants, , , symptoms, hemorrhages, blood pressure in, henle, membrane of, hill and barnard's blood pressure instrument, hirschfelder's blood pressure instrument, his, bundle of, , hygienic treatment, hyperpietic arteriosclerosis, hypertension, , , , , cause of arteriosclerosis, classification of cases, hypertrophy of left ventricle, hypotension, i incompetence, aortic, , indicanuria, infants, arteriosclerosis in, infectious diseases in arteriosclerosis, blood pressure in, insomnia, treatment of, intermittent claudication, , treatment of, intoxications, chronic drug, intracranial tension, involutionary arteriosclerosis, iodides in treatment, , , k kidney diseases, blood pressure in, kidneys, sclerosis of, , l life insurance, relation to, light percussion, touch palpation, liver, cirrhosis, , local symptoms, m marey's blood pressure instrument, maximum pressure, , mean pressure, media, calcification of, , medicinal treatment, meningitis, blood pressure in, mental strain, mesaortitis, , , , mesentery, cross-section of small artery in, milk diet, minimum pressure, , moenckeberg type of arteriosclerosis, morphine in treatment, mosenthal test meal, muscular overwork, n nervous symptoms, nitrites in treatment, nitroglycerin in treatment, nodular arteriosclerosis, , normal blood pressure variation, o obstetrics, blood pressure in, occupation in arteriosclerosis, ocular symptoms, ophthalmic examination, importance in early diagnosis, , orthodiagraph, overeating, , , , overwork, muscular, p "p" wave, "p-r" interval, palpable arteries, palpation, , fingernail, finger tip, light touch, pathology, percussion, auscultatory, light, peripheral symptoms, personal habits, phlebosclerosis, phthalein test, physical signs, physiology of the circulation, potain's blood pressure instrument, practical suggestions, pressure, arterial, ausculatory method of determining, diastolic, , estimation of, in surgery, maximum, , normal variations, pulse, , , , systolic, , technique, venous, prognosis, prophylaxis, exercise in, pseudo angina pectoris, pulmonary artery, arteriosclerosis of, tuberculosis, blood pressure in, pulse, capillary, deficit, dicrotic, in arteriosclerosis, pressure, , , , , rate, venous, purgatives in treatment, , pyrosis, q "q r s" complex, r rabbits, lesions produced experimentally in, race in arteriosclerosis, radial artery, radials, sclerosis of, raynaud's disease, , recklinghausen's blood pressure instrument, renal disease, symptoms, rest in treatment, riva-rocci's blood pressure instrument, rogers' blood pressure instrument, s sanborn's blood pressure instrument, scaphoid scapula, schwellungsperkussion, sclerosis of veins, senile arteriosclerosis, , , , sex in arteriosclerosis, shock, blood pressure in, , spinal symptoms, spirochaeta pallida, stanton's blood pressure instrument, stenosis, aortic, stokes-adams syndrome, stomach, ulcer of, strain hypertrophy, , , surgery, blood pressure in, symptomatic treatment, symptoms, abdominal, arterial, cardiac, cerebral, dyspeptic, dyspnea, general, headache, heart, local, nervous, ocular, peripheral, pyrosis, renal, special, spinal, vertigo, visceral, syphilis, in aorta, syphilitic arteriosclerosis, systolic pressure, , , , importance of, t "t" wave, technique of blood pressure instruments, thayer and fabyan, theocin, thoma on arteriosclerosis, thoracic aorta, thyroid extract in treatment, tobacco, , , tonal arrhythmia, , toxic arteriosclerosis, treatment, aconite in, balneotherapy in, corpus luteum, dietetic, digitalis in, , diuretin in, exercise in, fibrolysin in, heart stimulants in, hygienic, iodides in, , , medicinal, morphine in, nitrites in, nitroglycerin in, of dyspnea, of headache, of insomnia, of intermittent claudication, personal habits in, purgatives in, , rest in, symptomatic, theocin in, thyroid extract in, trunecek's serum in, venesection in, veratrum viride in, trunecek's serum in treatment, tuberculosis, blood pressure in, tunica intima, media, "tycos" blood pressure instrument, typhoid fever as cause of arteriosclerosis, blood pressure in, u ulcer of stomach, urine, examination of, suppression of, v valvular heart disease, blood pressure in, vasa vasorum, veins, anatomy of, sclerosis of, velocity of blood in animals, of blood in aorta, venesection in treatment, venous pressure, pulse, ventricle, left, hypertrophy of, ventricular fibrillation, veratrum viride in treatment, vertigo, * * * * * transcriber's notes: irregular hyphenation has been preserved, as in blood pressure and blood-pressure. both "hg" and "hg." appear. minor typographical errors and inconsistencies have been silently normalized. the original printed list of illustrations shows the original locations; they have been moved closer to their discussion area in the text to not interrupt the flow of reading. page prescription symbol is replaced with r_{x} page apothecaries ounce symbol replaced with "ounce" mate in two moves by winston marks illustrated by ashman [transcriber note: this etext was produced from galaxy science fiction may . extensive research did not uncover any evidence that the u.s. copyright on this publication was renewed.] [illustration] [sidenote: _murt's virus was catastrophically lethal, but it killed in a way no disease had ever thought of--it loved its victims to death!_] love came somewhat late to dr. sylvester murt. in fact, it took the epidemic of to break down his resistance. a great many people fell in love that year--just about every other person you talked to--so no one thought much about dr. murt's particular distress, except a fellow victim who was directly involved in this case. high dawn hospital, where -year-old dr. murt was resident pathologist, was not the first medical institution to take note of the "plague." the symptoms first came to the attention of the general practitioners, then to the little clinics where the g. p.s sent their patients. but long before anything medical was done about it, the plague was sweeping north and south america and infiltrating every continent and island in the world. murt's assistant, dr. phyllis sutton, spotted the first irregularity in the _times_ one morning and mentioned it to him. they were having coffee in murt's private office-lab, after completing reports on two rush biopsies. she looked up from the editorial page and remarked, "you know, someone should do a research on the pathology of pantie raids." * * * * * murt spooned sugar into his mug of coffee and stared at her. in their six months' association, it was the first facetious remark she had made in his presence. to this moment, he had held an increasing regard for her quiet efficiency, sobriety, professional dignity and decorum. true, she wore her white coat more tightly belted than was necessary and, likewise, she refused to wear the very low hospital heels that thickened feminine ankles. but she wore a minimum of come-hither in both her cosmetic and personality makeup. this startling remark, then, was most unexpected. "pantie raids?" he inquired. "whatever would justify an inquiry into such a patently behavioristic problem?" "the epidemic nature and its increasing virulence," she replied soberly. "this spring, the thing has gotten out of hand, according to this editorial. a harmless tradition at a few of the more uninhibited campuses has turned into a national collegiate phenomenon. and now secondary effects are turning up. instructors say that intramural romance is turning the halls of ivy into amatory rendezvous." murt sipped his coffee and said, "be thankful you aren't a psychiatrist. bacterial mutations are enough of a problem, without pondering unpredictable emotional disturbances." his assistant pursued it further. "it says the classrooms are emptying into the marriage bureaus, and graduation exercises this year will be a mockery if something isn't done. what's more, statistics show a startling increase in marriages at the high school level." murt shrugged broad shoulders that were slightly bent from long hours over a microscope. "then be thankful you aren't an overworked obstetrician," he offered as an amendment. she glanced up from the paper, with annoyance showing in her dark, well-spaced eyes. "is it of no interest to you that several hundred thousand youngsters are leaving high school and college prematurely because they can't control their glands?" "be glad, then," murt said coldly, "that you aren't an endocrinologist--now drink your coffee. i hear the microtome working. we'll have some business in a minute." dr. phyllis sutton rustled the pages of the _times_ together, folded it up and threw it at the wastebasket with more vigor than was necessary. the subject was momentarily closed. * * * * * his staff position at high dawn paid less, but the life suited dr. murt better than the hectic, though lucrative, private practices of many of his colleagues. he arrived at the hospital early, seven o'clock each day, to be on hand for quick tissue examinations during the morning operations. by ten, the biopsies were usually out of the way, and he spent the rest of the morning and early afternoon checking material from the bacteriology section and studying post-operative dissections of tumorous tissues and organs removed in surgery. it was engrossing, important work, and it could be accomplished in a normal work-day, leaving the pathologist considerable leisure to study, read and relax. shortly after the pantie-raid conversation with phyllis sutton, he found the evening paper attracting more than his usual quick perusal. this emotional fuss in the young human animal was beginning to preoccupy the newspaper world. writers were raising their eyebrows and a new crop of metaphors at the statistics, which they described variously as alarming, encouraging, disheartening, provocative, distressing, romantic or revolting, depending upon the mood and point of view. as june, the traditional mating month, wore into july, national statistics were assembled to reveal that marriages were occurring at almost double the highest previous rate, that the trend was accelerating rather than diminishing. jewelers and wholesale diamond merchants chalked up fabulous increases in the sale of engagement and wedding settings. clergymen and qualified public officials were swamped with requests for religious and civil marriage ceremonies. parks, beaches and drive-in theaters were jammed with mooning and/or honeymooning couples, and amusement parks began expanding their over-patronized tunnel-of-love facilities. the boom in houses, furniture, appliances and tv was on, and last year's glut of consumer goods for the home was rapidly turning into a shortage. all was not good news, however. the divorce courts reported their calendars stacked months ahead of time, and an increasing number of lurid headlines were devoted to the love-triangular troubles of the rich, famous and notorious. love-nest exposés and bigamous marriages rocketed in number. the whole world, adolescent and adult, was falling in love, with the inevitable unrequited infatuations, the jealousies, infidelities and the bitter-sweetness of wholesale, illicit, impossible love situations in which vulnerable people found themselves increasing astronomically. writers of popular newspaper psychology columns attributed the rampaging emotional fire to everything from mass-hysteria, caused by sunspots, to the paternalism of a government that gave increased income-tax deductions to married people. * * * * * dr. murt's growing interest was not entirely academic. his bachelorhood was no accident of fate, but rather a carefully contrived independence, for which he paid the price of eternal vigilance. as the world supply of eligible bachelors diminished sharply, his wariness increased, and he became more and more curt with nurses and female technicians at the hospital. he revealed the depth of his leeriness one afternoon at the scrub-up sink, where he and his assistant were washing after a messy dissection. phyllis sutton remarked, "holly, down in personnel, showed me a tabulation she ran off for her own curiosity today, doctor. do you realize that in this whole hospital there are only _eight_ unmarried female employees?" murt threw water droplets from his bare arms and muttered, "yes, and every one of them's giving me the eye--to say nothing of half the married ones." his aide dried her long arms and slender hands and looked at him with a crooked smile. "not to underestimate your good looks, doctor, but i am one of the unmarried females. i trust i'm not giving you too much trouble?" he looked up, startled. "yes--no, _no_--of course not. i'm referring to the nurses and the technicians. what's got into them? the whole lot seems to be on the make!" phyllis combed out her short dark hair and looked at him in the mirror. "i assure you the males are just as bad. these interns and four of the male nurses give me a physical with their eyes every time i happen to meet them." "i suppose this ties in somehow with your pantie-raid theory." "well, what do _you_ think?" "i don't think. i just dodge. you'd do well to do the same," murt told her, putting on his jacket and adjusting his tie. she sat down in his oak swivel-chair and crossed her slender ankles. "are you aware of the problem they have downstairs in the out-patient clinic?" "hadn't heard," murt said. * * * * * she removed a file from her purse and touched up her short nails. "the outlying clinics are sending their overflow to us. they can't seem to diagnose the odd symptoms they're getting." "i had noticed the large number of negative test results coming out of the lab," murt acknowledged. "haven't followed any of them through, though." "i have," phyllis said with a little frown. "seems to be a psychosomatic nightmare down there." "what are the symptoms?" "mostly neurotic," she said. "listlessness, loss of appetite, palpitations, cold sweats and absent-mindedness." "why don't they go to the psychiatric clinics?" "overloaded. they're sending patients here." "what age groups?" "from puberty to senility. i'd like your permission to do a little special work on blood samples." "another theory?" he asked caustically. "yes. will you give me your permission to test it?" murt adjusted his panama straw in the mirror and noticed that the nostrils of his straight nose were flared for some reason. "your time is your own after three p. m. every day. if you want to take time out from your thesis research, that's your business." he crossed to the door and was opening it when he became aware that he had had no answer. he looked back at the profile of his assistant's body, which was now stretched out full length, suspended at three points--her higher-than-practical heels on the linoleum tile, her spine and curved hips using only an inch of the chair's edge, and her head tilted over the chair's back. she inhaled from a king-size filter-tip cigarette and blew a feather of smoke at the ceiling. "_yuh!_" she said finally. her flat abdomen jumped at the exhaled syllable, and so did her generous breasts under the soft emerald-green street dress. "good _night_!" murt closed the door behind him quickly and became aware of a sharp stab of what he defined as pure rut--the first he had suffered in fifteen years. ii he taxied downtown to the athletic club, where he maintained his three-room apartment. the -story building was a citadel of masculinity--no females allowed--and recently it was an especial relief to enter the lobby and leave behind the world of turbulently mixed sexes. the small but lush entry chamber had a deserted air about it this afternoon. at the room desk, crumbley, the clerk, handed him his key with a pallid hand and returned to sigh over a colored picture in _esquire_--it was the "fold-out" page, featuring a gorgeous blonde reclining at full length. crumbley's expression, however, was far from the loose-lipped, lecherous leer that he normally exposed to such art. his eyes had a thin glaze over them, he breathed shallowly and, if dr. murt had not known the little man's cynically promiscuous nature so well, he'd have sworn crumbley was in love. upstairs, murt donned rubber-soled gym shoes and sweat clothes and rode the elevator back down to the gymnasium. three times a week, he put his muscles through the whole routine-work on the bars, rings, the leather horse, the rope climb and a twenty-lap jog around the balcony racetrack. afterward, he showered, took a dip in the swimming pool and retired to the health service department for a rubdown and some sunlamp. throughout the whole routine, he encountered not a single other member. while charlie, the husky blond masseur, hammered and kneaded his muscles, murt reflected on the abating interest in athletics at the club. "are we losing members, charlie?" he asked. "you'd think so from how dead it is up here," charlie replied. "but crumbley says we aren't. the guys just aren't exercising. can't figure it, doc. even with the usual summer slump, it's never been this slow." when he had absorbed all the punishment he could stand, murt rolled off, went into the ultraviolet room, set an alarm clock and lay down by himself on one of the paper-covered tables. he adjusted the dark goggles and reflected thankfully that he didn't have to go to the beach for his sun and have sand kicked in his face by a procession of predatory females, ogling his long limbs and trying to attract his attention. the clean smell of ozone was pleasant, the warmth of the lamps relaxed him, and he dozed off. he dreamed that he heard someone else come in and lie down on the next table and, when he raised his head to see who it was, was amazed to discover his assistant, dr. phyllis sutton, stretched out like himself, wearing only shower-sandals and goggles. the alarm clock wakened him from the disturbing dream. he was sweating profusely and took another shower, using the cold water at full needle force to dispel his shock at his subconscious. * * * * * wrapping the robe around him, murt returned to his apartment to dress for dinner. as he snapped the paper laundry band off a clean shirt, he caught himself wondering how old phyllis sutton was. twenty-eight? thirty? she appeared younger, but she was in her last year of residence to gain her specialty of pathology. that meant over eleven years of school and practice. she was a lovely creature, but she was no child. he had half an impulse to phone her for dinner, then became lost in studying his own reaction to the thought. pulse over a hundred, respiration quickening, irregular. there was a tensing of the abdomen, a faint burning in the pit of his stomach. he remembered the urge at the office, the dream in the sunroom, the sudden sweat that had required five minutes under the cold needle shower. after so many years of deliberate, scholarly celibacy, what was happening to him? he stared at the phone. with six motions of one finger, he could dial phyllis sutton's face into view, and suddenly he yearned to do that very ridiculous thing. after staring at her, off and on, for the six months since she had transferred to high dawn to complete her residency, now he wanted to see her face outside of working hours for some inexplicable reason. call her up, date her, take her dancing, proposition her--get this silly feeling off your chest! suppose she was busy or refused to go out with him? suppose she already had a boy friend? this last thought deepened the burn in the pit of his stomach, and he finished dressing listlessly. to hell with it! this was poker night. if he did succeed in dating his assistant, they'd inevitably talk shop. that was why he enjoyed a night of cards with his six non-medical brother clubmen, once a week. it was refreshing to break away from the professional point of view. no, he wouldn't sacrifice that for any woman. * * * * * he ate alone, read the paper, joined the poker party at seven o'clock, played six hands of stud, cashed in his chips and returned to his room. in a mood of deep irritation, he found phyllis sutton's home phone number and rang it four times with no result. he thought to try the hospital. she answered from the lab extension on audio only, but her voice and its frankly curious tone sent vertically polarized chills through him. "i--i wanted to apologize for my rudeness this afternoon," he said with difficulty from a suddenly dry mouth. there was a brief silence. "have you been drinking, dr. murt?" he noticed that she did not call him sylvester. why was he so damned thirsty for some little sign of warmth and friendliness from her? he cleared his throat. "no, i'm serious. it occurred to me that your interest in the out-clinic problem was commendable, and that i was rather short in my remarks to you." "oh! i take it i have your permission to work my project in during the day, then?" "that's right, so long as it doesn't interfere with the routine." he sounded stuffy to himself, but he was entirely out of practice in speaking to please a female. "thanks," she said wryly, and the conversation ended. somehow, the brief talk with her restored his perspective. once again she was his assistant, and the significance of her as a woman faded. she was a dedicated physician like himself. in another few years, she would find a residency of her own. she had no more inclination to knock off and become a woman than he had to squander his time and energy on attaining the status of family man. * * * * * it was with mounting admiration that he followed her new project in examining blood samples. as they came up from the clinic, she sorted the specimen tubes at once, putting a tiny snip of yellow scotch tape under the label of each sample that belonged to a patient with the new undiagnosed disorder. then, after the requested hemoglobin, blood sugar and other standard tests had been run, she retrieved the samples from the technicians, grouped them in a special rack and devoted every spare minute to further examination. she centrifuged, precipitated, filtered and stained over and over, using every qualitative procedure in the book. murt signed her requisitions for exotic reagents and rare stains. he helped her balance out the large centrifuge to get the maximum r.p.m. from it. he let her use the most costly of the fine-porosity filters. he had little hope of success, but it was good practice for her. she was required to identify every organism she found, bone up on its known effects, then determine that it could not cause the symptoms reported. she did all this without impairing her usefulness to murt. when he needed her, she was at his side, dissecting, taking down notes, preparing delicate sections and checking slides before they came to him. in several weeks, she exhausted all known tests on the first samples. after lunch one day, she turned her palms up. "_nichts da!_" she said, pulling a mashed cigarette from the huge pocket of her white smock. he glanced at her and swiveled to stare out the window. it was part of his tight campaign to prevent a disastrous recurrence of the emotional tempest he had suffered the day she had begun this research. "it was a nice brush-up on your bacteriology," he said. "have you saved the filtrates?" "yes, of course. did i overlook anything?" "nothing that we could do here, but there's an electron microscope downtown at ebert industrial labs. how about photomicrography? could be a filtrable virus." he knew that she was aware of the possibility, and also that she was reluctant to ask him for additional funds to go into a virus hunt with the expensive piece of equipment. "wonderful!" she told him. "i did hate to ask you, but it would be a shame to waste all that immaculate filtrate." iii a week passed, during which a bulletin from the government health service announced official suspicion that the human race was suffering a mysterious, pandemic affliction which was as yet undiagnosed. although the symptoms, as reported by hundreds of clinics, were relatively mild, the effect on the nation's economy was growing serious. industry and business reported unprecedented absenteeism. factory supervisors and insurance companies were frantic over the upsurge in accidents. it was estimated that almost fifty per cent of the population exhibited the symptoms of depression, absent-mindedness, insomnia and loss of appetite. negligent driving was increasing the highway toll sharply. educational institutions reported classroom discipline rapidly vanishing. armed forces headquarters cautiously admitted a new high in desertions and awols. the consensus among psychiatrists and psychologists was that the condition stemmed from pathogenic causes. dr. murt raised his eyebrows when he read this. perhaps phyllis sutton was right, after all. the bulletin continued, "all clinical pathologists are requested to be alert to the presence of any unusual organisms discovered in body fluids or tissues examined. please report your findings to the u. s. public health service." murt found phyllis sutton at the microtome, finishing a wax section, and showed her the bulletin. "score one for woman's intuition," he smiled. "federal health service tends to agree with your theory." "now i _am_ eager to see those pictures," she said. * * * * * less than two hours later, a messenger brought the photomicrographs, and the two pathologists bent over them together. phyllis had submitted eighteen samples, six of which were controls taken from healthy, unafflicted subjects. per her instructions, smears of the specimens in various degrees of dilution had been photographed through the great electron microscope. [illustration] murt muttered to himself as they compared the controls with the "infected specimens." the "healthy" samples were relatively clear, except for minute protein matter. conversely, all twelve suspect specimens swarmed with shadowy six-sided dots. phyllis' eyes widened. "there is something there! do you suppose it could be the love bug?" "love bug?" "certainly. that bulletin didn't go into the psychologists' findings. the diagnosticians downstairs say that the symptoms appear to be no more than complaints of the lovesick." "are you back on the pantie-raid theme again?" "i've never been off it," she replied. "from the first, i've had a notion that some organism was increasing glandular activity. excess emotionalism often originates in overstimulated glands." "of course, but mental attitudes can trigger the glands, and they are interacting. how do you separate the effects? how could you guess that an organism was responsible?" she shrugged. "it was a possibility within our specialty, so i set out to prove or disprove it. from the appearance of these photographs, i don't think we have _disproved_ it." it was a properly cautious statement that pleased murt. they were a long way from proving that their newly discovered virus was the culprit, but the research had definitely produced a question mark. murt ordered copies of the photomicrographs from ebert industrial labs and arranged for a complete dossier to be forwarded to the u. s. health service. that night, he was startled by a headline and lead story that quoted the government bulletin. the science editor had a field day, tying in speculation that "doctors suspect love bug epidemic." * * * * * the next day, three reporters called upon him, each with the same query. "it's rumored that you are doing research on the love bug, dr. murt. anything to report?" he shooed them out angrily, after learning that someone at ebert labs had given them the tip. phyllis smiled at him as he slammed the door after the last reporter. "you still discount the love bug idea, don't you?" she asked. "i dislike sensationalism in a matter like this," he said. "even if their assumptions were true, i wouldn't like it." "you can't blame the papers. they're starved for some explanation. i pity your passion for anonymity if your virus proves to be the causative factor." "_my_ virus?" "certainly. the whole project is under your auspices and direction." "see here, phyl, _you_ did the work." "don't you dare mention my name," she said. "you're my superior and senior pathologist and it's your duty to protect me against the press. i don't want columnists popping out of my bathroom any more than you do." murt gave up. "the argument is entirely anticipatory," he pointed out. "the virus might turn out to be a batch of dormant german measles. would you consider having dinner with me tonight?" "why?" she shot the question back at him like a rebounding tennis ball. "answer that first!" murt opened his mouth. he could not recall ever hearing such a rude rejoinder to an invitation to dinner. not that there had been a plethora of amenities between them, but this was unthinkable! the question was, why _should_ she have dinner with him? give her eight good reasons. what was his motive in asking her? in one word, _why_? murt searched her face, but only a quiet interest showed in her expression. "why does any man invite any woman to dinner?" he countered. "you aren't _any_ man, dr. murt. nor am i _any_ woman. i want your specific reason for inviting me to dinner. is it to discuss professional matters or--what?" "good lord, dr. sutton!" he followed her lead in using the formal address. "man is a social animal! i would enjoy your company at dinner, that's all. at least, i thought i would." she looked at him unrelentingly. "if the talk will be about baseball, books or billiards, i'm for it. if it's to be moonlight, roses and dimmed lights--no sale." * * * * * it was like asking one's grandfather for a date. his regard for her highly professional approach turned to resentment. after all, she was a woman, a woman who persisted in belting her smock too tightly and wearing sheer nylons. why this absurd revulsion at his casual acknowledgment of her sex? he almost withdrew the invitation, but changed his mind at the last moment. "you name the place and the subject for conversation." she nodded. "very well, i'll pick you up at seven." he had his date--with an emancipated female, and she didn't let him forget it during the whole meal. the restaurant she picked was expensive, but about as romantic as a bus depot. she ordered beer instead of a cocktail, toyed wordlessly with a $ . steak, and argued over the check. only as they were preparing to leave did she betray a sign of femininity. a platinum blonde, two tables away, had been eying murt. suddenly, she lurched to her feet without a word to her escort, staggered over to the pathologist, slurred, "you're what i've b'n lookin' for all m'life," and planted a wet alcoholic kiss on his mouth before he could defend himself. her escort peeled her away with sad-eyed apologies. there was no jealousy or anger in his face, only a deep hurt. "she--she isn't well, i think," he said. "you know, this new--whatever it is that's going around." murt wiped off the lipstick and looked at phyllis, expecting to find at best sardonic amusement, but she seemed pale and annoyed. "i'm sorry i brought you here," she said. "think nothing of it," murt told her. "you heard the man. this is what's going around. do you think i'll catch it?" phyllis wasn't amused. she did let him ride the taxi to her apartment, but bade him a terse goodby at the door. except for the incident of the blonde and phyl's reaction, the evening had been a bust. murt wondered how he had ever visualized her as a warm-blooded, responsive female. he smiled at the evening of torment she had once given him. she was entirely frigid or else so leery of men that she might as well have been one herself. iv the following morning, he presided at a specialists' conference at the hospital, during which he revealed the results of the blood research. they had all read the health service bulletin and were sharply interested in the photomicrographs. when the meeting was over, feldman, the bacteriologist, and stitchell, an endocrinologist, volunteered to work with murt. they gave phyllis' "gland-irritation" theory more credence than murt. he outlined a program. both agreed to take the problem back to their own departments. the conference set murt behind in his work and he spoke scarcely five words to his assistant until he was ready to leave. as he finished scrubbing up, she handed him an early edition of the _times_. "local doctor isolates love bug!" the story was sketchy and not half so positive as the headline, but it did name him and high dawn hospital, and described the new virus. he stared at phyllis sutton. "did you--" "of course not. the reporters were here, but i sent them away. i told them we were medicine men, not tobacco men." "your name isn't even mentioned," he said suspiciously. "you signed the report to the health service," she pointed out. "the leak probably came at that end." she put her hand on his arm. "it wasn't your fault." his fury cooled as he noted her gesture. then she realized that he was looking down at her hand and withdrew it quickly. the next few days were blindly busy. a note from the government acknowledged receipt of his report and pictures, and was followed by a message that the virus could not be identified. the implication was that there was a strong possibility that it was the causative factor in the new _malaise_. * * * * * murt devoted more attention to the joint laboratory work on the virus. the newspapers continued to come up with confidential information they shouldn't have had, and they dubbed the love bug, _murt's virus_. the name stuck, and the pathologist found himself famous overnight. phyllis continued to force all the credit upon him, on threat of transferring out if he violated her confidence. except for the nuisance of dodging reporters, the accolade was not entirely unpleasant. his pictures--old ones, lord knew where they had dug them up--began appearing in the papers. instead of reproving him, the hospital board voted him a substantial salary increase and gave him a free hand in directing the research. a government grant was obtained to supplement his budget, and the work picked up speed. necessarily, the lead that phyllis sutton's early research had given them on the rest of the medical world was maintained largely because of the time lag in disseminating the information contained in murt's report, and the additional time it took for other clinical laboratories to confirm it. cages of experimental animals began arriving along with several additional specialists. ebert industrial labs, contrite over the original information leak, made available their electron microscope, and murt assigned the new toxicologist to work over there with feldman, the bacteriologist, studying ways to weaken or destroy the virus. stitchell, the endocrinologist, and a trio of psychologists from the state university began injecting monkeys with virus when feldman found he could propagate it in sterile medium. on september , , dr. sylvester murt became a victim of the virus which bore his name. * * * * * he had slept poorly and he awakened feeling empty. his first dismal thought was that phyl wouldn't be at the hospital this morning. he had told her to spend a few hours down at ebert labs, getting notes on their progress. as he shaved, dressed and breakfasted, this thought preyed on his mind. it wasn't until he had put in half the morning clock-watching and door-gazing that he stepped outside his wretchedness and took an objective look at his feelings. it wasn't that he missed her help--he had plenty of personnel at his disposal now. he simply longed for the sight of her, for the sound of her voice and her heels clipping busily around his office-lab. _here we go again_, he thought, and then he came up short. the feeling was similar to the silly evening of infatuation he had allowed himself, but it was intensified tenfold. the burn in his stomach was almost painful. he caught himself sighing like a frustrated poet, and he grew to hate the sight of the hall door, through which she kept right on not appearing. when she failed to show up by : , and he gagged over his lunch, he knew he was sick. he had murt's virus! now what? did knowing you had it make it any easier? easier to make a damned fool of himself, he supposed. he'd have to take hold of himself or he'd scare her off the grounds. at the thought of her leaving him for good, something like a dull crosscut saw hacked across his diaphragm, and he dropped his forkful of potato salad. back at his office, he diluted cc of pure grain alcohol with water and swallowed it. some of the distress and anxiety symptoms were relieved, and he bent determinedly to his work. when her distinctive steps finally came through the door, he refused to raise his head from the binocular microscope. "how are they making out over there?" he mumbled. "it's slow," she said, dropping her notes on his desk. "they're halfway through the sulfas so far. no results yet." * * * * * relief at having her near him again was so great, it was almost frightening. but he gained equal pleasure from finding his self-control adequate to keep from raising his head and devouring her with his eyes. "sylvester," her voice came from behind his stool, "if you don't mind, i'd rather not go over there again." "why not?" her voice was strangely soft. "because i--i missed...." at that instant, her hand rested on his shoulder and it sent a charge of high voltage through him. he stiffened. "_don't do that!_" he said sharply. he could see her reflection dimly in the window glass. she took a step backward. "what's the matter, sylvester?" he fought back the confusion in his brain, considered explaining that he was making a fine adjustment on the scope. but he didn't. he turned and let her have it. "because i've got the virus," he said in a flat voice. "and the object of my affection--or infected, overstimulated glands--is _you_!" "oh, dear! that blonde at the restaurant...." phyl's face was pale, but she composed her features quickly. "do you want me to leave?" "lord no! that magnifies the symptoms. stay with me and--and just be yourself. i won't bother you. if i lay a finger on you, clobber me." "have you had your blood tested?" "i don't have to. i've got all the symp--" he broke off, realizing that he was taking for granted that the new virus _was_ the cause of his feeling. clinically, this was nowhere near proved yet. slowly he rolled up his sleeve above the elbow. he dipped a swatch of gauze in alcohol and swabbed a vein. "all right, phyl, you're the doctor. make with the syringe." * * * * * by nightfall, murt came to understand the reasons for the increase in industrial accidents, absenteeism and the rest of the social effects of the "mild" epidemic. phyllis sutton was in his mind constantly. he deliberately did not look at her. but he was aware of her every movement, the texture and shape of her hand when she handed him a slide, the scent of her powder, the sound of her heels. when she left the room, he found himself awaiting her return and conjecturing on what she was doing every moment. not that it was difficult to adjust his behavior--no, that was relatively easy. all he had to do was think about every remark he made to her, censoring word, inflection and tone of voice--and, by keeping his back to her, it was easy to prevent his eyes from darting glances at her profile and staring at the curve of her hip below the tight belt. by staying busy, he fought off the depression until he left for the club, when it closed in on him like an autumn fog. he stopped at the club bar. curly, the bald-headed bartender, eyed him curiously when he ordered a double scotch. "heavy going down at the hospital these days?" curly asked. murt envied him his relaxed, carefree expression. he nodded. "pretty busy. i suppose you're catching it, too. lot of people drowning their sorrows these days?" curly looked up at the clock. "you said it! in about a half hour, the place'll be loaded. this epidemic is going to run the distilleries dry if it doesn't end pretty soon." "does liquor help any?" "seems to--a little. it's the damnedest thing! everybody's in love with the wrong people--i mean ten times as bad as usual. of course, not everybody. take my wife--she's got it bad, but she's still in love with _me_. so it could be worse." * * * * * "what do you mean?" murt asked, raising his head. "i mean it's bad enough for the poor woman to have the guy she wants. it's the jealousy angle. every minute i'm away, she sits at home wondering if i'm faithful. calls me up six times a shift. i don't dare take her out anyplace. every time another female comes in sight, she starts worrying. kate's a damned good wife, always has been, or i wouldn't be putting up with it. that's what's happening to a lot of marriages. some guys get fed up and start looking around. about that time, the bug bites _them_ and look out, secretary!" "but it's not her fault," murt said emphatically. "i know," curly shrugged. "a lot of people don't make any allowances for it, though. you know peter, the elevator boy? he and his wife both got it. for a while it was okay, but i guess they finally drove themselves nuts, keeping tabs on each other. now they can't stand to be together and they can't stand to be apart. poor joker ran the cage past the basement limit-switch three times today and had to be bailed out of the shaft. mr. johnson said he'd fire him if he could get another boy." the implication was shocking to murt. he had supposed that unhappiness would stem principally from cases of unrequited love, such as his own, but it was apparent that the disease magnified the painful aspects of mutual love as well. over-possessiveness and jealousy were common reefs of marriage, so it was hardly illogical that the divorce courts were as busy as the marriage license bureaus, after all. * * * * * it helped a little to immerse himself in the troubles of others, but, after another double scotch, he went to his apartment and immediately fell into despondency. the desire to phone phyllis was almost overpowering, though he knew talking to her wouldn't help. instead, he dressed and went to dinner. the club boasted a fine chef, but the food tasted like mucilage. later, he went to the bar and drank excessively. yet he had to take a sedative to get to sleep. he awoke in a stupor at ten o'clock. his phone was jangling persistently. it was phyllis sutton, and her face showed sharp concern. "are you all right, sylvester?" for a moment his hangover dominated, but then it all came back. "good morning! i'm _great_!" he moaned. "stitchell and the new toxicologist think they have something to report," she said. "so do i. alcohol is positively not the answer." "this is important. your suggestion on the sulfa series seems to have paid off." "i'll be right over," he said, "as soon as i amputate my head." "come down to the zoo. i'll be there." the thought of a remedy that might relieve him was a fair hangover cure. he dressed quickly and even managed to swallow a little coffee and toast. v at the hospital, he went directly to the "zoo" in the basement. a knot of personnel, including phyllis, peterson, the toxicologist, and feldman, opened to admit him to the cage under their inspection. a quick glance at the control cages showed no change in the undoctored monkeys. males and females were paired off, huddling together miserably, chattering and sadly rubbing their heads together. each couple eyed the other couples suspiciously. even here, the overpossessiveness was evident, and murt cringed from the pitiful, disconsolate expressions. the cage before him, however, appeared normally animated. the monks were feeding and playing happily. feldman was grinning. "had to try a new derivative, sylvester, but the sulfa series was the right approach." murt stared at the cage, redeyed. "hadn't realized you succeeded in producing the symptoms in monkeys." phyllis said, "why, i gave you that report yester--" she broke off with an understanding glance. peterson was exclaiming, "i never saw such a rapid-acting remedy! and so far, there's no evidence of toxic effect." "it must absorb directly into the gland tissue," feldman added. "hardly had time to materially reduce the virus content significantly." murt murmured words of congratulations to them, turned on his heel and stalked out. phyllis followed him to his office. "get me some of the stuff and notes on the dosages they administered," he ordered. "certainly," she said. "but why didn't you ask--_dr. murt, you aren't going to try it on yourself?_" "why not?" he barked hoarsely. "it'll be weeks before we can determine if it's safe," she protested, horrified. "we haven't got weeks. people are falling apart. this thing's contagious." even while murt said it, he felt it was the wrong approach. he knew his own perspective was shot, but phyllis would probably try to protect him against himself. she did not. instead, her face softened with sympathy and something else he refused to identify. she said, "i'll be right back." * * * * * the pressure in his head throbbed down his neck into his body. he wanted her so much, it was difficult to resist following her out into the hall. she returned in a few minutes with a -cc glass-stoppered reagent bottle half full of a milky fluid. "oral administration?" he asked. she nodded. "fifteen cc for the monkeys." she secured a small beaker and a tapered graduate from the glassware cabinet and set them before him. he poured cc into the graduated measure and transferred it to the beaker. [illustration] "what do they call it?" he asked. "sulfa-tetradine," she replied. "one of a series peterson was testing. there is no physiological data on it yet. all he knows is that it inhibited the virus in culture. so they tried it on the monkeys." murt raised the beaker to his lips. it was against every sensible tenet of scientific procedure. he was amazed that phyllis was silent as he swallowed the bland, chalky fluid. he heard a clink. turning, he saw her raising the graduate to her lips. in it was a like quantity of sulfa-tetradine. "what are you doing?" he half-shouted. "we don't need a test-control!" "i'm not a control," she said softly, touching her lips with a scrap of gauze. "i've had the virus for months." he stared at her unbelievingly. "how do you know?" "one of the first test samples was my own blood," she said. "you saw it. it was one of the twelve positive." "but the symptoms--you don't show a sign of--" "thanks," she said. "i started to break down yesterday, but you didn't notice. you see, you are my fixation and when you told me that you had it, too, i--" "_your_ fixation!" the beaker slipped from his fingers and smashed to the tile. "_you're in love with me?_" her arms hung loosely at her sides and tears rimmed her eyes. "pathologically or otherwise, i've been a case since before i started the blood tests." they moved together and clung to each other. "phyl, phyl--why didn't you tell me?" * * * * * fiercely, she closed his lips with her own, and her fingers dug deeply into his shoulders. his arms pulled her closer yet, trying to fill the void in him that was greater than the universe. for a long minute, the knowledge of her love and physical contact with her straining body dispelled the bleak loneliness. when their lips parted, they gasped for breath. it was no good. it was like tearing at an itching insect bite with your fingernails. the relief was only momentary, and it left the wound bleeding and more irritated than ever. even if they were married--look at peter at the club--peter and his wife, mutually in love and completely miserable. it wasn't normal love. it was the damned virus! as well argue with gravity. he tried to tell her, but he couldn't make her understand. her restraint had been magnificent, but when the dam broke, it was beyond stopping the flood of her emotion. and now he couldn't believe it himself. nothing this wonderful could be destroyed by mere misunderstanding. he cursed the years of his celibacy. all that time wasted--lost! it was six o'clock before they reached her apartment. the license bureau had been a mob scene. hours more, upstairs in the city hall waiting for the judge, while they held hands like a pair of college sophomores, staring into each others' eyes, drinking, drinking the elixir of adoration with a thirst that wouldn't be sated. phyllis weakened first. in the cab, after the ceremony, she released his hand and wiped her damp forehead. then, in the elevator, murt felt himself relaxing. the alchemy of sustained passion had exhausted them both, he decided. as phyllis slipped the key in the door, she looked up at him in surprise. "do you know, i'm hungry. i'm starved--for the first time in months." murt discovered his own stomach was stirring with a prosaic pangful demand of its own. "we should have stopped to eat," he said, realizing they had forgotten lunch. "_steaks!_ i have some beauties in my freezer!" phyllis exclaimed. they peeled off their coats and she led him into the small kitchen. she pointed at the cupboard and silverware drawer. "set the table. we'll eat in five minutes." * * * * * slipping into an apron, she explored the freezer for meat and french fries, dropped them into the hf cooker and set the timer for seconds. when it clicked off, she was emptying a transparent sack of prepared salad into a bowl. "coffee will be ready in seconds, so let's eat," she announced. for minutes, they ate silently, ravenously, face to face in the little breakfast nook. murt had forgotten the pure animal pleasure of satisfying a neglected appetite, and so, apparently, had his wife. _wife!_ the thought jolted him. their eyes met, and he knew that the same thing was in her mind. the sulfa-tetradine! with the edge barely off his hunger, he stopped eating. she did, too. they sipped the steaming coffee and looked at each other. "i--feel better," phyllis said at last. "so do i." "i mean--i feel differently." he studied her face. it was new. the tenseness was gone and it was a beautiful face, with soft lips and intelligent eyes. but now the eyes were merely friendly. and it aroused no more than a casual pleasure in him, the pleasure of viewing a lovely painting or a perfect sunset. a peaceful intellectual rapport settled over them, inducing a physical lethargy. they spoke freely of their sensations, of the hypo-adrenal effects, and wondered that there was no unpleasant reaction. they decided that, initially at least, sulfa-tetradine was a miraculous success. murt thought he should go back to the hospital and work out a report right away. phyllis agreed and offered to accompany him, but he said she had better get a night's sleep. the next day would be hectic. after four hours at his desk, he called a taxi and, without hesitation, gave the address of his club. not until he fell wearily into bed did he remember it was his wedding night. by mutual agreement, the marriage was annulled the next day. feldman and peterson were gratified at the efficacy of their drug, but both were horrified that murt had chosen to experiment on himself. as usual, phyl had insisted on being left out of the report. * * * * * after a week of close observation, one of the monkeys was chloroformed and tissue-by-tissue examination was made by an army of histologists. blood samples showed completely clear of the virus, as did a recheck on murt's own blood. no deleterious effects could be detected, so the results were published through the government health service. it was the day before christmas before dr. sylvester murt first noticed the approaching symptoms of a relapse, or reinfection--he couldn't guess which. the past weeks had been pleasantly busy and, as acclaimed authority on murt's virus, he had had little time to think subjectively about his experience. sulfa-tetradine was now considered the specific for the affliction and was being produced and shipped by the carload all over the world. the press had over-generously insisted on giving him all the credit for the remedy as well as the isolation of the disease virus. he was an international hero. the warning of another attack came to him at : in the afternoon, when phyllis sutton was leaving. she stuck her head back in the door and gave him an uncommonly warm smile and cried, "merry christmas, doctor!" he waved at her and, as the door closed, caught his breath. there was the burn in his stomach again. it passed away and he refused to give it further thought. his own cab wound its way through the heavy christmas eve traffic an hour before store-closing time. finally, the vehicle stalled in a jam. it was only six blocks to his club, so murt paid off the driver and walked. part of his strategy of bachelorhood had been to ignore christmas and the other sentimental seasons, when loneliness costs many a man his independence. but now it was impossible to ignore the snowflakes, the bustling, package-laden crowds and the street-corner santa clauses with their tinkling bells. * * * * * he found himself staring into department store windows at the gay decorations. a pair of shimmering, nearly invisible nylons caught his eye. they were the most impalpable of substances, only their bare outline visible against the white background. he thought of phyllis and, on impulse, went into the store and bought a pair. the clerk had to pick a size at random for him. outside, on the sidewalk, he stared at the prettily gift-wrapped package and finally acknowledged the tremor, the tension and the old ache in the region of his diaphragm. _relapse!_ he plodded three slushy blocks up a side-street before he found a cab. he gave phyllis sutton's address to the driver and sank back in the taxi as a wave of weakness overcame him. what if she weren't home? it was christmas eve. she would probably be visiting friends or relatives. but she wasn't. she opened the door under his impatient knock, and her eyes widened cordially. "sylvester!" she exclaimed. "merry christmas! is that for me?" she pointed to the package, clutched forgotten in his hands. "merry, hell!" he said dispiritedly. "i came to warn you to look out for a relapse. mine's been coming on all day." she drew him inside, made him take off his coat and sit down before she acknowledged his remark. the apartment was cozy, with a tiny christmas tree decorated in the window. she returned from the hall closet and sat beside him. "look what i did--on impulse," he said and tossed the package on her lap. "that's what really turned it on." she opened the nylons and looked up at him sideways. he continued unhappily, "i saw them in a window. made me think of you, and about that time the seizure began. i tried to kid myself that i was just getting you a little token of--of my esteem, but the symptoms are almost as bad as before already." * * * * * apparently she refused to accept the seriousness of the situation. her smile was fatuous, he thought, kissably fatuous. "don't you realize what this means?" he demanded. "peterson and feldman turned up a very distressing fact. sulfa-tetradine deposits out in the endocrines, so a single dose is all a person can take. this relapse of mine means we have it all to do over again." "think, dr. murt! just think a minute," she urged. "about what?" "if the sulfa deposits out in the very glands it's there to protect, how could you be suffering another attack?" his arms ached to reach out and emphasize his argument. "i don't know. all i know is how i feel. in a way, this is even worse, because--" "i know," phyllis said and perversely moved close to him. "my relapse came last tuesday when i bought you a tie for christmas. i sent a blood sample over to ebert labs right away. and do you know what?" "what?" murt asked in a bewildered fog. "it was negative. i don't have murt's virus." she slipped an arm around his waist and put her head on his shoulder. "all i've got is murt himself." adenoids and diseased tonsils their effect on general intelligence by margaret cobb rogers, ph.d. archives of psychology edited by r. s. woodworth no. columbia university contributions to philosophy and psychology new york april, agents: g. e. stechert & co.: london: ( star yard carey st., w. c.); paris ( , rue de conde) contents introduction purpose of the study. chapter i. previous literature concerning the relation of nose and throat defects to intelligence. chapter ii. method and procedure. . a statistical study. . a study of improvement after treatment. selection of cases. the tests. chapter iii. discussion of the results. . the statistical study. . the study of improvement after operation. chapter iv. measurement of improvement after a second interval of six months. chapter v. summary. conclusions. introduction--purpose during the last decade or two there has been a growing interest among physicians in defects of the nose and throat. this interest has centered in part upon those two afflictions of childhood--adenoids and diseased tonsils,--or even tonsils that are merely enlarged. there is no doubt of the physical handicap borne by a child who is possessed of them. as a seat of inflammation, a source of infection, a hindrance to proper breathing,--in a multitude of ways they have seemed to deserve the verdict,--"have them out." many physicians, to be sure, have cautioned against the wholesale removal of tonsils, saying that tonsils which are large in early childhood very commonly are absorbed at an early age. but it is not my purpose to discuss the question of the efficacy of removing adenoids and tonsils. the aim of this study is, rather, to determine experimentally whether or not there exists any causal relation between defect in this respect and lowering of intelligence level. one hears statements made both pro and con by physicians and laymen but there has been little experimental proof. it would seem to be rather useful for a physician to know in advance with how much probability of correctness he is speaking, when he advises a mother that the removal of adenoids and tonsils from the throat of her backward child will make him "bright." the question in the present case, however, is broader than that of relation between these afflictions and mental defect. we are inquiring not merely whether adenoids and tonsils are causes of sub normality or dullness, but also whether they tend to lower the intelligence quotient in general however high it may be. would the mentally normal child with adenoids and tonsils have been superior without them, and would the superior child have been still more superior? what is the relation between adenoids and tonsils, and intelligence? the method employed in the present experiment would seem to give it value from the point of view of the clinical psychologist. with the present emphasis upon exactitude in mental testing, investigators have become interested in problem of the constancy of the i.q. adenoids and abnormal tonsils have been suggested as possible factors affecting this constancy. the results of the experiment should throw some light on the question. it should be understood that this study is concerned with general intelligence, and not with the child's efficiency as a member of society. the latter question is much broader than the one we are investigating. it includes not only intelligence, but physical state, emotional make-up, volition: in short, the personality as a whole. success in school work for example, depends upon all of these factors. for that reason, the results to be reported here, cannot be interpreted as applying to this broader conception. we cannot say at the end whether or not the physical defects under consideration affect the child's success as a member of society. we hope to be able, however, to determine their effect upon one element of that success, namely intelligence. in presenting the results of this experiment, the writer is especially indebted to professor r. s. woodworth, under whose auspices the investigation was carried out, for his interest and advice; and to dr. leta s. hollingworth for the suggestion of the problem, practical aid in obtaining subjects, and constant inspiration. she is indebted to the school of education, teachers' college, for the provision of operative treatment for the subjects; to mr. mark and his officers at public school ; and to superintendent o'brien of the manhattan eye, ear and throat hospital. it must be said that by their hearty and generous cooperation they have contributed in a large measure to whatever value this study may possess. adenoids and diseased tonsils: their effect upon general intelligence chapter i. previous literature concerning the relation of nose and throat defects to intelligence there are very few experimental studies of the relation between intelligence and the two defects considered here. there are a few statistical studies, and among earlier writers especially many statements of opinion on the matter. characteristic of the latter is the following extract from an article in the boston medical and surgical journal, march, .[ ] [ ]: f. hooper, m. d., quoting from a paper by b. frankel. "... it is a fact that their intelligence may become weakened and their characters changed. they do not progress in their studies at school, are generally at the bottom of the class and remain in it longer than the prescribed time.... that the impairment of intellect and want of energy manifested by these children is real, and not merely in the expression of countenance, is made evident by watching these same children after the growths have been removed. to the gratification and astonishment of the parents and teachers, the children hitherto sluggish and dull of comprehension, now make rapid progress, and their comrades soon cease to make a laughing stock of them." the following quotation from an article by irving townsend, m. d., is in the same vein:[ ] [ ]: adenoid growths of the naso-pharynx. read before the homeopathic medical society of new york, february, . "aprosexia is the rather imposing term applied to the imperfect or arrested mental development attributed to this condition. this is denied by some authors, who claim that the dullness of comprehension and inattention are only apparent, and due only to defective hearing. a strong evidence of its reality lies in the fact that these children show most marvelous intellectual development after the removal of the growth, even in cases where deafness is not markedly improved." a most enthusiastic denouncer of adenoids and abnormal tonsils is h. addington bruce. concerning their direful effects upon the intelligence, and the magical results of their removal, he is continually reiterating:[ ] [ ]: h. addington bruce, psychology and parenthood, . "often a surprising development of both mental and physical power follows the removal of adenoids. in one case reported by professor swift, a girl of fourteen grew three inches within six months after an operation for adenoids, and at the same time showed an improvement in her school work that contrasted strikingly with the dullness that preceded it. another, three years younger, grew six inches in about five months, and from being a sad idler was transformed into an unexpectedly attractive and bright pupil. a boy of twelve, backward both mentally and physically, likewise lost his dullness and laziness within an astonishingly short time after the impediment had been removed." and again: "the boy or girl suffering from adenoids[ ] is usually a mouth-breather because of the difficulty experienced in breathing through the nose. but mouth-breathing means difficult breathing, and this in turn means deficient oxidation of the tissues, with a resultant lowering of vital activities generally and of the activity of the brain in particular. accordingly, the psychologist of today insists that every adenoid-afflicted child should be given prompt medical attention, with a view to correcting the vicious mouth-breathing habit, and thus aiding the child to gain a fair start in the development of mental and physical health." [ ]: h. addington bruce in the century magazine, --the mind of the child. the following extracts are quoted from burgerstein's "handbuch der schulhygiene": "bresgen und heymann machen endlich darauf aufmerksam, dass die ursache der kephalalgie haufig in der behinderung der nasenatmung zu suchen ist, als folgerscheinung von verengerung der nase bei ingen baue des knochengerustes, knochenkaries und geschwulsten, schwelungen der scheimhaute, akuten schnupfen, verstofungen der highmorshöhle, vergrosserung der mandeln u. s. w."... "viele kinder erscheinen schwachbegabt, ohne os zu sein, da bei denselben entweder nach behebung von ohrenkrankheiten, nach herstellung der freien _atmung oder gebrauch einer entsprechenden brille die scheinbare geistesschwache schwindet_."[ ] [ ]: the italics are mine. quotations like these, and equally unsupported by experimental evidence, might be multiplied indefinitely, especially if we look into the literature of a dozen years ago. since they can have little authoritative value, i shall limit myself to two more specimens, one taken from the psychological clinic, .[ ] [ ]: psych. clinic, , , - . anna johnson. the teacher in the retarded school. "but when these physical defects (poor eyesight, defective hearing, adenoids, bad tonsils, etc.) are corrected so that the mind can function without any outcry from the physical body, these children recuperate mentally and often make greater progress than the so-called normal children in the regular grades." the second is a quotation from jelliffe and white, "diseases of the nervous system." lee and ferbiger, , p. . "an important group (of mental defects) is due to adenoid vegetations in the posterior pharynx. under such conditions of ill health, development is impaired and does not proceed at a normal rate. with ... infected tonsils, which produce a constant toxemia, the child cannot be expected to proceed in his development with normal rapidity." in the medical and psychological literature of the last few years, along with the growth of general discussion into the various phases of the operation itself, we find a general disinclination to take on faith the magic effect of adenectomy and tonsillectomy. this growth of critical spirit has shown itself in statistical investigations, and in studies of pedagogical and mental improvement after operation. the statistical studies of physical defects in the schools reveal almost universally a positive relationship between school retardation and possession of adenoids and diseased tonsils. one of these was conducted by ayres for the backward children investigation of the russell sage foundation in new york city.[ ] the investigators examined the school records of , children from fifteen schools in manhattan. eight thousand of these had been examined by school physicians. the records of the physical examinations showed that per cent of the children who were normal for their grade had physical defects while only about per cent of the retarded children were physically defective. [ ]: psych. clinic, , , - . the effect of physical defect on school progress. this astonishing result was found upon re tabulation of the data by ages, to be due to the fact that for each defect there is a gradual falling off in frequency from the age of six up to fifteen--eye-defect, only, excepted. since the retarded children in each grade will be the older children in that grade, and since older children have fewer defects, the retarded children will show a smaller proportion of defect. to overcome this difficulty, ayres used an age basis instead of a grade basis in interpreting his results. records of all the children at the ages of , , , and were re tabulated, a group of children, and rated as dull, normal or bright according to the grade in which they were found. the results were worked out in percentages of a group, and are shown in the following tables: dull normal bright number of children examined defects per child · · · enlarged glands defective vision defective breathing defective teeth _hypertrophied tonsils_ _ _ _ _ _ _ _adenoids_ _ _ _ _ _ _ other defects defective not defective average number of grades completed by pupils having no physical defects, compared with the number completed by those suffering from different defects: children, - years, grades - average grades completed % lost children having no physical defects · children having enlarged glands · · children having defective vision · children having defective breathing · · children having defective teeth · · _children having hypertrophied tonsils_ _ · _ _ · _ _children having adenoids_ _ · _ _ · _ children having other defects · · cornell reports several investigations in the psychological clinic, january and may, . three of these, in which children were rated on the basis of grades received in school work, are here combined to show the grades of normal children, "average" children, generally defective children, those possessing adenoids and tonsils, and the deaf. general adenoids no. of cases normal average defective and tonsils adenoids deaf allison th st. claghorn grade in language th st. · · · claghorn · · · grade in arith. th st. · · claghorn · grade in spelling th st. · · · grade in geography claghorn · · · average of grades allison · th st. · · · claghorn · · · an additional investigation of four classes in the same grammar grade of the claghorn school gives the following results: class class class class bright children dull dullest number of children normal defective percentage of normal · · in the same article, dr. cornell gives the results of another study of philadelphia schools, made in . the study comprised a comparison of children exempt from examinations on account of high standing, with those not exempt. the results follow: exempt children non-exempt children normal defective normal defective th st. primary rutledge school allison school camac school claghorn school --- --- --- --- percentage defective · · when the four classes of bright and dull children were examined again, and the different sorts of defects compared for the groups, enlarged tonsils, adenoids, deafness, and nasal catarrh, were found to occur much more frequently among the two classes of duller children. class class class class bright children dull dullest number of children nose and throat conditions, number defective _tonsils_ _ _ _ _ _ _ _ _ _adenoids_ _ _ _ _ _ _ _ _ deaf catarrh percentage of children, nose and throat defects · · during the same year, another examination along the same lines was conducted in the william mckinley primary school,[ ] where a large number of dull children had been grouped in special classes. [ ]: cornell, psychological clinic, , . none of these children were mentally defective, says dr. cornell, and only a few were really backward. the proportion of physical defect was found to be very large,--in pupils, physical defects ( eye-strain, nasal obstruction, miscellaneous, hypertrophied tonsils.) in a special class at the wharton school, numbering children, of the children suffered from adenoids, associated in cases with enlarged tonsils. since no comparison is made with normal classes, this survey cannot be regarded as conclusive. wallin, in his book, "mental health of the school child," discusses several other investigations of the relation of intelligence to physical defect. only those studies in which were included adenoids and tonsil conditions will be reviewed here. those by ayres and cornell have been described above. in elmira, new york, says wallin, "an investigation of repeaters in the second grade showed that per cent of those who required three years and per cent of those who required four years to complete the grade had adenoids, as against only per cent of those who required only two years to do the grade." another study described by dr. wallin was made by heilman in of camden repeaters. the correlation between pedagogical retardation and percentage of defect in each group was as follows: defects retardation yr. yr. yr. yr. yr. per cent health · · · · · nutrition · · · · · _adenoids_ _ · _ _ · _ _ · _ _ · _ _ · _ speech · · · · · visual defects · · · · · auditory · · · · · burpitt[ ] describes an investigation of children, male and female, considered by their teachers to be "dull and backward, but not to fall within the meaning of feeble-mindedness as given in the mental deficiency act of ." the children were examined for physical defects and other abnormal conditions. the author says that in per cent of the cases, the cause for backwardness was found to be "inherent dullness." (the basis for judgment of inherent dullness is not given.) adenoids and tonsillar tissue were found in · per cent of the cases, and were "more prevalent than among the children of the area as a whole." [ ]: h. r. burpitt. relative degrees of dullness and backwardness in school children and their causation. journal of mental science, . the degree of retardation, based upon the number of school standards below normal, was ascertained for pupils who suffered from various defects. the relative retardation was expressed by the fraction n/(a- ) where n = number of years retarded, and a = age. eighteen per cent of the children were so retarded that the fraction was greater than - . these were divided into two groups,-- - to - and - to - . the results are given in the following table: causes children children - to - - to - inherent dullness only inherent dullness and one or more physical defects irregular attendance with one or more physical defects irregular attendance _adenoids only_ _ _ _ _ turning to what the author calls single causes,--present in cases out of the ,-- causes children children - to - - to - irregular attendance _adenoids_ _ _ _ _ inherent dullness the term "cause" seems to be rather loosely used in this study. the author says concerning this, "dealing with physical defects first, although they amount in the aggregate to per cent (omitting defective speech, which is a secondary condition), in percent only do they represent the whole cause. this is made up of those cases where the defect is of such intensity as to produce retardation in otherwise ordinary children, and of other cases of less intensity, but sufficient to weigh down the balance against those near the level of what we may call for convenience the lower limit of normal intelligence." how he determines, without removing a defect, what the child's intelligence would be without it he does not explain. the following table compares the physical condition of two groups, one comprised of children examined in the regular routine examinations during the year ,--the other a group of retarded school children, given a special examination:--[ ] [ ]: transactions of the international congress on school hygiene, , the physical condition of retarded school children. group i group ii no. of children examined , , no. with physical defects , -- · % , -- · % no. of defects found , , defect no. % no. % anaemia malnutrition , · · defective vision , · · defective hearing , · _defective nasal breathing_ _ , _ _ · _ _ _ _ · _ _hypertrophied tonsils_ _ , _ _ · _ _ _ _ · _ defective teeth , · · pulmonary disease · · cardiac disease , · · average no. of defects per child · · in an investigation of , exempt and , non-exempt children in the philadelphia schools,[ ] dr. newmayer found the following percentages of defect: [ ]: ayres: "laggards in our schools." . exempt children non-exempt children defect no. examined % no. examined % defective vision · · defective hearing · · _defects of nose_ _ _ _ · _ _ _ _ · _ _defects of throat_ _ _ _ · _ _ _ _ · _ orthopedic defects · · mentally defective · · skin diseases · · miscellaneous · · total , · · it is evident from the majority of these investigations that there is some relationship between physical defects and pedagogical retardation. but whether or not the relationship is a causal one, they do not indicate. simple co-existence of two characteristics is not necessarily significant that one is cause of the other. plainly, though, if the removal of a physical defect is followed by improvement in the school progress, it may be argued that the presence of the defect was a causal factor in the previous retardation. the method in the few following studies, which seems to be employed to a greater degree than formerly, consists of measurement of such improvement. the journal of psycho-asthenics, march and june, , contains a paper on the "results obtained from the removal of tonsils and adenoids in the feeble-minded," by wm. j. g. dawson, m. d. the author starts out rather discouragingly by regarding his hypothesis as an axiom. he says, "it is a well-known fact that hypertrophy of the tonsils and presence of adenoids may produce more or less dullness of the intellect in normal children. this is a result of the imperfect aeration of the blood which supplies the brain, on account of obstruction to respiration. in the feeble-minded, conditions are more or less similar." one hundred and twelve cases in the sonoma state home, eldridge, california, were operated on. of these are recorded as borderline, as morons, as imbeciles, and as idiots. adenoids were always removed when they were present. the results of the operation are as follows: number number before after operation operation mouth breathing eneuresis sore throats ear trouble change in voice improved tonsillar tissue recurred in general physical health improved borderlines morons imbeciles idiots mental improvement from observation improved borderlines morons imbeciles idiot the inaccuracy of this investigation is evident. the mental improvement was measured by "observation," which is at best inexact, and susceptible to the influence of any expectation of improvement on the part of the observer. the degree of improvement is not mentioned, nor is the time interval allowed for the appearance of such improvement. there is no control group, and consequently, no way of knowing whether the improvement was due to the removal of the defect. a similar, though rather more careful study is reported by dr. charles james bloom in the new orleans medical and surgical journal for april, . dr. bloom's experiment consisted of eighteen months' observation on the mental and physical state following the removal of adenoids and tonsils from one hundred and fourteen children. this number was later reduced to fifty-seven, because of the fact that a number failed to return. there was no selection, all the patients being taken as admitted. the patient's physical and mental state was recorded at the time of admission. school reports were used as an index of intelligence. from this time on the patients were examined, weighed and measured at monthly intervals. the ages of the children ranged from four to fourteen years, inclusive. thirty-five per cent were under six years, and sixty-five per cent, therefore, over six. twenty-nine were boys, twenty-eight girls. omitting a part of the study which though interesting has no bearing upon our problem, we turn to results in the way of mental status. there were fifty-seven cases, ten of whom were under the school limit. of the remaining forty-seven, seven sent in no report. in four, or ten percent of the forty remaining, there was no progress. in thirty-six, or ninety per cent, appreciable progress was reported. one of the four unimproved cases was syphilitic, the other, the author says was a moron. quotation of the teachers' reports will be of interest. "'some improvement.' 'better work than previous year.' 'more effort displayed.' 'improved wonderfully.' 'improvement first term, not so much second.' 'before removal, not transferred; after removal transferred.' 'very much improved, both mentally and physically.' 'has made progress.' 'remarkable improvement.' 'not transferred before removal, but after.' 'more attentive.' 'a very small but gradual improvement.' 'am happy to tell you that he is studying more since tonsils and adenoids were removed.' 'greatly improved.' 'attention better.' 'more concentration.'" in this experiment like the preceding, the judges are liable to the effect of expectation of improvement. although the reports are more explicit, they are still couched in general terms, and not commensurable. some reports refer to intelligence and some to pedagogical standing. there is no control group. on the basis of these results, the author concludes: "children exhibiting some alternatives in the normal histology of tonsils and adenoids, give marked evidences of mental impairment." this seems to be a rather sweeping statement in consideration of the number of intellectually superior children who suffer from adenoids and diseased tonsils. another investigation was made by dr. cornell in the philadelphia schools,[ ] where seventy more or less retarded pupils in grades one to four were operated on for adenoids. according to the teachers' reports-- per cent improved considerably. per cent improved. per cent did not improve. · per cent deteriorated. · per cent deteriorated considerably. of those who had two chances of promotion, · per cent were promoted twice. · per cent failed twice. · per cent were promoted once. · per cent failed once. with one opportunity, · per cent were promoted. · per cent failed. [ ]: wallin: "mental health of the school child." . "the promotion record was thus decidedly poor. it is possible, however, that the time for promotion came before the orthogenic effects of the operations had become effective." the same criticisms may be brought against this investigation as were mentioned in connection with the preceding ones. teachers' estimates of improvement, especially when such improvement is expected, and without means of measuring it objectively, are necessarily inaccurate. again there is no control group. of even less value are the results of an investigation in new york city by cronin, where, out of eighty-seven cases operated on for enlarged tonsils and adenoids, "many advanced three grades during the rest of the school year, and only three lost time." an interesting study is one that is described by john c. simpson, m. d., in the journal of the american medical association, april , . dr. simpson's results are based on a study of boys of girard college who had been operated on for adenoids and tonsils. improvement was studied along several different lines, among them scholastic ability. for this part of the study, were chosen alphabetically, from each section. the only selection was for boys who were operated on long enough after coming to school to give an idea of scholastic ability; and long enough before the present study to permit a judgment as to their improvement. monthly averages were taken of each boy up to the time of the operation and from then to the time of this study. they were based on an average of per cent. as a control group, there were chosen boys who had had no operation, and who lived and worked under the same conditions. they also were taken alphabetically, from each section. the general average of the operative cases at the first measurement was · . of these , or · per cent gave an average increase in monthly standing of · after operation, while the remaining , or · per cent suffered a decrease of · . the average of the boys in the control group was · and for the first group after operation · . "it is interesting to note," says the author, "that the standing of slightly more than half of those operated on was improved, but when compared with those not operated on, no difference is seen." in a similar study of younger boys who had undergone the operation on entering college, and who had since had a year's study (again a group of ), the general average was · . compared to in the same classes not operated on, who had an average of · , the operative group is very slightly superior, · points. another study of pedagogical improvement, and a valuable contribution, is that reported by a. h. macphail in pedagogical seminary for june, , entitled "adenoids and tonsils; a study showing how the removal of enlarged or diseased tonsils affects a child's work in school." "the children studied were pupils in the adams and cranch schools. only cases were considered where there was a record of ten school months before the date of the operation, and where there was a record for at least ten month after the operation. there were thirty-one cases in all. "school records were looked up for the ten school months preceding operation, and for each school month subsequent--up to the date of leaving school, or in the case of children still in school, up to the date of the study. there were thus longer school records for some than for others. "the history of each case was divided into periods of ten school months each. eighteen cases had a record of twenty months after operation and eleven cases of thirty months. "comparing the first period after the operation with the period before, it is found that only about one-third showed improvement, and a little over half were doing poorer work. by comparing an average of _all_ work done subsequent to the operation with what was done before, it became evident that improvement in school work is not often observed until after a year from the date of the operation." in the cases that had records for twenty months, show that better work was done in the second period after the operation than in the period before. table a table showing where improvement begins. _per cent of cases showing improvement_ period period period based on cases · based on cases · · based on cases · · based on all groups · · these cases were compared with a control group chosen at random. they comprised a total of children who had records for four consecutive school years. table b table showing how time of improvement of "operated cases" compares with improvement among children at random. period period period a--per cent of cases · (operated upon) per cent of children at random b--per cent of children-- · · months (operated upon) per cent of children at random c--per cent of cases for · · months (operated upon) per cent of children at random "... immediately after operation, there seems to be a dropping off in the quality of school work done," but thereafter a marked improvement while the random group shows a comparatively static percentage of improvement from year to year. the conclusion of the author is: "here seems good reason to believe that the removal of diseased tonsils and adenoids is a factor in beneficially influencing the mental life of the school child. not only is the health impaired by failure to remove these diseased parts but the mental life and activity of the child as well." it is conceivable that pedagogical retardation might exist without any defect of intelligence. the physical effects of adenoids and tonsils might produce a tendency to fatigue, an emotional instability and consequent lack in attention, which would seriously influence the quality of school work, even though the child were of normal or superior intelligence. the relation of physical defects to intelligence has been investigated experimentally by a method which will be employed to some extent in the present investigation. in the two studies to which i refer psychological tests, rather than school standings were used as a basis for judging the intelligence. in each the effects of treatment were measured, and in one, a control group makes possible a more accurate interpretation of results. the first of these investigations is described by wallin.[ ] it was "an attempt to determine by controlled, objective, mental measures the influence of hygiene and operative dental treatment upon the intellectual efficiency and working capacity of a squad of twenty-seven public school children in marion school, cleveland, ohio (ten boys and seventeen girls), all of whom were handicapped to a considerable degree with diseased dentures or gums, and an insanitary oral cavity." the experiment extended over one year, from may, , to may, . the treatment included corrective work upon the teeth and mouth, and also instruction in oral hygiene, and follow-up work by an employed nurse. five series of psychological tests were given at stated intervals during the course of the experiment. they included tests of immediate recall, spontaneous and controlled association (opposites), adding, and attention-perception (cancellation). there were six sets of each test, numbered from one to six, of equal difficulty, and given under uniform conditions. tests and were given before the treatment began, and the average was taken as the "initial efficiency." the last four, or the last two, were averaged to represent the pupils' "terminal efficiency." [ ]: wallin: "mental health of the school child." . the results show the following influence of dental treatment upon the working efficiency of the pupils. . the indices of improvement are about the same for boys and girls. . improvement was about the same for older and younger pupils. . there were great individual differences in initial proficiency and in improvement. . improvement in one test does not presuppose improvement in another. . there is a decided gain in every test, "and not only are the gains decidedly more frequent than the losses but the largest gains are invariably emphatically larger than the largest losses." . the average gains in the tests were: memory, per cent with losses and gains. spontaneous association, per cent with losses and gains, addition, per cent with loss and gains. controlled association, per cent with losses. perception-attention, per cent with losses. average gain for all tests, per cent. unfortunately, wallin was unable to form a control group, so that it is impossible to estimate accurately how much of this gain is due to the treatment of the defect, and how much to other causes, such as growth, etc. "but," the writer adds, "if we concede that one-half of the gain--and that is, i believe, a sufficiently liberal concession--is due to a number of extrinsic factors, such as familiarity, practice and increased maturity, the gain solely attributable to the heightened mentation resulting from the physical improvement of the pupils would still be very considerable. there is corroborative evidence to show that there was a general improvement in the mental functioning of these pupils. this evidence is supplied by the examination of the pedagogical record of scholarship, attendance and deportment. most of the members of this experiment squad were laggards, and repeaters, pedagogically retarded in their school work from one to four years, but during the experiment year only one pupil failed of promotion, while six did thirty-eight weeks of work in twenty-four weeks, and one boy finished two years of work within the experimental year." the second investigation was equally careful in its method. it was pursued by the rockefeller foundation, under the direction of e. k. strong, with the purpose of examining the "effects of hookworm disease on the mental and physical development of children." the children were divided into five groups and tested at intervals of three and one-half months. the tests used were opposites, calculation, logical memory, memory span, hand-writing, form-board, and binet-simon. after the first test-series was given, the five groups were divided into sub-groups on the basis of this initial performance, so that the improvement was compared only for those sub-groups in which this was equal. the improvement of group a--uninfected children--proved to be greatest, and was taken as per cent. on this basis, group b--infected children not treated--showed the least improvement,--only per cent. group c--children completely cured of infection--improved per cent. group d--severely infected children, treated but not completely cured--improved per cent, and group du--an older sub-group of d--improved per cent as much as the normal children, and much less than the untreated younger children. dr. strong reaches the following conclusion: "the figures show, then, that hookworm disease unmistakably affects mental development. treatment alleviates this condition to some extent but it does not, immediately, at least, permit the child to gain as he would if he had not had the disease. and the figures apparently further show that prolonged infection may produce prolonged effects upon mentality,--effects from which the individual may never recover." chapter ii. method and procedure the following investigation was carried on during the year and a half from october, , to april, . the subjects were pupils at public school , manhattan, or patients at the manhattan eye, ear and throat hospital. all were boys, between the ages of six and fourteen years. the testing in the study of improvement was done by the investigator, assisted by three other examiners, all competent and experienced in the technique of giving psychological tests. a statistical study in addition to the more lengthy experiment, a statistical study was made, comparing the intelligence levels of two groups of children, the one selected for the presence of tonsils, the other for freedom from them. these two groups were obtained from a large group of children whose i.q.'s were gained from the records of public school , where, so far as possible, all children are tested upon entering school. we had, therefore, a group unselected for intelligence level. all the children for whom we had i.q.'s were examined by the school nurse or physician. on the basis of this examination the two groups were selected. the tonsil group consisted of those cases which in the opinion of the nurse or doctor, were pronounced enough to deserve treatment. the normal group was composed of those who were not defective, or in whom the defect was so slight as not to demand treatment. the two groups were arranged each in a surface of distribution according to the i.q.'s of the members. the results of the distribution appear in table i, and in figs. i. and ii. a study of improvement after treatment the method employed here is based on the hypothesis that if a physical defect is the cause of retardation in mental or physical development, removal of the cause will tend to lessen the retardation. in other words, if a child's working efficiency is lowered by the effects of adenoids and bad tonsils, their removal should, unless such lowering be permanent, be followed after a reasonable time by an improvement. but improvement in efficiency, following the removal of adenoids and tonsils proves nothing unless we shall compare it with the change in efficiency of a control group, whose members have not been operated on, and who thus still suffer from the effects of the growths. selection of cases the selection of the children for the experiment was effected in the following manner. the teachers at public school were asked to report any cases which had come to their notice, as being seriously afflicted with adenoids and diseased tonsils. in this way a fairly large group was obtained. the parents of the children were visited with the purpose of obtaining permission for examination and operation at the post graduate hospital. it was fairly easy to obtain permission to have the children examined. they were taken in groups of four or five to the clinic, the experimenter attending in person every examination in order to learn from the doctors the degree of the defect. as a result of this method, we discarded all those cases where there was any doubt as to the serious nature of the defect. from the large group examined, we were finally successful in securing operative treatment for children. discarding the cases where defect was slight, there remained a number of children who, for one reason or another, did not undergo operation. in some instances the parents refused their permission, in some they failed to keep appointments, in one or two there was sickness in the family, and in a number the hospital was overcrowded and could not receive the children. all members of this group were examined,--to the number of fifty-six, and from them the control group was finally selected. since we were unable to secure a large test group from public school , the experiment was continued at the manhattan eye, ear and throat hospital where opportunity was given for testing the children after they had been admitted for operation. in order to be sure that in each case the defect was sufficiently pronounced to render decisive the results of the experiment, each child's card was examined. only those children were included who were undergoing operation for both adenoids and tonsils. it may be here remarked that mental tests were given to these children on the morning of operation, and in some cases only a short time before it. the possibility suggests itself, therefore, that the results of the tests may have been influenced by excitement or fright on the part of the patients. actually, however, this did not seem to be the case. the children were perfectly cheerful and showed no signs of nervousness. the tests were given in a waiting room with the door closed so that any disturbing sights and sounds were eliminated. the possible lowering of the performance by the causes mentioned would tend to exaggerate the improvement shown by the retests, so that in the light of the results, it will be seen that they could have had little effect. the test group, then, was composed of forty members; ten from public school , who received operation at the post graduate hospital, and the remaining thirty from various schools throughout the city, patients at the manhattan eye, ear and throat hospital. the control group of forty was selected as previously described, and the pairs were arranged so as to have the ages of the members of one pair as nearly as possible the same. the tests since the main interest of this investigation lies with intellectual development, two tests of intelligence were given: namely, terman's revision of the binet test, and healy's picture completion test, number ii. the starred terman was always used, since it was necessary to economize time. it was expected that improvement in general health would probably follow the removal of the defects. this physical gain should come to light in increased height and weight. in every case, therefore, height and weight were measured. it is conceivable that adenoids and tonsils might have no effect upon general intelligence, and yet might cause a noticeable pedagogical retardation, simply as a result of the child's physical handicap, tendency to fatigue and consequent defect in attention or sustained effort. in order to gain some measure of this physical factor, strength of grip and speed in tapping were found. an effort was made, also, to obtain teachers' estimates of the pedagogical rankings, but this was for the most part unsuccessful, since in many cases teachers misunderstood directions, and in others the tests were made too soon after the opening of school for any such estimates to be possible. the tests described above were given before the operation to each child in the test group, allowing as short an interval as possible between test and operation. in the case of the manhattan hospital children, test and operation fell on the same day. in no case did the interval exceed ten days. the members of the control group were tested, each one within a week of his partner.[ ] [ ]: in a few cases where the operation was postponed after the test had been given, the child and his control were retested just previous to the operation. since both cases were retested, practice effect is of no great importance. six months after his first test, each child was retested, whenever possible. since some children had dropped out of the groups for one reason or another, the final number in each group was twenty-eight. it was necessary to rearrange the control cases somewhat in order to fill in spaces left vacant by those who were lost. in this rearrangement, the effort was made, . to pair cases whose ages were approximately the same; . to pair cases whose first tests were dated fairly close together. since all the children were tested and retested under approximately the same conditions, this rearrangement will probably not greatly influence the results. the tests were always given in the same order. the following table shows a list of the two groups, as originally paired, and as finally rearranged, with dates of tests and retests. dates of operation are given for the first group. test case original control final control test i op. test ii test i test ii test i test ii jb - - - - lost ss - - - - ll - - - - - - lj - - lost ss - - - - hk - - - - - - mg - - - - ms - - - - - - aa - - - - gf - - - - - - sd - - - - rj - - - - - - nf - - - - jj - - - - - - ml - - - - ag - - - - - - lp - - - - ik - - - - - - al - - - - hg - - - - moved control removed ac - - - - - - jf - - - - cl - - - - - - jf - - - - mr - - - - moved control removed sr - - - - - - pg - - - - ik - - - - moved control removed ao - - - - - - sk - - - - rb - - - - moved control removed dt - - - - mastoid control removed al - - - - moved control removed jd - - - - - - dd - - - - ls - - - - - - ks - - - - jb - - - - moved control removed hs - - - - - - mr - - - - am - - - - - - jm - - lost hh - - - - so - - - - - - ss - - wrong boy ma - - - - if - - - - - - (adenoids pk - - - - ad - - - - - - lc - - (removed ib - - - - jr - - - - moved ib - - - - jn - - - - moved ma - - - - lf - - - - hs - - - - - - sb - - - - ii - - - - - - bf - - - - uf - - - - - - lf - - - - sm - - - - - - lg - - - - am - - - - - - bg - - - - ck - - - - - - nf - - - - fb - - - - - - jf - - - - aa - - - - - - ls - - - - moved control removed ma - - - - ft - - - - - - lp - - - - moved hh - - - - chapter iii. discussion of the results statistical study the statistical study compared two groups of cases in respect to i.q. these groups were selected from one large group, on the basis of presence or absence of tonsillar defect. the tonsil group was composed of cases, and the normal group, of . the distribution of the two groups according to intelligence is set forth in table i, and in figs. i and ii. table i tonsil group normal group i.q. no. of per cent of no. of per cent of cases cases cases cases - · - · · - · · - · · - · · - · · - · · - · · - · · - · - · average · · median · · q · · [sigma] · · from these it is evident that the two groups are practically equal in intelligence. the average i.q. for the normal group is · , as compared with · for the tonsil group. the medians are equally close,-- · in the normal group and · with the tonsil cases. the difference in variability is negligible, q being · and [sigma] · in the tonsil group, while in the normal q is · and [sigma] · . the two cases with the lowest i.q.'s were tonsil cases, but the three highest i.q.'s also belong in this group. fig. . distribution of i.q.'s. number of cases. fig. . distribution of i.q.'s by percentage of total number of cases in the group. if the frequencies are expressed in terms of per cent of the total number of cases in the group, the two may be compared further. the following details are noticeable. i.q. per cent of per cent of tonsil group normal group below · · below · · above · · above · · above · in other words, in the percentage of cases below normal intelligence, the tonsil group exceeds by · per cent. the percentage of defective cases is also slightly greater in the tonsil group--the difference here being per cent. the normal group has a negligible predominance of bright cases,--only two-tenths of one per cent difference, while with the very superior cases, the tonsil group again exceeds,--by · per cent. the per cent of the tonsil group which reaches or exceeds the median of the normal is per cent. these figures seem to indicate remarkable similarity between the two groups considered. the two distributions are almost identical. while the slight predominance of cases below normal mentality in the tonsil group may indicate a very feeble tendency toward coincidence of tonsillar defect and mental dullness, it does not seem large enough to be at all significant. this is especially true when we consider that the tonsil group exceeds in superior children. if we allow the preceding contention of coincidence between dullness and tonsils, must we not argue here in the same manner for a tendency toward coincidence of superiority and tonsils? the chief source of error in this part of the study is the fact that the throat examinations were not conducted by the same person throughout the investigation. for this reason there must have been some slight disagreement as to what should constitute a reportable case. in the event, then, of a positive relationship between tonsil defect and lowering of the intelligence quotient, placement of normal tonsils in the "tonsil" group, and of diseased tonsils in the "normal" group would raise the first, and lower the second, thus tending to conceal the difference between the two. on the other hand, the cases where disagreement would occur would naturally be those of slighter defect, in which the intellectual retardation would be less likely to occur, so that the result would probably be merely an increased height at the overlapping portion of the curves, with no change at the ends. in any case, the two examiners had worked together previously, so that each must have been somewhat familiar with the opinions of the other. they were aware, also, that pronounced tonsillar defect was what we were attempting to detect. however this may be, there must always be some disagreement in diagnosis. when this is allowed for, the results of the investigation may be taken for what they are worth. contrary to expectation, there seems to be very little difference in intelligence between a group of children whose throats are normal, and one in whom the tonsils are diseased or badly enlarged. study of improvement after operation the complete results of the tests and retests are collected in table ii, where each control case is listed immediately below its respective test case, and where age, height, weight, grip, tapping rate, i.q., and score in healy picture completion are shown. from these data the more detailed observations have been made. the improvement of each child in the various tests has been computed, and a comparison drawn between the two groups. as we have previously stated, any improvement shown by the test group in excess of that of the control group, may be looked upon as significant. let us consider first the improvement of the children in general health, as shown by height and weight. in tables iii and iv we have tabulated the results, in such shape as to permit of comparison. an inspection of these tables will establish the fact that after a six months' interval, the test group shows, in respect to height and weight, a very slight gain over the control group. in weight, the average of the amounts by which the test group gains exceed the control group gains is · lbs., and in height, only · inches. the medians of these amounts are · lbs. and · inches respectively. comparing the improvements for the two groups, we find that in the case of the weights, the smallest gain (a loss of · lbs.) occurs in the control group, while the largest gain ( · lbs.) is in the test group. table ii. results of tests blank spaces indicate where tests were omitted for one reason or another n age weight height grip, kg. lbs. in. best hand - - · · · c - - · · · · - - · · · · c - - · · · - - · · · · c - - · · · · - - · · · · c - - · · · - - · · c - - · · · - - · · · · c - - · · · · · - - · · · · c - - · · · · - - · · · · c - - · · · · - - · · · · · c - - · · · · · - - · · · · · c - - · · · · - - · · · · c - - · · · · · · - - · · c - - · · · · - - · · · c - - · · · · - - · c - - · · · - - · · · c - - · · · · - - · · · c - - · · · - - · c - - · · · - - · · c - - · · · · - - · · c - - · · · · - - · · · c - - · · · - - · · · · · c - - · · · - - · · · c - - · · · · · · - - · · · · c - - · · · · · - - · · c - - · · - - · · · c - - · · · · · · - - · · · · c - - · · · · - - · · c - - · · - - · · · · · c - - · · · · table ii. results (continued) blank spaces indicate where tests were omitted for one reason or another n tapping, / min. i.q. healy, score best hand - - c - - · c - · · c · c - c · - c - - c · · · c · · c + + - · c + + + + - c + + - - · + c - - + + c + + - · · + + · · c + + - · + + c + + · + · c + + + + · c + + · + + - · - c + + - - + · c + + - - + + - c + + + + c + + · · + + · · c + + · · + + · c + + + + · c + + · · + + c + + · + + · c + + · + + - c + + · + + · · c + + · · we have therefore: pairs of i.q.'s to be compared pairs of weights pairs of heights pairs of grip measurements pairs of tapping speeds pairs of healy completion scores. again, in only five pairs does the gain of the control exceed that of the test case, while in the remaining sixteen pairs the gains of the test cases are greater than those of their respective controls. the greatest loss of test as compared to control is · lbs., while the largest gain is · . it would seem then, that after a six months' interval a child who has been operated on for adenoids and tonsils will tend to show a slightly greater increase in weight than a child who continues to suffer from the defects. the very small group renders this conclusion far from assured. since it doubtless takes some little time to recover from the effects of the operation, and since there is comparatively little gain in weight in a six months' interval, it would be well to extend the experiment over another year. for the greater reliability of results, some degree of after-care should be given the operative cases, the control cases of course receiving the same treatment. while this was impracticable in the present study, it happened that three pairs of cases were members of a nutrition class, and therefore underwent some hygienic treatment. in one pair, (no. ) the test case lost · of a pound, while the control gained · . the test cases of pairs and gained · lb. and · lbs. respectively, over and above their controls. however, these three cases alone are of little significance. a study of increase in height suffers even more than one of weight gains from the short interval which elapsed between measurements. normally, there is very little growth in six months. there are only nineteen pairs of cases in this portion of the study, a fact which renders it of even less value. however, results are offered for what they are worth. the smallest increase in height (· in.) is in the test group, while the greatest growth ( · in.) is also in the test group. there is, however, a gain of · inches in the control group as well as one of only · inches. there are seven pairs in which the test group growth is less than that of the controls, one in which the two are equal, and in the remaining eleven the growth of the test cases exceeds that of the controls. the variability table iii gain in weight, months, pairs n[ ] test group (a) control group (b) lbs. test test gain test test gain a-b · · · · · · - · · · · · · · - · · · · · · · - · · · · · · · - · · · -· · · · - · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · - · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · av. · · · · · · · m · · · %ile · · · %ile · · · q · · · p. e. (distribution) · · · p. e. (average) ±· ±· ±· ---------------- av. = · p. e. m. = · p. e. [ ]: numbers refer to cases as listed on table ii. of the test group growth is greater than that of the control group. the three nutrition pairs show the following records of growth,--in number , the test case shows a growth of·. in. more than his control. number is the pair in which the growth is equal. in number the test case again exceeds in growth by · of an inch. more reliable than height and weight considered separately, as an index of physical welfare, is weight in relation to height and age. table v shows the improvement in this relationship for the two groups. the numbers in columns , , and show the per cent under or over weight of the individual cases, in relation to their respective heights and ages. the authority upon which the figures are based, is the table published by the american child health association, giving standard weights for height and age in boys. there was an average loss of · per cent in the weight-height-age relationship for the test group, and of · per cent for the control group. the average improvement of the test group in excess of the control group is, then, · per cent. the median improvement of test group over and above control is · per cent. the test group is more variable than the control in improvement. the greatest improvement, per cent, is found in both groups. table iv gain in height-- months, pairs n[ ] test group (a) control group (b) inches test test gain test test gain a-b · · · · · · - · · · · · · · - · · · · · · · - · · · · · · · - · · · · · · · -· · · · · · · -· · · · · · · -· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · av. · · · · · · · m · · · %ile · · · %ile · · -· q · · · p. e. (distribution) · · · p. e. (average) ±· ±· ±· av.= p. e. m= · p. e. the greatest loss, per cent, is in the control group. eight cases show a loss in comparison to their controls, and nine reveal a gain. on the whole, there is some significance in the small net improvement manifested by the test group. the average is · p. e.'s, and the median · p. e.'s. the dynamometer results show no gain in strength of grip six months after operation. indeed the average of the gains of the operative cases is slightly less than the average gain of the controls. comparing the test group with the control, we find the average of the differences to be -· . but the variability is so high (p. e. = ±· ) as to render this figure unreliable. the greatest loss in strength of grip is found in the control group, but the greatest gain is also in this group. seven cases in the test group show a loss, as compared with only three control cases. in eight, or one-half of the sixteen cases, the control member of a pair gained more than the test member. considering the three pairs of nutrition cases, we find that in pair number the test case loses · kg. when compared with the control; and in pair number , · kg., while the test case in pair gains kg. the conclusion from the data would seem to be that, within the space of six months at any rate, operation for adenoids and tonsils brings about no increase in strength of grip. table v showing change in per cent over or underweight for height and age, pairs a b a-b n[ ] - - - - + - - - - - - - - - - - - - - - - - + + - - - - - - - - + + + + + + - + - - + + - - - - + - + - - - - - - - - - + + + + + + + + - - - + - - + - - - + - - + + - - + - - + + + - + - - - - - - + - + + + - + - - - - - + + + + + - + av. - · - · - · - · - · - · + · m + · - · + · %ile + · %ile - - · - q · · p. e. (distribution) · · p. e. (average) ±· ± ± av.= · p. e. m.= · p. e. is there, after operation, an improvement in motor control and attention, and a lessening of fatiguability as these may be demonstrated in the tapping test? table vi gives the number of taps in the first half minute of tapping for both groups before and after the six months interval. the test group suffers an average loss of · taps, and a median loss of . the average loss of the control group is · , and the median . table vi gain in grip-- months-- pairs n[ ] test group (a) control group (b) test test gain test test gain a-b · - · - · - - - - - - - · · · · - · - · - · · - · - · · · · · · · - - · · · · · · · · · - · · · - · · av. · · · · · · - · m - · %ile · %ile - - · q · p. e. (distribution) · · · p. e. (average) ±· ±· ±· av.= -· p. e. m.= - · p. e. there is practically no change then in the tapping ability of either group. the high unreliability of the difference (p. e. = ± · ) is noteworthy. it would seem that incidental causes have a much greater effect upon tapping ability than can be demonstrated as resulting from the removal of adenoids and tonsils. use of the tapping test as a measure of the decrease in tendency to fatigue similarly brings out no indication of any improvement in the operative group of cases. the measure of fatigue was taken as a ratio; namely, the number of taps in the first, minus the number in the second half minute over the number of taps in the first half minute. then, if there is a greater number of taps in the second, the ratio will be minus, indicating that fatigue effect is so small as to be overcome by practice effect. this was a fact in only four cases. since what we are measuring is improvement, the ratio for test is subtracted from the ratio for test to find the gain in overcoming fatigue. table viii shows the average gain for group one to be -· , and the median -· . that is, there is an average increase in fatiguability of · units and a median increase of · with a p. e. of ± · . this increase in fatiguability occurs also in the control group, average , and median · with p. e. of ± · . the average gain of test group over control group is -· and the median gain is -· . again variability is relatively large, p. e. being · , so that the median and average gains are -· p. e. and -· p. e. respectively. we may say, then, that the capacities brought out by the tapping test seem to undergo no improvement in six months after removal of adenoids and tonsils. the main line of interest in the present experiment lay with the relation of adenoid and tonsil defects to general intelligence. the results of the two tests dealing more specifically with this side of the problem are here set forth. table ix shows the i.q.'s. of the two groups before and after the six months' interval, together with changes plus or minus in i.q., and a comparison of the separate pairs in respect to improvement. we find that the test group shows an average gain in i.q. of · points. the median gain is points, the total range points and p. e. of the average is ± · . the control group shows an average gain very slightly higher, · points, the median gain being . the range in this case is points, but p. e. is only ± · . the average of the compared gains of separate pairs is - · . these numbers are so small as to be insignificant. actually, we may say that the operative group as a whole showed no gain over the control group. if we examine individual cases we find that the greatest loss in i.q. was in the control group, ( points) but the greatest gain ( points) also appears in this group. in the test group cases table vii gain in number of taps in one-half minute, pairs--right hand n[ ] test group (a) control group (b) test test gain test test gain a-b - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - av. · · - · · · - · · m - - %ile · · · %ile - - · q · · · p. e. (distribution) · · · p. e. (average) ± · ± · ± · av. = · p. e. m. = · p. e. lost in i.q., as compared with in the control group. thirteen test cases lost in comparison with their respective controls. two gained equally with their controls, and the remaining thirteen showed a larger gain. in regard to the three pairs taken from the nutrition class, number gained points and his control, . number lost a point and his control lost , while number lost points with a gain of point by his control. so that these cases, in spite of most favorable conditions, show no consistent gain in i.q. the results of the healy tests are similar. there is a slightly higher average gain in the control group. the test group contains eight cases which made a poorer score at the end of the interval, the control group six. the range of gains is from - to + , or points, in the test group, while in the control group the gains range from - to + · or · table viii decrease in fatigue in tapping--difference in rates of second half minute over first half minute. sixteen pairs n[ ] test group (a) control group (b) test test gain test test gain a-b -· · -· · -· · -· · · -· · · · -· · · -· · · · -· -· · -· · · · -· · · -· · · -· -· · · -· · · -· -· · · · · -· · -· · · -· · · · -· · · -· · · -· · · · · · · · · · · · · · -· · · · -· · · -· · · · · · · -· · · · · · · -· · · · · · · -· · · · · · · -· · av. · · -· · · · -· m -· -· -· %ile · +· · %ile -· -· -· q · · · p. e. (distribution) · · · p. e. (average) ±· ±· ±· av. = -· p. e. m. = -· p. e. points. seventeen of the operative cases showed a smaller gain than their respective controls. the three pairs of cases from the nutrition class show the following gains:--pair ; the test case loses points, the control gains points; pair , test case gains · , but control gains points; pair , test case gains points, and control gains · points. from this test then, we can find no general tendency for cases operated on to improve in intelligence in excess of improvement in a control group which was not so treated. this question presents itself:--is there any relationship between improvement in physical well-being as revealed in weight, and improvement in intelligence? if, as has been supposed, adenoids and diseased tonsils cause mental retardation indirectly through physical deprivation, it would seem as though greater improvement in intelligence after operation should accompany greater improvement in weight, and smaller intelligence gain should accompany slighter gain in weight. in order to determine whether this was true for our cases, improvement in i.q. was correlated with gain in weight, for the test group. the order of merit method was used, and the formula [rho] = - (( [sum] d_n) /( n(n²- ))) where f = sin ([pi]/ )[rho]. the resulting value of r was -· with unreliability of · , calculated by the formula [sigma]t.r - obt.r = ( · ( -r²)) / [sqrt]n. there is therefore no correlation between improvement in intelligence and gain in weight. table ix improvement in i.q., pairs n[ ] test group (a) control group (b) test test gain test test gain a-b - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - av. · · · · · · - · m - %ile %ile - - - q · · p. e. (distribution) · · p. e. (average) ±· ±· ± · av. = -· p. e. m. = -· p. e. table x improvement in performance of healy test, pairs n[ ] test group (a) control group (b) test test gain test test gain a-b - - - · · - - - · · - - · - · · · - · · - · · - · · · - · - · · - · · - · - - - · · · · · - · - - - · · - - - - · · - · · - · - · - - - - · · - · · - - - · - · - - - · · · - · · · - - - - · · - · · · - · · · · · - - · · - · · · · - · · · · - av. · · · · · · - · m · · - · %ile · %ile - - · - · q · · p. e. (distribution) · · · p. e. (average) ± · ± · ± · av. = - · p. e. m. = - · p. e. similarly, it might be thought that the children who had suffered from the defects for a comparatively short time, might reveal greater improvement in intelligence after six months than those who had been afflicted for a longer space of time. we had no way of knowing definitely how long the defects had been present in the cases studied. roughly, though, we may say that in general the older boys have had defective tonsils and adenoids for a longer time than the younger ones, and that the older the boy, the older the defect. on this basis, if correlation of youth with gain in i.q. should give a larger positive value for r, we might be justified in saying that the younger boys, who have been handicapped for a lesser period, show greater mental recuperation than their older companions. such a correlation was attempted in the test group, correlating age at the first test with gain in i.q. the same methods and formulae were used as in the weight and intelligence comparison, the greatest gain in i.q. being given first position, and the lowest age. the resulting value for r was -· , with an unreliability of · . the relationship would appear to be in the other direction but it is so small, with an unreliability measure so large as to be insignificant. once more, then, we find in our results no correspondence between recency of defect and quick mental recovery. table xi showing percentile ratings of the members of the two groups at the beginning and end of the six months' interval weight height grip tapping · · · · · · · · c · · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · · · c · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · · c · · · · · · · · · · · · · c · · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · · c · · · · · · · · · · · · · c · · · · · · · · · · · · · · · c · · · · · · · · · · · · · c · · · · · · · · · · · c · · · · · · · · · · · · · · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · c · · · · · · · · · · · · · · c · · · · · · · · · · · · · · · · c · · · · · · · table xi (continued) showing percentile ratings of the two groups at the beginning and end of the six months' interval n[ ] i.q. healy total possible average gain · · · · · · c · · · · · · · · · · · · c · · · · -· -· · · · · · · c · · · · · · · · · · · c · · · · · · · · · · c · · · · · · · · · · c · · · · · · · · · · · c · · · · · · · · · -· -· c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · -· -· · · · · -· -· c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · -· -· c · · · · · · · · · · -· -· c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · - · -· c · · · · · · · · · · · · c · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · · · · · · · c · · · · · · table xi expresses the results of table ii, with the scores given in percentile values. in each test, the group was taken as composed of the two scores of every individual--the total number of scores in tests and retests, eliminating those scores where the other member of the pair was lacking, or where no retest was given. thus case number was just within the lowest % of the group in weight at the first weighing, but had advanced to the percentile at the second. in height he gained from the percentile to the percentile. his total gain in all tests is percentile out of a possible , and the average gain is·. . the reader may see by scanning the table that the gains in the test group are practically equaled by those in the control group. there seems to be no consistent relationship between a low score in the first test and a large gain. this is true even though the method of calculation tends to minimize gains at the high end of the group, and losses at the low end. in table xii this may be seen more clearly in respect to i.q. and the results for all the tests taken together with the i.q. weighted by being counted twice. a large possible gain indicates that the score at the first testing was low, and vice versa. considering i.q. values, the largest possible gain in the test group was per cent of the group. this occurred twice, in one case the actual gain being % of the group and in the other %. in the control group, the largest possible gain was % of the group, but actually this case fell % of the group. if we correlate possible gain with actual gain for each group, using the formula r = sin(([pi]/ )[rho]) when [rho] = - (( [sum] d²)/(n(n²- ))) we get a coefficient of correlation · in the test group, and · table xii showing gains in percentile rating for i.q., and for a total of all the tests with i.q. weighted by being counted twice. i.q. total a b st d possible actual possible actual av. gain p.r. p.r. gain gain gain gain c - · · c - - · - · c · c c · c · c · - - - · c · · c - · c - · - · c - - · - - - · c · · c - · c - · - c c c · · c · c · - - - c · - - · c · · c - · · c - - - · c - · c - · - c - · - · c · c · in the control group. with the small number of cases involved the probable error is too great to allow either of these measures as indicative of relationship. we may say, then, that there is no definite tendency for those of low i.q. to improve in six months after operation to a greater degree than those of higher i.q. finally, in order to compare the results of the various tests, the measures of the gains of the test group in excess of the control were, for each test, expressed in terms of p. e. the averages and medians of these measures are collected in table xiii. they show a very slight tendency toward gain in weight, height, and weight-height-age relationship; neither improvement nor loss in grip, tapping fatigueability and i.q., and a rather curious tendency to loss in the healy scores. this latter is very probably not a true measure since performance in the healy picture completion test shows a rather high variability, and the cases are so few as to make the influence of single very high or low scores unduly great. table xiii showing improvement in various tests of operative group over and above such improvement in control group. expressed in terms of p. e. weight height height- grip tapping tapping i.q. healy weight fatigue p. e. p. e. p. e. p. e. p. e. p. e. p. e. p. e. average · · · -· · -· -· - · median · · · -· · -· - · chapter iv measurement of improvement after a second interval of six months in view of the fact that one of the experimenters[ ] found improvement in school work when her study was extended to cover a second time interval after operation, it was deemed advisable to similarly extend the present investigation in order to determine whether our operated cases showed any improvement after twelve months. to this end, the fifty-six children composing the final groups of the first study, were sought after a second interval of about six months. conditions made it impossible to give all the retests exactly twelve months from the time of the operation. as a matter of fact, the period ranges from ten to seventeen months. an effort was made to keep the interval between tests equal for the two members of a given pair. [ ]: a. h. macphail, adenoids and tonsils: a study showing how the removal of enlarged or diseased tonsils affects a child's work in school. ped. sem., june, , pp. - . the same tests were given as in the first study. about half of the testing was done by one of the former examiners, but she was obliged to turn the work over to another before it had been completed. the second examiner was highly recommended, and had had training and practical experience in the giving of tests. she was instructed in the methods which had been employed previously, so that conditions were as far as possible kept constant. the results of the tests are collected in table xiv. in the first column is given the length of the time interval for each case. it may be seen that the final group was composed of forty-two children, forming twenty-one pairs. there were fifteen pairs which received a second rating in weight; thirteen in height; thirteen in grip; fifteen in tapping, eleven in fatigue as shown by tapping, twenty-one in i.q., and eighteen in the healy test. these numbers while they are smaller than we could wish, would seem to be great enough to indicate table xiv results of the tests after an interval of from to months n[ ] mos. weight height grip test test test test test test · · · c · · · · · · · · c · · · · · · · c · · · · · · · · c · · · · · · · · · c · · · · · · · · c · · · · · · · · · c · · · · · · · c · · · · · · · c · · · · · · c · · · · c · · · · · · · c · · · · · · c · · · · · c · · · · c · · · · c · · · · · · c · · · · · · c · · · · · c · · · · · · c · · · · table xiv (continued) n[ ] tapping i.q. healy test test ( ) ( ) ( ) ( ) - c - · · c · · · c · · c - c · · c + + - c + + · + + - · c + + - - + c - · + + · c + + - · · + + · c + + - · + + c + + · + c + · + + - · · c + + - - + · · c + - - + + c + + · + + c + + · + + · · c + + + + - · c + + · + + · · c + + · · any very consistent tendency toward improvement. the question, whether or not the results are affected by the differences in time interval, will be considered later. in weight, the test group showed an average gain of · pounds, with a median of · (table xv). the average gain of the control group was · pounds and the median · . the gains in the test group are less variable than those of the control. the average of the gains of the test group in excess of those of the control is · pounds, and the median is · pounds; while the unreliability of the difference is ± · the average, then, is only · p. e. and the median · p. e. if we turn to table iii and compare the results there set forth with the results at the end of the second period, we find the gains of the test group exceed those of the control in the following manner. table xv weight, second retests, pairs n[ ] test group (a) control group (b) test test gain test test gain a-b · · · · - · · · · · · - · · · - · · · · · · · - · · · · · · · - · · · · · -· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · - · · av. · · · · · · · m · · · %ile · · · %ile · · - · q · · · p. e. (distribution) · · · p. e. (average) ± · ± · ± · av. = · p. e. m. = · p. e. months months average of gains in test group in excess of control · · median · · p. e. of difference ±· ± · average in terms of p. e. · · median in terms of p. e. · · after a twelve months' interval, therefore, the actual average and median gains are slightly larger than after the first six months, but the variability is very much greater. therefore, when expressed in terms of p. e., the gains are smaller. one of the test group cases (no. ) who had gained pounds after six months, gained pounds in the second period of six months, making a total gain of pounds. this gain is exceeded, however, by one in the control group (no. ) who gained · pounds in six months, and · pounds more in the ensuing five months. this is certainly an enormous gain for five months, under any circumstances. turning to table xiv we find no corresponding gain in i.q. for this child. indeed there is a loss of five points. other children in the test group who made large gains, were case , with a gain of · pounds after twelve months, compared with · pounds after six months; case , gain of · pounds after first six months, and pounds after months; case , whose gain after the first period was · pounds, but who gained · pounds after twelve months. in these cases the gain in the second period greatly exceeds that for the first. table xvi height, second retests, pairs n[ ] test group (a) control group (b) test test gain test test gain a-b · · · · · - · · · · · · · - · · · · · · · - · · · · · · · - · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · av. · · · · · · · m · · · %ile · · · %ile · · · q · · · p. e. (distribution) · · · p. e. (average) ±· ±· ±· av.=· p. e. m.= · p. e. in weight, then, the mean gain of the test group over and above the control continues to increase through the second period of six months. the variability, however, increases enormously, which fact is due possibly to varying conditions which may enter in during the longer period to affect the health and thus lessen the gain of some of the children. in order to determine whether the slight inequalities in interval length have any considerable effect on the results, we have calculated the relation between the length of interval and amount of improvement. the coefficient of correlation by the method of rank differences is equal to · . the small number of cases renders the unreliability of correlation very great, but we can at least say that there is no consistent relationship between improvement and time interval, within the narrow limits here set. we are probably justified in taking twelve months as the interval, since such was the case in eight out of the fifteen test cases, while the greatest variation above this made was four months, and below it, one month. the gains in height after twelve months are shown in table xvi. the average gain of test group in excess of control, is only · inches, and the median · inches. variability is about the same as at the end of six months, p. e. ± · . the average is only · p. e., but the median is a little larger, · p. e. if these measures are compared with the results after the first period, we have: months months average of gains of test group in excess of control · · median of gains of test group in excess of control · · p. e. of difference · · average in terms of p. e. · · median in terms of p. e. · · there seems to be little gain in height after the first period. test cases and each show a gain of · inches after fifteen and twelve months respectively, compared with gains after six months of · , and · inches. but case in the control group, makes still greater comparative gain, + · inches after six months and · inches after seventeen months. in this case there are almost six additional months for the child to grow, which may account for the larger gain. control case , however, may be compared with his partner, mentioned above, since the interval between tests was the same for both. this boy grew · inches in six months, and · inches after months. this is practically equal growth with test case . control case also shows relatively great growth during months, + · inches, whereas the growth in six months was only · inches. out of the test group, cases gained more in the first period of six months, than in the second, while only gained more in the second than in the first. of the control group, cases made more than half of their total gain during the second six months of the total twelve months' period. since this is true, it seems likely that whatever increase in growth we find during the second half of the twelve months' interval, may be explained by incidental causes, and that so far as actual gain in height is considered, there is no further effect from the operations, after six months. as was mentioned in the previous chapter, height and weight are of less significance when considered alone, than when taken in relation to each other and to the age of the individual. the gain in this weight-height-age relationship following upon operation for adenoids and tonsils, will be considered in the same manner as were weight and height gains. we have, then: table xvii height-weight relationship, second retests, pairs showing changes in per cent over or underweight after months' interval n[ ] test group (a) control group (b) test test change test test change a-b - + + - + - - - - - - + - - - - - - - - - - + - + + - + + + + + + - - - + + + - - + - - + - - - - - + - - + + + + + - - + - - + + + + + - + - + + - - - + + + + - - - + av. - - · · - · · · · m - %ile · · %ile - · · - q · · · p. e. (distribution) · · · p. e. (average) ± · ± · ± · av.= · p. e. m. = · p. e. months months average of gains of test group in excess of control · · median of gains of test group in excess of control · p. e. of difference · · average in terms of p. e. · · median in terms of p. e. · · the mean of the actual gains in the second period exceeds that of the first. again the second group of results is more variable, decreasing the reliability. there seems, however, to be a definite increase in the net gain of the test group during a second six months' period. some individual cases may be cited. the greatest gain after six months is units in the test case, matched by an equal gain of units in the control group. after twelve months, the test group shows one gain of units, the highest gain in the control group being . six cases in the test group, and in the control had lost at the end of six months, but after twelve months, all but of the test cases showed a gain, and all but of the controls. in test cases out of the total , more than half of the gain occurred during the second six months. in the control group, six of the cases made more than half of their gain during the second six months, and the second interval gains of the other cases exceeded the per cent mark by so little that they may be accounted for by chance. these results seem to indicate a slight but actual increase in the net gain of the test group during the second six months of the experiment, and an accompanying growth in the variability of these gains. it will be remembered that the results described in the previous chapter show no gain in strength of grip as a result of operation. comparison of the cases tested after the second interval, with the cases at the end of the first, gives results as follows: table xviii gain in grip, second retest, pairs n[ ] test group (a) control group (b) test test gain test test gain a-b - - - - - - - · · - · -· - · · -· - · · · · · · · · · - · - · · · · · · · - av. · · · · · · - · m · - · %ile · · · %ile - · · -· q · · · p. e. (distribution) · · · p. e. (average) ±· ±· ±· av.=- · p. e. m.=- · p. e. months months average of gains of test group in excess of control -· - · median of gains of test group in excess of control - · - · p. e. of difference ±· ±· average in terms of p. e. -· - · median in terms of p. e. - · - · the greatest gain in the test group after twelve months is kg. (case ). during the first six months this case lost kg. there are two gains of kg. in the control group. of these two (cases and ) had gained kg. during the first interval and another (case ) kg. the greatest loss in the test group after the twelve months' period was kg., by case , which had already lost this amount at the end of six months. the greatest loss in the control group was suffered by case , a loss of kg., all in the second period. after the first period, out of cases in the test group gained in strength of grip, and in the control group. after the second period, the test cases showing gain numbered only out of , while all of the control cases had gained except . of the test group cases in the second period either gained less than half of the amount they had improved in the first period, or dropped from the scores they had made at that time. the corresponding numbers for the control group are and . there is evidently no improvement in strength of grip twelve months after operation. the unreliability of the results is very great. however, there is certainly no tendency toward improvement. why this should be is a question. it may be that the change in examiners is partly responsible, for performance in this test is influenced to a surprising extent by the manner in which it is presented. table xix tapping--second retest, pairs n[ ] test group (a) control group (b) test test gain test test gain a-b - - - - - - - - - - - - - - av. · · · · · · · m %ile · · · %ile - · - · q · · · p. e. (distribution) · · · p. e. (average) ± · ± · ± · av.= · p. e. m. = · p. e. there were pairs of cases who performed the tapping test at the end of twelve months. comparison with the pairs after six months yields the following results: months months average of gains of test group in excess of control - · · median of gains of test group in excess of control p. e. of difference ± · ± · average in terms of p. e. · · median in terms of p. e. · the gain in the second interval is greater for the tapping test than for any of the tests yet described. after the first six months there is no gain. at the end of ten months the average gain is · , and the median taps per half minute. after six months' interval, of test group cases had lost. at the end of twelve months, only out of had lost. the control group, on the other hand, lost in out of cases after six months, and in out of at the end of twelve months. all but one of the test group cases made more than half of their gain in the second period. of the control group only cases did this. the variability of gains after months is about equal to the variability at the end of six months. strangely enough, decrease in fatigueability as described in the previous chapter does not show itself after months. in fact, the negligible loss in ability noticeable after six months has increased after a period of twelve months. in only out of test group cases, is the gain in the second period equal to that of the first, a similar result to that found in the control group, where out of the cases made half their total gain in the second interval. the results are compared below. months months average of gains of test group in excess of control -· - · median of gains of test group in excess of control -· - · p. e. of difference ±· ± · average in terms of p. e. -· - · median in terms of p. e. -· - · table xx tapping for fatigue, second retests, pairs n[ ] test group (a) control group (b) test test gain test test gain a-b -· · -· · · · -· · · -· · -· · -· -· · -· · · -· -· · · · · -· · -· -· -· · · · · -· · · -· · · · -· · · · · · · -· · · · · · · · · -· · · · · · · -· · · -· · · · -· · · · -· · av. · · · · · · -· m · · -· %ile · · · %ile -· · -· q · · · p. e. (distribution) · · · p. e. (average) ±· ±· ±· av.=- · p. e. m.=- · p. e. the point of greatest interest in the present study is, as has been said, improvement in intelligence. does operation for adenoids and tonsils result in improvement in intelligence, as measured by i.q.? if such improvement does not manifest itself after six months, can it be found after a second period of the same length? the latter question is answered by observation of table xxi and attention to the following facts, gathered from the pairs of cases who were given intelligence tests after the twelve months' interval. months months average of gains of test group in excess of control - · - · median of gains of test group in excess of control - - p. e. of difference ± · ± · average in terms of p. e. - · - · median in terms of p. e. - · - · the result after twelve months remains the same as that after the six months' interval. a gain or loss of two or three points in i.q. is negligible, so that the mean gain of the test group in excess of the control is practically zero at the end of each period. variability increases with the length of the interval. one case in the test group (case ) gained nothing in six months, but showed a gain of points after months. however, there is a control case to match this,--case , who gained point in the first six months and points after months. case in the test group lost points in the first six months, but gained back these and additional in the second period. but control no. gained points in the second interval after having lost in the first. on the other hand several cases lost in the second period, as compared with the first. test group case , for example, gained points in the first six months, and lost of them in the second. case in the same group lost points in the first period, and failed to regain any of them. case lost points in six months and more before the end of months. in the control group, case gained pounds in the first six months and lost eight of them in the second. summing up gains and losses in the second period, for both groups: table xxi i.q., second retests, pairs n[ ] test group (a) control group (b) test test gain test test gain a-b - - - - - - - - - - - - - - - - - - - - - - - av. · · · · · · - · m - %ile · · %ile -· - · - q · · · p. e. (distribution) · · · p. e. (average) ±· ± · ± · av.=- · p. e. m.=- · p. e. lost in nd gained in nd no gained equally period period change with gain in st period test group control group the average gain of the test group was · points after months, compared with · after six. the control group, however, made an average gain of · after months, the gain after six months being · . these numbers are insignificant as gains, but they at least show no improvement in the test group which the control group does not reveal as well. on the basis of the results, we may say that there has been no improvement in i.q. as a result of operation, either after six months or after twelve. there remains to be considered only the result of the healy picture completion test. we have scores in this test for pairs of cases. when these scores are compared with those in the former tests, the results stand as follows: average of gains of test group in excess of control - · - · median of gains of test group in excess of control - · p. e. of difference ± · ± · average in terms of p. e. - · -· median in terms of p. e. - · · the figures given above show no gain in the healy test as a result of operation. both after six months, and after twelve, we find that the test group has gained no more than the control group. as before there are individual cases showing considerable gain in the second period, but these are matched by control cases which reveal equal or even greater gains. in the test group, cases lost in the second period in comparison with the first, gained, and gained as much in the second period as in the first. the control group lost in the second period in cases, gained in , and gained as much as in the first period in cases. the two groups, then, are practically equal, both showing a gain in the second period, but this gain cannot be due to the operations, since the control group did not undergo operation. table xxii healy a, second retests, pairs n[ ] test group (a) control group (b) test test gain test test gain a-b - - · · - · · · - · · - · - - - · · - · · - · · · - · · - · · · - - - · · - · · - · · · · - · · · · · - · · - · · · · - · · - - · · · · - · · · · · · - · · - - - · · · av. · · · · · · - · m · · %ile · %ile · · - · q · · · p. e. (distribution) · · · p. e. (average) ± · ± · ± · av.=-· p. e. m.=+· p. e. table xxiii weight in height in height-weight grip in gains pounds inches percents kg. lb. p. e. in. p. e. % p. e. kg. p. e. av. · · · · · · - · - · av. · · · · · · - · - · m. · · · · · · - · - · m. · · · · · · - · - · p. e. ± · ±· ±· ±· p. e. ± · ±· ± · ±· gains taps in tapping in / min. fatigue ratios i.q. healy score taps p. e. ratio p. e. pts. p. e. pts. p. e. av. · · -· - · - · - · - · - · av. · · -· - · - · - · - · - · m. · · -· - · - · - · - · - · m. · · -· - · - · - · · p. e. ± · ±· ± · ± · p. e. ± · ±· ± · ± · in table xxiii are collected the results discussed in the foregoing chapter. the mean results are expressed in terms of p. e. and as gross values, so that the various tests may be compared. chapter v. summary. the results obtained from the experiment may be summarized as follows: . six months after operation for adenoids and tonsils, there seems to be a slight but not very reliable gain in weight as the result of the operation. after twelve months this has increased; indeed, it has very nearly doubled. . gain in height, resulting from operation, is so slight as to be unreliable. this gain does not increase during a second period of six months. . the height-weight-age relationship is an excellent measure of the physical well-being of the child. the figures expressing this relationship show no very reliable gain in the first six months, but improvement increases considerably during the second period. . the test group shows no gain over the control group in strength of grip. there seems on the other hand to be a slight loss; which does not decrease in amount during the second period. . speed of tapping did not increase during the first period, any more for the test group than for the control. during the second period, however, there is a marked improvement. . operation for adenoids and tonsils does not lessen fatigueability as shown by the tapping test. the probability is, however, that the test is at fault. . no rise in i.q., as a result of operation, makes itself evident after six months or after twelve months. . there is no improvement in the performance of the healy test either after six months or after twelve. . in every test except grip and tapping, there is a marked increase in the variability of the gains after the second period. this is possibly due simply to the fact that the longer interval permits the intervention of more extraneous factors which may influence the scores in one direction or the other. . a group of children with diseased tonsils showed equal distribution of i.q. with a group of children who were normal in this respect. conclusions the article by macphail, which has been reviewed in a former chapter, showed pretty conclusively that the removal of adenoids and tonsils was followed by improvement in school work. that such improvement was not due to a rise in general intelligence can be concluded from the present experiment. that efficiency in school work does not rest wholly upon intelligence has been demonstrated more than once. the tendency here noted to improve in general physical tone may, perhaps, serve as a sign of the factor upon which such improvement depends. improved health means better attention, better emotional response, greater resistance to fatigue, and probably increased efficiency. interesting investigations of such improvement in efficiency might be made by administering educational tests to groups similar to those of the present study. the results of such an experiment would be exceedingly instructive, and would be more significant than conclusions drawn from school marks. by this means also we might determine along what special line efficiency is most affected. since there was no recuperation in intelligence resulting from operation for adenoids and tonsils, it is reasonable to expect that there had been no retardation from which to recuperate. this supposition is borne out by results of the statistical study, wherein we found that a group of children suffering from diseased tonsils possessed equal intelligence with a group which was free from such defect. we can say to physicians, then, with fair amount of assurance, that removal of adenoids and tonsils will probably not raise to any great degree the intelligence level of the mentally defective child who is brought to him. we can say to students of the constancy of the i.q., that it is not greatly lowered by adenoids and diseased tonsils and we may say to the clinical psychologist that these defects have no demonstrable effect upon general intelligence, whatever effects they may have on volitional and emotional normality,--the two elements which, along with intelligence are necessary for the maintenance of the individual as an instrument of social efficiency. well, naturally kaiser would transmit baby talk messages to his mother ship! he was-- growing up on big muddy by charles v. de vet illustrated by turpin [transcriber's note: this etext was produced from galaxy science fiction july . extensive research did not uncover any evidence that the u.s. copyright on this publication was renewed.] kaiser stared at the tape in his hand for a long uncomprehending minute. how long had the stuff been coming through in this inane baby talk? and why hadn't he noticed it before? why had he had to read this last communication a third time before he recognized anything unusual about it? he went over the words again, as though maybe this time they'd read as they should. oo is sick, smoky. do to beddy-by. keep um warm. when um feels better, let usns know. ss ii kaiser let himself ease back in the pilot chair and rolled the tape thoughtfully between his fingers. overhead and to each side, large drops of rain thudded softly against the transparent walls of the scout ship and dripped wearily from the bottom ledge to the ground. "damn this climate!" kaiser muttered irrelevantly. "doesn't it ever do anything here except rain?" his attention returned to the matter at hand. why the baby talk? and why was his memory so hazy? how long had he been here? what had he been doing during that time? listlessly he reached for the towel at his elbow and wiped the moisture from his face and bare shoulders. the air conditioning had gone out when the scout ship cracked up. he'd have to repair the scout or he was stuck here for good. he remembered now that he had gone over the job very carefully and thoroughly, and had found it too big to handle alone--or without better equipment, at least. yet there was little or no chance of his being able to find either here. calmly, deliberately, kaiser collected his thoughts, his memories, and brought them out where he could look at them: the mother ship, _soscites ii_, had been on the last leg of its planet-mapping tour. it had dropped kaiser in the one remaining scout ship--the other seven had all been lost one way or another during the exploring of new worlds--and set itself into a giant orbit about this planet that kaiser had named big muddy. the _soscites ii_ had to maintain its constant speed; it had no means of slowing, except to stop, and no way to start again once it did stop. its limited range of maneuverability made it necessary to set up an orbit that would take it approximately one month, earth time, to circle a pinpointed planet. and now its fuel was low. kaiser had that one month to repair his scout or be stranded here forever. that was all he could remember. nothing of what he had been doing recently. a small shiver passed through his body as he glanced once again at the tape in his hand. baby talk.... * * * * * one thing he could find out: how long this had been going on. he turned to the communicator and unhooked the paper receptacle on its bottom. it held about a yard and a half of tape, probably his last several messages--both those sent and those received. he pulled it out impatiently and began reading. the first was from himself: your suggestions no help. how am i going to repair damage to scout without proper equipment? and where do i get it? do you think i found a tool shop down here? for god's sake, come up with something better. visited seal-people again today. still have their stink in my nose. found huts along river bank, so i guess they don't live in water. but they do spend most of their time there. no, i have no way of estimating their intelligence. i would judge it averages no higher than seven-year-old human. they definitely do talk to one another. will try to find out more about them, but you get to work fast on how i repair scout. swelling in arm worse and am developing a fever. temperature . an hour ago. smoky the ship must have answered immediately, for the return message time was six hours later than his own, the minimum interval necessary for two-way exchange. doing our best, smoky. your immediate problem, as we see it, is to keep well. we fed all the information you gave us into sam, but you didn't have much except the sting in your arm. as expected, all that came out was "data insufficient." try to give us more. also detail all symptoms since your last report. in the meantime, we're doing everything we can at this end. good luck. ss ii sam, kaiser knew, was the ship's mechanical diagnostician. his report followed: arm swollen. unable to keep down food last twelve hours. about two hours ago, entire body turned livid red. brief periods of blankness. things keep coming and going. sick as hell. hurry. smoky the ship's next message read: infection quite definite. but something strange there. give us anything more you have. ss ii his own reply perplexed kaiser: last letter funny. i not understand. why is oo sending garble talk? did usns make up secret messages? smoky the expedition, apparently, was as puzzled as he: what's the matter, smoky? that last message was in plain terran. no reason why you couldn't read it. and why the baby talk? if you're spoofing, stop. give us more symptoms. how are you feeling now? ss ii the baby talk was worse on kaiser's next: twazy. what for oo tending twazy letters? fink um can wead twazy letters? skin all yellow now. cold. cold. co the ship's following communication was three hours late. it was the last on the tape--the one kaiser had read earlier. apparently they decided to humor him. oo is sick, smoky. do to beddy-by. keep um warm. when um feels better, let usns know. ss ii that was not much help. all it told him was that he had been sick. he felt better now, outside of a muscular weariness, as though convalescing from a long illness. he put the back of his hand to his forehead. cool. no fever anyway. he glanced at the clock-calendar on the instrument board and back at the date and time on the tape where he'd started his baby talk. twenty hours. he hadn't been out of his head too long. he began punching the communicator keys while he nibbled at a biscuit. seem to be fully recovered. feeling fine. anything new from sam? and how about the damage to scout? give me anything you have on either or both. smoky kaiser felt suddenly weary. he lay on the scout's bunk and tried to sleep. soon he was in that phantasm land between sleep and wakefulness--he knew he was not sleeping, yet he did dream. it was the same dream he had had many times before. in it, he was back home again, the home he had joined the space service to escape. he had realized soon after his marriage that his wife, helene, did not love him. she had married him for the security his pay check provided. and though it soon became evident that she, too, regretted her bargain, she would not divorce him. instead, she had her revenge on him by persistent nagging, by letting herself grow fat and querulous, and by caring for their house only in a slovenly way. her crippled brother had moved in with them the day they were married. his mind was as crippled as his body and he took an unhealthy delight in helping his sister torment kaiser. * * * * * kaiser came wide awake in a cold sweat. the clock showed that only an hour had passed since he had sent his last message to the ship. still five more long hours to wait. he rose and wiped the sweat from his neck and shoulders and restlessly paced the small corridor of the scout. after a few minutes, he stopped pacing and peered out into the gloom of big muddy. the rain seemed to have eased off some. not much more than a heavy drizzle now. kaiser reached impulsively for the slicker he had thrown over a chest against one wall and put it on, then a pair of hip-high plastic boots and a plastic hat. he opened the door. the scout had come to rest with a slight tilt when it crashed, and kaiser had to sit down and roll over onto his stomach to ease himself to the ground. the weather outside was normal for big muddy: wet, humid, and warm. kaiser sank to his ankles in soft mud before his feet reached solid ground. he half walked and half slid to the rear of the scout. beside the ship, the "octopus" was busily at work. tentacles and antennae, extending from the yard-high box of its body, tested and recorded temperature, atmosphere, soil, and all other pertinent planetary conditions. the octopus was connected to the ship's communicator and all its findings were being transmitted to the mother ship for study. kaiser observed that it was working well and turned toward a wide, sluggish river, perhaps two hundred yards from the scout. once there, he headed upstream. he could hear the pipings, and now and then a higher whistling, of the seal-people before he reached a bend and saw them. as usual, most were swimming in the river. one old fellow, whose chocolate-brown fur showed a heavy intermixture of gray, was sitting on the bank of the river just at the bend. perhaps a lookout. he pulled himself to his feet as he spied kaiser and his toothless, hard-gummed mouth opened and emitted a long whistle that might have been a greeting--or a warning to the others that a stranger approached. the native stood perhaps five feet tall, with the heavy, blubbery body of a seal, and short, thick arms. membranes connected the arms to his body from shoulder-pits to mid-biceps. the arms ended in three-fingered, thumbless hands. his legs also were short and thick, with footpads that splayed out at forty-five-degree angles. they gave his legs the appearance of a split tail. about him hung a rank-fish smell that made kaiser's stomach squirm. the old fellow sounded a cheerful chirp as kaiser came near. feeling slightly ineffectual, kaiser raised both hands and held them palm forward. the other chirped again and kaiser went on toward the main group. * * * * * they had stopped their play and eating as kaiser approached and now most of them swam in to shore and stood in the water, staring and piping. they varied in size from small seal-pups to full-grown adults. some chewed on bunches of water weed, which they manipulated with their lips and drew into their mouths. they had mammalian characteristics, kaiser had noted before, so it was not difficult to distinguish the females from the males. the proportion was roughly fifty-fifty. several of the bolder males climbed up beside kaiser and began pawing his plastic clothing. kaiser stood still and tried to keep his breathing shallow, for their odor was almost more than he could bear. one native smeared kaiser's face with an exploring paw and kaiser gagged and pushed him roughly away. he was bound by regulations to display no hostility to newly discovered natives, but he couldn't take much more of this. a young female splashed water on two young males who stood near and they turned with shrill pipings and chased her into the water. the entire group seemed to lose interest in kaiser and joined in the chase, or went back to other diversions of their own. kaiser's inspectors followed. they were a mindless lot, kaiser observed. the river supplied them with an easy existence, with food and living space, and apparently they had few natural enemies. kaiser walked away, following the long slow bend of the river, and came to a collection of perhaps two hundred dwellings built in three haphazard rows along the river bank. he took time to study their construction more closely this time. they were all round domes, little more than the height of a man, built of blocks that appeared to be mud, packed with river weed and sand. how they were able to dry these to give them the necessary solidity, kaiser did not know. he had found no signs that they knew how to use fire, and all apparent evidence was against their having it. they then had to have sunlight. maybe it rained less during certain seasons. the domes' construction was based on a series of four arches built in a circle. when the base covering the periphery had been laid, four others were built on and between them, and continued in successive tiers until the top was reached. each tier thus furnished support for the next above. no other framework was needed. the final tier formed the roof. they made sound shelters, but kaiser had peered into several and found them dark and dank--and as smelly as the natives themselves. the few loungers in the village paid little attention to kaiser and he wandered through the irregular streets until he became bored and returned to the scout. the _soscites ii_ sent little that helped during the next twelve hours and kaiser occupied his time trying again to repair the damage to the scout. the job appeared maddeningly simply. as the scout had glided in for a soft landing, its metal bottom had ridden a concealed rock and bent inward. the bent metal had carried up with it the tube supplying the fuel pump and flattened it against the motor casing. * * * * * opening the tube again would not have been difficult, but first it had to be freed from under the ship. kaiser had tried forcing the sheet metal back into place with a small crowbar--the best leverage he had on hand--but it resisted his best efforts. he still could think of no way to do the job, simple as it was, though he gave his concentration to it the rest of the day. that evening, kaiser received information from the _soscites ii_ that was at least definite: set yourself for a shock, smoky. sam finally came through. you won't like what you hear. at least not at first. but it could be worse. you have been invaded by a symbiote--similar to the type found on the sand world, bartel-bleethers. give us a few more hours to work with sam and we'll get you all the particulars he can give us. hang on now! soscites ii kaiser's reply was short and succinct: what the hell? smoky _soscites ii's_ next communication followed within twenty minutes and was signed by the ship's doctor: just a few words, smoky, in case you're worried. i thought i'd get this off while we're waiting for more information from sam. remember that a symbiote is not a parasite. it will not harm you, except inadvertently. your welfare is as essential to it as to you. almost certainly, if you die, it will die with you. any trouble you've had so far was probably caused by the symbiote's difficulty in adjusting itself to its new environment. in a way, i envy you. more later, when we finish with sam. j. g. zarwell kaiser did not answer. the news was so startling, so unforeseen, that his mind refused to accept the actuality. he lay on the scout's bunk and stared at the ceiling without conscious attention, and with very little clear thought, for several hours--until the next communication came in: well, this is what sam has to say, smoky. symbiote amicable and apparently swiftly adaptable. your changing color, difficulty in eating and even baby talk were the result of its efforts to give you what it believed you needed or wanted. changing color: protective camouflage. trouble keeping food down: it kept your stomach empty because it sensed you were in trouble and might have need for sharp reflexes, with no excess weight to carry. the baby talk we aren't too certain about, but our best conclusion is that when you were a child, you were most happy. it was trying to give you back that happy state of mind. obviously it quickly recognized the mistakes it made and corrected them. sam came up with a few more ideas, but we want to work on them a bit before we send them through. sleep on this. ss ii * * * * * kaiser could imagine that most of the crew were not too concerned about the trouble he was in. he was not the gregarious type and had no close friends on board. he had hoped to find the solitude he liked best in space, but he had been disappointed. true, there were fewer people here, but he was brought into such intimate contact with them that he would have been more contented living in a crowded city. his naturally unsociable nature was more irksome to the crew because he was more intelligent and efficient than they were. he did his work well and painstakingly and was seldom in error. they would have liked him better had he been more prone to mistakes. he was certain that they respected him, but they did not like him. and he returned the dislike. the suggestion that he get some sleep might not be a bad idea. he hadn't slept in over eighteen hours, kaiser realized--and fell instantly asleep. the communicator had a message waiting for him when he awoke: sam couldn't help us much on this part, but after research and much discussion, we arrived at the following two conclusions. first, physical property of symbiote is either that of a very thin liquid or, more probably, a virus form with swift propagation characteristic. it undoubtedly lives in your blood stream and permeates your system. second, it seemed to us, as it must have to you, that the symbiote could only know what you wanted by reading your mind. however, we believe differently now. we think that it has such close contact with your glands and their secretions, which stimulate emotion, that it can gauge your feelings even more accurately than you yourself can. thus it can judge your likes and dislikes quite accurately. we would like to have you test our theory. there are dozens of ways. if you are stumped and need suggestions, just let us know. we await word from you with great interest. ss ii by now, kaiser had accepted what had happened to him. his distress and anxiety were gone and he was impatient to do what he could to establish better contact with his uninvited tenant. with eager anticipation, he set to thinking how it could be done. after a few minutes, an idea occurred to him. taking a small scalpel from a medical kit, he made a shallow cut in his arm, just deep enough to bleed freely. he knew that the pain would supply the necessary glandular reaction. the cut bled a few slow drops--and as kaiser watched, a shiny film formed and the bleeding stopped. that checked pretty well with the ship's theory. perhaps the symbiote had made his senses more acute. he tried closing his eyes and fingering several objects in the room. it seemed to him that he could determine the texture of each better than before, but the test was inconclusive. walking to the rear of the scout, he tried reading the printed words on the instrument panel. each letter stood out sharp and clear! kaiser wondered if he might not make an immediate, practical use of the symbiote's apparent desire to help him. concentrating on the discomfort of the high humidity and exaggerating his own displeasure with it, he waited. the result surprised and pleased him. the temperature within the scout cabin seemed to lower, the moisture on his body vanished, and he was more comfortable than he had yet been here. as a double check, he looked at the ship's thermometer. temperature , humidity --just about the same as it had been on earlier readings. * * * * * during the next twenty-four hours, kaiser and the mother ship exchanged messages at regular six-hour intervals. in between, he worked at repairing the damaged scout. he had no more success than before. he tired easily and lay on the cot often to rest. each time he seemed to drop off to sleep immediately--and awake at the exact times he had decided on beforehand. at first, despite the lack of success in straightening the bent metal of the scout bottom, there had been a subdued exhilaration in reporting each new discovery concerning the symbiote, but as time passed, his enthusiasm ebbed. his one really important problem was how to repair the scout and he was fast becoming discouraged. at last kaiser could bear the futility of his efforts no longer. he sent out a terse message to the _soscites ii_: taking short trip to another location on river. hope to find more intelligent natives. could be that the settlement i found here is analogous to tribe of monkeys on earth. i know the chance is small, but what have i to lose? i can't fix scout without better tools, and if my guess is right, i may be able to get equipment. expect to return in ten or twelve hours. please keep contact with scout. smoky kaiser packed a mudsled with tent, portable generator and guard wires, a spare sidearm and ammunition, and food for two days. he had noticed that a range of high hills, which caused the bend in the river at the native settlement, seemed to continue its long curve, and he wondered if the hills might not turn the river in the shape of a giant horseshoe. he intended to find out. wrapping his equipment in a plastic tarp, kaiser eased it out the doorway and tied it on the sled. he hooked a towline to a harness on his shoulders and began his journey--in the opposite direction from the first native settlement. he walked for more than seven hours before he found that his surmise had been correct. and a second cluster of huts, and seal-people in the river, greeted his sight. he received a further pleasant surprise. this group was decidedly more advanced than the first! they were little different in actual physical appearance; the change was mainly noticeable in their actions and demeanor. and their odor was more subdued, less repugnant. by signs, kaiser indicated that he came in peace, and they seemed to understand. a thick-bodied male went solemnly to the river bank and called to a second, who dived and brought up a mouthful of weed. the first male took the weed and brought it to kaiser. this was obviously a gesture of friendship. the weed had a white starchy core and looked edible. kaiser cleaned part of it with his handkerchief, bit and chewed it. the weed had a slight iron taste, but was not unpalatable. he swallowed the mouthful and tried another. he ate most of what had been given him and waited with some trepidation for a reaction. * * * * * as dusk fell, kaiser set up his tent a few hundred yards back from the native settlement. all apprehension about how his stomach would react to the river weed had left him. apparently it could be assimilated by his digestive system. lying on his air mattress, he felt thoroughly at peace with this world. once, just before dropping off to sleep, he heard the snuffling noise of some large animal outside his tent and picked up a pistol, just in case. however, the first jolt of the guard-wire charge discouraged the beast and kaiser heard it shuffle away, making puzzled mewing sounds as it went. the next morning, kaiser left off all his clothes except a pair of shorts and went swimming in the river. the seal-people were already in the water when he arrived and were very friendly. that friendliness nearly resulted in disaster. the natives crowded around as he swam--they maneuvered with an otter-like proficiency--and often nudged him with their bodies when they came too close. he had difficulty keeping afloat and soon turned and started back. as he neared the river edge, a playful female grabbed him by the ankle and pulled him under. kaiser tried to break her hold, but she evidently thought he was clowning and wrapped her warm furred arms around him and held him helpless. they sank deeper. when his breath threatened to burst from his lungs in a stream of bubbles, and he still could not free himself, kaiser brought his knee up into her stomach and her grip loosened abruptly. he reached the surface, choking and coughing, and swam blindly toward shore until his feet hit the river bottom. as he stood on the bank, getting his breath, the natives were quiet and seemed to be looking at him reproachfully. he stood for a time, trying to think of a way to explain the necessity of what he had done, but there was none. he shrugged helplessly. there was no longer anything to be gained by staying here--if they had the tools he needed, he had no way of finding out or asking for them--and he packed and started back to the scout. kaiser's good spirits returned on his return journey. he had enjoyed the relief from the tedium of spending day after day in the scout, and now he enjoyed the exercise of pulling the mudsled. above the waist, he wore only the harness and the large, soft drops of rain against his bare skin were pleasant to feel. when he reached the scout, kaiser began to unload the sled. the tarpaulin caught on the edge of a runner and he gave it a tug to free it. to his amazement, the heavy sled turned completely over, spilling the equipment to the ground. perplexed, kaiser stooped and began replacing the spilled articles in the tarp. they felt exceptionally light. he paused again, and suddenly his eyes widened. * * * * * moving quickly to the door of the scout, he shoved his equipment through and crawled in behind it. he did not consult the communicator, as he customarily did on entering, but went directly to the warped place on the floor and picked up the crowbar he had laid there. inserting the bar between the metal of the scout bottom and the engine casing, he lifted. nothing happened. he rested a minute and tried again, this time concentrating on his desire to raise the bar. the metal beneath yielded slightly--but he felt the palms of his hands bruise against the lever. only after he dropped the bar did he realize the force he had exerted. his hands ached and tingled. his strength must have been increased tremendously. with his plastic coat wrapped around the lever, he tried again. the metal of the scout bottom gave slowly--until the fuel pump hung free! kaiser did not repair the tube immediately. he let the solution rest in his hands, like a package to be opened, the pleasure of its anticipation to be enjoyed as much as the final act. he transmitted the news of what he had been able to do and sat down to read the two messages waiting for him. the first was quite routine: reports from the octopus indicate that big muddy undergoes radical weather-cycle changes during spring and fall seasons, from extreme moisture to extreme aridity. at height of dry season, planet must be completely devoid of surface liquid. to survive these unusual extremes, seal-people would need extreme adaptability. this verifies our earlier guess that natives have symbiosis with the same virus form that invaded you. with symbiotes' aid, such radical physical change could be possible. will keep you informed. give us any new information you might have on natives. ss ii the second report was not so routine. kaiser thought he detected a note of uneasiness in it. suggest you devote all time and effort to repair of scout. information on seal-people adequate for our purposes. ss ii kaiser did not answer either communication. his earlier report had covered all that he had learned lately. he lay on his cot and went to sleep. in the morning, another message was waiting: very pleased to hear of progress on repair of scout. complete as quickly as possible and return here immediately. ss ii * * * * * kaiser wondered about the abrupt recall. could the _soscites ii_ be experiencing some difficulty? he shrugged the thought aside. if they were, they would have told him. the last notes had had more than just a suggestion of urgency--there appeared to be a deliberate concealing of information. strangely, the messages indicated need for haste did not prod kaiser. he knew now that the job could be done, perhaps in a few hours' time. and the _soscites ii_ would not complete its orbit of the planet for two weeks yet. without putting on more than the shirt and trousers he had grown used to wearing, kaiser went outside and wandered listlessly about the vicinity of the ship for several hours. when he became hungry, he went back inside. another message came in as he finished eating. this one was from the captain himself: why have we received no verification of last instructions? repair scout immediately and return without further delay. this is an order! h. a. hesse, capt. kaiser pushed the last of his meal--which he had been eating with his fingers--into his mouth, crumpled the tape, wiped the grease from his hands with it and dropped it to the floor. he pondered mildly, as he packed his equipment, why he was disregarding the captain's message. for some reason, it seemed too trivial for serious consideration. he placated his slightly uneasy conscience only to the extent of packing the communicator in with his other equipment. it was a self-contained unit and he'd be able to receive messages from the ship on his trip. * * * * * the tracks of his earlier journey had been erased by the soft rain, and when kaiser reached the river, he found that he had not returned to the village he had visited the day before. however, there were other seal-people here. and they were almost human! the resemblance was still not so much in their physical makeup--that was little changed from the first he had found--as in their obviously greater intelligence. this was mainly noticeable in their facile expressions as they talked. kaiser was even certain that he read smiles on their faces when he slipped on a particularly slick mud patch as he hurried toward them. where the members of the first tribes had all looked almost exactly alike, these had very marked individual characteristics. also, these had no odor--only a mild, rather pleasing scent. when they came to meet him, kaiser could detect distinct syllabism in their pipings. most of the natives returned to the river after the first ten minutes of curious inspection, but two stayed behind as kaiser set up his tent. one was a female. they made small noises while he went about his work. after a time, he understood that they were trying to give names to his paraphernalia. he tried saying "tent" and "wire" and "tarp" as he handled each object, but their piping voices could not repeat the words. kaiser amused himself by trying to imitate their sounds for the articles. he was fairly successful. he was certain that he could soon learn enough to carry on a limited conversation. the male became bored after a time and left, but the girl stayed until kaiser finished. she motioned to him then to follow. when they reached the river bank, he saw that she wanted him to go into the water. * * * * * before he had time to decide, kaiser heard the small bell of the communicator from the tent behind him. he stood undecided for a moment, then returned and read the message on the tape: still anxiously awaiting word from you. in meantime, give very close attention to following. we know that the symbiotes must be able to make radical changes in the physiology of the seal-people. there is every probability that yours will attempt to do the same to you--to better fit your body to its present environment. the danger, which we hesitated to mention until now--when you have forced us by your obstinate silence--is that it can alter your mind also. your report on second tribe of seal-people strongly indicates that this is already happening. they were probably not more intelligent and humanlike than the others. on the contrary, you are becoming more like them. danger acute. return immediately. repeat: immediately! ss ii kaiser picked up a large rock and slowly, methodically pounded the communicator into a flattened jumble of metal and loose parts. when he finished, he returned to the waiting girl on the river bank. she pointed at his plastic trousers and made laughing sounds in her throat. kaiser returned the laugh and stripped off the trousers. they ran, still laughing, into the water. already the long pink hair that had been growing on his body during the past week was beginning to turn brown at the roots. on phlebitis. ----"whose effect holds such an enmity with blood of man, that, with a sudden vigour, it doth posset and curd, like eager droppings into milk, the thin and wholesome blood." hamlet. plate shewing the first morbid appearance produced by the stagnation of vitiated blood in the capillaries of the lungs. [illustration: surface of lung with pleura removed. section of lung.] on the origin of inflammation of the veins, and on the causes, consequences, and treatment of purulent deposits. by henry lee, f.r.c.s. assistant surgeon to king's college hospital, etc. "there is more to be learnt of the use of the blood in the animal economy from its coagulation than from its fluidity."--hunter. [illustration: coat of arms] london: henry renshaw, , strand. . london. richards, printer, , st. martin's lane. preface. since the period when humoral pathology fell into merited disrepute, comparatively few attempts have been made, to define with any degree of accuracy, the conditions under which morbid secretions may find their way into the circulation. the diseases produced by the presence of vitiated fluids in the general system, and in parts of the body at a distance from their original source, have received more attention; but they are still far from occupying that position in our systems of medicine and surgery which their importance deserves. the difficulty of tracing diseased secretions after they have become mingled with the blood, or of recognising their presence in the vessels, has rendered the investigation of their actions often tedious and inconclusive; while, on the other hand, the changes of structure in solid parts, readily appreciated by the senses, have been more calculated to arrest the attention, and to afford that ready solution of the origin of the symptoms which, whether imaginary or real, has a tendency to relieve the mind from farther doubt and suspense. hence it has happened, that the pathology of the solid parts of the body has received a very disproportionate share of attention. most of the observations which have tended to advance our knowledge of the effects of the introduction of diseased fluids into the blood, have been recorded under the name of phlebitis or inflammation of the veins; and i have retained this title, although it is obviously inadequate to express those constitutional affections which form the most important and characteristic features of these complaints. the introduction of pus into the system has justly been regarded as the most important of this class of diseases. but the theory of the circulation of pus globules with the blood, supported as it has been by much ingenious reasoning, and most conveniently adapted to explain the formation of purulent deposits, has yet never obtained general belief. the stoppage of the pus globules in the capillary tubes, has appeared to many accustomed to the practical observation of diseases, too mechanical a solution of the origin of these abscesses; and it has become necessary to determine, with more precision than has hitherto been done, the actual conditions under which pus in substance can be received into the circulation. the simple experiment of mixing some pus with healthy, recently drawn blood, will at once shew that such a combination cannot circulate in the living body. it will be found that the blood coagulates round the globules of pus, and forms a solid mass which will adhere to the first surface with which it comes in contact; and it will be evident, that it is not till the coagulum thus formed is broken up or dissolved, that its elements can circulate with the blood. it appears not a little surprising that this, perhaps the simplest and the most instructive experiment that can be performed in reference to the subject of the formation of purulent deposits, should not have been resorted to in preference to others which have been difficult in their execution, and inconclusive in their results. it has been remarked by sir charles bell, that we can seldom rely upon the answers that are extorted from living animals by experiments which go counter to the natural feeling of mankind; and that it is our duty, if experiments are performed, at all events to prepare for them by the closest previous application of our reason, and so to narrow the question as to be certain that advantage may be gained by our proceedings. had the simple experiment mentioned above, illustrating the action of pus upon blood out of the body, been duly considered, it might have saved some of the vague and useless experiments which have been performed upon living animals in the investigation of the present subject. _sept. ._ _ , dover street, piccadilly._ part i. on inflammation of the veins: with experiments illustrating the effects of a vitiated condition of the blood. i. john hunter expressed his belief that the blood has "the power of action within itself",[ ] and that when it coagulates, it does so in consequence of an "impression" which it receives. such an impression may be communicated by separation from the living vessels, or from "cessation of natural action"[ ] in them. in certain circumstances also the living vessels themselves may be the means of exciting coagulation.[ ] in others, the admixture of extraneous substances may either retard or hasten this operation.[ ] the experiments made to determine the last point, mr. hunter informs us, "were rather imagined than fully carried out; and the subject rather broached and touched upon, than prosecuted".[ ] in these experiments, different articles used in medicine were mixed with portions of blood taken from the body; and it was found that, in some cases, they altered both "the time," and "the firmness of the coagulation".[ ] the circumstance of medicines being used in such experiments, conveys the idea, that, in instituting these researches, hunter conceived that substances which would tend to produce such actions out of the body, might likewise produce some effect upon the blood in living animals. in endeavouring to prosecute the idea thus thrown out, i have been led to try the effect of different substances upon the blood, and to consider the changes which may be produced in that fluid, by the admixture of animal secretions. the experiments which will be hereafter detailed, not only confirm mr. hunter's notion, that foreign substances may induce actions in the blood when withdrawn from the body, but also show that some of these effects may be produced still more rapidly in the living vessels. [ ] hunter on the blood. ed. , p. . [ ] p. . [ ] p. . [ ] p. . [ ] p. . [ ] p. . in these experiments, pus was used in preference to any other fluid; first, because the power of coagulating the blood which it was found to possess, enables its influence to be traced within the body; and secondly, because, being an animal secretion, the results obtained are likely to be analogous to those produced by the admixture of other secretions with the blood. when pus is mixed with blood, fresh-drawn from a healthy animal, it is found in a marked manner to favour coagulation. this effect does not take place immediately, as in the case of the mixture of an acid with the blood; and i have reason to believe, that where the blood has lost its natural power of coagulation, no visible change is produced in it by the addition of pus. it appears, therefore, that this effect depends rather upon a vital than a chemical influence. in some cases, the coagulation takes place in less than two minutes; in others, after a longer period; but in all the experiments made, the influence of pus, when added to blood, in promoting its coagulation, was sufficiently evident. putrid pus was found to act more rapidly than healthy pus (exp. , _b_), but the admixture of water was found to retard the operation; the result, in this respect, differing in some degree from the conclusion drawn from a similar experiment performed by hunter.[ ] the causes which usually favour coagulation out of the body, are rest, and separation of the blood into small quantities. these conditions are, in some degree, brought into play during the circulation of the blood through the capillaries; and when the influence of the admixture of pus with the blood is not sufficient to produce coagulation at once, we should naturally expect the effect to be more readily induced, where these two additional causes concur in favouring such an action. when the pus introduced is in any large quantity, the coagulation of the blood is at once determined, and the entrance of pus into the circulation thereby prevented. the experiments vi, vii, and viii, appear to furnish evidence of the correctness of this opinion, and to show that the result may be produced more quickly in the vessels than elsewhere. in these cases, so sudden was the effect, that the mixture of blood and pus coagulated before it could traverse the jugular vein, as indicated by the induration and cord-like feeling of the vessel. [ ] op. cit. p. . in experiment viii, the obstruction formed was sufficient to resist even firm pressure, and in a great measure, if not altogether, to prevent the pus injected from finding its way along the vein. the coagulum was felt in the vessel during the operation, and was there found after death. one effect of the coagulation of the blood thus immediately produced, is necessarily to retain the vitiated blood in the part, and to prevent its being carried in the course of the circulation. this intention may be interfered with, either by accident or design. the coagulum, as in experiment vi, may be broken up during the process of its formation, or after it has formed, and the parts of which it was composed carried forward with the circulating blood. in such a case, the vein in which the coagulum first formed, is found in its natural condition (except at the part where it may have been mechanically injured), and dark patches of congestion may be found in distant systems of capillaries. if the coagulum be allowed to remain, the vein in which it is formed soon becomes thickened; but, as the experiments cited prove, _this thickening is the effect and not the cause of the stagnation of the vitiated blood in the vessel_. ii. when blood coagulates in a serous cavity, a thin pellicle forms upon its surface, and, becoming thickened by deposition from the fibrin of the blood, forms a cyst, which completely circumscribes the effusion. this point has not probably received the attention which it deserves; and as it is believed to be of primary importance in the investigation of the present subject, a short space will be devoted to the purpose of fully establishing it, and tracing its connexion with other and subsequent changes. every layer of lymph observed upon dissection, has perhaps too generally been considered as the result of inflammation; and hence there has arisen a confusion in the terms employed. that lymph may be derived from the blood directly, and deposited in the form of a membrane, without being secreted by any vessel, has been fully shown by a paper in the _medico-chirurgical transactions_.[ ] such layers of lymph assume so much the appearance of others, derived by secretion from inflamed capillaries, that they have been described as identical. but the mode of their formation in the two instances is altogether different. in the one case, the process is a local one, confined to the blood itself, and subsequently to the membrane with which it happens to be in contact. in the other case, it is an effort of the constitution, accompanied by constitutional symptoms. the former of these processes was clearly described by hunter. in describing the process of union by the first intention, "coagulation", he says, "i imagine to proceed upon exactly the same principle as the union by the first intention. it is particle uniting with particle by the attraction of cohesion, which, in the blood, forms a solid; and it is this coagulum uniting to the surrounding parts which forms the union by the first intention: for union by the first intention is no more than the living parts when separated, whether naturally, or by art, forming a reciprocal attraction of cohesion with the intermediate coagulum, which immediately admits of mutual intercourse, and, as it were, one interest."[ ] "when the blood has coagulated, so as to adhere to both surfaces and to keep them together, it may be said that union has begun."[ ] "the uniting medium becomes immediately a part of ourselves, and the parts not being offended at it, no irritation is produced." "if the quantity of blood extravasated be large, the whole will not become vascular, but the surface only, which is in contact with the surrounding parts."[ ] the process thus described in general terms may take place in serous cavities. in the third plate at the end of mr. hunter's work, is represented a coagulum of blood adhering to the _tunica vaginalis_. "the adhesion was firm, though it admitted of a separation at one end; when separated, fibres were seen running between it and the testis." [ ] vol. x, p. - . [ ] op. cit. p. . [ ] p. . [ ] p. . it might seem unnecessary to dwell upon this process further, had not some of the highest authorities in surgery, both here and on the continent, described it as identical with adhesive inflammation. thus bichat[ ] says, "the cicatrization of wounds in veins after bleeding is a result of inflammation." now, it is submitted, that when the blood coagulates, either in serous cavities or in veins, the process of union is not usually one of inflammation, or one in which the powers of the constitution are called into increased activity. it is true, that in both cases, inflammation may take place, and lymph, as the result of such inflammation, may be secreted; but this is only when, to use mr. hunter's language, the "primary intention" has not been fulfilled.[ ] [ ] anatomie générale, vol. ii, p. . [ ] in speaking of the two principles, i shall use the term by "first intention", to designate that the fibrin is derived from coagulated blood; and restrict the term "adhesive inflammation" to indicate the effusion of lymph from inflamed vessels. when a membranous layer of lymph is deposited from effused blood, it adheres with some firmness to the surface with which it is in contact; but, as there is at first no vascular connexion established between them, it may be separated, leaving the part to which it adhered in its natural condition. lymph derived from adhesive inflammation, on the other hand, when separated, leaves the surface upon which it was formed rough and uneven. coagulated fibrin, when recently deposited, may thus be distinguished from effused lymph. the changes which blood undergoes when effused in serous cavities, may likewise take place when it is detained in injured or exposed veins. the coagulation of the blood in such cases (exp. vii and viii) serves as a bond of union between the sides of the veins (which may be either temporary or permanent), so as to prevent the entrance of any foreign matter into the circulation. when the blood thus coagulates in veins, changes may be produced analogous to those mentioned as occurring in serous cavities. if the quantity of blood be large, a thin pellicle is at first formed upon its surface (see preparations - and - , in the museum of guy's hospital). this membrane becomes thickened and adheres to the internal surface of the vein (see plate no. , cooper and travers' _surgical essays_, part i, and prep. no. , in the pathological museum of the college of surgeons). it then becomes vascular, and finally so firmly united to a part of the circumference of the vessel as to be inseparable from it, without lacerating its lining membrane. if the wounded vessel be small, or if the animal be strong and robust, the whole of the blood in the vein may at once coagulate and become united to its sides. the usual economy of nature, however, is here exercised, with a precision proportionate to the strength of the patient. a simple wound in a vein, in healing by the first intention, will not obstruct the circulation through the vessel under ordinary circumstances. a coagulum will form, sufficient to unite together the divided edges, and the circulation of blood through the vessel will be uninterrupted; but if the wound does not readily heal, coagula may form, which encroach more or less upon the cavity of the vein. there are then three ways in which a coagulum may obstruct the circulation through a vein. . by the outer layer of the coagulum forming a membrane, which contains the more fluid parts of the blood. . by the whole of the blood contained in the vessel forming a solid coagulum. . by a coagulum adhering to the injured side only of the vessel. in whichever of these ways the process of repair is commenced, it may be interfered with, and the union dissolved. this is practically known to farriers; who, when they want to bleed a second time from the same orifice, break down the "union by the first intention" by a blow upon the vein. during the time that the parts are united only by the fibrin from the blood, any violence must tend to produce the same effect. if the constitution is good, and the coagulating power of the blood unimpaired, the union may be frequently interrupted, and yet be as frequently re-established in the same way. when from any local cause, or from any constitutional peculiarity, the union by the first intention fails at the seat of the injury, it may yet be attempted at some distance up the vein; and then we have coagula formed at different distances along the vessel. if these coagula fill the vein, are firm, and remain undisturbed by violence, the union may be complete, and the vessel sealed at those parts, even although the original wound should suppurate. but it sometimes happens, that the same peculiarity of constitution, or the same local cause, which prevented the union at the original wound, may prevent complete union by the first intention at any other point of the vein; and then its canal is open to any secretion that may be introduced into it. foreign matter may thus find its way along a vein; but still there is a provision against its being carried the round of the circulation. it has been already shown that the blood, when in a natural condition, has a tendency to coagulate around pus, and, probably, many other fluids, even out of the body (experiments i, v), and that this property is exercised in a still more remarkable manner in the living vessels (see experiments vii, viii). foreign matter, even after it has got into the veins, may then, by the same means, be prevented from proceeding farther towards the centre of circulation. the process that takes place under such circumstances, is strictly analogous to union by the first intention. the blood may coagulate and adhere to the sides of any part of the vascular system. the union thus formed may be permanent, or the coagulum may be again broken up and carried with the blood in the course of the circulation, as shown in experiment vi. when this occurs, as is shown in the same experiment, other changes supervene in remote parts of the body. this tendency to coagulate around the foreign matter once impressed upon the blood, cannot be destroyed by the coagulum being mechanically broken up, as indeed is proved by the fact already mentioned, that after one attempt at union in a vein (in consequence of the introduction of foreign matter) has failed, another attempt is made immediately farther up the vessel. under these last circumstances, we may find a vein partially obliterated at different points, leaving intervals where lymph or pus are secreted. if the purulent matter introduced is allowed to remain a short time only in the vein, no inflammation is produced (experiment vi). but when any irritating fluid is detained there in consequence of the blood coagulating around it, adhesive, ulcerative, or suppurative inflammation, will be excited (experiments vii and viii). the slowness with which veins inflame when cut, tied, or bruised, has been made a subject of comment by different authors; and mr. travers, in particular, has endeavoured to reconcile "the infrequency of its occurrence" with the rapid and violent character of the inflammation in certain cases. although, under ordinary circumstances, a wounded vein does not inflame, yet the annexed experiments show, that pus introduced into its cavity will produce inflammation, in which the system will sympathize. other fluids besides pus will no doubt produce similar effects; but those of pus are here particularly noticed, as affording a good illustration of the series of changes produced by the introduction of foreign matter into the blood. what the symptoms are which characterize the presence of pus, as distinguished from other secretions in the blood, it would probably be difficult to determine in cases as they occur in practice. the examination of the blood in these instances affords no very satisfactory information; for the characters of pus, when the blood has once coagulated round it, are so altered, that i know of no means by which a small quantity can be recognized, when it has once entered the circulation. the conclusions drawn from the different facts now stated are,--first, that inflammation of a vein, or phlebitis, is no essential part of the primary affection which precedes constitutional symptoms, even when morbid matter has found its way into the circulation through a vein. secondly, that when inflammation of a vein does occur, in some instances at least, it is not the cause, but the consequence of the introduction of diseased or foreign matter into the blood. thirdly, that although veins are with difficulty inflamed by any mechanical injury, they are susceptible of rapid inflammation, accompanied with constitutional disorder, whenever any irritating fluids are introduced into their cavities. iii. when the principal veins in a part become obstructed, it is natural to suppose that changes should be produced in the smaller veins which supply them. these changes may be expected in a more marked degree, when the obstruction depends upon coagulation of the blood, than when it arises from other causes, inasmuch as the coagulum usually extends to several veins at the same time. in the experiments that have been made upon animals, it has been a matter of surprise that, while extreme pain was evinced upon the injection of irritating fluids into the veins, comparatively little or no suffering was produced, when similar experiments were performed upon the arteries. the foreign matter introduced in these cases would probably have the effect of coagulating the blood, as in the instances already mentioned. if this occurred in an artery, the supply of blood below the obstruction would be diminished; but if in a vein, the return of blood would be prevented: in the latter case, the continued influx of blood to the part would necessarily distend the capillaries. in m. cruveilhier's[ ] experiment, of injecting ink into the veins of dogs, he found, that in thirty-six hours the legs swelled, and a number of bloody patches (_foyers apoplectiques_) were found in the substance of the muscles and the cellular tissues of the limb. the large veins were distended with adherent coagula of blood, and the smaller veins around the livid patches were also filled with coagulated blood. if the animal were allowed to live, the congested spots suppurated. the appearances thus produced in the muscles and cellular tissue of the limb were evidently not those of inflammatory action propagated along the coats of the veins, for the affection in the capillaries was circumscribed, and terminated in many places abruptly, leaving the veins in the immediate neighbourhood perfectly healthy; still less could the appearance produced depend upon the injected fluid finding its way through the veins (contrary to the course of the circulation) to the capillary system; nor, lastly, could it depend upon the ink finding its way into the general circulation, and producing its effects in its course a second time through the limb; for, not to mention that the capillaries of the lungs and other parts would be equally liable to be affected, one essential condition of the success of the experiment is mentioned to have been, that the fluid injected should _not_ find its way along the vein in the usual course of the blood. we therefore conclude, that it was the coagulation of the blood in the large veins which caused the congestion of the capillaries, those veins remaining unaffected which could discharge their contents by some collateral channel. [ ] cruveilhier's path. liv. xi. in cases of phlegmasia dolens after child-birth, the same principle can sometimes be traced; thus, in a dissection performed by mr. lawrence,[ ] the external and common iliac veins were filled with a substance like the laminated coagulum of an aneurism. "the tube was completely obstructed by this matter, adhering as firmly as the coagulum does in any part of an old aneurismal sac. in its centre was a cavity containing about a teaspoonful of thick fluid of the consistence of pus, of a light brownish red tint, and pultaceous appearance." the femoral vein was in this case also filled with a coagulum; but, as is observed in the account of the dissection, the red colour of that vein might have been caused by the clot everywhere in contact with it, and therefore cannot be deemed a proof of inflammation. [ ] medico-chirurgical transactions, vol. xii. mr. guthrie[ ] has published a case of inflammation of the veins after amputation, resembling phlegmasia dolens, in which the veins of the opposite limb, even down to the foot, had become affected. in this case, on the fourteenth and fifteenth days after amputation of the right thigh, the left leg began to swell, and became intolerably painful. "the swelling was elastic, yielding to the pressure of the finger, but not in any manner like an oedematous limb. _upon a careful examination, no pain was felt in the course of the iliac vessels upon that side_; the stump looked well, save at one small point, corresponding to the termination of the femoral vein." on examination after death, the termination of the vein on the surface of the stump _was open_, and in a sloughy condition. at the left groin, the iliac vein was greatly distended with pus. sir henry halford[ ] has also mentioned three cases of what he has termed phlegmasia dolens, occurring in the male, in one of which the iliac vein was found obliterated after death. in this case, the patient had suffered, for several years before his death, from swelling of the left leg and thigh. in the interior of the obliterated vessel there is a coagulum, which has lost its colour, and become firm and completely adherent to the inner surface of the vein. (see prep. no. , path. mus. coll. of surgeons.) the rapid swelling and general pain of the limb in such cases, indicate a sudden obstruction to the circulation, while the absence of tenderness in the course of the vessels during the first stages of the disease, tends to show that the contents of the vessels, and not the vessels themselves, are primarily interested in its production. [ ] medical and physical journal, vol. lvi. [ ] london medical gazette. the foregoing remarks have appeared necessary, in order to explain a circumstance mentioned by hunter, upon which considerable stress has been laid by subsequent writers. mr. hunter observed that the whole side of the head in horses that had been bled would frequently become swollen and inflamed. the explanation of this fact appears very simple, when viewed in relation to the general principle illustrated by the above cases. the horse has only one jugular vein upon each side; and, although in the usual operation of bleeding, its channel is not obstructed, yet if the wound do not readily heal, its contents will coagulate. the circulation will then be obstructed in all the distant branches, and the blood, if long retained, will coagulate in them also. it will then part with its serum, and give rise to all the symptoms of inflammation in the distant vessels; a pulpy elastic swelling, accompanied with great pain, will then be the principal symptom, while the turgescence on the surface will be less than where the superficial veins have been mechanically compressed. it will, however, very frequently happen, that a vein in a part may be felt distended without any symptom of inflammation being present; and, in other cases, the pain and swelling will appear and disappear too rapidly to allow the idea that they depend upon inflammation of the coats of the vein. it has occurred to the author, to feel a vein in the arm and hand distended during life, and after death, to find it empty, and its coats of their natural colour and thickness; in such a case, the coagulum gives way, becomes broken up, and mixed with the circulating blood. iv. when pus, or other diseased fluid, is confined to the cavity of a vein, the constitutional symptoms produced are comparatively mild, as long as it remains limited and circumscribed by adherent coagula; that is to say, so as to be excluded from the rest of the circulating system. (compare the frequency of the respiration in experiments vi and vii.) but the tendency of a clot of blood is to contract; and a time comes when the coagulum is either broken up, or shrinks, so that if no further changes are produced, the current of blood through the vein is re-established.[ ] meanwhile, however, the coats of the veins have undergone changes corresponding to the degree of irritation produced by the contained fluids, and the intention or result to which the inflammation tends. if the coagula have long remained, the coats of the veins are always found thickened, sometimes to three or four times their natural thickness, and sometimes so as to completely obliterate the vessels. the contents of the veins are occasionally found to consist, as far as can be seen, simply of coagulated blood; at other times, they are found filled with soft yellowish coagula, deprived, more or less perfectly, of their colouring matter; more rarely, the cavity of a vein will be found filled with dark-coloured membranous layers, leaving still a channel through the vessel; and occasionally it will be found completely obstructed by "dense, dark-coloured, bluish membranes." [ ] this remark i have had opportunities of verifying in cases, where needles have been introduced under varicose veins in the lower extremities, and allowed to remain, with a ligature around them, for ten days or a fortnight. the circulation through the vein will in such cases be obstructed; but, in a year or two, will be found to have become completely re-established. as the coagulum contracts in a vein, if the intention is to obliterate the vessel, its sides are gradually approximated. in the smaller veins, and in the divided extremities of large veins, the sides are soon completely drawn together. but the latter, if not wounded, may for a long time (see prep. , path. mus., coll. of surg.) retain coagulated blood in their contracted, but not completely closed, cavities. in both cases, the coagula which close the veins are liable to be displaced by accident, or to have their adhesions loosened by the changes which they undergo. the position of a vein, and the structure of the organ through which it passes, may be unfavourable to its healthy reparation. the process of repair goes on frequently during a continued flow of blood over the part, and sometimes during the constant action of the muscles in the neighbourhood: at other times, an injured vein will be situated immediately in the bend of a joint, and will be subject to be continually bent and extended with the motions of the limb. in the structure of the bones, the veins lie in unyielding channels, and are consequently deprived of the assistance derived from the approximation of their sides, as in soft parts, during the process of reparation. as the coagula contract in such a case, there is danger lest the union by the first intention should be disturbed, and that the cavities of the injured veins should be left exposed. again, in the uncontracted uterus after child-birth, the veins which open upon the placental surface, pass through the firm texture of the organ, and are incapable of contraction independently of the muscular structure which surrounds them. the coagula which close their extremities secure them against the entrance of any foreign matter; but should these coagula be removed before the vessels are otherwise protected, their open mouths are exposed to any secretions that the uterus may happen to contain. in these cases, if a coagulum is not firmly formed, or if it is displaced by violence, it may be broken up, and portions of it mixed with the fluid blood. subsequent coagula may form in the veins and offer fresh obstructions to the admission of any foreign matter, but these may, as in the first instance, be disturbed, and carried, together with any admixture of the secretions of the part, in the course of the circulation. the period at which the union of a coagulum in a vein is dissolved, is sometimes marked with great precision. in a case recorded by dr. davis,[ ] a patient was convalescent from an attack of phlegmasia dolens, when death took place instantaneously, while the patient was in the act of changing the sitting for the recumbent posture; the left external iliac vein was thickened, and its internal tunic was studded in several places with deposits of adherent lymph. the portion most remarkable for this incrustation, as well as for other disease, was immediately beneath poupart's ligament; the vein, although contracted, was _manifestly pervious_. [ ] medico-chirurgical transactions, vol. xii. v. it has been shown in the previous sections, that secretions mixed with the blood will alter its properties, and influence the period of its coagulation: that when the blood is thus altered, it may pass through a vessel without leaving any trace of its passage; but that if it coagulates and remains in a vein, the coats of the vessel will then take on increased action. the exciting cause of the inflammation in such cases appears to be conveyed by means of the contents of the vessels to the vessels themselves. but, as in post-mortem examinations, the changes produced in the vessels are much more easily recognized than the alterations in their contents, the former have of late years almost exclusively occupied the attention of pathologists. the cases in which constitutional symptoms follow inflammation of the veins, will be found to divide themselves principally into three large classes. . those in which one of the larger veins has been opened. . those in which some portion of bone has been involved in the original lesion. . those that occur after child-birth. in each of these three classes of cases, a free communication will be found to exist between the injured part and the general circulation. the natural mode of sealing this communication, when it is no longer proper, is the coagulation of the blood in the veins of the injured part. when, from some constitutional affection, or from some local peculiarity of structure, this intention is not fulfilled, a ready passage remains open, through which the blood may become infected. when pus has been injected into the veins, it has frequently happened, that no great constitutional disturbance, and no signs of secondary inflammation, have been produced; but this is believed to have depended upon the coagula in the veins having prevented (as probably occurred in experiments vii and viii) the foreign matter from finding its way along the vessels. but if this obstruction be not offered, or be overcome, then the appearance of secondary inflammation, accompanied by corresponding constitutional symptoms, will be produced. if water be injected into the cancellous structure of bone, it will find its way out in drops through the apertures of the nutritious vessels. the ready communication which is thus shown to exist between the interior of bones and the veins, has been but too often exemplified by m. cruveilhier's experiments of introducing mercury into their cancellous structure, and finding it subsequently in the vascular system. this fact assumes peculiar significance, when taken in conjunction with the very large proportion of cases, in which some portions of bone will be found to have been involved in the primary lesion, in those who have died of secondary inflammations. of fifty-two consecutive cases, occurring in surgical hospital practice, of which i have preserved notes, in no less than forty-one was some portion of the osseous system implicated. again, in the third class of cases above-mentioned, if the vena cava be injected after parturition, the injection will very speedily find its way into the uterus.[ ] the ready communication which is thus shown to exist between the vascular system and the local affection, in each of the three large classes of cases which usually give rise to subsequent disease, would of itself afford at least a very remarkable coincidence. but more direct evidence presents itself of the way in which the system becomes contaminated in these affections: thus, after an operation for hæmorrhoidal tumours, an effusion of lymph and pus has been found in the hæmorrhoidal veins,[ ] from thence the same appearances have been traced to the inferior mesenteric vein, and the severity of the secondary affection, indicated both by the symptoms and the post-mortem appearances, has fallen upon the liver. these circumstances all tend to point to the venous system as the means by which morbid matter in such instances is introduced: and the still more conclusive facts afforded in the production of secondary disease, by injecting fluids into the veins,[ ] allow scarcely a doubt to remain upon the mind, that the unprotected veins are the channels, in a very large proportion of cases, through which the blood becomes infected. [ ] dance. archives générales de méd. vol. xviii, p. , dec. . [ ] in cases where pus has been found in veins surrounded by coagula, its presence and detention there have been differently accounted for. m. cruveilhier appears to have imagined that the loose coagula act as filters, through which the blood passes, while the pus is retained. (_dict. de méd. et de chir._ t. xii, p. .) the true explanation of the way in which coagula form round pus in the veins has already been given. [ ] see m. gaspard's experiments. vi. the cancellous structure of bone may be compared to the cellular tissue in soft parts. when inflamed, its intervals become filled up by effusion from the vessels, and an abscess may be as accurately circumscribed in the hard as in the soft structures of the body. in a healthy constitution, the adhesive inflammation will, in this way, always precede the suppurative; but where the inflammation is not circumscribed by adhesion, the secretions may permeate from cell to cell in unadhering parts. in soft structures, a remedy is at hand for allowing the escape of the matter, by a free division of the parts; but in bone, where the same thing takes place, the hard unyielding sides offer an effectual obstruction to the escape of any effused fluid. the cells of the bone then may become infiltrated, and, unless the veins of the part have been closed, there is nothing to prevent the diseased secretions from finding their way into the circulation. m. cruveilhier assures us, that a single drop of mercury introduced into the cancellous structure of living bone, may subsequently be detected in the capillaries of the lung, where it becomes the centre of one or more patches of livid congestion. this experiment appears to afford a perfect illustration of the way in which diseased secretion may be conveyed into the circulation, when the natural processes of repair in bone are abortive. these processes are the same in bone as in the other structures of the body; viz., union by the first intention, and adhesive inflammation. in soft parts, as the fibrin, which forms the bond of union in the first of these, is absorbed, the divided veins collapse, and thus continue closed; but in bony structures, where the injured vessels are held open, as the fibrin which at first closed their extremities becomes removed, their channels may be left as much open to the diseased secretions of the part, as to the globule of mercury in m. cruveilhier's experiment. the low degree of organization in bone, and the comparative slowness with which actions are there carried on, render it, in a peculiar degree, liable to interruptions in the process of repair; especially when, as not unfrequently happens, there is reason to believe that the vitality of some portion of the bone has been threatened. the offensive smell of the bone, as well as the appearance of its cancellous structure infiltrated with puriform matter, will frequently show in such cases, that the processes above-named have not followed their natural course. vii. as a necessary deduction from the accompanying experiments, and those of m. cruveilhier, alluded to in the previous section, we arrive at the conclusion, that a vitiated condition of the blood may give rise to inflammation of the veins in different parts of the body. the circumstances which occasionally attend reparation of the uterine veins after child-birth, will be found to lead to the same inference; and the same general proposition will derive fresh support from the consideration of this class of cases. the veins which terminate upon the placental surface of the uterus are necessarily open when this organ is distended, and become more or less perfectly closed when it contracts. in cases when the contraction is incomplete, innumerable open-mouthed orifices are left bathed in secretions, which are often offensive and undergoing decomposition; the natural protection to the vessels then, is the coagulation of the blood in them. if examined, the uterine veins will be found filled with coagula for some distance. but in cases where this power is impaired, all the uterine veins and arteries recently separated from the placenta may be found bathed in the secretions of the part, under circumstances most favourable for their absorption. the passage of diseased secretions through the vessels cannot always be traced in this, any more than in the other forms of the disease. many of the substances introduced artificially into the circulation by m. gaspard, produced no action upon the coats of the veins through which they passed, and yet the general symptoms were precisely similar to those originating from genuine phlebitis. in accordance with this, it may be observed that the uterine veins are often found perfectly healthy when the spermatic, or renal, or still more distant veins are thoroughly disorganized. in either case, the healthy condition of the veins near the original lesion forbids the idea of inflammation having been propagated along the coats of the vessels, while all analogy appears in favour of the disease being transmitted through their contents. in a certain number of cases no lesion will be found in any of the veins of the body, but the uterine veins will be found to contain some unnatural fluid; at other times coagula of blood, which have lost their elasticity, gritty to the feel, and greyish or light brown in appearance, will be found filling the veins or leaving intervals in them, where lymph or pus may be recognized. it matters little whether the unnatural fluids, thus found in the uterine vessels, have been absorbed from the cavity of the uterus, or are the product of venous inflammation. the effect upon the blood in either case would be the same. when obstructions form in the spermatic veins, they are not indicated by any external symptoms; but when the veins opening into the internal iliac are similarly affected, the coagula are liable to extend into its cavity, and even beyond it to the external and common iliac vessels. the free return of the blood from the inferior extremity, will then be prevented. the effects of this have already been described (sec. iii.) the connection of this form of disease with affections in distant parts of the body, has been noticed by several eminent writers. legallois has expressed his conviction, that phlegmasia dolens, puerperal fever, and many other puerperal ailments, are solely dependent upon the absorption of pus from the uterine surface. this opinion appears to have been formed upon too hasty a generalization, inasmuch as other fluids besides pus, as evinced by some of the annexed experiments, may produce similar effects upon the blood. but that pus, when absorbed, will determine the coagulation of the blood in the iliac as well as in other veins, must be allowed; and that the symptoms of obstructed venous circulation arising from this cause, will exactly resemble those of phlegmasia dolens, will scarcely be denied. "besides depositions of pus in certain portions of the frame," observes dr. ferguson, "i have seen two other states of the limb, which are connected with and traceable to the cause originating puerperal fever. in one of these the malady looks like erysipelas...; in the other, the leg is attacked with a disease so exactly resembling phlegmasia dolens, as to leave no doubt in my mind that they are one and the same malady. in this, as in other forms of the disease, there may be a tendency to gangrene of the skin." the period of the occurrence of what has been described under the name of uterine phlebitis is marked with much precision, and the affection of the system is often general and sudden. it may be stated as the result of all the observations hitherto made, that it occurs most frequently from the th to the th day after parturition.[ ] if the inflammation in such cases were propagated along the vessel only, it would be difficult to account for such an apparently capricious selection of time for its development. this difficulty, however, disappears when the period is observed to be so strictly in accordance with the time at which the same symptoms occur after other local complaints, and to be, moreover, the time at which the coagula formed in the veins, may naturally be expected to shrink. [ ] dr. lee. medico-chirurgical transactions. it has been observed, that inflammation after child-birth usually attacks the spermatic veins alone, and for the most part the one only on that side of the uterus to which the placenta has been attached. the hypogastric veins are comparatively rarely affected. the appearances observed upon dissection in the spermatic vein, usually terminate abruptly at its opening into the vena cava on the right side, or into the renal on the left. this fact is in perfect accordance with that observed by mr. arnott, that the coagulum in veins extends usually only to the nearest collateral branch; the explanation appears to be the same in both cases, as illustrated by experiment vi. if the coagulating blood be left undisturbed, it will form adhesions to the sides of the vessel and produce increased action in its coats; but if mechanically disturbed, it will be carried forward before the process of coagulation is completed, and leave the vein in its natural condition. when any portion of a vein is obstructed, the blood is kept at rest between the obstruction and the next collateral branch; and, if disposed to coagulate, there is nothing to interfere with such an action. but the case is different, as soon as one vein opens into another. a fresh current of blood is then continually sweeping the orifice of the obstructed vessel; and, even although the blood at this point should have a tendency to coagulate, it is carried on in the course of the circulation, before it can adhere to the sides of the unobstructed vein. the sudden termination of the diseased appearances in these cases, affords an additional proof that the blood is the medium by means of which this affection is transmitted. it is true, in such instances the diseased fluid cannot be always, or even generally, traced in the veins, and very many cases occur where a retained and putrid placenta, or decomposing coagula, remain in contact with the mouths of the uterine veins, without any of the symptoms of local phlebitis being produced; but this is only in accordance with what is observed in cases where purulent or other fluids have been directly injected into the blood. the examination of the blood, or of the vessels, in such cases, will by no means invariably indicate the presence of foreign matter after it has once become thoroughly mixed with the blood, nor will inflammation of the vein through which the fluid passes, be by any means invariably produced. when a foreign substance is introduced into an artery, any immediate effects upon the blood may naturally be looked for in the system of capillaries which it supplies. if the blood then coagulates, local symptoms alone, will, in the first instance, be produced, and the constitution will remain unaffected. m. magendie,[ ] indeed, asserts that fluids injected into the arteries of animals, return quickly through the corresponding veins, and that this takes place even more rapidly in the living than in the dead body. if this were universally true, it would matter little whether foreign matter were introduced into the arterial or venous system. the effect upon the constitution would be the same in either case. but if, as is now maintained, extraneous matter introduced into the blood may, under certain circumstances, produce its coagulation, then the effects will be confined, more or less completely, to the first system of capillaries which the blood meets with in the natural course of its circulation, and the constitution will be affected only in consequence of the changes which then take place. m. gaspard has shown that greasy fluids, and such as contain sediments, do not find their way readily from the small arteries into the veins. they become entangled in the intermediate capillaries, and there produce, first patches of local congestion, and subsequently serous effusion and abscesses. some clear fluids, on the other hand, such as solutions of tartar emetic, of opium, and of nux vomica, when introduced into an artery, pass readily in the course of the circulation, and produce their full effect upon the constitution; and in such cases no irritation is manifested in the capillaries through which they pass. the first of these poisons produces vomiting and purging, the second stupor, and the third tetanic rigidity, exactly in the same manner as if they had been introduced into the stomach, or injected into a vein. [ ] précis elémentaire de physiologie, t. ii, p. . there are yet another class of substances differing in their effects from both of the former; and under this head are classed infusion of tobacco, solution of acetate of lead, putrid fluids, etc. these are distinguished from the first class above mentioned, as not offering in themselves any mechanical impediment to the circulation of the blood, and from the second, as not producing the same constitutional symptoms when injected into an artery as when thrown into a vein. m. gaspard found that, when introduced into an artery, the infusion of tobacco neither produced vomiting nor stupor, the solution of acetate of lead did not act upon the intestines, and the putrid fluids did not produce the evacuations usually observed after their introduction into the system by other means. all these substances, however, were found to produce violent local irritation in the parts to which the branches of the injected artery were distributed, and the constitutional symptoms were those produced in consequence of the local irritation, and not those which would arise directly from the action of those poisons upon the system. in experiment xx, seven or eight cubic inches of common air were gradually injected into the carotid artery of a dog, and half an hour afterwards an ounce of water, to which seventy drops of medicinal prussic acid had been added, was thrown into the same vessel; none of the peculiar effects of the poison followed this operation. at the expiration of another quarter of an hour, an ounce of a saturated solution of nux vomica was likewise injected, still without producing any constitutional symptoms. it is very remarkable in this experiment, that m. gaspard[ ] should have considered that the elasticity of the air contained in the vessels was sufficient to counteract the impetus of the blood, and thus to prevent the progress of the poison along the vessels, especially when we find him stating that, on a post-mortem examination, the smaller vessels appeared to have been _obstructed by very hard clots of blood_. [ ] journal de physiologie, t. v, p. and . experiment i. (_a_). on the th of september, , having procured four small vessels of equal sizes, i placed in the first some dilute sulphuric acid, in the second some offensive pus, and in the third some water. the fourth vessel was left empty. they were then all equally warmed, and some blood from the jugular vein of a healthy horse was received into each of them so as to fill them to the same level. they were now stirred with separate pieces of wood. at the expiration of two minutes (noted by a watch), the contents of the second vessel had become coagulated into one uniform mass. the contents of the first vessel (containing the acid) were thickened and of a dark brown colour; in the third and fourth cups the blood was of its natural fluidity, but darker coloured in the cup containing water than in the other. at the expiration of ten minutes, the blood contained in the fourth cup had begun to coagulate; the blood and water still remained fluid. at the expiration of a quarter of an hour, the blood had completely coagulated in the fourth cup, containing blood alone; and had very partially coagulated in the third cup containing the blood and water. (_b_). four vessels were taken, each capable of holding three fluid ounces. in the first was placed half an ounce of cold water, in the second half an ounce of dilute sulphuric acid, and in the third half a drachm of pus, which was quite fresh and sweet. all the vessels were then quickly filled with blood, from the jugular vein of a horse. the contents of each vessel were stirred. the blood and dilute sulphuric acid became thick, and changed in colour almost immediately, as in the first experiment, but did not coagulate. the pus and blood coagulated in six minutes, and the mass was firm in seven. the pure blood coagulated in twelve minutes and was firm in sixteen. the blood and water coagulated in about the same time, but took nineteen minutes to become firm. the above and the following experiments were made at the suggestion of the author, in conjunction with mr. t. w. mayer,[ ] veterinary surgeon. [ ] the present mayor of newcastle-under-lyme. experiment ii. an abscess was opened in the groin and a quantity of pus received into a gallipot; some blood from the divided vessels was also received into the same vessel; they were then stirred together, and in two minutes the mass coagulated. some blood taken from the same patient in the same manner, but not mixed with pus, coagulated in eleven and a half minutes. experiment iii. on the th of january, , an inflamed and suppurating abscess was opened, and the blood and pus which flowed from it were mixed together. they coagulated in two minutes and twenty seconds. this experiment was repeated several times, with nearly similar results. experiment iv. in june , a tense inflamed swelling was opened in the perinæum of a patient, who had for years laboured under a very obstinate stricture. a quantity of matter first escaped, and subsequently serum, mixed with shreds of lymph and small quantities of pus and blood, continued to flow for some time. portions of this mixed fluid were received into separate vessels; they coagulated on an average in about two minutes. experiment v. two ounces and six drachms of blood were taken from a healthy horse, and two drachms of pus were mixed with it. the mass coagulated in three minutes and three-quarters. experiment vi. a healthy male ass, three years old, was procured, and, with the assistance of mr. mayer, was made the subject of the following experiment, on the rd of september, . three drachms of pus were collected from an issue in the chest of a horse, which laboured under inflammation of the lungs. the pus thus obtained was quite pure and sweet, and having been warmed, was injected, by means of a syringe, into the left brachial vein of the ass. the animal lay quiet, till nearly the whole of the pus was injected; it then struggled, and a small quantity of the pus may have been lost. when the operation was completed, the sides of the vein were brought together with a pin, and the animal was allowed to get up. the vein above the opening could now be felt as a hard, unyielding cord, as high as it could be traced with the hand; but upon gentle pressure being made, so as to propel the blood in the course of the circulation, the hardness completely disappeared. the vein which, immediately after the operation, was hard and prominent, no longer presented anything remarkable to the touch. the animal now moved from side to side, as if inclined to lie down. two hours and a half after the operation, the pulse, which naturally was , had risen to ; and the respiration from per minute had increased to . _september th._ pulse ; respiration ; mouth hot; ears cold. in the evening the pulse became and the respiration ; he coughed occasionally. _ th._ pulse ; respiration ; some dullness of countenance, but he is lively and occasionally playful. the left fore-leg is swollen; the ears are very cold. in the afternoon he was killed, and the blood was allowed to flow from the body. _post-mortem appearances._ the wound in the left leg opened directly into the brachial vein, which was filled with lymph and a thin pus for a very short distance, both above and below the external opening; immediately above this, the vein was healthy, nor was there any appearance of disease in any of the other veins of the limb, nor in the veins leading to the heart. the glands in the axilla were swollen. the lungs were found studded irregularly in different parts, with circumscribed spots of livid congestion: these existed both upon the surface and in the substance of the lungs; they were generally about the size of a filbert, but in some places they occupied a single lobule, and were accurately circumscribed by its outline. experiment vii. on the rd of november, , about an ounce of perfectly pure pus (previously warmed) was injected into the right jugular vein of an aged ass; the vein immediately became "corded", and the blood appeared to have coagulated in the vessel. the operation did not much excite the breathing; but the pulse, which naturally was in the minute, rose to , and subsequently fell to . _ th._ the animal dejected; appetite indifferent. the vein can be traced as a thickened cord as far as the sternum. respiration (the natural standard); pulse . _ th._ the parts around the vein much infiltrated with serum: pulse ; respiration . _ th._ the wound in the neck began to suppurate, and an abscess subsequently formed in the course of the vein, about midway between the opening and the sternum. the general symptoms continued, with very slight variation, until the th of december, when the animal was destroyed. _post-mortem appearances._ the jugular vein was found to have become inflamed only in the course of the circulation, and to be obliterated a short distance below the external opening. the surrounding parts were greatly infiltrated with serum and lymph, and several abscesses had formed in the immediate neighbourhood. the lungs did not present any well-defined patches of congestion, as in the last mentioned experiment. experiment viii. a healthy ass, six years old, was operated on upon the th of november, . the respiration was naturally in the minute, and the pulse . about two ounces of highly offensive pus, obtained from the frontal sinus of a horse, were injected into the left jugular vein; the pus had unintentionally been mixed with water previous to its being injected. the vein became full during the operation, as though the blood in it were in a semi-coagulated state. the pulse now became , and the respiration in a minute; slight rigors occurred in two hours. _november th._ the animal is tranquil; appetite good; pulse , small and wiry; respiration . in the evening he was rather more excited; the vein was becoming inflamed downwards towards the heart; pulse ; respiration . _november th._ the vein was more inflamed, and slight suppuration was visible at the orifice of the wound. respiration ; pulse . from this period to the rd, the pulse continued from to , and the respiration varied from to . _november th._ the swelling in the situation of the vein is rapidly subsiding; pulse ; respiration . the animal gradually recovered, and on the th of february, , was made the subject of another experiment. the right jugular vein having been opened, two fluid ounces of pure healthy pus were injected, and propelled in the course of the circulation, by pressure upon the vein externally. the vein became tense during the operation, and sensibly resisted the attempts that were made to propel its contents towards the heart. _even forcible pressure was not sufficient to overcome the resistance offered to the return of blood._ soon after the operation, the animal had a rigor; the breathing became laborious, but not accelerated; pulse . after the lapse of seven hours, the animal appeared dejected; he refused to eat or drink; the extremities were cold; breathing in the minute; pulse , small and irregular. _february th._ the vein can be felt thickened as far as the sternum. the general symptoms are the same as on the previous evening. _ th._ there appears less constitutional irritation; pulse ; respiration . _march nd._ appetite still indifferent; pulse ; respiration . from this date to the th, when the animal was destroyed, the general symptoms continued much the same, but the induration and swelling around the jugular vein, from the opening to the sternum, became greater. _post-mortem appearances._ the left jugular vein was found completely obliterated. the remains of a firm coagulum obstructed its canal for some distance below the opening which had been made into it, and terminated, below, in an elongated conical portion, which adhered to one side only of the vessel. on the right side, an abscess had formed in the course of the vein; and for two inches, the whole of the parts were imbedded in a confused mass of pus and lymph, in which it was impossible to distinguish the structure of the vein. both above and below this, for several inches, the vein was filled with coagula, which effectually obliterated it. these coagula extended for several inches in the course of the circulation; but beyond them, in both directions, the vessel was pervious. the lungs presented some slight spots of congestion, but not of the same characteristic kind observed in experiment vi. the other organs were healthy. experiment ix.[ ] [ ] this, and the following experiments, are among those recorded by m. gaspard, referred to in the foregoing dissertation. two drachms of pus, somewhat fetid, derived from a large common ulcer, and diluted with a little water, were injected into the jugular vein of a middling-sized dog. the animal immediately made several convulsive efforts to swallow, and soon became faint. it showed indications of pain, and vomited more than six times in the course of the day. at the expiration of an hour, it appeared slightly relieved by an evacuation, and by passing turbid urine. in the evening, it was very ill; it lay upon its side with its legs extended; had a very feeble pulse and scarcely perceptible respiration. ten hours after the experiment, it passed black, liquid, and extremely offensive motions; these were accompanied by immediate relief. the animal regained its appetite, eat and drank freely, and went to sleep. the day following, it appeared nearly well. on the third day, three drachms of the same pus were injected into the opposite vein; after the lapse of a certain time, there occurred, as in the first instance, faintness, vomiting, and frequent desire to pass urine; twelve hours after the injection, frequent liquid, white, and very fetid motions were passed, and the animal died at the expiration of twenty-four hours. on opening the body, no alteration was found either in the intestines or other organs. experiment x. the last experiment was repeated on a greyhound with the same results: faintness, fever, vomiting, and repeated evacuations succeeded each other, with recovery after the first experiment, but not after the second. on opening the body, no lesion was observed, except that the inferior lobes of the lungs were gorged and almost hepatized. experiment xi. three drachms of recent pus, derived from the same patient as in the last experiments, were injected into the jugular vein of a small emaciated unhealthy dog. after the expiration of three minutes, there was an abundant evacuation of urine, followed by continued vomiting, and repeated ineffectual efforts to pass fæces. for nearly a quarter of an hour, there was a kind of emprosthotonos, rigidity of the limbs, and a death-like condition. subsequently, fresh vomiting ensued, with very fetid liquid evacuations, which were followed by apparent relief; soon after, however, long continued tenesmus made its appearance, and terminated in death, five hours after the injection of the pus. on opening the body, the mucous membrane of the intestines was found red, swollen, and inflamed, especially in the colon and rectum. experiment xii. half an ounce of pus, similar to that used in the preceding instances, but more putrid, in consequence of having been longer kept, was introduced into the veins of a middling sized dog. the animal, as in the other cases, was seized with vomiting, accompanied by violent straining. subsequently, strongly marked nervous symptoms made their appearance. the eyes wandered; there was extreme sensibility, and involuntary convulsive twitching over the whole body, accompanied by faintness, hiccough, and short piteous cries. the walk was unsteady, staggering, and without apparent object. there was furious delirium, ardent thirst, dyspnoea, palpitation of the heart, etc. this state lasted for nearly two hours, and the animal died in frightful convulsions, without having experienced any critical evacuations, as in the former cases. _post-mortem appearances._ on opening the body, while still warm, the venous blood was found very firmly coagulated, not parting with any of its serum when left at rest; the left ventricle of the heart showed, on its external surface, some stains of the colour of lees of wine, formed by a kind of concrete pellicle, which disappeared only after long rubbing and maceration. the other organs appeared healthy. experiment xiii. some beef was allowed to decompose in some dog's blood; half an ounce of the fluid resulting from the decomposition, was injected into the jugular vein of a little bitch. immediately, the animal made several convulsive efforts to swallow, and soon became oppressed, uneasy, and faint. at the expiration of an hour, there was great prostration, accompanied by repeated gelatinous and bloody evacuations, and vomiting of bilious matter. the strength became gradually less, and the animal died three hours after the injection. _post-mortem appearances._ the lungs were found inflamed in a very peculiar manner. they were gorged with blood, of a violet or black colour, and presented many petechial spots, like small ecchymoses. these spots existed also on the left ventricle of the heart, in the spleen, in the mesenteric glands, in the gall-bladder, and even in the subcutaneous cellular tissue. the peritoneum contained some spoonsful of a reddish serum; but the mucous membrane of the digestive organs was found to have been principally affected. in the stomach it was slightly inflamed. in the intestines, but especially in the duodenum and rectum, it was of a livid colour, presenting many black spots, and covered by a gelatinous and bloody secretion, resembling lees of wine. the tissues in these parts were slightly thickened. experiment xiv. the preceding experiment was repeated, by injecting into the jugular vein of a moderately large dog, an ounce of fluid, derived from the maceration of putrid beef in water. the animal very soon passed extremely offensive, liquid evacuations, with much urine. the breathing became quick and deep, the pulse small and quick. repeated efforts were made to empty the bowels. there was great depression and want of strength. at the expiration of an hour, a kind of diarrhoea or dysentery made its appearance. liquid, bloody, and fetid evacuations, continued for an hour and a half, when the animal died. _post-mortem appearances._ livid, brown, and black patches were found scattered over the lungs. the intestinal canal was filled with a bloody mucous secretion, resembling the matter that had been voided; its mucous membrane was of a livid colour, as in the preceding case. experiment xv. two ounces and a half of thick fetid fluid, derived from the maceration of cabbage leaves in an equal quantity of water, for two days, at a temperature of fah., were injected into the right jugular vein of a moderate sized dog. during the operation, the animal made several efforts to swallow, and soon became faint, and vomited several times. some hours afterwards, there was great uneasiness and oppression, with recurrence of the vomiting, and continued faintness during the day. after nine hours, a most copious and very fetid evacuation took place. the discharge was as black as soot, and composed of mucus, with a little fæcal matter, and a large quantity of what appeared to be corrupted blood. some time afterwards, there was a second evacuation of bloody mucus, exactly resembling the first. on the following day, there was much loss of strength: the animal lay upon its side, or staggered as it walked. there was great and insatiable thirst, with a small feverish pulse. but the most remarkable symptom was the occurrence, at intervals, of palpitation of the heart, accompanied by extraordinary force and sound, resembling that produced by long continued hypertrophy of that organ, in consequence of aneurism[ ] of one of the large arteries. on the third and fourth days, the animal was better, but there were still great thirst, fever, and occasional rejection of fluids from the stomach. on the fifth day, the symptoms became aggravated; there was extreme weakness, a tottering gait, excessive thirst, the eyes red and filled with gum; the nostrils were stuffed, swollen, and obstructed with mucus; and the lining membrane of the mouth was tumid, and of a violet red colour. in the middle of the day, there was a liquid greyish white evacuation, resembling pus in its odour, consistence, and appearance, mixed with some clots of putrified blood. death occurred during the following night. [ ] i once observed a similar condition in a young woman in st. george's hospital. each pulsation of the heart could be heard with great distinctness at a distance of two or three yards from the patient; during the paroxysms, there was the greatest difficulty of breathing; the countenance became anxious and livid, and a distinct thrill was communicated to all the arteries. after death, the countenance and upper part of the body were found livid from venous congestion. the lungs did not readily collapse when the chest was opened. the auricles of the heart were greatly distended with black blood; the inner surface of the left ventricle presented a white patch, of about two square inches in extent; the lining membrane of the aorta, for several inches, was of a bright red colour; this extended round one-third only of the circumference of the vessel. no other structural change could be found in the heart or vessels, which would account for the symptoms observed during life. _post-mortem appearances._ the mucous membrane of the eyes, nose, and mouth, was red or violet, and covered by a very abundant thick mucus. the lungs were of a dark colour, with some black patches, but still crepitant. the left ventricle of the heart presented several brown stains, resembling ecchymoses, which penetrated into its tissue. its internal surface was of the colour of lees of wine, offering a singular contrast to that of the right side, which, however, contained a hard fibrinous concretion, two drachms and a half in weight, of a light yellow colour, and resembling grease in appearance. this was of the same consistence throughout, everywhere free, with the exception of a portion of the size of a finger nail, which adhered to an irregular and apparently inflamed spot on the inner surface of the ventricle; no appearance of the injected fluid could be recognized in this clot. it was continued of the same colour and consistence into the pulmonary artery, and into the vena cava, the vena azygos, the axillary, and even the right jugular vein. the intestinal mucous membrane, especially in the rectum, the duodenum, and a small portion of the small intestines, was of a violet red colour. it was inflamed in longitudinal stripes and in patches, which gave a mottled appearance, even to the outer surface of the intestines, before they were opened. this discolouration was not accompanied by any thickening of the tissues, nor by ulceration, and appeared rather the result of ecchymosis or hæmorrhage. the lining membrane of the rectum was principally affected, and its mucous glands were swollen and very prominent. this intestine contained puriform fluid, resembling the matter evacuated before death. the other intestines contained a very thick greyish white mucus. the mesenteric glands were inflamed, and appeared as if infiltrated with blood. the gall bladder was mottled on its surface by brown and violet patches, and contained black, thick, ropy bile, resembling melted tar. experiments xvi and xvii. _shewing the effects of the introduction of mercury into an artery._ an ounce and a half of mercury, mixed with water, was injected into the left carotid artery of a sheep. the animal immediately evinced pain, and stood immoveable upon its feet. the head was held down, there was stupor and heaviness, and the eyes were protruded and widely open. the fore legs subsequently became bent, and the head inclined over the right shoulder with a kind of convulsive rigidity, which continued till death. two hours afterwards, the animal became comatose, with some convulsive motions of the limbs, and the left eye became red and inflamed. death took place fifty hours after the operation. _post-mortem appearances._ the left eye was found in a state of suppuration, and contained mercury. many of the branches of the left carotid artery also contained some mercury, which had not penetrated to the capillary system. all the organs supplied with these vessels were red, swollen, and inflamed, in consequence of the presence of the foreign matter. the thyroid gland, the tongue, the cheeks, and the lips, were, however, only affected as far as the median line, leaving the opposite halves pale and in their natural condition. a drachm and a half of mercury, mixed with some warm water, was injected into the crural artery of a large dog. the animal evinced no pain, and walked resting slightly on the affected limb, which became sensibly colder. after the expiration of an hour, the animal refused its food, became restless, and indicated severe pain in the limb, which was now very hot. on the following day, the leg was swollen and oedematous. on the third day, there was extreme thirst, increased oedema, and great suffering. the animal was killed sixty hours after the operation. _post-mortem appearances._ no disease was found in any organ, excepting the affected limb. this was swollen and oedematous in every part; abscesses of different sizes had formed, which contained sanious fluid, mercury, and pus; some parts were in an incipient state of mortification, and gave out a considerable quantity of air. globules of mercury were found in different parts, occupying usually the centre of the abscesses, and ran out upon the scalpel when incisions were made into the limb. experiment xviii. _shewing the effect of the injection of oil into an artery._ three drachms of olive oil were thrown into the crural artery of a large dog. slight pain was experienced, and the limb became evidently cold, and the pulse under the tendo-achillis could no longer be felt. two hours afterwards, a like quantity of oil was again injected. the leg now began to inflame, and became tender. the following day, the whole limb was oedematous, much swollen, and very painful. twenty-nine hours after the first experiment, the muscles of the thigh and leg, as well as the cellular tissue, were found in some places gorged with blood, and inflamed in livid patches; in others, infiltrated with yellow serum and gelatinous exudations. no oil could be detected in the affected parts. experiment xix. an ounce of putrid water, in which some beef had been macerated, was injected into the crural artery of a middling-sized dog. the artery having been tied, the pulse ceased below the tendo-achillis; the limb, however, preserved its usual degree of heat, offering a contrast in this respect to the last experiment. a considerable degree of fever and restlessness followed the operation; this continued the whole day and the following night, without any vomiting or evacuations, which so constantly followed similar operations upon the veins. the next day the limb was very painful, but not swollen; there was thirst, with the ordinary secretion of fæces and urine. on the third day, the animal was evidently better; the appetite had become almost natural, and he could walk more easily, although the limb was still very painful. in the night, there were some soft, almost liquid, evacuations. the fourth day, the animal was evidently recovering, when an ounce and a half of very fetid and very concentrated fluid (derived from the maceration of beef), was injected into the crural artery of the opposite limb. the animal immediately evinced pain, accompanied by very violent and remarkable palpitation of the heart. it walked lame, keeping the leg raised, and soon became feverish and uneasy. the symptoms were exactly the same as after the first experiment. the leg became gradually more and more painful, extremely sensitive, but not infiltrated with serum. during the night, there was much expression of pain, and the animal was in continual motion. death occurred nineteen hours after the second injection. the limb had become swollen only within five or six hours previous to death. _post-mortem appearances._ the limb presented a very large quantity of bloody fluid infiltrated in all the tissues. the superficial muscles were black, and presented more or less the appearances of gangrene. the deep muscles existed as such no longer, but were entirely disorganized, and converted into a putrid pulp, resembling masses of the red lees of wine, extremely fetid, and disengaging a quantity of gas. the limb first injected was still swollen, and presented, in the interior of the adductor muscles, two or three cavities filled with a putrid bloody serum. in the chest, the lungs were healthy, as were also the right cavities of the heart; but the left cavities presented several reddish-black spots, scattered over their external surface. in the left auricle was a firm yellowish-white coagulum, adhering to an inflamed spot on its inner surface. the intestinal canal was filled with a brownish red fluid, resembling altered blood, which, in the stomach and duodenum, was of the colour of soot. the mucous membrane of these organs, as well as of the jejunum and rectum, were gorged with blood, of the colour of the lees of red wine, but without any inflammatory thickening of their coats. experiment xx. _shewing the effect of the introduction of air into an artery._ seven or eight cubic inches of common air were injected gradually into the crural artery of a large dog. a peculiar rustling noise, depending upon the admixture of the air with the blood, accompanied the operation. no particular symptoms followed; but after some minutes the corresponding vein became distended with frothy blood, which moved with difficulty, and became stagnant in the vessel. the whole limb crepitated upon pressure, but no untoward symptom presented itself for more than half an hour. an ounce of water, to which seventy drops of medicinal prussic acid had been added, was now injected into the same artery. this produced no apparent effect upon the constitution. a quarter of an hour after, an ounce of saturated solution of nux vomica was injected into the same vessel. this also was followed by no particular symptoms. an hour after the first injection, half an ounce of a weak infusion of tobacco was introduced into the same artery. excessive pain immediately followed, accompanied by great rapidity of breathing. the animal now appeared as if he were going to die; however, he slowly recovered, appeared giddy and inclined to vomit, and kept himself in a continual state of restlessness. this condition was succeeded by fever, accompanied by extreme sensibility of the limb, and irregularity of the pulse. at the expiration of some hours, he appeared better; the pulse became more regular and less feverish, but the leg continued swollen, and extremely painful upon pressure. during the night, the pain returned, indicated by howling and restlessness. there were several evacuations of fæces and urine. the following morning, there was great prostration with much fever, and apparent suffering. the limb was slightly emphysematous, swollen, inflamed, and infiltrated with serum. on the following day, two ounces and a half of water, in which some nux vomica had been boiled, were injected into the crural artery of the opposite limb. the dog expressed no pain; but, at the expiration of ten or twelve minutes, slight convulsive motions became evident, which were gradually converted into violent tetanic spasms. the animal threw himself backwards with his limbs extended, and died, after repeated convulsive attacks, an hour and a half after the last injection. _post-mortem appearances._ on opening the body, _no unusual appearances were observed in the limb_ upon which the last experiment had been tried, but the opposite one was tumid and emphysematous, infiltrated with a greyish red frothy serum of a fetid odour. _the small vessels were obstructed by firm clots of blood._ the gall-bladder was greatly distended; and the intestinal canal contained a quantity of yellowish mucus. part ii. on the introduction of vitiated fluids into the blood; its consequences, and treatment, with cases. viii. the experiments cited in the first part of this essay, illustrate the power possessed by the blood of preventing certain foreign substances from circulating with it. they shew that pus, in particular, has a tendency to coagulate the blood; and that by this means, when introduced into the vessels, its progress is arrested in some part of the circulating system. this fact, which, taken by itself, might appear of little consequence, assumes considerable importance when considered as one of the inherent properties of the blood, at all times ready, under favourable circumstances, to be called into action in the living body. the conditions under which pus will determine the coagulation of the blood, and those under which it will circulate in the living vessels, require to be accurately ascertained, before we can rightly interpret the discordant evidence which we at present have upon this point. dr. sédillot,[ ] in a work recently published, mentions, that a great number of cases are met with, in which pus is poured into the general circulation without meeting with any obstruction, and states that, in such instances, he can detect the globules of pus in different parts of the circulating system. he even affirms that he can recognise a disease caused by purulent infection, by examining, under a microscope, a portion of the blood abstracted from the body. [ ] de l'infection purulente, p. . m. dance, and, since his time, equally accurate observers, have, on the other hand, failed to detect the characters of pus in the blood, even when that fluid had been injected into the veins of living animals. the results of these different observations may perhaps be reconciled, by considering the influence exercised upon the globules of pus by the blood, before its coagulating power has been impaired. this subject appears not to have hitherto occupied the attention of pathologists. in all the cases quoted by dr. sédillot, in which he detected the globules of pus in the blood, the patients died of the disease; but in the researches instituted by m. dance and others, the experiments were made upon animals in perfect health. in the latter, the pus cannot enter the circulation, as has already been shewn, or can only do so after the blood has partially or entirely coagulated round it, and the coagulum has subsequently become broken up. in the act of coagulation under these circumstances, the appearances of the globules of pus are changed,--these being perhaps mechanically compressed by the contraction of the fibrine,--so that the most experienced eye can no longer recognise them. pus, mixed with healthy recently drawn blood, out of the body, will entirely lose its characters in this way; and as the coagulation, is by no means retarded in the living vessels, we may, without fear of contradiction, affirm, that globules of pus cannot be detected when introduced into the vessels in small quantities, and mixed with healthy blood. in cases where, from long-continued disease and the repeated introduction of vitiated fluids into the circulation, the blood has lost its power, there appears no reason to doubt the correctness of dr. sédillot's observations; and it is probable that pus-globules may then circulate with those of the blood. in experiments upon animals, it has always been found that the power of the constitution, in resisting the effects of the injection of pus into the veins, was much greater at the first than at any subsequent operation. this circumstance would appear to associate itself directly with the observations now made, and to afford another illustration of the power of healthy blood in resisting the entrance of some foreign matters into the system. from the consideration of these facts, and of the experiments previously recorded, it becomes evident, that the introduction of pus into the system through an injured or inflamed vein, can rarely be the first step towards purulent infection of the system. some change must previously have passed in the blood, by which its coagulating power is impaired, or some unusual mechanical means must have been employed, before the pus can find its way in the course of the circulation. the contradictory statements which have been made by those who have injected pus into the veins, may thus be reconciled, by taking into account the power exercised by the blood in the experiments which have been made. there can be little doubt that, while, in some instances, a portion of the pus has been forced into the general circulation, in the great majority of cases it has been detained in the vein into which it was first introduced, and has never become part of the circulating fluid. we accordingly find some experimenters recording the secondary diseases which they observed, while in other hands these appearances were not produced. dr. sédillot[ ] has attempted to prove that the globules, or solid parts of pus, must be introduced into the system, in order to produce well-marked indications of purulent infection. but this hypothesis would not only appear to be at variance with the oft-repeated experiments of mm. gaspard and cruveilhier, in which similar effects were produced by the injection of mercury and of putrid fluids, but would also leave unexplained the mode of the introduction of these globules, where there is evidence that the disease has been communicated through the lymphatic system. the changes which all substances undergo in their passage through the absorbent glands, would at once forbid the idea that globules of pus could be thus introduced unchanged into the circulation; and yet we have direct evidence (case xxix) that irritating fluids are conveyed in this way into the system, and lead to the formation of secondary abscesses. [ ] in deducing general conclusions from experiments upon animals, it must be borne in mind, that in them suppuration is induced with great difficulty. many of the appearances produced by the injection of putrid fluids (as in experiment xiv) would, in man, probably have terminated in suppuration. dr. sédillot has nevertheless established the fact, that, generally speaking, a different class of post-mortem appearances may be expected from the introduction of decomposed serum, to those produced from fluids containing solid particles. another class of cases, in which there would be difficulty in admitting the doctrine of the introduction of pus in substance into the circulation, presents itself, where, in the primary affections (as in case vi), no evidence can be obtained of the original lesion having suppurated. the fluids effused in such cases may be serum, lymph, or blood, mixed in different proportions; and yet the constitutional symptoms will be exactly similar to those which follow the formation of pus in other instances. there may exist, both in the primary and in the secondary affection, every intermediate gradation between the healthy secretion of a part, and the formation of pure pus, or pus mixed with blood or lymph, without any of the essential characters of the disease being absent. an inflamed bursa, or a punctured wound, without the formation of pus, (cases iv and v), may give rise to symptoms as severe, and consequences as fatal, as any that arise from the direct introduction of pus into the system. the secondary affections, in such cases, may run their course and prove as speedily fatal, as where well-formed purulent deposits have taken place. the most severe constitutional symptoms will sometimes be followed by the effusion of bloody fluid only, in one of the serous cavities (case xxx). it would be unphilosophical, even were it practicable, to refer such cases to a different disease, merely because the accidental circumstance of the formation of pus is wanting. the origin of the affection in such instances may be as well-marked, the poison can often be traced as distinctly into the system, and the secondary disease may be as clearly connected with the primary, as in any case where pus has been originally formed. in some cases again, the constitutional symptoms which accompany, or are followed by, effusions into distant parts of the body, begin before sufficient time has elapsed to allow the supposition that pus can have been fully formed at the original seat of injury. such instances occasionally, although rarely, present themselves in extensive burns and scalds, occurring in enfeebled habits, and after amputation of the limbs in scrofulous children. in nearly all cases, when the origin of the constitutional disease cannot be traced to the introduction of diseased fluid into the system through an open vein, it will be found that the part primarily injured has wanted the degree of vigour, requisite to establish and maintain healthy adhesive inflammation. upon another occasion,[ ] i have endeavoured to show that, where lymph is effused around a poisoned wound, the virus will find its way less easily along the absorbent vessels, than when no such effusion has taken place; and that when, in such a wound, the effusion of lymph is checked or prevented, as by the administration of mercury, a larger proportion of cases will indicate an affection of the lymphatic system, than when the natural process has not been interfered with. there can be little doubt, that the same principle may be observed with regard to ordinary wounds. the number of cases in which the absorbents inflame, will be in inverse proportion to the number of those in which the original wounds are circumscribed by healthy adhesive inflammation. in case xxvii, it is mentioned, that the surface of a muscle, implicated in the original lesion, was as cleanly dissected as if done with a scalpel, thus showing the total absence of any surrounding effusion of lymph. the absence of, or defect in, the process of adhesion may thus be associated with inflammation of the absorbents, as the want of "union by first intention" has been shown to be connected with inflammation of the veins (section ii.) [ ] london journal of medicine, vol. i, p. . the minuteness of the absorbent vessels, and the changes which their contents undergo in their glands, prevent any unhealthy fluids from being as readily recognised in them as in the veins. but when the progress of inflammation can be traced along these vessels from a wound, towards the centre of the circulation, marked, as it often is, at intervals, by the formation of abscesses, we cannot doubt that an irritating fluid has found its way along their canals: and when the constitutional symptoms, which arise at the same time, terminate in the formation of purulent deposits (as in case xxix), we cannot but admit that the absorbent vessels are the direct means by which, in such cases, diseased secretions are poured into the blood, and the system becomes infected. it would, therefore, appear that there are two principal conditions, under which local disease may produce a general infection of the system by the direct introduction of vitiated fluids into the blood. the first of these is connected with defective union in injured veins; the second is associated with want of healthy adhesion in inflamed lymphatics. the period of invasion of the attack differs in some degree in the different classes of cases, but it is generally marked with great precision: even when apparent recovery has been followed by a second attack, the occurrence has in each instance been accurately noted by the sudden appearance of constitutional symptoms (see case xxxvii). when one of the large veins has been originally affected, the period which elapses before symptoms of infection of the system manifest themselves, is comparatively short (case i). in cases occurring after child-birth, it is usually longer, extending to the end of the second week. after surgical operations or accidents involving some portion of bone, the access of the disease will be marked by a rigor during the third or fourth week; and finally, when the absorbent system is primarily affected, the period of the occurrence of the constitutional symptoms may be much farther removed from that of the original injury (if any such existed), and is by no means so accurately defined. at the time of the occurrence of the general disturbance of the system, the local injury or wound will generally put on an unhealthy appearance. the skin in the immediate neighbourhood will sometimes assume a dull brownish-red appearance, which will gradually fade into the colour of the surrounding parts. this symptom will usually commence near the termination of the vessels, which are derived from the same trunk as those which supply the injured part. when the original injury is complicated with a wound upon the surface of the body, it will usually become dry and glazed, and the blush upon the skin will commence in its neighbourhood, or a short distance from it, and will usually extend towards the centre of the circulation, without presenting any very defined margin: occasionally it will extend, in the form of erratic erysipelas, over a large part of the body.[ ] [ ] in a case of fracture of the femur into the knee-joint, i have observed a dark ill-defined erysipelatous blush extend from the affected limb to the body, and thence to the head. purulent deposits formed in various parts of the body, of which the patient died. ix. the commencement of constitutional disease, after direct infection of the blood, is marked by a sudden change in the manner and appearance of the patient; a severe rigor is usually the most prominent symptom, and is followed by much febrile excitement, or by extreme depression; a very peculiar heat of skin (case xxii) will sometimes be present, while, at other times, the surface will be covered by a profuse clammy perspiration. the rigor may be repeated at irregular intervals, but occasionally it will recur about the same hour for three or four days in succession (case xxxvii); and in a few instances it will not be observed at all. great depression frequently accompanies even the first stages of this disease, indicated by a want of tone in the pulse, by an extremely listless manner, and sometimes by a tendency to syncope (case i). the countenance becomes anxious, the tongue dry and brown in the centre, and red at the edges, or, in other instances, it presents a coating of a pasty yellowish-white colour; a dusky yellow hue frequently pervades the skin, and sometimes the conjunctivæ of the eyes. this may or may not depend upon an accompanying affection of the liver. the pulse varies much in frequency in different cases, and at different times in the same case: generally it is very rapid, especially when accompanied with much heat of skin. the pain is sometimes severe, and may be referred exactly to the spot which subsequent examination shows to have been the seat of secondary inflammation; at other times it is not confined to any particular situation, but consists of general ill-defined feelings of short duration, and recurring at irregular intervals. the peculiarity of such sensations is best expressed by the terms applied to them by the patients themselves. "catching pains all over", "soreness of the stomach", and "thrilling in the blood", not unfrequently accompany this disease. vomiting may occur, either as a symptom of constitutional disturbance, or as indicative of inflammation of an abdominal organ (case xxvi). in the latter case, it is extremely obstinate, and the fluid ejected is generally of a green colour. diarrhoea is a symptom of frequent occurrence, and appears to exercise a considerable influence on the course of the disease. its appearance will not unfrequently be accompanied by relief of the other symptoms (case iii); when it occurs, it is generally profuse, and little under the control of medicine, but, if checked, may be followed by a sudden change for the worse in the condition of the patient. the intellect is seldom affected during the first stages of the complaint; but subsequently, in severe cases, restlessness, delirium, and coma, seldom fail to succeed each other. these symptoms are all peculiar, both in regard to the rapidity with which they make their appearance, and also the sudden manner in which they occasionally disappear. the disease may seem, within a few hours, to leave a part which it has first attacked, and to fall upon a different organ in some remote part of the body. x. the post-mortem appearances observed in those who die in consequence of the introduction of vitiated fluids into the blood, cannot, for the most part, be distinguished from similar changes produced by other causes; yet there are some effects which are peculiar, and may be directly associated with the reception of foreign matter into the circulation. the most characteristic circumstance, attending the extension of disease to different organs of the body through the medium of the blood, is that several parts of these organs, or even different organs, will be simultaneously attacked. the disease will appear at once in various spots, which will become rapidly disorganized, while the surrounding textures will remain unaltered, either in structure or colour. the appearances observed upon dissection will vary according to the part attacked, and the stage of development in which the disease is found. the lungs are the organs in which the successive changes may best be observed. when puriform fluid has entered the circulation, the first appearance produced in the structure of the lungs, is that of one or more congested or dilated veins[ ] of very small diameter. this will be followed by a well defined spot, of much darker colour than the surrounding texture. several of these spots will probably appear at the same time, and each one of them will soon become surrounded by a hard spherical patch of purple congestion. effusion of lymph will now take place, commencing in the centre of each affected portion, and gradually extending towards its circumference. if the disease continue, each spot will suppurate, and the different parts will become softened and broken down, in the same order in which they were previously solidified. [ ] for the knowledge of this fact, i am indebted to mr. cæsar hawkins, of st. george's hospital. the liver frequently becomes the seat of secondary inflammation. in the early stage, brownish-red spots may be observed scattered through its substance. these, as they extend, assume a bluish or slate-colour; and the structure of the liver thus affected is found to have lost its consistence, and to be very easily broken down by pressure. every part affected here, as in the lungs, proceeds rapidly to suppuration; and the usual appearance presented after death, is that of several small circumscribed abscesses, around which the structure of the liver has been condensed only to a very small extent. it sometimes happens, that the larger veins in the liver become inflamed. these vessels, being held open by the firm structure of the part, are not so readily obliterated as in other situations; and it consequently happens, that the lymph and pus poured into them become irregularly mixed with the blood, more or less perfectly coagulated, which they contain: a very peculiar mottled appearance, resembling granite, is thus occasionally produced. affections of the spleen, produced by the introduction of foreign matter into the blood, are probably not so readily recognised as similar affections in the lungs and liver. for, although the spleen is often found to be diseased in those who die from infection of the blood, yet it is comparatively seldom that secondary abscesses have been found in it. in the accompanying table, containing twenty-three cases, some morbid appearance, not recognised as peculiarly the result of secondary inflammation, was observed in the spleen in no less than eight instances. so large a proportion of cases renders it probable, that the alterations observed have more than an accidental connexion with the disease of which the patient died, although they presented no characters which could be said to be peculiar to that disease. in well-marked cases of secondary affections of the spleen, one or more well defined, but frequently irregular indurations, of a chocolate colour, may be recognised; such patches are usually seen soon after the commencement of the complaint, and in a very short time become softened or broken down. the rapidity with which they lose their original character, may probably account for their being comparatively seldom observed in post-mortem examinations. deposits of lymph are sometimes met with in the kidneys; but these are of small extent, of a light colour, and resemble lymph deposited in consequence of ordinary inflammation. the patches of congestion, so characteristic of this disease in other organs, are not here observed. this may depend upon the peculiar disposition of the capillary system of the kidney. the blood has to pass through the malpigian tufts, and may be purified, or altered in character, before it reaches the proper venous system of the organ. in cases where purulent infection of the blood has been purposely produced, portions of the kidney will not unfrequently be found inflamed and firmer than natural; but, if the origin of the disease were not known these appearances could not be distinguished from those produced by inflammation of the kidney from other causes. the skin is liable to be affected in three different forms. (see cases i, ii, iii, ix, x, and xxxiv). the first of these occurs very rarely, and consists of small deposits of matter in the structure, or upon the surface of the skin, resembling in many respects the pustules of small-pox. the second form is also of rare occurrence, and consists of small congested spots on the surface of the skin. these are generally of a dark purple hue, but i have seen one case in which they were of a bright red colour. in this instance, a secondary abscess had formed in the knee-joint, and some pustules appeared upon the skin in the neighbourhood. a fortnight before the death of the patient, a number of small bright red spots made their appearance in different parts of the thigh and upper part of the leg; some of these were three or four lines in diameter while others were so small as not to be seen without attention; they appeared in accurately defined spots, of a brighter colour than the mucous membrane of the lips, and continued unchanged in appearance till death. the third form presents itself much more frequently than either of the others, although it has not hitherto much attracted the attention of pathologists, in connexion with purulent or other infection of the blood. it commences very suddenly, and frequently without any particular attention being directed to the part. a large circular patch of congestion, livid or purple in the centre, but becoming of a lighter colour towards the circumference, will form, usually upon some part of the lower extremities. the skin of the calf of the leg is perhaps more frequently attacked than that of any other part. in the centre of the congested portion, mortification very rapidly takes place, and is indicated by the part assuming a black or dull leaden colour. in some cases, it would be difficult to say where the mortification ceases, and the congestion begins; but in other instances, there is a distinct line of demarcation formed: a zone of bright red congestion will then occasionally surround the mortified part. some modifications of this third form of affection of the skin may be met with occasionally in the course of the disease. blotches assuming a livid or dusky red appearance (which gradually fades into the colour of the surrounding skin), will present themselves in different parts (case xxxvi), and terminate in thick exfoliation of the cuticle, or in small sloughs of the skin. in some instances, the superficial portions only of the skin are destroyed, and the parts beneath appear comparatively unaffected; small circumscribed portions of the outer layer of the skin will exfoliate, and the subjacent parts will heal without suppuration, by a process similar to that of scabbing (case iii). it is remarkable in this disease, that the most vascular parts are those which soonest lose their vitality. thus, in the case last referred to, portions of the surface of the skin perished, while the deeper layers recovered; again, it is not unusual to observe the whole thickness of the skin destroyed, without any corresponding affection of the cellular membrane beneath. the quantity of blood sent to a part would thus appear to favour mortification in this disease. the reason of this peculiarity will be considered in the next section. in two of the instances recorded in the appendix (cases xxii and xxvi), the lining membrane of the rectum was found of a very dark colour, and in one it had assumed a greenish appearance. this discoloration was at first looked upon as some accidental complication, or as depending upon previous disease. but m. gaspard has noticed a similar condition, after the artificial introduction of putrid fluid into the blood.[ ] in one of the experiments referred to, the mucous membrane of the intestines was everywhere healthy, except in the _rectum_ and _duodenum_. in the former situation, the rugæ were prominent, and of a violet colour; in the latter, the membrane was of the colour of pale lees of wine. from the coincidence thus observed, we are led to believe that the same condition which produces congestion in the skin, may produce an analogous affection of the mucous membrane. nor must we omit to note, in connexion with this subject, the fact of the mucous membrane of the vagina being occasionally found of a dark purple colour in those who die of puerperal affections. [ ] journal de physiologie, t. iv, p. . in the cellular membrane, serum, lymph, and pus, may be deposited, mixed with each other in various proportions. the surrounding vascularity, in these cases, is unusually small, and the lymph effused not properly organized; there is, consequently, no natural boundary to the disorganizing process, and the fluid secreted becomes infiltrated in the surrounding parts. when the muscular structure is affected, suppuration takes place with great rapidity; portions of muscles may be found quite soft, and sometimes pultaceous, in circumscribed patches, around which the fibre is perfectly healthy. pus is occasionally deposited on the exterior of muscles; and it will be then smeared over the surface, and rather infiltrated in the cellular tissue, than contained in a cyst. in the interior of muscles, there is the same absence of the natural limit to the inflammation; but, owing to the more compact structure of the part, the deposits of matter generally remain circumscribed. the brain and its membranes frequently present diseased appearances in those who die from secondary inflammation; these, for the most part, may be altogether independent of any peculiar effects of the disease; but, in some cases, it appears probable that they are not altogether unconnected with it. in one of the accompanying cases, the _pons varolii_ and _medulla oblongata_ were found of a pink colour, in consequence of congestion, where the system had become contaminated by the absorption of diseased secretion; and, in another, a layer of purulent lymph was found within the cavity of the arachnoid, accompanied by marks of inflammatory action in the fourth, and in one of the lateral ventricles. the serous membranes are peculiarly liable to be attacked by secondary inflammation; and, when affected, suppurate with the greatest readiness. they generally exhibit but a slight degree of vascularity, and sometimes scarcely appear more injected than in their natural condition. in the peritoneal cavity, large quantities of unorganised lymph are frequently poured out, mixed with turbid serum or pus. the synovial membranes of joints, when affected, appear to run directly into suppuration, and will become distended with pus in a very short space of time. the pleura, on the other hand, will seldom suppurate at first; but lymph will be deposited upon its surface, and its cavity will contain turbid serum, occasionally mixed with blood. xi. in the first sections, the changes produced in the blood, both in and out of the body, by the admixture of purulent or diseased secretions, were considered; and, in the last section, the post-mortem appearances observed in the different organs of those who have died in consequence of secondary inflammations, have been described. it now remains to connect these two series of observations, and to trace the relation that they bear to each other. the most direct way in which diseased blood produces disease in the parts to which it is conveyed, is by communicating to them its own condition. even foreign substances, which have no natural connexion with the body, may, in this way, be conveyed in the blood, and deposited in the organs of the body. hunter relates a case,[ ] in which a house-painter, who had been paralytic in his hands and legs for a considerable time, had his thigh broken, and died, about three weeks after, of the accident: "on examining the body, after death, the muscles, particularly those of the arms, had lost their natural colour; but, instead of being ligamentous and semitransparent, as happens in common paralysis, they were opaque, resembling exactly in appearance parts steeped in a solution of goulard's extract. from this case it appears, that the lead had been evidently carried along with the blood into the muscles themselves. the blood can thus receive and retain extraneous matter capable of destroying the solids." [ ] op. cit. p. . if foreign matter may, in this way, be conveyed to different parts of the frame, and there produce its chemical effects, it will readily be admitted, that a mechanical or vital action commenced in the blood,[ ] may be continued in it when moved to a different part of the body. [ ] it may appear unusual to speak of action going on in the blood; but, in so doing, we only illustrate the principle with which we commenced, viz., that "the blood has the power of action within itself." in those who die of secondary inflammations, the result of such actions may frequently be traced from the seat of the primary injury even to the heart itself; and, as it has already been shown that contaminated blood will communicate morbid action to the vessels in which it is contained (section iii), there no longer remains any difficulty in accounting for the sudden way in which this disease may fall upon a particular organ, or the unexpected manner in which the symptoms may shift from one part of the body to another. the conditions of the blood, which may be observed upon dissection, in this disease, so far as they tend to illustrate the present subject, may be included in two general expressions: st, those in which the blood has had a preternatural tendency to coagulate impressed upon it; and, nd, those in which its coagulating power has, to a greater or less extent, been impaired. in one case, the blood is generally found of a dark colour, with firm, and sometimes adherent coagula in the vessels; in the other, it is thin and fluid. when a preternatural tendency to coagulate has been impressed upon the blood, it will lodge in different parts of the vascular system, in situations which are most favourable to such an action; when, on the contrary, it has lost its coagulating power, extensive effusions may be expected, or the symptoms included under the term "gangrenous diathesis" may manifest themselves. as the aggregate diameter of the vessels in the body decreases, the blood in them flows with greater rapidity and force; and when near the heart, it is placed in circumstances unfavourable to coagulation, in consequence of the rapid motion there communicated to it; and we accordingly find that, although adherent coagula may be formed in the veins leading from the seat of injury, and may be traced thence through other larger vessels, they will usually terminate abruptly, when these open into the vena cava. but when the blood arrives in the cavities of the heart, the tendency to coagulate may again manifest itself. diseased coagula, presenting a "mottled appearance, partly brown, and partly of a dirty yellow colour", or "dark coloured, and partly composed of a yellowish grey opaque substance", or "with portions inelastic, and of an opaque yellow colour", will be found entangled among the projecting fibres of the auricles and ventricles. in the arteries, the blood is in the most unfavourable circumstances for coagulation during life, in consequence of the comparative smallness of their diameters, and the succession of impulses communicated to their contents; but even here, diseased and adherent coagula may be found in cases of secondary inflammations. m. cruveilhier[ ] relates an instance in which, after child-birth, the pulmonary artery was found filled with coagula following its divisions. the principal clot had lost its colour, and was _adherent_ to the sides of the vessel, and contained in its centre puriform fluid. [ ] op. cit. p. . in another case, following the operation for necrosis, the following post-mortem appearances were observed. the left lung presented, in several places, patches of red hepatization, perfectly defined, and resembling so many spots of lobular inflammation. when cut into, these patches presented several puncta of puriform fluid. the _veins_ of the lung contained fibrinous-looking coagula blocking up their cavities; and in the centre of these coagula was a whitish purulent looking fluid. the diseased condition of the blood may thus be traced visibly from the original wound, through the larger vessels, to the heart, and again from the heart to the capillary system. the disposition to coagulate, once impressed upon the blood, is not destroyed by that fluid being conveyed to a different part of the body: the action may be retarded by motion in, as well as out of the body, but will nevertheless occur when it is placed under more favourable circumstances. these circumstances, in the living vessels, are when the blood becomes separated into small quantities, and when it moves slowly along the capillaries. the blood will then coagulate in circumscribed patches,[ ] as illustrated in the first characteristic marks of secondary disease which have already been mentioned as occurring in the lungs, the liver, the spleen, and the skin. the accompanying plate is taken from the lung of a donkey in which purulent fluid had been made to circulate with the blood. the stagnation of the blood, when the pus was first introduced, was mechanically prevented, and the livid spots produced by its subsequent coagulation in the capillaries of the lungs has been very faithfully represented. (see experiment no. vi.) [ ] the term ecchymosis does not appear appropriate to the discoloured condition of parts observed in the commencement of this disease; the blood is not at first extravasated from the vessels, but coagulated in them. "besides the disposition for coagulation," observes mr. hunter, "the blood has, under certain circumstances, a disposition for the separation of the red globules, and probably of all its parts; for i have reason to believe, that a disposition for a separation of the red part and coagulation, are not the same thing, but arise from two different principles. this is always observable in bleeding; for if we tie up an arm and do not bleed immediately, the first blood that flows from the orifice, or that which has stagnated for some time in the veins, will soonest separate into its three constituent parts: this circumstance exposes more of the coagulating lymph at the top, which is supposed by the ignorant to indicate more inflammation, while the next quantity taken suspends its red parts in the lymph, and gives the idea that the first small quantity had been of such service at the time of its flowing, as to have altered for the better the whole mass of blood. best, therefore, maybe regarded as one of the immediate causes of the separation." _hunter_, p. . this disposition of the blood to separate into its constituent parts is evinced in a very marked degree in one class of secondary affections. extensive effusions of serum, lymph, and pus, mixed in different proportions, will take place in the serous cavities of the body, and become infiltrated in the cellular membrane, accompanied with very slight indications of inflammatory action. the colouring matter of the blood will also sometimes become effused with its other parts; but when this is the case, the blood will be found to have lost its coagulating power: in this respect presenting a direct contrast to the effusion from a healthy wounded vessel. the lymph deposited will be found lying in unorganized flakes, wanting its usual adhesive properties, and very slightly attached to parts, presenting little or no increased vascularity. the rapid manner in which these depositions take place, shows that they are separated from the blood without undergoing any very elaborate process. in this condition of the system, any organ upon which the disease falls, may rapidly become disorganized, or may readily mortify; and, after death, a tendency to rapid decomposition will be manifested. the veins on the surface of the body may frequently be traced as dark blue lines, as though the skin covering them were stained by the colouring matter of the blood. the lungs and other organs may, under these circumstances, be found in every grade of disorganization, till they present all the characteristics of gangrene: even the peculiar fetor which accompanies mortification of the lung, will, in some instances, be present. a tendency to the formation of petechial spots may also be observed in different parts; and even the organs which do not appear to have been the peculiar seat of the disease, will be found to have lost their consistency, and to break down upon comparatively slight pressure. mr. hunter found, that in proportion as the blood retained the power of coagulation, it had the power of resisting putrefaction; and conversely, we observe that, in this class of cases, the deficiency of the former is accompanied in a marked manner by the absence of the latter. the two conditions of the blood which have now been mentioned, appear to bear a direct relation to the two classes of post-mortem appearances, observed in cases of secondary inflammations: the first being generally connected with congestion of different organs during the first stages of the disease, the second with extensive effusions, accompanied with comparatively little vascularity. xii. the treatment of secondary inflammations naturally divides itself into local and constitutional, both as regards the primary lesion and the subsequent affections. the circumstances which interfere with union by the first intention in veins, have been shown to be the same as those which precede the formation of purulent deposits, in a large class of cases. whatever then tends to favour the healthy reparation of a wounded vein, may be regarded as affording security against any subsequent disease; and the chief point in the local treatment is, perhaps, to prevent any accidental circumstances from interfering with the natural process of repair. when the powers of the constitution are enfeebled, even the natural motions of a part may interfere with recovery, and rest sometimes becomes an important object in the treatment. how necessary this is after child-birth, when the divided veins are being closed, every one who has attended such cases practically knows. again, after bleeding, the arm will inflame in a much greater proportion of cases, when the patient is obliged to follow his usual occupation, or when, from accidental circumstances (as from the pain experienced in case i), the arms are kept in motion. it has occurred to me, to see the symptoms of purulent deposits set in, on the day following prolonged attempts to bring fractured portions of bone into position. in all such cases, any external violence (as in experiment no. vi), or even the motion of the body, as in dr. davis's case (section iv) may loosen the coagula formed, either between the wounded edges, or in the cavities of veins. in the treatment of the local injury, a valuable hint has been left us by mr. hunter, connected directly with the consideration of the pathology of the disease. "the way in which sore arms after bleeding come on, shows plainly that they arise from the wound not healing by the first intention"; and he recommends that the two sides of the vein should be approximated by a compress, until union of the divided edges has taken place. it has been shown upon very high authority, that the sides of a vein do not unite after venesection (as has sometimes been presumed to be mr. hunter's opinion); but that the divided edges only of the vessel are agglutinated by the coagulum, which "serves as a bed to the new membrane." but the case is different, should this first attempt at union fail; the sides of the vessel may then become united, and its cavity for a time obstructed (section iv). the approximation of the sides of the veins would materially facilitate this action, which is the natural security, under the circumstances, against the admission of foreign matter. when an abscess is suspected to have formed in a vein, a similar mode of treatment is recommended by hunter; the compress, in this case, being placed between the inflamed part and the centre of the circulation. in the pathological museum of the college of surgeons, one of mr. hunter's preparations (no. ) exhibits such a case, where, from the imperfect union of a vein, the contents of the abscess had become mixed with the blood. as the process of reparation has been variously described by authors, so the different theories propounded have led to different kinds of treatment. at the veterinary college, even within the last few years, it was publicly taught, that a coagulum in a vein was a foreign substance, and ought to be removed; and the jugular vein in horses which had been bled, was sometimes slit up for several inches, in order to remove the coagula which formed in successive portions of its course. that a coagulum in a vein may be an irritating substance has been fully proved (sections i and ii); but the irritation depends upon the accidental admixture of foreign matter: and the inflammation of the veins, produced by the contact of impure blood, requires to be carefully distinguished from the natural mode of union by the first intention. to remove coagula which have formed round purulent secretion (if such could be recognised), might be to remove a cause of irritation; but to remove them in ordinary cases, is to remove the very means prepared by nature for the restoration and safety of the part. in operations involving large vessels, the local conditions which may influence the actions in the veins, appear not to have been fully determined; for while some surgeons regard the tying or cutting of a vein as a serious operation, others are in the habit of doing it without any unusual precaution. in operations upon hæmorrhoidal tumours, the veins involved are of some size, and in two of the instances recorded in the appendix, a ligature applied to them was followed by purulent deposits. in the usual mode of passing a needle armed with a double ligature through the base of such a tumour, the hæmorrhoidal veins are necessarily sometimes wounded, and there is danger that, in tying the ligatures, the sides of a wounded vein may be drawn asunder. the vessel may thus be held open, and be in a similar condition to the vessels contained in bony structures. a safe way of performing this operation, when admissible, is to destroy a portion of the mucous membrane with strong nitric acid. the blood in the vessels then becomes charred, and their cavities obstructed, till they are permanently closed by adhesive inflammation. every means of treating a local injury which tends to produce healthy union or adhesion, may be considered in some sort as a preventive mode of treatment. position, topical applications, bandages, and temperature, may all have their influence in producing these healthy actions; but, as the wounds which precede purulent deposits are generally characterized by feeble powers, those conditions which tend to invigorate the parts are principally indicated. "when action is greater than strength, whatever has the tendency to raise the power above irritability should be used: the object of this practice consists in bringing the strength of the constitution and parts as near upon a par with the action as possible, by which means, a kindly resolution, or suppuration may take place, according as the parts are capable of acting." the irritability of a wound frequently appears nothing else than a series of attempts to bring about an action, which it has not the power to accomplish: as soon as that is fulfilled, which the necessity of the parts demands for their healthy condition, irritation will cease. in such cases, everything that will confer strength to carry out the intended action, will prevent inflammation. but no local applications will be sufficient to produce this effect, unless the powers of the constitution are supported at the same time. a heavy man received a wound in the back of his head from an iron spike; he was kept very low, complaining occasionally of want of food. repeated hæmorrhage took place at intervals of a day or two, which no local applications could suppress, and he ultimately died from loss of blood. the wound was found to extend through the bone into the lateral sinus, which contained only some fluid blood. no inflammatory action had taken place within the skull, nor had any attempt apparently been made to close the wounded vessel. any vitiated secretion in contact with the lacerated edges of the vessel would, in such a case, have free access to the circulation. the constitutional treatment of cases, liable to be succeeded by purulent deposits, is most important; for during the healing of the primary wound, the system may be influenced by remedies, which may be subsequently quite useless. it is evident, observes m. cruveilhier,[ ] that the treatment of phlebitis ought to be concentrated on the first period of the disease, viz., that of the coagulation of the blood; for as soon as pus has become mixed with the circulating blood, medicine is generally of no avail. when there are indications of the extension of inflammation along a vein, the mode of treatment usually adopted in this country has been the administration of calomel and opium; and, in france, general bleeding, but especially the application of large numbers of leeches. "we may subdue inflammation of veins, whatever their situation, by general blood-letting, and especially by local bleeding, repeated sufficiently often and in sufficient quantities!"[ ] it is true that patients recover after such treatment; but the published records of cases not unfrequently terminate with such a description as the following: "the patient was repeatedly bled, and with apparent relief every time, the blood being extremely sizy. _two days, however, previous to death, the vital principle was so exhausted as to need the use of cordials!!_" [ ] op. cit. p. . [ ] op. cit. p. . if the explanation of the mode of adhesion in veins already given be correct, neither the propriety of bleeding, nor of the administration of mercury, as a rule, derives much support from a consideration of the pathology of the disease. careful comparative experience is still wanting, before we can form a satisfactory judgment of the value of these remedies. the theoretical views upon which they have been adopted, are confirmed neither by the statistical records of cases, nor by the principles of sound physiology. the numerical evidence which we have in some instances, even tends to indicate an opposite plan of treatment. at a period when puerperal fever was rife, forty cases, attacked with some form of the disease, "were treated without any bleeding or leeching, or without any attempt to induce the constitutional effects of mercury; and of these, only two died."[ ] "in irritable habits, when the inflammation becomes more diffused," says mr. hunter, "bleeding should be performed with great caution: even a quick, hard pulse, and sizy blood, are not always to be depended upon as sure indications of bleeding being the proper method of the resolution of the inflammation; more must be taken into the account. the kind of blood is of great consequence to be known; for although it should prove sizy, yet if it lies squat in the basin, and is not firm in texture, and if the symptoms at the same time are very violent, bleeding must be performed very sparingly, if at all; for i suspect, that under such a state of blood, if the symptoms continue, bleeding is not the proper mode of treatment. if we had medicines which, when given internally, could be taken into the constitution, and were endowed with a power of making the vessels contract, such, i apprehend, would be proper medicines. bark has certainly this property, and is of singular service, i believe, in every inflammation attended with weakness; and therefore, i conceive, should be oftener given than is commonly done." [ ] ferguson (dr.) on the diseases of women. these cases formed one-fifth of the whole number treated. in bleeding women suffering from puerperal fever during an epidemic, in which the disease frequently terminated in purulent deposits, i have occasionally seen an irregular transparent bluish layer form upon the surface of the blood, almost immediately after the operation; in consequence of this, a repetition of the bleeding was sometimes had recourse to, when the subsequent stages of the disease appeared to indicate that it had not been required. the transparent layer of lymph on the surface of the blood, may, in such instances, be only an indication of its tendency to separate into its different parts, as previously described. large bleedings, under such circumstances, inasmuch as they tend to diminish the already enfeebled power of coagulation in the blood, may predispose to the infection of the system, and to the formation of purulent deposits. the influence of mercury upon the system, as illustrated in case xxvi, may have the same tendency. the action of mercury, so far as it can be traced upon the surface of the body, is certainly unfavourable both to union by the first intention, and to adhesive inflammation; and, inasmuch as the safety of the patient, after an injury or wound, depends upon the due performance of these processes, its effect upon the system must be regarded as of, at least, doubtful advantage. when salivation has been induced, serum is poured out, and the texture of the gums is loosened and rendered spongy. when lymph is effused upon the iris, the action of mercury loosens its adhesions, and dissolves its connexions; it cannot, therefore, be supposed that its effect upon the system should render the union of divided vessels stronger, or the newly-formed adhesions in wounds, firmer. the cases in which purulent deposits usually form, indicate a debilitated state of constitution. they are of much more frequent occurrence in large towns than in the country, and in hospital than in private practice. the depressing influences which give rise to erysipelas, or puerperal fever, will also predispose to the formation of these abscesses; and as scanty diet, loss of blood, debilitating surgical operations, and over-crowded rooms, have been found among the causes of the former, so may they be looked upon as favouring the production of the latter. the treatment of inflammation of the veins, in which purulent deposits frequently originate, is thus spoken of, after matured observation: "all the experience that i have had on the subject, would lead me to believe that, like erysipelas, it has its origin in a low asthenic state of the system, and that those persons are especially liable to it, who have been much lowered by hæmorrhage at the time of an operation, or by too scanty a diet afterwards. an operation is a shock upon the system, making a great demand upon the vital powers. the effects of this shock are often much aggravated by loss of blood, and a very scanty diet actually makes the patient more liable to some kinds of inflammation. our mode of practice ought to be rather to sustain his powers by allowing him wholesome nourishment, and not to add to the influence of the other depressing causes, the still worse one of starvation."[ ] [ ] brodie (sir b. c.) medical gazette, vol. xxxvii, p. . the lowering influence of mercury may be considered in a similar way. there can be little doubt that while, on the one hand, it favours the absorption of vitiated fluids, it may, on the other, render the system less able to resist the injurious consequences which they produce. as many circumstances, besides mere debility, tend to depress the vital powers, so tonic medicines, and a generous diet, must not be looked upon as the only preventive modes of treatment. each case that occurs in practice may present some peculiarity; in one case, the patient will be found to have previously suffered from diabetes; in another, from disease of the spleen; and in a third, from organic disease of the kidney; and, in each of these, a peculiar mode of treatment may be required. the general management of this disease, after the formation of purulent deposits has commenced, is probably as little satisfactory as any that come under the notice of the surgeon. the whole character of the affection is characterized by what has been aptly designated as action without power. the excitement of the system will imitate all the acts of genuine inflammation, without any of its healthy results; and loss of energy will appear immediately after, or even arise in conjunction with, the first symptoms of increased action. in the treatment of such cases, it must be borne in mind, that the secondary inflammations are not the disease, but the effect of a concealed cause, which may develope itself in any part of the system; and that, while the relief of one organ is sought by depletion or mercurial remedies, additional vigour may be given to the latent evil, so as to render it more ready to develope itself in some other part. when purulent deposits occur, the sudden congestions, which indicate their commencement, are not accompanied by any reparative actions, and the lymph, which is effused in the second stage of their formation, is not so disposed as to circumscribe and limit the inflammation; there is, therefore, no natural process by means of which such collections of fluid can be evacuated; hence, when situated near the surface, they should be opened as soon as they are detected. it will sometimes happen, that, after the symptoms of secondary inflammation of internal organs have commenced, an abscess will present itself near the surface of the body, and relief will be afforded to the part first affected; at other times, an obstinate and violent diarrhoea will precede recovery. although the mode of treatment adopted may have little influence either in bringing on, or checking, such salutary actions, it is important to watch their occurrence, and perhaps still more important, to be careful not to mistake a remedial action for a symptom of the disease. "what treatment," says cruveilhier, "shall we oppose to purulent infection? to this question experience is as yet dumb, while theory would seem to point to diffusible stimuli and tonics; to ammonia, quinine, and sudorifics; to hot external applications, to the vapour baths, to purgatives, and especially to emetics; to tartarized antimony, in large doses; to vesicatories, and to strong diuretics. calomel has been extensively employed, to create a fluxion from the intestinal mucous membrane; but all these means have failed as signally in my hands as in those of others; yet, when the injection of putrid matters into the veins of living animals has been followed by abundant and very fetid evacuations, they have usually got well. it is a fundamental fact of pathology, that the intestinal canal is chiefly affected in diseases caused by miasmata. i am certain that diseases resulting from purulent infection would not be stamped with the seal of incurability, and that nature, seconded by art, would triumph in the majority of cases, if the pus, which is incessantly renewed, did not incessantly renew the sources of infection. as soon as constitutional symptoms manifest themselves, neither general nor local bleeding affords any advantage. a portion of the _materies morbi_ is, no doubt, abstracted with the blood; but, as it is constantly being reproduced, the constitution is only deprived of the power it would otherwise have of resisting the disease."[ ] in accordance with this remark, m. gaspard found that animals, which recovered after the injection of a certain quantity of pus into their veins, often died when the experiment was repeated. the recovery was usually preceded by black, liquid, and extremely fetid evacuations, which often seemed to afford immediate relief. when such evacuations have taken place in other diseases, the gall-bladder has been found distended with black bile;[ ] and it appears probable that the liver, in these cases, is one of the principal organs through which the cleansing of the system is attempted. if the supply of morbid matter to the system could be checked, mercurial action, in this stage of the disease, might be of service, by enabling the liver, or other organs, to throw off their vitiated secretions. when patients recover from purulent deposits (cases iii and xxvii), they are often left in a debilitated and languid state, in which ordinary tonics exercise little influence. the consequences of the disease appear to hang about the system, long after the cause which gave rise to it has ceased. the pulse will sometimes continue irritable, and there will be a tendency to derangement of the secretions of the skin, bowels, and other organs, accompanied by occasional slight attacks of fever. in this condition, an alterative course of mercury, combined with sarsaparilla, has been found beneficial. these remedies, by stimulating the activity of the excreting organs, may assist the constitution in throwing off the disease; and their mode of action may be the same as in other cases, where the system has been infected by an animal poison. [ ] op. cit. p. . [ ] i have observed this condition after injuries of the spine which proved fatal, by causing inflammation of other parts. appendix of cases. a. cases of secondary inflammation, accompanied by mortification of the skin. case i. william ford, , an apparently healthy man, was seized with the symptom of strangulated hernia, at harrow, december th. he was bled in both arms; but, as the hernia remained unreduced, he was sent to town, in a state of considerable restlessness and suffering. during his journey, the hernia returned of its own accord. he left quite relieved, and remained well till the st, when he had a rigor. on the st of february, there was a considerable degree of febrile excitement, and the anterior part of the left arm was red, swollen, and painful upon pressure. the tenderness and pain soon extended up the arm, in the course of the cephalic vein: the redness assumed the character of erysipelas. on the rd, he suffered from sickness, the matter vomited being green and acid. he had two severe rigors, followed by great heat of skin, and a quick full pulse. the orifice in the left arm discharged a thin serous fluid. on the th, he complained of stiffness in the right arm; also of being very feeble and faint. th. wandered much during the night. the right arm was a good deal swollen about the end of the elbow-joint, and presented a patch of a bright red colour above the condyle. the pulse was weak and tremulous; motions of the hands were occasionally observed. he complained of pain in the ring-finger of the right hand, and in the ball of the right great toe. the skin, in both these situations, had assumed a red appearance. th. was delirious during the greater part of the night; countenance expressive of much anxiety; pulse very weak; tongue covered by a brown dry fur; profuse perspiration; complained of severe pain in the calves of his legs. he died during the following night. _post-mortem appearances._ a small deposit of thick pus was found on the external surface of the left cephalic vein. the blood was coagulated in its cavity, its coats were thickened, and its lining membrane appeared very red. this redness could be traced, though in a less degree, through the whole extent of the vena innominata. on the right side, the cellular tissue, both above and below the elbow-joint, was greatly distended with serum. the cephalic vein of the right arm presented marks of having been inflamed; but not nearly to the same extent as upon the opposite side. the joints in which pain had been experienced during life, were distended with turbid pus; deposits of pus were also found in the anterior mediastinum, and between the oesophagus and trachea. a large gangrenous spot was observed in the skin of the calf of the right leg. the subjacent cellular tissue was much distended with serum. case ii. richard mason had a small cancerous tumour removed from the lower lip. the operation was performed in the usual way, and the wound appeared to heal by the first intention; a small abscess, however, followed by some ulceration, subsequently appeared in the neighbourhood of the cicatrix. nine days after the operation, he complained of sore throat and general uneasiness, and three days afterwards he was seized with rigors, followed by cold perspiration and coma. _post-mortem appearances._ a small deposit of matter was found, situated beneath the fascia of the left thigh. the synovial membrane of the left knee was highly inflamed, and contained a large quantity of pus. on the right side, the skin of the whole inferior extremity presented a dark livid appearance, with the exception of that situated upon the fore part of the thigh. the same dark colour was observed in the muscles of the limb, which were infiltrated with blood and serum. the arteries and veins were discoloured, but in other respects presented nothing remarkable. it was ascertained, that, two years previously, this patient had suffered from diabetes; and upon examining the urine found in the bladder, it was found to contain sugar. case iii. jane thornton, æt. , came under treatment on the nd of march. a week previously, her right ancle had become red and painful, and inflammation subsequently extended up the inner side of the leg. when first seen, she was evidently much out of health, although no one organ could be said to be particularly affected. on the th of march, she was attacked with severe rigors, and experienced pains in different parts of her limbs: the rigors were repeated for several days in succession. the inflammation of the leg now entirely disappeared, and she complained of pain in the right knee, which was slightly swollen. on the st, her bowels became much relaxed; there was great general depression, and much nervous agitation. both knees were swollen. the general symptoms now became somewhat relieved; but on the th april, she was attacked with vomiting, which recurred frequently during the day, and was accompanied with great depression, and severe pain in the epigastrium. on the th, the sickness continued, apparently quite uninfluenced by any remedies. she passed considerable quantities of blood by stool: her countenance presented a dusky yellow hue: the pulse was excited, without power, and the sense of depression was greatly increased. on the th, the vomiting still continued, and she still passed blood by stool. some spots of a dark purple colour now made their appearance upon her face. the hands both became slightly swollen; and upon the right one, some small, dark, livid spots, similar to those upon the face, made their appearance. she was much troubled with hiccough. on the th, the countenance was very anxious, the complexion more sallow: some more livid spots appeared upon the face and cheeks. the right hand and arm were swollen and painful: some fresh livid spots appeared, upon the knuckles. complained much of faintness: had extreme debility with occasional hiccough: pulse extremely weak: the surface of the body was covered with cold perspiration. the sickness had entirely ceased, and there was no blood in the motions: the tongue was rather dry in the centre, but tolerably clean. th. she wandered slightly during the night, and vomited once: some blood again appeared in the motions; the right hand and arm were less swollen. th. the countenance was anxious, the pulse about , and intermitting irregularly. the vomiting recurred several times. the livid spots on the right hand had not increased in size, but appeared like distinct small black superficial sloughs of the skin; these all scabbed off, without suppuration. th. the pain and swelling of the arm had nearly subsided. the bowels acted very freely with the aid of medicine, and she expressed herself much relieved. from this time the patient slowly but gradually improved, with one or two slight intermissions, till the beginning of may, when she again complained of pain at the inner part of the right arm, above the elbow. some hardness could here be felt in the course of the basilic vein. some small collections of matter were now deposited upon the back of the right hand, resembling, in some respects, the eruption of confluent small-pox. on may th, she had regained much of her strength, but still felt some pain in the elbow upon motion. she also complained of the joints of one of her fingers. she now left london for change of air. b. _the following table is formed of cases taken consecutively during one year._ --------------------------+-----------------+------------------------- | period | heads of cases. | of secondary | post-mortem | inflammation. | appearances. --------------------------+-----------------+------------------------- case iv. elizth. | a few days after| dark-coloured serum, mackintosh, æt. . | the appearance | mixed with shreds of inflamed bursa patellæ; | of the | recently effused lymph, erysipelatous inflammation| erysipelatous | in the cavity of the in the neighbourhood of | inflammation; | left pleura; large the right axilla; sudden | three days | quantities of suppression of the | before death. | seropurulent fluid, catamenia; rigor; periton-| | with recently effused itis; tongue covered with | | lymph, in the yellowish white coating; | | peritoneal cavity. sickness; "catching pains"| | in the epigastric region. | | | | case v. james stevens, æt.| twenty-seven | bloody fluid in the . punctured wound of the| days after the | cavity of the left finger whilst opening a | injury; about | pleura; pus in the rabbit; diffuse cellular | seven days | left elbow-joint. inflammation of the right | before death. | arm; spasmodic and | | "catching pains", princip-| | ally referred to the | | epigastrium; expectoration| | of bloody fluid. | | | | case vi. william | twenty days | cavity of the knee- collins, æt. . bruise of| after the | joint containing a the patella, caused by the| accident; | quantity of thick wheel of a carriage; | three days | grumous fluid, apparent recovery; erysip-| before his | apparently a mixture elatous redness over the | death. | of blood and synovia; same knee; rigor; rapid | | fibrous degeneration pulse; hot skin, followed | | of a portion of the by perspirations, pains in| | cartilage of the the head, restlessness, | | patella; turbid serum delirium. | | in the sub-arachnoid | | cellular tissue; | | bloody puncta in the | | brain, larger and more | | numerous than natural; | | posterior part of both | | lungs gorged with | | blood. | | case vii. maria martin, | several months | the skin of the upper æt. . caries and necro- | after the | part of the leg and the sis of the tibia, with | occurrence of | whole of the thigh of a large ulcer of the leg. | caries of the | mottled appearance, | tibia; a few | caused by extensive | days before | dark patches of | death. | incipient gangrene; | | the cellular tissue of | | the limb infiltrated | | with lymph and pus. | | case viii. george mason, | nine days after | increased degree of æt. . compound commin- | the injury; | congestion, both in the uted fracture of the meta-| twenty-two | grey and white sub- carpal bones; inflammation| days before | stance of the brain; of the absorbents; erysip-| death. | substance of the pons elatous redness of the | | varolii and of the med- skin; secondary abscess in| | ulla oblongata of a the affected arm; rigidity| | pinkish colour, and of the muscles of the | | presenting irregular tongue; trismus; universal| | streaks of increased affection of the muscles. | | vascularity; spleen | | soft, and somewhat | | congested. | | case ix. sarah leg, æt. | a few days | effusion of serum and . necrosis of a portion | before death. | lymph in the cellular of the tibia, accompanied | | tissue, which surrounds by a large foul ulcer. | | the pharynx and oeso- | | phagus; inflammation | | and ulceration of the | | mucous membrane of the | | larynx; slight inflam- | | mation of the lungs; | | the spleen of a greyish | | red colour, more solid | | and more easily | | lacerated than natural. | | case x. elizabeth moleno, | eight days after| the lining membrane of æt. . strangulated | the operation; | the right internal femoral hernia of the left| four days | saphenic vein of a dark side; operation; erysipe- | before death. | livid colour throughout, latous blush around the | | the cavity of the wound upon the third day, | | vessel filled with a followed by sickness, cold| | large quantity of perspiration, and | | coagulated blood mixed delirium; several dark | | with puriform fluid; patches upon the skin of | | pus in the common iliac the right leg. | | vein; effusion of serum | | around the veins of the | | leg; liver large and | | congested; mottled | | degeneration of both | | kidneys. | | case xi. jane cox, æt. .| a short time | mortification of the scalp wound; erysipelas of| before her | skin of the lower part the head and face; | death. | of the leg, ankle, and transverse fracture of the| | foot; slight extravas- external malleolus, | | ation of blood into the followed by suppuration | | arachnoid cavity, and of the ankle-joint. | | into the substance of | | the brain; kidneys | | coarse in structure, and | | remarkably soft. | | case xii. bartholomew | five days after | mortification of the sullivan, æt. . lacerat-| the accident; | skin and cellular tissue ed and contused wound of | eight days | of the right leg; the the leg, followed by | before his | veins of the limb diffuse cellular inflamma-| death. | healthy; spleen of a tion, and inflammation of | | pale colour, and very the absorbents; delirium; | | soft. a separate large patch of | | mortification, surrounded | | by bright red congestion, | | appeared in the right | | groin the day before | | his death. | | | | case xiii. george foscutt,| six days after | hepatization of both æt. . fracture of the | the accident; | lungs, with secondary femur into the knee-joint;| twenty-two | abscesses in the left rigors; erysipelas of the | days before his | one; kidneys soft and limb, ill defined and very| death; pain | coarse in texture, the slow in its progress; | in the chest | left presenting a small coma; abscesses in the | the day before | deposit of apparently leg and thigh; mortificat-| his death. | tubercular matter; ion of the skin on the | | spleen large, pale, and dorsum of the foot, and | | soft. over the left hip. | | | | case xiv. william wright, | erysipelas | effusion of lymph in the æt. . fracture of the | appeared a month| pleura; secondary patella; erratic | after the | abscesses in different erysipelas; diarrhoea; | fracture of the | stages of formation in abscesses in the leg, and | patella, and | both lungs, and deposit in the knee-joint. | about the same | of lymph in one kidney. | time before his | | death. | | | case xv. henry bateman, | three months | recent effusion of lymph æt. . fracture of the | after the | upon the pleura; fibula; diffuse cellular | accident; three | incipient secondary inflammation of the leg; | weeks before his| abscess in both lungs; suppuration in the knee- | death. | the tibia exposed, and joint; necrosis of a | | its structure of a black portion of the fibula. | | colour, and soft. | | case xvi. john clark, æt. | nineteen days | effusion of lymph . large scalp wound; | after the | between the dura mater rigor; followed by | accident; three | and the bone, and of pus paralysis of one side; a | before death. | and lymph in the cavity portion of bone exposed, | | of the arachnoid; pus, of a darkish green colour,| | mixed with blood, in the and when removed of a | | superior longitudinal putrid odour. | | sinus; deposit of lymph | | in the structure of the | | pia mater; recently | | effused lymph in the | | cavity of the left | | pleura; secondary | | abscesses of the left | | lung. | | case xvii. matthew elmes, | the tenth day | secondary abscesses, in æt. . injury of the | after his | various stages of wrist; diffuse cellular | admission into | formation, in both lungs; inflammation; abscesses in| the hospital; | suppuration between the the cellular tissue, and | four days before| different bones of the in the wrist-joint; lower | his death. | carpus; both kidneys extremity of the radius | | large, coarse in texture, denuded; pains in various | | and flabby; the spleen parts of the body, | | soft, easily lacerated, especially the head and | | and of a pale colour. abdomen. | | | | case xviii. mary hopkins, | erysipelas | low inflammation of a æt. . ulceration of the | appeared a week | portion of the left cartilages, followed by | after | lung; dark-coloured suppuration of the knee- | amputation; | patches of deposit in joint; amputation; | sixteen days | the spleen. erratic erysipelas over | before death. | various parts. | | | | case xix. john wilkinson, | pain in the | turbid serum in the æt. . compound fracture | right side a | right pleural cavity; of the right tibia; | week after his | incipient secondary inflammation around the | admission. | abscesses in both lungs; wound, with collections | | large cysts in the of matter; slight | | delirium; sickness. | | | | case xx. james bryant, æt.| twenty-four days| bone exposed to the . scalp wound, denuding | after the | extent of a shilling, of the bone; puffiness of the | accident; five | a yellow colour, and scalp upon the eighteenth | days before | with a very dark diploë; day; rigors, followed by | death. | effusion of lymph and profuse perspirations; | | pus between the dura restlessness; delirium; | | mater and the bone, projection of the | | extending to the base of eyeballs. | | the skull, and through | | the sphenoidal fissures | | into the orbits; effus- | | ion of pus into the | | arachnoid cavity; incip- | | ient secondary abscesses | | in the lower lobe of the | | left lung; spleen large, | | and very soft, mottled; | | degeneration of both | | kidneys. | | case xxi. james williams, | ten weeks | large cavity containing æt. . fracture of the | after the | foul matter, in contact lower extremity of the | accident; | with the sacrum, which left radius; diffuse | one week | was exposed; abscesses cellular inflammation of | before death. | between the bones of the the arm at the expiration | | left wrist and hand; of four weeks; abscesses | | spleen soft, congested, in the limb, one of which | | and grumous. communicated with the | | fracture; diarrhoea; | | vomiting; tongue dry | | and brown. | | | | case xxii. john munday, | the eighth day | the mucous membrane of æt. . prolapsus ani; | after the | the whole of the large hæmorrhoids; operation; | operation for | intestine of a very dark rigor; anxiety of | hæmorrhoids; | colour; congested patches countenance; great heat | the fourth | of it thrown up into of skin; pulse . | before death. | prominent folds; recently | | effused lymph upon the | | right pleura; secondary | | abscessesin both lungs. | | case xxiii. esther polley,| the tenth day | a double fracture of the æt. . lacerated wound of| after the | fifth metatarsal bone; the foot; separation of a | accident; | inflammation of the small portion of the base | the third | right pleura; secondary of one of the metatarsal | before death. | abscesses in right lung. bones; pain in chest; | | rapid pulse; depression, | | with delirium. | | | | case xxiv. henry lacy, æt.| the eighteenth | yellow matter in the . scalp wound, exposing | day after the | diploë of the parietal the bone; fracture of the | accident; and a | bones, in the neighbour- skull; signs of nausea; | week before | hood of the part where pains in the head; | death. | the trephine had been "soreness of the stomach";| | applied; effusion of drowsiness and | | lymph upon the surface insensibility; paralysis | | of the dura mater; pus of one side; muscular | | and lymph in the poster- twitchings; portions of | | ior half only of the bone removed by the | | longitudinal sinus; trephine, near the top of | | effusion of pus in the the head. | | cavity of the arachnoid; | | some bloody serum in | | both pleural cavities; | | incipient secondary | | abscesses in the liver. | | case xxv. thomas meed, æt.| | vessels on the surface . injury of the leg; | | of the brain congested; small suppurating sinus | | lateral ventricles upon the outside of the | | distended with fluid; a limb; erysipelas; | | thick layer of purulent diarrhoea; coma. | | lymph upon the arachnoid | | membrane at the base of | | the brain; some slight | | spots of ecchymosis on | | the anterior surface of | | both lungs. | | case xxvi. thomas daffey, | the tenth day | incipient secondary æt. . hæmorrhoids; | after the | abscesses in the right operations; rigors; | operation; | lung; liver studded, sickness; great abdominal | and ninth | throughout its whole pain; diarrhoea; hiccough.| before death. | extent, by secondary this patient had been | | abscesses; mucous salivated previous to the | | membrane of the rectum operation for the | | of a dark greenish hæmorrhoids. | | colour; effusion of pus | | and lymph into the | | hæmorrhoidal and inferior | | mesenteric veins; cavity | | of the left knee-joint | | distended with pus; | | spleen soft, pultaceous, | | and thickly-studded with | | dark-coloured blotches. | | --------------------------+-----------------+------------------------- c. case xxvii. george burton, æt. , a stout navigator, was first seen september th, . he had an enormous slough of the skin and cellular membrane, covering the lower part of the abdomen on the right side. he gave a most imperfect history of himself, and seemed frequently incapable of comprehending the questions which were put to him. the skin was hot and dry, the pulse . for several days, he remained in the same apathetic condition. the bowels were particularly obstinate, and the purgative medicines which were administered produced no effect whatever. when the slough separated, the surface of the external oblique muscle was left as clean as if recently dissected. the skin was undermined for some extent, and no attempt was apparently being made to limit the progress of the disease, by the effusion of lymph. fresh portions of cellular tissue consequently became affected, and the whole surface ultimately exposed was full six inches in diameter. _sept._ th. complained of some pain in the chest and upper part of the abdomen; has a constant short cough; perspires very freely. th. the pulse has become weaker, but remains of the same frequency ( ). it communicates a peculiar jerking sensation to the finger. th. pulse , weaker; slight diarrhoea; he vomited several times during the day. th. restless, with delirium. th. passed another restless night, but became better in the course of the day; his appetite returned. _oct._ th. his appetite again failed; complained of a sense of distension in the abdomen. th. an abscess was discovered at the lower and back part of the right leg; the skin over this presented various shades of yellow and brown, giving the appearance of having been extensively bruised. about two ounces of discoloured pus were evacuated, together with a considerable quantity of grumous blood. th. has much improved since the last report; the wound discharges dark semi-coagulated blood. th. a second abscess now presented itself in the same leg, and the skin covering it assumed the same discoloured appearance as in the first instance. when opened, it discharged dark-coloured semi-coagulated blood with the matter. he now rapidly improved in health, and at length perfectly recovered. case xxviii. samuel todd, æt. , fell from a wagon fifteen miles from town, and was brought up in an open cart, during a sharp frost. there was a compound fracture of the left leg. two days afterwards, he suffered from cellular inflammation around the wound. on the th day, he had a slight rigor, and complained of slight stiffness in the right shoulder. he ate and drank well till within two days of his death, which took place on the thirty-fourth day. _post-mortem appearances._ both lungs contained secondary abscesses, in various stages of formation. the left external iliac and common femoral veins were blocked up with firm coagula, and confined by these was a quantity of purulent-looking fluid; an adherent layer could, for some distance, be peeled off the internal surface of these vessels. case xxix. james howard, æt. , had a small abscess in the dorsum of the right foot, which was followed by inflammation of the absorbents; abscesses subsequently formed in the right thigh and groin. two months after the first appearance of the abscess on his foot, he was seized with rigors, vomiting, and profuse perspiration. he complained also of pain in the lower part of the left lung, and it was said that the respiratory murmur was deficient in this situation. he died on the rd day from the appearance of the symptoms of the secondary affection. post-mortem appearances. the skin and conjunctivæ were of a light yellow colour; there were incisions in the right groin. in the cavity of the right pleura, were some patches of recently effused lymph, of a yellowish colour. in the lower lobe of the right lung, were several patches of secondary deposit; these were found in different stages of their formation, and some of them were of considerable size; some of the pulmonary veins, in the neighbourhood of those which had suppurated, were found to contain a fluid resembling pus. on the left side was a small abscess, under the pleura costalis. the liver was healthy in structure, rather larger than usual. kidneys healthy. the veins in the groin presented a healthy appearance. case xxx. a gentleman was operated upon for hæmorrhoidal tumours in the usual manner, and died shortly afterwards, with effusion of bloody serum into one of the pleural cavities. the only peculiarity that could be detected in the appearance of the rectum was, that the blood was still fluid in one of the largest veins. this vein led directly to an ulcer produced by the operation; and, even at its extremity, it contained no appearance of coagulum. d. cases in which vitiated fluids were observed in the veins of the uterus after child-birth. case xxxi.[ ] on the second day after a natural labour, a woman had prolonged rigors, which were followed by abdominal pain and much perspiration. on the fourth day, she was affected with syncope and bilious vomiting, accompanied by extreme prostration. on the fifth day, the abdominal pain, which had subsided, re-appeared with agitation and delirium. on the sixth, she had cold sweats, irregular pulse, rapid breathing, and vomiting. she died on the following morning. _post-mortem appearances._ there was a small quantity of limpid serum in the cavity of the peritoneum. some of the uterine veins were found to contain a turbid fluid. the heart was half filled with brown blood. the lungs were congested, and the other organs natural. case xxxii. a woman, twenty-two years of age, of a nervous temperament, miscarried at the expiration of the first month. she was almost immediately afterwards attacked by rigors and bilious vomiting, accompanied by pains in the loins and in the hypogastrium. on the following day, there was coma, with indications of extreme debility. on the third day, consciousness returned. there was difficult articulation, and moaning. the extremities became cold, the pulse imperceptible, and death occurred upon the same day. [ ] this, and the two following cases, are taken from tonellé. the author is responsible for the accuracy of all the preceding cases. _post-mortem appearances._ the peritoneum was slightly injected, and contained a small quantity of reddish serum. the cervix uteri was covered with a layer of pus. semi-transparent lymph was found in some of the uterine veins. the brain, and other organs, were found healthy. case xxxiii. a feeble girl, years of age, was confined at the expiration of the eighth month. on the fourth day, there was shivering and prolonged fainting. the following morning, she had acute abdominal pain, fever, and diarrhoea. on the seventh day, the symptoms had all subsided, but on the eighth the abdominal pain returned, accompanied by syncope. she died two days afterwards. _post-mortem appearances._ the peritoneum was slightly injected, and contained about a pint of red-coloured serum. the uterus was large, white, and firm, its veins half filled with fluid blood; its lymphatics natural; its inner surface lined with a layer of fetid brown blood, but otherwise healthy; the cervix covered with a grey, thin exudation. the lungs, heart, brain, and other organs, were quite sound. case xxxiv.[ ] anne biggs, æt. , confined march th, , eighth child. on the evening of her confinement, her manner was much excited. on the th, she was incoherent, and complained of pain in the calf of the right leg, which was tender on pressure. the pulse being hard, she was bled to eight ounces. on the th, the leg was swollen and white; the pain in it much increased: towards evening the calf of the limb became black, while, at the tendo-achillis, the skin was hot, tender, dry, and mottled. the bowels were much opened, the head giddy, the pulse quick and strong. she was again bled, to twenty-six ounces, and twelve leeches were applied to the temple. on the st, there was nausea, vomiting, and diarrhoea. on the rd, she complained much of the confusion in her head, the leg was tolerably easy, but the upper and inner part of the thigh was very tender. on the th, the diarrhoea continued, and there was increased weakness. a hard swelling, about half as large as an egg, appeared at the wrist, and one of the orifices made by venesection was black and painful. she died in the evening. [ ] dr. ferguson. _post-mortem appearances._ all the ventricles of the brain were dilated with serum, and there was a good deal of effusion into the arachnoid and pia mater. the viscera were perfectly healthy, except the heart and spleen: the latter was very large, and on pressing it, a large quantity of dirty red pulpy matter exuded. the lining membrane of the right auricle and ventricle, when washed, had a dark red hue. the femoral vein, just at the ingress of the saphæna, and the superficial vein in the back of the leg, had their coats much thickened, so as to cut like arteries. their lining membrane was similar to that of the right cavity of the heart. when they were divided, purulent matter, mixed with thin light-coloured blood, escaped. the cellular tissue forming the sheath of the femoral vessels, and on the calf of the leg, shewed marks of recent inflammation; but there was no appearance of pus in these situations. none of the glands in the groin or ham were enlarged. the inferior vena cava appeared healthy. e. cases of purulent deposits, connected with inflammation of the veins after delivery, recorded by dr. robert lee in the med.-chir. transactions. case xxxv. mrs. mayhew, æt. , was delivered on the nd march . on the th, there was a discharge of blood from the uterus. from the th to the th, she made no complaint of uneasiness in any region of the body, though her strength rapidly declined. the countenance was of a dusky yellow hue. the heat of the surface slightly increased; the respiration hurried, particularly on bodily exertion, and the pulse above , and feeble; the tongue pale and glossy, with loss of appetite. the lochial discharge had a peculiarly offensive smell. she died upon the th of march. _post-mortem appearances._ when the uterus was laid open, there was found to be a portion of the placenta, about the size of a nutmeg, in a putrid state, adhering to its inner surface. the substance of the uterus, to the extent of an inch around this, was of a peculiarly dark colour, almost black, and as soft as a sponge. on cutting into it, about a teaspoonful of purulent matter escaped from the veins, and a small additional quantity was pressed out from them.... on opening the capsular ligament of the right knee-joint, about six ounces of thin purulent matter escaped, and the cartilages of the femur and tibia were extensively eroded. there was no appearance of inflammation, however, on the exterior of the capsular ligament. the right wrist was swollen, and the cellular membrane around it was unusually vascular, and infiltrated with serum. case xxxvi. mrs. pope, æt. , was delivered, on the th of oct., of her fourteenth child, and appeared to recover favourably until the rd of nov., when she was suddenly attacked with a severe rigor. this was followed by intense head-ache, vomiting, general soreness of abdomen, and suppression of lochia. nov. th. great prostration of strength; laborious respiration, with pain at the bottom of the sternum, and frequent hacking cough; pulse , extremely feeble; skin hot and dry.... occasional retching and vomiting. several hard, lumpy cords were found running up in the inside of the thigh, in the direction of the superficial veins. th. delirium; general debility greatly increased; the surface of the body was covered with a yellow suffusion; the middle finger of the left hand was much swollen around the second joint, and the skin covering it was of a dusky red colour. case xxxvii. mrs. edwards, æt. , was suddenly attacked, three weeks after delivery, with pain in the calf of the right leg, and loss of power in the whole right inferior extremity. on the th day from the attack, a considerable swelling, without induration, had taken place from the ham to the foot, and great tenderness was experienced along the inner surface of the thigh to the groin. the extremity became universally swollen, painful, and deprived of all power of motion. the temperature along the inner surface of the limb increased; the integuments were pale and glistening, not pitting upon pressure. the femoral vein, from the groin to the middle of the thigh, was indurated, enlarged, and exquisitely sensible; pulse ; tongue much loaded; thirst; bowels open. on the rd day from the attack, the disease was apparently declining. the femoral vein could no longer be felt, but there was still a sense of tenderness in its course down the thigh, and she experienced considerable uneasiness between the umbilicus and pubes, as well as in the loins. she now, for the first time, began to have rigors, accompanied by a quick pulse, loaded tongue, and thirst. from this period to the st day, the swelling of the limb and tenderness in the course of the femoral vessels subsided, but she experienced attacks of acute pain in the umbilical region, loins, and back, which assumed a regular intermittent form. every afternoon there was a rigor of an hour's duration, followed by increased heat, and profuse perspiration: the skin was hot and dry; pulse ; tongue brown and parched; bowels open. these febrile attacks gradually declined in severity, and she appeared to recover till the rd day, when she had a long and violent fit of cold shivering. the countenance now became expressive of great anxiety, and the pulse extremely weak and feeble. th day. vomiting; pain upon the left side, increased upon taking a deep respiration. th day. another severe and prolonged rigor; skin hot and dry; pulse ; tongue brown and parched; diarrhoea; respiration hurried, with frequent cough; surface of body presenting a peculiar yellow tinge. the conjunctiva of the right eye now suddenly became of a deep red colour, and so much swollen, that the eyelids could not be closed. on the day following, the left eye also became red and swollen, the surface of the body was cold and clammy, pulse , extremely feeble, with great debility, and repeated attacks of vomiting. from this date, the patient lived nearly three weeks, but for the last fortnight the vision in both eyes was entirely destroyed. _post-mortem appearances._ the left pleural cavity contained upwards of two pints of a thin, purulent fluid. the inferior lobe of the left lung was of a dark colour, and soft in texture. in its centre, about an ounce of thick cream-coloured pus was found deposited in its dark and softened texture. this was not contained in any cyst or membrane, but was infiltrated into the pulmonary tissue. the coats of the vena cava inferior were considerably thickened; its whole cavity was occupied by a coagulum, terminating above in a loose pointed extremity. the left common iliac vein was plugged up, by a continuation of the coagulum from the cava. the coagulum was continued beyond the entrance of the internal iliac, which it completely closed, and terminated in a pointed extremity about the middle of the external iliac. neither the remainder of the vessel, nor the femoral vein, exhibited any morbid changes. the right common iliac vein was contracted to more than one-half its natural size; it was firm to the touch, of a greyish blue colour; to its internal coat adhered an adventitious membrane of the same colour, containing within it a firm coagulum. the internal iliac was rendered quite impervious by dense, dark coloured bluish membranes; and, at its entrance into the common iliac, it was converted into a solid cord. the contracted external iliac contained within it a soft yellowish coagulum; its coats were three or four times their natural thickness, and lined with dark-coloured membranous layers. the right femoral vein, from poupart's ligament to the middle of the thigh, was diminished in size, and almost inseparable from the artery. its tunics were thickened, and its interior coated with a dense membrane, surrounding a solid purple coagulum strongly adherent to it. f. case, shewing the period at which a coagulum may give way in a wounded vessel. case xxxviii. george haydon, ætat. , received a wound about half an inch in length over the right radial artery, on march th, . the hæmorrhage was arrested by pressure. on the th, a small slough formed in the bottom of the wound, the edges of which were inflamed and painful. on the th, slight bleeding from the wound occurred, which at first was arrested by the application of cold; but in the evening it recurred in considerable quantity, and again was checked by cold and pressure; during the night, however, profuse hæmorrhage again took place, and was only stopped by the application of the tourniquet above the elbow. on the th, the radial artery was tied; but as this did not prevent the hæmorrhage from returning, when the tourniquet was relaxed, the original wound was enlarged. the opening in the radial artery was now with some difficulty discovered; it extended two-thirds round the circumference of the vessel, leaving one-third undivided. g. cases shewing the organisation of the outer layer of extravasated blood; reported by mr. hewett. case xxxix.[ ] a middle-aged man received a severe injury of the chest; he lived eleven days after the accident, and during this time he never presented a single inflammatory symptom. the cavity of the left pleura was found completely filled with bloody fluid, and was subdivided into two compartments, by a portion of coloured fibrine, presenting a honeycombed appearance, which passed from the ribs to the lung. the lower compartment was itself subdivided into several others, by layers of coloured fibrine intersecting each other. large portions of loosely coagulated blood were found in all the cavities; some of these clots were of a rusty colour, others approached nearer to the natural colour of the blood. the lung was compressed against the spine, and the whole surface of the pleural sac was coated by a false membrane, about two lines in thickness, formed by coagulated fibrine. the fibrine which lined the pleura pulmonalis and pleura diaphragmatica, presented on its inner surface a smooth and polished appearance, and in colour exactly resembled the yellowish fibrine found in the clots of the heart of this patient. so uniform was the coating, and so continuous was it throughout its whole extent, that it looked at first merely like thickened pleura; but this appearance was easily destroyed, by peeling off this adventitious membrane from the serous tissue, which there presented the same appearances as the pleura on the opposite side, with the exception of not being quite so smooth: there was neither thickening nor the slightest increase of vascularity in this pleura. a large rent, from which the hæmorrhage had proceeded, was found in the substance of the lung. [ ] med.-chir. transactions, vol. xxviii. case xl. a man was attacked with diffuse cellular inflammation of the inferior extremity, which terminated in two days with extensive gangrene of the skin. in the superficial and common femoral veins were extensive coagula; these did not completely fill the veins, but slightly adhered at different points to their internal coats. these clots still retained, in some places, the colouring matter of the blood, whilst at others the colourless fibrine alone remained; in both veins, the clots were enveloped in a perfectly transparent, smooth, and polished membrane, presenting the appearance of a serous tissue. in the structure of these membranes were several distinct arborescent vessels, minutely injected;[ ] some of these vessels were of sufficient size to allow of the blood being made, by gentle pressure, to circulate through them; but no communication could be traced between these vessels and the coats of the veins. the membranes were easily peeled off from the surface of the clots with which they were in contact. the interior coats of the veins presented their natural colour and polished surfaces, except at the points where the slight adhesions above-mentioned existed. [ ] mr. gray, the curator of the museum of st. george's hospital, has recently shewed me the outer layer of an effusion of blood into the arachnoid cavity, injected from the middle meningeal artery. finis. richards, printer, , st. martin's lane. * * * * * transcriber's notes page , case xxvii. aug th follows september th. this has been changed to oct th. italics are represented thus _italic_. syndrome johnny by charles dye illustrated by emsh [transcriber's note: this etext was produced from galaxy science fiction july . extensive research did not uncover any evidence that the u.s. copyright on this publication was renewed.] the plagues that struck mankind could be attributed to one man. but was he fiend ... or savior? the blood was added to a pool of other blood, mixed, centrifuged, separated to plasma and corpuscles, irradiated slightly, pasteurized slightly, frozen, evaporated, and finally banked. some of the plasma was used immediately for a woman who had bled too much in childbirth. she died. others received plasma and did not die. but their symptoms changed, including a syndrome of multiple endocrine unbalance, eccentricities of appetite and digestion, and a general pattern of emotional disturbance. an alert hospital administrator investigated the mortality rise and narrowed it to a question of who had donated blood the week before. after city residents were eliminated, there remained only the signed receipts and thumbprints of nine men. nine healthy unregistered travelers poor enough to sell their blood for money, and among them a man who carried death in his veins. the nine thumbprints were broadcast to all police files and a search began. the effort was futile, for there were many victims who had sickened and grown partially well again without recognizing the strangeness of their illness. three years later they reached the carrier stage and the epidemic spread to four cities. three more years, and there was an epidemic which spread around the world, meeting another wave coming from the opposite direction. it killed two out of four, fifty out of a hundred, twenty-seven million out of fifty million. there was hysteria where it appeared. and where it had not appeared there were quarantines to fence it out. but it could not be fenced out. for two years it covered the world. and then it vanished again, leaving the survivors with a tendency toward glandular troubles. time passed. the world grew richer, more orderly, more peaceful. a man paused in the midst of his work at the u.n. food and agriculture commission. he looked up at the red and green production map of india. "just too many people per acre," he said. "all our work at improving production ... just one jump ahead of their rising population, one jump ahead of famine. sometimes i wish to god there would be another plague to give us a breathing spell and a fair chance to get things organized." he went back to work and added another figure. two months later, he was one of the first victims of the second plague. * * * * * in the dining hall of a university, a biochemical student glanced up from his paper to his breakfast companion. "you remember johnny, the mythical carrier that they told about during the first and second epidemics of syndrome plague?" "sure. syndrome johnny. they use that myth in psychology class as a typical example of mass hysteria. when a city was nervous and expecting the plague to reach them, some superstitious fool would imagine he saw syndrome johnny and the population would panic. symbol for death or some such thing. people imagined they saw him in every corner of the world. simultaneously, of course." it was a bright morning and they were at a window which looked out across green rolling fields to a towering glass-brick building in the distance. the student who had gone back to his paper suddenly looked up again. "some peruvians here claim they saw syndrome johnny--" "idiotic superstition! you'd think it would have died down when the plague died." the other grinned. "the plague didn't die." he folded his newspaper slowly, obviously advancing an opening for a debate. his companion went on eating. "another of your wild theories, huh?" then through a mouthful of food: "all right, if the plague didn't die, where did it go?" "nowhere. _we have it now._ we all have it!" he shrugged. "a virus catalyst of high affinity for the cells and a high similarity to a normal cell protein--how can it be detected?" "then why don't people die? why aren't we sick?" "because we have sickened and recovered. we caught it on conception and recovered before birth. proof? why do you think that the countries which were known as the hungry lands are now well-fed, leisured, educated, advanced? because the birth rate has fallen! why has the birth rate fallen?" he paused, then very carefully said, "because two out of three of all people who would have lived have died before birth, slain by syndrome plague. we are all carriers now, hosts to a new guest. and"--his voice dropped to a mock sinister whisper--"with such a stranger within our cells, at the heart of the intricate machinery of our lives, who knows what subtle changes have crept upon us unnoticed!" his companion laughed. "eat your breakfast. you belong on a horror program!" * * * * * a police psychologist for the federated states of the americas was running through reports from the bureau of social statistics. suddenly he grunted, then a moment later said, "uh-huh!" "uh-huh what?" asked his superior, who was reading a newspaper with his feet up on the desk. "remember the myth, of syndrome johnny?" "ghost of syndrome plague. si, what of it?" "titaquahapahel, peru, population nine hundred, sent in a claim that he turned up there and they almost caught him. crime statistics rerouted the report to mass phenomena, of course. mass phenomena blew a tube and sent their folder on syndrome johnny over here. every report they ever had on him for ninety years back! a memo came with it." he handed the memo over. the man behind the desk looked at it. it was a small graph and some mathematical symbols. "what is it?" "it means," said the psychologist, smiling dryly, "that every crazy report about our ghost has points of similarity to every other crazy report. the whole business of syndrome johnny has been in their 'funny coincidence' file for twenty years. this time the suspect hits the averaged description of johnny too closely: a solid-looking man, unusual number of visible minor scars, and a disturbing habit of bending his fingers at the first-joint knuckles when he is thinking. the coincidence has gotten too damn funny. there's a chance we've been passing up a crime." "an extensive crime," said the man at the desk softly. he reached for the folder. "yes, a considerable quantity of murder." he leafed through the folder and then thought a while, looking at the most recent reports. thinking was what he was paid for, and he earned his excellent salary. "this thumbprint on the hotel register--the name is false, but the thumbprint looks real. could we persuade the bureau of records to give their data on that print?" "without a warrant? against constitutional immunity. no, not a chance. the public has been touchy about the right to secrecy ever since that police state was attempted in varga." "how about persuading an obliging judge to give a warrant on grounds of reasonable suspicion?" "no. we'd have the humanist press down on our necks in a minute, and any judge knows it. we'd have to prove a crime was committed. no crime, no warrant." "it seems a pity we can't even find out who the gentleman is," the crimes department head murmured, looking at the thumbprint wistfully. "no crime, no records. no records, no evidence. no evidence, no proof of crime. therefore, we must manufacture a small crime. he was attacked and he must have defended himself. someone may have been hurt in the process." he pushed a button. "do you think if i send a man down there, he could persuade one of the mob to swear out a complaint?" "that's a rhetorical question," said the psychologist, trying to work out an uncertain correlation in his reports. "with that sort of mob hysteria, the town would probably give you an affidavit of witchcraft." * * * * * "phone for you, doctor alcala." the nurse was crisp but quiet, smiling down at the little girl before vanishing again. ricardo alcala pushed the plunger in gently, then carefully withdrew the hypodermic needle from the little girl's arm. "there you are, cosita," he said, smiling and rising from the chair beside the white bed. "will that make me better, doctor?" she piped feebly. he patted her hand. "be a good girl and you will be well tomorrow." he walked out into the hospital corridor to where the desk nurse held out a phone. "alcala speaking." the voice was unfamiliar. "my deepest apologies for interrupting your work, doctor. at this late hour i'm afraid i assumed you would be at home. the name is camba, federation investigator on a health case. i would like to consult you." alcala was tired, but there was nothing to do at home. nita was at the health resort and johnny had borrowed all his laboratory space for a special synthesis of some sort, and probably would be too busy even to talk. interest stirred in him. this was a federation investigator calling; the man's work was probably important. "tonight, if that's convenient. i'll be off duty in five minutes." thirty minutes later they were ordering in a small cantina down the street from the hospital. julio camba, federation investigator, was a slender, dark man with sharp, glinting eyes. he spoke with a happy theatrical flourish. "order what you choose, senor. we're on my expense account. the resources of the federated states of all the americas stand behind your menu." alcala smiled. "i wouldn't want to add to the national debt." "not at all, senor. the federated states are only too happy thus to express a fraction of their gratitude by adding a touch of luxury to the otherwise barren and self-sacrificing life of a scientist." "you shame me," alcala said dryly. it was true that he needed every spare penny for the health of nita and the child, and for the laboratory. a penny saved from being spent on nourishment was a penny earned. he picked up the menu again and ordered steak. the investigator lit a cigar, asking casually: "do you know john osborne drake?" * * * * * alcala searched his memory. "no. i'm sorry...." then he felt for the first time how closely he was being watched, and knew how carefully his reaction and the tone of his voice had been analyzed. the interview was dangerous. for some reason, he was suspected of something. camba finished lighting the cigar and dropped the match into an ash-tray. "perhaps you know john delgados?" he leaned back into the shadowy corner of the booth. johnny! out of all the people in the world, how could the government be interested in him? alcala tried to sound casual. "an associate of mine. a friend." "i would like to contact the gentleman." the request was completely unforceful, undemanding. "i called, but he was not at home. could you tell me where he might be?" "i'm sorry, senor camba, but i cannot say. he could be on a business trip." alcala was feeling increasingly nervous. actually, johnny was working at his laboratory. "what do you know of his activities?" camba asked. "a biochemist." alcala tried to see past the meditative mask of the thin dark face. "he makes small job-lots of chemical compounds. special bug spray for sale to experimental plantations, hormone spray for fruits, that sort of thing. sometimes, when he collects some money ahead, he does research." camba waited, and his silence became a question. alcala spoke reluctantly, anger rising in him. "oh, it's genuine research. he has some patents and publications to his credit. you can confirm that if you choose." he was unable to keep the hostility out of his voice. a waiter came and placed steaming platters of food on the table. camba waited until he was gone. "you know him well, i presume. is he sane?" the question was another shock. alcala thought carefully, for any man might be insane in secret. "yes, so far as i know." he turned his attention to the steak, but first took three very large capsules from a bottle in his pocket. "i would not expect that a doctor would need to take pills," camba remarked with friendly mockery. "i don't need them," alcala explained. "mixed silicones. i'm guinea pigging." "can't such things be left to the guinea pigs?" camba asked, watching with revulsion as alcala uncapped the second bottle and sprinkled a layer of gray powder over his steak. "guinea pigs have no assimilation of silicones; only man has that." "yes, of course. i should have remembered from your famous papers, _the need of trace silicon in human diet_ and _silicon deficiency diseases_." * * * * * obviously camba had done considerable investigating of alcala before approaching him. he had even given the titles of the research papers correctly. alcala's wariness increased. "what is the purpose of the experiment this time?" asked the small dark federation agent genially. "to determine the safe limits of silicon consumption and if there are any dangers in an overdose." "how do you determine that? by dropping dead?" he could be right. perhaps the test should be stopped. every day, with growing uneasiness, alcala took his dose of silicon compound, and every day, the chemical seemed to be absorbed completely--not released or excreted--in a way that was unpleasantly reminiscent of the way arsenic accumulated without evident damage, then killed abruptly without warning. already, this evening, he had noticed that there was something faulty about his coordination and weight and surface sense. the restaurant door had swung back with a curious lightness, and the hollow metal handle had had a curious softness under his fingers. something merely going wrong with the sensitivity of his fingers--? he tapped his fingertips on the heavy indestructible silicone plastic table top. there was a feeling of heaviness in his hands, and a feeling of faint rubbery _give_ in the table. tapping his fingers gently, his heavy fingers ... the answer was dreamily fantastic. _i'm turning into silicon plastic myself_, he thought. but how, why? he had not bothered to be curious before, but the question had always been--what were supposedly insoluble silicons doing assimilating into the human body at all? several moments passed. he smoothed back his hair with his oddly heavy hand before picking up his fork again. "i'm turning into plastic," he told camba. "i beg your pardon?" "nothing. a joke." camba was turning into plastic, too. everyone was. but the effect was accumulating slowly, by generations. * * * * * camba lay down his knife and started in again. "what connections have you had with john delgados?" _concentrate on the immediate situation._ alcala and johnny were obviously in danger of some sort of mistaken arrest and interrogation. as alcala focused on the question, one errant whimsical thought suddenly flitted through the back of his mind. in red advertising letters: try our new model rust-proof, waterproof, heat & scald resistant, strong--extra-long-wearing human being! he laughed inwardly and finally answered: "friendship. mutual interest in high ion colloidal suspensions and complex synthesis." impatience suddenly mastered him. "exactly what is it you wish to know, senor? perhaps i could inform you if i knew the reasons for your interest." camba chose a piece of salad with great care. "we have reason to believe that he is syndrome johnny." alcala waited for the words to clarify. after a moment, it ceased to be childish babble and became increasingly shocking. he remembered the first time he had met john delgados, the smile, the strong handclasp. "call me johnny," he had said. it had seemed no more than a nickname. the investigator was watching his expression with bright brown eyes. johnny, yes ... but not syndrome johnny. he tried to think of some quick refutation. "the whole thing is preposterous, senor camba. the myth of syndrome plague johnny started about a century ago." "doctor alcala"--the small man in the gray suit was tensely sober--"john delgados is very old, and john delgados is not his proper name. i have traced his life back and back, through older and older records in argentina, panama, south africa, the united states, china, canada. everywhere he has paid his taxes properly, put his fingerprints on file as a good citizen should. and he changed his name every twenty years, applying to the courts for permission with good honest reasons for changing his name. everywhere he has been a laboratory worker, held patents, sometimes made a good deal of money. he is one hundred and forty years old. his first income tax was paid in , exactly one hundred and twenty years ago." "other men are that old," said alcala. "other men are old, yes. those who survived the two successive plagues, were unusually durable." camba finished and pushed back his plate. "there is no crime in being long-lived, surely. but he has changed his name five times!" "that proves nothing. whatever his reasons for changing his name, it doesn't prove that he is syndrome johnny any more than it proves he is the cow that jumped over the moon. syndrome johnny is a myth, a figment of mob delirium." * * * * * as he said it, he knew it was not true. a federation investigator would not be on a wild goose chase. the plates were taken away and cups of steaming black coffee put between them. he would have to warn johnny. it was strange how well you could know a man as well as he knew johnny, firmly enough to believe that, despite evidence, everything the man did was right. "why must it be a myth?" camba asked softly. "it's ridiculous!" alcala protested. "why would any man--" his voice cut off as unrelated facts fell into a pattern. he sat for a moment, thinking intensely, seeing the century of plague as something he had never dreamed.... a price. not too high a price in the long run, considering what was purchased. of course, the great change over into silicon catalysis would be a shock and require adjustment and, of course, the change must be made in several easy stages--and those who could not adjust would die. "go on, doctor," camba urged softly. "'_why_ would any man--'" he tried to find a way of explaining which would not seem to have any relationship to john delgados. "it has been recently discovered"--but he did not say _how_ recently--"that the disease of syndrome plague was not a disease. it is an improvement." he had spoken clumsily. "an improvement on life?" camba laughed and nodded, but there were bitterness and anger burning behind the small man's smile. "people can be improved to death by the millions. yes, yes, go on, senor. you fascinate me." "we are stronger," alcala told him. "we are changed chemically. the race has been improved!" "come, doctor alcala," camba said with a sneering merriment, "the syndrome plagues have come and they have gone. where is this change?" alcala tried to express it clearly. "we are stronger. potentially, we are tremendously stronger. but we of this generation are still weak and ill, as our parents were, from the shock of the change. and we need silicone feeding; we have not adjusted yet. our illness masks our strength." he thought of what that strength would be! camba smiled and took out a small notebook. "the disease is connected with silicones, you say? the original name of john delgados was john osborne drake. his father was osborne drake, a chemist at dow corning, who was sentenced to the electric chair in for unauthorized bacterial experiments which resulted in an accidental epidemic and eight deaths. dow corning was the first major manufactury of silicones in america, though not connected in any way with osborne drake's criminal experiments. it links together, does it not?" "it is not a disease, it is strength!" alcala insisted doggedly. * * * * * the small investigator looked up from his notebook and his smile was an unnatural thing, a baring of teeth. "half the world died of this strength, senor. if you will not think of the men and women, think of the children. millions of children died!" the waiter brought the bill, dropping it on the table between them. "lives will be saved in the long run," alcala said obstinately. "individual deaths are not important in the long run." "that is hardly the philosophy for a doctor, is it?" asked camba with open irony, taking the bill and rising. they went out of the restaurant in silence. camba's 'copter stood at the curb. "would you care for a lift home, doctor alcala?" the offer was made with the utmost suavity. alcala hesitated fractionally. "why, yes, thank you." it would not do to give the investigator any reason for suspicion by refusing. as the 'copter lifted into the air, camba spoke with a more friendly note in his voice, as if he humored a child. "come, alcala, you're a doctor dedicated to saving lives. how can you find sympathy for a murderer?" alcala sat in the dark, looking through the windshield down at the bright street falling away below. "i'm not a practicing medico; only one night a week do i come to the hospital. i'm a research man. i don't try to save individual lives. i'm dedicated to improving the average life, the average health. can you understand that? individuals may be sick and individuals may die, but the average lives on. and if the average is better, then i'm satisfied." the 'copter flew on. there was no answer. "i'm not good with words," said alcala. then, taking out his pen-knife and unfolding it, he said, "watch!" he put his index finger on the altimeter dial, where there was light, and pressed the blade against the flesh between his finger and his thumb. he increased the pressure until the flesh stood out white on either side of the blade, bending, but not cut. "three generations back, this pressure would have gone right through the hand." he took away the blade and there was only a very tiny cut. putting the knife away, he brought out his lighter. the blue flame was steady and hot. alcala held it close to the dashboard and put his finger directly over it, counting patiently, "one, two, three, four, five--" he pulled the lighter back, snapping it shut. "three generations ago, a man couldn't have held a finger over that flame for more than a tenth part of that count. doesn't all this prove something to you?" the 'copter was hovering above alcala's house. camba lowered it to the ground and opened the door before answering. "it proves only that a good and worthy man will cut and burn his hand for an unworthy friendship. good night." disconcerted, alcala watched the 'copter lift away into the night, then, turning, saw that the lights were still on in the laboratory. camba might have deduced something from that, if he knew that nita and the girl were not supposed to be home. alcala hurried in. johnny hadn't left yet. he was sitting at alcala's desk with his feet on the wastebasket, the way alcala often liked to sit, reading a technical journal. he looked up, smiling. for a moment alcala saw him with the new clarity of a stranger. the lean, weathered face; brown eyes with smile deltas at the corners; wide shoulders; steady, big hands holding the magazine--solid, able, and ruthless enough to see what had to be done, and do it. "i was waiting for you, ric." "the feds are after you." ricardo alcala had been running. he found he was panting and his heart was pounding. delgados' smile did not change. "it's all right, ric. everything's done. i can leave any time now." he indicated a square metal box standing in a corner. "there's the stuff." what stuff? the product johnny had been working on? "you haven't time for that now, johnny. you can't sell it. they'd watch for anyone of your description selling chemicals. let me loan you some money." "thanks." johnny was smiling oddly. "everything's set. i won't need it. how close are they to finding me?" "they don't know where you're staying." alcala leaned on the desk edge and put out his hand. "they tell me you're syndrome johnny." "i thought you'd figured that one out." johnny shook his hand formally. "the name is john osborne drake. you aren't horrified?" "no." alcala knew that he was shaking hands with a man who would be thanked down all the successive generations of mankind. he noticed again the odd white web-work of scars on the back of johnny's hand. he indicated them as casually as he could. "where did you pick those up?" * * * * * john drake glanced at his hand. "i don't know, ric. truthfully. i've had my brains beaten in too often to remember much any more. unimportant. there are instructions outlining plans and methods filed in safety deposit boxes in almost every big city in the world. always the same typing, always the same instructions. i can't remember who typed them, myself or my father, but i must have been expected to forget or they wouldn't be there. up to eleven, my memory is all right, but after dad started to remake me, everything gets fuzzy." "after he did _what_?" johnny smiled tiredly and rested his head on one hand. "he had to remake me chemically, you know. how could i spread change without being changed myself? i couldn't have two generations to adapt to it naturally like you, ric. it had to be done artificially. it took years. you understand? i'm a community, a construction. the cells that carry on the silicon metabolism in me are not human. dad adapted them for the purpose. i helped, but i can't remember any longer how it was done. i think when i've been badly damaged, organization scatters to the separate cells in my body. they can survive better that way, and they have powers of regrouping and healing. but memory can't be pasted together again or regrown." john drake rose and looked around the laboratory with something like triumph. "they're too late. i made it, ric. there's the catalyst cooling over there. this is the last step. i don't think i'll survive this plague, but i'll last long enough to set it going for the finish. the police won't stop me until it's too late." * * * * * another plague! the last one had been before alcala was born. he had not thought that johnny would start another. it was a shock. alcala walked over to the cage where he kept his white mice and looked in, trying to sort out his feelings. the white mice looked back with beady bright eyes, caged, not knowing they were waiting to be experimented upon. a timer clicked and john delgados-drake became all rapid efficient activity, moving from valve to valve. it lasted a half minute or less, then drake had finished stripping off the lab whites to his street clothes. he picked up the square metal box containing the stuff he had made, tucked it under his arm and held out a solid hand again to alcala. "good-by, ric. wish me luck. close up the lab for me, will you?" alcala took the hand numbly and mumbled something, turned back to the cages and stared blindly at the mice. drake's brisk footsteps clattered down the stairs. * * * * * another step forward for the human race. god knew what wonders for the race were in that box. perhaps something for nerve construction, something for the mind--the last and most important step. he should have asked. there came at last a pressure that was a thought emerging from the depth of intuition. _doctor ricardo alcala will die in the next plague, he and his ill wife nita and his ill little girl.... and the name of alcala will die forever as a weak strain blotted from the bloodstream of the race...._ he'd find out what was in the box by dying of it! he tried to reason it out, but only could remember that nita, already sickly, would have no chance. and alcala's family genes, in attempting to adapt to the previous steps, had become almost sterile. it had been difficult having children. the next step would mean complete sterility. the name of alcala would die. the future might be wonderful, but it would not be _his_ future! "johnny!" he called suddenly, something like an icy lump hardening in his chest. how long had it been since johnny had left? running, alcala went down the long half-lit stairs, out the back door and along the dark path toward the place where johnny's 'copter had been parked. a light shone through the leaves. it was still there. "johnny!" john osborne drake was putting his suitcase into the rear of the 'copter. "what is it, ric?" he asked in a friendly voice without turning. _it would be impossible to ask him to change his mind._ alcala found a rock, raised it behind syndrome johnny's back. "i know i'm being anti-social," he said regretfully, and then threw the rock away. his fist was enough like stone to crush a skull. google books (the university of california) transcriber's notes: . page scan source: https://books.google.com/books?id=u spaqaaiaaj (the university of california) the seafarers by the same author a bitter heritage. fortune's my foe. the scourge of god. across the salt seas. the clash of arms. denounced. in the day of adversity. the hispaniola plate. the desert ship. a gentleman adventurer. the silent shore. his own enemy. the seafarers by john bloundelle-burton author of 'the clash of arms' 'fortune's my foe,' 'across the salt seas' london c. arthur pearson limited henrietta street w.c. to all old friends and comrades who have been, or are still seafarers either in the royal navy or other branches of the sea service i inscribe this book contents chap. . 'sweeter than blue-eyed violets or the damask rose' . stephen charke . 'let those love now who never loved before' . portsmouth _en fête_ . 'so farewell, hope!' . 'and bend the gallant mast, my boys' . 'an ocean waif' . 'his name is--what?' . 'through the salt sea foam' . the growing terror . the terror increases . stricken . 'spare her! spare her!' . struck down . a light from the past . man overboard . 'farewell, my rival' . 'she will never know' . 'i almost dreaded this man once' . 'i do believe you' . washed ashore . a sailor's knife . 'the tiger did that' . beaten! defeated! . 'i have loved my last' . 'here is my journey's end' chapter i 'sweeter than blue-eyed violets or the damask rose' that bella waldron should have felt sad, and her night's rest have been disturbed in consequence, was, in the circumstances, most natural. for one cannot suppose that any young girl leaves her home, her mother, and her country without much grief and perturbation; without tears and sorrow and heavy sighs, as well as tremendous fears that she may never return to, nor see, them again. and such is what bella was about to do when this particular night should have come to an end: she was about to traverse not one ocean, but two; to pass from a life that, if not luxurious, was at least comfortable, to another which, if more brilliant, would undoubtedly be strange, and, consequently, not easily to be adopted at first. in fact, to go from one side of the world to the other. yet, all the same, it was singular that, between her intervals of weeping and sobbing, and when she had at last cried herself to sleep, she should have been tormented with such frightful dreams as those which came to her. dreams of horrors that in their weirdness became almost ludicrous, or would have been ludicrous to those who, knowing of them, did not happen to be experiencing them. thus, the idea of a crocodile regarding one with a glittering eye from its ambush in the sand, seems for some reason, in our waking moments, to conjure up a comical sense of terror--perhaps because of the 'glittering eye'; yet there was nothing comical about it to the mind of bella as she awoke with a shriek from her sleep after the vision of the creature had had momentary existence in the cells of her brain. and, even when she was thoroughly awakened and knew that she had only been suffering from a bad dream, she still shuddered at the recollection, and muttered, 'it appeared as if it was creeping towards me to seize me with its horrid jaws! oh, it was dreadful!' then she slept again--only, however, to dream of other things. of a desolate shore at first, with, upon it, a misty creature waving its hands mournfully above its head, those hands being enveloped in some gauzy material, so that the figure appeared more like a skirt-dancer than aught else; then, of two lions fighting savagely; and then of a vast black cave with an opening as high as st. paul's and as wide as a railway terminus is long, against which, armed with a spear and protected with a buckler, she seemed to stand trembling. trembling, too, because she could not see one yard into the deep and profound darkness before her, yet into which, as she peered furtively and with horror, she appeared to perceive things--forms half-animal and half-human--crawling, revolving, creeping about. then, again, she awoke with a start. but by now the room was light with the gray, mournful glimmer of the approaching dawn; so light that she could see her wicker-basket trunks in their american-cloth wrappers standing by the wall, with the lids open against it; soon, too, she heard the sparrows twittering outside, as well as other congenial suburban sounds, such as the newspaper boys shrieking hideously to one another, and the milkman uttering piercing yells; and--though it was her last day in england--she was glad to spring out of bed and know herself once more a unit in the actual world instead of a wanderer in a world of dreams. 'i wish,' the girl muttered to herself, standing by the window and drawing up the blind half-way, whereby she was enabled to see that the gray dawn of a may morning gave promise of a warm, fine day later on, 'that, if i were to have such bad dreams at all, i might have been spared them on the very day of my departure for the other side of the globe. i am not superstitious, yet, yet--well!--i shall think of this dream, i know, for many a day to come.' then she slipped on her dressing-gown, thrust her pretty little white feet into some warm, felt bath-slippers, and, opening her door quietly, because it was still early and she did not wish to awaken those in the house who might be asleep, she went across the passage to her mother's room. yet, ere she did so, let us regard this young girl, whose story and adventures we are now to follow--this girl whose dreams of leering crocodiles and dark, mystic caves, with hideous creatures gyrating in them, will, as we shall see, be far outnumbered and outshone by the actual realities that she will experience in her passage across the world. for it had been resolved on by fate, or providence, or destiny, or whatever one may term that power which controls our earthly existence, that to bella waldron were to come experiences, strange, horrible, and fantastic, such as the last decade of our expiring century rarely assaults men with, and women hardly ever. standing there in the now clear light of the morning, her long dressing-gown enshrouding her tall, shapely, and _svelte_ figure, and with her masses of hair hanging dishevelled--hair a warm brown with golden gleams in it, such as has the ripening corn--an observer would decide at once that she was beautiful. beautiful, also, by the gift of clear, hazel-gray eyes--eyes that were pure and innocent in their glance; beautiful as well by her softly-rounded face, her rich red lips--the upper one divinely short--and also by her colouring. if, too, one applies to her the lines of that old poet dead and gone two hundred years ago, the words describing gloriana:-- more fair than the red morning's dawn, sweeter than pearly dews that scent the lawn, than blue-eyed violets, or the damask rose when in her hottest fragrancy she glows, bella waldron may be considered as depicted. 'mother,' she said, going in now to the room where the poor lady whom she addressed had herself passed a sad and tearful night, bemoaning the fact that soon--in a few hours--indeed now--because the fateful day had come--her child was to be torn from her. 'oh, mother! it is to-day--to-day! oh, my darling! how can i part from you?' and then, folding her mother in her arms while she sat on the bedside, the two women wept together. 'yet,' said mrs. waldron, to whom advancing years brought the power of philosophic resignation, if not the thorough strength to overcome that which rendered her unhappy, 'yet, bella, my dearest, it is so much for you. such a position, such a future! oh, think of it! a position you could scarcely ever have hoped to obtain. and the love, my child, the love! think how gilbert loves you and you love him. for you do love him, bella. of all men, he is the one for you.' 'with my whole heart and soul i love him!' her daughter answered. 'mother, if i had never met him i do not believe i could have ever loved any other man. ah, i am glad juliet called romeo the god of her idolatry! it has taught me how to think of gilbert.' 'and the position, bella. the position--think of that! in our circumstances, even though you come of a good stock and are descended from ladies and gentlemen on both sides from far-off years, you could never have hoped to make such a match.' 'the position is nothing to me, mother. i love gilbert fondly. i long to be his wife. why should i think of the position?' 'every woman must think of it, child. when you are as old--and worn--as i am, you--you will teach your own children to think of it. it is everything to be the wife of a gentleman, better still the wife of a man of rank. everything! short of being the wife of a distinguished man, a man whose name is on everybody's tongue, there is no other position so good. and, even then, that distinguished man may not be a gentleman as well. that would be dreadful. yet your husband will be both. think, bella! he is sure to become a nobleman, and he may become the most renowned admiral in the navy.' 'you dear old mother! but i love gilbert because he is gilbert. otherwise, neither the nobility which is certain, nor the renown which is prospective, would take me across the world to him. do you think i would go to bombay to marry the heir to a title or a possible admiral if i did not love him?' 'heaven forbid!' mrs. waldron replied, as she sat up in her bed and smoothed her hair. 'heaven forbid! yet,' she murmured, perhaps a little weakly for a lady who had just delivered herself of such admirable sentiments, 'yet i do honestly think, darling, that the love you bear each other--yes! above all, the love--and the position--i must think of the position, bella!--and the certainty of a brilliant future for you, reconcile me a little to parting with you. some day, when you are a mother, you will understand me.' 'i understand you now, darling. yet, yet--ah!' and now she sobbed on her mother's shoulder--'yet, to think of our being parted for so long--for three years! gilbert must remain on the station for that length of time.' now it is certain that mrs. waldron was sobbing too, yet, because there was something of the spartan mother, something, too, of cornelia, mother of the gracchi, about her, she calmed her sobs. for she, too, had been ruthlessly torn by an all-conquering lover, who would take no denial, from her parents, arms. yet that lover had had no such proud future to offer her as the gilbert of whom they spoke had to offer his beloved arabella; for her there had been nothing to flavour her existence except the glorious spice tasted by us all--of loving and being loved. and now--now that she was what she called old--which was not the case, since she was still short of her forty-fifth year--now she knew--and, knowing, said--that love accompanied by brilliant prospects and an assured future was the most satisfactory of all loves. 'your father,' mrs. waldron said, 'remained on his station, the pacific, for seven years, and we were separated all that time. he there, i here, in london. and in lodgings, bella--oh those lodgings and that cooking!--you remember, darling? you must remember the lodgings and the cooking, child though you were. and he was not a future peer, though he did once think he might become an admiral.' 'forgive me, mother,' bella said, kissing her mother again and again. 'i will not repine any more. i ought not to do so, i know. for is not my gilbert the handsomest, bravest sailor that ever wore the queen's uniform? and it won't be so long after all. only--only--i do wish there wasn't that awful journey. oh if there were only a bridge!' and for the first time she smiled. 'or a railway,' she added. 'i am sure, bella,' her mother said, forgetting how she would feel that evening when her child was gone, and neither the bright voice nor brisk footsteps would be heard any more in the house, 'i am sure you cannot complain of the manner in which you are going out. the vessel may not be as comfortable as they say the great liners are, but at least your uncle is the captain, and it is his own ship. and that cabin he showed us yesterday, when we went down to gravesend, is far better than anything you could get in any liner, even the best. i had one once, when i went out to join your father at halifax, in which there was nowhere but the pockets of my clothes to keep things in, while the other lady above me could open the scuttle as she lay in her berth. and your cabin is as big as a dining-room, with a sofa----' 'you dear, darling mother!' bella exclaimed. 'you are an angel to comfort me thus, when i know all the time that your heart is as sad as mine. oh if we had not to part!' and again the two women hugged and kissed each other. chapter ii stephen charke a year before this momentous day when arabella waldron was to set sail for india in her uncle's full-rigged ship, the emperor of the moon, there had come to her that supreme joy which is the most sweet experience of a young girl's life. the man she was madly in love with had asked her to be his wife, and, so far as it was possible to forecast the future, it seemed that before them both there stretched a long vista of happy years to be spent together, or as many years together as a sailor and his wife can pass during the greater part of their lives. yet, who can foretell the future--even so much as what to-morrow may bring forth? to-day we are here, to-morrow we are gone. a bicycle accident has done for us, or we have caught a fever or pneumonia, and we are no more. how, then, was bella to know that events would so shape themselves that, ere she had been a year engaged to her future husband, she would be on board the _emperor of the moon_, bound for the other side of the world, and that during her passage in the good old ship, named after an ancient play--a representation of which one of the late owners had witnessed in his boyhood--she would encounter such calamities and perils? but let us not anticipate. rather, instead, let us describe who bella was, and how she came to love and to be loved, to be wooed and won. our english girl! the girl fairly tall, and full to the brim with health; full, too, of a liking for all exercise which befits the dawning woman--for boating, riding, walking, cycling: not ashamed to acknowledge that she likes a good dance and that she has a good appetite for a ball supper; one who is, withal, not a fool! where in all the world can you find anything better than that--better than the honest girls who have been our mothers, are our wives, and, please god, are what our daughters will be? such a one was bella waldron. she could take a scull--and pull it, too--as well as any of her sisters whom you shall meet 'twixt richmond and windsor; she could cycle thirty miles a day, eat a good dinner afterwards, and then go to a dance in the evening; and she thought nothing of walking from west kensington to piccadilly or regent street, with a glance at the kensington high street shops on her way!--especially when the winter remnant sales were on and advertised daily in glowing terms. of riding she knew little, because horse-exercise is a more or less expensive luxury, and also because an income of £ a year does not allow much in the way of luxuries, even when there are only two people in the family and two servants (with an odd boy) kept. and that sum represented mrs. waldron's income. bella's mother had been a miss pooley, who had married the late commander waldron (retired with the brevet rank of captain), and to this lady there remained only one near relative, besides bella, at the time this veracious narrative opens. now, this gentleman merits a slight description, not only because he plays a considerable part in those adventures and tribulations which, later on, befell the girl, but also because he occupied a position almost unique and, consequently, conspicuous in these modern days. fifty--nay, thirty years ago, there would not have been anything peculiar in the career he followed; but now, with the twentieth century close upon us, that career was almost a singular one. captain pooley was a sea captain--a mercantile sea captain--owning two ships of his own, and always in command of one of them. that which he now commanded was the very _emperor of the moon_ of which you have already heard, and of which, if you follow this narrative, you will hear a great deal more; the other was a brig called _sophy_, which will not figure at all in these pages. now captain pooley, as he was called by everybody, though, of course, he had no right whatever to that distinctive appellation, had as a young man possessed an extraordinary love for the sea, so intense a love, indeed, that he, not being able to obtain a nomination for the royal navy, had induced his father to apprentice him to the merchant service. later in life--one must be brief in these preliminary descriptions!--he had, after obtaining all his certificates, purchased one after the other, with some little money he had inherited, shares in first the one ship and then the second, and eventually, by aid of savings and successful trading, had become the entire owner of both. for the rest--to be again brief--he was a gentleman in manner and in feelings, while in his person he was a handsome, burly man, with the brightest of blue eyes, a vast shock of remarkably white hair above a good-looking, ruddy, tan-brown face; and was also the possessor of a smile which appeared more often than not upon his good-humoured countenance, and helped to make him welcome wherever he went, both at home and abroad. he was, it should be added, a married man, but childless, and it was not unusual for him to occasionally take his wife on the voyages he made for the purpose of transporting the goods which he sold in distant parts of the world, as well as for the purpose of purchasing other goods for sale in england. otherwise, mrs. pooley remained at home in a pretty little villa at blackheath, of which he owned a long lease. it was a year before the great joy of bella's life came to her that the 'captain,' returned from a voyage to calcutta, and, as was always the case with him, he went to west kensington to visit his sister and niece, accompanied by his wife. these visits were invariably paid, and also invariably returned by mrs. and miss waldron, and were generally productive of a great deal of pleasure on either side. captain pooley--as we will continue to term him--was a kind-hearted, open-handed man, who loved his own kith and kin and cherished an old-fashioned notion--still in existence, heaven be praised, amongst many members of various classes of society--that people should do as much as lay in their power to make their relatives happy. wherefore, on this night, he said, as he took the head of mrs. waldron's table--which she always insisted on his doing whenever he stayed with her--and while he carved a pair of most excellent fowls: 'so i think we shall have a good time of it all round, mary,'--mary being mrs. waldron's name. 'to-night we will go to the lyceum, and to-morrow--well, to-morrow--we'll see. then, next week, southsea. southsea's the place for us. great doings there next week, bell. the visit of the foreign fleet now there will beat everything that has gone before.' 'but the expense, george!' exclaimed his sister. 'the expense will be terrible. i saw in the paper that everything would be at famine price.' the captain pooh-poohed this remark, however, saying that an old friend of his, who had retired from the royal navy and was now living at that lively watering-place, knew of a little furnished house which could be obtained reasonably if taken for the following week, as well as for the principal one. and he clinched the remark by saying, 'and i have told him to secure it.' there was therefore nothing further to be said on that score, bella alone remarking that she had the best old uncle and aunt that ever lived. 'there will be,' he continued, putting a slice of the breast upon her plate, probably as a reward for her observation, 'plenty to amuse bella. there is a garden-party at whale island; another given by the general; and a ball given by the navy at the town hall. that's the place for you, bella. if you don't find a husband there--and you a sailor's daughter, too--well!----' but these remarks were hushed by his wife, who told him not to tease the child, and by the beautiful rose blush which promptly rushed to his niece's cheeks. yet, all the same, bella thought it very likely that she would have a good time of it. they were playing _madame sans-gêne_ at the lyceum that evening--though pooley rather wished it had been something by shakespeare--and on the road to the theatre in the cab he told them that he had taken another stall, to which he had invited a young friend of his whom he had run against in town a day or two ago. 'and a very good fellow, too,' he said, 'besides being a first-rate sailor. and he has had a pretty hard struggle of it, owing to his being cursed with a cross-grained old father, who seemed to imagine his son was only brought into the world that he might sit upon him in every way. all the same, though, stephen charke got to windward of him somehow.' 'whoever is he, uncle?' bella asked, interested in this story of the unknown person who was to make a fifth of their party; while her mother addressed a similar question to mrs. pooley. 'he is,' said the captain, 'a young man of about thirty, who once went to sea with me in the _sophy_; the son of an old retired officer, who was years ago in a west indian regiment. after petting and spoiling the boy, and--as stephen charke himself told me--almost treating him with deference because he happened to have been born his son, he afterwards endeavoured to exert a good deal of authority over him, which led to disagreeables. he wanted the lad to go in for the army, and stephen wanted to go to sea.' 'and got his way, apparently,' said bella. 'he did,' her uncle replied, 'by absolutely running away to sea--just like a hero in a boy's book.' 'how lovely!' the girl exclaimed. 'ha! humph!' said pooley, rather doubtfully, he being a man who entirely disapproved of disobedience in any shape or form from a subordinate. 'anyhow, his experiences weren't lovely at first. they don't take runaways in the best ships, you know. however, he stuck to it--he had burnt his boats as far as regards his father--and--well!--he holds a master's certificate now, and he's both a good sailor and a good fellow. he is in the naval reserve, too, and has had a year in a battleship.' 'and his father?' mrs. waldron asked. 'are they reconciled?' 'the old man is dead, and charke has three or four thousand or so, which makes him more or less independent. he's a queer fish in one way, and picks and chooses a good deal as to what kind of ship he will serve in. for instance, he won't go in a passenger steamer, because, he says, the mates are either treated with good-natured tolerance or snubbed by the travellers, and he aims at being an owner. however, as i said before, he's a good fellow.' by this time the cab had forced its way along the strand amidst hundreds of similar vehicles, many of which were disgorging their fares at the various other theatres, and at last, after receiving a gracious permission to pass from those autocratic masters of the public--the police stationed at the foot of wellington street--wrenched itself round and pulled up in its turn beneath the portico of the theatre. 'there's charke!' said pooley, while, as he spoke, a rather tall, good-looking man of dark complexion, who was irreproachably attired in evening dress, came up to them and was duly introduced. to bella, whose knowledge of the world--outside the quiet, refined circle in which she had moved--was small, this man came more as a surprise than anything else. she knew nothing of the sea, although she was the daughter of an officer who had been in the royal navy, and her idea of what a 'mate' was like was probably derived from those she had seen on the jersey or boulogne packet-boats, when her mother and she had occasionally visited these and similar places in the out-of-town season. yet stephen charke (she supposed because he was a gentleman's son, and also because of that year in a battleship as an officer of the r.n.r.) was not at all what she had expected. his quiet, well-bred tones as he addressed her--with, in their deep, ocean-acquired strength, that subtle inflexion which marks the difference between the gentleman and the man who is simply not bad-mannered--took her entirely by surprise; while the courteous manner in which he spoke, accompanied by something that proclaimed indubitably his acquaintance, not only with the world, but its best customs, helped to contribute to that surprise. so that, as they proceeded towards their stalls, she found herself reflecting on what a small acquaintance she had with things in general outside her rather limited circle of vision. chapter iii 'let those love now who never loved before' the 'captain' led the way into the five stalls he had booked, followed, of course, by the elder ladies, and, as stephen charke naturally went last, it fell out that bella and he sat by each other. and between the acts, the intervals of which were quite long enough for sustained conversation to take place, the girl had time to find her interest in him, as well as her surprise, considerably increased. she had perused in her time a few novels dealing with the sea, and, in these, the mates of ships of whom she had read had more or less served to confirm her opinion, already slightly formed from real life. but, when charke began to talk to her about the actual source from which the play they were witnessing was drawn, she acknowledged to herself that, somehow, she must have conceived a wrong impression of those seafarers. certainly he, she thought, could not be one of the creatures who cursed and abused the men if they objected to their food, and threatened next to put them in irons; nor did she remember that such individuals had ever been depicted in sea stories as knowing much about the revolution in france and the vulgar amusements of napoleon. then, during the next interval, he approached the subject of the forthcoming festivities at portsmouth, to which bella's uncle had told him he was going to take his relatives, and from that he glided off into the statement that he himself would be there. 'i am going down next monday,' he said, 'to see one or two of my old mess-mates of the _bacchus_--in which i served for a year in the channel squadron--and i fancy i shall be in at most of the functions. have you ever been to a naval ball?' bella told him she never had been to one, her mother's intimacy with the service having entirely ceased since captain waldron's death, and he then proceeded to give her an account of what these delightful functions were like. indeed, so vividly did he portray them that bella almost wished they were going on that very night to take part in one. when the play was over, she--who acknowledged to herself that which probably no power on earth would have induced her to acknowledge so soon to any one else, namely, that stephen charke was an agreeable, if not a fascinating, companion--in company with the others prepared to return to west kensington, bidding goodbye to him in the vestibule of the theatre. 'where are you staying?' mrs. waldron asked him, as they stood on the steps waiting for their cab to make its appearance in turn. 'and are you in london for any time?' charke mentioned the name of a west end caravanserai, at which he had a room, as his abode for the next day or so, and by doing so he administered one more shock of surprise to the girl standing hooded and muffled by his side. for, again, in her ignorance, or perhaps owing to her reading of nautical novels, she had always thought of the officers of merchant vessels as living somewhere in the purlieus of ratcliffe highway when ashore, and rarely penetrating farther west than the city itself. it seemed, however, that either she had formed a totally erroneous impression of such people, or that the above sources of information must be wrong if all were really like mr. charke. but then, suddenly, there occurred to her mind the fact that her uncle had said this young officer was in possession of some few thousand pounds of his own--and this, probably, would explain why he was living in a comfortable manner when he was ashore. 'i am at home to my friends every other friday,' mrs. waldron said, as now the cab had got to the portico, and a man was bawling out 'mrs. pooley's carriage' at the top of his voice--which announcement, nevertheless, served the purpose required--'and the day after to-morrow happens to be one of those fridays. if you care to call--though i know gentlemen despise such things--we shall be glad to see you.' 'i do not despise them,' charke answered, 'and i shall be delighted to come.' then he bade them all good-night, saw the cab off, and strolled down to his hotel. in his innermost heart charke did despise such things as 'at homes,' or 'tea fights,' as he termed them contemptuously to himself, yet, in common with a great many other men, he was willing enough to go to them when there was any attraction strong enough to draw him. and he told himself that there was an attraction at mrs. waldron's such as he had never been subjected to before. 'what a lovely girl,' he thought to himself; 'what eyes and hair--and a nice girl, too! now i begin to understand why other men curse the sea, and say they would rather earn their living on shore driving busses than following our calling. and, also, why they nail up photographs in their cabins and watch every chance of getting mails off from the shore. i suppose i should have understood it earlier if i had ever met a girl like this.' he did call on the following friday, after having passed the intervening two days in wandering about london; in going to a race meeting one day and a cricket match at the oval the next; in trying a dinner at one foreign restaurant on the wednesday, and another at a second foreign restaurant on thursday; but all the time he felt restless and unsettled, and wished that four o'clock on friday was at hand. 'this won't do,' he said to himself, before the cricket match on thursday was half over, and while he sat baking in the sun that streamed down on to the oval--which disturbed him not at all, and had no power to make him any browner--'this won't do. i must go to sea at once. by the time i have seen that girl again i shall be head over ears in love with her. and the interest on £ in india stock--by jove! it isn't quite £ since i've been loafing about on shore!--and a chief officer's pay won't keep a wife. not such a wife as she would be, anyway.' he did not know it--or, perhaps, he did know it and would not acknowledge it to himself--but he was very nearly head over ears in love with bella waldron already. and he had only seen her once--been by her side at a theatre for three hours--with three intervals of ten minutes in which to talk to her! yet the girl's beauty, her gentle innocence, and above all, that trusting confidence with which she seemed to look out upon all that was passing before her, and to regard the world as what it appeared to be and to take it at its own valuation, had captured him. still, he should have known--he must have known--that when a man who has never thought much of the women he has met heretofore, and has generally forgotten what their features were like by the next day, takes to lying awake for hours dreaming at last of one woman with whom he has by chance come into contact, he is as nearly in love with her as it is possible for him to be. so, at least, those report who have been in love, and so it has been told to the writer of this narrative! he made his way to montmorency road, west kensington, exactly at four o'clock, and while he sat in the pretty drawing-room talking to mrs. waldron, who was alone at present--the appearance of bella being promised by her mother in a few moments--he found himself wondering what the girl did with her life here. he had seen a bicycle in the passage as he was shown upstairs, so he supposed she rode that; while there were some photographs of rather good-looking men standing about on the semi-grand and on the plush-covered mantelshelf--which made him feel horribly annoyed, until mrs. waldron, seeing his glance fixed on them, informed him that they were mostly cousins who were out of the country, and that one or two of them happened to have succumbed to various climatic disorders abroad, for which catastrophes he did not seem to feel as sorry as he supposed he ought to do. then bella came in, looking radiantly beautiful in a summer dress (a description of which masculine ignorance renders impossible), and stephen charke was happy for ten minutes. for they all talked of the impending _fêtes_ at portsmouth in honour of the foreign fleet, and charke found himself in an elysium when bella promised him--without the slightest self-consciousness or false shame--that she would undoubtedly have some dances reserved for him. yet, soon, other callers came in, and stephen charke found himself deprived of the pleasure of further conversation with bella. an elderly dowager claimed her attention, and a middle-aged lady--of, as he considered, menacing aspect--regaled him with the evil doings of her domestic servants, a subject of about as much interest to this wanderer of the seas as that of embroidery or tatting would have been. an irish doctor of divinity also disturbed his meditations on bella's beauty by telling funny stories, the point of which the divine had forgotten until he refreshed his memory by reference to a little note-book in which he had them all written down, while a young militia subaltern who had failed for the army--and seemed rather proud of it!--irritated him beyond endurance. yet, even through this fatuous individual, there came something that was welcome to him, since he saw bella regarding the youth with a look of scarcely veiled contempt, and he longed to tell the idiot that the only failure for which women have no pity in this world is that of the intellect. 'goodbye,' he said to bella, who accompanied him to the head of the stairs, after he had made his adieux to her mother. 'goodbye. next week--portsmouth--and--my dances.' 'i shall not forget,' she said. after which he wandered off by devious and intricate ways (which reminded him of some of the narrow passages he knew of between the islands in the china seas) and so arrived at the district railway. and all the time he was telling himself that he was a fool--an absolute fool. 'i have fallen in love with a girl i have only seen twice,' he meditated, as the train ran through the sulphurous regions underground, and he endeavoured to protect his lungs by smoking cigarette after cigarette; 'a girl who is not, and never can be, anything to me. she will make a good match some day; she must make a good match--girls of her position and looks always do; and, a year or two hence, i shall luff into some unearthly harbour abroad, and run against pooley, who will tell me that she has done so.' yet, all the same, he took comfort from remembering that he had not seen anybody at mrs. waldron's 'afternoon' who was likely to be the individual to carry her off. but, in spite of this soothing reflection, he braced himself to a stern resolution: he determined that, as already in his life he had triumphed over other things, so he would triumph now. he would triumph over this swift-flowering and still growing love; conquer it by absence from the object which inspired it; trample it down till there was nothing left of life in it. 'i have no money to keep a wife,' he thought, as he walked up from charing cross station to his hotel; 'certainly no money to keep such a wife as she would be. and, even if i had, it is not likely that she would marry me; "a common mate," as i have heard ourselves called. portsmouth shall end it,' he concluded. 'i'll have one good week there, and then to sea again on a long cruise. that ought to do it! i'll go down to the docks to-morrow and see what's open.' wherefore, full of this determinate resolution to drive from out of him the frenzy which had taken possession of his heart and mind, he went to the hotel and read in his bedroom for an hour or so, during all of which time bella waldron's face was looking out at him from the pages of the _navy and army illustrated_, and was always before him until he went forth to try still another foreign restaurant. yet she was there too, and her pure, innocent eyes were gazing at him across the imitation flowers and the red candle-shades in the middle of the table; and so, also, they were in the stalls of the empire, until he fell asleep in his seat. nor was she absent from his mind during the long hours of the night. chapter iv portsmouth _en fÊte_ the lunch at whale island was over, and there was a slight breathing-space ere the garden-party, which followed it, began. meanwhile, from southsea pier, from down by the pontoon at the foot of the old hard, and over from gosport, picket-boats, steam pinnaces, and launches--all belonging to her majesty's ships lying out at spithead--were coming fast, as well as shore boats and numerous other craft that blackened the waters. and they bore in them a gaily-dressed crowd of men and women, the ladies being adorned in all those beauteous garments which they know so well how to assume on such an occasion; while, among the gentlemen, frock-coats, tall hats, and white waistcoats, as well as full dress, or 'no. ' uniform, were the order of the day. for all these ship's-boats, after putting off from the battleships and cruisers to which they belonged, had, by order of the vice-admiral commanding the channel squadron, called at the above-named places to fetch off the visitors to the whale island festivities. stephen charke, in the uniform of the r.n.r., came in the picket-boat of the _bacchus_, wherein he had been lunching with the wardroom officers, and as she went alongside of southsea pier, and afterwards at the old town pier, he had eagerly scanned the ladies who were waiting to be taken off. he was not, however, particularly disappointed or cast down at not seeing the one girl he was looking out for at either of them, since, in the continual departure of similar boats, and the running backwards and forwards of these craft between whale island and the landing-stages, it was, of course, hardly to be supposed that she would happen upon the particular boat in which he was. he saw her, however, directly he, with his companions, had made their way to the lawn on which the wife of the port-admiral was receiving her guests, and--in so seeing her--he recognised instantly that he was not going to enjoy his afternoon as much as he had hoped to do. 'who's that?' he asked of the staff-commander of the _bacchus_, with whom he happened to be walking at the moment. 'i mean that flag-lieutenant talking to the young lady in the white dress?' 'that?' replied his companion, regarding the young officer indicated. 'oh, that's gilbert bampfyld, flag-lieutenant to the rear-admiral. he's a good chap; i'll introduce you later. a lucky fellow, too. he's heir to his uncle, lord d'abernon. he's all right,' he concluded inconsequently. 'i know the young lady,' stephen said. 'i've been at sea with her uncle.' 'good-looking,' said the staff-commander, who was a single man. 'fine girl, too. i hope she's coming to the ball.' 'she is,' charke replied, and then stood observing her companion from the little group of which they now formed part. certainly the young officer was 'all right,' if good looks and a manly figure can entitle any one to that qualification. he was undoubtedly handsome, with the manliness which women are stated (by authorities on such matters) to admire: his bright eyes and good complexion, as well as his clear-cut, regular features, leaving little else to desire. he was also fairly tall, while, if anything were required to set off his appearance, it was furnished by his full-dress and his flag-lieutenant's aiguillettes. he was talking now in an animated way, as charke could see easily enough from where he stood by the refreshment tent; and it was not possible for him to doubt that he was making himself very interesting to bella. for a moment, stephen stood hesitating as to whether he should go up and present himself to the girl who had never been out of his thoughts since he said 'goodbye' to her in west kensington; then, while he still debated the matter in his mind, bella saw him and smiled and nodded pleasantly, while she looked--as he thought--as though she expected he should come up to her. which of course decided him. there was no affectation in the manner wherewith bella greeted him; in truth, she was glad to see him and, honestly, as she did everything else, she said so. 'i have been looking for you for the last half-hour,' she remarked, as he reached her side, 'and wondering if you were coming or not'; after which she introduced stephen charke and gilbert bampfyld to each other. then, some other officers coming up at this moment, more introductions took place, while bampfyld said that he must move off. 'i have escaped from my admiral for a few moments,' he said, while he added with a laugh: 'i am not quite sure, however, that he is not congratulating himself on having escaped from me. i hope, miss waldron,' he added, 'that you have an invitation for the ball?' 'yes,' bella said; and she smiled at lieutenant bampfyld's request that he might not be forgotten on that occasion, though she did not say positively whether that calamity would occur or not. then, when he had moved on to join the distinguished officer to whom it was his duty to be attached almost as tightly as a limpet to a rock, she said to charke, 'come, now, and see mamma. she is in the shade behind the tent, and she has found an old friend of father's.' but it was so evident that mrs. waldron was thoroughly enjoying herself with that old friend, who was a retired post-captain (she was, indeed, at the moment of their arrival engaged in reminiscences of the north american and west indian stations), that they strolled away together, and, finding soon another shady seat, sat down and passed an agreeable hour or so. wherefore, as you may thus see, stephen charke did spend a happy afternoon, notwithstanding that first apparition of the flag-lieutenant in converse with the girl who was now never out of his thoughts. indeed, it would have been to him a perfect afternoon, had he not more than once seen bampfyld (who again appeared to have escaped from his admiral!) roaming about the place with a somewhat disconsolate, as well as penetrating, look upon his face; which look charke construed into meaning that the other was seeking for the girl of whom he himself had now obtained temporary possession. however, even so, he did not think it necessary to call bella's attention to the fact. but we must not tarry over these soft summer beguilements to which the old naval capital and all in her had given themselves up. there lie other matters before us--matters which, when they afterwards occurred, caused three people now partaking of these enjoyments to, perhaps, cast back their memories,--memories that were not untinged by regret. suffice it, therefore, that we hurry on, and passing over another garden-party which took place at the military commandant's, and an 'at home' given on board the foreign visitors, flagship, as well as entertainments at which only the male sex were present, we come to the naval ball at the town hall. that was a great night, a night on which, if one may judge by subsequent events, many loving hearts were made happy; on which, too, some saw the dawn of the first promise of future happiness--and one man, at least, was made unhappy. it was a great night! a night no more forgotten by three people in the days that followed it than was the garden-party which preceded it by a day or so. the first lord of the admiralty led off the quadrille with the wife of the commander-in-chief, while the prince who was in command of the foreign fleet danced with the first lord's wife; there being in that set, round which the other guests formed a vast circle, the most prominent individuals then present in portsmouth. and bella, standing close by with her hand upon the arm of stephen charke, while they waited for the first dance in which all the guests could participate, felt that, at last, she knew what a ball was. 'it isn't quite like a state ball,' whispered lieutenant bampfyld to them as he passed by with his admiral, he being qualified to give such information in consequence of his duties as flag-lieutenant having often given him the opportunity of attending those great functions, 'but it is much prettier.' then he disappeared for a time. 'it could scarcely be prettier than it is,' bella said to charke. 'how has the room been made so beautiful?' 'the men of the _vernon_ have done it all,' her companion answered; 'they are good at that sort of thing.' as, indeed, they seemed to be, judging by the effect they had produced. trophies of arms, flags, devices, life-buoys white as snow, with the names of vessels belonging both to the visitors and ourselves painted in gold upon them, decorated the vast room; while, from the dockyard, had been unearthed old armour and weapons, such as, in these present days, are forgotten. also the colour lent by various uniforms, naval, military, and marine, as well as by flowers and the bouquets carried by ladies, added to the brilliant scene--while the sombre black of civilians helped to give a contrast to the bright hues. for civilians were not forgotten: admiralty officials, private residents, special correspondents--with a wary eye on their watches, so that they might be able to rush over to the post-office with their last messages for the great london and provincial papers--were all there. 'come,' said stephen charke, as the band of the royal marines struck up the first waltz, 'come, miss waldron; it is our turn now.' and for ten minutes he realised what happiness meant. that he would have to resign her for the greater part of the evening, he knew very well--her programme was already full!--his name appearing three times on it, and lieutenant bampfyld's also three times--yet, later, he did so none the less willingly for that knowledge. how could he? he loved the girl with his whole heart and soul--madly! 'i shall love her always, until i die,' he muttered to himself as he stood by, seeking no other partner and watching her dancing now with the flag-lieutenant. then, next, he saw her dancing with the flag-lieutenant of the other admiral--though that did not seem to him to be so disturbing a matter. 'till i die!' he repeated again; and then once more called himself a fool. his second dance with her arrived, and once more he was in his seventh heaven; for the moment he was again supremely happy. 'i hope i may have the pleasure of taking you in to supper,' he almost whispered in her ear as they paused for a moment for breath, and it seemed as if the light of his enjoyment--for that evening at least--had been suddenly extinguished when she, raising those sweet, clear eyes to his, exclaimed: 'oh, i am so sorry! but i have promised lieutenant bampfyld that he shall do so.' for the remainder of the ball charke did not let a single dance pass by without taking part in it, and allowed his friends to introduce him right and left to any lady who happened to require a partner, though reserving, of course, the one for which he was engaged to bella at what would be almost the end of the evening. in fact, as his friend the staff-commander said, 'he let himself go pretty considerably,' and he so far exemplified that gentleman's remark that he took in to supper one of the plainest of those middle-aged ladies who happened to be gracing the ball with their presence. yet this lady found nothing whatever to complain of to herself (to her friends she would have uttered no complaint of her cavalier, even though he had been as stupid as an owl and as dumb as a stone, she being a wary old campaigner), but, instead, thought him a charming companion. perhaps, too, she had good reason to do so, since, from the moment he conducted her across the temporarily constructed bridge which led from the town hall proper to the supper tent erected in a vacant plot of ground, his conversation was full of smart sayings and pleasant, though occasionally sub-acid, remarks on things in general. yet, naturally, it was impossible that she should know that the undoubtedly bright and piquant conversation with which he entertained her was partly produced by his bitterness at seeing gilbert bampfyld and bella enjoying themselves thoroughly at a table _à-deux_ close by where he and his partner were seated, and partly by his stoical determination to 'let things go.' and by, also, another determination at which he had arrived--namely, to go to sea again at the very first moment he could find a ship. chapter v 'so farewell, hope!' nine months had passed since the entertainment of the foreign fleet at portsmouth--months that had been pregnant with events concerning the three persons with whom this narrative deals; and bella sat now, at the end of a dull march afternoon, in the pretty drawing-room in west kensington. she sat there meditating deeply, since she happened to be alone at the moment, owing to mrs. waldron having gone out to pay several calls. of all who had been at those entertainments, of all in the party which, in the preceding june, had gathered together at portsmouth, the three ladies of the family, mrs. waldron, mrs. pooley, and bella, were alone in england; the three men--the three sailors--were all gone to different parts of the world. captain pooley had sailed with his vessel to australia; stephen charke had gone to china as first officer of a large vessel; and gilbert bampfyld, who, in consequence of the rear-admiral's retirement, no longer wore the aiguillettes of a flag-lieutenant, had been appointed to the _briseus_, on the east indian station. and bella, sitting now in her arm-chair in front of the drawing-room fire, with a letter lying open on her lap before her, was thinking of the writer of that letter, as well as of all that it contained. if one glances at it as it lies there before her, much may be gleaned of what has happened in those nine months; while perhaps, also, some idea, some light, may be gained of that which is to come. 'my darling,' it commenced (and possibly the writer, far away, may have hoped that, as he wrote those words, they would be kissed as often by the person to whom they were addressed as he fondly desired), 'my darling--your letter came to me to-day, and i must write back to you at once--this very instant--not only because i want to put all my thoughts on paper, but also because i can thus catch the p. and o. mail. how good! how good you are! while, also, i do not forget how good your mother is. i know i ought not--at least i suppose i ought not--to ask you to do such a thing as come out to me, and i can assure you i hesitated for weeks before daring to do so. yet, when i reflected that, if you could not bring yourself to come, as well as induce your mother to give her consent to your coming, we could not possibly be married for three years, i could not hesitate any longer. and now--now--oh, bella, my darling! i could dance for joy if my cabin was big enough to allow of such a thing--you are coming! you will come! how happy we shall be! i can think of nothing else--nothing. you don't know how i feel, and it's useless for me to try to tell you....' no more need be read of this letter, however, and, since the reader will shortly be informed of what led to it, nothing more need be said than that, after a good deal of explanation as to how the young lady to whom it was addressed was to make her plans for reaching bombay, it was signed 'gilbert bampfyld.' so that one sees now what had been the outcome of that week of delight at portsmouth during the last summer; one understands all that had been the result of those garden-parties and that ball. they--the festivities--were followed by a renewal of the acquaintanceship between mrs. waldron and her daughter and gilbert bampfyld, as, indeed, the latter had quite made up his mind should be the case, and as--since the truth must always be spoken--bella had hoped would happen. they were followed, that is to say, directly the naval man[oe]uvres were over, for which important function both divisions of the channel squadron were of course utilised, while not a week had elapsed from the time of the return of the ships to their stations before gilbert bampfyld presented himself in montmorency road. and that presentation of himself at this suburban retreat was, it is surely unnecessary to say, succeeded by many other things, all showing what was impending and what actually happened later on. gilbert bampfyld told bella that he loved her and wanted her for his wife, and--well, one can imagine the rest. what was there to stand between those loving hearts? what? nothing to impede their engagement, nothing that need have impeded their immediate marriage, except the fact that bella's maiden modesty could never have been brought to consent to a union so hurriedly entered into as would have been necessary, had she agreed to become gilbert's wife ere he set out for bombay to join the _briseus_, to which he was now appointed. one regrets, however, when describing such soft and glowing incidents as these, that space is so circumscribed (owing to the canvas having to be filled with larger events now looming near) as to leave no room for more minute description of this love idyl. it would have been pleasant to have dwelt upon bella's ecstatic joy at having been asked to be the wife of the one man--the first man--whose love she had ever desired (ah, that is it--to be the first man or the first girl who has ever touched the heart of him or her we worship); only it must not be--the reader's own imagination shall be asked to fill the missing description. let those, therefore, who remember the earliest whispered word of love they ever spoke or had spoken to them; who recall still the first kiss they ever gave or took; and those who can remember, also, all the joy that came to them when first they loved and knew themselves beloved, fill the hiatus. that will suffice. 'we shall be so happy, dearest,' gilbert said, when all preliminaries had been arranged in so far as their engagement was concerned, and when he did not know at the time that he was about to be sent on foreign service, but hoped that he would either be allowed to remain in the channel squadron or be transferred to the training squadron, or, at worst, appointed to the mediterranean. 'we shall be so happy, darling. i hoped from the first to win you--though--though sometimes i feared there might be some one else.' 'there could never have been any one else. never, after i had once met you,' she murmured. 'oh, gilbert!' and then she, too, said she was so happy. yet a moment later she whispered: 'but, somehow, it seems too good to be true. all has come so easily in the way that i--well, as we--desired, that sometimes i think there may be--that something may arise to--to----' 'what--prevent our marriage? nothing can do that. nothing could have done that--nothing!' 'suppose your uncle, lord d'abernon, had objected?' she said, remembering that she had heard how this nobleman was not always given to making things quite as easy and comfortable to those by whom he was surrounded as was considered desirable. 'suppose that had happened?' 'oh, he's all right,' gilbert replied. 'he expected his opinion to be asked and his consent obtained, and all that sort of thing, but, outside that, he's satisfied. and if he wasn't, it wouldn't have made any difference to me--after i had once seen you.' for which remark he was rewarded with one of those chaste salutes which bella had learnt by now to bestow without too much diffidence. as regards mrs. waldron--well, she was a mother, and it was not to be supposed that such a distinguished match as bella was about to make could be aught but satisfactory to her; while captain pooley, who had not yet departed with the _emperor of the moon_ for australia, told his niece that she was a lucky girl. he also informed gilbert that, as he was a childless man, bella would eventually fall heiress to anything he and his wife might leave behind them. matters looked, therefore, as though they would all go merry as the proverbial marriage bell. all, as the old romancists used to say, was very well. then fell the first blow--the one that was to separate those two fond hearts. gilbert was suddenly appointed to the _briseus_ and ordered to proceed to bombay to join her at once, and a fortnight later he was gone, and poor bella was left behind lamenting. she was sitting, lamenting still, before her fire on this march day, with this newly-arrived letter on her lap--in solemn truth, she had been lamenting his departure ever since it had taken place--when, suddenly, there broke in upon her ears the sound of a visitor's knock below. then, ere she could distinguish whose voice was addressing the servant who had answered the door, she heard a manly footstep on the stairs, and, a moment later, the maidservant announced: 'mr. charke.' mr. charke! the man whose memory had almost faded from her mind--as she had reproached herself for more than once, when it did happen to recur to her--the man whom she had learnt to like so much during all that happy time last year. now, as she gazed on him, and noticed how brown he was as he came forward--more deeply browned, indeed, than she had thought it possible for him, who was already so tanned and sunburnt, to be--and noticed, too, the strong, self-reliant look on his face, she reproached herself again. she acknowledged, also, that she had liked him so much that even her new-found happiness ought not to have driven all recollection of him entirely from her mind. then she greeted him warmly, saying all the pleasant little words of welcome that a woman whose heart goes in unison with her good breeding knows how to say; and made him welcome. yet, as she did so, she observed that he was graver, more sad, it seemed to her, than she had ever remarked before. 'you are not ill?' she asked, as this fact became more and more apparent to her. 'surely, you, a sailor, have not come back from the sea unwell? at least i hope not.' 'no,' he said, 'no. nor, i hope, do i seem so. do you know that, besides any desire to call and see you, i came for another purpose?' and now his eyes rested on her with so strange a light--so mournful, deep a light--that in a moment her woman's instinct told her what he meant as plainly as though his voice had done so. like a flash of lightning, that instinct revealed to her the fact that this man loved her; that, from the moment they had parted, months ago, she had never been absent from his mind. she knew it; she was certain she was right--she could not be deceived! then to herself she said: 'heaven help him--heaven prevent him from telling me so.' but aloud, her heart full of pity, she said: 'indeed,' and smiled bravely on him while she spoke. 'indeed, what was that purpose?' 'to congratulate you. to---- 'congratulate me!' 'yes. i met the _emperor of the moon_ at capetown. we were both homeward bound. and--and--your uncle told me the news. i offer my congratulations now.' yet, as he said the words, she saw that his face was turned a little aside so that she could not perceive his eyes. congratulations! well, they might be sincere in so far as that, because he loved her, he wished her well and desired that she should be happy, but--but--otherwise--no! it was not to be thought upon. as he said the words: 'i congratulate you,' he followed an old custom--one more foreign than english--and held out his hand, taking hers. and he kept it, too, fast in his own, while he said in the voice that his struggles with the elements had made so deep and sonorous: 'yes, i congratulate you. i must do that. to--to--see you happy--to know you are so, is all that i have--all--i hope for now. yet there is no treachery to him in what i say. heaven help me! i mean none--but--but--i--from the first--i have lo----' 'no, no,' she murmured, striving to withdraw her hand, yet not doing so angrily. 'no, no. don't say it, mr. charke. don't, pray don't.' and, now, neither could he see her eyes nor her averted face. 'don't say it. you do not desire to make me unhappy?' she murmured. 'never, as god hears me. but--i have said it. i had to say it. goodbye.' 'goodbye,' she said--and then, as he neared the door, she turned once and looked at him with eyes that were full of intense pity and compassion. chapter vi 'and bend the gallant mast, my boys' events are now drawing near to that night when bella was to have those distressing dreams which have been mentioned at the opening of this narrative; all was arranged for her departure to bombay. a little more, and she will be on her way to india and to wedlock. yet all had not been quite easy and smooth in the settlement of affairs. at first, mrs. waldron, good, loving mother though she was, and fully cognisant of the facts--namely, that bella loved lieutenant bampfyld madly and would be an unhappy woman if she did not become his wife long ere three years had passed, and that the match which her child was about to make was undoubtedly a brilliant one--refused to hear of such a thing as that she should go out to him. 'if you are worth having,' she said, when first the proposal was submitted to her, 'you are surely worth coming for.' and, since this was a truism, it was hardly to be gainsaid. yet, as we know by now, she had been won over by her daughter's pleadings and entreaties; by, too, the plain and undeniable fact that there was not the slightest possibility of lieutenant bampfyld being able to come home to marry her, or to return to england in any way--short of being invalided--until the _briseus_ herself returned. then, no sooner had this difficulty been surmounted than another reared its head before mother and daughter. how was she to go out to bombay alone and unprotected? a young married woman, who had to proceed to india to join her husband, might very well undertake such a journey, but not a young single woman such as bella was, while for chaperon or protectress there was no one forthcoming. at first, it is true, mrs. waldron had meditated accompanying bella herself (she being an old sailor, to whom long sea voyages were little more than railway journeys are to some more stay-at-home ladies); only, down in the depths of her nature, which was an extremely refined one, there was some voice whispering to her that it would be indelicate to thus bring her daughter out in pursuit of her affianced husband. it is true, however, that authorities on social etiquette who have since been consulted have averred that this was a false feeling which was in possession of mrs. waldron's mind; but be that as it may, it existed. then, too, she still regarded the matter of her child going to her future husband, instead of that husband coming to fetch her, as one of particular delicacy; one of such nicety as to permit of no elaboration; and she resolved that, come what might--even though she should have to purchase, or hire rather, the services of an elderly and austere travelling companion--she must not herself accompany bella. 'heaven knows what is to be done,' she said to her daughter, as they discussed the important point, 'but i suppose it will come to that'; the 'that' meaning the hired chaperon. then she sighed a little, remembering how the late captain waldron had encompassed thousands of miles in a voyage which he made from the antipodes to espouse her. yet, ere many days had passed, the clouds of obstruction were suddenly removed in a manner which seemed almost--as the fond mother stated--providential. captain pooley's ship had followed home, after a week or so of interval, that in which stephen charke had returned to england, and its arrival was soon succeeded by his own in montmorency road. 'going out to him to be married!' he exclaimed, after his sister--who happened to be alone at the time of his visit--had made him acquainted with what she had given her consent to some two or three months before, on gilbert's application backed up by bella's supplications, and which consent she had moaned over inwardly ever since she had so given it. 'going out to be married, eh? why, she must want a husband badly!' yet, because he knew well enough the customs of her majesty's service and the impossibility which prevailed in that service of an officer coming home to marry his bride, he did not repeat her words, 'if she is worth having, she is worth coming for.' 'so other people have thought, if they have not openly said so,' mrs. waldron replied. 'i am sure they must have thought so. yet,' she went on, with determination, 'i have agreed to it, and i cannot retract my word. it is given, and must be kept. no, it is not that which troubles me.' 'what, then?' 'why, the getting out. how is the child to go alone, in a great liner, with two or three hundred passengers, all the way to bombay? how?' she repeated. 'bombay, eh? bombay. oh, well, if that's her destination, she can go comfortably enough. there need be no trouble about that. only she will be more than double the time the p. and o., or any other line, would take to carry her.' 'what do you mean, george?' 'why,' he said, 'i happen to be taking the old _emperor_ to bombay next month with a general cargo--calling at the cape on the way. she can go with me, and welcome. there's a cabin fit for a duchess which she can have.' * * * * * * it was a cabin fit for a duchess, as bella and her mother acknowledged when, a fortnight later, they went down to gravesend to inspect the _emperor of the moon_, and after it had been decided in solemn family conclave that, by this ship, the former should make the voyage to india. and it was more than likely that the girl would make it under particularly pleasant circumstances, since this was one of those occasions on which mrs. pooley had decided to accompany her husband, she not having felt very well during the past winter. at present, the cabin was empty and denuded of everything, pooley having decided to have it refurnished; but when he told them how that furniture would be arranged in the great roomy place, which would have been dignified as a 'state-room' in one of the old clippers, bella said again, as she had said so often before, that 'he was the best old uncle in the world.' now the _emperor of the moon_ was a smart, though old-fashioned, full-rigged ship of about six hundred tons, her lines being perfect, while leaving her full of room inside. her saloon was a comfortable one, well furnished with plush-covered chairs and benches--the covering being quite new; a piano--also looking new--was lashed to the stem of the mizzen-mast, while there were swinging vases, in which, no doubt, fresh ferns and flowers would be placed later. on deck she was very clean and white, with much brass and everything neat and shipshape, while the seaman who should regard her bows and stern would at once acknowledge that she left little to desire, old as she was. for, in the days when she was laid, they built ships with a view to both sea qualities and comfort, and the _emperor of the moon_ lacked neither. her sleeping-cabins were bedrooms, her saloon was a dining-room as good as you would find in a fifty-pound-a-year suburban residence, and her masts would have done credit to one of her majesty's earlier ships. altogether, bella was pleased with everything, especially with her cabin, which was on the port side of the saloon, and she was, besides, pleasantly excited at the idea of so long a sailing voyage. 'i know,' she said to her uncle, 'that we shall have a delightful time of it, and for companionship i shall have you and auntie. that's enough.' 'you will have some one else, too,' pooley said, with a smile; 'you know i have two officers. come'--and again he smiled--'it is our "lay days,"' by which he meant that they were shipping their cargo. 'come, i will introduce them to you.' then he led the way up the companion to the deck. they met one of these officers, the second mate, a young man whom pooley introduced as mr. fagg, and then, while they were all talking together, bella heard a deep, low voice behind her say: 'how do you do, miss waldron?' a voice that caused her to start as she turned round to find herself face to face with stephen charke. 'you!' she exclaimed involuntarily. 'you! are you going on this voyage?' 'i am first officer,' he said. 'i wanted a berth, and captain pooley has given me one.' and amidst her uncle's joyous laughter and his remark that he knew this would be a pleasant surprise for bella, and while, too, mrs. waldron said that she was delighted to think he would be in the ship to look after her daughter, that daughter had time to think herself--to reflect. in her heart, she would far rather that charke had not been here; while she wondered, too, how he could have brought himself to accept his present position, knowing, as he must have known, that she was going in the ship. 'it is so vain, so useless,' she thought; 'and can only lead to discomfort. we shall both feel embarrassed all the way. oh, i wish he were not coming!' then, although she pitied him, and although she had always liked him, she resolved that, through the whole of the time they were together in the ship, she would see as little of stephen charke as possible. 'you do not object to my presence, i hope?' he said a moment later, as they both stood by the capstan alone--pooley and his wife and sister having moved off forward. 'i should be sorry to think that my being here was disagreeable to you. i have to earn my living, you know.' 'what right could i have to object, mr. charke?' 'perhaps you think i have behaved indiscreetly?' for a moment she let her eyes fall on him and rest upon his own; then she said: 'i will not give any opinion. you have to earn your living, as you say; while as for me--well, you know what i am going to india for.' 'yes,' he answered. 'i do know.' after which he added: 'do not be under any wrong impression. i shall not annoy you. i am the chief officer of this ship and you are a passenger. that is, i understand, how the voyage is to be made?' 'if you please,' bella replied very softly, and the tones of her voice might well have brought some comfort to him, if anything short of the possession of her love could have done so. a fortnight or three weeks later the pilot had left the _emperor of the moon_, the lee main braces were manned, the ship was lying over under her canvas, the wind was well astern. bella was on her way to india and her lover! let us pass over this parting between mother and child, the fond embraces, the tears and sobs which accompanied that parting following after the dawn when we first made the girl's acquaintance, and following, too, that night of unrest and disturbing dreams. no description of such partings is necessary; many of us, young and old, men and women, have had to make them; to part from the loved, gray-haired mother who has sobbed on our breast ere we went forth to find our livelihood, if not our fortune, in a strange world; many of us have had to let the child of our longings and our hopes and prayers go forth from us who have sheltered and nurtured it--from us who have perhaps prayed god night and day that, in his mercy, it might never leave our side. we go away ourselves because we must; also they go from us because they must; and there is nothing but the same hope left in all our hearts--the hope that we shall not be forgotten--that, as the years roll by, those we have left behind will keep a warm spot for us in their memory, or that those who have left us behind will sometimes turn their thoughts back longingly to us in our desolation. it has to be, and it has to be borne; alas, that parting is the penalty we all have to pay for having ever been permitted to be together. and, so, across the seas, the stout old _emperor of the moon_ went; buffeting with the channel, throwing aside the rough waves with her forefoot as though she despised them, sinking england and home behind her with every plunge she made. and at the moment that she was leaving the lizard far away astern of her, and was running well out into the atlantic, a telegram was delivered in montmorency road addressed to bella, which was opened by her mother. a telegram signed 'gilbert,' which ran: 'don't start. _briseus_ appointed to east coast africa, slaver catching.' a telegram that had come three days too late! a telegram that was re-forwarded to capetown, where it lay for forty-seven days awaiting the arrival of the _emperor of the moon_, and, then,--was forgotten! chapter vii 'an ocean waif' from the time the men had sheeted home the topsails as the _emperor of the moon_ got under way until now when, having left the cape of good hope behind her, she was travelling through the water at a very fair speed and with her head set due north, scarcely anything had occurred much worthy of note. soon--after the first two days had passed, during which time bella had lain flat in her berth in the large roomy cabin provided for her by her uncle, while his wife had administered to her odd glasses of champagne, little cups of rich, succulent soup, and such like delicacies--the girl was able to reach the deck. and, once there and under an awning stretched from the ensign staff to past the mizzen-mast, she would sit and meditate for hours on the forthcoming meeting with her lover which was drawing nearer and nearer with each plunge of the emperor's forefoot into the sapphire sea. sometimes, too, she would read aloud a novel to mrs. pooley, who, perhaps because she was good and motherly, and fat, would listen to nothing but the most romantic love-stories which the vivid brains of fashionable novelists could turn out; though, when alone, and reading for her own amusement, bella would pore over books of adventure in wild parts of the world, or devour some of the histories of marine voyages which her uncle possessed in his neat mahogany bookcases below. of stephen charke she saw, of course, a good deal, as it was natural she should do. you cannot be in a ship, however large or small, without seeing much of all on board; but when it comes to sitting down every twenty-four hours to what captain pooley called 'four square meals a day, with intervals between for refreshments,' you must not only be brought into constant touch with your companions, but also enter into much discourse with them. yet, as the girl told herself, charke was behaving well, extremely well; so that, gradually, she lost all sense of discomfort that would otherwise have arisen through being thrown continuously into his society, and, ere long, she would observe his approach without the slightest tremor of susceptibility. soon, too, she began to acknowledge to herself that stephen was a gentleman in his feelings, and that, no matter what his sentiments might be towards her--if they existed still and were unchanged from what they had once been--he at least knew how to exercise that control over them which a gentleman should be capable of. until now, he had never said one word to her that any other person might not have uttered who had found himself thrown into her society on board the _emperor of the moon_, nor had he unduly sought her presence or, being in it, endeavoured to remain there as long as it was possible. nothing of much note had occurred thus far on the voyage, it has been said; yet there had of course been some of those incidents without which no voyage of any distance is ever made. once through the bay, and, while they ran swiftly south, they had found themselves in a dense fog--a most unusual thing in such a latitude and at such a time of year; then, upon the top of that fog, there had sprung up a stiff breeze which gradually developed into a gale, so that, from clewing the main royal to furling the top-gallant sails of the mizzen and foremasts was but the action of a moment, as was the next work of taking in the main top-gallant sail. and thus, ere long, bella had her first experience of what a storm at sea was like, and, as she heard the live stock grunting and squealing forward; the ship's furniture more or less thundering about wherever it could get loose; the piano--on which, only the night before, she had played the accompaniment to her uncle's deep bass voice as he trolled out 'in cellar cool'--thumping heavily against the bulkhead to which it was usually lashed, and the cries of the sailors as they uttered words which might not, perhaps, be properly denominated as 'cries, alone, she began to wonder how her darling gilbert could ever have chosen such a calling. while, too, the streaming planks when, at last, she ventured on deck, the dull sepia clouds and the mournful look of the emperor herself, under reefed topsails, foresail, fore topmast staysail, main trysail and spanker, as she rolled and yawed about in the troughs and hollows of the sea, and took the water first over one bow and then over another--and then, for a change, over her stem--only increased that wonder. yet, lo! the next morning--for the sea is a great quick-change artist, volatile and variable as a flirt, though too often as tragic as medea herself--when bella looked out of her scuttle, against which the green water now slapped boisterously but not viciously--all was changed. a bright sun shone down from the blue heavens, the ship had still got a roll on her, though not an unpleasant one--and the girl felt hungry. which was as good a sign that the storm was over as could well be wished for. 'it has been a rough night,' stephen charke said, as he rose from his breakfast on her entrance to the saloon, helped her to her chair, and bade the steward bring coffee and hot rolls and bacon--all of which were already perfuming the air. 'your uncle is now on deck. we have been there all night.' 'i thought,' said bella, pouring out her coffee and smiling pleasantly, since now all fear had departed from her mind that charke would misconstrue any friendly marks of intimacy she might be disposed to graciously bestow on him, 'that i was at the end of my journey. indeed, that we all were; that it was brought to a sudden end; accomplished. that----' 'that,' said stephen, smiling too, sadly enough, yet enhancing wonderfully his dark, handsome looks by doing so, 'that perhaps mr. bampfyld might miss his bride!' for a moment bella's hazel eyes flashed at him, and he thought how wondrously beautiful they looked as they did so--then a serious expression came on her face. while, after pausing a moment, as though scarcely knowing what answer to make or whether she should make one at all, she said: 'yes. that he might miss his bride. my death, and that alone, could cause him to do so.' and as she spoke she looked stephen straight in the face, while feeling again--to her regret--that old sentiment of doubt of him which she had come to believe she had conquered and subdued. 'his death would cause the same result,' he answered, speaking slowly, hesitatingly, for in truth he felt as if he were treading on dangerous ground. and in a moment he found such was the case. 'mr. charke,' the girl said, very quietly now, 'i should be so much obliged to you if, during the remainder of our journey together, you will neither discuss my affairs nor those of my future husband, nor him. it will make the voyage pleasanter to me if you will do that.' as she spoke, the bell struck two, and, since the watches had been disorganised by the storm of the night, that sound meant that captain pooley would now come below for his breakfast, and his place above be taken by the mate. therefore, he turned towards the stairs, muttering: 'i beg your pardon, i am sure. pray forgive me. i will not offend again.' then he disappeared on to the deck. yet an hour later he stood by her side beneath the awning, and now he was directing her attention to something that, a mile off, was the object of attention from every one on board. the captain and his wife were both regarding it fixedly; so, too, were the men forward; the only persons not present being, of course, the watch below and the second mate, mr. fagg, who had now turned in. 'what do you make it out to be?' asked pooley of stephen, as they still gazed at it. 'it is not a baby nor a child; yet it is scarcely bigger than the first. can it be a dog?' 'no,' said charke authoritatively, as though his younger eyesight was not to be disputed; 'it is either a young tiger or a panther cub afloat on a water-cask. there has been a wreck during the night, i expect, and it has got adrift. perhaps,' he said, 'if we cruise around a bit we may find some human life to save.' 'how should it be aboard any ship?' asked the captain. 'who takes tigers or panthers for passengers?' 'plenty of people,' charke answered quietly. 'they are brought home to sell to the menageries and zoos. a cub like that is worth twenty pounds--worth looking after. guffies bring them home sometimes, sailors often. meanwhile,' he added, 'according to the set of the waves, that thing will be alongside us in a quarter of an hour. i'll bet a day's pay it strikes the ship betwixt the main and mizzen channels.' 'oh,' exclaimed mrs. pooley and bella together, 'do let us save it and get it on board! it will,' said the latter, 'be such a lovely plaything--and such a curiosity! fancy a girl from west kensington who has never had a plaything or pet more stupendous than a canary, a cat, or a fox-terrier, having a tiger. why,' she exclaimed, with a laugh which gave to her short upper lip an appearance of tantalising beauty, 'una will be outdone by me--a girl of the nineteenth century!' tantalising or not as that smile might be, it led to the salvation of the cub; for, with a swift look at the captain which was meant to ask for his assent, charke called to one of the sailors to get over into the channels and down on to the fourth futtock, he telling him with wonderful accuracy the exact spot where the water-cask would strike the stationary ship. five minutes later, that which he had calculated with such precision came to pass, the cask touched the vessel's side almost immediately beneath the man's feet, and, in another moment, the cub had been caught by its loose skin in the exact middle of its back and hauled up, squealing, spitting and scratching, on to the deck. 'the little beast!' exclaimed the mate, as he sucked the back of his hand where the creature had clawed him; 'the little beast! this is a pretty reward for our saving it from drowning!' and he administered a sound kick to the thing as it lay on the deck. so sound and rousing a one, indeed, that it gave a grunt of pain, and, with its claws--about as big, or bigger, than those of a good-sized cat--endeavoured to fasten on to his legs. while, from its yellow, scintillating eyes, it emitted a glance of such malignant ferocity as, had it been more fully grown, might have alarmed a braver man than he. 'oh, how cruel to kick that poor little half-drowned thing!' bella exclaimed reproachfully; 'it never meant to hurt you, only it was frightened. poor little thing!' she said again, and, even as she spoke, she knelt down on the deck and stroked the wet, striped ball that lay there. and it seemed as if her gentleness had some power to soothe whatever ferocious instincts--still dormant and undeveloped at present--were smouldering within it. for, instead of now using its paws as weapons with which to strike out and attack anything near it, it played with her as a kitten plays with a ball, tapping at her hand and trying to catch it, and pushing and kicking against her with its hind legs. 'you see,' she said, looking up at charke with a glance in which she could not disguise her dislike of his violence, 'you see, at present, at least, it does not try to harm those who treat it well.' 'yes,' he said, 'i see.' then he added, half-bitterly, half-morosely: 'no one doubts your powers of fascination, miss waldron.' chapter viii 'his name is--what?' the saving of this creature, which bella elected to call bengalee, because she said she was sure it came from bengal, and also because she had once sung a song having that name, was followed by no other events of any importance whatever. nor need their stay at the cape be dwelt upon, because it consisted simply of various visits which were paid in the outskirts by mr. and mrs. pooley, accompanied by bella; by the unloading of a considerable portion of the cargo of the _emperor of the moon_, and by the refilling of the hold with other goods saleable in india. and, now, they were once more on their way towards the equator, going due north instead of due south, as when they had last approached it, and with a cool southern breeze driving the emperor along under full sail. yet, so gentle was this breeze that, even if there had been any who were not sailors in the ship--as bella, as well as mrs. pooley, might now well be considered, after the length of voyage she had already gone through, added to a few extra days and nights of turbulence and storm--scarcely would they have felt any inconvenience from the motion. thus, therefore, with occasionally a dropping of the wind which reduced their speed a few knots, and, sometimes, with a total drop in it, so that they did not progress a knot an hour, while the ship swung slowly round and round the compass, they found themselves at the time which is about to be described in about latitude . s., and longitude . e., or, as near as may be, about miles to the s.w. of mauritius. wherefore, since the _emperor of the moon_ has arrived thus far in the indian ocean there has now to be set down a series of strange events which befell her, of so remarkable and peculiar a nature that one wonders that those events have never been chronicled before. for, far different from the ordinary stress and disasters which overtake ships at sea were those which have to be described; far different from those which the recorders of maritime calamities are in the habit of chronicling either in romance or dry-as-dust descriptions of facts. all of which the writer now proceeds to relate, beginning with so strange a coincidence as, perhaps, none but those readers who, in their voyage through life, have recognised that truth is more strange than the wildest fiction, will be willing to allow within the bounds of likelihood. however, to make a beginning--since the coincidence is true--the _emperor of the moon_ was in those latitudes above described when, it being a bright hot morning with the sea already gleaming like molten brass, with the pitch between the planks already of the consistency of putty, and with the brasswork in such a state of heat that it was unsafe to touch it unless one wanted to leave the skin of his palms and fingers behind them, the look-out on the fo'c's'le head yelled: 'sail, right ahead!' now, since nothing of this kind, neither steamer nor sailing vessel, had been seen since they had northed out of the west-wind drift, and since, also, the liners were rarely found outside of the equatorial current, this cry was sufficient to fill every one on board with a considerable amount of interest and excitement. 'whereaway?' called out charke, who was on the poop at this moment, the captain, his wife, and bella being below at breakfast; and, ere the man could repeat that the sail was right ahead and about five miles off, all those others there had come on deck. 'how pretty it looks, shining in the sun!' the girl exclaimed, as she regarded it through a pair of marine glasses which her uncle had placed at her disposal; 'and how the sail glistens! it looks like a star.' 'humph!' said the captain, as he gazed through his binocular. 'like a star! true enough, so it does. and,' he said, addressing the two mates who were standing near him, 'we have seen such stars hereabouts before, eh? do you think,' he went on, addressing charke, lowering his voice a little, 'it is one of those?' 'don't know,' charke said, working his own glass a good deal. 'can't see how it can be; too far to the east. bussorah, muscat, ras-el-had, mohamrah, oman--that's their mark. what should they be doing here?' 'all the same,' exclaimed pooley, 'it's the rig, and the true shape, that of a jargonelle pear cut in half. i do believe that's what it is. they might have been blown out of their course, you know, or chased by one of her majesty's ships. what do you think?' 'i think,' said charke, who always spoke of everything connected with his calling in the most unemotional manner possible, 'i think we shall know when we come up to her, as we must do in about half an hour. while,' he continued, with a subdued tone in his voice, while his eye glinted sideways towards where bella stood, 'we are not naval officers but only humble merchant seamen. there's no prize-money for us, therefore it is not our business.' bella had, of course, been listening attentively to all that had been said since she had come on deck after running lightly up the poop ladder, and now, hearing these words about 'naval officers' and 'prize-money,' her interest became more intense than before. 'oh, uncle!' she exclaimed, putting her hand on his sleeve, 'what does it all mean? naval officers and prize-money! that's not one of her majesty's ships?' 'no, my dear,' the captain replied, 'that is not one of her majesty's ships; but i shall be precious surprised if she doesn't turn out to be one of the very craft that her majesty's ships are always on the look-out for hereabouts, only rather closer in towards the african coast than this. she has all the build of an arab slave-dhow.' 'ay,' exclaimed charke, who was still using his glass freely, from where he stood behind them. 'ay, and something more than the build, too. if i'm not mistaken, her hatches have open gratings. what do you say, fagg?' turning to his junior. 'seems so, sir,' said that young officer, who never wasted more words than necessary, 'though i'm not quite sure.' 'i am,' replied charke. 'i can see the grating slits perfectly as we get nearer.' 'what does that mean?' asked bella, to whom this conversation conveyed nothing. 'it means,' said pooley, 'that there is live stock below those gratings. black cattle, as they used to be called on the west coast. ordinary hatches, to simply cover up cargo, are not made to let the air in. cargo can do without breathing.' 'how awful!' bella exclaimed, while through her mind there ran recollections of what she had heard or read casually of the slave trade in the old days, and also of the horrors of the north-west passage. 'how awful!' 'bad enough,' replied pooley, 'though not as bad as the old west african days, nor as shocking as you might think. the slave trade is a valuable one in this ocean, and those who are carried in the dhows are well enough fed. rice, indian corn, maize, and cassava is given them for food, and they have mats and matting galore to sleep on. persian merchants and arab gentlemen don't buy starved scarecrows for their domestic servants.' 'whatever she is, and whatever her cargo is, there's something wrong with her,' the chief mate suddenly exclaimed. 'she's off the wind now, and the fellow who was at the helm has left it. it is abandoned. by jove!' he exclaimed, 'he is lying wriggling by it. what on earth's the matter?' 'and,' added the second mate, 'there's a negro woman waving a red scarf. something's wrong there, no doubt.' 'we shall be up to them in ten minutes,' the master said, all bustle and excitement now. 'let go the foretack. stand by to lower the starboard-quarter boat'; while, as he spoke, the men of the watch who had been leaning on the fife-rail rushed to the falls to be ready to let the boat sink to the water when the proper moment came. to bella this seemed the most exciting moment of her life! there, in front of her, was one of those vessels, the name of which, or class of which, was almost unknown to her, except that, from odds and ends of conversation with her lover, she had gathered that these were the things in the chasing of which part of his existence might be passed until they met once more at bombay. here, on this glistening, glassy sea, the dhow lay--her one mast raking towards her bow instead of her stern, as is the case with most vessels of the western world, and her long white triangle of a sail unfilled and flapping listlessly. a dhow--perhaps a slaver! as her uncle and the mate had said--a dhow in sore distress with, writhing by her helm, the man who had lately been steering her, and, over her bow, that negro woman waving frantically the red scarf. excitement there was, indeed, in all this; excitement which caused bella, even as she eagerly watched the vessel they were approaching, to wonder how the striking up of the band at a ball, or the ring of the prompter's bell ere the curtain rose on a drama that all london was flocking to see, could have ever stirred her pulses. what were they, those trivialities, to the smiling, glistening face of this eastern sea--to the horror and the cruelties that this now tranquil ocean's bosom had enfolded through the ages. still the negress waved, not recognising, perhaps, in her blind, besotted, dumb, animal-like ignorance that help was at hand, and still, through their glasses, they could see that he who had steered the dhow now lay motionless. then, at her ear, as the _emperor_ came within six cable-lengths of the dhow, her uncle gave a few rapid orders, the second mate, accompanied by the boat's crew, jumped into the quarter-boat--the man at the wheel luffed until the vessel had not a motion in her. swiftly the boat was lowered, the rudder and thole pins shipped, and she was on her way to the dhow. 'what do you make of it?' the master roared to fagg ten minutes later, as, by then, the _emperor of the moon_ had come closer to the dhow through the motion of the swell. 'what?' 'i don't know what to make of it, sir,' the second mate called back. 'the man who was steering is, i think, dead. he does not move, and there is a white film over his eyes. the woman who waved the handkerchief seems well, but i cannot understand what she means. she does nothing but howl and point below.' 'are the hatches grated?' 'yes, sir, and there are four negroes beneath them. it is a slave dhow for certain. the negroes are shackled and handcuffed.' 'have you searched further?' 'i am going to do so now. the ship is settling, i think. there is a kind of poop superstructure forming cabins.' 'search at once; then bring all alive on board us.' in a moment mr. fagg had disappeared into what he had termed a 'kind of poop superstructure,' and, while he was in it, all on board the _emperor_ were occupied in speculating on what could have brought a slaver so far to the east and out of her ordinary course, and also in wondering what the mate would find during his further search. but that wonderment was soon to be resolved, for, ere mr. fagg had been out of their sight five minutes, he rushed back from the superstructure to the deck, and bawled through his hands: 'there is a young naval officer lying in the poop cabin, and he is slightly wounded. his name is--is----' 'what?' roared pooley, astonished at the mate's hesitation. 'it is marked on the rim of his cap--inside. it is--i--i am afraid it is miss waldron's _fiancé_. the--the--name is bampfyld.' chapter ix come over, come home through the salt sea foam. never, perhaps, on all that old highway of the waters, that silent road along which so many had steered their course to fabled ormuz and to ind, nor amidst fierce sea-fights 'twixt arab and persian, or arab and european in later centuries, nor in the howl of storm when the waters closed around the shipwrecked and doomed, had there arisen a more piercing shriek than that which now issued from bella waldron's blanched lips. 'my god!' she screamed, repeating the second mate's words. '"the name is bampfyld!" oh, it's gilbert--gilbert! there is no other in the navy list. let me go to him, uncle!' 'no, no,' the master said, while good mrs. pooley put her arms round the girl as she stood there by the poop-rails and endeavoured to calm and soothe her. 'no, no, bella; they will bring him on board directly, then,'--and in his desire to ease the girl's heart he raised the ghost of a smile to his lips--'then you shall nurse him till he is well. yet,' he muttered to charke, as he walked over to where the first mate stood, 'yet, how on earth does he find himself in that infernal dhow!' 'heaven knows,' the other answered. 'but, perhaps, 'tis not so strange, after all. there may have been a fight between his ship and the slaver--though there's not much fight in them when they get a sight of the british flag!--or he may have been sent to board her and got cut down, or half-a-hundred things. all of which,' he added, with his now usual cynicism, 'are equally likely or unlikely. anyhow, he is here--or will be in a few moments--and we shall have him for a passenger to bombay. your niece is in luck, sir,' and he turned on his heel and went down the ladder to the deck to see to the raising of the boat, which was now making its way back to the ship. to stephen charke, still loving the girl as madly as he did, still raging inwardly at the knowledge that every knot which the ship made was bringing her nearer to the man who, as he considered, had torn her from him, this incident seemed the last and most crushing blow of all. god knows what hopes the mate had cherished in his bosom since first he had learnt that bella was to be a passenger in her uncle's ship for about four months; what ideas might have been revolving in his mind as to whether, in those four months, something extraordinary, something almost unheard of--not to be dreamt of nor foreseen--might happen to give him one more chance of winning her. he was a romantically-minded man, a man with so rich an imagination that, to him, there sometimes came ideas that few are ever burdened with. and, in that full and teeming imagination, there had been pictured to him visions of the _emperor of the moon_ being wrecked and bella and he alone spared--he, of course, saving her at the peril of his own life and winning her away from her more aristocratic lover by so doing. or, he dreamt of that lover being himself wrecked and lost, or pierced by an arab spear in some affray, or shot in a hand-to-hand fight with a particularly bold slaver (since he knew well enough that the ships of the bombay station were often enough down here) or--or--or he cherished any mad vision that first rose to his brain. and now--now--this very man, this successful rival, this aristocratic naval officer, with his high birth and future peerage, was actually being brought aboard the ship where the woman was whom they both loved--brought on board 'slightly wounded,' and his own last chance thus gone. gone for ever now! perhaps, therefore, it was no wonder he should bite his lip and smother unholy murmurs deep down in his throat; perhaps, too, he merits compassion. he had loved this girl fondly since first he set eyes on her, and once, at one time, he thought he had almost won her. then this other had come in his way, had swept him out of bella's heart, or the approach to it, and his chance was over. yet, once again, they had met through an almost unheard of, and scarcely to be imagined, opportunity, and--lo! here was his successful rival once more at hand to thwart him. it was hard on him, or, as he muttered to himself, 'devilish rough.' the quarter-boat was coming back to the ship now, fagg steering her, while, between him and the stroke oar, there lay the body of the young naval officer, clad in his 'whites.' and again as bella, madly whispering 'gilbert, gilbert, my darling,' stood by the head of the accommodation ladder--which had been lowered while the boat was gone to the dhow--the men brought her lover gently up and laid him on the deck under the awning. 'oh, gilbert!' she cried again, as now she bent over him, while stroking his hair, which, on the left side of his head, was all matted with thick coagulated blood, 'oh, gilbert! to think that we should meet thus! sir!' she screamed to fagg, who was about to descend again to the boat to fetch off the others still in the dhow, 'where is he wounded? where? have you had time to discover?' 'i have looked him over, miss waldron, and, to tell you the truth, i do not think there is much the matter with him.' 'thank god! oh, thank god!' 'that blood,' the second mate continued, 'comes from a heavy contusion at the side of his head, but the skull is uninjured. also there is no concussion--observe the pupils of the eyes are not at all dilated.' then he turned away and went swiftly down the ladder again, muttering that, if he was to save the arabs and the negroes, there was no time to be wasted. the dhow was filling fast, he added. there was a big hole in her below the waterline, and a quarter of an hour would see the end of her. and now gilbert was carried to the cabin corresponding with bella's on the port side of the vessel, aft of the saloon, and mrs. pooley, with the steward, went in to undress him, telling bella that, as soon as he was comfortably placed in the bunk, she should come and take her place by his side. whereon the girl, distracted by both her hopes and fears--hopes that the second mate was right in his surmises as to her lover's wounds, and fears that he was wrong--sat herself down on the great locker that was in the gangway, and gave herself up to tearful meditations. 'ah, if he should die!' she murmured; 'if he should die! then my heart will break.' though, as you shall see, and have undoubtedly divined, gilbert was not to die then, at least. but, by this time, other things were taking place above which were almost as startling as the discovery of lieutenant bampfyld in that slave-dhow. startling, not only because of the unexplained cause that had brought the arab slaver into this portion of the indian ocean, but also because of the strange and mysterious behaviour of those others who were now being conveyed on board the _emperor of the moon_. ere they came, however, mr. fagg had sent over information surprising enough in itself, and sufficient to prepare all on board the ship for what, a little later, they were to see. 'the owner--if he is the owner,' he cried, 'the man who fell down while steering, is dead. he is stiffening. i presume i had best leave him to go down with the dhow?' 'ay,' called back pooley. 'ay. what about the others?' 'i cannot make them out. the negress seems well enough, but terribly frightened. as for the four men below, they all appear blind. we have taken their shackles off and they grope their way about as though in the dark. my men have to lead them up the ladders--yet their eyes look clear enough.' 'have they been kept in the dark, think you, and is the sun dazzling them now?' 'no, sir. the open gratings have furnished the part of the hold they were in with plenty of light.' he paused a moment, and those in the _emperor_ saw him gazing down steadfastly to that hold; then he called again: 'we must come away now, sir. the water is pouring in. the dhow will not swim much longer.' 'do so,' answered back pooley; and five minutes afterwards the boat was on her way to the ship, laden with the rescued negroes. mr. fagg had proved right in his surmise as to the necessity for leaving the slaver at once. for, ere he came on board, she was observed to heel over a little to starboard, then to further do so with a jerk; then, suddenly, she righted until she was on a level keel--and, next, sank below the waves like a stone, the body of the dead man, who had fallen down while steering, alone remaining above the heaving waters, and being swirled round and round in the whirlpool caused by the wreck, until it too went down. creeping up the companion, their hands directed to the side-ropes by the sailors; feeling the steps with their huge splay feet--as a mule feels its way along the thin line of insecure path that rounds the smooth face of a precipice--those stricken men came; huge, splendid specimens of the swart negroes of wyassa and wahiyou and wagindo, whom the arab slaver ships from kilwa, below zanzibar, and transports to bussorah and mohamra, whence they often reach the more distant turkish harems. now, looking at them as they stood on the deck of the _emperor of the moon_, it seemed as though their course was almost run. for, though these men would never be slaves to arab or persian or turk, of what use to himself or any one else is an unhappy blind nigger who, to exist at all, must work like a dray-horse? 'poor wretches!' said pooley to charke as they both stood regarding these blacks, 'see how the shackles have eaten into their ankles. poor brutes! they say that sometimes these fellows sell themselves willingly into slavery; i doubt much if these have done so. ah, well! we must take them with us to bombay, where, at least, they will be free. i wish,' he added, 'we could communicate with them somehow and learn who and what they are.' 'perhaps,' said charke quietly, unemotionally as ever, 'lieutenant bampfyld can tell us when he comes to. since he was in the dhow, he probably knows what she was and where she came from.' then, breaking off to cast his eye around, he said: 'sir, there is a breeze coming aft. shall we not make sail?' 'ay,' cried pooley, springing to the poop, 'ay, we have had little enough wind for some days. summon the watch.' a few moments later the order to square the yards thundered along the deck; the men rushed to the braces. far off, up from the dusky, wizard south, the wind was coming as they fisted the canvas, and the _emperor_, heeling over, gathered way and sped once more towards india. she gathered way faster and faster as outer jib and topsails were loosed and sheeted home, fore and main top-gallant sails and spanker yards braced sharp up, and main-sail, main-royal and mizzen top-gallant sails set, as well as jibs and staysails. she talked, as the sailors say, as she went through the water; she hummed and sang beneath the breeze that came up from far down by the antarctic circle--a breeze whose cool breath was gone and was, instead, perfumed now by the warm spicy odours of adjacent mauritius and reunion. away, over the vast waste of golden waters she flew, and the master, standing on the poop, called down to his first mate joyfully to ask him if this would not do well enough for bombay. 'ay, ay, sir,' answered charke, turning round from giving orders to the men aloft to answer his chief. 'ay, ay, sir.' while to himself he muttered: 'bombay! india! well, when we are there, all is ended for me!' chapter x the growing terror the sailor is, as all the world knows, a light-hearted, mercurial creature. face to face with death in some form or other during every hour of his life--although, often, the mere presence of death is neither known nor suspected--he is only too elated and happy when momentarily without anything to cause him anxiety. such was the case now with captain pooley, since his beautiful ship was rapidly picking up all the time she had lost by lack of wind and delays, 'and since,' as he jovially phrased it, 'all his new passengers were doing well.' 'first and foremost,' he said that evening, as he sat at the head of his table with bella in the place of honour on his right hand, his wife on the left, and mr. fagg opposite to him, while his honest, sunburnt face gleamed rubicund beneath the inch of white under his hair which his cap had preserved from the sun, 'bella's young man is all right. then bella's new plaything, the tiger, takes kindly to its lodgings--though you will have to sell it, my child, directly we get to bombay, and distribute the money it fetches among the men. then those wretched slaves--even they will eat and drink, won't they, fagg?' 'not much of that, sir,' the second mate answered, who was eating and drinking pretty well himself, however; 'they don't care to do much of either. they make a good deal of moaning up in that deck-cabin forward which you have given them. the woman, however, seems all right. i suppose the lieutenant has not been able to tell you much about the dhow yet, miss waldron?' he asked, bending forward a little as he addressed her. 'at present,' she replied, 'we have had little conversation. he says, however, that he sent me a telegram from bombay, telling me not to start as the _briseus_ was coming down here. he only came-to an hour ago, however,' she went on, while a ravishing blush swept over her face, 'and we--we--have had so much to----' 'spare her, fagg,' said pooley, with a laugh, and passing the claret at the same time. 'spare her. suppose you woke up one fine afternoon and found your sweetheart bending over you in your berth and whispering all sorts of endearing things in your ears, as well as kiss----' 'uncle!' cried bella, while mrs. pooley touched her husband's arm reprovingly with her forefinger, and mr. fagg hid his face behind the vase of brilliant cape gooseberries on the table. 'uncle!' whereon the bluff, good-natured sailor desisted, and began to speculate on the blindness with which the rescued negroes were attacked, and on that attack being, as he imagined, a recent one. 'they capture these poor wretches inland,' he went on musingly, 'in the big lake region as often as not; but, as far as i have ever heard, blindness is not one of their afflictions. moreover, these arab owners and captains wouldn't buy blind slaves, either for selling farther north, or for using as sailors in their dhows. therefore, i take it, this blindness must have come on them since they were shipped. that's strange, isn't it?' while, as he spoke, he rose, and went to his neat mahogany bookcase which was securely fastened to one of the saloon's bulkheads, and took down the two medical works he possessed--the one dealing with all general human complaints to which our flesh is heir, and the other with tropical diseases more especially. yet neither under the heading of 'eye,' nor 'blindness,' nor 'optics,' could he find aught that bore upon the subject; nor, in his book on tropical complaints, could he discover any information that might enlighten him as to why the four negroes should be so stricken. he spoke again, however, after turning over the leaves of these erudite volumes a second time, saying: 'fever, i know, sometimes produces blindness as an after-effect, yet--well, we have all seen these fellows, and there's no fever in them, i should say. oh, deuce take this confusion of tongues!' he exclaimed irritably; 'if it did not exist we could find out so much from the sufferers themselves. bella, our only hope is in you and your patient. if lieutenant bampfyld can't tell us something, we shall never know who these men and the woman are, where they came from, what is the matter with them, and to whom the dhow belonged. can he speak anything but english, child?' 'he knows some hindustani,' bella replied; 'and, i think he said, some words of swahili. he has taken up eastern languages in the service, which was one of the reasons for his being appointed to the _briseus_. he may be some help. at least he can tell us how he came on board that horrid ship.' as she spoke, eight-bells struck on deck, and, as the sound came through the skylight, both she and mr. fagg rose, the girl doing so because it was the hour at which she intended to visit gilbert again, and the latter because it was time to relieve stephen charke, who would now come below to take his supper. for bella had fixed this hour for paying her last evening visit to her future husband because she knew that the second mate would then descend, and she was never now desirous of being more in his company than necessary. she therefore left the saloon before fagg could have relieved charke, and, going to the cabin in which gilbert bampfyld lay, pushed back the curtain that hung at the door and went in to him, while observing as she did so that he was awake and gazing upwards as he lay. and she saw that he smiled happily on perceiving her, and whispered the word 'darling' as she advanced to his bedside. 'you are better, dearest,' she said, bending over him and putting her hand on his forehead, which was cool and moist. 'much better. aunt will come soon with fresh bandages for your poor head, and then you will have a good night's refreshing sleep. and to-morrow, perhaps, you will be able to tell us how you came to be in that hideous slaver. oh, bertie!'--for so she often called him--'what a mercy it was that we found you as we did. and what a miracle that we should have met thus. home-keeping and narrow-minded people would say, if they read it all in a book, that such a thing was unnatural and impossible.' their first meeting, their joy at discovering that they had come together again in this marvellous manner; their rapture when, a few hours before, gilbert bampfyld had emerged from his stupor and unconsciousness, has not been forgotten, although the description of it has been omitted. omitted for the simple reason that most of us have been, or are, lovers; most of us have known in our time, or know now--and those are the happy ones!--the sweet, unutterable joy with which such meetings are welcomed. who does not remember the sudden, quickened beat of the heart at some period of their existence, as they met again the one they loved the best of all in this world; the creature upon whom their thoughts were for ever dwelling, and from whom those thoughts, however wandering they had heretofore been, were, at last, never more to roam! picture to yourself, therefore, what rhapsody was bella's when, forgetting everything else but that she held her lover to her heart, she wept over his salvation from an awful, swift, impending death; picture also to yourself the delirious joy which coursed through gilbert's now unclouded mind, as he found himself in her arms--with her--close to her. picture this, and no further description is needed of their meeting in that cool, darkened cabin of the old ship. imagine for yourself what your own ecstasy would have been in such or kindred circumstances, and you possess the knowledge of what theirs was. 'darling,' he said again now, as she held to his lips a cooling drink that she had brought into the cabin with her, 'darling, i can tell you in half-a-dozen sentences or less----' 'no,' she said. 'no; not now. to-morrow, when you have slept----' 'yes, now. why, dearest, i am well! i could take the middle watch to-night if necessary, or--or--do anything that a sailor may be called on to do. and as for finding me in that dhow, why, it's the simplest thing on earth--or the waters. listen. the _briseus_, as you would have learnt by that telegram i sent you if you had ever received it, was suddenly ordered to join the cape squadron--dhow-catching. and i can tell you we were not so very long before the game began, since by the time we were abreast of kilwy--which is the southern limit of the legal slave trade--we fell in with twelve dhows, one of them being our friend from which i was rescued by your people. and you may depend we were after them like lightning, while beginning to ply them with shell and shot from our little gun forward. they scattered, of course, though some got hit and lay disabled on the water, while i went off in the whaler with her crew to attack one that seemed badly knocked about. the one in which i was when found by you.' 'the horror!' exclaimed bella, with a pretty shudder. 'no, no; don't call her that, because, after all, i owe my life to her.' 'well, the angel!' exclaimed bella now, with sudden change. 'though i don't altogether know that the captain meant to save me----' 'the wretch! i'm glad he's dead.' gilbert laughed at these variations in bella's mental temperature. then he continued. 'they are artful--incredibly artful--in these dhows. they will let our pinnaces or whalers or any other of the ship's boats come alongside, then, all of a sudden, they cut their lee halliards, and down comes their great sail over us, enveloping the boat and all in it, just as if it was in a net or a bag.' 'ah!' gasped bella. 'and that's not all. when you are caught like that, they have another pleasing little way of firing at you from above through the canvas, so that you are being shot down while, all the time, you have no chance of escape.' 'oh!' exclaimed bella. 'to think of it! ah, the wretches.' 'they do, bella. fortunately, however, this one couldn't do it, being disabled, and she had, therefore, come up to the wind with hardly any way on her. this was all right for us, as i meant to board, so as we came alongside each other we hooked on to her anchor cable, which was hanging pretty low down, and we should have got on board, too, only at that moment the dhow gave a lurch which sent the whaler half-seas under, and i got a blow on the head which knocked me insensible----' 'oh, gilbert! that wound on your head!' 'i suppose so. at any rate, i knew no more about it; and i don't know anything further, now, since i was insensible till i woke up here this morning and found you bending over me. however, i'm all right now, or soon shall be.' 'but how did you come into the dhow you were found in?' bella asked, while pouring out, directly afterwards, one question after another. 'and when did it happen--yesterday, or a week ago? and where was the whaler, and the sailors, and the _briseus_? and why did they all desert you? what a nice kind of a captain yours must be, to be sure!' 'my opinion is now,' said gilbert, 'that the dhow you found me in, rescued me--picked me up. and i expect our captain--he is a rattling good skipper, bella, all the same--heard i was drowned and thinks i've missed my muster. my cousin jack will imagine for a month or so--till we get in to bombay--that he is the future lord d'abernon,' and he laughed as he thought of how soon cousin jack would be undeceived. 'but the dhow we found you in--how did she escape, and why didn't the _briseus_ capture her?' 'some must have got off in the confusion since it was only an hour from dark. i'm certain to be reported lost when the ship goes into either zanzibar or aden, and---- what's that?' he exclaimed, breaking off suddenly. 'surely that's your uncle's voice!' he recognised it because captain pooley had been in to see him after he recovered his consciousness and had congratulated him on doing so, as well as on being practically restored, while saying also that he was delighted at being the means of rescuing him out of the sinking slaver. 'yes,' bella replied, 'that's uncle's voice; and the other is that of mr. charke, the first mate.' 'listen! what is it he is saying?' it was perfectly easy to hear what he was saying, since both master and mate were conversing in the saloon, to which charke had descended. and the words which reached their ears, as they fell from the latter's lips, were: 'oh, no doubt about it whatever, sir; not the least. the negress is now as blind as the negroes themselves. she cannot see her way along the deck, nor any of the signs we have made before her eyes.' chapter xi the terror increases the southerly wind did not hold as it should have done considering the time of year, and the consequence was that the _emperor of the moon_ was by no means making such a passage as was to be expected of her. indeed, by the time that the second day had passed since the rescue of gilbert from the slaver, and when the evening was at hand, she was almost motionless on the water, while such sails as were still left standing hung as listlessly as though they were suspended in a back room. now, this was disheartening to all on board--that is to say, to all except one person--as is generally the case when such things happen. the master was grieved because he looked upon the delay as an absolute waste of valuable time, while as for bella and gilbert--well, it is scarcely necessary to write down here what they were looking forward to at the end of their journey, or what visions haunted the mind of the latter concerning the cathedral in bombay and a ceremony of marriage being performed at the altar-rails by the bishop. yet, all--passengers, master, officers and men--had to swallow their disappointment as best they might, and to recognise the fact that bombay was still over three thousand miles away and not likely to be reached for very many days. the one person who was, however, resigned to the affliction of delay was stephen charke, in whose brain there still lingered a wild and chimerical idea that there might yet be sent by fate some extraordinary piece of good fortune which would, even at the last moment, sever gilbert and bella, with the subsequent result of bringing him and her together. it has been said that he was a dreamer, and never had he been so more than now, since, sleeping and waking, he still mused on the possibility of some extraordinary set of circumstances arising which should force the girl into his arms. yet, he had to own to himself that nothing was more unlikely than that any such circumstances could by any possibility arise. if anything visited these seas, this stupendous ocean, at this period of the year, it was most likely to be a flat calm such as that which they were now experiencing, instead of storms; and, even if storms should come, of what avail would they be to separate gilbert bampfyld and bella waldron? 'i am a fool,' he would mutter to himself, as he smoked his pipe in either the solitude of his own cabin or on the deck at night, 'a fool. a madman! one has only to observe how they love each other, how they never leave each other's side, to see that nothing could ever bring her to me. even though she and i were cast on some deserted shore, even though i saved her from forty thousand threatened deaths--even though bampfyld himself were dead and buried, she would never give herself to me. i am,' he would repeat again, 'a fool.' and this acknowledgment would, for a time, operate wholesomely on him--a man whose mind was not altogether that of a visionary and whose heart was not, by nature, a perverted or warped one--and he would resolve that, henceforth, he would think no more of this girl for whom his love was so fierce and, to him, so disturbing. he made resolutions, therefore, and kept them--until the next time that he saw the lovers together, smiling, talking, happy in each other--'billing and cooing,' as he called it, with a smothered curse. they were on deck together, now, on the evening of the second day of calm as stephen went up to take the first watch, since gilbert had refused to remain a prisoner in the cabin allotted to him for more than twenty-four hours, and pooley was also there, fagg being below finishing his supper. mrs. pooley sat on the poop in a deck-chair engaged in some needlework she had constantly on hand, and, forward, the men were engaged in smoking and telling yarns, while the general idleness which pervades the forecastle when a ship is becalmed prevailed everywhere. one man was reading a short story to his mates out of a country paper six months old, another had a sewing-machine between his legs with which he was mending his and his comrades, clothes, a third was teasing and playing with 'bengalee,' the tiger cub, which was growing--or seemed to be growing--fast. at present, however, it was safe to let it loose since it had no more strength than a large-sized cat, and teeth not much bigger than those domestic animals possess. generally, the creature followed bella about wherever she went, rolling down the companion ladder after her like a striped ball when she went below, or lying on the edge of her dress when she sat on deck; but at night it was shut up in a locker forward and looked after by the sailors. the hour for its temporary retirement had not, however, yet arrived, wherefore it was still gambolling about amongst the men. altogether, the vessel presented a peaceful scene as she lay 'idle as a painted ship upon a painted ocean,' while, from forward, there came the droning voice of the sailor who was reading the storiette to his mates, interrupted only by the laughter of the others at the cub's leaps and growls; and, from the after part of the ship, the talk of the 'quarter-deck' people arose. 'come,' said pooley now, addressing charke, 'come, let us go and look at those unfortunate niggers. the lord knows what is to become of them. the woman, you say, never rises from the floor of the cabin, but only lies there and moans. it is the strangest thing i ever heard of in my life. i wish, mr. bampfyld,' turning to that gentleman as he passed with bella, 'that you could give us some information about that dhow we found you in.' but, of course, gilbert could tell them no more than he had already done a dozen times, while repeating in substance all that he had said to his _fiancée_. 'i am sorry,' he had said on each occasion, and again said now, 'but i know absolutely nothing. i was insensible when i was taken into the dhow--as taken in i must have been, since i could never have got in by myself--and, as you are well aware, i was insensible when i was brought out. i positively know nothing.' 'the helmsman's death was as strange as anything,' pooley observed. 'fagg says there was no wound about him that he could see. what, therefore, could he have died of?' 'sunstroke, i imagine,' the first mate said, in his usual emphatic, crisp manner. 'sunstroke. it could not have been fever, otherwise these negroes would have it, too. yet,' he went on, in a manner more meditative than usual with him, 'those arabs, if he was an arab, rarely suffer from that. it takes a white man to get sunstroke.' 'well, come,' said the master again, 'let's go and see to them. the sun is on the horizon; it will be dark in a quarter of an hour's time.' whereon he strode forward, accompanied by charke, while mr. fagg, who had come up from the saloon, began to keep such watch as was necessary. and gilbert, bidding bella go and sit with mrs. pooley, strode after them, since he was anxious to have a look at the unhappy creatures who had been rescued at the same time as himself. the male blacks had been put into a deck cabin (in which was usually kept an assortment of things such as spare lamps, a boat sail or two, and mr. fagg's bicycle, on which he disported himself whenever he got ashore anywhere), wherein some matting had been thrown down for their accommodation. and, as now they neared this cabin, they heard sounds proceeding from within it which were really moans, but, to their ears, had more the semblance of the bleating of sheep. also, it seemed as if one of them within was chanting some sort of song or incantation. 'we shall have to stop this noise in some way, sir,' charke said to the captain; 'it has been going on more or less ever since they came on board, and the men complain that it disturbs them in the fo'c's'le. it's a pity we can't communicate with them somehow. perhaps lieutenant bampfyld might try, as he says he knows some words of swahili'; while as he spoke he looked at the man who had once more, as he considered, or chose to consider, stepped in between him and the woman he loved. yet, because he never forgot that he was a gentleman born, there was nothing in his manner that was otherwise than polite when he addressed gilbert. 'i have tried,' said the latter, 'more than once to-day. and either my swahili is defective, or that is not their language. i suspect that it's galla, of which i do not know a word.' meanwhile, the captain had drawn back the cocoanut matting which hung in front of the deck cabin door, though, after peering into the sombre dusk for a moment, he started back, exclaiming: 'good heavens! what has happened now? have they murdered one of their companions, or what?' it was, in truth, a weird sort of scene on which he, as well as gilbert and charke, gazed, as the swiftly-failing tropical evening light illumined the interior of the cabin. flat on the floor of it lay one of the negroes, undoubtedly dead, since there was on his face the gray, slate-coloured hue which the african assumes in death. yet his eyes were open, only now, instead of that bright glassy look which all their eyes had had since they were brought on board, there was a dull filmy look, which told plainly enough that there was no life behind them. still, dead as the man undoubtedly was, he did not present the most uncanny spectacle of all within! that was furnished by those who of late had been his comrades, and by the strange grotesqueness--a grotesqueness that was horrible in itself--of their actions. all three of the living negroes were on their knees in the cabin, which was roomy enough to amply admit of their being so, while, with their great black hands, they were pawing the man all over, feeling his breast and body, and endeavouring to bend his fingers and toes as well as his legs and arms; while, even as they did so, from their great mouths came that moaning incantation which resembled so much the bleating of sheep. doubtless they felt almost sure that their fellow-slave was dead, and these actions were being performed as tests. yet, also, there was a solemn, wild unearthliness attached to the whole thing by the manner in which, when one of the visitors standing at the door and peering in made a remark, all turned their sightless eyes towards that door and then held up each a hand, and emitted a hissing noise through their great pendulous lips, as though enjoining silence and respect for the dead. they held up those hands with the fingers stretched enormously apart and with the palms towards the intruders. their eyes were bright enough as they glared at the three white men outside, whom they could not see, yet, somehow, the gleam in them and the knowledge that they were sightless gave so creepy a feeling to those regarding them that they could not restrain a shudder. 'what in god's name is it?' exclaimed pooley, he being the first to speak. 'what? what horrible disease that blinds them to commence with, and then kills--and kills not only negro, but arab--captured and captor? who--which--will be the next?' as he spoke, a thought struck each of the three as they stood there gazing at one another in the swiftly-arrived darkness of the tropical night--a thought to which, however, not one of them gave utterance. _who_ would be the next? an arab had died from some strange, unknown disease in the ship wherein these men had been found, and, now, one of them, too--a negro! had, they reflected, this insidious horror been, therefore, brought into a ship full of white men? would they also fall victims to that which had killed the others? that was the thought in their minds--in the minds of all of them, though not one gave voice to that thought. 'he must be got away from them--taken out of that cabin,' pooley said, his speech a little changed now, and more husky and less clear than usual. 'perhaps the woman, the negress, may be of some avail. i doubt if they will let us remove him without difficulty--though--poor blind things as they are--they could scarcely make any resistance. go across to the other cabin, mr. charke, and fetch her over.' he had been anticipated in his order, however, by the chief mate ere he spoke, charke having, through some idea of his own, already crossed the deck to the opposite cabin in which the woman was placed. therefore, as pooley looked round to see why the mate did not answer him, he saw in the darkness that he was returning; while he perceived--even in this darkness, which was not quite all darkness yet, and by the light of the foredeck lantern--that charke looked pale and agitated. 'the woman,' he said, 'is dead, too, i believe. she is lying on the cabin floor motionless--and cold.' chapter xii 'stricken' it was from this time that there began to creep over the ship a feeling shared by all, both fore and aft, that the voyage would not end without something untoward happening. what form, however, any misfortune which might come to them would be likely to take, none were bold enough to attempt to prophesy. yet, all the same, the feeling was there, and, since every man on board the ship was a sailor, while, for the ladies, one was a sailor's wife and the other a sailor's future wife (each of whom was certain to be strongly receptive of the ideas and superstitions of her own particular sailor), it was not very strange that such should be the case. and, there was also in the thoughts of all that idea to which none of the men congregated outside the cabin, when the negro had been found dead, had ventured to give expression--the idea that the unknown, insidious disease--which had struck him and the negress, and also, possibly, the arab _negoda_ down--might eventually seize on them. there were, however, at present at least, no symptoms of anything of the kind happening. all on board continued well enough, and, up to the time that the man and woman had both been buried in the sea for more than twenty-four hours, no complaints were heard from any one of feeling at all unwell, while the three remaining blacks seemed no worse than before. yet, it was a pity, perhaps, that at this time the ship should still have been forced to remain becalmed and almost motionless; that neither from south nor west any breeze blew--from the north and cast there was scarcely a possibility of wind at this season--and that, except for the strong southern current which carried her along at a considerable though almost imperceptible rate, she hardly stirred at all. a pity, because it gave the sailors too many idle watches wherein to talk and chatter, to spin yarns of old-time horrors which had fallen upon vessels in different parts of the world, and to relate strange visitations which they had either personally suffered under or had 'heerd tell on,' and so forth. nor aft, in the saloon, did those who used it fail to discuss the strange circumstance of--not so much the death which had stricken the africans--as the blindness that had fallen upon them. and here, stephen charke, better read perhaps than any of the others owing to his studious nature, was able to discuss the matter more freely than either the captain or those who sat at his table. 'i do distinctly recollect reading somewhere,' the mate said one evening, as all sat under the great after-deck awning, fanning themselves listlessly, while fagg worked a kind of punkah which his ingenuity had devised, 'i do distinctly recollect reading somewhere of all those in a ship, on board of which was a large cargo of west african negroes bound for america, being stricken with blindness. i wish i could recall where i read it. in that way we might be able, also, to find out how to take some steps to avoid the same thing happening to us in the old _emperor_.' 'a cheerful prospect, truly,' said the captain, 'if that is to occur'; and as he spoke he roamed his eye around the tranquil, glassy sea, on which there was not so much as a ripple. 'a pleasant thing, indeed, if one-half of us get blind and a rough time comes on. how, then, is the ship to be worked three thousand miles. how are the sails to be attended to?' and now he directed his eyes aloft to where all the canvas was neatly furled with the exception of the studding sails. 'we'll hope it won't be as bad as that, sir,' said fagg. 'only the black people, and those out of another ship than ours, seem to suffer. until one of us,'--by which he meant the europeans on board--'gets affected we haven't much to fear, i take it. while, you know, sir, we can find shelter before we reach bombay. there are the seychelles, for instance, from which we are not so very far off.' 'such a delay as that would mean a very serious loss for me,' pooley replied. 'as it is, i expect, one way or another, i shall miss one voyage out of two years.' 'i hope not,' said gilbert bampfyld, seriously, 'otherwise i shall begin to think it was a pity you ever came in contact with the dhow in which you found me.' yet, as he spoke, he saw bella's beautiful eyes fixed on his face, and knew that no more crowning mercy had ever been vouchsafed to any two mortals than had been accorded to his sweetheart and himself by his rescue. 'well,' said pooley, 'we won't talk about that. i am devoutly thankful that we were enabled, by god's mercy, and also by the aid of something which is almost a miracle, to rescue you. for the rest a sailor must take all that comes in his way and never repine. the _emperor_ has been a good old tank to me; pray heaven she continues so to the end.' then he suddenly stopped and peered forward under the awning towards the forecastle, where, beneath another awning, the sailors had been lying about, some sleeping, some chatting idly, and most of them--even to those who had dropped off--with a pipe between their lips. 'what's that commotion forward?' he asked, addressing himself to charke, who, ever on the _qui vive_ as became a chief officer, had sprung to his feet and was gazing keenly towards the foredeck. 'what's the matter with the men, and why are those three holding wilks up like that?' 'forward there!' sang out charke in a voice like a trumpet, as he, too, saw that which the master had described, namely, three of the hands standing up round the man named wilks, and one grasping him on either side, while he himself pushed his arms out before him in a manner that implied a sort of doubting helplessness on his part. 'forward there! what's the matter with that man?' 'he says he can't see, sir,' roared back another man on the forecastle deck, pulling his hair to charke as he spoke. 'he was asleep just now; and then, when he woke up, he asked what time o'night it was because it was so dark.' 'my god!' exclaimed pooley, while the faces of all around him took on a blanched, terrified look, and bella, with the beautiful carnation of her lips almost white now, grasped her lover's arm. 'my god!' then he turned to fagg and muttered, repeating the other's words: '"not much to fear until one of us gets affected." heavens! we haven't had long to wait!' while, following charke who had already gone forward, and followed by fagg, he went towards the forecastle. his mates were bringing wilks down the ladder now, since charke sang out that he should be taken into the comparative darkness of their quarters at once, thereby to escape the glare of the sun; and not one of those who were eagerly watching his descent but observed how like his actions were to the actions of the blind negroes when they were brought off from the dhow, and the actions of the others to the behaviour of the men who had assisted them to come on board. for his companions directed his hands to the ladder's ropes even as the blacks, hands had been directed; while in each of his motions was the same hesitation, followed by the same careful grasping of the rail, as there had been in the motions of the slaves. 'oh, gilbert,' bella exclaimed piteously, as she clung to him, 'what is going to happen? what is hanging over us? supposing--supposing----' 'what, darling?' 'that--oh, i don't dare to say what i dread. but if this terrible thing should spread all through the ship. if uncle, if you, if all the sailors were attacked. and you--you--dearest; you, my darling.' 'let us hope it will not come to that. besides i, personally, matter the least of any----' 'bertie!' she almost shrieked, alarmed, 'when you know that those others--some of them at least--that those poor black creatures have died after it. and you say that you matter the least of any; you, whom i love so.' 'i meant as regards the ship. i am not one of her officers, nor concerned in the working of her; and bella, dearest bella, don't get those dreadful ideas into your pretty head. never give way to panic in an emergency. doubtless some more will find their eyesight leave them--temporarily--but it can scarcely be that all will be attacked. and as regards death following, why, those other niggers are all right, and they are just as blind as those who have died!' it happened--as so often such things happen in this world--that he spoke a little too soon. he hit upon the denial of the likelihood of a possibility occurring which, by a strange decree of fate or chance, was, at the very moment of that denial, to occur; since, just as the repudiation of such probability was uttered by him, and before the men helping wilks had had time to get him comfortably into his berth in the forecastle, there arose once more that strange, weird, moaning kind of incantation from the deck-cabin in which the remaining negroes were, that had been heard before by all. and, added to it, was something more than any had heretofore heard, namely, a series of wild turbulent shouts in the unknown barbaric tongue used by the africans--shouts that seemed to issue alone from one of their throats. a noise, a bellowing, in which, though on board the _emperor of the moon_ there was not one person who could understand the words that voice uttered, all recognised the tones that denote fear, terror, and misery extreme. instantly, so stridently horrible were those cries, every one of the englishmen about rushed towards the cabin, pooley and charke being the first there, while gilbert, running forward from the afterpart and along the waist, was soon by their sides. and then, looking in, they saw that the poor blind, excited savage who was emitting those shouts had, in truth, sufficient reason for his frenzy. he seemed--he was, indeed--demented, as, with both his great hands, he felt all over the bodies of his comrades who were lying lifeless on the cabin deck, and presented an awful appearance to those who gazed on him as his great features worked in excitement, his vast mouth, with its adornment of huge white teeth, opened and shut like a wild beast's at bay, and his blind, but brilliant, eyes glared hideously. that he was nearly mad with fright and terror was easily apparent, since, while recognising without seeing that there were others near, he snarled and bit at the space in front of him, and struck out with his fists or clawed at the air with his enormous hands. 'he will spring out at us directly,' charke said, drawing to one side of the cabin. 'the fellow is mad with fear or grief.' then, ready in expedient as ever, he ran the cabin door out of its slide and shut in the negro with his dead companions. nor did he do so too soon, since, a moment later, those without heard the huge form of the man leaping towards the door; once they heard him slip, as though he had trodden on the body or one of the limbs of those lying dead on the floor; and then there came a beating and hammering on that door which seemed to promise that, in a few seconds, the panels would be dashed out and the maddened black be among them. 'this is too awful,' muttered pooley. 'is he really gone mad, do you think?' he asked, appealing to charke, gilbert and fagg at one and the same time. 'no doubt about it,' they answered together. 'no doubt. and if he once gets out to the deck, sir,' said charke, 'a dozen of us will not be able to hold him.' 'we must capture him if he does. better throw a rope round him somehow. if he were not blind, we should have to shoot him. ha! see, he has smashed open the panel! stand by there, some of you men, to catch him as he leaps out.' while, even as he spoke, the gigantic madman, with another howl, broke down the door and sprang amongst them. chapter xiii 'spare her! spare her!' mrs. pooley, bella and gilbert sat alone in the saloon that night, the faces of the two women being careworn and depressed in appearance, while on that of the young naval officer was a look, if not of consternation, at least of doubt and anxiety. that all of them should present this appearance of perturbation was natural enough, because by this time it was impossible to suppose that any less than a calamity was impending over the _emperor of the moon_ and all in her. two more men, named burgess and truby, had been attacked with blindness, while the negro, who had been the last survivor amongst the slaves, was himself now dead. 'it was too awful,' said gilbert, who had come below to tell the ladies that which had happened above, since to keep silence on the subject was useless, in consequence of the turmoil in the ship which had accompanied the poor creature's last moments. 'he died a raving maniac--nothing short of that. you heard his howls and yells after we had got him safely tied up; _we_ saw a sight that i, at least--and i should think everybody else--hope never to see again. even roped as he was, his leaps and convulsions were something shocking. thank god, they soon came to an end. i believe he died of the exhaustion caused by his mania.' 'what is to become of us all?' asked mrs. pooley sadly. 'what? the ship moves only by the current; my husband said just now that, if things go on and get worse, there will be none left to control her when the wind does come.' 'the trouble is,' said gilbert, 'that, if they make sail when the wind springs up, there may be no men to take it in if that wind comes on too strong. and, at all events, it will be serious if more men are attacked. i have offered my services in any capacity if wanted, and will serve either as officer or man if captain pooley will let me.' bella threw an admiring glance at her lover in approval of what she, in her own mind, probably considered his noble disinterestedness; then she said: 'but surely all are not going to be attacked one after another in this way? and if so, uncle can't possibly think of trying to get to bombay when the wind does come.' 'i have suggested the same thing to him that fagg did this afternoon--namely, the seychelles. they're all right, and the climate is first-rate for the tropics. he says, however, he will see what happens by the time we get a wind. he won't give in if no more men are attacked.' meanwhile, even as he spoke, each of the trio were occupied with thoughts which they would not have cared to put into language. mrs. pooley's were those good wifely reflections which busied themselves only with her husband's interests, and were disturbed by considerations of what a loss to him the delay would produce should it be further prolonged. yet, there was also growing upon her, if it were not already full-grown--as was now the case with all others in the ship--a gruesome, indefinable horror of what might be the outcome of this strange affliction that had fallen on the vessel. suppose, she had asked herself a hundred times in common with all the others on board--the sailors alone expressing their thoughts openly--suppose everyone in the _emperor_ succumbed to this blindness! what then would happen, even if it were not followed by death? would they drift about the ocean helplessly if the calm continued, until they were seen and rescued by some other vessel; or, if a strong gale came up, would they--with no one capable of so much as steering the ship be shipwrecked and sent to the bottom? while, as to the horrible idea of death following on blindness, and the _emperor of the moon_ drifting about, a floating catacomb--that was not to be thought about! it was too fearful a thing to reflect upon and still preserve one's sanity. yet, all the same, not only was it thought about but talked about among the sailors, while many ideas were propounded as to what was to be done ere the worst came to the worst. as for bella, her reflections were all of one kind, and one only. would gilbert be spared! for herself she cared but little, though she would scarcely have been the brave, womanly girl she was if she had not repined at the dark cloud which had now settled down over the existence of her lover and herself, and which threatened, if it continued to hover over them and their fortunes, to darken that existence still more. further than this she did not dare to look, and, consequently, could only pray fervently that the cloud might be lifted ere long, even as she strove to force herself to believe that such would undoubtedly be the case. yet gilbert's meditations were perhaps the most melancholy and bitter of any of the three persons now assembled in the saloon--brave, self-reliant young officer as he was, and full of hope and belief in many happy years still to come and to be passed in the possession of a beautiful and devoted wife, as well as in the service of a glorious profession. for he could not disguise from, nor put away from, his mind the recollection that, with his coming into this ship, with his rescue, there had come also that intangible, mysterious disease which was striking down those around him one by one at extremely short intervals; and, although he knew that he was no more responsible for its presence than if he had never been found in that accursed dhow, he began to think that there were many in the _emperor of the moon_ who would regard him as being more or less so. which, in truth, was a weak supposition, born in his usually strong, clear head by the calamities now happening with great frequency one after the other; a supposition shared by no one else in the ship. for--as he himself knew very well, yet took no comfort in knowing--had he not been in the dhow her other inhabitants would have been rescued all the same and taken off by pooley, and would have brought on board with them the infection which was now supposed to be at the root of the disasters that were happening. the meditations of all three were now, however, disturbed by the descent of stephen charke to the saloon, he being about to eat his evening meal before taking the first watch. as usual and, almost, it seemed, unjustly so--since never had he said any further words to bella which she could construe into an approach to anything dealing with his regard for her--his appearance was unwelcome to her. he seemed, however, to be entirely oblivious of what her sentiments towards him might be, and, after giving a slight bow to both ladies, rang the bell for the steward to bring him his supper. then, as he seated himself at the table, he said: 'i fancy we shall have to avail ourselves of your offer of service after all, lieutenant bampfyld, and in spite of our having refused it an hour ago. fagg,' he went on, as he cut himself a crust from the loaf, 'is attacked with blindness now.' 'great heavens!' exclaimed gilbert, while bella, scarcely knowing why, burst into tears and hid her head on mrs. pooley's ample shoulder. 'yes, it is too awful. so is payn, the bo'sun, attacked.' 'my god!' and now mrs. pooley's fortitude gave way too, and she sobbed quietly to herself until, recognising that two tearful women were scarcely in their proper place in the saloon with these young men, she rose, and, taking bella with her, they went off to their cabins. 'the watch, of course,' went on charke, 'is nothing now with the ship at a standstill. yet one has to keep it more or less. fagg's turn would have been the middle of to-night, but if you like to fall in you can take the first, and i'll----' 'thank you,' said gilbert quietly, 'but i have done plenty of watch-keeping, both before and after i was a flag-lieutenant. the middle watch won't hurt me. i will relieve you at midnight.' 'as you like. of course, the skipper and i recognise that it is a great obligation on your part----' 'oh, rubbish! we are absolutely and literally "all in the same boat" now, and we've got to make the best of it.' then gilbert rose and said: 'by the way, i should like to go and see that poor chap, fagg, if he is in his cabin. he's a nice young fellow.' 'he is, and a good sailor, though he doesn't make any fuss. lord knows what's going to be the end of it all. i hope to heaven those who are struck won't go the way of those niggers, and that their sight will come back before long.' 'i hope so, too; or else this will be one of the most awful calamities that ever fell upon any ship on a voyage. and the worst is, no one knows what the end is to be.' then he turned on his heel and moved away with the intention of going to fagg's cabin, while charke, who was now half-way through his supper, went on steadily with it; yet, as gilbert reached the gangway outside, the other made a further remark. 'by-the-by,' he said, 'another strange thing has happened. that infernal tiger-cub of miss waldron's--her pet!--seems going the same way as the others. it is crawling about the foredeck in a half-blind fashion, and evidently can't see signs made before its eyes. as far as the little beast goes, i shouldn't mind seeing it fall through one of the scuppers back into the sea it was dragged out of. it was rather rubbish to save it at all!' the words 'that infernal tiger-cub of miss waldron's' grated somewhat on gilbert's feelings, as did also the brutality of the remark about its falling into the sea. why this was so he did not know, unless it was that he had seen the interest bella took in the little creature, and in feeding it and calling every one's attention to the extraordinary manner in which it seemed to grow almost hourly. nevertheless, the observation did grate on him, and he began to tell himself that he did not care much for stephen charke. however, like a good many other young naval officers, he had thoroughly learnt the excellent system of controlling his thoughts in silence, wherefore, without making any further remark than saying that he was sorry to hear about 'bengalee,' he went on his way towards mr. fagg's cabin, leaving the first mate to finish his supper by himself. he left him, also, to some strange meditations which, had they been uttered aloud in the presence of any listener, might have caused that person to imagine that he was the recipient of the babblings of a visionary. put into words those musings would have taken some such form as this:-- 'supposing this malady or pestilence, or whatever it is, should be followed by madness and death, as was the case with the negroes. and supposing also that, among those who are struck, our friend lieutenant bampfyld--the future lord d'abernon!--should be one. what happens? bella'--for so he dared to call her in his thoughts and to himself--'bella is deprived of him. suppose, also, that the whole management of the ship falls into my hands; pooley may be attacked, too--then--then--then----' but here his mental ramblings had to come to a conclusion, because, wild as his riotous thoughts were, his mind was clear enough to perceive that he was just as likely to be attacked by the blindness as was either pooley or bampfyld. while he saw very plainly that so, too, was bella. and this pulled his meditations up with a jerk, since he could imagine nothing more horrible that could occur now than that the majority of all the men on board should remain sound and unstricken, and capable of working the _emperor of the moon_ safely into some port or other, while the beautiful girl whom he worshipped and adored so much should succumb to the hateful affliction. 'oh, my god!' he almost moaned aloud, 'if--if she should be the next. if she should be taken and we left. how--how could i endure that?' and then, because he was a man with the best of impulses beneath all the gall which had arisen in his heart at losing the girl he had once hoped so much to win, he moaned once more: 'not that--not that. spare her, at least, heaven! spare her, even though i have to stand by and see him win her after all. spare her! spare her!' chapter xiv struck down but still the days went on and no wind came--the one thing which, even now, after they had been becalmed for nearly a week, might have saved the ship from any fearful calamity that was at last, almost without a doubt, in store for her. for, according to their reckonings, taken regularly both by aid of the brilliant sun which still poured down its vertical rays upon them, and also by the use of a cherub log which they possessed, as well as the ordinary ones, the current had drifted them some three hundred miles north, so that they had consequently the northern coast of madagascar on their port bow, as well as the aldabra islands, and with galega, providence and farquhar islands almost directly ahead of them. only--the wind would not come, and the ship lay upon the water as motionless, except for the current, as though she had been fixed upon the solid and firm-set earth. and, meanwhile, the blindness which had seized upon one man after another was still continuing its progress, and more than half--indeed, three-parts--of the complement of the _emperor of the moon_ were now sightless. of seventeen sailors, eleven were down with this terrible, paralysing affliction, as well as one officer, mr. fagg; so that, if now the long-hoped-for breeze should spring up, there were scarcely enough men in the whole vessel to set the sails, even including pooley--who certainly could not go aloft with safety!--and charke and gilbert; while, presuming all of them could do so and the wind should freshen much, they would undoubtedly be far from able to take them in again. and then the result must be swift--undoubted--deadly. the ship would rush to her destruction, would be beyond all control; she would either go over under the force of the elements, or be dashed to pieces on some solitary coral island which she might encounter in her mad, ungovernable flight. consequently, there remained but one chance, and one only, for her, that chance being to forgo the advantage of the wind when it came at last, and to let her drift under bare poles until they were seen, and perhaps rescued, by a passing vessel. but, again there arose the fear in all hearts, as already it had done before--namely, would any other ship which might encounter them be willing to take on board men in such a plight as they were, and suffering from a disease that none could venture to doubt must be contagious? meantime, the life in the vessel itself was, possibly, the strangest form of existence which has prevailed for many a long sea-voyage. for she was subject to no stress whatever of weather, the elements were all in favour of her safety, if not her progress; she was comfortable and easy and well found with everything of the best--since, in the _emperor of the moon_, there was neither rotten pork nor weevily biscuits for old shellbacks to grumble and curse at and mutiny over, as those who wish to make the sailor dissatisfied with his lot are too often fond of representing to be the case--every one was well housed and well provided with good, wholesome food. yet, all the same, she was a stricken ship--stricken, in truth, by the visitation of god; smitten by the hand of god with a curse which none could understand or explain. fortunately, however--if the word fortune may be used in connection with those now in her!--this curse seemed to have stopped at the blindness--though god knows that was bad enough! death did not seem to be following after it, nor madness, nor delirium, as had been the case with the others--certainly as death had been. those who were down lay in their berths, blind, it is true; but otherwise there was nothing else the matter with them; and, since they were ministered to by those who, up to now, had themselves escaped the visitation, they did not suffer in any other way. bella and mrs. pooley were at this time more or less in charge of the provisions, the latter dealing out the men's rations under the orders of her husband, while bella, arrayed in a long white apron which gave her a charmingly strange appearance in the eyes of all who beheld her, attended to the meals of those who used the saloon, took her place in the cook's galley--the unfortunate man being one who was down with the scourge--and saw to all preparations necessary for their now hastily devised and uncomfortable meals. 'she's a good 'un,' the six remaining healthy men muttered to themselves, as they saw her busying herself about the ship, making soup and broth for them as well as for the after-cabin, and working indefatigably from morning to night on behalf of all on board, 'a real good 'un. and this here navy lieutenant what's to marry her is a lord, ain't he, bill?' 'he ain't a lord yet, but he's a-going to be. ah, well; if we ever all gets safe into port, her ladyship will know summat about what her servants ought to be like. her cooks won't get to windward of her in a hurry, i'll go bail!' 'if we ever get safely into port!' that was the sentiment which pervaded all minds on board the _emperor of the moon_ at that time. 'if they ever got safely into port!' for all on board began now to doubt whether they would do so. the eighth day of their being becalmed had come, even as those forecastle hands discussed the girl's goodness--with also, in whispers, many an admiring remark on her beauty and generally trim-built appearance--the eighth day had come and, suddenly, just as the forenoon watch was over, two more men suddenly called out together that they were 'struck'--were blind! two more, leaving now only four sailors and three officers--counting gilbert in place of fagg--and two helpless women! 'well,' said the chief mate, coming up to where gilbert and bella were discussing gravely this new affliction, while close by them the usual business was going on of getting the two fresh cases into their berths in the forecastle--which was now a lazaretto--'well, this ends it. the wind may blow as much as it likes now, we shall never be able to make sail. we must drift about till we are picked up or----' then, seeing the look of terror on bella's face, he refrained from finishing his sentence, saying instead: 'if we had as many hands to do one man's work as you have in her majesty's service, lieutenant bampfyld, we should still be all right.' 'i don't know,' gilbert replied coldly, and in a manner which, quite unknown to himself, he had been gradually adopting of late towards his unsuspected, would-be rival. 'i don't know. we may have a dozen hands to do one man's work in our service, as you seem to suggest, and as is often supposed, yet, all the same, i'd back four of our men and two young officers to get a lot of sail on a ship of this size, anyhow!' 'they might. yet, clever as they are, you wouldn't like to back them for much to furl those sails again if the breeze freshened into a strong wind, would you?' 'i think so,' said gilbert, still more coldly. 'at any rate, i'd back them to have a rare good try.' 'try!' exclaimed charke. 'try! oh, we can all try! as far as that goes, i'd have all the blind ones out to put their weight on the braces while the rest went aloft, if the wind would only come; they could do that without seeing. and we could try getting the sails off again if it blew too hard--but i doubt our doing it. any one can try.' after which he walked forward to make inquiries about the two fresh cases of blindness. 'i don't like that man, bella,' gilbert said when the other was out of hearing, 'although he's a smart officer and a gentleman. and i don't think he likes me.' for a moment she stood there saying nothing, and with her eyes cast down on the soft pitch of the seams, which was greasy and seething under the fierce sun. then she looked up at her lover and said: 'no more do i much now, bertie. in fact, i almost fear him.' 'i wonder if he was ever in love with you?' bampfyld said, while remembering, as she spoke, how once, in those delicious days when they had first acknowledged their own love for one another, she had jokingly told him that he was not the first sailor who had tried to woo her. and he recalled, too, the fact that charke had been introduced to her mother's house by her uncle, and had been more or less of a frequent visitor there. 'was he, bella?' he continued. 'was he the sailor you once told me of who wanted your love?' 'yes,' she said, gazing up at him with her clear, truthful eyes. 'he was. he told me so long after i met you. and i believe now--i have thought so for some time--that he would never have applied for the position he holds in this ship if uncle hadn't told him that i was coming in it. he was far too ambitious for such a post when i first knew him, and aspired to be captain in one of the great liners, and eventually to be an owner.' 'i'm glad you've told me, darling. especially as it quite explains his not liking me over much. poor chap! i can understand that he should not do so in the circumstances,' he added, while gazing down on his sweetheart with such a glowing look of love as to cause her to forget all their unfortunate surroundings and revel only in her delight at being so much beloved by him. 'yet,' gilbert continued, 'i can't understand his wanting to come into this ship, even though it would give him three or four months more of your society. such a thing as that would have been maddening to ordinary men--i know it would have been to me! if you had rejected me--i--i--well, there! i can't say what i should have done; but, at any rate, i couldn't have borne the torture of being in your presence--especially if you were on your way to marry another fellow.' 'he is a strange man,' bella said, 'and although i never loved him, i cannot help admiring his force of character. his father, a selfish old man, treated him badly and baulked him of going into your service, yet he managed to be a sailor in another way, and to enforce respect from every one. and he is a cultivated man and wonderfully well read. still, i don't altogether like his force of character, or rather, the direction it takes. he told me, on that day at portsmouth, that he never faltered in his purpose, and that, when once he had made up his mind to do a thing or get a thing, he did it, or got it, somehow. i believe, too, that he meant it as a kind of defiance to me.' 'did he, though!' exclaimed gilbert, as now they sat beneath the awning, at which they had arrived while talking. 'did he! well, he won't get you, anyway, will he? not while i'm alive, anyhow. if, however, i were to die----' but this remark was promptly hushed by bella, who would not allow her lover to even finish it, and, as his watch commenced at six o'clock, he now went below to get an hour or so's rest before that time arrived, while she still sat on beneath the awning, thinking dreamily of him alone and of their future--if any lay before them, which now seemed doubtful, or, at least, very uncertain. then, suddenly, as thus she mused, there happened a thing which startled and amazed her so that she sprang out of her singapore chair and gazed aft, away down towards the south. a thing which even she, a landswoman, a girl originally unacquainted with anything connected with seafaring matters, had, by now, come to recognise and understand as vital to all on board that ship. she had felt the back of the straw hat she wore lifted by a slight warm ripple of air, while, at the same moment, some of the pages of a book she had left lying on the table were suddenly turned over swiftly and with a loud rustle. 'it is the breeze,' she muttered, 'the breeze! the wind at last!' the others on deck had perceived it as quickly as she. at once, those who were about had sprung into action and thrown off the listlessness which had pervaded all in the ship since they had been becalmed. in an instant all was bustle and confusion; the four remaining men who could see rushing about eagerly. the master came out from where he had been talking to some of the sufferers, while charke, running along the waist, called out: 'miss waldron! miss waldron! where is the lieutenant? we want his services now, at once. perhaps he, too, can do as much as any of his own men could if we look alive.' 'i will fetch him directly,' bella cried, full of excitement, and, swiftly, she ran down the companion to the saloon on her way to hammer on gilbert's cabin-door and awaken him. but, as she reached the place she stopped, petrified almost and filled with a vague alarm at she scarcely knew what, while, at the same time, she smothered a shriek which rose to her lips, and exclaimed in its place: 'bertie! bertie! what is the matter?' for she saw him standing by the saloon-table gazing at her, smiling even as he heard her loved voice, yet holding on to the edge with one hand while, with the other, he felt, as it seemed, cautiously before him. and again she cried: 'bertie, what is it? what does it mean?' then she heard his voice saying: 'it means, darling, that i too am struck down. that i too am blind.' chapter xv a light from the past four seamen only left untouched by blindness now, and two officers, to work a ship of six hundred tons! how was it to be, how could it ever be, done? the task was hopeless, and so all recognised on board that unhappy, ill-omened ship, even as now the wind freshened and the bosom of the ocean became flecked with little white spits of foam, while the breeze, hot as the breath of a panting wolf, swept up from the south. a breeze hot now, though once it had been cool--glacial--as it left the icebergs of the antarctic circle. what was to be done? they muttered now, as, together, the six unstricken men took counsel while they stood in the shade of the foredeck awning, and forgot, in their excitement, that one was the master and owner, the other the first officer, and the four remaining ones only poor, ignorant sailors. what! what! what! 'i,' exclaimed pooley, at last, after much discussion, 'can at least steer her. some one must do it if she is to move at all; otherwise, in spite of my seventeen stone, i would be up those ratlins like a boy. but, even then, of what use are five to fist all the canvas she can carry?' 'we can fist some of it, at any rate,' said charke, strong, determined as ever. 'by heaven!' he cried, 'lieutenant bampfyld shall never go back to any of her majesty's ships and say that half-a-dozen men under the red ensign couldn't do something; couldn't make one stroke to save themselves!' then, in an instant, he asked the captain to go to the wheel, while he sent the man, whose trick it was, forward, and, a second later, he was issuing orders to his subordinates. somehow, these orders were obeyed, and in about an hour, during which time all worked with a will and as if their lives depended on it, the _emperor of the moon_ was under close-reefed topsails, foresail and fore-topmast staysail, when, if she had only had her full complement of able-bodied men to do the necessary work, she might well have been under full sail before the still increasing wind, and making a good nine or ten knots an hour. but, now, that was impossible; even if those five could have got all her canvas on her the thing would have been madness. a little further increase of force in the wind, and they would at once have to shorten sail again--which, in the circumstances, it would be almost impossible for them to do--or to stand by and see the masts jumped out or blown overboard. as it was, the _emperor_, under the combined power of the current and what wind they could avail themselves of, was making something like five knots an hour. during all this time bella had been below with gilbert and a prey to terrible anguish, yet endeavouring in every way to cheer and solace him and to thrust her own fears and forebodings into the background. fears and forebodings of she scarcely knew what, yet fears that were, all the same, assuming by degrees a more or less tangible shape. for of late--indeed, long since--there had been intensifying more and more in her mind that feeling of dislike and mistrust of stephen charke which she had experienced from the first moment that she had discovered him to be the second in command of the vessel in which she was to make so long a voyage; for, over and over again, she had remembered, had recalled, how he had said that he was never baulked in the end of what he desired to obtain, and that if he wanted a thing he generally managed to get it. and she knew that he had meant it as a warning, if not a threat; though, certainly, since that miracle had happened which had brought her lover into the very ship which was taking her to india and to him, she had laughed at, had inwardly despised, the threat, if it was one. but now--now! with gilbert stricken down by her side, helpless, crippled by blindness, unable to do aught for himself or her, and with her uncle broken down and worn almost to equal helplessness with his enforced labour and his despair at the ruin which threatened him through the probable destruction of his ship, what--what might not charke do? _he_ was not blind yet, nor---- then, as her meditations reached this point, and while gilbert sat by her side on the pretty plush-covered locker with his head on her shoulder, he broke in on those meditations, and what he said could not by any possibility be construed by her as helping to dispel them, but, rather, indeed, to aggravate them. 'at the rate we have been going on,' he said, 'since i came aboard, there will not be a living soul left with their eyesight by the end of the next two or three days. oh, my god! bella, what will it be like when this ship is at the mercy of the ocean, with every person on board blind.' 'don't let us think about it, darling. don't, don't! and even now some may retain their sight. uncle, i, mr. charke, the men----' 'ah,' he said, 'charke; yes, charke. excepting you, dearest, i would sooner charke kept his sight than almost any one else.' 'why?' she asked, thinking that of all who were in the ship she, perhaps, cared less whether charke preserved his sight or not. 'think what a strong, self-confident man he is. even if all the others were blinded and he was not, he would devise something for keeping the vessel afloat, though, of course, he could not work her. he would manage to get us all taken off somehow.' this, the girl acknowledged, not only to him but herself, was true enough. as regarded charke's sailor-like self-confidence, courage and determination, as well as how to do everything best that was necessary in the most sudden emergency, there was nobody on board the ship, nor ever had been, who was superior, or even equal, to him. yet--in sole command and possession of that ship, supposing the other inhabitants of her should also be attacked with blindness and helplessness--what might he not do, if his dogged resolution never to be baulked of anything he had set his mind upon was allowed full sway? her imagination was not a tragic one, nor more romantic than that of most young women who had been brought up as she had been, yet--yet--she shuddered at fears which were almost without actual shape in her thoughts. with all the others blind, herself included; with none to observe what charke did; with the opportunity of removing for ever from his path any who had crossed it--of removing the one whom she felt sure, whom she _divined_, he was anxious to remove; with an open sea around him----'oh, god!' she broke off, while exclaiming to herself, even as her reflections shaped themselves thus, 'never--never will i believe it. never will i think so basely of any man, especially since he has given me no cause to do so. and, as yet, there are plenty left with their eyesight; plenty to see what is going on.' her uncle and aunt came into the saloon now, full of a distress that was visibly marked upon both their faces as well as their demeanour, yet both as kindly as ever in their manner, and uttering expressions of sympathy with gilbert in his affliction. but, all the same, bella could not but observe the look of absolute illness and grief on captain pooley's countenance, nor help trembling inwardly at the fear that he might be the next one attacked. nevertheless, he said cheerfully enough, after he had exhausted his condolences with the young man: 'we are doing some good now, at any rate. the "cherub" is marking about six knots; if the wind keeps where and as it is we may yet fetch mahe, or one of the other seychelles. in fact, we must reach them, or some other place, or----' 'or what?' asked bella, looking at him with tear-laden eyes. 'or,' her uncle said, not, however, concluding his speech as he had originally meant to do, 'or drift about until we fall in with another vessel. we ought to do that, too,' he continued, 'for we are almost in the direct track from the red sea to australia; we are in the track of the big liners.' 'how,' asked gilbert now, while forcing a smile to his face as he spoke, although it was but a poor, wan substitute for the bright, joyous one that generally lit up his countenance--and, indeed, it was only assumed with the hope of cheering his sweetheart by his side, wherefore, like all other substitutes for the real thing, it was but a wretched copy--'how are my brother-sufferers? it would be cheering news to hear that some of them were regaining their sight.' 'at present,' pooley replied, 'only one of your "fellow-sufferers" seems to be doing so, and that's not a human being but no other than bella's _protégé_ the tiger-cub. that creature is, we all believe, coming round. it is rambling about the deck by itself, but it undoubtedly can see now to avoid hitting its head against the raffle lying there. however,' he went on, 'here's a little information which you may both be glad of, upon which he dropped his hand into his nankeen jacket and produced from it an old, dirty, and much-thumbed book, on which, in addition to many other unclean marks and stains, were added droppings from candles.' it was evidently, as bella at once divined, one which had been pored over at night; while, had she been well acquainted with the habits of those who dwelt in the forecastle, she would have also understood that mercantile jack is often in the habit of sticking lighted bits of candle about whenever he wants to read, and even to the sides of his bunk in which he lies, when he sleeps in one instead of in a hammock. 'millett,' her uncle went on, naming one of the men who had still retained his eyesight, 'showed me this an hour ago. it belongs to poor wilks, and is a book entitled _calamities of sailors_, it being a collection of odds and ends accumulated from various writers by an unknown hand. now, here,' he went on, 'is a strange account of blindness attacking a vessel in much the same way as those in my poor old _emperor_ have been attacked, and----' 'did they regain their sight?' exclaimed his listeners together; all three, namely, mrs. pooley, gilbert, and bella, asking the same question in almost the same words. 'they did,' the master went on, 'in this case. it happened on board the _james simpson_, in . but in another, i am sorry to say, they did not; and also, i am sorry to say, this is a very circumstantial account, given by m. benjamin constant to the french chamber of deputies, in , when he was speaking on the horrors of the west african slave trade. he tells how a french ship, _le rôdeur_, having a crew of twenty-two men and a hundred and sixty slaves, left bonny in , and was attacked with almost precisely the same blindness which has now fallen on most of us. things were worse with them than in this ship, however. they had scarcely any water, the air below was horribly impure, and, when the poor wretched slaves were allowed on deck, they locked themselves in each other's arms and leaped overboard in their agony, so that the french captain ordered some of them to be shot as a warning.' 'yet,' exclaimed gilbert, '_le rôdeur_ must have got safely into harbour at last, or m. constant would not have given his information.' 'yes,' said pooley, 'that of course is so. pray god we do, too'; whereon he closed the book and dropped it into his pocket. it was well he should do so. well, too, that bella did not ask to be allowed to read it for herself, for it contained a good deal more than her uncle had thought fit to read out, and described further horrors which it was not advisable that any in that saloon should be made acquainted with.[ ] chapter xvi man overboard another day had passed and the south wind still blew gently, neither increasing nor decreasing in force, so that the log showed that the _emperor of the moon_ had progressed between a hundred and fifty and two hundred miles farther north. farther north, as all said now, but not to bombay, since they had abandoned all hope of reaching that port in their present short-handed condition, and without obtaining fresh assistance--but towards the seychelles. that was the harbour of refuge to which their thoughts and aspirations pointed at this time; the spot where, even though they should obtain nothing else, they would at least be in safety, and the one from which they could be taken off by some other ship if they were not able to find the means of working their own. but, even as this day was drawing towards its conclusion--a day hotter, it seemed to all on board, than any they had previously experienced, and when neither the awnings nor the breeze that came aft protected them sufficiently to allow of their being on deck, unless duty demanded that they should be there--a change was perceived to have taken place in the condition of one or two who had been attacked by blindness. mr. fagg had declared that he was regaining his sight, and that, although he could not distinguish small objects with any amount of clearness, he was nevertheless able to see large things, such as the form of a man or woman, in a blurred, indistinct manner if he or she happened to enter his cabin; while wilks averred that his sight was also returning rapidly to him. 'for, see here, sir,' he said to charke, who, learning what was happening, or said to be happening, had gone forward to question him on the subject, 'i can walk aft to the break of the poop without stumbling against anything or over anything either. may i show you, sir?' 'ay,' replied charke. 'show me. let's see what you can really do,' while at the same time he motioned to a sailor, who happened to be by the mizzen-mast, to throw down gently a coil of rope he held in his hand so that, when wilks neared the spot where it was, they would be able to observe whether he could see clearly enough to avoid it or not. meanwhile, wilks, having received the necessary permission, had started from close by the fife-rail, where the conversation had been going on, and was making it perfectly clear that what he had stated was undoubtedly the truth. for, independently of the coil which the sailor had deposited abreast of the mizzen-mast, there was at this moment a good deal of raffle lying about the deck, as well as a bucket or so, and also a squeegee alongside the saloon skylight. but wilks saw them all and steered himself along, avoiding each and every object both great and small, while, when he approached the coil of cable, he passed round it in almost precisely the same manner that a man in possession of his ordinary eyesight would have done. then he looked back--at least he turned his face back--towards where he had started from, and, with a gratified grin on his countenance, asked charke if he was not all right. 'yes,' replied charke, 'or getting so. if one or two more of your mates would only recover in the same way, we might bend another sail and, so, make a few more knots. yet, curse it!' he muttered to himself, 'as one gets well another gets ill.' this was unhappily only too true, for not an hour before he had been called to observe that wilks seemed to be on a fair way towards recovery, he had learnt that pooley was, although not stricken with the blindness, yet rapidly becoming blind. he had himself discovered such to be the case when, after lying down for an hour, he had been unable to perceive anything clearly on awakening. and, in another hour after this had been found by him to be the case, he was obliged to acknowledge his darkness of vision was becoming more intense, and that he feared his sight would be entirely gone by nightfall. this was, perhaps, the greatest blow of all to several on board the unfortunate ship; on bella it fell with overwhelming force. for now she recognised that, of all others, the very man she most feared and dreaded--though she could not have explained why that dread should have taken possession of her--was in absolute control over the ship, and could indeed do what he liked with it. her uncle, she understood, could of course still issue orders, but--how was it to be known that those orders were being obeyed? then, strong-minded as she was, and feeling more so, as well as more self-possessed because of the presence of her lover in the ship, she again forced herself to discard such miserable and--as she termed them in her own mind--ridiculous fears, and set herself about the task which had now for some time developed on her of attending to the catering of the ship and looking after the sufferers generally. for, from mrs. pooley, bella had not at any time received much assistance, owing to the fact of the poor lady having been quite ill since the calamities on board began to follow each other in such frequent succession, while, now that her husband was struck down, she appeared to have collapsed altogether. indeed, at this present time, she was doing nothing except lying on the plush-covered sofa of the saloon, while moaning feebly that they were all doomed, and that, even if the ship was not utterly cast away and lost, there would soon not be a living soul on board who would be able to see. 'and then,' she sobbed, 'what can happen to a vessel--in the night, especially--full of men and women who are all blind and cannot find their way from one end of the deck to another?' 'nonsense, aunty, dear, nonsense!' bella replied, while endeavouring bravely to dispel her aunt's forebodings, which, in solemn truth, she shared to the full with her, though not for worlds would she acknowledge that she did so. 'are not some already getting well--mr. fagg, and the sailor, wilks, and bengalee----' 'while at the same time others succumb to the blindness,' mrs. pooley interjected, still with a moan. 'and now your poor uncle, of all others.' 'well,' said bella, still stout of heart, 'we have this comfort: it soon passes away. let me see. bengalee has been blind about a fortnight, wilks and mr. fagg about twelve days--whatever is that noise!' she exclaimed, breaking off suddenly. as she uttered that exclamation there had come a sudden racket above their heads, the noise descending through the wide-open skylight. a noise which seemed first like the yelp of a dog in pain; then another which resembled somewhat the spitting of a cat, followed by a shrieking kind of growl, and then the voice of charke exclaiming angrily: 'i'll have the infernal thing thrown overboard. here you, catch hold of it--make a loop and fling it over its neck. catch it, one of you!' 'oh!' cried bella, forgetting everything else for the moment, and rushing towards the companion, 'it's bengalee!' then she swiftly ran up to the deck, and saw the tiger-cub standing close up by the frame of the skylight and growling at charke, whom it regarded with terribly vicious eyes. and she noticed, too, that it held up one of its hind legs as though it were injured. 'what are you doing to the creature?' she cried. 'you have been kicking it again, you----' she was going to say 'brute,' but restrained herself. 'and you shall not have it thrown overboard, as i heard you order the men to do!' she continued. then she went towards the creature perfectly fearlessly, and spoke to it, and eventually stroked its back, so that at last its growls subsided altogether. the chief mate's face had presented an appearance of scowling rage as she reached the deck, while it had on it an expression that boded ill for any extended existence being accorded to bengalee had she not appeared at the moment she did. yet, by the time she had ceased petting the animal he had managed to control himself considerably, and to smooth out the look of temper from his countenance. and now he said: 'oh, of course i did not really mean to do that, miss waldron. though it will have to be got rid of eventually. it is impossible that it can be kept much longer. and, you know, we have enough work to do without attending to such an animal as this. just think! i am the only officer fit for duty, and i have only four able men to work with--since wilks cannot be called well yet.' honestly, bella felt sorry that she had spoken as hotly as she had done, since she did indeed recognise the almost superhuman amount of work that had fallen on charke's shoulders just now. he seemed never to sleep but was on deck night and day, sometimes steering, sometimes even going aloft alone, and hardly ever snatching a quarter of an hour for his hasty meals. she murmured, therefore, some words of regret, and was going on to say how sorry she was for having been excited, when he stopped her. 'no, no, miss waldron. it was nothing--nothing. the thing did spring at me angrily as i passed where it was sleeping, and i kicked it. i am sorry, too. and you know i would not injure anything you liked,' while, as he spoke, he bent his dark, handsome eyes on her. perhaps it was a pity he uttered these last words, since in her own heart she did not believe that they were true. she had seen his glances more than once directed at gilbert when he had not known that she was observing him, and she thoroughly believed that, in them, there was a malignant look, a look of hatred, which belied his words. and she had seen--she _thought_ she had seen--something else in those glances when gilbert was first attacked with blindness which, if not gloating, was very like it. she said, therefore, now, as she turned towards the ladder: 'then you won't punish it, mr. charke, will you? you won't let it be thrown overboard in any circumstances, will you?' 'it shall be as sacred to me as you are,' he replied. 'its life as sacred as yours.' but all the same, she told herself as she went back to the saloon, that, if there was anything charke hated in that ship, or rather, any two things he hated more than all else, those things were her lover and bengalee. presently, not ten minutes later, she again heard his voice, calling out loudly to one of the men this time: 'if we could only get another on her we could make two more knots, i believe. if only some of those who are blind but not otherwise incapacitated would help on the braces and get the yards round, we could do it.' she was not the only person who heard these words. not a moment had they left his lips before the curtains in front of gilbert's and mr. fagg's cabins were pushed swiftly back with a metallic jangle, as the rings ran along the rod, and each of the young men appeared in the saloon and began making his way guided by his hands, towards the stairs leading up to the deck. 'oh!' cried bella, not quite understanding what it was charke wanted done, or what assistance could be rendered by persons who were blind, 'what are you going to do? gilbert, don't do anything rash! nor you, mr. fagg!' though she saw by their faces and the smile that came to each that she had overrated any harm that was possible. 'we'll get that sail on,' exclaimed gilbert, as he felt his way up the stairs, and fagg said: 'we will so,' as he followed him after they had each jostled the other at the foot in a slight collision which their sightlessness had caused, and, a moment afterwards, bella and mrs. pooley were left alone in the cabin. yet they could hear, plainly enough, the words of approval bestowed on gilbert and fagg for their promptness, when the meaning of it was recognised by those on deck; and they caught, too, the orders bawled with great rapidity by charke the instant he had received this extra assistance. also, they heard him ordering one man to the starboard main braces and another to go forward and loose the jib. a moment later they heard something else as well. the cry of two or three voices together, the roar of charke, and then his trumpet-tones, exclaiming: 'my god! he's overboard!' and bella, with the image of one man alone in her mind, reeled backwards towards the sofa where mrs. pooley lay, and gradually slid, fainting, on to the cabin floor by her side. chapter xvii 'farewell, my rival' had bella known more about a ship and its intricacies she would have understood that, notwithstanding some one had undoubtedly gone overboard, the sailor, whoever he was, could not by any possibility have been one of those who had gone to help in squaring the yards. instead, she would have been aware that such an accident could only have happened to some seaman who had either gone aloft or out on to the jib-boom. and, in fact, the latter was the case; the unfortunate fellow, a man named brown, falling off the boom while endeavouring to set the flying jib, and being struck a moment later by the frame timbers forward as he fell. yet the unhappy sailor seemed still to have some life left in him, as those who rushed to the port side could see, since, as he was passed by the ship, he was observed to rise to the surface--his head all shiny with blood--and to strike out manfully. but what could that avail, since, by the time the _emperor_ could be brought to the wind and a life-buoy thrown overboard, he was half a mile astern? to lower the boats in time to save him would also have been an impossibility, even if it could have been done at all; and, moreover, the swift-coming instantaneous darkness of the equator was at hand, so that the man himself was, by now, almost invisible. 'steer her course again,' charke called out, therefore, to the man who was at the wheel, in a voice in which regret for the unfortunate sailor was mingled with a tone denoting some other sentiment that, perhaps, none would have been able to understand, even though they had been swift to observe it, as, in their excitement, none were. then, at once, in a few moments, the _emperor of the moon_ was again heading towards where the seychelles lay. what was that other sentiment which now pervaded the breast of this strong, masterful sailor; this man who had worked untiringly for hour after hour on stretch, and who seemed to rise triumphant over nature's command that both sleep and meals should be properly partaken of? the man who had not changed his clothes for three days, nor even had them off his back when he sought a quarter of an hour's rest here or ten minutes there? what was this sentiment? nothing but a certainty that this was the last voyage the ship was ever to make--a feeling of intense conviction, which had been growing upon him for some time, that all in the ship were doomed. for he, at least, could see--_he_ was not blind yet--and, more than all else on board, perhaps, could feel; and his sight showed him things over the water, in the density of the atmosphere, even in the appearance of the brassy heavens above, which told him that, ere long, the slight whispering breeze which blew would be changed into a hurricane howling across the ocean. his feelings, his nerves, the moisture of his skin corroborated, also, what his sight proclaimed. 'it will come,' he muttered to himself, as now he paced the after-deck, with his eyes never off the light sail that the ship was carrying. 'it will come soon, and then we are done for, even though i get every inch of canvas off her first. this man's death leaves me and three other sailors as the only persons to work the ship. it is strange if, even under bare poles, we continue to swim.' then, as he turned his head towards where bella (who had soon recovered from her faintness) was now standing talking with her uncle and her lover, he muttered another sentence to himself--a sentence which, should a romancist or a dramatist inspire one of his characters with it, would, perhaps, be deemed unnatural, yet which this man of iron will and fierce determination muttered to himself as calmly as he would have given an order to one of his few remaining sailors. 'if it blows, as i believe it will, twenty-four hours will see the end of us all. she--oh, my god! she will be dead--but so will he and so shall i. well, there's consolation in that. if i can't have her, no more can he. that thought makes the end mighty cheap.' here he strode towards those three standing by the break of the poop, and touching his cap to bella--he was, as she had observed, a gentleman, and in all that became the outward semblance of a gentleman he never failed--he said quietly to the poor, blind captain standing by her side with his fingers resting lightly on her arm: 'we must get in all the sail, sir, now. there is a change coming; i know it--feel it. the glass, too, stands very low, and since we cannot work the ship in a storm, short-handed as we are, we had better commence at once. it will be pitch dark in ten minutes and there is no moon.' 'good god!' exclaimed pooley, 'what is to happen next? the glass low, you say? well, that means a change of some sort, though not necessarily bad weather. what are these feelings you speak of, charke?' 'the feelings of a sailor,' he replied. 'you know them as well as i do. ha!' he exclaimed, 'there's lightning in the south. no time to be lost.' then he seized the boatswain's whistle, which he had hung round his neck and used since the man himself had become disabled, and blew it as a signal to his three remaining hands to be ready for his orders. 'now then,' he cried, 'up with you and stow the few sails that there are. what do you say?'--to one who muttered something--'tired--been working all day? why, damn you! haven't i been working too.' charke rarely swore, but he was impelled to do so now, especially as he had moved out of bella's hearing. 'do you see that lightning down there in the south? do you want the ship to be blown over and go to the bottom in her? here, you stop at the wheel,' addressing the man who was already at it, 'we others can do it somehow. follow me'; and away he went to the topsail yard, selecting the most arduous part of the business for himself. while he muttered to himself as he did so: 'now, if i should go, too--fall off the yard--they are doomed beyond all help. nothing then can save him.' which thought caused a strange, weird kind of smile to be on his face as he sprang up the ratlins. and, stirred to action by his own indomitable energy, the men did set about the work and managed it somehow, the sails being stowed in a very unshipshape fashion (or what would have been an unshipshape fashion if the proper quantity of sailors had been there to do the job) and in such a manner that the first gust of the coming tempest would be as likely as not to blow them clean off their lashings. still, it was done at last, and not too soon either, since, ere they had concluded their work, the lightning was flashing incessantly and huge drops of rain were falling. 'it's a south-easterly wind,' said gilbert to bella, turning his cheek towards it. 'where will it blow us to now?' charke thought he knew, as he listened to the remarks, since he had returned to their vicinity after coming down from the topsail-yard, but he uttered never a word. even now he loved the girl by their side too much to frighten her more than was necessary. yet, had he said that he knew that, short of a miracle, it must be the bottom of the ocean--as was the case--she would probably not have heard him, since, at this moment, with a devilish shriek, the gale was upon them. upon them and almost pooping the ship as it struck her right aft, and then driving her forward in the churned sea with a horrible, sickening motion, while, since she was fairly deeply laden, she recovered herself from the avalanche of water but slowly. an avalanche that, sweeping over the poop with a roar and a swish, took bella and gilbert off their feet and hurled them forward staggering, and buffeted against each other. 'below--go below, all of you!' roared charke to them, and also to pooley, who had himself been sent sliding along the deck and was now hanging on to a belaying-pin, even as he called out to know where bella was. 'below, i say! we must close the hatches, or she will have the sea in her. below, quick!' and, rushing towards bella, he led her to the after-companion, dragging gilbert with his other hand and returning for pooley. and now the tropical lightning--that violet-hued lightning which is so beautiful and also so sure a sign of awful turbulence in the elements--played incessantly on the ill-starred _emperor of the moon_; the seas were mountains at one moment, valleys at another. the ship, too, was rolling so that it seemed as if everything on her deck must be pitched off her into the sea--as was indeed the case with many of the smaller things which went to form the raffle lying all about--and each time that she went over to port or starboard she took tons of water over her side. then, a still more gigantic wave caught her on her port-bow, and absolutely threw her up, it rolling directly afterwards under her counter and letting her drop directly afterwards into the trough, while over her poop, again, came that which seemed to be not a wave but the whole indian ocean itself. amidst it all charke still stood at the wheel, holding on to it as perhaps few solitary men had ever held on to a wheel in such a sea before; his arms actually bars of iron, yet appearing to him as though deprived of all sense and feeling. he stood there silent, determined, resolved, awaiting death, knowing that it must come and not dismayed--because it must come to that other, too, that man below in the saloon who loved and was beloved by bella. then, suddenly, he knew that he was not to die there alone at his post while his rival expired in his sweetheart's arms, or she in his; he knew--he discovered that not to him alone was to belong all the bravery and the resolution. creeping up from below, thanking god that the hatch had not yet been closed, feeling his way by his hands and gradually reaching the wheel--buffeted here and there; knocked down once, then up again--gilbert bampfyld crept to his side, and, an instant later, was fingering and, next, gripping the spokes. 'let me help you!' he roared, so as to be heard, while feeling as he did so which way the other man who already had hold of the wheel was exerting his force. 'blind as i am, i can do that. who are you?' 'stephen charke,' the other answered, also shrieking his name. 'help, if you like. but it is useless. we are going.' 'i know it,' gilbert answered. 'well! we will go down standing.' and charke, still endeavouring to hold up the ship, still to protract life from one moment to another, muttering inwardly: 'curse him! he is a man. one worthy of her.' then, unceasingly, he continued his work, wrenching, striving, endeavouring in every way to save the ship from being pooped or flung over as the waves took her and cast her up like a ball, or hurled her down like a falling house into the gaping, hellish troughs that lay below, yawning for their victim. but still the lightning played upon the doomed craft, illuminating her from stem to stern, showing the fore top-gallant mast gone and the jib-boom carried away, broken off short, three feet from the bowsprit head. also it showed something else--something that, had he had time to think of aught but preventing the ship from falling off the course he was endeavouring to steer, might have struck a feeling of wild horror to his uncanny breast. for some of the blind, stricken men forward had crept by now out of the forecastle and other places where they had herded, and were crawling about the foredeck, holding on to whatever they could clutch--belaying-pins, the fife-rail, the racks, even the ring-bolts. amongst them, too, was the tiger-cub, an almost unrecognisable lump, except for the topaz gleam which his eyes emitted: a gleam that, as a sea, which was in truth a cataract, washed it from the foremast almost to where he stood, appeared to charke malignant, devilish, threatening. and he heard those unhappy men's voices, cursing, blaspheming, praying: roaring that they feared no death which they could see, but that they wanted to go neither to heaven nor hell enveloped in utter darkness. 'no jack who ever sailed,' they screamed, 'feared a death that he could face, but we fear this. and if we had but our sight, maybe there'd be no death at all!' 'ay, but there would, though,' muttered charke to himself--'there would. ha! by god, look there,' he cried aloud, forgetting that the only man who could hear his words was blind. the ship had given another hideous plunge--had wrenched herself as a giant might give a wrench in endeavouring to free himself from the chains that bound him--then down! down! down! she went into the hollows of the ocean, so that up above her on either side were nothing but vast walls of sea. walls that would, that must close together, charke understood, fifty feet above their heads, leaving the ship beneath them. and then he turned to the other man by his side, saying calmly: 'now is the time! you love bella waldron. so do i. and neither of us will ever set eyes on her again. farewell--my rival!' chapter xviii 'she will never know' 'how in heaven's name has she ever done it?' muttered charke to himself, three minutes later, as, dripping like a dog dragged out of a pond, he still stood by the wheel while holding on like a vice to the spokes. and still both he and gilbert had each got their legs twisted in the radii to prevent them from slipping, since now the ship lay over frightfully to starboard and did not recover herself at all. 'ah, well,' he continued, 'it does not matter much how. another five minutes and over she goes--turtle. it is a hundred to one she has six feet of water below.' how had she done it? that was the wonder, the marvel; the more especially a wonder if, as charke thought, she had six feet of water in her, since twice that amount would have taken her to the bottom even though she lay in the most tranquil waters of the universe. it was impossible she would have risen again, if overloaded thus. yet, water in her or not, she had accomplished a marvellous feat for any craft that ever left the shipbuilder's yard. for, from down below in those awful depths, with, on either side of her, and glistening all around her in the glare of the lightning like the sides of a crevasse, those walls of sea, she had still risen above them and had (a moment or so after they seemed to be closing in on her and shutting her out for ever from the world above) been once more poised on the crest of a huge billow. she had done it, and now lay listing over on to her starboard side, as some great wounded creature might do whose right ribs had all been broken in by the blows of a pole-axe. but still she travelled through the water in the darkness of the night; for now the lightning was ceasing and, also, she carried no lighted lantern since there were none to attend to such things--while, even though there had been, the beating of the gale would soon have extinguished them. she travelled swiftly, too, cutting her way through billow and wave, taking in huge seas aft which swept her decks--yet going still. but with some of those spectral forms, those blind groping men, departed for ever; swept down the sloping deck by tons of water, down and over into the ocean. and of the few, the three who had still their sight, one lay with a broken neck at the foot of the foredeck companion-way, having been flung down the hatch-way head foremost; the other two were drunk. they had broken into the steward's room, where there were none to control them, and had found some bottles of beer, as well as one of brandy and one of rum--and this was the result! at that moment the wheel spun round in gilbert's hands, dragging him with it in its revolution, so that he thought he would have to let go or be thrown in a somersault over into the sea; then, as he forced it back, he heard charke's voice bellowing at him: 'can you hold her up for five minutes? i can grasp the spokes no more; i am done. i would not have let go like that, god knows i wouldn't, but i have lost all sensation in my arms and hands. i will lead fagg out. perhaps he can help.' 'i may hold her steady,' gilbert answered, 'but no more. what can a blind, stricken man do?' 'it is enough,' charke said. 'sight would not aid you to do more, and, after all, it is of no use. we but prolong life for nothing. yet, here goes.' he made his way below, falling, sliding down the companion-ladder, tumbling along in the darkness to where he judged the door of fagg's cabin was; he fell over things that had been hurled out of the steward's pantry on the port side--broken dishes, plates, tin utensils, potatoes peeled ready for cooking, and a joint of meat--he felt all these with his feet and benumbed hands, and found a bottle, too, which his smell told him was rum. then he tore the cork out of it with his teeth and drained a tumblerful of the raw spirits. that gave him fresh life and energy; the blood coursed and danced through his veins again, his fingers began to feel, his arms to strengthen. sliding back the door of fagg's cabin he called him by name, and, receiving no answer, felt in the berth to see if he was there, while, even as he discovered that the bed was empty, he trod on an upturned face, and then stooped down and felt it and the head, and found the latter all broken. whereby he understood what had happened to the unfortunate young officer, and knew that he had either been hurled out of his bed against a bulkhead, or, being out of it, had been dashed to death. he would have gone back now to relieve gilbert, and was turning to do so when his eye caught the glimmer of a light down the narrow gangway leading to the saloon, and he knew at once that somehow those within had managed to get the bracket-lamp over the table lit. whereon he went towards that saloon, intent on seeing how those who were in it--especially _one_ in it--were preparing to meet their end. were they bearing up bravely? was she--was that girl who maddened him, that girl, through his unrequited love for whom, he knew, he felt, that all his better qualities had been driven out of him--preparing to meet her death nobly, valiantly? the sight he saw might have struck horror to a bolder, a better man than he. a sight more fitting to meet the eyes of one who gazed into a catacomb or charnel-house than into what had been, not long before, a pretty, bright saloon. mrs. pooley lay flat upon her back, moaning feebly, her stout body rolling backwards and forwards with every swing of the ship and every plunge it made. the captain was on his face, and above him lay half the debris of the shattered, sea-wrecked cabin. but bella! she frightened, startled him! 'the others may be dead,' he whispered, 'but she, surely she is alive. god! how her eyes stare, yet--yet how lovely she is still.' the girl was sitting upright upon the saloon sofa, her hands gripping the head of it as though, all unconscious as she appeared to be, she still knew that she must do that to save herself from being flung down, and her lips moved faintly. then he wrenched the bottle of rum from out of his pocket, he having put it there with a view to administering some to gilbert when he regained the deck, rival though he was, and moistened her lips with it. 'miss waldron--bella,' he whispered, allowing himself in those last moments the luxury of calling her by the name that he had whispered so often softly to himself. 'bella! for god's sake, say something. tell me that you are not dying.' and she did whisper something--a word that he heard above all the roar of the hurricane thundering aloft, above the awful concussions of the ship's sides as again and again the tons of water struck at her, heavily, savagely, and as, also, she struck at them in her maimed progress; above even the rattle of ship's furniture rolling about, and the sickening thumps of the unlashed piano as it beat against the stem of the mizzen-mast. she whispered a word or so. 'gilbert,' those white, cold lips muttered; 'gilbert, my darling, we are dying together. clasp me to your arms now. hold me in them to the end.' with a moan, not a curse!--a curse would not have availed or eased him now--he started back in that dim cabin, hurling the bottle from him as he did so. his rival! his rival! again, even now! his name the last word on her lips, his image the last thing present to her in the hour of death. then he fled from the cabin back again to his post, back to the wheel to which he swore he would lash himself, and so go down thinking of nothing but his duty. there was, his fevered mind told him, nothing but that--but his duty--left. as he went along he noticed, distraught though he was, that the vessel was making a kind of rotatory movement under him; that she seemed, indeed, to be gliding round and round in a circle although beaten back more than once by the awful force beneath her. 'he has left the wheel!' he cried, his swift and accurate seaman's knowledge and intelligence telling him at once what had happened. 'is he mad--or dead?' and clutching, grasping at everything that offered a hold to him, he forced himself back to where the wheel stood, only to find when there that gilbert was lying senseless by it. senseless but not dead, as one thrust of charke's hand under the other's wet clothes, towards the region of the heart, told him very well. an instant later he had resumed his hold on the spokes, and was endeavouring to put the ship on her course before the howling winds, to keep her straight on into the dark, impenetrable depth of blackness ahead of her. again the marvel was that she did not go over, or did not suddenly sink beneath the weight of water that was pouring in on all sides--sink like a stone. and he began to tell himself now that, as she had borne up so long, as the storm could, by no possibility, become worse and must, at last, abate, there was still a hope. a hope of what? that he and bella might both be saved; be saved, and saved alone, together. 'she is alive and i am alive. the others are dead, or dying. oh, god! if she and i are spared----' but that sentence was never finished! for, as he partly uttered it there came an awful crash, a crash that hurled him back, then flung him over and over on the poop--a grinding, horrible concussion, followed by the most terrible thumps and by the sudden cessation of the ship's passage. and, a moment later, the vessel heeled over, though still beating and thumping heavily, so that now the water poured into her forwards, and, gradually, her fore-part was entirely immersed. but still the pounding and the awful grating continued, while growing worse and worse. 'she has struck,' he muttered to himself. 'struck on a reef or a rock. the end has truly come.' in a moment he had picked himself up from the poop-deck, and, difficult as it was to move with the vessel beating backwards and forwards, had dragged himself down to the saloon--down to where bella was, the woman whom he would save or die with. the lamp had gone out with the concussion. all was in darkness, and, above the roar of the tempest outside, he could hear the furniture beating about the saloon as the ship swayed and wrenched. yet he went on towards where he had left her ten minutes before; on towards the sofa on which she had been sitting almost unconscious. she was not there he found, but, instead, lying insensible at the foot of the sofa. insensible, he knew, because, to his words, his summons, she returned no answer. then, in a moment, he had seized her in his arms, had lifted her up, and, with her head upon his shoulder, was groping his way with unsteady, stumbling feet towards the gangway. her head upon his shoulder now, her hair brushing his face now, in this moment, in the hour of destruction--for one, for both of them! her head upon his shoulder! and he a mortal man! it was beyond endurance; more than he could bear! acknowledging this, recognising it, he slightly moved, with the hand which was around those shoulders, that face so close to him, that face so close, so cold and chill--and kissed her long and passionately. 'she will never know,' he muttered, 'never know. yet--yet it has made death sweeter. death! the death that will be ours ere many more moments have passed.' yet, near as that death was, so near as to be beyond all doubt, as much beyond all doubt as that the rocking, shivering ship was breaking up fast, he felt his way towards where he knew the life-buoys were, and rapidly fitted one on to each of them; while, as he did so, he murmured again and again: 'if any are saved it can only be she and i. yet even of that there is no hope.' chapter xix 'i almost dreaded this man once' the indian ocean lay beneath the purple-scarlet rays of the setting sun as calmly and as peacefully as though, across its treacherous bosom, nothing more violent than a cat's-paw had ever swept. indeed, so calm and peaceful was the spaceless sheet of cobalt that, almost, one might have thought he gazed upon some quiet tarn, or inland lake, shut in and warded off from any breeze that might blow or any tempest that could ever roar. only--he who should stand upon the pebbly beach of a little island upon whose white stones the surf hissed gently as it receded slowly and faintly--as though it were asleep and languid--would have known that, for thousands of miles ahead of him, there was nothing to oppose the tempests of the east and south, or prevent them from lashing that now calm and placid ocean into madness, or from exerting their powers of awful destruction. a little island set in that glittering, sapphire sea, with, all around its circumference of five miles, a belt of white bleached stone and sand, and with, inland and running up from the belt, green grassy slopes, in which grew tall palm trees, vast bushes or tufts of bananas, orange and lemon trees, mangoes and yams. there, too, were grassy dells through which limpid streams of pure cool water ran until they mingled with the salt ocean; there the wild turtle-dove cooed from guava and tamarind tree, the quails and guinea-fowls ran about upon the white silvery sands; while, to complete all these natural advantages, neither mosquito nor sandfly existed. a little island girt by coral reefs--the ocean's teeth, strong, fierce, and jagged; teeth that can rip the copper sheathing off a belated vessel as easily as a man can rip the skin from off the island's pink and golden bananas; teeth that can thrust themselves a dozen or twenty feet into the bowels of forlorn and castaway barks and tear them all to pieces as the tusk of the 'must' elephant tears the bowels of its victims. a little island, one of a thousand in that sometimes smiling, sometimes devilish, sea--such as are in the chagos archipelago, or the seychelles, or the cormoras, and, like so many of those islands, untrod, unvisited by man. unvisited because, where all are equally and bounteously supplied by nature, there is no need for any ship to draw near this solitary speck that is guarded from all approach by those belts of coral, and also because, to this small island, there is no natural harbour should rough winds blow. now--as still the setting sun went swiftly down amidst its regal panoply of purple and violet and crimson, while, above those hues, its rays shot forth great fleaks and flames of amber gold--it was not uninhabited, not desolate of all human life. upon a grassy slope a man lay, his head bound up with linen bands; one of his hands being swathed, too, in similar wrappings. and his eyes were closed as though he were sleeping--or dead. to her who gazed on him it seemed almost as if it must be the latter--the greater, the more everlasting sleep, that had fallen on him. for there were two in this island now; she who thus looked down on the prostrate man being a woman clad in a long dress, which once had been of a soft, delicate white fabric, but, now, was stained and smeared with many splashes and marks, and was rough and crumpled with hard usage and by the effects of seawater. her hair, too, was all dishevelled, uncombed and unbrushed; tossed up in a great mass upon her head; bound with a piece of ordinary tape. and still she was as beautiful as she had ever been; beautiful in this negligence which was the result of shipwreck and of battling with tempest, of cruel buffetings from merciless waves and jagged rocks--beautiful, though on her face and in her eyes was now the sombre beauty of a despair and misery too deep for words. for he whom she loved, he whose wife she was to have been, was not upon that island with them, and had no more been heard of since, in the arms of stephen charke, she had been plunged into the sea and, in those arms, borne to safety and to life. she gazed down on him now, in the last glimmering beams of the golden light that shot athwart the island, while regarding him with some expression in her glance which caused that glance to be not altogether a reflex of her own misery and despair. an expression that seemed to denote a supreme pity, an almost divine regret for him who lay before, and beneath, her, in pain and suffering. 'how brave--how strong he was!' she murmured inwardly, her lips not moving. 'how he fought with that storm--fought with death to save me and himself! no!' she broke off, still uttering her meditations to her own heart alone--'why do him such injustice even in my thoughts? it was not to save us both, but me alone. there was but one desire in his soul--to save me!' she turned and went to a small heap of fruit that she had gathered earlier in the day, and selected one of the great pink bananas--pink with a lustrous beauty which those who only see them when they arrive in northern climes could never believe they have once possessed--then she took a scooped-out cocoanut shell, and, going to a little babbling rill that ran through the grassy defile, filled it with water. after which she returned to where the other lay, and, kneeling by his side, gazed on him again. 'my god!' she whispered. 'i almost dreaded him once. feared him for i knew not what. feared him! him! and he has been my saviour.' he seemed to know that she was by his side and near him; for, even as she murmured these words to herself, stephen charke opened his eyes--a faint smile appearing in them--and gazed into hers. 'you are better?' she asked, as she gave him the shell with the water in it, which he was not too weak to be able to take and raise to his lips, while she tore off the rind of the banana. 'your forehead,' she went on, while putting her hand upon it calmly, as a sister might, 'is cooler. are you still in pain?' 'no,' he answered. 'no--only very weak. are--are--any more saved from that?' and he directed his glance to where, two hundred yards off from the island, lay something protruding above the water which looked like the rounded back of a whale, but was, in truth, the torn and lacerated keel of the _emperor of the moon_. in her last struggles--in her last convulsions as the gale had hurled her on to the coral reef--she had turned almost completely over. 'no,' she replied, her face an awful picture of despair and anguish. 'none are saved but you and i. oh!' and she buried that face in her hands and wept aloud, piteously, heartbrokenly. 'god rest their souls,' he said solemnly. 'god pity them! why i, too, should have been spared except to save you, i do not know. i might as well have gone down with them.' 'no! no!' she cried. 'no, mr. charke. you must be spared for better days, for greater things. oh,' she exclaimed, 'how bravely you battled with it all! uncle told us,' she went on through her tears, 'when we were below and before i became insensible, that your efforts were superhuman; that, if the ship could be saved, it would be by you alone. and,' she continued, 'how you saved me i do not know. only--only--i wish i had gone with him, with gilbert.' 'nay,' he said--'nay. do not say that. and--and--i ask you to believe that, had it been possible, i would have saved him too. but it was impossible. impossible to so much as slip a life-buoy over his shoulders. the end was at hand, the ship broken in half. it was impossible,' he repeated earnestly. 'how,' she asked, as she sat by his side gazing out across the calm, waveless sea through the fast-coming tropic night, and watching the great stars--almost as big as northern moons---sparkling, incandescent like, in the blue heavens above--'how did you do it? i remember nothing till i found myself lying there,' and she pointed down to the white sand, from which there came, through the sultry night, the gentle hiss of the sea, 'and saw you lying near me, and dead, as i thought.' 'nor do i remember, or only very little more than you can do. i dragged you from the saloon, and, after fixing a life-buoy on to each of us, leaped into the sea with you, striking out vigorously to avoid the ship. and i can recall my battlings with the waves for a few moments--only a few--then feeling my breath knocked out of me. and, then, nothing more until i came to and found you looking at me here. it was the life-buoys that saved us.' 'in god's mercy. under his providence. yet--yet--if it were not wicked to say so--if it were not for my poor dear mother at home--i--should----' 'no, no!' he almost moaned. 'no, no! not that!' then, after a moment or so of silence, he said: 'do you know how long we have been here? can you guess?' 'this is the second night, i suppose,' she answered. 'when i came-to yesterday morning, i imagine it was the first one after the wreck.' 'possibly. and have you seen nothing pass at sea, either near or far off?' 'nothing. yet i have gazed seaward all the time it has been light on each day. where do you think we are?' 'if the island is uninhabited, i think it must be one of the cormora group, since it can scarcely be part of the chagos archipelago--they are too far to the east. and all the others in the indian ocean--certainly in this part of it--are inhabited.' she made no reply now--she did not say what almost every other woman in her position would undoubtedly have said--namely, that she hoped they would in some way be taken off the island. for, in absolute fact, she did not hope so. to be saved from this desolation, to be put on board some ship which might be going to any part of the world, even though that part should be england itself, meant leaving gilbert behind--leaving him to his ocean grave. and she would not--certainly she would not yet--consent to believe that he had met with such a grave. the _emperor of the moon_ was still there, a part of her above the water although she was almost turned upside down, or 'turned turtle,' as she knew the sailors called it, and--and--might not some of those who were in her when she struck be still sheltering, clinging to some portion of the wreck that happened to be above water? she did not know much about ships, this awful, fateful voyage being her only experience, wherefore she thought and hoped and prayed that such a chance as this which she imagined in her mind might be possible. while, too, she remembered that gilbert and her uncle were both blind. therefore, if they were still alive, they could not cast themselves into the sea to escape out of the vessel--they would not, indeed, know that there was an island close to them, and, probably, would imagine that the ship was wrecked upon some reef or rock, so that it would be doubly dangerous to venture to leave her. and, again, even if they could by any wild chance have guessed that there was an island near, how would they in their blindness have known which way to proceed to reach it? thus, by such arguments, she had endeavoured to solace her sad, aching heart, and now, as she rose to leave stephen charke for the night, she put into words the thoughts which had been present to her mind from almost the first moment she had discovered that they themselves were saved. 'do you think,' she asked, standing there gazing down on him once more--'do you think any who were in the ship when we escaped can be still alive? is there any hope of that?' he looked up at her swiftly as she made the suggestion, then--because he felt that it was useless to encourage such vain longings--because, also, he knew that such a thing was impossible--absolutely, entirely impossible, he said: 'no, no! it cannot be. those who were in the cabin would be submerged as the ship went over, and those who were on the deck would be thrown into the sea.' she gave a bitter sigh as he answered her--and it went to his heart to hear that sigh, since now his pity for her was heroic, sublime, in its self-abnegation--as great as were also his love and adoration; then she asked: 'and where was gilbert--lieutenant bampfyld?' 'he--he--was lying by the wheel. god pity him! he was a brave, noble officer. even in his blindness he had crept up to help at the wheel, and was determined to do something towards saving the ship if possible. then--then--he fell down from exhaustion. he----' '--is dead!' she muttered, in a voice that sounded like a knell. 'dead! oh, my god! he is dead. i wish i were dead, too!' chapter xx 'i do believe you' she moved away from him now that the night was at hand, intending to seek a little knoll that was hollowed out by nature so that it presented the appearance of a small cave of about six feet in depth and the same in breadth. above it there grew, tall, stately, and feathery, two cocoa trees close together; around it trailed tropical creepers and huge-leaved plants which bore upon them large white flowers. it was into this cave she had crept the night before and had slept, and to it she now intended to go again, it being, as she thought, better perhaps to pass the night there than in the open air. yet, had she but known, it offered her no necessary shelter, since, in truth, none was required--especially at this season. dews scarcely ever arose in the island, there being little, if any, of that dampness at night for which the poisonous deadly west coast of africa is so evilly renowned, and one might sleep in the open air as free from the dangers of exhalations as in any closed place that could be devised here. but, not being aware of this--as how should she who, hitherto, had known so little of the world outside london--outside england?--she spoke to stephen charke ere she left him for the night, saying: 'i wish there was something to cover you with--something to protect you. yet there is nothing--not a rag.' 'it is of no importance,' he said, looking up at her, and able to see her face, pale and ghostlike, by the light of the stars. 'of none whatever. i shall be able to lie here and sleep very well. there is no fear of damp or fever in all this locality. i know it well. and, tomorrow, i hope to be able to get up and go about the island. perhaps, beyond that mountain at the back, there may be some signs of human habitation--of human life. do not think of me. good-night. sleep well. try to sleep well.' 'good-night,' she answered, 'good-night'; and then she slowly withdrew to the cave in the little knoll, and so left him. but, when she had gone, and had lain herself down upon the soft, dry sand within that cave, sleep refused to come to her. the night before she had slept long and soundly, perhaps because of all that she had gone through, and because also she was battered and bruised and weak after her immersion in the sea and the contact with the rocks. but to-night she could not do so--her mind was now triumphant over her body; the hour of that mind's agony was upon her. and she bent and swayed beneath this agony, and recognised, acknowledged, all the ruin that had fallen on her future life and hopes and dreams of happiness to come. her lover, her future husband, was gone--was dead! her heart was broken; there was in actual fact no future before her. she had loved him madly, blindly, almost from the first time she had set eyes on him, and now--now he was dead. there was nothing more. she would never love any other man; none other could ever find his way into her heart as gilbert bampfyld had done, nor set every pulse and fibre in her body stirring, nor cause her to thank god when she awoke each morning that another day had dawned when, even though she might not see him, she could still pass many waking hours in thinking of him. no; no other man would ever have the power to cause all that. henceforth, if she ever left this island alive, it would be to return to a joyless, hopeless life--a woman widowed ere she had become a wife. thus she thought and mused as she lay in the cave, her head supported on one hand while she looked out on all that devilish, cruel waste of waters which had hurled the ship to its destruction and slain almost every soul on board her, and which now--like some wanton trampling on the ruin and despair that she has caused--was smiling before her in the rays of a crescent moon that was just peeping above the eastern horizon. indeed, the glimmer which this young moon sent shimmering along the tropical sea was not unlike the false sad smile that a wanton's lips might wear in the hour of her victim's ruin; the smile that bespeaks 'the painting of a sorrow, a face without a heart.' a little breeze sprang up now, a ripple soft as a lover's kiss; balmy, too--as it played among all the rich tropical vegetation of the island--as a young girl's pure breath, and she saw that her fellow-castaway perceived it, since he turned himself so as to bring his face towards it--doubtless to cool his heated frame and to get relief from the warm, tepid air that hung all around--air that was like the atmosphere of a turkish bath. and this led her thoughts away from her own sorrows into the direction of those griefs which must be his--towards this brave, valiant man, who had saved her life at, as she knew must be the case, the risk of his own. his lot was also sad, she recognised, sad because he loved her--as it would have been the merest affectation for her to pretend to doubt--and because she knew that never could this love obtain that which it hungered for. yet, all the same, there had come into her heart a feeling of intense sorrow for him; sorrow and pity that had welled up into her bosom and was almost holy in its depth and purity. 'to love and lose, as i have done,' she murmured; 'to love and never win, as is the case with him. oh, god! could there be aught to make our bitterness--our lot--more terrible?' suddenly, she started and raised herself higher with her elbow, her nerves quivering, her heart beating violently, her eyes staring intently into the shade beneath a copse, in which grew in wild profusion a tangled mass of cocoa trees and tamarinds, of orange bushes and lemon trees, and into which, now, the new moon's rays were glinting. for she had seen something moving there--something creeping, crawling close to the ground--stealthily, secretly--as though desirous to approach the spot where they were both so near together, without being heard or seen. what new horror was this that approached them in the night, that crept in ambush towards them as though intent on secret murder and attack? what! some native of this horrid region lusting for the stranger's blood, or some wild beast as fierce! her; tongue cleaved to her mouth--she could feel that the roof of the latter was becoming dry--she tried to scream--and failed! and, still, close to the earth, that thing crept--nearer--nearer--and once, as it either pushed some underbrush aside or came more into view, a ray of the moon glistened on a pair of eyes, illuminating the pupils for a moment. then she found her voice and shrieked aloud: 'mr. charke! mr. charke! there is something creeping towards us. save us! save us!' in a moment he was endeavouring to spring to his feet, but this he could not do owing to his soreness and contusions; yet, nevertheless, he staggered up a moment later and gazed around, wishing that he had some weapon to his hand. that cry of bella's--it rang along the desolate beach as, may be, no woman's voice had ever rung there before!--brought matters to a crisis. there was a rush, a spring from the creature that had, by now, crawled so near to them; a spring which hurled charke back reeling as the thing passed him and then brought it, itself, close to bella, about and around whom it at once began to gambol, rudely and roughly, as some great watch-dog might do who had found its lost mistress. the creature was bengalee, the tiger-cub, and, in some way, it, if nothing else, was saved from the wreck of the _emperor of the moon_. 'oh!' cried bella, half fearfully at its furious bounds and leaps, which, even in her nervousness, she could not but construe into a wild, savage joy on its part at once more being in her presence, 'it is bengalee. oh, thank god!' 'thank god?' charke repeated, not understanding. 'thank god for what?' 'it is a sign,' she said, 'a sign that we are not the only ones who have escaped. think! think! if this creature could get ashore, so--so may others have done.' for a moment he said nothing, contenting himself with watching the exultation of the creature and in reflecting that it was her shriek which had told it who those were to whom it had drawn so near--with, perhaps, if stung by hunger and privation, a vastly different intention from that of fondling either of them! and he did think of what she hinted in connection with its safety and its having reached the island alive, as well as of that safety pointing to the fact that others, that human beings, might also have done so. only--he knew, and knowing, refrained from saying, that her deduction was by no means accurate. this animal had been on the deck when the ship heeled over on the reef; it was confined only in a locker from which it might easily have forced its way out in its terror, or, indeed, might have fallen out of it, but it was an animal, and its blindness had left it! gilbert bampfyld had also been on the deck, charke remembered, but was still blind. there was no analogy between the tiger-cub and any human soul on board. 'you do not answer,' she said, as now bengalee lay panting at her feet, its rough evidences of delight having ceased for a time; 'you do not speak. you think there is no likelihood of any others being saved from the wreck?' 'i cannot think so. heaven knows that, if i could comfort you with such hopes, i would. but----' and now he repeated aloud those silent thoughts and arguments of a moment ago; while, as he did so, he saw, in the moonlight, that she turned from him, and he heard her whisper low: 'heaven help me!' then, because her misery and woe struck like a knife to his heart, he said: 'to-morrow, if i am strong enough, as i think i shall be, i will make a journey round the island and explore every spot upon it, where, if--if any one should have, by god's mercy, been fortunate enough to reach the land, i must light upon them. believe me, nothing shall be left undone that i can do.' 'i do believe you,' she cried; 'i do, indeed. ah, mr. charke,' she almost wailed, 'how good and noble you are! oh that such goodness, such nobility must go for ever unrequited!' 'that,' he answered, and she, also, could see by the aid of the moon's rays that on his face there came a wan smile, a smile that had not even the ghost of happiness in it, 'that is not to be thought of--never. let us put away for ever all thoughts of my desires; let us think only of what we have to do. to find, first, whether, in providence, there should be any others who have escaped from the wreck, and, next, how we are to escape out of this. if there are other islands near here which are inhabited, no matter by whom or what, it may be easy.' 'and if not?' 'then we must wait until, by some signal or other which i may devise, we can attract the attention of a passing vessel. beyond this i can think of nothing.' 'oh!' she exclaimed, 'much as i long to return home to england, to my mother--i think only of her now, i have none other of whom to think--yet--yet, ah, i could not go till i was sure, sure beyond all possibility of doubt, that gilbert was not here or somewhere near. think, if he should be still alive and blind and wounded! here and unable to help himself. oh, it would be almost worse than to know that he was dead.' 'i do think,' charke answered; 'i understand. and until we are sure, one way or the other, we will not go: no, not even though rescue came to-morrow.' then, looking down at the tiger-cub which had now risen to its feet again, and was pacing restlessly about with the sinuous, lithe movements peculiar to its race, he said: 'but there is also one other thing that must be done. that creature is now beyond control, even by you; and these beasts are treacherous to the core. if it is to live, and we are to live also, it must be secured--made prisoner. otherwise something terrible will happen. i know it; feel sure of it.' chapter xxi washed ashore they had both slept again by the time that the morning broke with the suddenness of the tropics, while the coming of the sun was heralded by the pale primrose hue which all who have been between capricorn and cancer know so well; that hue being followed by the vermilion and golden shafts of light, and then by a deep blood-red tinge which suffused all the horizon. they had slept uneasily, each in their place; with--outside, near the opening of the little cave under the knoll--the tiger lying tranquilly as though keeping watch and ward over her whom, probably, it deemed its friend and mistress. yet, ever and again, as she, while waking to regard it more than once--because of the fear which stephen's words had engendered in her mind--saw very well, its yellow eyes peered out restlessly from their closed slits of eyelids, the pupil of each eye being itself a horizontal slit only. and she acknowledged that charke had spoken aright, that the time had come for the creature to be either imprisoned or made away with. all its evil instincts were undoubtedly being developed with its growth; soon, they would have obtained their full force and be, perhaps, exerted. it was time. but now the dawn was come, the blood-red of the eastern sky was plainly visible, and the birds of the island were twittering to each other and pluming themselves; whereon the girl rose and left the cave, and passed quietly by the creature lying so close to her as though in fear of arousing it. in actual fear of it, indeed, since she did not know but that it might turn and rend her at any moment. for it was big enough and strong enough to do so now, its size being that of a large retriever, or a year-old mastiff; and she, or he, even--that stalwart muscular sailor--would probably have had little chance against it if it had set upon them, since both were unarmed and both were weakened and broken down by their struggles in the tempest-tossed waves. charke, seeing the girl rise from her recumbent position, rose also, quickly and quietly, and came towards her, while as he did so he said: 'now, to-day is the time for me to make that search round the island which i promised you. we will but eat a little fruit, and then i will set out.' 'shall i go with you?' she asked, as, taking up the cocoanut shell, she turned to go towards the rivulet that ran at her feet, 'or is it better for me to remain here? perhaps, too, it may be more than i can do. or, indeed,' she hastened to add, 'more than you can accomplish in one day, and in such heat as there will be. oh, mr. charke,' she continued, 'you are not strong enough to undertake it yet!' 'i feel strong enough this morning,' he replied, 'and, if i cannot make the whole tour of the place in one day, i can at least do a considerable part of it. i will begin at once, before the sun becomes too fierce. but, as for you, perhaps it would be best if you stayed here. the outlook from this portion of the island is, i think, the one from which any ship that happened to pass would be most likely to be observed. you see, we look west from here, towards where africa lies, and vessels use that track in preference to running more out into the open.' 'i will do anything you suggest,' she said. 'anything you think will be for the best. but'--and again there came upon her face that stricken look which made his heart so sad for her, and which, whenever he observed it, caused him to bury every sorrow for himself in a more profound and unselfish one for her--'but--you know--i--i--at present--just at present--for a day or so--do not wish to see a ship come here to rescue us.' 'i know, i know,' he answered, not daring to keep his eyes fixed full upon that lovely but unhappy face. 'i know. well, we will not look out for rescue yet. but, still, i think you had better stay here. we do not know for certain the size of this island; it is only guesswork on my part. it may be too far a walk, too much of an undertaking for you. you are not afraid--of that?' he continued, as he directed his eyes towards bengalee, while seeing how, as he was speaking, she, too, had let her glance fall upon the cub, which was now pacing restlessly about at their feet. 'no,' she said, 'i am not. yet what you said in the night was true. it is growing beyond control, and, of course, i know how treacherous and savage these animals are. it was a piece of girlish folly on my part to beg poor uncle to save it.' 'i scarcely know how we are to make away with it,' he replied. 'i have nothing but this,'--and he took from his pocket a little white-handled penknife, which he had probably bought for a shilling off a card exposed in a london shop window. 'i could hardly kill it with that. however, one thing is certain, it will die of starvation ere long on this island. it cannot live on fruit as we can, nor catch birds, and there are no signs of animals, not even rats or mice, as far as i can see.' 'oh, poor thing; what a dreadful death to die!' the girl exclaimed, her pity at once awakened for a creature which had been more or less her pet for some few weeks. yet she hastened to ask if starvation did not make such animals even more fierce than usual, and if the risk to them both would not, thereby, be increased. then, before he could reply, she suddenly exclaimed, as her glance fell on the sea, 'what is that out there? surely--surely--it is not a drowned man? oh, not that--not that!' following the direction of that glance, he saw something drifting about on the tranquil, almost rippleless, water over which by now the rays of the risen sun were gleaming horizontally. something that, since it was end-on towards them and the island, was not easily to be distinguished, yet was, all the same, undoubtedly no drowned man nor human body, alive or dead. at first he thought it might be a dead shark--his knowledge of the sea telling him at once that it was not a living one, since they never expose aught but the dorsal fin when swimming--then, a second later, he recognised what the object was. 'no,' he exclaimed, anxious to appease her terrors at once--while knowing to whom, and, above all others, to whose _dead_ body those terrors pointed--'no, that is no body, living or dead. instead, it is one of our quarter-boats. washed out of the chocks when the ship turned on her side, no doubt, and floating about ever since.' 'it is coming nearer,' bella exclaimed, her eyes still on it and full of delight at hearing that in it there was, at least, no confirmation of one awful fear; 'do you not think so?' 'undoubtedly it is coming nearer. it will strike the shore just there if the reef does not catch it'; and he pointed with sailor-like certainty to a spot close by. 'it will be a mercy if it does.' 'why? we could not escape from this place in that, could we?' 'hundreds of sailors have escaped death in smaller boats than that; ay, and lived for many days, too, on an open and rough sea in such boats. but it is not for that only. if it comes ashore i can make a visit to the poor old _emperor_ and find out something, if not all, that i--that we---want to know. while, though we need not put to sea in it, we may use it to get to some other island which is inhabited, by, perhaps, white men; but, anyhow, by some one. it will be of the greatest assistance, especially as, since it floats, it must be undamaged. i trust the oars, if not the sail, are in it.' and now, listening to his words, bella became as eager for the quarter-boat to come ashore as her companion was, and, together, they went down to the spot he had indicated as that which the boat was likely to arrive at--a spot about sixty yards from where they were. as bella walked by her preserver's side she was wondering many things, and especially if he would, indeed, be able now to discover what the fate of the others in the _emperor_ had been, and, above all, if, by the aid of this boat, he would be enabled to solve for her the question she hourly, momentarily, asked herself by day and night--the question whether there was any hope left of a life of happiness and bliss to be passed by her lover's side, or whether, for her, the future could bring nothing but a joyless, heartbroken existence henceforth. also, she mused upon one other thing--namely, what charke was thinking of while, with his eyes never off the incoming boat, he meditated deeply as, from his knit brows and fixed look, she felt sure he was doing. the thoughts, those that actually were in his mind, he would, undoubtedly, not have divulged, even though she had asked him to do so, since they were such as could only have caused grief unspeakable. for he was thinking that, since this quarter-boat had been washed out of the chocks and off the deck into the sea, and had then floated about for forty-eight hours in the neighbourhood previous to being directed by some subtle current to the island, so other things that were on deck would be subject to the same conditions. the bodies of drowned men; the body of her lover! he knew that the sea and its currents and tides work in calm weather with as much regularity as the sun and the moon work in their rising and setting, and, indeed, as the seasons themselves work; and he knew, also, that if gilbert's body--which was close to where the quarter-boat rested when the ship struck--had been washed into the sea at the same time as it, then it was most probable, nay, almost certain, that it also would come ashore at the same spot and perhaps almost at the same time. what horror, what fresh horror, would that be for this poor devoted girl to experience! for, in his own heart, he never doubted for one moment that somewhere close at hand the body of gilbert bampfyld was floating about. the boat was coming very close into the shore now, so close that they could see that one oar was in it, but only one, and that there was nothing else, while they observed, too, that the rudder was not fixed in the braces. yet that mattered little to stephen charke if he could only once get possession of the boat itself, since with one oar on such a glossy sheet of water as this ocean was now, he could propel and steer it easily enough. 'i am glad, thankful, it is coming ashore,' he said now. 'i had thought of swimming out to the ship, only i dreaded the sharks. little use as one's life may be, one would scarcely care to lose it by the jaws of those brutes.' and, though he did not see it, the girl by his side gave him a glance such as would, perhaps, have cheered his heart had he done so. 'was not her own life, also, of little enough use,' she asked herself as he spoke, 'to make her sympathise with his remark? would it not be a broken and dejected one, henceforth, if that which she dreaded, which she had almost forced herself to feel sure must be the case, should be proved to be so beyond all doubt before many more hours had passed?' for every hope with which she had buoyed herself was sinking in her breast, as moment after moment went by and the time grew longer and longer since the wreck had taken place. the boat touched the white, pebbly beach now, grating on it with a gentle scrape, and stephen, who had gone close to the water's edge to await its arrival, put out his hand, and, seizing first the stern and then the painter, drew it a foot or two farther on shore. then he got into it, and, grasping the solitary oar which had remained in the boat simply because the loom, or handle, had got caught beneath the stern thwart, prepared to shove off in it. 'you will not mind,' he said, as he did so, 'being left alone for half an hour? this will not take me away from you for so long as when i go round the island.' while she, in answer, shook her head to indicate that she was not at all afraid of being left by herself. chapter xxii a sailor's knife 'she is perfectly sound and watertight,' he called back to her as, with the hand which was uninjured, he threw the oar over the boat's stern, and worked her out from the shore. 'if we want her to help us off to another island she will do it, if i can only find another oar floating about somewhere.' then he propelled her as swiftly as he could to where the _emperor of the moon_ lay outside the rock, her keel and copper bottom gleaming in the bright morning sun. as he drew near to the ship he began to perceive how all hope of the likelihood that any one should still be alive and imprisoned in the ship must be abandoned. she had turned over even more than he had at first imagined when regarding her from the shore of the island, so that the keel was almost level in a manner exactly the opposite from what sailors mean when they talk about a 'level keel.' it stuck up now, so far as it was out of water, as some sharp mountain ridge seems to stick up when regarded from a valley, and showed an almost horizontal line; while, beneath the keel and above the water, for half the length of the vessel, there was visible a portion of the outside of the main hold, down to (or up from) her diagonal ribboned-lines. and, here, there was a great gaping wound, a hole smashed into her side large enough to have let the whole indian ocean pour into the devoted ship directly it was made, and (although there might well be others which were not visible) sufficient to have filled and sunk, forthwith, the largest vessel that was ever launched. the force of the impact was to be appreciated, too, by the manner in which her copper sheathing was driven into her and burst, so that, where the blow had been struck by the jagged tooth of the rock, the latter looked like a destroyed _chevaux-de-frise_, or, for a better comparison, a paper hoop through which an acrobat had passed. and, in this burst and broken protection, as in other and less terrible circumstances it might have been (though naturally it had proved useless here), the sheathing-nails stuck out like brilliant, gleaming yellow teeth, all broken and distorted. charke brought the quarter-boat alongside the upturned or leaning bottom, so that, by looking through this gaping wound, he could peer into the now reversed decks and see that there lay, on what had once been the roof of it but was now the floor, a mass of articles, such as is usually stowed away in a ship's lower decks. a mass, composed of cables and old and new sails, as well as some stores, consisting of dozens of tinned-meat cans unopened, boxes of sardines, and so forth, and several old sea chests and trunks--all lying, of course, helter-skelter, as they had been thrown together by the ship's reversal. 'there are some things of use here,' charke thought, 'and worth taking away,' whereupon he ran the painter through a small hole in the sheathing and tied it tightly, and then scrambled up the vessel's inverted side until he was able to drop himself through the opening into the deck, taking care that he tore neither his flesh nor his clothes in doing so. being there, he selected a small sail which he found; it was indeed, a boat sail, and had its gear of mast and tackle attached, while, passing it through the orifice, he dropped it carefully into the boat, and then he took next a few of the tins of provisions, and dropped them into her, too. and, also, he found something which would be to him, in the utterly unprovided condition in which bella and he had escaped to the island, of the greatest service. this was a long, sharp knife in its leather sheath, such as sailors strap to their sides, and was new and in good condition, so that he did not doubt that the last seaman who had been sent below to this deck had dropped it there, and he was able to picture to himself the man's annoyance, probably expressed aloud and with a good deal of vehemence and strong language, over his loss. this done--and the doing of it had not taken long--he prepared to leave the disordered hold, when he remembered that there was one thing he wanted, namely, some cable. 'that tiger has to die at once,' he muttered to himself. 'with a piece of stout rope and this knife--which would slay anything, from a horse downwards--its death should not be difficult of accomplishment.' then, having selected two or three pieces of cable of different strands, he got out through the hole again and into the boat. it is almost needless to write down that he found no sign of human life as he rowed about and round the wrecked _emperor of the moon_ for some moments afterwards. needless, too, perhaps, to add that he had never expected to find any. he was a sailor, accustomed to disaster at sea and full also of much acquired knowledge pertaining to many of the calamities which it had never been his lot to experience heretofore; and he knew--he felt sure, and would have staked his life upon the certainty of his convictions--that of all who had been in that doomed ship an hour before she struck, none except bella waldron and himself were now alive. those who had been below in the cabins or saloon, those also who were in forecastle or galley, had met, must have met, not only with their deaths but their graves at one and the same time; while as for the unhappy and blind young officer who had caused him so much heartache by winning the woman whom he loved so fondly, and whom he had once hoped to win--why, it was impossible that he should still be alive. if he had been washed ashore, it could be only as a corpse, and it was most improbable that even that should have happened. in truth, he believed that, with all the others, he had been carried below by the overturning of the ship and then pinned down, buried, beneath the mass of the fabric. otherwise, since the boat had floated ashore, so, too, would he have done by now. 'the woman he had hoped to win,' he repeated softly to himself, as still he sculled the quarter-boat round and round while peering down into the dark blue depths as far as he could penetrate; and while endeavouring also to perceive some sign or memorial--even so much as a cap or straw hat--of one of those poor drowned sailors imprisoned below--'the woman he had hoped to win!' and as the phrase rose to his mind, though not to his lips, he recalled as well how he had cherished the thought of the length of voyage that had lain before her ere she could join her lover in india; how, too, he had pondered on half a hundred things which might happen ere the old _emperor_ should be anchored in bombay harbour. almost, now, those meditations seemed to have been prophetic--for what had not happened! the girl's lover was gone, removed by death, and she had none other in the world on whom to lean but himself. and what was more, she spoke kindly to him; she pitied him, he could well perceive; there was something between them now, a deep sympathy, a reliance on each other in their misfortunes, which had never existed before. 'the woman he had hoped to win?' well!--he scarce dared whisper the thought to his longing heart, yet it was there!--the thought, the hope that in days to come, in after-months, perhaps years, when her grief for gilbert bampfyld was mellowed and softened by time, when she knew him better and should fully recognise how profound his adoration for her was, he might still win her! she could not, young as she was, and with all the years of a long life before her, sorrow for ever--sorrow for a memory that would at last be nothing but a shadow. 'he _would_ win her!' he said aloud to himself now, as he worked the boat ashore, 'he was resolved he would.' the one obstacle in his path was removed, the brave, gallant young officer was gone, brushed aside by fate. he would win her yet! he stepped ashore now to where she was standing watching him, and it seemed almost--if his recent thoughts had not tinged his present fancies with a roseate hue--that there was a look of greeting and welcome to him in her eyes, even as she saw that he had come back--even at the ending of so short an absence as his had been! was she beginning now--now that she had none other in the world to watch for--to desire to have him always near her? ah, if that were indeed so! then--then he might win her at last. 'you found,' she asked, speaking low, and in those sad tones which had come into her voice of late, and since disaster had fallen heavily on them, 'you found no sign of any others having been saved?' 'no,' he said, also softly. 'no, there are no signs of that. miss waldron--i am neither cruel nor hard of heart, but--oh, how can i say it!--it is useless to hope.' 'useless! ah, well, i suppose it is--it must be! and, god help me, it must also be borne.' then she turned away from him with the desire to prevent the tears which had risen to her eyes from being seen by him, and went back to the shade of the trees under which she had been sitting until she saw the quarter-boat returning with him in it. and he followed her, carrying the cable which he brought away from the ship; the knife which he had found being in his pocket and the sail with its gear left in the boat. the sun was terribly fierce now, so fierce that to be beneath its rays for only a few moments was to risk sunstroke or to be burnt more red than he had long since been, or she since her exposure on the island; and, of course, he could not attempt the projected tour of the place until that sun once more sank low in the west. there was, therefore, nothing now to do but to sit idly gazing out to sea and watch for signs of any ship which might pass near enough to perceive them, when they should have erected signals. 'after the tour round the island,' he said to her, as he sat by her side beneath the palm trees and occupied his time in plaiting some of the long, thick grass which grew at their feet into something that should serve for hats, or, at least, coverings for their heads, 'after the tour, when we have had the last sad satisfaction of knowing that there can be none who have escaped, you will not object to my endeavouring to arrange for our being taken off? the mozambique channel is full of ships on their way to india during the time of the southwest monsoon--you will let me make signals, will you not?' 'i am in your hands,' she replied, her eyes on him. 'you must do all that you think best. ah, mr. charke, you do not know how grateful i feel to you!' 'never say that. not a word. i knew, i thought, i could save one besides myself, and, naturally,' he went on simply, 'i saved you.' then both sat on musing and meditating in silence. 'here comes the tiger,' he said now, seeing the creature stalking towards them in the lithe, treacherous manner peculiar to its race. 'i imagine it has been endeavouring to find food. i brought off some tinned things from the ship; yet, cruel as it seems to be, it is not advisable, i think, to give it anything in the shape of flesh. meanwhile, if it will only go to sleep we ought to secure it,' and, as he spoke, he took up one of the pieces of cable and commenced tying what is known to sailors as a double-diamond knot. but, previously, he had fastened the other end securely round one of the palm trees that grew close by him. 'there will be one advantage in this,' he said, 'namely, that the more it pulls against it the tighter will come the loop, so that its intelligence will prevent it from straining at the rope and strangling itself.' 'poor wretch,' bella exclaimed, 'how gaunt and lean it is growing! i recognise that it cannot be kept alive or even taken off with us when we are found here; yet--yet i am sorry for it.' 'yes,' he answered, 'i understand that, but it has to be done--must be done--it is imperative. in the state it is now in from hunger, and also owing to its increasing strength, our lives are no longer safe with it, and certainly not with it at large; while, if one of us were to scratch our hands, or even get the slightest wound, and the creature smelt the blood, which it would undoubtedly do--well, the result might be terrible. now, see, it's going to sleep; it appears exhausted. i must drop the loop over its head.' 'no,' she answered, 'let me do that. it is still very docile with me,' and, as she spoke, she took the loop from his hand and, while patting the creature's head--whereon it raised it as a dog will raise its head when stroked by a loved hand--she dropped that hand down until the rope was round its neck, though not without muttering some words of regret as to what she deemed her treachery. 'it is no treachery,' he said, 'no more treachery, indeed, than to tie up a mastiff in its kennel. and, even though it were, it would not matter. these creatures are themselves the incarnation of treachery. however, the main point is that it is now secure. it is not yet strong enough to burst this rope.' such was the case, yet it was strange that to so acute a mind as charke's there had not occurred the idea that it would not take a tiger very long to gnaw a ship's rope through if it desired its release. chapter xxiii 'the tiger did that' when the sun began to drop towards where africa lay, afar off and invisible, and when (because of the dense foliage which crowned the slopes of the island that rose behind the beach) that portion where they sat was rapidly becoming shaded from its burning rays, stephen charke said that the time had come for him to think of making his tour of the place, or, at least, of accomplishing a part of it. the air, it is true, still resembled that which one feels when they have approached too near to a furnace, or, for a further simile, have descended into the engine-room of a steamer. yet, now, there would be no danger of sunstroke, and the expedition, such as it was, might very well be undertaken. 'my idea is,' charke said, 'to begin now, this afternoon, by starting to the left and going on along the shore until i am nearly opposite this place on the other side of the island; then i will come back here, crossing it, and to-morrow i will do the same thing with the other side. that way there cannot be much left unexplored by to-morrow evening. what do you think?' 'i think,' bella answered, 'that you are the most unselfish, heroic man i ever knew. ah, mr. charke,' she continued, 'i know very well why you are doing this, why you are going to make this journey round the island. it is to satisfy me, it is for my sake. if you were alone here you would never do it, but occupy yourself only on thoughts of how to get away, and----' 'no,' he said, 'no. had i been the only person who got ashore from the wreck i should, as a sailor, as a comrade of the others, have deemed it my duty to make a thorough search through the island ere i took steps to quit it. i shall have, as the survivor of the _emperor of the moon_, to make a report----' 'i understand,' she said quietly. 'i understand. nothing that you can say will make me feel my obligations to you any the less.' for bella waldron knew as well as stephen charke himself knew, that what she had just said was the absolute fact; she knew that he was going to undertake this fresh toil--for toil it was, after all he had gone through, after his bruises and buffeting with the waves, and in this terrible torrid-zone heat--for her and on her account alone. he was going to undertake it with the desire of easing her heart and preventing her, in after-years, from being able to reproach herself with having left the spot while any chance remained of there being one of those who were dear to her upon it. she was, too, perfectly aware that he did not for one moment believe--alas! how could he, a trained, intelligent seaman, believe?--that there was any other soul left alive out of all those who had been in the ill-fated vessel when she struck on the rock. and, being thus unable to believe, could she regard him as aught else than that which a moment before she had termed him, 'a most unselfish, heroic man'? before he left her he asked if she would not partake of some of the tinned meats, or sardines, which he had managed to obtain from the upturned hold, but as the girl replied that it was far too hot to eat anything but the wild fruit growing in such profusion all around, and also that she was not hungry, he decided that he would not open one of the tins for himself. he, too, could do very well on what there was to their hands for the trouble of picking, since, here, in this tropical, steaming atmosphere, eating scarcely seemed a necessity of life; while, if it were, then those glorious bananas whose golden and crimson hues merged so superbly into each other were amply sufficient. but, also, he had another reason for not opening the preserved meat. the odour of it would--might--arouse the cub's desires, and, once aroused, they would possibly stir the animal almost to frenzy if ungratified. he rose now and prepared to set out, there being still two full hours of daylight left; two full hours ere the sun would be gone and the swift, dark night had fallen at once upon all around--the outcome of a dusky veil which the sun appears to fling behind it as it departs, and out of which emerges black obscurity, lit only by the burning, silvery constellations. but, ere he went, he asked if she feared to be left alone for so long. 'no,' she replied, 'no. why should i? what is there to hurt me here?' 'there may be people on the island all the same,' he replied, 'even if they have not yet discovered our presence; although i do not think it likely.' 'nor do i. if there were they would by now, in two days, have observed that,'--and she pointed towards the wreck--'and have come down to it. we are alone,' she concluded with a sigh. 'there is no one else here but you and i.' and still again she sighed. 'yes,' he answered, understanding all that her words meant, all the heartbrokenness that they expressed. 'yes, we are alone; there are no others.' after which he left her, saying that, by dark, or very shortly afterwards, he would be back again. when he had departed, after looking round once to wave his hand ere a bend of the shore hid him from her view (and she noticed that, true to his sailor's instincts, he went towards the boat and inspected it, and then drew it up a little more on to the white-pebbled beach and made the painter more secure), she went down to the rivulet and cooled her face and hands and feet in it, and made some attempt at arranging her hair, while using the stream as a mirror. yet it was little enough that she could do in the way of a toilet, since she had nothing that would serve as a comb nor any soap or towel. after which, feeling refreshed, nevertheless, by this attempt, she returned to where she had been sitting and gazed out seaward, meditating deeply. 'what an end,' she murmured, as she did so, while from her eyes the tears flowed freely now--the more so because there was none to observe them--'what an end to all! gilbert, who was to have been my husband, dead! gilbert, whom i so loved with my whole heart and soul, dead! and lying beneath that ship. oh, gilbert, gilbert, gilbert, my love, come back to me. and my poor uncle and aunt, too. oh, god, what a disaster! what a disaster!' and now she wept piteously, so piteously that, if that other man, who had risked his own chances to save her as well as himself, could have seen her, the sight would have gone near to break his heart. that other man! at this moment her thoughts turned to him too. almost unconsciously she found herself thinking of him, speculating on what his future would be. 'he will never marry,' she murmured. 'i know it. feel sure of it. it would be the idlest affectation to ignore his sentiments for me. yet--yet--how sad, how mournful a life must his be henceforth; no home to go to, no wife to welcome him, none to make him happy. poor mr. charke. poor stephen. our lots will be similar, we must be friends, always friends.' meanwhile, he was making his way along the beach, which was still shaded from the sun and becoming, indeed, more and more so as he progressed farther round the island, away from the west. and every step which he took served only to confirm him in what he had believed, known from the first--the unlikelihood of there being any other person saved from the wreck. 'surely,' he muttered to himself, 'if he should have drifted ashore, it would have been here. the current sets this way, and also the monsoon blows towards this island. living or dead, he would have come to this neighbourhood if he had come at all. the tiger did that, and, doubtless----' he paused at those words. 'the tiger did that!' and for a moment it seemed to him that his heart stood still. 'the tiger did that!' ay, but did it? was he wrong in the surmise, wrong in his deduction? did the cub land here or hereabouts? reflecting, recalling the night before, the early dawn, when bella shrieked to him and awoke him from a half-slumber into which he had fallen, he recollected that the beast had sprung forth from the copse of orange and lemon trees that was to the right of the little spot where he had waded ashore with the girl in his arms, and where, after carrying her up far above the waterline, he had dropped senseless. it had sprung at them from the right side, was coming from the right; and it was not to be believed, it was, indeed, beyond all belief, that it could previously have passed across where they were from the other side without having been noticed by one of them, especially by bella, who was wide awake. it was coming from the right; it had, doubtless, therefore, got ashore, been cast ashore, to the right. and he was seeking for signs on--had set out to--the left! had he, therefore, chosen the most unlikely place in which, if, by the most remote chance, any human being should have been washed ashore, to discover them? 'shall i go back,' he mused, 'and begin again on the other side? shall i?' yet, as he meditated, he reflected that there would be little use in doing so; certainly little use in doing so to-day. an hour had now passed, or nearly so, since he quitted bella; the sun, he knew, since he could no longer see it, was sinking fast--over the whole of the rich, luxurious vegetation that stretched inland there was now the golden hue, the amber light that, in the tropics, follows after the dazzling, blinding, molten brilliancy of the noontide, directly the sun is no longer vertically above the globe. and also, there was the odour of the coming night all about him, the odour of the declining day when, from every fruit and flower that has drooped through the hottest hours of the earlier portions of that day, there exudes the luscious, sickly scent that travellers know so well. 'no,' he said to himself, 'no. it would be little use to turn back now or to begin again to-night! and--and,' he murmured, thinking deeply as he did so, 'even though he had been cast ashore, he could not now be alive. blind--unable to see his way--to find any of all the fruit that grows here in such profusion, poor bampfyld would succumb to starvation, even if the life had not been beaten out of him by the waves.' it was of gilbert bampfyld alone that he thought, of him alone about whom he speculated, since, of all the others who had been in the _emperor of the moon_, he was the only one whose body could by any possibility have come ashore. they, those others, pooley and his wife, were in the submerged cabin, no power on earth could have got them out of it; any men left in the galley and the forecastle were in as equally bad a plight. nothing could have saved them, or have even released their bodies. but, as he thought of gilbert bampfyld, so he felt sure that he also must have perished, even though he was not thus below as those others had been. still musing on all this, but with one other image ever present to his mind--the image of the woman he loved--dishevelled and storm-beaten, but always beautiful--the woman of whom, now, he began to dream once more, to dream of winning for his own in some distant day--he went on along the beach, his eyes glancing everywhere around and near him. glancing into the wild, tangled vegetation, along the channels of the rivulet's courses, but sometimes with them fixed on the beach. suddenly he stopped, his heart quivering again, beating fast. at his feet there lay a sailor's rough jacket, and, a little farther off, a cap--a common, blue-flannel thing, such as the mercantile sailor buys for a few pence at a ratcliffe highway slop-shop. he stopped, regarding them--not with that agitation which the greatest romancer who ever lived has depicted as clutching at crusoe's heart when he saw the footmarks, but, instead, with a feeling of astonishment; yet a feeling of astonishment which, he told himself, he, a sailor, ought not to experience. 'do not all wrecks,' he muttered, 'send forth around them countless articles of débris, countless portions of the raffle that encumbers their decks? what more likely than that a sailor's jacket and a cap should have floated ashore?' then he stooped, and, feeling them, found that they were thoroughly dry, so that they must have been ashore for some hours at least, since even the fierce sun of the now declining day could not have dried them in less time, all soaked with water as they had been. chapter xxiv beaten! defeated! 'no,' he said to bella some time later, and when he had returned to her, 'no other signs than these. nothing,' while, as he spoke, he pointed to the jacket and cap at his feet. he had brought them with him after the discovery, thinking that perhaps they might be useful when the time came for them to set out in the quarter-boat, as he fully imagined they would have to do, thereby to reach some other island. 'yet,' she whispered, 'if they, if this animal, too,' indicating bengalee, who now, what with his being made prisoner by the rope and also by his long fasting, displayed a horrible state of nervous agitation, a state which frightened bella and rendered even charke very uneasy, 'if they could be thrown ashore, why not others? mr. charke, do you think there is any hope?' 'i cannot buoy you up by saying that i do think so,' he answered. 'yet be assured of one thing--you will know soon now. to-morrow, at the first sign of dawn, i set out to accomplish the inspection of the other half of the island. it is smaller even than i thought; it will not take long.' and at daybreak he roused himself to carry out his undertaking, though, even as he rose from the warm, soft sand on which he had lain, he knew, he felt sure, that he was going on a bootless task. again and again he had told himself, through the night, that, even though gilbert bampfyld's body had reached the island, it had never done so with life in it. yet he would make sure for her sake and for his. 'heaven bless you,' she exclaimed from where she also rose as she saw him do so, and while going towards him. 'heaven bless you. you spare yourself no trouble nor fatigue on my account.' 'it is best,' he answered, though he scarcely knew what reply to make. 'it is best that there should be no chance lost. if--if----' then he held out his hand to her as he had not done before, and at once, after she had taken it, set out upon the remaining portion of his search. and, for some reason which he, perhaps, could not have explained to himself, he cast back no last look at her in the swift-coming daylight--nor gave any word of farewell as he had done on the previous afternoon. that daylight brought a little breeze with it which was cool and soft as it came off the ocean that, for some hours, had been free from the burning rays of the sun; and charke made his way along the beach while glancing everywhere, as he had done during his search of yesterday,--into every spot wherein, if any one, anything, had come ashore, they would probably have been cast. but as it had been when he proceeded towards the left or south, so it was now as he went towards the right or north end of the island. he found nothing; not even, this time, a rag of clothing or a spar from the ship. he observed, however, amongst other things of which his vigilant eyes took notice, that here the formation of the island was considerably different from what it had been on the southern side. there, as he made his way back inland to bella, cutting across from the eastern to the western shore, he had found the glades and groves almost flat, except for small knolls and little eminences on which, as everywhere else, there grew the long, deep-green grass, the cocoa trees and tamarinds, and the flowering shrubs and bushes. but here, upon the side he was now following, all was very different. inland, he could perceive that the surface rose until it developed into quite high hills, and that those hills, forming into spurs as they ran down to the water's edge, created a number of little bays or coves, some of them being scarcely more than fifty yards in breadth. also he perceived that on high, where the crests or summits of these spurs were, their sides were abrupt declivities resembling often the sheer sides of cliffs instead of sloping gradually and being covered by the deep emerald-green, velvety grass. and they were white as english cliffs--as those of dover!--and, sometimes, as precipitous. huge masses, too, of fallen, crumbling rock lay tumbled together at their base and in the tiny valleys which they formed between them, and gave, thereby, signs of either a convulsion which had some time or another taken place, or of their lack of solidity and insecure composition. 'i shall have,' charke thought, 'a mountainous, up-and-down kind of return journey if i go back to her inland. yet it will cut off a good deal of the way and make it easier for me.' he found as he progressed, however, that soon, if he wished to continue his inspection of the whole of the coast, he would, in any circumstances, have to continue his walk more or less inland, since now he could observe, by looking about, that the spurs ran quite out into the sea, so that they hid each little bay from its neighbour on either side of it. consequently, if he wished to inspect the space between each, he would have to mount to their tops and thus peer down into the recesses that they formed. at present, however, there was no necessity for him to do this. still looking, he saw that there were three more bays, or coves, which he could reach by walking between the feet of the spurs and the water, the spurs stopping some yards short of the gentle surf which the morning breeze was raising. 'three,' he said, 'three. this one where i am now, the first; then two more. and, after that, i must ascend and gaze down. there will be no getting farther along the bank.' so he entered the first cove, finding it as desolate and bare as the others into which he glanced in his journey; bare of everything, and with its white beach so void of all else but its own stones, that it might, that morning, have been swept clean and clear. the second was the same, except that here, upon its beach, there lay the long iron shank of an anchor with one arm and fluke upon it, but with the other gone. an anchor that, he knew at a glance, had never been made in recent days--that, by its quaint form, must be some centuries old. and, even as he continued his journey, he wondered how it had come there, and if, in long-forgotten and unnumbered years, some toilers of the sea had been flung ashore in this spot, and if this was all that had been left by time to hint at the story. then he entered the third, and last, bay or cove which remained passable by the shoreway--the last he would be able to inspect until he ascended to the cliffs above. as he did so he started--knowing, feeling, that beneath his bronze and sunburn he had turned white--recognising that he was trembling with a faint, nervous tremor. for this cove to which he had penetrated was different from the previous ones; it ran back between the two spurs which formed its walls until it merged into the wooded, grassy declivity that sloped down from above, while, at the foot of that declivity, was more grass forming a little carpeted ravine and, growing on it, some of the island trees--orange trees, lemon trees, even bananas. and on the grass there lay a man. dead or asleep! a man, fair-haired, clad in a white drill suit with brass buttons--they glistened now in the rays of the risen sun!--the white uniform of the royal navy. a man who was gilbert bampfyld. his heart like ice within his breast--all was lost now, every hope gone that, of late, he had once again begun to cherish!--stephen charke advanced to where that man lay, and, approaching noiselessly, looked down on him. looked down and recognised that here was no sign of death or coming death; that the man was sleeping peacefully and calmly; that he was rescued for the second time within the last month from a sudden doom. he also saw something else--he observed that bampfyld had recovered his sight. this he could not doubt. near him was some fruit which he must have gathered recently. and he had pulled down some of the branches of the trees which grew close by, and had shed them of their leaves, upon which he was now lying, they making an easier pallet than the grass alone would have done, while charke perceived, also, that he had been fashioning a sturdy branch of the tamarind into a stout stick. doubtless, he had recovered his sight through the shock of his immersion, when the ship heeled over. strong, determined, masterful as stephen charke had been through all the disasters which had overwhelmed the _emperor of the moon_; brave and stalwart as he had shown himself when, with none other left to command the doomed ship but himself, he had helped to furl and unfurl sails, to steer like any ordinary seaman at the wheel, and to endeavour manfully to hold the vessel up and ward off instant destruction--he was beaten now. beaten! defeated! and he felt suddenly feeble, so feeble that he was forced to sit down by the saved man's side, while doing it so quietly that the other did not awaken. beaten! defeated! ay, and with nothing left of prospect in the future, nor ever any hope. nothing! nothing! nothing! what had he hoped? he found himself asking: what, in these last few days? what dreamt of? a home, a wife; perhaps, in the future, children waiting for his return, running to meet him and to beg for stories of the sea, of tempests surmounted, of dangers passed. now, there would never be any home, nor wife, nor children. nothing! he had loved one woman fondly, madly; the one woman in all the world for him. until ten minutes ago he had believed that, some day, he would win her. and, now, it was never to be. his home would be the desolate home which the sailor ashore inhabits; his existence a long series of toiling across the seas in any ship wherein he could find employment, first one, then the other, for poor wages and without one gleam of sunshine to cheer him. what a life! and--and it had seemed, only an hour ago, that all was likely to be so different. she, bella waldron--his love--no, not his! never his now--was being drawn towards him, she relied on him, trusted in him; but, henceforth, she would need him no more. this other had come back, would come back into her life again, and--he would go out of it for ever. god! it was bitter. his hand, as he lifted it in his agony and let it fall again, struck against something hard in his pocket. thrusting it into the pocket, he felt there the sailor's knife which he had found in the hold of the ship, and drew it forth, regarding it. it was a good knife, he found himself reflecting, a good knife. the man who owned it had kept it in excellent order, too; sharp and keen. how he must have railed at losing it. and he, stephen, had found it! a good knife, long and stout-bladed, well pointed--a knife that would sever the stoutest cable or----! men had been slain with worse weapons than this. a blow from it over the heart, under the left shoulder, and struck downwards--yes! such blows must be struck downwards, or otherwise they might fail--and a life could easily be taken. easily--in a moment. it was a good knife, he thought again. as he opened it and ran his finger along its tapering blade, and observed the thick, solid back which that blade possessed, he could not but acknowledge this. the man who had owned it and lost it had paid money for that knife. this was no slop-shop thing bought of a thievish whitechapel or houndsditch jew who preyed on poor seamen. a good knife! he turned his head and looked at gilbert bampfyld lying there, still sleeping peacefully; looked at the man whom he had come out to seek, and--had found! found as he had never expected to do, as he had never believed it possible he should do. he looked at him, recognising all that his being there meant, all that this third human existence on the island, where formerly there had been but two persons, meant to him; the ruin that it cast upon his hopes. and again he regarded the knife, holding it by the tip, weighing it, balancing it. it _was_ a good knife; one that would strike hard and sure. and, as he so thought, he rose from his seat, went down to where the surf was beating violently now upon the beach, and flung the thing far off into the sea. then he returned to the sleeping man, and, kneeling by his side, shook his arm gently, saying: 'come, lieutenant bampfyld. come! wake up, rouse yourself.' chapter xxv i have loved my last, and that love was my first. 'my god!' exclaimed gilbert, as, beneath that light touch, he awoke and saw stephen charke by his side, 'is it a dream! you--you here! saved! thank god for all his mercies. i thought all were lost but me.' then, suddenly, even as he rose to his feet (limping on one of them, as charke saw, and grasping the tamarind cudgel he had cut himself as though for support), he cried, lifting his other hand to his eyes--'but, bella. oh, bella, my darling! are,' he added hoarsely, 'any others saved besides yourself? speak, put me out of my misery, one way or the other.' he saw, he must have seen, the answer in stephen charke's eyes, for now he fell down on the leaves and grass at his feet and clasped his hands as though thanking heaven fervently for its mercies. but he could not speak yet, nor for some moments, or only spoke to once more mutter incoherent words of thanksgiving for this last crowning mercy. 'yes,' charke said, and it seemed to himself as though his voice was tuneless, dead--as if it came from him with difficulty. 'yes, she is saved; is safe. and she hopes always to see you again.' 'but how? how? for god's sake, tell me that. she was in the cabin--surely she was in the cabin--i left her there when i struggled to the wheel. how was she saved?' 'i,' said charke, 'was enabled to help her. we got ashore together.' 'to help her!' gilbert said, looking into his eyes. 'to help her! it was more than that, i know. i am a sailor as well as you; such help is no light thing. should you not rather say you risked your life for hers? you could have done it in no other way.' 'no,' charke said, 'i risked nothing. it was nothing. any one could have done it.' again the other looked at him, knowing, feeling sure that the man before him was refusing to take any credit for what he had done. then he said: 'where is she? can i see her at once, now? soon?' 'she is not far. within two miles from here; she awaits, hopes for, your coming.' 'two miles! heaven help me! i can scarcely crawl. two miles, and i think my ankle is sprained.' 'she can come to you,' charke replied, and the deadness, the lack of tone in his voice, the lifelessness of it, was apparent to the listener now, as well as to himself. 'i can fetch her.' 'do! do! at once, i beseech you. oh to see her, to see my girl again. yet, still i do not understand. how could she hope to ever see me in life again, how await my coming? she could not dream, she could not dare to dream, that i might be saved.' 'she would not believe anything else. for myself,' charke went on, scorning to say that which was not the case, 'i did not believe you could be saved. it seems to me now, as you stand before me, that a miracle must have been worked in your behalf. and i told her so, mincing no matters. i told her you must be dead. but she would not believe. instead, she bade me, besought me to search this island, though, to be honest, i considered it useless to do so. yesterday i took the other side, to-day this. and she was right. i--have found you.' his tone was not aggressive, crisp and incisive though his words might be, yet there was something in the former, and, perhaps, the latter, which told gilbert bampfyld that the search he spoke of had been one of chivalrous obedience to a helpless woman's request, and not one made at his own desire. and he remembered how bella had told him this man had loved her once, and had hoped for her love in return. well, no matter, he had saved her at what must have been peril to his own life. he could not cavil at, nor feel hurt at, the coldness of his speech. 'what you have done,' he said, 'is more than words can repay; and, even though they were sufficient, now is not the time for them. mr. charke, can you bring her to me?' 'i will go at once. but--but she will, undoubtedly, be anxious, excited to know something of how you were saved. as we return to you she will desire to be told everything; will be impatient to hear. what shall i tell her, over and above the greatest news of all, that you are restored to her?' 'there is not much to tell. as i was swept over the ship's side my hand touched the port quarter-boat which was being thrown out at the moment.' 'ah! it has come ashore too.' 'and, naturally, i clutched at it. i would not let go; i held on like grim death, knowing that my only chance was in it. and, do you know, i found that i could see again; distinctly, or almost so. i could see the waves, the surf ahead; knew that some shore or coast was near. but, even as i recognised this, wondering, too, why at the moment when i was doomed to be drowned i should have this gift accorded me, i lost my hold on the boat and, a moment later, was thrown ashore or, at least, touched bottom. and--and it was a hard fight; i never thought to win through it. each recoil of the waves tore me back again only to find myself thrown forward with the next. three times it happened. then--then, at last, when i knew that, on the next occasion, i should have no breath left in my body, i was flung still farther on land than i had been before, and, this time, i determined i would not be dragged back alive, so i dug my foot and hands into the soft sand. i wrestled with those waves and i beat them. they receded, leaving me spread-eagled on the shingle, free of them for a moment, and, ere they could return and catch me again, i had scrambled out of their reach.' 'was that here, on this spot where we are now?' 'no, it was farther that way, between a mile and two miles farther.' and, as gilbert bampfyld spoke, he pointed with the stick in the direction where bella waldron and stephen charke had taken up their quarters since they had got ashore. therefore, her lover had been close to them once, and they had never known it! 'i stayed there one night,' gilbert went on, 'then feeling sure there were islands to the north--as there must be, you know--i came this way. only, i slipped on the beach and, i think, sprained my ankle, so that i could get no farther.' 'god has been very good to you,' stephen said, 'and to her. now i will go and bring her here: it will not take long. soon, very soon, you will be together. you will be happy. in a couple of hours she will be here. it would, perhaps, be in less time than that, only, you observe, the sea is rising and the surf getting very high. we must come inland, above, by the cliffs. farewell till then.' 'farewell. god bless you. ah, mr. charke, if you could only know my gratitude to you for saving her, also what happiness you have brought into my life again. if you could only know that!' but charke was on his way back to where he had left bella almost before gilbert had concluded his sentence, and, beyond a backward wave of his hand, had made no acknowledgment of his words. he climbed up to the summit of the cliffs easily enough, for by now all his strength had come back to him, and he felt as vigorous as he had ever done in his life. yet, when he gained the top, he noticed that there was still something wanting, some of the spring and elasticity which had characterised the manner in which he had returned to bella yesterday from the other side of the island. why was this, he asked himself? why? but he could find no answer to the question. yet, perhaps, his musings on what he had heard half an hour before were sufficient to have driven all the life, all the hope, out of him. his musings on the change that this last half-hour had brought into his future. god! his future. 'he was there, close to us,' he reflected, 'and we neither of us knew nor dreamt of it. i could have sworn it was impossible he should be saved. she--well, she did not dare to hope. and for two days! for two days he has been close to us, and--and in those two days what have i not pictured to myself, what dreams have i not had! what a fool's paradise i have been imagining for myself. now, there is nothing before me. nothing--now, or ever.' but still he forced himself to stride on, passing sometimes beneath the cocoa trees that grew on the little upland, sometimes through open glades in which the morning sun beat down upon his head with a fierceness only inferior to the strength it would assume an hour or so later--yet he heeded nothing. he felt that he must reach bella as soon as possible and tell her everything. there was no more joy left in existence for him, but he was the bearer of news that would give her joy extreme, and--he loved her. because he did so he would not keep that news from her one moment longer than was necessary. 'yet,' he whispered to himself, while thinking thus, 'she would have come to love me in his place some day, she would--she must. i divined it, saw it. now, it will never be. never. my god! it is a long word.' then he braced himself up still more and went on, until he stood upon the summit of the little elevation which rose behind the spot that they had made their resting-place. perhaps she had seen him returning; perhaps she had had some divination of his approach, since he perceived that she was coming towards him and was mounting the ascent to meet him, her head protected by the cap of the drowned sailor, while, over it, she held with one hand a great palm leaf to protect her from the sun. then, as they approached each other, she gave a gasp--it was almost a shriek, and cried out: 'mr. charke! mr. charke! what is the matter? what has happened? you are ghastly pale beneath your bronze. and--and your face is changed. what is it?' 'i come,' he said,--and now she gave another gasp, for his voice was changed too,--'as the bearer of good--of great tidings. of----, and he paused. for as he spoke she, too, had turned white. then, raising both her hands to her breast, she stood panting before him. 'he is saved!' she said. 'he is saved! gilbert is saved. is that it? are those the tidings?' 'yes,' he answered. 'yes. he is saved.' for a moment she stood before him, her hands still raised to her bosom, then, suddenly, she swayed forward and would have fallen but that he caught her in his arms, and, an instant later, had laid her on the soft grass, while he ran down to the rivulet to fetch some water to revive her. this happened directly after he had returned, but, when he had bathed her forehead and moistened her lips with the water, she soon sat up, saying: 'come, let us go to him. at once. we must go at once. yet--why does he not come to me?' 'he has hurt his foot. but it is nothing. only a sprain. if you are recovered from your swoon let us set out. it is not far. we shall be there soon.' whereon he gave her his hand and assisted her to rise, repeating that it was best to set out at once. and then they did so, he offering his arm to assist her up the slope, while explaining that, owing to the increased roughness of the sea, it was impossible to proceed by the beach to where her lover was. and, next, he began the account of how he found gilbert, and went through with it almost uninterruptedly, she listening without saying a word beyond now and again exclaiming, 'poor gilbert!' or 'thank god!' indeed, her silence during his narrative was such that more than once he glanced down at her, while wondering at that which seemed listlessness on her part. yet he would have wronged her deeply had he really believed her listless, since bella waldron would have been no true, honest, english girl had she by this time become indifferent to the news that her betrothed was saved. indeed, in her heart she was thanking god again and again, and far more often than she was giving outward utterance to those thanks, for having saved her lover and preserved him to her---only! only what? only, that she knew how, with their restored happiness, there had come to this other man--to him to whom she owed her life and, with it, the possibility of being once more united to gilbert--a broken heart and the destruction of every hope of happiness that he had cherished. she could see it in his face, hear it in his voice, discern it even by the manner in which he walked by her side. that which she knew he hoped for could never have been, she told herself; never, never, never! had gilbert died, still it could never have been; none could ever have taken his place. but, she was a woman with a true woman's heart in her breast--and her pity was womanly--sublime. chapter xxvi "here is my journey's end, here is my butt, and very seamark of my utmost sail." they had progressed so far towards the cliffs above the little bay or cove, where gilbert was, that now they had but to cross the summit of one more spur and then they would be able to descend to him. 'you will see him soon now,' charke said to the girl, 'very soon. then you will be happy. to-night, he and i will arrange the signals that may bring some succour to us. at any rate, it cannot be long in coming. if we are where i think, hundreds of ships pass near here annually. and, at the worst, one may live here very well for some time.' she heard his words, she missed no tone nor inflection of his voice--but she could not answer him. it was impossible. for, though he spoke on subjects which were appropriate enough to their surroundings, she knew that his speech, instead of conveying his thoughts, was only used to hide them; and that beneath what he said lay a sadness too deep for utterance. therefore, she made no attempt at reply, but contented herself with letting her eyes rest on his face now and again, and then withdrawing them directly afterwards. suddenly, however, and after having cast a glance backwards across the little plateau which they had passed along, he exclaimed: 'why, lieutenant bampfyld will find another companion of his in the poor old _emperor_ here to greet him. see, there comes bengalee, behind us. how has he broken away from the cable? it was stout enough to hold a small frigate,' and, as she turned to look in the direction he had indicated, she saw the tiger-cub coming after them along the plateau at a considerable pace. coming swiftly, too, and always with the lithe and hateful sinuosity which marks the progress of the species. then, as she, too, turned and saw its striped body winding in and out beneath the tamarind and palm trees, she remembered that she had observed it gnawing at the cable ere she set out, and told stephen so. and she also told him that it had seemed much excited at being left behind, and had made considerable struggles to break loose when she moved away. 'it will perhaps be appeased,' he answered, 'when it finds itself once more with you. poor wretch! its hunger must be frightful. yet--yet--how else to kill it? and killed it must be.' 'i wish,' she said again, as she had so often said before, 'that i had never asked to have it saved. it would have been better to have let it die in the sea.' 'perhaps,' he answered. 'perhaps. we can, however, leave it here when we get taken off, and then it must take its chance.' they were now upon the last ridge of the spur beneath which he had left gilbert, and he told her that, in another moment, she would see him by looking down. 'indeed,' he said, 'if you glance over now you can see him, i imagine.' then he bade her hold his hand and lean over the lip of the precipice, and trace the run of the hill seawards. following his instructions, she did so, when suddenly, below, they heard a rattling, a sliding as of a mass of earth and stones slipping, and he felt a slight withdrawal, a sinking of the ground, beneath their feet. he felt it and understood its significance in an instant, while recalling the masses of fallen chalk and earth which he had observed lying at the foot of this and other cliffs earlier in the day. 'back,' he cried, 'back!' while, as he did so, he seized bella with his other hand as well as the one she already held, and sprang away from the ridge, the violence of his action causing her to fall on her knees. yet, still knowing her danger--their danger--he dragged her back and saved her. though not a moment too soon--not an instant!--for, as he clutched at her, the earth for a foot or so in front of them--the very portion of it on which they had been standing! the very portion, indeed, across which he had but now drawn her--gave way. it gave way, broke off in a long line, and fell with a crash to the depths below, leaving an abyss above the spot over which he had drawn her. 'my god!' she gasped, 'you have saved my life again! again--ah!' that last exclamation was, in truth, a shriek of dismay, of awful agony, of terror in the extreme. for she, whose face was towards the way they had come, as his back was towards it, saw that which he had no knowledge of; that which paralysed her, struck her an instant after dumb with horror. she saw the tiger-cub close behind him and crouching for a spring, she saw its devilish eyes gleaming like topazes, and she saw its body hurled with tremendous force towards charke as he stood looking down on her. full at him it sprang, its savage jaws open and its forelegs extended. and it partly missed him through passing on his left side, yet not doing so altogether. instead, it struck his left shoulder, spinning him round like a drunken, reeling man, and causing him to stagger backwards towards the chasm and, with a gasp, to fall over it and disappear. and bella, left alone in that awful moment--for the tiger's leap had carried it far over the cliff and to its own destruction--saw a man below--her lover--shouting and gesticulating--and then she knew no more. * * * * * * an hour later, stephen charke lay on his back below the cliff, his eyes upturned to the sun, which was by now peeping over the hill and illuminating all the little valley with its rays--he lay there breathing his last and with his back broken. by his side knelt bella waldron, while gilbert bampfyld stood near, their faces the true index of their sorrow. 'no,' stephen whispered hoarsely, now, in answer to a question from her. 'no. i feel no pain, nothing but the numbness of my back and lower limbs. nay, nay, do not weep.' then he lowered the poor, feeble voice a little more and whispered even more calmly to her--'i am content, well content. and--it--is better so. there was no life, no future for me.' 'oh!' she said, wringing her hands while the tears streamed from her eyes and dropped upon his upturned face. 'oh! that you should have died in saving me. that you, whom i honour so, should die at all--young, strong, as you are. and through the outcome of my wilfulness, of my letting that creature be saved. saved to slay you. ah! god, it is too hard!' 'it thought,' he said, after a pause, during which she wiped the drops from his forehead and moistened his lips, 'that i was attacking you. doubtless it did so. it hated me and loved you.' then, he added to himself, 'as all love you.' 'gilbert,' she shrieked now to her lover, 'gilbert, can nothing be done; nothing to save him? ah! perhaps his back is not broken; it may be but a terrible fall--he may recover yet. can we do nothing?' but it was stephen who answered, 'nothing.' 'old chap,' said gilbert, also close by him now, and kneeling down to take his hand, 'is--is there anything you want done; any message sent to any one at home? only say the word. you know you can depend on me.' 'if it can be,' the dying man said, and now his voice was very low, almost inaudible, 'if you can have it done later, when you are found, bury me--at--the--spot where she and i--came ashore. there, in the little knoll. you know.' and his eyes sought hers. 'that is where i want--to lie--until we meet again.' they could not answer him, their voices were no longer their own; hardly could they see him through their tears, but still they were able to tell him by their gestures that it should be as he desired. after which gilbert managed to rise to his feet and whisper in bella's ears, 'he is--going--now. the end is close at hand. say--say "goodbye" to him, and--and kiss him. he deserves it from you, and--i shall not grudge it.' then, in his manliness, he turned away from them. perhaps the dying man guessed what had been said; and, because he knew his hour had come, he opened his eyes for the last time and gazed wistfully at her. 'goodbye,' he said. 'farewell.' 'goodbye. oh, god! that i should have to say it to you. goodbye--goodbye, stephen,' and she stooped down and kissed the cold, white lips of the man who had loved her so. and, next, she put her arm beneath his neck and let his head lie on it, while, amidst the tempest of her sobs, she heard him murmur feebly: 'i loved you--from--the first--moment. i love--you--now.' then his head turned over on her arm and lay there motionless. * * * * * * the wedding was over, gilbert bampfyld and bella were man and wife, the marriage having taken place at capetown. while the only difference between the ceremony and that which had been originally intended was that the archbishop of capetown joined their hands instead of the bishop of bombay doing so. therefore, at last, these two loving hearts were made happy, and, in spite of all that had threatened both bella and her lover during the past few months, the future now looked bright and cheerful. not three days had elapsed since stephen charke's death when gilbert (who, with bella, sat from sunrise to sunset beneath a clump of cocoa trees on the highest point to which they could attain, he being soon able to reach it quite easily by the aid of his cudgel and owing to the rapid improvement in the sprain he had suffered from) saw a vessel not two miles away from the island. 'and i swear,' he exclaimed, 'one of her majesty's cruisers. look at those yellow funnels, one aft of the other. that's a cruiser right enough. i wonder if it's the _briseus_.' then he fell to making every kind of signal which he could devise when unprovided with the means of attracting her attention either by pistol-shot or fire, and in about half an hour they had the joy of seeing one of her cutters manned and lowered, and, a moment later, making for the shore. the cruiser turned out to be the _clytie_, on her way home from calcutta to plymouth, and, even as the cutter fetched the shore, the coxswain recognised gilbert as an officer with whom he had previously served. then he furnished him with the intelligence that he was reported dead. 'not yet,' said gilbert; 'though, since i left the _briseus_, when in charge of her whaler, i have had two narrow escapes. unfortunately, others, with whom i have been in company, are so.' then, briefly, he told the man all that had happened to him, and stated that he was going to ask the captain of the _clytie_ for a passage for himself and his future wife, the young lady by his side. first, however, there was one thing to be done--namely, to bury stephen charke in the place which he had indicated. this was a thing which would now be very easy of accomplishment, since the sea was perfectly calm again and the body could be easily carried from the spot where he had fallen to that where he desired to be buried. but, to begin with, the permission of the captain had to be obtained, which was done by signalling, and then the rest was easy. some more men were sent off in the second cutter, with the chaplain as well as some spades for digging a grave, after which the sailors marched under gilbert's command to where he and bella had covered up stephen charke's remains with palm and other leaves that were within their reach, and then removed the body. and very reverently was the interment performed, all standing round the spot with the exception of bella, who was so overcome that she had to be led away from the grave. and so they laid him in it; and there, in the little solitary island, they left him to his long sleep. perhaps, nothing so much as his death--not even his heroism in the stricken ship, nor his masterful strength in fighting the storm and the waves, and in succeeding at the risk of his own life in saving that of the woman whom he so tenderly loved--kept his memory green in both their hearts. perhaps, too, that last sacrifice which he made--his life!--at the moment when once more he was preserving hers, furnishes the reason which again and again prompts gilbert to say to his wife, in a voice always full of a tone of regret for the brave man who lies so far away: 'after all, bella, i am not sure that you chose the right one. poor stephen charke was the better man of the two.' yet, when he observes the glance she gives him in return, he is comforted by knowing that, in no circumstances, could that other have ever won her heart as he did. footnotes [footnote : this is not fictitious. m. constant made his speech to the chamber of deputies on june , , and it contained all attributed to it above. it described how the crew of _le rôdeur_ were themselves struck down one by one soon after the outbreak among the slaves, how many of the slaves were flung overboard to save the cost of supporting them, and also how, while the ship was subject to this terrible calamity, a spanish slaver, named the _leon_, spoke her, asking for assistance, as almost every one on board her was stricken with sudden blindness. _le rôdeur_, the account went on to say, eventually reached guadaloupe with only _one_ man left who was not smitten, and he became blind directly after he had brought the vessel into harbour. the spaniard was never heard of again.] the end contagion by katherine maclean [transcriber's note: this etext was produced from galaxy science fiction october . extensive research did not uncover any evidence that the u.s. copyright on this publication was renewed.] minos was such a lovely planet. not a thing seemed wrong with it. excepting the food, perhaps. and a disease that wasn't really. it was like an earth forest in the fall, but it was not fall. the forest leaves were green and copper and purple and fiery red, and a wind sent patches of bright greenish sunlight dancing among the leaf shadows. the hunt party of the _explorer_ filed along the narrow trail, guns ready, walking carefully, listening to the distant, half familiar cries of strange birds. a faint crackle of static in their earphones indicated that a gun had been fired. "got anything?" asked june walton. the helmet intercom carried her voice to the ears of the others without breaking the stillness of the forest. "took a shot at something," explained george barton's cheerful voice in her earphones. she rounded a bend of the trail and came upon barton standing peering up into the trees, his gun still raised. "it looked like a duck." "this isn't central park," said hal barton, his brother, coming into sight. his green spacesuit struck an incongruous note against the bronze and red forest. "they won't all look like ducks," he said soberly. "maybe some will look like dragons. don't get eaten by a dragon, june," came max's voice quietly into her earphones. "not while i still love you." he came out of the trees carrying the blood sample kit, and touched her glove with his, the grin on his ugly beloved face barely visible in the mingled light and shade. a patch of sunlight struck a greenish glint from his fishbowl helmet. * * * * * they walked on. a quarter of a mile back, the space ship _explorer_ towered over the forest like a tapering skyscraper, and the people of the ship looked out of the viewplates at fresh winds and sunlight and clouds, and they longed to be outside. but the likeness to earth was danger, and the cool wind might be death, for if the animals were like earth animals, their diseases might be like earth diseases, alike enough to be contagious, different enough to be impossible to treat. there was warning enough in the past. colonies had vanished, and traveled spaceways drifted with the corpses of ships which had touched on some plague planet. the people of the ship waited while their doctors, in airtight spacesuits, hunted animals to test them for contagion. the four medicos, for june walton was also a doctor, filed through the alien homelike forest, walking softly, watching for motion among the copper and purple shadows. they saw it suddenly, a lighter moving copper patch among the darker browns. reflex action swung june's gun into line, and behind her someone's gun went off with a faint crackle of static, and made a hole in the leaves beside the specimen. then for a while no one moved. this one looked like a man, a magnificently muscled, leanly graceful, humanlike animal. even in its callused bare feet, it was a head taller than any of them. red-haired, hawk-faced and darkly tanned, it stood breathing heavily, looking at them without expression. at its side hung a sheath knife, and a crossbow was slung across one wide shoulder. they lowered their guns. "it needs a shave," max said reasonably in their earphones, and he reached up to his helmet and flipped the switch that let his voice be heard. "something we could do for you, mac?" the friendly drawl was the first voice that had broken the forest sounds. june smiled suddenly. he was right. the strict logic of evolution did not demand beards; therefore a non-human would not be wearing a three day growth of red stubble. still panting, the tall figure licked dry lips and spoke. "welcome to minos. the mayor sends greetings from alexandria." "english?" gasped june. "we were afraid you would take off again before i could bring word to you.... it's three hundred miles.... we saw your scout plane pass twice, but we couldn't attract its attention." * * * * * june looked in stunned silence at the stranger leaning against the tree. thirty-six light years--thirty-six times six trillion miles of monotonous space travel--to be told that the planet was already settled! "we didn't know there was a colony here," she said. "it is not on the map." "we were afraid of that," the tall bronze man answered soberly. "we have been here three generations and yet no traders have come." max shifted the kit strap on his shoulder and offered a hand. "my name is max stark, m.d. this is june walton, m.d., hal barton, m.d., and george barton, hal's brother, also m.d." "patrick mead is the name," smiled the man, shaking hands casually. "just a hunter and bridge carpenter myself. never met any medicos before." the grip was effortless but even through her airproofed glove june could feel that the fingers that touched hers were as hard as padded steel. "what--what is the population of minos?" she asked. he looked down at her curiously for a moment before answering. "only one hundred and fifty." he smiled. "don't worry, this isn't a city planet yet. there's room for a few more people." he shook hands with the bartons quickly. "that is--you are people, aren't you?" he asked startlingly. "why not?" said max with a poise that june admired. "well, you are all so--so--" patrick mead's eyes roamed across the faces of the group. "so varied." they could find no meaning in that, and stood puzzled. "i mean," patrick mead said into the silence, "all these--interesting different hair colors and face shapes and so forth--" he made a vague wave with one hand as if he had run out of words or was anxious not to insult them. "joke?" max asked, bewildered. june laid a hand on his arm. "no harm meant," she said to him over the intercom. "we're just as much of a shock to him as he is to us." she addressed a question to the tall colonist on outside sound. "what should a person look like, mr. mead?" he indicated her with a smile. "like you." june stepped closer and stood looking up at him, considering her own description. she was tall and tanned, like him; had a few freckles, like him; and wavy red hair, like his. she ignored the brightly humorous blue eyes. "in other words," she said, "everyone on the planet looks like you and me?" patrick mead took another look at their four faces and began to grin. "like me, i guess. but i hadn't thought of it before. i did not think that people could have different colored hair or that noses could fit so many ways onto faces. i was judging by my own appearance, but i suppose any fool can walk on his hands and say the world is upside down!" he laughed and sobered. "but then why wear spacesuits? the air is breathable." "for safety," june told him. "we can't take any chances on plague." pat mead was wearing nothing but a loin cloth and his weapons, and the wind ruffled his hair. he looked comfortable, and they longed to take off the stuffy spacesuits and feel the wind against their own skins. minos was like home, like earth.... but they were strangers. "plague," pat mead said thoughtfully. "we had one here. it came two years after the colony arrived and killed everyone except the mead families. they were immune. i guess we look alike because we're all related, and that's why i grew up thinking that it is the only way people can look." _plague._ "what was the disease?" hal barton asked. "pretty gruesome, according to my father. they called it the melting sickness. the doctors died too soon to find out what it was or what to do about it." "you should have trained for more doctors, or sent to civilization for some." a trace of impatience was in george barton's voice. pat mead explained patiently, "our ship, with the power plant and all the books we needed, went off into the sky to avoid the contagion, and never came back. the crew must have died." long years of hardship were indicated by that statement, a colony with electric power gone and machinery stilled, with key technicians dead and no way to replace them. june realized then the full meaning of the primitive sheath knife and bow. "any recurrence of melting sickness?" asked hal barton. "no." "any other diseases?" "not a one." max was eyeing the bronze red-headed figure with something approaching awe. "do you think all the meads look like that?" he said to june on the intercom. "i wouldn't mind being a mead myself!" * * * * * their job had been made easy by the coming of pat. they went back to the ship laughing, exchanging anecdotes with him. there was nothing now to keep minos from being the home they wanted, except the melting sickness, and, forewarned against it, they could take precautions. the polished silver and black column of the _explorer_ seemed to rise higher and higher over the trees as they neared it. then its symmetry blurred all sense of specific size as they stepped out from among the trees and stood on the edge of the meadow, looking up. "nice!" said pat. "beautiful!" the admiration in his voice was warming. "it was a yacht," max said, still looking up, "second hand, an old-time beauty without a sign of wear. synthetic diamond-studded control board and murals on the walls. it doesn't have the new speed drives, but it brought us thirty-six light years in one and a half subjective years. plenty good enough." the tall tanned man looked faintly wistful, and june realized that he had never had access to a full library, never seen a movie, never experienced luxury. he had been born and raised on minos. * * * * * "may i go aboard?" pat asked hopefully. max unslung the specimen kit from his shoulder, laid it on the carpet of plants that covered the ground and began to open it. "tests first," hal barton said. "we have to find out if you people still carry this so-called melting sickness. we'll have to de-microbe you and take specimens before we let you on board. once on, you'll be no good as a check for what the other meads might have." max was taking out a rack and a stand of preservative bottles and hypodermics. "are you going to jab me with those?" pat asked with interest. "you're just a specimen animal to me, bud!" max grinned at pat mead, and pat grinned back. june saw that they were friends already, the tall pantherish colonist, and the wry, black-haired doctor. she felt a stab of guilt because she loved max and yet could pity him for being smaller and frailer than pat mead. "lie down," max told him, "and hold still. we need two spinal fluid samples from the back, a body cavity one in front, and another from the arm." pat lay down obediently. max knelt, and, as he spoke, expertly swabbed and inserted needles with the smooth speed that had made him a fine nerve surgeon on earth. high above them the scout helioplane came out of an opening in the ship and angled off toward the west, its buzz diminishing. then, suddenly, it veered and headed back, and reno unrich's voice came tinnily from their earphones: "what's that you've got? hey, what are you docs doing down there?" he banked again and came to a stop, hovering fifty feet away. june could see his startled face looking through the glass at pat. hal barton switched to a narrow radio beam, explained rapidly and pointed in the direction of alexandria. reno's plane lifted and flew away over the odd-colored forest. "the plane will drop a note on your town, telling them you got through to us," hal barton told pat, who was sitting up watching max dexterously put the blood and spinal fluids into the right bottles without exposing them to air. "we won't be free to contact your people until we know if they still carry melting sickness," max added. "you might be immune so it doesn't show on you, but still carry enough germs--if that's what caused it--to wipe out a planet." "if you do carry melting sickness," said hal barton, "we won't be able to mingle with your people until we've cleared them of the disease." "starting with me?" pat asked. "starting with you," max told him ruefully, "as soon as you step on board." "more needles?" "yes, and a few little extras thrown in." "rough?" "it isn't easy." a few minutes later, standing in the stalls for spacesuit decontamination, being buffeted by jets of hot disinfectant, bathed in glares of sterilizing ultraviolet radiation, june remembered that and compared pat mead's treatment to theirs. in the _explorer_, stored carefully in sealed tanks and containers, was the ultimate, multi-purpose cureall. it was a solution of enzymes so like the key catalysts of the human cell nucleus that it caused chemical derangement and disintegration in any non-human cell. nothing could live in contact with it but human cells; any alien intruder to the body would die. nucleocat cureall was its trade name. but the cureall alone was not enough for complete safety. plagues had been known to slay too rapidly and universally to be checked by human treatment. doctors are not reliable; they die. therefore spaceways and interplanetary health law demanded that ship equipment for guarding against disease be totally mechanical in operation, rapid and efficient. somewhere near them, in a series of stalls which led around and around like a rabbit maze, pat was being herded from stall to stall by peremptory mechanical voices, directed to soap and shower, ordered to insert his arm into a slot which took a sample of his blood, given solutions to drink, bathed in germicidal ultraviolet, shaken by sonic blasts, breathing air thick with sprays of germicidal mists, being directed to put his arms into other slots where they were anesthesized and injected with various immunizing solutions. finally, he would be put in a room of high temperature and extreme dryness, and instructed to sit for half an hour while more fluids were dripped into his veins through long thin tubes. all legal spaceships were built for safety. no chance was taken of allowing a suspected carrier to bring an infection on board with him. * * * * * june stepped from the last shower stall into the locker room, zipped off her spacesuit with a sigh of relief, and contemplated herself in a wall mirror. red hair, dark blue eyes, tall.... "i've got a good figure," she said thoughtfully. max turned at the door. "why this sudden interest in your looks?" he asked suspiciously. "do we stand here and admire you, or do we finally get something to eat?" "wait a minute." she went to a wall phone and dialed it carefully, using a combination from the ship's directory. "how're you doing, pat?" the phone picked up a hissing of water or spray. there was a startled chuckle. "voices, too! hello, june. how do you tell a machine to go jump in the lake?" "are you hungry?" "no food since yesterday." "we'll have a banquet ready for you when you get out," she told pat and hung up, smiling. pat mead's voice had a vitality and enjoyment which made shipboard talk sound like sad artificial gaiety in contrast. they looked into the nearby small laboratory where twelve squealing hamsters were protestingly submitting to a small injection each of pat's blood. in most of them the injection was followed by one of antihistaminics and adaptives. otherwise the hamster defense system would treat all non-hamster cells as enemies, even the harmless human blood cells, and fight back against them violently. one hamster, the twelfth, was given an extra large dose of adaptive, so that if there were a disease, he would not fight it or the human cells, and thus succumb more rapidly. "how ya doing, george?" max asked. "routine," george barton grunted absently. on the way up the long spiral ramps to the dining hall, they passed a viewplate. it showed a long scene of mountains in the distance on the horizon, and between them, rising step by step as they grew farther away, the low rolling hills, bronze and red with patches of clear green where there were fields. someone was looking out, standing very still, as if she had been there a long time--bess st. clair, a canadian woman. "it looks like winnipeg," she told them as they paused. "when are you doctors going to let us out of this blithering barberpole? look," she pointed. "see that patch of field on the south hillside, with the brook winding through it? i've staked that hillside for our house. when do we get out?" * * * * * reno ulrich's tiny scout plane buzzed slowly in from the distance and began circling lazily. "sooner than you think," max told her. "we've discovered a castaway colony on the planet. they've done our tests for us by just living here. if there's anything here to catch, they've caught it." "people on minos?" bess's handsome ruddy face grew alive with excitement. "one of them is down in the medical department," june said. "he'll be out in twenty minutes." "may i go see him?" "sure," said max. "show him the way to the dining hall when he gets out. tell him we sent you." "right!" she turned and ran down the ramp like a small girl going to a fire. max grinned at june and she grinned back. after a year and a half of isolation in space, everyone was hungry for the sight of new faces, the sound of unfamiliar voices. * * * * * they climbed the last two turns to the cafeteria, and entered to a rich subdued blend of soft music and quiet conversations. the cafeteria was a section of the old dining room, left when the rest of the ship had been converted to living and working quarters, and it still had the original finely grained wood of the ceiling and walls, the sound absorbency, the soft music spools and the intimate small light at each table where people leisurely ate and talked. they stood in line at the hot foods counter, and behind her june could hear a girl's voice talking excitedly through the murmur of conversation. "--new man, honest! i saw him through the viewplate when they came in. he's down in the medical department. a real frontiersman." the line drew abreast of the counters, and she and max chose three heaping trays, starting with hydroponic mushroom steak, raised in the growing trays of water and chemicals; sharp salad bowl with rose tomatoes and aromatic peppers; tank-grown fish with special sauce; four different desserts, and assorted beverages. presently they had three tottering trays successfully maneuvered to a table. brant st. clair came over. "i beg your pardon, max, but they are saying something about reno carrying messages to a colony of savages, for the medical department. will he be back soon, do you know?" max smiled up at him, his square face affectionate. everyone liked the shy canadian. "he's back already. we just saw him come in." "oh, fine." st. clair beamed. "i had an appointment with him to go out and confirm what looks like a nice vein of iron to the northeast. have you seen bess? oh--there she is." he turned swiftly and hurried away. a very tall man with fiery red hair came in surrounded by an eagerly talking crowd of ship people. it was pat mead. he stood in the doorway, alertly scanning the dining room. sheer vitality made him seem even larger than he was. sighting june, he smiled and began to thread toward their table. "look!" said someone. "there's the colonist!" shelia, a pretty, jeweled woman, followed and caught his arm. "did you _really_ swim across a river to come here?" overflowing with good-will and curiosity, people approached from all directions. "did you actually walk three hundred miles? come, eat with us. let me help choose your tray." everyone wanted him to eat at their table, everyone was a specialist and wanted data about minos. they all wanted anecdotes about hunting wild animals with a bow and arrow. "he needs to be rescued," max said. "he won't have a chance to eat." june and max got up firmly, edged through the crowd, captured pat and escorted him back to their table. june found herself pleased to be claiming the hero of the hour. * * * * * pat sat in the simple, subtly designed chair and leaned back almost voluptuously, testing the way it gave and fitted itself to him. he ran his eyes over the bright tableware and heaped plates. he looked around at the rich grained walls and soft lights at each table. he said nothing, just looking and feeling and experiencing. "when we build our town and leave the ship," june explained, "we will turn all the staterooms back into the lounges and ballrooms and cocktail bars that used to be inside." "oh, i'm not complaining," pat said negligently. he cocked his head to the music, and tried to locate its source. "that's big of you," said max with gentle irony. they fell to, pat beginning the first meal he had had in more than a day. most of the other diners finished when they were halfway through, and began walking over, diffidently at first, then in another wave of smiling faces, handshakes, and introductions. pat was asked about crops, about farming methods, about rainfall and floods, about farm animals and plant breeding, about the compatibility of imported earth seeds with local ground, about mines and strata. there was no need to protect him. he leaned back in his chair and drawled answers with the lazy ease of a panther; where he could think of no statistic, he would fill the gap with an anecdote. it developed that he enjoyed spinning campfire yarns and especially being the center of interest. between bouts of questions, he ate with undiminished and glowing relish. june noticed that the female specialists were prolonging the questions more than they needed, clustering around the table laughing at his jokes, until presently pat was almost surrounded by pretty faces, eager questions, and chiming laughs. shelia the beautiful laughed most chimingly of all. june nudged max, and max shrugged indifferently. it wasn't anything a man would pay attention to, perhaps. but june watched pat for a moment more, then glanced uneasily back to max. he was eating and listening to pat's answers and did not feel her gaze. for some reason max looked almost shrunken to her. he was shorter than she had realized; she had forgotten that he was only the same height as herself. she was dimly aware of the clear lilting chatter of female voices increasing at pat's end of the table. "that guy's a menace," max said, and laughed to himself, cutting another slice of hydroponic mushroom steak. "what's eating you?" he added, glancing aside at her when he noticed her sudden stillness. "nothing," she said hastily, but she did not turn back to watching pat mead. she felt disloyal. pat was only a superb animal. max was the man she loved. or--was he? of course he was, she told herself angrily. they had gone colonizing together because they wanted to spend their lives together; she had never thought of marrying any other man. yet the sense of dissatisfaction persisted, and along with it a feeling of guilt. len marlow, the protein tank-culture technician responsible for the mushroom steaks, had wormed his way into the group and asked pat a question. now he was saying, "i don't dig you, pat. it sounds like you're putting the people into the tanks instead of the vegetables!" he glanced at them, looking puzzled. "see if you two can make anything of this. it sounds medical to me." pat leaned back and smiled, sipping a glass of hydroponic burgundy. "wonderful stuff. you'll have to show us how to make it." len turned back to him. "you people live off the country, right? you hunt and bring in steaks and eat them, right? well, say i have one of those steaks right here and i want to eat it, what happens?" * * * * * "go ahead and eat it. it just wouldn't digest. you'd stay hungry." "why?" len was aggrieved. "chemical differences in the basic protoplasm of minos. different amino linkages, left-handed instead of right-handed molecules in the carbohydrates, things like that. nothing will be digestible here until you are adapted chemically by a little test-tube evolution. till then you'd starve to death on a full stomach." pat's side of the table had been loaded with the dishes from two trays, but it was almost clear now and the dishes were stacked neatly to one side. he started on three desserts, thoughtfully tasting each in turn. "test-tube evolution?" max repeated. "what's that? i thought you people had no doctors." "it's a story." pat leaned back again. "alexander p. mead, the head of the mead clan, was a plant geneticist, a very determined personality and no man to argue with. he didn't want us to go through the struggle of killing off all minos plants and putting in our own, spoiling the face of the planet and upsetting the balance of its ecology. he decided that he would adapt our genes to this planet or kill us trying. he did it all right.'" "did which?" asked june, suddenly feeling a sourceless prickle of fear. "adapted us to minos. he took human cells--" * * * * * she listened intently, trying to find a reason for fear in the explanation. it would have taken many human generations to adapt to minos by ordinary evolution, and that only at a heavy toll of death and hunger which evolution exacts. there was a shorter way: human cells have the ability to return to their primeval condition of independence, hunting, eating and reproducing alone. alexander p. mead took human cells and made them into phagocytes. he put them through the hard savage school of evolution--a thousand generations of multiplication, hardship and hunger, with the alien indigestible food always present, offering its reward of plenty to the cell that reluctantly learned to absorb it. "leucocytes can run through several thousand generations of evolution in six months," pat mead finished. "when they reached to a point where they would absorb minos food, he planted them back in the people he had taken them from." "what was supposed to happen then?" max asked, leaning forward. "i don't know exactly how it worked. he never told anybody much about it, and when i was a little boy he had gone loco and was wandering ha-ha-ing around waving a test tube. fell down a ravine and broke his neck at the age of eighty." "a character," max said. why was she afraid? "it worked then?" "yes. he tried it on all the meads the first year. the other settlers didn't want to be experimented on until they saw how it worked out. it worked. the meads could hunt, and plant while the other settlers were still eating out of hydroponics tanks." "it worked," said max to len. "you're a plant geneticist and a tank culture expert. there's a job for you." "uh-_uh_!" len backed away. "it sounds like a medical problem to me. human cell control--right up your alley." "it is a one-way street," pat warned. "once it is done, you won't be able to digest ship food. i'll get no good from this protein. i ate it just for the taste." hal barton appeared quietly beside the table. "three of the twelve test hamsters have died," he reported, and turned to pat. "your people carry the germs of melting sickness, as you call it. the dead hamsters were injected with blood taken from you before you were de-infected. we can't settle here unless we de-infect everybody on minos. would they object?" "we wouldn't want to give you folks germs," pat smiled. "anything for safety. but there'll have to be a vote on it first." the doctors went to reno ulrich's table and walked with him to the hangar, explaining. he was to carry the proposal to alexandria, mingle with the people, be persuasive and wait for them to vote before returning. he was to give himself shots of cureall every two hours on the hour or run the risk of disease. * * * * * reno was pleased. he had dabbled in sociology before retraining as a mechanic for the expedition. "this gives me a chance to study their mores." he winked wickedly. "i may not be back for several nights." they watched through the viewplate as he took off, and then went over to the laboratory for a look at the hamsters. three were alive and healthy, munching lettuce. one was the control; the other two had been given shots of pat's blood from before he entered the ship, but with no additional treatment. apparently a hamster could fight off melting sickness easily if left alone. three were still feverish and ruffled, with a low red blood count, but recovering. the three dead ones had been given strong shots of adaptive and counter histamine, so their bodies had not fought back against the attack. june glanced at the dead animals hastily and looked away again. they lay twisted with a strange semi-fluid limpness, as if ready to dissolve. the last hamster, which had been given the heaviest dose of adaptive, had apparently lost all its hair before death. it was hairless and pink, like a still-born baby. "we can find no micro-organisms," george barton said. "none at all. nothing in the body that should not be there. leucosis and anemia. fever only for the ones that fought it off." he handed max some temperature charts and graphs of blood counts. june wandered out into the hall. pediatrics and obstetrics were her field; she left the cellular research to max, and just helped him with laboratory routine. the strange mood followed her out into the hall, then abruptly lightened. coming toward her, busily telling a tale of adventure to the gorgeous shelia davenport, was a tall, red-headed, magnificently handsome man. it was his handsomeness which made pat such a pleasure to look upon and talk with, she guiltily told herself, and it was his tremendous vitality.... it was like meeting a movie hero in the flesh, or a hero out of the pages of a book--deer-slayer, john clayton, lord greystoke. she waited in the doorway to the laboratory and made no move to join them, merely acknowledged the two with a nod and a smile and a casual lift of the hand. they nodded and smiled back. "hello, june," said pat and continued telling his tale, but as they passed he lightly touched her arm. "oh, pioneer!" she said mockingly and softly to his passing profile, and knew that he had heard. * * * * * that night she had a nightmare. she was running down a long corridor looking for max, but every man she came to was a big bronze man with red hair and bright blue eyes who grinned at her. the pink hamster! she woke suddenly, feeling as if alarm bells had been ringing, and listened carefully, but there was no sound. she had had a nightmare, she told herself, but alarm bells were still ringing in her unconscious. something was wrong. lying still and trying to preserve the images, she groped for a meaning, but the mood faded under the cold touch of reason. damn intuitive thinking! a pink hamster! why did the unconscious have to be so vague? she fell asleep again and forgot. they had lunch with pat mead that day, and after it was over pat delayed june with a hand on her shoulder and looked down at her for a moment. "i want you, june," he said and then turned away, answering the hails of a party at another table as if he had not spoken. she stood shaken, and then walked to the door where max waited. she was particularly affectionate with max the rest of the day, and it pleased him. he would not have been if he had known why. she tried to forget pat's blunt statement. june was in the laboratory with max, watching the growth of a small tank culture of the alien protoplasm from a minos weed, and listening to len marlow pour out his troubles. "and elsie tags around after that big goof all day, listening to his stories. and then she tells me i'm just jealous, i'm imagining things!" he passed his hand across his eyes. "i came away from earth to be with elsie.... i'm getting a headache. look, can't you persuade pat to cut it out, june? you and max are his friends." "here, have an aspirin," june said. "we'll see what we can do." "thanks." len picked up his tank culture and went out, not at all cheered. * * * * * max sat brooding over the dials and meters at his end of the laboratory, apparently sunk in thought. when len had gone, he spoke almost harshly. "why encourage the guy? why let him hope?" "found out anything about the differences in protoplasm?" she evaded. "why let him kid himself? what chance has he got against that hunk of muscle and smooth talk?" "but pat isn't after elsie," she protested. "every scatter-brained woman on this ship is trailing after pat with her tongue hanging out. brant st. clair is in the bar right now. he doesn't say what he is drinking about, but do you think pat is resisting all these women crowding down on him?" "there are other things besides looks and charm," she said, grimly trying to concentrate on a slide under her binocular microscope. "yeah, and whatever they are, pat has them, too. who's more competent to support a woman and a family on a frontier planet than a handsome bruiser who was born here?" "i meant," june spun around on her stool with unexpected passion, "there is old friendship, and there's fondness, and memories, and loyalty!" she was half shouting. "they're not worth much on the second-hand market," max said. he was sitting slumped on his lab stool, looking dully at his dials. "now _i'm_ getting a headache!" he smiled ruefully. "no kidding, a real headache. and over other people's troubles yet!" other people's troubles.... she got up and wandered out into the long curving halls. "i want you june," pat's voice repeated in her mind. why did the man have to be so overpoweringly attractive, so glaring a contrast to max? why couldn't the universe manage to run on without generating troublesome love triangles? * * * * * she walked up the curving ramps to the dining hall where they had eaten and drunk and talked yesterday. it was empty except for one couple talking forehead to forehead over cold coffee. she turned and wandered down the long easy spiral of corridor to the pharmacy and dispensary. it was empty. george was probably in the test lab next door, where he could hear if he was wanted. the automatic vendor of harmless euphorics, stimulants and opiates stood in the corner, brightly decorated in pastel abstract designs, with its automatic tabulator graph glowing above it. max had a headache, she remembered. she recorded her thumbprint in the machine and pushed the plunger for a box of aspirins, trying to focus her attention on the problem of adapting the people of the ship to the planet minos. an aquarium tank with a faint solution of histamine would be enough to convert a piece of human skin into a community of voracious active phagocytes individually seeking something to devour, but could they eat enough to live away from the rich sustaining plasma of human blood? after the aspirins, she pushed another plunger for something for herself. then she stood looking at it, a small box with three pills in her hand--theobromine, a heart strengthener and a confidence-giving euphoric all in one, something to steady shaky nerves. she had used it before only in emergency. she extended a hand and looked at it. it was trembling. damn triangles! while she was looking at her hand there was a click from the automatic drug vendor. it summed the morning use of each drug in the vendors throughout the ship, and recorded it in a neat addition to the end of each graph line. for a moment she could not find the green line for anodynes and the red line for stimulants, and then she saw that they went almost straight up. there were too many being used--far too many to be explained by jealousy or psychosomatic peevishness. this was an epidemic, and only one disease was possible! the disinfecting of pat had not succeeded. nucleocat cureall, killer of all infections, had not cured! pat had brought melting sickness into the ship with him! who had it? the drugs vendor glowed cheerfully, uncommunicative. she opened a panel in its side and looked in on restless interlacing cogs, and on the inside of the door saw printed some directions.... "to remove or examine records before reaching end of the reel--" after a few fumbling minutes she had the answer. in the cafeteria at breakfast and lunch, thirty-eight men out of the forty-eight aboard ship had taken more than his norm of stimulant. twenty-one had taken aspirin as well. the only woman who had made an unusual purchase was herself! she remembered the hamsters that had thrown off the infection with a short sharp fever, and checked back in the records to the day before. there was a short rise in aspirin sales to women at late afternoon. the women were safe. it was the men who had melting sickness! melting sickness killed in hours, according to pat mead. how long had the men been sick? * * * * * as she was leaving, jerry came into the pharmacy, recorded his thumbprint and took a box of aspirin from the machine. she felt all right. self-control was working well and it was pleasant still to walk down the corridor smiling at the people who passed. she took the emergency elevator to the control room and showed her credentials to the technician on watch. "medical emergency." at a small control panel in the corner was a large red button, precisely labeled. she considered it and picked up the control room phone. this was the hard part, telling someone, especially someone who had it--max. she dialed, and when the click on the end of the line showed he had picked the phone up, she told max what she had seen. "no women, just the men," he repeated. "that right?" "yes." "probably it's chemically alien, inhibited by one of the female sex hormones. we'll try sex hormone shots, if we have to. where are you calling from?" she told him. "that's right. give nucleocat cureall another chance. it might work this time. push that button." she went to the panel and pushed the large red button. through the long height of the _explorer_, bells woke to life and began to ring in frightened clangor, emergency doors thumped shut, mechanical apparatus hummed into life and canned voices began to give rapid urgent directions. a plague had come. * * * * * she obeyed the mechanical orders, went out into the hall and walked in line with the others. the captain walked ahead of her and the gorgeous shelia davenport fell into step beside her. "i look like a positive hag this morning. does that mean i'm sick? are we all sick?" june shrugged, unwilling to say what she knew. others came out of all rooms into the corridor, thickening the line. they could hear each room lock as the last person left it, and then, faintly, the hiss of disinfectant spray. behind them, on the heels of the last person in line, segments of the ship slammed off and began to hiss. they wound down the spiral corridor until they reached the medical treatment section again, and there they waited in line. "it won't scar my arms, will it?" asked shelia apprehensively, glancing at her smooth, lovely arms. the mechanical voice said, "next. step inside, please, and stand clear of the door." "not a bit," june reassured shelia, and stepped into the cubicle. inside, she was directed from cubicle to cubicle and given the usual buffeting by sprays and radiation, had blood samples taken and was injected with nucleocat and a series of other protectives. at last she was directed through another door into a tiny cubicle with a chair. "you are to wait here," commanded the recorded voice metallically. "in twenty minutes the door will unlock and you may then leave. all people now treated may visit all parts of the ship which have been protected. it is forbidden to visit any quarantined or unsterile part of the ship without permission from the medical officers." presently the door unlocked and she emerged into bright lights again, feeling slightly battered. she was in the clinic. a few men sat on the edge of beds and looked sick. one was lying down. brant and bess st. clair sat near each other, not speaking. approaching her was george barton, reading a thermometer with a puzzled expression. "what is it, george?" she asked anxiously. "some of the women have slight fever, but it's going down. none of the fellows have any--but their white count is way up, their red count is way down, and they look sick to me." she approached st. clair. his usually ruddy cheeks were pale, his pulse was light and too fast, and his skin felt clammy. "how's the headache? did the nucleocat treatment help?" "i feel worse, if anything." "better set up beds," she told george. "get everyone back into the clinic." "we're doing that," george assured her. "that's what hal is doing." she went back to the laboratory. max was pacing up and down, absently running his hands through his black hair until it stood straight up. he stopped when he saw her face, and scowled thoughtfully. "they are still sick?" it was more a statement than a question. she nodded. "the cureall didn't cure this time," he muttered. "that leaves it up to us. we have melting sickness and according to pat and the hamsters, that leaves us less than a day to find out what it is and learn how to stop it." suddenly an idea for another test struck him and he moved to the work table to set it up. he worked rapidly, with an occasional uncoordinated movement betraying his usual efficiency. it was strange to see max troubled and afraid. she put on a laboratory smock and began to work. she worked in silence. the mechanicals had failed. hal and george barton were busy staving off death from the weaker cases and trying to gain time for max and her to work. the problem of the plague had to be solved by the two of them alone. it was in their hands. another test, no results. another test, no results. max's hands were shaking and he stopped a moment to take stimulants. she went into the ward for a moment, found bess and warned her quietly to tell the other women to be ready to take over if the men became too sick to go on. "but tell them calmly. we don't want to frighten the men." she lingered in the ward long enough to see the word spread among the women in a widening wave of paler faces and compressed lips; then she went back to the laboratory. another test. there was no sign of a micro-organism in anyone's blood, merely a growing horde of leucocytes and phagocytes, prowling as if mobilized to repel invasion. * * * * * len marlow was wheeled in unconscious, with hal barton's written comments and conclusions pinned to the blanket. "i don't feel so well myself," the assistant complained. "the air feels thick. i can't breathe." june saw that his lips were blue. "oxygen short," she told max. "low red corpuscle count," max answered. "look into a drop and see what's going on. use mine; i feel the same way he does." she took two drops of max's blood. the count was low, falling too fast. breathing is useless without the proper minimum of red corpuscles in the blood. people below that minimum die of asphyxiation although their lungs are full of pure air. the red corpuscle count was falling too fast. the time she and max had to work in was too short. "pump some more co_{ } into the air system," max said urgently over the phone. "get some into the men's end of the ward." * * * * * she looked through the microscope at the live sample of blood. it was a dark clear field and bright moving things spun and swirled through it, but she could see nothing that did not belong there. "hal," max called over the general speaker system, "cut the other treatments, check for accelerating anemia. treat it like monoxide poisoning--co_{ } and oxygen." she reached into a cupboard under the work table, located two cylinders of oxygen, cracked the valves and handed one to max and one to the assistant. some of the bluish tint left the assistant's face as he breathed and he went over to the patient with reawakened concern. "not breathing, doc!" max was working at the desk, muttering equations of hemoglobin catalysis. "len's gone, doc," the assistant said more loudly. "artificial respiration and get him into a regeneration tank," said june, not moving from the microscope. "hurry! hal will show you how. the oxidation and mechanical heart action in the tank will keep him going. put anyone in a tank who seems to be dying. get some women to help you. give them hal's instructions." the tanks were ordinarily used to suspend animation in a nutrient bath during the regrowth of any diseased organ. it could preserve life in an almost totally destroyed body during the usual disintegration and regrowth treatments for cancer and old age, and it could encourage healing as destruction continued ... but they could not prevent ultimate death as long as the disease was not conquered. the drop of blood in june's microscope was a great, dark field, and in the foreground, brought to gargantuan solidity by the stereo effect, drifted neat saucer shapes of red blood cells. they turned end for end, floating by the humped misty mass of a leucocyte which was crawling on the cover glass. there were not enough red corpuscles, and she felt that they grew fewer as she watched. she fixed her eye on one, not blinking in fear that she would miss what might happen. it was a tidy red button, and it spun as it drifted, the current moving it aside in a curve as it passed by the leucocyte. then, abruptly, the cell vanished. june stared numbly at the place where it had been. behind her, max was calling over the speaker system again: "dr. stark speaking. any technician who knows anything about the life tanks, start bringing more out of storage and set them up. emergency." "we may need forty-seven," june said quietly. "we may need forty-seven," max repeated to the ship in general. his voice did not falter. "set them up along the corridor. hook them in on extension lines." his voice filtered back from the empty floors above in a series of dim echoes. what he had said meant that every man on board might be on the point of heart stoppage. * * * * * june looked blindly through the binocular microscope, trying to think. out of the corner of her eyes she could see that max was wavering and breathing more and more frequently of the pure, cold, burning oxygen of the cylinders. in the microscope she could see that there were fewer red cells left alive in the drop of his blood. the rate of fall was accelerating. she didn't have to glance at max to know how he would look--skin pale, black eyebrows and keen brown eyes slightly squinted in thought, a faint ironical grin twisting the bluing lips. intelligent, thin, sensitive, his face was part of her mind. it was inconceivable that max could die. he couldn't die. he couldn't leave her alone. she forced her mind back to the problem. all the men of the _explorer_ were at the same point, wherever they were. moving to max's desk, she spoke into the intercom system: "bess, send a couple of women to look through the ship, room by room, with a stretcher. make sure all the men are down here." she remembered reno. "sparks, heard anything from reno? is he back?" sparks replied weakly after a lag. "the last i heard from reno was a call this morning. he was raving about mirrors, and pat mead's folks not being real people, just carbon copies, and claiming he was crazy; and i should send him the psychiatrist. i thought he was kidding. he didn't call back." "thanks, sparks." reno was lost. max dialed and spoke to the bridge over the phone. "are you okay up there? forget about engineering controls. drop everything and head for the tanks while you can still walk." june went back to the work table and whispered into her own phone. "bess, send up a stretcher for max. he looks pretty bad." there had to be a solution. the life tanks could sustain life in a damaged body, encouraging it to regrow more rapidly, but they merely slowed death as long as the disease was not checked. the postponement could not last long, for destruction could go on steadily in the tanks until the nutritive solution would hold no life except the triumphant microscopic killers that caused melting sickness. there were very few red blood corpuscles in the microscope field now, incredibly few. she tipped the microscope and they began to drift, spinning slowly. a lone corpuscle floated through the center. she watched it as the current swept it in an arc past the dim off-focus bulk of the leucocyte. there was a sweep of motion and it vanished. for a moment it meant nothing to her; then she lifted her head from the microscope and looked around. max sat at his desk, head in hand, his rumpled short black hair sticking out between his fingers at odd angles. a pencil and a pad scrawled with formulas lay on the desk before him. she could see his concentration in the rigid set of his shoulders. he was still thinking; he had not given up. * * * * * "max, i just saw a leucocyte grab a red blood corpuscle. it was unbelievably fast." "leukemia," muttered max without moving. "galloping leukemia yet! that comes under the heading of cancer. well, that's part of the answer. it might be all we need." he grinned feebly and reached for the speaker set. "anybody still on his feet in there?" he muttered into it, and the question was amplified to a booming voice throughout the ship. "hal, are you still going? look, hal, change all the dials, change the dials, set them to deep melt and regeneration. one week. this is like leukemia. got it? this is like leukemia." june rose. it was time for her to take over the job. she leaned across his desk and spoke into the speaker system. "doctor walton talking," she said. "this is to the women. don't let any of the men work any more; they'll kill themselves. see that they all go into the tanks right away. set the tank dials for deep regeneration. you can see how from the ones that are set." two exhausted and frightened women clattered in the doorway with a stretcher. their hands were scratched and oily from helping to set up tanks. "that order includes you," she told max sternly and caught him as he swayed. max saw the stretcher bearers and struggled upright. "ten more minutes," he said clearly. "might think of an idea. something not right in this setup. i have to figure how to prevent a relapse, how the thing started." he knew more bacteriology than she did; she had to help him think. she motioned the bearers to wait, fixed a breathing mask for max from a cylinder of co_{ } and the opened one of oxygen. max went back to his desk. she walked up and down, trying to think, remembering the hamsters. the melting sickness, it was called. melting. she struggled with an impulse to open a tank which held one of the men. she wanted to look in, see if that would explain the name. melting sickness.... footsteps came and pat mead stood uncertainly in the doorway. tall, handsome, rugged, a pioneer. "anything i can do?" he asked. she barely looked at him. "you can stay out of our way. we're busy." "i'd like to help," he said. "very funny." she was vicious, enjoying the whip of her words. "every man is dying because you're a carrier, and you want to help." * * * * * he stood nervously clenching and unclenching his hands. "a guinea pig, maybe. i'm immune. all the meads are." "go away." god, why couldn't she think? what makes a mead immune? "aw, let 'im alone," max muttered. "pat hasn't done anything." he went waveringly to the microscope, took a tiny sliver from his finger, suspended it in a slide and slipped it under the lens with detached habitual dexterity. "something funny going on," he said to june. "symptoms don't feel right." after a moment he straightened and motioned for her to look. "leucocytes, phagocytes--" he was bewildered. "my own--" she looked in, and then looked back at pat in a growing wave of horror. "they're not your own, max!" she whispered. max rested a hand on the table to brace himself, put his eye to the microscope, and looked again. june knew what he saw. phagocytes, leucocytes, attacking and devouring his tissues in a growing incredible horde, multiplying insanely. _not his phagocytes! pat mead's!_ the meads' evolved cells had learned too much. they were contagious. and not pat mead's.... how much alike _were_ the meads?... mead cells contagious from one to another, not a disease attacking or being fought, but acting as normal leucocytes in whatever body they were in! the leucocytes of tall, red-headed people, finding no strangeness in the bloodstream of any of the tall, red-headed people. no strangeness.... a toti-potent leucocyte finding its way into cellular wombs. the womblike life tanks. for the men of the _explorer_, a week's cure with deep melting to de-differentiate the leucocytes and turn them back to normal tissue, then regrowth and reforming from the cells that were there. from the cells that _were_ there. _from the cells that were there...._ "pat--" "i know." pat began to laugh, his face twisted with sudden understanding. "i understand. i get it. i'm a contagious personality. that's funny, isn't it?" max rose suddenly from the microscope and lurched toward him, fists clenched. pat caught him as he fell, and the bewildered stretcher bearers carried him out to the tanks. * * * * * for a week june tended the tanks. the other women volunteered to help, but she refused. she said nothing, hoping her guess would not be true. "is everything all right?" elsie asked her anxiously. "how is jerry coming along?" elsie looked haggard and worn, like all the women, from doing the work that the men had always done. "he's fine," june said tonelessly, shutting tight the door of the tank room. "they're all fine." "that's good," elsie said, but she looked more frightened than before. june firmly locked the tank room door and the girl went away. the other women had been listening, and now they wandered back to their jobs, unsatisfied by june's answer, but not daring to ask for the actual truth. they were there whenever june went into the tank room, and they were still there--or relieved by others; june was not sure--when she came out. and always some one of them asked the unvarying question for all the others, and june gave the unvarying answer. but she kept the key. no woman but herself knew what was going on in the life tanks. then the day of completion came. june told no one of the hour. she went into the room as on the other days, locked the door behind her, and there was the nightmare again. this time it was reality and she wandered down a path between long rows of coffinlike tanks, calling, "max! max!" silently and looking into each one as it opened. but each face she looked at was the same. watching them dissolve and regrow in the nutrient solution, she had only been able to guess at the horror of what was happening. now she knew. they were all the same lean-boned, blond-skinned face, with a pin-feather growth of reddish down on cheeks and scalp. all horribly--and handsomely--the same. a medical kit lay carelessly on the floor beside max's tank. she stood near the bag. "max," she said, and found her throat closing. the canned voice of the mechanical mocked her, speaking glibly about waking and sitting up. "i'm sorry, max...." the tall man with rugged features and bright blue eyes sat up sleepily and lifted an eyebrow at her, and ran his hand over his red-fuzzed head in a gesture of bewilderment. "what's the matter, june?" he asked drowsily. she gripped his arm. "max--" he compared the relative size of his arm with her hand and said wonderingly, "you shrank." "i know, max. i know." he turned his head and looked at his arms and legs, pale blond arms and legs with a down of red hair. he touched the thick left arm, squeezed a pinch of hard flesh. "it isn't mine," he said, surprised. "but i can feel it." watching his face was like watching a stranger mimicking and distorting max's expressions. max in fear. max trying to understand what had happened to him, looking around at the other men sitting up in their tanks. max feeling the terror that was in herself and all the men as they stared at themselves and their friends and saw what they had become. "we're all pat mead," he said harshly. "all the meads are pat mead. that's why he was surprised to see people who didn't look like himself." "yes, max." "max," he repeated. "it's me, all right. the nervous system didn't change." his new blue eyes held hers. "my love didn't, either. did yours? did it, june?" "no, max." but she couldn't know yet. she had loved max with the thin, ironic face, the rumpled black hair and the twisted smile that never really hid his quick sympathy. now he was pat mead. could he also be max? "of course i still love you, darling." he grinned. it was still the wry smile of max, though fitting strangely on the handsome new blond face. "then it isn't so bad. it might even be pretty good. i envied him this big, muscular body. if pat or any of these meads so much as looks at you, i'm going to knock his block off. understand?" * * * * * she laughed and couldn't stop. it wasn't that funny. but it was still max, trying to be unafraid, drawing on humor. maybe the rest of the men would also be their old selves, enough so the women would not feel that their men were strangers. behind her, male voices spoke characteristically. she did not have to turn to know which was which: "this is one way to keep a guy from stealing your girl," that was len marlow; "i've got to write down all my reactions," hal barton; "now i can really work that hillside vein of metal," st. clair. then others complaining, swearing, laughing bitterly at the trick that had been played on them and their flirting, tempted women. she knew who they were. their women would know them apart, too. "we'll go outside," max said. "you and i. maybe the shock won't be so bad to the women after they see me." he paused. "you didn't tell them, did you?" "i couldn't. i wasn't sure. i--was hoping i was wrong." she opened the door and closed it quickly. there was a small crowd on the other side. "hello, pat," elsie said uncertainly, trying to look past them into the tank room before the door shut. "i'm not pat, i'm max," said the tall man with the blue eyes and the fuzz-reddened skull. "listen--" "good heavens, pat, what happened to your hair?" shelia asked. "i'm max," insisted the man with the handsome face and the sharp blue eyes. "don't you get it? i'm max stark. the melting sickness is mead cells. we caught them from pat. they adapted us to minos. they also changed us all into pat mead." the women stared at him, at each other. they shook their heads. "they don't understand," june said. "i couldn't have if i hadn't seen it happening, max." "it's pat," said shelia, dazedly stubborn. "he shaved off his hair. it's some kind of joke." max shook her shoulders, glaring down at her face. "i'm max. max stark. they all look like me. do you hear? it's funny, but it's not a joke. laugh for us, for god's sake!" "it's too much," said june. "they'll have to see." she opened the door and let them in. they hurried past her to the tanks, looking at forty-six identical blond faces, beginning to call in frightened voices: "jerry!" "harry!" "lee, where are you, sweetheart--" june shut the door on the voices that were growing hysterical, the women terrified and helpless, the men shouting to let the women know who they were. "it isn't easy," said max, looking down at his own thick muscles. "but you aren't changed and the other girls aren't. that helps." through the muffled noise and hysteria, a bell was ringing. "it's the airlock," june said. peering in the viewplate were nine meads from alexandria. to all appearances, eight of them were pat mead at various ages, from fifteen to fifty, and the other was a handsome, leggy, red-headed girl who could have been his sister. regretfully, they explained through the voice tube that they had walked over from alexandria to bring news that the plane pilot had contracted melting sickness there and had died. they wanted to come in. * * * * * june and max told them to wait and returned to the tank room. the men were enjoying their new height and strength, and the women were bewilderedly learning that they could tell one pat mead from another, by voice, by gesture of face or hand. the panic was gone. in its place was a dull acceptance of the fantastic situation. max called for attention. "there are nine meads outside who want to come in. they have different names, but they're all pat mead." they frowned or looked blank, and george barton asked, "why didn't you let them in? i don't see any problem." "one of them," said max soberly, "is a girl. _patricia_ mead. the girl wants to come in." there was a long silence while the implication settled to the fear center of the women's minds. shelia the beautiful felt it first. she cried, "no! please don't let her in!" there was real fright in her tone and the women caught it quickly. elsie clung to jerry, begging, "you don't want me to change, do you, jerry? you like me the way i am! tell me you do!" * * * * * the other girls backed away. it was illogical, but it was human. june felt terror rising in herself. she held up her hand for quiet, and presented the necessity to the group. "only half of us can leave minos," she said. "the men cannot eat ship food; they've been conditioned to this planet. we women can go, but we would have to go without our men. we can't go outside without contagion, and we can't spend the rest of our lives in quarantine inside the ship. george barton is right--there is no problem." "but we'd be changed!" shelia shrilled. "i don't want to become a mead! i don't want to be somebody else!" she ran to the inner wall of the corridor. there was a brief hesitation, and then, one by one, the women fled to that side, until there were only bess, june and four others left. "see!" cried shelia. "a vote! we can't let the girl in!" no one spoke. to change, to be someone else--the idea was strange and horrifying. the men stood uneasily glancing at each other, as if looking into mirrors, and against the wall of the corridor the women watched in fear and huddled together, staring at the men. one man in forty-seven poses. one of them made a beseeching move toward elsie and she shrank away. "no, jerry! i won't let you change me!" max stirred restlessly, the ironic smile that made his new face his own unconsciously twisting into a grimace of pity. "we men can't leave, and you women can't stay," he said bluntly. "why not let patricia mead in. get it over with!" june took a small mirror from her belt pouch and studied her own face, aware of max talking forcefully, the men standing silent, the women pleading. her face ... her own face with its dark blue eyes, small nose, long mobile lips ... the mind and the body are inseparable; the shape of a face is part of the mind. she put the mirror back. "i'd kill myself!" shelia was sobbing. "i'd rather die!" "you won't die," max was saying. "can't you see there's only one solution--" they were looking at max. june stepped silently out of the tank room, and then turned and went to the airlock. she opened the valves that would let in pat mead's sister. doctor by murray leinster illustrated by finlay [transcriber's note: this etext was produced from galaxy magazine february . extensive research did not uncover any evidence that the u.s. copyright on this publication was renewed.] suddenly the biggest thing in the universe was the very tiniest. there were suns, which were nearby, and there were stars which were so far away that no way of telling their distance had any meaning. the suns had planets, most of which did not matter, but the ones that did count had seas and continents, and the continents had cities and highways and spaceports. and people. the people paid no attention to their insignificance. they built ships which went through emptiness beyond imagining, and they landed upon planets and rebuilt them to their own liking. suns flamed terribly, renting their impertinence, and storms swept across the planets they preëmpted, but the people built more strongly and were secure. everything in the universe was bigger or stronger than the people, but they ignored the fact. they went about the businesses they had contrived for themselves. they were not afraid of anything until somewhere on a certain small planet an infinitesimal single molecule changed itself. it was one molecule among unthinkably many, upon one planet of one solar system among uncountable star clusters. it was not exactly alive, but it acted as if it were, in which it was like all the important matter of the cosmos. it was actually a combination of two complicated substances not too firmly joined together. when one of the parts changed, it became a new molecule. but, like the original one, it was still capable of a process called autocatalysis. it practiced that process and catalyzed other molecules into existence, which in each case were duplicates of itself. then mankind had to take notice, though it ignored flaming suns and monstrous storms and emptiness past belief. men called the new molecule a virus and gave it a name. they called it and its duplicates "chlorophage." and chlorophage was, to people, the most terrifying thing in the universe. * * * * * in a strictly temporary orbit around the planet altaira, the _star queen_ floated, while lift-ships brought passengers and cargo up to it. the ship was too large to be landed economically at an unimportant spaceport like altaira. it was a very modern ship and it made the regulus-to-cassim run, which is five hundred light-years, in only fifty days of earthtime. now the lift-ships were busy. there was an unusual number of passengers to board the _star queen_ at altaira and an unusual number of them were women and children. the children tended to pudginess and the women had the dieted look of the wives of well-to-do men. most of them looked red-eyed, as if they had been crying. one by one the lift-ships hooked onto the airlock of the _star queen_ and delivered passengers and cargo to the ship. presently the last of them was hooked on, and the last batch of passengers came through to the liner, and the ship's doctor watched them stream past him. his air was negligent, but he was actually impatient. like most doctors, nordenfeld approved of lean children and wiry women. they had fewer things wrong with them and they responded better to treatment. well, he was the doctor of the _star queen_ and he had much authority. he'd exerted it back on regulus to insist that a shipment of botanical specimens for cassim travel in quarantine--to be exact, in the ship's practically unused hospital compartment--and he was prepared to exercise authority over the passengers. he had a sheaf of health slips from the examiners on the ground below. there was one slip for each passenger. it certified that so-and-so had been examined and could safely be admitted to the _star queen's_ air, her four restaurants, her two swimming pools, her recreation areas and the six levels of passenger cabins the ship contained. he impatiently watched the people go by. health slips or no health slips, he looked them over. a characteristic gait or a typical complexion tint, or even a certain lack of hair luster, could tell him things that ground physicians might miss. in such a case the passenger would go back down again. it was not desirable to have deaths on a liner in space. of course nobody was ever refused passage because of chlorophage. if it were ever discovered, the discovery would already be too late. but the health regulations for space travel were very, very strict. he looked twice at a young woman as she passed. despite applied complexion, there was a trace of waxiness in her skin. nordenfeld had never actually seen a case of chlorophage. no doctor alive ever had. the best authorities were those who'd been in patrol ships during the quarantine of kamerun when chlorophage was loose on that planet. they'd seen beamed-up pictures of patients, but not patients themselves. the patrol ships stayed in orbit while the planet died. most doctors, and nordenfeld was among them, had only seen pictures of the screens which showed the patients. * * * * * he looked sharply at the young woman. then he glanced at her hands. they were normal. the young woman went on, unaware that for the fraction of an instant there had been the possibility of the landing of the _star queen_ on altaira, and the destruction of her space drive, and the establishment of a quarantine which, if justified, would mean that nobody could ever leave altaira again, but must wait there to die. which would not be a long wait. a fat man puffed past. the gravity on altaira was some five per cent under ship-normal and he felt the difference at once. but the veins at his temples were ungorged. nordenfeld let him go by. there appeared a white-haired, space-tanned man with a briefcase under his arm. he saw nordenfeld and lifted a hand in greeting. the doctor knew him. he stepped aside from the passengers and stood there. his name was jensen, and he represented a fund which invested the surplus money of insurance companies. he traveled a great deal to check on the business interests of that organization. the doctor grunted, "what're you doing here? i thought you'd be on the far side of the cluster." "oh, i get about," said jensen. his manner was not quite normal. he was tense. "i got here two weeks ago on a q-and-c tramp from regulus. we were a ship load of salt meat. there's romance for you! salt meat by the spaceship load!" the doctor grunted again. all sorts of things moved through space, naturally. the _star queen_ carried a botanical collection for a museum and pig-beryllium and furs and enzymes and a list of items no man could remember. he watched the passengers go by, automatically counting them against the number of health slips in his hand. "lots of passengers this trip," said jensen. "yes," said the doctor, watching a man with a limp. "why?" jensen shrugged and did not answer. he was uneasy, the doctor noted. he and jensen were as much unlike as two men could very well be, but jensen was good company. a ship's doctor does not have much congenial society. the file of passengers ended abruptly. there was no one in the _star queen's_ airlock, but the "connected" lights still burned and the doctor could look through into the small lift-ship from the planet down below. he frowned. he fingered the sheaf of papers. "unless i missed count," he said annoyedly, "there's supposed to be one more passenger. i don't see--" a door opened far back in the lift-ship. a small figure appeared. it was a little girl perhaps ten years old. she was very neatly dressed, though not quite the way a mother would have done it. she wore the carefully composed expression of a child with no adult in charge of her. she walked precisely from the lift-ship into the _star queen's_ lock. the opening closed briskly behind her. there was the rumbling of seals making themselves tight. the lights flickered for "disconnect" and then "all clear." they went out, and the lift-ship had pulled away from the _star queen_. "there's my missing passenger," said the doctor. * * * * * the child looked soberly about. she saw him. "excuse me," she said very politely. "is this the way i'm supposed to go?" "through that door," said the doctor gruffly. "thank you," said the little girl. she followed his direction. she vanished through the door. it closed. there came a deep, droning sound, which was the interplanetary drive of the _star queen_, building up that directional stress in space which had seemed such a triumph when it was first contrived. the ship swung gently. it would be turning out from orbit around altaira. it swung again. the doctor knew that its astrogators were feeling for the incredibly exact pointing of its nose toward the next port which modern commercial ship operation required. an error of fractional seconds of arc would mean valuable time lost in making port some ten light-years of distance away. the drive droned and droned, building up velocity while the ship's aiming was refined and re-refined. the drive cut off abruptly. jensen turned white. the doctor said impatiently, "there's nothing wrong. probably a message or a report should have been beamed down to the planet and somebody forgot. we'll go on in a minute." but jensen stood frozen. he was very pale. the interplanetary drive stayed off. thirty seconds. a minute. jensen swallowed audibly. two minutes. three. the steady, monotonous drone began again. it continued interminably, as if while it was off the ship's head had swung wide of its destination and the whole business of lining up for a jump in overdrive had to be done all over again. then there came that "ping-g-g-g!" and the sensation of spiral fall which meant overdrive. the droning ceased. jensen breathed again. the ship's doctor looked at him sharply. jensen had been taut. now the tensions had left his body, but he looked as if he were going to shiver. instead, he mopped a suddenly streaming forehead. "i think," said jensen in a strange voice, "that i'll have a drink. or several. will you join me?" nordenfeld searched his face. a ship's doctor has many duties in space. passengers can have many things wrong with them, and in the absolute isolation of overdrive they can be remarkably affected by each other. "i'll be at the fourth-level bar in twenty minutes," said nordenfeld. "can you wait that long?" "i probably won't wait to have a drink," said jensen. "but i'll be there." the doctor nodded curtly. he went away. he made no guesses, though he'd just observed the new passengers carefully and was fully aware of the strict health regulations that affect space travel. as a physician he knew that the most deadly thing in the universe was chlorophage and that the planet kamerun was only one solar system away. it had been a stop for the _star queen_ until four years ago. he puzzled over jensen's tenseness and the relief he'd displayed when the overdrive field came on. but he didn't guess. chlorophage didn't enter his mind. not until later. * * * * * he saw the little girl who'd come out of the airlock last of all the passengers. she sat on a sofa as if someone had told her to wait there until something or other was arranged. doctor nordenfeld barely glanced at her. he'd known jensen for a considerable time. jensen had been a passenger on the _star queen_ half a dozen times, and he shouldn't have been upset by the temporary stoppage of an interplanetary drive. nordenfeld divided people into two classes, those who were not and those who were worth talking to. there weren't many of the latter. jensen was. he filed away the health slips. then, thinking of jensen's pallor, he asked what had happened to make the _star queen_ interrupt her slow-speed drive away from orbit around altaira. the purser told him. but the purser was fussily concerned because there were so many extra passengers from altaira. he might not be able to take on the expected number of passengers at the next stop-over point. it would be bad business to have to refuse passengers! it would give the space line a bad name. then the air officer stopped nordenfeld as he was about to join jensen in the fourth-level bar. it was time for a medical inspection of the quarter-acre of banthyan jungle which purified and renewed the air of the ship. nordenfeld was expected to check the complex ecological system of the air room. specifically, he was expected to look for and identify any patches of colorlessness appearing on the foliage of the jungle plants the _star queen_ carried through space. the air officer was discreet and nordenfeld was silent about the ultimate reason for the inspection. nobody liked to think about it. but if a particular kind of bleaching appeared, as if the chlorophyll of the leaves were being devoured by something too small to be seen by an optical microscope--why, that would be chlorophage. it would also be a death sentence for the _star queen_ and everybody in her. but the jungle passed medical inspection. the plants grew lushly in soil which periodically was flushed with hydroponic solution and then drained away again. the uv lamps were properly distributed and the different quarters of the air room were alternately lighted and darkened. and there were no colorless patches. a steady wind blew through the air room and had its excess moisture and unpleasing smells wrung out before it recirculated through the ship. doctor nordenfeld authorized the trimming of some liana-like growths which were developing woody tissue at the expense of leaves. the air officer also told him about the reason for the turning off of the interplanetary drive. he considered it a very curious happening. the doctor left the air room and passed the place where the little girl--the last passenger to board the _star queen_--waited patiently for somebody to arrange something. doctor nordenfeld took a lift to the fourth level and went into the bar where jensen should be waiting. he was. he had an empty glass before him. nordenfeld sat down and dialed for a drink. he had an indefinite feeling that something was wrong, but he couldn't put his finger on it. there are always things going wrong for a ship's doctor, though. there are so many demands on his patience that he is usually short of it. jensen watched him sip at his drink. "a bad day?" he asked. he'd gotten over his own tension. * * * * * nordenfeld shrugged, but his scowl deepened. "there are a lot of new passengers." he realized that he was trying to explain his feelings to himself. "they'll come to me feeling miserable. i have to tell each one that if they feel heavy and depressed, it may be the gravity-constant of the ship, which is greater than their home planet. if they feel light-headed and giddy, it may be because the gravity-constant of the ship is less than they're used to. but it doesn't make them feel better, so they come back for a second assurance. i'll be overwhelmed with such complaints within two hours." jensen waited. then he said casually--too casually, "does anybody ever suspect chlorophage?" "no," said nordenfeld shortly. jensen fidgeted. he sipped. then he said, "what's the news from kamerun, anyhow?" "there isn't any," said nordenfeld. "naturally! why ask?" "i just wondered," said jensen. after a moment: "what was the last news?" "there hasn't been a message from kamerun in two years," said nordenfeld curtly. "there's no sign of anything green anywhere on the planet. it's considered to be--uninhabited." jensen licked his lips. "that's what i understood. yes." nordenfeld drank half his drink and said unpleasantly, "there were thirty million people on kamerun when the chlorophage appeared. at first it was apparently a virus which fed on the chlorophyll of plants. they died. then it was discovered that it could also feed on hemoglobin, which is chemically close to chlorophyll. hemoglobin is the red coloring matter of the blood. when the virus consumed it, people began to die. kamerun doctors found that the chlorophage virus was transmitted by contact, by inhalation, by ingestion. it traveled as dust particles and on the feet of insects, and it was in drinking water and the air one breathed. the doctors on kamerun warned spaceships off and the patrol put a quarantine fleet in orbit around it to keep anybody from leaving. and nobody left. and everybody died. _and_ so did every living thing that had chlorophyll in its leaves or hemoglobin in its blood, or that needed plant or animal tissues to feed on. there's not a person left alive on kamerun, nor an animal or bird or insect, nor a fish nor a tree, or plant or weed or blade of grass. there's no longer a quarantine fleet there. nobody'll go there and there's nobody left to leave. but there are beacon satellites to record any calls and to warn any fool against landing. if the chlorophage got loose and was carried about by spaceships, it could kill the other forty billion humans in the galaxy, together with every green plant or animal with hemoglobin in its blood." "that," said jensen, and tried to smile, "sounds final." "it isn't," nordenfeld told him. "if there's something in the universe which can kill every living thing except its maker, that something should be killed. there should be research going on about the chlorophage. it would be deadly dangerous work, but it should be done. a quarantine won't stop contagion. it can only hinder it. that's useful, but not enough." jensen moistened his lips. nordenfeld said abruptly, "i've answered your questions. now what's on your mind and what has it to do with chlorophage?" jensen started. he went very pale. "it's too late to do anything about it," said nordenfeld. "it's probably nonsense anyhow. but what is it?" jensen stammered out his story. it explained why there were so many passengers for the _star queen_. it even explained his departure from altaira. but it was only a rumor--the kind of rumor that starts up untraceably and can never be verified. this one was officially denied by the altairan planetary government. but it was widely believed by the sort of people who usually were well-informed. those who could sent their families up to the _star queen_. and that was why jensen had been tense and worried until the liner had actually left altaira behind. then he felt safe. nordenfeld's jaw set as jensen told his tale. he made no comment, but when jensen was through he nodded and went away, leaving his drink unfinished. jensen couldn't see his face; it was hard as granite. and nordenfeld, the ship's doctor of the _star queen_, went into the nearest bathroom and was violently sick. it was a reaction to what he'd just learned. * * * * * there were stars which were so far away that their distance didn't mean anything. there were planets beyond counting in a single star cluster, let alone the galaxy. there were comets and gas clouds in space, and worlds where there was life, and other worlds where life was impossible. the quantity of matter which was associated with life was infinitesimal, and the quantity associated with consciousness--animal life--was so much less that the difference couldn't be expressed. but the amount of animal life which could reason was so minute by comparison that the nearest ratio would be that of a single atom to a sun. mankind, in fact, was the least impressive fraction of the smallest category of substance in the galaxy. but men did curious things. there was the cutting off of the _star queen's_ short-distance drive before she'd gotten well away from altaira. there had been a lift-ship locked to the liner's passenger airlock. when the last passenger entered the big ship--a little girl--the airlocks disconnected and the lift-ship pulled swiftly away. it was not quite two miles from the _star queen_ when its emergency airlocks opened and spacesuited figures plunged out of it to emptiness. simultaneously, the ports of the lift-ship glowed and almost immediately the whole plating turned cherry-red, crimson, and then orange, from unlimited heat developed within it. the lift-ship went incandescent and ruptured and there was a spout of white-hot air, and then it turned blue-white and puffed itself to nothing in metallic steam. where it had been there was only shining gas, which cooled. beyond it there were figures in spacesuits which tried to swim away from it. the _star queen's_ control room, obviously, saw the happening. the lift-ship's atomic pile had flared out of control and melted down the ship. it had developed something like sixty thousand degrees fahrenheit when it ceased to flare. it did not blow up; it only vaporized. but the process must have begun within seconds after the lift-ship broke contact with the _star queen_. in automatic reaction, the man in control of the liner cut her drive and offered to turn back and pick up the spacesuited figures in emptiness. the offer was declined with almost hysterical haste. in fact, it was barely made before the other lift-ships moved in on rescue missions. they had waited. and they were picking up castaways before the _star queen_ resumed its merely interplanetary drive and the process of aiming for a solar system some thirty light-years away. when the liner flicked into overdrive, more than half the floating figures had been recovered, which was remarkable. it was almost as remarkable as the flare-up of the lift-ship's atomic pile. one has to know exactly what to do to make a properly designed atomic pile vaporize metal. somebody had known. somebody had done it. and the other lift-ships were waiting to pick up the destroyed lift-ship's crew when it happened. the matter of the lift-ship's destruction was fresh in nordenfeld's mind when jensen had told his story. the two items fitted together with an appalling completeness. they left little doubt or hope. * * * * * nordenfeld consulted the passenger records and presently was engaged in conversation with the sober-faced, composed little girl on a sofa in one of the cabin levels of the _star queen_. "you're kathy brand, i believe," he said matter-of-factly. "i understand you've been having a rather bad time of it." she seemed to consider. "it hasn't been too bad," she assured him. "at least i've been seeing new things. i got dreadfully tired of seeing the same things all the time." "what things?" asked nordenfeld. his expression was not stern now, though his inner sensations were not pleasant. he needed to talk to this child, and he had learned how to talk to children. the secret is to talk exactly as to an adult, with respect and interest. "there weren't any windows," she explained, "and my father couldn't play with me, and all the toys and books were ruined by the water. it was dreadfully tedious. there weren't any other children, you see. and presently there weren't any grownups but my father." nordenfeld only looked more interested. he'd been almost sure ever since knowing of the lift-ship's destruction and listening to jensen's account of the rumor the government of altaira denied. he was horribly sure now. "how long were you in the place that hadn't any windows?" "oh, dreadfully long!" she said. "since i was only six years old! almost half my life!" she smiled brightly at him. "i remember looking out of windows and even playing out-of-doors, but my father and mother said i had to live in this place. my father talked to me often and often. he was very nice. but he had to wear that funny suit and keep the glass over his face because he didn't live in the room. the glass was because he went under the water, you know." nordenfeld asked carefully conversational-sounding questions. kathy brand, now aged ten, had been taken by her father to live in a big room without any windows. it hadn't any doors, either. there were plants in it, and there were bluish lights to shine on the plants, and there was a place in one corner where there was water. when her father came in to talk to her, he came up out of the water wearing the funny suit with glass over his face. he went out the same way. there was a place in the wall where she could look out into another room, and at first her mother used to come and smile at her through the glass, and she talked into something she held in her hand, and her voice came inside. but later she stopped coming. * * * * * there was only one possible kind of place which would answer kathy's description. when she was six years old she had been put into some university's aseptic-environment room. and she had stayed there. such rooms were designed for biological research. they were built and then made sterile of all bacterial life and afterward entered through a tank of antiseptic. anyone who entered wore a suit which was made germ-free by its passage through the antiseptic, and he did not breathe the air of the aseptic room, but air which was supplied him through a hose, the exhaled-air hose also passing under the antiseptic outside. no germ or microbe or virus could possibly get into such a room without being bathed in corrosive fluid which would kill it. so long as there was someone alive outside to take care of her, a little girl could live there and defy even chlorophage. and kathy brand had done it. but, on the other hand, kamerun was the only planet where it would be necessary, and it was the only world from which a father would land his small daughter on another planet's spaceport. there was no doubt. nordenfeld grimly imagined someone--he would have had to be a microbiologist even to attempt it--fighting to survive and defeat the chlorophage while he kept his little girl in an aseptic-environment room. she explained quite pleasantly as nordenfeld asked more questions. there had been other people besides her father, but for a long time there had been only him. and nordenfeld computed that somehow she'd been kept alive on the dead planet kamerun for four long years. recently, though--very recently--her father told her that they were leaving. wearing his funny, antiseptic-wetted suit, he'd enclosed her in a plastic bag with a tank attached to it. air flowed from the tank into the bag and out through a hose that was all wetted inside. she breathed quite comfortably. it made sense. an air tank could be heated and its contents sterilized to supply germ-free--or virus-free--air. and kathy's father took an axe and chopped away a wall of the room. he picked her up, still inside the plastic bag, and carried her out. there was nobody about. there was no grass. there were no trees. nothing moved. here kathy's account was vague, but nordenfeld could guess at the strangeness of a dead planet, to the child who barely remembered anything but the walls of an aseptic-environment room. her father carried her to a little ship, said kathy, and they talked a lot after the ship took off. he told her that he was taking her to a place where she could run about outdoors and play, but he had to go somewhere else. he did mysterious things which to nordenfeld meant a most scrupulous decontamination of a small spaceship's interior and its airlock. its outer surface would reach a temperature at which no organic material could remain uncooked. and finally, said kathy, her father had opened a door and told her to step out and good-by, and she did, and the ship went away--her father still wearing his funny suit--and people came and asked her questions she did not understand. * * * * * kathy's narrative fitted perfectly into the rumor jensen said circulated among usually well-informed people on altaira. they believed, said jensen, that a small spaceship had appeared in the sky above altaira's spaceport. it ignored all calls, landed swiftly, opened an airlock and let someone out, and plunged for the sky again. and the story said that radar telescopes immediately searched for and found the ship in space. they trailed it, calling vainly for it to identify itself, while it drove at top speed for altaira's sun. it reached the sun and dived in. nordenfeld reached the skipper on intercom vision-phone. jensen had been called there to repeat his tale to the skipper. "i've talked to the child," said nordenfeld grimly, "and i'm putting her into isolation quarters in the hospital compartment. she's from kamerun. she was kept in an aseptic-environment room at some university or other. she says her father looked after her. i get an impression of a last-ditch fight by microbiologists against the chlorophage. they lost it. apparently her father landed her on altaira and dived into the sun. from her story, he took every possible precaution to keep her from contagion or carrying contagion with her to altaira. maybe he succeeded. there's no way to tell--yet." the skipper listened in silence. jensen said thinly, "then the story about the landing was true." "yes. the authorities isolated her, and then shipped her off on the _star queen_. your well-informed friends, jensen, didn't know what their government was going to do!" nordenfeld paused, and said more coldly still, "they didn't handle it right. they should have killed her, painlessly but at once. her body should have been immersed, with everything that had touched it, in full-strength nitric acid. the same acid should have saturated the place where the ship landed and every place she walked. every room she entered, and every hall she passed through, should have been doused with nitric and then burned. it would still not have been all one could wish. the air she breathed couldn't be recaptured and heated white-hot. but the chances for altaira's population to go on living would be improved. instead, they isolated her and they shipped her off with us--and thought they were accomplishing something by destroying the lift-ship that had her in an airtight compartment until she walked into the _star queen's_ lock!" the skipper said heavily, "do you think she's brought chlorophage on board?" "i've no idea," said nordenfeld. "if she did, it's too late to do anything but drive the _star queen_ into the nearest sun.... no. before that, one should give warning that she was aground on altaira. no ship should land there. no ship should take off. altaira should be blocked off from the rest of the galaxy like kamerun was. and to the same end result." jensen said unsteadily; "there'll be trouble if this is known on the ship. there'll be some unwilling to sacrifice themselves." "sacrifice?" said nordenfeld. "they're dead! but before they lie down, they can keep everybody they care about from dying too! would you want to land and have your wife and family die of it?" the skipper said in the same heavy voice, "what are the probabilities? you say there was an effort to keep her from contagion. what are the odds?" "bad," said nordenfeld. "the man tried, for the child's sake. but i doubt he managed to make a completely aseptic transfer from the room she lived in to the spaceport on altaira. the authorities on altaira should have known it. they should have killed her and destroyed everything she'd touched. and _still_ the odds would have been bad!" jensen said, "but you can't do that, nordenfeld! not now!" "i shall take every measure that seems likely to be useful." then nordenfeld snapped, "damnation, man! do you realize that this chlorophage can wipe out the human race if it really gets loose? do you think i'll let sentiment keep me from doing what has to be done?" he flicked off the vision-phone. * * * * * the _star queen_ came out of overdrive. her skipper arranged it to be done at the time when the largest possible number of her passengers and crew would be asleep. those who were awake, of course, felt the peculiar inaudible sensation which one subjectively translated into sound. they felt the momentary giddiness which--having no natural parallel--feels like the sensation of treading on a stair-step that isn't there, combined with a twisting sensation so it is like a spiral fall. the passengers who were awake were mostly in the bars, and the bartenders explained that the ship had shifted overdrive generators and there was nothing to it. those who were asleep started awake, but there was nothing in their surroundings to cause alarm. some blinked in the darkness of their cabins and perhaps turned on the cabin lights, but everything seemed normal. they turned off the lights again. some babies cried and had to be soothed. but there was nothing except wakening to alarm anybody. babies went back to sleep and mothers returned to their beds and--such awakenings being customary--went back to sleep also. it was natural enough. there were vague and commonplace noises, together making an indefinite hum. fans circulated the ship's purified and reinvigorated air. service motors turned in remote parts of the hull. cooks and bakers moved about in the kitchens. nobody could tell by any physical sensation that the _star queen_ was not in overdrive, except in the control room. there the stars could be seen. they were unthinkably remote. the ship was light-years from any place where humans lived. she did not drive. her skipper had a family on cassim. he would not land a plague ship which might destroy them. the executive officer had a small son. if his return meant that small son's death as well as his own, he would not return. all through the ship, the officers who had to know the situation recognized that if chlorophage had gotten into the _star queen_, the ship must not land anywhere. nobody could survive. nobody must attempt it. so the huge liner hung in the emptiness between the stars, waiting until it could be known definitely that chlorophage was aboard or that with absolute certainty it was absent. the question was up to doctor nordenfeld. he had isolated himself with kathy in the ship's hospital compartment. since the ship was built it had been used once by a grown man who developed mumps, and once by an adolescent boy who developed a raging fever which antibiotics stopped. health measures for space travel were strict. the hospital compartment had only been used those two times. * * * * * on this voyage it had been used to contain an assortment of botanical specimens from a planet seventy light-years beyond regulus. they were on their way to the botanical research laboratory on cassim. as a routine precaution they'd been placed in the hospital, which could be fumigated when they were taken out. now the doctor had piled them in one side of the compartment, which he had divided in half with a transparent plastic sheet. he stayed in that side. kathy occupied the other. she had some flowering plants to look at and admire. they'd come from the air room and she was delighted with their coloring and beauty. but doctor nordenfeld had put them there as a continuing test for chlorophage. if kathy carried that murderous virus on her person, the flowering plants would die of it--probably even before she did. it was a scrupulously scientific test for the deadly stuff. completely sealed off except for a circulator to freshen the air she breathed, kathy was settled with toys and picture books. it was an improvised but well-designed germproof room. the air for kathy to breathe was sterilized before it reached her. the air she had breathed was sterilized as it left her plastic-sided residence. it should be the perfection of protection for the ship--if it was not already too late. the vision-phone buzzed. doctor nordenfeld stirred in his chair and flipped the switch. the _star queen's_ skipper looked at him out of the screen. "i've cut the overdrive," said the skipper. "the passengers haven't been told." "very sensible," said the doctor. "when will we know?" "that we can go on living? when the other possibility is exhausted." "then, how will we know?" asked skipper stonily. doctor nordenfeld ticked off the possibilities. he bent down a finger. "one, her father took great pains. maybe he did manage an aseptic transfer from a germ-free room to altaira. kathy may not have been exposed to the chlorophage. if she hasn't, no bleached spots will show up on the air-room foliage or among the flowering plants in the room with her. nobody in the crew or among the passengers will die." he bent down a second finger. "it is probably more likely that white spots will appear on the plants in the air room _and_ here, and people will start to die. that will mean kathy brought contagion here the instant she arrived, and almost certainly that altaira will become like kamerun--uninhabited. in such a case we are finished." * * * * * he bent down a third finger. "not so likely, but preferable, white spots may appear on the foliage inside the plastic with kathy, but not in the ship's air room. in that case she was exposed, but the virus was incubating when she came on board, and only developed and spread after she was isolated. possibly, in such a case, we can save the passengers and crew, but the ship will probably have to be melted down in space. it would be tricky, but it might be done." the skipper hesitated. "if that last happened, she--" "i will take whatever measures are necessary," said doctor nordenfeld. "to save your conscience, we won't discuss them. they should have been taken on altaira." he reached over and flipped off the phone. then he looked up and into the other part of the ship's hospital space. kathy came out from behind a screen, where she'd made ready for bed. she was beaming. she had a large picture book under one arm and a doll under the other. "it's all right for me to have these with me, isn't it, doctor nordenfeld?" she asked hopefully. "i didn't have any picture books but one, and it got worn out. and my doll--it was dreadful how shabby she was!" the doctor frowned. she smiled at him. he said, "after all, picture books are made to be looked at and dolls to be played with." she skipped to the tiny hospital bed on the far side of the presumably virusproof partition. she climbed into it and zestfully arranged the doll to share it. she placed the book within easy reach. she said, "i think my father would say you were very nice, doctor nordenfeld, to look after me so well." "no-o-o-o," said the doctor in a detached voice. "i'm just doing what anybody ought to do." she snuggled down under the covers. he looked at his watch and shrugged. it was very easy to confuse official night with official day, in space. everybody else was asleep. he'd been putting kathy through tests which began with measurements of pulse and respiration and temperature and went on from there. kathy managed them herself, under his direction. he settled down with one of the medical books he'd brought into the isolation section with him. its title was _decontamination of infectious material from different planets_. he read it grimly. * * * * * the time came when the _star queen_ should have come out of overdrive with the sun circe blazing fiercely nearby, and a green planet with ice caps to be approached on interplanetary drive. there should have been droning, comforting drive noises to assure the passengers--who naturally could not see beyond the ship's steel walls--that they were within a mere few million miles of a world where sunshine was normal, and skies were higher than ship's ceilings, and there were fascinating things to see and do. some of the passengers packed their luggage and put it outside their cabins to be picked up for landing. but no stewards came for it. presently there was an explanation. the ship had run under maximum speed and the planetfall would be delayed. the passengers were disappointed but not concerned. the luggage vanished into cabins again. the _star queen_ floated in space among a thousand thousand million stars. her astrogators had computed a course to the nearest star into which to drive the _star queen_, but it would not be used unless there was mutiny among the crew. it would be better to go in remote orbit around circe iii and give the news of chlorophage on altaira, if doctor nordenfeld reported it on the ship. time passed. one day. two. three. then jensen called the hospital compartment on vision-phone. his expression was dazed. nordenfeld saw the interior of the control room behind jensen. he said, "you're a passenger, jensen. how is it you're in the control room?" jensen moistened his lips. "the skipper thought i'd better not associate with the other passengers. i've stayed with the officers the past few days. we--the ones who know what's in prospect--we're keeping separate from the others so--nobody will let anything out by accident." "very wise. when the skipper comes back on duty, ask him to call me. i've something interesting to tell him." "he's--checking something now," said jensen. his voice was thin and reedy. "the--air officer reports there are white patches on the plants in the air room. they're growing. fast. he told me to tell you. he's--gone to make sure." "no need," said nordenfeld bitterly. he swung the vision-screen. it faced that part of the hospital space beyond the plastic sheeting. there were potted flowering plants there. they had pleased kathy. they shared her air. and there were white patches on their leaves. "i thought," said nordenfeld with an odd mirthless levity, "that the skipper'd be interested. it is of no importance whatever now, but i accomplished something remarkable. kathy's father didn't manage an aseptic transfer. she brought the chlorophage with her. but i confined it. the plants on the far side of that plastic sheet show the chlorophage patches plainly. i expect kathy to show signs of anemia shortly. i'd decided that drastic measures would have to be taken, and it looked like they might work, because i've confined the virus. it's there where kathy is, but it isn't where i am. all the botanical specimens on my side of the sheet are untouched. the phage hasn't hit them. it is remarkable. but it doesn't matter a damn if the air room's infected. and i was so proud!" jensen did not respond. * * * * * nordenfeld said ironically, "look what i accomplished! i protected the air plants on my side see? they're beautifully green! no sign of infection! it means that a man can work with chlorophage! a laboratory ship could land on kamerun and keep itself the equivalent of an aseptic-environment room while the damned chlorophage was investigated and ultimately whipped! and it doesn't matter!" jensen said numbly, "we can't ever make port. we ought--we ought to--" "we'll take the necessary measures," nordenfeld told him. "very quietly and very efficiently, with neither the crew nor the passengers knowing that altaira sent the chlorophage on board the _star queen_ in the hope of banishing it from there. the passengers won't know that their own officials shipped it off with them as they tried to run away.... and i was so proud that i'd improvised an aseptic room to keep kathy in! i sterilized the air that went in to her, and i sterilized--" then he stopped. he stopped quite short. he stared at the air unit, set up and with two pipes passing through the plastic partition which cut the hospital space in two. he turned utterly white. he went roughly to the air machine. he jerked back its cover. he put his hand inside. minutes later he faced back to the vision-screen from which jensen looked apathetically at him. "tell the skipper to call me," he said in a savage tone. "tell him to call me instantly he comes back! before he issues any orders at all!" he bent over the sterilizing equipment and very carefully began to disassemble it. he had it completely apart when kathy waked. she peered at him through the plastic separation sheet. "good morning, doctor nordenfeld," she said cheerfully. the doctor grunted. kathy smiled at him. she had gotten on very good terms with the doctor, since she'd been kept in the ship's hospital. she did not feel that she was isolated. in having the doctor where she could talk to him at any time, she had much more company than ever before. she had read her entire picture book to him and discussed her doll at length. she took it for granted that when he did not answer or frowned that he was simply busy. but he was company because she could see him. doctor nordenfeld put the air apparatus together with an extremely peculiar expression on his face. it had been built for kathy's special isolation by a ship's mechanic. it should sterilize the used air going into kathy's part of the compartment, and it should sterilize the used air pushed out by the supplied fresh air. the hospital itself was an independent sealed unit, with its own chemical air freshener, and it had been divided into two. the air freshener was where doctor nordenfeld could attend to it, and the sterilizer pump simply shared the freshening with kathy. but-- but the pipe that pumped air to kathy was brown and discolored from having been used for sterilizing, and the pipe that brought air back was not. it was cold. it had never been heated. so doctor nordenfeld had been exposed to any contagion kathy could spread. he hadn't been protected at all. yet the potted plants on kathy's side of the barrier were marked with great white splotches which grew almost as one looked, while the botanical specimens in the doctor's part of the hospital--as much infected as kathy's could have been, by failure of the ship's mechanic to build the sterilizer to work two ways: the stacked plants, the alien plants, the strange plants from seventy light-years beyond regulus--they were vividly green. there was no trace of chlorophage on them. yet they had been as thoroughly exposed as doctor nordenfeld himself! the doctor's hands shook. his eyes burned. he took out a surgeon's scalpel and ripped the plastic partition from floor to ceiling. kathy watched interestedly. "why did you do that, doctor nordenfeld?" she asked. he said in an emotionless, unnatural voice, "i'm going to do something that it was very stupid of me not to do before. it should have been done when you were six years old, kathy. it should have been done on kamerun, and after that on altaira. now we're going to do it here. you can help me." * * * * * the _star queen_ had floated out of overdrive long enough to throw all distance computations off. but she swung about, and swam back, and presently she was not too far from the world where she was now many days overdue. lift-ships started up from the planet's surface. but the _star queen_ ordered them back. "get your spaceport health officer on the vision-phone," ordered the _star queen's_ skipper. "we've had chlorophage on board." there was panic. even at a distance of a hundred thousand miles, chlorophage could strike stark terror into anybody. but presently the image of the spaceport health officer appeared on the _star queen's_ screen. "we're not landing," said doctor nordenfeld. "there's almost certainly an outbreak of chlorophage on altaira, and we're going back to do something about it. it got on our ship with passengers from there. we've whipped it, but we may need some help." the image of the health officer aground was a mask of horror for seconds after nordenfeld's last statement. then his expression became incredulous, though still horrified. "we came on to here," said doctor nordenfeld, "to get you to send word by the first other ship to the patrol that a quarantine has to be set up on altaira, and we need to be inspected for recovery from chlorophage infection. and we need to pass on, officially, the discovery that whipped the contagion on this ship. we were carrying botanical specimens to cassim and we discovered that they were immune to chlorophage. that's absurd, of course. their green coloring is the same substance as in plants under sol-type suns anywhere. they couldn't be immune to chlorophage. so there had to be something else." "was--was there?" asked the health officer. "there was. those specimens came from somewhere beyond regulus. they carried, as normal symbiotes on their foliage, microörganisms unknown both on kamerun and altaira. the alien bugs are almost the size of virus particles, feed on virus particles, and are carried by contact, air, and so on, as readily as virus particles themselves. we discovered that those microörganisms devoured chlorophage. we washed them off the leaves of the plants, sprayed them in our air-room jungle, and they multiplied faster than the chlorophage. our whole air supply is now loaded with an airborne antichlorophage organism which has made our crew and passengers immune. we're heading back to altaira to turn loose our merry little bugs on that planet. it appears that they grow on certain vegetation, but they'll live anywhere there's phage to eat. we're keeping some chlorophage cultures alive so our microörganisms don't die out for lack of food!" the medical officer on the ground gasped. "keeping phage _alive_?" * * * * * "i hope you've recorded this," said nordenfeld. "it's rather important. this trick should have been tried on kamerun and altaira and everywhere else new diseases have turned up. when there's a bug on one planet that's deadly to us, there's bound to be a bug on some other planet that's deadly to it! the same goes for any pests or vermin--the principle of natural enemies. all we have to do is find the enemies!" there was more communication between the _star queen_ and the spaceport on circe iii, which the _star queen_ would not make other contact with on this trip, and presently the big liner headed back to altaira. it was necessary for official as well as humanitarian reasons. there would need to be a health examination of the _star queen_ to certify that it was safe for passengers to breathe her air and eat in her restaurants and swim in her swimming pools and occupy the six levels of passenger cabins she contained. this would have to be done by a patrol ship, which would turn up at altaira. the _star queen's_ skipper would be praised by his owners for not having driven the liner into a star, and the purser would be forgiven for the confusion in his records due to off-schedule operations of the big ship, and jensen would find in the ending of all terror of chlorophage an excellent reason to look for appreciation in the value of the investments he was checking up. and doctor nordenfeld.... he talked very gravely to kathy. "i'm afraid," he told her, "that your father isn't coming back. what would you like to do?" she smiled at him hopefully. "could i be your little girl?" she asked. doctor nordenfeld grunted. "hm ... i'll think about it." but he smiled at her. she grinned at him. and it was settled. goddess of the moon _a complete planet novel_ by john murray reynolds death hid behind a smile in the white-and-gold city of gral-thala. gibson, earth-spy off the derelict strathoship, well knew his captive-fate. but if he died, then the good green planet perished from the gray death.... if he died, then died diana, fair goddess of the moon. [transcriber's note: this etext was produced from planet stories spring . extensive research did not uncover any evidence that the u.s. copyright on this publication was renewed.] the tokyo-to-new york stratholiner swept down toward the manhattan municipal airport early on a winter evening, with the port-holes gleaming all along the -foot length of her polished steel body. rockets cut off well above the city in accordance with the strict american traffic regulations, she came down with half a dozen big props spinning under the drive of her powerful diesel auxiliaries. a dozen whirling helicopters had been upthrust to take the strain. she came down to a city that lay murmurous and uneasy under the greatest threat that mankind had ever faced--the threat of the gray death! a band was playing in the liner's saloon, and passengers in the smoking-room were hurriedly gulping down the last of their drinks. there was a forced and unnatural gaiety on board. most of the passengers had taken more than a few drinks on the way across from tokyo--for the news of the spread of the gray death was ominous. it is hard to retain peace of mind when a strange new epidemic rages unchecked from alaska to cape horn and from nova zembla to new zealand. men and women were dying like flies, and all the medical science of this twenty-fourth century seemed helpless before the deadly plague. it was the steady vibration of the diesels that brought larry gibson back to an awareness of his surroundings. their resonant hum was distinctly different from the pounding blast of the rockets, and any experienced stratho-pilot could tell the difference in a second. larry tossed off the last of his drink and wiped his mouth with the back of an unsteady hand. then he pushed back his chair and stood up, swaying as he tried to hold his balance on the slightly tilted floor of the descending liner. a man at the next table glanced curiously up at him. "guess we're landing, friend," he said. "y'know, they say that there are a thousand deaths a day here in new york city now. they're digging graves in the cemeteries with electric shovels, i understand." "life," said larry with alcoholic gravity, "is cheap. too cheap. one hundred lives equals a man's career. it's all been worked out mathematically. good evening." larry left the third-class bar where he had been sitting, and walked slowly along the corridor. mechanically he turned the collar of his frayed coat up around his neck and pulled the brim of his wide hat well down over his eyes. there was always the possibility that someone would recognize him, and in these past months he had learned to keep in the shadowy byways of life. the time would come when men would forget that an unlucky person named larry gibson had ever existed, but in this year there were still plenty of people who would recognize his face. * * * * * gibson was not traveling in the first-class section of the big liner, in those luxurious quarters built into the giant wings to which his rank had once given him free entry. back in the days when he had been chief pilot of all the strathofleet he could ride there as a matter of course. now he could not afford it. he could not even afford the second-class accommodations amidships. instead, he rode in the third-class quarters back in the tail. when a man knows that he has no possible chance of getting another job, he has to hoard the money he has saved up. the giant airliner came down to an easy landing, and rolled across the field on her big wheels. the lights of the airport burned as brightly as ever, but anyone accustomed to new york could tell that there was something wrong. there were no crowds of spectators at all, and the few people who met the incoming travelers looked harassed and nervous. even the airport attendants went about their business in a listless and somehow furtive manner. it had been ten days ago that the blight first struck a peaceful world that believed it had at last made life safe and pleasant for its inhabitants. a few peasants in honan province in china had taken convulsions and died while their skins turned a peculiar silver gray. within twenty-four hours similar deaths were reported from points as widely separated as bergen, norway and santos in brazil. since then the strange new epidemic had raged unchecked. all the medical and financial resources of the confederated nations of earth had been thrown into the fight without effect. the gray death struck quickly, men and women alike dying within six hours of the appearance of the first tell-tale patches of silver on their skin. the population had not yet started to panic, except in a few isolated instances, but the nerves of all men were ragged and jumpy from the strain. standing in the crowd of third-class passengers that had just alighted from the liner, larry gibson heard two of the airport attendants talking. "he claims he's going to take that old rocket-ship to the moon!" one of them said, and his companion chuckled. "crazy, all right." "guess he is. but what i'm wondering is how he got a crew to go along with him." "have you seen them? they're the damnedest bunch of derelicts i ever saw." for a moment larry was tempted to ask the attendant for the name of the vessel they were discussing. it sounded like the one place where a disgraced and black-listed officer might get a berth. then he shrugged and turned away. nothing mattered very much, any more. ii the alighted passengers strayed slowly across toward the glass and chromium entrance to the administration building. the landing lights were cut off, and the airport became a deep pool of quiet shadow in the midst of the towering ramparts of new york's buildings. most of the structures were two hundred stories high in this queenly city that had been built on the site of the old one destroyed in the final world war of . then a woman began to scream. she was standing in the glow of light from the administration building, holding out a shaking hand that was already turning silver on the back. people hurriedly backed away from her. she was already in convulsions before the white-garbed attendants from the airport hospital could get her under shelter. a man swore tonelessly, and people kept far apart as they hurried from the field. the gray death had struck again! most of the passengers took elevators to the upper floors. there they boarded monorail trains that took them to the part of the city where they were bound. or, if they happened to live near the airport, they simply went along one of the glass-enclosed cross-walks that clung to the outside of the buildings and bridged the streets in graceful curves. larry gibson did not go into the administration building at all. there would be too many people who might know him, and he dreaded their sneering smiles of recognition. he went out a small gate at the side of the airport, a gate that led to the tenth-floor level. the lower parts of new york's towering buildings formed the zone of factories and warehouses. there were few lights here at this hour, and the cross-walk was nearly deserted. larry was looking for a cheap place to stay, to conserve his dwindling resources. it wasn't that larry was particular about the kind of work that he was willing to do. that stage was far behind him! it was simply that, in this simplex and highly organized civilization of the twenty-fourth century, a man couldn't get a job without showing his properly authenticated identity papers. and when a prospective employer saw his papers, it always turned out that there were no vacancies available. there was a hard bitterness in larry gibson's eyes as he trudged away from the airport. after about half a block, larry turned in at a little place called the moorings bar. it was dingy, and smelled of stale beer. most of the customers were night-shift factory employees, waterfront loafers, and the crews of the water-borne ships that still crawled sluggishly across the ocean with those bulky and cheap commodities that the airliners did not care to handle. half a dozen roughly clad men leaned on the greasy bar. larry sat down at a corner table and called for a drink. so he was back in new york--the city that had been his home before the stratholiner _pegasus_ fell into the sea with a loss of a hundred lives two years before! larry wondered how long he would stay here. not long. a month, or perhaps six weeks. the latter would be a long time for him to remain in one place nowadays. he had become a wanderer. a rolling stone that gathered neither moss nor worldly goods, nor even much of the peace of mind that he sought. so he passed like a shadow from city to city and from land to land. he made no friends nowadays. larry gibson was still a young man, but there was a cold grimness about his face that did not encourage advances. * * * * * a radio behind the bar had been playing music, but now the sound abruptly ceased and the television screen went blank. then the face of a government announcer appeared on the screen. his voice came from the speaker sharp and clear. "though the toll of the gray death continues to be very heavy, the government of the confederation is pleased to announce to the peoples of earth that the mystery of the disease has been solved. it is found to be a new and malignant form of leprosy, caused by some hitherto unknown germ. it has also been found that the proper use of radium can control the disease, when applied by what doctors call the riesland method. that is the end of this bulletin." the radio returned to playing music. the bald-headed bartender grinned broadly. "maybe we'll have a chance to go on living after all, boys," he said. "i guess that calls for a drink on the house." "aye--the mystery of the gray death is removed!" a deep voice behind larry rumbled with heavy sarcasm. "i could have told them that answer a week ago, if i'd thought the thick-headed fools who run this planet would listen to me! but what they haven't announced is that the riesland method calls for a lot of radium, and all earth's supply is not enough to check this epidemic in time to save the population of the planet!" larry turned around to glance at the speaker. it was a man who sat alone at a table by the wall. he was a very tall man, gaunt and gray-haired with a pointed beard that jutted forward at a pugnacious angle. exceptionally heavy eyebrows gave him a quizzical appearance. his unpressed clothes were badly stained, and rakishly tilted on one side of his head was a slouch hat of a type that had gone out of style many years before. a half-empty bottle of rum stood on the table before him. somehow he gave the impression of having already consumed what liquor was missing from the bottle, and of having every intention of emptying it before leaving his table. well, larry gibson reflected with a sardonic grin, _he_ was no one to criticize a man for a little thing like excessive drinking. his own record in that regard had been pretty lurid for the past two years. just then the other man grasped his bottle firmly in one hand, and his glass in the other, and lurched over to larry's table. "mind if i join you for a bit of conversation, young feller?" he boomed. "rum, more than any other essence of bacchus, is a friendly drink that needs to be shared." larry looked up at him without cordiality. he had been living alone with his bitterness and frustration for so long that he resented any intrusion on his privacy. then he suddenly grinned. there was a reckless and irrational gallantry about this gaunt old man that appealed to some part of his own nature that had now been dormant for a long time. "sure, sit down," he said. "thanks, young feller. my name is crispin gillingwater ripon, and i feel the need of a little company after a hard day trying to recondition a rocket ship with the lousiest collection of shiftless renegades that ever signed on as crew for such a craft." "what ship is that?" larry wanted to know. "the _sky maid_." "never heard of her," larry said thoughtfully and slowly. "you wouldn't! she used to be the _orion_, but she is now renamed and my ship--subject to a matter of a few liens and some faulty hull insulation and a very good chance of never coming back to port again after i start on my voyage. have a drink, young feller!" "the _orion_!" larry exclaimed "why, she was condemned as not air-worthy over a year ago!" "how else do you think i bought her?" ripon grinned. "i'll concede that, if the world had shown a proper appreciation for my varied talents, i'd be a millionaire many times over, but i happen to be almost broke. you appear to be a promising lad, young feller. how about signing on for a trip to the moon?" "so you're the crazy man who is talking of going to the moon," larry grinned. ripon glowered at him from under his heavy brows for a minute, then grinned in return. "be more careful with your language, young feller, or i'll bust this bottle over your head! i may be eccentric, but i'm a lot saner than those pedants who claim the trip can't be made." iii ripon was sprawled back at his ease, a smoldering pipe in one hand and his glass in the other. he was smiling at larry's startled expression, but he seemed to be serious. vague memories were stirring in larry gibson's mind, memories of things he had read and heard in the old days before he became a drifter whose main effort was to avoid thinking at all. crispin gillingwater ripon! he had heard the name before, though it had been in connection with abstract science rather than with practical rocket-ship flying. somehow, his memory of the name was connected with failure, with public derision, and with rumors of outright charlatanism. "i think i've heard of you," he said cautiously. "in that case you have heard no good!" ripon said cheerfully. "i am at present the problem child of the scientific world. the horrible example! a laughing stock for seedy professors and callow students. mention of my name produces hoarse guffaws of mirth in scientific circles at the moment, young feller, but it will be different when i return from my successful trip to the moon. better come along." "why are you going at this time?" "because there are radium salts on the moon, i am convinced. this world hasn't treated me with much respect, young feller, but i've had a good time on it for my sixty-odd years and i'm fond of the old place. i want to make the trip and get back before the gray death wipes out our population--including myself!" "but you can't take a rocket-ship to the moon," larry protested. "professor staunton's attempt proved that thirty years ago." "all it proved was that neither staunton nor his ship were ever heard of again," ripon said calmly. "i knew staunton well. he was a good man, a careful man--but he wasn't crispin gillingwater ripon! i'm making some changes of my own in the _sky maid_; changes that should spell the difference between success and failure." when he looked back at it later, larry had only a hazy recollection of the rest of that evening. the rum got to him. the one thing that did stick in his mind was a snatch of song that he and ripon had sung over and over again, pounding their glasses on the table while the other men in the dingy little barroom stared at them in good-natured derision. "there's only a few of us left, and we never were worth a damn, but i'll follow my vagrant star, that's the kind of a guy i am! (drink it down!) that's the kind of a guy i am!" * * * * * larry gibson awoke the next morning to the sound of many hammers beating on a steel shell. there was also a sharp and comprehensive ache that started at the top of his head, which felt as though someone had been hitting him with the butt of a ray-gun, and spread all down through his body. he groaned and sat up. he lay in a bunk, in a steel-walled cabin. evidently the officers' quarters on some strathoship. across the white painted ceiling, where flakes of red rust were showing through the dirty paint, the word condemned had been stenciled in black. sitting upright on the edge of his bunk, larry momentarily dropped his head in his hands. then he stood up and left the cabin, grinding his teeth at the ceaseless pound of the hammers on the steel shell. at intervals, as larry went slowly down the corridor, he passed the word condemned stenciled on the walls and bulk-heads. when the government inspectors decided that a a rocket-ship was no longer safe for flights through the vast emptiness of the strathosphere, they made the fact very evident! he climbed a ladder to an open manhole, and emerged into the bright sunlight of a winter morning. for an instant he filled his smoke-tainted lungs with deep gulps of fresh air. then he looked about him. he stood atop the red-painted hull of a rocket-ship. it was an old v- , a type that had been first built some thirty years before and was now obsolete. the weathered paint was badly rust streaked, and the worst spots had been touched up with bright red lead so that they looked like livid scars. the ship was lying in a corner of the airport, and a gang of men were busy at what appeared to be an attempt at general reconditioning. after one look larry didn't think it would do much good. turning forward along the top of the super-structure, larry met a man in a faded blue uniform that bore the two stripes of a second officer. he was a lean, swarthy-faced man with a meticulously pointed mustache that contrasted strangely with his otherwise down-at-the-heels appearance. "morning," he said shortly. "i'm colton, the second officer. guess you're the new first mate." "if so, it's news to me!" larry said grimly. "where's the madman that commands this decrepit craft?" "you'll find the old man in the control room. and if you use your head, you won't speak slightingly of the _sky maid_ in his presence." "when i want your advice i'll ask for it," larry said. colton's eyes blinked momentarily, but then he smiled and larry immediately marked him down as a man to be watched. he didn't trust people who smiled when they were insulted. "suit yourself," colton said as he turned away. crispin gillingwater ripon was bent over a set of strange diagrams spread out on the chart table in the control room. thick smoke swirled from the short pipe clenched in his teeth. his face was deeply lined this morning, and there were wrinkled hollows under his eyes, but he looked up with a broad grin as larry came into the dusty control room. his reckless eyes were bright and cheerful in spite of being bloodshot. * * * * * "cheerio, young feller!" he boomed. "how's the pride of the strathosphere this morning?" "all right," larry said shortly. "it seems that i owe you thanks for a night's lodging. but what's this about my being first mate of this hulk?" "accepting your unspoken apology for having maligned my ship," ripon said severely, "the statement is correct. you signed on last night. i have your signature to prove it--although it's a bit shaky because i had to guide your hand which seemed unable to hold the pen." "do you know who i am?" larry asked grimly. "do i know who you are?" ripon's lean, brown face suddenly crinkled into a smile. "good lord, young feller, you spent two hours last night telling me your life's history while you cried into your beer." "then i can't have told you the whole story." the hang-over, and the fact that he had not had any solid food in nearly twenty-four hours, were making larry slightly dizzy. his voice rose in spite of himself. "i'm larry gibson, black-listed in every airport in the world. 'gibson the murderer,' the newspapers called me. i'm the man who was master of the rocket-liner _pegasus_ when she fell into the south pacific with a loss of a hundred lives. it wasn't really my fault, but the inspectors believed some fools who lied to save their own skins. now, my friend, do you see why i can't sail on even your shaky old craft? i was drummed out of the service, and ever since...." "and ever since you've been going around feeling sorry for yourself!" ripon's voice cut sharply through the mists of larry's bitterness. "hell, young feller, i've been disgraced worse than that more than once. i just don't pay any attention to it. forget it. i need a first officer on this trip, and i believe your story that the disaster wasn't your fault, and there's an end to it! you're coming along." "but i haven't even a license any more." "that doesn't matter. governmental regulations don't apply to a trip to the moon. they don't license a man for what they think is suicide, you know! go ashore and get some breakfast to steady you down. then, when you feel better, come back and i'll go over the details of the trip with you." for a long moment larry stared at ripon. then he began to laugh. "by the lord harry, i think you're crazy!" he said. the gaunt scientist grinned back at him with complete good humor. "better people than you have called me that, young feller," he said cheerfully. "they've been expecting me to get myself killed for years. but crispin gillingwater ripon is still alive and healthy--albeit somewhat battered. follow my star and you'll have plenty of excitement, even though it may get you nothing more than a broken head." iv when larry gibson returned to the ancient and seedy-looking _sky maid_ after a breakfast at a nearby restaurant, he paused to look at the work in progress outside her hull. it was like nothing that he had ever seen before. a network of interlacing wires was being bolted to the outside of the ship's cigar-shaped hull, so that they formed a sort of screen with the strands some two inches apart. other men were busy at caulking rivets and repacking insulation. this last was routine stuff in connection with any attempt to recondition an old vessel for travel in the thin, chill regions of the strathosphere--but he was completely puzzled by the painstaking labor of fastening those criss-crossing wires in place. he found ripon still in the vessel's dusty control room. much of the equipment had been ripped out when the ship was first condemned. the missing articles had been hastily replaced with second-hand equipment which was often of a slightly different pattern from the original, so that the whole room had a makeshift appearance. the lean scientist looked up from the clouds of blue and vile-smelling smoke that swirled upward from his pipe. "well, young feller!" he boomed in his deep voice that could easily carry above the dull roar of rocket motors. "how do you feel now? ready to go to work?" "listen!" larry said. he had intended to be sharp and sarcastic, but he was grinning in spite of himself. it was hard to stay angry with anyone as irresponsibly cheerful as crispin gillingwater ripon. "seriously! you couldn't take the best rocket-ship on earth to the moon, let alone this old derelict. not if you want to come back alive. it's been proven that, by the time you reach the velocity of escape to get away from the earth's attraction, you have a speed too great for our present knowledge of rocket-ship technique to brake in time to prevent disaster...." "_how_ has that been proven?" ripon interrupted, jerking the pipe from between his teeth and pointing the smoking stem at larry as though it were the barrel of a ray-gun. "why--by the two attempts that have been made! you know the story. two hundred years ago, at the time we had the last war on earth, that group of defeated outlaws stole the giant transport _mercury_ and started for the moon and vanished. then, it was only thirty years ago that professor lester staunton made his attempt in the rocket cruiser _orestes_, and he vanished." "you're like all the rest," ripon grumbled. "always jumping to conclusions based on a few scraps of evidence. no man on earth really knows how a rocket-ship would behave in interplanetary travel, because it hasn't yet been done. there is a great mass of unproven theories that are generally accepted as true--but those are not facts. it was once generally accepted that the earth was flat. however--i have a new method of propulsion for this ship, by means of the amplification of magnetic currents, and i expect to supplement the rockets with that new equipment." "i think you're crazy," larry said, "but i'll go along with you anyway." "now you show the proper spirit, even if not good sense," ripon said cheerfully. it was after midnight that night before the _sky maid_ was ready to go. the crew were at launching stations, and the ship's old-fashioned diesels were rumbling as they were warmed up. larry was standing under the dome of duralite glass that covered the upper observation platform when colton came up to stand beside him. "well--we'll be off in a few minutes!" the swarthy second officer said. "wonder if we'll ever come back." "lord knows!" colton shrugged, and his dark eyes were somber. "the police of half a dozen countries are looking for me anyway. i've had my fingers crossed the whole time we've been refitting this craft." "why tell me all this?" larry asked. colton shrugged again, and his smile was half a sneer. "your own reputation isn't much better, gibson. i figure that if this trip works out it may give us both a chance to square ourselves, and if it doesn't we're not much worse off than we are now." "you may have something there," larry admitted. then ripon shouted a command, and the helicopters started to spin. only a handful of loafers watched the _sky maid_ take off. a few waved. others tapped their heads derisively. man's third attempt to navigate the , empty miles to the moon had begun! * * * * * the old ship's rickety helicopters and creaking diesels could hardly lift her high enough to reach the level required by law before the rockets could be started. high clouds veiled the stars, but the many lights of new york were still visible below them when ripon at last cut in the rocket motors. the _sky maid_ shivered all along her length as their blasting roar began, and then she started to shoot upward at a steep angle. her whole fabric creaked and groaned, and larry gibson shook his head dubiously. a few air-leaks would be all they would need to make their situation utterly hopeless. the drive of the rockets carried them into the belt of clouds. for a few seconds the glass ports were veiled by gray mist. then they were above the clouds and zooming upward in the cold light of the moon. the crew were released from their launching stations as the ship settled down to a smooth routine, and larry took over the watch. a minute later he was alone in the darkened control room with the dim glow of the varied instrument panels to keep him company. already the air was starting to thin out, so he closed the ports and turned on the vessel's air-conditioning system. the atmosphere took on the faintly chemical odor characteristic of travel in a sealed ship in the high places. from somewhere nearby larry could hear a deep voice lifted in song, a voice that rose above the pulsating throb of the rockets. the words were familiar: "there's only a few of us left, and we never were worth a damn, but i'll follow my vagrant star...." larry wondered if ripon was hitting the bottle again. they were in a bad spot if he was, for certainly no one else on board understood the new equipment that ripon had installed to solve the difficulties that had blocked previous attempts at interplanetary travel. in larry's mind there was a steadily strengthening conviction that this whole expedition was destined to failure from the start. it was too makeshift. too poorly organized and planned, too lightly financed. ill-manned and poorly equipped, led by a drunken genius on a rickety ship that wasn't really fit to navigate at all, they were probably sailing to their doom somewhere in the cold reaches of outer space. if they reached the moon at all, it would likely be as a twisted wreck dropped on the cold slope of one of that body's barren craters. larry shrugged. he had made his decision, and he did not regret it. and then, leaning beside one of the control room's glass ports while he kept an eye on the slowly climbing needle of the speed indicator, larry suddenly realized that he had found the peace of mind he had so long been seeking. the clouds were a silvery ocean far below, the moon was a glowing disc ahead. the _sky maid_ snored onward through the night with her rockets pounding. he was again back where he belonged, standing a watch in a vessel's control room. nothing else seemed to matter very much at the moment. ripon came out into the control room a little later, a faded uniform cap pushed to the back of his graying head and his empty pipe clenched in his teeth. "it's tough not to smoke," he rumbled glumly, "but i don't want to put a strain on our none too good air-conditioning equipment. how are things going?" "not so well," larry said, "the rockets aren't balanced, and we have a drift to starboard. three micro-units in every fifteen minutes. i have to keep cutting down the port rocket tubes for short periods to equalize it." "how's the speed?" "not what it should be." larry looked dubiously at the indicator needle. "even with as much rocket power as she's got, we've only built our speed up to a thousand miles an hour even though the atmosphere is greatly thinned. i don't think that we can build up the necessary velocity, chief. i'm afraid it just can't be done." "okay, friend pinzon," ripon said. catching larry's look of puzzled surprise, the gaunt scientist smiled faintly. "there was once a man named columbus who thought he could sail the atlantic, which had not been done before. he was a bit of a faker and a bluff, that genoese adventurer, and there was more than a touch of the charlatan in him. the pinzon brothers who commanded the other two ships of his fleet knew from the start that the voyage could never succeed. i'll admit that columbus didn't find just what he expected to find, but he did cross the atlantic!" ripon laughed, and dropped a hand on larry's shoulder. "hold her on to the course a while, my friend. we're not licked quite so soon!" v ripon was still staring out the control room window at the disc of the moon ahead of them. his voice came somberly as he spoke without turning around. "what's the speed now?" "eleven hundred. velocity of escape is twenty-five hundred." "y'know, larry, it seems one of fate's little ironies that the only hope of saving the people of earth from the gray death lies with this creaking ship and her polyglot crew! oh--i have no illusions about the forlornness of our hope! we have no right to get through. but i'm not entirely a fool, and i have a few aces in my sleeves. i guess it's time to try out my magnetron controls. stand by to cut rocket motors!" ripon moved to several strange-looking control boxes that had been set up at one side of the room. instrument dials glowed into light as he threw a switch, and there came a faint hum. "these tubes are the magnetron oscillators," ripon said. "these switches control the magnetic converters. this other bank governs the selectors." "but i don't get the general principle," larry said. "it's simply a selective utilization of the lines of magnetic force that fill outer space. this ship is naturally para-magnetic, so that she is easily permeable by the lines of force. by charging the wires outside the hull i can make all or part of the ship diamagnetic. furthermore, i can change its charge so that the lines will draw in either direction." "i know enough of the general principles of magnetism to understand that," larry said. "you can vary the direction of the effect, and perhaps vary the dynes. but...." "this indicator shows the hysteresis loop, the lag of magnetic indication behind the magnetizing force at any particular time," ripon continued. "the heart of my system is the group of selectors and amplifiers set up in the compartments directly below us. with them i can select the magnetic currents suited to our course, and amplify them till they move the ship along with them just as the lines of magnetic force move iron filings about a bar magnet. at least," he said with a sudden flash of his reckless smile, "that's what i think i can do. if not, we'll probably never be heard of again. you'd better hope i'm right, young feller!" ripon's craggy profile with its jutting beard was silhouetted against the moon as he bent over his dials and switches. twice he checked them, then he lifted one hand. "ready--cut rockets!" he snapped. larry threw over the lever of the engine room indicator, and the roar of the rockets abruptly ceased. the sudden silence was strangely startling to ears that had become accustomed to that steady pounding astern. running feet sounded in the passage as colton came charging into the control room to find what had gone wrong. for a moment larry had a sensation of falling, and then the _sky maid_ danced about like a leaf in a wind. he steadied himself by clinging to a stanchion and anxiously watched ripon. the gaunt scientist was hunched above his control boards like a gnome, his hands leaping from switch to dial and back again at furious speed. then the motion abruptly ceased. the _sky maid_ became steady as a rock, with the bright disc of the moon dead ahead through the forward port. there was a faint singing sound from one of the control boxes, but otherwise everything was so quiet and still that it seemed as though the ship lay motionless in space. then larry looked at the speed indicator, and saw the needle moving steadily upward. the _sky maid_ was shooting through the heavens at a speed faster than she had ever traveled when she was new and in good condition! * * * * * "gentlemen," said ripon, solemnly shaking hands with both larry and colton, "this is an historic moment! this is a prelude to that day when interplanetary travel becomes as commonplace as are rocket ship flights through the strathosphere nowadays! no longer will the name of crispin gillingwater ripon be a thing of scorn and derision. and just wait till i get a chance to spit in the faces of some of those living fossils back at the national university...." "if the ship holds together!" larry said. ripon sighed. "you _would_ bring that up, young feller. but maybe our luck will hold good. at least this method of travel is less hard on an old craft than the steady strain of a rocket blast. if the ship holds together, we'll be on the moon in forty-eight hours!" colton was grinning broadly as ripon left the control room a minute later. the second officer gave the points of his mustache an added twist, and then rubbed his hands together. "looks like the old goat really came through with something after all," he said. larry looked at him grimly. for all ripon's eccentricities, he was an able man in a great many things. it annoyed larry to hear somebody like colton, a confessed thief and an indifferent officer, speak of him in quite that tone of disrespect. "don't speak of doc ripon in that way when you're with me, colton!" he snapped. the other man's thin mouth twisted in a sneer. "trying to go high hat on me, gibson? you're no better than i am." "if we go into that i'm likely to throw you through the bulkhead," larry said evenly. "so we'll just let it go that i have some gratitude and respect for the man who picked me up out of the gutter--even if you haven't. now clear out of here till it's time for you to take over the watch." for two days and nights the _sky maid_ moved steadily forward on her way. there was, of course, neither day nor night in the airless emptiness of outer space, but they kept routine hours on board. the whole atmosphere of the ship had brightened and changed since ripon's utilization of magnetic force had proven practical. even the slovenly crew went around with their shoulders straighter. the feeling of gloom and failure had been succeeded by one of optimism. now the talk was of whether or not they would really get the desired radium salts on the moon, and of what reward they would all receive when they got back to earth. the watch off duty started a poker game based on notes against the rewards they all expected to get. ahead of the _sky maid_, the moon was now a vast disc that filled half the sky when seen from the control room ports. the bigger peaks and craters were visible to the naked eye now. back in the after observation room, the dwindling but still vast profile of earth had taken on a strange and unfamiliar appearance. it was a lonely feeling, to be so far from that friendly planet. larry wondered how things were now going there, and what had caused the spread of the gray death in the first place. probably a virus brought in on a meteor from some unknown and unhealthy planet. the hope of mankind resting within her rusty hull, the _sky maid_ slogged onward. by earthly standards she was moving at a terrific speed, but compared with the velocity of heavenly bodies and the vastness of interplanetary space she crawled slowly across a small corner of the solar system. vi at last there came the hour when the ship hovered a few hundred miles above the surface of the moon. below them was a vast and uneven surface of barren and pitted rock, round craters and jagged peaks stretching to the horizon in all directions. larry realized now how uneven the surface of the satellite really was, how different from the orange-peel appearance it had when seen through a telescope from earth. all the crew were at landing stations. ripon had adjusted his controls to hold the ship steady in space, and now he stepped back. "there's no use bothering with helicopters," he said. "since there's no atmosphere here, they'd be useless. that's probably what wrecked the ships before us--you can't make an easy landing with rockets alone, and we have no padded landing platform." "can't you lower her down easy with your magnetic control?" larry asked. "that's what i hope to do, but we're not experienced and there may be a jolt. cut off the reserve air tanks, and have all hands put on space suits." the crew of the _sky maid_ looked like a group of fantastic monsters in the metal-cloth space suits with their round helmets of duro-glass. designed for use by emergency repair crews aboard stratholiners in case of trouble, the space suits would keep a man alive and warm in an airless atmosphere for a great many hours. small containers of chemicals kept the air purified, and earphones made communication possible. "stand by for a landing!" ripon's voice buzzed in the ear phones as larry reported all hands ready. "we're going down!" the _sky maid_ went down in a series of jerky drops. with eventual refinement, a ship equipped with the ripon magnetic control would probably be able to come down as gently as a falling leaf, but this first apparatus was crude and experimental. just at the end one of ripon's elbows touched the wrong switch. the rocky surface swept up to meet them at high speed. he shouted hoarsely and spun compensating dials, but before he could check the momentum they struck with a heavy crash. the ship heeled over, and all the lights went out. as larry was flung off his feet he heard a sharp hiss of escaping air. * * * * * momentarily half stunned, larry lay on the floor in a corner of the control room with the body of another of the crew across his legs. then he saw a bulky, space-suited figure heave to its feet across the room and heard ripon's voice in his ear phones. "leaping ray-blasts, what a crash! but i seem to be alive and in one piece. how about the rest of you?" other men struggled to their feet and answered their names. one had his helmet smashed and was already dead in the airless atmosphere that remained after the air had rushed out through the shattered wall of the control room, but the rest had nothing more serious than a few bruises. "well," colton said. "here we are! and here we're likely to stay." "it may not be that serious. the first thing is to take stock of our damage." the _sky maid_, they found on making a complete survey, was far less seriously damaged than might have been the case. the wall of the control room was punctured by a jagged splinter of rock, but there were only a few other minor leaks. many of the compartments had retained their air. once the hole was patched and the other leaks stopped, their reserve tanks still held enough air to let them make a homeward voyage in safety. the network of wires outside the hull would require considerable reconditioning, but none of the internal magnetic equipment was ruined. "about five days' work!" ripon summed up. "and it's primarily a job for the engine room force. gibson, colton, the two quartermasters and i will go ashore with several days' supply of chemical capsules for the air conditioners on our helmets. chief engineer masterson remains in command of the ship. get her back in navigating shape as soon as you can, chief." masterson, a grimy and bullet-headed little man with a drooping mustache and something of the look of a mournful airedale, slapped the side of his duro-glass helmet in a casual salute. larry knew that the ship was being left in good hands. he had come to have considerable respect for the taciturn engineer. he did not know why masterson was on board the _sky maid_, very likely because he had been in some trouble similar to larry's own, but he was certainly an efficient engineer. he wished he felt as sure of the three men who were going ashore with ripon and himself. colton he considered thoroughly untrustworthy, and the two quartermasters were a pair of sullen derelicts of the sort that ripon had picked up off the beach for most of the crew. "landing party ashore!" ripon snapped. "let's get going! this isn't an ordinary exploring party, and every hour counts." vii they stood on a bare expanse of pitted rock. the _sky maid_ had crashed on the outer slope of one of the craters, and the ground rose steadily to the jagged rim of the rocky bowl. other bare peaks were all about them, black teeth against the starry sky. the earth gleamed large and pale above them. the scene was bleak and silent, unutterably desolate and forlorn, and the little group of earthlings drew closer together. then ripon pointed up the ridge. "we'll go up there and look around. larry--you carry the radium detector. we mustn't let the exploring fever make us forget our main purpose in having come here." they toiled slowly up the slope. walking was difficult. due to the power of their earthly muscles on this planet of so much lighter gravity, they had a tendency to bound into the air at each step in spite of the heavy leaden soles on the feet of the space suits. gradually they learned the necessary muscular control, a sort of sliding step, and then they made better progress. ripon was some yards in the lead as they reached the rim of the crater. for a moment the tall scientist was silhouetted against the stars, then he abruptly dropped flat on the rock and motioned back to them to do the same. his voice was a faint whisper in the ear phones. "crawl up here slowly, one at a time. careful!" larry was the first to join him, lying flat on the rock at ripon's side. together they peered down into the crater. it's flat floor was swarming with some sort of queer animal! this particular crater was a small one, and the level floor was only some thirty yards below the rim. larry stared in amazement at the creatures who were coming to sit in long rows around a small mound in the center of the crater. he hardly knew whether to call them men or animals. they had the hard shell and articulated legs of an insect, but their faces had a semi-human appearance in spite of the pair of long antennae that grew out of their foreheads. their feet made a dry rustling sound as they clambered down over the rock, and they carried metal clubs with spiked heads. larry saw that they walked with four of their six limbs while the upper pair were equipped with three curved fingers each. on the top of each antenna was a round ball that glowed with a phosphorescent light. "i thought there wasn't any life on the moon!" larry whispered. ripon grinned at him through the duro-glass of his helmet. "you thought a lot of things that were wrong, young feller!" it was a weird scene in the cold pale light of the earth. some of the insect men came out of small, dome-shaped mounds that might have been houses. others came climbing down the far side of the crater. their glowing antennae bobbed in ceaseless motion, and there was a constant dry clicking. suddenly larry realized that the creatures were talking together! that meant that there was at least some atmosphere on the moon! enough to carry sound! perhaps it had a different composition than the atmosphere of the earth. it was certainly very thin, for the air in the control room had instantly escaped through the shattered side and the man with the broken helmet had smothered, but there was enough here to sustain these odd creatures. then ripon touched him on the arm, and larry saw something that a group of the insect-men were very ceremoniously carrying to the mound in the center of the crater. it was an ordinary metal chair of a very common and familiar earthly pattern, the sort of chair to be found in the cabins and mess rooms of any stratholiner. "one of those old ships must have reached the moon after all!" larry whispered. "that chair must be from the wreckage." "heaven help the survivors if those many-legged devils got hold of them!" "they can't be very strong, with the moon's gravity so slight," larry said. "that doesn't prove a thing. they can be light in frame and still very strong. think how many times his own weight our ant can carry, or how far a flea can jump." the chair had been placed in the center of the mound, and the insect-men drew back. now thin jets of steam or mist began to pour up around the mound, forming a foggy curtain that hid it. the mist only rose a little way, then dropped slowly down again to form an icy film on the cold rocks. the jets ceased, and mist vanished, and larry gibson stared in open-mouthed amazement. a dark-haired girl was standing erect on the crest of the mound! viii the girl was white-skinned and lovely, utterly different from the grotesque creatures who surrounded her. larry was crouching near enough to see her faintly smiling eyes, and the curve of her red lips, and the dark hair that fell to her waist behind. except for the grotesque metallic helmet on her head, and the fact that she wore no clothing except for a silver loin cloth, she might have been a girl of the sort to be seen along the elevated cross-walks of new york city. "do you see her too?" ripon whispered. "i do." "we can't both be that crazy, so she must really be there. but how she breathes in that atmosphere, and how she avoids freezing to death, is more than i can tell you." the ceremony had evidently some sort of a religious significance, for the insect-men were clicking rhythmically and were bowing down before the dark-haired girl. goddess of the moon! the girl's head-dress was a grotesque representation of an insect, set with jewels. at the tops of the flexible antennae were a pair of giant rubies. "boy! wouldn't i like to get my hands on those stones!" colton whispered from where he crouched on ripon's left. then larry noticed something else! a group of perhaps a hundred of the insect-men were moving swiftly forward between the ranks of their bowing comrades. this group carried shields as well as clubs, and they had the purposeful air of men with a grim and serious errand to perform. the girl was staring over the heads of the crowd with a distant and goddess-like manner, and did not notice the newcomers till they had almost reached her. then her eyes widened in alarm. she leaped up from her throne and burst into a torrent of shrill clicking. in an instant the crater was in a turmoil. the group of the heavily armed insect-men charged straight for the mound in the center. others flung themselves in their path, rallying to the defense of the goddess. there was a wild flurry of swinging clubs. the spiked heads clanged on metal shields, or cracked sharply on the brittle brown shells of the insect-men. the significance of the scene before him was still obscure to larry, but it was evident that some kind of a revolt had broken out. the rebels among the insect-men were outnumbered, but their metal shields gave them a big advantage and they were better organized. like a spear-point they drove straight through the confused mass of worshipers and surrounded the low knoll in the center. they brushed its defenders aside and swarmed up toward the dark-haired goddess. larry had already drawn his ray-gun, but ripon was the first to leap to his feet. "come on, young feller!" he roared. "that girl is the first human thing we've seen on the moon. we can't let her down. let's show those many-legged devils how an earth man can fight!" larry and ripon went down the slope of the crater in a series of bounding leaps. the milling insect-men opened before them, seeming to welcome these unexpected reinforcements. some of the rebels had already forced the struggling girl to her knees and were lashing her hands behind her back. a solid rank of them faced about with their round shields locked and a tossing fringe of spiked clubs waving atop the metal wall. * * * * * the two earthlings dove for the shield-wall with their guns flashing. larry ducked as one of the insect-men hurled a club which just missed his glass helmet, then pressed the trigger of his ray-gun. the murky beam of the rays stabbed into the shield, melted a hole through it in a fraction of a second, and struck down the man behind. the flashing ray-guns of the two adventurers ripped the shield-wall asunder. a wave of the loyal insect-men poured in behind them. larry shifted his ray-gun to his left hand, and snatched up a fallen club with his right. it was heavier than he had expected, a well balanced and efficient weapon. the hard brown shells of the rebels cracked like china under the smashing blows of his earthly muscles. then he bounded up on the mound and struck down the pair of rebels who held the girl. her wrists were now tied behind her. throwing an arm about the girl's shoulders, larry hastily faced about. ripon was a few yards away. a ring of his slain lay around him, but his weapons had been knocked from his hands and he was struggling in the grip of a pair of the insect-men. a third of the creatures was swinging a club to strike a blow at the scientist's glass helmet. larry instantly fired, the beam of the ray striking the arm that held the club and shearing it clean off at the shoulder. a viscous yellow liquid dripped out, and the creature dropped writhing on the rock while it clicked in pain. then colton and the two quartermasters came charging belatedly up, and the fight was over. the crater was dotted with the still forms of dead insect-men. larry noticed that their hard shells gleamed dully in the dim light. the surviving rebels had fled off across the far rim of the crater, and the rest of the throng had gone chasing after them. no one remained in the crater except the strange girl and the party from the _sky maid_. when larry had freed the girl's hands, she turned to the five earth-men and touched her forehead in a gesture of thanks. then she stepped across to touch some hidden spring on the far side of the mound, and a trap door opened in what had apparently been solid rock. the girl led the way down a narrow flight of stairs, motioning for the last man down to pull the trap closed behind them. they stood in a small chamber that had walls of roughly smoothed rock. it was evidently the work of men, for tool marks showed here and there. it was lighted by a green globe set in one wall. the globe appeared to be made of some kind of flexible glass, and it glowed with a faint greenish radiance that overcame the darkness enough to give the place a dim and eerie light. at one side of the room was an oval hole like a slanting well cut in the floor. beside it stood a pile of low, flat carts. they were about two feet wide by four feet long, and they were supported on axles bearing small wheels the diameter of a man's hand. the girl spoke to larry twice, first in the clicking talk of the insect-men and then in some soft and musical tongue that was unlike anything larry had ever heard. both times he shook his head. motioning for them to follow her, she put one of the low carts down near the rim of the hole and sat on it. then she gave a push with her hands--and vanished. "come on," larry said, raking another of the carts. colton stared at him. "down that hole?" he asked. "why not? we've got to find out what all this is about." * * * * * a second later larry gibson found himself shooting down into the interior of the moon by means of a sloping tunnel cut in the rock. a series of the greenish globes were set in the ceiling at intervals to give the rocky shaft a dim light. the wheels of the cart ran in two grooves cut in the floor, and he shot swiftly downward with a dull humming sound. larry was trying to estimate the speed of his downward movement. it was not so terribly fast, probably not really as fast as the nearness of the walls made it appear while they flashed by on either hand. the slope was a gentle one. although he had gathered considerable momentum, he had no feeling of the car being out of control. as the minutes passed, larry saw something else. the moisture that had been on the outside of his space suit from the air within the _sky maid_ had frozen into a white frost a few seconds after the breaking of the control room wall let the outer cold into the ship. now the frost was melting! they were getting into warmer regions as they went down. perhaps they were also running into a heavier atmosphere! larry held his hand up before him, and had a distinct feeling of pressure against it from the rush of air sweeping up to meet him. a minute later he had tested the atmosphere with the portable oxygen-gauge carried in the equipment pocket of any space suit. then he took off his helmet. the air was quite warm, and though still very thin it was definitely breathable. its clean, earthy odor was a pleasant contrast to the chemical product used over and over again inside the helmet of a space suit. a moment later he saw a brighter light ahead and realized that he had come to the bottom of the long shaft. they were in a square room whose walls were of polished gray stone. as larry got up from his cart and moved in aside from the landing platform, the girl gave him a friendly smile. she had already taken off her ornately jeweled head-dress and placed it in a metal cabinet fastened to the wall. completely without embarrassment, she tied a strip of gayly colored silk across her bare breasts. then she tossed her long hair back from her forehead and bound another strip of silk to keep it in place. "that was quite a ride," larry said. he had spoken in english, knowing that the girl would not understand but hoping the sound of the words would convey a generally friendly impression. she stared at him in startled surprise for a second. "it is much pleasanter than the upward trip," she said at last. "but--but you spoke in english!" larry gasped. "why shouldn't i? my father is a man from earth. i am diana staunton." ix as the others came sliding down into the room, larry gave each one a formal introduction to diana. the glow in the girl's eyes showed that she enjoyed their utter amazement. for a girl who had been born on the moon, even though of earthly parents, diana staunton had a great deal of poise and self-possession. "i am only a goddess to the sluggish minds of the insect-men," she explained in answer to ripon's question. "to our own people of the lost caverns i am simply the daughter of one of the nobles." "i knew your father thirty years ago," ripon said. "he has always told me that other men from earth would come some day." "your father can tell me most of the things i want to know, but i am wondering how you managed to survive up there on the surface where there is little or no air and it is always so cold." "i could not stay very long." from a fold in her loin cloth the girl drew out a tightly closed glass bottle that held some white tablets. "these contain oxygen mixed with some gases unknown on earth, the whole very strongly compressed into solid form. ten minutes after i swallow one, it is safe for me to go out on the surface. the effect lasts for about fifteen minutes." "pretty risky if anything delays you," larry said. diana shrugged, and her blue eyes grew somber. "someone has to do it. the loyalty of the insect-men is our greatest protection against the evil lords of gral-thala. this is the first time there has ever been anything like a revolt among the insect-men. i do not know what lies behind it, but it probably means trouble for us of the lost caverns." colton was the last to come down the rocky shaft. larry noticed that the second officer was ill at ease, disinclined to meet his eyes, and wondered if colton was ashamed of either his late entry into the fight or his fear of coming down into the moon's interior. hardly likely! from what he knew of gerald colton, the man was not likely to be ashamed of anything he did. they went through a maze of gray walled passages, still trending downward. once or twice larry thought he heard stealthy footsteps behind them, but there was no one in sight when he looked back. on several occasions they passed sentries wearing a makeshift armor, who saluted diana with long bladed swords. sometimes they spoke to her in english with a peculiar soft accent, sometimes in that strange tongue that diana had first used. larry noticed that these lunarians looked only slightly different from the peoples of earth. they had larger eyes, and a greater delicacy of feature. the principle distinguishing feature was their very thin legs. often they had wide shoulders and deep chests, but since they did not need strong supporting muscles in view of the moon's slight gravity their legs were thin and narrow. the sentries stared curiously at the earth-men in their bulky space suits, but the fact that the newcomers were with diana staunton seemed to be sufficient passport. they began to pass a greater number of people in the corridors, and finally they stepped through a heavily guarded gate and came to a vast cavern. the place was huge, extending for a good mile ahead of them and with a lofty roof lost in the shadows overhead. some of the gigantic columns that supported the roof were made of heavy stone blocks. others were natural rock that had been smoothed and polished. all over the floor of the cavern were narrow streets, and small cottages built of some queer composition that came in a rainbow of different colors, and little patches of some sort of green grass. a golden and rather misty light pervaded the whole cavern. square shafts of a brighter radiance darted down from above at irregular intervals, and wherever one of them struck the floor of the cavern there was a small patch of cultivated ground with long-leafed plants. "agriculture by chemical control!" ripon whispered in larry's ear. diana glanced back at them over her shoulder. "this is chotan, largest of the lost caverns," she said. "the council of elders is now in session, and it will be best that we go direct to them." "why do you call these the lost caverns?" larry asked. "because we who live here are outlaws, and the location of these vast caves is not known to the lords of gral-thala who rule the other side of the moon." "apparently not all the inhabitants of the moon are so friendly," ripon said. "if you came into the hands of the lords of gral-thala," she said grimly, "they would tear the skin from your bodies and use it to lace their scented golden boots!" large-eyed lunarians stared curiously at the earth-men as they hurried through the streets of the underground village. diana led them direct to a broad-beamed, red-roofed building that stood by itself in the center of the cavern. a dozen elderly men sat behind a long table of carved wood that was black and cracked with age. it was, larry realized, the first wooden thing he had seen since he landed on the moon. at either side of the chamber stood a squad of armored warriors. larry was staring at a curious device that was carved in the center of the table, and carried on a banner hung above the heads of the council, and inlaid in a white metal on the bluish steel shields of the guards. and then he recognized it! it was the crescent earth, the profile of the mother planet as seen from the moon when the americas were still in sunlight and the shadows of night were creeping across the atlantic. the sight of it made him home-sick. the crescent moon had been a religious symbol to many of the ancient races of earth, and it was fitting that the crescent earth should hold a similar place on this isolated satellite. it seemed to larry that diana was a trifle nervous over something. she had entered the council chamber with an air of confidence, lifting one arm in a stately gesture of greeting and asking the elders to accept the men from earth as friends and guests, but he sensed a degree of uncertainty behind her manner. in hasty phrases she told the council of the revolt of part of the insect-men, and of the timely arrival of the strangers from the mother planet. "and so i request that you accept these men into the brotherhood of the caverns!" she finished. the graybeards behind the long table nodded gravely, but before they could speak another voice rang but in a sharp challenge. "and i, o elders of chotan, demand that these interlopers be put to death in accordance with the ancient law of the caverns concerning unwanted strangers!" x the speaker was a fair-haired young man in a green cloak. he looked more like an earthling than a lunarian, with his sturdy legs and small eyes. he pointed an accusing finger straight at larry in a dramatic gesture, and diana wheeled to face him with anger in her voice. "you talk very loudly of the ancient laws, xylon, for a newcomer only recently taken into the brotherhood because you fled as an outlaw from the lords of gral-thala!" "i did not make the laws!" xylon retorted. "the death penalty for strangers has not been strictly enforced for many years--or _you_ would not now be alive! it is up to the decision of the elders!" the council chamber was in an uproar, with shouted phrases flung back and forth. larry laid a hand on the butt of his ray-gun. a keen-eyed officer of the guards caught the gesture, and instantly larry found a pair of rifles directed at his chest. at least, they looked like some sort of compressed air rifles. they had fiber stocks, and long barrels, and a cylindrical magazine beneath the barrel. then a deep voice dominated the tumult as a red-haired man in full armor forced his way through to the forefront of the crowd. "the girl is right, o elders and members of the brotherhood!" he boomed. "xylon talks like a fool. i, pyatt of kagan, urge that the strangers from earth be accepted. let xylon remain among us for a little while longer before he attempts to dominate our councils!" larry could sense the swing of sentiment in their favor, could feel the lessening of the tension. the man called xylon shrugged and turned away. then the council took a formal vote, waving the ancient death penalty and allowing the strangers the freedom of the caverns. one of the elders near the end of the table rose to his feet. he wore the typical black robes of the council, but as larry looked closely at the man's lined face he saw the resemblance to diana and knew that he was looking at lester staunton. "since these men are from what was once my own land," staunton said, "i will make them comfortable in my house for the duration of their stay here." as the crowd began to stream out of the council-chamber, the red-headed man pushed his way through to ripon and larry. he was unusually burly and big-thewed for a lunarian, and though his face was marred by a pair of old scars he had a wide and cheerful smile. "welcome to the cavern of chotan!" he boomed. "i am pyatt of kagan, military commander of all the armed forces of the caverns. later i will want to talk to you about that revolt of the insect-men, which is something that has not happened before. also, we will drink a goblet of wine together." "then you have wines on the moon?" ripon asked, visibly brightening. "aye, wines of many sorts. though my own taste runs more to the strong-waters that fire the blood and set a man's head to spinning." "i can see that you and i have a lot in common!" ripon grinned. * * * * * just before they left, xylon came up to shake hands with larry. "no hard feelings, earthling!" he said. "it is just that the safety and liberties of the caverns are very precious to one like myself, who has so recently become an outlaw, and i did not think that we should take any chances." "that's all right," larry said shortly. now that he saw xylon at really close range, he realized that the man was older than he had thought. his appearance of youth vanished when you saw the many fine wrinkles in his face and the weariness around his eyes. he had a dissolute appearance. xylon might be sincere in his bid for friendship, but larry felt that there was something serpentine and evil about the man. with diana and her father and a few others, they walked along one of the many winding paths of chotan. larry noticed that the chemically grown plants had no scent at all. the motionless, warm air was suffused with a misty and golden light. small, neat houses built in various bright colors stood amid their plots of grass. it was a strange scene to earthly eyes, that cavern far below the moon's chill surface, but it was a pleasant spot in its way. the women they passed along the walks were dressed like diana, in a gayly colored loin-cloth with a narrow band across the breasts. most of the men wore a loose, colored cloak in addition to the single garment. only a few were armed. larry had taken off the right mitten of his space suit to shake hands with pyatt and xylon in the council chamber. several times he had started to replace the mitten, but something had always distracted him and he was still carrying it in his left hand. now, as he happened to give the mitten a shake, a small insect of a blood-red color fell out and landed on the walk. it looked something like a miniature scorpion. larry had only a hasty glimpse before pyatt of kagan leaped forward and crushed the crawling thing with the heavy sole of his sandal. "that was a _spanto_!" he said. "their bite means death within ten seconds. i wonder how it came to be in your glove!" "i wonder myself!" larry said grimly, looking across the field at the green-cloaked figure of xylon, who had turned off on another of the branching walks. it would not have been hard for xylon to have dropped the insect in his glove! as if in answer to his thought, diana spoke quietly: "i do not trust xylon any farther than i can see him, friend larry! there is something unclean in his eyes when he looks at me." "if he looks at you too much while i'm here i'll break his jaw!" larry said. the girl looked up at him with a sudden smile that was also a challenge. "i begin to understand why my father has always said that i would like the men from earth better than the lunarians!" xi they sat in professor staunton's laboratory, a square chamber where earthly equipment taken from the wreck of his space-ship was mingled with typically lunarian furniture and equipment. the walls were light blue, of that polished composition resembling bakelite that was used for building in the caverns. the walls were about ten feet high, and they ended in an ornamental cornice without any ceiling or roof at all. overhead there was a glow of misty light, and far above the rocky top of the cavern. "why should we need roofs?" diana said in reply to larry's surprised comment. "here in these caverns there is neither rain nor snow nor wind, nor any change in temperature at all. the walls give privacy, and there is no need for anything else." ripon was bending over a table on which staunton had spread a large map of the moon. the cavern of chotan was indicated by a red dot, and larry saw that there were a dozen others scattered around within a radius of a few hundred miles. "our space-cruiser was wrecked near one of the entrances to this cavern when we landed here thirty years ago," staunton said. "as you have guessed, it was the inability to land safely with rockets, in a practically airless atmosphere where helicopters were useless, that smashed us. as you did, we had fortunately put on space suits before trying to land. our ship was too badly wrecked for any chance of return." "but how have you succeeded in getting all these people to learn english?" ripon asked. "they knew that language before i came! but it is best that i give you a hasty outline of lunarian history. the simple-minded but husky insect-men were the aboriginal inhabitants of the moon. long æons ago, while most of the people of earth were living crudely in caves and using chipped stones for tools and weapons, an isolated people developed a high civilization in what i have roughly identified as the region of the himalayas. a series of great earthquakes destroyed their civilization, but a large number of them escaped and came to the moon in some kind of a space-ship. here they found, in those days, a small planetary body that had a thin but breathable air. they founded a civilization on the other side of the moon where it is always sunny, and called it gral-thala. those were pleasant days, if the old legends are to be believed, the golden age of lunarian civilization." for a moment staunton paused. all those in the room, including the lunarians who had been familiar with this tale since childhood, hung intently on his words. the broad face of pyatt of kagan was somber and moody as he sat bent forward with the scabbard of his sword resting across his armored knees. "as the centuries passed, the atmosphere continued to thin," staunton went on, "so the ancients took care to preserve what was left. gral-thala is in the fertile part of the moon, and lies in a vast valley completely surrounded by a lofty mountain range. by means of the superior engineering knowledge of the ancients, they built a lofty wall or barrier along the crest of the range so that its top is miles above the level of the valley floor. they then sucked all the air within the great barrier. gral-thala itself thus lies in a great pool of air surrounded by the ranges and the barrier. on the rest of the moon, as here, air only remains in deep crevices and caverns like this." "but these caves were a great labor in themselves..." ripon began. * * * * * "originally these caverns were built as outposts of gral-thala, built here because of their nearness to valuable mineral deposits. people came out from the sunlit cities within the great barrier to put in a tour of duty in the caverns. again life on the moon had reached a pleasant equilibrium. and then came the great disaster! some two centuries ago a group of several hundred outlaws fleeing from earth came here in a big space-ship." "the _mercury_!" larry exclaimed. "exactly. those men and women who came from earth were few in comparison to the population of the moon, but they were cruel and ruthless and they had weapons of war. the peaceful lunarians had at that time no weapons at all, for they had no need for them. within a few months the invaders made themselves lords of all gral-thala! that was when english, the language of the invaders, came to be spoken by everybody on the moon as well as the softer tongue of the lunarians themselves. a few of the hardier folk in gral-thala fled to these caverns as outlaws. the invaders made only half-hearted attempts to come after them, and with the passing of the years the location of these refuges has been forgotten by people living within the great barrier. that is why these places are now known as the lost caverns." "and the invaders still rule?" "their descendants are still lords of gral-thala. cruel and ruthless they always were, decadent and dissolute they have now become as well, but they still rule the sunny valley that was the pride of the ancient lunarians. they hold the power, and they are aided by a few groups among the people of gral-thala who have sacrificed their honor to fawn upon their masters. our spies, who penetrate beyond the barrier, tell us that before long there will come a day when the people are ready for revolt--but the time is not yet." "but surely!" said pyatt of kagan, his deep voice breaking in on the low monotone in which staunton had spoken, "surely our visitors will return to earth, now that interplanetary travel has become possible, and bring us the warriors and equipment to storm the high palaces of the tyrants of gral-thala!" "i should think that the confederation of earth would send help, particularly since the original invaders were outlaws from that planet," staunton said. "how about it, friend ripon? how are conditions back on earth at this time?" ripon straightened up and shook his shoulders. the glow in his eyes faded away, and the lines in his face deepened once more. "the lunarians can look for no help from earth until one thing is accomplished," he said. "i have been letting scientific enthusiasm make me lose sight of our reason for coming here. how are conditions on earth, you ask? i can tell you in a single sentence. unless we of earth very quickly get a new supply of radium salts suitable for use with the riesling method, in a few weeks we all perish!" "i do not understand." in a few hasty phrases ripon sketched the development of the terrible plague that was so swiftly robbing earth of its inhabitants. at the end staunton leaned back in his chair. "such salts are available on the moon in ample quantity," he said slowly, and something in the quality of his voice robbed the words of the reassurance they would otherwise have held, "but--they are all located well within the area of the great barrier. and the lords of gral-thala would never let you have even a single milligram!" "then there's only one thing to be done!" larry stood up and began to peel off his space suit. "if someone will show me the way, i'll go into gral-thala and bring out as much of the radiatron extract as i can carry." "and i will go with you!" boomed pyatt of kagan. "by gorton and laila, mythical gods of the moon, it will take more than a few of those cold-eyed tyrants to stop us!" xii time was the thing that counted. the remorseless pressure of minutes and hours that passed and could never be recalled! the tyrants who lorded it over gral-thala had no weapons more deadly than the electronic guns that had been common on earth two hundred years before. a battalion of troops from earth, wearing armor of dura-steel and carrying ray-guns, could probably have overthrown the invaders very quickly. but--there was no time! the toll of the gray death was increasing with each passing hour, back there on the good green planet, and the little group on the moon would have to do what they could without hope of assistance. they could not pause for proper preparations or careful planning. it was only half an earth day after they had landed on the moon, time enough to snatch a few hours' sleep, that larry found himself moving up toward the surface in a slowly crawling cable car. chotan already lay behind and far below them, and the oxygen indicator fastened to the sleeve of the space suit showed him that the air was thinning rapidly. colton and pyatt were with him. all three of them wore space suits of the lunarian patterns, that had a metal helmet with glass windows at the front and sides, for the difference in design of the space suits from the _sky maid_ would have made them too conspicuous. pyatt had come along because he had often penetrated beyond the great barrier in disguise, and a second lunarian was waiting for them up on the surface. ripon had also wanted to come, the idea of this daring raid setting the old, reckless light danging in his eyes. finally he agreed that one of the leaders of the _sky maid_ expedition had better remain in the caverns in case of disaster to the raiders. "that's the hell of getting along in years, young feller!" he rumbled regretfully. "there's nothing i'd like better than to penetrate the barrier with you and pull the whiskers off the tyrants in their lair. a quick wit and a ready weapon! but i couldn't keep up with you younger men if the going gets hot--though i never thought the day would come when i'd hear crispin gillingwater ripon admit a thing like that!--and you'd better go on without me." "we'll be back soon," larry said. ripon snorted. "if you're not back in five days i'm coming after you with the crew of the _sky maid_ and as many of the folk of the caverns as i can get to come along!" * * * * * the cavern of chotan was in that part of the moon which is sometimes in sunlight and sometimes in darkness, and it was night when they came out of the tunnel. the moisture on the space suit instantly froze into a fine white frost. a few lunarian sentries waited for them there, and nearly a hundred of the insect-men. with them were two carts that had high wheels and springs, something like an old-fashioned earthly buckboard. for a few moments, pyatt talked to the leaders of the insect-men in their clicking tongue. the glowing knobs atop their antennae bobbed up and down as they nodded their heads in understanding. then pyatt motioned colton into one of the carts and climbed in beside him. another lunarian, slender even in the bulky space suit, climbed into the second cart beside larry. pyatt swung his right arm forward. a score of the insect-men instantly scampered ahead as scouts, spreading out like the spokes of a fan. small parties went out to either flank. the rest, about thirty to each cart, gripped the trailing ropes and darted ahead with the wagons following behind them. they went at almost incredible speed, the four legs of each giving them a steady drive. even though the insect-men were picking the smooth stretches of the rock and were evidently following a definite though unmarked trail, it was rough going. the light wagons jolted and banged as they whizzed along, and larry had to cling to the rail with both hands to keep from being thrown off. "is all the way as rough as this?" he panted to his companion. "better soon," the lunarian said shortly. after about three hours they turned into a smooth and level road. it wound up and down over the rolling rocky plain, evidently a highway of great age. occasionally they passed crumbling ruins beside it. larry supposed that the road and the ruins dated back to those very ancient days before the lunarians withdrew their shrinking supply of air within the great barrier. now that the road was smooth, the insect-men pulled the carts along at a whizzing pace. the light wheels whirred as the wagons shot ahead. the scene, larry reflected, was like a nightmare. all about him were the chill mountains and craters of the moon, lifting their jagged peaks against the cold stars. ahead of the speeding wagon ran the toiling cluster of insect-men, their hard shells gleaming faintly in the starlight and their glowing antennae bobbing in a swift rhythm as they ran. the treads of the wheels rattled on the rocky surface of the road, the horny feet of the insect-men made a steady scraping sound as they ran. the two men seated in the cart ahead were monstrous and misshapen figures in their space suits. larry's companion had remained sullenly silent, in spite of several efforts to start a conversation. this was unusual in one of the normally pleasant and talkative lunarians, but larry had not thought much about it. now, as he made some remark about the speed of their progress, he heard a low chuckle and in his earphones sounded the voice of diana staunton. "yes, larry, we travel fast. in a few days we will enter the zone of sunlight." "_you_," he exclaimed. "this expedition is too dangerous. i would never have let you come if i had known." "why else do you think i kept so silent until now, when it is too late to send me back?" she asked, and though he could not see her face through the glass of her helmet in the darkness he could tell that she was smiling. "neither would pyatt of kagan or my father have let me come. i stole the space suit of the young man who was to accompany you and left him locked in a storeroom." "you will have to remain outside when we go within the barrier." "where you go, i go," she said with finality. * * * * * sunrise on the moon! there was no sudden onslaught of light as on the earth, for the moon day was twenty-eight days long! yet, as they progressed steadily toward the horizon, the moon's rotation brought the edge of the sun gradually into sight above the barren horizon, and as the days passed, a blinding glare of light swept in upon them and they moved the dark glasses into place in front of the windows of their space-suit helmets. the temperature rose rapidly with the coming of the two weeks' sunlight, and before long the frost on the space suits was melting. then, stretching along the crest of a mighty mountain range ahead, larry saw a lofty gray wall that went so high its top was almost lost from view above. they had come within sight of the great barrier! xiii several times along the way they had been halted by sentry-patrols from some of the other outlaw caverns, who warned them that an unusual number of strong parties of troops from gral-thala were roaming the waste-land. however, they came without incident to a tiny outlaw hide-out. this was within half a mile of one of the caverns that was under the domination of the lords of gral-thala. two hours later larry and the others stood with a score of other people, in an air-lock in a great tunnel that led through the mountain range and into gral-thala. all these people were residents of the valley returning from a tour of duty in the caverns, and the four outlaws from chotan had been furnished with forged documents that gave them the same identity. the space suits had been removed and hung on numbered racks. the three men wore the tight tunics and loose trousers that were the customary dress within the valley, as distinguished from the loin cloth and cloak of the cavern outlaws. this was fortunate, for the trousers concealed the sturdy earthly legs of larry and colton which would have stood out in sharp contrast to the typical spindly shanks of the otherwise well-built lunarians. diana wore a loose robe, with tight wrappings concealing her hair and a thin veil over her face. a heavy guard of soldiers checked the papers of all the travelers before they let them through. these troops wore light armor, and each carried an electronic gun slung from his shoulder. the officers were evidently of the invaders, cruel-eyed men cast in the same mold as xylon. the men were lunarians, generally of a rather debased type and drawn from among the worst element in the population. a heavy-featured trooper glanced at larry's papers in a perfunctory manner, then handed them back. "all right, all right!" he growled. "get along. don't block the way!" the tunnel ended on the inner slope of the mountain range surrounding gral-thala, where many cars ran down the steep incline into the city below. it was a pleasant and smiling land that larry gibson saw before him, a sunlit and fertile valley so vast that even the lofty range on the far side was invisible over the horizon. towns and villages dotted the plain. farms lay among their fertile fields. a small river wound through the center. directly below him, clustered against this part of the valley wall, was a mighty city. "this is the city of pandonaria," diana's voice came softly through her veil, "capital city of gral-thala." the city itself was a terraced mass of colored buildings cut by many streets and interspersed with gardens. several towering palaces of white and gold, the abodes of the lords of gral-thala, dominated the lower buildings. it was good to see real sunlight again! to see birds flying overhead! to smell the odor of flowers and growing things, in contrast to the flat and motionless air of the lost caverns! it was hard to believe that this pleasant spot was really the scene of such a brutal tyranny as he had been told. then they rounded a bend in the sloping road and came to an abrupt halt. * * * * * at the side of the road stood a sort of gallows, made of strips of a ruddy metal bolted together. from it hung the nude body of a young lunarian girl. she was suspended by her bound wrists high above her head, and her feet swung far off the ground. from the clotted blood at her bound wrists, and the way the eternal sun of the valley had burned her skin, larry knew that she had hung there many hours. the girl was far gone but she was not yet dead. at intervals her drooping head moved feebly from side to side. a pair of armored soldiers leaned on their weapons below the gallows. around the girl's neck hung a sign, lettered in the archaic english script that was the official language of gral-thala: "this girl dared strike one of the nobles of gral-thala who condescended to notice her." fierce anger filled larry gibson's heart, a consuming anger that set his clenched fists shaking. for some reason he thought of diana. though she stood only a few feet away from him, he visioned her hanging from such a gallows if the dissolute tyrants of this land ever stormed the lost caverns. then pyatt of kagan laid a hand on his arm. "careful, my friend!" the lunarian hissed. "your anger shows on your face, and that is bad. we cannot help that poor girl now. come!" they went down into the city, avoiding the broad boulevards and keeping to the narrower streets where the poorer people were. as they passed by the base of one of the high palaces, they came to the body of a girl who lay crushed on the stones and had evidently been thrown or jumped from one of the upper windows. an aged man stood astride the body, leaning back and shaking his skinny fists at the white and gold bulk of the palace above him. "woe be upon the lords of gral-thala!" he screamed in his shrill old voice. "triple woe upon the tyrants and upon the decadent parasites who fawn upon them. evil lies in wait for ye, lurking in your white palaces with your guards and your harlots! the hour of doom is not far away! the vengeance of gorton and laila may be long delayed, but it comes in the end! woe to the lords of gral-thala!" an uneasy, sullen, murmuring crowd was gathered around the ragged old man although they left a broad circle of vacant space around him and the body of his granddaughter. a few troopers of the garrison were making a half-hearted effort to push the crowd back. they were uncomfortable in the face of the unspoken but obvious hatred of the throng. larry and the others prudently kept to the back of the crowd. even so, they were near enough to see what happened next. silver bells rang sharply, and lackeys called an arrogant summons to clear the way. in the midst of a circle of armed guards, porters carried a swaying gilt litter. on the cushions of the litter rested a man. it was one of the nobles of gral-thala, a perfumed degenerate in silken robes with a rouged and painted face. for a moment he stared at the crowds with his arrogantly scornful eyes. then, as he saw the old man beside the girl's body and heard the curses he was shouting, his patrician face was distorted into a sneering frown. the noble snarled an order, and one of his guards lifted his electronic rifle. there was a flash of blinding light! a sudden clap of miniature thunder, and a smell of ozone. the man-made lightning bolt struck the old man in the chest and knocked him sprawling across the body of his granddaughter. with a faint smile the noble leaned back on the cushions of the litter and waved languidly to his porters to move on again. "let us go, my friends!" pyatt whispered hoarsely. "we cannot right all the wrongs of gral-thala at one stroke, and our mission is the most important thing at the moment." xiv they were walking slowly down one of the quiet streets of the city, a quarter where there were few guards and little chance of discovery. larry noticed that all the windows were equipped with heavy shutters, so that the light could be closed out when the inhabitants of this land desired to sleep. it was a place of unending daylight, always turned toward the sun, where darkness never came. colton was more interested in the metal rails that ran along the walks on the outside of the buildings. "my lord!" he said softly, "these are gold!" "of course," pyatt of kagan said absently, "gold is one of the most common metals in gral-thala. our problem is the matter of the radium salts. i happen to know that they are stored in small boxes made of ura-lead, in one of the government storehouses. it would be easier to steal some direct from the mines, but there is no time for that because of the question of proper packing and handling. we must risk everything on a bold attempt to raid the warehouses." "suits me," larry said quietly. just then diana gripped him by the arm and jerked him back against the wall of the nearest building. "look there!" she hissed. another litter was passing along the cross street just ahead of them. this litter went in evident haste, with lackeys swinging whips to clear the path and the passenger bending forward to urge his bearers to greater haste. the man who rode in the litter was xylon! the four outlaws stared at each other in grim and ominous surprise. there had been no doubt of the identity of the man who had just passed within a few yards of them. "but what does _that_ mean?" larry gasped. "it means that i have been a fool!" pyatt snarled. "xylon is evidently no outlaw who came to the caverns to seek shelter, but a spy sent out by the lords of gral-thala. now i understand the reason for that revolt among the insect-men! he must have stirred it up in an attempt to kidnap diana here because of her hold over those simple creatures. now the location of the lost caverns is at last known to the tyrants, and there will be an attack in force." "and xylon knows that we are here in pandonaria!" diana exclaimed. "which means that all our lives hang by a thread no heavier than a woman's hair! we must get under cover at once! then we will send word back to the caverns by secret radio, that they may prepare for an assault. after that we will plan an attempt on the radium salts." the outlaws of the lost caverns had certain confederates within the city, and they now took refuge in the house of a small merchant who was a distant cousin of pyatt. larry watched as pyatt and the merchant crouched over the sending set concealed in a small closet built in the thickness of one of the walls, the arkon-bulbs flashing as they sent the warning to chotan to be spread to the other caverns. at last pyatt straightened up. "at least that is done," he said. "now we will wait two hours, which will be the time of the third meal. there will be few people on the streets, and the warehouse guards will be drowsy, and we will have our best chance." * * * * * pyatt and colton had gone somewhere else in the house, and larry sat with diana in a small room whose windows looked out on the green fields beyond the city. the girl had loosened her blue veil so that it hung in soft folds about her chin. "this is the first time in my life i have been anywhere but in the caverns and on the waste-land," she said moodily. "this valley of gral-thala is a pleasant place." "you would like earth even better." "i suppose i would. will you take me back to that earth of yours when you return, larry?" "not until the gray death is overcome! i would not want to take any chance of it striking you down." "do you love me, larry?" she asked, without either coquetry or embarrassment. "i guess i do. of course, we've only known each other for a few hours--but i guess i do." "i am glad," she said simply. the two hours passed, and pyatt came striding back into the room. they had given him one of the ray-guns brought ashore from the _sky maid_, and he carried it thrust in his girdle close to his hand. "it is time to go," he said. "we must make our attempt now, win or lose. where is colton?" "i thought he was with you." "haven't seen him in two hours!" a hasty search of the merchant's house and small grounds revealed no trace of the missing officer. pyatt stood glowering blackly and pulling at his chin. "i don't like it," he said. "yet, if the soldiers had taken him, they would have come for us as well." a different thought was running through larry's mind, a grim and unpleasant suspicion. he was remembering colton's past history ... his general sullenness ... the greed that he had shown throughout the entire expedition. he was also remembering that he had seen colton in deep conversation with xylon a few hours before they had left chotan. "i am afraid," he said bitterly, "that colton has sold us out to xylon and the lords of gral-thala for promise of reward. we had better get out of this house right away, before...." larry never finished that sentence. there was a roaring crash, and the door was shattered by the impact of a pair of electronic bolts fired by the soldiers who had crept up to the house. armored figures came pouring in the door! others were at the back. pyatt of kagan, fighting furiously, went down under press of numbers. larry managed to get his ray-gun up and fire one blast that crumpled a charging trooper in mid stride, but then half a dozen gripped him and the brief fight was over. they were taken! xv the hands of the three prisoners were tied behind their backs, and nooses were placed around their necks. then they were dragged out into the street. the merchant was not taken prisoner at all, simply killed out of hand with the body left lying across his shattered threshold. a thin-lipped, hooked-nosed officer spat in larry's face as he was led past the body of the dead merchant. "not for you will there be such an easy ending," he sneered. "an example is to be made. you will die before crowds, in the plaza of the four virgins, and the process will be a slow one." they were surrounded by a double rank of guards as they were led along by the nooses about their necks. all three had been stripped to a loin cloth, and the sun was scorching hot upon larry's back and shoulders. at least, he thought thankfully, diana's long black hair gave her some protection. there were jeers and hoots as they were led through the crowded streets, but most of them came from members of the tyrant class and from the few over-dressed and foppish lunarians who aped their masters. the mass of the people gazed in stony and somehow sympathetic silence. into one of the tall white-and-gold palaces of the lords of gral-thala they were taken, and down into stone-walled dungeons far underground. they were placed in a single cell. they stood with their backs against the walls, arms out-stretched and wrists lashed to rings set in the stone, able to move little more but their heads. then, for a while, they were left alone. "well," said larry with grim humor, "here we are." "so it seems!" pyatt's voice was rasping and bitter. "i am indeed a fool for ever having allowed xylon to live in the cavern of chotan, in spite of the kind-hearted ruling of the elders." "what will they do with us?" larry asked. pyatt hesitated, licking his lips and glancing at diana, but the girl answered for herself. "we shall probably be skinned alive in the public square, dying slowly under the torture," she said. "it is the favorite punishment of the tyrants for those they particularly hate." it was a day of triumph for the lords of gral-thala. xylon's triumphant return with the information that would lead to the wiping out of the always troublesome outlaws of the lost caverns, and the capture of the three prisoners, made it a holiday for the ruling class of the valley. they came in hundreds to see the three captives. the famous military leader of the outlaws ... the girl who was considered a goddess by the primitive insect-men of the waste-land ... the the stranger from that distant earth whence their own ancestors had fled. they came to throng the dungeon corridor and stare in at the trio of captives spread-eagled against the wall of the cell. larry watched them through the barred door. for hours on end there were always a few of them in the corridor, staring and jeering. foppish men in white and gold with their curled hair laden with scent. haughty and jewel-clad women whose sharp featured faces held even more cruelty than their male companions. many were attended by lunarian slave girls whose fettered hands held their trains up from the floor, and the bare backs of the slave girls were usually marked with the crossing red marks of whips. larry knew, now, that the tales told in the caverns about the cruelty of the lords of gral-thala had not been exaggerated. * * * * * xylon came to see them after a while, opening the cell door and walking in to stand sneering at them with his thumbs hooked in his jeweled girdle. "colton sold you out for the promise of wealth and a place in the ranks of our nobles," he said. "it will be a pleasure to watch you die." for a moment he walked over to stand in front of diana who looked back at him with an expressionless face. "you are not a bad-looking wench. i can take you for one of my slaves if you wish to be agreeable." "i would rather go with an insect-man!" the girl said with calm scorn. xylon shrugged and turned away. "so be it. at that, it would be a pity to rob the crowd of the pleasure of watching you die." as near as larry could judge it, the equivalent of an earthly day had passed before they were taken out of the cell. they were given an hour to ease their stiffened muscles. then the guards bound their wrists before them, and by the trailing ends of the ropes led them out of the dungeons and through the streets to a broad open space just at the foot of the inclines that led down from the tunnel by which they had entered the city. the plaza of the four virgins, named from the four gigantic statues of polished stone that had been placed at its corners in some long ago day before the invaders came, was a vast paved space in front of an ancient temple that was now used as a government building. in front of the temple a metal scaffold had been erected with two heavy uprights and a cross-piece. the rulers of gral-thala were sprawled in cushioned ease on the steps of the temple, well guarded by their troops, and the floor of the plaza was filled with the common people of the city. these latter were present in great number, a silent and ominously sullen mass. the three prisoners were stood in a row on the scaffold. their hands were raised above their heads, and the ropes made fast to the cross-piece so that they were held tautly erect and motionless. sharp laughter and occasional jests came from the nobles and their women clustered on the steps, but as larry looked out over the crowd in the plaza he saw faces that were grim and intent. the threat of the electronic rifles of the guards would keep the unarmed mob from trying to aid the prisoners, but there was no doubt where their sympathies lay. glancing up at the tyrants grouped on the temple steps, larry suddenly saw colton. the former second officer of the _sky maid_ now wore the white and gold robes of a noble of gral-thala. xylon kept his promises! colton flushed uncomfortably when his glance met larry's grim stare, quickly turning his eyes away. he looked uncomfortable and ill-at-ease. larry glanced at him again a few minutes later and saw colton staring at diana's bound and motionless form with definite misery in his eyes. one of the nobles stepped to the front and began to address the crowd. shrill yells and catcalls drowned his words. the guards raged, but the men in the front ranks of the mob were discreetly silent and they could not reach or identify the culprits in the ranks behind. many of the nobles were muttering nervously among themselves, showing definite signs of fear. "there was never a scene like this in pandonaria before!" pyatt of kagan exulted from where he was bound beside larry. "we may die, but our death is likely to stir the people to such a pitch that the revolt will soon come!" xylon, for all his faults, was made of sterner stuff than most of his fellow nobles. he sneered down at the muttering crowd, then signed to the officer commanding the guards. "pay no attention to the dogs," he commanded sharply. "give these three a taste of the whip before the flayers rip the skins from their bodies. begin with the girl." a heavy-featured man in a black tunic stepped up to diana, pulling the lash of a heavy whip through his hands to test its suppleness. before he could strike there came a sudden interruption. a small car had been speeding down the incline from the tunnel entrance and now a gilded officer of the invaders leaped out and came running across the plaza. "great news, oh xylon and nobles of gral-thala!" he shouted. "one of our patrols has captured a great force of outlaw warriors and their insect allies, who were moving in to raid our nearer caves. some more earthlings are with them!" "good, by gorton!" exulted xylon. "we will delay the execution of these three till the others are here to see it." larry's last hope was gone. he had remembered ripon's promise to come after them if they had not returned quickly, and in the back of his mind had been the thought that the doughty scientist might yet accomplish a rescue in some way. now that hope had vanished. he sighed, and beside him diana sagged visibly in her bonds. "guess it's the end," she said. "good bye, larry!" xvi from where he stood on the scaffold, larry could see a number of the big transport cars coming down the incline. they were crowded with prisoners and guards, and he caught the gleam of the hard brown shells of insect-men. once unloaded from the cars, they all formed up in columns and came quickly across the plaza. behind the front rank of guards larry saw ripon, and some of the men from the _sky maid_, and many whom he recognized as leaders among the lunarians of the lost caverns. it was all over now. the prisoners trudged along like beaten men, utterly disheartened although they were but thinly guarded. the nobles grouped on the temple steps were laughing loudly, all their nervousness of a moment ago gone before the reassurance of this victory. then, as the prisoners were halted in the plaza directly before the double line of soldiers that guarded the temple, an officer beside xylon leaned forward to point down at the commander of the patrol that was bringing in the prisoners. "that man wears the insignia of an ensign of the first rank," he shouted, "but there is no such man in the ranks of our officers! there is treachery here!" before the man's words had died away, crispin gillingwater ripon had whipped a ray-gun out from under his cloak and smashed the officer's chest into a charred pulp with the deadly blast of the rays. in an instant the plaza was a wild turmoil. the pretended prisoners drew their hidden weapons. those who had been masquerading as guards, using the armor they had taken from the soldiers they surprised and overwhelmed when they stormed the tunnel entrance, threw the uniforms aside and charged into the fight. the rippling crashes of the electronic guns rang out again and again, the murky flashes of the earth-men's death rays stabbed into the fray, and a clicking horde of insect-men charged home with their spiked clubs swinging. [illustration: _in an instant the plaza was in a wild turmoil.... the rippling crashes of the electronic guns rang out again and again. the murky flashes of earth-men's death rays stabbed into the fray, and a clicking horde of insect-men charged home with spiked clubs swinging._] for the first few moments the fighting centered around the scaffold. xylon led a charge of picked men down to seize and keep the three prisoners bound there, ripon came storming through to effect a rescue. when the mélee was over, larry and pyatt were free and xylon had retreated back to the temple steps, but diana had disappeared. "we got the rest of the crew from the _sky maid_ and all the men we could collect at chotan and crept up to the tunnel mouth," ripon panted as he thrust a ray-gun into larry's hand. "we took the guards by surprise and killed them before they could warn the valley behind." it had been a daring raid, and at first its sheer audacity had carried it near to complete victory. now the superior numbers of the guards were beginning to tell, and more of the troops of gral-thala came pounding up at the double. the crash of the electronic guns became a steady roar, and bodies were thickly strewn about the blood-smeared surface of the plaza of the four virgins. then, with a long-drawn and sullen shout, the mass of watching lunarians flung themselves on the soldiery. hundreds died, but the others tore the guards to pieces with their naked hands and then snatched up their weapons. the people of gral-thala had risen against their oppressors at last! * * * * * with the uprising of the people, the battle ceased to be a fight and became a massacre. the troops were selling their lives, as dearly as they could, but thousands more citizens carrying improvised weapons were pouring in from every street and the thing was only a matter of time. then, in the rear of the panic stricken mass of nobles who were fleeing into the temple to make a last stand, while the vengeful pack bayed at their heels, larry suddenly saw xylon! the tyrant was standing beside one of the great stone columns that supported the portico of the temple. he held the half naked body of diana before him as a shield. the girl's hands were still tied and she could not pull away. a swarm of insect-men, who were bounding up the temple steps, halted as they saw xylon hold an electronic pistol to the head of their goddess. "keep back or she dies!" he shouted. "she is hostage for our safety!" larry lifted his ray-gun, and then lowered it again with a groan. he dared not shoot with diana's struggling body in the way. nor had he any doubt that xylon would kill the girl without compunction if attacked. xylon began to edge back toward the temple door. larry still stood indecisive, the others seemed frozen in their places. then another white-and-gold figure darted out from the temple behind xylon. the renegade colton twisted the gun from xylon's hand! the thing was over in an instant. xylon released diana and turned on colton with an oath, and the girl instantly dropped to the ground. steel flickered in the sunlight. xylon drove a long knife home between colton's ribs, but before he could dart away larry's ready ray-gun struck him down with its blast. his quivering body rolled slowly down the steps till the insect-men reached it and literally tore it into bloody bits. xvii the dying colton was sinking fast. his face was gray as he looked up with a faint smile at the others who were grouped around him. "i never was much good," he said faintly. "guess it just wasn't in the blood. gold always led me into twisted paths, and i couldn't resist xylon's offer. but it did something to me when i saw the way those devils were going to torture the girl. well--i guess i paid my debt at the end." "you've paid it--and you'll live to go back to earth with us," larry said. colton shook his head, his eyes glazing. "don't try to kid me. i'm cashing in my checks," he said--and died. now that it was all over, larry felt very tired. he put one arm around diana, and leaned back against the base of the column. there was still some intermittent fighting going on where mobs of vengeful lunarians had cornered some of their oppressors, but the victory was won. ripon looked about at the carnage with a satisfied smile and them sheathed his ray-gun. "it was a good fight!" he said. "i haven't had as much fun since the time i wrecked a saloon in port mahon. now, young feller, you just take care of the lady here while i take a squad and get the radium salts from the store-house." "and the _sky maid_?" larry asked. "that sour-puss masterson has been standing over the men with a ray-gun in one hand and my last jug of rum in the other ever since you left. all the repairs are finished. we start back to earth as soon as we can get our cargo aboard." "then the people of your planet will be saved?" diana asked. "they will be saved. and as soon as the gray death is checked i'll come back for you. then the moon will have to get along without its goddess for a while." "i'll be waiting," she said. one against the stars by vaseleos garson earth's last hope against the vicious radio-plague. a gleaming ship racing to bring salvation back from venus. and hidden on the ship a thirteenth man--a plague carrier whose touch brought screaming death. [transcriber's note: this etext was produced from planet stories summer . extensive research did not uncover any evidence that the u.s. copyright on this publication was renewed.] this was it. its slim bright shape was earth's last hope. what matter the sweat, the blood and the tears that had gone into each rivet, every plate? what matter the eyes blurred and dulled with plans, blueprints? what matter the cost. this was it. it was done. they stood there--the riveters, the welders; the draughtsmen, the engineers; the mathematicians, the technicians--and there glowed in their eyes a living flame. this was the ship of hope. its rockets flickered into blue flames. their soft purr of power deepened. abruptly, the earth was trembling to the throaty roar of rockets. in its long steel-rollered cradle, the ship trembled. one of the workers, his denim trousers grease-stained, bending down, scooped up a handful of the dust at his feet, flung it at the shining ship. "just for luck," he said. in the glass bulge atop the shining ship, john bairn, the pilot, licked feverish lips. he brushed the black hair away from his gray eyes. his stubby fingers raced over the keys of the control panel before him. his right hand touched--almost reverently--the scarlet handle of the firing lever. he pushed the lever forward one notch ... two ... three.... he braced himself in the hydraulic-cushioned pilot's chair. "venus, here we come!" the rockets roared faintly even in this sound-proofed cubicle. then the pounding blood in his ears washed out all other sound. the pounding in his ears grew throatier, louder. the g acceleration blacked him out. that dive was a little too steep, he was thinking, first time i ever blacked out with somebody on my tail. he jerked his head around to see where the butcher was. and then he remembered. he looked ahead. the stars were steady white flames in the black pool of space. ah, there it was! the pale green flame that was venus. somewhere, there, lay earth's salvation. arlington arden, the metal expert, came into the cubicle then, his blond face pale. "some shove, huh?" he opined. bairn nodded, his gray eyes watched the orientation chart whose red and green and yellow lights were flickering in the rhythm that showed they were on the mathematically-charted course. "think the stuff is really there, arlie?" bairn questioned. "we're staking our lives on it, john." "yeah, and the lives of a billion like us. what if it isn't?" "venus' spectrum shows its presence. it's not an emanation that is easily duplicated. if it isn't, it's too much of a grim joke--because the money in this ship could have paid for a thousand experiments. my mary's got a touch of blue coloring in her skin--the first symptom, y'know." "sorry," bairn said, and his voice was soft. "beautiful," arden said. "i hope mary can see it sometime." he was looking out at space, his arms clasped behind him. "it's not like i thought, though--this being the first humans to see the stars away from earth." he stopped. "it's so damn big and beautiful it hurts," he said at last. "yeah, i know," bairn put in. "it makes guys like us feel cheap and small." "no!" the word was explosive. bairn jerked around in the pilot's cradle and stared. arden had a frown on his forehead. "and who in blue blazes are you?" bairn snapped. "joe," the big blocky youngster said, as if that explained everything. "joe, huh?" bairn grunted. "how did you get on this ship?" * * * * * joe's brown eyes stared steadily at bairn, and his big shoulders shrugged. "i stowed away." and then as the two stared blankly at him, he hurried on: "i had to. really. there's a legend in our family that a man named joe will be the first to reach the stars. it was promised way back when. so i had to come. i had to!" bairn grunted again. "isn't much we can do about it now, i guess. but you'll have to earn your way. what can you do?" joe grinned--a big grin that made bairn and arden smile. he shrugged and grinned again. "i don't know. but i'll be good for something. you'll see." "all right. arlie, will you take him down to the rocket room? maybe the gang can find something for him to do." "come on, joe," arden said. joe shook his head. "not just yet," he answered. "i'd like to tell you something first." he pointed out toward the stars. "a minute ago, you said"--he nodded at bairn--"this makes us feel cheap and small. "you're wrong. you're just afraid. all this is man's--yours, mine, ours. it's just so darn big, we don't realize it. but this is our destiny--that's what the prophet said a long time ago. it took a disease like that sweeping the earth now to get us here. but we're here. the stars are our destiny. no sense in being otherwise. no sense in feeling cheap and small." he stopped, looked at bairn and arden. "don't you feel it?" joe asked. "this first time the earth shackles are loosed? don't you feel the power and understanding and strength the stars give you out here? "this is where i belong," joe said. "out here where you can see what you're reaching for. that's why i had to come." he stopped and a slow embarrassed flush crept over his face. "see what i mean?" surprisingly, it was bairn who answered: "thanks, kid, you're good for something all right. i don't know what it is about you, but you give a guy a sense of--peace, i guess you'd say." "belonging?" arden put in. "that it, johnny?" "yeah, that's it," bairn said, and turned back to his orientation board. "so run along, kid." arlie arden, leading the way down the circular staircase that went to the power room, said abruptly: "you're no city man, are you, joe? i've never seen cloth like that made in the cities. that tunic you're wearing looks like it's made up for the north forests." "no," joe answered shortly, "i'm not a city man. i'm a wooder." they left the stairway, moved along a tube passage. "not a member of that crazy cult that wants a back-to-the-forests movement?" joe's denial was quick, and arden looked at him sharply. the stowaway was looking down at his toes as he walked on. arden shrugged. "here," arden said at last, stopping before a huge oval door that jutted from the tube. he twisted a wheel on the door, pushed the heavy portal open. arden watched the stowaway as he stepped into the power room. joe stopped and his brown eyes lifted first, then dropped down to rest on the huge generators that were making the air pulse with vibration. then his eyes moved to the huge dull-metal bulk that occupied the whole far end of the power room. his gaze took in the feeder pipe that evenly cleaved the huge bulk of the machine in half; the long neat rows of switches and valves that broke the austere front of the power plant. joe breathed deep once then turned questioningly to arden who was watching him. * * * * * "that's what drives the ship, joe," arden said. "reduced to its simple terms it's an atom smasher. hidden deep within that bulky outfit lies a block of uranium, constantly bombarded with electrons made a trifle heavier by running up against a magnetic current operating at right angles to them. the resultant disturbance of the uranium is harnessed and fed into the rocket tubes." arden glanced at joe whose eyes were fixed on the feeder pipe. "that's a funny thing, joe, that pipe you're looking at." "why?" "through that pipe comes water." "water?" arden nodded. "for some reason that not even the technicians who worked on that plant know, microscopic jets of water have to be hurled into the chamber with the bombarding particles to cause proper power." "water?" joe asked. "you drive this ship with water?" arden smiled. "yes, water and the help--not negligible either--of uranium. it'll take exactly two hundred and twelve gallons of water to drive to venus, and the same amount back--at least that's what black tom figures." arden nodded to the huge dark-skinned, black-haired man in white coveralls who stood by an instrument panel, checking figures off on a clip board he held. "come on, joe," arden said, heading for a ladder that was bolted to the wall at one side of the huge power room. joe followed up the ladder, was on the heels of arden as the metal expert crawled through a cubbyhole at the top. "see?" arden said straightening up. "water." joe looked at the row of horizontal metal cylinders that stretched before him. the tops of them were a foot taller than his head, and he moved to the side, and counted aloud to eleven before arden said: "we might starve and go naked, but we'll never run out of catalyst or get thirsty," arden opined. "each of those tanks holds six hundred gallons and there're twenty-four of them." joe moved to the nearest of the tanks, rubbed his hands on the moist surfacing and commented absently: "it feels like velvet." arden laughed a little. "come on, joe, i'll turn you over to black tom and he'll put you to work doing something. he never likes to see anyone idle." they crawled out of the wall cubby and down the ladder. a second white-garbed man had joined the power room head and they were talking together as arden and joe approached. "that's whitey burnet," arden said, and started, for joe had halted dead in his tracks. black tom morrissey and burnet turned then. morrissey said, "hello, arlie," briefly and turned back to his gauge panel. burnet stood rigid for a moment at the sight of joe. then with three quick strides burnet was at joe. he said softly: "damn you, joe." and lashed out with a hard fist. the blow caught joe on the cheek, cutting the skin, and staggering him momentarily. joe started to swing his browned fist up, then slowly he lowered it. he looked at burnet with quiet brown eyes. "i can't hit you, paul. you know that." paul's face was white. "no," he said, and he was almost bitter. "i know that." then he turned his back on joe and walked away. arden's blue eyes watched the by-play, observed: "whitey doesn't like you very much, huh?" joe's brown eyes were dull looking as he pulled his gaze from burnet's retreating back and looked at arden. "no," he said, and his voice was flat. "paul doesn't like me much." with an effort he smiled, added: "shall we find out what i can do?" arden nodded.... joe wilding met the rest of the crew at the arbitrary meal that was termed supper. * * * * * joe came in behind arden, and unobtrusively slid to one side of the door, and watched the men around the table laughing and joking. arden said: "fellas, i'd like you to meet a new crew member." the laughing and joking stopped, and the eyes of eleven men measured joe wilding. black tom winked at joe and went back to his eating. whitey burnet, after a brief angry glance, turned back to his plate. arden added: "his name is joe wilding." the others at the table smiled, nodded or spoke according to their habits--except one, a nervous redhead, who stared at joe. then he looked around at the others at the table. he was a little apologetic. the redhead said: "i know this guy. i piloted the ship that took him to the rock for sedition. i don't think we want him on the ship. he's one of those wild ones who tried to kidnap the president." arden grunted: "i thought so." burnet, his normally ruddy face white, reared to his feet: "no!" he shouted. "you're wrong, herd. he was pardoned. i know. they found he had nothing to do with the kidnaping." "maybe so," charlie herd, assistant pilot said, still apologetically. "but i know i took him to the rock--and i didn't hear anything after that about him. but he's the same guy. "he was a wild one," herd said almost dreamily. "he knocked out two of the guards, grabbed one of the chutes and was almost out of the ship before i rolled the crate over and bashed him against the cabin wall." whitey burnet's face was still white. "look," he said. "i don't like joe, but it's something personal. the tribunal found him innocent, so why not give him a chance?" arden turned to joe who still stood by the side of the door, his handsome bronzed face stiff. "well?" arden asked. joe smiled. he said, looking at the red-headed herd: "you're right as far as you went. i was taken to the rock. i did try to break loose. the tribunal found me not guilty and apologized. i was released. and here i am." herd looked back at joe, and then he smiled, half-apologetically: "i'll take you at face value. you look all right." "thanks," joe said. bob and ronnie guetschow, the bulky professor twins, broke the ensuing silence with: "come on and eat." the ice broke silently. arden motioned joe toward an empty chair at the table. joe moved forward, then stopped as his eyes counted the men at the table. "sit down, joe," arden grunted, picking himself a convenient, padded chair. surprisingly, joe shook his head. "no," he said, and for the first time he looked embarrassed. there was a slight flush under his tan. the table talk stopped again. george keating, the thin, wiry electrical engineer, said half-jokingly: "afraid you'll get contaminated?" joe's tan skin lost its red of embarrassment, twisted strangely. "sorry," put in keating hastily. "only joking." joe swallowed. then: "i'm just superstitious, i guess." the words rushed out. "if i sit down, that'll make thirteen." * * * * * ed parman, black-haired assistant to black tom, jumped hastily to his feet. "good gravy, he's right. you sit down, joe, i'll finish my pudding in the corner." joe said: "sit down. i'm used to discomfort. i'm a wooder." he grinned. parman grinned back, started in on his pudding. joe, the men were to notice in the coming days, seemed to make a point of never eating with the bunch after that. but he did it so smoothly, it wasn't offensive.... venus, in the days that followed, grew from a tiny yellow-green flame, that bairn, the pilot, had noticed in the first hours of the flight, to a white globe, just hinting a tint of blue, that began to fill the heavens before him. joe, on an off hour from the power room, sat quietly in the co-pilot's chair, drinking in the planet. he and bairn, usually so taciturn, had talked much in the days of the flight. this day, when joe came in, bairn looked at him with a strange twist to his mouth. he said nothing for quite a while, the two just sitting there, joe looking up and ahead, bairn, apparently preoccupied with figures on his charts. finally bairn said: "has arden said anything to you?" joe shook his head. "no," he said. "why?" bairn, apparently speaking absentmindedly, said: "arlie's wife, mary, has the radio disease. she's in the first stage. has the blue coloring. it means everything to arlie that this ship gets to venus and back. venus has the only radio-active static compound that matches the stuff from the meteorite." "yes," joe said. "i know. it was only luck that scientist, struthers, had that meteorite in the room with him when he had the disease. it cured him. and then scientists and astronomers searched star spectrums to find a match for the color scheme that they found in the meteorite metal." "this ship," bairn put in, "cost billions; it meant the first real cooperative program the world's nations ever had. it would be ghastly if one man caused the destruction of earth's last hope from doom. wouldn't it, joe?" joe's face was grim as he nodded. "how would you feel if you were to blame for drowning out humanity, joe?" joe stood up, and his body was shaking. "tell me, joe," bairn said quietly. "why have you kept yourself from eating with the rest of the guys? why is it when you come here you're always smelling of antiseptic?" there were tears in joe's brown eyes when he faced bairn. "okay, john, what shall i do?" "there's not much harm done yet? arlie says that in the first stages, it's only communicable by contact. but once it gets past that first stage, it goes hog wild. "tell me, joe, when did the nauseous attacks first come?" joe's brown eyes were dead. "two days before the ship left." "you were willing to sacrifice mankind just to see the stars yourself, joe?" it was arlie arden who came in quietly, then. "no," said joe, and then he looked at the two of them. "believe me," he said, and his voice was deep, vibrant. "i was drawn to the ship by a power greater than any of us. i knew the terrible gamble. for if this ship crashes before it gets back to earth with that venus ore, it means the end of man. "i knew that. everything my mind said pointed out the consequences. my mind said no in every possible way. but ... my mind had no chance against the impulse that drove me aboard ship. "somehow i know that my presence on board this ship means the salvation of mankind...." he shook his head at arden whose lips were pursed to speak. "it's not egotism or some crack-brained idea. i couldn't rest until i was aboard ship. i'm chosen to do something to preserve mankind, not destroy it. it's just as if something bigger than me or you or the universe had taken hold of me, placed me here." arden said: "do you know what we're going to do to you, joe?" joe looked at him steadily as arden drew a gun from his pocket. "we're going to kill you and throw you out in space. it's the only way to keep you from contaminating the rest of us." joe said: "you can't." simply, he said it. bairn said quietly. "we will, joe." arden lipped: "do you think we can value one life against earth's billions? this is the ship of hope, joe. this is earth's last chance. if we fail, it's the end. for once the disease starts, there is no stopping it." he leveled the automatic "good-bye, joe." * * * * * joe's body slumped, almost in weakness. then he galvanized into a human whirlwind. the gun cracked but joe was not there. he'd spun quickly, diving for the cubicle door, flinging a chart as he fled. the flying chart disturbed arden's aim. the gun blasted, and joe felt the wind of the bullet fanning his cheek. then joe was in the sloping passageway, sliding down the ramp. he heard the crack and the banshee wail as another bullet struck the duralloy wall and ricocheted. he hurled his body toward the branch passage that led toward the power room, and then a communications speaker ahead of him cried out, bringing arden's voice from the pilot's cubicle: "kill joe wilding--but for your life don't touch him!" joe stopped running abruptly then. he was trapped, for that communications system had outlets all over the ship, and it wouldn't do to advertise his presence by running. only the stealth he'd learned in his years of wooding could help him now. but what good was all his wood training in this huge hulk of shining metal? no chance for camouflage, no chance to dive into a creek and swim away so that your spoor could be lost in the swirling water. and then joe smiled and began to run softly. he had a place to hide if he could make it. the quick pat of hurrying steps stopped him short and his quick mind hurled his body to the side of the passage and asprawl on the floor where the lights cast a shadow. it was paul burnet hurrying up the passage, the light glinting on the butt of the automatic belted at his waist. only for an instant did burnet hesitate, then he ran on. his voice drifted back softly: "i'm giving _you_ another chance. we're even now, joe." joe rose to his feet and hurried on to the power room. joe halted, breathing deeply. black tom would be too interested in his charts to hear what little sound he might make. at the huge oval door leading into the power room, joe halted, breathing deeply. then, quietly, easily, he swung open the heavy door, stepped inside, his eyes searching for black tom. softly, he pulled the portal closed, stood there breathing in long, quiet breaths. then he moved across the huge power room, feet moving as cautiously as if he were stalking a deer in the autumn woods. black tom's head was bent over a report sheet, his fingers were busy with a pencil. he shook his head, and joe was motionless. then a chuckle came from black tom's lips, and under cover of the sound, joe made for the ladder leading to the water compartment. black tom's head lifted as if startled; his head began to turn toward the exit door. joe went up the ladder like a frightened monkey, fairly blasted himself through the cubbyhole at the top and then rolled quietly inside. he lay there, his heart pounding with the quick exertion as he heard black tom's footsteps moving across the floor. he held his breath; black tom's grunt of puzzlement came muted to his ears. the footsteps returned to the chart table, and joe risked a look to see black tom's head once more bent in study. joe lifted himself to his feet, went over and touched the wet surface of the first of the water cylinders reverently. he walked on down the line, patting each of the huge tanks till he had reached the last. his arms reached up, his hands gripped the top of the cylinder and the sinewy muscles in his back and arms lifted himself to the top of it. then he slid down from the top into the wedge shaped space between the circumference of the tank and the bulwark of the wall. this was sanctuary, joe thought. like a cave in the forest when the wolf-pack keened out their howls for your blood. only different. for it was your friends who wanted to kill you. in the darkness, joe's teeth gleamed in a quick smile. then joe fell asleep. * * * * * arden was weary when he met john bairn coming down from his time of duty in the pilot cubicle. "he's gone," arden said. "just as if he had stepped out into space. now we're worse off than ever." bairn nodded, said: "i get it. if he's on this ship, he'll have to come in for food; we won't know what he's touched. maybe one of the more susceptible among us with a scratch may touch something he had and won't know. the infected one will pass like the touch of death among us." arden said: "everything we know he might have touched has been destroyed or disinfected, but there may have been something we missed. damn him!" arden's voice was flat, hopeless. "it's hard to imagine joe as the destroyer he is. i talked to him by the hour. i liked him; and even now, when i know what a potential of death he is--that's what makes me so damn mad." "tomorrow," arden said abruptly. "tomorrow we'll know if this cruise is in vain." bairn amended it: "tomorrow, we land on venus; if the stuff's there, okay. if it isn't, we won't have to worry about joe wilding any more." * * * * * joe didn't know what time it was when it happened. but he knew the first leg of the journey was over. that steady thrumming of the motors that had worked its way into his body so that it had become a part of him drew away gradually and left a sense of emptiness behind. joe climbed down from his hiding place, flexed his cramped muscles and stood erect. he faced the wall, the blank duralloy steel wall and stared as if his eyes could pierce the opaqueness and look out upon venus. he stood there a long time, his hands clenched into hard fists at his side, bright-eyed and staring. "god!" he whispered. how did it look out there on venus--on that planet when this first earth ship landed? was it like earth--friendly, familiar? or inimical, alien? if he came out now, he could see it with his own wondering eyes--and die. if he stayed here, he might never see it. but his mission was not fulfilled. somehow, quite clearly, he realized that. so joe crawled back into his metal cave, into the darkness. the only sound in the quiet water compartment was a muffled sobbing. * * * * * arden it was who closed the heavy door to the chamber. "that's it," he said, and his voice was a caress. "there's enough of it in that lead-lined vault to rid the world. it's up to you, john, to take us safely home." some one of the men said: "how about wilding?" a hush came to the room, a silence tight and somehow menacing. arden's voice was harsh: "he can't hurt us now. we have the metal to cure us if he should contaminate us." whitey burnet said: "why not cure him?" "no," said arden. "i have the key to the vault. if one of us is infected, i'll open it and treat him. but joe wilding deserves to die. it wasn't his fault that we are still uninfected. he was willing to destroy the earth in order to be here. that threat is gone now, but he must suffer." "arlie," bairn said softly. "would mary want you to let joe wilding die?" arden spoke coldly: "did wilding care about mary when he stowed away on this ship?" bairn had no answer. * * * * * joe wilding was restless. even the fiery fever that racked him could not quiet him. he paced the long water compartment, legs weary but restless. he couldn't stand it here much longer; he had to get out into the light, out where he could move and see and feel something besides the dampness dripping upon him, the quick mutter of the pumps as they drove the catalyst to the firing chambers. he walked to the cubbyhole, looked down into the power room. whitey burnet was there, alone. impulsively, joe wilding climbed out of the cubbyhole and down the ladder. "paul," he said softly. "i'm hungry." paul burnet turned slowly. "hello, joe." they stood there, the two of them. whitey burnet, immaculate in his white work clothes; joe wilding, a heavy growth of beard on his face, his tunic dirtied, his hair mussed. "i gave you your chance, joe. just as you gave me mine. we're even." burnet turned to the communications phone, then turned back suddenly. "now you know, joe. now you know how i felt. you know how it is to be hunted, to be afraid of your own shadow, to know what a despicable creature you are. to be followed by a fear that freezes your guts--" "but i'm not afraid, paul. i'm just hungry, and tired of being alone." "i was alone, joe." "no, paul, you weren't alone, ever. carol's thoughts were ever of you. i hunted you the world over; but you always ran away. you never would give me a chance. and carol's letters always came back marked: 'no such person at this address'." paul's voice was almost mocking: "even now you act the gentleman, pretending. i hate your guts, joe wilding. but for you, carol and i would have been married long ago. i liked you once, joe wilding, i even thought what a wonderful brother-in-law you'd make. even now, i find myself liking you a little bit--but god knows i don't know why." "you'd better call them, whitey," joe said. "no, not yet. you saved my life when you dragged me away that day my kidnap plan failed. you carried me, fractured skull and all, away from the greatest chance a man ever had to make this a real world. if we had got the president we could have forced the wildwood doctrine down the people's throats." joe shook his head. "the people won't take forced medicine. they must have sugar-coated pills to cure them and lead them right." whitey cut in: "then you made me promise i'd quit. and you told carol of my plot, and she wouldn't look me in the face when i came." "she cried her eyes out when you left. she asked me to find you and bring you back. but you wouldn't listen." then, softly, "she's still waiting, paul. waiting for you." paul stood tensely, his eyes searching joe's bearded face. the atomic motor thrummed quietly. "you'd better call them, paul." whitey jumped unexpectedly, as the shrill keening of the danger siren suddenly keened into the power room. bairn's voice cracked through the speaker: "grab something, guys. a meteor, and we can't dodge!" like an exclamation point to his words came the heeling crash. * * * * * joe and paul were flung to the floor as the ship rocked and heaved. the lights went out, the motors suddenly cut off. there was a shuddering scream as metal tore; the air turned hot and dry. [illustration: _hell burst in the engine room._] the ship kept rocking as if caught in a great stormy sea. rolling on the floor, joe heard a deep roar that was beginning to grow shrill. a warning bell was ringing in his head; then he realized it was the bell signaling escaping air. then he was on his feet, holding himself against the heeling motion of the ship, crying out: "paul, where are you? paul, paul, paul...." "here," whitey's voice was weak, but joe followed it. he found paul, heaved him to his shoulders and staggered away toward a wall. it was the wall to the passageway he decided dully and felt along it until he found the door. it opened easily as if pushed by a giant hand. he struggled hard to get across the threshold against the pushing air. he made it, dropped paul to the passageway. then he tugged desperately against the pull of the air against the door as he dragged it shut. somehow, he got it closed, twisted the locking lever. he sat down against the wall of the passage and breathed in long, shallow breaths. in the darkness, he heard paul's voice: "did you mean that about carol," paul asked, and his heart was in it. "yes," said joe. "she's still waiting for you to come back to her." it was quiet there for a moment, with only the muted ringing of the bell from the power room seeping through the wall. joe said: "did i hurt you when i dropped you, paul?" "not much," burnet answered. "my head's a little dizzy, but it takes more than an easy jar like that to make it dangerous. forget it." "but how did you get through the physical for the trip? the metal plate in your skull should have barred you." "i'm one of the few who know what the power plant here is like, remember? besides, the physical wasn't too steep. and joe, i'm sorry i was such a heel to sock you when you couldn't hit me back. you'd have killed with the blow." "i know," said joe. he heard paul breathing in harsh gasps. "paul," he said anxiously. "it's all right." "but it isn't! here, i'll carry you to the first aid room." joe got up, lifted paul to his shoulders. joe had carried paul perhaps a hundred feet when lights flickering on the walls and the sound of footsteps signaled the advance of the others. "so," came arden's voice as the beam from a flashlight centered on joe's face, "the rat came out of his hole." after the blackness, the light hurt joe's eyes and he lowered his head. arden came forward quickly, slapped joe openhanded across the mouth. "i've waited a long time for this!" he slapped him again, and joe felt the blood trickling from his lips. joe lowered paul burnet easily to the floor. he wiped his lips with the back of his hand, said: "you don't understand. i'm bringing paul, he's hurt. his skull was fractured a long time ago, and it's reacting." he knelt beside burnet, took the hurt man's wrist. "how are you now, paul?" burnet smiled weakly: "a little better." arden kicked joe aside: "keep your diseased hands off him, traitor." joe got wearily to his feet. "arden," he said, "bairn told me how upset you are about your wife. that's why i excused those slaps. but this--" joe's right arm drew back swiftly, drove his doubled fist to arden's jaw. arden dropped as if the floor had fallen from under him. "that tears it, joe," bairn said. "i'm sorry, joe. but we have no recourse but to lock you up. you're a walking plague, and socking arden was the last straw." from the floor, burnet said weakly: "but arden had it coming...." "we can't be the judge of that. joe is worth no consideration now. don, lock joe up in one of the empty storage rooms, but don't get near him." "right," said timnson, the mathematician. "come on, wilding." joe started to move away, stopped and said: "see that one of the twins looks after paul, will you?" "go on," said bairn. joe went ahead of timnson. * * * * * the heavy door clanged shut behind joe, and he was alone in the darkness. the motors were still silent, and he wondered how much damage the meteorite had done to the ship. he felt his way to the communications phone, unhooked it. but the steady hum that signified that it was alive was absent. even the call speaker gave no sound. wearied, joe sat down against the wall, and despite the hunger feeling throbbing in his stomach fell asleep. it was the overhead light shining into his eyes that awakened him. his ears sought for the sound of the motors, no familiar thrum. the wandering meteor must have done quite a bit of damage. the communications phone buzzed. joe answered. "hello, joe," it was burnet's voice. "how are you, paul? the dizziness gone?" "right, but i guess it doesn't do any good. we're not going anywhere." burnet's voice was a little strained. "why?" put in joe. "that damn meteor knocked hell out of the rear blasting tubes, and some of the fellows are outside trying to replace the busted ones. but even if they get it fixed we're still derelict. that meteor took all of our water, and i guess you know what that means." joe was silent. then: "no catalyst, no move, is that it, paul?" "uh huh," paul answered, "no h- -o, no go." "the cans," joe said, abruptly. "cans?" paul questioned over the wire. "cans?" "sure," said joe, and he was breathless as he hurried on. "paul, all that canned food. there's water in them. and there must be some water left in the pipes to the kitchen and the lav? have they thought of that?" "yes," said paul. "the pipes, i mean, not the cans. arden and bairn are having the pipes pumped out now, doc guetschow tells me. but i'll pass along the can suggestion." "was it really bad?" joe asked. "sure, they got the power room sealed again. but that water compartment was mashed to junk, and the water just went pftt! it's a good thing you got out there when you did, or you'd have been pftt! too. i'll ring you back with any later developments." joe pronged the receiver. he began to pace the room. he couldn't stay in here. there must be something he could do out there. but this room was better than any prison. his eyes searched the room. joe's eyes were sparkling all of a sudden. bless the planners who laid out this ship! he broke the heavy crowbar from the emergency wall chest. he twisted the heavy steel in the locking mechanism on the inner panel of the door. bracing his feet against the door and drawing the heavy bar toward him, he strained desperately. he knew from his meandering around the ship that the locking device was only to insure the doors would not open accidentally. the muscles in his back and shoulders bulged so that the tunic he wore split down the back. he tugged until his muscles quivered with the strain. he should break loose now so he could open the door from the inside. but nothing happened. * * * * * joe relaxed, stood back and wiped the sweat from his brow; the lack of food had weakened him. the locking mechanism should have given way. once more he inserted the bar in the device. once more he called on his wood-trained muscles. he tried desperately this time, exerting all the strength he could summon. blackness threatened to engulf. then as if in a dream, he heard the muffled cling! that meant the device had snapped. he fell to the floor, his breath coming in sobs. then he quieted, lifted his body up, and twisted the wheel. it turned easily, and the door pulled open at his tug. he came out into the passageway to face arden, gun drawn. arden cursed softly: "won't you stay put, joe?" joe shrugged. "you need me," he said. "need you?" repeated arden. "need you to infect us so we can't get the ship going again." joe watched arden, then he said: "arden, why not cure me; then i won't be dangerous and i can help?" "no." arden's voice was flat. "i'm the only man on ship who knows how to give the treatment, and you're not getting any. your life is forfeit for what you almost managed to do." "you won't stop me, now, arden," joe said. "you can barely see me now, and you're trying so hard to keep from vomiting out your guts. you've got the radio disease; why don't you cure yourself?" joe moved back slowly; arden's gun followed him hesitantly. "you," arden said. "you did it. you gave it to me." the gun steadied. "no," joe said. "you had it before i ever came aboard ship. but you didn't know it, did you, arden? you're a carrier, and you came to the ship straight from your wife." arden shook his head weakly. "i took the usual tests; it showed me free of it." "but you know the usual tests, arden; you know you can't tell for sure until you get the nausea. and it acts at varying speeds with different people, doesn't it?" arden's fingers whitened on the gun; and joe leapt aside suddenly. the shot blasted out. then the gun dropped from arden's fingers and he fell forward on his face, retching. joe lifted the fallen metal expert almost tenderly, and carried him toward the hospital room. when he brought his burden in, joe saw burnet sitting on the edge of the bed, slipping on his sandals. doc guetschow, one of the professor twins, was remonstrating with him, trying to keep him in bed. burnet shook himself free and stood up. then he saw joe placing arden's body on the bed. "well!" joe turned and smiled. then he was serious: "arden's got the radio disease." "your fault, joe," burnet said. "he was right." "no," joe said doggedly. "he had it when he came aboard, too. he's got it bad, too. see what you can do for him, doc." then joe trotted out of the hospital room, and headed for the kitchen storerooms. wick wilson, who doubled as cook and metallurgist, was opening cans and draining off the liquid into a tub. "help?" asked joe. wick wilson looked at joe briefly, said: "i thought you were in the brig." then, "sure, lug the tub down to the power room. we're trying to get enough water out of the juice to make catalyst." joe hoisted the tub to one shoulder. "how about something to eat?" wick went into the kitchen, pulled a half chicken out of the refrigerator, brought back. "southern fried," he said. "it'll hold you together." joe bit off a chunk and carried the rest in one hand as he balanced the tub of fruit and vegetable juices on one shoulder and strode from the room. * * * * * black tom was putting the finishing touches on a metal cylinder he had salvaged from some of the shattered tanks. as joe came in the power room door, black tom asked: "how does it look? been a long time since i did any welding, but it'll hold water." black tom and herd, the assistant pilot, had bolted the jury rigged tank to the floor, and had, through some amateur plumbing work, hooked up a pipe system to the atomic motor. joe jerked his chicken-filled hand at the tub on his shoulder. "where does this juice go?" morrissey apparently had just realized that joe was free. he looked at him blankly for a moment. "dump it in the tank," he said, pointing to the metal ladder leaning against the tank. "but keep your distance," he added. "we don't want to catch the plague." joe grinned, stuffed the remainder of the chicken in his mouth, carried the tub up the ladder, and dumped the conglomerated juices into the circular opening at the top of the tank. joe came down the ladder. "got enough yet?" he questioned. "hell, no," exploded black tom. "look at the gauge we rigged up. here." joe looked at the gauge affixed to the side of the tank. it was about two inches below a chalk line black tom had drawn. "the white line marks the absolute minimum of water we need to get the ship within gravitational pull of the earth; from there in it's up to our extensor vanes." "how much do you need yet?" joe asked. black tom grunted. "about twelve gallons--and if those juices run out, we'll have to do some wholesale lemon and orange squeezing." joe started to turn. black tom said: "thanks, joe, for the can suggestion. it may pull us through." joe nodded, went up with his tub for another load of juice. when he had dumped the second load in, he said: "wick's got whitey, ronnie guetschow and keating squeezing lemons. this is the last of the loose juice." he shook his head to clear his mind, said briefly, "excuse me," and hurriedly left the power room. when he came back, his face pale, his limbs shaking from the retching stomach, bairn and ed parman were talking to black tom. * * * * * bairn looked serious. "hell," he said. "it would boil down to that. the motor's okay, ed says. but i don't know where in blue blazes we're going to get enough water. timnson's got the hydraulic press from the workroom rigged up squeezing out the garbage we didn't dump." he turned to black tom: "you're sure your sand filter will take all the solids out, so it won't plug up the water jets?" black tom nodded. it was then bairn noticed joe. bairn said wearily: "haven't you caused enough grief, joe? arden's sick with the disease because of you. you've been a jinx ever since the trip started. why don't you crawl in a hole and die?" "i'm trying to help," joe said. "nuts," said bairn tiredly. then he turned to black tom. "we've got gasoline galore for operating the electrical units. think gas'll work?" "no," tom said briefly. joe's stomach was beginning to quiver again, and the figures of tom, bairn and parman were weaving. he could feel his pulses pounding raggedly, as if a million drummers were anxious to keep out of tempo. he forced himself to walk slowly from the room, but the dizziness caught him at the door and he had to hang on to the lever to keep from keeling over. his thoughts were kaleidoscoping, but one finally broke through clearly. it was the answer. he pulled himself erect, said through feverish lips: "bairn...." bairn said, without turning his head: "beat it, joe!" "please, john," joe said, "i know where to get more water." he staggered toward the three men, the floor rocking under him. he felt his mind shouting the words, but his desperate mind couldn't make his lips move. his eyes wouldn't focus; his legs wouldn't work. he only half-felt the hurt as his head struck the power room floor. "good," said bairn, almost pleased. "that's taking care of him. parman, shove him over in the corner. better put these rubber gloves on." it was a good three hours later when bairn and black tom stood at the gauge measuring the height of the water in the tank. "not good enough," black tom said. "if we don't crash on the moon, we'll end up as a satellite. that's all the water we can squeeze out of it." "damn," breathed bairn, "another gallon would take us home. but there isn't another lick of water on the ship." he checked off on his fingers: "the lav, the connecting pipes, the canned food, the garbage, the storage batteries, that does it, guys, i guess." the others stood quietly. bairn went on: "we might as well get going. maybe, the fruit juice has got more umph to it than the water, and we might coast in. but black tom says we've got enough to reach the moon's orbit track, but not enough to reach the gravity pull of the earth. "we've done all we can," he said. "now it's up to whatever providence watches over people like us." he licked dry lips and smiled. * * * * * the muted thrumming of the atomic motor gradually worked its way into joe's consciousness. he moved wearily, and then his mind, short-circuited by the ravages of the fever, cleared itself and he became aware of his surroundings. how long he'd lain there, joe couldn't tell as he staggered to his feet and toward the door. he had the answer, if he could make bairn listen. his glazed eyes stared around the power room. there was no one there. he weaved toward the water gauge, stared at it for a long time before it registered. why, his mind said dully, the tank's almost empty. joe staggered for the door. the door was a ton weight that fought against him to open it. when it finally opened, he left it that way. he got outside in the passageway, and his stomach rebelled. he was very sick for many moments. he crawled and staggered up the circular stairway toward the pilot's cubicle. his body was bruised and hurting from the many times his weak legs had betrayed him before he reached the door to the cubicle. he couldn't move the lever to the door. he tried to shout, but his voice was hoarse, weak. he pounded with both hands against the thick metal. but there was no answer. once again, he was sick. then wearily he retraced his footsteps, pounded lengthily on each door with his weakened muscles. they couldn't hear him, a bitter voice nagged at him. he had the answer, and they wouldn't listen. he didn't feel the pain as he rolled down the circular steps and lay at the bottom in a heap. somehow he moved on, crawling. if they couldn't listen, he'd have to do it. he reached the door to the power room, lifted his body across the threshold, and then weakness held him motionless. was this it, his heart questioned. this was what he had to do before the radio disease got him, wasn't it. he couldn't see, he couldn't hear, he couldn't feel. oh, god, he couldn't even think. was this it? his heart asked again. whatever the answer, it was somehow adequate ... for joe's body, weakened by the life-sucking plague moved slowly ... so very slowly.... * * * * * "we've nearly reached the last of the catalyst, if black tom's figures are right," bairn said to the men crowded into the pilot's cubby. "there's earth," parman said, and his voice was a caress. the whole crew was there in the cubby, save for arden and burnet and the medical guetschow twin. doc guetschow was down in sick bay with the other two, burnet's head having started to act up again after three days without water. "tom, you're sure your figures are right?" the other guetschow twin asked. "much as i hate to say it, yes. only a few hundred miles and we're finished." tom licked his puffed lips. it was quiet there in the cubby as the atomic motor drove the ship at tremendous speed through the void. "can't we coast in?" parman asked. "we've got tremendous acceleration." "but not enough," bairn said, "with the moon's gravitation field to reckon with." all their hearts must have stopped then, when the steady thrum became a staccato beat. "this is it," bairn said. the staccato turned to a broken rhythm, hesitated, and finally halted. "god," said herd, the co-pilot apologetically, "if the moon weren't around to hold us back." but it was there, looming huge and ugly off the starboard side. parman said: "i can feel it pulling." the strain made two or three of them giggle. bairn said as if to a naughty child: "it isn't that strong, ed." bairn's hand moved to click off the firing lever when the motors suddenly broke into thrumming life. the inertia of new flight came to the ship again. * * * * * they made a frozen tableau, those men standing in the pilot's cubby. ed parman was the first to break the tableau. he slumped to the floor, and lay there, his shoulders shaking convulsively. "herd," bairn said suddenly, "take over. come on, tom. whatever did this is in the power room." "joe?" herd asked. "i don't know." the two of them fled, leaving behind them, parman on his knees staring at the void, the others half-crying, half-laughing. bairn and black tom morrissey came into the power room. they stood awed at what they saw. joe was there. bairn said finally, voice as soft as the night wind over earth: "joe was right. he was good for something after all." tenderly, he and black tom lifted joe's dead body down from the tank, laid him gently on the floor. "the only thing we forgot, tom," bairn said. "_blood._" crimson still oozed slowly from joe wilding's cut wrists. there was a smile on his dead lips. for it was a man named joe who was the first to reach the stars--and the roaring rockets had scattered his eternal life across the star trails.